BMJ

Manchester Eye HospitalAuthor(s): Mr. WalkerSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 6, No. 137(May 13, 1843), pp. 134-135Published by: BMJStable URL: http://www.jstor.org/stable/25492042 .

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134 CATARACT-OPERATION FOR EXTRACTION.

the abdominal cavity, with the contents strangulated; and as no swelling was perceptible, while the usual

symptoms of strangulation continued, the diagnosis was rendered extremely obscure. The author gives the details of the two cases which occurred in his own practice, and describes minutely the steps of the ope ration which he performed in each. In one case, owing to the deceptive nature of the symptoms, and absence of external tumor, the operation was deferred too long, and the patient died. On examination, the hernial sac was found to occupy a considerable space just within the abdominal parieties, in the vicinity of the internal ring; the fundus lay a little below its level, towards the cavity of the pelvis; while the neck, still contracted, so as obviously to have been the original seat of stricture, was between three and four inches distant from the situation of the ring, and

lay in an upward direction towards the umbilicus. The whole sphacelated contents were empty, col

lapsed, and in a pulpy state. In the second case, the result of the operation was successful. In describing its stages, the author mentions that before the hernial sac could be reached it was necessary to lay open the

inguinal canal by dividing the tendon of the external

oblique muscle. Near the external ring the spermatic cord was seen lying bare, or only covered with a little fat. It was only when the finger was passed through the internal ring (the firm borders of which were dis

tinctly perceptible), and pressed a little more deeply within the abdomen, that a round tense tumor could

be felt, which was found to be the hernial sac. The

internal ring was cut through, and this allowed the sac to be drawn downwards; when it was opened, the

stricture divided, and the bowel returned into the ab domen. The author concludes his paper by adding observations on the propriety, in doubtful cases of

strangulated hernia, of performing an exploring ope ration to ascertain the exact nature of the case. He

points out, at considerable length, the various condi tions of the parts in the inguinal canal, from which,

when taken along with the history of the case, the

surgeon may judge whether the hernial sac, with the bowel strangulated within it, has been forced into the

abdominal cavity, and expresses his opinion that such an operation will not involve the patient in much ad

ditional danger.

MANCHESTER EYE HOSPITAL.

[Practice of Mr. Walker.]

CATARACT-EXTRACTION FROM BOTH EYES.

Thomas Ourid, aged sixty, was admitted a patient of the hospital, November 8, 1842, on account of the

defective condition of his sight. He stated that both

eyes began to fail, in a slight degree, six or seven

years ago, but more especially within the last eighteen months, from which latter period they have continued to get gradually worse. At the time of admission

he was unable to read or to follow his employment that of a smith. His occupation had exposed him

much to the action of large fires. When he looked at

any object he could imperfectly discern it, but could not distinguish colors. At a few yards' distance

every object was obscured by an apparently dense

atmosphere of smoke. On looking at the flame of a

candle it appeared as a circle of light, of a blueish

color, with a light red tinge around the edge, the

diameter appearing to be about eight inches. If he looked at the full moon, there was an appearance, of

seven or eight different moons, without any change of

color. The sun presented a similar' appearance as

did other luminous bodies. He usually observed his

vision to be more distinct in a dull light, as the twi

light. He had never felt pain, or had any inflamma

tion of the eyes, or any headache, but had occasion

ally experienced slight vertigo. His general health was very good; he was rather corpulent in appearance, but very temperate in his habits, and of a pacific dis

position. The eyes presented a generally healthy aspect, but

the arcus senilis was observed around the margin of

the cornea, particularly at its upper portion; the anterior chamber tolerably spacious; the iris healthy, and of a blue color, and the pupil very active. The

crystalline lens was of a dark amber color, the centre

more especially opaque, the outer laminae retaining a certain amount of transparency, and the capsule

perfectly transparent. There was no perceptible difference observable in either eye.

A solution of extract of belladonna, as a collyrium, and a mild purgative pill were prescribed, and, as he could manage to find his way about, he was advised

to wait for some little time, and attend occasionally for examination.

Jan. 10, 1843. Nothing particular had occurred until this date, when the right eye was found to be

suffering under a slight attack of iritis, which the

patient attributed to exposure to wet. The pupil was much contracted, and of a cloudy appearance, the surface of the iris rather dim and discolored, and

there was some congestion of the sclerotic vessels; vision was also much worse in this eye. A blister was ordered to be applied to the right temple, and to be kept discharging with the cantharides ointment; ten grains of blue pill to be taken night and morning;

and the continued use of the solution of extract of belladonna to the eye.

24. The right eye had now returned to the condi

tion it was in previous to the attack of iritis, vision

not being materially worse than before. March 24. He had experienced no irritation in

either eye since last report, but the vision of both was

found to be considerably diminished. He was very

desirous that something should now be done with a

view to the improvement of sight; it was accordingly determined to admit him as an in-patient, and to per form the necessary operation.

April 1. He was admitted into the house on the

28th ultimo, since when he had been cupped at the

nape of the neck, had taken several doses of purgative

medicine, and restricted to a spare diet. Some extract

of belladonna had been applied to the eyes, and the

pupils were consequently well dilated. Having been removed to the operating room, he was placed on a

sofa with the head somewhat elevated. The operator

sat at the head of the patient, so as to command the

upper eyelids, the operation determined on being that of extraction through the upper margin of the

cornea. The left eye was the first selected, the

double-edged cataract-knife being passed rapidly

through the anterior chamber, and snade to cut out

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DR. MARTIN BARRY ON THE DEVELOPMENT OF THE BLOOD CORPUSCLES. 135

directly upwards, so as to make an opening just round the superior border of the cornea. 'No sooner was

the incision completed, which was instantaneously effected, than the opaque crystalline escaped, and that without any pressure or any attempt to puncture the capsule having been made. A rather free dis charge of vitreous humor accompanied the escape of the cataract. Strips of adhesive plaster were there fore applied to the eyelids before proceeding to the operation on the other eye. The same operation was

then performed on the right eye with precisely the same result, the lens immediately following the knife, and there being a still freer discharge of vitreous humor. Plaster strips were then applied to the eye lids. A draught, containing forty drops of laudanum,

was given immediately, and another with thirty drops ordered to be repeated at bed time. He was after

wards carefully removed to bed. 2. Had slept well during the night, not having ex

perienced much pain. The external appearance of the eyes was favorable, and the dressings were there fore not removed. The anodyne ordered to be repeated at bed-time.

3. The plasters were this morning removed, the conjunctiva of both eyes was very vascular, but the

cornea perfectly clean; the patient had a very vivid perception of light and not much pain, but the eyes were very watery. Repeat the draughts at night.

4. Much the same as yesterday, and could distin

guish surrounding objects with both eyes. Plaster dressing to be continued, and to take a purgative pill to-night.

7. Going on favorably; complained of some irrita tion on exposure to light, but of very little pain; the conjunctiva continued very vascular, but the cornea

was perfectly transparent in each eye. The plasters were ordered to be discontinued, and, instead, to

apply a thin fold of linen, dipped in warm water, to

the surface of the palpebrae; a purgative pill to be

taken occasionally. 13. Considerable irritation was still experienced in

both eyes, the conjunctiva continuing very vascular, but the cornea quite clear. On closely examining the eyes, the wound of the cornea of the left appeared

quite smooth and completely cicatrised, whilst that of

the right was somewhat irregular and appeared to

be healing by granulation. Vision was improving, and he could bear exposure to light rather better; his general health was not much impaired, and the

bowels had been kept free. A blister was ordered to

the nape of the neck, to be kept open for a few days, and the warm water bath to be used frequently to

the eyes. 22. The vascularity was now materially diminished;

the lachrymation, intolerance of light, and other symp toms of irritation abated; vision improved; and, on

the whole, the patient considered to be going on ex ceedingly well.

May 2. The eyes had now so far recovered from

the effects of the operation that it was not deemed

necessary to detain him any longer in the house; he

accordingly returned home, having regained excellent vision, and being able, with optical aid, to read with

facility. The details here given clearly prove that the ex

pulsion of the lens immediately after the completion

of the incision, even when followed by a rather copious discharge of vitreous humor, is not necessarily followed

by any unpleasant result, since nothing could be more favorable than the progress and termination of this case.

OBSERVATIONS ON THE MICRoscorIC CHARACTERS AND MANNER OF

DEVELOPMENT OF THE BLOOD CORPUSCLES.

By Dr. MARTIN BARRY.

Dr. Martin Barry, in a paper read before the Royal Society, has thus described the development of the blood corpuscle:-" 1. The mammiferous blood cor

puscle, like one of the cells of the ovum, is at first a

disc, or what is now called a ' cytoblast '-i. e., a cell

germ. It is now a flattened vesicle or cell; like other cells or cytoblasts, however, it may and does become a cell, but then it is no longer flat. In the

blood disc you see a cchtral, colorless, concave portion, around which lies the red coloring matter.

2. As usually met with the blood disc is round, with the exception of the two or three instances, in

which, from the observations of Mandl in France, and Gulliver in this country, it has been discovered to be

elliptical. I have since found that even in mammals,

where the blood disc is usually met with round, its

originalform is elliptical. I have seen this to be the

original form of the blood disc in man.

3. The discs first become round, continuing flat; subsequently, they pass into an orange shape; and, lastly, become globules. They also very much in crease in size.

4. Along with these alterations in the form and

size of the blood discs, there takes place another

change; instead of a mere concavity, there is now seen a colorless, pellucid, semifluid substance, which, as the corpuscle becomes orange-shaped, is found to

be, not in the centre, but on one side. It is the

nucleus of the corpuscle, the corpuscle itself having become a cell. This pellucid substance, or nucleus,

divides into and gives off globules. Each globule, appropriating to itself new matter, becomes a disc;

and each disc, undergoing changes like the first, gives

origin to other discs, a group of which constitutes the

colorless corpuscle of the blood, for with the changes

now mentioned the red coloring matter is consumed.

Thus, as the red pass into the colorless corpuscles,

there must exist all intermediate stages; between

them no line of distinction can be drawn.*

5. The corpuscles of the blood are propagated by

means of parent cells-a parent cell has its origin in

a colorless corpuscle, this colorless corpuscle being an

altered disc. As the parent cell is forming, the new

discs within it gradually become red, and are at

* The colorless corpuscles in other vertebrata, for instance, the batrachians, being much smaller than their red corpus

cles, cannot be these red corpuscles in an altered state, nor

is any such change to be expected here. The red corpuscles

usually seen circulating in these animals are not, as in mamma

lia, discs, but nucleated cells. Some of these nucleated cells, however, give origin to discs, having very much the same

form, size, and general appearance as the blood discs of the

mammalia. In the frog I saw such discs passing into the

state of colorless globules, which, acted on by acetic acid,

presented just the same appearance as the colorless corpus cles of the human subject."

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