varying position of the corneal reflection, even in a good photograph, is so confusing, that the photographs are useless as records of results.

I have had this same difficulty in several other cases which I have not included in this report, as I had no means of indicating the improvement obtained.

In this case I gave, as a rule, three applications a week for the first six months, and since that time once a week.

The patient, on her own statement, is much improved. Vision is still about 200, but she can now see with the head erect, the field is much enlarged, and as the fellow-eye is extremely near-sighted, this improvement is a great assistance to the patient. The iris can now be seen through any part of the scar, the density, even in the lower part, which was in the beginning almost as white as the sclera, is greatly lessened, and above, the cloud has entirely disappeared down to about the middle of the pupil. The capsular opacity can be clearly seen, and fully explains the lack of improvement in vision.

The case has progressed but slowly since treatment has been applied but once a week, but I can see that it does improve surely all the time.

ment.

CASE VII.-J. Q., male, presented himself at the N. Y. Eye and Ear Infirmary on February 3, 1889. On the 3d of July previous he had been struck in the eye by a piece of coal. An inflammation was set up which lasted for some two months, after which time the eye became quiet and annoyed the patient only by its defective vision. The eye was at this time free from all irritation. Vision 2000, with a mydriatic 20/? Patient was referred to me by Dr. Derby for treatI gave him 1⁄2 m. a. for one minute, and as this produced no disturbance, I repeated it on February 5th. On February 11th, 11⁄2 m. a. for two minutes was given. On the 13th, vision was improved to 20/100 + and 11⁄2 m. a. for three minutes was given; on the 19th, vision 20/70 ? the current at this sitting was increased to 3⁄4 m. a. for three minutes. This treatment was repeated on the following day, and on February 25th vision 20/50 was obtained; 34 m. a. for four minutes was given at this time. The patient subsequently presented himself, but as I was prevented at this time by sickness from seeing him, I lost track of him, and no further record could be obtained.

CASE VIII.-M. J., female, aged sixteen, patient of Dr. Mittendorf, referred by him for treatment, on February 9, 1889. This patient had suffered from an ophthalmia in infancy, which had produced in the

* Homatropine.

right eye an adherent leucoma. The iris was adherent at the lower nasal side, drawing the pupil out to an oblong slit, which was covered by the leucoma, save at the extreme tip, where a little clear pupil was exposed and vision of /200 (as taken by Dr. Mittendorf) was obtained. by the patient when looking slightly down. The leucoma was very white and dense at the centre, and extended through the entire thickness of the cornea. The left eye was covered by a still larger leucoma, with closed pupil and only V. = 1. p.

I endeavored to get a photograph of the case, but was prevented by the nystagmus which was present.

20 / 200°

The vision was 15/200 when I examined her under atropia. I did not wait till the effects of the atropia had passed away before beginning treatment, so have no record of the near vision till February 23d, when she could see J. 8 at 12". The patient improved quite rapidly at first, and by the last of March had V.: In this case I used stronger currents than in any of the preceding. I began with 1⁄2 m. a. for three minutes, and soon increased it to 11⁄2 or 2 m. a. for three to four minutes, but little irritation followed the treatment. The patient was quite regular in attendance till the middle of April, when she informed me she had secured a place at service, her vision now being much improved.

She could see J. 5 at 12′′, and the leucoma was certainly reduced in size. She had, at this time, had fifteen applications.

After this I saw her at irregular intervals, and vision did not improve any further. I think, however, that the density of the leucoma was still further reduced while under treatment. She disappeared in July, and no further records were obtained.

CASE IX.-M. F., male. On May 14, 1889, patient presented himself at my clinic at the Long Island College Dispensary, giving the following history: Twenty-seven years ago he lost left eye from an injury. Two months before his visit to the dispensary right eye became inflamed and painful. He was treated at the Brooklyn Eye and Ear Infirmary, and made a good recovery. Present condition: Leucoma in right eye, covering the pupillary area. V./200, with atropia, V. 201 100, not improved with glasses. Pupil dilates under atropine irregu

larly.

He was given 1 m. a. for one minute, and no reaction following, the current was gradually increased, and vision improved by June 8th to 16/200 The eye which had been somewhat irritated after treatment for a few preceding applications became quite severely inflamed at this time, and treatment had to be suspended. By August 5th vision had improved to 2/100 Treatment was again resumed, and by August 27th

70

vision of 200 was obtained. Wishing to determine whether or not the treatment was entirely responsible for the improvement, I suspended treatment from August 27th until October 20th, when I found V. 20/70, as on the last visit in August.

Treatment was again for some time discontinued, to be begun again the latter part of February, after six more applications, V. 20/50 was obtained March 7th; and after eleven more applications, V. 2010 ? on May 14th.

CASE X.-K. L., aged thirty, female, patient of Dr. Joye at Brooklyn Eye and Ear Infirmary, referred for treatment on May 17, 1889. In February of preceding year, patient suffered from keratitis in O. S., which lasted for about six weeks, and left a corneal opacity covering the lower two-thirds of the cornea. V. not improved by glasses, with atropia V. 20/ The patient was a phthisical subject, well advanced in the malady, and the general nutrition was very defective.

20/200

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Treatment began with 14 m. a. for three minutes, which was increased up to 14 for three minutes. The case never made very encouraging progress. The vision did improve somewhat, being 10/200 on June 2d, and 1/200 on July 15th, and 20%, on October 9th, after a long interval of rest from treatment. The appearance of the eye was not noticeably improved, except at the lower nasal margin, where an area of clear cornea was visible.

200

I think the very poor general condition of the patient prevented a more prompt response to treatment. The eye was never very much irritated after treatment, but I was in constant dread of the cornea breaking down and making trouble. The patient's health finally became so poor that I advised her to abandon treatment.

Both the galvanic and faradic currents through the closed lids have, I believe, been employed in the treatment of corneal opacities, but have not thus far commanded the confidence of the profession. From a study of the foregoing cases, I am convinced that when applied. directly to the opaque cornea, galvanism becomes a valuable and reasonably reliable method of treatment. I do not believe that I could have obtained equally good results from any other method, and in most of these cases the ordinary methods had been tried without benefit before I instituted treatment by electricity. As will be seen, the rapidity of visual improvement varies much in different cases, and in a large measure depends upon the position of the area of the greatest density of the opacity. The clearing is at first only observable at the periphery of the opacity, and when the scar is concentric with

the pupil no improvement in vision is manifest until late in the progress of the treatment. When, however, the pupil is obscured by the less dense margin of the opacity, most rapid improvement will be obtained from the first few applications.

The age of the opacity seems to have little to do with the rapidity of the improvement under treatment. As will be seen in the foregoing series of cases, which include both very recent and very old opacities, the improvement was as rapid in those which had existed for a long time as in the very recent ones. I would not begin treatment by galvanism till the limit of improvement which would naturally take place had been reached, but as soon as the eye is quiet and no further clearing seems to be taking place, the treatment should be instituted by very weak currents.

My experience with the treatment is not sufficient to warrant me in saying how much we may reasonably expect from it, and what cases we must decline as hopeless. In cases with dense opacities, treatment must be continued for a very long time to accomplish any noticeable results. But in cases I., III. and IV., all cases of long standing, with very dense opacities, there was a steady improvement while under treatment. How long this would have continued it is quite impossible to say. Our knowledge of the action of galvanism, when applied to the living human body, is not by any means as great as we could wish, and it is quite impossible to say at all definitely how it accomplishes the absorption of corneal opacities. It seems to me to be a matter of increased nutrition and of a retrograde metamorphosis of the scar tissue, accomplished by the electrolytic action of the currents. since when we speak of the different actions of the current, that it is electrolytic in one case, cataphoric in another, etc., it is chiefly a matter of words, the observed phenomena are of much more importance.

After any destructive process in the cornea new material is hastily thrown up to repair the damage, and later on the scar tissue, which is opaque, is replaced by clear tissue. This process will continue till the new tissue becomes so firmly organized as to resist the effects of nature to remove it.

During this process of repair there is a high state of vascularity in the part, and in those cases where vessels are seen running on to the cloudy area, the prognosis is, I think, more favorable. Now, during the application of electricity, this picture is reproduced. The vessels are no doubt dilated by the action of the current. They are seen in great abundance running to the corneal margin or on to the scar. In some cases the scar is seen to be covered during treatment with a fine mesh of vessels, which extend only to the edge of the opacity and disappear with it, as under treatment the clear cornea encroaches upon the

scar. After the application the vessels almost immediately disappear, but I have no doubt that in a less degree the increased vascularity and stimulated nutrition continue for some time, and in treatment I endeavor to keep this process as active as possible without over-stepping the limit and producing a condition of stasis.