the colour of the skin, at first as large as a walnut; at a later period it had attained the size of a small orange.

August 8th, 1846. It was examined by Mr. Key, who considered that it contained liquid, that it might have some connection with the salivary gland, and that, therefore, it should not be interfered with until after dentition.

February 7th, 1847. The tumour was punctured with a grooved needle, and some drops of serum escaped. The tumour then equalled the size of the head of foetus seven months old, and extended from the sternum to the ascending ramus of the inferior maxilla. The form of the chin was entirely effaced on this side.

March 11th. Increase of size, elasticity, insensibility to pressure. A puncture made with a small trochar gave issue to three or four ounces of a thin, yellowish, straw-coloured liquid; slight decrease in size; moderate flow for two or three days. Tincture of iodine and alterative doses of mercury and iodide of potassium.

June 6th. Assisted by Dr. Crisp, I passed a seton needle with five or six silk threads. A little aqueous matter escaped.

7th. The same liquid escapes in small quantity. There is neither fever nor inflammation.

8th. Coma for three hours in the afternoon; convulsions of three quarters of an hour's duration. On my arrival they had ceased. Fever, intense heat of the head, inflammation, and increase of the size of the cyst. The seton removed, warm bath, poultice and fomentation to the part; castor oil.

9th. Intense fever, heaviness of head, skin hot, look depressed, constipation. Calomel and saline purgative; cold applications to the head; fomentations to the neck.

10th to 13th. The state of the patient is less alarming.

14th. Sense of fluctuation. I saw the patient with Bransby Cooper, who made a puncture at the most projecting portion; a small quantity of clear pus escaped. 15th to the 21st. Very slight escape.

22nd. Bad night; infiltration of the right eyelid, diarrhoea, loss of appetite. 24th. Swelling and hardness around the temporo-maxillary articulation; the parotid appears inflamed.

28th. Considerable sero-purulent discharge from the right ear; diminution of the fever.

29th and 30th. Depression. Quinine and citrate of iron.

July 1st. Anxiety, emaciation, anorexia; considerable oozing from the meatus anditorius.

19th. Extreme susceptibility, frequent cough, purulent expectoration.

23rd. Hectic fever, excessive fever and emaciation. Quinine, beef tea, arrowroot, wine; opiate at night.

26th. Rapid diminution of the tumour.

31st. Better; appearance of large pustules over the whole body, which are immediately opened.

August 19th and 20th. The cough has ceased; the patient is carried out in

the air.

30th. He begins to walk; is getting plump. The tumour has almost completely disappeared.

April 16th, 1850. Perfect health. A small portion of loose and wrinkled skin, identical with that which was observed some days after birth, is the only trace of the previous enormous tumour.

I have had the opportunity of observing one of these cysts at the Necker Hospital. It was in 1842, in a child twenty-one days old, admitted in consequence of pneumonia, which caused death.

This child had at the left side of the neck, beneath the lower jaw, a tumour of about the size of an egg, rather projecting, unequal, irregular, soft, compressible like an erectile tumour, without pain and change in the colour of the skin. No part of it appeared internally in the mouth; I did not then know the nature of the tumour, and I had not come to any conclusion when the child died. This tumour, situated at a little distance from the skin, in front of the sterno mastoid muscle, rested on the vessels and nerves of the neck, was irregularly elongated from above downwards, projecting slightly beneath the ramus of the jaw, and descended along the larynx as far as the thyroid body.

It was composed of serous cysts, colourless, irregular, of the size of hemp seeds or of nuts. These cysts were close together, and isolated by fragments and lamellæ of fatty cellular and fibrous tissue. They might be called a cluster of hydatids.

More recently in 1851, I have observed a very similar case presented by M. Morel to the Society of Biology; and this physician has informed me that he has seen another instance in which the cyst was formed of a single pouch divided internally by tendinous bands.

The cysts of the neck are then unilocular or multilocular, and nature appear to be formed of fibro-cellular or fibrous walls, filled with serosity which is either colourless or reddened by the colouring matter of the blood.

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These cysts increase daily in number and size, and cause symptomsurse which are due to compression of the vessels and of the nerves of the cervical region. They obstruct the circulation in the neck, the movements of the head, the nervous current, the passage of air into

the larynx, and may occasion asphyxia by suffocation.

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They should be treated by surgical means, either by acupuncture, as timel Hawkins recommends, or by slender setons composed of rather numerous lengths of silk, as Dr. Evans has done.

Acupuncture does not cause any bad symptoms, and should be combined with iodine frictions over the tumour, or with compression when this is possible.

Setons may determine a rather extensive suppuration accompanied by fever and severe general symptoms. Poultices should then be applied over the tumours and frictions with mercurial ointment repeated several times a day. This is the best method of treating these symptoms.

[Professor Mütter (Philadelphia Medical Examiner; vol. vii, p. 257), relates four cases of what he terms hydrocele of the neck, and subjoins a short account of its symptoms and treatment. The first case was a congenital one, and consisted of numerous sacs not having intercommunication, some of which reached a very large size, and encircling the throat and chin, embarrassed the respiration. When they did so to a great extent, one of them was punctured with great relief, and that on two or three occasions. The child, however, died from œdema of the glottis, probably brought on by the compression of the distended sacs, which were found to be both large and numerous. The three others were acquired,

and were all, as is the case with the bulk of recorded instances, situated on the left side. In one in which a radical treatment was opposed, forty-four ounces of a chocolate-coloured fluid were drawn off, and several months elapsed before

reaccumulation. In another case a seton was introduced, which produced no bad symptom, and was followed by a radical cure. In the last case this was obtained by dissecting out the cyst, which was only the size of a walnut.

Speaking of treatment, Dr. Mütter observes that the operation of excision should be confined to cases in which the tumour is small, circumscribed, and superficial, and when a small scar is not considered of importance, under which circumstances it is the preferable plan. Repeated tappings, care being taken to empty the sac of all fluid lest it infiltrate into the cellular tissue, may be employed as a palliative in congenital hydrocele of the neck, when severe measures might be undesirable and may sometimes effect a radical cure by keeping the sac constantly empty. In old cases it may be resorted to relieve urgent symptoms, or when the patient will not submit to other means. The chance of a radical cure is increased by scratching the interior of the sac with the trocar before withdrawing it; and after the operation, moderate pressure should be kept up over the sac. The shortest plan of curing one of these tumours, if superficial, is free incision of the sac, following it by moderate compression; but the long and unsightly scar it leaves would be with many an insuperable objection. In order to convert the surface into a granulating one, several surgeons have combined with incision the application And of stimulating substances to the sac, as lint, iodine, wine, &c. This, however, excites great inflammation, is followed by a large irregular cicatrix, and requires De felt much time. Injections have been abandoned on account of the inefficiency of weak

and the danger of strong ones, but it would appear that iodine injections are suitable, and indeed have been used with success in this affection. The seton is 45 the best means for cases in which extirpation, repeated tapping, or incision are inappropriate or have failed. No means is so promising when the disease is #unilocular and of long standing. The treatment occupies several weeks perhaps, but the method is safe, easy, slightly painful, certain, and followed by scarcely any scar.-P.H.B.]

BOOK XX.

ON DISEASES OF THE EYE.

ON THE PURULENT OPHTHALMIA OF INFANTS.

The term purulent ophthalmia is applied to a specific inflammation of the ocular and palpebral conjunctiva, often united with shores

inflammation of the cornea.

In this disease, the eyelids are red and considerably swollen; the dalio conjunctiva secretes an abundant quantity of pus, and the eye is often compromised or ultimately lost.

Purulent ophthalmia is developed in infants at the third or fourth me, 3 or day after birth, in those whose mothers have habitually fluor albus

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or are affected with syphilitic blennorrhagia, and lastly, in those who are born at the time of epidemics of puerperal fever. Purulent alla b ophthalmia is more frequent in this last circumstance than in ordinary circumstances.

It is also developed in children at the breast placed in unfavourable hygienic conditions, and particularly in children who are brought to

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the "Enfants Trouvés," or to hospitals devoted to children. It is then dyphilitic often observed in an epidemic manner, and it seizes upon a great blue a number of children at a time.

This disease is often contagious; it is therefore proper to wash the hands after having touched the eyelids of a child labouring under it. This measure is dictated by prudence, for it is impossible to distinguish inflammatory purulent ophthalmia from blennorrhagic ophthalmia. Besides this is evidently contagious and transmissible by direct contact. The necessary precautions should be then taken in respect to both of them, so as not to contract the disease ourselves or to communicate it to other children.

Purulent ophthalmia is one of those diseases which should be early recognized; for it is so quick in its progress, so destructive in the rapid and serious lesions that it causes in the organs of vision, that if we delay the necessary remedies for its treatment, it becomes impossible to treat it successfully. The disease is cured, but the eyes (un are lost.

At the beginning, the eyelids are a little reddened and slightly swollen. At first only a single red transverse line occupying the centre of the eyelid is observed; but soon the edges and the internal angle of the eye become red and painful on pressure. The action of

light is painful, and a constant pain exists which causes the children to cry and deprives them of sleep. The conjunctiva is generally injected. The eye does not present any change.

These alterations rapidly assume much intensity. In the space of the ferrer, twelve or twenty-four hours, the redness of the eyelids becomes so general and their swelling so considerable, that the eyes can no longer open. usbeeThe upper eyelid overlaps the lower one; they become agglutinated together by dry pus, and when they are separated from each other, a creamy, whitish, thick matter, of purulent appearance, escapes and flows out externally. The ocular and palpebral conjunctiva is very red, much swollen, and covered with very numerous minute granulations.

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The eye as yet presents no alteration. The cornea has not losts its transparency.

The puriform secretion quickly changes its colour; it is very , abundant, greenish, and sometimes mixed with blood. It is then that inflammation of the cornea, its softening, ulceration, perforation, and frequently loss of the eye, are observed.

It is often difficult to appreciate in a satisfactory manner the progress of these changes, for we cannot sufficiently separate the eyelids without forcibly pressing against the child, and this manoeuvre causes horrible suffering. However, we may take advantage of the moment in which a collyrium is introduced into the eye to examine the surface of this organ. We then observe that the cornea has lost its brilliancy and polish, and that it presents one or two specks of a greyish tint, differing from aded the colour of the neighbouring parts. This grey tint belongs to the 4 portion of the cornea which is softened. The centre of this softening

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soon becomes perforated, the humours of the eye escape, and the eye empties itself, unless as is sometimes met with, hernia of the iris takes place which obliterates the opening and opposes the escape of the vitreous humour. In either case we may regard the eye as lost for the he purposes of vision.

We moreover observe on the cornea an ulceration of greater or less depth, with or without softening of the neighbouring parts. When the ulceration is large, it may cause symptoms similar to those which the preceding alteration has produced, that is to say, the loss of the eye.

Lastly, in some children there is only purulent infiltration of the cornea, which is opaque to a more or less considerable extent. This infiltration and the cicatrix of the ulcers of the cornea are the origin of those specks which are observed after the cure of purulent ophthalmia. As soon as the inflammation is lessened, the swelling and redness of the eyelids diminish; suppuration is less abundant, less thick, and assumes an improved appearance. The child supports the light better and opens the eyelids with more facility. We can now see whether the eye is much damaged; then we observe the opacity and staphyloma