left, has a slight hazy or nebulous appearance; but when examined by a strong magnifying glass, the cornea is studded over with distinct, round, whitish spots, (about the size of small pin heads when magnified four or five times), giving it a dotted or mottled appearance, (see Plate.) These spots seem to consist of lymph deposited on the inner surface of the cornea or membrane of the aqueous humour.

The pupils of both eyes are of an irregular form, which is more conspicuous on the application of belladonna. The pupillar margin of the iris is then seen to adhere at different points to the anterior part of the capsule of the lens, by small masses of effused lymph.

General health somewhat disordered and strength much reduced by spare diet, calomel, &c.

To take quinine and rhubarb twice-a day; hydrargyrus c. calce and Dover's powder, in small doses, every night. More full and strengthening diet, consisting of animal food and wine, and belladonna to be applied every second day. Is also to use frequently a collyrium of acetate of lead and camphor.

September 4th. Has continued the above treatment, which has required no change on account of the progressive improvement which has taken place. The increased vascularity is now gone; the vision is much improved; the pupils are more regular in form; the spots on the cornea are now much fewer and smaller; and her general health is much improved. To use warm poppy fomentations when any increased excitement takes place.

September 24th. Continued the same treatment, but has taken less of the mercury of late, on account of the mouth having been sensibly affected. The opaque spots on cornea are gone; right eye nearly well; pupil of left still somewhat oval when belladonna is applied. To discontinue the medicines gradually.

October 25th. Is better than she has been for several months past.

November 17th. Is now nearly quite well. No specks of cornea; pupils natural; vision and general health much improved.

CASE II.-A. F. æt. 18, a copper-plate printer, of somewhat delicate but healthy appearance.

October 21st. Complains of dimness of sight, particularly in the left eye. There is a deep-seated red zone around the cornea. When examined with a magnifying glass, numerous small round. opaque spots are seen on the inner surface of the cornea at its lower part. These are more numerous on the left eye, the pupil of which is of an oval form when belladonna is applied. Some pain about the forehead.

States that the complaint came on eight days ago without any

evident cause. The loss of sight is much greater than could be accounted for by the spots on the cornea.

The treatment of this case consisted in small doses of quinine and rhubarb, mercurial pills, blisters, and belladonna, which were continued more or less for several months. At the end of December the report of his case is as follows.

Vision has continued gradually to improve. The opaque spots diminished in size and number till they have altogether disappeared. The proper form of the pupil is now restored, and he reports himself to be quite well.

CASE III.-J. F. aged 23, of fair complexion, with yellow hair, and rather delicate appearance.

February 24th. Complains of great dimness of sight, which prevents her from being able to read. The cornea of both eyes, (but especially the right,) is a little hazy or slightly opaque, opposite to the lower part of the pupil. When examined with magnifying glass, the opacity is seen to be caused by small, distinct, opaque points, producing a dotted or mottled appearance. These opaque spots appear to consist of lymph on the inner surface of the cornea. Pupils somewhat irregular in form, and have some adherent points to capsule of lens. Some deep-seated redness forming a zone around the cornea; has no pain.

States that her eyes have been weak for several years, during which time they have often been slightly inflamed. During the last two months, her sight has become much more affected than formerly, and now she cannot see minute objects, and sees very indifferently to go about.

To take a blue pill every second night-Quinine and rhubarb morning and evening.

Belladonna to be applied every second or third day.

Lotion of acetate of lead. Moderate diet, with animal food once a-day.

March 17th. Opaque spots much fewer in number. Sight of right eye so much improved that she now sees to read.

has not affected her mouth.

Mercury

April 5th. Continues to improve. To take the blue pill every second night. Cont. alia. May 15. This patient is nearly quite well. The spots have disappeared, the pupil is larger and of more regular form,—and her vision is very much improved.

These cases sufficiently illustrate the nature and character of inflammation of the membrane of the aqueous humour. In the instances here detailed, the disease was of a chronic character; and was obviously confined chiefly to the membrane lining the

chambers of the aqueous humour; affecting those parts which cover the interior of the cornea, the iris, and capsule of the lens. This was manifest from the effusion of small portions of lymph on these parts, causing the mottled appearance of the cornea, and the irregularity of the pupil, from its adhesion to the capsule of the lens.

In other cases of this disease, particularly in young subjects, the symptoms are more acute, and other parts of the organ partake of the inflammation; such as the choroid coat, the cornea, the conjunctiva, and even the retina, accompanied with great intolerance of light. And when these parts become affected, the morbid appearances become so complicated, that the peculiar characters of the inflammation of the membrane of the aqueous humour are masked, and often prevented from being recognised.

In cases of more general inflammation of the eyeball, the membrane of the aqueous humour and cornea are much affected; to such a degree, that the cornea bulges, and forms partial or comlete staphyloma from distension. In some cases the sclerotic coat becomes of a bluish colour, or even staphylomatous.

The disease, in some cases, is much less extensive than in the instances above detailed, and is observed to affect only the iris or cornea. In one instance the mottled appearance was confined to the surface of the anterior part of the capsule of the lens. Repeated relapses, or states of acute inflammation, of short duration, are apt to occur. In some cases, too, there is more obscurity of sight than could be accounted for by the opacity of the cornea; leaving us to infer that other parts, or the retina itself, may be implicated in the disease.

I consider this disease to be a modification of strumous ophthalmia; and that, therefore, it requires very particular attention to the constitutional as well as local treatment.

The indications requiring attention are, 1st, to subdue states of excitement or acute inflammation by local and general antiphlogistic remedies; 2d, to stop the progress of the chronic stage of the inflammation; and 3d, to prevent a relapse by tonics and nourishing diet.

The first of these indications is generally answered by topical bleeding, by means of cupping or leeches; the application of warm fomentations and blisters. Purgatives, particularly when combined with antimonials, are very useful auxiliaries. The second indication is to be fulfilled by the moderate administration of mercury. But, in the subjects of this disease, mercury requires to be very sparingly given, so as only slowly to affect the system. The third indication is to be answered by the giving quinine and rhubarb in small doses two or three times a day, along with light nourishing diet, including animal food once a-day, and

in some cases a small allowance of wine. A combination of quinine and rhubarb seems to me to be the best tonic in cases of strumous ophthalmia, and is the one which I find most generally applicable. But, in some cases, this may not agree, or may, from peculiar circumstances, require to be changed for some others. In such cases, magnesia and rhubarb,-carbonate of soda, with rhubarb or colombo, or preparations of iron may be used with advantage.

In some cases a fourth indication is to relieve excessive distension of the eye, caused by a morbid accumulation of aqueous humour, producing excessive pain of eye, orbit, and head. This is to be accomplished by the puncture of the cornea, as proposed by Dr Wardrop, with a grooved needle, by which the excessive accumulation of fluid is evacuated.

When there is distracting pain from distension of the eyeball, caused by a morbid increase of its humours, by which the ciliary nerves are pressed against the unyielding sclerotic coat, there is no remedy which gives such immediate and complete relief as the evacuation of the aqueous humour, when all other means have failed. If, from continuance of the inflammation, the symptoms requiring it return, the puncture may be repeated with the same beneficial effects in removing the pain and lessening the tension of the eye, which allows the parts to recover from the disease.

Another indication requiring attention is, to obviate irregularity and contraction of the pupil.

The contraction or closure of the pupil is to be prevented by the repeated application of a carefully-prepared solution of extract of belladonna, or a solution of atropine.

In mild genial weather, moderate exercise in the open air during the treatment, and cold bathing when the disease has been removed, are of much importance.

The glasses which I have lately found most useful in examining the characters of diseases of the eye consist of a combination of two plano-convex lenses, of from 1 to 2 inches focus. They are to be placed, with the convex surfaces opposed to each other, at a certain distance, so as to form "Ramsden's eye-piece.' These magnify the object from four to eight times, according to the power of the glasses employed. For the purpose in view a more powerful glass is inconvenient, both by requiring to be held too near to the eye of the patient, so that the light is prevented from falling upon it, and by requiring the eye of the observer to be too close to the patient. The focal distance of the glass when complete should be about half an inch; and a tube, making the instrument altogether nearly three inches long, is an improvement which renders it more convenient. The advantages of this glass are, that it possesses sufficient magnifying

power with a very flat field, and is nearly achromatic. The light upon the object may be increased in intensity by being concentrated with another convex lens.

Explanation of Plate I., Figures 7, 8, and 9.

Figure 7. represents the appearance of the eye of the patient, Case II., when magnified.

Figure 8. represents the glasses, combined and constructed as recommended in the preceding pages. This is the modification which I have devised as most suitable to the purpose in view.

Figure 9. represents another modification of the same, in the form of a small telescope which draws out to the proper focal distance.

The distance to which the lenses are placed from each other is twothirds of the focal distance of one of them. When so combined, they have the power of a single lens, the focal distance of which is three-fourths of that of one of them.

51 Queen Street, Edinburgh, May 1845.

ART. IV.-On Malarial Fevers as observed in Canada from 1838 to 1845. I. On Malarial Continued Fever. By THOMAS STRATTON, M. D., Edin.; Navy Medical Department..

THE disease which it is here proposed to call Malarial Continued Fever prevails throughout a great part of South-Western or Upper Canada, and chiefly along the water boundary separating this part of British America from the United States. It is met with along the line of the Rideau canal and the Great Cataraqui river; at Kingston, Toronto, &c. on Lake Ontario; at Queenston and Chippawa, on the river Niagara ; at Port Colborne, Port Maitland, Dunnville, &c. on Lake Erie; at Amherstburg and Sandwich, on the river Detroit; at Chatham, near Lake St Clair. After this, the boundary-line still going to the north, the disease is more rare, though it is sometimes seen at Goderich on Lake HuIt is found at various places around Lake Michigan and on the United States' side of the great lakes. Cases appear first in May, gradually become more numerous in June and July, are most numerous and severe in August, and gradually decline in frequency and intensity during September and October. After the frost sets in, no new cases occur, and any remaining ones speedily recover.

ron.

Symptoms. The disease generally commences with a feeling of weakness, impaired appetite, and slight headach; often there is observed by the friends, an irritability of temper or some other unusual mental state. After a couple of days these symptoms increase, so that the individual has to confine himself to bed. There