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case. Some months afterwards, I heard that he continued perfectly well.

9. Of the Effects of discharging the Aqueous Humour in

Staphyloma.

The effects which are produced by discharging the aqueous humour in some cases of staphyloma, illustrate in a very satisfactory manner, the mode by which this operation seems to alleviate the symptoms of ophthalmia which have been already noticed. For in many cases of this disease, whilst the staphylomatous tumour is increasing in bulk, the ball of the eye becomes inflamed, and the patient generally complains not only of a sensation of uneasiness and fulness in the eye itself, but of a pain more or less severe in the brow of the affected side; and, under these circumstances, the escape of the aqueous humour fails not to produce immediate relief, and none of the inflammatory symptoms recur until a regeneration of that fluid takes place.

The aqueous humour is often evacuated without the interference of art, the portion of the cornea which most easily gives way allowing an exit to that fluid. In several cases I have been able to observe this process frequently take place, so that ultimately a fistulous opening was established, which either remained always pervious, or which was occasionally closed by a thin, pellucid membrane which gave way, wherever a superabundant quantity of fluid was collected in the eyeball.

This natural progress of the disease points out a very easy method of affording relief when the pain and inflammatory symptoms are severe: under such circumstances, the aqueous humour may be evacuated by puncturing the tumour, an operation which cannot fail to alleviate all the symptoms, in as complete a manner as would be fulfilled by that process which nature would ultimately have accomplished.

VOL. V.

K

No. 17.

CASE VIII.

A gentleman who had a staphyloma of one eye for some years, produced in consequence of a severe attack of inflammation, but which, till now, had given him little pain or uneasiness, was suddenly seized with pain in it, which soon spread to the brow and back part of the head; and became so agonizing, that in a few hours he was nearly distracted with its severity. He became extremely pale, and his pulse was very feeble.

Treatment. I discharged the aqueous humour, from which he obtained instant relief; and in a few hours he was perfectly recovered. He was three or four times similarly attacked, at the intervals of several weeks. The discharge of the aqueous humour was each time followed with instant and complete relief; and in order to prevent the recurrence of the symptoms, after puncturing the most prominent part of the cornea, I cut out a small circular portion of it. This opening was afterwards covered with a thin pellucid membrane, which readily gave way whenever there was a superabundance of the aqueous humour; and since the opening hath been made, he has remained free from pain.

CASE IX.

A woman received a sharp blow on her eye, which was considerably enlarged from a staphyloma. Two days afterwards the diseased eyeball was inflamed, extremely sensible to the touch, and she complained of a severe pain in the brow, extending through the head, accompanied by great prostration of strength, sickness, and fever. I punctured the staphyloma, and discharged a bloody fluid, after which she received much relief: the pain in the head disappeared, and the eye became easier. Four days afterwards the pain returned, but complete

relief was obtained by again evacuating the contents of the staphyloma.

It is very probable, that in this case all the violent symptoms were produced from an effusion of blood within the eyeball, in consequence of the injury.

$10. Of the Effects of evacuating the Aqueous Humour in Prolapsus of the Iris.

Even after the cornea has given way, and the aqueous humour has been evacuated, in severe cases of ophthalmia, the relief which that discharge produces does not remain permanent, for the portion of the iris which is prolapsed, so completely fills up the wound, that no more aqueous humour can escape, should its quantity become superabundant. Under such circumstances, an artificial discharge not only alleviates the inflammatory symptoms, but, if the protrusion of the iris has been recent, the depletion of the anterior chamber will permit the iris to fall back into its natural situation. In a case of this kind, where Mr. Ware performed the operation, immediately after the evacuation of the aqueous humour, the iris resumed its natural position. Should the iris still continue to be pressed forward, even after a puncture has been made on the cornea, recourse might then be advantageously had to the ingenious proposal of the late Mr. Gibson of Manchester. When the iris was prolapsed, either through a wound or ulcer of the cornea, Mr. G. found that the displacement arose from the portion of the aqueous humour lodged behind the iris, constantly pressing that membrane forwards at the point where there was least resistance. In such cases he made a puncture in the prolapsed portion of iris; and when the fluid collected behind it was discharged, it immediately regained its natural situation; unless in those cases, where, from the duration of the disease, the situation of the iris had become unalterable, from adhesions having formed between it and that portion of the cornea with which it was in contact.

§ 11. Of the Effects of evacuating the Aqueous Humour, in Injuries of the Eyeball.

Injuries of the eyeball are very often followed by severe and tedious attacks of inflammation, more particularly when from punctured wounds, and wounds penetrating into any of the cavities.

Besides a powerful antiphlogistic treatment, much benefit will often be derived by discharging the aqueous humour, especially in those cases where, along with pain and redness of the eye, there is a sense of fulness and dull pain about the eyebrow, or some other part of the head;-symptoms of ophthalmia, which, it has already been remarked, the evacuation of the aqueous humour is particularly well calculated to remove. In all cases, too, where there is a tendency to the formation of matter after injuries of the eye, the discharge of the aqueous humour becomes a powerful auxiliary to the other means usually employed.

CASE X.

of a

At the union of the cornea and sclerotica of the eye middle aged woman, towards the upper and nasal part, there was a prominent bluish-coloured tumour, covered with a network of red vessels, and the iris was drawn towards that part, so that the pupil was of an oblong form. There were a good number of red vessels over the sclerotic coat, and a dimness of the whole anterior chamber.

She complained of much pain in the eyeball, but particularly in the brow and temples. Her sight was impaired, and the pulse frequent and full. About eight days before, she had received a wound of the eye, either from the spur or beak of a cock. All the symptoms were alleviated by the discharge of the aqueous humour, particularly the pain in the head, which was instantly removed; and the redness of the conjunctiva was much diminished. A slight heaviness about the eyebrow re

mained for a day or two, but went off by the use of brisk purgatives.

CASE XI.

While a strong healthy man was employed hammering melted iron, a piece of it fell into the eye, and was found lying between the eyeball and under eyelid. It occasioned most excruciating pain, and although it was removed in a few minutes, violent inflammation succeeded, and I saw him four days after the accident. The whole conjunctiva was then very much inflamed, and it was so much swelled, that the cornea appeared as if depressed. There was a white slough towards the inferior part of the sclerotic coat, and on the corresponding portion of the internal palpebral membrane; but the cornea was not injured, nor its transparency diminished. He complained of great pain in the ball of the eye, extending over the forehead, and through the whole side of the head. He could not raise the upper eyelid without the assistance of his finger. Light gave considerable uneasiness, and his vision was so much destroyed, that he could only distinguish between light and darkness.

Treatment.-Under these circumstances I discharged the aqueous humour by making a small opening through the transparent cornea. The operation occasioned a smarting pain, which lasted a few seconds; when it went off, he said he could open the eyelid much easier; and was surprised to find that he could even distinguish the furniture of the room and books in a library. Slight scarifications were afterwards made on the under eyelid, which bled freely; and he was advised to foment the temples and adjacent parts; and as his pulse was frequent and full, he was bled at the arm, and ordered a brisk purge. During the remaining part of the day, the pain of the eyeball was much alleviated, and that of the head was completely removed, except that an uneasy sensation still remained in the brow. On the following day there was no vestige of the wound of the cornea; the pain and swelling of the conjunctiva were

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