On the Treatment of Acute and Chronic Bright's Disease

G. Johnson
1870 BMJ (Clinical Research Edition)  
August 6, I870.1 THE BRITISH MEDICAL 7OURNAL. its posterior surface is very slightly increased. With this alteration of its figure, the axis is lengthened and the transverse diameter shortened. The pupillary region of the iris approaches the cornea, and the circumference of the iris retreats from it. The lens with its capsule is elastic, but without contractile irritability; its r6le is passive. When the suspensory ligament is tight, it must exert traction on both surfaces of the lens (chiefly
more » ... the lens (chiefly on the front, by reason of the greater stoutness of the fibres and of their attachment to the lens advancing rather further from the edge of the lens), tending to compress the lens in the direction of its axis and to flatten it-the shape of the lens in looking at a distant object, which is a passive act, not requiring accommodation. When the radial or longitudinal bundles of the ciliary musdle contract, and the distance between their extreme points of attachment is lessened, the previously tense suspensory ligament is relaxed; and the lens, no longer compressed by it, becomes more convex by virtue of its own elasticity. If at the same time the circular bundles of the muscle were to shorten, this would tend to contract the circle of the ciliary processes, by which the suspensory ligament would be still more slackened. I doubt, however, whether they can act as a compressor of the edge of the lens. The ciliary muscle derives its nerves from the lenticular ganglion. They pierce the sclerotic not far from the optic nerve; and, gaining the inner surface of this coat, they run forwards between it and the choroid till they reach the ciliary muscle, on the outer surface of which they break up and recombine in the well-known beautiful plexus, a large portion of which is, however, destined for the innervation of the iris. From this coarse plexus, bundles of nerve-fibres dip into the muscle, in which they form a finer net, from which single fibres of extreme tenuity are traceable for long distances amongst the muscular bundles; but I have not yet discovered the actual nature of their ultimate connection with the muscular fibre. In my last course of lectures, I adverted to the occurrence of ganglion-cells in this plexus. They first became known to me by the beautiful preparations of Schweigger, and are not the coarser gangliform swellings recognisable under slight enlargement described by Dr. R. Lee, jun. The arteries of the ciliary muscle are drawn from the circulus arteriosus major iridis, which distributes many recurrent twigs to it. These are not infrequently offsets of the arterioles which this arterial circle sends to the ciliary processes. The venous blood escapes in two directions-posteriorly, through veinlets which join those of the ciliary processes and lead to the venme vorticosve; and in front, through veinlets which empty their contents into the circulus venosus in Schlemm's canal.
doi:10.1136/bmj.2.501.135 fatcat:zrgsrhz24zdjzihu54z7zuekme