GLAUCOMA: 
BY 
HENRY D. NOYES, M. D GLAUCOMA: 
BEAD BEFOBE THE 
NEWYORK STATE MEDICAL SOCIETY, 
AT THE ANNUAL SESSION, FEBBUABY, 1869. 
HENRY D. NOYES, M. D., 
OF NEW YORK. 
PROFESSOR OP OPHTHALMOLOGY IN BELLEVUE HOSPITAL MEDICAL 
COLLEGE ; SURGEON TO NEW YORK EYE AND EAR 
INFIRMARY, ETC. 
[Extracted from the Proceedings of the New York State Medical Society.] 
WEED, PARSONS & CO., PRINTERS. 
1869. 
ALBANY: ARTICLE V. 
Glaucoma— By Henry D. Noyes, M. D., Professor of Ophthalmology in Bellevue 
Hospital Medical College, Surgeon to New York Eye and Ear Infirmary. 
I beg leave to call your attention to tlie subject of glaucoma, a dis- 
ease of the eye long ago recognized, and whose designation is derived 
from one symptom, namely, the discoloration of the pupil which occurs 
in extreme cases. In former days, the disease was not recognized 
until this ultimate period had set in, a stage in which the malady is as 
much beyond our control at the present time as it was to our prede- 
cessors. My reason for bringing the subject forward is, to set forth 
the fact, that the disease is capable of recognition at a very early 
period, that the means of diagnosis fall, to a great extent, within the 
capacity of every physician, and that in its early stages it may be 
arrested. 
While the name “ glaucoma ” is retained in modern nosology, the 
meaning attached to it is totally different from what it was. The 
central idea of glaucoma is no longer a greenish discoloration of the 
pupil, but is a state of excessive tension of the eye-hall, accompanied 
by a peculiar kind of excavation of the optic nerve. Out of these 
elements are evolved a complex series of symptoms and several pretty 
well defined types of the disease. 
Increase of intra-ocular pressure is the clue to the phenomena of 
glaucoma, and the explorer, who, by a happy stroke of genius, first 
seized this thread, was Prof. Graefe, of Berlin ; and, after the clue bad 
revealed the mystery of the symptoms, it was not long before he 
found the key to its treatment. 
But, at the first, there was some misapprehension of the various 
phases which the disease assumes. Prof. Graefe supposed that, in all 
cases, the disease was to be regarded as an inflammation a kind of 
cloroiditis, chronic, subacute, or acute. A sharper criticism and 
greater experience before long corrected this view. The first to give 
utterance to the statements which express the nosological types of 
glaucoma, as now generally accepted, was Prof. Bonders, of Utrecht. 
The modification in Graefe’s nosology, which Bonders set forth, is 
of great practical importance, and furnishes the motive which has 
impelled me to bring this topic to your consideration. 
It is in the highest degree needful to be known and remembered by 
the medical profession, that glaucoma often begins and sometimes pur- 4 
sues its course to a fatal goal, without any evidences of inflammation 
of the eye. 
Divisions of Glaucoma.—The disease was divided by Donders into 
glaucoma simplex and glaucoma cum ophthalmia,—the inflammatory 
action being acute, subacute, or chronic. 
Symptoms.—First, the symptoms of glaucoma simplex. The sub- 
jects are usually in the latter half of life, that is, beyond forty, and of 
the female sex. It is very common for them to have had chronic 
rheumatism or gout, and to show atheroma of the arteries. 
The earliest sign of trouble is rapid development of presbyopia, and 
occasional obscurations of vision. They see rainbow hues about a 
candle, and, after a time, all objects become misty. This state of 
things may continue for months, and the eye show no external evi- 
dence of mischief; the pupil may be sluggish, but continues contractile. 
One eye alone is at first affected, and when the patient asks advice, it 
may be because he has accidentally discovered one eye to be nearly 
blind. When the disease has fairly seated itself, the following signs 
will betray its true character : first, the eye ball, when gently touched 
with the finger, will feel hard. The second sign is, contraction of the 
visual field. For example, when looking straight ahead, with one 
eye closed, the patient can count fingers on the outer, upper and 
lower sides of the field; but on the inner side his sight fails. A 
careful scrutiny shows that this limitation is not because of the pro- 
jection of the nose, but is a pathological narrowing of the field. In 
cases of very protracted, simple glaucoma, the limitation of the field 
may not be chiefly on the nasal side, but may be quite uniform all 
around (Wecker). With the impairment of the field is associated a 
deficiency in direct vision, when measured by suitable tests, viz., 
Snellen’s type. 
All of these signs may be appreciated by any observant medical 
man and give strong ground for suspicion of incipient glaucoma. 
The picture becomes complete when, by the ophthalmoscope, is to be 
discerned, excavation of the optic nerve and spontaneous or easily 
excited pulsation of the retinal vessels. On the intra-ocular symp- 
toms I will not dwell at present. Without them a very probable case 
can be made out a type of disease in which the hardness of the 
globe would suffice to give a hint of the nature of the process, and 
save the patient from condemnation to one limbo of the unknown 
and incurable, viz. amaurosis. 
Tension of the eye.— This symptom of tension has so great impor- 
tance in ophthalmology that many efforts have been made to give us 
exact measurements of its amount. Instruments called tonometers 
have been made to give the amount of the elasticity of the eye on 5 
external pressure, and other instruments called manometers have 
been constructed to show the pressure excited by the intra-ocular 
fluids. The former are complicated and inexact; the latter are not 
applicable to the living human eye because they require a tube to be 
introduced into its interior. The latter have been brought to high 
perfection and have been successfully applied to the eye of animals in 
physiological experiments. We are left to the sense of touch, the 
tactus eruditus, in our judgment of the tension of the globe. The 
amount of resistance offered is evidently dependent, as Stellwag says, 
upon two elements, the quantity of fluid within the globe and the 
rigidity of the sclera. Both factors probably enter into the problem 
of glaucoma. The normal eye gives way to gentle pressure with the 
finger but promptly reacts as the force is removed. If abnormally 
tense the resistance is increased and the globe feels like the cover of a 
book, like the surface of a table, or even like stone. The various 
degrees of increased tension are subject of judgment rather than 
measurement, although the signs +T, +TX, + T2, +T3, have been 
suggested as indicative of various degrees. They are useful, but, of 
course, not exact, and when the letter T is prefixed by the sign 
(minus) an abatement of tension is signified. 
/Symptoms of glaucoma accompanied hy inflammation.— Glaucoma, 
accompanied by inflammatory action of various grades, presents the 
second type of the disease, and this is divisible into special forms 
according to the peculiarities of the inflammation the inflammatory 
process may be acute, subacute, or chronic. When slow in its action 
the changes observed will be, a little vascular injection of the ciliary 
region of the sclera; a marked turgidity of the anterior ciliary veins, 
those which pierce the sclera near the insertion of the recti muscles ; 
the aqueous humor will be turbid consequently, both iris and pupil 
will lose their clearness; there may in some cases be blood in the 
anterior chamber this space habitually becomes very shallow, the 
reason being that the iris and lens are pushed toward the cornea. The 
pupil, I have said, loses its clearness —it may give back a strong 
smoky reflex which, in some cases, so closely resembles senile cat- 
aract as to be considered a perfect specimen of this disease. It is 
true that cataract frequently follows in the train of glaucoma, but it 
is much more common to see in the pupil the appearance alluded to, 
which strongly simulates cataract, and to find, on examining by the 
mirror of the ophthalmoscope, that the lens is transparent. 
It is important to remember this circumstance because a case is 
liable to be considered cataract, and in this way its loss of vision ac- 
counted for, while it may in truth be glaucoma. If merely cataract, 
the advice to wait until further developments occur may be sound; if 6 
glaucoma, this advice may be fatal to sight. Sometimes the, media 
become so far altered that the typical greenish hue is reflected from 
the pupil, but this appears only in the last stages of the disease. 
As already said, cataract is one of the complications which may 
appear. The sclerotica often exhibits a glistening and striking white- 
ness, and this brings out in strong relief the swollen tortuous veins 
which course over its surface. The lens and iris are pushed forward 
to the cornea and thus in advanced cases the anterior chamber be- 
comes excessively shallow. Very often at this period the surface of 
the cornea looks rough by changes in its epithelium. The hardness 
of the globe is often so great that it feels like touching a stone. 
While these signs are developing the patient suffers more or less 
pain, and it may be very acute. It is in the eye and also shoots 
along the branches of the fifth nerve on the temple, forehead and 
vertex. Necessarily sight is badly damaged or totally lost. 
Other signs noticed in the chronic forms of the disease are dilated 
and fixed pupil, loss of sensibility of the surface of the cornea, the iris 
becomes atrophied. In the deeper tissues of the eye the changes are 
as follows: 
Symptoms within the eye.— The vitreous becomes hazy, diffluent 
the optic nerve excavated, the retinal veins flattened as they pass over 
the disc, they and the arteries pulsate spontaneously or upon slight 
pressure; sometimes the veins on the retina became varicose or even 
beaded as is shown in one of Liebreich’s plates there are sometimes 
extravasations on the retina. The appearance of the optic nerve is 
the characteristic sign. It is excavated as if driven back by a punch; 
in place of the normal elevation of its surface about one-half a milli- 
meter above the adjacent retina, it is pressed down to one or one and 
one-half millimeters below this level. The nerve tissue is thus sub- 
jected to a mechanical paralysis and there necessarily ensues perma- 
nent change of structure, its fibers undergo atrophy. The means of 
recognizing this state of things are very perfect. In the first place 
the vessels are pushed out of their direct course against the sides of 
the pit, and as the perforation through the sclera is broader externally 
than internally, being a frustrum of a cone with its base backward; 
some of the vessels are for a short space concealed from view, and as 
they climb over the edge of the pit, they are not in direct continuation 
with their course upon the bottom of the excavation— hence the pecul- 
iar look shown in these plates (Jaeger). There is also a stasis of blood 
in the veins and a darker spot at the margin of the excavation; some 
vessels may appear to spring from the edge and not to have come up 
from below. The vessels which lie at the bottom are less distinct 
than those on the retina, because more out of focus. Examining by 7 
the inverted image, if the objective lens be moved to and fro a little, 
of course the image moves with it, and the difference in level of the 
vessels will appear by the greater degree of excursion which the 
deeper vessels perform as compared with those in front of them. If the 
observer change his point of view to one side, a shadow will be thrown 
on one side of the nerve. If wTe examine the eye by the binocular 
opthalmoscope the excavation of the nerve will declare itself with the 
utmost distinctness and to its full depth. The color of the nerve in 
chronic glaucoma arrests attention; it is too pale, the small vessels 
being atrophied, and is of a gray or dirty hue; the lamina cribrosa 
shows with great distinctness. This change in the nerve tissue be- 
comes most evident upon examination by the upright image —to do 
this a concave lens must be put behind the mirror whose strength 
shall be in proportion to the depth of excavation. The number of 
this lens may be used to measure the depth of the excavation, as 
Mauthner has shown. When the bottom of the pit is brought to 
focus, the signs of degeneration of the nerve fibers become very ap- 
parent ; they show a glistening opaque pearl gray look. Another result 
of the pressure is the greater breadth acquired by the so called scleral 
ring which surrounds the optic entrance. 
With these signs of pressure it is easy to understand that the retina 
suffers severely and its tissue must undergo material degeneration. 
The damage to sight in such cases is precisely analogous to the 
injury to the functions of the brain which ensues when it is subjected 
to pressure by tumors, depressed bone or clots. 
The picture of disease will vary in individual cases, as the various 
features which I have enumerated are combined together, and as 
some or others become more conspicuous. For instance, in some 
cases the pupil is but little dilated; in others, it is very large, some- 
times the engorgement of external vessels is very great, at other times 
moderate; sometimes the vitreous is quite clear, again very hazy; the 
lens may not be opaque. The loss of sight will sometimes be com- 
plete and absolute; sometimes there may remain the ability to see 
large objects, or even large print. Such being the symptoms of sub- 
acute or chronic inflammatory glaucoma, let us- briefly consider the 
signs of acute glaucoma. 
Symptoms of Acute Glaucoma.—These are very striking, and will 
always arrest attention. There is great swelling of the lids, injec- 
tion of the eye-ball, abundant sub-conjunctial edema, a copious 
flow of watery fluid from the lids, the anterior chamber shallow, the 
aqueous muddy, the pupil dilated, and the media so cloudy that the 
fundus can scarcely be seen ; tension of the globe felt to be extreme 
when the finger, pushing through the oedematous cushion of the lids, 8 
readies the globe; sight almost extinguished; pain intense, often 
agonizing. Such is the startling picture. It has developed rapidly; 
but, on inquiry, the person will be found to have had glaucomatous 
indications before. This state of things might be confounded with an 
attack of purulent conjunctivitis, but is easily distinguished by the 
absence of purulent secretion, by the tension of the globe, by the great 
loss of sight without ulceration of the cornea, and by the violent 
suffering. Such an inflammation was formerly called arthritic oph- 
thalmia. An attack like this may abate after a time, and permit 
recovery of some vision, but settle down into the appearances of 
chronic glaucoma. It may also irrecoverably destroy sight and leave 
the eye-ball permanently painful. 
Prognosis.—ln both simple glaucoma and the inflammatory types 
of glaucoma, the prognosis is, that the disease will continue its progress, 
and sight ultimately be lost. Attacks of acute inflammation are to be 
apprehended, and these may suddenly destroy sight, or give place to 
the chronic state, with a material loss of visual power. 
Etiology.—The etiology of the disease has excited much attention, 
and there is hope we may ere long comprehend it. The striking 
feature is increased intra-ocular pressure and to produce this result, 
manifestly two elements must co-exist, viz., sufficient resistance and 
stiffness in the sclera, and increase in its fluid contents, Cusco 
and Adamieuk and Stellwag have called attention to the changes 
which occur in the sclera. It may undergo fatty degeneration, analo- 
gous to atheroma of the arteries; it certainly becomes more rigid, 
especially in its posterior segment. The sclera, in early life and 
in the normal state, although not strictly elastic, is flexible. The 
posterior ciliary veins which carry off the blood from the choroid jDass 
through the tunic obliquely, and if this have become very rigid, the 
ready efflux of blood is liable to be hindered and a stagnation to take 
place in the choroid. It has been proven by experiment on animals, 
that if the posterior ciliary veins be tied, the tension of the globe 
becomes greatly increased, a result which we should naturally expect. 
But it is very remarkable how the circulation in the eye continues 
uniform, notwithstanding the vessels in the neck may be obstructed. 
Another theory has been put forth to account for increase of intra- 
ocular tension, namely, some irritation of the nerves which preside 
over secretion. Bonders at first made this suggestion, and it has 
received strong confirmation by late physiological experiments by 
Grilnhagen and Hippel. It is shown that irritation of the third 
nerve and of the sympathetic nerves produce little or no augmenta- 
tion of tension, while, if the fifth or trigeminus nerve be irritated a 
hypersecretion ensues which carries up the tension of the eye far 9 
beyond any other cause much farther than is produced by tying 
the abdominal aorta. 
While the facts narrated do not fully explain the causation of 
glaucoma, they are suggestive, and give us hints for future observation. 
Treatment.—'Treatment is the next topic. But one method has 
any value, namely, the performance of an operation and this for 
all the forms of the disease. The design of the operation is to pro- 
cure a permanent diminution of tension and this iridectomy can do. 
The practical consideration in a given case is whether the eye is in a 
condition to permit iridectomy, and may yet be benefited by its per- 
formance. Tor example, in glaucoma simplex take the following case: 
Mr. John H., 43, living in Indiana, a lawyer, being in Hew York, 
consulted me for deficiency of the sight of one eye. It had reached its 
present state so gradually that, though an intelligent man, he could relate 
very little about it. It did not exhibit any outward signs of serious 
change, but vision was reduced to |£ instead of being ; the visual 
field was limited by an irregular, nearly horizontal, line, above which 
he was blind, and also blind on the nasal side; the globe was emphati- 
cally hard to the touch; the optic nerve was deeply excavated and 
the vessels displaced—the substance of the nerve betrayed signs of 
atrophy. 
There was no doubt as to the propriety of operating on this eye 
and it was done; the effect was a diminution of tension and arrest 
of the disease, proven by inspection four months after. In the other 
eye glaucoma had begun, but the tension of the globe was but little 
greater than normal, the nerve retained its proper pinkish hue, was 
but slightly pushed back and vision was |£. It was deemed well not 
to operate on this eye as the patient’s business required his attention. 
It was found after four months not to be perceptibly changed and he 
wTas sent home to return after another period of four months in the 
expectation of then submitting to the operation. 
In this case the operation must be done to check the advancing 
mischief, but the rate of progress is so slow that something may be 
conceded to the patient’s business engagements. 
In some cases the propriety of iridectomy may be doubtful that 
is when the disease has finished its work when perception of light 
is gone, the tissues of the eye entirely degenerated. The only reason 
then for iridectomy is to relieve the pain consequent on the intra- 
ocular tension. But we are then not always successful in this result, 
because the eye is very liable to certain accidents in the operation. 
Take the case of which I show you this pathological specimen. 
Mrs. M., 68, came to me eighteen months ago with glaucoma 
in the left eye and vision greatly impaired. She -was urged to submit 10 
to an operation, and tlie advice was enforced by ber son-in-law, himself 
skillful in ophthalmology, but through timidity she refused. In No- 
vember, 1868, I was called to see her suffering greatly in body and 
mind, because of pain in the eye which was first affected and whose 
sight was now destroyed, and because sight in the remaining eye was 
rapidly declining. She submitted under protest to an operation, and 
iridectomy was done with care upon both eyes,— in the one to restore 
sight, in the other to relieve pain. But loss of vitreous took place in 
the worse eye at the operation. Bor two weeks after, everything 
went well. Decided improvement took place in the sight of one eye 
and the other became quiet. But in the third week the bad eye be- 
came again inflamed and had to be extirpated. In the specimen you 
will be able to read what took place. At the operation, in spite of 
proper care, the thin hyaline burst and permitted prolapse of vitreous, 
the thin vessels also gave way, and you may see large clots between 
the choroid and the sclera. I may remark that the lens was cataract- 
ous when the operation was done. Because of these disturbances it 
was that the secondary inflammatory action took place, which nothing 
but enucleation could properly relieve. It would have been better for the 
patient to take out this eye at first, when the iridectomy was done on the 
other. I have seen a similar eye in which a similar accident occurred at 
the operation, go on for weeks giving the patient extreme pain and finally 
becoming reduced in size and softened, show nothing but an atrophied 
bulb. There are other accidents which may occur in such degenerated 
eye-balls. The iris may be so thin by atrophy as to be torn completely 
away from its whole circumference. An accident which is prone to 
happen in all chronic cases even those where sight may be restored is 
the production of cataract by the operator rupturing the capsule of the 
lens or the zonula of zinn. This is done either by undue pressure on 
the eye, by too sudden efflux of the aqueous humor, or by the entrance 
of the point of the knife into the lens. 
I know no other cases than those above mentioned which are at the 
two extremities of the list, in which it is not imperative to tell the 
patient you must have or rather you may have an iridectomy done. 
I say may becasuse so much certainty inheres in the operation if skill- 
fully done and suitably early, that it is a priceless boon to the patient; 
medication is absolutely useless, rest is useless, paracentesis is to tem- 
porize, iridectomy is to arrest the disease and either to improve or 
perfectly restore or retain the sight. The amount of benefit to sight 
which may be expected depends on how long the disease has lasted 
and what sight remains. The earlier the case is taken in hand 
the more hopeful the issue. In old glaucoma simplex, the most 
to be hoped for is to keep intact the degree of sight remaining. In 11 
cases with noticeable inflammatory symptoms, the effects of iridectomy 
are most satisfactory. A notable improvement of sight is the direct 
effect, and in many cases additional sight is gained during several 
months afterward. 
Never do the achievements of modern ophthalmology shine with 
such brilliant lustre as when iridectomy is done for acute glaucoma. 
A violent inflammation is at once subdued, agonizing pain gives place 
to comfort, darkness almost perfect no longer oppresses the mind, as 
light dawns upon the eye and brightens ere long to perfect day. 
To make iridectomy effectual it must be done in the edge of the 
sclera, at least half a line from the transparent edge of the cornea, and 
a piece must be removed one-fifth or one-sixth the circumference of 
the iris. In some cases a second operation becomes needful, because 
by the first the tension is not perfectly abated. It is often difficult to 
do the operation satisfactorily because the anterior chamber is shal- 
low, the margin of the cornea hazy by arcus senilis and the iris 
reduced to a narrow band. In such cases if the usual lance-knife can- 
not be relied on, the operation may be done by the narrow knife used 
in modified linear extraction of cataract, (Graefes’ operation.) I show 
these various instruments. The best place to make the iridectomy is 
upward, but this spot is the most difficult, and we may do it outward. 
It is usually best to give an anaesthetic to get rid of the strain and 
spasm of the ocular muscles. The lids are separated by a speculum, 
the globe gently steadied by fixation forceps—the knife entered in 
the sclera as gently as possible when the size of the cut is deemed 
sufficient the knife is slowly withdrawn ; the curved iris forceps take 
hold of the membrane and drag it out, if it do not already prolapse 
into the wound, and the assistant cuts it off so as not to leave if pos- 
sible a trace of it in the wound. The person who uses the scissors 
must do it skillfully, and if the assistant is not to be trusted the oper- 
ator must do this himself, letting the assistant hold the fixation forceps 
if needful. 
It is better to permit the blood to escape, so as not to fill the anterior 
chamber, by slightly keeping the wound open. Then put on a com- 
press of cotton-batting or picked lint, and retain in place by a flannel 
bandage. This need not be removed for forty-eight hours, and may 
be changed once in two days the whole time of its application will 
be eight to ten days, and the eye may then be well though not strong 
for twelve to twenty days. 
The operation suggested by Mr. Hancock, which is a cut made in 
one of the meridians of the globe, through the limbus cornea and back, 
for one-quarter of an inch, into the sclera, may take the place of iri- 
dectomy in cases of acute glaucoma, but is not to be depended on as a 12 
means of permanent relief in less urgent cases. It is useful to a prac- 
titioner to know that this simple procedure may conquer the acute 
attack and save the eye; his skill, perhaps, not being equal to the 
proper performance of iridectomy under circumstances in which it is 
often extremely difficult. 
The question will be asked, how does iridectomy effect its purpose ? 
I am not bound to answer how, when I can confidently affirm that it 
does accomplish a permanent abatement of tension. To this fact all 
modern operators subscribe. The following points have been sug- 
gested as giving a partial explanation of the effect: A portion of iris 
containing a certain number of blood-vessels which supply their quota 
of secretion is removed, a freer communication is opened between the 
vitreous and aqueous chambers, though the zonula of zinn is not rup- 
tured ; and what is, perhaps, the most essential, the cut is made at that 
part of the eye-ball which is most resisting. We see sometimes that 
when healing takes place, the wound does not unite by immediate 
apposition, but a considerable quantity of cicatricial tissue appears, 
which is more yielding than the sclera, and sometimes bulges out in a 
little prominence. This in fact occasionally becomes the cause of sub- 
sequent trouble. 
It happens that the operation sometimes causes hemorrhage into the 
vitreous and into the nerve and retina, because, by the sudden relief 
of pressure, the thinned vessels give way. By this accident, the 
restoration of sight may be retarded, and it is desirable to avoid it if 
possible. Hence, the caution not to withdraw the knife suddenly 
from the eye, so as to allow a quick gush of aqueous humor. 
I have perhaps already said too much. My aim has been so to 
depict the disease that it may be always recognized, or at least sus- 
pected ; and, when recognized, to bring the mind of the practitioner 
to the instant decision: this case must not go any further. An 
operation, and nothing but an operation, can save the patient from 
blindness. Iridectomy shall be done. 
To enforce this conclusion, I may adduce the following case: Mrs. 
C——, aged 72, widow, living in Schoharie county, 17. Y., came to me, 
in September, 1868, blind in both eyes. Her husband I had success- 
fully operated on for cataract eight years ago. The experience of her 
husband made Mrs. C alive to troubles of sight, and, as during a 
year she noticed such indications, she frequently complained of them, 
and wanted to come to Hew York for help. But, though she had 
some pain in her eyes, her trouble was looked upon as cataract, and 
as she retained some sight, it was deemed premature for her to seek 
further advice. In truth, wdien I saw her, the case, before the eyes 
were touched, looked extremely like senile cataract. The lenses were 13 
partially opaque, but through them the ophthalmoscope enabled me 
dimly to discern the nerve. To the touch the eye-balls were hard as 
a stone. Sight was entirely abolished; there was no perception of 
light. I had no encouragement to give, but the old lady importuned 
me to do an operation. I consented to do it only because the total 
blindness had lasted but two weeks. 
I did iridectomy upward in both eyes, without mishap and without 
an anaesthetic she preferred not to take ether or chrloroform and 
endured the operation with perfect fortitude. The usual dressing 
was applied, viz., a quantity of cotton over each eye and a flannel 
bandage, bio unpleasant reaction took place. After nine days the 
eyes looked well, but though direct sun light was allowed to fall on 
them, the retinae made no response. Seeing her three months after- 
ward, the tension of the globes was felt to be below the normal 
standard, but sight had not improved. 
Had an instructed practitioner put his fingers on Mrs. C.’s eye- 
balls six months before she came to Hew York, he would at once 
have perceived the disease to be glaucoma; had an iridectomy then 
have been done, the issue would, in all human probability, have been, 
not blindness, but sight. 
New Yoke, 73 Madison Avenue.