superior, the silver to an inferior one, all the ulcers situated in a direct line between the two plates improve in appearance, become healthy sores, and cicatrize, while those on either side of the current remain unaltered, and sometimes degenerate.

6. When the silver plate is applied upon the extremity of a fistulous sore, the effect does not extend beyond the edges; but if a projecting portion of the silver be carried to the bottom of the fistula, granulation rapidly follows. It is very easy to perforate the silver plate by a screw, the point of which is smooth, and adapted in size and shape to that of the fistula. I found this plan answer admirably in a case of perineal fistula, which persisted long after perfect dilatation of a stricture of the membranous portion of the urethra. In cases of open bubo, with burrowing sinuses, I have introduced a small silver chain to the bottom of the cavity, and connected it either with the plate of the single pair or with the copper end of Pulver macher's chain. The result has been invariably satisfactory. I saw a case in H. M. S. Scourge, of a man who had been eight months on the sick-list from a bubo in this state; yet he was well after the chain had been used for one week only, in the manner I have described, by my friend Dr. Davidson, surgeon to the ship.

7. In several cases, normal innervation has been restored in paralysed parts under the use of this apparatus, the zinc being placed superiorly, and the silver inferiorly, so as to include as nearly as possible the whole of the paralysed part. Disordered function of particular nerves has been also remedied, by so placing the two plates that the nerve lies between them.

8. Whether the single pair of plates, or Pulvermacher's hydro-electric chain, be used, a much better imitation of the natural currents of vital electricity is afforded than by the batteries in common use. The action of the latter is powerful, and only susceptible of temporary application; while that of the former is mild, uniform, and continuous, an electric current circulating continually in the same direction from one plate, or one end of the chain, to the other, through any part of the body which is between the two poles. The single pair of plates never causes any pain or uneasiness to the patient, never producing more than slight itching or numbness; while in many cases where the action is very evident, no sensation whatever is felt. When Pulvermacher's chains are used, the sensations vary with the length of the chain, and the strength of the acid in which it is soaked before application. That I have most commonly used has been only eight links, and soaked in distilled vinegar. Itching or tingling sensations are felt for an hour or two, and are renewed as often as the chain is soaked in the vinegar, but nothing approaching to pain is complained of. With a chain of twenty-four links, soaked in the same acid, the tingling sensation is sometimes so acute as to be troublesome, but still not painful. With regard to the relative advantages of the chains, or the single pair of plates, my present experience would lead me to prefer the plates in ordinary cases of ulcer, where they could be applied without producing painful or injurious pressure. I have found, that even where a chain of eight links was only moistened with water, the current has been too strong, and made an ulcer irritable. On the other hand, the chains have great advantages over the plates when ulcers are situated over bones, or are too sensitive to bear inetallic pressure. They are also to be preferred in cases of indolent ulcers in weak persons, as, in such cases, the current of the single pair of plates is too feeble to excite any very speedy influence.

I shall conclude this paper by some short notices of some cases in which the plates or chain have been applied during the year in this ship.

Case 1.-J. B., aged 18, grazed the right shin by a fall. Three superficial ulcers followed, and he was put on the list on the 15th of October. Water dressing was used until the 20th, but no change for the better took place. Pulvermacher's small chain, excited by vinegar, was applied on the 20th, kept constantly fixed, and only removed to be soaked again in the vinegar in the evening. On the following day the ulcers were so nearly cicatrized that it was not thought necessary to re-apply the chain. Water dressing was used, and the sores again degenerated. On the 3rd of November, the chain was applied again near the sore, but, from the slipping of the upper end, in such a way that the current did not pass through it. On the following day no change had taken place, but the chain was re-applied, so that the current should pass through the sore. On the 5th it was very nearly healed. Chain kept applied. On the 6th cicatrization was perfect, and he was discharged to duty on the 7th.

Case 2.-C. H., aged 17, received a wound below the left external_malleolus, which was followed by an indolent ulcer. He was put on the list on October 15, and treated in various ways until the 26th without any benefit, when the single pair of plates was applied. On the evening of the 27th, no change having taken place, Pulvermacher's chain was applied. On the 28th half the uleer was quite filled up and cicatrized, the other half nearly so. On the 29th, the chain having been constantly applied, cuticle had formed in the centre of the ulcer at the exact spot where the metal had been in contact. In order to determine if this were accidental, or owing to the galvanic current, the chain was discontinued, and simple dressing applied. The boy got his feet wet with salt water, and the sore again assumed an indolent, unhealthy appearance. On the 16th of November the chain was applied, but wetted with water only. On the 17th not much effect had been produced, but the surface appeared more healthy. Continue. 18th.-Slight improvement. Wet the chain with acid. 19th.-Cicatrization nearly complete. Continue. 20th.-Cicatrix quite perfect. He returned to duty on the 22nd.

Case 3.-E. H., aged 27, applied on the 3rd of January, with an unhealthy sloughing ulcer on the foot, with inflamed edges. Poultices were first used, but no improvement followed. On the 5th the single pair of plates was applied. 6th.-Sore cleaner. Continue. 7th.-Slough separated. Wet compress only used. 8th.— The wound had again degenerated, and continued to do so until the 10th, when the plates were again applied. On the 11th the surface appeared healthy, but there was à deep, excavated, cup-like ulcer left, which did not appear to fill up. On the 14th Pulvermacher's chain was applied. On the 15th the sore was much contracted in circumference. Continue. On the 20th, the granulations being level with the surface, the chain was omitted, and water dressing used; cicatrization afterwards proceeding naturally.

Case 4.-G. W., aged 19, applied on the 9th November with an open bubo in the right groin, which he had concealed as long as possible. It had opened spontaneously. The edges were inflamed and undermined, the whole surface appearing very unhealthy, with a bloody sanious discharge. Black wash was first applied, then a lotion of diluted nitric acid, with solution of opium, but no improvement whatever had taken place up to the 14th. On that day Pulvermacher's chain was applied, the copper end being connected with a metallic plate which covered the whole exposed surface. It was kept constantly applied during that and the following day. On the 16th there was an appearance of commencing granulation, which, on the 17th, was much more distinct. The chain was still continued. The granulations had reached the surface by the 20th, when it became necessary to open a long narrow sinus, which extended downwards and inwards, and on the 23rd another, which extended outwards. Simple water-dressing was used until the 26th, but no healing process began. On that day the single pair of plates was applied. From this time granulation and cicatrization went on rapidly, the plates being kept constantly applied; but he was not sent to duty until the 20th of December, owing to an attack of diarrhoea.

Case 5.-Mr. D., aged 20, had suffered on the coast of Africa, with an obstinate ulcer on the leg over the middle third of the tibia, and, after being four months on the sick-list of his ship, had been invalided. The ulcer healed in England, but left a large, thin, red cicatrix adherent to the surface of the bone. This gave way when he was in the Vengeance on this station, and he was again several months on the list before it healed. On any slight injury to the cicatrix it broke down. He wore a padded metallic plate for protection, but he applied to me on the 30th of April, the old cicatrix being then completely converted into an ulcer three inches in length and two in breadth, with a livid soft surface, and fetid sanious discharge. Various simple and stimulating applications were used without effect. The single pair of plates was applied, but the pressure on the tender surface of the ulcer could not be borne. Pulvermacher's small chain was applied and produced a good effect, but so slight that the large one of twenty-four links was used. After this very rapid improvement took place, and he returned to duty after having been thirty-four days on the list, the ulcer, according to his own statement, having been in a worse condition than when he had been several months on the list on former occasions. He was again on the list in June, September, and November, with the same ulcer, which had been reproduced once by the kick of a horse, and the other twice by blows received

on board. On each occasion, the inutility of ordinary applications was proved, and the great benefit derived from the long chain of Pulvermacher was most obvious. The average stay on the list on these three occasions was twenty-two days. The cicatrix is now much firmer, harder, and less adherent to the bone than when he joined the ship.

I might narrate many other cases, but the foregoing appear sufficient to illustrate the statements I made as to the therapeutical efficacy of galvanism in the treatment of ulcers.-Med. Times and Gazelle, July 23, 1853, p. 84.

DISEASES OF THE EYE AND EAR.

119.-ON THE TREATMENT OF IRITIS.

By JOHN FRANCE, ESQ., F.R.S.

[The first part of the treatment manifestly should consist in preventing the effect of atmospheric vicissitudes upon the eye, and removing, if possible, any foreign body exciting or keeping up irritation. Next, we have to subdue the inflammation, and here, amongst the antiphlogistic measures, Mr. France makes venesection the exception and not the rule. When the inflammatory action is great, and there is good constitutional power, six to twelve ounces of blood may be removed from the temple by cupping. The effects of this proceeding should be first noted, and the necessity of a further abstracrion decided upon.

These measures having been premised, and the intestinal canal having been cleared by appropriate medicine, the next step is to administer mercury in doses proportioned to the severity of the case and the constitutional vigour of the patient. In the syphilitic disease this medicine is, in fact, our sheet-anchor; and where the inflammation is acute, and the degree of power pretty good, calomel should be exhibited in one or two grain doses three times a day, and be persevered with steadily until the gums begin to show signs of the establishment of mercurial influence upon the system, or, which is tantamount to this, until the complaint begins to recede. In either event the dose should at once be moderated, as actual salivation is never called for. Indeed, in the great majority of cases, the effect becomes apparent upon the disease before either the gums, tongue, throat, breath, or salivary secretion betray any evidence of the action of the medicine. We have then no need to push mercury farther; no benefit accrues, but the reverse, from insisting upon the production of its physiolagical effects; its therapeutical effects (if I may be allowed the distinction) are what we require, and what we may very generally obtain quite independently of the other class. To check any purgative action of the calomel, which in syphilitic iritis is undesirable, I consider that the use of chalk mixture is preferable to combining opium with the pills, the latter drug having, it is well known, a tendency to cause contraction of the pupil, which in iritis of all kinds it is so great an object to prevent. In syphilitic cases of milder character, or occurring in subjects of impaired general powers, calomel must be given in smaller doses, and be less frequently repeated. The mercurial part of the treatment is in such instances similar to that which is habitually sufficient in simple and arthritic iritis. Here the exhibition of a grain of calomel, or five grains of mercury pill, or lead pill, night and morning, is commonly the full extent to which mercurials should be carried; and even this quantity should be diminished as soon as the subsidence of the disease permits. When iritis ensues upon an operation for extraction of cataract, mercury must be altogether withheld until the flap has securely adhered, and then (if required) be given in extremely small doses, for fear of preventing or disturbing union. With this exception, the initiatory measures of depletion and the employment of mercury are applicable (with a proviso on the degree of activity requisite in carrying them out) to all species of iritis. The further progress of the treatment is, however, in several respects different in details. In arthritic cases, after the use of the means already spoken of, should there be considerable pain, disturbing the night rest, the extract of conium may be given in doses of from five to ten grains twice or three times a day. Conium seems occasionally to exert quite a specific influence over arthritic inflammation of the eye, so that it may occasionally be exhibited, to the exclusion of

any other except local remedies. Its beneficial influence, however, is not uniformly manifested in an equal degree. Hence the moderate use of mercury is preferable, which should be accompanied by alkalies, saline purges, and colchicum.

When the acute stage has passed, and the complaint is retroceding, a few greins of powdered bark generally assist in re-establishing tone in the vessels, and repressing lingering congestion. At the same time, a corresponding improvement in diet should take place; for at the commencement in every form of iritis, spirits and fermented liquors must be forbidden, and when the patient's age or debility contraindicates his restriction to slops and farinaceous food, at least the quantity of meat allowed should be very moderate.

In thus describing the next course of constitutional treatment, I have not referred to a potent, and sometimes admirable remedy, aconite. The action of the drug is uncertain, and, in incautious hands, it has been productive of serious and even fatal consequences. Hence it is best to reserve aconite for cases which resist the ordinary course of treatment, and continue under constant observation. Under such eircumstances, ten minims of the tincture may be prescribed thrice daily, the effects being carefully watched. I have witnessed the greatest benefit from this medicine, but am far from recommending its indiscriminate administration.

In simple iritis there is in general at the outset no call for other internal remedies than mercurials guarded from acting purgatively. In the syphilitic disease, if, as frequently happens, the patient is tormented by racking pain about the globe, forehead, and temple, with nocturnal exacerbations, we may be compelled to prescribe an opiate, and then the compound ipecacuanha powder, or one of the preparations of morphia, is the best. Indeed, should full dilatation of the pupil have been obtained by belladonna, the objection to the internal use of opium falls to the ground, and any preparation deemed best suited to the case may be administered. The benefit of these anodynes is not simply palliative, but by tranquillizing the irritable frame of the patient, and perhaps procuring sleep, they contribute to place his system in a more favourable condition for receiving the curative impressions of other remedies. Much likewise may be done in allaying pain in all forms of the disease by the mercury and opium ointment, or the belladonna liniment rubbed in over the seat of pain around the orbit.

Pain is not unfrequently created by the application of belladonna to the brow in arthritic cases, apparently from the tension excited in the contractile fibres of the membrane affected with rheumatism. Such appears the simplest explanation of the circumstances, for the pain subsides on removal of the belladonna, and is quite of the rheumatic kind.

Notwithstanding this occasional inconvenience, it is right in all cases of iritis, including those of the arthritic kind, to apply belladonna; in the majority of instances its effects prove wholly salutary. When deprived of this most valuable auxiliary, in order to avoid contraction of the pupil as far as possible, we must keep the patient in a darkened room, and abstain from the exhibition of opium. As a general rule, the moistened extract should be smeared night and morning around and over the palpebræ, and be prevented from becoming dry and inert in the interval. I think this mode better while the inflammation remains, than applying a solution of belladonna or atropine to the conjunctiva. In young children it is safer to use the remedy in the form of plaster, to avoid the chance of its being conveyed to the mouth. The utility of this application in the early stages of iritis originates thus: The posterior aqueous chamber, owing to the convexity of the lens, is much shallower towards the axis of vision, or opposite the centre of the pupil (where the posterior wall of the capsule bulges forward, and approaches the plane of the iris), than at the periphery. The more dilated, therefore, the pupil is, the further is its edge removed from the capsule, and vice versa. Hence a dilated pupil is less liable than a contracted one to form adhesions; the adhesions if formed are longer, while of course there is greater probability of saving some portion of a large than of a small pupil from being overspread.

At a later stage the object of applying belladonna is, first, to save any portion of the pupil remaining permeable, and of its margin yet unattached; and secondly, to obtain, if possible, as inflammation subsides, the elongation and eventual rupture of adhesions already formed. And here I must mention incidentally a physiological fact, demonstrated by our occasional success in effecting the liberation of the iris

after adhesion, and by the phenomena which precede such liberation. It is, that dilatation of the pupil is not merely a passive result from relaxation of the force which produces contraction, but is itself an active change. Thus, in a case where adhesions have formed, when the pupil expands under the influence of belladonna, we may notice that the margin of the iris is arched or deeply recessed from adhesion to adhesion, evidently by the exertion of an active dilating power upon the intervening spaces. We see, moreover, that the morbid bands connecting the edge of the iris to the capsule are maintained in a state of absolute tension so long as the belladonna is kept applied, and these fræna remain unbroken. Hence it is plain that dilatation of the pupil is no more a painful state than contraction-an inference confirmed by the occasional rupture of such adhesions and disengagement of the iris, as also by the disentanglement of the membrane from apertures in the cornea, effected by use of the same remedial application, belladonna.

We are more frequently successful in effecting the detachment of adhesions in cases of syphilitic than of arthritic iritis. In the former the adhesions commonly assume the shape of narrow bands at the points where the greatest thickening or tuberculation of the iris has occurred. In arthritic iritis, the inflammation being more diffuse, the adhesions are usually broad, and involve a large part of the margin of the pupil; they possess therefore much greater firmness and power of resistance to the action of belladonna than do those of the syphilitic kind, in which consequently we apply the extract, even in advanced stages of the disease, with better hope.

Mr. Carmichael, of Dublin, introduced the use of turpentine in syphilitic iritis to the notice of the profession some years since. Of its remedial influence in these cases there can be no doubt. I have exhibited it, and had occasion to be satisfied of the truth of this statement. But the medicine is very apt to disagree, and act violently upon the kidney, so that in many instances its administration cannot be persisted in; while, when borne, its power over the disease is inferior to that of mercury. Were we only to give mercury in one fixed dose, repeated at unvarying intervals, then indeed turpentine might often be a more eligible remedy; but as we can adapt the dose of mercury at once to the exigencies of the part and of the constitution, and these are seldom really at variance, we have little need of a medicine which, though sometimes efficacious, is often irritating and distressing, and always uncertain. However, in cases of no great acuteness, which do not yield so readily as expected under mercury, assisted by the remedies above enumerated, there can be no objection to giving the oil of turpentine a trial. A drachm may be given three times a day, or every six hours, made into an emulsion, with milk or almond mixture, the patient being warned of the probability of some little interference with the functions of the urinary organs. Should such inconvenience intervene, we should obviate it, if possible, by quietude and alkaline drink; and this failing, intermit or altogether relinquish the use of turpentine, especially if the urine become tinged with blood, and pain arise in the loins.

As iritis becomes chronic and subsides, the mercury should be further diminished. It must be entirely abandoned when once the external marks of inflammation have disappeared, and vision has regained its former degree of perfection. When we have failed to prevent the formation of a film of lymph within the pupil, still by steady perseverance with an alterative course, assisted by sarsaparilla, with soda and iodide of potassium, or in syphilitic cases with nitric acid, much diminution in the density of the effusion and improvement of vision may generally be effected. When the final failure of these endeavours is certain, though the globe in other respects retains the general indication of health, and the patient is capable of distinguishing the transit of an opaque body before the eye, there is yet a prospect of affording relief by operation. If the other eye be previously lost, such operation is to be recommended. In the chronic stage of all species of the disease, there are no more useful auxiliaries than blisters applied behind the ear or to the nape of the neck, of which situations the former is preferable. Never let a blister be placed on the temple or forehead for the relief of inflammation of the eye, for almost invariably the symptoms will be aggravated by the application, which, from undue proximity to the affected part, becomes a direct instead of a counter-irritant.

You will probably have reason to observe, even in cases checked at an early stage of the disease, the extreme liability which one attack of iritis engenders to another; a little exposure, indiscreet indulgence, and over-exertion of the eye, being often