regained its transparency, nor was the sight fully restored until nearly the end of a year, during the greater part of which time she was using mercury more or less actively. In a few months she came again to the infirmary, and said that she had the same complaint coming on in the left eye; she found the sight dim, and had considerable pain in the head; in short, the same symptoms which she had before complained of in the other eye. We had an opportunity of treating this eye from the first. We took blood from the temple by cupping, and employed the other treatment I have just particularised, and in six or eight weeks the complaint was completely put a stop to, although the cornea was generally nebulous when she came. The difference of treatment was very striking, and the results were equally so.

Partial inflammation of the cornea.--Most frequently inflammation affects the entire cornea, especially in young persons. Sometimes, however, about or after the time of puberty, the affection commences in one spot; other points become affected in succession, and thus disease may gradually extend over the whole. Pain has been felt in the eye; partial dulness is found at one point near the edge of the cornea; a little redness is seen on the external surface of the eye, corresponding to the nebula corneæ. On close inspection, this redness proves to be sclerotic, and the conjunctiva is unaltered: enlarged vessels are seen on the sclerotica, and we find minute ramifications extending from them upon the cornea. Another patch of nebula occurs, and ultimately the whole cornea, or the greater part of it, is affected.

CASE. A young lady, about sixteen, of florid complexion and full habit, had an attack of external inflammation in the left eye, from which she had recovered under active treatment. She began to complain of the right eye: some of the sclerotic vessels were enlarged, and the corresponding portion of the cornea, near its margin, was nebulous. Active antiphlogistic treatment did not prevent the progress of the inflammation, and its extension into general inflammation of the cornea, for which a long continued course of treatment, by purgatives, mercury, and issue, was required.

CASE. In a young boy, of rather pale and languid appearance, the same progress was observed. He had an attack of external inflammation, which got well, when partial corneitis came on, and gradually extended over nearly the whole cornea. It was accompanied with chronic iritis, and partial ad

hesion of the pupil took place. Issue in the temple, and mercury, ultimately removed the affection, but not till after a long time.

In another patient, near thirty years of age, of light complexion and pallid appearance, partial inflammation of the cornea showed itself first, and fresh portions of nebula appeared successively, till the affection became general. But in this, and in the last case, the inflammation was in roundish patches, the intervening portions being comparatively transparent. The central and most opaque part of these patches had a slight yellowish cast. Here too the iris was involved.

The same treatment was successful.

In a young lady of delicate habit, about twenty-four, patches of opacity showed themselves in the lower half of the cornea. They were small, roundish, dense, and yellowish in the centre, and shaded off at the circumference. After antiphlogistic treatment, mercury and issue were employed. Considerable benefit was produced, when the mouth became affected. The treatment was interrupted, and relapse occurred; it was resumed, the mouth was again affected, and the influence was kept up for some weeks without much benefit. The affection, indeed, began to show itself in the upper portion of the cornea, which had been previously clear. I did not witness the termination of the case.

Local applications are not of much advantage. In the inflammatory period, and when intolerance exists, fomentations are most comfortable to the patient. Stimuli and astringents are hurtful so long as active inflammation exists. When that is removed, and the complaint is beginning to yield, the vinum opii, or the four grain solution of lunar caustic, may be tried, and a small portion of the mild red precipitate ointment may be introduced between the lids at night.

Inflammation of the cornea is not an unfrequent occurrence in strumous subjects. Although it is sometimes spoken of as a particular affection, under the name of corneitis scrofulosa,* its local characters do not differ essentially from the description already given. The affection is very obstinate; yielding difficultly to treatment, and liable to relapse. It is attended sometimes, after long continuance, with increased secretion of aqueus humor, and consequent enlargement of the anterior

* The progress and phenomena of the affection, with some of its consequences, are well described and delineated by Dr. R. FRORIEP, in his Dissertation de Corneitide Scrofulosa.

chamber. The treatment must be the same in principle as that already laid down, with such modifications as the strength and constitution of the patient may require. The general management pointed out, under the head of strumous ophthalmia, and the administration of sulphate of quinine, may be necessary.

CHAPTER XV.

INTERNAL INFLAMMATIONS OF THE EYE; ARTIFICIAL DILATATION OF THE PUPIL.

THIS is a part of the subject of the greatest importance. With much less external appearance of disease, with fewer visible marks of inflammation, with less to excite the attention of the patient or the alarm of friends, than in the external affections already described, there is much greater danger to vision. Slight alterations in the pupil, in the transparent media behind it, or in the retina, are sufficient to impair or destroy sight. These often take place without any external redness, without any changes visible to superficial observation. The commencement and progress of chronic internal inflammation are often most insidious; the existence of the affection, when confined to one eye, not being discovered till the change of structure is irreparable, and then only observed accidentally. This part of the subject has been much neglected by English writers, almost to the present time. Mr. WARE, the former great authority in these matters, in his treatise on the ophthalmy, does not even hint at inflammation of the internal parts. You might read him through without learning that the latter are even subject to inflammation; he does not seem to have been aware of the fact; a remarkable illustration of the difference between seeing and observing disease; or rather a proof that the most obvious things will not be seen unless persons know what to look for. The subject has been more accurately and successfully investigated by the Germans than by any others: they deserve the merit of having first observed, described, and discriminated the principal forms of internal ophthalmic inflammation.

Inflammation may be confined to one of the internal structures, or these may be involved altogether. The close connexion between the different internal parts, and their common vascular supply, are sufficient to account for the circumstance of inflammation spreading from one to another, and indeed make it difficult to understand how it is so often limited to one part. If inflammation commences in the iris, it easily extends to the ciliary body, choroid coat, vitreus humor, and retina; on the other hand, it will spread forward to the anterior part of the eye; so that a case of iritis often involves, in its progress, the greater part or the whole of the internal tunics, and the external parts also. Inflammation beginning in the retina spreads in like manner to the vitreous tunic, choroid, iris, &c. The phenomena of inflammation have been most accurately noticed as they present themselves in the iris, because it is immediately open to external observation; hence its history, progress, and treatment are best understood. We are not so fully acquainted with the appearances of inflammation in the retina, choroid coat, and vitreus humor; we cannot give so clear and satisfactory an account of choroiditis and retinitis, as these affections have been termed, as we can of iritis. We labour under peculiar disadvantages in the pathology of these parts; their internal position secludes them from observation during life, so that we do not see the actual changes which constitute the inflammatory state; and we have no opportunity of investigating these changes after death, because the affections do not destroy life. There are hardly any recorded dissections of such cases in the active state of inflammation. The few examinations hitherto made have been in instances of long standing blindness; hence they have only shown the ultimate effects, without elucidating the origin, progress, or primary state of the affections.

The observations which I shall have to make upon the internal inflammations of the eye I shall arrange in the following order; and shall speak,

1st. Of Inflammation of the cavities which contain the aqueus humor, the anterior and posterior chambers of the

eye.

2dly. Of Iritis, or inflammation commencing in the iris. 3dly. Of Inflammation of the internal tunics generally. 4thly. Of Inflammation of the posterior tunics of the eye, as the membrane of the vitreus humor, the choroid coat, and retina; frequently occurring in arthritic subjects.

Artificial dilatation of the pupil.-The state of the pupil is

one of the most important points in the internal ophthalmiæ; to preserve its circular figure, its natural dimensions, and permeability to light, is our principal object in most instances. Here we derive essential assistance from that anomalous and hitherto unexplained power, which certain narcotic vegetables possess, of acting upon the iris so as to dilate the pupil.* Before I describe the internal inflammations, I shall speak of the effect, which these substances produce on the eye. The power in question resides in the atropa belladonna,†, (deadly nightshade,) the hyoscyamus niger, (henbane,) the lauro cerasus, (cherry laurel,) and the datura stramonium, (thorn apple.) It is found in the recently expressed juice of these vegetables, in an inspissated decoction of them, in the extract, or in the active narcotic principles, lately discovered by Ger

The influence of belladonna on the pupil had been observed long ago, and is incidentally mentioned, as if it were well known, in a case of amaurosis, related in ARNEMAN'S Magazin, vol. i. REIMARUS, who saw a striking instance of it, proposes to employ the application as a means of facilitating extraction of the cataract. See BALDINGER, Sylloge, as quoted in the next note. But the attention of the profession was first expressly directed to the subject by Professor HIMLY, in some remarks on Paralysis of the iris by the local application of hyoscyamus, and the use of this remedy in the treatment of some diseases of the eye," published in his " Ophthalmologische Beobachtungen, Bremen, 1801. These were translated into French, and published at Altona in 1801, under the following title: "De la paralysie de l'iris par une application locale de la jusquiame, et de son utilité dans le traitement de plusieurs maladies des yeux." EHLERS, who translated the observations of HIMLY, communicated their purport to DUBOIS, who used hyoscyamus to dilate the pupil in cataract operations in the following year at the Hopital de Perfectionnement.

HIMLY has the merit of first seeing and clearly explaining the practical utility of this artificial dilatation in various states of the eye. It is so important in internal inflammations, by preventing contraction of the pupil; in the distinction of cataract from other affections; in discriminating the several species of cataract; in facilitating some of our operations, and as a palliative remedy in contractions and displacements of the pupil, and in many cases of glaucoma and cataract, that its introduction into practice by Professor HIMLY, may be deemed an important epoch in ophthalmic surgery.

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Mr. WISHART has given a good account of the circumstances connected with this subject, historical as well as practical, in the ninth volume of the Edinburgh Medical and Surgical Journal, in a short paper, entitled Case of congenital cataract, with some observations on the means of artificially dilating the pupil in the operations of extracting and depressing the cataract."

This effect of belladonna, which was known to our countryman, RAY, was observed in a young man, who had some of the fresh juice accidentally applied to the eyes. The pupils remained dilated for three weeks. See BALDINGER, Sylloge Opusculorum, vol. ii. 1777.

The fact was first noticed by Professor HIMLY, in 1799, in a case where the eves had been bathed with a solution of hyoscyamus: see his Ophthalmologische Beobachtungen, quoted in the last note but one.

Auswahl aus

CONRADI Saw full dilatation of the pupil produced by the external application of cherry laurel water, as a remedy for opacity of the cornea. dem Tagebuche eines praktisehen arztes, Chemnitz, 1794, p. 23.