Gambar halaman
PDF
ePub

from protruding through an aperture caused by a wound or ulcer near the centre of the cornea ; in all cases of central cataract; where the cornea is opaque in its central portion, or that a portion of the pupillary margin of the iris is allached to the back of the cornea, after the dislission of a cataract; or, in fact, in any case in which we wish to produce permanent or complete dilatation of the iris, the solution of atropia will be found much more efficacious than the usual mode of applying the extract of belladonna externally. It is, moreover, much more cleanly, and is not liable to the objection urged against the latter, of producing an unpleasant eruption around the brow on which it is applied, and it is preferable to the ordinary mode of placing a few drops of the solution of the extract between the palpebræ, inasmuch as it causes no pain nor irritation.

In cases, however, where there is much conjunctivitis, or even deeper seated inflammation, attended with lachrymation, present, it does not possess the immediate and marked power over the iris which it does in the healthy eye, and its effects pass off much sooner; and this remark is applicable even to the three-grain solution. It is possible that in such cases the mucous discharge, and particularly the lachrymation which is present, may dilute it too much, or the morbid irritability and increased vascularity of the organ may render it less susceptible of the local application of this remedy than it would be in an otherwise healthy condition, therefore, in cases of violent irritic inflammation, the syphilitic for instance, where the disease had considerably advanced, and extensive exudations of lymph had taken place, we would not solely depend upon the atropia solution, but likewise apply the extract round the orbit. In cases of recent protrusion of the iris through the central portion of the cornea, the result either of injury, or rupture from ulceration, &c., and when there was no great irritability and blepharospasmus present, we have applied the strong atropia solution externally, by means of a small portion of linen rag wet with it, and retained for a short time upon the closed eyelids, with the most happy results.

We may here remark that the benefits arising from dilatation of the pupil have not been sufliciently attended to in the general treatment of ulcers of the cornea. We have, on several occasions lately, been able not only to save the eye, but even to prevent adhesions between the cornea and iris (synechia anterior.) and consequent blemish, by means of the judicious application of the preparations of belladonna. In cases of rupture from ulceration, when we have seen the patient shorily alier the rupture occurred—and in many of those instances hernia of ihe iris had absolutely taken place-se at once applied the atropia solution, closed the lids, kept them in that condition with isinglass plaster, and then applied a large pledget of lint smeared with the extract of belladonna over the eye and brow, and retained it in position by a light handage, al the same time that we employed, when necessary, local depletion by means of lecches on the temples and over the malar bone, together with blistering, and constituiional treatment calculated 10 lower the inflammation and prevent the further spreading of the sloughy or ulcerative process in the pornea. We keep the eye covered up in this state for thirty-six or fortyeight hours, and have had, in most instances, the satisfaction of finding,

7

VOL. X.

when we came to examine the eye, that the iris had been withdrawn from the wound, the pupil had dilated, and the cornea had united.

There are, however, certain cases in which the use of atropia is inac. missible, namely, in examining the eye for cataract, where we do not wish the dilatation of the pupil to continue longer than a few hours, if possible. In cases where we wish to dilate the pupil before we perform the operation for absorption of the lens, we have more than once seen unpleasant consequences result after this manner. It is well known to operative ophthalmic surgeons, that after the dilatation with the ordinary belladonna extract or infusion, the iris will, during the operation of keratonyxis, partially contract, either from the loss of a few drops of aqueous humour, or from its irritability being excited by the side or flat of the needle touching the margin of the pupil, or from the cataractous lens, whole or in a broken condition, pressing against it: and this condition is rather serviceable than otherwise, for should the lens be inclined 10 start from its bed, and press forward through the pupil into the anterior chainber, the iris acts as a partition to keep it in its place; while in a few hours the aqueous fluid is regenerated, the iris falls back into its natural position, and can afterwards be kept dilated by the continued external application of the belladonna.

If, however, the pupil has been previously dilated by the atropia, it is thoroughly immoveable, and the lens is liable either to press into it or become dislocated, and get into the anterior chamber. This latter accident occurred to us some time since, in breaking up the lens for congenital cataract. We had ordered a solution (No. 2) of atropia to be dropped into the eye the night previously, and on arriving in the morning we found the iris reduced to a mere ring. The child struggled a good deal, and a few drops of the aqueous liquid were lost during the operation, which consisted in a mere crucial incision into the capsule. On withdrawing the needle we remarked that there was no contraction of the pupil, into which the lens pressed. On visiting the child in the evening it had been so uncasy and complained so much of pain, and there was so much lachryination present, that we were induced to remove the bandage and examine the eye.

The cornea was found to have become plump, from the regeneration of the aqueous fluid, but the iris had remained immoveable, and the lens had started into the anterior chamber, where it caused considerable irritation and subsequent inflammation. It absorbed completely, however, without a second operation, and in a much shorter time than usual.

In cases of photophobia following cataract and other operations on the eye, and attended with myosis, which had resisted the continued external application of belladonna, as well as the strong atropia solution dropped into the eye, we have found the most marked beneficial elfects result from the internal administration of the extract of belladonna, given in the form of solution, to the amount of the sixteenth of a grain, from three to five times a-day. This, in the course of thirty-six or forty-eight hours has seldom failed to relieve the pain and intolerance of light, and also to dilate the pupil as far as possible.

In neuralgic affections of the eye, characterized by pain of a burning

description coming on at a particular, and often regular intervals, sometimes at particular hours of the day, yet induced by reading or using the eye in any fine work, and unattended with inflammation or any apparent alteration in the texture or motion of the organ, &c. &c., in which rest, change of air, tonics of various descriptions, particularly iron, and other means, had failed, we have latterly administered belladonna internally, with the very best effect, in doses varying from the sixteenth to the sixth of a grain three times a-day, given in the form of a solution. It may appear strange, but it is nevertheless true, that in some cases of old and inveterate photophobia, as in that form accompanying pannus, or the ophthalmia attended by vascular cornea in discharged soldiers, the internal use of belladonna will be found most efficacious.

We quote the following from a recent Number of the Gazette des Ho. pitaux: For a long time M. Berrard has employed in his practice at La Pitie, in place of the extract of belladonna, collyria containing the active principle of belladonna, atropia. This substance, signalized for the first time by M. Brandes, who had not, however, obtained it in its pure state, but since isolated by MM. Meire and Seines, presents many advantages over the extract of belladonna ; first, by acting with extreme rapidity in dilating the pupil, and by being endowed with great energy, sufficient to produce its effect in a solution of 0.05 or 0.10, in twenty grammes of distilled water, possibly a consideration of little importance in an hospital, but of great value in private practice in enabling one to avoid the employment of black unctions, which disfigure so much, and for which some patients, particularly females, have a great repugnance."Dub. Quart. Journ. of Med. Science.

The Letheonat the New York Hospital.—The inhalation of the ætherial compound recently patented by Morton, a dentist of Boston, for the purpose of inducing insensibility to pain during the performance of surgical operations, was tried to-day on a female, from whom two teeth were extracted. A dentist of this city, who has been appointed agent for the above patent—the inhaler and its contents was present on the occasion. After some explanatory remarks relative to its peculiar properties, mode of administration, etc., he proceeded to exhibit its effects.

The inhaler consists of a glass globe, six or eight inches in diame. ter; it has two valves, one of which is attached to the mouth.piece and the other to the opposite side. Within this vessel is a large piece of sponge, and an ounce or two of liquid which has the odour of æther. The mouth piece having been placed within the lips of the patient, she was directed to breathe naturally, the nostrils being closed. During the inhalation, she coughed slightly once or twice, and required some persuasion to induce her to continue the process sufficiently long to produce the desired effects. After the lapse of six or eight minutes, she appeared to be in a state resembling that of intoxication ; at this moment she was directed to open her mouth, and the teeth were rapidly extracted. The manifestations of apparent suffering, differed in no respect from what is usually seen during similar operations, though on being interrogated when consciousness had partly returned, she acknowledged that she had felt little or no pain ; that she knew nothing more of what had been done to her, after she was told to open her mouth.

On being questioned as to the state of her feelings, whilst under the influence of the vapour, whether they were pleasant or otherwise, she remarked ihat they were very unpleasant; this, the operator stated, was altogether different from what is usually experienced, the sensations being of the most delightful kind. When she arose to leave the theatre, she staggered like a person under the influence of liquor, and the assistance of two individuals was necessary to enable her to proceed.

The result of this trial, seems to confirm what has been stated in reference to the anodyne properties of this ætherial vapour, and that to a certain extent it renders ihe patient almost wholly insensible to pain. Though such be the fact, it cannot be denied that the employ. ment of this patented nostrum by the profession—we mean those of it, who, by the position or rank they hold, are entitled to more than ordinary consideration and respect—is a wide departure from propriety, and the strict observance of the code of medical ethics. What now, we ask, is to prevent any member of the profession from using in his practice, any one, or all, if he pleases, of the patented medicines which he finds daily advertised and puffed in the newspapers, especially after the example set him by several of the surgeons of the two largest hospitals in the country? These gentlemen, have, we fear, incautiously ventured upon slippery ground, and it would be well for them to pause and reflect ere they proceed further."

[We have given place to the preceding statement, kindly furnished us by an eye witness, because we thought, that as public chroniclers of passing events, we were bound to furnish our readers with a notioe of what was doing in a matter now exciting general interest. The results appear to be confirmatory of those obtained elsewi ere by the use of the Letheon, although the gentleman under whose auspices they were undertaken, has been heard to express himself as by no means satisfied, that it would be found equal to what is anticipated by more sanguine experimenters. It is not our intention to make any comments, since no public testimony of approbation will probably follow. Moreover, the Letheon has as yet been confined to operations in dentistry. We do not object to dentists making use of this vapour, but referring to our preceding remarks upon the subject, we cannot but rejoice, that an accident has deprived us of the necessity of applying io a surgeon of the New-York Hospital, the remarks we felt bound to make on the conduct of those of a similar institution in a neighboring city. It is true that the fluid has since been used, in the case of a patient upon whom a camphor moxa was burned, and with its customary tranquillizing effect, and that this trenches a little more closely upon the domains of our own science. But even ibis is a small matter, and as we flatter ourselves that no further trials will be made, so long as the secret is kept, we shall dismiss it sub silentio, and willingly leave the Letheon, so far as the New York Hospital is concerned, to the operation of those Lethean waters which will soon, no doubl, flow into it, and which, mingling with it, as with those of a whilom celebrated watery predecessor, will speedily so dilute it, as to lessen at once its dangers and its supposed efficacy.

Meanwhile, as was to be expected, the novelty has been eagerly caught at, as novelties ever are, and sundry persons have been in haste to make hay while the sun shines. Everything now a-days, must be introduced to the public, as well as to the profession, and Dr. Kimball, the agent for the Letheon in this city, has edified the world in a long article in a city paper, upon its virtues. It appears from this, that two surgeons of this city, one of them placed upon the very highest pinnacle of surgical fame, have successfully used the Letheon in their private practice. We can only regret that these gentlemen did not take the same view of employing patented and secret nostra as ourselves, a view, which, it gratifies us much to find, meets with very general favour in the minds of the profession.

It is pleasing to the philanthropist, who must appreciate Dr. Kimball's disinterested zeal in the matter, to be told that Dr. K. is constantly employing it at his house, No. 522 Broadway, with the most gratifying results. But perhaps the most remarkable recent instance of the application of this celebrated sedative, is that in which it was administered to a patient, who underwent, under its influence, the removal of a cancerous mamma. The case will doubtless be subInitted hereafter to the medical profession, through an appropriate medium; but the philanthropic haste of several editors of newspapers, who had been invited” to be present, has forestalled the operator, Dr. C. T. Collins, of this city, and a circumstantial account has already appeared in several of the daily papers. The patient, we are told, was insensible to the whole operation, and with the edi. tor of the Sun, we "congratulate the accomplished and humane Dr. Collins," on his success. These congratulations are mingled, however, with a dread, that among certain prejudiced persons in the profession, who cling with tenacity to obsolete and antiquated notions of propriety, there may be found some fault, that editors of daily secuiar papers should have been invited to witness a surgical operation, without being cautioned that they were not to suffer any account of it to appear in the prints under their control, a thing not only unusual, but liable to the suspicion of having been done for the sake of giving éclat to the operator, rather than to the Letheon; as tending slightly towards charlatanry; opposed to that nice sense of rectitude of conduct possessed by the persons aforesaid, and detracting in some degree from that sole regard to the interest of the patient, which it is thought by them should characterize the actions of every highminded and honourable medical man. Such persons might be disposed (which we are not) to attribute to Dr. C. himself, some hand in this matter, and to opine that such conduct ill became one who had been himself a teacher of others, and the pages of whose journal

« SebelumnyaLanjutkan »