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was exposed to a bright light. The disease had continued three weeks. It began with the sensation of a mote in the eye, attended with pain; the following morning it was very red, and every symptom had increased daily.
Treatment. The aqueous humour was discharged, which caused a good deal of smarting, but in a few minutes it subsided. A great change took place in the transparency of the cornea, all the general cloudiness instantly going away, and the speck left much more distinctly circuinscribed. During the course of the day the pain of the head and eye went off, and she slept well during the night, whereas formerly her nights were very restless and disturbed by startings. On the day subsequent to the operation, she had not the least pain in the head or eye; the eye was not very sensible to light, and the number of blood-vessels was very much diminished. She could now readily distinguish all her fingers, and observe large objects at a considerable distance.
CASE XIII. The eyeball of a woman, thirty-eight years of age, was very much inflamed, and some spots of a purulent looking fuid were seen in the anterior chamber; whilst, at the same time, there was a considerable degree of opacity throughout the cornea. She complained of an intense pain of the eyeball, and in the forehead and temples. The disease was of three weeks standing
Treatment. The aqueous humour was discharged, the parts were afterwards fomented, and she took a brisk purge. On the following day the pain of the head was much easier, and the blood vessels were less numerous.She rapidly got well.
A lady, thirty-two years of age, had complained, during eleven weeks, of an inflammation in her right eye, attended
with pain occasionally in the forehead, and inability to look at objects. There was a very opake speck of the cornea opposite the pupil, with a degree of turbidness around it, so that nearly the whole pupil was hid; the white of the eye was slightly red, and the eyelids were of a purple colour towards the edges; the eye watery. Scarifications, opiates, and stimulants, gave no relief.
Treatment. The aqueous humour was discharged, and instantly the whole speck, except a small central portion, disappeared, and she could distinctly see with this eye immediately afterwards. All the inflammatory symptoms subsided in a few days by fomentations.
CASE XV. The whole of the white of the eye of a healthy middle-aged man was crowded with vessels of a large size, and of a bright red colour: these vessels all terminated at the margin of the cornea, ran in a straight direction towards it, and did not ramify until they approached it, and there they divided into numerous branches. The transparency of the anterior chamber was diminished, and all objects appeared dim. The eyelids were a little swelled, and the blood-vessels on their internal surface, though not much increased in number, were enlarged and turgid. He had a violent pain in the forehead, which was not constant, but came on in such severe paroxysms that he could scarcely support their violence. The inflammation had come on four days before without any evident cause.
Treatment.-When the aqueous humour was discharged, the anterior chamber acquired its natural transparency, and he could more clearly distinguish objects. A remarkable change took place in the blood-vessels of the white of the eye; the number of them was so much diminished, and also their size, that the eye at once lost all the appearances of inflammation. Vol. V.
Besides ordering a purge, and applying fomentations to the eye, it was thought proper to bleed this patient, from the violence of the inflammation and its accompanying fever. Under that treatment he got well rapidly.
Two Cases of Ulcers in the Cornea, where the Aqueous Humour
was advantageously discharged.
CASE XVI. In a young lady the anterior chamber of one eye appeared very turbid, and there was an ulcer on the central
of the cornea, and a cluster of blood vessels passing towards it; the whole eyeball was much inflamed, having the peculiar redness of the pustulous ophthalmia.* She complained of an agonizing pain in the forehead, which sometimes went off during the day, but was always severe in the night. The inflammation had lasted fifteen days, the pain in the head only eight days; little sleep, pulse quick, and the tongue white.
Treatment.--Discharged the aqueous humour by puncturing the cornea at the place where the vessels passed. The pain in the head never afterwards returned; and all the other symptoms rapidly subsided by the use of fomentations, and the vinous tincture of opium.
CASE XVII. A healthy looking young man had an ulcer of the cornea, accompanied with a good deal of inflammation and pain in the eyeball, in consequence of the suppuration of a pustule. The ulceration and inflammation subsided rapidly by the use of the vinous tincture of opium.
A few days after the eye had recovered this attack, he was suddenly seized with acute pain in it, which soon extended
See Essay on the Morbid Anatomy of the Eye.
to the head. When I saw him, three days after its commencement, there was a distinct erosion, in two or three different places, with a good deal of muddiness of the cornea. There was also a bright redness on the white of the eye; he had intense pain in the head, accompanied with excessive languor and debility; his tongue white, and a quick hard pulse. The obscurity of the cornea instantly disappeared by the evacuation of the aqueous humour, and the pain of the head was alleviated. He was bled at the arm profusely, and the eye was fomented. On the following day all the symptoms were much relieved; and in a few days the ulcer healed, and the eye recovered perfectly, without the aid of any local applications.
Observations on the Cataract. By BENJAMIN TRAVERS, Esq. Demonstrator of Anatomy at
Guy's Hospital. Surgeon to the Hon. East India Company, and to the London Infirmary for Diseases of the Eye.
[From the London Medico-Chirurgical Transactions for 1813.) OPACITY is the result of inflammation in a transparent part, as is seen in the scarf-skin, the conjunctiva, the cornea, the crystalline and vitreous humours of the eye, and their membranes. If the inflammation is arrested before it reaches the stage of effusion, the opacity, which probably depends upon the turgescence of the colourless vessels, is partial; and the part recovers its transparency when the inflammatory action ceases. This is proved by the haziness of the cornea in acute inflammation of the conjunctiva, accompanied by dimness of vision; a symptom which gradually goes off after the inflammation is subdued. When effusion has taken place even in a moderate degree, as in the nebula of the cornea, the opacity is more slowly removed, and seldom perfectly, even long after the inflammation has ceased. Where a deposition has taken place in consequence of a breach of the natural texture, as after an ulcer of the cornea, the opacity, greater or less according to the extent of the deposition, is permanent. Inflammation is the only cause of cataract open to observation. The simplest example of it is afforded by the accidental wound of the crystalline by a penetrating instrument; in this case the opacity is partial, and the cicatrix of the wound is the centre of the opake spot. Another frequent example is the cataract following acute inflammation of the choroid and iris, whether arising spontaneously or from injury, as a violent contusion of the eye. In this case the opacity is sometimes diffused over
. the capsule of the lens which adheres to the contracted pupil; sometimes it is only a central spot, and the iris seems to adhere to a transparent part of the capsule.
A conformation of body favouring a determination of blood to the brain, or frequent exposure of the eye to the stimuli of heat and light in more than ordinary intensity, or the habitual vision of minute objects in a depending position of the head, by which an undue proportion of blood is thrown upon the organ, commonly induce opacity of the crystalline or of the retina; which in one species of amaurosis turns of a green yellow colour, and becomes distinctly visible.
Cataracts are very frequently of spontaneous occurrence in persons of advanced years, in whom no signs of inflammation have preceded the complaint.
Transparent parts obviously tend to become opake in age, as may be instanced by the want of clearness of complexion in old persons, and the arcus senilis, as it is called, which is an opacity without inflammation encroaching upon the cornea. The very minute serous vessels of the crystalline run in the cellular substance which unites the lamellæ. This interstitial texture is probably absorbed in age, and the vessels may be gradually obliterated by compression;* but this must be matter of conjecture.
A change in the action of so minute and remote a system of vessels we should not expect to discover otherwise than by its local effects. Changes in other organs, similar to those which produce the different kinds of cataract,