firm to the touch; the other membranes were natural in appearance. At the time he lost the sight of the left eye, he had no pain or uneasiness in it. A variety of remedies were adopted in this case without the smallest benefit. They were the following:-Repeated bloodletting and blistering, a course of mercury of four weeks' duration, and the application of the opiate wine to the eyes. is strengthened by the fact, that, even after the determination has been relieved, amaurotic symptoms continue, until those means calculated to remove depositions of lymph have taken effect. The central artery of the optic nerve becoming distended with blood, is also capable of producing a powerful pressure on its substance; and, besides, when it is remembered that the choroid coat, immediately exterior to the retina, is composed entirely of blood-vessels, it is easy to imagine how its delicate "Treatment. The treatment of this structure may be compressed against species of amaurosis consists in adoptthe vitreous humour, and thus paralyzing all those means which are calculated, when its vessels become turgid with ed to lower the tone of the system. blood. That this actually does take Hence the abstraction of blood both loplace, is clearly proved by the signal cal and general, together with abstirelief experienced when blood is ab- nence, are chiefly to be relied on. The stracted in such a case. quantity of blood to be taken must be regulated according to the constitution of the patient, and repeated as often as necessary. "CASE 3. Amaurosis from Suppressed Catamenia. A young robust woman applied on account of a diminution of her vision. Saw objects dimly, and covered with mots; pupils were enlarged, and sluggish, but jet black; eyebrows, also, were swollen, and felt heavy. Stated that the disease came on a month previous to application, after a sudden suppression of the catamenia. An emetic with emmenagogue medicines were prescribed. Three days after application, a great change to the better; saw objects clearer and free from mots; eyelids, however, still appear swollen, in consequence of which she was bled to twelve ounces, and in a few days dismissed cured. "CASE 4. Amaurosis from Plethora, with Moveable Pupil. Mr. applied on account of nearly a total loss of sight in the left eye, and diminution of it in the right. He lost the sight of the left eye a year before application. The iris was of a deep green colour, and the pupil readily obeyed the different impressions of light. After the application of the belladonna, the humours were observed to be slightly muddy. He could not distinguish the outlines of large objects with the left, and, with the right, was only sensible of the difference between light and darkness. The eyeball was of its natural size, and "It sometimes, however, happens that when the balance of the circulation is lost, that abstraction of blood produces only a temporary relief. I once met with a case of this kind. The patient was a strong athletic man from Ayrshire, who applied to me, in February, 1828, in consequence of a loss of vision. This patient bore evident marks of plethora; the face was full and florid; pupils enlarged, and sluggish; the external tunics were also varicose, together with a vascular zone between the sclerotic and cornea. He was cupped on both temples, and put on a course of mercury. For a few days, vision was much improved, but symptoms of congestion returned, and it became as bad as ever. The same thing happened again and again in despite of repeated bloodlettings, and at last he was dismissed uncured. "Next to the abstraction of blood, the exhibition of mercury operates most powerfully in arresting the progress of inflammation. This is most beautifully seen in iritis, when, as soon as that mineral has taken effect, a decided check is given to the inflammation, and the already effused lymph is absorbed. The same thing happens in congestion, or inflammation of the deep-seated parts of the eye. The bowels must also be kept freely open, by means of saline purgatives combined with antimonials. Blisters should be frequently applied, and a constant discharge maintained, by means of an issue in the nape of the neck. The diet must also be strictly antiphlogistic. When there is reason to suppose the attack brought on by the sudden disappearance of any accustomed discharge, medicines, calculated to re-establish it, should be administered. The hair on the head should also be kept short. Species 3d. Amaurosis from Sympathy. Amaurosis is also sometimes produced from the retina sympathizing with some other part of the body. This species might with propriety be called amaurosis sympathetica, vel gastrica. "The remote sympathies that exist between the different parts of the body, are often truly astonishing, and with none are these more strikingly exemplified, than with the abdominal viscera. Hence amaurotic affections are often produced by gastric impurities, and derangements of the primæ viæ. Many examples are on record of amaurosis being produced by a disordered state of the alimentary canal, as well as after eating a hearty meal. The most marked example, however, of amaurosis being produced from sympathy, is that which is often met with in children troubled with worms. I have only once met with a decided case of this kind. The patient, a child seven years of age, was brought to me in August 1828. The case is entered in my eye case book as corneitis of left eye, with sympathetic amaurosis of both from worms. Small doses of calomel and scammony were prescribed with the happiest effect, a great number of ascarides being discharged. In proportion as these were removed the amaurotic symptoms disappeared. The following in general will be found to be the symptoms, when amaurosis is produced by worms. Eyeballs natural in appearance, pupils very much dilated and sluggish, but jet black, belly generally tumid, or enlarged, appetite voracious, with picking at the nose. "One of the most remarkable, and at the same time distressing cases of amaurosis from sympathy that I have heard of, occurred lately. The patient, a young lady, had a needle in the ribbon around her waist, which accidentally run into the hand near the wrist, and broke. The family surgeon had to be sent for to remove it. Severe pain was experienced at the time, and continued for some time afterwards. She became on the following day (I believe) amarotic of one eye, and of the other also in a few days after. "This and the first species of amaurosis are the only instances, as far as I have observed, that are ever remittent, intermittent, or periodical. For those cases which depend on the greater clearness of one day, or part of it, over that of any other, are not to be considered either as remittent, or periodical, as they obviously depend on the degree of light presented to the eye, and not on any variation of the powers of vision. They also admit of being oftener cured than any of the other species, because they do not depend on any organic change of the eye, or its appendages, and hence it is that the pupil in them is always jet black. “Treatment. It is in this species of amaurosis that the emeto-purgative plan of Scarpa and Richter will be found most serviceable. If, as sometimes happens, the amaurosis should have succeeded a hearty meal, and there is reason to suppose that the disease is produced by it, an emetic should be administered, and repeated at proper intervals. The bowels ought also to be kept freely open, with pills composed. of calomel and colocynth, or any other strong purgative. "When worms are the supposed cause of the affection, medicines calculated to remove these should be administered. A combination of calomel and scammony I have found a most valuable anthelmintic. Turpentine enemata are also highly beneficial. "The treatment of sympathetic amaurosis from wounds, must be regulated by existing symptoms. The free division of the part as recommended by Beer and others in amaurosis conse quent on wounds of the superciliary nerves should not be lost sight of, as in some cases of the above description, it has been found serviceable. Strict attention must also be paid to the state of the alimentary canal." We shall be very glad to see the second part of Mr. Knox's paper, and hope to profit by its perusal. XXIV. ON THE DISEASES OF INDIA. By JAMES ANNESLEY, Esq. Vol. II. Continued from Vol. XI. of this Journal, page 512. 1. Cursory Remarks on the Presence of Worms in the Large Bowels. Intestinal worms are very frequently met with between the tropics. Among Europeans they are generally the consequence of torpid bowels, or accumulations of morbid secretions in the alimentary canal. Ascarides, Lumbrici, and Tæniæ are the most frequently observed. Among the natives there are scarcely any free from these parasitical animals. "It will generally be found amongst the natives of warm climates, and among those Europeans who have been much weakened by their residence in them, that the secretions, which form the principal part of the fæcal discharge, are seldom thrown off from the mucous surface of the large bowels in so quick a manner as in the robust individual who enjoys an energetic state of the circulation and of all the organic functions; and being thus retained, they form at least the soil in which worms are reared, whatever may be the primary source from which these creatures proceed. Hence the importance of endeavouring to prevent the retention of morbid secretions and fæcal matters, and to impart energy to the digestive functions generally. "The possibility of worms perforating the parietes of the intestines has been argued for by some pathologists, and denied by others. Without pretending to decide the question, we shall adduce the particulars of a case which came before us, in which the parietes of the bowel must have been perforated by them; but whether the perforation was effected previous to inflammation and ulceration having been excited in the part of the intestine in which they were lodged, or subsequently to that event, is a point which cannot be determined, from the imperfect history of the case, to which we were called only in its last stages. "CASE-In which Lumbrici passed from an opening at the Umbilicus. August 5th, 1820.-J. W. four years of age, according to the account furnished by his father, began to complain, about three months since, of swelling and hardness about the umbilicus, with pain on pressure. Opening medicines were prescribed by the medical man in attendance; and afterwards, finding that the tumour did not subside from their operation, poultices were applied. From the middle of April, the time at which the hardness was first detected, until the end of July, it gradually increased. The bowels, however, were always regular, even without the assistance of medicine, and the appetite was unimpaired. During July the swelling had increased considerably, was fluctuating, and slightly inflamed. The child's temper became irritable, and considerable symptomatic fever, with loss of appetite and cerebral irritation, supervened. Animal food was now abstained from, and saline diaphoretics and laxatives were given. On the 1st of August the abscess broke through two openings in the umbilicus, and discharged a great quantity of thick offensive matter. The usual dressings were applied. On the 2d, about a pint of yellowish watery fluid was discharg ed, with some thick offensive matter, similar to that which passed on the preceding day; and as a substance appeared to protrude through the aperture, which the father of the child fancied was the bowel itself, he became alarmed, and sent for us. We immediately drew from the opening two large lumbrici. This was the first time of our seeing the case. After this the child lived several days: the fæces, with eight or nine large lumbrici, passed through the opening at the umbilicus, and very little by the anus, during this period. "On examination, the lower part of the ilium was found obstructed, its convolutions agglutinated together, and its canal, in parts, constricted to the size of a goose-quill. It presented no marks of recent inflammation, and was of a pale colour, both externally and internally. The agglutinated mass of small intestines adhered also to the abdominal parietes, around the umbilicus; and one of the most superficial convolutions of the intestine had an ulcerated opening through it, communicating with the external aperture at the umbilicus. The other abdominal viscera were natural in appearance." In respect to the treatment, Mr. Annesley has not any thing new to offer. After proper purgation has been pursued to clear away the nidus of the worms, he was in the habit of prescribing enemata of castor oil and spirit of turpentine with great advantage. After this tonics were ordered. In cases of tania, the oil of turpentine was advantageously given by the mouth, as also the bark of the pomegranate-tree. This curious affection is very frequent between the tropics-especially among the natives of India. Mr. Annesley conceives that whatever be the peculiar condition of the sensorium or retina, in hemeralopia, the cause is debility, "accompanied with accumulations of morbid secretions in the primæ viæ, more particularly in the cæcum and colon, together with torpid function of the liver and stomach." The disease among the natives is usually induced by insufficient nourishment and inattention to the bowels. He has frequently found a well-regulated diet and purgative medicines sufficient for the removal of hemeralopia without any other remedy. Among Europeans the purgative medicines are essentially necessary, and they generally bring away copious, offensive, dark-coloured gelatinous stools, when the bowels become more sensible to purgatives, and then smaller doses suffice. Among debilitated Europeans and natives, generous diet and tonics are afterwards necessary, in order to prevent the generation of worms. III. FURTHER REMARKS ON ACCUMULATIONS OF MORBID MATTERS IN THE BOWELS, AS A CAUSE OF NERVOUS AND OTHER AILMENTS. Our author commences this sub-section by remarking that, when the cacum and colon become loaded, they disturb other viscera mechanically by pressure. Thus the right iliac veins and nerves are pressed upon by the distended cæcum, hence, he thinks, pains of the right lower extremity, or even partial paralysis. When the collections take place in the sigmoid flexure of the colon, the same phenomena take place in the left side. "In addition to these symptoms, patients thus circumstanced frequently complain of pains in the loins, with oc casional disorder of the urinary secretion, which is generally of a deeper colour than natural, and either depositing a very thick sediment, or exhibiting a very thick, mucous-like cloud, or both. When the fæcal accumulations are carried to the greatest height, then, in addition to the above ailments, or even independently of them in some cases, an oedematous state of the lower extremities supervenes, with an inability to use them, or at least a difficulty in subjecting them to the least voluntary exertion." Mr. A. does not deny that there may be other causes for these symptoms; but merely asserts that this is one cause. He thinks the same collections of morbid matters are often the cause of rheumatism and gout. The functions of the liver are deranged in this way→→ but hepatic disorder is not seldom the precursor and cause of the intestinal accumulations. The distention of the bowels by flatus or more ponderous materials, will also embarrass the function of the lungs and the action of the heart. Indeed our author is inclined to trace almost all the diseases of the liver to this loaded state of the bowels—having, no doubt, his worthy chylopoietic master, of Bartholomew's, in view. It need hardly be added that the methodus medendi is reiterated purgation of the most active kind. The following is one of the best and most interesting cases which Mr. A. has adduced under this head. We shall give it unabridged. Case of Accumulations in the Cacum and Colon, occasioning Anomalous symp toms. "Mrs. aged about 27, had long been subject to daily paroxysms of fever: her hands were dry and white, as if powder lodged in the pores of the skin; the nails so brittle as not only to break easily, but to chip off in small flakes in every part of them. She had constant heaviness and noise in the head, with extreme pain supervening occasionally at the back of the neck, also weakness of sight, and a morning sleep invariably threw her into profuse perspirations. For these complaints medical advice had frequently been resorted to, but without advantage. Towards autumn the disorder assumed an intermittent character, and in the second week of October, 1822, medical advice was again called in. " Her side was now submitted to the pressure of the hand, but as it was examined only to the termination of the ribs, she felt but trifling inconvenience from the touch; between the false ribs, however, and the umbilicus, the pressure of the hand occasioned the most acute pain; and her medical attendants immediately pronounced her liver diseased. Morning perspirations continuing, she was ordered to rise as soon as she awoke from a first sleep, however early it might be. This was of little avail, and decoction of bark was administered, which checked the perspirations for a time, but affected the head, and occasioned so much pain in the throat and stomach, attended with a burning and smarting sensation, that she was obliged to discontinue it. These sensations she began to feel after taking the first draught; and the slighest exertion, even lifting a chair, or walking across the room, would produce such extreme dryness in the throat as fre quently to compel her to take some fluid to enable her to speak. "She soon afterwards experienced increasing pain in the side and head; her spirits fluctuated, and sometimes became so depressed as to terminate in hysteric affections. "She was now quite unable to lie upon her right side, as the least pressure occasioned acute pricking pain between the short ribs and the hip; and when lying upon the left side she had the sensation of heaviness and a dragging from the right; also, according to her own words, a pain down the middle of the body, from the chest to the umbilicus, as if the position in which she was placed had occasioned the liver to press upon the alimentary canal; she, therefore, invariably slept upon her back for many weeks. She also felt great difficulty in using her right arm, as the use of it produced heat and pain in the side and chest. "Still her appetite was tolerably good, but she frequently felt compelled to sleep after dinner, particularly if she dined late; and she always found herself more comfortable when she divided the day so as to have her meals (breakfast, dinner, and tea) at nearly equal distances of time. "In the beginning of February 1823, she stooped one day hastily to tie her shoe: this exertion soon proved to her how much the malady had increased. Acute pains succeeded, and in the night a violent attack of spasm. Some time after this she stooped suddenly to the right side, when she instantly suffered most severe pain in the soft part of the body, between the ribs and hip, with the addition of feeling near the groin as if a horny substance were piercing the intestines; and spasms succeeded in the night, as before.' She now every day felt increasing indisposition, weakness in the knees and ancles, a sensation of fulness in the right leg, with general debility; and the thumb of the right hand suddenly swelled, and became entirely useless. "The direction that the pains of which she complained now took, was from the throat to the abdomen, in a straight line, branching off from the |