About three weeks ago, whilst he was employed in breaking stones, and shortly after micturition, a particle of stone struck his left eye, which led him immediately to rub it with his fingers. Pain, and swelling of the eye lids took place, he says, instantly, and the inflammation ran to such a degree as to destroy all vision of that eye in the course of an hour. The right eye became affected in the same manner a week afterwards. From the commencement of the

attack he has experienced very severe pain in the ball, lids, temples, and occipital region, and also that sensation of minute extraneous particles on the conjunctiva so frequently observed in inflammation of that membrane, arising from distention of the conjunctival vessels; and these symptoms now continue, though much less intense than they have been, in the right, but not at all in the left eye. He has made use of no application to the eyes, and has taken only opening powders.

Upon separating the lids of the left eye, which was done with some difficulty, the lens immediately escaped, with a portion of the vitreous humour, through the cornea, which was in a sloughing condition, although no force whatever was used at the time. There was slight chemosis of the conjunctiva of the right eye, with imperfect vision and great intolerance of light; but the cornea appeared clear. Pulse frequent, but not full. Tongue white, and rather dry Appetite not much impaired. The quantity of urethral discharge was not profuse, it having, he said, diminished upon the occurrence of inflammation in the eye to

nearly one half. Ardor urinæ still remains. Ordered, small doses of magn. sulph. in infus. ros. co. Pil. sapon. c. opio. gr. iv. o. n. Milk diet. Hirudines vj. tempori dextro, et lotio plumbi. Empl. lyttæ pone aur. dextram. A bread poultice to the left eye.

Nov. 3d. Pain of head somewhat less, and also of both eyes, which appear much in the same state. Pulse a little quick, and small; tongue whitish R. Soda carb. gr. v. Pulv. cinchonæ, Dss. M. ft. pulv. 4ts horis sum. Rep. hirudines. An alum lotion substituted for that of lead.

7th. Discharge from the conjunctivæ is less, and the patient's sufferings likewise -no pain now in head or temples-redness of right conjunctiva not so vivid-sight more indistinct. Leeches have been twice applied since the 3d to the temples and eyelids; the pain of right eye is alleviated for about two days by each application-pulse soft-desire expressed for animal foodbowels have a tendency to constipation, but are opened by house-medicine. chonæ, 3ss. Sodæ carb. gr. v. 6tis horis. Beef infusion twice daily. Rep. hirud. 3tüs

auror.

Pulv. cin

12th. Pain of eyes and head very trifling, being greatly relieved by the leeches—discharge from the eyes becoming less-that from urethra has gradually decreased since his admission-chemosis of the right eye increases, and the cornea appears dull.

17th. Conjunctiva of right eye more swollen and prominent-in other respects the state of eyes remains the same. On the 15th a blister was ordered to the nucha, to be kept open by savine cerate; the lead lotion was also resumed. Bark and soda omitted. R. Quinæ sulph. gr. j. Magnes. sulph. 3j. Inf. ros. co. 3x. t. d.

able to open the right eye, the vision of 22d. For the last three days he has been which, he says, is rather more distinct, but surface of the cornea. ulceration has taken place over the greater charge has greatly diminished from both The purulent dis orbits; from the right there is a free watery secretion, apparently lachrymal—no pain— great improvement in other symptoms.

Dec. 1. Puriform secretion has ceased, but sight is very little improved.

13th. Ulceration of cornea in great

measure removed by a lotion of argenti nitras, in consequence of which the sight is rendered more distinct.

20th. The cornea more clear, and has a

cluster of red and varicose vessels ramifying upon it. The iris is irregular, and adherent in some parts to the former membrane.

28th. There is less irregularity of the pupil, and the circle of vessels is diminishing patient says his sight seems gradually improving.

1829, Jan. 10th. Vision a little increased -some deep opacity of the cornea opposite the pupil appears to prevent better sightdrops of the nitrate still used.

Jan. 24th. No alteration, according to the patient's account, in the powers of the organ -the transparent cornea has lost a little of its convexity. The ball is considerably

sunken within the orbit, as if from the cushion of fat at its back part having become absorbed. Some firm adhesions have become established between the conjunctiva of the lower lid and that opposed to it covering the sclerotica. The iris is generally adherent anteriorly, and is of course devoid of mobility. In a few days the man left the house.

Case 2. Robert Suttle, æt. 29, received into the hospital on the 27th Nov. 1828, was attacked about a month ago with gonorrhea, which now continues, but without any inflammatory symptoms, and the discharge being very inconsiderable. Inflammation commenced in his right eye eighteen days ago, accompanied with the symptoms of purulent ophthalmia in a mild degree. He said that he was himself ignorant of a direct cause of these symptoms, although Mr. Travers, who saw him before he applied at the hospital, distinctly traced their origin to the local application of matter from his urethra. After an interval of three days the left eye was similarly attacked. He lost no time in applying for advice, and underwent antiphlogistic treatment, general and local, with very great advantage. This improve ment was, however, completely negatived by his travelling about ten days since from Southampton to London on the outside of a coach, when the weather was rainy and the wind cold. The inflammation of both eyes was materially aggravated; the lids of

the right swelled to a great extent, and the small power of vision which the organ had before possessed was now entirely destroy

ed; the sight of the left eye, which, he said, was pretty good before, was in like manner lost. Very severe antiphlogistic means appear to have been judiciously put in practice He at this time by a practitioner in town. was bled repeatedly, cupped from the temples, and leeched; and had blisters, &c. with free purgation. The severity of the renewed attack was thus lessened, and the following were the principal points of the case on the day of admission: the eyelids were not much swollen, and the pain was not acutehe could see but very imperfectly, and could not open either eye-the conjunctivæ of both eyes and palpebræ were swollen, of a deep red colour, and of irregular surfacespurulent discharge had been abundant, but was not now so great. The secretion from the urethra had observably diminished since the eyes had been attacked, and the patient thought more rapidly during the last ten days. Patient slept but little; pulse quick and small; bowels not open; tongue white. Considering the disease to have passed into the atonic stage, Mr. Green prescribed as follows:-Quinæ sulph. gr. ij. ter die. Sulph. alum, gr. j. Aquæ, 3j. to be injected over the eyes. Hirud. ij. sing. palpebris. Pul. rhæi c. hydr. stat.

Nov. 29th. Leeches produced considerable relief of pain and swelling; he could partly open his eyes yesterday. Bowels opened once only. Pulv. scamm. c. hydr. gr. xv. Hirudines iv. sing. palpeb. Sulph. alumin. gr. iss. ad aquæ, 3j. Empl. lytta nucha.

Dec. 2d. Both corneæ in a sloughing condition-the pain is less.

16th. Patient's strength and appetite are beginning to return; he asks for some porter; pulse has a little more strength, and is not quite so frequent. Little alteration is perceptible in the organs of vision. Quinæ sulphat. gr. iij. ter quotidie.

23d. Sloughing has advanced-increased dulness in portions of cornea not destroyed,

and chemosis undiminished. He has been seen by Mr. Travers. Very slight hopes of the recovery of vision are entertained.

1829, Jan. 7th. Inflammation has greatly subsided, but the appearance of both corneæ

is very unfavourable; these being flattened, having lost all transparency, and being covered with irregular lines of deposit between their laminæ. There are some marks of pupils, of most unnatural figure. Light can be just discerned.

20th. Some improvement of sight has taken place, allowing him to distinguish the motions of his hands. The natural prominence of both eyes now no longer continues.

30th. There is very little prospect of any change in the state of the cornea or in that of vision, the great disorganization which is produced being beyond further relief. Considerable vascularity of conjunctiva is to be observed in each eye. The quinine has been persevered with internally, and alum lotion externally.

As it is admitted that the form of purulent ophthalmia, connected with the disease of gonorrhoea, is the most dangerous and rapid in its progress of any, so, in its early stages, the most vigorous treatment is called for, and by nothing but this have we any chance of arresting its destructive effects. But after this stage has terminated, and with it the violent inflammatory symptoms, the inflammation not infrequently assumes a passive character, as in both of the instances we have related, and, under such circumstan ces, a different mode of treatment is necessarily required. And the evidence of these two cases would appear to shew that an effectual plan of relief during the atonic stage consists in giving general support to the system by bark or quinine, and in removing the local congestion by leeches or cupping; the former of these will be usually found to answer best, as they can be applied directly to the loaded vessels on the surface of the conjunctiva. The preservation (though by no means complete) of the cornea in the first instance before us, was certainly fortunate, for "after the first, or acute stage, is over, we are not in general able to save this membrane from destruction by sloughing."

In each of the above cases the disease seems to have originated from the application of gonorrhoeal matter to the eyes. Mr. Travers and Mr. Green entertain different opinions touching the cause of this destructive ophthalmia. The former gentleman states from experience that no case has ever fallen under his notice, in which he could

not trace its origin to the contact of matter, and, therefore, this he believes to be the cause of the disease. And so minute a quantity of the morbid matter is sufficient to give birth to the affection, that he has known some of his dressers, who, we may fairly presume, did not act altogether unguardedly during their operations, to be attacked with it, and ultimately deprived of sight, from the reception of a small portion of the matter upon their hands or fingers, of which they were quite unaware, when employed in cleaning the eyes of ophthalmic patients with a syringe. On every occasion the unfortunate gentleman acknowledged that they had applied their fingers to their eyes in rubbing them, or some other mode, either at the time of using the syringe, or shortly afterwards. In a clinical lecture upon the second case, Mr. Green mentioned that a sympathetic action might take place between the mucous membrane of the eye and that of the urethra, when this was affected with gonorrhoea, and a secretion be poured forth from the former similar to that from the latter. Discharges of an unnatural kind are very often produced in parts from sympathy with others at a distance, and this relation of sympathy is especially maintained in membranous surfaces of the same class. In gouty affections, Mr. G. observed, there sometimes occurs a very profuse discharge from the urethra not dissimilar to the gonorrhœal; and taking the number of uncleanly persons who have gonorrhoea into consideration, we might expect that the frequency of this form of ophthalmia would be much greater than it is, if the disease were produced by application of the poisonous matter. We leave it to others more experienced than ourselves to form their own judgment upon this point.

II. EXTRAORDINARY AND DANGEROUS SYMPTOMS FROM DRINKING PORTER.

On Thursday, January 15th, two men, between 20 and 25 years of age, were taken into the hospital about twelve o'clock in the day, both under the same circumstances, and affected with similar symptoms.

They were in a state of complete insensibility, and had lost all power of voluntary motion and all sensation. Their pulse were at first weak and very slow. The men

were quickly carried into two different wards. In the course of a quarter of an hour the pulse had become, in both patients, full, hard, and labouring, between 40 and 50; respiration difficult, and somewhat stertorous; pupils rather contracted, and motionless; jaws firmly closed; profuse and cold perspiration on the body, which was greatest and of longest duration upon the face ;no sickness or vomiting; no paralysis of the sphincters; face and trunk were said by some friends of the patients to be swollen. Venesection from the arm was immediately practised to a large amount in both instances.

uation of the stomach. Cold was applied to the head after the stomach-pump was withdrawn. It was also used in the preceding instance. A degree of coldness of the extremities and general surface of the body with an alteration in the pulse, indicated considerable reduction of the vital powers by 2 p. m. The breathing was a good deal relieved, and the pupils had some slight motion. Stimulants were now administered, and with the best effect. About 4 o'clock the patient rallied, and gradually recovered from that hour even more rapidly than the

former.

In the one case cupping was also perform ed at the back of the neck, and emetics of sulphate of zinc given repeatedly, but ineffectually. Croton oil was then administered in two or three doses, but we believe no evacuation was produced from the bowels thereby. The volume of the pulse was reduced by these measures, it became more frequent and natural, the extremities and surface in general were diminished in temperature, and a state of exhaustion had ensued by 3 o'clock, p. m. An enema of castor oil was given, and mustard sinapisms applied to scrobiculus cordis; copious dilution of the contents of the stomach by warm water got down at short intervals.

No re

turn of sensibility was, however, produced, and stimulants appeared to be indicated; brandy and water were accordingly exhibited. The stomach was emptied of its contents by the tube and syringe at 4o'clock, and the stimuli of brandy and ammonia afterwards thrown into it. At 7, p. m. he had revived a little, was able to answer questions, and his dangerous symptoms had begun to disappear. The temperature of the body was raised, and the pulse had risen from the stimuli. This amendment continued during the evening, with the gradual return of volition and consciousness, and on the next day the man said he was quite well, independently of the effects of the treatment adopted.

In the other individual the greater portion of the contents of the stomach was drawn off as soon as the instrument could be made to act. The tube of the usual length, was not sufficiently long to effect complete evac

The

It appeared that both of these men, having been unemployed for some time, had, on the above day, recommenced labour by taskwork, at the new London Bridge; that they had worked hard from 7 o'clock in the morning to half past eleven, when they relaxed for a few minutes, considerably heated and fatigued, and drank, most probably at one draught, some warm porter with ginger in it, (one account stated that this was floating on the top of the fluid in their cups,) the one a pint, and the other half a pint. porter was poured out of a large vessel which was full, and they were the first who drank of it. Some of the persons (fellow labourers) who accompanied them to the hospital, declared that others had drunk after them of the porter in the same vessel without suffering any inconvenience; but one or two others, on whom more reliance was to be placed, denied the fact of any one else having tasted the same porter. In the space of ten minutes after having drunk the porter, we learnt from the one man after his recovery, that he observed the other to be giddy and complaining of general malaise, but almost immediately after this he was seized himself with giddiness, and would have fallen down, had not another man come to his assistance. About 20 minutes from the time they drank, they were both perfectly insensible, and we may suppose, in nearly the same condition as that in which they were admitted. Both men informed us, when recovered, some days afterwards, that they had perfect recollection of what had transpired for a quarter of an hour after having drunk their draught, but from that period to their returning to sensibility at the times specified they remembered nothing.

A most interesting point for consideration, and one important to ascertain if it were

possible, depends upon what gave rise to the anomalous, and truly dangerous (for no one who saw the cases entertained other than unfavourable opinions of their termination) symptoms here presented. That they did not arise from the effect of the porter per se, we do believe, as it was obtained from a house of respectability, and many other persons had previously, and have, no doubt, since drunk of the same. The general impression upon the minds of those acquainted with the particulars of the cases appears to be this, that some poisonous and intoxicating article was intentionally (by way of joke) thrown into the cups out of which the men drank, by some of their companions, mixed with the ginger alluded to. Some facts give a very strong colouring to the probability of this, such as the affirmation by the other workmen, that others had drunk out of the same large vessel with impunity, which was again contradicted; the circumstance of the substance floating on the surface of the liquor, as if not thoroughly mixed with the whole; the production of equally severe symptoms with the other, where half the quantity of porter was taken in the one instance, supposing that the same quantum of noxious ingredient was made up for both; and as the unfortunate men were Irish, newly engaged, and most likely strangers to the rest, these might contemplate a joke of the kind, any thing but a bad one. But nothing poisonous, or unusual, has been detected in the fluids extracted from the stomach of the subject of the second case, by Dr. Burton, our Lecturer on Chemistry, though doubtless great pains and care have been observed in the analysis; and in the absence of such proof we cannot give our undivided assent to the above supposition regarding the cause of the symptoms induced. Might not the simple fact of the men having taken an instantaneous stimulus, when exhausted, account for all the phenomena produced by this porter, especially as it was conjoined with ginger? We know from experience that the energy of the brain and nervous system, reduced to a low ebb, may be occasionally overcome by by the immediate exhibition of stimuli, these being too great for its then impaired condition, and from such a state these two men appear, in our minds, not to have greatly differed when they drank the porter.

Note by the Editor.-These cases are very mysterious, as to the cause of the symp

toms. Had the porter been cold, the weather hot, the fatigue great, and the draught copious, the phenomena might fairly be attributed to the sudden impression of cold on the stomach, by which many lives are annually lost, especially in the southern states of America. But a draught of half-a-pint of warm porter, with ginger, however great the state of fatigue on the part of the drinker, affords no probable solution of the mystery. The Editor is, therefore, inclined to think that some narcotic substance had been put into the porter by some means or other; and as this would, of course, be of a vegetable kind, the detection afterwards would be very difficult by means of chemical analysis. Was it the berry of the deadly night-shade? Or was it (which is most likely) powdered tobacco-leaves? It is highly probable that a sufficient dose of the latter would produce the phenomena in question, though the intention might have only been to make the men sick.

XXXIV.

HOPITAL DE BEAUCAIRE,

ACUTE INTERMITTENT DYSPNEA.

The following very interesting case, exemplifying one of the anomalous forms which ague assumes, is recorded by Dr. Bland, senior physician to the Beaucaire hospital.

Case. On the 19th September, a little girl of five years of age, who had experienced a fright some days previously, was seized with difficulty of breathing, cough, and mucous expectoration, unaccompanied by fever or any thoracic pain. This continued till the night of the 23d, when the oppression was unusually great; and, from this period, the complaint assumed the intermittent, or at least the remittent characer. Every morning at 2 or 3 o'clock the paroxysm of dyspnoea came on, and continued for several hours. The cough was