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swelling was intense and the pain for several days was very great. Local application failed to afford relief, and morphia was required. At this period in my experience, stimulated by this discouraging feature, an effort was made to determine the cause of the pain. The anatomical fact that the long ciliary nerves lie in exposed grooves along the concave surface of the sclera, leading forward to the ciliary region, led at once to the hypothesis that the cause of the pain was the tension, pressure and inflammatory irritation to which these nerves were subjected.
To test the truth of this hypothesis the entire concave surface of the sclera was cauterized with pure carbolic acid immediately following evisceration in a case of extremely painful panophthalmitis consequent upon an incision, the suffering attending which had been intense for several days.
The result surpassed all expectations. The pain ceased with the operation. The degree of swelling was small and the patient was discharged in five days. Since this operation the number of eviscerations has been about twenty-five. The results have not been uniformly so brilliant. Sometimes the conjunctiva has become œdematous and been forced out through the palpebral aperture, but in no case, in which the cauterization has been efficient, has there been the type of pain which was remarked previous to the cauterizing treatment.
It is believed that the use of the acid in this connection is indicated
- On account of its quality as an antiseptic.
- Because it is an anæsthetic.
- Because it is believed to close the apertures in the sclera, and thus prevent the escape into the orbit or sheath of the nerve, of any microörganisms which should escape the action of the acid.
