These were the different stages and appearances of ophthalmia in the above patients; when, on the 7th of May 1808, a piece of fine linen was impregnated with matter discharged from the eyes of each, by keeping the eye-lids asunder, and carefully applying a fold of it to the globe of the eye and inside of the eye-lids, so as to absorb a portion of the discharge. This piece of linen, thus imbrued with the ophthalmic discharge yet fluid, I immediately applied over my own eyes, in the form of a shade, keeping the matter in contact with my eyes, by pressing on the linen with the fingers. On some of the matter getting between the eye-lids, a slight smarting sensation was produced.

I kept the shade applied in this manner somewhat more than an hour; then took it off, walked about a mile, and on my return felt no unusual sensation in my eyes. On this day, that oppressive and disagreeable wind, known in Sicily by the name of scirocco, prevailed, and blew clouds of dust in all directions.

I dined and took the usual quantity of wine; returned to my room at 9 in the evening, applied the linen over my eyes as before, and wore it all night. I removed it at 7 in the morning, examined my eyes, and could perceive no appearance of inflam

mation.

A few drops of tepid water were rubbed on the discharge, now become hard and crusted; and I applied that part of the linen where the matter was thus softened to the globe of each eye. No inconvenience ensued.

This last trial was made with a view of determining whether the ophthalmic discharge might not receive additional activity from the atmosphere; and its action thereby become more certain, through the medium of sponges, towels, wearing apparel,

&c.

This experiment was made at Messina in Sicily; and at a period of about eight months after the 62d regiment had returned from Egypt, where, during its stay in the summer months of 1807, ophthalmia had made extensive and destructive progress in several battalions, particularly in the 21st regiment. Numerous cases likewise occurred in the 62d regiment while quartered there, but in very few was vision much impaired; and in none completely destroyed.

The foregoing trial is, by no means, given as a decisive proof of the innoxious property of ophthalmic secretions; as I am fully aware, however accurately performed, it will appear too solitary a fact to warrant any positive conclusion, or to shake the present structure of popular opinion relative to ophthalmic contagion; though, it is presumed, it may not only tend to draw nearer the bonds of analogy which exist between ophthalmia

and other phlegmasiæ, but also to direct the inquiries of others to a closer examination of facts connected with the subject.

On the embarkation of the British regiments at Alexandria in Egypt, some very severe cases of ophthalmia occurred on board the transports on our passage to Messina; and I have had repeated opportunities to remark, that, on this occasion, as well as on several others on board transports, where effectual separation of those attacked was impossible, it was not the comrade, or those in the same or nearest birth, who were the next sufferers, but others in a different part of the ship, for the most part contigu ous to a port-hole or open hatchway.

On foreign service, the buildings occupied as regimental hospitals are, from necessity, frequently ill calculated to admit of the classification or separation of diseases, as, perhaps, one large apartment constitutes the entire hospital. Under such circum. stances favourable for the communication of ophthalmia, if contagious, I have never seen the complaint make any progress in the other patients; and, if a solitary case of ophthalmia took place, it most generally occurred in a person whose bed was near a door, window, or some aperture which admitted a current of air, and not in the vicinity of those labouring under the disease.

The fact of ophthalmia making rapid progress in one battalion, while another, which appears similarly situated, is comparatively free from the disease, though much relied on, may not be a conclusive argument in favour of contagion.

The predisposing causes of many diseases are not sufficiently obvious to come under common observation; and, in every regiment, the individuals composing which being continually subject to the same condition, and obedient to the same unvaried habits, a certain collective disposition, or general temperament, (if I may be allowed the expression,) will be gradually formed and prevail, which, as is observed in individuals, bestows a peculiarity of character that distinguishes corps; and although this temperament, or distinctive feature, is, in most regiments, too subtle to be detected or described, yet it may, notwithstanding, predispose to particular diseases.

From the curious structure, situation, use, and great delicacy of the organ of vision, it is necessarily more subject to the va rious causes which predispose to or excite inflammation, than any other part of the body; " ingentibus vero, et variis casibus occuli nostri patent."-CELSUS.

From these considerations, and from daily observation, I am led to suppose that ophthalmia, under all its varieties, unconnected with constitutional disease, depends on the same predis

posing and exciting causes as the other phlegmasiæ, and is produced without the adventitious aid of contagion. However, on a question of this nature, where an opposite opinion rests on high and respectable authorities, I am unwilling to judge with the confidence of absolute decision. While any doubt remains, it is prudent to guard against the possibility of contagion, as far as circumstances may admit.

The division of ophthalmia into purulent and other species, uninfluenced by constitutional complaints, although ingenious, may not be supported by truth.

In the course of a few days, these appearances of the disease may be seen occurring in the same company and barrack-room, and will yield to the same mode of treatment. The purulent discharge, as well as the chronic stage, may be looked on as casual modifications and progressive changes, and not essential distinctions in the same complaint.

An attentive consideration of the peculiarities which mark any situation where ophthalmia most frequently prevails, will materially tend to illustrate the causes of that complaint. To answer such an inquiry, Egypt presents to the medical observer her low plains, sandy deserts, lakes in the neighbourhood of Alexandria, and the dazzling glare reflected from the uniformly white surface which every object there presents. To these also should be added, an atmospheric temperature much above that to which Englishmen are accustomed, night dews unusually heavy, and the minute particles of hot sand which float in the air, and are raised by the lightest breeze;-causes, on the pernicious effects of which, in producing the worst cases of this disease, it is unnecessary to dwell.

The habits, duties, and mode of living of any class of persons most subject to attacks of a particular disease, likewise form material points of consideration in an investigation of this nature. The habitudes, customs, and duties incidental to a military life, peculiarly distinguish the soldier from those of the like sphere and condition who are occupied in civil pursuits, and often, even under the utmost care of the officer, render the exciting causes of ophthalmia unavoidable.

Before closing these remarks, I beg leave to say a few words on the treatment of ophthalmia,-a subject now so exhausted, as to render any further discussion almost needless; nor do I believe that some of the many publications relative to it have considerably advanced our knowledge. To a mind untutored in the school of extensive experience, the impressions received from a confused mass of contradictory materials, convey false

notions; and, tending to produce a habit of inconclusive reasoning, render our practice inert, and its principles fluctuating.

Laying aside, therefore, all subtility of distinction, and refinement in hypothetical reasoning, were I permitted to refer to the testimony derived from an experience of twelve years in the treatment of ophthalmia, under almost every possible variety of circumstance that could influence the disease, I would give unlimited assent to the opinion of those who inculcate bold and rapid depletion as the safest and most effectual mode of treat

ment.

In the present state of medical science, where even the phenomena of disease, most generally admitted as facts, are often disguised, or rest on the unstable basis of doubtful analogy, positive assertions must wear the unseeming garb of unbecoming confidence. But, if such assertions were ever allowable, I would confidently affirm with Scarpa and some others, that a tardiness in the use of evacuants, particularly a sparing use of the lancet, is the chief cause of subsequent disorganization and destruction of the eye, in the various shapes of suppuration, ulceration, sloughing and rupture of the cornea, adhesions of the iris, opacities, &c.; and, if these bad results do not occur, such omissions will tend to form and protract an obstinate chronic stage, from the debility induced in the vessels of the membranes, owing to previous excessive action and distention.

That this mode of treatment will succeed in every instance, it would be absurd to advance; and such an assertion would imply a power not within the sphere of human exertion, however wisely directed. In some few cases, the rapid progress and violent symptoms are so urgent as to set at defiance all our resources and disorganization is effected in the course of a few hours. But this very seldom occurs; and, in a great majority of cases, a prompt application of proper means in the commencement will arrest every bad symptom.

In the spring and summer months of the year 1813, ophthalmia extensively prevailed in the British garrison of Palermo. Many of the inhabitants were likewise attacked with it. No less than 193 cases occurred in the 62d regiment, between April and September, in all the different gradations of severity. Of this number, only one eye was lost by ulceration and sloughing of the cornea; and this occurred in a scrofulous habit, and in an eye impaired and rendered opaque from early infancy by the small-pox.

The excellent interior economy of the regiment enabled me to see the patients almost at the first moment of attack; and unless the case was very slight, blood was immediately extracted,

the quantity being regulated by the extent and severity of the inflammation, and apparent habit of the patient, but seldom or never under thirty ounces in any case where the lancet appeared

necessary.

Frequently where peculiar severity marked the case, both temporal arteries were opened at the same time, and sixty or seventy ounces rapidly extracted, which was followed by the most immediate relief. In every violent case of ophthalmia, there is, for the most part, an increased vascular action, particularly in the branches of the temporal artery, which enables the surgeon to extract the necessary quantity of blood. To prevent secondary hæmorrhage, the divided artery was secured by the tenaculum, as the pressure of a tight bandage round the temples will, in severe cases, add to the tumefaction of the palpebræ, and increase the pain and inflammation. Nor should the ligatures be applied in a careless manner; both the divided ends of the artery will sometimes require to be secured, particularly in warm climates, where increased atmospheric temperature gives additional force to arterial action. Under such circumstances, unless the artery is secured by ligature, serious loss of blood may occur; particularly in the night-time, when a compress or bandage is liable to be rubbed off or disturbed.

It might prove tedious and uninteresting to detail the secondary means that were used; such as alvine evacuations, scarifications of the turgid vessels on the conjunctiva, incisions into, or removing a portion of, the tumid chemosis. In some cases, where the inside of the eyelids became much swelled, and assumed a granulating spongy appearance, which formed the principal source of the purulent secretion, relief was obtained by removing a portion of it, as recommended by Mr Ware. Blisters were found a doubtful expedient, and should not be employed during the violent inflammatory stage, or previous to evacuants. A pint of the common sea-water, with a small portion of the tartrite of antimony dissolved in it, was found a good purgative; producing, at the same time that it opened the bowels, a gentle diaphoresis on the surface.

The pernicious custom of dark rooms and closed windows should, in most instances, be avoided, particularly in warm climates. In the acute stage of ophthalmia, by raising the temperature of the ward, they render any good effects from the exclusion of light doubtful; and tend powerfully to protract the chronic stage by keeping the patients, as it were, in a warm bath of animal effluvia,-by denying a free circulation of air, and the admission of light, the stimulus of which, perhaps, proves the best remedy in old protracted caseș.