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disease. Like most others, however, who have introduced new re- 

 medies, or suggested new modes of treatment, he has carried his 

 views of the efficacy of bark and quinine to an extent that sub- 

 sequent experience has not justified. He considers cinchona a 

 specific in this disease, and trusts to it alone, without reference to 

 the state of the eye, or the condition of the patient'3 general 

 health. My own experience has convinced me that the use of qui- 

 nine, in connection with other means, is of great benefit ; that, in 

 some cases, as that of Wilson, to be hereafter referred to, it is 

 capable alone of effecting a cure. The broad ground, however, 

 taken by Mr. Wallace, that in all cases, whatever may be the state 

 of the eye, or the condition of the general health, the use of quinine 

 is alone sufficient, will be found as untenable as that taken by Mr. 

 Mackenzie, that we can rarely dispense with the use of the lancet, 

 even though the patient be suffering from great debility. Both, to 

 a certain extent, are right, and both, to an equal or greater extent, 

 are wrong. That there are cases of postfebrile ophthalmia which 

 are benefited by moderate depletion, there can be no doubt — that 

 there are others which are injured even by moderate depletion, and 

 greatly benefited by the use of tonics, is equally true. The great 

 point in practice is to discriminate between these cases, to decide 

 beforehand which require depletion, and which require building up. 

 In both, as far as the state of the eye itself is concerned, they pre- 

 sent quite the same appearance; in both, there are the same redness, 

 pain, intolerance of light, the same change of structure and disturb- 

 ance of vision, and it is only by carefully examining into the state 

 of the general health, that we are enabled to decide upon the pro- 

 per course of treatment. I believe, with Mr. Wallace, "that there 

 are many physicians who scarcely extend their therapeutics beyond 

 the lancet, the leech and the purge, and when these fail, the case is 

 treated empirically, or set down as hopeless, or is left to Nature, 

 who often, on such occasions, performs the office of a skilful phy- 

 sician, and when allowed to proceed without interruption, sets up 

 processes of restoration which are quickly followed by recovery." 

 In the treatment of diseases of the eye, as in that of most local 

 affections, the state of the patient's system has been too much ne- 

 glected, and I cannot permit this opportunity to pass, without ex- 

 pressing my opinion of the great obligation the profession are under 

 to the late Mr. Tyrrell, for so ably enforcing by argument, and illus- 

 trating by examples, as he has done in his valuable work on the 

 eye, the necessity of ascertaining whether your patient is, as he so 



