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.

    856/902 (page 840)
    Circumscribed collections of matter some- times form in the centre of the cornea, and these are perhaps more deserving the name of abscess than any other deposition. They ap- pear as a yellow spot, around which the rest of the cornea is opaque, from an effusion of lymph, such as takes place in the walls of other abscesses. Central abscess usually occurs as a conse- quence of acute ophthalmia, such as variolous or catarrho-rheumatic ; but it is occasionally met with, in exhausted states of the system, unaccompanied by any severe inflammatory action. The whole cornea again may become infil- trated with matter, as in purulent ophthalmia. The mere deposition of matter at the lower margin of the cornea, called onyx, is in general rapidly absorbed as the attendant inflammation is subdued ; but central abscess is dispersed more slowly, and is apt to leave considerable opacity behind. Such a result, however, is favourable, compared to another termination which often takes place, viz. ulceration of the cornea over the abscess, and the discharge of its contents leaving a deep ulcer. The abs- cess also sometimes opens into the anterior chamber, and the matter evacuated falling to the bottom of this, forms w'hat is called false hypopyon. As regards the abscess itself, no interference is admissible. The only indica- tion is to subdue the inflammation which has produced it as quickly as possible, and then nature will do more for the removal of it than any thing \ve can. As one means of giving a sudden check to the inflammation, evacuation of the aqueous humour is very useful. When the cornea has become infiltrated, ulceration takes place at the circumference, and the whole substance is gradually separated and thrown off in sloughs. The inevitable result is staphyloma of the iris. Ulcers of the Cornea. Ulceration of the cornea is a result of various inflammations of the eye. It may be limited to the conjunctival layer, or it may affect the proper substance also. The membrane of Descemet does not appear to be liable to ulceration, but, when exposed and deprived of support by ulceration of the proper sub- stance of the cornea, bursts. Superficial Ulcer of the Cornea.—This resem- bles a mere abrasion, the ulcerative absorption being limited to the epidermic part of the con- junctiva cornese. It has a great tendency to spread, and while it spreads on one side, cica- trization takes place on another. Increased vascularity of the cornea is very frequently combined with superficial ulceration, especially when it is an accompaniment of granular con- junctiva. In such cases it is the upper part of the cornea which is the principal seat of the disease. Semi-opacity only results from the cicatri- zation of this ulcer. Deep Ulcer of the Cornea.— Circumscribed deep ulcer of the cornea most generally results from the bursting of an abscess of the cornea, or a phlyctenula or an aphthous pustule. The characters of such an ulcer depend en- tirely on the kind and degree of inflammation present. The ulcer may be both deepandlarge, with ragged and everted edges j its bottom filled with a grayish, sloughy-looking matter, which is thrown off to be succeeded by the same thing, whilst the ulcer goes on increasing in depth. On close inspection, single red vessels may be seen coursing towards the part from different directions. In another case, the ulcer, neither so large perhaps nor so foul and flocculent-looking, is the point of termina- tion of a fasciculus of enlarged corneo-conjunc- tival vessels. The cornea for some distance around an ulcer is usually more or less nebulous. But when the ulcer begins to heal, its edges become decidedly gray and opaque. Where there is a fasciculus of vessels, one after an- other shrinks and disappears, and their track remains for some time marked by a nebulous streak. According to the extent and depth of the ulcer, so is the extent and degree of the opacity of the cicatrice. The opacity does not entirely disperse, though it has a tendency to become more and more circumscribed as the mere lymphatic effusion, which had taken place in the adjacent sound part of the cornea, is removed by absorption. There is a circumscribed and sometimes rather deep ulcer of the cornea, met with es- pecially in weak states of constitution, wUich is circular, with smooth round edges, quite clear even to its bottom, and the cornea around scarcely, if at all, nebulous. The cor- nea looks simply as if a small piece of it had been scooped out. After this ulcer has healed a clear facet remains. Destructive ulceration of the cornea, with- out much or any appearance of inflammation of the eye, is sometimes observed in cases of great exhaustion of the system from whatever cause, and also in cases of disease of the fifth pair. In cases of purulent ophthalmia, attended with chemosis, though abscess and destruction of the cornea may not have taken place, the cornea is sometimes found, after the chemosis subsides, ulcerated exactly at the place where the chemosed conjunctiva had pressed. The ulceration presents itself, therefore, in the form of a more or less deep groove, concentric with, but a little within, the margin of the cornea, and extending round it to a greater or less extent. Sometimes the whole surface of an ulcer of the cornea is found covered with a matter re- sembling (to use the comparison of Mr. Ward- rop) wet chalk. This appearance is attri- buted by Dr. Jacob to a precipitate from the acetate of lead solution so frequently em- ployed as an eye-water. Beer had already remarked that the use of lead lotions rendered the cornea opaque. Any part of the conjunc- tiva, if abraded, may be the seat of the deposit, but attention is most usually drawn to it when