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substance, which may occur entirely, thus denuding the cornea, or in points and patches. This loss of substance is an unfavorable complication, as it may extend deeper, and extensive ulcers form, leading to perforation of the cornea, and subsequently to synechia or staphyloma. After pannus has existed some time, the cornea becomes thinned, and yielding to intra ocular pressure, bulges forward, thus,losing its normal curvature. This fact is important, for even after the cornea has become transparent vision will be imperfect owing to this faulty curvature giving rise to astigmatism.

Causes. The most prolific source of this disease is Trachoma, or granular ophthalmia, in fact, in most all cases where the opacity is confined to the upper half of the cornea, if you evert the lid they are readily seen. These granulations, by their prominence, produce irritation. by the constant friction upon the cornea. Among other causes may be mentioned inverted lashes which, following every movement of the lids, continually scrape the surface of the cornea; cretefaction of the meibomian glands by presenting an uneven or rough surface when passing over the globe; purulent ophthalmia by the direct contact of pus favoring the exposure of the corneal layer to irritants by producing loss of subtance.

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Pathology.This disease, which is of common occurrence, is regarded as being due to growth of neo-plastic beneath the epithelium; these cells undergo a tendency to be developed into connective tissue and to have blood-vessels appear in this new structure. I propose, by the peculiar pathology which I shall present, though radical it is based upon extensive observation, to demonstrate how a successful mode of treatment can be followed out. The question that presents itself is from where comes the innumerable cells that infiltrate the inflamed tissue immediately after its irritation. Cohnheim relates the following remarkable observation: He introduced finely powdered a line blue in the lymph sac of a frog, then irritated the cornea with and found that numbers of wandering cells containing anili ally collected at the cauterized point; hence the cor upon irritation white blood corpuscles wander from t the tissue; these white blood corpuscles constitute th infiltration and subsequently the inflammatory r primary connective tissue. From this new to tive tissue it is probable that many of the growths originate are these migrated white The next step in the development of these cells is the increase in their protoplasm and division of their nuclei, thus forming many new cells either by division or germation; then comes the development of these young cells into the tissue precisely similar to that from which they originated. This is epithelium from epithelium, corneal from corneal; hence it is that we have the new growth similar to the contiguous tissue. Now, if the relative position of component parts of the cornea are in any way altered, either by pressure or an increase of its natural tension, it presents an opaque milky appearance. Thus from this new growth of cells, producing crowding, we have a cause for the opacity of the cornea. We have next to consider what relation this develop

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ment of cells has to the increased vascularity of the cornea, premising that it is a law of development that in the growth of new tissue it is always either step by step accompanied, or else shortly followed, by its own system of vessels, hence the appearance of these vessels, histologically considered, are normal. The cornea is a non-vascular tissue, the capillaries terminating in loops at its margin, but under this increased irritation what takes place? Why, to supply this tissue the walls of the vessels send out shoots which communicate with the vascular loops of the surrounding borders; by this, however, there is only a scanty union. The complete anostomosing taking place not by dilatation of the vessels, but by interstitial growth of the walls of the vessels. So with each exacerbation, new vessels are being constantly formed from the increasing neoplastic growth of cells, until, in the chronic cases, we have that characteristic, fleshy appearance of the anterior segment of the globe, which is likened to raw meat or washleather.

Treatment. What must our treatment, or in fact any successful plan of treatment, have for its object? Namely, but one, and that to destroy the vessels and prevent their ramifying upon the cornea. Let me here contrast the following treatment, which emanates from the Royal London Ophthalmic, suggested as one of the plans which the surgeons are acquainted with, for effecting this result. We have a case where the lids are partially or wholly curved, and after exhausting every resource of his art, the surgeon still finds the patient's cornea permanently opaque, and traversed in every direction by vessels; for such desperate cases, a seemingly desperate remedy, namely, inoculation, consisting in the production of a fresh attack of purulent ophthalmia, by applying to the conjunctiva some of the morbid secretions from the eyes of a person suffering under the acute form of that disease. This treatment is extensively used in Germany, and is being revived in this country, the object being that the new disease will cause such a change as to produce wasting of the vessels of the cornea and hence ultimately restore its transparency.

*

By my method we obtain two results: 1st. We deprive the blood vessels of the cornea of their supply, which, from histological structure of the cornea, it is seen that they are abnormal, hence by this we reduce the vascularity. 2d. By completely depriving the cornea of its vascularity, we deprive the tissues of their abnormal nutrition, thus reducing the tendency to new formations, and thereby obviating its concomitant opacity of the cornea, which is produced by displacement of the corneal elements. If, upon averting the lids, granulations are found, examine closely and see if you detect any vessels running over the margin of the cornea; if you do, take a Von Graefe or Wecker cataract knife, and cut each vessel horizontal to their axis on

* In a letter written by Robert S. Newton, Jr., M. D., dated London, December 17, 1876, he says, speaking of the system of inoculation, "I have seen in the London Ophthalmic Hospital some of the most brilliant results follow this plan, though not always successful; yet, when it does succeed, it is wonderful in its results, and the successes are frequent enough to allow its maintenance in the category of dernier resorts."

the conjunctiva, thus completely dividing them. As new vessels appear from day to day, continue to cut them until you have absolutely destroyed their continuity. What takes place after we have severed these vessels running to the cornea? Why, it is followed by the disappearance of the newly-formed vessels, whose walls fall together, and they become fine connective strings. The cells assume the flat form of connective tissue corpuscles or disappear. Possibly some of them remain as wandering cells, and return again to the lymphatics. Thus, by this retrograde metamorphosis, the cornea is left perfectly transparent. If there is pain or sense of heat produced by the cutting, I recommend

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Atropine should always be used, as it acts as anodyne to tissues, allaying their irritation and diminishing intra-ocular pressure. Use mild zinc ointment to the lids nightly. All conditions indicating deranged function are to be met, as there is some periodicity to the attacks. I usually give sulph. quinine and phos. iron. Keep the bowels open; never allow constipation to take place.

DIPHTHERIA.

BY S. E. MORTIMORE, M. D., of New York city.

I have waited patiently during, and subsequent to, the recent epidemic of diphtheria along our North Atlantic coast, for a solution of the mystery which hides the pathology of this most malignant disease.

Among all the literature of the past and present which I found available I have sought for an explanation of certain conditions which accompany this disease, and find that if the authors of the numerous articles on this subject were as well-informed as could be desired, they have failed to place the matter clearly before the minds of their readers.

At the period of incubation of this disease, the first symptoms presented by authors is that of extreme lassitude-lassitude to such an extent that those of active temperament will sleep while sitting in a chair. Then follows soreness of the throat and swelling of the glands, after, or during which, the pseudo-membraneous deposit is discovered. Lassitude, however, is not the first symptom of incubation. The mother or nurse will tell you that the day before the lassitude appeared the child was in the best possible health; indeed, she had never known the "little one" to enjoy such perfect health; that it was wildly exuberant in spirit, demanding restraint to prevent mischief from creeping into its pastime. If the throat had been examined at this time there would have been discovered upon the fauces numerous papillæ, raised slightly from the surface, whose center appeared as yellow spots, the epithelial layer of the mucous membrane inclosing, at these raised points, a thin icherous fluid. If these papillæ do not break there will be no pseudo-membranous deposit, but if they do break, to such an extent will the deposit take place, and as they become confluent so will the ulcer be formed.

These papillæ may be distinctly seen on the mucous membrane, immediately about the edges of the membranous deposit, during the period of its progression.

Every practitioner who has given this subject attention is aware that the same deposit (pseudo membranous) which appears in the throat has been observed on the hand of a patient, when the cuticle is accidentally denuded, immediately before or at the time of incubation of this disease. But few know of this condition and deposit being found in the vagina and about the cervix uteri:

The period of catamenia marks the attack of diphtheria as particularly malignant. One case was reported to me where the vaginal condition occurred simultaneously with the difficulty of the throat.

The slow convalesence was attributed to the non-appearance of the menses, until it was discovered that the uterus was swollen and painful to the touch. Upon examination with a speculum the attending physician found the os uteri occluded by something not unlike the mucus plug of pregnancy, but, being satisfied that pregnancy did not exist, he concluded that to the recent attack of diphtheria the occlusion was due, and that the contents of the uterus must be retained menstrual flow.

The fact here mentioned establishes the fact that diphtheria is not a local but a constitutional disease, and that local treatment cures by accident and not design.

A fact as remarkable as any presented during the study of this morbid condition, is this: Where there had been success in the treatment of this disease among the "old school" practitioners, I found it shrouded in a great deal of doubt, some believing it to be a local, others a constitutional difficulty, but all agreeing the best treatment to be the application or administration of one or more of the following remedies: Mercurii Biniodid, Mercurii Sol., Argenti Nitras, Potassæ Bichrom., Tr. Ferri Perchlori., Soda Chloras, Potassa Chloras and Acidum Carbolici.

Exploring the writings of the Homœopathists, I found them possessed of a specific "dilute nitro-muriatic acid," applied locally, and administered generally, and it certainly has and will affect cures, in a manner prompt and pleasing both to the patient and his medical attendant.

Last, but by no means least, I turned to the practitioners of our own "school," and found specifics in profusion. I desire you to note the fact that all the following remedies are acids or contain acids.

Prof. Robert S. Newton remarks: "If there is a specific for any disease it is Kennedy's Fluid Extract of Pinus Canadensis, applied locally and administered generally." Where this remedy has been "pushed," I have never known it to fail save in one instance, and that through the gross neglect of the attending physician during the early stage of the disease. Expecting much from this remedy, it was administered, even in the state of collapse in which the patient was found when the first dose was administered. I was satisfied, in observing its action then, that, had the patient had the benefit of this remedy twenty-four hours sooner, she would have recovered. I can ask for nothing better in my practice.

The next best remedy given me by an eclectic physician was: dilute Nitro-Muriatic Acid, fifteen to twenty drops, in about three ounces of water, a teaspoonful to be administered every half hour, if necessary. In nine cases out of ten this remedy will work with as much certainty as the Pinus Canadensis, there being this difference in favor of a choice between them: the latter contains a tonic property which the Nitro-Muriatic Acid does not.

The next best remedy given was, dilute Sulphuric Acid. Never, so long as I shall live, will I forget the justifiable enthusiasm of the gentleman who first called my attention to this remedy, for he had reason to be proud of his success. As he shook As he shook my hand" good-bye,"

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