No. 1352.

JULY 28, 1849.

LEAVES FROM THE CASE-BOOK OFA PRACTISING PHYSICIAN.

BY JOHN CHARLES HALL, M.D.,FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, EDINBURGH; MEMBEROF THE ROYAL COLLEGE OF SURGEONS, LONDON; AUTHOR OF "REMARKSON THE NATURE AND TREATMENT OF SOME OF THE MORE IMPORTANT

DISEASES, INCLUDING THE PRINCIPAL DISEASES OF THE EYE;" ETC.

(Continued from p. 6, vol. ii. 1849.)

" Haee denum sunt quse non subgesset phantasise imaginatricis teme-retas, sed phaenomena practica edocuere."-SYDENHAM.

LEAF THE FOTRTH. ,

Injuries of the Conjunctiva, and Opacities of the Cornea. ’

SOME cases in -which I have recently been consulted, arisingfrom the accidental contact of the eye with lime and mortar,induce me to select injuries of the conjunctiva, produced byescharotics, and opacities of the cornea, as the subject for in-vestigation in the present paper.The most frequent cause of this kind of injury is the acci-

dental contact of the eye with lime or mortar. I have alsoseen patients in whom the injury has been produced by apowerful acid; and one case in which heated lead had occasionedthe mischief. Nothing is more common than for smiths to sufferfrom pieces of heated iron coming with great force in contactwith the eye. I saw a patient suffering from this cause, atBawtry,l only a few days ago. I remember also seeing agentleman, many years ago, in consultation with Mr. Allison,an intelligent general practitioner, in very extensive prac-tice at East Retford, in whom the mischief had been producedin uncorking a bottle of strong liquor ammonise. Mr. Allisonfound his patient labouring under severe head symptoms, andwe certainly feared for some days an unfavourable termina-tion of the case, the inflammation having extended from theback of the orbit to the brain. Under the judicious and activetreatment of this gentleman the patient recovered.*!-The form of escharotic which has occasioned the mischief

will produce some slight degree of difference in the symptoms;if lime, little rounded particles will beseen sticking to the eye-lids, and that portion of the cornea on which they have restedwill be found opaque. If the injury has resulted from a strongacid, the inner surface of the eyelids exhibits the powerfuleffects of the escharotic, which extend generally, more or less,over a considerable portion of the face; the dress is also fre-quently spotted with it. When the conjunctiva is injured byheated iron, or molten lead, both the eyelids and cheeks willfrequently have suffered, in the same way as when an acid hasbeen applied. Although the effects are the same upon theconjunctiva as when lime has been thrown into the eye, thepain is not nearly so severe or so long-continued; the partsfirst coming into contact with the heated fluid are swollen,dull, and encircled by a zone of inflammation, but it will re-quire even lead to be applied of considerable heat before theconjunctiva is destroyed.The treatment of these injuries must depend upon the

peculiar agent by which they have been produced. If limehas been thrown into the eye, it should be washed as quicklyas possible, with vinegar largely diluted with water. This atonce decomposes the lime, annihilates its caustic property,im-mediately dissolves it, and thus takes away its power of actingas an irritant. Some years ago, a little boy was sent to me byMr. Blagg, a highly respectable medical practitioner, residingat Leverton. In play another boy had taken up some fresh-mixed mortar and thrown it into both eyes. The little fellowwas in very great agony, which was soon much relieved bywell washing the parts with a solution -of vinegar-and-water.(Vinegar, one ounce and a half; water, fourteen ounces and ahalf.)

If a powerful acid has been the cause of the accident, theeye must be washed with a solution of sesquicarbonate of sodaand water; and if this cannot be obtained, soap-and-wateranswers very well. If heated iron or lead has occasioned the

* The anterior elastic lamina of the cornea, as described by Mr. Bowman,is formed ofa continuous sheet of homogeneous membrane, perfectly trans-parent and glossy, and not influenced by acids. When we consider thepeculiar nature of this elastic membrane, it will not be difficult to under-stand how it is that small particles of steel adhere so firmly to the cornea,although only appearing to rest upon its surface. Unless the reader hasattempted to remove them, he can form no idea of the firmness with whichsuch particles adhere. Their removal requires great care and gentleness onthe part of the surgeon, the slightest scraping of the cornea producing themost excruciating pain.t I have seen some very interesting cases of inflammation, extending from

the ear to the brain, to which a future paper shall be devoted.

injury, the particles should.be removed as quickly as possible,should any be found sticking in the cornea, or under the-eye-lids, and any inflammatory symptoms that may arise must betreated in the usual manner. These injuries, are always verydistressing, and often productive of more or less damage to.sodelicate an organ as the eye, notwithstanding the most jadicious treatment. When the sloughs of dead matter are thrownoff, the granulating surfaces, both on the eyeball and palpebrae,being opposed to each other, there is some risk of the twosurfaces imiting, unless the greatest possible care be taken .toprevent it. The granulations are therefore, from time .totime, to be broken down with a probe, and this plan must berepeated by the surgeon, until a new mucous membrane isformed. If the corneal surface has suffered, indelible opacityusually remains, because the new formation is much thickerand more dense than the original membrane.

Opacities of the Cornea.It is very important to distinguish as nearly as possible those

opacities of the cornea which are likely to be removed by theunaided efforts of nature, from those which cannot be dispersedwithout the assistance of art, and also to ascertain the propertime for commencing the use of appropriate remedies; for ifthere be any external inflammation, or an irritable state-:ofthe eye ;-if the general state of the’system require attendingto, or if the opacity result from chronic corneitis, it w.ould behighly improper to apply local stimulants, until these- affec-tions are removed. A young lady was brought to me fromBarnsley, during the autumn of 1847, in whom I had occasionto regret the want of this precaution. I attended a younggentleman (July 1844) in whom there was, when I was con-sulted, considerable opacity of the cornea, resulting from theap-plication of lime. The boy said " he had been bled and leeched, after which he had used some drops." The accident hadoccurred ten days before he was brought over to Retford toconsult me, and he had then been using a solution of thenitrate of silver for a week. This plan of treatment notonly occasioned him very great and unnecessary pain, butproduced a permanent opacity which -could never be re-

moved.In this journal’- (p. 125, vol. i. for 1834) a case is related in

which a very extensive opacity of nearly the whole cornea wasremoved by the unassisted efforts of natureand other casesin which-vision was most unexpectedly restored,will be foundscattered over the medical journals; still I think it more.thanprobable that, in the great majority of these cases, the wantof transparency on the part of the cornea has been the resultof continued inflammation, and that the return of translucencywas produced by the mere subsidence of the corneitis.

Platerus says that "an odd accident happened in his timeby the surgeon’s mistake ; having sprinkled the fine powderof sugar-candy upon the cornea of a chad’s eye, in order toremove the speck thereon, intercepting the sight in a greatmeasure, at one time he took out of the wrong box the powderof sublimate, whence immediately ensued so great a fluxionand inflammation, as endangered the whole eye; but straightendeavouring to rectify his error and take off the disturbance;the patient, as. it happened so far. from being, injured, that thecicatrix being merely deterged, the sight was again restoredby the removal of the same speck, an argument that. the globeof the eye, or its coats, are able to bear strong applications."

’ " Richard Harland, aged eighteen, of a delicate habit, applied forrelief on the 25th of August, 1833. The right eye was inflamed,and there was a large speck on the cornea. The eye was also turbid,probably in consequence of some opacity of the membranes invest-ing the crystalline and vitreous humour. He stated that the painwas not acute, and that the opacity had only existed for two days.Judging from other cases, I conceived that be was mistaken in this, andthat the deposit had been for some time progressing. Leeches, purgatives,and a saturnine collyrium, were prescribed. On the following day he was

blistered behind the ear ; and with a view of suspending morbid action,two grains of calomel were administered three times a day, for three orfour days, but the result was unavailing. He experienced little or no pain;neither was there much intolerance of light, but a thick white deposit nowcovered two-thirds of the cornea. Full doses of the sulphate of quininewere given for four or five days, at the expiration of which time not a rayof light could enter the eye, and his case appeared hopeless; consequentlyno further treatment was adopted. Ten days after this, I accidentally metmy patient, and recognised the case as a confirmed leucoma, which probablymight, in process of time, pass into staphyloma." Last week the boy called, and wished me to examine his eye, stating that

of late he had found his sight improve daily. There was slight chronic in-flammation, but the greater portion of the cornea was transparent. A littlestimulating lotion was given to him as a placebo. Yesterday I observedthe progress of the case; his sight is now in a great measure restored, andwill very soon, I trust, be completely re-established."This sketch differs from many submitted to the medical world. In this

case nature was ultimately left to her own resources, and accomplished acure.

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31r. Guthrie, whose opinions on all subjects connected withthe eye, command the greatest attention, has revived thisopinion of Platerus, and considers that the " insensibility ofthe eyeball" is a point of great practical importance.When a student in Paris,frequent opportunity was afforded

of witnessing the effects of the application of calomel forthe purpose of removing opacities of the cornea, and theremedy was most certainly highly advantageous, more parti-cularly in cases in which the opacity had only existed for ashort time. This is a fact confirmed by the experience of thecelebrated Dupuytren, who states, "that those opacities of thecornea which arc recent and slight are completely dissipatedin one or two weeks; specks of a longer standing, thicker andbroader, usually disappear in a month or six weeks," and hehas "seen some which occupied nearly the whole cornea, andobstructed the entire pupil, completely intercepting the light,disappear entirely in the course of a few months."A solution of the sulphate of cadmium (in the proportion of

half a grain to one ounce of distilled water) has been stronglyrecommended by Graaffe, Rosenbaum, and Tott, for the re-moval of opacities of the cornea. The solution is to be appliedto the opaque spot two or three times a day, with a camel-hair pencil. I have not used it, or seen it used, and thereforecannot offer an opinion as to its advantages; but my friend,

I

Mr. Middlemore, of Birmingham, has employed it a good deal ’at the Eye Infirmary in that town, and the conclusion he- arrived at was, that the effects of the remedy were most " cer-tainly manifest, but that it did not produce its effects near soquickly as the bichloride of mercury."*

Opacities of the cornea, arising as they do from a greatvariety of causes, admit of division into three classes-

1st. Opacities resulting from the original structure havingbeen destroyed by sloughing, or ulceration, followed by a de-posit of opaque matter forming a cicatrix.

2nd. Opacities resulting from the application of a powerfulescharotic.

3rd. Cases in which opaque matter is deposited upon thetexture of the cornea, without any previous loss of structure.

Treatlnent of Opacities of the Cornea.Simple nebula of the cornea can be removed without much

trouble by the daily application of a solution of nitrate ofsilver in distilled water-(distilled water, seven drachms;nitrate of silver, one to three grains; wine of opium, withoutthe aromatic, one drachm.) Or what is better still, in moresevere cases, by the following drops, which I have now beenin the habit of prescribing very frequently during the last tenyears, and with much advantage:-Take of the bichloride ofmercury, two grains; distilled water, an ounce: mix for alotion, to be used once or twice a day. I would repeat, thatwhatever lotion be employed, it is far better not to drop it intothe eye as we commonly see, even in hospitals; a camel-hairpencil should be dipped into the solution, and the opaque spottouched with it, by which means the remedy is at once broughtinto direct contact with the part to which you wish its opera-tion to be confined, and that, too, without decomposition ordilutation from the tears, which must always be the case inthe ordinary method.Whoever has had much experience in diseases of the eye,

will have observed that when any of these drops are employedfor the purpose of removing opacities of the cornea, after a fewweeks they appear to lose their useful effect, the disease be-coming, as it were, invincible to them; I would thereforesuggest that the nitrate-of-silver ointment, or drops, should beused for a week or ten days; then a weak solution of the bi-chloride of mercury; then the opium wine, and then the nitrateof silver a second time. This plan keeps up a continued stateof improvement, and the disease is removed in a much shorter

space of time than if one of them only had been persisted in.When a patient comes before us with the worst possible

form of opacity, leucoma arising, as is too often the case, frompteLfi’-ve ulceration, which has altogether changed the natureof the corneal surface, or with an extensive opacity, resultingfrom the application of a powerful escharotic, (which, althoughit may not have destroyed the vitality of the part, appears tohave produced some chemical change in its structure,) it isquite labour in vain to attempt the cure of such an affection,and truly dishonest, time after time, to pick the pocket of theunfortunate patient of fees, by exciting hopes which can neverbe realized-hopes, the blighting of which, in the end, muchincreases his misery. Still, although this opacity cannot bedestroyed by any means at our command, nor removed by the-surgeon, this admission often only applies to the central por-tion of leucoma. In many cases we have the happiness to find the

.,. On Discpses ofthe Eye. By R. bliddlemore, F.R.C,S. P. 753.

edges becoming gradually less and less opaque; a halo of hopesurrounds this dimness of vision, and although it may not bewithin the compass of our art to improve the more densecentral portion, something may yet be effected with the sur-rounding edges; and I have been consulted in cases where asteady continuance in the application of remedies has most cer-tainly produced very great benefit, and the results recorded inthe archives of the profession are doubtless such as to justifytheir employment in many of these unfortunate cases.According to my experience, the most useful remedy is the

nitrate-of-silver ointment, of a strength proportioned to thecondition of the affected eye. Counter-irritation should alsobe kept up behind the ears or at the nape of the neck byblisters. Many advise certain ointments or liniments for pro-ducing irritation on the skin. I have little practical experi.ence of their effects, but a very short trial of them most fullyconvinced me that they were very inferior to blisters. In thefirst place, several days must elapse before any useful influencecan be exerted, and, in addition to this loss of time, which isoften highly important, I am much mistaken if this St.-John-Long practice of applying plasters of tartarized antimony &e.above the eyebrows does not often produce permanently mis-chievous results; and too much care cannot be exercised indaily watching their effects, more particularly when appliedto the head and face of young persons, in whom, in some cases,their application has been followed by a state of inflammationand sloughing which has even threatened the loss of life.During certain stages of many inflammatory actions existing

in the eye, setons and issues can be most advantageously em-ployed. They are easily made by the surgeon, cause littlepain or trouble, can be enlarged or diminished at pleasure, andbeing perfectly manageable, combine, within any limits wemay be inclined to mark out, the advantage of a moderatedegree of counter-irritation with a most salutary discharge.The advantages connected with the use of blisters are many-the convenience of their application-the rapidity of theiroperation-the quick subsidence of their effects when nolonger required.* There may, however, be cases in which,from peculiar irritability of the skin, from the liability of thepatient to attacks of erysipelas, or from their having, on someformer occasion, produced a violent effect on the urinary organs,some other form of counter-irritation must be used ratherthan blisters.The following is the form in which I have usually employed

the nitrate-of-silver ointment: -To take nitrate of silver,from three to ten grains; solution of diacetate of lead, twentydrops; lard, one drachm. This ointment must be used everynight or every second night. A very small portion (notlarger than a large shot-corn) being put into the eye, italways creates more or less ophthalmia, and its applicationmust be regulated accordingly.During the employment of this ointment, I would in many

cases most strongly advise the internal exhibition of the bi-chloride of mercury. When there is nothing to counter-indicate its use, I have given it for six or eight weeks in thefollowing form, without any severe affection of the gums,irritation of the bowels, or any other symptom requiring thatthe dose should either be intermitted or reduced. Orderedsolution of the bichloride of mercury, one drachm; tincture ofbark, one drachm; distilled water, seven drachms and a half.To be taken twice a day.fAs an alterative, the bichloride or oxymuriate of mercury,

though doubtless more frequently prescribed than formerly inthese cases, is not, I venture to think, so extensively used as itought to be. It can be given in solution, which is of considerableadvantage, rendering its action much more certain, more equal,and by readier absorption probably more effectual in producingan alterative influence upon the whole system. Dr. Hollandremarks that he has " seen its influence in augmenting thesecretions, procuring the absorption of morbid growths, alter-ing the state of the skin in many cutaneous disorders, andchanging the character of morbid actions generally throughout* With regard to the application of blisters in certain diseases of the eye,

the situation most desirable for applying them is the nape of the neck, orbehind the ears. Of course, in some cases of acute inflammation this mustnot be done until local or general bleeding has been resorted to. Theymay in time require to be brought nearer to the affected organ; one maythen be put over each eyebrow, or upon the temples; or if the sub-acutesymptoms do not subside, a more permanent form of counter-irritation-for example, an issue in the arm-may be desirable. This is a very con-venient place for the purpose. A small issue does not occasion any dis-agreeable scar, gives no trouble, and frequently not only improves theaffected eye, but, at the same time, the general state of the health so much,that the patient becomes as unwilling to allow it to be healed as he was atfirst reluctant to permit its formation.

t It is better to commence with a small dose. I know a case in whichfour drachms of the solution of bichloride of mercury were taken dailyfor six weeks without affecting the gums,

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the system, in cases where he believes no other medicine orcombination of medicines would have had equal effect. Itscombination with bark, steel, sarsaparilla, &c., afford resourcesof the greatest value in the treatment of disease; and thoughotherwise held by common opinion, he thinks it, on the whole,as safe a medicine as calomel in the hands of the practitioner,inasmuch as its distribution can be made as equal and deter-minate, and its effects, from being given in a state of solution,are much less likely to be interrupted by mechanical hindrancesin the stomach and bowels."*

I would add also, and it is worthy of note, that this medicine(bichloride of mercury) may be continued in uninterrupteduse for a very considerable period, without obvious injury orinconvenience, and in certain cerebral and spinal affections, along unbroken course of this preparation is of singular avail;*but to reap its fullest benefits, we must be watchful, patient,and decided in its use, for in cases in which, in the end, thehappiest results follow the administration of the remedy, thechanges are often the slowest,-and not testified by those in-stant and obvious results which are sometimes desirable tofortify even the mind of the physician in the perseveranceproper to the practice, still more to convince the patient, hisfamily and friends, that time is necessary for the development Iof the full and complete advantages of the means employed. ’,Thus it frequently happens that the patient, alarmed, it maybe, at the name of the medicine, and by the precautions takenas to its dose and effects, or tired by the little progress he ap-pears to make, refuses after a time to go on with the remedy,very often at the moment when becoming most effective, andwhen there was every reason for thinking a dangerous or dis-tressing malady would eventually yield by a further employ-ment of it. I have many times seen the beneficial resultsarising from a long-continued use of small doses of the bi-chloride of mercury, in solution, in chronic iritis, and also inseveral cases of paraplegia, the slow progress of the diseasegiving full scope for its effects, and the great danger in pro-spect, justifying a long trial of the remedy. Of course in stru-mous children, mercury in any form can seldom be employedwith advantage, and in treating opacities of the cornea in them,in addition to appropriate remedies to the eye, it will be neces-sary to strengthen the system by attention to diet, shower-baths, sponging the body with cold water, the administrationof the disulphate of quinine, and a residence of some monthsduring the summer, when the circumstances of the parents willpermit, at the sea-side.When, notwithstanding all our efforts, a considerable cen-

tral opacity remains, the case is far from being without hope;an artificial pupil may often be made by the operating surgeon,and very useful vision restored. But this is a part of the sub-ject exclusively belonging to the surgeon, and as I have everthought the good old rule, " Ne sutor ultra crepidam," appliesto our profession, and that we ought all to keep to that par-ticular branch of it in which we have elected to practise, Imust, as a matter of course, take care that these leaves frommy Case-book relate to the consideration only of what mayfairly be said to belong to the sphere of the physician,t for itis only by confining himself, so far as he is able, to what mayfairly be regarded as consultation practice, and by lookingto the profession rather than to the public, that the physicianhas a right to expect to gain the friendship, countenance, con-fidence, and support of the surgeons in general practice; andthe cultivation of this mutual understanding and good feelingbetween each other cannot fail to raise us in the estimation ofour fellow-men, and to prove as beneficial as the want of it-has hitherto proved injurious! .

A late lamented friend, whose sudden and melancholy endwill give additional interest to any communication from hispen, the late Mr. Carmichael, of Dublin, was kind enough,-some little time ago, to supply me with the result of his ex-tensive experience with regard to opacities of the cornea. I

fancy Mr. Carmichael was the first to employ nitrate of silverin opacities of the cornea; at any rate, it was used by himprior to the year 1808, in which year he published a paper onOpacities of the Cornea, intimating that from inductivereasoning, he had been induced to use the nitrate of silver inthese cases. Its application has since become so general innebula and leucoma, that Dr. Jacob, who had considerablepractice in diseases of the eye, has remarked, " In almost allcases of opacity of the cornea for which I am consulted, I findthe conjunctiva stained with that peculiar slate-colour whichthe nitrate of silver imparts. If the remedy had not been

* Medical Notes and Reflections. Second Edition, p. 242.t It is said, I know not with what truth, that to define the cases proper

for the pure consulting surgeon is somewhat difficult. Perhaps the con-snlting surgeon regards those cases only as medical which do not pay fees ?

(as it most certainly is, when properly used) found generallybeneficial, it would nothave been thus extensively employed."*The following passage from a letter of Mr. Carmichael, willshow why he was induced first to make use of it. He says,

" The lymph deposited on the cornea, which occasionsthe opacity, is similar to the lymph which is depositedby the other membraneous parts of the body, when theyare in a state of inflammation; but when first deposited,it is not organized, nor does it become so until vesselsshoot into it, and form a net-work; consequently, till thisevent, it is equally obedient to chemical agents as deadanimal matter; but in order to discover the chemical agentsmost likely to affect it, so as to change the disposition of itsintegral particles, and render it unfit for the purposes designedby Nature-a bed for the production of vessels, we must fixour attention on the principles of which it is composed, andthese have been sufficiently ascertained to be albumen andgelatine.’t

If we turn to the work of Dr. Bostock, we shall find anumber of useful and truly practical tests for the discovery ofthe different primitive animal fluids; he demonstrates by ex-periment, that " a solution of the nitrate of silver, or of thebichloride of mercury, is the most certain test for albumen,tannin for gelatine, and aqua-lythargyri acetati for mucus;"and Mr. Carmichael says, " For many years I have used thethree former with the happiest effects, in cases of opacity ofthe cornea."When any of these collyria are dropt into the eye, white

flakes are immediately precipitated to the bottom of the orbit,and on the lotion again running from the eye, it is observed tohave acquired a milky appearance, and the sight becomesbrighter after the smarting pain has subsided. A portion ofthese flakes may proceed from the muriate of soda containedin the tears, but they are, for the most part, composed of thealbumen and gelatine,"+- suffused over the cornea, and creatingthe opacity, or the patient would not be so quickly sensible ofan improvement in his sight, after the precipitation takesplace, when the smarting is over, which is almost invariablysaid to be the case.

(soluble1

IUU.UUU

:t The composition of gelatine, according to Mulder, is much more simplethan that of the proteine compounds, so far as regards the number of atomsentering into its composition, for it consists of 13 Carbon, 10 Hydrogen,2 Nitrogen, 5 Oxygen, and the composition is the same, whether the sourcewhence the gelatine has been obtained be from isinglass, fibrous membranes,or from bones. A solution of one part of gelatine in 100 of water will, whencool, form a consistent solid, and its reaction with tann;c acid is so distinct,that the presence of one part of gelatine in 5000 of water is at once detectedby an infusion of galls. It has not yet been clearly discovered how gelatineis produced in the animal body, although there can be no doubt that it maybe elaborated from albumen, since a very large proportion of gelatine isfound in the tissues of young animals, which are entirely formed fromalbuminous matter, and also in the tissues of herbivorous animals ; and it isquite impossible they can derive it from their food, for vegetables yield nosubstances resembling gelatine. It has been considered probable thatgelatine may be formed from the decomposition of proteine, one characteristicof which appears to be the facility with which it undergoes decomposition,when acted upon by alkalies. If a proteine compound be brought into con-

tact with an alkali, ammonia is immediately disengaged, indeed, the alka-line solution can hardly be made weak enough to prevent the disengage-ment of ammonia. This is a property which must be continually acting inthe living body, since the blood has a decided alkaline reaction.

If either albumen or any other protein compound be boiled with potash,it is completely decomposed; at first it is not resolved into its ultimate con-stituents, or altogether into simple combinations of them; for the mostpart, three other organic compounds are produced-leucin, protid, anderythroprotid. Leucin is a crystalline substance, forming colourless scales,without taste or smell; composition, 12 Carbon, 12 Hydrogen, 1 Nitrogen,4 Oxygen. Protid is of a light yellow, Erythroprotid of a reddish-browncolour; neither are crystalline, and both, in composition, bear a very strongresemblance to gelatine. The composition of protid is 13 Carbon, 9 Hydrogen,1 Nitrogen, 4 Oxygen; and erythroprotid, of 13 Carbon, 8 Hydrogen,1 Nitrogen, 5 Oxygen. Gelatine is composed of 13 Carbon, 10 Hydrogen,2 Nitrogen, 5 Oxygen. Ammonia, with formic and carbonic acids, are alsoproduced. The acids unite with the potash which is employed to producethe decomposition, the ammonia being set free. Protein, which may beobtained from either kingdom of Nature, without much trouble, by dissolvingboiled albumen in a very weak solution of caustic alkali, has been describedboth by Liebig and Mulder; but as there is some difference in their analysis,it may be better to give the formula of each.

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According to the experience of Mr. Carmichael, u the solu-tion of oxymuriate of mercury, or of the nitrate of silver, pro-duces a greater precipitate than the tannin,* which demon-strates that there is more of albumen than gelatine in the

lymph spread over the cornea in this disease."’

Whatever the solution employed, it should be applied to’the opaque spot four or six times a day, if the eye will bear it;-should much inflammation arise, the remedy must be usedless frequently. Advantage will be derived from washing theeye four or five times daily with an infusion of oak-bark, whichhas a twofold effect-a chemical one on the opacity, and atonic effect on the enlarged vessels of the conjunctiva.The judicious application of these remedies, employing

first one of them for five or six days, and then making use ofanother, will often produce marked and lasting benefit, andnot only will the lymph disappear, but with it those vesselsalso which the surgeon often in vain attempts to extirpatewith the knife.A correct knowledge of the anatomy of the cornea. is a

matter of the greatest possible interest and importance. Thestudent will do well to read with care the truly beautiful de-scription of Mr. T. Wharton Jones, in the "Cyclopaedia ofPractical Surgery," or the more recent work of Mr. Bowman,*which contains a very interesting and correct account of thestructure of the cornea.

I may, however, be permitted (as these papers are writtenwith a view of affording, it is hoped, some little assistance tostudents in search of practical information for their futureguidance in the practice of the profession they have selected)to say in conclusion, that the cornea of the eye closely resem-bles cartilage, both in composition and in structure, corre-sponding with the cellular rather than the fibrous form of that

. tissue. The cells are not so numerous as those of the articularcartilages, and around them is a plexus of very bright fibres,very loosely joined to each other, and not unlike areolar4issue.§Two sets of vessels-a deep-seated and a superficial-sur-

round the margin of the cornea; the superficial vessels be-longing to the conjunctival membrane, of which, as alreadystated, the outer layer of the cornea is composed, (see note,p. 85,) and they are prolonged to the distance of one-eighth, orhalf a line from its margin, then returning- as veins. The

deep-seated vessels do not enter the true cornea, but terminatein dilatations, from which veins arise at the point where itbecomes continuous with the sclerotic. In diseasedeonditionsof the cornea, both the superficial and deep vessels pass into it.The -cornea may be regarded as made up of the following

parts:-1st. The cornea proper. This consists of a lamellated tissue,

of which the greater bulk of the membrane is made up.2nd. An anterior elastic lamina, on which rests the conlunc-

.tival epithelium.3rd. The posterior elastic lamina which supports the epithe-

Hum of the aqueous humour.The cornea proper is formed of about sixty lamellae, the

fibres of which interlacing, produce those interspaces, for thefirst demonstration of which we are indebted to the industryof Mr. Bowman: they are of a tubular form, resting on super-posed planes. The adjoining tubes, on the same plane, arenearly all parallel; they cross those from the contiguousplanes at an angle, and do not comtnunicate with them, or at t.any rate very rarely do so. j

This peculiar structure is best observed in the eye of the ’

* Either a strong infusion of tannin or of galls, which contains a consider-able portion of tannin, may be used.

t Vol. i. p. 831.t Lectures on the Parts concerned in the Operations on the Eye, &e. By

W. Bowman, F.R.S.§ Recent examinations have thrown a good deal of light on the arrange-

ment and multiplication of the cartilage cells. The groups of cells are said,by Dr. Leidy, to lie perpendicularly in the deeper parts of the cartilage,(nearest the attached surface,) and obliquely or irregularly, as they ap-proach the free surface; but at or near that surface they lie parallel to it.The deeper groups of cells are more numerous than the superficial, and inthe stratum forming the free surface, single isolated cells may frequently beobserved. This free surface is covered, in thefaetus, by synovial membrane,in which, basement membrane and epithelial cells (the characteristic ele-ments) may be clearly recognised ; after birth, this appears to be graduallyworn away by pressure, attrition, or, more probably, in a great degree,from the retirement of the superficial vessels towards the circumference.Dr. Leidy describes the curious phenomenon of the multiplication of thecartilage cells by division, as closely resembling that of cell multiplication,in the lower and more simple algse; hence the opinion that the cell has aprotoptasmatic envelope or primordial utricle within the proper cell wall,from which it seems to retire, immediately the contraction that causes theduplication commences. The matrix of the cartilage cells is said to exhibita distinctly marked filamentous arrangement, each filament being formedof a row of very fine granules; these filaments are placed perpendicularlyto the attached surface, and parallel to the free surface, thus forming therea membranous layer, by which, fractured portions of cartilage are heldtogether.

ox, the necessary injection being made with much difficulty.inthe human eye. Mr. Bowman, however, has seen this curioustubular arrangement of the interstices also in the human eye,

and concludes that these tubes are designed to promote thepermeation of the thick non-vascular cornea by the fluid por-

I tions of the blood which alone have access to it.; The structure of the anterior elastic lamina has already. been noticed; in the human eye its thickness is about -rs’srthi of an inch, and to it is due the smooth glistening surface which

is brought into view, by scraping off the conjunctival epitlie-, lium.

Sheffield, July, 1849.(To be confinued.)

ON THE CAUSE AND TREATMENT OF THEGROWING INSPIRATION OF INFANTS.

BY W. MUTRIE FAIRBROTHER, M.D., Southwark.A veny. uncertain, often intractable disease, and unsatis-factory both to .the friends of the patient and to the medicalpractitioner, is laryngismus stridulus. It having been myfortune lately to see many cases of this complaint, it may notbe altogether useless that some notice should be taken of themeans which have been found most beneficial for their im-pravement or cure. It is well known, that during the periodof dentition, infants are peculiarly liable to attacks of spuriouscroup, and it will be found, that those possessing the scrofulousdiathesis form a large proportion of those attacked. Probablythis accounts- for the opinion which Dr. Ley formed of thecause of this disease-viz., enlarged lymphatic glands pressingon the par vagum; but although many instances present thisappearance, it will be sufficient to upset the theory that manyscrofulous infants are perfectly free from crowing inspiratiop,although enlarged lymphatics situated immediately over thecourse of the pneumogastric nerve are very evident. It ismore probable that the immediate cause will be found in theirritation produced by teething; that the affection having beenonce produced is constantly repeated, until, like many otherdiseased conditions, it becomes -a confirmed, and often, forsome time, irreclaimable habit. In one instance, which.oc-curred to an infant, five. months old, the fits of croup were in-creased in frequency, thirty or more in four or five hours, inconsequence. of cerebral congestion and inflammation of themembranes of the brain. Here leeching, with active purging,were found beneficial, and a small blister placed on the top ofthe sternum, cold lotion being at the same time applied to thehead. Small doses of calomel were administered night andmorning for several weeks, then discontinued, and again givep,combined with sulphate of magnesia and tartar-emetic. inmixture, and the child is now but rarely troubled with theold complaint. It is remarkable that fits of crowing inspira-tion occur in many cases immediately the infant wakes, andthe weather and winds also have an influence upon it. Thewarm bath is generally serviceable, and an occasional emeticto those children who are fed, if there is reason to suspectthat the stomach is full. Another child, aged two years,.sub-ject to this disease, and to convulsions, for these last sixmonths, was seemingly in a hopeless state of apnoea, the lipsand body livid, and the eyes fixed. A warm bath was in-stantly prepared, cold water dashed in the face, and cold airpuffed at intervals with a common bellows upon the face andneck. Leeches were applied to the temples, and after sedulousapplication of the draughts of air, the livid appearance leftthe lips, and the child fell into a quiet sleep. Perhaps Dr.Marshall Hall’s advice saved life in this instance. That thestimulus of cold air puffed into the face will prolong life forsome time has been fully proved; and in a comatose child- Ihave occasionally watched an increase both in the frequencyand force of action of the muscles of respiration until theperiod arrived when the excitor nerves were no longer influ.enced by this stimulus. The great danger to be avoided in thegeneral treatment of crowing inspiration is not to medicatetoo actively. If left alone it will not often kill, and the prac-

titioner may himself produce a fatal result, by having thetheory of inflammation and false membranes before his eyes.In true croup, children bear a large amount of calomel well,! and often recover; in the false variety, small doses frequentlyrepeated will prove exceedingly useful.

’ London-raad, 1849.

THE HL’N’l’ERIAN ORATtox.—Mr. F. C. Skey, of St. Bartho-lomew’s Hospital, is the gentleman appointed to deliver thenext Oration -at the Royal College of Surgeons, in memory ofthe founder of the Hunterian Collection.