TENSION OF THE EYEBALL; GLAUCOMA; ETC. SOME ACCOUNT OF THE OPERATIONS PRACTISED IN THE NINETEENTH CENTURY FOR THEIR RELIEF. [A paper read before the Midland Medical Society, February 3rd, 1863.] BY JAMES VOSE SOLOMON, F.R.C.S., SURGEON TO THE BIRMINGHAM AND MIDLAND EYE HOSPITAL; GENERAL DISPENSARY. LONDON: JOHN CHURCHILL AND SONS, MDCCCLXV. 160. e. 16. INTRODUCTION. To attain a correct estimate of the progress of medical science, it is essential to take a retrospective glance at what has been done by those who have preceded its representative men of our own time, and endeavour, in a spirit of eclecticism, to adjudge the advantages which have resulted to society from more recent discoveries and methods of practice. The substance of the following paper, entitled "Some Account of the Operations practised in the Nineteenth Century for the Relief of Tension of the Eyeball, Glaucoma, etc.," was read before the Midland Medical Society on February 4th of the present year, and has since appeared in the BRITISH MEDICAL JOURNAL. So great is the interest which continues to be manifested by the profession in the surgical treatment of intraocular tension and glaucoma, that I would fain believe no apology will be required for publishing the paper in a separate form. A few words in explanation of the meaning of tension of the eyeball. If a healthy eye be pressed by the point of the finger, it will be found to possess a certain degree of elasticity, which—although varying somewhat in different persons, without a corresponding alteration of the acuteness of vision, or of the power of adjustment-affords a standard by which surgeons, who have patiently studied the subject in a practical manner, may in numerous cases judge of the pathological significance of this sign, when the eye is diseased. In order to conduct the examination with a due regard to accuracy of diagnosis, the patient should be instructed to gently close the lids, as in sleep; while the surgeon, standing in front, fixes the globe by placing the index finger of one hand and the second of the other on either side of the eye, taking care to avoid active pressure. He then makes one or two delicate and momentary compressions of the eyeball with the point of the index finger, which is at liberty; using sometimes, for this purpose, two fingers at the same instant. In all cases, he should examine in succession the degree of resistance afforded by the vitreous and the anterior chambers, and the irido-ciliary region. If the examination be conducted in a rude or sudden manner, an erroneous conclusion will be arrived at, in consequence of an artificial and temporary tension being induced by the spasm which the manipulation excites in the lids and muscles of the eyeball. The degree of intraocular tension is in some diseases subject to so much variation from local and general causes, that it becomes of importance to repeat the examination at intervals, and even more than once at the first interview with the patient. The degree of uneasiness or pain produced from a tension in excess of the normal standard depends on the nature of the disease and nervous susceptibility of the patient. Mr. Wardrop does not seem to have known the value of a digital examination, but to have relied on the situation and nature of the pain felt, and the appearance of the cornea. This remark in regard to pain suggests to me it may be useful to notice that considerable and most injurious pressure is sometimes present without exciting any local uneasiness whatever, the patient having only discovered his blindness or impairment of vision from perhaps an accidental closure of the more perfect eye. The existence of a tension greater than normal does not of necessity entail a surgical operation for |