Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney.
- Date:
- 1873
Licence: Public Domain Mark
Credit: Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![gcstecl or inflamed parts through the vessels, to remove the hindrances to circulation, and.in a revulsatory way to regulate the development and increase of a stasis, to diminish the rapidity of the circulation and of the increased molecular attraction. The means of local blood-letting are the natural and artificial leeches, wet cups, in- cisions and scarifications of the conjunctiva. Natural leeches as well as the artificial ones are, as a rule, most properly applied on the temporal region. In order to attain any effect in the case of very small chil- dren, one to two leeches should be applied; in those who are older, three to four; in adults, six to eight of medium size. Care should be taken that the leeches bite as nearly as possible at the same time, and that after they drop off the flow of blood is not interrupted. [In this country, as a rule, the use of leeches in the treatment of eye-disease in children is not justifiable. Wet cups should never be applied to young children.] Since the effect of natural leeches is evanescent, and the changes in the current of blood are quickly over, it seems advisable, for the sake of an expansion as far as possible of the temporary effect, to apply the leeches in the beginning of an ex- acerbation of the inflammation. It is at this time that the process receives an im- petus, its products are more abundant, and the pain also increases. The fossa angularis, as well as the integument of the lid, are improper positions for the appli- cation of leeches, because the marks of the bites remain for a long time, and disfigure the patient. But this position is chiefly to be avoided because the leeches very often bite through the skin, which is exceedingly thin in this place, even to the veins, and thus considerable bleeding is caused, as well as extravasations in the loose subcutaneous connective tissue. These extravasa- tions may exist for weeks and months before they completely disappear. Sometimes even worse results are seen. Inflammations and abscesses are occasionally caused. The mastoid process may be a point for the application of leeches when any con- gestion or inflammation of the eye is connected with hypersemia of the base of the brain. On the whole, the therapeutic results of the application of natural leeches are of importance only in the external ophthalmia, that is, in inflammation of the lids and of the conjunctiva. In inflammation and hypersemia of the globe, especially of the interior of it, the results are scarcely satisfactory, and may be with good reason con- sidered doubtful. This is chiefly explained by the fact that the anatomical connec- tion between the vessels of the temporal region and of the ciliary vascular system is not very intimate, but is relatively distant. The therapeutic effect of natural leeches may be increased by the so-called hdellatomy, which has been recently rec- ommended. By this not only the quantity of the evacuated blood, but also the rapidity with 'which it is taken from the vessels, is considerably increased. Bdellatomy is best performed by means of a spring lancet. It may, however, in case of neces- sity, be done with an ordinary lancet. The best moment is when the leech has filled himself quite well. The end of the animal is then carefully lifted up and the blade is thrust vigorously in the side of the leech, better the left. The incision is not so well done in the back, badly in the belly. After the incision the wound should be kept free from coagulations, by means of a moist sponge, or by the injection of lukewarm water, in order that the blood may flow freely from the abdominal cavity of the leech. A leech thus treated sucks much longer than one which is uninjured, and draws a much greater quantity of blood, sometimes taking one and even two ounces. If, in consequence of the restlessness of the patient, or of rough handling of the leech, it falls off too quickly, if reapplied it again acts freely. If carefully kept in clean water the same leech may be repeatedly applied, and incised at intervals of days or weeks {Fischer). The speedy local removal of greater quantities of blood is attained most cer- tainly by the artificial leech.](https://iiif.wellcomecollection.org/image/b21987634_0055.jp2/full/800%2C/0/default.jpg)
