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minister of the place, with whom we have conversed upon the case, and who, from first to last, has taken a very lively and intelligent interest in it. Feeling solicitous that no doubt or uncertainty should exist regarding it, we thought it advisable, in drawing up our report, afresh to apply to Mr Renton, who has sent us the following specific details:

"W. J. could see no object by day, but from the very first of his illness, could see by night. He found no deficiency of sight by night, which was the same in all respects as before his illness. For example, he could not have walked on the road by day, without stumbling, and he required a guide. At night, he could do so quite well. On the night of his return from Edinburgh last March, it being quite dark (about nine P.M.), he found his way home to his own house, from the coach-office, ALONE, which during the day he could not have done.

"When standing at the door of his cottage at night, he could see distinctly the opposite wall (there are no houses directly opposite his), which divides the road from the fields; he could distinguish the top of it, and if asked, could have given a good idea of its height. All this he could not have done by day.

"He could see by night, when looking westwards, a large house at about 200 yards distance, while during the day, he could not see half the distance of the length of himself.

"At night, looking at the sky, he could quite well discern the stars and the moon, and the clouds passing over the moon. During the day he could see nothing; a cloudy and a clear sky being alike invisible.

"In a moon-light night he could distinguish animals passing his door,-for example, a cow from a horse. By day, he could not possibly have done so.

"In conclusion, his power of vision by night continued during all his illness, and was not at all affected by the recovery of his sight by day."

Amaurosis.-The following amaurotic case, which apparently belongs to that variety, whose cause is referable to congestion of the optic nervous apparatus, we select chiefly because it happens to be confined within narrow limits :

J. M., æt. 49, a coach-hirer, of dark complexion and spare habit, and by his own confession rather intemperate, had been troubled for a month with an increasing dimness and imperfection of sight in both his eyes. disease chiefly to sleeping for several weeks in a damp room. He attributed his distinguish a man from a woman across the street, to read the signboards of the He was unable to shops, or the large capitals on our admission cards. There was no vascularity of either eye; but the pupils were sluggish, and their expression vacant. was deficient in power, and his tongue furred. The case seemed decidedly unHis pulse promising. The treatment was at first directed mainly to his constitutional health. The bowels were cleared out with moderate doses of croton oil, and a few ounces of blood were taken from the temple by cupping. He was then directed to take cod-liver oil, and a blue pill at bed-time, until the gums should be slightly affected. He commenced this course on the 7th of September, and on the 19th, vision was so much improved, that he could read the large print upon our cards without difficulty. The mercury was steadily continued, and on the 21st of November, two months afterwards, it is noted,-" vision still improving; he can read the smallest print easily." He was never confined during the treatment; and when last seen, in the beginning of January, all amaurotic symptoms had disappeared.

We here take occasion to remark, that in employing the atropa belladonna as a mean of exploring the deeper-seated parts of the eye, the solution of the atropine will be found a much more agreeable as well as powerful agent than the extract of the juice of the belladonna itself. So energetic are its powers, that in some instances circumspection is required, as it not only induces great mydriasis, but sometimes, and especially in amaurotic cases, so long maintains the increased

We feel much obliged to Mr Cafe for his daily and assiduous services to the Institution.

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dimness of vision, that the patient is both alarmed and discouraged, whilst the medicine and the practice are apt to be stigmatised and condemned. Such panics, however groundless, it is well to avoid.

AFFECTIONS OF THE APPENDAGES OF THE EYE.-We have little room left for remarks upon cases or diseases affecting the appendages of the eye. they must be confined to a few sentences.

Affections of the Third Pair of Nerves.-These cases have been enumerated in the table under the name of Ptosis, this perhaps being the most prominent symptom of the complaint. As during the past year, three cases have presented themselves, the affection cannot be regarded as a very rare one; and a fourth case has since appeared, evidently occasioned by the Bacchanalia of the newyear's-day festivities. In one of our cases, the disease was double, by which we mean, that it occurred in both eyes, though more severely in the one than in the other. In this instance, though the vision was very imperfect, and the iris was not strikingly dilated, the power was decidedly improved when exercised through a small hole in a card. Whenever the palsied eyelid was raised, giddiness to a distressing extent, as usually happens, was superinduced. Dr Marshall Hall, we should think, is quite correct in stating that this affection is an instance of cerebral paralysis; nor is this view at all contradicted by what is stated by Mr Wharton Jones, that the disease is sometimes produced by exposure to cold and damp, like that blight which so frequently occurs in the portio dura of the seventh pair, inducing the paralysis of the numerous muscles it supplies. We have not happened to see any instance of the ophthalmic disorder proceeding from this cause. Our cases have been all obstinate, and success in the treatment, when attainable, will be the result of searching and enlightened views of the cause of the disorder,—at once general, as it respects the condition of the whole frame, and accurate, as it regards its true and peculiar exciting cause.

Strabismus.-The number of our cases of squinting, amounted to nine; and it was but a small proportion of these that required, or admitted, of operation. One case presented itself of the Strabismus sursumvergens, not a very common disorder. It occurred in a youth aged sixteen years, who had been annoyed with it from infancy. In the morning, after being refreshed with sleep, he was comparatively but little incommoded; but as the day advanced, and the exhaustion of fatigue supervened, it became exceedingly vexatious. We offered to attempt its removal by operation, to which the patient most willingly consented. His parents, however, refused their concurrence, and prohibited him from submitting. In the cases in which we have operated, the results have been such as to vindicate the high character and complete success of the operation.

CONCLUSION.-But we must conclude. Whilst we had planned at the commencement of our report, to illustrate the importance of every practitioner keeping abreast of the rapid advances making in anatomy, physiology, and the other correlative sciences, we had moreover, intended to include what we consider a not less important topic, namely, the regarding the local diseases of the eye, not as isolated, but also, and chiefly, as in connection with the whole frame, whenever and howsoever morbidly affected. This we would venture to affirm, in many surgical and medical cases occurring in ophthalmological disorders, is the true secret of successful practice. The principle is nothing more than what Mr Abernethy so ingeniously demonstrated nearly half a century ago; and what we believe particularly distinguishes, at the present time, many members of the profession who are successfully introducing improvements, and establishing for themselves an honourable and exalted fame. We believe that ophthalmic practice might afford a most striking demonstration of this important truth; and we regret that we may not now enlarge upon the theme. There are few of the disorders which have been above adverted to,-the most important and the most insignificant,whether asthenopy or amaurosis on the one hand, or the slighter, as ophthalmia tarsi, or mucocele of the sac on the other, in which it is not most important for the practitioner to direct attention not only as much, but even more, to the constitutional disorder than to the local disease. The truth of this in some com

plaints is so obvious, that it cannot escape the observation of the most careless attendant. Thus is it in arthritic ophthalmia, perhaps the most troublesome of all its forms; and in the rheumatic, scarcely less vexatious. We were lately called to a patient labouring under rheumatic ophthalmia in both eyes, complicated with constitutional venereal disorder, whose ocular pain was so severe, that for three nights, as he expressed it, he had not had a wink of sleep. He could scarcely discern a single object, his pulse beat 120 in the minute, and at the time he had no rheumatism in any other part of the body. The specific appearances, however, of the ophthalmia were most marked, and the treatment indicated, was precisely that required for articular rheumatism or rheumatic fever. This was vigorously adopted, and with speedy and most marked relief. The principle we are now contending for has long been familiar to every one, as it regards strumous ophthalmia; in many varieties of which it would scarcely be too much to affirm, that nine-tenths of the treatments must consist of constitutional remedies-correcting the diathesis-and the remaining tenth of local: And the gist of our thesis is this, that a principle somewhat similar, a similar enlargement of view, with corresponding practice, at once varied and specific, is required in a vast number, we would say the majority, of ophthalmic disorders. In a word, all judicious and efficient practice should be based alike on an intimate acquaintance with physiology, pathology, and therapeutics; and unceasing attention should be directed to the digestive organs which supply the nourishment to the frame, to the respiratory, which renovate the vital fluids,-to the circulatory system, which distributes these, and last, though not least, to the excretory organs which should maintain the purity and salubrity of the whole.

PUBLICATIONS RECEIVED.

Ninth Report of the Birmingham and Midland Counties Pathological Society. Birmingham, 1851.

General Index to the First Thirty-Three Volumes of the Medico-Chirurgical Transactions, published by the Royal Medical and Chirurgical Society of London. London: Longman. 1851.

Religion and Science: their Independence of each other, and their Mutual Relations. By a Physician. Lond.: Churchill. 1851. Dr Hooper's Physician's Vade-Mecum. New Edition. By Wm. Augustus Guy, M.B., Cantab. London: Renshaw. 1851. Medicines their Uses and Mode of Administration. By J. Moore Neligan, M.D., &c. Third Edition. Dublin: Fannin & Co. 1851.

The Transactions of the American Medical

Association. Vol. iii. Philadelphia, 1850. Surgical Anatomy. By Joseph Maclise, F.R.C.S. London: Churchill. 1851. Fasciculus VIII.

On the Causes, Symptoms, and Treatment
of Spermatorrhoea. By M. Lallemand,
of Montpellier. Translated and Edited
by Henry J. M'Dougall, Surgeon, &c.
Second Edition. London: Churchill.
1851.

Essays and Notes on the Physiology and
Diseases of Women, and on Practical
Midwifery. By John Roberton, formerly
Senior Surgeon to the Manchester and
Salford Lying-in-Hospital, &c. London:
Churchill. 1851.

Journal of the Statistical Society of London.
Vol. xiv. Part I. March, 1851.
Cases in Midwifery. By the late John
Green Crosse, M.D., F.R.C.S., with In-
troduction and Remarks by Edward Cope-
man, M.D., F.R.C.S., &c. London and
Norwich, 1851.

A Letter to Lord Campbell on the Chloro-
form Clause in the Proposed Prevention
of Offences Bill. By John Snow, M.D.,
&c. London, 1851.

COMMUNICATIONS RECEIVED.

We have received communications from Dr Van der Byl; Dr Wilson, Kelso; Mr Fraser, Aberdeen; and Dr Potts, Cranbourne, Dorset.

A letter, addressed to the Editor, by Professor Miller, we must decline to insert in this Number of the Journal.

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PERINEAL SECTION.

LETTER TO THE EDITOR, IN Reference to MR SYME'S COMMUNICATION,

BY PROFESSOR MILLER.

[Since the last sheet went to press, the following communication has been received from Mr Miller :-]

51, Queen Street, March 24, 1851.

MY DEAR SIR,-This evening, I wrote to you to the following effect:"I think it right to address you in your official capacity, as Editor of the 'Edinburgh Monthly Journal,' as well as Secretary to the Edinburgh MedicoChirurgical Society; taking the liberty to remind you that simple justice and ordinary fair dealing require that no statement of the questions between Mr Syme and myself, as exhibited at the last meeting of the Medico-Chirurgical Society, shall appear in the Monthly Journal,' without a sufficient opportunity having been afforded of laying both sides of the question fairly before the professional public."

At a quarter to eleven o'clock P.M., I have received your answer, with the proof of an article by Mr Syme, containing groundless personal charges against me, which, when originally made at the recent meeting of the Medico-Chirurgical Society, I had met and disproved. These charges, as they now stand, seem to be somewhat modified from their original form; but still remain sufficiently offensive to require indignant contradiction and refutal.

This is the first notice you have given me of your intention to publish Mr Syme's paper in this number of your Journal, without any report of the discussion to which it led; an instance of haste and hurry all but unprecedented, at least since the Journal came under its present management.

You ask me to furnish you with my "reply," "by to-morrow afternoon at four P.M." It is now midnight. To-morrow, as usual, unavoidable professional engagements will occupy my every hour, from early morning till past the time you have specified. It is, therefore, manifestly impossible for me to furnish you with the documents on my part, which ought to have accompanied Mr Syme's paper. Herein, I consider myself aggrieved.

If Mr Syme's paper is published in your April Number, you have put it out of my power to furnish any other present reply than the letter I now write. And, while I protest against this, I shall expect as an act of simple justice, that you afford me space, in the May Number, for a short and dispassionate statement, embodying the oral refutation which Mr Syme's charges against myself have already received. Meanwhile, I beg to append a note from Dr Matthews Duncan in reference to the case to which Mr Syme alludes; and, taking that as a sample of the evidence which I may have it in my power to produce, I have little doubt the profession will spontaneously withhold their judgment until they have heard both sides of the question.

"6, Wemyss Place, March 26, Vespere. MY DEAR SIR,-I have read, in the Lancet of last Saturday, an account of your case of aggravated urethral stricture, in which Mr Syme operated by his own new method.

"I was present at, and assisted in, the operation.

"In the course of the third night afterwards, I was called from my bed by the patient's attendants to see him.

"I found him in the most serious condition of collapse (coldness of skin-feebleness, almost absence, of pulse at the wrist-vomiting, rigors, &c.)

"From this time till the period of his leaving Edinburgh, I saw the patient daily.

"I can confidently state, that your account in the Lancet' of the sequence of phenomena, and their interpretation, in this case, during that period, is to my certain knowledge faithful, unbiassed, and correct in every particular. "I am, my dear Sir, yours very truly,

"To Professor Miller."

"J. M. DUNCAN.

3 E

Dr J. M. Duncan having alluded to the narrative of the case in the “Lancet,” it is right to insert it here:

"In illustration of such risks, I may here briefly narrate the leading particulars of a case in which Mr Syme and I have a common interest; and as we have also a common object in view-namely, the truth-it seems immaterial from which party the narrative shall proceed, the more especially as I extract the particulars from an account written by the patient himself a gentleman of middle age and great intelligence. He had long laboured under tight and very irritable stricture. He had been under the care of Mr Liston and myself, at various times; but the remarkable irritability of the urethra prevented continuous treatment, and his life was embittered by oft-returning attacks of cystitis. This seemed a case in all respects suitable for perineal section. It was just possible, that by the aid of chloroform the bougie alone might have ultimately removed irritation, and accomplished a cure-as has happened to me in other examples (Principles of Surgery, 2d edition, p. 792). But, on the whole, Mr Syme's operation seemed preferable. And, accordingly, this having been agreed to in consultation, it was performed by Mr Syme on the last day of January 1850. After the operation, suppression of urine took place, during twenty-four hours, along with unpleasant symptoms of shock. Fever set in, accompanied by pervigilium, and great general uneasiness. After forty-eight hours, the catheter was removed. On Feb. 3, the constitutional disturbance became extreme; as indicated by violent sickness and vomiting, rigors, loss of voice, cold blue surface, feeble pulse, and recurrence of suppression of urine. After about twelve hours' continuance, these symptoms yielded to stimulants.-Feb. 5: There was great uneasiness about the scrotum and perineum; and on the 7th, abscess had formed in front of the wound. This was opened, and through the aperture urine as well as pus was discharged; the former continuing to pass through this wound as well as through the original one for many days. The greater part of the urine, however, came per urethram, in a flat yet free stream; and without that peculiar distress to which the patient had previously been so long accustomed. When the wounds had nearly closed, a bougie was passed; but the effect was to re-open the wound, with increase of pain in the urethra. And, in consequence, at the urgent solicitation of the patient, the bougie was refrained from till a more advanced period of the case.-Feb. 22: The urine had become very loaded and fœtid, and continued to be of a depraved character for nearly a month. Up to this date, "no appreciable sleep had been enjoyed; the patient never knew that he had slumbered, even in broken rest, for one moment; he was reduced to skin and bone; and now began to feel great discomfort in lying on his right side. At the same time, intense pain occurred in the rectum after stools." These symptoms increased; and on the 15th of March, I detected a large abscess pointing in the rectum, about two inches from the anus, and mainly occupying the right side of the pelvis. This I immediately evacuated, with instant relief; and "the patient, with the aid of morphia suppositories, was afterwards blest with the first genuine night's rest since the 30th of January." The abscess continued to discharge for about three weeks; and at the end of that time the presence of matter could no longer be detected in the stools. On March 31, the wounds had been closed for fourteen consecutive days, and accordingly it was deemed safe to pass the bougie. Nos. 8 and 9 were insinuated with great gentleness; but next day the perineum was again inflamed; abscess formed; and once more the urine was discharged in front by the opening in the scrotum. From this date, however, the patient gradually recovered. He left Edinburgh for the south on the 18th of May, with the perineum quite closed, and passing his urine in a very satisfactory way. In July he returned, to have a bougie passed; and No. 9 entered without difficulty or evil result. "The contraction of the urethra, however, was by no means permanently cured;" and accordingly, on the 9th of November, the regular use of bougies was commenced, with the view of securing final and full dilatation. At first, I passed No. 6 with difficulty, but No. 12 now enters without obstruction; and the patient himself having acquired the power

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