the membrane, and being accompanied by a variety of coincident effects, such as hæmorrhage, displacement of the lens, and concussion or even rupture of the retina.

Mydriasis from a blow on the eye is sometimes attended, Mr. Cooper states, by rupture of the pupillary margin of the iris. He gives, in illustration, the case of an officer in whom the iris was reduced to a narrow band, was quite motionless, and presented at its lower portion a serrated appearance from laceration. The case affords a good example of what generally happens under such circumstances-namely, a slow and incomplete recovery. (p. 171.)

From the practice of Mr. St. John Edwards, our author quotes the following case of fracture of the orbit and effusion of blood on the brain, from a blow on the eye:

"An unfortunate girl received a blow on the left eye, which blackened it; eleven days afterwards she died, and on post-mortem examination from five to six ounces of blood were found in the left arachnoid cavity, partly fluid, partly coagulated; the latter portion contained in its centre a fibrinous clot about the size of a small nut. The fluid portion of the blood was found to extend downwards to the base of the brain. The membranes were deeply stained with blood, as also the substance of the convolutions. The small wing of the sphenoid bone on the left side was found disarticulated and displaced backwards and upwards, exactly in a position to have wounded the middle cerebral artery in the fissure of Sylvius. Mr. Edwards was of opinion that the blow on the eye displaced the bone, which in its turn gave rise to the hemorrhage by rupturing some vessel, but that it temporarily plugged the vessel, and ultimately failing to do this, rapid extravasation of blood and death ensued." (p. 177.)

The following cases of detachment of the retina, the one in consequence of a blow on the eye and the other of a fall, are interesting:

A countryman, aged twenty-six, received accidentally a violent blow over the right eyebrow from a flail. He fell stunned, and was unconscious for some minutes. He then became sick, and discovered that he had lost the sight of his right eye. A week after the injury the brow still bore marks of the blow, the pupil was dilated and motionless, and the only sight was perception of shadows of objects when the image was thrown on the temporal portion of the retina. The ophthalmoscope revealed detachment of the retina over a space about two lines in diameter, behind which was a coagulum of blood, of a deep reddish brown. Where detached, the retina was slightly opaque, and had a generally congested and unhealthy aspect.

A man, aged forty-five, of robust constitution, in running violently, fell, and received a severe shock. About three weeks afterwards, on accidentally covering the right eye, he perceived to his astonishment that he could not see with the left. Examined about four months after the accident by Dr. Williams, he stated that he had never experienced the slightest pain or uneasiness in the eye. Of objects placed before him, or to his right side, he had not the faintest perception, but recognised, although very imperfectly, large bodies placed towards his left side, The pupil was dilated and immovable.

Examined with the ophthalmoscope, the refracting media appeared.

perfectly transparent, and the retina presented no abnormal vascu✩ larity; but it was easy to recognise that this membrane, to a large extent, and all round the entrance of the optic nerve, was elevated by a liquid, and had a trembling movement during the oscillations of the eye. During these movements those deep folds which the membrane ordinarily forms in dropsy of the retina were not discernible; the folds were superficial and the undulations quite limited. These phenomena, taken in connexion with the pearly colour which the elevated membrane presented, could be explained only by supposing that the retina was raised by a turbid liquid, similar to what is often observed in pericarditis and other serous inflammations.

Mr. Cooper mentions that he had seen several instances of cysts within the eye, arising without any well-ascertained cause; but three which fell under his notice were clearly traceable to injury.

"These cysts," he says, "as they ordinarily present themselves, appear to consist in the morbid formation of fluids between the iris and the uvea; but in some cases the seat of origin seems to be rather the ciliary margin than the posterior surface of the iris. In one of the cases, the growth took place behind the iris, and gradually pushed its way through the pupil. The irritation caused by these cysts is great, and is mainly the result of their being enclosed within the unyielding tunics of the eye; as they increase and require more space, painful tension is excited." (p. 186.)

"There is a tendency on the part of these cysts to refill if they are merely punctured, and therefore I prefer lacerating the membrane with a broad needle; when punctured the fluid jets out, and the delicate membrane, which has been kept on the stretch, collapses. If this treatment does not succeed, and the pouch is large, it may be drawn out of the eye with canula-forceps, and a portion snipped off. This will effectually cure it." (p. 191.)

The following remarks are illustrative of a subject which has hitherto scarcely attracted notice-namely, posterior rupture of the eye.

"Rupture of the eye posteriorly, that is, behind the point of reflexion of the conjunctiva, is a rare accident; and as the true character of the injury can only be ascertained by excision of the eye, doubtless cases in which it has taken place have escaped observation in the absence of the performance of that operation. It is the result of a sudden and violent blow inflicted full on the eye, and is attended with the sensation of the globe bursting; the eye fills with blood, and pain of the most distressing character racks the patient for many weeks, not a gleam of light being bearable; for though the injured eye is absolutely blind, the other is exquisitely sensitive to light. The symptoms subside by slow degrees, and atrophy of the eye takes place, varying in degree according to the extent to which the coagulum within the eye is absorbed; for it must be borne in mind that this coagulum does not always disappear. I have met with a case in which the colouring particles were absorbed, but the fibrin remained in a firm mass." (p. 197.)

The

In illustration, Mr. Cooper gives a case which occurred in the practice of Mr. Bowman. An elderly gentleman was struck full on the left eye by the door of a brougham suddenly thrown open. agony was intense, but sight was not immediately extinguished, though after a few hours it became so. The anterior chamber was so full of blood that no part of the iris was visible, and the conjunctiva was chemosed. The accident had occurred a month prior to Mr.

Cooper's seeing the patient, during the whole of which time his sufferings had been intense. He could not bear a gleam of light. When the right eye was completely covered the left could be opened, but it was absolutely blind. The pupil, of a dull reddish-brown colour, appeared as if enormously dilated, and the iris reduced to a mere strip. There did not appear to be blood in the anterior chamber, but the back of the eye seemed full of it. The conjunctiva and sclerotica were acutely inflamed.

During the operation of removing the eye by Mr. Bowman, it was found that the sclerotica had been ruptured in the posterior part, and that a large coagulum lay partly without and partly within the eye. The vitreous humour had escaped at the time of the accident. The aspect of the anterior chamber had been deceptive, for though it had appeared free from blood, it was found filled with coagulum, behind which lay the iris, with the pupil of natural size, the apparent strip of iris being really the small portion visible beyond the margin of the coagulum. (Ibid.)

The facts of this case, as stated by our author, seem in some measure at variance with one another. The sight was not extinguished for some hours after the accident, and yet the vitreous humour had escaped through a posterior rupture of the eyeball. Either the patient must have been mistaken in supposing that he saw for some hours after the accident, or the rupture of the eyeball must have happened during the operation of extirpation.

The subject of dislocated lens is fully considered by the author. (pp. 200-220.)

When an opaque lens lies in the anterior chamber, it can only be regarded in the light of a foreign body, and ought to be removed under chloroform. In such a case, the moment that the section of the cornea is made, the lens is apt to sink back either entire or divided by the knife, through the pupil into the vitreous humour. In a case related by Mr. Cooper (p. 206), one portion of the lens retreated through the pupil as the other was extracted. The best plan for preventing such an accident, is to begin the operation by passing a curved needle through the sclerotic, and fixing it in the dislocated lens; then, to open the cornea, and with the needle to push the lens out of the eye.

In determining the question which sometimes arises after injuries of the eye, whether the crystalline is in its natural situation in the eye, or in the eye at all, Mr. Cooper has recourse to the catoptrical test; as, if the lens is absent from behind the pupil, neither the inverted nor the deep-erect image is visible, but only the image formed by the cornea. Opportunity is here taken by Mr. Cooper to state, that the catoptrical test, as a means of detecting the existence of cataract, has been superseded by the ophthalmoscope, which certainly is not the fact. In many cases of incipient cataract, the fundus oculi appears under the ophthalmoscope with almost no change of colour, while the haziness of the lens is so slight as to escape detection, especially if a strong and concentrated light is used; but the lighted taper, passed in front of the eye, by showing the changed condition of the

two deep images, instantly reveals the true state of the lens. We regard the catoptrical test as a simple and elegant means of diagnosis, which no one who has studied it with sufficient care, and comprehended its value, will think of abandoning.

The ophthalmoscope, again, is of great use in determining the amount and situation of extravasations of blood in the vitreous chamber, and of injuries of the retina.

The right eye of a farmer having been struck with a hollow wooden pear, thrown in sport, Mr. Dixon discovered with the ophthalmoscope, what he considered to be a rent in the retina, and a considerable coagulum of blood, which lay against that membrane. The case was subsequently examined by Mr. Cooper in consultation with Mr. Dixon.

"The pupil was slightly dilated and motionless; nothing abnormal visible beyond this; objects were seen by the patient indistinctly, and a black patch abscured the central portion; pica type was read with difficulty, each word requiring to be separately made out.

"The ophthalmoscope showed the seat of the rent in the retina as an opaque, irregular line, nearly in the axis of vision, and there were many small spots around this, evidently the remains of the coagulum of blood which had not been entirely absorbed.

"In our report we were enabled to state with confidence that, though Mr. J. might retain a certain amount of sight in the injured organ, we were of opinion that it would never be restored to its former perfection." (p. 234.)

The patient in this case sought compensation for the injury. He claimed 2000%., but the referees awarded 7007., which, says Mr. Cooper, was accepted with very ill grace (p. 318). We think the case should have been watched for a considerably longer space of time before any legal or medical decision was given. It does not seem at all probable that, with a rent of the retina nearly in the axis of vision, the patient could have read pica type or any type. Might not what seemed a rent have been merely a streak of blood?

A blow on the eye is apt to produce effusion of blood between the sclerotic and choroid, between the choroid and retina, or within the vitreous humour. In all these cases vision is likely to be materially injured, if not destroyed.

"When a vessel," says Mr. Cooper, "has given way between the retina and choroid, there will be seen a deep-red projection in the fundus of the eye, formed by the coagulum over which the retina is stretched. In some instances the retinal vessels are distinctly visible coursing over the surface; after a time the retina may give way, and the blood then comes into contact with the vitreous humour, in which it may remain as a coagulum, or diffuse itself in the form of flakes." (p. 235.)

We cannot deny the possibility of such a rupture of the retina happening as is here mentioned; but we do not recollect any evidence to show that such an event has actually followed any considerable time after the receipt of the injury.

Mr. Cooper remarks that

"Very serious intra-ocular hæmorrhage may arise after operations on the eye, especially extraction of cataract. It is one of the rarest and most disas

trous complications that can present itself, utterly defeating the object of the operation and entailing much suffering on the patient." (p. 245.)

"A sudden and most acute pain darts from the eye back into the brain, and is followed by a sensation of tearing or dragging the eye from the socket. If the vessel gives way during or immediately after extraction, the vitreous humour will escape, and be followed by a flow of blood; but if some resistance is offered by union of the wound, the hyaloid becomes filled with blood, and the vitreous is lost sight of. The agonizing pain soon involves the brow and side of the head, and the eyelid is so exquisitely sensitive that it cannot bear the slightest touch.

"The first burst of pain is followed by faintness and nausea, often amounting to sickness, which nausea may continue many hours. The retching, however, does not prevent the stomach retaining small quantities of sustenance, and is best combated by soda-water, and by effervescing draughts containing dilute hydrocyanic acid; also by swallowing ice, either in lumps or as lemon ice. Cold jelly and cold beef-tea are also grateful.

"When the wound is sufficiently united to offer resistance to the immediate escape of the contents of the eyeball, the hyaloid becomes filled with blood; and when the wound is burst open it gradually protrudes through the corneal section, and then between the lids, as a pouch filled with blood. The retention of this increasing the suffering, it should be snipped off.

"As the eyeball becomes distended with blood, the flap is widely opened, the upper lid thrust forward, and more or less oedema arises, commencing at the inner corner.

"The blood is usually venous, oozing from the eye and trickling down the cheek; there is every reason to believe that it is caused by disease of the choroidal vessels, and their morbid condition prevents their ready contraction, nor probably does the bleeding cease till they feel the influence of the pressure caused by the coagulated blood within the eye." (p. 246.)

"The careful examination of four eyes in the museum at Moorfields is conclusive to my mind as to the seat of hæmorrhage. In one case the eye was excised for intra-ocular hæmorrhage after extraction, being the second case in which excision was performed there for that occurrence. Two eyes were excised from one individual; in each Gräfe's operation had been performed for acute glaucoma; in each hemorrhage took place, and they were removed. In the fourth case a staphylomatous eye was ruptured by injury.

"In all these preparations there is most distinctly visible the coagulum of blood lying between the choroid and sclerotica, pushing the choroid and retina inwards, or inwards and forwards, according to the magnitude of the clot. In not one did the bleeding take place from the inner surface, but in all clearly from the external surface of the choroid, probably from the vasa vorticosa. A precisely similar condition existed in another eye excised for hæmorrhage after extraction, the description of which is in the ninth volume of the Transactions' of the Pathological Society. I am therefore of opinion, that intra-ocular hæmorrhage after extraction is due to a diseased condition of the choroidal vessels, that it does not arise from rupture of the central artery of the retina, and that it occurs irrespective of loss of the vitreous humour, though the sudden withdrawal of the support afforded to the weakened vessels by that body may be a powerful predisposing cause." (p. 248.)

Three cases of hæmorrhage after extraction, which occurred in his practice, are related by Mr. Cooper. They are extremely instructive, and we only regret that our space does not allow of our quoting them at large.

Considering the very diseased state of the choroid in glaucoma,