Dr. Maclean's Cases
Extract from theLancet, of January 7th, 1842. Cases in which the vapour of prussic acid was employed for the cure of Ophthalmic disease, by Donald J. Maclean, M.D., Lic. Roy. Col. Surg. in Edinburgh.
"I have been induced, for my own satisfaction, (in consequence of some observations made by Sir George Sinclair, who had witnessed its effects on patients under Dr. Turnbull's care), to give a very extended trial to the prussic acid in cases of ophthalmic disease which might be considered suitable for its application, and desire that the results of some of the cases should be submitted to the consideration of those of our profession who may take an interest in the subject I have, therefore, made out a report of the following cases. In our present state of knowledge it is impossible to explain themodus operandiof the prussic acid; it will be sufficient, meantime, to observe accurately, and merely give the results of treatment. In what kind of cases it will be found most suitable can only bedetermined by further inquiry and experience. If, however, the results prove permanent, the prussic acid must occupy a very high place amongst our remedial agents; and, possessing stimulant properties of a peculiar character, it may prove useful under many circumstances where diseases of the eye are not readily amenable to ordinary treatment.
"J. Mackay Reay, aged 11 years. Diffused opacity of the cornea, the result of a protracted attack of scrofulous ophthalmia. The vapour of strong prussic acid was applied, daily, for thirteen days, by exposure of the eye to it, during which period the cornea gradually got transparent. On the fourteenth day no remains of former opacity existed, and the vision of that eye was perfectly restored.
"Margaret Mackay, Thurso, aged 12 years. Severe rheumatic ophthalmia, of three weeks' duration. She complains of deep-seated aching pain in the eye-ball, greatly aggravated in the evening and through the night; no apparent disorder of the general health. The ordinary remedies were used, viz., leeching, blisters, calomel, and colchicum: they appeared to give no relief. The prussic acid was applied, daily, for about ten days; the relief following each application was extraordinary; the pain was trifling for the rest of the day. At the expiration of twelve days the intolerance of light, the injected state of the vessels on the sclerotica, and the other symptoms, entirely disappeared; and since September the little patient has continued quite free from any symptom of her former ailment.
"A girl, namedMunro, from Mount Pleasant. Albugo of corneæ in both eyes, the result of an attack of acute conjunctival ophthalmia, which she had about two years ago, whilst residing in Dundee, where various means were tried for her relief. Vision was almost completely destroyed; she could not distinguish the outlines, form, or colours, of objects presented to her. At her own urgent request, but without holding out any prospect of her being benefited by it, the prussic acid was applied, daily, for about six weeks.
"11th day.—She states that she can see some objects. The corneæ appear more transparent. At the end of another week she was able (in the presence of Sir George Sinclair) to state the names of some objects, and to recognise, with accuracy, the colours of a variety of flowers which were presented to her in order to test the degree of progress that had been made. She can nowwalk out and home to her own residence (a distance of a mile and a half from Thurso) without assistance. The improvement continues to be progressive, and the corneæ are now comparatively translucent.
"Sinclair Sutherland, a labourer, aged 26 years. Staphyloma of one eye, and occlusion of pupil in the other, from effused lymph. In the centre of this there was a small opening which would admit the point of a fine needle. The prussic acid was applied, daily, for about three months. Felt great relief in the staphylomatous eye since its application; the prominence of cornea diminished at least one-half, and though formerly opaque, from repeated attacks of inflammation and ulceration, it is, at this date, quite translucent. The effusion of lymph in the other pupil has been disappearing gradually,and the pupil is now about four lines in diameter. The patient is quite sensible of the improvement taking place, and can now name various objects presented to him.
"Mr. Alexander Macdonald, jun., merchant, Thurso, has suffered for the last six months from an affection of the retina, characterised by the following symptoms, viz., obscurity of vision, excessive intolerance of light, and deep-seated pain in the orbit. The external appearance of the eye is quite healthy, and the motions of the iris are natural; ascribable, he says, to too great application to business, and night reading: and, in many respects, the symptoms resemble those of inflammation of the retina. The ordinary treatment of this affection was resorted to with some benefit, and the eye kept constantly shaded; but the deep-seated pain continued, and the patient was getting uneasy. The prussic acid was applied, daily, for about six weeks. The relief obtained was great, and at the expiration of one month all the former distressing symptoms had totally disappeared; but I thought it advisable to continue the remedy for some time longer. The patient can bear a strong light with impunity, and exert his eyes on any object, however minute, without uneasiness, and is now quite well.
"Mrs. M'Kenzie. Capsular cataract of one eye, of three or four years' duration. By way of experiment, the prussic acid was applied for about five weeks, daily. Absorption of the diseased structure was slowly taking place all this time; it has now entirely disappeared, and vision of this eye is quite restored. The result in this case was very satisfactory.
"Mrs. M'Beath. Suffered for many years past from a disease combining the characters of conjunctival and sclerotic ophthalmia. The prussic acid was applied, daily, for about three weeks, and at the expiration of that time the redness and angry appearance of the eye disappeared; the organ looked clear and healthy, and no pain whatever was felt. The patient can bear a bright light without uneasiness, and is now free from any symptom of her former ailment.
"Thurso, Caithness, Dec. 20, 1842."