• 6 i 77 W cataract,* or in that variety of cataract which succeeds the removal of the lens by an operation. * See Plate XV. Fig. 5. VOL. II. I CHAP. XXXVII. OF CATARACT OF THE CAPSULE OF THE LENS.* From the general observations which have already been made on the structure and functions of the Capsule of the Lens,'}" it may readily be perceived how it should frequently be the seat of opacities. Indeed there is, perhaps, no disease of that mem- brane which is not either accompanied or followed by a diminution in its transpa- rency. These opacities, of which there are * Cataracta capsularis vel membranacea. Der Kap- selstaar. f See Chap. XXXII. OF CATARACT, &C. 115 several varieties, have been, by most au- thors denominated Capsular Cataracts. Sometimes the whole capsule of the lens becomes opaque ; and, in other instances, the opacity is confined to one portion of it. This is either the pupillar or neural por- tion ; and the former of these, which, in its natural state, is much thicker than the other, sometimes exhibits a still greater inequality when diseased. That the two portions of this capsule should present dif- ferent diseased appearances, may have been suspected from the difference in their connections, for the pupillar portion being covered by a portion of the reflected cap- sule of the aqueous humor, naturally par- ticipates in its diseases, whilst the neural portion is, in a similar manner, connected with the capsule of the vitreous humor.* The appearances of Capsular Cataracts are very various. Some of tlnm are of a pearl white colour, and glistening others * See Plate XIII. Fig. 1. ■f See Plate XV. 116 OF CATARACT OF THE are of a dull, milky whiteness ; — others are mottled with small white spots upon a more opaque ground,* — or they have a reticulated appearance. Sometimes they have large white spots, and sometimes they appear like a delicate white web or flake of snow.-'j- Their texture, too, is very vari- ous, being sometimes soft, and very pulpy; sometimes brittle, and easily ruptured ; and sometimes very tough and elastic. In two or three instances, this membrane has been found in adults of considerable thick- ness, very much resembling cornea when long immersed in water. ij; I have observed several examples of capsular cataract where the opacity was confined to the central portion of the cap- * Plate XV. Fig. 2. •j* See Practical Observations on the Formation of an Artificial Pupil in several deranged States of the Eye. To which are annexed. Remarks on the Extraction of Soft Cataracts, and those of the Membraneous kind, through a Puncture in the Cornea. By Benjamin Gibson, Surgeon to the Manchester Infirmary, &c. &c. London, 1811. + Ibid. CAPSULE OF THE LEXS. 117 sule, an opaque white point appearing in the centre of the pupil, with several shades or degrees of opacity around it, forming circles, so that the diseased capsule re- sembled the section of a calculous concre- tion composed of concentric laminae.* When a cataract of this kind is extracted, the pupillar portion of the capsule is found very much thickened, whilst the lens is sometimes quite transparent. Though the neural portion of the cap- sule of the lens cannot be separated by dissection from the vitreous humor, the connection between these two capsules is sometimes completely destroyed by dis- ease ; and the lens inclosed in its capsule can be easily separated, -j~ or is altogether detached, and allowed to float in the cavity of the aqueous humor, passing and repassing through the pupil, according to the position of the head .J In almost all * See Plate XIV. Fig. 4. f Cataracta cystica, — elastica. Balgstaar. X Cataracta luxata. 118 OF CATARACT OF THE the cases of this kind which I have had an opportunity of examining, the capsule of the lens had become detached only after a considerable change had taken place in the structure of the parts contained in the posterior chamber; the vitreous humor being changed in colour and consistence, and the functions of the retina destroyed. In most cases, where the lens is found in the anterior chamber, it is extremely probable that it remains inclosed in its capsule, otherwise it would be dissolved by the action of the aqueous humor. In some cases of cataract, -where the lens, as well as the capsule, is opaque, and where the iris has an undulatory motion, the cataract is also moveable, the motion appearing to be communicated to it from adhesions between the capsule and iris.* In some cases this variety of cataract is accompanied with a change in the struc- ture of the vitreous humor and its cap- * Cataracts tremulans. — Cataracte branlante — Zit- terstaar. CAPSULE OF THE LENS. 119 sule, the humor losing its natural trans- parency and consistence, and the connec- tion between the capsule and the ciliary processes being more or less destroyed. This disorganization of the eye is generally the consequence of violent inflammation, and is always attended with total blindness. Most frequently the capsular cataract is Congenital. Though it is generally ac- companied by an opacity of the crystal- line lens, yet in many cases the capsule is found alone in the eye, the lens having been dissolved.* This change in the con- genital cataract is not unfrequent ; for, in some cases, the capsule, without any evi- dent cause, gives way, and allows the lens, which is usually in children degenerated into a milky fluid, to pass through the pupil, and mix with the aqueous humor, where it is dissolved. In other cases, this change is the effect of a blow on the eye. Mr. Gibson gives an account of a child born blind, who received a blow on the eye, * Cataracts membranacea primitiva of Scarpa. 120 OF CATARACT OF THE which was immediately followed f V„t „,/‘ir.n//rr//lr y„ r//,„U<:«ds a „VrU„> Cti„,„/.r, ,„/irrd,r y, . ■ ; „ /^„ . EXPLANATION OF PLATE XI. 271 followed the injury soon abated, and all this opaque matter was ultimately ab- sorbed. It is probable, that, in this case, the bristle had penetrated not only the cornea, but also the capsule of the lens, thus allowing the thinner parts of the lens to come through the wound into the ante- rior chamber; where they immediately became opaque. This appearance is very different from that produced by inflam- mation of the capsule of the aqueous humor, and precisely resembles the effects of the operation of Keratonixis , where the capsule of the lens is wounded by the point of the needle. I have several times had an opportunity of observing similar effects of injuries to that represented in this drawing ; in all of them the opaque matter has been ultimately absorbed. In Fig. 2.-—' The whole anterior chamber is filled with a yellow-coloured matter, whilst the conjunctiva covering the eye- ball is so much inflamed, as to produce 272 EXPLANATION OF PLATE XI. what has been called Chemosis. The lens of this eye had been couched a few days before the drawing was taken, and though vision was not restored, yet the effused albuminous fluid was finally absorbed. Fig. 3. — This represents the appear- ances of a net- work of lymph, as referred to in p. 14, after the extraction of a cata- ract. Towards the inferior edge of the cornea, a white semicircular cicatrix is perceptible ; the pupillar opening is of a full size, and throughout the whole ante- rior chamber may be perceived filaments of coagulated albumen interwoven in va- rious directions, so as to form a sort of net- work. This case is narrated by Beer. Flakes of coagulated albumen are often found floating in the anterior chamber, or loosely attached to the iris, of the eyes of horses and other animals. -FIAT! TJl — /f? rr '/ s///.o/t ///, / /’kj < > fy-r/t ///f . y >/., PLATE XII. Fig. 1. — Is intended to illustrate the ap- pearances of Prolapsus of the Iris, in con- sequence of ulceration of the cornea. In this case, two Ulcers, such as have been delineated in Plate V. fig. 2., had pe- netrated the cornea, given an outlet to the aqueous humor, and portions of the Iris passed through the opening. The whole cornea has become clouded and vascular, and round each portion of iris there is an opaque white circle, produced from a sub- stance resembling wet chalk ; — an appear- ance rather unusual. 274 EXPLANATION OF PLATE XU. The whole white of the eye is consider- ably inflamed. The two next Figures are intended to il- lustrate the effects of Injuries of the Iris. Fig. 2. — Represents a small portion of Iris torn from its attachment with the ci- liary ligament. In this instance, the lace- ration was the consequence of a blow with a whip, which did not produce any other injury, and was followed by no defect in vision. Fig. 3 . — In this case, the whole Iris, except a small portion, is destroyed, the person having had his eye wounded by a thorn. A small Staphylomatous tumor has ari- sen at that part of the sclerotic coat where the thorn entered the eye. This man could see so as to be enabled to read, by looking through a small hole made in a card. I //, PLATE XIIL No. 1. and 2. — Are drawings of two Con- genital Cataracts, in both of which the cen- tral part of the lens is converted into an opaque white or chalky-looking substance. In No. 1. — The central opacity has a triangular form, and is embedded in the transparent lens. In No. 2.- — The central opacity has a more oval form. Exterior to it there is another opacity, resembling what is met with in the more common kind of cataract, 276 EXPLANATION OF and the external margins of the lens re- mains perfectly transparent. No. 3. — Shows the radiated appear- ance which the crystalline lens sometimes assumes in Cataract. The rays come from the centre of the lens, but are lost to- wards its circumference. The central part is of an amber colour, and of a firm con- sistence, whereas, towards the circumfer- ence, the amber hue fades into an opaque leaden grey, the lens becoming much softer, and nearly pulpy. The drawing was made from a lens re- cently extracted from a middle-aged pa- tient. Its appearance in the eye was of a pale grey colour. No. 4. — Shows a Capsular Cataract after being removed from the eye. In this case, the anterior portion of the capsule has become perfectly opaque, and acquired a great degree of thickness, being as thick as a common wafer, whilst the posterior por- PLATE XIII. tion, is of its natural thinness and transpa- rency, and is raised on the point of a pair of forceps. This cataract was removed from a young man who had suffered severely from ophthalmia. When the inflammatory symptoms had subsided, a dark yellow opaque body appeared behind the pupil, resembling fig. 3. Plate X. the pupil being immoveable from its adhesions to the opa- city. This opaqe substance was the thick- ened capsule, on extracting which, the vi- treous humor was found converted into a watery fluid, and the retina had lost its sensibilitv. •/ The two remaining figures show the ap- pearances of Ossification of the Lens and Capsule. No. 5. — Is a perpendicular section of a lens, showing its appearance when ossified, as described in Chap. XXXIV. The Ossi- fication is seen commencing in the centre of the lens, and extending towards its cir- 278 EXPLANATION OF PLATE XIII. cumference in the form of concentric bony laminae. The central portion was a dark brown coloured and hard bone ; the exte- rior laminae were of a paler colour, and more friable. No. 6 . — Represents an Ossification of the Capsule of the lens. In this case, nearly the whole capsule, particularly its anterior portion, was converted into a shell of bone. Where the shell is not complete, the dried lens is seen lying within it. The Ossifica- tion was in this case of the thickness of paper, and had all the external charac- ters of bone. The case is particularly described in Chap. XXXVIII. ^ r?s. j\r?s. 7\r. e e. PLATE XIV. These figures show several different kinds of Cataract. No. 1 — Shows the appearances of the more usual form of the Capsular Cataract in the adult, where the anterior portion of the capsule has become much thickened, and of a pearl-w T hite colour. No. 2. — In this eye may be perceived the usual appearances of Glaucoma , or of cataract combined with a dilated and im- moveable pupil. The lens has a bluish- 280 EXPLANATION OF grey colour, but not of an equal degree of opacity, and the shade varied so much when the eye was inspected in different directions, that those who looked at it com- pared it to a cat's eye. The pupil was permanently dilated, and at one part a portion of the iris is eroded. The lens was extracted, and found to be soft. The lady from whom the drawing was taken had an incipient cataract and Amaurosis of the other eye. No. 3. — Exhibits one of the more usual appearances of the Crystalline Cataract. The lens is of an opaque bluish-grey colour, and of an equal shade throughout. The iris is beautifully streaked. The other eye was sound. The drawing was made from a girl three years of age, and the cataract had been perceived several months. No. 4. — This figure represents the pecu- liar form of cataract which may be deno- minated Laminated. There is, in the pupil, PLATE XIV. 281 a very opaque white central spot, and around it a less opaque ring, the limits of both being accurately defined. No. 5. — This figure represents a Cataract formed in consequence of an Injury of the lens. A needle had penetrated the anterior chamber of a young lady’s eye, torn the edge of the iris, and punctured the lens. The pupil is seen of an irregular oblong form, and is separated into two portions by a slender filament of iris, detached from the edge of the pupil ; behind one portion lies the opaque lens, whereas the other re- mains perfectly transparent. In cases of this description, the wound which renders the lens opaque, seems to destroy its organization. The drawing was made three months after the accident. No. 6. — This represents a lateral view of a conical-shaped opaque body, whose base rests on the capsule of the crystalline lens, 282 EXPLANATION OF PLATE XIV. and whose apex reaches the cornea. The pupil was quite moveable, vision was im- paired, and both eyes had been affected with the disease from birth. The drawing was taken from a boy four years of age. This peculiar form of cataract, which I have denominated Pyramidal , is described in Chap. XXXVIII. fbUz iS. PLATE XV. In this Plate are illustrated some of the -diseases of the Crystalline Capsule. No. 1. — This is an example of the an- terior portion of the Crystalline Capsule become very much thickened and opaque from inflammation. The pupil has lost its circular form, and is immoveable, whilst the opaque body behind it is of a pale grey colour. No. 2.— Congenital Cataract in which 284 LXPLANATION OF both the Lens and its Capsule are opaque. There is a green opacity throughout the lens, and in the capsule there are nume- rous spots. The pupil being dilated by belladona, the whole opacity is exposed to view. This figure is copied from the work of the late Mr. Saunders, and exhi- bits very distinctly the appearances of one form of diseased capsule. No. 3 — In this figure are contrasted the appearances of an opacity of a portion of the Capsule of the lens, and Cornea. The opaque portion of capsule hangs from the upper edge of the pupil, whilst the opacity of the cornea is opposite to the in- ferior portion of the iris. In this case, the operation of extraction was performed in the usual manner, and no bad affects arose from the incision being carried through the diseased portion of cornea. Whilst making efforts to remove the capsule, the lens es- caped. The capsule thus let loose floated upwards behind the iris, and the pupil PLATE XV 285 afterwards remained transparent, and vi- sion was restored. No. 4. — In this instance, the whole edge of the Iris adhered to the Capsule of the lens, and the iris had aquired a convexity, being pressed forwards in its middle part. The capsule has become quite opaque, and a small red vessel passes into it from the edge of the iris. These appearances are very frequent after attacks of Gouty in- flammation of the eye. No. 5. — This drawing shows the appear- ance of the Pupil and Capsule of the lens, after extraction. The irregularity in its form did not proceed from any injury done to the Iris during the operation, but from a portion of the capsule of the lens, which was pushed through it, adhering to the wound of the cornea, and become opaque. No. 6. — Circumscribed, opacity of the Crystalline Capsule, in consequence of a punctured wound. PLATE XVL Fig. 1. — Represents an Ossification found within an eye-ball, which appeared to be completely disorganized. The patient died of phthisis, but no history could be obtained of the diseased eye. The general form and shape of the eye were completely chang- ed ; the cornea was opaque, its margin not distinctly marked, and the anterior cham- ber almost entirely obliterated. The scle- rotic coat was easily separated from the parts within, and upon removing it, the ca- vity was found occupied by a hard irre- gular-shaped mass of bone. The ossifica- Flats ±6. % EXPLANATION OF PLATE XVI. 28 7 tion was covered by the choroid coat and iris, these having lost their natural appear- ance, and no vestige of retina could be detected. The Ossification consisted of two different portions. The upper one was smooth, and a thin hollow shell, which, from its rounded form and position, must have been the Capsule of the Lens ossified. The inferior portion was a very irregular- shaped mass, and appeared to be the Capsule of the Vitreous humor converted into bone. Fig. 2. — Ossification of the capsule of the lens, and hyaloid membrane, described in Chap. XL. the drawing having been made from a preparation where the parts had been dried, and kept in turpentine, in the collection of Mr. Blizzard, to whom I am indebted for this representation. The os- sified capsule of the lens is seen in the centre of the preparation, and is readily distinguished from the other pieces of bone by its smooth surface, and more opaque white colour. 288 EXPLANATION OF PLATE XVI. Fig. 3 . — A thin cup of Bone which was found between the sclerotic coat and re- tina. A few thin and easily torn cellular laminae were observed on the external sur- face of this ossification, which seemed to be the only remains of the choroid coat. At the apex is seen a small rounded perfora- tion, through which passed the retina, to be expanded on the interior surface of the ossification. This eye was Amaurotic, but the particular history of the case was not known. The gentleman was also blind of the other eye, but in it there were no ap- pearances of diseased structure. In these three figures, the Ossifications in the two first resemble one another, that of the third being quite different. I PLATE XVII. Fig. 1. — Is the drawing of a Tumor on the Optic nerve from Mr. Heaviside’s collection, for which I am indebted to Mr. Howship. The tumor appears to have formed in the Neurilema of the nerve, and no further history of the patient was known, than that he was Amaurotic of this eye. Fig. 2. — Represents a vertical section of the eye-ball, described in Chap. XXIX. p. 70, where a watery fluid had collected between the choroid coat and retina, in VOL. ir. u 290 EXPLANATION OF PLATE XVII. such quantity, as to compress the retina, into a chord, and produce a complete ab- sorption of the vitreous humor. This drawing represents the anterior por- tion of the eye-ball, so that the compressed retina is distinctly seen terminating at, and closely surrounding the neural portion of the crystalline capsule. a, a, a , The outline of the sclerotic coat. b , b , b , The choroid coat. c, The Retina covering the neural por- tion of the crystalline capsule. d , Section of the Retina compressed into a chord. The eye in this instance appeared, on a superficial examination, to be affected with cataract, a white substance being seen be- hind the pupil. An attempt was made to couch what was conceived to be the opaque lens, — a fruitless operation, which gave great pain. i-late yrm. ■ ‘'L Ay ,y / />, . /rA /','L‘~ f /-,// . V PLATE XVIII. In this plate is delineated a Staphyloma- tous swelling of the sclerotic coat, the cor- nea being at the same time quite disor- ganized ; these changes having taken place in an adult in consequence of a se- vere attack of Puriform Ophthalmia. END OF VOL. II. Loudon : Printed by W. Buimerawi W, Nicol Cleveland-row, St. James’s. I Wardrop 183^ v, 2