vapour of prussic acid was employed for the cure of Ophthalmic disease,
by Donald J. Maclean, M.D., Lic. Roy. Col. Surg. in Edinburgh.
"I have been induced, for my own satisfaction, (in consequence of some
observations made by Sir George Sinclair, who had witnessed its effects
on patients under Dr. Turnbull's care), to give a very extended trial
to the prussic acid in cases of ophthalmic disease which might be
considered suitable for its application, and desire that the results
of some of the cases should be submitted to the consideration of those
of our profession who may take an interest in the subject I have,
therefore, made out a report of the following cases. In our present
state of knowledge it is impossible to explain the _modus operandi_
of the prussic acid; it will be sufficient, meantime, to observe
accurately, and merely give the results of treatment. In what kind of
cases it will be found most suitable can only be determined by further
inquiry and experience. If, however, the results prove permanent, the
prussic acid must occupy a very high place amongst our remedial agents;
and, possessing stimulant properties of a peculiar character, it may
prove useful under many circumstances where diseases of the eye are not
readily amenable to ordinary treatment.
"CASE 1.
"J. MACKAY REAY, aged 11 years. Diffused opacity of the cornea, the
result of a protracted attack of scrofulous ophthalmia. The vapour
of strong prussic acid was applied, daily, for thirteen days, by
exposure of the eye to it, during which period the cornea gradually
got transparent. On the fourteenth day no remains of former opacity
existed, and the vision of that eye was perfectly restored.
"CASE 2.
"MARGARET MACKAY, Thurso, aged 12 years. Severe rheumatic ophthalmia,
of three weeks' duration. She complains of deep-seated aching pain in
the eye-ball, greatly aggravated in the evening and through the night;
no apparent disorder of the general health. The ordinary remedies were
used, viz., leeching, blisters, calomel, and colchicum: they appeared
to give no relief. The prussic acid was applied, daily, for about ten
days; the relief following each application was extraordinary; the pain
was trifling for the rest of the day. At the expiration of twelve days
the intolerance of light, the injected state of the vessels on the
sclerotica, and the other symptoms, entirely disappeared; and since
September the little patient has continued quite free from any symptom
of her former ailment.
"CASE 3.
"A girl, named MUNRO, from Mount Pleasant. Albugo of corneæ in both
eyes, the result of an attack of acute conjunctival ophthalmia,
which she had about two years ago, whilst residing in Dundee, where
various means were tried for her relief. Vision was almost completely
destroyed; she could not distinguish the outlines, form, or colours,
of objects presented to her. At her own urgent request, but without
holding out any prospect of her being benefited by it, the prussic acid
was applied, daily, for about six weeks.
"11th day.--She states that she can see some objects. The corneæ appear
more transparent. At the end of another week she was able (in the
presence of Sir George Sinclair) to state the names of some objects,
and to recognise, with accuracy, the colours of a variety of flowers
which were presented to her in order to test the degree of progress
that had been made. She can now walk out and home to her own residence
(a distance of a mile and a half from Thurso) without assistance.
The improvement continues to be progressive, and the corneæ are now
comparatively translucent.
"CASE 4.
"SINCLAIR SUTHERLAND, a labourer, aged 26 years. Staphyloma of one eye,
and occlusion of pupil in the other, from effused lymph. In the centre
of this there was a small opening which would admit the point of a fine
needle. The prussic acid was applied, daily, for about three months.
Felt great relief in the staphylomatous eye since its application; the
prominence of cornea diminished at least one-half, and though formerly
opaque, from repeated attacks of inflammation and ulceration, it is, at
this date, quite translucent. The effusion of lymph in the other pupil
has been disappearing gradually, and the pupil is now about four lines
in diameter. The patient is quite sensible of the improvement taking
place, and can now name various objects presented to him.
"CASE 5.
"MR. ALEXANDER MACDONALD, jun., merchant, Thurso, has suffered for the
last six months from an affection of the retina, characterised by the
following symptoms, viz., obscurity of vision, excessive intolerance
of light, and deep-seated pain in the orbit. The external appearance
of the eye is quite healthy, and the motions of the iris are natural;
ascribable, he says, to too great application to business, and night
reading: and, in many respects, the symptoms resemble those of
inflammation of the retina. The ordinary treatment of this affection
was resorted to with some benefit, and the eye kept constantly shaded;
but the deep-seated pain continued, and the patient was getting
uneasy. The prussic acid was applied, daily, for about six weeks. The
relief obtained was great, and at the expiration of one month all the
former distressing symptoms had totally disappeared; but I thought it
advisable to continue the remedy for some time longer. The patient can
bear a strong light with impunity, and exert his eyes on any object,
however minute, without uneasiness, and is now quite well.
"CASE 6.
"MRS. M'KENZIE. Capsular cataract of one eye, of three or four years'
duration. By way of experiment, the prussic acid was applied for about
five weeks, daily. Absorption of the diseased structure was slowly
taking place all this time; it has now entirely disappeared, and
vision of this eye is quite restored. The result in this case was very
satisfactory.
"CASE 7.
"MRS. M'BEATH. Suffered for many years past from a disease combining
the characters of conjunctival and sclerotic ophthalmia. The prussic
acid was applied, daily, for about three weeks, and at the expiration
of that time the redness and angry appearance of the eye disappeared;
the organ looked clear and healthy, and no pain whatever was felt. The
patient can bear a bright light without uneasiness, and is now free
from any symptom of her former ailment.
"Thurso, Caithness, Dec. 20, 1842."
Extracted from the _London Medical Gazette_, of January 13th, 1843:--
PRUSSIC ACID IN DISEASED CORNEA.
"_To the Editor of the Medical Gazette._
"Perth, December 31st, 1842.
"SIR,--If you deem the following case of diseased cornea, &c., worthy
of a place in the _Medical Gazette_, I shall feel myself obliged,
while I have the honour to be, &c. &c.,
"G. K. H. PATERSON,
"Surgeon."
"CASE.--M. J., æt. 29, of a strumous diathesis, has been repeatedly
attacked with inflammation in both eyes alternately, accompanied with
more or less intolerance of light, and pain of head, ever since she had
small-pox, about her ninth year: to relieve this her friends sought
various means, but without any avail, and on entering her eighteenth
year she became blind. The catamenia had never appeared before she
was twenty; and from that period onwards, till about four years ago,
menstruation had always been scanty, and attended with the usual
symptoms of dysmenorrhœa.
"On the 28th September, 1842, her eyes presented the following
state:--The right cornea transparent, with an unusual quantity
apparently of aqueous humour on the anterior chamber, so as to give
it externally a somewhat conical aspect; iris of a dark red colour,
and its pupillary edge contracted to the size of a pin-hole, and in
close contact with the capsule of the lens. No vision in this eye
remaining. That of the left cornea was all but opaque, from coagulated
lymph between its layers, with the exception of a small lucid segment,
at the upper and outer margin of its circumference; behind which, on
the eye being turned downward and inward, the pupil could be seen
contracted also, and of an oblong shape, along with a great increase of
aqueous humour in the anterior chamber, and the cornea, to external
appearance, much more bulged forward than that of the right. With this
eye she could only distinguish an object when it was rolled downward
and toward the inner canthus, on being passed between her and the light.
"This ill-fated woman being altogether an object of charity, her
friends solicited me to take up her case, of which I was not at all
sanguine. However, having previously perused, with much pleasure,
a brief extract by Dr. Turnbull, on the fumes of prussic acid as a
valuable remedy in certain diseases of the eye, I was led to make trial
of a few applications of it in the above case, according to his method;
and I must candidly confess, that ere long I was completely astonished
on observing the rapid effect it produced on the opaque cornea before
mentioned; more so, as the longer I cautiously and perseveringly
used it, the greater in proportion did the inspissated lymph become
absorbed, and the layers of the cornea, over a wide space, begin to
assume their natural transparency, as also in dilating the pupil to
a considerable extent; so much, indeed, that before one month under
its use, she could observe objects in a very different light, and ere
another had elapsed, she could find her way out of doors by herself,
and come to my residence for any medicine she required; since which
she has gone on gradually to progress favourably, without any more
applications, and the vision is now sufficient to enable her to go
about free from the dread she had before, or the use of a guide.
"During the use of this potent remedy, it struck me very forcibly that
the extract of belladonna might assist the case considerably (more
especially when one had reasons for suspecting adhesions to exist),
in keeping up a greater effect on the pupil than that arising from
the use of the acid, which every one will admit at once, who has seen
its powers depicted upon the human eye, to be only temporary, and,
I believe, still less so in disease of the cornea and iris than in
any other incident to such an organ. With such an object in view, and
after once applying the extract, smeared round the eye, at bed-time, I
soon found it to be also of considerable service, along with the daily
use of the fumes of the acid, which were both, afterwards, employed
assiduously in this manner, for the rest of the treatment.
"But in drawing my remarks to a close at this time, I cannot refrain
from saying less, in regard to the utility which is likely to arise
from this medicine, when properly applied, than that, in such a
similar case as I have stated, I would not for a moment hesitate
again in giving it and the extract of belladonna a fair trial, so
convinced am I now, after employing it pretty freely by itself, in
different affections of the same organ (in all of which more or less
improvement of vision was manifested), of its potency to remove many
of those formidable diseases of the eye, more especially that of the
cornea, which are so often the opprobium of our art. However, before
I have done, it is but justice to ascribe this noble discovery to Dr.
Turnbull, whose indefatigable research has not failed to find out
others, no less wonderful in their effects, as they are useful to
mankind; and for such he cannot but claim to himself the best thanks of
the profession at large."
CHAPTER II.
ON THE ACTION OF ESSENTIAL OILS, &C.
In October, 1835, a paper of mine appeared in the _London Medical and
Surgical Journal_, stating the beneficial action of a concentrated
tincture of capsicum for diseases of the eye, by rubbing it for a few
minutes daily over the forehead and temples with a sponge.
Soon after this I was induced to try what effect essential oils,
possessing powerful stimulating properties, might possess in removing
amaurosis and diseases generally of the eye. The formulæ which I use
are--
EMBRO. CARYOPH. CO.
℞--Ol. Caryoph.
-- Lavand _āā_ Ʒiv.
-- Cinnamom. Ʒss.
Sp. Vin. Rect. ℥iij.
M. Ft. Embro.
EMBRO. PIMENT. CO.
℞--Ol. Piment.
-- Rosmar. _āā_ ℥ss.
-- Cinnamom. Ʒss.
Sp. Vin. R. ℥iij.
M. Ft. Embro.
Finding great utility to arise from the use of the cloves and pimento,
it appeared by no means undesirable or hopeless to administer them
internally for the same complaints. In order to shield the pungency
of these oils I united them with calcined magnesia, which, by its
very strong affinity with these essential oils, forms a body nearly
solid, and thereby removes all pungency, warmth, and even smell; for,
in this state, it requires to be held in the mouth for a considerable
time before it produces any warmth or pungency. They are thus rendered
easily taken, in sufficient quantity, without heat or uneasiness.
Some children are the subjects of many diseases of the eye, producing
blindness from opacities, &c. I ordered the same to be made into a
powder, in which form it can be taken easily in any vehicle, without
exciting disagreeable warmth. The formulæ are--
PIL. CARYOPH. C.
℞--Ol. Caryoph.
Magnes. Cal. _āā_ Ʒi.
Ol. Cinnamom. qtt. vi.
M. Ft. Pil. xxiv.
PIL. PIMENT. CO.
℞--Ol. Piment.
Magnes. Cal. _āā_ Ʒi.
Ol. Cinnamom. qtt. vi.
M. Ft. Pil. xxiv.
The dose of these pills is one or two thrice a day.
Expedition is required in the making of these pills, otherwise it
becomes a solid mass, and unable to be formed into pills.
I have found an alcoholic extract of cloves and pimento, made into
pills with magnesia, equally efficacious.
PULV. CARYOPH. C.
℞--Ol. Caryoph.
Magnes. Calc. _āā_ ℥i.
Ol. Cinnamom. Ʒi.
M. Ft. Pulv.
PULV. PIMENT. CO.
℞--Ol. Piment.
Magnes. Calc. _āā_ ℥i
Ol. Cinnamom. Ʒi
M. Ft. Pulv.
The dose of these powders is from four to eight grains thrice a day.
In the making of these powders, the oil and the magnesia ought to be
well mixed and allowed to remain for half-an-hour, then reduce the mass
to fine powder, and keep it in glass bottles with stoppers.
These medicines, by their local application, increase the circulation,
and give a greater supply of blood to the deficient organs, and thereby
produce natural tone and power. They are equally useful in removing
chronic diseases, where thickening and opacity have taken place, by
rousing into activity the absorbent and nervous influence by their
stimulating power. Among many others possessing the same power, is a
concentrated tincture of pepper nigrum, ginger, &c.
The internal administration has been found much more serviceable in
chronic diseases of the eye, such as opacities, &c., than in amaurosis.
The manner of using the embrocations is, by rubbing the forehead and
temples with a sponge saturated with the liquid. This plan alone, kept
up daily, is beneficial; but the efficacy is more than doubled if
another sponge, with warm or cold water, is rubbed upon the forehead
for a minute afterwards. By this the energy of the medicines in
inducing a free circulation is greatly augmented, and greater warmth
is rapidly developed. The rationale, in my opinion, is, that the large
quantity of carbon in some of the essential oils, and its solubility
in alcohol, permits it, by the friction, to pass through the cuticle
and unite with the oxygen. As the oils are very insoluble in water, and
as the alcohol has a strong affinity for the water, the carbon is more
readily disengaged, and forms a union with the oxygen in the vessels,
and thereby produces heat and great activity of circulation. I have no
doubt that that is the reason why many bodies are so pungent, when put
into the mouth. I have only given two cases--viz., John Plunkett and
William Dale--as illustrative of the action of the essential oils.
It will be seen in the following extract from Tyrrell on the Eye,
"Functional amaurosis arises from a deficient supply of red blood." He
says--
"In these cases there always exists, I believe, a want of general
power and vigour of circulation at first; but in some instances of
long-continued affection of this kind, the local circulation never
regains its proper force and fulness; and the supply of blood is
inadequate to support the functions of the part, although the general
system recovers its natural tone and power."
I think this statement very correct, and therefore the embrocations
producing so much additional circulation, point out at once the
essential oils, along with the water, as its proper remedy. I here
quote Magendie, who corroborates the plan which I adopt--viz., the
medicines being most useful when applied to the forehead and temples in
amaurosis:--
EXTRACTS.
"Lectures on the Physiology of the Nervous System, delivered in 1836,
in the College of France, by Majendie."--_Lancet, April 29th, 1837,
page 186._
"The integrity of both the optic and the fifth nerves, then, is
indispensably necessary for the exercise of vision, which is lost
whenever either of these nerves is separately destroyed."
_Lancet, May 20th, 1837, page 279._
"Nervous pains of long duration and the greatest intensity have been
quickly removed by topical applications to the temporal region."
_Lancet, page 280._
"Amaurosis cannot be considered as a simple affection of the optic
nerve; at least, in the actual state of the science, it is generally
impossible to say that the fifth nerve has no connexion with the
loss of sight, and in many cases the connexity is evident. Hence
a rule which I invariably follow of addressing my remedies, in the
first instance, to some of the branches of the frontal nerve; and
I have frequently had the satisfaction of observing some of these
cases of incomplete amaurosis improve sensibly under the influence of
therapeutic agents applied to the fifth pair. I would go even further
and say, whenever you have a case of incipient amaurosis, commence
by acting on this nerve, for it is at once the most expeditious and
efficient method. I cannot, however, quit this point without assuring
you that no physician is capable of treating diseases of the eye
unless fully in possession of the facts I have just had the honour
of explaining to you. These facts are daily becoming more numerous
and more convincing, and already a considerable number of our younger
practitioners, who devote themselves to the study of diseases of the
eye, are fully aware of the immense influence of the fifth pair of
nerves over the exercise of vision."
_Lancet, page 281._
"To resume, then, what I have said concerning the sense of vision and
our several experiments, allow me once more to impress you with the
idea that sight can never be exercised in a complete and perfect manner
without a certain influence of the fifth pair of nerves; destroy that
influence, and you destroy vision. This is all we know upon the matter;
for up to the present moment we have been unable to determine how far
this influence extends, or in what manner it is communicated."
_Case of Amaurosis._
JOHN PLUNKETT, Mermaid Gardens, Hackney, formerly an attorney's clerk,
visited me in May, 1837, and stated that he had been blind and obliged
to be led about by his children for the last four years. For five years
previously his sight had been gradually diminishing. He further stated
that he was much troubled with floating images before his right eye, as
well as with clouds resembling animals, strange goblins, and sometimes
with flashes of lightning, vivid red, changing into light blue. One
great peculiarity of this miserable man's case was, that when he threw
back his head there appeared a stream of blood flowing from the top
of the right eye to the centre, where it formed into a circular pool
about the size of a split pea, but ultimately it became as large as a
shilling. It often remained a considerable time, and then diminished
gradually in red streaks. This was a matter of great alarm to him. He
had been at several Ophthalmic Institutions for nine years previously
to his visiting me. He has had electricity, tartarate of antimony,
blisters, issues, stramonium, mercury (until it produced dysentery),
and almost every kind of treatment that could be suggested, tried, but
to no purpose.
When I saw him the pupil was immoveable, and the eye dull in the
anterior, and very obscure. The left eye was destroyed. He could not
discern, in a bright light, the shadow of white paper when it was moved
between him and the light.
The compound embrocation of oil of cloves was used by rubbing it upon
the forehead and temples daily, and in the space of twelve days he was
able to discern objects and could touch them. In two months he could
put his finger through a ring when held by another person. He continued
occasionally under my care for about a year, during which time the
embrocation was regularly used. He could walk alone, and the eye was
generally useful, but he was not able to read with it. He could see
objects at the distance of thirty feet.
The last month he has visited me once or twice a week, for the purpose
of having the prussic acid vapour applied to his eye, to ascertain if
the sight could be restored sufficiently to enable him to follow his
occupation as a clerk. In this case an advantage has been gained. The
patient is now able to read a little, which, previously to the use of
the prussic acid vapour, he was unable to do.
_Amaurosis._
WILLIAM DALE, boot-maker, of 14, Clarence Gardens, Regent's Park,
visited me in July, 1837. He stated, that with his right eye, for the
last year, he could only discern light from darkness; and that for
several months before he was much troubled by clouds and spots floating
before his eyes. The evening gaslight produced a continued flashing
of light from his eye. The light looked as if surrounded by all the
colours of the rainbow.
He first went to an Ophthalmic Hospital, where he was blistered on
the temple and salivated. Nux vomica produced such an effect upon him
that all his limbs were involuntarily twitched, so as to alarm them
exceedingly. He then left, and went to another institution for three
months; and at length was told that the optic nerve was injured, so
as to render a restoration of vision impossible. The left eye, when
looked into, had a dark green, muddy hue, and the pupil was exceedingly
dilated and immoveable. He was unable to distinguish an object placed
before his eyes; yet he states that he could distinguish light from
darkness.
When he applied to me I had the compound embrocation of pimento applied
occasionally to the forehead and temples, by means of a friction
sponge. During the first month he was able to discern objects and
colours. The pupil acted under the impression of light almost equal to
the good eye. It was not until this application had been used for a
year that the patient was enabled to read with the eye.
I saw the patient this day (the 25th of Jan. 1843). The eye, upon
examination, appeared to be in a healthy state. The sight was not so
good as when he left me, and after he left off the applications, but
this he attributes to the circumstance of his general health not being
good, owing to his having suffered from intermittent fever.
* * * * *