Reflecting on the insufficiency of previous treatment, and on the physical character of the disease, I concluded that I had before me a case that warranted operation. I decided to employ the miniature gouge, which, as you know, I generally use to remove foreign substances from the cornea, and to pick away, as it were, the opacity. This I considered safer than to use a knife.

I selected the right eye, picked away at the outer margin of the opacity, detaching some, and was not a little gratified to find that it was superficial, and, as I hoped, not deeper than the anterior elastic lamina. Finding my attempt successful, the opacity reduced, and transparency of the cornea thus far restored, I repeated my little process four times, at intervals of a month, and operated twice on the left eye. Now, there was vision enough with the right for her to read large type, and with the left she could move about alone. Still, in both, especially the left, some opacity remained.

She ceased to attend me from this period till the present summer, when I operated twice more on the right eye, and nearly, but not quite, established a clear cornea, a small spot of opacity passing deeper than I deemed it prudent to penetrate. The left eyeball, too, was scraped a few times, and here, also, a central deep bit resisted removal.

To conclude the report, the appearance of the eyes is so far natural, that it needs a careful examination in a favourable light, to detect the remaining opacities. The form and outline of the corneæ are normal, and their entire surfaces reflect the light. Vision is nearly perfect. With either eye she can thread a common sewingneedle, (No. 6,) but the left is rather the more perfect.

As this is the only case of the kind of which I have personal experience, I have little to add to the facts that it affords.

Perhaps the first points of practical import that demand remark, are the fitness of the case for the means used, and the signs by which such cases may be diagnosed. Concerning the first, the opacity being raised, and to all appearance of an earthy nature and superficial, induced me to interfere. I suspected that there was a circumscribed deposit of a foreign substance, which could be removed, just as one would extract a particle of iron, or any other extraneous matter, imbedded in the cornea. As to the second, I trust it is sufficient to put you on your guard to prevent you from mistaking small staphylomata of the cornea, or fungous growth from the conjunctiva, for this affection. You must be observant to prevent such errors. by personal observation alone that you can learn their distinctive characteristics. Of the precise nature of the substance scraped away, I cannot speak, as neither minute chemical nor microscopic examination was made. I did not detect any grittiness with the instrument, but this does not disprove an earthy nature.

It is

I must tell you that this class of treatment is not restricted to opacities that are raised. So long as we have tolerable assurance that

the loss of transparency of a part of the cornea is due to deposit of earthy material, there can be no reason against operating, although such deposit does not interfere with the natural outline of the part. At the same time, the opposite state renders diagnosis more certain, insomuch as it goes to prove that there is some material superadded. Nor does the practice end here; it has been applied to opacities the result of cicatrices from loss of substance of the cornea, or from opaque deposit, the consequence of inflammatory attack; but I should be travelling away from the case before us to enlarge on this; you may find a full account of the subject in my Work on 'Operative Ophthalmic Surgery,' in the chapter on the removal of opacities of the cornea by operation. I shall, therefore, confine myself to a short statement from Mr. Spencer Wells, who was present at one of the occasions of my "scraping." Mr. Wells saw Malgaigne perform his second operation, of paring opacities of the cornea, at the Hospital of St. Antonia, Paris, 1845, as follows:-He made an incision above the upper edge of an opacity, which covered the lowered part of the cornea, and divided the external laminæ. He then fixed the edge of the opaque portion with fine forceps, and on raising it this peeled off very easily, and the separation was completed by another incision round the lower edge. Mr. Wells saw the first patient upon whom M. Malgaigne had operated six months before, and the cornea was perfectly transparent. Mr. Wells tells me that he has himself repeated this operation in two cases, with equally favourable results.

You should realise to your mind, that this application of practical surgery has reference to a portion of the eyeball, about the thickness of one's thumb-nail, and to separate the component parts of which, even on the dead eye, demands exquisite manipulation.

Let us now inquire a little into the conditions essential to the success of scraping the cornea. It is necessary that that portion of it posterior to the operation, do retain its transparency, and that the repair of the injury inflicted by the instrument be effected by transparent material. I imagine that little is to be apprehended from failure in the former, and the fulfilment of the latter must, I conclude, depend on the depth to which the true corneal tissue, the laminated part, is penetrated.

I strongly suspect that the perfection of repair differs in the two instances of loss of structure from ulceration, and from wounds, being by far more complete in the former. That a breach by ulceration, provided it be small, which will penetrate far into the laminæ,-nay, even go through them,-may, under favourable conditions, be filled by a material in no respect inferior in transparency to the original structure, while the removal of any of the lamina by art, or the separation of them, must be attended with the greatest risk of opacity, and that in proportion to the extent of the wound. It is said that Malgaigne, who made a great stir about the operation at the time of its revival among educated surgeons, for it seems that it had lapsed into the

hands of itinerant oculists, sought to convince himself of its practicability by removing laminæ from the corneæ of animals, and obtained success that encouraged him to operate on man. The chance of inflammation of the cornea supervening on any of these operations, and so spoiling that which had been transparent, must be taken into the general account in deciding on the mechanical treatment of opacities. The dread of this was the reason of my proceeding cautiously and in so piecemeal a manner, effecting by many stages what might perhaps have been accomplished at once, or at least by much fewer operations. I have nothing to regret from my caution. But slight action followed each of the applications of the gouge, and the effect so caused passed off in two or three days. It is probable, judging from the result of the operation, that the instrument never penetrated beyond the anterior elastic lamina. The restoration of epithelium, always. rapid in slight abrasions of the cornea, was quickly effected.-Medical Times and Gazette, Nov. 5, 1853, p. 469.

137.-Pathological Remarks on the kind of Palpebral Tumour usually called in England, Tarsal Tumour. By H. HAYNES WALTON, Esq. Mr. Walton describes the intimate structure of one of these tumours as follows:]

It consisted externally of a dense fibrous cyst, continuous with the fibrous tissue of the lid; within this a layer of fibro-plastic matter, soft, pink, abundantly supplied with vessels from the fibrous cyst, composed of fibro-plastic cells, with a very little intercellular fibrillary matter; within this a thin pellucid cyst, containing a puriform fluid, made up of pus globules, epithelium cells loaded with oil, and in the centre a perfectly round pellet of sebaceous matter. In conclusion, he suggests the following to be the order of development-first, the formation within a Meibomian follicle of a pellet of hard sebaceous. matter; secondly, the secretion of a more copious epithelium and fluid matter around; thirdly, the addition of fibro-plastic matter around the obstructed gland follicle, distending the loculus of fibrous membrane. into a cyst. This, together with a dissection of other tumours of the kind, as also the structure and relation of the Meibomian glands and their ducts, were illustrated by accurate drawings. Mr. Walton suggests the term Meibomian tumour. In a postscript to the paper he advises that whenever the Meibomian tumour takes an outward direction, and calls for the exercise of practical surgery, it is better to divide it on the outside, squeeze out the contents, and pull away the cyst with a pair of forceps. He adds that there need be no fear respecting the formation of a scar, provided the incision be made horizontally, and the edges accurately brought together by a plaster.-Lancet, Feb. 4, 1854, p. 137.

138.-New Instrument for Injecting the Lachrymal Sac. By MR. OBRE.-The extreme difficulty, if not impossibility, of introducing fluid into the lachrymal sac, in cases of chronic inflammation, with Anel's syringe, passed through the puncta, induced Mr. Obre to have a silver canula constructed, the same shape and size as the sound of Gensoul, to which is attached a small vulcanized india-rubber bag, about the size of a nut, into which the injecting fluid is introduced. The canula having been passed through the nasal duct by the inferior meatus, slight pressure of the thumb on the india-rubber bag propels fluid. No more difficulty is found in passing this instrument than the ordinary sound, a little practice soon overcoming any difficulty. It is necessary there should be a canula for either nostril; the india-rubber bag is made to screw on either as required. Mr. Obre stated he had not brought this instrument before the notice of the profession until he had first given it a fair trial and proved its utility. It is made by Mr. Coxeter. The diagram represents the invention.Lancet, Jan. 28, 1854, p. 111.

139-M. KOTZIUS'S NEW OPHTHALMOSCOPE.

By T. SPENCER WELLS, Esq.

The instrument of Helmholtz is undoubtedly a great assistance in examining the condition of the refracting media of the eye. The condition of the lens and its capsule and of the vitreous humour can be much more accurately defined by its use than by ordinary observation; but, after numerous trials, I became convinced that its illuminating power is far too feeble to enable one to see at all distinctly anything whatever on the retina, and that an instrument more recently contrived by M. Kotzius, of Leipzic, is immeasurably superior in this respect. The instrument of Helmholtz is preferable for examining the refracting media, and it possesses the great advantage, that it may be used with an undilated pupil without producing much contraction: while the intense light from Kotzius's instrument requires full dilatation, or the pupil becomes closely contracted. But, for the grand object of examining the condition of the retina itself, this latter instrument is very far superior to any other that I have seen.

This instrument consists, as may be seen by the accompanying woodcut, of a perforated mirror and a lens. The rays of light from a

lamp are concentrated by the lens and thrown on the mirror. This is held before the eye to be examined, and the rays are thrown through the pupil on to the retina. The unabsorbed rays return in the same direction, and are received by the eye of the observer, which is behind the mirror, at the spot where it is perforated.

In a healthy eye, the part behind the pupil is absolutely dark. Even when the lens and vitreous humour are clear and transparent, no ordinary examination, even when the pupil is dilated, can afford any information as to the appearance of the retina. Without some artificial assistance, we cannot illuminate the retina and also see the illuminated part. The rays of light return from the retina in the same direction as they were thrown on to it, so that we cannot bring our eyes into the direction of the rays of light returning from the retina without at the same time cutting off the supply of those rays. But, by the aid of this instrument of Kotzius, the rays are reflected at an angle upon the mirror, are then conveyed to a focus on the retina by the media of the eye, and the unabsorbed rays, on leaving the eye, return to the mirror whence they came, and are also received by the eye of the observer.

When the instrument is to be used, the pupil is dilated by atropine, if not naturally dilated. The patient is seated in a dark room near the corner of a table, on which a bright lamp is placed at the level of the eye. The surgeon sits before the patient, and screens the face of the latter by an upright shade, so that the eye is the only illuminated part. Holding the mirror opposite the eye, he then adapts the lens in such a manner that a bright concentrated light is seen to fall on the pupil. Then he applies his own eye to the back of the mirror. The instrument is held at different distances from the eye until a clear view is obtained, and then the patient, by moving his eye in different directions, exposes the different parts of the retina to view. This appears rather difficult at first, but a very little practice enables one to find the proper position of the instrument. When the retina is not clearly seen, although the pupil is well illuminated, a concave glass is interposed between the mirror and the observed eye, by the hand not employed in holding the instrument.

Examination of the retina in this manner is very interesting. Bloodvessels are first distinctly seen ramifying upon it, and by tracing