Chapter 17 - Surgical Diseases
Modern Surgery
Suppuration and Abscess
Ulceration and Ulcers
Malignant Pustule
Burns and Scalds
Frost Bite
Septic Wounds
Incised Wounds
Rules for Examining and Dressing Wounds
Antiseptic Dressings
Way Wounds Unite
Punctured Wounds
Lacerated Wounds
Granulation and Scarification
Gunshot Wounds
Poisoned Wounds
Way Broken Bones Unite
Different Diseases of Bones
White Swelling
Stiff Joint
Water in the Scrotum
Blood in the Scrotum
Varicose Veins
Deformities and Irritations of the Spine
Wry Neck
Foreign Bodies in the Eye
Inflammation of the Edge of the Eyelids
Disorder of the Lashes
Chronic Inflammation of the Lachrymal Sac
Inflammation of the Cornea
Inflammation of the Iris
Weakness of Sight
Imperfect Vision
Short and Long Sight
Affections of the Ear
Inflammation of the Meatus
Wax in the Ear
Inflammation of the Tympanum, Deafness
Bleeding from the Nose
Ingrowing Toe Nail
Chafing and Excoriation
Foreign Substances
Bleeding from Wounds
Proud Flesh
Compression of Arteries to Stop the Flow of Blood
Care of the Teeth
Rotting of the Teeth
Filling Teeth
The First Teeth
Cleaning the Teeth
Ulcer of the Stomach
Riggs' Disease

17.56 Opthalmia

Purulent Ophthalmia. Egyptian Ophthalmia.

OWING to the glaring sunshine, and the particles of sand with which the air is loaded, this disease is endemic in Egypt. Hence its name. Egyptian ophthalraia.

Symptoms. It begins with stiffness, itching, and watering of the eyes, and a feeling as if there were dust in them. The lids are a little swelled, and become glued together during sleep. The mucous membrane which lines the lids and covers the ball is intensely red and swollen, and discharges a copious quantity of pus. There is a severe burning pain extending to the cheek and temple, with headache and fever. The eyes cannot be opened. It is both contagious and infectious.

Treatment. At the very beginning, apply a nitrate of silver wash (211) twice a day With this application, a low diet, and five to ten drop doses of fluid extract or tincture of veratrum viride, every hour, this terrible complaint may often be broken up.
If the disease have reached its height, and there is great fever and headache, the patient may be freely purged (31), and the pain be allayed by cocaine applied with a camel's hair brush.
The patient must be kept in bed, in a dark room, with the head elevated.
The eyes should be frequently washed out gently with warm water, or a decoction of poppies, containing one grain of alum to an ounce. This must be done with a piece of fine sponge, or with a small syringe. Once or twice a day, a few drops of solution of nitrate of silver, two grains to the ounce of soft water, may be dropped in the eyes from a camel's hair pencil. As soon as the disease begins to give way, the alum in the poppy decoction may be increased a little.

Purulent Ophthalmia of Children.
This always begins within a short time after birth, generally on the third day.

Symptoms. The edges of the lids at first become red, and glued together, and the membrane. lining them is red and rough. The eye remains closed. The conjunctiva or membrane which covers the globe, next becomes intensely scarlet, and so much swelled, at times, that the lids turn out; and it discharges a thick purulent matter. The child is feverish and restless.

Causes. Exposure to cold and damp, bad nursing, omitting to wash away from the eyes the cheesy secretions of the skin, and the contact of gonorrheal and leucorrhea secretions of the vagina at birth.

Treatment. Wash out the eye frequently, and gently, with a weak astringent wash (207), (203), or put between the lids once a day, a large drop, with a camel's hair pencil, of a solution of nitrate of silver, 4 grains, water 2 ounces. Men the disease is declining, apply to the lids, with a camel's hair pencil, the ordinary citrine ointment of the druggist.

Catarrhal Ophthalmia.

Symptoms. In this complaint, the white of the eye becomes inflamed and very red, the redness being superficial, so that the vessel can be moved by pulling the eyelids; generally there is a thin mucous discharge, which, in severe cases, becomes thick and purulent. It is caused by cold and clamp.

Treatment. If there be considerable pain and headache, give purgatives (31), (19), and continue them, once a day, till the symptoms of active inflammation subside. Apply to the eyes a poultice of slippery elm, and bathe them frequently with a decoction of poppy leaves, lukewarm or cold, according to the choice of the patient. Smear the edges of the lids at night with fresh lard; and when the inflammation begins to decline, use diluted nitrate of mercury ointment instead. Keep the eyes well protected from the light with a shade. A large drop of a solution of nitrate of silver, two to four grains to the ounce of water, may be put into the eye two or three times a day. Sometimes sulphate of zinc, four grains to the ounce of water, will do well or cocaine solution, 4 per cent.
When the disease reaches the chronic stage, the pain and headache having passed off, some astringent applications will be required, as a very weak solution of nitrate of silver (208), or a dram each of powdered witchhazel leaves and golden seal, steeped for ten minutes in a gill of boiling water, and strained when cold.

Scrofulous Ophthalmia.

This disease is chiefly confined to children under eight years of age.

Symptoms. Entire inability to bear light; the lids are spasmodically closed, and the bead constantly turned away from the light. The blood vessels of the conjunctiva are not particularly injected with the exception of one or two large ones which run toward the cornea, and terminate in one or more small opaque pimples. The cornea frequently ulcerates, and the complaint is very obstinate, being liable often to recur.

Treatment. As in all scrofulous complaints, it is important in this to look after the general health. No more physic is required than to keep the bowels open; and even this, if costiveness exist, had better be done by bread made from unbolted wheat flour, by injections of cool or tepid water, and by exercise. The health must be supported by iron, sarsaparilla, stillingia, and quinine.
The eye is to be strengthened by cold water applied to the lids, the forehead, and the temples. The eyes may be bathed likewise with a warm decoction of poppies, or of chamomile flowers or cocaine.
But one of the best applications is a solution of nitrate of silver, one or two grains to the ounce of water, a few drops being put into the eye once or twice a day. Occasionally a solution of sulphate of copper, of the same strength, may be used with decided advantage.
Both eyes should be protected by a shade.

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