244 
FRANK H. MILLER. 
owner, send the patient forth, fully expecting a more or less 
rapid resolution under careful treatment. This diagnosis may 
be absolutely correct, so far as it goes, but its very incomplete¬ 
ness will almost certainly end in permanent injury to vision, in¬ 
asmuch as the cause has not been demonstrated. 
My personal experience has taught me the importance of 
carefully locating the relation of these corneal disturbances. b»o 
many of them lie internal to a line drawn perpendicularly 
through the centre of that part of the eye as to serve as a sort 
of wayside fingerboard to indicate the direction from which the 
all-important irritation is coming, and besides a most incom¬ 
plete examination of the eye and its appendages has been car¬ 
ried out where the entire posterior surface of the membrana 
nictitans has been overlooked and not carefully passed upon. 
Had we taken the precaution, while the membrane was anaes¬ 
thetized, to have picked it up carefully with a pair of eye 
forceps and drawn it well forward and reflected it upon itself and 
away from the eye and examined its posterior side thoroughly, 
we would in one and the same moment have been placed in 
position to have given a clear and complete diagnosis of the 
case and to have outlined a treatment calculated to speedily and 
certainly overcome the disease and check the ravages caused 
by it, rather than to have prescribed for a series of symptoms, 
leaving the process proper to itself and even aiding its progress, 
perhaps, by the use of certain agents as atropine, calomel, etc., 
since they appear almost invariably to greatly stimulate the con¬ 
dition, causing the entire chain of symptoms. In such an exami¬ 
nation of a patient suffering from this particular form of 
conjunctivitis we are able to detect upon that portion of the 
mucous membrane covering the tertiary lid near, but invariably 
a short distance removed from, the fornix, a well-defined patch 
of granulations varying in area from a very small spot in some 
cases to almost the entire surface in others. The individual 
granulations are seen when examined by the lens to vary in 
size from that of the finest to the coarsest particles of sea sand, 
and in color and consistency from the smallest and softest semi- 
