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Title: Treatment of the diseases of the eye, by means of prussic acid vapour, and other medicinal agents

Author: Alexander Turnbull

Release date: October 19, 2015 [eBook #50254]

Language: English

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        http://www.pgdp.net (This file was produced from images
        generously made available by The Internet Archive)


*** START OF THE PROJECT GUTENBERG EBOOK TREATMENT OF THE DISEASES OF THE EYE, BY MEANS OF PRUSSIC ACID VAPOUR, AND OTHER MEDICINAL AGENTS ***




Produced by The Online Distributed Proofreading Team at
http://www.pgdp.net (This file was produced from images
generously made available by The Internet Archive)






    TREATMENT

    OF THE

    DISEASES OF THE EYE,

    BY MEANS OF

    PRUSSIC ACID VAPOUR,

    AND OTHER MEDICINAL AGENTS.

    BY

    A. TURNBULL, M.D., EDIN.,

    HONORARY PHYSICIAN TO THE INDIGENT BLIND VISITING
    SOCIETY; AUTHOR OF "A TREATISE ON PAINFUL AND
    NERVOUS DISEASES," "VERATRIA, ACONITINA,
    DELPHINIA," ETC., ETC.

    LONDON:

    JOHN CHURCHILL, PRINCES STREET, SOHO.

    1843.




PREFACE.


Amid a multiplicity of professional duties I have appropriated a few
spare minutes to the preparation of this little work. It must, under
such circumstances, have many literary imperfections, for which I must
crave the indulgence of the Profession. But I trust it embodies some
useful and original principles and facts, that are, at least, entitled
to a dispassionate consideration. I take this opportunity of thanking
those Medical Gentlemen who so kindly, and so patiently watched several
of the cases recorded in these pages.

 48, Russell Square, Feb. 1st, 1843.




CONTENTS.

                                          Page

 Introduction                                 1

 Action of Hydrocyanic Acid upon the Eye      3

 Action of Chlorocyanic Acid upon the Eye     7

 Remarks on the Action of Carbon, &c.        15

 Cases of Opacities of the Cornea, &c.       18

 Cases of Staphyloma                         27

 Case of Inverted Eye-lashes, with Opacity
 of the Cornea                               33

 Case of Conical Eye                         35

 Cases of Cataract                           37

 Cases of Amaurosis                          41

 W. H. Newnham, Esq.'s letter                47

 Professor Forbes's letter                   48

 Case of Staphyloma, treated by
 J. C. Atkinson, Esq.                        51

 Dr. Maclean's cases                         53

 Case of Diseased Cornea, treated by
 G. K. H. Paterson, Esq.                     61

 CHAPTER II.

 Action of Essential Oils, &c.               67

 Formulæ                                     ib.

 Amaurosis                                   75

 A. Cruikshanks, Esq.'s letters              83

 Dr. Kent's letter                           86




INTRODUCTION.


In submitting to the public the following interesting cases
illustrative of the effects of my mode of treating diseases of the eye,
I have prefixed to them the original communications transmitted by me
to the _Lancet_ and the _Medical Gazette_. My reason for so doing is
this--I wish it to be seen by actual comparison, that in every instance
the confidence I have expressed in the efficacy of these medicines has
not been overrated; on the contrary, it will be seen that I have said
less than the facts really warrant.

It will also be found, that the cases which have come under my
treatment are, without exception, such as have been regarded
either as hopeless, or at least such as have previously enjoyed,
without sensible benefit, all the advantages of our best Ophthalmic
Institutions. It cannot therefore be contended, that the ordinary
treatment would have proved equally efficacious if it had been
previously tried.

I have also given the cases that are at present under my treatment,
in order that all who take an interest in the subject may have ample
opportunity of watching their progress, and forming, from their own
observations, just conclusions.

I have also added some important observations concerning the action
of the essential oils on the eye, as exhibited both externally and
internally.




ACTION OF HYDROCYANIC ACID, &c.

UPON

THE EYE.


In September, 1841, I made the following communication to the editor of
the _Medical Gazette_, which he kindly inserted:--

It is a well-known fact, that the eyes of those who have been destroyed
by hydrocyanic acid show none of the usual symptoms of dimness for
a length of time after death.[1] On the contrary, the eye is clear
and the pupil much dilated. This satisfied me that the acid exerted
a specific action upon the eye, which might be made available as a
medical agent for relieving many of the diseases to which that organ is
so subject.

 [1] Morbid appearances produced by hydrocyanic acid in a case related
 by Hufeland.

 The inspection was made the day after death. The eyes were still
 glistening like those of a person alive; but the countenance
 was pale and composed like one asleep. The arteries and left
 cavities of the heart were empty, and the veins and right cavities
 distended.--_Christison on Poisons, page 708._

 In most instances venous turgescence and emptiness of the arterial
 system is commonly remarked throughout the whole body.--_Christison on
 Poisons, page 710._

 It appears that long after death the eye, as in Hufeland's case,
 has a peculiar glistening and staring expression, so as to render
 it difficult to believe that the individual is really dead; and
 this appearance has been considered by Dr. Paris so remarkable, as
 even alone to supply decisive evidence of poisoning by hydrocyanic
 acid.--_Christison on Poisons, page 711._

 Numerous reports have now been made of those who have died in
 consequence of this poison, and the most striking effects to be
 observed are, the extraordinary state of the eye, which has indeed
 been considered as the most characteristic phenomenon, and at once
 to point out the cause of death: the shining, glistening, sparkling
 lustre of the eye has been, on most occasions, observed. No one has,
 so far as I am able to learn, attempted to explain this most striking
 appearance; it has, however, been said, that those who die from the
 effects of charcoal often exhibit the same unearthly lustre.--_Dr.
 Sigmond on Poisoning with Prussic Acid.--The Lancet, August 26th,
 1837, page 797._

My first experiment was undertaken in 1837, with the diluted acid, by
dipping a sponge into it, and rubbing it upon the forehead for the
space of a few minutes, which gave the skin a very red appearance; but
the patient experienced not the least sense of heat, and the pupil
was slightly dilated. I continued to use this with very beneficial
effects in incipient cataract, opacities of the cornea, inflammation,
amaurosis, iritis, &c. Of late, instead of the diluted acid I have
applied the _vapour_ of the concentrated acid to the eye with much more
decided effect, and without the slightest danger. The plan I generally
adopt, is to put into an ounce-phial a drachm of the acid, and hold it
in close contact with the eye, the eyelid being open, for the space
of about half a minute, or until such time as the patient feels a
little warmth, or the person holding the phial sees the pupil greatly
dilated, and the vessels of the eye injected with blood, which is the
invariable effect of the application of the acid. The patient is not
sensible of pain from this peculiar state being induced, which appears
to me to result from the powerfully sedative influence of the acid,[2]
thereby showing that two opposite powers--to wit, the stimulating and
the sedative--are exerted at the same time; and thereby the uneasiness
arising generally from a stimulant alone is prevented. Its great power
in removing these diseases chiefly arises from the two powers being so
blended, and thus enabling the eye to bear a sufficient stimulating
action without injury. The person who holds the acid to the eye should
_be careful not to allow the patient to smell it_.

 [2] _Lancet, Sept. 16th, 1837, page 883._--In whatever manner it is
 prescribed or administered, either therapeutically or as a poison,
 hydrocyanic acid operates directly on the nervous centres.--_Professor
 A. T. Thompson._

The _Medical Gazette_ and the _Lancet_ gave insertion to the following
statement of mine, of date Oct. 20, 1842.

SIR,--In October, 1841, I gave an account of the action of the vapour
of _hydrocyanic acid_ upon diseases of the eye. Since that period I
have been engaged in investigating the action of various other bodies
on the same organ, and under the same form.

One reason why I did not rest satisfied with the effects produced by
the hydrocyanic acid, was, that its action, like that of all other
medicines, decreased in power by continued application; thereby
rendering it necessary to have occasional recourse to other medicines,
in order to insure a more speedy recovery. Another reason was, the
reluctance of many individuals to submit the eye to the action of so
potent a medicine.

The first medicines to which I shall refer, and which I have employed
with some success, are the _chlorocyanic acid_ and _sulphuretted
chyazic acid_. The plan I pursue is that of putting a drachm of one
of the medicines into a bottle (containing a small piece of sponge) of
about two-ounce size, having a mouth precisely fitted to the eye, and
with a ground-glass stopper.

The action of these medicines is very different from that of the
_hydrocyanic acid_, in as far as they both stimulate the eye, and
produce much greater warmth and irritation, with less dilatation of the
pupil. Few, however, can bear the _chlorocyanic acid_ to be applied
longer to the eye than half a minute; though, in a minute after its
application, all irritation is removed, and the eye feels perfectly at
ease.

The next medicine which I have employed in the form of vapour was the
chloruret of iodine. This medicine produces very little warmth or
uneasiness to the eye, if continued for the space of two minutes or
upwards; but a sensation of irritation, accompanied with a flow of
tears, takes place on its removal. It contracts the pupil, and in no
case have I seen it dilate it. Its vapour rises very readily, and does
not leave the yellow disagreeable colouring on the skin produced by the
vapour of iodine when uncombined, which is a great drawback in the use
of iodine in diseases of the eye.

The last medicine which I have employed is the bisulphuret of carbon,
which is so volatile, that the application of it to the eye, when the
bottle is held in a warm hand for a few seconds, is as much as can be
borne, in consequence of the intense prickling heat and flow of tears
which it occasions. Owing to this fact, I generally use it by causing
the patient to shut the eyelid during its application, which can then
be continued for a minute or two, with the same beneficial effect upon
the eye, without inconvenience to the patient. It generally contracts
the pupil, and very seldom dilates it.

I used to employ iodine by putting it into the same bottles, and
immersing it in hot water, and in its state of vapour applying it to
the eye; but I find it answers much better when dissolved in the
bisulphuret of carbon.

It is my intention, shortly, to give a full account of the action of
these medicines upon the various forms of disease to which the eye
is subject, and also what particular disease each medicine is best
calculated to remove. At the same time I shall state such instances
of failure as have occurred in my experience, in order that a just
estimate may be formed of the value and importance of each medicine.

It may not be out of place here to state, that I have employed,
with great success, the bisulphuret of carbon to enlarged indurated
lymphatic glands. In the first instance, I rubbed equal quantities of
the bisulphuret of carbon and alcohol upon the parts affected, but
without any effect upon the glands. But as its effects were so great
when its vapour was confined to the eye, I was led to apply it in the
form of vapour, and by means of glass bottles similar to those I have
described. By these means I excluded the action of the medicine from
the external air, and thereby prevented its speedy evaporation. When it
had been applied about one minute, the patient felt the part very cold,
but immediately after a gradual heat, accompanied with great prickling;
the heat increasing the longer the medicine was kept in contact with
the part, until it could be no longer endured. On removing the glass,
the part was red to an extent two or three times greater than the part
enclosed. In a few days the change in the size of the glands was very
great; and by its daily repetition, a complete and speedy removal of
the disease was effected. I also find that its action upon diseased
glands is more decided if the surface of the skin is well moistened
with water previous to the application of the bottle to the part.

The water, in fact, not only prevents the escape of the vapour between
the glass and the skin, but assists the imbibition of the carbon; a
point of the highest importance, inasmuch as all its action on the part
depends upon the exclusion of the atmosphere from the vapour. I may
here observe that these applications occasion no injury whatever to the
skin.

I have also found the _bisulphuret of carbon_, and the chlorocyanic
acid, valuable medicines in the removal of deafness, depending upon
a want of nervous energy and deficiency of wax. The mode of its
application is substantially the same as that which I employ in
diseases of the eye, with this difference only, that the bottle is
formed with a small neck and stopper adapted to the size of the orifice
of the ear, and held close to the organ until a considerable degree of
warmth is produced.

The action of these medicines, which contain so large a share of
carbon, arises from the carbon in the vapour permeating the cuticle,
and coming in contact with the oxygen in the vessels, which is conveyed
through every part of the frame by inspiration and otherwise, and
thereby forming carbonic acid gas, which evolves heat in the ratio of
the quantity consumed by the oxygen.

The following quotations from Professor Liebig, in his work on "Organic
Chemistry," sufficiently prove the correctness of this position:--"It
is only in those parts of the body to which arterial blood, and,
with it, the oxygen absorbed in respiration, is conveyed, that heat
is produced. Hair, wool, or feathers, do not possess an elevated
temperature. This high temperature of the animal body, or, as it
may be called, disengagement of heat, is uniformly, and under all
circumstances, the result of the combination of a combustible substance
with oxygen. In whatever way carbon may combine with oxygen, the act of
combination cannot take place without the disengagement of heat. We can
no longer doubt that gases of every kind, whether soluble or insoluble
in water, possess the property of permeating animal tissues, as water
penetrates unsized paper."

Does not the action of medicines containing so large a portion of
carbon, which can be brought into contact with the whole external
surface of the body, and thereby capable of being easily disengaged,
suggest a method of relieving pulmonary disease likely to be attended
with no ordinary success, by calling into greater activity the action
of the skin, and thereby materially lightening the labour of the lungs?
Are we not the more encouraged to expect such remedial influence in
diseases of the lungs, from the fact of its great power in removing
indurated glands, which are so common accompaniments of consumption?
There can be no doubt of the usefulness of bisulphuret of carbon in
skin diseases.

I have submitted these observations under the conviction that they
embody principles which may be carried out, and made of great utility
to mankind.

  I am, Sir, your obedient servant,
  A. TURNBULL, M.D.

  48, Russell Square, Oct. 20, 1842.

A few weeks after the appearance of the above (Nov. 8, 1842), I wrote
to the Editor of the _Literary Gazette_ as follows:--

 REMARKS ON THE ACTION OF CARBON, ETC.

  (_To the Editor of the_ "Literary Gazette.")

  48, Russell Square, Nov. 8, 1842.

 SIR,--I beg leave to tender my sincerest thanks for your kind notice
 in the last _Gazette_ of my recent discoveries on the treatment of
 diseases of the eye, &c. Allow me to intrude for once in your crowded
 columns, by referring to what you accidentally omitted--viz. the
 manner of applying the _bisulphuret of carbon_, and also to add a
 few reasons illustrative of the fact which you have quoted from me,
 that its action depends on its union with the oxygen. The plan I
 adopt is this:--I put a drachm of the bisulphuret of carbon into a
 two-ounce bottle; the medicine is so volatile that the heat of the
 hand causes the vapour rapidly to rise, and come into contact with the
 skin. The action is more decided if the skin is previously moistened
 with water; as the water not only prevents the escape of the vapour
 between the glass and the skin, but also excludes the external air,
 a point of the very highest importance. In my paper, which appeared
 in the _Lancet_, of October 29th, I stated, that "when it had been
 applied about one minute, the patient felt the part very cold, but
 immediately after a gradual heat, accompanied with great prickling;
 the heat increasing the longer the medicine was kept in contact with
 the part, until it could no longer be endured. On removing the glass
 the part was red, to an extent two or three times greater than the
 part enclosed. These applications occasion no injury whatever to the
 skin." Showing that the action of the bisulphuret of carbon depends on
 its union with the oxygen in the blood-vessels, I will merely state
 the following experiments:--Carbonic acid gas was applied in a similar
 bottle, and in the same way, to the skin, the external air being
 excluded, and the skin moistened with water, for the space of ten
 minutes; but neither redness nor any sensible heat was induced; for
 this satisfactory reason, that heat is the consequence of oxidation
 with the carbon, which oxidation, in the case of carbonic acid gas,
 had of course been previously effected. _Alcohol_, _sulphuric ether_,
 _nitric ether_, and many other _ethers_--all of which contain a large
 portion of carbon--were similarly tried, but had no effect; for the
 same reason--viz. that it is already in a state of union with oxygen
 in all these highly carbonized bodies.

  I remain, Sir, your obedient servant,

  A. TURNBULL, M.D.




CASE 1.

_Opacity of the Cornea, the sequel of Small-pox._


JOHN WRIGHT, a porter, aged 23, No. 10, Bear Yard, says that he has
been nearly blind in the right eye from small-pox, since he was two
years old. Five years since he was attacked with violent ophthalmia,
in consequence of exposure to cold. He then applied to one of our
Ophthalmic Institutions, where he remained as an out-patient for
eight months. For the first six months he had, thrice a week, caustic
applied to his left eye, after which black ointment for the remainder
of the time; but without receiving benefit. He then went to another
institution, where he remained an out-patient for seven months. The
treatment here consisted in dropping into the eye a liquid, and at
other times a powder was shaken into it, from which he derived no
benefit. He then consulted a private practitioner, who relieved him;
but, not satisfied with this, he went to another surgeon, who said
that the cause of his blindness was owing to a little squint, and he
submitted the eye to be operated upon for that purpose; but no good was
derived from this operation. None of the medical men attempted to do
anything to the right eye.

In September, when I first saw him, his left eye was very much
diminished in size, and the cornea studded with white spots; the vision
very imperfect, and constantly discharging water. The right eye was so
opaque that neither iris nor pupil was to be seen, and he could only
see the shadow of an object.

On the 23rd of January the left eye had got tolerably clear and free
from all specks, but still subject to water when exposed to the wind.

The right eye is now becoming transparent, and vision in it is
improving. He states that it will soon be the best eye.




CASE 2.

_Opacity of the Cornea from Inflammation._


ANN FITZGIBBONS, aged 13, daughter of Thos. Fitzgibbons, 11, Stratton
Mews, is a day scholar at the Blind School, Queen Square.

Her father states that in infancy she lost the left eye, owing to an
attack of inflammation. The right eye four years since became similarly
affected. She has been a patient at two Ophthalmic Institutions, where
she attended for several months without any benefit. She was brought to
me by her father on the 1st of October, 1842, who stated that for the
last four years she had been obliged to be led, and could only discern
the shadow and outline of objects, but could not distinguish them.

On examining the left eye, I found it shut, and all the humours lost.
The right eye was much diminished in size, and the cornea was very
opaque, excepting at the upper part, where a small portion of light was
admitted. The bottle containing the acid was held to the left eye as
well as to the right, to ascertain what effect would be produced. To
my surprise, in the period of a month the chambers of the eye became
partially filled with aqueous humours, to the extent of at least half
the size of a healthy eye; the pupil was small, but the patient could
not see in the slightest degree. The right eye has become almost
transparent, and she can now see with it sufficiently well to be able
to go anywhere. Indeed, her sight has become almost perfect. The change
is so great that many are disposed to question the identity of the
girl, and the father is frequently asked whether the girl is really his
own daughter, whose eyes were so disorganized.




CASE 3.

 _Inflammation, ending in Opacity of the Cornea in the right eye and
 Staphyloma in the left._


WILLIAM GRINDLEY, aged 37, boot-maker, formerly of 16, Whitecomb
Street, Pall Mall, East, now of St. James's Workhouse, states that he
was attacked with acute inflammation in both eyes in 1839. He at first
had the advice of private practitioners, and subsequently went to two
different Ophthalmic Hospitals. He remained in one eleven months, in
the other fifteen. It appears from his own account that his sufferings
were very great, for he asserts his eyes and eye-lids were swollen very
much. The treatment consisted in bleeding, cupping on the temples,
lancing frequently the eye and eye-lids; caustic was applied to the
eyes, and seatons to the nape of the neck; leeches. The patient had two
caustic issues in the temples; he was salivated, and had administered
to him various potent drugs.

On the 9th of August he was sent to me from the Board of St. James's
Workhouse, when he could scarcely discern light from darkness. He
said that he had been led about for the last three years. The left
eye was afflicted with staphyloma, and was perfectly opaque. The
cornea of the right eye was covered with a dense opacity, so much so
that no appearance of iris or pupil could be discerned through it.
The right was not so unnaturally prominent as was the left eye. The
vapour in this case was daily applied, and the progress of cure was so
rapid, that in the course of a month he was able to come to me from
St. James's without his accustomed guide. At Christmas he obtained
permission from the Board to be absent for a few days for the purpose
of visiting his wife and children. It was his wish to see the faces
of those near and dear to him; for in his former visits he could only
hear them talk, for not one glimpse of their countenances was he able
to obtain. The cornea of the right eye is rapidly becoming transparent.
The convexity of the left eye is still considerable, but the opacity is
so far removed as to give evidence that a continuation of the medicine
will render it again perfect, although it must take a considerable time
to effect so desirable an object.




CASE 4.

_Two cases of ---- Ophthalmia, ending in Opacity of the Cornea._


SARAH HOPPING, aged 15, daughter of Thomas Hopping, boot-maker, 20,
King Street, Drury Lane, and of the Blind School, Queen's Square, about
nine years ago had a violent attack of inflammation in both eyes. She
was taken to an infirmary, and remained there for many months, where
she became perfectly blind. She was afterwards taken to two Ophthalmic
Hospitals as an out-patient--one for six months, another three. The
treatment generally was lancing the inner eye-lids, and applying
caustic to both the eyes and temples, leeching and blistering both the
neck and temples often. The left eye was altogether opaque, and did not
show the least appearance of either iris or pupil when looking at it in
a strong light. The right eye appeared quite lost, for there was only
in the socket a small red tumour, about the size of a pea.

The vapour was applied, and at the present time the opacity is so far
gone that she can see to walk alone; but there yet remains much to be
removed.

Her sister Elizabeth, aged 12, was similarly affected, but the disease
had not attained to the same height. She is now almost well.




CASE 5.

_Case of Ophthalmia, terminating in an Opacity of the Cornea._


JOHN GADD, aged 31, of 16, Little Britain, bookbinder, states that
he has been blind and unable to guide himself for upwards of twelve
months, but for some months previously he felt himself gradually losing
the sight of his right eye. He went to an Ophthalmic Institution, and
in two or three days he was seized with a violent attack of ophthalmia,
which he attributed to the applications used for his recovery. He did
not know the nature of the ointment inserted in his eyes, but was
told it was black ointment. In ten days he visited another Ophthalmic
Institution, where he remained for two months. In this institution a
liquid was dropped into his eye, leeches were applied every night for
a week, issues were inserted in the temples, carbonate of iron was
administered for six weeks, and counter-irritants were applied to the
neck.

From this time he became quite blind. He then went to another
Ophthalmic Institution, where he was cupped in the temples; the eyes
were scarified, aperient medicines were given, and lotions used. The
inflammation still continued, and he was unable to lift his head, or
allow the bandages to be taken off his forehead, without experiencing
the most excruciating pain.

In this state he was brought to me on the 9th of September, 1840, when
I ordered for each eye two drops of the oil of almonds (after being
warmed) to be put into the eyes. The relief that he experienced was
so great, that he said he felt as if he were in another world. In
eight days the pain had greatly diminished. He was enabled to open
his eye-lids, but could discern no object whatever. I then ordered
castor oil to be dropped into each eye, for the purpose of removing the
opacity. He left me at the end of December, at which time he could see
very imperfectly; but returned to me in January, 1843, when the opacity
of the cornea still continued. He has had, almost daily, the prussic
acid vapour applied to his eye. He is at the present time so well that
he can read the smallest diamond print.




CASE 6.

_Opacity of the Cornea and Staphyloma._


GEORGINIA LARKINS, aged 10, at No. 25, Grafton Street, Newport Market,
and at the Blind School, Queen Square. Her aunt states that this
patient has been blind since she was six days old, in consequence
of an attack of inflammation, which gave rise to a great discharge
from the eyes. In her infancy fluids of various kinds were injected
underneath the eye-lids, and when four months old she was taken for
three years regularly to an Ophthalmic Hospital, where she was told
that the right eye was destroyed. The left eye had caustic applied
to it for a length of time thrice a week. Ointment was then applied
underneath the eye-lids until the eye became so very large that she
was at last told that it was a hopeless case, and that no more could
be done for her. Her next visit was to an eminent oculist, who said
he would not undertake the treatment of such a case. She then went to
another Ophthalmic Institution, where she remained for about two years
without deriving any improvement in her sight; but she was relieved
from much pain.

I saw her first on the 6th of April, 1840, when the appearance of the
left eye seemed to be at least twice the size of a natural eye. It
was of a dark-blue colour, standing out beyond the lids; and where the
pupil ought to have been, there was a blue circular ring of lighter hue
than the rest of the eye, and in the centre of this ring was a white
body about the size of a pea.

The right eye was quite a contrast, for it appeared perfectly white,
without the slightest appearance of iris or pupil. The eyes were
continually rolling about in their sockets. Looking at the little
creature, I said, "What do you expect me to do in such a fearful case?"
Without waiting for a reply, I said, "I will endeavour to diminish the
size of the eye, but unquestionably no hope can be held out that I can
restore the use of sight."

I at first put, daily, a drop of castor oil into each eye, occasionally
substituting for the castor oil the oil of almonds. This treatment
in about two months diminished much the size of both eyes, and the
opacity of the right eye greatly decreased; so much so that a little
edge of the pupil became visible, and the child began to see, and in
four months she could walk alone. Shortly afterwards the pupil could
be distinctly seen, and there appeared a white speck upon the anterior
capsule of the lens. She ceased to be a patient of mine in December,
1840, but returned in January, 1842, when the prussic acid was daily
applied to both eyes. The left eye is diminished about one-half in
size, and light is becoming perceptible. The right has assumed a
healthy appearance; the cornea is transparent, and there is still a
spot upon the capsule, about the size of the eighth part of the pupil.
This does not appear to impede the vision. She can now read, with the
eye, the raised letters with great quickness. She was formerly taught
to read the letters with her fingers; she is also learning to read
common print.

When the child came to me I had not had sufficient experience of the
effects of the prussic acid vapour, and I hesitated in using a remedy
of such acknowledged potency until I had, with great care, thoroughly
investigated its properties. This I have been engaged in doing for
several years, and I am now able to state, that in no case in which I
have used it has it been attended with any injurious effects either to
the eye or general health.




CASE 7.

_Staphyloma of both Eyes._


MARY ANN GOODMAN, aged 22, of St. Giles's Workhouse, and a scholar at
the Blind School, Queen Square, fourteen years ago was attacked with
violent inflammation of both eyes. To remove this she was subjected
to very active antiphlogistic treatment. The inflammatory symptoms
subsided, after which she was regularly led for five years to an
Ophthalmic Institution, at which place the right eye was operated upon
five times; in addition to which she was cupped three times and bled
from the arm twice; caustic was applied frequently to the inside of
the eye-lids; she was also blistered behind the ear and nape of the
neck. The patient was unable to walk about without assistance; if she
attempted to do so, she was knocked and jostled about.

On the 4th of March her friends brought her to me, to ascertain whether
I could do anything for her. I could not hold out to her any great hope
of recovery; for both eyes were affected with staphyloma, and perfectly
opaque and studded with blue spots, and standing prominently out beyond
the lids, and having no appearance of iris or pupil in either eye.

In the space of a fortnight the eye assumed a very different
appearance; each eye became greatly diminished in size. As the opacity
cleared off, a large triangular pupil made its appearance at the bottom
of the iris in the right eye, enabling her to see with the eye with
which, for fourteen years, she had not been able to discern light from
darkness.

The progress of cure in the left eye is fully equal to that of the
right; so that now she is able to walk about in the crowded streets
with safety, and is intrusted to lead about two or three other persons
in the Blind School. She can distinguish colours, and is able to
perceive large letters.

In such a state of disorganization as this poor girl's eyes were in, it
is unreasonable to anticipate that she can make much greater progress.




CASE 8.

_Inverted Eye-lashes, with Opacity of the Cornea._


DIANA PRIMROSE, aged 32, of No. 2, Benborough Street, St. Giles's, says
she had a violent attack, eight years back, of ophthalmia in both eyes,
accompanied with great swelling and constant discharge of matter from
the eye-lids, arising from the eye-lashes of both eyes being turned in.

She was an out-patient to one of the Ophthalmic Hospitals for two
years, but, instead of getting better, she became worse. She then
applied to another Ophthalmic Institution, where she was subjected to
treatment for four months, but no improvement took place. Three years
ago her sufferings prompted her to visit a third institution, when one
of the surgeons cut off the upper eyelid of the left eye, which gave
rise to great pain and inflammation, but the opacity was not diminished
nor the vision improved. She was obliged, during the eight years, to
have her eye-lashes constantly pulled out.

She visited me on the 28th of October, 1842, when the eye-lashes of
the right eye, both above and below, were still turned in, and rubbing
against the cornea. The eye-lids were exceedingly red; the cornea of
both eyes was nearly opaque, and only a small portion of the pupil
could be observed through the opacity. Her vision was so imperfect
that she could do little more than find her way about. She was often
confined to the house for a week at a time, through inflammation.

The vapour was only applied for the space of a week, after which she
could see much better. The opacity was greatly diminished, and the
eye-lashes began to resume their proper position. She continues to use
the prussic acid vapour three or four times a week, and at the present
time she is able to follow her occupations with comfort, and the eye
is resuming all the appearance of health. She never has had occasion
to pull one eye-lash out since I first saw her. She is now very
comfortable, and can see tolerably well.

This is the first case of the kind that I have treated with prussic
acid.




CASE 9.

_Conical Eye._


WILLIAM STEVENS, aged 25, at No. 20, Gracechurch Street, states that he
had been for several months at two different Ophthalmic Institutions,
where many modes of treatment were adopted to improve his vision; but
he was at length told they could do him no good, as the disease under
which he laboured was conical eyes.

When I examined him, in May, 1840, I found the right eye so prominent
that it had the appearance as if a large transparent bead had grown
from the cornea. With this eye he could see a short distance. The
conical state was not only greater in the left eye, but there was an
opacity on the apex of the cornea. He could see nothing with it, if the
right eye were shut, unless the objects of vision came in contact with
his face. He continued to visit me, professionally, two or three times
a week, for four months, and had a drop or two of castor oil put into
both eyes each time. This treatment greatly diminished the prominency
of the right eye, and lengthened the vision; but the left eye was only
slightly benefited by it, although all opacity had been removed, and it
had diminished in size.

In December last he again called upon me and wished to know if more
could not be done for him? He said he had continued to follow his
business with the use of concave glasses, but saw with great difficulty.

The vapour was employed thrice a week for about three weeks, when
his vision was restored to its natural length. I saw him on the 21st
of January, and he said he was perfectly well, and could follow his
business with great pleasure to himself.




CASE 10.

_Amaurosis of the Left Eye, and Cataract of the Right._


GEORGE TROUSDALE, aged 37, horse-keeper, 37, William Street, Hampstead
Road, says, that when he was 8 years of age, a shoemaker's awl was
accidentally pushed through the right eyelid into the eye, which gave
rise to an attack of severe inflammation in both eyes. When the
inflammation subsided he found the vision of the right eye entirely
gone. The left eye became dim in May last, and his sight was much
disturbed by floating clouds passing before the eye. When he looked
steadily at an object the vision almost vanished. He experienced great
pain in the forehead and temple on the same side.

He applied to an infirmary, where he remained as an out-patient for six
weeks. He was salivated, cupped, and leeched. He was then told that the
right eye was of no use, and they feared the vision of the left also
was destroyed.

He then went to an Ophthalmic Institution, where he remained as an
out-patient for seven weeks. He was again salivated; a liquid was
dropped into his eye regularly, and he was blistered, but no good
resulted.

He then went to a private oculist, under whose care he remained for
six weeks. He again was salivated; but still the sight became more
obscured, and the pains in his forehead and temple more acute.

I saw him first in October; he was then suffering from severe pain
in the forehead and temple. The left eye was so blind that he could
not distinguish, even when placed close beside it, a large bookcase.
He said he could scarcely guide himself in the street. The pupil was
almost immoveable. There was a white cataract in the right eye, and a
total want of vision.

He has had the vapour of the prussic acid applied to both eyes almost
daily since October. He can now, with the left eye, read ordinary-size
print, and is free from all pain. Nearly the upper half of the cataract
of the right eye is absorbed, and he is beginning to see with it. This
case shows the power of the acid in not only producing absorption, but
in the removal of amaurosis at the same time. Unless the capsule of the
lens had been lacerated by the awl, I do not think that the acid could
have had any power in causing absorption in a case of cataract which
had existed for the long period of twenty-eight years. He is still
under treatment.




CASE 11.

_Cataract._


MR. MONRO, aged 28, at No. 16, Featherstone Buildings, twelve years
ago, had violent inflammation, occasioned by the lash of a whip
striking the left eye, from which time he has been unable to see more
than the shadow of an object. He says that many have advised him to
submit to an operation for cataract, but others have recommended him
not to do so as long as one eye remained sound.

On the 16th of May, when he applied to me, I tried, as an experiment,
the vapour of the prussic acid, which was employed for about three
months. At the end of that time he could see different objects, and
discern countenances, when the other eye was closed.

Afterwards he went into the country, where he remained without using
any medicine. On his return to town, on the 18th of January, 1843 he
called upon me, when I found the eye was not improved in appearance.
He is now again under my care, and has had the vapour applied five
times. It appears to produce a very decided effect upon the vision. In
three or four parts the cataract appears as if it had been operated
upon with a couching needle.

This is a case of great interest, and it is impossible for any
unprejudiced person to doubt the great absorbent powers of prussic acid
in many diseases of the eye; but I am certain it will not be a general
remedy for lenticular cataract (unless employed in its incipient state)
without operation, unless aided by rupturing the capsule of the lens by
the needle first. Many are the cases where we want such a solvent power
after operations.




CASE 12.

_Amaurosis._


ANN WEEKS, of No. 19, Little Queen Street, aged 14, daughter of Thomas
Weeks, carman, 52, Great Wilde Street, has been blind in her right eye
since she was two years old. The left eye is unaffected. When two years
of age she was taken to an Ophthalmic Hospital, where various modes of
treatment were adopted for the recovery of the eye, until the month of
March, 1842, when she went to another Ophthalmic Hospital, where she
attended for six months, but received no benefit.

On the 16th of June the Rev. Peter Hall, of Long Acre Chapel, brought
her to me; and when examined in a strong light, with her face towards
the window, we could not perceive the slightest action of the pupil.
Mr. Hall and I tried her with a sheet of white paper, moving it before
her eyes several times, but she was perfectly unconscious of it. After
the eye was exposed to the vapour of prussic acid for a short time the
pupil acted slightly when exposed to light; and she was able, not only
to see the paper, but to take hold of it with her hand, and could walk
round the table when the left eye was shut. She continued the vapour
four or five times weekly for the space of six weeks.

When she left me the eye was so far recovered as to answer all ordinary
purposes of vision, although not quite equal to the other.

I have examined her to-day (Jan. 20, 1843), and find the improvement
continues.




CASE 13.

_Amaurosis._


FRANCES READ, aged 14, daughter of ---- Read, 71, Fetter Lane, and one
of the scholars at the Blind School, Queen Square. Her mother said that
she took her daughter to an Ophthalmic Institution until she was tired.
No good was effected. The parents of this case were unable to say when
the blindness first developed itself. She has always been able to see a
little with the right eye.

I was first consulted in this case in July, 1842, when the right eye
appeared to have some vision. The pupil acted under a strong light,
but very sluggishly. She could observe objects very indistinctly with
the left eye.

The prussic acid was employed almost daily, for three months, to both
eyes. The right eye recovered so that she can now thread her needle.
She is also learning to read.

Upon the pupil of the left eye the prussic acid does not appear to have
the least effect.

As a general rule, I have found that when prussic acid does not dilate
the eye, in amaurosis, much good is not to be expected from its use.
In such cases I am inclined to believe that the disease is caused by
pressure upon the optic nerve.

It is my intention to persevere in the application of the vapour to the
left eye, with the view of ascertaining whether the sight may not be
restored. I do not despair of success.




CASE 14.

_Congenital Amaurosis._


GEORGE PRITCHARD, aged 7 years, son of Edward Pritchard, cab-driver,
Black Bull Yard, Gray's Inn Lane, and one of the scholars at the Blind
School, Queen Square.

This patient has been totally blind from birth. His case has been
examined by almost all the eminent oculists of London, and has been
taken to several hospitals; but all the medical men, without one
exception, stated that they would not prescribe for him, as they could
do nothing for him.

He was brought to me in May, 1840, at which time the eye appeared more
than half sunk in each orbit, and the pupil, when exposed to the action
of strong light, was fixed and immoveable. In fact, he had not the
slightest perception of light.

Two drops of castor oil were put into his eye daily, for the space of
three months, before the pupil manifested a disposition to act. At
each successive month there was a visible change in the size of the
eye. When he left me, in Dec., 1840, he was not able to discern more
than light from darkness.

He has visited me since the month of April, 1842, and has had, once
or twice a week, the vapour of the prussic acid applied to his eye.
He is now so improved that he is beginning to distinguish one object
from another, and the eye is assuming a healthy appearance. From
the progress that this boy has made the last two months, I think it
probable that the medicine may ultimately effect much greater good.

The following letter was forwarded to me by H. Newnham, Esq., for the
purpose of publication:--

  "January 24th, 1843.

 "MY DEAR SIR,--Having, by the vapour of prussic acid, been nearly
 cured by yourself of an opacity of the cornea, which, for twenty years
 past, had rendered the sight of my left eye of little worth more than
 to distinguish light from darkness; and firmly believing that, when
 I shall be able to replace myself under your care, my sight will be
 perfectly restored; and having also, during my attendance at your
 house, witnessed the beneficial effects of this remedy on many other
 persons, the subjects of cataract, amaurosis, staphyloma, &c., I
 earnestly beg you will accept this testimony of my high opinion of its
 efficacy in these cases.

  "I am yours gratefully,

  "WILLIAM H. NEWNHAM, Surgeon, &c.

  "Late of Alton, Hants."

  "To A. Turnbull Esq., 48, Russell Square."

Extract from a letter of Professor Forbes, of King's College, Aberdeen,
Jan. 23rd, 1843:--

"I seized the first hour which I could command after receiving your
note to call on Milne, that I might see in what state he was, as I
had not heard of him for some time. I was also desirous of having the
particulars of his case accurately from himself.

"John Milne was a cooper, and in that capacity had gone with the
whale-ships to Davis's Straits and Greenland for sixteen years.

"In July, 1836, he was seized with a violent inflammation in one of
his eyes, which soon extended to the other. After two years he became
so blind that he could not walk with safety in the streets, and after
meeting with a severe accident from his want of sight, he gave up
attempting to walk out alone.

"He continued for more than two years in this state, always becoming
worse and worse in his sight. His eye-balls were covered with ulcers;
he suffered extreme pain, except when lying in bed with the room quite
darkened; and was at various times confined for six weeks without
being able to bear the admission of light into his room. During the
whole of this long period he was under medical treatment by different
surgeons without deriving any benefit, but, on the contrary, his case
seemed to become daily more hopeless. The only relief, indeed, which he
experienced was, he says, from the division of the blood-vessels, from
time to time, with which the eye-ball was covered.

"In these circumstances he was brought to you by a surgeon who had
attended him, and began, under your direction, the application of the
prussic acid vapour. This gave him immediate relief, and in six weeks
the whole ulcers had disappeared, light was no longer troublesome to
him, and he saw quite well to go about his business and to read.

"This was his state in autumn, 1841, at which time I first saw him, and
he continues equally well down to the present date. A slight opacity
in the cornea of both eyes still remains, and he cannot expose himself
to the blaze of a very bright day or to violent winds for a length
of time without experiencing a return of uneasiness. He is, however,
quite positive, that had he continued under your care for a sufficient
period, he would have quite recovered; and he has been planning a
voyage to London to have your additional advice. I discovered, however,
from him, that he has never got _the prussic acid of sufficient
strength_ since you left this; for it has never had the power of
bringing on the state of the eye which the strong acid did, and which
he found to be attended with so good effects. I have taken means to
get the acid prepared for him of the right strength, and hope that its
application will be as efficacious as he so confidently expects.

"N.B.--The patient Milne was brought to me by George Rainy, Esq.,
Surgeon to the Aberdeen Ophthalmic Institution."

Extracted from the _Lancet_ of December 31st, 1842:--

"PRUSSIC ACID VAPOUR.--Mr. J. C. Atkinson, of Romney Terrace,
Westminster, in a letter to the Editor, dated December 26th, after a
few prefatory remarks, writes on this subject as follows:--A patient,
aged 28, who had rather a severe attack of variola last May, became,
after the recovery, subjected to staphyloma, one of the sequelæ of that
formidable complaint. In this he was treated according to the approved
methods, both at two public institutions and by private practitioners,
for some months, without any apparent advantage, when I was applied
to; I instantly determined on a trial of the prussic acid vapour,
having read in your able journal an account of this new remedy some
time before. After fourteen applications the opaqueness and prominence
abated considerably, and the eye is now very serviceable, and nearly as
useful as the sound one, no inflammation or appearance of irritation
being observable. The plan adopted by me was most simple: the affected
eye, open, was placed over a two-ounce phial, containing about half an
ounce of the acid, while the patient's hand, properly directed, was to
retain it in the position that was thought necessary. The time occupied
in this operation was from five minutes to a quarter of an hour. The
eye became in a short time inflamed, the conjunctiva exhibiting the
appearance of deep injection, which gradually disappeared in a few
hours, but which was not accompanied by any pain. No paralysis of any
of the appendages of the eye has resulted from the application. Such is
the outline of the case. I feel assured that this remedy will prove a
powerful auxiliary in the hands of a surgeon-oculist."

Extract from the _Lancet_, of January 7th, 1842. Cases in which the
vapour of prussic acid was employed for the cure of Ophthalmic disease,
by Donald J. Maclean, M.D., Lic. Roy. Col. Surg. in Edinburgh.

"I have been induced, for my own satisfaction, (in consequence of some
observations made by Sir George Sinclair, who had witnessed its effects
on patients under Dr. Turnbull's care), to give a very extended trial
to the prussic acid in cases of ophthalmic disease which might be
considered suitable for its application, and desire that the results
of some of the cases should be submitted to the consideration of those
of our profession who may take an interest in the subject I have,
therefore, made out a report of the following cases. In our present
state of knowledge it is impossible to explain the _modus operandi_
of the prussic acid; it will be sufficient, meantime, to observe
accurately, and merely give the results of treatment. In what kind of
cases it will be found most suitable can only be determined by further
inquiry and experience. If, however, the results prove permanent, the
prussic acid must occupy a very high place amongst our remedial agents;
and, possessing stimulant properties of a peculiar character, it may
prove useful under many circumstances where diseases of the eye are not
readily amenable to ordinary treatment.




"CASE 1.


"J. MACKAY REAY, aged 11 years. Diffused opacity of the cornea, the
result of a protracted attack of scrofulous ophthalmia. The vapour
of strong prussic acid was applied, daily, for thirteen days, by
exposure of the eye to it, during which period the cornea gradually
got transparent. On the fourteenth day no remains of former opacity
existed, and the vision of that eye was perfectly restored.




"CASE 2.


"MARGARET MACKAY, Thurso, aged 12 years. Severe rheumatic ophthalmia,
of three weeks' duration. She complains of deep-seated aching pain in
the eye-ball, greatly aggravated in the evening and through the night;
no apparent disorder of the general health. The ordinary remedies were
used, viz., leeching, blisters, calomel, and colchicum: they appeared
to give no relief. The prussic acid was applied, daily, for about ten
days; the relief following each application was extraordinary; the pain
was trifling for the rest of the day. At the expiration of twelve days
the intolerance of light, the injected state of the vessels on the
sclerotica, and the other symptoms, entirely disappeared; and since
September the little patient has continued quite free from any symptom
of her former ailment.




"CASE 3.


"A girl, named MUNRO, from Mount Pleasant. Albugo of corneæ in both
eyes, the result of an attack of acute conjunctival ophthalmia,
which she had about two years ago, whilst residing in Dundee, where
various means were tried for her relief. Vision was almost completely
destroyed; she could not distinguish the outlines, form, or colours,
of objects presented to her. At her own urgent request, but without
holding out any prospect of her being benefited by it, the prussic acid
was applied, daily, for about six weeks.

"11th day.--She states that she can see some objects. The corneæ appear
more transparent. At the end of another week she was able (in the
presence of Sir George Sinclair) to state the names of some objects,
and to recognise, with accuracy, the colours of a variety of flowers
which were presented to her in order to test the degree of progress
that had been made. She can now walk out and home to her own residence
(a distance of a mile and a half from Thurso) without assistance.
The improvement continues to be progressive, and the corneæ are now
comparatively translucent.




"CASE 4.


"SINCLAIR SUTHERLAND, a labourer, aged 26 years. Staphyloma of one eye,
and occlusion of pupil in the other, from effused lymph. In the centre
of this there was a small opening which would admit the point of a fine
needle. The prussic acid was applied, daily, for about three months.
Felt great relief in the staphylomatous eye since its application; the
prominence of cornea diminished at least one-half, and though formerly
opaque, from repeated attacks of inflammation and ulceration, it is, at
this date, quite translucent. The effusion of lymph in the other pupil
has been disappearing gradually, and the pupil is now about four lines
in diameter. The patient is quite sensible of the improvement taking
place, and can now name various objects presented to him.




"CASE 5.


"MR. ALEXANDER MACDONALD, jun., merchant, Thurso, has suffered for the
last six months from an affection of the retina, characterised by the
following symptoms, viz., obscurity of vision, excessive intolerance
of light, and deep-seated pain in the orbit. The external appearance
of the eye is quite healthy, and the motions of the iris are natural;
ascribable, he says, to too great application to business, and night
reading: and, in many respects, the symptoms resemble those of
inflammation of the retina. The ordinary treatment of this affection
was resorted to with some benefit, and the eye kept constantly shaded;
but the deep-seated pain continued, and the patient was getting
uneasy. The prussic acid was applied, daily, for about six weeks. The
relief obtained was great, and at the expiration of one month all the
former distressing symptoms had totally disappeared; but I thought it
advisable to continue the remedy for some time longer. The patient can
bear a strong light with impunity, and exert his eyes on any object,
however minute, without uneasiness, and is now quite well.




"CASE 6.


"MRS. M'KENZIE. Capsular cataract of one eye, of three or four years'
duration. By way of experiment, the prussic acid was applied for about
five weeks, daily. Absorption of the diseased structure was slowly
taking place all this time; it has now entirely disappeared, and
vision of this eye is quite restored. The result in this case was very
satisfactory.




"CASE 7.


"MRS. M'BEATH. Suffered for many years past from a disease combining
the characters of conjunctival and sclerotic ophthalmia. The prussic
acid was applied, daily, for about three weeks, and at the expiration
of that time the redness and angry appearance of the eye disappeared;
the organ looked clear and healthy, and no pain whatever was felt. The
patient can bear a bright light without uneasiness, and is now free
from any symptom of her former ailment.

 "Thurso, Caithness, Dec. 20, 1842."

Extracted from the _London Medical Gazette_, of January 13th, 1843:--

PRUSSIC ACID IN DISEASED CORNEA.

  "_To the Editor of the Medical Gazette._

  "Perth, December 31st, 1842.

 "SIR,--If you deem the following case of diseased cornea, &c., worthy
 of a place in the _Medical Gazette_, I shall feel myself obliged,
 while I have the honour to be, &c. &c.,

  "G. K. H. PATERSON,

  "Surgeon."

"CASE.--M. J., æt. 29, of a strumous diathesis, has been repeatedly
attacked with inflammation in both eyes alternately, accompanied with
more or less intolerance of light, and pain of head, ever since she had
small-pox, about her ninth year: to relieve this her friends sought
various means, but without any avail, and on entering her eighteenth
year she became blind. The catamenia had never appeared before she
was twenty; and from that period onwards, till about four years ago,
menstruation had always been scanty, and attended with the usual
symptoms of dysmenorrhœa.

"On the 28th September, 1842, her eyes presented the following
state:--The right cornea transparent, with an unusual quantity
apparently of aqueous humour on the anterior chamber, so as to give
it externally a somewhat conical aspect; iris of a dark red colour,
and its pupillary edge contracted to the size of a pin-hole, and in
close contact with the capsule of the lens. No vision in this eye
remaining. That of the left cornea was all but opaque, from coagulated
lymph between its layers, with the exception of a small lucid segment,
at the upper and outer margin of its circumference; behind which, on
the eye being turned downward and inward, the pupil could be seen
contracted also, and of an oblong shape, along with a great increase of
aqueous humour in the anterior chamber, and the cornea, to external
appearance, much more bulged forward than that of the right. With this
eye she could only distinguish an object when it was rolled downward
and toward the inner canthus, on being passed between her and the light.

"This ill-fated woman being altogether an object of charity, her
friends solicited me to take up her case, of which I was not at all
sanguine. However, having previously perused, with much pleasure,
a brief extract by Dr. Turnbull, on the fumes of prussic acid as a
valuable remedy in certain diseases of the eye, I was led to make trial
of a few applications of it in the above case, according to his method;
and I must candidly confess, that ere long I was completely astonished
on observing the rapid effect it produced on the opaque cornea before
mentioned; more so, as the longer I cautiously and perseveringly
used it, the greater in proportion did the inspissated lymph become
absorbed, and the layers of the cornea, over a wide space, begin to
assume their natural transparency, as also in dilating the pupil to
a considerable extent; so much, indeed, that before one month under
its use, she could observe objects in a very different light, and ere
another had elapsed, she could find her way out of doors by herself,
and come to my residence for any medicine she required; since which
she has gone on gradually to progress favourably, without any more
applications, and the vision is now sufficient to enable her to go
about free from the dread she had before, or the use of a guide.

"During the use of this potent remedy, it struck me very forcibly that
the extract of belladonna might assist the case considerably (more
especially when one had reasons for suspecting adhesions to exist),
in keeping up a greater effect on the pupil than that arising from
the use of the acid, which every one will admit at once, who has seen
its powers depicted upon the human eye, to be only temporary, and,
I believe, still less so in disease of the cornea and iris than in
any other incident to such an organ. With such an object in view, and
after once applying the extract, smeared round the eye, at bed-time, I
soon found it to be also of considerable service, along with the daily
use of the fumes of the acid, which were both, afterwards, employed
assiduously in this manner, for the rest of the treatment.

"But in drawing my remarks to a close at this time, I cannot refrain
from saying less, in regard to the utility which is likely to arise
from this medicine, when properly applied, than that, in such a
similar case as I have stated, I would not for a moment hesitate
again in giving it and the extract of belladonna a fair trial, so
convinced am I now, after employing it pretty freely by itself, in
different affections of the same organ (in all of which more or less
improvement of vision was manifested), of its potency to remove many
of those formidable diseases of the eye, more especially that of the
cornea, which are so often the opprobium of our art. However, before
I have done, it is but justice to ascribe this noble discovery to Dr.
Turnbull, whose indefatigable research has not failed to find out
others, no less wonderful in their effects, as they are useful to
mankind; and for such he cannot but claim to himself the best thanks of
the profession at large."




CHAPTER II.

ON THE ACTION OF ESSENTIAL OILS, &C.


In October, 1835, a paper of mine appeared in the _London Medical and
Surgical Journal_, stating the beneficial action of a concentrated
tincture of capsicum for diseases of the eye, by rubbing it for a few
minutes daily over the forehead and temples with a sponge.

Soon after this I was induced to try what effect essential oils,
possessing powerful stimulating properties, might possess in removing
amaurosis and diseases generally of the eye. The formulæ which I use
are--

           EMBRO. CARYOPH. CO.

 ℞--Ol. Caryoph.
     -- Lavand           _āā_ Ʒiv.
     -- Cinnamom.         Ʒss.
      Sp. Vin. Rect.      ℥iij.
              M. Ft. Embro.

           EMBRO. PIMENT. CO.

 ℞--Ol. Piment.
     -- Rosmar.          _āā_ ℥ss.
     -- Cinnamom.         Ʒss.
     Sp. Vin. R.          ℥iij.
               M. Ft. Embro.

Finding great utility to arise from the use of the cloves and pimento,
it appeared by no means undesirable or hopeless to administer them
internally for the same complaints. In order to shield the pungency
of these oils I united them with calcined magnesia, which, by its
very strong affinity with these essential oils, forms a body nearly
solid, and thereby removes all pungency, warmth, and even smell; for,
in this state, it requires to be held in the mouth for a considerable
time before it produces any warmth or pungency. They are thus rendered
easily taken, in sufficient quantity, without heat or uneasiness.

Some children are the subjects of many diseases of the eye, producing
blindness from opacities, &c. I ordered the same to be made into a
powder, in which form it can be taken easily in any vehicle, without
exciting disagreeable warmth. The formulæ are--

      PIL. CARYOPH. C.

 ℞--Ol. Caryoph.
    Magnes. Cal.   _āā_ Ʒi.
    Ol. Cinnamom.   qtt. vi.
       M. Ft. Pil. xxiv.

      PIL. PIMENT. CO.

 ℞--Ol. Piment.
    Magnes. Cal.   _āā_ Ʒi.
    Ol. Cinnamom.   qtt. vi.
       M. Ft. Pil. xxiv.

The dose of these pills is one or two thrice a day.

Expedition is required in the making of these pills, otherwise it
becomes a solid mass, and unable to be formed into pills.

I have found an alcoholic extract of cloves and pimento, made into
pills with magnesia, equally efficacious.

      PULV. CARYOPH. C.

 ℞--Ol. Caryoph.
    Magnes. Calc.   _āā_ ℥i.
    Ol. Cinnamom.    Ʒi.
       M. Ft. Pulv.

      PULV. PIMENT. CO.

 ℞--Ol. Piment.
    Magnes. Calc.   _āā_ ℥i
    Ol. Cinnamom.    Ʒi
      M. Ft. Pulv.

The dose of these powders is from four to eight grains thrice a day.

In the making of these powders, the oil and the magnesia ought to be
well mixed and allowed to remain for half-an-hour, then reduce the mass
to fine powder, and keep it in glass bottles with stoppers.

These medicines, by their local application, increase the circulation,
and give a greater supply of blood to the deficient organs, and thereby
produce natural tone and power. They are equally useful in removing
chronic diseases, where thickening and opacity have taken place, by
rousing into activity the absorbent and nervous influence by their
stimulating power. Among many others possessing the same power, is a
concentrated tincture of pepper nigrum, ginger, &c.

The internal administration has been found much more serviceable in
chronic diseases of the eye, such as opacities, &c., than in amaurosis.

The manner of using the embrocations is, by rubbing the forehead and
temples with a sponge saturated with the liquid. This plan alone, kept
up daily, is beneficial; but the efficacy is more than doubled if
another sponge, with warm or cold water, is rubbed upon the forehead
for a minute afterwards. By this the energy of the medicines in
inducing a free circulation is greatly augmented, and greater warmth
is rapidly developed. The rationale, in my opinion, is, that the large
quantity of carbon in some of the essential oils, and its solubility
in alcohol, permits it, by the friction, to pass through the cuticle
and unite with the oxygen. As the oils are very insoluble in water, and
as the alcohol has a strong affinity for the water, the carbon is more
readily disengaged, and forms a union with the oxygen in the vessels,
and thereby produces heat and great activity of circulation. I have no
doubt that that is the reason why many bodies are so pungent, when put
into the mouth. I have only given two cases--viz., John Plunkett and
William Dale--as illustrative of the action of the essential oils.

It will be seen in the following extract from Tyrrell on the Eye,
"Functional amaurosis arises from a deficient supply of red blood." He
says--

"In these cases there always exists, I believe, a want of general
power and vigour of circulation at first; but in some instances of
long-continued affection of this kind, the local circulation never
regains its proper force and fulness; and the supply of blood is
inadequate to support the functions of the part, although the general
system recovers its natural tone and power."

I think this statement very correct, and therefore the embrocations
producing so much additional circulation, point out at once the
essential oils, along with the water, as its proper remedy. I here
quote Magendie, who corroborates the plan which I adopt--viz., the
medicines being most useful when applied to the forehead and temples in
amaurosis:--


EXTRACTS.

"Lectures on the Physiology of the Nervous System, delivered in 1836,
in the College of France, by Majendie."--_Lancet, April 29th, 1837,
page 186._

"The integrity of both the optic and the fifth nerves, then, is
indispensably necessary for the exercise of vision, which is lost
whenever either of these nerves is separately destroyed."

_Lancet, May 20th, 1837, page 279._

"Nervous pains of long duration and the greatest intensity have been
quickly removed by topical applications to the temporal region."

_Lancet, page 280._

"Amaurosis cannot be considered as a simple affection of the optic
nerve; at least, in the actual state of the science, it is generally
impossible to say that the fifth nerve has no connexion with the
loss of sight, and in many cases the connexity is evident. Hence
a rule which I invariably follow of addressing my remedies, in the
first instance, to some of the branches of the frontal nerve; and
I have frequently had the satisfaction of observing some of these
cases of incomplete amaurosis improve sensibly under the influence of
therapeutic agents applied to the fifth pair. I would go even further
and say, whenever you have a case of incipient amaurosis, commence
by acting on this nerve, for it is at once the most expeditious and
efficient method. I cannot, however, quit this point without assuring
you that no physician is capable of treating diseases of the eye
unless fully in possession of the facts I have just had the honour
of explaining to you. These facts are daily becoming more numerous
and more convincing, and already a considerable number of our younger
practitioners, who devote themselves to the study of diseases of the
eye, are fully aware of the immense influence of the fifth pair of
nerves over the exercise of vision."

_Lancet, page 281._

"To resume, then, what I have said concerning the sense of vision and
our several experiments, allow me once more to impress you with the
idea that sight can never be exercised in a complete and perfect manner
without a certain influence of the fifth pair of nerves; destroy that
influence, and you destroy vision. This is all we know upon the matter;
for up to the present moment we have been unable to determine how far
this influence extends, or in what manner it is communicated."


_Case of Amaurosis._

JOHN PLUNKETT, Mermaid Gardens, Hackney, formerly an attorney's clerk,
visited me in May, 1837, and stated that he had been blind and obliged
to be led about by his children for the last four years. For five years
previously his sight had been gradually diminishing. He further stated
that he was much troubled with floating images before his right eye, as
well as with clouds resembling animals, strange goblins, and sometimes
with flashes of lightning, vivid red, changing into light blue. One
great peculiarity of this miserable man's case was, that when he threw
back his head there appeared a stream of blood flowing from the top
of the right eye to the centre, where it formed into a circular pool
about the size of a split pea, but ultimately it became as large as a
shilling. It often remained a considerable time, and then diminished
gradually in red streaks. This was a matter of great alarm to him. He
had been at several Ophthalmic Institutions for nine years previously
to his visiting me. He has had electricity, tartarate of antimony,
blisters, issues, stramonium, mercury (until it produced dysentery),
and almost every kind of treatment that could be suggested, tried, but
to no purpose.

When I saw him the pupil was immoveable, and the eye dull in the
anterior, and very obscure. The left eye was destroyed. He could not
discern, in a bright light, the shadow of white paper when it was moved
between him and the light.

The compound embrocation of oil of cloves was used by rubbing it upon
the forehead and temples daily, and in the space of twelve days he was
able to discern objects and could touch them. In two months he could
put his finger through a ring when held by another person. He continued
occasionally under my care for about a year, during which time the
embrocation was regularly used. He could walk alone, and the eye was
generally useful, but he was not able to read with it. He could see
objects at the distance of thirty feet.

The last month he has visited me once or twice a week, for the purpose
of having the prussic acid vapour applied to his eye, to ascertain if
the sight could be restored sufficiently to enable him to follow his
occupation as a clerk. In this case an advantage has been gained. The
patient is now able to read a little, which, previously to the use of
the prussic acid vapour, he was unable to do.


_Amaurosis._

WILLIAM DALE, boot-maker, of 14, Clarence Gardens, Regent's Park,
visited me in July, 1837. He stated, that with his right eye, for the
last year, he could only discern light from darkness; and that for
several months before he was much troubled by clouds and spots floating
before his eyes. The evening gaslight produced a continued flashing
of light from his eye. The light looked as if surrounded by all the
colours of the rainbow.

He first went to an Ophthalmic Hospital, where he was blistered on
the temple and salivated. Nux vomica produced such an effect upon him
that all his limbs were involuntarily twitched, so as to alarm them
exceedingly. He then left, and went to another institution for three
months; and at length was told that the optic nerve was injured, so
as to render a restoration of vision impossible. The left eye, when
looked into, had a dark green, muddy hue, and the pupil was exceedingly
dilated and immoveable. He was unable to distinguish an object placed
before his eyes; yet he states that he could distinguish light from
darkness.

When he applied to me I had the compound embrocation of pimento applied
occasionally to the forehead and temples, by means of a friction
sponge. During the first month he was able to discern objects and
colours. The pupil acted under the impression of light almost equal to
the good eye. It was not until this application had been used for a
year that the patient was enabled to read with the eye.

I saw the patient this day (the 25th of Jan. 1843). The eye, upon
examination, appeared to be in a healthy state. The sight was not so
good as when he left me, and after he left off the applications, but
this he attributes to the circumstance of his general health not being
good, owing to his having suffered from intermittent fever.

       *       *       *       *       *

In January, 1834, I published the first edition of my work upon
Veratria, and gave an account of two cases of amaurosis, combined with
tic-douloureaux, cured by the external application of veratria. I
there suggested that it was probable that amaurosis, uncombined with
tic-douloureaux, might be removed by applications of a stimulating
nature to the branches of the fifth pair of nerves. No notice of this
suggestion having been taken by medical men, I determined to put the
plan into execution, and employed a surgeon to carry it into effect
in St. Giles's Workhouse, where blind cases were given me for that
purpose. I here extract the case of Eleanor M'Cartney, for the purpose
of showing the power of capsicum when rubbed upon the forehead and
temples. I select this case of amaurosis for several reasons; she was
the first patient on whom I tried the efficacy of capsicum. She had
had, seven years previously, a stroke of palsy, which removed all power
of the right side. The only power recovered was that of the right
arm. The hearing was perfectly gone; and she had not had the least
perception of sight for seven years. It is now nearly eight years
since her recovery; and, at the present date (27th of Jan. 1843), she
can read perfectly well; and has never had another application since
the three first days. It will also satisfy the minds of many that a
recovery by stimulating applications of this description, is not of a
temporary nature.

I here quote the case as given in my work on "Painful and Nervous
Diseases," page 131.

"ELEANOR M'CARTNEY, aged 40, an inmate of St Giles's Workhouse,
was attacked, seven years ago, with palsy of the right side, when
perception of light and sound, in the right eye and ear, was
extinguished. There was a constant and profuse flow of tears, and the
pupil was immoveable.

"The treatment commenced on the 19th of October, 1835, and was
continued for three days only. On the first day after the commencement
of the treatment there was a great abatement of the flow of tears, and
she could perceive light and light-coloured objects. On the second day
she could see a watch, and direct her hand to it, and distinguish the
palm from the back of the hand. On the third day she could distinguish
objects with great facility. There was no further application of the
remedy after the third day. On the fifth day she could read a duodecimo
prayer-book with ease. On the seventh day the flow of tears ceased, the
pupil moved readily, and her sight and hearing were perfect. She is
still an inmate of the workhouse, and may be seen on application to the
matron, Mrs. Bailey."

The next case which I select from the same work is that of ALEXANDER
CRUIKSHANKS, Esq., of Strathcathro Castle, Forfarshire. When this
case came under my care he was undergoing the necessary preparation
for an operation for cataract. The peculiar difference in the removal
of cataract without operation is, that the person afterwards needs
no cataract glasses, as will be seen from the extracts of two of Mr.
Cruikshank's letters to the author. It is now seven years since his
recovery, and he is at the present date perfectly well.

"March 8th, 1836.--My right eye was affected with dimness, or defect of
vision, so long ago as the year 1810, and commenced by the deceptious
effect of seeing two objects distinctly where there really was but one.
This deception of double vision gradually disappeared as the vision
of the eye became imperfect. The other eye was not affected until
about four or five years ago. The affection of this, like the other,
commenced and continued, with the double vision, until Dr. Turnbull's
remedy was continued six weeks, when it totally disappeared. The right
eye, by this time, was restored to such a healthy state, that I could
read 'Blackwood's Magazine,' or the leading article of a newspaper,
without glasses, and the smallest print with them. By the way, it may
be proper to mention that it was not till July last, 1835, that I
ascertained, beyond question, the nature of the complaint with which I
was affected. In that month I applied to an eminent oculist, who, after
two examinations, informed me the complaint was cataract."

       *       *       *       *       *

"May the 10th, 1836.--I am favoured with your letter of the 3rd
instant, intimating that you had heard it reported that the benefit I
had derived from your treatment of my eyes had disappeared. The only
person with whom I have had any communication on the subject is my
friend, Mr.----, whom I informed that the remedy was applied to my
forehead and temples, by friction only, without your having prescribed
or administered one grain of medicine, or having confined me to the
house, or directed the slightest change in my former habits of living,
either as to drink or diet; and that my sight was good enough to read,
write, fish, shoot, and to see a pin on the floor at the most distant
corner of an ordinary-sized room. What more can, or ought, a man of 67
years of age wish for in this respect? But if any are sceptical as to
your mode of treatment, let them produce a testimony like this of a
superior method.

  "My dear Sir,

  "Yours very faithfully,

  "ALEXANDER CRUIKSHANKS."

  "A. Turnbull, Esq., M.D."

The only other case which I intend to quote, in order to show that the
recoveries are lasting when the essential oils have been employed,
is the case of Dr. Kent. This gentleman continues perfectly well.
It is now nearly seven years since his recovery. He had, alternate
days, rubbed upon his forehead and temples, with the friction sponge,
the compound clove and pimento embrocation, quoted from page 136, on
"Painful and Nervous Diseases."

[Illustration: Friction Sponge]

The following case was communicated to me, by letter, from the patient,
DR. KENT, who was for several years a physician in extensive practice
at Walsall, in Staffordshire, now residing in Harley Street, Cavendish
Square.

  "39, Duke Street, St. James's,
  "April 19th, 1836.

 "MY DEAR SIR,--Thinking that an outline of the principal features in
 my case might be perused with advantage by many who take an interest
 in the success of your efforts, I have subjoined it in as concise
 a form as justice to the subject would admit. Upon my return from a
 very cold ride in a violent storm of snow and sleet, on the evening
 of the 29th of January, 1836, I discovered that the sight of my right
 eye was gone. In a few hours violent inflammation supervened, and
 continued several weeks, in spite of the most vigorous and energetic
 treatment, its principal seat being the optic nerve, and subsequently
 the iris. The inflammation was at length overcome, but vision was
 not restored; and the irritability in both eyes was so great as to
 render it absolutely necessary not only to avoid all attempts to use
 them, but also to exclude them from the light. The sight of the right
 eye was entirely, and, as I feared, irrecoverably gone; its pupil
 contracted almost to the size of a pin's point, and immoveable. I
 removed to the country, by the advice of the professional friends who
 had attended me, in the hope that, as my general health improved, the
 irritability would subside, although they gave me no reason to expect
 that the organ, originally diseased, would ever again prove of much
 use to me. In this opinion a medical gentleman of high celebrity, in
 Oxford, coincided; but he strongly recommended me to consult some of
 the most eminent oculists in the Metropolis. A much esteemed friend
 having mentioned your success in the treatment of many obstinate and
 almost inveterate cases, I placed myself under your care on the 2nd
 of April, and had the satisfaction to find, that after the lapse of
 three or four days, a very considerable alteration was observable in
 the appearance of the right eye, and that my perception of light, and
 afterwards of objects, became more distinct. The improvement has been
 regularly progressing, and I am now (the 19th of April) able to read
 with ease with that eye which, only three weeks ago, could scarce
 distinguish light from darkness. I may also add, that the irritability
 which so long annoyed me, ceased almost immediately after your first
 application, and I have not since been troubled with it.

  "I am, my dear Sir,

  "Yours, very sincerely, and much indebted,

  "BENJAMIN ARCHER KENT, M.D."

  "A. Turnbull, Esq., M.D., &c. &c."


    THE END.




    CITY PRESS, LONG LANE: D. A. DOUDNEY.




  FRICTION SPONGE.

  See Plate, page 66.




  _Preparing for Publication_,

  In One Vol.


  SUGGESTIONS

  FOR AN

  IMPROVED TREATMENT OF THE
  DISEASES OF THE HEART
  AND LUNGS, &c.

  BY A. TURNBULL, M.D., EDIN.




WORKS BY THE SAME AUTHOR.


Price 6s. boards.

ON THE MEDICAL PROPERTIES OF THE NATURAL ORDER RANUNCULACEÆ; AND MORE
PARTICULARLY ON THE ALKALOIDS, VERATRIA, SABADILLINE, DELPHINIA, AND
ACONITINE.

"In our last number we expressed a hope that the experience of others
might confirm that of the author, promising at the same time that we
should communicate the result of our own trials. It is unnecessary
to assure our readers that on this, as on every other subject of
professional inquiry, our minds have not been biased either by
prejudice or partiality. Truth and justice are ever the only guides of
our conduct.

"We are satisfied that the medicine exerts a very peculiar effect as a
counter-irritant; it seems to differ from all others in this respect,
that its operation is confined solely to the nerves of the part, the
blood-vessels being scarcely affected.

"It is therefore our decided opinion that Veratria is a useful and
very potent medicine in certain nervous affections, and that it
deserves to be, and no doubt will become, an established member of
the Materia Medica."--_Editorial Remarks on Veratria, Dr. Johnson's
Medico-Chirurgical Review, July, 1834._

"I have often cured most successfully cases of Tic-Douloureux of the
face, by sprinkling small blisters, made in the course of the affected
nerves, with one or two grains of Veratria, and repeating it every
three or four days. I use the same means, and with equal advantage, in
cases of paralysis. I need not add, that in these cases the application
should be made in the course of the facial nerve."--_Majendie's
Formulary, 8th edition, 1835._

"I have now made a very considerable trial of the Veratria ointment as
an external application in gout, and with such share of satisfaction
in its effects, that I acknowledge myself much indebted to the work of
Dr. Turnbull for the possession of a very useful remedy.

"My conclusive opinion of the action of the Veratria ointment in gout
is, that we may consider it to be entirely a local remedy. I have not
detected any constitutional effects to be produced by it in any case of
gout in which I have prescribed it. Probably the absorbents of a part
affected with gout are in a torpid state. It is no small praise of the
application, that it does not produce any inconvenient effects, and the
patient is pleased with its mode of operation."--_Sir C. Scudamore's
Principles of the Treatment of Gout, 1835._

"Veratria has, since the last year, become so important a medicine,
having been recommended first by Dr. Turnbull; and now fairly ranking
among the most salutary ingredients in Materia Medica, it must
naturally be of great interest to the pharmaceutical and medical world
to obtain so valuable a substance in its purity."--_Silliman's American
Journal, April, 1836._


Price 3s. 6d. boards.

ON THE PREPARATION AND MEDICINAL EMPLOYMENT OF ACONITUM NAPELLUS AND
ITS ALCALOID ACONITINA.

"Aconitine will cure a local pain where every description of depletive
and counter-irritant has failed."--_London Medical Gazette, Nov. 5,
1836._

"Dr. Turnbull's work will be read with great interest by persons
afflicted with neuralgia and other painful diseases. The profession
is certainly indebted to him for drawing the attention of the
public to an important, very potent, and much-neglected class of
substances."--_London Medical Gazette, April 1st, 1837._

"As a topical remedy, aconitine is most valuable for the relief of
neuralgic and rheumatic pains. In neuralgia no remedy, I believe,
will be found equal to it. One application of the tincture produces
some amelioration, and after a few times use it frequently happens
that the patient is cured. In some cases the benefit seems almost
magical.--_Pereira's Elements of Materia Medica, vol. II., page 1808._

"Of the great efficacy of aconitina in neuralgic and rheumatic
affections, no one can entertain any doubt who has submitted the remedy
to trial."--_Pereira's Elements of Materia Medica, vol. II., page 1812._

_Aconitine, discovered by Geiger and Hesse, in Aconitum Napellus and A.
Ferox._--Our knowledge of this base is very limited. There is reason
to think, from the experiments of Dr. Turnbull, either that the plant
contains two bases, or that the aconitine of Geiger and Hesse is an
_altered product_.

"Dr. Turnbull has succeeded in producing, but with difficulty and in
small quantity, an aconitine possessing in perfection all the active
properties of the plant. It produces _numbness_ of the _tongue_ when
applied to it, and is said to _contract the pupil_, whereas Geiger's
aconitine _dilates_ it. In obtaining the aconitine of Turnbull, much
appears to depend on the freshness of the plant; and the alkaloid
itself is easily decomposed, especially by alkalies.

"As a remedy in neuralgia and similar painful and obscure diseases,
the aconitine of Turnbull possesses most valuable powers. Could it be
obtained at a reasonable price, it would be extensively employed. At
present, however, only one manufacturer has been able to obtain it,
and that in small quantity. The aconitine of Geiger and Hesse does not
appear to possess the same action on the system.--_Turner, Leibeg, and
Gregory's Elements of Chemistry, 1842, page 1167._


CORRIGENDA.

In part of the impression the following errors occur:--

  Page 37, line 14, _for_ "28" _read_ 8.
  Page 38, line 15, _for_ "months" _read_ weeks.

       *       *       *       *       *

Transcriber's Notes

Obvious typographical errors have been silently corrected, other
variations in spelling and punctuation remain as in the original.

The original began with an unidentified illustration. This appears
to be the Friction Sponge referred to at the end of the book. The
illustration has been placed on page 86 where its use is described and
a caption has been added.

In the heading of CASE 4, "Two cases of ---- Ophthalmia, ending in
Opacity of the Cornea." ---- represents a word crossed out in all
available copies of the book.

The first of the corrigenda has been implemented, the second had
already been corrected in the original.







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