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Looking Back.FROM

THE LANCET, SATURDAY, OCT. 21, 1826.

Mr. ABERNETHY resumed his lecture until he haddescribed the situation, &c., of the ossa nasi, two in

number, forming an arch for the protection of the nasallamella, which supports the ethmoid bone. He thensaid : this arch is a very strong arch indeed, protectingthe nasal lamella, and how important is this! If it werenot so, a man having a blow on the nose might have hiscristcc galli driven in upon his brain. What’s to preventit ? Many a man has his crista galli driven in npon hisbrain, producing cerebral inflammation, and the man dies inconsequence ; I have seen accidents of that kind. Nowwhat’s to be done if a man gets a blow on his nose, and hashis crista galli driven in upon the brain ? What’s to bedone? why, you must try to pull it out again. You have toraise up the ossa nasi, introduce an instrument lined withsponge, raise up the depression, and then pull it out. But,luckily, this is a very rare accident, and don’t believe thatevery broken no-e is followed with such frightful con-

sequences. You see the nose is excessively well constructedto elude the effects of violence ; the blow lights on the elasticpart of the nose which breaks the effect of it. and the blowmay operate on the nose without driving in the nasal lamella.’Faith, if every one had their crista galla driven in, whenthey have their nasal lamella broken, I myself would havehad it, because on one occasion, when I was riding, myhorse’s head and my own came pretty near together. I was

iridii-i-, and on putting the spur to him and pulling thebridle, he threw up his head and struck me with it rightupon the nose. The blood flowed from it, just like as if ithad been streaming from an arm after you had introduced thelancet. 1 got off ; got into a stable near at hand ; washedmy face, and squeezed the bones into their proper situationas well as I could. The people were certainly very kind,and wished to send for a surgeon to me ; but I told them Iwould rather they sent for a hackney coach (much laughter),which they did, and I went home in it. I then perceived,for the first time in my life, an imperfection in my sight.I could not see more than two-thirds of an object. First ofall, however, I should tell you, my vision was indistinct, butI found it arose from the eclipse of the third of every objecton the right hand. I ascertained this particularly as I wenthome, because if I saw such a long name as my own, forinstance, A-ber-ne-thy, in a booksellers’s shop window, or anysuch place, I could see A-ber-knee, but I could not see the

thigh at all. (Loud laughter.) Well, I looked with one eye,then I looked with the other, and I looked with both, butstill I perceived that the third of every object was eclipsed,on what I may call mv right side. Now this sort of case isalluded to by Dr. Woollaston, and he contends that it mightbe a defect in the optic nerves. Well, I was telling all thisto a medical friend of mine-a very clever man, and he said,it was impossible. I said, well, I don’t know whether it is

impossible or not, but I know that what I tell you is true.It afterwards happened that he had a fall from his horse, Ibelieve, or something of that kind, and he had the sameimperfection of sight, the eclipse of the objects being on theopposite side. I said to him, there was only one thirg I

regretted, which was, that when I was in that state, I hadnot squinted, to have seen how the things would have lookedthen. He told me he was convinced it arose from the nerve.But I said, did you squint ? 0 gad, no, said he, I never thoughtof squinting. But since that time I have been entertainedwith it often, and often without having had any blow ; andI have on those occasions squinted too, and it’s just thesame. And let those who can account for it as arising froma decussation of the nerve, do it ; my opinion is, that itarises from the irregular actions of the retina. You know

there are people who see ghosts, and goblins, and so on ; not

blue devils; I suppose they don’t see any of those, but theyabsolutely see men and women ; you know all that I daresav.There is a very curious case related, of a man who was

a well known character, and a man of sense,-where it wassaid, he used to see a number of people in the room with him.Now, he himself has described the whole of the pheno-menon, and all the adjuncts to it. He has said, after taking

a cup of coffee or tea, or so on, they came into his room ingreat numbers ; and as he got better, and less nervous, hehas only seen the arms or legs of the persons, without seeingany other part of them. Now this is all an irregular actionof the retina. A gentleman sitting in his library one day,reading or writing, on turning round his head, saw, sittingin a chair, a woman in a red cloak. And he said, how cameyou in here, good woman ? ? The woman said nothing. Whatis the meaning of your being here, woman ? No answer wr smade. You have no right to be here -Go out of the roou).She took no notice of him. He got up and rang the bell forthe servant. The servant came in. Turn this woman out.What woman, Sir ? Why the woman in a red cloak. There’sno woman, nor any red cloak, Sir. Well, go and fetch thedoctor for me ; tell him I am ill and wish to speak to him.The man, however, was not to be frightened by this, becausehe knew it was a delusion of his sight. Now I have had itso often, that it has been a matter rather of amusementto me, than anything else. I have stood before a glass,and seen the upper part of my head, and eyes, and nosevery distinctly ; but I never saw that I had any mouthor jaw ; and I have seen my shoulders very well, but allwas blank between my nose and shoulders. Why, now Isay, what can you make of this, but that it is, errors ofaction, or inactivity in parts of the retina 1

THE TENTH INTERNATIONAL CONGRESSOF OPHTHALMOLOGY, LUCERNE, 1904.

THE proceedings of this most successful Congress com-menced on Sept. 13th with a reception at the Hotel Nationalgiven by the town under the Presidency of Dr. HERMANNHELLER. The Congress was officially opened on the follow-ing day at the Kursaal by Dr. DEUCHER, member of theFederal Council, who was followed by Professor MARCDUFOUR (Lausanne) with an admirable address.The real work of the Congress then commenced with

Professor KUHNT (Konigsberg) as the first president, thelater presidents being Professor de Lapersonne (Paris), Dr.D. Argyll Robertson (Edinburgh)., Professor Reymond (Turin),and Professor Fuchs (Vienna). The first and certainly themost important discussion was upon the question of indemnityfor an eye injured or lost raised by the elaborate and care-fully written reports of Dr. Sulzer, Dr. Axehfeld, and Dr.Würdemann. The French law upon the subject of injury to aworkman insists on an allowance being made to the injuredemploye equal to half the reduction in wage-earning capa-city in partial and temporary incapacity and two-thirds intotal and permanent incapacity. With the exception ofBelgium most countries accept this, or a somewhat similar,principal of indemnity. The subject aroused considerablediscussion.

Mr. M. McHARDY congratulated Dr. Sulzer, Dr. Axenfeld,and Dr. Wurdemann on their report and pointed out thatwhen total loss of an eye resulted from an accident theinjured man under the present system would have the greatestdifficulty in securing further employment, because, from anindemnity point of view, he was a dangerous man to employ ;an accident to the remaining eye might make him totally andpermanently incapacit t >d. For this reason Mr. McHardyconsidered that an indemnity equal to at least 50 per cent. ofthe loss in earning ability should be allowed.A commission was subsequently appointed consisting of

representatives from every country, those representing GreatBritain being Mr. J. Priestley Smith and Mr. George A.Berry.The next question on the agenda was to consider the pro-

positions of the French Society of Ophthalmology on thenotation of visual acuity. This subject is closely connectedwith the previous one of indemnity, as it is obviously neces-sary to have some simple means of recording the vision ofemployes when first engaged.

Mr. BERRY said that he thought it a pity to attempt toattain very great accuracy ; he considered Snellen’s types werequite sufficient for the purpose and advised that for theilliterate a type made up of paral’el lines should be used.

After some further discussion a commission was formed toconsider the subject, connstirg of Professor Hess, Professor

1 Excerpt from Mr. Abernethy’s Physiological, Pathological, andSurgical Observations, delivered in the Anatomical Course of Lectures,at St. Bartholomew’s Hospital.

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Dimmer, Professor Reymond, Dr. Charpentier, Dr. Eperon,Dr. Nench, and Mr. W. H. H. Jessop.An admirable plan was adopted with regard to the 61

papers which had been sent in ; these were printed anddistributed to the members a month before the commence-ment of the Congress. At the meeting the papers weretaken as read and the discussions followed immediately uponthe announcement of the titles. In spite of this excellentarrangement the time at the disposal of the Congress onlyallowed of the consideration of some 30 papers in thismanner.

An afternoon was devoted to demonstrations under the

presidency of Professor Fuchs. One of the most interestingof these was a lantern slide demonstration by Mr. E. TREACHERCOLLINS to show the development of the suspensory ligamentof the lens. Mr. Collins pointed out that the ciliary bodyand the lens are in contact at the fourth month of foetal

life ; later there is a gradual separation of the ciliary bodyfrom the equator of the lens. It is natural to suppose thatthe adhesions which join the lens to the ciliary body-viz., the fibres of the suspensory ligament-would befirst formed whilst those structures are in contact andthat they would be stretched out and rendered tenseas the structures become separated. The ciliary body,when it is first formed, occupies a position much anteriorto that which it will later adopt and thus different portionsof the ciliary body are in contact with the sides of the lensat different times and adhesions which form between themmust originate at different times. The first to be formed arethose fibres which pass between the anterior part of the lenscapsule and the nou-plicated part of the ciliary body(orbicullo-antero-capsular fibres). Next in formation are

the adhesions between the posterior part of the non-plicatedportion of the ciliary body and the posterior part of the lenscapsule (orbiculo-postero-capsular fibres). The ciliary pro-cesses now commence to form and grow backwards betweenthe rudimentary non-plicated part and the side of the lensand pass between the bundles of the orbiculo-antero-capsularfibres. The fibres therefore come to lie ultimately in thevalleys between the ciliary processes. While the ciliary pro-cesses are in contact with the lateral portions of the lensadhesions form which on separation of those structuresbecome lengthened out into cilio-postero-capsular fibres andcilio-equatorial fibres. Mr. Collins went on to show howthese fibres acting in different directions were the cause ofthe lateral diameter of the lens growing out of proportion toits antero-posterior diameter.An excellent exhibition organised by the members of the

Congress was open daily. Among the most noteworthy. exhibits were Professor Axenfeld’s cultures of organisms

obtained from the human conjunctiva, Mr. Jessop’s collectionof Indian instruments, and Professor Dimmer’s apparatusfor photographing the fundus oculi with some wonderful

examples of his work. There was also an interesting tradeexhibition by many instrument makers which was held in thegymnasium of the Pestalozzischule.

Besides many private dinners a banquet was given on

Sept. 15th at the Schweizerhof and was well attended. Amost delightful excursion on the lake was provided by thetown on Sept. 16th when all the chief places of interest werevisited. The town of Lucerne throughout the proceedingsdid everything possible to relieve the members of expenseand to make the meeting a success and in consequence theTenth International Congress of Ophthalmology of 1904,both from a social and scientific point of view, was mostsuccessful. The proceedings concluded with the good wishesof all concerned for an equally successful reunion in Italy in1909.

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ROYAL COLLEGE OF SURGEONS OFENGLAND.

A QUARTERLY meeting of the Council was held onOct. 13th, Mr. JOHN TWEEDY, the President, being in thechair. The SECRETARY reported the death, on August 9th, of

Sir William Mitchell Banks, past member of the Council,and a vote of condolence with Lady Banks was passed. TheSecretary reported the death, on Sept. 13th, of Surgeon-General James Jameson, C.B., Honorary Fellow of theCollege, and the PRESIDENT stated that he had written toMrs. Jameson to express the sympathy and condolence of theCouncil.

The committee of the annual report submitted for theconsideration of the Council a draft copy of the report tobe presented to the Fellows and Members at the annual

meeting to be held on Nov. 17th, 1904. The report wasapproved and it was ordered to be circulated.The Council, in pursuance of the recommendation of the

Jenks’ Scholarship Committee, elected Mr. Charles Gibsonas the twelfth Jenks scholar, till lately a student at EpsomCollege and now a student at the London Hospital.

Sir Henry G. Howse was re-elected a member of theCommittee of Management and Mr. H. T. Butlin was re-elected a member of the Laboratories Committee.The PRESIDENT reported that, together with the President

of the Royal College of Physicians of London, he had calledon the Secretary of State for the Colonies and had com-municated to him the course which this College proposedto adopt with regard to the proposal to institute an examina-tion and diploma in tropical medicine.The PRESIDENT reported that in connexion with the visit

of French physicians and surgeons to London a receptionhad been held in the Museum of the College on Oct. 10th.The PRESIDENT stated that the Bradshaw Lecture would be

delivered by Mr. A. W. Mayo Robson on Thursday, Dec. lst,at 5 o’clock P.M., and that the subject of the lecture wouldbe Cancer and its Treatment.A letter was read from Mr. Arthur P. Simon thanking the

Council for its resolution of condolence in reference to thedeath of his uncle, Sir John Simon, K.C.B.A letter was read from Mrs. Trimmer thanking the Council

for the donation towards the purchase of an annuity.A letter was read from Mr. Andrew Clark, chairman of

the Council of the British Medical Association, callingattention to a recently issued order of the Government ofIndia in regard to the remuneration of medical officers forattendance on native chiefs and nobles, the withdrawal ofwhich, as an improper interference between the patient andthe medical attendant, the British Medical Association is

endeavouring to obtain, and suggesting that the licensingbodies might advantageously take up the question. TheCouncil was of opinion that it would not be expedient forthe College to take any action in the matter and thePresident was requested to write to this effect.

ASYLUM REPORTS.

Hertford County Asylnm, Hill End, St. Albans (AnnualReport for 1903).-The daily average number of patientsresident during the year was 587, comprising 268 males and319 females. The admissions during the year amounted to132-viz., 60 males and 72 females. Of these 128 were firstadmissions. Dr. A. Norman Boycott, the medical superin-tendent, states in his report that" at the present rate ofincrease the spare beds belonging to the asylums in Hertford-shire will be exhausted in nine years. It is probable thatwith the increase of population in the larger towns ofHertfordshire the actual increase [of the insane] will be ata greater rate....... In addition to the patients actually inasylums there are 90 Hertfordshire lunatics either in work-houses or residing with friends for whom accommodation

may at any time have to be provided." Of the 132admissions 18 were transfers from other asylums, 13 wereepileptics, 11 were due to alcoholic excess, and three werecriminal lunatics. The mean age of the admissions was 41years. Hereditary predisposition to insanity was presentin 28 caes. The number of cases discharged as recoveredduring the year amounted to 48-viz., 22 males and 26females, or 8.2 2 per cent. of the average number resident.The deaths during the year amounted to 41, or 7 ’ 0 per cent.as calculated on the same basis. Of the deaths two weredue to renal disease, three each to apoplexy and pulmonarytuberculosis, four to pneumonia, five each to generalparalysis and to cardiac disease, six to senile decay, and therest to other causes. Post-mortem examinations were madein 39 cases out of the 41 deaths. The general health of theinmates has been satisfactory. There have been three casesof dysentery, one of which proved fatal. Two male patientsescaped but both were recaptured and. taken back in a

short time. The asylum was supplied during.the year withfarm produce of the value of .61964. The chief supplieswere milk, butter, eggs, pork, beef, poultry, potatoes andvegetables. Numerous plants, were also , supplied to thewards from the greenhouse. The Commissioners in Lunacy