quinine were discontinued, and ammonia with more wine given. There had been delirium.

6th. In the morning about nine o'clock he became quite incapable of recognizing any one, but lay in a low muttering delirium. Pulse from 130 to 160, very feeble, and unequal. Constant profuse perspiration. Bowels since yesterday have been repeatedly moved unconsciously. A rubbing sound is still heard over the heart. The pupil is occupied by opaque milky effusion. The chemosis is gone, and there is much less redness.

He is now having wine and beef-tea every half hour, and takes it pretty well. After this he continued delirious till his death, which took place at about ten o'clock next morning, being the 12th day of his acute disease.

Examination twenty-seven hours after death.

Chest.-Lungs natural, except slight recent adhesion of the right where overlapping the pericardium. Pericardium distended with several ounces of turbid, flaky serum. The entire surface of the pericardium and heart covered with mossy fibrine, in most parts drawn into threads half an inch long, but over the pulmonary sinus of the right ventricle, and at the base of the left ventricle behind, it was thicker, and formed a closer pile. The heart was hypertrophied. One of the aortic valves was perforated by a large hole, with smooth, though irregular and tuberculated edges. This seemed to be in part at least an old diseased condition, and was, perhaps, (together with the hypertrophy) assignable to the old attack, of which mention has been made. But, besides this, there was on the semi-lunar valve, corresponding to the mitral valve, a large mass of ragged tuberculated fibrine; and, in continuation of this, down upon the flap of the mitral valve, another still larger, which almost concealed this flap. The central part of this was so ragged that the valve seemed to be destroyed, and on looking at the opposite or auricular surface, a corresponding, but smaller spot, covered with fibrine, was seen. The valve was, in fact, perforated here, and the aperture occupied with loose, soft fibrine. The lining membrane of the heart, except at these points, was natural.

Abdomen.-Natural.

Head.-The arachnoid natural on its free surfaces. Underneath, on the surface of both hemispheres, in the tissue of the pia mater, chiefly in the sulci, an abundance of recent pale yellow lymph. Much, also, at the base; and, in the fourth ventricle, half a drachm of creamy pus. No ulcer or abscess. Sinuses healthy. Substance of the brain healthy.

Left eye.-All chemosis and outward redness had subsided, and the globe looked very much as the other, except that the pupil was rendered opaque by an effusion of lymph, adherent to its border, and to the capsule of the lens. The front of the iris had hardly lost any of its brilliance: the aqueous humor was clear, and the cornea transparent. On dissecting the outer surface of the eyeball, the areolar tissue contiguous to the sclerotica was found in some parts thickened, and rendered semi-transparent by the effusion which had attended the external inflammation.

K

The optic nerve was itself natural, but its sheath, for half an inch nearest to the globe, was distended with clear serum, in which floated a few nucleated cells. This effusion gave the nerve a bulbous and semi-transparent appearance. It could be made to gravitate from side to side, because it did not tightly distend the space it occupied around the nerve. It lay in the large meshes of the peculiar tissue intervening between the external layer of the sheath and the nerve. On carefully opening the sclerotica, the choroid was found everywhere in contact with it, and apparently healthy. The vessels and nerves on its outer surface seemed as usual. The ciliary muscle also natural. But the moment a puncture was made in the choroid, a turbid yellow serum, with small flakes and granules, escaped. This effusion lay between the choroid and retina, which latter was thrown somewhat inwards upon the vitreous humor, and lay in folds. The quantity of fluid altogether may have been about 20 minims. It coagulated by heat. On examination under the microscope, it was seen to contain-(1), small masses of granules, very like the agglomerated granules of the retina; (2), many exudation-corpuscles merging into pus-corpuscles; and (3), much amorphous, finely-granular matter. Nothing like the particles of Jacob's membrane, or fragments of them, could be found in it. The cavity in which this effusion lay extended in a forward direction only as far as the ora serrata, in front of which the ciliary processes of the choroid adhered naturally to the vitreous body. Backwards, it did not reach the point of entrance of the optic nerve, being limited by a quantity of yellow lymph (with pus in its centre), disposed in a layer 1-12th of an inch thick, uniting the choroid and retina, but most intimately adherent to the latter. The inner surface of the choroid, in contact with the effused fluid, was everywhere coated with lymph, which gave it a mottled aspect, and varied in quantity at different parts. None of the pigment seemed to be detached, and the lymph appeared to lie on the retinal surface of the choroidal epithelium. The choroidal was somewhat thickened, and tore more readily than natural. It also contained more blood than usual.

The state of the retina was very remarkable. When exposed to view, by the removal of the effused turbid serum already described, it appeared everywhere entire, and of its natural texture, except near the optic nerve, where, as above mentioned, a considerable mass of lymph adhered to it. The retina, however, exhibited throughout its whole extent either isolated or confluent specks of ecchymosis, which were so abundant around the optic nerve as to give to that part of it a nearly uniform crimson tint, but none existed over the extremity of the nerve, where it is seen within the globe. These ecchymoses all lay in the substance of the internal or vascular layers of the retina: seen from within, they were very vivid: seen from the outside, they were fainter and bluish, being covered by the non-vascular layers or portions of them. When the retina was afterwards dried on a sheet of glass, they continued to be strikingly obvious.

I carefully examined the structure of the retina when fresh, with the view of ascertaining the changes which the inflammation might have occasioned in its elementary tissues. I could discover no trace of the elements composing Jacob's membrane, which had apparently been all dissolved or destroyed by the contact

of the effused fluid. But the granular layer, the gray nervous layer with the delicate filaments contained in it, and, above all, the caudate nucleated globules, were all visible, and nearly in their natural state, though falling asunder too easily. The caudate corpuscles had all the characteristic appearances of these structures elsewhere: they were small and numerous, and much more readily seen than in the fresh and healthy retina. In fact, they strewed the field of the microscope, among the rest of the debris of the membrane. Numerous exudation corpuscles were likewise intermingled.

The retina was adherent to the hyaloid as usual: no effusion separated them. On removing the retina, some little of the extravasated blood rested in points upon the surface of the hyaloid.

The vitreous humor was diminished in size, of rather firmer consistence than natural, and of a green straw colour. Though mostly semi-transparent, it was in some parts (viz. at the bottom of the eye, and on one side, near the lens), of an opaque yellow colour, from a denser effusion of lymph into its substance. Under the microscope it was seen to contain multitudes of minute amorphous granules, with very numerous nucleated particles, like those in the fluid effused between the choroid and retina, and evidently of inflammatory origin. These were most numerous where the opacity was densest, and on their presence the opacity manifestly depended. The hyaloid membrane was entire, and no trace of capillary vessel or red blood-corpuscle could be found in the vitreous body.

Finally, the lens and its capsule preserved their transparency, if we except that portion of the capsule which occupied the pupil. This part of it was rendered opaque by a film of lymph which covered it, and adhered to the margin of the pupil; and it was not a little remarkable that this lymph did not fill the posterior chamber, so as to glue the uvea to the lens, but that aqueous fluid intervened as usual between these parts, and their surfaces were free and healthy. The lymph on the capsule was limited to the area of the pupil, and by its adhesion to the border of the pupil, shut off the posterior chamber from the anterior.

CASE O-Cataract of 5 years' standing, relieved by spontaneous depression of the lens, vision remaining.

May 24th.-Wm. Rogers, æt. 65, a hale man, has had cataract in the right eye for 5 years. The lens is tremulous, and so is the iris. The cataract is apparently hard, and in the substance of the lens only. More recently the left lens also has become opaque; but he can still see his way about, with the aid of Belladonna. Both irides are active, and there is no obvious cause to account for the cataracts. Gutt. Belladonnæ, bis die.

June 28th.-In exactly the same state. Rep. Gutt.

July 19th. He states that his sight is greatly improved in the right eye, so that he can see large objects. On examination, the right lens, which was previously in the axis of the eye, is found to have disappeared from the pupil, but when the pupil is dilated, the upper border of the lens can be just discerned be

hind its lower edge. In fact, the cataractous lens, before partially loosened, has now dropped down, as if it had been couched. He suffers no pain or uneasiness: there is no inflammation, and with a cataract glass he can see to read a printed page.

I saw him again in August and September, when the condition remained precisely the same, and nothing was attempted on the other eye.

CASE P.-Spontaneous depression of a cataractous lens, from loosening of the suspensory ligament and softening of the vitreous humor.

22d November, 1848.—Mr. T. M., æt. 78, a very intelligent old gentleman, now in reduced circumstances, of active and regular habits, was told by Dr. at 20, that he would die of consumption, and he has been ailing all his life, and has now some chronic cough.

He was near-sighted from the age of 15: wore spectacles, and his near-sight diminished. About 40, he began to have little black specks (intensely black) flying before his right eye when he looked at any light object. These continued very gradually getting worse, but did not much annoy him. They were spots and filaments flying about, but he could still "make shift" to read with this eye, till nine years ago, when, on getting up one morning, he thought the right side of his nose was black, till, on going to the glass, he was undeceived. As the day advanced, the obscurity increased: spots and a network, much more than previously, appeared, and at night he was quite blind, and has so continued since, with that eye (the right). This attack was not attended with any pain or appearance of inflammation. The eye looked as well as ever it did. He was attended by an eminent oculist in London.

About a twelvemonth afterwards, the lens turned of a pearl colour rather suddenly, i. e. in the course of a few weeks, and when this opacity had become fully established for a week or two, having taken a blue pill over night (this is his description), the next morning he was surprised, on going to shave, to find the cataract totally gone, though of course he continued blind.

This right eye has now very much the natural appearance, except that the pupil is fixed at about one-sixth of an inch diameter. On looking, however, carefully through the pupil from above, the upper edge of the vanished lens is perceptible behind the iris, having sunk down in nearly the same position as was mentioned in the last case.

Such is the state of the right eye, but he comes for advice regarding the left. He says that eight years ago, or shortly after the total blindness of the other, a film and spots appeared in the left. The film, as it then appeared, he represents as an arched line with a circle at one end, and a small brush at the other, appearing suddenly, and extending horizontally across a surface of about two feet in width. (Fig. 38, a). It gradually diminished, and in a few days had contracted itself into a fainter and smaller line, having the same general shape, and still

terminated by a circle. Thus it still remains. (Fig. 38, b). He has no pain, and only fears it may get worse.

FIG. 38.

a

Appearance of fixed muscæ. (Case P). a, First appearance; 6, The same after eight years.

Present state of left eye.-With the pupil (which is active) contracted, no morbid appearance. With the pupil dilated I see a faint yellow film moving or glancing behind the lens according to the motions of the eye. The film is very small (the size of a large pin's head), with a string attached. It seems to shoot up from the lower and inner side, on any sudden turn of the eye, as far as opposite the middle of the lens, and immediately falls again when the eye is tranquil. The vitreous is of course so far fluid as to allow of this; but the tension of the globe is natural. The lens is slightly greenish, without striæ. The three images are seen, but the inverted one is not quite so distinct as it ought to be. He sees to read very fairly with this eye.

CASE Q.-Spontaneous dislocation of the lens into the anterior chamber, probably from previous loosening of the suspensory ligament.

A gentleman of middle age, tall, and of good constitution, was brought to me by a surgeon, and I gathered the following particulars of his previous history:Eighteen months ago, one eye was noticed by his friends to have something odd about it, different from the other; at the same time he could not see in shooting so well as before, was "bothered," and could not tell the distance. There was no inflammation or pain, and he took no particular heed of it. He appears, however, to have had some unusual irritability of the eyes, and subsequently some trivial ophthalmia at times, till about five months ago, when after a few weeks' indisposition in the eyes, for which he took no advice, he was seized one morning on waking with severe pain in the left eye. The pain was intense, and deep seated in the globe, not in the orbit or brow. No scintillations. The pupil was widely dilated and fixed, and it was irregular, being more dilated on one side. He was actively treated for the inflammation, with leeches, blisters, and mercury, and found the eye somewhat better in the course of some weeks, but he was much reduced by the treatment. The sight, however, was nearly