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14th. The eye has been " very easy." The ulceration is not deep, and vessels shoot into it. The central portion of the cornea, which has been hazy, is clearer. Rep.

21st.-Steady improvement. The ulceration does not spread, but is filled up nearly to the level of the central part, which is clear. The ulcerated part is defined by an abrupt line from the healthy cornea, and is opalescent. On the inner side, in the seat of the original ulcer, it admits of our seeing the iris through it.

28th.-More irritability of the eye, and pain in the cheek. The ulcerated parts, though not so deep, are more extended, and occupy all but a central portion of a quarter of an inch wide.-Rep. Pulv. Ipecac. C. gr. viii. o. n.

Oct. 23d.-Little alteration. The eye has been, on the whole, quieter; but every now and then becomes more irritable for a few days. Still has the issue.-Rep.

30th.-More aching pain in the globe. The ulceration is no where deep, only slightly below the level of the remaining cornea, and looks like a very old vascular leucoma,-having vessels of considerable size running into it from the conjunctiva and sclerotica. The remaining non-ulcerated portion is more opaque. There is nothing new in his general state, and no new injection of the eye.

Nov. 8th.-The remaining portion diminishes by encroachment of the ulcer, which still exhibits no tendency to advance into the deepest layers. A vessel from the outside shoots into the central part, which is quite dull.

27th. He suffers much less irritation; has had no sharp or severe pain for some time; sleeps very well; feels very well; no bulge of that portion over which the ulceration has extended; the ulceration still slowly spreads.

Jan. 25th, 1849.-There is now but a small point of the cornea of its original level; very little irritation.

Feb. 1st.-The whole original front of the cornea now gone. The new surface is opaque, smooth, on a level with the conjunctiva scleroticæ, and traversed with a few large purple veins. An ulcer occupies the spot where the last remnant of the original surface was situated, and threatens to perforate.

March 1st. This ulcer continued stationary for a few weeks, but is now nearly healed. The cornea has its natural curvature, though formed only by the posterior layers, fortified by leucomatous deposit and vessels. Though it is very opaque, he can distinguish large objects. The eye gives him no distress. The irritation appears to be permanently subsiding.

CASE G.-Chronic vesication of the cornea, in an eye the seat of slow
disorganising action.

(Under the care of Mr. DIXON.)

Feb. 7th, 1848.-Lucy Dudgeon, æt. 48, a phlegmatic, pale-looking, nervous woman, older in look than in years, has had glaucoma, with cataract and staphyloma sclerotica of the left eye, for three years. The right eye has for a year been gradually becoming impaired. The deep-seated vessels are large,

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and easily fill on irritation; the pupil is large,-irregular; sight very dim; has had scintillations, &c.

The cornea is perfectly clear; but the epithelium over one-fourth of the area, near the centre, is loosened from the cornea, with a very little fluid beneath it, as in a vesicle. When the lower lid is pushed upwards, against and over the cornea, the loose epithelium is wrinkled, and bulges with the fluid behind it. When the front of the cornea is untouched, the epithelium lies smooth, so small is the quantity of the enclosed fluid. This affection seems a consequence of general impairment of nutrition in the organ, and not of any inflammation in the cornea, which is quite transparent. I have seen the same state in several other instances.

CASE H.-Acute glaucoma; subsequent slow disorganization of the corneæ; and (in one eye) escape of the humors and retina. Examination of these structures.

June 26, 1848.-Mary Kilby, æt. 54, was led to the Ophthalmic Hospital, having been totally blind for nine months. She had suffered from bad health for some time, with occasional slight dimness of sight, when she was taken ill in the street, with some head affection, of which she does not give any distinct account, but it was unattended with paralysis or loss of consciousness. Being taken home, she found herself totally without sight next morning, and she has not had the least glimmer since. The attack was attended with great pain in the temples, which has been, and still is, her principal grievance. She kept her bed for seven months.

Present state of the eyes.-The corneæ dewy, as though breathed upon; scleroticæ contain large congested vessels; irides brown and slate-coloured; pupils dilated, irregularly oval, and fixed; lenses greenish and semi-opaque. She has constant pain in the brows, or, if not there, in the occiput, aggravated at intervals.

Appetite very good; bowels regular; tongue clean; usually sleeps well. Tartar emetic ointment to the temples; Haust. Pot. Iodid. bis die.

Oct. 2.-Less pain in the brows; irritation of the right globe from vesication of the conjunctival epithelium of the cornea, a portion of which is detached. The rest is dim.-Gutta Zinci Sulph. o. m.

30th.-The right cornea opaque: its surface dim, especially near the centre, with more inflammation.

Dec. 2nd.-The right cornea thickly nebulous in the inner half, with imperfect pannus. The left cornea is in process of slow disorganization; the anterior layers are loose and flaccid, as though in a state of slough, and yet they do not separate. On the outer side there is a semi-circle of opaque yellow deposit in the lamellæ, a little way from the margin; there is also much chronic vascularity of conjunctiva, and tendency to chemosis. Much pain in the left eye, and some in the right. That in the left eye and brow is sudden and darting, night and day, and often so severe as to cause her almost to start from her chair; yet her appetite is good, and she says she is "pretty well in health."-Emp. Lyttæ pone aur. sinist.; Ung. Hyd. c. Opio supercilio.

11th. She reports that on the 9th, as she sneezed, the left eye burst and bled, with severe pain. I find the cornea has given way at the point previously sloughing. The whole cornea, except a narrow rim, has separated, leaving the iris exposed, with the lens pressing forward, but not apparently inclined to escape. In this state of things, as she was suffering very much, I thought it might relieve her much to remove the lens, which I accordingly did, leaving the capsule in situ. The capsule was of quite horny consistence, and when incised the soft substance of the lens escaped, looking nearly of its proper transparency. The nucleus, I think, remained in the eye, for as a little vitreous humor was beginning to escape, I desisted from any further attempt to extract it.

14th.-The eye has been much easier since the operation. It continues to discharge, but no blood. Still much headache. She was now received into King's College Hospital.

During her stay here she was still a great sufferer from aching and throbbing pain in the brows, chiefly the right; and in the course of about a fortnight (Dec. 29th), the right cornea gave way as the left had done, but in this instance the separation of the slough was attended with forcible protrusion of the lens, the whole vitreous humor, and the retina. Considerable hæmorrhage attended this grave accident, but it was readily arrested by slight compression of the lids. By the prompt zeal of Mr. S. J. A. Salter, the house-surgeon, who was at once called up by the nurse, and found the protruded parts on the patient's cheek, I was enabled to examine them when perfectly fresh, and as such opportunities are very rare, I shall relate the exact condition in which we found them.

FIG. 33.

External view of a portion of the retina (case of Glaucoma).

The lens could not be found. The vitreous humor was perfectly pellucidneither yellow nor greenand of its natural consistence. The hyaloid membrane was also natural in appearance. In the substance of the vitreous near the hyaloid were seen a few irregular granules.

The retina had to the naked eye very much its ordinary appearance. Under

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a, ends of the rods. b, bulb of Jacob's membrane. , a high magnifying power, light space apparently formed by the coalescence of its outer surface presented several bulbs. d, large circular light space. e, another in some places the usual with included caudate bodies. Magnified 350 diam. series of the rods (a), and

bulbs (6), of Jacob's membrane in their natural arrangement and proportions, but in others, certain departures from the healthy condition were noticed, which are imperfectly represented in the woodcut, fig. 33.

There were numerous transparent spaces among the rods, some seeming to

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be formed by the running together of adjacent bulbs (c), others by the great enlargement of the bulbs, or of the beds in which these had rested (d). These latter large transparent spaces seemed to occupy nearly the whole thickness of the retina, where they were close together: the retina looked cribriform. They were occupied by transparent fluid, in which lay a few small and very delicate caudate bodies, like small caudate nerve-vesicles, but without nuclei (e).

In the middle of January she left the hospital, still suffering a good deal of pain in the region of the brow.

CASE I.-Symmetrical opacity of both cornea, extending horizontally over the central region, and obstructing vision; consisting of an earthy deposit limited to the anterior elastic lamina, and successfully removed by operation.

James Kemp, æt. 55, for forty years a house-painter, a man of healthy constitution, but of late reduced by deficiency of food, arising from want of power to follow his occupation, came under my care in January, 1849. On each cornea was a horizontal band, of brownish opacity, extending from side to side, and so much broader opposite the pupil as completely to hide it from view, unless the pupil was dilated, or was examined either from above or below, through the still transparent cornea. Both the iris and the pupil could then be seen to be perfectly natural and active. When the pupils were considerably dilated, he obtained some useful vision, especially with the left eye, where the opacity was not quite so extensive as on the right. The opaque part was very finely mottled with dark dots, some of which were only to be seen with a lens: its margins were shaded off rather abruptly, and the cornea beyond them was perfectly clear. The opacity had the appearance of occupying a superficial position, and of being

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Left eye of Kemp, showing the appearance of the opacity, when the pupil was rather more than usually dilated. He could then see his way about, the light entering above the opacity. Magnified 2 diameters. Drawn by Dr. Westmacott.

very slightly raised, but the surface reflected the light as brilliantly as other parts. The shape of the opaque tract was peculiar in being slightly inclined downwards from the inner side, so that its lower edge in each eye corresponded exactly with the margin of the lower lid, when the eyes were directed to a near object. The inner end of the opacity in the left eye was traversed by a narrow line in which the cornea was as transparent as ever.

The singularity of these opacities led me to inquire particularly into the man's history. He had had an ophthalmia ten years before, lasting only a fortnight, and leaving no blemish. After a period of about three years, his wife noticed that he had a speck on each eye, but as his sight was perfect, he doubted it. After two or three years more the specks were more evident to others, and he began to find that in a strong light his sight was clouded, so that he applied for relief at the Ophthalmic Hospital, and remained a patient there for about two years, during which he was treated with drops and lotions, but rather got worse than better: in fact, the opacity seemed confirmed and incurable, and was steadily encroaching over the front of the pupil. Within the last year he has been quite thrown out of work, able to see only in an obscure light, and then only objects on one side.

Like those who had previously seen him, I regarded these opacities as indelible, but as he came from time to time, it occurred to me to make an attempt to shave off a portion of one of them, in order to examine its nature more completely. I accordingly made the patient come from the hospital to my house, where I could at once place any particle I might be able to detach under the microscope. The first scratch with the point of the lancet on the right eye (January 20th) detached the epithelium, which seemed healthy, and brought me down upon the opacity, which felt hard to the instrument, and had a smooth surface. In scraping and trying to slice off a thin film of it, a thin flake cracked off and separated, leaving what seemed a hole through the cornea; but the aqueous did not escape, and I then saw that the pupil was visible through the

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Right eye of Kemp, after the removal of the opacity from over the pupil, which is here shown dilated more than ordinary. Magnified 2 diameters. From a Drawing by Dr. Westmacott.

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