I. CASE OF CORNEAL TRANSPLANTATION FROM 
THE RABBIT’S TO THE HUMAN EYE. 
II. A SINGULAR CASE OF INJURY. 
BY 
william; f. smith, m.d. 
MEMBER OE THE HEIDELBERG OPHTHALMOLOGICAL SOCIETY; LATE OCULIST TO 
COOK COUNTY HOSPITAL; OPHTHALMIC SURGEON TO THE ALEXIAN 
BROTHERS’ HOSPITAL; OCULIST AND AURIST TO THE 
EMERGENCY HOSPITAL, CHICAGO. 
[Reprintedfrom the Archives of Ophthalmology,Vol. xix., Nos. 2 & 3,1890] CASE OF CORNEAL TRANSPLANTATION FROM 
THE RABBIT’S TO THE HUMAN EYE; 
RESULT NOT VERY FAVORABLE. 
By WILLIAM F. SMITH, M.D. 
MEMBER OF THE HEIDELBERG OPHTHAI.MOLOGICAL SOCIETY ; LATE OCULIST 
TO COOK COUNTY HOSPITAL ; OCULIST AND AURIST TO THE 
AI.EXIAN AND EMERGENCY HOSPITALS. 
(With Two Figures). 
December 6, 1888, Mary Katus, a Polish woman, was brought 
to my office by her brother. She is twenty-seven years old, 
very delicate, and slightly built. When she was three years old 
she suffered from an attack of small-pox, which left her totally 
blind. 
The bulb of the left eye is soft and partially atrophied. The 
corneal membrane is entirely changed into cicatricial tissue. 
There is no perception of light. The sightless ball diverges and 
is in constant motion. 
The right eye is nearly normal in size and tension. A dense 
leucoma occupies almost the entire extent of cornea, leaving 
only a very narrow margin (less than 1 mm in width) of partially 
transparent membrane just within the sclero-corneal junction. 
There is no visible anterior chamber, the iris apparently being 
firmly united to the posterior surface of the leucoma. The ten- 
sion is not quite normal, making it probable that the lens was 
evacuated when the cornea was ruptured. Light perception, 
however, is good and the phosphenes are easily excited. 
According to Von Hippie’s rules it did not seem a case for 
which a transplantation could be done successfully. The rela- 
tives were very persistent, however, and I finally consented to 
make the attempt. 
Reprinted from the Archives of Ophthalmology, Vol. xix, No. 2, 1890. 137 
Corneal Transplantation. 
Von Hippie’s instrument not being available, I had one made 
by Messrs. Sharp & Smith, of this city,—a simple trephine with- 
out spring or clock work. It consists of a cutting-cylinder 4 mm 
in diameter and 10 mm long. This is cup-shaped, and perforated 
through its bottom, the perforation furnished with a screw thread. 
Into this is screwed a shaft, 2 inches long, furnished with a milled 
head. Cutting-cylinder with shaft attached is shown at A, Fig. 1. 
Over the shaft fits a metal cylinder just long enough to play 
FIG. I. 
freely between the end of the cutting-cylinder and the milled 
head of the shaft. One end of this cylinder is furnished with a 
screw thread for the hood, £7, which moves over the cutting- 
cylinder. The instrument, when put together for use, is repre- 
sented at D. By means of the hood the depth of the incision 
may be exactly graded. The free end of the hood is square-cut. 
Its inner edge plays as closely as possible to the outer surface of 
the cutting-cylinder. 
The patient was assigned a bed in the Emergency Hospital. 
A healthy rabbit, one year old, was procured. The operation 
was made December 13. The most thorough antiseptic pre- 
cautions were taken before, during, and after the operation. I 
was assisted by Dr. Hall and Mr. Schwann. Anaesthesia by 
chloroform was carried to as complete a degree as safety would 
allow. The patient proved a most excellent subject for chlo- 
roform, and took it kindly, with no struggle or any tendency to 
vomit. 
The hood of my little instrument was fixed so as to expose 
exactly 0.9 mm of the cutting-cylinder. The point chosen for William F. Smith. 
138 
its action was about 2 mm downwards and inwards from the 
centre of the cornea. The instrument was held firmly with the 
left hand, while the milled head of the shaft was turned slowly 
with the right, so that the cutting edge, which was as sharp as it 
could be made, sank readily and evenly into the cicatrized cor- 
nea. The button to be removed was fixed by the fixation bident, 
with points reversed, and drawn upwards while it was carefully 
cut out with a small Graefe knife. This I found to be a very 
delicate piece of work, but was reasonably successful. The bot- 
tom of the mortise thus made was still opaque, except in one 
small spot not larger than half of the area of a pin’s head, and 
it was impossible to determine whether or not this was a remnant 
of the membrane of Descemet. Further efforts to clear away 
tissue were abandoned for fear of penetrating the bulb. There 
was some little bleeding from the margins of the cut, which was 
stilled by a few drops of a solution of boric acid. The rabbit 
was now slightly narcotized with chloroform, and a few drops of 
a 10 °J0 solution of cocaine were allowed to fall on its cornea. 
The nictitating membrane, or third lid, was cut across with a 
strong pair of scissors, as was also the orbicularis at the external 
canthus. This was done to prevent interference by spasmodic 
action on the part of these muscles. 
The hood over the cutting-cylinder was moved back so as to 
expose several millimeters of the free end, and an attempt was 
made to cut through the clear cornea at one turn of the cylinder. 
This failed. The division was not complete, and as it was im- 
possible to replace the knife so that it would complete the 
incision, the other eye of the rabbit had to be prepared. This 
was done after some little delay, when the second attempt, during 
which several turns of the cylinder were made, was entirely 
successful. The button of the rabbit’s cornea had been forced 
up into the cup of the cutting-cylinder. The instrument was 
taken apart, and after the shaft had been removed the cutting- 
cylinder was fitted into the mortise already prepared in the 
patient’s eye, and the button of cornea from the rabbit was 
forced down into it by means of a wooden tooth-pick fashioned 
for the purpose. The transplanted membrane lodged snugly in 
the place designated for it. It will be remarked that its surfaces 
had not been handled or in any way interfered with by any harsh 
instrument after it had left its natural location. The eyelid was 
drawn down over it and held t?y the hand of an assistant while 139 
Corneal Transplantation. 
the patient was, as gently as possible, brought from under the 
influence of the chloroform. The fact before mentioned, that 
there had been no vomiting, was of great assistance in carrying 
out the details of the operation. 
The importance of remaining perfectly still was impressed 
upon the patient. She was carried to her bed, and I think I can 
say she did not move for twenty-four hours ; a trained nurse was 
at her side during all that time, and so assured me. To this fact, 
and to the gentle, tractable nature of the patient, is due the per- 
fect union that occurred, and was maintained till the healing 
process was complete. No bandage or packing was used other 
than a simple strip of gauze fastened round the head in such a 
manner as to hold the lids gently closed. I should have stated 
that the patient’s face and eye had been cleaned with a boiled, 
saturated solution of boric acid, and with sterilized water. None 
of the usual irritating, antiseptic solutions had been used about 
the eye operated on. 
For seven days the patient was kept, for the most part, in a 
recumbent position, after which she was allowed some liberty. 
The healing process seemed to be complete in about two weeks, 
and in three weeks after the operation she returned to her home 
in Streator, Illinois. 
At the time of leaving the hospital the transplanted piece was 
slightly elevated above the surrounding tissues, but the margin of 
union was smooth and presented no evidence of irritation. The 
button of rabbit’s cornea had retained its transparency, but 
rested upon an opaque surface, except at the small spot before 
mentioned, which was dark, and through which evidently some 
light reached the fundus. She could see any object held between 
the eye and the light, but could tell nothing about outlines. More 
could not be expected from one who had been so long totally 
blind. 
About six months after the operation I was informed by the 
relatives of the girl that she could do “ ordinary house-work”; 
and a few weeks ago a paragraph appeared in a local paper to 
the same effect. I had repeatedly written for the parents to bring 
the girl to the city in order to be able to report upon the condi- 
tion after so many months. For some reason they were not able 
to come till last week, when her brother again brought her to the 
office. William F. Smith. 
140 
Her general health has very much improved. She is now 
robust and stout. The transplanted piece of cornea has sunk to 
a level with the surrounding tissues, indeed somewhat below them, 
especially at the centre, so that it appears like a facet polished on 
the surface of a sphere. The tissue upon which it has grown is 
not any more transparent than before. The small spot still has 
the dark appearance that indicates partial transparence, and she 
can now tell something about the outlines of objects held between 
her and the light. Her brother says she can tell the “ chickens 
from the dogs and cats and other animals in the farm-yard,” and 
that “ she does considerable work about the house.” The accom- 
panying drawing, Fig. 2, is a rough sketch of the eye as it now 
appears to me. 
Fig. 2. 
The line separating the transplanted piece from the rest of the 
cornea is not quite as well marked as here represented, and I 
have failed to show the facet-like appearance spoken of. The 
curved line passing from the centre of the cornea downward is a 
blood-vessel. The spot to the left of it indicates the location of 
a chalk-like deposit (calcareous matter) in the thickness of the 
leucoma. On examining closely the transplanted portion with a 
lens, it is easily recognized as transparent, and the bottom of 
the mortise can be seen as a rough surface dotted over by very 
fine points of the same chalk-line deposit. In the lower, inner 
quadrant is seen the dark, semi-transparent portion before 
described. 
Both the patient and her brother say that her vision is im- 
proving. For some reason the very narrow margin of cornea 
described as existing at the first examination near the sclero- 
corneal junction seems to have widened, and the blue of the 
underlying iris is more perceptible. Perhaps her improved 
general health, and consequently increased activity, constitute 141 
Corneal Transplantation. 
the reasons her relatives have for believing that her vision is 
actually improving. 
I have attempted corneal transplantation five times in hospital 
practice, and this is the only case approaching success. It must 
be acknowledged that in it the circumstances were exception- 
ably favorable to successful union. The result cannot be con- 
sidered very favorable. It only shows that in a case of central 
leucoma the cicatricial tissue of which does does not include 
the membrane of Descemet, and where an anterior chamber still 
exists, a transplantation may be successful, and the transparency 
of the transplanted section may be maintained. But in just such 
a case an iridectomy would be a far preferable operation. 
204 Dearborn St., Chicago, March 26, 1890. A SINGULAR CASE OF INJURY — BLINDNESS FROM 
A PENETRATING WOUND OF 
CHEEK AND ORBIT. 
WILLIAM F. SMITH, M.D., of Chicago. 
January 2d, of this year, I was called, in consultation with Drs. 
Lee and Murphy, to see a boy who had become blind in his left 
eye from an accident. 
The patient, twelve years old, healthy and well developed for 
his age, gave the following account of the injury. Himself and a 
few companions had been playing in a stable near his father’s 
house. They were in a hay-loft, and he had accidentally fallen 
through a concealed opening to the floor below. One of his 
companions had been chasing him about the loft, and had in 
his hand a hay-fork with two tines. This fork fell, or was thrown, 
through the opening at the moment our patient fell, and when 
he reached the floor one of the tines of the fork went into his 
cheek. The fall in itself did not hurt him; he was not bruised 
or dazed, but pulled the tine out of his cheek himself. When 
asked how far it had penetrated, he held up his hands so as to 
indicate about two and a half or three inches. He started to 
the house with his little friends. When he got to the door-step, 
he says he noticed that he was blind in the left eye. He was 
sure about this, because he said he had accidentally closed the 
right eye and found that he could see nothing at all with the 
other. 
The mother said the boy had complained of very little pain, 
but being very much alarmed she had sent for the nearest doctor, 
who had simply put a few drops of an eye-water in the eye, the 
purpose of which she did not know. 
The accident had happened forty-eight hours before I saw 
him. 
Upon examining the eye we found that the pupil was dilated, 
but as the physician who had been first called had evidently 
used a solution of atropine, this was of no significance. The 
most careful tests failed to show that there was any perception 
Reprinted from the Archives of Ophthamology, Vol. xix. No. 2, 1890. 143 
Blindness from a Penetrating Wound. 
of light in this eye. The ophthalmoscope showed the optic 
mediae perfectly clear, and the circulation of the fundus normal. 
On the left cheek, about half an inch below the alveolar pro- 
cess of the superior maxillary bone, and about half way between 
the chin and the angle of the lower jaw, was a small penetrating 
wound. It could be traced upwards, backwards, and inwards 
entirely through the cheek. Opposite the wound in the inner 
side of the cheek another opening, evidently the continuation of 
the wound, was found in the mucous membrane over the alveolar 
process, and near the root of the second molar tooth. There 
was no discharge from this opening, and we did not penetrate it 
to any depth. There was no evidence of fracture anywhere, yet 
we had to conclude that the wound was in some way responsible 
for the blindness. The patient showed no evidence of any in- 
flammatory process, there was no elevation of temperature, no 
headache, and no symptoms of cerebral lesion. 
Upon returning to the office I took a skull to examine the rela- 
tion of the parts. With a letter-opener, which is a long, narrow 
blade, I was surprised to see that when I pressed its point against 
the alveolar process of the second molar in the direction of the 
wound we had been examining, it found its way directly through 
the spheno-maxillary fissure at about its centre, across the apex 
of the orbit, and exactly bisected the optic foramen, the point 
being arrested by the upper anterior wall of that foramen. Indeed, 
pressing the point of the instrument anywhere within half an inch 
of the spot first chosen, the bones of the neighborhood formed 
a sort of funnel, which drove the instrument directly to the optic 
foramen. I was therefore forced to the conclusion that the tine 
of the fork had actually crushed the optic nerve just where it 
enters the orbit. 
I have since made three examinations of the patient at inter- 
vals of ten days. At the last occasion I was able to determine 
that the optic disc had lost some of its color. The arteria cen- 
tralis retina, however, seemed as prominent as ever, and the rest 
of the fundus had undergone no change. The eye became con- 
siderably diverged, and was displaced upwards. The pupil was 
dilated to a medium degree when the other eye was covered, but 
reacted promptly with the other. There has never been the 
slightest light-perception since the accident. I have kept the 
eye under observation with considerable interest. 
Has any confrere ever heard of a similar case ? 
204 Dearborn St., Chicago.