Volume 1

The cyclopedia of practical surgery, including an etymological and critical terminology; detailed descriptions of instruments and apparatus; a copius bibliography; and an historical view of the progress of the science to the present day: ... a complete digest, alphabetically distributed, of the doctrines and practice of surgery / conducted by William B. Costello ; assisted by numerous distinguished writers ; illustrated with numerous engravings and wood-cuts.

Date:
1841-
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopedia of practical surgery, including an etymological and critical terminology; detailed descriptions of instruments and apparatus; a copius bibliography; and an historical view of the progress of the science to the present day: ... a complete digest, alphabetically distributed, of the doctrines and practice of surgery / conducted by William B. Costello ; assisted by numerous distinguished writers ; illustrated with numerous engravings and wood-cuts. Source: Wellcome Collection.

    855/902 (page 839)
    Subjective Sym2)to7ns.—Dimness of vision first attracts attention. In the slighter form of the disease there is not much pain ; perhaps, merely a feeling of distention, or of dull pressure on the front of the eyeball; and the eye feels weak. When the inflammatory appearances are marked, there is pain in the eye and head, with heat, intolerance of light, and lacryma- tion, to a greater or less degree ; and, in addi- tion to these, there are general feverish symp- toms, especially at the commencement of the complaint, or when an exacerbation occurs. Inflammation of the proper substance of the cornea is an obstinate disease. It may go on for a long time alternately getting better and worse. Aquo capsulitis and iritis readily su- pervene, and the sclerotica, choroid and ciliary body may also become involved, in which case there is added to the increased prominence of the cornea a conical projection of the whole front of the eyeball, in consequence of an attenuation and yielding of the anterior part of the sclerotica, which also permits the cho- roid to shine through of a blueish colour. Under such circumstances, the retina has also suffered ; and there are, consequently, more or less of amaurotic symptoms. r Predisposition.—The scrophulous constitu- tion is usually well marked in the subjects of keratitis parenchymatosa, who are generally of an age from eight to eighteen, and more fre- quently females than males. In females, dis- turbed menstruation often accompanies the complaint. In adults, the disease occurs with a rheumatic character. Causes.—The disease sometimes supervenes to another ophthalmia. External violence, or cold and wet, often appear to be the exciting causes. Sometimes the inflammation comes on after the retrocession of an affection of the skin. Often the etiology is obscure. Prognosis.—When the inflammation can be arrested, the cornea clears sometimes very rapidly, and to an extent not previously ex- pected. The clearing of the cornea takes place from the circumference towards the centre, where opacity usually lingers, and too often continues fixed. Increased prominence of the cornea, having once taken place, is per- manent. Frequent relapses are apt to discourage patient as well as practitioner. The supervention of puberty or the restor- ation of regular menstruation in the female, may be expected to have some beneficial effect. Treatment.—Good air, moderate light, at- tention to the state of the skin by tepid bath and friction, comfortable clothing and simple nourishing diet, are important dietetical ad- juvants. Emetics and purgatives will usually be found useful at the commencement of the treatment. A carefully-conducted alterative course of mercury, along with or followed by quinine or other tonics, such as iron, baryta, Ac. will then prove of great advantage. Abstraction of blood is not often necessary; but counter-irritation will generally be found useful. Blisters over the eyelids have been highly talked of. Steaming the eyes with hot water, into which some of a spirituous solution of extract of bella- donna has been pul, is of great use in soothing the eye, and mitigating the intolerance of light. Belladonna is also sometimes necessary for the purpose of keeping the pupil dilated wTen it is feared the iris has become affected. The only admissible wash for the eye is tepid w^ater impregnated or not wuth poppies, hyos- ciamus, or belladonna ; but when the disease has been fairly arrested, the corrosive subli- mate solution, with vinurn opii, or the latter alone, does good. Evacuation of the aqueous humour is some- times of at least temporary use, especially in chronic cases with great distention of the cornea. Dr. Hull ^ of Norwich has found turpen- tine in corneitis, as in iritis, frequently a very efficient remedy, either alone or in alterna- tion with mercury. He finds that in slow cases, Mr. Carmichael’s ordinary dose, 5j thrice daily, suffices ; otherwdse 3j every few hours ; or 3ij may be most efficacious. He finds the turpentine most easily taken “ floating on w'a- ter, or weak hollands and water, or diluted gin and he has remarked that “ children bear the remedy best ; even occasionally in doses, from which the stomach of the adult revolts.” For Inflammation of the Membrane of Descemet, see Article Aquo-membranitis. Abscess of the Cornea. In various inflammations of the eye, especi- ally w'hen of a severe form, or neglected, the proper substance of the cornea is apt to be- come the seat of purulent deposit. This, which often takes place suddenly, and without any previous appearance of inflammatory action in the cornea itself, is always a threatening symp- tom, because extensive destruction of the cornea by ulceration and sloughing is very apt to be the result. The lower part of the cornea is the place where deposition of matter most usually occurs. Such deposition, on account of its presenting the form of the lunular spot at the root of the nails, is called unguis or onyx. An onyx, and a collection of matter at the bottom of the anterior chamber, which is called hypopyon^ are distinguishable from each other by the following circumstances. The upper edge of the former is convex, that of the latter straight or even concave ; but the principal difference is that the matter of onyx is immoveable, while that of hypopyon is displaced by turning the patient’s head to one or other side. Lastly, on looking at the cornea in profile, the depo- sition in onyx appears nearer the surface than that in hypopyon. Both onyx and hypopyon, it is to be remarked, however, may exist at the same time. ‘ On the Morbid Eye, pp. 52,53.