an albugo or pearl, as it is termed; but should it not take this fortunate turn, it progresses to the next stage, when breach of the corneal texture takes place; this is what is termed slough. I have already, however, stated my objection to that term, nevertheless I shall for the present retain it for conveniency, to designate the morbid appearance it is applied to, as I shall have occasion to refer to it often.

Although where this stage of it occurs, there is an abatement of the inflammation generally, still it is in some way as yet present in a kind of sub-acute state, and while it is so, healthy action cannot set in decidedly. If the consecutive sloughing of Mr. Saunders be correct, it is a clear proof of this, as it can only result from it. I therefore, even here, would have recourse to a leech or two to subdue it; blistering or cold application I should not think of much utility.

By this time the disease may have been of long standing, and this, together with the sufferings of the infant, generally reduce it much; we should therefore be very guarded as to the extent we carry antiphlogistic means, as they must add to this already existing evil. Mr. Saunders has very judiciously advised the tonic plan to be now adopted; his recommendation of the extract of bark is also most judicious; I have given it frequently, and with the most decided benefit in the manner he recommends it, to the extent of sixteen or eighteen grains in the day in repeated doses; it must, as he states, be softened down and given in a little pap.

Sulphate of quinine, it might be supposed from its condensing the virtues of the bark in a small space, would be peculiarly adapted for these cases. I have tried it, and in my hands it has not been as serviceable as the other preparation : the sulphate of quinine, even in the adult, often disagrees with the stomach, and if it should have that effect with the infant, which is a very likely thing, it is impossible any advance shall be made in the cure; when the stomach is deranged, local or even constitutional disease progresses but badly towards amendment.

Doctor Mackintosh has advised the exhibition of two drops of brandy to the infant in a little food. I have given it, or what is the same, good whiskey, and with very decided benefit; three or four drops is the most I have gone to, three or four times a day: the amendment in the eye is evident in a day or two, the transparent bluish tinge, spoken of in the last section, appearing; but it is in the general appearance, and particularly in the face of the child, it is manifested; the sunken, worn-out aspect giving way, and becoming replaced by the ruddy tinge of health; the bowels must still be attended to.

I do not approve of collyria in these cases; they have been advised in order that they may effect the removal of the sloughs, for the purpose as it is said of enabling the proper application to be made to the ulcer to stimulate it to heal; my objection is to this very point, it is on mechanical principles, and I shall state it.

We know not to what depth the slough may have gone, it may have bared the membrane of the aqueous humour extensively, and if so, its 'presence alone keeps the part so denuded in situ; its premature removal therefore must necessarily be followed by an advance of that membrane, most probably accompanied with a portion of the iris, and of course leading to the destruction of the eye. I prefer attacking the breach by the above constitutional measures, and for the present should be rather desirous for the continuance of the slough. The state of the parts probably is-deep ulcer of the cornea occupied with the slough; now, ulcers of the cornea, like those in other parts, heal from the bottom, and if we succeed in forwarding this process to a certain extent before the slough is removed, the part is as it were secured against the impending danger, (hernia of the iris,) and then on its removal a manageable ulcer is what we have to deal with; but under the other circumstance the untoward result I have mentioned must follow.

It may be imagined by those who have not seen this morbid condition of the parts, that a slough could scarcely restrain the

pressure from within in the way stated; more particularly if the morbid matter be diseased lymph such as I have described it. It is, however, of peculiar tenacity; in the adult, something similar to it occasionally does take place, completely perforating the cornea, and by its remaining in its position blocks up for the time being the perforation so made. I have in such cases (for the experiment could not in the infant obviously be made) sometimes passed a fine Anel's probe completely into the anterior chamber till its point appeared behind the cornea, demonstrating in these cases the extreme tenacity of such matter, and its consequent capability to block up these openings; there is also in Mr. Saunders something tantamount to a similar statement; he observes, that the membrane of the aqueous humour is sometimes bared, with its destructive consequences, when by a succession of sloughs the entire of the cornea anterior to it is removed. We differ only as to the nature of the so consecutively removed parts, whether they be actually portions of cornea dead and cast off in the shape of slough, or what I have stated them to be; my reason for adopting the latter opinion I have already advanced.

Whether, however, they be sloughs, or what I contend for, is immaterial, I think, for my position; it is admitted on all hands, that advance of the iris is endangered on their complete removal, and therefore I would object to the practice that must lead to it prematurely.

For these reasons then, I am opposed to collyria in such a state of parts, and my reasons are, lest they might effect that for which they are employed by those who advise them, namely, the removal of the sloughs.

If the case go on favourably, I mean so that the eye shall be ultimately saved, it sometimes happens that there will be a cessation of the reparative process, it will be at a stand and resist the collyria, and all tonic means. I prefer, in such cases, throwing a jet of a one grained solution of nitrate of silver on the ulcer from an Anel's syringe, to increasing the strength of the

collyrium; if a favourable opportunity be taken while the infant sleeps, this can readily be done, and it generally excites a return of the healing process.

I would again, however, observe, that we are not to be too sanguine in these cases, particularly if the lesion be at the edge of the cornea, even when matters appear favourable.

The advance of the iris is easily detected; its appearances have been already stated; it is generally the completion of the destructive process, and our object should now be to restrain it in its progress, so as if possible to save the pupil. I believe, for this purpose, there is but one means, namely, the application of the solid nitrate of silver; but in order to this, the application should be made with particular caution; a pencil of it must be thinned and brought to a very fine point, by repeatedly dipping it in water, and with a piece so prepared, the top of the little button of the iris is alone to be touched. If the application be made with rudeness, so that the caustic is brought in contact with the cornea, great irritation will be produced, and perhaps the state of parts rendered worse by it; besides, if we succeed in stopping the advance, the cure will be attended with opacity of the cornea, rendering the eye useless; but by proceeding in the way here advised, (touching solely the top of the eminence,) there is no inconvenience experienced. Very frequently, when the protrusion is not extensive, by such cautious mode of proceeding it recedes, and vision is preserved. In order to succeed in this way, a proper opportunity should be selected; when the child sleeps, the upper lid is to be then cautiously opened by the practitioner, standing at the head of the infant, and the nitrate carefully brought into contact with the part. I have tried solution of the salt in the strongest possible form, but it had little or no benefit, the solid nitrate is alone decidedly serviceable, when service can be rendered, and the caution above advised in its employment is to be attended to.

It is almost needless, however, to remark, that we cannot by 2 I VOL. XV. NO. 44.

any means generally expect this stage of the disease to assume so manageable a form; when protrusion takes place, the eye, in the great majority of instances, is lost, the results as to appearances being various. Most frequently, the advance of the iris, or of the iris covered with a plate of the cornea, goes on, terminating ultimately in staphyloma, which sometimes continues to extend, until the enlarged globe becomes incapable of being received within the closed lids. The deformity now is considerable; the protruded, diseased cornea being constantly exposed to the action of the atmosphere, inflammation is quickly set up in it, accompanied with the greatest irritation, and only to be relieved by surgical interference, so as permanently to evacuate or destroy the globe, and thus to allow it to shrink. within the orbit. I have sometimes known this state to be, to a certain extent, repressed by the action of the solid nitrate of silver, but generally after some time it ceased to have its effects, and the disease advanced; however, as this condition of the parts, when it occurs, constitutes another affection, (staphyloma,) to enter upon it or its treatment, in anything of detail, would be foreign to the object of this communication, which professes alone to speak of the purulent ophthalmia of infants.

ART. VII.-On the Diagnosis and Treatment of Hydrothorax. By HENRY KENNEDY, A. B.

[Read before the Medico-Chirurgical Society, February 2nd, 1839.]

THE subject matter of the following paper is the result of observations on cases which have occurred under my own care, and which have been confirmed by numerous cases of a similar description met with in hospital: for opportunities of making observations on these last cases I have been much indebted to my friend Dr. Russell. It was remarked by Laennec, and confirmed by all subsequent observers, that hydrothorax was seldom if ever an idiopathic disease, and that properly speaking it is