to the patient, it will save him much suffering if the contents of the globe be evacuated, when the injury is irreparable, and when particles of stone are driven into it. The mere stroke from a bullet is not the worst injury which can befall an eye; a shower of gravel driven up by a cannon-ball or the explosion of a shell,' may mutilate it fearfully, and leave within it and in the orbit fragments which may be a source of the greatest suffering.

After an injury of this description the eye should be carefully examined, and every particle of foreign body removed; and then, if the case be a simple rupture or lacerated wound,

'It is well known that the great Lord Nelson lost the sight of one eye at the Siege of Calvi, and never having seen an accurate account of the particulars, I have taken pains to ascertain them.

In a letter to his wife (August 18th, 1794), Nelson states,-"A shot having hit our battery, the splinters and stones from it struck me with great violence in the face and breast. Although the blow was so severe as to occasion a great flow of blood from my head, yet I most fortunately escaped, having only my right eye nearly deprived of sight; it was cut down, but is so far recovered as for me to be able to distinguish light from darkness. As to all purposes of use, it is gone; however, the blemish is nothing-not to be perceived unless told. The pupil is nearly the size of the blue part-I don't know the name." The immediate effect of the injury was only to confine Nelson from duty one day, but he appears to have suffered a good deal subsequently.

Sir John Liddell was so polite as to cause search to be made among the records at the Admiralty, but he informs me there are no documents whatever relating to the injury that Lord Nelson received at the Siege of Calvi.

Having consulted every work that I could find bearing upon the subject, and well weighed the various statements, I am of opinion that the primary injury was concussion of the retina, which would account for the loss of sight and great dilatation of the pupil. I have been puzzled by the expression that the eye was "cut down"-a nautical phrase, signifying diminished in size-and at first thought that rupture of the globe had taken place; but if so, Nelson would surely have been confined more than one day, and the medical officers would have reported the injury, which they appear not to have done. It is most probable that secondary inflammation took place, which would account for the annoyance caused afterwards; atrophy of the globe may have been the ultimate result. The constant use of a patch to conceal the eye would imply disfigurement.

cold-water dressings, and the lightest possible applications, should be adopted.

The following case, which occurred in St. Mary's Hospital, illustrates this form of injury; for although fired from a pistol, the effects were similar to those produced by gravel driven by a heavy shot or shell.

Emily L., aged 23, was brought to St. Mary's on the 7th July, 1856, having been shot in the face half an hour previously with a horse-pistol loaded with pebbles. Immediately after the pistol was fired, she fell to the ground stunned by the blow. When admitted, there was an irregular contused and lacerated wound over the right orbit, and the upper eyelid was torn through at the outer canthus. On raising the eyelid, which was much swollen, the eye was found quite destroyed, with the iris protruding. The left upper eyelid was swollen and red, ecchymosed in patches, and incapable of being opened.

During the next three days she suffered agonizing pain in the right eyeball, the swollen lid of which was exquisitely tender to the touch; and this pain continued, more or less, until the 14th. The right eye was utterly destroyed, and when an examination could be made of the left eye, it was ascertained that the cornea was ulcerated in one or two points, and there was considerable surrounding inflammation, evidently caused by grains of powder impacted in the sclerotic conjunctiva. The judicious treatment employed by Mr. Ure gradually subdued the inflammation, and when the patient left the hospital, she was able to use the left eye, although there remained several grains of gunpowder impacted in its surface. The deformity caused by the bursting and complete sinking of the right eye was materially diminished by the introduction of an artificial eye.

Two remarkable cases of recovery from gun-shot wounds

are mentioned by Dr. Dunlop. In a duel in the West Indies, one gentleman hit another in the eye, which was completely demolished, and the ball passing in through the orbit came out in front of the ear; notwithstanding which the officer recovered with rapidity.

Lieutenant Gray, a brother officer of Dr. Dunlop, received a buck-shot in the left cheek; the ball lodged behind the right eye, which was instantly deprived of sight, and remained much inflamed for some days; these symptoms subsided, and no further inconvenience was felt than a want of power in moving that eye (which remained blind) in concert with the other.'

After wounds from bullets, sabre-cuts, or extensive lacerations of the eye received in action, the strictest antiphlogistic treatment must be enforced. The injured eye should in the first instance have cold-water dressings; if suppuration takes place fomentations must be substituted; heavy dressings to be avoided, as calculated to heat the parts; if there be much discharge, the dressings should be changed frequently, as it is highly

Fig. 18.

Tel

objectionable for them to become foul and offensive. The diet should be low, and the usual means adopted to prevent inflammation.

Beck's 'Med. Jurisprudence,' p. 629.

If the painful fungous growths described by Dr. Hennen arise, they should be carefully sliced off with scissors (fig. 18) level with the eye; the use of nitrate of silver drops, four grains to the ounce, applied to the wound, will check their

recurrence.

CHAPTER IV.

THE class of wounds which last engaged our attention are simply destructive to vision; the class now to be considered are made instrumental to the restoration of sight, because operations for cataract and artificial pupil come under the denomination of incised and punctured wounds; it is not, however, with that division of the subject that I propose to deal.

To avoid needless repetition I shall consider punctured and incised wounds together, as for practical purposes they are merely modifications of one description of injury.

To Mr. Bowman we are indebted for an accurate account of the changes manifested in the cornea when pierced with a knife or a needle, and a right understanding of these changes is necessary to enable us to follow the process of reparation.

If we puncture or incise the cornea, the first effect is a change wrought in the natural actions of nutrition then existing in the wounded part-a change which can only be described as a mechanical interruption to those actions. This is speedily followed by the presence of an increased quantity of blood in the vessels that are nearest to the wounded part, and thus the materials from which the breach is to be made good are brought in greater abundance to the part that

'Lectures on the parts concerned in the Operations on the Eye,' p. 28.