The eye of an infant was wounded by two fragments of glass, of which one penetrated through the sclerotic and the other membranes to the bottom of the eye. A great quantity of vitreous humour escaped, and the anterior chamber was half filled with blood. The pieces of glass were extracted, the lids were closed, and ice applied. Antiphlogistic treatment and the position of the child on its back favoured the rapid healing of this wound, which was happily followed by no imperfection of sight.

Though injuries may give rise to detachment of the iris and the formation of a supplementary pupil, it does not necessarily follow that confusion of vision results. A striking illustration of this, quoted from Graefe and Walther's Journal, is recorded in the 'Medical Gazette' for 1828.1 A young man received a severe wound in the eye with a pointed instrument. When the supervening inflammation was subdued, it was discovered that the margin of the iris was torn in three places, and that a portion was lost. There were now three openings through the iris; the pupil in the centre, and an aperture on each side. Nevertheless the patient afterwards saw objects in their true position, had no multiplication of images, and saw distinctly with the injured eye when the other was closed.

The following is one of those unlooked-for instances of restoration of sight which occasionally present themselves. A person became the subject of cataract in each eye; the right eye was accidentally wounded by a splinter of wood, which divided the sclerotic close to the cornea on the inner side. There resulted an artificial pupil, which was as useful for vision as if made by art; the cataract still existed, so that the vision was by the side of the lens.2

'P. 453.

2 A. Von Graefe, op. cit.

Instances present themselves where the very laceration of the iris is the means by which the sight is preserved. Fig. 6, plate xvi, in Dalrymple's 'Pathology of the Eye,' exhibits a case of leucoma and adhesion of the iris to a dense opacity occupying nearly two fifths of the cornea, which had been the effect of ulceration consequent on a wound inflicted by a percussion cap. The injury to the cornea was accompanied by laceration of the iris, and the subsequent prolapsus and adhesion of that membrane to the cicatrix gave rise to great contraction of the pupil, which was indeed nearly obliterated; it was divided into two apertures by the adhesion of a torn strip of iris, and this being cut across and contracting, gave a sufficiently large and well-directed opening for all purposes of distinct sight.

A remarkable instance of restoration of sight, after long suspension of its function in consequence of a wound, is related by Dalrymple in the same work.

A. B., aged 60, when a child, had lost the sight of his left eye in consequence of a punctured wound of the cornea; prolapsus iridis followed, and closure of the pupil by a dense and organized deposit of fibrin. The right eye had remained good, and he had pursued his occupation as a barrister's clerk up to the year 1846, when he was unfortunately knocked down by a carriage and received a severe concussion of the brain, that for some weeks endangered his life. On his recovery from this accident, it was found that he had also received concussion of the right eye, and had become amaurotic; from this latter condition he never recovered. Finding him thus hopelessly blind of his right eye, Mr. Dalrymple thought it fair to give him a chance of regaining some degree of vision in the left eye, and after a series of operations and absorption of an opaque lens, an artificial pupil was effected with but little improvement. By slow

degrees, however, it strengthened, and at the end of a year he was able to read with cataract-glasses bold type.

Though rare, instances have been known of tetanus following wounds of the eye, of which an interesting example has been recorded by Mr. George Pollock.1

J. S., aged 33, was admitted into St. George's Hospital, January 10th, 1847. He had that morning received a cut from a gig-whip on the left eye, which lacerated the cornea, dividing it through its entire thickness, and extending obliquely across from one margin nearly to the other. The aqueous humour had escaped, but there was no prolapsus iridis, and but little pain or chemosis. Goulard's lotion was applied, and an antimonial and aperient saline ordered every six hours. On the following day the lids were distended and tense, and there was great chemosis, the conjunctiva almost hiding the cornea; the pain also was great in the globe and forehead. Six leeches were ordered to the left temple, and warm fomentation. The above symptoms were still further aggravated on the following day, when several punctures were made in the upper lid, which afforded immediate relief. On the third day the leeches were repeated, and three grains of calomel and half a grain of opium was ordered twice in the day. On the sixth day the visible portion of the cornea was cloudy; and on the seventh there was purulent discharge from the tense and projecting globe. On the evening of the same day the muscles of the face on the right side appeared contracted, and the patient complained of stiffness about the jaws. On the ninth day trismus was fully established, which was followed by general tetanic symptoms, and the patient died on the following morning.

A case of tetanus is also reported as having followed a

''Medical Gazette,' 1847, p. 1006.

wound of the eye in the Crimean war; the particulars are not known to me.

TREATMENT. We have now to consider an important subject, namely, the treatment, general and local, proper after the removal of foreign bodies from the interior of the eye, and after wounds of the globe.

It might at first sight appear that this could be comprised in a few words-repose, darkness, depletion, mercury, and low diet-but such is far from the fact. There is no class of cases which call for more discrimination than these, or which by their result show more accurately the skill and judgment displayed in their management.

It may be laid down as an axiom, that if the eye receives an injury, the speedy recovery will depend far more on the state of the system of the patient than on the extent of the wound. A mere scratch will light up a flame that will destroy one eye, whilst another eye will bear with impunity the most severe laceration or incision. Nothing can be ruder or better calculated to destroy an eye than the operation for cataract as performed by the natives of India; yet so little is thought of it, that immediately after its conclusion the patient goes about his ordinary business as if nothing had happened yet inflammation is most rare.

So, in this

country, patients who have been brought into a fitting state, recover from an extraction of cataract (which involves an extensive wound and serious disturbance of the eye) in from ten days to a fortnight.

It is undoubtedly true, as laid down by Dr. Jacob,' that so far from the inflammation which follows injury of an eye being of a simple or uniform character, it is specially the

1 'On the Inflammations of the Eyeball,' p. 293.

inflammation which affords examples of peculiar and specific modification.

It will be intense in its nature and rapid in its effects, or languid in its action; it will assume the rheumatic, the arthritic, the scrofulous, or neuralgic character, and may even display the syphilitic taint.

One patient will require support and stimulants to urge the sluggish powers to the reparation of the injury; whilst another will need the most rigid discipline and active depletion to keep the inflammatory action within reasonable bounds.

Again, there is no class of cases in which the directions of the surgeon should be more rigidly enforced; to errors of judgment we are all liable, and perchance the view taken of a case may not be strictly correct; but it is far worse for ill-judging friends or captious patients to endeavour to escape from the thraldom of the surgeon as soon as his back is turned, and to think only how the pleasure or the whims of the sufferer can be most agreeably consulted. I say this advisedly, for though the patient is the real sufferer if the eye be lost, ill-deserved blame is too often attached to his medical attendant. In many affections a false step can be retraced, but with the eye we cannot afford to have our orders disobeyed. I can never reflect without indignation on a case which fell within my own knowledge. I had performed extraction on an old gentleman, and nothing could be better than his progress during the first three days; on the evening of the fourth day his wife declared that he would be suffocated if he remained in his bedroom, and insisted on taking the poor man into the drawing-room, in which there was a blazing gas chandelier. Need I say that acute inflammation followed and destroyed the eye?

It appears to me, that the undoubted value of mercury as