"On another occasion a man was admitted into the same hospital, under the care of Mr. M. Collis, with a popliteal aneurism, the history of which I do not recollect with very great accuracy, except that it was rather of large size, not compressible, and there seemed to be not much fluid blood in the sac. A bandage was applied to this in a similar manner to that in the former case; it caused immense pain, and on the following morning the pulsation in the tumour was no longer to be felt. It, however, reappeared after a little time, but so very indistinctly that it was a questionable matter whether the sensa tion was not communicated from the finger of the examiner, and not from the tumour. The application of the bandage was persevered in, and in the course of a very few days no doubt could be entertained of the cure."

In the second volume of the Dublin Medical Press, Dr. Brunker of Dundalk, has related a somewhat similar case. The patient, aged 32, was admitted into the Louth Infirmary in August, 1839. His occupation had been very laborious and the aneurism had been first observed fifteen months previously. "On examining the ham, the entire space was observed to be completely filled up by a pulsating tumour, beating synchronously with the heart, soft and compressible, but becoming distended on the removal of the pressure. Pressure being made on the femoral artery in the groin, the pulsation instantly ceased, and the size of the tumour was sensibly diminished. He was ordered to remain in bed, and was placed on low diet.

"Two days after admission, a piece of dry sponge was placed over the aneurism, and retained in situ by a roller rather loosely applied." Five days subsequently, on the removal of the bandage and compress, the tumour was much diminished in size, and no pulsation whatever could be detected in it. The pressure was continued, and the patient was directed to remain in the recumbent posture. He left the infirmary a few days afterwards. He was seen about a fortnight subsequently, and the bandage and compress had been continued, and he had remained quiet." On removing them (Dr. Brunker observes) I could scarcely discover any traces of the former tumour, and no pulsation whatever was to be felt. A very obscure pulsation was to be felt in the anterior tibial artery, which could not before be discovered on a very careful examination.'

It appears to me that the cause of the cessation of pulsation in the cases of aneurism which have been detailed, and in other similar ones, instead of being obscure, is easily explicable upon the principles laid down in the preceding pages; aud that their history tends still further to corroborate what I have already said respecting the mode in which compression effects the cure of aneurism.

Thus, in every case that has been reported, the disease was of long standing, and the tumour had attained a considerable size. In the majority of cases, likewise, it was hard and solid, and did not diminish in size when the artery above was compressed; proving that a deposit of fibrine had already taken place in the sac, and that nature had already made some progress in the process by which the cure

was ultimately to be accomplished. In fact, the condition of the parts was similar, in almost every respect, to that which we endeavour to bring about by the application of pressure; and which when it occurs, is the most satisfactory proof that the case is progressing towards a cure. In the third case which I have quoted, the tumour, though of long standing, is reported to have been "soft and compressible;" but it will be observed that pressure was maintained for five days before the aneurism ceased to pulsate, evidently a sufficient length of time for a deposit of fibrine to take place. Indeed in some of the cases of aneurism treated by compression, previously given, the pulsation ceased within a shorter period.

The mode in which the bandage and compress acted in effecting the cure of the aneurism in these cases appears to be similar to that in which nature in some rare instances, has effected this object-viz., the solid, or nearly solid sac was pressed against the artery from which it sprung, or against the orifice by which the sac communicated with the artery, in consequence of which the stream of blood which entered the sac was much diminished in amount and force, the disposition of fibrine then went on rapidly until the sac and artery at the part were obstructed; when, of course, the pulsation ceased.

Although "no principle of practice could be established" upon such cases, as long as the old theory respecting the cure of aneurism continued to be entertained, yet now that it has been proved that the cessation of pulsation in an aneurism is brought about by the deposition of fibrine in the sac, not by the coagulation of its contents, they afford us a useful practical hint in the application of pressure. For instance, after compression has been kept up for a time, if the sac becomes hard to the feel, and does not increase in size on the removal of the instrument, (although it still continues to pulsate,) we may then apply local pressure to the aneurism, by means of a compress upon the sac, with every prospect of effecting a cure more quickly than if we continued to make the pressure solely upon the artery above.— Dub. Med. Press.

SURGICAL SOCIETY OF IRELAND.

Foreign Bodies in the Eye. By DR. JACOB.-Professor Jacob begged to bring under the notice of the society a small matter of which he had no written statement, but which he considered not destitute of pathological interest. The specimen he had to show was one of a foreign body projected into the eye, which he remarked was not unique, for some cases of the kind were on record. In breaking or dressing stones, it frequently happens to stone-cutters and others that a particle of the stone is driven with considerable force into the eye. This it was that happened in the case to which he was about to direct the attention of the society. A particle of stone had been so projected, and lay in the anterior chamber between the cornea and iris, but the interesting fact connected with this was that it should have remained in that situation for four years without having effected the

destruction of the organ. He had extracted it the other day, and had every hope that he would ultimately be able to save the eye. The lens is opaque, and the pupil eccentric, and it will probably be yet necessary to break up the lens more effectually than could have been done in the course of the operation of removing the foreign body. In cases of this kind, those men most often suffer who are employed in dressing mill-stones, cutting or breaking siliceous rocks; such accidents seldom occurring from cutting granite or lime-stone. The fragment in the present case was at least a fourth of an inch long and a sixth in diameter, and very sharp. Cases in which foreign bodies of this description had passed into the eye without destroying it, have (Professor Jacob observed) been recorded by Mackenzie, Lawrence, Wardrop, and others, so that, as he had before remarked, there was nothing very new in the case now before the society, but its pathological interest he considered of the first importance, showing as it does that when a foreign body of such a description finds its way into, and remains for such a lengthened period, in an organ of all others in the body so profusely supplied with nerves and vessels without causing its destruction, it need not to be considered necessary to search with such anxiety after foreign substances that find their way into other and so much less important parts of the body, under the apprehension that they will make their way eventually to the surface, instead of which they often remain at rest after a little time, if the part be kept quiet.

Another case had come under his care some years ago: it was that of a little boy into whose eye a portion of a copper gun-cap had passed through the pupil, and lodged in the crystalline lens itself, where it lay without producing any distress or mischief for two or three years. But the very curious fact connected with it was, that the copper never lost any of its metallic brilliancy, and never became even in the slightest degree corroded or oxidated. This case he temporized with, and the sequel proved very instructive; the lens became absorbed, and the bit of copper got entangled in the opaque capsule, and believing that it might not be possible to extract it, the patient being young and unmanageable, he still continued to temporize with the case, and lost sight of the boy for some time.

In about a year after, however, he again came under his notice, and now the copper cap had disappeared, and the anterior and posterior chambers were filled with blood, as if from some recent injury. The pupil was dilated, but the eye was spoiled. The cap being nowhere visible, it was probable that it had fallen to the bottom of the eye, so Professor Jacob considered it better to leave the eye alone, and the case was lost sight of. It is not alone in the anterior chamber, or in contact with the iris or crystalline lens, that bodies of this kind stick, but sometimes under the conjunctiva itself, though (Professor Jacob observed) from the toughness of the parts, it did not often happen; this, however, occurred in the case of a young lady, whose younger brother, in playing with a toy-gun, drove a portion of the cap into her eye, where it lay under the conjunctiva, its situation.

being indicated by a small blackish tumour underneath that membrane. Having felt the little body with the point of a needle, he was enabled to remove it with the scissors without difficulty. In this case the foreign body had lain for nine months without producing any material mischief. Many instances are recorded in which bits of straw, pieces of rush, twigs, and such matters, become impacted, and where (Professor Jacob observed) one would never suppose they could lie quietly for any time, and that not alone beneath the conjunctiva, but in the fold of reflection of this membrane to the upper lid. Here they sometimes lie without attracting any attention until the production of a fungous tumour over the foreign body brings the case under the notice of the practitioner. A gentleman presented himself under circumstances of this kind to him, and on attempting to remove the tumour with a fine pair of scissors, he found that he could not do so in consequence of some hard unyielding material, which he extracted after snipping off the tip, and which proved to be a portion of the flowering part of a rush half an inch long, which had probably been driven into the part some months before; the patient having had a fall from his horse in the field about that time.

Now, (Professor Jacob observed) the question suggests itself as to how cases of this kind are to be dealt with; should they be temporized with? This he considers we are perfectly justified in doing if the body has lain quietly for a considerable time, and more especially, if it be exceedingly small; but if the foreign body is the source of a certain amount of irritation, the distress experienced will of course compel the surgeon at once to remove it. In the case first alluded to, and a specimen of which had been sent round, there had been, as he had stated, a great deal of inflammation, followed by an eccentric pupil and opaque lens, yet no shrinking of the eyeball or other indication of destructive inflammation. With respect to the mode of procedure for the removal of foreign bodies in the interior of the eye, Professor Jacob would recommend the method pursued in the case of the fragment in the anterior chamber, so little effusion or distress had followed upon it. In such a case it is supposed that it is only necessary to make an incision in the cornea, and let the foreign body pass out as the lens would in extraction; the operation is, however, attended with greater difficulty than might at first sight be expected.

In the first place, if recently lodged in the eye, a good deal of difficulty attends its extraction. It is stated by Lawrence, Tyrrel, and others-though he (Professor Jacob) was not satisfied of the factthat these bodies become adherent, that they become imbedded or enveloped in lymph. This, to be sure, one might expect, arguing from what occurs in other parts of the body under similar circumstances, but such was not the result of his experience; for instance, in the case under consideration, the particle of stone was perfectly clean and as distinctly visible in the anterior chamber, as if placed for examination in a drop of water. There was positively no lymphy coating either on the stone or in the case of the copper-cap; indeed, he could not clearly see where the lymph was to come from; if

lymph were shed, it would of course be the result of inflammatory action, and the foreign body would become adherent in consequence.

He would not, as he had said, deny that such might have occurred in other hands, but it was not so with him, and perhaps the statement was made by others under the conviction that a foreign body could scarcely remain in such a situation without becoming encysted. At the same time in the operation of extracting such substances it is well to be aware that they may be and probably often are adherent. In proceeding to extract them, as a general rule he would say, that the incision should be as large as possible, for the difference of mischief to the eye, between a small and large incision, is as nothing compared with the difficulty of dragging the foreign body through a small orifice. This will more particularly be necessary if the foreign body be a stone, as happened in the case now described, in which it was only after a second or third trial that Professor Jacob was enabled to extract it. Having waited between each attempt at extraction for the patient to become composed, and the spasmodic action of the muscles to subside, he was at length enabled to remove the fragment with the aid of the curette, and not without a good deal of force employed in disentangling it, for the little body was no doubt adherent, though not at all imbedded or encysted. Notwithstanding a good deal of violence having necessarily been employed, the case is going on well, there being no inflammation, such as would lead to the destruction of the organ. The man has already so much vision as to satisfy Professor Jacob that ultimately the eye will enjoy a useful amount of it. At the stage of his remarks, Professor Jacob said, it became a question for consideration whether in cases of this kind seen immediately after the accident, the practitioner would proceed at once to the removal of the foreign body. By all means, he would say, if he sees the case in the course of the day upon which the mischief has been done, it ought, if possible, to be removed at once, and this may sometimes be effected with the greatest facility, while in other cases the greatest difficulty is encountered. Thus it will happen that to remove a body lying in the anterior chamber there is nothing to be done but to pass the knife, cut through the edge of the cornea, and the foreign body immediately drops out; but in other instances, in spite of the utmost caution, it falls backwards into a fold of the iris, and entirely disappears from view; following it, however, with the curette, the extraction may be effected, notwithstanding that the lids are squeezed up, and every effort made by the patient to turn the eye. away from the operator. In this college, many years ago, (Professor Jacob said) a case of this kind occurred in a pupil of the institution, who, while at work in the laboratory, had a splinter of glass driven into his eye from the bursting of a glass vessel. The particle passed through the cornea, and on seeing him immediately after, Professor Jacob observed the bit of glass lying in the anterior chamber, with one point resting against the cornea, and the other against the iris. Having made a considerable opening with the extracting knife, the foreign body almost disappeared at first, having fallen into the fold of