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air was moist and cold, from six to ten infante would be seized on the same day and usually in both eyes. When, too, the catarrhal affections took on a "septic" character, numerous cases of umbilical phlebitis, purulent infection, gangrenous erysipelas, croup, &c, were observed. The croupal form of the disease is characterized by exudations of various thickness, which may assume the membranous form with newly created vessels and is often accompanied with the development of false membranes in the mouth and pharynx. When this variety took on the septic . • character, loss of vision might be predicted, though but a small portion of the— .* /»> . j i cornea was affected. "• 1

It is very important to decide whether the disease is merely local or symptomatic ^UV/l <>//"/ / . of a general affection. The former is the case when the mother is healthy and the child well nourished, the influence of an external agent recognizable, symptoms <£.//.'.' ' •' i of catarrh, or exudations on the other mucous membranes, absent, and one eye alone affected, at least at first. It then rarely gives rise to large ulcerations, and //<.. t f**"' causes fever only when the inflammation is intense. Its prognosis is favourable, and the influence of caustics is speedy and beneficial. When, however, the reverse _ &OW // /». of the above circumstances prevail, we should regard pyophthalmia as a very serious

diseafie- U&uM C,

Of 454 children affected with pyophthalmia during 1836-9 Dr. Mildner states that twenty-nine lost their sight, and during the following years but twenty-two in 689 / „ hji and ten in 300—an amelioration chiefly due to the improved hygienic conditions, effected. When the disease is local and confined to the conjunctiva, especially \i / when produced by the contact of gonorrheal or syphilitic poison, it will yield readily rnM to the nitrate of silver (gr. one to four, to four oz. of distilled water). . . .

Von Ammon treats the disease by a collyrium composed of three or four grains Vi i< /■ ^ of the ext. of belladonna, six to eight drops of aqua oxymuriatica, and three or* —'

four oz. of water. After a while the proportion of water is gradually diminished. C/UL4-llt -J I have found cases of this disease rapidly tractable in private practice by hourly injections of alum, gr. v to 5 j> °T of nitrate of silver, from gr. ij to gr. v to 3 j of ,/,;t. :"'■ /.■,, water—but it is of the highest importance that the injections should be thoroughly /

and frequently applied.—P.H.B.] /yt_ /.*/ /: ■ •

Congenital Cataract. fH-^-^ <;' ■

[The early and foetal existence is its only peculiarity: in the majority of cases ,'../*•'' J Walton has seen, the capsule has been opaque and very much thickened, and "". contained either a small portion of the lens, or merely a milky fluid; yet, the lens^, ///' ui > only may be implicated, and in all respects just as in cataract occurring after birth. He imagines that the partial lenticular opacity occasionally met with in young persons is often of congenital origin, though it is often overlooked; especially when /" {tj '■,. , it is very small and remains for a while stationary j and it would seem that exceptions to the general law of the ultimate implication of the entire lens, after £c /): f><-' a part has lost its transparency, occur most frequently in partial congenital lenticular opacity.—Operative Ophthalmic Surgery. ..L. >/1(_ /» ,'

Dalrymple remarks that ** in those cases of congenital opacity of the lens, not-' unfrequently met with, in which partial vision exists for a considerable length of ~u Jp j! <• time, there appears to be an arrest of development at a period, varying in different cases, anterior to the birth of the infant; for if we see the patient for the first /.., _< time, in youth, or early manhood, we find, on dilating the pupil, that the lens is c*A:"i'i'"''probably not more than two-thirds its natural bulk—that in fact, a clear ring of / /

black may be seen between the pupillary margin of the iris and the circumference of the opaque lens."

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There are very great and important anatomico-pathological differences between , a congenital cataract examined soon after birth, and one seen only several yean (ll£Lrl&JtJ' later, say towards the adult period. The recent congenital cataract is capsnlo1 _ lenticular, while the older one is capsular only. Saunders first explained the

/ I-j (tHLU-*1 mechanism by which this change is effected. The lens of the recent cataract gradually softens, and the capsule actively absorbs it, or that it disappears entirely fl !i ftl'J-ei'i ky the seventh or eighth year. But as in general no fluid replaces the removed * lens, the anterior portion of the capsule falls back, and adheres to the posterior, il£-h C tf^JyiYaiA^, by reason of its attachment to the hyaloid membrane, undergoes no displacement. The posterior chamber of the eye becomes thus much enlarged, and the K 'I 1 L £ < 'TM» m contort with the increased quantity of the aqueous humour that fills this, , receives from it during the contraction of the muscles of the eye an undulatary

IiH (C llJ movement, which has been designated as a tremulance of the iris. The true value 1 '1 /, of this symptom should be understood, for it has been regarded erroneously by /; l\K l#» some authors as indicating the existence of a synehysis or an amaurosis.—Tavignot,

/ '/: A -ft- / 7 Gazette del HSpitaux; No. 50.

r I ,M. Sichel, in some observations on cataract, recently drew attention to the case

{1IV4L '^/""oi a young girl in whom he had lacerated a secondary capsular cataract, as

1 j exemplifying the hereditary character of congenital cataract. Her father and uncle

were both operated on, about two years since, for congenital cataract of both eyes,

/? /( t which had however only become complete in the thirty-third year, an interval of

a year elapsing in each case before such completion and the operation in the second

rfiXl i t'&lr, *ye- The cousin of the girl, aged fifteen and a half, son of one of the brothers, was

operated on at eighteen for a congenital cataract which had been complete at

fourteen. There is one in the other eye not yet complete. In none of the ascending

branches of the family had cataract manifested itself. In my attendance at the

London Ophthalmic Hospital I have met with numerous instances of the hereditary

character of congenital cataract.

-' Congenital cataract should be operated upon early—within four months if possible,

/ .'.*/ Itf -lest the eye, which when born blind habitually oscillates from side to side, may

never acquire the power of being directed to one particular object. The pupil

being well dilated, the child tightly wrapped in a sheet, should be placed on a

„ . «-, table—the head on a pillow, and rather hanging over it—the arms and head being

'/• 'fixed, and the lower eyelid depressed by assistants. The operator then seated

'1' (i t / (7 behind the patient, elevates the upper lid and fixes the globe with an elevator

and performs the operation for absorption, by introducing the needle behind the

,,.' iris, freely dividing the anterior layer of the capsule, drilling a hole once or twice

through the substance of the lens. Care must be taken not to dislocate the lens,

''' / • and not to wound the posterior capsule or vitreous humour. The cataract will

be more or less dissolved by the vitreous humour and be absorbed. After the

lapse of a few weeks the operation may be repeated, the capsule may be lacerated

more extensively and the lens cut into fragments; the operation may be repeated

again and again if necessary—it excites so little inflammation in children that

both eyes may be operated on at once.—P.H.B.]

BOOK XXI.

ON DISEASES OF THE EAR. .

The ear is the seat of numerous diseases which are not all equally*^" ^|"v> '_ frequent in young children. Acute otitis, chronic otitis, and otorrhoea, Q^MJUi^^) are the only ones which are observed in the tender age, and even gfcwH

then they are very rare. /%il£ &Gh~,

Acute otitis sometimes results from the inflammation of the buccal ^u . mucous membrane, which, by means of the Eustachian tube, invades the internal ear where it becomes fixed. It often succeeds acute C?tAU-*<' diseases, particularly measles, and occasions loss of hearing, persistence < .^. , of the fever, more or less acute pains, and lastly, at the end of several days, perforation of the membrane tympani and the escape of pus hyJuJtu. (J)/(<^ the external auditory canal. The pus continues to be discharged for <*P^ajL

several days, then ceases to flow, if the inflammation terminates by'^^fr <

resolution. ^jL&rc&Jj-***

Usually the inflammation passes to the chronic state, suppuration , continues and prolongs itself several weeks or some months. This rtufit*4-) transformation of the disease has received the name of otorrhoea. It is very commonly observed in weak, lymphatic scrofulous subjects, or in ku/^Jfj^j those born of ill-constitutioned parents, who are themselves more or less / / tainted with scrofula. Lastly, in some cases, suppuration of the interior Q-axjkj "■*,Jj of the ear alters the walls of the tympanum and extends to the mastoid cells and to the petrous portion itself in consequence of the alteration /)/)/. FT of the bones, and of their necrosis or of their consecutive caries. Then" the disease becomes indefinitely prolonged, suppuration does not/j {.Aw v1' diminish, fragments of bone are rejected, and the disease, advancing daily, extends from the petrous portion to the dura mater, to the ''L meninges and to the brain, whence meningitis and death result.

Amongst the cases I have collected, some are worthy of interest; the following is the summary: /LAhW

1st. A child named Yver, two years old, was admitted into the Neclcer t - (illH.1Hospital with acute bronchitis. ,

His head was of large size, like that of a hydrocephalic patient and like that dj^-t'''1of other individuals of the family.

It often had convulsions. Ci' '> - •

In consequence of measles, acute otitis, suppuration and perforation of the . walls of the tympanum, prolongation of the disease.

Chronic otitis, caries of the petrous portion of the temporal bone, expulsion \, f of very evident fragments of bone.

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Intermittent hectic fever.

Death at the end of eight months, after an attack of acute meningitis.

This child was not completely deaf, and learnt fresh words every day.

2nd. Another child (Boissonnade) eighteen months old, twelve teeth, thin, weak, ill-developed, had acute otitis, afterwards chronic otitis consequent on a serious attack of bronchitis. The two ears suppurated, and at the end of a year very porous portions of bone escaped from the auditory canal. Intermittent hectic fever became established, and the child, becoming gradually more feeble, died of chronic enteritis, with caries of one of the petrous portions of the temporal bone.

The deafness in this child was incomplete; it retained and every day pronounced monosyllables which it could not say the day before; and at length answered questions.

Chronic otitis and otorrhcea ought to be treated internally by the iodide of potassium, cod liver oil, antiscorbutic syrup, syrup of bark, syrup of walnut leaves, and externally by mucilaginous or astringent injections. These last are much the most useful, and decoction of strawberry root, of red roses, of walnut leaves, &c, are those which should be employed.

[Inflammation of the dura mater is occasionally the result of otorrhcea. Sometimes acute inflammation arises within the tympanum, when there has been no previous disease; the patient has severe headache; at length a gush of matter comes from the external meatus, but the pain doeB not, as it usually does in such cases, cease; it continues, and even increases in intensity, the patient begins to shiver, he becomes dull and drowsy, slight delirium perhaps occurs, and by degrees he sinks into stupor. In some instances no pus issues externally. Similar symptoms more commonly supervene upon a chronic discharge of purulent matter from the ear.

The following examples illustrate the phenomena of this disease: A youth, sixteen years old, applied to the late Dr. Powell (Transaction* of the College of Physician*; vol. v) on account of an eruption with an acrid discharge behind the right ear. He had become deaf Ave years before, after scarlet fever, but no discharge took place at that time from the ear. In the following year, however.

f he had the measles, and then an abscess formed in the right ear, and after giving him much pain it burst. He had again suffered, three days before Dr. Powell first saw him, a sudden attack of very severe pain in the same ear. The pain quite v ' v v deprived him of rest; but he had no fever, nor delirium, nor coma. He slept indeed a great deal, but that was the effect of opiates which he took to relieve the pain. This symptom was quieted by the opium, but it always returned with severity if the medicine was suspended. A foetid discharge came from the ear. On the tenth day of this attack, after a most violent paroxysm of pain, his strength rapidly , / / ,/ declined, and he died.

"When the head was examined the structure of the dura mater was healthy and

natural, but beneath this membrane the whole superior surface of the right hemi

r sphere was covered with a layer of coagulable lymph and pus. The vessels of the

substance of the brain were not more numerous or loaded than usual, and the brain

;/, *>, t itself was healthy in every part. In the base of the skull the dura mater adhered to

the bone, except at one part of about half an inch diameter, just over the petrous

portion of the temporal bone, where it was black and sloughy. The subjacent

. portion of the bone itself was carious, black, and crumbling, and contained foetid pus.

It will be observed that in this case there was no symptom to mark the extensive

mischief within the head, except the pain; the pulse never exceeded seventy-two,

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