406 OHAPTEIi 57. 



same in either di«ease, we may wait i)atieutly for the develu])meiit of 

 further symptoms. 



Sometimes the disease comes on slowlj', at other times it gains ground 

 rapidly. There is turgescence of the lids, a flow of tears, intolerance of 

 light, and an inflamed state of the conjunctiva investing the outer margins 

 of the cornea. As the above symptoms increase, the eye becomes some- 

 what sunk in its socket by the action of the retractor oculi muscle, and 

 at the same time the membrana nictitans is brought partly forward over 

 the eye. Then, there is a great redness of the conjunctival membrane, 

 and blood-vessels ap}tear in it, some of them running in a circular direc- 

 tion and others radiating to a central point ; there is also general dim- 

 ness of the surface, and a copious flow of hot tears. These symptoms will 

 soon be followed by the aqueous humour appearing thick and muddy, and 

 by the iris losing its brilliancy. In very acute cases there soon occurs a 

 deposit of lymph often tinged with blood, wliich fills up the anterior 

 chamber of the eye, so that the state of the interior can no longer be 

 seen. The lymph is the result of exudation from the inflamed vessels of 

 the internal structures. 



When amendment is about to take place, the curtain of lymph gradu- 

 ally falls down from the superior border of the anterior chamber, if it has 

 been attached there, and we are then enabled to see what mischief has 

 been going on within the eye. These changes, both for better and for 

 worse, take place in a remarkably short space of time. 



We may tind even after the first attack, that the iris is adherent to the 

 caj)sule of the lens, or that cataract has commenced to form in the lens 

 or in its capsule. But these marked eflfects do not usually appear until 

 after several attacks. More generally we find no other trace of the 

 attack than that the iris has lost in a very slight degree the brilliancy of 

 its colour, the lens a little of its clearness, and that the pupil of the eye 

 attacked is somewhat smaller than that of the other. A little opacity, 

 varying more or less according to the virulence of the attack, is also left 

 in the cornea, particularly round its margins. The iris also does not act 

 quite so freely in the diseased as in the other eye, and hence the pupil is 

 not kept (juite so dilated as it ought to be. All these effects are due to 

 the effused products of inflammation not being completely absorbed and 

 uarried away. In a first attack the patient usually recovers quickly after 

 the disease begins to decline. 



These symptoms show clearly enough that the malady affects the deep- 

 seated tissues. In common ophthalmia, on the contrary, the interior of 

 the eye, except when the cornea itself is injured, seldom shows any 

 alteration. 



The great peculiarity of Specific ophthalmia lies in its frequent remis- 

 sions of intensity, as described above, and the almost certainty of future 

 attacks. It is very common for the second attack to take place in the 

 eye not first affected. This also shows plainly that the disease is con- 

 stitutional, not local. The first, second, and third attacks may last from 

 about ten days to a fortnight ; but as they become more frequent, their 

 period of intensity is shorter. After each attack the structures within the 



