who had been blind four years. She is small, emaciated, of sallow complexion, mother of three children. Vision had become impaired gradually several years ago after inflammation of the eye. She then saw snow-flakes and spider-webs in the atmosphere. In 1856, April 29th, she could hardly distinguish light from darkness; pupils dilated and mobility of the iris partially impaired, crystalline lens obscured, of whitish color, and uniformly shaded; no pain; inability for four years to continue her occupation. Euphrasia 30th, May 16th, improvement, continue Euphrasia, higher potency, three globules at once.

Aug. 4th. Begins to distinguish objects but they look distorted. Cannabis 30, continued till Dec. 1. Condition not changed. Sulph. 200, three globules given at once. March 2d. The crystalline lens appeared less clouded. Could distinguish persons though as in a mist. 'Causticum 200.

April 30th. Still saw black spots before the eyes; but vision improving, Silicea 30. At the end of May, the patient overjoyed at her condition, can readily distinguish all objects; could recognize the letters in a book; that she could devote herself again to her former occupation. Sees a halo around the light of a candle. Phosphorus 30. Two months later, she came to render thanks for the benefits she had received. Her vision was so far improved that she could thread a needle, could sew and could read with ease. Three years afterwards the sight continued good.

7. GLAUCOMA.

Mr. Hancock says he does not regard the disease merely as a choroiditis, or irido-choroiditis, with infusion into the vitreous and aqueous humors, as this view seems to regard results rather than causes. He believes "that glaucoma, whether acute or chronic, is essentially a disease of the blood and the blood-vessels, and that the effusion or infusion, as it may be described, is the result of this condition, which if not arrested, sooner or later destroys sight." He does not rely on any operation for the cure of glaucoma, relying mainly upon constitutional remedies.

"In acute glaucoma," says Mr. Hanson, "the eyeball is constricted and marked by a circular depression at the point corresponding to the ciliary muscle, whilst the vessels around this part are gorged to a great degree. The eyeball is elongated in its antero-posterior diameter, and the cornea lessened in all its diameters, and rendered more conical than natural; whilst, when the patient turns his eyeball sideways, irregular bulging of the sclerotica (Staphyloma), is exposed to the view. In one or two cases, also, in which I performed iridectomy, the pupil was dilated to excess, and the iris so tense and rigid that it resembled a cat-gut, and could with difficulty be drawn through the wound."

The

pathology is not clear. This author thinks he can "readily understand that the lateral expansion of the eyeball being, in a great degree, prevented by the constriction of the ciliary muscle, the force of the compressed fluid acts more powerfully in the antero-posterior direction; hence the puckering and cupping of the retina, the irregular bulging of the choroid, the alteration in the shape of the cornea, and elongation of the eyeball."

A more careful examination of the pathological appearances led this observer to suspect that the ophthalmoscopic and pathological appearance of the blood-vessels were greatly enhanced by, if not in some instances entirely due to, the obstruction of the circulation caused by the undue and excessive constriction exerted upon them by the spasmodic or extreme contraction of the ciliary muscle, analogous to the spasm so often observed in the muscular fibres of the urethra, as well as in the sphincter muscle in certain affections of those parts.

"This supposition was strenghtened by the character of pain so often described by patients as ushering in the attack of acute glaucoma; in one case, a lady who had been exposed to a very strong light at a party, felt upon her return home, as though she had received a violent blow upon her eye." (Lancet, Feb., 1860.)

PATHOLOGY.-In glaucoma the pupil is dilated, of a sea-green, bottlegreen, or dirty-green color; the cornea is somewhat flattened anteriorly, and nearly as sensitive as in the natural state; the iris is rather convex anteriorly; the globe of the eye is harder than usual; the sight is diminished from slight amblyopia to complete blindness; the ophthalmoscope, shows the papilla of the optic nerve, as it enters the globe and spreads out into the retina, to be concave, in place of convex, as it is normally; it likewise demonstrates pulsation of the arteria centralis retinæ. Von Græfe attributes all these symptoms to increase of the intra-ocular pressure. He divides glaucoma into acute and

chronic.

Acute glaucoma, is considered to consist in a choroiditis (or iridochoroiditis) with diffuse imbibition of the vitreous body and aqueous humor, and in which increase of the intra-ocular pressure, compression of the retina, and the well-known series of secondary symptoms, are produced by the increased volume of the vitreous humor.

TREATMENT OF GLAUCOMA.-This disease, previously regarded as incurable, has been treated with partial success by Von Græfe by the operation of iridectomy. J. W. Hulke, assistant surgeon to the London Ophthalmic Hospital, &c., has reported two cases thus treated. It is claimed that "the hardness of the eyeball, the peculiar progressive contraction of the field of vision, the paralyzed dilated pupil, the in tense throbbing pain, the excavation of the optic nerve entrance, and pulsation of the retinal vessels," are consequences of "excessive tension

of the eyeball, produced by a superabundance of fluid within it, which is probably exuded from the choroidal vessels and distends the vitreous humor." "The eye being an organized living tissue, having a locular or cellular arrangement, the distention of its loculi with dense fluid, as serum, would give the whole tissue an unnatural turgidity, and stiffness. The fluidity of the organ, which occurs later in the disease, depends upon the breaking up of its dissepiments, when it shares the atrophy which finally involves all the ocular structures." Von Græfe long ago demonstrated a flattening of the cornea in this disease, "by comparing the size of the image which the flame of a candle forms upon the glaucomatous cornea with that which it forms upon the healthy cornea of the other eye;" it is "immediately apparent that the glaucomatous cornea furnishes the larger image, proving that its outline has a larger (flatter) curve.

"The excavation of the optic nerve entrance" is explained in the Jacksonian prize essay on "Diseases of the Retina," Dec. 1860. (Archiv für Ophthalmologie.") It is there shown that "the optic nerve entrance constitutes the weakest, the most yielding point in the fundus, where the first visible effects of excessive pressure would naturally be expected." (Medical Times and Gazette, Sept. 1, 1860, London Lancet, Feb. 1861, p. 144.)

SURGICAL TREATMENT.-Von Græfe first attempted to treat it by paracentesis of the eye, and he accordingly performed this operation repeatedly in a large number of cases; but of these only two were permanently cured, though there was temporary amelioration in most.

He next attempted to produce "permanent diminution of the intraocular pressure" by iridectomy; but the general result was not very satisfactory; it seemed only to cause rather a refilling of the atrophied or softened eye. The result, however, of the same operation "in ulcerations and infiltrations of the cornea" gave hopes of further advantages in the other cases.

Cases, in which this operation was performed.-First :-In the premonitory stage of glaucoma. In this it was successful, even when this stage had lasted a long time.

Second:-Early stage of acute inflammatory glaucoma. "Vision was perfectly restored in all cases in which the operation was performed before the termination of two weeks from the occurrence of the inflammation." Some of these cases were perfectly desperate, for every trace of the qualitative perception of light had been already extinguished."

Third:-Later period of acute glaucoma. Here improvement was obtained, though less apparent; the improvement was considerable, even after the inflammation had lasted many weeks, "provided the field of vision was not contracted, nor the optic papilla excavated.”

In the opposite condition the operation not advised by excrutiating spasmodic pain, which lasted several hours."

He had tried Græfe's method by iridectomy and found it objectionable, from

First:-"The disfigurement resulting from the removal of a portion of the iris, the formation of a coloboma iridis."

Second:-The removal of one-fifth of the iris.

"All agree that the smaller the quantity of iris removed the better. By excision of a portion of the iris, the edge of the lens, with its suspensory ligament passing in front of the vitreous humor to the ciliary process, is exposed to view. To remedy this inconvenience, Mr. Bowman makes an incision above, believing that the cover thus given to the upper lid to the margin of the lens which has been exposed by the removal of the iris contributes to the perfection of vision. Third: "The loss of the power of adapting the eye to near objects, which it in some degree retains in chronic glaucoma."

Operation proposed by Hanson.-"Introduce a Beer's cataract knife at the outer edge of the cornea where it joins the sclerotica. The point of the knife is pushed obliquely backwards and downwards until the fibres of the sclerotica are divided obliquely for rather more than one-eighth of an inch. By this incision the ciliary muscle is divided, whilst the accumulated fluid flows by the side of the knife."

8. HYPERMETROPIA.

Defective Power of Accomodation of the Eye.

This disease was first described by Von Græfe in his "Archiv für Ophthalmologie, II. 1,179. It has since been thoroughly investigated by Donders. We abridge their views, as presented by another author."*

By hypermetropia is meant that peculiar condition of the eye in which the refractive power of the eye is too low, or the optic axis (the antero-posterior axis) too short; we may, however, have both these causes co-existing. We may also diagnose the hypermetropic eye by its peculiar shape; it appears flatter and smaller than the normal eye, it does not fill out the aperture of the lids, there is a greater or less space (like a little pouch) between the eyeball and the canthus, more particularly the outer canthus.

The normal eye unites parallel rays upon the retina with little or no effort of accommodation, but it also possesses the power of accommodating itself without difficulty or annoyance for divergent rays, coming from objects six to eight inches from the eye, for a short time it can

* Mr. J. S. Wells, Medical Times and Gazette.

even unite rays upon the retina which come from three to four inches distance. The focal point of the dioptric system lies in the normal eye exactly upon the retina.

In the myopic eye, the state of refraction is too great, or the optic axis too long, so that when the eye is in a state of rest, the focus of the dioptric system lies in front of the retina, and parallel rays (emanating from objects at an infinite distance) are brought to a focus before the retina, and only more or less divergent rays are united upon the latter. "Now in hypermetropia we have just the reverse of this. The refractive power of the eye is so low, or its optic axis so short, that when the eye is in a state of rest, parallel rays are not united upon the retina, but behind it, and only convergent rays are focussed upon the latter.

TREATMENT. When the eye does not possess sufficient refracting power to converge the parallel rays of light to a focus on the retina, the only successful mode of treatment consists in selecting and adapting to the wants of the individual convex glasses which by giving the rays of light a sufficiently convergent direction may neutralize the hypermetropia. The mode of suiting the eye with glasses of the proper convexity is best described by Mr. Wells, according to the theory of Donders.

"The presence of hypermetropia is thus tested. If a person can see distant objects through a convex-glass, he is hypermetropic. The best object is Jæger's test-type. The strongest glass with which the patient can read at a distance of twenty inches gives us the degree of hypermetropia before the action of atropine. If this glass be convex 24, his hypermetropia equals . The power of accommodation is then to be paralysed by a strong solution of atropine (4 grains to one ounce of water): after this has acted for from two to three hours, the degree of hypermetropia is to be again tested. In young persons with a good range of accommodation, the difference in the convex glass required before and after atropine is often very considerable. In the normal eye the far-point begins to recede from the eye about the age of fiftyfive or sixty, the eye becomes hypermetropic, at eighty the hypermetropia may, according to Donders, equal.

"Range of Accommodation."-We change the hypermetropic eye into a normal one by means of the suitable convex glass, and then find the nearest point at which No. 1 of Jæger can be read with this glass. If the near-point lies at seven inches, A=+.

"It has already been pointed out that presbyopia may co-exist with hypermetropia.

"Spectacles."-A person suffering from hypermetropia must be gradually accustomed to wear those glasses which neutralized his hypermetropia after the accommodation was paralyzed by atropine. At first