The patient was a female child, aged eight years, a hydrocephalic idiot. The history given was that about one year previously a white spot had appeared on the right eye and that the eye began to project. Six months later a growth was first noticed on the right cornea, and this had constantly increased in size. Latterly a white spot had appeared on the left eye. On examination of the eyes there was seen a large conical tuberculated excrescence protruding between the lids of the right eye. It was half an inch in length and its base attached to the cornea covered about four-fifths of its surface. The left cornea exhibited a yellowish infiltration just below the pupil, over which the cornea was bulging; the anterior chamber was deep, the iris was immobile, the tension was slightly raised, and the eye was quite blind. Both globes were very anæsthetic, and there was considerable muco-purulent discharge from a chronic inflammation of both conjunctival sacs. The growth upon the right eye was accidentally detached a few days after admission into the hospital, and it was then seen to have been attached to the cornea at the apex of a central staphyloma, which was left covered by a fleshy soft core which had formerly been embodied in the center of the growth. The cornea was entirely opaque, and the eye was quite blind. After removal of the right eye a few days later examination of the globe revealed a co-arct retina with evidences of chronic degenerative changes in all the various structures. The anterior chamber was completely abolished, the iris throughout its extent being firmly adherent to the back of the cornea, which was bulging centrally. The apex of the corneal staphyloma had evidently been the site of a large perforation, which was closed by the fleshy granulations which formed the core of the growth. The growth itself measured half an inch from apex to base and one and a half inch around its base.
The interior portion was soft and crumbling, but the external layers were hard and horny and cut with difficulty. A wedge-shaped piece was cut away from the growth and specimens were cut and stained with carmine. The microscope showed that the external layers consisted of several faintly fibrillated strata of a dense, homogeneous nature. The layers occupied about one-quarter of the entire thickness of the walls, the rest being entirely composed of small nucleated cells, those most external being stratified. Adopting Mr. Bland Sutton’s classification of human horns, this growth would be an example of a cicatrix horn, the rarest of all varieties of horn, and one which had been usually found in connection with cicatrices of burns and scalds. The probable ætiology in this case was an overgrowth of granulation tissue closing the perforation in the cornea, which, owing to an unhealthy condition of the wound and eye, which was anæsthetic and atrophic, had become exuberant, simulating exactly the condition known as “proud flesh” elsewhere. By a process of accumulation and heaping up, the granulations gradually formed a cap over the cornea, whilst the external layers gradually became stratified and horny from the pressure of fresh growth from the central core and by the action of the air. The nature of the growth was evidence that the corneal epithelium bore no share in its production and discounted the possibility that it might be due to a huge crust of inspissated conjunctival discharges.