Treatment of the Diseases of the Eye, by Means of Prussic Acid Vapour, and Other Medicinal Agents

CHAPTER II.. Action of Essential Oils, &c. 67

Action of Essential Oils, &c. 67

Formulæ ib.

Amaurosis 75

A. Cruikshanks, Esq.'s letters 83

Dr. Kent's letter 86

INTRODUCTION.

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

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

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

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

ACTION OF HYDROCYANIC ACID, &c.

UPON

THE EYE.

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

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

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

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

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

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

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

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

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

The Medical Gazette and the Lancet gave insertion to the following statement of mine, of date Oct. 20, 1842.

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

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

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

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

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

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

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

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

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