of the cornea, deformity of the pupil, consequent upon abnormal adhesions of the iris; and, lastly, emptiness of the globe of the eye. Course Such are the symptoms of purulent ophthalmia; they are, as will be observed, very serious; sometimes they scarcely last a few days, and Shush the disease terminates favourably. But when they last a longer time, he it is seldom that the globe of the eye has not been atacked; then they persist for several weeks and even for several months.

disease Amongst the changes in the eye which succeed purulent ophthalmia,minatio there is one which is less serious than we might be led to expect. The

opacity of the cornea, which results from the ulceration or from the Haverally

softening of this part, terminates by disappearing in process of time. For this, it is necessary that it should not be general, and that it should not invade all the layers of the cornea. We observe rather frequently alles in young children—and this observation is well known-we observe, I say, the very evident but superficial opacity of the cornea disappear completely, or only leave imperceptible traces behind. This disappearance is always slow, and it requires several months and even several years to accomplish it. I have seen it brought about in some weeks, but these cases are very exceptional. We should take care to do nothing with the intention of hastening its flight, under pain of occasioning fresh symptoms which might have quite a contrary result Yunika

to that which we wished to obtain.

Purulent ophthalmia should be promptly treated from its comSlight & mencement by the most energetic means. Some have recommended pacity the application of one or two leeches to the temples, but this abstraction of blood is not always followed by great amelioration. Moreover, as in Ce this case there is little time to be lost, we should make use of those means which most constantly succeed; compresses moistened with astringent liquids, and particularly with alum solution, should be applied to the eyelids. In addition we should instil twice a day beneath the eyelids, by means of a syringe, or, still better, by means of a camel'shair brush, a solution of nitrate of silver, of which the following is the formula:

Dissolve, and keep from the action of the light. These proportions are not indifferent; for if we are to modify the inflammation of the conjunctiva by means of this excitant, it is equally necessary not to exceed the object we would obtain. So that, if we employ a more concentrated solution, we might, instead of advantageously modifying the inflammation, give it a fresh activity and thus hasten the loss of the eye.

In some cases the palpebral conjunctiva, and even the cornea, should be slightly touched with a stick of nitrate of silver. This cauterization

Creaking

Le cet a ne smeta via i is very mach swollen and a vm de mimare amazons we have mentioned. Ulcerations The "Tha shut be mezei vim they can be easily and perfectly

The Tits nens i de lest we can pat in force and the only v sul mig. Compresses moistened with cold ve mu v brwi sengas siym of the sulphate of copper, fasurare if me. ct is made use of; but there is no AUSUNT VIA - Časy replace the nitrate of silver.

Bence insting is dugar we ndia to mention an accident which sirtme By Cens ʼn dhe nause of the reatment of parulent ophthalIs es de fuit of the prætomer than of the child, but we

La mi we wnd separate them in order to examine the e mi kạy de rayw, dhe did opposes, struggles, contracts TÜR BRs ni de års the eversion of the tarsal are viri iens a amçea of the upper eyelid. This eversion > parily if we danserience; i cesses as soon as the eyelid is Acaramel but a sme alba it remains, and this luxation of the asi arlige aan my be reduced by introducing a foreign body unter the grabi, making use of the hand to replace them in their We should avoid the displacement of the edge of de arder at have the trectie of such an operation. 3 the all resists we re mold open the eye, we should not TISING, but shall be contented with slightly separating the eyelids, as nai iss necessity irodare the brush moistened with nitrate of smer bei w them. By a contending against the little patient YNTHE are certam đề not determining this eversion, which is so difficult režice i sume dirennstores.

PREZENT OPHTHALMIA.

Xure than file) esses from the basis of Dr. Miner's Essay Annales d'Oculistique ; serum i 7 Tel, sad daring only four months of 1844-3, 300 infants were zeal fr this Esease in the Prage Founding Hospital. It commenced most mrequently between the sixth and ninth day, and in only seven out of 300 cases as a seized to ane eye. The mean duration of the disease was twenty-nine • žars... Of the 39) esses. 111 had ticerations of the cornea, but in sixty-two these were not sufficiently serious to interfere much with vision. Ten children (in 300) were binded, and thirty-seven died of various diseases. In 112 cases there was aise Esease of the digestive organs, in 102 jaundice, and in ninety-four pharyngeal expÈstions.

The caterial form of the disease may be either local or a symptom of general affection; and most of the children, in fact, manifested "an albuminous crasis of the blood,” characterized by a catarrhal state of the mucous membranes, marasmus, and debility. The influence of atmospheric causes was obvious, and often when the wards were overcrowded with puerperal women, especially if the

air was moist and cold, from six to ten infants 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

cornea was affected.

It is very important to decide whether the disease is merely local or symptomatic

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 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, anda? 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 cons of the above circumstances prevail, we should regard pyophthalmia as a very serious disease.

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 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

when produced by the contact of gonorrheal or syphilitic poison, it will yield readily the Leonk

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
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.
I have found cases of this disease rapidly tractable in private practice by hourly

Causties, injections of alum, gr. v to 3 j, or of nitrate of silver, from gr. ij to gr. v to 3 j of the Ju

water-but it is of the highest importance that the injections should be thoroughly and frequently applied.-P.H.B.}

CONGENITAL CATARACT.

[The early and fœtal existence is its only peculiarity: in the majority of cases 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 lense for

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 it is very small and remains for a while stationary; and it would seem that exceptions to the general law of the ultimate implication of the entire lens, after a part has lost its transparency, occur most frequently in partial congenital lenticular opacity.-Operative Ophthalmic Surgery.

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 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 serie time, in youth, or early manhood, we find, on dilating the pupil, that the lens is 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."

Congenital There are very great and important anatomico-pathological differences between

Intärad

a congenital cataract examined soon after birth, and one seen only several years later, say towards the adult period. The recent congenital cataract is capsulolenticular, while the older one is capsular only. Saunders first explained the 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 au alesef by the seventh or eighth year. But as in general no fluid replaces the removed

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lens, the anterior portion of the capsule falls back, and adheres to the posterior, which, by reason of its attachment to the hyaloid membrane, undergoes no displacement. The posterior chamber of the eye becomes thus much enlarged, and the iris, in contact with the increased quantity of the aqueous humour that fills this, receives from it during the contraction of the muscles of the eye an undulatory The movement, which has been designated as a tremulance of the iris. The true value of this symptom should be understood, for it has been regarded erroneously by Which is some authors as indicating the existence of a synchysis or an amaurosis.—Tavignot, Gazette des Hôpitaux; No. 50.

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

ind Exlarge of a young girl in whom he had lacerated a secondary capsular cataract, as

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, at, which had however only become complete in the thirty-third year, an interval of Tubir, eye. The cousin of the girl, aged fifteen and a half, son of one of the brothers, was

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

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,

24Ṭr 1st eye, born blind habitually from side to 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 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 equa equally the child in

frequent in young children. Acute otitis, chronic otitis, and otorrhoea, are the only ones which are observed in the tender age, and even then they are very rare.

Acute otitis sometimes results from the inflammation of the buccal mucous membrane, which, by means of the Eustachian tube, invades the internal ear where it becomes fixed. It often succeeds acute CCLLA: diseases, particularly measles, and occasions loss of hearing, persistence Causes!. 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 by flu the external auditory canal. The pus continues to be discharged for several days, then ceases to flow, if the inflammation terminates by resolution.

It is

Usually the inflammation passes to the chronic state, suppuration continues and prolongs itself several weeks or some months. transformation of the disease has received the name of otorrhoea. very commonly observed in weak, lymphatic scrofulous subjects, or in those born of ill-constitutioned parents, who are themselves more or less tainted with scrofula. Lastly, in some cases, suppuration of the interior audys 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 of the bones, and of their necrosis or of their consecutive caries. Then the disease becomes indefinitely prolonged, suppuration does not diminish, fragments of bone are rejected, and the disease, advancing daily, extends from the petrous portion to the dura mater, to the 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:

1st. A child named Yver, two years old, was admitted into the Necker Hospital with acute bronchitis.

His head was of large size, like that of a hydrocephalic patient and like that of other individuals of the family.

It often had convulsions.

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 of very evident fragments of bone.