INFLAMMATION OF THE SCLEROTICA. 
173 
it is supposed that in true rheumatic cases, the periosteum 
lining the orbit participates in the inflammation. Be that as 
it may, the patient is generally awakened about two in the 
morning by a paroxysm of pain, which gradually increases 
up to a certain point, and then as gradually subsides ; and 
this is repeated night after night, till the sufferer, though 
jaded and weary, dreads the approach of bed-time, and the 
morning finds him tossing, feverish, and unrefreshed. 
“ When the great vascular communication which extends 
from tunic to tunic of the eye is considered, we may readily 
conceive that inflammatory action commencing in the scle- 
rotic is speedily extended to the other membranes. Accord- 
ingly, within a few days after the pinkiness of the sclerotic 
manifests the presence of inflammation, the conjunctiva will 
redden, and the iris will be slightly changed in colour; for 
instance, a blue iris will assume a slight greenish tinge 
without perceptible dulness, and about the same time the 
patient complains of some mistiness of vision ; the pupil too 
will be rather contracted, and will not act freely. These 
symptoms indicate that the iris and choroid participate in 
the morbid action. When the iris becomes involved, the 
characteristic zone around the cornea becomes strongly 
marked, being gradually shaded off into the general pink of 
the sclerotic, above which a pretty close network of inflamed 
conjunctival vessels can be seen. 
“ At the first onset of sclerotitis, the whole membrane is 
not suffused at once ; a patch, generally near the cornea, 
first becomes injected, and from this the inflammation, if not 
checked, rapidly extends. * * * * 
“As a general rule, there can be no doubt that judicious 
depletion, by cupping or leeching, is beneficial. The vessels 
are thereby unloaded, and brought into a favorable condition 
for responding to the action of the medicines ; and I may 
remark, that the mastoid region is preferable to the temple 
for the abstraction of blood. The bruised and tender feeling 
of the temple, which is characteristic of sclerotitis, renders 
cupping on that spot a very painful proceeding, and leeches 
occasionally cause much irritation and erythematous swelling, 
when applied there ; these objections do not apply to the 
mastoid region, and the relief is equally great when the blood 
is taken from thence. 
“ As regards general treatment, much will, of course, de- 
pend on the condition in which the patient was found. The 
bowels should be well cleared in the first instance, but after- 
wards mere purging does little good. The point to be held 
in view, should be correction of the secretions, and regulation 
