tacked with variola, and on the last of March she was dismissed in a state of tolerable convalescence. It appears, however, that, on the 19th of April, she returned to the hospital with all her symptoms nearly as violent as ever.

Dr. Duncan appears to have taken considerable pains to prove that, contrary to the doctrine of Cullen, catalepsy may be real, and not feigned. We have not the smallest doubt of the reality of the disease in the foregoing, and in many other cases. We are, at this moment, attending a young lady who has cataleptic attacks every day, and many times during each day. They are generally so transient as to be mostly imperceptible in company-and her great object is to conceal them. They escape notice, except upon particular occasions. Thus, if she is reading, or playing on the piano-forte, the sudden cessation of voice or action is remarked, of course. But if she is merely sitting in company, or joining in general conversation, it is ten to one if the cataleptic suspension of volition be perceived. Once in six or seven days she is seized with a convulsion, in all respects answering to pure epilepsy. The attack commences with a shriek-she falls down-struggles violently becomes hideously distorted-bites her tongue-and requires two or three attendants to constrain her contortions. She then falls into a profound sleep, and awakes sore and rather poorly, but unconscious, except by these sensations, of what has passed. The complaint has been gradually increasing in violence and frequency, from the age of six to sixteen years. The catamenia have only appeared once, and have not since recurred. Moving in a high sphere of life, this young lady has had the very best-and perhaps the very worst, advice which England could afford. Not the slightest impression has ever been made on the distressing malady on the contrary, it has progressively augmented in force. though the intellectual faculties have suffered less than might have been expected, they have not escaped uninjured. The memory is impaired, and application to some particular studies is greatly abridged. She dares not in

Al

dulge in music-and she is incapable of making the slightest progress in arithmetic. She cannot perform even the most common operations in figures. She delights in history; but the impressions are like those made in water, or, at most in sand. They are soon obliterated. The eyes are expressivethe pupils very large-the complexion exquisitely fair-the features beautiful

the temper mild-and the anxiety to be relieved from her malady intense. The intestinal secretions and excretions are exceedingly depraved-and the catamenia are stopped. These last are phenomena which she cannot feign, if she would;—but who could be so sceptical, or rather so insane, as to imagine that the other distressing phenomena, which deprive her of the pleasures which her rank in life entitle her to, and which she longs for, can be the work of deception? It is preposterous. Her great object is to veil her attacks, and the cataleptic paroxysms usually escape the observation, except of her parents or intimate relations. If she is reading, for example, she will suddenly stop, for an instant-perhaps for half a minute or a minute; being, for that period, like a marble statue-and then she utters a kind of sigh, and takes up the word, or part of the word, where she had stopped. Considering the length of time which the complaint has obtained, we cannot, of course, form any sanguine hopes of recovery. The first object which we have in view, is to correct the alvine derangements and to reproduce the uterine functions. The result of the case we shall freely and candidly communicate to our readers.

To revert to Dr. Duncan's patient. After concluding that her malady was not feigned, and, indeed, could not be feigned, he remarked as follows:

"The symptoms of the case viewed together, might be arranged under the following heads: 1st, total loss of external perception and sensation; 2dly, suspended volition; 3dly, the continued action of the mixed and involuntary muscles. It was a matter of speculation, whether the functions of the mind were also suspended or not; of their continuance, as yet there had been

and remains in the infirmary. We shall report on both the cases mentioned in this paper on a future occasion.

XXXVII.

symptoms, as we shall immediately see, are very different from those of any other ophthalmia; and although ultimately the whole eye may be involved by inflammation commencing in the choroid, yet choroiditis, in the early stage, exists without any signs of disease in the iris, and without any other

Солт.*

OUR attention having been particularly drawn to a paper bearing the above title, from the pen of our former confrére, and a very able surgeon, Mr. Mackenzie, we were induced to con it over with care. The perusal justifying the encomia pronounced on it by our correspondent, we shall introduce it to the notice of a far wider circle of readers, than the original respectable journal in which it appeared can possibly obtain for it.

The situation and characters of the choroid coat, says Mr. Mackenzie, supply sufficient reasons for the inflammation which attacks its texture, having hitherto failed to attract attention or having bid defiance to precise elucidation. It is generally acknowledged that iritis is occasionally attended by inflammation of the choroid, but as the arteries of the parts are distinct in course and distribution, the idea of a separate choroiditis and iritis is, à priori, rendered probable.

"For some time, the separate existence of choroiditis was with me rather a matter of speculation, and a conclusion from analogy, than a fact ascertained by observation. I am now convinced, however, that the choroid is sometimes the seat, almost quite independently, of inflammation; that in certain cases of ophthalmia, it is the focus of the disease, and that the neighbouring parts may be as little affected when that is the case, as the sclerotica is in iritis, or the iris in sclerotitis. That it is of importance to distinguish the disease which I am now about to describe, will appear very evident, when we consider its dangerous nature. Its

Glasgow Journal, No. IX.

than those which must necessarily arise from the pressure of an inflamed and swoln membrane, placed in contiguity with other membranes, more or less susceptible of suffering from that pressure. I consider choroiditis, therefore, as completely a primary and distinct disease."

SYMPTOMS. 1. Discoloration of the White of the Eye. From the pressure of the inflamed choroid the exterior tunics become extenuated, so that the dark choroid shewing through the sclerotica gives to it a blue or purplish hue. This is a very remarkable and early symptom, whilst the degree of discoloration varies with the severity and duration of the attack, and is best observed by comparing the healthy with the morbid eye.

2. Tumour. When the discoloration has existed for a time the affected part protrudes, commonly on one side only of the eye-ball near the cornea, as if the corpus ciliare was the seat of the disease, and most frequently at its superior or temporal side. The tumour may enlarge to the size of half a filbert or more, and is then generally of a deep blue, with varicose vessels running over it, a state to which the name of sclerotic staphyloma has been given. Several such tumours may surround the cornea.

"The front of the eye, however, is not the only seat of choroid staphyloma, as it might be called with more propriety than sclerotic, considering the actual origin of the protrusion. Scarpa, tells us that he had never met with any tumour or elevation of the sclerotica on its anterior surface, resembling a sta phyloma; but that he had twice happened to meet, in the dead body, with staphyloma of the posterior hemisphere of the sclerotica. The first time was

in the eye of a woman of forty years of age. The eye was of an oval figure, and upon the whole, more voluminous than the sound eye on the other side. On the posterior hemisphere of the diseased eye, and to the external or temporal side of the entrance of the optic nerve, the sclerotica was elevated in the form of an oblong tumour, like a small nut. As the cornea was sound and pellucid, and the humours still preserved their natural transparency, on looking through the pupil, there appeared towards the bottom of the eye, an unusual brightness, produced by the light penetrating that part of the sclerotica, which had become thin and transparent where it was occupied by the staphyloma. When the eye was opened, the vitreous humour was found entirely disorganized, and converted into limpid water, and the chrystalline lens somewhat yellowish, but not opaque. When the posterior hemisphere of the eye was immersed in spirit of wine, with a few drops of nitrous acid added to it, in order to give the retina consistence and opacity, it was distinctly perceived that there was a deficiency of the nervous expansion of the retina within the cavity of the staphyloma; that the choroid was very thin at this part, deprived of its natural colour, and of its usual vascular net work; and that the sclerotica, particularly at the apex of the staphyloma, was so thin as scarcely to equal the thickness of writing paper. The woman from whom this eye was taken, had lost the faculty of seeing on that side some years before, during an obstinate ophthalmia, attended with most severe, and almost habitual pains in the head.

Scarpa had an opportunity of making similar observations on an eye met with accidentally by Dr. Monteggia of Milan. It was taken from a woman, thirty-five years of age, was of an oval figure, and longer than its fellow. The staphyloma was situated exactly as in the former instance. The vitreous humour was dissolved; the chrystalline capsule was distended by a thin whitish fluid; the lens yellowish, and less than natural; the retina deficient within the

staphyloma; the choroid and sclerotica, forming the tumour, thinned, so as to transmit the light. Nothing positive could be ascertained regarding this woman's sight."

3. Effusion between the Choroid and Retina. There can be no doubt that the vessels of the choroid are greatly enlarged in this disease, indeed our author remembers having seen a preparation in the hands of Professor Beer, in which the varices were as large as small peas. Frequently also there is an effusion of watery fluid, and sometimes coagulable lymph, between the choroid and retina; the former Mr. M. has often had occasion to evacuate with a needle. If this be not done, it accumulates to such a degree as to press the retina before it, and having occasioned the absorption of the vitreous humour, it gathers the retina into a cord, which looks, through the pupil, like a deepseated cataract, or the advancing tumour in medullary fungus. The latter is still more closely counterfeited by the effusion of coagulable lymph between the choroid and retina. In one case such an effusion was occasioned by a penetrating wound of the eye, and the lymph lay in white masses, which remained unchanged so long as Mr. Mackenzie could watch the case. another instance, however, the lymph has assumed a red colour, and pressed forward almost into contact with the cornea. The same appearances have been noticed by Mr. Travers.

In

4. Redness. The arteries of the distended sclerotica are much enlarged in choroiditis, and not unfrequently we observe a patch of redness near the edge of the cornea, fed by one or more of these dilated vessels. Sometimes the redness is confined to the upper part of the eye-ball; there is seldom any of the conjunctiva, but either it is sclerotic, or consists in an enlargement of the visible ar eries derived from the recti muscles.

5. Displacement of the Pupil. "The iris is not affected with inflammation in choroiditis; but the pupil, in almost every case which I have witnessed, has undergone a remarkable change of place. The iris is always narrowed to

wards the portion of the choroid which is affected, and in many instances, the pupil is observed to have moved so much out of its natural situation, as to be almost directly behind the edge of the cornea. Upwards, and upwards and outwards, are the directions in which the pupil is most frequently observed to become displaced. It occasionally continues small and moveable, in other cases it is immoveable, but not dilated; in very severe cases it is greatly enlarged, the iris having entirely disappeared at that part of its circumference towards which the diplacement of the pupil has happened.

The remarkable displacement of the pupil which attends choroiditis is owing probably to some affection of one or more of the ciliary or iridal nerves, which running forward between the sclerotica and choroid, pass through the annulus gangliformis, and ultimately reach the iris. This symptom has been remarked by Beer as an attendant on syphilitic iritis. That it is not a constant attendant is well known. I have seen it in other varieties of iritis. It has never been attributed to any affection of the choroid, nor has any explanation of its cause been offered.

"The pupil does not return to its place, even although the choroiditis is subdued."

6. Opacity of the Cornea. This is a frequent, though not necessary attendant on choroiditis, and generally it is the edge of the cornea nearest the portion of affected choroid that becomes opaque, whilst the rest remains perfectly clear. In other cases there are pretty extensive but irregular spots of whiteness, rather the effect of interrupted nutrition than of inflammation. In some severe and long-continued cases of choroiditis the cornea becomes almost entirely opaque, and even dilated and staphylomatous, when this alone may destroy the patient's vision.

7. Exophthalmos and Exophthalmia. "In consequence of choroiditis, the eye may enlarge, and even protrude from the orbit to a very considerable degree, without much inflammation of the sclerotica and conjunctiva, these tunics being merely thinned by the

pressure of the distended choroid. After a time, however, the eye in this state of exophthalmos, is apt to suffer from external inflammation, in consequence of being but imperfectly protected by the lids, or it may be, in consequence of cold or mechanical injury. When the inflammation, thus excited, runs to a great height, the conjunctiva becomes chemosed, puriform fluid is deposited behind the cornea, or between its lamellæ, the eye bursts, continues to swell and protrude still more, assumes a fungous appearance, bleeds profusely, and being productive of great pain and deformity, evidently requires to be extirpated."

8. Intolerance of light and epiphora, are generally considerable.

9. Pain. This varies much in different individuals. It is moderate when there is no protrusion; it becomes severe and sometimes furious, when the sclerotica is much pressed and distended, especially when this takes place suddenly, and is attended with considerable increase of redness. Hemicrania is also present, affecting principally the top of the head, the high part of the temple, and the cheek. It is not strictly circumorbital, nor is it strikingly nocturnal.

10. "Vision is variously affected in cases of choroiditis. In some, the very first symptom complained of, is dimness of sight. Hemiopia, all objects to one or other side of a perpendicular line, or above or below a horizontal line, appearing dim, all objects appearing confusedly, and as if double, even when viewed with one eye, are symptoms which not unfrequently distress the patient long before any redness or blueness of the eye is visible. If the disease goes on, we sometimes find that total blindness ensues, even when the choroid appears but partially affected; while in other cases the whole choroid is evidently affected, the whole eyeball enlarged and discoloured, and yet a considerable degree of vision is retained."

CONSTITUTIONAL SYMPTOMS. The subjects of this disease are adults, and those of strumous habit are most subject to it. Various degrees of febrile