The cyst continued daily to extend itself, and to separate the fungous edges; the fluctuation became more manifest, and the membranes thinner. At length, on the 15th of June 1757, Mr. Hopkins opened the cyst with the point of a lancet, and let out a large cup-full of limpid serum, without smell or taste. The boy felt very little pain in this operation. The cavity was filled with dry lint, and compresses dipt in warm red wine and water were applied over it. All the night following, and several days after, a great discharge of serum came away. On the 19th the fungus was considerably lessened. Mr. Hopkins then dressed the wound with warm unguentum é gummi elemi, and washed the fungus with a lotion of aquarum calcis, rosarum, et tincturæ myrrhæ. On the 23d, upon his removing the dressings, he saw the cyst loose and collapsed; which he extracted with his forceps, without the least difficulty, or pain to his patient. The fungus daily wasted afterwards, the wound digested well, and the lad was intirely cured on the 7th of August.
His right eye is perfectly strong, and he has been free from complaint ever since. The remainder of the coats of the eye, and of the muscles, bear up the eye-lids, that when uncovered he only seems to have closed the left eye: however, he has wore all the winter a back patch over it, to guard against fresh cold.
The cyst, when first taken away, measured three inches and half in length, one inch and half in diameter, and contained a large cup-full of water. It appeared to be the tunica sclerotica, was of a clear pellucid white, and of so delicate a texture, as scarce to admit of being touched without tearing; and when dried with all possible care, became so brittle, that Mr. Hopkins could hardly preserve it in the manner I now send it.
REMARKS.
In both Susannah Earle and John Law’s cases, the eye was distended by the accumulation of the aqueous humour, separated in great quantity by the repeated straining of the blood-vessels in the whooping cough, which might gradually relax and enlarge the aqueous ducts of Susannah Earle’s eye; and possibly by the rupture of those ducts, and of some blood-vessels, at the time John Law exerted himself violently in beating dung about the close: for in either case the impetus of the blood must have been so violent, as to produce those effects. However, from the hydrophthalmia succeeding the operation on John Law, the fungous excrescence, and continual serous discharge during several months from the wound, it plainly appears, that an abundance of aqueous humour was discharged at first by the distention or laceration of the aqueous ducts, and latterly for want of a contraction of those vessels, and of the lymphatics, which were no longer of use.
Both these cases shew the necessity of inquiring particularly into the causes of diseases of the eyes, as well as of other parts of the body; for by barely attending to the symptoms, the disease will not be removed, tho’ the symptoms be alleviated. Bleeding, and moderate evacuations, would certainly have, at first, decreased the tension and pain, and assuaged the inflammation; but both topical applications, and internal medicines, were properly to be adapted, and a suitable diet regulated.
Not to mention the absurd and impertinent abuse of empirics, what benefit could accrue, in both these cases, from unctuous, laxative, or emollient applications, from drastic and mercurial purges? Tho’ such applications might be well intended, to take off the tension and inflammation; yet, as the distension of the blood-vessels only increased gradually, as the globe of the eye was enlarged; so whatever application relaxed the coats of the eye, must infallibly stretch out the vessels yet farther, and cause a greater pain and inflammation; which drastic and mercurial purges would also increase.
The only method then to be pursued in such bad cases would be at first to endeavour to remove the fullness of the blood, and make use of such topical remedies as would contract without irritation. If the cause remains, as the whooping cough in Susannah Earle’s case, no amendment of the eye can be expected, while the patient’s blood-vessels are continually strained by frequent coughing. This illness therefore should be attended to, and removed as soon as possible.
But should the eye be so enlarged, as to protrude itself out of the orbit, there seems no other way to lessen the bulk of the eye, than by making a puncture with a proper instrument, to let out the aqueous humour; and then apply such agglutinant and contracting collyria, as may reduce the distended coats and vessels to their former size. This operation should be performed before the humours are vitiated, the sight lost, the vessels in a state of suppuration, and the coats of the eye too far extended; for at that time nothing less than extirpation can be of use.
Professor Nuck, in his Tractatus de Ductibus Oculorum Aquosis, p. 120, & seq. relates the success he had in curing a young man by five repeated punctures, and a strict observance in a proper use of all the non-naturals.