TREATMENT
OF THE
DISEASES OF THE EYE,
BY MEANS OF
PRUSSIC ACID VAPOUR,
AND OTHER MEDICINAL AGENTS.
BY
A. TURNBULL, M.D., EDIN.,
HONORARY PHYSICIAN TO THE INDIGENT BLIND VISITING
SOCIETY; AUTHOR OF "A TREATISE ON PAINFUL AND
NERVOUS DISEASES," "VERATRIA, ACONITINA,
DELPHINIA," ETC., ETC.
LONDON:
JOHN CHURCHILL, PRINCES STREET, SOHO.
1843.
PREFACE.
Amid a multiplicity of professional duties I have appropriated a few
spare minutes to the preparation of this little work. It must, under
such circumstances, have many literary imperfections, for which I must
crave the indulgence of the Profession. But I trust it embodies some
useful and original principles and facts, that are, at least, entitled
to a dispassionate consideration. I take this opportunity of thanking
those Medical Gentlemen who so kindly, and so patiently watched several
of the cases recorded in these pages.
48, Russell Square, Feb. 1st, 1843.
CONTENTS.
Page
Introduction 1
Action of Hydrocyanic Acid upon the Eye 3
Action of Chlorocyanic Acid upon the Eye 7
Remarks on the Action of Carbon, &c. 15
Cases of Opacities of the Cornea, &c. 18
Cases of Staphyloma 27
Case of Inverted Eye-lashes, with Opacity
of the Cornea 33
Case of Conical Eye 35
Cases of Cataract 37
Cases of Amaurosis 41
W. H. Newnham, Esq.'s letter 47
Professor Forbes's letter 48
Case of Staphyloma, treated by
J. C. Atkinson, Esq. 51
Dr. Maclean's cases 53
Case of Diseased Cornea, treated by
G. K. H. Paterson, Esq. 61
CHAPTER II.
Action of Essential Oils, &c. 67
Formulæ ib.
Amaurosis 75
A. Cruikshanks, Esq.'s letters 83
Dr. Kent's letter 86
INTRODUCTION.
In submitting to the public the following interesting cases
illustrative of the effects of my mode of treating diseases of the eye,
I have prefixed to them the original communications transmitted by me
to the _Lancet_ and the _Medical Gazette_. My reason for so doing is
this--I wish it to be seen by actual comparison, that in every instance
the confidence I have expressed in the efficacy of these medicines has
not been overrated; on the contrary, it will be seen that I have said
less than the facts really warrant.
It will also be found, that the cases which have come under my
treatment are, without exception, such as have been regarded
either as hopeless, or at least such as have previously enjoyed,
without sensible benefit, all the advantages of our best Ophthalmic
Institutions. It cannot therefore be contended, that the ordinary
treatment would have proved equally efficacious if it had been
previously tried.
I have also given the cases that are at present under my treatment,
in order that all who take an interest in the subject may have ample
opportunity of watching their progress, and forming, from their own
observations, just conclusions.
I have also added some important observations concerning the action
of the essential oils on the eye, as exhibited both externally and
internally.
ACTION OF HYDROCYANIC ACID, &c.
UPON
THE EYE.
In September, 1841, I made the following communication to the editor of
the _Medical Gazette_, which he kindly inserted:--
It is a well-known fact, that the eyes of those who have been destroyed
by hydrocyanic acid show none of the usual symptoms of dimness for
a length of time after death.[1] On the contrary, the eye is clear
and the pupil much dilated. This satisfied me that the acid exerted
a specific action upon the eye, which might be made available as a
medical agent for relieving many of the diseases to which that organ is
so subject.
[1] Morbid appearances produced by hydrocyanic acid in a case related
by Hufeland.
The inspection was made the day after death. The eyes were still
glistening like those of a person alive; but the countenance
was pale and composed like one asleep. The arteries and left
cavities of the heart were empty, and the veins and right cavities
distended.--_Christison on Poisons, page 708._
In most instances venous turgescence and emptiness of the arterial
system is commonly remarked throughout the whole body.--_Christison on
Poisons, page 710._
It appears that long after death the eye, as in Hufeland's case,
has a peculiar glistening and staring expression, so as to render
it difficult to believe that the individual is really dead; and
this appearance has been considered by Dr. Paris so remarkable, as
even alone to supply decisive evidence of poisoning by hydrocyanic
acid.--_Christison on Poisons, page 711._
Numerous reports have now been made of those who have died in
consequence of this poison, and the most striking effects to be
observed are, the extraordinary state of the eye, which has indeed
been considered as the most characteristic phenomenon, and at once
to point out the cause of death: the shining, glistening, sparkling
lustre of the eye has been, on most occasions, observed. No one has,
so far as I am able to learn, attempted to explain this most striking
appearance; it has, however, been said, that those who die from the
effects of charcoal often exhibit the same unearthly lustre.--_Dr.
Sigmond on Poisoning with Prussic Acid.--The Lancet, August 26th,
1837, page 797._
My first experiment was undertaken in 1837, with the diluted acid, by
dipping a sponge into it, and rubbing it upon the forehead for the
space of a few minutes, which gave the skin a very red appearance; but
the patient experienced not the least sense of heat, and the pupil
was slightly dilated. I continued to use this with very beneficial
effects in incipient cataract, opacities of the cornea, inflammation,
amaurosis, iritis, &c. Of late, instead of the diluted acid I have
applied the _vapour_ of the concentrated acid to the eye with much more
decided effect, and without the slightest danger. The plan I generally
adopt, is to put into an ounce-phial a drachm of the acid, and hold it
in close contact with the eye, the eyelid being open, for the space
of about half a minute, or until such time as the patient feels a
little warmth, or the person holding the phial sees the pupil greatly
dilated, and the vessels of the eye injected with blood, which is the
invariable effect of the application of the acid. The patient is not
sensible of pain from this peculiar state being induced, which appears
to me to result from the powerfully sedative influence of the acid,[2]
thereby showing that two opposite powers--to wit, the stimulating and
the sedative--are exerted at the same time; and thereby the uneasiness
arising generally from a stimulant alone is prevented. Its great power
in removing these diseases chiefly arises from the two powers being so
blended, and thus enabling the eye to bear a sufficient stimulating
action without injury. The person who holds the acid to the eye should
_be careful not to allow the patient to smell it_.
[2] _Lancet, Sept. 16th, 1837, page 883._--In whatever manner it is
prescribed or administered, either therapeutically or as a poison,
hydrocyanic acid operates directly on the nervous centres.--_Professor
A. T. Thompson._
The _Medical Gazette_ and the _Lancet_ gave insertion to the following
statement of mine, of date Oct. 20, 1842.
SIR,--In October, 1841, I gave an account of the action of the vapour
of _hydrocyanic acid_ upon diseases of the eye. Since that period I
have been engaged in investigating the action of various other bodies
on the same organ, and under the same form.
One reason why I did not rest satisfied with the effects produced by
the hydrocyanic acid, was, that its action, like that of all other
medicines, decreased in power by continued application; thereby
rendering it necessary to have occasional recourse to other medicines,
in order to insure a more speedy recovery. Another reason was, the
reluctance of many individuals to submit the eye to the action of so
potent a medicine.
The first medicines to which I shall refer, and which I have employed
with some success, are the _chlorocyanic acid_ and _sulphuretted
chyazic acid_. The plan I pursue is that of putting a drachm of one
of the medicines into a bottle (containing a small piece of sponge) of
about two-ounce size, having a mouth precisely fitted to the eye, and
with a ground-glass stopper.
The action of these medicines is very different from that of the
_hydrocyanic acid_, in as far as they both stimulate the eye, and
produce much greater warmth and irritation, with less dilatation of the
pupil. Few, however, can bear the _chlorocyanic acid_ to be applied
longer to the eye than half a minute; though, in a minute after its
application, all irritation is removed, and the eye feels perfectly at
ease.
The next medicine which I have employed in the form of vapour was the
chloruret of iodine. This medicine produces very little warmth or
uneasiness to the eye, if continued for the space of two minutes or
upwards; but a sensation of irritation, accompanied with a flow of
tears, takes place on its removal. It contracts the pupil, and in no
case have I seen it dilate it. Its vapour rises very readily, and does
not leave the yellow disagreeable colouring on the skin produced by the
vapour of iodine when uncombined, which is a great drawback in the use
of iodine in diseases of the eye.
The last medicine which I have employed is the bisulphuret of carbon,
which is so volatile, that the application of it to the eye, when the
bottle is held in a warm hand for a few seconds, is as much as can be
borne, in consequence of the intense prickling heat and flow of tears
which it occasions. Owing to this fact, I generally use it by causing
the patient to shut the eyelid during its application, which can then
be continued for a minute or two, with the same beneficial effect upon
the eye, without inconvenience to the patient. It generally contracts
the pupil, and very seldom dilates it.
I used to employ iodine by putting it into the same bottles, and
immersing it in hot water, and in its state of vapour applying it to
the eye; but I find it answers much better when dissolved in the
bisulphuret of carbon.
It is my intention, shortly, to give a full account of the action of
these medicines upon the various forms of disease to which the eye
is subject, and also what particular disease each medicine is best
calculated to remove. At the same time I shall state such instances
of failure as have occurred in my experience, in order that a just
estimate may be formed of the value and importance of each medicine.
It may not be out of place here to state, that I have employed,
with great success, the bisulphuret of carbon to enlarged indurated
lymphatic glands. In the first instance, I rubbed equal quantities of
the bisulphuret of carbon and alcohol upon the parts affected, but
without any effect upon the glands. But as its effects were so great
when its vapour was confined to the eye, I was led to apply it in the
form of vapour, and by means of glass bottles similar to those I have
described. By these means I excluded the action of the medicine from
the external air, and thereby prevented its speedy evaporation. When it
had been applied about one minute, the patient felt the part very cold,
but immediately after a gradual heat, accompanied with great prickling;
the heat increasing the longer the medicine was kept in contact with
the part, until it could be no longer endured. On removing the glass,
the part was red to an extent two or three times greater than the part
enclosed. In a few days the change in the size of the glands was very
great; and by its daily repetition, a complete and speedy removal of
the disease was effected. I also find that its action upon diseased
glands is more decided if the surface of the skin is well moistened
with water previous to the application of the bottle to the part.
The water, in fact, not only prevents the escape of the vapour between
the glass and the skin, but assists the imbibition of the carbon; a
point of the highest importance, inasmuch as all its action on the part
depends upon the exclusion of the atmosphere from the vapour. I may
here observe that these applications occasion no injury whatever to the
skin.
I have also found the _bisulphuret of carbon_, and the chlorocyanic
acid, valuable medicines in the removal of deafness, depending upon
a want of nervous energy and deficiency of wax. The mode of its
application is substantially the same as that which I employ in
diseases of the eye, with this difference only, that the bottle is
formed with a small neck and stopper adapted to the size of the orifice
of the ear, and held close to the organ until a considerable degree of
warmth is produced.
The action of these medicines, which contain so large a share of
carbon, arises from the carbon in the vapour permeating the cuticle,
and coming in contact with the oxygen in the vessels, which is conveyed
through every part of the frame by inspiration and otherwise, and
thereby forming carbonic acid gas, which evolves heat in the ratio of
the quantity consumed by the oxygen.
The following quotations from Professor Liebig, in his work on "Organic
Chemistry," sufficiently prove the correctness of this position:--"It
is only in those parts of the body to which arterial blood, and,
with it, the oxygen absorbed in respiration, is conveyed, that heat
is produced. Hair, wool, or feathers, do not possess an elevated
temperature. This high temperature of the animal body, or, as it
may be called, disengagement of heat, is uniformly, and under all
circumstances, the result of the combination of a combustible substance
with oxygen. In whatever way carbon may combine with oxygen, the act of
combination cannot take place without the disengagement of heat. We can
no longer doubt that gases of every kind, whether soluble or insoluble
in water, possess the property of permeating animal tissues, as water
penetrates unsized paper."
Does not the action of medicines containing so large a portion of
carbon, which can be brought into contact with the whole external
surface of the body, and thereby capable of being easily disengaged,
suggest a method of relieving pulmonary disease likely to be attended
with no ordinary success, by calling into greater activity the action
of the skin, and thereby materially lightening the labour of the lungs?
Are we not the more encouraged to expect such remedial influence in
diseases of the lungs, from the fact of its great power in removing
indurated glands, which are so common accompaniments of consumption?
There can be no doubt of the usefulness of bisulphuret of carbon in
skin diseases.
I have submitted these observations under the conviction that they
embody principles which may be carried out, and made of great utility
to mankind.
I am, Sir, your obedient servant,
A. TURNBULL, M.D.
48, Russell Square, Oct. 20, 1842.
A few weeks after the appearance of the above (Nov. 8, 1842), I wrote
to the Editor of the _Literary Gazette_ as follows:--
REMARKS ON THE ACTION OF CARBON, ETC.
(_To the Editor of the_ "Literary Gazette.")
48, Russell Square, Nov. 8, 1842.
SIR,--I beg leave to tender my sincerest thanks for your kind notice
in the last _Gazette_ of my recent discoveries on the treatment of
diseases of the eye, &c. Allow me to intrude for once in your crowded
columns, by referring to what you accidentally omitted--viz. the
manner of applying the _bisulphuret of carbon_, and also to add a
few reasons illustrative of the fact which you have quoted from me,
that its action depends on its union with the oxygen. The plan I
adopt is this:--I put a drachm of the bisulphuret of carbon into a
two-ounce bottle; the medicine is so volatile that the heat of the
hand causes the vapour rapidly to rise, and come into contact with the
skin. The action is more decided if the skin is previously moistened
with water; as the water not only prevents the escape of the vapour
between the glass and the skin, but also excludes the external air,
a point of the very highest importance. In my paper, which appeared
in the _Lancet_, of October 29th, I stated, that "when it had been
applied about one minute, the patient felt the part very cold, but
immediately after a gradual heat, accompanied with great prickling;
the heat increasing the longer the medicine was kept in contact with
the part, until it could no longer be endured. On removing the glass
the part was red, to an extent two or three times greater than the
part enclosed. These applications occasion no injury whatever to the
skin." Showing that the action of the bisulphuret of carbon depends on
its union with the oxygen in the blood-vessels, I will merely state
the following experiments:--Carbonic acid gas was applied in a similar
bottle, and in the same way, to the skin, the external air being
excluded, and the skin moistened with water, for the space of ten
minutes; but neither redness nor any sensible heat was induced; for
this satisfactory reason, that heat is the consequence of oxidation
with the carbon, which oxidation, in the case of carbonic acid gas,
had of course been previously effected. _Alcohol_, _sulphuric ether_,
_nitric ether_, and many other _ethers_--all of which contain a large
portion of carbon--were similarly tried, but had no effect; for the
same reason--viz. that it is already in a state of union with oxygen
in all these highly carbonized bodies.
I remain, Sir, your obedient servant,
A. TURNBULL, M.D.
CASE 1.
_Opacity of the Cornea, the sequel of Small-pox._
JOHN WRIGHT, a porter, aged 23, No. 10, Bear Yard, says that he has
been nearly blind in the right eye from small-pox, since he was two
years old. Five years since he was attacked with violent ophthalmia,
in consequence of exposure to cold. He then applied to one of our
Ophthalmic Institutions, where he remained as an out-patient for
eight months. For the first six months he had, thrice a week, caustic
applied to his left eye, after which black ointment for the remainder
of the time; but without receiving benefit. He then went to another
institution, where he remained an out-patient for seven months. The
treatment here consisted in dropping into the eye a liquid, and at
other times a powder was shaken into it, from which he derived no
benefit. He then consulted a private practitioner, who relieved him;
but, not satisfied with this, he went to another surgeon, who said
that the cause of his blindness was owing to a little squint, and he
submitted the eye to be operated upon for that purpose; but no good was
derived from this operation. None of the medical men attempted to do
anything to the right eye.
In September, when I first saw him, his left eye was very much
diminished in size, and the cornea studded with white spots; the vision
very imperfect, and constantly discharging water. The right eye was so
opaque that neither iris nor pupil was to be seen, and he could only
see the shadow of an object.
On the 23rd of January the left eye had got tolerably clear and free
from all specks, but still subject to water when exposed to the wind.
The right eye is now becoming transparent, and vision in it is
improving. He states that it will soon be the best eye.
CASE 2.
_Opacity of the Cornea from Inflammation._
ANN FITZGIBBONS, aged 13, daughter of Thos. Fitzgibbons, 11, Stratton
Mews, is a day scholar at the Blind School, Queen Square.
Her father states that in infancy she lost the left eye, owing to an
attack of inflammation. The right eye four years since became similarly
affected. She has been a patient at two Ophthalmic Institutions, where
she attended for several months without any benefit. She was brought to
me by her father on the 1st of October, 1842, who stated that for the
last four years she had been obliged to be led, and could only discern
the shadow and outline of objects, but could not distinguish them.
On examining the left eye, I found it shut, and all the humours lost.
The right eye was much diminished in size, and the cornea was very
opaque, excepting at the upper part, where a small portion of light was
admitted. The bottle containing the acid was held to the left eye as
well as to the right, to ascertain what effect would be produced. To
my surprise, in the period of a month the chambers of the eye became
partially filled with aqueous humours, to the extent of at least half
the size of a healthy eye; the pupil was small, but the patient could
not see in the slightest degree. The right eye has become almost
transparent, and she can now see with it sufficiently well to be able
to go anywhere. Indeed, her sight has become almost perfect. The change
is so great that many are disposed to question the identity of the
girl, and the father is frequently asked whether the girl is really his
own daughter, whose eyes were so disorganized.
CASE 3.
_Inflammation, ending in Opacity of the Cornea in the right eye and
Staphyloma in the left._
WILLIAM GRINDLEY, aged 37, boot-maker, formerly of 16, Whitecomb
Street, Pall Mall, East, now of St. James's Workhouse, states that he
was attacked with acute inflammation in both eyes in 1839. He at first
had the advice of private practitioners, and subsequently went to two
different Ophthalmic Hospitals. He remained in one eleven months, in
the other fifteen. It appears from his own account that his sufferings
were very great, for he asserts his eyes and eye-lids were swollen very
much. The treatment consisted in bleeding, cupping on the temples,
lancing frequently the eye and eye-lids; caustic was applied to the
eyes, and seatons to the nape of the neck; leeches. The patient had two
caustic issues in the temples; he was salivated, and had administered
to him various potent drugs.
On the 9th of August he was sent to me from the Board of St. James's
Workhouse, when he could scarcely discern light from darkness. He
said that he had been led about for the last three years. The left
eye was afflicted with staphyloma, and was perfectly opaque. The
cornea of the right eye was covered with a dense opacity, so much so
that no appearance of iris or pupil could be discerned through it.
The right was not so unnaturally prominent as was the left eye. The
vapour in this case was daily applied, and the progress of cure was so
rapid, that in the course of a month he was able to come to me from
St. James's without his accustomed guide. At Christmas he obtained
permission from the Board to be absent for a few days for the purpose
of visiting his wife and children. It was his wish to see the faces
of those near and dear to him; for in his former visits he could only
hear them talk, for not one glimpse of their countenances was he able
to obtain. The cornea of the right eye is rapidly becoming transparent.
The convexity of the left eye is still considerable, but the opacity is
so far removed as to give evidence that a continuation of the medicine
will render it again perfect, although it must take a considerable time
to effect so desirable an object.
CASE 4.
_Two cases of ---- Ophthalmia, ending in Opacity of the Cornea._
SARAH HOPPING, aged 15, daughter of Thomas Hopping, boot-maker, 20,
King Street, Drury Lane, and of the Blind School, Queen's Square, about
nine years ago had a violent attack of inflammation in both eyes. She
was taken to an infirmary, and remained there for many months, where
she became perfectly blind. She was afterwards taken to two Ophthalmic
Hospitals as an out-patient--one for six months, another three. The
treatment generally was lancing the inner eye-lids, and applying
caustic to both the eyes and temples, leeching and blistering both the
neck and temples often. The left eye was altogether opaque, and did not
show the least appearance of either iris or pupil when looking at it in
a strong light. The right eye appeared quite lost, for there was only
in the socket a small red tumour, about the size of a pea.
The vapour was applied, and at the present time the opacity is so far
gone that she can see to walk alone; but there yet remains much to be
removed.
Her sister Elizabeth, aged 12, was similarly affected, but the disease
had not attained to the same height. She is now almost well.
CASE 5.
_Case of Ophthalmia, terminating in an Opacity of the Cornea._
JOHN GADD, aged 31, of 16, Little Britain, bookbinder, states that
he has been blind and unable to guide himself for upwards of twelve
months, but for some months previously he felt himself gradually losing
the sight of his right eye. He went to an Ophthalmic Institution, and
in two or three days he was seized with a violent attack of ophthalmia,
which he attributed to the applications used for his recovery. He did
not know the nature of the ointment inserted in his eyes, but was
told it was black ointment. In ten days he visited another Ophthalmic
Institution, where he remained for two months. In this institution a
liquid was dropped into his eye, leeches were applied every night for
a week, issues were inserted in the temples, carbonate of iron was
administered for six weeks, and counter-irritants were applied to the
neck.
From this time he became quite blind. He then went to another
Ophthalmic Institution, where he was cupped in the temples; the eyes
were scarified, aperient medicines were given, and lotions used. The
inflammation still continued, and he was unable to lift his head, or
allow the bandages to be taken off his forehead, without experiencing
the most excruciating pain.
In this state he was brought to me on the 9th of September, 1840, when
I ordered for each eye two drops of the oil of almonds (after being
warmed) to be put into the eyes. The relief that he experienced was
so great, that he said he felt as if he were in another world. In
eight days the pain had greatly diminished. He was enabled to open
his eye-lids, but could discern no object whatever. I then ordered
castor oil to be dropped into each eye, for the purpose of removing the
opacity. He left me at the end of December, at which time he could see
very imperfectly; but returned to me in January, 1843, when the opacity
of the cornea still continued. He has had, almost daily, the prussic
acid vapour applied to his eye. He is at the present time so well that
he can read the smallest diamond print.
CASE 6.
_Opacity of the Cornea and Staphyloma._
GEORGINIA LARKINS, aged 10, at No. 25, Grafton Street, Newport Market,
and at the Blind School, Queen Square. Her aunt states that this
patient has been blind since she was six days old, in consequence
of an attack of inflammation, which gave rise to a great discharge
from the eyes. In her infancy fluids of various kinds were injected
underneath the eye-lids, and when four months old she was taken for
three years regularly to an Ophthalmic Hospital, where she was told
that the right eye was destroyed. The left eye had caustic applied
to it for a length of time thrice a week. Ointment was then applied
underneath the eye-lids until the eye became so very large that she
was at last told that it was a hopeless case, and that no more could
be done for her. Her next visit was to an eminent oculist, who said
he would not undertake the treatment of such a case. She then went to
another Ophthalmic Institution, where she remained for about two years
without deriving any improvement in her sight; but she was relieved
from much pain.
I saw her first on the 6th of April, 1840, when the appearance of the
left eye seemed to be at least twice the size of a natural eye. It
was of a dark-blue colour, standing out beyond the lids; and where the
pupil ought to have been, there was a blue circular ring of lighter hue
than the rest of the eye, and in the centre of this ring was a white
body about the size of a pea.
The right eye was quite a contrast, for it appeared perfectly white,
without the slightest appearance of iris or pupil. The eyes were
continually rolling about in their sockets. Looking at the little
creature, I said, "What do you expect me to do in such a fearful case?"
Without waiting for a reply, I said, "I will endeavour to diminish the
size of the eye, but unquestionably no hope can be held out that I can
restore the use of sight."
I at first put, daily, a drop of castor oil into each eye, occasionally
substituting for the castor oil the oil of almonds. This treatment
in about two months diminished much the size of both eyes, and the
opacity of the right eye greatly decreased; so much so that a little
edge of the pupil became visible, and the child began to see, and in
four months she could walk alone. Shortly afterwards the pupil could
be distinctly seen, and there appeared a white speck upon the anterior
capsule of the lens. She ceased to be a patient of mine in December,
1840, but returned in January, 1842, when the prussic acid was daily
applied to both eyes. The left eye is diminished about one-half in
size, and light is becoming perceptible. The right has assumed a
healthy appearance; the cornea is transparent, and there is still a
spot upon the capsule, about the size of the eighth part of the pupil.
This does not appear to impede the vision. She can now read, with the
eye, the raised letters with great quickness. She was formerly taught
to read the letters with her fingers; she is also learning to read
common print.
When the child came to me I had not had sufficient experience of the
effects of the prussic acid vapour, and I hesitated in using a remedy
of such acknowledged potency until I had, with great care, thoroughly
investigated its properties. This I have been engaged in doing for
several years, and I am now able to state, that in no case in which I
have used it has it been attended with any injurious effects either to
the eye or general health.
CASE 7.
_Staphyloma of both Eyes._
MARY ANN GOODMAN, aged 22, of St. Giles's Workhouse, and a scholar at
the Blind School, Queen Square, fourteen years ago was attacked with
violent inflammation of both eyes. To remove this she was subjected
to very active antiphlogistic treatment. The inflammatory symptoms
subsided, after which she was regularly led for five years to an
Ophthalmic Institution, at which place the right eye was operated upon
five times; in addition to which she was cupped three times and bled
from the arm twice; caustic was applied frequently to the inside of
the eye-lids; she was also blistered behind the ear and nape of the
neck. The patient was unable to walk about without assistance; if she
attempted to do so, she was knocked and jostled about.
On the 4th of March her friends brought her to me, to ascertain whether
I could do anything for her. I could not hold out to her any great hope
of recovery; for both eyes were affected with staphyloma, and perfectly
opaque and studded with blue spots, and standing prominently out beyond
the lids, and having no appearance of iris or pupil in either eye.
In the space of a fortnight the eye assumed a very different
appearance; each eye became greatly diminished in size. As the opacity
cleared off, a large triangular pupil made its appearance at the bottom
of the iris in the right eye, enabling her to see with the eye with
which, for fourteen years, she had not been able to discern light from
darkness.
The progress of cure in the left eye is fully equal to that of the
right; so that now she is able to walk about in the crowded streets
with safety, and is intrusted to lead about two or three other persons
in the Blind School. She can distinguish colours, and is able to
perceive large letters.
In such a state of disorganization as this poor girl's eyes were in, it
is unreasonable to anticipate that she can make much greater progress.
CASE 8.
_Inverted Eye-lashes, with Opacity of the Cornea._
DIANA PRIMROSE, aged 32, of No. 2, Benborough Street, St. Giles's, says
she had a violent attack, eight years back, of ophthalmia in both eyes,
accompanied with great swelling and constant discharge of matter from
the eye-lids, arising from the eye-lashes of both eyes being turned in.
She was an out-patient to one of the Ophthalmic Hospitals for two
years, but, instead of getting better, she became worse. She then
applied to another Ophthalmic Institution, where she was subjected to
treatment for four months, but no improvement took place. Three years
ago her sufferings prompted her to visit a third institution, when one
of the surgeons cut off the upper eyelid of the left eye, which gave
rise to great pain and inflammation, but the opacity was not diminished
nor the vision improved. She was obliged, during the eight years, to
have her eye-lashes constantly pulled out.
She visited me on the 28th of October, 1842, when the eye-lashes of
the right eye, both above and below, were still turned in, and rubbing
against the cornea. The eye-lids were exceedingly red; the cornea of
both eyes was nearly opaque, and only a small portion of the pupil
could be observed through the opacity. Her vision was so imperfect
that she could do little more than find her way about. She was often
confined to the house for a week at a time, through inflammation.
The vapour was only applied for the space of a week, after which she
could see much better. The opacity was greatly diminished, and the
eye-lashes began to resume their proper position. She continues to use
the prussic acid vapour three or four times a week, and at the present
time she is able to follow her occupations with comfort, and the eye
is resuming all the appearance of health. She never has had occasion
to pull one eye-lash out since I first saw her. She is now very
comfortable, and can see tolerably well.
This is the first case of the kind that I have treated with prussic
acid.
CASE 9.
_Conical Eye._
WILLIAM STEVENS, aged 25, at No. 20, Gracechurch Street, states that he
had been for several months at two different Ophthalmic Institutions,
where many modes of treatment were adopted to improve his vision; but
he was at length told they could do him no good, as the disease under
which he laboured was conical eyes.
When I examined him, in May, 1840, I found the right eye so prominent
that it had the appearance as if a large transparent bead had grown
from the cornea. With this eye he could see a short distance. The
conical state was not only greater in the left eye, but there was an
opacity on the apex of the cornea. He could see nothing with it, if the
right eye were shut, unless the objects of vision came in contact with
his face. He continued to visit me, professionally, two or three times
a week, for four months, and had a drop or two of castor oil put into
both eyes each time. This treatment greatly diminished the prominency
of the right eye, and lengthened the vision; but the left eye was only
slightly benefited by it, although all opacity had been removed, and it
had diminished in size.
In December last he again called upon me and wished to know if more
could not be done for him? He said he had continued to follow his
business with the use of concave glasses, but saw with great difficulty.
The vapour was employed thrice a week for about three weeks, when
his vision was restored to its natural length. I saw him on the 21st
of January, and he said he was perfectly well, and could follow his
business with great pleasure to himself.
CASE 10.
_Amaurosis of the Left Eye, and Cataract of the Right._
GEORGE TROUSDALE, aged 37, horse-keeper, 37, William Street, Hampstead
Road, says, that when he was 8 years of age, a shoemaker's awl was
accidentally pushed through the right eyelid into the eye, which gave
rise to an attack of severe inflammation in both eyes. When the
inflammation subsided he found the vision of the right eye entirely
gone. The left eye became dim in May last, and his sight was much
disturbed by floating clouds passing before the eye. When he looked
steadily at an object the vision almost vanished. He experienced great
pain in the forehead and temple on the same side.
He applied to an infirmary, where he remained as an out-patient for six
weeks. He was salivated, cupped, and leeched. He was then told that the
right eye was of no use, and they feared the vision of the left also
was destroyed.
He then went to an Ophthalmic Institution, where he remained as an
out-patient for seven weeks. He was again salivated; a liquid was
dropped into his eye regularly, and he was blistered, but no good
resulted.
He then went to a private oculist, under whose care he remained for
six weeks. He again was salivated; but still the sight became more
obscured, and the pains in his forehead and temple more acute.
I saw him first in October; he was then suffering from severe pain
in the forehead and temple. The left eye was so blind that he could
not distinguish, even when placed close beside it, a large bookcase.
He said he could scarcely guide himself in the street. The pupil was
almost immoveable. There was a white cataract in the right eye, and a
total want of vision.
He has had the vapour of the prussic acid applied to both eyes almost
daily since October. He can now, with the left eye, read ordinary-size
print, and is free from all pain. Nearly the upper half of the cataract
of the right eye is absorbed, and he is beginning to see with it. This
case shows the power of the acid in not only producing absorption, but
in the removal of amaurosis at the same time. Unless the capsule of the
lens had been lacerated by the awl, I do not think that the acid could
have had any power in causing absorption in a case of cataract which
had existed for the long period of twenty-eight years. He is still
under treatment.
CASE 11.
_Cataract._
MR. MONRO, aged 28, at No. 16, Featherstone Buildings, twelve years
ago, had violent inflammation, occasioned by the lash of a whip
striking the left eye, from which time he has been unable to see more
than the shadow of an object. He says that many have advised him to
submit to an operation for cataract, but others have recommended him
not to do so as long as one eye remained sound.
On the 16th of May, when he applied to me, I tried, as an experiment,
the vapour of the prussic acid, which was employed for about three
months. At the end of that time he could see different objects, and
discern countenances, when the other eye was closed.
Afterwards he went into the country, where he remained without using
any medicine. On his return to town, on the 18th of January, 1843 he
called upon me, when I found the eye was not improved in appearance.
He is now again under my care, and has had the vapour applied five
times. It appears to produce a very decided effect upon the vision. In
three or four parts the cataract appears as if it had been operated
upon with a couching needle.
This is a case of great interest, and it is impossible for any
unprejudiced person to doubt the great absorbent powers of prussic acid
in many diseases of the eye; but I am certain it will not be a general
remedy for lenticular cataract (unless employed in its incipient state)
without operation, unless aided by rupturing the capsule of the lens by
the needle first. Many are the cases where we want such a solvent power
after operations.
CASE 12.
_Amaurosis._
ANN WEEKS, of No. 19, Little Queen Street, aged 14, daughter of Thomas
Weeks, carman, 52, Great Wilde Street, has been blind in her right eye
since she was two years old. The left eye is unaffected. When two years
of age she was taken to an Ophthalmic Hospital, where various modes of
treatment were adopted for the recovery of the eye, until the month of
March, 1842, when she went to another Ophthalmic Hospital, where she
attended for six months, but received no benefit.
On the 16th of June the Rev. Peter Hall, of Long Acre Chapel, brought
her to me; and when examined in a strong light, with her face towards
the window, we could not perceive the slightest action of the pupil.
Mr. Hall and I tried her with a sheet of white paper, moving it before
her eyes several times, but she was perfectly unconscious of it. After
the eye was exposed to the vapour of prussic acid for a short time the
pupil acted slightly when exposed to light; and she was able, not only
to see the paper, but to take hold of it with her hand, and could walk
round the table when the left eye was shut. She continued the vapour
four or five times weekly for the space of six weeks.
When she left me the eye was so far recovered as to answer all ordinary
purposes of vision, although not quite equal to the other.
I have examined her to-day (Jan. 20, 1843), and find the improvement
continues.
CASE 13.
_Amaurosis._
FRANCES READ, aged 14, daughter of ---- Read, 71, Fetter Lane, and one
of the scholars at the Blind School, Queen Square. Her mother said that
she took her daughter to an Ophthalmic Institution until she was tired.
No good was effected. The parents of this case were unable to say when
the blindness first developed itself. She has always been able to see a
little with the right eye.
I was first consulted in this case in July, 1842, when the right eye
appeared to have some vision. The pupil acted under a strong light,
but very sluggishly. She could observe objects very indistinctly with
the left eye.
The prussic acid was employed almost daily, for three months, to both
eyes. The right eye recovered so that she can now thread her needle.
She is also learning to read.
Upon the pupil of the left eye the prussic acid does not appear to have
the least effect.
As a general rule, I have found that when prussic acid does not dilate
the eye, in amaurosis, much good is not to be expected from its use.
In such cases I am inclined to believe that the disease is caused by
pressure upon the optic nerve.
It is my intention to persevere in the application of the vapour to the
left eye, with the view of ascertaining whether the sight may not be
restored. I do not despair of success.
CASE 14.
_Congenital Amaurosis._
GEORGE PRITCHARD, aged 7 years, son of Edward Pritchard, cab-driver,
Black Bull Yard, Gray's Inn Lane, and one of the scholars at the Blind
School, Queen Square.
This patient has been totally blind from birth. His case has been
examined by almost all the eminent oculists of London, and has been
taken to several hospitals; but all the medical men, without one
exception, stated that they would not prescribe for him, as they could
do nothing for him.
He was brought to me in May, 1840, at which time the eye appeared more
than half sunk in each orbit, and the pupil, when exposed to the action
of strong light, was fixed and immoveable. In fact, he had not the
slightest perception of light.
Two drops of castor oil were put into his eye daily, for the space of
three months, before the pupil manifested a disposition to act. At
each successive month there was a visible change in the size of the
eye. When he left me, in Dec., 1840, he was not able to discern more
than light from darkness.
He has visited me since the month of April, 1842, and has had, once
or twice a week, the vapour of the prussic acid applied to his eye.
He is now so improved that he is beginning to distinguish one object
from another, and the eye is assuming a healthy appearance. From
the progress that this boy has made the last two months, I think it
probable that the medicine may ultimately effect much greater good.
The following letter was forwarded to me by H. Newnham, Esq., for the
purpose of publication:--
"January 24th, 1843.
"MY DEAR SIR,--Having, by the vapour of prussic acid, been nearly
cured by yourself of an opacity of the cornea, which, for twenty years
past, had rendered the sight of my left eye of little worth more than
to distinguish light from darkness; and firmly believing that, when
I shall be able to replace myself under your care, my sight will be
perfectly restored; and having also, during my attendance at your
house, witnessed the beneficial effects of this remedy on many other
persons, the subjects of cataract, amaurosis, staphyloma, &c., I
earnestly beg you will accept this testimony of my high opinion of its
efficacy in these cases.
"I am yours gratefully,
"WILLIAM H. NEWNHAM, Surgeon, &c.
"Late of Alton, Hants."
"To A. Turnbull Esq., 48, Russell Square."
Extract from a letter of Professor Forbes, of King's College, Aberdeen,
Jan. 23rd, 1843:--
"I seized the first hour which I could command after receiving your
note to call on Milne, that I might see in what state he was, as I
had not heard of him for some time. I was also desirous of having the
particulars of his case accurately from himself.
"John Milne was a cooper, and in that capacity had gone with the
whale-ships to Davis's Straits and Greenland for sixteen years.
"In July, 1836, he was seized with a violent inflammation in one of
his eyes, which soon extended to the other. After two years he became
so blind that he could not walk with safety in the streets, and after
meeting with a severe accident from his want of sight, he gave up
attempting to walk out alone.
"He continued for more than two years in this state, always becoming
worse and worse in his sight. His eye-balls were covered with ulcers;
he suffered extreme pain, except when lying in bed with the room quite
darkened; and was at various times confined for six weeks without
being able to bear the admission of light into his room. During the
whole of this long period he was under medical treatment by different
surgeons without deriving any benefit, but, on the contrary, his case
seemed to become daily more hopeless. The only relief, indeed, which he
experienced was, he says, from the division of the blood-vessels, from
time to time, with which the eye-ball was covered.
"In these circumstances he was brought to you by a surgeon who had
attended him, and began, under your direction, the application of the
prussic acid vapour. This gave him immediate relief, and in six weeks
the whole ulcers had disappeared, light was no longer troublesome to
him, and he saw quite well to go about his business and to read.
"This was his state in autumn, 1841, at which time I first saw him, and
he continues equally well down to the present date. A slight opacity
in the cornea of both eyes still remains, and he cannot expose himself
to the blaze of a very bright day or to violent winds for a length
of time without experiencing a return of uneasiness. He is, however,
quite positive, that had he continued under your care for a sufficient
period, he would have quite recovered; and he has been planning a
voyage to London to have your additional advice. I discovered, however,
from him, that he has never got _the prussic acid of sufficient
strength_ since you left this; for it has never had the power of
bringing on the state of the eye which the strong acid did, and which
he found to be attended with so good effects. I have taken means to
get the acid prepared for him of the right strength, and hope that its
application will be as efficacious as he so confidently expects.
"N.B.--The patient Milne was brought to me by George Rainy, Esq.,
Surgeon to the Aberdeen Ophthalmic Institution."
Extracted from the _Lancet_ of December 31st, 1842:--
"PRUSSIC ACID VAPOUR.--Mr. J. C. Atkinson, of Romney Terrace,
Westminster, in a letter to the Editor, dated December 26th, after a
few prefatory remarks, writes on this subject as follows:--A patient,
aged 28, who had rather a severe attack of variola last May, became,
after the recovery, subjected to staphyloma, one of the sequelæ of that
formidable complaint. In this he was treated according to the approved
methods, both at two public institutions and by private practitioners,
for some months, without any apparent advantage, when I was applied
to; I instantly determined on a trial of the prussic acid vapour,
having read in your able journal an account of this new remedy some
time before. After fourteen applications the opaqueness and prominence
abated considerably, and the eye is now very serviceable, and nearly as
useful as the sound one, no inflammation or appearance of irritation
being observable. The plan adopted by me was most simple: the affected
eye, open, was placed over a two-ounce phial, containing about half an
ounce of the acid, while the patient's hand, properly directed, was to
retain it in the position that was thought necessary. The time occupied
in this operation was from five minutes to a quarter of an hour. The
eye became in a short time inflamed, the conjunctiva exhibiting the
appearance of deep injection, which gradually disappeared in a few
hours, but which was not accompanied by any pain. No paralysis of any
of the appendages of the eye has resulted from the application. Such is
the outline of the case. I feel assured that this remedy will prove a
powerful auxiliary in the hands of a surgeon-oculist."