soldiers together; unfavorable climatic influences; bad location of the camp; exposure to high temperature; consumption of large quantities of spirituous drinks, &c. The disease may be epidemic in character instead of contagious.

PROGNOSIS.-The persons most liable to attack are those most intimately associated with the sick; those exposed to other common causes of disease; and those especially in whom, with the naked eye, we can detect in everting the upper lid, a small red elliptical spot seated in one or other, rarely in each angle, whilst the rest of the conjunctiva is normal, and in the centre of this spot a red projection of the membrane with one or more little eminences (commencing granulations), the patient all the while complaining of nothing else. A mild form of the disease is seen in cases in which there is congestion of the conjunctiva with diminished secretion.

In a severe attack the granulations arise over the whole surface of the conjunctiva and cornea, and the secretions are more rapid, and profuse.

The most serious cases of all are those in which not only a constant discharge of pus exists, but often also ulceration and its consequences, appear in the course of a few hours or days.

Convalescence is evidenced by our discovering in the conjunctiva no abnormal change; by the blood recovering from its morbid condition. TREATMENT.-The earliest efforts at treatment have generally been directed to the extermination of the above described vesicles, and thus to the bringing of the disease speedily to a termination at its first stage, and whilst it is curatively local.

The patients who first become the subjects of granular ophthalmia in any locality should be immediately separated from all healthy and convalescent persons; the eye must be protected from light, draughts of air, and dust; forbid all stimulants in drink or food; no linen but fresh and clean must be used, and the towel he touches must not be used by others.

MEDICAL TREATMENT.—Aconite, Bell., Apis, Argent-nitr., Arsen., /na Calm Euphras., Digitalis, Mercur., Lycopod., Rhus, Sulphur, correspond to this disease.

LOCAL-REMEDIES.-The best local specific is the sulphate of copper in substance, a small piece of which is to be smoothly polished, and rubbed lightly over the granulations once or twice a day, following application with a camel's-hair brush filled with pure water. A persevering use of this substance will, as we know from experience in these cases, cure the most inveterate forms of the complaint.

Among the modes of treating this disease Nitrate of Silver carefully applied in substance has held the first rank. It is directed to hold the stick of the fused Argentum-nitricum between the fingers as a pencil,

introducing it carefully between the eyelid and the globe, while the patient looks upwards, and thus, to rub it lightly on the vesicles, and on them alone, till they are destroyed. The burning pain which follows is to be alleviated as it may be by washing the eye, applying wet cloths, &c. That the Argent.-nitricum is homoeopathic to the inflammatory condition is not questioned; but many homoeopathists have objected to this heroic application of it. General experience in this peculiar form of ophthalmia has sanctioned it; and it will most probably maintain its ground.

In conjunction with the above means, we may employ one of the following medicines: Sulphur, Calcarea-carbonica, Hepar-sulphur, Aodine, Graphites, and Actd-nitric., as internal remedies.

In selecting our internal remedy, regard must be had to the cause as well as the symptoms of the disease. We advise the first attenuations, and the dose to be repeated once in twelve or twenty-four hours, as long

as necessary.

Sulphur-Commencing catarrh; tension as if sand in the eye; dryness of the eyeball; itching in the eyes and lids; disagreeable heat and burning as if the eye were about to inflame, accompanied by redness of the eye and swelling of the lids; lachrymation, and closure of the eye.

Aconite.-Inflammatory and febrile symptoms commencing.

pain, redness, burning and heat increasing.

Cold Lotions.-Ice-water, fomentations, &c.

The

Belladonna. The pain in the eye becoming intense and throbbing. In alternation with Aconite.

Digitalis.-Pain in the eye tensive. In alternation with Mercur. in gonorrhoeal ophthalmia. Followed at the end by Lycopodium.

Argent.-nitr.-Appears to be indicated in most forms of this disease. and has in many cases induced a rapid cure. In contagious catarrhal ophthalmia commence with one drop of the sixth dilution, in water, twice a day or oftener. If improvement is not soon seen, try the third dilution, a drop in a tea-spoonful of water. At the same time the affected eye should be washed over with the medicine in water. At first ten drops of the first dilution may be tried, afterwards, a solution of one grain of Nitrate of silver in the ounce of water may be used by absorption in a pledget of linen, folded and laid over the eye, and renewed occasionally.

In blepharo-blenorrhoea the same local use of this article may be tried, even to the strength of three or four grains to one or two ounces of water; diminishing the strength as the severity of the disease subsides.

In addition to this application, the eyes should be washed repeatedly with warm water; the surface of the cornea should be kept as

clean from pus as possible; often needing washing every half hour to prevent the accumulation of pus and exudations.

In hard fibrinous granulations the morbid growths may be touched over with lapis infernalis, followed by cold fomentations.

Dr. Hawr treated blepharo-blennorrhoea with drops of a solution containing five to ten grains of nitrate of silver in the ounce (after washing the eye) and generally with astonishingly good effects. In granular ophthalmia, even when accompanied by highly inflammatory symptoms, redness, swelling of the conjunctiva palpebrarum, redness of the eyeball radiating from the corneal margin, photophobia, lachrymation, spasm and headache, and, undeterred by the inflammatory symptoms, he touches with lapis infernalis the characteristic vesicles in conjunction with the lid, in order to avert the chronic state. A milder preparation consists of two parts of Nitr. silver, and two of pure nitre, and its use was soon followed by abatement of the symptoms and a speedy convalescence. Dr. Hawr said this treatment was better, quicker and more certain, even if not more pleasant than the old antiphlogistic plan. By cauterizing the granulations he usually got rid of the photophobia lachrymation, cramp and pain; he would cut off sarcomatous growths and then cauterize the raw surface. The Russian military surgeons pursue a similar practice; employing nitrate of silver six to twenty grains to the ounce of distilled water.

Arsenicum. The pain in the eye is unbearably scalding, and the eyeball feels like a red hot coal in the orbital cavity. This may be in the early stage; and it may be used during the use of the cooling lotions. Arsenicum is also useful in the second stage of blennorrhoeal inflammation with suppuration of the eyelids.

When the conjunctiva forms a wall around the cornea, the secretions are accumulated in the centre, so as to endanger that structure, the pains extend to the neighboring parts, it is proposed to cut out a portion of the conjunctiva with a pair of curved scissors; first raise a piece of the puffy membrane with the forceps, and then cut with the convex surface of the scissors. If the conjunctiva of the upper lid is puffed and protruding so as to prevent the opening of the eye and the necessary washing, no harm is done by cutting off a portion, as the swelling of the eyelid is at the same time diminished.

Rupture of the Cornea.-The local application of Belladonna is the principal reliance. Three grains of the extract may be dissolved in two drachms of water, and once or twice daily dropped into the eye. By this means the pupil is retained in a permanent state of dilatation, and the sight thus preserved after the cornea is healed.

Intense Ulceration of the Eye.-REMEDIES:-Arsen., Alum., Baryta, Bellad., Calc., Carbo-veg., Hepar, Lycopodium, Mercur., Natrum-mur., Pulsat., Rhus, Sepia, or Sulph.

Spots on the cornea-nebula, remaining after inflammation has ceased, may be removed by the use of Apis, Arsen., Cale, Cannabis, Conium, Kali-iod., Lycop., Mer., Staphys.

Purulent Ophthalmia, or Blennorrhea Egyptiaca, as well as the ophthalmia neonatorum are of sycotic origin. The first appears particularly after re-vaccination among the soldiery. Dr. Wolf proposes Thuja as the remedy, though he has tried it in but few cases. He succeeded in some with Aconite and Apis. The same treatment will also cure chronic ophthalmo-blenorrhoea. The greatest danger is produced by the localization of the sycotic poison in the brain, where it causes all the symptoms of the most acute inflammation; and yet after death no sign of inflammation is found. Such cases are of rare occurrence, though they originate in the suppression of a fresh blennorrhoea, or of a catarrh in children after vaccination, or in scarlet fever. In such cases Apis, Belladonna and Stramonium fail; Thuja promises to be the effectual remedy. In doubtful cases Aconite or Apis may be tried; and if the fever still progresses, one dose of Thuja 300°.

Sclerotitis.-Though the sclerotica may be specially inflamed it is not commonly much diseased, except in connection with inflammation. of other tunics or structures, which are more delicate and more essential to the safety of the sight; therefore, in the complicated inflammations which involve the sclerotica more serious disease generally is going on in other structures. Thus injection of the vessels of the sclerotica takes place whenever the cornea or iris are seriously affected, or when the entire globe is attacked, or an abscess forms within it; its structures may become thinned from disease of the choroid; but in all these circumstances the alterations in other parts precede those in the sclerotica, and are the important objects of our attention. The sclerotica in all of these cases calls for no special care, but the treatment necessary for the whole case depends rather on the nature and degree of the disease of the associated structures.

6. OPACITY OF THE CORNEA.

DIAGNOSIS.-Opacities or specks upon the cornea vary much in size and appearance. Various appellations have been given to these different opacities, as: nebula, leucoma, albugo, &c., depending upon the nature of the cause, and the particular tissue affected. The opacity may consist of slight misty or opaque spots, diffused over a part or even the whole of the cornea, of a light color, such as are caused by a perverted secretion of the inner lamina, and termed nebula; or of smali and circumscribed spots, of a pearl color, and entirely opaque, caused by a kind of false membrane under the conjunctiva, and termed leu

coma; or of cicatrices resulting from the healing of ulcers and wounds of the cornea, and termed albugo.

When the disease consists of a simple diffused nebulous opacity, we can distinguish through it the pupil and iris, and the rays of light pass to the retina so as to give rise to imperfect vision; but the other kinds of opacity do not permit the passage of luminous rays, and, consequently, when situated in front of the pupil, destroy or seriously impair

vision.

The two first varieties are caused by purulent ophthalmia and granulated lids, and are results most to be dreaded, especially in constitutions tainted with scrofula, syphilis, psora, or mercury.

TREATMENT. The best local stimulus is a collyrium, composed of one grain of Sulphate of Zinc to four ounces of water. A few drops of this may be put into the affected eye, from two to four times in twenty-four hours, until the opacity begins to disappear, when we should omit it as long as the amendment continues.

The internal remedies most to be relied on are: Calcarea-carb.. Iodine, Mercurius, Sulphur, Sepia, Arnica, Hepar-sulphuris, Acidnitricum, Aurum-muriaticum.

Attenuations and repetitions the same as in chronic ophthalmia.

II. AFFECTIONS OF THE DEEPER-SEATED STRUCTURES OF THE EYE

1. INFLAMMATION OF THE CORNEA.

DIAGNOSIS.-Inflammation of the cornea may exist as an independent affection, or it may occur during the progress of iritis, and other acute derangements of the internal textures of the eye. Soon after the inflammation sets in, a number of the serous vessels are observed to carry red blood; the cornea loses its brilliancy; the eyes become sensitive to light; a profuse secretion of tears is induced from exposure to cold, air, light, dust, and smoke; tension and pains are experienced in the eye; yellow spots, composed of pus, are observed between the lamella of the cornea, by looking obliquely through the eye; these abscesses, if the disease continues, eventually burst internally, and discharge their contents into the anterior chamber, or externally, and form those troublesome ulcers of the cornea, which so often endanger sight. When these ulcers are small and confined to the anterior portion of the cornea, they may often be cured without material injury te the eye; but when the ulceration pervades the whole lamellated structure of the cornea, it is not uncommon for the aqueous humor to escape through the opening, and even the iris itself to protrude.

ULCERATION OF THE CORNEA.-Case by Dr. Alex. Walker. (Month Hom. Review. Vol. 5, p. 268.) A lady, after three miscarriages, &c., VOL IL-8.