remedy in the puriform ophthalmia. Its introduction into those countries where the disease is particularly prevalent, and where it appears in the most severe and dangerous forms, would be attended with the most beneficial effects, and its judicious employment might be the means of saving the eyes of many of our soldiers who are abroad, more particularly those on the Mediterranean stations.

Little difficulty can occur in selecting the fit cases, and in determining the proper period for performing the operation. No states of the eye, during the progress of this disease, can arise, as far as I know, which could render it improper, provided the accompanying symptoms are in any degree severe; and therefore the practice should be had recourse to, in all cases where the pain in the head and sense of distension in the eyeball are considerable. In those cases where the cornea threatens to burst, the operation becomes particularly urgent, and should be had recourse to without delay. The bursting of the cornea, in some cases, is preceded by an apparent change in the structure of that part of the eye; in other cases no previous alteration can be detected. The changes generally observed are, that the cornea becomes muddy in one part, or over the whole surface; or its surface is studded with small white spots, which run into one another, as the inflammation advances to suppuration; and then ulceration of the cornea, to a greater or less extent, always takes place. In other cases, the cornea suddenly gives way, without any apparent previous change.* This has been particularly taken notice of by Dr. Veitch, and he remarks, that in some cases of this ophthalmia, where he had an opportunity of examining the eye, both immediately before and after the aqueous humour was discharged, this fluid had escaped "by a division of the cornea, which was nearly as clean as if it had been cut with a knife." In the purulent ophthalmia of children, I have had repeated opportunities of making the same remark, and

Observations on Ophthalmia, by Charles Farrel, M.D,

observing a straight division toward the centre of the cornea, the adjacent cornea being apparently sound.

$5. Of the Evacuation of the Aqueous Humour in the Puriform Ophthalmia of Children.

The history, symptoms and consequences of the puriform ophthalmia in children, are so extremely similar to those of the puriform ophthalmia of the adult, that what has been said of the effects of evacuating the aqueous humour in the one, may be repeated regarding the other. When the inflammation arising in the conjunctiva advances to the other textures of the eye, and is not arrested in its progress, the eyeball often bursts by a rupture of the cornea. Now when there is any danger of apprehending such an accident, when an ulcer of the cornea is making rapid progress, or where the violence of the inflammatory symptoms indicate the danger of a rupture of the cornea, the aqueous humour may be evacuated, with the hope, not only of alleviating the severe symptoms of the disease, but of preventing that destruction of the cornea which is always followed by a change in the form of the eyeball, an obscurity of more or less of the cornea, a displacement of the iris, and a deformity or destruction of the pupil.

6. Of the Evacuation of the Aqueous Humour in the Gonorrheal Ophthalmia.

Though we have no means of arresting the progress of some specific diseases, yet a great deal may be done to mitigate their symptoms. When the eye becomes affected with gonorrheal ophthalmia, the progress of the disease is generally so rapid, and the symptoms of it so severe, that the most powerful remedies are necessary to prevent its speedy destruction. Besides, therefore, the extensive depletive system,

which should in such cases be adopted, it will be of great importance to watch the progress of the disease in the anterior chamber, and when any symptoms do occur which indicate a rupture of the cornea, the aqueous humour should be evacuated without delay.

$7. Of the Discharge of the Aqueous Humour, where the Capsule of that Humour is inflamed.

On a former occasion* I attempted to show, that each of the three distinct textures which compose the cornea may be separately inflamed. There is no inflammation of the eye, where so much benefit is derived from evacuating the aqueous humour, as when that inflammation affects the internal layer of the cornea or membrane which contains the aqueous humour.

This disease is marked by a muddiness or turbidity of the anterior chamber, which an ordinary observer would not readily ascribe either to an opacity of the cornea, or to a diminution in the transparency of the aqueous humour. Besides this diffused cloudiness there are generally one or more defined spots, which distinctly denote an opacity of the cornea. These do not resemble a common speck, but have a mottled appearance, and around the opake, white, central points there is a kind of disk, very like what we perceive in some agates, and what are commonly called the eyes of pebbles.-There is not much external redness accompanying the obscure anterior chamber-a blush of vessels only being seen around the sclerotic coat, at that place where the iris is attached to it; neither does the patient seem to suffer much pain from the effects of light, as he can generally open the eyelids and keep them so, and finds no benefit from a shade. The symptoms of this disease which are most distressing, are a sense of fulness and Essays on the Morbid Anatomy of the Eye, p. 3.

Vol. V.

I

No. 17.

distension of the eyeball-as if it was filled with matter, and a dull agonizing pain, generally either in the brow or back part of the head; or in both these parts.

In this disease I have never found the evacuation of the aqueous humour fail in procuring an immediate relief of the pain of the head, and an instantaneous restoration of the transparency of the anterior chamber.

CASE I.

A woman, fifty years of age, had a general milkiness of the anterior chamber of the left eye, and a slightly opake spot nearly on the centre of the cornea. On the white of the eye there were a considerable number of distinct red vessels, none of which passed over the cornea. She could distinguish light with this eye, or a dark object placed between her and the light; but neither form nor colours. Exposure to light gave her little uneasiness.-Had occasional epiphora, but particularly complained of a dull pain, extending through the head and eyeball.

The affection had lasted about a fortnight. After having had headach during the night, she found the eye red and painful when she awoke, and objects appeared as if seen through a mist. The symptoms had afterwards gradually increased.

Treatment. I discharged the aqueous humour by a puncture through the cornea; and immediately after the operation she could perceive a finger with a ring on it, which was held before her eye. She complained of a sensation as if a mote were in the eye, but she felt no acute pain. The cornea immediately regained its natural transparency, except at the speck, which became more distinctly circumscribed.

Some hours after the operation, the pain recurred with considerable violence, but it was relieved by the operation of a purge, fomenting the parts adjacent to the eyeball, and cup

ping the temples; and in a few days the eye was quite recovered.

CASE II.

In a youth fifteen years of age, the anterior chamber of the right eye had lost a good deal of its natural transparency, which appeared as if it proceeded partly from an obscurity of the cornea, and partly from a turbidity of the aqueous humour. There was a bright crimson redness over the whole albuginea; the vessels appeared deep, yet their ramifications were distinct. He complained of a sense of fulness in the eyeball, and of a dull, heavy pain in the orbit, eyebrow, and extending through the head. The pain of the eye was much increased by exposure to light. The inflammation had existed for three weeks, and had from its commencement been attended with the pain in the head.

Treatment. The pain in the brow and head subsided immediately after the aqueous humour was discharged, and în the course of two days, the redness and obscurity of the anterior chamber went off.

CASE III.

There was a want of transparency in the anterior chamber of the right eye, which seemed, partly, to proceed from an opacity of the cornea, and partly, from a turbidness of the anterior chamber.

A bright scarlet-coloured inflammation appeared over the whole albuginea, and the vessels seemed deep, but the ramifications were quite distinct. Exposure to light was very painful, and the patient complained of a sense of fulness in the eyeball, and of a heavy pain in the orbit, and brow, extending through the head. The inflammation had continued three