membrane of croup. Yet, the action which produces bronchial polypus never rises to such a height as in croup. This view of the disease leads to the cure. The consideration of this need not detain me; we have only to adopt the general indications laid down for the treatment of inflammations to the disease in question.

In the case which is subjoined, the polypous membrane gave me comparatively little concern. But in a patient whose constitution was broken, the concomitant symptoms were alarming. The active measures pursued removed these, and prevented any return of the polypous expectoration, which otherwise might have become a chronic affection, as in the cases related by Dr Dixon, in Duncan's Medical Commentaries, and by Dr Nicol, in the Philosophical Transactions, cases which, in other respects, resembled this.

Dr Baillie, when treating of bronchial polypi, has not shown his usual caution. He says that this discase is not attended with inflammation. The more eminent a man is in the profession, of the greater importance is it to rectify his errors. In the case which follows, in Dr Dixon's case, and in Dr Warren's (Trans. of the College of Physicians of London), and in the case given in Vol. 8th of the London Medical and Physical Journal, 1802, not to mention De Haen's case, where the polypus was a symptom of pleurisy, and M. Bussieres', where purulent matter was found in the lungs, the presence of inflammation is indisputable. Dr Baillie leads us to doubt whether these polypi are ever solid, when he observes, "that the trachea has been said to be sometimes filled with a solid substance of the same kind with that which we have described." The bronchial polypi in Dr Baillie's museum may be all tubular; but, in the majority of cases which are upon record of this morbid appearance, the concretion undoubtedly was solid. As far as can be judged, without taking them out of the spirits, the specimens in Dr Monro's museum are all solid.

CASE.

Mr L. between 50 and 60 years of age, has for some months been declining in his health. He has had stomach complaints, and a diarrhoea, which has become habitual; and I am led te think that he has contracted a diseased liver from drinking diluted spirits, a custom which, unconscious of its ruinous tendency, he has long indulged in, although never to intoxication. From having been a corpulent and muscular man, his limbs are wasted, and the flesh of his whole body has become soft. In his cheeks

there i

there is all the vinous plethora of those who are addicted to the daily use of spirits.

Some days ago I was desired to visit him. In addition to his other complaints, he felt an unusual degree of weakness and languor. His friends observed that there was a change in his aspect, and he had become apprehensive and anxious.

I found him with a cough and dyspnoea. He had thirst, a hot and dry hand, and a pulse full, and rather quick. His tongue was loaded, and his breath of a heavy and disagreeable smell. I desired him to take P. Ipec. gr. xxv. and I begged him to live. more temperately.

I saw him again yesterday. He still complained much. The. emetic, he thought, had increased the diarrhoea. The breathlessness was increasing. I ordered him a blister for his breast; and as he complained of want of sleep, and of the restlessness of the two preceding nights, I allowed him to have 30 drops of laudanum and antimonial wine. I wished to restore the healthy condition of the skin, which was exceedingly parched.

To-day (May 9th) I found that he had had a better night; his skin was softer, and he imagined himself much better; he is still very feverish, his pulse 100; his urine high-coloured, and his breathing troublesome and wheezing, and aggravated by the cough.

Last night he casually mentioned that, for some time, he had been in the habit of spitting up, as he imagined, from his stomach, a substance which appeared to him to be a part of his food undigested. I desired him to preserve it. He presented me this morning with a considerable quantity of this substance, which I find to be portions of a bronchial polypus. These portions are segments of a large circle, and appear to have lined the trachea before its bifurcation. The expectoration takes place after coughing some time with great violence. Many of the pieces are an inch long, streaked on the convex surface here and there with blood. These excretions are of a much greater density than the membrane of croup, and of a finer white. They consist of a succession of layers, are tough on the side which has adhered to the trachea, and are about half a line in thick

ness.

A pound of blood was taken from the arm, and a low diet enjoined.

May 10th.-There is a thick coat of size on the blood; his pulse 90, and very strong; he has feverish heat, with dyspnoea, hoarseness, and a troublesome cough; he was again blooded.

Upon calling in the evening, I find that the second as well as the first bleeding has given great relief; he is cooler, his cough

is easier, and he expectorates freely. The mucus expectorated is puriform. Since the first bleeding, he has expectorated only one piece of the membrane, about an inch long, and nearly as broad; and, on the surface, which seems to have adhered to the trachea, it is of a dark bloody colour, as if the membrane of the trachea had been eroded, and the concretion torn off with violence. I understand that, for several weeks, he has been in the habit of daily expectorating even a larger quantity of the consistent substance than he did yesterday; generally it is quite colourless. The surface of the blood drawn this morning is contracted to less than a half of the diameter of the cup which contains it. His tongue is moist, he has less thirst, and feels easier; pulse 94, and full; bowels still very loose.

May 11th. He has had a good night; his cough has been troublesome since morning; pulse 88, and calmer, and his skin is moist; he has no thirst. The hoarseness, dyspnoea, cough, and puriform expectoration continue, but there has been no more of the concretion expectorated. He is so weak that he cannot walk across the room.

May 13th.-Mr L. having had an increase of fever yesterday, the bleeding was repeated in the forenoon, and it was followed with the same relief; the fever abated, and he breathed with more ease. After the bleeding he had a good day and night; for his cough he took, every fourth hour, five drops of lauda

num.

This morning his pulse is 80, and fuller: the blood is still sizy; his breathing is more oppressed; belly regular. He was bled for the fourth time. In the course of this day he has expectorated only one bit of the concretion, surrounded with mucus. The mucous expectoration is less, and evidently from a surface less inflamed.

May 15th. The diarrhoea has so completely subsided, that he has not had a stool since the 13th. His breast feels lightened of an oppression which has never been absent since the pectoral complaints seized him. Last night he took at bed-time 35 drops of laudanum, and, during the night, he had no cough; his pulse is 76, his skin moist, and his tongue clean. He lives in an ill-aired street, and it is resolved that he shall go to country lodg. ings to-morrow.

May 20th.-He removed on the 16th to the country; he continues to recover; his respiration is regular and free; he has scarce any cough; his pulse 76; his tongue clean, and his skin cool and soft; his bowels are regular; for four or five days he has had only one stool daily; he lives on milk and vegetables; he sleeps well; he has regained his appetite, and wishes for per

mission

mission to walk out; his voice is clear, and his complexion more healthy; he has once or twice expectorated a small portion of the concretion, not larger than a silver penny, filmy, but as hard as cartilage, and resembling it in the purity of its colour. Leith, Aug. 8th, 1808.

IV.

On the Sensibility of the Inflamed Cornea to the Transmission of Light. By JOHN VETCH, M. D. in charge of the Ophthalmia Depôt, Selsey Barracks.

ALTHOUGH a morbid increase of sensibility may be considered

both as a cause and an effect in the circle of phenomena which constitute inflammation, it has been observed by patholo gists, that the presence of this action in an organ of sense, has the effect of diminishing the powers of its specific perception. This conclusion is readily supported by a reference to the effects of inflammation on the organs of taste, smell, and hearing. It is the object of the following remarks to show, that it is applicable also to the organ of vision, and, at the same time, to offer a consistent explanation of that morbid irritability to light which frequently occurs in inflammation of the eyes.

The ophthalmia which has been brought into this country from Egypt, occurs in two different forms, the one of a nature extremely violent, in which the eye is rendered less sensible to the light, the other is proportionally mild, but often attended with a very troublesome intolerantia lucis. In the earliest stage of the disease, an attentive observer may distinguish to which of these characters it belongs. In the violent form the vessels are exceedingly minute, the formation of pus is more abundant, and there is an early tendency to tumefaction in the conjunctiva. The che mosis which succeeds is not formed by a plexus of vessels, but by an effusion, which may be compared to a ring of coral surrounding the cornea, varying, like that substance, in the intensity of its colour, for the most part having only a tinge of red. As the deeper parts of the eye become affected, it is rendered less and less sensible to light; together with an excessive discharge of matter, the palpebra swell and preclude any further inspection

When the vessels, on the other hand, are observed to be large r, more distinct, and tortuous in their course, the disease has little tendency to proceed deeper than the conjunctiva, from which,

however,

however, it does not readily recede: the vessels, from the first, extend over its whole surface, and at last they encroach upon the margin of the cornea, which no sooner takes place than the light becomes extremely offensive, and continues the most troublesome symptom with which the patient is affected. When red vessels have once appeared on the cornea, it gradually loses its transparency; and, by this insidious progress of the disease, the vision may ultimately be lost.

In the violent form of the disease, the effusion into the conjunctiva, while it marks its extreme violence, effectually prevents the approach of vessels to the cornea; and, as the natural state of the membrane is restored as soon as the chemosis subsides, the cornea, although liable to be ruptured by the pressure from behind, or ulcerated by the lodgement of matter on its surface, is never directly involved in the disease, and the light is never found to give uneasiness.

In the morbid actions of the cornea, there is an essential distinction to be remarked between those which are entirely confined to the part, and those which are connected with an inflammatory action of the vessels of the conjunctiva. When an eye has been once weakened by a severe attack of ophthalmia, the cornea is liable to a species of ulceration, which begins in the form of a pellucid dimple; as it enlarges, the iris first inclines forward, at last an adhesion takes place between it and the centre of ulceration; every part continues transparent, excepting at the point of adhesion, which has no resemblance to the colour of the iris, but is always of a deep black; the pupil becomes distorted, and the two sets of fibres of the iris are rendered beautifully distinct; the part occupied by the ulcer now gradually becomes convex, acquires a bluish colour, and forms a partial staphyloma. During this process there is no visible inflammation, and the gradual diminution of sight is the only intimation the patient has of its progress. But when ulceration of the cornea takes place, with active inflammation on the conjunctiva, it is then attended with an extreme sensibility to the light, and the grosser changes which accompany the action in other parts. Sometimes it originates in a hard white slough; at other times, with less change in its colour, it causes a very copious formation of pus.

I pass thus cursorily over some interesting varieties of ocular inflammation, as my object is merely to show how much a morbid sensibility to light is affected by the state of the cornea, from the general import it has in the pathology of the eye. I have now carefully marked the fact, in an immense number of cases, for nearly two years, since the observation first occurred to me,

and