LECTURES ON THE ANATOMY, PHYSIOLOGY, AND DISEASES OF THE EYE.

LECTURES

Of the latter, those, air, suffer’ most; for instance, those of the nose, cous

membranes.

most

exposed

to the external

lungs, and eyes.

There is also a particular disease in such parts of the in their structure ; as are ANATOMY, PHYSIOLOGY, AND DISEASES the)is frequently, in such indiviOF THE EYE. duals, a thickening and tumefaction about the nose and upper lip, and in the glands BY MR. LAWRENCE. of the lids. The mucous membranes ot these individuals are easily disturbed; London Ophthalmic Infirmary, Moorfields. those ot the alin.entarycanalare deranged by slight er.ors of diet, in quantity or quality, or by trifling causes, which would LECTURE XIV. produce no effect on other persons, or at least would not materially derange the functions of the stomach and bowels. Strumous or Scrofulous Ophthalmia. When these organs are disturbed in their functions, the whole nutrition of the Gentlemen, Strumous or scrofulous ophthalmia is an body becomes more or less impaired. We external inflammation of the eye, exhibit- observe a general want of energy, a paleing certain modifications in its symptoms, ness, and a disposition to coldness in the progress, and consequences, derivable skin in such persons, and a flaccidity in from peculiarities of constitution in the the mnscular fibres generally. The vitat individuals whom it affects, and requiring processes in general, and the functions of corresponding modifications in treatment. the nervous system in particular, go on We might say, that scrofulous ophthalmia languidly. There is another description is inflammation of the eye, occurring in of individuals who display a greater destrumous subjects. Now we know that gree of nervous initability ; slight exterthere are great natural diversities of or-- nal agents act on them with greater ganization, and consequently great varie- force. They have very thin skin, and the ties in the dispositions to disease in the cutaneous veins appear through it. These human race; we find, indeed, that almost peculiarities are seen from infancy ; and every individual has something peculiar to therefore we ascribe them to original conhirnselt: We cannot, therefore, in mak- figuration; and further consider, that they ing our observations on diseases, and on are transmitted from parents to children. the effects of remedies, fail to admit that ; A similar disposition to disease may be there is something peculiar in the con,,4ti- also acquired : the crowding together of tutions of different individuals. If man- numerous persons in confined dwellings, kind were all alike, the business of the the unwholesome air of large towns, and physician and surgeon wonld be much the want of domestic comforts are the most powerful agents in producing such more simple than it is. There are certain congenital peculi- effects. Their injurious influence is pararities of organization, the assemblage of ticularlv observable on the health of chilwhich is denoted by the phrase " stru- dren in the poorer classes of cities, where mous constitution." Some individuals are large families not only live in small houses, subject to certain forms of disease, which but even in single rooms; where they are come on so easily and retB1111 so readily, hadly clothed and fed, and where there that it is almost impossible to prevent is great inattention to personal cleanlitheir occurrence. We see disposition to ness. A state of constitution is produced, disease in ceitain structures, as in the by the combined influence of such ch". absorbent glands, the lungs, and the mu- cumstances, not distinguishable from that ON THE

to disposition body

hence

[No.135.

glandular

[ April. 1826.]

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hereditary disposition to disease before character, originally seated in the conand it is particularly evidenced junctiva, often affecting the sclerotic coat in an unhealthy condition of the alimencornea, seldom going deeper, but octary carat and skiu, and in a conseqnent- casionally extending even to the iris. Jy vitiated condition of the whole frame. SJjmptoms.-There is increased redness

and

described;

man-

The circumstances I have mentioned of the eye, and that redness is partial, in patches ; the distended vessels are in exhibited in the most striking in the earlier periods of life. The fasciculi, which rnn toward the cornea, changes which occur at puberty, render and extend over its margin, or stop short the body less susceptible of disease, or at the boundary between it and the scleat least of those forms called strumous, rotica. Where the fasciculi terminate, so that the latter are seldom seen after you will generally see little pustules prothat period. Again, strumous disease is duced. There is great intolerance of light ; not seen in the earliest periods oflite. It light is very painful to the organ, and the is very unusual to observe any form of uneasiness produced by its presence is it in the infant. Perhaps this is owing carried to an extreme degree, so as to to the kind of food which is prepared for constitute a distinguishing symptom of the infant by nature, and which agrees the complaint. The lids are spasmodivery well with its organization, supply- cally closed, and a most powerful coning the matedals from which the body is traction of the orbicularis palpebrarum built up, without producing any derange- offers an effectual obstacle to any attempt ment in the functions ot’ the organs; opening them. If they are forced moreover, most of the exciting causes of open, the cornea is turned np under the disease are absent. During the period edge of the orbit, away from the light. from the end of suckling to puberty, the The f-pastoodic action of the orbicularis various processes of nutrition and growth excited by exposure to light, causes ac. are going on with great activity, and then tna) pressure on the eye, and makes the if any cause interfere with them, disease child scream with pain. This action of is readily produced. Afterwards, the the orbicularis makes the lids look as if circulating and absorbing systems are not they were swollen, but they are act so. Hence we shall ex- The child makes an effort to protect the so actively at work. pect to find strumous ophthalmia almost organ from the painful impression of light, confined to young subjects ; but among contracts the brows, and draws up the them it is very frequent. Beer states, alae of the nose, and puts into action all that at Vienna, of one hundred children the muscles of the face. Hence arises a affected with inflammation of the eye, peculiar and characteristic physiognomy ninety had that form called scrofulous. of the disease, so that you can easily deA more recent German writer on this sub. termine its nature on the first sight of the ject says, that Beer’s statement is by no child. The painful impression of light means exaggerated, and that in the town upon the organ in severe cases, is such in which he resided, Breslau, in Silesia, that the child seeks the very darkest corwhich is ill built, and not well ventilated, ner of the room, to escape from the light, the proportion was ninety-five in a hun- and, if in bed, it will turn the face against dred. We might expect that scrofulous the pillow, or hide it under the clothes, ophthalmia would be found a very fre- to accomplish the same purpose. For the quent disease in England, and especially same reason, if brought into the light it in London. It has been supposed, that presses the hand against the eyes and scrofula is a frequent disease in this coun- holds the head down ; great irritation, try ; but it the observations of Professor redness and eruption being often proBenedict of Breslau, and of Beer, be cor- duced upon the forehead and nose by so rect, it appears that such diseases are not doing. This position of the head cannot more numerous here than in other conn- take place without producing a greater tries. The late Dr. Gregory used to re- determination of blood to the affected mark in his !ect)))’e<, that there is not a parts; and the consequence is that the family in Scotland in which traces I disease in the eye is aggravated. This scrofula may not be found. great sensibility of the retina is not the There is a great tendency in strumous result of inflammation, nor is it in a direct individuals to inflammations of the lids proportion to the increased redness, being they take on the form of induration and often excessive where the eye appears thickening, or of hordeolum. The lachry- almost natural ; indeed redness is not mal sac and nasal duct also frequently essential to the disease; but it is a symsuffei- in such habits. These subjects I pathetic or functional affection merely shall not advert to at present, vishing In such cases as I am now describing to now to directyour attention to an external you, there is no immediate disorder whatmflammation of the eye, of a strumous ever of the retina ; the child will be able are ner

at

of

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3

open its eyes, and to see as well as if is difficult to say when the patient is perthere was nothing the matter with them, manently recovered. The affection of the towards dusk, or in the evening. It is a eye often alternates with other sympdisordered sensibility of the retina, de- toms ; the ears become worse, and the pendent on the state of the alimentary eyes get better, or vice versa. These cases are generally accompanied canal. Of the nature of that connexion, or of the mode of influence, we know by a disordered state of the stomach and nothing ; it is called sympathy, but that z, bowels ; and you should endeavour to term does not explain how the plienonie- correct that disordered state, and when The retina, however, is you can do so you will find the tendency non happens. not immediately affected, nor are you to to relapse removed also. If you examine into the condition of the child’s health expect that vision will be impaired. There is a copious flow of tears in scro- minutely, you will find that there is a furred fulous ophthalmia when the affection is tongue, a fetid breath, a tumid or disfirst produced ; the external surface of tended abdomen, and a grinding of the the organ suffers great irritation, the teeth during sleep, with an unnatural, lachrymal gland sympathises with that morbid or depraved kind of appetite. irritation, and the flow of tears is increased The state of the skin is generally unin a very marked way, so that when yon healthy, havinga harsh, dry, or scaly attempt to examine the eve, a quantity of feeling and appearance. acrid hot fluid runs out from between the - Serofutousinnammation of the eye often lids. When the eye is exposed to light, a !.produces very serious consequences, parcopious flow of hot scalding tears takes ticnlarly on the cornea, and it may do so, place; the passage of these into the nose although the external redness may not be excites sneezing, often for several times in a great degree. We are accustomed in succession. These irritating tears pro- to measure the degree of inflammation duce redness of the lids, and excoriate and to judge of its consequences, in other the patpebrse and face. They cause itch- forms of ophthalmia, by the extent of the ing and soreness in the parts upon which exterior redness. but in strumous inflamof the complaint is they fall and aggravate the original com- mation, the plaint ; the child rubs and scratches the very insidious, and we may have changes affected parts, which become very red, of structure produced in the cornea when sore, and pimply. Small yellow (.ustules the symptoms are not of a very marked form on this inflamed skin, and produce kind. The pustules, which I mentioned a discharge which incrusts. The affec- as being formed at the end of the fasciculi tion extends on the forehead, temples, of vessels, often go into ulceration, and and face, the pustules and incrustations this ulceration may extend deeply into the increasing ; in its worst form it is called cornea, and pass through the whole of its crusta lactea, and is the state off skin laminae, so as to occasion prolapsus iridis ; called by Dr. Willan pO1Tigo larvalis, from there may be two or more of such ulcers. its coating like a mask. Now an There is often a dalness of the cornea eruption or this KIUU, commencmg m rne produced by an inte.stitial deposit into lids and spreading over the face and head, its texture. Red vessels extend from the will sometimes extend over the body. conjunctiva and sclerotica over the corThe mucous membrane of the nose is nea, the texture of the eorneal conjuncoften affected ; there is an acrid secre- tiva becoming at the same time thickened tion with excoriation of the nostrils, with and opaque: these changes proceed someswelling and redness of the atae nasi, and times to the extent of making the whole often a very tumid condition of the upper cornea red and opaque, causing the aplip. The ears are red and sore, and often pearance technically called pannus. In excoriated behind; and the absorbent such a great and serious affection of the glands of the neck are frequently swelled. cornea, there will occasionally be produThe symptoms are worse during the ced adhesion of the iris to it ; and as the day ; there is a remission when the sun texture of the cornea is weakened, it may has descended below the horizon. Cfeil- yield to the pressure from within, and be dren, who have hid themselves in the enlarged into the external protuberance dark all day, recover their activity at called staphyloma. These are the disnight and open their eyes without pain. organizing processes effected in the exterThe inflammation of the eye may stid- nal parts of the eye by strumous inflamdenly get better, and will as suddenly re- mation ; and the changes of structure turn. There are often repeated attacks produced by this affection are generally at longer or shorter intervals, and slight limited to the external parts of the organ. exciting causes will renew disorder where Occasionally the effects of strumous inthe disposition is strong. In this way the flammation extend to the sclerotic coat affection lasts for months and years, and it and iris ; but we have seldom an opporB2 to

progress

the face

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4

tunity of observing the first stage of this ral morbid affections are not so clearly change in the iris, on account of the characterised as they expected. If we changes going on in the cornea. When establish a certain number of diseases,

scrofulous ophthalmia has existed a great length of time, or when the patient has had repeated and severe attacks, the sclerotic coat may be so much changed in structure, that the form of the eye may altered ; the coat may yield to the pressure of the contained parts. A greater secretion of the internal humours taking place, the eyeball gradually enlarges, and yon have what is called hydrophthalmia produced. Or you may have the sclerotic coat yielding partially to the pressure exerted on it, and then there will be staphyloma-scleroticse found.

be

many artificial points to be but all torms of disease are arranged under the heads which we have selecced; we find that there is an insensible gradation between the forms of disease upon which we have chosen to descant. There is such an insensible gradation from one to the other,

we

set np so

to ; attended not to be

that we cannot draw a precise boundary between strumous and common ophthaimia. Nature has not made those nosological distinctions which we find in books ; they are the mere products of the ingenuity of men. There is a troublesome inflammation, occurring in the eyes of which appears to be referrible Diagnosis.-Strumous ophthalmia is children, of the skin, stomach, and distingnished by the characters I have to the state which does not present all the and bowels, the intolerance of mentioned; by light combined with trifling external redness characters I have mentioned as belonging and copious lachrymal secretion. These to the strumous affection just described. the symptoms of symptoms frequently co existing with the You will find more ofmore external redother marks of strumous inflammation in common inflammation; the lips, the nostrils, behind the ears, and ness ; not so much intolerance of light; in the glandular structuras in other parts nor so many marks of strumous disposition of the body, form altogether so well in the system. In severe cases of highly strumous children, you will have marked an affection, that you cannot con- delicate intolerance of light without any other found it with others. symptom, and you wifl find that this has Prognosis.-The prognosis is favourable sometimes received a distinct name, so long as the cornea remains ctear. It having been called photophobia scrofulosa, is favourable if the cornea should be or the scrofulous intolerance of light. opaque, provided the opacity be only Between this simple intolerance on one superficial, or if it appear to be owing to hand, and acute external inflammation deposition between the laminae of the with general and vivid redness on the cornea, for you may, by suitable treatment, other, there is every possible intermedigenerally succeed in removing it. Ulce- ate shade. In infants, who are the subration leaves behind a permanent opacity. jects of crusta lactea, the eye suffers which very seriously injures vision when sometimes from the extension of the cttit is opposite to the pupil. Should it be taneous affection. These various affecattended with prolapsus iridis, the conse- tions in.children may be considered howquences are worse, but much depends on.. ever, in point of pathology and treatment, the position and extent of the protrusion. as coming under the head of strumons The cornea, when vascular, and it often ophthalmia. becomes vascular when the affection is Causes.-Besides the circumstances to neglected, may generally be restored to its natural smoothness and transparency. which I have already directed yonr atIf several ulcers have formed on the cor- tention, as predisposing to this affection ; nea and have extended deeply, if it should besides the constitutional tendency to the have become generally opaque, and if there complaint, and the unhealthy condition of be also affection of the iris or change of the digestive organs and skin arising out structure in the sclerotica, the prospect of that tendency, you will observe the unfavourable influence of all those exteris most unfavom able. In describing diseases, we find it ne- nal circumstances which are capable of cessary to select the most prominent cases exciting ordinary inflammation iii other for our purpose ; we turn our attention to infants. Exposure to cold and met fathe instances in which the characters of the vours the occurrence of strumous affecdisease are best marked. We do not find tions generally, and not less so that of diseases occurring exactiy as they are sci-oftilotis ophthalmia. Hence children described in books and lectures ; and they, suffer much, especially when insufficiently who are only acquainted with them as clotherl, from cold East and North winds, they are pictured in books, discover, when and from sudden changes in the weather. they have to examine the sick, that seve- The disposition to strumous inflammation

5

should be given, must also be attended toChildren of strumous habit should by no means be condemned to low or vegetable diet; they should have plain but wholesome and nutritious food, such as meat, milk, eggs, bread, and other farinaceous substances. It will be snfficipnt to take meat once a day ; but if febrile exciteTreatment.-The treatment of strumous ment or mnch irritability exists, or if the ophthalmia must be principally directed tongue is foa! and the breath offensive, it to removing that unhealthy condition of should be omitted. When strength is resthe digestive organs and skin, which is so tored, if there is disposition to fulness prominent a feature in the complaint, and of habit, meat should be allowed only consequently to invigorating the constitu- sparingly, or even entirely omitted. Portion. Unless these objects can be accom- ter or wine should be allowed only where plished, means applied to the eye will be there are obvious signs of debility, and of no service. Hence the treatment i.4 here they may supersede medical cordials more general than local. In the first and tonics. Patients should not be perplace the state of the alimentary canal mitted to take food in the intervals of must be attended to. This is generally in meals; and it is particularly necessary such a condition, as to require the use of to attend to this point in the numerous purgatives ; and those of a very active instances where there is unnatural craving kind are often necessary, even in young for food. The condition of the skin should he children. You may begin by giving an active dose of calomel with jalap or rlm- particularly attended to ; the warm bath barb, or calomel followed by castor-oil, has a powerful effect in strengthening the and it may be necessary to repeat these cutaneous circulation, and the increased purgatives two or three times, to be sa- determination to the capillaries of the tisfied that the canal is completely freed skin relieves the affected parts. If warm from the accumulated load of ill-digested bathing cannot be easily procured, let the food and unhealthy secretions. The ad- surface be washed daily with warm water, ministration of two or three such doses with the occasional addition of soap, and often produces the greatest relief to the then well dried by rubbing with a towel ; sufferings of the child. When this has common salt may be added to the water been accomplished, a mild course of al- thus used, to bring it to the strength of terative and aperient medicine? will be sea water. When the strength is in some use’ul; such as calomel and rhubarb in degree restored, the shower or cold bath small doses, every second or third day, may be used. ’the clothing should be It or the hydrarg. c. creta with magnesia or warm, particularly in cold weather. rhubarb, or calomel with antimony. After is absurd to expose weak and delicate the bowels have been evacuated, it is children to the cold, as is commonly done, often advantageous to combine light to- under the idea of invigorating them. Some nics with the aperients ; bark or ealumba of these naturally feeble being!’ must be may be given with rhubarb, two or three treated like exotic plants; we must keep times in the day ; the extract of bark the latter in hot houses, if we wish to may be used. The dilute sulphuric acid save them, and not expose them to all the is a good tonic in these cases ; ten to vicissitudes of our almosphel è, I do not thirty drops may bp given three times a mean to say that they should never be day, in water or infusion of roses sweet- exposed to the air, quite the contrary ; ened with a little sugar. Steel has an but that they should not be so exposed, excellent effect in pallid and languid except when properly protected by suitable subjects; the tinctura ferri ammoniati, clothing ; under this restriction air and and the vinum ferri are the most conve- exercise should never be lost sight or: nient forms ; the latter may be combined Here it may be necessary to consider how with the dilute snlphnric acid, and given far the air of the sea may be beneficial to in the in fusion of roses. Alterative me- strumous children. Undoubtedly the indicines should be continued at the same fluence of the air on the sea coast during time, and a few grains of hydrargyrus i the mild seasons of the year is very adc. creta will very well answer the pur- ; vantageous to such constitutions. But pose ; some rhubarb may be added, when there is an objection arising from the inthe bowels require it. i tolerance of light, which accompanies In cases of this kind, the regulation ofstrumous ophthalmia, and from the mordiet is very necessary, both as regards the bid susceptibility, which often continues quantity and quality of the food ; the after the other symptoms are at an end. number of times in the day in which food The glare of light from the water and the

will be caUed into action by any of those which weaken the constitution; it causes is found frequently to occur after measles, small-pox, hooping cough, scarlet fever, in short after the operation of any causes which have produced a temporary of the system.

debility

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sand is very offensive to the eyes so long opii sedativus the best form. Half a this unnatural sensibility continues ; drachm or a drachm may be added to an consequently a healthy inland situation is ounce of rose water for a wash, to be used preferable to the coast under those cir- tepid. Two or three drops may be allowed cumstances. When, however, this parti- to pass between the lids. cular source of inconvenience is gone by, Blisters, after the necessary evacuathere can be no doubt that the air of the tions, are very serviceable in cases of strnmous ophthalmia ; they will often give sea is very advantageous. When the constitutional disturbance is decided relief to the photophobia, or the considerable, and the local disease ac- intolerance of light; they should be aptive,-when the changes of structure al- plied to the back of the neck, or behind ready described are going on in the cor- the ears. It is necessary to be cautious nea, and that part is becoming vascular in the use of blisters, especially in young and opaque, you must have recourse to subjects. I have often seen them irritate mercury, and that pretty decidedly, after the skin of children very much, and I you have thoroughly evacuated the bow- may mention that I have seen severe inels. Calomel combined with James’s or flammation and ulceration produced by Dover’s powder will answer the purpose ; them, and even fatal mortification. I a grain of the former may be combined never think of applying blisters until the with two grains of either of the latter, bowels have been well cleared of their and given once, twice, or thrice a day. contents ; and I am not inclined to keep The hvdrargyrus cnm creta may be em- them open. It is a proper precaution to ployed in the dose of four or five grains. limit their application to six or eight These means must be repeated and con- hours; a blister in six hours will genetinued according to circumstances ; they rally produce inflammation enough for must be persevered in until the disorga- the purpose. The German writers have nising processes are checked, which is recommended the tartar emetic ointment generally accomplished in chtldren with- to be rubbed in on the temples, behind the ears, or on the back of the neck, out the affection of the mouth. With respect to local means, the first especially when change of structure is point is to decide how far it is right to going on in the cornea. I am more in the abstract blood. Leeches must be ap- I habit of making an issue in the temple in plied sparingly in these cases. You must I such cases. It is one of the most powerparticularly guard against the error of ful remedies, and produces the most adsupposing that leeches are necessary in vantageous effects in conjunction with the proportion to the intolerance of light; , employment of mercury, in arresting for it is found by experience the depletion changes of structure in the organ. The rather increases the irritability of the general power., are to be supported under organ, which is again lessened by tonics such a treatment, by a nutricious and raand a generous and nutricious diet. In ther general diet. How far can it be advantageous to apcases which partake of the nature of common inflammation, and where there ply stimulants to the eye in cases of struis much external redness with the other mous ophthalmia They have been much symptoms, leeches are proper ; but I sel- employed ; and these are the cases in dom use them until after the exhibition of which they have been most strongly rean active purge. They are also to be commended. I confess that I have the used in conjunction with the internal same doubts respecting their utility in means already mentioned, when disorga- strumous ophthalmia as I have expressed nizing inflammation is going on in the in the treatment of the common form of I believe that the best local ap- inflammation. If the nitrate of silver bad cornea. plication is warm water, or poppy fomen- any power of correcting the morbid irritation. As regards the intolerance of tability of the organ, we should gladly light, that may be often relieved by a avail ourselves of it in these cases. But fomentation of a strong decoction of pop- I believe that the intolerance of light will pies and chamomile flowers ; a bit of soft be much more effectually and speedily flannel wrung out of this fluid and ap- removed by the means I have mentioned, plied to the eye as warm as it can be borne than by any local application. The room is frequently very comfortable to the feel- should be darkened when the intolerance ings of the patient. It is doubtful whe- is severe, and the patient should wear a ther the intolerance of light and spasm of light green shade. At any rate, you the lids can be relieved by the local em- would not think of using local stimuli ployment of opinm. I rely on the inter- until the general treatment had been nal and general measures already de- tried, and I believe that will be found to scribed. If you should be disposed to use answer the purpose best. If you should opium, you will find Mr. Battley’s liquors meet with any cases in which this treatas

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ment should fail, then yon may try a weak When used with the greatest judgment, solution of the nitrate of silver, putting a it will sometimes fait ; while there are

many circumstances of inflammation to which it is not adapted, and in which it may even prove injurious. It is much to be wished that we knew the way in which bloodletting effects its purpose, in the cure of inflammation; for this knowledge, if it could be obtained, would greatly assist us in the application of it. The subject, however, is difficult, and I am not sure that it is sufficiently understood. You crusta lactea, which is very tronblesome to are not to suppose, as ignorant people the child, and annoying to the parents often appear to do, that we bleed a pa and friends, may in general be greatly tient in order to draw off the bad blood benefited by the use of the oxyd of zinc he may have in his veins. Nor is there lotion ; a drachm of the oxyd to an much better foundation, I believe, for the ounce of water is about the proportion in opinion, that it is useful in any case, by which it is used. The morbid surface merely lessening the quantity of blood should be well cleaned with tepid water in the system, upon the supposition that two or three times in the day, and the there is an over-fnlness of the vessels, or wash may then be applied to the part. A what is termed plethora. Again, it is not solution of the corrosive sublimate, a simply by inducing weakness that the is attained ; for then the good efgrain to six ounces of water, may be used object as a lotion with advantage. No means of fect would be more in proportion to the this kind should be resorted to, until after quantity of blood lost, than is found to the use of purgatives, and when the be the case. A small quantity of blood tongue is clean. A sudden repulsion of drawn in a certain way, often produces the eruption may aggravate the ophthal- much greater advantage, than a large Children are often quantity differently taken. The relief exmic inflammation. much disfigured by the. incrustations; perienced from bloodletting is sometimes very but there is one consolation, the scales so instantaneous, even while the blood is as not to admit of the supposinever leave any cicatrices or pits in the Howing, tion that it proceeds merely from the the is unand skin, personal appearance weakness occasioned by it. It seems more injured even in the worst cases. reasonable to believe, that the good effect is owing to the impression made on the general system, influencing its mode of acting ; just as in cases of what are called counter- irritation, which I have before explained to you, and with which this LECTURES appears in some degree analogous. If this be true, it must be desirable to take ON THE blood in that way which will make the THEORY AND PRACTICE OF PHYSIC, greatest impression on the system, and at the least possible expense. Now the more rapidly blood is taken BY DR. CLUTTERBUCK. away, the greater is the immediate effect ounces Theatre, General Dispensary, Aldersgate- produced by it; so that a very few street. bursting suddenly, as it were, from the vessels, will affect the system more than treble the auantitv when slowlv drawn. If it be drawn faster than the blood vesLECTURE XX. sels are disposed to contract, so that the Gentlemen, sides of the vessels are not brought in I HAVE, in this Lecture, to speak contact with the blood, the circulation will be at a stand, and syn. as a remedy for Inflam- cope necessarily )f Bloodletting, Now the blood or fainting enue. mation. vessels contract more readily in some inThere is no remedy which will bear a dividuals than in others, and such percomparison with this, in point of efficacy ; sons do not so soon become faint from and none which, under certain circum- bleeding. This does not depend altostances, can be so little dispensed with. gether npon the general strength, but You are not, however, to Imagine that it upon other circumstances. When the is always successful, or always proper. system is in a febrile state of action, faint-

drops into the eye two or three times day. In cases of spreading ulcer and great irritability, you may employ the solution of nitrate of silver, or of the composition I before described, the lapis divinns. 7he vinum opii is of no service. I can only say, with regard to the great variety of stimulants and astringents that have been recommended, that I have never seen much good done by them. The

few a