occur, when there is no plausible apprehension for amaurosis; and he ought to have said so distinctly. We know a young surgeon, who misled by this catalogue of symptoms, and never dreaming that they would apply to any thing but amaurosis, was thrown for several weeks into great alarm for his sight, till Mr. Wardrop quieted his mind, and soon cured him of headache, and the more distressing symptoms.

Even in recent times, diseases of the EXCRETORY ORGANS OF THE EYE, have been in this country, ignorantly confounded under one name, though in their nature, they present the greatest diversity, and, of course, require a corresponding variety of treatment. The term fistula lachrymalis, indeed, like that of scirrhus, and of caries, seems to have been employed to conceal ignorance, or to stiffle investigation, for it appears to have been employed in many instances, where no fistula existed. This confusion is now, fortunately, in a great measure dis sipated, and, besides, the simple fistula, described by Desault, Pott, and Ware, as the only disease affecting these organs, inflammation, hernia, and dropsy of the lacrymal sac are par ticularised, and for each, a separate mode of treatment is employed. 31

*****

According to Weller, HERNIA of the lachrymal sac, is known by a bean shaped, insensible swelling, natural in colour, and situated immediately under the internal canthus, from which, when pressed by the finger, a mucous fluid readily flows, cither through the puncta lachrymalia, or through the nasal canal, (provided the puncta are closed by pressure, with the point of the finger), in consequence of which the tumour is emptied, but soon fills again. The disease consists in a relaxation and distension of the anterior wall of the lachrymal sac, and will be generally observed to be a consequence of inflammation of it. The cure, he says, is easily effected by the application of constant pressure, with graduated compresses and a suitable bandage, and moistening the compresses with astringents.

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He describes DROPSY of the lachrymal sac again, as a bean shaped swelling in the nasal canthus, which becomes always larger, and at last discoloured; it is elastic and insensible; its contents cannot be emptied either through the puncta lacrymalia, or through the nasal canal; and when it has attained the size of a pigeon's egg, and threatens to burst, it causes a continual pressure on the nose, on the region of the eye-brow, and on the eye itself. The disease, evidently as the symptoms, indicate, originates from obstruction of the caniculi lachrymales, though the pasal duct and the lachrymal sac, obstructed both above and below, still continues to secrete mucus The sac gradually

fills, and appears, according to circumstances, in form of a swelling, sometimes fluctuating, and sometimes hard and immoveable.

The TREATMENT in this instance, is not always attended with the same success as in hernia of the lachrymal sac, because it cannot be known, whether the obstruction in the nasal canal can be completely removed.

The tumour should be opened with a lancet-shaped knife, and the mucus in the sac should be removed by repeated syringing with warm water, by means of Anel's syringe. Afterwards the treatment is the same as in other circumstances of obstruction of the lachrymal sac. In this country, the nature and treatment of hernia and dropsy of the lachrymal sac, have not as yet been well understood. It has, indeed, been asserted on good autho rity, that in cases of hernia, though the sac is completely pervious, the disease has been treated by the stile, in the same manner as fistula lachrymalis; while dropsy of the sac has been mistaken for a cancerous tumour and treated accordingly. Mr. Travers, notwithstanding his very extensive experience, ingenuously says, that he is not practically acquainted with the effect of pressure upon the relaxed, or hernial lachrymal sac. In dropsy of the sac, he exposed the distended and transparent sac by dissection, and removed by the scissars the two anterior thirds of it. A process of suppuration which ensued, was for some time troublesome, but the wound at length healed soundly, and the complaint was cured.

On the best mode of remedying PERMANENT STRICTURE of the lachrymal canal, our authors are at variance with each other. Weller recommends the practice of gradual dilatation by the silver probe of Mejean, and afterwards by graduated catgut strings, at first, the size of the E violin string, afterwards, increased to that of the A; and lastly, to that of the D string. Mr. Travers objects to this as triffling, tedious, and painful; and prefers overcoming the obstruction in the duct at once, and afterwards placing a stile or tube in the newly formed passage. M. Dupuytren has had great success in Paris, by making an incision into the lachrymal canal, with a straight bistoury, and immediately afterwards introducing a golden canula, to supply the place of the natural passage. This canula, should be of the e same length as the nasal duct, of a line, or a line and a half in diameter, and rather broader at the upper than at the lower part: it is to be slightly curved, so as to be readily adapted to the course of the canal. The upper margin is to be a little prominent on the external surface: it is destined to prevent the canula from falling into the nose, which would permit a relapse of the complaint; the lower extremity of the canula is to be cut

off obliquely, in order that one of its sides being shorter than the other, may not extend beyond the internal side, which terminates before the external side of the nasal canal.

We give the CASE of a lady, so treated by M. Dupuytren. At the internal angle of her left eye, was an opening of three lines in diameter; the edges lined by skin, which had acquired the organization peculiar to fistulous openings, giving passage to foreign bodies the tears incessantly flowed down, and excoriated the skin of the cheek. At the inner angle of the other eye, there had existed for four years a small tumour; the size of which was greater in moist than in dry weather, and in the morning than in the evening. The tumour was easily evacuatedby pressure, when a purulent mucous fluid, mixed with the tears, flowed out of the puncta lachrymalia; both nostrils were dry. Two months after the canule were passed into the lacrymal canal, the course of tears was re-established completely, and the patient felt so little inconvenience from their presence, that she could scarcely believe that they had been left behind after the operation.

Mr. Travers gives an unfavourable opinion of this practice, both from its not producing permanent benefit, and from the consequent irritation. He has, he tells us, had several opportunities of trying the plan since the publication of the first edition of his work, and has no reason since then, to alter his opinion.

He recommends a set of silver probes, of about five inches long, varying in size, flattened at one end, and slightly bulbous at the point; one of which to be passed three or four times from the puneta lachrymalia, through the sac and lachrymal canal at an interval, in each instance, of one or two days. He has found many cases of recent origin, and in which the stricture has no great degree of firmness, to be, by this plan, completely cured..

Mr. Travers acknowledges, that this method is always painful and often tedious, but he has found it on the whole more successful, when cautiously used, than several other plans which he has tried. The size of the probes should never be such as to distend the lachrymal canal; and no considerable pressure should be made with one that might be bent easily.

We cannot go into an elaborate consideration of IRITIS, a discase, which from having been unknown or disregarded, has now become the favourite object of study among those who pay particular regard to affections of the eye. At the present time, indeed, it seems to be the fashion to call every affection of the eye iritis, even though the IRIS is quite unaffected, or merely participates in the common inflammation of the organ. Both these errors

should be avoided. There can be no doubt, however, that the iris is more frequently the seat of inflammatory affection, than any part of the eye, except, perhaps, the conjunctiva. But a very nice discrimination, is not always necessary, for the simple antiphlogistic method, will in ordinary cases be attended with success in iritis, as well as in ophthalmia.

Mr. Travers claims the discovery of treating iritis with the free employment of mercury, and informs us, that the salutary effects of mercury in iritis was observed at the same time by Dr. Farre and himself at the London Infirmary for diseases of the Eye; and was first published in the second edition of Mr. Saunders' work, then in the press. "I am quite satisfied," he says, "that the treatment was original, notwithstanding all the attempts of the German scholars to convince us that at Vienna, and elsewhere, it was a matter lippis et tonsoribus notum. I shall further add, that I am unacquainted with any fact in medical surgery which ranks with this in point of importance; whether we consider the urgency or frequency of the occasion, or the indispensable necessity, and almost unerring efficacy of the remedy."

The German claims are supported on the grounds, that the second edition of Mr. Saunders' work bears the date of 1816, while Professor Beer's work, in the first volume of which the above practice is recommended, appeared at Vienna in 1813. Schmidt's treatise on secondary cataract and iritis, after operations for cataract, though so lately known in this country, was published much earlier.*

On these statements we pretend not to decide; but we know it is impossible for a gentleman of known honour like Mr. Travers, to allow such insinuations to pass without explanation. On our parts we promise to do him every justice; so far as truth and fact will bear us out. We are sure that there must be some mistake in the affair."

But we must stop. We are sorry that our limited space prevents our consideration of other important points which crowd upon our notice; but we promise not to lose sight of these, and shall take care to introduce all that we think practically useful in them, in a paper on the English and German medical schools, which is in preparation.

See Quarterly Journal, Vol. 1. p. 65. for a Review of Schmidt on Iritis.

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MAGENDIE, ROBERT, PETROZ, AND CHOMEL, ON THE SULPHATE OF QUININE.*

THE inquiries of medical men have frequently been directed to ascertain in what quality of cinchona its febrifuge power resided. It undoubtedly is bitter, and therefore bitters were tried in intermittents; these failing, recourse was had to aromatics and astringents, but neither would these do. It was next imagined that the virtue sought for must depend on a conjunction of these principles, and many combinations were tried of quassia, gentian, and sarsaparilla, with the whole tribe of aromatics and astringents; but all failed in supplanting the cinchona. Now, we do not wonder at such a result, since, if we may credit the French physicians, all the powers of this valuable remedy reside in CINCHONINE and QUININE, two of its constituent principles. The processes for obtaining these employed by Pelletier and Caventon, and Badolier, are now pretty well known, we shall therefore give that used by M. Robert, as it presents considerable advantages over any other.

PREPARATION OF THE SULPHATE OF QUININE.

After the cinchona roughly powdered, is exhausted of its substance by successive decoctions, in which two ounces of hydrochloric acid are used to every pound of cinchona, finely powdered chalk is thrown into the mixed fluid, on which a brisk effervescence is produced. The chalk in this case acts only on the excess of hydrochloric acid; and does not affect the hydrochlorate of quinine, which remains suspended in the liquid. A copious precipitation then takes place of the red colouring matter, and the liquor is left pure and almost colourless. This is decanted, and

✦ Journal de Physiologie experimentale, 1821.

Note. sur le Sulphate de quinine; par M. Robert, pharmacien de l'HotelDieu de Rouen,

De Emploi des Sulfates de quinine et de cinchonine dans le traitement des fièvres intermittentes, et de néuralgies périodiques; par M. PETROZ. » A

(Memoire lu à l'Academie des Sciences.)

Extrait du rapport fait par M. Hallé à l'Institut de France, sur deux Memoires d'un de M. PETROZ, l'autre de M, CHOMEL; l'un et l'autre sur l'emploi des sulfates *de quinine et de cinchonine dans le traitement des fièyres intermittentes,noue (Revue Medicale, 1821.) Philadelphia Journal of the Medical and Physical Sciences, 1821,