ced period of the disease, when the symptoms will be placed in a very different light. Early after the commencement of the disease, a bluish, and very slightly puffy state of the eyelids, chiefly of the upper one, takes place; and as an effusion of purulent-like fluid is observed from the interior parts, a corresponding swelling may be remarked, which overlaps the lower palpebra, and hides the eve from view.

These symptoms I have described, from notes taken at the bed of the patient, during the early period of the complaint, before remedies were employed to put a stop to the malady, and before matters were too far advanced, to place the recovery of the patient beyond the power of the surgeon.

In the variety of the ophthalmia which I have just endeavoured to describe, it is well known, that venesection is attended with the happiest effects, and if performed with decision on the part of the practitioner, I have every reason to believe, cannot fail to put a stop to the disease; but the quantity to be taken away must be always considerable, and repeated as often as a return of pain shall demand. No fact in medical science ought to be more strictly attended to than that just stated, as on it the degree of success attending the treatment of ophthalmia will be found to depend. I may remark, that in no case where such treatment has been adopted, has any derangement of vision taken place in the number of men which I have had an opportunity of observing.

It remains for me to state, that the use of the lancet is not, as has been generally delivered, applicable to every case of this ophthalmia. The second variety of attack commences in the whole surface of the convex conjunctiva: in the course of a very few hours, that membrane becomes loaded with enlarged vessels, running tortuously towards the cornea, which in a little time may be seen affected, to the extent of a line in its whole circumference, with a slight elevated vascular border; the eyelids, of a red colour in the place occupied by the conjunctiva, feel stiff and uneasy; exposure of the affected organ to light gives considerable irritation; but it seldom happens that pain warns the patient of his complaint; lachrymation, but no purulent discharge takes place; and chemosis is never present, nor can the vessels of the deeper seated membranes be discovered affected, as in the former variety. If the disease be permitted to go on, and, as I have noticed, still more if venesection be employed, it presents day after day the same appearance; the eyelids become thickened, and slightly everted; and the cornea begins to suffer, either from the encroachment of the border affecting its circumference, already described, or from the deposition of matter between its lamine

and consequent ulceration, hypopion, and staphyloma, generally pretty near to the place corresponding to the pupil.

It is after an attack of this kind that the eye continues weak, weeping, and unable to bear exposure to the light, and suffers so repeatedly from what has been called relapse.

In what regards the cure of this variety of the complaint, I have to mention that general venesection, so far from curing, does, in my opinion, tend to weaken the vessels of the conjunctiva, and render the disease more obstinate; and as it is of no avail, must be deemed hurtful.

If I mistake not, this is the form of the complaint which has been so much benefited by scarifying the vessels of the tunica conjunctiva, and dropping immediately afterwards on the eyeball a composition of a stimulating nature; the author of which practice (an army surgeon) I cannot at this time remember. Scarifying has been condemned in purulent ophthalmia in general; but more minute attention to the varieties which I have endeavoured to point out, will, in my belief, correct the opinion which has perhaps been too hastily, and too generally delivered. I shall be sorry to think that such a statement should seem to convey arrogant decision. I only wish it to be understood, that, so far as I have observed, (and I think there is concurring evidence of the truth of the assertion), scarifying the conjunctiva has at least been of more use than any other remedy. It fails, however, it must be confessed, and that frequently; for in defiance of every remedy, as above stated, a slow and insidious vascularity of the cornea takes place, which in no long time destroys vision.

Disappointed by every method hitherto recommended, I endeavoured to make the eye, affected with the latter variety, assume the inflammatory action of what has been called purulent ophthalmia, and to this I applied the usual remedy, venesection. In several cases, the practice has proved successful, not a single enlarged vessel remaining at the end of a fortnight. How far it may answer the purpose intended, I have not yet had sufficient evidence to enable me to decide. Daily reports of the practice, and its effects, may enable me at a future period to lay it before army surgeons.

Glasgow Barracks, Sept. 5th 1810.

1

II.

An Essay on Staphyloma pellucidum conicum. By ROBERT LYALL, Surgeon, Paisley; Member of the Royal Physical Society of Edinburgh, and Corresponding Member of the Literary and Philosophical Society at Manchester, &c.

THE

HE disease of which I am to treat in the following pages, has seemingly but little engaged the attention of medical men. It is a disorder, however, which attacks one of the most important organs of the human body; and consequently the investigation of its pathology must be an object worthy the consideration of every practitioner.

The first mention relative to the disease hereafter described, which I have observed, is in the French translation of Scarpa's work on the diseases of the eye, by Leveillé.

Under the section of that work devoted to the consideration of Staphyloma, we find a note by Leveillé which I shall transcribe.

"Il m'est arrivé n'aguère, d'observer un singulière maladie de la cornée; je ne saurois trop dans qu'elle classe de maladie des yeux la ranger, si on ne peut la rapporter au staphylôme. Chez un dame de trente-cinq ans, ayant les deux yeux naturellement saillans, saine d'ailleurs, le centre de la cornée des deux yeux se souleva graduellement, au point que cette membrane ne formoit plus, comme à l'ordinaire un segment regulier de sphère, mais un cône notablement saillant, et terminé en pointe dans son milieu. La cornée de chaque œil regardée de côte sembloit un petit entonnoir transparent, dont la point étoit tournée en dehors. Dans certaines positions de l'œil, il sembloit que la pointe de cône fut un peu moins transparente que le reste de la cornée; dans d'autres, ce qui etoit nébuleux, l'etoit si peu, qu'il ne pouvoit faire un obstacle notable à la vision. En plaçant l'œil directement contre un fenètre, ce point saillant du centre de la cornée, plutôt que de transmettre la lumière, la refléchissoit avec une telle force, qu'elle sembloit étincelante; et comme ce phenomene avoit lieu precisement contre la pupille, il en resultoit qu'etant retrécie dans un grand jour, elle ne permettoit à la malade que de distinguer confusément les objets.

Dr Edmonstone, in his excellent treatise on ophthalmia, barely states, that he has seen an affection of the eye similar to that above mentioned by Leveillé; and more lately, Mr James War

drop, in his valuable essays on the morbid anatomy of the hu man eye, at some length describes the same disease; and merely, I suppose, on account of its appearance, has denominated it conical formed cornea.

Under that denomination, Mr Wardrop notices two cases, and adds some remarks regarding the derangement of vision produced by such an affection; but says nothing relative to the nature or cause of the disease. Leveillé is equally silent as to the last mentioned points; and confesses, that he did not know under what class of disease conical cornea ought to be arranged.

Before proceeding farther, I shall take the liberty to relate four cases of conical formed cornea; and afterwards will add some remarks on the nature, &c. of the disorder.

CASE I.

PHOEBE GREENALGH, æt. 28, was admitted a patient of the Manchester Dispensary, on account of bad vision.

In a front view, her eyes have a peculiar dazzling, or rather sparkling appearance; and, in the language of the vulgar, it would be said that she had "very full eyes.

*

in a lateral view, the corneæ are observed to have assumed a conical form, and resemble a piece of pure crystal, being completely transparent. The cornea of the left eye is more conical than that of the right. The iris of both eyes performs its usual motions regularly.

The following observation, made by Dr Brewster, respecting one of Mr Wardrop's cases, is applicable to both of the cornea. “In every aspect in which the cornea was viewed, its section appeared to be a regular curve, increasing in curvature towards the vertex. With one eye, the patient can distinguish colours at the distance of 6 or 7 inches. When she looked at some large buildings, or a number of shrubs at some distance, she took the former to be one mass, similar to a rock, and the other to be one tree. At the distance of 24 feet, she says she can see the whole of a violin hanging against the wall; but at any greater distance, her view is confined to a part of it; and even that part is perceived obscurely.

When she looks at a candle about 30 or 40 yards off, sometimes she sees a number of candles, sometimes only one or two, with a sparkling appearance around; and at other times she

Similar to what is represented by Mr Wardrop in his seventh plate; but to a greater degree.

compares it to the sun; but at the distance of 14 inches, it appears to her single and distinct.

She can name the letters of ordinary print slowly, when about 1 or 2 inches from her eyes.

Having placed the patient in a dark room, on holding a candle at the distance of a foot from one eye, while the other was covered; and observing the changes which the reflected image underwent, I perceived, that when it passed through the centre of the cornea, or apex of the cone, it was smallest, but gradually increased in size, the more distant it was from that point, i. e. the nearer the image was to the juncture of the cornea with the sclerotica, it was the larger.

P. Greenalgh was admitted a patient of the Dispensary on the 31st of January 1809, and had a collyrium and some alterative calomel pills ordered for her. On the 5th February, while sewing, she was suddenly attacked with severe headach, and great pain in the left eye, accompanied with a copious discharge of hot tears. She became easier next morning, and continued so till the 7th of February, when, on examining the left eye, the apex of the cone was observed to be quite opaque; but the right eye is exactly in the same state as when I saw her last.

She was made an infirmary patient, and at the time of admission complained of slight headach.

Different collyria and internal medicines were used with the intention of relieving her.

Some days afterwards, by applying the pencil caustic gently to the cornea, a violent action of the vessels was produced, and the opacity of the cornea partly disappeared. I mentioned my opinion, regarding the nature of this patient's complaint, to Mr Hamilton, and obtained his leave to evacuate the aqueous humour of the left eye.

About 1 o'clock p. m. I punctured the cornea near its juncture with the sclerotica, and evacuated a large quantity of aque ous humour. The anterior margin of the iris immediately projected forwards, and the cornea fell down upon it, so that the conical appearance stili in some degree remained.

I ordered the patient to bed, and desired the nurse to apply an astringent collyrium assiduously to the eye. A purge to be taken at night. About 4 p. m. the cornea was partly distended, and she saw better than usual. At 10 p. m. the cornea was still more distended, or, as I calculated from appearance, about two-thirds of the aqueous humour was regenerated; and the patient was astonished to find that she saw better than she had zen for some years. Delusive moment! Next day the cor