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Chapter 10
File I/O

◼ Multiple Choice
1) An ___________ allows data to flow into your program.
(a) input stream
(b) output stream
(c) file name
(d) all of the above
Answer: A

2) An ____________ allows data to flow from your program.

(a) input stream
(b) output stream
(c) file name
(d) all of the above
Answer: B

3) Files whose contents must be handled as sequences of binary digits are called:
(a) text files
(b) ASCII files
(c) binary files
(d) output files
Answer: C

4) The output stream connected to the computer screen is:

(a) System.exit
(b) System.quit
(c) System.in
(d) System.out
Answer: D

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.

1
2 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

5) In Java, when you open a text file you should account for a possible:
(a) FileNotFoundException
(b) FileFullException
(c) FileNotReadyException
(d) all of the above
Answer: A

6) There are two common classes used for reading from a text file. They are:
(a) PrintWriter and BufferedReader
(b) FileInputStream and Scanner
(c) BufferedReader and Scanner
(d) None of the above
Answer: C

7) The scanner class has a series of methods that checks to see if there is any more well-formed input
of the appropriate type. These methods are called __________ methods:
(a) nextToken
(b) hasNext
(c) getNext
(d) testNext
Answer: B

8) All of the following are methods of the Scanner class except:

(a) nextFloat()
(b) next()
(c) useDelimiter()
(d) readLine()
Answer: D

9) The method _________ reads a single character from an input stream.

(a) readLine()
(b) skip()
(c) read()
(d) close()
Answer: C

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 3

10) When the method readLine() tries to read beyond the end of a file, it returns the value of:
(a) 1
(b) -1
(c) null
(d) none of the above
Answer: C

11) A __________ path name gives the path to a file, starting with the directory that the program is in.
(a) relative
(b) descendant
(c) full
(d) complete
Answer: A

12) The stream that is automatically available to your Java code is:
(a) System.out
(b) System.in
(c) System.err
(d) all of the above
Answer: D

13) All of the following are methods of the File class except:
(a) exists()
(b) delete()
(c) getDirectory()
(d) getName()
Answer: C

14) The class ObjectOutputStream contains all of the following methods except:
(a) writeInt()
(b) writeChar()
(c) writeDouble()
(d) println()
Answer: D

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
4 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

15) The method __________ from the File class forces a physical write to the file of any data that is
buffered.
(a) close()
(b) flush()
(c) writeUTF()
(d) writeObject()
Answer: B

16) The class ObjectInputStream contains all of the following methods except:
(a) readLine()
(b) readChar()
(c) readObject()
(d) readInt()
Answer: A

17) The read() method of the class RandomAccessFile returns the type:
(a) byte
(b) int
(c) char
(d) double
Answer: B

◼ True/False
1) A stream is an object that allows for the flow of data between your program and some I/O device or
some file.
Answer: True

2) Every input file and every output file used by your program has only one name which is the same
name used by the operating system.
Answer: False

3) The FileNotFoundException is a descendant of the class IOException.

Answer: True

4) When your program is finished writing to a file, it should close the stream connected to that file.
Answer: True

5) Only the classes provided for file output contain a method named close.
Answer: False

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 5

6) The methods of the scanner class do not behave the same when reading from a text file as they do
when used to read from the keyboard.
Answer: False

7) Using BufferedReader to read integers from a file requires the String input to be parsed to an integer
type.
Answer: True

8) A full path name gives a complete path name, starting from the directory the program is in.
Answer: False

9) The File class contains methods that allow you to check various properties of a file.
Answer: True

10) Binary files store data in the same format that is used by any common text editor.
Answer: False

11) Binary files can be handled more efficiently than text files.
Answer: True

12) The preferred stream classes for processing binary files are ObjectInputStream and
ObjectOutputStream.
Answer: True

◼ Short Answer/Essay
1) Explain the differences between a text file, an ASCII file and a binary file.
Answer: Text files are files that appear to contain sequences of characters when viewed in a text
editor or read by a program. Text files are sometimes also called ASCII files because they contain
data encoded using a scheme known as ASCII coding. Files whose contents must be handled as
sequences of binary digits are called binary files.

2) Write a Java statement to create and open an output stream to a file named autos.txt.
Answer: PrintWriter outputStream = new PrintWriter(new FileOutputStream("autos.txt"));

3) Explain what happens when an output file is opened in Java.

Answer: In Java, when an output stream is connected to a file, the program always starts with an
empty file. If the file you are trying to connect to exists, the contents of the file are deleted before
the output stream writes new data to the file. If the file you are trying to connect to does not exist,
then a new empty file is created.

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
6 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

4) Write a Java method that returns a String representing a file name entered by the user. Use the
BufferedReader class to obtain input.
Answer:

public static String getFileName() throws IOException

BufferedReader stdin = new BufferedReader(new

InputStreamReader(System.in));

System.out.print("Enter the name of the file to open: ");

String fileName = stdin.readLine();

return fileName.trim();

5) Use the output stream to the file autos.txt created above in number 2 to write the line “Mercedes” to
the file.
Answer: outputStream.println("Mercedes");

6) What happens when the method close is invoked on a stream?

Answer: When the close method is invoked, the system releases any resources used to connect the
stream to the file and does any other housekeeping that is needed.

7) Create try and catch block that opens a file named statistics.txt for output. Writes the integers 24,
55, and 76 to the file, and then closes the file.
Answer:

PrintWriter outputStream = null;

try

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 7

outputStream = new PrintWriter(new

FileOutputStream("statistics.txt"));

outputStream.println(24);

outputStream.println(55);

outputStream.println(76);

outputStream.close();

catch(FileNotFoundException e)

System.out.println("Error opening the file autos.txt");

System.exit(0);

8) Write a Java statement that creates an output stream to append data to a file named autos.txt.
Answer: PrintWriter outputStream = new PrintWriter(new FileOutputStream("autos.txt", true));

9) Write a Java statement to create an input stream to a file named autos.txt. Use the BufferedReader
class.
Answer: BufferedReader inputStream = new BufferedReader(new FileReader("autos.txt"));

10) Write a complete Java program using a BufferedReader object that opens a file named autos.txt and
displays each line to the screen.
Answer:

import java.io.BufferedReader;

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
8 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

import java.io.FileReader;

import java.io.FileNotFoundException;

import java.io.IOException;

public class TextDemo

public static void main(String args[])

BufferedReader inputStream = null;

try

inputStream = new BufferedReader(new FileReader("autos.txt"));

String line = inputStream.readLine();

while(line != null)

System.out.println(line);

line = inputStream.readLine();

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 9

inputStream.close();

catch(FileNotFoundException e)

System.out.println("Error opening files.");

catch(IOException e)

System.out.println("Error reading from file.");

11) Write a Java statement that creates an output stream to a binary file named statistics.dat.
Answer:

ObjectOutputStream outputStream =

new ObjectOutputStream(new FileOutputStream("statistics.dat"));

12) Use the output stream created in number 11 above to write the String BBC to the file named
statistics.dat.
Answer: outputStream.writeUTF("BBC");

13) Write a Java statement to create an input stream to the binary file statistics.dat.
Answer:

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
10 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

ObjectInputStream inputStream =

new ObjectInputStream(new FileInputStream("statistics.dat"));

14) Write a complete Java program that opens a binary file containing integers and displays the contents
to the screen.
Answer:

import java.io.ObjectInputStream;

import java.io.FileInputStream;

import java.io.EOFException;

import java.io.IOException;

import java.io.FileNotFoundException;

public class BinaryInputDemo

public static void main(String args[])

try

ObjectInputStream inputStream =

new ObjectInputStream(new

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 11

FileInputStream("statistics.dat"));

int stat = 0;

try

while(true)

stat = inputStream.readInt();

System.out.println(stat);

catch(EOFException e)

System.out.println("End of file encountered");

inputStream.close();

catch(FileNotFoundException e)

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
12 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

System.out.println("Unable to locate file");

catch(IOException e)

System.out.println("Unable to read file");

15) Write a Java statement that creates a stream that provides read/write access to the file named
autos.txt.
Answer: RandomAccessFile ioStream = new RandomAccessFile("autos.txt", "rw");

16) Write a Java statement to create an input stream to a file named “statistics.dat”.
Answer: Scanner inputStream = new Scanner(new FileReader("statistics.dat"));

17) Write a complete Java program using a Scanner object that opens a file named autos.txt and displays
each line to the screen.
Answer:

import java.util.*;

import java.io.FileReader;

import java.io.FileNotFoundException;

public class TextDemo

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
 Chapter 10 File I/O 13

public static void main(String args[])

Scanner inputStream = null;

try

inputStream = new Scanner(new FileReader("autos.txt"));

String line = inputStream.nextLine();

while(line != null)

System.out.println(line);

line = inputStream.nextLine();

inputStream.close();

catch(FileNotFoundException e)

System.out.println("Error opening files.");

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
14 Walter Savitch • Absolute Java 5/e Chapter 10 Test Bank

©2013 Pearson Education, Inc. Upper Saddle River, NJ. All Rights Reserved.
Random documents with unrelated
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 101 Ophth. Atlas, Taf. vi. Fig. 2.

102 Graefe und Saemisch, Bd. v. p. 581.

103 Diseases of the Eye (Am. ed.), p. 382.

104 H. Eales, Birmingham Med. Review, Jan., 1880, p. 47.

Exceptional forms of albuminuric retinitis have been recorded where

the only change seen in the fundus oculi was a pronounced choking
of the disc similar to that with which we are familiar in cases of brain
tumor. The writer has seen cases which at the start could not be
diagnosticated by the ophthalmoscope from cases of retinal
hemorrhage due to other causes. Magnus has published similar
cases.

In the course of Bright's disease uræmic amaurosis is much more

rarely encountered than albuminuric retinitis. It is, however,
occasionally developed in cases in which albuminuric retinitis already
exists. It is rapid in its development, and in its subsidence is without
retinal changes, the blindness being evidently due to some transient
affection of the cerebral centres.

DISEASES OF THE SKIN.—The eczema of the lower lid, nose, angle of the
mouth, and external meatus of the ear which so frequently
accompanies the phlyctenular conjunctivitis of scrofulous children is
probably the most common example of coincident skin and eye
disease. Lepra is a frequent cause of severe affections of the eye in
localities where it is endemic. Bull and Hansen105 assert that the
cornea is frequently attacked. They divide the manifestations of the
disease upon this membrane into two varieties—the one in which
there is a diffuse infiltration of the tissue, and the other where there
is a formation of tubers. The first variety is a gray opacity limited to
the border of the cornea, not separated from its circumference by
any such clear area as is found in arcus senilis. This opacity becomes
vascularized, and may remain quiet for years till another attack of
hyperæmia occurs, which, also in time receding, leaves the tissue
more opaque than before. In the second there are nodes which
appear to start at the margin of the cornea and to accompany either
its superficial or its deep layer of vessel-loops: this latter form is
more dangerous to vision. The paralysis of the orbicularis muscle
which is a frequent attendant upon the smooth form of the disease
allows an exposure of the membrane to irritants which often
produce a third form of inflammation. The iris also exhibits the
smooth and the tuberous forms of the disease. Iritis occurring in
lepra is, however, by no means pathognomonic; 50 per cent. of all
cases exhibiting synechiæ are the result of extensions of corneal
inflammations due to orbicular paralysis. The superciliæ and the
eyelashes are said to be frequent seats of leprous tubercules. In the
lids the first symptom is the falling of the eyelashes, which is
dependent upon the formation of the tubers before they become
manifest to sight and touch. Mooren106 maintains that chronic skin
eruptions favor the development of cataract by causing creeping
inflammatory processes which alter the character of the exudations
into the vitreous humor, and moreover claims that when such skin
eruptions have their seat in the scalp they favor the occurrence of
retinitis by maintaining a constant hyperæmia of the meninges. He
further cites a case where he observed a decrease in the acuity of
vision corresponding with the breaking out of a skin eruption, and an
increase in the power of vision coincident with the disappearance of
the eruption. Foerster107 agrees with Mooren in the statement that
cataract may be formed in cases where chronic skin affections favor
the development of marasmus. Rothmund108 reports a noteworthy
curiosity to the effect that cataract followed a peculiar degeneration
of the skin in three families living in separate villages in the
Urarlberg. The skin of these patients showed a fatty degeneration of
the rete Malpighii and of the papillæ, with consecutive thinning and
atrophy of the epidermis: this was most marked on the cheeks, chin,
and the outer surfaces of the arms and legs. In the individuals thus
affected the skin disease commenced between the third and sixth
months of life, whilst the cataract appeared in both eyes between
the third and sixth years. Rothmund thinks that the same congenital
predisposition to disease exists in both organs, because the lens is
developed out of an unfolding of the external skin.
105 The Leprous Diseases of the Eye, Christiana, 1873.

106 Ophthalmologische Mittheilungen, 1874, p. 93.

107 Graefe und Saemisch's Handb., vol. vii. p. 152.

108 A. f. O., xiv., 1, p. 159.

Disturbances of Vision caused by Disease of the Sexual

Organs.

The eyes and their appendages frequently exhibit the effects of

perverted function or diseased conditions of the sexual organs. As
might be expected, these ocular effects are most marked in the
female, whose generative apparatus is so much more complex and
extensive. While it is true that there are thousands of women with
grave disease or derangement of these organs who are free from
any uncomfortable eye symptoms, still, clinical experience shows
that there are crowds of others who present eye lesions due entirely
to such causes. Still more frequently do we see some slight optical
defect (previously scarcely noticed) become so unbearable that the
patient is unfitted for any useful employment. In fact, at most eye
hospitals, and still more markedly in private practice, we find an
excess of female over male patients. This excess becomes more
palpable when we throw out of consideration the large number of
male patients who are under treatment for injuries of all sorts the
result of mechanical occupations not pursued by females, and the
inflammations due to direct exposure to storm, cold, and intense
heat.

MENSTRUATION.—When menstruation is profuse its effects are with

difficulty distinguished from those of anæmia and loss of blood, but
where it is retarded, irregular, or scanty the effects are more readily
traced. All surgeons of experience are agreed that it is undesirable to
perform operations for cataract or to make iridectomy at the
menstrual period, and it is well known that eyes which have been
progressing favorably after operations become congested and
irritable during the monthly period. In trachomatous eyes retardation
of the catamenia often causes the eruption of a fresh crop of
granules, while in cases of phlyctenular and interstitial keratitis there
are still more frequently relapse and exacerbation of the disease.
Vaso-motor disturbances connected with the period of puberty and
with that of cessation of the menses are of daily occurrence: we
constantly see cases at these epochs where some slight astigmatism
or hypermetropia, which has previously given no practical annoyance
to the patient, becomes absolutely unbearable. The eyes become
watery and sensitive to light; there is marked congestion of the
retina with tortuosity of its veins, together with serous infiltration
and swelling often sufficient to obscure the margins of the disc.
These symptoms frequently entirely disappear when the menses
have either become established or have permanently ceased. In
some rare cases the symptoms are anomalous and striking: thus the
writer has seen vicarious menstruation from the lachrymal caruncle,
and a case of pemphigus of the upper lid occurring regularly at each
menstrual period for some months. In another patient menstruation
came on during the thirteenth year with intense headache, epistaxis,
and photophobia, and for a long time afterward there was utter
inability to use the eyes for school-work even during the catamenial
interval. At almost every menstrual epoch during a period of eight
years there has been a recurrence of these symptoms, although they
subside sufficiently in the interval to allow the patient to use her
eyes for a very limited amount of near work. At the first examination
the ophthalmoscope showed that the retinal fibres were swollen and
oedematous, hiding the outlines of the discs, while the lymph-
sheaths of the retinal vessels at their point of emergence from the
disc presented an almost snow-white appearance. The discs and the
retinæ have never quite resumed a normal appearance.
Disturbances in the circulation of the eye and its appendages are
frequently associated with the menopause. The writer recalls a case
where for years there was headache with intense congestion of the
palpebral and bulbar conjunctiva, with a fulness and pressure on the
orbits at each menstrual period, all these symptoms disappearing
with the cessation of the menses. The most striking examples of the
influence of the menses on the eyesight are those where the flow
has been suddenly checked. Rejecting examples from the older
authors, where the want of exact helps to diagnosis might leave
room for a different interpretation of the symptoms, we will content
ourselves with two examples where the testing of the eyesight and
the ophthalmoscopic examination were made by skilled observers.
Thus, Mooren—to whom we are indebted for a careful discussion of
the relations between uterine disease and disturbances of sight—
recites109 the case of a peasant-woman aged twenty-three years who
had complete stoppage of the menstrual flow from exposure to wet
during the catamenial period: this was accompanied by high fever
and delirium, with pain in the region of the right ovary. When these
symptoms subsided, she noticed that there was absolute loss of
sight in the right eye, and so great a diminution of it on the left that
she could only distinguish movements of the hand. The
ophthalmoscope showed in the right side a multiple detachment of
the retina, and on the left an intense neuro-retinitis. Rest in bed,
inunctions of mercurial ointment, and cataplasms over the region of
the ovaries, with leeches to the septum of the nose and the neck of
the uterus, gradually brought about amelioration of the symptoms,
with restoration of the eyesight in the left eye. As might be
expected, the retinal detachment and consequent loss of vision in
the right eye remained permanent. In confirmation of this case, but
in contrast with it as regards the retinal symptoms, is the one
related by Samelsohn.110 The patient (a peasant-girl) by standing in
a cold running brook while at work had her menses suddenly
stopped. There was no marked uterine or abdominal pain. The
patient complained of a feeling of pressure on the orbits, and
experienced a gradual failure of sight with contraction of the field of
vision. In five days there was absolute amaurosis of both eyes (no
sensation of light and no phosphenes to be obtained by pressure).
The sight gradually returned in each eye, this being preceded by a
copious flow of tears, so that in sixteen days the patient could read
small print fluently. In seven weeks the menses returned. There
were no ophthalmoscopic symptoms: each eye, both during the
attack and subsequent to it, showed only striation of the retina and
tortuosity of its veins, the calibre of the retinal arteries being
unchanged. Unfortunately, any pupillary changes that might have
been recognized were annihilated by previous instillation of atropine
into the eye. In the first case there was every probability in favor of
a serous effusion into the subarachnoidal and the intravaginal
spaces. The latter case is more difficult to explain: if it were due to
orbital or intracranial neuritis, why should there not have been some
ophthalmoscopic changes during the time that the patient was under
observation? If to effusion within the cranium or to local circulatory
disturbances in either the corpora quadrigemina or the occipital
lobes, why were there not other symptoms of intracranial
disturbance?
109 Arch. f. Augenheilkunde, Bd. x., 1881.

110 Berliner klin. Wochenschrift, Jan., 1878, pp. 27-30.

In further illustration of the effects of a stoppage of menstruation,

Mooren111 cites the case of a peasant-woman aged thirty-one who
had complete suppression of the menses after the birth of her fourth
child, and where subsequently an almost continuous headache,
dimness of vision, and eventually epileptiform attacks, followed. The
ophthalmoscope showed a double neuritis so intense as to lead to
the supposition of a possible cerebral tumor. Mercurial inunctions
with seton to the back of the neck were resorted to without result.
Emmenagogues also failed to give relief. An examination of the
uterus was now made, which showed great enlargement and
hyperplasia, especially of its mouth and neck, for which scarifications
and sitz-baths were employed with good result. The headache and
epileptoid attacks disappeared, and the vision improved so far that
the patient (who when admitted to the hospital could only decipher
Jaeger No. xviii.) could read fluently Jaeger No. iii.
111 Loc. cit., p. 551.

DISPLACEMENTS OF THE UTERUS.—Anteflexion and retroversion of the

uterus are frequent causes of retinal hyperæsthesia. In this
connection we may quote from the same author two cases, as
showing how slight mechanical irritations of the uterus may cause
eye disturbance—one where a patient had an episcleritis and a
chronic metritis with malposition of the uterus, in whom there was
an exacerbation of the ciliary neuralgia and of the local eye
inflammation every time that the ulcerated os uteri was cauterized or
a pessary introduced; and a second with an adhesive kolpitis, in
whom the introduction of a pessary caused unpleasant feelings
about the head and oppression in the cardiac region, accompanied
on two separate occasions by capillary hemorrhages into the retina,
all of these symptoms disappearing rapidly after the removal of the
pessary. Mooren112 has also seen a double neuro-retinitis caused by
retroversion of the uterus. The sight was so much impaired that the
patient could with difficulty decipher Jr. No. xx.; but it was entirely
regained within a few months after the uterus had been replaced in
its proper position. No other treatment was employed.
112 Ophthalmologische Mittheilungen, 1878, p. 97.

PELVIC CELLULITIS.—Still more frequently are the reflex eye

disturbances caused by parametritis and the various forms of pelvic
cellulitis. Every practitioner has had abundant opportunity of
studying the easy fatigue of the eye, the burning and stinging
conjunctival sensations, the orbital and periorbital pains, the retinal
hyperæsthesia and sensitiveness to artificial light, which characterize
the early stages of the affection, accompanied later on by symptoms
of retinal anæsthesia. Inasmuch as the cause of these symptoms is
irremediable, we find in the majority of cases that it is impossible to
relieve the sufferings of the patient; this cause consisting in the
cicatricial shrinking of the parametrium and the pelvic connective
tissue. Sleep gives relief only so long as it lasts, and the patients
upon awakening, instead of feeling rested, often experience their
greatest pain and discomfort. Foerster113 and Freund, who were the
first to demonstrate this form of parametritis, call special attention to
the fact that the patients have their good and bad days entirely
independent of any use of the eyes. In many of the milder cases,
however, we find that the sufferings of the patients are enhanced
and aggravated by the presence of some defect, such as
astigmatism, hypermetropia, or insufficiency. Although the careful
correction of such defects will give considerable relief and enable the
patients to use their eyes for near work for a much longer period,
nevertheless the pain and discomfort are out of all proportion to the
amount of error. Of course, we are very far from having converted
such eyes into useful instruments for every-day work or for long-
continued labor, but we have removed an appreciable source of
irritation from an oversensitive nervous system, and done much to
relieve the toedium vitæ in cases which perhaps for months
previously have been unable to amuse or occupy themselves by the
use of their eyes in either reading, writing, or sewing.
113 "Allgemein-Leiden und Veränderungen des Sehorgans," in Graefe und Saemisch,
vol. vii. pp. 88-96.

MASTURBATION is also an occasional cause of reflex eye disturbances.

Mooren114 relates two aggravated cases in women who for years had
been excessively addicted to the vice. In both of these there were
accommodative asthenopia and tenderness in the ciliary region,
dread even of moderate illumination, which increased from year to
year. In both cases there were attacks of dyspnoea and other
disturbance of innervation of the pneumogastric nerve. Cohn has
also published a number of cases of eye disease in the male sex due
to the same cause. The main symptoms were a feeling of pressure
on the eyes, bright dots moving before them, and a sensation as if
the air between the patient and the object looked at was wavy and
trembling. In some of the individuals a discontinuance of onanism
and a moderate indulgence in sexual intercourse effected a complete
cure. Travers115 gives a case of loss of sight from excessive venery,
and another from masturbation. Mackenzie116 quotes Dupuytren as
relating the case of a man who lost his sight on the day after his
wedding, but where it was promptly restored by the use of a cold
bath with stimulants and the application of counter-irritation to the
skin of the lumbar region. Foerster117 has recorded a case of
kopiopia hysterica in a man where, from the eye symptoms alone,
he diagnosticated disease of the genital organs, and where it was
afterward proved that there was inability to copulate, the patient
having extremely small testicles and there being a thin whey-like
discharge from the urethra.
114 Loc. cit.

115 Synopsis of Diseases of the Eye, 1820, p. 145.

116 Diseases of the Eye, 1854, p. 1075.

117 G. u. S. Handb., vol. vii. p. 95.

CONGESTION AND INFLAMMATION OF THE OVARIES.—Disease of the ovaries is

frequently associated with retinal oedema and hyperæsthesia. In
women complaining of weak and painful eyes pressure in the ovarian
region often causes pain. Where only one ovary is tender to the
touch, we often notice that the patient complains more of the
corresponding eye, although there may be no difference or
abnormality in the ophthalmoscopic appearance of the two eyes.
Under this head may be appropriately mentioned the eye symptoms
of patients affected with hystero-epilepsy, a disease which is always
associated with ovarian trouble, of which Charcot has given us so
graphic a picture. He says that previous to the attack the patient
experiences an aura which starts from the abdomen. The convulsion
is ushered in by a loud cry, which is accompanied by pallor of the
face and loss of consciousness. These symptoms are succeeded by
twitching and rigidity of the face-muscles, with foaming at the
mouth, followed by contortions of the muscles of the trunk,
abdomen, and lower limbs, the paroxysm terminating with sobbing,
weeping, and laughing. Landolt has given us a careful description of
the eye symptoms in such cases, and groups them into four stages.
In the first, the outer and inner tunics of the eye appear healthy and
the acuity of vision is normal, but there is a contraction of the form-
and color-folds, always more marked on the affected side. In the
second group the acuity of vision begins to fail, and the symptoms
become more marked on the hitherto sound side. In the third with
the more affected eye fingers can scarcely be counted, while the
field of vision is limited to a few degrees from the fixation point; at
this stage the ophthalmoscope shows a serous swelling of the retina,
with fulness and tortuosity of its veins. In the fourth stage there is a
partial atrophy of the optic nerve on both sides.

PREGNANCY.—Cases of amaurosis occurring during pregnancy, in which

the vision was impaired after delivery, are recorded by Beer,
Ramsbotham,118 and other writers of the preophthalmoscopic period.
Some of them, at least, may probably be accounted for by the
occurrence of albuminuric retinitis in the puerperal state, but no
such interpretation can be put on the more recent cases reported by
Lawson119 and Eastlake,120 which in their main features strongly
recall the amaurosis after loss of blood, although there is no history
of any similar hemorrhages. In Lawson's case, we have an
amaurosis which commenced during the gestation of the eighth
child, and recurred during the ninth and tenth pregnancies. After the
eighth labor the patient recovered sufficient sight to be able to sew;
the amount of vision being gradually lessened after each gestation
until finally complete atrophy of the optic nerve ensued. In
Eastlake's case, the patient (æt. thirty-four) had borne nine children
at full time. The labors were normal in character, and the amount of
blood lost was not excessive. On the second or third days after the
second and each subsequent delivery, sudden loss of vision
occurred, and the woman became insensible. On recovering her
consciousness, her sight did not at once return, the amaurosis
remaining from three to five weeks. After the last labor there was
complete and permanent loss of sight in both eyes: Z. Laurence
examined this case with the ophthalmoscope, and reports only a
slight contraction of the retinal arteries, without other positive lesion.
Zehender,121 in treating of the subject, remarks that "almost every
busy eye-surgeon has encountered similar sad cases."
118 Med. Times and Gazette, March 7, 1834.

119 R. L. O. Hos. Rep., vol. iv. pp. 65, 66.

120 Obstet. Trans., vol. v. p. 79 (1864).

121 Handbuch der Augenheilkunde, vol. ii. p. 180.

PUERPERAL PHLEBITIC OPHTHALMITIS.—According to Mackenzie, this dread

malady, which, as a rule, causes the death of the patient, may
develop at any time from the third to the thirtieth day after delivery.
It frequently attacks both eyes, and in those cases which do not
terminate fatally eyesight is usually lost. Hall and Higginsbottom,122
Mackenzie,123 Fischer,124 Arlt,125 and Hirschberg126 have all given good
clinical descriptions of the disease, with careful autopsies. As in
other forms of metastasis, it is ushered in with a chill. Soon after,
transient darting pains are felt in the eye, which are sometimes
associated with photopsies and followed by serous infiltration of the
conjunctiva bulbi. Later, owing to effusion in the capsule of Tenon
and to the swelling of the orbital tissues, the eye projects forward
and its motility is impaired, these symptoms being accompanied by a
clouding of the cornea and the formation of pus in the anterior
chamber. If the patient lives, we may have either discharge of pus
through the cornea or sclera, or its gradual absorption: in either
case, the eyeball shrinks to a small stump. Anatomical examination
shows that the starting-point of these symptoms is a septic
embolism of either the choroidal or central retinal blood-vessels.
According to Hirschberg, "In other pyæmic affections in which the
eye is attacked with septic embolism life is dangerously threatened,
but there is a larger percentage of recovery with permanent
blindness (single or double) than in the puerperal form."
122 Medico-Chirurgical Transactions, 1829, vol. xv. p. 120.

123 Treatise on Diseases of the Eye, London, 1854.

124 Lehrbuch der Entzündungen und Organischen Krankheiten des Menschlichen

Auges, 1866, p. 285.

125 Die Krankheiten des Auges, 1863, Bd. ii. pp. 167, 269.

126 Archives of Ophthalmology, 1880, vol. ix. p. 177.

Influence of Lactation.—The asthenopia, feeble accommodation,

photophobia, and obstinate phlyctenular inflammations of the
conjunctiva and cornea which occur during prolonged lactation are
subjects of daily observation to every ophthalmic surgeon. They
unfrequently fail to yield to appropriate remedies so long as the
patients continue to nurse their children. Besides these symptoms,
Critchett127 has called attention to the sudden unilateral affection of
sight which occurs during lactation, and is due to hemorrhage
situated either in or behind the retina. This author has frequently
seen such cases coming on without pain.
127 Medical Times and Gazette, 1858, p. 118.

PATHOLOGY.—As regards the pathology of these affections we are still

very much in the dark. Mooren in his elaborate paper (previously
quoted) considers that the reflex disturbances of the retina and optic
nerve may either be transmitted directly, or may cause primarily a
spinal myelitis, which in its turn affects the eyes. He points out that
the subperitoneal connective tissue of the pelvis and the uterus is so
rich in blood-vessels, lymphatics, and nerves that Rouget has likened
it to cavernous tissue. He asserts that the uterine and pelvic nerves
re-enter the lumbar cord, while the veins anastomose freely with the
veins of the spinal column; and quotes Röhrig to show that electric
stimulation of the ovary causes a rise in the general blood-pressure
and a diminution of the heart's action—effects which he attributes to
irritation of the vagus. He further maintains that any long-standing
or often-repeated congestion of the visual centres, of the optic
nerve, or of the retina would cause increase of connective tissue and
a subsequent tendency to contraction, while the lymph which is
poured out, acting on the cylinder axis of the nerves, causes them
first to swell, and finally to absorb (Rumpf,128 Kuhnt129).
128 Untersuchungen am d. Physiol. Institut. d. Univ. Heidelberg, Bd. ii. Heft 2.

129 Ueber Erkrankung der Sehnerven bei Gehirnleiden, 1879.

Febrile and Post-febrile Ophthalmitis.

VARIOLA.—Various affections of the eye which at times impair its

functions, and at others destroy vision, frequently arise during the
course as well as during the subsidence of smallpox. When pocks
form in the skin of the eyelids, they cause the lids to swell to such
an extent as to completely close the eye: many patients so affected
relate how, after being blind for a week or ten days, they again
recovered their eyesight. The cicatricial processes which ensue often
produce falling of the eyelashes with incurvation of the tarsus, which
changes the direction of the ciliæ and causes the lashes to rub
against the eyeball. During the first stage of the disease there is
always flushing and congestion of the conjunctiva, frequently
associated with increased flow of tears and sensitiveness to strong
light. In some cases we find small elevated yellowish spots, often in
groups of two or three, surmounted by an area of vascularization on
the edges of the lids and in the tarsal conjunctiva. Similar
efflorescences are at times seen in the conjunctiva bulbi and on the
limbus corneæ. These coincide in the time of their appearance with
the eruption on the skin, and are probably of the same nature,
although from the difference in the anatomical structures they do
not present the same appearance as the pocks in the skin. Hebra,
who has observed and analyzed twelve thousand cases, says that 1
per cent. of the total number presented efflorescences in the
conjunctiva. Neumann, Knecht, Schely, Buck, and other German
authorities describe them; and Adler in his able monograph (On Eye
Diseases during and after Variola) gives an accurate account of
them. In opposition to the above statement it should be mentioned
that Gregory maintains that no mucous membranes except those of
the fauces, larynx, and trachea are capable of taking on variolous
inflammation. Marson130 also, who from his position at the London
Smallpox Hospital had unusual opportunities for witnessing the
disease, maintains "that pustules never form on the conjunctiva;"
Coccius131 is also of the same opinion. These authors call attention to
the fact that the well-known abscesses of the cornea which occur
during the drying and desquamation of the eruption, and which have
frequently been described as pocks by the older authors, cannot in
any sense be considered as pocks. Beer, however, while calling these
formations pocks, distinctly states132 that they occur during the
suppurative or drying stage. There seems to be no good reason why
the above-described conjunctival efflorescences, which come on
simultaneously with the skin, should not be considered as analogous
in their natures, although from the absence of the corium in the
conjunctiva they cannot assume the well-known form of the skin
eruption. At times the conjunctivitis becomes catarrhal, and even
purulent, leaving in some cases an acute dacryo-cystitis (Adler), and
more frequently a low grade of blenorrhoea of the lachrymal duct.
Beer states that "those authorities may be right who suppose that
there is a real eruption of pocks in the mucous membrane of the
tear-sac, because no other sort of inflammation of it is so apt to
cause complete closure in its entire length."133 The cornea may
present either diffuse or interstitial keratitis. Malacia or abscesses are
more frequent in the severe cases, where there are evidences of
metastases to other organs. They usually form in the outer quadrant
of the cornea, and are accompanied by marked ciliary injection, the
patients complaining of stitches in the ball with frontal and temporal
neuralgia. Prolapse of the iris and often the formation of a
staphyloma are produced by the perforation of resultant ulcers;
sometimes the entire cornea is swept away. Marson declares that he
has seen this last condition occur within forty-eight hours from the
time of the commencement of the corneal affection. Iritis is a less
frequent complication. It is of the seroplastic variety, and, according
to Adler, comes on only after the twelfth day and in cases where the
progress of the disease is slow and insidious. It is always
accompanied by some degree of cyclitis and by vitreous opacities.
Four cases of glaucoma are on record as occurring during variola;
and one (that of Adler) is noteworthy from the fact that the
prodroma of glaucoma coincided with those of the smallpox. It was
successfully operated on, notwithstanding the fact that the incision
was made difficult by the necessity of avoiding a pock on the limbus
of the cornea. Fortunately, the present generation has rarely an
opportunity of seeing great numbers of eye affections from
smallpox, and when they do occur, the partial protection from
previous vaccination often modifies their severity. In these days of
antivaccination societies, it is interesting to turn back to the accounts
of the disease given by those who were in active practice at the time
of Jenner's great discovery, and to see how serious the matter
appeared when viewed through their spectacles. Thus, Andreæ says,
"No disease is so dangerous to the eyesight as the smallpox, and
before the introduction of vaccination it caused as much blindness as
all other eye inflammations put together."134 Benedict135 also bears
testimony to the great diminution in the intensity of variolous
ophthalmia after the introduction of vaccination.
130 London Med. Gazette, 1838-39, pp. 204-207.

131 De Morbis Oculi humani que e Variolis exedi, etc., Leipzig, 1871.

132 Lehre von den Augenkrankheiten, vol. i. p. 527.

133 Op. cit., p. 525.

134 August Andreæ, Grundriss der Gesammten Augenheilkunde, vol. ii. p. 260.

135 P. W. G. Benedict, De Morbis Oculi humani inflammatorii, lib. iii. p. 367.

Writing later, Himly136 says: "Smallpox, formerly a rich source of all
eye diseases by which the doctor was most busied, is at present only
feebly represented by the varioloids (i.e. smallpox modified by
cowpox)." Mackenzie137 states that "in former times smallpox proved
but too often the cause of serious injury to the eyes, and even of
entire loss of sight. It was by far the most frequent cause of partial
and total staphyloma." Dumont in his work on blindness, the result
of his own observations at the Hospice des Quinze-Vingts at Paris,
and from its extensive statistics in previous years, records that out of
a total of 2056 blind, 262 were blind from variola (or 12.64 per
cent.); and, further, that the old records of the hospice showed 17.9
per cent., whilst at present (1856) it was 12 per cent. amongst the
older inmates, and but 7 per cent. amongst the more recently
admitted. He quotes Carron du Villars as giving the ratio before
Jenner at 35 per cent. From immunity we become careless, so that
when an epidemic breaks out (as that in Mayence in 1871) we have
a state of suffering which forcibly brings back our remembrance of
old times. Thus, Manz asserts that "the pestilences of the last
(Franco-German) war have revived the remembrance of a disease
which in the beginning of this century was a terror to humanity, but
which in the last decade was so rare that many now living physicians
know it only by the writings of the older authors: the late epidemics,
however, have enlarged their experience, and added a new
contingent to the almost extinct army of the smallpox-scarred
blind."138
136 Krankheiten u. Missbildungen des Auges, Berlin, 1843, p. 481.

137 Diseases of the Eye, p. 500.

138 Jahresbericht f. Ophth., 1873, pp. 178-183.

RUBEOLA.—Preceding the outbreak of the skin eruption, or coincident

with it, every case of measles presents a greater or less degree of
catarrhal conjunctivitis, often accompanied by lachrymation, itching,
and burning of the lids, slight pain, and photophobia. In from two to
three weeks the catarrh usually disappears of itself, but in many
cases leaves behind it an asthenopia and sensitiveness to light which
often lasts for months. In some fortunately rare cases the catarrh
increases, and we have a severe muco-purulent inflammation of the
eyes, causing partial or total sloughing of the cornea, and thus
leading either to the formation of a staphyloma or to the total loss of
the eye. Moreover, we often have the development of phlyctenular
keratitis as one of the sequelæ, especially among the weak and
badly nourished. Some authors (Rilliet and Barthez, Mason, Schmidt-
Rempler, De Schweinitz, etc.) relate cases where diphtheritic
conjunctivitis, with all of its well-known symptoms—yellow, ropy-like
secretion, great bulbar chemosis, and hard board-like infiltration of
the lids—set in during the course of the disease. Kerato-malacia (a
rapid sloughing of the cornea with marked anæsthesia of the ball,
without swelling of the lids) was probably first observed as a
consequence of measles by Fischer.139 He had seen three cases,
each accompanied by suppression of the skin eruption, severe fever,
and delirium. The corneæ were entirely destroyed in twenty-four to
forty-eight hours, and the children died soon after the development
of the eye affection. Beger and Begold (Leber) have each reported
similar cases. Sometimes in the course of this disease, amaurosis,
either permanent or transient, is doubtful. Graefe140 gives a case
where failure of sight came on during convalescence, and where for
a week there was absolute loss of perception of light, without any
other ophthalmoscopic appearances than a slight neuritis, the
patient gradually recovering his eyesight. In an epidemic of measles
with severe cerebral symptoms, Nagel141 records a case of a child
where on the third day sopor, convulsions, opisthotonos, and
dilatation of the pupils set in. The patient remained soporose for ten
days, and then, on regaining consciousness, was found to be entirely
blind. On the twenty-fifth day from the setting in of the convulsions,
perception of light was dubious, and the pupils, which remained
insensitive to the reflection from the ophthalmoscopic mirror,
contracted slightly on exposure to the full glare of daylight. There
was eventually complete recovery both of health and eyesight, the
return of the latter being apparently hastened by the use of
strychnia. The same author relates two other cases, in one of which
the ophthalmoscope showed neuritis. One of them was fatal, the
other terminated in recovery, and in neither was there any return of
eyesight. In some cases of measles where Bright's disease of the
kidneys is pre-existent or sets in during the attack, there may be the
development of the characteristic form of retinitis albuminuria.
139 J. N. Fischer, Lehrbuch der Entzündungen und Organischen Krankheiten des
Menschlichen Auges, Prag, 1846, p. 275.

140 A. f. O., xii., 2, p. 138.

141 Behandlung der Amaurosen, pp. 24-30.

SCARLATINA.—In scarlatina we have usually a hyperæmia of the

conjunctiva coincident with the skin eruption. Inflammatory
affections of this membrane and of the cornea are much less
frequent than in measles. Martini142 remarks that only in one case in
twenty is there any inflammation of the eye. Beer143 informs us that
the tears are more irritating than in morbillous ophthalmia, and that
the photophobia is more persistent. When ichorous ulcers form, they
attack not only the cornea, but also the white of the eye, and spread
much more rapidly in this situation than in the conjunctival leaflet of
the cornea. Kerato-malacia occurs more frequently than in rubeola.
Bonman144 relates that in a severe epidemic of scarlet fever five boys
in one family were taken sick, and that two of them lost their sight
from sloughing of the cornea within a week of their seizure. Of
these, one died, and the other was brought to him with a shrunken
globe and without light-perception. The eyes of the other three
children were not affected. Arlt in the first volume of his work on
diseases of the eye145 has given us a clinical description of this form
of kerato-malacia. The patient, a boy of four and a half years, was
first seen by him on the eighth day of the disease. The child was
very pallid, with a burning-hot skin, hoarse voice, slight diarrhoea,
and flat abdomen. The right cornea was evenly clouded throughout,
swollen, and softened, while the left had lost its brilliancy and was
slightly clouded, presenting the appearance of an eye thirty-six hours
after death. The conjunctivæ of both eyes were white, with a few
vessels and ecchymotic spots in their lower parts. On the tenth day,
the right cornea was converted into a mass as soft as schmeer-käse,
and was beginning to be thrown off on the centre, where there was
a hernia of the hitherto unaffected membrane of Descemet. Both
eyes eventually had the cornea completely destroyed, and the
patient died on the seventeenth day. Iritis is more frequent than
after measles.
142 Von dem Einflusse des Secretions Flussigkeiten, vol. ii. pp. 267, 268.

143 Lehre von dem Augenkrankheiten, Bd. i. pp. 536, 537.

144 Lectures on the Parts concerned in the Operations in the Eye, London, 1870, p.
110.

145 Krankheiten des Auges, vol. i. pp. 211-213.

Considering the frequency of acute nephritis in this disease, the

retinal lesions are comparatively rare. Schreiber146 gives two
interesting plates of chorio-retinitis after scarlatina. Ebert147 at a
meeting of the Berlin Medical Society in 1867 called attention to
some cases of transient blindness in the course of scarlatina without
ophthalmoscopic changes; and Graefe, who presided at the meeting,
remarked that in all these cases of absolute blindness there was still
reaction of the pupil to the light, and that therefore there could be
no neuritis or decided lesion between the corpora quadrigemina. He
considered the prognosis favorable so long as there was pupillary
reaction, and not necessarily bad where it was wanting. Although
this is the rule, the prognosis is certainly more favorable when the
pupil reacts promptly and to moderate light. Hirschberg148 has
recorded a case of blindness following meningitis, where light-
perception failed to return, although the pupillary reaction lasted
several weeks.
146 Veränderungen des Augenhinter-grundes, Plates iii. and iv., Figs. 7 and 8.
 147 Berliner klin. Wochenschrift, Jan. 15, 1868, pp. 21-23.

148 Ibid., 1869, p. 387.

Relapsing typhus fever is frequently followed by amblyopia and

inflammation of one or both eyes. Considerable variety in the
intensity and in the symptoms of the disease has been manifested in
different epidemics, and the ratio of the percentage of eye cases has
greatly varied. In most outbreaks of relapsing typhus fever
amblyopia is followed by inflammation. This was the sequence of the
symptoms in the epidemic in Dublin in 1826, in Glasgow in 1845,
and in Finland in 1865, although in the last-mentioned the
inflammatory symptoms were less prominent and severe than in the
first two. The eye symptoms rarely develop during the first attack of
the fever, but usually occur after a second or third attack or during
convalescence. The earliest careful study of the eye symptoms in a
severe epidemic is that of Wallace,149 who tells us that "there is
often that haggard and worn aspect, that sickly, mottled, pallid hue
of skin, that sleepy, exhausted, and oppressed appearance of the
eye, which is more easily observed than described. The patient only
half opens the lids of the affected organ. They are of a purplish-red
color and humid. Their subcutaneous vessels are preternaturally
enlarged. The vascularity of the sclerotic and conjunctiva is greatly
increased. The vessels of the former describe a reticulated zone
round the cornea, and those of the latter run in a direction more or
less straight to the edge of this membrane, and sometimes appear
to pass on the edge. The hue of the redness is peculiar; it is a dark
brick-red. The pupil is generally much contracted, and its edge
thickened and irregular. The iris is altered in color, generally
greenish, and incapable of motion. There exists dimness of the
cornea, which may be compared to the appearance glass assumes
when it has been breathed upon. There is often a turbidness of the
aqueous humor, and a pearly appearance of the parts behind the iris
may be observed by looking through the pupil. There is great
intolerance of light, and a copious, hot lachrymal discharge. The
vision will be found for the most part so extremely imperfect that the
patient can merely distinguish light from darkness, and he is often
tormented by flashes of light which shoot across his eye, and these
occur more particularly in dark places; or he is troubled by brilliant
spectres or by the constant presence of muscæ volitantes. There is
very considerable pain, which returns in paroxysms, and these are
almost always more severe at night. The pain is sometimes referred
to the ball of the eye, sometimes to one of the lids, sometimes to
the temple or to the circumference of the orbit." Mackenzie agrees in
the main with the foregoing description: his cases were also
accompanied by severe inflammation, with hypopyon and copious
precipitates in the membrane of Descemet and on the anterior
capsule of the lens. He also called attention to the diminution of the
intraocular tension and the consequent flabbiness of the eyeball, and
states that out of 1877 cases of fever admitted to the Glasgow
Infirmary during the epidemic of 1843, 261 (one-seventh) were
attacked by the disease of the eye. Anderson,150 who describes the
same epidemic later in the course, takes exception to Wallace's
statement that there is always an amaurotic stage at the outset of
the disease. He computes these cases at two-thirds of the entire
number, and tabulates five cases of inflammation without amaurosis.
He also describes and gives plates which show opacities of the
vitreous, posterior synechia, pigment on the anterior capsule,
posterior polar cataract, and other forms of lenticular degeneration;
these conditions ensuing not only in this disease, but in all other
affections where the circulation in the ciliary body and the
constitution of the vitreous are profoundly involved. Schweigger, in
describing an epidemic in Berlin, says that in one-third of the cases
of ophthalmia there was simple unilateral iritis, and that in a second
third there was diffuse punctiform or flocculent vitreous opacities
without any trace of iritis or external symptoms of disease; while in
the remaining third there was iritis with vitreous opacities in
common: when it ensues in its usual form the effects of annular
synechiæ or detachment of the retina; rarely from suppuration of
the corneæ. Although of late years the Russian writers have
materially added to our knowledge of the affection, nevertheless in
most essentials their observations agree with those above quoted.
Thus, Blessig151 gives an account of an epidemic in St. Petersburg,
while Logetschnikow152 describes an epidemic in Moscow in which he
encountered over 700 cases of this form of ophthalmia. Larionow153
relates the history of a mild epidemic in the Russian army of the
Caucasus, and tabulates 767 cases of the fever, in which are also
included a number of cases of exanthematic typhus and a few cases
of typhoid fever. Exclusive of the ischæmia of the retina and
feebleness of the accommodation which were present in every case
during convalescence, there were 3 cases of serous retinitis, 2 of
hemeralopia, and only 3 of iritis; while in 10 per cent. of these there
were vitreous opacities. He did not see a single case of genuine
irido-choroiditis in the entire number. Estlander154 has given a
masterly description of two epidemics which he observed at
Helsingfors in Finland, both of which occurred after a failure of the
crops and consequent famine. In the first of these epidemics, which
was of a mild type, only 3 out of 222 patients died, and the
concomitant eye affections were few in number; while in the latter,
18 out of 242 patients died, and extensive vitreous opacities with
severe inflammation of the eyes were frequent. He agrees with
Mackenzie that the fever attacks few children under ten years of
age, and says that although the disease is much more liable to
attack people between twenty and thirty years of age, here it is less
frequent than it is in patients between ten and twenty years of age,
where it exists in one half of the cases. Arlt155 agrees with this, and
says that it is due to the fact that hunger and malnutrition are in
general much worse borne by adolescents than by adults. As regards
the period of the disease at which the eye symptoms come on,
Estlander says that out of 28 carefully observed cases it developed 6
times during the fever or a week after its cessation, 11 times
between the second and fourth week, 5 times in the second month,
and 6 times from the third to the fifth month. These figures agree
well with those given by Mackenzie, and show that there is both a
feeble state of constitution and a prolonged convalescence from this
severe fever. Pepper,156 in a previous volume of this work, has given
an interesting account of an epidemic in this city in which he states
that eye affections were of rare occurrence.
 149 "An Essay on a Peculiar Inflammatory Disease of the Eye, and its Mode of
Treatment," Trans. Med.-Chir. Soc. of London (read Dec. 11, 1827).

150 "Post-febrile Ophthalmitis," Monthly Journ. Med. Sci., 1845, pp. 723-729.

151 Congrès internationale d'Ophthalmologie, Paris, 1868, pp. 114-117.

152 "Entzündung der Vorderen Abschnitten der Choroidea als Nachkrankheit der
Febris Recurrens," A. f. O., Bd. xvi., 1, S. 352-363.

153 Klinische Monatsblätter f. Augenheilkunde, 1878, pp. 487-497.

154 A. f. O., xv. 2, pp. 108-143.

155 Klin. Darstellung der Krankheiten des Auges, 1881, pp. 289-291.

156 Vol. I. p. 399.

Exanthematous typhus fever is occasionally followed by the same

train of symptoms as pointed out in discussing Larionow's statistics,
who gives vitreous opacities as the most frequent forms of the eye
affection. Out of a total of 57 fever patients with typhus
exanthematicus, he found 1 case each of iritis, keratitis, and neuro-
retinitis, 2 cases of contraction of the field of vision, 5 of
subconjunctival ecchymosis, and 2 of conjunctival catarrh.

Abdominal Typhoid Fever.—Severe eye complications are less

frequent in this disease than in either of the foregoing affections.
During convalescence from this, as from all other exhausting
diseases, there is usually feebleness of the accommodation, and
occasionally the development of vitreous opacities, with or without
the formation of cataract. The most common eye affections show as
an optic neuritis or paralysis of some of the muscles supplied by the
third pair of nerves, and are due to a complicating meningitis.

Yellow Fever.—In this disease most writers have called attention to

the accompanying ocular symptoms—flushing and injection of the
conjunctiva with increase of lachrymation, followed later by a change
of the color of this membrane to a yellow hue, which precedes a
similar change of the color of the skin of the face and other parts of
the body. The first epidemic of the disease in Philadelphia occurred
in 1762. Redman,157 in describing it, says: "The patients were
generally seized with a sudden and severe pain in the head and
eyeballs, which were, I think, often, though not always, a little
inflamed or had a reddish cast." Another severe epidemic of the
disease visited the city in 1793, of which Rush158 has given us a
valuable account. Among the premonitory signs he enumerated "a
dull-watery-brilliant, yellow or red eye, dim and imperfect vision;"
and he defines his meaning by saying that the dull eye was found
among the severe cases, and the brilliant one where the poison was
less intense. Later in the disease there was "preternatural dilatation
of the pupil," and in one case "a squinting which marks a high
degree of morbid affection of the brain." There were hemorrhages,
chiefly from the nose and uterus, and in but one case "a dropping of
blood from the inner canthus." A dimness of sight was very common
in the beginning of the disease, and many were affected with
temporary blindness. In some there was a loss of sight in
consequence of gutta serena or a total destruction of the substance
of the eye. The eyes seldom escaped the yellow tinge. There were a
number of cases of uncommon malignity without this symptom, but
sometimes the yellow color appeared on the neck and breast before
it invaded the eyes. Wood,159 who witnessed a later epidemic (also in
Philadelphia), says that even in the earliest period of the disease the
white of the eye is often reddened and turbid, and in bad cases
appears sometimes as if bloodshot. As before stated, in the course
of the disease this redness yields to a yellow or orange color.
Féraud,160 in speaking of the symptoms of the second stage, lays
great stress on the brilliancy of the eyes, their lachrymose condition,
the fulness and nicety of the conjunctival injection, the dilatation of
the pupil, and the presence of photophobia; adding that this
congestion is diminished during the remission of the fever if the
attack is not severe, but that if the conjunctiva darkens and assumes
an icteric aspect, which becomes more and more intense, the case is
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