eye, completely tore it out of the socket. The man did well, but was so unlucky as to lose the other eye some time after by a blow in a drunken squabble.

It is, however, by musket-balls that this injury is most frequently caused. During one of the sanguinary convulsions in Paris, a man, passing through the Rue de Cléry, was struck by a bullet fired from a window. The ball grazed the right superciliary region, passed before the bridge of the nose, entered the left orbit, and turned the eye out as cleanly as if done with a curette. The globe was not quite detached, but hung suspended by some strips of muscle and nerve. The man came under the care of M. Jobert, at the Hotel Dieu; and the eye having been replaced, ultimately shrank sufficiently to admit of an artificial eye being worn.

A case is related in the first volume of Gräfe and Walther's Journal, in which a cart-wheel went over the side of a man's head, and tore out the eyeball, with seven lines' length of the optic nerve, the muscles of the eye being left behind, and the orbit uninjured. The patient, though seventy-five, recovered without a bad symptom.

A drunken fisherman at Ostend, named Degruyter, coming home one evening very far gone, stumbled in the act of undressing himself, and fell with all his weight against the room door. In the fall the right orbitary region struck against the ring of the key which was in the lock of the door; and as the key was worn thin by long use, it divided vertically the upper lid, entered the orbit, and acting as a kind of lever, tore out the eye, so that it rolled upon the floor. It might have been supposed that such an accident would have sobered the man; but he went to bed and fell asleep, quite unconscious of the injury he had sustained. His wife, on rising in the morning, was astonished at the quantity of blood which her husband had lost from an appa

rently slight wound of the lid; but her astonishment changed to fear when she found an eye on the floor.

Dr. Verhaeghe, who was sent for, found the man in bed, his clothes saturated with blood, the orbit filled with coagula, and portions of some of the muscles of the eye hanging out between the lids. The bleeding had ceased.

The eye and the key, reduced one third, are represented in the accompanying wood-cut (fig. 36).

The eye was entire; its muscles had been torn across at different distances from their insertions into the sclerotic. The optic nerve was divided at about an inch from the globe. The key was bent into an obtuse angle from the fall against it of so heavy a weight. The patient speedily recovered.1

If the eye be torn out, little can be done beyond removing any ragged strips that may be hanging from between the lids and applying cold wetted rags. In neither of the cases related was the hæmorrhage formidable, nor is it likely to proceed beyond the control of cold and pressure.

Ann. d'Oculistique,' t. xxvi, p. 99.

If the orbit be in a fit state, an artificial eye may be introduced after about a week. How far it may partake of the movements of the other eye will depend on the quantity of the muscles of the globe and soft parts remaining to form a stump on which the eye can be placed.

CHAPTER VIII.

TRAUMATIC effusions of blood into the eyeball may be caused by violence acting directly upon the globe, or by blows inflicted in its vicinity, and acting indirectly by concussion. The shock produced by a powerful blow on the chest has even been known to give rise to it, and I have seen it follow a heavy fall on the occiput. Larrey remarked upon the frequency of intra-ocular hæmorrhage from bullets striking the margin of the orbit.

Blood may be effused into the anterior chambers (hypoæma), into the vitreous chamber (hæmophthalmos), or, in extreme cases, into both.

Effusion of blood into the anterior chambers of the eye is far from uncommon after smart strokes, as those from a whip, small branches of a tree, &c. This, though it may, by occlusion of the pupil, temporarily extinguish the sight, is not usually serious, unless attended with other injury. Far otherwise is it when the blood is effused into the chamber posterior to the lens-an accident always serious, often destructive to vision.

The appearance presented by effusion of blood in the anterior chamber is represented in fig. 2, Plate I. The drawing was taken from the eye of a lad who had been accidentally struck by a whip, the end of the lash falling just at the outer margin of the cornea. There was slight congestion of the conjunctiva, the anterior chamber half filled with

florid blood, and for a time the sight was extinguished as an effect of the concussion. Cold water only was applied, and at the expiration of thirty-six hours the blood had entirely disappeared. The sight was restored in a few days.

If the anterior chamber be filled with blood, the patient will have a red glare before the sight, but no vision; if only partially filled, objects may be seen through the portion of the pupil that is not covered. Even then there may be a reddish tinge imparted to the vision from the aqueous humour holding colouring matter of the blood in solution.

The anterior chamber sometimes fills with blood during the operation for cataract by puncture through the sclerotica. Von Ammon' has represented this in one of his plates. The blood would here flow from the choroidal or ciliary vessels; when it is confined to the anterior chamber, it is probably effused from the ciliary margin of the iris; in some cases slight detachment of that membrane exists. Free bleeding, it may be remarked, always accompanies separation of the iris from its attachment. In cases in which there is considerable effusion of blood into the anterior chambers,2 although there is no trace of injury to the iris, we are justified in supposing that it is the ciliary vessels whence the blood has been poured.

When hæmorrhage into the anterior chamber has followed a blow, a recurrence may take place. In 1852, a man was admitted into St. Mary's who had received a blow upon his right eye with a small stick; there was some ecchymosis, and the anterior chamber was nearly filled with blood; this disappeared after three days, under the application of cold, but on the fourth day the eye felt full and uncomfortable, and

''Klin. Darstell,' Bd. I, Tab. xiii, fig. 1.

The expression, anterior chambers, here includes the entire cavity in front of the lens.