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PRACTICAL OBSERTATIONS 
 
 ON 
 
 CONICAL CORNEA, 
 
 AND ON THE 
 
 SHORT SIGHT, 
 
 AN D 
 
 OTHER DEFECTS OF VISION CONNECTED WITH IT. 
 
 BY 
 
 J. NOTTINGHAM, M.D., 
 
 FELLOW OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, CORRESPONDING 
 MEMBER OF THE MEDICAL SOCIETY OF EMULATION OF PARIS, OF THE ROYAL 
 MEDICAL SOCIETY OF BERLIN, OF THE ACADEMIES OF MEDICINE AND 
 SURGERY OF MADRID AND BARCELONA, AND OF THE ACADEMY 
 OF NATURAL SCIENCES OF SPAIN I SURGEON TO 
 THE ST. ANNE’S EYE AND EAR INSTITUTION, 
 
 LIVERPOOL. 
 
 LONDON : 
 
 JOHN CHURCHILL. 
 LIVERPOOL: DEIGHTON & LAUGHTON. 
 1854 . 
 
chaw 
 
 " 9?ut tie giiUe jut tffarljeit 
 Unb in Sibgtunb wof;nt tie Saf>t$eit. 
 
TO 
 
 THE MEMORY 
 OF 
 
 JalrgmpU, 
 
 THESE PAGES ARE MOST RESPECTFULLY DEDICATED, 
 
 AS A TRIBUTE OF ADMIRATION FOR 
 
 DEPARTED GENIUS, 
 
 AND FOR EXCELLENCE ASSOCIATED WITH A NAME 
 
 WHICH IS ALREADY INSCRIBED UPON MONUMENTS 
 
 OF MORE DURABLE CHARACTER. 
 
ERRATUM. 
 
 Page b, line 14, for “less,” read “more.” 
 
PREFACE. 
 
 The observations contained in the following pages 
 relate to— 
 
 1. The symptoms and physical characteristics of 
 
 conical cornea. 
 
 2. The modes of origin of this malady, in con¬ 
 
 nection with which it is viewed as a result, 
 in most instances, of inflammatory action, 
 although this antecedent may not, at all 
 times, be observed. 
 
 3. The concurrence of other diseases of the 
 
 visual apparatus, or of distant organs. 
 
 4. The progress and terminations of the affection. 
 
 5. The treatment : in some measure for the 
 
 purpose of showing that surgical operations 
 
VI. 
 
 can only be of service in a few exceptional 
 cases, and that optical instruments, in the 
 earlier stages, or less developed forms of 
 the disease, may be of great use. 
 
 6. The anatomical changes associated with the 
 
 affection which require elucidation by obser¬ 
 vations more numerous than have hitherto 
 been made. 
 
 7. Certain other morbid conditions of the eye, 
 
 directly or indirectly connected with the 
 subject of conical cornea, or capable of 
 throwing light on the origin, nature, diag¬ 
 nosis, or treatment of this disease. 
 
 8. The possible occurrence of the malady amongst 
 
 the lower animals, as a matter worthy of the 
 attention of pathological inquirers. 
 
 The writings of ophthalmologists of the most 
 cultivated nations have been more or less consulted, 
 both in human and comparative medicine, and their 
 observations as frequently quoted; and obligations to 
 English and French, German, Dutch, Belgian, and 
 
VII. 
 
 Italian authors, should be more especially acknow¬ 
 ledged. To Danish writers I am somewhat indebted, 
 less to Swedish, least of all to Spanish and Portu¬ 
 guese ; it should, however, be mentioned, that some of 
 the excellent Spanish treatises on comparative medi¬ 
 cine and surgery, such as those of Sampedro, Casas, 
 and Santos, have been carefully consulted, previous 
 to the expression of opinions respecting the occur¬ 
 rence of conical cornea amongst the lower animals. 
 But, before closing this notice of obligation, especial 
 mention should be made of the original observations 
 of Dr. Pickford, of the late Mr. Walker of Man¬ 
 chester, of Mr. Middlemore and Mr. Gervis, of the 
 valuable monograph on conical cornea of Mr. W. 
 W. Cooper, (not to mention many names of equal 
 merit in France, Germany, and Italy, and which may 
 be found in the following pages,) and last, but not 
 least, of the profound work of Stellwag von Carion, 
 and the methodic and beautiful treatise of the brilliant 
 Cappelletti;« a name, in connection with which it 
 may be remarked, that the practice of Italian sur- 
 
Vlll. 
 
 geons, in this department of ophthalmology, has 
 been relatively little noticed by writers on the 
 subject in other European countries, although Italian 
 observations have been numerous, curious, and 
 scientific, doing honour to a land once 
 
 “Sacred to the Gods, ”* 
 
 and even now, a favoured abode of Genius dwelling 
 amongst men. 
 
 My best thanks are due to my Liverpool pub¬ 
 lishers,—Messrs. Deiglitou & Laughton,—for their 
 ample supply of the most recent English and Foreign 
 w T orks on Ophthalmology, by which my wants have 
 often been anticipated, and the observations on the 
 subject-matter of this essay considerably extended. 
 
 Liverpool, June 1, 1854. 
 
 Italia diis sacra." 
 
 C. Pi. inti, Lib. iii. 
 
 * (.1 
 
PRELIMINARY REMARKS. 
 
 In the year 1748, Mauchart published, at Tubingen, 
 
 a Dissertation on Conieal Cornea, or “ Staphyloma 
 
 Diaphanum,” as he terms it; and in 1766, Taylor, 
 
 in his “Nova Nosographia Oplithalmica,” published 
 
 at Hamburg and Leipzig, has concisely described 
 
 the same disease, under the name “Ochlodes;” the 
 
 remarks, however, of these authors do not seem to 
 
 have attracted much attention, for even the learned 
 
 Scarpa, in his work published at Pavia in 1801, in a 
 
 long note connected with the article Staphyloma, 
 
 describes a case of conical cornea in a female, which 
 
 had recently come under his observation, saying, 
 
 that if it were not referred, in classification, to 
 
 staphyloma, he could not tell where, amid ophthalmic 
 
 b 
 
X 
 
 diseases, to place it; while he makes no allusion to 
 the descriptions of Mauchart, or Taylor, but speaks 
 of the affection in such manner as leads the reader 
 to suppose that he had neither seen nor read of it 
 before. 
 
 By the case of Scarpa, however, this malady of 
 the cornea was again introduced to the notice of 
 surgeons, and his account of it was too graphic, 
 clear, and complete, to be lost upon the hook-shelves, 
 as those of earlier observers had been, while the 
 fame of his writings, with their English, German, 
 and French translations, spread a knowledge of the 
 matter in all countries where the healing art is 
 rationally cultivated. By some English writers, 
 the merit of this so-called first notice of conical 
 cornea, has been given to Leveille, the French trans¬ 
 lator ; the note in his translation which corresponds 
 to that in the original of Scarpa having been acci¬ 
 dentally, but erroneously, regarded as an addition 
 made to the French version of the work; it is some¬ 
 what remarkable that such a mistake should have 
 
XI 
 
 been made in this country, and even at a time when 
 an excellent English translation of Scarpa’s treatise 
 presented the note in question in plain English dress; 
 while no one seems to have given to Briggs, the 
 
 t 
 
 English, or to Martens, the German translator, the 
 credit or the compliment which fell to the lot of 
 Leveille; the error, however, was first started with a 
 name of some authority, and on that account, perhaps, 
 was longer and more readily copied. 
 
 The causes, nature, and treatment of conical 
 cornea have not yet been illustrated by observations 
 sufficiently numerous and varied to enable us to 
 consider that this ocular malady is as well understood 
 as are many other complaints that attack the organ 
 of vision j hence it is obvious, that additions to our 
 store of materials for the study of this affection seem 
 to be more in request than are attempts at anything 
 like systematic treatises on the subject: the morbid 
 anatomy of the disease is the department in which 
 accurate information is most scanty ; having, in itself, 
 no tendency to destroy, or to shorten life, oppor- 
 
Xll 
 
 tunities for observing its vestiges, post mortem, 
 have hitherto been exceedingly rare; for, although 
 much that relates to the anatomical state of the cornea 
 may he plainly seen by the observer during life, this, 
 in the main, belongs to the external or anterior sur¬ 
 face of the tunic, while the posterior surface, as well 
 as the intervening structure containing the true 
 corneal lamina, are nearly out of the reach of satis¬ 
 factory observation, so long as their transparency 
 remains undisturbed. 
 
 The etiology of the disease is not more advanced 
 than its pathology, although many very interesting 
 observations have been made respecting the time of 
 life, constitutional peculiarities, concomitant affections, 
 general or local, as well as the iufluences of exposure 
 or occupation of the eyes, which seem to have been 
 noticed in connection with the origin or aggravation 
 of the malady; some, however, of the conditions 
 alluded to, may now and then be regarded as acci¬ 
 dental, and, if so, must occasionally be viewed in the 
 light of coincidence, rather than in that of cause. 
 
Xlll 
 
 The treatment of the disease has exercised a 
 great amount of ingenuity, relatively more, perhaps, 
 than most other affections which belong to the domain 
 of surgery; for medicine, surgery, optics, and 
 mechanics have been taxed for the production of 
 therapeutic agents, capable of lessening or removing 
 the serious defects of vision which this formidable 
 disease of the eye, even in its earlier stages, or minor 
 forms, is capable of producing; in the application of 
 these, success has been various, and disappointment 
 by no means rare; with one practitioner, general 
 treatment has been fortunate; with another, local 
 applications; a third has been gratified by the favour¬ 
 able results of a surgical operation ; a fourth, with the 
 improvement of vision effected by some optical or 
 mechanical contrivance; in the hands of some, various 
 combinations of these means have been wisely and 
 usefully adapted, in accordance with the special 
 conditions or particular forms of the malady; while 
 others, having met with cases of unfavourable 
 character, have tried, without any satisfactory 
 
XIV 
 
 result, even the most accredited methods of 
 treatment. 
 
 It is worthy of remark, that scarcely any two 
 practitioners have been equally fortunate with the 
 same remedial means; this, however, may be ac¬ 
 counted for in various ways, for cases of conical 
 cornea are not only rare, but differ considerably in 
 their nature; and it may be remarked, that diffe¬ 
 rences in the size, form, and degree of transparency 
 of the cone itself, would be sufficient to prevent 
 similarity of results from any one plan of treatment, 
 but more especially from the surgical or optical; and 
 when, in addition to this, it is remembered that 
 morbid conditions of the retina but too often accom¬ 
 pany a conical state of the cornea, we see another 
 grand source of disappointment with regard to effects 
 of treatment, which cannot fail now and theu to pre¬ 
 sent a barrier to the surgeon’s success; besides 
 which it must be borne in mind, that the surgical 
 operations performed for the relief of conical cornea, 
 are unquestionably of the most delicate kind, includ- 
 
XV 
 
 ing, as they have done, operations on the cornea 
 itself, on the iris, and on the crystalline lens, and, in 
 some instances, on more than one of the parts men¬ 
 tioned ; so that occasional failure, never mind how 
 well such operations may have been performed, 
 belongs, of necessity, to the average results, and to 
 the statistics of surgery; not to give more than a 
 bare mention of the important fact, that, after surgical 
 treatment of this refined cast is applied to an organ 
 so exquisitely delicate as the eye, a great deal 
 depends upon the patient and his friends; a little 
 carelessness, rashness, or neglect, and the trans¬ 
 parency of the cornea may he lost, or the interior of 
 the eye destroyed by active inflammation. In the 
 application of optical contrivances, numerous diffi¬ 
 culties have to be overcome; a great variety of lenses 
 and apparatus must be patiently tried, great care 
 being taken not to allow fatigue of the eyes by efforts 
 too long continued, or by instruments injudiciously 
 selected; various minutiae must here be attended to, 
 and while careful trials will sometimes be amply 
 
XVI 
 
 rewarded, those hastily made may as frequently end 
 in disappointment. 
 
 To the treatment proposed and advocated as suc¬ 
 cessful hy some, others have raised very strong 
 objections; these have related more especially to the 
 applications of operative surgery ; some writers avow¬ 
 ing that, in cases of conical cornea, no benefit will 
 accrue from the performance of any operation upon 
 the eye; while compression of the eyeball, puncture 
 of the cornea, the formation of artificial pupil, and 
 operations on the lens, to say nothing of various 
 combinations of these proceedings, have all had their 
 opponents as well as advocates; it should, however, 
 be borne in mind, that certain curative plans may be 
 rationally or well suited to a given stage of the 
 disease, but not equally applicable to all; and that 
 certain operations, which appear in some cases to be 
 indicated by what we may term the optical condition 
 of the eye, might he performed, and nevertheless fail 
 in producing any improvement of vision, by virtue of 
 alterations in the vital condition of the organ, pro- 
 
XV11 
 
 duced by the operation itself, and from which the eye 
 is not able sufficiently to recover; the mechanical or 
 optical rationale of the proceeding being all the 
 while without fault; provided the vital condition of 
 the eye, and the probable effects of interfering with 
 it, had been more correctly appreciated. 
 
 The observations on conical cornea which the 
 accompanying pages contain have no pretension to 
 be regarded as a treatise on the subject; they are 
 not, therefore, associated with any limited theoretical 
 views respecting the causes or nature of this malady; 
 the individual cases, original or selected, are stated 
 with all the attainable particulars relating to them, 
 and some of them accompanied by remarks which 
 their special characteristics seemed naturally to sug¬ 
 gest; an addition to the store of materials in this 
 branch of surgical literature being the object more 
 especially kept in view. Some cases, which depart a 
 little from the genuine forms of conical cornea, have 
 been noticed, and certain sources of morbid action iu 
 the cornea, and other parts of the eye, connected, 
 
 c 
 
XV111 
 
 apparently, with disturbance of the fifth cerebral 
 nerve, have received that attention which their im¬ 
 portance seems to merit. 
 
 As there is, comparatively, so little to be found 
 relating to this interesting subject in the medical 
 writings of any one country, it has seemed desirable 
 to extend our means of information from various and 
 distant sources. 
 
 In the surgical writings of some European coun¬ 
 tries, nothing relating to conical cornea is to be dis¬ 
 covered ; in those of some others only translated 
 notices are met with; while, in the professional 
 literature of Great Britain, Ireland, and America, of 
 Germany, France, and Italy, the accumulated facts, 
 with their physiological, pathological, and surgical 
 comment, which show the light in which this subject 
 should be viewed, the further studies required to 
 elucidate it, and the practical importance attached to 
 it, are for the most part to he found. The notices of 
 the disease derived from observation of it in the 
 East, but more especially in China, and mainly from 
 
XIX 
 
 the pen of British, or American observers, have been 
 published in this country as well as at Canton. 
 
 The malady does not seem to have been known 
 to the ancients, for Hellenists find no satisfactory 
 account of it in the writings of the Greeks; in the 
 medical literature of Rome it is not mentioned ; and 
 Oriental scholars do not tell us of its especial notice 
 in the books of the Hindoos or Arabians. 
 
 In some of the warmer countries of Europe it 
 would seem to be little known, and in Spain it might 
 be very rare, for in the “ Manual de Afectos 
 Esternos,” of Garcia, it is not described ; but this 
 author, as a definition of staphyloma, says : “ Se da 
 este nombre a la salida de la cornea trasparente, 
 fonnando prominencia hacia adelante—a definition 
 which would include what we call conical cornea, 
 but this malady does not appear to have been con¬ 
 templated by the author; and the surgical work of 
 Don Jose Alarson gives no further information on 
 the subject; but the surgeons of the peninsula have 
 had better opportunities of studying this affection 
 
XX 
 
 since the Spanish translation of the great work of 
 Vidal de Cassis has been published in the language 
 of Castile. 
 
 In the surgical writings of Holland, perhaps the 
 best account of the complaint is to he found in the 
 Dutch translation of the work of Ruete, which has 
 received additional value from the notes and com¬ 
 ments of Donders. 
 
 In the Danish language, we find here and there 
 observations and inquiries not altogether foreign to 
 the subject ; thus, in the beautifully - illustrated 
 “Bidrag til Oiets Anatomie, Physiologie og Patho¬ 
 logic,” of Hannover, the sections of various normal 
 forms of the cornea, representing the curve of the 
 transparent front of the eye in different animals, are 
 characterised by au accuracy and beauty which do 
 honour to the physiology and lithography of Den¬ 
 mark ; while the report of results of experimental 
 inquiry relating to the modified nutrition or destruc¬ 
 tion of the cornea after removal of the superior 
 cervical ganglia of the sympathetic nerves, may be 
 
XXI 
 
 regarded as an interesting step in the progress of an 
 important inquiry, the whole length of which has not 
 yet been travelled. In a more recent work of 
 another distinguished physician of Copenhagen—the 
 “ Ophthalmologerue ” of Brion—the phenomena of 
 keratitis and its various consequences have received 
 an attention in accordance with their importance. 
 
 In the Swedish Dictionary of Diseases of the 
 Eye, “ Ogonlakeren,” a short notice of the malady is 
 given under the word “ Ochlodes,” the appellation 
 formerly adopted hy Taylor; hut there is little doubt 
 that the Scandinavian writers have more important 
 productions connected with this matter, with which 
 time and literary intercourse may make us better 
 acquainted, a notice of which, however, I do not find 
 in the general bibliographical works of Sweden, 
 Denmark, or Norway, nor in the “Bibliotheca Da- 
 norum Medica ” of Wiuther. 
 
 In Germany, where ophthalmology, in general, 
 has long been so profoundly studied, conical cornea 
 appears to have attracted attention upwards of a 
 
XXII 
 
 century ago; one, however, of the earliest writers 
 
 on the subject in the German language was not a 
 
 \ 
 
 native of Germany but of England. 
 
 There is too much in the medical writings of the 
 Arabians that has never been multiplied by the 
 typopraphic art, to allow of the unreserved assertion 
 that the attention of their oculists, who were nume¬ 
 rous and famed, was not directed to the subject of 
 conical cornea. This statement may seem to require 
 illustration, and the following notice, one out of 
 many which might easily be adduced, will answer 
 the purpose:— 
 
 A Latin translation of the Dresden manuscript of 
 the Arabic work on the Anatomy, Physiology, and 
 Diseases of the Eye of Alii Ben Isa, is in course of 
 publication ; hitherto, however, only a small portion 
 has appeared, hut this is sufficient to shew something 
 of the general scope of the production; and what is 
 more, as far as our inquiry is concerned, the table of 
 contents for the pathological part, which is given in 
 the introductory section, displays a certain amount 
 
XX111 
 
 of progress and refinement in connection with the 
 division and arrangement of the diseases of the 
 cornea, as the following short extract may show :— 
 
 1. De numero morborum strati corneae. 
 
 2. De speciebus ulcerum eorumque tract. 
 
 3. De pustulis corneae. 
 
 4. De nubecula et albugine ejusq. tract. 
 
 5. De pigmento nuheculae et colore caeruleo 
 
 oculi ejusq. tract. 
 
 6. De excoriatione (ulcere superfic.) corneae. 
 
 7. De abscessu corneae (bypopyo vero). 
 
 8. De carcinomate corneae. 
 
 9. De excavatione (cicatricibus) corneae. 
 
 10. De mutatione coloris corneae ejusque tracta- 
 
 tione. 
 
 11. De humiditate tunicae corneae. 
 
 12. De exsiccatione et corrugatione (rhytidosi, 
 
 atrophia) tun. corneae. 
 
 13. De pure pone corneam collecto (bypopyo 
 
 spurio). 
 
 14. De discrimine inter protuberantiam (cerato- 
 
XXIV 
 
 cele, vel staphyloma corn, pellucidum) et 
 pustulas (phlyctaenas) corneae. 
 
 15. De dissolutioue unitatis (vulneribus) corneae. 
 
 It is obvious that such study of diseases of the 
 cornea as may be supposed to have been associated 
 with the view of the subject which the above head¬ 
 ings suggest, may have brought the “ conical 
 cornea” of modern writers under the attentive ob¬ 
 servation of the Arabic physician who flourished 
 centuries ago; and even this short notice suggests, 
 that we do not rightly neglect the science of Islam, 
 and shows that if we care for the productions of 
 Yemen, we must not confine ourselves to the Arabian 
 Nights. 
 
 Some allusions have been made to the state of 
 the cornea after operations upon the cerebral and 
 sympathetic nerves, mainly to shew the different 
 views of eminent physiologists on the subject; while 
 it should be remembered, that operations which enable 
 the inquirer to divide nervous cords within the skull, 
 or in the depths of the neck, will often leave compli- 
 
XXV 
 
 / 
 
 cated and not easily defined injuries behind them, 
 the general effects of which, as viewed in connection 
 with those belonging to the especial aim of the 
 operation, done, or intended to be done, it must 
 always be difficult to analyse or to isolate. 
 
 The disease here treated of has been called b,v 
 many different names; and it may be well to observe 
 that, in the following pages, the terms “ keratoconus” 
 and “ hyperkeratosis,” when employed, are regarded 
 as synonymous with conical cornea. 
 
 Some irregularities, in the concatenation of the 
 
 materials of the following pages, have arisen from 
 
 the reception of recent, and unexpected, continental 
 
 works on ophthalmology, the subject matter of which, 
 
 in connection with conical cornea, I was unwilling to 
 
 leave without some little gleaning; and hence, in more 
 
 than one place, have ceded the desired arrangement 
 
 of facts to the accidental increase of their number, 
 
 thus offending order, in a manner which requires 
 
 some apology, and risking the applications of that 
 
 just criticism which censures immethodic book- 
 
 d 
 
XXVI 
 
 making; this remark may also be received, in expla¬ 
 nation of adding an index to an essay, for which, 
 a table of contents, with better method, might have 
 been regarded as sufficient. 
 
 The Bibliography of conical cornea has not 
 hitherto any very great scope; the disease is, of 
 course, noticed in all systematic works on oph¬ 
 thalmology, as well as in treatises on the patho¬ 
 logical anatomy ot the eye, and the monographs 
 relating to it are mainly to be found in the 
 English, German, French, and Italian languages. 
 
ON CONICAL CORNEA. 
 
 It is familiar knowledge that tlie front of the eye is 
 very differently shaped in different animals; that it 
 is very flat in fishes, and flat, but in a less degree, 
 in creatures that have their eyes sometimes under the 
 water, and at others in the air, as in amphibia, and 
 in some aquatic birds; that it is more rounded in the 
 larger animals whose common abode is in the lower 
 region of the atmosphere, in other words, upon, or 
 near to the surface of the earth, as in the best known 
 mammalia, and in many of the feathered tribe; while 
 it is rounded in the extreme, and very prominent, in 
 creatures that exercise vision, in a great measure, in 
 the higher regions of the atmosphere, as for instance 
 in the high-flying birds of prey. 
 
 It is obvious that these different forms of the 
 eye are wisely adapted to the circumstances, or to 
 the nature of the element, in which the beings 
 possessing them are placed. The flat cornea of the 
 
 A 
 
2 
 
 fish would not answer the purpose of rightly refract¬ 
 ing the light passing- from the air into the eye, if it 
 were found in lofty soarers, such as the eagle; while 
 the anteriorly prominent and rounded organ of this 
 visitant of the clouds would have been of equally 
 little use, had it been supplied to a creature in¬ 
 habiting the depths of the ocean. Hence, it is easily 
 seen that the beings in question must require for 
 their varied abodes, in air or in water, modifications 
 of form in the organ of vision, as well as in the 
 apparatus of breathing, or in the machinery of 
 locomotion. 
 
 The human eye, with regard to its anterior 
 rotundity, or form of the cornea, in the healthy state, 
 may be said to hold a medium position between the 
 prominent organ of the eagle, and the flattened one 
 of the fish; but particular abnormal or morbid for¬ 
 mations of the eye are now and then met with, in 
 which, a something approaching to one or other of 
 the types above alluded to, as peculiar to the eye 
 of animals, may be observed as a characteristic of 
 disease in the visual organ of man ; want of rotun¬ 
 dity, giving rise to flat cornea in an extreme degree, 
 and without other disease, is uncommon, (although. 
 
3 
 
 in a lesser degree, it is not rare,) but excess of 
 prominence, giving rise to the state known as 
 conical cornea, is not so unfrequent; in this class 
 of cases the front of the eye, or cornea, has com¬ 
 monly an aspect of peculiar brilliancy, from the 
 manner in which the light is reflected from it; and 
 in connection with this fact, there is one instance 
 on record, in which the presence of conical corneae 
 was regarded as an advantage, on account of the 
 dazzling brilliancy which they gave to the counte¬ 
 nance of a comedian, who had a fancied treasure 
 in possessing a pair of eyes of this kind. 
 
 Conical cornea was first noticed in medical writ¬ 
 ings somewhat less than a hundred years ago, but 
 its study was scarcely entered upon before the com¬ 
 mencement of the present century; and the clinical 
 facts of interest, out of which suggestions respecting 
 its nature and treatment have sprung, are for the 
 most part productions of the last twenty years. 
 
 Observations shew that it may affect the eye of 
 the child before birth, and that in the other extreme 
 the organ of vision of the aged may suffer from it, 
 while intermediate ages are not exempted from its 
 attack; youth, however, seems most favourable to it, 
 
4 
 
 and this move especially in girls, in whom, between 
 the ages of 10 and 16, it is perhaps most frequently 
 met with; and, as a general statement, it would he 
 correct to say that it is very rarely originated after 
 the body has received its full development. 
 
 It has been observed and treated of as occurring 
 in the Mongolian and Caucasian branches of the 
 human race, and in greater proportion in the former, 
 as observations made in China tend to show; in the 
 other varieties of mankind it has yet to be studied; it 
 has been said not to occur in savages, but whether 
 or no it affect them may very well he left for another 
 generation to decide. 
 
 It has not yet been brought into the domain of 
 comparative medicine, and veterinarians of eminence 
 have said that they do not meet with it amongst 
 domestic animals, and more especially is it affirmed 
 that it rarely, if ever, occurs in the horse; in con¬ 
 nection with this remark, however, the following 
 observation may be made, which is, that although vete¬ 
 rinarians in their systematic works have not specially 
 devoted articles to conical cornea, they have never¬ 
 theless in other articles, such for instance as those on 
 hydrops oculi, and staphyloma, here and there 
 
5 
 
 described conditions, in appearance corresponding to 
 the so-called conical cornea; in addition to which it 
 must be remembered that the name, conical cornea, is 
 comparatively recent in writings relating to human 
 ophthalmology, and this more especially in some of 
 the continental countries, amongst which France 
 must be mentioned, where, until very lately, and in 
 some cases even now, the account of this disease is 
 to be found under the head of staphyloma, of which 
 it is called the transparent variety, thus correspond¬ 
 ing to the descriptions found in veterinary treatises. 
 
 If the disease were viewed in connection with 
 country, climate, or season, it would be requisite, in 
 the first place, to note the limit of the observations 
 already made, which upon the whole must be 
 regarded as narrow, when compared with those which 
 belong to other branches of ophthalmology. 
 
 In some European countries, and to some prac¬ 
 titioners, thousands of cases of ocular disease have 
 occurred, without one sample of this malady being- 
 observed, and this for years together; and from 
 various public notices and reports, it would seem 
 that those surgeons who are most likely to have 
 paid particular attention to the complaint have often 
 
not had one case of it in a thousand, and have sel¬ 
 dom exceeded three of it in a thousand; but a 
 greater proportion than this has been observed in 
 Asia, possible errors connected with nomenclature 
 or definition being left for future consideration. 
 
 From observations hitherto made, it would seem 
 that the disease is more frequent as we approach 
 the tropics, and more rarely found in higher latitudes; 
 but as the malady appears, in some cases at least, 
 to be a consequence of inflammatory action, it is 
 worthy of remark that its frequency in certain warm 
 countries is perhaps to be accounted for by the 
 greater prevalence of the ophthalmiae of those regions. 
 
 It is said that the observers of North Britain, 
 and of Northern Germany, have had very few 
 opportunities of studying conical cornea, and that 
 Himly, amongst others, had not seen a case when he 
 wrote. 
 
 In Scotland it has been so rare, that out of 
 15,924 cases in the Glasgow Eye Infirmary, there 
 were but 4 of conical cornea; nevertheless, Dr. 
 Mackenzie has stated that “ Sir David Brewster 
 examined a great variety of cases of conical cornea.” 
 
 Here it may he well to remark, that conical 
 
7 
 
 cornea is a malady which does not in most instances 
 diminish the clearness or brightness of the eye; 
 hence those who suffer from it, not finding them¬ 
 selves troubled with any visible disease of the organ 
 which they are able to appreciate, will doubtless, for 
 the supposed weakness of the eye, very often seek 
 relief in the aid of spectacles, aud hence apply to 
 the optician instead of the surgeon; and if so, the 
 number of cases of conical cornea really existing in 
 any community may not he adequately known by 
 consulting surgical reports; to which we may add, 
 that the fame of individual opticians may tend to 
 lessen considerably the opportunities which neigh¬ 
 bouring surgeons may have of observing or studying 
 this interesting affection of the organ of vision ; to 
 these observations, however, must be added the 
 remark, that opticians in different towns in the north 
 of England have told me that they very rarely see 
 a case of conical cornea. 
 
 Conical prominences of the cornea, with disease 
 of its tissue, and with more or less of opacity, are 
 not uncommon, as in cases of staphyloma; hut 
 that conical state of this part of the eye which is 
 not generally associated with any loss of transpa- 
 
8 
 
 rency, or other appreciable alteration of the tunic, 
 if we except apparent and occasional modifications 
 in its thickness or smoothness, is an exceedingly 
 rare disease, and, as it often destroys distinct vision, 
 while its nature and treatment are neither of them 
 to be regarded as quite settled, any contribution to 
 the clinical facts of this branch of ophthalmology may 
 not be deemed unworthy of notice. 
 
 The following is a short account of a remarkable 
 case of conical cornea, with which the patient could 
 not distinguish the face of his friends, but where, 
 by the adaptation of a peculiar optical contrivance, 
 answering in some measure the purposes of an arti¬ 
 ficial iris, the sight was so much improved that he 
 could afterwards read, without fatigue, a small news¬ 
 paper type. 
 
 Mr.-■, 23 years of age, of good constitution, 
 
 tall, and thin, with fair complexion and blue eyes, 
 says, that although not very strong, he has generally 
 enjoyed good health, and that he knew nothing of 
 the ocular complaint from which he now suffers 
 until the age of about 14£ years; at this time he 
 grew very rapidly, and the defect in his vision, then 
 first complained of, was attributed by his friends to 
 
9 
 
 his recently rapid growth; since which, increase of 
 it, rather than diminution, has progressed. 
 
 Even when he enters a room, if at all attentively 
 observed, his eyes present a very peculiar appearance, 
 their brightness being much greater than usual, and 
 having something of that aspect which the eye of a 
 child has, when a large and lucid tear is holding 
 on its anterior surface; this appearance evidently 
 depending upon the peculiar curve of the cornea, and 
 the associated luminous reflection and refraction. 
 
 On the left side the cornea is conical, prominent, 
 and perfectly transparent, its aspect rather favouring 
 the idea that it is somewhat thiuner than usual at 
 its most prominent part, which part is a little to the 
 outside of its centre, while at its base or sclerotic 
 margin there is no evidence of deviation from the 
 ordinary or healthy condition. 
 
 Supposing the crystalline system to be in its 
 usual place, and regarding the aqueous humor as a 
 lens, or as one of the refracting media of the eye, 
 it is obvious that its antero-posterior measure is 
 increased in proportion to the advance of the apex 
 of the cone,—unless the cornea were much thickened 
 at this part, which it does not seem to be. There 
 
 B 
 
10 
 
 is no vestige of ulceration, or of inflammatory action 
 in either cornea. 
 
 The state of the iris and pupil did not suggest 
 any special pathological remarks, the former was 
 vertical, the latter of the usual size. 
 
 To the right eye the above description also 
 applies, but in this eye the couicitv, which corre¬ 
 sponds as to position, appears to be somewhat less 
 than in the other. 
 
 Both eyes feel firm to the touch, and have their 
 normal sensibility. 
 
 It would be shorter, and perhaps better, in few 
 words to say, that amongst the objective phenomena 
 of the case, two were mainly remarkable; one was 
 the peculiarly glittering aspect of the prominent 
 cornea, the other was an appearance of over 
 sensitiveness in the eyes, when bright light fell 
 upon them, giving rise to winking motions of the 
 lids, with undue approximation of their margins. 
 
 When out of doors, in the sunshine, the patient 
 is dazzled by the light, and cannot see any thing 
 with distinctness; in the moderate light of a clouded 
 day, or in an apartment, the vision is still defective, 
 but the dazzling of course less. 
 
11 
 
 To view small objects, the patient places them 
 very near to his eyes, and a little to the temporal 
 side. Mere double vision is not complained of, 
 but a candle, when looked at, appears like a number 
 of lights, confusedly running into one another; but 
 without coloured fringes, or other phenomena of 
 chromatic aberration. 
 
 The confusion, or want of vision, and the 
 dazzling, are evidently attributable to the altered 
 form of the anterior part of the eye-ball; so that 
 the question at once suggests itself, What is the 
 mechanical or optical contrivance most likely to 
 correct in any measure the disturbing effects pro¬ 
 duced by the conical form of the cornea ? 
 
 It was obvious that we had to contend with what 
 may be called optical difficulties, arising from 
 spherical aberration, in a case where no chromatic 
 aberration was met with; and it is well known 
 that the correction of the former, in instruments of 
 human invention, is chiefly sought by modifications 
 in the form of lenses, or by diminution of their 
 aperture, while that of the latter requires a due 
 selection and combination of the material of which 
 lenses are composed. In the subsequent notice of the 
 
12 
 
 treatment adopted in the case here related, it will be 
 found, that the two methods of correcting spherical 
 aberration, above alluded to, were both found to he 
 useful. 
 
 1. It seemed probable, that darkened glasses, of 
 double concave form, would be likely to assist the 
 patient when walking in the street, on the suppo¬ 
 sition that their form might, in some small degree, 
 meet the wants of the eye, while their colour would 
 lessen the dazzling so much complained of. 
 
 2. The cylindric lens, of concavo-convex form, 
 next suggested itself for correcting the effects pro¬ 
 duced by the before-mentioued curves of the cornea; 
 and here it was w r ell to bear in mind, that each 
 cornea presented two curves, the extremities of which 
 were on the same vertical plane, but tbe arcs of 
 w hich were not of the same length; hence the 
 concavo-convex cylindric lens seemed likely, in 
 some measure, to answer our purpose; the curve of 
 which could be placed vertically, so as to correspond 
 with the shorter curve of the cornea; thus taking 
 something from that which seemed to be the line 
 of greatest refraction ; the lesser refraction of the 
 glass counteracting the greater refraction of the 
 prominent anterior tunic of the eye. 
 
13 
 
 3. It is obvious that the two instruments already 
 noticed were intended to modify the effects of the 
 light falling upon the whole of the cornea; the next 
 which suggested itself was one W'hich should alter 
 the conditions under w r hich vision might he exercised, 
 by allowing the light to fall only upon a part of the 
 cornea. To attain this end, a piece of black wood, 
 in form more or less like the one-half of a walnut 
 shell, was taken and perforated, so as leave a circular 
 opening, heyond and around which a small nipple 
 projected on the exterior, thus converting this hole 
 into a very short tube, standing on the outer surface 
 of the shell of wood, the aperture being, not in the 
 centre, hut a little to the inner side of this point; these 
 black goggles being held before the eyes, the axes 
 of their tubular apertures were convergent, more or 
 less, as the axes of the eyes are when near objects 
 are contemplated. 
 
 It may now be asked how these contrivances 
 answered, or which of the three was the best; to 
 which it might he replied that every one of the three 
 was useful; the first, or darkened bi-concave lens, 
 assisted the wearer very much when walking in the 
 sunshine; and, as there was nothing disagreeable in 
 
14 
 
 its appearance, was adopted and approved of, for 
 reasons now explained: with the second or cylindric 
 lens small newspaper type was read, to the great 
 gratification of the gentleman; but while the optician 
 was engaged with the glasses, the artificial iris was 
 considered, and, when tried, found to be somewhat 
 better than the last-mentioned lens. 
 
 The cylindric lens, in coloured glass, was not 
 tried. 
 
 If the perforated cups of black wood had been 
 less successful, a combination of artificial iris, with 
 artificial lens, might have been tried ; in other words, 
 spectacles with very small glasses, surrounded by a 
 broad and blackened rim of metal, wood, horn, ivory, 
 or other opaque substance, would have suggested 
 themselves. 
 
 The general health of the patient being good, and 
 the defect of vision being so much alleviated by the 
 instruments above noticed, it is obvious that further 
 medical or surgical treatment was by no means 
 indicated. 
 
 When we remember how little is known of the 
 real causes of conical cornea, and at the same time 
 bear in mind the varied characteristics which in 
 
15 
 
 different cases it presents, it need not seem surprising 
 that many and very different methods of treatment 
 should have been found useful in different instances, 
 and hence strongly recommended for its cure. 
 
 Remedies administered by way of the stomach, 
 topical applications to the eye and neighbouring 
 parts, optical contrivances to assist the vision, 
 surgical operations performed on the eye-balls, with 
 the various combinations of these, may be said to 
 include the main proceedings hitherto suggested; in 
 connection with which it must be remarked, that in 
 some cases benefit is only to be derived from a 
 judicious combination of general and local treatment, 
 or of operation and after-treatment. 
 
 1. As internal remedies tonics have been given, 
 and also medicines which must generally be regarded 
 as debilitating; such as sulphate of zinc and sulphate 
 of magnesia, in combination. The dose, twenty 
 grains of sulphate of zinc, with half an ounce of 
 sulphate of magnesia, every morning, if circum¬ 
 stances permit, and the nausea or vomiting can 
 be supported by the patient. Preparations of 
 arsenic have in some cases been supposed to be 
 beneficial, and the tincture of sesqui-chloride of iron, 
 
16 
 
 with aloes and myrrh, carbonate of iron, and 
 galbanum, are amongst the medicines of a long list. 
 
 2. Topical applications; amongst others those 
 which are soothing, stimulant, astringent, or escha- 
 rotic, have been employed. To the action of the former 
 allusion need not be made; but with regard to the 
 escharotic class, it may he stated, that the nitrate of 
 silver, in substance, has been especially recommended 
 to he applied to the apex of the morbid cone, when it 
 is found that this apex is becoming opaque. It is 
 said that this has occasionally done good, and it is 
 not improbable that it might occasionally do harm. 
 
 Imponderable agents have been tried, especially 
 electro-magnetism. 
 
 In. collyria, acetate and sulphate of zinc, as well 
 as preparations of lead. Infusion of tobacco dropped 
 upon the eye, has been recommended. In unguents, 
 the nitric-oxide of mercury has had a place. 
 
 In cases where the apex of the cone had become 
 opaque, the employment of the vapour of prussic 
 acid has been followed by the diminution of the 
 opacity. 
 
 Counter irritation has been produced, by blisters 
 and various liniments to the back of the neck, or 
 
17 
 
 behind the ears, as well as to the temples or forehead ; 
 and nitrate of silver and tincture of iodine have 
 been applied to the eyelids, with subsequent appear¬ 
 ances of improvement. 
 
 Next may be mentioned the application of cold 
 to the eye, or eyes, affected, as also that of pressure, 
 as well as the combination of the two; for this 
 refrigeration and pressure, various mechanical con¬ 
 trivances have been resoited to, — such as springs 
 arching over the head, with their point d’appui 
 on the occiput, holding, or holding and pressing, 
 upon the fore part of the closed eye, ice, or other 
 cooling substances, contained in capsules of animal 
 membrane, bags of caoutchouc, &c., along with 
 which there is the inconvenience of rapid rise in 
 temperature, as well as the gradual loss of the fluid, 
 of which some part in most cases soon escapes from 
 the bag or capsule employed. Folds of linen 
 dipped in cold water, and renewed at short intervals, 
 have been recommended as especially useful, in cases 
 of conical cornea associated with derangement of 
 the catamenia. The apparatus of Langenbeck, or 
 that of Chassaignac, is intended to facilitate the 
 application of cold to the eyes ; the former is a double 
 
 c 
 
18 
 
 ring of horn or other substance, charged with ice, 
 and placed over the eyes ; the latter is a mask of iron 
 wire, receiving little hags of ice, and holding them 
 over the eyes, with the aid of a spring arched over the 
 head, and by its expanded and cushioned extremity, 
 holding on beneath the occipital protuberance. 
 
 Patients with alteration in the form of the cornea 
 may be occasionally recommended to try whether 
 vision is improved by gentle pressure or pulling on 
 the eye-ball above, below, or laterally, practised with 
 the end of the finger, applied to the integument near 
 the canthus, or upon either of the lids. 
 
 Belladonna, or atropine, for dilating the pupil, 
 may be mentioned amongst topical applications. 
 
 Amongst optical contrivances to assist the vision 
 may be named artificial lenses, artificial irides, and 
 combinations of the two ; the bi-coucave lens might 
 seem to be indicated, but it is not always useful, 
 aud the bi-convex is very rarely tried; but even this 
 has been said in certain rare cases to have been ser¬ 
 viceable,— the meniscus might seem to promise bet¬ 
 ter*—and glasses with oue plane and one curved sur¬ 
 face, are useful in diagnostic trials, and now and then 
 might possibly be of service to the patient, either 
 
19 
 
 alone, or in some of their combinations. A couple 
 of plano-concave spherical lenses, the flat surfaces 
 in juxta-position, with the curves crossing one 
 another, has been found an useful combination. 
 
 Combinations of lenses of different figures, the 
 ocular one bi-concave, the distal convex, with ad¬ 
 justing apparatus, have in some cases been of use. 
 Lenses with posterior surface corresponding to the 
 front of the eye, and anteriorly of regular figure, 
 are amongst the means proposed for correcting the 
 altered refraction ; along with these may be men¬ 
 tioned lenses of transparent animal jelly, contained 
 in capsules of glass, to be placed on the front of the 
 eye, and kept there as long as the patient will bear 
 spectacles of this kind. 
 
 The meniscus, with a bi-convex lens of unequal 
 spheres behind it, has not been tried, but seems not 
 unworthy of notice. 
 
 Should a case present itself in which the pheno¬ 
 mena of chromatic, as well as those of spherical 
 aberration are complained of, it is obvious that the 
 optical correction might be sought in a com¬ 
 bination of flint and crown glasses with different 
 dispersive powers. 
 
20 
 
 For determining the state of the vision, as well 
 as for correcting its defects, not only should a variety 
 of spherical lenses of equal and of unequal spheres 
 he at hand, but those which are cylindric, parabolic, 
 or hyperbolic, when procurable, may he useful; and 
 some means of having them steadily supported are 
 essential to accuracy and success. 
 
 The diaphragm, or artificial iris, may be plane 
 or curved, with central or eccentric aperture, and 
 with or without tubular prolongation in front of this; 
 or, instead of the foramen, a slit. 
 
 In most cases, for viewing near objects, when 
 both eyes are affected, the apertures seem best placed 
 a little to the inside of the centre, and if in front 
 of them there be a very short tubular prolongation, 
 the pencil of rays will be more completely limited. 
 
 A combination of the diaphragm and lens, is 
 now and then found useful in practice. 
 
 For the improvement of vision in cases of conical 
 cornea, surgical operations have been performed with 
 varied success upon the cornea itself, upon the 
 iris, and upon the crystalline system, and occa¬ 
 sionally upon more than one of these parts; their 
 main objects have been two:—1. To lessen the 
 
21 
 
 refracting power of the eye by flattening the cornea, 
 or by removing the lens. 2. To improve vision 
 by artificial pupil, made in some part of the rim 
 of the iris, which corresponds to a transparent and 
 circumferential part of the cornea, which is less 
 rounded than its conical prominence, and not uneven, 
 or otherwise diseased on its surface. 
 
 Flattening of the cornea has been attempted by 
 different operations; puncture of this tunic, so as to 
 let out a part of the aqueous humor, is generally 
 followed by flattening of the cone, and in some 
 cases, after a few hours there is considerable 
 improvement in the vision, but a few more hours 
 having elapsed the aqueous humor is again suffi- 
 ciently abundant to distend the cone as before, and 
 thus the vision returns to its previously defective state. 
 
 Puncture of the cornea, evacuation of the 
 aqueous humor, and pressure, or rather support to 
 the cornea, applied immediately afterwards, and 
 steadily persevered in for several weeks, is a mode of 
 proceeding that has had more than one advocate; 
 but to produce a perfect, lasting, and efficient cushion 
 for keeping up this pressure or support has been 
 found, as before said, a very difficult matter. 
 
22 
 
 It is obvious, that in a case of conical cornea, if 
 a part of the cornea were excised, and the lips of the 
 corneal wound approximated, and this proceeding 
 followed by a favourable agglutination of the parts, 
 that flattening of the cone might be expected; hence 
 this plan has been resorted to, by dividing the cornea, 
 as in the operation for extraction of cataract, and 
 then cutting away a small portion from the loose 
 flap. One patient, after recovering from an operation 
 of this hind, had the apex of the cone inclined down¬ 
 wards, and the myopia was somewhat lessened; the 
 lower part of the cornea was divided in the operation, 
 aud the practitioner afterwards recommended a like 
 section to be made of the higher part, but the patient 
 did not consent. 
 
 Fario, an Italian surgeon, at three different 
 times, cut out three small portions of the cornea, each 
 time leaving a hole through which the aqueous 
 humor gradually drained; the closed lids were held 
 together by sticking-plaster, and the corneal breach 
 was found to fill up in about eight days. The first 
 excision was practised at the upper part of the 
 cornea, the second at the lower, the third at the 
 upper and inner; into the aperture made by excision 
 
23 
 
 at the lower part of the cornea, a prolapsus of the iris 
 took place, but this was remedied by the application 
 of belladonna. Each piece of cornea removed was 
 triangular, the apex being near to the sclerotic 
 margin, and, the sides having been cut with the 
 cataract knife, excision was completed by dividing 
 the base with the scissors; the flattening of the eye 
 and the cure thus effected are reported in a medical 
 journal of Bologna. 
 
 Breaking up, dislocation, and extraction of the 
 lens have all been practised in cases of conical 
 cornea, and it might be supposed that, in some 
 instances, the operation of extraction would have two 
 advantages; first, that of flattening the cornea by its 
 section (a possible occurrence), and secondly, the 
 lessening of the refracting power of the eye by 
 taking away that of the lens; these operations for 
 destroying or removing the lens in cases of conical 
 cornea, have sometimes been performed in the cata- 
 ractous or opaque state of the lenticular system, as 
 ■well as in its healthy and transparent condition. 
 
 It has been supposed that some patients would 
 see better through the outer part or side of the 
 cornea than through the middle of it, and hence a 
 
24 
 
 portion of the iris has been removed, so as to form 
 an artificial pupil opposite to some part of the cornea 
 less rounded than its conical prominence, and which 
 did not present irregularities on its surface; this 
 proceeding has been more or less successful with 
 different practitioners. 
 
 The thought suggests itself whether, after this 
 operation, in cases where the cone is very prominent, 
 a small opaque disk might not be advantageously 
 placed in front of it. It would be easy to make a 
 dark point upon the middle of a spectacle glass, and 
 then gradually extend this until the annular eclipse 
 of the glass attained its most advantageous degree; 
 after this the light would mainly fall upon the outer 
 and less altered part of the cornea. 
 
 In some rare instances, both artificial pupil and 
 removal of the lens have been practised, so as to do 
 away with the refracting power of the lens, and at 
 the same time, to admit light through a less conical 
 and less refracting part of the corneal tunic. 
 
 It would, perhaps, be quite fair to say that, in the 
 majority of cases of conical cornea, hut little benefit 
 will be derived from internal remedies alone, and 
 perhaps not much from topical applications, if we 
 except the mechanical agents for producing pressure. 
 
25 
 
 It is obvious that, before proceeding to surgical 
 operation, the different forms of optical contrivance 
 should be resorted to, and their various combinations 
 carefully tried when the more simple ones fail to 
 assist vision. 
 
 Of surgical operations, puncturing the cornea 
 is the most simple, and least dangerous, and if, when 
 once, or oftener done, it should not succeed, it is 
 probable that the eye may not be damaged by the 
 attempt; the chances of its success seem to be 
 increased by the subsequent and continued applica¬ 
 tion of pressure. 
 
 In some cases corotomia offers a prospect of 
 success, and if practised by way of the cornea, it is 
 evident, that to select a part of this tunic, which 
 seems by virtue of its position, form, state of surface, 
 and comparatively healthy aspect, to favour our plan, 
 is a consideration of no small importance. 
 
 It is to be feared that in most cases it would be 
 very difficult, by the practice of any incision or 
 excision, to cut away, or to do away with the apex of 
 the cone. 
 
 In some rare cases of conical and transparent 
 cornea, of long standing, the lens having become 
 
 D 
 
26 
 
 opaque has been removed, and after this the patient 
 has not required cataract glasses, but has seen better 
 without them; here, operation on the lens is clearly 
 indicated, but any operation on the lenticular system 
 during its healthy state, although practised already 
 with some success, and recommended by high 
 authority, is less established by experience. 
 
 There is a work by Tome, of Bonn, on the tran¬ 
 splantation of the cornea, which may be consulted by 
 those who are likely to take interest in such a branch 
 of surgery. 
 
 The progressing or stationary condition of conical 
 cornea should be carefully considered before we 
 decide upon any plan of treatment to be applied to 
 it; and it is evident that this is more especially 
 requisite in cases where surgical operation is contem¬ 
 plated : otherwise, the success of the attempt might 
 be prevented by the subsequent march of the malady. 
 On the other hand, the importance of meeting the 
 disease by suitable remedies, in its early stages, is 
 not to be overlooked; and this remark is more espe¬ 
 cially applicable with regard to general or local 
 treatment, intended to arrest the affection in its 
 
 course. 
 
27 
 
 Two questions of great interest present them¬ 
 selves in connection with the origin of conical 
 cornea: one relating to this peculiar -condition as 
 now and then assumed by the eye of the child 
 in the womb; the other relating to its occurrence 
 at the various periods of extra-uterine life; to which 
 a third might be added, for the purpose of noticing, 
 in an especial manner, the fact, that conical cornea 
 most frequently attacks the young under or about 
 the age of puberty, or at that period of life when 
 minor defects in the form and refracting power of the 
 organs of vision are not unfrequently met with. 
 
 The eye, in the human embryo, is met with as 
 an opaque and rounded mass, in the earlier periods 
 of existence, when no distinction between sclerotica 
 and cornea can be made; but a line of demarcation, 
 shewing the junction of the two parts, is afterwards 
 produced, and subsequently the transparency of the 
 cornea gradually increases. 
 
 In the twelfth week of embryo existence, the 
 prominence of the cornea is relatively greater than at 
 any other period of intra or extra-uterine life; and, 
 after this time, it becomes gradually less, as Bischoff, 
 Gescheidt, Ammon, and Wimmer have observed. 
 
2S 
 
 At this period, also, the cornea is thick, and becomes 
 thinner as the epoch of parturition approaches. 
 
 It is not difficult to conceive how a disturbance 
 of the nisus formativus, an arrest of development, or 
 whatever else we may call it, may give to the new¬ 
 born child, and to the subsequent adult, an anatomical 
 condition which properly belongs to an earlier era 
 of being, by introducing, as it were, the embryo 
 type to a stage of existence behind the scene of 
 which it ought to have been left, and presenting that 
 as a morbid condition in the man which, at one time, 
 may have been a natural or normal state, during 
 intra-uterine life. The morphology of the human 
 being is not less interesting than is that of the 
 butterfly; and the march of metamorphosis may go 
 astray in either. 
 
 Anatomists have paid great attention to the 
 intra-uterine development of the eye, from the first 
 display of the ocular germ to the removal of the 
 pupillary membrane; but, relatively, a less amount of 
 attention would seem to have been given to its pro¬ 
 gressive growth, in the earlier periods of extra-uterine 
 life—from that primary condition in which this organ 
 is vacant, undirected, and feeble, to an after state 
 
29 
 
 of brilliancy and perfection—to describe which has 
 exhausted the efforts alike of physiologists and poets. 
 
 The twelfth week has been mentioned as an 
 interesting period in the intra-uterine development 
 of the eye; and the twelfth year, or an age not far 
 from this, now and then invites attention to important 
 changes in the advancing eye of the child. About 
 this period, and from it onwards to the age of sixteen, 
 that excess of promiuence in the cornea is most 
 frequently observed, which, in ordinary cases, requires 
 for its relief the employment of double concave 
 glasses 5 and the further progress of which might 
 lead on to conical cornea, the treatment of which 
 must be regulated by the form of the cone and by 
 the complications with which it may be associated. 
 
 'In the form and thickness of the cornea, in the 
 earlier period of life, we find anatomical conditions 
 of great interest, in connection with the gradual 
 occurrence of conicity of the cornea, as well as with 
 the curative process adopted by nature in the gradual 
 removal of opacity of the same structure; for it is 
 not difficult to understand how, in a case where the 
 thick cornea of a child has become opaque, after 
 inflammatory action, the subsequent and gradual 
 
30 
 
 thinning of the cornea may help the removal of the 
 white material from its structure; and a little further, 
 or a little too far progress, of the same action may 
 thin the cornea in such a way as to favour the occur¬ 
 rence of the conical shape of this part; for. although 
 it would not seem that the cornea is morbidly thin in 
 all cases where it is conical, it is not unreasonable to 
 believe that such a condition may sometimes exist; 
 and, what is more, it has, in a few instances, been 
 discovered in autopsies carefully made. 
 
 If conical cornea be met with as an error of 
 development of the eye, it is obvious that cases of it, 
 viewed in connection with their source, must be 
 move or less of the same nature, whether they occur 
 before or after birth, while those cases of this malady 
 which present themselves as direct or indirect conse¬ 
 quences of inflammatory action, or of any ordinary 
 form of ocular disease, must be regarded as belong¬ 
 ing to another variety. It is evident that this 
 distinction may have its use in a therapeutic as well 
 as in a pathological point of view; and hence the 
 importance of not considering our diagnosis of this 
 complaint as satisfactorily completed before the 
 phenomena of the malady have been sufficiently 
 
31 
 
 analysed to enable us to approach a solution of the 
 question here alluded to. 
 
 It is easily understood that opportunities for 
 making post mortem examinations of cases of 
 conical cornea must have been very rare; a few 
 nevertheless have been made, and hence important 
 information has been derived, relating not only to 
 the condition of the cornea itself, but also to that 
 of other parts of the eye, as well as to the optic 
 nerves, their commissure, the optic thalami, the 
 cerebral mass, and the cranium ; but anatomists 
 seem to have neglected in some measure the con¬ 
 ditions of the orbit, of the motor and sentient nerves 
 within it, as well as that of the ocular muscles; for, 
 with regard to the eye and the contents of the 
 orbit, it would be quite true, in the language of 
 Cicero, to say, that all the parts which enter into 
 the composition of the organ of vision, — 
 
 “ Habent quoddam commune vinculum, et quasi cognitione 
 quadam inter se continentur,”— 
 
 hence the importance of determining the precise 
 condition of all the parts when any morbid state, 
 which has been more especially recognised in one. 
 
32 
 
 has been found to disturb the harmony and actions 
 of the whole. 
 
 With regard to the thickness of the cornea in 
 the conical part, some writers have reported it to 
 be increased, others have seen it diminished, and 
 in one instance, recently published, the thickness 
 of the cornea was found equal, and unaltered 
 throughout; hence it is evident, that in this respect, 
 cases may vary, and it is not improbable, that 
 interesting points of difference may be established 
 by future observation. 
 
 Those irregularities on the anterior surface of the 
 cornea, which have been spoken of as distinct Jacettes 
 on its curve, reminding us of conditions observed 
 in the eyes of some insects, and which have been 
 thought to act like the planes of a multiplying glass, 
 giving a plurality of images, have been noticed only 
 in the living cornea. 
 
 It is said, that in some cases, alteration in the 
 position of the pupil takes place, — this aperture 
 passing nearer to one part or other of the greater 
 margin of the iris, travelling, as it were, in that 
 direction in which it may be best supplied with 
 light. 
 
33 
 
 This observation has been made during life; but, 
 if such a change should, or could occur before death, 
 it is easily understood that a soft and yielding film 
 like the iris, having lost its tonicity or contractile 
 power, while yet steeped in surrounding fluid, 
 would not lend itself very easily, in post mortem 
 examination, after the changes which evaporation 
 and exosmose may have produced, to the accurate 
 determination of that which was its previous position 
 and form. 
 
 Any observer, fortunate enough to meet with 
 a case in which conical cornea and eccentric or 
 displaced pupil co-exist during life, would do well 
 to determine, if possible, the time when, and the 
 order in which, these two morbid phenomena pre¬ 
 sented themselves; for, in such a case, the question 
 naturally arises,— Did the two come together, did one 
 precede the other, and if so, which was the first? 
 
 Disturbance in the nervous system, more espe¬ 
 cially in the system of the sympathetic, might 
 derange the actions of the iris, through the medium 
 of the ciliary nerves; and hence we can, without 
 difficulty, imagine an alteration in the position, form, 
 or size of the pupil; and it is quite as easy to 
 
 E 
 
31 
 
 understand that the same source of ocular disease 
 might also affect the membrane of the aqueous 
 humor, or the quantity of fluid which it surrounds; 
 and if, in this way, the aqueous humor should 
 become increased, alteration in the form of the 
 cornea might follow, to say nothing about the nutri¬ 
 tion of the cornea itself; for even this might partake 
 of the evil influences in question, which, although 
 easily concatenated with the pen, cannot so readily 
 be displayed with the scalpel. The main purpose 
 of the remark is nevertheless attained, if it be 
 understood that a displaced pupil, if discovered in 
 a case of conical cornea, is not of necessity a con¬ 
 sequence of the previously existing conicitv of the 
 cornea, but that it may have been coeval with such 
 conicity, or may even have preceded it. 
 
 In some of the congenital cases of conical cornea, 
 abnormal forms of the head have been also observed, 
 amongst which the conical or sugar-loaf cranium, 
 spitz-kopf of the German pathologists, seems to have 
 been the most frequent; but the antero-posterior, 
 as well as the upward elongation of the head, has 
 been met with, as an associated morbid condition. 
 
 In Cooper’s Surgical Dictionary, we find that 
 
35 
 
 “ Burgman saw a remarkable case, where the 
 cornea of both the eyes of a person who bad been 
 hanged, were so prodigiously extended, that they 
 reached down to the mouth, like two horns.” For 
 the spread of this case, the profession is indebted 
 to the “ Bisputationes” of Haller; and it has been 
 quoted by different authors in connection with 
 alterations in the form of the cornea, some of whom 
 have omitted to mention that it properly belongs 
 to the poetry of the subject. 
 
 As conical cornea, and conical cranium, have 
 been found in some instances to co-exist, it is 
 perhaps worthy of remark, that comparative anatomy 
 might be tasked to accumulate facts relating to 
 the relative forms of cranium and cornea, ’mid the 
 varying series of the animal kingdom. 
 
It is not improbable that some cases of couical 
 cornea, which first attract attention in early life, 
 may have existed for some time unobserved; this 
 is likely to happen more especially in the children 
 of the poor, or in those whose imperfect vision is 
 but little known, partly from the fact of their 
 eyes being less exercised on minute objects con¬ 
 nected with educational processes, than are those of 
 children in the higher classes, where, in reading, 
 writing, or drawing, defective sight is more readily 
 discovered; and it seems very possible, that here¬ 
 after the repeated and accurate observation of 
 conical cornea may tend to shew that it is more 
 frequently a congenital disease than has hitherto 
 been supposed; but in making this observation we 
 must not lose sight of the general truth, that the 
 cornea is often more convex in the earlier than it 
 is in the later periods of life, and that it is prone to 
 assume its greatest degree of convexity as the age 
 of puberty approaches; so that young people often 
 
37 
 
 complain of short-sightedness at this period of life, 
 who knew nothing of it before, and hence we 
 can easily imagine, that one additional step of 
 development might be sufficient for the production 
 of the conical form in the cornea; and thus a case 
 which would only have been one of ordinary 
 myopia easily remedied, had the forwarding of the 
 cornea stopped a little sooner, by its further pro¬ 
 gress becomes one of indistinct vision from conically 
 prominent cornea, requiring various appliances of 
 art, and sometimes admitting of hut very imperfect 
 relief. 
 
 In estimating the convexity of the cornea in 
 very early life, along with its refracting power, the 
 greater rotundity of the lens, and its proximity to 
 the iris, at this period, are not to he forgotten. 
 
 It is a well known fact that congenital diseases 
 of the lenticular system, now and then affect 
 several children born of the same parents, and not 
 unfrequently, several members of the same stock 
 in successive generations; and it is not improbable 
 that further observation will shew that a corre¬ 
 sponding truth prevails with regard to congenital 
 malformations of the cornea, or of the cornea and 
 
38 
 
 other parts at the same time. Ammon, in his 
 Zeitschrift, has a case in point, where several sisters 
 were alike horn with conical cranium, and conical 
 cornea; it is uot however said that their progenitors 
 suffered in a similar manner. 
 
 The previous remark may, in some measure, be 
 illustrated by the following observation : — 
 
 In the summer of 1852, two patients applied at 
 the Eye and Ear Institution, Rose Hill, at the same 
 time ; the one, a woman, of forty-four years of age ; 
 the other, her daughter, a young girl of twelve; both 
 were myopic in an extreme degree. The mother 
 stated that she had been troubled with extreme 
 shortness of sight ever since the age of five years, 
 and that her daughter was equally the subject of 
 this defect of vision at the same early period of life. 
 
 In both the iris was grey, and the pupil of 
 normal character; the cornea) were prominent, but 
 not conical, and whether or no there was any pecu¬ 
 liarity, or extreme rotundity of the lens, could not 
 of course be satisfactorily determined; hut the same 
 bi-concave glasses enabled both patients to see well. 
 
 Nevertheless, we occasionally find that conical 
 cornea is acquired after birth, and that in various 
 
39 
 
 ways; sometimes in connection with depraved health, 
 or disturbances of the general system; at others, in 
 connection with ocular complaints, or with conditions 
 that tell especially on the eyes. 
 
 The following cases of alteration in the form of 
 the eye, of conical cornea, and other morbid condi¬ 
 tions connected with it, may serve to illustrate some 
 of the previous statements : — 
 
 A young lady engaged as a governess, twenty- 
 five years of age, not complaining of any special 
 malady, but enjoying what might be called hut feeble 
 health, was attacked by small-pox, from which in a 
 few weeks she completely recovered; there was no 
 pitting of importance on the face, but the aspect of 
 the countenance was nevertheless very much changed 
 by the altered condition of the visual apparatus; the 
 eyes upon the whole looked goggling and prominent, 
 and the convexity of the cornea was remarkable, 
 and there was extreme myopia. In vain the patient 
 waited for a gradual alteration in these morbid con¬ 
 ditions; the new state of the eye continued, hut 
 the myopia was relieved by the use of concave 
 glasses. 
 
 There was no remarkable affection of the eyes 
 
40 
 
 during the progress of the eruption ; nothing to 
 suggest the thought that any deposit was taking 
 place within or behind the eye-hall, nor any thinning 
 of the ocular tunics; the cornea and humors retained 
 their transparency, the iris was active, the pupil 
 natural, and the retina had its normal sensibility. 
 
 Rowley has related the case of a lady, who, after 
 the effects of a severe parturition, became affected 
 by conical cornea in an extreme degree; the front 
 of the eye acquired a sugar-loaf shape, and the 
 defect of vision was not removed by any glasses 
 that could he met with. 
 
 In the following notice of a case of conical 
 cornea, in addition to the ordinary history of the 
 matter, we have an outline of some interesting 
 peculiarities, which characterised the patient during 
 life, while the details of the autopsy relating to the 
 brain, as well as to the eye, are such as might 
 be expected from the pen of Ammon ; suggesting, 
 as they do, the importance of attending in these 
 cases, not only to the condition of the cornea, hut 
 also to that of the other parts of the eye, as well 
 as to the state of the nervous centres, the cranial 
 and facial bones and cavities. 
 
41 
 
 “ Mr. B., a native of Switzerland, residing in 
 Dresden, 40 years of age, of nervous temperament, 
 with conical cranium, suffered from myopia in an 
 extreme degree, so that when he wished to see 
 objects at all distinctly, he was compelled to hold 
 them almost in contact with the eye, but always 
 a little to one side; he never spoke of his short¬ 
 sightedness, and invariably avoided any conversation 
 at all likely to lead to a notice of it. 
 
 “For many years (says the German Oculist) I 
 saw him daily, and observed an opalescent appear¬ 
 ance in the eyes, especially when they were quickly 
 moved; this frequent observation also convinced me 
 that both the corneee were conical. In 1846, Mr. B. 
 died of typhus, and after his death, through the 
 kindness of Dr. Hedenus, I was enabled to make 
 a careful examination of the head and eyes. 
 
 “The diameters of the eyes were greater than 
 usual; in form the visual organ somewhat resembled 
 that of the foetus, and both cornese were very conical. 
 
 “ The ocular muscles were attached to the sclero¬ 
 tica, farther back, or farther distant from the cornea, 
 than usual, and this was the more remarkable from 
 the great advance of the front of the eye, which was 
 
 F 
 
42 
 
 helped forward by the prominence of the cornea. 
 The left sclerotic being divided, it was found to be 
 very thin, and less resisting than natural. 
 
 “ The crystalline capsule had its normal form and 
 transparency; its two portions, at their approximated 
 borders, were united less closely than usual, and 
 the connection with the ciliary processes was less 
 regular than is generally seen; viewed with a 
 lens, the capsule had not a polished, but a serrated 
 appearance. 
 
 “ The fibres of the musculus orbiculus capsulo- 
 ciliaris, had received but a feeble development. 
 The liquor Morgagni was abundant, and of normal 
 , character. The peristoma Doelliugeri was fully 
 developed; the pigment of the uvea, of a deep 
 black colour, was removed, as if it had been a distinct 
 membrane. On the posterior aspect of the uvea, 
 a great number of nerves, entering its parenchyma, 
 could be seen coming from the ciliary processes. 
 The choroid was of a chocolate colour The 
 circle of the ciliary processes seemed to have 
 undergone a slight displacement. The corona 
 ciliaris appeared to be a little retracted, without 
 pigment, and as if withered. The retina was very 
 
43 
 
 thin, and marked by a great number of folds; 
 there was no central foramen, on either side; but 
 the yellow spot was largely developed. The ciliary 
 ligament was very thick, and very broad. The 
 anterior surface of the iris was marked by elevations 
 and furrows, such as are seldom seen; and, along 
 with the thick ciliary ligament, which was as broad 
 as the iris, produced a very remarkable appearance. 
 There was nothing peculiar on the anterior surface 
 of the cornea. A vertical section was made of the 
 right cornea, which was found to be regularly solid, 
 and not thicker near to the sclerotic margin than at 
 the apex of the cone. Both the cornea and sclerotic 
 were thinner than usual. Before the right cornea 
 was divided, its conicity was very great, almost 
 pyramidal. This form vanished as soon as a section 
 of it was made; but even now, the preparation, kept 
 in alcohol, shews that the cornea is every where of 
 equal thickness. In both eyes the membrane of 
 Descemet was plicated vertically, as well as trans¬ 
 versely; the folds very much resembling those so 
 readily assumed by the isolated crystalline capsule. 
 The substance of the brain was normal, but its form, 
 like that of the head, was not. The brain was very 
 
44 
 
 like to one previously met with, in which the optic 
 thalami were diseased, and along with which the 
 patient had suffered from deformity of the head, 
 amaurosis, and congenital conical corneae. A notice 
 of this brain, with a representation of its base, has 
 been published in the “ Klinische Darstelluugen” of 
 Ammon. 
 
 “The optical portion of the brain was very much 
 developed. In front of the commissure, the optic 
 nerves were very broad; traced from the eye, they 
 met in the commissure, at a very obtuse angle; 
 behind the chiasma, the nerves were found beneath 
 the large thalami, imbedded in a thick mass of 
 cerebral substance.” 
 
 In the preceding case, although the anatomical 
 or objective characteristics are given, the physiolo¬ 
 gical or subjective phenomena are in great measure 
 wanting. In the following case, extracted from the 
 “ Zeitsclirift ” of Ammon, the two groups of pheno¬ 
 mena, to a limited extent, are placed side by side; 
 and the case has some features of peculiar interest, 
 amongst which is the co-existence of conical cornea 
 and conical cranium, along with an opalescence in 
 
45 
 
 the depth of the eye, resembling more or less that 
 observed in the case last related. 
 
 A young man, twenty-one years of age, had 
 conical cornea; the affection was supposed to have 
 been congenital; the patient had also a small and 
 conical cranium. At sixteen years of age he began 
 to learn the business of a tailor, hut was compelled 
 to relinquish it, after five years, on account of extreme 
 short-sightedness ; the right eye was the worst of the 
 two, with it distant objects were not seen at all, near 
 ones with difficulty; double vision, or something- 
 more, was complained of—two things for one, three 
 for two, and five for three were seen. The cornea 
 presented no opacity, but in the depth of the eye, an 
 opalescent appearance, more especially in sidewav 
 view, was observed; this appearance, however, was 
 less marked in the left eye, which had less of conicity. 
 
 Seiler, in his valuable work, entitled, “Beobach- 
 tungen urspruenglicher Bildungsfehler und gaen- 
 zlichen Mangels der Augen,” published at Dresden, 
 in 1833, gives the observations made by Professor 
 Jaeger, of Wurzburg, on the post mortem, examination 
 of a case of conical cornea, in which both eyes were 
 affected; this account, which for some time was the 
 
 G 
 
46 
 
 only pathological record of the kind, has many points 
 of great interest, connected, not only with the impor¬ 
 tant minutiae of its morhid anatomy, hut also with the 
 previous blindness of the patient, and the failure of 
 art in attempting to afford him relief; it may be 
 reproduced as follows: 
 
 “The right eye and the optic nerve entering it 
 were in normal condition; the cornea was driven 
 forward by slight pressure. The anterior part of the 
 sclerotic and the cornea were separated from the 
 choroid. There was no cicatrix found on the inner 
 surface of the cornea; the membrane of Decemet 
 was not thickened, and as usual could be separated 
 in small transparent flocculi. The cornea, when held 
 between the fingers, was found to have a depression 
 in the middle, and this was surrounded by a well 
 marked and elevated margin; a section of the cornea 
 being made, its middle third was found to he not 
 more than one third the natural thickness, or about 
 that of fine writing paper, while the two other, or the 
 outer thirds, were much thickened; and this thick¬ 
 ening had taken place not in the outer, nor in the 
 inner, but in the middle lamella, the substance of 
 which was homogeneous. The thickening of the 
 
47 
 
 outer ring of the cornea was gradually lost in its 
 thinned central part, the latter, in size, corresponding 
 to a moderately dilated pupil. The choroid, the 
 yellow spot, and the ciliary nerves were in normal 
 condition; the retina was firm, presenting on its 
 outer surface several dark brown spots, produced, 
 apparently, by adhering portions of pigment, while on 
 the inner aspect of the somewhat thickened choroid, 
 dark spots were also observed, which did not seem to 
 belong to the normal condition of this surface. The 
 lens was healthy; the vitreous humour not perfectly 
 transparent, the streaks seen during life not obser¬ 
 vable, and the fossa in its anterior part undefined. 
 
 2. “ The left eye had been punctured with a view 
 to curative effect. In it, the following anatomical 
 observations were made:—The upper part of the 
 membrane of Decemet, and the inner lamella of the 
 cornea, were closely connected with the border of the 
 iris, and with the ciliary ligament; in its outer part 
 the cornea had more than its natural thickness; at its 
 central part, not more than half its natural thickness ; 
 the pupil was nearly closed; the uvea at the pupillary 
 margin adhering to the capsule of the lens; the 
 choroid and yellow spot normal; as in the right eye. 
 
48 
 
 the retina was firm, with brown spots on its exterior; 
 the vitreous humor perfectly transparent; the aqueous 
 humor was not more abundant than natural in either 
 eye; the lens was milk-white, with chalky-looking 
 points in it; it was also small and soft, so that some 
 portion of it seemed to be lost. Recollecting the 
 conditions which prevailed during life, the following 
 observations seem to be important: 
 
 “ The patient was 39 years old, of middle size, 
 and strong body, blind from his youth: he was not 
 aware of ever having suffered from inflammation of 
 the eyes, but from the age of 6 to that of 11 years, he 
 was much troubled by an eruption on the scalp; the 
 head square, broad, and of strong bony formation; 
 the forehead small, the right tuber frontalis and 
 arcus superciliaris stronger than the left; the eye¬ 
 brows strongly marked ; the eyes deeply situ¬ 
 ated in the large orbits, the fat within the latter 
 being in small quantity; the eye-lashes, especially 
 the upper, unusually long. Upon the whole, the 
 eye-balls have their normal structure and consistence. 
 The right cornea is evenly distended, and forms 
 nearly a hemisphere; the most prominent part of it 
 being, not at the middle, but a little below this point. 
 
49 
 
 Passing from above downwards, a slight and irregular 
 opacity is observed; the outer parts of the cornea are 
 perfectly transparent; the brown iris is somewhat 
 concave on its anterior aspect. The pupil is not 
 perfectly black, but has somewhat of a smoky 
 appearance; and after the widening of it the 
 partially darkened fossa of the vitreous humor is 
 seen through the lens; this fossa has an emerald 
 green appearance, with whitish and shining striae 
 passing from without inwards, as well as upwards 
 and downwards. The cornea of the left eye has 
 greater conicity; the convexity is tolerably regular, 
 from the outer towards the middle part of the tunic, 
 the highest point of it being placed a little above 
 the middle of the cornea; a little below the middle 
 there is an opacity stronger than that observed in 
 the opposite eye. The sclerotic, iris, and pupil 
 resemble those of the other eye; the deep-seated 
 striae are not observed; the eyes are unsteady in 
 their motions, resembling what we meet with in cases 
 of congenital cataract. In March, 1830, Professor 
 Jaeger punctured the cornea in the middle, with 
 Beer’s cataract needle, but without the least benefit 
 to vision. In July of the same year, the patient 
 
50 
 
 died of consumption, having previously suffered from 
 pneumonia and asthmatic attacks.” 
 
 In this case the blindness of the patient was so 
 complete, that he had never seen sun, moon, or 
 colour, and had no idea of the aspect of things 
 around him. In his tenth year he received a blow 
 on the sacrum, which was followed by epilepsy, the 
 attacks of which used to return once in eight or 
 ten weeks ; on this account he was occasionally 
 bled from the arm, and was in some measure 
 relieved by the venesection. 
 
 It is especially worthy of remark, that the patient 
 had previously lost a brother and a sister, both 
 born before himself, who were also blind from 
 
 their infancy ; the precise nature of their blind¬ 
 
 ness is not known ; they were probably amau¬ 
 rotic; but whether or no, they also had conical 
 
 cornea; or whether at the same time any abnor¬ 
 
 mal form of the cranium prevailed, we need not 
 attempt to surmise. 
 
 The three following cases are reported by Dr. 
 Wimrner, in the second volume of Ammon’s Oph¬ 
 thalmic Journal: Dresden, 1832. 
 
 In the first case the ocular disease affected one 
 
51 
 
 eye only, and was probably the consequence of 
 infantile ophthalmia, and was not accompanied by 
 any peculiarity in the form of the head; in the 
 second and third cases the disease was congenital, 
 accompanied by amaurosis, also congenital, and 
 associated likewise with flattened forehead, and 
 more or less conical or elevated cranium; in the 
 first case the patient had good vision with one 
 sound eye, in the other two blindness prevailed. 
 
 “John Frederick Hartmann, a boy, 13 years 
 old, from Kopenick, near Berlin, has now been 
 six years in the Waldheimer Orphan Institution, 
 and from infancy has suffered from malformation 
 of the right cornea ; along with this he had for¬ 
 merly feeble vision in the eye affected, but this 
 eye is now totally blind. 
 
 “I saw this boy (says the German Author,) 
 on the 4th May, 1832; his appearance was healthy, 
 his constitution moderately strong, and in his aspect 
 there was no marked characteristic of scrofula. The 
 cornea of the right eye was very prominent, reach¬ 
 ing beyond the margins of the eyelids. It appeared 
 to have attained a projection about three lines 
 greater than natural, the most prominent point cor- 
 
52 
 
 responding to the middle of the cornea. As is 
 often the case in hyperceratosis, the cornea had 
 a crystalline and opalescent appearance, especially 
 in side-way view. The upper and outer part of 
 the cornea presented a streak of opacity of about 
 a line in breadth, but the central part was perfectly 
 transparent. The iris appeared to be pushed a little 
 backwards, and shewed a few red points, as if from 
 the widening of its vessels, similar to what Chelius 
 in one instance observed. The pupil was somewhat 
 widened, and had the natural black appearance. 
 The patient did not complain of any pain in the 
 eye. It would seem that the boy has had this 
 disease from his earliest infancy; and Dr. Neuhof 
 reports, that within the last six years it has not 
 in the slightest degree changed, hence it is probable 
 that it has either been congenital, or that it has 
 followed an attack of ophthalmia neonatorum. Whe¬ 
 ther or no myopia prevailed previous to the extinc¬ 
 tion of sight, could not be ascertained. The left 
 eye is perfectly sound.” 
 
 It is worthy of remark, that, in this case, the 
 conical cornea is reported as being perfectly trans¬ 
 parent at the centre, although this centre had for 
 
5:3 
 
 some years projected beyond the margin of the 
 eye-lids ; such transparency could scarcely have 
 been preserved unless the patient had enjoyed the 
 power of completely closing the eye, or of sleeping 
 with the globe perfectly covered; hence it is probable 
 that although the apex of the cone might seem to 
 be in advance of the tarsal margins, that these, 
 in waking hours, were enabled to protect the organ 
 by their approximation in winking motions, as well 
 as to shield it by their continued closure during 
 sleep. 
 
 “ Charles Traugott Klosse, 11 years old, from 
 Friedricbswalde, near Pirna, (in the Blind School 
 of Dresden,) was born blind, and has a scrofulous 
 appearance, and in his fourth or fifth year suffered 
 from chronic ophthalmia, probably of a scrofulous 
 character. With the exception of a peculiar form 
 of the head, his bodily conformation is good. The 
 forehead is flattened, and the parietal and occipital 
 bones, as it were, pushed upwards and backwards 
 in an unusual degree; the parietal protuberances 
 being at the same time much elevated. 
 
 “ In both eyes the cornea has the peculiar 
 form and aspect which characterise hyperceratosis, 
 
 H 
 
54 
 
 advanced but to a limited degree, the forward 
 bulging or conical prominence of the cornea not 
 having more than one line of abnormal advance, 
 but the glancing brilliancy of the coues is very 
 remarkable. There is but little mobility in the 
 pupils, which are placed towards the lower and 
 inner part of the iris, the rim of which is narrow 
 here, and considerably broader at the upper and 
 outer aspect. On the nasal side the iris has changed 
 its natural blue for a brownish-yellow colour; this 
 being probably a result of former inflammation. 
 The iris and cornea are remarkably large in both 
 eyes; the latter, as well as the conjunctiva, being 
 in a state of irritation. There is no other case 
 of ocular disease in the family of the patient.” 
 
 “Augusta Schurig, 11 years old, from Rode, 
 near Grossenhayu, of rather weak constitution, but 
 otherwise healthy, and free from any appearance 
 of scrofula, was born amaurotic: she is very quick, 
 and intelligent, and says that she never suffered 
 from any inflammation of the eyes, which is corro¬ 
 borated by the corresponding statement of her 
 parents. In form, her head nearly resembles that 
 
55 
 
 of Klosse, the forehead being flattened, the parietal 
 regions carried upwards and backwards. 
 
 “ The prominence of the cornea is considerable, 
 not less than a line too much on each side, and 
 this is accompanied by that sparkling brilliancy 
 which is rarely wanting in cases of hyperceratosis. 
 There is but little mobility in the pupils, which 
 are carried somewhat to the inner or nasal side, 
 that of the left eye being also lower than natural. 
 In this little girl, the blue colour of the iris, at 
 its inner part, is changed for a brownish yellow. 
 (May this have been a result of inflammation?) 
 The eyes are deeply placed in the orbits, but in 
 addition to the above noticed morbid conditions 
 betray no abnormal characteristics. 
 
 “This patient has a younger sister, 18 months 
 old, suffering, as it would seem, from the account 
 of the parents, from amaurosis, and conical cornea; 
 conditions which followed an attack of ophthalmia 
 neonatorum ; four other sisters, as well as the 
 parents, are in perfect health, and without any 
 ocular complaint.” 
 
 In the following case, reported by Dr. Heyfelder, 
 in the fourth volume of Ammon’s Journal, we find 
 
5fi 
 
 a notice of peculiarity in the form of the head, 
 (flattened forehead,) along - with conical cornea, which 
 may have been congenital, although this condition 
 of the cornea could only he traced back to very 
 early infancy. Temporary improvement of vision 
 was afforded by dilatation of the pupil, and it is 
 perhaps not improbable that cylindric lenses might 
 have been tried with some prospect of further 
 success. 
 
 “ In a man from the neighbourhood of Mengen, 
 iu the Grand Duchy of Baden, 32 years of age, 
 of scrofulous constitution, and with forehead remark¬ 
 ably flat, the cornea presented that remarkable pro¬ 
 minence to which, by some ophthalmologists, the 
 name Hyperceratosis has been applied; while, by 
 others, the more suitable appellation of Conical 
 Cornea has been given to it; a third class having 
 preferred to designate it Staphyloma Conicum. 
 
 “ In the right eve the cornea had a sort of sugar- 
 loaf shape, the centre of the pyramid corresponding 
 to that of the cornea and pupil ; in the left eye 
 the cornea was less prominent, and, as to form, 
 might more conveniently be compared to a mole¬ 
 hill ; the central part being the highest point, as 
 
57 
 
 in the cornea of the opposite side. On both sides 
 the cornea was perfectly transparent, while the grey- 
 blue iris at its outer margin seemed to be pushed 
 towards the base of the corneal pyramid, and at 
 several points to he so closely connected with it 
 that the name Staphyloma Conicum might easily 
 have arisen from such anatomical conditions and 
 relations. Light acted but slightly on the pupil, 
 this aperture was nevertheless freely dilated by the 
 application of hyoscyamus ; otherwise partial adhe¬ 
 sions of the iris would have been suspected. Viewed 
 in front, both eyes looked as if opacities existed 
 opposite the pupils ; these were better seen when 
 the globe of the eye was moved by the finger in 
 the approximated state of the lids. Viewed side¬ 
 ways, the conical cornea had a sparkling, and, at 
 the same time, an opalescent appearance. In the 
 left eye the sight was not quite so bad as in the 
 right; nevertheless, at the distance of even six feet 
 the patient was unable to distinguish objects. To 
 see any thing distinctly, he placed it sideways, or 
 immediately under his nose, and vision thus exer¬ 
 cised was improved alter the employment of the 
 hyoscyamus drops. 
 
58 
 
 “ This ocular complaint had prevailed since the 
 earliest period of life. From his mother’s account 
 it would seem that he was not horn with it, for she 
 declares that it was produced by a violent fit of cough¬ 
 ing, which occurred during the time that lie suffered 
 extremely from hooping cough, iu his second year; 
 how far this is correct we need not attempt to 
 determine ; but it seems not unreasonable to sup¬ 
 pose that conical cornea might he produced during 
 the violent agitation of the system accompanying 
 a fit of hooping cough, as ivell as by those efforts, 
 strains, or screams, which are associated with uterine 
 actions in the progress of parturition, and which 
 are regarded by some as capable of giving rise to 
 hyperceratosis. 
 
 “ From the long standing of the malady, com¬ 
 plete cure seemed out of the question ; so that 
 the patient was merely advised to use the drops of 
 hyoscyamus, with a view to the occasional dilata¬ 
 tion of the pupil, hy the aid of which it was found 
 that, in his case, objects were a little better dis¬ 
 tinguished. 
 
 “ The anatomical examination of such a case 
 of conical cornea would be very interesting, for the 
 
59 
 
 purpose of discovering whether, and how far, the 
 lamellae of the cornea are affected ; and also for 
 determining whether any morbid condition of the 
 aqueous humour, or the want of this fluid, had 
 acted as a cause of the malady. In the case here 
 related, if the appearances were not deceptive, the 
 aqueous humour existed, but in very small quantity.” 
 
 In cases of conical cornea, it must generally 
 be very difficult, during life, to form any accurate 
 idea of the amount of aqueous humor which the 
 eye may contain ; for it is not unreasonable to 
 suppose that if the cornea were thin, as well as 
 conical, that the amount of aqueous humor might 
 occasionally be found greater than natural; while, 
 on the other hand, a cornea thickened, as well as 
 conical, might in some degree encroach on the space 
 which, in the normal state, the aqueous humor 
 would occupy. In post mortem examinations of 
 cases of conical cornea, this tunic has sometimes 
 been found unaltered as to thickness, at others 
 thicker than natural ; in some instances, thin at 
 one part and thick at another; but the most fre¬ 
 quently observed condition seems to be that in 
 which the cornea is found thin in the central part, 
 
60 
 
 or in that corresponding to the prominence of the 
 cone, a state more likely to he associated with 
 increase than with diminution of the quantity of 
 the aqueous humor; in connection with which 
 it is not unworthy of remark, that cases occasionally 
 present themselves where the practitioner requires 
 to pause before he allows his diagnosis to be com¬ 
 pleted, with the expression, conical cornea , on the 
 one hand, or with that of hydrops oculi, on the 
 other. 
 
 In the cases of conical cornea which have come 
 under my notice, in man, as well as in some of the 
 lower vertebrata, the aspect of the eye has favoured 
 the idea that the cornea was thinner, and the quan¬ 
 tity of the aqueous humor greater than natural; hub 
 the clear, crystalline, and dazzling look of the eye 
 has rendered it impossible to say positively at what 
 point, in the direction backwards, the cornea might 
 end, or where the aqueous humor might begin. 
 
 This observation is quite true with regard to 
 the following case of conical cornea, where the 
 cornea seemed to he thin anteriorly, or in the most 
 prominent part, as well as fully distended, by per¬ 
 fectly clear aqueous humor, hut, as elsewhere 
 
61 
 
 observed, the thickness of the affected tunic could 
 not be determined in any perfectly satisfactory 
 manner. 
 
 S. H., aet. 31, a tall and thin young woman, from 
 the vicinity of Manchester, consulted me on account 
 of an affection of both eyes, in September, 1852. 
 
 It was evident, even at first sight, that she 
 suffered from conical corneas, the sparkling aspect 
 of the eyes betraying this at once to ordinary obser¬ 
 vation. 
 
 She commenced the account of her sufferings 
 by saying that she had constantly “a worm” before 
 her eyes, or an appearance, as if a large worm were 
 nearly always moving or floating in a slanting 
 direction before her view, and that this appearance 
 was seen with both eyes, and also with the right, 
 or with the left eye alone, but most of all when the 
 left eye only was employed. 
 
 Her next remarkable statement was that her 
 vision was very imperfect, and as it were deceptive, 
 and hence it happened that she often made mistakes 
 as to her position with regard to things around 
 her; now aud then, for instance, supposing herself 
 
 I 
 
62 
 
 to be at the bottom of a flight of stairs, when, in 
 reality, she was some steps above the neighbouring 
 floor; and in this way, from time to time, she fell 
 so as to injure herself severely. 
 
 She is a young woman of moderately strong 
 constitution ; in earlier life her health was good, 
 the catamenia having commenced at the age of 15. 
 
 At the age of 19, a scrofulous affection mani¬ 
 fested itself on the neck and neighbouring parts, 
 where, from this age to that of 23, open scrofulous 
 sores existed, the cicatrised remains of which are 
 seen at present over the whole length of the right 
 sterno-mastoid muscle, in the lower part of the neck 
 immediatelv above the sternum, as well as beneath 
 the left ear. 
 
 At the age of 20 she received a severe blow 
 on the top of her head, from a piece of iron against 
 which she struck in mounting a stair, and to this 
 injury the ocular complaint was attributed; for, 
 about two months after the blow, she began to 
 suffer from severe pain across the forehead and 
 immediately above the eye-brows, with such sense 
 of weight that the head was frequently held down 
 and supported on the palms of her hands. 
 
63 
 
 In about three months after the commencement 
 of (he suffering in the head, the patient found that 
 her eyes were dim ; she was now blistered on the 
 temples and at the back of the neck, after which 
 the head-ache was lessened, but the dimness of sight 
 remained. The orbits are large, so that anteriorly 
 the eyes are far from seeming to fill them ; hence 
 there is a considerable space between the round 
 of the upper lid, where it rests on the somewhat 
 prominent eye-ball, and the arched border of the 
 orbit above ; an aspect in some measure remind¬ 
 ing us of the appearance not unfrequently pre¬ 
 sented by people with large facial bones, and who 
 have suffered from long-continued disease, which 
 has thinned the tissue or reduced the plumpness 
 of the soft parts. There are no marked vestiges 
 of ophthalmia in either eye. 
 
 A taper being held before either eye, its images 
 are distinctly seen; but appear very small when 
 the flame is opposite to (lie most conical part of 
 the cornea. 
 
 The “ phosphenes” are somewhat brighter in the 
 right than in the left eye. 
 
04 
 
 The conicity of the cornea, as before remarked, 
 was inferred from the glancing or sparkling bril¬ 
 liancy of the eyes, and on both sides the advance 
 of the cone was readily seen in lateral view of the 
 organ ; while, by more careful observation, it was 
 found that the most prominent part of each cornea 
 was a little to the left of its middle point; in the 
 left eye opposite to the outside, in the right eye 
 opposite to the inside, of a moderately widened 
 pupil, each prominence being at the same time 
 a little lower than the centre of its respective or 
 corresponding pupil. The appearances just noticed 
 were observed with the naked eye, with convex, 
 and also with concave lenses; but the apparent or 
 varying magnitudes were found to have the cor¬ 
 respondence which was expected. 
 
 The perfect clearness and lucidity of parts 
 observed in front of the iris, was not marred by 
 any opacity, nebulosity, trace of cicatrix, or vestige 
 of any previously existing morbid action, which 
 the .naked eve could detect; on the anterior surface 
 of the cornea perfect smoothness prevailed, and 
 it is probable, at least, that a surface equally smooth 
 existed behind. 
 
65 
 
 It is the more important in cases of conical 
 cornea to attend to these details, as closely as pos¬ 
 sible, inasmuch as some authors have supposed that, 
 in all instances of conical cornea, ulceration has 
 previously existed, a generalization which would 
 seem to have been based on particulars not suffi¬ 
 ciently numerous. 
 
 The only alteration of the cornea about which 
 we could be perfectly satisfied was that of form, 
 (iu the most prominent part it was perhaps thinner 
 than natural,) but this could not be determined in 
 a manner which would meet the demands of mor¬ 
 bid anatomy; the observation is equally true of 
 both sides. The iris had its natural position, and 
 betrayed no mark of disease, and the pupillary 
 motions were good; and although more or less of 
 myopia prevailed, the action and aperture of the 
 eyelids had not undergone any alteration worthy 
 of pathological record. 
 
 The function of the retina, as exercised in this 
 case under the altered conditions of the refracting 
 apparatus of the eye, is worthy of the greatest 
 attention, the main difficulty which the patient 
 
66 
 
 experienced being associated with the altered focus 
 of the visual rays, and the accompanying impos¬ 
 sibility of seeing any distant object clearly; hence 
 at times dangerous mistakes respecting the posi¬ 
 tion of things around her. 
 
 Near objects were better seen ; with both eyes 
 she read a few verses of a Bible in the small pica 
 type, at the distance of two inches ; at that of 
 three inches she read the same with the right eye 
 alone, but with the left eye alone she could not 
 distinguish the letters; at the same time that she 
 held the book with position and inclination which 
 favoured the function of the right or better eye. 
 
 Before closing the observations which relate to 
 the retina, the phenomenon of the worm, if so it 
 may be styled, will require a passing notice; here 
 two questions suggest themselves, the first. What 
 was it? the second, Whence was it? 
 
 With regard to the former we may remark, 
 that there is reason to think that it was mainly a 
 retinal, rather than a corneal phenomenon, belong¬ 
 ing to the class of muscae, with forms as various 
 as the Proteus of antiquity, but perhaps somewhat 
 better understood. 
 
67 
 
 In this case the appearance of the so-called 
 worm did not precede, hut followed the occurrence 
 of the conical cornea; but we must bear in mind 
 that marked head symptoms, with pains in the 
 neighbourhood of the orbits, apparently betraying 
 something of general disturbance in the eye, if not 
 in the head as well, were forerunners of the cor¬ 
 neal affection ; hence it is possible that a morbid 
 condition of the retina, as well as of the cornea, 
 may have prevailed at an early period in the history 
 of the disease, and that the muscse, now so much 
 complained of, may be a vestige of former disturb¬ 
 ance of the deeper parts of the eye; hut whether 
 in this view the retina should be alone noticed, or 
 whether at the same time the vitreous humor 
 or other part should be associated with it, as capable 
 by any morbid condition of giving rise to the 
 annoying phenomenon, we need not attempt to 
 surmise. 
 
 It is very probable that in any case where muscse 
 volitantes, arising from morbid condition of parts 
 at the back of the eye, are associated with remark¬ 
 able alterations of form in the refracting apparatus 
 
68 
 
 in front, that the trouble they will give rise to, 
 as well as the morbid state of the retina or other 
 part on which they depend, will not be lessened, 
 but rather increased, by abnormal refractions pro¬ 
 duced in the transparent media of the visual appa¬ 
 ratus ; to which observation we may add, that 
 although it is not probable that the altered form 
 of the cornea is the cause, in this instance, of the 
 muses we now attend to, instances may occur 
 where a cornea, altered in form, or in surface, may 
 present mechanical conditions that favour the resting 
 upon some parts of its exterior of tears, mucus, 
 or bubbles of air, separately or in combination, and 
 in this way may give rise to modified appearances 
 of muses, which would be spoken of as being of 
 anterior or corneal origin. 
 
 One of the most interesting considerations belong¬ 
 ing to this case is that which relates to its pri¬ 
 mary phenomena, and to the constitutional condi¬ 
 tions or circumstances associated with its beginning. 
 
 It is important to bear in mind that the patient 
 and her friends attributed the ocular complaint to 
 an accidental blow on the top of the head; but we 
 must recollect, at the same time, that for some 
 
69 
 
 months previous to this injury she had suffered from 
 strongly marked scrofulous disease ; and as conical 
 cornea has been repeatedly observed in connection 
 with the scrofulous condition, its occurrence in this 
 instance would not have been regarded as any 
 thing very extraordinary, even if the blow had 
 not been met with; at the same time we must not 
 rob the blow of its possible importance, inasmuch 
 as the supposition is not unreasonable, that a pre¬ 
 disposition to ocular disturbance, already existing, 
 or such disturbance, in any measure, having already 
 commenced, might be, in some degree, roused, or 
 helped on, by the external injury, now regarded as 
 an exciting cause. 
 
 There was nothing in hereditary or family asso¬ 
 ciations, nor in the mode of life, or occupations of 
 the patient, which requires to be noticed in connection 
 with the occurrence of conical cornea ; while, in 
 negative information, two observations are important— 
 first, that the disease was not congenital ; and, 
 second, that it did not occur at that early period 
 of life, say from twelve to sixteen years of age, 
 at which, relatively, it often happens ; lienee the 
 apparently greater importance of the constitutional 
 
 K 
 
70 
 
 conditions and morbid phenomena that prevailed 
 at the time of its origin. 
 
 In this case, it did not appear that any medical or 
 surgical treatment, general, local, or operative, would 
 be likely to exert any beneficial influence on the state 
 of the corueae; and inasmuch as it seemed probable 
 that the fault of refraction could be in some measure 
 corrected by optical contrivance, recourse to this was 
 evidently indicated; the artificial iris, the ordinary 
 concave lens, and the concave cylindric lens, were iu 
 turns tried ; when it was found, that all were bene¬ 
 ficial, but in very different degrees; the concave cylin¬ 
 dric lens being the instrument which afforded efficient 
 and surprising relief; for, with it, the patient could 
 at once read, at an ordinary and comfortable reading 
 distance, the book which the moment before was 
 brought close to the face when she attempted to read 
 with the naked eye. 
 
 In adapting optical instruments to cases of this 
 kind, it is absolutely necessary to be provided with 
 full sets of lenses, or other apparatus that may he re¬ 
 quired, otherwise the surgeon, or the optician, may 
 easily miss his aim; as, in these matters, trial alone 
 can determine what is wanted, by shewing that which 
 
71 
 
 answers our purpose ; and it is found that without the 
 practical application of the artificial iris, and of the 
 lens, or of both, we cannot at once say whether one 
 or the other, or a combination of the two, may in 
 any case answer the best; comparison of results being 
 the only means which enables us to arrive at a satisfac¬ 
 tory conclusion in this respect. Several lenses should 
 be tried, that the patient may compare the states of 
 vision produced by the aid of each, and all haste in 
 the trial should be avoided, and confusion from the 
 employment of numerous lenses guarded against, by 
 allowing a short interval of rest to the eyes, between 
 the laying aside of one and the exercise of the sight 
 with another. 
 
 At least four different forms of artificial iris should 
 be tried in these cases. 
 
 1. The flat disc of blackened metal, with a pu¬ 
 pillary opening in the middle ; when a couple of such 
 discs are mounted in spectacle frames, the apertures 
 in their centre should be capable of approximation, 
 or of separation, by the employment of sliding pieces 
 that carry the opening towards the inner or towards 
 the outer part of the spectacle circle or eye-piece, or 
 by the aid of a joint in the bridge of the instrument, 
 midway between the two eye-pieces. 
 
2. The same disc of blackened metal with a 
 transverse slit instead of a central foramen ; the discs 
 with the slit should be circular, and so placed in the 
 spectacle frame as to be capable of being easily turned 
 round, so that the slit if requisite may he placed 
 obliquely, instead of transversely; a position more 
 likely to suit the Mongolian than the Caucasian 
 eye, but which nevertheless may now and then be 
 found useful in the latter. 
 
 3. The small black cup of ebony, or other dark or 
 hard and blackened wood, the concavity to be turned 
 towards the eye, and with a pupillary aperture in the 
 centre; a couple of such pieces being fixed in ordi¬ 
 nary spectacle frames. 
 
 4. The same concavo-convex pieces of wood with 
 eccentric foramina, so that the pupillary aperture in 
 the wood may be tow ards the inner side, thus favouring 
 the convergence of the two eyes; but at the same time, 
 by turning, admitting of the aperture in either piece 
 being more outwardly directed. Combinations of the 
 artificial iris, with various forms of the ordinary con¬ 
 cave, or of the concave cylindric lens, if kept ready 
 for use, would now and then be found to render 
 important service to the surgeon, when he seeks to 
 
73 
 
 determine the kind of optical assistance by which 
 some cases of conical cornea are so remarkably bene- 
 fitted. 
 
 It is evident, that if in cases of this kind the 
 prominence of the cornea could be flattened in but a 
 very small degree, by any mechanical agency that 
 would not injure the surface of the tonic, such 
 flattening might at once lead to improvement of the 
 sight, which would be likely to continue as long as the 
 modification in the form of the cornea could be sus¬ 
 tained. 
 
 In the case just related a mechanical contrivance 
 was resorted to for the purpose of altering slightly 
 the form of the cornea, and in this way considerable 
 improvement in the vision was immediately produced ; 
 but as the instrument employed for producing the 
 effect had been previously contrived for another case, 
 and in it used with success, a notice of its mechanism 
 and supposed modes of action may better be given 
 along with an account of the remarkable case of 
 myopia to which it was first applied ; and to the 
 history of which we shall hereafter proceed. 
 
 In connection with the conical or prominent state 
 of the cornea, and with myopia, the function and con¬ 
 ditions of the eyelids are worthy of particular notice. 
 
74 
 
 Every one observes the tendency, iu short-sighted 
 people, to close, or approximate the eyelids when near 
 objects are viewed, and this shutting of the lids has 
 supplied the classical name myopia, as the designation 
 for the short-sighted condition; a name, which con¬ 
 tains no literal allusion to short sight, but points 
 literally to the movements of the eyelids by which 
 nature attempts, in some measure, to lessen or to 
 remedy this morbid state. By these actions of 
 the lids the more disturbing part of the light is 
 excluded, and at the same time it is possible that the 
 position, and even the form, of the eye, may in some 
 small degree be influenced by the backward pressure 
 which the organ feels from the more or less close and 
 firm contraction of the orbicularis muscle. 
 
 It may however he observed, that these efforts of 
 the eyelids are not commonly equal to the adequate 
 correction of the defect, which they, as it were, 
 instinctively seek to lessen; hence it has seemed 
 interesting, by observation and experiment, to have 
 found, that by making an artificial addition to this 
 action of the lids, we may, in many cases, com¬ 
 pletely remove the myopia, and this hy a contrivance 
 of a very simple character. 
 
75 
 
 If, in a case of extreme myopia, the outer can- 
 thus be drawn outwards and backwards, by applying 
 the end of the index finger upon the neighbouring 
 temporal integument, the lids, by such traction, are 
 somewhat approximated, and pressure is exerted on 
 the cornea, when it is not a little surprising to find 
 that the patient will often, all at once, declare that be 
 sees things at a distance with perfect distinctness, of 
 which be bad the moment before but an indistinct or 
 confused view, or which be perhaps could not see 
 at all. 
 
 This pressure may be kept up without any great 
 inconvenience, and for a considerable time, by a steel 
 spring, with a small round pad, a little larger than a 
 sixpence, at the end of it, the pad, lined with a soft 
 material, being placed upon the temporal integument, 
 which has been previously drawn back in the manner 
 above noticed. A point d'appui is easily given to 
 such a spring, by allowing it to pass downwards and 
 forwards, towards the can thus upon which it has to 
 act, from another spring encircling the fore-part of 
 the head, in shape like a horse shoe, and completed 
 by an elastic band carried round the occiput, so as to 
 form a kind of fixed and steady bead-band, upon one 
 point of which, more or less near to the parietal-pro- 
 
76 
 
 minence part of it, the end of the other may he 
 rivetted, so as to permit a little forward or backward 
 motion at the rivet joint. 
 
 The subject of the following very interesting case 
 had suffered from corneitis, and, in consequence, had 
 opacity of the left cornea, and alteration in the form 
 of the right cornea without opacity ; he was troubled 
 with very short sight, by which he was prevented fol¬ 
 lowing his occupation, this being one in connection 
 with which he could not conveniently use spectacles; 
 hence I was induced to attempt the mechanical con¬ 
 trivance just noticed, for the purpose of altering 
 slightly the condition of the eyelids, as well as the 
 position and form of the eye; this proved successful, 
 and by its aid the myopia was removed, and tem¬ 
 porary distinct vision obtained. 
 
 J. .T., aged 19 years, a young and robust sailor, 
 had inflammation of the eyes in early infancy, from 
 which, at this period of life, he was nearly blind during 
 three years; at the age of 14 he had the small-pox, 
 when his eyes again suffered, so that he was blind 
 during six days, but after his complete recovery from 
 the variola, his vision was found not to have been 
 impaired by this attack. 
 
 At the age of 15 he went to sea, and during the 
 
77 
 
 first year of his service his sight was equal to any 
 occupation then given to him ; but after a while, when 
 he was required to “ take the wheel,” he found that he 
 could not see the compass by lamp-light, in the night, 
 although in the day time it was visible to him ; hence, 
 in the night, he was induced to resort to the expedient 
 of steering by a star, which he selected and kept 
 steadily in view. 
 
 For the purpose of testing the state of his sight, 
 as well as with the view of supplying him with some 
 efficient means of relieving his infirmity, a series of 
 lenses were tried, and amongst these it was found that 
 the bi-concave and crossed cylindric glasses were of 
 greater service than others; these enabling him to 
 read a type which he could not see without them. 
 
 The following observations relate to the right 
 eye, to aid which, the instrument above alluded to 
 was made. 
 
 When the eyelids (but more especially the upper) 
 were drawn somewhat closely upon the eye-ball, so as 
 to make gentle pressure upon it, the upper lid at the 
 same time descending very slightly below the level of 
 the highest part of the pupil, (at this time rather 
 wide,) the vision was at once improved, so that tilings 
 
 L 
 
78 
 
 which appeared confused, the moment before, were 
 now distinctly seen. 
 
 When supplied with this instrument, the patient 
 tried his vision upon different objects, amongst others 
 upon a flower-pot and its contents, viewed across the 
 street; without the spring, he could see the flower-pot 
 in au indistinct manner, but with the aid of the 
 instrument, and the associated retraction of the lids 
 and their pressure upon the eye, he could see clearly 
 not only the flower-pot, hut also the plant and flower 
 it contained, and while viewing them spoke with 
 accuracy of their position, size, form, and colour. 
 
 Since the trial made with the spring, in the case 
 here related, the vision of other myopic patients has 
 been found to he improved by a similar application, 
 not, however, as far as I have yet seen, in so remark¬ 
 able a manner, saving in one other instance, where a 
 clergyman, very short-sighted, and always using a 
 glass for viewing the more distant objects around him, 
 was surprised to find the improvement in his vision 
 which was effected by the application of the spring. 
 
 As may easily he supposed, the effect requires to 
 he produced with great nicety; too little or too much 
 traction on the integument spoils the attempt; and iu 
 
79 
 
 more than one instance I have found that a slight 
 inclination upwards of the outwardly drawn canthus 
 has a tendency to improve the result. 
 
 It is to be borne in mind that an instrument 
 applied in the way we have noticed may act in more 
 ways than one ; that it indirectly causes a slight pres¬ 
 sure on the cornea we cannot well doubt; while it 
 may be remarked, that in cases of conical cornea, with 
 thinning of this tunic, a very slight pressure may be 
 capable of effecting considerable alteration of form, 
 which alteration might be of an unfavourable kind, 
 if exerted above and below the apex of the cone, and 
 too near to it; in other words, if it acted upon it in 
 such a manner as to produce additional advance in 
 the most prominent part. One mode of producing the 
 desired effect is to request the patient to close the eye¬ 
 lids with firmness, then, while they are so closed, to 
 put them on the stretch required, and next apply the 
 spring to fix them; the patient may now as it were 
 allow them to open with the least possible effort, when 
 their condition will be such that the amount of light 
 falling on the cornea will be limited by their approxi¬ 
 mation, while its refraction will be modified by the 
 altered curve of the tunic; and it is perhaps fair to 
 
80 
 
 regard these combined conditions as the source of the 
 improvement in vision, while the least fortunate part 
 of the matter is the fact that the spring must require 
 frequent removal, and lienee, as far as convenience 
 is concerned, is not to be compared with spectacles, 
 although it is capable of a longer and continued 
 application than might at first he supposed. 
 
 The sympathies of different, and often distant, 
 parts of the body frequently attract the attention of 
 medical practitioners, betraying, at times, the pro¬ 
 bable localities or modes of origin of disease; at 
 others, suggesting plans of treatment in accordance 
 with the special indications of the case. The sym¬ 
 pathies of the digestive tube and organ of vision, are 
 amongst the most interesting of the group here 
 alluded to; alterations in the conditions of the 
 former, are often the immediate forerunners of 
 serious changes in the latter; the dyspeptic, and 
 those who suffer from functional derangements of the 
 stomach and liver, not unfrequently seek relief for dis¬ 
 turbances in the eye, even while neglecting the morbid 
 state of the chylopoietic viscera, with regard to which 
 they are less apprehensive. Changes in the condition 
 
81 
 
 of the circulatory system of the digestive tube, are 
 frequeutly observed to tell remarkably on the eye; 
 sometimes being followed by impaired vision, at 
 others, by complete blindness. The sudden occur¬ 
 rence of haemorrhage, in an extreme degree, or the 
 suppression of haemorrhage which has for a long time 
 been periodical, returning, with more or less regular 
 intervals, from some part of the mucous surface of 
 the gastro-intestinal system, or from some neigh¬ 
 bouring division of the corresponding membrane of 
 the respiratory apparatus, belong to the occurrences 
 here contemplated. Cases of conical cornea capable 
 of being adduced as illustrations of the above remark 
 are of very rare occurrence ; in the following instance, 
 however, the associations alluded to seem to have 
 existed. 
 
 A. B., set. 27, a strongman, of sanguine tempera¬ 
 ment, was attacked, without any very apparent cause, 
 by iritis, in the left eye; the inflammatory action 
 was severe, with strongly marked redness of the 
 sclerotic vessels, as well as traces of red vessels 
 advancing towards the centre of the transparent 
 cornea; the proper organization of the iris was 
 rendered nearlv invisible by the reddish-brown 
 
 %j 
 
62 
 
 lymph deposited upon it, the pupil was irregular, 
 contracted, and fixed, and vessels containing red 
 blood were visible upon the iris; while this mem¬ 
 brane, with the aspect of considerable tumefaction, 
 looked as if it were pushed forward into the anterior 
 chamber; the photophobia was extreme. Venesec¬ 
 tion, six or eight times repeated, calomel, mercurial 
 frictions, and the local application of cold, were 
 resorted to, and in about ten days the good effects 
 of the treatment were obvious; immediately after 
 this favourable change, and when the eye could 
 bear a little light, so as to allow the separation of 
 the lids, and the careful observation of the organ, 
 it was observed that the cornea was much distended, 
 and its form already changed by a great accumula¬ 
 tion of perfectly clear aqueous humor behind it; 
 this, however, should be regarded as but one part 
 of a general distension of the eye-ball, which at 
 this time prevailed. The outer part, or ring of the 
 cornea, was for some time a little hazy, but the 
 central portion was clear, and in about three weeks 
 after the beginning of the iritis, the commencement 
 of conical cornea was observed, and in the course 
 of ten days the change in the form of the cornea 
 
83 
 
 was so remarkable, that, at the end of this time, a 
 completely conical shape was acquired ; the apex 
 of the cone being placed a little below the centre, 
 and slightly towards the inner side; the most pro¬ 
 minent part of the cone was evidently thin, and 
 was easily depressed, or bent under a light touch, 
 while the outer circle of the cornea did not appear 
 to have lost any thing of its thickness or strength. 
 At the time now contemplated, the patient had 
 completely recovered from his iritis; the deposit 
 on the iris had been absorbed ; the pupil was mode¬ 
 rately round and active, but drawn a little towards 
 the outer side ; there was no apparent morbid con¬ 
 dition of the lenticular system ; the retina did not 
 seem to have undergone any serious change, for 
 the sensibility to light was not complained of, but 
 in viewing objects the myopia was extreme; and 
 the cornea presented at the conical part such a 
 remarkable aspect of fullness, that the surgeon pro¬ 
 posed the puncture of this tunic, with the view of 
 lessening the distension from which it seemed to 
 suffer; to this operation, however, the patient did 
 not submit. Bi-concave glasses were afterwards 
 resorted to, and with benefit to vision. The right 
 
84 
 
 eye, at this time, was not affected by auy corre¬ 
 sponding' disease, but it bad formerly suffered from 
 pannus, and enjoyed but a limited amount of sight. 
 
 It seems peculiarly worthy of remark, that this 
 patient bad been constantly troubled with haemor¬ 
 rhoids during- more than twelve months, losing fre¬ 
 quently a considerable quantity of blood from them; 
 and, on recovering from bis iritis, be first related 
 this part of bis case, and remarked, that the bleed¬ 
 ing from the piles bad stopped somewhat suddenly 
 about a week before the iritis came on. 
 
 In the two following cases, we have illustrations 
 of disease of the iris, (perhaps rather of the mem¬ 
 brane of the aqueous humor) associated with pre¬ 
 vious disturbance of the cutaneous and fibrous 
 systems. 
 
 A man, 24 years of age, suffered from an 
 attack of acute rheumatism, which was accompanied 
 by iritis, and the iritis was followed by conical 
 cornea, displaying the brilliant eye and other 
 characteristics of the disease, without muscae voli- 
 tantes, or symptoms of amaurosis; with perfect 
 transparency of the cornea, and with normal con¬ 
 dition of the irides; but with extreme myopia. 
 
85 
 
 A man, 30 years of age, had a severe catarrhal 
 affection, which was accompanied by iritis; after 
 which, conical cornea, without opacity, followed, 
 with normal condition of irides, and without amau¬ 
 rotic symptoms, but with extreme myopia. 
 
 Attentive observation seems to lead to the con¬ 
 clusion, that internal ophthalmia, occurring in connec¬ 
 tion with various cachectic conditions, may sometimes 
 affect more especially, the membrane of the aqueous 
 humor, at others, that of the vitreous humor, while 
 in a third class of cases it may interfere more espe¬ 
 cially with the deep tunics of the eye, telling upon the 
 retina, the membrane of Jacob, or upon the choroid, 
 separately, or in connection; hence, in the first 
 class of cases, we may have aquo-capsulitis, or 
 iritis, as it is oftener called, and occasionally, 
 conical cornea, as a consequence; in the second, 
 synchisis, or, now and then, glaucoma; in the 
 third, choroiditis, or amaurosis; and hut too often, 
 various combinations of these morbid conditions. 
 
 Of the first class of cases, illustrations have 
 
 been already given, by virtue of which, conical 
 
 cornea might, as it were, be traced back through 
 
 aquo-capsulitis, to the general derangement of the 
 
 M 
 
86 
 
 system, in connection with which the ophthalmia 
 occurred; we may next proceed to interesting 
 illustrations of diseased conditions of the vitreous 
 humor, occurring in individuals who laboured under 
 a well-marked cachectic condition of body; of which 
 the following case seems to afford a curious and 
 valuable example. 
 
 P. B., aged 53 years, a man of middle stature, 
 who formerly enjoyed both good health and great 
 strength, applied to me on the 4th December, 1852, 
 saying that he was blind; that he could distinguish 
 light and dark perfectly well, but that he was 
 unable to discern the position, form, or outline, of 
 objects. During more than 30 years of his life, 
 or from the age of 17 to that of 52, he had been 
 much addicted to the drinking of ardent spirits; 
 rum was his favourite beverage, and if he make no 
 mistake in his confession, he frequently quaffed 
 more than a pint of this liquor, “ raw,” before 
 breakfast. Nevertheless, his health was good, and, 
 to use his own expression, the rum “always cleared" 
 his head, while ale, when he drauk it, made him 
 stupid. 
 
 About ten years ago his right eve suffered from 
 
87 
 
 an attack of inflammation, of the causes of which 
 he does not seem to have any available recollec¬ 
 tion ; and after this ophthalmia the sight of this 
 eye was permanently damaged, but the vision in 
 the left eye being good, the patient was careless 
 respecting the loss sustained in the other. He was 
 destined, however, to be roused from this careless¬ 
 ness, by disease attacking the left eye also, from 
 which he began to suffer about a fortnight before 
 he came under my notice, during which time, it 
 was, that the blindness above mentioned had 
 gradually come on, and that without any accident 
 to the eye, and without the occurrence of any pain, 
 or visible disease, of which the patient or his friends 
 could take cognizance. 
 
 The appearance of the patient accorded well 
 with what we understand by the expression “ hard- 
 worn;” it seemed to betray at once the results 
 of intemperance, and of toil, for in reality he had 
 both worked hard and drank hard; his aspect and 
 movements were those of a man not able to see 
 the objects which surrounded him. On examining 
 the eyes, the following interesting conditions were 
 met with. 
 
88 
 
 Right Eye.—In form, size, and degree of firm¬ 
 ness, this eye seemed to be very nearly in the 
 normal condition; but, at first sight even, it was 
 noticed, that the iris betrayed a tremulous movement, 
 such as is not observed in the healthy state of the 
 globe; and this phenomenon seemed to be, in part, 
 at least, accounted for, by the condition of the lens 
 aud vitreous humor; the lens was opaque, and hence 
 visible, and was seen floating behind the iris, in 
 the lower part of the posterior chamber, presenting 
 an appearance not unlike what is observed after 
 the dislocation of cataract, in cases where the vitre¬ 
 ous mass has been softened down, and lienee takes 
 no hold of the lens, which is pushed within it; 
 the oscillations, or trembling, of the iris, as well as 
 the undulations of the lens, seemed, probably, to 
 be connected with a condition of synchisis, or lique¬ 
 faction, partial, or complete, of the hyaloid body. 
 The opaque lens, spoken of as existing in the 
 posterior chamber, seemed to be rather the capsule 
 of the lens, than the lens itself, for it did not 
 present any thing of the lenticular form, but had 
 that appearance which may be easily supposed to 
 result from the approximation of the anterior and 
 
80 
 
 posterior portions of the opaque lenticular capsule. 
 The pupil was of moderate size, and was not in¬ 
 sensible to light; a taper being held before the eye, 
 only one upright image of it was seen; the lenticular 
 images, for reasons already obvious, being wanting. 
 
 Left Eye.—The observations relating to the 
 right eye apply equally to the left, saving that 
 which belongs to the opaque and dislocated lenticu¬ 
 lar apparatus, of which there was no visible trace 
 in the left eye. 
 
 In the right eye the lens had been dislocated, 
 and the remains of the displaced body were visible 
 in the opaque and floating structure before noticed; 
 whence the absence of the posterior images of the 
 taper in this eye; but a corresponding absence of 
 these images was also observed in the left eye, 
 although in this organ there was nothing visible 
 which corresponded to the opaque and dislocated 
 lens of the opposite side; whence it seemed probable 
 that the lens in the left eye was also displaced, 
 probably thrown down into the lowest part of the 
 posterior chamber, and being there at rest, and as 
 yet transparent, was not seen from the exterior; to 
 say nothing of the possibility of its being invisible 
 from some other peculiarity of position. 
 
90 
 
 That this was a correct view of the matter, was 
 rendered extremely probable by the fact, that, with 
 the aid of a convex lens, the patient was enabled 
 to see with either eye; and with both, saw so well, 
 that he could perfectly distinguish small objects in 
 a window across the street. 
 
 It is also to he borne in mind, that, in the eye 
 where the dislocated lens was not to be seen, that 
 its disappearance after dislocation might possibly be 
 due to its absorption; a process not unlikely to 
 occur to the lenticular apparatus when deprived of 
 its normal and vital connections, and which, in rare 
 instances, does happen to the lens while in situ, and 
 this without the interference of art. 
 
 In several cases I have met with, synchisis has 
 been observed in men long addicted to the drinking 
 of ardent spirits; in such instances it commonly 
 affects both eyes, but it not un frequently happens 
 that the vision of one eye fails long before that of 
 the opposite organ is complained of; and we also 
 find that such patients, in many instances, do not 
 seek surgical aid, until some change has taken place 
 in the lenticular system, on one or both sides, until, 
 in short, cataract, with, or without partial or complete 
 dislocation of the lens, has happeued, while it need 
 
91 
 
 scarcely be mentioned, that the prognosis in a case 
 of cataract associated with synchisis, must differ 
 considerably from that which would be given in a 
 case of simple opacity of the lens, occurring without 
 any previous change in the vitreous humor, or other 
 part of the eye-ball. 
 
 A previous remark, respecting the spontaneous 
 absorption of the lens, may be illustrated by the 
 following observation, which shews something of the 
 unaided vis medicatrix natures, in the cure of cataract 
 by the gradual removal of opaque material from the 
 lenticular apparatus; and the fact of the removal of 
 this opacity, is the more remarkable in this case 
 from having occurred, not in the ordinary or 
 healthy state of the system, but during the 
 prevalence of a severe illness by which the patient 
 was attacked some months after the occurrence 
 of the cataract. 
 
 F. T., aged 43 years, was struck on the left eye 
 by a small piece of iron, on the 12th April, 1852; 
 the cornea, at its lower and inner part, was wounded, 
 and the injury seemed to have extended to the iris; 
 for after the accident, the pupil was altered in form, 
 and drawn toward the injured part, and this change 
 
92 
 
 seemed to have been more an immediate consequence 
 of the injury, than an alteration produced by subse¬ 
 quent inflammatory action. On the 25th June, 
 when I first saw the patient, the lens was completely 
 opaque, and of a greyish-white colour; considerable 
 irritation of the eye as yet prevailed with con¬ 
 junctival injection, from which, however, with the 
 aid of ordinary remedies, he, iu a short time, com¬ 
 pletely recovered; the cataract, of course, still 
 remaining, with the pupil somewhat improved in 
 form by the use of belladonna. During some weeks 
 I had seen nothing of the patient, when on the 4th 
 November, 1852, he returned to me, and on exami¬ 
 ning the eye, I found the cataract cured as if by 
 operation; a crescentic and opaque portion, apparently 
 of capsule, being now observed at the outer and 
 lower part of the pupil, looking very much like the 
 condition often observed after the artificial breaking 
 up of cataract, all the other part of the pupil being 
 clear and black; vision had returned, and with the 
 aid of a cataract glass, the patient could see things 
 around him with the affected eye alone, and this 
 happy condition of matters seemed to have prevailed 
 during the previous week ; and iu connection with 
 
93 
 
 its probable cause, he stated that, in the previous 
 month of October, he had suffered from an attack of 
 “Typhus fever,” with considerable abdominal pain 
 and disturbance, but without suffering in the head', 
 and that he was confined to bed with this malady 
 from the 21st to the 28th of the month, but after¬ 
 wards recovered rapidly, and found also that his 
 previously lost sight was returning. It could not be 
 ascertained that he had taken, during his illness, any 
 remedy at all likely to affect the condition of the 
 eye, so that it is but fair to give nature the credit 
 of the spontaneous absorption of the opaque material, 
 which would seem to have disappeared during the 
 prevalence of the fever, more or less in the same 
 way that the superabundant fat of the body may 
 have done. 
 
 This case shews how the lens, or how portions, 
 or layers of the lens, may be spontaneously removed, 
 under the influences of morbid action telling on the 
 body generally, and. even induces the inquiry as to 
 the possibility of changes occurring in the form of 
 the cornea, by virtue of a loss of substance, which 
 may have taken place during some morbid or 
 cachectic condition of the system; in connection 
 
 N 
 
94 
 
 with which, a case previously noticed, may again 
 lie alluded to; where a remarkable alteration in 
 the form of the anterior part of the eye occurred 
 during the progress of a case of small pox, 
 —so that the patient, after recovery from the 
 variola, was compelled to wear a pair of spec¬ 
 tacles, which corrected the abnormal refraction 
 produced by the new condition of the transparent 
 parts of the globe. 
 
 The following is an interesting case of conical 
 cornea, evidently arising from inflammatory action:— 
 
 M. E., set. 16, a fine, healthy-looking young 
 woman, was born in Liverpool, but at the age of 5 
 years went to Egypt, where she remained with her 
 parents until the age of 10 years, residing during 
 most of the time at Cairo, where both she and her 
 mother suffered from ophthalmia. While in Egypt, 
 she says that her eyes were “ always diseased,” and for 
 a great part of the time, her suffering with them was 
 extreme, complete blindness now and then prevailing. 
 The left ophthalmia was much more severe than the 
 right; she was attended by two surgeons, one an 
 English, the other, a French gentleman; and says 
 that blisters were applied behind both ears, and that 
 
95 
 
 a small quantity of a white powder was for some time 
 blown into the left eye twice a day; she took a good 
 deal of medicine, hut never had her mouth particu¬ 
 larly affected by it; castor oil was for a long time 
 taken every morning, and collyria were frequently 
 employed. 
 
 Before she left Egypt the left eye had improved, 
 but on her voyage home, in the Oriental Steam Packet, 
 it got worse, and, on this account, after her arrival 
 at Southampton she was again under surgical treat¬ 
 ment; the left eye at this time was blind, and on 
 three occasions the extract of belladonna was applied 
 to the lids, hut without any effect on the sight. 
 
 The catamenia appeared at 14, and have been 
 regular ever since. The eyes are grey, with a very 
 slight admixture of blue; the right eye is healthy 
 and strong, so that she is able to read or sew, with 
 its aid, for a considerable time; but the feeling of 
 weakness occurring in the other eye, compels her 
 to lay aside such occupations sooner than she would 
 otherwise do. 
 
 The right eye being healthy, further remark 
 need not be made about it; so that the remaining 
 notice may be confined to the left, or diseased organ. 
 
96 
 
 When the eye-lids on both sides are closed, and 
 the eye-halls examined by the touch, it is easily felt, 
 even through the lids, that the left eye projects for¬ 
 ward farther than the right, whence, upon the whole, 
 the left eye feels larger than the other. The general 
 form of the cornea, as seen in lateral view, is that 
 of a truncated cone; the base, of course, corres¬ 
 ponding to the sclerotic margin of the cornea; the 
 truncated apex being opposite the pupil. The flat¬ 
 tening down of the point of the cone, has probably 
 been a consequence of ulceration and concomitant 
 inflammatory action, of which vestiges are seen in 
 the flattened part, which displays a whitish opacity, 
 or rather nebulous condition, through which the light 
 in part passes, saving at one little point, opposite 
 the lower part of the pupil, and not larger than the 
 head of a pin, where the opacity is of a dense white, 
 and where an ulcer may at some former time have 
 existed. This partial opacity near to the centre of 
 the cornea, as well as the flattening of this tuuic, 
 seems to prevent that glancing and brilliant aspect 
 which the conical cornea might otherwise have. 
 
 With the naked eye, there is no irregularity of 
 figure to he observed in the cornea, beyond what has 
 
97 
 
 been already alluded to, but with the aid of a 
 powerful lens, it is found that minute deviations 
 from regular curve are easily to be seen; these, 
 however, are not angular, but rounded, and are 
 doubtless the result of morbid action, as they are 
 greatest as we approach the nebulous part of the 
 cornea, and are much more remarkable than any 
 irregularity of outline which can be seen in the right 
 cornea, with the aid of the same magnifying power. 
 
 Upon the whole, the sclerotic has not so good, or 
 so white an appearance as that of the opposite side; 
 anteriorly, it seems slightly thinned, so that the 
 blueish appearance of the choroid, as seen through 
 it, is more visible than it should be; and .the line of 
 demarcation between this tunic and the cornea, is 
 less sharp and fine than that of the opposite eye, for 
 a sort of hazy ring, apparently derived, as it -were, 
 from the edge of the sclerotic, encircles the neigh¬ 
 bouring margin of the cornea. The conjunctiva 
 betrays the remains of former, and long-continued, 
 inflammatory disturbance, hence the lining of the lids 
 is much redder than that of the opposite side, while its 
 vessels are relatively large and tortuous, where they 
 correspond to the white of the eye. 
 
98 
 
 The pupil has its normal situation, and is of 
 medium size, and was soon widened by the applica¬ 
 tion of atropine; its ordinary inactivity being in 
 some measure accounted for by the little veil of 
 nebulous cornea placed before it. With the naked 
 eye the patient sees the light, but cannot see any 
 object, either in the ordinary, or in the artificially- 
 widened state of the pupil. 
 
 In the following case, conicity of the cornea 
 was the consequence of accidental injury, and sub¬ 
 sequent inflammatory action. 
 
 P. J., a man, jet. 34 years, was struck in the right 
 eye by a portion of percussion cap, which started from 
 the lock of a pistol, fired at the moment by a com¬ 
 panion, side by side with whom he was standing; 
 this occurred on the 14th of October, 1852, and now, 
 January 14th, 1853, the state of the eye is as follows. 
 A chronic ophthalmia of severe form prevails, the 
 conjunctival and sclerotic vessels are much charged, 
 so that the white of the eye is lost in the deep 
 redness which the sclerotic portion of the ball 
 displays; on the conjunctival lining of the lids a 
 deep red is also seen, and the photophobia is great, 
 although the vision of this eye is entirely lost. 
 
99 
 
 The lens is opaque, and the iris is driven forwards 
 by a partial dislocation of the crystalline body, while 
 the cornea has assumed a conical form, the apex of 
 the cone looking downwards, and corresponding to 
 a point opposite the lower margin of the pupil, at 
 medium dilatation. At the upper and outer part 
 of the cornea is a cicatrix, which followed a wound 
 inflicted at the time of the above-mentioned injury. 
 The pupil is oval, the long diameter passing from 
 the outer and upper to the inner and lower part of 
 the iris. 
 
 In any case, where the cornea has acquired the 
 conical form, and where this is the principal morbid 
 alteration observed, it seems fair enough to give the 
 name conical cornea to the affection; various dif¬ 
 ferences may, however, he easily observed between 
 cases that arise as consequences of severe, and, 
 perhaps, long-treated ophthalmia, and others that 
 occur, as it were, spontaneously, and without being 
 preceded by any form of ocular disease which has 
 attracted the attention of the patient; to which it 
 may be added, that the latter more especially cor¬ 
 respond to conical cornea, as described by most 
 writers on this subject, and it is not improbable that 
 
100 
 
 further observation and inquiry will lead to the 
 determination of well-marked varieties in this group 
 of ocular diseases;—whether these relate to the time, 
 and mode of origin of the malady, to the forms 
 assumed by the anterior part of the eye, to the 
 conditions of texture, surfaces, or connections of the 
 cornea, to the state of the iris and pupil, or to 
 that of the retina or vision, or to the organic or 
 functional derangements, general or local, by which 
 the complaint may have been preceded, or with which 
 it may be associated. 
 
 It is worthy of especial, and perhaps of repeated 
 notice, that conical cornea is not particularly confined 
 to any period of life; although it would seem to 
 occur much more frequently to the young than to 
 the old. As, however, it does present itself at ages 
 so various, and in circumstances so different, it 
 would he highly interesting to discover any one 
 common cause to which its origin could often he 
 referred. In connection with such considerations, 
 the following case, which came under my notice in 
 February, 1853, would seem to have a peculiar 
 interest:— 
 
 M. A. C., aet. 3 months, was attacked by ophthal- 
 
101 
 
 mia in the left eye when one week old, and at the 
 age of three weeks the right eye began to suffer in 
 like manner; purulent matter poured from both 
 eyes,—from the right eye during about three weeks, 
 from the left about two months; immediately after 
 the purulent discharge abated, opacity of the left 
 cornea was observed by the mother; this opacity is 
 now seen on the outer side of the cornea only; 
 while, on the inner side, the cornea presents a pro¬ 
 minent and remarkable cone, with a peculiar 
 glancing brightness, the apex of the cone looking 
 directly forwards, its base corresponding to the 
 inner two-thirds of the cornea, which portion looks 
 peculiarly clear, and, as if thinned, where it forms 
 the cone itself. The pupil is of moderate size ; 
 the eye-lids have regained their natural condition, 
 saving that, when closed, the forward bulging of the 
 cornea can be felt through them. The eye is 
 evidently not blind; but the nature or amount of 
 the vision cannot, of course, in such a patient, be 
 accurately determined. 
 
 We have here presented to our notice a well- 
 marked case of conical cornea, evidently the result 
 of ordinary infantile or purulent ophthalmia; a case 
 
 o 
 
102 
 
 in which, at one time, the eye was covered with 
 pus, with diminution, without doubt, of the trans¬ 
 parency of its corneal tunic, which afterwards is not 
 only altered in form, but, in a considerable portion of 
 its extent, has a more than natural brilliancy im¬ 
 parted to it. 
 
 If, along with the case just noticed, we call to 
 mind the account of others, previously related, we 
 cannot fail at once to see the connection which, in 
 some instances, conical cornea has with previously 
 existing ocular inflammation ; be this, purulent oph¬ 
 thalmia, as it occurs in the new-born child,—the 
 ophthalmia of hot countries, with peculiarities of soil 
 and climate, such as are met with in Egypt, where 
 the frequency of ocular disease is but too well known, 
 —or be it some form of scrofulous disturbance, with 
 accompanying inflammatory action, the bearing of 
 which on complaints of the eye need not be further 
 dwelt upon here. 
 
 In cases of conical cornea, following infantile oph¬ 
 thalmia, similar to that which occurred in the instance 
 just related, it is evident that alteration in the form 
 of the cornea follows morbid action which has pre- 
 viouslp existed on its anterior surface; and it is not 
 
103 
 
 unreasonable to suppose that in some instances the 
 alteration of form in the corneal tunic may follow 
 on morbid action from which its posterior surface 
 has first suffered, as in cases where this malady 
 appears to have been associated with conditions of 
 cachexia and of internal ophthalmia; it is obvious, 
 however, that the two corneal surfaces are very 
 differently situated with regard to facilities for accu¬ 
 rate observation, either during the progress of disease, 
 or after its consequences are established. 
 
 The appearance of the disease in this instance 
 reminded us of the interesting case related by Mr. 
 Middlemore, respecting which he says:— 
 
 “ I have seen one instance of this affection occur¬ 
 ring only very partially, for the conical portion of 
 the cornea was only as large at its base as the plane 
 surfaec of a small split-pea; it existed at the lower 
 part of the cornea, resembled a small and extremely 
 conoidal portion of beautifully-transparent glass 
 placed upon the surface of the cornea, and occasioned 
 great confusion of sight from the unequal refraction 
 of the rays of light. The appearance of the disease 
 was extremely singular, and exhibited the nature of 
 
104 
 
 the affection in a manner which could neither be 
 mistaken nor misunderstood.” 
 
 In the one case, the cone was raised on the inner, 
 in the other, on the lower segment of the cornea; 
 in the first instance the alteration of form was pre¬ 
 ceded by inflammatory action, in the second, it does 
 not appear that previous inflammation had been 
 observed. 
 
 Cases of conical cornea in which the base of the 
 cone rests upon some part of the cornea, the 
 remainder of the tunic not being affected by the 
 abnormal elevation, appear to be worthy of particular 
 notice; for some authors have asserted that the 
 malady is nearly always observed in both cornece, 
 while instances such as the above-mentioned com¬ 
 pletely show that it may be confined to a part even 
 of one cornea. 
 
 The part affected may or may not correspond to 
 the centre of the cornea—in the cases just related the 
 elevation was away from the centre; but in another 
 case, not less interesting, related by Vidal, there 
 was seen a sort of nipple on the centre of the cornea, 
 clear and bright as crystal; the patient was an old 
 lady of 70, extremely myopic, and along with the 
 
105 
 
 conical corneae had cataracts, which were operated 
 on with complete success; and after the operation it 
 was found that for reading, which she had to prac¬ 
 tise in the teaching of children, she did not require 
 the aid of cataract glasses ; on which account the 
 case has been noticed by some writers as favourable 
 to the theory of Sir Wm, Adams respecting the 
 depression or breaking up of the healthy or diseased 
 lens, when the cornea in front of it is conical—on 
 the supposition that where the conical cornea refracts 
 the light so much, the additional refraction of the lens 
 only assists in confusing vision, which would there¬ 
 fore be better without the aid of the lenticular body; 
 the optical question connected with this matter may 
 be further noticed hereafter. 
 
 Conical cornea may not only follow disease of its 
 anterior or posterior surfaces, where the conjunctiva 
 or the membrane of Decemet have previously 
 suffered, but it may also be the result of morbid 
 action, which has first attacked the sclerotica and 
 afterwards the corneal tunic; of this statement 
 illustrations are occasionally seen amid cases of 
 ophthalmia associated with rheumatism in different 
 parts of the body, one consequence of which, now 
 
106 
 
 and then met with, is dropsy of the anterior chamber, 
 sometimes with rounded, at others with conical 
 prominence of the cornea. 
 
 A young theologian observed a bluish spot in his 
 right cornea; it gradually increased in size, and in 
 the course of fourteen days the same kind of aspect 
 was acquired by nearly the whole of this tunic; the 
 appearance was compared to that tint of blue which 
 is seen on milk whence the cream has been 
 removed ; the middle of the cornea had assumed a 
 conical form, the apex of which had more of the 
 blue appearance than was observed in the surround¬ 
 ing parts, the greater part of the cornea not being 
 deprived of its transparency, nor the conjunctival or 
 anterior surface of its smoothness. There was a 
 small cicatrix of long standing on the cornea, but 
 no further morbid appearances; the iris and 
 pupil were in normal condition. It seemed that the 
 above-mentioned conical form of the cornea was the 
 result of inflammatory softening of its substance, 
 in consequence of which it was not able to w ithstand 
 the pressure exerted by the aqueous humor. After 
 the patient had used the ointment of red precipitate 
 during one month, the greater part of the cornea 
 
107 
 
 had regained its clearness, the conical form was 
 much lessened, and the vision had greatly improved. 
 This patient died several years afterwards of 
 hydrothorax; so that Fischer, the distinguished 
 ophthalmologist of Prague, who observed and 
 treated the case, speaks of it in his “ Klinischer 
 Unterricht,” as one in which a dropsical affection 
 of the eye preceded, although by a long time, a 
 corresponding affection of tire serous sacs of the 
 chest, by which life was extinguished. With 
 regard to this case further details are not given by 
 Fischer, but the patient is spoken of as a young 
 theologian in such a way as permits us to suppose 
 that he was probably a hard-working divinity 
 student, giving as little rest as possible to his eyes, 
 and thus allowing a constitutional tendency to tell 
 at an early period upon the condition of a delicate 
 and over-strained organ. 
 
 As cases of this kind, occurring to literary and 
 studious men, have a peculiar interest, from the 
 great efforts to which the eyes of such readers are 
 inevitably subjected, the following, so concisely 
 related by Lawrence, may here be added:— 
 
 “An old clergyman, who was the subject of this 
 
108 
 
 affection for nearly thirty years, was enabled to con¬ 
 tinue his duty in the pulpit with tolerable accuracy 
 to the time of his death, which happened when he 
 was about seventy. The apex of the cone had 
 become opaque in his case; the opacity was dimi¬ 
 nished by the solution of the nitrate of silver, and 
 he employed belladonna to enlarge the pupil.” 
 
 Here allusion might also he made to the old 
 lady operated on by Vidal; the patient was a school¬ 
 mistress by profession, and was of necessity much 
 employed in reading, if not in looking at various 
 and minute objects. 
 
 Every careful observer of diseases of the eye 
 must have noticed the apparent connection between 
 ocular complaints and derangements of the pelvic 
 viscera ; hsemorrhoidal affections, for instance, 
 frequently precede and accompany amaurosis ; 
 and the same malady is now and then met with 
 in conjunction with various pathological states of 
 the uterine system; and the occurrence of nycta¬ 
 lopia, or of other forms of partial or periodic 
 amaurosis, as a consequence of masturbation, which 
 has more than once come under my observation, 
 is not unworthy of particular notice in this place ; 
 
109 
 
 for it would not seem unreasonable to suppose 
 that any morbid condition capable of exerting an 
 important influence on the nutrition, vital state, 
 and function of the retina, might also tell on other 
 parts entering into the composition of the eye-ball; 
 so that the occurrence of conical cornea along with 
 continued inactivity or derangement of the uterine 
 system, need not be regarded as more extraordinary 
 than the associated phenomena already alluded to: 
 a statement which may be closed by the further 
 expression, that amenorrhoea and chlorosis have 
 been frequently observed as the forerunners and 
 companions of pellucid staphyloma. 
 
 It must also be borne in mind that in cases of 
 conical cornea, observers have often met with dis¬ 
 eased states of the retina, the symptoms of partial 
 amaurosis, accompanying, not unfrequently, the 
 physical characteristics of hyperceratosis; and we 
 have had opportunities of studying these complica¬ 
 tions of ocular disease along with marked derange¬ 
 ments of the pelvic viscera; instances of this kind 
 might lend themselves with some prospect of success 
 to the nauseating or emetic treatment, or to the 
 administration of chalybeate preparations, and better 
 
 p 
 
110 
 
 still, perhaps, to the employment first of the former, 
 and afterwards of the latter plan. 
 
 In cases where derangements of the pelvic viscera 
 have preceded the occurrence of conical cornea, or 
 where they are fouud to accompany this affection, 
 it is of importance to attend particularly to the state 
 of the head ; as in some instances, headache, with 
 fulness of the cerebral vessels, will be found to have 
 occurred before the patient suffered from any ocular 
 complaint. Mr. Lawrence mentions the case of “ a 
 young woman from the country, who laboured under 
 this affection,” and who “ had symptoms of conges¬ 
 tion in the head, which were relieved by cupping, 
 and the sight was assisted by using concave glasses.” 
 
 A case of conical cornea was observed by Arlt, 
 in a chlorotic girl of sixteen. 
 
 The following is another, which has been 
 described by the same observer. Mad 1 !® G. was 
 eighteen years of age in 1846, when her eye-sight 
 became so defective that the approach of amaurosis 
 was feared ; in the left eye, vision was very imperfect, 
 while that of the right was dazzled and confused, 
 and when the patient was first seen by Arlt, these 
 morbid conditions had been increasing during the 
 previous eight weeks. 
 
Ill 
 
 The cornea was perfectly clear and smooth, but 
 in advance of its true position; the centre of the 
 cone was a little above the mathematical centre of 
 the cornea, and slightly to its outer side; the cornea, 
 when viewed side-ways, reminded the observer of a 
 window-pane with a prominent, rounded, and move- 
 able piece, or whirl, fitted into it. There was no 
 opacity, and no apparent disease of the substance of 
 the cornea, no lacrymatiou, photophobia, pain, or 
 vascular injection. In reading, sewing, or viewing 
 near objects, the defect of vision was much felt, and 
 led to the occasional covering of the left eye ; never¬ 
 theless, with the left eye, near objects, although not 
 clearly seen, were better discerned than those at a 
 greater distance, but the organ was fatigued even 
 with but little effort. The patient had suffered more 
 than three years from chlorosis, and was without 
 doubt the subject also of tubercular disease, from 
 which she had already lost two brothers. A little 
 while before the occurrence of the ocular complaint, 
 the young lady suffered, during several weeks, from 
 a very severe facial neuralgia, which she attributed 
 to the influence of cold. Two years after the occur¬ 
 rence of the malady, the apex of the cone became 
 slightly opaque, and afterwards remained during 
 
112 
 
 three years with very little alteration ; there was no 
 apparent inflammation, and no loss of substance. 
 
 General treatment was thought more important 
 than local; well-regulated diet, bathing, and recrea¬ 
 tion were attended to, and preparations of iron were 
 on different occasions employed, and that for a con¬ 
 siderable time. 
 
 Amongst topical applications, laudanum, and a 
 weak solution of nitrate of silver, were employed. 
 The treatment was followed by some improvement; 
 the left eye became gradually more accommodating, 
 allowing the right to be longer used than before, 
 but the patient was not enabled to look at minute 
 objects for any considerable time. At three inches’ 
 distance, she could read the smallest print with the 
 left eye, and could distinguish her friends four paces 
 off, but not more; the general health was very much 
 improved. 
 
 Whether or no any optical contrivance was 
 resorted to in this case, with a view to the improve¬ 
 ment of vision, is not stated by the Bohemian 
 surgeon. 
 
 Various opinions have been entertained by different 
 writers respecting the influence of uterine affections, 
 
1 ] 3 
 
 such, for instance, as dysmenorrhma, on the produc¬ 
 tion or aggravation of conical cornea; some, such 
 as Juengken and Sicliel, thinking it great, while 
 others have been unwilling to attach any considerable 
 importance to it, or unable to discern the possible 
 connection of the two. 
 
 It may, nevertheless, be admitted, that certain 
 conditions of the uterine system do tell upon different 
 parts of the eye. Amaurosis is now and then met 
 with as a consequence of abortion and parturition, and 
 that in cases where it does not seem fairly attributa¬ 
 ble to the associated loss of blood. M. Sicliel has 
 described a peculiar form of ophthalmia, connected 
 with derangements of the function of the uterus; and 
 there lately came under my notice a young woman 
 who lost the left eye from a violent ophthalmia, fol¬ 
 lowing an exposure to wet and cold, which caused 
 suppression of the menstrual discharge, at that time 
 going on : in this case, the interruption of the uterine 
 function, had, doubtless, contributed to the severity 
 of the ocular complaint. 
 
 It is tolerably evident, therefore, that the retina 
 and conjunctiva may sympathise, if this expression 
 be permitted, with morbid and altered conditions of 
 
114 
 
 the womb ; and that the cornea should share in 
 such sympathy need not seem very surprising. 
 
 Here we may also mention the occasional occur¬ 
 rence of strabismus soon after conception, — its 
 prevalence during pregnancy, and its disappearance 
 after delivery,—as another illustration of the sympa¬ 
 thies, now and then observed, between the generative 
 organs and the apparatus of vision. 
 
 The occurrence of squinting, in the manner just 
 mentioned, is undoubtedly rare; hut other sympathies 
 of the organs alluded to are much more frequent; 
 for it must he borne in mind that amaurosis is often 
 observed as an association of the chlorotic, as well 
 as of the pregnant state; and that it may follow 
 excess, or sudden suppression, of the lacteal secre¬ 
 tion, or of the menstrual, leucorrhoeal, or lochia], 
 discharge. 
 
 The cases of conical cornea observed by Rosas, 
 occurred mostly in scrofulous girls under fourteen 
 years of age; and Andreae treated several cases of 
 this ocular malady in very scrofulous women, who 
 had suffered from syphilis long before the corneal 
 affection began. 
 
 Three cases, related by Pickford, and which were 
 
115 
 
 improved by the nauseating and other treatment, 
 were observed in women of the respective ages of 
 twenty-one, twenty-seven, and twenty-eight years. 
 
 The patient of twenty-one had suffered from 
 hysteria; the conical cornea affected the left eye 
 only, and was perfectly cured after twelve months’ 
 treatment ; but after the lapse of thirteen months 
 more, the malady again returned, and the treatment 
 was repeated with equal success. The patient of 
 twenty-seven was a sempstress, who had well-marked 
 conical cornea on the left side; after three months’ 
 treatment it was improved, the cornea having become 
 flatter ; in two months more, further flattening of the 
 cornea and general improvement had taken place, 
 and the patient could see better than before; fourteen 
 months after the commencement of the treatment 
 great improvement was observed. 
 
 In about five monlbs afterwards the malady 
 returned, and was again cured by the same treat¬ 
 ment continued during another year, after which the 
 patient was able to resume her occupation. These 
 relapses and second cures appear to me worthy of 
 especial attention. In the patient of twenty-eight, 
 the left eye was also affected; but the right did not 
 
116 
 
 appear altogether free from a tendency to the same 
 malady. 
 
 Chelius relates a case of conical cornea in a 
 young woman of twenty, which was improved by a 
 seton at the back of the neck, along with the admi¬ 
 nistration of purgatives, burnt sponge, and digitalis, 
 accompanied by the rubbing of iodine ointment on 
 the parts around the eye. Such report of the good 
 effect of an anti-strumous treatment in a case of 
 conical cornea, seems worthy of particular con¬ 
 sideration. 
 
 Congestion of the eye-ball or its appendages 
 may suddenly, or gradually, lead to alterations in 
 the refracting power of the eye ; in such cases, 
 changes in the form of the cornea may now and 
 then occur, and although conical cornea may hitherto 
 have been scarcely met with as arising in this way, 
 the cases of myopia that do present themselves are 
 not unworthy of notice, on account of analogies in 
 the chain of observation in which they may hereafter 
 be found as connecting links. 
 
 In a case related by Dr. Smith, a person sud¬ 
 denly became myopic on coming out of a cold hath. 
 An officer was attacked by the same ocular malady 
 
117 
 
 at the end of a troublesome ague (Revielle-Parise). 
 A lady who was excessively far-sighted, became near¬ 
 sighted during a severe attack of conjunctivitis, and 
 presbyopic again after recovery from her ophthalmia, 
 (Desmarres). A lady, mentioned by Mr. Tyrrell, 
 required concave glasses to relieve her myopia, while 
 suffering from granular lids, (W. W. Cooper.) 
 
 In such instances the humours of the eye may 
 have been altered in quantity or quality; but it is 
 also possible that the cornea may have been 
 influenced, either alone, or along with changes in 
 the retina, and other parts. 
 
 Whether myopia, or conical cornea, or other 
 affection of the membranes or humours of the eye 
 occur in connection with derangement of the general 
 health, along with any local or organic congestion, 
 or after the suppression of any recent or accustomed 
 discharge, or as an apparent consequence of any 
 debilitating cause, it is obvious that attention should 
 first be directed to the morbid conditions with which 
 the ocular malady is apparently associated, and that 
 the primary treatment should be planned accordingly. 
 
 Walther met with a case of conical cornea in 
 the right eye, after a severe attack of blepharoph- 
 
 Q 
 
118 
 
 thalmia, in a scrofulous man, twenty-one years of 
 age. The conical cornea was first noticed after the 
 affection of the eye-lids had existed two years; the 
 apex of the cone was of a greyish white, hut else¬ 
 where the cornea was bright aud clear. This apex 
 was a little away from the corneal centre, or towards 
 its inner and lower part. The iris was in normal 
 condition. The patient saw things, even distant 
 objects, “distinctly” (?) hut as if through a mist. 
 Geometric figures, triangles, or squares, he distin¬ 
 guished as such ; hut lines ruled nearly together 
 seemed to run into one another. The light of a 
 taper was seen to he surrounded hy prismatic colours. 
 The cornea had no sparkling aspect in any position 
 in which it could he observed. 
 
 In a case of right and left conical cornea, observed 
 by JSchon, both corneae sparkled like crystal, so that 
 the pupil could not he distinctly seen ; this aperture, 
 however, did not appear to he contracted, and the 
 mobility of the blue iris was retained. The patient 
 was a cachectic man, thirty-one years old, extremely 
 myopic from his childhood, afterwards amblyopic, 
 and next amaurotic, so that along with the conical 
 corneas, as observed by the Hamburg anatomist, but 
 
119 
 
 very little sight remained. In these conical corneae, 
 observed when of eight years’ standing, the middle 
 point of the cone on both sides was a little below the 
 middle of the tunic; the right cone was perfectly 
 transparent, but the left, at its apex, a little cloudy. 
 
 Such facts are in part opposed to the doctrine of 
 Sichel, who was of opinion that opacity was always 
 discoverable in the neighbourhood of the apex of the 
 cone; in connection with which, the two cases 
 observed by Lhommeau, in Berard’s Clinique, might 
 also be mentioned; in one of which the entire cone 
 was perfectly free from any trace of opacity,—a fact, 
 determined as well with the lens as with the naked 
 eye. 
 
 Here it may be observed, that, in many cases of 
 conical cornea, which are met with as results of 
 inflammatory action, the cornea is marked with 
 opacity of varying extent; this too, frequently affect¬ 
 ing the apex of the cone,— and that in some instances 
 the lenticular system does not altogether escape: of 
 this statement the following cases may be given as 
 illustrations. 
 
 J. W., aet. sixteen, a strong boy, with dark hair 
 and dark eyes, had no ocular complaint until the age 
 
120 
 
 of nine, when lie suffered from a severe attack of 
 small pox; the variolous affection was accompanied 
 hv inflammation of the left eye, which prevailed 
 more or less during about two mouths, and then left 
 the patient with conicity of the left cornea, and with 
 an opaque state of the summit of the cone, which 
 summit is a little below, and a little to the outer 
 aspect of the corneal centre. 
 
 'I he opaque part of the cornea seems thickened, 
 and the anterior chamber somewhat enlarged ; the 
 iris and pupil, as seen through the clear circumfer¬ 
 ence of the cornea, have their normal aspects, corre¬ 
 sponding well with what is seen on the opposite side; 
 but behind the centre of the pupil, a small cataract, 
 not larger than the head of a piu, apparently seated 
 in the anterior part of the capsule of the lens, is 
 seen. 
 
 J. H., set. sixty-six, a healthy man, had good eyes 
 and sight until the age of forty-six, when the right 
 eye suffered from inflammation, and ever since has 
 gradually got worse in its vision, so that at present 
 it is but of little use. 
 
 Disease of the left eye afterwards began, and 
 that at a time when he was engaged doing very fine 
 
121 
 
 work as a shoemaker. The conicitv of the left 
 cornea is remarkable ; its apex, central, sharp, and 
 opaque; red vessels also meander on the corneal 
 surface; there seems to be a little thickening of the 
 tunic at the central or opaque part, and the aspect of 
 the cornea as a whole, shows how small an amount 
 of deposit, or how trifling a degree of additional sub¬ 
 stance, on the exterior of the corneal centre, would 
 he sufficient to alter the spherical to the conical form. 
 
 W. IT., eet. thirteen, a healthy hoy, with dark 
 brown eyes, had scarlet fever in December, 1852; 
 ophthalmia, affecting both eyes, accompanied this 
 malady, and on recovery he was left with opacity of 
 the lower part of the left cornea, with a rather small 
 and apparently fixed pupil; the opaque part of the 
 cornea presents a conical elevation, corresponding to 
 the lower half of the affected tunic. But little vision 
 remains. 
 
 M. S., set. fifteen, a healthy-looking young girl 
 (in all except the aspect of her eyes,) suffered much 
 from ophthalmia, between the ages of ten and thirteen, 
 and at this period of life the accompanying trichiasis 
 rendered the evulsion of the cilise from time to time 
 necessary; the eye-lashes have now regained their 
 
J ‘22 
 
 normal condition, but the left cornea is conical, the 
 apex of the cone corresponding to the loner and 
 inner part of the cornea; the lower part of the 
 conical cornea is opaque; light is seen, but the 
 patient has no vision of objects. 
 
 When the eye is raised, the upper lid, being 
 stretched over the apex of the cone, gives a peculiar 
 appearance to the organ : the aperture of the lids in 
 this state is more or less triangular; the margin of 
 the lower lid represents the base of the triangle, — 
 the apex of the cone, over which the upper palpebra 
 is bent, divides, as it were, this eye-lid into two 
 parts, which i*epresent the other two sides of the 
 triangle. The right cornea presents no morbid 
 appearance; and the sight of the right eye is good. 
 
 W. G. D., aged thirteen months, was attacked 
 
 by purulent ophthalmia when three days old ; the 
 
 consequence has been an apparent flattening of 
 
 the right cornea, with opacity of its inner half, 
 
 and in the left eve a remarkable conicitv of the 
 ^ * 
 
 cornea. The base of the cone is less than the 
 cornea, and is placed a little towards its inner 
 and lower aspect. The apex is opaque, and 
 projects beyond the lids ; and there is a sort of 
 
123 
 
 inferior strabismus, by which the prominent cor¬ 
 nea is pressed upon the margin of the lower 
 lid, which is thus bent beneath it in a very 
 characteristic manner. 
 
 W. L, seven weeks old, had purulent ophthal¬ 
 mia within the first week after birth ; the 
 central part of the right cornea is now conical 
 and opaque ; it is also softened, and the iris is 
 driven forward into the cup of the cone. As in 
 the last case, the affected eye is constantly di¬ 
 rected downwards, so that the cornea rubs against 
 the lower tarsal margin. 
 
 J. A., set. six years, suffered from puru¬ 
 lent ophthalmia ; the left eye was attacked on 
 the third day, the right on the tenth day after 
 birth. At five weeks old, an eruption on the 
 scalp appeared, and henceforth the ocular inflam¬ 
 mation diminished, and soon vanished entirely. 
 From exposure to cold, at the age of twenty- 
 nine months, he had another attack of inflam¬ 
 mation in the eyes, which continued during fourteen 
 days ; again an eruption of the scalp appeared, 
 and again the ophthalmia immediately abated. 
 The first eruption on the head prevailed during 
 
121 
 
 eighteen months ; the second and last continued 
 twelve months ; and during both these periods 
 the general health was good ; and it is so at 
 present. The eyes are very sensitive to im¬ 
 pressions of damp or cold, — becoming suffused 
 and injected from very slight causes of this 
 kind. Both cornese are conical ; the cones are 
 tolerably central, and their apices are affected by 
 a barely visible trace of opacity, or rather ne¬ 
 bulosity, which, in the left eye, is discerned 
 with less difficulty than in the right. The 
 images of a taper held before the eyes are very 
 small ; the iris and pupil, on both sides, ap¬ 
 pear normal, phosphenes would seem to be good, 
 and the retinae apparently sound ; when re¬ 
 quested to look at a printed page, the little 
 patient places it about two inches in front of 
 his eyes ; but his mother reports that his or¬ 
 dinary way of looking at small objects is bv 
 holding them somewhat to the outer side of his 
 right eye. 
 
 As far as the form of the cornea may be 
 concerned, it is worthy of remark, that, amongst 
 the consequences of ophthalmia in new-horn chil- 
 
125 
 
 dren, we see—1, the cornea unaltered as to 
 
 form ; 2, irregular prominence of the cornea ; 
 
 3, spherical prominence of the cornea ; 4, co¬ 
 nical prominence of the cornea ; 5, flattening of 
 
 the cornea ; 6, extreme flattening, sinking, or 
 
 depression of the cornea ; all of which are 
 at least worthy of mention in this place : for, 
 although some of these alterations are more fre¬ 
 quently associated with staphyloma than with 
 transparent and conical cornea, we now and then 
 amongst them meet with cases of transition, as 
 it were, where the one form of disease seems 
 to pass into, or to be blended with the other. 
 
 G. 5$., cet. thirty, a heallhy-looking man, has 
 conicity of both corne®, with opacity of the apex 
 of the left cone, and a very slight degree of 
 
 haziness on that of the right ; the malady is 
 
 attributed to an attack of ophthalmia, from which 
 the patient suffered when ten years of age. 
 
 There is a roughened surface on the fore part 
 of the left cornea, looking like a result of ulce¬ 
 ration ; the pupils are in normal condition ; 
 and the sight of the right eye is much im¬ 
 proved by a concave cylindric lens. 
 
 R 
 
120 
 
 E. C., set. twenty, lias lost the tarsal margins 
 of both eye-lids, on the right side, by an uncon¬ 
 trollable, or at any rate uncontrolled, ulcerative 
 process, which followed a “ stye ” on the upper 
 lid, from which she suffered at the age of 
 thirteen. The conicity affects the lower part of 
 the cornea, the prominent portion of which has 
 become hazy; and red vessels run towards it 
 from the neighbourhood of both cauthi. In this 
 case, the conical cornea was an indirect result 
 of irritation and inflammatory action, associated 
 with palpebral disease, which does not seem 
 to have been connected with any other local 
 ailment, or general morbid condition of the 
 economy. 
 
 J. L , a man, aet. sixty-five, had measles at ten 
 years of age, and “ weak eyes ever after.” Both 
 corneae are conical ; the cones opaque and trun¬ 
 cated ; and the little vision which the patient 
 enjoys appears to take place through the upper 
 part of each cornea. The cones have evidently 
 been truncated by the ulcerative process, both 
 displaying considerable irregularity of surface, ap¬ 
 parently due to this morbid action. 
 
127 
 
 A. C., ret. thirty, a female servant, had good 
 eyes until the age of twenty-two, when a feeling 
 of roughness occurred inside the left upper lid, 
 which was followed by severe general ophthal¬ 
 mia, whence an increased prominence of the 
 cornea, in an irregularly conical form — the 
 apex of the cone at the upper and outer part. 
 The opacity is most remarkable at the lower 
 and inner part of the cornea. There is sy¬ 
 nechia anterior — obliteration of the pupil — ex¬ 
 ternal strabismus — and total blindness of this 
 eye ; the opposite organ being sound and its 
 vision good. 
 
 By passing in careful review a great number 
 of cases of conical cornea, it will occur to the 
 observer, that this disease has at least two apparently 
 very different modes of origin : 1, Occurring without 
 any previously existing inflammatory action of 
 which the patient or his attendant has been able to 
 take cognizance, and most frequently in feeble, 
 cachectic, or impaired constitutions; in these cases 
 inflammatory action, and consequent opacity, may 
 follow the development of the disease, from irrita- 
 
123 
 
 tion produced by the eyelids in their active or 
 winking motions, more especially when the cone 
 has become very prominent; or by the atmosphere, 
 or other external agents, acting upon the advanced 
 and prominent corneal surface; the cornea in many 
 of these cases remains long transparent and bright, 
 and is now and then altered as to its thickness; 
 and the base of the cone, in its outline, may corre¬ 
 spond with the circumference of the cornea, or with 
 some lesser portion of its surface ; the. direction 
 of the cone being sometimes directly forwards, at 
 others inwards, outwards, upwards, or downwards. 
 
 2, Occurring after previously existing inflam¬ 
 matory action, acute or chronic, severe or barely dis¬ 
 cernible, of a part, or of the whole of the cornea, 
 with, or Avithout more extensive ophthalmia; often, in 
 patients who are otherwise healthy and strong, 
 the cornea, in many cases, more or less affected bv 
 opacity ; the apex of the cone often opaque, and 
 not unfrequeutly betraying the vestiges of former 
 ulceration in visible cicatrised spots; now and then 
 the cornea is considerably altered in thickness, while 
 the cone may vary in size, position, or direction, 
 as in the first class of cases. 
 
129 
 
 It is perhaps doubtful whether, in any case, the 
 cornea becomes conical without some alteration in 
 its nutrition, be this called perversion, diminution, 
 or excess; in other words, the change of form is 
 rather connected with a process of morbid growth, 
 than a mere result of distension. Along with this 
 observation, however, we must bear in mind the 
 fact, that in post-mortem examinations of conical 
 cornea, alterations of thickness in the affected tunic 
 have not always been met with; it might not there¬ 
 fore he amiss to remark, that if we entertain this 
 view respecting the altered nutrition of the cornea, 
 that the first class of cases may be spoken of as 
 instances of conical cornea from alteration in the 
 nutrition of this membrane without visible traces 
 of inflammatory action ; and the second class, as 
 cases of conical cornea, also from perverted nutri¬ 
 tion, but preceded or accompanied, or both, by the 
 visible phenomena of inflammation ; or, in fewer 
 words, cases of conical cornea, produced by keratitis, 
 or by some more widely spread form of ophthalmia. 
 After more numerous autopsies have been made, 
 it is not improbable that the apex of the cone or 
 part of the cornea most affected, may often be found 
 
130 
 
 thin in cases of the first class; while such atrophy 
 seems less likely to be observed in those of the 
 second class. 
 
 With regard to the first class of cases, it would 
 be highly interesting to determine, if possible, the 
 manner in which the nutrition of the cornea may 
 fairly he supposed to be perverted,—in connection 
 with which the thought suggests itself, that some 
 altered condition of innervation might here be taken 
 into account. 
 
 In the report of one case of conical cornea, 
 partly related at page 62, we have the remark, that 
 “ at the age of 19, a scrofulous affection manifested 
 itself on the neck and neighbouring parts; where, 
 from this age to that of 23, open scrofulous sores 
 existed, the cicatrised remains of which are seen at 
 present over the whole length of the right steruo- 
 mastoid muscle, in the lower part of the neck, 
 immediately above the sternum, as well as beneath 
 the left ear.” To suppose that the cervical ganglia 
 of the sympathetic may have been disturbed by 
 the progress of such morbid action, would perhaps 
 be allowed as a reasonable assumption, in connection 
 with which the results of experiments on these 
 ganglia may be named : — 
 
After removal of the superior cervical ganglion, 
 in dogs, it has been observed, that the secretion 
 of tears and mucus is increased, and that redness 
 of the conjunctiva comes on. 
 
 In the patient alluded to above, great suffering- 
 prevailed in the head during about three months 
 before the dimness of sight associated with conical 
 cornea occurred; whether or no this could be fairly 
 attributed to any morbid condition of the fifth cere¬ 
 bral nerve, cannot, of course, be very satisfactorily 
 determined; but it is well to bear in mind the fact, 
 that the division of this nerve, especially if practised 
 in front of the Gasserian ganglion, is soon followed 
 by “destructive inflammation” of the eye; such 
 considerations suggest at least the importance of 
 careful inquiry respecting the condition of the cere¬ 
 bral nerves, but more especially of those connected 
 with the eye-ball, or its appendages, in all cases of 
 perverted nutrition of the cornea. 
 
 Relating to this matter, Arlt has the following 
 observations, in his work on Diseases of the Eye, 
 which is now in course of publication : — 
 
 “ Fodera, Mayo, Majendie, and others, have 
 shown the influence of the nerves on the life of the 
 cornea; and in connection with this subject the 
 
132 
 
 results of the researches of Szokalsky, Longet, 
 and Pappenheim, may be briefly communicated : — 
 ‘ After the division of the Trigeminus nerve in 
 front of the Gasserian ganglion, sensibility in the 
 parts supplied by this nerve is first lost, and the 
 conjunctiva is deprived of feeling. The pupil is 
 extremely contracted, but does not lose its power 
 of alteration with the varying conditions of the 
 light. After a few hours the pupil becomes wider, 
 but still retains its mobility. On the second day the 
 cornea begins to lose its transparency, this change 
 being first observed at the centre ; while its 
 exterior surface retains its natural smoothness. 
 Examined anatomically at this time, the central or 
 most affected part of the cornea appears thicker than 
 natural, without any trace of new formation being 
 discoverable in its structure. If the animal on which 
 the experiment has been made be kept alive, about 
 the eighth or tenth day the cornea is milk-white, 
 and as if swollen ; the central opacity having 
 gradually spread towards the circumference until 
 every trace of transparency is lost. Anatomically 
 examined at these periods, the cornea is found still 
 more thickened, not merely from watery deposit, 
 
133 
 
 but by organisable granular exsudation. If the 
 animal live, the next remarkable change is a soften¬ 
 ing of the central part of the cornea, the con¬ 
 junctival surface comes off, and the cornea itself, 
 layer by layer, falls away ; next to the sloughing 
 of the cornea is the loss of the contents of the 
 eye-ball. When the morbid process, just traced as 
 occurring in the cornea after the division of the trige¬ 
 minus nerve, is carefully considered, it will be found 
 to differ materially from what we observe in inflam¬ 
 mation. Neither Dr. Pappenheim nor myself, amid 
 our numerous observations, could find anything like 
 lymph or pus globules ; granular exsudation and 
 the small detritus of fibres of the cornea were all 
 that we could find in the disorganized material or 
 remains of the corneal texture. It must also be 
 remarked, that when the division of the nerve is 
 practised between the Gasserian ganglion and the 
 brain, sensibility is lost, but the cornea retains 
 its transparency; whence it seems that the loss of 
 transparency and the destruction of the cornea, 
 depend in reality upon the destruction of the Gas¬ 
 serian ganglion, and upon that of the great sym¬ 
 pathetic nerve, which is closely connected with the 
 
 s 
 
134 
 
 ganglion as well as with the ophthalmic branch 
 of the third.’ ” 
 
 In his report of experiments made on kittens, 
 “ Forsog angaaende Virkningen af Extirpationen af 
 Gauglion cervicale supremum paa Diet,” the cele¬ 
 brated Danish physiologist, Hannover, has shewn 
 that after removal of the superior cervical ganglion, 
 the cornea is one of the parts in which pathological 
 effects may be observed. 
 
 In one kitten operated on when four days old, 
 the superior cervical ganglion was removed on both 
 sides; as well as two and a half lines of the neigh¬ 
 bouring part of the sympathetic nerve on the left 
 side ; on the sixth day after the operation the 
 wounds in the neck were healed, and on the four¬ 
 teenth day after it, ulceration of the middle of the 
 right cornea was noticed. 
 
 A contracted state of both pupils was another 
 remarkable phenomenon seen amid the effects pro¬ 
 duced on the kitten ; while, in another kitten, where 
 the same operation was performed on the right side 
 only, (the ganglion, with a line and a half of the 
 nerve, being removed,) the left pupil was found to 
 be widely dilated, but the right, or that on the 
 
135 
 
 opreated side, was contracted, not, however, in so 
 great a degree as were the pupils of the other 
 kitten. 
 
 “ Even in 1712, the effect produced on the nutri¬ 
 tion of the eye, as observed in the cornea, by dividing 
 one half of the great sympathetic, was shewn 
 in experiments practised on dogs by Pourfour du 
 Petit.” 
 
 The interest and value of some of these experi¬ 
 ments is perhaps not lessened by the fact, that nature 
 had performed them, after her manner, long before 
 the distinguished physiologists in question discovered 
 this method of interrogating her secrets. 
 
 In cases of disease of the temporal bone, such, 
 for instance, as now and then follow affections of 
 the ear, occurring during the progress of measles 
 or scarlet fever, the fifth cerebral nerve, the Gas¬ 
 serian ganglion, and the ophthalmic, superior, and 
 inferior maxillary nerves, passing from the front of 
 this body, may one, more, or all become involved 
 in the progress of morbid action; in such cases 
 I have watched the origin of remarkable alterations 
 in the cornea, which seems first to lose something 
 
136 
 
 of its sensibility, soon after which its anterior surface 
 displays a loss of substance, ulceration or absorption 
 of the part having occurred, all the while the cornea 
 may be transparent, and without vascular injection or 
 other well-marked sign of inflammation. Such were 
 the appearances in the case of a girl, 7 years of age, 
 and now under my observation. Nevertheless, it was 
 remarked, that after the above-named phenomena 
 had existed about two days, another set of appear¬ 
 ances presented themselves ; and these seemed to 
 depend on changes, occurring on the posterior surface 
 of the cornea, or in the membrane of Decemet, 
 which now lost its clearness, and became hazy and 
 dull, and at a point immediately behind, or corre¬ 
 sponding to the previously observed ulceration of the 
 cornea, an opaque deposit, apparently of pus, was 
 seen, rounded in form, and not exceeding the one- 
 eighth of an inch in diameter. 
 
 Upon the whole the conditions observed seemed 
 to suggest the idea, that along with the altered 
 vitality of the parts affected, the insensibility of the 
 anterior surface of the cornea, or of its conjunctival 
 coating, had led to a loss of that protection which 
 is afforded by the winking movements of the eye- 
 
137 
 
 lids; hence the atmosphere itself, as well as the 
 dust with which it might be charged, along with 
 the detained tears and mucous secretion, would 
 be the more likely to injure the delicate surface of 
 the front of the eye, to say nothing respecting the 
 transparent nerves of the cornea discovered by 
 Schlemm, and derived from the nervuli ciliares, or 
 of the possible effect on the nutrition of the mem¬ 
 brane, which their indirect injury might cause. 
 
 In studying the causes or modes of origin of 
 conical cornea, the complicated nervous system 
 of the face should not be overlooked, while the 
 nerves in the dental arches, which are so much 
 exposed to sources of irritation and disease, seem 
 to be especially worthy of attention; for although 
 these remarks may at first sight seem to be rather 
 away from the subject of conical cornea, we have 
 only to call up a recollection of that which belongs 
 to disease, which in its origin may be connected 
 with reflex phenomena, to be enabled to conceive 
 the possibility of the pathological concatenation 
 here alluded to. 
 
 Believing that these considerations, relating to 
 the morbid condition of the teeth as met with in 
 
138 
 
 some cases where conical cornea exists, are of impor¬ 
 tance in a practical point of view, a short illustra¬ 
 tion may not be altogether out of place. 
 
 A. B., aet. 30, a weaver, from the neighbour¬ 
 hood of Wigan, a stout, liealthy-looking man, of 
 short stature, consulted me on account of disease 
 of the right eye, in June, 1853. The cornea was 
 conical; the apex of the cone nearly central, and 
 opaque; in the sound eye a blue iris was seen, 
 but in the diseased organ this membrane had 
 assumed somewhat of a greenish tint; the pupil 
 in its centre being of medium size and regular 
 in form, but immovable, or unaffected by the ordi¬ 
 nary changes of light. 
 
 When the two eyes were tried with a view to 
 the production of phosphenes, these phenomena 
 were normal in the left eye, but incapable of being 
 produced in the right. With the right eye, the 
 patient cannot see any object ; in short, he barely 
 perceives the illumination produced by a lighted 
 taper held before this eye, when the opposite organ 
 is covered. 
 
 • The dental arches are in very bad condition, 
 many teeth have been entirely lost, while of others, 
 
139 
 
 stumps, worse than useless, remain. The main 
 loss of teeth took place between the ages of 18 and 
 25, several having been destroyed by decay, while 
 others were extracted. These observations apply 
 to both jaws, and to both sides of each. The patient 
 says that along with the tooth-ache the right eye 
 suffered very much, and that in the right side 
 of the upper jaw two of the teeth were much more 
 painful than the rest ; and he further remarks, 
 that heretofore, when these teeth ached, the right 
 eye always became inflamed. 
 
 In this case it was clearly made out, that the 
 dental preceded the ocular disease, and that after 
 the occurrence of the latter it seemed to be aggra¬ 
 vated by the continuation of the former; the disease 
 within the jaws seemed to have produced neuralgia 
 of the eye, on which deep-seated inflammation of 
 the eye-ball appears to have followed) and of which 
 the present state of the organ is doubtless a con¬ 
 sequence. The insensitive retina, the fixed pupil, 
 the altered colour of the iris, the injected sclerotic, 
 and the conical and opaque cornea, may now be 
 regarded as a group of strongly marked vestiges 
 of former morbid conditions, actions, and changes. 
 
140 
 
 The intense pain often felt in the eye-ball at the 
 moment, a tooth is separated from the jaw, in the 
 act of extraction, is an illustration of the nervous 
 connection of the two parts, which we are told 
 can scarcely be sufficiently appreciated except by 
 those who have felt it. 
 
 It would not be difficult to adduce other illus¬ 
 trations of sympathy (to keep to the old term) 
 between the dental nerves and those of the visual 
 apparatus, and for which the ramifications of the 
 trigeminal and sympathetic systems mainly account; 
 and it is especially worthy of notice, that in some 
 of these cases the eye is much disturbed in its 
 nervous system; in others, in its vascular system ; 
 in a third class, in both. 
 
 F. P., aet. 30, had suffered violently for upwards 
 of twelve months, first with neuralgic pain in the 
 left temple and eye, and afterwards with pain more 
 especially confined to the eye-hall itself, the torture 
 being so great that the patient resolved to have the 
 organ extirpated if necessary; and, with this view, 
 consulted Professor Galenzowski, of Wilna, who 
 found that the first upper molar tootli on the left side 
 was carious. This tooth being removed, a foreign 
 
141 
 
 body was found at the end of its fang. “ A small 
 splinter of wood, about three lines in length, which 
 had traversed the centre of the tooth, and had 
 probably been introduced in picking the teeth. 
 A probe passed from the socket into the antrum, 
 from which a few drops of thin purulent fluid escaped. 
 The pain ceased almost entirely, and, on the same 
 evening, the eye began to be sensible to light, vision 
 gradually improved, so that on the ninth day the 
 patient could see as well with the left eye as with 
 the right, after a blindness of thirteen months.” 
 
 In a case which recently came under my notice, 
 a gentleman suffered severe pain in the left eye¬ 
 ball, which had already continued for several weeks, 
 and the sight of the organ was considerably 
 impaired ; the pupil was a little more contracted 
 than that of the opposite side, but was less sensitive 
 to changes of light: this gentleman dined at six, 
 and the ocular affection was frequently worse in the 
 evening. 
 
 On examining his mouth, I found that he had 
 “a piece of teeth” in the upper jaw on the left side, 
 based on a gold plate, in connection with which 
 there was some soldering of another metal. I recom- 
 
 T 
 
142 
 
 mended the artificial teeth to be laid aside, and 
 requested the patient for a time to do as well as he 
 could without them ; this advice was taken, and at 
 the end of the first week after there was no more 
 ocular complaint. 
 
 In this case it appeared to me that the foreign 
 body in the mouth was probably the cause of the 
 diseased condition of the eye; but whether any gal¬ 
 vanic or other action, due to the presence of metals, 
 were added to the irritation mechanically produced, 
 cannot be satisfactorily determined. 
 
 It might be said that such cases have no con¬ 
 nection with conical cornea; to which, however, 
 it may be replied, that the cornea is an important 
 part of an organ, which may suffer, as a whole, in 
 these, and in many other equally curious ways; 
 while it is obvious, that in any case, where conical 
 cornea exists, and where its cause has not been 
 determined, the state of the nose and mouth, but 
 more especially of the jaws and dental system, are 
 matters not unworthy of the attention of the prac¬ 
 titioner. 
 
 Before leaving these considerations, relating to 
 disturbances in the nervous system of the eye, it 
 
143 
 
 may be remarked, that the prognosis in cases of 
 conical cornea, must generally be unfavourable, 
 when any such morbid complication exists; whether 
 this be want of sensibility in the retina, or diseased 
 state of the nerves or ganglia, in the neighbourhood 
 of the orbit, affecting either the nutrition or sen¬ 
 sibility of the organ, the movements of the iris, or 
 those of the globe of the eye. 
 
 Oscillation of the eye-ball, a phenomenon not 
 unfrequently associated with amaurosis, has been 
 observed in connection with conical cornea. 
 
 In advanced cases of conical cornea the iris is 
 said to have been found tremulous, from the abun¬ 
 dance of aqueous humour, — and, at the same time, 
 concave on its anterior surface. It may be a ques¬ 
 tion, whether such tremulous condition of the iris 
 may not sometimes depend on alteration in the 
 vitreous, as well as on that of the aqueous humour; 
 and whenever such alteration in the vitreous humour 
 seems probable, particular attention should be paid 
 to the condition and position of the lenses, either or 
 both of which may he altered, as a remarkable case, 
 previously related, tends to show. Such considera¬ 
 tions might be especially important in any case 
 
1-14 
 
 where operation on the eye-ball, but more especially 
 upon the lens, might be contemplated; as there is 
 every reason to think that it would be worse than 
 useless to attempt any operation on the lens, if this 
 body had been previously dislocated, absorbed, or 
 both, or even if it had but partially undergone either 
 of these alterations. 
 
 In a case related to me by a distinguished 
 optician, a tremulous state of the iris was observed, 
 along with conical cornea; the vision of the patient 
 was very confused, and was not in the least assisted 
 by any form of concave lens. 
 
 In one case of conical cornea, observed by Clielius, 
 the polyopia was so remarkable, that a candle held 
 before the eye was seen as fifty or sixty, by the 
 patient. This phenomenon is attributed, by Clielius, 
 to the different thickness of different parts of the 
 cornea, and hence to its having, in different points, 
 different refracting powers. Hence we see that 
 Clielius ascribes to alterations in the thickness of 
 the cornea, that which Sir David Brewster has 
 ascribed to alterations or inequalities on its surface. 
 
 These opinions seem, however, to he based on 
 no great number of observations, which, if frequently 
 
145 
 
 repeated, might give additional interest to the subject, 
 by adequate confirmation of the view of either of 
 these eminent men. 
 
 It may, however, be remarked, that neither 
 irregularities of the surface, nor alterations in the 
 thickness of the cornea, are essential to the produc¬ 
 tion of polyopia, as we have more than once met with 
 it without these, as in some cases of cataract, in 
 amblyopia, associated with morbid conditions of the 
 abdominal viscera; and, now and then, continuing for 
 several weeks, after accidental blows on the eye; and, 
 inasmuch as some of the morbid states alluded to are 
 occasionally found associated with conical cornea, it is 
 requisite, in diagnosis, to determine the more probable 
 source or sources of the phenomenon witli that 
 rigorous analysis which the difficulty of the inquiry 
 suggests. 
 
 Strabismus, internal or external, has been spoken 
 of by Dieffenbach, as now and then met with in 
 cases of conical cornea. 
 
 I have met with internal strabismus in one case 
 of conical cornea, of the second class, which came 
 on as a consequence of ophthalmia, associated with 
 an exanthematous attack, in a boy, 10 years of age; 
 
146 
 
 iu this case the central and inner parts of the cornea 
 were opaque, and the patient was blind, but sight 
 was restored by making an artificial pupil in the 
 outer part of the rim of the iris. 
 
 In this case of strabismus, nature, as it were, 
 had anticipated art ; as the internal squint might be 
 regarded as a natural effort to bring the most trans¬ 
 parent part of the cornea directly in front, thus to 
 receive a greater amount of light; so that after the 
 operation for artificial pupil on the outer side, the 
 internal strabismus was a positive advantage, and 
 had it not existed, its production might well have 
 been attempted artificially, by dividing the external 
 rectus muscle of the eye. 
 
 It is probable that a hydrocephalic state of the 
 foetus in utero might affect the structure and contents, 
 as well as the position, of the eye-ball; but it is 
 nevertheless doubtful whether the opinions of some 
 German ophthalmologists respecting this mode of 
 origin of conical cornea, in cases of intra-uterine 
 hydrocephalus, be sufficiently established by obser¬ 
 vation. 
 
 I have often, and carefully, examined the figure 
 as well as other characteristics of the eye, in the 
 
147 
 
 human embryo, as well as in that of several mam¬ 
 malia, at various periods, but have never met with 
 an instance in which the cornea had a conical form; 
 so that as far as my own observations have gone 
 I should doubt whether at any period of intra-uterine 
 existence the cornea of the foetus in the normal state 
 is conical, whatever its varying degrees of promi¬ 
 nence may be. In connection with this matter, 
 however, we must not forget that there is a little 
 practical difficulty, inasmuch as the precise form 
 of the living eye depends, in a great measure, on 
 its vital conditions; so that the figure of this living 
 and beautiful optical instrument is but imperfectly 
 transferred to the organ which we examine post¬ 
 mortem. 
 
 In the study of conical cornea, we should advance 
 considerably if any means of accurately determining 
 the thickness of the living cornea could be hit upon, 
 to say nothing of the difficulty in precisely ascer¬ 
 taining its condition with regard to tension. 
 
 Flarer and others have thought, that softening 
 of the central part of the cornea, and distension of 
 this tunic, from increased accumulation of aqueous 
 humour, were essential to the formation of “ cornea 
 
148 
 
 conica pellucidait may, however, be doubted whe¬ 
 ther either of these conditions be absolutely essential 
 to the morbid change in question ; for, without 
 caring much at present for the aqueous humour, or its 
 supposed varying quantities, it may be asked whether 
 the cornea, which is supposed to undergo processes 
 of softening and atrophy, for the formation of conical 
 cornea, may not also be capable of undergoing pro¬ 
 cesses of induration and hypertrophy ; in either 
 way the front of the eye might become conical; in 
 the one case, the cone would be in great measure 
 made up of the fluid of the aqueous humour; in the 
 other, it might mainly consist of the solid material 
 of the cornea. Both these conditions have been 
 observed and described by writers of repute, although 
 it is not intended in this place to offer either of them 
 as an illustration of what most commonly happens 
 in cases of conical cornea. 
 
 In three cases observed by Riberi, conical cornea 
 followed a slow keratitis, which, after long duration, 
 disappeared without suppuration or ulceration of the 
 cornea; this tunic, however, was thinned and weak¬ 
 ened “ by loss of cohesion, from interlamellar or 
 interstitial absorption,” and hence gradually yielded 
 lo the pressure of the humours from behind. 
 
149 
 
 It would be interesting if we could satisfactorily 
 determine by observation that two different, and, as 
 it were, opposite processes of nutrition go on in the 
 same cornea at different times, or in different stages 
 of the progress of conical cornea. The opinion of 
 Himly seems to have leaned towards this view ; he 
 thought that in many cases the central part of the 
 cornea was at first softened, and hence yielded so 
 as to be pressed forward in consequence of the action 
 of the recti muscles ; but that such pressure, through 
 the medium of the aqueous humour, upon the cornea, 
 afterwards led to the thickening of this tunic, so 
 that softening and atrophy in the earlier stage might 
 be followed by hypertrophy in the latter. 
 
 Some cases of conical cornea having occurred 
 suddenly, or having been supposed to have occurred 
 suddenly, it has been imagined, that a rupture of 
 the membrane of the aqueous humour and of the 
 posterior layer of the cornea, from the influence 
 of violent cries or muscular exertion, and disturbed 
 respiration, was, in such instances, the immediate 
 cause of the affection ; the anterior layers of the 
 cornea being pushed forward by the same force which 
 caused the breaking of the posterior. This view, 
 
 v 
 
150 
 
 however, could not well be maintained, if we attend 
 to what commonly happens in connection with the 
 influences of force applied in the manner here sup¬ 
 posed ; for the anterior layer of the cornea in such 
 circumstances would be the part put most on the 
 stretch, while at the same time it is not supported by 
 anything, if the strength of its own tissue be excepted ; 
 the posterior layer all the while is put less on the 
 stretch, (wedging onwards, if we may be allowed 
 the expression, towards the anterior, which is bent 
 over it,) and also receives support from the front 
 layer, behind which it is placed ; so that if auy 
 rupture took place in the cornea as a consequence of 
 pressure exerted from behind, it would seem that the 
 anterior rather than the posterior layer should give 
 way. 
 
 The opinion entertained by Adams and others, 
 that, iu cases of conical cornea, the prominent or 
 conical part of the tunic is generally thickened, so 
 as to present on the fore part of the eye a solid mass 
 of living crystal, as it were, seems not to be suffi¬ 
 ciently established by the results of pathological 
 observation. If such a state of parts ever occurs, it 
 probably belongs rather to the exception than to the 
 general rule. 
 
151 
 
 Fario and others have supposed, that in cases 
 of conical cornea the tunic is first thickened by 
 hypertrophy, and afterwards thinned by inflammatory 
 action, tending to, or ending in ulceration; so that 
 the latter stage of the disease, as noticed by this 
 distinguished oculist of Italy, corresponds, as it were, 
 to the whole course of the malady as viewed by 
 Benedict, who says that this complaint is often 
 produced by inflammation, which leads to ulceration 
 of the centre of the cornea, whence that distension 
 under the influences of which the cornea assumes 
 the conical form. 
 
 A distinguished Parisian ophthalmologist does 
 not seem to have been acquainted with the theory 
 of Benedict; for when he published the same thing 
 as new in France, it was already growing old in 
 Germany : and allusion has also been made to this 
 as an occasional, or exceptional, mode of origin of 
 cases of conical cornea, by other writers on the 
 subject. 
 
 Weakness and “ paralysis ” of the membrane 
 of the aqueous humour, have been regarded by 
 some as sources of conical cornea; and increase in 
 the quantity of this humour, and at the same time 
 deposit of serous and transparent fluid between the 
 
152 
 
 lamellae of the cornea, have been looked upon as 
 pathological conditions associated with this disease; 
 aud the malady has also been attributed to an 
 increased nutrition of the cornea, with or without 
 irritation in the vascular system of the eye. 
 
 Before alluding to weakness and paralysis of the 
 membrane of the aqueous humour, in any state of 
 disease, it would have been well, had it been possible, 
 to determine what its strength or action in the 
 normal state may be. It seems probable that in 
 some cases of conical cornea the morbid action may 
 begin in the back part of the cornea, but the impor¬ 
 tance which, in the above-named view, is attached 
 to the membrane of the aqueous humour, would 
 seem to be relatively somewhat great. 
 
 Amongst the many opinions entertained respect¬ 
 ing conical cornea, two are especially remarkable; 
 1. The opinion that the cornea is weakened and 
 thinned, so that the aqueous humour encroaches 
 upon it, and presses it forward ; 2. The idea 
 
 that the cornea is strengthened and thickened, in 
 such manner that it might even be supposed to 
 encroach on the aqueous humour, and press it back¬ 
 ward. 
 
153 
 
 If the cornea were thinned at the centre, a coni¬ 
 cal prominence of such centre would be likely, in 
 most cases, to follow, the aqueous humour fully and 
 evenly distending the chamber in which it is en¬ 
 closed • hut how the tunic should as regularly become 
 conical by virtue of a process of thickening is not so 
 easily understood, — to which the remark may be 
 added, that the centre of the cornea, which may 
 be regarded as farthest removed from the sources of 
 nutrition, might, as far as this reason is concerned, 
 be more likely to suffer from atrophy than from 
 hypertrophy. These observations, however, should 
 be regarded as more peculiarly applicable to those 
 cases of cornea conica pellucida, which have not been 
 preceded or accompanied by the ordinary phenomena 
 of inflammation, inasmuch as it is obvious that they 
 would not so well apply to many cases of opaque 
 conical cornea, or ordinary staphyloma, in which 
 remarkable thickening, as well as other alterations 
 of the whole of the cornea, are frequently found to 
 have taken place. 
 
 Again, this great hypertrophy of the cornea, 
 without any diminution of transparency, is not so 
 easily understood. But we do occasionally observe 
 
154 
 
 remarkable thinning of the cornea bv ulceration 
 affecting its anterior surface, and that without loss 
 of the diaphanous condition. It is not unworthy 
 of notice that, in some cases of this kind, where 
 the cornea is very much thinned, its weakened tunic 
 is not thrust forward by the aqueous humour. In 
 one case, which recently came under my notice, 
 the cornea, towards the outer side, where it was 
 thinned, presented anteriorly a somewhat regular 
 and concave surface, which gave an inverted image 
 of a small taper held before it. 
 
 In one case of conical cornea, the thin tunic was 
 burst by a slight blow on the eye. Such illustra¬ 
 tions, however, of the extreme tenuity of true conical 
 cornea must be regarded as exceedingly rare; while 
 the bursting of the e} r e, either spontaneously or 
 accidentally, after previous and long continued dis¬ 
 tension and thinning, may more frequently occur 
 in cases of hydrops oculi. Between these two 
 diseases, however, there are many points of resem¬ 
 blance, which cannot fail to interest the pathologist 
 and the practitioner ; and it is evident that it 
 would be no disadvantage either to staphyloma, 
 conical cornea, or hydrops oculi, if they were studied 
 
155 
 
 more side by side. In one case observed by Walther, 
 a conical state of the cornea, along with an oval 
 form at its margin, was observed in connection with 
 bydrops oculi. 
 
 The facts which favour the idea that, in many 
 cases of conical cornea, the affected tunic is 
 thinned, are many and various; in one instance 
 related by Flarer, the conicity of the cornea was 
 gradually removed by the long-continued oozing 
 away of the aqueous humour, which passed through 
 a fistulous opening consequent on a simple para¬ 
 centesis of the cornea. Had the conical cornea 
 depended on thickening of this tunic, the disappear¬ 
 ance of the conicity could scarcely have occurred 
 in the manner just noticed; and the fact at the same 
 time tends to show that, in such cases, if any means 
 of lessening the quantity of the aqueous humour 
 could be devised, an important remedial agent might 
 thus be supplied; while it is obvious that a delicate 
 paracentesis of the cornea might be practised, and 
 repeated with some hope of doing good, either with 
 or without the after employment of pressure. If the 
 apex of the cone were at any considerable distance 
 from the centre of the cornea, such apex might be 
 
156 
 
 chosen as the site for the puncture ; but if the apex 
 were at, or very near to the centre of the cornea, 
 which, as we know, is not unfrequent, then, of course, 
 the point for paracentesis must not correspond with 
 the point or transparent apex of the cone, lest the 
 consequent opacity should be great euougli to prevent 
 the light traversing the part affected. If, however, 
 such apex had become opaque, this caution would 
 be less required. 
 
 Here it may not be unworthy of notice, that in 
 cases of conical cornea treated by the formation of 
 artificial pupil, for which the cornea is punctured 
 near its margin, the patient has, at the same time, 
 the benefit, it may be, of a paracentesis of the cornea, 
 through which the aqueous humour may ooze for 
 a little time, more especially if, within the aperture, 
 the cornea has been rubbed a little by drawing a 
 small portion of the iris into or through the opening 
 previous to the removal of such portion with the 
 scissors, — an act likely to interfere, more or less, 
 with the immediate re-union of the cornea. 
 
 To previous observations relating to the operative 
 surgery of conical cornea the following considera¬ 
 tions may be added. 
 
157 
 
 If it should appear desirable to practise para¬ 
 centesis of the cornea, and, at the same time, to 
 remove an extremely small portion of this tunic, 
 at the point where the instrument is introduced, so 
 as to secure a continued oozing out of the aqueous 
 humour, for some little time afterwards, without the 
 repeated application of instruments, which would 
 be likely to produce too much irritation ; it would 
 seem, that, for this purpose, an instrument of very 
 refined construction, but in principle resembling 
 that employed for perforating the membrane of the 
 tympanum, and at the same time securing a future 
 opening at the point of perforation, by removing 
 a very small portion of this membrane, might not 
 he altogether unworthy of the attention of the oculist. 
 When the cornea is punctured with an ordinary 
 needle, the aqueous humour commonly runs out 
 with sufficient readiness, so that any particular 
 contrivance, such as the grooved needle, or the 
 “ aiguille a pompe,” would not seem to be required 
 when our object is merely to let out a small quan¬ 
 tity of this fluid, especially as its consistence, or 
 rather tenuity, is rarely found to have undergone 
 any remarkable alteration. 
 
 w 
 
158 
 
 In the case of Fario, mentioned at page 22, 
 an oozing out of the aqueous humour for some 
 days after each operation was one of the effects 
 produced by excision of small portions of the 
 cornea. A subsequent effect would probably be 
 the formation of a firm and small cicatrix at the 
 part whence the little triangle of cornea had been 
 removed ; so that the patient would first have the 
 benefit of some degree of flattening of the cornea, 
 from a diminution of the quantity of the aqueous 
 humour, while, in the next place, the small cica¬ 
 trices of the tunic, and their gradual contraction, 
 might tend to prevent any reproduction or exten¬ 
 sion of the conical form. 
 
 Corresponding results, in other words, the 
 gradual draining away, for a time, of a portion of 
 the aqueous humour, and the subsequent formation 
 of cicatrix, were obtained by Flarer, in another 
 way. In the Medical Gazette of Milan, this dis¬ 
 tinguished Italian surgeon has reported a case of 
 conical cornea, in which, with a fine needle, he 
 passed a delicate seton of silk through the affected 
 tunic; a proceeding which was followed by very 
 favourable results. 
 
159 
 
 It is obvious that a very nice discrimination 
 must be required to enable us to select judiciously 
 tbe cases which are suited to, or which are likely to 
 be benefited by, operations such as these. In any 
 case where the seton has been introduced, the great¬ 
 est care should be taken not to allow it to produce 
 too complete, or too long-continued, an evacuation 
 of tbe aqueous humour ; and it is evident, that we 
 should be very careful not to permit it to remain 
 too long in the eye, for, in this place, if such play 
 with language were allowed, it would be very true 
 to say, that the sight of the patient may hang- 
 on a very delicate thread ; and it need scarcely be 
 remarked, that the success of such an operation must 
 depend mainly on the nice watching of the changes 
 it induces, and on the associated measurement of its 
 tendencies and effects. 
 
 Both the operations above noticed; or, the 
 excision of portions of the cornea as practised by 
 Fario, as well as the passing of a seton through this 
 tunic, performed by Flarer, — seem to have been 
 suggested by well-observed efforts of nature, in cases 
 where ulceration, and subsequent firm cicatrization 
 of the cornea, had been followed by the lessening 
 
160 
 
 of its previously conical form ; or where a small 
 fistulous opening for some time existiug had kept 
 up a gradual drain on the aqueous humour, and had 
 thus favoured the gradual lowering of the conically 
 elevated cornea. 
 
 In operating for conical cornea, by removal of 
 small portions of the tunic, after the manner of Fario, 
 it is not difficult to imagine a case in which the 
 operation might be more or less successful or unsuc¬ 
 cessful, as the position of the part operated upon 
 might be favourably or unfavourably placed, with 
 regard to the effect to be produced by the subsequent 
 cicatrization ; thus the side of the cone next the 
 temple might be relatively long and flat, while on 
 the nasal aspect it might be shorter. If, in such an 
 instance, one portion of cornea were excised, and 
 this were taken from the temporal, the outer, or more 
 flat side of the cone, and from the margin of the 
 tunic, the effect produced would probably not be so 
 good as it might have been had the excision been 
 practised on the nasal side, where the contraction 
 of cicatrix would have a better chance to tell upon 
 the apex or highest part of the cone, which, being 
 nearer to it, is, as it were, more within the reach of 
 
161 
 
 the effect which a minute and contracting scar would 
 be likely to produce. 
 
 The record of these Italian operations is both 
 important and interesting, although it he quite 
 obvious that they are not likely to be often repeated; 
 the cases were peculiar or exceptional, the remedial 
 measures not less so; and in connection with such 
 facts, it may be remarked that in the therapeutics of 
 conical cornea there are no general rules capable 
 of being constantly or widely employed. Cases of 
 this malady are so dissimilar, either as regards the 
 state of the cornea, or that of some other part of the 
 eye, to say nothing of the various morbid conditions 
 of distant organs, now and then found to accompany 
 the ocular affection, that a special plan of treatment 
 must be devised for almost every case ; and if this be 
 true, it necessarily follows, that, in attempting to 
 apply generally, or constantly, any method of treat¬ 
 ment previously laid down, never mind how success¬ 
 ful it may have been in the hands of others, the 
 practitioner must not be surprised if he meet with 
 frequent disappointment. 
 
 Hence, too, the great value of many practical 
 observations relating to various modes of treatment. 
 
162 
 
 and operative proceedings, employed for the relief 
 of this affection, by eminent surgeons of Great 
 Britain and Ireland ; in the study of which we cannot 
 fail to observe that the results of certain operations 
 have, in practice, been more favourable than ordinary 
 physiological views would have led us to suppose; 
 so that even opinions based on the geometric form of 
 the cornea and lens, and helped by the most careful 
 consideration of the optical properties of these bodies, 
 separately, or combined, have not always been in 
 accordance with the results of operations, which have 
 occasionally effected an improvement in vision, not 
 predicted, nor accounted for, by theoretical conside¬ 
 rations ; all which, however, tends only to show that it 
 is extremely difficult, in any individual instance, 
 mentally to seize on all those sources of success or 
 disappointment, which, in such matters, may be so 
 delicately combined. 
 
 These observations are intended more especially 
 to apply to cases of operation for the destruction, dis¬ 
 location, or removal of the crystalline lens, which seem 
 upon the whole to be very uninviting, and which 
 are apparently condemned by theoretical views, but 
 which, nevertheless, have in a few instances been 
 
163 
 
 practised with success, or, at any rate, with subse¬ 
 quent improvement of vision, by Adams, Butter, 
 Walker, Yidal, &c. 
 
 When, in such cases, the cornea is divided, and 
 the lens extracted, the benefit may be, in part, con¬ 
 ferred by after flattening of the cornea, as would 
 seem to have happened in the interesting case related 
 by Mr. Walker, so that we might err in attributing 
 an improvement of vision mainly to the removal 
 of one refracting body, which is, in reality, in some 
 measure due to alteration in the form of another. 
 
 In some cases of conical cornea in which the 
 operation for artificial pupil has failed, other morbid 
 conditions of the eye may have co-existed; disease 
 of the retina, or of the vitreous humour, would be 
 sufficient to prevent success ; and this consideration, 
 it is obvious, should not be lost sight of in our esti¬ 
 mate of the value of such an operation, which is 
 evidently good in some cases, but often likely to fail. 
 
 The cornea may be conical in cases where 
 the conicity depends upon the thickening of an 
 opaque centre; artificial pupil, in such cases, may be 
 practised with success ; the light afterwards entering 
 the eye by way of an aperture in the rim of the iris. 
 
164 
 
 having previously traversed the outer and transparent 
 part of the cornea ; but, in such iustances, it might 
 he said, that the treatment is adapted rather to 
 opacity than conicity of the cornea; and here we 
 may observe, that there is some reason to believe that 
 differences in the results of treatment of cases 
 of conical cornea would be better understood, if the 
 application of terms in this matter were more 
 rigorously attended to. 
 
 A single instance of success from the formation 
 of artificial pupil, in cases of true conical cornea, 
 would be sufficient to suggest that the operation is 
 not to be altogether rejected; and such have been 
 recorded by Mr. Tyrrel, Mr. Wilde, and others; 
 while the failure of the same proceeding, in some 
 cases, shows clearly the great importance of a refined 
 diagnosis, and of adequate attention to concomitant 
 circumstances. 
 
 It is worthy of remark, that with some practi¬ 
 tioners the formation of artificial pupil has been 
 followed by favourable results in two, three, or even 
 more cases in succession; while others, in an equal 
 number of operations, have not had one case of happy 
 termination. Such a disparity of results might be 
 
105 
 
 accounted for in various ways, which need not be 
 dwelt upon here ; but one important consideration 
 must ever be borne in mind, we allude to what may 
 be called the question of time; for, to be able to 
 form an adequate appreciation of the effects of any 
 surgical operation, these should be considered, in 
 many instances, not a week, nor a month, but, at 
 least, twelve months, after it has been practised. If 
 then, the patient give a good account of bis condition 
 as improved by operation, the benefit may be regarded 
 as certain ; but amid the industrious classes of the 
 community, whose cases are more frequently reported 
 than others, the frequent change of abode, as well as 
 other circumstances not less important, render an 
 accurate knowledge of ultimate results nearly impos¬ 
 sible in a great number of instances. 
 
 In any case, therefore, where, at first, a good 
 effect seems to have been produced by operation, or 
 other plan of treatment, the patient should be seen 
 occasionally for a few months, and afterwards a com¬ 
 plete report drawn up, containing the details of an 
 impartial and frequently repeated observation. With 
 less than this, the accurate observer or cautious 
 practitioner can never be completely satisfied; it must 
 
 x 
 
166 
 
 nevertheless be admitted, that, however easily these 
 remarks may flow from the inkstand, it is very 
 difficult to apply them in practice. 
 
 In connection with the operative treatment of 
 conical cornea, the very interesting case of Mr. 
 Gervis requires to be mentioned. 
 
 The patient was a young woman, 25 years 
 of age; “ the cornea, as usual in such cases, was 
 prolonged, not opaque, presenting an appearance as 
 if a crystal projected from its centre, which, by the 
 refraction of the rays of light, deprived her of sight, 
 except in a modified degree, when looking at objects 
 in a lateral direction, and then most imperfectly.” 
 
 Mr. Gervis says, “ with a view of breaking up 
 the laminae of the projecting cornea, and to promote 
 absorption of what I considered its thickened struc¬ 
 ture, or hypertrophy, I punctured it several times 
 with a couching needle, and about three times 
 a week applied to the conical centre the argent nit., 
 making a sweep across it; the puncturing with the 
 needle produced some opacity of the globular-shaped 
 projection, just as is seen after severe inflammation 
 of the cornea. I then applied the ungt. liydrarg. 
 nit. oxyd. daily, to the eyelid, with marked success ; 
 
167 
 
 and by perseverance with these combined means i 
 completely succeeded, within three months, in gain¬ 
 ing my object, the restoration of her sight; and the 
 cornea assumed its normal appearance. I have seen 
 the young woman since the cure was completed; 
 she continues perfectly well, and has returned to her 
 employment without the least injury to her sight.” 
 
 The patient at first had a blister to the temple; 
 she took large doses of carbonate of iron, and the 
 compound galbanum pill, with port wine, and a 
 generous diet. 
 
 With regard to the more especially surgical part 
 of the case, I have thought it best to quote the words 
 of Mr. Gervis, as the method of puncturing the 
 cornea which he resorted to was peculiar, if not 
 unique, inasmuch as this puncturing was confined to 
 the texture or substance of the cornea, and <£ never 
 went so deep as to reach the aqueous humour.” 
 
 By such application of the couching needle 
 Mr. Gervis would be able to judge of the thickness 
 of the affected part of the cornea, as he passed the 
 point of the needle into this part; and as he dis¬ 
 tinctly speaks of its thickened structure, or hyper¬ 
 trophy, we must regard this case as an illustration 
 
of conical and transparent cornea, with thickening of 
 the conical part, this part having become more or 
 less opaque, from the employment of the needle, but 
 recovering its transparency in the after course of 
 treatment. 
 
 In a second “ case of conical cornea, with 
 opacity,” Mr. G. “ resorted to similar treatment, and 
 with success.” 
 
 In the Report of Mr. Gervis, the observations 
 relating to the employment of nitrate of silver are 
 very significant, where he says, “ it acts as a direct 
 •stimulant to the absorbents, increasing their power 
 of action to take up the thickened structure of the 
 anterior lamince of the cornea,” where the thickened 
 state of the cornea, as well as the potency of the 
 nitrate of silver, is obviously recognised. 
 
 In such cases it might not be amiss to employ 
 a feeble solution of the salt of silver, during a few 
 days, and then gradually increase the strength of 
 this, before the solid nitrate is applied; as this caustic, 
 when applied to the eye, or eyelids, in some constitu¬ 
 tions, produces a very great amount of irritation and 
 re-action. 
 
 Taking the view of Mr. Gervis, we should he 
 
169 
 
 disposed to employ it cautiously, in those cases of 
 conical cornea which seem to have been associated 
 with over-exertion of the eye, or with some particular 
 mode of using it; here we may mention, by way of 
 illustration, the case of conical cornea in the right 
 eye of a sportsman, (W. W. Cooper,) the eye which 
 he solely employed in levelling his fowling-piece, 
 without entering upon the question of cause and 
 effect, or that of coincidence, which might here be 
 suggested ; or inquiring whether by any contractile 
 or elastic structure, connected with the cornea, or 
 with any other part of the organ of vision, there may, 
 or may not be, any change in the form of the anterior 
 part of the eye at the time the organ is intently 
 employed, as in the act of taking aim. 
 
 But few r writers on hyperkeratosis have spoken 
 positively respecting the thickened state of the 
 cornea; amongst these, Juengken and Rosas may 
 be cited; while Radius, Himly, Ammon, and Schon, 
 are not forgotten. Juengken and Rosas mention 
 the increased thickness of the tunic, in such terms 
 as shew that they entertained no doubt respecting 
 it, without, however, alluding to any autopsy. The 
 
170 
 
 observations of the late Mr. Walker, and of Mr. 
 Middlemore, may be placed side by side with the 
 cases given above; the interesting contrast tending 
 to shew, that additions to our knowledge of the 
 subject derived from post-mortem examinations are 
 much to be desired. 
 
 A case of conical cornea occurred in the practice 
 of Mr. Windsor, of Manchester, in which, after 
 death, “ the cornea generally was found very much 
 thinner than natural, and in the centre especially so.” 
 The autopsy was made by Mr. Walker, and is noticed 
 in his “ Oculist’s Vade-Mecum.” 
 
 At page 532 of the first volume of Mr. Middle- 
 more’s treatise, we find the following as part of a 
 note: — 
 
 “ I have had one opportunity of examining after 
 death the state of the cornea, in a person who was 
 affected with conical cornea in an extreme degree, 
 and in that instance its laminae were less moveable 
 upon each other, its circumference was of a natural 
 and ordinary degree of thickness, but its apex was much 
 thinner than usual, and rendered opaque on its 
 exterior only, for its neural surface, even at the apex, 
 was perfectly transparent; in other respects it did 
 
171 
 
 not appear to have undergone any change, unless 
 I mention that alteration in the evenness and equa¬ 
 lity of its surface discovered by Dr. Brewster, but 
 which was not visible to the naked eye.” 
 
 The fact alluded to bv Mr. Middlemore, of the 
 laminae of the cornea being “ less moveable upon 
 each other” than in the normal condition, has not 
 hitherto been dwelt upon by other pathologists; 
 indirectly it reminds us of a curious remark of 
 Juengken, who describes small nebulous spots as 
 seen on the middle of conical cornea, or about the 
 apex of the cone, such as are often met with as 
 consequences of scrofulous ophthalmia, but which, 
 he says, have this peculiarity, that they now and 
 then change their place, and even disappear alto¬ 
 gether, and return after a while. 
 
 Supposing this phenomenon to have been well 
 observed, it is certainly not easy to account for it in 
 a satisfactory manner; for if the same opaque or 
 nebulous spots appear, then disappear, and after 
 a while become visible again, we are, of course, 
 curious to know what, and wdiere, they are; and 
 being willing to imagine that they are not generally 
 entozoa, or other opaque forms floating about in the 
 
172 
 
 aqueous humour, we must endeavour to think that 
 they belong' to the cornea, and that they move 
 between its laminae; and this, it must be admitted, 
 would, for most cases, be somewhat difficult; whether 
 the opaque spots might consist of lymph, the product 
 of keratitis, or of some other matter, we need not 
 stop to enquire ; and it need scarcely be mentioned, 
 that the minute spots which present themselves in 
 cases of corneitis punctata, some to vanish altogether, 
 others to leave traces of their previous existence 
 behind them, should be guarded against as a possible 
 source of error in this kind of observation; while 
 cataracta punctata, along with synchisis, and moveable 
 lens, seems sufficiently away from any chance of 
 troubling the diagnosis. 
 
 In the horse, the mule, the ox, the pig, and the 
 dog, entozoa have been found in the eye; in these 
 animals, more especially the former three, the filaria 
 papillosa is sometimes the cause of ophthalmia, while 
 in the mule, dog, and pig, the cysticercus cellulosae 
 has been more frequently met with; it would not 
 seem, however, that any conical alteration of the 
 cornea has hitherto been observed in connection with, 
 or as a consequence of, the presence of any entozoon 
 
173 
 
 « 
 
 within the organ of vision of the animals above 
 mentioned; carefully made observations relating to 
 this matter would be worthy of record; as inflam¬ 
 mation of the eye caused by the presence of a para¬ 
 site, or its products, within this organ, would not he 
 unlikely to increase the quantity of the aqueous 
 humour, and thus to alter the form of the cornea, 
 if not to soften or otherwise change its structure. 
 
 The internal or deeper complications of conical 
 cornea, or those affections of the aqueous humour, 
 lens, vitreous humour, retina, or other part, which 
 may exist in connection with altered form of the 
 anterior tunic of the eye, should always be very 
 carefully studied; and if one of the German eye 
 specula, or one of the recent improvements upon 
 the instrument of Helmholz, such as the ophthalmo¬ 
 scope of Follin and Nacliet, be brought to bear 
 upon the investigation, the diagnosis may receive 
 a more satisfactory finish, as, with their aid, the 
 condition of the retina, as well as that of the refract¬ 
 ing media of the visual organ, may be more com¬ 
 pletely determined, provided the eye has not been 
 previously disturbed by depression or removal of the 
 lens. 
 
 Y 
 
174 
 
 Rosas gives an interesting definition of conical 
 cornea. He says, that cornea conica is a disease 
 in which the cornea, without any adhesion with the 
 iris, projects in the form of a cone, and is, at the same 
 time thicker than natural; the cornea being, in some 
 cases, transparent, and without any degeneration 
 of structure, while, in others, having undergone 
 morbid change in texture, it is found to be opaque. 
 
 He further states, that the disease is scarcely 
 ever preceded by inflammation, mentions polyopia 
 as one of its symptoms, regards compression of the 
 eye, as recommended by Demours, as useless; and 
 says that by avoiding painful or fatiguing employ¬ 
 ment of the eyes, and by exercising vision on distant 
 objects, the progress of the affection may be retarded. 
 
 There is no doubt that in cases of conical cornea, 
 repose of the affected organ should he recommended; 
 but, in many instances, its exercise upon distant 
 objects would he found difficult and fatiguing ; in 
 this place, however, we may regard the word 
 distant as a relative expression, and, at the same 
 time, venture to suggest, that the attempt should, 
 in favourable cases, be made, gradually, to increase 
 the distance at which objects are viewed, so as, 
 
175 
 
 if possible, to help the eye in its adaptation under 
 abnormal conditions ; and for this purpose a little 
 mechanical contrivance may not be altogether unwor¬ 
 thy of notice. 
 
 When the shortest distance at which a near 
 object, such, for instance, as large letters, can be 
 seen, is determined, the head being steadily sup¬ 
 ported, and the book at rest, either one or the other 
 may be moved, so as to increase the distance of the 
 letters, by a few lines, the quarter, or the half, of an 
 inch, and as a very gradual and well-regulated 
 widening of the distance should be secured, it is well 
 to rest the head upon an apparatus, provided with 
 a screw, so adapted as to be able by a slight turn 
 to widen the space between the eye and the book, 
 and thus, by very slow degrees, try, if possible, to 
 increase the range of vision. 
 
 It is evident that this suggestion only applies to 
 the less serious forms of alteration in the cornea, 
 or to such as are characterized by symptoms more 
 or less like those of ordinary myopia; for the relief 
 of which'Berthold contrived the instrument to which 
 he has given the name of “ Myopodiorthoticon,” 
 and of the results of which he speaks so favourably; 
 
176 
 
 this is simply an apparatus for supporting a book 
 below, and the bead above, with screws for increas¬ 
 ing or diminishing the distance of the two, and hence 
 of the eye from the object looked at, and a scale for 
 noting the various distances employed. 
 
 In cases of myopia in the young, I have more 
 than once found great improvement to take place, 
 by regulating the employment of the eyes, and 
 gradually increasing the range of vision. 
 
 Rosas remarks, that in cases of conical cornea 
 the broiement of the crystalline lens improves the 
 vision, but without altering the form of the cornea ; 
 and here it may perhaps be well to observe, that 
 in connection with most of the cases of conical 
 cornea that have been reported as improved by 
 operations on the crystalline lens, very minute 
 details have not been published ; where the lens 
 was cataractous, it may have been sufficient to speak 
 of its opacity ; but where its transparency was 
 apparently undisturbed, it might have been a matter 
 of some interest at the time of the operation, to have 
 noted, as nearly as possible, its exact position, which 
 would be indicated by the part at which the needle 
 would meet with resistance in commencing the 
 
177 
 
 breaking up or dislocation of the lenticular body; 
 for, if any abnormal and forward prominence of the 
 lens, or of the anterior part of its capsule, prevailed, 
 the disturbance of vision associated with conical 
 cornea might be considerably increased ; and in this 
 place the words of Ulrich, relating to this kind of 
 alteration, as connected with the first stage of dropsy 
 of the capsule of the lens, seem worthy of quota¬ 
 tion, where, alluding to the various causes of 
 myopia, he thus gives one : — 
 
 “ In primo phacohydropsite stadio, quo capsulse 
 lentis paries anterior nirnia sanguinis seri exuda- 
 tione magis antrorsum proeminet.” 
 
 We will not here dwell upon the difficulty of 
 diagnosis, which must prevail, with regard to an 
 affection of so recondite a character. 
 
 It is not improbable, that in some cases, where 
 the formation of artificial pupil seems desirable, that 
 a portion of the iris, on both sides of the pupil, 
 might be removed with advantage ; to operate at 
 the same time for double artificial pupil by the 
 removal of one portion of the iris above, and of 
 another below the pupillary aperture, would not be 
 so likely to answer, unless in some exceptional case, 
 
178 
 
 or where the aperture of the eyelids might be wider 
 than usual. Before this, or any other surgical opera¬ 
 tion, is practised on the eye, in cases of conical 
 cornea, the organ should not only be carefully 
 inspected, but also delicately examined by the touch, 
 whenever the state of its sensibility will permit this 
 mode of extending our observation ; and here we may 
 remark that some writers on conical cornea have 
 spoken of diminished sensibility of the affected tunic, 
 as one of the characteristics of the malady in ques¬ 
 tion; and Textor mentions a case of conical cornea 
 in which the conical part of the tunic was very pro¬ 
 minent and thin, and within which he distinctly 
 felt the fluctuation of the aqueous humour; but for the 
 patient to bear a digital examination of the cornea, 
 sufficient to allow a fluctuation of this humour to be 
 distinctly felt by the finger of the surgeon, must 
 generally be somewhat difficult. 
 
 Many curious facts tend to shew how profitably art 
 may imitate or follownature in the treatment of some 
 cases of conical cornea; this is sometimes observed 
 in connection with the results of morbid processes 
 of spontaneous origin, at others it may be seen 
 along with the effects of accidental injury to the 
 
179 
 
 eye. Ulceration, and fistula of the cornea, and their 
 occasional consequences, supply illustrations of the 
 first class; accidents, such as the following, related 
 by Mr. Estlin of Bristol, and quoted by Mr. W. 
 White Cooper belong to the second. Mr. E. says, 
 “ One case occurred to me, where the lens of an 
 eye with conical cornea was wounded by a needle, 
 which ruptured the capsule and produced a cataract, 
 which became absorbed by the effect of the accident 
 which occasioned it. The loss of the lens improved 
 the power of seeing.” The practical application of 
 such observations of the “vis medicatrix naturae,” 
 in circumstances corresponding to some of those here 
 alluded to, has been in some measure illustrated in 
 the foregoing pages. 
 
 The study of the embryo, foetal, or congenital 
 forms of conical cornea has hitherto been very limited, 
 and the few facts relating to this part of the subject 
 are mainly derived from the zeal of German observ¬ 
 ers. Mr. W. W. Cooper says, “Mr. Wilde is of 
 opinion, that when this conformation is congenital, the 
 axis of the cone is seldom in the middle of the cornea, 
 but is either above, below the centre, or to one 
 side;” to which it might be added, that the centre 
 
180 
 
 of the cone, in cases of conical cornea, seldom 
 corresponds precisely to what Arlt has called the 
 “mathematical centre” of the cornea, but that in 
 the cases of embryo, or congenital conicity of the 
 cornea, hitherto observed, the inclination of the cone 
 towards any part of the circumference of the cornea 
 has but rarely been the subject of especial obser¬ 
 vation, so that a greater number of facts in this 
 department would add to the interest of any view 
 relating to the eccentric position of the apex of the 
 cone, in any particular class of cases. 
 
 Ammon speaks of the eyes of a foetus of two 
 months, in which the corneae were at all points of the 
 same thickness, but prominent, and conical, so that 
 the case was regarded as one of conical cornea; 
 while, with the exception of the so-called conical 
 cornea, the eyes were in normal condition. 
 
 In two other cases of conical cornea, mentioned 
 by the same writer, the corneae, on post-mortem 
 examination, were found of equal thickness through¬ 
 out. 
 
 In the cases of congenital conicity of the cornea 
 hitherto observed, it would not seem that any remark¬ 
 able alteration in the thickness of this tunic has been 
 
181 
 
 met with; a fact which, if confirmed by further obser¬ 
 vation, would perhaps suggest the idea, that cases 
 of this affection, occurring in utero, are often to be 
 regarded, rather as instances of malformation of the 
 cornea, than as products of any disease of this part 
 occurring in the embryo or foetal state; but inasmuch 
 as malformation of the cornea might, doubtless, be 
 a result of disease, as even an arrest of development 
 might follow the occurrence of morbid action in 
 the part, the distinction above alluded to must he 
 regarded as one which can rarely be determined 
 in a satisfactory manner. 
 
 Of late years, cases of conical cornea have been 
 described, in which the conical elevation affected 
 only a part of the tunic, the base of the cone being 
 smaller than that of the cornea itself; but earlier 
 writers on conical cornea defined this disease as 
 consisting in conical form of the part, the mar¬ 
 gin of the base of the cone coinciding with the 
 margin or periphery of the cornea; the transparency 
 of the latter remaining unaltered. 
 
 If, in more recent times, it had been thought 
 requisite that cases of conical cornea should corre¬ 
 spond to this hind of definition, their number would 
 
 z 
 
182 
 
 have been materially lessened; but when the disease 
 is regarded as one which may affect either a part 
 or the whole of the cornea, and in which this tunic 
 may be perfectly transparent, or may be more or 
 less marked by opacity, that which we may call 
 the numerical range of the malady, is, at once, 
 very much extended, while, at the same time, it is 
 obvious, that, if one writer take the former, and 
 another the latter view of what a case of conical 
 cornea is, or should be, the management of the 
 disease, as viewed and treated by such observers, 
 will betray much discrepancy in its results ; and 
 the necessity for such remark is sufficiently apparent 
 if we bear in mind the fact, that, while some of the 
 earlier observers speak of conical cornea as a disease 
 in which the cornea retains its transparency, amongst 
 recent writers, some are to be found who declare, 
 that this tunic is always more or less opaque, when 
 in cases of hyperkeratosis it has assumed the conical 
 form; these two modes of viewing conical cornea 
 have evidently been, in great measure, the source 
 of some of the great differences of opinion which 
 have prevailed with regard to the effects of curative 
 treatment applied to it; for, while it is quite true 
 
183 
 
 that cases of conical cornea do occur without any 
 marked phenomena of keratitis, or other form of 
 ophthalmia, having been previously observed, and 
 in which, for a long time, there may be no loss of 
 transparency in the corneal tunic; other cases are 
 met with in practice, which are evidently the results 
 of well marked, and often long continued inflam¬ 
 matory action, and in these, opacity of the cornea 
 to a greater or less extent may be found to exist; 
 in the first class of cases the whole of the cornea 
 is commonly occupied by the cone, although excep¬ 
 tions may occur; in the second, the conical eleva¬ 
 tion not unfrequently rises upon a part of the cornea, 
 while the curve of the remainder of the tunic is not 
 perceptibly altered in its form; and if further sub¬ 
 division were allowable, it may be remarked, that 
 cases of the first class, in which no loss of transpa¬ 
 rency is commonly observed, are now and then found 
 to pass over, as it were, to the other group; the 
 cornea, in such instances, may have been conical, 
 yet perfectly transparent, for a considerable time, 
 irritation of the eye, with pain, lachrymation, and 
 photophobia, come on, and, afterwards, gradually 
 subsiding, leave opacity of the cornea behind; while 
 
184 
 
 the various causes of such change need not be dwelt 
 upon here ; this alteration, however, from the trans¬ 
 parent to the opaque condition, has been spoken of 
 by some as now and then occurring without any 
 appearance of inflammation : thus Ware remarks, 
 that “ a small speck sometimes forms on the centre 
 of this tunic, without any previous inflammation, in 
 those peculiar cases in which the cornea undergoes 
 a change from its round figure, and assumes a 
 conical or sugar-loaf shape.” 
 
 In some cases of conical cornea the anterior 
 surface of the affected tunic is more or less deprived 
 of its smoothness, little foveae or depressions, varying 
 in number, from one or two, to half a dozen or more, 
 are now and then observed, and may he better seen 
 with the aid of the lens; these, in most cases, seem 
 to be results of ulceration, the remainder of the 
 cornea having its normal aspect, as far as surface 
 and smoothness are concerned. 
 
 In other cases, the surface is irregular as a whole, 
 and when viewed with a high magnifying power 
 looks rougher than the corresponding part of a sound 
 eye; while vestiges of ulceration cannot generally 
 be satisfactorily observed. These conditions, however, 
 
185 
 
 of the corneal surface are by no means peculiar to 
 conical cornea, for they are occasionally observed as 
 results of morbid action, in cases where this tunic 
 has not assumed a conical form. 
 
 Amongst the various constitutional, general, or 
 nervous affections, that have been observed in con¬ 
 nection with conical cornea, hysteria is perhaps 
 worthy of more attention than it has hitherto 
 received ; increased accumulation of the aqueous 
 humour, or hydrops oculi, with alteration in the 
 form of the cornea, has been observed along with 
 severe cases of hysteria, and amongst the records 
 which relate to such observations those of Dr. Bruck 
 have both interest and value, as the three remarkable 
 cases, related in Ammon’s periodical, may show ; 
 which, although not given in connection with conical 
 cornea, are not far from analogies that belong to it. 
 
 There is not, perhaps, any other disease of the 
 organ of vision, which a careful observer would he 
 likely to mistake for conical cornea; in a case of 
 dropsy of the anterior chamber, a little extra caution 
 with regard to diagnosis might be requisite ; but 
 in such instances the anterior part of the eye 
 has commonly an appearance of remarkable ro- 
 
186 
 
 tundity, reminding us of the expression, “ cornea 
 globosa,” rather than of that of “cornea conica,” 
 and, at the same time, that sparkling and bril¬ 
 liant aspect of the eye, so often met with in cases 
 of conical cornea, is generally wanting in those 
 of hydrops oculi; to which it may be added that 
 the diameter of the sclerotic margin of the cornea 
 is often increased along with the general enlarge¬ 
 ment of the tunic in cases of hydrops oculi; a state 
 of things rarely to be observed in connection with 
 conical cornea. 
 
 In some rare cases, where suppuration and ulcer¬ 
 ation have affected the posterior surface of the cornea, 
 and have thus weakened it as a whole, the anterior 
 and yet transparent lamina may project forward, and 
 may assume more or less of the conical shape; 
 this form of disease, if called conical cornea, should 
 be qualified by the expression, consecutive, or, at any 
 rate, distinguished from cases that are not preceded 
 by the ordinary phenomena of inflammation, as well 
 as from those that follow conjunctival ophthalmia, or 
 affections of the anterior part of the cornea. 
 
 Conical eye-ball is occasionally met with; in 
 which the sclerotic tunic appears lengthened or pro- 
 
187 
 
 longed anteriorly ; its shape, in some measure, 
 resembling that of the wider part of a funnel, on 
 the smaller or anterior extremity of which the cornea 
 is, as it were, fitted; the appearance of the eye in 
 these cases might be compared to that observed 
 in the organ of vision of raptorial birds) but the 
 form alluded to, as observed in the human being, 
 is generally a consequence of chronic inflammation, 
 frequently of syphilitic character ; in such cases 
 vision is generally destroyed, and the appearance 
 of the malady has nothing which we could regard 
 as very similar to conical cornea. 
 
 The eye, in cases of conical cornea, when looked 
 at in front, has often a bright, but, as it were, watery, 
 and, hence, deceptive appearance, mainly from the 
 optical effect of the prominent, transparent, and 
 conical tunic; this appearance, if but slightly noticed, 
 might be mistaken for lachrymation, and thus its 
 real cause, and the true nature of the complaint, 
 overlooked; so that while it is not easy to mistake 
 any other malady for conical cornea, it is not so 
 difficult to overlook conical cornea, thinking some 
 other affection, and that alone, to be present. 
 
 The following is a remarkable case of conical 
 
188 
 
 eye-ball, and seems worthy of notice in this place, 
 helping, as it does, to illustrate some of the points 
 of difference between conical cornea, and conical 
 eye-ball. 
 
 P. C., set. 24, a strong young man, with grey 
 iris, got syphilis nine months ago, for which, during 
 two mouths, he had no medical treatment. 
 
 Four months ago, he had iritis on the right side, 
 and one month ago, the same complaint on the left 
 side; the left sclerotic seeming to suffer much at the 
 same time; this tunic, the left sclerotic, appears now 
 to have been thinned at its anterior part, and, as it 
 were, stretched forward, so as to have lifted onward, 
 or forward, the cornea connected with it; hence, at 
 present, the eye, in figure, might be compared to an 
 egg, one end of which is relatively very small, with 
 the cornea fitted as a sort of dome upon this small 
 end, the cornea all the while preserving its normal 
 form; it is very remarkable that, as nearly as could 
 be ascertained by careful measurement, the most 
 anterior part of the cornea in the eye affected, is 
 half an inch in advance of the corresponding part 
 on the opposite side. The patient sees the light, 
 but cannot distinguish any object; the iris is pushed 
 
189 
 
 forward, so as to be rounded on the fore part; the 
 pupil is irregular, and fixed, the cornea somewhat 
 hazy. When the eye is closed, the lids seem much 
 on the stretch; when opened, a great portion of 
 sclerotica is seen, presenting an appearance very 
 different from what is commonly observed in cases 
 of conical cornea. 
 
 The diagnosis of some diseases of the eye may be 
 facilitated by the study of good drawings, which 
 represent them; and many works, both English and 
 Foreign, on ocular maladies, contain representations 
 of conical cornea, which give an accurate idea of the 
 form of the cornea, when seen sideways; but that 
 peculiar and brilliant appearance of the front of the 
 eye, which is often met with in cases of true conical 
 cornea, is somewhat beyond the reach of the art of 
 the draftsman; inasmuch as the difficulty here to be 
 overcome by the pencil is not unlike that which 
 would be encountered in attempting the pictorial 
 representation of the diamond; nevertheless a fac¬ 
 simile of conical cornea may be produced in the 
 artificial eye, the general resemblance of which to 
 the diseased condition of the living organ is 
 peculiarly striking. 
 
 A A 
 
190 
 
 The lamented Dalrymple lias shown how much 
 can be done in the pictorial representation of mor¬ 
 bid conditions of the eye ; and the beautiful u Icono- 
 graphie ” of M. Sichel, now in course of publication, 
 and with improvements upon former sketches of the 
 cornea, seems destined to place England and France 
 side by side, and unrivalled, in this department 
 of art. 
 
 In the attentive observation of the artificial eye, 
 I have more than once noticed, that the glancing, 
 brilliant appearance, often characteristic of conical 
 cornea, is seen on the artificial piece, if the curve 
 of the part representing the cornea should happen to 
 be irregular, or the surface itself such as approaches 
 the polyhedral form ; besides which, it may be 
 remarked, that the slightest approach to the form 
 of conical cornea, in the artificial eye, is sufficient 
 to betray the non-natural character of the part, by 
 a peculiar glancing appearance, not seen in the 
 opposite organ, and which, in some instances, 
 is the first source of the discovery that a person 
 has really availed himself of the aid of ocular 
 prothesis. 
 
 If a simple and perfectly transparent cone of 
 
191 
 
 glass be fashioned in imitation of pellucid ana 
 conical cornea, it may be held before the healthy 
 eye, when objects looked at are confused, and cannot 
 be distinguished ; and the confusion and indistinct¬ 
 ness are rendered greater if a bi-concave lens be 
 held before the transparent cone ; but if, instead 
 of this, a bi-convex lens he held in front of the 
 cone of glass, objects again become visible ; and 
 the effect, as far as I have observed, is not mate¬ 
 rially altered by introducing, within the cone of 
 glass, a transparent piece, to represent the crystal¬ 
 line lens. 
 
 Side by side with this fact, it may be mentioned 
 that Dr. Hull, in his work on the “ Morbid Eye,” 
 says, in allusion to conical cornea,— 
 
 “ In as bad a case as I ever saw, I have known 
 most benefit received through an instrument made 
 by a Mr. Abraham, an optician, in Bartlett Street, 
 Bath. It is formed of two lenses, with an adjust¬ 
 ment. The farthest and largest lens is convex. 
 The lens near the eye is smaller, and doubly 
 concave.” 
 
 This instrument may be modified by an addi¬ 
 tional concave lens, of small size, and fitted in an 
 
192 
 
 opaque circle, wide enough to act as a diaphragm ; 
 the apparatus mounted in this way is made hy Mr. 
 Abraham, of Liverpool. 
 
 For the purposes of the ophthalmologist, it is 
 obvious that a variety of lenses must occasionally 
 be tried, so that the frame should be so constructed 
 as to allow of their removal and change. 
 
 In the instruments I have seen, the adaptation 
 of the convex lens is effected by means of a spring 
 slide, passed into a hole, at one, or both ends of the 
 spectacle frame, outside, but near to the hinge joint; 
 if one eye only is affected, the corresponding side 
 of the spectacles is fitted with the two lenses; if both 
 eyes suffer, lenses, and combinations of lenses, 
 should be very patiently tried for both, in different 
 distances, positions, and inclinations, and the frame 
 fitted up accordingly. It has appeared to me, that 
 a very delicate rack movement might be employed, 
 instead of the slides, with the aid of which the 
 patient would command a smoother and more precise 
 adjustment. With many patients, the first trial 
 with this sort of instrument will be likely to fail; 
 for the eye becomes fatigued before the desired 
 combination is hit upon; but by trials repeated at 
 
193 
 
 suitable intervals, varied, and patiently sat down to, 
 in some instances good will be done. 
 
 Neither transplantation nor glazing of the cornea 
 seems to have been seriously thought of in this 
 country, as ever likely to repay the trouble and 
 suffering associated with their performance ; if such 
 operations were really capable of supplying a trans¬ 
 parent front to the eye, devoid of annoyance, and 
 of which the patient could avail himself in vision, 
 their repetition would, doubtless, be desirable, and 
 cases of conical cornea, accompanied by opacity, 
 might occasionally lend themselves to the attempt; 
 but with regard to results of practice in this depart¬ 
 ment of art, the expectations of surgeons are not yet 
 likely to be very sanguine. 
 
 Transplantation, as recommended by Himly, has 
 been essayed in Germany, France, America, and 
 other countries, and has everywhere failed in restor¬ 
 ing sight to the blind. 
 
 It is true that a piece of the human cornea, when 
 opaque, may be cut off ; and a piece of correspond¬ 
 ing size taken from the healthy cornea of a dog, 
 pig, or other animal, with an apparently suitable 
 eye, may be put on, as a substitute, and united by 
 
194 
 
 two or more sutures, and uuiou of the adjusted 
 parts may follow, and for a few days the engrafted 
 piece of cornea may retain more or less of its trans¬ 
 parency, hut, in most cases, this is afterwards lost; 
 sometimes with, sometimes without, shrivelling of 
 the part. The accidents associated with imperfect 
 union, or with total failure of union, and suppura¬ 
 tion of the eye, need not be further alluded to 
 here: these, however, are by no means unfrequent, 
 as, by experimental inquiry in animals, I have 
 more than once found. 
 
 I have taken the liberty of employing the expres¬ 
 sion of “ glazing the cornea,” for the operation 
 proposed by Nussbaum, and which he has practised 
 upon rabbits, and with results which he seems to 
 regard as worthy of the attention of ophthalmologists. 
 
 A sort of glass button is prepared, with two little 
 otf-sets, or folds, to enable it to hold on, and be 
 steady in the cornea ; a short transverse incision 
 is made in the cornea, and the glass piece, as it 
 were, buttoned in; and that this can be done without 
 any after and long-continued irritation of the eye, 
 the bit of glass remaining fixed and steady, is 
 proved, as Nussbaum says, by his living rabbits 
 
195 
 
 which wear it; while he further remarks, that the 
 appearance of the thing is by no means bad. 
 
 “ Dass Anselien eines also bewaffneten Auges is 
 kein besonderes hassliches.” 
 
 With respect to such a matter, however, tastes 
 may vary. 
 
 If the foreign body, employed in the manner 
 described by Nussbaum, can be worn with impunity, 
 and even without apparent annoyance, the fact is 
 certainly interesting, and the curious in researches 
 of this kind might perhaps be disposed to repeat his 
 inquiries; but we feel satisfied that, in the human 
 subject, the glazing of the cornea would not be 
 tolerated; so that it need not here be proposed as a 
 remedial agent in cases of conical, or conical and 
 opaque cornea. 
 
 Causes that act on the anterior surface of the 
 cornea seem now and then to alter the form of this 
 tunic by thickening it, while those that influence 
 its posterior aspect, in the first place, occasionally 
 change its figure, by pushing a part, or the whole 
 of it, forward; illustrations of this truth are now and 
 then met with in practice, and the following may be 
 shortly noticed. 
 
196 
 
 R. F., a young man of 18, has had trichiasis 
 and entropion of the lower lids during the last six 
 years, which followed an attack of ophthalmia brought 
 on by frequent wetting of the feet. 
 
 Jn the left eye, whicli was more affected than 
 the right, the entropion has been removed, by divi¬ 
 sion of the orbicularis muscle; and the malady on 
 the opposite side has yielded to treatment without 
 the employment of the knife, and hence by the 
 removal of the palpebral irritation, the morbid condi¬ 
 tion of the eye is lessened, and the vision considera¬ 
 bly improved, but the corneae are thickened, more 
 especially in the middle, (from the effects of the 
 long - continued inflammatory action, produced by 
 the tarsal margins and ciliae,) and hence present 
 a marked conical form, which is easily seen in lateral 
 view; this, as well as the next case of alteration in 
 the form of the cornea, from a cause acting in front, 
 may be contrasted with the case, next hut oue, where 
 the morbid agency which affected the figure of this 
 tunic evidently operated behind it. 
 
 One of the most remarkable cases of conical 
 cornea, from injury, which has come under my 
 observation was that of a miner, set. 33, from the 
 
197 
 
 neigbourhood of Wigan, who lost the sight of both 
 eyes from an accidental injury, about three years 
 before I saw him; in blasting stone, some portions, in 
 flying off, struck his face; both eyes were injured, and 
 afterwards became, the one sunk and flattened, the 
 other prominent and conical, from hypertrophy of the 
 corneal tissue, which looked as if an additional layer, 
 of new and opaque growth, had been placed upon the 
 central part of the cornea. Total blindness prevailed. 
 
 Morbid conditions of the posterior surface of the 
 cornea are not necessarily associated with the occur¬ 
 rence of any conicity, or even of any forward promi¬ 
 nence of the tunic, for, in cases of tuberculosis of 
 the membrane of Decemet, we may occasionally 
 watch the progress of the affection up to the effusion 
 of a crescent of purulent matter in the space between 
 the lower part of the cornea and the corresponding 
 portion of the iris, without any bulging forward of the 
 transparent front of the eye; it should, however, be 
 borne in mind, that this is not the case in every 
 instance, inasmuch as a thinning, weakening, and 
 bulging of the cornea may be a consequence of 
 ulceration and suppuration occurring at its back part, 
 which, in some instances, leads to conical prominence 
 
 B B 
 
198 
 
 of the whole, or of a part, of the corneal tunic; but 
 this state of things, as previously remarked, should 
 not be regarded as belonging to that disease to which 
 the name conical cornea is more especially applied; 
 besides which, in cases such as those here alluded to, 
 conicity, or even prominence of the cornea, is rather 
 the exception than the rule ; for while the degenera¬ 
 tion at the back part of the cornea is in progress, 
 some degree of flattening of the front of the eye not 
 unfrequently takes place, a remai'kable illustration 
 of which has recently come under my observation. 
 In the following case the alteration in the form of 
 the cornea evidently depended upon causes operating 
 behind it. 
 
 Mrs. M., aet. 60, had very good sight until about 
 the age of 53, when the right eye became “ weak,” 
 and two years later, after an attack of influenza, was 
 found to suffer from cataract, and at the time when 
 cataract was discovered in the organ of the right side, 
 the left was free from any visible opacity of the len¬ 
 ticular apparatus, but its vision, although clear and 
 distinct, was peculiarly short ; and it was not until 
 eighteen months afterwards that opacity of the lens 
 occurred in the left eye. 
 
199 
 
 The patient first discovered her shortness of sight 
 with the left eye when in church, by finding that she 
 could not see a person across the aisle in an opposite 
 pew, while those in the pew joining her own were 
 distinctly seen; and at this time she found that she 
 could read without spectacles the very smallest of 
 type, and could clearly discern minute objects, 
 which, during the former and healthy state of her 
 vision, she was unable to perceive. 
 
 At this time her medical attendant observed, that 
 the cornea on the left side was peculiarly prominent, 
 evidently more so than that of the right; and it is 
 not less worthy of remark, that this prominence of 
 the cornea gradually increased, and as gradually the 
 myopia became more extreme. Somewhat remark¬ 
 able as it may seem, it is stated, as the result of most 
 careful observation, that the prominence of the 
 cornea in this case was subject to variation, the 
 extremes of which, in elevation or depression, were 
 seen by the naked eye, and accompanied by corre¬ 
 sponding alterations in tlie myopia. I found both the 
 cataracts hard, at the time of the operation by which 
 sight was restored. 
 
 In the myopia which occasionally precedes the 
 
200 
 
 occurrence of cataract, visible alteration in the form 
 of the cornea is commonly absent; the case just 
 stated may be regarded as an extreme form of this 
 affection, which has beeu attributed to diminution 
 of the volume of the vitreous humour, and conse¬ 
 quent projection of the cornea from the action of the 
 recti muscles, pressing upon the hinder and less 
 distended part of the eye-ball; also to increase in 
 the density of the crystalline lens, and might possi¬ 
 bly be associated with slight alteration in the volume 
 of the eye-ball as a whole, or with the effects pro¬ 
 duced upon the eye by the habitual use of lenses, 
 or by new modes of using the organ which its modi¬ 
 fied vision had brought into practice. 
 
 It seems especially worthy of remark, that in 
 this instance, the myopia could be accounted for by 
 a physical condition clearly seen by the naked eye ; 
 and, inasmuch as the state of the cornea sufficiently 
 explained the shortness of sight, any possible change 
 in the structure of the lens did not require to be taken 
 much into account when the causes of the affection 
 were considered; in addition to which it may be 
 remarked, that at the time when this myopia occurred 
 iu the left eye, there was not the slightest visible 
 
201 
 
 opacity of any part of the lens through which vision 
 was exercised, and the patient herself spoke of the 
 remarkable clearness of her sight, at this time, in 
 very strong terms. 
 
 There was no cough, or other morbid condition 
 of the apparatus of breathing, or circulation, likely 
 to disturb or alter the organ of vision; the influences 
 of which, in connection with prominent and conical 
 cornea, are worthy of attention. 
 
 A study of the mode of occurrence of such a change 
 in the cornea, seems to lead to some interesting con¬ 
 siderations not unconnected with the subject of hyper¬ 
 keratosis; for it is probable that some alteration in the 
 nutrition of the ocular humours was the cause of the 
 change in figure which, in this case, the cornea 
 assumed, and it is not difficult to imagine that, in a 
 case of conical cornea, the first alteration of this tunic 
 might be in its bend, or in the form of its curve, 
 only, while it might afterwards undergo some change 
 in density, or thickness, more especially at the centre, 
 not so much at first, perhaps, from being put on the 
 stretch, as from the subsequent effect produced on 
 its nutrition by the physical alteration which it had 
 undergone; while the next question in the progress 
 
202 
 
 of inquiry seems to relate to the condition of the 
 vascular and nervous system of the eye in which 
 such changes have taken place; and of this inquiry, 
 that part which belongs to the nerves that preside 
 over the nutrition of the eye-ball is perhaps the most 
 important; a remark which leads us to the addi¬ 
 tional observation, that the fifth pair, and sympathetic, 
 have an especial claim on our attention in connection 
 with this interesting subject. 
 
 Dr. Pickford’s opinion respecting the mode of 
 origin of conical cornea is thus expressed : 
 
 “ 1 believe conical cornea to depend upon some 
 disturbance in the function of the great sympathetic, 
 spinal nerves, and par vagum; producing, tlTrough 
 the medium of the lenticular ganglion and fifth pair 
 of nerves, faulty action of the nutrient capillaries 
 and absorbent vessels of the cornea itself ; ”— and 
 in the valuable “ Manual of Physiology,” of Kirkes 
 and Paget, we have the following anatomical obser¬ 
 vation closely connected with this matter : 
 
 “ The existence of ganglia of the sympathetic 
 in connection with all the principal divisions of the 
 fifth nerve, where it gives off those branches which 
 supply the organs of special sense ; for example, 
 
203 
 
 the connection of the ophthalmic ganglion with the 
 ophthalmic nerve at the origin of the ciliary nerves; 
 of the sphenopalatine ganglion with the superior 
 maxillary division, where it gives its branches to the 
 nose and palate ; of the otic ganglion with the 
 inferior maxillary, near the giving off of filaments to 
 the internal ear; and of the submaxillary ganglion 
 with the lingual branch of the fifth;—all these con¬ 
 nections suggest that a peculiar and probably conjoint 
 influence of the sympathetic and fifth nerves is exer¬ 
 cised in the nutrition of the organs of the special 
 senses; and the results of experiment and disease 
 confirm this, by showing that the nutrition of the 
 organs may be impaired in consequence of impair¬ 
 ment of the power of either of the nerves.” 
 
 The results of the experiments of Hannover upon 
 the cervical ganglia of the sympathetic, which have 
 been already noticed, seem favourable to the views 
 above expressed, while the observations made by 
 Budge in his more recent experimental inquiry have 
 an opposite tendency; this distinguished physiologist 
 removed the superior cervical ganglion of the sympa¬ 
 thetic, from both sides of the neck, in a female rabbit, 
 on the 24th February 7 , 1853 ; the animal soon 
 
204 
 
 recovered from the operation, without any apparent 
 defect of nutrition, and, in the following June, 
 brought forth six young ones, which she suckled and 
 reared quite well; so that the removal of the ganglion 
 in question seemed not to have affected the nutrition 
 of any one of the seven. 
 
 A case of synchisis, with spontaneous dislocation 
 or absorption of the lens, has been already related in 
 the foregoing pages, in some measure for the purpose 
 of directing attention to the state of the refracting 
 apparatus of the eye generally, in altered conditions 
 of the vision ; and it seems worthy of remark, that 
 in all cases of alteration in the form of the cornea, 
 but more especially when this tunic remains per¬ 
 fectly transparent, so as to facilitate the examination 
 of the deeper parts of the eye, the condition of the 
 lenticular apparatus should be especially observed, 
 in illustration of which the following case may be 
 shortly related: 
 
 Mr. S., ffit. 35, a military man, on entering a 
 room appears to be very nearly blind ; his loss of 
 sight is the result of three attacks of ophthalmia, in 
 1841, 1842, and 1844; for each attack he took mer¬ 
 cury. The left eye being altogether lost, as to vision, 
 
205 
 
 iieed not be particularly noticed, but the pathologic 
 condition of the light eye is peculiarly interesting, 
 more especially in connection with the history of the 
 changes which it seems to have undergone. 
 
 At the commencement of the present year (1853), 
 he had already been blind of the right eye during 
 eight years, and he now gradually lost the sight of 
 the left, and, as gradually, some sight in the right 
 eye returned. 
 
 The question naturally arises, what was the 
 nature and cause of the right side blindness, and 
 how was it removed P 
 
 The answer to this question is perhaps more 
 satisfactory than might at first be expected; for, on 
 careful examination of the eye, it is evident that the 
 crystalline lens no longer exists in front of the 
 vitreous humour ; it seems probable therefore that 
 a diseased and opaque condition of the lenticular 
 body had shaded the retina from the light; but that 
 afterwards the morbid changes in the lenticular 
 apparatus, and perhaps also in the vitreous humour, 
 had led to the dislocation, the absorption, or to both, 
 of the lens and capsule; after which there no longer 
 remained an opaque centre between the anterior and 
 
 c c 
 
206 
 
 posterior humours of the eye, so that the retina could 
 again be reached by the light; although itself not in 
 a perfectly healthy state. 
 
 The cornea, in front, has a watery and brilliant 
 aspect, and, when viewed sideways, an unusual 
 degree of prominence is observed; and a deep con¬ 
 cave lens being placed before the eye, the patient is 
 surprised at the improvement in his sight. Here we 
 have a case of prominent cornea, although not a 
 case of true conical cornea, where nature seems to 
 have performed the experiment which Sir W. Adams 
 and others have recommended, viz , the operation for 
 causing the absorption of the crystalline lens; but 
 nevertheless, the undue refraction of the rays of 
 light continues, and the concave glass is required. 
 The absence of the lens was determined by the 
 usual optical tests; and, as the patient formerly 
 enjoyed normal vision, its previous existence need 
 not be doubted. 
 
 In a remarkable case which came lately under 
 my notice, a young man was thrown, at five o’clock 
 in the afternoon, from the shaft of a cart, upon which 
 he was riding; he appeared to have suffered from 
 a kind of general concussion without having received 
 
207 
 
 any injury of importance on the exterior of the body; 
 soon after eight o’clock in the evening, he vomited 
 a great quantity of “pure blood,” and an hour later, 
 a second, and similar, attack of haematemesis 
 occurred: on the morrow some general indisposition 
 and headache prevailed, and, after ten days, internal 
 strabismus on the right side came on ; I saw him 
 ten weeks after the accident, when the squinting was 
 strongly marked, and the vision of the affected eye 
 seriously impaired ; it was, however, very gratifying 
 to find that, with the aid of a convex lens of 
 36 inches focus, the defect of vision was removed. 
 
 Here two very interesting considerations present 
 themselves; one relating to the cause of the mus¬ 
 cular deviation of the eye ; the other relating to 
 the cause of the defect of vision. 
 
 Gastric and intestinal irritations, of spontaneous 
 origin, are known to disturb the condition and func¬ 
 tions of the eye, and it seems reasonable to suppose 
 that a corresponding morbid change, although of 
 accidental occurrence, might tell upon the state 
 of the visual apparatus, through the medium probably 
 of the par vagum and sympathetic, to say nothing 
 of the indirect connection or continuity of the 
 
208 
 
 mucous membrane of the digestive tube with that 
 of the palpebrae aud front of the eye; this therefore 
 may be regarded as one imperfect manner in which 
 it seems not unreasonable to account for the occur¬ 
 rence of the strabismus. 
 
 There is little doubt that the normal and well- 
 balanced action of the ocular muscles exerts some 
 influence on the form, as w r ell as on the position, 
 of the eye-ball; and that, when the globe of the 
 eye is habitually turned far inwards, the traction and 
 pressure exerted upon it, by the united influence 
 of the recti, is unfavourable to the ordinary promi¬ 
 nence of the central part of the cornea, which may, 
 in consequence, lose somewdiat of its rotundity, 
 however infinitesimal such loss may be, or however 
 incapable of being determined by tbe unassisted eye 
 of the observer; in this way a slight diminution of 
 the refractive power of the eye, as w r ell as its com¬ 
 pensation by the convex lens, may be accounted for; 
 it is, however, to be borne in mind, that in some of 
 these cases, the nervous, as w r ell as the optical or 
 refracting, apparatus undergoes some alteration ; the 
 changes, nevertheless, which take place in the latter, 
 seem w'orthy of especial attention. 
 
209 
 
 In this case a large blister was applied to the 
 region of the stomach, and the surface for some 
 days kept in an irritated condition, by dressing with 
 an ointment containing a small quantity of the 
 Spanish fly; and afterwards allowed to heal, along 
 with the application of a weak unguent of bella¬ 
 donna ; the patient took a pill containing the twen¬ 
 tieth part of a grain of strychnia three times a day, 
 during a fortnight, the sound eye being bandaged 
 all the while ; decided benefit resulted from this 
 treatment ; the vision has improved, and the squint¬ 
 ing, now barely perceptible, is likely, by persever- 
 ence in treatment, to vanish without the aid of 
 surgical operation. 
 
 As in cases of squinting, with altered vision, 
 we hope to improve the sight by restoring the 
 balance of muscular action ; so, on the other hand, 
 in cases of myopia, if not of conical cornea, lessen¬ 
 ing the effect of the forward pressure of the ocular 
 muscles, by tenotomy, so as to prevent further 
 lengthening of the eye, anteriorly, or bulging of the 
 cornea, may, at least, be thought of. 
 
 Division of the recti muscles of the eye is, 
 perhaps, not unworthy of notice, in connection with the 
 
210 
 
 treatment of the early stage of some cases of conical 
 cornea; the section of two opposite tendons, at the 
 same time, leaving the remaining two for after 
 consideration, is the proceeding which suggests 
 itself as amongst the least objectionable; it should, 
 however, be mentioned that, so long as the ocular 
 affection is capable of being relieved by glasses, the 
 proposal of such an operation is likely to be post¬ 
 poned, more especially as the undue prominence 
 of the cornea is, perhaps, in most cases, in a great 
 measure, if not altogether, independent of abnormal 
 muscular action. 
 
 A transatlantic invention for altering the form of 
 the cornea, and thus removing defects of vision 
 depending upon its flattened state, has lately been 
 introduced to the notice of the Americans; if it have 
 the effect ascribed to it, of rendering the cornea 
 more convex, it is worthy of consideration whether, 
 in any case, it might bring it into the conical form ; 
 for various reasons, however, we think that in this 
 respect it is not to he feared. We proceed to the 
 notice of it with all requisite apology. 
 
 It is “ an invention of a simple character, by the 
 use of which the sight may be preserved through 
 
211 
 
 life without the use of glasses, or it may be restored 
 after glasses have been worn many years.” 
 
 “ This wonderful effect is produced by an instru¬ 
 ment, philosophically constructed, by which the cornea 
 of the eye is gradually raised to its original con¬ 
 vexity, causing the focus to impinge on the retina 
 without the aid of convex lenses.” 
 
 Two such instruments are employed, and are 
 called “ Eye-cnps.” They resemble the instrument 
 employed in this country for dry cupping, or for 
 application to the female breast, hut are, of course, 
 smaller; consisting of a hollow" sphere of india rubber, 
 very much like that used here as a toy, to which is 
 connected a cup of hard wood, in shape like the 
 receiving part of an egg-cup, the interior of the 
 two communicating, so that, if the india rubber hall 
 be first pressed, and then the edge of the wooden 
 cup be applied to the cheek, closed eyelids, or other 
 part, the sudden expansion of the caoutchouc sphere 
 permits the rarefaction of any atmospheric air which 
 is confined in the apparatus beneath it, and hence 
 of the suction effect. The “ Directions for using the 
 cups” are given as follows : 
 
 “ After pressing a portion of air from the rubber 
 
212 
 
 ball, place the cup centrally over the eye with the 
 lid closed, and then allow the rubber gradually to 
 expand. Occasionally press the cup with the fingers 
 upon the eye as much as can be borne without pain. 
 The first week the cup should be used every night, 
 not exceeding five minutes. The second week the 
 applications may be increased to ten minutes every 
 night. Contiuue using the cups ten minutes at 
 each application, until the sight is fully restored .” 
 
 Respecting these instruments, one American 
 medical writer thus expresses himself : 
 
 “ They are well calculated for that condition of 
 the eye—too great flatness of the globe—which is a 
 frequent cause of imperfect vision, and for chronic 
 weakness of the eye from deficient circulation.” 
 
 One case in which these cups had been used 
 came under my observation ; the patient was a 
 mercantile gentleman, of middle age, who suffered 
 from a defect of vision, which he was led to believe 
 would be remedied by the employment of the new 
 invention ; he applied the cups in America, just as 
 he was about to cross tbe Atlantic; the effect they 
 produced was a black-red state of ecchymosis sur¬ 
 rounding the cornea, from blood extravasated appa- 
 
213 
 
 rently between the conjunctiva and sclerotic, accom¬ 
 panied with much uneasiness and inability to employ 
 the eyes as usual; this state prevailed during the 
 few days occupied in steaming across to Liverpool, 
 where it gradually disappeared after the employ¬ 
 ment of astringent collyria along with a little general 
 treatment. 
 
 It is probable that, in this case, the cups were 
 not at first emplo3^ed with sufficient caution; the 
 result, however, which the patient arrived at, points 
 out one method of exciting the circulation of the 
 eye, if this were ever desirable, by removing a little 
 of the atmospheric pressure from the front of it; 
 but it is especially worthy of remark, that, although 
 so much effect was produced upon the circulatory 
 apparatus of the organ of vision, no phenomenon 
 was met with which conld be referred to alteration 
 in the figure of the cornea. 
 
 d n 
 
214 
 
 It was previously observed, that conical cornea has 
 been spoken of as more common in China than 
 elsewhere, hut that, as the malady appears not 
 unfrequently to he a consequence - of inflammatory 
 action, it is worthy of remark, that its frequency 
 in certain warm countries is perhaps to be accounted 
 for by the greater prevalence of the ophthalmice of 
 those regions ; and this, I have lately been able, 
 in some measure, to verify, by the examination 
 of notices relating to this subject, which were 
 published at Canton in 1841. 
 
 In the “Chinese Repository” for 1841, vol. x., 
 Mr. Lockhart has given a list of cases of disease of 
 the eye, which were treated at the Hospital of 
 Chusan, of which the following is a copy. 
 
215 
 
 HOSPITAL OF CHUSAN, 
 
 Register of Cases from Sept. 23 rd, 1810, to Feb. 0.0th, 1841. 
 
 “ Diseases of the Ete and its appendages. 
 
 Abscess on Eyelid . 3 
 
 Hordeolum . 3 
 
 Small tumour of lid. 1 
 
 Ulcer of lids . 1 
 
 Inflammation of Meibomian glands. 1 
 
 Trichiasis.144 
 
 Entropium (operated on 22) 70 
 
 Ectropium. 35 
 
 Contraction of tarsi. 40 
 
 Contraction of tarsi (after native operation for 
 
 entropium) . 24 
 
 Lippitudo... ... 95 
 
 Conjunctivitis . 20 
 
 Catarrhal ophthalmia, severe .134 
 
 Chronic ophthalmia. 8 
 
 Granular lids, slight opacity .220 
 
 Granular lids, with much opacity . 30 
 
 Pterygium (operated on 6) 146 
 
 Contraction of puncta lachrymalia. 1 
 
 Ulceration of cornea, slight . 80 
 
 Ulceration of cornea, severe . 51 
 
 Opacity of cornea .. ... 311 
 
 Opacity of cornea, very dense. 8 
 
 Staphyloma . 12 
 
 Abscesses of eyelids and scalp, causing great con¬ 
 traction of eyelids, and loss of vision . 1 
 
 Loss of vision in both eyes, from dense vascular 
 
 opacity of cornea . 2 
 
 Brought flown . 1441 
 
216 
 
 Brought over . 1441 
 
 Loss of vision in one eye, from entropium . 1 ^ 
 
 Loss of vision iu both eyes, from entropium . 8 
 
 Loss of vision in one eye, from opacity of cornea ... 18 
 
 Loss of vision in both eyes, from opacity of cornea... 10 
 Loss of vision iu one eye, sloughing cornea, from 
 
 catarrhal ophthalmia. 16 
 
 Loss of vision in both eyes, sloughing cornea, from 
 
 catarrhal ophthalmia. 8 
 
 Hernia iridis of one eye. 6 
 
 Hernia iridis of both eyes . 2 
 
 Closure of pupil, by lymph . 1 
 
 Contraction of both pupils to a point . 1 
 
 Synechia anterior . 4 
 
 Synechia posterior . 8 
 
 Cataract, leuticular. 6 
 
 Cataract, capsular . 5 
 
 Amaurosis. 4 
 
 1554” 
 
 Of these 1554 cases, it is very remarkable that 
 more than 1500 are diseases either of the cornea 
 
 itself, or of parts in connection with the morbid 
 condition of which the cornea is likely more or less 
 to suffer; the list, nevertheless has not one case of 
 conical cornea; but the absence of this affection iu 
 one particular report need not be especially insisted 
 upon, if its frequency, as noted in others, be well 
 established. 
 
 In the 342 cases given in Dr. Hobson’s 
 
217 
 
 register, there is only one case of conical cornea, 
 while about 260 cases of the list are corneal, or 
 circum-corneal, affections. 
 
 Mr. Lockhart attributes the great frequency of 
 diseases of the eye, in the Chinese who came under 
 his observation, mainly, to two causes, first, — to 
 inflammation of the organ from exposure to the 
 northerly and north - easterly winds, in October, 
 November, and December, and its consequences; 
 secondly,—to the injurious effects of an every-day 
 practice of the Chinese barbers, who cleanse or 
 “wash” the eyes of the people with an ivory or 
 bamboo instrument, shaped like a small scoop, which 
 they pass under the lids and deeply into the canthi; 
 this “ operation ” leaves the eye red and irritated, 
 and as if to make the worst of it, the irritation of 
 the eye is but too often attributed to an inade¬ 
 quate cleansing, whence the repetition of the bar¬ 
 barous process, and the additional mischief which 
 follows it. 
 
 In Dr. Hobson’s “ Register of Diseases attended 
 to in M. M. S. Hospital, at Macao, from August, 
 1840, to July, 1841,” the “Diseases of the Eye” 
 stand as follows: 
 
218 
 
 “ Catarrhal ophthalmia . 35 
 
 Chronic ophthalmia. 21 
 
 Conjunctivitis, acute and chronic, . 38 
 
 Cataract . 22 
 
 Entropium . 16 
 
 Ectropium . 4 
 
 Granular lids . 43 
 
 Opacity of cornea- . 35 
 
 Ulcers of cornea . 8 
 
 Staphyloma . 5 
 
 Pterygium. 28 
 
 Leucoma . 10 
 
 Trichiasis. 15 
 
 Amaurosis. 12 
 
 Epiphora. 6 
 
 Hypopium. 3 
 
 Glaucoma. 1 
 
 Iritis. 6 
 
 Nyctalopia . 4 
 
 Synechia posterior . 1 
 
 Closure of pupil . 2 
 
 Loss of vision. 11 
 
 Diseased eyelids . 11 
 
 Conical cornea. 1 
 
 Ptosis . 1 
 
 Tumour of upper lid. 1 
 
 Enlarged caruncula. 1 
 
 Abscess of lachrymal sac. 1 
 
 342” 
 
 Amid these united groups of 1896 cases of 
 diseases of the eye, only one case of conical cornea 
 is found; indirectly, however, the tables are very 
 
219 
 
 interesting, showing, as they do, the great propor¬ 
 tion of diseases of the anterior part of the eye, and 
 of the lining of the eyelids, amongst the ophthalmic 
 affections of this part of the eastern world; no one 
 can look over these lists without noticing how much 
 the cornea must suffer in several of the diseases 
 above named, so that, if conical cornea occur more 
 frequently in China than in some other coun¬ 
 tries, where it has been observed, it is probably, 
 not because there is anything there, which is 
 especially favourable to this 'particular malady of 
 the tunic, hut rather, because circumstances favour 
 the occurrence of diseases of the cornea in general, 
 amongst which, some cases of conical cornea will as 
 certainly occur in China as in Egypt or elsewhere. 
 
 The Chinese expression “ Gan Fa,” or “flowered 
 eyes,” is used in the Canton dialect to denote 
 dimness of sight, (Morrison,)—a form of speech not 
 unlikely to he adopted by a people amongst whom 
 opacity of the cornea is often observed ; inasmuch 
 as it does not seem to be one of those figurative 
 expressions of Chinese politeness framed for doing 
 honour to old age. 
 
 Pathological facts, such as some of the foregoing, 
 
220 
 
 are undoubtedly favourable to the opinion entertained 
 by Jaeger, Jacobs, and others, that conical cornea is 
 frequently observed as a consequence of keratitis, 
 and further, tend to suggest the question, as to 
 whether, or no, the inflammatory condition is not 
 always a precursor of the alteration in form which 
 the cornea, in such cases, undergoes; many cases 
 of conical cornea have, without doubt, been observed, 
 in which no inflammatory action was present, or had 
 been previously recognized ; but in others, the 
 practitioner has had good reason to suspect the 
 previous existence of keratitis, the more active 
 phenomena of which had already passed away. 
 
 Conical cornea, as occurring in China, has 
 been alluded to as possibly connected with the 
 “pyramidal” or “conical” head of the Chinese 
 people; in connection with which the question might 
 well be asked,—Have the Chinese, generally, a 
 conical or pyramidal head, in those parts of the 
 empire where conical cornea has been observed ? 
 I am not able to answer this question in a very 
 positive manner; but may state, that, by one gen¬ 
 tleman, who has had good opportunities of observa¬ 
 tion, in those parts of China which are visited by 
 
221 
 
 the English, I am told, that such is not the case. 
 It is true that some ethnographers speak of the 
 Mongols (a name, as Dr. Prichard observes, very 
 vaguely employed) as a people in whom “the fore¬ 
 head is low and slanting and the head altogether 
 of a square form,” (Lawrence;) but it should be 
 borne in mind, that the form of the head which they 
 exhibit “ belongs to many very distinct and widely- 
 separated human races,” ( Prichard,) amid most of 
 whom conical cornea has yet to be studied; besides 
 which, if conical cornea were any natural or neces¬ 
 sary associate of conical cranium, or if the extremely 
 conical cranium had anything to do, if we may be 
 allowed the expression, with the production of conical 
 cornea, the latter ought certainly to be more frequent 
 in countries where the former is regarded as general. 
 Ethnographers describe, and represent, the skulls 
 of the Esquimaux as more pyramidal than others, 
 nevertheless, they do not appear to suffer from coni¬ 
 cal cornea, in connection with which the two follow¬ 
 ing quotations may be offered, the names of the 
 observers being a sufficient guarantee for the excel¬ 
 lence of their remarks. 
 
 “The Esquimaux, a race separated into a great 
 
 E E 
 
222 
 
 number of hordes, and occupying the shores of the 
 Polar Sea, from Asia, where they exist northwards 
 of Kamtschatka, to Greenland in the west, have the 
 pyramidal, or conoidal, or broad-faced skull, in a 
 most marked degree.”— Prichard. 
 
 Mr. YV. White Cooper says, “ Sir John Richard¬ 
 son informs me that he * observed no cases of conical 
 cornea among the inhabitants of the northern regions 
 of America. Conjunctival ophthalmia is exceedingly 
 common among the Indians and Esquimaux, and 
 often terminates in blindness and opacity ; but 
 diseases of the humours, or ball of the eye, are not 
 common.’ ”—Sir John Richardson. 
 
 The European cases of conical cornea already 
 recorded, in which, at the same time, any remark¬ 
 able deviation from the ordinary form of the cranium 
 was observed, are undoubtedly interesting, and 
 suggest, as before said, topics for anatomical obser¬ 
 vation and inquiry ; but do not seem hitherto to 
 prove anything more than what we may term a 
 pathological coincidence, so that a conical elevation 
 of the skull, and a conical advance of the eye, 
 cannot yet be fairly introduced to the analogies or 
 homologies of human development. 
 
223 
 
 The diseases of the anterior part of the eye, 
 of the cornea generally, and the cases of conical 
 cornea, in particular, as observed in China, seem 
 fairly attributable, in the main, to causes such as 
 those alluded to by Mr. Lockhart; for the circum¬ 
 stances of country and climate, and the meteoro¬ 
 logical conditions, which prevail at Chusan and 
 Macao, as well as the habits of the people, are 
 highly favourable to the occurrence of such maladies ; 
 and if this potent group of causes be adequately 
 established as such, we shall expect to discover but 
 little in seeking for minor or accidental sources 
 of the same complaints. 
 
 Whether, or no, the Chinese practice of shaving 
 the head have any injurious tendency that should 
 here be noted, or whether the head in the shaven 
 state has in any way affected the estimate of its 
 form, we need not step' to consider. 
 
 It would be interesting to know to what extent 
 tuberculosis, or the characteristics of scrofula, may 
 be met with amongst those who suffer from ocular 
 disease in China; for, if cases of true conical cornea 
 he as frequent in this country, as from some pub¬ 
 lished accounts it would seem, opportunities may 
 
224 
 
 hereafter occur, of determining by anatomical and 
 other inquiry, whether or no the cases of conical 
 cornea that come on, as it were, insidiously, and 
 without any well marked phenomena of inflamma¬ 
 tion, have been preceded or accompanied by any 
 conditions or changes in the affected organ, that 
 could be regarded as belonging to the tubercular 
 diathesis ; along with which the ordinary vital 
 actions, as well as the phenomena of disease, so often 
 betray a want of tone and vigour. 
 
 No mention of hydrops oculi occurs in the 
 previous reports, whence we may suppose that alter¬ 
 ations in the size, form, and position of the cornea, 
 from this cause, are not frequent in China; which, 
 in this respect, may be contrasted with some parts 
 of the north of Africa, where hydrops oculi is said 
 to be endemic, and occasionally hereditary, (Ruete,) 
 but where ordinary myopia is exceedingly rare.— 
 Furnari. 
 
 Hitherto, as is well known, the observation of 
 diseases of the eye has been confined, for the 
 most part, to the lower classes of the Chinese, 
 whose habits are far from being cleanly, whose 
 food is coarse, and whose exposure to the weather 
 
225 
 
 and to the smoke of their huts renders them pecu¬ 
 liarly liable to the ocular affections from which they 
 are known to suffer; as far, however, as the influ¬ 
 ences of smoke may be concerned, their condition is 
 not unlike what prevails in some parts of Ireland, 
 and in the north of Europe. •* 
 
 From the hut or tent of many a Lapland moun¬ 
 taineer, the smoke escapes only by chinks in the 
 sides, by a small hole at the top, or by the door-way, 
 during a long night of winter; while the women 
 wear their eyes by needlework, and the men try 
 theirs in making or mending their nets and rein-deer 
 gearing, by a light as miserable as their dwellings. 
 With their skins japanned, and their eyes reddened 
 by smoke, they all at once leave their winter’s dark 
 and gloomy abodes, to gaze on snow-clad mountains 
 whence the light of the returning sun is brilliantly 
 reflected; a double exposure, which accounts well 
 enough for the diseased eyes so often found amongst 
 them, and not less for a popular expression well 
 known in Sweden, —■ “ He is as blear-eyed as a 
 Laplander.” 
 
 From the continued conjunctivitis of the winter 
 months, the young Laplanders mostly recover in the 
 
226 
 
 summer, but as age advances, the blear-eyed state 
 becomes an established and permanent condition. 
 
 Dr. Magnus Huss and other Swedish writers, 
 who have described these forms of disease, as affect¬ 
 ing - so commonly the hardy natives of the north, 
 have not dwelt upon conical cornea as one of their 
 associations; this particular malady, however, being 
 relatively so rare, might easily pass unnoticed in any 
 general account; even although this should relate 
 to the ocular complaints of a people who have 
 often something of the peculiar form of head above 
 noticed. 
 
 The following case of disease of the eyes, occur¬ 
 ring to an English sailor in China, may be thought 
 worthy of mention in this place. 
 
 C. B., set. 30, a robust sailor, consulted me 
 on account of extreme myopia, by which he was 
 attacked three years before, when at Hong Kong; 
 at this time he suffered from headache, dizziness, 
 ocular and orbital pain, which were relieved by 
 bleeding, but left him with extremely short sight, 
 from which he had never suffered before; in this 
 case, the corneae were very prominent, the ante¬ 
 rior chambers apparently large. The shortness of 
 
227 
 
 sight was remedied by spectacles with double 
 concave lens. 
 
 The impression of the patient was, that his 
 attack was brought on by exposure to intense heat 
 and light; his symptoms appear to have been those 
 of cerebral and ocular congestion ; and the 
 relief from depletion was such as might fairly he 
 expected. 
 
 In such a case, the continued application of cold 
 to the eyes, or rather to the closed eyelids, with 
 moderately continued and methodic pressure, such, 
 for instance, as the weight of pledgets of lint, 
 charged with water, applied to the exterior palpebral 
 surface, while the patient remained in the recumbent 
 posture, might probably have been attended with 
 additional advantage ; this mode of treatment I have 
 occasionally employed with very apparent benefit, 
 in cases of cerebral and ocular congestion occurring 
 in free livers, or plethoric subjects. 
 
 In the ocular affection, above related as occurring 
 in the East, puncture of the eye, for the purpose of 
 evacuating any part of the aqueous humour, seems 
 not to have been indicated, but, in more extreme 
 instances, the practice might at least be thought of; 
 
228 
 
 more especially if the cornea were really found to be 
 acquiring the conical form. 
 
 The case seems to belong to the class alluded 
 to at page 116, and is one of those that take, as it 
 were, a medium position between an ordinary case 
 of myopia, relieved by concave glasses of low power, 
 anu a complete case of conical cornea, such as the 
 first related at page 8; its record in this place 
 seemed the more desirable on account of the place 
 and manner of its occurrence; for although we may 
 be disposed to attribute the cases of conical cornea 
 which have been observed in China to inflammation 
 of the anterior part of the eye, and its consequences, 
 in general, or for the most part, it becomes the more 
 requisite that any special or apparently exceptional 
 cases, or anything that seems to border upon such, 
 should receive that additional attention which their 
 peculiarities may seem to deserve. 
 
 It is impossible to determine what was the precise 
 condition of the eye at the time of the attack; that 
 there was anything like keratitis seems somewhat 
 improbable ; so that the question naturally enough 
 suggests itself, as to whether, or no, the sources of 
 excitement and increased vascular action to which 
 
229 
 
 the patient had been exposed, were sufficient to 
 account for any superabundance in the secretion 
 of the aqueous humour which had not been counter¬ 
 balanced by a corresponding absorption, and hence 
 had led to an increase of projection in the anterior 
 part of the eye ; if such had been the case, it had 
 not led to any accompanying alteration in the state 
 of the iris, which was of dark brown colour, and 
 normal aspect, obeying, in its pupillary motions, the 
 varying conditions of the light; nor was there 
 the slightest visible vestige of any previous inflam¬ 
 matory disturbance of the conjunctiva, cornea, or 
 membrane of Decemet. 
 
230 
 
 Alteration in the form of the cornea sometimes 
 follows affections that tell at first upon the conjunc¬ 
 tiva ; in illustration of which, cases of staphyloma, 
 and conical cornea, more or less like some of those 
 already referred to as occurring after the purulent 
 ophthalmia of children, might be adduced ; the follow¬ 
 ing, however, is an instance of a less frequent kind :— 
 
 Mr. F., set. 60, had a severe attack of influenza, 
 when in America, about eight months ago; the left 
 eye suffered at this time, and its cornea is now very 
 conical, and opaque at the centre,—the light is indis¬ 
 tinctly seen through the margin of the iris, and 
 cornea, more especially at the outer part; the pupil is 
 contracted, and fixed, and vision of objects is lost. 
 
 Conicity of the cornea, in some instances, accom¬ 
 panies keratitis, accidentally, and suddenly, pro¬ 
 duced, and may disappear with the temporary morbid 
 action which has given rise to it. A young girl, of 
 18, now under my care, has conicity of the cornea, 
 
231 
 
 which is easily observed in lateral view; she lately 
 received a blow on the eye from a snowball thrown as 
 she was passing along the street; the centre of the 
 cornea seems to have received the main shock, and 
 injury; keratitis followed, and the middle of the 
 cornea has become the apex of the cone which it 
 now displays; the pupil is contracted, and opacity of 
 the lenticular capsule is observed. 
 
 Since the preceding observations were written, a 
 very well marked case of conical cornea has come 
 under my notice, in a man of 30; in this instance 
 the conicity of the cornea has been gradually acquired, 
 under the influences of a chronic and long-continued 
 ophthalmia, which commenced as conjunctivitis,—the 
 cornea being subsequently affected ; the cone, in one 
 eye, is a little more pointed than that in the other, 
 hut the conicity in both eyes is very well exhibited; 
 the anterior surface of the cornea has lost that 
 smooth, polished, or shining aspect, which it has in 
 a state of health,—being roughened by the ulcerative 
 process, but nevertheless imperfectly transparent,— 
 except where marked by red vessels, of which there 
 is a little display at the higher part of each cornea. 
 I first saw this patient about twelve months ago. 
 
232 
 
 when he harl already suffered from ophthalmia for 
 some months, but the cornea had not then acquired 
 that state of conicity which is now observed; so that 
 there is no doubt of the fact, that the conical form of 
 the cornea, which did not formerly exist, has come 
 on during the operation of the influences alluded to. 
 
 The pupil is small in both eyes, the blue iris 
 a little dulled in colour; the patient sees well enough 
 to find his way, and to distinguish large objects, but 
 for any finer vision his eyes are useless; the case is 
 highly interesting as another instance of conical 
 cornea observed as a consequence of inflammatory 
 action, and its present aspect is such, that it seems 
 quite possible that, after a lapse of time, when all 
 traces of inflammation shall have disappeared, the 
 cornea might present more or less of that clear, and 
 even glancing appearance, which is met with in certain 
 cases of hyperkeratosis in connection with which 
 keratitis may not have been observed. 
 
 Tbe first occurrence of the long-continued ophthal¬ 
 mia is attributed to “cold;” the patient is now a 
 healthy-looking man, but has led an irregular life, 
 and has suffered much from exposure to the weather. 
 With a view of lessening the remains of ocular 
 
233 
 
 irritation, a seton in the nape of the neck is recom¬ 
 mended ; the case having already been met by treat¬ 
 ment suited to the indications which have from time to 
 time been obvious. In both eyes the apex of the 
 cone corresponds very nearly to the centre of the 
 cornea; and it would not seem very difficult to 
 account for the occurrence of conicity in such a case; 
 the whole corneal surface, on both sides, having been 
 affected by the inflammatory action, softened, ulcer¬ 
 ated, and weakened, the central part of the cornea is 
 more likely to yield to the influences of pressure from 
 behind, than any lateral or circumferential portion of 
 the tunic, supposing the strength at all points to be 
 equal; for, in this particular instance the alteration 
 in the substance of the cornea seems to have been 
 associated with loss from ulceration, and not with 
 gain from new deposit, at least hitherto; and if we 
 suppose that the centre of the cornea was of the 
 same thickness as the circumference, or nearly so, 
 at the time the process of distension, or stretching, 
 or yielding of the corneal tunic began, there would 
 ere long be a somewhat thinned state of this central 
 part, from its new physical condition by pressure from 
 behind, supposing this thinning, however infinitesimal, 
 
234 
 
 not to be compensated for by additional nutrition and 
 deposit; the occurrence of which would not seem to 
 have taken place; in connection with which we may 
 allude to the greater elasticity of the central part of 
 the cornea, noticed by Sir Everard Home, of which 
 further mention will hereafter be made. 
 
 A considerable time has already elapsed since 
 the morbid changes in the case here related began; 
 and from the present aspect of the eyes, it seems 
 probable that a gradual and reparative process might 
 yet occupy many months to come, during which the 
 corneal surfaces may he cleared and brightened, 
 while the affected tunic regains something like its 
 former condition of firmness, after which any addi¬ 
 tional change will he less likely to occur; and here 
 it may be remarked, that when conical cornea has 
 once got into a stationary or quiescent state, it may 
 remain without further alteration during even many 
 years; a truth of which Cappelletti has given a 
 striking illustration in the case which he mentions, 
 where a patient who came under his notice had 
 conical cornea, which, during the previous thirty-six 
 years, had not undergone any appreciable alteration. 
 
 If true conical cornea occur suddenly, haemoph- 
 
235 
 
 thalmos might possibly be associated with it, as in 
 cases where it is reported to have arisen, at once, from 
 great efforts or cries, and thus an additional distension 
 of the cornea would be easily accounted for; to 
 which it may be added that in some cases of 
 amenorrheea, a disease, along with which conical 
 cornea has often been observed,—periodic hsemoph- 
 thalmos has been noticed, of which a very interest¬ 
 ing case is related in the “Practical Work ” of Mr. 
 Tyrrell. It is quite obvious that in such cases altera¬ 
 tion in the form of the cornea might occur without 
 previous inflammatory action, whatever vascular ex¬ 
 citement might he associated with the after-establish¬ 
 ment of the keratoconic condition ; and also, that these 
 exciting causes of keratoconus, being such as are 
 likely to have their operation very soon suspended, 
 (unless they disturb the balance of secretion and 
 absorption of the aqueous humour,) the amount of 
 effect which they have produced, if not speedily 
 removed, might possibly remain as a permanent 
 condition, and without further change during a con¬ 
 siderable length of time. 
 
 In many cases of hsemophthalmos suddenly pro¬ 
 duced by blows on the eye, I have more than once 
 
236 
 
 seen injury of the front of the cornea, by which this 
 tunic may fairly be supposed to have been weakened, 
 as in instances where a thin anterior layer of the 
 membrane has been abraded or scraped away; but 
 the effusion of blood has been gradually absorbed, 
 and the injury of the cornea repaired, without any 
 alteration of form in the front of the eye. 
 
 It has been previously mentioned, along with 
 remarks respecting diagnosis in cases of conical 
 cornea, that this affection may sometimes be over¬ 
 looked, wffiile some other disease is supposed to be 
 present; and this is more likely to happen in the 
 earlier stage, or before the advance of the cone is 
 considerable; and with this notice may be united 
 that of the author of the article “ Staphylome,” in 
 the “ Dictionnaire des Sciences Medicales,” who 
 observes, that in some cases the patient sees in a 
 surprising manner, despite a well-marked prominence 
 of the cornea; a fact which, if sufficiently often 
 observed, w 7 ould suggest an additional caution with 
 regard to diagnosis. 
 
 The same writer has given a very interesting 
 case of conical cornea in the right eye of a young 
 girl of 15, who was attacked by a slight ophthalmia 
 
237 
 
 on the right side, after walking in the sun with the 
 head uncovered ; the prominence of (lie cornea was 
 observed on the third day of the inflammatory affec¬ 
 tion, when there was no remarkable alteration in the 
 transparency of the part; but on the eighth day the 
 apex, or most prominent part of the cone, had 
 become a little dull, and remained so after the disap¬ 
 pearance of the inflammation; this condition, how¬ 
 ever, did not produce any considerable deformity, 
 and the vision was not altogether lost. This case is 
 another illustration of conical cornea occurring as a 
 consequence of inflammation, which, as its author 
 observes, may precede, accompany, or follow this 
 malady; but he also remarks that conical cornea has, 
 in some cases, been altogether unconnected with any 
 inflammatory attack. 
 
 The attentive study of the various modes of ter¬ 
 mination of conical cornea, more especially in cases 
 where surgical operations have not been performed, 
 might supply new and interesting observations bear¬ 
 ing upon the nature and treatment of this affection; 
 indeed, it might fairly be said, that our knowledge of 
 the malady is least perfect as far as its two extremes 
 may be concerned; in other words, its beginning 
 
 G G 
 
238 
 
 and end, of which relatively little, in the majority of 
 cases, has hitherto been observed; the intermediate 
 part of these cases, or their conditions when suffi¬ 
 ciently developed seriously to interfere with vision, 
 having been, for reasons that are obvious, more 
 commonly presented to the view of the surgeon. 
 In connection with some of the cases previously 
 related, that have been treated with success by the 
 employment of general or local remedies, or by both, 
 the question easily arises, as to what the results 
 might have been had the disease been left to the 
 efforts of nature ; and although we have not the 
 means of replying in a satisfactory manner, certain 
 sources of information, bearing upon this part of the 
 subject, are suggested by attending to the inquiry. 
 
 In a few cases of conical cornea, the progress 
 of which has been from time to time atteuded to, the 
 alterations observed have taken place most frequently 
 in the apex of the cone, which, from being previously 
 transparent, has afterwards become opaque, and some 
 instances have been reported, in which the apex, 
 after being previously opaque, has regained its 
 former transparency; the latter, however, is un¬ 
 doubtedly the most rare occurrence of the two; and 
 
239 
 
 the causes which seem to favour the progressive 
 opacity have been already alluded to. 
 
 One of the most remarkable cases of conical 
 cornea on record is that related by Sanson, in which 
 a spontaneous cure took place after the malady had 
 previously existed during many years. 
 
 This distinguished Parisian ophthalmologist was 
 of opinion, that, in cases of conical cornea, the 
 anterior or prominent part of this tunic is hyper¬ 
 trophied, or converted into a solid, thick, and trans¬ 
 parent piece; this view, however, is totally incom¬ 
 patible with other notices which occur in his own 
 account of the disease, as the following observations 
 may show :— 
 
 Sanson describes conical cornea under the names 
 of “ Staphylome transparent conique. Propulsion 
 conique de la cornee. Hyper ceratosis.” He states 
 that “ it sometimes appears suddenly, as a conse¬ 
 quence of great efforts, or cries; but oftener its pro¬ 
 gress is slow, and its cause unknown; however this 
 may be, the apex of the cone, which is generally at 
 the centre of the cornea, is thick, and sometimes 
 slightly opaque, but more frequently transparent.” 
 
 It is obvious that the name “Conical propulsion 
 
240 
 
 of the cornea” does not accord very well with the 
 idea of thickening or hypertrophy of this part; and 
 if the disease in reality depended upon or were 
 associated with thickening of the corneal tunic, it is 
 not easy to understand how this should be suddenly 
 produced by great efforts or cries. Out of three 
 cases of conical cornea observed by the distinguished 
 surgeon of the Hutel-Dieu, one remained unaltered 
 after six months’ active treatment; in the second the 
 centre of the cone became softened, and afterwards 
 nearly the whole of the cornea opaque; in the third, 
 and most remarkable case, as above stated, a spon¬ 
 taneous cure took place. 
 
 The opinions of Sanson above noticed were pub¬ 
 lished in 1836, and may be contrasted with those of 
 Mr. Guthrie, which appeared several years earlier, in 
 his “ Lectures on the Operative Surgery of the Eye.” 
 Speaking of conical cornea, Mr. Guthrie says, “ I 
 have two cases of this kind under my care at the 
 infirmary, one in a young, the other in a middle-aged 
 man; both eyes are affected in each, without any 
 other appearance of disease save that of a very slight 
 increase of vascularity. The cornea in such cases is 
 decidedly thinner than usual, and if irritation takes 
 
241 
 
 place upon it, the apex of the cone becomes opaque, 
 and causes it to represent in shape a conical total 
 staphyloma. The cause of these two complaints 
 cannot, then, be so essentially different as the German 
 hypothesis would lead us to believe.” 
 
 This observation of Mr. Guthrie, respecting the 
 gradual conversion of conical cornea into a condition 
 which might be viewed as staphyloma, is evidently 
 of great importance, taken in connection with the 
 pathology or progress of the disease ; while the 
 difference between his view and that of Sanson, 
 respecting the morbid anatomy of the cornea in this 
 affection, should even yet attract attention, although 
 the results of recent inquiry tend so much to con¬ 
 firm the accuracy of the opinion published in Mr. 
 Guthrie’s valuable work. 
 
 It seems worthy of remark, that a thickened state 
 of the anterior part of the tunic, in cases of conical 
 and transparent cornea, would form a lens, which 
 might be found, if sufficiently regular, to possess 
 some of the properties of the meniscus, in connection 
 with the figure and surfaces of which both the refrac¬ 
 tion and reflection of light would form an interesting 
 study; but this kind of thickening, or lenticular 
 
242 
 
 formation, is undoubtedly a very rare occurrence 
 in cases of conical cornea; nevertheless it might 
 possibly take place as an ulterior consequence, even 
 in cases such as have been here related; for the 
 reparation of an ulcerated state of the front of the 
 cornea might be at length effected through the 
 medium of deposit in or about the depressions pre¬ 
 viously made by ulceration, by which increase of 
 thickness, and irregularity of surface, might at the 
 same time be favoured; so that, if transparency 
 existed, a refracting lens would be formed, as well as 
 an irregular mirror, or perhaps a cluster of mirrors, 
 in the same structure, in addition to which we may 
 here be allowed to remark that, independent of irre¬ 
 gularities of surface from elevations and depressions, 
 the surface of the cornea in cases where this tunic is 
 regularly conical may be regarded as a conical 
 mirror, made up of a series of zones, every one of 
 which has a different curve, and hence a different 
 optical power; any flatter portion met with in certain 
 cases, near to the circumference of the tunic, might 
 be regarded as an accidental irregularity in form, but 
 of which, in the treatment of the disease, an impor¬ 
 tant advantage, in some cases, might possibly be taken. 
 
243 
 
 In connection with the question as to whether 
 the cornea is thinned or thickened in cases of hyper¬ 
 keratosis, the observation of Jaeger is not to be lost 
 sight of, as in the autopsy of the remarkable case of 
 conical cornea related by him, and which has been 
 previously noticed, the cornea was found abnormally 
 thin at the central part, and abnormally thick in the 
 exterior rim ; a state which may perhaps be allowed 
 to suggest the inquiry as to whether there had pre¬ 
 viously been a thickening of the whole of the cornea, 
 which, at the central part, might afterwards have 
 been thinned by a secondary or subsequent morbid 
 process; to which we may add that a few well-made 
 observations of this kind would at least establish the 
 fact that, in certain cases of conical cornea, an 
 increase of thickness is to be found in a part, if not 
 in the whole, of the affected tunic ; but even here, 
 by way of contrast, we must recall to mind the case 
 of Mr. Middlemore, in which, although the apex of 
 the cone was thin, the circumference of the cornea 
 had its normal thickness; as also the case of Mr. 
 Walker, in which “ the cornea generally was found 
 very much thinner than natural, and in the centre 
 especially so:” so that the observations of Jaeger 
 
244 
 
 and of Walker do not precisely correspond, as even 
 Stellwag von Carion, in his profound work, has 
 stated. 
 
 As, possibly, in favour of the occasional occurrence 
 of thickening of the transparent cornea, we may 
 notice the peculiar case related by Stellwag von 
 Carion, in which the front of the right cornea pre¬ 
 sented a sort of ring of hypertrophy (?) nearly 
 encircling its central part, and of which the features 
 appeal' sufficiently interesting to warrant the follow¬ 
 ing quotation :— 
 
 “ Die rechte Hornliaut war wollkommen durcli- 
 sichtig, allein ihre Kriimmung hot eiu bisher noch 
 nirgends beschriebenes und auch auf seine Grundur- 
 sache kaum sicker zuriickfuhrbares Verhaltniss dar. 
 Es war der Centraltheil der Hornhautvorderflache von 
 einem hei hohem Walle durchsiclitiger Corneal- 
 substanz umgeben, welcker Wall, spharisch ge- 
 kriimmt, fast drei Viertheile eines Kreises von 
 Durchmesser umsclirieb und seine beiden Endspitzen 
 nach abwarts kehrte.” 
 
 The patient was a pupil in the Institution for the 
 Blind at Briinn (Basin of the Elbe), with opacity of 
 the left cornea, as well as the peculiar disease above 
 
215 
 
 noticed; he had some vision, but his history of it 
 could not be relied upon, for, being desirous of leav¬ 
 ing the institution, he gave contradictory accounts of 
 his sight, which were characterised by the aspect of 
 falsehood. 
 
 Upon the whole, it would seem that the thinning 
 of the central part of the cornea is the pathological 
 condition most uniformly observed, the state of the 
 exterior rim of this tunic having been different in 
 different cases; normal in thickness, abnormally 
 thick, or abnormally thin, as the three cases just 
 cited tend to show; but here we must remark that 
 inasmuch as patients do not die of conical cornea, 
 the anatomical condition of the cornea, which in such 
 cases is met with, after death, should be attentively 
 studied in connection with general morbid conditions, 
 or with the disease of which the patient has died ; 
 be this phthisis, as in the case of Jaeger, or other 
 disease likelv to alter much the nutritive function in 
 general, or to affect absorption in any particular part ; 
 and this remark may be allowed to suggest a prac¬ 
 tical consideration of some importance, in connection 
 with surgical operations on conical cornea; for it is 
 obvious that the state of the general health, and the 
 
 H H 
 
246 
 
 peculiarities of constitution, should here be especially 
 attended to, as previous remarks tend to show ; and 
 considering the frequent occurrence of the charac¬ 
 teristics of scrofula, along with keratoconus, and the 
 doubtful success of operations upon the eye with such 
 combination of morbid conditions, it is evident that 
 surgical interference should not be resorted to without 
 great circumspection. 
 
 Such appearances of the iris and pupil as would 
 be seen through the cornea, were its anterior part 
 thickened into the condition of a transparent lens, 
 would not seem, hitherto, to have been noticed, and 
 as they could not fail to strike any attentive observer, 
 it seems fair to suppose that they have rarely, if ever, 
 been seen by those who have described conical 
 cornea. An approach to the abnormal aspect, which 
 in such conditions the pupil might present, may be 
 seen by forming a fac-simile of conical cornea in 
 glass, with the anterior part, or rounded apex, 
 thickened into lenticular form, behind which, or inside 
 the cone, the central or coloured part of an artificial 
 eye may be placed. With such a meniscus, we 
 shall find the pupil of the artificial eye largely mag¬ 
 nified ; but this is not the case, if the fac-simile of 
 
247 
 
 tlie cornea, or glass cornea, is either of equal thick¬ 
 ness throughout, or thick at the circumferential part, 
 and thin in the middle or apex part of the cone. 
 
 Cuvier, in his “ Lemons d’ Anatomie Comparee,” 
 states that the meniscus form is constantly found in 
 the cornea of animals. His interesting remark may 
 here be quoted :— 
 
 “ Dans tous les animaux, la cornee est composee 
 de lames minces, transparentes, collees ensemble 
 par une cellulosite serree, et formant par leur assem¬ 
 blage un menisque plus epais dans le milieu que sur 
 ses bords, et qui peut deja par lui-meme faire con¬ 
 verger les rayons lumineux.” 
 
 According to such view, it is obvious that the 
 thickest part of the cornea would be opposite to the 
 thickest part of the sclerotic; in other words, the 
 strongest parts of the ocular shell would be found to 
 correspond to the centre of the cornea in front, and, 
 behind, to that part of the sclerotic which surrounds 
 the optic nerve, where, as is well known, the fibrous 
 membrane in the human eye has its greatest thick¬ 
 ness. 
 
 The observations of Sir Everard Home and Mr. 
 Ramsden may be placed side by side with the opi- 
 
248 
 
 niou of Cuvier; in allusion to these, Mr. Dalrymple 
 says: “ We have the high authority of Sir E. Home 
 and Mr. Ramsden on this subject, who made some 
 very minute and accurate experiments, wherein the 
 result stated was, that the cornea is thickest, as well 
 as most elastic, in its very centre.” 
 
 Such thickness and elasticity of the central part of 
 the cornea should not be lost sight of in the studv of 
 hyperkeratosis. 
 
 If, in cases of hyperkeratosis, the cornea is 
 more than usually exposed to the influences of the 
 atmosphere, irritation about the apex of the cone, 
 and consequent opacity, often result; hut it is worthy 
 of remark that the mere friction or play of the eye¬ 
 lids upon the healthy cornea, when it is completely 
 and even permanently covered by the palpebrse, does 
 not generally produce such effects; of this statement 
 the following illustration may be given :— 
 
 • C. M., a young man of 18, had strumous oph¬ 
 thalmia five years ago, by which he lost the sight of 
 the right eye, not from morbid change in the globe 
 of the eye itself, but from complete union of the tarsal 
 borders of the two lids, the only point at which they 
 were not agglutinated being at the internal cantbus, 
 
249 
 
 close to the puncta lacrymalia; the function of 
 these apertures, and the action of the tears in their 
 situation, seeming to have aided in preventing the 
 adhesion at this part, so that a sort of palpebral pupil, 
 about as large as the iridic pupil of the day-time, 
 was here left, through which the patient could per¬ 
 ceive the light when his eye was rolled inwards. 
 The union of the tarsal borders was effected through 
 the medium of a dense and red structure, the product 
 of the granulation at the time of the ophthalmia; a 
 broad director, such as is used in the operation for 
 strangulated hernia, being passed behind this, and 
 from the inner to the outer canthus, the eye-ball was 
 thus protected, and the narrow and hard bond of 
 union divided with the bistoury from behind forwards, 
 and in this way the healthy eye was brought into 
 view; at the outer extremity of the incision a suture 
 was introduced, to eke out the length of the incised 
 opening by a short division, to be gradually effected 
 with the tied thread, which was thus also an agent 
 to prevent the reunion of the separated tarsal mar¬ 
 gins, and these in addition were touched with the 
 sulphate of copper, and afterwards with a little oil 
 along the incised border. The results were per- 
 
250 
 
 fectly successful, and tlie restoration of the sight 
 complete; the cornea being found in a healthy state, 
 and the other parts of the visual organ in equally 
 good condition. 
 
 It has been previously shown, that a very small 
 amount of pressure directly or indirectly applied to 
 the cornea, when this structure has acquired an 
 abnormal form, is capable, in some cases, of im¬ 
 proving the sight, apparently by altering the 
 curve of the cornea, and thus producing a condition 
 more favourable to that amount of refraction which 
 the exercise of distinct vision requires ; and here, on 
 the other hand, it seems worthy of remark, that 
 pressure on the healthy cornea, practised in the 
 same way, may alter distinct vision, so that objects— 
 the moon, stars, or comets, for instance—in their 
 apparent size, form, position, or direction, may differ 
 from the reality, by the kind of artificial parallax 
 thus given to them, the measurement of which we 
 need not speak of; but even this may require to be 
 taken into account in connection with the different 
 manner in which celestial bodies are seen by eyes 
 which differ slightly in the forms of their refracting 
 media; a truth which should not pass unnoticed in 
 
251 
 
 connection with physical astronomy, and requires to 
 be considered in its relations to both the vertical and 
 the horizontal curve of the cornea. This interesting 
 subject has received some attention from the illus¬ 
 trious Humboldt, who has found that his view of the 
 stars differs from that of some of his erudite and 
 astronomical friends. (Kosmos.) 
 
 Allusion has been previously made to the absence 
 of chromatic aberration in a case of conical cornea, 
 in which the correction of spherical aberration was 
 the main desideratum ; and in many cases of hyper¬ 
 keratosis, the patient may suffer from great defect of 
 vision without being disturbed by false colours, if 
 this expression may be employed; but it is worthy of 
 notice that, in cases such as the one of which the 
 autopsy was published by Jaeger, and where the 
 cornea is found much thinned at the central part, 
 while its outer ring retains its normal, or has even 
 an increased thickness, and where there is what we 
 may call an intermediate and inclined plane of the 
 tunic, uniting the two portions, the thinned, or cen¬ 
 tral part, with the exterior division which remains 
 unaltered or thickened, it is evident that this ring of 
 the cornea, if excised, would have somewhat of a 
 
252 
 
 prismatic form, when viewed in section, although 
 previously without refracting angle, and hence the 
 part presenting such morbid alteration seems worthy 
 of study, in connection with the refraction, reflection, 
 and decomposition of light; although the presence of 
 angular elevations, whether pointed or linear, are 
 undoubtedly rare on the posterior surface of the 
 cornea, but are nevertheless amongst the possible 
 products of ulcerative absorption. 
 
 It is known to ophthalmologists that cancerous 
 degeneration, although in such cases very rare, has 
 nevertheless been observed as a termination of 
 staphyloma; hitherto we dp not meet with notices 
 of cases of conical cornea terminating in a similar 
 way. 
 
 Conical cornea has not as yet received any special 
 attention from writers on legal medicine, although in 
 all systematic treatises on medical jurisprudence, 
 the subject of myopia, real or feigned, receives a 
 notice in accordance with its importance. 
 
 From previous remarks it will be understood that 
 the physical signs of transparent and conical cornea, 
 in an early stage, might easily be overlooked by a 
 practitioner not much accustomed to the observation 
 
253 
 
 of ocular disease; at a later period, however, the 
 extreme brightness of the cornea when viewed in 
 front, and its figure when seen laterally, along with 
 the myopia, or other alteration of the sight, would 
 scarcely permit it to be either overlooked, or mis¬ 
 taken for any other malady; and although myopia is 
 so often feigned for the purpose of avoiding or escap¬ 
 ing from military service, neither soldier nor civilian 
 need attempt to feign the physical characteristics of 
 conical cornea. 
 
 In connection with this part of the subject it is 
 worthy of remark, that conical cornea has been fre¬ 
 quently met with amongst soldiers, more especially 
 in Flanders, as a result of ophthalmia; and hence 
 would seem to merit the attention of military sur¬ 
 geons. The distinguished Julian Van Roosbroeck, 
 Professor of Ophthalmology in the University of 
 Ghent, has bad many opportunities of observing 
 cases of this kind, and he considers that, as a con¬ 
 sequence of the ophthalmia of new-born children, of 
 gonorrheal ophthalmia, and of the acute ophthalmia 
 from which military men often suffer, that a softened 
 state of the cornea now and then follows, a “ ramoll- 
 issement interstitiel ” the true nature of which we 
 
 11 
 
254 
 
 do not understand, but which favours the subsequent 
 occurrence of conical cornea, which may present 
 itself without any accompanying ulceration of the 
 cornea, but which would seem still more likely to 
 happen should such ulceration also exist; to which 
 it may be added, that the observer of the Netherlands 
 has frequently met with conical cornea without any 
 trace of ulceration, and thinks that, as ulceration of the 
 cornea is relatively so common, conical cornea would 
 be much less rare if such ulceration were its essential 
 cause; thus showing how he differs in opinion from 
 a distinguished Parisian oculist, whose observations 
 have been previously noticed. 
 
 The treatment of the professor of Ghent is not 
 less interesting than his pathological views; he has 
 tried most of the remedies for this affection, which 
 have been strongly recommended by different 
 writers, but with results less happy than those which 
 the inventors seem to have arrived at. A strong 
 solution of tannin, in Peruvian or oak bark, has 
 now and then seemed of use in his practice; but 
 the deep cauterisation of the centre of the cone, 
 with a pencil-shaped piece of nitrate of silver, is the 
 plan which he has found most efficacious. By this 
 
255 
 
 practice the centre of the cornea, if previously 
 transparent, is made opaque, or, if any opacity at 
 the centre already exist, it is increased; but such 
 new state of central opacity is less injurious to vision 
 than the abnormal conditions which before prevailed 
 with their associated optical interference; while the 
 employment of belladonna is indicated when the 
 margin of the pupil falls within that of the corneal 
 opacity in front of it. 
 
 Ulceration of the membrane of Decemet is per¬ 
 haps very rare; by some its occurrence is doubted; 
 and this tunic is evidently out of the way of many 
 causes of morbid action which tell upon the anterior 
 part of the cornea, where ulceration is so common. 
 Nevertheless, an attentive study of abrasion, rupture, 
 vesication, or ulceration, affecting either face of the 
 cornea, appears to be a matter of some importance to 
 the advancement of our knowledge of hyperkeratosis. 
 
 Amongst the varieties of ulceration affecting the 
 cornea, anteriorly, that which has been called the 
 “rheumatic” seems to be here especially worthy of 
 mention, on account of its leaving the cornea with 
 “facettes” on its surface, which now and then 
 give rise to diplopia or polyopia, and which, by 
 
256 
 
 weakening the tunic, might lead to its conical 
 projection. 
 
 It has been previously stated that abrasion of the 
 cornea is, in many cases, soon repaired, without any 
 tendency to alteration in the form of this tunic from 
 the partial loss of substance which has taken place; 
 but those painful vesications of the cornea, which 
 have been lately noticed by Mr. Wilde, and which 
 are now and then accompanied by alteration in the 
 quantity, and perhaps in the quality, of the aqueous 
 humour, as well as in the form of the cornea, should 
 not be lost sight of, as capable of leading to a weak¬ 
 ened, thinned, or softened state of this part of the 
 eye, and along with which conicity might occur. 
 
 The bursting of an abscess, or onyx of the cornea, 
 inwards, into the anterior chamber, is noticed by Mr. 
 T. W. Jones as one source of corneal prominence, of 
 a conical shape; the inner part of the corneal sub¬ 
 stance being destroyed, and the outer part afterwards 
 incapable of withstanding the pressure from within. 
 
257 
 
 As before remarked, we do not find that the 
 attention of veterinarians has been particularly 
 directed to any disease occurring amongst the lower or 
 domesticated animals, to which the name conical 
 cornea has been given, although conical staphyloma 
 is particularly discussed, and staphyloma, in some 
 treatises, is divided into the transparent and opaque 
 varieties ; it is nevertheless more than probable, and 
 analogy seems favourable to the view, that with the 
 progress of the veterinary art, cases of conical cornea 
 will be observed amongst our domesticated animals, 
 whose eyes suffer from a host of diseases which cor¬ 
 respond to similar affections of the organ of vision in 
 man. 
 
 I have had opportunities of observing alterations 
 of the form of the cornea in the dog, after chronic 
 ophthalmia, as well as dropsy of the anterior chamber 
 of the eye, but have not yet seen a case of true 
 conical cornea in this animal; in more than one 
 instance, however, in carefully-made autopsies, I 
 have found a thinned condition of the central part of 
 
258 
 
 the cornea, which during life had betrayed faint 
 traces of opacity; with increased prominence, yet 
 without conical elevation; but along with which the 
 animal seemed to be nearly blind. 
 
 After having paid some attention to the form of 
 the eye in fishes, I was much interested, in the sum¬ 
 mer of 1852, in observing a case of conical cornea in 
 the eye of a goldfish, which had loug been kept in a 
 large glass globe, or vase, the general form of which 
 was that of the glass vessels commonly used to im¬ 
 prison these little animals, but the exterior surface of 
 which was of polyhedral form, from the glass on this 
 aspect being cut into numerous facettes: conditions 
 here mentioned on account of their influence on the 
 transmission, refraction, and reflection of light. The 
 vessel contained two fishes, which differed little in 
 size, form, colour, or general appearance, but in the 
 shape of their eyes a well-marked difference was 
 observed, while the requisite precautions were taken 
 to prevent mistake, or optical illusion, by viewing 
 them in air, as well as in water: in the fish with 
 conical cornea, both eyes were affected. A similar 
 observation made by a friend has induced me to 
 think that this fact has some little interest, so that 
 
259 
 
 its notice may perhaps be excused, although the 
 diseases of the tenants of the waters have hitherto 
 occupied so small a space in the domain of compara¬ 
 tive pathology. 
 
 Inasmuch as opportunities for the post-mortem 
 examination of cases of conical cornea, in the human 
 subject, are exceedingly rare, it is a matter of some 
 importance to the study of this malady, to extend the 
 inquiry relating to it by any observation of disease of 
 the cornea in the lower creatures which may seem at 
 all allied to hyperkeratosis as found in man ; for, in 
 domesticated animals, suffering from complaints of 
 the cornea, with conical prominence of this tunic, 
 the time of the pathological examination might be so 
 chosen as to throw the greatest possible amount of 
 light upon the mode of origin, as well as upon the 
 true nature of the malady; and in this department 
 of observation, any affection of the line of union of 
 the cornea and sclerotic, which is so different in 
 different animals, would invite the attention of 
 anatomists, while the investigation, as a whole, 
 might repay the microscopic inquirer; and if car¬ 
 ried on with the aid of treatises on comparative 
 ophthalmology, such as those of Leblanc and Muel- 
 
260 
 
 lev, the value of comparative pathology, so well 
 expressed by Rayer, would, ere long, be more com¬ 
 pletely established:— 
 
 “ La pathologie comparee est la patbologie gene- 
 rale, et je ne puis mieux en faire voir la portee, qu’en 
 rappelant, que la patbologie bumaine n’en est qu’un 
 cas particulier.” 
 
INDEX. 
 
 Aberration, chromatic, in case of 
 conical cornea, 118, 251. 
 Abnormal form of head, 34. 
 Abrasion of cornea, 256. 
 Achromatism, 11. 
 
 Adams, opinion of, 150. 
 
 Adaptation of eye to surrounding 
 element, 1. 
 
 Ages, in cases of conical cornea, 3. 
 Ague, with myopia, 117. 
 
 Alteration in form of cornea, 125. 
 
 position of pupil, 32,33. 
 apex of cone, 238. 
 Amaurosis, remarkable case of, 140. 
 Amenorrhcea, with conical cornea, 
 109. 
 
 American eye-cups, 210. 
 
 Amphibia, form of cornea in, 1. 
 Anchyloblepliaron, case of, 248. 
 
 successful ope¬ 
 ration for, 249. 
 
 Andre®, his cases of conical 
 cornea, 114, 
 
 Animal jelly, lens of, 19. 
 
 Annular spectacles, 24. 
 
 Aperture, position of, in artificial 
 iris, 20. 
 
 Applications, topical, in conical 
 cornea, 16. 
 
 Aquatic birds, form of cornea in, 1. 
 Aqueous humor, evacuation of, 21. 
 
 increase of, 34. 
 
 Arlt on division of the trigeminus 
 nerve, 131. 
 
 Arsenic, in conical cornea, 15. 
 
 Artificial eye, appearances of, 191. 
 iris, 8, 18, 20, 71. 
 lens, 18. 
 
 pupil, 21, 24, 25, 156,163, 
 164. 
 
 teeth, a source of im¬ 
 paired vision, 141. 
 
 Atropine, application of, 18. 
 
 Belgium, conical cornea in, 253. 
 
 Belladonna, application of, 18. 
 
 Benedict, opinion of, 151. 
 
 Birds, form of cornea in, 1. 
 
 raptorial, form of cornea in, 1. 
 
 Blindness from foreign body in 
 tooth, 140. 
 
 Blepharophthalmia, conical cornea 
 after, 117. 
 
 Blow, conical cornea attributed to, 
 62. 
 
 Brain, form of, in case of conical 
 cornea, 43. 
 
 Breaking up of lens, 23. 
 
 Broiement of lens, 23. 
 
 Bruck, Dr., his cases, 185. 
 
 Budge, his experiments on the 
 sympathetic, 203. 
 
 Burgman, his case of elongated 
 cornea, 35. 
 
262 
 
 Cancerous degeneration of cornea, 
 252. 
 
 Cappelletti, his cases of conical 
 cornea, 234. 
 
 Carbonate of Iron in conical cornea, 
 
 16 . 
 
 Cataract, preceded by myopia, 198. 
 
 spontaneous cure of, 91. 
 
 Chelius, on polyopia, 144. 
 
 China, conical cornea in, 214. 
 
 Chinese barbers, their operations 
 on the eye, 217. 
 
 Chinese, lower classes of, diseases 
 of eye in, 224. 
 
 Chromatic aberration in case of 
 conical cornea, 118, 251. 
 
 Chlorosis with conical cornea, 109, 
 
 110 . 
 
 Chusan, eye diseases at hospital of, 
 215. 
 
 Comparative medicine and conical 
 cornea, 253. 
 
 Cohesion of eyelids, 248. 
 
 successful 
 
 operation for, 249. 
 
 Collyria in conical cornea, 16. 
 
 Cold, apparatus for application of, 
 17. 
 
 application of, 17. 
 
 Comedian, case of conical cornea in, 
 3. 
 
 Concomitant disease, importance of 
 attending to, 117. 
 
 Congenital diseases of eye, 37,181. 
 
 Cylindric lens, 13. 
 
 Curves of cornea, 250. 
 
 Conical cornea, after,— 
 
 Egyptian ophthalmia, 94. 
 blepharophthalmia, 117. 
 keratitis, 148. 
 
 Conical cornea, after,— 
 
 haemorrhoids and iritis, 84. 
 external injury, 98, 196, 
 231. 
 
 infantile ophthalmia, 55, 
 
 101 . 
 
 influenza, 230. 
 iritis, 81, 84. 
 measles, 126. 
 parturition, 40. 
 trichiasis, 121. 
 ophthalmia, 125,127, 231, 
 236. 
 
 Conical cornea,— 
 
 case from Ammon, 40. 
 attributed to blow, 62. 
 a comparatively new 
 name, 5. 
 
 earliest notices of, 3. 
 equal thickness of, 43. 
 various thickness of, 32. 
 from hooping cough, 58. 
 in an aged clergyman, 107. 
 in an aged female, 104. 
 in connection with com¬ 
 parative medicine, 253. 
 in connection with legal 
 medicine, 252. 
 cases of, 240. 
 cases of Mr. Gervis, 166. 
 cases of Riberi, 148. 
 anti-strumous treatment 
 of, 116. 
 rarity of, 5. 
 
 observations of, not hither 
 to numerous, 5. 
 rare in Scotland and nor¬ 
 thern Germany, 6. 
 observed in Asia, 6. 
 within the tropics, 6. 
 
263 
 
 Conical Cornea, progress of, 2(3. 
 
 remarkable case of, (51. 
 stationary condition of, 26. 
 congenital, thickness of, 
 181. 
 
 partial, 103, 104. 
 relapses, and second cure 
 of, 115. 
 
 Conical cornea, and hysteria, 115. 
 and scrofula, 114. 
 and syphilis, 144. 
 and staphyloma, 241. 
 cylindric lens applied to, 
 12, 61, 125. 
 cases of Riberi, 148. 
 cases of Andreas, 114. 
 cured by paracentesis, 155. 
 definitions of, 182. 
 diagnosis of, 186. 
 opinion of Flarer on, 147. 
 instrument for shearing 
 effects of thickness of, 246. 
 question of thickness, 246. 
 in China, 214. 
 imitation of, 190. 
 in soldiers, 253. 
 of long duration, 107, 234. 
 observed by Schon, 118. 
 partial section of, 163. 
 puncture of substance of, 
 166. 
 
 spontaneous recovery 
 from, 239, 240. 
 seton passed into, 158. 
 stages of, 149. 
 supposed accidental origin 
 of, 149. 
 
 state of general health 
 with, 215. 
 
 Conical Cornea, terminations of, 237. 
 
 unusually good sight with, 
 236. 
 
 watery aspect of, 188. 
 
 Conical cornea, with,— 
 
 amenorrhcea, 109. 
 dropsy, 107. 
 chlorosis, 109. 
 chromatic aberration, 118. 
 oscillation of eye-ball, 143. 
 diseased teeth, 138. 
 disease of tarsi, 126. 
 strabismus, 145. 
 tremulous iris, 143, 144. 
 polyopia, 144. 
 hydrocephalus, 146. 
 hydrops oculi, 155. 
 thickening of cornea, 166. 
 hsemophthalmos, 235. 
 entropion, 196. 
 trichiasis, 196. 
 depressions on, 185. 
 
 Chelius on polyopia, 141. 
 
 Cone, opacity of, opinion of Sichel, 
 119. 
 
 apex of, alterations in, 238. 
 
 Conical cranium, 35, 53, 54, 56. 
 
 Conical eyeball, 187, 188. 
 
 Connection of conical cornea and 
 conical cranium, 221, 222. 
 
 Conjunctivitis, with myopia, 117. 
 
 Cooper, Mr. (W.W.), cases of 
 myopia, 117. 
 
 Counter-irritation in conical cornea, 
 16. 
 
 Correction of spherical aberration, 
 
 11 . 
 
 Correction of chromatic aberration, 
 
 11 . 
 
 Corotomia, stats of cornea for, 25. 
 
264 
 
 Congenital conical cornea, thick 
 ness of, 181. 
 
 Cornea, thickness of, in the em¬ 
 bryo, 28. 
 
 thickness of, in early life, 
 29, 181. 
 facettes of, 32. 
 elongated, case of, 35. 
 surgical operations upon, 
 20 . 
 
 state of, for corotomia, 25. 
 puncture of, 21, 25. 
 excision of part of, 22. 
 form of, altered by oph¬ 
 thalmia, 125. 
 
 transplantation of, 20,193. 
 and temporal hone, 
 disease of, 135. 
 and trigeminus nerve, 
 disease of, 135. 
 and sclerotic, connection 
 of, 250. 
 
 diseases of, in China, 211. 
 very convex, with absorp¬ 
 tion of lens, 201. 
 concavity on anterior sur¬ 
 face of, 151. 
 curves of, 250. 
 difficulty of estimating 
 thickness of, 117. 
 fistula of, 155. 
 flattening of by section, 
 103. 
 
 glazing of, 193. 
 hypertrophy of, 160. 
 injury of, with lisemoph- 
 thalmos, 235. 
 innervation of, 130. 
 meniscus form of, 211. 
 mirrors of, 212. 
 
 Cornea, nerves of, 137. 
 
 nutrition of, 129. 
 observation relating to, 
 of Sir E. Home, 217. 
 of Cuvier, 217. 
 of Mr. Eamsden, 247. 
 peculiar elevation on sur¬ 
 face of, 214. 
 puncture of, 106. 
 seton passed into, 158. 
 studied by astronomers, 
 250. 
 
 Cuvier, his anatomy of the cornea, 
 217. 
 
 Dalkyhple, his pictorial work, 190. 
 Danish physiologist, his experi¬ 
 ments, 131. 
 
 Darkened glasses, 12. 
 
 Dazzling brightness of eye, in case 
 of conical cornea, 9. 
 
 Decemet's membrane, tuberculosis 
 of, 197. 
 
 Decomposition of light by cornea, 
 251. 
 
 Defective eye of children, 36. 
 Definitions of conical cornea, 182. 
 Depressions on conical cornea, 185. 
 Desmarres, his case of myopia, 117. 
 Diagnosis of conical cornea, 1S6. 
 Diaphragm, optical, 20. 
 
 Discisiou of lens, 23. 
 
 Disease of teeth, with conical cor¬ 
 nea, 138. 
 
 Dislocation of lens, 23. 
 
 Division of trigeminus nerve, 131. 
 
 sympathetic nerve, 135. 
 Dog, disease of cornea in, 251. 
 Drawings of ocular disease, 189. 
 Dropsy, with conical cornea, 107. 
 
2 65 
 
 Egyptian ophthalmia, conical cor¬ 
 nea after, 94. 
 
 Electro-magnetism in conical cor¬ 
 nea, 10. 
 
 Elongation of cornea, 35. 
 
 Embryo, human, eye of, 27, 147. 
 
 thickness of cor¬ 
 nea in, 28. 
 
 Entropion, with conical cornea, 
 case of, 196. 
 
 Esquimaux, head of, 221. 
 Evacuation of aqueous humor, 21. 
 Excision of part of cornea, 22,1G0. 
 External injury, Conical cornea 
 after, 98, 196, 231. 
 
 Extraction of lens, 23. 
 
 Eye, defective, of children, 30. 
 Eyeball, conical, 187, 188. 
 Eye-cups, American, 210. 
 
 Eyelids, retraction of, instrument 
 for, 75. 
 
 Facettes of cornea, 32. 
 
 from rheumatic 
 ulceration, 255. 
 
 Fac-simile of conical cornea, 190. 
 Fario, his operation, 22. 
 
 his opinion, 151. 
 
 Fish, conical cornea in, 254. 
 Fischer, his case of conical cornea, 
 107. 
 
 Fishes, form of cornea in, 1. 
 
 Flarer, his opinion on conical cor- 
 » nea, 147. 
 
 his case of fistula of cornea, 
 
 155. 
 
 his seton in cornea, 158. 
 Flat cornea uncommon, 2. 
 Flattening of cornea by its partial 
 division, 163. 
 
 Flattening of cornea, contrivance 
 for, 73. 
 
 Foetus, conical cornea in, 27. 
 
 Follin, his ophthalmoscope, 174. 
 
 Foreign body in tooth, blindness 
 from, 140. 
 
 Form, abnormal, of head, 34, 35, 53, 
 54, 56. 
 
 Form of cornea altered by ophthal¬ 
 mia, 125. 
 
 Fovese, on conical cornea, 185. 
 
 Furnari, on myopia in Africa, 224. 
 
 Gaienzowski, his remarkable case 
 of blindness, 140. 
 
 Ganglia of sympathetic, extirpation 
 of, 134. 
 
 Gasserian ganglion, 131, 132, 133, 
 135. 
 
 Germany (Northern), conical cor¬ 
 nea rare in, 0. 
 
 Gervis, Mr., his cases of conical 
 cornea, 166. 
 
 Girls, their liability to conical cor¬ 
 nea, 4. 
 
 Glasses, darkened, or neutral tint, 
 
 12 . 
 
 Glass, inserted in cornea, 193. 
 
 Glazing of cornea, 193. 
 
 Goggles, of wood, perforated, 13. 
 
 Granular lids, myopia with, 117. 
 
 Guthrie, Mr., his cases of conical 
 cornea, 240. 
 
 H^mophthalmos, with conical cor¬ 
 nea, 235. 
 
 Htemophthalmos, with injury of 
 cornea, 235. 
 
 Hannover, his experiments, 134. 
 
266 
 
 Head, abnormal forms of, 34. 
 conical, 220. 
 
 Helmholz, his “ Augenspiegel,” or 
 ophthalmoscope, 174. 
 
 Himly, opinion of, 149. 
 
 Hobson, Dr., his cases of eye- 
 disease in China, 210. 
 
 Hong Kong, myopia occurring at, 
 226. 
 
 Hull, Dr., his. notice of compound 
 spectacles, 191. 
 
 Human eye, form of, 2. 
 
 Humboldt, his observations, 251. 
 
 Humor, aqueous, increase of, 34. 
 
 Huss, Dr. Magnus, on eye-diseases 
 of the Laplanders, 226. 
 
 Hydrocyanic acid, in conical cor¬ 
 nea, 16. 
 
 Hydrops oculi, 60, 185. 
 
 with conical cornea, 
 107, 155. 
 
 Hyoscyamus, drops of, to dilate 
 pupil, 57. 
 
 Hypertrophy of cornea, 166. 
 
 Hysteria and conical cornea, 115. 
 
 and hydrops oculi, 185. 
 
 “ Iconographie ” of Sicliel, 190. 
 
 Image, inverted by concavity on 
 cornea, 154. 
 
 Dnitation of conical cornea, 190. 
 
 Increase of aqueous humour, 34. 
 
 Infantile ophthalmia, conical cor¬ 
 nea after, 55, 101. 
 
 Influenza, conical cornea after, 290. 
 
 Injury from American Eye-cups, 
 
 212 . 
 
 external, conical cornea af¬ 
 ter, 98, 190, 231. 
 strabismus after, 206. 
 
 Innervation of cornea, 130. 
 Instrument for myopia, 77. 
 
 for slight pressure on 
 cornea, 73. 
 
 Internal ophthalmia, effects of, 85. 
 Iris, artificial, 8, 18, 20, 71. 
 
 state of, in case of conical 
 cornea, 10. 
 
 surgical operations upon, 20. 
 tremulous, with conical cor¬ 
 nea, 143, 144. 
 
 Iron, carbonate of, in conical cor¬ 
 nea, 16. 
 
 Jacobs, Dr., opinion of, 220. 
 
 Jaeger, opinion of, 220. 
 
 his case of conical cornea, 
 45. 
 
 Jelly, animal, lens of, IQ. 
 
 Julian, Van Roosbroeck, on conical 
 cornea, 253. 
 
 Keratitis, preceding conical cor¬ 
 nea, 148. 
 
 Ivirkes and Paget, on the sympa¬ 
 thetic and fifth nerves, 203. 
 
 “ Kliniseher Unterrieht," of Fischer, 
 107. 
 
 Laplanders, diseases of eye in, 
 225. 
 
 Lawrence, Mr., his case of conical 
 cornea, 107. 
 
 Legal medicine and conical coruea, 
 252. 
 
 Lens, artificial, 18. 
 
 broiement of, 23. 
 corresponding to form of 
 cornea, 19. 
 
Lens, crystalline, surgical opera¬ 
 tions upon, 20. 
 cylinclric, 13. 
 diseision of, 23. 
 dislocation of, 23. 
 extraction of, 23. 
 formed of animal jelly, 19. 
 position and form of, in the 
 young, 37. 
 
 spontaneous absorption of, 
 205. 
 
 Lenses, combinations of, 19. 
 
 variety of, bow employed, 
 
 20 . 
 
 Lockhart, Mr., bis cases of Eye- 
 disease in China, 214. 
 
 Longet, his researches, 132. 
 
 Magnesia, sulphate of, in conical 
 cornea, 15. 
 
 Mammalia, form of cornea in, 1. 
 Mankind, varieties of, in which 
 conical cornea has been observed, 
 
 4. 
 
 Membrane of aqueous humor, 
 weakness of, 151. 
 
 Meniscus lens, 18. 
 
 of cornea, 241. 
 
 Microscopic inquiry recommended, 
 259. 
 
 Middlemore, Mr., his case of partial 
 conical cornea, 103. 
 
 Mirrors of cornea, 242. 
 
 Mongols, form of head in, 221. 
 Muscee, in case of conical cornea, 61. 
 Muscles of eye, abnormal attach¬ 
 ment of, 41. 
 
 Myopia, after ague, 117. 
 
 after cold hath, 116. 
 after small-pox, 39. 
 
 Myopia, cases of, 76, 198. 
 
 during granular state of 
 eyelids, 117. 
 hereditary, 38. 
 instruments for, 77. 
 in the young, 29. 
 occurring at Hong Kong, 
 226. 
 
 preceding cataract, 198. 
 source of its name, on, 74. 
 with conjunctivitis, 117. 
 
 Nachet, his ophthalmoscope, 17 
 
 Nature, question of disease left to, 
 238. 
 
 Neutral tint glasses, 12. 
 
 Nerves of cornea, 137. 
 
 Nervous system, morbid condition 
 of, state of pupil in, 33. 
 
 Nictitation as a symptom of conical 
 cornea, 10. 
 
 Nitrate of silver, employment of, 
 16, 168. ' 
 
 Nussbaum, his insertion of glass in 
 cornea, 194. 
 
 Nutrition of cornea, 129. 
 
 Object of surgical operations for 
 conical cornea, 20. 
 
 Occurrence of conical cornea, modes 
 of, 127. 
 
 Ocular and uterine complaints, 113. 
 disease, drawings of, 189. 
 
 Opalescence of eye, in cases of coni' 
 cal cornea, 41, 45, 52, 57. 
 
 Oqieration of Fario, 22. 
 
 Operations, surgical, for conical 
 cornea, 20. 
 
 success of, 162, 163. 
 
268 
 
 Operations, ultimate results of, 
 165. 
 
 Ophthalmia, a source of change 
 in form of cornea, 125. 
 conical cornea after, 
 231, 230. 
 
 infantile, conical cor¬ 
 nea after, 101. 
 internal, effects of, 
 85. 
 
 Opticians, observers of conical cor' 
 nea, 7. 
 
 Oscillation of eye-ball in conical 
 cornea, 143. 
 
 Opinion of Adams, 150. 
 
 Benedict, 151. 
 
 Fario, 151. 
 
 Flarer, 147 
 Guthrie, 241. 
 
 Himly, 149, 
 
 Bickford, 202. 
 
 Sanson, 239. 
 
 Sichel, 119. 
 
 Ware, 184. 
 
 respecting conical cor 
 nea, 152. 
 
 Pappexheim, bis researches, 132. 
 Pickford, Dr., his opinion, 202. 
 
 cases of conical 
 cornea, 114. 
 Pictorial work of Dalrymple, 190. 
 Photophobia, as a symptom of 
 conical cornea, 10. 
 
 Polyopia, as a symptom of conical 
 cornea, 11. 
 source of, 144, 145. 
 with conical cornea, 144. 
 Pourfour du Petit, his division of 
 sympathetic nerve, 135. 
 
 Pregnancy, strabismus during, 114. 
 
 Presbyopia, after external injury, 
 207. 
 
 Pressure, 21. 
 
 apparatus for application 
 of, 17. 
 
 Prichard, Dr., on the skull of the 
 Esquimaux, 222. 
 
 Prognosis, unfavourable, cases for, 
 143. 
 
 Progress of conical cornea, 26. 
 
 Prussic acid in conical cornea, 16. 
 
 Puncture of cornea, 25, 155, 156, 
 157. 
 
 Pupil, altered in position, 32, 33. 
 artificial, 21, 24, 24. 
 
 Recovery, spontaneous, from coni, 
 cal cornea, 239, 240. 
 
 Relapses of conical cornea, 115. 
 
 Remedies for conical cornea, 15. 
 
 Retraction of eyelids, instrument 
 for, 75. 
 
 Revielle-Parise, his case of myopia, 
 117. 
 
 Rheumaticulceration of cornea, 255. 
 
 Riberi, his cases of conical cornea, 
 148. 
 
 Richardson, Sir John, on eye- 
 diseases of the Esquimaux, 222. 
 
 Roosbroeck, Julian Van, on conical 
 cornea, 253. 
 
 Rowley, his case of conical cornea 
 after parturition, 40. 
 
 Ruete, on hydrops oculi in Africa, 
 224. 
 
 Rupture, supposed, of posterior 
 layer of cornea, 149. 
 
 of membrane of Dece- 
 met, 256. 
 
269 
 
 Sanson, opinion of, 239. 
 
 Sclilemro, his discovery of nerves 
 in the cornea, 137. 
 
 Schon, his cases of conical cornea, 
 
 118. 
 
 Scotland, conical cornea rare in, 6. 
 Scrofula and conical cornea, 114. 
 Second cure of conical cornea, 115, 
 Seiler, case quoted from, 45. 
 Sensitiveness of eye, in case of 
 conical cornea, 10. 
 
 Seton passed into conical cornea, 
 158. 
 
 Short-sight, preceding cataract, 198. 
 Sichel, his opinion respecting opa¬ 
 city of cone, 119. 
 
 his “ Iconograpliie,” 190. 
 Sight, unusually good with conical 
 cornea, 236. 
 
 Smith, Dr., his case of myopia, 116 
 Speck on conical cornea, 184. 
 Spectacles, annular, 24. 
 
 in a case of strabismus, 
 207. 
 
 Soldiers, conical cornea in, 253. 
 Spontaneous recovery from conical 
 cornea, 239, 240. 
 absorption of lens, 205. 
 Staphyloma and conical cornea, 241. 
 Stationary condition of conical cor¬ 
 nea, 26. 
 
 Strabismus, after accidental injury, 
 206. 
 
 after hsematemesis, 206. 
 during pregnancy, 114. 
 spectacles, in case of, 
 207. 
 
 with conical cornea, 145. 
 Sugar-loaf shape of cornea, 184 
 
 Sympathy of eye and pelvic viscera 
 109. 
 
 digestive or¬ 
 gans, 80. 
 
 Synchisis, case of, 86. 
 
 in excessive drinkers, 90 
 
 Syphilis and conical cornea, 114. 
 
 Szokalsky, his researches, 132. 
 
 Taper, small image of, 63. 
 
 Teeth, artificial, source of impaired 
 vision, 141. 
 
 attention to, 137. 
 disease of, with conical cor¬ 
 nea, 138. 
 
 Temporal bone and cornea, dis¬ 
 ease of, 135. 
 
 Terminations of conical cornea, 237. 
 
 Thickened conical cornea, puncture 
 of, 166. 
 
 Thickening of conical cornea, 166. 
 
 Thickness of conical cornea, various, 
 32, 59. 
 
 of cornea, difficulty of 
 estimating, 147. 
 of congenital conical cor¬ 
 nea, 181. 
 
 Tome, on transplantation of cornea, 
 26, 
 
 Tonics, in cases of conical cornea, 
 
 15. 
 
 Tooth, blindness from foreign body 
 in, 140. 
 
 Touch, employed in examination of 
 the eye, 10. 
 
 Topical applications in conical cor. 
 nea^.16. 
 
 Traction on eyelid, 18. 
 
 Transplantation of cornea, 26, 193 
 
270 
 
 Treatment, anti-strumous, of coni¬ 
 cal cornea, 116, 
 
 Trichiasis, conical cornea after, 
 121, 196. 
 
 Trigeminus nerve and cornea, dis 
 ease of, 135. 
 
 division of, 131. 
 
 Tremulous iris, with conical cornea, 
 143, 144. 
 
 Tuberculosis of posterior surface 
 of cornea, 197. 
 
 Tyrrell, Mr., his case,—of periodic 
 hsemophthalmos, 235. 
 
 of myopia, 117. 
 
 Ulceration of cornea, 255. 
 
 Unfavourable prognosis, cases for, 
 143. 
 
 Uterine and ocular complaints, 113. 
 
 Van Roosbroeck, Julian, on conical 
 cornea, 253. 
 
 Varieties of mankind,'in which coni 
 cal cornea has been observed, 4. 
 Vesication of cornea, 256. 
 
 Veterinary medicine and conical 
 cornea, 257. 
 
 treatises, in connection 
 with conical cornea, 4. 
 Vidal, his case of conical cornea, 104. 
 Vision, in case of conical cornea, 
 deceptive to patient, 61. 
 unusually good with conical 
 cornea, 236. 
 
 Vitreous humour, alteration of, 143. 
 
 Walther, his cases of conical cor¬ 
 nea, 117, 155. 
 
 Waterv r aspect of conical cornea, 188. 
 Winking, as a symptom of conical 
 cornea, 10. 
 
 Young people, myopia in, 29. 
 
 Zinc, sulphate of, in conical cornea, 
 15. 
 
 THE END. 
 
WORKS BY THE SAME AUTHOR. 
 
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