ON SOME PRACTICAL POINTS 
IN THE 
TREATMENT OF THOSE FORMS OF EYE DIS- 
EASE OF MOST FREQUENT OCCURRENCE 
IN GENERAL PRACTICE. 
IVit/i the. Compliments of 
the A utlior. 
BY A. M. ROSEBRUGH, M.D., 
SURGEON TO THE TORONTO EYE AND EAR INFIRMARY. 
Read before the Canadian Medical Association, Halifax, N. S., Aug. 4, 1875• 
TORONTO: 
DUDLEY & BURNS, PRINTERS, 11 COLBORNE STREET. 
1876. ON SOME PRACTICAL POINTS IN THE TREAT- 
MENT OF THOSE FORMS OF EYE DISEASE 
OF MOST FREQUENT OCCURRENCE IN 
GENERAL PRACTICE. 
BY A. M. ROSEBRUGH, M.D. 
SURGEON TO THE TORONTO EYE AND EAR INFIRMARY. 
Read before the Canadian Medical Association, at Halifax, N. S., on the 4th of August, 1S75. 
I. Catarrhal Conjunctivitis.—In preparing a paper to 
be read before this Association, it has been my endeavour to 
write a practical paper that would be interesting both to those 
of extensive and to those of limited experience in ophthalmic 
medicine and surgery. I have purposely omitted all unnecessary 
technicality, and avoided all pathological points not absolutely 
necessary for the purposes of this communication. I wish to 
direct your attention to “some practical points in the treat- 
ment of those forms of eye disease of most frequent occurrence 
in general practice,” namely, certain diseases of the Conjunctiva 
and Cornea. 
Of simple Conjunctivitis, 1 would merely say, in passing, 
that it is nothing more than a passive congestion of the ocular 
conjunctiva, with no oedema, and with very little discharge. It 
does not usually run a course of more than one or two weeks 
and readily yields to a simple astringent, such as that of the 
solution of the sulphate of zinc, of the strength of from one 
to two grains to the ounce of distilled water, applied three or 
four times a-day. In purulent conjunctivitis we have the other 
extreme, the inflammation being most intense, and frequently 
resulting in total sloughing of the cornea in a few days. The 2 
Treatment of Eye Disease 
characteristic symptoms are oedema and elongation of the upper 
eyelid, with copious purulent discharge from the conjunctival 
surface. The sub-conjunctival tissue is intensely infiltrated, and 
the conjunctiva raised into a hard ring around the cornea, giving 
rise to the condition called chemosis. This form of ophthalmia 
is very contagious; but fortunately, in Canada it is as rare as 
it is destructive. Catarrhal conjunctivitis occupies a position 
between these extremes, and is the form of ophthalmia to which 
I wish now to specially direct your attention. At the Toronto 
Eye and Ear Infirmary, about four per cent, of the eye cases are 
registered as cases of catarrhal conjunctivitis; but this percentage 
does not accurately represent the relative frequency with which 
these cases occur in Western Canada, as patients with acute 
inflammation of the conjunctiva are seldom sent to be treated 
as hospital patients. Catarrhal conjunctivitis is characterized 
by congestion and an oedematous condition of the ocular con- 
junctiva, with muco-purulent discharge. There is little infil- 
tration of the sub-conjunctival tissue, and the conjunctiva, though 
raised and deeply colored, remains soft and movable. The upper 
eyelid does not become elongated nor the integument oedematous, 
and the inflammation of the cornea is very rarely suppurative. 
It is contagious in the acute stage only, and then by direct con- 
tact of the discharge with the conjunctival surface. Usually 
in six or eight days after the affection begins in one eye, the 
other becomes affected, unless special precautions are taken to 
prevent the discharge passing from one eye to the other. I find 
the disease more prevalent among farm labourers and shanty 
men, where very frequently one wash-basin, with one towel, is 
made to do duty for a number of persons. So far as these cases 
have come under my observation from the Province of Ontario, 
and the neighbouring States of New York and Michigan, I find 
that, not unlike the exanthematous diseases, they run a regular 
course, which is usually from two to four weeks of acute inflam- 
mation ; then the oedema and vascularity of the ocular conjunc- 
tiva subside, and the patients affirm and believe that their eyes 
are perfectly cured; but upon everting the eyelids, the palpebral 
conjunctiva will be found to be velvety and the papillae already In General Practice. 
3 
somewhat hypertrophied. In many of the slight cases, I doubt 
not that this hypertrophied condition recedes spontaneously; but 
in other cases, and I think the larger number, the disease, if 
inefficiently treated, extends to the sub-conjunctival tissue, and 
the papillae become very much elongated, giving rise to the con- 
dition erroneously called “granular lids.” This swollen and 
roughened condition of the palpebral conjunctiva is a constant 
source of irritation, and in many cases is the direct cause of 
vascular and ulcerative diseases of the cornea. 
Catarrhal inflammation of the conjunctiva is an innocent 
disease that seldom, in the acute stage, results in any serious 
trouble to either cornea or ocular conjunctiva; but the so-called 
“ granular lids,” in its effect on the cornea, undoubtedly leads 
to more cases of impaired vision and blindness than any other 
disease of the eye. The subjective symptoms in this affection 
are so misleading, that the patient is clamorous for treatment 
when comparatively little local treatment is required, and on 
the contrary, can with difficulty be induced to continue treat- 
ment afterwards, when it is absolutely necessary to prevent 
hypertrophies of the palpebral conjunctiva and the diseases that 
result therefrom. 
In the treatment of catarrhal conjunctivitis, I do little more 
the first week than order the eye to be bathed frequently with 
warm water, and direct simple cerate of fresh lard to be applied 
to the edge of the eyelids at bed-time. A solution of atropia- 
sulph. (grs. ij—3i) applied occasionally to the conjunctiva will 
show, by its effect on the shape of the pupil, whether the iris is 
involved or not. This is a point of great practical importance, 
and especially so to young practitioners, who have little expe- 
rience in diagnosing inflammation of the iris. In the second 
week, the use of local applications should be begun, and I do not 
know which of two remedies to recommend most highly, namely, 
weak solutions of nitrate of silver, or the red oxide of mercury 
plasma. I have used the two remedies side by side, that is, one 
in the right eye, the other in the left, and have had about equally 
satisfactory results. The plasma of the red oxide of mercury is 
used of the uniform strength of eight grains to the ounce of 4 
Treatment of Eye Disease 
the plasma; but in using the nitrate of silver, a solution of three 
grains to the ounce of distilled water is advised, and the strength 
gradually increased to fifteen grains to the ounce, during three 
weeks of treatment. The three-grain solution may be dropped 
into the eye by a nurse or friend three or four times a-day, and 
the eyes bathed afterwards in warm water. After the first week 
of treatment, when a stronger solution is being used, the eyelids 
should be everted, and the remedy applied to the palpebral con- 
junctiva with a camel’s hair brush, and in a few seconds any 
excess of tne solution washed ofi' with warm water, before the 
lid is replaced. The stronger solutions are applied in this manner 
once a-day, and in addition, the three-grain solution may be still 
used two or three times a-day, while the ocular conjunctiva 
remains congested and cedematous. The treatment is continued 
until both the ocular and palpebral conjunctiva have resumed 
the healthy condition. When the plasma of the red oxide of 
mercury is used, it is applied to the everted palpebral conjunc- 
tiva twice a-day (and not washed off), and no other local appli- 
cation used, with the exception of the occasional use of atropia 
solution as before mentioned, and fresh lard to the edge of the 
eyelids at bed-time. 
II. “ Granular Lids.”—With the exception of phlyctenular 
diseases of the cornea, there is no affection of the eye more preva- 
lent in Ontario than that of so-called “ granular lids.” Out of a 
total of 1957 eye cases tabulated at the Toronto Eye and Ear 
Infirmary, 193, or about ten per cent., were recorded as cases of 
trachoma or “ granular lids.” In my private practice, the per- 
centage is a little less than ten per cent. 
The disease is a hypertrophied condition of the papillae 
and sub-conjunctival tissue of the palpebral conjunctiva, and 
is the sequel of, and probably caused only by catarrhal con- 
junctivitis. Cases of “ sago-grain,” or follicular granulations, 
said to be the most common cause of granular ophthalmia among 
the military and in the crowded poor-houses of the Old World, 
have not come under my observation. To avoid circumlocution, 
I will continue the use of the term “granular lids,”—it is at least In General Practice. 
5 
Suggestive of the appearance, if not of the pathological condition 
of the palpebral conjunctiva. In order to treat these cases suc- 
cessfully, I find it of the utmost importance to secure, at the 
outset, perfect control over the patient, I never take charge of 
a case unless it is distinctly understood that the patient must 
not only be regular in his daily or semi-daily attendance, but 
that he must continue the attendance four, eight, or twelve weeks, 
according to the length of time that the treatment will probably 
require. In cases where the surgeon fails to secure this control 
over the patient, the treatment usually ends in disappointment 
to both. 
The local treatment is that of stimulation. Absorption is 
most active when the palpebral conjunctiva is kept in a constant 
state of hypercemia. We stimulate without cauterizing, and take 
care not to irritate the sensitive ocular conjunctiva Moist heat, 
applied externally to the eyelids, is a very good method of indi- 
rectly stimulating the palpebral conjunctiva. I have never been 
able to carry out the experiment, but I doubt not that some of 
these cases might be cured by the stimulus of hot water alone. 
In one case there was also a penetrating ulcer of the cornea, the 
hot water treatment was used exclusively for two weeks, at the 
end of which time the ulcer was nearly healed, and the condition 
of the palpebral conjunctiva very much improved. We endeavour 
to keep up a pretty uniform condition of hypermmia of the pal- 
pebral, without irritating or stimulating the ocular conjunctiva. 
The lid should be well everted, morning and evening, and a 
stimulating (not a cauterizing) application made to the palpebral 
conjunctiva. The exposed palpebral conjunctiva is immediately 
bathed with warm water, using either a soft brush or a small 
syringe. This bathing removes any excess of the stimulating 
application, and thus saves the cornea and ocular conjunctiva 
from irritation. Between the applications, the eyelids are bathed 
once or twice with warm, almost hot, water. In cases imme- 
diately following the catarrhal inflammation, the treatment is 
commenced with a ten-grain solution of nitrate of silver, and the 
strength is gradually increased to twenty grains. In chronic 
cases, where the lid is thick, and the “granulations” prominent, 6 
Treatment of Eye Disease 
and where the patient is in robust health, with no phlyctenular 
or ulcerative inflammation of the cornea, either a solution of 
nitrate of silver (thirty grains to the ounce) may be applied, the 
solid sulphate of copper, or the mitigated stick of nitrate of silver 
and nitrate of potash. In cases, however, either recent or chronic, 
where there is present, or where there is a tendency to phlyc- 
tenular or ulcerative inflammation of the cornea, the nitrate of 
silver or sulphate of copper is inadmissible. Again and again 
have I seen cases put back for weeks by an attack of phlyc- 
tenular keratitis, evidently caused by the use of the “blue stone” 
or nitrate of silver. In these cases, the plasma of the red oxide of 
mercury, of the strength of gr. j—3j, may be applied morning and 
evening, without, however, brushing or syringing with water, 
the everted lid being returned with the oxide adhering to the 
palpebral conjunctiva. The eyelids are bathed occasionally, 
during the interval, with very warm water. The application of 
the red oxide is not so stimulating as the sulphate of copper or 
nitrate of silver, and consequently the treatment extends over a 
longer period; but in my experience, there is no local application 
that is so well adapted to the corneal complications, and none 
that will more certainly prevent their recurrence. Of course the 
general condition of the patient must not be neglected. A gen- 
erous diet should be allowed, and when necessary, tonics pre- 
scribed The local treatment is continued until the palpebral 
conjunctiva is restored to its wonted healthy appearance, and 
the fibrous structure of the sub-conjunctival tissue distinctly 
seen beneath. 
I have endeavoured to give an outline of the general plan 
of treatment pursued with satisfactory results for the last fifteen 
years. The most chronic cases usually recover in from eight to 
twelve weeks; and in recent cases the treatment does not usually 
last more than three or four weeks. Any phlyctenular disease 
of the cornea present at the commencement, invariably disappears 
during the treatment, and relapses seldom or never occur. 
Whether the same satisfactory results with the same treat- 
ment could be obtained anywhere except in the salubrious climate 
of the Province of Ontario, I am not prepared to state. In General Practice. 
7 
III. Phlyctenular Ophthalmia.—During the last fifteen 
vears, fully 1,000 cases of phlyctenular ophthalmia have been 
either directly or indirectly under my treatment, and as the 
results, upon the whole, have been most satisfactory, I trust 
that an outline of the treatment pursued will prove interesting 
and suggestive, both to the general practitioner and specialist. 
The frequency with which these cases occur in practice may 
be inferred from the fact, that at the Toronto Eye and Ear 
Infirmary, out of a total of 1,957 eye cases, the large number of 
315, or over 16 per cent., were cases of phlyctenular inflamma- 
tion of the conjunctiva or cornea. Among children, this per- 
centage of phlyctenular disease is much higher; of all the 
children in attendance at the Infirmary for eye disease, about 
35 per cent, were suffering from some form of phlyctenular 
ophthalmia. Out of a total of 330 cases of eye disease among 
children under fifteen years of age, 118 were cases of phlyctenular 
ophthalmia. And of all cases of conjunctival and corneal disease 
among children, probably not less than four-fifths are of a phlyc- 
tenular character. 
This disease has been called pustular and scrofulous oph- 
thalmia. The prominent symptoms are photophobia and lachry- 
mation; the former is frequently excessive, and the latter is 
usually profuse. In children, there is also in many cases excori- 
ation or eczema of the integument of the lower eyelid and face, 
and the nasal mucous membrane is frequently affected also. 
With regard to photophobia, my experience is that it is asso- 
ciated almost exclusively with irritation of the conjunctiva or 
cornea, and never with disease of the retina or choroid. I make 
this remark in passing, as I not infrequently hear an opposite 
opinion expressed by some of the best physicians. Photophobia 
and lachrymation may be caused by irritation arising from 
mechanical and chemical injuries, or by the presence of inverted 
cilise or other foreign bodies; but in all other cases these symp- 
toms are caused, almost exclusively, by phlyctenular disease. 
In the general treatment of phlyctenular ophthalmia, it is 
not necessary at the outset to make any distinction between 
phlyctenular conjunctivitis and phlyctenular keratitis. The 8 
Treatment of Eye Disease 
indications are, to allay local irritation and to build up the con- 
stitution. Phlyctenular keratitis is of course the more serious 
form of the disease, both on account of the tendency to deep 
ulceration of the cornea, and also on account of the tendency of 
the ii’is to become involved. Phlyctenules on the cornea will 
result in opacities more or less dense, according to the depth of 
the ulceration; and inflammation of the iris may result in occlu- 
sion of the pupil. 
In treating children with phlyctenular disease, it is fre- 
quently necessary at the outset to administer chloroform. While 
under its influence, the eyes can be thoroughly examined and 
the local remedy efficiently applied ; moreover, the spasm of the 
orbicularis (blepherospasm) and the photophobia are often decid- 
edly diminished after the anaesthetic. 
The best local treatment in the case of young children, is to 
keep the eye constantly under the influence of atropine. The 
four-grain solution is applied twice a-day, the excessive watery 
secretion being first removed, to prevent the dilution of the 
atropine solution. Excoriation of the integument of the eyelids 
and cheek can be prevented to a great extent, by absorbing the 
excessive watery discharge from the eyes with pads of lint ban- 
daged over the eyeballs. Bandaging, however, should be resorted 
to in those cases only where the lachrymation is unusually exces- 
sive, and abandoned as soon as practicable, for the photophobia 
does not diminish while the eyes are kept secluded from the 
light. Any accompanying eczema or ulceration of the nasal 
mucous membrane may be treated with the local application of 
the nitrate of mercury ointment, or the plasma of the red oxide. 
Children under five years of age should be put on a milk diet, 
combined either with stale bread or well cooked oatmeal por- 
ridge. The less the deviation from this wholesome diet the 
better; if the milk is rich in cream, tne administration of cod- 
liver oil is rendered less necessary. A tonic course of treatment 
is invariably indicated, and there is probably no preparation 
better adapted to these cases than that of the syrup of the iodide 
of iron. The sleeping apartments and playrooms should be made 
as healthy as possible ; and when the weather is favourable, the In General Practice. 
9 
patients should be properly clad and taken into the open air. 
As soon as practicable, the eyes should be exposed to the light; 
toleration of light increases the more they can be used. 
In phlyctenular, as well as in interstitial inflammation of 
the cornea, inflammation of the iris sometimes occurs, and fre- 
quently escapes notice; this should be anticipated by appropriate 
treatment. In the local treatment of phlyctenular ophthalmia, 
the solution of atropine, applied two or three times a-day, will 
allay the irritation of the conjunctival and corneal nerves, and, 
when the iris is not involved, keep the pupil dilated; but in 
cases where we are unable to ascertain the condition of the iris, 
the midriatic should be applied more frequently. Where any 
irregularity in the shape of the pupil is seen, the four grain 
solution of the neutral sulphate should be applied six or eight 
times a-day, until the pupil becomes widely dilated and free 
from adhesions. Of course, in very young children, the solution 
cannot be applied so frequently, on account of its toxic effect.* 
Since writing the above, a little girl has been brought to 
me, who had recovered from an attack of phlyctenular keratitis; 
but an accompanying iritis had been overlooked, and plastic 
effusion had bound down the iris behind a leucomatous central 
opacity of the cornea. If atropine, instead of nitrate of silver, 
had been used, adhesions of the iris would have been prevented, 
and perhaps the phlyctenular disease cured, before ulceration of 
the cornea had taken place. 
In adults, the photophobia is seldom excessive; in mild 
cases it is entirely absent. It is this milder form of phlyc- 
tenular inflammation that is the great stumbling-block to 
many general practitioners. Phlyctenular conjunctivitis is some- 
times mistaken for that most rare disease, sclerotitis, and the 
patient put on iodide of potassium and colchicum. It is treated, 
by some, as catarrhal conjunctivitis, and by others, as “chronic 
ophthalmia.” I have frequently seen cases of recognized phlyc- 
tenular keratitis under the influence of mercury; the physician 
evidently believing such a course of treatment to be as appro- 
* The neutral sulphate of atropine is soluble without the addition of acid, and 
this solution does not irritate the eye. No alochol should be added. 10 
Treatment of Eye Disease 
priate and necessary for opacity of the cornea, as for plastic 
effusion in the iris. This treatment is not indicated, and it 
depresses, and perhaps permanently injures, a constitution that 
requires to be invigorated. 
In the local treatment of phlyctenular inflammation, either 
of the conjunctiva or cornea, in adults, the plasma of the red 
oxide of mercury may truly be said to be a specific. I have 
used this remedy for nearly fifteen years, and I do not remember 
a single case that did not readily yield to this local treatment; 
and I cannot now recall more than four cases where a relapse 
occurred during the treatment. In one case the relapse followed 
the operation of canthoplasty, and in another,—iridectomy ; the 
other cases were Infirmary patients. In ordinary cases, the 
treatment does not usually last more than three or four weeks ; 
in slight cases, not more than one or two weeks. Except in 
these cases of relapse, the worst cases are usually cured in six or 
eight weeks. Even in cases complicated with “granular lids,” 
the treatment does not usually extend beyond two months. 
After the patient is discharged, he is directed to continue the 
use of the red oxide for two or three weeks longer.* In cases 
where the photophobia is excessive, the atropine solution is 
applied two or three times a-day ; and in cases where the ulcers 
of the cornea are not healing, and especially where they show a 
tendency to penetrate, the eyes are bathed two or three times 
a-day, for fifteen minutes at a time, with water as hot as can be 
borne. This is a most valuable remedy ; and in the only case of 
phlyctenular keratitis in which I gave it an exclusive trial, a 
cure was effected in three weeks. 
The mercurial plasma is applied twice a-day, as follows 
Instead of applying it simply behind the lower eyelid, as is done 
by some practitioners, the eyelashes of the upper eyelid are held 
by the thumb and finger of the left hand, and the lid drawn 
forward; a small quantity of the plasma is now pushed up 
* The red oxide is also used in the case of children, when there are leucoma- 
tous opacities remaining on the cornea, after the diminution or disappearance of the 
photophobia. These opacities, if not the result of deep ulcers, will, in most cases, 
completely disappear, if, after the subsidence of the phlyctenular inflammation, the 
case be followed up perseveringly with the semi-daily use of this remedy. In General Practice. 
11 
under the lid with a camel’s-hair brush. Before the brush is 
withdrawn, the lid is pressed down, so as to retain the plasma; 
and on the removal of the brush, the oxide is well diffused over 
the eye by rubbing the eyelid over the eye. The treatment, in 
any case, should be commenced with the least quantity that will 
adhere to the end of the brush, and the quantity increased as it 
is tolerated. In cases of ulceration, where the patient can keep 
the eye steady, I apply the plasma directly to the affected part, 
and allow it to remain a few seconds, or so long as the eye can 
be kept open. Where the case is complicated with “granular 
lids,’’ the oxide is applied to the everted palpebral conjunctiva 
and allowed to remain about half a minute before the lid is 
closed. 
The strength generally used is one grain to the drachm ; 
but in some cases where the patient has been under treatment 
for several weeks, a preparation of double that strength (two 
grains to the drachm)* is frequently well borne, and the case 
improves more rapidly. 
The plasma of glycerine and starch is preferable to the 
ointment. It does not become rancid, and, being soluble in the 
lachrymal secretion, is more readily diffused over the conjunc- 
tival surface. 
I am aware that others, including some of my own profes- 
sional friends, who, apparently, have given the plasma of the 
red oxide a fair trial, are not able to report the same satisfactory 
results. This want of success can be explained partly by the 
fact of the want of care in its preparation, and partly from want 
of faith in its efficacy. There are cases, where, at the first, the 
eye is rendered more irritable by the treatment; here it would 
seem to be contra-indicated, and a strong faith in its ultimate 
efficacy is necessary in order to carry out the treatment perse- 
veringly; moreover, it is possible that these cases of phlycten- 
ular disease, as well as those of “ granular lids,” respond to treat- 
ment more readily in Western Canada than elsewhere. 
* After applying the stronger preparation, however, the eye should be exam- 
ined in about ten minutes, and any particles of the oxide lodged on the palpebral 
conjunctiva removed, otherwise ulceration of the membrane may occur. 12 
Treatment of Eye Disease 
In the city of New York, relapses occur in a large percent- 
age of these cases, to prevent which the operation of canthoplasty 
is frequently performed. In some Infirmary patients, this oper- 
ation has been done with benefit; but I have never had occasion 
to perform the operation in a single case in private practice , 
and am of opinion that it will be less frequently needed, as the 
merits of the treatment with the oxide of mercury are better 
appreciated. 
Dr. Pagenstecher, of Wiesbaden, recommends the yellow 
amorphous oxide of mercury, in these cases, in preference to the 
red precipitate, on the ground that it is less irritating, and 
adapted to a larger class of cases. It is true that, in the prepar- 
ation of the yellow oxide, it is precipitated in a state of the finest 
possible division; whereas, the red oxide consists of crystals, 
which are found triturated to different degrees of fineness in 
different shops. An ointment or plasma made with the former 
should therefore be a more reliable preparation than that of the 
latter (as it is usually prepared), and we might expect the oint- 
ment of the yellow oxide to be more uniform in its effects; but 
when the red oxide is properly triturated, and not used stronger 
than from eight to sixteen grains to the ounce, it does not usually 
cause much irritation,—the reaction usually passing away in ten 
or fifteen minutes. 
Pagenstecher uses an ointment as strong as from thirty to 
sixty grains to the ounce, but I have never used it stronger than 
eight to sixteen grains to the ounce. One of my colleagues at 
the Eye Infirmary has used the stronger preparations of the 
yellow oxide, but soon abandoned it, as he found its action alto- 
gether too energetic. In the trials made with the weaker pre- 
parations, the results were not satisfactory, and the yellow oxide 
was found to have the disadvantage of being more inclined to 
collect in masses behind the upper eyelid. In General Practice. 
13 
An ointment made of the yellow oxide is undoubtedly pre- 
ferable to one made with the ordinary red precipitate of the 
shops; but when the latter is properly triturated and thoroughly 
mixed with the glycerine plasma of proper consistence, it seems 
to leave nothing to be desired as an ophthalmic ointment. 
Unfortunately, it is very difficult to procure a reliable pre- 
paration of the plasma of the red oxide of mercury, and one 
carelessly prepared is worse than useless. The apothecary objects 
to the trouble and length of time involved in its preparation, 
unless it is ordered in large quantities. For many years, the 
only reliable preparation that I could obtain was that of the 
firm of Moore & Brierly, Hamilton; but of late, Mr. H. J. Rose, 
of Toronto, has been supplying the preparation used both at the 
Eye Infirmary and in my private practice. Mr. Rose’s formula 
is as follows : 
“ To make simple plasma or Glycerinum Amyli B.P., take 
1 oz. starch and 8 fluid oz. pure glycerine (I find corn starch to 
make the best product, though it seems to require a greater 
degree of heat), rub the starch with an ounce of distilled water 
till quite blended, then add the glycerine and apply heat, gradu- 
ally increased, till a thick jelly is produced. The preparation 
must be constantly and thoroughly stirred while making, and if 
an appearance of granular lumps is shown, squeeze the product 
before it is cold through cheese-cloth, or doubled muslin, pre- 
viously well washed to remove any loose fibres. 
“ To make the mercurial plasma, it is necessary to have a 
perfectly smooth and even-surfaced mortar and pestle, in order 
to obtain the oxide in an impalpable powder. While triturating, 
keep it moist by the addition of rectified spirit from time to 
time. Care is also required to keep the powder, which may 
adhere to the pestle, scraped off very frequently. When tho- 
roughly triturated, the simple plasma is added in the desired 
proportion, and mixed thoroughly. 
“ The efficiency of the trituration may be best tested by 
rubbing a few grains of the plasma on a piece of fine white paper. 
On holding this up to the light, there should be no appearance 
whatever of any specks.”