British Medical Journal.] ORIGINAL COMMUNJICATIONS. [April 21, 1886.

process at several points on the edges of the sore,and pain in it was reduced to a minimum. As forthe case of the breast, the woman herself had somuch improved in health, that it would have beendifficult to recognise in her, the same thin, cachectic-looking creature of three months back, for hercachectic look had wholly disappeared, and no oneby looking at her now, could have supposed that shelaboured under a disease of such a serious nature,and which had progressed so far. The tumour itselfwas no larger than it was three months before, per-haps rather smaller, and several of the smaller soreshad healed over entirely.And now it was resolved to try the effect of carbolic

acid in the above cases, and this was commenced onDecember 28th of last year. About this time, twoother cases of cancer applied for advice. The onewas an extensive tumour of the neck of the uterus,and implicating the whole of the vagina, accompaniedby very great pain, and a most profuse and exceed-ingly fetid discharge. Indeed, so fetid was the dis-charge, that no one could stay even for a short timein the room with the patient. The other was anenormous schirrous tumour of the breast, of veryrapid'growth. It had been in existence only fourmonths, and already it extended from the floor of the&.mpit almost to the sternum. The subject of ithad been in one of the largest of our provincial hos-pitals, and had got nothing, either there or anywhereelse, which gave her any relief from the extremepain, and the horrible fetor of the discharge. Thecarbolic acid in the form of a very dilute lotion*was ordered in all four cases, with the followingresults.In the case of the tumour behind the jaw, the

lotion was about as effectual in relieving the pain aseither the citric or acetic acid lotions. Applied inthis weak state, its solvent effect was much the sameas that of the citric acid; but applied in a more con-centrated form, the effect was a most vigorous eatingaway of the tumour, and with much greater rapiditythan by the two acids formerly used. But therewere very feeble attempts at skinning under the useof the dilute carbolic acid in this case, and none ofcourse when the strong acid was employed.In the case of the mammary tumour, which had

been treated before by the citric and acetic acids, thereport was that the pain was as effectually controlledby the carbolic acid as by either of the other two;that under its use the " thick, serrated and evertededges" disappeared much more rapidly than withthe other two; and that when the weak solution wasemployed, cicatrisation was seen going on over manyof the sores, wherever the cancerous exerescenceswere eaten down to below the level of the surroundingskin. In the case of the disease of the uterus andvagina, the effect was equally striking; wheneverthe weak lotion was employed the pain almostentirely disappeared, and with it the horribly offensivedischarge. The poor woman, from wishing herselfdead, began to have her spirits raised, to eat andsleep well, and now no foetor was perceived by thosein the room with her. And the general improvementin her appearance was beginning to be visible whena severe attack of hmemorrhage nearly carried her off,since which time her progress towards recovery hasbeen very slight.A like result was obtained in the fourth case, that

of the large mammary tunibur. The pain, instantlyon the application of the carbolic acid lotion, dis-appeai'ed as if by magic, and the fcetor of the dis-charge 'was very much lessened. The tumour was

extirpated a few days after the application of theacid, and the case has gone on well since.Two or three more cases of cancer of the breast

had the carbolic acid lotion applied, but the patientslive at a distance, and no report has been received.from them.

I may mention that, on treating cancer-cells underthe microscope with acetic and carbolic acids invarying degrees of dilution, I found that in aboutequal strength the carbolic acid dissolved the cellsmuch more rapidly and effectually than the aceticacid, and caused the nucleus also to disappear almostentirely when applied in a concentrated state.From the above experiments with the three acids.

then, it appears that they have about an equal effectin removing pain in cancerous growths; that thecarbolic acid has a powerful effect in correcting theoffensive feetor of cancerous discharges; and thatthey all have a solvent effect on cancerous tissue-the citric acid least, the acetic next in degree, andthe carbolic most powerful.

I hope that those who have tried these acids insimilar cases, will publish their experienco of theircomparative efficacy, and that others may be in-duced to give one or all of them a fair trial.

* R. Acidixoarbolici 3iss-3ii; spirit8s vini rectificati Ii; aqu|ad lbs. ii.

408

REMINISCENCES OF A FOUR MONTHS'STAY WITH P1ROFESSOR A. VON

GRAEFE IN BERLIN.By A. SAMELSON, M.D., Manchester.

[Concluded from page 385.]PROCEEDING to the Affections ofthe Iris, we first noticethe case of a foreign body, which had entered theanterior chamber, and was seen to ride, as it were,on the pupillary edge of the iris, setting up an irrita-tion which called for its removal. This was effectedby linear extraction; whereupon the attempt waspersistently made to readJust the iris, which, in thepreceding manceuvre, had been variously touchedand moved towards the incision. As the pupil, how-ever, could not quite be restored to its circularshape, a piece of iris was finally excised. We takethis opportunity of mentioning the wonderment ex-pressed by an elderly gentleman from this country,who for a short period attended the operations atthe Clinique, in these characteristic terms: "Buthow is it ? They here perform iridectomy for every-thing!" And, in fact, iridectomy has here even re-placed Mr. Critchett's ingenious method of iriddesis.Thelatter, which was formerlypractised byVon Graefe,has at his hands, as elsewhere, been found not to be asufficiently innocuous proceeding, but apt to set up cy-clitis. Of this we chanced to see an instance in theeye of a lady, on which an iriddesis had been made,apparently in due style, by another surgeon. Cycliticdisease had resulted, which now required the per-formance of iridectomy at Von Graefe's hands. Avery small incision, so performed as to secure a longchannel for the iris to travel through, is the meansof making iridectomy answer all the purposes forwhich iriddesis has been recommended and had re-course to.In all instances where either cosmetic or optical

considerations require, and present circumstancsspermit, the excision of iris in an upward direction,this, in avowed imitation of the English example, ispreferred. In the performance of iridectomy, unlesssynechie or other circumstances hinder, the iris isregularly made to follow the lance-knife out of theanterior chamber, in order to be spared the intro-duction of the forceps.

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IIn regard to the Affections of the LenticUhW Siys-tem, our remarks will be confined to the item ofCataract. According to Von G(raefe's experience, dia-betes is of much more frequent occurrence in casesof cataract than appears to be generally received.He does not in his practice regard immaturity as anessential obstacle to the removal of cataract. Theretrogressive condition of the latter is by him consi-dered much more to darken the prospect of thoroughsuccess; and a form which he appears prognosticallyto dread more than any other is that of posteriorcortical cataract, from its being mostly accompaniedby other and more serious morbid changes. Amongthe local circumstances of inauspicious significance,it is especially the small-sized cornea which is lookedupon with misgiving. In capsulo-lenticular cataract,the opaque capsule is pretty frequently removed byitself, immediately before the extraction of the lens.As regards instruments, in the bent cystotome,with its fleam, in the one specimen looking tothe right, in the other to the left, we saw amost useful auxiliary for upwards extraction. Thecurette preferred for most purposes is a curvedspoon, the construction of which is a sort of compro-mise between Waldau's and Critchett's instruments.Repeated introduction of the curette into the ante-rior chamber, which has here always been held inabhorrence, is most religiously abstained from. Avery light but efficient kind of manacles, consistingof two firm bands, an inch wide, buttoned about thewrists, and fastened by a tape to the foot-end of thebed, is employed after cataract-extraction, to ward offinjury by the patient's own hands.A proceeding which seems to be in special favour

with Von Graefe, and which we have witnessed in apretty large number of cases, is the formation ofwhat he calls a diametral pupil. This is obtained bysuperadding an upward iridectomy, mostly just be-fore the act of extraction, to the iridectomy down-wards performed some weeks previously; or vice versd,as the case may be. A large vertical gap is, in eyesthus operated upon, seen to replace the former pupil.The proceeding is pointed out as the best means forthorough extinction ofthe actionof the sphincter. It isneedless to say that the plan is not wantonly adopted,but onlyresorted to in suitable cases. It appeared to usas a thing very apt to be carped at; but remember-ing, as we do, those unfortunate cases of extremevulnerability occasionally met with in cataractouseyes, in which such a measure is most likely to pre-vent mischief, we think that others, remembering asmuch, will probably become not only lenient critics,but thankful imitators too. We give the followingcase. The patient had had extraction performed onhis left eye. The imperfect result was ascribed tothe influence of syphilis, which had not entirely leftthe system at the time of the operation. The righteye, now about to be operated upon, had likewisebeen the subject of iritis, as a residue of which, asynechial band appeared skirting the top of the largegap which appeared within the lower half of theiris, the product of a first iridectomy. A second andequally extensiveone was now superadded, whereuponthe capsule was dilacerated, and the cataractous lensattempted to be removed with the spoon. It issuedin two parts, which, put together, showed the nu-cleus and the cortex immediately surrounding it tohave come away complete. Much remaining surface-matter, however, was gradually expelled by pres-sure on the sclerotic with the spoon. The adhesionreferred to had, in the act of dilaceration, been tornacross with the sharp hook which, in this case, waspreferred to the cystitome. Whenever the eye hap-pens to jerk whilst the spoon is being introduced,the caution is observed and enjoined, quickly tc

follow the movements of the former, as the onlychance of avoiding rupture of the hyaloid fossa.Very exceptionally only, and then for the most

part at theyurgent desire of the patient, extractioniL performed on both eyes in one sitting. We weretold by Professor von Graefe himself of the case of a

high dignitary, in which the faultless progressof the operation on one eye induced him forth-with to extract the lens from the other; this was

equally accomplished without a hitch, when, never-theless, both eyes were lost, so far as regardsuseful vision, by speedily supervening suppura-tion-an event which, manifestly arising fromsystemic causes, could not further be accountedfor but by this vague assumption. On the otherhand, we witnessed ourselves a most successful bila-teral extraction in a Swedish parson, some 60 yearsold, of commanding presence, who, loth to extendhis stay or undertake the long journey a second time,insisted upon having both eyes operated upon in im-mediate succession. Another case of bilateral oper-ation, for congenital cataract, in a child, was the fol-lowing. On the left eye, linear extraction from theouter side was resorted to; the iris prolapsed;dilaceration was effected with the hook; the capsulewas found tough, and but very little lenticulax sub-stance was present, which, too, could not be com-

pletely evacuated. By dint of friction on the closedeyelids, the iris returned; but the pupil, nowaysduly black, did not quite resume its former regu-larity either. After this, discission, freely performed,was the method chosen for the left eye. Here, froma likewise very tough capsule, a much larger quan-tity of lenticular matter came forth, which nowpressed the iris forward into the anterior chamber.Before the case was dismissed from the couch, apieceof iris was excised from the right eye.

Perhaps, further, of some interest are the followingthree cases of unilateral extraction. In the first, amiddle-aged man, the operation was performed onthe left eye, and, as usual, without chloroform. Inthis case, owing to the patient exerting his orbicu-laris muscle just at the most critical moment, somevitreous humour, though but a very moderate amount,escaped; and the pupil could not entirely be fredfrom cortical masses. The case, though not an extra-ordinary one, was instructive, in the operator's ownopinion, as showing the usefulness of chloroform, iftime will permit of its employment. The next caseis that of a noble lady, of 65 years of age, whose lefteye had, at the hands of an eminent German pro-fessor of ophthalmology, undergone the operation ofiridectomy for glaucoma, in the course of which-chloroform not being used, which Von Graefe like-wise but exceptionally employs in glaucoma-thecapsule was injured. The traumatic cataract thusproduced afforded evidence of the unmanageablenessof the patient, whose case was beforehand pointedout to us as a most unpromising one. Before theanmsthetic told upon her, she gave continual vent toher anguish. A large upward iridectomy was made;and the capsule, although accessible from the originalinjury, was expressly dilacerated afresh. While in-serting the spoon, the operator called our attentionto this as the critical moment. The nucleus, toge-ther with a moderate quantity of cortical substance,came away, but was immediately succeeded by somevitreous humour; the play of the orbicularis justsupervening when the cataract made its exit.Thorough narcosis had, again, not been induced.In this case, the operator held that the zonula hadbeen ruptured before the operation. Only a scantyamount of vitreous humour, however, had escaped.The corneal wound was well adapted; but the pupilwas not quite black, because occupied by blood.

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Several times the eyelids were now -widely sepaxated,and the patient directed to look downwards, whichdid not lead to any further escape of vitreous humour.The right eye of the patient was the seat of chronicglaucoma, with a contracted field of vision; whilstm the left eye the visual field was normal; and onthat account the operation was ventured upon. Thecase did well. In the third case, one of accidentalcataract in a youth, in which chloroform was dis-pensed with, a, glistening foreign body became visibleafter dilaceration and the escape of some soft len-ticular substance. The foreign body was, togetherwith some more solid cataractous matter, very care-fully removed by the spoon, and the pupil remainedperfectly clear.

In the hospital, I saw still a female patient, oper-ated on before I arrived, with a pupil partly occupiedby capsular remains, in the cataract extracted fromwhose eye a cysticercus had been found by Von Graefe-an occurrence of whieh we hear that no instancehas yet been recorded.We have seen every method of operation fur cata-

iact which is still in use practised at the Cinique,except, of course, reclination and depression; and wemay perhaps add, except the method of Jacobson, as

chiefly characterised by the induction of thoroughchloroform narcosis prior to the steps of theoperation. But what we have likewise failed to wit-ness within the -space of more than four months atVon Graefe's clinique is even a single case of flap-ex-traction. To account for this, at first sight, certainlyvery strange -omission, we have to enter on the ex-position of a method of operation recently excogi-tated and practised by Von Graefe, which, it is our-belief, will be very generally appreciated, and, if ap-proved by experience, form another solid accession tothe wealth of ophthalmic surgery. At the last meet-ing of the Ophthalmological Congress at Heidelberg,Von Graefe has, we hear, made a communication on-the subject; a substantial treatise on which will bepublished in the forthcoming volume of the Archivfi-r Ophthalmologie.* We have been fortunate enoughto witness, as it were, the incubation of the newmnethod; attend at its first trials; and observe itsgradual perfection and thorough establishment.When we had witnessed at the Clinique a number ofcases subjected to modified linear extraction, per-formed advisedly in strict accordance with the prac-tice and precepts of Critchett and Bowman, weheard Professor von Graefe broach the idea-to throwor -ling (as he colloquially expressed it) the lens outof the eye without the intervention of the cumbrousand anything but inoffensive spoon. Within lessthan a fortnight after this, we found him supplied-with the instruments in his opinion requisite for therealisation of his idea. Thus provided for, proceed-ings commenced; and by rapid degrees perfectingand completing his armoury, in the course of aboutthree months (at the end of which the long vacationset in) he had perifrmed the new plan upwards ofsixty times, at about forty of which we had thegood fortune to be an intensely interested spectator.We have thus seen the hand of the operator, in theexecution of a novel act, become more and more firm,until it had attained to the freedom habitually at-tending his surgical handiwork. During the firstperiod of trial, we frequently heard him remind thebystanders that what they were witnessing were yet"des essais." As regards the nature of the cases,perhaps only the first half of them were specially se-

lected for the purpose. The object being a thoroughand extensive trial of -the merits of the new scheme,

very soon every desciption of cataract, which else

would have fallen within the scope of either flap- orspoon-extraction, was subjected to the new proceed-ing. In this, the administration of chloroform was butseldom deemed necessary.The steps of the operation, as performed in my

presence, were as follows. The eyelids having beenseparated by the stop wire retractor, and the con-junctiva at the bottom of the cornea seized withtoothed forceps, the point of the knife devised byDr. Waldau for the removal of prolapeed iris,the edge looking upwards, is inserted in thesclerotic, at the distance of half a line fromthe margin of the cornea and about half a line belowthe plane of its vertex. When the point has beenmoved straight on so far as to appear in the anteriorchamber, it is directed downwards, and pushed ontowards the pupil. As soon as the point is seenabove the pupil, it is advanced in an upward direc-tion until it has reached the spot directly opposite ina straight line to that where it first appeared in theanterior chamber; carried onward a little further, itis made to emerge through the sclerotic at the samedistance as its insertion was from the cornea.The knife is now pushed on in an horizontal direc-tion towards the great angle, until its edge has en-tirely cut through the corneo-seleral junction, whenit is turned edge forward to divide the wall of con-junctiva which is still before it. For, the incisionfalling quite in the limbus cornew, and often, we be-lieve, lying altogether in the sclerotic, causes theconjunctiva to rise above the knife as if distended byemphysema, and thus a conjunctival flap to beformed. More or less bleeding, sometimes con-siderable, from the conjunctiva, is the immediateconsequence. The length of the incision, accordingto Von Graefe's measurement on the dead subject, isfrom four and a half to five lines-i.e., somewhatlarger than any which can be produced by thelargest lance-knife as employed in the Mloorfieldsmethod; moreover, the course of the incisionis more strictly linear than that of any obtainableby the lance-shaped knife. The next step in theoperation is the laying down with iris-forceps of theconjunctival flap over the top of the cornea, in orderto fully expose the incision. Thereupon the hand ofthe assistant glides under that of the operator totake hold of the fixing forceps, whilst the surgeonnow seizes a pair of delicate forceps and scissors toremove a moderate piece of iris. This done, and thefixing forceps having been resumed by the operator,he clears the pupil, if necessary, from blood effisedin front of it, lacerates the capsule extensively withthe curved cystitome, and mostly endeavours to

effect the -exit of the cataract by gentle pressure witha DavieIl's curette on the slerotic above the incision.If this remain unsucceseful, he pushes a :bent hookon the flat about two lines deep into the posteriorcortex, whereupon the point of the hook is turnedforwards, and, by a slight upward movement of theinstrument, the cataractous lens is lifted out of thewound. This being accomplished, the fixing forcepsand retractor are expeditiously removed from the eye.After a moment's waiting, the eyelids are againseparated by the hands of the surgeon; and what-ever is found to remain of cortical substance in thepupil, is, by alternate sliding over the globe of theupper and lower lids, made to issue as completely aspossible. The reversed conjunctival flap having beenreturned to its original position, and the woundcleared by forceps of the filamentous coagulum whichis very generally found to overlie it, the eye is closedand dressed with the protective bandage. Theafter-treatment does not in any respect differ fromthat generally observed after extraction. Of the

* The paper has since appeared, and a translation of it is incourse of publication in the Ophthalmic Review.

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Api 21, l86&J ORIGINAL COMMUNIOATIONS.factory result can be obtained. The employment forthe incision of a Beer's knife is dispproved of aswell as the caprice of invariably performing theiridectomy upwards, in consideration of the dangerinvolved in a sudden rotation of the eye in thatdirection; since, as a rule, chloroform is not adminis-tered in the operation.

In regard to Opacities of the Vitreous Body, it wasurged that a certain description of them-those, viz.,of a membranous character-are apt, from the diffi-culties of ophthalsmoscopic examination, which, at al1events, should be conducted by subdued lamplight,to be mistaken for folds of detached retina. At VonGraefe's hands, great success has attended the opera.tive division of such-like veils suspended in thevitreous humour. In the performance of this opera..tion, as well as in that of perforating the retinawhen detached from the choroid, the ophthalmoscopehas recently been called in requisition. A Liebreich'sophthalmoscopc, fixed in a spectacle-frame, enablesthe operator to guiide his instrument within thevitreous space by the light reflected from the fundus.For the purpose of operating in this manner, it isnecessary to place the lamp at a rather considerabledistance, in order to lessen the angles of the refleximages.The condition of the field of vision is, as in all other

instances of amblyopia, from whatever source, alsoin the case of Retinal Separation invariably tested ivboth daylight and subdued lamplight, when the re.sults of both kinds of examination are confronted.Often the photometer devised by Professor von Grasfeis called in use to exactly determine the quantity ofperception. After the division of detached retina,Ithe eye is, within a very short delay, again sub.mitted to examination, in order to control the imme-diate effect of the operation.The uncommon occurrence of Removal of a Cy8a&

cel-CUs from the Vitreous Space through the Sclerotic,after previous extraction of the lens, which took plaoeduring my stay, I was unfortunately, by illness, pre-vented from witnessing. The entozoon, which I sawafter the operation, was presented to Dr. Desmarresof Paris, whose presence had been held by Professorvon Graefe to be a fit opportunity for the perform-ance of anact so interesting from its rarity.As regards Anahlyopia, in its various forms, there

is the less occasion for dwelling on the subject,as the essential points of Von Graefe's views adpractice are just now being published in theOphthalmic Review. As of recent origin, we maymention the contrivance recommended by VonGraefe for the use of amblyopic patients in thevisual exercise ordered them in suitable eaes; itconsists in the combination of two convex glasses,fixed at an inch distance from each other in a tubewhich is provided with a handle. The two lenses awby their combined focuses to represent a single con.vex lens of shorter focus. The advantage of the com-bination is, that it enables the patient to read at agreater distance, while the spherical aberration islessened. For the recovery of joint vision, wherea chance remains, the use of the stereoscope is pre-scribed, as lately recommended by Jamain. Therather frequent occurrence in actors of a bad form ofamblyopia, mostly, it appears, of spinal origin, al-though not exactly like that atttending tabes dorsalis,seems to have inclined Von Graefe to regard it as aform siti generis, arising apparently from a co-opera-tion of causes peculiar to the calling of the patients.In some cases of Amblyopia, with Concentric Con.

traction of the Visual Field, we hane had the oppor.tunity ofver'fying the (rood effect of repeated blood-lettingfronm taleteimpjle by means of Ieurteloup's

artifiejill 2 InN. "',b,^,:;. 6,characterised by411

tbre hooks in progress of time devised for theremoval of the lens, the sharp one, calculated topenetrate into the nucleus, is but seldom called in,se; the object of thle new plan being rather topromote the gliding of the lens, if possible, bymere external pressure, than to draw it out ofthe wound. Again, of the two blunt hooks, the onepresenting some surface, though differing in its modeOf action from the sharp hook, is yet, for the samereason, but rarely employed; so that there remainsonly the blunt hook which is Mlender throughout asthe instrument ordinarily used in lieu of the dis-carded curette. It is needless to say thlat, in theevent of rupture of the hyaloid fossa, resulting in theescape of vitreous humour before the removal of thecataract, extraction is nevertheless insisted upon. Itis then effected with the necessary despatch by weansof the spoon.Of the sixty operations before referred to, not one

was an utter failure-i. e., ending in the entireloss of vision; though we cannot doubt the successobtained in the various eases must have varied indegree. According to recent news, Von Graefehas perfortned upwards of one hundred operations onthe new plan; and, amongst this total, there are nomore than five or six cases requiring an after-opera-tion, the remainder having furnished quite satisfac-tory results. The advantage of the proceeding ap-peared, in Von Graefe's view, mainly to consist inthe precisely linear character and the peripheralsituation of the incision, enhanced in value by itsconsiderable length, and further by its subcon-janctival position. As a point of much importance,in regard to the immediate consequences, we have,heardhim state that the prejudicial proliferation ofthe intracapsular cells, so habitually observed aftersceopsextraction, appeared to be in a great measurediscountenanced by the new proceeding.As regards the technical steps of the latter, variouspoints are, according to Von Graefe's own admission,borrowed from the proceedings of others-viz., Des-marres and Jacobson. What we know to be original isthe mode of performing the incision on the one hand,and the supersession of the obnoxious spoon by theless offensive hook on the other. We have endea-voured to describe the operation aswe have seen itperformed. It may be and is not unlikely to have beenmodified in various points since. As the comingyear will see the new method put to the test far andwide, the voice of the profession will ere long beginto be heard on its merits.*We have but little to convey respecting the dis.eases of the deeper parts-viz., the vitreous body,choroid, retina, and optic nerve. The operationsfor Glaucom4, hitherto performed by Professor von

Graefe, amount to upwards of nine hundred; in noneof which a mishap, such as lesion of the capsule, hasoccurred. The employment of the Calabar beanex-tract has sometimes (as but very recently in theneglected caseof the wife of a celebrated physician)beenfound usefuil in inducing a slight enlargementof the exceedingly narrow seam of iris not unfre-quently met with, which in itself, however, is neverconsidered an obstacle to operation, as the removalota fair portion of iris remains always possible. Theremark was made, that in some cases the operationproves unsuccessful because the lens, from ruptureof the zonula, is luxated and leans against the ir8,when extraction inmut be performed before a satis-

Fram a comrmunication received a monthsince, I learn that, inhis lsRt fit-v caRee, P'rore-nrvon G-aefe hasbeen ai!e entirely todispense WiLh the hook, effctitug othremoval of the atasrnct laymere extertial lpressure (the <so-eallel ' slide-inaacetivre"). Cit (titermhal Of LaLe been virdtily employed at ail illthe operatitn, .411ifCape ofvitreoushumour uccitried in live or biz per cent.of theeses only.

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the well known plaques, the employment of this re-medy is, however, expressly warned against as likelyrather to do harm than good.Of Syphilitic Retinitis, two forms are distinguished.

In the one generally known, the retinal opacity ap-pears as though it were splashed from the locality ofthe papilla, and is often exactly limited to the inter-spaces of several neighbouring vessels, beyond theextreme of which nothing morbid isto be found.The whole appears, so we believe Von Graefe has it,as if a greasy finger had been carried over the af-fected part. The other form, very rarely seen, isoharacterised by a delicate white stippling, whichskirts the vessels in close proximity to the maculalutes, but does not extend so far as the papilla. Inthis form, the morbid change is held principally toconsist in the sclerosis of nerve-fibres.A phenomenon of interest ophthalmoscopically,

because rarely met with, to which we had our atten-tion once directed, was the appearance of an ecchy-mosis in the fovea centralis.In reference to the defects of refraction, we have

only to relate the proceeding observed in the selec-tion of glasses in cases of Astigmatism. The firststep is to determine whether the astigmatism is posi-tive or negative. The patient is directed to look atthe largest among Jaeger's test-types, suspendedabout twenty feet distant; alternately convex andconcave cylindrical glasses (say of 14 inches' focus)are rotated before his eye, in order to ascertain theposition of the glass which affords the best correc-tion of the defect. The positive or negative natureof the astigmatism thus determined, stronger orweaker glasses are tried for the purpose of ascertain-ing its quantity. If now the acuity be found not yetto be normal, the question remains to be solved inthe ordinary way, whether the patient's eyes, whileprovided with the appropriate cylindrical glasses, are,besides, ametropic in one or the other sense. Thisbeing likewise established, glasses of the proper focusare ordered, to be ground spherically on the one andoylindrically on the other surface.

Injuries of the Eye are at Berlin, it appears, ob-served in less number than in our great manufacturingcentres. Accordingly, sympathetic ophthalmia alsoseems to be of less frequent occurrence-amongst thetown population at least. We saw a case, but rarelyoccurring, though not unexampled we were told, inwhich, during some operation, an eyelash hadslipped into the antenor chamber, and set upiritis, which was followed by sympathetic iritisil the fellow eye. The eyelash was removed, andthe patient, a boy, made a good recovery. Inanother case, a piece of metal had pierced the cornea,so that its extremity was discovered to project fromthe posterior surface of the cornea into the anteriorchamber. Its removal, insisted upon and finallyachieved, waa perhaps. of all the operations we havewitnessed at the Clinique, the one most trying theendurance of the operator, who found it necessary,before dismissmig the patient from his hands, to per-form an iridectomy as the last step of the operation.In his judgment, the occurrence was one of sulfficientgravity to make it the subject of a clinical lecture.The case did very well. A most singular case of ac-cident also occurred, in which a solid and rathersharp-edged piece of iron, three-quarters of an inchlong, was extracted from the eye, in which it hadlodged for eight or ten days unnoticed, although thetraumatic cataract had, on account of the irritationit caused, been removed from the organ. The foreigrbody was first detected by its point pressing againstthe sclerotic, which it caused to bulge out much itthe shape of a partial staphyloma. Lastly, we werEshown a case of aocidental cataract, the effect of somE

412

concentrated mineral acid, without there bein atrace observable of an injury inflicted either uponthe cornea or the sclerotic. Professor von Graef re-marked that a number of cases of the same origine.tion had in course of time come under his notice.

Enucleation, in the rapid performance of which,though chloroform is regularly administered, V0oGraefe appears to take some pride, is usuallyeffectedin two minutes. Yet he prefers to make the conjune.tival incision close to the cornea, as securing a bettercondition of the stump, although the operation canbe accomplished more expeditiously by dividing theconjunctiva nearer to the insertion of the muscles.The suture, after the removal of the bulb, is dig.pensed with. Immediately before the division of theoptic nerve, the stump of the external rectus is laidhold of with strong forceps. In case of enucleatioron account of malignant tumour, the nerve is ad-visedly cut a few lines further back than usual. Inone case, before the nerve came to be divided, theretina was plainly felt to have undergone ossifica.tion: in the division, the nerve was heard to creakunder the scissors.During our stay, the rare case was once seen of

Congenital Acpia-i.e., total absence of eye-globes,In fine, we have to refer to a disease which perhaps

cannot as yet be classified. We mean ExophthalmicGoitre, of which several instances occurred. The in.sufficient relaxation of the levator palpebr muscle-a symptom first pointed out by Von Graefe-is thephenomenon on which he relies for diagnosis in inci.pient or yet indifferently marked cases. We took anopportunity of bringing such a one, in a young lady,before him, when he judged it to undoubtedly be aninstance of the malady in question. The remedypreferred is iron; besides, a trial of the continuouselectric current is advised, which is said to haveproved successfil in Remak's hands. In the case justreferred to, iron was for a time employed, apparentlywith good effect, when the patient removed for a whileto a country-place, affording natural and slightlychalybeate baths, of which a number were taken,while concurrently she made use of whey in themorning. Nothing, however, availed so much as acourse of thorough milk-diet, thanks to which shereturned after a couple of months almost perfectlycured; at all events, able to work again, and verystout, whilst she had been extremely thin when sheleft. The catamenia also, which had been absent fornearly a year, have since returned.

I have thus brought my fragmentary recollec-tions to a close; and it only remains for me, in

La few words, to sum up my impressions. Parfrom underrating any desert, and without dis-

,puting the positive claims of mediocrity itself,in our present state of being, I think we have but

rthe more reason to take it as a special favour inlife's vicissitudes, if we are admitted for a spae

)to dwell in the atmosphere of genius. Profemovon Graefe cannot, in regard to his inquiry and experience, be upbraided with reticence. He has pub.tished a great deal; has fed many a studious mindwith useful and suggestive lore; and ha, by hisliterary productions alone, helped to call forth a hostof earnest and industrious labourers, practical as well

ras scientific. But thero is, in the immediate out-Ipourings of his mind, a pregnancy, an imspiratoryIpower, which, during the short period of little moreethan twelve years, has perhaps done for science andahumanity as much as his writings. And having soafar dwelt on the intellectual manifestations of aIt great mind, what is to be our comment on the ethicalf character of its working? We shall not endeavoureto improve upon his friend, Mr. W. Bowman, who,ewith inimitable felicity, has vindicated for Pro-

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Ail1 21, 186] -taflEWS AND NO7IOES. [British Medidtiin'I.fossor 'Von Gmrefe "the transparent candour of hisdisposition."

[The reading of this paper, which was finished inNovember last, before the Manchester Medical So-ciety, was unavoidably postponed from the Decembermeeting of the latter to its next ordinary meeting inFebruary; hence the tardy publication.]EBRATA. The following corrections should be

made in the former part of Dr. Samelson's paper.Page 383, col. i, line 18 from bottom, for "homo-

geneous", read " homonymous".Pag.e 385, col. i, line 32, for " cornea", read

"zonula".

TRANSACTIONS OF THE ETHNOLOGICAL SOCIETYOF LONDON. Vol. IV. New Series. London:1866.

WE welcome with pleasure this new volume ofTranwactions, published by the Ethnological Societyof London, and strongly recommend its carefulperusal and study to our readers, many of whom, wefeel assured, must be interested in ethnological re-searches. It contains a series of highly interestingpapers, twenty-seven in number, read before the So-ciety, during the presidency of Sir John Lubbock.Of these, four are from its present venerable presi-dent, Mr. Crawfurd, the Nestor of the Society; butwith whom advanced age gives no evidence of de-clining mental vigour. The subjects are: 1. On theSupposed Stone, Bronze, and Iron Ages of Society;2. On the So-called Celtic Languages in referenceto the Question of Race; 3. On Cannibalism in Re-lation to Ethnology; and 4. On the Physical andMental Characteristics of the Negro. Mr. Crawfurdis an earnest and able advocate for the polygenetichypothesis of the origin of man; and, in all thesepapers, we need scarcely say, that the views whichhe holds are set forth, with great force of argument,and supported with a vast array of facts, as mightwell indeed be expected from a man of Mr. Craw-furd's great learning, and from his vast and variedexperience of mankind, acquired in those Easterncountries, where peculiarities of circumstances influ-encing the character of man are in their greatestactivity and most strikingly exemplified.We are glad to notice that Professor George Busk

and Mr. R. Dunn are contributors to the volume.They are both Vice-Presidents of the Society. Pro-fesor Busk has two papers: 1. An Account of theDiscovery of a Human Skeleton beneath a Bed ofPeat on the Coast of Cheshire; 2. Description ofTwo Andamanese Skulls-respecting which, he justlyremarks that they constitute a very interesting andimportant addition to our knowledge of the cranialconfigurations of the Andaman Islanders.Mr. Dunn's paper is on Civilisation and Cerebral

Development; and we cannot help thinking thatthose of our readers who were interested in the ab-stract which appeared in our pages at the time whenthe paper was read before the Society, will now beglad of the opportunity of studying this paper ineqsteno. The influence of civilisation upon the de-velopment of the brain in the different races of man,is a most interesting and important inquiry; and it

is one, judging from what has been contributed byhim to our own pages, that is well suited to the au-thor's habits of thought and inquiry.The volume abounds with papers of interest, but

on which, we regret, our space will not permit us todwell. We may mention those of Mr. Wallace, onthe Progress of Civilisation on Northern Celebes; ofDr. Rae, on the Esquimaux; and of Mr. Markham,on the Arctic Highlanders-as well worthy of care-ful perusal. The erudite paper, On the True As-signation of the Bronze Weapons, by that distin-guished archaeologist, Mr. T. Wright, the HonorarySecretary of the Society, has already called forthanother, in reply, from Sir John Lubbock, the authorof Prehistoric Times, and is full of archaeologicalinterest. But the paper of all, perhaps, the mostcalculated to excite the greatest interest, in the mindof the general reader, is that on Stonehenge, by Pro-fessor S. Nilsson of Sweden. He says truly that thereis something mystical and solemn in these remains ofantiquity. They have been attributed to the magicarts of Merlin, as the Cathedral of Lund in Swedenwas supposed to be erected by Finn the Giant.Whether he has hit upon the true interpretation,the reader must judge for himself; and we stronglyrecommend to his serious and deliberate study Pro-fesor Nilsson's theory on the origin of Stonehenge,as a temple dedicated to the Sun by a people whowere worshippers of Baal.

DR. J. MOORE NELIGAN'S PRACTICAL TREATISEON DISEASES OF THE SKIN. Second Edition,revised and enlarged. By T. W. BELCHER, M.A.,.M.D.Dub.; B.M., M.A.Oxon.; Fellow, Censor,Examiner in Materia Medica and Medical Juris-prudence for Arts, and Honorary Librarian, Kingand Queen's College of Physicians in Ireland, etc.Pp. 526. Dublin: 1866.

THIS volume, Dr. BELCHER informs us, contains thesubstance, generally the very words, of the editionissued in 1852 by the late Dr. Neligan; but an ad-dition of above a hundred pages has been made, and" the discoveries of medical science and the opinionsof the best authorities" from 1852 to the presentyear, have been added in their proper places. Theresult of Dr. Belcher's own experience has been givenwhere it has specially confirmed or differed from thatof Dr. Neligan.Among the additidns made to the work, are notices

of the following diseases: rubeola, scarlatina, va,-riola and its allies, furunculus, anthrax, malignantpustule, and lepra Hebruorum; and a full descriptioitof elephantiasis, morphie (of Brazil), frambosia, mor-bufs Tauricus (the leprosy of Astrachan), Aleppo evil,ngerengere, pellagra, and morbus Addisonii.The previously useful treatise of Dr. Neligan has

been decidedly improved by the process of revisionand addition which it has undergone at the hands ofDr. Belcher; and we can cordially recommend it toour readers as one among the modern works ofmerit on skin-diseases from which they may deriveprofitable information.

Scupvy appears to be on the increase in our mer-cantile navy, rather than on the decrease. Its ex-istence, of course, proves that the sailors, hygienic-ally, are improperly treated-ill-fed, or ill-lodged.

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