745 
SURGERY. 
the constitutional irritation a great degree have subsided, 
and, in short, all the acute symptoms much mitigated. 
There still however remains a considerable degree of irrita¬ 
bility in the eye, on exposure to light, some artificial 
defence to exclude the light will be necessary, and the 
person will still be incapable of applying the organ to the 
ordinary purposes of vision. 
The treatment of the chronic conjunctivitis may be 
considered in conjunction with that of the termina¬ 
tions of acute inflammation, the object in the former is 
to excite new action, and constringe the dilated blood 
vessels; for this purpose a variety of lotions are in use. 
A few drops of tincture of opium, put into the corner 
of the eye with a camel-hair pencil, or syringing the eye 
with solutions of lead, seem to answer as well as any thing. 
No local treatment is however likely to be successful, if the 
general health remains unimproved. And in strumous 
subjects especially we find chronic inflammation, and its 
consequences, excessively troublesome. The consequences 
of conjunctivitis, are treated of course according to their 
various natures in various ways. Nebula may generally be 
removed by mild stimuli, not however, that these must 
be used while any inflammation of consequence is going 
on. Pustules sometimes occur on the conjunctiva. These 
are generally seated at the junction of the transparent with 
the opaque cornea; but they may sometimes occur in the 
cornea itself, or the conjunctiva covering it, or the ball. 
The appearances that they present at first are red or yel¬ 
lowish spots arising from a deposit of lymph in those parts, 
and are slightly elevated. These ulcers are difficult to 
manage, as they often occur in scrofulous habits of body, 
and broken up constitutions, and are apt to become chronic, 
and consequently difficult of cure. As for the treatment 
this affection requires, it will be hardly necessary to say, 
that if considerable inflammation exists, depletion must be 
employed.—The inflammation, however, is of the atonic 
kind.—First apply leeches, not in too large numbers, so as 
to carry depletion to too great an extent—it will be proper 
to evacuate the bowels, not by drastic purges, but mild 
aperients, and to attend to the secretions. Blisters will be 
useful if the sight be affected. Mild astringent collyria 
used; the best is the vinum opii. 
Fungus sometimes grows on the conjunctiva. It becomes 
loose and red; the vessels turgid with blood, and there is a 
fold of this membrane on the inside of the lids, which pro¬ 
duces considerable irregularity on its surface—a morbid 
secretion is kept up on the part—and not unfrequently 
eversion of the lids is the result. To prevent this, and 
remedy the complaint, the loose portion of the conjunctiva 
should be removed with a pair of curved scissars. 
The same treatment may also be used, when we find little 
granulations growing on the membrane, or when we have 
a pterygium (which is a little triangular thickening between 
the cornea and the inner canthus), or an encanthus, (which 
is a granulated thickening of the caruncula lachrymalis). 
Next to the conjunctiva, the iris is that texture of the eye 
which is most frequently affected with inflammation, and 
the changes which this process occasions, can no where else 
be so distinctly seen and examined. 
Scarcely any disease to which the eye is subject, has a 
more immediate or rapid tendency to destroy vision, that in¬ 
flammation of the iris. In the idiopathic iritis, as (Pro¬ 
fessor Schmidt observes,) besides the common symptoms of 
ophthalmia, certain changes happen at the very commence¬ 
ment, indicating the seat of inflammation. The pupil appears 
contracted, the motions of the iris are less free, and the pupil 
loses its natural bright black colour. The brilliancy of the 
colour of the iris fades, and it becomes thickened and 
puckered, with its inner margin turned towards the crystalline 
lens. The change of colour happens first in the lesser circle 
of the iris, which becomes of a darker hue ; and afterwards 
in the greater circle, which turns green, if it had been greyish 
or blue; and reddish, if it had been brown or black. The 
redness accompanying these changes is by no means com 
Vol. XXIII. No. 1605. 
siderable, and is at first confined to the sclerotic coat, in 
which a number of very minute rose-red vessels are seen 
running in straight lines towards the cornea. In the words 
of Mr. Saunders, the vascularity of the sclerotica is very 
great, whilst that of the conjunctiva remains much as usual; 
the plexus of vessels lying within the latter tunic. The inos- 
culations of these vessels are numerous, and form a species 
of zone at the junction of the sclerotica and cornea. Here 
the vessels disappear, not being continued over the transpa¬ 
rent cornea, as in a case of simple ophthalmy, but penetrating 
the sclerotica, in order to pass to the inflamed iris. The 
irritation caused by the light is distressing, and the patient 
is much incommoded by any pressure on the globe of the 
eye, or by the rapid or sudden motions of this organ. Con¬ 
siderable uneasiness is felt over the eyebrow, and acute lan¬ 
cinating pains shoot through the orbit towards the brain. 
The pupil loses its circuiar form, becomes somewhat irregular, 
and presents a greyish appearance. Examined by means of 
a magnifying glass, this appearance is seen to be produced 
by a substance very like a cobweb occupying the pupil, and 
which can soon afterwards be distinguished, even without 
the aid of the glass, to be a delicate flake of coagulable 
lymph. Into this, says Professor Schmidt, the processus or 
dentations of the irregular pupillary margin of the iris seem 
to shoot, and it is afterwards found that adhesions are apt 
to be established at these points. Owing to these adhesions, 
the patient, whose vision has been all along indistinct, now 
complains of being able to see only one side or part of an 
object. Occasionally, when the cornea has been attacked, 
it becomes cloudy, thickened, and adherent to the iris, before 
any visible effusion of lymph takes plaee; or, when the 
inflammation is violent, and extends to the other tunics, the 
eye is totally destroyed by suppuration; but the disease 
rarely advances to this extreme, and generally terminates in 
the adhesive stage. Lymph is then deposited on the anterior 
surface of the iris, and between the iris and the capsule of 
the crystalline lens, and often in so large a quantity, as to 
extend through the pupil, and drop pendulously to the bot¬ 
tom of the anterior chamber. If this process is not inter¬ 
rupted, the pupil is entirely obliterated, or the iris adheres 
to the capsule of the lens, leaving only a very minute aper¬ 
ture, which is most commonly occupied by an opaque 
portion of the capsule, or of organized lymph, and the 
patient is totally blind. 
From the preceding description, it is evident that the prin¬ 
cipal danger in iritis depends upon the effusion of lymph, its 
quick organization, the rapid formation of adhesions between 
the iris and other parts, and the closure and obstruction of 
the pupil. Of late years great improvement has unquestion¬ 
ably been made in Ihe treatment of this disease, an improve¬ 
ment derived from a knowledge of the fact, that mercury is 
one of the most effectual means of stopping the effusion, and 
promoting the absorption, of lymph in the adhesive inflam¬ 
mation. 
In the idiopathic iritis, before lymph is effused, copious 
bleeding either from the temporal artery or veins of the 
arm, and cathartics, followed by nauseating doses of tartar- 
ized antimony, with a view of enfeebling the pulse, are the 
means from which most benefit may be expected. When 
general bleeding has been carried as far as the state of the 
pulse will allow, leeches are to be applied to the vicinity of 
the eye, and their application repeated at short intervals. 
When the inflammation stops in this stage, the cure may be 
completed by covering the eye with linen, wet with a colly- 
rium of the acetate of lead, and keeping the patient for some 
time in a dark room. Professor Schmidt, however, describes 
cold local applications as quite useless in iritis, and he says, 
the only topical treatment which is admissible, is the fomen¬ 
tation of the eye with water, made as warm as the patient can 
bear, which will sometimes mitigate the violence of the pain. 
In the first stage of the process, he observes, that blisters to 
the temple, or behind the ears, have little or no effect, though 
a large one on the nape of the neck sometimes seems to be 
of service. 
9 D 
When 
