A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    HYPOPIUM. '187 p very thing, which may irritate the eye, or ; be likely to renew (lie inflammation ; am) .he should only employ such means, as are conducive to the resolution of the second inflammatory stage, depending on relaxation of the conjunctiva and its vessels, and such '; remedies as tend, at the same time, to invigo- '' rale the action of the absorbents. There- fore, in this state lie ought first to examine carefully the degree of irritability in the eye affected with the hypopium, by introducing, ■ between the eye and eyelids, a few drops of vitriolic collyrium, containing the mucilage 'of quince seeds. Should the eye seem too -strongly stimulated by this application, it must not he used, and little bags of warm [ mallows with a fe - grains of camphor are to be substituted tor it. In theintervals, the vapours of the liquor amnion, comp may ; be applied, and recourse had again to a ' blister on the nape of the neck. When the •' extreme sensibility of the eye is over the zinc collyrium must be used again, after- ward strengthened with a few drops of • camp' lirit. Un ler such treatment, proceeds Scarpa, the surgeon may observe, that, in proportion as the chronic ophthalmy disappears, and the action of the absorbents • is re-excited, the* tenacious matter of the . hypopium divides first in'o several small masses; then dissolves still further; ands afterward, decreases in quantity : descend- ing towards the inferior segment of the cornea ; and. finally, vanishing But Scarpa accurately observes, that the eon cannot successful, whether the disease occur during the first, or second sta^e of violent acute ophthalmy, if the tenacious lymph, suddenly extravasated in the interior of the eye, 'prevail in such quantity, as not only to fill, but strongly distend, the two chambers of the aqueous humour, ami the cornea in particular. In tins state, notwithstanding the most .skilful treatment, the unpleasant complication is often followed by another inconvenience, still worse than the hypopi- um itself; viz. ulceration, opacity, and burst- ing of the cornea. The ulceration of the cornea ordinarily takes place \vit!: sue!] celerity, that the sur- geon seldom has lime to prevent it. As soon as an aperture has formed, the exces- sive abundance of coagulating lymph, con- tained in the eye, (sometimes named em- pyema oculi) begins to escape through it, and a degree of relief is experienced. But, this melioration is not of long continuance ; for scarcely is the glutinous fluid evacu that distended the whole eye, and especially the cornea, when it is followed by a portion of the iris, which glides through the ulcera- ted aperture, protrudes externally, and con- stitutes the disease termed prolapsus of the iri^. (See Ins, Prolapsus of.) But, if in such an emergency, the cornea already ulcerated, opaque, and greatly deranged in its organization, should not immediately bunt, the surgeon is then constrained by the violence of the symptoms, depending on the prodigious distention of the eyeball, to make an opening in this membrane, in order to relieve the immense constriction, and even the danger in which life is placed. Were there the least chance of restoring, in any degree, the transparency of the cor- nea, and the functions of (lie organs of vision, after opening the cornea, Scarpa acknowled- ges that it would certainly be more prudent to make the opening at the lower part of this membrane, U it fcn the case of empye- ma of the eye, now considered, in which the cornea is universally menaced will] ulcera- tion and opacity, and stems ready to slough, there can be no hope of its resuming its transparency at any point, and he therefore deems it the best and most expeditious me- thod of relict to divide its centre with a small bistoury to the extent of a line and a half; and then to rai-e with a pair of for- ceps the !i tie flap, and cut it away all round with one stroke of the scissors, so as to let lite humours escape without any pressure. The '«ye is to he covered with a bread and inek poultice, which is to he renewed p\wy two hours, the use of sm h general remedies, as are calculated to check (he progress of acute inflammation, and to quiet die nervous i, not heingnmitled. hi proportion as the inteii.ir of the eye suppurates, the eye- ball gradually diminishes, shrinks imo the orbitj and at length cicatrizes, leaving things in a favourable slate for ihe application of an artificial eye. When Scarpa delivers his opinion, that in the above a-gravmed form of hypopium, tbetecanbe no chance of the cornea resu- ming its transparency at any point. I think his ion rather imprudent. Nor admitting its general truth, does it follow as a matter of course, that it is necessary and right to cut away a piece of the centre of the cornea, and absoluli whatever little chance may yet be let! of saying the eye. In sup- port of this remark, let me contrast what Mr. Travels has said m ilh the advise of St ar- pa. When the hypopium is so large as to ri'-e towards ihe pupil, and the ulceration of ihe cornea is i standing, I think its discharge by section near its margin adviseable. If not too long delayed, the ulcerative process is checked by it, which would otherwise run into sloughing, and ike cornea recover with only partial op city and disfigurement. (Sy- ' the D,^nscs of the Eye, p 28t.r.) Man eh art de Hypopyo. Tubing/?, 1742. C. P. Lepprin, itc Hypopyo Mo. Goctl. 1778. Goeldlin, Oiss.de Hypopyo. Erlang. lsio. Wnllher Mi tl< Hung tines Eiler- auges,\c. Sro. Lands/nit, 1SI9. / observe, that in Hufeland and Hurley's Journal for Oclob. 18W9, p. 93, there is an account of the treatment if an hypopium, or case of effused lymph in the chambers of the eye, by exhibit- ing from 12 to 18 gmitis of the submvriale of mercury, in the space of 12 hours, and then giving bask, while as an external application the Unci, opii eroeat. was employed. Thus we see. thai the efficacy of mercury in checking the effusion of lymph in the eye, and promoting. an absorption; has been known many years in