and extensive haemorrhage, found, two months after, the left eye becoming weak and dim; lachrymation ensued; finally ulcers appeared on the cornea; these were accompanied by excessive suffering, loss of rest and appetite; considerable fever. In the course of a few months the eye seemed slightly improving; but metastasis took place to the right eye. The diseased condition persisted for sixteen years, during which eighteen different physicians and oculists in succession endeavored to cure it without success. Stimulants had been prescribed in full variety. The patient was found sitting with her back to the window; the blinds all down, room darkened; photophobia excessively distressing. Seven ulcers were visible on the cornea; lachrymation so extensive as to saturate four or five handkerchiefs in a day; inflammation higher at night, pain and suffering preventing sleep till four or five next morning; sclerotica and conjunctiva fiery red; meibomian glands much ulcerated; outer ring of the iris dusky red; violent pains in the supra-orbital and temporal regions, increasing toward evening; great nervous debility; depression of mind; flatulence; constipation, indigestion. The patient inherited a rheumatic diathesis. The latter fact influenced the prescription. Stimulants discontinued. Bryonia was given twice a day, and a dose of Aconite at bed-time. Weak collyrium of Bryonia to the eye. This was continued for five days, and then omitted for two. At the end of the first week the inflammation of the cornea, iris, sclerotica and conjunctiva was much reduced. After the third night some refreshing sleep, and improved digestion, less flatulence Cold water was used in the morning and after dinner, cold bath in the morning; diet simple, plain but nourishing; suppers forbidden. In the course of the treatment under which she recovered full health in a few weeks, she took Sulphur, Calcarea-carb., Mer.-sol., and, occasionally, Aconite. The remedies were generally employed in the sixth and third potencies. Some patients are powerfully affected by the high potencies, others who are insensible to the high are satisfactorily cured by the low.

CONICAL CORNEA.-Mr. Bowman's operation for relief of this affection consists in "puncturing the cornea near its lower margin, drawing out the iris by means of a short blunt hook, and securing it outside of the corneal wound by a fine ligature."

2. IRITIS.

DIAGNOSIS. This peculiar affection of the eye is by no means easy of detection, on account of the situation of the iris, and the small number of external symptoms which characterize the complaint. Inflammation of this texture is, however, more productive of constitutional or febrile symptoms than affections of the external tunics. This may in

part be owing to the loose attachments of the conjunctiva to the eye, and the more ample scope for effusions into the subjacent cellular tissue.

Iritis commences with a dull, pressing, heavy, and deep-seated pain in the orbit; contracted pupil; change in the natural color of the iris to a dark, greenish, or reddish color; a moderate rose-colored blush of the conjunctiva; diminished power of vision, and considerable sensibility to light.

As the disease advances, the pains become acute, and extend from the eye into the temples and to the top of the head; the contraction is more strongly pronounced; sparks and luminous flashes pass through. and before the eyes; the nervous system is excited; the pulse accelerated; the skin hot and dry; the intestinal and urinary secretions are partially suppressed, and there are other indications of constitutional disturbance.

After these severe symptoms have continued some time, the iris presents an irregular, angular, and thickened appearance, and is covered with specks of yellow lymph. Small abscesses now form on the iris, which ultimately burst into the anterior chamber, which is afterwards usually absorbed. If extensive adhesions have formed between the iris and the capsule of the lens, or if the more deep-seated parts have become involved in the disease, an almost total loss of sight is the common result.

In some instances the inflammation extends from the iris to the retina, the choroides, the cornea, and finally involves the whole internal. structure of the eye, when the malady will present symptoms characteristie of the inflammation of these different structures. In cases of this description, the symptoms are of the most violent character, the pains are exceedingly acute and painfully throbbing; there is a very rapid contraction of the pupil, the sight is speedily extinguished, the constitutional signs are very urgent, and the patient is always in imminent danger of rapid loss of vision.

CAUSES. The most common cause of iritis is the abuse of Mercury. Syphilis has been often assigned as a cause of it, but we believe, without just reason. It has often been observed during the treatment of syphilis by Mercury; but, we think, never in syphilitic diseases where Mercury has not been employed. Other causes are: mechanical injuries, rheumatism, gout, excessive use of the eyes over minute objects. TREATMENT.-The most appropriate remedies are: Hepar-sulph., Acid-nitr., Muriate of Gold, Cocculus, Calcarea-carb., Nux-vomica, Belladonna, Conium, Lycopodium, Staphysagria, Arnica, Aconite. Hepar-sulphuris, Nitric-acid, and Aurum-muriaticum are curative in iritis arising from abuse of Mercury, with aching, throbbing and tearing pains in the orbit, sometimes extending to the top of the

head; pains in the bones about the eyes; fiery sparks before the eyes; intolerance of light; contracted pupil; partial or entire loss of vision; dark or greenish color of the iris; spots of yellow lymph, or ulcers on the iris; febrile disturbance.

Cocculus, Nux-vomica, and Belladonna are indicated in arthritic and rheumatic iritis, accompanied with deep-seated, lancinating, tearing, or contractive pains in the ball, and extending to the top of the head; involuntary, spasmodic movements of the globe; irregular contraction of the pupil; discolored and puckered iris; photophobia; pains aggravated on moving the eyes, or stooping; luminous specks or dark objects float before the retina; greatly impaired vision; effusion of blood and matter into the anterior chamber of the eye; indications of gastric derangement, and of general constitutional disturbance.

Calcarea-carbonica, Conium, Lycopodium, and Staphysagria are appropriate in iritic inflammations connected with a scrofulous diathesis. These remedies cover: greenish or yellowish color of the iris; pupil much contracted and distorted; ulcers which have opened internally or externally; outward distention of the iris; adhesions of the iris to the capsule of the lens; moderate participation of all the structures of the eye in the morbid action; photophobia; vision destroyed or much impaired; difficulty in distinguishing the iris from effused lymph and pus into the anterior chamber of the eye; great general irritability; aching, throbbing, lancinating, or pressing pains in the eye; rapid and irritable pulse; restlessness; hot skin; loss of appetite; mental and physical prostration.

'Arnica is necessary when the disease can be traced to a wound, or to any mechanical injury of the eye. It may also be properly employed in cases which proceed from sudden exposure of the eyes to an intense and glaring light.

Aconite will often be required, either in alternation with one of the other remedies, to control undue febrile excitement, and to remove the violent, congestion, which now and then occurs in iritis.

Mercurius-corrosivus.-Case by Dr. Henderson, of Edinburgh.A gentleman in May, 1852, had inflammation of one eye, declared rheumatic by an eminent oculist in Glasgow. Bleeding, Calomel, and Opium rapidly improved the eye, but the mouth and tongue became sore and inflamed, which confined him to the house for a month, part of the time in bed. He afterwards relapsed several times within the month, though the attacks were not severe. During the winter he was well, but in March, 1854, he had a new and severe attack. The sclerotica around the cornea was closely and densely injected with vessels and so deeply colored as to present the appearance of ecchymosis; aching pain in the eyeball; the iris dull color; pupil regular,

though somewhat dilated. The disease had lasted four days when the second homœopathic dilution of corrosive sublimate was prescribed one drop every four hours. Each dose therefore consisted of only the tenthousandth part of a grain of the medicine. In four days the eye was nearly well, and on the fifth day of the treatment the patient was in perfect health. He had taken five doses per day of the medicine. In a few weeks he had a slight relapse, which was cured by the same remedy without confining him to the house. No mercurial disease accompanied this mercurial treatment.

CLEMATIS.-Rheumatic iritis; sensation of pressure upon the eyes, with photophobia and lachrymation, particularly in the open air; lids forcibly contracted in the morning, with sensation of heat.

ADMINISTRATION.-The remedies may be employed at the first, second and third attenuations, depending upon the age and susceptibility of the patient, and the violence of the inflammation. The dose should be repeated in acute cases every two hours, until we are certain of a medicinal impression upon the diseased texture. In less urgent cases, a repetition will suffice once or twice in twenty-four hours.

Belladonna, and its alkaloid Atropine, are among the most powerful remedial agents in acute iritis. Mercurius, which is also truly homœopathic to this disease, agrees very well in alternation with Belladonna. It also acts well internally while Belladonna is applied externally.

Græfe advises in the slighter cases of acute iritis the application of a solution of Atropine (four grains to one ounce of water), six, eight, or ten times a day, and in severe cases as often as twenty times in the twenty-four hours.

When synechia posterior with broad and extensible adhesions exists, the tendency to the recurrence of iritis is so great, that the patient and doctor are both ready to adopt the severest measures-even extirpating the eyeball, to get rid of the ever-recurring torment, and to prevent the sound eye from participating sympathetically with the diseased one. In such cases Græfe performs iridectomy by excising a small portion of the iris. This treatment he has found efficacious in apparently the most desperate cases, where the anterior chamber was almost effaced, the iris discolored and bulging very much forwards, and the globe of the eye softer than natural and perfectly atrophied. He has repeated the operation on the same eye sometimes as often as six times, and with great advantage. The iris regains its healthy appearance, the anterior chamber refills with aqueous humor, and the whole globe becomes firm The sight too is restored more or less perfectly.

The rationale of the cure in these cases is not very clearly made out. Von Græfe says: "The increased power of vision was in no way dependent on re-absorption of the pupillary exudations, but was

entirely to be ascribed to an improvement of the choroidal compli cations."

Mode of performing the Operation of Iridectomy.-The lanceshaped knife is introduced into the sclerotic, at the distance of half a line from its junction with the cornea, and pushed forwards into the anterior chamber. Through this wound the forceps is introduced, the iris seized and dragged out, and a portion, amounting to a fifth or even a third of the whole, cut away. The remains of the prolapsed iris are left in the wound.*

3. CHOROIDITIS.

The commencement of organic disease of the choroid, though unattended by marked symptoms of inflammation, is still a serious matter, as inflammation often breaks out suddenly.

The existence then of the network or gauze, or appearance of large spots in the field of vision, unaccompanied by pain or uneasiness, or any other evidence of increased action in the vessels of the conjunctiva or sclerotica should meet with prompt attention.

The organ should have perfect rest and be kept from exposure to bright light. Counter-irritation in the vicinity has been found partially successful; stimulating drinks are to be avoided; food should be regulated to that extent that the patient's condition may direct. The patient's general health must be corrected.

Bleeding has formerly been considered indispensable; but in many other cases those who have tried it, found the bleeding to aggravate the disease; in young, delicate females, Mr. Tyrrell (Encyclopedia of Surgery, p. 90) saw "the continuance of the depletory treatment most injurious in augmenting the morbid action and hastening the disorganizing process." Unfortunately, as relief frequently follows the local abstraction of blood, the patient on every fresh attack or relapse is desirous of resorting to the same treatment again; still finding the relief of short duration; the same course is resumed with temporary benefit, but the powers of the patient are successively reduced, and the local disease makes progress in disorganization; each relapse promotes further inflammation, and the anti-phlogistic treatment lessens the powers of the system to resist the progressive amaurosis; and, eventually, vision is completely destroyed, and the general health is at the same time materially injured. Mr. Tyrrell says: "I have seen several distressing cases of permanent amaurosis resulting from such treatment, and I have also known many instances in which the disease has been

Memoirs on certain forms of Iritis, Choroiditis, and Glaucoma. Sydenham Society. 1859.