SPEC. III. a O. puru lenta epide exist in other parts of the world than Egypt, the disease GEN. VIII. has been since detected in other parts as well: and as we shall presently remark, appears to have been known and attended to in former times as minutely as in the Egyptian present. mica. ophthalmy. miasm the A peculiar miasm, however, formed in hot and swampy Perhaps a soils, is perhaps the ordinary cause; there may be others singular as in the case of fever, but this seems to be the most real cause. certain and obvious. "The true cause of the disease", says Dr. L. Frank, "is to be found in the atmosphere, Epidemic. and consists in a principle peculiar to the air of Egypt." He afterwards supposes this, but with little reason, to consist of muriatic acid. Such a cause, however produced, must necessarily render the disease epidemic; and the pus, as in one or two of the succeeding varieties, secreted apparently from the sebaceous, or rather the mucous follicles of the tunica conjunctiva (for M. Bichat is probably right in regarding the conjunctiva as a mucous membrane) is impregnated with a specific contagion; and hence the disease is propagated with great rapidity between those who come in contact with each other by tagion. sleeping together, or using the same towels. I have Received known it caught by a surgeon's assistant merely in con- easily. sequence of syringing the eyes of a patient, a part of the discharge having, from the force of the syringing, spurted into one of his own eyes, which was for some days in a state of danger. Impreg nated with specific con gress. The general symptoms and progress of the disease are Symptoms those already noticed in the definition. From the vio- and prolence of the morbid action, the eye-lids soon become excessively tense and edematous, sometimes inseparably closed, with the edges drawn inwards, and sometimes gaping with the edges broad, turgid, and everted. The secretion of pus and tears is prodigious; and the pus is discharged thus freely even when there is no ulceration: on which account Professor Beer has proposed to call this species ophthalmo-blennorrhoea. But an ulceration often Ophthalmotakes place, and sometimes during the first night of the blennoattack. It commences usually in the cornea, which, from rrhoea. SPEC. III. a O. purulenta epide GEN. VIII. the onset of the disease, looks more or less muddy, or is studded with white spots. The ulcerative progress is sometimes checked before it spreads over the whole disk mica. of the pupil, and, in this case, the sight is partially preEgyptian ophthalmy. served. But, very frequently, it makes a rapid and irresistible advance over the entire cornea, lays open the iris, and works its way to the membranes, and even to the cellular substance below: in consequence of which the aqueous, and a part of the vitreous humour escape, the iris protrudes, and more or less adheres to the ruptured cornea, and the eye loses its figure as well as its power of vision. The pain, through the whole progress, is intolerable in the eye itself there is a sense of scalding or burning, and an agony in the head that drives the patient mad. "I have seen", says the younger Dr. Frank, "the bravest soldiers cry like children for a whole night: and have heard them declare that they would readily allow the affected eye to be torn out if they could hereby get rid of the pain" *. Effects sometimes In some cases the symptoms are less violent, and graless violent. dually subside without ulceration, in three or four days; and especially where the disease has been actively opposed by the process we shall have to notice presently. But innumerable granulations have, by this time, often formed upon the conjunctiva of one or both eye-lids, and a destructive irritation is hereby still kept up, which becomes a secondary source of blindness. Treatment adopted at first. The earliest mode of treatment pursued by the French, as we learn from the account of Dr. Antonio Savaresi, as well as of Dr. L. Frank, consisted in little more than the general treatment of the common acute ophthalmy; as local bleeding, drawn, however, from the jugular vein or temporal artery, blisters, saline purgatives, anodyne lotions, and a low diet. The bleedings do not appear to have been very copious. And yet the first writer tells us that by this process alone he was so fortunate, that out of a thousand, or thereabouts, who were confined in the * De Peste, Dysenteria et Ophthalmia Ægyptiaca, 8vo. Viena. GEN. VIII. SPEC. III. O. purulenta epide mica. Not ried to its utmost French military hospitals in Egypt under his care, not more than two lost their sight completely, though some others suffered the loss of one eye. In the hands of our own army-practitioners the plan Egyptian of treatment thus limited, completely failed of success: ophthalmy. and the bleeding, which was almost solely depended upon, gene was carried, from the first day of the attack, and re- cessful, peated for several days afterwards to as great an extent, not only as fainting, but as life itself would allow. The though carfirst accounts we had of this practice seemed to show that it was in the highest degree successful*: but later extent. experience has not justified the representation, and the extensive lists of blind pensioners at this moment supported by the Chelsea and Greenwich hospitals, are a sufficient proof that the success of the evacuating plan was considerably exaggerated. A free abstraction of blood by leeches applied to the conjunctive tunic itself, does not appear to have been tried till of late by Dr. Crampton, in the Dublin Hospital, where it seems to have been of very decided advantage when employed in its first stage, though it is insufficient afterwards. Saunders: who disco vered that the inflammation constages. sists of two The late Mr. Saunders was in consequence induced Improvement by to turn his attention upon its full stretch to this most acute and maddening disease: and he was the first in the present day to discover that the blindness which is so apt to follow, even after the first attack of virulent inflammation has subsided, proceeds from the friction upon the transparent cornea, of innumerable irritating granulations, as he denominated them, thrown forth from the surface of the tunica conjunctiva that lines the interior of the palpebræ, and which become a new source of inflammation, less violent indeed, but as fatal in its effects; and the disease has hence been very correctly divided into two stages, that of primary and that of secondary or apparently granulating inflammation. Mr. Saunders endeavoured to cut the disease short in its first stage Account of the Ophthalmia which has appeared in England since the return of the British army. By J. Veitch, M. D. SPEC. III. a O. puru lenta epide mica. Egyptian ophthalmy. Management of the first stage: of the second stage. In both cases further improved by Adams. GEN. VIII. by exciting nausea, and maintaining it for a considerable period of time so as to lower the living power, and hereby take off the inflammatory action. And where the disease had proceeded to what he called the granulating stage, he removed the minute caruncles from the tunica conjunctiva by cutting them off with a pair of scissors, and afterwards applied a solution of nitrate of silver to prevent their sprouting again. Sir William Adams appears very essentially to have improved upon both plans. Instead of the nauseating process employed in the first stage, he boldly prescribes active and powerful vomiting continued for eight or ten hours by giving two grains of tartar emetic at first, and continuing one grain every half hour afterwards through the whole of this period; by which violence a change of action, or new but more manageable excitement is often produced in the eye, and the disease is stopped in the course of ten or twelve hours from its onset. Though, as observed under the Leeches ap- first species, the benefit of leeches applied to the affected plied to the conjunctiva. tunic or conjunctiva itself is so striking and considerable, that it ought not to be superseded by the emetic process. Nor should it be forgotten that in this first stage the disease has been often subdued and granulations prevented from forming by the use of sulphuric acid applied to the conjunctiva, as we shall have occasion to mention in the everted eye-lid. Sulphuric acid. In the feeble practice pursued too generally by the physicians to the French Egyptian army, emetics were as little resorted to as venesection. Dr. L. Frank disapproves of the former, and affirms that the latter, as well as purging, is always hurtful. Opium was chiefly relied on as a general remedy and a stimulant ointment of butter of antimony and the red oxyde of mercury as a local application with aromatic vapours. The opium was given largely, sometimes a grain an hour for twentyfour hours together. Where the second or granulating stage has commenced, Sir William Adams slices away by a knife the diseased surface of the conjunctiva, instead of the granu α SPEC. III. mica. to be useful lating points alone; by which the morbid action is des- GEN. VIII. troyed not only with less pain, but far more radically & O. puruand effectually; and he afterwards employs a solution of lenta epidealum, instead of a solution of nitrate of silver, as the Egyptian latter is hereby rendered unnecessary; not to mention ophthalmy. that the agony it excites is often intolerable, and that a new inflammation has followed, in some instances almost as dangerous as the original inflammation itself. Eme- Emetics tics, indeed, have long been occasionally made use of as long known a mean of relieving inflammation in the eyes; but not in ophthal in the particular kind before us, nor perhaps at any my; and time of the inflammation with the precise object in but upon a employed, view, proposed by Sir William Adams. Stoll, for in- different principle. stance, employed them successfully in periodic ophthal mies*; and Dobson, as already observed, in ophthalmies of a like chronic kind, accompanied with nervous debility; the bark being interposed between their repetition +. The nearest approach, however, to this practice which I have met with on medical records is Dr. Dobson's case, already noticed under acute taraxis. Yet though the emetic plan carried to this extent, and employed for the express purpose just stated, does not appear to have been had recourse to in this form of ophthalmy till our own day, it has been very clearly shown by those who have critically and historically examined into the subject, that this very affection was long ago known to the world, and has been rationally as well as successfully treated in different ages. As the Greeks were much better acquainted with Egypt than ourselves, it is hardly to be supposed that it could have escaped their notice, and it has hence been suggested, with much probability, that it is referred to by them under the term PLADAROTIS‡; while it is ingeniously affirmed by a learned critic of our own day to have been described by the old surgeons of our own country under the expressive * Nat. Med. Part 11. p. 102. + Med. Comm. Edinb. Vol. III. p. 444. The pladarotis of the Greeks: |