days, or even longer when eserine is used, whereas without it delay seemed almost fatal to the chances of saving or restoring sight. In hospital practice, and perhaps even more so in private, it is often difficult to convince patients of the extreme urgency of the symptoms; and even if convinced, the dread of the knife keeps back nervous patients from the necessary ordeal until it is perhaps too late. It is therefore a great advantage to have at hand a remedy the effect of which is to render delay less dangerous than it must otherwise be, and in eserine we possess such a remedy. The two following cases illustrate this point in a way which to me is very convincing:

CASE 1-Simple Glaucoma of both Eyes, with Excavated Discs and Pulsating Vessels-All the Symptoms relieved by the use of Eserine.

Elizabeth C., aged 39 years, a small woman with dark hair and irides, married and with six children, came to the South London Ophthalmic Hospital on December 30th, 1878, with all the subjective and objective symptoms of simple glaucoma. She said she had been nursing a sick husband, and from various causes had very disturbed nights, and yet been obliged to work hard during the day. For the last eight months her sight had been failing, and she had noticed coloured haloes round the candle. She had never had any pain either in her eyes or in the surrounding bones. The tension was increased in both eyes. Vision of the right eye, letters of J. 20; vision of left, J. 10. Both pupils fixed and half dilated. Both anterior chambers shallow, especially that of the right, in which also the cornea and aqueous were very turbid. Both optic discs were excavated, that of the right eye being very much cupped and pale, as if from some degree of atrophic anemia, while that of the left eye retained its normal colour, and was even hyperemic. Venous pulsation was seen in the right eye, but not in the left. This was a clear case for iridectomy or sclerotomy. An operation was at once proposed, but, as might have been expected, the mother of six children, with a sick husband to nurse, was in no mood for sudden and active measures, even though threatened

with the possibility of losing her sight. She was, however, fully warned of the risks she was running by refusing operation, and told in the meanwhile to use the eserine drops twice a day.

January 3rd, 1879.-Patient declares that she has never had the coloured haloes before her eyes since she used the drops. Her vision has decidedly improved; right eye, T. 3, V. J. 10; left eye, temperature normal, V. J. 8. In both the anterior chamber is clear, and the plane of the iris normal.

17th. The drops have been continued, and there is still further improvement of vision. It is doubtful whether there is now any tension, even of the worst eye.

An operation was again urged upon the woman, who is, however, so well satisfied with the improvement in her sight that she still declines, and is therefore directed to continue the use of the eserine drops and to take quinine.

The improvement in this case followed so closely upon the application of the eserine and its known action upon the pupil, that it is hardly possible to avoid the conclusion that the local application produced the improvement. As, however, in simple glaucoma, temporary ameliorations of all the symptoms are not uncommon apart from medical treatment, it is quite within the range of possibility that a temporary improvement, due to natural causes may have been accidentally contemporaneous with the use of eserine, and that the effect of the latter was simply not detrimental, though perhaps not actively beneficial.

In the following case the symptoms were more acute, and though the influence of the eserine was watched for a short time only, there was good evidence that during that period its effect was decidedly beneficial.

CASE 2.-Acute Glaucoma-Relief of Pain, but no Effect on

the Pupil by the use of Eserine-Iridectomy successful. Maria D., aged thirty-seven years had suffered for five weeks with well marked glaucoma of the right eye. There were chromopsiæ, severe pain, extreme tension (T), and great impairment of vision. She applied on January 20, 1879. The pupil of the right eye was then dilated and immovable, and the

Vision = mere per

With the ophthal

cornea and anterior chamber very turbid. ception of light at the outer side of the field. moscope only a dull-red reflex was obtainable when examining the pupil. Iridectomy was proposed, but the usual difficulty about the care of children at home (one being eight months old and sucking her mother's breast, and five others being dependent on her care, made it necessary to postpone the operation. Erserine was applied: it relieved the pain, but did not cause contraction of the pupil nor diminution of the tension.

On January 24, the daily use of eserine having no permanent effect beyond the slight relief of pain, iridectomy upwards was performed. On the 31st this patient could tell the time by the watch, the tension was normal, and only a slight amount of pain was complained of. She was directed to continue the use of eserine and to take quinine.

Here was a typical instance of acute glaucoma. The operation was unavoidably postponed, and the use of eserine appeared to delay the progress of the glaucoma during the interval so that eventually the operation was successfully performed. In several instances similar good effects have been obtained. It is therefore probable that in future the use of eserine in glaucoma will become very general. There is a danger, however, that its undoubtedly beneficial influence may be relied on as a substitute for iridectomy or sclerotomy. According to my experience hitherto, its action in the cases in which it has been used would not justify its employment with this view, and I hold that surgical measures must still occupy the first place in the treatment of glaucoma, while local medication, if used, must take the place of a handmaid or assistant to, not that of a substitute for, operative treatment.-Medical Times.

Notes on Military Surgery. (By Surgeon J. LEWTAS, M.B., LOND., Guides Cavalry.)—A few notes of some of the injuries received in the cavalry affair near Futehabad, Afghanistan, on April 2nd, may perhaps interest some of the readers of The Lancet. The portion of the Guides Cavalry present on that occasion numbered about two hundred sabres,

and our casualties were five killed and twenty-eight wounded. CASE 1. Penetrating Gun-shot Wound of Frontal Bone.The subject of this injury, a Sikh trooper, was hit by a stray bullet before the cavalry came into action. The bullet entered just above and to the right of the root of the nose. At the same time, also, the right eye-ball projected prominently forwards and was painful. He did not lose consciousness but complained of pain in the head, and especially in the right eye. The eye-ball was uninjured, but the conjunctiva was injected, and there was a small quantity of blood between the lids. He thought that the ball had passed out through the right orbit—a not impossible hypothesis, since bullets were coming across from our left, where the enemy was outflanking us. The subsequent history of the case, too, gave support for a while to his idea, for it seemed to indicate but slight injury to the brain. During the first eleven days the only symptoms were diffused headache and drowsiness, while there was dilatation of the right pupil and ptosis of the right upper eye-lid the two latter symptoms being not impossible results of an injury to the orbit only.

Suddenly, however, on the eleventh day new symptoms developed themselves—viz., epileptiform convulsions followed by coma. The first fit occurred about midnight on April 13th. This passed off in half an hour, leaving a condition of extreme susceptibility to muscular spasm; so much so that the attempt to give him a drink brought on locking of the jaws, twitching of the facial muscles on the right side, and spasmodic movements of the limbs. About an hour later he had a second fit, and the convulsive stage of this was of such duration and attended by such exhaustion-his body being bathed in perspiration and his pulse rapid beyond counting-that I resorted to chloroform-inhalation to bring on the stage of coma at once. A subcutaneous injection of one-sixth of grain of morphia was given to him while under the influence of chloroform, and he then slept for four or five hours. The next day, April 14th, he had a third fit, which was similarly treated, and since then up to the present date April 23rd, there has been no return. Dilatation of the right pupil and ptosis persist. There is, however, no squint, nor are any of

the movements of the eyeball impaired. He is drowsy and somewhat irritable. There is also decided impairment of the memory, as he no longer remembers the occurrences of that day, or even that he was wounded. There is still an abundant discharge of yellowish-green pus from the opening in the frontal bone, and there is some prominence of the inner angle of the roof of the right orbit.

Remarks.-The course and symptoms have not, I think, confirmed the opinion of the man himself that the ball escaped by way of the right orbit; the injury to the contents of the latter would have been greater, whereas the protrusion of the eye-ball would be sufficiently accounted for by a depression of the roof of the orbit caused by the bullet in its passage backwards. There can, I think, be little doubt that the ball has lodged within the skull, but at what precise spot it is impossible to determine.

CASE 2. Gun-shot Fracture of Great Trochanter of Femur; death on nineteenth day. The bullet in this case entered at the outer side of the left thigh, about two inches below the great trochanter, passed upwards and inwards, splintering that projection, and finally lodged superficially over the base of the sacrum, where it pointed. Its position, however, was not so superficial that the bullet could be grasped between the finger and thumb ; it gave rise rather to a diffused swelling, in which the exact position of the bullet was uncertain. Hence, I did not feel justified in cutting into this prominence, and sent him as he was to the field hospital at Jelalabad, where a few days later the bullet worked towards the surface, and was extracted. The discharge from the track of the bullet was abundant and fetid; syringing the wound twice and sometimes oftener daily with carbolic lotion, and a free use of lisinfecting powder (McDougall's) failed to keep down the fetor He was further weakened by obstinate diarrhoea, over which treatment of various kinds had little effect. He died on April 20th, nineteen days after receiving the injury. Remarks. It is not the time yet to gather up the lessons upon gun-shot fracture of the thigh derived from the war. Five cases have now come under my notice, and they have all supported the received canons of military surgery; especially have