IRITIS. 



at fome points to this membrane ; and vifion is impaired, but 



not dellroyed. . . , . . i „ . 



Sometimes the inflammation of the ms extends to othe> 

 When the cornea is attacked, it be- 

 d the iris projefting, the 



textures of the eye. 



comes cloudy and thickened; and '\'''' T^ fJZ 

 two inflamed textures come into contaft, and adhere befo e 

 any vif.ble effuf.on of lymph takes place Should the in- 

 fla^mmation fpread more deeply, and attack the membranes 

 f the lens, and of the vitreous humour, the choroid coat, 



purates, burlls, and almoll entirely difappears. 



In the Syphi/inc Iri/is, a pale rednefs all round tjie comea 

 is the tirft fy mptom which is perceived. It is at firft feated 

 in the felerotic coat alone ; but the conjunftiva very foon 

 Ihares in it, and afterwards becomes even redder than the 

 preceding membrane. However few the veffels may be elfe- 

 fvhere, there is always a broad zone of them all round the 

 cornea, a zone formed at this place, not only by the vafcular 

 net-work in the conjunftiva, but by the ciliary veffels on 

 the external furface of the fclerotica. The rednefs has a 

 peculiar tint ; for inftead of being bright red, it is brownidi, 

 fomething like the colour of cinnamon. The whole cornea 

 Becomes uniformly hazy. The pupil alfo becomes con- 

 trafted, and the iris hmited in its motions, as in common 

 iritis ; but the pupil does not preferve its natural fituation. 

 It is removed in a direftion upwards and inwards towards the 

 root of the nofe, and is irregular. At the fame time, the 

 iris lofes its natural colour, and projefts forwards. 



Towards evening, there is always an aggravation of the 

 fymptoms ; the intolerance of light and painful fenfibility 

 of the whole eye increafing, and a gulh of tears following 

 every change of light and temperature. At length, a re- 

 gular nightly pain lets in, of an extremely fevere kind, but 

 ftriftly limited to that part of the cranium which is imme- 

 diately above the eye-brow. It ufually begins between fix 

 and feven in the evening, gradually increafes, reaches its 

 utmoft height about midnight, and then diminilhes till about 

 four or five in the morning, when it ceafes. After every 

 fuch attack of pain, the pupil is found more contrafted, 

 drawn farther upwards and inwards, the iris more altered 

 both in colour and form, the quantity of lymph increafed, 

 and confequently vifion more impeded. 



Peculiar appearances then take place in the iris ; for, either 

 on its pupillary or ciliary margin, or on both, one or more 

 reddifli-brown tubercles arife, which have a fpongy look. 

 Their growth is pretty rapid. Lardy-looking ulcers fome- 

 times appear on the cornea and white of the eye, or on 

 the eye-lids. Even when fyphilitic iritis terminates in the 

 moft favourable manner, the eye for a long time afterwards 

 is pecuharly fenfible to the influence of cold and moifl:ure. 

 On every expofure to thefe, the organ becomes morbidly 

 fenfible to hght, of a reddilh colour, and difcharges tears. 

 Indeed, frequently for more than a year afterwards, on every 

 fudden change of temperature, a pale violet -coloured zone 

 appears around the cornea, but goes off" when the eye has 

 remained for fome time expofed to an equal temperature. 



In the iritis which appears in conjunftion with the erup- 

 tions fuppofed to be connefted with the abufe of mercury, 

 the inflammation feems lefs a£tive than in the other kinds. 

 The pupil is not much contrafted, and lymph is lefs apt to 

 be effufed. A veficle full of yellow matter fometimes 

 rues on the iris, without any other alteration on this mem- 

 brane than that of colour, the pupil remaining almoft un- 

 changed. By the ufe of proper remedies, this veficle, even 

 when it feems quite ready to burft, can generally be made 



to difappear in a few days, without any rupture taking 

 place. The hlood-veffels of the conjunftiva are large and 

 dillended, without being varicofe ; they have a more livid 

 colour than in the iritis of arthritic perfons, and run quite to 

 the edge of the cornea. 



The treatment of iritis is condufted on the fame priu- 

 ciples as that of inflammation in general, with one differ- 

 ence, which is deduced from the important faft fo well 

 explained by Dr. Farre and Mr. Travers, 'viz. that in iritis, 

 the free exhibition of mercury is the moft effeftual means of 

 preventing the effufion of coagulating lymph, and promot- 

 ing its abforption after it has taken place, from which effu- 

 fion the thickening and adhefions of the iris, the foi-mation 

 of opacities in the pupil, and other mifchievous and deilruc- 

 tive effefts upon vifion, are principally derived. According 

 to Mr. Travers, indeed, whatever may be the caufe of 

 iritis, mercury is the grand remedy for refifl:ing theprogrefs 

 and confequences of the effufion of lymph in the eye. Ac- 

 cording to profeffor Schmidt, of Vienna, general bleeding 

 is neceffary only where there is a great degree of fymptom- 

 atic inflammatory fever. Hence, it is principally in the 

 idiopathic iritis that large bleedings from the arm are requi- 

 fite. In the fyphilitic Ipecies, he fays, it is never neceffary 

 to open a vein. In the arthritic, it is fometimes attended 

 with benefit ; but in patients of this defcription, a fmall 

 bleeding, repeated next day if neceffary, is found to anfwer 

 much better than a large bleeding at once, even though the 

 conftitutional difturbance be confiderable. In the rheumatic 

 iritis, it is alfo fometimes highly beneficial to bleed from 

 the arm. Local bleeding, by means of leeches to the fore- 

 head, produces the moft decided benefit iu all the varieties 

 of iritis. 



Purgatives, given fo as to aft copioufly, profeffor Schmidt 

 defcribes as being ufeful only in the idiopathic iritis ; and 

 as for cold local application, he tells us that they are in 

 all cafes quite ufelefs. 



In the idiopathic iritis, he recommends us to take fixteen 

 or twenty ounces of blood from the arm ; and to repeat 

 the bleeding if circumftances ftiould require it. Six or 

 eight leeches are to be applied to the eye-brow or temple. 

 A fmart purgative fliould then be given. The application 

 of leeches, but in fmaller number, ftiould be continued every 

 day, or every other day, until an abatement of the inflam- 

 mation has evidently taken place. In the firft ftage of the 

 procefs, blifters to the temple, or behind the ears, have little 

 or no effeft ; though fometimes a large one on the nape of 

 the neck feems to be of fervice. According to Schmidt, 

 the only topical treatment which is admiffible is the foment- 

 ation of the eye with water made as hot as the patient can 

 bear it, which fometimes procures a mitigation of the vio- 

 lence of the pain. Care, however, muft be taken to dry the 

 eye-lids and circumference of the orbit well after ufing this 

 application. 



When the difeafe paffes into its fecond ftage, or that in 

 which the effufion of coagulating lymph commences, mercury 

 is to be given with the views already mentioned. Two grains 

 of the fubmuriate of mercury, and half a grain of opium, 

 made into a pill, are to be given every evening and morning ; 

 or common mercurial friftions may be employed. Exter- 

 nally, profeffor Beer applies a folution of the oxymuriate of 

 mercury in water, to which mucilage and a confiderable 

 quantity of the vinum opii have been added. When this 

 collyrium lofes its effeft, or the eye cannot bear any fluid 

 application, which is fometimes the cafe, then he inferts 

 daily between the eye-lids a fmall quantity of a falve com- 

 pofed of two drachms of frefli butter, fix grains of red pre- 

 cipitate, and eight grains of extraft of opium. According 



to 



