A Practical Treatise on The Diseases of The Eye (second edition of 26 October 1834)
by William MacKenzie MD surgeon of the Glasgow Eye Hospital
reviewed by Stephen Meynell

I am grateful for Optiboard allowing me to review this unique volume written by a surgeon who learned his craft at the Battle of Waterloo and went on to help found Scotland's first hospital specializing in eyes ( the hospital exists today).

Doctor Mackenzie wrote this book as a standard text and so its range is extensive. He starts by chapters on anatomy. You would be surprised by its modernity. Then follows illustrated discourses on injuries and infections of the eye, and their treatment. He taught mainly by discussing cases he came across or heard. His patients often died mid treatment and he usually reports the autopsy. He was a scientist of the highest order with a sharp mind. He was an astute business man whose council was to get fees in advance as it was difficult to get payment after the patients demise. Treatments were often leeching, blistering to the back of the neck, blood letting and operating ( there being no anaesthetics, operating was only considered on patients of strong mind. The eye being held by a burly assistant so tightly that the aqueous streamed on first incision). Mercury and herbal remedies were also used.

“A soldier received a thrust with a sword in the inner canthus. The patient remaining in his usual state of mind applied a poultice till the tenth day when he was seized with a violent fever, which in two days proved mortal. The wound was found to have passed the lateral ventricle and slanted up almost through the skull.”

“A labourer thrust a long lathe, with violence, into the inner canthus of another labourer. It broke off short so that a piece two and a half inches by half an inch wide remained buried so deeply it could scarce be seen. He rode for one mile to Mr. Morse, who could not extract it. He called on the blacksmith who pulled it with his tongs. The man continued dangerously ill for some time but recovered entirely with sight in that eye. But on leaning forwards he felt great pain in his head.”

“ Percy had under his care a fencing-master, who, in an assault, received so furious a thrust that the foil penetrated six inches into his head and broke short. The man fell into a swoon and very soon the swelling was so great as conceal his foreign body. In order to lay hold of it, Percy opened and evacuated the contents of the eyeball. His forceps not being strong enough he sent for a clock-maker and borrowed from him a pair of screw pincers. With great difficulty he extracted the foil blade. The fencing master died some weeks afterwards more from intemperance than from his injuries. Commenting on the case Percy remarks that it is better to remove the foreign body and the eye as he found the other eye could be threatened with destructive sympathetic inflammation.”

He deals with burns and scalds, then moves on to infections which he describes with relish.

“Warts are common on the eye lids. Keeping the excrescence constantly covered with lint saturated with a decoction of tormentil root will serve its removal.”

“Molly Prior age 12 years had a soft red fungus growing out of the eye, as large as a filbert. It was of 3 weeks standing and was attributed to a straw striking the eye. This fungus originated in the conjunctival fornix of the eye. It was cut away, but in three weeks was as large as ever. It was again cut away, and at the fornix angle a bit of straw was observed which was extracted. The cure was complete within a few days.”

“Chronic dacryocystitis in scrofulous children is frequently connected with caries. I have known a smart dose of calomel and jalap remove all the symptoms. In almost every case advantage will be reaped from country air and exercise.”

“I was sometimes ago, consulted by a gentleman, who, after spending the whole night in writing,was affected by the most distressing double vision. When I bound up what I thought to be the bad eye he saw things now single, but he suffered the most violent headaches. Fearing I had bound the wrong eye, I bound the other and he saw with the minimum of uneasiness. After a while he complained of vertigo, but no headache. The symptoms slowly subsided after rest, bloodletting, blistering, purgatives and mercury.”

“A young man had been in the habit of bathing his eyes every morning with urine while yet still warm, in order to strengthen his sight. Although he had contracted gonorrhoea he did not abstain from his habit, fearing no harm. The consequence was a severe ophthalmia attended with an acrid discharge of purulent matter which rapidly destroyed one eye. The other eye yielded to bathing with sugar of lead water.

“Symptoms of Myopia – the eye which perceives nothing distinctly beyond 10 inches may be considered myopic. The eyes are frequently prominent. It is rarely the case that the two eyes of the same person correspond in refractive power. Few are aware of the disparity which often exists between their eyes, until a comparative trial is made. Although Myopia is gradual in its progress manifesting its self at puberty it can occur at any age, a late onset making one suspect dropsy of the aqueous. Myopia is much more common in the higher ranks than the lower ranks of life and among those who occupy themselves with close examination of minute objects.

The treatment of Myopia is to remove the incipient symptoms of this very serious imperfection. One should abstain from reading, sewing, painting and engraving. Haller recommends looking through a small aperture, but there is good effects to be derived from frequent exercise outdoors, walking and riding. Recourse can be had to the employment of concave lenses in recalcitrant cases. These are numbered 1,2,3 etc., beginning with the longest focus. We must recommend the person to be content with the lowest number which answers his purpose. If the patient wishes to order his glasses by writing to an optician. Let the person multiply the distance at which he can read with the naked eye (say 4 inches), by the distance he wishes to see (say 12 inches). Then divide the answer by the difference (8) and the quotient is the focal length of the glasses required.”

The book continues for over 600 pages and are full of interesting cases. Perhaps I will be allowed to review more.