scarcely a wound be left large enough to be seen. A small body flying very rapidly penetrates the eye and occasions so little pain that even the patient will declare nothing has entered the globe, because he feels no sensation of pain, but we know that such a body may lodge very deeply in the eye, and not occasion as much pain as a larger body moving more slowly, which may lodge only on the surface of the cornea, or on the conjunctiva, hence a very thorough ophthalmoscopic examination should be made. In conducting such an examination the wound should first be found; then it is necessary to decide whether the body has passed through the eye, has rebounded, is lodged in the tunics themselves, or has penetrated them, and is resting on the humors of the globe. In directing attention to the cornea as being the part most frequently wounded from its prominent and exposed position, it must be borne in mind that a very small wound is sometimes very difficult to find. Its polished surface acts as a reflector, and necessitates light being thrown on it at different angles to discover an abraded spot or a puncture. If oblique illumination is used, the wound can scarcely escape detection.

Remembering that we may have a wound of the cornea, and yet the substance which produced it may have rebounded, several considerations should guide us in deciding the very important question, has the body penetrated, and is it still in the eye? If there be blood in the anterior chamber, without the possibility of the patient's having received a blow sufficiently hard to produce rupture of any of the intraocular vessels, or if the iris has been drawn into the wound by the sudden escape of the aqueous humor, we know the body has penetrated. Again, if the iris is brought forward and touches the cornea, even though there may be no prolapse, or if a small hole is seen in the iris of the same size as the corneal wound and corresponding to the position of the wound in the cornea, or if with a wound in the cornea a cataract is forming rapidly, we have evidence that the foreign body is in the eye, or has passed

through it. If, however, as it may sometimes happen, none of these evidences present themselves, there is left the evidence the ophthalmoscope may give while the pupil is widely dilated with atropia. You will now discover either blood in the vitreous, or a milky way through it, or see the foreign body itself, which is, of course, conclusive evidence, but it may rest immediately behind the iris and yet escape detection, particularly if several hours have elapsed since the receipt of the injury, and the external wound has closed. In this case we have simply to await developments, for undoubtedly something will happen to assist the diagnosis. The sight may be lost at once, or very little altered from normal. The tension of the globe may not be altered because the body may have been so minute, and the rupture in the eye tunics so small, that neither aqueous or vitreous has escaped. If the wound be in the sclerotic, a small ecchymotic spot will denote its position, and if it be simply an incised wound, and the foreign body which made it be not within the eye, it will require a simple cold compress, and a bandage. If the wound be large, and manipulating its edges will not cause the vitreous to escape, a fine suture or two will be best, but this is delicate work. The question again comes up for decision, has the body entered the globe, and is it still there? Only the ophthalmoscope will clear this point, bearing in mind that a wound in the iris or blood in the anterior chamber is strong presumptive evidence that the body is in the eye. If, then, the wound in the conjunctiva and sclerotic be large, ordinarily the humors of the eye will have been lost, and collapse of the globe will result. Enucleation is the only remedy left by which to escape sympathetic trouble of the sound eye, as well as leave a suitable stump for an artificial shell. After enucleation has been perforined, the foreign body should be searched for, and if not found within the ruptured eye tunics, a closer search of the tissues remaining within the orbit will disclose it driven sometimes into the bony orbital walls. Of course it will be removed: Small bird shot passing through the eye and destroying sight at

once may remain in the orbit without producing further trouble, although, as Williams observes, they may produce an aneurism of the ophthalmic artery. Wounds of the optic nerve will cause immediate loss of sight. A foreign body which has penetrated the eyeball, and remains within it, is dangerous according to its size, its condition and its position. A small shot, for instance, if in the vitreous, may become encysted, and do no harm. If in the ciliary region, there will almost certainly be further trouble, and places the sound eye in greater jeopardy. If in the lens, no further trouble after a traumatic cataract is formed need usually be feared. While considering the best plan of treatment of wounds of the eyeball, we should bear in mind that the utmost conservatism should be practiced, without placing the sound eye in jeopardy of sympathetic ophthalmia. The patient's condition in life should be considered, means of obtaining a livelihood, the distance from which he lives from confident advice, sex, etc.

Yet we must remember that a foreign body in the eye is a most serious thing, lying quiescent for many years, and then setting up a sympathetic trouble which may produce total blindness so insidiously that all hope of retaining sight is lost before a surgeon is reached. These considerations will make you most careful and guarded, both in giving advice and in operating. A wound of the conjunctiva, even though it be a very extensive tear, is easily treated with soothing collyria and a compress bandage, taking care that a symblepharon may not result, as often happens after an extensive loss of the conjunctiva. Only the mildest applications should be used in the eye, such as borax or boracic acid; stronger remedies, such as solutions of nitrate of silver, will produce very troublesome complications, the cicatrices formed leading to epiphora, entropion, and displacements of the lids, causing an endless trouble in the lachrymal apparatus. If the cornea be the seat of the wound, other troubles are produced demanding even more careful treatment. The foreign body producing the wound must first be removed, and if it has not perforated, a bandage and cold compress will answer; but if, on

In

the other hand, it has opened the anterior chamber, the aqueous will suddenly be lost, and there will be a hernia of the iris. If seen at once the iris can be replaced with a spatula. But if some hours have elapsed since the receipt of the injury, plastic exudation takes place, and the iris is imprisoned between the lids of the wound. You have now to excise the prolapsed portion of the iris, and a four per cent. solution of cocaine will place the eye in a condition in which your manipulations will not be felt. After the removal of the prolapse, eserine instillations, with compresses, is the treatment. But it is necessary for the future of the eye that every particle of iris be removed from the incision. If not only the cornea and iris be implicated, but there is also a wound of the lens, the danger is increased, as from the rapid swelling of the lens substance so much pressure is made upon the iris that the intra-ocular tension is increased, and perhaps total loss of sight from panophthalmitis will result. such a case remove the iris from the wound, and push atropine instillations, that the pupil may be as widely dilated as possible, to prevent iritis. Should the lens protrude through the rent in its capsule, it is best to remove it at once by a linear incision or by enlarging the wound in the cornea. This will prevent any danger from sympathetic ophthalmia, and while but little or no sight is left, the eyeball is retained, which is certainly better than an artificial shell. Should the foreign body have gone still further, and is resting within the posterior chamber, one of two courses must be followed, either immediate enucleation or the removal of the body by some one of the methods mentioned below. Sight is now lost, and we have to concern ourselves for the safety of the remaining eye. It becomes an important matter to decide between immediate enucleation and attempting to save the ball when the matter of saving sight to the patient is impossible. If the patient can be kept under close observation, it is better to use every endeavor to save the ball. The patient presents himself with a recent wound of the cornea, prolapse of the iris,

science sufficiently represented in the teaching of the Faculty?" The faculty took three months to deliberate, and then replied with the following resolution: "Resolved, that the creation of chairs for specialties would be a very disastrous measure, which would alter the proper character of education, and would prove of no utility for the practical instruction of the student."

At the present time, out of the twenty-two medical schools of France, fourteen have made no provision for the study of diseases of the eye, and the University of Paris appointed its first Professor of Ophthalmology in 1879. Paris, deaf to the calls of progressive medicine, has seen her supremacy depart, while Vienna, putting her ear to the ground listening for the footsteps of approaching progress, and preparing for her reception by making due provisions for specialties, has become the Mecca for those advanced medical students from all parts of the world who once made their pilgrimages to the French capital.

Austria appointed Joseph Barth Professor of Ophthalmology in the University of Vienna in 1773, and at the present time every university in that country has its independent eye clinic, with its professor at the head, aided by competent assistants. Attendance at the lectures and clinics is obligatory on students, and occupies ten hours a week. Strange to say, the Universities of Edinburgh and London have declared themselves opposed to demanding a knowledge of Ophthalmology from their graduates, and both in England and America little attention is paid to this subject in the schools. From most of them a student may graduate without any instruction in, or knowledge of, this important branch.

Ernst Fuchs, in a recent book, entitled "The Causes and Prevention of Blindness," estimates that there are in Europe at the present time more than 300,000 blind persons. He estimates. that at least one-third of this might have been prevented, and that the cost of maintaining this one hundred thousand of unnecessarily blind is not less than five million of dollars yearly. He urges as a matter of economy, leaving out the larger question