ANNUAL ABSTRACT 
OF 
Ophthalmological Literature. 
1881-1882. 
BY C. S. TURNBULL, M.D., 
Oculist to the German Hospital. 
OF PHILADELPHIA. SECOND 
ANNUAL ABSTRACT 
OF 
OPHTHALMOLOGICAL LITERATURE. 
FOR 1881-82. 
BY C. S. TURNBULL, M.D., 
Oculist and Aurist to the German Hospital, Philadelphia. 
Reprinted from the MEDICAL AND SURGICAL REPORTER, Philadelphia. 
Effects of Eserine and the Mydriatics, Atropine, 
Duboisine, Homatropine and Hyoscyamine. 
After a series of careful experiments,* Herman 
Schafer (A. f. Oph., Yol. x, No. 2) states, in 
regard to the influence of eserine upon the three 
agents, atropine, duboisine, homatropine, that it 
counteracts the effects of homatropine completely 
and permanently ; that of duboisine, and more 
particularly that of atropine, however, only when 
instilled in larger quantities, and then only for a 
brief period, after which it yields again to the 
affects of the latter. 
The absorption into the aqueous humor of these 
three substances (atr., dub., hom.), as well as 
their transniissibility, has been demonstrated 
by experiments. Aqueous humor containing 
atropine and duboisine acts more rapidly when 
transferred. Aqueous humor containing atropine 
and duboisine secures maximum dilatation, but 
that charged with homatropine does not effect 
this result completely. 
In general, it is sufficiently demonstrated that, 
as respects the dilatation of the pupil, atropine, 
if somewhat slower, possesses a more lasting in- 
fluence than duboisine ; that the latter dilates the 
pupil in a shorter time, and momentarily acts 
more energetically, but loses its influence more 
quickly ; finally, that homatropine develops its 
influence in a briefer time than either of the 
other agents, but produces a lesser dilatation of 
the pupillary diameter, and is the first to decline 
in its effects. The degree of concentration in 
which the homatropine is employed is apparently 
without influence upon the duration of the effect. 
The accommodation is paralyzed more rapidly 
* Translated by Isidor Ftirst, m.d., of New York. 
by duboisine and homatropine—by duboisine 
even a little more so than by homatropine ; with 
the latter, however, the normal state returns in 
twenty-four hours, with duboisine after three to 
four days. Paralysis of the accommodation by 
atropine proceeds very gradually, and persists 
the longest. 
In accordance therewith would be the practi- 
cal application of these three agents. Where it 
is desired to secure simply dilatation of the pupil 
for the purpose of examining the fundus, or to 
paralyze the accommodation for the certain de- 
termination of the state of the refraction, homatro- 
pine is decidedly to be preferred to the other drugs. 
Dr. S. D. Risley, in a recent paper,* also 
concludes “That for the correction of ano- 
malies of refraction in otherwise normal eyes 
the homatropine is to be preferred.” 
If, on the other hand, a therapeutical effect is 
desired, homatropine is to be set aside, on account 
of its insufficient and too restricted effect, and 
the application of atropine and duboisine can 
alone enter into consideration. Risley (loc. cit.), 
from a therapeutic standpoint, concludes “ That, 
if retino-choroidal disturbance is also present, 
hyoscyamine or duboisine are preferable ; (a) to 
atropine, because of the shorter duration of the 
treatment; (6) to homatropine, because of their 
more persistent control over the ciliary muscle ; 
and that hyoscyaminef is preferable to duboisine, 
since the tendency to systemic poisoning is not 
so great.” 
* “ The Comparative Value of the Mydriatics, ” 
Transac. Am. Ophthal. Soe., 1881. 
■(•Hyoscyamine grs. ij to fgj. R. fears they adulter- 
ate Hvos. with Atrop. (Read, “ Identity of the Mydri- 
atic Alkaloidsp. 16,1st Abstract. T.) 2 
Schafer recommends the use of duboisine in 
iritic conditions, with or without extensive syne- 
chise, where atropine had been employed for 
some length of time, and with but partial success, 
on account of conjunctival and ciliary injection. 
Duboisine, he says, never causes conjunctival 
irritation, and even diminishes that caused by 
atropine.* 
Dr. H. Knapp (Archiv f. Ophthal., Vol. x, 
No. 2) reports three cases of quinine amaurosis. 
The characteristic features of this affection, 
according to Roosa, Wecker, Voorhies, Michel, 
Gruening and Knapp, are:— 
1. Total blindness subsequent to the taking cf 
large quantities of quinine.f 
2. Pallor of the optic disks. 
3. Marked diminution of the retinal blood ves- 
sels, in number and calibre. 
4. Contraction of the visual field. 
K. mentions some other symptoms: “1. Dimin- 
ution of the color-sense (red-green, then green 
blindness); 2. Diminution of the light-sense (as 
if a vail was over the eyes) ; 3. The pupils dur- 
ing the total blindness are irresponsive to light, 
but (Gruening) move on accommodative efforts ; 
4. Anaesthesia of the cornea-, 5. Impairment of 
hearing, to total deafness, and tinnitus aurium 
in every case, though transient.” 
The subjective noises and deafness, though ex- 
ceedingly frequent symptoms of quinism, are 
always transient; I, at least, have not been able 
to trace one case of persistent deafness or tinnitus 
aurium to the use of quinine alone. (L. Turn- 
bull has long since emphatically expressed him- 
self in a similar way.—Rep.) The impairment of 
sight will, I suppose, disappear entirely in the 
mild cases, whereas in the severe typical ones 
the restoration of the central acuteness of vision 
seems to be complete only in a certain number 
of cases ; in almost all, however, a fair amount, 
to of S., is regained. The contracted 
visual field expands slowly, commonly does not 
reach its natural limits again. 
The progress of quinine amaurosis, even in ad- 
vanced cases, is, on the whole, good, as there is, 
thus far, no case of permanent blindness on 
record, and the typical, i.e., fully developed 
cases, are very rare. How frequent the mild 
cases are, and how rapidly they recover, remains 
for further investigation to ascertain. 
No beneficial mode of treatment seems yet to 
have been discovered. The “depletingtherapy” 
to which v. Graefe ascribes the recovery in his 
second case will, in view of the marked ischaemia 
of the retina discovered of late, scarcely find any 
advocates now. Nitrite of amyl, given in the 
way of inhalation, by Voorhies, Gruening and 
Michel, showed no effect. Strychnia and other 
remedies, as well as electricity, were likewise 
inefficient. Horizontal position, as long as the 
general anaemia, and particularly that of the brain 
and eye, are marked, seems beneficial. Generous 
diet, with perhaps gentle stimulants, and as soon 
as practicable, sojourn and exercise in a healthy, 
invigorating atmosphere, appear rational means 
of recovering strength, and supplying the retina 
with what it most needs—blood.” 
Dr. J. J. Chisholm, of Baltimore, at the last 
meeting of the Am. Med. Association, read a 
paper on the Actual Cautery Needle in the Treat- 
ment of Conical Cornea. The operation is per- 
formed with a fine sewing needle, heated to 
whiteness in an alcohol lamp, and thrust through 
the apex of the cone. The subsequent cicatriza- 
tion causes a flattening of the cone. Dr. C. also 
exhibited a needle designed for the destruction 
of the hair-bulbs, in cases of displaced cilia, by 
electrolysis. It consists of a needle set into a 
handle, which is introduced cold into the root of 
the hair-bulb. By pressing on a button, con- 
nection is made, and the needle becomes heated, 
and the electrolytic action is manifest by the 
bubbles of gas escaping. Reported (A. f. 0., 
Yol. x, No. 2, by S. Burnett, m. d.) 
In his abstract of Am. Ophthal. Literature 
for the first quarter of the year 1881, Dr. Swan 
j M. Burnett, of Washington (loc. cit. p. .235), re 
ports the following : — 
H. M. Bannister. On Some Points in Regard 
to Color Blindness. (Jnl. of Nervous and Men- 
tal Diseases, Jan.) B. takes the same position 
as the reviewer (Burnett), in his article in the 
last number of the Archives f. Oph.,viz.: that the 
cause of some cases of color-blindness is to be 
found in the brain-centre and not in the retina; 
and thinks that the defect in color-sense can be 
improved by exercise. He thinks Holmgren’s 
j test tends to magnify slight defects in the color- 
| sense, and that more than one method of exami- 
nation should be used where we want extreme 
accuracy. 
C. S. Bull. A contribution to the Pathology 
of Orbital Tumors-, being a study of the secondary 
processes in the peri-periosteum and bones of the 
orbit and vicinity (N. Y. Med. Journal, March). 
Case 1.—Encapsulated orbital sarcoma; ex- 
j tirpation ; return of the growth as a myxo-sar- 
' coma ; infiltration of the bones of the orbit, and 
*We cordially endorse Shafer’s recommendation of 
duboisine in iritic conditions. 
| The total blindness, in all the oases thus far made 
known, was only temporary. 3 
of the facial bones of the left side in general; 
three operations for the removal of the tumor. 
Case 2.—Intra-ocular sarcoma ; secondary in- 
filtration of the optic nerve and orbit; degenera- 
tion of the orbit and face ; four operations for 
the removal of the growth. 
Case 3.—Fibro-sarcoma of the orbit, involving 
the periosteal lining, and subsequently, the bones 
of the orbit and face. 
B. concludes, from a study of these cases, that 
such growths are not fit subjects for operative 
interference.” We would most emphatically en- 
dorse B.’s opinion, as experience, in numerous 
cases similar to his, has taught us how futile 
operative interference has proven itself to be. 
J. C. Dalton. . Centres of Vision in the Cere- 
bral Hemispheres (N.Y. Medical Record, March 
26th). From experiments performed on dogs, D. 
feels justified in concluding : “ 1. Extirpation of 
the angular convolution causes loss of visual per- 
ception on the opposite side. 2. This operation 
is not followed by any disturbance of the intelli- 
gence, attitude, power of locomotion, or general 
sensibility. 3. It does not interfere with the 
local sensibility of the retina or conjunctiva, 
the reaction of the pupil to light, nor with the 
normal consentaneous movements of winking. 
Its effects are, therefore, confined to the exercise 
of visual sensibility. 
J. P. Wall. Congenital Absence of the Eye- 
balls “Anophthalmia” (N. Y. Med. Record, 
Mar. 26th). The tutamina oculi were perfectly 
formed, but there were no eyeballs, even in a 
rudimentary form. The lachrymal gland was 
present. The child was a white male, and six i 
months old. 
W. C. Ayres. The Physiology of the Visual 
Purple (N. Y. Med. Journal, May). A. sums 
up his conclusions as follows: “ We know that 
the purple is a photo-chemical substance which 
is sensible to light, and that its seat is in the | 
outer segments of the rods, whereas it is never 
found in the cones. The cones, on the other 
hand, being the only elements found in the 
fovea centralis, we are forced to the conclusion 
that distinct vision, both for objects and for 
colors, is independent of its existence. In the 
higher classes of animals it is sensitive to light, 
but in some deep-sea fishes, cephalopods, etc., j 
it has its seat in the rods, but is no longer sensi- 
tive to light, although it has the same color as 
before. Where it is not sensitive to light the 
optical structure of the eye is very defective. It 
is an albuminoid compound, and is a secretion 
of the pigment epithelial cells of the retina ; 
but this secretion is not controlled by any of the 
larger nerve trunks, which have a part to play in 
the functions of the eye. We know of no drug 
which can diminish its secretion, but pilocarpine 
and muscarine greatly increase it.” 
In their report on the Progress of Ophthal- 
mology, for the first half of the year 1880,* Drs. 
H. Magnus and A. Nieden, note the following:— 
Beauregard. Suppuration of the Vitreous. 
B. says the pus cells come from the cells of the 
choroid. (Sec. de Biol, Paris, June 12th, 1880.) 
Kxies, M. Argyria Oculi (Z. M., Yol. xvm, 
p. 165). After external application of the nitrate 
of silver stick for' fifty years, K. observed two 
modes of staining of the tissues, one being dif- 
fused, the other consisting of minute granules. 
The cornea was stained brown, especially in the 
centre; the epithelium and endothelium of Des- 
cemet’s membrane were free; the subconjuncti- 
val tissue was, in its whole extent, pervaded by 
lymph spaces, which were densely filled with 
granules of silver. In transverse sections the 
blood vessels were surrounded by black rings, 
the adventitia being densely filled with granules. 
Haltenhoff. Conjunctival Hemorrhage in a 
new-born child. Haemophilia; uncontrollable 
hemorrhage caused death in thirty-six hours 
(Rapp. sur. les trav. dela. Soc. M6d. de Genbve, 
p. l’an, 1879). 
IIogyes, A. The Changes of the Eye after 
Extirpation of the Facial Nerve (Archiv. f. 
Exper. Pathol., Yol. xi, p. 258). After simple 
division of the nerve permanent affections of the 
cornea are rare; after evulsion, the cornea be- 
comes dry, with more or less extensive ulcera- 
| tion ; after division of the trigeminus the eye is 
! always lost by the subsequent neuropathic keratitis. 
Kretschmer. Keratitis Neuro-paralytica. 
| Panophthalmitis after neurectomy of the infra- 
orbital nerve (C. /. A., March, p. 65, with po- 
lemic correspondence, 1. c., pp. 168,236, 293,863). 
Galezowsky. A Case of Congenital Irideremia 
(absence of the iris) through several genera- 
tions (Rec. d' Oph., 3, No. 2, Feb). 
Wolfe (Glasgow). A Case of Bleeding Tumor 
of the Iris, about four mm. in diameter, bleed- 
ing every four to six weeks (Med. Times and 
Gaz., May 8th, p. 504). 
Chisholm, J. J. A piece of metal in the eye 
for 23 years, without causing sympathetic oph- 
thalmia (Bost. Med. Jour., Vol. cii, p. 248). 
Schnabel. Secondary Glaucoma. Upon an 
observation of glaucoma after traumatic luxation 
of the len3 and stretching of the fibres of the 
zonula in incarceration of the capsule into the 
* Translated by R. O. Born, m.d., of N. Y., Archiv 
Ophthal., Vol. x, No. 2. 4 
wound, the author is opposed to Rnies’ view of 
an occlusion of Fontana’s spaces. The abnor- 
mal stretching of the zonula is said to be the 
only cause of glaucoma, especially since the 
author observed the cure of an acute attack in 
chronic glaucoma, by the spontaneous luxation 
of the lens, with detachment, and thus relaxation 
of the zonula (Wien. Med. Bl., Yol. hi, Nos. 
6 and 7, p. 130). 
Bremer, Victor. Among 223 deaf-mutes, 
Hansen and Krenschel found 9 cases = 4 per 
cent, of retinitis pigmentosa (Inaug-Dissert., 
Kopenhagen, 1880). 
GIatli, Fr. Amaurosis produced by salicylate of 
soda poisoning (Gaz. Degli. Ospit., Yol i, p. 129). 
Urthoff. Atrophy of the optic nerve, with 
special consideration of, 1, the causes; 2, the 
knee-phenomenon (patellar-tendon); 3, the con- 
dition of the visual field. It comprises 83 cases. 
The knee-phenomenon is absent in 13 out 
of 15 cases of spinal atrophy of the optic nerve, 
in one-third of the cases of genuine progressive 
atrophy, and is, therefore, a valuable symptom 
for the differential diagnosis. In 7 patients 
there was at the same time myosis. In spinal 
and simple optic nerve atrophy, the limitation of 
the visual field begins in a small majority of 
cases at the outer side (A. f. 0., Vol. xxvi, 
No. 1, p. 244). 
Haffner. Bare migration of a round icorm, 
3 cm. in length, into the left lower lachrymal 
canal, in a child suffering from severe whooping- 
cough (Berlin. Klin. Wochensch., No. 24). 
Sigismund. A small splinter of wood kept in 
the eye for 47 years ivithout any disturbance 
(Berlin. Klin. Wochensch., No. 5, 1880). 
Erb. The ocular affections in tabes dorsalis. 
Among 56 cases there was seven times atrophy of 
optic nerve, and seventeen times paralysis of ocular 
muscles (Deutsch. Archiv.f. Klin. Med. 1879). 
Stewart, Grainger. The eye symptoms in 
locomotor ataxia. Among 70 cases there were 
20 cases of squint, three of ptosis, four of diplo- 
pia, without manifest squint; seven of myosis, 
four of difference in the pupillary diameter, 
eight of immobility to light, while the pupils con- 
tracted upon convergence ; four times temporary 
amblyopia with subsequent improvement; four- 
teen times atrophy of the optic nerves with 
amaurosis in one-half of the cases at quite an 
early period (C. f. Med. W., 1880, p. 62). 
Hosch (Basel). Embolic Panophthalmitis in 
Puerperal Fever. Literature of 15 cases. H. 
found in one case large accumulations of micro- 
cocci in some of the smaller retinal vessels, also 
in numerous uriniferous tubes, and in more 
developed stages in the vitreous body (A.f. 0., 
Vol. xxvi, No. 1, p. 177). 
ON THE EXTRACTION OF CATARACT. 
Knapp’s Modification of Graefe’s Peripheric linear 
and Wecker’s Flap-section, with Peripheric Cap- 
sulotomy and Subsequent Discission of the Capsule. 
Both observation and experience induce us to 
recommend what is known as “ Knapp’s modifi- 
cation” of the operation for the extraction of 
cataract,* and, as we consider his method of suffi- 
cient interest and importance, we quote his own 
words and describe the details of the operation 
somewhat at length, in the hope of tempting 
the more progressive, and especially the younger, 
members of the profession to give this method 
a fair trial, with the full assurance that.it offers 
more advantages and less disadvantages than 
any other, and, on the basis of statistical data, 
claims a peculiar influence on the final object of all 
operations for cataract—the restoration of sight. 
In a recent lecturef Knapp makes a synopsis 
of thirty extractions, which serve as a basis for 
the following remarks, in the course of which he 
describes in detail the steps of his operation ; 
and we have added cuts of most of the instruments 
he employs:— 
“ The youngest patient was a servant girl, aged 
thirty-two years, whose cataract I would, under 
ordinary circumstances, have operated on by 
division, but as she was blind in both eyes, had 
only recently come to this country, and was with- 
out support, I preferred that operative procedure 
which restored her sight in the shortest time. 
There were three patients between forty and for- 
ty-eight years of age; the remainder were over 
fifty. The oldest was eighty-two. 
“ The method was a more or less linear or low- 
flap section, with a broad iridectomy, and peri- 
pheric opening of the capside. In the first opera- 
tions (Fig. 1), Graefe’s section begins and termi- 
nates one millimeter 
in the corneo-scleral 
junction, its apex be- 
ing at the transparent 
margin of the cornea, 
or even one to two 
millimeters below it. 
Gradually I shifted 
into the flap-section 
(Fig. 2),which De Wecker, of Paris, recommends 
as the best, namely, a section with a Graefe’s 
knife, situated exactly in the transparent margin 
of the cornea, extending over its upper third. 
* Knapp’s previous report of a hundred cases of ex- 
traction (the sixth hundred), published in the July 
number, 1879, of the Archives of Ophthalmol., refers to 
66 successive cases of extraction with peripheric 
capsulotomy, and, together with the preliminary com- 
munication in Vol. vi, and later in Vol. x. No. 3, con- 
tains the substance of his views and experience on 
this subject, also historical and critical remarks on 
the peripheral opening of the capsule. 
f On the Extraction of Cataract. By Herman Knapp, 
m.d. The Medical Record, New York, Feb. 18th, 1882. 
Fig. 1. 
Fig. 2. 5 
For fall-sized cataracts, I made it somewhat 
larger. Both sections—the linear and the flap 
—have their advantages and their disadvantages ; 
the linear does not incline to tilting, and shows a 
very accurate coaptation, but as its ends are 
nearer to the insertion of the iris, it is more 
liable than the flap to adhesions and incarcera- 
tions of the iris and to cyclitic processes. With 
regard to firm closure of the wound, one of the 
most important factors in the whole operation, 
the flap, though easily gaping during the opera- 
tion and soon after it, has one redeeming quality 
—it cuts the lamellae of the cornea obliquely, not 
at right angles, as the linear section does. This 
principle of oblique piercing is frequently made 
use of, and with admirable ingenuity, in the 
animal organism. Let me only mention the 
ductus choledochus piercing the wall of the 
duodenum obliquely, by which contrivance the 
bile can, without obstacle, flow into the gut, but 
the food, while passing from the pylorus on- 
ward, will press the inner wall of the valve-like 
opening of the bile-duct against the outer, and 
thus completely close the aperture. Somewhat 
in the same manner the inner lip of the flap- 
sedtion is pressed against the outer by the con- 
tents of the globe, whereby a firm and lasting 
closure may be established. Theorizing is a 
fine thing in its way, but worthless without the 
test of experience, because in complicated pro- 
blems we commonly fail to know and appreci- 
ate the quality and quantity of all the cooperat- 
ing factors. Wecker’s section has thus far shown us 
very kind healings, encouraging to further trial.” 
The most approved form of speculum, 
i. e., Graefe’s modified, is shown by Fig. 3. 
The arms are curved so that the loop of 
spring and adjusting screw are out of the ope- 
rator’s way. There is a right and left specu- 
lum. Fixation forceps 
by Fig. 4, and a typical 
Graefe’s cataract knife, 
by Fig. 5. 
“The iridectomy in almost all of our operations 
was large. The coloboma varies from £ to of the 
corneal circumference. When the corneal section 
and the opening of the capsule are peripheric, it 
must be large, or the columns of the coloboma 
will be an obstacle to the exit of the lens, which, 
if overcome by force, entails bruising and incar- 
ceration of the iris. When the iris is being cut, 
it ought not to be dragged 
with the iris forceps / / 
(Fig. 6) into the corners /j/ 
of the section, since /W 
there the lips of the /fj 
wound act like clamps, holding the iris-tissue 
tight between them. It is good practice to seize 
the iris in the centre of the section, draw it 
straight up and cut it off close to the cornea— 
carefully avoiding the corneal tissue itself—in 
one, two, or three strokes of the iris scissors 
(Fig. 7), as may prove convenient, and afterward, 
according to the sufficient or insufficient size of 
the coloboma, either reduce or exsect iris tissue 
which may still lie in the corners. Such tissue, 
even after a clean and apparently satisfactory 
iridectomy, remains hidden in the wound more 
frequently than we imagine. Proofs: 1. The 
anatomical examination of eyes on which iridec- 
tomy had been made for glaucoma, or combined 
with cataract extraction, commonly found the 
stump of the iris or its adjacent tissue united 
with the corneal scar, even if no outward inspec- 
tion could discover such a condition. 2. Many 
times, when passing the cystotome from the cor- 
ners of an apparently unobstructed corneal sec- 
tion toward the centre, I drew iris-tissue along, 
which was either the periphery of the adjacent 
iris, or the stump of the part which had been 
removed. Such portions, of course, have to be 
grasped with the forceps and cut off. This ob- 
servation has taught me not to rest satisfied 
with an apparently correct coloboma, even if its 
sphincter edges are in the anterior chamber, but, 
before opening the capsule, to clear the whole 
Fig. 6. 
Fig. 7. 
Fia.3. 
Fra. 4. 
Fro. 5. 6 
extent of the corneal section, especially the cor- 
ners, of iris-tissue, which, with a delicate probe 
or spatula, may be stroked back into the anterior 
chamber.” 
“ When the wound is clean the operator takes 
the fixing forceps in his own hand, Dresses 
gently with it on the globe, so 
as to make the corneal section 
slightly gape, and passes the 
needle cystotome (see Fig. 8) 
from the inner corner of the sec- 
tion to the outer, through the an- 
terior capsule of the lens. This 
manoeuvre has to be closely 
watched ; a far-sighted ope- 
rator should make himself 
near-sighted by convex spec- 
tacles, and either daylight or 
artificial light ought to be 
thrown on the eye by a large 
convex hand-lens, so that the 
point of the cystotome can be 
accurately followed in its 
course through the capsule. 
An insufficient capsulotomy is 
commonly without conse- 
quences, as the cataract on 
its way out enlarges the open- 
ing ; only in tough capsules it 
is an obstacle to the expulsion 
of the lens, and may lead to 
prolapse of vitreous. When 
I had practiced this mode of 
opening the capsule in about 
two hundred cases, I varied 
it, not because I was dissatis- 
fied with its results, but in 
order not to get wedded to one 
particular procedure. There is 
no conceivable way of opening 
the capsule that has not here 
and there been tried. The one 
just described is the simplest 
in execution, and the least injurious to the eye, 
but it has the disadvantage of necessitating, in the 
majority of cases, an after-operation,viz: the sub- 
sequent central splitting of the capsule. In order 
to avoid that, I have lately joined to the horizontal 
division a larger vertical one than I made a few 
years ago while practicing a T-shaped opening. 
A bent needle cystotome is introduced into the 
anterior chamber, and the capsule slit open from 
the lower edge of a middle-wide pupil, up to the 
centre of the corneal section. In order not to 
let the outcoming lens enlarge the upper end of 
the capsular wound irregularly, I made the hori- 
zontal incision in one case with a delicate, sharp- 
pointed scalpel, the point of which was inserted 
into the upper end of the vertical incision of the 
capsule at the centre of the corneal section, 
pushed forward toward one corner of the wound, 
and then, by raising the hilt, one-half of the 
upper margin of the capsule was ripped open. 
In the same way the other half was dealt with. 
In another case I made the horizontal incision 
of the capsule with the needle cystotome, which 
was passed first from one, then from the other 
corner of the corneal section through the capsule, 
so as to meet the upper end of the vertical cap- 
sular section. If the cystotome were passed 
from one end of the section to the other, it would 
split the first half of the capsule, but 
most likely not the second, for when 
fallen into the vertical section, it would 
enlarge this by dragging the capsule 
before it rather than cut it. The few 
cases thus operated on did well; the 
first one showed some transient adhe- 
sions of the iris to the shreds of the cap- 
sule. It remains to be seen whether a 
greater number of cases will yield as 
smooth recoveries, and better perma- 
nent vision than the other now well tried 
method. 
The expulsion of the lens is effected by 
pressing with a hard rubber spoon (Fig. 
10) on the lowest part of the cornea. 
“The after-operation, the subsequent 
central division of the capsule, is an es- 
sential feature in this mode of operating 
for cataract. Without it the method 
could not stand, as it has also virtually 
been abandoned by the operator who 
first, in 1873, tried it on a larger scale, 
namely, Professor Gayet, of Lyons. He 
made no after operations, and was 
dissatisfied with the imperfect visual re- 
sults. The empty capsule will wrinkle 
and opacify, requiring subsequent split- 
ting, in the majority of cases. But then, 
the visual results are permanently good, 
and better than by any other method, 
except the removal of the lens within the capsule, 
which, according to its warmest advocate, Dr. 
Herman Pagenstecher, is indicated in thirty per 
cent, of the patients only.* But do the methods 
with central opening of the capsule, even in their 
successful cases, commonly yield good vision per- 
manently? By no means. With them, too, the 
capsule will wrinkle and opacify, and vision be 
reduced to a surprising degree. 
“ The subsequent division of the capsule com- 
prises not only its anterior, but also its posterior 
half, and, therefore, gives a perfectly unobstructed 
pupil. The imperfect visual results, after the 
primary central division of the anterior capsule, 
have always been felt by the profession, and 
given the incentive to different attempts at obvi- 
ating this disadvantage, among which I will men- 
tion the puncture of the vitreous, imjnediately 
after the expulsion of the lens, which Professor 
Hasner, of Prague, has made for many years, 
and which, as I saw last summer, has been 
adopted, on trial at least, by Schweigger. Both 
gentlemen assert that this procedure is not dan- 
gerous, but neither has, as yet, published statis- 
tics to convincingly support their assertion. The 
subsequent division of both capsules is an inno- 
cent operation : I have done it more than a hun- 
dred times. Only in a few cases the reaction 
from it lasted longer than a few days, and never 
was the vision made worse. The technique of 
the operation, however, is peculiar, and has to 
be learned. The operation requires, above all, 
two things, without which nobody should under- 
take it: first, good artificial light, thrown on the 
eye with a large lens, so that during the opera- 
Fig. 10. 
Fig. 8. 
Fig 9. 
* On the Extraction of Cataract in its Capsule. By H. 
Pagenstecher, m.d., of Wiesbaden. Archiv. f. Ophthal. 
Yol. vm, p. 243, Yol. x, p. 152. 7 
tion every wrinkle, dot and stria of the capsule 
can be seen, as well as the course and effect of 
the needle ; second, a sharp, well proportioned 
scalpel needle* (see Fig. 9), with which the cap- 
sule can be cut without tearing. I first make a 
horizontal incision, then a vertical one, varying 
them, however,Taccording to the conditions of 
the capsule. No aqueous should, none need 
escape. I have described it in the Archives of 
Ophthalmology, Yol. vm, No. 2, p. 200, Yol. x, 
No. 3, p. 295. 
“ Now, in conclusion, a word or two on antisep- 
sis in cataract operations. I have never thought 
much of the specifically antiseptic substances 
which ophthalmology has recently borrowed 
from general surgery, and I cannot yet see any 
reason to change my opinion. If the adherents 
of the antiseptic method affirm that this essen- 
tially consists in the careful observation of all 
the rules that secure or at least favor union by 
first intention, they have no warmer friend 
than me. Those rules are no modern reve- 
lation, and in no operation have they been 
more carefully studied than in the extrac- 
tion of cataract. If, however, antisepsis means 
“ bacteria-killing ”—to express it in one word— 
and its advocates assert that all their methods 
and antiseptic substances employed before, dur- 
ing, and after the operation have this fundamen- 
tal aim and object, then I think they hunt a 
phantom. I am far from denying the existence 
of micrococci and bacteria ; they are on and in all 
open, moist tissues, though the conjunctival 
sac shows them less than most other places 
(see Wernich’s instructive book, “ Die Desinfec- 
tionslehre ”). I do not, of course, deny the exist- 
ence of infectious substances, such as blennor- 
rhoic, even dacryocystitic, and similar secretions, 
as well as decomposed and fermenting bodies; 
but, gentlemen, these substances are but one 
group of irritants, which, as all the others, ought 
carelully to be guarded against. Besides them, 
there are plenty of mechanical and chemical irri-' 
tants, which have equal claims on our considera- 
tion. The great modern dictum, “ No suppura- 
tion without bacteria,” which was until quite 
recently ardently defended, has proved unten- 
able ; even its most zealous advocates had to 
concede that croton-oil and other substances 
produced Suppuration, without any cooperation 
of bacteria.' One of the latest investigators of 
this subject, Dr. N. Uskoff, answers the question 
whether or not suppuration is possible independ- 
ently of low organisms? positively in the affirm- 
ative ( Virchow's Archiv, vol. Ixxxvi, p. 150, etc., 
October, 1881), and does so, not from theoretical 
speculation, but based upon numerous experi- 
ments made by him and Professor Ponfick, at 
the Pathological Institute of the University of 
Breslau. Lister himself, in closing the discus- 
sion on this subject, at the last International 
Medical Congress, said: “Solid bits of dirt are 
the great sources of danger, rather than certain 
invisible particles that float in the air, and have, 
perhaps, been invested with more deleterious 
functions than they really possess” (British 
Med. Jour., October 1st, 1881, p. 550). 
“The antiseptic methods which have conquered, 
for good reasons, the greater part of the surgical 
world, have also many adherents among the first 
names in ophthalmology. I will mention to you 
only Wecker, Horner, Snellen, Leber, H. Pagen- 
stecher. Alfred Graefe, whose early paper on 
the subject, in Graefe’s Archives, has made so 
many converts, had the mortification to see that 
the good results, not to say the good luck, which 
had attended his earliest antiseptic procedures 
had unaccountably deserted him later, so that he 
is said to have become skeptical. Horner stated, 
in London, that, apart from antiseptic precau- 
tions, success depended upon the most delicate 
execution of every step of the operation. Now, 
what has experience to say on the question of 
antiseptics in ophthalmology? Where are the 
all-important statistics to support it ? They have 
not yet come forward. The best operators, e. g., 
Wecker and Horner, still concede one per cent, 
to two per cent, of total loss by suppuration. 
This is a less percentage than the old flap showed, 
but not less than is obtained by a careful execu- 
tion of Graefe’s extraction, without antiseptics, 
and the results in this institution, for years, have 
been no worse. There were two cases of suppu- 
ration in the last hundred extractions I reported 
on. Since then, March 3d, 1880, fifty-two ex- 
tractions were performed,without the occurrence 
of suppuration, even without the loss of an eye 
from any cause. Several larger series of opera- 
tions, performed under antiseptic precautions, 
have been published (Just. Reymond and others) 
which are quite unfavorable. Yet this subject is 
still under discussion, and, though I am not 
prejudiced in favor of the bacteria killing con- 
trivances, I shall not tire in giving the question 
how to secure healing by first intention, how to 
avoid inflamrpation in general, my undivided 
attention. In order not to judge of the subject 
without personal experience, I shall continue to 
give antisepsis a fair trial, until facts sufficiently 
numerous pronounce their unambiguous verdict. 
Every alternate operation in the thirty cases 
which were witnessed, and which were the 
basis of these remarks, was performed under 
antiseptic precautions. Though I shall have 
to return to this subject later, I may here state 
that a difference in the course of healing has 
not been apparent, and, if asked my candid 
opinion, I would say that the best antiseptic is 
twenty years’ experience.” 
That we may do full justice, we quote from no 
less distinguished an authority than Dr. Her- 
man Pagenstecher (loc. cit.*) who advocates 
the operation of extraction of all mature cataracts 
in their capsule, and says, “ Indeed, I go so far 
as to say that we make a great mistake—will 
the older operators pardon my expression ?— 
when we operate on cataract afterirido-choroidi- 
tis, or on hyper-mature, or Morgagnian cataracts, 
in any other way than by extraction in the cap- 
sule.” He at the same time, by calling attention 
to an old and well established ophthalmological 
i fact, says he lays down one important rule, which, 
* Reliable needles of this kind, as well as the other 
instruments, are made by Tiemann & Oo., New York, 
and Snowden, of Philadelphia. 
* Translated by James A. Spalding, m.d., Portland, 
Maine. 8 
nevertheless, will bear constant repetition, i. e., 
“ cataracts which have matured rapidly, say in the 
course of a few months, should never be removed 
in the capsule, but always by opening the cap- 
sule. In some cases the capsule does not obtain 
sufficient strength in comparison with that of the 
zonula.” 
“ One reason why (says Pagenstecher) this 
method has been so little employed is, that every 
one likes to continue with the operation which 
he first learned and practiced, and which has 
probably, so far, given satisfactory results ; sec- 
ondly, everybody imagines that it is a violent pro- 
cedure to pass the flat spoon into the eye, for 
the purpose of removing the lens. Then it is a 
common opinion that loss of vitreous endangers 
the eye; further, we are told that we are never 
sure of removing the lens with the whole of the 
capsule; and, finally, many have never seen the 
operation, and hence have had no chance for 
deciding upon its merits from their own knowledge. 
“In the first place, it is necessary for us 
to be sure what cases are to be operated upon by 
extraction in the capsule, and what cases are not. 
Our own (P. and his brother, the late A. Pagen- 
stecher) observations, combined with a moder- 
ate degree of attention, soon throw light upon 
this point, and he who at first only ventures to 
employ the operation in the cases where it is 
undoubtedly the best, such as cataracts after 
irido-choroiditis, pronounced hyper-mature cata- 
racts and Morgagnian cataracts, will soon gain 
more and more confidence in the operation, and 
discover for himself in what further series of 
cases it is indicated.” 
Comment is unnecessary upon this method of 
extraction of the lens within the capsule, which, 
says Knapp, “ is, according to its warmest advo- 
cate, Dr. Herman Pagenstecher, only indicated 
in thirty per cent, of all cataracts.” 
Congenital Dislocation of the Crystallien Lens; 
Dinlokoria. 
As ophthalmological anomalies, P. D. Key- 
ser (Archiv. Ophthal. Vol. x, No. m) reports 
three cases of congenital dislocation of the crys- 
talline lenses, in one (Medical and Surgical 
Reporter, July 10th, 1880) aged 26, the lenses 
were dislocated differently but not symmetrically, 
as is usually the case. In the R. E. the lens 
was dislocated inward, and the L. E. directly 
upward. In the other two cases, which were also 
anomalies, the lenses were dislocated directly 
downward, entirely out of the region of the pupil. 
These two cases were daughter and mother. 
A case of double pupil, diplokoria, in but one 
eye of a lady aged 26. There was a broad band, 
V mm. in width, running across, from margin to 
margin of the iris, at an angle of 110°. It ex- 
tended only from the extreme pupillary edges of 
the iris, and was of the same thickness arid color 
and continuous structure of the iris. 
Patient had never suffered from any 
inflammation of the eye. As a con- 
genital anomaly of the iris, it was 
rare, as occurring in but one eye. By a small 
incision through the cornea, in the lower an 1 
inner quadrant, K. introduced a delicate pair of 
iris forceps, grasped the band in its entire breadth 
and cut it off. Then its lower attachment was 
divided and the protruding iris was replaced 
from the corneal incision. Pilocarpine solution 
was instilled into the eye. No inflammation fol- 
lowed, the pupil became round, and the action 
of the iris has been good ever since. 
J. J. Chisholm (loc. cit.) reports two cases of 
sympathetic, ophthalmia, as a sequel to cataract 
extraction, and of iridectomy in glaucoma. Pain 
and inflammatory process promptly checked by 
neurotomy of the lost eye. Dr. C. makes the 
point, i. e., in an eye in which nerve cutting was 
effected, there was a complete effacing of a corneal 
staphyloma. 
Wm. C. Ayres (loc. cit., p. 273) in examining 
a glioma retinae endophytum, mentions his dis- 
covery of a peculiarly interesting condition, viz : 
a gliomatous infiltration of the lens. The glioma 
cells had passed both without and within the 
canal of Petit, along the whole length of the 
pensory ligament, up to the lens capsule. When 
outside of the ligament they seemed to have im- 
pinged upon the capsule and passed around it. 
When within they seemed to have passed direct- 
ly to the lens and to have forced themselves up 
beneath the fibres of the ligament, as they at- 
tached themselves to the anterior capsule. 
Though they had not disturbed the continuity of 
the capsule at any other place, just under the at- 
tachment they had broken through and entered 
the body of the lens. They had also entered in- 
to the body of the capsule itself, and split it into 
j distinct layers, to a distance of some mm. from the 
I capsular rent. 
In another case Ayres, in examining a phthis- 
ical eye (phthisical after a severe inflammation 
in childhood), found bone within the lens capsule, 
i. e., “ the lens was full size, normal in curvature 
of capsule, while at the same time the body of 
the lens was entirely replaced by bone. The 
space within the capsule was filled with true 
bony tissue, having a perfect system of canals 
and typical bone corpuscles, with the exception 
of a narrow zone of connective tissue, holding the 9 
same relative position as the glioma cells in the 
case of gliomatous infiltration. Ossification had 
taken place in layers parallel to the connective 
tissue next to the capsule, and where these layers 
of bone were thin, it appeared as if the original 
fibres had ossified, but, of course, this is impos- 
sible, since the lens, being epithelial tissue, can- 
not ossify.” 
Dr. Chas. J. Kipp, of Newark, N. J., reports, 
in brief (Archiv.fi'. Ophthal, Yol. x, No. 3), the 
Transactions of the American Ophthalmological 
Society for 1881, at which Dr. Wm. F. Norris, 
of Philadelphia, read a paper 
On the Administration of Anaesthetics in Bright’s 
Disease of the Kidneys, and on some Cases of 
Sudden Death after Cataract Operations. 
Two deaths. In both cases the patients were 
etherized; both died comatose, and, in both, care- 
ful autopsies revealed no organic lesions, except 
those belonging to Bright’s disease. The first 
patient was a child five months old, and in good 
health, upon whom he operated by discission. 
The child recovered consciousness, but died soon 
afterward. Intense congestion of kidneys, cloudy 
swelling, and fatty degeneration of epithelium, 
most marked in the cortical portion. There was 
no history of hereditary disease. The second 
patient was a woman, sixty years old, supposed 
to be in perfect health. Recovery from anaes- 
thesia was prompt. On the evening of the fol- 
lowing day she was somewhat feverish, and the 
urine diminished in quantity and loaded with 
urates. From fourth to ninth day she sat up and 
felt pretty well. After that time unfavorable symp- 
toms manifested themselves. On the sixteenth 
day she was delirious. On the seventeenth day 
urine was found to contain a small quantity of albu- 
men, and hyaline, and fatty and granular casts. 
Patient died on eighteenth day after operation. 
Autopsy showed all organs to be healthy, except 
heart, in which there was moderate enlargement 
of left ventricle ; and the kidneys, which were 
markedly congested, and showed increase of in- 
terstitial tissue, fatty degeneration of epithelium, 
and cast material in the uriniferous tubules. 
In the discussion which followed the reading 
of Dr. N.’s paper, Dr. Mathewson, of Brooklyn, 
said he “ had extracted cataracts, under ether, 
from patients known to have Bright’s disease 
and who recovered promptly.” Dr. Carmalt, of 
New Haven, related two cases in which death 
followed cataract extraction performed without 
anuesthetics. In one case death took place four 
hours after operation, and seemed to be due to 
shock, which might possibly have been avoided 
by the use of an anaesthetic; no autopsy. In 
the other case the patient had had diabetes, 
from which she had apparently recovered. Dr. 
C. assisted in the operation. There was no 
attempt at repair. Patient failed rapidly and 
died on fourth day. Dr. Norris remarked that 
the action of ether, in many cases of fatty heart, 
was beneficial rather than otherwise. Dr. Noyes, 
of New York, had used ether and chloroform 
freely in a large number of cases, but had not 
had a fatal result in consequence. He had used 
ether when he knew there was Bright’s disease, 
and also in cardiac complications. He is in the 
habit of using bromide of potassium, and some- 
times hydrate of chloral, before the operation, 
and thinks that in a certain proportion of cases 
the occasion for the use of anaesthetics has 
thereby been considerably diminished. It has 
been his practice, where anaesthetics are given, 
to produce simply the primary anaesthesia, make 
the corneal incision, and then allow the patient 
to fully recover consciousness, which is utilized 
in the subsequent steps of the operation.” 
(Concerning the administration of anaesthetics, 
especially ether, to patients suffering with any 
form of chronic kidney disease, there seems to be 
but one opinion, as expressed by all authorities, 
i. e., that such procedure is, as a rule, followed 
by fatal results, and the weight of testimony con- 
firms this assertion. Nay, it goes further. It 
condemns such administration as reprehensible, 
and if operators insist upon setting aside experi- 
ence, and by so doing trifle with human life, it 
will not be long before a well-grounded suit for 
damages will bring some careless, or call it ob- 
stinate, administrator up with a round turn. We 
would deprecate Dr. Mathewson’s views, if re- 
ported correctly, and so also those of Dr. Noyes, 
if the latter did not beg the question after saying 
“ he had used ether and chloroform freely in a 
large number of cases “ where he knew there 
was Bright’s disease and cardiac complications,” 
by adding, “It has been my practice, where 
anaesthetics are given, to produce the primary 
anaesthesia, make the corneal incision, and then 
allow the patient to fully recover consciousness.” 
This we cannot admit as “ using anaesthetics free- 
ly,” or even operating under anaesthesia. In 
conclusion, we would warn the inexperienced, 
and would suggest that it will not be many years 
before juries will refuse to render such verdicts 
as exonerate the criminally careless adminis- 
trators of fatal doses of anaesthetics, but they will 
call for post-mortem examinations of the kidneys, 
heart, etc., and in proportion as these are found, or 
known to have been, diseased will they (adminis- 
trators, operators, etc.) be held responsible. T.) 10 
Of especial interest in this connection is a 
paper read by Hasket Derby, m.d., of New York, 
On Anaesthesia and Non-anaesthesia in the Ex- 
traction of Senile Cataract, with Comparative 
Statistics of 200 Cases. 
The author avoided anaesthetics as much as 
possible. Of 200 uncomplicated cases of senile 
cataract 100 were operated under ether, and 100 
without anaesthesia. The average age of the pa- 
tients operated under ether was 67.7, without, 
65.8. Loss of vitreous in fourteen with ether, 
and nine without. The duration of treatment 
was 18.3 with ether, 16.5 without. Vision, or 
more, was obtained in eighty-one with ether, and 
eighty without. Partial success (vision from -j?T 
to ff) in eight cases with ether, and nine without. 
There was reasonable prospect of success from 
a secondary operation in two of the last-named 
operated under ether, and one without. The 
total failures were nine with ether, and one with- 
out. In the discussion which followed, Dr. D. 
B. St. John Roosa, of New York, and Dr. H. W. 
Williams, of Boston, thought that the advantages 
obtained by the use of ether were considerable. 
Dr. Kipp, of Newark, thought that the danger 
of escape of vitreous is much greater than with- 
out anaesthesia. Dr. B. Joy Jeffries, of Boston, 
saw no objection to the use of ether, but does not 
hesitate to operate without it. 
Dr. W. S. Little read a paper entitled a 
Contribution to the Study of Glaucoma, 
in which he gave the details of four cases, all bi- 
lateral. The patients were all under 20 years of 
age. Three of the cases occurred in one family. 
In all cases the eyes were hypermetropic, and in 
three of the cases the patients suffered also from 
hemorrhoids. In one of the cases acute fulminat- 
ing glaucoma was developed twelve hours after 
the instillation of atropia, and some days later 
the fellow eye became glaucomatous. The author 
thinks the fact that three of his cases occurred in 
one family is especially instructive, as showing a 
tendency to heredity, and he infers, from the co- 
existence of hemorrhoids in three of these cases, 
and in some others observed by him, that, since in 
both diseases textures supplied with a sphincter 
muscle are involved, a somewhat similar morbid 
action may take place in both. 
Dr. Geo. C. Harlan related a case of 
Congenital Paralysis of the Sixth and Seventh Nerves 
of Both Sides. 
Patient aged 18, male; marked epiphora and slight 
haziness of cornea. R. S. = L. The 
author thought that the complete paralysis of the 
two abducens, which are so widely separated in 
their course after they leave the brain, pointed 
to a central cause and supported the view that 
they arise from the same nucleus. 
Dr. E. W. Bartlett, of Milwaukee, who formerly 
saw a great deal of 
Conjunctival Inflammation after the use of Atropia, 
says that since he had used Merk’s preparations 
the difficulty had entirely disappeared. 
Dr. F. Buller, of Montreal, reported a case of 
Sudden and Complete Blindness after Large Doses 
. of Quinine (1) 
As the subject had just been confined, and 
was threatened with puerperal septicaemia, we 
consider the case too doubtful to mention in de- 
tail, especially as the doses of quinine (20 grains, 
night and morning, for two days) were compara- 
tively small.—(T.) 
Marked Narrowing of the Field, with Diminished 
Acuteness of Vision (Glaucoma? Kipp) Following 
the Use of Duboisia, 
presumably due to .the use of the drug, was the 
title of a paper by Dr. J. P. Morrell, of Terre 
Haute. 
Dr. Noyes reported a case of 
Pulsating Exophthalmus, 
which differed in its history and treatment from 
any on record. A girl, four years ago, after 
some severe form of fever, was suddenly taken 
with a pain in the left side of the head, and about 
the left eye; the globe began to protrude, and 
within one week there was marked exophthalmus 
without inflammatory disturbance. For four 
years the condition of the eye remained substan- 
tially unchanged, except that she had occa- 
sional attacks of fugitive inflammation. While 
passing through Dublin, on her way to America, 
she had a severe attack of inflammation of the 
eye. On her arrival in New York she came 
under his observation. He found swelling of the 
lids, considerable ecchymosis. There was marked 
protrusion of the globe, and at the lower and 
inner angle of the orbit a projection was felt, 
which at first seemed to be a solid growth. 
Pulsation, however, was felt, and an operation 
was proposed. Examination under ether showed 
the tumor to be a distended blood vessel, which 
came from the orbit, forward, and returned upon 
a loop. A bruit was heard over the exophthal- 
mus, but not upon the temple. ■ Pressure upon 
the carotid completely stopped the pulsation, 
but had no effect upon the protrusion. From 
this he concluded that it was a purely vascular 
anomaly, and not wishing to perform so grave an 
operation as ligation of the carotid, and not being 
clear with reference to the diagnosis, he decided 
to ligate the angular artery, and to dissect down 
to the enlarged vessel, and tie it off. With great 11 
Library, 1881), devotes a page and a third 
to “ Croupous, or diphtheritic conjunctivitis,” 
(p. 168). Though he describes croup and diph- 
theria under the same title, he points out the 
principal distinction between the two forms of 
exudation, but also regards the croupous mem- 
brane as an unessential feature of muco-purulent 
ophthalmia. 
I have changed my opinion on this subject, and 
concur with Arlt,* Stellwag,f Saemisch,j; and 
Wecker,§ who, especially Saemisch, give clear 
descriptions of the disease, and state that we 
have to consider croup as a distinct form of con- 
junctival inflammation. It differs from catarrh, 
blennorrhoea, and trachoma, by the presence of 
the characteristic whitish membranes, and from 
diphtheria, by several points, which I beg leave 
especially to mention :— 
1. In diphtheria the lids are very stiff and 
hard ; it is difficult or impossible to evert them ; 
in croup the lids are supple and soft, and can be 
easily everted. 
2. The diphtheritic lid is unusually hot and pain- 
ful to the touch, whereas the croupous lid can be 
handled without much pain. 
3. The diphtheritic exudations are continuous 
from the deposit on the surface, through the 
superficial and deeper layers of the conjunctiva, 
whereas the croupous exudation is a surface de- 
posit only. 
4. The diphtheritic membrane cannot be easily 
removed, but must be torn off with some force, 
leaving the subjacent tissue pale and ragged; 
whereas the croupous membrane can be wiped 
off as a whole, leaving the subjacent tissue dark 
red, bleeding, and uneven—finely nodular. 
5. The tissue of the diphtheritic lid when cut 
into is anaemic, and has, in the developed cases, 
a white, lardaceous appearance, whereas the tissue 
of the croupous lid is highly congested and soft. 
6. The diphtheritic process leads to mortifica- 
tion of the invaded conjunctiva; the croupous 
process to proliferation, and cauliflower or poly- 
poid excrescences. 
7. Diphtheria readily extends from the lids to 
the bulbar conjunctiva and the cornea, whereas 
croup is long limited to the lids, and only the 
severest cases affect the cornea, and seem 
always to leave the scleral conjunctiva free. 
Croupous conjunctivitis begins with the symp- 
* Text-book, first edition, 1851, p. 85, and his next text- 
book, Klinische Darstellung der Krankheiten des 
Auges, 1881, pp. 16 -19. 
f Text-book, fourth edition, 1870, p. 423. 
t G-raefe-Saemisch’s Handbuch, Vol. iv, No. 1, pp. 
94-101. 
§ Wecker-Landolt. Traits Oomplet d’ Ophthalmol., 
1878. Tome I, p. 320. 
difficulty he succeeded in ligating the angular 
artery. Then dissecting up the protruding vessel, 
which was as large as a good-sized lachrymal 
probe, he traced it down, placing one ligature 
after another in the vessel, and cutting between 
them. He demonstrated that it was a vein, which 
he finally ligated at the spheno-maxillary fissure. 
He then concluded that it was the anterior orbi- 
tal vein, coming out of the spheno-maxillary 
fissure, and going back to empty into the caver- 
nous sinus. The wound healed kindly. At the 
end of six weeks the exophthalmus had dis- 
appeared.” 
Contagious Ophthalmia. On C roup of the Conj unctiva, 
with Remarks on the Treatment of the Contagious 
Forms of Conjunctival Inflammation. By H. 
Knapp, m.i>. Archiv. Ophthal., Vol. xi, Ao. 1. 
The observation of so-called extreme cases is 
sometimes required to throw our mind away from 
the track of familiar views, into new channels of 
thinking. We then recognize the significance of 
certain manifestations which we failed to appre- 
ciate so long as we noticed them only in low de- 
grees of development. Such an extreme case, 
from the common group of muco-purulent con- 
junctivitis, came under my care lately, and forced 
me to change my opinion of that kind of inflam- 
mation, which several authors have described as 
croupous or membranous conjunctivitis. 
Mild cases of this affection are not in- 
frequent. They begin under the form of acute 
catarrh or moderate blennorrhoea, but soon are 
distinguished by the formation of thin, whitish 
membranes, covering the palpebral portions of 
the conjunctiva. Under the ordinary treatment 
of astringents, cold applications and careful 
cleansing, they get well in from three to six 
weeks. Having seen so frequently that the mem- 
branes had no appreciable influence, either on 
the gravity or the course of the disease, I did 
not consider them as an essential feature of the 
disease, and classified the cases mostly as acute 
catarrh. Sometimes, when the discharge was 
more puriform than mucoid, as acute blennor- 
rhcea. 
C. S. Bull, in the third American edition of 
Soelberg-Wells’ text-book, devotes fifteen lines 
to croupous conjunctivitis, in which he says: 
“ This form has been regarded by some English 
and Continental authorities as a distinct variety 
of conjunctivitis, but there seems good reason to 
doubt this. * * * The treatment consists in 
stripping off the membrane and cauterizing the 
surface, as in catarrhal or purulent conjunctivitis. ’ ’ 
H. D. Noyes, in his recent treatise on the dis- 
eases of the eye (Wood’s Standard Medical 12 
pseudo-membranes, which are interspersed with 
lymphoid cells and deposited on the surface, 
infiltrating the tissues of the lid. Its causes are 
those of catarrh and blennorrhoea. The disease 
is contagious and mostly affects both eyes. A 
constitutional predisposition may, perhaps, be 
admitted, as the catarrho-blennorrhoeic conjunc- 
tivitis, which in asylums goes from one inmate to 
the other, only in a few assumes the croupous 
character. Croupous conjunctivitis, like pha- 
ryngo-laryngeal croup, is prevalently a disease 
of childhood. Some patients have croup of the 
eye and sore throat simultaneously. 
The prognosis, on the whole, is favorable, the 
disease showing no marked tendency to affect the 
cornea, and, unlike diphtheria, leading to no 
gangrene of the parts affected. 
As to the treatment, I can only concur with 
Arlt and Saemisch, in advising to abstain from all 
kinds of irritant medication as long as the forma- 
tion of the pseudo-membranes is still active. 
Uninterrupted application, day and night, of iced 
compresses to the lids, and careful washing away 
of the secretion with a soft sponge dipped in a 
very weak solution of chloride of sodium, chlo- 
rate of potash, and the like, should be enforced 
so long as the inflammation is progressing or at 
its height. As soon as the swelling decreases 
and the membranes break off, the cold applica- 
tions may be limited to an hour every morning, 
noon and evening, and gradually left off. Weak 
solutions of nitrate of silver then seem to 
be the best remedy, and also mild touching 
with the sulphate of copper crystal acts benefi- 
cially. Saemisch thinks that in a few mild cases 
he has cut short the progress of the disease by 
dusting powder of sulphate of quinine on the af- 
fected conjunctiva. I have no experience on the 
use of quinine in this manner, and Saemisch him- 
self warns us not to use it in severer cases, lest 
the powder, acting as a foreign body, stimulate 
the inflammation. 
I beg leave to take this opportunity for mak- 
ing some remarks on the utility of methodical 
1 applications of cold in the severer forms of con- 
junctivitis, and on the general management of 
these affections. They are all contagious, yet 
not in such a manner that an infection through 
micro-organisms or other substances floating 
in the air need be feared. Practically, the dis- 
ease is transmitted only by inoculation. Under 
proper care, the most virulent gonorrhoeal or 
diphtheritic inflammation of one eye is never 
transmitted to the fellow eye, even if left open : a 
fact of which I have convinced myself by hun- 
dreds of cases treated in hospital or private prac- 
toms of an acute catarrh, or mild blennorrhoea, 
but soon characterizes itself by deposition of 
whitish membranes on the retrotarsal folds of 
both lids, extending toward the front of the con- 
junctiva and the free edge of the lids, as far as 
the so-called papillary body is found. The mem- 
branes consist of coagulated fibrine enclosing 
lymphoid cells in varying quantities. They may 
cover the palpebral conjunctiva in patches only, 
or as a continuous layer of 0.1 mm. to 1.5 mm. 
in thickness. They can be more or less wiped 
off, and are quickly reproduced. The surface 
from which they are detached is dark-red, easily 
bleeding, uneven, not ulcerous, but finely granu- 
lar. The lid is moderately swollen, not very 
sensitive, and can be everted without much diffi- 
culty or pain. The discharge is sero-mucous or 
sero-puriform and moderate. The progress of 
the disease is marked by the uneven swelling of 
the papillary body passing over into prolifera- 
tion, with the production of smaller and larger 
cauliflower, and polypoid excrescences. The 
pesudo-membranes cover all the productions, dip 
into the depressions and crevices of the prolifer- 
ous conjunctiva, and cannot be detached without 
lacerating and tearing off portions of the con- 
junctiva, thus causing effusion of blood, which 
shows a high degree of coagulability. Croup, in 
contradistinction to diphtheria, seems never to 
affect the scleral conjunctiva, and only exception- 
ally the cornea, there producing ulcers. These 
ulcers may be superficial, and disappear in a 
short time, or become more extensive, occupy 
and destroy the whole cornea. Prom their 
whitish aspect and firm, even surface, which is 
rather raised than depressed, I am inclined to 
believe that they also are covered with a croup- 
ous deposit. Even in that stage they are capable 
of restitution, leaving an, unexpectedly small 
corneal patch, when compared with their former 
size and intense milky opacity. They are com- 
plicated with consecutive plastic iritis, which 
may get well without adhesions or papillary ob- 
struction. 
Course.—The milder forms of the disease are 
not infrequent, the severest ones very rare. The 
characteristic croupous stage seems to follow the 
catarrhal initial symptoms in a few days ; may 
last for one or several weeks, or from two to six 
months. When the membranes disappear they 
get softer, thinner, and brittle ; the discharge 
then is muco-purulent, but still moderate, when 
compared with genuine blennorrhoea. 
The nature of the disease consists in a swelling 
and proliferation of the papillary body of the 
conjunctiva, and the formation of fibrinous 13 
tice. Under proper care ? What is proper care? 
Proper care is two skilled and trusty nurses, the 
one for the day, the other for the night, who 
never leave the patient ; further, a rational 
physician who is not too meddlesome a therapeu- 
tist. I speak now of ophthalmia neonatorum, 
blennorrhoeic or gonuorrhoeic ophthalmia of the 
adult; of croupous and of diphtheritic ophthal- 
mia ; also of the acute stage or acute paroxysms 
of trachoma. The treatment of all of these 
cases is the same, and amounts to this : So long 
as the disease is on the increase or at its height, 
abstinence from all but indifferent local reme- 
dies, methodical and uninterrupted application of 
cold, and careful cleansing; in the stage of de- 
cline, the same treatment in milder form ; in 
torpid and protracted cases, astringents or mild 
caustics. 
The infant of three days and over, who has 
blennorrhoea, should have cold applications day 
and night,by means of thin iced compresses, which 
cover no more than his burning eyelids. Every 
fifteen to thirty minutes the lids should be gently 
separated and the secretion carefully washed out 
with a fine, soft sponge, dipped in a very weak 
solution of common salt, chlorate of potash, and 
the like. Several sponges should always be at 
hand, kept in an abundance of pure water, so as 
to keep them perfectly clean. There is no ma- 
terial equal, in softness and efficiency, to fine 
sponges. To see that they are free from infec- 
tion is our business, and a very easy business it 
is, for among all the disinfectants there is one 
which, unshaken, has stood the test of time: 
abundance of water. There is no contagion that 
is not made harmless by sufficient dilution ; con- 
tagia can all be drowned. As soon as the little 
sufferer shows the least tendency to open his 
eyes, he should be encouraged in his endeavors. 
Darken the room moderately, so that the influ- 
ence of bright light does not make him shrink. 
The opening of the eye is beneficial in two ways : 
1st. The movements of the lids beat the corro- 
sive secretion out of the conjunctival sac. 2d. 
They accelerate the circulation in the affected 
parts, thus diminishing congestion, stasis, and 
infiltration. We know that the venous circula- 
tion in the extremities of our body is materially 
favored, I mean mechanically assisted, by mus- 
cular action. When a child opens his eyes, the 
danger is over, only a relapse must not be al- 
lowed to occur. The iced applications have to 
be continued, until the swelling of the lids and 
the creamy character of the discharge have dis- 
appeared. No child need lose its eyes from 
ophthalmia neonatorum, and no child does, if 
faithfully treated in the way just described. I 
unhesitatingly commit myself to this assertion, 
since the cases over which I had full control 
terminated favorably, and they count, not by the 
dozen or hundred, but by the thousand. Other 
modes of treatment may be good—and there is 
no doubt that certain eyes escape destruction 
under all kinds of treatment—but the one pointed 
out is capable of saving them all, and only in 
order not to be absolute I admit the restric- 
tion of saying, “almost all.” But great 
and incessant care is needed. Prophylactic 
measures, such as cleansing the vagina before 
and during delivery, and washing the child’s eye 
with weak, so-called antiseptic solutions, of 
which nitrate of silver one-tenth to one-fifth per 
cent, is the best, may be useful, and need only 
be mentioned. I cannot speak with the same 
satisfaction of the results of the treatment of 
gonorrhoeic ophthalmia in adults, though the 
same plan of treatment pursued with the same 
rigorousness and persistency saves, as far as my 
experience goes, the great majority of cases. 
Slitting of the outer commissure, if there be great 
tension, is beneficial, but can almost always be 
avoided, since the cold keeps the swelling down. 
The proposition of Critchett, of London, to divide 
the upper lid in its centre, in order to save the 
cornea from destruction, need certainly not be 
adopted. 
What good the application of cold may do in 
croupous ophthalmia is exemplified by experience. 
In diphtheria of the conjunctiva I know of no 
more important remedy than the energetic and 
persistent application of cold. I cannot counte- 
nance the proposition of Mooren and Berlin, by 
warm applications to abridge the true diphther- 
itic stage and lead the process more quickly over 
into the less dangerous blennorrhoeic stage, since 
I am convinced that nothing is so powerful in 
diminishing the violence of this dreadful inflam- 
; mation as cold, and I am afraid that warmth may 
temporarily increase it and favor destruction of 
the cornea. I have to differ from the statement 
of Dr. Noyes and others, that diphtheria of the 
I conjunctiva is a very rare disease in New York. 
My former assistant, Dr. Born, has taken notes 
of over seventy well marked cases during the 
three years that he was house surgeon at the 
Ophthalmic and Aural Institute. The great 
majority of those cases, as well as others in my 
private practice, were cured under the above plan 
of treatment, persistently carried out. What 
good the same plan, though less rigorous, may 
do in severe cases of trachoma, few persons who 
have not witnessed it would believe. A patient 14 
may go for months, and even years, to the dispen- 
sary, and then show the usual alternation of better 
and worse, till a new crop of granulations, or 
blindness from corneal opacity, compels him to 
enter the hospital. He is treated with iced com- 
presses several hours during the day, is directed 
to dip his face into cold water, and is admonished 
by every moral effort, assisted, if necessary, by 
mechanical appliances, to keep his eyelids open 
as much as possible; his lids are touched with 
the sulphate of copper crystal, and the improve- 
ment in most cases is very marked, not to say 
astonishing. In the course of three or four 
months I have seen trachomatous lids restored 
to a healthy condition, with scarcely perceptible 
cicatrices, and a trachomatous cornea, through 
which fingers could not be counted, so much 
clear up that fine type could be read. 
What I have said is only a sketch, and if I did 
not trespass on your time and indulgence, I would 
fain say more, for I am deeply impressed with 
the fact that among all questions in ophthal- 
mology—that of cataract, perhaps, excepted— 
there is none so important as the treatment of 
contagious ophthalmia.” 
A Case of Quinine Amaurosis Manifesting Itself 
Primarily in One Eye. Arch. Oph. Vol. xi, No. 1. 
C. M. Hobby, m.d., Iowa City, Iowa, reports 
the case of a young lady, aged twenty one, in 
whom, for severe left supra-orbital neuralgia. 
Subsequently, what was supposed to be episcleritis 
of the left eye occurred, accompanied by conjunc- 
tival injection and oedema of the eyelids. The 
neuralgia being considered malarial in character, 
was treated with large doses of quinine, and 
fomentations of belladonna were applied to the 
eye. “ Large doses of quinine were required, to 
produce cinchonism. Patient was anaemic, and 
on ophthalmoscopic examination, both before, 
and still more markedly after, the administration 
of quinine, ischaemia of the retina was noticed. 
“ At the time the patient came under my ob- 
servation she presented an anaemic appearance, 
had very little appetite, and was still suffering 
from occasional attacks of neuralgia. There was 
no injection of the conjunctiva or sclerotic ; the 
right eye was apparently normal; in the left eye 
the pupil was widely dilated, and not appreciably 
affected by light. Right eye = —xtl; Left eye 
— On the fourth day following she returned 
with both pupils dilated to the utmost. R. — 5 
L. At this time she reported that the left eye 
began to get worse upon her return home, but 
she noticed no trouble with the right eye until 
the previous day. 
“ Recognizing the probable existence of qui- 
nine amaurosis, Dr. Hobby commenced the use of 
strychnia hypodermically, increasing the quan- 
tity each time, until the physiological effects 
were apparent. The improvement was rapid, 
and in ten days the acuteness of vision had re- 
turned from — to xx for both eyes, and the visual 
field of each eye, which had been reduced to 
about one-tenth of the normal, had doubled. 
During the use of strychnia the malarial symp- 
toms disappeared, and the general physical con- 
dition improved. Six weeks later the acuteness 
of vision was unchanged and the visual field 
much increased in extent, but still less than half 
the normal, 
“ The inference to be drawn from this case 
would seem to be that the toxic effect of quinia 
' primarily manifests itself in a single eye.” 
(As there were symptoms of an episcleritis and 
supro-orbital pain of the left eye, and as bella- 
donna had heen used and the light had evidently 
had an irritating effect upon the retina of that 
eye, we would prefer to infer that in one con- 
gested, if not inflamed, eye of a pair to be af- 
fected by poisonous (toxic) doses of quinia, ambly- 
opic symptoms are primarily manifest in the 
weaker eye of the two, both of which must sooner 
or later participate in the toxic amblyopia. T.) 
H. Derby, m.d., of Boston, reports {Arch. Oph. 
Vol. xi, No. 1) 
Three Cases of Hydrophthalmus Treated with 
Iridectomy, 
which he prefaces by the following remarks :— 
“ Cases of hydrophthalmus, cornea globosa, 
are as rare as they are unpromising. In the re- 
cord of twenty years’ practice I found but five 
instances of this disease. The only treatment 
seriously proposed has been iridectomy ; and the 
encouragement to the performance of this opera- 
tion has been given on grounds that are mainly 
theoretical. Instances of its performance have 
rarely been published. In his monograph on the 
subject,* written in 18G9, Muralt states that he is 
not aware of any results having yet been recorded, 
and gives, himself, the notes of a single case. 
He admits that the operation is, in this disease, 
attended by unusual danger as regards healing 
and the chance of hemorrhage. And Schmidt, 
writing in 1877,f says “ The secondary glaucoma 
which complicates cornea globosa (hydrophthal- 
mus congenitus) offers a poor prognosis for iridec- 
tomy. Besides the danger of cyclitis, which may 
be easily excited by this operation, there are 
perilous possibilities of purulent infiltration of 
* Uber Hydrophthalmus Congenitus. Zurich, 1869, 
p. 60. 
t G-raefe-Saemisch, Handbuchder gesammten augen- 
heilkunde, vol. v, p. 136. 15 
the vitreous, or of choroidal hemorrhages. When 1 
in these cases the rapid increase of intra-ocular 
pressure renders some kind of action necessary, 
it is best to try the effect of repeated paracentesis, ( 
which is certainly free from danger.” 
As we stated in the outset, the disease is very 
rare. Operations for its relief are, however, so j 
much rarer, and so infrequently reported, that : 
these cases here cited may well serve as a basis 
for generalization. They show that iridectomy, 
undertaken at a late stage of the affection, is 
liable to be complicated by hemorrhage, and to 
leave the eye in a state of chronic and painful 
irritation. But it cannot be denied that the dis- 
ease is arrested, and that an amount of vision 
that was rapidly becoming extinct is spread over 
a series of years, to the great comfort of the pa- 
tient. Case one had already lasted 14 years, 
and there was distinct optic-nerve atrophy at the 
time of the operation. Case two at least ten. 
Case three was taken in an early stage, and the 
disease at once stayed. Eleven years have 
elapsed and no progress is manifest. I feel, 
therefore, justified in dissenting from the writer 
in Graefe-Saemisch, and in advising iridectomy.” 
Dr. J. L. Thompson, of Indianapolis, Indiana, 
records some “Practical Remarks on the Extrac- 
tion of Foreign Bodies from the Iris.”* 
In the December number of the Archives of 
Ophthalmology, Yol. x, No. 4, Dr. Hirschberg, 
of Berlin, in his article on the 
Extraction of Chips of Iron and Steel from the Inte- 
rior of the Eye, 
quotes from the London Lancet, as follows:—- 
“ On May 18th, 1859, a girl, aged fourteen, was 
brought to St. Mary’s Hospital, under the care 
of Mr. White Cooper. The previous day, while 
standing near her father, who was turning a 
piece of hardened iron in a lathe, a chip struck 
her left eye, which had since been in constant 
pain, though the sight was not materially affected. 
The chip was sticking in the iris, almost midway 
between its upper border and the pupil. The 
anterior chamber was full, and there was no mark 
of entrance in the cornea Mr. White 
Cooper, fearing that difficulty would arise in 
grasping the smooth metal with forceps, sus- 
pended as it was in the loose membrane, decided 
on trying the effect of a magnet. The iris having 
been brought under the influence of atropine, 
whereby the foreign body was drawn near the mar- 
gin of the cornea, the patient was chloroformed, 
and a cataract knife was passed through the 
cornea opposite the chip, and a sufficient open- 
ing made for its escape. A magnet was then 
applied to the wound, and in an instant the chip 
leaped from its situation in the eye and attached 
itself to the magnet The eye was well 
in a week.” 
To the majority of the readers of the Archives, 
doubtless, the report of this case without com- 
ment will do no harm ; but to the inexperienced 
it is likely to work immense mischief, by caus- 
ing them to use atropine in similar cases. Yet 
we think that the end by no means justified the 
means used. The following case will show what 
dangers attach to the use of a mydriatic where 
foreign bodies lie in the anterior chamber. 
W. F., aged 40, came to me in 1875, two days 
after the receipt of an injury to his right eye while 
hammering the iron hoop from a paint keg with 
the blade of a hatchet. A small piece of either 
the hoop or the hatchet flew into the eye, passing 
through the cornea and lodging in the stroma of 
the inner lower portion of the iris, midway be- 
tween the ciliary and pupillary margins. The 
corneal wound had entirely healed, leaving 
scarcely a trace of opacity. His vision was 
good and he suffered but little pain. I proposed 
removing it, with probably a small portion of the 
iris, but he went off, promising to return shortly. 
I saw nothing of him for two days more, when 
he presented himself again, with the iris fully 
dilated and the body forced into the lens. I 
asked him how he came to use the atropine, and 
he replied that he had been reading “ Gunn’s Do- 
mestic Medicine.” A well-marked opacity of a 
portion of the lens so obscured the metal that it 
could not be seen. Of course, I did nothing 
further than to watch and wait further develop- 
ments. The last time I saw him, which was 
about two months after the injury, the lens was 
almost totally cataractous, with no inflammation 
remaining. He then passed from under my no- 
tice. 
In the above case, by sacrificing a very small 
portion of the iris, he could have been given use- 
ful vision, and probably even without said sacri- 
fice ; but after the use of the atropine the body 
was forced through the delicate iris, the lens 
wounded, and now, of course, if anything is done 
it must be the removal of the lens, a very ques- 
tionable operation where the other eye is not 
aphakial. 
How would atropine have acted in the follow- 
ing case ?—• 
White, Joseph, aged 28, a stone cutter, was 
wounded while dressing a stone with hammer 
and chisel, Jan. 3.1st, 1880. He immediately went 
* To those of our readers who are settled in either a 
manufacturing or a mining district, we would call es- 
pecial attention to Dr. Thompson’s eminently practical 
remarks and valuable hints on the use of atropia. o. s. t. 16 
to a “ Surgical Institute,” where, he says, they 
worked on'him every day until he came upon me, 
on Jan. 5th, 1881, when I found a foreign body 
lodged on the upper pupillary margin of the iris, 
about three fourths of it upon the iris and the re- 
mainder hanging over and into the pupil. I 
placed him under chloroform, made a section of 
the cornea at its junction with the sclerotic, and 
removed the body, with a small portion of the 
iris, without any difficulty whatever, before the 
class, at our City Hospital. The operation was 
made on Saturday, and he read in the pres- 
ence of the class on the following Wednesday. 
Now, had one used a mydriatic in his case, the 
body would as surely have been stripped off of the 
iris and against the lens, as was the foreign body 
forced through the iris, in the case above men- 
tioned. 
I have simply reported the two cases to show 
the danger of the use of atropine where bodies 
are imbedded in the iris. Many others, where 
percussion caps and pieces of iron have been so 
placed, have I, as well as all other eye surgeons 
ofexperience, had to do with, but their mention in 
detail would be unprofitable and superfluous.” 
Kupture of the Eyeball in its Posterior Hemisphere, 
from a Blow in the Face (loc. cit. p. 45). 
By Julian J. Chisholm, of Baltimore. 
The two cases of recent occurrence which I 
here report, although novel in my personal ex- 
perience, would not have had publicity beyond 
the staff of the Presbyterian Eye and Ear Char- 
ity Hospital, before whom the diagnosis was 
made and verified after extirpation of the de- 
stroyed eyeballs, had I not found in a recent work 
on “ Injuries of the Eye,” by Ferdinand Yon 
Arlt, a recognized authority on such matters, the 
following passage. I make the quotation from a 
translation of the German work by Dr. Chas. S. 
Turnbull, an American publication.* 
A paragraph on page 37 reads as follows : 
“ Cases of rupture of the sclerotic are not rare. 
Such rents extend, without exception, to the cili- 
ary body, even through it. Of ruptures in the 
posterior and sclerotic area, only one case is re- 
corded (by Bowman), and here the rupture was 
not recognized until after the eyeball had been 
enucleated.” 
From the same work I make an extract from 
pages 22 and 23 : “When a foreign body im- 
pinges against the eye with a certain degree of 
sudden force, and, on account of certain physical 
properties, such as size, bluntness, etc., cannot 
perforate its tunics, it expends this force by con- 
tusing the surface against which it strikes, or it 
causes either flattenings or indentations, the 
degree or extent of which depend on the charac- 
ter of the injuring surface, while, in the moment 
of injury, perhaps, no movement of the eyeball, 
as a whole, takes place. Now, an indentation 
or flattening of the eyeball cannot plausibly be 
considered possible, unless the same also changes 
its form in toto. Suppose we consider the point 
attacked as the pole, and the direction of the at- 
tacking force as the axis of a sphere; then the 
equator of the latter must become longer at the 
moment of the injury. Any resistance at the 
opposite wall, especially if distributed over an 
extensive area, will only serve to increase this 
change of form. The occurrence of a gap in 
such a wall, or of a projection upon it, will, 
when the globe is pressed against, produce a 
localized bulging—in the former case corres- 
ponding in shape and dimensions to the gap, and 
in the latter to an indentation or perforation of 
the sclerotic ; but such conditions hardly, if ever, 
occur.” Sclerotic rupture is of rare or non- 
occurrence in those very localities where choroidal 
rents are most frequent.” Again, from page 
27 : “ The constant parallelism of the sclerotic 
rent to the corneal margin has an additional 
reason in the histological fact that the fibres of 
the sclerotic coat run parallel to the latter, with- 
in the confines of the ciliary region.” Again, at 
page 38, “The sclerotic rent is linear or slightly 
arched, more or less serrated, and usually runs 
parallel to the limbus cornea, at a distance from 
two to five millimeters from the latter. In one 
case only (Schrceter, Klinische Monatsbldtter, 
1866, p. 248) did the rent run at an acute angle.” 
The following extract is made from a stand- 
ard work-on 
Eye Injuries, 
by George Lawson, f.r.c.s. “The split in the 
sclerotic is almost invariably near the margin of 
the cornea.” 
Case 1.—N. L., aged 27, was struck in the 
left eye with a chair, during a drunken broil. 
He was knocked down insensible, and had his 
nose and brow badly cut. When he came to 
himself he was taken home. In the meantime 
the eyeball had become very prominent, from 
swelling. He complained of great pain in it, 
and also of loss of sight. He was brought to the 
Presbyterian Eye and Ear Charity Hospital, for 
treatment, on the day after the accident. I 
found the eyeball very protruding, with lids much 
swollen and firmly stretched over the projecting 
ball, which was half exposed. The conjunctiva 
was much discolored with blood extravasation, 
and was chemosed in a heavy fold, parallel with 
the free border of the lower lid. When the lids 
* “ Injuries of the Eye and their Medico-Legal 
Aspect,” by Ferd. Yon Arlt. m.d. Translated by per- 
mission of the author, by C. S. Turnbull, m.d. Pub- 
lished by E. Ulaxton & Co., 930 Market St., Philada. 17 
were drawn apart the eyeball protruded so con- 
spicuously as to show the whole anterior half of 
the sphere, and presented the condition known 
as paraphimosis of the eyelids. When thus ex- 
posed, the whole front of the eyeball was entire, 
apparently without any injury to its outer walls. 
The anterior chamber was full of blood, and 
there was no perception of light. I was induced 
to palpate the eye, and found its tension de- 
cidedly minus. It was so soft that the cornea 
could be corrugated, a condition that could not 
exist in connection with the intra-ocular hemor- 
rhage without a giving way of the eyeball and 
the escape of some of its contents. Upon this 
diminished tension and excessive blood extra- 
vasation, with great prominence of the eyeball, 
I diagnosed laceration of the posterior hemi- 
sphere of the sclerotic. To prevent future suffer- 
ing, I advised enucleation, which operation was 
satisfactorily effected, under chloroform. After 
making the conjunctival section around the cor- 
nea, the opening of the capsule of Tenon to reach 
the tendon of the external rectus muscle allowed 
the escape of a quantity of dark fluid blood, and 
indicated the location of the scleral opening, 
which an examination of the eyeball after its 
removal confirmed. The rent, which was a large 
flap, opening in the outer wall of the sclerotic, 
was located in the posterior hemisphere of the 
eyeball, between the insertions of the external 
rectus and the oblique muscles. The source of 
hemorrhage was choroidal. The blood, after 
filling the eyeball and displacing the lens and 
vitreous body which had escaped through the 
sclerotic rent, had freely effused itself into the 
orbital space, and by excessive infiltration had 
caused the extrusion of the eyeball. 
This was the first case that I ever diagnosed, 
in the absence of any visible wound, as posterior 
laceration of the sclerotic coat of the eyeball, as 
I was surprised at the facility with which the 
diagnosis could be made. The eyeball, full of 
blood, with excessive extravasation under the 
conjunctiva, and accompanied by marked minus 
tension, made the diagnosis very positive, of 
escape of some of the eye contents through a 
wound concealed from view. 
I had been very much surprised, on previous 
occasions, at the amount of bleeding which could 
take place from a sclero-choroidal wound. In 
one, a case in which the eyeball had been perfor- 
ated by a fragment of iron over the insertion of 
the superior rectus muscle, I had much difficulty 
in checking the profuse bleeding from the wound, 
which saturated thick compresses. I was, there- 
fore, quite prepared for the excessive extrava- 
sation in this case. The accident just reported, 
of posterior scleral laceration, was from a blow 
received, through the lid, upon the elastic eye- 
ball, resulting in the giving way of the eye-coats 
at a point nearly opposite to that upon which 
the blow fell; clearly a case of laceration by 
counter stroke, and at a point where the eyeball is 
well supported by muscles as well as by the fatty 
cushion of the socket. 
This accident was the sequel of a Christmas 
frolic. In accordance with the experience of 
every surgeon who finds rare cases running in 
company, the day after New Year another case 
of eye injury, nearly similar in its results, was 
brought to the hospital dispensary for treatment. 
Case 2.—I. F., aged 23, was wounded in the 
right eye, under the following peculiar circum- 
stances : He and a friend were discharging pistols 
at a mark. While the patient was loading his re- 
volver, his companion, standing near him, fired at 
a stone lying on the ground some ten feet in front 
of them. With the report of the pistol the in- 
jured man cried out that he had been shot, which 
remark caused much merriment, from the ap- 
parent impossibility of such an accident, as the 
shot had been fired away from him. Blood was 
seen, however, upon his face, oozing from a 
wound in the upper lid. The eye immediately 
commenced to swell. He complained of great 
pain, and said that his sight was knocked out. 
I saw him the day after the accident. The eye- 
ball was very prominent, with excessive ecchy- 
mosis of the conjunctiva and with the anterior 
chamber full of blood. The pistol ball, in re- 
bounding backward from the stone, had struck 
the lid, but not with force enough to penetrate. 
The skin of the upper lid only was broken, and 
from it the blood had escaped. The eyelids were 
much stretched over the protruding eyeball, and 
a fold of discolored, chemosed conjunctival tis- 
sue seemed to fill up the palpebral cleft. I ele- 
vated the lid upon a retractor, and found that 
there was no wound in the front of the eyeball, 
and yet upon palpation I found the tension very 
much diminished, so that I could corrugate the 
cornea. With the case of a week before fresh 
in memory, I did not hesitate to make the diag- 
nosis of posterior rupture of the sclerotic coat of 
the eyeball, and recommended immediate extir- 
pation of the destroyed and painful organ, as the 
quickest means of obtaining relief from suffering 
and safety for the other eye. Under chloroform 
the eye was enucleated. The eye-shell was found 
full of coagulated blood. Its normal contents 
had escaped through a large rent in the upper 
part of the ball, which opening extended back- 
ward from the insertion of the superior rectus 
tendon. The tendon of the muscle restricted 
the laceration to the posterior hemisphere of the 
eyeball, and prevented the wound from being 
seen when the eye was examined, before the ope- 
ration. 
The laceration seemed to have started from 
the point of the eyeball upon which the blow im- 
pinged, and had extended directly backward. An 
explanation for this rare accident may be found in 
the fact that when the injury was received the 
wounded man wasloading his pistol,and was look- 
ing down toward his hand. He, therefore, had not 
only the eyeball well covered by the upper lid, 
but in the extreme downward movement of the 
eye a large part of the upper hemisphere was ro- 
tated forward and exposed to receive the blow. 
The pistol ball must have been somewhat spent, 
as it only broke the skin of the lid ; but the blow 18 
was sufficiently sudden and sharp to indent the 
eyeball to splitting, and thereby make the rent 
through which the contents of the eye were pro- 
jected into the socket and incarcerated within the 
cone of muscles. 
These two cases, while rare accidents, at least 
as far as the establishing of a diagnosis is con- 
cerned, differ in the immediate cause of the rent. 
In the first case the laceration in the eye-coat 
was not in a portion of the eyeball brought im- 
mediately under the influence of the blow. 
When the man was struck in the face by the 
chair, the bruised temple, brow and nose indi- 
cated that the blow was received directly across 
the eye, upon its front, through the medium of 
the lids. The common seat of laceration near 
the corneo-scleral juncture did not yield, al- 
though this was nearest to the surface receiving the 
blow. When the sudden flattening of the eye- 
ball took place the rent occurred near the oppo- 
site pole of the eye impinged upon. In the sec- 
ond case the rent started at the point receiving 
the blow, and extended backward in the direc- 
tion of the posterior pole, and at right angles to 
the so-called circular laceration around the cor- 
neal periphery. 
Serious Effect of Calomel upon the Eye. 
F. C. Hotz, m.d., of Chicago (Archiv. Ophthal., 
Yol. xi, No. 1). In November, a railroad em- 
ploy6, aged thirty-eight years, consulted me for 
an affection of his right eye, which resembled, 
in every feature, an extensive burn of the ocular 
conjunctiva. The eyelids were red and swollen, 
especially the upper one, so much so, that the 
eye could be opened but very little. The con- 
junctiva of both lids were very red, succulent 
and roughened by enlarged papillae. The retro- 
tarsal portions of the conjunctiva protruded in 
two thick, succulent folds when the lids were 
everted ; and the ocular conjunctiva was also in- 
tensely red and swollen, so that its limbus pro 
jected considerably over the surface of the cornea. 
But what attracted my attention the most was a 
large, white crescent in the lower half of the ocu- 
lar conjunctiva; its convex border reached down 
to the lower retro-tarsal fold ; its concave border 
was parallel to and about 4 mm. from the mar- 
gin of the cornea. The horns of this crescent 
extended upward around the sides of the cornea, 
and tapering off gradually, terminated in sharp 
points in the upper half of the eyeball. The 
surface of the crescent was markedly depressed 
below the level of the surrounding conjunctiva, 
and exhibited the whitish, dry, bloodless appear- 
ance of mortified tissue, which we usually find 
after a severe burn of the conjunctiva. 
The lustre and transparency of the cornea were 
not disturbed ; the iris, however, was discolored, 
the pupil was contracted, and dilated very irregu- 
larly, under the influence of atropia, on account 
of numerous fine synechise. 
Upon inquiring into the origin of this peculiar 
affection, I received the following information : 
The patient’s habits always had been very regu- 
lar ; he never had gonorrhoea or syphilis, and 
never had sore eyes. 
The present trouble began two weeks ago, with- 
out any known cause, with swelling of the eye- 
lids, redness of the eyeball, photophobia, profuse 
lachrymation, and some pain in and about the 
eye. He took some medicine internally (which, 
according to the prescription, contained quinine 
and morphine), but no medical application of any 
kind was made to the eye until two days ago. 
On that day his physician prescribed powdered 
calomel, which the patient’s wife dusted into his 
eye by means of a camel’s hair brush. He could 
not say how much calomel was thrown in the eye, 
but the application caused considerable pain, in- 
creased the flow of tears, and the tumefaction of 
the lids, and on the next morning his wife dis- 
covered on the eyeball a large white patch which, 
as she very positively asserted, was not there 
when she applied the powder on the preceding 
day. Under proper treatment, the iritis sub- 
sided quickly, and after the elimination of the 
eschar the extensive defect in the ocular con- 
junctiva was closed by cicatrization. At the ex- 
piration of three weeks the eye had recovered a 
normal appearance, with a regular and mobile 
pupil ; the only evidence of the past trouble was 
a callous white scar in the ocular conjunctiva, 
below the cornea, with linear extensions around 
the sides of the cornea. 
Remarks.—From the history of this case it is 
evident that originally the trouble was an acute 
iritis, with an unusual degree of chemosis. Upon 
a grave error in the diagnosis, calomel was pre- 
scribed, and its local application was followed by 
the lesion in the ocular conjunctiva so directly that 
the existence of a causal relation seems very 
probable. If the patient had been taking iodide 
of potassium, there would have been nothing re- 
markable in the unusually violent action of the 
calomel; for we know that under these circum- 
stances it is converted into iodide and bichloride 
of mercury. But, as the patient had only taken 
a quinine mixture, I suspected the calomel was 
not chemically pure, the more so, as it was not 
obtained at a first-class drug store. The chem- 
ist who examined the calomel for me reported 
the presence of considerable free hydrochloric 
acid ; and to my further question as to the chem- 19 
ical changes such calomel might possibly suffer 
in contact with the lachrymal fluid, he replied 
that at the temperature of the human body chlo- 
ride of sodium can convert a little calomel into 
bichloride of mercury, and that this alteration is 
greatly favored by the presence of free hydro- 
chloric acid. The production of corrosive sub- 
limate, of course, explains the caustic effect. 
When the calomel was dusted in the eye, I think 
the cornea was probably turned upward, and the 
powder was sprinkled on the lower portion of 
the chemotic ocular conjunctiva, and afterward 
rubbed into it by the pressure and movements of 
the swollen eyelids. This would account for the 
fact that the cornea escaped unscorched, and 
that the caustic action was most severe upon the 
more dependent portion of the ocular conjunctiva. 
Two Cases of Malignant Tumor of the Sphenoidal 
Cavities, Implicating Vision.* 
(loc. cit. p. 52) Julian J. Chisolm, m.d., Bal- 
timore. “ Within eighteen months two cases of 
malignant disease, supposed to have originated 
in the sphenoidal cells, have come under my ob 
servation, making four cases of this serious le- 
sion which I have seen in the past ten years. 
In both of these last cases the disease seemed to 
have started on the right side of the bone, at the 
base of the skull. The eye complication was 
recognized as of post-ocular origin, and the le- 
sion was located about the Sella Turcica, on ac- 
count of the ophthalmoscopic appearances of 
the discs and the disturbed action of the eye 
muscles. In both cases the left eye became sec- 
ondarily involved, both as to the functions of 
the optic nerve and the action of the muscles 
moving the eyeball. In each case the nose im- 
plication was subsequent to the eye trouble. 
The first action of the growth in its malignant 
development was to invade, by bone expansion, 
the optic foramen at the apex of the orbital 
cone, and impress the structures passing through 
this opening, then slowly involving contiguous 
parts, until both sides of the skull about the me- 
dian line became affected. In both cases pro- 
gress was slow, requiring many months for de- 
velopment. In each, treatment was unavailing 
to stop the steady growth of the disease, until one 
succumbed to the general poison, and in the other, 
life seems to be rapidly ebbing away amidst 
severe torture, which morphia in large doses and 
frequently repeated can scarcely mitigate. One 
case was in a boy 7 years of age, the other in a 
member of the medical profession aged 37 years. 
“While the two cases have this in common, 
* See another case by Chas. S. Turnbull, m.d. Trans- 
actions Philadelphia (Jo. Medical Society, Sep., 1882. 
viz., a malignant growth at the base of the skull, 
destroying sight, then developing in the direc- 
tion of the face, filling the eye sockets, pushing 
out the eyeballs, invading the nares, and exhib- 
iting a striking similarity in the disfigurement 
produced, there are symptoms peculiar to each. 
The youth suffered no pain whatever when the 
disease was making rapidly fatal progress ; the 
older patient, on the contrary, has suffered 
severely from the very beginning of his trouble, 
and the intense agony of his every-day life has 
shown no mitigation. The younger case com- 
menced with nausea and vomiting, with head- 
ache, before any other symptoms could be de- 
tected. When attention was called to the eye, 
for deterioration of sight, the cerebral 
symptoms of nausea and headache suddenly 
passed away. They did not return, although 
for sixteen months the disease, in its anterior 
development, filling up the face cavities with its 
cancerous growths, steadily progressed to a 
fatal issue. In the elder the nausea with vomit- 
ing appeared among the last symptoms, when 
sight had already been nearly destroyed, and 
when prominent growths were developing in the 
temple and in the roof of the mouth. In both 
cases the mind remained dear throughout. In 
both the disease extended from the right to the 
left side. In neither case was there any general 
paralysis nor any evidence of extensive encroach- 
ment by the growth in the direction of the 
cranial cavity. The loss of smell was secondary 
to that of sight in the youth, while it was retained 
in the older case, even when the disease had in- 
vaded the left orbit and had reduced vision in 
this eye to recognition of large objects, sight in 
the right having been utterly destroyed by pres- 
sure on the optic nerve. The youth suffered 
from an external squint with ptosis, the older 
with internal squint followed afterward by ptosis. 
In both the drooping of the lids of each eye 
became prominent.” 
A little more than a year after the time of the 
boy’s first visit to Dr. Chisolm, he received a 
letter from his family physician, announcing the 
death of the boy. From this letter the following 
extracts were made : “ Death apparently came 
from exhaustion and septic poisoning. The eye- 
balls protruded excessively, in hideous deformity. 
Bleeding, fungous masses protruded from each 
nostril, and also could be seen behind the 
palate. These emitted a most offensive odor. 
His hearing was only implicated a few days be- 
fore his death. The most wonderful part, to me, 
was the total absence of all pain. I was not able 
to make a post-mortem examination.” <• 20 
Tumor of Lachrymal Gland. 
By Joseph A. White, m.d. (loc. cit. p. 62). 
As tumors of the lachrymal gland are not very 
common, these few notes from my case book, 
in relation to the successful removal of such a 
growth, may be of some interest. 
Mrs. E. Pye, a German lady, 60 years of age, 
has had a gradually increasing swelling at the 
outer part of the left upper eyelid, for more than 
a year. Of late its increase has been more 
rapid, the eye being pushed down and toward 
the nose, so that it is now (May 1, 1881), diffi 
cult to close the lids over it. At times the eye 
is quite painful and tender to the touch, is in- 
flamed, and has a constant muco-purulent dis- 
charge. Y = both eyes, with -f- |.*R. V = 
f# with + y L. Y = f§. Ophthalmoscope 
shows left optic nerve to be quite reddened, with 
hazy outline and large tortuous veins. 
The case was evidently one of lachrymal gland 
tumor. On May 13th I removed the tumor through 
an incision made along outer third of edge of 
orbit, just below the brow. It was dissected out 
with probe-pointed bistoury and scissors. It was 
firmly attached above to the periosteum and be- 
low to the conjunctiva,and extended far back into 
the orbit, pressing upon the optic nerve. It was 
removed intact; was ovoid in shape, measuring 
one and a quarter inches in its long, and 
three-quarters of an inch in its transverse 
diameter. 
Very little bleeding followed the operation. 
The wound was closed by stitches, leaving a 
small drainage tube at outer angle. 
Though there were considerable ecchymosis 
and swelling of the eyelids and cheek, the wound 
healed kindly, and required little after treatment. 
Three weeks later it was entirely healed ; the 
eye had returned to its position, its movements 
were free, the vision the same as before the 
operation, and the lid drooped slightly. 
It is now six months since the tumor was re- 
moved, and the most careful examination can 
detect no signs of a recurrence; the eye and lids 
are perfectly normal, both in appearance and 
motion, and the vision has improved to f$ with 
+ TV- My friend, Dr. Swan M. Burnett, of 
Washington, D. C., who, duringthemeetingofthe 
American Medical Association, had examined 
the case, requested me to send him the tumor 
for microscopical examination when I should re- 
move it. I sent him the specimen, and am in- 
debted to his kindness for the following descrip- 
tion of the tumor :— 
Microscopic appearances, by Dr. Swan M. Bur- 
nett, Washington, D. C. The tumor is far from 
uniform in its histological structure. The con- 
nective tissue element is rather abundant in some 
parts, while in others it is very scant or entirely 
wanting. The cellular element, which is largely 
predominant, is likewise irregular in its distribu- 
i tion. It consists of rather large, round cells, 
with very thin cell walls, and large, granular 
nuclei. There are other cells, smaller, with 
small or no nuclei, which are distributed in some- 
what large collections throughout the tumor mass. 
The characteristic form of myxomatous tissue is 
seen in abundance in all parts of the specimen. 
Cylinders and alveoli lined with cells in the char- 
acteristic arrangement of adenoma are met with, 
particularly near the centre of the sections pass- 
ing through the tumor in a transverse direction. 
The remains of those structures are quite abund- 
ant, but in only one or two places have I been 
able to find them entirely intact and in anything 
like a normal condition. The alveoli are often 
filled with a hyaline mass (Becker), less fre- 
quently with round cells or granular matter. 
From these appearances I think we are justified 
in describing the tumor as a myxo-adeno- sarcoma. 
From an examination of this specimen alone it 
would not be possible to trace a general history 
of such tumors, but it tends to confirm the opin- 
ion of Becker* that all the forms of tumor of the 
lachrymal gland hitherto described are but dif- 
ferent stages of the same morbid growth. It seems 
likely that they all begin as adenomas and that the 
various forms of degeneration—myxomatous, sar- 
comatous, colloid, encephaloid, etc.—come on 
later. The appearances in this specimen differ 
from that of Becker’s in this, that the degenera- 
tion was greatest toward the periphery, while 
in his the periphery appeared the more nearly 
normal. 
Systematic Report on the Progress of Ophthalmology 
During the Third Quarter of the Year 1881. 
By H. Magnus, m.d., Archiv. Ophthal., Vol. 
xi, No. 1, under the head of General Ophthalmo- 
logical Literature. 
W. Sykes. Clinical note and remarks on a 
Disease of the Eyes Peculiar to Colliers (Brit. 
Med. Journal xlii, p. 77, July 16, 1881). 
The sight first fails in bad light, and grows 
gradually worse, till the pupils are dilated 
and insensible to light, and only a perception of 
light remains, while nystagmus is well marked. 
Recovery takes place on exposure to light and 
air, without other treatment. The miners attrib- 
ute the disease to the bad light given by the safety 
*Ueber. das Adenom der Thranendrtlse. Bericht 
tiber die Augenklinik der Wiener Universitat, 1803-66. 21 
lamp, but Sykes believes it to be toxic, from 
gases accumulating in the pits. 
Fialkowsky. Ueber den Einfluss russicher 
Bader auf das gesunde und kranke menschliche 
Auge. (On the influence of Russian baths on the 
healthy and the diseased human eye.) Wratsch, 
1881, No. 9. The influence upon diseased eyes 
is greater than on healthy eyes. After the bath 
the pupils are somewhat dilated, or react slug- 
gishly ; both the far point (?) and the near point 
are slightly removed from the eye ; the range of 
accommodation is, therefore, somewhat dimin- 
ished. Visual acuteness suffers no change. More- 
over, after the bath, conjunctival and retinal hy- 
persemia occurs ; the secretion of mucus and tears 
becomes increased. Any inflammations present 
are intensified. 
Gunn, R. M. On the Continuous Electrical 
Current as a Therapeutic Agent in Atrophy of 
the Optic Nerve and in Retinitis, Pigmentosa 
(Roy. Lond. Ophth. Hosp. Rep. vol. x, pt. 2, p. 
161, June, 1881). 1. In optic atrophy, Weiss’ 
continuous current battery (the Foreaux-Smee ; 
the elements are zinc and platinized silver), of 2o 
cells was the instrument used. The positive pole 
was placed on the closed eyelid, and the negative 
applied to the supra-orbital region, the top of the 
spine, and to a point just behind the mastoid 
process, in order to determine which position 
gave the greatest light impression. Five or seven 
cells were only employed at first. The supra- 
orbital region was the point selected in the ma- 
jority of cases. The position of the poles was 
changed during the sitting, which lasted from five 
to six minutes. Of the eighteen cases thus 
treated, six improved, four were doubtful, and 
eight did not improve, or grew worse. Two of 
the six cases which improved returned some time 
afterward, with their sight as bad as before, and 
did not improve under further treatment. No 
really conclusive results were obtained, because 
of the smaller number of the cases, and the fact 
that this was not the sole method of treatment, as 
iodide of potassium, or strychnia, or other nerve 
tonics, are noted as having been given in all the 
cases but one. 
Gunn considers, nevertheless, that when we 
compare the above results with those obtained 
where no galvanism has been employed, there 
must be a strong presumption in favor of its util- 
ity in certain cases. He is skeptical of the effi- 
caciousness of iodide of potassium, and looks 
upon strychnia and the other nerve tonics as 
possibly of some use when combined with good 
food. He gives an analysis of the cases with 
reference to the question of prognosis, and the 
conclusion he arrives at is, that “ he should give 
the most favorable prognosis when the patient is 
young or middle-aged, with recent failure of 
sight and present ability to count fingers, at least. 
Color-perception is possibly defective. The disc 
is white, but the large vessels are of normal size. 
There is no history of severe injury to the brain 
or spinal cord, but perhaps there are symptoms 
of locomotor ataxy. 
Retinitis Pigmentosa.—Of the value of gal- 
vanism in this disease Gunn speaks hopefully. 
He reports four cases, in each of which there 
was a decided improvement. In case 1, the 
patient’s condition on admission was, Right eye, 
V=fingers at 3r/; Left,V = f$with36//; and when 
discharged ; Right, V = nearly; Left, V = fli- 
nearly. Gunn refers to the literature of the 
subject, and draws attention to cases reported by 
Neftel and Dor, in which there was marked 
benefit by this treatment. He considers that 
the continuous current is capable of stimulating 
the conductivity of the optic nerve, both as re- 
gards the electrical current and the current 
originated in the impression produced upon its 
end-organs by means of light,and that this counter- 
acts the degeneration of the nerve tissue which 
follows the absorption of light by the pathological 
pigment deposits. The defective blood supply 
also tends to produce further degeneration, 
and possibly galvanism has a temporary effect in 
dilating the blood-vessels, and so improving 
the nutrition of the tissue. 
The caution to be observed in using the 
remedy is to begin with a weak current of five 
or seven cells for a short time, and then grad- 
ually increase if necessary. 
(While observing the caution Gunn has just 
named, and after using the constant current in 
the same manner he has indicated, i. e., as re- 
gards the position of the poles,I have, in specific 
paresis of the pupil and the forms of “neuritis 
optici,” usually following these pareses, had de- 
cidedly satisfactory results in the way of making 
cures. I now consider electricity as an indis- 
pensable therapeutic agent in ophthalmology. 
With the positive pole on the closed eyelid, the 
negative pole on the top of the spine, I seldom 
employ more than five to six cells,and rarely ex- 
cite more than the blue (weak) light impression, 
and if improvement be characteristic the light 
impression will change to white and yellow. T.) 
The Laws of Inheritance in Relation to Disease. 
Lecture iv, delivered by Jonathan Hutchinson, 
at the Royal College of Surgeons of England. 
(Medical Press and Circular, Yol. xxxn, p. 22, 
July 13th, 1881.) 22 
In his fourth lecture on “ Laws of Inheritance, ’ ’ 
Jonathan Hutchinson treats of heredity of retin- 
itis pigmentosa. It rarely appears at birth, 
though he believes the tendency to it to be 
present, but it shortly develops and increases 
with age. Consanguineous marriages tend to 
strengthen the predisposition to the disease, and 
Liebreich has found it to be very common among 
Jews. Retinitis pigmentosa is allied to certain 
forms of choroiditis and to disease of the optic 
nerve. In retinitis pigmentosa the choroidal 
structure is interrupted and the retina is gradu- 
ally obscured by a dense pigmentary deposit. 
The vessels shrink, and when once the series of 
events is established, it pursues a certain and 
inevitable course to the end. He then refers to 
the tendency of defects of the optical structure 
of the eye to be transmitted and become heredi- 
tary, and quotes cases in point, e. g., myopic 
families. He further says : functional changes 
once duly fixed by pathological changes are trans- 
mitted from individual to individual, and that 
which at the outset ranked only as an idiosyn- 
crasy may by and by develop into a determinate 
disease. An instance of this is afforded by a form 
of amaurosis due to the excessive tobacco-smok- 
ing, the tobacco here acting not as the actual 
producing cause of the disease, but as an excitant 
of the tendency to defect when once originated. 
Michel Jul. Affections of the Eye from Dis- 
turbed Circulation in the Carotid. (Beitrdge zur 
Ophthalmologie. Festgabe zur Feir des 25— 
jahrigen Jubildums von Horner. Weisbaden, 
1881.) If a carotid artery be compressed in 
man, a paling of the papilla of the corresponding 
side, a fainter column of blood in the arterial ves- 
sels, and a diminution in width of the venous 
retinal vessels, may be observed for a short time. 
This stage passes quickly, and great venous 
stasis and absence of venous pulsation show 
themselves. A similar venous stasis of the reti- 
na is visible when one arm is stretched upward. 
Ligation of one carotid is followed, immediately 
after the operation, by complete arterial and 
venous anaemia ; later, by filling of the collateral 
channels ; but a venous hyperasmia persists, on 
account of the diminution of arterial pressure. 
This alteration is observed in the eye corre- 
sponding to the ligated carotid. In the venous 
system of the side opposite to the ligated vessel, 
a stronger rhythmical pulsation can be seen. 
Atheroma of the carotid is in intimate relation 
with opacities of the lens ; the so-called senile 
cataract, as well as unilateral cataract with un- 
known cause, finds in this a satisfactory expla- 
nation. (Arch. f. Ophthal., Vol. xi, No. i.) 
Noyes. Cure of Cataract by Electricity. (Amer. 
Ophth. Soc., at Newport, 1881, July 27th, 28th.) 
A seeming cure of cataract by electricity proved 
to be a case of choroiditis, in which, under elec- 
trical treatment, flakes in the vitreous had disap- 
peared. (loc. cit.) 
Sorokin. Parasitic Groicths in the Eye. Der 
Arzt. No. 16. The forms observed by Forster 
and Grafe do not belong to leptothrix. In 
the cornea of an eye which had perished from 
panophthalmitis, he observed long, thin, opaque 
filaments ; they are thicker than those of lep- 
tothrix buccalis, show a tendency to twist 
themselves lengthwise around each other, or to 
assume a curved form. Attempts at cultivation 
failed, excepting in human blood ; here the fila- 
ments lengthened, gathered themselves together 
in a curved form, showed transverse marks of 
segmentation, and divided into two to five pieces 
of different length; the process lasted from 
twenty-five minutes to one hour. The new 
pieces congregated, and thus formed additional 
bundles. This is a new form, leptothrix oculorum 
Sorokini. In an eye effected with panophthal- 
mitis after iridectomy, and also in an existing 
catarrh of the lachrymal passages, he found fila- 
ments dividing dichotomically, having a thickness 
of 2 or 3 division marks of the micrometer ; they 
also exhibited transverse division,and thus formed 
widened rings. The twigs branch off only where 
there are transverse divisions. Besides these, 
there were folds of cells of various size and 
shape. All attempts at cultivation failed. (loc.cit.) 
Wolfe, J. R. On Artificial Pupil. Medical 
Times and Gazette, June 1, 1881, p. 611. In a 
lecture delivered at Anderson College, W. gives 
the indications for the operation, and among the 
contra indications, says that in occclusion from 
specific iritis no operation should be attempted 
till twelve months after all disappearance of irri- 
tation in the eye. 
During the twelve months’ interval the patient 
must be kept on iodide of potassium and mer- 
cury. He described the operation and points of 
selection. He deprecates the employment of 
iridotomy. (loc. cit. Fitzgerald.) 
Theobald. Remarks upon the use of Duboisia 
in Ophthalmic Practice, with report of a case in 
which alarming constitutional symptoms fol- 
lowed its application to the eyes. Maryland 
Med. Jour., vol. viii. T. thinks the toxic action 
of the drug more likely to manifest itself in an 
uninflamed eye than in one that is inflamed. 
Its unpleasant effects are manifest within an 
hour after it is applied to the eye. (loc cit. 
Swan M. Burnett.) 23 
Haab. Anatomical Examination of an An- 
ophthalmus, at the age of 27. Ophthalmological 
contributions on the occasion of the Jubilee of 
Horner. Weisbaden, 1881. The ocular mus- 
cles normally developed; the globes appeared 
as small nodules the size of a bird-shot; the 
optic nerves were delicate, thin threads, the 
orbits of normal size. Sclerotic, choroid, pig- 
ment epithelium, retinal elements, and vitreous 
could be demonstrated in the eye, but no conjunc- 
tiva, cornea, iris, ciliary body and lens. The 
optic nerve consisted only of connective tissue. 
The optic tracts could be followed as white 
strings up to the corpus geniculatum internum. 
The corpus geniculatum externum was absent, 
the pulvinar thalami optici distinctly smaller. 
The thalamus and corpora quadrigemina could 
not be distinctly traced, (loc. cit.) 
Hirchberg. Coloboma and Microphthalmus. 
C.f. A., September. Congenital microphthal- 
mus is in some cases combined with amaurosis, 
opacity of the lens, diminished tension, cyclitis 
and coloboma of the iris. Hirchberg has ob- 
served four cases of this kind. (loc. cit.) 
Leydig. The Eye-like Organs of Fishes. Bonn, 
1881. Certain spots upon the ventral surface of 
some sea-fishes, which by Leuckart had been 
explained as secondary eyes, are not taken as 
organs of special sense by Leydig, who sup- 
poses that they are allied to the spendo-electri- 
cal or electrical organs of other fishes, (loc. 
cit.) 
Michel. Iris and Iritis. G. Arch. f. Ophth., 
vol. xxvii, 2. I. Histology. The proper sub- 
stance of the human iris is enclosed between two 
membranes ; the anterior limiting membrane is 
a delicate layer of endothelial cells; the pos- 
terior one consists of peculiar cellular elements ; 
upon its posterior surface is a pigment layer of 
nearly round, irregularly arranged, pigmented 
cells. Behind the endothelial membrane is a 
layer of anastomosing cells, interspersed with 
lymphoid cells, and resembling the reticulated 
structure of the lymphatic glands ; for this reason 
Michel calls it the reticulated layer. Behind 
this layer, and partly projecting into it, is a 
radiating trabecular arrangement of connective 
tissue fibres ; these trabecles support the numer- 
ous blood vessels and nerves; they are covered 
with flat cells, and the spaces between the 
trabecles and between these and the posterior 
limiting membrane, are filled with a reticulum of 
cells, arranged in a similar manner as in the 
reticulated layer. For this layer Michel pro- 
poses the name “vascular layer.” From in 
front, backward, the iris consists, therefore, of 
the following layers : 1, anterior limitans (endo- 
thelial membrane); 2, reticulated layer ; 3, vas- 
cular layer ; 4, posterior limitans ; 5, pigment 
layer. From its histological elements, the iris 
would appear to be a modified glandular struc- 
ture. The system of lucunse are lymphatic cavi- 
ties in which the nutritive material, filtered from 
the blood vessels, is collected ; the anterior cham- 
ber is a large lymph cavity. II. Development. 
1. In the human embryo, the development of the 
sphincter portion takes place very early; that of 
the ciliary portion at the end of the sixth month. 
2. The pupillary membrane is a pellicle which 
contains nuclei, epithelial cells and blood ves- 
sels ; the latter two disappear, and the pupillary 
membrane becomes the endothelial layer upon 
the anterior surface of the iris. 3. At a certain 
period of foetal life there is a fold in the ciliary 
portion, the plica iridis. If the two opposite sur- 
j faces of the pupillary membrane are not sepa- 
rated, the so-called membrane pupillaris perse- 
verans will be formed. 4. At a certain period of 
foetal life the posterior portion of the iris 
shows three layers: the pars ciliaris retinae, the 
pigment layer, the limiting membrane. The pars 
ciliaris retinae becomes pigmented and disap- 
pears. 5. The pigment layer and limiting mem- 
brane send projections into the sphincter por- 
tion ; the largest and most strongly pigmented 
1 projection is at its peripheric portion, the so- 
called pigment spur. 6. During embryonic life 
smooth muscular fibres cannot be demonstrated in 
any part of the posterior limiting membrane. 7. 
During the last months of embryonic life, and in 
the new-born, the posterior portions consist of 
only two layers, the pigment layer and the limit- 
ing membrane. 8. The limiting membrane must 
be taken as a continuation of the primitive lim- 
itans retina. 9. The projections from the pos- 
terior limiting membrane into the sphincter are 
j the connective-tissue septa, which separate the 
bundles of the muscle. The pigmentation of the 
so-called stroma of the iris is of post-foetal devel- 
opment. (loc cit.) 
OgnefF. Histiogenesis of the Retina. Cen- 
tralblatt, f. d. Med. Wissensch., No. 35 1. 
In the earliest stages (rabbit’s embryo) the retina 
consists throughout of spindle-shaped cells with 
oval nuclei and a narrow zone of protoplasm. 
From both ends of the cells, which lie on a 
different level, both inward and outward, are 
processes which are vertical to the outer surface 
of the retina, and which pass through its entire 
thickness. Here and there upon the outer 
surface of the retina are large transparent 
elements with round nuclei. Distinct mem- 24 
branes which would be taken as the outer or 
inner limiting membranes are not found at this 
stage. 2. The next changes are that the inner- 
most cells become divided, larger and rounder. 
Their nucleus becomes more distinct, and they 
send off several processes which again form mul- 
tiple ramifications. The processes, which run 
inward, and of which each cell sends off one only, 
turn and take a course parallel to the inner 
surface of the retina. They are the first indica- 
tion of the layer of nerve fibres. The outermost 
layer of cells is distinguished by thick, at their 
inner end,-foot-like projections ; these elements 
are the embryonic Muller’s radical fibres. 
The formation of the nerve cells and of Muller’s 
fibres is therefore one of the first embryonic 
changes in the retina. 3. Then between the 
nerve fibres and the spindle-cells above them 
there appears a small stripe, the first indication 
of the molecular layer. At this period the layer 
consists of numerous processes of the nerve cells, 
of the straight columns of Muller’s fibres and of 
processes of the spindle-cells and numerous very 
small granules. 4. The layers become more and 
more developed; especially the molecular and 
nerve cell layers become more sharply defined 
and thicker. Free ndclei and roundish cells appear 
in the molecular layer. The differentiation of the 
retinal layers becomes completed by the formation 
of the rods, and of the two layers and granules. 
The rods are processes of the outermost layer of 
cells, which grow beyond the outer limiting 
membrane. The retina of the mammalia shows 
the same process of development as that of the 
birds and batrachia. {loc. cit.) 
Wiilchli. Microscopical Examination of the 
Colored Globules in the Retina of Birds. G. A. 
f. Ophth., vol. xvii, 2. There are three kinds 
of coloring matter in the globules, sphaerorhodin, 
sphseroxanthin and sphserochlorin. [I. c.) 
Wall. Congenital Absence of the Eyeballs. 
N. Y. Med. Rec., March 26, 1881. The appen- 
dages of the eyes and the lachrymal glands were 
present. (l. c.) 
Wetschtamon. An Anomalous Structure of 
the Human Eye. Aerztliche Zeitung, Nov. 
1881, No. 36. Absence of both irides. Both 
eyes turned in and up. (l. c.) 
Wiethe. A Case of Congenital Deformity of 
the Papilla. Arch. Ophthal., vol. xi, No. 1. 
The papilla showed two dark elliptical depres- 
sions. {1. c.) 
Deutschmann. On the Physiological Chemis- 
try of the Fluids of the Eye. Arch. f. Ophth., 
vol. xxvii, 2. In the fresh aqueous humor there 
is 0.03 of albumen. In the vitreous there is 
much more than in the aqueous. It increases in 
both after death, more rapidly in the aqueous. (Z.c.) 
Pfliiger. “Internat. Ophth. Congr. in Milan,” 
p. 197. Atropine reduces the ocular ten- 
sion. Eserine increases it, also the continuous 
current. Experiments to be continued. (loc. cit.) 
Butz. Preliminary communication on the 
examination of Physiological Functions of the 
Periphery of the Retina. Arch. f. Anat. und 
Phys., Phys. Department, 1881, vol. 5. The 
sensibility to light of every wave length increases 
from the centre toward the periphery up to 80°, 
then decreases more or less rapidly, according to 
the kind of light. The increase in the sensibility 
to all kinds of light varies ; in the most peripheric 
part of the retina it is highest for violet and 
lowest for red. 
Goltz. The Functions of the Cerebrum. Gesam. 
Abhand. Bonn, 1881. The supposition of cir- 
cumscribed centres in the cerebral cortex, with 
special functions, is untenable, consequently 
there is no part of the cerebrum which is dis- 
tinctly set apart for vision. The visual disturb- 
ances which occur after traumata to one side of 
the cerebrum are symptoms of a general dul- 
ness in all the senses, and are caused by a general 
intellectual dulness. Goltz proposes the term 
cerebral diminution of sight, or cerebral ambly- 
opia. (l. c.) 
Landolt. The Functions of the Retina. Arch, 
d' Ophth., vol. 1, 3. The retina has three func- 
tions, the perception of light, color and form. 
That of light is distributed over almost the whole 
retina equally, only in a small part around the 
fovea centralis it is somewhat greater. Peri- 
metrically it extends outward 1003, inward 60°. 
The color perception decreases rapidly toward 
the periphery, but by higher intensities of light, 
colors are recognized to the limit of the field of 
vision. Perception of form decreases rapidly 
toward the periphery, so that at 50° from the 
point of fixation they are no longer recognized. 
The cause is want of practice. (l. c.) 
Parent. Optometry, Ophthalmoscopy and the 
Inverted Image. Rec. d' Ophth., 1881, Sept. 
Refraction can be4 determined in the inverted 
image in two ways. (1) By gradually moving 
the object lens to or from the eye, and noticing 
the change in the size of the image. In emme- 
tropia it remains the same, whether the lens is 
held nearer to or further from the eye. In 
hyperopia the size of the image decreases when 
the object lens is removed from the eye exam- 
ined. In myopia it increases under the same 
conditions. (2) By observing the parallactic 
displacement in comparison to a certain amount 25 
of upward motion of object lens. If we move 
the lens in the vertical plane, the image changes 
as follows : in emmetropia to an equal extent, 
in myopia to a lesser extent, in hyperopia to a 
greater extent. If we place certain glasses 
before the eye examined, and make these ex- 
periments, we can almost tell the amount of the 
anomaly of refraction by trying until the motions 
correspond to what they should be in emmetro- 
pia. 
Schon. Venous Pidsation in the Retina. Klin. 
Monasbl. f. Augenheilk., p. 345. 1. Venous 
pulsation is a phenomenon of impediment. 2. 
The exit of the usual quantity of venous blood is 
diminished by compression. 3. The pulsation is 
brought about by arterial pulsation. 4. The 
region in which this happens must include the 
optic nerve up to the lamina-cribrosa. (Z. c.) 
Bjernum. Hemianopia for Colors. Dansk. 
Hosp. Tidende, January 18, 1881. Total color- 
blindness in the left half of the field. The 
margin passed precisely through point of fixation, 
in a vertical direction. There was an acute brain 
trouble; at least, the patient complained of a 
severe headache, and died suddenly. He was 39 
years old. Unfortunately there was no post- 
mortem. Bjernum cites this case in upholding 
a theory of the existence of a color centre. 
(Samelsohn reported a similar case in November 
of last year.) (Z. c.) 
Brailey. Report of the Committee of the 
Ophthalmological Society on Color-blindness. 
Trans. Ophth. Soc., vol. 1, p. 191. British 
Medical Journal, April 23, 1881. C. f. A., 
Sept., p. 289. There were 18,088 patients ex- 
amined, 16,431 men, and 1657 women—with 
Holmgren’s worsteds test. Of the men, 949 were ! 
Jews, showing 4.9 per cent., and 491 Quakers, 
showing 5.9 per cent.; 145 deaf mutes with 13.7 
per cent, of color blindness. Of the remaining 
14,846 men (of all conditions) there were 3.5 per 
cent, color-blind. 
Among the women there were 730 Jewesses 
with 3.1 per cent., 122 deaf mutes with 2.4 per 
cent., and 216 Quakers with 5.5 per cent. 
Among the remaining 489 women, 0.4 per cent, 
were color-blind. This unusual number among 
women is explained by the fact that Brailey says 
that in them it was not very pronounced. 
It was first doubted in the reference in the 
Centralblatt and absolutely contradicted by 
Cohn, of Breslau, that such a difference is found 
between the higher and lower classes, as Brailey 
says that in the lower classes he found 3.7 per 
cent., and in the higher only 2.5 per cent. All 
who could not distinguish the paler shades were i 
classed as slightly color blind; those who con- 
founded red and green as pronounced. There 
were 615 of the latter class, and three cases of 
total color blindness. It was very seldom that 
blue and violet were mistaken for one another. 
Those who compared pink with deep blue, or 
violet and scarlet with dark green, were consid- 
ered red-blind. Those who compared pink with 
gray or green, and scarlet with light green or 
light brown, were considered green-blind. The 
red-blind had no perception of light coming from 
the distance through a red glass, while those 
who were green-blind distinguished it perfectly. 
Red-blindness appears to be somewhat more 
frequent than green-blindness in England. The 
intelligence of the person had no connection with 
the color perception. It was hereditary. (Z. c.) 
Donders. Color Blindness. An. d'Oc., Sept., 
; 1881. A. f. Ophth., Vol. xxvii. 1. The first 
| part is principally historical. He argues against 
Hering’s theory, and also for the separate con- 
i dition of a red- and a green-blindness. There are 
I four primary colors, red, yellow, green, blue, 
| and 5-6000 color impressions. 
Dor. Perception of Colors. “Intern. Med. 
| Congr.,” in London. Arch. Ophthal., x, p. 339. 
The perception of colors takes place in the brain 
; or optic nerve, but not in the retina. 
Dor. Concerning Our Knowledge of Dalton- 
ism. “Intern. Ophth. Congr.,” in Milan, p. 
179. Discusses the priority of Holmgren’s 
method. As early as 1859 he used a similar 
method, employing the same test colors. Since 
he did not publish it, Holmgren could not have 
known it. He rejects the classification into red, 
' green, and violet-blindness, and admits five 
| kinds : total color-blindness, red-green blind- 
ness, with normal or shortened spectrum ; blue- 
yellow blindness, with normal or shortened 
spectrum. Holmgren’s method is not a certain 
one. Rejects the Young-Helmholtz’s theory. 
Delbceuf’s cure for color blindness is in reality 
no cure. (l. c.) 
De Fontenay. Om Farvesansquelser. Hospi- 
tals-Tidende, July 28, 1881. Recommends a 
systematic education of the color sense in school, 
and in his Kontrol Med. Farveblindheden. Hos- 
pitals-Tinende, Sept. 14, 1881. He examined 
2737 men, finding 3 per cent., and 502 women, 
with 0.6 per cent, of color blindness, in railroad 
employes. (See another paper by the same 
author, based on the examination of 9659 per- 
sons. Archives Ophthal., Yol. x, p. 8, etc.) 
J'ager. Method of Educating and Developing 
the Color Sense. Natur, No. 47. Recommends 
the system of Magnus. (Z. c.) 26 
Jeffries. On Some Points in Regard to Color 
Blindness, Journ. of Nervous and Mental Disease, 
July, 1881. Contests the assertion of Bannister, 
that color-blindness can have no practical bear- 
ing in railroading, it being a well-known fact 
that color-blind people can perfectly distinguish 
colored signals. (l. c.) 
Mac6 et Nicati. Contribution to the Study of 
the Visual Field, for Color. A. d' Ophth.,vol. 1, 
p. 506. A red, a green, and a blue glass is held 
successively before the eye, and it is determined 
how far a white piece of paper can be dis- 
tinguished on the perimeter. The field for 
red is most contracted on gradually diminishing 
the intensity of light. Atrophy of the optic nerve 
and glaucoma show the narrowest field for red, by 
good illumination ; and also the most pronounced 
reduction of central vision, when a red glass is 
held in front of the eye. In alcoholic amblyopia 
the central scotoma for red is the most pro- 
nounced. 
Pierduh. Une visite aux ali6n6s de la province 
h Mombello. Internat. Ophth. Congr. in Milan, 
p. 162. In Italy Daltonism is not so frequent as 
in Northern Europe. This is due to climatic and 
geographical influences,and also to the great voca- 
bulary of words denoting colors. Among 900 
insane persons there was not one case of Dalton- 
ism. Violet was the color, distinguished with 
most difficulty. A majority of those suffering 
from melancholia shrank from bright colors. (loc. 
cit. W. C. Ayer's Transl.) 
The Progress of Ophthalmology During the Fourth 
Quarter of tne Year 1881, by H. Magnus, Bres- 
lau; C. Horstmann, Berlin; and A. Nieden,Bochum; 
and others.—Arcliiv. Ophthal. Vol. XI, No. 2. 
Translated by Dr. F. E. D' Oench, New York. 
J aval. Eclair age tflectrique au point de vue de 
Vhygiene de la vue. Soc. de Mfed. Publ. de 
l’Hygifene Professionelle. Seance du 26 Oct., 
1881. Progr. Mtd. No. 51. Javal hopes that 
the use of electric light may become uni- 
versal. If the necessary precautions are ob- 
served, especially in the use of goggles, the eye 
is not endangered. In place of blue or gray 
goggles, Fieusal recommends yellow ones, as 
they absorb the violet rays more completely. 
Mesmil argues against the electric light. 
Reich. Israelites and Military Service. Med. 
Zeitung, No. 9. In fifteen cases, all of them 
Israelites, a traumatic cataract had been inten- 
tionally produced, in order to escape military 
service.—Hirchmann. 
Weber. Examination of the Eyes in the High 
Schools of Darmstadt. Appendix to the Medical 
Report of the Grand-ducal Ministerial Depart- 
ment for the years 1877-80. Darmstadt, 1881. 
The author treats the subject very thoroughly, 
and comes to the following conclusions: 1. In 
view of the injurious results of poor illumina- 
tion, the windows, where skylights cannot be 
introduced, should not extend lower down than 
the height of the scholars when standing up- 
right; where there are windows already, they 
should be provided with ground glass up to this 
height, on the south and west sides, in their en- 
tire extent; rooms for drawing and female handi- 
work should be lighted from above. In view of 
other demands connected with the question of 
illumination, a revision of the laws governing 
the building of schools, based on the principles 
of hygiene now established, is urgently advised. 
2. In view of the attributes of a good school- 
bench set forth, the introduction of Lickroth’s 
school bench, with a top 50 cm. broad, is to be 
ordered : for drawing and female handiwork, 
they should be replaced by other apparatus. 3. 
In view of the different size of the scholars of 
the same class, they should receive seats corres- 
ponding to their height, as determined at the be- 
ginning of each term. 4. In view of the neces- 
sity of sufficient ventilation, and the injurious 
influence of long-continued sitting, and its in- 
sufficient neutralization by play, as proved by 
statistics, instruction should be limited to three 
quarters of an hour at a time, and the remain- 
ing fifteen minutes be devoted to gymnastic ex- 
ercises, drilling, etc. 5. In view of the injurious 
influence of poor carriage of the body, the 
teachers are instructed to see that the distance 
between eye and work is at least 35 cm., and 
that there is always the necessary amount of light, 
to be determined by appropriate trial-plates. 
6. In view of the injurious influence of poor 
material, all printed matter not in accordance 
with the principles established in respect to it 
should be discarded, also checkered blank-books, 
plates, models for drawing, printed charts, and 
too fine needlework. 7. In view of the injurious 
influence of sewing of all kinds on children not 
at least ten years old, and in view of the neces- 
sity of stricter mental occupation at this age, a 
complete reform of this instruction is demanded. 
8. In view of its mentally as well as physically 
injurious influence, the present system of pen- 
manship should be replaced by a round-hand 
form. 9. In view of the unprofitableness of dic- 
tation, it should be forbidden from principle, 
and only allowed for the shortest notes. 10. In 
view of the necessity of constant medical con- 
trol over the hygienic postulates of the school. 
Dufour. Transplantation of the Conjunctiva. 
Transac. of the Intern. Med. Cong., London, 27 
viii. Rev. Med. de la Suisse Rom., 1881, No. 
10, Oct. 15. The human conjunctiva may be 
replaced by that of the rabbit; also by other 
mucous membranes. There must be no bleeding 
of the spot upon which the mucous membrane is 
transplanted. Great care must be taken in ap- 
plying the sutures ; it is best to insert them into 
the patch before transplanting it. Dufour did 
not observe any shrinkage of the transplanted 
piece of mucous membraile. It is not advisable 
to use salicylic acid during or after the operation. 
Forster. Some Improvements in the Operation 
for Senile Cataract. Schlesische Gesellsch. f. 
Vaterldndische Cultur, Oct. 18, 1881. Breslau, 
drztl. Zeitchr., 1881, No. 24, and Rep. on the 
thirteenth meeting of the Ophth. Soc. at Heidel- 
berg. When the cataract ripens slowly a squint 
hook, after previously making an iridectomy, 
should be passed over the cornea several times, 
pressing and rubbing upon it; the corticalis, be- 
ing not yet entirely opaque, is thus broken up 
within the capsule. The capsule should not be 
opened with the cystotome, but with a fine for- 
ceps, as in this way the greater part of the ante- 
rior half of the capsule may be removed from 
the eye, thus diminishing the danger of sub- 
acute iritis, ofirido-cyclitis. Carbolic acid for dis- 
infecting the eye or the instruments should be 
discarded. The instruments, however, should 
be disinfected in absolute alcohol before the 
operation. Not much weight is attached to dis- 
infecting bandages. 
Brettauer. The Local Application of Iodoform. 
Report of the thirteenth meeting of the Ophth. 
Soc. at Heidelberg, 1881. Iodoform not only 
seems to cause irritation in diseases of the con- 
junctiva and cornea, but also seems to diminish 
the secretion of the conjunctiva, to bring about 
retrogressive changes in granulations, and to act 
beneficially in sclerosing keratitis. It is used in 
form of a powder, or as a salve in equal parts 
with vaseline. 
Carreras-Arag6.' Pilocarpine in Diseases of 
the Eye. Revista de cienc, Med., de Barcelona. 
Report C. f. A., p. 341. Its use is indicated in 
all affections in which an energetic contraction of 
the pupil is desired ; for instance, in conical 
ulcers threatening incarceration of the iris. 
Success slight in detachment of the retina. 
Josso. Paris, 1881. Doin, 60 pages. Out of 
sixteen cases, fifteen were successfully treated by 
subcutaneous injections of pilocarpin. Compare 
the less favorable results obtained by Carreras- 
Arag6 precisely in regard to this point. 
Kauders. Pilocarpine as an Antidote of Atro- 
pine. Wiener Med. Wochenschr., 1881, No. 45, 
Pilocarpine is a speedily acting and sure antidote 
of atropine. 
Krijmer. On the TJse of Antiseptic Solutions of 
Atropine and Eserine. Correspondenzblatt f. 
Schweizer Aerzte, 1881, No. 19. Boiling the 
solutions, and adding boracic acid 4: 100 and 
carbolic acid 1:1000, keeps them clear and free 
from the development of bacteria. 
Konigstein. Notes on the Histology of the Eye. 
Graefe's Arch., Bd. xxvii, 3. 1. The nerves of 
the sclera. The human sclera has nerves of its 
own ending within it. 2. The pupillary membrane. 
It consists of four to five larger blood vessels, 
forming arches ; numerous small blood vessels, 
coming from the iris and communicating with 
each other, empty into these arches. The centre 
of the pupillary membrane is always free from 
blood vessels. The blood-vessels of the pupillary 
membrane do not come from the circulus iridis 
minor, but in conjunction with the blood vessels 
of the ciliary muscle and ciliary processes from 
the ciliary blood-vessels. The retrogressive 
change begins toward the end of the 7th or the 
beginning of the 8th month. 
Cahn. The Physiological and Pathological 
Chemistry of the Eye.. Beitschr.f. Phys. Chemie. 
Bd. v. p. 214. The reaction of fresh retina is gen- 
rally alkaline; on the external surface sometimes 
acid. Theretinaof the ox contained water 86.52 ; 
albuminous substances 6.77 ; substances resem- 
bling albumen 1.59; alcohol extract 0.25; aqueous 
extract 0.42 ; cholesterine 0.77 ; fat 3.47; leci- 
thine 2.03 ; soluble salts 0.93 ; insoluble salts 
0.02 ; traces of cerebrine. There is no essential 
difference between the chemical composition of 
the aqueous humor and the vitreous. The lens 
consists of globuline. In cataractous lenses a de- 
crease of albumen could be demonstrated, as also 
the coagulation of a portion of the albumen. 
Denissenko. Investigations on the Nutrition 
of the Cornea. Virchow's Arch., Bd. lxxxvi, 3. 
1. The cornea does not draw its nourishment 
from the anterior chamber (Knies, Ulrich), but 
from the surrounding blood vessels in the sclera. 
Therefore, the cornea is nourished in the same 
manner as every other tissue of the body. 
2. Although the blood vessels nourishing the 
cornea are situated in the sclera, at some dis- 
tance from the sclero-corneal margin, the nour- 
ishing fluid, after leaving them, is conducted 
through the fibres and fissures of the sclera to 
the corneal margin, where it enters the lacunar 
system, and is distributed throughout the entire 
thickness of the cornea, and then discharged 
into the anterior chamber. 3. The current does 
pot flow from the centre to the periphery of tho 28 
cornea (Knies, Ulrieh), but from the periphery 
to the centre (Cohnheim, Szokalski), and not 
from behind, forward (Knies, Ulrich), but from 
in front, backward. 4. Therefore, the stomata, 
which Klebs and others have demonstrated in 
the epithelium of Descemet’s membrane, do not 
form the commencement of Recklinghausen’s 
lymph spaces for drawing nourishment from the 
anterior chamber, but serve to discharge the 
waste products. 5. This shows that the cornea 
does not draw its sustenance from the anterior 
chamber, but that, on the contrary, the waste 
products are discharged into the anterior cham- 
ber. 6. It therefore follows that the anterior, 
chamber is an enlarged duct for discharging the 
aqueous humor. 7. Therefore it may be said 
that not the anterior chamber nourishes the 
cornea, but the cornea the anterior chamber. 
Schmidt-Rimpler. The Empiric Theory of 
Vision. Sitzungsber. der Gesellcli. zur Befor- 
derung der ges Naturwissensch. zu Marburg, 
1881, No. 4, Dec. A child, three years old, had 
forgotten its sight so completely, in consequence 
of an acquired opacity of the lens, that after be- 
ing successfully operated, it had to learn to see 
again. This is against the view of Dubois-Rey- 
mond, according to which’ the ability to inter- 
pret correctly the impressions on the senses is 
not exactly congenital, but comes suddenly, the 
child not being taught by experience, in the way 
assumed by the empiric theory. 
Frankhauser. Examination of the Scholars 
of the High School at Burgdorf for Color Blind- 
ness. Ann. Rep. of the high school at Burg- 
dorf, at the close of the school year 1880-81. 
Holmgren’s and Pfliiger’s methods were em- 
ployed. Stilling’.s plates are not always reliable, 
and can, therefore, not be recommended. Red- 
green blindness was found in 6.2 per cent, out of 
177 scholars ; 44 made mistakes, though not color 
blind. It is advised to cultivate the color sense 
at school; the system of Magnus was used for 
this purpose, with good results in general. 
Lagethschnikoff. A Rare Case of Elephan- 
tiasis Palpebrarum. Med. Uebersicht, Bd. xv, 
p. 894. Both lids are very much enlarged ; the 
upper hangs down to the nasal angle. The dis- 
ease began in early childhood. (Hirchman.) 
Mandelstamm. A Case of Sarcomatous Ec- 
tropium, with some remarks upon Trachoma. 
Arch, of Ophth., Bd. xxvii, 3, p. 101. From 
the condition of the ectropionized lids, the author 
concludes that the tendency of the epithelium of 
the conjunctiva to become hypertrophic is great, 
not only when directly exposed to the air, but 
also when, in consequence of unknown injurious 
influences (dust, smoke, scrofula, barrack air, 
etc.), trachoma develops. The hypertrophy of 
the epithelium, together with the hyperplasia of 
the adenoid tissue, is of primary importance in 
trachoma; perhaps the pertinacity of the disease 
may be ascribed to it. When the hypertrophy 
has once begun, it can cause, at any time, fresh 
irritations of the adenoid tissue. 
E. Gruning. Traumatic Ophthalmoplegia. 
Med. Record, Nov. 12; All the muscles of the 
left eye were paralyzed by a blow of the fist. 
The 0. N. showed no alteration with the 0. S., 
but there was total blindness. G. thinks there 
must have been fracture of the pyramid of the 
orbit, with laceration of the optic nerve. (Swan 
M. Burnett.) 
C. Higgens. On Distention of the Frontal 
Sinuses. Guy's Hosp. Reports, vol. xxv, 27, 
1881. A report of four cases in H.’s practice, with 
critical remarks and citation of published cases 
and opinions. In case 1, M., 32, there had been 
abscess in the same place at age 7, and injury 
followed by removal of dead bone from same 
place; age 16, tumor noticed eight months. 
Case 2. M., 13, no injury, swelling noticed six 
months. Case 3. F., 19, no injury, tumor 
eight months. Case 4. M., 36, age 14, was 
kicked over his eyes ; age 29, another injury by 
iron bar over orbit. Pain in L. supra-orb. region 
began two years later, together with some ptosis 
and pain at pulley of supr. oblique. No swell- 
ing till three and-a-half years, after which he 
first was seen, or five to six years after second 
injury. All treated by free incision and estab- 
lishment of an opening from floor of distended 
sinus into nose ; result good in all. Remarking 
on the difficulty of diagnosis in this disease, H. 
makes the important, and probably new obser- 
vation, that the swelling (when it has caused ab- 
sorption of bone) varies in size at different times 
of day, being smaller after lying down for some 
hours; it always points above the tendo-oculi.— 
E. Nettleship. 
Kramosztyk. A Foreign Body in the Orbit. 
Gaz. lekarsk, 1881, p. 76. A man 45 years old 
was attacked with typhoid fever, shortly after 
having received a blow from the shaft of a 
wagon. The whole time he was ill he com- 
plained of severe pains in the eyes. Three 
months later slight blepharospasm developed ; 
the eye was deflected inward considerably. 
There was a small ulcer at the upper inner mar- 
gin of the cornea, next to which a foreign body, 
firmly imbedded, was detected by the probe. It 
was extracted with difficulty and found to be a 
piece of wood six cm. long. The canal in which 29 
it lay had a smooth cicatricial surface, and bone 
was exposed. The convergent squint was caused 
by formation of this canal, which extended in- 
ward along the internal rectus muscle. Vision 
was not perceptibly reduced.—Hirschmann. 
Nsarkiewicz-Jodko. Cases of Lesions of the 
Eye, of Traumatic Origin. Gaz. lek, 1881. 
After an insignificant injury an inflammation of 
the orbital tissue set in, which led to the forma- 
tion of an abscess. The abscess was opened, 
and a temporary improvement ensued, though 
there was soon a relapse. The patient, who 
went elsewhere, was treated expectantly. Three 
weeks later a second abscess opened spon- 
taneously, and all the symptoms of disease dis- 
appeared. The eye, however, was totally amau- 
rotic, showing atrophy of the optic nerve. It 
follows, therefore, that in abscesses of the orbit 
an active, not a waiting, treatment must be 
adopted at an early date. 
. Berlin. A Case of Injury of the Optic Nerve 
Through Fracture of the Optic Canal. Ber. 
iiber de 13, Vers. d. Ophth. Ges., p. 81. The 
author observed, at the autopsy of a suicide, a 
fracture of the optic canal, which had severed 
the nerve, not only within the canal, but also 
within the brain. 
J. R. Wolfe. Aneurism of Orbit (Pulsating 
Exophthalmus) Following Injury Cured by Liga- 
ture of Common Carotid. Lancet, Dec. 3, 1881, 
(ii, 945). F., 22 ; symptoms began three months 
after a blow on left eye, with pain and beating in 
the head, slight proptosis and bruit heard in 
orbit; eight months after injury, proptosis 
greater; a short, pulsating tumor near inner 
canthus, with thrill and puffing bruit; pulsa- 
tion stopped by pressure on parotid ; papillitis, 
with extreme venous engorgement. Vision some- 
what defective ; ulceration of cornea. Ligature 
of common carotid by Dr. Foulis, eight and a 
half months after injury ; full antiseptic precau- 
tions and catgut ligature. Pulsation stopped 
and tumor much diminished. S. recovered per- 
fectly and 0. D. cleared. Four weeks after ope 
ration only slight proptosis (E. Nettleship). 
Skrebitzky. Case of Anophthalmus, with 
Congenital Cysts in the Loioer Lids. Klin. 
Monatsbl. f. Augenhk., B., xix, p. 423. In a 
child six months old, otherwise healthy, and 
with a normal skull, the orbit was found abso- 
lutely empty. Globular tumors of the size of 
normal eyes protruded upward beneath mucous 
membrane of the lower lids; fluctuation was 
easily perceptible. Either they were cysts of 
the lower lids or malformed eyes. 
Kranhik. The Cause of the Diseases of the 
Conjunctiva in the Army. Wratsch, No. 10,1881. 
The causes are insufficient sleep, drill in the sun, 
too tight cravats and collars, besides bad air in 
the barracks, and diseases of irritability of the 
conjunctiva acquired before serving.—Hirsch- 
mann. 
Fialkowsky. A Case of Papulous Syphilis of 
the Conjunctiva Bulhi. Wratsch, No. 5, 1881. 
After a syphilitic angina and condylomata at the 
anus, a nodule resembling a phlytsenula de- 
veloped on the conjunctiva of the globe three to 
four mm. downward and inward from the cornea, 
which ulcerated on the fourth day, and disap- 
peared without any local treatment after fourteen 
subcutaneous injections of sublimate (cgrm. per 
dose). 
Mikucki. Eserine in Keratitis, Medycyna, 1881. 
Mikucki recommends the use of eserine in ulcers 
of the cornea, especially at the periphery, basing 
his advice on the clinical history of twelve cases. 
Kramsztyk. Neuro-paralytic Keratitis, Medy- 
cyna, 1881. Kramsztyk discusses the identity of 
the so-called neuro-paralytic keratitis, with other 
affections of the cornea which occur in severe 
forms of the disease, when the patients remain 
unconscious for some length of time, with eyes 
half open. They are due to the loss of moisture 
of the cornea. 
Gouvea Hilario (de Rio Janeiro). Aniridia 
Congenita of Both Eyes, with Deficiency of the 
Ciliary Bodies and Anterior Part of the Choroid. 
Transact, of Intern. Med. Congr., London, vol. 
iii, p. 120. Man, 23 years old ; complete ab- 
sence of iris in both eyes ; lenses dislocated up- 
ward, so that there is an aphakic space at the 
lower corneal margin. No sign of the presence 
of ciliary processes, nor of the anterior part of 
the choroid, while the posterior part is more or 
less normal, as are also the blood vessels of the 
retina. 
Hansell. Experiments in Vaccinating Syphi- 
lis upon the Iris and Cornea of the Babbit. G. 
A. f. 0., Bd. xxvii, 3, p. 93. The experiments 
were made with the thin, purulent contents of a 
gumma which was still intact. On the twenty- 
fifth day after vaccination iritis set in in both 
eyes, together with the growth granulamas resp. 
papules and gummata in the ciliary body. When 
only the cornea was vaccinated, several small, 
very vascular nodules developed. The animal 
died after six months of marasmus. The lungs 
and liver were infiltrated with small tumors re- 
sembling tubercles. The same result ensued in 
about four weeks, when the secretion from 
“ plaques muquesses,” well known for its high 
infectious power, or from particles of a still in- 30 
Rymarkiewicz. Polycoria in the Left Eye. 
Medycyna, 1881. The normal pupil was some- 
what displaced downward and inward. The 
second pupil was situated slightly upward and 
outward, was of an oval shape, with a major 
diameter of two mm.,and a minor of one mm. 
The pupil of the right eye is slightly dislocated 
downward.* 
Priestley-Smith (Sheffield). Acute Glaucoma 
Following Concussion, Cured by Eserine. Trans- 
act. of the Ophth. Soc. of the Unit. Kingd. The 
Lancet, No. 25. 
Arlt. Spontaneous Rupture of the Anterior 
Capsule of a Cataractous Lens. Ber. d. Heidelb. 
Ophth. Ges., 1881, p. 130. A cataract has slowly 
developed in a myopic woman, 34 years old; 
seven years earlier detachment of the retina had 
taken place. The spontaneous rupture of the 
capsule happened during the night. A linear 
section was made, and a portion, consisting of 
cholesterine and fatty lenticular substance, re- 
moved. The eye remained good. 
Critchett. Practical Remarks on Cataract. 
The Ophthalmic Review, vol. i, Dec. 1881, p. 21. 
C. divides his subject into two heads: 1. Cata- 
ract during its period of formation. 2. Cataract 
when it has so far arrived at maturity as to justify 
operative interference. The first of these he 
discusses under the head of “ Preliminary Treat- 
ment of Cataract.” He thinks we are too apt 
to treat cataract patients merely as subjects for 
operation, and that, consequently, they are often 
led to seek the advice of unscrupulous pre- 
tenders, who either promise to remove the opacity 
or to arrest its progress. He recommends a 
constant surveillance of the case from the time 
the opacity is clearly made out. He next con- 
siders the question as to how far it is expedient 
to inform the patient of the existence of the dis- 
ease during its early stages. He concludes that 
it is impossible to lay down any hard or fast rule 
as regards this, for each case must be dealt with, 
as far as the exercise of judgment will permit, 
according to its own special requirements. With 
reference to the question as to what can be done 
for the patient in the way of palliative treatment, 
C. speaks of good results being often obtained by 
the employment of stenopoeic glasses, with or 
without magnifying power. As regards the use 
of atropine, it is impossible to lay down any rule, 
but as a matter of policy, he indicates discretion 
in prescribing it, and insists upon the importance 
of always ordering a weak solution, and never 
instilling it into both eyes at once. (Fitzgerald.) 
Goldzieher. Ossification in the Periphery of 
the Lens. Ber’d. 13, Heidelb. Ophth. Ges, 1881, 
tact sclerosis, was used. A characteristic differ- 
ence between the syphilitic and tuberculous nod- 
ules consists in much greater vascularization of 
the former, and in the tendency of the latter to 
caseous disintegration. Vaccinating with lupus 
produced no result whatever. 
Hosch. Primary Sarcoma of the Iris. C. f. 
a., Bd. v. p. 361. It has developed in a person 
66 years old, at a spot upon the iris where a pig- 
mentation of a darker brown has existed ever 
since his youth. The tumor proved to be a pig- 
mented spindle-cell sarcoma, which had not yet 
touched the choroid and ciliary body. The 
author assumes with Knapp the probability of a 
conversion of the normal pigmented hyperplastic 
tissue in the neoplasm during the later years of 
life. The newly formed pigment undoubtedly 
comes from the blood vessels. 
Hosch. A Case of Gumma of the Ciliary 
Body. C. f. a., Bd. v. p. 365. The author adds 
six cases which were overlooked by Seggel in 
his bibliography in (loc. cit.) Patient 37 years old ; 
7 months after infection a rapidly growing tumor 
developed under violent symptoms of inflam- 
mation of the iris and choroid, and soon reached 
the size of a small cherry. Energetic inunction 
(120 grms. of blue ointment and one grm. calomel 
were used daily) gradually reduced the size of 
the tumor until it finally disappeared entirely. 
Masse. Pearly Tumors of the Iris. Rec. 
d1 Ophth., July, August, 1881. After an injury 
of the eye combined with a penetrating wound of 
the cornea, sometimes cysts develop upon the 
iris, sometimes solid tumors. Many intermedi- 
ate stages exist between these two varieties, the 
serous translucent cysts and the epithelial pearly 
tumors. Some cysts are almost entirely solid 
and filled with fat and epidermis cells; the 
pearly tumors also contain epithelial cells, fat 
and crystals of cholesterine. The want of an 
enveloping membrane in the pearly tumors, 
which the author doubts, constitutes only an ap- 
parent difference. Masse reports a case of a 
pearly tumor of the iris, observed by himself, 
which had developed around three lashes; they 
had entered the anterior chamber through a 
wound and lay upon the iris. The author has 
shown, by experiments upon rabbits, that when 
the lashes are deprived of the bulbs and brought 
into the anterior chamber, they do not cause the 
development of tumors of the iris ; these are 
due to the presence of the bulb or small particles 
of the epidermis or conjunctiva. After introduc- 
ing a piece of conjunctiva into the anterior 
chamber a cyst and pearly tumor of the iris de- 
veloped in the same rabbit.—Marckwort, 31 
p. 155. In a globe enucleated on account of 
phthisis dolorosa, the anterior surface of the lens 
was found covered with an osseous capsule. 
Total detachment of the retina and choroid, due 
to the contraction of the cyclitic tissue. 
Purtscher. Erythropsia after Traumatic Cata- 
ract. C. I. A., Bd. v, p. 333. The cataract 
was absorbed spontaneously and completely. The 
pupil was perfectly black two and a half months 
after the injury. V = J. One morning, five 
months later, he saw all objects red, and this con- 
tinued for three days. Two weeks later, after 
being much heated, the same phenomenon, with- 
out any ophthalmoscopic changes. V = £. 
Report of a second similar case in senile cataract. 
Abadie. Galvano-puncture in the Treatment 
of Detachment of the Retina. Soc. de Chir., 
Stance, Nov. 30, 1881. Prog. M6d., 1881, No. 
49, et Gaz. H6bd., Dec. 9, 1881. Detachment 
of the retina frequently has a local cause ; it is, 
therefore, open to surgical treatment. Abadie 
recommends galvano-puncture with a platinum 
knife for this purpose. The sub-retinal fluid is 
allowed to escape through an incision, so that 
the retina can re-adapt itself. The inflamma- 
tion which then sets in is supposed to fix the 
retina in its position. Eight cases were treated ; 
six chronic ones, with transient good results ; 
two cases of limited detachment, with “ satisfac- 
tory” results. As the tension was permanently 
reduced in these cases after the operation (per- 
haps without galvano-puncture, from the detach- 
ment.—Reviewer), the author thinks of treating 
glaucoma in this way (Marckwort). 
J. Hutchinson. On Retinitis Pigmentosa and 
Allied Affections, as Illustrating the Laws of 
Heredity. Ophth. Rev., vol. 1, Nov., 1881, p. 
2. After treating of the disease in general, the 
author reports his experience in regard to the 
influence of consanguinity upon the development 
of retinitis pigmentosa. He possesses the data 
of twenty-three persons or their families. Eight 
of these sprang from marriages among relatives, 
among whom there was no record of a previous 
case of the kind. Three of these patients were 
partially or completely deaf. In four of the eight 
cases, only one person was affected ; ten times, 
more than one member of the family was af- 
fected ; twice, three children; eight times, two 
children. In ten cases no consanguinity in the 
family could be proved by anamnesis, and among 
these, in five cases, two members of the family 
were affected. The author thinks that consan- 
guinity is undoubtedly an important factor in the 
development of ret. pigmentosa, as it is for deaf- 
mutism and idiocy. 
Retinitis Hcemorrhagica, especially in its 
Relation with Gout. Med. Times and Gazette, 
Dec. 10th, 1881, ii, 675. Considerations and con- 
clusions based on twenty-four cases (including 
the case in Jaeger’s Hand Atlas, pi. xiv, fig. 65). 
Of this number twelve had had gout, five others 
were probably gouty, and in seven no gouty his- 
tory was obtained ; nine were over 60 years old, 
none less than 45; thirteen males, eleven females. 
One eye affected in seventeen; both in seven. 
Gout probably predisposes to this affection, 
through the medium of disease of blood vessels, 
and “an incomplete thrombosis of the vena 
centralis” is probably the actual cause of the 
attack, suddenness of onset and asymmetry be- 
ing in favor of this view. It differs from the re- 
lapsing intra-ocular bleeding of young adult 
males. H. refers to the possible connection of 
this latter disease, and also of haemophilia, with 
gout, by the hereditary transmission of arterial 
disease.—E. Neltleship. 
Macheck. Retinitis Pigmentosa. Przcglad 
Lek., 1881. Of seven children of consanguineous 
parents, five are affected with ret. pigmentosa 
hemeralopia, and atrophy of the optic nerve. 
The other two children (daughters) are well, and 
their children have normal eyes. Symptoms of 
hemeralopia first manifested themselves after the 
tenth year ; the only boy became totally blind when 
eighteen years old, while the sight of the four 
daughters was still moderately good in their 
twentieth year. The eyes were mostly myopic, 
5 to 9.5 D. ; all had nystagmus. The retinal 
deposits were accompanied in two cases by acute 
inflammation of the choroid, after strychnine had 
been tried for a time. Color blindness was ob- 
served in three cases; one complete, twice partial. 
St. Marenitsch. Unilateral diffuse syphilitic 
retinitis, with complete loss of sight, cured in 
forty-eight days, by the use of iodine and mer- 
cury. Prot. d. Med. Ges. in Wilna, 1881, No. 
3.—Hirschmann. 
Mas. An Interesting Case of Amaurosis Due 
to Hysteria, La Union de las Ciencias M6dicas 
de Cartagena. Two successive attacks of amau- 
rosis in consequence of hysterical eclampsia, 
without any ophthalmoscopic changes, the one 
lasting five, the other thirty-one days, the amau- 
rosis disappearing suddenly each time. These 
cases also are open to doubt. 
Reid and Hunter. Embolism of Central 
Artery of Left Retina. Glasgow Medical Jour- 
nal, Oct. 1881. An ordinary case of embolism 
with partial recovery, the important point being 
the history of numerous attacks of temporary 
total blindness of same eye, lasting from half an 32 
hour to two hours, and usually coming on after 
severe exertion ; at least twelve such attacks 
occurred in the three months preceding the final 
“embolism.” 
Priestley Smith. Retinitis Pigmentosa, Con- 
nected with a History of Maternal Shock. The 
Ophthalmic Review, vol. i, Dec., 1881, p. 30. In 
the history recorded by S. there was no consti- 
tutional nerve disorder in the earlier generations, 
and no consanguineous marriage. The mother 
of the cases he relates had borne two healthy 
children. She suffered a severe nervous shock 
during the earlier months of the third pregnancy; 
the child, and all the subsequent children, ex- 
cepting one which died in infancy, developed 
retinitis pigmentosa with partial deaf-mutism.— 
Fitzgerald. 
Unterharnscheidt. The Development of De- 
tachment of the Retina in Myopia. Berl. Klin. 
Wochenschr., No. 40,1881, p. 585. The author 
concludes: If the ciliary muscle is suddenly re- 
laxed when powerfully contracted (especially 
when wrong glasses are used or objects are 
brought excessively near), a reduction of the 
tension of the vitreous body ensues, which for 
the moment is considerable, and which cannot 
always be compensated for by a corresponding 
contraction of the eyeball, because the increased 
tension, the bulging and its consequences have 
diminished the elasticity. As the elasticity 
of the scleral tissue, which acts as a regu- 
lator, fails here, the law of the “ horror vacui,” 
so to speak, comes into play, which suffices, 
when there is the predisposition, to detach 
the stretched retina from the choroid, whose 
connection with the retina has been loosened. 
If the accommodative strain continues, the 
slight elevation may develop into a bullous de- 
tachment of the retina. As the increased intra- 
ocular tension which accompanies the accom- 
modative action also causes absorption of the 
vitreous humor, it becomes mainly the part of 
the stream of diffusion which sets in when the 
accommodation is suddenly relaxed to fill the 
vacuum created. The compensating fluid from 
the blood vessels of the choroid would then in- 
crease the detachment, as the retina is no longer 
any obstacle. The author then discusses the 
therapeutics and prophylactic measures. 
C. Higgens. Three Cases of Simple Atrophy 
of Discs in the same Family. Lancet, Nov. 19, 
1881, vol. 2, 869. The fourth, fifth and eighth 
children of a family of ten, born alive. S. be- 
gan to fail at set 15 years in the fourth, 11 in 
fifth, and 10 in eighth. No other symptoms 
than simple atrophy of discs with almost blind- 
ness ; failure rapid in fourth and eighth, slow in 
the fifth. Mother, symptoms of syphilis soon 
after birth of No. 4; Nos. 6, 9 and 10 healthy ; 
No. 7 died almost at birth ; between Nos. 4 and 
5 were several miscarriages. Retinal blood- 
supply below normal. H. thinks the atrophy 
due to disease of blood vessels.—E. Nettleship. 
Talko. Injuries of the Eye in Recruits. 
Gaz. lekarsh, 1881, C. f. a., Bd. v. p. 386. In- 
juries of the cornea by caustic potash, nitrate of 
silver, or bites of leeches, are frequently found 
among the Russian conscripts. An artificial 
trauma of the eye was proven in sixteen cases 
out of two hundred and thirty-five who were 
suspected of simulating, or 7 per cent. 
Drosdoff. Epidemic Scurvy. Journal of the 
Kasan Med. Soc., 1881, Nos. 14 and 15. From 
a report by Kriickow. Among 200 scurvy pa- 
tients, 28 with diseases of the eye. Besides 
hemorrhages beneath the conjunctiva and skin 
of the lids, four cases of keratitis serosa diffusa 
(one with a corneal ulcer), two cases of iritis, 
four of hemoralopia.—Hirchmann. 
v. Hippel. Affections of the Eye in Recur- 
rent Fever. Ber. uher d. Ophth. Klinik Zu 
Giessen, Stuttgart, Enke, 1881. Among 193 pa- 
tients, 23 cases — 11 per cent, were observed 
with affections of the eye. Most of them irido- 
choroiditis. Hypopyon was never observed. 
In four cases the ocular affection set in during 
the attacks in the others, one to four weeks later. 
In two cases hemorrhages of the retina were ob- 
served. Result favorable in all cases. 
Luchhau. Diseases of the Eye and Ear in 
Recurrent Fever. Ver. fur Wissench. Heilk. 
z. Konigb. Berl. Klin. Wochenschr., No. 43. 
Among 180 patients, six cases with diseases of 
the eye during the attack, in three iritis in one 
eye (once with hypopyon), in two optic neuritis 
of both eyes, and in one iritis in one eye with 
hypopyon during the first attack, from which re- 
covery was complete, and during the second at- 
tack irido-cyclitis and neuro retinitis in both 
eyes. 
Hirchberg. Tuberculous Inflammation of the 
Eye. Transact, of the Internat. Med. Congr., 
London, 1881, p. 117. Among 1700 patients, 
three cases ; one of the conjunctiva bulbi, one 
of the iris, and one of the choroid. The diag- 
nosis was confirmed in each case by the anatom- 
ical investigation. In three cases, swelling of 
the lymphatic glands was observed as a second- 
ary symptom, so that it is advisable to remove 
tuberculous deposits as rapidly as possible by 
operation. The changes in the eye are undoubt- 
edly of a specific character. 33 
J. A. Ormerod. The Diagnostic Symptoms of 
Tabes Dorsalis. St. Bartholomew's Hospital Re- 
ports, Vol. xvii, 39, 1881. 0. directs his atten- 
tion in the interesting paper, chiefly to the ab- 
sence of the knee phenomena and affections of 
the pupils in the early stages of tabes. He ob- 
serves, in the first place, that (as is known) the 
true “Argyll Robertson pupil” (a small pupil 
was associated, but with no reflex action) is sub- 
ject to variations ; it may be larger, but act as 
above ; or it may be motionless to associated as 
well as to reflex stimulus. In eight cases, with 
marked incoordination, reflex action of pupils lost 
or feeble ; associated action normal in six ; both 
actions wanting or feeble in two. In four, with 
slight incordination, reflex action lost, associated 
action normal, two ; both feeble, one ; variable, 
one. In four with other symptoms but no inco- 
ordination, reflex action lost or feeble, associated 
action normal in three ; both absent, one. In 
twenty-one cases, optic atrophy in four ; six pa- 
tients were more or less deaf, two of them hav- 
ing optic nerve atrophy (E. Nettleship). 
1702 Chestnut Street. 
J. Hughlings-Jackson. Tumors of the Cere- 
bellum. Proceedings of the Medical Soc. of Lon- 
don, vol. v, 50, 1881. The point of special oph- 
thalmic interest is the author’s statement, that 
he has never seen defective V. in cerebellar tumor 
without optic neuritis ; thus, in reference to the 
hypothesis that such tumor, especially if of the 
middle lobe, might cause blindness by pressing 
on corp. quadrige'n. 
Zaufal. Value of Ophthalmoscopic Examina 
tion for the Diagnosis, Prognosis and Thera- 
peutics of Diseases of the Ear. Prager Med. 
Wochenschr., Bd. vi, No. 45, p. 448. When 
an inflammation of the middle ear spreads to 
the meninges, the eye of the same side is first 
attacked; generally, however, both eyes are 
affected. After trephining the mastoid pro- 
cess, the hyperaemia of the corresponding eye 
vanishes more rapidly. Almost all cases of 
otitis media, with or without caries, which lead 
to meningitis and thrombosis of the sinus are 
complicated with affections of the fundus of the 
eye.