which oedema may appear. How far this is an affection really different from anasarca may certainly be questioned; there is, however, in all the cases we have referred to, this peculiarity, that the

In the first, or plethoric variety, not only must the general remedies be employed, as bleeding and purging, but if there be any tenderness in the course of the femoral vein, leeches should be applied to the tender part, and they should be re-affection is entirely local; that it by no means peated again and again, so long as any tenderness remains.

The second or middle variety requires a mixed treatment, as we have already indicated; leeches, if any tenderness is present in the course of the femoral vein, and alternate tonic and depleting -remedies as the symptoms vary.

The dema in the third variety, in which the system is suffering from exhaustion, is most benefited by the exhibition of steel; but for a more complete direction for treating these cases we refer to the article AMENORRHEA, of which disease ædema is usually one symptom.

When oedema occurs at the change of life, there are so many symptoms which intimate a plethoric state, that there can be no hesitation in • recurring to depletory measures, both bleeding and purging; and as the oedema is very liable to return, till the catamenia are entirely suspended, the repetition of these remedies will be required as often as this happens.

necessarily leads to dropsy; and that life may ter-
minate without any apparent progress being made
in converting it from a local to a general affection
of the system.
JOHN DARWALL.

OPHTHALMIA. Under this head it is proposed to consider inflammation of the conjunctiva only, although, strictly speaking, the term is more applicable to inflammation of the eye itself. The universal use of the term to designate inflammation of this membrane has probably arisen from this being the most frequent and obvious inflammatory affection of the organ. In approaching the consideration of this subject the student should first pause to ascertain whether his knowledge of the structure and functions of the conjunctiva enables him to announce the changes reasonably to be expected from inflammation of its texture, and afterwards should determine whether observation justifies his anticipations. The conjunctiva being a modification of the common tegumentary membrane, intermediate between the skin and mucous membrane, the changes produced by inflammation are of the same character as those induced by the same cause in these two structures. These changes are, increased vascularity, tumefaction, pain and altered secretion. The increased vascularity is characteristic: when the inflammation is slight, the enlarged vessels present the appearance

Old persons are frequently subject to œdema of the lower extremities, and which as their debility . increases, extends higher and higher towards the trunk, yet seldom assumes the general phenomena of dropsy, there being neither a decrease in the flow of urine, nor any other inconvenience experienced excepting what is the consequence of the weight and stiffness of the limbs. Sometimes it seems to become at length connected with a drop-of a distinct red net-work spread over the white sical diathesis, and after many years have elapsed, during which this oedema has remained stationary, ascites and general anasarca ensue.

sclerotic when more intense, the appearance of distinct vessels is lost, and the surface assumes a uniform deep red colour. The tumefaction is inSo long as the disease remains merely in the considerable unless the inflammation be very sestate of œdema, nothing more is required than to vere, in which case the vessels become enormously support the integuments by means of a laced distended with blood, and the subjacent and surstocking or bandages; when, however, dropsy rounding cellular membrane loaded with serum, supervenes, it must be treated upon the principles constituting the appearance technically denomiwhich have been laid down in the article DROPSY.nated chemosis on the globe of the eye, or produExcessive fatigue is also a cause of oedema. Soldiers, after long marches, are subject to swellings of the ankles, and the oedematous state of the legs of horses after over-work is well known to horse-keepers, who are also aware that it is merely a state of debility; hence they bandage the legs of such horses in the stables, that the cellular tissue may have an opportunity of recovering its tone.

Edema will also be caused by any thing which | obstructs the circulation of the blood through the venous system; hence it is common in the latter months of pregnancy, from the pressure of the ⚫ uterus upon the iliac veins. Ligatures also have a similar effect. The presence of oedema in the arm in cancer of the breast is probably to be accounted for on the same principle. It seldom happens till the disease has made considerable progress, and in the cases which have fallen under our notice, the axillary glands have been much affected. In our experience this oedema is much ⚫ more common after the removal of the breast, and upon the recurrence of the disease, than in those cases in which no operation has been performed. These appear to be the principal forms under

cing a most distressing prominence of the lids. The pain is uniformly at first such as is produced by the presence of a grain of sand beneath the eyelid, but it subsequently is accompanied by a sensation of heat, producing the same description of distress as arises from a scald. The intense aching pain experienced in violent inflammation arises from the globe of the eye becoming involved in the disease. The conjunctiva being lubricated by a fluid derived from a source different from its own surface-the lachrymal gland-the first alteration in the nature or quantity of the secretion from the surface cannot be ascertained. The alteration, however, becomes speedily obvious, and is as characteristic of the disease as the other changes enumerated, purulent matter in considerable quantity being poured out. It must not, however, be assumed that the secretion of purulent matter is a necessary consequence of conjunctival inflammation; instances of the contrary will presently be adduced.

Inflammation of the conjunctiva presents the distinct characters above enumerated, because it is [At the termination of this article, inflammation of other parts of the eye has been added.]

inflammation of a structure of equally distinct anatomical character, but it is so completely modified by circumstances, that few other inflammatory diseases appear in so many different specific forms. The inflammation of this membrane is either circumscribed in the form of pustule, or diffused, as in the different varieties of purulent ophthalmia. Either or both of these are again modified by the presence of other diseases, and hence gonorrhoeal, variolous, and other distinct species.

1. MILD INFLAMMATION OF THE CONJUNC TIVA. That there is a form of conjunctival inflammation entitled to the above appellation, which

tinction to be drawn between the inflammation and its consequences. Hitherto this distinction has been so far made as to form a division of the disease into the acute and chronic stages, but it is worth considering whether the condition which is called the chronic stage should be considered analogous to that which exists during the inflammatory or acute stage. The alteration in the treatment to be adopted when the disease assumes the chronic form, and which is carefully inculcated by Inflammations of the conjunctiva may, there- every practical writer, proves that those symptoms fore, be divided into pustular and diffused; the which are to be subdued by depletion and other pustular into common pustular and variolous, similar means have disappeared. It is true that and the diffused into catarrhal, severe purulent, the increased vascularity, augmented and altered gonorrhoeal, and the purulent of infants. The secretion, and even painful sensation still exist, grounds upon which these specific distinctions are but in a very different degree, and of very different established will be stated as each is submitted to character. The tense, tumid, glazed chemosis subinquiry. sides, and is succeeded by a soft, pulpy, villous While considering the nature of conjunctival vascularity; the secretion from the surface is pro inflammation in general, it is expedient to consider fuse, and its purulent nature more remarkable, also the principles which are to guide us in the and the painful sensation is mitigated and unac treatment of that inflammation. The resources companied by the scalding which characterizes the available for the removal of inflammation in other distress of the inflammatory period. The eye is structures are equally available in this. The ac- not injured or destroyed by conjunctival inflamtivity of the circulation is to be diminished by mation unless the inflammation extend to the general and local bloodletting-the contents of the other textures, producing sloughing of the cornea, stomach and bowels removed by emetics and pur- or suppuration of the eyeball; or unless it progatives the condition of the system which nau-duce the altered or disorganized state of the memseating medicines produce is to be induced-in-brane which leads to vascularity or opacity of the flammation in the vicinity, or counter-irritation as conjunctiva covering the cornea, or granular conit is called, is to be excited by blistering-the tem- dition of the lining of the lids. perature of the inflamed part is to be lowered by cold applications-or the condition, whatever it may be, which warm moisture causes, should be encouraged by warm fomentations. In conjunc-presents a specific character perfectly distinct from tival, more than in any other form of inflammation, the practitioner has had recourse to the immediate application to the part of those remedies to which astringent, sedative, or irritating properties are attributed, and in considering their application to each form of disease, their comparative value will be submitted to inquiry. Particular circumstances may demand additional remedies or peculiar management- the inconvenience arising from accumulation of purulent discharge is to be avoided-the gumming together of the lips obviated the vessels of the surface may require to be opened by scarification, or the serum of chemosis discharged by puncture. It may be necessary to produce the peculiar constitutional effects of mer-duals in the same family. It affects young per cury-to encourage the secretions of the skin, intestines, or liver-to restore the flow of milk from the breasts to regulate the functions of the uterus or to reproduce suppressed discharge of blood from piles. The consideration of conjunctival inflammation in detail will prove the importance of paying the most careful attention to the differences of constitution presented by different individuals, in order to substitute tonic medicines, and invigorating diet and regimen, for a system of depletion and abstinence. It is obvious that each specific form of this disease will require a corresponding variation in the application of these principles, and that the treatment must be modified with every modification of the symptoms induced by circumstances.

In studying the progress and treatment of conjunctival inflammation, the practitioner should never lose sight of the marked and important dis

every other, there can be no doubt. It is rather vaguely defined by authors under the title of catarrhal ophthalmia, but does not appear to be considered so completely different from the severer purulent ophthalmia as its history, at least according to the writer's experience of the disease, in Ireland, warrants. It is distinguished, as the title implies, by the comparative mildness of its symptoms, the vascularity never passing into true chemosis, or inducing sloughing of the cornea; the pain not being so severe, and the purulent discharge being much less copious. It occurs in spring and autumn, is epidemic or endemic, and, whether contagious or not, attacks several indivi

sons more frequently than adults, and sometimes seizes a great number of children in schools or other institutions where they are collected. The following is the history of the disease: The patient experiences a sensation of itching, with slight uneasiness, as if a mote or eye-lash had passed beneath the lid, which is greatly aggravated by the efforts made to remove it by rubbing of handling the eye. If the organ be now examined, nothing more can be discovered than an increase of vascularity, with a copious flow of tears. Next day all the characteristic symptoms may be recog nised. The conjunctiva lining the lids, especially the lower, has acquired a uniform deep red appearance, and that covering the sclerotic, presents an equal vascular network, permitting the white structure of the former membrane to appear in the meshes or areola; the vessels not crowding together so as to produce the deep general redness

of the chemosis of severe ophthalmia. This vascularity is well represented in Mr. Wardrop's work on the Morbid Anatomy of the Eye, which contains more well-drawn and faithful representations of diseases of this organ than any other ac-. cessible to the student. There can be no difficulty in distinguishing this characteristic vascularity from the equally characteristic vascularity of the sclerotic in internal inflammation of the eye. The high degree of vascularity, with prominence of the membrane from effusion of serum beneath it, constituting the appearance denominated chemosis, never perhaps exists in mild purulent conjunctival inflammation, and therefore, when it does occur, must be considered evidence of the presence of the severer form of the disease. The secretion of purulent matter from the surface is most obvious after the night's rest; the eye-lashes are gummed together by it; clots produced by the evaporation of the more fluid parts of the discharge are formed at the angles; and when the lower lid is depressed, flakes and films of it may be observed in considerable quantity. The existence of purulent discharge is not so obvious in the course of the day, especially if the patient has been in the open air, the irritation of the surface causing such a flow of tears as removes it as fast as it is secreted. In this case, inquiry should be made as to the state of the eye upon awaking in the morning, and the patient should be allowed to remain for a quarter of an hour with the eyes closed, when, upon depressing the lower lid, flakes of yellow matter may be seen floating in the tears. The sufferer experiences repeated attacks of scalding pain, with copious flow of tears, so much resembling the effects of a mote or grain of sand beneath the lid, that he can scarcely be persuaded that such does not actually exist. Vision is not very materially impaired during the prevalence of these symptoms, but there is generally a slight degree of haziness experienced, especially when looking at the flame of a candle, and occasionally alarm is excited by tenacious films of purulent matter adhering to the cornea.

dicious, unnecessary, or injurious interference; or it is so modified by scrofulous constitution, or by neglect, filth, and deficient food and clothing, that its character is totally altered.

The treatment of mild conjunctival inflammation is as obvious as the disease is simple. The bowels should be emptied, and the secretion from the mucous membrane of the intestinal canal excited by purgatives in moderate and repeated doses. The infusion of senna and tamarinds, with the addition of sulphate of magnesia and of tartrate of antimony in the proportion of a grain to eight ounces, may perhaps be preferred for this purpose. The abstraction of blood by the lancet is seldom required; but it is frequently necessary to apply eight or ten leeches to the hollow of the temple behind the external angular process of the frontal bone, or over the cheek-bone. The bites of leeches in the thin and flaccid skin of the eyelids generally produce so much irritation and inflammation, that their application there is often injurious. Locally, cold or warm applications may be resorted to, according to the relief the patient experiences from one or the other. If there be much heat and scalding pain, a light fold of old linen, wrung out of cold water, may be laid over the closed lids, and changed as it becomes warm; or a soft sponge or scrap of flannel, wrung out of hot water, and held in the hollow of the hands beneath the eyes, may be used to induce the soothing effects of warm moisture. At bedtime the edges of the lids should be smeared with cream, unsalted butter, or any other oily application not rancid or burned. Rest of the lids should be enjoined, as the constant friction of the surface greatly increases the irritation; the eyes should be kept closed as much as possible; but the patient should not be immured in a dark room, or have his eyes covered with a shade, as is frequently practised. The propriety of applying astringent washes to the inflamed surface during the first stage of the disease may be justly questioned. 'It' is not to be denied that such applications may have the effect of arresting the progress of the The symptoms here enumerated continue for disease at once; but if they have not that effect, two or three days; the period depending much they are liable to produce an increase or irritation. upon the circumstances under which the patient In Dublin, where no adequate relief is afforded to is placed: they then begin to yield and alter, the the destitute poor in their own homes, it is often painful sensation of a foreign body beneath the expedient to endeavour to cut short the disease Jids, with scalding and flow of tears, becomes less by the direct application of a strong astringent frequent, the vascularity loses its intensity and solution, to prevent the establishment of that shining appearance, and the purulent discharge is chronic vascularity and opacity of the cornea more freely secreted. Subsequently, these symp- which filth, starvation, and rags would otherwise toms gradually diminish and finally disappear, produce. For this purpose, a saturated solution leaving the parts somewhat more vascular and of acetate of lead or alum may be resorted to with irritable than before this attack; but in a few weeks perfect safety and decided effects, and a few drops this condition disappears, and the recovery is com-introduced between the lids every night and mornplete. That this is the true history of the symp-ing. To remove the vascularity and that conditoms, progress, and termination of mild conjunction which accompanies the secretion of purulent tival inflammation in a healthy subject can scarcely matter, weaker astringent solutions may be used be denied; but it is not the history of the disease as it is observed in daily practice. This simple form of inflammation must obviously disappear after passing through its different stages, unless the natural processes tending to recovery be interrupted. This interruption, however, generally takes place. The disease is frequently exasperated, and the efforts of nature to restore the healthy functions of the part suspended by inju

more freely. Five grains of alum or of the acetate of lead to an ounce of water, make a wash as efficient and safe as any other of the various salts resorted to for this purpose: the comparative value of these will, however, be presently considered.

In addition to the above observations, an ab stract of Mr. Lawrence's valuable account of catarrhal ophthalmia, delivered in his lectures,