differ from the common ophthalmia of Europe; and objects to an appropriate appellation connected with a distinction which he has shewn really to exist.

If the ophthalmia, which first appeared in the English and French armies, while they were in Egypt, is contagious, and those best informed on the subject admit it to be so, it differs essentially from the common inflammation of the eyes occur. ring in Europe before the year 1801, and as "observed among the people of Great Britain;" then the term Egyptian ophthalmia becomes appropriate, for it marks the origin of the disease, and connects with that origin its most formidable quality, CONTAGION: and the appellation, instead of dis turbing our opinions, gives them a fixed point of rest, and impels to that caution which may restrain, perhaps, exterminate the disease.*

These remarks have arisen, not out of a propensity to censure, but from the importance of the subject, and a regard to our public duty. We should be much concerned to see the faculty, on such grounds, negligent of the only means that can prevent the dissemination of a most formidable disease; and that a separation of the infected from the healthy should be rejected, as futile and absurd.+

noticed by our army medical men; the degree to which the disease prevailed in the army; the continuance of it in some regiments after leaving the country; and the circumstance of its not only attacking a great number of men of the same corps after once appearing in it, but of its spreading from one corps to another; have very justly given rise to the opinion, that this species of ophthalmia has been introduced into our army in Egypt, and that it is contagious. In addition to these facts, I can safely state, that this species of ophthalmia prevailed, to an alarming degree, in some regiments in Egypt in 1807; and that it was much more prevalent for a year, or more, in some of the regiments which returned from that country to Sicily in that year, than in those which did not form a part of the expedition to Egypt. I can farther say, that when it made its appearance in any regiment, whether it had been in Egypt or not, it generally attacked a large proportion of the men of that corps. These are imposing facts; and though some of them may be accounted for without adopting the supposition of the disease being contagious, still I am disposed to think that the impartial consideration of the whole of them will lead to, if not firmly establish the inference of the contagious nature of the disease." P.51.

* "I have myself always acted on the supposition of the disease being contagious. Indeed were the evidence less strong and persuasive on this side of the question than it really is, I think it would be the duty of every medical man in the army to incline to it, until the matter is put beyond all doubt, as it holds out numerous and obvious advantages." Farrell, p. 53. Obs. &c. &c.

We do not mean to state that Dr. Farrell considers the separation of the diseased from the healthy as useless. On the contrary (p. 54) he

considers

Ophthalmia is considered in these "Observations," to be dividable, with practical utility, into three species. Two of these are described as acute, and one chronic. The acute species is subdivided into O. mitis and Q. gravis. The 1st Chap. treating on O. mitis, we shall pass over with merely observing, that this variety of the disease is supposed to be a common affection of the organ of vision, occasioned by exposure to cold, &c. &c. &c. It readily subsided under the usual methods employed against local inflammations. This form of the disease Dr. F. found to be much more frequent in Sicily than in Egypt. Notwithstanding our author considers his O. mitis to be "that form of the disease with which most practitioners in private life are conversaut," it appears to us to have been only his Q. gravis (Egyptian ophthalmia) with a milder train of symptoms, arising in peculiar idiosyncracies, but more particularly meliorated by a removal from its parent climate. The O. mitis was sometimes met with in Egypt, but in Sicily it was the most frequent form of the disease. The chap. on O. gravis begins with observing, that all the symptoms enumerated in the O. mitis are present in the 0. gravis, but they exhibit in this latter a much greater degree of violence." In the 2d chapter, Dr. Farrell gives an animated, and, we fear, a faithful picture of this dreadful malady.

"The conjunctiva in the early stage of this disorder is red, swelled and turgid. The secretion of tears is copious. I have never met with a case in which this symptom was absent. The patient complains of excessive pain and roughness of the ball of his eye, and he cannot bear even a feeble light. The eye-lids are red at their edges, and swelled, and there is often a sense of weight and scalding of the eye. Sometimes the integuments of the forehead and temples are red, swelled, and painful; or there is a soreness of the integuments of the whole head, with head-ache, a hard quick pulse, rigors, and other symptoms of fever. In almost all cases there is pain shooting across the forehead or along the temples. To these symptoms succeed in a very short time, adematous swelling and tension of the eye-lids, and prodigious tumefaction and turgescence of the conjunctiva, with a feeling as if the eye was to burst out of the head. If a ray of light now fall on the retina, the patient stoops his head with extraordinary celerity, covers his eye with his hand, and describes his feeling as if some sharp instrument was thrust into his eye, or as if something of a red colour darted through it. The eye lids are painful to the touch, and the force necessary to use in opening them causes much distress. The coats of the eye being now enorconsiders it of the utmost importance, and he has no doubt of diminishing the number of persons attacked, by thus cutting off the source of contagion. But if it is believed that this resembles in every respect any other violent inflammation of the eyes," its specific character will be overlooked, and this essential species of quarantine neglected.

mously

mously inflamed, distended and tense, and the eye-lids, and very pro. bably the lachrymal glands, and every part contained within the orbit, being in a similar state, the globe of the eye must be greatly pressed, and its motion in the socket rendered difficult and painful. The muscles which move the eye, being themselves inflamed, are rendered highly irritable by this circumstance, and act with redoubled force on the ball of the eye. This violent action of the muscles is, no doubt, a source of pain in itself, as far as the muscles are concerned; but the violence of the action on the inflamed and distended ball of the eye, already pressed by the swollen parts within the orbit, must cause a lancinating pain in every motion of the globe of the eye. As the muscles of the eye are almost always put in motion by the impression of light upon the retina, on a person's coming from a dark place into the light, I think it probable that a portion of the excruciating pain following the impression of light on the retina in the case of violent inflammation, is owing to the violent action of the muscles on the ball of the eye, and to the difficulty of its motion in the orbit. In addition to all these causes of pain, it may be observed that the inflamed parts are chiefly membranous, or of an extremely delicate texture; and that inflammation in such parts runs a particular course, and is attended with most exquisite pain.

"In some cases the under eye-lids are turned outwards, in others both eye lids are closed, and swollen, and the skin of these parts has an efflorescent, shining appearance. It is not unusual to see the eye-lids open, and the conjunctiva so much swelled and turgid as to protrude from the eye in the form of two or three folds. The tarsi in these cases are necessarily separated from one another, and the tumefed conjunctiva fills the whole anterior part of the space between the eye-lids, so that it is not possible to obtain, by any means, a sight of the cornea, or other parts of the globe of the eye. When, however, the tumefaction of the conjunctiva is not so great, and the eye can be brought fully into view, the cornea appears sometimes to be unusually pellucid; the pupil is contracted; the iris is discoloured, or, as it were, full of spots, and I have often thought that it was forced nearer to the cornea than it is observed to be in the healthy state of the eye."

This is but the first act of an awful tragedy, for as the inflammation proceeds,

"A secretion of a purulent-like matter takes place from the surface of the conjunctiva and glands of the tarsi. This matter is pent up for some time within the eye-lids, in cases in which the tarsi come in contact; and in others where these are separated, it flows out of the eye mixed with the tears. It is so acrid as to irritate the eye exceedingly, and to excoriate the palpebræ and cheeks in passing over them. The sufferings of the patient in this stage of the disease are excessive. He describes his feelings as if boiling water was poured into his eyes. He is hot and feverish. He can get no sleep by night or day; nor can he remain long in any one posture or situation. Bleeding from the temporal artery, large doses of opium, and washing the acrid matter repeatedly from the eye, will bring slight relief in most cases; but in others, no topical application or internal remedy will alleviate the sufferings of the patient, and he at last becomes delirious. If a sight of the ball of the eye can e now obtained, it is found bathed with the purulent matter;

groove or

or depression, filled with this matter, runs round the whole circumference of the cornea; and the cornea itself is muddy in a part or the whole of its extent, or its surface is studded with small white spots. These appearances are unfortunately the commencement of a suppura tion of the cornea, and when the disease has got this length, the muddiness partial or general of the cornea increases, or the white spots increase in size, or run into one another, and a suppuration of the cornea to a greater or less extent always takes place. Sometimes the whole of the cornea is included in the suppuration and destroyed; the iris is laid bare, the lens and vitreous humours are forced forwards on the iris, or entirely evacuated, and even the form of the eye does not remain At other times, a portion only of the cornea suppurates, and the sight is more or less affected afterwards, according to the point at which the suppuration has taken place, and the extent to which it has gone. the abscess be situated before the pupil, and if it penetrate the whole depth of the cornea, the aqueous humour, in escaping, will carry with it a portion of the iris through the aperture in the cornea, and the pupil will be generally totally obliterated by the protrusion of the iris, and its subsequent adhesion to the sides of the ruptured cornea.”

If

The whole compages of the eye, locked within the orbit, and excessively increased in volume, occasion the most acute sufferings to the patient. From this painful state of compression he is relieved, however, by the coats of the eye giving way, generally, in a violent paroxysm of pain.

"In cases of partial suppurations of the cornea, the patient feels at the moment of the escape of the aqueous humour, as if something in his eye gave way, or as if fire was knocked out of it by a blow. The escape of the aqueous humour, and a protrusion of a portion of the iris, events apparently so much to be dreaded, are followed by an abatement of the sufferings of the patient. The tension of the eye, and of all parts within the orbit, and even that of the eye-lids, is considerably diminished by this circumstance. The inflammation of the eye begins to decline from this moment, and the state of the eye to improve, unless in the melancholy instances in which the iris continues to protrude."

It would occupy too many of our pages to follow Dr. Farrell through his elaborate, but, perhaps, irregular descrip tion of the train of morbid appearances arising in the progress of this disease; but we cannot help noticing at the close of his detail, that some doubts arise in his mind with regard to the rejection of the term Egyptian Ophthalmia. Though he has rejected this " title," he is willing to allow, that if the frequency of a disease in any country gives a right to a special denomination, no name was ever more justly applied."

In the treatment of this form of ophthalmia our author adopts the method of depletion, which has been carried to such a severe extent by other practitioners, particularly by 'Dr. Veitch.

"As

"As all the symptoms are of an highly inflammatory nature, and as the organ concerned can suffer no derangement in its structure, without greater or less injury to its functions, it is evident that a resolution of the inflammation must be the primary object. This, in a number of cases, is not to be accomplished, unless judicious and active means be em ployed within twenty-four or thirty hours after the accession of a violent degree of inflammation. Such is the tendency of the cornea to suppurate after this time, that the most active antiphlogistic means, pushed to a great extent, sometimes fail to prevent its suppuration. In no dis ease is it more necessary than in this to adopt a fixed and vigorous mode of treatment, in order to ensure success. As time is of the utmost im. portance, it will not answer to try first blisters and collyria, and then go on to blood-letting, topical or general-Bleeding, and that from one or both temporal arteries, as one or both eyes may be affected, to the amount of sixteen, twenty ounces of blood, or more, according to the urgency of the case and the strength of the patient, is to be the first measure. After this a large dose of salts is to be administered; the whole head is to be shaved; and large blisters are to be applied behind the ears and to the nape of the neck. The patient is to be lodged in a dark but well ventilated room, and the ball of the eye, if there be any purulent discharge, is to be repeatedly washed by injecting some mild fluid between the eye-lids. It is particularly necessary to avoid violence in injecting or introducing by any other means the fluid into the eye. I do not expect any advantage from this latter measure but that of simply removing the acrid and irritating matter from the surface of the conjunctiva. Whether there be a purulent discharge from the eye or not, the ball of the eye, palpebre, and forehead, are to be kept constantly cool and moist, by means of one fold of fine old linen, wet with a weak 'solution of cerussa acetata, laid loosely over them. I must observe, that in some few instances the saturnine solution seemed to irritate and disagree very much with the eye; and that I have been obliged to desist from its use, and substitute for it a mixture of vinegar and water, or water alone. The cerussa acetata appeared to aggravate the symptoms in some cases in which there was a redness of the forehead and temples. When I had it in my power, I caused the temperature of the fluids I used in this way to be reduced by means of ice, and I applied them in that state to the eye."

The aggravation of the symptoms by the application of the solution of the superacetate of lead, as above noticed, is in some measure accounted for by the following remark :— "When this solution is used, it will be necessary to wash the linen occasionally with which it is applied; to prevent the accumulation of this preparation of lead on it, which hap pens in consequence of the evaporation of the water. By neglecting this precaution, it sometimes happens that a much stronger solution is applied to the eye than was intended." The observations upon collyria and other applications to the eye, as stated in our analysis of Mr. Stevenson's treatise, (p. 75.) will enforce the propriety of attending to this cir

cumstance.

As