and the lids loaded with granulations. I need not say that he is totally blind, and many months will elapse before he recovers his sight. Such cases are by no means uncommon, and their result is a sufficient proof of the impropriety of the practice.

"There is also another common practice which is equally prejudicial; the unnecessary confinement of patients suffering under ophthalmic inflammation, in dark chambers. A high degree of morbid sensibility to light is thus induced, which does not belong to the disease. Inflammation of the conjunctiva, when not modified by struma, is attended with very little intolerance, and hardly even requires the use of a shade; confinement in the dark is never necessary. No better guide can be found than the patient' own feelings: and he should be kept in just that quantity of light which is pleasant and agreeable to him. By an opposite practice, patients are often thus confined even months, until they cannot bear the slightest ray of light in their apartments: and long after the inflammation has subsided, the eyes are still useless from their want of power to bear its admission.

"When the inflammation is more deeply seated, and the superficial vessels of the sclerotic become enlarged, shoot over the margin of the cornea, and involve that membrane in the disease; then, indeed, intolerance of light becomes a marked and distressing symptom; and it is necessary so far to diminish the light of the patient's chamber as to make him comfort. able. But even in this case, absolute darkness is prejudicial. A patient deprived of all light in his room, suffers acute and distressing pain at the opening of a door, or any other unavoidable admission of light; whereas if the room be only partially obscured, he suffers little inconvenience from any temporary admission of light.

"Observations so minute as these may perhaps appear trivial; but they are of so much consequence to the comfort of our patients, that they cannot be ceemed useless." pp. 272, 3.

Granular Ophthalmia of the Eyelids.-This disease, accompanied with opaque cornea, is extremely common in every part of the State of New-York, but more particularly in the northern counties. It is a consequence of purulent ophthalmia, and its continuance is a very common cause of permanent blindness.

"When such cases present themselves, they are always accompanied with more or less of inflammation. Our first object must be the removal of this inflammation, and before this is effected, all operations are improper. For this purpose, the usual means in common use are sufficient, cupping or leeches, keeping the bowels open by proper medicines, regulating the diet, and removing all sources of irritation. Counter-irritation is, how

ever, our most efficient agent in fulfilling this indication, and should be kept up during the whole course of the treatment. Blisters behind the ears, kept open by ung. sabin. or ung. canthar. may be employed; or still more conveniently, the tartar emetic ointment may be applied to the same situation, or to the nape of the neck. In the recent state of the disease, a due perseverance in these means will often be sufficient to subdue it ; and, in all cases, they must be continued as long as inflammation is pre

sent.

"If they do not succeed, it becomes necessary to use means for the direct removal of the granulated surface, and the restoration of the conjunctiva to a healthy condition. For this purpose, in mild cases, we may succeed merely by the use of astringent applications to the granular surface; and of these, one of the mildest and most efficacious is the liq. plumb. acet. undiluted, dropped into the eye once or twice a day, or smeared over the diseased surface with a camel's hair pencil. Other astringents are useful with the same view, such as solutions of alum and of nitrate of silver; but neither of them is so efficacious as the liq. plumbi. The ung. hydr. nitrat., diluted with three or four parts of lard, may at the same time be applied to the edges of the lids every day, to prevent their agglutination, and act as a beneficial stimulant to the parts Counter-irritation should still be kept up either by means of ung. tartr. antim. setons, or issues.

"If the case be more severe, or these means fail, still more active measures must be resorted to. If the granular bodies be large and hard, they should be removed by the knife, as directed by our author, and the oper ation should be repeated if they grow again, until they are removed as far as possible. As the whole of the disease, however, can hardly be eradicated in this manner, escharotic substances are employed to complete their removal; and of these the sulph. cupri arg. nitrat., and the mineral acids are the best; the first preferable to the other two. In applying them, the lids must be everted, and the sulph. cupri be used; it should be lightly rubbed over the granulated surface; if the arg. nitrat., the projecting points may be slightly touched with it. The part should then be freely washed off with water to prevent the application of the caustic to the eyeball. When the acids are employed, they should be diluted with three parts of water, and applied with a camel's hail pencil. Sometimes the use of any of these means excites active inflammation in the eye; and then all irritating applications must be avoided, and antiphlogistic and soothing treatment employed.

"The use of the knife or scissors to remove the granulations is very rarely necessary, and I believe falling much into disuse in Europe. The sulph. cupri is a better remedy, and generally adequate to the object in view, if perseveringly employed. It may be applied every other day with perfect safety.

"Having succeeded in removing the diseased state of the palpebral conjunctiva, the vascularity and opacity of the cornea generally subside, without the use of any direct remedies for their cure. They are excited

and kept up by the irritation of the granular lids, and disappear with their cause. They are removed more rapidly, however, by still persisting in the use of the ung, tartr. antim. The circular incisions around the cor. nea recommended by Mr. Travers will sometimes quicken the process, but should never be used while any inflammation is present, nor until the palpebral lining is restored to a healthy condition. When employed under these circumstances, they sometimes excite severe inflammation.

"This last remedy the division of the enlarged vessels which overshoot the cornea, is so frequently employed in this country, that it is necessary to make some further remarks with regard to it. Another modification of the same remedy, as recommended by Mr. Ware, the excision of a portion of the enlarged vessels is also much in use among us, and when improperly made use of, is still worse than the first; indeed, if either be necessary, a simple division of the vessels is adequate to every purpose which the remedy is capable of effecting, and is liable to do much less mischief. Mr. Ware's method, therefore, is never necessary; and the other very rarely. Our object should rather be to remove the inflammation which enlarges the vessels, than to diminish their diameters by any operation on themselves. An opposite practice is very often productive of serious injury to the organ, by increasing the inflammation and aggravating all the symptoms. The common error is, to divide the vessels while inflammation still subsists; very often it is done in its very commencement. In severe acute inflammation of the cornea, in ulcers of that membrane with red vessels running to them, and even in common pustular inflammation of the conjunctiva, this operation is very commonly performed, and in every such case, if it does any thing, it does harm. No arguments are necessary to prove the impropriety of the practice in such cases; it is repugnant to the very first principles of surgery, and its employment cannot be justified on the slightest ground. Were I not a daily witness of the mischief arising from the improper use of this remedy, I could not have supposed that what is so evidently wrong, should so often be done. But with this evidence constantly before me, I feel it absolutely necessary to caution the student of this branch of surgery against an operation he will often be advised to perform." pp. 297—9.

Conical Cornea.-To show the effect of removing the lens in cases of this kind, the following is an interesting

case.

"A young man from Rhode-Island applied at the New-York Eye Infirmary about eighteen months since, with both corneæ conical and a cataract in one eye. His near-sightedness was so extreme, that he could read with great difficulty. The cataract was removed from the one eye, and with much advantage to his vision. He could see without any glass much more distinctly with the eye operated upon, than with the other assisted by a concave glass of any degree.

"This case tends somewhat to prove the propriety of the plan recommended by some surgeons of removing the lens in cases of conical cornea, in order to compensate for the increased refracting power of the cornea. I have had no opportunity, however, of ascertaining the degree of permanency of the improved vision in this case, as the patient immediately returned home, and I have learned nothing from him since." pp. 311, 12.

Artificial Pupil.-On this subject Dr. Delafield has added important and elaborate notes at pages 374 and 432 to 445; but as much of what is contained in these notes has already been published in a previous number of this Journal, (No. 14) we deem it unnecessary to dwell upon them.

In concluding our notice of this work, we cannot in justice omit an allusion to the mechanical execution of it, which is in every respect superior to the generality of medical publications in this country. The plates especially are exquisitely executed, and do the highest credit to the artists employed.

ART. II. First Report of the Committee of the Philadelphia Medical Society or Quack Medicines. Read on the 15th December, 1827, and ordered to be published by the Society. Philadelphia, 1828. 8vo. pp. 37.

WE rejoice to perceive that the physicians in Philadelphia are at length aroused to a sense of their duties, and, that following the laudable example of their brethren in this city, have raised their voice against quackery and quack medicines. In no other city of these United States, has empiricism thrived so much, or been encouraged so extensively as in Philadelphia. And lofty as are the pretensions of the medical profession of that city to pre-eminence in science, and whatever relates to the cultivation and improvement of our art, it has been the occasion of great wonder and greater regret, that there should have been found among its most prominent and influential members, individuals, who, forgetting

alike what was due to their own reputation, and to the dignity of their profession, so far from attempting to arrest and abate this evil, actually abetted in its extension and propagation, by publicly sanctioning with their names, the use of one of the most imposing, and necessarily dangerous nostrums, ever palmed off upon public credulity. We can scarcely find terms sufficiently strong, to convey our reprobation of such unprofessional, and we will add, mischievous conduct. For what was the unavoidable effect, of the recommendations issued under the name of physicians high in office, and pos sessing the confidence of the public as practitioners, but the indiscriminate use of an article, administered for quackish purposes, by a notorious and ignorant quack?

This article, in the hands of a skilful physician, or even under the direction of an intelligent and well educated man, might, no doubt, in certain cases of disease, be frequently productive of benefit. It was not to restrict its use, however, that the recommendations published in a well known pamphlet were intended. They were used, and we have every reason to assert, were intended to be used, as passports to the employment by the public of the proprietor of the article, to the necessary exclusion of the only class of men really capable of deciding upon the propriety of its administration in any one given case. It would have been well too, for the professional reputation of the eminent individuals who thus became the patrons of a notorious nostrum vender, if the reasons which had induced them to descend from the elevated ground marked out for them by the strict principles of medical morality, and to glide in with popular clamour and weakness, were at all defensible, even on the ground of momentary delusion. The benefit of this extenuation, they are, however, deprived of, if we can place reliance on the assertions advanced in the pamphlet before us. Take a single instance. At page four we are informed by the committee, that " Dr. Dewees' experience of this article having been found useful, is limited to four, or at most five cases," whereas his own practice, in which he has prescribed it several times, does not, he