The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones.

  • Thomas Wharton Jones
Date:
1863
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Licence: Public Domain Mark

Credit: The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    with in this disease. It is circular, with smooth, round edges, quite clear to its bottom, unaccompanied by any extension of vessels into it, and the cornea around is scarcely, if at all, nebulous. The cornea looks simply as if a small piece had been scooped out of it. After this ulcer heals, a small clear facet remains (p. 91). The inflammation continuing unchecked, ulcers which may have formed, often go on increasing in depth, until the proper substance of the cornea is perforated, in which case the membrane of Descemet is protruded through the opening at the bottom of the ulcer in the form of a small transparent vesicle {hernia of the cornea), which soon bursts, and the aqueous humor escapes, the consequences of which have been described above (p. 90 et seq.) Iritis sometimes supervenes in this form of ophthalmia. Sometimes, also, inflammation of the posterior tunics, by which the eye is left amaurotic, atrophic, or in a state of varicosity. From long continuance of the forced closure of the eyelids (p. 127) entropium is apt to be induced. There is less tendency to ophthalmia tarsi in this, than in scrofulo- catarrhal ophthalmia. This is one of the most obstinate of all the acute inflammations of the eye, and one of those most liable to relapse. The disposition to the disease, however, diminishes on the approach of puberty. If the cornea be still free from phlyctenules or ulcers the prognosis is good; but if phlyctenulae or ulcers exist, the prognosis must be qualified by the likelihood of a speck or specks on the cornea. See above. The state of the constitution, and the circumstances in which the patient is placed, must greatly influence the prognosis. The dismissal, when cured, should always be accompanied by a warning as to the great tendency of the disease to return, and in- structions as to the diet and regimen best calculated to guard against a relapse. Treatment.— The treatment is always advantageously commenced with an emetic—and an antimonial emetic is the best. (Vin. antimon. Sj ; aq. pur. sij—a tablespoonful every ten minutes until vomiting). After this small doses of hydrargyrum cum creta (gr. ij-iij), in combination with powdered leaves of belladonna (gr. ss-j), are to be given night and morning for a few days. A dose of calomel and rhubarb or scammony may be required in addition. The digestive organs having been by the alteratives and purgatives brought into a better state, the disulphate of quina, in doses of gr. j- ij, three times a day, will be found, in a large proportion of cases, to act like a specific. [Cal. (gr. S-J) and quin. sulph. (gr. |-ij), or hyd. chlor. corros. gr. ^g-y'-i in ext. cinchon. fluid. f5j-ij, t. d. answered admirably.— Ed.] Under its use, the inflammation and intolerance of light soon begin to subside, and this is followed by the disappearance of the phlyctenule and healing of the ulcers on the cornea. Cod-liver oil, with or without quina, is often of great efficacy. In some cases, iron, or sulphuric acid, and in others, rhubarb with car- bonate of soda, will be found useful as tonics. [In many cases of this