be not in the centre of the membrane, and finally surround it in the manner mentioned, nor will the ulcer be repaired, if it be reparable, till they are both manifested.

We are not, however, to flatter ourselves with the assurance of a perfectly favourable termination in every case they are to be observed in; they are, as I have said, no doubt, the announcement of healthy action, and set in when the diseased one has abated; but even after that, the viscid tenacious substance of this lymph will sometimes, layer after layer, be removed, until finally, the depth of the parts are so thinned, that the iris cannot be retained in situ, when its protrusion takes place with the consequences already detailed; and as I have often seen this to occur during the presence of those healthy symptoms, among others, it is one of the reasons why I am disposed to question the dotrine of Mr. Saunders, as to consecutive sloughs of the cornea itself, inasmuch as, if that were the case, such a succession of them could only be the effect of unhealthy action in the part, and thereby the presence both of the diseased and the healthy existing at the same time in the very same part be implied, which I take to be very improbable. I have, however, been frequently disappointed in my expectation under these apparently most favourable circumstances, and where, in addition to these, the ulcer appeared clearing, and the papilla, so well known to those acquainted with ophthalmic disease, occupying the bottom thereof, when the iris has slowly entered the little sac, gradually coming forward, on some occasions capable of being repressed, while on others engaging the pupil therein, and finally destroying the eye. These cases, as I have already hinted at, usually occur when the ulcer is towards the edge of the cornea, when situated in the centre I have more frequently witnessed a favourable result.

Notwithstanding that this unfavourable turn sometimes takes place as the curative process is progressing, it does not, however, suspend those general appearances that I have denominated healthy; they still continue, like an endeavour on the part

of nature, to repair the injury sustained. This unfavourable turn, however, cannot be considered as proceeding from the opposite or unhealthy action, it must be regarded rather in the light of mechanical injury, in the way of pressure of the iris against the ulcerated cornea, and probably would, more correctly, come under the head of accidental; it therefore cannot, by any means, be considered as militating against the position I have laid down, of healthy and diseased action being incompatible at the same time in the same part.

If the reparative process go on favourably, and the ulcer make a perfect and undisturbed cure, the appearances on its edges are somewhat peculiar, they become elevated, and coursed over, particularly where they lie near the sclerotica, by the thick fringe of vessels already spoken of; very frequently this process is slow and becomes nearly stationary, but may be roused into activity by a stimulus properly used. The purulency often continues very troublesome in these advanced stages, and I have known it resist every judicious local application, and internal remedy, and then disappear altogether in one day, as it would seem of its own accord.

I have stated, that when the cornea is morbidly engaged, the inflammation of the lids generally abates, it however does not altogether disappear, but seems to linger as it were about their edges, nor is it finally disposed to yield until the amendment on the globe is decisive; and I have sometimes predicted the presence of corneal disease, previous to my examination of the eye, in consequence of the existence of this morbid appearance on the edge of the lids, where I had been informed the disease was of very long standing. We may also observe, where one cornea is injured, and the other not, that the lid of the affected one continues diseased at its edges, while that of the sound one has probably become perfectly natural.

The process above described as that whereby the eye falls a sacrifice in this disease, would, like the complaint itself, seem to be peculiar to the new-born child, and not observable in other

affections of the organ in after life. There may probably, however, be some explanation of it derived from the anatomical character of the cornea in infancy so very early, and which quickly changes as existence proceeds.

In extreme infancy the cornea is exceedingly loose and open in its substance, the anterior chamber can scarcely be said to exist in consequence of its thickness; in after life, however, it becomes more thin and firm, and ultimately approaches to a horny nature'; hence its name. The result of these opposite conditions, I would suggest, then must be, that in the first, when inflammation exists in the sclerotica, a facility is thereby afforded for its being at once transmitted into the cornea, (the vessels of the latter being, as I have already stated, the continuance of those that have previously traversed the former membrane,) whereas as we approach to adult life, its increasing density must offer an obstacle to such an occurrence, a mechanical resistance as it were being thereby opposed to the transmission of other than the transparent parts of the blood, except under peculiar circumstances. Nor is this all; it must likewise, I think, follow, that when the membrane does become the seat of inflammation, it is possessed of very little power of resisting its effect; hence large patches of it fall a sacrifice, deeply and extensively engaging it, and quickly destroying the eye, an event which is better resisted in its changed state, and when it occurs, is more limited. Compare the effect of disease on it in the different stages of life; in that we are speaking of, deep and extensive; the pustular affection peculiar almost to the next succeeding age; and the disposition the cornea has to resist inflammation and its consequence in the adult, when sclerotic inflammation exists even extensively, unless modified by struma or some other peculiarity.

Viewing then the condition of the parts in this, which is their true light, may it not be fair to imagine, that the very destructive nature of the purulent ophthalmia of new-born infants, arises from this peculiar state of the organization of the cornea, and

that were the membrane at such periods of life endowed with the firm compact nature it afterwards possesses, the disease would probably pass off after some time, without the sad effects which unfortunately but too often now do follow. It is admitted on all hands, that the discharge can have no effect in producing these extensive changes on that membrane, and it requires but very little attentive observation to see that the state of the conjunctiva can in no way influence them, as it most probably does in its true specific inflammations, as the gonorrhoeal and purulent ophthalmia of adults. Sclerotic inflammation, the precursor of corneal disease, in its ordinary state, is not observed to induce them, and to what then are we to attribute such rapid, extensive destruction which sometimes here does take place, unless it be to some peculiar susceptibility of the cornea, (the seat of all the evil,) at these periods of life to be readily effected by inflammation and its results, and which the physiological fact here stated may possibly account for.

I am aware that in support of a specific virulent character in this disease may be urged, the destructive inflammation which sometimes is supposed to take place in the eyes of the mother, or attendant on the infant affected with it, in consequence, as it is supposed, of the application of its matter.

With respect to this, however, I can only say, that so far as my experience has gone, I have seen but very few instances of it, indeed I cannot say more than two; and in these the disease in the mother not only possessed all the characters of gonorrhoeal ophthalmia, but the subjects of them were precisely of that description of persons where such a case would be most likely to occur. If, therefore, these instances were specimens. of the purulent ophthalmia of new-born infants set up in the eye of an adult, in consequence of the transfer of its matter, I can only say they differed from the latter in many circumstances, and precisely resembled the former in all; the result was unfavourable in each instance, as well with the mother as the child; for notwithstanding the resemblance that exists between the two

diseases in external appearance, they are, nevertheless, capable of being discriminated. In the purulent ophthalmia of infants, the swelling of the lids is more tumid; in the gonorrhoeal, though swelled, they are more flaccid and drooping, or at least soon become so; when attempted to be raised in the former, the internal surface rolls inwards or droops down, filling up the space between the cilia, no matter how far their cartilaginous borders are separated; whereas in the other, although the latter appearance likewise, to a certain extent, occurs, their internal surface, however, has not quite the fleshy character to be observed in the former, neither is there that difficulty in exposing the eye. There is also some difference in the discharge; in the first it is copious, flowing with a stream almost peculiar to itself, and in resemblance in every respect precisely that of pus with some very few exceptions, whereas in the latter it is not so abundant, and is more of purulent matter commixed with tears or mucus; there is likewise the extensive chemosis in the gonorrhoeal, which I can only say, I have never observed in the purulent; besides which, the mode the eye is destroyed, in each is different; I have already stated that whereby this is effected in the infant, in the gonorrhoeal the excessive, tumid chemosis would appear at least to contribute a principal part therein, constringing the vessels that nourish it, and acting, as stated by Mr. Travers, in the same way that a bad case of paraphymosis does in other parts, destroying the entire of the membrane on some occasion at once in a very short time, to which may be added, the different tendencies of the two diseases as already noticed; the one naturally disposed to get well, in many instances without any or but little treatment, the other to progress to organic destruction, in defiance of the most judicious we are acquainted with.

These different characteristics between the two diseases, will enable us often to detect the one from the other, however apparent the resemblance between them may be, and judging from them, I infer that the few cases alluded to were gonor