without any relief being afforded, and certainly not until the expiration of five minutes from the first exclamation of pain, did blood appear from between the eyelids. This I attribute to the resistance offered by the firmness of the union of the corneal section; very shortly after the blood appeared, a mass projected from the eye, and gradually increased in size until it hung halfway down the cheek; this was the hyaloid, filled with blood and pushed out of the eye; besides this protrusion there was a trickling of venous blood down the face. The moment the nature of the case became apparent I sent for ice, and on obtaining it applied it pounded to the lids. When the hyaloid was fully protruded I cut it off, and found the surface covered with the retina.

The blood continued to ooze from the eye for thirty-six hours notwithstanding the constant application of cold; the patient suffered from severe nausea and retching, and the pain about the brow and head was distressing.

When the eye was examined five days afterwards, the wound was gaping widely open, and a clot of blood occupied it; this gradually came away, the margin of the corneal flap disappeared by ulceration, the wound closed up after the expiration of a month, and the globe atrophied.

There are two courses open to us in cases of intraocular hæmorrhage to excise the eyeball, as has been four times done at Moorfields, or to adopt palliative measures; doubtless excision materially hastens the recovery, but it necessitates administration of chloroform, and may not be readily assented to by the patient; for when a person, after much consideration, submits to an operation with the confident expectation of recovery of sight, the removal of the eyeball, as a finish to the operation, is far from an acceptable proceeding.

Should the eye not be excised the bleeding will gradually cease, and the globe will either suppurate or atrophy. In the latter case the projecting corneal flap long continues a source of irritation, but ultimately disappears, and the wound heals, the globe becoming puckered.

Little can be done in the way of treatment beyond subduing the severity of the suffering and supporting the strength of the patient when there is age and debility to contend against; the most comfortable topical application is a poultice of warm ground rice, which being light, of uniform consistence, and very soft, is superior to bread or linseed; it should be frequently changed, the eye being carefully cleansed each time.

In other respects the treatment must be conducted as described elsewhere.

CHAPTER IX.

THE eyes beyond all other organs are liable to serious injury from the contact of heated substances; and the amount of injury will depend on the nature of the material, its temperature, the part of the eye it comes in contact with, and the length of time that contact lasts. Molten pitch may adhere to the conjunctiva, but becoming semi-fluid at a comparatively low temperature, it may inflict less injury than the momentary contact of boiling water. A hot iron striking the eye, or a fall against a fire-grate, causes terrible damage. In their effects burns and scalds are so analogous that they may be considered together.

If the temperature of the heated substance be not suffi ciently high to destroy vitality, it only excites ordinary inflammation, which may subside and leave no ill consequences; but if the heat be beyond a certain point, the effect is the same as in other parts of the body; a slight touch causes a blister to rise; a longer contact kills the tissues, which being thrown off as sloughs, are replaced by cicatrices and adhesions, interfering with sight and disfiguring the countenance.1 A scorch from an explosion, as gas or fire-damp, produces a somewhat different effect. The transparency of the cornea may at first be but little affected, so little as to disarm suspicion as to the severity of the injury, though on

'The frightful disfigurement caused by burns is well represented in 'Teale on Plastic Operations,' p. 27.

dose ZARAC I vi se z Estay a peculiar rough10 BÙ VI Í TIRE the case of a few days opancy reps Indus segends on loss of vitality of the superioni soul is in of slowly and replaced by page manera the costs almost cerby ads 2 is I s

The phenomena restling from the contact of heated metal with the g R. Kring any coservation, the flowing. In the ist instance the cornea is either blistered or rendered stigny hil de bundary of the injury being indicated by a white roage ime: the sclerotica is also blistered and soon becomes reddered. Within twelve hours, infammation, with chemoss of the whole conjunctiva, takes place, the membrane presenting numerous points of extravasated blood; the lids rapidly swell and assume a purplish tint; the burnt surfaces have now become opaque, and pus begins to be secreted after the lapse of about thirty hours. Inflammation often reaches a high point, the sclerotica and iris being involved, pain severe, and sight nearly or entirely extinguished. The inflammation and chemosis linger in the eye, the burnt surfaces appearing as excavations out of the swollen membrane. If only a portion of the cornea be burned, the other portion becomes turbid from inflammatory deposit; this is at first generally diffused, but in about eight days pus appears here and there in the substance of the membrane, most marked beneath and around the seat of the wound. At this period the conjunctiva has assumed a thickened fleshy aspect, of a deep red. The œdema of the lids having diminished, enables them to be opened more widely, and if the palpebral conjunctiva has participated in the injury, it will now be very apparent.

When the burn is deep, the injury cannot fail to be very serious: the part destroyed is slowly detached, for the vitality

of the tissues on which reparation depends being diminished by the injury, tedious ulceration follows, and it is common to find staphylomatous projections result from the thinning of the cornea.

Melted metal or fluids gravitate to the fold between the lower lid and the eye, and here extensive sloughing and ulceration may take place, giving rise to hopeless symblepharon. Dr. Mackenzie has pointed out an effect of burns of the conjunctiva, which I have occasionally seen. It is effusion of blood into the substance of the cornea near the burned part, and this ecchymosis is very slow of removal. Tendency to conjunctival ecchymosis exists in all burns, whether mechanical or chemical, as seen in fig. 3, Plate III, the blood being effused in patches around the seat of the injury.

A severe burn of the eye came under my notice recently, at St. Mary's Hospital.

Richard Landor, aged 27, hammerman at the Great Western Railway Works, was admitted as an out-patient, January 15th, 1859. About an hour previously, whilst hammering a piece of red-hot iron, it flew from the anvil and struck his left eye with considerable force. He was in great pain, but had I not been aware of the deceptive character of such injuries, I should scarcely have anticipated from what was then visible, the formidable consequences which ensued.

The lower half of the cornea presented a faint haze, and had lost its polish, the limits of the injury being marked by a white line; the sclerotic beneath the cornea was severely burned and raised in a blister. (Sweet oil to be placed in the eye thrice daily; cold to be constantly applied; purgatives; low diet.)

18th.-Lids oedematous, greatly swelled, and of a purple