from the junction of the iris with the ciliary ligament, and to have bulged forward from thence into the anterior chamber. There was still redness around the cornea, and a feeling of distension and aching increased by exposure to light.

I first contented myself with puncturing the cyst, but it refilled; at the end of three weeks I again used the needle, but more freely, cutting and tearing the cyst in various directions. The relief afforded was permanent, the shreds of the cyst gradually shrank and disappeared, and the eye perfectly recovered.

There is a tendency on the part of these cysts to refill if they are merely punctured, and therefore I prefer lacerating the membrane with a broad needle; when punctured, the fluid jets out, and the delicate membrane, which has been kept on the stretch, collapses. If this treatment does not succeed, and the pouch is large, it may be drawn out of the eye with canula-forceps and a portion snipped off. This will effectually cure it.

CHAPTER VII.

ONE of the most formidable accidents which can befall the eye is rupture of its tunics by a sudden and violent blow. The concussion may be destructive to the retina; there is always some escape of the humours, frequently of the lens, and effusion of blood within the eye, besides external hæmorrhage.

The usual seat of rupture is in the sclerotica, immediately anterior to the insertion of the recti, most frequently above the cornea. It is very rare to find the cornea itself burst. Mackenzie, however, mentions a curious case of a gentleman who accidentally struck his right eye with his thumb and ruptured the cornea at its upper edge, giving rise to a large prolapse of the iris. There was a strongly marked arcus senilis in the cornea, and a small clear space between it and the sclerotica; it was at this point that the rupture took place.

A singular case is recorded of rupture of the cornea, occurring during the extraction of a molar tooth. It is said that at the moment both sight and hearing were lost; and as the maxillary bone was fractured, we may suppose the shock was very great. The cornea of the eye immediately presented a peculiar livid appearance, and hernia of the iris suddenly took place through the rent. Violent inflammation followed, and was succeeded by a large staphyloma. This was removed by Dr. Duval on the eighth day after the

accident, by which means the pain and inflammation were greatly lessened.

An extensive wound of the eye is likely to be attended with prolapse of vitreous humour; when, through the cornea, it is generally preceded by the lens, which is forced out by accidental violence or by spasm of the muscles of the globe. Prolapse of the vitreous humour will be recognised by the wound being filled with a clear, transparent albuminous mass, which holds apart its edges, and is forced out more and more as the eye is irritated by exposure. The sooner, therefore, that the lids are closed, the better. The remains of the prolapse of the vitreous humour may be recognised as a mass resembling white of egg, which clings to the edges of the wound.

Rupture of the eyeball is attended with excruciating pain and considerable flow of blood. The crystalline lens (vulgarly known as the "sight") and vitreous humour may be found either on the cheek or the patient's dress; and I have had the lens brought to me carefully preserved, in the vague hope that it might be replaced in the eye. An eye may be emptied and recover its shape from being filled with blood. Mackenzie has seen the sclerotica and conjunctiva rent behind the cornea, the humours evacuated, the eye flat, and cornea sunk back into a cavity. Next day the eye was plump and cornea natural, the globe being distended by blood. It is needless to say the eye was blind.

In 1856 my opinion was asked respecting an eye which had been ruptured under singular circumstances. Some years before the patient had received a blow on the left eye from a piece of copper cap, which had deprived it of sight, but in nowise altered its appearance.

Two years afterwards, when travelling by rail, he and his wife were placed in a coupé, which was provided with a small

flap table. This had been opened, and they were congratulating themselves on the convenience, when the patient, happening to be stooping down, was requested to close the window. Forgetting the table, he started up to do this, and struck the left eye with great force against its corner. He fell back with a sensation as if he had been shot through the head. The eye was completely burst open, and the flow of blood profuse. When he reached his destination the lids were greatly swollen, and his sufferings most acute. Violent inflammation followed, and the globe ultimately atrophied. When seen by me there was an extensive cicatrix of the sclerotic, indicating the seat of the wound, and the eye was still irritable.

When an eye has been burst and emptied of its contents it usually remains collapsed, puckered, and in size a mere button. I have before remarked on the manner in which the iris and cornea adapt themselves to the diminished proportions of the globe. Most marked is this when the eye collapses from rent in the sclerotica, the iris and cornea remaining intact. These ultimately assume so small a size that they might be easily overlooked; yet the proportions of the convex cornea, the anterior chamber, and the diminutive iris, remain distinct, as in the following case, though the pupil is always obliterated.

In August, 1857, I was consulted by Captain E., aged 26, who brought with him from a regimental surgeon a report of his case, of which the following is an abstract.

"March 2d, 1857.-Captain E., a healthy, spare, fullblooded young man, in playing racquets, was struck by his opponent's ball on the right cheek; he was stunned for a short time. I examined him, and found a small triangular cut below the right eye. The humours of the eye were partly on the cheek, partly protruding from the eye. The cornea

seemed entire; the conjunctiva and other coats were broken through just below the cornea and the inner canthus, and the eye was filled with blood.

(The treatment adopted was, the lowest diet, active aperients, and darkness. Warm fomentations afforded great relief.)

"March 16th.-The eye opened itself, and it is in the following state: cornea clear and entire; conjunctiva highly inflamed and congested; a wound about three fourths of an inch long is situated at the inner canthus, partly covered by the lower lid; discharge small in quantity. Allowed small quantities of toast.

"March 31st. The patient has gradually progressed toward recovery, and the eye is as follows: conjunctiva clear, cornea glistens, healthy and transparent; cicatrix formed part under the cornea, and covered by the lower lid; the eye considerably sunk in the head."

When I saw Captain E. in August, the condition of the eye was as follows: globe softened and much diminished in

size; cornea retaining its form, but singularly diminished, so that it was not a tenth of the natural size (fig. 34); more like