An Account of an Extraordinary Case of a Diseased Eye: In a Letter to Matthew Maty, M. D. F. R. S. By Daniel Peter Layard, M. D. F. R. S.

Monday night. This storm broke every pane of glass on the north side his house, and destroyed all his garden things entirely. He mentions likewise the heats to have been rather more than usual in that country this summer; and particularly on the 9th of August his thermometer (which is hung on the outside of his house on the north aspect) was at 97, by Fahrenheit's graduation, and some other days as high as 94 or 95. I am, SIR, Your most obedient humble Servant, Jermyn street, 18 October, 1758. Wm. Fauquier. CI. An Account of an extraordinary Case of a diseased Eye: In a Letter to Matthew Maty, M.D. F.R.S. By Daniel Peter Layard, M.D. F.R.S. Dear Sir, Huntingdon, 20th May, 1758. Read Nov. 9. IN October 1755. I communicated to you, and you inserted in the last volume of your Journal Britannique, the case of Susannah Earle, of Hemmingford-Grey in this County, who, in consequence of the whooping cough, was afflicted with a protruded eye. The case I now send you, somewhat similar to that young girl's in its first appearance and progress, but by accident attended with a second disease, will perhaps deserve your attention. tention, and not seem unworthy of being presented to the Royal Society. John Law, of Fenny-Stanton, also in the County of Huntingdon, a strong and robust lad, thirteen years and six months old, in Easter week 1756, beating dung about a close with unusual force, on a sudden felt a violent pain in his left eye. The pain increased, an inflammation ensued, and the eye grew daily larger. The poor boy's mother followed the directions, which she received, without the least benefit to her child, after having, besides other expences, been defrauded by a quack of two guineas; a great sum for a poor cottager! The widow Law, in her distress, heard of Sannah Earl's cure. She went to see her; and determined to bring her son to Huntingdon, for Mr. Hopkins's assistance. Accordingly, October the 7th 1756, she came to Mr. Daniel Hopkins, surgeon, in this town; and having desired my opinion, we both examined the eye together. The left eye was protruded out of its orbit, and hung down over the cheek to the upper lip. The coats were greatly discoloured, all the vessels turgid, the sight totally lost, and the humours appeared like fluctuating pus. We saw the necessity of an immediate extirpation, to save the right eye, already greatly inflamed; and having apprized the mother and boy of the state the eye was in, a consultation was desired with two surgeons of St. Ives. Mr. Dawkes, who was present with Mr. Skeels at Sannah Earle's operation, being dead since that time, Mr. Thomas Skeels and Mr. Thomas Want very charitably met Mr. Hopkins and me the next day, October the 8th, at the widow Law's cottage. The eye appeared to these gentlemen as I have related: and upon Mr. Want's pressing with his finger on the pupil, the globe burst at the edge of the Iris, and discharged pus. The extirpation of the eye was unanimously agreed upon, and immediately performed. Mr. Hopkins made a puncture with a lancet close to the external and small canthus of the eye, and then with a pair of crooked scissors took off all the distended globe close to the eye-lids. He then cleaned the cavity of the purulent humours, and filled it with soft lint, over which he applied bolsters dipped in warm red wine and water, and the monoculus bandage to keep on the whole dressings. The lad was bled in the arm; nitrous medicines, and anodynes, were prescribed, and a suitable regimen. The fever, and inflammation of the eye, gradually decreased; the suppuration of the wound in few days was good, the distended eye-lids contracted, and a cure was soon expected. But on November the 7th the lad went to open the street-door, and it being a cold and rainy evening, he quickly felt the bad effects of the cold wind, which drove the rain in upon him. That night the wound became again very painful, the eye-lids puffed up, and next day appeared much inflamed, as were all the contents of the orbit. Fungous excrescences soon followed, and an intermittent fever. An emetic being improper, he was purged with rhubarb, and afterwards took the bark infused in red wine. The fever was removed after some time; but the contents of the orbit continued increasing, and the fungous excrescences became so large and spongy, as to be of equal equal bulk with the diseased eye before extirpation. All topical applications, to contract this fungus, were ineffectual, and the application of caustics or escharotics was prudently avoided, lest they should produce a carcinomatous ulcer. The discharge was chiefly a purulent serum: on which account, ever since the beginning of November he was kept upon a dry diet. In February 1757, the remaining coats of the eye began to appear at the most prominent parts of the excrescence, and seemed white like a part of the conjunctiva. On touching it with the finger, a distinct fluctuation was felt, and an hydrophthalmia perfectly discovered; but neither the thickness of the coats, nor the sensibility of the parts, would permit a puncture to be made, till the cyst, which appeared formed by the distension of one of the coats of the eye, was freer from the fungus. The cyst continued daily to extend itself, and to separate the fungous edges; the fluctuation became more manifest, and the membranes thinner. At length, on the 15th of June 1757, Mr. Hopkins opened the cyst with the point of a lancet, and let out a large cup-full of limpid serum, without smell or taste. The boy felt very little pain in this operation. The cavity was filled with dry lint, and compresses dipt in warm red wine and water were applied over it. All the night following, and several days after, a great discharge of serum came away. On the 19th the fungus was considerably lessened. Mr. Hopkins then dressed the wound with warm unguentum gummi elemi, and washed the fungus with a lotion of aquarum calcis, rofarum, et tincturae On the 23d, upon his removing the dressings, he saw the cyst loose and collapsed; which he extracted with his forceps, without the least difficulty, or pain to his patient. The fungus daily wasted afterwards, the wound digested well, and the lad was entirely cured on the 7th of August. His right eye is perfectly strong, and he has been free from complaint ever since. The remainder of the coats of the eye, and of the muscles, bear up the eye-lids, that when uncovered he only seems to have closed the left eye: however, he has wore all the winter a back patch over it, to guard against fresh cold. The cyst, when first taken away, measured three inches and half in length, one inch and half in diameter, and contained a large cup-full of water. It appeared to be the tunica sclerotica, was of a clear pellucid white, and of so delicate a texture, as scarce to admit of being touched without tearing; and when dried with all possible care, became so brittle, that Mr. Hopkins could hardly preserve it in the manner I now send it. **REMARKS.** In both Susannah Earle and John Law's cases, the eye was distended by the accumulation of the aqueous humour, separated in great quantity by the repeated straining of the blood-vessels in the whooping cough, which might gradually relax and enlarge the aqueous ducts of Susannah Earle's eye; and possibly by the rupture of those ducts, and of some blood-vessels, at the time John Law exerted himself violently in beating ing dung about the close: for in either case the impetus of the blood must have been so violent, as to produce those effects. However, from the hydrophthalmitia succeeding the operation on John Law, the fungous excrescence, and continual serous discharge during several months from the wound, it plainly appears, that an abundance of aqueous humour was discharged at first by the distension or laceration of the aqueous ducts, and latterly for want of a contraction of those vessels, and of the lymphatics, which were no longer of use. Both these cases shew the necessity of inquiring particularly into the causes of diseases of the eyes, as well as of other parts of the body; for by barely attending to the symptoms, the disease will not be removed, tho' the symptoms be alleviated. Bleeding, and moderate evacuations, would certainly have, at first, decreased the tension and pain, and assuaged the inflammation; but both topical applications, and internal medicines, were properly to be adapted, and a suitable diet regulated. Not to mention the absurd and impertinent abuse of empirics, what benefit could accrue, in both these cases, from unctuous, laxative, or emollient applications, from drastic and mercurial purges? Tho' such applications might be well intended, to take off the tension and inflammation; yet, as the distension of the blood-vessels only increased gradually, as the globe of the eye was enlarged; so whatever application relaxed the coats of the eye, must infallibly stretch out the vessels yet farther, and cause a greater pain and inflammation; which drastic and mercurial purges would also increase. The only method then to be pursued in such bad cases would be at first to endeavour to remove the fullness of the blood, and make use of such topical remedies as would contract without irritation. If the cause remains, as the whooping cough in Susannah Earle's case, no amendment of the eye can be expected, while the patient's blood-vessels are continually strained by frequent coughing. This illness therefore should be attended to, and removed as soon as possible. But should the eye be so enlarged, as to protrude itself out of the orbit, there seems no other way to lessen the bulk of the eye, than by making a puncture with a proper instrument, to let out the aqueous humour; and then apply such agglutinant and contracting collyria, as may reduce the distended coats and vessels to their former size. This operation should be performed before the humours are vitiated, the sight lost, the vessels in a state of suppuration, and the coats of the eye too far extended; for at that time nothing less than extirpation can be of use. Professor Nuck, in his Tractatus de Ductibus Oculorum Aquosis, p. 120, & seq. relates the success he had in curing a young man by five repeated punctures, and a strict observance in a proper use of all the non-naturals. I am, with the greatest regard and esteem, Dear Sir, Your most affectionate Brother, and very humble Servant, D. P. Layard.