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AN  ESSAY
OPHTHALMIA,
INFLAMMATION OF THE EYES.
          BY ELIJAH GRIFFITHS,
                  mm
ONE OF THE PHYSICIANS OF THE PHILADELPHIA ALMS-HOUSE,
  AND HONORARY MEMBER OF THE PHILADELPHIA MEDICAL
  SOCIETY.
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            PHILADELPHIA:

TRINTED FOR THE AUTHOR BY HUGH .MAXWELL, NO. 25, NORTH
      SECOND-STREET, OPPOSfTE"' CHRIST-CHURCH.

               "l804. ' 
/ 
AN INAUGURAL DESSERTATION

               FOR

           THE DEGREE

               OF

 DOCTOR  OF MEDICINE:
              SUBMITTED

           TO THE EXAMINATION

                 OF THE

REVEREND JOHN ANDREWS, D. D. Provost,

              (pro^tempore),


                  THE

    TRUSTEES, AND MEDICAL PROFESSORS

                 OF THE

       UNIVERSITY OF PENNSYLVANIA,

    i.»N THE FIRST DAY OF JUNE, ONE THOUSAND EIGHT
             HUNDRED AND FOUR. 
4 
TO THE
  PROMOTERS OF MEDICAL SCIENCE,
                       IN
           EVERY PART OF THE WORLD

     This  Essay is inscribed as a tribute of esteem,
 or their laudable exertions in alleviating the unavoid-
able miseries of mankind : also, for improving their
health and happiness, as far as human means can go to
attain those objects.

                        THE AUTHOR. 
 
PREFACE.
     In the following pages I have endeavoured to
give a short account of Ophthalmia,  its causes,  and
the method of cure.
     In the first part of the essay, I have made a few
observations on the laws of animal life; then the  dis-
ease is described;  afterwards the causes, both gene-
ral and local, are considered: and the method of treat-
ing it concludes the essay.
     I have  omitted giving the an atom}- of the  eve,
as that subject must be familiar to the medical reader;
and to most others it would be too unintelligible to be
interesting. 
 
PRELIMINARY OBSERVATIONS.
     PREVIOUS to treating of Ophthalmia,  I shall
 make a few observations on the laws of animal life.
     There is in the animal body a capacity to be
 acted on by various stimuli, by which all the motions
 of life are supported.  This susceptibility to take an
 action, upon the application of stimuli, has been called,
 by Doctors Brown and Rush,  " Excitability."
     It appeal's to he governed by the following prin-
 ciples, viz,. Stimuli, when applied in an exact ratio
 to the excitability of the system, produce regular and
 healthy excitement, whilst an increase or diminution
 of usual stimuli, produce debility.   This debility is
 called indirect when caused by the former, and direct
 vyhen caused by the latter.
     Debility from either  of the above mentioned
causes, is soon succeeded bv an increase of excitabi-
                       2 
10
lity.   The excitability is by no means alike in every
part of the body, when in this accumulated state; but
is in proportion to parts previously debilitated by the
action of the remote cause: hence the irregular or
morbid excitement that  follows  the application of
stimuli in this state of the system.*

           * See Professor Rush's Inquiries, vol. 4. 
11
DESCRIPTION  OF THE DISEASE.
     The patient first complains of itching in the eye,
succeeded by pain and redness.  The latter is owing
to the vessels, which, in their healthy state, admit but
serous, being now distended with red blood.
     When the inflammation, though it be consider-
able, is seated in the superficial  coats and vessels of
the eye,  the  patient is seldom feverish, nor does he
experience much pain, or suffer from loss of sleep;
the light is not very distressing to him, for he gene-
rally follows his usual avocations without much incon-
venience.  But  when the choroid coat, retina,  and
vessels distributed to the  humours  of  the  eye,  are
much aftected, the patient suffers exquisite pain from
the admission  of light  to the now highly  excited
organ. He is distressed by a frequent and deep-seated
pain,  shooting from the eye into the head, accompa-
nied by soreness in the parts around the eye. 
                       12
    There is more or less fever present, with loss of
sleep, restlessness, and  sometimes delirium.
     It  frequently happens that the vessels of  the
tunica conjunctiva, are  so much enlarged as to en-
tirely destroy its membranous appearance, and make
the cornea appear as if it were depressed, forming the
Chemosis of authors, so common in Egypt.
      The secretion from the lachrymal gland,  is not
only  increased  in quantity,   but  is  so  altered in
quality  as to become quite acrid,  and thereby keep
up the inflammation*
    When the disease is violent, and cannot be relieved
either by nature, or art, the inflammation increases to
such a height as generally to terminate in blindness,
either by the effusion of  coagulable lymph between
the laminae of the cornea, so as to produce opacity
 of that coat,  or into the  crystalline lens, forming
the disease called Cataract,  and  sometimes by the
 effusion of pus into the chambers of the eye.  When
 a small quantity of pus is  effused in the anterior
 chamber*  it is  called  Onyx: when a  large quantity,
 it is called Staphylom.
      The pus sometimes causes  the  iris to  adhere
 to the capsule of the crystalline lens, and thereby
 renders the iris motionless: the extravasated matter,
 at other times, adheres to the edge of  the iris, round
 the pupil, in such a manner as to form an opaque body 
                        13
in its place,  and completely obstruct  the  passage of
the rays of light to the retina.
     I deem it unnecessary to go into any further
detail on this subject, as it is very fully treated of by
Messrs.  Ware,  Edward  More  Noble,  and other
learned writers on the diseases of the eves. 
14
CAUSES OF TB[E  DISEASE.
    Having, in the preceding pages, considered this
disease as an inflammation of the eyes, we infer, that
the causes which produce  it are such as bring on
inflammation in other parts of the body;  but from the
peculiar sensibility of that organ, and its consequent
p-reater susceptibility of inflammation, stimuli, when
applied  to  it, produce greater irritation than in any
other part of the body.
     The causes of Ophthalmia may  be divided
into general and local; the latter I believe are the more
frequent of the two.
     The  general causes are such as affect the eye
through the medium of the whole system.
     It is a well  known law of the animal economy,
that disease  always  attacks the  weakest part,  and
the eve,  whether labouring under previous debility, 
15
  or not, may, from its organization, be considered one
  of the weakest parts of the body.
     It would be no very difficult matter, to shew that
  inflammation  of the eyes frequently depends on the
  usual causes of fever.   Who has witnessed the ra-
  vages of the Yellow Fever, without marking the red
  or muddy eye, both depending on  inflammation of
  that organ?
      The inflamed  and watery eye,  in measles and
  small-pox,  are so familiar to every body, that  it is
  only necessary to mention them to recall the painful
  sensation.
      Hippocrates, long  ago  speaking of the Epide-
  mics  of Thasus, says, many persons were taken ill in
 the spring,  "  First  of all appeared humid Ophthal-
 " mias, with weepings, pain, and indigestion.   Little
  "  concreted matter broke out with difficulty on the
 " eyes of many persons,  returned again in most, and
 " went away at last about autumn."*
     Thucydides, speaking of the plague of Athens,
 (one of the most fatal on the records of medicine)
 says,  " Others who were  in  perfect health, were
 " taken suddenly, without any apparent cause,  with
" violent heats in their heads, and redness  and in-
" flammation in their eyes, "f
    * Hippocrates on Epidemics, p. 56.
    f Hippocrates on Epidemics, p. 96. 
                        16
     In Mr. Ware's valuable work on the diseases of
 the eyes,  I  find  the  following observations,  " It
 " (Ophthalmia) frequently comes on in the most sud-
 " den and unexpected manner, without any preceding
 Li or concomitant illness.   When it happens in this
 " way, the common people call it a blast in the eyes :
 " and,  indeed, it seems to proceed from some pecu-
 " liar property in the air that  surrounds  us.   Like
 " other epidemical diseases, it often affects  a whole
 "' neighbourhood at the same time, as was the  case
 " during the summer 1778, at  Newberry, in Berk-
 " shire, and in several of the camps, where it was
 " called the ocular disease."*
     In Sir Robert Thomas Wilson's History of the
 British Expedition to Egypt,,  he says,  page  304,
 " The  Plague commences  in Egypt when the  Nile
 " begins to fall, and ceases  to be fetal (almost  to a
 " day,  many  pretend  precisely so) after the  17th
 " June, which is the period of summer solstice, and
 " when the Nile  is supposed to receive the first in-
 "■ crease."
     The same author says, page 310, " The period
" no sooner  arrives when  Egypt for a  season  is
" relieved from the Plague, than another  malady
tc succeeds immediately,  distinguished by the name
" of Ophthalmia."
    * Ware on OphthaJ.my, p. 17. 
                        17
     In page 313, he says,  " Ophthalmia and Dysen-
 " tery are evils,  generating and expiring together."
 Although Sir Robert  makes the above observations,
 he does  not suppose Ophthalmia, Dysentery, and
 Plague to originate from the same causes; the former
 he attributes to foreign matters floating in the atmos-
 phere, coming in contact with the eyes.
     Mr. Power, one of  the  regimental  surgeons,
 belonging to the  English  expedition  to Egypt,
 ascribes  Ophthalmia,  Dysentery,   eruptions on the
 skin, and ulcerated sore throat, to the same virus
 which cause the  Plague.  He, however,   supposes   ,
 these  various affections are produced by the local
 application of the virus to the eye,  skin, throat, and
 other parts affected.
     Doctor Rownd, of this city, has politely favoured
 me with  the following information, viz. that he has
 several times seen ophthalmias prevalent in the sickly
 parts  of Maryland and  Delaware  states, where  he
 practised  medicine for many years.
     The doctor has  not been able to trace the disease
 of the eyes to any local cause peculiar to that coun-
 try, or an evident irritation offered to die eyes.
    The  Ophthalmia does  not prevail  at the season
 of bilious fevers, but either precedes or  succeeds
those fevers.
                         3 
                       18
     In addition to the above respectable authorities,
I beg leave to observe, that several persons afflicted
with violent ophthalmias came under  my own  care
the last autumn ;  in none of them was I able to dis-
cover  that any  injury had been  done  to the  eyes.
The patients  were labouring men, in the  vicinity
of this city,  and had been exposed to all the usual
causes of autumnal fevers.   In every  case fever was
present,  and  they were cured by general and local
depletion.
     Having concluded the general, I shall now men-
tion a few of  the local causes of  Ophthalmia, which
are  all such  as produce inflammation when applied
immediately to  the eyes.  These  are  injuries  from
external violence, acrid substances*coming in contact
with the globe of the eye,  viewing the sun or other
luminous bodies, sudden transition from a dark to a
lighted room, with many others.*
    * It is not my  intention to speak of Sjrphalitic  or Scrophulous
 Ophthalmia. 
19
TREATMENT OF OPHTHALMIA.
     Our prescriptions in this complaint, as in every
other, are to be regulated by the "state of the system,"
and  the  remedies accordingly adopted to  the force
of the disease.
     If the patient  labours  under much fever, and
complains of pain about the head and temples, and
the inflammation of the eyes be violent, bleeding in
as large quantities as his strength will admit of, should
be practised.   In the use of this inestimable remedy,
we are to be guided principally by the pulse and the
violence  of the  disease.   To specify what quantity
of blood it would be necessary to draw,'would appear
idle to the practitioner of medicine, who prescribes
according to the  " state of the system," and not the
name of a disease.  Bleeding should be done as near
as possible to the part affected; in urgent cases the 
20
temporal artery, or one of the external jugulars, may
be opened in preference to vessels more remote from
the eyes.  The application of cups to the temples and
adjacent parts, should never be neglected, as they sel-
dom fail to have the most salutary tendency.  Leeches
may be repeatedly applied, and the nearer they fix to
the parts inflamed, the greater will be the benefit re-
sulting from their employment.
    Another method of bleeding called scarification
of the eye ball and lids,  is eminently entitled to our
attention, as by it, blood is  drawn immediately from
the inflamed vessels-  Some have started objections
to this practice, by supposing that the irritation offered
to the inflamed organ, more than counterbalanced the
benefit derived from it,- but from much experience,
I can  confidently assert the contrary.  However it re-
quires confidence and care,  to perform the operation
with advantage to the patient.
    The next indication is to attend to the  state of
die alimentary canal r costiveness, when present, is to
be removed, and obviated afterward.  At the head of
cathartics,  I wrould place calomel  and jalap; these
may be followed by saline  purgatives,  as sal. glau-
beri, crem. tart,  or phosphat soda.  After the excite-
ment  of the system is considerably diminished by the
above means, nitre and  tartar emetic  may keep the 
                        21
 bowels in a proper state of laxity, and assist in over-
 coming the remains of inflammatory action.
     The diet of the  patient is also an object of our
 attention.   It ought to be purely vegetable,  void of
 spices and fermented liquors, taken at short intervals,
 and in small quantities.  I can readily conceive, that
 great abstinence, approaching to a state little short of
 starvation,  may rapidly diminish the  morbid excite-
 ment in the vessels of the eyes, by creating a  more
 painful sensation in the stomach.
     The remedies next in importance to those alrea-
 dy mentioned, are blisters.   These should be applied
 to the temples, behind the ear,  on the forehead so as
 to surround the eye, and sometimes all over the head.
 Whether they act by creating a discharge, and there-
 by diminish the inflammation, or by exciting a coun-
 ter action and overcoming the morbid one present, I
 shall not determine.   My object is only to enforce the
 necessity of their application.  They should be kept
 running for a considerable length of time, by frequent
 dressings with epispastic, and other stimulating oint-
 ments.
    If there be a probability of the disease continuing
for some  time, a drain in the back of the neck,  by
means of a seton,  would be advisable; as it will greatly
benefit the patient, by the steady discharge kept up
in the part. 
22
    As light is a stimulus directly applied to thieve,
the necessity of abstracting it becomes urgent in pro-
portion to the violence of the inflammation.  For this
purpose  Messrs. Ware and Edward Moore Noble,
recommend the patient wearing a pasteboard hood,
so as to defend the  eyes from  the admission of the
rays of light.  There can be no doubt but this expe-
dient may have a very salutary effect,  and will  en-
tirely obviate the necessity of bandages and pledgets,
that by pressing on the inflamed organ, must increase
the complaint.
     But I am of opinion that all we can expect from
this remedy may be obtained by confining the patient
in a dark chamber,  which has the additional good
effect of taking off the stimulus of exercise and thereby
diminishing arterial action.   This practice should be
stricdy adhered to through the whole of the disease,
although it should last for weeks.
     It often happens that we are disappointed by all
the above remedies in not  removing the complaint.
When this is the case, we should resort to the use of
mercury, and continue the exhibition of it until a sali-
vation is excited.  Calomel, corrosive sublimate, or
the blue pill, may be given in moderate quantities so
as not to affect the mouth too suddenly, or to bring on
too profuse a ptyaiism.  More advantage will be
obtained by keeping the patient under a moderate sali- 
23
 vation, which can be continued longer without doing
 so much injury to the system.
     If the patient is very restless, and the pain very
 acute, notwithstanding the  inflammation be violent,
 opium may be administered with the happiest effect.
 I know that many  practioners would consider such
 prescriptions  improper,  but the testimonies  in  its
 favour are so numerous and respectable, that I, with-
 out hesitation, recommend its use.
     In the Opthalmia peculiar to Egypt, where the
 inflammation  is so violent as to produce a  perfect
 chemosis,  Mr. Power used it with the greatest suc-
 cess.  Sir Robert T. Wilson also speaks of its utility.
 Sonini when  in  Egypt, laboured  under a  violent
 Ophthalmia, and was cured, in a short time,  by a
 decoction  of  poppyheads.   In confirmation of the
 above I may  add,  that  the same medicine has fre-
 quently proved serviceable in my own practice.
     When treating of the general causes of inflam-
 mation of the eyes,  it appeared probable that the epi-
 demic cases there mentioned, depended on the usual
 causes of  febrile diseases; hence, in the management
 of Ophthalmia, the physician ought  to have an eye
 on the reigning epidemic,  and to the season of the
year, in order to accommodate his  remedies to the
State of the patient. 
                       24
     A variety of applications have been recommend-
ed to be made use of to the eyes, and are to be found
in the works of every author on this subject, to men-
tion them all, would be of little use to the reader, and
would far exceed the limits of my essay; beside many
of them are inert, useless,  and  improper.   Those
only which are in most esteem, among modern sur-
geons, will be attended to.
     A moderate degree of cold is serviceable in all
active inflammations,  and particularly so in that of
which we are treating.
     The best method of  applying it is by frequently
washing the eye in cold water, or by applying pledgets
of fine old linen, wet with cold water, to the eye, and
changing them very often for fresh ones.
     The mildest application that can be made use of
when the inflammation is  great, is an infusion of the
pith of '■„  sassafras.   This appears to act merely by
sheathing the eye from the acrimony of the tears, and
removing any foreign matter that might irritate it.
     After the inflammation is a little reduced,  a weak
 solution of saccharum saturni in rain or river water,
 may be applied to the  eyes.   Should the application
 give pain, the strength of the  solution is to be reduc-
 ed.  Vitriolum album,  or  the  sulphate of  zinc,
 ranks high  among the external remedies for Ophthal- 
                          25
  mia.   A  weak  solution of it,  applied to the eyes,
  sometimes has the happiest effect.
       " I have found i^ the thebaic tincture," Mr.
  Ware says, (London Dispensitory) "wherein opium is
  " the principal ingredient, to be eminently service-
  " able; and the mode in which I have applied it, has
  " been to  drop one drop of it into the eye once or
  " twice a day, according as the symptoms were more
  11 or less violent.  When first applied it causes a sharp
  " pain,  accompanied with a copious flow  of  tears,
  " which continues  a  few minutes,   and  gradually
  " abates;  after which a great and remarkable degree
  "  of ease generally succeeds.
      " The inflammation is  often visibly abated  hy
  " only one  application of this tincture; and many
  " bad cases have been completely cured by it in less
 " than a fortnight;  after  every other kind of remedy
 " had been used for weeks,  and sometimes months,
 " without any success."*
     Mr. Ware goes on to remark that this remedy
 is not always equally successful and speedy; for  in
 some it is slow in its effect.  While in a few it alto-
 gether fails.
     In  cases of long standing, a weak solution of
sublimate has been applied with great advantage to
the patient.
              *  See Ware's Remarks, p. 43. 
                        Z6
      Mr. Thomas Moore  Noble has recommended
 the application  of water to the eyes as warm as the
[ patient  can bear it.  The sa/ne gentleman also ad-
 vises a weak mixture of spirits of wine and water to
 the eyes; but as I have never had an opportunity of
 using  either of these  remedies, I cannot say any
 thing for or against their utility.
      I  have seen slow inflammation of the eyes very
 much relieved by a weak infusion of galls ; to which
 a small quantity of brandy had been added. -
      I have thus concluded a short essay on the causes
 and cure of Ophthalmia. I think no other apology for
 its imperfection necessary,  than its being the effect
 of necessity, and not choice, to fulfil a law of the
 university.
                               THE  AUTHOR. 
 
 
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