As the favourable termination of the disease uniformly depends on moderating the inflammatory action of the first stage, the subsequent observations in which the mode and degree of blood-letting are particularly detailed, must prove acceptable.

"If the inflammation do not become considerably more moderate in eight hours after the first bleeding, it will be necessary to take more blood from the temporal artery, regulating the quantity according to the intensity of the inflammation, and to apply a blister to a great part or the whole of the surface of the head. And if the inflammation has not completely subsided in eight hours more, it will be still necessary to repeat the bleeding from the temporal artery to a considerable amount if the symptoms seem to require it.

"In conformity to this plan, I have, in many cases, taken from the temporal artery from thirty to fifty ounces of blood in the space of the first twenty-four hours of the disease; and I have had the satisfaction to see the most violent degree of inflammation completely subdued by this practice in conjunction with the application of blisters and the other means just pointed out. It is not to be understood, however, that it is necessary to carry the bleeding in all cases to this extent, which I think may be fairly stated as the maximum. The inflammation, espe cially when attacked early, may be completely subdued, in many cases, by one bleeding of sixteen or twenty ounces, or by two bleedings of ten or fifteen ounces each, in conjunction with the effect of blisters and the other means. It is difficult to give precise rules as to the extent to which the bleeding is to be carried; but as it is the principal remedy upon which the cure of the disease rests, it is evident that it ought to be proportioned to the degree of violence of the symptoms, and repeated until all the inflammatory symptoms are very considerably abated.”

To this powerful means of reducing inflammation, blistering to the head, to the neck, and behind the ears, purging, and a spare diet, were added as auxiliaries.

On the use of opium in inflammatory affections, opinion has been much unsettled. Conclusions formed on the hypo, thetical notion of its being a powerful stimulant, must necessarily condemn its employment in such cases: but actual observation has distinctly shewn, in a variety of instances, its useful effects, in opposition to the hypothesis. "I have no dread of this medicine," says Dr. Farrell, at any moment of the inflammatory stage; but it is to be considered only as a palliative remedy. It is particularly well adapted to those cases in which the pain comes on in violent paroxysms.

The first and great object of the practitioner, in encountering this rapidly destructive disease, is, very early, to reduce the inflammatory action. If this cannot be effected, the structure of the visual organ will be destroyed, or so altered, as to impede, or to annihilate its functions. Frequent and copious bleeding seems the only means on which dependance (No. 148.) 3 Y

can

can be placed. The abstraction of blood, according to the experience of Dr. Farrell, is only decidedly effectual when made from the temporal artery. Cupping, leeching, and bleeding from the arm, he considers as inadequate to this important object. As inflammation going on to a certain point, is always followed by a suppuration which destroys the organization of the eye, we cannot doubt the propriety of the energetic methods here laid down by the author.

Our limits will not permit us to go into a detail of the phenomena of the second stage of this disease, or those which arise when suppuration takes place. For the history and treatment of these we must refer to the work itself.

The third chapter treats of a form of Ophthalmia, which the author denominates ophthalmia chronica. The idiosyncrasies, or accidents that give rise to this variety of the disease, are thus stated.

Ophthalmia is often found to pass into the chronic state in conse. quence of its repeatedly occurring in the same person. This state succeeds much more frequently to attacks of the virulent, than to those of the mild species of the disease. It sometimes assumes the chronic state after a first attack of the mild species; but this is in general owing to some peculiarity of constitution, or to bad treatment, especially the im proper use of astringent or stimulant collyria. If one eye be weaker than the other, as is generally the case with persons who squint, the inflammation in the weak eye is extremely liable to pass into the chronic state, and to be afterwards revived by the slightest causes. As the other eye is affected by sympathy, persons with a defect of this kind, are liable to repeated attacks of inflammation in both eyes from causes which scarcely affect the eyes of others.

"I have found ophthalmia prone to pass into the chronic state, when it attacked patients labouring under other complaints, or persons in a state of debility recovering from disease. It sometimes assumes the

chronic state in patients under the influence of mercury; and it is not unusual to see it pass into the chronic state in persons who have suffered much from pulmonic or rheumatic complaints, or in those labouring under herpetic affections, and in persons whose constitution is shattered by intemperance. It is extremely obstinate in all these cases, and often produces more or less imperfection of sight, or even total blindness.”

A syphilitic taint of the system, without there being any affection of the bones of the orbit, has been adopted by Dr. Farrell, as one source of chronic ophthalmia. There have been doubts whether the syphilitic virus does ever produce inflammation of the eye, through the medium of its diffusion in the system. Mr. Hunter almost denies the occurrence of a symptomatic ophthalmia as arising from this cause. this fluctuating state of opinion, we cannot refuse to lay before our readers the observations of Dr. Farrell, which ap

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pear to have been taken from nature, and to possess considerrable discrimination.

"I have often suspected that chronic ophthalmia was connected with a venereal taint in the constitution. I was led to adopt this opinion, from having observed some peculiarity in the appearance of the eye and character of the inflammatory symptoms, when this form of disease occurred in persons labouring under secondary venereal symptoms, and more especially, when a venereal eruption on the skin formed one of them. Both eyes are generally affected; the patient complains little of pain, and still less of intolerance of light, and is not in fact conscious of any thing being wrong with his eyes, until the sight begins to grow dim. The eye is more watery than natural, but there is no great secretion of tears. The redness of the conjunctiva is not so vivid, as when the disease of the eye is unconnected with lues; the form of the pupil is sometimes irregular, or its edges are jagged, and the cornea is muddy in its whole extent, without any red vessels passing over it. Vision, as may be easily conceived, is totally lost for a time, or imperfect according to the degree of opacity of the cornea. This series of symptoms corresponds pretty well with the appearances of the eye in by far the greatest proportion of patients labouring under this complication of ophthalmia and lues; but the pain, weeping, and intolerance of light, go sometimes to a much higher degree. The inequality in the form, or jaggedness of the edges, of the pupil, will be found a pretty constant symptom; but I am apt to think, the opacity of the cornca, without any red vessels shooting over it, is the symptom the most strongly characteristic of a venereal taint being connected with the disease of the eyc. There is in soldiers a peculiar expression of countenance, not easily to be described, which, in conjunction with the preceding symptoms, establishes in my mind the existence of a venereal taint in the constitution.

"The connexion between the affection of the eye and "lues, is rendered still more probable, by the fact of the opacity of the cornea disappearing, and the redness of the conjunctiva vanishing as soon as the venereal symptoms on the skin, or in other parts, begin to disappear."

Many remedies and methods of treatment are suggested, as collyria, caustic, scarification, excision of portions of the conjunctiva, blisters, &c.; we can, however, for reasons before given, notice only in a general way, that our author found confinement in an hospital retarded the cure; that exposure to a moderated light was more serviceable than keeping the patient in darkness; and, that after every effort had failed to remove the symptoms, the disease frequently subsided in a short time, on discontinuing all applications to the eye.

The second part of the volume, on the "Consequences of Ophthalmia," is divided into four chapters, treating of Relapses, Ectropium, Entropium, and Pterigium.

In the chapter on Relapses is found the following statement

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of the plan pursued in Sicily for the management of the convalescents from this disease.

"The convalescent, on being discharged from the hospital, is removed to a spacious well ventilated building, fitted up on purpose for the reception of such persons. Here he is given in charge to a military and medical officer, and he is in every respect as well accommodated and attended as he was in hospital. He is allowed his full ration of bread, meat, and wine, unless the medical officer see something in his case which will justity him in withholding the wine. As soon as he appears likely to be benefited by exercise, he is obliged to walk out in the open air, with a shade over his eyes, for such length of time as may be thought useful to him, under the command of a commissioned officer. The moment a relapse is discovered, and from the vigilance observed, such an event can exist only a short time without being detected, the patient is immediately sent back to the ophthalmic hospital, which, I may observe, is distant only a few hundred yards from the building occupied by the convalescents. But if all things go on well with the convalescent, and his eyes gain strength, he is selected out by a medical officer and transferred to another convalescent establishment which is some miles distant from the former. Here he is also comfortably accommodated and placed under the care and controul of a military and medical officer; but he is allowed to walk about a great part of the day at his own discretion, and he is occasionally exercised in marching, and other military employments. In this way his general health is improved, his eyes regain strength, and he is gradually habituated to exercise in the open air, and to the occupations in which he is to be afterwards em. ployed. It is, among other things, the duty of the medical officer to see that the military discipline to which the convalescent is subjected be suited to the state of the eyes and general health. The convalescent is sent from this latter establishment to join his regiment, but not without being previously selected by a medical officer as a fit subject to be discharged.

"The advantages arising from this plan might be predicted from a knowledge of the disease and the habits of soldiers; and I have no hesitation in saying that they will more than equal a reasonable expectation. Its good effects were not confined to patients purely convalescent. The same mode of management adopted with many patients in whom the disease had assumed the chronic state, and for whom little or nothing could be done in hospital, was found to be attended with manifest advantages, without the assistance of any topical remedy to the eye, or internal medicine. It will be often necessary, however, to contribute to the improvement of the eye by the ordinary remedies on such occasions, and to attend also to the means calculated to accelerate the reestablishment of the general health”

In works treating on the diseases of distant countries as observed on the spot by their authors, it does not unfrequently occur that the express subject of the volume makes its least interesting past. Incidental remarks on the manners, habits, and various peculiarities of the natives of remote countries; meteorological appearances; facts in the natural history of animals,

animals, vegetables, and minerals, are often of great importance. Where these remarks and facts are recorded without a bias to system, from which the medical observer will seldom be free when treating of diseases, they become particularly valuable. Though the following relation (note, p. 48.) is not entirely free from hypothesis, we consider it as too curious to pass unnoticed.

"I often suspected (says Dr. F.) that the dust, carried about in such quanties by the winds in Alexandria, and in the adjoining desert, contained a considerable portion of pulverized salts. The surface of many parts of the desert abounds with salts, the water obtained by digging in almost every place about Alexandria, is brackish, and the ruins and walls of ft houses of Alexandria are incrusted with saline productions. Perhaps some explanation of the fact of the salts being so abundant in the soil of Egypt, might be derived from the circumstance of the land being so nearly on a level with the sea. The formation of salts on the walls of the houses of Alexandria, and the absolute disintegration of the calcareous stone of which the walls are built, form an interesting subject of chemical inquiry. The stones have totally disappeared in parts of the walls of many houses, and the mortar in which they were bedded remains. It appears to me that the demolition of the stone is effected by its particles being detached from one another by the crystallization of the salts in its pores, and by a part of its composition going to the formation of saline compounds. Perhaps it is in the same way that the calcareous stones used for the construction of the ancient Syracuse, and many other cities, have disappeared, as it is said, from . the face of the earth."

·Practical Observations on the Formation of an Artificial Pupil, in several deranged states of the Eye, to which are annexed Remarks on the Extraction of soft Cataracts, and three of the Membranous Kind through a Puncture in the Cornea. By BENJAMIN GIBSON, Surgeon to the Manchester Infirmary, &c. 8vo. Lond. Cadell and Davies, 1811. Plates. pp. 155.

SINCE the return of our army from the shores of Egypt, the attention of surgeons has been more particularly directed to the treatment of those derangements of the organs of sight, producing imperfect vision, than formerly; and which are frequently succeeding an attack of what is termed Egyptian ophthalmia, as well as the consequence of inflammation, induced by other causes. Anterior to that period our information was extremely limited, and, consequently, our operations were performed with hesitation and timidity. The experiments and writings of Daviel, Janin, Bart, Richter, Demours, Mounoir, Scarpa, and others, had completely established the pre-eminence of the Continental surgeons in this department