A simple mode of examining the Fundus Oculi. By A. M. ROSEBURGH, M.D., Toronto, C. W. I find that the fundus of the eye can be examined without the mirror of the ophthalmoscope as follows: The lamp is placed on a table in a darkened room. The patient is seated on a chair two or three feet from the table, and facing the light. The chair of the observer is placed with the back against the table and between the patient and the lamp. When the surgeon is seated, the lamp should be immediately behind the right shoulder and very nearly on a level with the eye. By now bringing the right eye in a line with the lamp and the eye of the patient, but so as not to shade it, if the pupil had been previously dilated with atropine—the fundus is seen to be illuminated. In order to see the details of the posterior internal surface of the eye, a lens of about two inches focus is placed within an inch or two inches of the eye under examination. An inverted image of the fundus can now be seen forming an aerial image about two inches in front of the lens. The optic nerve entrance and the radiations of the retinal vessels can be seen by directing the patient to look at the light or two or three inches farther from the surgeon's eye, but in the same horizontal line. Toronto, September 1st, 1865. HOSPITAL REPORTS. Two cases of Epilepsy; occurring at the Montreal Dispensary. Under care of Dr. FRANCIS W. CAMPBELL. He W. D, a youth of 17 years, presented himself at the Montreal Dispensary, on the 2nd of May, 1865, stating that he was the subject of epileptic fits. For several years he was addicted to the vice of masturbation, but for a year past he asserts he had given it over. has a low forehead, and a very dogged expression. The fits first came on about four years ago-appearing once in three weeks. He several times sought medical treatment, but he continued to grow worse. About six months ago—they attacked him once every four days; and so continued up till the day he presented himself at the Dispensary. I ordered him to take a tablespoonful of the following mixture three times daily zinci sulph gr viii fld ext. belladonna 3 ii aquae ad viii. May 15th. Fits have occurred with the same frequency, and had one to-day-also complaining of feeling dull and stupid. I stopped the sul phate of zinc and belladonna, and ordered him a mixture containing in each dose, four grains of the bronie of potassium. This he was to take four times a day. May 22nd. Patient returned to Dispensary to-day feeling and looking somewhat better. State chat he has not had any fits since the 14th. Yesterday about noon he felt as if he would be attacked, but it passed away. May 30th. Had a very slight fit this noon, being the first since the 14th; did not feel nearly so dull and sleepy after it as usual; still to continue the bromide of potassium. Ordered six grains four times a day. June 19th. The patient reports to day that he had a slight fit yesterday afternoon, and one this morning-but is confident he is improving. The people he lives with, says when he took the fit yesterday that he was hardly convulsed at all. July 31st. Since the date of last note the patient has presented himself several times at the Dispensary—each time with a more favourable report. He has improved greatly in appearance-eyes brighter and expres sive not so downcast, as when first seen on the 2nd of May. He has not had a fit since the 19th of June-a period of forty-two days. He was to leave Montreal the same afternoon for New York in search of employment. I accordingly gave him the prescription, increasing the bromide of potassium to eight grains four times a day. From this date, of course, I had lost all trace of my patient. Susan Tucker, aged 23-a tall girl-of a somewhat nervous temperament came to the Dispensary on the 10th May, 1865. The symptoms described by herself and a friend who accompanied her, were those of epilepsy. None of her family were subject to it. She was attacked with the first fit quite suddenly about a year and a half previous to date, it being very severe. Eight months elapsed ere another occurred, when they came on very frequently, sometimes having as many as seven in one day. She sought relief from a physician in the city, and received much benefit from treatment. On the 24th of April, 1865, she was married to a soldier, not having had any relapse for five months-but the day after her marriage, had a fit-and one, sometimes two daily-till her application at the Dispensary. Believing the cause to be uterine, I gave her some advice, and prescribed the following mixture: R zinci sulph gr viii fld ext. belladonna 3 ii aquæ ad viii. Take a tablespoonful three times a day. May 22nd. She returned to-day. Has not had any attack since the 13th. Had one also on the 11th. June 7th. Reported at the Dispensary to-day that there has not been any return of the attacks. August 12th. Met the patient in the street to-day. Still remains quite well. These two brief hospital reports are interesting, as showing the results of two opposite modes of treating the same disease. Had the cause of the attacks in the latter case been as obscure as it usually is, I am doubtful if the zinc and belladonna would have suited. My experience not alone personal, of the benefits from these drugs-in epilepsy -is not of the most favourable kind. I may observe that both patients when first attacked had distinct premonitions of an attack—but in a brief period it ceased to appear, and the patient suddenly and without warning became unconscious. Case of Clonic Convulsions. Reported by JOHN BELL, M.A. Acting assistant house Surgeon and Apothecary to the Montreal General Hospital. Charles Allen, a barber, aged 19, a native of New York, was admitted into the Montreal General Hospital under care of Dr. Scott, on the 14th August, 1865, while suffering from severe epileptiform convulsions. When he entered the Hospital he was in a state of complete insensibility, breathing laboriously but not stertorously. Pupils much contracted. While waiting to be sent up to his ward, he was seized with a violent convulsion which affected both sides of the body symmetrically, and threw the whole of the muscles of the face, including those of the eyelids, into violent jerking spasms. The man who brought him stated this to be the sixteenth fit he had within the last three hours, the first one occurring at 2 a.m., when the patient was seen by Dr. F. W. Campbell. Between the convulsions he lay still and insensible, with the exception of a jerking motion of the eyelids. At half past six a.m., when he entered the hospital, ol tiglii gtt. ij, calomel gr v, were administered, and sinapisms were applied to his feet and legs. A catheter was at the same time introduced and a small quantity of urine drawn off, which, on examination, proved to be highly albuminous. At half past eight, two enemata were given within a short time of each other, the first consisting of ol ricini, ol terebinthinæ and gruel, the second of soap and water. At half past ten he was bled by Dr. Drake to 16 oz. At four p.m., the oil and injections not having operated, a full drachm of pulv jalapæ co. was exhibited with the desired effect, and his bowels afterwards remained in a soluble state. On Monday and Tuesday, cold water was kept applied to his head day and night. On Monday night his urine was removed with a catheter, but afterwards he did not require this aid. Before he was bled he went from one fit immediately into another. The bleeding, however, restored consciousness to such a degree that he could speak intelligibly. It also checked the convulsions, as the patient had but two afterwards, one at noon and the other 7 p.m., of the same day, and these were of but short duration. During Monday he remained also motionless, and could be made to answer questions but with the greatest difficulty, and then only in monosyllables. In the evening he took some beef-tea. On Tuesday he was very restless, kicking his legs about and moving his body while his head remained still. He was however less feverish, and more conscious as he replied to questions without much rousing, and appeared greatly annoyed if disturbed. His urine is now but slightly albuminous. Wednesday; urine quite free from albumen. The patient is a mulatto about 5 feet 6 inches in height and of good physical development, with negro features well marked. He was born at Lockport, and lived there until he went to Simcoe, a year ago, where he kept a barber's shop. He has always been very healthy with the exception. of an attack of typhoid fever when thirteen years of age. He has never indulged to excess, either in brewed or distilled liquors, nor has he ever received any injury. Previously to his present attack he never had any fits. From Simcoe, he went to Hamilton, where he remained the greater part of this summer as a barber. He left this latter place, he thinks, a week ago, and went to Port Hope as bone player to a strolling musician. He remembers having played in five places at Port Hope, but cannot remember how long he was there. The next circumstance he remembers is having wakened up in this hospital on the morning of Wednesday, the 16th. He then complained chiefly of his tongue, which was swollen and painful from his having bitten it during the convulsions. His convalescence was very rapid, as he was discharged at his own request on the 18th, perfectly cured. The chief points of interest in this case are:-1st. That the man had never previously suffered from convulsions. 2ndly. That the convulsions supervened without any assignable cause. 3rdly. That during the height of the convulsions the urine was observed to be highly albuminous and diminished in quantity. Case of Embolism—Paralysis of Left Side. Reported by HERBERT S. TEW, M.D., Assistant House Surgeon Montreal General Hospital. John Wright, aged 36 years, a native of Scotland, was admitted into Hospital, under the care of Dr. Fenwick, on 20th July, 1865, suffering from symptoms of fever of a continued type. He was a farmer, and had resided in an agueish district in Upper Canada, and had suffered from attacks of ague some years past. Upon examination, the spleen was found considerably enlarged, in fact presented the condition known as ague cake. Quinine was prescribed, and aperients occasionally, as the bowels were exceedingly sluggish. The case progressed favourably, and he was, to all appearance, improv ing. The spleen gradually lessened in size. On the morning of the 29th, while lifting the bottle of medicine from his table, the glass fell from his hand, and he rolled on the floor, although he did not lose consciousness. The poor fellow had to be lifted into bed, when it was found that he had lost all power of the left side. At the hour of visit it was noticed the features were drawn to the right side; there was inability to close the left eye, and, when the tongue was protruded, it was pushed over towards the left. There was total loss of motion of both left arm and leg, but sensation was hardly, if at all, effected. The bowels were still rather sluggish, and two drops of croton oil were ordered to be given immediately, to be followed by calomel and antimonial powder every fourth hour. A blister was applied to the nape of the neck, extending down between the shoulders. The pulse was rather full, but soft. There was no headache, dizziness, nor rigidity of the muscles; no spasms-but he complained of difficulty in swallowing, and his articulation was rather imperfect. The following morning I examined the heart, when a loud systolic bruit was heard towards the left side, near the apex of the heart. The patient then mentioned for the first time that he had suffered from rheumatism some years ago, and had occasionally since been troubled with palpitation of the heart. The case was diagnosed to be embolism produced by the detachment of a fibrous concretion or warty excrescence from the mitral valves as there was evident disease of old standing of this valve. The concretion had apparently separated, and had been carried on in the current of blood, and blocked up some vessel on the right side of the brain, occasioning the symptoms observed. The medicine was continued until the gums were slightly touched, when it was omitted; the treatment subsequently consisting of nourishment and mild aperients when found necessary. He continued much in the same state, with the exception that he regained the power of closing his eye; swallowing and speech were improved; but the extremities were in no way changed. He slept tolerably well, took nourishment, and was more cheerful, though he had repeated hallucinations, especially at night, on which occasions he was troublesome, requiring to be watched, otherwise he would make attempts to leave his bed, declaring his desire to go home. On the evening of the 27th July he had a fainting fit, which lasted only a few moments. The countenance was blanched; there was slight rigidity of the affected extremities; pulse 120; consciousness was |