arrested and vision preserved by raising and maintaining the general powers" and pursuing a proper medical treatment.

TREATMENT.-Ipecacuanha.-In one case the following symptoms were presented: A lady, aged 47, had excessively painful shootings in the eyeballs, could not gaze on any object without copious flow of tears; blue and red halo around the flame of a candle; pupils neither dilated nor contracted, and moved freely; vessels of the palpebral conjunctiva slightly injected without pain; conjunctiva and cornea uninjured; constipation; no known cause for the inflammation. At the end of six weeks Dr. Tamhayn, in remembering the resemblance of the symptoms to those produced by the dust of Ipecacuanha on a pill-maker employed in a druggist's shop, prescribed that article.

Jan. 15th, 1858. Ipecac. twelfth dilution, two globules in 200 grammes of water; a table spoonful three times a day for six days. Jan. 22d, the suffering was less, gazed on objects with less difficulty; the halo around the candle less visible; bowels improved. Ipecac. sixth dilution, two globules. Jan. 29th, improving. The patient can read and work in the daytime. Continued improvement, though some occasional shootings in the eyes, more in the left eye or that first affected. Diarrhoeic evacuation about every morning. Ipec. twelfth dilution, two globules. Dr. Heniel, of Paris, gives a case in which there were lancinations excessively painful in the optic globes, copious flow of tears on looking steadily at any object. Blue and red aureoles surround the flame of the candle; pupil mobile; no external inflammation, slight injection of the palpebral conjunctiva. Such symptoms had been caused in a druggist, pounding Ipecac., and it was prescribed Ipec. 12°, a two globules in water, three times a day for six days. The first week after there was improvement; constipation removed. A week later, could see to read and sew in daylight. (L'Art Medical.)

Ammoniac.-"A glittering appearance before the eyes as of molten metal." (Dr. Kleinert.) In this case, inflammation of the deeperseated parts, the choroidea, &c., is present, with which amaurosis often commences. Traces of the change must be perceptible in the provers by the aid of the ophthalmoscope.

Muriatic-acid.-Perpendicular hemiopia; thus partial paralysis of the optic nerve, perhaps exudation-extravasation of blood on the choroidea.

Alumina causes vision of yellow, perhaps perceptible on the corpus vitrei and the aqueous humor, a purely icteric symptom which may appear on other parts of the body.

Mercury.-Amaurosis consequent on chronic choroiditis, is often if not always pathologically identical with mental imbecility consequent on chronic meningitis. In the first case the delicate structure of the retina, vesicular neurine which is expanded on the optic nerve,

has been pressed upon by its vascular serous membrane, and the choroid and membrani Jacobi are thickened by a morbid deposit. In the second the vesicular neurine of the hemispherical ganglion is pressed upon by the thickened pia-mater and arachnoid. The success of treatment in inflammations of the eye should encourage us to make efforts equally persevering in the treatment of chronic meningitis. Mr. Tyrrell cured most obstinate cases of amaurosis by persevering in the use of minute doses of the gray mercurial powder every night or every second night for twelve months, taking care in all this time that it should never affect the mouth. He even said that he had often seen the cure arrested, and sometimes entirely defeated by salivation, in cases in which it occurred through the impatience of the invalid, who was too anxious to be speedily cured. By long persistence he said he had "restored many a poor fellow to sight whose case had been considered hopeless."

4. AMAUROSIS.

Impaired vision coming on suddenly or gradually, and the loss of sight more or less complete; it may be permanent from its first accession, or transient, varying in degree, and returning only at intervals, sometimes in the day only or in the night only. It sometimes comes on after great exertion of the eyes with minute or very bright objects, or when the digestive powers are greatly disordered. In some cases the loss of sight is confined to a part of the field of vision; or objects appear crooked, distorted, mutilated, changed in size, or inverted; flashes of light; shining stars, globes of light, or muscæ volitantes, are common when the retina is inflamed; when the vital energies of the organ are exhausted, as in dyspeptics or debilitated persons; motes, black specks, muscæ volitantes and thick mists of clouds are seen; double vision is caused by disease within the cranium. At a later stage the vision is obscured by clouds, or a net-work of gray, black, or white silvery, luminous red, luminous in the dark. In some cases pain is felt in the eyes, in others there is only a desire for stronger light, in others there is dryness of the eyes and nostrils; the constitution generally presents some peculiarities indicating hereditary disease, or functional derangement of important organs; there is a staring, unmeaning look in the eyes; an unsteady, uncertain gait; the motions of the eyes or eyelids may be impeded or palsied; the eyes unusually prominent; the sclerotica bluish, or ash-colored, and, in some, covered with small varicose veins; the eyeball is firmer to the touch or softer than natural. After vision is extinct, the pupil is more or less expanded and motionless, though when only one eye is amaurotic, the pupil of that eye follows the motions of the sound one. Sometimes both eyes

are

amaurotic, and yet the motions of the iris continue under the nervous influence of subsidiary nerves, particularly of the branches of the third and fifth pair. The iris may contract irregularly, may protrude towards the cornea or be pressed inwards.

DIAGNOSIS.-Distinguished from cataract by the dimness, or loss of sight, being either sudden or partial, presenting the appearance of fly-spots, or motes covering parts of an object. In cataract, the difficulty of sight increases very slowly, and is compared to a diffused mist, thin cloud, or gauze, intervening between the eye and the object. Amaurosis, if in its first stages a cloud or mist be visible, goes on increasing till sight is extinct; but complete deprivation of sight never occurs in cataract. In cataract the opacity generally commences in the centre of the lens, and the misty appearance is most noticed when looking directly forward, vision being most distinct when he looks sideways; this seldom occurs in amaurosis. In amaurosis the patient desires strong light; in cataract strong light contracts the pupil and renders vision less perfect, as the rays have to pass through the central opaque part of the lens. Amaurosis is usually connected in its origin with headache, vertigo, and disease of the digestive organs. Cataract has seldom any such association. In amaurosis the pupil is either jetblack in health, or a pale greenish color visible when examined in a particular light. (Copland. Vol. I., p. 65.) In amaurosis with glaucoma the opacity is always greenish, in incipient cataract it is always grayish. In the former the opacity seems at a considerable distance behind the pupil; in lenticular cataract it appears close behind the pupil. In posterior capsular cataract the opacity is streaked, in glaucomatous amaurosis it is always uniform. In the former the opacity seen through a double convex lens appears slightly rough; the glaucomatous opacity is smooth and polished. In the former the eyeball is of the natural degree of firmness; in glaucomatous amaurosis it is firmer than natural. Glaucoma progresses slowly, occupying several years; in cataract the sight rapidly declines. In incipient cataract the contractions of the pupil are as extensive and rapid as in health; in amaurosis it is dilated and fixed, or its motions are limited and slow. In cataract the movements, eyeballs and eyelids are perfect; in amaurosis they are imperfect and difficult, there is a want of direction to the eyes, and sometimes a slight degree of strabismus. (Mackenzie, on Diseases of the Eye.)

SYMPTOMS.-The partial or total loss of sight which particularly characterizes this disease, is principally dependent upon a diseased condition of the optic nerve and retina, although other structures occasionally participate in the disease. Amaurosis occurs at all ages, and in both sexes, but is most common at the period of the cessation of the menses in females, and at the age of forty or fifty years in males.

The chief circumstances which predispose to it, are: a plethoric and sanguine temperament; hereditary pre-disposition; tendency to sanguineous congestions to the head and eyes; and an impaired constitution from the abuse of drugs, stimulating drinks, and venereal excesses. Physicians of the old school are much divided respecting the nature and treatment of amaurosis; some suppose it to be a debility requiring tonics and stimulants, while others describe it as an inflammatory affection, demanding an antiphlogistic course of treatment. In view of these discordant opinions, and the empirical modes of treatment based upon them, it is not surprising that so few amaurotic patients are cured by allopathic treatment.

Amaurosis may be imperfect or perfect. In the former there is a partial, and in the latter a total loss of sight. In the first, the patient sees as through a gauze, or but half of the object, or double, or only when the eye is in a particular position, with respect to the object; while in the last, the patient cannot distinguish day from night.

The signs of the approach of the disease are: pain in the forehead and temples, diminishing with the advance of the amaurosis, and ceasing when it has become complete; vertigo; weakness and cloudiness of vision, apparent when looking at distant or at minute objects; sparks and moats, or muscæ volitantes, float before the eyes, annoying the patient, and impairing the sight; in reading or writing, a stronger light than usual is demanded; a slight diminution in the brilliancy of the pupil.

After these precursory symptoms, the loss of vision gradually becomes more complete, until after months or years there remains a condition of settled and more or less perfect amaurosis. In other instances, the disease advances with rapidity, and terminates in partial or total blindness in a few days. But it is not an uncommon occurrence for complete amaurosis to follow instantaneously, leaving the victim in blindness so profound that he cannot distinguish light from darkness. When either of these three conditions obtains, there are usually but few signs which indicate the presence of so serious an affection; the principal symptoms being only a dilated and immovable pupil, a loss of contractile power in the iris, and occasionally slight strabismus. But even these signs are not uniformly present; for cases of complete amaurosis are reported, in which the pupil remained natural, or became preternaturally contracted, and mobile on exposure to light, and in which the iris and all other visible parts of the organ were in a normal condition. The color of the pupil in this disease is ordinarily jet-black, with, perhaps, a very slight diminution of its natural brilliancy, but it sometimes presents a red, greenish, or white and cloudy appearance. Cases of this last description are often mistaken for incipient cataract, and when the loss of sight is but partial, it is not easy to distinguish between the

two maladies; but the following characteristics will afford us material assistance in deciding the matter. In cataract, the dense white appearance is situated immediately behind the pupil, while in amaurosis the cloud is more deep-seated. In the former the flame of a candle appears to be surrounded by a thin, white, diffused mist or cloud, "which increases with the distance of the light," while in the latter, "a halo or iris appears to encircle or emanate from the mist, the flame seeming to be split when at a distance." (Stephenson.)

The shape of the pupil is usually round, but somewhat more dilated than in the normal state, thus allowing a large number of luminous rays to enter the eye. In a few cases it loses its circular form, and becomes angular.

but

Amaurosis is attributed by most writers to a paralytic condition of the optic nerve, retina, or to some disease of the thalami nervorum; does not the peculiar immovable condition of the pupil and iris, when their natural stimulus, the light, strikes them, indicate a loss of sensibility and contractility in these structures? And does not the partial loss of voluntary power over the globe, which occurs during the progress of the disease, indicate a loss of tone in the whole organ?

We have mentioned, as one of the precursory symptoms of amaurosis, floats and muscæ volitantes before the eyes. In the imperfect form of the disease, these appearances vary much in their character, and are a source of great annoyance to the patient. Sometimes a single black speck obstructs the sight; sometimes there is an appearance as if a dark gauze or net-work were before the eyes; sometimes as if flies, small objects of different forms, sparks, fireballs, and various colored lights, were moving in various directions. The objects are more troublesome in a strong light than in dark situations, being in the former of a black or sombre color, and in the latter presenting themselves in the appearance of sudden flashes of light or fire.

We are occasionally presented with the disease in an intermittent form, and, in rare instances, as a temporary attendant of some particular morbid condition of the system, like pregnancy, disordered menstruation, hysteria, worms, and the irritation of indigestible food.

In addition to the symptoms already described, we sometimes observe in young and plethoric amaurotics, strongly pronounced determination of blood to the head and eyes, a constant stupefying headache, more or less redness and congestion of the eyeballs, sensitiveness of the eyes to light, a full and hard pulse, a sense of fullness, tension, and pain in the affected eye.

It is a point worthy of note, that black eyes are far more subject to amaurosis than blue or gray eyes. Beer supposes that where one blue or gray eye becomes amaurotic, at least twenty-five or thirty black ones.