A practical treatise on the diseases of the eye / To which is prefixed, an anatomical introduction explanatory of a horizontal section of the human eyeball, by Thomas Wharton Jones. From the 4th rev. and enl. London ed. With notes and additions by Addinell Hewson.

  • William Mackenzie
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of the eye / To which is prefixed, an anatomical introduction explanatory of a horizontal section of the human eyeball, by Thomas Wharton Jones. From the 4th rev. and enl. London ed. With notes and additions by Addinell Hewson. 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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    patient readily acceded to submit to it, as indeed she -would have done to any operation, so extreme was the pain she endured. Mr. Ware introduced a spear-pointed couching needle through the sclerotica, a little farther back than where it is usually introduced for depressing a cataract. As soon as the instrument entered the eye, a yellow fluid escaped, sufficient in quantity to wet a common handkerchief quite through. The needle was kept in the eye about a minute, in order to afford the fluid a more ready exit; and as soon as it was withdrawn, the discharge ceased. The tension of the eye was considerably diminished by the operation. A com- press dipped in a saturnine lotion was bound upon it, and the patient put to bed. She continued in pain about ten minutes, but then fell inlo a sound sleep which lasted upwards of two hours; and on awakening, her eye was quite easy. The compress was again moistened with the saturnine lotion, and she took some nourishment. She passed the next night comfortably, without laudanum, although previously it had been given her in large doses. The same application Avas continued to the eye, which afterwards remained perfectly easy, with scarcely any appearance of inflammation. The pupil continued dilated, but did not become opaque. About three weeks after the operation, the patient caught a cold, and complained that the eye felt more tender than usual. Mr. Ware was alarmed lest a fluid might again be efl'used in the old place, and the pain return; but this was happily prevented by the application of a blister on the side of the head.^ Althoiigli the following case is related by no less an authority than Pro- fessor Panizza, as one of medullary fungus, I think the reader will grant, that the appearances on dissection vindicate me in placing it under the head of sub-choroid dropsy. The color, consistence, and relations of the diseased mass are widely different from what has been observed in fungus ha?matodes. Case 320..—The patient was a lively, healthy child, aged 20 months, aflfected with •what was considered to be malignant or medullary fungus, originating in severe internal ophthalmia, consequent to painful dentition. The appearances attributed to fungus had been observed for a month. The diseased eye was of the same size as the other, perfectly movable, and not inflamed; the pupil was Avidely dilated, and immovable. Behind the pupil, and apparently in the bottom of the eye, was a spot of a pale yellow color, divided by furrows into three tubercular-like eminences. In the fui'rows, a red vessel was seen ram- ifying. The spot was better seen, and appeared nearer to the pupil, by looking down inte the eye than upwards. When it was looked at in the direction of the eye's axis, it seemed more distant, or at the bottom of the eye. Vision was entirely lost. Donagana extirpated the eye, on the 10th December, 1822, six weeks after the com- mencement of the complaint. In 1826, when Panizza published the case, there was no reappearance of the disease. The extirpated eye was natural in size and form, but its consistence somewhat firmer than common. The optic nerve seemed healthy. The canary colored spot was seen through the cornea. On removing the cornea, the aqueous humor was discharged. The iris was healthy. By tearing it away from the orbiculus ciliaris, the crystalline was ex- posed, perfectly transparent, and inclosed within its capsule. Looking through the lens, the spot to all appearance lay at the bottom of the eye; but on opening the capsule, and removing the lens, it was seen to be close to the posterior capsule. Its apparent distance, then, when viewed through the crystalline, was an optical illusion. By removing a line's breadth of the choroid, which, as well as the ciliary processes, was natural, a yellowish soft fungous substance was exposed, apparently containing a fluid. At its upper part, there was a triangular area, where the hyaloid was healthy, and the vitreous humor lim- pid. On puncturing the hyaloid, and giving exit to a small quantity of vitreous fluid, one of the three yellowish prominences suddenly rose, as if it had been compressed, and took the place which had been occupied by the vitreous humor just discharged. Panizza con- cluded from this, that the vitreous body had become atrophied by the growth of the tumor. The tumor was soft, elastic, and where it was marked by the furrows already mentioned, its prominences could be separated a little with the probe. Desirous of discovering more completely the relations of the tumor, which seemed to be the retina in a fungous state, Panizza removed a ])ortion of the sclerotica towards the back of the eye, and was pro- ceeding to cut through the choroid, when there sudilenly issued a fluid of a canary color, and the three tubercular eminences immediately sank down a little. The fluid which escaped coagulated by coming in contact with alcohol. To prevent the remainder from escaping, the eye was put into alcohol. The fluid which had escaped was glutinous, and of a salt taste; it lost much of its yellowish color on being suddenly' coagulated by the alcohol into a homogeneous consistent mass. The eye being left in a cup filled with al- cohol till next day, was found adhering to the bottom of the cup by means of some of the fluid which had coagulated.