ment of cap was found in the poultice or in the coagulum which closed the opening into the eye. Within a short time after the operation, and in each case, the threatening symptoms of sympathetic inflammation of the other eye disappeared.

The after management of eyes from which foreign bodies have been extracted differs in no respect from that proper for wounds of the eyes in general. I shall, therefore, reserve its consideration for a future chapter.

CHAPTER III.

GUN-SHOT Wounds of the eye, whilst presenting many points in common with injuries from other foreign bodies, possess characteristics entitling them to separate consideration.

A shot striking the eye may cause simple bruising and concussion, or it may glance off, cutting a groove without penetrating; it may pierce through the tunics and lodge in the globe; or, lastly, it may traverse the eye and bury itself in the orbit.

The first accident is usually the effect of a spent shot; in the others the shot retains its velocity. In a large majority of cases it has glanced from a stone or tree, and is flattened, angular, or jagged. It is remarkable how frequently, when one shot strikes a person, the eye is the seat of the injury.'

The effect of a spent shot is generally to produce concussion of the retina, and subconjunctival ecchymosis. Ecchymosis almost always attends bruising or grazing shot injuries, rendering it difficult to decide at the first glance whether the coats of the eye have been pierced or not; and our judgment

1

' A distressing accident has happened near Salisbury: Mr. W. F— was out partridge shooting with his son, Mr. H. F—, and having fired at a covey of partridges, he hastily turned and discharged the contents of a second barrel at a bird which had separated from the rest. Unfortunately, his son was standing at no great distance, and received a portion of the charge in his chest and face. Singularly enough, there were only two shots which reached his face, and they, after breaking the glasses of the spectacles he wore, entered his two eyes, completely destroying, it is feared, the sight of one, if not both of them.-Salisbury Journal.

of the severity of the injury must be formed from actual examination, irrespective of the opinion of the patient; for in some instances the person becomes sick and faint, though the injury may be trifling. Others, whose nervous systems are less impressionable, treat the accident with indifference, though the eye may be seriously damaged.

A surgeon summoned to a gun-shot of the eye may expect to find the patient and those about him in alarm and distress, and may have some difficulty in obtaining a correct account of the accident.

The first thing to be done is to carefully cleanse the eye, if there be either blood or dirt, and then a full and satisfactory examination should be made to ascertain the nature and extent of the injury.

There may be little or nothing visible externally, but the sight may be dimmed. This will indicate concussion, and the actions of the iris are usually either suspended or impaired. More frequently the eye presents such an aspect as is represented in fig. 1, Pl. I, and the ecchymosis should be carefully inspected, lest a wound be concealed by the effused blood.

It is important to ascertain, if possible, the relative position of the injured and injuring parties when the accident occurred, and especially the direction of the patient's face at the moment. A shot crossing obliquely, and striking the inner or nasal side of the eye, will almost certainly penetrate; a shot striking the external side has a better chance of glancing.

In determining the question as to whether or not a shot has pierced the eye, the following points have to be considered the weight of the shot, the distance from which it was discharged, the position of the eye, and the direction whence the shot came. A heavy pellet will plunge into the

eye at a hundred yards, when a light shot would glance, or fail to enter, at fifty. The more obtuse the angle of incidence, the less the chances of the shot penetrating. The elasticity of the tunics is such, that a round pellet direct from a gun may be thrown off, when an angular or jagged shot, rebounding from a stone, will tear through them; and the laceration within the eye will depend on the size, shape, and force of the shot.

After accidents of this description the surgeon will be anxiously questioned as to the probable result. A guarded answer is at all times proper. A slight graze may, by its concussion, detach the retina and cause hopeless amaurosis, and when a shot has entered the eye the risk is always grave. In two cases within my own knowledge (one in the practice of Mr. G. D. Pollock, the other a patient of my own), the shot simply pierced the cornea and dropped into the anterior chamber, whence it was extracted without difficulty, the eyes receiving no permanent injury; but such escapes are altogether exceptional. When a shot penetrates behind the iris, it either lodges in the interior of the globe, where, unless extracted, it is sure to set up such irritation as to destroy sight, or it tears its way through the eye, generally, but not invariably, blinding it.

If a shot passes through the eye, and lodges in the cellular tissue of the orbit, it may give rise to severe neuralgia. I know a gentleman who was shot through the eye, and in whom there is reason to believe the shot has lodged near the lachrymal gland. He is a martyr to brow-ague, and the pain always commences in the spot above indicated.

The following is an example of the slightest form of injury:

A man, aged 32, was acting as "marker," and had ascended a tree to obtain a good view. A covey of partridges

rose between him and the sportsmen, who were distant about 100 yards, and on their firing at the birds the marker was struck by several shot, one hitting his left eye; the pain was at the moment acute, and the sight greatly impaired. He came under my notice two days afterwards. There was considerable ecchymosis over two thirds of the sclerotic, but no breach of surface. The application of cold and the use of astringent collyria removed the extravasated blood, and the sight, which was not materially impaired, gradually recovered.

I have not myself met with an instance in which complete amaurosis was caused by a glancing shot, but Mr. Lawrence has mentioned a case. The following are examples of the temporary suspension of sight from this cause:

Major M—, aged 42, consulted me in January, 1856. The previous day, while shooting with a party, he was struck by a glancing shot on the left eye. He felt a smart stroke, and the sight was extinguished. No blood flowed, though much became effused under the conjunctiva. Six leeches were applied the same evening, and the eye was frequently bathed; during the journey to town, which occupied four hours, it had been covered with a handkerchief.

Its condition was as follows when examined by me: pupil dilated and motionless; the whole surface of the sclerotica covered with effused blood, but no breach of surface could be discovered; humours of the eye clear.

The treatment was, repose in bed in a darkened room, cold-water dressings to the eye, a brisk purgative, and strict abstinence.

On the third day large objects became visible to the injured eye, and day by day the sight improved; the severity of the

14 Lancet,' vol. ix, p. 531.