We have recently seen a very remarkable instance of this curious complaint. A lady of distinction and title, aged between 60 and 70, had enjoyed the most perfect health till within these few years. About that period she experienced some anomalous feelings about the head, indicative of fulness of the cerebral vessels, and these were accompanied and followed by certain vitiations of the senses of tasting and smelling. These symptoms she disregarded, her health being, in other respects, pretty good. Gradually, however, she began to perceive a weakness in the left lower extremity, with some uneasy sensations in the line of the sciatic nerve between the hip and the knee. This debility steadily increased, during the last twelve months, and she is now obliged to go on crutches. The muscles of the thigh, but not of the leg, are flabby and a little wasted.

She can move the extremity in every direction; but has not the power of leaning in the slightest degree upon it. The most singular phenomenon, however, is this;that, whenever she either bends or extends the knee, a crackling noise is distinctly heard, even at a considerable distance, along the course of the rectus femoris muscle, exactly resembling the cracking of fingers when stretched. The action of flexion and extension is accompanied by painful sensations in the rectus femoris, the two vasti, and the cruræus. When at rest, she feels no pain. Mr. Brodie and the senior Editor of this Journal examined the thigh with the greatest care. The ear was repeatedly applied along the muscles above-mentioned, and the crackling noise was loudly heard. As the ear approached the knee-joint, the noise diminished, and it was perfectly evident that the sound did not proceed from the joint, but from the muscles of the thigh. In the whole course of his experience, Mr. Brodie never met with but one case at all resembling this. It was a gentleman who complained to him of such strange and anomalous sensations about the right shoulder and side of the back, that he

Mr.

was hypochondriacal, and fancied a host of morbid and unintelligible feelings. In one of his visits the patient asked Mr. Brodie what could be the cause of the cracking noise in his back. Brodie had not been made acquainted previously with this symptom. But the patient soon convinced him of its reality; for, on moving the arm up and down, there was a cracking noise emitted from the muscles about the shoulder, and especially the latissimus dorsi, so loud that it could be plainly heard even in an adjoining room. Mr. B. examined with the ear, and clearly ascertained that the noise proceeded from the muscles, and not from the shoulderjoint. In this case there was no diminution of muscular power, but only painful sensations. The gentleman, in the course of some years, got rather better; but Mr. B. lost sight of him, and the final result is not known. In respect to the lady, various means had been used, and half a score of physi cians and surgeons had been consulted, without the slightest benefit. She was finally recommended to go on a tour up the Rhine in August of the present year, more to divert her mind, and give a fillip to the general health, than with any prospect of recovery from the local complaint. She had heard so much of the "Bubbles of the Brunnens," that she was anxious to try their efficacy. They will probably burst and leave no mark of their power behind.

What is the nature or the cause of the phenomena above-mentioned? We believe it would puzzle a Philadelphia lawyer to solve the problem. For our own parts, we are completely pozed— and we shall not trouble our readers with any of the hypotheses we have formed to unriddle the mystery. The lady, who is very intelligent, says that she feels as if the muscles were dry, and snapped or cracked, with some pain, when she puts them in motion. By the way, can any one explain the cracking of the finger-joints when forcibly extended? It rarely happens that a joint can be made to crack more than once, however often the extension may be repeated at that time. Is it the for

yellow and thick mucous secretion is lodged.

The inflammation, however, soon spreads to the ocular conjunctiva, the vessels of which become extensively injected with red blood, and, on close inspection, are found to form a beautiful net-work. In severe cases, the conjunctiva is partially thickened and elevated by deposition of serum between it and the sclerotic, constituting a partial chemosis, and occasionally small spots of ecchymosis are perceived from the rupture of some minute vessels.

If the disease extends farther, it produces ulceration of the cornea.

This ophthalmic disease seldom exists without some symptoms of general catarrh, such as headach, sense of fulness about the frontal sinuses, sneezing, increased secretion from the nose, and some general febrile symptoms: the local and general diseases are usually reciprocal.

In young subjects the catarrhal-ophthalmia is often modified by a strumous diathesis, which occasions the local affection to be more severe, augments especially the intolerance of light and lachrymation, and disposes to the formation of pustules.

This disease may occur at any period of life. It is produced by a peculiar state of the atmosphere, during the continuance of which there is considerable difficulty in entirely removing the ophthalmia."*

The treatment must be modified by the severity of the symptoms, the extent of the constitutional disturbance, and the condition of the general power.

"When there is simply affection of the palpebral conjunctiva with morbid mucous secretion and little general disturbance, and sufficient constitutional power, I prescribe a brisk aperient of calomel and colocynth, or calomel and rhubarb, or jalap, and afterwards a small quantity of some of the preparations of mercury with antimony, or with Dover's powder at night, and a mild saline aperient in the morning, also mild diet, principally vegetable and fa

MED. QUART. REV. No. IV. p. 416.

rinaceous, with quiet, and the avoidance of cold or damp, or of bright light. Locally, I employ merely tepid water, to cleanse the eyes; or warm water to foment them when uneasy, and some simple ointment, which should be smeared upon the lids and eyelashes before the patient goes to sleep.

When the local disease is acute and the constitutional affection considerable, general or local bloodletting must be resorted to; the former being only necessary in persons of naturally full habit or subject to inflammatory diseases; and after bloodletting the treatment above described will be applicable.

In a few days the mild or acute form, if treated as I have described, passes into the chronic stage, which is denoted by a general mitigation of symptoms, but more especially by an alteration in the mucous secretion, which becomes thin and pale, and by the change in colour of the conjunctiva, which loses its brilliant aspect, and presents a more pale and lax appearance; at the same time it is found that the general power is failing under the continuance of the constitutional affection; the treatment must therefore be changed. Instead of exciting the secretions, they must now be kept as near as possible in their natural state, and a more generous diet must be allowed, but still the patient must abstain from such food as may tend to excite vascular action. It is necessary, in persons of feeble power, to give, in addition, some medicinal stimulus, as some of the preparations of bark, mineral acid, or ammonia.

To subdue the remains of the local disease, a slightly astringent lotion must be substituted for the tepid water, as a solution of the acetate of lead, half a grain, or a grain to the ounce; or a solution of alum, a grain or two grains to the ounce; the sulphate or acetate of zinc, a quarter or half a grain to the ounce, or nitrate of silver in the same proportion. Also a stimulating ointment must be applied instead of the milder form, as the dilute citron ointment composed of half a scruple or a scruple of the unguentum hydrargyri nitratis, to two drachms of unguentum

cetacei, or a scruple of the unguentum hydrargyri nitrico-oxydi to a drachm of the unguentum cetacei."

Where a strumous diathesis prevails, and where, as was observed, there is much intolerantio lucis, counter irritation by blisters is necessary. The intolerance exists both in the acute and chronic form, which renders it difficult to distinguish between them, though it is necessary to discriminate in the treatment. Mr. T. is convinced that more benefit results from repeated blisters, than from keeping one open. Cold applications are injurious to the eyes of strumous children. He uses tepid water in the acute stage, and trusts to general remedies in the chronic. We now proceed to the

CATARRHO-RHEUMATIC
OPHTHALMIA.

"This affection commences with symptoms similar to those of the catarrhal, but with more early suffering: for in addition to the symptoms of the catarrhal disease, the patient experiences a constant dull aching pain in the globe of the eye, and in the temple and eyebrow: the globe feels tense, and as if it had been bruised; and these pains and sensations become so much augmented towards evening as to prevent sleep. The accession of pain is accompanied with intolerance of light and a feeling of dryness of the conjunctival surface, so that the motions of the eyelid upon the eye produce excessive pain; but occasional gushes of tears occur, which for a few moments produce some relief; while the symptoms continue thus acute, the globe of the eye, the temple and eyebrow, are extremely tender to the touch.

In the intervals between the severe attacks, when there is but slight intolerance of light, vision is frequently indistinct, and occasionally sinall black spots or muscæ are perceived by the patient.

On superficial inspection of the eye, the appearances denoting catarrhalophthalmia of an acute kind are apparent; such as the red palpebral margin, the thick mucous secretion, the

thickened and villous state of the palpebral conjunctiva, with the tortuous vessels and vascular net-work on the ocular portion of the membrane; but an attentive examination soon discovers that the colour of the ocular conjunctiva is more uniform and deeper than in the simple catarrhal disease: and this upon further observation is found to depend upon the existence of another set of minute vessels filled with red blood, which can be traced in the intervals between the tortuous vessels of the conjunctiva as passing beneath them in a straight course from the margin of the cornea towards the orbit; these vessels are situated in the sclerotic coat; they are occasionally found more abundant in one part than another; as, for example, more upon the nasal than the temporal side of the cornea, and of course augmenting the depth of colour in such particular situations : it requires therefore a careful examination of the whole ocular surface to detect them.

When the vision is affected, being cloudy or troubled with muscæ, some change is perceptible in the iris; its pupillary aperture is contracted, its brilliancy is diminished, or its colour slightly altered; which circumstances are best detected by comparing the iris of the affected eye with that of the healthy organ: the motions of the affected iris also are sluggish. The iris suffers in consequence of inflammation extending to it from the sclerotic.

Sometimes a partial or complete ashcoloured line is seen between the cornea and vessels injected with red blood, most frequently the line forms a complete circle around the cornea; but I have seen it merely occupying a portion of the circumferance of the cornea, being apparent at its temporal and nasal margins, and deficient superiorly and inferiorly. This appearance is considered by the continental and also many of our own ophthalmic surgeons, as a diagnostic of rheumatic inflammation. Such opinion, however, I consider to be erroneous, for I have seen a similar line present in iritis, simple sclerotitis, and choroiditis. I believe it results from the mode of junction between the sclerotic and cornea, occurring when

any of the diseases alluded to are present, and seen most distinctly when the junction of the two structures is very oblique, but not at all evident when the textures are joined with little or no ob liquity. Now and then the margin of sclerotic overlaps or joins obliquely the circumference of the cornea, more in one part than another, and this I have observed most frequently on the temporal and nasal sides, so as to make the transverse diameter of the cornea less than the perpendicular diameter. When such formation exists and inflammation affecting the slerotic occurs, the ashcoloured line is apparent only towards the nose and temple.'

The exciting causes are cold and moisture; and Mr. T. suspects that the simple catarrhal affection is often converted into the rheumatic, by the injudicious application of cold lotions.

TREATMENT.

When inflammation preponderates in the conjunctiva, and the sclerotic is but slightly affected, leeches must be applied, and brisk purgatives given. For a few days, Mr. T. employs the same means as in the simple catarrhal affec tion, excepting that, when the circumorbitar pains are severe, he directs blisters, or a few grains of mercurial ointment, with opium, to be rubbed on the temple and forehead at night. As soon as the severity of the conjunctival affection has subsided, he prescribes a more nutricious diet, and small doses of cinchona and soda, sarsaparilla and lime-water, or some mild tonic with an alkali. Locally, warm water is occasionally used to cleanse the eye; "but the patient must carefully wipe it, and not allow the surface of the lids to remain moist, as I am confident it augments the mischief." The repetition of blisters is serviceable where there is much intolerantia lucis, or continual circumorbitar pains. When irritability, with little vascularity, remains, a drop or two of vinum opii once or twice in the 24 hours, dropped into the eye, is useful.

"If the catarrhal affection of the conjunctiva be slight, and the inflam