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Conical cornea. "The discharge of the [aqueous] humor is
equally [useless] in this case, & so are all applications
to arrest the disease. I have found repeated blisters 
& the more powerful tonics as steel or arsenic decidedly 
serviceable. To these may be added cold bathing, & the 
practice of often opening the eyes in cold spring water.
I am unable to say whether a section of the cornea, as in 
as traction would be productive of benefits. It has occurred
to me as not improbable. The disease however is 
constitutional I must be so treated. The Techular spulade
frame with a pupillar assertive, I have found to
afford more aid in correcting the vision them our form 
of lens.” Traven Shyness. P. 286. 



Contents 
Page
Introduction - 1
Simple Inflammation of the Eye - 7.
Puriform Ophthalmia - 12.
Pustular Ophthalmia or
Poor Ophthalmia - 17.
Stumous Inflammation of 
the Conjunctiva - 20
Purulent Ophthalmia - 32
Nebula - 44
Fungous Conjunctiva - 50
Granular Conjunctive - 57.
Eneanthis - 57
Pterygium - 58.
Various other morbid States of 
the conjunctiva, as the formation
of folds connected frænum
tumors- warty excrescences &c } 63
Inflammation of the Sclerotica 69.
Ulcer of the Cornea - 72.   

Page
Conical Cornea - 88
Inflammation of the Iris - 91
Sequelæ of Inflammation of 
the Choroids} 113 
Inflammation of the Retina 116
Amaurosis - 119
Hydrophthalmia - 141
Suppuration of the Eye ball 142 
Diseases of the Vitreous humor 144
Fungus Hæmatodes Oculi - 152 
Carcinoma of the Eye - 157 
Cataract - 161
Diseases of the Appendages 
Tumors - 199
Strabismus or Ptosis - 200
Varicose Tumor - 201 
Hordeolum - 203 
Lippituds, Tinea Ciliaris, Crusta tactea - 206 
Trachealis & Ectropium - 209
Fistula Lachrymalis - 215   

On the Diseases of the Eyes.
The diseases of this organ are but little 
familiar to the men best of the Profession 
at layers notwithstanding the labors
of several eminent men as Mr.
Pall Scarpa. Saunders fr. The reasons 
why, this has been the case are 
eugy obvious & natural. It is to be 
attributed to the circumstance that 
the exclusive treatment of those diseases 
for belonged to persons who have not 
enjoyed the advantages of a liberal education 
They have anguised a degree of 
manual dexterity, thereby engrossed
the greater part of the practice to the 
exclusion of others, but they have not 
practice according to Scarified principles.
I do not mean to make this 
Remark without some exceptions.
There have been several oculists who 
have given to the profession, many, 
valuable observations on these diseases 

The diseases of the Eye are like the diseases  
of all other organs. The general 
nature of them is the same they 
have nothing, peculiar & the separation 
of them is unnatural. It is 
like deciding the [branch] of a tree from 
its [trunk].
But you will say that disease in the 
eye is modified by its particular 
structure. Granted - & so is disease of 
the Skin off the other organs. But 
all modification of Structure are 
only someday considerations, the original 
morbid action in the same. 
Inflammation is always the same whatever 
part of the body, it may attack: 
therefore, the diseases of the eyes are only 
to be properly comprehended by persons 
who have been well educated & who are 
competent judges of disease on consequence
of such education. And they are 
extremely important on amount of the 
importance of the Eye to all the purposes 
of Life, & therefore deserve must consideration 

3
consideration also on account of the facility 
which it affords of witnessing 
the diseases of morbid action, which 
has always been the subject favorite 
subject of modern physiologists.
To afford a comprehensive view of the 
diseases of the Eyes, & to give a facility
to the learner, some mode of Classification 
should be adapted that which 
I shall employ will be according to the 
different textures of the organ. First, 
I shall speak of the conjunctiva & its 
diseases, then the Sclerotica, the Choroid 
coat & Katina then the different Humors 
in succession & the Chrystalline
Lens. From the globe of the eye, I shall 
proceed to its appendages the Orbital
plates & parts contiguous – the palpebra 
lachrymal passages &c.  
It must be obvious to you, gentlemen, 
that it is only the simple & elementary 
forms of disease, which admit 
of management & a methodical plan 
of treatment. The ultimate changes 

of it are so numerous, diversified 
& complicated that they defy, arrangement.
These last depend upon various 
causes upon the length of time 
which it has excited - upon varieties
of Constitution &c. To attempt therefore 
an arrangement of these secondary 
forms is unnecessary, as well as 
impossible, because they are so endless 
In studying the pathology of any 
organ, it is necessary, to pay, any minute 
attention to it, in order that we 
may be able to separate the symptoms 
descendant upon its minute structure  
from those dependent upon a general 
cause. By separating there simple from 
general symptoms, we learn the seat & 
character of the disease, & the tendency of 
the morbid action is illustrated, Chemises
is in example of this. It has been set 
down by writers as an appearance common 
to inflammation of the eyes when 
in an advanced stage : where as it is an  

5.
appearance peculiar only, to the 
supperative inflammation of the 
conjunctiva.- To also [Hemurania]  
This has been laid down as dependent
upon a general cause, where as it is a 
symptoms which belongs to inflammation 
of the interior Tunics of the eye. 
The samples of this Kind are very numerous
but it is not necessary, to 
multiply them.
Our treatment must be founded according 
to the nature of the diseased 
action foresent in an organ. Some 
inflammations are local & other constitutional 
some attach the organ itself, 
others merely, its integuments. 
Some are acute & belong originally,
to the stherice class, others are chronic 
even from their commencement.
Before speaking of the diseases of 
the conjunctiva, I shall just point 
out the anatomy of it. Besides lining 
the membrane of cycloids &c it dips 
into the puncta lachrymalia, & lines 

6.
the lachrymal said, the nasal ducts, & 
is thus connected with the Shneiderian 
membrane which lines the fauces- 
Upon the interior part of the tarsus,
it adheres very closely. Its attachment
is more loose upon the palpelsa In 
the orbit of the eye till it approaches 
the cornea. It is a mucous membrane 
& possesses a texture in common 
with the membranes of that class- it has 
properties similar to them & its morbid 
affections are the same. There however 
vary a little according to their situation.
They are different upon the base or 
visible hemisphere of the eye, then when 
it advances nearer upon the cornea  
on this part, the circulation is absolutely
serous or colorless, & therefore, when inflammation 
takes place on it, it is more like 
inflammation of the serous membranes.
It is everywhere transparent & extremely 
sensible.- The colorless vessels are infinitely 
numerous as is seen in inflammation 

7
inflammation. In general, the distribution is reticulated, 
but this depend upon the 
looseness of the subjacent cellular membrane, 
for are find that there is much 
less frequent anastomosis, in proportion 
as it advances to the cornea, where 
it adheres more closely. Then there are 
old or meshes are seen much more frequent 
towards the palpebra, & towards 
the Cornea, the vessels parsec a straighter
course. The Veins be much more 
specifically, they are extremely tortorous
& convoluted & of a purplish colour.
Of Simple Inflammation 
of the Eye.
This most commonly arises from simple 
irritation local. The inflammation
is always accompanies with a 
slight elevation of the conjunctiva from 
the turgid state of, its vessels, which causes 
a sensation of weight. It seems to 
the patient, as if the globe of the eye uses 

8.
too large for its socket. A man of 
an irritable habit of body, will suffer 
more sympathetic pain from a 
very, slight injury of the eye, than an 
other of a stronger habit from a must 
more violent one. for the same with 
the Constitutions symptoms. 
The Eye may be raid, if I may be allowed 
the term to be a Capillary, organ, 
& altho’. it is highly vascular, the 
constitution when it is inflamed does 
does not take ingridame of it, unless 
the inflammation is so established or 
to threaten its own safety. Therefore, give 
so often lower inflammation of the eye very 
secure, without being accompanied 
with fever.-
The predisposing & occasional causes of 
Aphthalmia are the same as those of other 
Inflammations. They are often caused 
by the state of the system , & particularly 
that of the digestive organs. It is 
the predisposing cause of inflammation 
of all Kinds. I was never the subject of 

inflammation of the eye but once, & 
that was after I had been confined a 
fortnight with a broken shin from 
which I suffered much constitutional 
irritation. I was soon afterwards 
exposed to Cold & a severe attack of Pustular
ophthalmic followed it.
The Exciting causes are very commonly 
A draught of air blowing upon it 
Thro’ a chink &c. changes of temperature, 
& a peculiar state of the atmosphere, 
which contributes to render inflammation
of the eye frequent & 
sometimes epidemic.
By duration & unchecked violence 
of the inflammation, it may extreme 
to the internal Tunics & produce Suppuration, 
Amaurosis & cures complete 
disorganization. But there are 
uncommon, & do not happen but 
from neglect.- The ordinary Terminations 
are the following. Œdema or 
effusion of serum into the cellular Texture 
beneath the conjunctive, protruding 

10
in a circular sac around the 
cornea This may be considered the 
weakest as well as the first termination
of inflammation of the conjunctiva. 
It commonly stops here.
The 2). Is a termination in adhesive 
inflammation, as a diffused deposition 
of lymph into the cellular connection 
between the conjunctive & cornea 
producing appearance more or less 
dense, & presenting all the chads of difference
from a mottled speckled appearance 
to complete haziness, which 
is term & nebula.
The 3) Pustules on the conjunctiva 
covering the cornea, which consist in 
a circumscribed deposit of lymph with 
pus in the centre. It is the adhesive inflammation 
running into the suppuration 
form, I most commonly a superficial
ulcer of the cornea is the result of 
it. The conjunctive is to the cornea
what the periosteum is to the bone, & 
when it is denuded of it, it will ulcerate.  

11.
Purgatives combined with local & 
general bleeding are the best remedies. 
Of the former, I prefer Calomel
combined with neutral salts. This 
has the effect of increasing the secretions. I must 
from the chyls pactic viscera, & none 
is more useful in repelling inflammatory 
action.-
Many people think that Warm application 
as Collyria are inferior to cold.
I must confess, that I generally prefer 
the mild & warm. I am generally governed
in this respect entirely by the 
comfort & feelings of the patient. Paper
perfectly with scrape who has written 
very well upon this as well as other 
subjects, that they should not be long 
continued. There is a point , where the 
vessels continued turgid, not from inflammation,
but from the effects of it 
not from obstruction, but from a 
want of power, the arteries are in a state,
in which they are unable to unload 
themselves. In such a condition 
of the membrane, they are bad applications. 

12. 
applications. At such a time, which is indicated
by subsidence of pain, we should 
substitute astringent Collyria, as the   
super Acetat. of Lead largely, diluted 
R. Sup. Acetat. Plumb. Gr x
Ag. Ros.  ℥is vel vj th
If Alum is employed, it should not be 
stronger than from 1 grain to two to the 
ounce. 
When the conjunctives covering the cornea 
is affected, with any of the morbid 
[ terminations] changes of termination, 
it is not necessary, to say, that the 
treatment must be proportionally more 
vigorous, & as long as the symptoms exist 
it should be continued.
Of Piriform Ophthalmic 
This is a very frequent & well marked 
form of ophthalmic. It is properly
speaking ophthalmic of the palpeha  
& it affects the Tunica conjunctiva by 
continued Sympathy. It has various
names applied to it. It is the same disease 
as the Poor ophthalmy.
It is an inflammation of the mucous 
portion of the conjunctive, & is in a condition 

condition resembling the nares in a catarrh 
& the urethra in a gonorrhea, & like them
it is attended with a puriform discharge
The natural secretion from the Meibomian
glands is a transparent mucus which 
is diffused over the eyes, in order to render 
its motions more easy. The exhalents 
from the surface of the eye secrete a fluid 
for the same purpose. There secretion 
when the actions of the vessels are altered, 
by inflammation are converted into 
a fluid, resembling pus, which continues 
to flow from both, until the inflammation 
is subdued, when they 
are again brought back again to the 
natural healthy mucus. 
This disease is like gonorrhœa thro' the 
medium of its matter of a contagious
nature. This is proceed by, its spreading
from one person to whole families &
schools, which circumstance has often 
been obscured at our Infirmacy.
This inflammation is not of a violent 
or disorgarishing character. It is a 
mild tractable disease. It is quite the 
reverse of active, being of the atonic 

14
Kind. The Sensation of foreign particles 
in the eyes, is always a predominant
symptom. In light & particularly that 
of a candle produces very considerable 
irritation & uneasiness. The conjunctiva
covering the orbit, is not renders very vascular 
but on the eye, lids the blush is of 
a despise color. The edges of the Lids which 
are discovered to be the seat of the disease. 
are often rendered quite spoke by the vascularity.
They are generally Tumid & in a 
protracted state of the disease, the conjunctiva 
of the eye is rendered villous, 
but [chemosis] is never produced.
A yellow mucus is secretes from the lids 
by which they often stick together in the 
morning after sleep. The borders of the 
tarsi are frequently excoriated in consequence 
of the continued acrid discharge 
running over them. This leads to an incipient
states of Lippitudo. When the 
inflammation has continued sometime, 
this secretion is thrown out from the tarsi, 
the thinner parts evaporate, & a nest is 
formed remaining round the Celia. The removal  

of there, causes little ulcers, & 
tinea is the consequence- 
This is a disease of Strumous habits. It
is generally attended with a disordered 
state of health & in a great degree, it 
is a constitutional disease. An affected 
of the other mucous membranes at the 
same time is by no means uncommon 
It is most frequently found among the 
lower classes of people. In the children 
of such who are poorly nourished, & 
thereby, weakened & unhealthy, speaks
tinea thickened eye- lids ulcers of the 
necks & ears & various cutaneous diseases 
are extremely uncommon.
Like all other affections of the mucous 
Membranes, this after being cured is 
extremely liable to a relapse, & when it 
subside into this chromic state, it is often 
very obstinate & intractable. A defective 
or vitiated. See action from the 
Meibomian glands is often a primary 
disease & is met with in the better 
ranks of society. It is accompanied 
with a peculiar sensation of stiffness,

16.
dryness & a ful of weight upon the 
upper eye lid, there is also great in 
tolerances of candle light, & an agglutination 
of the lids during sleep.  
The treatment of this disease is only the 
antichloristic plan in moderation 
It should be carried to such an extent only 
as to moderate the inflammation, 
without producing, debility. You should  
begin early, with weak astringent Lotions
& Ointments as the ointment of 
Sully as the Unguent. Oxyd. hydras.
Nitrat. But in a very, dilutes state.
When the disease is approaching to a chronic 
state, the palpebral may be scarified
with great advantage, & the strength 
of the ointment may be increased. at 
the same time it will be well to exhibit 
the lighter form of toniest, especially the 
Acids, they will often prevent a relapse 
In that form of the disease which appears
to result from a relaxed state of the 
vessels, where there is no change of texture 
but only a morbid secretion from the 
glands, one drops op the Thebaic tincture 

17
let fall occasionally, into the eye, was 
particularly recommended by, Ware 
Stimulants may, unquestionably, he 
often used with efficacy in this state 
but this has no advantage over atheist
the fault is that their use has been for 
indeterminate. Mr. Ware, before his 
death, made some qualifications in 
regard to the use of Thebaic tincture 
The scarifying of the lids, he has found
of great advantage. 
Of Pustular Ophthalmia.
The inflammation sometimes goes on 
In the conjunctive, till a pustule is 
formed in the margin of the cornea 
or some other part of the membrane 
It is small & conical. a single fasciculus
of vessels is seen running thro’ it 
& stermmating in a little pennicilli 
at its apex. The character of this inflammation 
is marked by the remaining
portion of the conjunctive being 
colorless & free from vessels. 
There is often a sort of elevation of the 

18.
of the part & a peculiar arrangement 
of vessels, manifesting, a disposition 
to pustule before it is formed; by, which 
an experienced practitioner is enabled 
to anticipate its approach. 
Often the lymph which is deposited in 
the centre of the pustule is absorbed without 
ulceration being produced. When it 
does not a small ulcer follows. Sometimes 
two or three pustules follow from 
the same fasciculus of vessels, sometimes 
a zone of pustules appears forming a 
complete circle round the cornea. 
The pustule stops at ulceration. By the 
continuance of inflammation, it becomes 
diffused, the characters are lost, & 
the symptoms op heat, prickery pain  
immobility of the eyes & I profuse flow 
of tears come on.
When the disease is of long duration
& the patient is of strumous habit of 
body, secondary pustules often follow 
upon the conjunctive of the 
cornea, & go on until they become is irritable 
ulcers.  

19.
The inflammation of pustular ophthalmia
is of the Atonic Kino, & therefore, in
your treatment of it, you should avoid 
the use of drastic purges. The antiphlogistic
plan must be adopted, but it shouts 
be used only according to the nature of the 
inflammation. Won’t persist in the expiration 
of Calomel purgatives. Your indication 
must be to diminish irritability
without depressing power. Your best 
remedies are Pela. Hydroy. & Sulph.
Bragnes: athematic. Blisters are of 
great service in shmous inflammation 
of all Kinds. You should begin 
early with weak astringent lesions;
if there is much pain, they should be 
at the same time of a soothing nature. 
Tonics should also be early employed, 
taking care that they do not increase
action. Is a word you must heat it 
altogether as a device from a weak 
constitution.  

20.
Strumous Inflammation 
of the Conjunctiva.
This is characterized by intolerance of 
light. It affects those persons mostly 
who have the marks of Scrofulous habit 
& especially children & young people. 
Intolerance of light is a symptom
of all inflammation of the eye, but 
in this Kind, it is the most predominant 
symptom. The eyelids are immoveable
by any effort of the patient, 
& when they are opened, his features are 
convulsed from the pain which it occasions. 
His head is constantly carried 
between the shoulders & inclined to the 
side from which the light enters. When 
an attempt is made to open the eyes, 
the patient writhes about from the agony 
which it produces. The orbicularis 
palpebrarum seems to be spasmodically 
contracted, the globe of the eye 
is drawn upwards & outwards, or that 
the fore–part of this is mostly concealed 
behind the upper eye-lid.

If the patient is an adult & can exist
sufficient resolution to open his eyes, 
you will observe, that he at the same 
time depresses his lower jaw, & the angles 
of his mouth. This is very familiar
to those who are in the habit of 
seeing much of this disease. The patient 
seems to have no power over 
the [locator] palpebræ, or at least 
not enough to enable him to raise it. 
Some little address is required in opening 
the eyes of the patient in order 
to examine them. If it is a child,  
it will be best to place the head between 
the Knees, & carrying the finger 
over the orbit, the skin of the superior 
palpebra should be embraced
with its point & raised. If this is 
not managed skillfully the tarsus    
is very apt to be everted. The lower 
lid can be depressed in the same manner
by the fore finger of the other 
hand. 
Is the Idiopathic strumous ophthalmia 

22.
ophthalmia, which is peculiar to children 
you find intolerance of light to an
exceeding great degree, the patient 
is never easy, except in the most 
total darkness, he buries his eyes 
in the pillow of his bed or in the lap
of his mother, & there appear to be 
the only natural means of obtaining 
relief. With all this, the inflammation 
of the conjunctiva is but inconsiderable, 
nor do the internal membranes
seem to be inflamed.   
Some have supposed that the Retina
was the seat of this disease, but that 
it is not is proved by the vision being 
completely unimpaired after its removal. 
I am disposed to consider it as a 
morbid irritability of the, membrane 
dependent upon the state of the alimentary
canal with which it sympathies.
There are always more or less
disordered by worms, sorder &c during 
the presence of this affection. And a 
parallel circumstance which serves 

23.
to prove it’s the propriety of this opinion,
is the state of remote morbid Sympathy 
existing lecture on there & other 
parts: the stomach during an unhealthy 
state of the bowels often rejects foods 
& the ear is effected with unusual sounds.
The Inflammation accompanying 
pustules of the eye in weak habits, is precisely
of the same character. There is excessive  
irritability before the healing process 
is affected. There is an extreme [dep??] 
of action with deficient powers.-   
When the strumous disease has been in 
existence sometime, it terminates in 
a peculiar spaiety of the cornea, resulting 
from a gradual deposition of 
lymph, equally diffused over it, or from 
a thickening of the conjunctiva itself 
which covers it. Is this stage of the 
disease, the natural appearance of the 
cornea is totally changed its lustre is 
gone, it looks glared, like the eye
of a lead person. The vision is completely 

completely eclipsed. The cupely of the conjunctiva 
overshoot the margin of 
the cornea, advancing in radic upon 
it about 1/5 its surface. This is peculiar 
to the advanced stage of strumous 
ophthalmic. With this then 
is also a peculiar appearance of 
the cornea which has been termed 
herpetic. It has a mottled appearance 
numerous small yellow 
points seem to be sprinkled over its 
surface. This irregularity, this 
of vessels is peculiar to strumous 
ophthalmia. The great intolerance 
of light in this inflammation 
seems to defy, to retard, to pervert the 
disposition forwards healing.
Some authors think that the cornea 
is inflamed under these circumstances: 
but it is really difficult to say 
whether it is true or not. We can sell 
it this exists in parts which do not 
admit of red vessels. Those which are 

25
seen on it, seem all to proceed from 
the Tunica conjunctiva. We should 
hardly say, that the finger nail
which admits no red vessels was inflamed,
altho’ we might readily admit 
it in more soft & vascular 
parts. The cornea to be sure, seems to 
partake of the disease, but I attribute
this to its long duration only; 
The conjunctiva is undoubtedly the 
primary seat of it.
I have Known the cornea to be so 
clouded over in strumous ophthalmia, 
or that the ins & pupil were 
completely obscured, & upon the clearing 
away of the opacity, complete 
amaurosis was produced. I was    
then surprised at finding do fatal 
a change, when I was, not so familiar  
with the disease as I am at present.
This care reminds me of an 
Other circumstance which particularly 
demands your attention. This 

26.
is that strumous ophthalmic is entirely 
unaccompanied with pain,
& this fact frequently illustrates the 
nature of the disease. The same is observed 
with respect to this inflammation 
in other parts of the body 
it is everywhere marked by a dulness 
of sensibility, & the pain is slight in comparison 
with that of other inflammations. 
The necessity, therefore of examining 
the eye frequently in order 
to ascertain the nature of the disease, 
for we are not as in other ophthalmia
informed of its progress by pain 
Paints are in general very anxious
about intolerance of light in this disease,
& regard it as a dangerous symptom 
But it is not so. I have Known 
it to last twelve months, so that a curved
spine has been brought on in case 
by the constant habit of leaning forward, 
& yet the child recovered perfectly
of the ophthalmic. I never saw a 

case, in which the vision was impaired, 
if the cornea remained transparent, 
& the inflammation was 
confined to the conjunctiva.
The Treatment of this disease requires 
a delicate degree of discrimination 
Your indication is to check inflammatory 
action, without producing 
an enfeebling effect. all the secreting 
surfaces are disordered, the tongue 
is dry & covered with a white fur, 
exhibiting the red points of papilla
erect thro’ the fur. This has been called  
the straw berry tongue. The skin is 
dry & parched. Now you find the treatment 
of this disease so difficult, 
that it is hard to hit upon the right remedy 
at first, & you are obliged to try 
one after the octree. I cannot mention 
any one certain cure. But I will 
paint out what appears to me the proper 
indications, & perhaps this is all 
that should be done in a Lecture. 

28. 
The particular application of these 
indications you must make for 
yourselves. 
I believe you will relieve intolerance
of light best, by producing a gentle 
increase of the secretions generally 
a moderate diaphoresis must be 
brought on. The medicines which I have 
found most efficacious are the 
Liquor. Ammon. Acct. combined with 
Ain. Antimon. & to children, a little 
syrup of poppies should be added. 
Or sometimes small doses of Ipecacuanha
Conp. will answer very well 
or what will be still better small doses 
of Calomel & opium in order to 
produce an action at the same time 
upon the bowels & intaneous pores 
The syrup of poppies is best vehicle 
to administers [Calomel] opium to children
Local applications are of but little service.
Warmth seems to nourish
morbid sensibility & should on this account 
never be used in any way.
But I will not disease topical application 

29
applications in all cases. Fumigations
with Laudanum in boiling water, 
will sometimes give complete relief.
I believe that Sedative & Cold applications 
are preferable to all others.
But in this as in all other cases where 
the system is wrong; they are but of 
little use.
It is very important to attend to the 
Dietetic treatment. Attention should 
be paid to the nutrition of the patient 
to Air & Exercise. The combined effects 
of these produce much good. The chamber
should be large, well ventilated
& totally dark. But the light should 
never be kept out by bandages over 
the eyes. There are always hurtful.- 
With regard to local applications, 
there is one which is of considerable 
efficacy. I should never be omitted. 
This is a blisters in intolerance. There 
is no topical remedy upon which 
I place so much reliance. I have   
Known it to produce almost immediate
relief in a bay laboring under. 

30.
under complete intolerance. This 
throws some light upon the nature
of the disease. They may be kept 
discharging for several days. Perpetual 
blisters are of no service.
Oculists have been in the habit of applying 
Stimulants to the Eye, & tonics 
internally. But there is little encouragement
to do it. When however 
medicines have been administered 
so as to operate gently upon the 
skin & bowels, you will find tonics 
of singular service. The best of these 
are the Acids & Infusion of Roses 
The Solution of the Oxy – muriate of 
Mercury is a food tonic. It should be 
given in the proportion of about 1/16 
of the grain, three times a day. Sedative,
& tonics combined, have sometimes a very 
excellent effect, as the Exhort of Bark 
& Humulus, & several others. But 
these should only he employed
when the intolerance becomes chronic 
I don’t advise you to communes them  

at any time, they ought to form 
the sequel of the treatment. 
All acrid & raw vegetables should be 
avoided. The diet should be stimulant, 
but not heating. The bed clothes
also, should be looked to, they ought 
not to be too warm & heating. If the 
season of the year permit, tepid 
salt water bathing should be used. 
The seas air will afford peculiar advantage.
When the cornea is undergoing a change 
of structure, topical bloodletting & 
leeches should be freely used. Under 
these circumstance, there is only one 
remedy upon which we can rely, & 
that is mercury. It should operate so 
as to excite ptyalism, & this should be
kept up for some time, till some 
change taker place upon the cornea 
The Hydragyrus P. Creta is a very 
good form for children. It excites
the action of the absorbent, & the cornea   
becomes cleared. 
Struma is unlike other inflammations 

32
inflammations in this respect: after it has subsided, 
you are obliged to give medicines 
to excite a new action in the 
system & to promote absorption.-
Injections in strumous ophthalmia,
must be very cautiously employed 
on account of its tendency to relapse 
& of their stimulating nature.
Of Purulent Ophthalmia
The suppurative inflammation of the 
conjunctiva is must vehement in 
its nature & tendency. It frequently 
attacks & destroys the eyes of children
of Soldiers & travellers in hot sandy 
situations. From its virulence amayour 
Sailors at Egypt, it obtained the 
Name of Egyptian Ophthalmia. 
From the circumstances under which 
it then appeased, that was supposed 
to have been its origin. But the disease   
was well Known in this country before 
the Egyptian expedition. Our 
Soldiers after produced it by the application 
of corrosives for the purpose 

33.
of invaliding themselves. I have  
seen it result from injury. It is often
the consequence of contagion. It is 
less prevalent now than it was formerly. 
It is often caused by the vaginal 
secretions of the mother, coming 
in contact with the eyes of 
the fœtus in its birth. It often also is 
brought on by the application of the 
matter of gonorrhæa. It seldom shows 
itself unaccompanied with some 
circumstance which will explain 
its origin. It is a violent inflammation
of the tunica conjunctiva running 
into the Suppurative stage.
When very violent, I have seen ulceration 
of the membrane accompany 
it. It does met appear to 
be allied with Erysipelas as some 
have supposed. This opinion arose 
from the great tendency which was
manifested in the cornea to slough 
but this may be readily accounted 
for by local circumstances. -

34.
It is extremely common among newborn 
infants. Sometimes it appears 
within the week, & generally within 
3 months. Out of 20 there is commonly 
not more than one or two who 
are attacked with it later than this 
period. It is ushered in by violent 
pain, heat & pricking, there is a swelling
of the lids & an uniform redness 
& elevation of the conjunctiva. The secretion 
is at first like mucus. In 24 
hours, it is sensibly, increased in quantity,
& has become more viscid in its 
quality. It acquires the true gonorrhæal
tint & has all the properties of pus 
The patient is incapable of raising his upper 
eye lid & after the disease has been prolonged;
it is so much swollen as entirely 
to cover the lowers lid, & has the appear once 
of a circular roll overlapping the deck. 
There is an actual increase of bulk in 
the conjunctiva, so that it overlaps the 
cornea producing what is called chemises
The cornea now begins to save a hazy   

look, a sort of black lustre, its looses 
its brilliant appearance. In conjunctiva   
is so minutely injected, that is appears 
completely covered with vessels.
It has been compared to a finely injected 
fœtal stomach. 
If you look at the conjunctiva with 
A magnifying glass during this disease 
open will see very distinctly pus oosing
from the vessels which terminate on its 
surface.- Sometimes the chemosis 
extends to the conjunctiva of the 
palpchee, so that it becomes swollen 
seen to strangulation, & it is very difficult 
to reduce it, & sometimes we 
are obliges to remove it with a Knife 
There is at first a smart attack
of fever & the patient generally relapses 
afterwards into an exhausted 
state.- This disease terminates 
in a distinction of the cornea, by a 
strangulation of its nutrient vessels. 
This at least is any own opinion 
about the business. I have never seen 

36.
it advanced lass anybody else. Other  
authors saw ascribed it to different 
causes. One has attributed to the erosion
of the aired discharge another thinks 
it allied in its nature to acute erysipelas.
But I see no good foundation 
for any of these opinions. I believe 
that the constriction which is produced 
by the vessels of the conjunctiva. 
gangrenes the cornea exactly or phymosis
does the glans of the penis.
Sometimes the death of the cornea is 
confined to a circumscribed portions 
& at other times the whole dies & fall
off in one piece. In the first case 
subjacent lamella are destroys, unequally
one after the other, so that 
the bole or fouls which is left even 
sequence of it, is funnel shaped being 
broader at it, top than bottom.
When the while become dead, a chink 
Or sulcus is formed by the action of 
The absorbents, which act in the same 
Way as in the other parts of the body. 

They work until the whole is detached.
By the mode in which this 
separation takes place, the result or 
extent of it may always be anticipated 
by the presence or absence of 
lymph around the edges of the ulcer, 
which is throw out by adhesive inflammation, 
& sets up a boundary 
to its progress. This is deposited in a 
halo in the lamina of the cornea 
surrounding the ulcer & is to be considered 
as a singularly favorable appearance.
If proper measures an pursued after 
the faction of cornea has sloughed,
it will terminate in a small prolapsus
of the Iris, so that the pupil is 
drawn forwards, & a narrow aperture
is still left in it. It is not wholly  
closed. Sometimes it terminates in a 
total adhesion of the Iris. 
The Chemosis is always peculiar to 
this disease. It is not ecchymosis or 
effusion of lymph or serum into the 

38.
cellular substance of the conjunctiva. 
Of the treatment. You may consid. 
it a fortunate circumstance if you are 
called in early to this disease. During 
the first hours of its existence, the lancet 
should be boldly used. Perhaps these is 
no disease which requires more decision 
in the practitioner than this. With regard  
to bloodletting, it is of no importance
whether the blood is taken away from 
parts neighboring to the organ, or from 
the arm. Your object is to make the 
organ feel the loss thro’ the medium of 
the system. If you wish to unload the 
vessels of the organ, topical bleeding is 
proper, but if you wish to depress the 
powers of the system, [ the] it must be 
general. Alaim evacuation must 
be promotes at the same time. For this 
purpose, perhaps, a full dose of Calomel 
is preferable to all others.
where the inflammation is of a vehement 
secrete kind, you will derive great advantage 

39.
from the use of another remedy-
the Torture of Antimony given 
in divided doses of ¼ or ½ gr., so as to 
Keep up a constant nausea. This is 
one of the most powerful means of 
depressing the powers of the system
under violent inflammation. 
All Local applications in this disease 
should be emollient. Herbs of this nature, 
as the marshmallow dissolved in 
milk may be applied over the eyes 
in gauze bags.
But with yard to these means especially 
V Section, the degree to which they 
are employed must be different in different 
individuals. In the robust peasant
as the hardy soldier, such means are allowable
to a much greater extent, than 
in the sickly artisan. Bleeding in this 
disease in the army (as Army, surgeons 
have asserted to me has often been carried 
to the extent of 50, 60 & 70 ounces 
before Deligrium has been produced 
But there is seldom occasion, however  

40.
to carry it to such an extent from 
the nature of the injury, or the strength 
of the patient. 
You must guard against being deluded
by the signs of lowness in this disease  
There is no doubt about the trial of these 
means fully in its early stage, & if chemosis
becomes diminished, the sense of 
tightness [diminished] abated, the discharge 
abundant & bland & ropy, if the pulse 
is soft & skin moist, your depleting 
plan has fulfilled its desired object, & 
should be then moderated.
When the disease has been of longer continuance,
the conjunctiva is flabby in 
its appearance, the discharge throughout 
profuse, ichorous & thin, the constitution 
much prostrated & a good deal of debility
the countenance sallow & pale, the 
skin cold & clammy, the pulse quick 
weak & small, & the patient disposed to 
yawning. The antiphlogistic plan of 
treatment must be immediately suspended,
& tonics given without delay.  

41.
of there, the extract of bark is the 
most efficient. To a child qr. [?] should 
be given, beginning with one or two 
grains at a dose three times a day. 
The decoction will be best for adult 
patients. The diet should at the same 
time be more generous & nutrient.
The salutary effects of this change, is 
sometimes remarked in a very 
short time after it has been commenced
upon, often in a few hours 
only. It will arrest the progress of the 
slough, [arrest] induce the healing process, & 
the halo of lymph will be deposited 
around the ulcer, & become organism
with vessels. Nevertheless, it will be 
still necessary to diminish local congestion 
by leeches, & to continue the 
other treatment. At the same time 
that you are supporting the system, 
you must relieve the organ itself. 
It will be obvious that to be nice in 
the treatment of the disease, consists 
in depleting the system at a sufficiently 

42.
sufficiently early period, & exhibiting tonics or 
soon or they are required. You must 
be guided by the state of the constitution 
& the stage of the disease. 
[Injury] In discriminate practitioners 
have done much injury by the too long 
continuance of the antiphlogistic plan 
We see innumerable instances of this 
at our Infirmary. Men are too much 
accustomed to look at the purulent discharge 
as the disease itself & often they 
continues their remedies as long as this 
continues, & sometimes without ever 
examining the state of the eye. 
On the other hand, insipient opacity, is 
not or has been supposed a precursor
of gangrene, & a measure assisting 
the disorganizing process or much as 
has been said. It is allied to the nebula 
of high inflammation. It is a congestive
of the serous vessels of the cornea & 
conjunctiva, but a state of gangrene 
on the contrary is a total strangulation 
of the circulation. It loses its polish

43
like the peritoneum in a hernia. 
It looks dull like the cornea of a dying 
person. To use the words of Saunders,
as it is ragged, cindery flocculent 
It is an indication for a total alteration
of remedies.
Stimulant applications are improper,
& serve only to increase the [achemence]
of inflammatory action. Weak 
astringents however may be used: they 
assist in restoring the tone of the [cyre] 
[Kind] vessels; as moderate solutions 
of Sulph. of Lim and Alum. ½ gr, of the 
one & 2 or 6 grs of the other to the ounce 
of water. They should be injected by 
a little ivory or silver syringe about 
every 3 hours. The secretion is very 
rapid as well as profuse, & if the eye
is left unwashed two or three hours, 
the lids become glued together, & are 
with difficulty separated, & when 
opened, a profuse discharge of pus follows.  
Though pus is not of an injurious
quality & never prevents the   

44
healing process, yet the discharge
should never be pent up. Bandage, 
therefore, as they have been used in the 
army are very unfavorable & should 
never be employed. They confine the 
matter & produces heat & so injury 
Coolness & cleanliness are additional 
auxiliaries in the inflammation 
of this as well as other parts.
Of Nebula.
I shall now speak of the secondary 
[stages] diseases or the morbid sequelæ 
of inflammation.
Opacity or nebula is a deposition of 
lymph into the cellular substance 
which connects the cornea & conjunctiva 
together, the lamellæ of the 
former with each other. It is distinguished
by its tenuity semi-transparency
& by its diffusion over the 
surface of the cornea 

45.
While recent it is absorbable, & the 
cornea may be again rendered transparent. 
Topical bleeding is necessary 
& calomel should be properly used, 
if inflammation has given rise to 
the nebula & has not yet subsided. 
If it has subsided, a slight mercurial
action will be required.
When the inflammation has been 
more violent, the effusion will be much
more dense. The conjunctiva is not 
only thickened & obscured by the deposition 
intervening between its 
cells, but it is also attend. In this case 
the texture becomes sometimes totally 
changed, without any breach of 
substance being produced. Similar 
examples of this take place in other 
parts of the body as in the pleura
which is sometimes converted into 
bone, & this without any ulceration.
This opacity is not diffused like 
the other, but circumscribed nor 
softened at it margin. It is not more 

46. 
nor less white, but after a while, it 
acquires a color, resembling the interior 
of an oyster shell. Another difference 
is that which is presented by the 
cornea & conjunctiva, as they become 
the seat of this opacity. In the first, it 
is highly polished, & the opacity seems 
deeply situation. When the conjunctiva 
becomes the seat of it, there is a slight 
semitransparency, giving the appearance 
of tenuity, it is devoid of luster
& appears like dead skin. It does not 
admit of being improved, but the nebulous
deposit accompanying & surrounding 
its margin, may be relieved by 
the use of washer, & thus the 
opacity will be rendered of a small diameter. 
When opacity has reached the chronic 
stage, it is very slowly benefited. It 
will always be rendered worse by too 
early or frequent use of stimuli The 
criterion which is to be your guide 

in the employment of them, is the 
duration of the inflammation by 
which it has been produced. If the 
reaction is but temporary, they may
be repeated, but if [temporary] permanent, 
inflammation will be again 
produced by them. All stimuli act 
upon the same principle. viz: they 
excite an increased arterial action, 
which is followed by a parallel degree  
of absorption. I have observed 
a child operated upon for cataract, 
in whose eye, there was an opacity 
& in consequence of the inflammation 
which followed it, was entirely 
cleared, so that the cornea was transparent 
You will hardly, know when the interstitial
absorption begins to take place 
by the appearance of the eye, but 
the patient however Knows it by the 
improvement of his vision, & is so 
much pleased, that he is generally 
willing to continue your measure 

48.
however painful. The Solutio of Oxym.
of there or the lrysert hit gr. j vel ij to an ounce 
of distilled water, may be used at 
the subsiding of the inflammation 
& no stronger application can be employed 
with impunity at this period. 
The weaker solution of Caustic,
will sometimes do very well. This 
has the effect of a stimulant & sedative
at the same time. I am well convinced
of this. You have seen this when it has 
been applied to the urethra in structure.
Altho’ an active stimulant, it has produced 
almost instant relief to the most 
violent pain. 
Where the opacity is absolutely chronic 
the most powerful applications are the 
most effectual. I have seen most surprising
effects arise in such cases from 
the Liquor Hydrarg. Oxy mur. grs to 
℥I of water, also the Aqua Lithorygs
Arct. Lig. Rumb. Lub. Acct. But  
they should be confined to the opacity. 

or they may increase the disease. I 
has seen this effect in an opacity 
which has resulted from a healing ulcer.
Stimulating ointments are sometimes 
employed, as the Muriate of 
Antimony applied to the opake spot 
with a camel’s hair pencil. Finely
powdered glass has also been blown 
upon the part, & powdered loaf sugar 
& calomel with the same view- 
to act as rubefacients, & upon this principle,
they certainly do good, & promote 
the absorption of the effused matter. 
But I object to them on account of 
their excessively irritating qualities
the effects of which cannot always be 
limited, & since the matter cannot 
[always] only be absorbed thro’ the medium 
of the vascular system, we cannot 
be too cautious not to do too much.

50. 
Fungous Conjunctiva.  
This disease is of two kinds – the [com] 
Benign & the Malignant.
In the first there is suppurative inflammation 
with puriform discharge 
The globe is diminished in volume, & the 
under eyelid falls back I has its margin
turned in so as to production a state of trichiasis.
the vessels of the sclerotica coat 
are relaxed & turgid. On exerting the 
lids, loose flesh like appendices appear 
between the palpebræ. This disease has 
been called a redundancy of the tunica 
conjunctiva.
The treatment consists in everting the 
lids with the fingers of an assistant 
& then the surgeon raising this projecting 
portion by a pair of forceps, he 
removes it at one stroke with a curved
pair of scissars. There is always a 
tendency in it be afterwards reproduced, 
& therefore the cut surface may 
be ruble lightly over with Sulphate of 
Copper or Lunar Caustic. 

If the fungus arises above the margin 
of the lid, as it sometimes does, 
it turns it outwards & produces [less]
opium. 
The second or malignant is that operus
of the disease, which is accompanied 
with disorganization of the globe
of the eye. It is the result of the malignant 
disease as the carcinoma, to 
which it is similar.
There is an enormous projection from   
the orbit, formed from the eye & conjunctiva,
giving a most hideous deformity 
to the patient, for which extirpation 
of the globe is the doubtful
but only remedy.  
Granular Conjunctiva 
This is another of the sequela of the puriform
or suppurative inflammation  
of the conjunctiva. It is generally 
attended with a state of preternatural
vascularity of this membrane. 
It turns villous & becomes the seat 
of a morbid secretion. It also becomes 

52 
fundamentally thickened, & covered 
with numerous granular paints, 
which are very tender. Friction upon 
them in any gives the patient 
much pain an exceptive irritation.
The conjunctiva of the palpebra is exceedingly 
vascular, & elongated so 
as to produce numerous sugar which 
rise up between them. The Tarsi are thickened 
& sometimes excoriate by the 
maller which is confined upon them. 
Flake of lymph are often found lying 
between them. The secretion of tears is 
unusually copious & very irritating 
to the eye. The patient is unable to raise 
the upper lid, it is so much swollen, & 
it is close gated as during the action of 
inflammation. A fourble opening of 
the lids is followed by a profuse flow 
of tears. In patient is very liable to a 
relapse of the inflammation. The cornea
is so nebulous as entirely to obscure
the vision. The veins of the conjunctiva
which are very much relaxed  

in this stage of the ophthalmic, becomes 
turgid & more elevated than usual,
assume a Knitted & irregular 
appearance, & ultimately are seen 
ramifying upon the cornea.
The granulation should be all case 
fully removed with a Keen lancet 
or curved pair of scissars, which is 
perhaps preferable. The Sulphate of 
Copper or Lunar Caustic will sometimes 
be useful afterwards, in repressing 
the granulations.  
It is necessary, also to divide the turgid 
veins of the varicose conjunctiva. It 
should be done with a round lancet, 
which is only a jum lancet in miniature. 
It should be done at once by 
carrying it in a quick continued 
success round the cornea. It is often 
found difficult to raise the upper lid 
when we wish to do this operation. 
the fingers should be so placed as 
to project the globe & render the conjunctiva 
over it tense. This will 

54.
very much assist you in the operation
it is as very painful one & requires 
some little address on the part of the 
practitioner, & would not be submitted 
to, if the patient were aware of it.
His resistance should always be anticipated.
There is no use in dividing the 
membrane vessels of the membranes partially. 
It must be done throughout – the 
Knife carried all around the cornea, or 
it will also do no good. You need not 
be afraid of making sufficient prepare
upon the sclerotic for it firmness will 
be sufficient to prevent it from being 
injured. The operation after requires repetition,
but by perseverance any
great good will be effected.
Three two states of granules conjunctiva 
& vascular cornea do not always 
co-exist. The operation has a twofold 
good effect. First, it interrupts the 
vessels in their course running from 
the conjunctiva to the cornea, & secondly 
it causes a barrier of lymph to be 
set up in which the divided vessels  

55.
shoot & are turned out of their former
course. The relaxed vessels may afterwards 
[m] be constringed by the application 
of the Liquor Plumbi, & similar 
Lotions, which are often very efficacious. 
Where the case is desperate 
neither of these means can be employed 
Blisters & issues are frequently very 
useful in these cases: but I have 
Known them to produce dangerous erysipelas
on account of the great debility
which the patient generally labors 
under from the long, continuance of 
this irritating disease.
Perhaps it will be proper to produce 
An alteration of this state of the system, 
by a little mercury combined with 
Colocynth. There are the modes of treatment 
which are the most efficacious. 
Stimulants are very improper. From the 
erroneous opinion use of them, I have 
seen many very had cases which had  
been evidently artificially rendered 
what they were I never saw any advantage 
from mercury in these cases.

56.
After injuries of the eyes in consequence 
of falls or blows, diseases of 
the orbit or of the eye causing a displacement 
of it, there is often remaining 
a chronic [state] morbid state of the 
conjunctiva, on eliptical portion of it 
will sometimes project between the tares
so as entirely to conceal the lower lid, & 
sometimes indeed a portion of the face.  
It is generally of a cartilaginous hardness, 
& the cellular texture beneath it becomes 
obliterated. The treatment consists 
in the excision of the whole of the 
protracted portion by means of a Knife 
The wormed which this occasions in the 
tunica conjunctiva will soon heal, &
the deformity becomes, entirely removed 
all wounds of this membrane commonly 
heal very Kindly.
A gentleman, in consequence of a fall 
from a horse had an attack of inflammation 
of the conjunctive which was ferociously 
sound. It was followed by this 
preternatural projection. He came to me 
& excises it, & it did very well.

Encanthis. 
This is a morbid growth of, the caruncula
lachrymalis, & neighboring semilunar 
fold of the conjunctiva. In 
its early stages it has generally, or 
granulated appearance, which has been 
said to resemble a mulberry. But 
when it is more advanced & of a larger 
size, the whole of it has not this 
appearance but it is of a smooth, lived 
whitish color, streaked with varicose 
vessels. By its situation, the internal 
nasal angles of the lids are Kept asunder, 
& it compresses the puncta lachrymalis
or turns it out of its natural course, & 
so interrupts the passage of the tears into
the nose, & they in part are made to flow
owe the cheek. & often grows as large
as a hazelnut. Sometimes there is a 
morbid growth of the little delicate 
hairs which are growing about this part. 
This disease has been sometimes represented 
the malignant, & that in that 
stage it ulcerates, bleeds become livid 
& shoots out an ill-conditioned fungus.

58.
But I believe that this idea is altogether 
hypothetical. I have never had 
an opportunity of seeing any thing 
of the Kind.
In treatment of it consist in its neat
extirpation by means of the cornea 
Knife.
Pterygium
This is divided into two Kinds the membranous
& fleshy. The first is a thin film  
or membranous like expansion, of a 
dull white color having a few strait 
long isolate vessels which run along its 
surface & converge towards the cornea 
giving, to it a fan like appearance. 
Its situation is most commonly between 
the lower eye lid & the cornea. It is moveable
& loose upon the sclerotica. This arrangement 
of vessels may generally be seen 
before the opacity becomes evident 
They do not form an acute angle.
The treatment is simple. You must 
snip up the crescentic portion of the pterygium
about two lines beyond the margin 
of the cornea & excise them with  

a pair of scissors. There is no disposition
in this disease to return. you
must be careful to extend the paints 
of your incision beyond the diseased
part, or the remaining vessels will 
access upon the cornea, & produce a nebulous
opacity of it. The pterygium 
is in fact an nebula of the conjunctiva.
The only difference between them 
is its texture & the degree of is adhesion 
The fleshy portion pterygium is of a 
more formidable character. It has the 
appearance of an elevated dense fatty 
membrane of growing from the inner
canthus where the conjunctiva is most 
loosely attached, & being drawn into a 
wedge like shape as it approaches the 
cornea from the increasing adhesion 
of the conjunctiva as it advances to this 
part. At the margin of the cornea, it 
terminates by a sort of tongue shaped 
extremity. It is a deposit of lymph or 
a sort of adipose substance into the 
cellular membrane of the conjunctiva.

60
When accompanied with inflammation, 
it is a very formidable disease  
Its effect upon the cornea is to seperate 
the conjunctiva from it, & the degree of 
adhesion of this membrane, shows you 
The slow gradual progress of the disease 
& determines its triangular figure. Generally, 
there is a nebulous opacity 
which precedes, & anticipates as it were 
the advance of the pterygium, & its progress
should be arrested before the transparent 
cornea becomes affected.
The difference between the membranous 
& fleshy pterygium, is that the one is 
a mere opacity of the conjunctiva & 
the other a deposit of lymph in it subjacent
cellular texture forming a 
tumor. In the first it extends to the cornea
by the vessels over running it form
the conjunctiva as in strenuous ophthalmic
& in the second it does it by disuniting
the conjunctiva from the cornea. The opacity 
is therefore considered differently in 
the two diseases 

When the fleshy tumor assumes the 
firm permanent & tranquil character, 
I should advise that it should 
not be middle with. But if vision 
is threatened by its encroachment upon 
the cornea, it should be removed, 
as it is a disease of a very, insidious
character & very quickly extends to a 
dangerous degree. My practice has 
been to excise the whole of it, & by it has 
a very strong tendency to be reproduced 
it will be necessary to apply, caustic 
afterwards- also to repeat the incisions 
& to form by them a line of discontinuity 
concentric to the margin of the cornea. 
Escharotic, when the application of 
them is general, are exceedingly imitating
& objectionable, because they sometimes 
produce great destruction by 
their operation. Tubercles or fungous
excrescence sometime result from 
their removal. 
Scarps & advises only the partial removal 
which he does by a semicircular
incision concentric to the margin  

62.
margin of the cornea. His objection to 
doing, more than this is that the white 
of the eye is denuded to too great an 
extent & in consequence of the great 
quantity of conjunctiva which is removed, 
& the direction in which it is 
done, the cicatrix following upon the 
white of the eye forms an elevated ridge 
which like a small cord confines it to 
the caruncula & prevents the freedom 
of its motion, particularly abductions 
The fact is well founded on which this objection 
is raised, but it is rather doubtful 
if it is an objection; for this cord or coalescence  
which is formed, seem to divert
the prepress of the disease. I am nevertheless
disposed to think, however, that 
a partial removal from the margin 
is better than the excision of the whole. 
After the operation, application of a 
soothing emollient nature should be employed.
Lymph becomes thrown out, & a
firm cicatrix follows. The removal of any 
portion of the substance of the cornea,

63 
is objectionable, because it produces 
an incurable kind of opacity. 
Sometimes two & even four pterygie
are seen upon the globe, with their 
apices meting upon the cornea, 
where they join together & produce 
the most total blindness.
Another morbid state of the conjunctiva
is the formation of folds upon it.
There are preternatural elongations of 
this membrane, in consequence of the 
relaxation of the cellular tissue, by 
which it is connected to the sclerotica
They are more reduplication of the conjunctiva,   
are of the dull white color & 
moveable on the different directions 
of the globe of the eye which are more 
or less impedes by them. Sometimes 
they overlaps the cornea, when the eye 
is turned much outwards or inwards. 
When directed in one way the pannus  
is turned in the other & vice versa.
The treatment is simple excision. They 
do not again return. Sometimes they 

64.
are confined to a part of the cornea. 
I have never seen them accompanied 
with inflammation. They seem to 
depend upon a relaxes state of the conjunctiva
they are most frequently 
found among the inhabitants of warm
climates, & eviction who have resides 
there mention them as more formidable 
diseases than we see them.
Another morbid state is the Connected 
Pranum, which unites the eye lids 
with the globe. It is analogous to the 
result we sometimes see in cicatrizes
from ulcers, wounds &c in consequence 
of the removal of tumors &c. During 
the process of healing, a coalescence take 
place from a little portion of lymph 
which becomes drawn out & organized & 
forms a little bridle connecting the 
parts together.- Here, simple division 
is no remedy, for in healing, the 
disease is generally aggravated. From the  
divided surfaces many cords sometimes 

form & unite in the same way. Escharotics 
also, do no good & rather exasperate 
the disease, because the whole 
surface then become inflamed.
Simple as it is, it sometimes is productive 
of great inconvenience. I 
have seen it produce strabismus. Of 
course, it must limit the motions of 
abduction & adduction. I have known
also complete hypochondriasis brought
on by it.- A Gentlemen fell down 
I struck his fore head, by which the 
eye lid was divided. It was united I did 
well. But afterwards, he by some 
accident divided it again, & the same 
operation was performed, & this 
disease which are have been describing
followed it. The little bridle was 
divided but in vain, for it again formed. 
A fresh operation was a second
time performed, with every  
precautionary measure to prevent 
this effect, but to no purpose. The 
man was rendered a complete hypochondriac

66.
hypochondriac. He was like one who meditated 
hanging himself, & abused 
me very much for doing any thing 
to him, altho’ it was not done but 
by his most urgent request.
If you could separate the points of contact 
in every way & presence them so 
by adhesive plaister or in any others 
way, you may be able to prevent the 
reformation of the disease. But I 
believe if the disease is of trifling inconvenience 
to the patient, you had 
better do nothing. One of the most 
useful things to be learnt in our profession, 
is when we are to do nothing. 
Young men who set out in practice 
with the idea that Surgery can do 
everything are often disappointed in 
their plans & expectations.
Tumors of the Conjunctiva are not uncommon. 
They are of an adipose, steatomatous 
or cartilaginous nature. 
Sometimes little [hoisis] are seen growing

growing from them. They appear in different 
ports of the globe & are covered
by conjunctiva which is thickened 
by morbid opacity. Sometimes they 
are connected with the eye lids. When 
they are unconnected with the lids,
simple excision may be sufficient 
for their cure, & there no danger of 
their being reproduced. But when 
they are tired by the angular processes 
the difficulties already stated will occur 
& threaten blindness from nebula as 
in pterygium.
Warty Excrescences occasionally appear
growing from all parts of the 
surface of the conjunctive of the Sclerotica.
Sometimes it resembles a fringe 
growing at the inner canthus, between 
the caruncle & cornea. It consists of 
numerous little mulberry like warts. 
It is a prolongation of the valvula
semilunaris. The treatment is simple 
excision . -

68.
The last disease state of the Conjunctiva 
is one which so far as I Know
has never been mentioned by any 
author. It is the conversion of the 
whole conjunctive into a thick dense
& spoke pellicle, which destroys vision 
entirely. Some dissected it off from the 
eye of a patient, & she recovered a momentary 
tho’ imperfect vision, & the 
care terminated at last in total blindness.- 
There is no cure for this disease, 
as you would readily be convinced 
if you could see it. The Sinus pal
pelrarum becomes completely obliterates,  
& the lids are completely tied 
down round the cornea. 
In the second care which I saw of this 
the patient was a young woman, & 
I was informed that the never had shed 
tears, altho’ the lachrymal glands were
found in a perfect state. At all events 
she did not shed tears, when informed 
that her case was hopeless. She had the 

complaint over from her childhood.
It began after the measles. I have named 
it the Pellicular Conjunctiva
Diseases of the Sclerotica.
The tunica Sclerotica, is of a dense,
fibrous ligamentous nature. It is 
supplied with blood from the Ciliary
vessels which penetrate it obliquely, 
& run over its surface to the plexus 
ciliaris. At this part too, the vessels of 
the conjunctiva & choroid anastomose.
The vessels of the first seem to turn in
& inosculate with the duper order of 
vessels of the latter. The annulus ciliaris
is only a congeries of these vessels 
& the zone which is seen surrounding 
the cornea in inflammation of the 
internal tunics is the effect of their 
anastomosis with those of the 
The firm texture of the sclerotica serves 

70.
as a shirt to protect the move delicate
internal parts of the eye from injury 
& alloros the external vessels to take on
inflammation without communicating 
it to the internal & the reverse 
Hence where the conjunctiva is inflamed, 
the choroid & iris are unaffected, 
& the cornea likewise. There is a certain 
disjunction between these parts 
which can ably be overcome by continued 
inflammation. When the iris becomes 
affected inflammation comes or 
in the conjunctiva as a secondary consequence, 
& a haziness of the cornea is 
these invariable. Inflammation can
not pass from the one to the other, 
without the sclerotica being affected, 
& this takes place very, slowly. Inflammation 
is rarely a primary affection 
of the sclerotica.-
One of the distinguishing marks of its 
being inflamed, is the strait direction 

71.
of the vessels surrounding the cornea 
which forms the anastomosis 
between the conjunctiva & the choroid
coat.
When with this appearance, there 
is pain in the organ of a dull deep
kind, the sclerotica may be considered 
as inflamed thro’ the cornea should 
be still clear & the iris moderately active.
The cornea presents few morbid
appearances under disease. It 
is capable of being considerably distended, 
& it is [seen] elastic, as is seen
after punthering it in hydrophthalmia,
yet by continued prepuce, it undergoes 
a sort of extenuation by interstitial
absorption, which renders it per
momently, thin as may be seen, in 
some species of amaurosis, where it 
assumes a leaden blues color. This is 
evidently an extenuation of the Sclerotica, 
by which the choroid coat is 
seen shining thro’ it.

72.
Diseases of the Cornea. 
The Cornea is nourished by vessels incapable 
of conveying colored blood: hence 
the phenomena of inflammation are 
not visible in its structure. But the affections 
of this port analogous to it, are 
always preluded by inflammation of 
the conjunctiva, therefore it is probably 
dependent upon that for its organization 
like the synovial membrane of joints.
If you could defect away the conjunctiva 
from the cornea, it would gangrenes
& slough.
In common with all other parts, having 
capillary organization, the Cornea 
is subject to ulceration. Thirds is either 
superficial or interstitial. The former 
is the most irritable, & accompanied 
with great increase of sensibility
The breach of the ulcer is ascertained by
its scabrous & jagged edges & is best 
seen in a lateral view. 

Cornea. 
Richerans by beautifully 
turned this 
coat. “le mirroir de
l'oil”. 



73.
The origin of the Interstitial ulcer, 
is an abscess of the cellular membrane 
connecting the lamella of the cornea. 
The first state (of Deposition) as has 
been improperly called ulcer, because 
it must necessarily terminal in it.
This state is analogous to inflammation 
of the cutis vera, in which the 
cuticle above remains entire, as in 
bulla & bleb. 
An interstitial ulcer may open internally 
or externally. The superficial   
ulcer may also go on till it penetrate 
the cornea & open into the anterior 
chamber. The conjunctiva does 
not accy readily ulcerate, & therefore 
the interstitial ulcer opens more frequently
internally than externally. 
In this case pus becomes lodged in the 
anterior chamber, forming the disease 
called [p] hypopion. The pus collected 
at the bottom of this cavity resembles 
the root of the finger-nail 

Sometimes, the quantity of it is so 
considerable, as to rise above the lower 
border of the pupil. Lymph is seen 
heaped around the ulcer & mixes 
with the pus. But it is not connected 
as some have supposed with inflammation 
of the iris. I have never 
seen it arise but from ulcer of the cornea.
When the ulcer opens externally, it is 
healed by the conjunctiva in a manner 
very curious. A nebulous layer
of lymph is deposited by the cellular 
membrane of the cornea into the heath 
formed by the ulcer & vessels shoot in 
to this from the tunica conjunctiva 
& organize it. When the cure is completed,
the vessels contract & disappear 
The cicatrix also which is left, does not 
entirely remain, but partial absorption
always takes place. The lymph  
forms a path for the vessels, & it always 
keeps a little ahead of them. 

75.
It has a reddish brown tinge.
I Know no instance in the body 
so clear as this of the production of 
new vessels for any purpose, & of 
their annihilation as soon as that purpose 
is fulfilled.
The superficial ulcer is healed by 
a gradual abatement of the inflammation. 
The rough & scabrous edges 
of the ulcer become smooth. This is  
rather a curious circumstance. It is 
effected by what Mr. Hunter calls 
the modelling absorption. This will 
escape your observation unless you inspect 
the eye closely. You must often 
vary the direction of the light in which 
the patient stands in order to obscure 
it. The tendency to a relapse of the inflammation 
gradually subsides.
It has been said, that the interior 
of the cornea is lined by a thin membrane 
which secretes the aqueous humor.

76.
I have never been able to see it 
on account of its extreme [cont] temerity
in the human eye, but I have seen 
it distinctly in animals. 
But in inflammation of this membrane 
of the aqueous humor, my very
worthy friend & colleague Dr. Tarre
has informed me that he has seen distinctly   
on appearance of red vessels running 
along the back of the cornea.
However, pathology aids the study of 
anatomy & elucidate the texture of 
many parts which are too delicate & 
minute to be ascertained by the Knife, 
as you have an example in ptenygium;
This disease clearly proves the continuation 
of the conjunctiva over the cornea 
which cannot be for over by dissection 
Gordon has called this opinion in question 
but nobody could ever for a moment 
doubt it, who had seen a case of 
Pellicular ptenygium. It is by disease 
alone, that me have been enabled to 

trace [tos] the capers synovial 
membrane of joints.-
Dr. Farre told me, he observed very 
distinctly a few years ago, in a case 
of ulcer of the cornea, which had gone 
thro’ a membrane of very delicate 
tenacity projecting thro’ it, just before
the iris prolapsed. This could have been 
no other but the internal membrane. 
If this internal conjunctiva existed,
it would take on the adhesive 
inflammation, & the prolapse would 
be prevented. But it is does not stop
here. Prolapses of the iris always follows
ulceration thro’ the cornea. 
Mr. Brodie however mentions to
one yesterday, that he had lately seen 
a case of ulceration which stopped 
here, & he attributed it to the internal membrane.
& he attributed it to the internal membrane.
The superficial ulcer then heals by a 
deposition of lymph, which afterwards
becomes organized, & the institial

78.
institial ulcer heals by, the iris protruding 
forwards, & shutting up the cavity 
& adhesive inflammation take
place between this membrane & the 
sides of the ulcer.
The treatment of ulcers of the cornea 
should be regulated by the stage of 
the inflammation, the seat & extent 
of the ulcer, & the constitution of the 
patient. Ulceration of the cornea as in 
other parts is preceded by suppuration,   
& suppuration by adhesion. Lymph
is thrown out under the last which 
forms a nidus for the pus & a boundary 
for the abscess. It occurs in the cellular 
membrane substance, connecting 
the lamella of the cornea together 
Your treatment should be vigorous during
the adhesive stage of the inflammation 
& the succeeding suppuration 
will be proportionally less: the ulceration 
will also be less, & the action will 
sooner commence. If the inflammation  

79.
is of the sthenic kind, so soon 
as it is subsiding, the healing process
will be set up. I have already mentioned 
the sign of healing, which is 
a light halo margining the ulcer,
the gradual filling up of the ulcer 
takes place, & it becomes blended 
with the surrounding parts, so as 
to form one uniform level opacity 
When the healing action is prevented 
from any cause, the force are 
transparent or filled with lymph 
which however distinct does not manifest
any disposition to cicatrization.
In this case after removing the 
congestion of the pact by local blood 
letting, you should invite the healing 
action by the application of stimulants.
Scarps has recommended
The Caustic pencil to be employed. 
But I think that the solution of
the caustic is better. This is preferable 
to all other applications. It 

It seems to allay in ordinate sensibility 
without exhausting the healing 
action, & under its stimulus, 
the lymph which was difficultly deposited; 
or which is deposited, but not 
organized, becomes vascular. Much 
attention is necessary to prevent an
over stimulus by injecting it too 
much or too frequently. If the injections 
are made during the acute inflammation 
you will produce ill
conditioned or extensive ulceration, or 
a deposition in morbid excess.
I have often been called upon to explain 
what appears to many, a paradox 
virz: how the same injection can be 
useful in the two opposite states of 
ulcer & opacity. I answer, that the 
same effect of a stimulus, is always 
determined [ enduresed] by the necessity of the part
punker.
This [???] is what Hunter calls the
stimulus of necessity. In ulcer a breach 
exists in the natural structure, & it is 

necessary, that it should be filled up 
when a corresponding action is excited.
But in the other case, there is 
no breach, but only adventitious 
matter deposited, of which there is 
necessity for a removal. But these 
good effects will always depend upon 
a nice adjustment of the stimulus 
to the nature & necessity of the case. 
When superficial ulceration is undergoing 
a change, referable to the action 
of the absorbents, you should abstain 
from injections. There is then a 
tendency to the relapse existing in this 
state- the disposition is altered for a 
time & the healing stage passed by ; &
this mode would be injurious. 
In that stage of superficial ulcer where 
absorption has produced a smooth 
surface, stimulants must never be 
employed. They excite an inflammation 
without an object. It is the same 
as if you should excite an healthy eye
by them. They have a tendency to effect 

82.
an indeterminate deposition, which 
may entirely impede vision. The 
previous state does not destroy but 
only [impedes vision] deposits it. 
A sort of finishing process in the healing 
of ulcers & cicatrizes of the cornea 
as is illustrated in other parts for example 
in the absorption of redundant 
callus. It is removed by vessels 
which become obliterated, afterwards 
& it is modelled so as to become adapted 
completely to the surrounding 
parts. In deep ulcers accompanied
by deep inflammation, which is 
marked by a zone of red vessels surrounding 
the cornea, you should not 
inject you would be unwise if you 
did.
It has been a question, whether when 
[onyx] is combined with this disease 
an opening should be made into the 
anterior chamber for its removal. If 
the matter in large quantity, it is 
desirable. It brings the particles of the 

chamber in contact. & quickens
the cure. But if it is considerable,
it is better not to do this, but 
to leave it to be absorbed by the natural 
process.
The objections to opening the chamber 
in onyx, are that the wound 
made in the cornea is apt to ulcerate,
& undress a process of thinning 
the matter, constantly dribble, thro’
it as fast as it is secreted, & prevents 
it from uniting.
Ulcers of the cornea which are very 
extensive, or takes on a sloughy
character are to be treated like the 
same kind of ulcers when they take 
place on any other part of the surface 
of the body. Instead of general 
depletion by the lancet, you should 
only [also] relieve local congestion by 
local means, & support the system. 
With this view, you should avoid 
& particularly only in old people, Calomel 
purges. I have seen this state of 

84.
ulcer induced by them. Bark should 
be employed together with Acids & 
the lighter tonics. And the injected 
appearance of the deep & shallow 
orders of vessels which you will often 
find under these circumstances,
must not deter you from pursuing
this plan of treatment. You should 
guard against being diseased by 
this appearance. It continues a 
long time after the inflammation 
has subsided. They have been a long 
time in getting into that condition 
& they will be slow in recovering
from it, & your treatment must accordingly 
correspond to this circumstance.
It is not owing to acute inflammation. 
The advantage of producing a healthy 
state of the constitution is very [grat]
as is proved by the change which is 
produced upon them in small pox.
Blindness from this disease is much 
less frequent now than it was formerly 

formerly. You often see persons blind 
who are at the same time much 
pitted with the small pox. If you 
examine the eye, you see an indelible 
opacity of the cornea. This is the 
termination of [Vainolous} ulcer. It 
follows also sometimes the measles
& scarlatina, & occasionally all the 
eruptive diseases. It oftener follows 
these than makes its appearance during 
their existence. The inflammation 
attending these ulcers is of a very 
irritable character. It is strumous
& the ulcer remains for a long time 
stationary. Sometimes, it is extremely 
rapid, becomes sloughy, & the humors
are evacuated. Practitioners often 
do much injury in these cases, 
mistaking the character of the disease 
& taking intolerance for a sign of
active inflammation. They act accordingly 
& as hasten the destructive 
process. 

86.
you ought frequently to inspect the 
eye in order to judge of the character 
of the inflammation. But let 
me caution you to do this very
gently. If you do not will endanger 
the escape of the humors. I have 
now & then seen the eschars humors & 
all fall forced out by the careless manner 
in which the eye has been opened. 
With [regard] to the opacities following 
ulcers a very few words well suffice 
They are not removable by absorption.
It like a portion of new skin
it is not transparent & cannot be recovered.
It is of considerable density
at first of a white, dead pale color &
afterwards becomes more like the color 
of pearl. When small it is called 
a speck & does not much interrupt 
vision. In children, it always gradually
disappears, so that at last 
we vestige of it remains. I have satisfied 
myself  quite of this circumstance 

87.
I therefore am not solicitous
about specks in the eyes of children 
& you may, always relieve the anxiety
of friend by assuring them that 
it will disappear. It can only, be effected 
I think in the natural process 
of growth. In the course of nutrition
there extraneous particles are removed 
& new ones deposited in their place.  
Some have thought that opacities 
change thin relative situation. But 
I believe this is delusive.
Eyes having opacities are subject to inflammation,
& when it takes place, 
ulcers are apt to form in these places, 
for the same season that they do in old 
vitalized in other parts of the body.  
They are not so well organized as other 
parts & are on this account more disposed 
to ulcerate.
Nebula sometimes covers the whole substance 
of the cornea. This has been called
Sarcoma or albago. But I do 

88.
not give it these names, because it 
is improper to make use of such 
cramped times our profession 
when it is unnecessary. They are all 
only different degree of the some 
thing. Opacity from simple inflammation 
in its slightest form, is 
called Nebula, when the inflammation 
is of a more active Kind, it is 
what is termed abbess, & that which 
fallows a breach of the cornea leuroma.
Conical Cornea. 
This is disease which the frequently 
met with, is I am sorry to say irremediable.
It results from a loss of 
the natural elasticity of the cornea; 
or from a process of interstitial absorption  
or perhaps from a combination
of both. The natural form of 
the cornea is lost. & it assumes a 
conied form. It has an appearance as 

if it was inescapable of containing 
the quantity of aqueous humor 
The apex of the cone has a degree of the 
pellucidity as if a drop of chrg. that 
was suspended from its point. It 
looks precisely like a drop of pure 
transparent fluid. 
The vision is rendered so short by it, 
as to be confused at any moderate 
distanced, the patient can hardly distinguish 
objects at all.
This change in the cornea is sometimes 
slow- sometimes rapid. It most commonly 
affects persons in middle 
life. I have never seen it in infancy 
or old age. I lately saw a case of 
it in consultation with Dr. Wells  
of this hospital in a healthy country 
woman which had only been 8 weeks
in making its appearance. It was  
not referable to any assignable cause- 
If inflammation comes on during 
Its existence, the apex of the cornea becomes
opaque. If the disease was 

of a progressive nature, it might 
perhaps be of use to excite inflammation 
in order to produce a thickening 
of the cornea, & so put a stop
to its further advances. But this can   
be of no use; for it never appears 
to go beyond a certain point if left
entirely to itself. It never breaks. 
Various attempts have been made to remove 
it by. Stimulants & astringents, but 
without any good effect. It has gone as 
to its natural termination, not withstanding 
them. It has been supposed 
that evacuations of the aqueous humor 
might perhaps prove beneficial, & they
have been made but in vain. Its progress 
has not been in the smallest degree 
arrested by this operation. Tonics
have been employed, but without any 
alteration. It is a disease really incureable. 
Sometimes the cornea assumes 
a spheroidal instead of a conical 
appearance, but this however is    

very rare.- It has occurred to 
me that a section of the corner as 
in cataract might be serviceable. It 
is, I think, justifiable as all other 
means have proved inefficacious  
Inflammation of the Iris.
When acute inflammation of the 
conjunctiva, has remained unsubdued,
& the deeper tunics become affected,
a second deeper order of vessels 
is distinctly represented under the 
conjunctiva, of a less florid aspect  
than the others, which take their 
course in long strait parallel lines 
I form a remarkable circle surrounding
the cornea, which is hazy. The 
pupil is contracted & motionless on
the application of light. When you 
examine the Iris vessels in a strong light, 
fine red vessels may be seen running 
from the ciliary to the pupillary border 
& sometimes also, little specks of 

92.
extravasated blood are found deposited 
upon it. The color of the iris 
does not correspond to that of its fellow, 
being more or less of a reddish
brown tint, & the circle of the pupil 
instead of being as usual of a narrow 
defined & flowing line, is more or less 
puckered, thickened & gibbous. Small
drops of lymph of a brownish color 
are seen upon the edge of the pupil, which 
contributes to this appearance, by turning 
parts of its inner margin in towards 
the Lens. The humor of the anterior chamber 
is turbid. At the same time, the 
patient complains of a dimness of vision 
he has also severe pain in the 
ball of the eye. It feels as if it were 
squeezed. There is pain also over the forehead 
in the occiput. It is a hemicranial
pain, but strictly confined to the 
median line It is not constant, but 
comes on in paroxysms, & especially 

in the night time. The patient awakes 
from sleep in torture. The 
pulse is quick & hard, the skin
hot & dry, the tongue furred, & the 
blood when drawn exhibits the buffy 
coat. Strait vessels are seen running 
along the sclerotica to the annulus  
ciliaris, & the zone which is formed 
aroused the cornea accuses from 
the free communication of the superficial 
with the ciliary, arteries. The free 
some of this anastomoses arises from 
a morbid state of the blood vessels, in 
consequence of the long continued in 
pulse of blood upon them. If you
could examined the condition of the 
tunics narrowly while in this state 
you would first all the branches of the 
ophthalmic artery gorged with  
blood, & it is to this that we are to attribute
the dimness of vision. It is  
to be explained more readily in 
this way than by supposing it to  

94 
arise from the haziness of the cornea,
or the turbidness of the humor, 
as the contracted state of the pupil.
Hence bloodletting is in this disease 
very beneficial. It is no matter whether 
it is taken from the part or elsewhere, 
provided it is done fully, & so 
as to effect the system, The bloodless 
state of the vessels which seems to be 
produced in the organ, by, Syncope
seems to be more than a momentary 
effect, & to allure the vessels to contract 
again & recover their lost tone. 
Altho’ the his from its situation presents 
all the visible signs of inflammation, 
yet from its connection 
with the chronic, which is the serene of 
its vessels & must partake in its inflammation,
I do not Know that the 
term Inflammation choroidea, as being 
more comprehensive would not 
be more appropriate. 
This inflammation, if allowed to go  

on, will always proceed to disorganization
it will produce Cataract 
with contraction pupil, or 
staphyloma of the choroid or amaurosis.
It is therefore of the greatest importance 
to subdue active inflammation 
of the iris, & it is never what 
can be effected by any half way 
mode of treatment. No more [cofeatmotive]
can be given to do this, than 
the knowledge that blindness will suspense 
upon it to a moral certainty 
if it be neglected.
But the Iris is also subject to an idiopathic 
as well as sympathic inflammation 
& the conjunctiva is sympathetically 
affective by it.
The principal cause of this idiopathic 
inflammation are attacks of 
acute Rheumatism & the use, or I 
should rather say abuse of Mercury. 
Improper exposure after a course 
of this medicine, almost continually 

96.
gives rise to it, & most especially 
in persons of strumous habit of 
body, I still more so if such person
have previously, been subject to inflammation 
of the iris. Close employment 
after recovery, from inflammation of 
the eye often gives rise to it, I recollect  
the care of a young gentleman in 
whom it was there produced, that 
made a strong impression upon my
mind. He has had inflammation of 
the eyes which recovered under the 
antiphlogistic treatment but being a 
merchant & having some important 
business to transact, he sat up one 
night till 12 o’clock writing his accounts 
by candle light. Twos days afterwards 
he applied to me with acute 
inflammation of the iris. I prescribed
for him, but the case went on from 
bad to worse, & at last terminated in 
perfect blindness. The late Mr. Ware 
was called in at the time with me 

97
Cataracts have since come on in both 
eye, & they were before perfectly amaurotic. 
I was a young man when 
this case occurred to me, & it was one 
therefore, which I never can forget 
A strong mark of distinction between 
the primary & secondary inflammation 
of the iris, is to be found
in the constitution of the patient. 
In strong constitutions you will find 
the one & in [the] weak & strenuous,
the other. In the first case where the 
patient is robust, bleeding very largely
is indicated, but in the second, you 
are prevented from doing this by 
the appearance & habit of the patient. 
Bleeding in the latter is not attended 
with any evident relief, the good 
effects of it are not at all proportionate 
to the other case. What is the 
main remedy in the first, is not 
so in the second. There is some difference 
also in the appearance of the 

98
eye. The lymph presents somewhat 
the appearance of a thin adventitives
membrane. It lays like a finger around 
the border of the pupil & not in [ridges]
tubercles. It is rapid also in its progress 
forming sometimes in from 
2, 4 to 6 hours, whereas is that inflammation
from continuance days & 
weeks will elapse previous to its formation. 
The pain in the first affects 
especially the head, that of the second 
is confined chiefly to the globe. 
inflammation of the iris is the only 
form in which Syphilis affects the globe 
of the eye. Some gentlemen in the profession 
& men of great merit too have 
questions the existence of a syphilitic 
affection of the eye. Others have placed 
it as a disease of the tarsi. But I 
think, if there is any dear & indisputable 
point respecting Lues, it is that 
of Syphilitic inflammation of the Iris. 
Indeed, I am so satisfied of it myself  

that I can only express my surprises
that a doubt has ever existed 
on the subject. Our interest on 
the paint is fortunately confined only
to the pathology, of the disease &
not to the farcical consideration of 
it. The treatment of it is exactly as 
if it were of a venereal nature.
The distinguishing marks of the Syphilitic
inflammation of the iris, are 
1st a peculiar lasky appearance of 
It, a sort of reddish buck, color 
2 dly, deposition of lymph in tuberculate 
masses on the face of the iris,
& generally on the pupillary margin. 
In pupil loose its circular appearance 
& is of a square form, the tubercle 
of lymph are commonly deposited 
at the angle corners of the eyes. There is 
no intolerance of light. The vision is 
much impaired & there is severe pain 
of the head at night. There is an evident 
exacerbation of it towards evening 

100:
evening. An eruption is commonly seen 
on the body in the fading, state of this 
[eruption] inflammation. Sore throat 
is often found to precede it, & nodes also
on the arms & legs.
If the curative effects apt Mercury, 
are any evidence of the existence of a 
general Syphilitic poison, the nature  
of this inflammation becomes derisive.
I have never seen a case in 
which it has failed to cure, & the more 
recent the case, the more obvious its 
good effects are. There is a very great
difference in the susceptibility of different 
constitutions to Mercury, & there 
the Cure must be longer in some persons 
than in others. But as soon as a 
factor is discovered in the heath, a favorable 
change may be observed, the zone 
becomes pales, the cornea clearer, the 
lymph is diminished in quantity, & 
the patients themselves pensive they  

are getting much better, I will 
tell you from day to day that then
vision improves. As the soreness of 
the mouth continue the eye becomes 
cleanse & the pupil assumes more 
its natural appearance. The vision  
is now as much better, that the patient 
is able to distinguish the features 
of those around him, whereas 
before, he could only discourse the 
face generally. In a few days more 
the lymph totally disappears, & 
the only vestige which remains is the 
ciliary zone, & this always continues 
some considerable time, until the 
vessels contract again to their former 
size, which is a slow process 
It is often a long while in being entirely
removed, & is readily made 
to reappear again after it has. opening 
the eyes to inspect it will sometime 
be sufficient to occasion it  

102. 
when the system is more slow in becoming 
affected by mercury, the change 
in the eye is sometimes very sudden 
I have often been suspended at this. In  
the course of 12 hours, I have seen the 
appearance of the eye entirely changed 
when there has not been the least improvement   
before for a month or 
more. When the disease is thus stationary 
& close, I need not tell you, the patient 
will require the almost confidence 
both in his Surgeon & the remedy. But 
you may depend upon it, he will 
not be disappointed at last. The improvement 
when it once commences 
will be gradual steady. 
I have often seen cares of this Chronic 
nature where the lymph is deposited 
in sparing quantity, the Zone formed 
aroused the cornea, & the pain tho’ 
mitigated has not been subdued, tho’ 
mercury has been employed for a considerable
while. The vision is almost 

103.
useless. I believe that this the result 
of an alternative course of Mercury.
The inflammation is altered 
but not removed. The patient thinks
perhaps that is continuance is 
owing to a cold which he has taken,
& the surgeon supposes that mercury
has had a fair trial, & goes to work to 
deplete, but no good is done by such
treatment. This care which I have 
been describing has been denominated 
Pounds, syphilis. I have invariably 
cured it by exciting a sore mouth 
& Keeping it up for three weeks or 
a month.
The treatment of simple inflammation 
of the Iris is by full bleeding 
purging. I prevent the deposition 
of lymph, I sometime subdue the inflammation  
at once. Mr Shatton, the 
hewer has labored under inflammation 
of the Conjunctiva for three or four  

104.
days. He was a robust athletic man. 
I was sent for to him in the middle 
Of the night, It has been suddenly 
attacked with much severe pain in 
the globe of the eye. On examination 
I found that he had inflammation of 
the iris. I immediately bled him ad
Deliquium. The next morning, when 
I saw him. I found that effusion had 
taken place- blood was thrown upon 
the iris, & the vessels were distinctly seen 
running from the pupillary, ciliary 
to the pupillary margin. I immediately 
bled him again as before, & by following 
up the plan of treatment already 
laid down, he got well with perfect vision.-  
This inflammation seldom 
yields to Depletion nor perhaps to any 
other remedy when a deposit has taken 
place except to the of Mercury 
For this Knowledge, we are endeity
to put the saddle upon the eight hours 

to the London Eye infirmary. When 
the disease has proceeded to the adherence
stage, it requires & will yield infallibly
to the exhibition of Mercury. 
It has been noticed that in small doses 
as an alternative, this remedy, 
checked the prossess of it, & when it 
had been accidentally introduced into
the system, that it entirely removed 
it. This gave the hint for its farther 
trial. From habits of education, which 
amount to prejudice, I confess, I felt 
a great repugnance at employing it
but so many cases occurred in favor 
of it, that & at last determined to try, 
its full effect, & if you should call upon 
me now to tell you, what I consider 
the greatest improvement in 
the treatment of disease of the Eyes, 
I should say, it is the use of Mercury 
in inflammation of the Iris. It
is given in the yellow fever of the E. Indies 

106.
Indies pretty much upon the same 
plan. I expect the days will come, 
when it will be more used in active 
inflammations, & I know that it
has long been a secret remedy, among 
the auslists of this country.
These remedies with Bark where it is 
necessary Cicuta &c are all state are required 
in this disease. Generally when 
the inflammation is established we use 
Cupping glopes, to the temples. They are   
preferable to leeches in the first instance 
& perhaps in all cases. In alimentary  
canal should be rendered a briskly secreting 
membrane, I generally combine 
Calomel with opium ¼ of a gr. to ½ or 
2 grs., three times a day. You are sometimes 
Prevented from doing this by 
the idiosyncrasies of some patients, is 
whom the mercury, excites terminal & 
griping. But you may obviate this 
& check the Mercurial fever, by giving  

107
giving on alternate days small doses 
of the Sulphas Magnesiæ.
When absorption has commenced, the 
Extracturn Belladonna should be 
rubbed over the Superciliary ridge, to 
assist in the recovery of the pupil.
It is of no use unless there has been previous 
disorganization. Its action is as 
a sedative upon the Iris. It causes 
it to become relaxed & so separates the 
adhesion which have been informed 
upon it. 
Altho’ no benefit is perceived from mercury
until the mouth becomes sore,
yet the Mercurial fever does not exasperate 
the inflammation & bloodletting
relieves it in an eminent degree 
It is difficult to explain the modus 
operation of mercury in producing
absorption, but as soon as 
the system becomes affected by it, the 
morbid appearance are changed at 

108.
changed at once. 
In strumous inflammation of the 
Iris, or where this inflammation attacks. 
person previously diseased 
from the use of Ardent spirits, the 
use or abuse of mercury, or by age, 
the disease always proves destructive
to the sight, because the strength 
of such patient is not equal to the 
action of Mercury. Mercury requires 
a certain degree of the power 
of the system, in order to produce 
reaction. There cases are very difficult 
to manage, & usually they terminate 
in complete amaurosis.
Inflammation of the Iris is sometimes 
unquestionably produced by 
by the action of Mercury. It is seen 
to follow the cure of Lues, or the use 
of mercury in cares of supposed 
pox. It comes on while the system 

109.
is still under use of it. It 
has the same appearance, & I consider  
it to be like the Mercurial sore
throat, which is a diffused redness over 
the throat, instead of deep ulcer 
with inflammatory margin. What 
seems to be very remarkable indeed 
almost paradoxical is that the mercury 
has given rise it, mercury alone 
will cure it. “It is the bane & antidote”.
But its administration acquires 
great caution & very nice management,
& the inflammation is very
liable to relapse. This however, is generally 
only Conjunctival & does
not require the use of Mercury.- 
I will relate to you the case of a 
young gentleman, a Student in the 
temple, who came under may care 
as an illustration of this fact. His 
first complaint was a bubo in the 

110.
groin which came on a few days 
after the appearance of a sore upon 
the prepuce. He was recommended 
to undergo a course of mercury, which 
he did & the sore healed speedily. This 
was in August, & the May, fall owing, 
he was attacked with sore throat & a 
rash which disappeared under a second 
course of Mercury. In September 
it came on again; he applied to 
a Surgeon of the first eminence who 
told him that it was decidedly, not 
of a venereal nature, & forbad the 
use of mercury. In October, following 
he became worse & worse, I went 
back to his former surgeon, who 
told him that his complaint was venereal 
& advised a third course of 
mercury, under which the throat a 
third time got well. 

111.
In December his Eyes were attacked 
with inflammation. He was 
now excessively reduced & in a state 
of extreme debility from the repeated 
courses of Mercury, & he was now 
put upon Bark & tonics. The inflammation 
however, went on to 
increase, & he was now entirely deprived
of vision. On account of the 
great pain which he suffered, Opium 
was ordered, & the Bark discontinued. 
The man was now excessively 
ill, he had a troublesome cough
& excessive spitting his pulse was 
130. I saw him in February. In addition 
to the sore throat & these other 
symptoms, I found his left eye destroyed,
& the right was in imminent 
danger.- In a consultation 
which was held upon his case, notwithstanding 
all these symptoms 

112.
I recommended Mercury. Mercury 
had brought him to the borders 
of the grave, but still I knew 
that it was the only remedy which 
could save him. But the other 
gentlemen would not consent to it. 
It was at last concluded on to wait 
a week, & see if he was not better, in 
which case I was permitted (entirely 
at my own risk) to give him mercury. 
At the end of the week, he was 
worse, & I took him under my care. 
I began with a very small dose. He 
took 3 grs of the Hydrogys. Cret.
with Calomel ½ gr twice a day.
Leeches were ordered at the same time 
& a blister to the temple. In a few 
days, when I saw him he was better.
He mended astonishingly & at last completely
recovered.

113.
Sequelæ of Inflammation of 
The Choroides when it is destructive
I shall make only, a few observations
on this. The first is a Staphylometaus
projection of the Choroid 
Coat. It seems to arise from a bursting 
thro’ the Sclerotica, or by an extenuation
of it by a process of absorption,
so that the choroid appears as 
if it were almost denuded of this 
covering. The surface of it is of a blueish
leaden color. Sometimes it appears 
on parts only of the surface 
of the globe, I sometimes it completely 
encircles the cornea. It often 
presents the appearance of a saccules
or pouch, protruding thro’ the cornea 
sclerotica. The eye is always 
completely amourotic, & the pupil
deformed. I have known it to be 

114
preceded by an appearance of deepseated 
Veins, or by hydrophthalmia.
I believe that the distenria
in this disease is accessioned by an 
increased secretion of the Aqueous humour.
The protrusion sometimes 
recedes of itself & wholly dis appears.
A state of Enlargement of the Globe 
with a complete disorganization of 
the internal structure of it is sometimes 
follows inflammation of the 
Choroid Coat. The pain is most interred, 
& you would be led to suppose 
by it; that the globe was going to 
suppurate. I have been induced to 
open the eye by a transverse incision 
with the hope of relieving the pain, 
& it has succeeded. It has been followed 
by no discharge of pus, or but very 
little fluid, altho’ from the appearance 
of the eye you would be led 

115 
to expect a great deal. I believe 
that the pain is relieved by taking 
off the distension. It is of little 
consequence what you do, if you can 
but diminish the pain, for the vision 
is always completely destroyed.
Opacity of the Capsule of the Lens 
is a very common sequela of inflammation 
of the Choroid coat. The opacity  
begins on the visible circumference 
of the Lens & gradually extends 
over the surface of it. The adhesions 
are very broad & more than you
would expect from the inflammation,
& they are so firm, that they cannot 
be removed by the Belladonna. 
The pupil is rendered so contracted & 
useless. Sometimes a map of lymph 
is deposited upon the pupil, which 
cannot afterward he absorbed 

116 
Frequently when there is no opacity, 
there is great deformity of the 
pupil. It is drawn out from the visual 
axis, or loses its circular figure 
I believe in there cases the Plied
choroidæa will be found agglutinated
to each other, by a deposition of 
Lymph & so adhering as to be inseperable. 
Inflammation of the Retina. 
The Retina becomes sometimes affected 
under continued inflammation 
of the Choroid & Iris. After acute inflammation 
of the iris extending 
to the Retina, vision is never recovers, 
& you generally find a state 
of Amaurosis follows. Sometimes   
the Retina is subject to Idiopathic
inflammation, which is ushered in 
by severe & intense pain of both 

117
orbits, extending to the back 
part of the occiput. The pupil becomes 
suddenly palsied, that is, is 
preternaturally dilated & fixed in the 
position, & the vision is almost completely 
destroyed. The humor becomes 
thickened.
The Inflammation however seems 
to be disproportioned to the rapidity 
of the loss of vision. It is followed 
by a complete amauratic effection. 
You Know it from inflammation 
of the Iris because the pupil is 
very much dilated, whereas in the 
other it is as much contracted.- 
The vision also is slowly lost in 
inflammation of the Iris, & subsequently 
to it while in inflammation 
of the retina, the loss is sudden. 
In the few cases of this affection 
which have come under my care 
the most vigorous treatment has been   

118.
adopted, but without any success. 
It has always terminated in complete 
Amaurosis, in defiance of all attempts 
of cure. I have never seen a 
successful case.  

119.
Amaurosis.
This is a morbid affection of the 
Retina. It may be divided into 
two classes. 1) that which is dependent
upon a morbid change in the 
structure of the organ 2.) that which 
is dependent upon the suspension 
or loss of its function, & where the 
structure remains unimpaired. 
Under the first of these, may be included 
a breach of the organ from a 
wound or any other cause. concussion 
of the news from a blow
exhaustion into the arteries or posterior 
part of it opacity following 
inflammation, a deposition of lymph 
on it, surface or behind it a cruising
of the virtuous humor, or disorganization 
from any cause. 
The second class, or that depending 
upon a loss of function, includes 

paralysis of the Retina from any
cause- congestion or its opposite 
state, apoplectics effusion hydrocephalus, 
tumors in the brain pressing 
upon the Optic nerve – opacity
of the vitreous humor palsy from 
the effects of poisons as Lead &c irritation 
of the prima viæ, suppression
excess or derangement of any of the
Secretions.- 
The first class is called Organic amaurosis,
the second the symptomatic, 
& they are not entirely independent 
of each other for by a continuance
of the functional amaurosis it may   
become amaurotic 
The disease may be perfect or imperfect- 
sometimes there is only defective 
precession at other times, these is complete 
want of it. Thus it may arise 
from an increase or diminution of  

121. 
Sensibility.
The organic amaurosis is obviously 
is remediable, the Symptomatic 
will yield to treatment, but only 
to that degree that we can relieve 
the disorder which has caused it: hemamourosis 
dependent upon tumors in 
the brain, opacity of the vitreous 
humor, cannot be amended, because 
there is an absolute charge of structure.
But when, on the other hand, 
it arises from congestion or languid 
circulation from nervous exhaustion
or uterine suppressions, it may generally 
be alleviated on a greater or less 
degree. When this disease exists from 
any cause, it is marked by a very 
dilated pupil, & a loss of association
between the tens eyes. This circumstances 
gives to the patient a vacant
unmeaning stare. You may generally  

122.
be able to recognize the disease 
by this alone, if you have been
much in the habit of seeing, it.- 
The History, & concomitant symptom 
of the disease, will generally explain 
its origin. If your patient in a child, 
& the disease comes on after hydrocephalus 
you may suppose this to be the 
cause of it. So also, if it has followed 
any accident, & there are present any 
symptoms of Cerebral congestion, as 
flushed face, tense pain as armed the forehand
tinnitus aurums &c lapse of 
the memory if the symptoms are the  
of general palsy, if the patient has 
a dribbling of saliva, an uneven protrusion 
of the tongue an unsteady or 
lettering gait, & general impaired motion, 
such symptoms will readily
yield to a just Knowledge of the cause 
of the disease. -

Amaurois often arises from blows 
& Concession. In such cases, I conceive 
that there is a concussion of the Optic
nerve, which causes it to be paralyzed.
When it follows acute inflammation 
of the Iris, it is believed to be in consequence 
of an effusion of lymph between 
the choroid & retina. Patients do 
not die from these affections, & hence 
an opportunity of examining the 
morbid condition of the organ very 
rarely, occurs.-
It may be causes by a deficiency of 
the humors of the eye, or by an increase 
of them as in hydrophthamia.
In the one case, there will be a collapse
of the retina, & in the other a prepare
upon it.- 
The pupil of a healthy eye present 
a clear fit black appearance. In an 
amaurotic eye on the contrary, it 
look semi-transparent & closely cloredy   

This appearance was formerly called 
Glaucoma. If you will look into 
the healthy eye of an horse you will 
always observe it. There is a state 
independent of the cloudy appearance, 
in which you may observe a
distinct circumscribed yellow spot. 
I have generally seen it in opacities of 
the retina following inflammation 
of the Iris. There is a peculiar hardness 
in cataract when it is accompanied 
by amaurosis. The opportunities
for examining the eye are so very infrequent,
that it is extremely difficult to 
tell the changes of structure which it 
has undergone. This general cloudy, state 
of the pupil, I have frequently seen in 
very early life, but I do not know 
the cause of it. It is very, common in 
age, & it might naturally enough be expected, 
that the humor of the eye should 

undergo some changes, at a period 
when almost every other part of the 
body becomes thickened & rigid. 
I lately dissected the eye of a man
who died having a cataract combined 
with amaurosis, & the appearances
were rather curious. He was a post 
bay but the cataract coming on, he 
was obliged to give up his business. 
Fortunately, & he became the subject of 
natural couching, & he regained the 
sight of one eye. He gradually however 
lost the sight of at again, but 
still the globe retained it, plumpness 
The vitreous humor was quite absorbed, 
& the retina collapsed. There amaurosis
resulted, from the collapse of the 
retina, & this was occasioned by the absorption 
of the vitreous humor. The 
plumpness of the eye was preserved by 
the increased secretion of the aqueous 
humor. If the retina, could have, by 

126.
any means been supposed therefore,
the patient might have seen. 
The external signs of organic amaurosis,
are a particular baden blue 
color of the allesoric coat, & a congestion 
of the veins of the conjunctiva 
The pupil is sluggish & generally lose 
its circular form. But in sympathies
amaurosis the pupil is the only index 
of [impaired] [vision] retina.
It occurs most frequently in artisans
who are much employed about [brilliant]
or small objects. The pupil is 
often vacillating & falls, back with 
out any change in its diameter.
Another cause of amaurosis is the total 
alrence of the pigmentum in green.
The age in these cases presents the same 
appearance as in the white rabbit or 
Albino. The iris is quite transparent 
as you may at any time see by examining 

examining the eye of the rabbit. Here is 
commonly a tremulous motion of 
the globe, the admission of light produces
great uneasiness, & vision is 
extremely imperfect. I have seen two 
whole families who were affected 
with it. It seems to run in families.
The only means of remedying 
this disease, which I have found of any
benefit is to shade the eye externally. 
This by absorbing the light, weakens 
its compression upon the retina. 
Sympathetic amarosis generally carries 
with its history, its cause. Certain 
professions which require the eye to 
be long exercised with bright objects 
are exciting cause of it e.g. person 
who apply their eyes much to polished 
reflecting surface, dealer in scarlet 
cloth &c Since the snew coinage 
has lately come into the bank, a 

128 
great many individuals have been 
employed in counting, it out & examining 
it & many of them have 
been attacks with amaurosis. 
A second injurious cause of this disease 
is the minuteness of objects. Thus   
it has been observed to be more common 
among tailors, shoemakers, 
Clerks &c. It is not uncommonly the 
result of hard sturdy. An excess or defect
of light will produce it- also 
the use of nautical glasses. Depressing 
passions when long indulges in will 
excite it. I have known several instances 
where Animism has produced 
it, & such cases are the most unfortunate 
of all, for the patient are generally 
in a state of the most fixed melancholy.
They hide themselves from eructy  
& are incapables of all enjoyment. 

What adds to one the misery of those 
fares, is that the patients are in a
state of complete anmic. 
Over long suckling of children is a 
very common cause of amaurosis
The poor who are anxious that they 
may breed slowly, are much in the 
habit of suckling their children very
long, & you will find this to be 
a very common disease among such 
persons. But perhaps the most prolific 
cause of all is Gastric Irritation.  
This always aggravate the disease 
& very often produces it. When it 
arises from this, may commonly 
Know it from the symptoms which 
are present. There is generally a sense 
of tension & weight over the forehead 
oppression of scrobiculus cordis, with   
lassitude hebetude, & frequently suppressed
menstruation .

130.
Pain over the fore – head & temples is 
generally, the precursor of this disease 
when these subside, the amaurosis
comes on. They are not always present 
but when you fine, that it has been 
precededby pain, you may consider 
it as in curable. Mared volitantes
are a most frequent symptom; they 
appear differently in different cases. 
They are evidently produced by a congestion 
of the retina or the opposite 
state. The proof of this is that persons 
laboring under dyspepsia have them 
temporarily. This is often the first symptom 
of it – then head ache so far as to 
produce membranes of the Scalp follows- 
& there is often a confusion of mind, incapacity
of utterance & loss of memory. 
The proof that they may arise from inanition 
too, [on the ] is that they are very      

common in the last moment of 
life, & in fainting.
Mused are sometime floating & sometimes 
fixed. They are single of or multitudinous
& they assume a very, great variety 
of forms. They have a slow rambling 
motion, & follow in some measure 
the movements of the eye up & down 
sometime they are seen only in one direction 
as in abduction of the globe. 
If they have been previously at some 
distance from each other, & appear
to approach nearer together, you may 
consider the case very alarming.
But where this is not the case, when 
they do not interrupt vision, & the 
eye is clear, & especially if there is very 
other affection of it, the case is different:
they are not then so alarming 
but they are always difficult to the gastric
of. Looking much al near objects 

132. 
sometimes causes them.
There are one or two other forms of amaurosis, 
of which I shall say a 
few words. One is that, in which the 
retina is incapable of bearing the 
stimulus of light, so that you see 
the patient laboring under a drooping 
fallen lid & absolutely unable to open 
the lids, & get with all this there are 
no signs of inflammation in the eye.
Another, is the reverse of this, or where 
The patient bears the light very well, 
but becomes quite blind at twilight.
Little is Known of the true nature of 
this. It is realy seen in this Country 
but it is a very frequent disease in 
tropical Climates. It is frequently to 
be met with in Sailors, who visit those 
climates. The only good account of it 
which I have seen is one published in the 
Medica. Cheney. Transitions, by a many  

Sicyon who had frequent opportunities
of observing it. He states that 
a course of permanent blisters has 
never failed to cure it. In neither does 
the retina appears to have suffered any 
permanent injury. 
Another state is a periodical pain 
of the eye ball un accompanied with 
any inflammation. It seems to be 
brought on by under exercise of the 
organ. It generally comes on every 
evening & is of a most [&] intents Kind 
preventing the patient from sleep & 
rendering him miserable from its severity.
It is not common however. 
This subject is very extensive. There are 
still great boundaries to our Knowledge  
of it from the paucity of remedies 
which have been successful.
I think that a more impartial view 
of it will show, that the reason 

134
why, it is a disease exciting or little 
hope, is from a want of proper discrimination 
in the Surgeon. There 
are certainly many Kinds of amaurosis 
which are relievable, & many 
others which are not, & I should advise 
you all to be very careful, in learning 
to discriminate these.- These are a 
class of most unfortunate patients, 
& will more than all others excite your 
sympathy. It is a has plan to attempt 
to cure in cureable cases. It will 
be always best to state candidly in 
such cases, & in the most delicate manner,    
your in ability, from the little 
which the profession Know of the nature 
of the disease. You will never 
loose credit by such procedure, where 
as you may by an opposite mode of 
acting.

135.
The habit of the patient generally 
affords a clue to the nature of amaurosis
& to the proper means of attempting 
its cure. If it arises from 
plethora it will be Known by the 
general appearance of the person.
It is most common however in persons 
of a opare habit of body & sedentary 
habits. You often most with it in persons 
who labor under defect of focal
power in the eyes, which from the constant 
effort to adjust the organ to objects, 
we akens, I believe the Retina. 
At certain periods of life, you Know
this focus changes, & the particular time 
at which it does so is rather uncertain. 
At all events whatever this focal, this 
telescopic power is, it is certainly
subservient to the Retina. When it 
is lost therefore, what may be caller 
a natural amaurosis takes place is 

136. 
consequence. Many circumstances
tend to prove this opinion. Persons 
thus affected, apply, their eyes a short 
time to objects then they become dim.
They rub the eyes a little, & the object
again becomes clear. As if they look
from the object a little to a distant 
one, they can then see clear again for 
a little while, till all before them becomes 
confused & indistinct: if they 
are reading for example, the spaces
between the words & lines are lost, & 
everything appears to them, as if jumbled 
together. If they persist in the effort,
a dull pain comes on over the 
fore head, with this, those are commonly 
other symptoms of debility present 
showing that the retina is affected. 
Strabismus which is an affection of the 
abductor oculi, is a concomitant symptom
of amaurosis, & Ptosis, which is 

137. 
a paralysis of the Levator palpebræ 
is another.
With regard to the Treatment of 
Amaurosis, the observations which 
I have been able to make, lead me to 
believe, that is must be entirely Constitutional.
The Cure depends upon 
the successful treatment of the disease 
upon which the amaurosis depends. 
Stimulants applied to the eye are of 
no more use than if when they are applied 
to other nerves, if their function 
are suspended. 
If there is a state of Congestion of the 
part, this should be removed. Leeches 
should be applied & a blister 
Kept open near the part. If there 
is deep seated inflammation, it is 
to be heated according to the rules 
already laid down when speaking 
of this subject by the Mercurializing
plan- & the more active the   

138. 
inflammation is, the more easy 
it will be to cure it. All acute diseases 
are very easy, to cures diseases
which are very, active in their natured 
may readily be relieved whereas 
those which are in inactive are more 
difficult. If the Stomach or Uterus
is disordered, they must be set right  
Whether as a cause or effect, the digestive 
system is always more or less 
disordered in amaurosis, & the medicine
which I have found to be most successful 
in these cases, is a long course of the 
blue pill- a course of six months. When 
the mouth is a little touched with it, it 
should be laid aside, until it gets well 
& then be resumed again. The blue 
pill may sometimes be combined with 
Rhubarb or Aloes, unless the patient is 
of a plethoric habit. There are slightly 
tonic, I will often form an useful combination.
From the employment of the 

139. 
higher class of tonics in amaurosis 
I have never seen any benefit derived. 
The Continental practice in this disease
is nauseating I divided doses of 
Partrite of Antimony, so as to Keep up    
sickness & destroy the appetite, & afterwards 
the Alactic pills. But I 
must say that, I never have seen any 
benefit desired from this plan. I have 
frequently tried it myself, & seen it 
tried by others, but never with any 
advantage. But I have seen many 
cases cured in the other way.
In speaking of Local application however,
I would not be understood to 
say that they never are of any use. If 
the tarsi are diseased & there is a defect 
or improper secretion in the Meibomian
plands, causing a dryness of 
the globe, in such cares the diluted 
Sulphate of Zinc with the Citrine ointment 
or the Thebaic tincture may prove
very serviceable. Sometimes, indeed, 

140. 
it seems of if the state of the Retina, 
sympathized with that of the 
conjunctiva.
In your treatment, be careful to separate 
the curable from the in curable 
cases- cause your patient to avoid 
strictly all the exciting causes of the 
disease. You should prescribe at the 
same time for the mind of your 
patient, finding amusement for 
him which will not require the exercise 
of his eyes, & giving him 
all the hope you can as to the result 
of his disease. Sometimes, I think, 
these are the best medicines in amaurosis. 

Hydrophthalmia. 
This a redundant secretion of the 
Aqueous humor. It sometimes follows 
chronic inflammation, tho' not 
always. It is not a very common complaint. 
The figure of the globe of the eye is 
preserved, it acquires a dark blueish
color, which is the choroid appearing 
thro’ the Sclerotic. The eye always presents 
this appearance whenever there 
is much distension of the Sclerotic. 
The pupil is large & in active- there is 
great dimness of vision, & ultimately
it becomes entirely extinct.
I know of no Cure for this disease. Evacuation 
of the aqueous humor, by 
marking an opening, produces no 
amendment of vision, & a course of 
purgatives do no good.

142.
Suppuration of the Eye ball. 
The eye ball sometimes suppurates
spontaneously, but more frequently 
it results from a blow or wound. When 
the suppuration is spontaneous, it arises 
from a long continued slow inflammation. 
The globe in this affection is 
much protruded, & feels exceedingly 
tense to the touch. The conjunctiva 
is thrown very much upon the cheek 
the pain is deep, laminating & exceedingly
severe. There is very great 
Irritation & the general health is must 
disordered. The patient has frequent 
shivering & flushes & symptoms of 
high Constitutional, Sympathy. Soft 
lymph & pus now appears under the 
cornea, a process of thinning takes 
place- at length it ulcerates thro’ & 
a discharge issues from it, when the 
patient experiences some relief.  

I know of no other made of relieving 
this disease but by making a 
section of the Cornea, as in extraction 
of the Lens, & so giving an [ousted] to 
the matter. The shrinking up of the 
coats of the eyes afterwards cannot be 
prevented, & it is unnecessary to say 
that vision must always be inevitably  
destroyed.
The Aqueous Humor sometimes 
becomes turbid from inflammation.
When this humor is drawn off it 
will be reproduced again it in ten 
or twelve hours. It will be generated 
again in all states of the organ.

Diseases of the Vitreous Humour.
The vitreous humor is often absorbed. 
In floating cataract following couching, 
this is frequently the case.
The eye does not loose its figure, but 
is quite flaccid. I mentioned to you 
the examination of a case of this 
Kind in my last Lecture. I have seen 
several of the same kind. It is frequently 
to be met with in the decayed eyes 
of horses. If you are curious enough 
to do to the slaughter house to examine 
them, you may find it. It is sometimes   
totally absorbed.
Another state, depending upon a 
reduced aqueous or deficient vitreous
humor, is a trembling Iris which 
always following the operation for cataract. 
Couching breaks down the 
Cells of the vitreous humor, so that a 

great portion of it becomes absorbed,
& the deficiency is supplied by 
an increased quantity of the aqueus
humor. A way great quantity of the 
vitreous humor may be lost without 
doing any very essential injury 
to vision. This is shown by the 
loss of it, sometimes occasioned by 
convulsive Spasms of the muscles of 
the eye, during the operation for cateract
by extraction. The vitreous humor
often looses its consistency, in 
a good degree previous to the operation 
so that as soon as the section of 
the cornea is made, a great portion 
of it trickles away, & get the patient 
afterwards recovers tolerable vision.
This state of the humor is most 
frequent in aged people. Its consistency 
is more dense in some, less so 
in others. The cornea in such often 
assumes a Conical shape 

146 
Another disease state of this humor, 
is that it frequently acquire 
a glairy consistence. Sometimes, in
these cares it is of a yellowish, & sometimes 
quite of a brown chocolate 
color, & as soon as the eye is punctured, 
it [snafus], & the eyes becomes collapsed. 
The cause of this, is that the 
natural cells of the humor are destroyed- 
it is not confined as in the healthy 
condition of the organ, & so it 
finds a ready exit as soon as an opening 
is made. 
A diseased state of the vitreous humor 
frequently occurs, after operations 
for Cataract. I operated a few
days ago on a gentleman from your 
mouth, & the operation seemed to 
succeed to our mutual great satisfaction.
He saw almost immediately,
but the next night, he got up 

147
to the close stool, I strained very much
to have a motion, when suddenly 
a very violent pain came on in the 
eye ball, shooting backwards to the occiput.
The next day, he was totally blind. 
The pain which he suffered was very 
slowly relieved, altho' the most active 
measures were taken. After some 
days upon examining the eye, on
extravasation was discovered in the vitreous
humor, which assumed a scarlet
color in the Sun, & looked yellow in 
the shade.- My friend & colleague 
Mr. Trames had a similar case at the eye, 
Infirmary. The same night of 
the operation a violent hæmorrhage 
come on, with most excessive 
pain, & the cornea was burst thro’, 
the vitreous humor with a quantity 
of blood escaped. It had the appearance 
of a pieced of dark, colored sponge 

148.
Considerable blood was lost Lime 
their time, I have more than once 
Known the same thing to happen 
in a whole & healthy state of the eye. 
I arose probably from a rupture of 
some of the small vessels.
I do not believe that the vitreous humor
is subject to an increase secretion
It is of a septa form structure, & if it 
were subject to such increase, it all
must of course be lacerated. 
I have already, secretion a Cloudy
appearance of the Vitreous humor 
in our form of amaurosis
It is subject to a complete & entire 
change so that its consistency, & transparency 
is altered, & yet the texture 
of its cells remains entire. It is not 
common. It appears like the 
form of cataract. The lens is convex 
so as so obliterate the anterior chamber. 

chamber. I one had a child under 
my care with this disease, in which 
the eye with the advice of Dr. Fane 
was extirpated, under the idea that 
it was the malignant fungus, to 
which all the appearances were similar.
It may be of importance perhaps 
to Know that this was not a 
malignant changed. The patient is 
new a fine healthy boy- he recovered 
perfectly the other eye is 
quite good, & he enjoys perfect vision. 
The eye however had acquired some 
increase of volume as it was drivers 
forwards considerably more than 
the other. Since this case, I have had 
an opportunity of observing a number 
of others, which were similar to 
it, & had the very same appearances.
The pupil was much dilated & fixed- 
motionless, & there was an opacity 

150 
at the bottom of the orbit of 
a yellow color, having a sort of splendor,
answering exactly to that appearance 
described in malignant fungus. 
And to my great surprise, 
the while was quite healthy, & suckled 
well, & the disease acquired no 
further progress. The child is still healthy.
This disease appears to me to be 
merely a morbid secretion of the all 
of the vitreous humor. It is unfortunate
that there are no accurate signs
by which we may distinguish this 
from the malignant form of the disease.
The convexity of the eye, the opacity 
of the chrystalline lens, the immoveable 
pupil &c are the same in 
both, & the yellow greenish color at the 
bottom of the eye in the same. 
The singleness of the disease, however, 

151
leads you to believe that it is 
not of a malignant character
If the other eye is healthy, if the absorbents 
glands are unaffected, & 
there are no Constitutional Symptoms, 
they all prove an opposite
state, & lead to an opposite inference  

152
Fungus Hæmatodes Oculi.
This is the fashion all names of that 
disease, which was formerly known
under the name of Soft Cancer of 
the Eye. It is invariably destructive
to vision. & to Life. It most frequently 
occurs to infants under four years of 
age. The only collects care, which I
have seen are those related by Dr. 
Fane in his edition of Saunders, &
those by Mr. Wardrop, who was at 
great pains to collect all that he could 
from his own practice & from his 
friends. 
The first appearance of the disease is 
an opacity of both eyes, having a 
sort of metallic lustre, which I have 
heard likened by the parents to several 
different things. They have generally 

153
generally noticed that such children have 
been blind sometime previous to 
this appearance. By degree this shining 
substance approaches to the 
pupil, & the iris is rendered convex.
It looks as if there were a soft cataract. 
The eye balt then becomes enlarged- 
the sclerotica assumes a deep
blue color, the vessels of the conjunctiva
are much dilated, & the eye 
lids are distended & varicose. The 
cornea becomes opaque & dies, & an issue   
is thus given to a slimy discharge 
then a red fungus escapes, mingled with 
a coagulum of blood. The child now be 
comes lethargic & heavy, & hangs its 
head upon the pillow, or the lap of 
its mother. The countenance looks 
pallid & fallen & it gets very, fidgety
& uneasy, screams often aloud in its 
sleep, & is as restless, that the mother 

is preventers from getting her proper
rest. It takes its good very capriciously.
The bowels are very torpid,
& then after a long continuance of the 
disease & much suffering it dies from 
exhaustion frequently in convulsion 
to which it is at last very subject. 
After both eyes become affected, & the 
parent is doubly alarmed at seeing 
the same coming in the other eye which 
had destroyed the first. A gentleman
was once called to one of these cases   
in consultation with Mr Hunter, & 
they mistook the disease for a cataract 
& proceeded to the operation, but 
finding that the flow of the humors, as 
soon as they had made the puncture, 
their mistake, they extirpated the 
eye. The case is related in the Medical 
Obscuration, & Enquiries.
It is very difficult to say, in what texture  

155
texture of the eye the fungus hæmatates
commences. In some dispertions
which I have seen, it has appeared 
to be the optic nerve, & in others 
it seemed to arise altogether from 
the vitreous humor. The eye on examination 
appears to be an undistinguishable  
mass of unorganized lymph
I show no single vestige of its proper 
original texture. In the last 
stage of the disease the sclerotic
becomes absorbed. It does not terminate 
in the orbit, but extends 
back as far as the thalamus itself. 
In its texture, it appears to be a
brain like matter, soft, & very easily 
breaking down on exposure
when it [fungates]. The absorbent an 
gland are generally inlayed at this 
period. 
It has not been determined by sufficient 
evidence that extirpation, even  
  
 


156.
in the earliest stage of the disease 
will save life. After there is an increase 
of bulk, it is extremely improbable. 
When both eyes are affected, 
the operation is certainly improper. 
I was called to a case the other day, in 
which both eyes were effects with this 
disease. In one, the cornea was about 
to slough, & in the other, the disease was 
in the incipient form. I saw another 
case lately, where only one eyes was affected 
the patient was a child, & but for 
the extreme emaciation & general ill
health which he appeared to be in, I certainly 
should have operated. 
It is all hypothesis, that this disease is 
one of the retina, & it is an opinion 
which is not borne out by analogy. 
The nerves of any other part are not affected 
in a similar manner. In fact it 
is a disease whose nature in still mysterious 

157
Carcinoma of the Eye 
This disease does not attack the 
humors of the eye nor their tunics
It affects the Mucous membrane & 
the Conjunctiva. It is the same disease
as takes place on other mucous  
membrane, the farces, the rectum 
&c. It begins on the conjunctiva in 
the form of a little warty, tumor; these
after a time granulate ulcerate & fungous
granulations arise which are very 
exuberant giving the appearance 
of very extensive diseased. It extends 
to the cannula Sachaymalis & the 
palpebræ, after affecting the membrane 
lining the ductus ad naseem, the antrum 
so as in the end, entirely to 
break up their structure, & that the 
whole check presents a map of cares 
nomatons disease. The glode of the 
eye is soon quite concealed, by it & 

158.
ultimately destroyed. An examination 
of this disease, you can find 
scarcely a vestige of the eye remaining
The Lachrymal gland is often 
found in a Schirrhous state.
The only remedy is extirpation, &
even this presents but a cheerless prospect 
of relief for you all know
very well the disposition in Cancer 
to return. I have seen the operation
performed three or four times, but 
the disease in all sheaved evident marks 
of a return in a few months. 
You will be at no loss in distinguishing 
it from the peculiar character 
of its ulceration its very peculiar
factor, & the acute lancinating pain 
which accompanies it. Besides the 
general aspect of the patient will 
soon teach you to discriminate 
the disease.    

Whether it is of the Carcinomatous
as Fungoid Kind, the operation
must be performed in the same 
way. It is always a horrible operation. 
If the globe of the eye has 
not given way, we commonly 
place a ligature thro’ the cornea, 
by which it is drawn forwards by 
an assistant. But if it forms a considerable 
tumor, this is not necessary. 
You make a little incision 
at the angle of the lids, which gives 
you more room to go round them, 
& so expedites the manduose. A
strait, narrow, bladed Knife having 
a double edge, should then be carried 
around close to the circumference 
of the orbit. It is best to 
have this Knife a little bent flat wise 
& then the muscles will be more easily 
& quickly divided. The hæmorrhage 

160
which follows this operation,
is sometimes very considerable. 
but it will generally be checked by 
putting on a dossil of lint, so as 
to fill up the cavity.
When the septum of the conjunctive
is cut thro’ the globe will be liber 
steady. I may be easily extracted with 
very little force. You should be very 
careful not to pull at it too forcibly
as much injury, may be done 
by so doing, & a very slight degree 
of force is all that is required for 
its removal. 

On Cataract. 
The transparent parts of the eye become
opaque in consequence of 
inflammation just as takes place 
in all other parts of the body. This 
is seen in the [while]. In a natural 
healthy state, it is transparent, but 
of new skin forms, it never after 
wards become clear as before. Age 
also makes a difference in it in 
this respect. If you look at the 
skin of an old person you find 
that it is rust as it always has been. 
It was once fair, but it has now become 
thicker & of a brownish cast. 
Then the conjunctiva, after undergoing
a process of inflammation, becomes
opaque. The arcus senilis
which is so frequently seen in aged 
people is the result of a slow inflammation 
of the cornea. The glaucoma 

162. 
is a change often depending upon 
slow inflammation. 
The simplest example of cataract 
is that which follows a puncture
of the Chrystalline lens, by a painted 
instrument. The consequence is 
that inflammation arises under 
which Lymph is deposited forming 
a natural cataract. But this disease 
often arises spontaneously. 
It is not unfrequently found in the 
fœtus in utero. Here it probably depends 
upon some mal organization    
In old people it is very frequent;
I suppose it arises from a gradual 
change in the inter lamellulor structure 
of the lens. The vessels here as in 
other parts generally become at this 
period shrunk up, & so it is caused.
Cataracts differ in their Consistence  
at different periods of Life. In children

163. 
they are almost semifluid, being 
not denser than jelly. In 
young, people, & adults they are 
not much harder; but in old people, 
they are much more so, being
gummy & tenacious. You sometimes 
see a hard cataract in the young, 
but it is extremely seldom that you 
meet with a fluid cataract in the aged.
A fluid cataract becomes in the 
course of time solid, but you do 
not find the reverse, except where 
spontaneous absorption takes place. 
A flatulent cataract does not become 
caseous, & when cataract is once formed, 
its consistency very seldom 
varies, excepting perhaps in age. 
It is useful to know this, because 
it sheaves the folly of the opinion 
which has been held by oculists, that 
a soft cataract ought never to be 
operated upon. They would not formerly 

164.
formerly meddle with it, when in 
this state, but waited, as they said, 
till it become ripe. 
Opacity may be capsular of lenticular 
or both. The capsular is confined 
entirely to the anterior or posterior 
lamellæ of the lens, while the 
lens appears at the same time transparent.
It may affect one or both 
lamellæ at once, & the lens become 
opaque or absorbed. This latter case 
is called the Membranous cataract.
When there is an opacity of the posterior
capsule, it may be Known by its great    
depth, by its concavity, & by the appearance 
of radii, corresponding to 
the radii of the lens itself. This radiated 
appearance is seldom to be observed 
except in this case. When this posterior 
capsule is opaque, the iris is often 
rendered concave by its being drawn 

into adhesions.
The membrane cataract is the
result of inflammation. Occasionally 
a gradual absorption of the lens takes
place, whereby the two sides of its capsule 
coallesce, forming a tough, opaque,
highly elastic substance. 
The Lenticular cataract is either milky 
or flocculent, or caseous or hard.   
These four are very readily distinguished,
& that without any very minute 
discrimination, & it is extremely 
important that you should be 
able to tell them. The milky cataract 
really looks like the substance 
whence it obtains its name. Sometimes 
little spots of a white matter 
appear in it. They are either in the 
Capsule itself, or they are the inspissated
parts of the fluid. Generally, if 
the pupil is completely dilated, you 
see no transparent rim surrounding 
it. The flocculent cataract can hard 

can hardly, be mistaken. Its texture 
is loose & irregular. It is white &
fleecy like flakes of snow, broken 
irregularly by instruction of transparent 
lens. It is never an uniform opacity 
often it is radiated. It always 
admit some degree of light to the 
retina. In Caseous cataract is 
of an uniform opacity. It may be 
soft or firm, generally it appears of a 
dirty white tinge. The motion of the 
pupil are always very sluggish. It interrupts 
much light, is seldom transparent 
& is more voluminous than any 
other.- The hard cataract, is concentrated
generally colored it is always 
more or less muleated, more dence
in its center than at its circumference.
It is of very material consequence that 
you should be accustomed to the diseases 
of the eye, so as to be able to discriminate     

discriminate these four kinds of cataract 
because your operation will be accordingly. 
The more nice gradations 
of cataract, are not perhaps as necessary 
to be Known, but the above are 
indispensably so. 
The Congenital cataract is seldom 
perceived until the child is some 
months old. It is generally, surrounded 
by a large transparent rim, so 
that the light is not prevented from 
performing a perfect image upon the 
retina. The child is never quite blind 
the nucleus is sometimes not larger 
than the head of a pin.
Mr. Poll’s operation of breaking up 
the substance of the cataract, by introducing 
a needle & turning it about 
in it, did not excite the alteration
which it merited. Perhaps it would 
not have been prosecuted further, if 
it had not been for Mr Saunders, who 

168 
first watched the process of the operation,
in a Stoe makes who had 
accidentally wounded his Chsystalline 
Lens by an [awl]. It was he who 
first devised & applied this operation 
to congenital & flocculent cataract. 
He performed on infants of all ages 
with the most complete success. 
The result was the restoration of very
good vision. 
It fell to my lot to succeed to Mr.
Saunders in her office at the London
eye infirmary, & I have repeated the 
operation very often on infants of all 
ages, & on a great number of adults 
who had soft cataracts, & I cannot help 
considering it one of the grandest discoveries 
made in Modern Surgery. Mr 
Saunders intended, ascertaining its result 
in adults, but he was prevented in the 
midst of his labors by an untimely 
death. I have followed up his intention, 

169.
but I must confess it has proved 
in adequate to my expectation. 
It is an operation which is only applicable 
to the soft & fluid cataract. 
Your object is to make such an opening
into the Lens, as to permit the 
aqueous humor to penetrate into it, 
If the cataract is fluid, its whole substance 
will sometimes escape forward 
into the anterior chambers
If it is flocculent, sometimes flakes 
of its substance will be thrown forward,
by which it will undergo a 
quicker solution. It seldom requires  
to be repeated more than twice or 
thrice. Sometimes one operation is 
sufficient. The principle of the operation 
is to secure a permanent urethra 
aperture in the Capsule, & afterward
to break up the whole of its substance. 
The Instrument which Mr. Saunders  
employed, was a spear-shaped needle 
cutting a little below its shoulders. 

170
The first operation consists in passing 
the needle thro’ the cornea about
the distance of a line from its circumference 
in a direction parallel to the
plane of the Iris until it reaches the 
pupil, when its point is to be dipped 
a little & the lens punctured by a continued 
& gentle working of the needle, 
from side to side making a vertical 
incision in the Capsule. The [crossed out] few 
touches more break up its [Capsule] 
texture. I should advise you never 
to make more than one incision. 
If you make a double incision you 
are in danger of leaving filaments 
which remain afterwards & intersect 
the pupil, & they become so elastic 
that they resist every effort afterwards 
to break them. After the first incision 
is done, the substance of the 
lens may be broken up by a gentle 
rotatory motion of the needle, which 
should then be with drawn.

The night before the operation, Belladonna 
should be applied over the 
Eye-brow, so that the pupil may 
become fully dilated.
Fragment of the capsule will become 
absorbed, but the continuous capsule 
never will.- If you put a lens 
into water, you will find after a day 
or two, that it has undergone a superficial 
Solution. If soft, it seems to  
dissolves like sugar.
The second operation is but little difficult, 
& it is generally required. It 
is for the purpose of breaking up the 
substance of the lens, so that it may  
all come in contact with the aqueous 
humor. The needle should be entered 
two lines behind the cornea, & 
carried onwad in an oblique direction,
backwards towards the axis 
of the globe. When it comes opposite 
to the pupil its point is to be brought 

172.
forward & it is to be punctured. 
Now you are to break up its substance 
more freely than before.-
The reason for passing with the Sclerotica
instead of the Cornea, is that 
it is the back part of the lens, which 
is now to be absorbed, & a seemd is 
that there is less reason to fear inflammation 
afterwards. The reason that 
you are to introduce it in an oblique
direction is to avoid wounding the 
process us Ciliaris, which will be otherwise 
endangered.
If your patient is a Child, he should 
be laid in a supine position. This 
I think, is indeed the best position 
in either case. The head should be 
rested upon a pillow. It will be 
necessary to employ. Pelliers speculum
in a child. It must be put 
under the upper lid. The operator 

sits behind the patient, holding 
the speculum in his left hand, if 
the right eye is the subject of operation,
& vice versa. By this he supports 
the upper lid, & an assistant is 
with his finger to draw down the 
lower lid. The speculum may be 
used as an elevator only. If much 
prepare is made with it, there will 
be danger of dislocating the Lens.
The head of the child must be grasped 
firmly by an assistant at its chin 
& occiput, by which he will be able 
to prevent its motion. You will 
find that a Child even a small one 
is capable of making immense
efforts, & the motion of the eye are 
so rapid, that very great case will 
be necessary to avoid destroying it.
In an adult, the speculum is a very 
dangerous instrument. There is 

174.
no double but that the globe of the 
eye might be entirely excluded 
from by it, if caution was not necessary 
to avoid employing too great 
pressure.- One of the greatest evil 
to be feared from the operation, is 
the undue degree of inflammation 
from too free a use of the needle.
Surgeons are apt to be afraid that the 
patient’s fortitude will not hold out 
to have a second operation performed, 
& so they do too much in the first.
Both the Surgeon & the patient ought 
to be aware that on account of its 
mildness, it may be repeated without 
any injury. not that I would recommend 
however, that this operation 
should be performed upon a cataract,
which was previously, Known 
to be so firm as to require very repeated 
operations.

175
It is not only unfit, but it is the 
worst of all operation in a hard 
cataract. The firmness of the Lens 
is in this case, so great that much 
force must be used in order to break 
it up, & which will accession it to be 
dislocated, before it is broken up. It 
therefore, never can be admitted.
The Congenital cataract is always a 
fit case for it, the capsules too- 
It is still your object to mark a pupil 
or permanent aperture still 
adhering to the legitimate principle 
of the operation. 
The inflammation which follows
This operation generally yields to 
low diet fomentations, of tepid water 
& purgatives. If you observe
that the conjunctiva becomes red, & 
injured, leeches may be applied, & 
the irritation of the body. Kept 
down by free evacuations. It is 

176.
necessary to attend to these things 
with the greatest attention. The patient 
should be made to avoid equally 
of all irritation both of body 
& mind, & indeed it is the duty of 
the Surgeon to acquaint him with 
this circumstance previous to the 
operation, & for fear that his mind 
should become irritable from confinement 
larger than he expected,
he should be prepared for one longer 
than required. I have known the worst 
consequences to ensue from a neglect 
of this precaution.
Children never have any inflammation 
worth mentioning after this 
operation unless something is done 
by the instrument, which ought 
not to have been done. I should inform 
you that a fluid cataract,
is sometimes viscid & think, & of such  

consistency that is spins out like 
a solid. I have seen very violent inflammation 
follow such cases. 
They will therefore require much caution.
When any patient of the cataract 
comes into the arteries chamber, 
& causes irritation by pressing 
upon the iris, it should be let out 
by a section thro’ the cornea as in 
Hypopion.
The ancients did not differ materially
from the moderns, respecting
the nature of cataract. They thought 
that it was formed by a thin pellicle 
anterior to the Chrystalline lens. 
They were not strangers to the anatomy 
of the eye. You will find in 
Celsius the anatomy of the eye, followed 
by a short description of 
Suffusion & he mention also the operation 
of Couching which shows 
its great antiquity.  

178
His description has been copied for
ages, & it is an operation which is 
strile preferred by many, to extraction 
Among there, I will mention the 
names of Poll, Scarpa, Hey, &c 
The needle now employed in this operation 
is the common spear shaped 
one. It was curved at its angle by 
Scarps. It is a needle with cutting 
edges terminated by an elliptical extremity.  
I consider Scarpa's best adapted 
to the operation. It has been 
improved by being considerably 
shortened. This is more convenient & 
gives the operator an opportunity 
of feeling better what he is about 
It is necessary previous to this operation,
to attend to some preliminary 
circumstances. The eye should 
receive a full but not a glairing 
light, & this should be made to fall 
upon it obliquely. This bearn should   

179
he made to strike upon the side 
of the eye next the temple, & not 
upon the pupil, became it obscure
the vision of the operator. The Surgeon 
may command the lids himself 
by means of his fingers holding 
[orces] upon the upper & one upon the 
leave lids or he may have the advantage
of an assistant to hold down 
with his fingers the lower lid. The patient 
should be stated on a low chair 
which has a perpendicular back, so 
that his back may be supported & his 
head not slip. The Surgeon is to sit 
higher. A common [Musce] stool is 
the most convenient seat for him, 
because he can by means of its, [screw] 
raise it or depress it, according as may
be most convenient. 
It has been directed by writes that 
the surgeon eye should be in a lens 
parallet to the eye of the patient,

180.
but he should be so fixed that his 
hand may be in a line with it.
His Knee is to be raised & fixed up 
on some firm support, & his elbow
to rest upon it. The opposite of eye 
of the patient should always be 
covered with a band age, to prevent 
the sympathizing motions of that 
which is to be operated upon. 
The operation thigh & leg should be always 
at a right angle because this 
position is more firm than any other,
& there is less danger of its slipping. 
Scalpa's needle a little shortened 
is to be used. It is to be introduced 
at about two lines distance 
from the edge of the hands parent cornea. 
having the handle of it parallel
to the patients temples. It paper 
behind the processers Celiares, thro’ the 
Vitreous humor. It is to be earned 
upwards, & forwards, till its point 
is apposite to the pupil. Then the 

Lens is to be laid hold of, & with 
a motion which describes the arc 
of a circle, it is to be carried downwards 
into the Vitreous humor. 
You are not to suppose that it is 
to be carried perpendicularly [ thro]
downwards, but it should take a 
half semicircular motion. This is 
to be done by a firm & bold motion. 
The principle of the operation requires 
that you should break a hole 
in the Vitreous cells for the lodgement
of the lens. It cannot be passed 
as has been supposed between 
the capsule & the vitreous body. It 
must be made to go into the body of 
the vitreous humor, & to do this the 
motion must be as above described 
If the lens should re ascend, it should 
be repeated, & more abruptly so as to 
hitch it in the breach made in the 
vitreous humor. When the lens is 

securely depressed, you should bring 
up the needle, & give it a twirl,
gently, so as to dissipate any
fragments which may remain, & 
throw them forwards into the anterior
chamber, where they will be 
dissolved. In this operation, it is 
better not to operate on the capsule 
separately. It should not be opened 
till you are ready to depress it, & 
then it should be all done at once. 
If you open it first, it is apt to descend 
sideways, & you create a greater 
breach, & it require greater force. 
One objection to this operation formerly 
was that so many cataracts 
were soft, that it was a very improper 
one. The only answer to this is 
that it is are operation not at all
suited to such cases. It is only calculated 
for those cataracts which are 
of a firm or case ores texture. 

A mode of couching has been lately 
practiced in Germany, which 
consist in passing the needle thro 
the lower margin part of the cornea, & carrying 
it forward in a line parallel 
to the plane of the iris as far as the 
pupil- then raising the handle to 
puncture the Len, & depress it into 
the vitreous humor. This is said to 
have been practiced with a considerable 
shore of success. A famous 
English empiric, by the name of 
Taylor, used to make a breach in the 
vitreous humor, by a previous incision 
thro’ the Sclerotic coat, & then 
with a needle to depress the lens into 
the breach. The arguments in favor
of the operation of couching, are its 
Simplicity & the care of its execution
2) It will apply to all kinds of Cataract:
if hard they may be depresses 
& if soft, they may be disposed of by 
Solution. 3) It is an operation which  

184.
is followed by less inflammation 
than extraction. 4) It does not risk 
the sudden & total loss of vision like 
extraction. But all these objections 
are hypothetical except one; which 
is, the injury done to the eye by 
this operation. It is followed frequently 
by very violent inflammation & subsequent
amaurosis. In all cases except 
one. I think extraction preferable to 
it & that is where the lens is adhering
to the Iris. Here couching is the preferable
operation.  
Extraction was first attempted by 
at the end of the seventeenth
Century. He thought it to be a mere 
pellicle, a condensation of the humor. After 
this Petit extracted the lens this the 
transparent cornea, & he published are 
account of it in the [Memoirs] of the [Funde]
academy in 1708. He was followed by 
Report & Haviel- but the latter was 
the first person who brought the operation    

185.
operation into respected. You will find 
his paper upon the subject in the 
Volume. It details the process & its 
history from the operation of Petit to 
his time & it will worthy your attentive 
perusal. It was afterwards performed 
by Baron Wentul, a German
& an itinerant oculist, who made a 
large fortune & afterwards settled in 
this country. Many surgeons have at different
times projected improvements in
this operation, but they are of no considerable 
importance, & therefore it is not 
worth our while now to mention them. 
You will find the best description of 
Daniel’s operation in Mr. Wares treatise.
He was an enthusiast in favor
of this operation, & he has there made 
a full enquiry into the causes of its failure.
I consider it as the best of his writings. 
It as so correct, that it leaves lit 

186. 
more to be raid upon the subject. 
With regard to the Light in this operation, 
the horal margin of the Cornea 
should be well illuminated.
With regard to steadying the Globe- Baron
Wenrel would not allow anyone to 
assist him. He merely raised the upper 
lid with the little finger of his hand 
& lift the eye entirely at liberty. But 
he possessed a peculiar command of himself 
in this operation, which few could 
attain. It is related of him, that he was 
operating upon a nobleman, & that after 
he had made the first incision, the 
patient immediately got up from his 
chair.- But the Baron would not 
be disconcerted, & arose also, & followed 
him around the room, & finished the 
operation without withdrawing his 
instruments.
Mr. Ware advised steadying the eye
with the conjoint assistance of his 

187.
finger & thumb, on the [Carmuscular]
side of the eye & continued until
the point of the Knife had proceeded 
thro’ the nasal side of the [nose] eye.
My opinion is that if you have a dense
cataract, you will have a steady eye, 
but it is better not to use Mr Ware’s 
mode of prepuce, because you will 
risk the throwing out the aqueous
humor.- The patient should be directed 
before you commence the operation 
to turn his eye outwards. The 
Knife should be entered about one 
line from the circumference, & a 
little about the transverse diameter 
of the cornea. It should be carried a 
little quickly across the eye, & continued 
until its point penetrates the 
nasal side. This is of primary importance.
As soon as the point is 
thro’ the assistant should drop the  

tarsus, which by the way he should 
hold not by the tarsus itself but only 
by a fold of the skin over the 
palpebræ. The point being through, 
& the Knife lying parallel to the 
Plane of the iris, your object is to 
carry it forwards in the direction it 
has taken, taking care, [ taking] to avoid 
the conjunctiva & the caruncle 
which however is not always possible.
There should be no downward
pressure until the section is pretty 
well advanced. There is frequently a 
difficulty in bringing out the Knife 
this is assisted by, pressing on the edge 
of the cornea against which the Knife 
is resting with the finger nail keeping 
the knife still, which the nail 
is pressing upon it. 
2dly) The eye lid should now be drawn 
up by a fold of the integuments 

gently, & the took which is only 
a needle a little curved, is to be introduces 
by, its arched side, & cornea 
on till it rather, the freight of the 
pupil, & when at its center it should
be turned, & by a motion of its point 
gently upwards & downwards, a crucial 
incision is to be made into its 
capsule. This being finished, it is to 
be turned & brought back again, 
by its arched side. The eye should 
now be cloud for a while. Then by 
a gentle prepuce upon the globe of the 
eye which the Surgeon is to graduate 
carefully according to the necessity 
of the case, & which he alone 
can manage, the lens will be protruded
into the anterior chamber, & 
thro’ the Cornea. If there is any 
appearance of opaque fragments
afterwards, if the pupil does not present   

190
a jet black appearance afterwards  
there is probably some portion
left- some floccular fragments
shelled off you should scoop them 
out by mean of the grooved director 
These portions should be gathered together
into it & made to flow out.
A light well setting night cap should 
afterwards be worn. Particular care 
should be taken that no fragments of 
the bus or no fold of the iris is insimated,
between the less of the incision 
for it will prevent its adhesion.- 
If there happen to be an abundant secretion 
of Lymph after the operation, & 
urge you to practice full & repeated 
bleeding. The bandages should not be 
disturbed oftener than is absolutely
necessary to examine the state of the
eye. The patient bed should not be 
made before the third a fourth day,  

& he should Keep to it at least a 
week, however well he may be doing.- 
The knives which are now 
employed in extraction are Dr. Wenzel’s 
a little modified however. This 
was a spear shaped Knife a little inclined 
however to the narrow. All 
have been modified from this. Kichtes
instead of the appear shaped, recommends
that the Knife should be strait 
on a line with the point, & the cutting 
edge should be convex.- Wore preferred 
that the paint of the Knife should 
be in a line between the bask & 
middle of it, & this shape in my 
opinion is the best.- I do not pretend 
to determine decidedly upon the 
respective merits of each, best & aisle
state my reason for preferring the 
one which & employ. The Knife of 
Dr. Wenzel has the advantage in passing 
in easily on account of its long 

point. Those who use it make a 
triangular section concentric with the 
cornea. Excepting about 1/8 of an inch  
from the point, there is no cutting edge 
It cuts equally upon both edges. In 
passing the knife, you should be careful
not to carry the point too obliquely
outwards or three is danger that it 
will go between the lamellæ of the 
cornea. Its passage will then be resisted ;
this also turns the paint, so that 
when entered, it will not be passed out 
again. So also if you make unsteady
prepuce, you will be in danger of turning 
its point.- you should always carefully 
examine your knife before the 
operation, to see that this is not the 
case. In this case supposing that 
the knife has entered, & the point is 
turned &, I should advise the young operator 
so with draw it. If the humor 
has escaped, it will be of no great importance.

importance. He can wait till another 
day & it will be renewed.- 
Suppose that your Knife has advanced 
as far as the pupil, & from 
the unsteady hands of the operator, 
the tumor escapes, he will then find 
it very difficult to incinerate the Knife 
to the opposite side without cutting   
the Iris or Cornea. You may be assisted 
in such a case by pressing your 
finger against the cornea, so that 
the iris may not intervene between 
the blade & cornea. But in ten cases 
out of leeches, you will not be able 
to succeed in affecting this, & in my opinion,
you had better not take the 
risk, but the best thing you can do, 
is to withdraw the knife, & finish
it with another instrument.- But
it you wish to finish it by a coup domain,
& are willing to take the hazard,
it is infinitely better, if one must  

194.
be injured, that it be the Iris rather 
than the Cornea. This will cause an
irregular pupil afterwards, but if 
the other is cut, you will have a cicatrix 
immediately opposite the pupil, 
& the section will in all probability 
be too small to extract the lens 
perhaps at all, at all events, not 
without much difficulty. If the section 
is sufficiently large, much harm
will not be done. In performing 
this section you should never allow 
your Knife to recede, for the finishing 
of the operation well depends upon 
the presence of the aqueous tumor.
If it escapes before the section is 
completed, you will be in danger of 
being foiled. The size of the section 
should be rather more, than the semi
circumference of the cornea. This will 
always allow sufficient room for the   

195. 
extraction of the Lens. Some prefer 
a curved pair of repairs for finishing 
the Section. 
Another accident which is liable to happen 
in this operation is the breaking 
of the point of the cornea Knife, 
which renders it impossible to break it 
out on the opposite side. The best way 
under such circumstances, is to carry 
it onwards, & to cut down upon it 
with the point of a lancet, or with another 
cornea Knife. You should be 
careful to bring out the knife as near 
as possible upon the inferior edge of 
the cornea, but never to entrench upon 
the cornea in doing it.- In the second 
stage of the operation, be always 
careful to see the pupil, when you use
the curette, so as to produce be sure 
that you are proceeding right. Do not   
be contented with a mere slit of the 

196
capsule; for in this case the lens 
will be apt to be protruded, but 
the capsule left entire. You should 
always make several openings thro
it.- The point of the instrument 
is very apt to penetrate the capsule 
& to go on so far as to reach the posterior
capsules, which circumstance 
will be followed by a gush of the vitreous 
humor. The opening should be 
in the centre of the anterior capsule
only, & it should be extensively lacerated.-
If this escape of a portion 
of the vitreous humor, follows the 
extraction of the Lens, it is of no great 
consequence, but if it precedes it, it 
is one of the worst of accidents that 
can happen in this operation. The effect 
of it is to permit the lens to 
sink to the bottom of the eye. You 

are obliged absolutely to fish for 
it, & every attempt brings away
more & more of the vitreous humor,
& increase the difficulty of your 
attempt. The lens gets completely turned 
in & it is almost impossible to 
succeed in extracting it. I have seen 
a prodigies quantity of the vitreous 
humor follow the extraction of the lens, 
without any material injury to vision. 
Some adventitives circumstances 
have great influence in this 
operation, such as the general healthy 
state of the eye- the firmness of the 
lens- & a good anterior chamber. If 
the patient is irritable, has a short 
neck, & a full habit, inflammation
of the Iris is very apt to ensure. In 
two or three days, if you look at 
the eye, you will find the pupil contracted, 
& an appearance of spots of 

198
blood are the Iris, & he will have violent 
pain in the head. It is a curious
circumstanced that it should 
come on about this time, & not sooner. 
I cannot account for it. 
The operation for extraction require 
great deliberation beforehand, & if 
any unforeseen accident occur during 
the operation, you had better 
not go on inconsiderately, but stop 
& consider the best mode to remedy 
it.- It is best never to perform the 
operation unless the patient wishes it.
You should advise him, to keep himself 
quiet & calm & to have no tremor 
or alarm at the time.
I think it decidedly the most difficult 
operation in Surgery, requiring 
the utmost steadiness deliberation 
& confidence on the part of the 
Surgeon.

199
Diseases of the Appendages. 
Tumors sometimes form within the 
orbit in the cellular & surrounding
substance supporting the globe of 
the eye. This is not a common disease,
but we now & then see it. It is 
of an oblong shape. It protrudes by 
the side of the globe so as to render it 
time & even to take away vision. 
It is commonly attended with Strabismus.
These tumors required removal. 
The operation is done by dividing 
the conjunctiva lying over, & before 
them freely, & separating & drawing 
them out. Where they are situated 
between the globe & superciliary 
ridge, you should be careful not to 
divide the superciliary nerve, because 
such a division leaves a very 
unpleasant sensation in the parts 
which it supplies with nerves,  

201 
for a long time afterwards. 
The adhesion of them tumors is sometimes 
so firm to the bone, that it is 
uncertain if it is not better to leave 
them alone. You are obliged to scrape 
them away before they can be removed. 
Strabismus or Ptosis. This 
sometimes arises from mechanical 
causes. A boy, came to me not long 
ago with it, on whom it was occasioned 
by a blow which he had recovered [er]
from the temple from another boys 
in fighting. An ecchymosis was produced 
by this blow. His Master perceived      
soon afterwards that he squinted- 
his sight was not injured. I thought 
it probable that it arose from concussion 
in consequence of which the 
abductor muscle was paralyzed- 
He completely recovered.

202
The Aneurismal or Varicose 
disease frequently takes place with 
in the orbit. Several instances of this
Kind have been seen. Two cases have 
occurred to Mr. Dalrymple & been 
cured. It may seem to be a trifling 
disease, but may judge that its nature 
is very important, when you learn 
that tying the Carotid artery is the only
mode of curing it. It is an aneurism 
which threatens the life of the 
patient as much as any other aneurism.
It is attended with a distinct
& strong pulsation, & destroys the 
patient if it is allowed to go on by 
repeated bleeding.- It is a disease 
of the extremities of the arteries or 
veins or both, & when it is so situated 
that it can be removed by the 
Knife, it as best, but when it is 
deep-seated you must resort to ligature 
upon the Carotid.

The Lachrymal Gland is subject to 
Enlargement like other glands, to the 
simple interstitial enlargement to suppuration  
& to Schirrhus. This last 
may generally be known by its lobulated 
structure, which may be felt by
distending the lid over it. In children, 
this gland when it inflames, not infrequently 
goes on to Suppuration.
I have seen a case of schirrhus of this 
gland, I removed it. Two years afterwards 
the child was very well, & appeared 
to suffer no great inconvenience. 
In taking it out, great care should be 
taken not to injure the levator muscle. 
The Hordeolum is a death or slough 
of the cellular membrane surrounding 
the little glands of the tarsus, which 
is thrown off by a surrounding inflammation.
It is opposed to phlegmon 



204
inasmuch, as it does not like that 
suppurate in the centre. It consists    
I think, in an obstruction of one or 
more of the Mechomian glands, in
consequence of which inflammation & 
abscess arises. 
Its treatment is extremely simple & 
The old women very properly say, 
it may be cured by friction with a 
black cats tail. If acute, it is to be managed 
like the acute inflammation 
in any other port & its disposition to
form again is to be prevented by subbing 
the part over with Citrine ointment 
or some such application 
Tumors often form upon the eye lids 
They are commonly of an encysted
Kind, containing fluid of various Kinds 
In the steatomatoces, you cannot feel 
a distinct edge, & it adheres so firmly 
to the inner membrane, that it is difficult 

difficult to detach it, without cutting 
thro’ this. The steatomatous tumor 
is easily turned out after an incision 
is made over it. The atheromatous
frequently forms upon the edge 
of the tarsus, they are often as large 
as a bean. They are very common in 
Scrofulous habits, they are easily 
squeezed out. If they are not ulcerated
you have only to make a little 
incision into them.  
If it is an object to avoid the scar 
which remains, it can be done by
everting the tarsiers, & cutting them 
out from the inner side. Warts 
often form upon the lids, they require 
only to be snipped off with a 
pair of scissors.
Lippitude or blear eye as it is 
sometimes called, appears in two forms. 
The simplest form is an exfoliation 
of the cuticle at the margin of the tarsus  

206
tarsus. In its more advanced form alteration
takes place, & the surface of the disease extends  
to the surface of the conjunctiva. 
In this state of it the secretion from 
the Methomian glands undergoes a
material alteration. It acquires an unusual
degree of acrimony. It is commonly 
the result of some inflammation. 
It is always preceded by it, it 
is called by some Prorapk thalmia
which is inflammation, when it has 
subsided into Lippitude.
In the acute form of the inflammation 
your remedies must be such
as we have already laid down for 
this stage, & when Lippitude is the result 
of it, the unguent. Hydroy. Nets:
reduced in strength according to the 
necessity of the cases is a remedy of 
notorious celebrity. On the Continent, 
the celebrated Lannin employs anointment,
composed of fully, & the White 

Oxyde of Mercury, rubble down with 
Spermaceti ointment.
When lippitado is combined with 
accession of the Lid, the use of the scarifying 
lancet previous to the application 
of the [Lancet] ointment is 
found to be extremely beneficial. In
those cases, the conjuncture is extremely 
lox in its texture & finger like 
the mucous follicle are found loaded  
with Sebaceous matter. In this stage 
it is rarely or never cured. It has then 
degenerated into a chronic form which 
it is exceedingly difficult to remove. 
the eye lids are subject to become dry
harsh & fall off. sometimes they become 
distorted & are turned out of thin natural 
direction 
The Tinea Ciliaris is an affection of 
the eyes lasts, similar to tinea capitis.
Whether it is the same thing exactly, or  

208
not, I cannot positively say, but 
the same Kind of scurf is observed about 
the roots of the Cilia
Tinea & Lippitudo are often combined, 
& here the hair glands are always
more or less destroyed.- 
There is a disease of the Cilia similar 
to an affection which sometime takes 
place in the finger & toe nail. An unhealthy 
hair is generated, & an ulceration
is going on in the little follicle, 
as hair & a hair is thrown up resembling 
the secretion which grouse sometimes 
from the nail gland. The treatment 
consists in plucking out the hair 
& applying some stimulating ointment.
Porrigs or Crusta Sactea is a very 
common affection of the eye lids, & is 
usually found on other parts at the 
same time. It is cured by a Lolithi 
on of Oxyde of Zinc in water, which 

by frequent application forms a 
dry scale, under which a new article
is generated. Of course this white 
crust is never to be disturbed, but allowed 
to remain on until it falls off. 
Srichiasis.
This is very troublesome disease &
exceeding distressing to the patient. It 
generally follows the production of a 
cicatrix on the internal may in of the 
tarsus, by which it acquires an under 
inclination against the eye ball.
Then every motion of the lid produced 
great irritates to the conjunctiva, & 
pain to the patient. There is an opponent
loss of elasticity of the tarsus & a 
redundancy of the skin of the eye lid. 
The eyes become very intolerant of light. 
The least motion of the lids produce

210. 
pain & suffusion. If allowed 
go on, its ultimate stage is a strumous 
opacity of the cornea, which becomes 
covered by vessels shooting in 
to it.- The mere removal of the hairs 
is quite insufficient for the Cure, for 
the disease is in the tarsus itself. 
The remedy consists in a removal 
of a portion of the skin of the lids. 
It is not the cutting away of this skin,
that affects it, but the consequent contraction 
which take place on the formation 
of a new cicatrix. It is such 
as to turn the inverted lid outwards. 
You ascertain the portion of the lid 
which is innervated, & opposite to it,  
you take up with the forceps a portion 
of skin, I cut it off so as to lay 
the fibers of the orbicularis palpebarum 
completely bare. It is not necessary  
or advantageous to apply lotuses. 

You do better without them. 
Dr Crampton of Dublin published 
a very good essay on entropion in 
which he considers it to depend on 
the contraction of the conjunctiva- 
Saunders recommended the excision 
of the whole tarsus, but it is a very, severe 
operation. It is exceedingly, delicate 
& difficult & tedious, & gives the 
patient severe pain. The taking out 
a portion of the integument, will generally 
remove all the difficulty, but 
if it does not prefer Dr. Crampton 
operation to Mr. Saunders. It answers
the purpose equally well & is mush 
less difficult & tedious.
The opposite disease Ectropion is often 
connected with with chronic 
lippitude. The cartilage seems to loose  
its elasticity & falls down. & the conjunctiva   
following it becomes soft & 
villous. As soon as it arrives to a certain 

212. 
certain extent, & the puncta lachrymalia 
become tumid & out of their direction
the team are not absorbed by 
them & continue constantly to flow over,
& by their irritation increase 
the disease.
It may seem curious to you that 
the same remedy which had been 
used in the opposite diseases is also 
practiced in this. But both diseases 
are to be cured upon the same 
principle. In order to produce contraction,
an elliptical portion of 
the conjunctiva is to be removed, & as 
the cicatrix forms, the tarsus becomes 
drawn upwards to its natural position. 
The simplest view of these diseases 
is this. In the one, the relation
is lost between the tarsus & 
skin, & in the other tarsus is elongated
& the skin contracted, whether  
   


from a bum, struma or ulcer, or 
any other cause. 
The result is therefore that in Trichiasis
whether the integuments are elongated, 
& the tarsus shortened & so turned 
inward, producing a stricture upon 
the eye, you are to remove a portion 
of the redundant skin, & by this 
means, the tarsus becomes again turned 
outwards & the evil is cured. And in 
the other when the skin is shortened & 
the tarsus elongates, you by, taking out 
a portion of the it shortens it & it is 
again turned inwards.
The operation which is now performed 
is to cut out a triangular portion of 
the tarsus with the apex of the triangle
downwards, & then by a section you 
connect the leases of the triangle. In 
this way, as nicest be obvious you shorten 
the tarsus, & this disease become, most 
completely removed. Sir Wm. Adams 

214.
has the merit of proposing this operation.
I have never seen it fail. It is 
not to be done, when it is probable, 
that a removal of a portion of the 
conjunctiva will cure. 
When with this disease, the Skin of 
the Cheek is ulcerated, it will be exceedingly 
difficult to cure. You are 
to separate the lid from its adhesions 
with the cheek by an incision & then 
remove a triangular portion of the
tarsus as before. But unfortunately 
the whole cellular substance is often 
in these cases, destroyed, & therefore 
no granulation will arise. 

Fistula Lachrymalis.
Perhaps no disease has occupied the 
attention of the profession more, then 
the obstruction of the Lachrymal passages.
It is improper to class all there 
obstruction of the passage of the tears 
as has been done under the name of 
fistula Lachrymalis. The proper term 
for the puncta lachrymalia for instance
is epiphora. It is what is vulgarly  
called the accessing eye.
This has not been much observed. It is 
a stricture of the puncta lachrymalia.
Sometimes the little canals are 
constricted, or close. It is known by 
a very troublesome watering of the 
eye whenever the patient uses it all.
If he reads or writes as is exposed to the 
air, they immediately become so 
suffuses with tears as that vision is 
interrupted. On examining the puncta  

216
puncta Lachrymalia, you find them 
so minute that they are scarcely visible.  
It is not without some difficulty
that you can see them at all. 
Having found them, you may open 
them with the point of a pin. This 
is the very best instrument of all for 
this purpose. Having done this, Aneb’s 
probe should be introduced into the 
puncta thro’ the Sac, or a little gold 
probe may be preferable to be tried 
at first. This commonly gives the patient 
most complete relief.-
An opposite state to this is when the 
puncta [is] are not stricture but dilated,
enlarged, so that their [its] power of attraction 
is lost. As in both cases, the 
tears are not received, in the first become 
the little canal is, strictured, & in the second,
because it has not its relation 
to the sac, so much as to be destroyed 
for the purposes of attraction. Here 

there is no obstruction of the Sac, & 
I know of no use for [of] it. It is quite 
sufficiently open. Stimulants may 
be tried. It is a common disease in 
old people who have eversion. If you 
can remove the eversion, you do 
something towards the cure. 
The next stage of the disease is when 
the conjunctiva membrane lining 
the ducts or lachrymal passages  
is inflamed. The result is a loss 
of tone, & probably a thickening
of the membrane. It is accompanied 
with an unhealthy mucous discharge:
unhealthy both in quantities & quality 
& there is probably a thickness 
of the membrane from stricture. 
Probably the nature & thickening 
of the mucous discharge increases 
the obstruction. It is not a complete 
obstruction, because you will find 

218.
on prepuce, a quantity of matter 
may be made to place back toward
the nose & eye.
If this state is combined with ophthalmia, 
the whole canal is so exquisitely 
sensible, that nothing can 
be introduced without a great deal of 
pain, & an evident increase of the 
[discharge] disease.
The ancients supposed that this disease 
was only loss of tone in the Sac.
& they were in the habit of making 
prepure by means of a screw to relieve 
it. When it happens in a child, it should 
be relieved by means of pressing with 
the finger occasionally for the purpose
of emptying the sac, & a frequent use 
of some Vitriolic wash. In the adult 
we use the puncture probe occasionally,
if the disease is in its Chronic state, 
& after this inject the whole course of 
The Lachrymal Sac, by means of [Aneles]

[Aneles] syringe which may be mediated,
if you please with some Vitriolic
work- more or less as the passage  
is more or less imperfect. There 
are the palliative modes. The ungues
turn hydrargyri rubbed over the 
part has sometime proved very 
serviceable.- This means will 
sometimes even cure the disease. 
But in the adult however, if there is 
much elevation of the sac, & a large 
flow of mucus from it continually, 
the operation of introducing a probe 
for the purpose of overcoming the obstruction,
must be performed. A variety 
of means have been proposed for 
this. The puncta have been syringed, 
setons passed thro’ the puncta into the 
nose- the sac injected as well from above 
as below- all manner of tents & cannula
employed- [leaden] pins & tubes 
over & over again. But the best 

220.
probe is that which was introduced 
into practice by Mr Ware.-
But their little operation are very 
troublesome. The patient generally becomes
dissatisfied with panful injections 
& is very ready at last to submit 
to have the style introduced. You
will find that however simple they 
may appear they are very troublesome 
operations. Sometime however a patient 
is so much relived by using 
the larger kind of probes, that he will
not submit to the operation of having 
the style introduced. Injections 
alone do not generally do much good. 
You should begin by the probe & inject 
afterwards, & then they will be 
more serviceable. In introducing the 
probe, it should at first be passed 
gently transversally, as if you were
going to put it against the os [corpus]. 
And when it has entered the sac, you 

Know it by the peculiar sensation 
which it gives you. It is similar to 
that which the sound gives in the urethra. 
Then elevate it a little & pass
it into the nose. If you attempt to 
turn it too soon you either take up 
in it point a fold of the membrane, 
or get into the wrong passage, or cannot 
get in at all. If you turn it at 
the proper time, it then readily goes 
on to the nose; it is perfectly easy to 
know when it is in the canal. If it play
easily in the canal, especially if its 
paint is free, you may be sure of it 
Form day to day, you may increase 
the size of the probe. If you are in 
doubt if the instrument is within the 
nose, you may ascertain it by passing 
a probe under the inferior turbinate 
bone, & if it is you will feel 
the probe sticking against it.  

222
Then desire the patient to blow 
his nose, & a little blood will be 
seen coming out from it. Probing 
& injecting should always precede the 
operation. If the disease is allowed 
to go on, it produced excessive deformity. 
From it not being confined to 
the angle of the eye but extending 
over the check, the skin becomes exceedingly 
edematous. This must be 
immediately relieved by the introduction 
of a probe. Generally, a 
probe will be passed immediately 
from the duct into the nose. It is 
desirable if you open the sac, to 
pass the probe into the nose. 
The state of Caries of the os unguis
does not add to the difficulty of the 
treatment. It much be treated just in 
the same way, as if there were no 
caries.-

The proper state of Fistula is that 
in which Ulceration takes place. 
This is the only state which ought to 
be denominated fistula Lachrymalis.
I have tried a great variety, of 
[remedies] methods in this disease, but 
know of none little than that of 
Mr. Ware’s. The nail-headed style 
is to be introduction & worn till the 
disease is overcome. With regard to 
the objection, that it leaves a fistulous 
orifice, I don’t Know how this 
can be overcome. If the patient is 
willing to part with it, after he has 
worn it a little while, it may be as 
well. But they, one so satisfied when 
they find the relief that it almost 
immediately gives them, that they  
are seldom willing to give it up.
If you wish to be further informed 
respecting this disease & operation,

224.
you will find a very good paper 
upon it in the French Academy of 
Sciences by Mrs. Petit, Mr. Poll 
also has written well upon it & the 
Ware. Mr. Ware's Knife is a narrow 
steel painted lancet, with a 
groove in the back for the purpose 
of introducing a probe upon it. The 
sensibility, of these parts goes off after 
wearing the style, a little while, 
very much as in all other canal.
When the nasal duct is completely obliterated,
you must introduce the 
probe by breaking down the a unguis.
The disease is relieved & the 
tears pass into the nose as must when 
the style is in as if it acers a hollow 
tube.- 







Ophthalmic Iridis
1014.
Thomas Evis aged 28 applied at 
The Infirmary for an acute inflammation 
of the Iris which has been of 
standing. He suddenly lost his 
sight yesterday in the left eye, from the 
deposition of a quantity of lymph from 
the Iris, which now completely [closes] fill up &
obscures the pupil.- He complains s of 
some pain in the eye. (April 25th.)
K. Calomel gr. ij.  Poi. Gr 1/3 her in 
die- Lotic Satum. Hined iij
temp. dexts.- 
May 2d- the white module of lymph 
filling up the pupil has now completely 
disappeared, but the sight 
is [f] very little improved from the 
great dowdiness of the humor & coats- 
Repetanter Vitd. O.n. Lot. Sat.
Sulph. Lod. ℥p.p.r.n.



Ophthalm : Iridis 
871. John Craggs aged 40 [by] a 
Salln, applied at the Infirmary, today
(April 14th) with inflammation 
of the Iris. The some of vessels is very 
distinct around the cornea, & there is 
contraction of the Iris. He complains 
much of head pain in the head eye 
during the night.- He underwent about 
four weeks, age a course of mercury for 
the secondary, symptoms of venereal, I 
complains nose very much of acute 
pain in all his joints. 
Cassias Hydray. e. Cret gr. v 
Myrces all dp her in die 
Lotes Satum Gutter Belladon     
Empl. Lytta temp sinsist.
Cerat. Sabin.-
April 23 The mercury has had no 
effect yet upon the mouth- the eye
is still very red & painful- the 

pil much contracted so that, he is only 
able to distinguish light from 
darkness- & adhesion are more evident 
forming about the Iris- 
Repetantur Medicament -
28th. 
The Mercury has not acted in the slightest
degree upon the mouth- his eye 
continues much in the same state 
with pupil much contracted- 
R. Calom. Gr. ij Opii . gr .1/3 tes in
die- Repet. Lot. & Gutta Bollad- 
Hirud is palped. sinist.-
May 4th.. The Mouth has been made 
very sore by the pills- pupil much 
contracted- no pain in head or eye- vision 
not all improved.-
Repetantur Medicamenta
9th
Mouth continues very sore pupil 
irregular & much contracted- vision 
not at all improved 
Rept. Pela o.n. & alia-

Purulent Ophthalmia
841. Henry Wallan age 10 has 
had weak eyes since his birth, but 
for the last two weeks they have been   
rather worse, there is much the same 
bone about the cornea, which character
ezes acute inflammation of the Iris-
(April 11)
R. Antim. Tart. Gr. is Ag.
fontan ℥iv, capt. ℥i ter gg. hor.
Calomel gr. is omne note. Lot. Sat.
P.P. is prorenata. Hirced is Palpe.  



880
Opthalm. Pterygium
April 14th Lot. Sulph. Zinc. Ung.
Hydrargyr Nitrat. dilect. Sulph.
Sad. ℥ss .p.r.n.

935
Purulent Ophthalmia. 
aged was attacked 
yesterday with inflammation 
of the eye- complains of much pain 
at present in the globe, which he compares 
to that produced by a grains of 
sand in the eye- the eye lids where 
together in the morning, the conjunctiva 
is not as yet very trengid. (April 18)
Hired: iij sing. occel. Calomel
gr. ij. o.n. Sulph, Lad. ℥fs p.r.n. Lot. 
Saturn. 

936
Purulent Ophthalmia 
Jerry Sullivan aged 33 complain 
of similar symptoms as the foregoing
case, [the] but the conjunctiva is 
much more vascular, the disease having 
existed for four days.
April 18th Lot. Alum. Hirced 
iij sing soul. Calomel gr. ij
onme norte P. Purgary. ℥ss,ss.
r.n.
April 21st By some neglect the leeches
were not applied to the eyes as directed, 
yet he thinks, they are some what 
easier 
[Cap] R. Tart Antim gr iv. Ag.
fontan ℥iv solve. Capiat ℥i ter gg.
hora







Lippitude
Sarah Wilkes aged 49 (May 2d)
Unguent Hydrarhys. Hit. Dil.
Lot. Linci Sulphatis, Sulph. Los.      
May 12. has been so much relieved
by the sentiment & wash, as to be 
discharged   

1230.
Granulates Lids
With Ophthalmia 
John Waldron aged 14 
May 5th. Hirud iij palpebs. dext. 
Pulv. Purgans& Lot. Saturn.
7th 
Eyes rather more inflamed & very 
painful the granulations 
more extensive, & lid much swollen 
Hirud iij palp. Dext. is thirsty, & feverish 
Sulph. Lod. P.r.n
Solut. Alk. e. Vin. Antrim gtts. xxo
Ter gg. h. Lot Satun 
9
continues somewhat easier, still complains 
of pain at night
Repetantus
Sulph. Lad. ℥ss p. r.n. 









Mr. H. in speaking of the Anastomoses
of Artericy, says, " So general is
this principle throughout the body 
that there is scarcely a vessel in it 
which will not admit of obliteration
by Ligature, without intercepting or rather
without preventing the Circulation.
The Aorta has been tied in animals, 
& from a free anastomosis of the 
arteries above the ligature, the animal 
has survived & done well.
This principle of anastomosis has 
not been understood till of late 
years. Forty years ago, it was so little 
Known that the operation of amputation 
used to be performed for 
Popliteal aneurism, I remember 
a man who used to come to these hospitals 
when I was an apprentice, 
& shew himself to the pupils as something
very wonderful, because he 
was cured of a popliteal a neurions
without amputation. There is only
one part of the body where it has not 

proved sufficient to authority the  
tying of the artery. This is in tying 
the Subclavian above the clavicle. 
It has never been successfully performed 
in this situation. The anastomosis 
of the supra scapular has not been 
sufficient to reestablish the Circulation
Below the clavicle it has been performatives
successfully. The reason 
of this is that the number of anastomosis 
by the pectoral is here much 
greater. It is a curious circumstance 
that the vessels in anastomosis not only
become dilated, but also take on a
serpentine course.
A case has been publisher by a Mr.
Paris of the gradual obliteration of the 
Aorta, in which the circulation was 
carried on by means of the Intercostals.  
The arteries are in a great degree insensible.
It does not appear in our 
operations that cutting them or tying their 
produces much pain. Nerves can 
be traced upon some of the arteries but 
not generally thus they have been seen  

upon the Carotid. It appears however 
that the Circulation may be 
carried on without the air of nerves. 
Thus when a blow is received upon 
The Spine causing paralysis of the 
lower extremities, the Circulation 
goes on notwithstanding. They are 
not even necessary [to] for the functions
of the involuntary organs. The 
heart will act, tho’ it is separated 
from the brain. Some physiologists 
as Haller have supposed Irritability
to be independent of nervous Influence
But this is not the opinion 
of the best physiologists of the present 
day. If opium is poured upon 
the Heart its actions will be suspended.
Diseases of Arteries
The diseases to which arteries are most 
commonly subject, are Ossification & 
Andersons. The eye are more particularly 
subject to the first. But in them 
perhaps, it is not so much to be considered 
a disease as a process instituted 
by nature for the Security of Life. 

The coats of the arteries becoming more 
feeble as age increases, would perhaps 
be unable to withstand the force of the 
Circulation, & to perform their functions 
were it not for this provision. This ossific 
deposit on arteries is a very rare occurrence
in young persons, unless it be 
produced by intemperance & over exertion 
Now & then the smaller arteries become 
ossified, but it is a rare occurrence. It is 
a disease, which attacks for the most part 
the large arteries as the Aorta. The seat 
of Ossification is between the muscular
& membranous Coats of the arteries.
Mortification is not uncommonly the 
result of ossification of the smaller arteries. 
This is in consequence of the retarded
circulation which it occasions, & 
from the want of anastomosis of the part 
This is probably the cause Mortification 
in the toes of old people. No means 
of relieving this disease are yet Known.
Arteries sometimes inflame in their inner 
Coats, but this to no greater sent for it 
Terminates in adhesion, which is sometimes 
the cause of mortification. I saw 

a case in which the hand became cold 
& blue, & mortified without any obvious 
cause, & upon examination after 
death, the Brachial artery was found 
obliterated, the Radial & ulnar in there 
natural state. This occurs not in very 
old people, but in persons from 40 to 
45 years of age. The effect both in 
young & in old people is to induce mortification 
when the obliteration is extensive. 
Here is a specimen of the complete obliteration 
of the femoral artery, the by 
mortified to the patient died. When however 
the large artery of a limb alone is 
ossified, the circulation is carried on by 
the smaller vessels, but when they also 
become subject to the disease, it is then 
followed by Mortification 
The next disease to which arteries are 
subject is Aneurism. It has 3 stages 
They produce different symptoms according
to the parts in which they are 
situated. When their seat is in the abdomen, 
there follow, Costiveness, Sickness 
loss of appetite, & a general wasting of the 
body. Should they burst into the bladder, 

it will be Known by a discharge of 
blood thro’ the penis. By prepare upon 
the ureters they sometime impede the 
course of the urine, & thus produce an 
enlargement of the Kidney by the accumulation 
which takes place in it.
The most formidable situation for the 
aneurismal tumor in the cavity of the 
abdomen, is in the loins, where it will 
be most difficulty to come at a correct 
diagnosis.
The Course of A. arising from the artery 
itself are three. 1) from absorptions
of a portion of the inner coat of the 
vessel. As soon as this thinning process 
takes place, nature throws out a coating 
of coagulable lymph for its protection,  
but still the thinning process goes on, until 
it is quite thro’, & a pouch is formed of 
the surrounding cellular membrane. 
2.) arises from the universal swelling of 
any portion of an artery &. 3.) from 
the bursting of the vessel. 
Mr. Cline, Surgeon, has seen a case of another 
genus of disease in the artery, where 
there was an entire what of its elasticity. 

There is also another disease of the
arteries in children, which has been 
well described by Bell, called [Nelvimatenic]. 
A bit of silver as a six pence 
or shilling should be placed upon the 
tumor, & prepuce applied over it 
with a bandage.
An aneurism in the ham is not to be 
considered a disease of arteries so much 
as when in other situations. You can
express with more confidence to the 
patient, that the aneurismal disposition
is not general. It is in this 
situation more commonly the result 
of accident.
When aneurisms are fluid, they may always 
be distinguished from other diseases, 
by pressing upon the artery above
the tumor, & when you remove the pressure 
you will see the tumor, which 
was found, to diminish a little under 
it suddenly rise again.
Tumors are sometimes situated over Arteries
& receive a pulsation from them 
which causes them to be mistaken for 

aneurisms, but they may be distinguished 
by lifting them from the [artericy], 
when the pulsatory feel will
cease.- When an artery runs out 
a tumor, it may be distinguished 
from aneurism, by the pulsation being 
wanting on the sides of it.
Arteries are diminished in elasticity
by Struma. This is proved by their 
being unfit subjects for injection.
The Coats of the arteries of a os ofulous 
subject are so weak, that they will 
break down under the force of the common 
syringe, in trying to make preparations 
of them. On this account 
probably it is that the Circulation in 
such patients is so feeble.-
Diseases of the Veins
The veins sometimes increase to such 
a size as to burst. This has been called 
a “starting of the veins” & is to be treated
by the recumbent posture, the 
wash & bandages.  
It has been proposed to tie veins, but 
the practice has been productive of mark 
mischief. In four cases it proved fatal.
Three of them were operated upon  

by me. So great was the inflammation 
which supervened, that abscess 
& death was soon the effect. 
The disease will return when the bandage
alone is used. 
Have meteoric have been supposed to 
be owing to a particular state of the 
veins. But I suspect that these appearances 
depend upon a disposed state 
o, the arteries, which are wanting in 
the elastic coat, for when an incision 
is made into them, it will be 
followed by a sudden gush of florid
blood, & no disposition is manifested
in the mouths of the bleeding repels to 
contract: but if an incision be made 
around the part, it may be removed & 
the bleeding stopped. These appearances
are attributed very justly to the influence 
which the mind of the mother 
has over the fœtus in utero. Such appearances
also take place in the children 
of those women, who are of very 
irritable habits. 

The Veins are subject to an enlargement  
called Varies. The quarter number 
of old ulcers in our hospital ours
from this cause. It is an enlargement 
a yielding of the Coats of the veins, 
so that the values no longer close their 
diameters, & the column of blood being 
no longer stopped by them, reaches from 
the heart to the extremities. In consequence 
of this, the heart & arteries 
are obliged to take on are inordinate 
action, in order to overcome the resistance 
occasioned by this accumulated 
quantity of blood in the veins. The effect 
of this column of blood, is a series 
of Cutaneous sores. The cuticle, becoming 
of a brownish cast, a thin dark
colored fluid is discharged, & the blood 
not being able to return, the arteries 
take on an action too great to form 
healthy cuticle, & inflammation is 
the consequence, which produce unhealthy 
cuticle. When that peels off, a 
thin ichorous discharge is set upon the 
surface. This is the stage in which with 
other remedies, Mr C.- recommends the 

yellow wash. It constringes the vessels,
& acts up a healthy action in 
the arteries.
R. Oxy, mur. Hyds. gr. ij  
Ag. Calcis ℥I [n] solve 
applied by means of a wetted rag 
& the whole covered with oiled silk,
which by preventing evaporation,
supersedes the necessity of using the 
wash more than two or 3 times a 
day.
The other kind of Varix is a dilatation
of the vein, resembling aneurism,
which sometimes prooves 
fatal. There is always a natural 
varix of this Kind in the Jugular-
It is intended as a sort of reservoir 
for the blood when circulation is obstructed 
in the head, which so often 
recurs from various causes.- 
The venous apoplexy of old people 
may be enumerated among the diseases 
of Veins. A surgeon of very considerable 
reputation, lately brought 
himself into disrepute by the treatment 
of such a case. He had been 

called to a Lady, who had violent 
hemorrhagy from her nose, by whole 
she repeatedly lost much blood, & became 
greatly exhausted. He always 
succeeded in arresting the hemorrhagys 
but it generally returned. Another 
Surgeon saw her & found she had 
Labored under long continued costiveness, 
which being relieved, the bleeding 
did not recur. Such bleedings generally 
depend upon the state of the Constitution,
& not upon any particular  
Local cause, they are therefore to be 
treated by general remedies.-
Of the Absorbents. 
The absorbents possess two tunics, or 
coats, the outer one having a muscular 
appearance & the inner a membranous.
They are so extremely thin as to be 
perfectly transparent. And yet, they 
are notwithstanding extremely strong 
so much so as to support the weight 
of a column of mercury which would 
break any other vessels in the body.
The muscular seat structure of the outer 
coat of the absorbents is as indistinct 
that it cannot be seen generally. But 

several reasons induce us to believe 
that it exists. 1) they have 
the power of shutting up their mouth 
& refusing certain fluids as the Bile,
& selecting others as the Chyle. 2) because  
we can increase their actions
at pleasure, by various means, which 
cannot be accounted for upon the old 
opinion of Capillary attraction.  
If they acted upon this principle 
they ought to act at all times, yet 
this is not the case, we find them 
absorbing fluids at one time, but 
not at another. This shews a power 
of action in their mouths if 
not in their canal.- It is in the 
inner coat of these vessels, that this 
Strength recedes, it is this which gives them 
the power of resisting injury. 
Another circumstance strongly evening 
their muscularity is their 
power of adapting themselves to 
their Contents, whether small or 
great. 
The superficial glands of the neck 
are generally affected with Scrofula
& the deeps, seated sometimes with Cancer.

The Glands of the absorbents are 
very vascular, & filled with many 
little cells or cavities- these cells 
contain a fluid very different from 
that which passes thro’ them. They 
are secreting organs, & not mere appendages
to these vessels.- What office 
they fulfill, is not yet ascertained. In 
the Mesentery, they probably assist in 
perfecting the Chyle.
With regard to the manner, in which 
part are absorbed, it is supposed 
that they undergo a previous solution 
a strong reason for this opinion is 
that insoluble substances, if introduced 
into the body, will not be absorbed,
& if a soluble be introduced into 
the body it undergoes that process before 
it is absorbed.- Mr. Cline once 
in operating for Cataract, evidentally 
broke the point of his Knife into
the eye. It could be afterwards distantly
seen, glistening thro’ the cornea. 
After a few days, a slight cloud of 
[dust] was seen around the port, which 
increased in a little while more, until
the whole chamber was filled with 
it, & in seven days, it become completely.

completely absorbed, & the eye resumed 
its natural appearance.
If Charcoal, which is an insoluble
substance is introduced into the 
body, it will remain during the 
remainder of life, without being 
absorbed. You see instances of this 
every day upon the arms of Sailors
which are made by gun-powder 
& which contains a portion of Carbon 
(Mr. Abernethy ridicules this opinion,
& attributes this notion of 
Physiologists, to their having, altogether  
lost sight of the infinite divisibility 
of matter.)
It was formerly, supposed that greater 
quantities of fluids were capable 
of being absorbed from the surface 
of the body, than later experiment 
shew to be true. The older 
physicians believed that the body 
when in a state of great exhaustion 
& debility might receive considerable 
nourishment by means of immersion
in a bath of warm nutrient or stimulating 

fluids. Dr. Currie of Liver
pool, however, has sufficiently shewn 
the fallacy of this opinion. An experiment 
to this effect was lately made in 
Guy’s hospital, on a patient who was 
laboring under structure of the Artophagous
which was so severe, that he was 
unable to swallow anything, & he was  
actually lying from inartistic. He 
was immersed in a bath where he remained 
a considerable time, & when 
he was taken out, & wiped dry, was 
found to have gained only two drachms.
& a part of this increased of weight 
was probably accessioned by the fluids 
retained in his hair. Similar experiment 
have been made on smaller quantities 
of water by immersing the arm 
into it & they have last nothing in 
weight. 
The action of the absorbents may be 
excited to increase by Stimuli. Thus 
blisters applied over the surfaces of tumors 
will promote their absorption 
you have often an opportunity of seeing 
their effects in promoting the removal 
of nodes.

17
Chefle which is formed from animal 
matter is formed to putrefy where 
taken from the body very speedily, 
while that from vegetable matter undergoes 
the process very slowly. The 
one begins to decompose in a week, &c
the other does not before the expiration 
of several weeks. Dr. Marcell was the 
first who ascertained these facts. He found 
what I have mentioned to be the result  
of exposing the chyle taken from 
the dog & that taken from the sheep & 
ox, under equal circumstances. The one
became putrid in a week, & the other 
was quite sweet after the expiration 
of several weeks. You may apply this 
fact to the explanation of disease, as 
in Secrecy. Those persons who are confined 
to animal food, are more apt to 
putrify than others.
The Absorbents are much larger in 
the inhabitants of warm climates than 
in those which are more cold. Thus, 
[Lasears] are always found to be the 
best subjects for making preparations

of the Absorbents. They are in such 
of a very considerable size. The thoracic
duct is in these people oftentimes
three times the common size [of] natural.
I have seen it or large as a 
goose quill. Whether it is from a 
mere residence in these climates, whether 
the absorbents would be found equally 
large in an European who would 
go there as in the natives, I do not 
know.
It is to this cause that I attributed 
the fact, that the inhabitants of warm 
climates are able to bear so much 
larger quantities of Calomel, than
those in colder climates. The absorbents
are probably not as active in the one 
as in the other, & do not take up substances 
so readily. It is not a necessary 
consequence that parts should 
increase in activity, because they increase 
in size. They are like varicose 
veins in this respect. 
I have seen the thoracic duct affected 
by the Fungoid disease. In a care 
of disease in the testicle, the thoracic 

thoracic duct was completely closed by
a tumor of the same nature. In 
there cares absorption is not always 
prevented, the fluid passes by 
anastomosis.
The absorbent vessels are sometimes 
found ossified to a considerable extent. 
Thus, there are three sets of vessels liable 
to be sometimes ossified. We have 
a very good specimen of an ossified
Saphenos vein in the collection.
The Absorbent glands are now & then 
found ossified. Here is a piece of earthy
matter, which was taken from the   
gland in the groin of a woman. It 
is as large as a Child’s head. It is not at 
all uncommon to meet with earthy 
matter in the glands of the mysentery
& sometimes it is found in the 
glands of the neck, but less frequently. 
Dr. Curry told me that he had 
spit up earthy matter from his lungs 
& I have Known several instances of 
of it. These substances are found to consist 
of common Carbonate of Lime. 

Of the Cellular Membrane. 
When fluids accumulate to a considerable 
quantity, nature sometimes, 
attempts a Cure by exciting inflammation 
in the part. This is generally 
of the Erysipelatous Kind. It goes on 
to ulceration & sometime to gangrene 
A small opening is thus formed, by 
which the water escapes, & gives to the 
patient very great relief. But from 
the debilitated constitution of the individual, 
such inflammation generally 
terminates in Gangrene.
Such cases can sometimes be relieved 
by Blisters, by the quantity of serous
discharge which may be kept
up from their surface. But the best 
mode of exciting a discharge is by
making small punctures. There however 
should never be made at any 
great distance from the centre of 
Circulation. The best place for making 
them is on the thighs & abdomen 
& not on the ancles & feet. Sometimes 
they may be made below the 
Knee, but not if there is any inflammation 

inflammation below it. They rarely however 
give more than a temporary 
relief. When the patient is advanced 
in Life & there is the least appearance 
of inflammation, it will be 
dangerous to operate- especially if 
there be a livid appearance of the 
parts. The powers of restoration being 
then very weak, there will occur
the death of the cellular membrane 
an eschar will form, & the separation 
will sometimes extend every far, even 
to produce death.
If the dropsical affection is the result 
of any other disease, there is a 
great deal of debility in the patient 
& the relief from the punctures is only 
for the moment. But if it has 
arisen from a fever, from which the 
patient is recovering, punctures
thus made, will sometimes relieve 
entirely. I recollect a case of this Kind 
in the other hospital. It was a patient 
of Dr. Marcell’s. He requested me to   

make punctures; I did so, the water 
was drawn off & contrary to my
expectations, he got entirely well. 
This was a fortunate case, but I 
ought to add, that I have seen very 
many unfortunate ones. It is dangerous 
under these circumstances to 
make your punctures at any distance. 
Physicians frequently ask me 
to puncture their patients in these 
cases, but I generally decline the 
honor, & say to them “This is a very 
simple operation, & you had better 
do it yourself: & I should advise 
you Gentlemen, to get rid of them in 
the same way. Such patients are generally 
almost dead, & they only want 
a little of your assistance to send
them quite out of the world.- 
Of the Nervous System. 
Of Spina Bifida. In the first 
stage of this disease the swelling is small
& not at all discolored: In the second it 
is ulcerated in its centre for them it is 
always connected with hydrocephalus 

externus; in which case you may 
Know that you have no hope of using 
it. This tumor has a pulsatory
motion, & contains a fluid nearly 
approaching in its characters to 
simple water. It is very different from 
serum, containing but a small proportion 
of albumen & salts. 
at present, I know of five examples
of the disease in which Life has been 
preserved. One was perfectly cured &
two were treated only in the palliative 
mode.
The first was the Child of a person 
who is now resident in this town. It 
was brought to my house at the same 
that I was attending a good deal to the 
subject of hernia, & finding that the 
tumor could be readily returned by 
pressure into the Spinal Canal & happening
to have a truss upon my table,
I applied it & protected the part
from irritation, by covering its surface 
with lint. I desired the mother to bring 

the child to me again in about a 
week, she brought it in that time 
& I found, he had borne the truss 
very well. Some time after, the tumor 
appeased to be a little diminished. 
He has now worn the truss many
years, goes to school like other boys
& enjoys very good health. One day 
whilst at play, the truss slipped off 
& he felt very great pain, & requested
his mother to replace it again, which 
she did immediately, & he was relieved. 
This case now was only palliative. 
The child will always be obliged
to wear the truss. He is in the condition 
of one who has a hernia & cannot
be cured.  
In the second case, the swelling was a 
little larger. I tried the influence of 
pressure, but could not do more than 
repress its growth. I then punctured 
it with a fine needle, & drew off a 
quantity of clear water. The child did 
not suffer from the operation. I made 
use of Pressure afterwards, if it was 

not done, the child complained of 
great pain, & great constitutional 
irritation. I punctured it again 
& again & drew off the water. At 
last, slight inflammation came on. 
I punctured it again & only a little 
Blood & serum issued. I directed a 
little pressure to be made, & the 
child was completely cured, & is 
now a fine healthy boy. The tumor 
has become contracted into wrinkles 
& is a small pendulous swelling looking 
like a little navel in the middle 
of his back.
In the next case, which I saw, I 
punctured the swelling, but the 
child has afterwards hydrocephalus 
internus & died. 
The next child is now a very healthy 
one. I punctured repeatedly, but was 
unable to bring on the adhesive inflammation, 
& was therefore under 
the necessity of applying the truss. 
He is now 5 or 6 years of age.

Mr. Hickman informs me, that 
he has cured a case by adhesion, & 
M, of Cumberland has also 
lately cured another.
You may able to tell in this disease 
as soon as you see it, whether it will 
admit of cure. If it has gone on till 
ulceration is produce on its surface 
you cannot cure it ultimately so 
far as I have seen. The Child will 
have hydrouphalus internus as well 
as externus, & the combined effects of 
the two, will be certainly to destroy 
him.
When the Skin is of a natural appearance, 
as to the palliative cure,
we have some confidence as also to 
the radical if the needle only is used.
If a large instrument is employed, 
you will kill the child. It is only when 
the tumor is of the natural appearance 
& when the needle is used that 
we can speak with any confidence. 
It is still a subject for investigation 
The Spinal Marrow is liable to 
have swellings formed, sometimes 

upon its surface, which by their 
pressure occasion paralysis. But 
this paralysis is on the same side 
as the tumor, & not on the opposite 
side as [ the tumors, & not on the opposite] 
a cures from the effect of pressure 
upon the Brain. Thus different effects 
are produced by the same cause 
operating on the Brain & Spinal 
marrow.- I made some experiments 
with a view to illustrate this circumstance 
still farther. I removed the external 
muscles of the back of the neck 
from the dog, then divided the ligament
connecting the Cervical vertebra, which 
separates readily so as to lay bare the 
sheath of the Dura mater. I then punctured    
it, & immediately about a teaspoonful 
of clear water came away.
I repeated this experiment & always
with the same effect. Thus in the living 
animal water is found in the Spinal column 
as in the Brain.- I then introduce 
a probe between the columns of 
the Spinal marrow, & divided one of 
them & as soon as this was done, that 

side was palsied the legs & the tail 
were drawn to the opposite side.
The animal lived just 24 hours. This 
proves therefore that there is not the 
same decussation in the Spinal marrow
as in the Brain. 
The Spinal marrow is occasionally 
like the Brain thrown into a state of 
Concussion. It is generally attended 
for a while with paralysis of the bladder 
& lower limbs. Such a care requires 
the application of a continued Blister
to the [ Limbs] Loins. They are generally 
from a month to 6 months in 
recovering.
The Nerves are said to arise from the 
Brain & Spinal marrow. But whether  
this is so much the ear as has 
been supposed, is perhaps rather 
doubtful. They seem rather to rest upon 
the brain, than to enter into 
its substance. An exception to this 
is perhaps the Portio mollis of the    
7th Pair, which arises apparently 
from the fourth ventricle, & its fibers
may be traced distinctly into it. 
They are rather now considered as connected 
with the Brain, than as making 

a part of it. And a strong reason 
for believing that this is true, is 
that you find the nervous system 
in the fœtus which is born without 
[the] a brain as perfect as where this 
organ is natural & complete. This 
fact shews, that the nerves are in as
considerable degree independent of 
the brain, tho’ connected with it. The 
same is true of the spinal marrow 
The nerves so not arise directly from 
it, but are connected by small branches
to its Surface.
With respect to the use of Ganglia 
the present opinion is, that they 
give to the nerves their involuntary 
power. This opinion was founded on 
the observation of the ganglion within 
the orbit of the eye. All the nerves going 
to the muscles of the eye, are derived
from the brain, because these 
muscles are voluntary. But the 
Iris is an involuntary muscle, to 
it is found that the nerves which 
supply it are derived from a little 
ganglion. Again, numerous ganglia 

are found to be connected with 
the grand Sympathetic Nerves, which 
are principally going to supply the 
involuntary ports within the thorax 
& abdomen. There is a considerable 
degree of plausibility therefore in 
this opinion. Whether it will stand
the test of future experiments remaining 
yet to be decided.
Sensation is influence by the division
of a Nerve, but after this division,
the nerves is capable again of 
being regenerated, so as to perform its 
original function. If the two par
vega in an animal are divided suddenly,
it will die in few hours.
But if one of them only be divided, 
& in a few days after, the other, the animal
will survive. This clearly proves  
that the function of the first was restored,
previous to the division of 
the second. Dr. Haightons experiment 
upon this subject, are the 
best which have been made. They 
show that union is readily restored 
in a nerve, but it does not seem 
to be a production of new nervous 

substance. There is always an employment 
at the place of their union. 
It presents the appearance of 
a small ganglion. From what we 
see in other animal, [that] there is 
reason to believe, that a new nervous 
structure may be formed after the 
division of nerves. 
After a nerve has been divided in 
Tic doloreux, the pain will often 
return before the numbness ceases. 
But Dr. H’s experiments prove 
that this sensation is carried on in 
the portion of new formed nerve, & 
not by its anastomosis with other nerves 
as has been supposed. Caustic has been 
put between the divided ends of 
nerves, without preventing their 
reunion. 
Sensation & Volition are in some 
degree distinct: i.e. a nerve going 
to a part may loose its volition &
still retain its sensation. Thus, a 
man may have such a numbness 
in his Limb, that any violence, such 
as bunning pinching or cutting may 

32.
be inflicted upon it, without giving 
pain, & yet the patient shall be able 
to move it as before. Dr.
Yellowly has mention an interesting  
case of this kind, in the Medico 
Chirny: Trars. The patient has no 
feeling whatever in his arm & hand 
under any injury inflicted upon 
it; yet he could move it readily in 
any manner, & was able to support
a considerable weight with it. But 
this power, however, was in a degree 
weakened, for if at the time that he 
was holding anything in his hand 
you directed his attention to any other 
object, it fell from it.
So, on the other hand, Sensation can 
remain, tho’ Volition is destroyed.
We had a man in this hospital in 
whom this was evinced. He was 
seized with paralysis of the right 
arm, yet so great was the sensibility 
of it, that he could not bear to 
have it touched, the least touch gave 
him most acute pains. So that he 
could not have his nails cut, & they 
grew to a most immoderate length.  

33. 
An attempt has been lately mode 
to shew that the involuntary functions 
are supposed by means of the 
Spinal marrow. Le Gallois has attempted
to shew this by a course of experiments. 
These same experiments
have been repeated in this country 
but with a very different result. The 
truth is, the reason that the destruction 
of the Spinal morrow in the former, 
stopped the motion of the heart & was 
because they were done so suddenly. It 
was produced by the violence of the shoots 
which was given by it to the whole 
body: for it was found, that if the spinal 
marrow was destroyed more slowly,
the same effects would not result 
still the involuntary function would 
go on. Mr. Clift, who knows more 
about comparative anatomy & physiology
than any other man in this 
Kingdom, has published an excellent 
paper upon this subject, showing 
That a destruction of the spinal marrow 
does not produce such an effect, particularly 
in fishes & some animals of 

that class. The truth is that the heart 
of the turtle will continue to beat 
even after it is removed from the 
body. I remember that I once had 
the heart of this animal which. I wished 
to inject, which had been out of the body, 
for some time, & immediately that 
I put it into warm water for this purpose,
it began to beat. But if you put 
a drop of Laudanum [of] upon it is actions 
will at once cease, & they can never
be restored. 
It has been said that some animals have 
no nerves. There are to minute that they 
cannot be discovered. But Gentlemen 
I draw no conclusion from observations 
made on these smaller classes of animals. 
It was supposed for a long time that the 
Star fish had no brain, but now this 
is proved to be quite a mistake.
Many of the lower orders of animals 
have no brains, but they have a ganglion 
which answers all the purposed of one

Muscular System. 
A curious circumstance in these,  
is that the power of Muscles is always 
in exact proportion to that which you 
mean to employ. Thus if you intend 
to raise a weight, which you think 
small, & you find it to be heavy you 
are disappointed in the power of construction,
which you applied to it. So also 
the reverse, if you think that you have 
a heavy weight to raise & it happen to 
be lighter than you expected, the power  
which you apply, light it suddenly
into the air.
The same thing you have all experienced 
in going up stairs, & supposing when at 
the stop, you have one more [stain] step to 
take, you suddenly put your foot down. 
It is still worse [ at the bottom] when you 
suppose yourself at the bottom of a 
stair case, I have yet one step to take. 
Muscles if exposed to a constant stream
of water, become converted into Adipose
a substance very much resembling 

resembling Spermaceti. This was first observed 
at Oxford, about 30 years ago 
where they are in the habit of throwing 
their bodies after dissection into a 
well, at the bottom of which there is 
a stream of water constantly flowing. 
I remember, when this was first 
made Known, that considerable noise 
was made about it, from an idea 
that bodies were taken up from the 
grave-yards to make Spermaceti
candles.-
Of the Glandular System 
The excretory ducts of glands are lined 
by a secrecy mucous membrane 
which constantly pours out a fluid for 
the purpose of defending it from the 
irritation of its own secretions. Thus 
the Bile, if it was not for this, would 
be highly irritating to the ducts & the 
urine as it passes along the urethra
would also be highly irritating to it 
of this, you are probably many of
you acquainted. When the natural 
secretion of this canal is suspended by 

a Class, the urine in passing a long 
its surface, produces so much pain 
that a man will sometimes refrain 
from making water for several days 
together. This is the reason also why 
it is so difficult to head ulcers of the 
bladder. The urine serves as a constant 
irritation to it them. The best 
mode therefore of curing them is to 
make the patient constantly wear
an elastic green [bottle] Cathates, by  
which the urine being constantly running 
away, as it is secreted, the sides 
of the ulcer may be brought together 
& healed.
Of the Bones. 
Some bones after they are featured 
will never unite by bone; as the 
joints which are covered by a capsular 
ligament. Such in the patella & the 
neck of the thigh bone. It has been 
said there are cases, in which this last 
has united by bone, but all I have to 
lay is that I doubt is. They are commonly 

united by ligamentous substance 
& in no other way. The truth of this 
has been double in France, & this lead
me to suppose that morbid anatomy 
has been more attended to in England 
than in that Country. If they had dissected
at all, it appears to me that 
they could not have been ignorant of 
this circumstance. If a fracture lathy
place in a portion of the condyle of the 
os humeri, within the capsular ligament, 
it will ever after remain disunited 
except by ligamentous substance. 
It is effected by this [ mean]. & not by 
means of bone. This is a fortunate circumstance
toe, for if it were not so anchyloses 
would be the consequence. 
How could the Knee be bent, if an inch
of bone was added to the patella. Thus 
it seems to be a wise provision of nature, 
to preserve motion, when fracture 
of this Kind have taken place. It is 
an astonishing thing to me that people 
could ever have doubled of this fact. They 

had only to open their eyes & they 
must have seen it.
Fracture sometimes will not unite 
at all. This arises often from the patient 
not Keeping his limb sufficiently still 
to allow of union. It may arise from 
the too long are of Evaporating Lotions. 
If it is not united in two months, the 
best plan is to first on splints firmly 
so as to prevent all lateral motion 
& then allow the patient to walk on 
it, & the stimulus which this causes 
will sometimes bring on inflammation 
& union. You have lately seen a good 
case of this kind, cured by making an 
incision down upon the bone, & touching 
the ends of it with Lunar caustic.
The man was enjoined perfect 
rest afterwards, & he went out of the 
hospital not long since cured. I have 
seen three cases nose of this kind.
Of the Periosteum
In some animals, this differs from the 
human in its color: the guinea fowl
for instance. This bird is said to have 

black bones. But this is a mistake 
his bones are the color of any other 
bones. But the periosteum is black-
which has given rise to this opinion 
When Cartilage becomes diseased, it 
exfoliates, but prior to this taking 
place it is converted into Bone. 
this you see in the Cartilages of the Larynx 
when they become ulcerated. It 
is not unfrequently the case. You often 
see the Corner of the thyroid cartilage 
converted into bone & exfoliating. Dr.
attended a boy who had injured 
the cartilages of the larynx in 
attempting to destroy himself, & he found 
that the healing process was interrupted
by the exfoliation of little portions of 
bone.- When the cartilages of ribs become 
broken, they are united by bone 
except in very young persons, in whom 
union takes place by means of cartilaginous 
substance. These cartilages 
assist in expiration by their reaction after 
the test has been dilated by the muscles. 

The Secretion from the Synovial 
membrane is liable to be changed.
It is sometimes exceedingly abundant. 
This is the case in Rheumatism. You 
have in this disease frequently considerable 
swelling which is owing to 
an effusion of Synovia. It is found not 
to possess all the characteristics of 
this fluid- it is more watery. The 
disease is distinguished by a swelling 
of considerable size, & when the Knee 
is bent a distinct fluctuation is 
felt upon each side of the patella. 
Besides Constitutional remedies, 
there is much advantage to be derived 
from local bleeding & the Empl. Ammon. 
e. Hydrayyro in strips. But 
if the accumulation has been of long 
standing, & the ligaments have been 
much distended, it will require the 
use of the Tart. Antimon. Unguent or 
the Empl. Lyttæ. This will generally 
succeed in producing absorption, after 
which a tight bandage should be  

worn, in order to support the part, 
or there will be danger of dislocation,
from the very relaxed state of 
the ligaments.
You often find a Crackling sensation 
in the Joints. You might suppose 
it to be a crepitus, but it is occasioned 
by an inspissated state of the synovia.
The Thera of the tendons is subject 
to same effusions as the Joints. 
The Synovial membrane is subject 
to Gouty inflammation, & a curious 
circumstance takes place in consequence 
of it, which is the effusion of a 
chalky substance into them. When the 
salt accumulates upon a joint, the 
parts over it will ulcerate, & the 
earthy matter be discharged. This process 
is quickened by touching the edges 
with Caustic. It is a curious fact 
that the Joint of Gouty persons will 
not inflame like those in a healthy 
state. There concretions happen not only
to the Joints, but also in the theca  

of the tendons. It was formerly supposed 
to be Calcareous, but it was 
particularly analyzed by Mr. Wollaston,
who found it to be the Urate of Soda.
It is the same substance as is frequently 
deposited in the bladder, in 
persons who are subject to Stone. 
Very large quantities of acid are found 
in the Stomachs of gouty old people. 
The remedy for the Gout is to give such 
medicines as shall counteract this disposition 
to form acids. The patient 
should refrain from those substances 
which have a tendency to run into 
the Acetous fermentation. 
The next disease the Joints is the 
formation of little bodies which are 
called Cartilages, but which are in fact 
chiefly composed of Ossific matter 
covered over by cartilaginous matter  
They are sometimes united to the cartilage.
They are produced in the following 
manner. A slight inflammation 
occurs, & occasions the effusion of a solid   

adhesive matter, blood vessels shoot 
into this matter, & render it vascular.
It is at first attached to the membrane 
by a narrow neck, as ossification 
goes on, it falls off & becomes loose 
in the Cavity of the Joint. It then 
often changes its place upon slight 
motion, & occasion great inconvenience 
by slipping between the bones. 
When the patient is commonly thrown
down & suffers much pain.
At last by these repeated accidents, 
the patient becomes wearied & requests 
you to remove the body. But you 
must be on your guard how you do it.
It is an operation which requires but 
very little skill, but it is extremely 
hazardous. The inflammation & suppuration
which succeed are so great 
that the patient becomes worn out by 
them. I know one who was treated in 
this way in the other hospital, & she 
died in consequence, & another in whom 
the most severe constitutional disorder 
arose, & it was supposed she would not 

recover. I took one of these bodies 
from the Knee joint of one of the 
gentlemen of this Class, some years 
ago, & the result was a very high 
degree of Constitutional irritation 
which we thought would have destroyed 
him, & he was lame for a very 
long time afterwards. 







But besides the ligaments [already]
described, there is another which is called 
the elastic ligament. Such is the 
ligament uniting the bones of the Spine 
You all Know this substance immediately 
under the name of Pay Wax.
Some animals have it very large, as in 
those animals who require the horizontal
posture, the ox, the horse &c
Their muscle would become very much 
fatigued by constant exertion, if it 
was not for this. It is a beautiful provision 
of nature for the purpose of saving 
muscular exertion. It is exactly 
similar in structure to the outer coat 
of an artery. It is exceedingly elastic 
having irregular fibers & possessing very 
little [ elasticity] vascularity. This then 
is the second moving power of the body.
When you separate the bones of the Spine,
by bending the body forwards it is not 
by the power of the muscles alone 
that it is brought back again. No person 
could sit for any length of time, if it 

were not for this structure, because 
the muscles would become so 
fatigued. The claws of the Lion, & all 
the Cat-tribe are supported by this 
elastic Ligament. If you look at one  
of these animals, when it is not irritated, 
you do not perceive its claws. 
they are retracted under the Skin, by 
this ligamentous substance. But 
when the animal is irritated, then 
the claws are brought into view by the 
action of certain muscles, which are 
attached to them.
Of the Joints 
Wounds of the joints are healed with 
Considerable difficulty for two reasons 
1.)	because they are secreting Surfaces                        
& the fluid which is constantly poured 
from them presses upon the parts so 
as to prevent adhesion. Therefore, it becomes 
necessary that a process of suppuration
& Granulation should be setup, 
by which at last they heal. These 
granulations are not always bony, therefore 
a stiffness only remains after; they 

become absorbed. If they are bony, it 
will terminate in permanent anchylosis.
2.) When Suppuration takes place, it 
is difficult to effect granulation, on 
[account] of the peculiar nature of 
the Cartilages covering the [ Joints] Bones.
The Cure necessarily presupposes absorption 
of the Cartilages. The bone must be  
exposed, because the cartilages cannot 
granulate- they must arise from the 
bone. This was known to the older 
Surgeons. Old Warner used to scrape 
off the cartilages from bones, in extensive
wounds of the Joints. That the Cartilage 
will not granulate you see when 
you amputate the finger at the joint. 
The skin does not unite to it, but a cavity
is afterwards remaining between 
them. This is the reason why wounds 
of the joints are followed by so much 
constitutional Irritation 











[Iritis set] It is a curious fact, that 
Iritis tho so very common in the adult, 
seldom attacks children. I do 
not Know to have ever seen an instance 
of it.- Where the Iris throws out 
a lymph an its posterior surface so 
as to be united to the capsule of the lens,
I Know of no remedy that can cause
its absorption. The Belladonna in all 
cases of Iritis should be applied to dilate 
the pupil even the first & acute stage 
of the disease. I think no objection to 
its use. It is best applied immediately
to the eye for this purpose but in cases 
where this is not allowable, the extract 
should be smeared over the eye lids.
Great care however is necessary to keep 
this moist during its application otherwise
it will often times not produce 
the slighter effect. It appears 
to me to act by paralyzing the fibers 

fibers of the Iris. A similar. State
of dilatation & paralyses of this organ 
is a constant attendant upon presses 
upon the Brain, as we see manifested 
in Hydrocephalus. We may see a 
similar dilatation, if we watch the pupil 
in the last moment of expiring 
Life- after but as soon as death ensues 
the pupil regains its ordinary, state. 
Specks 
Ulcers of the Cornea succeeding  
In Strumous Ophthalmic we cannot 
be too careful how we admire the application 
of Stimulants & the eye must 
be most assiduously watched during their 
use. As this is not possible in public 
practice, so use have frequent opportunities
of observing inflammation of the 
conjunctiva brought on from this cause 
This inflammation sometimes presents 
a some of red vessels very similar to that 
which takes place in Iritis, so that we 
are apt so conformed a deep inflammation  

inflammation with what is only superficially 
seated. You see a strikers instance 
in this case.
[Then] Ulcers of the Cornea require a 
very different applications, according 
to the appearance they present. Here, 
you see the ulcer is quite transparent,
there is no dark opacity surrounding 
it- it is simply disease of the Conjunctiva.
Whatever opacity may take place of 
the Cornea & however extensive, provided 
there is no change of Structure of the 
part, it will always yield to treatment. 
In the employment of, Stimulants 
to the eye, they should always be alternated-
much may be done in this 
way”
Farre.

Purulent ophthalmia very frequently
makes its appearance a few 
days or immediately after birth. 
In these cases it is attributed very 
commonly to the contact of the eyes 
of the child with some secretion from 
its mother in its passage thro’ the Vagina. 
I am [ would be] rather disposed to 
look for the exciting cause of the disease  
in the change of condition of the 
child from the [fœtus] womb to the world
In the womb- the eyes are closed, & subjected
at all times to an equal temperature- 
& being highly irritable, 
they do not bear well, the sudden
vicissitudes of the atmosphere after birth 
Very frequently too, they are exposed to 
the [sude] light of fire or a candle & 
[exposed] at the same time (the face 
being the only part uncovered) to currents 
of air in the room.
The treatment of the disease is very 

simple. Where the eye-lids are 
not so much swollen, but open 
easily, I employ nothing more than 
than a simple solution of alum in 
the proportion of 4 grs to the ounce 
with mild purgatives. Where the 
disease however is recent, the solution 
of half the strength is sufficient.-
Inflammation of the Iris, may be 
recognized, if there is no appearance of 
the zone surrounding the cornea, by 
pain referred to some part of the orbit 
of the eye or head, an affection 
similar to hemicrania, & which the 
patient himself calls Rheumatism 
This is sometimes accompanied too 
by a slight irregularity of the pupil; 
the faintest appearance of zone 
will however enable you to pronouns
decidedly upon its nature. It is of importance 
to attend to these symptoms, 
for as the disease is very insidious, in 

its progress, it may considerably impair
the vision before the patient or 
surgeon is aware of the mischief. 
The disease may always be arrested 
by Mercury.
Paralysis of the upper Eye-lid is 
always connected with an enlarged
state of the pupil of the eye- affected. 
It is rather curious that in this patient 
the vision should be so very perfect.
(as complete in the other eye) The 
Mouth has been made slightly sore by 
Mercury, & she think she has a little 
more power in raising her lid.
Now, I think that in there cases, there 
must be either a simple congestion 
of the vessels- as from the distension 
of there an effusion of serum or lymph.
The Mercury acts therefore by to exciting 
the other secretion of the body, restoring 
the balance of the irrullation
& thus relieving the distension & consequent
effusion. When this is taken off the absorbents 

absorbents still continuing to act, remove
any serum or lymph that has been 
deposited, & in this manner, is the 
healthy functions of the part again 
restored. 
Mercury acts in the same way in 
curing disease of the Liver & other 
organs of the body.- Here instead of 
serum, lymph is always effused, & 
hence it is that a section of the liver under 
disease has a whitish appearance. 
The quantity of mercury necessary to 
effect this change or restore this balance 
of circulation is very different 
in different individuals. I have 
Known it effected by a single grain
Dr. Fane recommends the following 
formula in Scrofulous Ophthalmia
R. Decoct. Lichen Soland. lbj
Acid nitric dilut. ʒij
This sweetened with the Symp of 

[Talow] is the only form in which 
children will frequently take the 
acid. 
Granulated lids may arise either 
from the Egyptian or Strumous Ophthalmia.
In the first they [th] are 
simply the effusion of coagulable lymph
with red vessels shooting into it, & are 
to be cured by the Knife or with some
escharotic application. That occurring 
in strumous habits is generally 
very unmanageable, & yields only 
to general remedies.- 

“Mollities Opium, This disease is 
very rarely met with. I would 
define it a peculiarity fragility of 
the bones. It has been confounded 
with Rickets but is different from
this- In Rickets, there is a deficiency 
of the boney deposit, but in Mollities
Opium, there is an increased 
absorption of the Phosphate of Lime 
& its indies the Cartilage. I shew you 
some specimens of this disease. You 
perceive the concereallatate structure 
is entirely destroyed & the shell 
of the bone is much thinner than 
natural & very porous.
The Bones, in this disease are liable 
to break from the slightest causes. 
I have Known a man to break
the os humeri, by the simple 
exertion of cutting a loaf of bread
yet this fracture threw out a callus 

callus, & united as usual.-
Anchylosis. This may arise 
from three causes: it may originate 
from bony matter being thrown in 
to the caution of joints, or it is deposited 
in other parts of the body, in arteries 
&c from old age. I shew you the 
Spine of Dr. thus united into
one bone (who lived to the age of 80)
I have already, shewn you the values 
& arteries of this same patient, ossified. 
Here is the back bone of a horse 
united in the same manner. You 
perceive the same anchylosis in the 
joints of the Pelvis, in the Secures 
of the Skull from age.
2.) It may originate from wounds 
made into Joints- There irritate 
the Synovial membrane, & cause 
a deposition of boney matter, & 
the joint from improper management 
may become perfectly stiff 

& useless. A Gentleman in 
the Country received & some injury 
of the Knee, & inflammation & 
swelling followed, & he was confined 
by his Surgeon for two months to 
bed.- Growing impatient, he came to 
town, & consulted another Surgeon, 
who perceiving still some swelling 
of his joint, did not think proper 
to alter the treatment, & Kept
him another month at rest. At the 
end of this time, he consulted me,
& without any Knowledge of what 
had previously been done for him, I
ordered the limb to be gently & passively
flexed, once of twice daily, 
& after this to rub it well for about 
an hour. I advised at the same time 
his taking exercise upon crutches. 
At the end of a few weeks, I met 
this man at Lincoln's Inn fields, 
so well as to be able to walk with 

a single crutch, & in a little time, 
he perfectly regained the use of the
leg.- This treatment, however, 
only answers in persons who are 
otherwise perfectly healthy. Where 
it is owing to some defect in the 
constitution, we should adopt precisely 
the opposite plan. Here absolute
rest is required.
In the third species, of anchylosis, 
the Cartilage of the Joint is absorbed, 
& granulations & bony matter sprout
from the ends of the bones. I shew 
you some specimen, in which you 
will perceive, the same cancellated   
structure, & shell of bone, as in an 
original bone. Here is one, in which 
the tibia is perfectly bent around at 
the joint. This was a patient of Mr. 
- & during life, this man carried 
his leg at right angles before 
his body.

Exostosis- This may arise from 
the Medullary part of the bone 
or the bony & outer shell.- In 
the former case, or the bony granulations 
sprout, the outer shell 
becomes entirely absorbed, or is converted 
into a sort of thin net-work, 
of which. I here show you a beautiful 
specimen. In all cases of the 
formation of new bone, there is a 
prior deposit of cartilage, similar to 
that which takes place in the formation 
of callus. This is proved by macerating 
any of these specimens (of
exostosis) in a little acid; the bony 
phosphate will be dissolved, & the elastic 
cartilage will remain unacted 
upon. Let others dispute this opinion 
as they place but I am as 
well convinced of it as any point 
in physiology.- 

The Medullary exostosis is commonly 
owing to Constitutional disease 
Amputation. therefore, will only 
excite the same action in some 
other part. -
When Exostosis occurs in any of the 
bones of the Skull, it is so perfectly
hard that it would be in vain to 
attempt cutting thro’ it with any .
of our trephines or saws- We might 
as well pretend to cut thro’ billiard 
balls-
There is a peculiar Kind of exostosis
we see frequently shooting forth like 
a spicula or thorn from a bone. This 
occurs most frequently upon the femur.
Here are three specimens of it 
upon this bone,”
Cooper.-

Hæmorrhoids- These are in the 
recent state nothing more than a varicose 
state of the Veins of the Rectum.
When they have existed a few
days, the vein becomes closed by adhesive 
inflammation, & the tumors 
contains nothing more than a firm
lot of blood. In this state, they frequently 
excite much pain & irritation, 
which is immediately removed 
by puncturing the part with a sharp 
lancet, & pressing out this evagulum
of blood.- If the disease is allowed 
to proceed, vessels will shoot into 
this evagulum, & instead of a bloody 
tumor, you will have a sort of flashy warty
excrescence made up of arteries
& veins. When there exist to any 
considerable extent, they occasion
a prolapsus of the Gut, which annoys 
the patient excessively, & debars  

debars him all exercise. This state 
is very much relieved by wearing 
a truss on the part. A Circular steel
belt [spring] is made to fit [to] round the 
body, to the back of which is attached 
a spring of the same metal, which 
is carried down into the perineum.
At the end of this is a [use] pad of 
cork or ivory, made to press exactly
upon the anus, so as to support 
the rectum.- I knew a gentleman, 
who lives about 3 miles from 
town, who was so afflicted with 
this prolapsus from piles, that he 
was not able even to walk as far as 
his garden without much torture. 
His health too was much affected from 
this want of exercise. I advised him 
to apply this truss, & he was soon so 
well as to be enabled to walk to 
town & back again in the course

of the day without any inconvenience.
By the aid of this truss 
I have even Known patients to 
ride very comfortably upon horse 
back.
Independent of this state of the Rectum
often produced by piles, they become 
exceedingly troublesome, when 
they show themselves externally, by the 
galling & friction caused by the notes 
in walking.
Whenever they excite any inconvenience
I never hesitate to remove them, by 
taking them up with a hook, & snipping 
them off with a pair of scissors. 
Never think of removing piles
by the Ligature as has been recommended 
by some timed Surgeons. 
This Keeps up excessive pain& irritation
for several days, [the] puts the 
patient to dreadful torment, & indeed 
frequently proves fatal. It is a dangerous 

dangerous practice. Excision, on the contrary 
is [ safe from] never dangerous, & is attended 
with scarcely any pain.
If the tumor are numerous, I generally 
take off but at one a time,
lest the removal of more excite too 
much irritation in the Constitution.
If this is attended with but little irritation,
I perhaps venture to snip
two the second time, & thus gradually 
remove the whole.- 
Some have objected to this made of 
operating for fear of, hemorrhagy
but I have never seen the least danger 
from this cause. If the tumors 
are seated internally, & there is any 
apprehension of bleeding, I pass a 
needle armed with a double ligature
thro’ the root of the tumor, & 
tie these lightly before. I remove it, by 
tightening there, I can easily command 
the hemorrhage, but they should be 

removed after four hours. 
Piles sometime slough, thus effecting 
a spontaneous cure. 
Fistula in Ano. This is most commonly 
a Constitutional disease, & 
is connected very frequently with 
some morbid affection in a distant
part as the Liver or Lungs. It sometimes 
follows [the debit] low Nervous
fevers- thus we see it the consequent
of typhus. In other cases, it is merely
Local, & arise from a want of 
attention to keep the bowels in a 
regular & open state.- In the former 
case, (when constitutional) the 
irritation & discharge produces very 
great debility, & Surgeons mistaking 
for a cause, what is [ the] only 
the effect of some other disease, have 
recourse to the operation, This however 
only aggravates the primary affection 
& it should never be resorted to, until  

the constitution is made sound 
& healthy.- The extent of the Suppuration 
is various in different cases- 
I have Known it to extend to both 
groins. The operation consists in 
laying open the abscess, & deciding completely 
the ophineter muscle. After 
this is performed, the Surgeon should feel 
carefully with a probe for any other 
sinuses leading from it, & expose there 
freely in the same manner, otherwise 
there will be little chance of scruffs
from the operation. In the dealing 
of the abscess, crass bands are very apt
to form, which block up the matter- 
There should be divided carefully with 
a pain of Scissars. The patient should 
be apprised of the nature of there, or 
he will be apt to think this [of] disease
has been treated very badly, I consider 
that every division of these hands is 
a new operation.

Where a fistula exists upon both 
sides of the perineum, the one is to 
be cured, & or the granulating process 
should be set up, before any operation 
is attempted upon the other.
If the abscess has not opened externally,
but only into the rectum, we   
commence the operation, by making 
an artificial opening in the perineum 
with a sharp pointed bistoury. 
This should be done in that  
part, where the patient feels most 
pain upon pressure. Having dose 
thirt the finger is to be introduced in 
to the rectum, in order to seek the 
opening into this & we are apprized 
of the exact spot, by the patient experiences
pain, when we touch it  
The bistoury should be directed to 
the point of the finger, & when it has 
reached it, drawn out in the usual 
manner. 

The Cure of fistulæ has been attempted
by a Leaden ligature, but this 
produces great irritation, much suppuration,
& instead of a few days confinement,
perhaps three or four weeks 
I would never attempt any other cure
than the operation I have already recommended 
to you.
Stimulating Injections have been thought 
to effect the Cure of fistula. I saw 
there succeed but once, & that was in 
a Lady who had been operated upon 
for fistula. Her disease returned, 
& from the great irritation & pain the 
suffered from the first operation, I 
found it impossible to persuade her
to undergo a second. I therefore advised  
the use of injection, as the Conserve
sublimate in Lime-water, & the abscess 
perfectly healed up. I have tried these 
injections repeatedly since that time

but without the smallest success.”
Copper.
Columbium. This metal is found 
both in North America & Sweden, & 
it is Known in the latter country by 
the name of Tantalium. As it was 
first discovered, however, in America 
& obtains there in the largest quantities, 
I shall retain the name Columbium
Arsenic None of the tests upon which 
we rely to prove the presence of this 
metal in the stomach, are sufficiently 
satisfactory. The Sulphate of Copper 
& Nitrate of Silver, are both equivocal,
since we have the same green precipitate 
on adding a solution of onions 
to the Sulphate of copper, & the a similar 
yellow one with the phosphate of 
Soda or other alkaline Salts with 
the Nitrate of Silver. The presence  
therefore, of either onions or any saline 

saline ingredient in the Stomach may 
mislead. I think the charge produced 
by the former can only be owing to 
their yellow color, which united with 
the blue of the sulphate of copper forms 
the greenish [separate] precipitate. Hence too, a 
greater source of error is the presence 
of bile in the Stomach, which acting 
upon the sulphate in the same way, 
produces the same colored precipitate.  
It is true, there colors may be distinguished 
by a very nice & experienced 
eye, still the difference is not sufficient 
in general, to ground any opinion. 
If we can obtain the white crystals of arsenic,
by subliming the what we obtain 
from the Stomach, with a little potash 
& charcoal in a glass tube, & if these 
yield on burning & smell of garlic, 
it is a sufficient test of their nature. 
Arsenic unites with Hydrogen forming 
the Arsenicated hydrogen gas. 

This gas is very combustible, & poisonous
when inhaled in the smallest 
quantity into the Lungs. It 
unites with Chlorine, & if the two
gases are not well mixed, they even
inflame. The Hydrogen gas in the state 
of arseniated hydrogen seems much 
condensed, I should suppose to about 
two thirds its original volume.- 
Chrome. This metal has been imported 
by two our great manufactures,
in great quantities from America 
for the purposes of dyeing. Dr
is that present engaged in extensive 
experiments with this view. 
A friend of mine at Paris, has of late 
introduced it into his Porcelain manufacture.
It forms a considerable 
acquisition to the coloring of porcelain;
no article having been heretofore 
discovered capable of giving a permanent 
green, & with standing the 

heat. It has the additional advantage 
of not running [or for] in to 
blotches, or appearing uneven upon 
the surface, which forms a considerable 
objection to the green dyes now
in use. It is now used in this 
country also for painting carriages
yellow, & its color is thought much superior,
& more permanent, than that 
of the substances formerly employed 
but whether or not this will overbalance
the [add] difference of expense 
I cannot tell. 
Antimony. This leads me to say a 
few words of James’ Powder. Dr. Pearson 
first discover the composition 
of this. It is prepared by mixing the 
Protoxide of Antimony & common 
Harts-horn shavings in a crucible & 
exposing these to a certain heat. Great 
care must be taken however, that these 
ingredients are not exposed to too violent 

violent or long, continued heat, otherwise 
the antimony will be converted 
into the peroxides, & the powder resulting, 
prove totally inert. An experienced
pharmaceutics will easily
prevent this, & the charge is Know
by the yellow color of the mixture, 
gradually turning to a white. As 
soon as this is observed the crucible 
must be removed from the fire, & the 
process may be considered as ended.-
Tartar Emetic. By the process directed
in the tart edition but one of the 
London Phanopœia, you would never 
prepare tartar emetic, but instead 
of it, nothing more nor less than the 
common Cream of Tartar. This therefore 
would prove perfectly inert for the 
purposes for which it is ordinarily given.
The process adopted in the later 
edition is [a] more fair, still I consider 
it as objectionable, & would prefer instead 
of 
Brande.

“Chorea & Epilepsy. I have dissected 
the Brains of the worst cases, I ever saw 
of these diseases, without perceiving 
the slightest alteration of Structure. 
Drs. Farre 7 Mr. Saunders, than whom
no men have been more minute & 
industrious in the investigation of 
morbid anatomy, have both confirmed
my observation. In general, however 
the vessels of the pia mater appear
very tinged & blood shot. In one instance, 
I have seen deposits of ossifi
matter upon this membrane.
The Shower both, I consider as one of 
the best means of curing these diseases 
I have used this in several instances 
with considerable success.- Where 
these diseases are recent & not confirmed 
I have performed frequent cures with 
the Axymurias Hydrorgyri [in a ] dissolved
in Spirits of Wine in the dose 
of about 1/8 gr, three times a day. This  

is one of the remedies upon which 
I rely, & I have often known it to 
succeed.” 
Copper.







Cancerous Lip-
Mr. Dupuytren recommends that the 
operation for the removal of Cancer in 
the lip should be performed, by removing 
a semicircular portion of the 
lip & leaving it to unite by granulation 
instead of taking out a triangular portion 
& uniting it immediately as has 
been heretofore practiced. His seasons for 
this are the following. It leaves the patient 
afterwards with a large mouth 
them after the old operation in which if 
the cancerous portion is considerable, he 
suffers great inconvenienced from the 
great contraction of the mouth. Beside 
the irritation occasioned by the pins & 
[needle] ligatures in the triangular operation, is 
apt to reproduce the disease. No fear need 
be apprehended that the lip will not in 
this new operation become entirely united  

united by granulation, without any 
fissure being left. He showed as a 
patient on whom it has almost filled 
up, & he promised in a month to 
shew the same patient perfectly cured. 
The deformity however which is left after 
this operation would be with most 
people a considerable objection, but 
this he considers of no importance what 
ever compared with the safety of the 
patient. 
Mr. Dupuytren this morning amputated 
a mans great toe. After the operation 
finding considerable difficulty 
in arresting the hemorrhagy, he stopped 
by the application of the heated 
Lion. He also filled the stump 
of a bay who had undergone amputation
about a week previous, with 
pulverized Cinchona on account of its 
gangrenous appearance. This was 

3
repeated several mornings successively-
but the boy died. It produced 
no visible beneficial effect- 
the discharge was not lessened nor 
improved. The patient was Scrofulous
& very debilitated previous to 
the operation, having long labored under 
diseases of the Knee-joint 
August 13th 1817.

Tetanos 
[S- L-] received a Burn of the 
fifth degree about a week since, 
for which he was received in to the 
Salle Sr Paul. The prognosis, altho’
the injury was so deep, was not unfavorable 
excepting that he was advanced 
in years (58) & he would perhaps 
suffer from obstinate & incurable ulcers 
as the part was as far removed 
form the centre of Circulation being 
upon the ancles, within the few last 
days however, very unfavorable symptoms 
have arisen. The burn has gone on 
well, the laugh nearly, thrown off, & 
suppuration established. But the night 
before last, he perceived a stiffness in the 
muscles, of his lower jaw, which has increase 
till now almost complete trismus
is produced. The masseter muscles
are very rigid , & it with great difficulty 

5.
difficulty that he can move them at all. 
We fear fatal symptoms will [cure]
that they will produce to complete 
Tetanus. This is one of the most incurable 
of diseases- one in which almost 
every remedy, has been employed with 
out success- & we know no medicine 
with which we can with any certainty
combat it. It after arises from 
wounds, particularly when patients 
are at the same time subjected to 
great changes of temperature. Thus, it 
is often obscured in armies, where the 
Soldiers are exposed to the heat of the 
Sun during the day & obliged to sleep
in their tents upon damp ground during 
the night.- This patient, of whom
we are speaking, has been exposed 
a good deal to changes of temperature 
& perhaps this may have been are exciting 

exciting cause of this affection in him-
this is however merely conjectural. 
Opium has upon the whole been found
the most successful in tetanic affections; 
& we have given it to this patient 
in large quantities, but with very 
little effect.- Alkaline Baths
have been very much recommended. 
We have tried them repeatedly in many 
cases, but without any success, & are 
have always been obliged to give them 
up, as they produced what we call 
“secouses des muscles” This is a symptom 
which I have constantly observed 
more or less, in all the cases which I
have seen of this unfortunate disease. 
It is a sudden & momentary exacerbation
of the contraction of the muscles, 
& is sometimes produced by the 
slightest causes- The least noise,

7.
touch, or accident, is sometimes 
sufficient to produce it. Our patient 
has as yet been very little affected 
by them, but there is reason to 
fear they will come on.
Mercury has had a fair trial in this 
disease. It has been taken by the mouth 
& introduced into the system by frictions-
but I have never Known it to
produce a cure, or any abatement of 
the symptoms. Antispasmodics have 
also been employed, musk & assafœtida
have been given in great quantities- 
but they will not cure. Opium 
seems upon the whole, the most successful
remedy. I have known it 
to produce a cure, the in consequence 
of great imprudence in the patient, 
the tetanic symptom returned, & 
he died in consequence. We have increased 

increased the dose of Opium in this 
case to eight grains, & if it does not 
produce the desired effect by the evening, 
we shall augment it to twelve 
& tomorrow to sixteen & so on, taking 
great care to avoid giving it in 
such quantities as to produce Narcotism
which is sometime done. We 
hope to cure him, but cannot help
fearing that he will sink from the 
effects of this obstinate affection.
Novr. 19th. Our patient died last 
night about 12 o’clock- we did not 
expect that the event would have occured 
so soon. The Opium which he 
took & was given by injection produced
a marked effect. Narcotism was 
accessioned, but still the symptoms 
of his malady were not relieved. While 
this state lasted, you observed that the  

9
eye-lids fell, & the lower jaw was 
relaxed also, during the Sleep which 
was profound, but if he was excited 
in this state, he instantaneously
opened his eyes, & the muscles again 
contracted. If a question was put to 
him, whilst excited, he answered it, 
but if left alone, he immediately relapsed 
into his profound sleep. There 
were no “secoupes” during the narcation-
it suspended them, but still 
as we said before, the symptoms increased, 
so that by the evening, we found 
it extremely difficult by force, to bring 
his chin down upon the chest. The 
pulse was a little abated during the influence 
of the opium, but by 12 0’ clock 
he died, I think in consequence 
of the Diaphragm becoming affected 
in the same manner as the other 
muscle, which put an immediate 

immediate stop to respiration. I think 
that [is] this is the immediate cause 
of death generally in these cases- 
Will Bleeding be of any service in 
this disease? It has been said to have 
proved very successful in many cases 
in Germany. It has been most 
fully tried here but it has done no 
good.- I have known opium to 
be given to the amount of 300 grs-
in this disease, yet it has failed of 
producing a cure. 
But little or nothing is Known of 
the real nature of this affection 
There appears to be no organic effect 
produced by it. It has been said 
that the Arachnoid membrane of the 
brain is generally inflamed in this 
disease. I have often sought for this 
appearance with great care, but 
in no instances have I distinctly 

11.
seen it to be the case. The Intestinal 
Canal too has been said to have 
been the Cause of this disease. & we 
are told that Worms will be always 
discovered here. But in all the dissection 
tha. I have had an opportunity 
of making, I have never found 
a single worm. An effect is often 
produced, I believe upon the stomach 
& bowels, by the medicines which 
are given to relieve diseases. & this 
is often mistaken for the disease itself
in our examination after death.
thus many mistakes have arisen is 
Morbid Anatomy.
I have come to the conclusion that 
Tetanus is purely a Nervous affection
& not dependent upon any Organic 
change.- The muscles in this 
disease are commonly found of a 
high red color- This circumstance 

commonly takes place in persons 
who have died suddenly.
The Skin & Cellular membrane [exciting] 
the [penates] of the abdomen, above  
the abdominal ring are quite 
loose & yielding, but directly over, 
& a little below it, & over the situation
of femoral hernia, they are 
much more dense & unyielding.- 
This may seem to be a remark, too
unimportant to make, but however 
so in health, it is not so in 
disease. In consequence of this difference
of structure we find that the 
instrument we have invented to [cure]
artificial anus, for the prevention 
of the escape of the fæces, the it answers 
the purpose very well in. In   

13
Inguinal, will be of no use in femoral
hernia. Sufficient of the parietes
cannot be taken up to effect 
it.- We have failed repeatedly.
Mons. Dr. shew us two patients 
[upon] whom he had cut for the Stone 
by the new method of making an 
incision opposite the rapha of the 
perineum. They had recovered 
without any unfavorable symptoms 
& cause perfectly well.   

Fracture of the Neck of the 
Thigh-bone. 
This should never be left to stuff 
from an idea that it will not heal 
With regard to the treatment, however 
I am decidedly opposed to 
that recommended by Depault 
for the following reasons. In the 
first place, it gives a great deal of 
pain to the patient, so much that 
you find few who can bear it. The 
constant & forcible extension which 
you are obliged to keeps up, causes 
excessive uneasiness in the parts which 
are pressed upon the groin & ancles: & 
often ulceration with great œdema
of the foot & thigh come on attended 
with vesications. So that after trying 
it for a few days, we are obliged 
to remove it on account of these symptoms,
& often giving the patient a 

15.
great deal of unnecessary pain, 
we are obliged to leave him just 
where we found him.- Another reason 
why I do not like this treatment,
is that the Muscles are not put by
it in the most favorable state of relaxation.
It is the counter-action of 
these powers, that constitutes one of 
the great difficulties in Keeping the 
fractured ends of the bone in opposition.
& according to Depaults plan
they all put upon the stretch.-   

Previous to the performance of 
amputations, when they are required
in consequence of old ulcers, or 
other diseases from which there has 
been a considerable discharge, they 
are in the practice in the Hotel [Diced]
of making an issue in the arm 
This is done upon the principle that 
it is dangerous to put a stop to habitual 
discharges, & that it removes one 
cause of danger in an operation 
which is never performed without 
some degree of uncertainty.
On examining the Kidnies & bladder  
of a man who died a few days 
age from a violent Hematuria,
Mr. D. observed the former to be of a 
deep purple color, & that they gave 
forth a sanguinolent discharge similar  

17.
similar to that which had issued from
the bladder. The Funders of the bladder 
was full of this fluid [ matter] mixed 
with a purulent matter it internal 
membrane highly vascular with 
numerous little sechymores over its 
whole surface, the bladder itself was
enormously distended & the its substance 
thickened, so that it looked very much 
like the uterus two or three days after 
delivery before it has contracted 
upon itself. It was of a deep 
violet colour & rough. The prostate 
gland was similarly diseased. 
This man was so much reduced 
by his disease when he entered the 
hospital, that no bleeding was thought 
advisable & he was left to take 
his fate. Mr. D. supposed the 
hematuria, the consequence of a high  

degree of inflammation of the bladder. 
There are cases in which there is 
little or nothing to be done & the patient 
generally, sinks under his disease.
P.C. has been treated for a burn 
which to received some months of 
by falling against a hot iron bar in 
a fire place. His leg was burnt upon 
the whole surface opposite the [ tibia]
fibula. It has been doing well till now 
when it has suddenly assumed a very unfavorable 
appearance. Instead of a healthy 
discharge of free, it has become sinuous
ishorous & excessively fated. From its   
percent appearance, these is reason to 
apprehend hospital gangrene 
We have ordered the application immediately 
of the Acid. Muriat Oxym. 
to it surface & the same remedy to be 

19
taken internally. We shall see the 
result of this which has been highly recommended, 
& if it does not produce  
the desired effect, we shall use the actual 
Cautery, which we generally employs 
to advantage in these cases. 
It may perhaps seem curious to some 
of you, that the hot iron should be 
employed to a sore, resetting from a 
burn, but you are to recollect that 
in the present situation, it is of a nature 
entirely different from those accidents 
& therefore must be treated accordingly.
The patient has been taking water 
mixed with the acids, till it was rendered
sour, & applying the same to 
the sore, & we have the pleasure of telling 
you that it has taken on an appearance 
altogether different. The granulations

instead of the grayish sluggish
unhealthy appearance, which they 
presented the other day, are now 
red & quite healthy, & the discharge is 
more bland & mild, & the patient appears 
to be doing well. The actual 
cautery is considered the best remedy 
for the hospital gangrene, but we 
hesitated in applying it in this case, 
because we feared that being applied 
so near to the fibula, it might cause 
necrosis, & retard to an alarming degree 
the cure of the patient, already very 
prolonged, he [now] having been nearly 
a year under our case.
We are in the habit of placing all
our fractures of the Limb in the 
straight position, & upon the whole 
after trying both, we think it preferable.
One of the reason why we do 

21
it, is that when it is left in the 
hint position, the arch of the bone 
is very apt to be increased, which 
occasions much shortening to the 
limb & much inconvenience to the 
patient afterwards.- The apparel 
should be removed as after as once 
in two days for the purpose of examining 
its condition, & this should 
be done in as delicate a manner
as possible, so as not to interfere
with the progress of the callus 
Mr Brodie, in speaking of dislocations
of the Shoulder-joint, remarks 
that not unfrequently, the 
head of the bone rest upon the 
Axillary plexus, [of] or rather the Nerves 
coming off from this, so as to paralyze 
the arm. He thinks too, that 

in a few cases, the Humeral nerve 
which goes to supply the Deltoid
muscle is ruptured. He was led to 
this conclusion from the circumstance 
of patients applying to the hospital 
for relief after dislocations of the shoulder,
which was supposed to have been 
badly managed. The deltoid muscle 
had in these case completely lost its power.
& was much lessened in bulk-
Nothing can be done in this condition of 
the part to restored its functions.- 
He relates too the Story of a poor man
who applied at the Infirmary with 
dislocation of the Lower-jaw of two 
months standing. This patient had applied 
to some surgeon “not much conversant 
in these accidents” who told him 
that it was Lock, jaw, & gave him 
some Mercurial ointment to rub in .

23.
The man was Kept in the hospital 
to watch the progress of his disease 
no attempt was made at reduction 
In a few weeks, it was evident, that 
the lower jaw was a little approximated 
to the upper, & in a few months 
the patient could nearly be being his incisores 
together, but the lower projected 
some distance beyond the upper, 
so as to present the appearance of what 
is termed, “under-jawed.”
Mr. Charles Bell cautions the Student 
against the practice of modern Surgeons
who [are] recommend when a piece of 
Scalp is torn off from the Skull & 
much [luirrated], to return it & attempt 
to unite it by adhesion. He thinks 
there is much danger in confiding too
far in this principle of adhesion & 

remarks, that after the margin of the 
wound has united, & the patient appears 
doing very well, matter will 
form very frequently under the flap 
after 10 or 14 days, & if this is neglected, it 
may produce very untoward symptoms.
as soon as this is discovered, it 
should be let out by a free incision
This is much more apt to happen when 
the scalps [ patient] has perhaps been torn off 
by the wheel of a carriage. & is Kneaded 
with the dirt, there is no chance 
at all of adhesion in these cases. 
Sometimes, the Scalp is carried off 
by the clean cut of a salve & a piece 
of bone is carried with it. Surgeons 
have in general advised, that the Scalps
be immediately replaced with the piece 
of bone, but Mr. B. is of opinion 
that it is far preferable to remove this 
portion of bone, or the scalp itself is 




25.
more apt to unite than the bone.  
Simple Contusion of the scalp [ skull] may 
be mistaken for fracture of the Skulls 
if the Surgeon is not very guarded in 
his examination. The scalp being every 
where convex, the part which immediately 
receives the blow, must be more 
injured than the surrounding portion. 
The Surgeon, feeling from the circumference, 
finds the scalp to swell & become 
firmer, till he approaches the centre, when
it becomes suddenly soft & fluid- 
This hardened circumference & softest centre 
has very much the fell of depression 
of the Skull.- 
In Punctured wounds of the Scalp, 
as with a bayonet, small record &c altho’ 
the mark of injury is scarcely apparent  
on the external table of the Skull,
Mr. B. imagine, that the inner table 
is broken & splintered, similar to a piece  

of glass when stuck by the same 
body, the operation of the trephine is 
frequently required in this accident.
Mr. B. beautifully illustrates the 
fact low small bodies moving with 
great velocity, as the blow of a hammer 
&c produce greater local injury & fracture 
than [ hard] large bodies moving with slower 
velocity, which cause more general commotion,
& an extensive fissure. Hence it 
is that the body falling to the ground 
which has comparatively a small velocity 
is more   

27.
Artificial Anus 
In [A] Cases of artificial anus the 
inferior portion of intestine ceasing 
to perform its natural functions, is no
larger of its usual dimensions- but 
it becomes contracted sometimes to one 
fourth its common size, at other to 
even to one half. By this means the 
experimentation, matter is turned from 
its ordinary channel, & is made to escape 
externally. Nature is frequently 
capable of effecting a cure of this disease;
she establishes by degrees a passage 
downwards for the descent of the fœcal
matter, till at length it ceases to flow
by the unnatural opening altogether.
She then closes the external wormed, &  
thus effect a natural Cure. Then have 
been many instance of this, but it 

is not, however very common; & it 
becomes our duty therefore to see what 
assistance Art is capable of giving her. 
Now, what are the Indications to be 
fulfilled in the Cure of this Complaint
There are evidently fever, & there are any 
distinct. The one must be effected, before 
the other can be attempted. The 
first, is, to establish some means, by 
which the fæces can find thin passage 
downwards, & after this is effected, the 
second equally important object, is to 
close up the external opening.
In some cases of artificial ones, the 
walls of the upper & lower intestine 
closely adhere side to side, & we have 
thought that by dividing there, a communication
between the two might 
be established, & is the abstracting cause 
to the decent of the fæces, destroyed. 

29
We attempted this at first by a cutting 
instrument, as a pair of Suparis
but as this may occasion an extravasation
of the fæces into the cavity 
of the abdomen & thus prodeaufal peritoneal 
inflammation, it was deemed 
a dangerous practice. This was tried 
in a patient lately, who was desirous
it should be done, & the care terminated 
fatally from this cause.- 
This could not therefore be repeated & 
gave rise to the necessity of adopting 
some other mode of establishing this 
connection, between the two portions 
of intestine, by which this danger 
might be avoided, & the following 
suggested itself to me. I thought, 
if I could cause a gradual mortification 
of the part, the surrounding 
inflammation would close the sides, 
before it separated, & there would be 

no danger of extravasation, & this is the 
Instrument which I employed for the 
purpose.-
It consists of two thin pieces of Steel, 
united like a pain of other forceps, in 
the centre, by a moveable pin. The lower 
Blades which come in contact were 
serrated, so as to make them retain 
their hold upon the bowel without 
danger of slipping off, & yet not to injure 
too quickly the parts contained in them. 
At the handles of this forceps was affixed 
a screw, by which just such a degree 
of compassion could [m] be made as 
was judged necessary.
This instrument is to be introduced 
& applied in the following manner. 
You are to carry one blade of it in 
the upper intestine, & the other in the 
lower- The blades are then to be turned 
gently upon thin axis, & the degree 
of resistance will joint out, whether 

31. 
they are both in the same portion 
of intestine or not. If they are, they 
will move round very freely, but 
if not, they will only perform a
small part of a circle. The Counterpoint
should then be introduce & the two 
blades untied- & compression is to 
be made, as much as is requisite for 
your purpose, by turning the snew 
at the handle. 
The instrument must be left in 
this situation, until it falls off- & this 
happens about the eighth day- In 
six different cases, it accused exactly
at this time- 
It becomes a question to what extent 
may the Intestine be in this manner 
destroyed? In the first case, I was
a little fearful of the consequences, 
& only applied it one inch. In the  
second, I became bolder, & applied 

it an inch & an half. In the third 
still more confident, I took up two 
inches, in the fourth three, & so on 
even to four inches. And in all these 
cases, the communication downward
was completely established.
This is our first Indication fulfilled,
& the second only remains, that of closing 
the external wound, & thereby relieving 
the patient from the necessity 
of wearing a bandage, which under many 
circumstances is extremely inconvenient,
& at all times, unpleasant. 
But this, however easy it may 
seem, we have found much the most 
difficult to effect. We have kept the 
wound closed firmly, week after week,
& month after month, during which 
time, nothing of any sort has escaped, 
yet when we have removed the compresses
& bandage, the wound has been  

33
found disunited, & the matter has 
again flowed from it. Every thing has 
been attempted, that we could think 
of; the worm has been stimulated in 
various ways, the callous edges have 
been entirely removed, & the lips 
brought & kept in close contact, but 
yet without success. I have invented 
an instrument for this purpose, 
which you have an opportunity of 
seeing more applied in one of the patient 
of this hospital. This has been 
Kept on for months together, during 
which time nothing visibly escaped, 
yet when taken off no union had taken 
place. The opening was precisely 
in its former situation. It has baffled 
all our attempts & proved contrary 
to our expectations & hopes, however 
well there seem to have been founded. 
What can be the cause of this obstinacy 

obstinacy, this indisposition to union?
Some have thought, that it depended 
upon the nature of the mucous membrane,
that adhesion was contrary to its 
functions. If this is not the cause, 
we are unable to give any other. 
Being a constantly secreting surface, it 
may be, that the such & matter constantly 
insinuates itself between the edges 
of the wound, & prevents union. But 
we are as yet unable to determine upon 
this point.
Thus, then, it remains to ascertain 
some mode by which our second indication 
is to be fulfilled. Unfortunately, 
we have not as yet, found any. But 
with regard to the first, we are satisfied 
entirely- we know that in eight 
days we can establish a communication 
between the upper & lower bowel
& that the faces will find their exit by

35.
the anus. We say, we are satisfied, because 
we have now had six successful 
cases, in which it has been effected to 
our entire satisfaction. Not that it 
may sometime fail, as do the means 
which are most successful generally 
in all disease. But it has not yet 
failed, & probability is entirely in its 
favor. 
Now if we can find any way, equally 
successful, of fulfilling the second indication,  
we could state a fixed time, 
in which this most cruel of all diseases,
may be cured. But this must 
be the result of future experiment.



Decr. 1. A patient came into the 
Sall Dr. Bernard last night having 
in consequence of a fall from a great 
height fractured his. When 
he came in, he was exceedingly pale
almost like a escapes- without pulse 
& almost deprived of the power of voice 
& excessively debilitated. To what were 
there symptoms to be attributed. Certainly 
not to the fracture. To discover 
if possible their cause, are examined 
his body carefully & found that he complained 
of pain an pressure made 
upon the right hypochondrium. From 
this circumstance, I think it probable 
he fell in some way upon his side 
& thereby occasioned a Rupture of the 
Liver, which is the cause of this pain 
& this extraordinary depression of Vital  
power. Leeches were immediately 
applied & soothing drinks given, with 

very light diet. 
Decr. 3d he is better- the pulse stronger 
but he complains of great pain 
over the Liver- he looks pale & debilitated.
The fatigue produce by his symptom 
may account in some manner 
for this. The great danger to be apprehended 
is Inflammation of the Peritoneum-
We have restricted him to a 
severe diet & ordered diluent drinks 
bleeding leeches & purgative medicines
Docs 4. He is pretty comfortable 
pressure does not occasion pain & his 
general appearance is improved.
he complains of some pain in the 
upper part of his left shoulder. 
7th he is much worse this morning 
the pain in the region of the liver 
has returned with much more violence 
than before, & pressure much 
increases this pain. The abdomen   

is tense- pulse full- & has passed 
a very restless night. This change  
may be owing to his having had visits 
yesterday from numerous of 
his friends, & to his having eaten things 
which they gave him, producing indigestion. 
We have ordered leeches to 
be freely applied to his side, & a large 
bleeding afterwards, if the pain is not 
much diminished. Fomentations- & 
emollient glysters. He vomited a 
large quantity of fluid just before 
we left him to day.- Thus you see 
in this case, what a slight cause 
will after produce much injury. 
Yesterday his vies in a good condition
& to day, he is much worse, indeed 
not entirely free from danger. 
Decr. 9 his situation is considerably
ameliorated- the bleeding have now 
been repeated six times- his pains 

one diminished, the abdomen is 
soft- 
11th some injection have been given 
him; he complains of pain in the 
right side, in consequence of which 
we have bled him- the blood flowed  
with difficulty- There is come fear 
that there is a new effusion of blood 





Of Injection 
Harvey was probably the first 
who used Injections, as they were necessary 
to prove the truth of his deserves
& at that time they were only 
colored fluids. A Dutch Anatomist
afterwards employed tallow, because 
of its being fluid when warm & 
becoming solid on cooling. His art   
he transmitted to Ruysh, who brought
it to a high degree of perfection; but 
a part of it appears to have been lost, 
for he would never communicate 
it even to his pupils. In the beginning 
of the 18th Century, Dr. Nicoll 
introduced this mode of injection in 
to England & made corroded preperations.
This at first not with considerable 
opposition from the supposition 
that the parts were distorted 

distorted I were not shown in a natural
state, 
Preparation may be divided into 
two classes the Wet & Dry. The 
first are immersed in some liquid.
as the Spirits of Wine which is the  
most convenient, & pressures them 
from putrefaction. The Dry are exposed 
to the air, & then varnished which 
preserves them afterwards from insects. 
The Wet have the advantage, but 
both are inadequate, for the spirits 
destroys the natural color & transparency- 
constringes & alters the shape, 
& in the Dry, the parts become hard, 
& their color is also lost.
Injection is a made of preparing, & 
this to be good. must have those two 
requisites. [crossed out] It should be as fluid as 
possible when warm, or when 
thrown into the vessel, I become  

solid there, so as to preserve & 
show the form of the vessel, with 
out being brittle.
Various substances have been made 
use of but they may all be divided 
into the Coarse the Fine, & the 
Mercurial injection. The first is 
used only to fill the large vessels. 
The best that I know is about equal
parts of Wax & Resin & Spirits 
of Turpentine to give it a proper
consistence. To Know whether it is 
of proper consistence, drop some of 
it in water & let it harden, then form 
a cylinder about the size of a quill, 
which when cold, should bear its 
own weight, & when struck with 
the finger, shoulder bend, not break 
For the fine, Spirit varnish is used, 
& I sin – glass- but the best is 

as it can always be procured, & is 
of a proper consistence 
There substance should be colored. 
This will depend upon the fancy & 
view of the person. The different sets 
of vessels should be distinguished by different 
colors- the arteries should be 
colored red, the veins yellow.
The Coloring matter should have 
four requisites. It should be bright, 
opaque, light & very finely pulverized.
For red, Vermillion is commonly 
employed, but it is heavy & requires 
great care in mixing, & you 
should lay the part upon that side 
which is intended to be displayed 
Kings yellow is commonly used 
for yellow, but it is not any bright 
Verdita is cried for Blue, but 
this asst to diploid in the spirit 
& on this account objectionable. 

Prussian blue is preferable. For 
Green, verdigris is the coloring 
matter, but it is apt to turn dark 
by age- it should therefore at first 
be made light, as a grass green.
The Black color is made by the 
Lamp- black or Ivory black. The 
White by flake – white, but it is difficult 
to procure this unadulterated 
& it is apt to turn black from the 
animal fluids acting upon it. 
The other ingredients too should be colorless, 
the resin white & the virgin
wax.
You should be careful in mixing 
them to add the coloring matter 
cautiously, & avoid its boiling over 
Stir it about well so as to get it 
equally diffused, & be careful to avoid 
its running into lumps.- 
do not expose it to too great heat- 
nor should it be thrown into the 

vessels too hot as it would injure
them. It is thrown in by a 
Syringe having a piston rod with 
a double value, & these should be accurately 
adapted to the barrel of the 
syringe. A stop cock should be adapted 
to the nozzle, & cocks of various 
sizes should be made to fit upon
this. Previous to injecting, a pipe
should be filled in the mouth of the 
vessels & tied there. The part should 
be properly heated, & this is a very 
essential circumstance. It is done 
by immersing it in water for some 
time, rather hotter than the hand can
bear. 
At first you should depress the piston 
rod rather suddenly, so as to fill 
the large vessels, & then continue the 
force rather gradually, when some 
resistance is afforded by the small  

vessels. When the resistance is complete,
with draw the Syringe.
It is well to be provided with an 
Injection, which may be used with 
out heat: for this purpose, Red had 
& linseed oil, mixed up to the consistence 
of common paint, & then 
brought down to the consistence of 
oil by turpentine varnish is a very
good one. Quicksilver is also 
used. It is bright opaque & fluid, 
& capable too of very minute division
It is used therefore for excretory ducts 
as of the tastes & breasts, & also for the 
absorbents, but it remains fluid,
& if an opening is made into the 
vessel, it will all escape from its 
great specific gravity, & it is apt
to rupture the vessels. For employing 
this, there is a glass tube, with 

a steel nozzle & stop cock, but 
the best instrument is a barometer
tube, melted in a spirit lamp- 
the point drawn out at right angles,
& then broken; & the side of the 
absorbent is to be pierced with this. 
Dry Preparations are to preserved 
large portions of the body in Situ
as the hollow parts, & membrane 
& large vessels. For this purpose, a 
subject is best, & it should be 
young, else the interstices between the 
muscles, will be filled with fat; & a 
male is preferable to a female, on this 
account, & the vessels are large. Trace
the vessels with as much quickness  
as possible, there is not any need of 
taking off the cellular membrane 
very closely as then you might cut 
the vessels, & the injection would exude 

exude in warm weather. The [vessels]
muscles should be raised up in order to 
admit air under them, & it is then 
to be hung up in a current of air, 
& watched to see, if the parts dry in 
a proper position. If during the 
warm weather, maggots should get 
into it, they may be destroyed by 
pouring on a little Spirits of turpentine.- 
Preparations in drying, are 
sometimes covered with a white 
greazy substance, which may be removed 
by an alkaline wash. 
When dry, it should be varnished,
to preserve it from the atmosphere 
& from insects: for this purpose, 
the white & brown spirit varnish
is used. If the part preserved 
be hollow, it should be distended, & 
if the outlets be easily secured, nothing 
is better than air, but if the parts are 

bulky & thick, curled hair, previously 
oiled to prevent its sticking is the 
best. A very small cavity may be 
filled with quicksilver, which is to 
be let out by a puncture where 
dried.
Thin & membranous parts should be 
stretched out & dried upon paper.
Corroded Preparations were first 
introduced by Dr. Nicolls they are only 
models of the vessels of the part.
The vessels are to be filled with [worse] 
injection, & it is well that it should not 
run too minutely, else the distinctness 
of the vessels is destroyed. The part 
should be placed in three parts of muriatic 
acid & one of water & handled 
very carefully, for if the wax be broken,
[th] your preparation falls to pieces. 
This liquor dissolves all but the injection,
& forms a soft pulpy mass.  

In from 3 to 6 weeks, it should be 
removed from this, & place under 
a stream of water, & then immerses 
in acid again. This should be 
repeated several times. When there 
is only the model of the vessels left, 
it should be covered with varnish,
& as it will not bear the prepare
of the brush this should be poured 
over it.
Wet Preparations are made to 
preserve the natural appearance 
of parts, & they are immersed in 
Spirits of Wine.- They should 
first be [evacuated] mace in water, & this 
should be changed daily, till it ceases 
to color the water, else this will 
color the [we] spirits. When it is 
free of color, remove all the cellular 
membrane, & parts, excepting those 
which are to be displayed. Pass a 
quill or bougie into any openings 

natural or artificial, & then hang
it in a glass immersed in Spirits, 
the proper strength of which should 
be that of proof spirits, or equal 
parts of rectified spirits & water: but 
if the part requires to be hardened as 
a piece of the brain, or is bulky, or 
you wish to preserve its colour, the 
rectified spirits is preferable. In mixing
the Spirits & water, it becomes 
turbid, & therefore, it should not used
at first. It is common to suspend 
the preparation by two small threads
but as they act as capillary syphons,
it is proper to put a piece of whale 
bone across & tie the threads to it.
Some employ a cord, or a glass float. 
A bladder well macerated, should be 
exactly applied over the rim of the 
glass, & then a piece of milled lead 

exactly the size of the opening- 
& then a bladder over this, brought 
over the bulge of the glass, & tied 
with a string around its neck-
When dry, remove the string & cover 
it with varnish or paint.
Sometimes, they are immersed in 
Spirits of turpentine. They are then 
in reality dried preparations, & 
are intended to display vascularity 
A good way of showing the vascularity
of bone, is in this way. Inject  
it- immerse one half in acid 
to remove the earth, dry it, & then 
put it in spirits of turpentine.
Bones from their hardness are 
prepared in a particular way, 
by maceration. The bones of a 
young subject are to be chosen, 
but not too young, else the epiphyses
will come off- nor should  

the subject be too old, as then the 
fat is collected in the Consellated 
structure, & is constantly exuding 
& makes the bones greasy. From 
twenty-five to thirty is the best age 
Remove all the parts, but do not 
Scrape the bone, or this injures them. 
Bore holes in each extremity & with 
a strong wire break down the cancellated 
structure. Put them in water 
& change it daily for a week
or ten days, in order to wash it away 
the blood. They should lay in 
it without being changed from 
three to six months. You know 
readily when it is a proper time 
to talk them out, by the separation 
of the Cartilages of the Joints.
Then clean & bleach them, but do 
not expose them to the rays of the 
Sun.  

The connection of a skeleton 
by wires or articulation requires 
practice & mechanical dexterity,
but it is an excellent way 
to learn the bones.
In the natural Skeleton, the ends 
of the bones are connected by 
their Capsular ligaments, & the 
most important parts are thus 
covered. If you with the separate 
bones of the Head, you should 
have subjects before twenty, the body 
of the Sphenoid bone should not 
be connected by bone to the cuneiform
process of the occipital bone. 
The Skull should be bleached, & the 
best way of separating the bones, 
is by the hand, as thus, you have 
the connections of different 
bones, & are less liable to injure 

the Sutures, as is generally done, 
when peas or beans are employed. 
If you wish bones for immediate 
use, boil them in a solution 
of pearl ash, in the proportion of
five ounces to a gallon, by which 
the grease is destroyed, & you avoid the 
excessive stink of macerating.
It would be well for you to preserve 
everything, that may tend to throw 
light upon the nature of disease, & 
you should, in examining bodies always 
look with this view. In inspecting 
bodies too, it is right to attend 
to the prejudices of the people 
& to decency. Make as few external
incisions as possible thus a 
circular one around the head is sufficient 
to enable & you to examine 
the contents of the Cranium &c &c