and projected between the lids, but was pale and serous. The cornea had become cloudy, the chambers were yellowish, the iris obscured by lymph, the pupil occupied by a yellow mass of lymph, which looked like an opaque lens. The lids had become less oedematous, so that the condition of the interior of the organ could be more exactly noted. Meanwhile the local symptoms of phlebitis in the stump were on the decline, and the stump assumed a more healthy aspect, the bones still protruding slightly. But the rigors now recurred daily, with considerable regularity, attended with much exhaustion; and about the 15th he was seized with pleurisy of the right side, for which he was blistered, and took a grain of calomel with opium every four hours for two days. At the end of this period the pain in the side had nearly subsided, and (what is interesting) the lymph was absorbed from the iris and the pupil, which resumed very nearly their natural appearance, the latter only remaining rather turbid. He had lost almost all pain in the organ, and the morbid action within it seemed entirely checked. Some pale chemosis remained, but the cornea was clear, and the globe wore no appearance of internal suppuration. All pain in the organ had likewise ceased.

On the 20th he died, after an aggravation of the symptoms betokening internal phlebitic abscessses.

I examined the eye before twenty-four hours had elapsed, and had appointed an hour for the inspection of the rest of the body; but this was unfortunately prevented by the interference of the friends.

The following is the result of a careful and deliberate examination of the eye itself.

The iris, seen through the transparent cornea, was clear green, without lymph on its surface, but firmly adherent by its entire posterior surface to the capsule of the lens, which presented only a partial opacity near its centre. This posterior synechia and opacity of the capsule appeared of old standing (and the patient had stated that this eye had been a poor one, and vision imperfect with it for many years).

The lens itself was perfectly transparent.

Under one of the recti, immediately behind its insertion, the sclerotic (and also the choroid) was much bulged, and so distended as to be almost giving way, evidently by pressure from within. It formed what would have been termed, from its shape and circumscribed figure, a staphyloma sclerotica. In order to ascertain its nature, I carefully cut all round it through the sclerotica only, and in detaching this coat I found that it was extremely thin, and its fibres as it were unravelled at the apex, where also the choroid was adherent to it by a film of recent lymph, and, like the sclerotica, distended from within. The outer surface of the choroid was perfectly natural, except at the apex of the swelling. On now cutting through the choroid, a whey-like fluid, with particles of lymph floating in it, escaped in abundance; and I found that this effused fluid was filled with nucleated and other irregular granules, hanging together in little masses, and resembling lymph rather than pus. In this turbid fluid there lay loosely a great number of smooth, round, or oval beads of soft yellow lymph, of every size up to that of a rape-seed, and these consisted of an agglomeration

of nucleated lymph-particles, with many shapeless granules in the connecting material. Scarcely any fibres could be discovered. I emptied the cavity between the choroid and retina, in which this effusion had collected, by syringing it under water, and the inner surface of the choroid then exhibited a coating of yellow lymph, which appeared to be deposited not merely on the surface, but also in the interstices of the capillary network which lies under the epithelium forming that surface; almost all trace of this epithelium (the "membrane of the black pigment" of Mr. Wharton Jones) being lost. The vitreous humor, in its enveloping hyaloid membrane, together with the broken remains of the retina, had been thrown by the effusion to the central part of the globe, where they occupied only about half their natural space. The retina was not at all coated with lymph, and its capillary network was perfect, but the nervous substance was in a great measure destroyed, as though macerated; yet what remained exhibited the characteristic elements of the nervous substance of that part.. In particular, I discovered several well-marked examples of the caudate nerve-vesicles, which I had never before unequivocally seen in that membrane, although strongly suspecting their existence. Jacob's membrane was nowhere visible.

The hyaloid capsule (that homogeneous glassy membrane which forms the outer covering of the vitreous humor, and in the adult eye shuts it off, as the capsule does the lens, from the capillary blood-vessels of surrounding parts, and constitutes it a non-vascular texture)-the hyaloid texture, was everywhere entire, but thrown into innumerable minute folds, in consequence of its collapsed form. A good many lymph-globules were accumulated on its exterior in certain parts, and the nuclei naturally present on its inner surface were very distinctly visible. But what I wish specially to notice was the state of the vitreous humor itself. This highly delicate structure, from its transparency and exquisite texture, displayed with remarkable clearness themorbid changes that had been taking place within it. In a state of health the vitreous body presents no corpuscles, but here every part of it was turbid and cloudy, from a finely granular and amorphous deposit in its substance. This deposit might be supposed to be a simple coagulation of albuminous matter; no trace of organization could be detected in it. But, in addition to this, there were disseminated through the vitreous humor innumerable nucleated cells, like those of the lymph already described. These nucleated particles were much more numerous immediately within the hyaloid capsule, in the superficial portions of the vitreous humor, than towards its centre, where they very gradually ceased. They were all distinct from one another, placed apart in the vitreous tissue, and had everywhere the same appearance and size. Mingled with them, however, were several smaller, more granular, and irregular particles, which might be in process of development. I could perceive no appearance indicating a multiplication of the particles by splitting or division. In the central part of the vitreous humor there were none of the nucleated particles, but in the neighbourhood of the optic foramen and yellow spot, and particularly near the ciliary processes at the border of the lens, and near its posterior surface, they were so abundant as

to render the vitreous humor perfectly opaque and yellow: yet even here they only differed in number from those found elsewhere.

REMARKS.-In this case the death was consequent on phlebitis and secondary inflammation, and probably suppuration of the viscera. The course of the symptoms, and especially the attack on the eye, render this as certain as can be, in the absence of an examination of the internal organs. By a reference to the recorded cases of destructive inflammation of the eye in such circumstances, their course will be found very variable, both in duration and severity. In some the eye has gone rapidly into general suppuration and discharge of the contents of the globe; in others, the organ has retained its figure, and the inflammation has been checked, after it has destroyed the integrity of the most important tissues.

The place at which the globe gives way under a distending force from within is well illustrated here. By exact examination it will be found that the sclerotica is thinner immediately behind and under cover of the insertion of the tendons of the recti than at any other points, these tendons grooving the fibrous coat slightly before their actual insertion into it. The bulge of this tunic was precisely at one of these weak points in the present case; and I believe it will be generally found that suppuration of the globe (not a consequence of conjunctival or corneal inflammation) will discharge itself in a similar situation. I have heard of the sclerotica being opened at this point by incautious use of the scissors in the operation for strabismus.

The principal seat of the effusion of lymph in this case is very interesting to notice, if we bear in mind that the choroid membrane, from which it seems to have proceeded, has its capillaries on its inner surface; its arteries, and especially its ample veins, on its outer surface. The effusion was on the inner surface, and clearly from the capillaries: the arteries and veins forming the outer surface were quite healthy; there was not a particle of lymph about them, except where the tunics were giving way.

The deposit was of lymph-of lymph consisting of little else than nucleated cells, which formed masses of rounded shape, floating in a turbid serum. It may be supposed that those which had been effused from the surface of the iris under the mercurial action were of a similar kind.

The capillaries of the retina, and the nervous tissue of the retina, though to some extent macerated and disorganized by the contact and pressure of the effusion within the choroid, yet did not appear to have any lymph adhering to them, or to have themselves exuded any.

The presence of the nucleated lymph-particles in the tissue of the vitreous humor within the homogeneous hyaloid membrane which separates the vitreous humor from the contiguous capillaries, seems to me a fact of great importance to the question of the source and mode of formation of such effusions. The opinion that pus is absorbed from suppurating surfaces and carried by the blood-vessels to distant organs, and there deposited anew, is one which, however it may seem, at a cursory glance, to explain the phenomena of "secondary

depositions," yet will hardly bear a rigorous scrutiny. How can pus or lymphglobules be absorbed by vessels which certainly have no open mouths? And how, admitting such globules to be in circulation in these cases, could they get out of the capillaries, and find their road, as here, through a homogeneous membrane such as the hyaloid, into the interior of the vitreous humor? The anatomical conditions here present seem demonstrative that these nucleated cells, lymph-corpuscles, or exudation particles, were formed at the spots at which they were found, from effusion, strictly fluid, through the capillary wall, the hyaloid membrane, and the vitreous tissue. It is interesting to observe that their relative numbers were far greater in those parts of the vitreous humor where it may be presumed that the ordinary processes of nutrition are carried on the most actively, and especially between the ciliary processes and the lens.

We see, in this instance of the morbid products of inflammation occurring in a non-vascular part, decisive proof of the possibility of real inflammation arising in that class of structures without their having vessels, and without their becoming vascular; and we find proof, also, of the subordinate or ministerial part which the blood-vessels play in inflammation—of their being, in reality, the channels only of the supply of that fluid, a certain change in the constitution of which forms the essential condition of the process. But of course where large masses of vascular tissues are inflamed, the blood-vessels must share largely in the production of the resultant phenomena.

CASE N.-Ophthalmitis, similar to that of the last case, but not so clearly of phlebitic origin, accompanying extensive inflammation of the heart and brain.

A. B., a medical student, who had been the subject of severe rheumatic fever when a boy, and continued to have a diastolic bellows-sound over the cardiac region subsequently, though otherwise in apparently good health, began to feel indisposed in the commencement of August, 1847. There was nothing, however, to alarm him, or to induce him to abandon his ordinary pursuits, and he even undertook to dress some patients for a friend on the 26th of the month, when he was seized on the 27th with sickness and diarrhoea, with much depression. The diarrhoea continued for four days, and then ceased. It was attended with great exhaustion, and a dry, furred tongue, and it was feared he might be suffering from the typhoid fever then prevalent. Saline medicines, opiate enemata, fomentations, and, on the 30th, ammonia, were employed.

On the 28th he discovered that the sight of the left eye was impaired, and on the following day he could not distinguish light from darkness. All this was without any scintillations, or other symptoms of retinitis, as ordinarily described. He had, however, some dull, deep-seated pain in the globe, but not extending to the brow or head.

On the 29th twelve leeches were applied round the eye. They relieved the pain for a short time, but the blindness was complete; and on the 30th a blister was applied to the temple.

On the 31st I was requested to see him, in consultation with Dr. Todd and Mr. Bloxham, with regard to the state of the eye. I found him totally amaurotic in this eye, in which he still complained of a dull, deep-seated, beating pain. The pupil was half dilated, almost immoveable. The humors quite clear. No morbid appearance in the tissue of the iris, which was of a dark brown. Slight conjunctival and sclerotic injection. The pulse was above 100, and had rallied under the ammonia. Tongue dry and brown. Some tenderness of abdomen over the region of the colon. A bruit de soufflet was heard over the heart, probably such as was known to have previously existed. Considering his prostration, which was such that he was unable to walk, and also the state of the bowels, it was a question whether to give mercury, though the state of the eye seemed so imperatively to demand it. It was agreed to rub in mercury, and to apply four leeches to the eye, with fomentations, and to continue the ammonia, with beef-tea, &c.

Sept. 1st.—The pain continues in the eye, though mitigated: more injection of the conjunctiva, and disposition to chemosis. The margin of the pupil slightly irregular, otherwise the eye appears the same; the general symptoms are the same.-Ext. Bellad. ad frontem. Rep.

2nd.-A more sunken countenance; the eyelids somewhat swollen; decided serous chemosis, overlapping the cornea a little. Humors clear. Iris apparently natural, except that the pupil is puckered. The pain in the eye as before, deep-seated and aching, not acute or intolerable, or preventing sleep. He complains of soreness and pain in the right shoulder, and on examining this and other joints, we found effusion in the left knee (query, rheumatism, or purulent infection?) It was deemed well to continue the inunction, as no mercurial action had yet manifested itself. Two glasses of sherry, beef-tea, arrow-root, a blister to the knee, and behind the ear.

3rd.-To-day more prostration. Tongue coated, moist; pulse 120; weaker. Has wandered, and slept little. More serous chemosis, projecting a little between the lids, which are swollen, but allow us just to see the cornea. This is clear, and so is the aqueous humor. The lens has a pale, milky tinge, especially. at the border of the pupil, which is irregular. Front of the iris natural. Pain in the eye not severe. Total blindness continues in this eye. The mercury has produced very slight soreness of the gums. He complains of some pain about the base of the chest, and catches at the breath. A friction sound over the heart. The lungs everywhere pervious. The effusion in the knee has disappeared. Is so low that he must omit the mercury.-Capt. Quin. gr. ii. 4tis horis, c. Tr. Opii, m v.; Morph. Acet. gr., horâ somni; Empl. Lyttæ lateri; port wine 3x.; beef-tea.

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4th.-Pulse stronger, 120. Has had no sleep; tongue brown and dry; less pain in the chest. A limited rubbing sound over the pericardium; still complains of the shoulder. The chemosis has disappeared; the sclerotica being still dull with vessels. Pupil fixed; lens more milky; mouth not sore.-Rep. omnia; Pil. Hydrarg. gr. v. h. s.; Bellad.

5th.-I did not see him, but no particular change occurred. The opium and