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DEFECTS
SIGHT  AND  HEAEING;

    THEIR NATURE,  CAUSES, PREVENTION, AND
             GENERAL MANAGEMENT. 
 
DEFECTS
                        OP


SIGHTAND   HEARING;

                       THEIR

          NATURE, CAUSES, PREVENTION,

                        AND

 GENERAL  MANAGEMENT.
                        BY j/

      T. WHARTON^JONES, F. R. S., F. R. C. S.,

PROFESSOR "' OPHTHALMIC MEDICINE AND SURGERY IN UNIVERSITY COLLEGE, LON-
 DON ; OPJu'HALMIC SURGEON TO THE HOSPITAL ; LATE FULLERIAN PROFESSOR OF
 PHYSIOLOGY IN THE ROYAL INSTITUTION OF GREAT BRITAIN ; FELLOW OF THE
 ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON; FOREIGN MEMBER OF
 THE ROYAL MEDICAL SOCIETY OF COPENHAGEN ; CORRESPONDING MEMBER OF THE
 IMPERIAL MEDICAL SOCIETY OF VIENNA ; MEMBER OF THE SOCIETY OF BIOLOGY
 OF PARIS, ETC.


                EDITED, WITH ADDITIONS,

         By LAURENCE TURNBULL, M. D.,

BURGEON TO THE DEPARTMENT OF DISEASES OF THE EYE AND EAR OF THE 'WEST-
 ERN CLINICAL INFIRMARY OF PHILADELPHIA; MEMBER  OF THE AMERICAN
 MEDICAL ASSOCIATION ; OF THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT
 OF SCIENCE, ETC.
               PHILADELPHIA:
C. J. PRICE & CO., PUBLISHERS AND BOOKSELLERS,
        NO. S3 SOUTH SIXTH STREET ABOVE CHESTNUT.
                     1859. 
\aJUJ
 IS59
       Entered according to Act of Congress, In the year 1858, hy
                      C. J. PRICE & CO.,
In the Clerk's Office of the District Court of the United States for the Eastern
                     District of Pennsylvania.
BB5BT B. ABHMBAD, BOOK AND JOB PRINTER,
        Oeorje Street above Eleventh. 
ADVERTISEMENT
TO THE  FIRST AMERICAN  EDITION.
  Approving  of the matter contained in this small volume, and



knowing it will  be found useful  to all who may consult it  as



a guide to the care of one of the most important of our senses,



I considered it  incomplete without a  few observations on the



care  of the Ear, an organ equal in importance to the Eye, and



not  as well  protected  by nature; complete  deafness  is also



believed, by many good  authorities,  to be a greater evil than



blindness, (See Introduction.)   Loss  of hearing is most apt to



arise from want  of proper care and  knowledge of the delicate



mechanism of the internal ear.   The suggestions added to this



volume will tend, I trust,  to diminish the number of the deaf, and



also  to inform those who have already become so, of the means



of alleviating this great evil by the use  of artificial membranes,



and also by the aid of the hearing trumpet, an account of which



has been introduced.  The additions of the American editor  on



the Eye are enclosed in brackets, consisting principally in a fuller



exposition of the interesting subject  of " Color-Blindness;" the 
VI
ADVERTISKMKNT.
application of the Ophthalmoscope to the diagnosis of certain
obscure diseases of the Eye;  a notice  of Artificial Eyes, and
their mode of introduction; also an article on the  proper use of
Spectacles, by  my  friend Mr.  Queen, of this city, a pupil of
the distinguished optician  and  philanthropic gentleman,  John
McAllister, Esq.
  Should  the work pass  through a  second  edition, I shall be
glad to make the additions more numerous.   The opportunities
of the American Editor,  for  seeing  diseases of the Ear, have
been good,  as  he has  charge  of that department in the only
institution  in this city, which makes this  a distinct and special
object of care and attention.
                                          THE EDITOR.
  1208 Spruce Street, Philadelphia.
          December 1, 1858. 
ADVERTISEMENT
TO THE  FIRST LONDON  EDITION.
  Much of the mortality which figures in the Registrar-General's
Reports, it has been shown, might be prevented by attention to
sanitary measures.   In like manner, much of the defective sight
and blindness which we  meet with is the result of disease, either
preventible altogether, or at least curable if taken in time.
  Impressed with this fact, it has occurred to  me  that  a  small
volume containing some guiding principles relative to the care
and  preservation of the sight would  be useful.  Accordingly,
I have thrown together, in the following pages, such observations
on the subject  as  appear  to me calculated  to answer  the end
in view.
                                           THE  AUTHOR.

  35 George Street, Hanover Square,
         London, August 1, 1856.
1* 
 
CONTENTS.
PART  I.
                         CHAPTER  I.
                                                              PAGE
Structure of the Eyes and Nature of the Sense of Sight...........  13
Structure of the Eyeball.................................................  14
Projection of Images on the Retina.......................................  17
Vital Action of the Optic Nervous Apparatus.............................  21
Mechanism of the Movements of the Eyeballs............................  23
Mechanism of the Movements of the Eyelids..............................  24
Mechanism of the Lachrymal Apparatus, &c..............................  25

                          CHAPTER  II.
Choice of Light for Working by, and General  Precautions to be
    observed in the Employment of the Sight........................  27

                          CHAPTER III.
Dangers to the Sight to be particularly guarded against.............  34
Injuries of the Eyes.....................................................  34
Prejudicial Reaction of certain States of the Body on the Eyes............  36
Ophthalmia, or Inflammation of the Eyes.................................  38
Use and abuse of Eye-waters, Salves, and Warm and Cold Applications to
    the Eyes............................................................  40
                           PART  II.
DEFECTS OF SIGHT IN PARTICULAR.................................  44

                          CHAPTER I.
Defective Sight depending on Derangement of the Dioptric Apparatus
    of the Eyes........................................................
Cataract................................................................
Hard or Common Lenticular Cataract of Old Persons......................  48
Extraction of the Cataract...............................................  52 
 X                            CONTENTS.

                                                                    riaa
 Displacement of the Cataract............................................  69
 Soft or Common Lenticular Cataract of Young People.....................  61
 Division of the Cataract.................................................  62
 Secondary Cataract.....................................................  63
 Comparative Advantages and Disadvantages of Extraction, Displacement
    and Division........................................................  64
 Palliative Treatment of Cataract.  Can Cataract  he cured without  an
    Operation ?.........................................................  M
 Mydriasis or simple Fixed Dilatation of the Pupil.........................  Cfl
 Myopia or Short-sightedness, Presbyopia or Far-sightedness...............  68
 Refraction by Convergent Lenses,and the adjustment of the Eye to different
    distances...........................................................  69
 Short-sightedness........................................................  71
 Far-sightedness.........................................................  77
 Cataract Glasses........................................................  82
 Cylindrical Eye.........................................................  83
 Conical Cornea.........................................................  84
 I."~s of Power of Adjustment............................................  85
 Chromatic or Colored vision.............................................  85
 Diplupy or Double Vi-ion, and Polyopy or Manifold Vision with One Eyo..  86
 Astbenopy, or incapacity to keep the Eyes fixed on near objects............  86
 Mubco' Volltantes, or appearances like 1 lies floating before the Sight......  89
 Qn the use of Spectacles.................................................   03

                            CHAPTER  II.
 Amaurotic Affections, or  Defects of Sight Dependimi on Pf.kvkktkd
    Impaired, or Lost Sknkibility of the Optic Nervous Apparatus... .  98
 Abnormal Excitement of Visual Sensations...............................  98
 Photopsy and Chroopsy, or Sensations of  Light and Color, Independent  of
    External  Light, excited by Internal Influences operating on  the Optic
    Nervous Apparatus.................................................  98
 Spectra consequent  to Impressions on the  Ketina, and  Complementary
    Colors.............................................................. 100
Phantasms.............................................................. 101
 Impairment and  Loss of Sensibility of tho Optic Nervous Apparatus, or
    Amaurosis In its various  Degree■•.................................... 107
 Daltonism, or Defective Perception of Colors............................. 108
 Transitory Hemiopy, or Half Vision..................................... 117
 Night Blindness........................................................ 118
 Fixed Muse*........................................................... 119
 Amaurosis.............................................................. 120
 On the use of  the Ophthalmoscope....................................... 124
 Artificial Eyes.......................................................... 126 
CONTENTS.
XI
                           CHAPTER III.
                                                                 paos
Defects of Sight depending on Loss of Correspondence of the Sensa-
    tions and Movements of the Two Eyes............................. 129
Single Vision with Two Eyes............................L...............129
Visual Perception of the Three Dimensions of Space, Length, Breadth and
    Thickness........................................................... 130
Diplopy or Double Vision with Two Eyes................................ 131
Strabismus or Squinting,  and Luscitas or Immovable Distortion of the
    Eyeball............................................................132
Paralysis of the Muscles of the Eyeball and Eyelids.......................135
PART III.
                          CHAPTER  I.

Prevention and Management of the Diseases of the Eyes apt to occur
    at the different periods of life.................................. 137
Early infancy, or period at and from Birth up to Teething.................137
Infancy and Childhood, or Period from the commencement of Teething up
    to the Eighth Year.................................................. 14*
Youth and Adolescence................................................. 146
Adult Age......................................•........................148
Turn of Life............................................................ 150
Old Age................................................................ 151

                           CHAPTER II.

Preservation of the Eyes in certain General Diseases, &c............ 153
Preservation of the Eyes in Measles,  Smallpox, Scarlet Fever, Hooping
cough.
153
Preservation of the Eyes after Fevers.................................... 154
Preservation of the Eyes in Childbed and Suckling.......................155
Preservation of the Eyes in Venereal Diseases............................ 155
Prevention of the Spread of Contagious Ophthalmia in Barracks, Schools,
    Workhouses, &c.................................................... I58
Prejudicial Influence on the Sight of the Excessive Use of Tobacco........158 
XI1
CONTENTS.
                          PART IV.
                                                              rial
INTRODUCTION....................................................... 159
The Deaf and the Blind................................................. 159

                          CHAPTER  I.

Diseases and Accidents to which thb Ear is subjbct...................163
Toynbee's Classification of Diseases of the Ear............................. 165
The Preservation of the Health of the Ear................................ 167
Cleanliness............................................................. 168
Scarlet Fever........................................................... 169
Typhus and Typhoid Fever..............................................170
Measles................................................................. 170
Influenza............................................................... 171
Scrofula and  Syphilis.................................................... 171
Bathing................................................................ 172
Accumulation of Cerumen............................................... 171

                          CHAPTER  II.

Foreign Bodies in thb Meatus......................................... 177

                         CHAPTER III.

Observations upon Otorrhea as a Sequela to Scarlet Fbver.......... 184

                         CHAPTER IV.

On tdk Che of an Artificial Membrana Tyhpani in Certain Forms of
    Deafness dbpbndent upon Perforation of the Natural Membrana
    Ttmpani............................................................ 198
The Mode of Applying the Artificial Membrana Tympani, by Mr. Toynbee. 206

                          CHAPTER  V.

Hearing Trumpets....................................................209

                         CHAPTER VI.

The Deaf and the Dumb............................................... 213
Instruction.............................................................. 216
Directions for Teaching Deaf Mutes at Home..............................220
On the Cure of Deafness (Deaf Dumbness) by Dr. M•■uiere................. 223 
DEFECTS   OE   SIGHT:
THEIR  NATURE,  CAUSES,  PREVENTION,
      AND  GENERAL MANAGEMENT.
PART  I.
                  CHAPTER I.

STRUCTURE OF THE EYES AND NATURE OF THE SENSE OF
                       SIGHT.

  The optic  nerves or special  nerves of sight—two  in
number—are each at one end connected with the brain, and
at the  other expanded into  a nervous membrane, named
retina, which lines the interior  of the  back part of the
eyeball.
  Like telegraphic wires, the optic nerves  constitute the
media of transmission  between the retina,  on which the
impressions of sight are  made, and  the brain, where the
sensations of sight are perceived.
  The segment of the eyeball in front of the retina is a di-
optric apparatus or system of lenses, by which the rays of
light entering the eye from external objects are so refract-
ed or bent that they are made to converge and come to foci
or points on the retina.  Images of the objects from which
       2 
14
DEFECTS OF 8IGHT.
the light comes are thus projected on that membrane as on
the table of a camera obscura, thus :—
  The impression so made on the retina being  transmitted
by the optic nerve  to the  brain, a  visual sensation of the
object is excited in the mind, or, in common language, we
see it.
Structure of the Eyeball.
             Optically  considered,
the
                           eyeball is, in its construction,
                           a true camera obscura.
                             The  wall of   the  ocular
                           chamber is  composed  exter-
                           nally of the sclerotic coat (a,)
                           except anteriorly,  where it  is
                           formed  by   the   transparent
                           cornea  (J),)  which,  like  a
                           window, closes in the front  of
                           the  eyeball.  The   sclerotic
                           coat  is  lined inside  by  one
                           more delicate, named the  <ho-
                       t hu. roid coat (c,) which  contains
    man eyeball, natural size.     much  dark pigment dispersed
throughout its  substance.   Towards the place where  the 
STRUCTURE OF THE EYES.
15
sclerotic joins the cornea, the  choroid coat presents a pe-
culiar plicated structure called ciliary body (d.)  On the
inner surface of the choroid coat  again, there  is a mosaic
pavement-like work of flat six-sided cells of microscopical
minuteness, filled with dark brown particles,    ^   ^
forming  the proper pigment membrane, by  gmglMfo
which the interior of the ocular  camera is ###®#
darkened for a purpose corresponding to that ^^^f ^
for which opticians obscure the interior of    W
their instruments by painting them black, viz., in order that
any extraneous rays of light may be absorbed and prevent-
ed  from  interfering  with the distinctness of  the  image
formed  on the table of the camera.
   Had the interior of our eyes been undarkened, not only
would our sight have been  indistinct, but we should have
suffered from a painful dazzling in the exercise  of vision in
bright light, as is the case with Albinos, in whom the pig-
ment of the eyes,  as well as that of the skin, is deficient.
   Situated behind the transparent  cornea, and supported
on both surfaces  by  the  aqueous humor, is seen the iris
{e e,) a  flat circular membrane, perforated by a round aper-
ture, called the pupil (/.)  The anterior surface  of the
iris, as  seen through the transparent cornea in the living
eye, is  differently colored in  different  individuals—blue,
hazel, &c. : indeed, it is the color of the  anterior surface
of the iris which,  in common language, is spoken of as the
color of the eye  generally; thus,  a blue eye or hazel eye,
means merely an  eye with a blue  iris or one with a hazel-
colored  iris.   The posterior surface of  the iris is invested
with a  dark pigment-membrane, which  is a modified  con-
tinuation of that  lining the inner surface of  the choroid
coat. 
16
DEFECTS OF SIGHT.
  The iris perforated by the pupil, thus  situated behind
the transparent cornea, is, in the camera of the eye, what
the shutter with  the hole in it is in the pfiinitivc  form of
the camera obscura, or what a stop or diaphragm is in more
perfect in.-truuicnts.   Rut  more than this, it is a  stop' or
diaphragm, the aperture of which is variable in size, and
self-adjusting:  by means  of the contractile power with
which the iris is endowed, the pupil admits of being varied
in size, but  not alone this,—there is a provision by which
the contractile power  of the iris is called into operation
without any  effort on our  part, under  the very  circum-
stances which require the variation in the size of the pupil,
viz., in bright light,  contraction—in dull light, dilatation
of that aperture.
  The retina (/), or  expansion  of the optic nerve, it  has
been above  mentioned, lines the interior of the back  part
of the eyeball, being  situated within the  pigment mem-
brane, and is the table on  which,  in our ocular camera
obscura, the  image of external objects is projected by the
dioptric apparatus placed immediately  in front of it.
  The  dioptric  apparatus  of  the eye consists  of  the
vitreous humor, the  crystalline  lens,  the  aqueous humor,
and the cornea.
  The vitreous humor (Jc) is a transparent jelly-like mass,
which fills up the  posterior and middle part of  the interior
of the eyeball.  It is  concavo-convex  in shape.   Its  con-
vexity, which is behind, is in  close  apposition with  the
concave surface of the retina; in  its concavity, which is di-
rected forward, the crystalline lens lies imbedded.
  The crystalline  lens (J) is double convex, but unequally
so.   The  more convex surface is the posterior, and is sunk 
PROJECTION OF IMAGES.
17
in  the  concavity  which  the  vitreous  humor presents
anteriorly.
  In front of the crystalline lens is the aqueous humor (m),
which owes its shape to that of the cavity wherein it is con-
tained.   The cavity in question is  convex anteriorly, and
concave posteriorly, being bounded in the former direction
by the posterior and concave  surface of the cornea; and in
the latter direction by the anterior convex surface of the
crystalline  lens.  Furthermore, this cavity containing the
aqueous humor is subdivided by the iris into two compart-
ments, communicating through the pupil, called the anterior
and posterior chambers of the aqueous humor.
  Lastly, the transparent watch-glass shaped cornea, at the
same  time that it closes in the  front of  the eye-ball, forms
an important part of the dioptric apparatus.

        Of the Projection of Images on the Retina.
  In  order that the mechanism by which images are pro-
jected on  the retina may be more readily understood,  it
will be useful to premise a brief explanation of the projec-
tion of images on the table of the camera obscura.
  It is a law of light, that its rays,  as long as they continue
in the same medium, proceed  in  straight lines.   Of the
rays of light which diverge in straight lines in all directions
from  the different points of any external object, some will
enter a hole in the shutter of a window looking towards the
object, while others will be  stopped by the shutter.   The
rays which  enter the  hole continue  their straight  course
within the chamber, the window of which is closed by the
shutter, until they  are stopped  by the opposite wall, or by
a sheet of white paper held up opposite the hole  in the
                          2* 
18
DEFECTS OP SK1IIT.
shutter.  On the wall, or on the sheet of paper  on which
the rays of light are received, there is seen a picture of the
external object whence the rays of light, which entered the
hole of the shutter, came.
  In regard to this picture, it is to be observed that it is
inverted and ill-defined, thus:
  The cause of the inversion of the picture, it will be seen
from the diagram, is that the rays of light from the upper
part of the object which  enter the  hole, continuing their
rectilineal  progression  within the  chamber,  necessarily
impinge on the lower part of the wall or paper, while the
rajs from the lower part of the object as necessarily impinge
on the upper part of the wall or paper; and so on  with the
rays from the sides and intermediate points of the object.
  The cause of the imperfect definition of the picture, again,
is, that the rays of light which form it  do not impinge on
the wall  or paper in points or foci corresponding  to those
of the object whence they issued, but in a state  of diver-
gence, as may  be seen in the diagram.
  If a convex lens be inserted  in the hole of the shutter,
the image is no longer indistinct, but well-defined when the
sheet of paper on which it is projected is held at a certain
distance behind the lens.  The explanation of this is, that
the rays of light diverging from all  the different  points of 
PROJECTION OF IMAGES.             19
the object are so refracted or bent from their original direc-
tion in passing through the convex lens, that they are ren-
dered convergent, and so meet again in foci or  points, as
they fall on the ^heet of paper, corresponding to  those
points of the external object whence they originally diverged,
thus:
  It will be  seen from  the diagram, that  though distinct
from  accurate definition,  the  picture is still  inverted, for
the same reason that  the  picture, formed without a lens in
the hole of the shutter, is inverted.
  To come to the projection of images on the retina :
  That a well-defined picture  is projected on the retina, as
shown in the  diagram (p. 14,) may be actually demonstrated
by taking the eye of  an animal  newly slaughtered, such as
an ox or a sheep, and cutting away a piece of the sclerotic
and  choroid  coats at its back part, when by directing the
cornea towards any object, a lighted candle for instance, we
shall see  a small inverted picture of the object shining
through on the exposed retina like the image on the screen
of the  phantasmagoria.  A similar demonstration may be
given on  a  white rabbit's eye, without other  preparation
than dissecting clean the  posterior  surface of the sclerotica.
   Like the lens of the camera  obscura, the ocular dioptric
apparatus so refracts or bends the rays of light, which enter 
20
DEFECTS OF sKiHT.
 the eye in a state of divergence from  the several  points of
 an external object, that they are made to converge to points
 or foci.   These points or foci of light impinge on the retina,
 as on the  table of a camera obscura,  in the same relative
 order as that in which  the rays forming  them  originally
 diverged from the several points of the external object.
   As to the particular action of the dioptric parts of the
 eye on the rays of light in their course to the retina: of
 the pencils of rays diverging from the various points of
 external objects, those only which fall  on  the cornea, and
 are transmitted by it to the  aqueous humor, and thence
 through  the pupil to the  retina, are  concerned  in vision.
 Those rays which fall on and pass through the circumferen-
 tial part of the cornea, are stopped by the iris, and  are
 either reflected or absorbed by it.  The effect of the refrac-
 tion by  the cornea, and of that by the different humors on
 the rays, is to make them converge;  hence, each  pencil
 represents two cones, with their bases touching each other
 at the anterior surface of the cornea, fig. 1, p. 14.
   Of all the dioptric parts of the eye, the  cornea is  that
 which contributes most to the convergence of the rays of
 light.  This is  because the rays enter it  from  the  air,
 which is of so much less refractive density than the cornea.
 The crystalline lens, though double convex, and of greater
 refractive density than the cornea, contributes comparative-
 ly little  to the convergence of the rays of light, because the
latter enter the  crystalline  lens from the aqueous humor,
the refractive density of which is not bo much exceeded by
that of the crystalline as the refractive density of the air is
by that  of the cornea.   The aqueous humor being  some-
what less dense than the cornea, and presenting  a convex 
VITAL ACTION OF OPTIC NERVES.          21
surface to the incident rays, the  convergence  which  the
light acquired in passing through the cornea is slightly di-
minished on  entering it.   The vitreous humor,  on  the
contrary, continues, and slightly augments the convergence
of the rays which enter.it from  the crystalline lens, as it is
of  less density than that body,  and  presents a  concave
surface to the incident rays.
   The curvatures of the refractive media of the  eye are not
spherical, but such as are  calculated to bring all the rays
of light to one focus, so that there is  no spherical aberra-
tion.  In like manner, the  concave surface  of the retina is
not spherical, but of such a curvature as to  be in its princi-
pal parts at a due focal distance behind the cornea and lens,
one of the conditions for the prevention of  distantial aber-
ration. *

       Vital Action of the Optic Nervous Apparatus.
   The act of seeing consists in the  mind's perceiving the
sensations of light and color excited by the impressions on
the retina made, in the manner now explained, by external
objects through the  medium of the  external agent, light.
The sensations of light and color, and the ideas which the
mind  reads  off therefrom  respecting the form, &c,  of ex-
ternal objects, depends  wholly on the  living  actions  and
endowments  of the optic nervous apparatus, and the co-ope-
ration of the mind through its organ, the brain.   When

  *See for further details regarding the curvatures of the eye, my "Anatomical
 Introduction, explanatory of a horizontal section of the human Eyeball," in
 Mackenzie's " Practical Treatise on Diseases of the Eye," 4th ed., London, Long-
 man and Co , 1854.  And for details regarding the correction of the optical aber-
 rations in the eye, see my "Essay on the  Wisdom and Beneficence  of the
 Almighty as displayed in the Sense of Vision," London, Churchill, 1851. 
DEFECTS OF SIOHT.
the optic nervous apparatus is paralyzed, it  is no  longer
susceptible  to the impression of light; hence, though  the
dioptric apparatus of the eye perfectly perforins its function,
there is blindness—the camera obscura in vain  throws the
picture on the insensible retina.  «
   In  the exercise  of  vision, we refer our perceptions to
without and to some distance from the eye, taking no cog-
nizance of the fact that the impression exciting the sensa-
tion is actually made on the retina, nor of the intervention
of the impressing agent, light.
   Whether  the perception of externality or  outness depend
on an original connate law of the economy, or on experience
and association acquired  through  the touch ? has been  a
question with philosophers.
   Among other arguments in support of the opinion  that
we do not originally perceive objects to  be out from  the
body, but that  the mind originally refers the visual  sensa-
tion to the eye, as it does a tactile sensation to the point of
the finger;  and  that  it  is only  by  experience,  through
touch, that we  learn to perceive the  outness of visible ob-
jects,  the statements of persons born  blind from cataract,
who  have acquired sight by an operation,  have been  ad-
duced.  Some of  these persons have alleged  that when they
first acquired sight, they thought all things touched  the
eyes.   Rut  this,  it could easily be shown, is  merely loose
figurative language.  Even if the fact were  as stated, it
would,  if strictly  examined,  prove  no support  to   the
opinion,  because  it was  merely the  surface  of  the  eye
which was alleged to be the scat of the sensation, whereas
it  ought to  have been the retina, and the person ought,
therefore, to have supposed that objects not only touched,
but were actually in the eye. 
MOVEMENTS OF THE EYEBALLS.           23
   Much more trustworthy evidence of what is the  fact is
supplied us by infants and the young of the lower animals.
An infant grasps at external objects.  A chick, on emerg-
ing from the shell, will  run and pick  up a grain;  an act
the animal would not likely perform if it referred the grain
to the interior of its own eye, instead of to without,  and to
some distance from its body.
   I  have no  hesitation in  expressing  my belief that our
faculty of perceiving  outness is  truly dependent  on an
original  connate law of our minds.  In support  of  this, I
would borrow an illustration from the sense of touch itself
—the very sense which is relied on in favor of the opposite
side of the question.  The illustration I would adduce, is
the well-known  fact, that  persons who have had the  mis-
fortune to lose a limb, sometimes feel as if the lost organ
were  still in connection with the body, and that some  part
of it, perhaps, is the seat of pain.   Thus, to quote from the
" Spectator:" "The poor fellow who lost his arm last siege,
will tell  you, he  feels  the fingers that were  buried  in
Flanders ache every cold morning at Chelsea." *

       Mechanism of the  Movements of the Eyeballs.
   Of a globular form, each eyeball  lies safely lodged in its
socket, where it is so balanced in the orbital capsule, as to
admit of being  turned  in all directions,  within  certain
limits, by  the action of its  six  muscles.  These muscles
acting singly, make it revolve in so man/ different direc-
  *For further details on this subject, and its bearing on the explanation of
erect vision, though retinal impressions are inverted, of the apparent size of ob-
jects, and of single vision with two eyes: See my Essay on "The Wisdom and
Beneficence of the Almighty as  displayed in the Sense of Vision," above
referred to. 
24
DEFECTS OF SIGHT.
tions—iuwards,  outwards, upwards, downwards, obliquely
downwards, obliquely upwards—on three imaginary axes;
but acting  in various combinations, they make it  revolve,
on other axes, in various other directions.
  The two eyeballs move in concert, and in order to this,
their  different muscles  act in various combinations, some-
times as associates, sometimes as antagonists, according to
the manner in which the eyeballs  require to  be directed,
so that  their axes may meet at the object looked at, their
centres  of revolution coincide, and  their vertical and hori-
zontal diameters be  parallel—conditions necessary for the
simultaneous projection  of the  images  of objects  on the
corresponding parts of the two retinae.

       Mechanism of the Mo cements of the Eyelids.
  At the same time  that the eyeballs are so placed in the
head and moved, that they may be directed to the various
objects in the field of view, they are  securely protected from
any ordinary violence.
  The upper eyelid is kept raised by a muscle for the pur-
pose (the terator,) whilst the  lower eyelid is held down by
its own  elasticity and that of the cheek.   There is a proper
muscle for closing the eyelids, namely, the orbicular.  The
action of the levator muscle of the upper eyelid  being
suspended in sleep, it is partly by the weight and elasticity
of the eyelid, and partly by the unrestrained action of the
orbicular muscle, that the eyes are  kept  closed.  It is also
by the momentary action of the same muscle every now and
then that winking is  caused;  overcoming the action of the
levator muscle of the upper eyelid and  the elasticity  of the
lower, it draws down the upper, and raises the  lower eyelid
considerably. 
LACHRYMAL APPARATUS.              25
      Mechanism of the Lachrymal Apparatus, &c.
  For the lubrication  and protection of the delicate and
sensitive borders of the  eyelids, an  unctuous matter  is
poured  out on their surface by the minute mouths  of the
ducts of the Meibomian  glands.  These  mouths may be
seen on close inspection of the surface of the broad border
of the eyelids, arranged in a row all along.
  The source of the tears is the lachrymal gland, which is
situated above and to the outer side of the eyeball, securely
lodged in a pit behind the edge of the socket.  When the
tears are  poured out in unusual quantity, as they are in
certain  affections of the mind, and in consequence of irrita-
tion of the eye from the intrusion of foreign particles or the
like, they run over the margin of the lower eyelid, and drop
down the cheek.   A flow of  tears in a less degree is, how-
ever, constantly taking place, by which the transparent front
of the eyeball and the surfaces of the conjunctiva in general
are washed and maintained in a moist state.   The direction
in which the tears flow over the surfaces mentioned, is from
above and near the outer corner of the eye, where the ducts
of the lachrymal gland open and discharge them, downwards
to the  inner corner, whence, as they accumulate, they are
drawn off into the nosel)y the derivative lachrymal passages.
   At the termination  of the firm border of each eyelid
towards the inner corner, there is a  slightly prominent
papilla, with a small orifice at its point.  These papillae are
directed towards the pit  or depression at the inner corner
(named lachrymal lake,') where the tears  accumulate.  Ry
the two orifices which  lead each into a small duct or canal,
the tears  are absorbed, and by the  ducts are conveyed into
the lachrymal  sac which lies concealed under the skin, in
        3 
26
DEFECTS OF SIGHT.
a particular groove of the orbit, at the inner corner of the
eye.  From the lachrymal sac, the tears pass, by the nasal
duct, into the nose.
  An eye, with the eyelids divided vertically, and the outer halves everted, to
•how the orifices of the ducts of the lachrymal gland, Into which hairs are
Inserted. The letters a and 6 indicate respectively the upper and the lower lach-
rymal points.  Along the border of the eyelids are observed the Meibomian tper-
tures.
  The mechanism by which the eyelids are moved, and the
tears drained away into the nose, is perhaps most strikingly
illustrated  when it is anywise disturbed  by disease.  Thus
the levator muscle of the upper eyelid is sometimes para-
lyzed,  in which case the upper  eyelid hangs down over the
eye, m consequence of the unrestrained action of  the
orbicular muscle.   Again,  the  orbicular  muscle  may  be
paralyzed,  in which case  the  eyelids cannot be closed, the
upper  being kept  elevated  by  its levator muscle, and the
lower depressed by its own  elasticity and that of the cheek.
Then as to the draining away  of the tears into  the nose,
this may  be prevented  by  obstruction of the  lachrymal
passages; or by the tears not being absorbed by the lach-
rymal  points, owing  to the  papillae being no  longer duly
directed to the lachrymal lake  at the inner corner, in con-
sequence of paralysis of the orbicular muscle. 
CHAPTER II.
CHOICE OF LIGHT FOR WORKING BY, AND GENERAL PRE-
  CAUTIONS  TO BE  OBSERVED IN  THE EMPLOYMENT OF
  THE SIGHT.

  Light, we have seen, is the agent through the medium
of which  external objects  make their impressions  on the
sense of sight.   We know by experience that a certain
moderate intensity of illumination is that by which we can
see objects at once most distinctly and most comfortably.
  Strong  light dazzles and confuses the vision at the same
time that  it pains the eyes, determines the blood to them,
and  excites a flow  of tears.   It is only after some time,
perhaps, that the eyes  recover themselves.  If the light
has been very intense—the direct light of the sun concen-
trated, for example—the spot of the retina impressed may
remain affected by it even to insensibility.
  The attempt to exercise  the sight by too weak illumina-
tion, on the other hand, strains and fatigues the eyes in  a
manner scarcely less injurious.
  It is daylight  alone which  affords that degree and kind
of illumination of objects which we find most agreeable to
the eyes, and by which we can longest and with the  least
fatigue exercise the sight.
  Artificial lights of all kinds  are much inferior.  The
mild diffusion of the light of day,  with the  necessary in-
tensity, uniformity, and  steadiness, can be but imperfectly 
28
DEFECTS OF SMIIT.
imitated in artificial light, which is usually either  too con-
centrated  or too weak and unecjual and flickering in com-
parison.   And then in respect to quality, what a difference
is there to the eyes between workiug in the clear colorless
light of day and the dingy red  and yellow light obtained
by combustion !
  Our own  natural feelings—a good monitor to  be guided
by in regulating  the quantity and quality of the  light to
which the eyes are exposed,—warn us that work at all try-
ing to the sight  is best  done by day.   And to  have day-
light as long as possible for our work, we should  follow the
primitive fashion  of rising with  the sun.   Work requiring
least exertion of the vision may  be done by artificial light.
Students and others, therefore, who have to read and write
much, should read by day and  write in the evening.   In
like manner, seamstresses should do fine and dark-colored
work by day and  coarser and lighter colored work by can-
dle-light.
  The window by which we read, write, draw, sew, or  do
other such work should look towards the north rather than
towards other directions.  And the desk or work-table
should be so placed  that the light from the window may
fall obliquely from behind and  over the left shoulder  on
the book,  paper, or work.  Ry this arrangement the light
docs not fall directly into our eyes, nor is it reflected di-
rectly back from the object into  them.
  We ought never to  exert the  sight with the sun shining
on the work.
  As working in  too weak a light  is as injurious to vision
as working in too strong a light, we  must not continue
poring over the book or seam when the light of day fails ao 
CHOICE OF LIGHT.                 29
that it is necessary to hold the object nearer in order to see
it.
   When we  use artificial light for working by, it  should
be, as far as  possible, sufficiently bright without being
dazzling.
   For reading, writing, or sewing by, the light yielded by
two or three  composite candles is, perhaps, the best.  The
light is sufficient in quantity, and, at the same time,  mild
and  not very much colored; and if there be no draughts of
air in the apartment, sufficiently uniform and steady.  The
candles should be placed to the left of the  desk, and  a lit-
tle in front, and still less brought between the eyes and the
object looked  at, as  is  sometimes  done  by  far-sighted
people.
   If the room be large, it is well, in addition, to illuminate
it generally, and for this purpose nothing  is better than a
moderator lamp, placed somewhere in the middle.   If gas
light be  employed, the burners should be suspended  from
the middle of the ceiling and provision made  for due venti-
lation.  [The best form of gas burner is the Argand, being
free  from the flickering light  of the common gas  burners
in use.]   In  either case the  light  should be moderated and
diffused by means of an obscured glass globe.  The  light
from lamps with opaque shades and the light concentrated
by glass globes  filled with water, as used by  watchmakers,
jewelers, and other such workmen, are by no means favor-
able to the eyesight.  They should be used, therefore, as
little as possible.
   Glaring and flickering lights irritate the eye  even when
not employed in any examination; but when so  employed
such light is  extremely detrimental.  We should not read,
                           3* 
30                 DEFECTS OF SIGHT.
write, draw, sew, or the like, under the shade of a tree for
any length of time, as every now and then, in consequence
of the motion of the leaves by the wind, streams of bright
light alternately with shadows fall irregularly on the paper
or seam.  We ought never to attempt reading,  nor indeed
doing anything  by  the flickering light of a fire.  Open
cooking fires are  bad for the eyes, both by their  blinding
light and radiating heat.
   Much exertiou of the eyes operates more prejudicially to
the sight  under  some circumstances  than under others.
Exertion of the sight is especially prejudicial immediately
after a full meal, after the use of spirituous drinks, while
smoking, when the body is in a recumbent or stooping pos-
ture, when dressed in tight clothing, especially tight neck-
cloth, tight corsets, and even tight boots or shoes, in close
ill-ventilated apartments lighted with gas, after bodily fa-
tigue, during mental distress, late at  night when sleepy,
after a sleepless night, while the bowels are much confined,
during convalescence  from debilitating illness.  Though
during recovery from severe  disease, the eyes cannot bear
much exertion, yet, for want of other employment, it is not
uncommon for convalescents to read even  more than when
in health.   Many persons have very much injured their
sight in this way.
   Patients confined  to bed are apt, from mere listlessness,
to tire their eyes in tracing the pattern  of the bed-curtains
or of the paper-hangings on the wall.
   Young  growing persons, persons at  the age of puberty,
persons  of weakly constitution, are incapable of supporting
much exertion of the eyes without injury to the sight.
   The eyes of children are often too much tried at school, 
            PRECAUTIONS IN READING, ETC.          31

and the ground is thus laid for future weak-sightedness of
different kinds.
  Reading and Writing.—In some cases, especially when
the health is  naturally good,  or care is taken of it, and
attention is  paid to  the  conditions under which the  sight
may be most safely exerted, the eyes, though  much tried,
whether by daylight or by artificial light, will continue to
stand exertion in reading and writing very well.  In many
cases, however,  continued reading  and  writing, especially
by  artificial light, proves very hurtful  to the sight, and
reading more  so than writing.
   When we have to read much, we should not read very
quickly.   Reading a novel is more fatiguing  to the sight
than reading a historical narrative or scientific work, because
in the former case we read faster;  whereas, in the  latter,
thinking  alternates  with the use of the eyes in  reading.
Reading from a broad page with the lines long and the print
small is very  tiresome, as it  is difficult  for the eye always
to take up the next  line.
   Writing  down one's  own  thoughts, or  to  dictation,
requires comparatively little exertion of the sight, not more
than to see to place  the words in proper  order  on the paper.
   Copying  is more  trying to the  eyes  than even reading,
as it is both reading  and writing and looking backward and
forward in addition.
   It is not  good to read or right at a flat table so that we
are compelled to stoop.   An elevated desk is better, espe-
cially one at which  the student stands.
   Reading  in bed  by daylight is injurious, but still more
so is reading in bed  by candle-light.   The  eyes are very
much strained.   The practice is especially prejudicial when 
32                DEFECTS OF SIGHT.
one is weak after illness.  Very obstinate  Asthenopy  or
weaksightedncss, with pain, in a lady, was brought on by
reading in bed during her confinement.
   It is very trying to the sight to read when driving in a
oarriage, or when walking, as, on account of the constant
motion, the eyes are compelled every moment suddenly to
alter their adjustments.  If there be sunshine, the circum-
stances are still  worse, for  at one time the page may  be
shaded by the body, and at another, in consequence of a
change of position, it may be brightly illuminated by the
light falling directly on it.
   In the  course of a  long journey it is better  to suffer
ennui than strain the eyes by reading.
   A distinguished mathematician, in an article  on printed
tables, expresses himself as " decidedly of opinion that the
substitution of dull and rather  dark paper for  the bright
and shining material now in general use, which dazzles the
eye  too  much,  is very  desirable.   Tables," he remarks,
" should not be  hot-pressed, and  not  even pressed at all.
The mischiefs  of pressure are twofold; first, the smooth
surface thereby created  makes the page a kind of mirror
which has a bright image in one place, whereas rough paper
dissipates the light equally in  all directions; secondly, the
other side of the leaf shows through much more  after pres-
sure than before.  It is also a mistake to suppose that great
blackness in the ink, combined with great whiteness in the
paper,  is favorable to  the reader.  Every increase of the
contrast, over and above what is necessary to perfect legi-
bility, is injurious to it; jet upon snow would in time destroy
the strongest eyes.  Of all the things meant to  be read, a
black monumental inscription  on white marble in  a bright 
PRECAUTIONS IN READING, ETC.          33
 light, is about the  most difficult.   One would suppose, to
 look at our specimens of extensive printing, that such an
 inscription was the  model which it was intended to imitate,
 and, if possible, to  surpass.  We are satisfied, after many
 trials and comparisons, that a dull paper, of a whitish-brown
 character, too thick to be seen through, and an ink which
 is of a dull brown  black, as it were,  the  deepest shade of
 the colour of the paper itself, are the  things which are per-
 manently agreeable  to most eyes.  Those who try it should
 remember that the  first page read  is not so good a test as
 the hundredth.
   " One of the most legible books we know of is the trade
 edition of Gibbon's  'Decline and Fall/ &c, in 12 vols., 8vo,
 London, 1820.   It  is considered by the booksellers  them-
 selves to be very badly executed.   Rut printers and pub-
 lishers  are too much in the habit of forgetting that a book
 is a book, and not a  line engraving.  They look at the page
 as a whole, and if the individual lines stand out and make
 their separate existences too perceptible, they pronounce it
 ugly.   Accordingly, the uglier they hold it to be, the more
 legible  the reader will pronounce it."*
   The  cautions above recommended to be observed for the
 preservation of the  sight in reading and writing, are in all
 respects applicable to sewing and other similar employments.
. Unfortunately, however, it often happens that workpeople
 cannot  help themselves, and their sight is sacrificed to the
 necessities of their circumstances.
  * Article " Table" in the  National Cyclopaedia of Useful Knowledge. London,
 Charles Knight, 1850. 
CHAPTER  III.
 DANGERS TO THE SIGHT TO BE PARTICULARLY GUARDED
                       AGAINST.

                  Injuries of the Eyes.
  Chemical or mechanical irritation of the  eyes excites
closure of the eyelids, and the discharge of a flood of tears.
If the irritation have been produced by a substance in the
state of vapor,  the eye  is,  in this way, protected from  its
further  action  and the  smarting soon subsides.   Strong
acid vapors,  however—of nitrous or hydrochloric acid—
may at once produce serious injury of the cornea.
  Particles of dust are sometimes washed out by the tears,
the discharge of which they have excited, or may be found
after  some  time lying  enveloped in mucus in the inner
corner of the eye, having been carried thither by the move-
ments of the eyelids and the stream of tears.  A  foreign
particle is very apt to adhere to the inner surface of the
upper eyelid, where  it causes great pain by being  pressed
against the surface of the eyeball.  On raising  and everting
the upper lid, the offending particle will be discovered, and
may be removed with a bit  of paper.  Foreign bodies with-
in the lower lid can be more easily detected and removed.
  Fmeign  particles  often adhere  to the front of the eye-
ball, generally the surface of the cornea.   This often hap-
pens to  workmen in various operations; ignited sparks call- 
INJURIES OF THE EYES.
35
ed fires projected against the eye sink into the substance of
the cornea.
  If the removal is effected soon, the distress is in general
relieved, or greatly mitigated.   Sometimes a sensation re-
mains  as if the body were still in the eye, owing to abra-
sion of the surface.  Lime is very fatal to the eye.  Slaked
lime less so than  quick  lime.   [One of the best applica-
tions when lime has been forced into the eyes, is  to apply
freely  a  solution of sugar.]
   Abrasion of the cornea  is  sometimes  produced  by a
scratch of  the finger nail or by awkward attempts to remove
a foreign body, or it is  the result of a stroke with a twig
or  an  ear  of corn, an accident to  which reapers are much
exposed. A severe form  of inflammation of the eye is often
excited  by such an abrasion.
    In passing through a wood, a rebounding twig is apt to
 strike the eye.   Even  a slight stroke will  sometimes oc-
 casion cataract or amaurosis.
    Though recovery from the  immediate  effects  of severe
 injury may take  place, the eye is  not yet quite safe, for
 after  some weeks an internal inflammation  may arise, not
 only of the injured but  also of the uninjured eye.
    This inflammation of the uninjured eye, called sympa-
 thetic ophthalmia, is very dangerous to the sight.  Sympa-
 thetic ophthalmia having proved  hitherto little amenable to
 treatment, the greatest  attention should be  paid to every
 case of ophthalmia  frem an injury, however slight appa-
 rently at  first, in the hope of  obviating an  attack.   And
 after  the  cessation of the inflammation in the injured eye,
  especial care should be taken by the  patient not to use
  either eye much  for a considerable time to come. 
36
DEFECTS OF 810HT.
   When  a foreign body has got  into  the  eye, prolonged
attempts to remove it by an incompetent person should not
be  permitted;  but the patient should forthwith obtain the
assistance of a surgeon.   In  general, the foreign body may
be at once discovered and removed with the  greatest case
and with little or no pain.  Scraping the cornea in attempts
to remove a particle adhering to its surface is, as above
mentioned, likely to excite a most dangerous inflammation
of the eye.
   Accidente often occur from arrows and other projectiles,
with which boys play, striking the eyes.   Such games should
be prohibited where people are passing to and fro.

  Prejudicial reaction  of certain states of  the  Body on
                        the Eyes.
  Suppression of the perspiratory action of the skin  is, as
is well known, very dangerous to the health in  general.  It
is so  likewise to the sight.   We ought, therefore, while
perspiring, to guard against being chilled.   The  state of
the skin, indeed, exerts as important an influence, for good
or evil,  on the eyes and sight as on any other  organ and
function of the body.
  Amaurosis [obscuration;  impairment or loss of vision
from  paralysis of  the  optic  nervous apparatus] has  been
brought on  by sudden  suppression  of perspiration  of the
feet,  and it is  not  at  all  uncommon  for  persons when
chilled to be seized with  a catarrhal or rheumatic ophthal-
mia.  If this occurs even to the healthiest, how much  more
readily  will the eyes be  affected when already predisposed
either by natural  delicacy,  by previous over-exertion, by
disordered digestion, &o. 
         REACTION OF ins liuuY ON THE EYES.       37

  In addition, therefore, to the great requisites for the pre-
servation of the health of the eyes, as well as of the body,
namely, wholesome and sufficient food (a person, it is to be
remembered, may eat too little as well  as too much,) with
temperance  in strong  drinks, regularity of the  bowels,
exercise in the open air, a due amount  of sleep (say eight
hours,) attention  to the state of the skin  is of the utmost
importance.
   Sponging  and  rubbing the skin daily are always most
beneficial, and when sufficient exercise in the open air can-
not be had they are indispensable.   Combined with proper
clothing,  flannel next  the  skin, and the outer garments
adapted to  the season, neither too thin in winter nor too
thick in summer, friction of the skin renders us less suscep-
tible to catarrhs,  rheumatism, &c.
  In  persons advanced in life, with eyes already in a state
of congestion,  a  chill  is apt suddenly  and dangerously to
affect the sight.   In such  persons also, if they have been
long  troubled with bleeding piles, the  suppression of the
discharge is to be carefully guarded  against,  as further
injury of the sight is very apt to follow.
   Again, when,  in consequence perhaps of costiveness,
there is already a disposition to determination of  blood  to
the head and eyes, the effort of straining at stool, especially
in the case of old persons,  is very apt  to aggravate it and
to injure the sight in various degrees even  to amaurotic
blindness.
   Here it  may  be observed, in regard to straining  at
stool, that in consequence of a swollen  and congested state
of the lower end of  the  rectum, which  often exists-  in
costiveness, the feeling  may be  occasioned as if there was
       4 
"8
DEFECTS OF SIGHT.
something to be expelled, when in reality there is nothing.
And so straining  is unnecessarily and  injuriously  persist-
ed in.
   In making great bodily efforts, the blood may be so de-
termined to  the head and eyes that the pressure occasioned
by the gorged blood-vessels on the retina will excite in  the
person the sensation as if light flashed from his eyes. And
it is to be remembered that if a first effort does  not produce
permanent  injury of sight, repeated efforts may.
   In  fits of sudden passion, blindness  is  apt  to be occa-
sioned by determination of blood to the  head and eyes.
   Exhaustion of the system  from prolonged suckling is a
not uncommon  cause of injury to the  sight.  So also great
loss of blood, venereal excesses, and the like.

        Ophthalmia, or Inflammation of the Eyes.

   The eyes arc apt to be very materially injured in their
structure by inflammation, and the sight  correspondingly
impaired or  destroyed.   The cornea  may be left more or
less opaque—the  pupil  closed or contracted—the retina
more  or less insensible to the impression of light.
   Without  having suffered such a degree of  injury,  the
eyes may, nevertheless, be left, by repeated  attacks of iu-
flammation, so  irritable as to be incapable of use.
   How important, therefore, is it  to prevent the occurrence
of  inflammation of the eyes,  or to cure  it speedily  when it
has occurred !
   The practical advantage of being  acquainted  with  the
causes of inflammation of the eyes, is to know how to avoid
them, and thus  to prevent the inflammation; or if they have 
INFLAMMATION OF THE EYES.
39
already produced inflammation, to know how to remove
them, if still in operation and removable.
  The causes of inflammation of the  eyes may be referred
to three heads, viz. : 1st.  Those which operate directly on
the eye; 2d. Diseases of other parts  with  which the eyes
sympathize, or which spread to the eyes;  3d.  States of
constitution and constitutional diseases which, though they
do not  necessarily determine inflammation of the eyes, at
least predispose  them to be affected by other causes, and
modify inflammations thereby excited.
   To the first head belong—injuries  of the eye;  exposure
to wind and cold;  direct action of very strong light, or of
this and strong heat together; over-exertion of the sight,
especially in bad light, either too weak or too strong, with
much stooping of the  head; the direct influence of acrid
vapors and contaminated air;  epidemic  or endemic  in-
fluences ; the direct application of contagious matter.
   These are all exciting causes, but some of them  require
 to  be assisted by other  causes, so that they operate partly
 as  predisposing causes also.
   To the  second head belong diseases of the skin; espe-
 cially  the  exanthematous  diseases,  as smallpox, measles,
 scarlet fever.
   To the third head belong  scrofula, rheumatism, gout, and
 syphilis.
   In the  treatment of  inflammation of the  eyes, the first
 points to be attended to by the patient (besides, as a mat-
 ter of course, the removal of the exciting cause, if still  in
 operation  and removable) are the protection  of the eyes
 from everything which  can cause or keep up irritation-
 such as using them or exposing them to strong light, and 
40
DEFECTS OF SIGHT.
the avoidance of whatever is calculated to operate injurious-
ly on  the  system  in  general,  such as exposure  to  the
weather, excessive corporeal exertion, errors of diet, \e.
   In  some inflammations of the eye there  is great intole-
rance of light; in other inflammations there  is little or
none  at all.  When the intolerance of light is great, Che
patient may be kept in darkness.  Rut  it is to be borne in
mind that long exclusion of the light renders  the eyes un-
duly  sensitive.   During  convalescence,  therefore,  even
though the cyv<. be still more or less impatient of the light,
the room occupied by the patient should not be quite dark-
ened.  It will  be  sufficient to moderate the light by the
blinds and curtains.   Under  such  circumstances, a blue,
green, or grey tint of the walls of the room best suits the
eyes.   Bright-colored objects  should be removed from the
room.

   Ise and abuse of Eye-waters, Soloes, and  lYarm and
              Cold Applications to the Eyes.

   It is a vulgar error, and a very serious one, to  suppose
that eye-waters or salves are the appropriate remedy for
every disease of the eyes, no matter of what kind.  In in-
ternal inflammations of the eyes, the  common irritating
eye-waters and salves are   both useless and  destructive;
aud this not only by the direct injury inflicted, but as lead-
ing to a neglect of the proper general  treatment.   In the
mere superficial inflammations, on the contrary, more good
is often effected by means of such applications than by any
other kind of remedy.
   There are two substances in very common use as ingre- 
PRECAUTIONS IN THE USE OF EYE WATERS.
41
dients of eye-waters, viz., sugar of lead and lunar caustic,
in regard to which a caution is necessary.
   A solution of sugar of lead is a popular eye-water, and
in certain cases it would be an useful enough  application,
if it had not the insuperable objection of leaving an opaque
white deposit on the surface of the cornea,  if abraded.
This bad  effect  may result  even from a single  application,
and cannot  be prevented.
   A solution of lunar caustic, again, dropped into the eye
is, in numerous cases, a most  valuable application, and, un-
like sugar of lead, is not  followed by any bad result if at
all judiciously  employed.  But,  it  often happens,  either
from carelessness or  ignorance, that  the application is mis-
used by being  persisted  in for a long time;  the effect of
which is, that the white of the eye  and  the inner surface
of the lower eyelid are  permanently dyed of  a dark olive
hue, or  actually black, whilst the inflammation,  for which
 the' remedy was  prescribed, is rendered  chronic  and
 incurable.
    [It has  been found that a solution of hyposulphite  of
 soda,  (gr.  x. ad si.) applied twice  a day by  means of an
 eye glass, will  remove the discoloration of the conjunctiva
 by the nitrate  of silver.]
    In applying  eye-waters, an eye-glass is not  to  be  recom-
 mended.   It is best to bathe the eyes simply by means of
 a bit of soft linen rag, taking care to let  the eye-water run
 into the eyes, and,  by  moving  the eyelids  upwards and
 downwards, to bring it freely into  contact with their  in.
 ner surface.
    Patients should not of their own  accord use any applica-
 tion to their eyes but water.  In  regard  to whether the
                             4* 
42
DEFECTS OF SKiHT.
water should be cold or warm, it is to be observed that, in
general, the ca>es in which cold water is best adapted are,
certain superficial inflammations,  floating  umsenc and va-
rious  irritable states of the eye; whilst, on tho  contrary,
in all internal inflammations  of  the eyes, \e., warm water
is preferable.   No precise rule, however, can be laid down
on the subject; but it maybe observed that, in general,
the feelings of  the patient constitute a good guide for the
choice.
   Cold spring-water is the best cold lotion.  It is applied
by means of compresses of old linen or lint, which should
be broad  enough to extend over the neighboring parts as
well  as over the eye,  but not  so heavy  as to  press un-
pleasantly.   When once commenced, the application of the
cold lotion  requir.es to be assiduously kept up as  long  as
is necessary, one compress  as soon  as it becomes warm,
being replaced by another just taken out of the water.
   The cold douche  bath consists  in a  fine stream of cold
spring water, allowed to play on the closed eye and neigh-
boring  parts.   Particular douche apparatuses are adver-
tised and puffed, but the jetting  of cold water on and into
the  eyes  is, after  all,  little better  than a mere bit of
trifling.
   In the weak and rheumy eyes of old persons, and in a
 similar state remaining after an attack of  ophthalmia, it is
 often agreeable, and, indeed, productive of great relief, oc-
 casionally to draw some cold body across the eyelids.  For
 this  purjio>e  a long slender bottle, with  a smooth round
 bottom, filled with ice, has been recommended.
   As warm applications to the eye, fomentations are much
 more convenient  and elegant  than  poultices.  Warm 
       PRECAUTIONS IN THE USE OF EYE-WATERS.     43

water simply may be used for the purpose, or chamomile
decoction, poppy decoction, and the like.  The application
is made by means of compresses, as just described for cold
lotions.  The application requires only to be  made occa-
sionally, and that merely for a period of from five minutes
to a quarter of an hour at a time.  Warm cataplasms and
fomentations should never be allowed to become cold on
the eyes.   After their removal, the  eyes  are to be gently
dried with a soft linen cloth, and care  taken that they be
not exposed to a draught of air.
  Warm have  the great advantage over cold  applications,
in that they leave the eyes, for some time after, pleasantly
cool and soothed;  whereas, if the cold application be inter-
mitted, the increased heat in the eye which supervenes is
most distressing.                       » 
PART II.
       DEFECTS OF SIGHT IN PARTICULAR

  The diseased state of  the eyeballs occasioning defective
sight may consist, either in derangement of the  dioptric
apparatus in front of the retina, or in an affection of the
retina itself, optic nerve, or brain.
  In some cases, the derangement of the dioptric appara-
tus occasioning  the defective sight complained of is very
evident, consisting of opacity of  the cornea,  obstruction of
the pupil, cataract, &c.  In other cases, there  is no defect
of the eye perceptible to simple examination.  Testing of
the  sight by  glasses, &c.,  is then  necessary to  ascertain
whether  or not the  defective sight  be owing  to  derange-
ment of the adjusting powers of the eye.
  When it has been determined by direct exploration of
the  eyes,  that the  defective sight does not  depend on
opacity of the cornea, obstruction of the pupil, cataract, or
the like,  nor, by the tests just referred to, on deranged ad-
justment, then there is reason to fear an amaurotic  affec-
tion, consisting in perverted, impaired, or lost sensibility,
from disease implicating the retina,  optic  nerve, or brain.
  There  are cases, it should be  observed, in which some
defect  both of the dioptric, and optic nervous apparatus
exists.
  But with eyes otherwise sound, there  are cases of  dis- 
DEFECTS OF SIGHT.
45
turbance of sight arising from loss of correspondence in the
direction and movements of the two eyeballs.
  Again, though there may be none of the defects above
mentioned, and  though the sight  may be in reality quite
good, it often happens that it cannot be properly exercised
in consequence of  some chronic inflammation or other dis-
ease of the accessory parts of the eyes, such as the eyelids
or lachrymal organs.
   These great classes of defective sight, though so different
in their  nature, are, in many of their kinds,  species, and
varieties, popularly  confounded under the common  name
of weak  sight. 
CHAPTER I.
DEFECTIVE SIGHT DEPENDING ON DERANGEMENT OF  THE
          DIOPTRIC APPARATUS OF THE EYES.

  The derangements of the dioptric apparatus of the eyes,
it has been  above  stated, consist, some in opacity of the
cornea,  obstruction  of the pupil,  cataract, and the  like,
whereby the light is interrupted in its passage to the  reti-
na ; others, in a want of adjustment.
  Of the defects occasioning interruption of the passage of
light to  the retina,  I pass over opacity of the cornea and
obstruction of the pupil, which are effects  of inflammation,
and can  be prevented only by preventing the occurrence of
inflammation,  or  by  quickly  curing  it, when  it   has
occurred.
  Here, I shall only speak of cataract—its nature,  its cure
by operation, and the question of  its prevention or treat-
ment without operation.

                        Cataract.
  Cataract is manifested by a grayness or  whiteness in the
pupil, which is naturally of a clear black,  and  consists in a
greater or less  opacity of the crystalline lens, whereby the
rays of light are, in a proportionate degree, intercepted on
their way to the retina.   The consequence is, that vision
is more or less impaired, or even  reduced to a perception
of light  and shade. 
CATARACT AT DIFFERENT PERIODS OF LIFE.
47
  Different  kinds of  cataract are  recognized  by surgeons,
and  the distinction of one from the other is a point of no
small importance, for on it  depends a correct conception
of the rise and progress of the disease, and, especially, the
discrimination of  the operative procedure best adapted to
effect a restoration of sight in a given case.
  Cataract, as above defined, is sometimes distinguished by
the  epithet true, into contradistinction  to what has  been
called false cataract, which  consists in opaque deposits of
lymph, matter, blood, &c, on the  crystalline body, ob-
structing the pupil—the consequence commonly of anterior
internal inflammation of the eye neglected or mistreated.
False cataract, however,  may be combined  with certain
kinds of true cataract.
   Relative frequency of Cataract at different periods of

 life.—
From  1 to 10 years
  "  11    20
  «  21    30
  "  31    40
  «  41    50
  »  51    60
  "  61    TO
  "  11 and  upwards
 14
 16
 18
 18
 51
102
172
109

500
  Lenticular cataract or opacity of the proper substance of
the crystalline lens constitutes the typical example of cata-
ract; and whilst it is the most common kind, it is fortu-
nately that  which  admits of the most  ready and perfect
cure
  In older persons, the  opaque lens is hard;  in younger

persons, soft. 
48                 DEFECTS OF SIC.IIT.
  Hard or Common Lent ictdar Cataract of old persons.
  From  fifty  years  old, and upwards,  is  the  age of  the
majority of persons, it will bo  seen from the above table,
who present themselves with cataract, and in them the cata-
ract is usually more or less harder than the lens naturally is.
  When the  cataract is pretty fully formed, every thing
right  before the patient generally appears to him as if ob-
scured by a thick cloud or gauze.   In bright light, which
causes the  pupil to contract, vision is still more indistinct;
in moderate dull light, which allows the pupil to dilate, it
is less so.   The  opposite of this, however, sometimes oc-
curs,  viz., that the patient  sees as well in a strong, as in a
dull light, sometimes  better.   Lastly, objects may not bo
seen at all; but vision may be reduced to a mere perception
of light and shade.
  The peculiarities in  the  state of vision now enumerated,
present themselves according  as the opacity is greater or
less in the  centre opposite the pupil, than at the circumfer-
ence of the lens, or as it is equally great in  the centre, and
at the circumference.
  When the pupil  is dilated  by belladonna,  or  its active
principle, atropia, vision  is still more decidedly improved,
as the dilatation produced is greater than that which takes
place in dull light.
  The dimness of sight and opacity in the pupil, in gener-
al, begin in a very unmarked manner, and increase slowly,
for  perhaps months  or years, until they have attained  the
degree above described.  Usually, one eye  is affected first,
and by and by the other.    In rarer cases, both eyes become
equally affected at the same time.
  Lenticular cataract of old people consists in a shriveling
of the fibres, and a granular state  of  the interfibrous mate- 
CATARACT OF OLD PERSONS.            49
rial of the proper substance of the lens.  It may be looked
upon in some degree as a natural change with the advance
of life, analogous to the hairs becoming gray or white.  But
there are some  circumstances  which  especially predispose
to the complaint, such as hereditary tendency, rheumatic
constitution, habitual exposure to strong fires, &c.
   When  once begun to form, it  may be  prognosticated,
that  the  opacity will go  on to increase until  all useful
 vision is prevented in the eye.   And it may also be prog-
 nosticated,  that  the  other eye,  if not already affected, will
become  so  likewise.   How rapid or how slow  the  pro-
 gress to loss of  useful vision may be, cannot, however, be
 prognosticated—it may be months, or it may be years.
   Restoration of vision can be "effected only by an opera-
 tion, by which  the opaque lens shall be  removed from its
 situation to below the level of  the pupil, (the operation of
 displacement,)  or  extracted from the eye altogether, (the
 operation of extraction.)   [In this city the operation by
 division  or absorption is  generally preferred, being well
 adapted to  the  removal of soft  or fluid cataract.]
    These operations  have for their common object the re-
 moval of the opaque body from behind the pupil, so that the
 rays of light may be again allowed to pass  on to the retina-
    To make up  for the loss  of  the crystalline  lens, the use
 of spectacles, with strong convex glasses,  is required after
 recovery from the operation.
    In cases fit for the operation, a successful result may be
 expected in a large majority.   Perhaps, out of twelve cases
 operated on, excellent sight may be recovered in eight, less
 good sight in  two or three, whilst  one or two will  prove
 unsuccessful.
         5 
50
DEFECTS OF SIGHT.
   When in one eye useful vision is lost, and in the other,
vision has become  dim from  cataract, it  is advisable to
operate as soon as possible on the  blind eye, in order, that
this may be fully recovered by  the time the opposite eye is
so blind as to require the operation.
   When in  an  elderly person, double lenticular cataract
has  become  so -far developed  as  to  interfere with useful
vision, the operation should  be had recourse to as soon as
possible, if extraction is the operation to be performed, for
there is more chance of a successful result  than at a later
period; if, on the contrary, displacement is to be performed,
the  operation may be delayed, if the patient prefers  it,
without disadvantage.
   When cataract is fully formed in both eyes, both may be
operated on at the same time, though it is better to operate
on one only at a time, if extraction, and on both, if displace-
ment, be the operation to be performed.
   The older surgeons laid great weight on what they called
ripe and unripe cataracts—that is, cataracts fit for operation,
and cataracts not yet fit.  And among  non-medical people
the distinction is still talked of.
   It was supposed that the opacity depended on the coagula-
tion of a fluid;  and until this process was judged to be
sufficiently advanced to permit  of the concretion beinf dis-
placed by the needle, the cataract was deemed unripe.  This
was an erroneous notion of' the nature of the disease; but
the practice recommended was  in some degree founded on
a pathological fact,  not however understood.
   The operation, in reference  to which the distinction  of
ripe and unripe was made,  was  couching orMeprcssing  the
cataract.  Now,  in the cataract of old people, when  the
opacity  of the lens is  fully formed, there is, at the  same 
OPERATION FOR CATARACT.
51
time, softening of the vitreous humor, and the connections
and  bands by which the lens is  held in its place are so
loosened, that it is easy with the cataract needle to depress
the lens, by tearing the loosened connections and bands,
into  the softened vitreous humor.
  In an early stage  of the cataract, the connections of the
lens  are  still firm and  the vitreous humor unsoftened, so
that  the  opaque lens does not admit of being  so  easily
depressed, and if forced down it is apt again to rise.   This
constitutes unripeness of the cataract.
   Ripeness and unripeness of the cataract has no bearing
on the operation of  extraction,  unless it be in a contrary
sense; for when the cataract is very ripe for couching, the
case is not very safe for extraction on account of the soft-
ened state of the vitreous humor; whereas, when the cata-
ract is as  yet unripe for couching, the eye is in the fittest
state for extraction.   Hence it is advisable, if the operation
of extraction is to be performed, to operate as soon as the
dimness of sight is such as to call for interference.
   Preparation  of the Patient for  undergoing an Operation
for  Cataract.—If the case be free from local or constitu-
tional complications, the patient requires no other prepara-
tion than a few days' rest of mind and body, some attention
to diet, and to the state of the bowels.   If, on the contrary,
any such  complications exist, he ought, before the operation
is undertaken, to be  subjected to such treatment as is adapted
either to remove them altogether, or to palliate them so far
as to remove or diminish the  risk of their interfering to
prevent the success of the operation.   The previous habits
of the patient as to  diet, the use of strong drinks, smoking,
&c, should be carefully considered.
   In very timid patients  chloroform may be occasionally 
52                DEFECTS OF SIGHT.

resorted  to, at least in operations with the needle.  [A
mixture of one part of pure chloroform with three or four
parts of sulphuric ether, is preferred to either chloroform
or sulphuric ether alone.]   The vomiting which  is apt to
supervene is a strong  objection  to its employment iu ex-
traction.
   Seasons of the year best  adapted for Operations for
Cataract.—Operations for cataract may be performed dur-
ing mild and steady  weather at  any  season; and such
weather  usually  occurs from March to the end of  October.
   Position of the Patient.—The  patient may either sit on
a chair,  or  lie extended on  a sofa or table  with  a pillow
under his head.
   In operating on the eye, it is of the  greatest moment to
have good light.  A window directed to the north should,
if possible, be chosen.  If there be more than one window
in the room, the others should have the curtains drawn.
   (opening and securing of the eyelids.—The patient, assis-
tant, and operator being in their places, the next  business
is to open and secure the eyelids.   The proper securing of
the eyelids is a most important point.   As some uneasiness
attends this, the patient is apt to flinch at it.  It  is, there-
fore, advisable  to accustom  the  patient to  the necessary
handling of the eyelids in opening and securing  them by
practising the  manipulation  daily for two  or  three days
before the operation,  the patient being at the same time
seated as it is proposed he should be at the time when  the
operation is actually performed.

                E.iIroelion of tlte Cataract.
   In the common hard lenticular cataract of old   persons,
the operation it  is most advisable to perform, when cireum- 
EXTRACTION OF CATARACT.            53
 stances admit of it, is extraction through an incision in the
 cornea.
   The operation is a nice and difficult, though not painful
 one, and for its success an otherwise healthy condition of
 the eye is of great importance.   Steadiness on the part of
 the patient during the operation diminishes to the surgeon
 the difficulties  attending  its performance, whilst after the
 operation, it is  calculated to promote the healing process,
 and to ward off the occurrence of such accidents as are apt
 to interfere with that process, and so mar success.   On the
 other hand, among the conditions unfavorable to, or wholly
 forbidding the performance of the operation, is restlessness
 on the part of the patient, chronic cough, and difficulty of
 breathing.
   When the case is one of common hard lenticular cataract,
 and when  the other conditions are favorable, the prognosis
 is good.   Recovery of the  eye from the effects of the opera-
 tion sometimes  takes  place in less than  three weeks; but
 not unfrequently some degree of external, or even anterior
 internal inflammation occurs, so that recovery is retarded.
 In general, convalescence should not be calculated on sooner
 than from four to six weeks.  Sometimes, although the case
 appeared to be in all  respects a proper one, and the opera-
 tion well and  successfully performed, the healing process
 does not proceed favorably, and sight is not restored.
   The operation having succeeded  as  an operation, more
 perfect vision is in general obtained after extraction than
after any other mode  of operating.
   The operation of  extracting a lenticular cataract, through
an incision in the cornea, may be viewed as comprehending
two principal steps, viz., 1st,  the section of the cornea} and,
                           5* 
i")4                 DEFECTS OF SIGHT.

2d, the laceration  of the  cajtsule, and extraction  of the
lens.
  The mode in which the section of the cornea is made, is
to pierce through the cornea on the  temporal side into the
anterior  chamber,  which constitutes the act of punctura-
tion ; then to push the point of the knife, the flat surfaces
of the blade being  to and from the  operator, through the
anterior chamber, across to the nasal side of the  cornea,
where the point of the  knife  is  again  made  to pierce
through the cornea from the anterior chamber, an act call-
ed counter-puncturation.  Ry now continuing to push the
knife onwards, it, by its increasing  breadth, cuts itself out
in the direction of the dotted  line (fig. p.  45) and so the
section of the cornea is  completed.  The section of the
cornea thus  comprehends three acts,  viz., puncturation,
counter-puncturation, and cutting out.
   In its natural state, the capsule, when punctured merely,
will readily tear and allow the lens to escape; and although
in lenticular cataract the same thing will often  happen, it
is proper not to trust to this, but to take pains to  lacerate
the anterior wall of the capsule freely.
   It often happens that  immediately on the laceration  of
the  capsule,  the lens begins to escape;  if it does so, the
surgeon at once proceeds to help it out; but if it does not,
the  eyt lids are allowed to fall together for a minute or  so
before the extraction is proceeded with.
   The lens having been extracted, the eyelids are  again al- 
EXTRACTION OF CATARACT.
55
lowed to close.   And, after a minute's rest to the patient,
the surgeon gently opens them to see if the iris  and flap of
the cornea are in their  proper  position.   If the iris and
pupil do not appear to be quite  right, the upper eyelid is
allowed to close, and is to be rubbed gently with the finger
over the front of  the eyeball, and then quickly opened to
the light, when the iris will contract,  and will thus,  along
with the pupil, be brought into a proper  situation.   This
being the case, and the flap of the cornea in accurate appo-
sition, the eyelids are to be closed, first the upper and then
the lower.
   After the operation, both eyes are to be kept closed, and
for this purpose a narrow strip of court plaster, extending
from the eyebrow to the cheek, is to be applied over the
 eyelids on each side; whilst  over all, is  placed  a shade
 composed of a fold  of soft linen, to which  is fixed a tape
 to tie round the head, thus,
  Another method of bandaging is, to lay over the  eyes,
when closed, a light fold of linen, and secure it by a band,
the middle of which is laid over the nape of the neck, and 
56
DEFECTS OF SIGHT.
the ends brought round over the eyes, crossed on the fore-
head, and pinned to each other behind.
   The  patient need not be put to bed  immediately after
the  operation, unless he desires it, but may recline on an
easy chair  or sofa,  until about his usual bed-time.  The
room should be somewhat darkened, and perfect quietness
observed in the house.   The  patient should refrain from
speaking, and endeavor to  keep himself as  composed as
possible.   His  food should be  so prepared as not to require
much chewing.
   At bed-time an  opiate  should not  be omitted,  if the
patient  is in the habit of  taking one to  procure sleep;  if
not  in  the habit,  an  opiate  is to be  given only  if the
patient be  restless.
   During  the night, the patient requires to be watched,
lest  by  turning in  bed or rubbing  the eye with his hand
while asleep, the eye should be injured.  A good precaution
is  to secure the patient's hands to his side, so far that they
may be prevented from being carried to the eye.
   The patient should not go to stool for the next day or
two  succeeding the operation, if this can be avoided.   If
not,  he ought to bear well  in mind to move with the great-
est caution, and that he must not make the slightest strain-
ing  effort.   Irremediable  injury to the eye,  by protrusion
of the iris, &c , has been the result of such  want of care.
After forty-eight hours some laxative medicine may be taken.
   The patient should lie on  bis back, or on the side oppo-
site that on which the operation has been performed, until
at least the third day, when, if matters go on well, he may
sit up in bed.   On  the fourth  day, he may be allowed to
get out of bed for a  few hours in the afternoon. 
EXTRACTION OF CATARACT.
57
  During the twenty-four or forty-eight hours succeeding
extraction, the patient feels as if he had received a  blow
on the eye, and also from time to time experiences a slight
smarting and pressing sensation, which is always relieved
when a watery fluid escapes from the eye.   From this and
encrusted Meibomian  secretion, the eye is to be from time
to time carefully cleansed with tepid water and a soft linen
rag.  The  eye is not to  be opened until the  third, fourth,
or fifth day, but that things are going on well may be in-
ferred if there is no pain, and the upper eyelid neither red
nor swollen.  On the third or fourth day, after the  bord-
ers  of the eyelids have  been cleansed  from any adherent
matter, by means of tepid water and a bit of soft lint, as
just mentioned, and the  strips of black court  plaster, if
they have been used, removed, the eye may be opened and
looked at, but closed again, and so  on from day to day, un-
til the ninth or tenth.   After that, the eyes being protect-
ed by a shade, the patient may freely open them.
  The corneal incision heals in the course of two or three
days, or even sooner, if  there is nothing  to prevent union
by the first intention, such as prolapse of the iris, with or
without prolapse of the vitreous body, or  non-apposition of
the edges of the incision.  The incision, when enlarged by
scissors, is apt not to heal completely by the first intention.
   Untoward occurrences during the operation.—Protrusion
of the iris may take place on the completion of  the section
of the cornea, and  again after the lens has been extracted.
But if uncomplicated with escape or protrusion of vitreous
humor, the protruded iris is in general easily replaced.  The
protrusion of the iris, which is apt to occur subsequently,
is much more to be dreaded. 
5*
DEFECTS OF SIGHT.
   When the vitreous body is of its natural consistence, and
its connections unweakened, as in  young persons, there is
little danger of its escape.  With the advance of age, how-
ever, softening of the vitreous body and its connections, as
above observed, tends to take place;  hence  it is that in  the
operation at present  under consideration, viz., extraction of
the common hard lenticular cataract of old persons, burst-
ing out of the vitreous humor, with or without the lens, is
apt to occur.
   In a case of bursting out  of the lens, together with a
greater or less quantity of vitreous humor  immediately on
completing the section of the cornea, the operation is com-
pleted, and whether  it  is likely to be followed by  a good or
bad result will, in a great measure, depend on the quantity
of vitreous humor lost.   If the quantity does  not exceed
one fourth, it is possible for the eye to recover with pretty
good vision; if more is lost,  such an event is not to be
hoped for.
   In any case, the mode of procedure is to close the eyelids
immediately, and leave things to nature.   Under the most
favorable circumstances, the wound  of  the cornea heals
slowly, and  the pupil  is  dislocated  towards the cicatrix.
Still, good vision may be restored.
   Should the vitreous  humor  begin to escape without the
lens, the small  hook is immediately to be introduced, and
the cataract hooked  by its lower edge, and brought out as
quickly as possible.
   Untoward occurrences after the operation.—Though the
cataract  have been extracted without accident, and  though
when the eye is bound up everything appears right, unto-
ward occurrences may yet take place.   Inflammation, Woth 
DISPLACEMENT OF CATARACT.
59
external and anterior-internal, acute or slow, may arise; in
either case impeding the union of the corneal incision and
disposing to protrusion of the iris.
  It has been above stated that protrusion of the iris is apt
to take  place at the time of the operation; but though such
has not  occurred, the eye is not yet safe from that accident,
for  in the course of the three  or four days following the
operation, the iris may yet protrude.  This secondary pro-
trusion  of the iris may be occasioned by some such effort
as straining at stool, or coughing, but it is generally owing
to non-union of the corneal incision, and swelling of the iris,
occasioned by supervening inflammation, or by extravasa-
tion of blood.
  Nothing should, in general,  be done  directly.   If the
protruded iris be large and appear to be much distended by
fluid behind, the propriety of puncturing it, or even snip-
ping it off, may come to be a  question. As the inflammation
subsides,  the protrusion sinks, and the iris will be involved
in the cicatrice of the cornea, which will be broad  and un-
sightly, whilst the  pupil will be displaced and contracted,
or altogether closed.  By and by, touching the protruded
iris once  a day or every  second day with the nitrate  of
silver pencil,  will  promote cicatrization.  This  may even
be done from the first, if, instead of  inflammation, there is
defective  action  in the part.

              Displacement of the Cataract.
  There are two modifications of the operation of displace-
ment, viz., couching or simple depression, and reclination.
In  the  one case the displaced lens  has its anterior surface
downwards and  somewhat forwards,—its posterior surface, 
60
DEFECTS OF SIGHT.
upwards and  somewhat  backwards,—its superior edge for-
wards and  somewhat  upwards,—its  lower  backwards  and
somewhat downwards, thus:
In the other case, the displaced lens has, at the same time
that it was depressed, been made to turn back on its lower
and outer margin, so that, its upper edge being forced back
into the vitreous humor, its  anterior surface comes to  be
uppermost, its posterior surface directed downwards, thus:
  Both couching and reclination of the cataract are usually
effected by introducing  the cataract-needle  through  the
sclerotica, that is, by sclerotic puncturation.
  Reclination effecting all that couching can, and being in
every respect a better  operation,  couching has altogether
fallen into disuse.
  The kind of cataract best fitted for displacement is the
same  as that best fitted for extiaction.  Whether or  not
therefore displacement  should  be performed instead of ex-
traction will depend upon the absence of the conditions 
        SOFT OR COMMON LENTICULAR CATARACT.      61

necessary for, or at least favorable to the successful per-
formance of extraction  or the existence of the conditions
unfavorable to, or wholly forbidding it.
  Tbe displaced lens, if disengaged from its capsule may
eventually disappear, or be reduced to a small size by solu-
tion and absorption, especially in persons of less advanced
age—say about  fifty—and when the cataract is not very
hard.  In many cases, however, it does not dissolve, and is
always apt to rise again.
   The light fold of linen, to hang  over both eyes, is suffi-
cient bandage. In other respects the same general manage-
ment is to be  adopted as above  recommended  after  ex-
traction.
   In the course of a few hours after the operation, vomit-
ing sometimes  occurs.   Reascension of  the lens may be
thereby occasioned.
   Acute internal inflammation of the eye is apt to be ex-
 cited by the operation.   Most frequently, however, the su-
 pervening inflammation is of a chronic character, ending in
 disorganization of the eye and loss of vision.

    Soft  or common lenticular  Cataract of young people.
   This  cataract is of the same consistence as that which is
 natural to the lens, or softer, and of a grayish white,  or
 milk and water opacity.
    Vision is diminished in proportion to the opacity, in a
 manner analogous to what is above described to be the case
 in hard cataract.
    The  occurrence of opacity of the lens in young persons
 is very much rarer  than in old persons.   It is  often met
 with as the result of injury.  In children  affected  with
         6 
62
DEFECTS OF SIGHT.
lenticular cataract, we are sometimes told that, tho opacity
made its appearance  after convulsions.  In other cases it
cannot be traced to any cause.  Frequently, it  is congeni-
tal.
   It is to be, remembered that this form of cataract is  not
unfrequently complicated with amaurosis.
   The kind of operation best adapted  for  the  removal of
soft  lenticular cataract is that by division, in order to its
solution and absorption.

                Division of the Cataract.
   The object  of this operation is to lacerate the capsule
and break up the lens, so  that the latter, being freely ex-
posed to the action  of the aqueous humor, may be gradual-
ly dissolved  and absorbed, and thus  altogether removed
from the eye.
   Considered as an  operation, division is the most simple
of all those for  cataract, both in  performance  and in  tho
extent of injury  necessarily inflicted on the  eye.
   In  the cases  proper for the operation, the prognosis is
good.  There is  in general little inflammatory re-action, but
though  the  lens may be  perfectly absorbed, the capsule,
which does not admit of solution and absorption, if  not al-
ready opaque  may become so, and  form  what  is called
secondary capsular cataract.   To  anticipate  this, the  an-
terior wall of the capsule should, during the first operation,
be as completely cut up as possible at the part correspond-
ing to the pupil.  The rapidity with which solution and
absorption go on varies from a few  days to several months.
In general it may be said that in  children  the  absorption
proceeds more quickly than in adults. 
SECONDARY CATARACT.
63
   One  operation may suffice; but, generally, solution pro-
ceeding slowly, the operation  requires to be repeated, and
that more than once.   This, as the operation is so simple
and painless, is no great objection.  The interval  between
the repetitions of the operation should be about six weeks.
   It is  best to operate on both eyes at the same time.  I
have observed that solution proceeds more quickly after the
operation on both eyes at the same time than after the ope-
ration on one eye only.   When the eye becomes inflamed,
solution appears to be arrested.
   If the retina was  previously quite sound, a perfect re-
storation of vision may be calculated on, if solution and ab-
sorption go on pretty quickly; if not, by the time the cata-
ract disappears, the  sensibility of  the retina may be  found
impaired.
   The  treatment after division is the  same in general as
after displacement,  except that the pupil is to be kept
dilated.

                  Secondary  Cataract.
   After the operation of extraction, some portion  of the
cataractous lens may remain obstructing the pupil, forming
what is called secondary lenticular cataract.  In such a
case no interference  is in general required, the lenticular
fragments being eventually absorbed.   The posterior strata
of the lens, both opaque  and firm, sometimes remain adhe-
ring to the posterior wall  of the capsule, and show little dis-
position to become absorbed.   In such  a case I have found
it necessary to have recourse to  the operation of division
some months after the  extraction had been performed.
   After the operation  of extraction of the lens, but espe- 
64
DEFECTS OF SIGHT.
cially after division, the capsule  is apt to become  opaque
and obstruct the  pupil.  This  forms secondary capsular
cataract.  The operative procedure for  secondary capsular
cataract depends on the particular circumstances of each
individual case.

Comparative advantages and disadvantages of Extraction,
              Displacement, and Division.
  By the operation of extraction, the cataract is removed
wholly and at once from the eye, and very good  vision re-
stored ;  but the  operation is a nice, if  not a very difficult
one, and liable to the  occurrence of the various  untoward
circumstances above  mentioned, by which its success may
be marred.
  The operation of displacement, which may be performed
in the same  cases as extraction, is  neither so nico  nor so
difficult  an operation, and  docs not expose the eye  to the
same immediate  risks;  the cataract is, indeed, apt to return
to its former place, but the  operation may be  repeated.
After displacement,  however,  though the operation may
have succeeded, and vision be restored, the  eye is not so
safe as after successful extraction;  but, as above mention-
ed,  is liable to become  affected with internal inflammation,
which may end in blindness.
  Extraction thus possesses a decided advantage over dis-
placement, and is therefore generally preferred, except when
the unfavorable complications, above mentioned, exist.
  The degree of softening of the vitreous  body requisite to
admit of safe displacement of  the lens is not so great as to
forbid extraction; but, of course, if in  the eases in which
the vitreous body is so much dissolved  that the  displaced 
         PALLIATIVE TREATMENT OF CATARACT.       65

lens is apt to float up again, displacement be contra-indicated,
extraction is much more so.
  All other things being equal, it might, perhaps, be laid
down as a general proposition that in the very eases  in
which displacement admits of being most readily and safely
performed, extraction is less safe, whilst, on the other hand,
in the cases in which, in consequence of the soundness of
the vitreous body, extraction is most safely and easily per-
formed, displacement is least so.
  As the cases for which division is best fitted are different
from those in which extraction or displacement is indicated,
there is no comparison to be made between them.

Palliative treatment of Cataract.   Can Cataract be cured
                 without an Operation ?
  In many  cases  cataractous patients have  their  sight
temporarily improved by dilating the pupil with belladonna
or atropia.  Some, however, are dazzled by this.   And in
some, though benefit is obtained, congestion of the eye is
induced.
  There have been, and there are at the present time, per-
sons who pretend  to cure cataract without an operation;
and witnesses to  their skill are not wanting, either in per-
sons who allege to have been themselves thus cured of cata-
ract, or in persons who aver that they are acquainted with
those who have been thus happily restored to sight.
   On the other  hand,  all medical men of reputation  and
experience in the treatment of the diseases of the eye, affirm
that they have never known a case in which true cataract,
when once formed, has been cured without operation, that
is, in which the lens, having once become opaque, has been
                           6* 
66
DEFECTS OF SIGHT.
again rendered transparent, or at least been removed, either
by the efforts of nature or by any kind of medical treatment.
  In corroboration of this, I have to add my testimony,
and at the same time declare my belief, that the allegations
that  cataract has been cured without an operation arc some
of them false, whilst  others are founded on  ignorance and
mistake as to the nature of the  eases treated  as cataract.
  Persons, by applying belladonna to the really cataractous
eye and thereby dilating the pupil, have improved the sight
for a time, and have called this curing cataract without an
operation.
  Another trick has been to puncture the eye and lacerate
the capsule with a fine needle without  the patient's know-
ledge, and to continue various applications, whilst all the time
the cataract  was disappearing by absorption in consequence
of the operation of division thus clandestinely performed.
  Again, specks of the  cornea  have been called cataract,
and  as these frequently admit  of being removed by treat-
ment, the case has been  put down as cataract cured.
  Lymph in the pupil from iritis  is known under the nrtmo
of false cataract.   Being removed by absorption, as it some-
times is, and the sight  improved, this  also  has  been put
down as cataract cured without operation.
  There are cases, again, in which the lens  may be really
somewhat opaque or cataractous, but not sufficient in itself
to interfere  very materially with  the  sight, and  in which,
from congestion of the eye, the  sight has become impaired.
Now, treatment in such cases often has the effect of remov-
ing the congestion, and thereby  improving the sight.  This
is then  held up as an indubitable  case of cataract cured
without an operation, whereas the  cataractous opacity of the 
PALLIATIVE TREATMENT OF CATARACT.      67
lens remains undiminished and will go on slowly to increase
as usual, and eventually obscure the sight in spite of all
treatment.
   There are other cases again in which there is an appear-
ance of dimness of the  lens, but not true cataractous dim-
ness, though it is liable  to be mistaken for such by medical
men not much  conversant with diseases of the eye.   Along
with this dimness in the pupil  there is impaired sight, not
from the dimness of the lens but from impaired sensibility
of the retina.   The sight in such  cases  being sometimes
capable of more or less temporary improvement by treat-
ment, such as counter-irritation, this improvement is  held
up as an example of the cure of cataract without operation.
In such cases, however, sight eventually becomes more and
more impaired, or actually lost.
   By a blow on the eye, the capsule  of  the  lens is  some-
times burst.  The immediate effect of this is cataract, but
gradually, by  the solvent  action of the aqueous humor, the
opaque lens is dissolved, and eventually removed by absorp-
tion.   The cataract is  in this  manner cured by the efforts
of nature, not, however, without an operation, for the injury
causing the capsule to burst was an operation—the same as
that which surgeons call the operation of division.  In short,
the injury  was at once both bane and antidote.
   It is thus evident, that there is full scope for imposition
in respect to  the curability of cataract without operation,
especially as there are so many people ready and willing to
believe in it,  and to believe  even still  more unfounded
pretensions. 
r.s
DEFECTS OK SIGHT.
    Mydriasis or simple fixed Dilatation if the Pupil.

  The pupil is, in ordinary light, of its medium size, which
is about one fifth of an inch in diameter.   Whcu the light
to which the eye is exposed  is strong, the pupil  becomes
contracted to a smaller size; but, on the contrary, when the
light is very dull, it is dilated to a larger size.
  Dilatation of the pupil, persisting in opposition  to  tho
influences to which the pupil is ordinarily obedient, some-
times occurs, unaccompanied by any other defect of sight
than may be accounted for by such a derangement  of  the
optical adjustment of the eye.
   That the case  is of this simple nature, and  not one of
that serious disease of the sight—amaurosis (of which dila-
tation of the pupil is a pretty common symptom,) is ascer-
tained  if the patient, on looking  through an aperture in a
card of less than the ordinary size of the pupil, is able to
see  objects quite distinctly.
  Not the less, however, should the patient take advice on
his  case, for the  dilatation is apt  to persist, and the sight
become more impaired.

Myopia,  or Short-sightedness. Presbyopia, or Far-sighted-
                       ness, etc.

  When the distance at which an ordinary sized type  can
be  read comfortably, is much less than twelve  inches,  the
vision is said to be myopic, or short;  when, on the contra-
ry,  it is much  greater, vision is said to be presbyopic, or
long.
  Preparatory to entering on an account of short-sighted-
ness and far-sightedness, it will be useful to make some ob- 
REFRACTION BY CONVERGENT LENSES.
69
servations on refraction  by convergent lenses, and on the
adjustment of the eye to different distances.

Refraction  by convergent lenses  and the  adjustment of
              the eye to different distances.
   The rays of light from very distant objects, though not
strictly parallel, are usually assumed to be  so.  The focus
to which  such rays are  brought by a convergent lens, is
called the principal focus of the lens.
   If rays do  not come from  such a  distant body as to be
parallel, but are more or less  divergent, then the  focus to
which they are brought by the lens, is farther off from the
lens  than its principal focus, viz., at some point between
this  and  infinite distance.  This point is nearer  the prin-
cipal focus the more distant the body whence the rays em-
anated ; in other words, the more nearly parallel  they are,
and vice versa.
   The point  of an object from which any given pencil of
 divergent rays  emanates, is  named the focus of incident
 rays, and the focus to which  these divergent incident rays
 are brought  by the lens is named the  focus of refracted
 rays.  These two foci, the focus of incident rays, and the
 focus of  refracted rays, in consequence of the relation be-
 tween  them above pointed out, viz., that when the one is
 near, the other is distant from the lens, are named conju-
 gate foci.
    From  this  it will be perceived, that if the refractive me-
 dia of the eye were incapable of change, either as regards-
 power, or as  regards  their relative position to the  retina,
 the  rays of light from  objects  at  one particular distance
 only, would  be collected into  foci  on  the retina.  Rays 
70
DEFECTS OF SIGHT.
from objects farther from the eye than that distance would
come  to foci,  before arriving at the retina,  and  having
crossed, would fall in a scattered state on the retina, or, as
it  is called, in circles of dissipation.   Hays  from  objects
nearer would  not come  to foci, except behind the  retina,
on which  therefore they would  fall likewise in a scattered
state (see figs. pp. 72 and 78.)
  The result  of this would be, that objects could bo seen
perfectly  distinctly  only when  situated at one particular
distance  from the eye.   But we know that this is not the
case.   We know that we can see objects perfectly distinct-
ly at different distances, within  certain limits.   Ilencc the
eye must admit of adjustment  to  different  distances, like
our optical instruments.
  Here the distinction is to be explained between  perfect
and distinct  vision.  In perfect vision, the outline, color,
and details of the object appear traced with the utmost ac-
curacy, clearness, and  strength; and this we have only
when the rays of light are brought accurately to foci  on the
retina.  In distinct vision, larger objects  are seen so well,
that they are  readily recognized; the title-page of a book,
for example, is easily read, but there is a want of clearness
of outline and strength of tint, and small objects or the de-
tails of large objects are very imperfectly  reeogni/ed ; this
is owing to the rays of  light not falling  on the  retina in
exact foci, but in small circles of dissipation.
  The limits within which  the  eye  can  see perfectly dis-
tinctly at different  distances, in  other words, the limits of
perfect  vision, varies  somewhat in different persons,  and
even in the two eyes of the same  person; but in  general
they may be put down at between  nine and fifteen inches. 
SHORT-SIGHTEDNESS.
71
For some distance below nine, or above fifteen inches, the
vision may be still distinct, but not perfect.
  Though there can be no doubt that the eye is capable of
adjustment  for vision at different distances, the  means by
which this is effected have not been unequivocally demon-
strated;  still, as the  power of adjustment is lost with the
crystalline body, it  is very probable that it depends  on a
change  in the position  and form of the lens.   By a  very
slight movement of  the lens forward,  and a very slight in-
crease of its curvature, the eye could be adjusted  for near
distances, and vice versa.
  When  the eye is  adjusted for near objects, the- pupil is
contracted,  and the  axes of the eyeballs converged,  and
vice versa ; but these variations in the size of the pupil and
direction of the eyeballs,  are merely a concomitant  and
auxiliary, not an essential condition.
  With a contracted pupil,  or by looking through a small
aperture, a presbyopic eye can see near objects, and a my-
opic eye, distant objects more distinctly.   This is owing to
the exclusion of the extreme circumferential rays of the
cones of light which enter  the  eye,  and the consequent
diminution of the circles of dissipation on the retina.

                    Short-sightedness.
  This  is that state of  vision in which the person can see
objects  perfectly distinctly  only when they are  at shorter
distances from the eyes, than the average above stated.- ^
  It is owing either to too great power of the refractive
media of the eye, or to the distance  of the retina behind
the crystalline being too great;  so that in either case, the
rays of  light come to a focus before arriving at the retina, 
DEFECTS OF SIGnT.
cross  and are in a state of dissipation, when they do  im-
pinge on that nervous membrane, and therefore  form indis-
tinct and confused images.
 a, Foen* of incident rays; 6, focus of refracted rays falling in front of tho
retina; c, the rays Impinging on the retina, In a scattered state.

   By bringing the object near, it is distinctly seen, because
the rays of light from it, which enter the eyes, being now
more divergent than when it was  distant, arc  not so soon
brought to a focus; in other words, the  different points of
the object, as foci of incident rays, and  the foci to which
these rays are brought in the interior of the eye  by the re-
fractive media, are  conjugate foci, and  accordingly, when
the foci of incident rays are brought nearer the  refractive
media, the foci of refracted rays recede from them.
   Too  great a refractive  power of tho  media of the eye,
may be owing either to too great convexity of their curva-
tures,—the curvatures of the cornea and crystalline,—or
too great  refractive density, or  both conjointly.
   The situation of the retina at too great a distance behind
the crystalline body, may be owing cither to a preternatu-
ral elongation of the axis of the eyeball, or to the  lens
being nearer the cornea than usual.
   In short-sightedness, the power of adjusting  the  eye to
different  distances,  is  still  retained, but within certain 
                  SHORT-SIGHTEDNESS.               73

limits, thus, the nearest  distance may be from two to four
inches, the furthest, from six to twelve.
  In  many cases, there  are no peculiar appearances pre-
sented by the eyes of myopic persons; but frequently the
eyes are  prominent and  firm, the cornea very convex, the
anterior chamber deep, and the pupil dilated.
  Short-sighted people see small objects  more distinctly
than other people, because from their nearness the objects
are viewed under a larger visual angle.
  They see them  also with a weaker light, because the ob-
jects being  near, a greater quantity of rays from them ar-
rive at the eye.  Hence, they can read small print with a
weak light.
  But they  can also see more distinctly, and somewhat
further off by a strong light than by a weaker one, because
the pupil is contracted by the strong light, and all but the
more direct rays of light thereby excluded.  On the same
principle they see at  some distance distinctly through a
pinhole in a card; and when they try to  view distant ob-
jects, they half close their eyelids.  The rays of light in
these cases  have their divergence at the  same time some-
what increased by diffraction.
  They sometimes see  objects beyond the limits of their
distinct vision, double, or even multiplied.
  Short-sightedness seldom occurs in so great a degree be-
fore puberty as to be troublesome; when in a great  degree
in children  it may be a symptom of central cataract. After
puberty, when the eyes come to be used in earnest, this de-
fect of sight is usually first discovered to exist, and  it may
go  on gradually increasing, especially if the person uses his
eyes  much in reading, and on minute objects; hence, the
       7 
71                DEFECTS OF SIGHT.
greater frequency of short-sightedness among the educated
classes, and those whose occupation  is with minute work.
Myopia docs not always  diminish with years.   We meet
with persons of the most advanced  ago who still find it ne-
cessary to  use glasses as deeply concave,  as  they did in
youth, if not more so.   Nay, short-sightedness sometimes
occurs in old persons, whose vision was previously good for
ordinary distances.
  The true or optical short-sightedness under consideration,
requires  to  be distinguished from  that  short-sightedness
which depends on defective  sensibility of the retina.   In
this latter  form, which may  be named nervous short-sight-
edness, although objects are seen  better near at hand, they
are not seen distinctly, as in true short-sightedness; and
help is obtained from convex instead of concave glasses.
  In  nervous short-sightedness near objects are, as above
said, seen better, because  more light being received into
the eye from them, a stronger impression is made on  the
retina.   ()u  the same principle,  convex glasses help the
sight, and that for distant as well as near  objects, by con-
centrating the light.   On the same principle also, well illu-
minated objects are seen better.
  An analogous form of short-sightedness is occasioned by
impaired transparency of the lens.
  To persons whose occupation is- with  minute objects,
short-sightedness, unless in a very great degree,  is rather
an advantage, as they are enabled to observe all the details
of their work very accurately ; and  in the ordinary exercise
of vision, the use of concave glasses is a ready and simple
help.
  When a  tendency to short-sightedness manifests itself 
SHORT-SIGHTEDNESS.
75
in youth, and  especially if the  future  occupation  of the
person is to be of a kind requiring good vision  for dis-
tant objects, .much  exertion of the eyes on minute work
should be  avoided, and the  eyes frequently exercised on
scenes in the open country.
  Concave glasses help the vision of short-sighted persons
for  distant objects, simply by increasing the divergence of
the rays  of light before they enter the  eye, so that  they
may be  less speedily  brought to foci  than  they would
otherwise be, in consequence of the increased refractive
power of the media of the eye; or, supposing the refractive
power of the media, of  the eye not increased, but the dis-
tance of the retina behind the  lens increased, that  they
may be brought to  foci at a  greater distance behind the
lens than they  would otherwise be, in order to correspond
with the greater distance of the retina behind  the lens.
  Concave  glasses are made of different degrees  of con-
cavity, the shallower being those adapted for  the slighter
degrees of  short-sightedness,  the  more  concave for  the
greater degrees.
  When very short-sighted, a person requires to use con-
cave glasses, not only to be enabled to see distant objects,
but also  for reading with, in  order  to avoid the necessity
of stooping.  For the latter purpose  shallower  glasses
suffice.   Less short-sighted people  use  glasses only to be
enabled to  see distant objects.
  The focal length of the concave glass which a  person
will require to  see objects at more than two or three  hun-
dred yards distance, should be about equal to the distance
at which he can see to read  distinctly an  ordinary  type
with the naked  eye,—six inches for example. 
76
DEFECTS OF SIGHT.
  The focal  length of the concave glass  which  a very
short-sighted person will require to sec to  read with  at a
convenient distance, is determined thus:—Suppose he sees
to read with the naked eye at the distance of six inches,
and desires to be able to read at the distance of twelve, the
one distance is to be multiplied by the other, and the pro-
duct seventy-two, divided by the difference between tho two
distances, viz., six.   The quotient  twelve, is the number of
inches the focal  length of the glass required should be.
  But when a person finds it necessary to have recourso to
glasses for short-sightedness, he should go  to an  optician,
aud select two or three pairs which appear to assist his vis-
ion best;  or send for two or three pairs of about  the focal
length, which according to the above calculation he thinks
will suit him, and try  them leisurely at home for a  day or
two before fixing his choice on one particular pair.
  The following are the circumstances which should guide
him in his choice—
  The glasses should  be of the lowest power which will
enable him to distinguish objects as he wishes, quite readi-
ly and clearly, and at  the same time comfortably   If  they
should make objects appear small and  very bright, and if
in using them the person feel his eyes strained and fatigued,
or if he becomes dizzy, aud if after putting them aside tho
vision is very confused, they are not fit for his purpose—
they are too concave.
   naviu'_r once  fitted  himself, a  person  should not  too
hastily change his glasses, although they may appear not to
enable him  to see quite so clearly as when ho first began
to use them.
   A glass to each eye should always be employed; vision
is by this clearer, and  its exercise  less fatiguing than when 
FAR-SIGHTEDNESS.
77
a glass to one eye only is used.   The use of a glass to one
eye only is, in fact, very detrimental, especially to the
opposite  eye.
  When, as is  sometimes the case,  the eyelids of short-
sighted people are tender and irritable, the sight should not
be much used in reading  or sewing.   In  such cases, it is
useful occasionally to bathe the eye-brows and temples with
some  cooling lotion.

                    Far-sightedness.
  With  this state of vision the person can see objects dis-
tinctly only when they  are at a very considerable distance
from  the eyes;  in reading, for example, he holds the book
at arm's length.
  Far-sightedness being in almost all respects the converse
of short-sightedness, the best way of discussing it here will
be  simply to reverse  the account above  given  of  short-
sightedness, and which will therefore stand thus*—
   Far-sightedness is owing  either to diminished power of
the refractive media of the eyes, or to the distance of the
retina behind the  crystalline body being too short;  so that
in either case the rays  of light tend to come to a focus at a
point behind the retina, on which therefore they  impinge in
a scattered state, and form indistinct and  confused images.
   By removing the object  from the eyes, it comes to be
distinctly seen, because the  rays from  it which enter the
eye,  being  now less divergent than when  it was near, are
more quickly brought  to a focus; in other words, the dif-
ferent points of the object as foci of incident rays, and the
foci to which these  rays are brought by the  refractive me-
dia are  conjugate foci; and accordingly,  when  the  foci of
                            7* 
7S                 DEFECTS OF SIGHT.
incident  rays are removed from  the  refractive media,
foci of refracted rays come nearer them.
 a, Focus of incident rays; 6, focus of refracted rays falling behind the rotlna ;
e, the rays in a scattered state, as they Impinge on the retlua.
   Diminished refractive power of the media of the eye  may
be owing to diminution of the convexity of their curvatures,
such as flattening of the cornea and crystalline.   As to re-
fractive density, there is probably an increase rather than a
diminution of it, but  this appears to be  moro than  over-
balanced by the diminution of curvature.
   The situation of the retina too near the crystalline may
be owing either to a preternatural shortening of the axis of
the c) i ball or a receding of the lens from the cornea.
   In far-sightedness,  the  power  of adjusting the eye to
different  distances is  much  weakened.   In  this respect
far-sightedness differs from short-sightedness, in which the
power of adjustment is still retained.   In  far-sightedness it
may be said that the habitual adjustment of the eye is for
distant objects, and that in trying to read, for example, the
power of adjustment  is exerted to the utmost, hence the
fatigue and confusion of vision which soon ensue.
   In many cases there is nothing  peculiar to be  observed
in the eyes of far-sighted people; but frequently the  eyes
are  sunk, the  cornea flat, and of small diameter, and the
pupil contracted. 
FAR-SIGHTEDNESS.
79
  Far-sighted people see small objects indistinctly at every
distance, because when near, they are out of focus,  and
when removed from the eye somewhat, they are  seen  at a
small visual angle and with little light.   By increasing the
light, they see  better.   Hence,  they do not see so well by
candle-light as before,  and when attempting  to  read by
candle-light, they place the candle perhaps between them
and the book held at arm's length.
  Large and distant objects they see-very distinctly.
  Far-sightedness seldom  occurs  except in persons  who
have passed middle age, and in  them it is so common,  that
it is to  be viewed as a  natural  change  in the  state of the
eye.  As it occurs in young  persons, it will be  spoken of
under the head of Asthenopy.
   Though  instances have occurred of persons who have
been long  presbyopic, recovering  their former vision, and
thereby being  enabled  to lay aside the use of their specta-
cles,  recovery from long-sightedness is not to be calculated
on, but this is of comparatively small moment, as  vision
can be  so perfectly assisted by means of spectacles.
   Something,  however, may be done in the  way of pre-
serving the sight by avoiding over-exertion of the eyes in
reading and other minute  work, especially  by artificial
light, at the time of life when  far-sightedness, with dimi-
nution  of adjusting power, usually comes on.
   As soon  as the eyes  begin to feel hot and  fatigued, we
should  take warning, and give them rest, by looking  off
the work before us.   A person, when he does find himself
to have become far-sighted, and  compelled to use spectacles,
should  still refrain as much as possible from exertion of his
vision by artificial light.
   Convex glasses help the vision of far-sighted  people for 
80                 DEFECTS OF SIGHT.
  near objects, by causing  convergence of the rays of  light
  before they enter the eye, so that they may be more speed-
  ily brought to foci than they would otherwise be, in conse-
  quence of the diminished refractive power of the eye ; or,
  supposing the refractive  power of  the eye not diminished,
  but the distance of the retina  behind the lens diminished,
  that they may be brought to foci at a less distance behind
  the lens,  than they would otherwise be, in order to corres-
  pond with the diminished distance of the retina  behind the
  lens.
    Presbyopic persons,  at  the same  time, that they have lost
  the power of adjustment  for near objects, may be somewhat
  cataractous,  or have their retina impaired in  sensibility.  In
xsuch cases, convex glasses, besides remedying the defective
  adjustment,  are of use by concentrating the light.
    Convex glasses are made of different degrees of convexity.
  The least convex being  those adapted for the slighter degrees
  of far-sightedness, the  more convex for the greater degrees.
    To see distant objects, far-sighted persons do not  in
  general  require  convex  glasses.   It is most commonly to
  enable them to read  and do  minute  work  that they use
  spectacles.
    If it is only at a very great distance that a person can
  see distinctly, the focal  length of the convex glass which
  he will require to enable  him  to read will be equal to the
  distance at which he wishes to  see to read.  [This paragraph
  will not apply to persons from 05 years and  upwards.]
    If he is not so very far-sighted, but can  see small objects
  distinctly at twenty inches distance, for example, the  focal
  lpngth of the  convex glasses, which  he will  require  to
  enable him to read at twelve inches distance, is determined
  by  multiplying the two  distances together,  and dividing 
FAR-SIGHTEDNESS.
81
the product, 240, by the-difference between them, viz., 8.
The quotient 30, is the focal length in inches of the glass-
es required.
   But when a person finds it necessary to have recourse to
glasses for far-sightedness, he should go to an optician, and
select two or three pairs which appear to  assist his vision
best, or send for two  or three of about the  focal length,
which, according to the above  calculation, he thinks will
suit him, and try them leisurely at home for a day or two,
before fixing his choice on one  particular pair.
   The following are the circumstances which should guide
him in his  choice:—The glasses  should be of the lowest
power which will enable him  to see  objects distinctly at
the distance he wishes, and  at the same time comfortably.
Glasses which make the objects appear larger  than natural,
and strain and fatigue the eyes  and cause headache, are not
adapted to his case,—they are  too convex.   It is  usually
found that glasses the  next  degree more convex than those
which suit by daylight, are required for work by artificial
light.
   The alteration in the eye on which  the far-sightedness
depends, generally goes on  to  increase with age, hence, it
is  necessary, after  a time,—a  few years,—to change  the
glasses first  chosen for others more convex.   In regard to
this exchange it is to be observed, that it ought not to be
too hastily had  recourse to, nor, on the  other  hand,  too
long delayed.  The same feeling of necessity which first
prompted to the use of glasses, will indicate  the necessity
of change.
   It is a not uncommon notion that glasses of certain focal
lengths  are  adapted to certain  ages, but this is erroneous.
Still, though the choice of glasses cannot be determined by 
S2
DETECTS OF SIGHT.
the mere age of  the person, Unue is a  certain  average
relation between the age aud the focal length of the convex
glass required, which may be expressed as follows:
Age in  years  .   .  40, 45, 50, 55, CO, 65, 70, 75, 80, 85, 90, 100
Focal length in inches 36, 30, 2-4, 20, 16, 14, 12, 10,  9, 8,  7.
   [We more  commonly commence with  glasses of  forty-
eight inches focal distance  at the age  of 40 to  45, aud
progress in the same ratio.]
   Glasses of a low power are  popularly called preservers,
and are sometimes had recourse to without  any necessity,
as if  they possessed  some specific quality preservative of
the sight.  The truth is, to good  eyes they  will prove not
preservers but depravers.
   Reading  glass.—This is  a double convex lens,  broad
enough to permit  both  eyes  to sec through it.   It is used
for the purpose of magnifying the object,—the names on
maps,  or the  like,—whereas,  convex spectacles are  used
merely to render objects distinct at a given distance, with-
out magnifying them as above mentioned.
                    Cataract Glasses.
   The  difference in  refractive power between the air  and
the cornea, being much greater than between  the  aqueous
humor and crystalline  body,  the greatest amount  of  re-
fraction which the  rays  of  light undergo  in the eye, in
order that they may converge  to  foci on the retina, is that
effected by the  cornea on their first entrance.  The crys-
talline  body contributes comparatively little  to the con-
vergency.   Hence,  vision after a  successful operation  for
cataract, may be tolerably distinct for objects at a certain
distance.  Still, in order, that it  may ha perfectly  distinct,
the use of convex glasses is required. 
CYLINDRICAL EYE.
83
  But as with the loss of the crystalline body, there is
loss of the faculty of the eye to adjust itself for different
distances, except  so far as  variations in the size  of the
pupil contribute to this effect, glasses of different degrees
of convexity are required according as the patient  wishes
to view  near or distant objects.   Thus, convex lenses of
two  and a half inches focus  are generally required for
reading, and  lenses of four and a half  inches focus for
viewing objects around him. [Lenses of three to three and
a half  inches focus  for viewing objects near him,  and
for distant objects four to four and a half inches.]
   Of course  before fixing on  any particular powers, the
patient will  try which suit him best, and the test which
should  guide him  in his  choice is, that when the  specta-
cles are put on, or, if hand-glasses, when they are held im-
mediately before the eyes, he sees objects distinctly at the
same distance  as  he  saw them before he  became blind.
[Hand glasses as a general rule are  objectionable, particu-
larly for cataract cases  such glasses should always be placed
before the eyes in  spectacle frames.]
   Kecourse  is not to be had to the use of cataract glasses
until the eyes have perfectly recovered from the operation,
 and have been so for some time,—say six months.

                     Cylindrical Eye.
   Cases are  met with  in which the rays of light in enter-
 ing the eye  are refracted to  a nearer focus in a  vertical
 than in a horizontal plane.  This would take place, if the
 cornea, instead of being  a surface of revolution, in which
 the curvature of all its sections through the axis  must be
 equal, were of some other form, in which the  curvature in
 a vertical plane is greater than in a horizontal.   This  is, 
84
DEFECTS OF SIGHT.
in fact, the natural form of the cornea, but in the instances
referred to, existing, perhaps, in  an exaggerated degreo ho
as to disturb vision.
   With such uunatural  conformation of the eye, a point
appears a line of a certain length; a circle an oval;  every
thing being seen elongated in one direction.   The cylindri-
cal deformation has been met with oblique, so that a square
appeared a parallelogram.
   The defect is  remedied by glasses which, to the healthy
eye, would make a line of the same length appear a point,
—which would, in fact, shorten all objects in the samo de-
gree and in the same direction, as they arc lengthened by
the defective eye.*  [Several cases  of  cylindricity have
been  known  to  opticians in  this country, and  have been
satisfactorily  relieved by glasses of the above kind.]
   Each ease of cylindrical eye being thus more or less pe-
culiar, lenses  must be specially prepared for it;  and it is
evident that this demands both skill and intelligence on the
part of the optician.  The general principle on which  the
glass is shaped,  Mr. Ross informs me, is this:  one side of
the lens is made a portion of a cylinder, of the same diam-
eter as the  cylinder cornea, having its  axis, however, placed
at right angles to that of the latter.   Tho other side of the
lens is made plane, convex, or concave, to suit the condi-
tion of the eye irrespective of its  cylindricity.

                    Conical  Cornea.
   Defective sight sometimes occurs, in consequence of the
cornea gradually becoming so prominent  in the  middle, as
to be of a conical  shape.   Short-sightedness first attracts
 * " On the Uas and Abuse of Spectacle*," by Andrew HohH, optician, London. 
            CHROMATIC OR COLORED VISION.          85

attention, and by and by vision becomes very indistinct at
any distance.   This is owing to the irregular refraction of
the light.  Deep concave glasses afford some assistance to
vision; but only in the slighter degrees of the complaint.

              Loss of power of adjustment.
   The eye may  fall  into a  state  in  which the vision is
neither myopic nor presbyopic, and in which the power of
accommodation being lost, convex  glasses are  required to
see near objects,  and concave glasses to see distant objects.

               Chromatic or colored Vision.
   The colored vision to be noticed here must be distinguish-
ed from that dependent on subjective excitement  of the
retina to be considered below.
   Although the  eye, strictly speaking, may not be perfect-
ly achromatic, it is so in the healthy state  to all intents
and purposes; but  in certain morbid states, its optical parts
may become so suffused and deranged as  to decompose the
light, and make objects appear as if surrounded by the
colors of the rainbow, thus :
   1st. In catarrhal inflammation  of the eye, films of mu-
cus suffusing  the cornea give rise to the  appearance of iri-
descence around objects.
   2d.  When  there is defective adjustment of the eye, and
when, consequently,  the rays of light do  not fall in  foci on
the retina, vision, at  the same time that it is thus rendered
indistinct, and even multiplied, may appear  slightly irides-
cent.  Hence iridescence around objects is  seen when the
adjusting power  of the eye  is disturbed by passion,  mental
abstraction, sleepiness, the  action of belladonna, mydriasis.
        8 
Mi
DEFECTS OF SIGHT.
Hence  also, persons who have one eye  myopic and  the
other presbyopic, often  see colors  when  tlity look at very
near or very distant objects with both eyes, because one eye
only is  adjusted to the distance of  the object.

Diplopy or double vision, and Polyopy <n- manij'old vision
                      tvith one eye.
   In  consequence, probablv, of the refractive media of the
eye not having perfectly regular curves, double  vision and
manifold  vision with one eye occur,  as just mentioned,
when the eye is not adjusted to the distance of the object
looked at; hence  short-sighted people  see distant objects,
and far-sighted people  near  objects, double  or  multiplied
with one eye as well as iridescent.
   But vision of one eye may be double or multiplied inde-
pendently of defective power of adjustment to distance, in
consequence of partial opacity of the cornea,  or, more gen-
erally, partial  opacity  of  the lens  or  its  capsule.  Tho
action of these morbid states is well  illustrated by Schemer's
experiment, which consists in  looking  at a pin, for  exam-
ple, through two pinholes in  a  card, placed  so close to each
other as to  be  included within a circle  not exceeding  the
pupil  in diameter.   The pin appears double, except when
held at  a certain  distance—that of perfect  vision with  the
naked eye.

  Astheuopy, or incnjiocity to leap  the eyes jlxed Oil hear
                        objects.
   An incapacity  to exercise vision  on  near objects, as in
reading, sewing, and the like,, for any length of time.  The
patient  is able  at fir.st  to see to read quite distinctly, but 
ASTHENOPY.
87
the vision soon  grows confused.   The words appearing  as
if mixed together.  The eyes, at the same time, become
tired and painful—the pain extending to the head.
   If the eyes are  closed, and rest given to them for a few
minutes, vision may be  again  exercised, but  in a  short
time the eyes will become fatigued and the vision confused
as before.
   Vision for distant objects  is not disturbed, and by the
use of convex glasses the exercise of sight on near objects
may be much assisted.
   Asthenopy commences  in childhood or  youth, and  may
continue throughout life; but it is seldom met with origi-
nating in middle age.
   The subjects of the affection often,  but by no means
always, labor under  general  nervous debility—the result
sometimes of general disease.
   There is often no evident cause.   A very frequent cause
is pure over-exertion of the  eyes, as in students, artists,
clerks, engravers, watchmakers,  tailors,  sempstresses, &c.,
especially by artificial light, together with want  of sleep,
want of exercise in  the open air, and too  early use of the
eyes during convalescence  after any severe illuess.   The
complaint sometimes occurs 'as a  consequence of inflamma-
tion of the  eye, especially scrofulous, external and internal.
Losses of blood, prolonged suckling,  venereal indulgences,
and the like, excite the affection, apparently by occasioning
general nervous debility.
   Asthenopy appears to consist  in weakness  of the appa-
ratus  by which the eye is adjusted  for the vision of near
objects.  It  is  as if  one were to hold  a book  too near.
Though he  might be able, by an effort,  to adjust his eyes 
88
DEFECTS OF SIGHT.
so as  to see to read for a minute or  two, the sight would
then become confused and the eyes tired.  The  use of con-
vex glasses would, however, prevent this.   Along with the
defective power of adjustment there is an irritable state of
the retina, connected in some manner with  tendency to in-
ternal congestion of the eyes.
   Asthenopy is  principally to be distinguished from prcs-
byopy,  night-blindness,  and  amblyopy,  or  incomplete
amaurosis.
   The prospect of complete cure is, on the whole, unfavor-
able, especially if tho complaint is of long standing; less
unfavorable, provided what  appears  to be  the  exciting
cause admits of removal.  Asthenopy, though it has be-
come confirmed,  is not likely to end in blindness.
   The first thing in  the  way of prevention and treatment
is the avoidance, or  removal by appropriate means, of any
cause which may appear to be in  operation, such as over-
use of the eyes, and other causes above enumerated.
   Rest to the eyes, the occasional application  to them of
cold water, good diet, exercise, country air, sea-bathing,
and the like, must in general constitute a leading  part of
the treatment of asthenopy.
   When the  patient requires to employ his eyes on  near
objects, he has no other resource than to use convex glass-
es, which, in some cases, must be of the very lowest power
only; but it would be advisable for the patient, if his oc-
cupation requires much use of the eyes, to change it if pos-
sible for one of an opposite kind. 
MUSCE VOLITANTES.
89
MusctB volitantes, or appearances like flies floating before
                       the sight.
  Muscae volitantes are described by the patient who has
made no particular examination of the appearance, as black-
ish motes, or a thin gray film, like the  wing of a fly,  or
semi-transparent  gray threads,  like spiders'  web;  but if
viewed attentively against the  clear sky, a white  wall,  or
the like, they are recognized to be made up of some such
appearances as are represented in the annexed figure.
  According as the distance of the field against which the
appearances are viewed is greater or less, they are seen
larger and fainter, or smaller and more distinct.
  Vision is not affected by floating  muscse.   Between the
several portions of the muscae and by the side of them, the
eye still sees  with  perfect  distinctness.  And after the
                           8* 
90
DEFECTS OF SIGHT.
muscne have ascended out of the field of view everything is
clear.
   Floating musca; are often  detected  suddenly, and  thus
are supposed to have just occurred.   They are most ob-
served when the patient looks at  the clear sky, a  thin
cloud, snow on the ground, a  white  wall, or the like.  They
are indistinctly, if at* all, noticed under the opposite cir-
cumstances of a dull light aud  looking  at a dark object.
They are not much seen when near  objects are looked at.
   They are generally observed to one or other side or above
or below.   The  patient thus seeing them only by a side
glance, finds it difficult to fix  them  in order to  study  their
appearance.   They move as  the eye  moves upwards and
downward-, or from side to side; but besides this motion,
which, as dependent on that of the eye, is merely apparent,
the luuscie  have  a real motion of their  own, and still more
extensive than   their  apparent  motion.  Thus,  if,   from
looking before him in a  horizontal direction, the patient
suddenly raises  his eyes and fixes them on some object
above the horizon, he  observes that  the musc;e fly upwards
considerably beyond that degree of elevation, and even be-
yond the field of view, and then come sailing down before
him till they  disappear below.
   Besides the motions of ascent and descent,  the muscac
volitantes under consideration  present lateral movements,
although less marked, as well  as changes in the  relative
position of their  several parts.
   Floating musca;  are  to be  distinguished from jlxed
muse a, appearances which have no  real motion, but appa-
rent motion only depending on  that of the eyeball.   Fixed
muscae are owing to insensible spots of the retina. 
MUSCE VOLITANTES.
91
   Hitherto a very common opinion as to the nature of
floating muscae has been, that they are  sensations, depend-
ing on some intrinsic change of state of the optic. nervous
apparatus, thus confounding them with fixed muscae; but
that they are  truly sensations, occasioned by  the presence
of particles in the interior of the eye, and close in front of
the retina, throwing their diffracted shadows on that ner-
vous expansion, admits of demonstration.
   But without entering minutely into  the matter, the pro-
position may be easily  illustrated thus : hold between a con-
vex lens and the white surface  on which the  image of the
light falls, some small  object, as a pin.   When this is near
the lens, its shadow is not  seen on the white ground, but
when it is brought nearer and nearer the white surface, its
shadow appears more and more distinctly.
   The particles,  moreover, appear to be of natural occur-
rence in the eye, for the appearance of floating muscae may
in general be seen by any person on simply looking through
a small aperture in a card at the clear sky,  or through the
eyeglass of a compound microscope at the flame of a candle
two or three feet distant,  or simply by nearly closing the
eyelids, and looking at a lighted candle.
   Muscae volitantes are often seen  by persons without any
particular  notice  of them-being taken, as  they are indis-
tinct, present themselves  occasionally only, and are there-
fore not troublesome.  They are seen most distinctly, and
are therefore most troublesome, when  there exists  an irri-
table state of the retina.   Such a state of  the retina  may
therefore  be viewed as  the general condition on  which
floating muscae, considered as a disease, depend.
   Dilution of the images of external objects favors—dis- 
92
DEFECTS OF SIGHT.
tinctness, on the contrary,  prevents—the  perception of
muscae.  Hence, when  the  person is short  or  far-sighted,
they appear less evident to  him when  he uses  the glasses
fitted to render his vision distinct.
  As exciting causes of the complaint, may be mentioned
—over-use of the eyes  on minute objects; inflammatory
diseases of the eyes, external as well as internal; the seek-
ing for them  in experiments; intemperance;  febrile dis-
eases; influenza; disease of the heart;  want of sleep;  dys-
pepsia; abdominal congestion;  hysteria; hypochondriasis;
morbid sensibility of the system generally, arising from
pressure  of business, anxiety, and distress  of mind.  All
these causes appear to operate in the same manner, occa-
sioning a congested state of the eyes.
  When a hypochondriacal person once detects muscae vo-
litantes, he takes such frequent notice of them, that they
Income to him more and more troublesome.
  From what has been said, it will be seen that the occur-
rence of floating muscae  is of itself no indication that either
cataract or amaurosis is taking place.   If,  however, there
be along  with the appearance of muscae a failure of vision,
and if that failure be not attributable to  myopy or presby-
opy, which may be ascertained by a concave or a convex
glass not improving vision, then cataract or impaired sensi-
bility of the retina may  possibly exist.
  In uncomplicated cases, the rnuscio may indeed increase
in numbers, but very slowly, and never to such an extent
as to  interfere with the  distinctness of vision in  any very
serious degree.   But very often the musca; remain station-
ary,  or even become less.
  As they depend on the vision of objects naturally exist- 
ON THE USE OF SPECTACLES.
93
ing in the eye, and  are  distinctly observed only in  conse-
quence of a morbid sensibility of the retina, whatever tends
to promote or relieve this will have the effect of promoting
or relieving the muscae.
   Jhe removal or abatement of the exciting cause, if it can
be detected, is the first thing to be looked to in the treat-
ment.   Rest  to the eyes, if they have been  overstrained,
relaxation from business, quiet to  the mind, regulated diet
and exercise, with change of air, are to be recommended.
Bathing of the eyes with cold water two or three times
daily,  for five or ten minutes, is the most important local
application.
     ON  THE  USE  OF SPECTACLES.

             BY JAMES W. QUEEN, OPTICIAN.

  There is a prevalent idea  that spectacles or spectacle
glasses should magnify to the wearer's eyes; a moment's
reflection  by those understanding the nature of vision or
the first principles of  the science of optics, will convince
them that such  an "opinion  is erroneous,  and, if carried
practically into  effect, the result would be a permanent
injury to  that most delicate  organ—the  eye.   Spectacle
glasses  undoubtedly must increase,  or  on  the contrary,
diminish  the apparent  size  of objects,  otherwise they 
94
DEFECTS OF SIGHT.
 would be  useless to those having impaired  vision;  that
 increasing  or  diminishing power, however,  must be  to
 the extent  actually necessary to restore as it  were the im-
 perfection of the vision of the wearer and no more. " 1  wish
 a pair of spectacles to magnify, yes, to magnify very much,"
 is a common call made at the optician's ; what is the result
 if the applicant is furnished with such as arc demanded ?
   First.—To see common objects, as reading,  writing, or
 sewing, distinctly,  a pair of magnifying  spectacles, will
 oblige the  wearer to hold such  objects much  nearer  the
 face  than  the  ordinary or natural distance of twelve  or
 fourteen  inches,  thus making it  very inconvenient,  and
 certainly not improving the grace  of position.
   Second.—Magnifying spectacles present objects of an un-
 natural  size, fine fabrics appear coarse; and heavy fabrics
 Btill  coarser.   A person wearing  such glasses when shop-
 ping,  should have an attendant with young or natural eyes,
 to judge truly of the quality of the goods,  for  the wearer
 of the magnifying glasses is not  capable of judging with
 accuracy.
   Third.—A permanent injury to the  eye  is  the sure re-
 ward  for the indiscretion of  wearing magnifying  glasses;
 the eyes very soon become accustomed to  the strong power
 and recession is impossible, a steady advance must be made
 in the power from time to time, and  thus  the  wearer be-
comes a slave to  spectacles by the indiscretion  of having
used magnifying glasses.
   The true, and legitimate use of spectacles,  it will be seen
by the foregoing  remarks, is to render objects  clear,  dis-
tinct,  and  of the natural  size, they should  be selected to
produce such an effect and nothing more. 
ON THE USE OF SPECTACLES.
95
   The  Quality of Spectacles.—Too much care cannot be
exercised in obtaining glasses,  or lenses, of such a quality
as to give the-necessary assistance to vision, without any
risk  of  injury to  the  eye; the highest charges made by
respectable opticians for a pair of spectacles, with correctly
made and adjusted lenses, is so small that  the most parsi-
monious should blush when attempting to cheapen so ser-
viceable an article.   A proper vigilance should be exercised
with  reference to  the empirics who  annually  visit the
various watering  places with  a  newly discovered,  patent
Brazilian crystal, periscopic  lens, or some other  long and
high sounding name to deceive the unwary; these summer
resorts are the fountains where the traveling optician de-
rives from the credulous, an abundance td enable  him to
live a life of ease  for the remainder of the year;  in a ma-
jority of instances, spectacles sold  by these  travelers have
the very cheapest and lowest quality of lenses in them, and
are well calculated to  do a permanent injury to the  eye.
A prudent person on finding his vision becoming impaired,
will resort to a dealer of some  science and reputation, and
with his advice, gained from experience, select such lenses
as will relieve the sight and not add to the  defect already
existing.
   Glasses  having correctly ground and polished surfaces
are the  only kind that should  ever be put before the eyes
in spectacles, all others being bent or moulded to the form
are positively injurious,  and any lenses  recommended as
capable of permanently rejuvenizing the sight.are  decep-
tions and should be avoided.
   Any  vendor demanding an extravagant  price  for his
lenses only,  and  claiming  for them  peculiar properties, 
96
DEFECTS OF SIGHT.
may be looked upon as attempting deception, for the very
best glasses can be purchased for so small a sum,  (less than
half a dollar,) that there is no  apology for claiming a high
price.
   When  to commence  the  use of spectacles.—Spectacles
should  never be resorted to  unless  there is  an  evident
necessity for their use;  it is no unusual thing for  persons
to desire  spectacles to  preserve  their sight, or in other
words to get such as will prevent  their sight from  failing;
there are also those who form  the resolution never to wear
spectacles; then there are those who desire the magnifying
glasses when they commence.
   It  is necessary to resort  to  the  use  of spectacles when
there is a disposition to put fine print or other small objects
at an unnatural distance off to see distinctly, or when it is
observed that  the letters in a book seem  to run together or
become blurred, or when it is found  necessary to put the
book behind the lamp or candle to be able to read easily,
such symptoms are the true admonitions of advancing years,
failure of sight, and  need of spectacles.
   There are no glasses,  no matter how costly, or by whom
recommended, or by whatever new name they may be called,
that  will prevent the sight from failing as age advances.
 .  It is folly to form the resolution  never to wear spectacles.
The writer Jias known  persons to worry along  for years,
not able to see any usual sized  print distinctly, and finally
be compelled to resort to glasses, aud be obliged to use so
strong a power, that  for  a considerable time the spectacles
were  an annoyance', whereas,  if spectacles had been re-
sorted to when the  symptoms of a failure of siejit were
confirmed, they could have  been used with a pleasurable 
ON THE USE OF SPECTACLES.
97
relief.  It is also  great folly to use glasses of too strong a
magnifying power, for the  reasons already stated in the
note on the use of spectacles.
   Finally, refrain from the use of spectacles until there is
a  certainty that  the sight  has commenced  failing, then
select them of such a power, as may be found sufficient to
make up the deficiency and  nothing more; eschew all re-
solutions not to appear old, admit the necessity of and use
spectacles,  when  nature  admonishes you  of a failure of
sight.  Never habitually  use glasses to magnify, they will
cause future trouble.
   There is no  certain age or time of life to commence the
use  of  spectacles, other  than the  certainty of the  sight
having failed.  Many do  not require their assistance until
fifty years of age, while  the majority  find it necessary to
begin at forty or forty-five years.   A long continued, close
application to dark sewing or fine  reading by an imperfect
light, will generally cause an early failure  of  the sight,
debility from  attack  of  fever will often  cause a failure or
the  necessity of  stronger glasses  by those already using
spectacles.
   Colored glasses are serviceable to protect the eyes from
bright or intense  light, it is very seldom that they can be
judiciously used for reading or viewing near objects.
   The London Smoke or neutral tint glasses lately intro-
duced, have been found much more grateful  to  the  eyes,
and  quite  as effectual in protecting them from  excessive
light as either  the green or blue glasses.
9 
CHAPTER IT.
 AMAUROTIC  AFFECTIONS, OR DEFECTS OF SIGHT DEPEND-
   ING ON PFRVEUTKO, IMPAIKKD, OU  LOST SENSIBILITY
   OF THE OPTIC NERVOUS Al'I'AKATUS.

       Abnormal excitement of Visual  Sensations.

   In amaurotic affections, various visual sensations though
 not in themselves unnatural, arc apt to be excited unnatu-
 rally.  Such sensations being important as symptoms, it is
 necessary to  study them; but, previously to doing so, tho
 circumstances attending their natural occurrence  must in
 each ease be  taken into consideration.

 Pliotopsy and  Chroopsy, or sensations of light and  color,
   independent of external  light, (.veiled by internal  injlu-
   tnces operating on the optic nervous  apparatus.
   In  the unexcited condition of the optic  nervous appara-
 tus, there is  darkness  before the  eyes, but in the excited
 condition, light and color are seen.
   The agent  by which the  optic  nervous apparatus  is
 usually excited  is the principle  of light; but an excited
 condition, and consequently the sensations of light and col-
 or, may be called forth  by  other  influences, such, for ex-
ample, as pressure.   And it is to be observed, that what-
ever may be the stimulus which  excites the optic nervous 
PHOTOPSY AND CHROOPSY.
99
apparatus, no other sensations but light and color can be
called forth in it.
   It is indifferent what part of the optic nervous apparatus
be excited in order that luminous sensations may be  per-
ceived—whether the retina itself be irritated, the fibres of
the optic nerve in the orbit irritated or cut, or whether the
cerebral part of the optic  nervous apparatus be  pressed on
by congestion or tumor.   Moreover, in  whatever part the
optic nervous apparatus be excited, the luminous sensation
which results is always referred by the sensorium to  the
surface; not only to the surface, however, but as in natural
vision, to without the body—(projection outwards.) See pp.
22 and 23.
  A familiar example of a luminous spectrum of  the kind
under consideration is that which, on pressing the eyeball,
is seen projected outwards, and on the side opposite to that
where the pressure is applied.
  Other examples are—a spectrum of the vessels of the re-
tina, light on a dark ground, which, in certain  states of
the eye, is seen, and which is owing to pressure on the re-
tina by its vessels in a state  of congestion;  the appearance
of a shower of lucid globules before the eyes on suddenly
rising from a stooping posture, from the  disturbance in  the
circulation in the  optic  nervous  apparatus  thereby  occa-
sioned.
  Analogous  appearances  of fiery sparks, flashes  of light,
and  colored  corruscations,  occurring spontaneously,  are
symptoms of irritation or  excitement of some part of the
optic nervous apparatus, cerebral or ocular, from inflam-
matory congestion.   As such inflammatory congestion may
end in amaurosis, so  the luminous and colored  spectra are 
100
DEFECTS OF SIGHT.
symptoms of incipient amaurosis.   They may continue to
appear, however, after all visual sensibility is lost.
  Sensations of color of the kind just considered arc to be
distinguished, on  the one hand, from  those which  depend
on  an optical derangement in the  eye itself, whereby  its
achromatism is destroyed, and on the other, from accident-
al or complementary colors, to be considered below.

Spectra consequent  to impressions on the Retina and com-
                   plementary colors.

  In the natural state, the  sensations of the retina remain
a short space of time after the impression which occasioned
them has ceased  to act.  Hence, an  image  of  an  object
may continue to be seen for some seconds after the eyes
have been turned away from looking at it.  This phenom-
enon is, in general,  most readily observed in twilight;  in
daylight, the impression of the object  on the  retina  re-
quires to have acted more  intensely and a longer time to
produce the  effect.
  The spectrum  appears when the eyes are directed to  the
sky, projected in the distance and of gigantic size.
  The spectrum  is  seen differently, according  as the eyes,
when  turned away from the object, are darkened or direct-
ed to an illuminated surface.  In the former case, the lights
and shadows are the same  as  appeared  at the time of re-
garding the  object;  in the latter, they are the reverse.
  If the object from which  the impression has been derived
is colored,  the spectrum is colored also, but differently
thus :—If the eye be fixed on a red-colored object for some
time,  and then turned away from  it, a spectrum of the  ob- 
OCULAR SPECTRA.
101
ject will continue to be  seen, but instead  of a  red, of a
green  color.  If, on the contrary, the object looked at be
green, the  spectrum will  be red; again, if blue,  the spec-
trum will be orange; if orange, the spectrum will be blue;
if yellow, the spectrum will be violet;  if violet,  the spec-
trum will be yellow.
   From this it is seen that the color of the spectrum  is
always  that which, being added to the  color of the  object
looked at, makes up the sum of the three prismatic colors,
yellow, red, and blue, which, by their  combination, form
white  light; hence  the name complementary which has
been given to the color of the spectrum.
   In the annexed figure  the primitive  colors, yellow, red,
and blue, are placed at the an-            Red
gles of the  triangle,  the com-        X/\^\
     ,1             . i .     j Orange / /   \   \ Violet
pound colors, orange, violet, and      /7C   )\   \
green, at the intermediate points.      I   /^/'\\  J
The primitive color and the  com- Yellow \—------~7 Blue
pound one, which thus stand op-          ---L—^
posed, viz.,  yellow  and  violet,
red and green,  blue and orange, are complementary of each
other.
   A spectrum  is very readily  produced by  looking  at the
setting sun.  If on turning the eyes away they are darken-
ed, the color of the spectrum  is at first luminous white;
it then changes to yellow, and  from that runs  through the
different colors of orange, red, violet, blue  to black, when
the spectrum ceases.   If, on the contrary, the eyes  are di-
rected  to a white surface, the spectrum is at first black,
then blue,  which color is succeeded by violet, red, orange,
                           9* 
1(12
DEFECTS OF SIGHT.
yellow,  until the spectrum, becoming  white, is no longer
distinguished.
  In certain morbid states of the retina, even although vis-
ion  be much  impaired, the sensation remains after the im-
pression a much longer time than natural; hence arise illu-
sions of vision from the spectrum and complementary col-
ors.  In such a case, for  example, if the person, after his
eye has  rested on some small and near object, the tassel of
a blind for example, should accidentally look towards the
sky, he  will see  a magnified image of it;  but not aware of
the cause, he is astonished by what appears to him a gigan-
tic human figure in the air.
  In illustration of the excitement of the sensation of light
by other agencies besides the agent properly called  light,
and how apt people are to mistake the former for the latter,
the following case is adduced :
  Some years ago in  Germany, a clergyman was assaulted
one dark night by two men, one of whom  struck him on
the right eye with a stone.  By the light which streamed
from his eye, in  consequence  of  the blow,  the clergyman
averred  that he was enabled  to see and identify the man
who committed the outrage.
  The question whether  this was possible was actually
raised in the criminal investigation, and the official district
physician was  referred to for his opinion.  This gentleman,
without fully admitting the possibility of what the clergy-
man maintained, still  thought  that there was some proba-
bility in it.
  Professor Miiller, the distinguished physiologist of Ber-
lin, who has well commented  on this singular case, sarcas-
tically but justly observes, that if the district physician had 
OCULAR SPECTRA.
103
pressed on his  own eye in the dark, and tried to read by
the light thereby emitted, he would probably have come to
a more decided conclusion.
  The alleged identification of a man in the dark by light
struck from the eyes  by a blow, is only paralleled by the
celebrated  exploit we read  of in the adventures of the
redoubtable Baron Munchausen.   In  an encounter with a
wild beast, the  German baron, to his dismay, found  that
the flint of his gun had dropped out.   Fertile in expedient,
however, our hero tells us, that he immediately gave his
eye a blow, and thus struck fire from it sufficient to ignite
the priming and discharge his  gun, laying the animal dead
at his feet!!!
  Though  the changes operating on the brain, whereby we
are rendered conscious of sensations, are usually the result
of the communication of impressions on the nerves of sense
made by external agents, such changes in the state of the
brain may  be the result of the communication of changes in
the state of the nerves of sense induced-by impressions made
by  some agency operating within them, or they may be
primarily induced  by some  cause directly operating within
the brain itself, as appears to have occurred in the following
case—
  A women,  deaf for  some years,  and troubled with noises
in her head, became subject to photopsy also; and fell into
the hallucination of supposing that people had everywhere
conspired to  annoy her, by throwing glares of light into
her eyes.   I found it impossible to convince her of the real
nature of her complaint.  Her intellect was evidently im-
paired,  from  the same disease of  the brain to which the
noises in the  head and the photopsy were owing. 
ll'l
DEFECTS OF SIGHT.
                      Phantasms.

   Besides  the  subjective  seusatious now spoken  of, and
which are  owing to the communication  to the brain of a
change  of  state of the nerves of  the  senses  concerned,
induced by a cause operating within them, there is  another
class of subjective seusatious which have their origin in the
reaction of  the  mind on the senses.   To  this class belong
phantasms.
   Phantasms of touch are exemplified  in the pains of hy-
pochondriacs.   In regard to phantasms of hearing, people
sometimes  imagine  that  they hear not  only sounds but
spoken words.  The phantasms of  vision are  those, how-
ever, which have attracted most interest.  Appearances as if
of various objects—landscapes and  figures, for example—
even walking figures—present themselves before; the eyes.
Nay,  phautasms of both  hearing aud vision may occur
together—tho human figures seen, being, at the same  time,
heard talking.   In the celebrated case of Xicolai, the Berlin
bookseller, the phantasms were, at first, seen only, but after
a time, they were heard also.
   Phantasms are of most common  occurrence in disease,
under the influence of opium and other narcotics, in drunk-
ard's  delirium,  and  in insanity; but they  may appear to
persons otherwise healthy, though in an excited state either
from  original temperament, or in  consequence  of being
placed in exciting circumstances.  And of course, exciting
circumstances will operate more strongly on a person al-
ready excitable  from original temperament.
   The mental state excited by some strong impression, or
by long brooding on a cherished  scheme, may, by its re- 
PHANTASMS.
105
action on the  senses, give rise to a vivid production of
phantasms relating to the predominating idea.
  This is exemplified by  Shakespeare, when  he makes
Macbeth exclaim:
        " Is this a dagger which I see before me
        The handle toward my hand ?  Come, let me clutch, thee:
        I have thee not, and yet I see thee still."
We  have a similar example in Brutus—" midst his slum-
bering host, startled by  Caesar's stalwart ghost."
   Phantasms  occurring  in persons of strong  mind and
cultivated intellect are  recognized as such.  This was the
case  with Nicolai,  already  referred  to.   The  arguments
used by the epicurean Crassus, to tranquillize the mind of
his friend Brutus,  after being startled by the apparition of
Caesar, showed that he took a correct view of the matter,
attributing the phenomenon solely to the imagination; and
Shakespeare makes  Macbeth raise the question, when he
adds to his first exclamation:
              " Art thou not, fatal vision, sensible
              To feeling, as to sight ?  Or, art thou hut
              A dagger of the mind ; a false creation,
              Proceeding from the heat-oppressed brain?"
   In the case of persons of uncultivated intellect, phantasms
have, no  doubt,  been  the  origin of many ghost stories.
Whilst in persons  of  weak intellect, not otherwise actually
insane, they may lead to hallucinations prompting to insane
actions.
   Every one  has  heard of the phantasms excited by the
use of opium, and the  still more remarkable ones excited
by Hashish, or Indian hemp—the drug said to have been
used by the sect  of  Assassins, under the blow of one  of 
106
DEFECTS OF SIGHT.
whom, Conrad, Marquis of Montfcrrat, one of the  leaders
of the Crusaders, fell, to raise phantasms, and  thereby ex-
cite  themselves  to  their violent deeds—hence the name
Assassin.
   The occurrence of phantasms in insanity has been men-
tioned, but it would be out of place here further to refer
to them.
   I  come, in  the last place,  to notice the phantasms  on
which has been founded a belief in " second sight."
   That  kind of  second  sight  referred to by Campbell, in
the following lines:
        " "Tis tho sunset ofllfe gives mo mystical lore,
          When coming ovents cast tliolr shadow before."

is, after all, a natural enough  kind  of second sight, and
one which we all acquire more or less by the experience
of life.
   Persons said to have been endowed with " second sight"
among the Scotch  Highlanders, appear to have been  of
excitable temperament and deeply contemplative character.
Alan Macaulay,  in Sir W. Scott's " Legend of Montrose,"
is a good example.  Such a person, having his mind intent-
ly and anxiously fixed  on  sonic stirring enterprise,  may
readily be supposed, when wrought up  to a paroxysm of
excitement, to have had presented to  his mind's eye, and
with all the distinctness of reality, a possible combination
of events.  In any case, when  the events  turned  out  in
the combination  predicted  by the seer, the  vision was re-
ceived as  supernatural,  and  the case was treasured up in
the memory of those concerned.  But when the events did
not correspond to the prediction, the failure, as generally
happens in unsuccessful cases, was unnoticed and forgotten. 
AMAUROTIC AFFECTIONS.
107
  Impairment and loss of sensibility of the Optic Nervous
     Apparatus, or Amaurosis in its various degrees.

   The sensibility of  the retina is greatest in the middle;
 from thence it diminishes towards the circumference.
   In consequence of this, we see only that part of an object
 very distinctly to which the  axes  of  the eyes are at  the
 moment directed.  In examining an object, therefore,  the
 axes of the eyes are so  moved, that the central region of
 the retina may be successively impressed by the image of
 its different parts.
   The difference in the degree of sensibility of the middle
 and  circumferential parts of the retina may be illustrated
 by a reference to the difference in the degree of sensibility
 of the skin of the lips for example, and the  skin of  the
 cheeks.   Whilst the points of the two legs of a pair of
 compasses, when separated a very short distance from each
 other, are applied to the skin of the lips, the mind dis-
 tinguishes the two impressions;  but when  applied to  the
 skin of the cheek, there is no distinct  perception of two
 points, but a sensation as if one impression only were made.
   As impressions on the less sensitive skin of the cheek
 are perceived, as if smaller than impressions on the  more
 sensitive skin of the lips; so objects seen by the less sensi-
 tive  circumferential part of the retina appear smaller than
 when seen by the more  sensitive middle part; or, ceteris
paribus, an imperfectly illuminated object appears smaller
 than one brightly illuminated.   In like manner, when  the
 sensibility of the retina is impaired, objects appear smaller
 than natural. 
108
DEFECTS OF SIGHT.
       Daltonism, or defective perception  of Color.
   Numerous cases are recorded, in which  persons were un-
able, in different degrees, to distinguish certain colors, their
sight in other respects being unimpaired.   Mr. Palton, the
late celebrated chemical philosopher, who was so affected,
wrote on the subject; hence the name.  Daltonism.
   [" Since the publication in  1794, by Daltou, of his own
case, the occasional  occurrence of the peculiarity of vision
called  " color  blindness," has  been  well  known to  the
world.*   But Dr. Wilsonf has the merit of being the first
to call attention  to the fact,  that  in  several of the lower
walks  of  life,  this  bodily imperfection  not only incapaci-
tates  the individual from  following his calling with  suc-
cess, but sometimes may imperil the lives  of others as well
as his  own.  Not only does the weaver,  the tailor, the gar-
dener, thus affected, commit mistakes, ludicrous enough to
the bystanders, yet  likely to lead to the starvation of the
poor man  who by them loses his  work;  but the railway
guard  or pointsman, and  the sailor, especially in  steam
service, may, by misunderstanding  colored  signals, cause
the  death of  thousands.   We  think,  therefore,  much
gratitude is  due  to  the Professor  of Technology  for  thus
calling attention  to the subject,  and investigating it with
the industry  exhibited in the volume.
   " Three forms, or rather degrees, of color-blindness arc
distinguished by the author.
  • Before that essay, only occasional notices of the phenomenon bad occurred.
The«e are collected by Wartmann, a translation of whoso paper may be found
in Taylor's Scientific Memolra for 1&46, p. 162.
  t lli-earches on Color-Blindness.  By George Wil.-ou, M. !>., F. K. S. E., Regius
Professor of Technology in  the University  of i; huburgh.   Edinburgh, 1&.M.
pp. 180. 
DEFECTIVE PERCEPTION OF COLOR.         109
   " 1. Inability to distinguish between the nicer shades of
composite colors, such as browns, greys, and neutral tints.
   " 2. Inability to distinguish between the primary colors,
red, blue, and yellow; or between these and the secondary
and tertiary colors, such as green, purple, orange,  and
brown.
   "3. Inability to discern any color, properly so-called, so
that black  and white (i. e., light and shade) are the only
variations of tint perceived.
   " Theflrst* or lowest, degree is apparently the rule rather
than the exception among persons of the male sex, whose
eye has been as little educated as is usual in our unaesthe-
tic community.  Dr. Wilson found  that of sixty persons
attending the Chemical Class of the Edinburgh Veterinary
College, the  great majority declined to  give names to any
colors but  red, blue, yellow, green, and brown.  Without
care, one might easily be led into thinking colored-blind-
ness to be much more  common than  it really is.   But
where the subject has so seldom  entered  the mind, and
where the nomenclature  consequently is so defective, it is
better to dispense altogether with  the names of colors in
testing cases of this affection, and to set the task of arrang-
ing pieces of cloth or skeins  of worsted in such a way that
the same colors  and shades  should be  classed  together.
When this is  done, it will frequently be found that those
who make no  mistake in matching  full tints of the  pri-
mary  and  secondary colors,  err  in certain  of  the  fainter
shades of  both, and  in all the shades of some of  the more
mixed colors.   Thus the difference  between pink and pale
 * British and Foreign Medico-Chirurgical Review.  No. xxxv. July, 1855,
p. 56.
       10 
110                DEFECTS OF SIGHT.
blue is a puzzle to many who  do not otherwise confound
colors.
  " ' Mr. Crombie, dyer, Brown street, Edinburgh, informs
me  of three persons known to him, connected with dyeing,
to whom the tints in question were  a constant  source of
mistake.   Messrs. Grieve, late of South  Bridge,  had in
their  employ  a person  who could match all  colors but
drabs.  Professor S.  is never certain, even by daylight, of
the difference between blue and green; and  many persons
confound pink  with pale yellow.'
  " Where this slight degree of color-blindness  is congeni-
tal, it is just as incurable as the more marked forms.   But
still it is practically convenient to separate  it from them,
because up to this point it may be simulated by a want of
discrimination, which is simply the result of deficient edu-
cation, and which, therefore, attention is quite  capable of
removing.
  " The second form is  that which  Dr Wilson has  most
investigated, and  has cited  in detail a  great  number of
marked cases.   In it, red,  blue, yellow, purple,  orange,
green,  brown, <v.c.,  are  respectively mistaken  for  one
another, or confounded together.    In less severe  cases,
the  majority  of colors  are  seen accurately, but  two at
least, (as  red  and green,) and generally four, (as red,
green, olive, and  brown,) are not distinguished  from each
other.
  "There  is a  considerable difference between the colors as
regards their  liability  to  be mistaken  for  one another;
and curiously enough,  it is  those  which to ordinary eyes
appear  most violently  contrasted, that  are  confused to-
gether, whilst  tamer and less  vivid tints are correctly 
DEFECTIVE PERCEPTION OF COLOR.         Ill
appreciated.   Thus, while yellow is almost universally re-
cognized, and rarely mistaken for its complementary pur-
ple, red, however glaring,  is constantly confounded  with
green, very often  with black, and for some  appears  to
have absolutely no  existence.  Blue, when pure, is usually
detected pretty readily, and also yellow, as above men-
tioned ; yet their combination, green, is one of the greatest
stumbling-blocks to the color-blind.
   " The third variety, where all objects are to the eye mere
light  and shade, and  where absolutely no difference be-
tween colors can be detected, is extremely  rare, and  no
instance appears to have come under the observation of
the author.   One, however, which  he describes, is a near
approach, viz.,  of  the  physician (Case  VIII.) who con-
founds  all colors equally by daylight, though  by gaslight
and transmitted light he is able to sort them  rightly.
   " The disadvantages of this  defect, even in its slightest
degree, we hold to be something positive, and worthy of
consideration.   It  is surely a  misfortune to miss  one of
the purest  and seldomest-abused pleasures which God has
given us: but independently of that, it obviously renders
a man less fit  for  a great number of positions in life to
which inclination and circumstances might otherwise lead
him.    Mourning warehouses are,  doubtless, a great re-
source  for the  unfortunate attendant, who  matches red
with  black—but what is to happen  to  the  house-painter
accustomed to have his colors mixed  by his wife, when he
becomes a widower ?  We have ourselves interceded for a
country carpenter who painted half a railing leaden-grey
to match a green, and saved him from  losing his  job as
well as his paint;  and how a barrister would annihilate 
112
DEFECTS OF SIGHT.
the medical witness who could not distinguish an  arseni-
cal precipitate by its tint!   Dr. Wilson's stories  of  the
tailor who  sewed a black  coat  with red thread—of  tho
chemical lecturer who always had  to ask, instead of toll-
ing, his pupils the colored reactions in his experiments—
of the physician to whom scarlet fever had no existence
—of the gentleman  who condoled with  a femalo  friend
dressed in  vivid green, supposing her to bo  in mourning
—of the Quaker who bought a bottle-green coat for him-
self and some scarlet merino for his wife—of the  school-
girl attempting  to arrange the  colors in her drawing by
the taste, &c, \e., are striking and amusing  instances of
the difficulties consequent on this defect.  One wonders
how he managed to come across so many; but that is ex-
plained by his having advertised in the 'Athenaeum'  tho
fact of his  being engaged in  these  researches, and  obtain-
ing in answer, the details of  their cases from tho sufferers
themselves.
   " But of more importance is  the consideration that the
use of color in railway and naval signals sometimes places
the lives of hundreds on  the  chance  of the  interpreter
having as full a conception of tho  chromatic tints, as tho
captain or the board  of directors;  and  the first discovery
of the defect may be  at a grim inquest  which it has given
rise to.
   "In the  Admiralty notice respecting lights to be  carried
by sea-going vessels, to prevent  collision, which is  at pre-
sent in force, the order is that all  British steamers are to
Bhow,  ' between  sunset and sunrise, a  white  light  at  the
foremast head, a green light  on  the starboard  side, and a
red light on the port side.'   When, then, one  vessel is 
DEFECTIVE PERCEPTION OF COLOR.        113
crossing  another's bows, the  foremast light goes for no-
thing, and the steersman of the latter is expected to know
by the color which side of the  crossing vessel is  towards
him, and consequently if it is going to his right or his left
—and  on a dark night  has no other guide whether he
should port or starbord his helm.  A similar principle is
applied, both by night and day, in railway signals.
  " The  number of the color-blind is larger than has been
generally supposed.  From a table exhibiting the results of
the examination of 1154 persons of various classes, at Edin-
burgh, in 1852-53, it may be inferred that in the northern
metropolis 5*6 per cent, (or more than 1 in 18) are thus
defective.  Of this 5-6 per cent., 1.8 per cent, (or 1 in 55)
confound red with green; 1-6 per cent. (1 in 60) confound
brown  with green; 2-2 per  cent, (or 1  in 46) confound
blue with green.  Dr. Wilson  remarks, that the distribu-
tion of these numbers among different classes of the popu-
lation is  'most capricious,' and makes no  attempt  to  trace
it as peculiar to any.
  "As to the influence of sex, Dr. Wilson's researches, both
the earlier series included in the body of  the  work, and
latter contained in  the  appendix, show  that color-blind-
ness is much rarer among females than males.  He does
not, however,  give numbers, but proposes  the  subject as
one open to inquiry by teachers of schools, medical in-
spectors of factories, &c.
  " The  thirty-four pages devoted by the author to the dis-
cussion of the theories of this defect are inconclusive, and,
from the very fact of their inconclusiveness, will not bear
condensation.  All that he deems himself  entitled to affirm
is, that in the  color-blind 'the cerebro-retinal apparatus
                          10* 
114
DEFECTS OF 8IOHT.
of vision is unendowed with that sensitiveness to colorific
impressions which  it  possesses  in  those whose vision  is
normal;' that is to say, that the cause lies between tho
humors of  the eye-ball  and the mind, excluding both the
suggestion  of Dalton, of its being  due to the existence  of
an abnormal coloring  in the lens or vitreous  humor, and
the idea which might not unnaturally occur  to a metaphy-
sical theorist, that the defect was not in the body at all,
but in the  mind.  Dr. Wilson  has spent several pages  in
overthrowing  the  first-mentioned  explanations;  and  it
may be observed, that his  trouble  is  not  without con-
siderable practical importance, for an Italian occulist, Dr.
Trinchinetti, has actually  proposed  the  extraction of the
lens as a cure.   To stop him, if possible, from carrying his
design into execution, a case is  recorded of a gentleman
who bad both lenses removed for  cataract, and experienced
afterwards, on many occasions, temporary attacks of color-
blindness, which before the operation never occurred.
  " The great majority of  cases of permanent color-blind-
ness are congenital, and their cause is to be sought only in the
theories above discussed; but instances of it  are related by
Mackenzie, White Cooper, and others, where  it could be
traced to 'congestion,  hepatic derangement, and  dyspep-
sia.'*  The disorder is usually temporary under such cir-
cumstances, and disappears after the  general treatment
employed for the state of  health.  A curious  example is,
however, detailed among Dr. Wilson's cases, where it was
caused by a severe accident, attended by  concussion of the
brain and  long-continued cerebral excitement.  Here the
* Article, Vision ; Cyclopedia of Anatomy and Physiology. 
          DEFECTIVE PERCEPTION OF COLOR.        115

color-blindness was permanent, and assumed all the inten-
sity and usual symptoms of the congenital origin.
  " The colors  most generally confounded were, red and
brown with  green, and pink with blue.  Yellow and  blue
were the colors  most readily recognized.
  " The affection appears to have been, in most cases, con-
genital,  and  incurable.
  " The cure of color-blindness  by any physical  agents
seems hopeless; and, according to Dr. Wilson's experience,
education seems to do but very little towards removing the
defect from  the body or the mind, whichever it is situated
in.   No case is on  record among the  many highly edu-
cated persons who have  thus  suffered, of  any body in-
venting a means of  improving their power of chromatic
diagnosis.
   " There are, however, some methods of alleviating or cor-
recting the  false judgments which  the imperfect sense is
led into.  One  is  the  comparison of doubtful with known
colors, by  carrying  about a chromatic  scale,  accurately
tinted  and  named.  This, however, is  available only to
a limited extent—that is, as  far as the colors of the scale
itself can be distinguished.  Another is  the employment
of touch, to  distinguish the alterations in texture made by
different dye-stuffs.  This may be of some  use to clothiers,
weavers, &c, who  have  a limited number of goods to
arrange, but would  not  assist  a customer in purchasing
unknown articles.   Perhaps to painters the  sense of smell,
higher educated than is usual, might be  a  help, and would
not be  open to the obvious objection  lying against the
employment of the taste.
   " A more important suggestion, which we owe to Dr. Wil- 
11G
DEFECTS OF SIOnT.
son, is the substitution of artificial light for solar in the
examination of colors.   It certainly is a strange thing that
candlelight, which to the healthy eye causes a confusion  of
delicate tints,  should render them more easily distinguish-
able  by a morbid sense.   Such, however, is the case,  as
several examples quoted  by Dr. Wilson arc sufficient  to
show.  The most striking of these is that of a draper, who
has long been in the habit of keeping a gaslight burning
in a dark room, to enable him by day to distinguish scarlet
from  green, and  crimson  from  blue.   This is  quite suf-
ficient to  induce every color-blind person at least  to try
the effect of artificial  light in  correcting his  erring per-
ceptions.
   " From the observation, that it is the yellow color of ordi-
nary artificial  illumination which  assists  the color-blind—
very white light, such as the lime-ball  and electric char-
coal light, being as useless as the solar rays—Dr. Wilson
inferred that the emjtloyment of yellow or orange transpa-
rent media might be of advantage; and such has proved  to
be the case in several trials.   It is, however, as might be
expected,  an inferior expedient to the direct use of yellow
illumination;  and the question of the best coloring sub-
stance, whether silver, uranium, iron, or organic matter,
is still open to experiment in each individual ease.
   " The employments for which color-blindness most seri-
ously disqualifies, are those of sailor and railway servant,
who  may daily peril human  life on an indication which a
colored flag or  lamp is intended to give.   For  this evil
there are two remedies.   First, a careful examination  of
the parties  employed, to test their capability  of  distin-
guishing rapidly the signals used;  and, secondly, to  make 
TRANSITORY HEMIOPY, OR HALF VISION.
117
the shape and movement of signals the chief index of their
meaning, so as to dispense with color except as a subordi-
nate aid to this."]
          Transitory Bemiopy, or, Half-vision.
  The following is an account of hemiopy, by Dr. Wollas-
ton, as it occurred in his own person  : " I suddenly found,
after  violent exercise,  two or three  hours before, that I
could see but half the face of a man whom I met;  and it
was the same with respect to every object I looked at.   In
attempting to read the  name Johnson over a door, I  saw
only     son ; the commencement of the name being wholly
obliterated to my view.   The loss of sight was towards my
left, and  was the same, whether  I looked with the right
eye or the left.   This blindness was not so complete as to
amount to absolute darkness, but was a shaded darkness,
without  definite outline.    The complaint was of short
duration, and in about  a quarter of an hour might  be said
to  be wholly gone, having receded with a gradual motion
from the centre of vision  obliquely upwards  towards the
left."
   More  than twenty years subsequently,  a similar attack
occurred again, without Dr. Wollaston being able to assign
any cause whatever,  or  to connect it with any previous or
subsequent indisposition.  " The blindness," says he, " was
first observed, as before, on looking at the face of a person
I met, whose left eye  was to my sight obliterated.  My
blindness was in this instance the reverse of the  former,
being to my right (instead of the left) of the spot to which
 my eyes were directed; so that I have no reason to  sup-
 pose it in any manner connected with the former affection. 
lis
DEFECTS OF SIGHT.
.   .   .   On this occasion the affection, after having lasted
with little alteration for about twenty minutes, was removed
suddenly and entirely by the excitement of agreeable news
respecting the safe arrival of a friend from a very hazardous
enterprise."
  In some persons, the affection is of frequent occurrence,
coming  on along with indigestion,  headache, and nausea,
but going off in a few hours.
  According as hemiopy depends simply on fatigue or gas-
tric derangement, so must the treatment be regulated and
the means adopted to prevent its recurrence.


                    Night Blindness.

  Indistinct vision, recurring regularly at night, is some-
times met with as a congenital and habitual infirmity ; there
are instances of its having  prevailed as an epidemic.  Most
frequently it is met with as an occasional  compliant, espe-
cially in warm countries and warm latitudes at sea.
  In  the beginning  of the complaint  the patient is still
able to see objects a short time  after sunset, and perhaps
to see a little by clear moonlight, and he can see  distinctly
by bright candlelight.  Vision, however, becomes more and
more imperfect  at night,  so  that, after a few  days, the
patient  can no longer discriminate the largest objects after
sunset or by moonlight, &c. ; and, after a longer lapse of
time, he ceases to see any  object distinctly by the bright-
est candlelight.
   The  principal causes of night-blindness  appear  to  be
fatigue and exposure  to the strong light of the sun and
gastric  derangement; lunar influence is also considered to 
FIXED MUSCiE.
119
operate as a cause.  I have met with two  cases apparently
arising from exposure of the eyes  to naphtha vapor.
  Congenital night-blindness  sometimes affects more than
one member of the same family.  A most remarkable his-
tory of night-blindness, hereditary in one family  for two
centuries, has been recorded.
  Under proper treatment, the prognosis, in  cases of the
occasional form of the complaint,  may be always favorable.
The duration of the disease is generally from two weeks to
three or six  months.  If,  however, it  be neglected  or
mistreated,  vision may become imperfect  in  the  daytime
as well as at night.
   Europeans who have been once affected with night-blind-
ness are particularly liable to a recurrence of the complaint
as long as they remain in tropical climates.

                     Fixed Muscat.

   These appearances never change their position, either in
regard to each other or to the optic axis.
   Fixed muscae vary in number, size, and form.  At  first
semi-transparent, they afterwards become black, or at least
dark.  They appear in reading like blotches on the paper;
but when the eyes are directed  to  a distant object, they
appear so large that they  cover it perhaps.  Fixed muscae
are most distinct in the light;  in darkness they are either
not seen, or seen as luminous appearances.  If confined to
one eye, they are most distinct when the other  eye is closed.
   Fixed muscse are owing to insensible spots of the retina,
The centre of the retina is sometimes the part  affected, and
the appearance seen is that of a dark spot in the middle of 
120
DEFECTS OF SIGHT.
the field of vision.  Thus the flamo of a eandlo is, perhaps,
invisible, whilst the light halo around is seen.
  Muscat may change in form, size, and darkness.  And
though any given musca may not alter its position, it may
disappear, whilst  others may present themselves in nnother
part of the field.
  The insensible spots of the retina on which tho appear-
ance of fixed  musca) depends, constitute partial amaurosis;
this may  pass into  total amaurosis, the insensible  spots
gradually  increasing  in size until objects  are  no longer
seen.
  Fixed musca)  are often merely a symptom  of evident
posterior internal inflammation of the eye.

                      A maurosis*
  Amaurosis is impairment or loss of vision from disease
of the retina, optic nerve, or part of the brain with which
the optic nerve is connected.
  Amaurosis is said to be incomplete or complete, according
as the sensibility  for visual impressions is impaired merely,
or quite lost; and part'ad or total  according as the defect
of sight extends  to a part only, or the whole field of view.
  In incomplete  amaurosis, the patient's field of vision is
obscured as if a  gauze or cloud were  interposed between
him and the  objects looked at.
  In partial  amaurosis, the  obscurity  may involve tho
centre or the circumference of  the  field, or some one side
only;  or it may be limited  to a mere spot, or to several

  * Gutta serena of the Arabians, in contradistinction to gulta opaca, the name
they gave to cataract. 
AMAUROSIS.
121
spots  dispersed  throughout the  field.  Objects  are  thus
seen or not, according to the part of the field of view in
which they are situated; or if large enough to occupy the
whole field, their circumferential or central part only is
seen,  or one  half only, or a part here and there.  When
the insensibility is limited to a spot or spots merely, the
appearance of fixed muscae is occasioned.
   Vision  is often better one day, worse another; sometimes
better in  the morning, sometimes  in the evening;  some-
times better after meals, sometimes worse.
   The amaurotic person generally sees an object indistinct-
ly, until such time as he has steadily fixed his eyes on it.
Sometimes, however, by moving the object before him, he
sees it better than when at rest.
   Objects sometimes appear smaller.
   The patient usually sees better  in strong light, but in
some cases, better in dull light.  Sometimes he is intolerant
of light, even when the blindness is complete.
   In some cases the patient sees distant objects better than
near; in other cases again, near objects better than distant.
   Photopsy, chroopsy, and the undue retention of impres-
sions, giving rise  to  ocular  spectra, and complementary
colors, are frequent attendants on  amaurosis.  The gauze
or network seen in the light may still be visible in the
dark; but instead of being gray or black, it is of a silvery
or gold color.
   The pupil is  more or less  dilated, and  if  not  quite im-
movable,  its movements  are limited and  slow.   This,
although  one of the most characteristic  appearances pre-
sented by the amaurotic eye, is not constant.
   The invasion of the amaurosis may be sudden or gradual.
        11 
122
DEFECTS OF SIGHT.
In  the  former case, vision may be  at onco wholly lost, or
nearly so;  in  the latter case, it may be  only after a time
that the vision is seriously impaired.  In some cases, the
impairment of vision remains at a  certain  stage  without
advancing, in other  cases  it  continues  to  increase, tho
obscurity thickening  and  spreading, until the whole field
of vision is obliterated to the sense, tho perception of light
lost aud the amaurosis complete.   Sometimes  amaurosis
commences as night blindness.
   Kxccpt when  the case is of a purely local  nature, both
eyes generally become affected,- one eye first,  perhaps; and
by-and-by the other.  The  blindness being complete and
total in one eye some  degree of sight may still bo retained
in the other.
  The diseases the previous existence of which are often
found to have some connection with the  amaurosis, cither
as cause, or as depending themselves on the same cause, arc,
scrofula, syphilis, gout,  rheumatism, indigestion,  hypo-
chondriasis, hysterics, apoplexy, epilepsy,  paralysis, in-
flammation of the brain, typhus fever, lead poisoning, &c.
  In some cases the disease is found  to occur in connection
with disturbed menstruation, hysterics, pregnancy, child-
bed, hemorrhoids, and again to disappear entirely, but  to
recur, and  then perhaps to remain permanently.
  The  paralysis of the optic nervous apparatus, on which
amaurosis depends, may be the  result of morbid conditions
of that apparatus, differing much in their nature :
  They may be congestion or inflammation, and its conse-
quences; nervous exhaustion ; super-excitation ; or pressure.
And the retina, or the optic nerve, or the cerebral  portion
of the optic nervous  apparatus, may be more particularly
the part affected. 
AMAUROSIS.
123
   The causes to which  congestive amaurosis is owing, are
very various.  Exposure of the eyes to strong  heat and
light, in those  who work before large fires, &c.  Over-ex-
ertion of the sight.   Forced exertions of the body while
stooping the  head, especially in plethoric or drunken per-
sons.  Pregnancy.  Sudden suppression.of discharges—the
menstrual, perspiratory, hemorrhoidal, purulent, &c.  Irri-
tation of the  liver, stomach, and bowels, as in  indigestion,
costiveness,   or  worms.  Passions of the  mind.   Fevers.
Spirit-drinking.  Excessive use of tobacco, &c.
   Exhaustion  of the  optic  nervous apparatus is  often a
mere accompaniment of general nervous exhaustion, arising
from great loss of blood, or excessive discharge of secretions,
as in protracted suckling, venereal excesses, or arising from
grief  and other depressing passions—from  low nervous
fevers, fright, &c.
   The cases  of amaurosis which arise from super-excitation
occasioned by  sudden  strong impressions  on the retina,
such as an intense glare of light falling on the eye, con-
cussion of the eyeball, or  a stroke of lightning, and also
those arising from overplying vision, appear to partake of
the nature partly  of  nervous  exhaustion,  and partly of
congestion.   For example, the spot of the retina acted on
by a sudden  glare of light, or by smart concussion from a
blow, is  at  once rendered  insensible, and  the result is a
fixed musea,  which may ultimately go away or remain ; or
the whole retina may become insensible, though this more
generally takes  place slowly, as a consequence of superven-
ing; congestion or inflammation.
   Of the cases  depending on pressure, the amaurosis is, in
some, but a secondary consideration, more grave symptoms 
124
DEFECTS OF SIGHT.
of the organic disease  being  present;  in other eases the
amaurosis may be the only or principal appreciable symp-
tom.
  The prognosis in a  decided ease of amaurosis is most
unfavorable.   The disease, when it  comes on  suddenly,
even when complete blindness is present, is not unfrequently
relieved or cured, if it  has not already existed long.   The
disease which has come  on gradually, accompanied by pains
in the head, is more hopeless in general, as in  this case
the cause  most usually  is material disorganization of some
part of the optic nervous apparatus; whereas, sudden eases
may be owing to some  congestion, extravasation of blood,
or the like, admitting of removal hy timely treatment.
   ON  THE USF  OF TIIF  OPTIIALMOSCOPE.

  [Aid  in the  accurate  diagnosis  of  certain diseases
classed under the names of amaurosis, glaucoma, &c, can
be obtained by the careful use of tho Ophthalmoscope or
Speculum  Oculi.
  " The chief value of which seems to consist in enabling
the surgeon to  set  aside  as positively hopeless, a  large
number  of cases formerly termed amaurotic or  nervous;
which were assumed to be still curable, because their real
nature could not be  demonstrated.  We  now know that
total disentegration of the vitrious body detachment of the
retina from its connection with  the  choroid, and  other 
ON the use of THE OPTHALMOSCOPE.      125
equally hopeless conditions of structure  essential to vision
may exist, without  any alteration  being produced in the
outward appearance of the eye."*
  The Ophthalmoscope I prefer and use, is the one usu-
ally  attributed to Anagnostakis,  a Greek  physician, but
which was introduced by the celebrated  Graefe, of Berlin,
who had  shown it to his  Greek friend when visiting that
city.  It  is a single  slightly concave mirror, with a hole
drilled through its centre, and of about five  inches circum-
ference ; it is fixed in a handle  and is generally used with
a small hand lens, interposed to act as a magnifier, unless
the physician is myopic.  Touse it, the  patient should be
seated by a table  in a dark  room, with  a lighted  lamp or
gas burner, stationed  near his ear, and his  eye dilated by
belladonna or atropia.  The observer must now seat  himself
before the patient, and so place  the mirror that the light is
thrown  into  the patient's eye,  at the same time  looking
through the small central opening.  As  soon as the eye is
illumed, which is known by a reddish color  in the  interior,
the observer  brings near to the  patient's  eye, a convex
lens which converges the rays of light,  that by the  addi-
tional refraction they undergo,  on  entering the eye they
quickly come  to a focus, cross, and fall in a state of  great
dissipation on the  retina, so that it is extensively illumi-
nated.  On withdrawing the lens  gradually, the reflection
grows smaller, until it becomes  oblong and very brilliant.
In  this manner or modified, according  to  circumstances,
any change in the transparent structure  and retina are to
be carefully noticed, and the true focus obtained, which no

  * A Guide to Diseases of the Eye.  By James Dixon: London, 1855. p. 7.
                         11* 
12G
DEFECTS OF SIGHT.
one can obtain unless he becomes  familiar with  the use of
the instruments by frequent trials, and studies with  care,
the normal anatomy of the healthy eye and  its retina.]
                 ARTIFICIAL  EYES.

  ["The  improvements which have of late been effected
by the principal  artists of L*idon and of Paris, in the
composition of,  and method of coloring the  enamels for
artificial eyes,  render the imitation so perfect that not only
is the casual observer deceived, but even  the professional
man who is conversant with  opthalmie practice may not
detect the substitute.
  " I find that patients always couple the idea of pain with
the wearing of the artificial eye, and this  arises from  its
supposed size,  and the belief that tho  sensitiveness which
belongs to the eye only in its integrity, is retained after its
loss.  With the destruction of the cornea the greater por-
tion  of the sensibility of  the  front  of the  globe is de-
stroyed.
  " An artificial eye, is but a very little light shell of ena-
mel, made to represent  the front of the  living  feature.
The shape and size must vary to suit different cases, almost
each requiring a different model, and this  adaptation, and
the correspondence in  size with  the other eye,  demand
much more nicety than is necessary to match the color. 
ARTIFICIAL EYES.
127
   " It is the duty of the surgeon to see that the entire sur-
face,  including the edges, is  enameled, since it is a com-
mon practice for workmen, or rather agents for the sale of
artificial eyes, who are  not makers, to  grind the shell to
the required size without afterwards restoring the desired
smoothness, for which the action of fire is required.
   " When an eye is lost before the orbit has attained its
destined growth, this cavity is never fully developed ; and
the earlier in life that the accident has occurred, the less
will be its  size, and the case will  be  proportionally less
adapted for  the assistance of art.
   " Besides the removal of deformity, the presence of the
false eye may be of essential service in keeping the lids in
their natural  position, and  preventing the cilia from irri-
tating the shrunken globe;  in placing the puncta in a more
natural position for conveying away the tears;  in acting as
a defence against intruding bodies, which are apt to be re-
tained within the  lids and to produce irritation ; and as a
means of keeping the cavity free from collections of lachry-
mal secretions.
   " The lids may require  some  slight surgical operation,
such as the  removal of adhesions, or of thickened conjunc-
tiva, or of ectropium.
   " The eye is to be inserted in the following manner; it
is  to be wetted, and the broad or outer end first passed
under  the  upper lid,  slid as far as it will readily go, and
kept there with the fore-finger of the one hand, while with
that of the  other, the under lid  is drawn down till the
lower part slips in.  For removal, the lower  lid must be
depressed, and the  finger-nail, the edge of a tooth-pick, the
head of a pin, a little  hook, or any small and blunt instru- 
12S
DEFECTS OF SIGHT.
 ment, passed under the edge and made to lift it  forwards,
 when it will slip out;  and care  should bo taken to receive
 it in  the  hand, or on a handkerchief, for a fall would  bo
attended with fracture.   A person  6oon  learns to do this
 for himself.  Occasionally it is necessary to accustom tho
 lids to its presence by wearing it at first for a few hours
 only  at a time, and it may even  be requisite to begin with
 one of a smaller size than that to be eventually worn.  All
 active disease should   have passed away before one is
used.
   " An artificial eye requires great cleanliness in order to
preserve it, and it should be removed every night.   This
cessation of use is farther  necessary to prevent further ul-
ceration of those  parts on which its  edges rest.  If tho
globe be much reduced, the interior of the lids should  be
syringed with tepid water  every morning.   Should  there
be an habitual, unnatural conjunctival secretion, or should
that be excited by the  presence  of the enamel, an astrin-
gent  lotion  used night and morning may remove or less-
en it.
   " Instances are met with in which the  false eye causes
too much uneasiness to be worn.
   "After  the gloss is lost,  a new eye is  needed;  for if
the damaged one  be  still  used, irritation of the lids  is
set up.   The average  period  of wear  is about twelve
months."*]
  * A Treatise on Operative Ophthalmic Surgery, by H. HayneH Walton, edited
by S. LltteU, M. D. Philadelphia, Lindsay and Blalditon, 1833, p. 489. 
CHAPTER  III.
DEFECTS OF SIGHT DEPENDING ON LOSS OF CORRESPOND-
  ENCE  OF THE SENSATIONS  AND  MOVEMENTS  OF THE
  TWO EYES.

  As an introduction to the present subject, the correspond-
ence  which naturally  exists between the sensations  and
movements of the two eyes, requires to be taken into con-
sideration.

              Single Vision with two Eyes.
  As the rays of light emanating or reflected from the
different points of a visible object, proceed in all directions,
and in  straight  lines, those from the  same  points  must
necessarily, some of them, enter the one eye, and some the
other, and so impress both retinae in the  same  manner, and
at the same time.  From this double impression, it is to be
observed, we have not a double perception of the object,
but only a single one, provided the eye be naturally directed,
that is,  provided their optic axes intersect at some point of
the object, provided their centres of revolution  coincide, and
provided their horizontal and vertical diameters are respect-
ively parallel.
   When the two eyes are thus naturally directed, the parts
of  the two retinae which receives similar and  simultaneous
impressions from the rays of light entering  them from  a
given point of the object, are their vertices, and their vari- 
130
DEFECTS OF SIGHT.
 ous parts equally situated  in relation to them, on tho half
 of one retina next the temple, and on the half of tho other
 next the nose.   These parts of the  two retinae, as similar
 and simultaneous impressions on them  yield but a single
 visual perception,  are  called  corresponding  or identical
parts.
   If the two eyes are not directed  in  tho manner above
 described, the rays of light from given points of the object
 will not then fall on corresponding parts of the two retime,
 and the consequence will be  that the two impressions will
 be perceived by the mind separately, aud the object will be
 seen double.
   Amidst  tho  various  movements  of  tho  eyeballs, tho
 correspondence in their direction necessary for single vision
 is maintained by the concurrent action of their muscles.
 (p. 24.)

 Visual perception of the three dimensions of space, Length,
                Breadth, and Thickness.

  By the combined  action of the two eyes we arc enabled
 to perceive at one glance the length, breadth, and thickness
 of objects.  This is owing  to the position of the two cyea
 in the  head, by which each is fitted to receive on its retina
 a different perspective picture of the object  in  a manner
 analogous to that in which,  with two fingers, we can receive
 impressions from  two sides of a solid body, so that we
 recognize its thickness as well  as its length and breadth,
 whilst  the  mind, in  conformity with an original  connate
law of the  economy, does  not perceive  two superposed
dissimilar images, but only a  single  one, and  that, unlike 
      DIPLOPY OR DOUBLE VISION WITH TWO EYES.  131

 either of the perspectives, in full relieve or intaglio, as the
 case may be.
   The stereoscope shows this.
   The stereoscope, it may here be observed, also shows how
 vain it is for a painter to attempt  to represent objects in
 full relief or intaglio, as seen with the two eyes.   All that
 can be  really and  naturally represented, by painting on a
 plain surface, is merely the appearance of relief or intaglio
 as seen when one eye only is used.   This explains why it
 is that,  in  looking at pictures, we see them to greater
 advantage when  one eye is closed;  in fact, when we  use
 both  eyes, the appearance of relief, even as perceptible to
 one eye, is in a great measure destroyed.
   The faculty of perceiving the three dimensions of spaces
 by the two eyes, implies the faculty of  recognizing  the
 distance and position of near objects  by the same means.

         Diplopy or double vision with two Eyes.
   It is to be observed that double vision with two eyes is
 altogether different in its nature from the  double or mani-
 fold vision with  a single eye above  considered, the latter
 being owing to irregular refraction.  A case of double vision
 with two eyes is at once distinguished by closing one  eye,
 when objects will  be seen single.
   Double vision  with two eyes is the result of loss of  the
 natural correspondence of the optic  axes, the coincidence
 of  the  centres of revolution,  and the parallelism of  the
 vertical  and  horizontal diameters  of the two  eyes,  the
 conditions on which,  as above  shown,  single vision  de-
pends.   The immediate cause of the  derangement alluded
to is, most frequently, paralysis  of some one or more of  the 
132
DEFECTS Of SIGHT.
muscles of the eyeball; but  it  may be some morbid pro-
duction in the orbit, or the like, displacing the eyeball.
  The relative  position of the two images seen in double
vision depends upon the direction and degree of the devia-
tion of the eyes.
  As sometimes the deviation of the axes or centres and
diameters of the eyes exists only when the person looks in
particular directions and  at  certain distances, so does tho
double vision in such cases take place only when the pa-
tient looks in those directions, and at those distances.
  When double vision is  owing to deviation of the optic
axes,  the misdirection of the  two eyes may exist in various
degrees, from an  evident  squint to a scarcely perceptible
cast.
  When, on the contrary, double vision is owing to devia-
tion  of the  vertical and horizontal diameters  of  the two
eyeballs  from  parallelism,  in  consequence  of abnormal
action of one of the oblique muscles,  there is no deviation
of the optic  axes, and, consequently, no squint or cast.
  The irregular or impeded  action of the muscles of the
eyeball, giving rise to diplopy,  may be owing  to an affec-
tion of the muscles themselves or of their  nerves, or it may
be owing to  disease or injury of the brain, or to drunken-
ness, or fear, or to derangement of the stomach, &c.

Strabismus or squinting,  and luscitas or immovable dis-
                 tortion of the Eyeballs.
  Strabismus and luscitas are equally characterized by loss
of the natural correspondence of the optic  axes;  but, in
the former,  this is owing to want of harmony in the move-
ments of the eyes,  not to loss of  motive power, for the 
STRABISMUS, OR SQUINTING.
133
squinting eye becomes straight and capable of being directed
to any object when the other eye is closed; whilst, in the
latter, it is owing to one eye being fixed more or less im-
movably in one direction, in consequence either of paralysis
of the muscle moving the eyeball in the opposite direction,
or of induration and shortening of the muscle, or the like,
on the side to which the eyeball is turned.
   The  principal forms  of  strabismus  or  squint are the
convergent or inward, and the divergent or outward; and
of these the former is by far the most common.
   The  exciting causes to which strabismus is in different
cases attributed, or attributable, are  very various.   They
are such as the following:—Convulsions during infancy, dif-
ficult teething,  hooping-cough, measles, smallpox, worms,
injuries and  diseases of the head, fright, anger, injuries,
inflammation, and other  diseases of the eyes, such as opaci-
ties of the cornea, imitation, and a  habit of misdirecting
the eyes.
   Most commonly, squinting has its origin in early life;
indeed, many of the diseases just enumerated as exciting
causes of the affection are diseases of early life.
   Frequently, no cause  at all can be  assigned.
   In most cases the vision of the squinting eye is imperfect.
   Whatever be the remote cause of strabismus,  there can
be no  doubt that its  proximate cause consists in some af-
fection of the muscles of the eyeball.   The question which
this conclusion naturally suggests is, what is  the nature of
the affection of the muscles of the eyeball ?
   The  various  exciting causes of strabismus which  have
been remarked, such as  imitation, affections of the  mind—
anger,  fear,  &c,—disease  of  the brain, intestinal canal,
        12 
134
DEFi:rrs OF SUiHT.
and other parts,  together  with the circumstance  that  it
may occur occasionally only, aud  the  phenomena  of tho
distortion in general, all point to the muscular affection
being owing to perverted nervous action.
   When  convergent squint is of recent origin, and if its
exciting cause can be discovered, and is  still in operation,
the removal of it ought to be the first object of treatment.
   It is scarcely necessary to say, that whatever prompts to
a habit of misdirecting the  eyes, whether imitation, trying
to look at objects too near the cyv^, or otherwise disadvan-
tageously  placed,  careless  employment  of the  sight, and
the like, must be carefully guarded against.
   Exercise of the habitually misdirected eye during  two
or three hours daily, by covering the other  eye, has often
been found  successful in curing squint.   But  it is apt to
happen that, whilst the habitually misdirected eye becomes
straight, the previously well-directed one  turns in.
   When convergent squint  has become fully established it
resists, as is well known, all treatment such as that above
indicated, and no other help remains but  the operation.
   Operation.—This  consists in division of the affected
muscle,  is very simple in  the  performance, and not ac-
companied by  much  pain.
   Section of the internal  straight muscle of the habitually
misdirected  eye alone may be sufficient, but section  of the
internal straight muscle of both eyes is generally necessary,
as it is found that, if one eye only is operated on, it either
still remains inverted, or, if it is rendered  straight, the
previously well-directed eye  is apt to  turn in.
   The latter circumstance is  analogous to that above pointed
out, viz.,  that when  the previously well-directed  eve is 
PARALYSIS OF THE MUSCLES OF THE EYE.    135
covered, and the habitually inverted one, by being thus
called into  exercise, becomes straight, the former turns in.
  In general, little treatment is required after the operation.
  It is, however, always  advisable to keep  the  patient at
rest for some days.  The eye should be bathed with luke-
warm water night and morning.
  Should a return of the squint take place, the operation
may be repeated.  Sometimes success has  been obtained
only after a second or third repetition.

   Paralysis of the muscles of the Eyeball and Eyelids.

  It sometimes  happens that  a^person is seized with  ina-
bility to open one eye.   When, in such  a case,  the  upper
eyelid is raised with the finger, it will perhaps be seen that
the patient, though he can turn his eye towards the temple,
cannot look inwards, upwards,  nor downwards.    If he
attempts to look forward or to the unaffected side, the
patient sees objects  double,  in  consequence of the non-
correspondence of the two eyes, and he is apt  to become
giddy if he tries to walk while he holds the eye open.
   In addition to the defects  in the moving power of the
eyelids and eyeball just  described, there may be persistent
dilatation of the pupil, with impairment of sight, depending
on that disturbance  of the adjusting power of the eye.
   Many such cases come on under the same circumstances
as rheumatism,  viz., exposure to cold and damp, and admit
of being  perfectly cured by active, general antiphlogistic
and alterative treatment.
   Sometimes the paralysis is of a more serious  nature, be-
ing owing to some disease within the skull. 
131)
DEFK.CTS OF SKiHT.
  Cases of paralysis of the muscle which turns the eyeball
outwards arc of rarer occurrence than the preceding. There
is no accompanying falling down of the upper eyelid ; hence
the double vision, arising from the  non-correspondence of
the two  eyes when the  patient  tries  to look towards the
side affected, is more felt.
  This palsy is more tedious of cure than the preceding. .
  Another form  of paralysis is that in which the eyelids
cannot be shut.   In such cases, all the corresponding side
of the face is usually more or less paralyzed.
  These  different  classes of cases require early attention
and careful treatment. 
PART  III.
                   CHAPTER  I.

PREVENTION AND MANAGEMENT OF THE DISEASES OF TnE
   EYES APT TO OCCUR AT THE DIFFERENT PERIODS OF LIFE.

Early  Infancy,  or period  at and from Birth, up to
                        Teething.
   Ophthalmia of New-born  Infants.—Within a few days
after birth, though sometimes later, infants are liable to an
inflammation of the eyes, attended  by great  redness  and
swelling of the eyelids, with  discharge of yellow matter.
   This disease, if taken in time, and properly treated, may
be in  general completely cured.   Left  to itself, or  ineffi-
ciently treated, however, it will run on so as to cause mate-
rial injury,  too often total destruction of the eyes.   This
is the cause of blindness  in a large proportion of the blind
poor.
  The manner in which this disease  is neglected, among
the poorer classes especially, is almost incredible, notwith-
standing the needful advice and medicines may  be had for
the asking.   It is usually only after the disease has  been
going on for two  or  three weeks, and when the eyes  have
already, perhaps,  been irremediably injured, that the oeu-
                         12 * 
13*          PRESERVATION OF THE SKillT

list is applied to.   In excuse for this neglect, we are often
told, by the mother or nurse, that the complaint of the eyes
was supposed to be nothing more than a cold ;  as if a cold
in the eyes might not, and did  not, in many cases, prove
very destructive to vision.   Tho truth  is, that, in numer-
ous instances, a cold has some share at bast in  the produc-
tion of this ophthalmia of new-born infants.
   Exposure of  the infant's eyes, immediately after  birth,
to light, the heat of the fire, or draughts of air; careless
bathing of the eyes, perhaps with a dirty sponge;  the direct
intrusion  into  the eyes of the soap used  in washing the
infant, or of the spirits sometimes rubbed over its  head,
appear to be common exciting causes of the disease.  That
the disease is also frequently occasioned by inoculation of
the eyes with morbid matter during labor, there can be no
doubt.
   The circumstance that a number of cases often come
under the notice of the  practitioner at the  same time,  and
that a considerable interval will  elapse before any new
cases  present themselves, would  appear to  show that  the
occurrence of thadisease, like that of epidemics, is in some
manner influenced by the weather.
   To guard against the  disease as far as possible, the eyes
of infants, immediately after birth, should be gently bathed
with simple warm water, by means of a bit of  soft linen
rag, and afterwards carefully dried.   The greatest attention
should always be  paid to protect the eyes from exposure to
light, heat, and draughts of air.   At  the  same time, it
must  be remembered that the air ought not to be confined
around the infant's face.  Of course, good ventilation of
the apartment is essential. 
IN EARLY INFANCY.
139
    In many cases of the disease, we find that the infant is
  not suckled, but is nourished with prepared food.  Under
  such  a  mode of diet, we find the inflammation apt to run
  a more dangerous  course;  and  there can  be little doubt
  that the want of the natural nourishment often promotes
• the invasion of the disease.   For this reason, as well as for
  many others, infants should  always, if possible, be brought
  up on breast-milk alone.
    That an infant is actually  affected with the inflammation
  of  the eyes  under consideration, may be known by the eye-
  lids being red and  swollen  at their edges, by their being
  gummed together after sleep, and by the discharge of yellow
  matter which  takes place from between them when they
  are opened.  As soon as these symptoms are discovered,
  medical assistance should be  called in.   Every hour's delay
  is fraught with the most imminent danger to the sight.
    It  is to be  kept  in  mind  by those engaged about the
  infant,  that the disease is catching—that matter from the
  infant's eyes accidentally coming into contact with the eyes,
  even  of a grown-up person,  is apt  to excite in them an
  equally dangerous and  destructive ophthalmia.   It is also
  to be kept in  mind, that, in  ill-ventilated apartments, in-
  fection  may be propagated through the air, especially from
  one infant to another.
    Even when the eyes are not materially injured, or totally
  destroyed by the ophthalmia of new-born infants, they are
  apt to be left in a much debilitated state and very suscepti-
  ble of future disease.
    Not unfrequently, when the eyes are sufficiently far re-
  covered to  admit  of accurate  examination, we discover
  central cataract. 
 140          PRESERVATION OF THE SKiHT

   Cataract in  Infants.—Whether the  central  cataarct,
 which we sometimes discover after the subsidence of  tho
 ophthalmia of new-born infants, existed  at birth, or came
 on during the inflammation,  cannot always be with certainty
 determined, for want of previous accurate examination  of
 the eyes at  birth.   There is, however,  no doubt  that  tho
 infant, at birth,  is sometimes affected with cataract; and it
 is probable that in many of the cases of cataract first noticed
 in infancy and childhood, the opacity had already existed,
 though in a less degree, at birth.
  Congenital  cataract appears to bo owing to an  original
 imperfect formation of the crystalline lens; and, as in eases
 of congenital malformation of other parts of the eye and of
 other organs, several children of the same parents arc some-
 times found affected  with it.
  Though the occurrence of tho disease in one child may
 make us dread lest  the  children of subsequent births be
 similarly afflicted, it is  quite beyond  our power to inter-
 pose any special  means of prevention.
  Of course, every attention should bo paid to  the mother's
 health during  her pregnancy, and  her  mind should be, as
 much as possible, diverted from brooding over the idea that
 the infant she is carrying may be also born blind from cata-
 ract.
  The only remedy for congenital cataract, as  for the cata-
ract which occurs at  other periods of life,  is an operation.
  If the cataract be limited to a small dot  of opacity in the
 middle of the pupil,  no operation is immediately called for.
 When, however, the opacity involves the whole lens, and
evidently interferes  materially with  the sight, it is proper
to operate. 
IN EARLY INFANCY.               141
  The period  after birth when the operation for the cure
of congenital cataract should be had recourse to is before
teething commences ; or, if that period has been allowed to
pass, as soon after teething has been completed  as possible.
  The reason for the early perfoamance of the  operation is
this:—As the infant  cannot see, its eyes are not  fixed on
objects, but roll about in a heedless manner.   This being
allowed to go on, the infant  loses command over the eyes,
or rather does not acquire command over them;  and even
if sight be afterwards restored by an operation, the  power
of directing the eyes properly and steadily towards objects
may never be fully gained.
  It is also to be observed that good sight is  more likely
to be restored by an early operation. Moreover, the impor-
tant opportunity of education of and by the sight is secured.
  The operation for congenital cataract is division.  In-
fants above two years old may be put under the  influence
of chloroform ; but this is scarcely necessary in the case of
younger infants.
  They are sufficiently  secured  by wrapping  them in  a
shawl, to  confine their arms and hands, and laying them
on their backs on a table.
  The tender and  delicate constitution of early infancy is
no objection to the performance of the  operation, because
this is in  itself extremely gentle.  Not more  than half a
minute is taken up in its performance, and the pain is not
greater tSan that of the prick of a needle. The infant will
cry at the moment, but very soon after becomes pacified.
  Usually no inflammation  results, and in the  course of
some weeks the opaque lens is removed by absorption and
sight proportionally restored. 
142                DEFECTS OF SIGHT
  Not unfrequently,  however, some degree of opacity of
the capsule supervenes, which  may require ft repetition of
the operation for its removal from behind the pupil.
   Congenital Imperfections of the Iris.—A congenital mal-
formation of  the eyes whkdi  sometimes  occurs consists  in
an incomplete formation of the  iris or its total absence.
  The unfortunate subjects of this  latter defect are pain-
fully impressed by the  too great influx of light  into  tho
eye, so that for relief they seek the dark, and keep their
eyebrows  depressed and their eyelids half closed.   Their
vision  is  also imperfect,  partly  from the  dazzling whioh
arises from the impression of too  much light on tho retina,
and partly in consequence of such optical aberrations as it
is the function of the iris with  its pupil  to correct.   Com-
paratively small amelioration of the latter defect is derived
from the use  of an artificial iris, or dark plate with a small
aperture in it, placed  before tho eye when the child is old
enough to wear it.
  In cases of congenital absence of the iris, if cataract does
not already coexist, it is very likely to come on  sooner or
later.
   Congenital Amaurosis.—It sometimes happens that an
infant,  though old enough  to notice, docs not  follow a
lighted caudle or other bright  object with its eyes.  This
is sufficient to raise a suspicion of blindness from amaurosis
or defective sensibility of the optic nerve.
  This suspicion will probably prove too well founded if
the eyeballs  are at the same  time smaller or  larger than
natural, or if they have a rolling  motion  in the sockets.
   If, however, the eyes arc otherwise healthy looking, and
especially if  the  pupils contract naturally under the in- 
IN EARLY INFANCY.
143
fluence of the light, the child may, in the course of some
months, come to give more and more evident signs of gain-
ing strength  of vision, which by the end of the first year
may appear perfect.
  When the eyes are much smaller than  natural, there is
no hope of sight being acquired.
  A larger size of the eyes than natural sometimes occurs
at birth, and is called dropsy of the eyes.   The cornea in
such  cases, besides  being unusually  large, is opaque  or
cloudy.   There  appears to be at the same time  defective
sensibility  of the retina.   In a  few  instances the  cornea
has, with the growth of the child, become clear and some
degree of vision been acquired.
   Congenital Imperfections of  the Eyelids.—Congenital
imperfections of the eyelids occur, such as defective power
of raising the upper eyelids, a state of matters occasionally
met with in several members of the same family.
   Children are sometimes born with eyelids grown together
at their edges.
   Moles or mother's marks of different kinds occasionally
occur on the white of the eye or on the eyelids, and  require
to be particularly attended to by the medical man.
   Protection of the Eyes of Infants.—The eyes of  infants
should  always  be guarded from  exposure to strong light.
Especial care should be taken not to bring an infant  sud-
denly from the dark into a bright light.
   Nursemaids are often seen carrying their infantile charge
with the  eyes  fully exposed to the  sun's rays, and even
stand a long time  gossiping with other nursemaids  not-
withstanding the child may be giving expression, by cries 
 144          PRESERVATION OF THE SIOHT

 of distress, to the suffering  it is undergoing  from tho ex-
 posure of its eyes to the light.
   Toys should not be held close to the eyes of infants; nor
 should cap-strings,  side knots of  ribbons; and any bright
 object about the bed or cradle, or light calculated to attract
 the eyes, be allowed to remain, for fear of the infant ac-
 quiring a habit of squinting.
   The eyes of infants while sleeping should be guarded
 from flies by gauze curtains to the cradle.

 Infancy and  Childhood,  or period  from  the commence-
       ment of teething up to about the eighth year.
   Phlyctenular Ophthalmia.—From the commencement
 of teething till about eight years of age, children are subject
 to an inflammation of the eyes usually attended by excessive
 intolerance  of light,  so that they cannot look up.
   Out of one hundred cases of inflammation of the eyes in
 children at that time of life, it has been estimated that ninety
 are of this  kind.  Now, when we reflect how readily  tho
 disease leads to impaired  sight, how obstinate it  is, and
 how prone  to relapse, the importance  of  palliative and
 preventive measures  may be conceived, especially as much
 may be done to mitigate its attacks, if not ward them off
 altogether.
  In children affected with this ophthalmia, there is usually
 a disordered state of the  general health.   The digestive
 organs and skin especially are found out of order.   Besides
 the inflammation of the eyes, there may be eruptions about
 the head, sore ears, running from the nose, tv_c.
  The disordered  state of general health, of which the
inflammation of the eyes under consideration is so often an 
             IN INFANCY AND CHILDHOOD.          145

accompaniment, is much dependent on an original delicacy
of constitution  of the child, but to a very great degree also
on the diet, regimen, and weather.
   Want of mother's milk during infancy, improper diet
afterwards,  impure air,  insufficient clothing  are  some  of
the predisposing causes of the complaint, whilst our variable
climate powerfully aids their operation.   We  see the effect
of the weather  in the rapid changes this ophthalmia under-
goes when it suddenly becomes either cold and wet, or dry
and warm;  all the symptoms being aggravated in the first
case and ameliorated in the latter.
   The  first attack of the disease often comes on from the
irritation of teething, after the measles, from  cold, &c.
   The preservation of the general  health, as far as possible,
by simple nourishing diet and comfortable clothing (flannel
next  to the skin,) tepid or cold bathing, friction of the
skin, well-ventilated  and moderately lighted  nursery (the
best-ventilated room in the house should be selected for the
nursery,) and  regular exercise in the open air, constitutes
the most important preventive of this ophthalmia.
   When the disease has once occurred, and there is a great
tendency to relapse, removal from town to country, or to a
more sheltered situation, or even  to a milder climate will
often be advantageous.  A dry, warm, inland situation  is,
perhaps, preferable to the sea-side, the glare  from the  sea
being apt to operate unfavorably.
   An actual attack of the disease should be most carefully
attended to, as neglect is very apt to lead to great  injury
of the eye and sight.
   Every new  attack  renders the eyes useless for a long
time at least,  breaking up  the  health  still  further, and
        13 
146          PRESERVATION OF THE SltiHT

spoiling the temper of the child, to say nothing of inter-
rupting the education.
  Blear Eyes.—This is the result of an inflammation chiefly
affecting the edges of the eyelids, which has suffered  fre-
quent relapses, or never been properly treated.
  The inflammation of the edges of the eyelids originates
under somewhat  similar circumstauces as the preceding, and
requires to be guarded against by similar means.
   Care and managenu nt of the Eyes during  Childhood.
—Children should  not be permitted to sit up late, nor to
fatigue  the eyes by attempting  to read,  draw, sew, or the
like, by caudle light.
  They should be  accustomed to rise early, but only after
a good long night's rest.
   liven when  the eyes arc impatient of light, the child
ought not to be confined  to a dark room, nor forbidden to
go out in  fine weather.   AY hen  the child does go out, tho
cy{j^ should be protected from the light  by a bonnet-front
shade.
  It is at this period that attention  is often  for the  first
time, or at least  more particularly, drawn to congenital de-
fects of sight.   Defective sight from congenital cataract in
a less  degree, for example, which  may have  hitherto re-
mained undetected, is now often  taken by the friends of the
child for short-sightedness.

                 Youth and Adolescence.
   Inflammation of the Cornea.—There are two forms of
this inflammation; one characterized by great intolerance of
light like phlyctenular ophthalmia,—the others not so much
so, if at all. 
IN YOUTH AND ADOLESCENCE.          147
  The persons affected are usually of a constitution and
state of health similar in  many respects  to what is above
indicated in the cases of phlyctenular ophthalmia and blear
eyes.   The  inflammation is equally, if not more  stubborn
and dangerous  to the sight.  The  prevention and general
management, therefore, are in principle, the same.
  Females are, perhaps, more frequently the subjects of
this inflammation, and in them when, about the  age of
puberty, there is often  disturbed menstruation.   Under
such circumstances, peculiar attention is requisite.  Amongst
other  precautions, the patient should not be bound tightly
up in stays.
  Anterior Internal Ophthalmia.—Iritis, or inflammation
of the iris, is sometimes  met with at this period of life—
perhaps as an  extension of the inflammation of the cornea.
Depending on the same state of constitution  and health,
and excited by the same causes, it  is to be guarded against
by similar means.
  Posterior Internal Ophthalmia.—Dimness  of sight, in
a greater or less  degree, is the symptoms which  generally
first seriously  attracts attention.  Fixed muscaa, photopsy,
headache, and intolerance of light,  may or may not be pre-
cursors or accompaniments.
  This form of posterior internal  ophthalmia is  met with
principally in  young adults of delicate constitution, more
frequently females than males, and is commonly attributable
to over-use of the eyes, with neglect of exercise, derange-
ment  of  the stomach and  bowels,  disturbed menstruation,
&c.
  The prognosis  is unfavorable;   in the more   advanced
stage, very much so. 
148
PRESERVATION OF THE SIGHT
   Care and management of the Sight in Youth and Adol-
cwnsc.—h  is at this period of life that  the eyes come  to
be used in earnest, and defects of sight, which  may have
had their source in  the  earlier periods of life, now  more
particularly attract attention, or become more fully develo-
ped.
   In many cases defective sight is, for the  first time, occa-
sioned by overwork of the eyes.
   Excessive use of the eyes about this period is especially
apt to render them asthenopic, that is incapable of main-
taining their adjustment  for near objects, as in reading  or
sewing, for any length of time, p. 80.
   Glasses for short-sightedness are now often  for the first
time required, p. ~a-
   Far-sightedness is  sometimes met with in young persons
after recovery from a  fever, influenza, &c.  Such cases should
not bo neglected, nor should those occurring under similar
circumstances, in which the sight is dim for both near and
distant objects, and in which,  though the former are seen
best, the sight is improved by  convex glasses.

                      Adult  Age.
   Catarrhal,  Rheumatic,  and Catarrho-rheumatic  Oph-
thalmia.—Persons of any age, of either sex, and otherwise
healthy, may, by exposure to cold, be attacked by a catarr-
hal ophthalmia—a prominent symptom  in which is as if
there were some particles of dust  in the eyes.   An inflam-
mation resembling rheumatism  in its accompanying  pain
and its exacerbations, as also in the constitutional symptoms,
inflammatory fever,  derangement of digestive organs, and
in its causes, predisposing as well as  exciting, occurs only 
IN ADULT AGE.
149
in adults, though more rarely than catarrhal  ophthalmia,
and than another inflammation partaking of the characters
of both catarrhal and rheumatic.
   Iritis, or inflammation of the Iris.—The causes of iritis
are various; but their effect, if neglected or mistreated, is
closure or obstruction of the pupil, whereby the light being
stopped on its way to the retina, sight is prevented.   In a
large proportion of cases, if not in all, this fatal effect may
be obviated  by proper  and  timely treatment.   But  in
numerous cases there is neither timely nor proper treatment.
Notwithstanding the pain around the eye which so often
attends the disease, the patient not only does not apply for
assistance  sufficiently  early to  prevent the obstruction of
the pupil, but perhaps uses some irritating eye water which
only makes things worse.   It is to be confessed, however,
that in some cases of injured or destroyed sight  from this
cause, the medical  man  has been at fault.   He has not
recognized the  true nature of  the inflammation, but mis-
taking it  for  an external inflammation, such as catarrhal
ophthalmia, he  has  merely ordered some stimulating eye-
water, which has only  aggravated the inflammation  and
hastened it on to its-much to-be-dreaded result of contracted
or closed pupil.
   The most common form of acute iritis is that connected
with a rheumatic habit of the system.
   The common exciting causes are : injuries; over-exertion
of the sight, which  may act as both predisposing and ex-
citing cause; exposure of the eyes to too strong light and
heat;  exposure of the body to cold.  Both eyes  usually
become affected.
   Relapse is very frequent; but the earlier and more com-
                           13* 
 150          PRESERVATION OF THE SICIIT

 pletely the  first attack has been subdued,  the less liability
 there is to relapses.
   Pn vent ion of relapse.—A  person who has once suffered
 an attack of iritis  should carefully guard against siuhlcn
 transitions from heat to cold, violent  exertion,  late hours,
 much  reading and writing, and, at the same time, attend
 strictly to his diet.  Sea-bathing is often useful in strength-
 ening the system against the susceptibility.   AVhcn a person
 has  become liable to  relapses,  residence in a  southern
 climate during two or three successive winters may be the
 means of saving  him from his dreaded attack and breaking
 up the tendency.

                      Turn of life.
   Inflammation of the Eyes.—The eyes require still to be
 guarded against  the  inflammations  above described  as
 occurring in adult age.
   Presbyopy and choice of spectacles.—The turn of life is
 the time when people most commonly find  themselves com-
 pelled to  have recourse to  spectacles on  account of pres-
 byopy or long-sightedness.   See "Far-sightedness," p. 77.
   Amaurosis.—About  this  time,  also, those  who have
 suffered at an earlier period  from repeated  attacks of  oph-
 thalmia, or who have  for a long time  over-exerted their
 eyes, are liable to a greater or less degree of impairment of
 the sight from diminution of the sensibility of the retina.
   Altogether, the turn of life is a critical time for the sight
as Vvell as for the system generally.   We ought, therefore,
to endeavor to avoid, as much possible, every unnecessarily
prolonged exertion of the eyes in reading  or other minute
work, especially by artificial light. 
IN old age.
151
                        Old age.

  Arthritic or gouty  Ophthalmia.—Persons liable to be-
come affected with this inflammation of the eyes have often
been long subject to derangement of the digestive organs
and internal congestions.
  The eyes have seldom been previously altogether sound.
The  person has been subject to a sensation of fulness in the
eyeballs, appearance of  sparks of fire before the eyes, and
even temporary attacks of  blindness, in  consequence of
stooping, becoming heated, &c.
  In persons in the condition of general health, and  with
the state of eyes just described, ophthalmic inflammation
induced by any common occasional cause is prone to assume,
the form of arthritic posterior internal ophthalmia.
  As more special causes, may be  mentioned, suppressed
gout, anxiety and mental distress,  suppression of hemorr-
hoids,  the suppression of any  other habitual  discharge,
continued over-exertion of the eyes, strong light, cold, ex-
cessive use of tobacco, spirit drinking.
  Presbyopy and change of Spectacles.—Long-sightedness
which commenced  about the turn of life is usually found
to have  increased  in old  age, requiring spectacles  of a
higher power.   Sometimes not only a pair for reading with,
but also a pair for viewing distant objects is necessary.
   Cataract.—Common, hard lenticular cataract is  now of
frequent occurrence.   See " Cataract of  old persons," p.
48.
   Glaucoma and  Amaurosis.—At this  period, sight is
often irremediably lost from glaucoma  or green cataract 
152         PRESERVATION OF THE BIGHT.

and amaurosis, which perhaps has been coming on gradually
for a long time.
   Under such  circumstances, a  sudden attack of gouty
inflammation of the eyes destroys the sight in  a few days,
or even a single night.
   Persons at this period of life, who arc at all predisposed
to inflammation of the eyes, ought to be particularly care-
ful in  guarding  against the  causes  of gouty  ophthalmia
above mentioned. 
CHAPTER  II.
PRESERVATION OF  THE  EYES IN CERTAIN  GENERAL DIS-
                       EASES, &C.

Preservation of the Eyes in Measles,  Smallpox,  Scarlet-
                 fever,  Hooping-cough.

   The eyes are liable to suffer from inflammation in these
diseases, especially the two former.
   Although, in general, the ophthalmia  subsides with the
general  disease under very simple treatment, it should  be
as carefully watched as  if it  were  an idiopathic  or inde-
pendent  inflammation.   By neglect, very serious or irre-
trievable injury to the eyes may accrue.
   The particular forms  of inflammation liable to arise in,
or to which a tendency is apt to be left by, measles, scarlet-
fever, and hooping-cough, are phlyctenular ophthalmia, the
inflammation of the edges of  the eye-lids, ending in blear
eyes, inflammation of the lachrymal passages, with watery
eye,—sometimes iritis.
   In  the course of the general disease, the  eyes should be
guarded  from strong light, and bathed  occasionally with
tepid water.
   During convalescense, especial  care should  be taken  to
guard against exposure to cold.
   Variolous  ophthalmia, or inflammation of the eyes  in 
154
PRESERVATION OF THE EYES
smallpox, is generally a much more severe and  dangerous
inflammation than that occurring in or supervening on the
other diseases above mentioned, as used  to be exemplified
with such lamentable frequency beforo the general  intro-
duction of vaccination.   Even  yet we occasionally  meet
with cases of smallpox in which the eyes arc  destroyed.
In smallpox, not  only is a tendency left to phlyctenular
ophthalmia, blear eyes, disease  of the lachrymal passages,
&c.; but  the eyelashes are often partly lest  and partly
turned in against the eyeball.
  As a prophylactic measure during the eruptive stage, any
matter which collects at the borders of the eyelids, is  to be
frequently washed away  by means of tepid  water;  and,
after each ablution, some mild salve is to be smeared along
the borders of the  eyelids.
  The eyes are not safe even after the smallpox-pustules
over the body have subsided,  and the scabs fallen off.   On
the contrary, then is the  chief danger to the  eye, by ab-
scess and destruction of the cornea.   This generally occurs
about  the twelfth  day  of  the eruption, but sometimes as
late as five or six  weeks after recovery from the primary
disease.
  In such a case, medical  assistance is indispensably neces-
sary.

          Preservation of the Eyes after Fevers.
  In great exhaustion, after typhus or yellow fever, abscess
of the  cornea occasionally  occurs.
  Amaurosis is not an uncommon effect of fever.
  In a fever which has prevailed at different times in  Dub-
lin, and  which  prevailed very  extensively in  1843 and 
                IN VENEREAL DISEASES.             155

1844 in Edinburgh and Glasgow, an internal inflammation
of the eye with amaurotic symptoms frequently supervened.
It occurred chiefly in young adults, and  its onset was
generally traceable to some such exciting cause as exposure
to cold, using the eyes too  early after  recovery from the
fever, &c.
  Over-work during convalescence from influenza is apt to
bring on muscae volitantes and even amaurosis.

  Preservation of the Eyes in Child-bed and  Suckling.
  A most dangerous inflammation sometimes attacks the
eyes in the fever of child-bed; but considering the  grave
nature of  the principal disease,  the affection of  the eye
constitutes but a comparatively secondary consideration in
the case.
   Amaurosis  is apt to come on after great  losses of blood
in child-bed.
   The eyes and  sight are very often much debilitated by
prolonged suckling.

      Preservation of the Eyes in Venereal  Diseases.
   Both gonorrhoea and syphilis are a source  of dangerous
and often destructive inflammation of the eyes.
   A most dangerous inflammation of the eye,—one indeed
which is often  rapidly fatal to the sight,—is a purulent
ophthalmia, occasioned by the accidental application of the
matter of gonorrhoea to the eye.
   The matter is sometimes accidentally applied to the eye of
 a healthy person through the medium of foul cloths, &c.   It
 is in this way that children are sometimes inoculated.  I 
156   PREVENTION OF CONTAGIOUS OPHTHALMIA.

have seen a little girl have her eye destroyed by the disease,
having  been inoculated by washing her face with a  cloth
which her worthless father had been using in wiping away
his gonorrhoeal discharge.
   Inoculation with the matter of gonorrhoea* is not  unfre-
quently the cause of the ophthalmia of new born infants,
when the mother labors under that disease at the time of
her confinement.
   A person who has suffered from gonorrhoea often remains
subject to severe attacks of rheumatism.  The eyes, under
such  circumstances, sometimes suffer from inflammation of
the  iris,  which  presents  the ordinary  character  abovo
noticed under the head of iritis.  This disease of the eyes
is  very liable to relapse, and by neglect or mismanagement
often ends in much impaired or lost sight.
   The inflammation of  the eyes  arising, as a secondary
effect, from  syphilis, is  most  generally an iritis of a very
severe and dangerous character.
   The constitutional  disease appears to be in some  cases
the exciting as well as the predisposing cause; but in  other
cases, the iritis is excited by exposure to cold, over-use of
the eyes, A;c, which should therefore be avoided  as much
as possible by a person in a condition rendering him liable
to be attacked.

Pn edition of the spread of contagious  Ophthalmia in bar-
              racks, schools, workhouses, rfx\
   The matter from an eye affected  with purulent  ophthal-
mia, if applied to a healthy eye, will  excite a similar  in-
* Inoculation with the matter of whites Is a more frequent cause. 
       PREVENTION OF CONTAGIOUS OPHTHALMIA.   157

flammation.  Such a communication by contact has often
taken place from the use in common of towels, basins, &c,
and  so  an ophthalmia has  spread  from  one person  to
another.  Without actual contact with matter, contamina-
tion  of  the air, by having matter dissolved in it, is a very
common mode  of propagation.  Thus, when large bodies
of people are crowded  together, especially in  dark,  dirty,
damp, ill-drained, and ill-ventilated dwellings, contagious
ophthalmia is apt to break out.  This is the explanation of
its propagation in armies, schools, workhouses, prisons, &c.
The  original cause of this disease was at one time supposed
to be a peculiar contagion, first imported into Europe from
Egypt (hence the epithet Egyptian,) by the English and
French  armies.   It is  now,  however, pretty generally con-
ceded, that the disease does not depend on any such pecu-
liar contagion, but that it may arise from occasional atmos-
pherical influences, sometimes in isolated cases, sometimes
epidemically.  There are also local influences which render
the disease endemic in  many other places besides Egypt.
  The disease, in a more or less latent state, is very com-
mon among the lower classes of Irish.
  When the disease  is  prevalent among a number of people
necessarily collected together,  the healthy  should be im-
mediately separated from the diseased,  and the eyes of the
healthy should be inspected daily.
  Amongst soldiers, the predisposition is  occasioned by
their exposure on guard, their crowding in barracks not
over-clean or well-ventilated, drinking, improper clothing—
especially tight collars  and heavy caps.
  About twenty years ago the disease was very prevalent
in the Belgian army.   By  the discharge of the diseased
       14 
159
DEFECTS OF SIGHT.
soldiers, and their  return to private life,  the  ophthalmia
has been propagated among the lower classes of civilians in
Belgium.

 Prejudicial influence on the Sight of the excessive use of
                        Tobacco.
  Without a disposition  to congestion of the eyes, the use
of tobacco operates most injuriously on the sight.   Persons
affected at an earlier  age than usual with glaucomatous
amaurosis, or that state of the eyes in which inflammation
from any occasional cause is apt to assume  the gouty char-
acter and rapidly destroy sight, I have often found to have
been long addicted to an excessive use of tobacco and some-
times spirit drinking. 
PART   IV.
                  INTRODUCTION.

          THE DEAF  AND THE BLIND.

   It is a great calamity to lose either the use of the eye or
the ear.  The loss of the first in early years, can be made
up by the valuable instruction now  received at our blind
Institutions, and so of the second in the  admirable asylums
for the deaf and dumb, found  now throughout the  length
and  breadth  of this  favored land,  due to  the labors of.
Gallaudet, Clerc, Wilde, Peet, Hutton, and other truly phi-
lanthropic men.  In  the adult male or female, the loss of
either of these senses will be felt more or  less a calamity
in proportion to the habits and taste of the individual; if
fond of music,  the loss of  the  eyes would be a matter not
so distressing as the loss of the sense of hearing, but if the
individual is fond of  the fine arts and painting, the loss of
sight to him would be the most severe punishment that
could possibly befall him.
   No better illustrations of these two conditions could be
found on record than that of Milton the poet, and  Beeth-
oven the musician.  Milton,  in one of  his  most beautiful
passages of his Paradise Lost, thus  expresses his feelings
when lamenting his blindness, but in another passage re-
joices in the other senses which are  left him:— 
160
DEFECTS OF HEARING.
                       ----" With the year
            Seasons return; bat not to mo returns
            Day, or the sweet approach of even or morn,
            Or sight of vernal bloom, or summer's rose."
   But in another passage  he tells  us—
            " That though his eyes their seeing have forgot;
            Nor to their idle orbs doth sight appear,
            •    *»»»••
            *    »      *     Yet I  argne not,
            Against Heaven's hand or will, nor bate a jot
            Of heart or hope; but still bear up and steer
            Right onward."
   " Contrast with Milton  an equally great genius, Beeth-
oven the musician, who in the prime of life had the mis-
fortune to  lose  his  hearing, and could  find almost  no
alleviation of his misery,  in gratifying the  senses which
remained.  Gloom, anguish,  and often the blackest despair,'
darkened all his later years onward to the  tomb."
   " Those who  are born, or  early become  deaf, are far
more  isolated all their  lives  from their hearing neighbors,
than the  blind  are from those who see.  The blind as a
class, are lively and cheerful;  the deaf are shy and melan-
choly,  often  morose and suspicious ;  and  naturally so, for
our interest in each other  far exceeds, and  ought to ex-
ceed our interest in the world, and from  all  this human
sympathy, the deaf are almost totally cut off; whilst the
blind,  excused from  many  duties which the  seeing  only
can discharge, are peculiarly free to indulge in gossip  with
their more  favored  neighbors,  and can largely exchange
opinions with them.  Moreover, the blind can scarcely fail
to find their own tastes suited in some portion of the talk
of their neighbors, and may  thus  gratify their inclinations
to a considerable extent; whilst the deaf, unless  they have 
              THE DEAF AND THE BLIND.           161

a great aptitude  for such  occupations as employ the eye
and the hand, are far more narrowed in their circle of stu-
dies, and are much more solitary than the blind.  No one
has illustrated this so touchingly as Dr. Kitto, in his strik-
ing book  on  the 'Lost Senses.'  When referring to  his
never having heard the voices of his children:
  " If there be  any one thing arising  out of my condi-
tion, which more than another fills my heart with grief, it
is this; to see their blessed lips in  motion, and to hear
them net;  and to witness others moved  to  smiles and
kisses by the sweet peculiarities of infantile speech which
are incommunicable to me, and which pass by me like the
idle wind."
  Dr. George Wilson, of Edinburgh, from whose work on
" The Five Gateways of Knowledge," the above quotation
is taken, goes on to say, "That Dream Land is a silent land,
and all the dwellers in it are deaf and dumb."    The prin-
cipal of one  of the largest Deaf and Dumb Institutions in
the country, in a letter  to me when I desired his opinion
in regard to the loss of  the eye or the ear, which was  the
greater calamity, remarks, "I agree with the  author in
giving  the  preference to the ear over the  eye.   As to
dream land,  I  believe the  mute  exercises  the same
machinery for thinking, that he does in his waking hours.
   " If more or  less educated, he thinks by signs  and by
letters, if not he thinks as he does when awake, very im-
perfectly, but by the recalled  phantoms of things, scenes,
&c, that he has seen.
   " As to ourselves, we have an idea of sounds when we
do  not hear them in  our waking  moments;  we have the
same idea of sounds in  our  dreams.  He  thinks all in
                          14* 
162
DEFKCT8 OF HEARINti.
dream land are deaf and dumb.  But these are only so in
the same way that the actors of our waking thoughts are
deaf and dumb, and in no other sense." 
CHAPTER I.
DISEASES AND ACCIDENTS TO WHICH THE EAR IS SUBJECT.

  Deafness is of various grades from the loss  and non
appreciation of the faint and low sounds, to the most com-
plete and total  loss of hearing.  The causes are various,
the chief of them are as follows : cold and moisture, blows
and falls, which are classed as local causes.   The general
causes are Parasites, Diathesis or Disposition  of the body,
Gouty, Syphilitic, Scorbutic,  Rheumatic,  Cancerous  and
Tuberculous.    Fevers,  Intermittent, Typhoid,  Typhus,
Scarlet Fever  and  Measles.   It is more frequent in the
male than the  female; this may be accounted for, as the
male is more exposed to the vicissitudes of the atmosphere
than the female.  According to Wilde, out of  two hun-
dred persons affected,  101 were males and 99 females. Dr.
Triquet* states, that of two  hundred cases  of disease  of
the ear,  126 were males, and 74 females.   Age has con-
siderable influence as  a predisposing cause.   Of two hun-
 dred  persons  from five months to thirty years  116, and
 from  thirty years to  seventy-three years', 78 cases  of dis-
 ease, in  all  194.   In 6 cases of polypus,  ages not given.
 Total, 200 cases.   In  44 of  the cases diseases of the ear
 were  hereditary  or communicated from progenitors.   In
 one family which has come  under  my observation, three
 members of it are deaf;  one  of  the predisposing causes of

   * Traite Pratique Des Maladies De Loreille, Par Le Docteur E. H. Triquet.
 Paris, 1857.  p. 68. 
164
DEFECTS OF HEARING.
 it  is  the  too  close  consanguinity of parents;  this ques-
 tion has been set at rest by the results of the Irish census,
 for out of " 100 instances in which the  parents were relat-
 ed in  the  degree of first, second or third cousins, 86 chil-
 dren were born  deaf and dumb, and 6  acquired it of one
 mute  in  a family; 4  of these  were dumb  only; and  4
 were  dumb  and idiotic."  M. Meniere, physician  to the
 Imperial  Institute for the deaf  and dumb at Paris, con-
 siders this infirmity where congenital, more often referable
 to  this cause than to  any other.   Dr.  S. M. Bcmiss has
 made  this subject the object of careful inquiry, and he
 states, that " his inquiries  have not, thus far, led to sim-
 ilar conclusions;  but  its great frequency among the off-
 spring of such marriages cannot be doubted."   A writer
 in the National  Intelligencer, some years ago  stated,  that
 " a great proportion of the asylums for the deaf and dumb,
 the  blind  and idiotic, are found to be the product of the
 intermarriages of cousins."*
   The diseases of  the ear in  regard to frequency, may be
 classed as follows:  in  200 cases of disease of the ear in
 the city of Paris.
   1st. Abscesses in the tube of the ear  and skin,     9
  2d.  Accumulations of cerumen (or wax,)      .     7
  3d.  Ear ache,    ......     3
  4th. Catarrhal  Inflammation, (the result of cold,)  49
  5th. Scrofulous Inflammation,      ...   22
  6th. Inflammation of the  Internal Ear, (fevers,)  22
  7th. Polypus of the  Ear,     ....   36
  8th. Nervous'Deafness, .....   52
                                    Total,      "200
 • On the Evil Effects of Marriages of consanguinity.—N. A.  Medico CMrur-
gical RtvUn-.  January, 1837  p 102 
        CLASSIFICATION OF DISEASES OF THE EAR.    165

      Toynbee's Classification of Diseases of the Ear.
  The  following are some of the  results obtained by Mr.
Joseph Toynbee, of England, who commenced in the year
1839, a systematic study of Diseases of the Ear, by careful
dissections, and which now (1857,) amount to 1,659.  They
are classified in his descriptive catalogues,* as follows:

  I. Diseased ears of deaf persons, the history of
        whose cases are known to him,     .     .272
 II. Diseased ears of deaf persons, the history of
        whose cases are unknown to him,   .     .  223
III. Diseased ears, to which  no history was at-
        tached,  .......  654
IV. Healthy ears,  .     .     .     .  *  .     .510

                                                1659

  He  then briefly states  the results to which his careful
and elaborate dissections have led.
  I. The discovery of the existence of osseous tumors n
the external meatus and their structure.
  II. The detection of the presence of molluscous tumors
in the external meatus; a disease  which in consequence of
the accompanying discharge of mucus, has  hitherto been
confounded with " otorrhcea."
  III.  The abolition of the terms " otitis and otorrhcea,"
and the substitution of names indicating the tissue affect-
ed,  and the peculiar nature of the  affection.
  IV.  The discovery of the existence of the dermoid layer
of the membrana tympani which plays so important a part
  » A Descriptive Catalogue of the Preparations illustrative of the Diseases of
the Ear, in the Museum of Joseph Toynbee, F. R. S. London. 1857. 
166
DEFECTS OF  HEARINO.
 in the diseases of that membrane.   It was previously sup-
 posed that the epidermoid layer was in direct contact with
 the fibrous layers.
   (That the healthy membrana tympani consists of five
 laminae, which commencing externally, are as follows:—Tho
 epidermis.  The dermoid layer.  The radiato fibrous layer.
 The circular fibrous layer.   The mucous layer with its epi-
 thelium.)
   V.  The ascertaining of the  true  relations of the two
 fibrous laminae of the membrana tympani, and the exist-
 ence and offices  of  the " tubular tensor  tympani  liga-
 ment."
   VI.  The  construction and application of the  artificial
 membrana tympani in  cases of perforation or destruction
 of the natural membrane.
   VII. The demonstration that the functions of the ossi-
 cles are analogous to those of the  iris of the eye, modify-
 ing the access of sonorous vibrations as the latter does the
undulations of light, attuning the labyrinth for the recep-
tion of either loud and harsh, or very low and very delicate
vibrations.
   VIII.  The establishment of the existence  as  a disease
of membranous and osseous ankylosis of the stapes to the
fenestra ovales, one of the most common  causes of deaf-
ness.
   IX.  The proof  that the  Eustachian tube remains always
closed, except during the  momentary act of swallowing,
when its  muscles cause it to open.
   X.  The use of the "otoscope," as a means by which
the condition of the Eustachian tube may always  be diag-
nosed without the use of the Eustachian Catheter.   The 
      PRESERVATION OF THE HEALTH OF THE EAR.   167

otoscope is  a  gum elastic tube eighteen inches long, one
end of which is placed in the patient's ear, and the other
in the ear of the surgeon.
   XL The various diseases which give rise to caries of the
petrous bone, and implicate  in  their  progress the  dura
mater, the cerebrum and the cerebellum have been describ-
ed, their nature and extent indicated, and means for  their
amelioration suggested.
   " In conclusion, it has long been the opinion of medical
men,  that the successful prosecution  of aural surgery was
opposed by almost  insurmountable obstacles.  Without,
however, attaching any undue weight to the results to which
pathological research has already led, may it not reasonably
be expected that the same energy and patient, persevering
inquiry which have so successfully surmounted obstacles—
surely not less formidable—in  other  branches of the pro-
fession, will in this also, be rewarded by discoveries calcu-
lated to advance medical science ?"

        The Preservation of the Health of the Ear.
   Prevention.—Having in a brief manner spoken of the
nature and causes of deafness, we will  pass to the  consid-
eration of the prevention.
   The neglect of the  health of the -ear is one of the most
serious difficulties which we have to contend with, for not-
withstanding its delicate structure and important function,
the most  simple rules  of prudence in regard to the care of
it, are sadly neglected.
   If we  would  but consider  for a  moment its  delicate
mechanism,  the tiny  bones which  conduct and  modify
sound,  its almost spider web-like membranes, perilymph, 
168
DEFECTS OF HEARING.
and  endolymph put  into  motion with  the  most  feeble
sounds in nature, and resisting with all the force  possible
the loud report or shrill whistle, and this  not only for a
time, but continuously with no interval of rest from birth
to death, always on the alert, for when the eye closes  by
the curtain  nature has so wisely given, the ear is never
closed, never slumbers, never sleeps;  it is on this account
more exposed than any other organ  to derangement  and
disease, and  should be, therefore, better cared for than
any other.
   Cleanliness.—This is all important to the ear, as it pre-
vents the propagation of parasites, and also the skin of the
ear,  with  its delicate  glands, from taking on  unhealthy
action  followed by inflammation, thus extending into the
interior of the ear.  Many persons think it  necessary to
cleanse the face and neck, but neglect the ears, and this is
especially so in children.   The  ears should  be cleansed
daily with a soft  sponge or towel, the sponge or towel
being introduced into the  ear with care; but  there is no
necessity for  any sharp body being employed, as they are
apt to  injure the delicate, lining  membrane  of the  ear,
and in  some instances causing perforation of the membrana
tympani.
   Another very prolific cause of  deafness is cold, or varia-
tions of  temperature, as in sitting or sleeping  opposite a
broken window, or being immediately under an open win-
dow, or in riding  in  a carriage  or railroad car.   Nurses
are very apt to carry young children to the window,  and
dress them opposite a crack or opening; the cold air from
the window causes acute inflammation,  which often ends
in permanent  deafness.  Much  care should be taken so 
SCARLET FEVER.
169
as to  protect the  ears  during windy weather, and care
should be taken to protect it during riding in cold  and
damp weather in an open carriage.

                     Scarlet Fever.
   According to Mr. Wilde, one of the most careful ob-
servers on this subject, scarlet fever, as manifested by the
extension of the inflammation  from the throat to the ear,
is one of the chief causes of  deafness; and he censures
physicians for their want of attention to the state of the
ear in  scarlet fever,  neglecting the application of remedies
for a disease which is,  even in the unhealthy condition
which  the patient usually is at the moment, amenable to
treatment, and the omission of which has, in numbers of
instances, led to permanent deafness, and when the patient
is young, to consequent  muteism.  " That I am," he ob-
serves, " not overstating the case, may be learned by any
person who will  examine the records of our deaf and dumb
institutions, or inquire into the causes of acquired  mute-
ism.  Thus, from the latest Continental table, that pub-
lished  by the Belgian government in 1847,* we learn that
of 1,892  cases  of acquired  muteism from all causes, 216
were from scarlatina, 80  from measles, and 28 from  small-
pox.   From the American tables, out of 86 cases of non-
congenital muteism, as many as 41-were from scarlatina ;f
and according to the investigations  of  the  Census Com-
mission! in Ireland, in  394 cases of specified causes of
acquired muteism,  in thirty-five instances it arose from
            * See Dr. Lauveur's Investigation.
            f American Annals of the Deaf and Dumb.
            J See Report of Irish Census Commission.
       15 
170
DEFECTS OF HEARINO.
scarlatina; and the results of the writer's investigations in
regard to the Philadelphia Institution, will  be found  in
the article on Otorrhcea.
  It will  be seen that this  is a fearful  cause of deafness,
and one that every parent should watch with the greatest
anxiety, to prevent his child from acquiring.   In spite of
the doctor's advice, nurses, and even indulgent mothers,
will allow their children,  suffering  from  this  disease,  to
look out of a window, or get out of bed too soon, and thus
the ears will  become worse, or  the child will  take  cold  in
the ear; they are  also apt to neglect to wash the cars out
because the child is not willing, or they  deceive the physi-
cian in not giving the medicine ordered,  or  see that the
gargle or wash  for the throat is properly employed.  We,
ourselves,  have  often  suffered  in  this way, and in some
instances  have seen  the most fatal  results ensue  from
neglect  in following  out the most  simple directions, on
account of the unmanageable nature  of  the child, all aris-
ing from the  want of proper authority of the  parent.

               Typhus and Typhoid  Fever
Are a cause  of deafness, this  however  being  rarely pre-
vented by any care on the part  of the  physician  or patient,
as it is generally the  result of an affection of the brain;
but in some rare instances the affection is inflammatory,
and should  be combated by antiphlogistic remedies  and
counter irritations, and not left to nature,  because in chil-
dren it may produce deaf-dumbness.

                        Measles.
  I have  already spoken of this, in connection  with Scar-
let  Fever, as a cause of deafness;  this  also,  requires the 
SCROFULA AND SYPHILIS.
171
watchful care of both physician and parent for, if neglect-
ed in the early stages, it often causes  much destruction of
internal  parts of the ear, if taken in time is very amen-
able to treatment  by cleanliness, a few leeches or a small
blister kept up for some time;  and if there is much dis-
charge the use of  some mild astringent wash with the in-
ternal use of a tonic.
                       Influenza.
  I have treated of influenza under the general cause of cold,
as it is often simply a catarrh or slight inflammation of the
pharynx and bronchial mucous membrane, but if neglected,
attacks the ear through the Eustachian tube, passing into
the middle ear.  As remarked by Mr. Wilde,  " many per-
sons will tell you, and especially those  who are deaf,  ' Oh !
I did not think it would signify.   I thought it was only a
cold, particularly as I had the influenza at the same time.'
Yes, the cause was in all probability a cold, or only the in-
fluenza, and both  are  very likely to  accompany or be at-
tended by disease of the middle ear."
                Scrofula and Syphilis.
  These two  causes  are  frequently found  to  produce
deafness for several  generations.  It is  chiefly  seen  in
the light haired, fair skinned and  blue-eyed, but it is also
found  among the  dark-eyed and  dark-skinned race;  our
negro or mixed races are very liable to it.   The first symp-
tom is  attributed to inattention, and the teachers  in  our
public schools are  often  the first to notice it, and then
complain to the child's parents ; but as a general rule, it
has  been the  neglect of  their not providing  the  proper
clothing, or else the child has been exposed to cold, and 
172
DEFECTS OF HEARING.
 gets a catarrh or cold  in  the head which is neglected, for
 unless scrofulous children are carefully watched and cloth-
 ed, there is  great  liability to  deafness  from  cold.  The
 other cause is to be treated by the usual anti-veuercarrcm-
 edies, and often requires months and years of treatment to
 rid the constitution of  the hereditary taint.

                        Bathing.
   Sudden diving into  the water is one of many causes of
 deafness, for  on account  of the  sudden  pressure  of the
 water, the membrana tympani is ruptured, aud from  neg-
 lect, the hearing is  lost; but if care be taken  and  a deep
 inspiration  immediately before  plunging, this  would not
 happen, as the ear is supplied with a counter pressure of
 air on the inside, by means of the Eustachian tube, just as
 a drum has its air hole  to equalize the pressure within and
 without.  Mr. Wilde also  states, that " cold  bathing is a
 much more frequent cause of deafness (by producing slight
 inflammation,) than is generally suspected. And we know
 entire deafness to result as the consequence from neglect
 of the proper  means of  cure in such cases.
  Deafness may result to the external ear or  auricle from
 pressure against a wall, falls,  or fighting with sticks or
 swords.  The  operation also  for  piercing the lobe  will
 sometimes produce erysipelatous inflammation, which may
 extend into the  interior and produce deafness.  Occasion-
ally a  foreign  body  gets into the auditory canal  and re-
quires removal;  if this is performed rudely, it will produce
inflammation, which may ultimately end in perforation of
the membrane and  deafness.  Blows on  the  side  of the
bead and on the  ear, will often cause permanent deafness. 
LOUD, SHARP REPORTS.             173
The introduction of the finger forcibly into the ear when it
is full of water, may cause the membrana tympani to burst.
  Loud, sharp reports as from a piece of artillery, or the
whistle  of a locomotive, or the  sudden ringing of a large
bell when near the ear, may not only cause temporary, but
even permanent, deafness, rupture of the membrana tym-
pani, and hemorrhage from the  meatus.  " These vibrations
act, 1st. By a  shock of all  the organism; 2d. By the im-
pression they produce on the organs of hearing.   The first
of these two effects can only result from violent vibrations;
very moderate, they produce slight  shaking, but the ear
loses little by little its  tolerance for loud vibrations, and
above  all for  noise.   From thence  arises an  incessant
cause of irritation for  this delicate apparatus.   A violent
shock of the ear by loud sounds or great noise, occasions
severe  disease, such as inflammations, hemorrhages, nerv-
ous deafness,  tinnitus  aurium,  and rupture of  the tym-
panum."*
  It is  stated, that artillery recruits frequently suffer from
bleeding from the ears.   The  late  Duke of Wellington
suffered from  this cause, and having fallen into  the hands
of a meddlesome surgeon, he was on the eve of  losing the
hearing of  one ear, from perforation  of  the membrana
tympani.   The effect of  position with reference to a gun,
is peculiar, (remarks Surgeon Thornton, in a letter to Mr.
Wilde,)—those men who stand  nearest the muzzle, feel
the report most sensibly; but all who are to leeward suffer
more than those to windward.  Thus, we should avoid the
causes above  enumerated;  but if it  is necessary to  be
near, we should get to windward of such agents.
                        * Triquet.
                   15* 
174
DEFECTS OF HEARING.
Deafness from  Accumulation of Cerumen,  etc.,  in flu-
                  Auditory Passages.
Western Clinical Infirmary. S.-rvlee of Dr. Turnbull. (Reported by F. E. Bond,
                    Resident Physician.)
  Thb is one of the most common forms of deafness, arising,
as a general rule, from some chronic inflammation and alter-
ation of the ceruminous glands situated within the auditory
canal.   The  following is the course pursued  by Dr. Turn-
bull in such eases :   First, the ear is submitted to simple
ocular inspection.   In  many cases it is only necessary to
draw the auricle upwards aud backwards, whilst tho audi-
tory passage is exposed  to the  light of the sun between the
hours of 12 and 2 o'clock, but in  other eases it is impossi-
ble to discover the mass of wax which is shining, perhaps,
in a thin layer on the very surface of the membrana tym-
pani, it requiring the speculum auris of various forms and
Bizes both as regards the tortuous form, and the great depth
and angle at which this  foreign body is placed.  Cases have
come  to the Infirmary in which the physician had, after a
simple examination of the ear,  prescribed something to drop
into it, without being able to see the condition of tho parts
at all, whereas, if  the speculum had  been used, the cause
would readily have been discovered, and the  patient saved
much distress and discomfort.
  April 17,  185s.—Eirst case.  Maria Cunningham, aged
five years;  deafness, with  an uneasy feeling in  the  left
ear, caused by catarrhal  inflammation  with  accumulation
of cerumen.  Directed  warm  olive oil-into the ear  fur two
or three nights, and the ear carefully syringed in the morn-
ing, by the resident physician.
   21st.—The ear has been  syringed, and now the curette 
ACCUMULATION OF CERUMEN.          175
is  introduced, and wax which is very adherent is broken
up and removed.   As the skin of the walls of the meatus
is red and abraded, three leeches  are directed behind the
ear, and a wash of plumbi acetat. gr. v to f Sj of water, to
be dropped into the ear every night until all pain is gone.
  24th.—On examination by speculum auris, we find that
all the wax has been removed, and the inflammation is
almost gone : hearing much improved.  Discharged.
  August 21,1858.—Rebecca Dempsey,  aged  forty years,
has suffered from deafness with pain and tinnitus aurium
for several months; she thinks it was the  result of sleeping
opposite  an open window.   On careful occular inspection
of the ears, nothing  definite could  be seen, but by the use
of Wilde's speculum auris, the right ear was found filled up
with a brownish mass of soft wax, not adhering to the mem-
brana tympani, except  in the  middle, as if it had become
somewhat loose on its edges.  By introducing a currette all
round it, elevating it gradually, the whole mass came out,
which, after  the  lapse of almost  a  month, weighed  five
grains.   Besides  cerumen, it consisted of epidermic des-
quamation  and hairs.   As  soon  as  it was  removed, the
patient found that her hearing was improved.
   25th. — Hearing  still  improving.   On  examination,
found a  small, dark portion not  removed.   Directed oil
to be dropped into  the  ear, and the resident to syringe
the ear.
   29^.—Not so well to-day.  Has pain, with some swell-
ing.   On examination, slight fullness and inflammation,
from  the use of the syringe.  Directed cantharidal collo-
dion back of ear, and purgation.
   Sept. 8th.—Pain  still  continued,  but  is  not so  severe, 
176
DEFECTS OF HEARING.
swelling all none, pain more neuralgic in character.  Con-
tinued blister, and directed ferri. earb. precip. •'> grs. three
times a day.   Patient did not  return.
   Dr. Turnbull remarked, that this case shows that syring-
ing should not be persisted in too  frequently, especially if
the ear is  tender, as you may in this way causo an abscess
to form, but  some warm sweet oil should be dropped into
the ear at bed-time, and  the  syringing repeated in a few
days, when all the excitement and  congestion has  disap-
peared.   In  some cases you  have an exfoliation of epi-
dermis, or epithelium  from   the  membrana  tympani  in
numerous  layers, which being  tinged brown, will, in some
cases, give the  impression to the eye of brown wax, deep
in the  passage, and time should be  given it to be thrown
off, and then  it can be removed.*

         * Medical and Surgical Reporter, Oct. IS, 1858, p. CI. 
CHAPTER II.
           FOREIGN BODIES  IN THE MEATUS.

  The  following interesting case will illustrate this sub-
ject :—
  Margaret-------, aged seven years, brought to one of
our public clinics by her father, who stated that a foreign
body had been in the ear three days.  The professor passed
in a probe and struck a hard substance, which he  stated
to be a stone.  He then placed the child's head at an angle
so as to get a good light, and endeavored to remove it by
means of a small pair of forceps; not being successful, he
then bent a silver wire in form of a hook, but still did not
remove it, the child kicking and screaming all the while,
and requiring the  assistance of three clinical  clerks.  He
then administered  ether and very soon brought her under
its  influence;  when she became perfectly quiet and still.
The Professor then  resumed his   efforts, which he  con-
tinued in all some thirty or forty minutes, finally trying to
remove it by a grooved director, but all his efforts were un-
availing in dislodging it, even using so much force as to
bring  blood, by lacerating the lining mucous  membrane;
the case was then discharged, being  directed to apply four
leeches and to  administer ten drops of tinct.  opii, and
return in a day to his office.
   The Dr. continued his efforts in  private for several days,
even with the assistance of a friend, and it was not until two 
178
DEFECTS OF HEARING.
 weeks after that the  foreign body was removed, which was
 accomplished with an instrument not unlike the wire em-
 ployed by the dentist in penetrating the  canal of the nerve,
 curved so as to get behind it.   He stated to me that there
 was no perforation of the membrana tynqmni, and that tho
 patient recovered.
   This case  is  one which conveys a great deal of instruc-
 tion, and one which a physiciau may not meet with every
 day in  practice.  In the first  instance, it was a very dif-
 ficult case, because three days had elapsed since its intro-
 duction.   All foreign bodies should  be removed as soon as
 possible, else  the pressure  and presence of such  a  body
 causes pain, swelling, and inflammation, resulting in otor-
 rhoea; and in some instances, from long-continued pressure,
 the membrana tympani has  been perforated.
   The second interesting feature about  it is, that in ether
 and* chloroform  we have agents  which entirely  prevent the
 struggling of children, and  should be at once employed so
 as to save the membrana tympani.
   The third important consideration is, that  in all  such
 cases where the foreign  body is small and  smooth, like a
 pebble, the injection  of  tepid water will often  effectually
 dislodge it by the reflux of the liquid forcing it outwards.
   The fourth consideration  is, that it is well to lubricate
 the canal with oil, which will facilitate the expulsion of the
foreign body.
   It must also be borne  in  mind that in adults the verti-
cal diameter  of the  canal is greater than  its  transverse
diameter.   Instruments, therefore, should be carried along
the inferior wall of the canal in order that they may be
insinuated  more  easily between  it and the  foreign body. 
FOREIGN BODIES IN THE MEATUS.         179
 In infants and young children, on the contrary, the trans-
 verse  is greater than the  vertical  diameter, so  that  an
 instrument must be introduced accordingly.
   The fifth consideration is, that the membrana tympani
 being  inclined from above  downwards, and from without
 inwards, care must be used  so  as not to  force the foreign
 body into  the angle which  is formed at  the internal ex-
 tremity of the canal.
   Sixthly. When instruments are to be used, the best form
 are those that are thin and delicate—steel-wire, curved and
 straight, and  reduced to the proper size for the ear; this
 is to be passed,  when flat or straight, to a  point beyond
 the foreign body, and then it is to be turned  so as to make
 a  hook of it, and it will, in most cases, answer very well;
 or, in some instances, if the body is rough, it can be seized
 by Fabrezi's Forceps, or those of Mr. Wilde, or by the use
 of the Ear Curette, or a silver wire.
   The last and  most  important consideration is,  that we
 must never in  any of these cases employ  much force;
 every  thing  must  be  done  with the greatest regard  to
 ultimate results, so as not  to do more mischief with our
 instruments than would have happened if after careful and
 delicate manipulation,  we should have to let the  foreign
body remain.
   In the  Transactions of  the  College of  Physicians  of
Philadelphia,  1858, the  following interesting  case was
reported:—
   " August 4.  Foreign Body in the Ear.—Dr. Corse read
the following report of a case of this:—
   "A  little  girl, aged seven  years,  daughter of  Simon
King, was brought to my office with something in her ear. 
180
DEFECTS OF  HEARING.
She had been to several physicians already, and tho meatus
auditorius  externus  was  swollen, bloody,  and  inflamed.
On examination by speculum, I was at first inclined to tho
belief that the parents were mistaken as to the  existence
of a foreign body in the ear; but they assured me that the
object had  been distinctly seen, and the little  girl said  it
was a stone.
   "On  further examination by means of a probe,  I could
feel a hard body at the bottom of the canal; and on further
inquiry, I was informed  that her ear had  been pulled at
very much, and that a considerable  amount of blood  had
flowed from it.   I then supposed the membrana tympani
to have been ruptured, and that the  hard body felt was the
petrous portion of the temporal bone, for the probe did not
cling to it as to a  stone, or bone denuded of its periosteum.
I have since been led to suppose that the slippery feel was
due to blood coagulated or encrusted  on the stone.  1 made
efforts to move  the body with a probe, but it was immov-
able.  After a close and attentive examination, I was unable
to make up my mind satisfactorily as to  the precise nature
of the case. The patient having a furred tongue and con-
stipated bowels, I directed a purge and other treatment to
keep down inflammation, and ordered the ear to  be gently
syringed  several  times a day with  lukc-warm  water, re-
questing her to return to me the next  day
   " On their return, they informed me that a stone had been
put into each ear while at play; and  on examination of the
other ear, I found truly a hard, white body near the middle
of the meatus.  I cautiously tried to get a pair of forceps
on it, but it constantly slipped from  the  grasp, and  was
soon at the bottom  of the meatus.  Mortified  with  my 
FOREIGN BODIES IN THE MEATUS.        181
failure,  I ceased my efforts,  and directed  the  parents to
return the next day, to continue the antiphlogistic treat-
ment of the inflamed ear, and do nothing at all  to the
other one.
  " I was satisfied there was a foreign body, hard and round,
in the ear, which filled the canal, or so nearly filled it that
no forceps I was acquainted with could pass down on each
side; it therefore became necessary to adapt some  instru-
ment to the case, and I drew  a diagram of this instrument,
which Mr.  J. H.  Gremrig,  surgical  instrument  maker,
Eighth street, below Chestnut, has  made for me.  It con-
sists of  two blades  and a fulcrum, the latter being separ-
able from the former.  Each blade should be 2-f  inches
long, T3g- of an inch wide, and  laterally curved so as to
form a segment of a cylinder }  of an inch in diameter, in
order that it would apply to the sides of the auditory canal.
The blades should not be more than J of a line in thick-
ness.  At first glance, this may seem too thin; but when
the cylindrical shape is remembered, it is easy to perceive
that the  strength is thus greatly increased, while the small
space we have to operate  in renders a thick blade entirely
useless.  There should be a slit in each blade,  at the outer
end, f of an inch long, and i a line wide, for the shank of
the button on the fulcrum to slide in.  The fulcrum must
be adapted so as to be movable, and have a button on each
side adjusted to  the slits in the blades, and  thus secure
them, as well as operate  as a fulcrum.   It must be T3T of
an inch in diameter, in order to  separate the outer ends of
the blades, and at the same time close the inner ones, and
by this means more effectually clasp the foreign body.  The
blades ought to be graduated, in order to know how deep
       16 
1*2
DEFECTS OF HEARING.
they can be inserted, lest they be pushed through the mem-
brana tympani.
   "In using this instrument in very difficult cases, a blade
must be applied anteriorly first, because the  anterior side
of the canal has a slight convexity, which makes it  neces-
sary for the outer end of the blade to  bo thrown strongly
back, in order for it to pass the foreign body if large; then,
by straightening it up, the body will be somewhat  moved
from the membrana tympani, and the danger of injury to
it avoided.   The other blade may then be applied  poste-
riorly,  aud not pushed quite as low down as  tho first one.
The fulcrum may then be applied; aud to do so, the ends
of the  blades must be separated, and the  fulcrum laid in
the hollow and  slid down until the buttons are  locked in
the slits on each side;  then making pressure in the middle,
with a  gentle to aud fro movement, the body  may be with-
drawn.
  " In appreciating the utility of this instrument, the shape
of the  cavity must be  referred to.  The meatus auditorius
extcrnus is described  as an ovoidal canal  about one inch
long and three lines in diameter, part bony and part mem-
brano-cartilngiuous, and curved.  It is somewhat constricted
in the middle, and  lined  throughout by a membrane,  which
crosses the  internal extremity obliquely and  closes it, and
constitutes the membrana tympani. The external extremity
of the canal is overhung by a part of the external car.   It
will be readily perceived that a foreign body of any con-
siderable size, that  passes  the middle of the canal, will  be
much more difficult to remove, on account of the narrow-
ing in the middle.
  " Dr. Coates remarked upon the difficulty, and the best 
FOREIGN BODIES IN THE MEATUS.        183
mode of extracting foreign bodies from the meatus  audi-
torius.  The danger of injuring the membrana  tympani
rendered all instrumental interference more or less objec-
tionable.  He had thought that quicksilver might be em-
ployed with caution for the  purpose;  and he would now
make the  suggestion, as one  of an  expedient,  at  least,
worth the  trial.   A small quantity only should  be  used,
just enough to  float  the  intruding body,  without injuri-
ously  pressing  on the  membrana tympani.   The only
objection that he was aware  of, was the  possible existence
of an opening in  the membrane.  Such an opening, how-
ever, would rarely occur; and  might generally be sus-
pected, when  present, from  previous  symptoms  which
would be ascertained by inquiry.
   "Dr. Corse thought that the  quicksilver might answer for
living insects, and for bodies not firmly impacted. He had
removed the latter, and dead  insects  by means of strong
jets of water from a good-sized syringe with a very slender
nozzle, in the usual way.   Insects, however, on account of
the  insufferable noise and pain  occasioned in the ear, are
generally "killed with oil, and  in dying  fasten  themselves
with their  claws, so as to be not easily detached.   The
quicksilver would be apt to  fail in such cases.   Dr. Corse
then dwelt at some length on the difficulties in the efficient
use of the ordinary instruments." 
CHAPTER  III.
 OBSERVATIONS  UPON  OTORRHEA  AS  A  SEQUELA  TO
                    SCARLET  FEVER.

  Otorrhea, or a chronic discbarge from the ear, is one of
the most frequent and  tedious affections which the physi-
cian has to treat.   It  may properly be  divided  into  two
great classes, depending on the nature of the discharge,
viz  : mucous and purulent.  The mucous form arises as a
termination of catarrhal otitis, from measles, or whooping-
cough.   Its  chief characteristic is the absence of true pus
from the discharge, and its being found much more amen-
able to treatment than the purulent variety, of which we de-
sign to treat in this paper.  Occasionally we find this sec-
ond form of dis< barge  difficult  to  manage in scrofulous
patients, when neglected; but if proper  counter-irritation
be made behind the car, and great cleanliness of the ear and
skin be  enforced, with  tonics,  astringents,  and  slightly
drastic purgatives, it will be found more amenable to treat-
ment than the form depending  on scarlet fever.   The great
importance of attention to this  second  form of otorrhua,
(chiefly  the  result of Bcarlct fever,) will  be better under-
stood, when  I state that it is the chief cause  of  non-con-
genital  deafness.   This  is proven by  the records of the
deaf and dumb  institutions both of this country  and of 
OBSERVATIONS UPON OTORRHEA.
Europe.*   An examination of the reports of the cases ad-
mitted into the Pennsylvania Institution for the Deaf and
Dumb,  in  the city of Philadelphia,  during  the  last six
years, also proves the  same fact.  In  1852, of the  thirty-
three pupils admitted, seventeen were  born deaf, three lost
their hearing by  scarlet fever, the remainder from five dif-
ferent causes, and four from cause unknown.
   For the year 1853, of the twenty-six pupils admitted,
twelve  were born  deaf, six  lost  their  hearing by scarlet
fever.
   In 1854, of the forty-seven  pupils admitted thirty-two
were born deaf, three lost their hearing by scarlet fever.
   In 1855, of the twenty-five pupils admitted, thirteen
were born deaf, five lost their hearing by scarlet fever.
   In 1856, of the sixty-three pupils admitted,  27  were
born deaf, 12 lost their hearing by scarlet'" fever.  In 1857,
of the  26 pupils admitted, 11 were born deaf and 4 lost
their hearing by scarlet fever.  The large number for 1856
may be accounted  for, by the fact that  in that year the
mortality from scarlet fever in Philadelphia was nine hun-
 dred and seventy-two in a population  of  500,000, while in
 1855, the deaths from scarlet fever were only 163.  This
 fever  also  prevailed throughout the State as an epidemic,
 during the latter part of the year 1855 and 1856.
    Otorrhoea, resulting from scarlet fever, is a disease which,
 if it becomes purulent and chronic, is very difficult to cure.
 This, I find to be the opinion of almost  every one who has
 devoted much attention to the  subject.    Itardf says : "It
 is of interminable  duration, and is one of the gravest dis-

   * See p. 169.
   + Traite des Maladies de l'Oreille et de l'Audition. Par J. M. G. Hard, p. 203.
                            16* 
1*6
DEFECTS OF HEARING.
eases  of  the  organs of hearing."  Mr.  Wilde*  remarks:
" The most unmanageable causes of otorrlnva which 1 have
met with in  practice, in which the most destruction has
taken place, and where  the ossicula have been  most fre-
quently lost, have been  the result of scarlatina."   In my
own  practice, one case had existed for thirty-five years,  in
another, twelve years, and a third case, which  came under
my care,  had  been more  or  less under medical and surgical
treatment, for seven  years.   In several  other  cases, the
duration  was  respectively, one, two, and three years.  The
most recent cases have been the  result of the late epidemic
in our city.  The profession  havo not,  at any time, been
sufficiently alive to the  great importance of  the  treatment
of acute  inflammation of the  tympanum, so as to prevent,
if possible, the destruction of the internal portion of the
ear, and the subsequent  otorrhcea.
   If the same amount of care and trouble were exercised
by physicians in the treatment of the ear, as of the throat,
a much smaller number of children would be permanently
deaf, and a much smaller number would suffer from destruc-
tion of the tympanum, or with chronic otorrhcea for months
or years  after.  Having been  successful  in  most of my
cases, during the late epidemic,  in preventing deafness, I
will  give au  outline of  my treatment, hoping  it may save
a few children that important organ, the ear, so  adapted to
in rease knowledge, and delight  mankind.
   Treatment.—In the early stage, when the scarlet fever
is at its  height, we must endeavor to arrest the acute in-
flammation of the  ear, by  depletion, but care  must be ex-
ercised, as this exanthem will  frequently  assume a low
                     * Wildr., p. 323. 
OBSERVATIONS UPON OTORRHEA.         187
type, which was the case during the recent epidemic.  In
such cases, local depletion (by leeches or small cups, to the
mastoid process and antiragus) should be employed as soon
as acute pain is complained of, and  sometimes it will be
found necessary to make pressure, as  the child may be too
young to  indicate the  point of pain, except by sudden
screaming  and crying; but pressure  at the lowest portion
of the ear  will reveal the cause instantly.
   Local depletion  should be repeated at intervals, and in
such  quantities as the strength of the child will permit,
assisted  by active purgation  by a  drastic  agent, as jalap,
scammony, or senna in infusion;  while, at the same time,
we support the child's strength with  nourishing diet, &c.
   If  the case will not bear depletion, or we are called too
late, then  we must still apply counter-irritation, and purge
the patient, but should  suppuration  have  commenced, in-
dicated  by a chill, with  increased pain, of a darting and
throbbing  nature, with a sense of bursting in the ear, the
meatus, on examination, being of a livid  red color, with
the membrane of the tympanum red and swollen, our pro-
per plan is to introduce a delicate cataract needle and punc-
ture the membrane.   This will liberate the fluid;  the pu-
rulent matter being pent up in the tympanum, from which
it cannot escape through the  Eustachian  tube, it may ul-
 cerate its  passage externally, or may, by its contact, cause
 destruction of  the  internal  ear, with destruction  of the
 tympanum by rupture, or even extend towards the menin-
 ges of the  brain, being not only fatal to the organs of hear-
 ing, but even to life itself.   Cases are on record, in which
 this ulcerative process has extended, so as to open the car-
 otid  artery into the Eustachian tube, causing death, from 
l^S              DEFECTS OF IIEAlUNG.
hemorrhage from the car.   Or the extension to the brain
mav be in the form of effusion or disease of the periosteum
and  death  from convulsions.   But instead of this  exten-
sion your remedies may have prevented death, and the dis-
ease may now take on  the  subacute  form attended  with a
discharge of a muco-purulent or sero-purulcnt matter.
  The treatment in such cases must  be both general  and
local. The general treatment, which is of the utmost  impor-
tance, is to improve the blood by tonics of iron, (juininc, and
cod-liver oil, with the frequent use of the bath, or wet towel,
with frictions, and out-door exercise in clear weather.  The
local treatment should be directed to  the throat, by the ap-
plication of solid nitrate of silver to the region of the Eus-
tachian tube, every third  day, with stimulating gargles,
and the internal use of weak  astringent washes to the ear,
while  most active counter-irritation  should be kept up  by
blisters,  setons, or croton oil, applied over the mastoid  re-
gion aud tonsils.  In some of the most unpromising cases
the  otorrhcea will gradually  cease, and the disease  may
thus be cured;  and if the case become chronic,  then  the
treatment must be continued  for months, and even years,
as may be seen by the record  of  a few  cases.
   Case I.   Scarlatina,  Loss  of Membrana  Tympani,
 Deafness,  Olorrhoza.—July 11,  1*50.   John B.,  vet.  10
years, had scarlet fever at the age of three; deafness  has
 ever since prevailed, with otorrhoea on both sides;  the  ex-
 ternal ear in normal condition;  meatus, good size; mem-
 brana tympani quite gone on  right side, while on the left
 it is thickened with a small opening  in its centre.
   He is pale, of scrofulous diathesis, with several enlarged
 cervical glands; no.se and throat in an irritable condition.
 Abie to pass air through both Eustachian tubes. 
OBSERVATIONS UPON OTORRHEA.        189
   Treatment.—After washing and drying out the meatus,
and opening in left membrana tympani, it was brushed over
with a solution of  nitrate of silver  every third day, while
internally was administered cod-liver  oil and £ grain of
sulphate of quinia in solution three times a day; counter-
irritation behind the ear by tincture of iodine.
   January, 1857. After six months' treatment, the  otor-
rhcea on left side is quite gone, and the opening filled up,
while the discharge from the right is very slight, unless on
exposure to cold air, which is much obviated by the intro-
duction of a portion of glycerine on a pellet of cotton, and
avoidance of cold  winds.   The  hearing was so much  im-
proved  that he was able to  resume his school duties, re-
quiring no artificial aid.
   Case II.—July 22,1856. David R., set. five years, had
scarlet  fever  at the  age of  two years  and seven months,
membrana tympani in part gone; general health not good,
pale,  anaemic;  cleansing and  application  of  solution of
nitrate of silver, with the internal use of sulphate of cin-
chona, one grain, three times a day; and as a local astrin-
gent, gr. v cupri sulphas to Sj of water; and to moisten
the meatus with glycerine,  in which  was suspended acid
tannic.
   Nov. 1857.  Hearing much  improved, and  discharged
improved.  (Case did not return.)
   Case III.   Scarlatina,  Loss  of Tympani,  Deafness,
Rheumatism  with Polypus.—August  15, 1856.—William
J. M., set. twenty-eight years;  otorrhoea from both ears;
had scarlet fever at the age of sixteen;  could only hear the
tick  of  the watch when applied over  the temporal bone;
Eustachian tubes  both  closed; bent  almost double with 
l!in
DEFECTS OF HEARING.
rheumatism; right car, membrana tympani entirely gone,
and  no malleus visible;  left  ear  filled up with a polypus,
covered with yellow pus, aud flowing out  over the edge of
the meatus.                 ,
   Treatmmt.—Two grains of iodide  of  potassium three
times a day, with a wash of ten grains zinei sulphas, to be
dropped into the  left  car.   Alter  cleansing  with  cotton,
applied solid nitrate  of silver to growths, by means of
Wilde's caustic holder.  Finding, after several  trials dur-
ing August, not much reduction  in size, 1 twisted off por-
tions, at three  different  sittings, and, as  the  hemorrhage
was considerable, 1 applied powdered alum, and again used
the nitrate of silver to get rid of what was still at the bot-
tom, but found  it did not entirely destroy the spongy granu-
lations, after eight months' persevering trial.
   Fibruary, 1S.~>7.  Applied a saturated  solution of zinei
chlorid., on a piece of cotton, by means of the speculum,
for three weeks, with the entire  contraction of  the granu-
lations, so that now, I can see the membrana  tympani, and
an orifice from  which the whole mass of granulations seems
to have sprouted, and as I touch the  surface, he feels a dis-
position in his throat to cough.  His general health is much
improved, being able to straighten himself, and rheumatism
gone.
   March, 1S57.  Dilated  Eustachian  tube by  means  of
Wilde's catheter and warm air twice, at  two  weeks' inter-
val.   IIis  hearing is  so  much improved that he can hear
me speak to him at a distance of six or seven feet.  (Jradu-
ally the membrana tympani closed over, and he was dis-
charged, cured.
   This case was one of great interest, and  shows the good 
OBSERVATIONS UPON OTORRHEA.         191
results to be obtained by persevering efforts, assisted as it
must me, by the willing  help of the patient, and the use
of constitutional.remedies.
   Case IV.  Otorrhoea, of twelve years' duration, of both
Ears, with Perforation of Membrana Tympani on one side:
Improved.—April 15,1857.   Benj. D. F., aet. twenty-four;
a healthy looking  young man, of fair complexion and blue
eyes.  (Blacksmith.)  When he  speaks, it sounds as  if
there was some obstruction in the throat, or nose. He stated
that he had scarlet fever at the age of about twelve, but  of
a mild  character.   On getting  well, he had more or  less
discharge from  both ears, and was deaf, and although he
has been under  the  care  of several  physicians, he has be-
come worse, so that he is unable to attend  properly to his
duties in his father's shop.   On examination with Wilde's
speculum, found the right membrana tympani with a small
opening in it, but he was  not able to pass air through it,
from obstruction  of the Eustachian  tube;  there was also
redness of the external meatus;  hearing distance, one inch;
left ear, discharge, with redness, and in places whiteness  of
of the  membrane, but no perforation;  able to inflate the
membrane on this side; hearing distance, three  inches.
Throat—both tonsils very much  enlarged, but  not very
hard; relaxation and elongation of uvula, with engorge-
ment.  Removed uvula, made application of zinei chlorid.,
in solution, to tonsils, and directed cleansing of the ear  by
a syringe, and application of solution of zinei sulphas, with
vin. opii gr. x to three ounces of distilled water, three times
a day.    For internal use, syr.  sarsap.  comp., with gr. j
biehl. hydrarg., a wine-glassfull three times a day, with
nourishing diet. 
192
DEFECTS OF HEARING.
  2'2d.  Throat of a much better color, and speaks plainer;
not much improved in  discharge from  ear, which annoys
him, having to wipe it  very frequently through  the day,
as I directed him to keep no cotton in tho ear, but to wash
it frequently each day with the wash diluted.
  Treatment of  the throat continued; applied cantharidal
collodion below and in front of the car, with application of
x gr. solution of argenti uitratis to ear, with insufflation of
powdered alum to throat and nose.
  2'uh.  Very  much improved.  Ordered  him  solution of
iodine  cmp.,  ten drops three times  a day in infusion of
hops.
  May 16. Finding the Eustachian tube continued ob-
structed,  introduced Eustachian  catheter,  and  gently
dilated  it with  warm  air, which produced  a feeling of
faintness, but which soon  passed  off.   Same  treatment
continued.
   2'.\d. Catheter again introduced, no feelings of faintness
being produced.  Same treatment.
   21th.  Both  ears  discharge less.   Eustachian tube open,
the air passing through  it into the middle ear, and being
discharged from thence outwards, by the  perforated mem-
brana tympani.   Hearing improved.
   June  ?ul.  Had  a slight relapse  from catarrh;  throat
more congested; discharge from ear increased; applied
solution to the  throat, also mild solution to the  ear;  di-
rected demulcents to be used.
   2§th. Again improving, but is feeble.  Ordered tonics,
sulphate of quinine, and cod-liver oil.
   July 11.  Discharge  ceased;  complains  of pain  in  his
head.   Ordered blisters behind ears, and an  infusion of 
OBSERVATIONS UPON  OTORRHC3A.         193
senna, to keep up action on the bowels, so as to prevent a
return of the pain.
  August.  Called again at the infirmary, and informed me
he was so much improved  as to be able to take his place
as superintendent of the shop, and when on a recent visit
to the river, he could hear the noise of the steamboat, which
he had not been able to do for many years.
  Case V.  Otorrhosa  of both Ears of five years' duration,
with loss of both Membrana Tympani.—The result of scar-
let fever and measles.   MaryT., aet. eight years, a delicate
dark-eyed  girl, is deaf in  both  ears,  with great  irritation
from  profuse purulent  discharge,  the  odor  from which is
very offensive.    Has  tried numerous  physicians without
success.  After the acute attack, the father was directed
by his physician to  syringe the  ears, every few days, with
tepid water, which he  continued, until one day  the dis-
charge came through the nose, and the child cried out that
something  had burst, since which  time numerous applica-
tions have  been tried, but with no permanent benefit.
  On  a careful examination and  removal of the profuse
secretion by pellets of  cotton,  I found both membrana
tympani entirely gone, the discharge  proceeding  from the
middle ear.   The tonsils were enlarged, the  throat red and
congested, with several enlarged cervical glands.
  I directed simple cleansing of the  ear with an infusion
of chamomile flowers, several  times a day, with a weak
lotion of subacetate of  lead, to reduce the irritation of the
auricle, to be applied with a pledget of lint.  Also, a solu-
tion of zinei sulphas gr. j to the Sj  of water, applied by
means of a small syringe, and then to allow it to flow out.
  Directed, also, that her diet should  be nourishing, with
       17 
194
DEFECTS OF HEARING.
 the use of cod-liver oil, a tea-spoonful three times a day,
 with a salt, bath once a week.
   March 24.  To-day,  offensive dischargo much less, right
 car very much improved in appearance.   Directed  J gr. of
 sulphate of quiuia three times a day with the cod-liver oil
 to be continued.
   April 8.  Much improved in all respects; discharge still
 continues; was able to resume school duties.
   Case VI.  Cephalic  Otorrhaa the  result of Searbt Ever
 of three years' duration; Post-mortem.—Mary  II. ;et. six
 years; had scarlet fever severely when three years of  age.
 Was a long time feeble, but her ear was not treated, except
 to wash and keep it clean.
   Towards May, 1*57, the child began to complain very
 much and came  to  my office.   Ordered a small  blister,
with a solution of one  gr. sulphate of zinc to one ounce of
water.   As an internal tonic £ gr. sulphate of quinia three
times a day.   On  examination, the  right membrana tym-
pani was  gone, and there was  considerable discharge  of
unhealthy pus  from the ear, showing disease of  tho bones.
 Having been benefited by the treatment, she did  not  re-
turn to the office until  June Oth, when  she was suffering
intense pain from catarrh in her head, the discharge being
much increased from  exposure; being a very wilful child,
the parent had but little control  over  her.   I directed
counter-irritation to  be renewed, with the internal use of
an opiate, to relieve pain; did not leech  her on account of
her feeble state.
   Visited her on the 8th.   Pain still very persistent,  and
head bent to the side of the affected  ear.   bearing convul-
sions, ordered four leeches to the back  of  each ear, with 
OBSERVATIONS UPON OTORRHEA.        195
sedatives internally,  opiate fomentations to the ear,  and
warmth to the feet, baths, &c.  In  spite of treatment she
continued to grow worse, and had a severe attack of con-
vulsions on June 26th, which yielded to leeching and cold
applications, but was soon followed by a state of coma.
  She died on the  28th of June, but previously had con-
siderable discharge of pus  from her nose, and was unable
to swallow for a day or two before convulsions set in.
  The family being  very unwilling to allow  an examina-
tion,  I was  only permitted to remove  the temporal bone
and ear, which I did by sawing a V shaped piece, and re-
moving the ear entire.  The coverings of the brain, in spite
of her anaemic condition and her inability to take nourish-
ment, were much congested and thickened, with effusion of
fluid  in the ventricles, with considerable softening of the
substance of  the brain.
  Ear.—The membrana tympani was  almost  gone, but,
strange to state, in the middle ear, although filled up with
green pus, and the  membrane  soft  and detached, I found
the malleus  and incus, which I have in my collection, but
On  cleansing the two  bones they  were found ulcerated.
The semicircular canals  and cochlea were almost free from
disease, which had passed from the middle ear to the mem-
branes and brain, causing a low form of inflammation, with
softening and effusion, ending  in convulsions and  death.
What  seemed very  remarkable in this  case was the long
period which the small bones remained  in the ear in spite
of the discharge, showing how slowly the ligaments which
attach the bones ulcerate; thus accounting for the power of
hearing in many persons suffering from otorrhcea; the chain
of bones, although ulcerated, yet retaining their place, and 
196
DEFECTS OF HEARING.
 communicating the sound to the nervous expansion of tho
 auditory nerve.  She had no symptoms during life, «>t facial
 paralysis; the bending of the  head to one  side seeming to
 indicate  some disease  of  the  top of  the vertebra1, but  no
 examination of that part was permitted by the family.
   This imperfect  paper  on otorrhcea, as a result of exan-
 thematous  inflammation of the mucous  lining of the tym-
 panal cavity, or extension of  the same affection from the
 throat, upwards  through  the  Eustachian  tube,  I  am well
 aware is not arranged  according to the anatomical classi-
 fication of  Mr. Toynbee, the most distinguished authority
 on this subject, for although I consider his a good one, yet
 it has its  defects  in  its  extreme  subdivision of  tissue
 affected.   It is  still doubtful  to my mind  how he, or any
 one else, can determine the precise tissue which  is affected
 in chronic  discharge from the car, more  especially at  a
 public clinic, for the time afforded for examination of each
 case is often so short, the history given so  imperfect, that
 it is difficult from  the patient's statement  to know what
 was  the primary cause of the mischief; for we certainly
 cannot, with all the light we can throw upon it, state which
 of the five layers  of the membrana  tympani is affected,
 when, perhaps, it has been for  years bathed in pus, mucus,
 or a substance which resembles very much the curdy mat-
 ter found in the  scrofulous abscesses.
   For those interested, I will  here  give a synopsis of the
 class of cases met with in my public clinic at the Western
Infirmary.
  A discharge from the ear will make one-half of my eases
arising from chronic inflammation of the external auditory
canal, ulceration  of the membrana tympani, or disease ol 
OBSERVATIONS UPON OTORRHEA.        197
the middle and internal ear.  Accumulation of cerumen,
causing deafness, or an entire want of it, with inflamma-
tion of the glands, occurred in  about  one-half of all my
cases with or without  pain and  tinnitus aurium.  Then
follows, in point  of frequency, catarrhal inflammation of
the auditory passage or middle ear, with mucous accumu-
lations in the Eustachian  tube, forming one-tenth of the
whole number.
   Polypi and fungous excrescences on the  auditory pass-
ages, or  projecting through  an  ulcerated opening in the
perforated membrane.   Acute  cases of inflammation of
the  membrana tympani are rare,  but chronic cases are
numerous, with  opacity, thickening, &c, with or without
occlusion of the Eustachian tube.  This is one of the most
difficult diseases to treat if it has been  of long standing.
   Eruptive affections of the auricle are numerous, as her-
pes, eczema, &c.
   There are certain diseases of the ear which are very rare,
namely,  nervous  deafness,  in which the  auditory nerve  is
alone affected.
17* 
CHAPTER  IV.
ON THE USE  OF  AN  ARTIFICIAL  MEMHRANA  TYMl'ANI
   IN CERTAIN FORMS  OF DEAFNESS, DEPENDENT  CI'oN
   PERFORATION OF THE NATlKAL MEMHRANA TYMPANI.*

   It will be seen by those interested in this  application,
that Itard  as early as 1821, employed goldbeater's skin as
an  artificial mcmhrami  tympani, to  relieve deafness;  ho
also in his work cites a  case in which deafness was relieved
by  the introduction of  a portion of  cotton  wool to  tho
bottom of the meatus, affordiug proof that his writings and
practice  were  far  ahead of  his  time, aud  that  he was
actually  writing for posterity.   Well might the  Academy
of Medicine, long  after his death, republish a  new edition
of his works, a compliment rarely conferred upon a medical
author.  This  work of  Itard  is one of the  most complete
treatises  on  the subject of tho  diseases  of the  ear, that
Las  ever been written in any language, so  full,  accurate,
learned,  and above all  truthful.  This useful  application
seems to have  remained  without utility, until   .Mr.  Joseph
Toynbee, of London, tested its merits  on the 12th of .Jan-
uary, 1852, on a patient named Peter T., who bad  been
deaf for  sixteen years,  the result of cold, and within  six
 • On the n»e of an Artificial Membrana Tympani in ca»<-n of ileafneng  I)< pen-
dent upon perforation or destruction of the natural organ. By Jom-ph Toynbee
F. K 8., Aural Surgeon tu st. Mary'a II.,«pltid, 4c, 4c. Fifth Edition: Loudon.'
John Churchhlll.  1856. 
ARTIFICIAL MEMBRANA TYMPANI.         199
years had apertures in.each membrana tympani with dis-
charge.   " Upon examination, an aperture between one and
two  lines in diameter,  was observed in each membrana
tympani, and the mucous membrane of the tympani, which
was the source of the discharge, was more thickened and
red than natural."
  The treatment consisted in keeping up counter-irritation
over each mastoid  process, and in the use of an injection
composed of three grains of acetate of zinc, to an ounce of
water.  Under this treatment, he somewhat improved, but
the hearing still remained so defective that he was preclud-
ed from  following  any avocation.   In the commencement
of June, I experimented on  this  patient with  the  first
membrana tympani, composed of vulcanized india rubber,
and  the  good effect was at once  decided. When it was
placed over  the surface of the original membrane, so  as
wholly to close the orifice, the patient made a movement of
his lips and said: " I hear as differently as possible from
what I have  done  for  many  years;  everything  sounds
clear !"  This  patient went away with the artificial mem-
brane in his ear, hearing conversation perfectly.  The fol-
lowing morning he  came to my house, saying that he had
accidentally  moved what I had left in his ear, and  he was
" as  dull as ever."   I replaced the artificial membrane—he
again heard well;  and being supplied with one which he
could introduce or remove  at pleasure, he  has worn it du-
ring the day ever since—a space of between three and four
months—and he has never complained of pain or discom-
fort from it.   Latterly he has found the hearing so much
improved that he has been able to dispense with the use of
the artificial membrane for a few hours daily; but he hears
much better with than without it. 
200
DEFECTS OF HEARINO.
   This patient  was shown at a meeting of the Pathological
Society  of  London, in  February.  l^."»:i ;  the  following  is
the published report :*—" The artitieial membrane having
been removed, the  members of the Society  had the oppor-
tunity of observing tho  perforate  condition of each mem-
brana tympani.  After the  removal of the membranes he
could not hear, uuless loudly spoken to; but when he had
replaced them, which he did with  apparent readiness, his
hearing was excellent."
   Mr. Toynbee  in  his  pamphlet  of '.12 pages, records  9
cases  which  were very  much improved,  aud  in  some of
them  perfectly relieved.   The following is  an outline of the
cases, the first case having been given in exteuso.  2d case,
."Miss B., tut.  twenty-one, each membrana tympani destroy-
ed by measles at four years  of age.   Hearing  restored by
the artificial membrane.  Very sensitive to sounds. Treat-
ment : an artificial  membrana tympani was introduced into
each ear.   3d case is from notes of a case by Dr. Shearman,
of Sheffield, no age given.   The deafness  in this case is of
nearly twenty years duration, was perfectly removed on the
left side, although the whole of the  left membrana tympani
is destroyed,  the false one acts perfectly.
  4th case, Miss S., :et. tuc■uty-four.  At the age of four,
suffered from an attack of  scarlet fever.   Examination :
Right ear.   The  hearing distance of the watch'is half an
inch.f  The central part of the meatus contracted to half
its  natural size.  Left  ear.   Hearing distance one  inch.
Tnatmi at.—Passed a small artificial membrana, so as to

 * Medical Time* and Gazette, February 12, 1833.
 f I have u»ed tLv same watch for juany years; the natural hearing dUtancoli
three feet. 
ARTIFICIAL MEMBRANA TYMPANI.         201
 cover the destroyed natural membrana tympani, caused by
 a slight tendency to  irritation : care was required in the
 management, but it ultimately did well.  Time not stated
 when first  seen.   In  the middle of February, 1854, the
 mother of the lady called and  stated that her  daughter
 " continued to hear perfectly, and that she was quite an al-
 tered person."
   Case 5th.  Miss Gr., aet. fourteen.  Deafness from scarlet
 fever during five years.   Upon inspection, it was found
 that  the  membrana tympani in each ear was  absent, the
 membrane of the tympanum was thick and red, and pour-
 ed out a mucous  secretion.   An  artificial membrana  tym-
 pani was  applied to each  ear, and the result was  so  com-
 plete a  restoration of the  hearing power, that the patient
 could hear  all that was said in  different parts of a  large
 room.
   Case 6th.  Mr. M., aet. twenty-three.  Deafness for twen-
 ty years from measles  and scarlet fever.   Greatly improv-
 ed by the artificial membrane.
   Case  7th.  Miss H., set. seventeen.   At seven years had
 a severe attack of scarlet fever, since which time  she has
 had discharge from each ear, requires to be spoken to dis-
 tinctly in a raised voice.   Treatment.—Application of the
 artificial membrane which  gave immediate relief, which
 continued by report from case,  one year after application.
  Case  8th.  S. H., Esq., aet. twenty-one.  Between six and
 seven years of age, had  an  attack of  scarlet fever, since
 which, at intervals, discharge from each ear.  Upon examin-
 ation, the  membrana tympani was found to have disappear-
ed from each  ear,  the watch was  not heard by the right
ear, and at a distance of five inches from the left.  By the 
202
DEFECTS OF HEARING
 aid of the artificial membranes he was able at onco to hear
 me talk across my room, and he soon  heard  general con-
 versation  perfectly.
   Case 9th. Lieut. L., ret.  twenty-seven, has  been dull of
 hearing for fifteen  years,  especially the right ear; com-
 plains of a siuging in both  ears, but especially in the right.
 On examination, the  membrana tympani was found to have
 disappeared from the right  ear, and the mucous membrane
 of the tympanum was red;  the watch was not heard, unless
 in contact with the  ear.  In the  left  ear the membrana
 tympani was white, like paper, and at its upper part was a
 small polypus.  Fpon the application of the artificial mem-
 brane to the right ear, the  patient heard well at  once, al-
 though he never remembers to have heard with it before.
   Pith Case. X. M., Esq.,  set. seventeen and a half.  He
 had measles when young, since which time he has had dis-
charges from each ear, accompanied by so great a difficulty
in hearing, that he requires to be spoken to distinctly with-
in the distance of a yard.   I'pon  examination, a consider-
able orifice was discerned in each membrana tympani. The
mucous membrane of each  tympanic cavity is  thicker than
natural.  On applying the artificial membrane  to each car,
 the hearing power was at once  r< stored;  he  said, that  he
 '' heard painfully well, and that his own voice sounded like
a trumpet."  He  soon learned  to put  the membrane  in
himself, and he continues to hear quite well.
  I will now give Mr. Toyubee's account of the formation
and use of an artificial membrana tympani.
  "The artificial membrana  tympani, made   by  Messrs.
Weiss from directions given by Mr. Toynbee, ' the portion
of vulcanized india rubber or gutta pcrcha is about three- 
ARTIFICIAL MEMBRANA TYMPANI.         203
quarters of an inch in  diameter, which leaves sufficient
margin for the  surgeon to  cut  out a membrane of any
shape that may seem to him desirable, and to leave the sil-
ver plate (two very fine plates of  silver, having a diameter
of about three-quarters of a line, between which the rubber
is to be placed,) either  in the centre or towards the circum-
ference, at bis discretion.'   He  now  invariably uses vul-
canized  india rubber,  not  much thicker than  ordinary
brown paper.  The silver wire  is of  sufficient length to
admit of the membrane being introduced or withdrawn by
the  patient, but is not perceived externally except upon
special observation.
   " A second kind of artificial membrane is made by fixing
the layer of gutta percha, or vulcanized India  rubber, be-
tween  two very  delicate silver rings,  from  the eighth to
the sixth of an inch in  diameter; these  rings are riveted
together, leaving a portion of the membrane drawn moder-
ately tense in their centre;   a margin  of  the membrane is
also left beyond the  circumference  of the rings, so as to
prevent the latter being in  contact with and irritating the
tube of the ear.   To the surface  of one of these rings the
silver wire is fixed by two  branches, and they should be
joined so that the  outer surface of the rings should  look
obliquely outwards  and forwards  instead of directly out-
ward, thus imitating the direction of the natural membrana
tympani.   This  kind  of membrane  is often preferable to
that previously described, if the meatus is sufficiently large
to admit of its passage.   In some cases, however, it pro-
duces a loud noise, as  if it were  too tense; it would, per-
haps, be desirable to have it with only one branch, so that
the surgeon  may be able to alter the angle of the mem- 
201
DEFECTS OF HEARINd
 brane with the stem, according to  the  ease.   A pair of
 forceps is  made  whereby the artificial  membrane can  bo
 more easily introduced and withdrawn.
   " In cases where patients require to be shouted to, close
 to the ear, the artificial membrane will  not  prove of any
 service."
   I  will conclude by the  recital of a case of completo per-
 foration of the membrana tympani,  in which there being
 no  hope  of restoring the natural membrane, an artificial
 one  was substituted with benefit to the patient.
   Otorrhoa  with Per/oration of the  M, mbrana  Tympani,
 with the Application of an Artificial Membrane with Suc-
 ciss.—James Riddle, aot. twenty-four years,  a  native  of
 Ireland, by occupation a silk weaver, applied January 21,
 1S")S, at  the Infirmary, on account of a troublesome dis-
 charge and  deafness  in his right  ear, from scarlet fever,
 which he had at  tho age  of thirteen.  lie has become  so
 deaf as not to hear a watch with the  right ear, even when
 placed in immediate contact.
  On examination with a good light, tho meatus was found
 filled up with dry mucus, pus, &c., upon removal  of which,
 by careful syringing with warm water, the membrana tym-
 pani was found entirely gone, and the lining membrane  of
 the  meatus  thickened aud  contracted.   Astringent  aud
 stimulating injections were now employed to  change  and
alter the secretion, and he was directed to take five grains
of iodide of  potassium  in an infusion  of  humuli, three
times a  day, with  counter-irritation  behind the ear, by
cantharidal collodion, and to cleanse the ear with warm
water three times a day.
  January 2.'W.  Parts free from accumulation.   After 
ARTIFICIAL MEMBRANA TYMPANI.         205
wiping out discharge of pus, &c, a small  portion of finely
powdered  cupri  sulphas  was  blown  upon  the  altered
mucous membrane,  and  a wash of zinei  sulphas gr. j  to
each f Sj aqua, was directed to be employed after washing
out the ear.
   2§th.  Discharge  has  moderated, but  hearing not im-
proved, not being able to pass air through the Eustachian
tube.   I,  therefore, carefully introduced  the Eustachian
catheter at two  different  sittings, and passed  air, after
some time, through the discharge, so that  I could hear the
air bubbling by the aid of the otoscope.
   29th. Same treatment; still improving.
   February 9th.  Discharge still less.  Tried the moistened
cotton, so as to improve  the  hearing, but it increased the
discharge; although  removed and cleansed, the itching was
so intolerable, that he removed it, being unable to bear  it,
and again  resorted to  astringent and stimulating applica-
tions to moderate the discharge.
   12th. Introduced  an artificial  tympanum of vulcanized
India rubber, made by Mr. Kolbe, of this  city, which gave
him no pain, and his hearing was improved.
   15th. The discharge is again on the increase, and has
blackened the silver  wire, and caused the India rubber  to
wrinkle and change  its color, so that it was removed, and
the ear allowed to rest,
   18th. Is very comfortable to-day; can hear best in the
open air.   Introduced  the tympanum himself, he finding
out the right spot; for if he  pushes it too far, it is of no
use to  him. He has been testing his powers of hearing by
a clock.
   24^. Returned to-day and states that  he cannot hear
       18 
200
DEFECTS OF HEAR1M1
so well; when, upon examination, I found the Eustachian
tube blocked up again with mucous accumulations.   1
again dilated it with a scries of injections of warm air;
and on  filling up the  car with a weak  solution of cupri
sulphas, by making  an  effort  to swallow, air  passed up in
bubbles through the liquid.   This effort to swallow, with
the nose and mouth closed, I told him  to make each day
when he removed  his  artificial membrane, so as to  keep
the tube pervious.
   Conclusion.—This patient continued  to  visit the In-
firmary twice a week until the 17th of March, when  he
left for the  country,  having but slight discharge, just
sufficient to moisten the artificial membrane; being able to
hear conversation with ease  and  comfort, and  even the
ticking of an ordinary clock across  a room.

 The Modi' of applying  the Artificial Membrana  Tympani
                   by Mr.  Toynbee.
   "As, in cases of perforation or destruction of  tho mem-
brana tympani, there is so frequently catarrhal inflamma-
tion of the  mucous membrane  of the  tympanum,  it is
obviously  important that no  foreign substance should  be
placed in contact with that  membrane; and as there is
always a margin of  the membrana  tympani remaining, the
object of the surgeon should be to  keep  the artificial mem-
brane external to the  latter.  After carefully noting the
size of  the inner extremity  of the meatus  to which the
natural  membrana  tympani  was  attached,  tho  operator
 should then  cut the artificial membrane as  nearly of the
 size and shape of the  natural one as possible, taking care
 at the same time  to keep the  margin  quite smooth and 
          ARTIFICIAL MEMBRANA TYMPANI.         207

regular.  In cases where only a small border of the natural
membrane remains, it is often desirable to cut  the artificial
membrane of.a size larger than the inner extremity of the
tube, so that its edge may turn outwards.
   " The  patient must then be placed with the  head in-
clined  to the opposite shoulder, while a  strong  light is
thrown into the  meatus,  which,  if  liable to discharge,
should have been previously syringed.  The operator will
now take the artificial membrane, and having  moistened it
with water, pass it,  by  means of the silver  wire, gently
inwards until it has  reached what he  considers the natural
position.  This he will  ascertain  by the occurrence of  a
faint bubbling  sound, caused by the escape of the slightly
compressed  air beyond it; he will also feel a slight obstruc-
tion offered  to  its further  passage by the remnant of the
natural membrane.   Should he attempt to pass the arti-
ficial membrane beyond this  point,  the  patient will  com-
plain of pain, which until then had not been felt.  The
most certain  test,  however,  of the artificial membrane
having been properly placed, is the  sensation of the pa-
tient, who  discovers, by the sound  of  his own  voice, or
that of the surgeon, or by the movement of bis tongue and
lips, that his hearing has been suddenly much  improved.
   "It will be  imagined  that  great care must be taken to
cut the membrane so that it shall fit  the inner .extremity of
the meatus with exactness, since if too large it would cause
discomfort;  and if too small, it would not fulfil its purpose
of rendering the tympanum an air-tight cavity.
   " The surgeon having ascertained that the artificial mem-
brane  is beneficial to the patient, if no pain is  experienced,
it may be allowed to remain in the ear for a few hours, and 
oii^              DEFECTS OF HE.VRlNd.

graduallv increased to the whole day.   It is often desirable
that the use of the membrnn i tympani should be preceded
or accompanied by  vesication  over the mi-toid  process,
whereby the  thick mucous  membrane  of  tho  tympanum
may be rendered more healthy.   In all eases the artificial
membrane should be removed at night; and, when there is
any discharge, the ear ought to be syringed each night and
morning with tepid water."
  I cannot finish this subject without giving some account
of the  Self-adjusting Artificial Tympanum of Mr. Vearsley,
which  consists of  a piece of wetted cotton, which  has a-
tendency to produce  partial or complete closure of the per-
forated membrana tympani.   Tn the year 18 IS,  Mr. Years-
ley published  his method, but the  great  drawback  to its
usefulness has  been the difficulty of applying it with such
nicety  by the  patients themselves  as is  necessary  to its
success.  In a recent publication," Mr Ycarsley  has im-
proved his  method,  so that  the most  timid patient  may
apply the remedy with safety and case.
  "A  piece  of cotton is to be  attached  to  a  thread and
drawn  through a silver tube  about  two inches  long, so as
to bring the cotton  against  the extremity;  then wet the
cotton, introduce it,  and move  about  at the bottom of the
passage until it reaches the  spot at which  the hearing is
improved; the thread may then be  let go  and the tube
withdrawn."
   The next  subject WC shall  puss to will  be  the use of
Hearing Trumpets to aid the deaf in hearing.
  ■ Med. Time* and Gazette, Dec 20, lb.w, and Bralthwalle Retrospect, July,
Part xxxt. ISO:, p. 116. 
CHAPTER V.
             HEARING TRUMPETS.*

  The  following  is  a list of the most recent  forms of
hearing trumpets in use in Europe and this country.
  1st. Earcap or reflector, small funnel shaped ear-trumpet
to remain in the ear.
  2d. Ear-trumpet of copper, turning  on  its  self  and
touching the auricle   of  the ear,  which holds  itself in
place.
  3d. Acoustic ears of silk solidified with caoutchouc, be-
in v easily hidden under the bands of the hair, the same as
the two preceding instruments.  [These are called auricles,
and  are only useful  to listen to a  sermon  or  a public
lecture.]
  4th.  Chin hearing pieces of the same  nature.
  5th.  Breast pieces of the same nature.
  6th.  Hearing Trumpet of  copper in the form of a shell.
  7th.  Hearing Trumpet of  brass, in a single piece.
  8th.  Acoustic trumpet of brass, elongating and shorten-
ing in the manner of  a long  telescope.
  9th.  Hearing  flexible  tube, formed  of a long  spiral
thread of iron wire, covered  with a tissue of silk or caout-
chouc, and furnished with a mouth-piece of cocoa or horn,
to be placed in the ear.   [This form has been found of
     * Maladies de L'Oreille. Par Dr. Triquet.  Paris. 1857. p. 457.
                          18* 
210
DEFECTS OF HEAR I NO.
considerable use by a number of moderately deaf persons
in this city, who use them when in conversation.]
   10th.  Hearing tube, allowing three persons to converse
with a deaf person.
   11th.  Bouquet forbearing, permitting two deaf persons
to converso together.
   12th.  Hearing basket of flowers.
   l.'Jth.  Hearing cane.
   14th.  Hearing ball costume.
   loth.  Miss Martineau's parlor (large) Hearing trumpet.
[This form of trumpet  is the  only one«for general conver-
sation, and is  recommended  by Mr. Wilde, but its use is
very trying to  tho ear  as stated  by Dr. Triquet,  causing
great confusion of sounds.]
   Kith.  Hearing staud for candlestick.
   17th.  Hearing easy  chair.
   isth.  Hearing pulpit for a preacher, or a professor, who
wishes without elevating his voice; too much, to  be distinct-
ly heard  by his hearers, and even  by  deaf persons, who
might happen to be in  tho audience.
   (Jbscrrations.—The  first eight instruments having  only
given negative  results, that is to say, that with the assist-
ance of these  trumpets, hearing  has not been much im-
proved.  The hearing  lead-dress  for the ball, should be
placed also in the same list.
   These  instruments  greatly augment  the intensity of
the  sound, but  the  objections to  most of them  is  that
they  produce  a  confusion  of sounds or  noise  at   one
point,  so that  the  deaf person is  unable  to  distinguish
clearly what is spoken.  Even in the healthy human  ear,
when these instruments are  employed for a short time, it 
HEARING TRUMPETS.               211
causes a high  state  of irritation by  the confused  noise
which they produce, even when  spoken into with a low
voice, and that their use would  soon injure the most heal-
tny constituted ear; therefore, persons suffering from deaf-
ness,  could  not bear them long without increasing their
infirmity.
  The results obtained from these instruments so far, have
been very unsatisfactory,  compared to those procured from
spectacles, microscopes, &c.   The whole  subject of acous-
tics, as applied to hearing, requires reinvestigation and ap-
plication.
   Observations on a  new form of Ear Trumpet.—Having
found most of the ear  trumpets  defective in  collecting
sounds  so as to render them distinct to a deaf aged lady
patient of mine, upon reflection and consultation with the
latest authorities  on  the  subject  of acoustics, and finding
that ear trumpets generally are so constructed as not to have
a true focus, I resolved, therefore, to  have an instrument
made of a spherical form, for it is well understood, that
cylindrical forms  give what  is called a caustic* in optics,
while a spherical form gives a  true focus; or in other words,
collects the sounds from all parts of its  surface, and con-  .
veys them to one point of space.  From a drawing of mine,
an ingenious artisan constructed a model in block  tin,  and
the lady informs  me, that it  affords her more satisfaction
than any instrument  she  has  ever used.  In numerous ex-
periments which she  kindly allowed me to make, in which
I employed several of the ordinary forms of trumpets, she
could hear a conversation one yard further and much more

  » Acoustics applied to Public Buildings, Smithsonian Report, p. £30. 1856. 
212              DEFECTS OF IlEAKIMi.

distinctly by my instrument. It is only 8 inches in length,
curved about 1 inch :  2 lines  less than  4  inches  at  its
spherical end, and the  opening at its base is  1  inch, grad-
ually tapering to an external orifice, which enters the ear,
of o lines diameter. 
CHAPTER VI.
               THE DEAF AND DUMB.

  I cannot in so small a work enter into a  history of
muteism,  nor of the early effort made  to  instruct them
by the  labors  of the good Jerome Carden of  Italy in
1576  and Petro de Ponce  in the sixteenth  century, those
who are curious on this subject I can refer  to the able in-
vestigation of Wilde and others. My object will be to make
the work  now offered to the public, one of  utility, by giv-
ing from the report* of our noble Pennsylvania Institution,
the third founded in this country, an outline of  its history
and mode of instruction, and also a  valuable letter on the
Cure  of the Deaf and Dumb, by Dr. Meniere.
   " The Board of Directors of the Pennsylvania  Institution
for the Deaf and Dumb was organized, and held its  first
meeting in  April,  1820.   President,   the Right  Rev.
William White, D. D.
   In  November following, a house was rented  in  Market
street, above Broad, and eighteen pupils assembled in it
for instruction.
   The  Institution  was supported by donations,  and  the
contributions of annual subscribers and of life-members.

  * The Annual Report of the Pennsylvania Institution for the Deaf and Dumb,
Philadelphia, 1853. 
214
DEFECTS OF HEARING.
  An Act of incorporation was passed by the  Legislature
of Pennsylvania,  in February, ls2l.   By this Act, tho
Commonwealth allowed one hundred and sixty dollars a
piece per annum for the education and support of indigent
pupils of the State.   The number was not to  exceed fifty,
and the term of each not to extend beyond  three  years.
The number has  since  been increased,  and the term ex-
tended  by several successive  enactments. The number
under the present appropriation being  ninety-eight,  aud
the term allowed six years.
  In September, 1^21, the Institution was removed to tho
corner of Market and Eleventh streets.
  In June,  1S24, a site was purchased at the corner of
Broad and  Fine streets, and preparations  made for  erect-
ing a large building.
  It was completed, and the Institution removed to it in
November, 1N25.
  In 182S, an additional lot in the rear  was procured, and
a school house erected on it.
  In ls:;!l, the buildings were extended, and  a story add-
ed to  the school  house.  The whole  establishment  was
then capable of accommodating one hundred  and fifty
pupils.
  A chaste  and simple Doric front of cut stone, with  por-
tico aud pillars, extends ninety-six feet on Broad street.
The buildings,  including the school  house, run  back  two
hundred and thirty-five feet,  and  enclose an  open space
laid out as a flower garden.
  There are two spacious yards, one for the  girls and one
for the boys, shaded by trees, and furnishing  ample .-pace
for exercise in the open air. 
THE DEAF AND DUMB.             215
  The school  building  contains ten school  rooms.  Each
one provided with appropriate furniture, as  slates, tables,
closets &c., when needed.  From  twelve to twenty pupils
usually constitute a class.
  At present there are eight classes, each under the care of
an instructor.
  Two of the teachers are mutes.  These classes are form-
ed in October, and  it  is  important that all new pupils
should  be  here at that  time,  that  the classes may  be
properly arranged.
  Contiguous  to the school rooms is a  Cabinet of appara-
tus, models, specimens, &c, to  assist the* teachers in pre-
senting clear  ideas on the various subjects, admitting of
ocular illustration.
  The centre building contains a lecture room,  capable of
seating two hundred persons.  It has  also facilities for
making  experiments, and presenting  diagrams,   maps,
sketches, &c.   In  this  room the  pupils are  assembled
twice every day,  sometimes in the evenings for lectures,
and on the Sabbath for  religious instruction.
  Underneath this apartment  is the dining room, in which
the pupils assemble through  opposite  doors, without in-
terfering with each other.  In the upper stories are the in-
firmaries, and  also two dormitories.
  The wings contain  the principal sleeping  rooms, the sit-
ting rooms, the shops,  the kitchen, bake-house, laundry,
cellars, &c.
  Attached to these are the  bath houses, washing rooms,
and other conveniences, accessible at all times without ex-
posure to the weather.
  The workshops give  employment to the boys two  or
three hours daily. 
210
DEFECTS OF HEARlMi
  The girls are taught plain sewing and drets-making, nnd
are  employed in  housewifery.   Habits of industry  are
thus forming, and  the pupils are preparing  for the duties
and practical business of life.  The hmirs of  tho day  are
apportioned to study, work, exercise and amusement.
  The establishment is lighted with gas, and  abundantly
supplied with the Schuylkill water.
  During the thirty years of the existence of  the Institu-
tion, there  has been expended for tho grounds, buildings,
appurtenances, &c, about niuety-fivo thousand dollars.
  The pupils  are  under the constant supervision of  tho
Principal,  the  Instructors, the  Matron, or the  Steward.
The  indisposed have  the prompt and devoted services of
the attentive  and skillful Physician, and in  critical cases,
the valuable advice of tho  distinguished consulting Physi-
cians of the Institution.  Thus, in sickness and in health,
the improvement, comfort, and happiness of the pupils, are
assiduously promoted.
  Instruction.—Some persons have desired to  know some-
thing of the  mode of instructing deaf mutes.   It is  not
easy, however, to'convey a clear idea of it to those who
are not familiar with signs.
  It is by means of signs that the process of teaching  tho
deaf and dumb is  principally conducted.  When wo look
at the Chinese characters  on a  tea-box, we  can  see no
meaning in them,  and might so look  forever,  without  be-
coming any wiser.  So also with the mute.  Our written or
printed words, are  as inexplicable to  him, as the  Chinese
characters are to us, and inspection alone could  never af-
ford any clue to their meaning.   An interpreter or a book,
could speedily convey to us the meaning of  the characters
through the medium of our language,  with which we have 
THE DEAF AND DUMB.
217
been familiar from early infancy.  But the deaf mute has
no  language.   To  enable  him,  therefore,  to  learn the
meaning of our words, he must acquire a language, through
which he can get that meaning.  Every mute of tolerable
capacity makes use of motions to indicate assent or denial,
approbation  or repugnance, as well as some common ob-
jects and familiar actions.   On these motions, limited and
imperfect as they are,  we graft by degrees a  system of
signs, which enables us finally to communicate consider-
able knowledge on many subjects, and to develop and call
into exercise, the faculties of the mind.   These signs con-
vey thought, and have no resemblance to words, but they
enable us to define words, explain their relations to other
words, give  their arrangement in sentences, and  the differ-
ent meanings which are attached to them.   This language
of signs can only be acquired from the living teacher. In-
comprehensible as it  may seem to a speaking person, un-
acquainted  with  the subject,  that  thought, however ab-
struse or refined,  may be conveyed  by varied  motions of
the arms, it is nevertheless true, and a  system of these
motions is the grand means of instructing the deaf and
dumb.
   This  being  premised, a class of ten to twenty mutes, is
furnished with large slates on which to write with chalk,
crayon or pencil.   The instructor presents  an object or a
picture  of one, or makes a sign for it.   He then  teaches
them to write the name, presenting  each letter by the
manual alphabet.  When  they can all write it,  it is erased
and rewritten a number of times, till it is impressed upon
the memory.   Some  information may be  communicated
respecting the object.
       19 
21*
DEFECTS OF HEARING.
  Questions may be asked to induce the pupil to  think.
In this way a number of nouns are taught, so that when a
concise sign is made for one of  them,  it will  be readily
written.   In the  same way words expressive of the quali-
ties and properties of bodies may be  taught.  When such
words are  presented with  appropriate nouns,  the  pupils
write them in connection.  They  arc then required to give
examples of similar combinations from their own resources.
This is the first attempt at composition.
  Another step  will be to make signs for actions, and
teaching  their names.   Then  the use  of these words in
combination with  the words  already familiar, as " a boy
sees a horse"—"a boy sees a strong horse."  Again, some
of the words expressive of the  relations of objects, may be
taught, as  "a lady sits  on a  chair"—"a bird flies  iuto a
cage."   Other words and other ideas are presented to them.
They endeavor to express the ideas in writing,  using the
words and forms  of arrangement  which had been taught.
These sentences are corrected, and the pupils are required
to give examples of their own.  These original  efforts arc
also corrected.  The connections of language, the abstract
terms, the phrases and the idioms are successively taught.
Series of seutenccs, anecdotes, narratives, &c., are written
off and explained by signs.  These are copied by the pupils
and studied as evening  lessons, and  in school  arc written
from memory, or  recited by signs.  There are  other even-
ing exercises, such as writing a number of original senten-
ces  on single words—composition on  particular subjects—
letters, &c.  from time to time the  elementary principles
of arithmetic  and geography are  taught.   Indeed, our il-
lustrations of words and  principles  are  drawn  from the 
THE DEAF AND* DUMB.
219
sciences, and the whole range of human knowledge, so that
in the course of their education a great  amount of  know-
ledge is communicated to them.  The  subjects of arithme-
tic, geography, grammar, history, &c., cannot be taught
systematically till the latter part of their course, when they
are supposed to have acquired a considerable command of
written language.
   Moral and religious subjects have also a  large share of
attention.    Much  useful information is communicated by
lectures, addressed in the language of signs, to all  when
assembled together.
   It  will readily  be inferred from  these statements that
much will depend upon the capacity  of the pupil, his at-
tention and his diligence.   There can be no set course or
limited periods for certain studies, which, when completed,
make an educated person.
   The  longer the mute is  under instruction, the greater
will be his command of language.
   It will  also  be  perceived that  much depends upon the
knowledge, ingenuity and tact of  the  teachers  in the use
of signs.
   The  language of signs is the  all important instrument
by which the educator is to reach the mind of the  mute
pupil, in  his early and his later efforts.  By this alone can
he lead the pupil  to reflect on  his own mental operations,
feelings, motives,  emotions and passions, and thus learn the
thoughts, feelings, &c., of others, and to understand and
use the language  employed to express ideas on  these  sub-
jects. When this point is reached the pupil may relinquish,
entirely and forever, if he please, the use of signs.
   A new instrument has been given to  him, by which he 
220
DEFECTS OF HEARINO
may explore the world of books, and communicate with his
fellow men to an unlimited extent.   Froei this point, self-
education may be  carried on, and continued to tho end of
life, through written language.
   It should be  remarked, however,  that a large number of
mutes  do not reach this  point, from want of capacity, yet
the acquisitions even of  such, are probably as valuable, in
proportion, as those made by the more gifted.   Tho pro-
boscis of the fly, is doubtless as important to the little in-
sect as the trunk of the  elephant is to that sagacious and
majestic animal.

      Directions for Teaching Deaf Mutes at home.
   It is very important to the  deaf  mute, that his parents
and friends should cultivate the language of signs, and en-
courage him in the use of them as early as possible.
   Let them observe the child, and imitate the  signs ho
makes.   When he is pleased with anything, invent a sign
for the thing, and  repeat that sign many  times afterwards.
Distinguish different persons by signs, suggested by a scar,
mole, beard, or any little peculiarity which the person may
possess.
   Imitate the actions  of riding, sewing, eating,  mowing,
cutting, throwing,  sowing, <tc.
   For  " good," kiss  the hand.   For " bad," bring  the
hand to the  lips, turn  the  palm  down, and throw it from
you.  For " glad," pat the heart rapidly, with a cheerful
expression of countenance.   For " sorry," rub the clench-
ed  hand  on  the heart,  with a sad expression of counte-
nance.
   For  " black," draw the end  of the forefinger along the 
THE DEAF AND DUMB.
221
eyebrow.   For " red,"  touch the lips with the forefinger.
For  "love," cross the hands and press them on the heart.
For  " hate," push  both hands, the palms  out, from- the
heart, as if repelling  something from  the left side.  For
" lie," move the  forefinger across the mouth horizontally.
For " true,"  place the forefinger perpendicularly across the
lips and thrust it forwards.
  These are a very few  examples,  merely as suggestive
hints.
  The child  can be taught to spell on the fingers at a very
early age.
  Any person can take an  object, as a hat; pick  out the
letters h-a-t from the  Deaf and Dumb alphabet, and learn
to place the fingers in the true position for each letter. No
matter how slowly it is done.   Let the  child imitate until
he can make the letters of the word in order without assist-
ance, at the same time show the object.  Do this very often,
until the child has learned to spell the word when  the hat
is presented to it, or to go and bring the  hat when the word
is spelled to it.
  Then take another object, as pin, go through the same
process until it is thoroughly learned by frequent repetition
every day.    So with arm, cat, dog, chair, &c.  The follow-
ing ten short words, the names of common objects, contain
every letter of the alphabet, viz: adz, fan, map, cow, box,
jar, sky, hat, quill, glove.
  After the power of spelling the names of many common
objects has been acquired, the  names of familiar  persons
may be taught.
  In a similar way, the child may be taught to write the
names of things on a slate quite early.   Let him  imitate
                          19* 
OO-)
DEFECTS OF HEARING.
the form of the letters for one word, as  hat, and repeat  it
many times, until he can write it as readily as he can spell
it  on the  fingers.  Take another word, and  go over tho
same process.  Point to each  letter, and require tho child
to  make the sign for the letter on the fingers.   By frequent
repetition,  the ability to write the names of  many things
and to form all the letters of the alphabet, will be acquir-
ed.  It is best to make the child form the letters as  round
as  possible, and not to  take off the pencil until tho word  is
completed.  The habit thus early begun, will save a great
deal of  time, and enable the writer to accomplish more in
a given time, and with  more ease than can possibly be done
on any other principle.  If it is desired to go further, write
the name of the child, as John  sees a chair—John  sees a
table.   Let him copy the sentence, explaining by signs the
word sees, and pointing to the chair, aud also  to the  child.
Then let him write John sees—and let him select another
object to fill up the blank ; and  finally let him cover his
slate with sentences thus formed.   Help  him to objects out
of  the house as well  as in.  Encourage him to write as
many such  sentences as he can.   All this may be the work
of  years, but the advantage to the child cannot be estimat-
ed.  A little attention, thus bestowed, every  day, will ac-
complish all this, and probably much  more." 
THE DEAF AND DUMB.
223
 ON  THE  CURE  OF  DEAFNESS,* [DEAF DUMB-
                          NESS.]

                 LETTER OF DR. MENIERE.    *

   Mr. President:—My title of Physician  to the  Institu-
tion  of  the  Deaf and  Dumb, perhaps, demands  that I
should not remain a mere spectator of the debate which is
now agitating  the  Academy;  but  the respect due to pro-
priety has  hitherto prevented  me from breaking  silence;
as I wished to leave to your illustrious body itself,  the care
of answering the official  questions.   Though this feeling of
deference for the initiative of the  Academy,  was not relish-
ed by everybody, still I should have remained silent in the
apprehension that my interference might have been attri-
buted to personal interests.  But several honorable  mem-
bers of  the Academy having  appeared astonished at my
silence,  and  not having appreciated  the reasons  which I
gave for it, I can no longer  remain  indifferent.  Permit
me, therefore, Mr. President,  to  furnish to the  judges  of
this question, the tribute of the observations which I have

 * From the American Annals of the Deaf and Dumb, edited by Luzerne Rae.
  [The Imperial Academy of Medicine at Paris, having been requested by the
Minister of the Interior, to give its opinion of a work on the Possibility of Curing
Deafness, by Dr. Blanchet, referred the  matter to a committee of its members.
On the 12th of April last, Prof. Piorry reported, in behalf of this committee, the
result of its investigations.  In the course of the discussion which  followed, a
letter from Dr. Meniere to the President  of the Academy, was read by the Sec-
retary, Mr. Dubois. This letter appears in the Moniteur, the "official journal
of the French empire," of May 5th ; for a copy of which paper we are indebted
to a friend in Paris. At our request, Mr. Clerc has translated Dr. Meniere's letter,
which, we trust, will be found worthy of the place it occupies in the Annals.
It will be seen that Dr. M. adds his testimony to that of other persons who have
carefully studied the subject, in regard to the ill success which has hitherto at-
tended all efforts for the permanent cure  of the deaf.—Editor.] 
224
DEFECTS OF HEARINd.
been  able to collect in  my particular position.  I needed
this encouragement, and I beg the Academy to grant mc a
few minutes of kind attention.
   Fifteen vears spent in the Institution  for the Deaf and
Dumb at Pari-; a visit (not ofiicial, it is true) to most of
the establishments of this description which exist in Prance,
Italy, Spain, Switzerland, England and (iermany; an atten-
tive study of the best works published on deaf-mutism ; the
habitual intercourse which I have had with the most compe-
tent men on this matter; the examination of a great num-
ber of deaf and dumb persons, both children and  adults,
belonging to all classes  of society;  perhaps authorize me
to form an opinion of this kind of infirmity, whether con-
genital or accidental, of tho consequences which it draws
along, and finally,  of the  possibility  of its being cured.
Such  an  opinion I solicit the  favor of  expressing in a few
words.
   We are generally apt, in the proud  sense of our own
perfections, to pity those who do not possess them as fully
as we do.   The pity which the  deaf and  dumb inspire,
takes  its source in a tacit comparison; few of them, how-
ever,  are disposed to accept it; aud among  the  more  in-
structed and more intelligent, many are found who entirely
reject that sympathy, the motive of which wounds their feel-
ings.   The deaf and dumb think themselves our equals in
everything; the resources which they believe they possess,
to communicate among  themselves, and  with those who
speak, are, in their opinion, sufficient for them, nor do they
think  themselves much to be pitied, because they do  not
hear what we say.  It is an illusion in  which it would, per-
haps,  be generous to leave them. 
THE DEAF. AND DUMB.
225
  Whatever it may be, deaf-mutism  is  very truly an in-
firmity, as it is an organic imperfection which places those
who are afflicted with it, in a state of inferiority to those
who hear;  it is then indispensable to resort to science in
order to repair a misfortune more or less  grievous to the
person whom it has  befallen.   But what is to be done ?
Can we cure  such defects, or if not,  can we improve the
sense of hearing to such a point as to render conversation
possible ?  If we could resolve this problem, it would in-
deed be a great benefit, and statues  should be erected to
the  honor of the successful inventor of a method capable
of restoring the  unfortunate deaf and  dumb to their nor-
mal conditions.   Nobody, certainly, need to despair of the
future;  it is not in a century like ours, in which the won-
ders of science  are every  day discovered,  that we should
renounce the hope of rendering so great a service to hu-
manity, but we  must acknowledge that, hitherto, all at-
tempts have failed.
   My position at the Paris Institution has procured me the
advantage of seeing the operations of a certain number of
pretended curers of deaf-mutism.   An  English physician,
patronized  by two members of the Academy, tried, in my
presence, the experiment of distilled water, containing, ac-
cording to  all  appearance, a preparation of aconite.   He
added to this specific, mechanical excitations of the  ear, a
 gymnastic  of hearing, to the great admiration  of  many
 spectators,  who wondered  at  the auditive vibration caused
by these excitations : but the deaf and  dumb children sub-
 mitted to  these  experiments, have  not ceased  to  figure
 among the  number of the pupils of the  Institution, in spite
 of the promises of the operator, who was to open to them
 the doors of the speaking and hearing world. 
226
DEFECTS OF HEARINO.
   Another personage having obtained the honor of a com-
mission from certain members of the Academy of Sciences,
practiced  for a month, and  under my eyes,  certain oper-
ations destined to awaken the sensibilities of the ear of ten
deaf  and  dumb persons taken from  among  the pupils of
the Paris  Institution.  I took notice not only of the feats
and gestures of that personage, but also of the results ob-
tained at the  close of each  sitting.   This  series of pro-
ceedings, the most circumstantial, and the most  exact, serv-
ed as a basis to the  labor of the  learned reporter, and it
has been  demonstrated, in the most evident  manner, that
this enthusiastic curer did not produce any change  at all in
the situation of the deaf and dumb who had  been  intrust-
ed to him.
   Another, still bolder, (it was nothing but self-confidence,)
durst apply the crown of his trepan to the skull  of a young
girl who is now among the pupils of our Institution.   By
that opening, the  child was  to perceive the  sounds;  the
child  was to hear.   But the child  does  not hear at all, or
at least, it is still deaf and dumb, and we do  all we can to
protect its head against the exterior shocks which might
easily kill it.
   Has the actual attempt on  the value of which the Acad-
emy is now called to pronounce, attained the object? Has
an experiment which dates from the end of 1847, and which
was pursued with singular perseverance,  finally given satis-
factory results 1
   Does it  ensue that because  some  partially deaf and dumb
persons succeeded in perceiving certain sounds, these poor
children cease to belong to the category of individuals who
can communicate with the  hearing only by means  of arti- 
THE DEAF AND DUMB.             227
fieial methods?   When, with the  aid of an acoiimeter, we
learn what number of vibrations is  wanted to shake  less
the ear than the skull of a deaf and  dumb person, ought
we to conclude thereby that the  articulated voice, or the
musical word, so  delicate, so intellectual, will be perceived
by an organ weakened, vicious  or dead ?
  It suffices to have  studied these little prodigies, to be
convinced  that the speaking deaf and dumb do  not hear,
but speak by seeing.  Those who have no interests to feign,
ingenuously acknowledge that the hand  placed before the
mouth of their interlocutor, breaks, in an instant, all com-
munication with  him, so that it is always the eye  which
substitutes itself for the ear, and causes to the ignorant
spectator, the simple or silly astonishment, the  explosion
of which soon takes place.
  I might say more  on the subject of these  medical illu-
sions.   The  love of science and  humanity is  not always
the noble object a man proposes to obtain.  In  resorting to
this insatiable desire  for curing, which  broods in the heart
of the parents of the deaf and dumb child, we  find  our-
selves  in the presence of an active credulity.  Magnetizers,
somnambulists, homoeopathies,  empiricists of every kind,
are eager for this work;  the promised, as well as the hoped
for benefit, will make us wait long;  it will not arrive; but
if the child is intelligent;  if its partial deafness permits it
to utter  some words; if its rapid eye learns to  read on the
lips of the speaking  person, there is enough to satisfy the
lets exacting, and the curers record a new triumph.
  Will the rigid appreciator of facts of this  kind, be  con-
tented with such success ?  Will the Academy  of Medicine
grant its high sanction to such results as these ?   We are 
228
DEFECTS OF HEARINO.
permitted to doubt it, so much the more  because, aa said
the  Hon. Mr. Gucneau de  Mussy,  with  so much  force,
"the means employed to cure the deaf and  dumb, have
nothing new, nothing special."  What  matters  it?   The
sonorous instrument is of little importance when the only
question is to awaken tho sensibility  of the ear.   Tho
orgue, monochard, acoumeter,  do not possess specific qual-
ities ; the shaking communioated to the  nerves of audition
by all these agents,  is a fact of uniform nature, whatever
may be its point of departure, its character, &c.   No one,
as far as I know, has yet discovered in the vibrations of
any body whatever, an occult virtue, and never will the art
of making a noise for the benefit of the deaf and dumb,
merit the honor of being called a me/hod.
  When by the couching of a cataract, or by the opening
of an artificial pupil of the eye, a dexterous  hand  gives
passage to a lucid ray, which falls  upon a sensible retina,
the phenomenon  of  vision  immediately manifests itself,
and very little practice  is necessary for the previously blind
man to take an exact  knowledge of objects.  Will  it be
the same thing when a sound  reaches an  auditory nerve ?
Will the vibration experienced by the labyrinthian appara-
tus, suffice  to give to the brain the faculty of comprehend-
ing the word;  to  establish by the aid of this new commu-
nication, the intellectual relations usually existing between
individuals who hear?  You  know, Mr. President, and
the Academy is not ignorant, that Dr. Itard demonstrated,
not long since, the impossibility of such a relation; nay,
the absolute difference which exists between those two forms
of comparison.  It does not suffice  to hear a  little in  order
to hear enough j the child which, on coming into the world, 
THE DEAF AND DUMB.
229
has a certain weakness of hearing, is irrevocably condemn-
ed to remain  in  an exceptionable class;  he is deaf and
dumb;  he must by absolute necessity use artificial means,
to make himself understood by other men; he is deaf and
dumb;  he will remain deaf and dumb; not one fact war-
ranted by sound  criticism, has yet come to protest against
this judgment; and what has taken place in our own time,
is far from supporting a contrary opinion.
   Let us  reserve  the rights of the  future.  I am willing.
Let us  hope that, one day, the  isolation of the deaf and
dumb will cease; but in the mean time, the men who live
in the midst of these unfortunates, and who keep a record
of acquired experience, should think of coming to the re-
lief of those whom this infirmity assails, and seek to resolve
the following  problem:  A deaf and dumb person being
given, to  endeavor  to make him the best person possible.
The question thus put in  its generality, without referring
to individual differences; without adhering with charitable
predilection to some scarcely privileged deaf and dumb,
capable of articulating sounds and  reading words  on  the
lips; by playing well the part imposed on us by Providence,
who welcomes all the unfortunate, and equally bestows its
benefits upon them; by following the way which is truly
worthy of a human government; we must do what is done
in France, receive all the deaf and dumb, and offer to them
all the means of  communication we are able to afford.
Reading  and  writing, the  alphabetical signs, the signs of
convention, the articulation of sounds, reading on the lips,
all these  means  compose  the system of education put in
practice in the two  principal schools at Paris and Bordeaux,
as well as in most of the departmental and private institu-
        20 
230
DEFECTS OF HEARING.
tions.  To be willing to confine one's self to one of these
proceedings would be considered as  failing of one's duty,
and  knowingly abandoning to radical  ignorance  all the
children who have not much intelligence,  and whose vocal
organs are essentially deficient.   In one word, it would bo
doing what is done in certain  countries where, by succes-
sive  eliminations, all  efforts come to be reserved for those
who  can the best profit by them, aud who, even  in the
absence of those  efforts, would find  sufficient resources to
create  for  themselves, in some way, sufficient  means of
communication with their fellow-citizens.
  Hitherto the public administration in France has pro-
ceeded more  generously.   The  State has better compre-
hended its duty,  it has  admitted into  the  Imperial
establishments all the deaf and dumb who are not idiotic;
it has  liberally tendered the most various instruction to
all these unhappy children, besides  a manual  profession
capable of insuring their subsistence; it has supplied them
with a mass of general  knowledge, which places our deaf
and dumb a great  deal above the average obtained in the
countries where an opposite method  is  adopted.   Permit
me,  Mr. President,  to  submit to the Academy  a  fact
of great  importance in  the examination  of this delicate
question.
  In Is 17, there  was at Pforzheim in the Grand Duchy of
Baden, a congress of all the teachers of the German deaf
and  dumb.   Invitations had been addressed to the pro-
fessors of the neighboring  countries.   Mr. Morel, now
Piiiv ipal of the Bordeaux Institution,  attended  that con-
vention.   He is familiar with  the German language.  He
took an active part in the  acts of that assembly;  and  it 
THE DEAF AND DUMB.
231
results from the verbal proceedings collected by this honor-
able professor, that the French  pupils generally instructed
by  the  mimic  method  possess, after  studying a certain
number of years, a more extensive knowledge than those
who, by great exertions are taught to speak.
  The reason of this difference is very simple.  Much less
time is required to learn a fact, than to express it in words;
ideas  are better than words;  a  child  has  more interest to
know than to say; intellectual furniture is a hundred times
preferable to the articulation of certain sounds.  Our pupils
in the Paris Institution know a  great deal more than they
can express; in  a word, ours  think much while theirs
endeavor to  say a little.
   Such is the summary of  a conference in which  the
French professor  had to struggle against men devoted to
another system;  but  the  German  professors have been
brought by  evidence  to see  that the method followed in
France, agreed better  with  a  majority of the deaf  and
dumb, and incontestibly gave them a greater intellectual
value, and rendered  them more useful,  better and more
fit  for the society in which they are called to live.   We
voluntarily acknowledge on our part, that the oral method
is more satisfactory to those who  live with the  deaf  and
dumb; but I may be permitted to say, that between  two
egotisms, it is  but just to give the  preference to that of
the more interested party.   The deaf and dumb, it is not
to be denied, are less  made  for us than we are for them;
it becomes  us  who are the rich,  the favored, to descend
to them; we ought to take the first steps and not  to im-
pose upon them the torture of articulating with much pain
a few words which they do not understand, and which they 
232
DEFECTS OF HEARING.
renounce as soon  as  they arc no longer under tho eyes of
their masters: in one word, the deaf and dumb, whatever
may be said to the contrary, form a class apart; they want
artificial methods to put themselves in communication with
us; we ought, therefore, to furnish them with the greatest
possible number of  these  means of communication, and
hitherto France  has not  failed in her  duty toward her
children, deprived  by nature of the sense of hearing.
  The Paris Institutiou is  at once a school of literary in-
struction and an industrial  establishment.  There is given
to all  the deaf and dumb, a practical education sufficient
for the generality of pupils; and moreover, various kinds of
trades are taught, which class them among the active and
useful  members of society.   But  there are intellectual
wants of a higher nature, and it has been felt that a more
refined aliment was necessary for tho most intelligent pu-
pils.  There  had  been for them a kind  of normal school
which  recruited itself from among the  most skilful; but
the ingenious philanthropy of Dr. Itard  has regulated this
disposition, and has rendered it obligatory and permanent;
he has, with a generous hand, endowed the Class of Per-
fection, in which, after concurrence, the most distinguished
pupils of the Institution are received, and the latter soon
become teachers in their turn.
  Thus the Paris school endeavors to make good deaf and
dumb citizens; deaf and dumb instructed, moral, laborious;
deaf and dumb provided with all the means of communica-
tion with other men; they write rapidly;  in the absence of
pen or pencil, they have the manual alphabet; this failing,
(as when  speaking persons do not understand  it,) they
have pantomime, so expressive, so  clear,  so rapid; finally, 
THE DEAF AND DUMB.
233
when no one of these means can reach the stupid mind of
an ordinary speaking person,  the articulation of sounds
comes to the succor of both,  and some phrases  more  or
less correctly pronounced,  remove the  obstacles  between
the two interlocutors.  If the  speaking person articulates
well; if he takes care to speak slowly by emphasizing all
the syllables; if his mouth  is well shaped; if it is not hid-
den by a long beard; if his face is sufficiently expressive,
then the deaf and dumb man can read on his lips; and this
is the last  means of understanding  each other.  But all
these conditions are not to  be had  as easily as can be im-
agined;  either the  one or the other,  too often, is wanting,
and all these advantages so laboriously acquired, are ren-
dered useless.
   Beading  on the lips is  an  art of infinite delicacy; an
exercised eye is necessary; but here, the eye  is even less
useful than quick and bright intelligence; a phrase must  be
guessed  by the  aid of  a word  hastily seized.  The logical
induction which  leads like  a dart,  from a word to an idea,
must be resorted to; and this  is so true, that but a  small
number of individuals are found, who can acquire much of
-this marvelous faculty.  Those  who, hitherto, have attained
the highest degree of perfection, belong to families in which
every thing has been done, to attain this object. These are
miracles of maternal love,  prodigies  of patience required,
and yet these are only efficacious among children who are
most fortunately endowed with intelligence.
   I believe,  Mr. President,  and  I dare  hope that the
Academy will also think like myself, that from the nature
of  these rare and  exceptional cases, it is impossible  to
make a uniform rule of public instruction; three-fourths of
                           20* 
2'M
DEFECTS OF HEARING.
the deaf and dumb, entirely so  or  not, submitted to this
system of instruction, will not derive any real profit. These
views pievail at the Paris Institution for the deaf aud dumb.
The State, in its active generosity, dispenses instruction to
all those who caunot acquire  it by ordinary methods,   lor
the deaf and dumb it establishes schools  in which experi-
enced teachers impart to those deprived by  nature, all the
knowledge  they need, to discbarge the  duties of useful
citizens; it does not look for imaginary perfection ;  it con-
tents  itself with meliorating  evil, diminishing misfortune,
and restoring to the great human family  those amoug its
children, whom ill-fate has separated from it.
  In conclusion, no one has  ever cured deaf and dumb per-
sons ;  the possibility of this art of healing is still confiued
to the number of the Desiderata,  the most uncertain  of
science.
  The attempts  renewed  ever since IS 17, have remained
unsuccessful, and it should bo so, for they  differ in nothing
from  those which  preceded  them, and which had  already
proved abortive.
  The auricular education of the deaf and dumb ought to
be considered impracticable;  it can only succeed with one
who has been cured of his deafness.
  The above article was translated  from the French by
Laurent Clerc, Ksq., himself a deaf mute, and many years
ago one of the celebrated pupils of the Abbe Sicard.   Mr
Clerc, in connection with the ltev. Thomas  II. Gallaudet,
LL.D., introduced the present system of deaf-mute instruc-
tion into our country, and thirty-two years ago introduced
it also into the Pennsylvania Institution, of which he then 
THE DEAF AND DUMB.
235
had the charge.  He has been  in  the  field  of deaf-mute
instruction for a period of nearly half a century, and is still
actively and successfully engaged in his benevolent labors.
  In accordance with the opinion of Dr. Meniere in regard
to the probability of restoring deaf-mutes to hearing, we
find the following passage in the appendix to a recent work
on Aural  Surgery,  by Dr. Wilde, of Dublin :—" Is deaf-
dumbness curable ?  To this serious question I must reply
in the negative.  Except by miraculous interference, I do
not believe the  true congenital deaf-mute was ever  made to
hear; and those who lose their hearing so early in life as
never to have acquired the faculty of speech, come  into the
same category." 
 
INDEX.
                        •                                           PAGE.
Abrasion of cornea....................................................    35
Adjusting power for distances weakened...............................78, 87
Adjustment of the eye to different distances............................    69
Adjustment, loss of power of..........................................    85
Adolescence and youth, care and management of the sight in.............146
Adult age, preservation of the sight in..................................   148
Affections, amaurotic.................................................98, 106
Albinoes, want of pigment in the eyes  of...............................    15
Amaurosis............................................................   120
          congenital..................................................   142
          diagnosis of, by the use of the opthalmoscope.................   124
          from congestion.............................................   123
          from exhaustion............................................   123
          from pressure...............................................   123
          from super-excitation........................................   123
          and glaucoma in  old age.....................................   151
Amaurotic affections.................................................98, 106
Anterior internal ophthalmia in adolescents............................   147
Application of eye-waters.............................................    40
Applications, warm and cold, to eyes...................................    42
Aqueous humour.....................................................    17
               anterior and posterior chambers of.....................    17
Arthritic or gouty ophthalmia in old age...............................   151
Artificial eye..........................................................   126
Artificial light........................................................    29
Asthenopy...........................................................    86

Blear eyes............................................................   146
Blindness, night......................................................   118
Blood, loss of, injurious to the sight..........■..........................    38
Blow on the eye, sensation  of light excited by a........................   102

Camera obscura.......................................................18, 20
Care and management of the eyes during adult age......................   148
                                     childhood......................   144
                                     old age........................   151
                                     turn of life.....................   150
                                     youth and adolescence.........   146
Cataract..............................................................    46
        can it be cured without an operation ?..........................    65
        congenital....................................................   14*'
        couching of...................................................    *>9
        displacement  of...............................................    ^9
        division of....................................................    62
        extraction of.................................................   '   o
        -glasses.......................................................    82
        in infants....................................................   140
        lenticular.....................................................    47
                 hard, of old persons.................................    48
        in old age....................................................   I51 
2.')8                           INDEX.


                                                                     PA(.r
Cataract, operations for, comparison* of.................................    * *
        palliative treatment of.........................................    '"•■
        reclination  of.................................................    ™]
        relative frequency of..........................................    y
        ripe and unripe...............................................    '.'':
        secondary................................................•  ■ •    ''■}
        soft...........................................................    "'
of young people.
Catarrhal, rheumatic, and catarrho-rheumatic ophthalmia...............    1*8
Catarrho-rheumatic ophthalmia.....................*..................    "J
Chambers of aqueous humour..........................................     J*
Child-bed preservation of eyes in.......................................    •*»•
Childhood, care and mauagoment of eyes during........................    1"
Choice of light........................................................     ^7
Choroid coat..........................................................     ',
Chromatic vision.
Throopsy.
. ...wy~j.........................................
Ciliary body..........................................................     "
Cold applications to eyes..............................................     40
     douche to the eyes................................................     4-
     dry, to the eyes..................................................     4.1
     water to the eyes.................................................     4-
Color-blind new........................................................    los
      defective perception of...........................................    1";s
      Influence of sex.................................................    ll«j
      theories of this defect............................................    H'
      methods of alleviating...........................................    115
Colors, complementary.................................................    100
Colored vision.........................................................     S''
Comparison of the operations for cataract...............................     <"''
Complementary colors.................................................    1°°
Congenital amaurosis..................................................    1 *'•!
           cataract....................................................    14°
           imperfections of the eyelids.................................    14M
      Imperfections of the Iris.........................................    112
Concave glasses.......................................................75, 70
           choice of...................................................75, 76
Conical cornea........................................................     81
Conjugate foci.....................................................6!i, 76, 82
Cntitiit:ions ophthalmia,  prevention of spread of.........................    13u
Convergent glasses, refraction by......................................     (>!>
Convex ^.'laaaea....................................................79, 80, Sj
Copying trying to the  eyes.............................................     31
Cornea................................................................     14
       abrasion of....................................................     36
       conical........................................................     84
       inflammation of................................................    146
Correspondiun parts of the two retinae..................................    l.'iO
Couching of the cataract...............................................     5U
Crystalline lens.......................................................     17
Cure of cataract without an operation...................................     65
Curvatures of refractive media of the eye..............................     21
Curvature of retina...................................................     22
Cylindrical eye.......................................................     83

Daltonism.............................................................    108
         Dr. Wilson's researches on..................................10ft,  116
Daylight..............................................................     27
Defective perception of color...........................................    108
Defects of eight in particular...........................................     41 
INDEX.
239
                                                                    PAG!.
Depravers............................................................    8J
Derangements of the dioptric apparatus of the eyes......................    46
Diagnosis of amaurosis, glaucoma......................................   124
Different distances, adjustment of the eye to............................    68
Dilatation, fixed,  of the pupil..........................................    68
Dioptric apparatus of eye............!.............................16, 20, 21
                  of the eyes, derangement of..........................    46
Diplopy, or double vision with one eye.................................    86
                        with two eyes................................   131
Displacement of the cataract...........................................    69
Distinct vision........................................................    JO
Division of cataract...%................................................    °2
Double vision with one eye............................................    86
              with two eyes...........................................   131
Douche, cold, to the eyes...............................................    42
Dry cold to the eyes...................................................    43

Early infancy, preservation of the sight in..............................   137
Efforts cause determination of blood to eyes.............................    38
Externality or outness, perception of....................................    23
Extraction of the cataract......'........................................    ^2
                        treatment after...............................    "•>
                        untoward occurrences during..................    57
                        untoward occurrences after....................    °8
Eye, adjustment  of, to different distances...............................    "9
     cylindrical......................................................    °3
Eyes, applications to...................................................    40
      artificial........................................................    i^6
               mode of inserting them.................................    1*1
               care in order to preserve them..........................    128
blear.
146
       during childhood, care and management of.......................   144
       foreign particles in..............................................    34
       of infants, protection of..........................................   143
       inflammation of..................................................    ;?°
       injuries of.......................................................    35
       preservation of, in child-bed and suckling........................   |55
                      after fevers.....................................•   j^"
•                     in measles, smallpox, scarlet fever, hooping-cough   153
                      in venereal diseases..............................   i55
 Eyeball a camera obscura..............................................    ir
        structure of....................................................    l •?
 Eyeballs, movements of................................................    fjj
 Eye-glass, single, detrimental to the sight...............................    '°
 Eyelids, congenital imperfections of.....................................   l*j
        movements of.................................................    fz
         securing of, during the operation for cataract...................    5^
 Eye-waters, application of..............................................    40
             &c, use and abuse of......................................*u> *a

 Far-sightedness........................................................77> |jj
               prevention of...........................................    °J
 Fevers, preservation of the eyes after..................................•   l°4
 Fixed musea;..............................•..........................   'so
 Flies, appearance like, floating before the sight..........................    °J
 Floating muscae.....................................................■ ■ •    °
 Foci, conjugate.....................................................ba> "> '?
 Focus, principal, of a lens..............................................    '"
 Foreign particles in eyes...............................................    6* 
240
INDEX.
                                                                      PA01.
Glasses, cataract-......................................................    *"
        concave....................................................Vo" so 83
        convex.....................................................7f*- K< ~
Glass, reading.........................................................    "f
Glaucoma and amaurosis In old age....................................   ';!'
                        diagnosis of..................................   ••*
Gouty ophthalmia In old age...........................................   '•''

Half-vision, transitory.................................................   J17
Hemiopy, transitory...................................................   \1'
Hooping-cough, preservation of the eyes in.............................   *'•••
Humour, aqueous....................................*................    j7
          vitreous............................»........................    1H

Identical parts of the two retina;........................................   '•'''
Images, projection of...................................................l'> J;
Imperfections bf the eyelids, congenital.................................   J 4.1
             of the iris, cengeuital.....................................   14'-
Incapacity to keep the eyes fixed on near objects........................    *'j
Inflammation of the cornoa.............................................   140
             of eyes..........................-.......................38, 144
                    causes and prevention of...........................39, 40
             of the iris...............................................   1 jij
                   prevention of relapse of.............................   149
Infancy and childhood, preservation of the sight in......................   137
Infants, cataract  in....................................................   14''
        protection of eyes  of...........................................   1;''
Injuries of eyes........................................................    •'«
Iridescent vision.......................................................    h-'
Iris....................................................................    \\>
     congenital imperfections of.........................................    ' '-
     lnflammatiou of...................................................    ' *"
                   prevention of relapse of.............................    14!'
Iritis, or inflammation of the Iris.......................................   1 l;i
      prevention of relapse of..........................................   149

Lachrymal apparatus.................................................    2s
 Lens, crystalline.......................................................    1"
      principal focus of................................................    79
 Lenticular cataract....................................................     61
 Levator muscle of eyelids..............................................     24
 Light, artificial........................................................     27
       cholco of.......................................................     27
       day-...........................................................     2s
       sensation of, excited by a  blow on t In; eye........................    102
       too  week, injurious.............................................    2'J
 Lunar cau«tic solution, bad effects of careless or ignorant use of..........41, 42
 Luscitas...............................................................   132

 Manifold vision with one  eye..........................................    86
 Measles, preservation of the eyes in.....................................   153
 Movements of eyeballs.................................................    21
            of eyelids..................................................     25
 Muses, fixed..........................................................   119
        floating........................................................    89
        volitantes.....................................................    S9
 Muscles of the eye, paralysis of.........................................   1:1.1
 Mydriasis............................................................    68
 Myopy..............................................................oft, 71
 Nerves, optic......................................................    13 
INDEX.                           241
                                                                    PAGE.
Nervous short-sightedness.............................................    71
New-born infants, ophthalmia of......................................   "'
Night-blindness.......................................................   i18

Ocular spectra........................................................   ;j°JJ
Old age, arthritic or gouty ophthalmia in..............................•   j'1
        common hard lenticular cataract of...........................48, 151
        glaucoma and amaurosis in...................................   1?1
        presbyopy and  change of spectacles in........................   l°0
        the sight in...................................................   l0}-
Old persons, common lenticular cataract of.............................    *°
Operation for catarect, preparation of patient for........................    °l
Operations  for  cataract, comparison of.................................    °*
Ophthalmia..........................................................   ■,.»
            anterior internal in adolescents............................   **'
            arthritic or gouty, in old age...............................   j°i
            catarrhal.................................................   1*5
            catarrho rheumatic........................................   j*8
            contagious, prevention of spread of.........................   ij>°
            of new-born infants.......................................   L6'
            phlyctenular.............................................
            posterior internal, in adolescents...........................   t"
            rheumatic................................................   1*4
 Ophthalmoscope on its use...........................................•  1 iw
               chief value of........................................!■"• ^
                of Anagnostakis.......................................    1™
                mode of using it.......................................   ^j?
 Optic nerves.....................;---•...............................    „,
       nervous  apparatus, vital action of...............................    f *
 Orbicular muscle of eyelids............................................

 Palliative treatment of cataract........................................   1 ™
 Paralysis of the muscles of the eye.....................................   *;*>
 Passion causes determination of blood to eyes...........................    |<*
 Perception of externality or outness....................................    ^
           visual, of the three dimensions of space.......................   ""
 Perfect vision............................: • • •.........................    „).
 Perspiration, suppression of, dangerous to sight.........................    ™
 Phantasms............................................................   -...
 Phlyctenular ophthalmia..............................................    *|
 Photopsy...............;•■.•• •••.....................................    i«
 Pigment of the eyes wanting in Albinoes................................    "
 Pigment membrane....................................................     Ji
 Polyopy, or manifold vision with one eye...............................     ?D
 Position of the patient during operation for cataract.....................    °£
 Posterior internal ophthalmia in adolescents............................   ™
 Precautions in the employment of the eyes and sight....................   ' t\
 Preparation of patient for an operation for contract......................     01
 Presbyopy............................................................   \r-
 Preservation of the eyes in childbed and suckling.......................    1^
                        after fevers..........................• • •---.• • •    10*
                        in measles, smallpox, scarlet fever and hooping-
                          cough.......................................    \53
                        in venereal diseases............................    *jjj>
 Preservation of the sight in early infancy...............................    137
                        in infancy and childhood.......................    1+*
                        at the turn of life...............................    1™
                        in youth and adolescence.......................   14o
 Preservers............................................................     7q
 Prevention of far-sightedness...........................................
21 
242                            INDEX.


                                                                     rA'iit.
Prevention of the spread of contagions ophthalmia......................    154
Principal focus of a lens...............................................     <>'>
Projection of Image* on retina..........................................     19
Protection of the eyes of infants........................................    138
PupU.................................................................     1«
     fixed dUatation of................................................     OS

Reading in bed Injurious...............................................     SO
        In a carriage Injurious........................................     32
        -glass........................................................     s-
        and writing, use of eyes in....................................     ftl
Reclination of the cataract.............................................     ■'■'■'
Refraction by convergent glasses.......................................     M
Refractive media of eye, curvatures of..................................     21
          power of the eye diminished.................................     78
                       too great.......................................     72
Retina................................................................13, 16
      curvature of.....................................................     21
      projection of images on..........................................19, 22
Retlnte, corresponding or identical parts of.............................    130
Rheumatic ophthalmia................................................    14s
Ripe aud unripe cataracts..............................................     50

Scarlet fever, preservation of tho eyes In................................    15.1
Sclerotic coat..........................................................     14
Seasons of the year for operations for cataract...........................     ■>'-
" Second  sight".......................................................    105
Secondary cataract....................................................     03
Securing of the eyelids during the operation for cataract.................     52
Short-sightedness......................................................71, 70
                nervous..............................................     74
                a symptom of central cataract.........................     73
Sight, care and management of, in youth and adolescence................    146
      defects of, in particular..........................................     44
      excessive use of tobacco, prejudicial to............................    138
      Injured by prolonged suckling, loss of blood, &c...................38, 155
      management of in old age........................................    151
      precautions in the employment of................................27, 28
      preservation of, In adult age.....................................    148
                     at the turn of life................................    150
      In youth and adolescence, preservation of the....................146, 147
"Bight, second".......................................................    106
Singlo eye-glass detrimental to the sight................................     76
      vision with two eyes............................................    129
Soft cataract...........................................................     01
Smallpox, preservation of the eyes in...................................    153
Spectacles, change of,  In old age........................................    151
          on the use of................................................     93
           magnifying, objections to them..............................     94
          true and legitimate nso of...................................     94
           the quality of...............................................     95
           when to commence the use of................................     yfl
           when it is necessary to resort to them........................     96
          when to refrain from the use of them........................     97
          colored green, blue or nentral...............................     97
Spectra, ocular........................................................    100
S;iecnlum oculi........................................................    124
Squinting.............................................................    \'s>
         operation for.................................................    ] 34
Btereoseope............................................................    131 
INDEX.
243
                                                                   PAGE.
Strabismus............................................................   132
          operation for...............................................   iff
Structure of eyeball...................................................    14
Suckling, preservation of eyes in.......................................   155
          prolonged, injurious to the sight..............................    38
Sugar of lead solution, a popular eye-water not to be recommended.......    41
Suppression of bleeding from piles dangerous to sight....................    37
Sympathetic ophthalmia...............................................    3o

Tobacco, excessive use of prejudicial to the sight........................   158
Treatment after the operation of extracting the cataract..................    55
Turn of life, amaurosis at the..........................................   1™
           inflammation of the eyes at the.............................   150
           presbyopy and choice of spectacles at the...................   150
           preservation of the eyes at.................................   150
Two eyes, double vision with..........................................   131
           single vision with.........................................   129

Untoward occurrences during the operation of extracting the cataract---    57
                     after the operation of extracting the cataract......    58

Venereal diseases, preservation of eyes in...............................   155
Vision, chromatic.....................................................    °5
colored .
85
       distinct........................................................    ®*
       double, with one eye...........................................    °b
              with two eyes...........................................   131
       half transitory.................................................   IjL7
       Perfect.........................................................    7°
       single with two eyes............................................   **»
Visual perception of the three dimensions of space.......................   130
       sensations, abnormal excitement of...............................    °8
Vital action of optic nervous apparatus.................................    21
Vitreous humour......................................................    1B

Warm application to eyes..............................................    42
       water to the eyes................................................    la
Water, cold and warm to the eyes......................................    ™
Writing and reading, use of eyes in.....................................    31
Young people, cataract of.....................• • • • ••;••■•...............   .?'
Youth and adolescence, care and management of the sight m.............   i*o
                      preservation of the sight in...................146, 149
PART   IV.
DEFECTS  OF  HEARING.
                                                                    PAGE
American tables of acquired muteism.................................    169
Artificial membrana tympani........................................'  , S
                   cases in which used.............................19B> M° 
244                            INDEX.


                                                                     PAO».
Artifleial membrana, mode of applying the............................     2<>fl
Accumulation of wax.................................................     174

Belgian tables of acquired muteism...................................     D'9
Beethoven, the deal musician.........................................     1"'H
Bliud institutions....................................................     159
Bodies, foreign, in the meatus externus............................... 177, 179
Brain, disease of, caused by affection of  the ear........................     197

Cannon, deafness from firing..........................................     173
Catheter, Eustachian, substitute for..................................     Hit!
Causes of deafness....................................................     1|;3
                bathing.............................................     172
                falls or fighting with sticks..........................     172
                influenza...........................................     171
                loud, sharp reports..................................     173
                measles.............................................     17ti
                pressure against a wall..............................     172
                scarlet fever........................................     1 <>!'
                Bcrofula............................................     171
                syphilis.............................................     171
                typhus and typhoid  fever............................     170
Causes of deaf-muieism..............................................     181
         otorrhcea...................................................     184
Cephalic Otorrhoea...................................................     1;»*
Cerumen, accumulation in auditory passages..........................     171
         treatment of................................................     171
         cases of......•.............................................     175
Classification of diseases of the ears Toynbee's.........................     163
                                  Trlquot's.........................     164
Cleanliness...........................................................     left
Cold as a cause of deafness...........................................     If is
Corse, Dr , his case of foreign lioilv in  the ear..........................     183
Cotton In the perforated membra n'a tvinpani...........................     208
Cure of deafness, letter of Dr. .Meniere.................................     223

Deaf-mutes, education of..............................................     216
           direction for teaching at homo.............................     220
           how he thinks............................................     Hi!
Deaf-mutelsm, causes of..............................................     184
              treatment of...........................................     223
Deafness, causes of...................................................     163
         connected with disease of the throat........................170, lftS
         nervous....................................................     lfil
         prevention of...............................................     1 fi 1
         from bathing...............................................     179
              foreign bodies in the ear..............................     177
              influenza..............................................     171
              lond, sharp reports.....................................     173
              measles..............................................     170
              scarlet fever..........................................169, 185
              scrofula...............................................     171
              syphilis...............................................     171
              thickening of membrana tympani.......................     l:i7
              typhus and typhoid fever..............................     170
Diat'Du-is of diseases of the ear by the  watch..........................189, 'joo
                             by the  use of otoscope..................     1 r,r,
Diminution of hearing from imperfect  secretion of wax.................     171
Discharges...........................................................     i s, i
Diseases of the auricle................................................     172 
INDEX.
245
                                                                   PAGE.
Diseases of the ceruminous glands.....................................    174
              meatus externus.....................................172, 174
              throat connected with deafness........................170,188
              tympanum...........".................................     19

Ear-ache, or otalgia..................................................    184
Ear, affection of, causing diseases of the brain..........................    194
     cleanliness of....................................................    168
     catarrhal affections of the throat aud........................168, 170, 188
     diseases and accidents to which  it is subject......................    163
     gout, cause of disease of..........................................    1™
     osseous tumors in................................................    l°j?
     rheumatic affections of...........................................    1°9
     -trumpets.......................................................    -09
Eczematous eruptions of the auricle...................................    1^
Education of deaf-mutes...............................................    *lj>
Eustachian catheterism, substitute for................................16b, 19*
Examination of the auricle...........................................    1J4
                  meatus externus..................................    174
                  membrana tympani................................    1*4
External ear or auricle................................................    "4

Foreign bodies in the meatus externus................................H9i j77
                    ear.............................................      '9
                        instruments for removal of..................179, 181

Gun, sharp reports of, causing deafness................................    J7.3
                                    Thornton's remarks upon........    173

Health of the ear...................................................••    "7
Hearing, defective, diagnosis  of......................................loa> *""
         diminution of, from imperfect secretion of wax................    1/o
         distance.....................................................    200
         -trumpets..................................................^09> ^
                  Miss Martineau's...................................    ^lv
                  new form..........................................    *U
Hereditary deafness, or communicated from progenitors................    103
                    Dr. Bemiss' opinion on...........................    1«4
                    Dr. Meniere's opinion on.........................    164
                                            .......................    171
                                                                     172
Injuries of the ear....................................................    10_
Influenza a cause of deafness
Institution for the deaf and dumb............
                              history of............................    4| jj
                              instruction in........................    21b
Instruments for the removal of foreign bodies from the ear.............179,181
Introduction...........................•.............................

Kitts', Dr., work on the lost senses....................................    lj>l
                   deafness..........................................

Local treatment of ear and throat.....................................    , fi.
Loss of the eye  or ear, which is the greater calamity...................    f°*
Loud and sharp reports a cause of deafness............................

Male more frequently deaf than the female............................    l°3
Meatus externus, catarrhal inflammation of............................    *°*
                examination of......................................    , „_
                foreign bodies in....................................      2
                injuries of...........................................

                                  21* 
2U\
INDEX.
                                                                    I-A'il.
Meatus externus, polypus of............."............................     J';!*?
                syringing..........................................     Jl*
Measles a cause of deafness............................................     ''"
Membrana  tvmpani..................................................     *,,
                  artificial.......................................... l!1N -^
                  examination of....................................     J'*
                  perforation or by ulceration.............. 1S8, lft9, 191, 1!'3
                  puncturing........................................, -o  J?«
                  rupture of........................................ l'-< ''JJ
Muteism, tables of A nieriran..........................................     J J"
                 Belgian............................................     1UB

Nervous deafness, number of cases....................................     1°4
Noises in the ear, or tinnitus aurluiu..................................     17J

Observations, general and local, on treatment......................... 1 80, 188
Ossicles of the car, functions..........................................     j1'']
Otorrhea............................................................     '*'
         cases following scarlatina....................................     jBh
         1 lard's observations on......................................     Js'
         tre.anient of.................................................     '*'
         W. Wilde's remarks.........................................     lMi
Otoscope, form and use of.............................................     ltJ<*

Pennsylvania Institiulon for the Deaf and Dumb.......................     1*5
                                           report of caBos admitted..     Isi
Perforation of membrana tympani...................................Isft, H'jJ
Polyj.1 in car........................................................lb:l. l97
            treatment...............................................     190
Preservation of the health of the ear...................................     107
Puncturing the membrana tympani...................................     187

Rheumatic affection of the ear.........................................     189
Rupture of the membrana tympani....................................172, 173

Scarlet fever, causo of deafnesH.......................................169, 1 si
Scrofula, cause of deafness............................................     '' 1
spoculum, use of.....................................................     1' '
Stone In tho ear..................................................... 177,180
Synopsis of cases at public clinic at W. C. Infirmary....................     174
Syphilis  cause of deafness.............................................     171
Syringing the ear....................................................174, 17'i

The deaf and the blind................................................    159
             dumb...................................................    213
Tinnitus auriom.....................................................    173
Tonsils, enlargement of...............................................    1!'I
Toyuboe's classification of diseases of the ear...........................    1U5
          mode of using artificial membrana tympani.................198, 200
Triquet ca-es oi deafness.............................................    103
        on hearing trumpets..........................................    209
Trumpets, hearing....................................................    209
Tympanum, acute inflammation of....................................    I !i I
            artificial membrane of...................................    lun
             perforating ulcer of membrane............................    1!U
             puncturing membrane  of..................................    Is7
             scrofulous inflammation of...............................    171
             syphilitic inflammation of................................    171
Typhoid fever, cause of deafness.......................................    17U 
INDEX.                           247
                                                                  PAGE.
Typhus as a cause of otitis............................................    170
Typhus fever, cause of deafness.......................................   • 170

Ulceration of the membrana tympani..................................    193
Uvula, removal of in deafness.........................................    191

Venereal disease a cause of deafness...................................    171

Wildes' two hundred cases of deafness................................    163
       on bathing as a cause of deafness..............................    172
          influenza as a cause of deafness.............................    171
          loud, sharp reports as a cause of deafness....................    173
          otorrhoea..................................................    185
          scarlet fever as  a cause of deafness..........................    169.
          the cure of deaf dumbness..................................    235
        speculum for the ear..........................................    175
Wilson, Dr. George, notice of his work................................    161

Yearsley's self-adjusting artificial tympanum.........................    20S
                                          mode of using it..........    208 
IESTABLISHBD ITee.)
McAllister  &  brother,
               OPTICIANS,
       No.  728 Chestnut  Street, below Eighth,
           Nearly opposite the Masonic Hall, Philadelphia

     Spectacles in Gold, Silver, and Elastic Steel Frames.
Narrow Sliding Sides.
Pclimt Pattern.
  Those who have occasion to use Spectacles, should, if prac-
ticable, attend personally to the selection of them.   By tr\ ing tho
Spectacles, and at the same time availing themselves of the expe-
rience of an optician, those of suitable degree and power may
thereby be  obtained.
  If, however,  persons  are at a distance, or from  other circum-
stances are not able to attend personally, they are recommended
to send the  Spectacles last worn, or one of the glasses;  and inform
us how long they have been using those glasses; and at how many
inches from the eye they arc  compelled to hold fine  newspaper
print, to read the most distinctly with those glasses.   The age of
the  person  should also be given, though this alone, is not a suf-
ficient guide, as persons of the same age do not always  require tho
same degreee.
  With this information correctly stated, we may be  enabled to
forward glasses adapted to the vision with the same degree of
certainty, unless in cases where the eye is diseased.

  Our Priced and Inscriptive Tatalogue (108 pages, 200 illustra-
tions,) of Optical, Mathematical, and Philosophical Instruments,
furnished yratuitoiuly, and  mailed free of charge to all parts of
the United States.
                    McAllister & brother,
                       7'J8 Cluxtnut Street, Philadelphia. 
   McAllister & brother,
           OPTICIANS, AND DEALERS IN
(Optical, ftlatlpwtifjl anto JjftitapJiitaJ Insirmuetttg,
      No. 728 Chestnut Street, below Eighth,
MICROSCOPES AND  MICROSCOPIC  OBJECTS.

               Separate and in Cases.
For Sunday-schools, Academies and Public Exhibitions.

  STEREOSCOPES AND STEREOSCOPIC VIEWS.
THERMOMETERS.
BAROMETERS.
GLOBES.
HYGROMETERS.
AIR PUMPS.
ORRERIES.
POLYORAMAS.
CAMERA LUCIDAS.
   &C.     &C.
SPY GLASSES.
PLATINA POINTS.
SURVEYING COMPASSES.
TAPE MEASURES.
OPERA GLASSES.
GALVANIC BATTERIES.
GYROSCOPES.
LANDSCAPE GLASSES.
  &c.     &c.
  Our Priced and Descriptive Catalogue, (108 pages, 200 illustra-
tions,) furnished gratis, and sent by mail, free of charge, to all parts
of the United States.
                 McAllister & brother,
                       728 Chestnut Street,
                Nearly opposite the Masonic Hall, Philadelphia. 
        SPECTACLES,    ,
(Dpttcal  aub  itlailjfmatifal  Instruments.
  Spectacles mounted with Gold, Silver and Elastic Steel Frames,
and furnished with Glasses of the purest quality, Convex, Con-
cave, London Smoke. Blue or Green; also, with Brazilian Pebbles.
Cataract Glasses carefully adjusted to the sight.
  The subscriber having thirty years' experience in tho science of
Optics, trusts that he is fully competent to assist those requiring the
aid of glasses, in selecting such as will be most suitable for their use.
               clttitroHtopefi.

  A largo assortment of Microscopes at from $2 to $150 each—
Objects  for the same.   Spy Glasses, Opera (Jlasses, Cu.-,cs  of
Drawing Instruments, &c, in every variety, for sale at the lowest
prices by
                         JAMES W QUEEN,
                      924 Chestnut St., near Ten^h,
                         X'XXXX.AXJKX.JHJMX/l.
Illustrated and Priced Catalogues furnished or sent per mail gratis. 
No. Ill  SOUTH EIGHTH STREET,

          PHILADELPHIA,

   Has for the last twenty-five years Manufactured

        EAB.  TUBES,


  mwwmm$s!smm  swbm,

         IM TKMPETS,

   ARTIFICIAL TYMPANUMS,

And other apparatus for the inner and outer
Ear, all of which have been employed with
signal benefit to persons afflicted with defec-
tive hearing. 
       D.   "W.   KOLBE.

No.  32  South Ninth two  doors  above Chestnut Street,
                       Philadelphia.

  The  Subscriber having retired from the late firm of Kikmerle
& Koi.be, informs his friends and the medical profession generally,
that he has commenced business for himself, and hopes to receive
a share  of the patronage heretofore so liberally bestowed on him
while in the late firm.
  Previous  to his  commencing  business in this city,  he was
engaged, for a considerable time, in  tho  most celebrated work-
shops of Paris, Belgium and Germany, and does  not  hesitate to
say, that there is no instrument, however  complicated or minute
it may  be, whose construction he is unacquainted with, or which
he could not manufacture.
  Deeply impressed with the responsibility attached to tho maker
of Instruments employed by Surgeons, he  will furnish  no instru-
ment without a conscientious certainty of its being as perfect as it
is possible to  make it.
  He would  especially call attention  to his Cataract Needles and
Knives, Strabismus, Artificial  Pupil and  Lachrymal Instruments,
sets of which  are fitted up in cases of American, French, Knglish
and German Patterns of the best quality.   Also the latest  styles
of Instruments  for Operations on the  Mar, Aitilicial .Membrana
Tympani.

                 MANUFACTURER  OF

     Obstetrical,  Dental and  Surgical Instruments,
Splints, Bandages,  Club-Foot  Apparatus,  and  Artificial
               Limbs of Every Description.

  He would refer,  by permission, to the following  well-known
Surgeons, who are familiar with the character of his instruments:
HENRY H. SMITH, SI. D., l'rof of Surgery, University of IVnnnylvaula.
H. L. HODGE, M. D., l'rof. of Olisti-tricM, I'uiv.rMty of l'mii-vl vaula.
GEORGE W. NORRIS, SI 1)., Surgeon to the  l'ennnylv;inia Hospital.
S. LITTELL, M. D., fiaiv-oii, Wills Hospital.
E. HARTBHORNE, M. I).,
A. HEWSON,  M 1).,         "    "
SAMUEL 1). GKOSS, SI  L>., Prof, of Surgery,  Jefferson Medical College.
JOSEl'H PAXCOAST, M. D , Prof, of Anatomy, Jefferson Medical College.
ISAAC HAYS M. I>.
I)  IIAYK- A'J.NKW, M. D., Lecturer, Philadelphia School of Anatomy.
I'. H  GODHAKJJ, SI. D.
L. Tl'lt.N BILL,  SI. D , Surgeon to the Department of the Eyo and Ear, of  the
     Western Clinical Infirmary. 
 
 
 
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