westminster hospital

206

appearances said by some writers to be characteristic ofovarian tumours, and, therefore, I have come to the conclu-sion that we have nothing trustworthy but the experienceof our finger-ends to help us in diagnosis., Birmingham.

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A NEW INSTRUMENT FOR ILLUMINATINGAND MAGNIFYING THE ANTERIOR

PORTIONS OF THE EYEBALL.

BY JAS. E. ADAMS, F.R.C.S.,SURGEON TO THE LONDON HOSPITAL ; ASSISTANT-SURGEON ROYAL

LONDON OPHTHALMIC HOSPITAL.

HAVING frequently experienced some difficulty in seeingminute foreign bodies on the cornea, I had this instrumentconstructed with a view simply to focus artificial light on thecornea, and to magnify the image, at the same time leavingone’s hands free for the necessary manipulations requiredto remove the foreign body. The difficulty, of course, onlyarises in private practice, where one has not a competentassistant at hand, but I have no hesitation in saying thatthis arrangement is even better than the aid rendered by themost expert persons.

I should not have thought so small a production worthy ofbeing brought into public notice had I not found how veryuseful it is for purposes other than those for which it was

originally intended. In the first place the cornea, aqueous,iris, capsule, and lens, can be examined, even by a novice,under most favourable conditions of illumination andenlargement.One of the lenses can be brought down in front of the eye

and used for producing an inverted image of the fundus forophthalmoscopic purposes if so desired.

But, above all, it enables one to perform an iridectomy orany other operation on the interior of the eye at any hourof the day or night without an assistant. A few days agoI was asked to see a case a short distance from town, inwhich an immediate iridectomy was called for, the tensionof the globe being + 3. Although it was dark, I was en-abled to perform the operation with the utmost ease andsafety, the illumination being derived from an ordinary gas-burner projecting from the wall of the patient’s bedroom.Another point is this, that if lights have to be brought nearto the patient’s face, chloroform must be substituted forether, whereas with this arrangement the light may beso far off as to render any precaution of the kind un-necessary.

B B

The instrument (made by Messrs. Krohne and Sesemann)will be readily understood from the accompanying sketch.The anterior part of the fillet is made of metal, into whichthe arms are screwed. These arms have movement in everydirection, and are so constructed as to enable one to com-mand a view of either eye. The posterior part of the filletis elastic, so that the instrument can be slipped on to thehead of the patient instantly.

Finsbury-circus, E.C.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

WESTMINSTER HOSPITAL.POISONING BY OXALIC ACID.

(Under the care of Dr. ALLCHIN.)

Nullaautem est alia pro certo noscendi via, nisi quamplurimas et morborumet disseetionum historias, tum aliorum, turn proprius collectas habere,etinter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Prommium,

FOR the following notes we are indebted to Mr. SamuelH. Butler, late house-physician.M. L-, aged fifty-eight years, was admitted at 5.5 P.M.

on Oct. 1st, 1879. When brought to the hospital it wasstated that she had taken a cupful of fluid containing oxalicacid between ten and fifteen minutes previously. She wasalmost unconscious, could not be made to speak, and theextremities were cold. There was no vomiting ; the pupilswere dilated, and acted slightly to light ; the pulse wasalmost imperceptible ; respiration hurried ; there was noevidence of corrosion about the mouth. With difficulty thepatient was made to swallow some chalk mixture, and wasthen carried into the ward, where some more chalk mixturewas given. After this she was very sick, and then more mixturewas given, and hot-water bottles were put to her feet.At 5.20 she had been sick two or three times since thelast dose of the mixture, of which eight ounces had beentaken. The patient was very drowsy, and asked to be letalone. The extremities were still cold, and the womancomplained of headache ; the pulse was small and hurried;the pupils acted more readily to light. Six ounces of chalkmixture were given. At 5.45 there had been no moresickness, and the extremities were warmer. She said shefelt better, but complained of sore-throat, pain, and greattenderness over abdomen. Next dav there had been nomore sickness. She complained of sore-throat, pain, andtenderness over the abdomen, also of headache, and she feltdepressed ; tongue pale and flabby ; the bowels had notbeen open. To have milk and lime-water. On the 3rd,the bowels were opened once ; she was slightly sick in themorning after milk. On the 5th the sickness continuedafter milk ; complained of pain in the lumbar region, aswell as in the abdomen, and great pain when swallowing.To have nutrient enemas, and ice to suck. On the 10ththe enemas were discontinued ; she was not sick after milk,and had no pain in swallowing. After this the patientgradually recovered, and began to take solid food by degrees.She was discharged on the 26th, feeling quite well ; no painor tenderness in abdomen.

It was ascertained that the patient had taken half anounce of oxalic acid mixed with water, which her husbandused for cleaning leather.

LEEDS GENERAL INFIRMARY.CASES OF NERVOUS DISEASE, PRESENTING OPHTHALMO-

SCOPIC PHENOMENA.

THE following notes, for which we are indebted to Dr.E. H. Jacob, late resident physician, are continued from

p.168.CASE 3. Cerebral Softening; Hemiplegia ; Optic Neuriti5.

M. E-, aged thirty-four, admitted on May 24th, 1878’under Dr. Heaton. She had been married eleven years, buthad had no children. Soon after her marriage she wasunder treatment for sores on her thighs, and a year beforeadmission she attended at the infirmary for pain in thehead. Three years before, she was laid up for a few daysafter a blow on the head. In March, 1878, she lost theuse of her left limbs, and her mouth was drawn to oneside.On admission she was but slightly intelligent. There was

some left facial paralysis, and she could move the arm or leg