A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen.

  • Wells, J. Soelberg (John Soelberg), -1879
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    for the inflammation is not only more severe, but the varioh:)US pustules may form on the lids, the conjunctiva, and even on the cornea, leading to grave, and often very dangerous complications. Happily, since the introduction of vaccination, the variolous ophthalmia is far less dangerous than formerly, when it led but too frequently to destruction of the sight. If a considerable number of pustules form on the eyelids, the swelling of the latter is often so great that it is impossible to open the eye. They are also apt to form at the very edge of the lid between the eyelashes, and often destroy the hair-bulbs, thus producing perhaps permanent loss of the eyelashes (madarosis). If they are situated on the palpebral conjunctiva near the edge of the eyelid, they may obliterate the openings of the Meibo- mian glands, and cause a stoppage and alteration in their secretions; or the growth and arrangement of the lashes may become affected, and distichiasis or trichiasis be produced. If the pustules form on the limbus conjunctivae, they are chiefly dangerous inasmuch as they may extend to the cornea. The very prevalent opinion that variolous pustules often form on the con- junctiva and the cornea, during the eruptive stage, has been distinctly denied by Drs. Gregory and Marson. The latter especially maintains most strongly that no pustules form on the eye. The conjunctival inflammation met with in smallpox may assume the catarrhal, muco-purulent, or phlyctenular character. The latter is perhaps the most common. The eyelids and lach- rymal apparatus are often affected, and this frequently gives rise to very obstinate and troublesome complications. But the eye may become impli- cated at a later stage of the disease, when the scales have fallen off from the pustules. Hence this has been termed by some writers, secondary variolous ophthalmia. Mackenzie mentions that he has often seen both central abscess of the cornea and onyx at its lower edge produced, after the general eruption has completely gone. Although this mostly occurs about the twelfth day, he states that it may even take place five or six weeks after the patient has recovered from the primary disease. At first an infiltration of the cornea occurs, which generally soon passes over into an ulcer, and this, increasing in circumference and depth, may perforate the cornea, producing prolapse of the iris or partial staphyloma. If several such infiltrations should coalesce, a large ulcer or abscess will be formed, giving rise to an extensive leucoma, even if the cornea does not perforate. Should the whole cornea be destroyed by suppuration, a complete staphyloma will be the result. Again, the inflam- mation may attack the other structui-es of the eye, and the latter be lost from panophthalmitis. The treatment should be much the same as that recommended for the con- junctivitis of measles and scarlatina. In order to prevent the formation of pustules on the eyelids, glycerine, olive oil, or unscented cold cream should be freely rubbed over them three or four times daily. Mackenzie recom- mends that two or three leeches should be applied to the temples, or behind the ears. The general health should be kept up by tonics, and the bowels properly attended to. If pustules form on the lids or conjunctiva, they should be pricked and emptied of their contents. If the cornea becomes implicated, and perforation is threatened, this must be treated according to the rules laid down in the treatment of ulcers of the cornea. [In eczema of the scalp and fiice, especially in the bad cases which are so frequent among the inlants and young children of the poor, a very severe conjunctivitis of the ])hlyctenular and catarrhal type is a very common accompaniment of the skin disease. The eyes are tightly closed by dried crusts, and when these are washed away, and the lids opened, a quantity of muco-pus exudes. When this has been removed, we often find pustules in
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