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SEELY: Notes on Ocular Thterapeutics.

NOTES ON OCULAR THERAPEUTICS. BY W. W. SEELY, M.D., CINCINNATI, 0.

THE first point I desire to notice is in the use of the yellow oxide of mercury in external ocular troubles. Probably every one has found the use of this remedy, whether in corneal or conjunctival diseases, like calomel in the past, often attended with pain. This often-recurring fact and disadvantage led me some time ago to institute some investigations in regard to the cause or causes. So far as regards the strength of the preparation, I have found that ten grains to the ounce of the vehicle is the best for all purposes. When I began to enquire into the mode of action of the yellow oxide I found that this preparation was regarded chemically as an insoluble substance. My theory in regard to its action at first was, copying from the supposed action of calomel, that a chemical change occurred; but finding that it was an insoluble substance, and &ence inert, this explanation seemed to fail. I took a large number of specimens, and had them analyzed, and found that all the so-called " chemically pure " preparations contained more or less bichloride, and the inference from this was that its action depended on this residuum in its manufacture. My assistant, Dr. Caldwell, has lately been working at the subject, and is satisfied that there is a certain amount of solubility in the yellow oxide, to what degree tests have not

decided. One point seems settled-that the less bichloride a preparation contains, the less the pain produced by the salve, efficiency remaining the same.

SEELY: Notes on Ocular Therapeutics.

5II

I desire to add one more practical point in the use of the yellow oxide and vaseline, as devised by myself some years ago in conjunctival affections. Those who have used this combination have doubtless found that in cases where there is a profusion of tears the salve is so quickly washed out that little or no benefit results. In such cases I substitute eserine or the bichloride in solution to contract the blood-vessels. The strength of the bichloride solution that seems to answer every purpose is one part to seven or eight thousand (one grain to sixteen ounces water), or about one-third the strength preventive of the growth of the bacteria of ordinary decomposition. Such a solution, entirely painless, has often, in my hands, set aside an acute catarrhal conjunctivitis of violent typeafter one to three or four thorough drenchings of the con-

junctiva. This is the strength I have used for a long time as an antiseptic in various operations. In corneal affections I still use, as I have done for a long series of years, a four-grain solution of eserine. I merely state this to introduce a point I regard of great practical importance. In my hands one thorough application of a four-grain solution once a day acts altogether better than more frequent applications, either of the same solution or that of weaker ones. This remark applies to all classes of pases. One point more in regard to eserine. For the reduction of intra-ocular tension eserine has for me entirely done away with paracentesis, and for so long a time and so completely that this procedure has really only an historical interest. Everyone has met with cases of iritis in which atropine does not seem to act promptly and satisfactorily, possibly because an increased tension prevents its entrance, or possibly because of the extreme vascularity of the iris, which I regard as the more probable. In such cases, instead of making paracentesis or abstracting blood, I instil once a day a few drops of a four-grain solution of eserine. In fact, the habit of instilling eserine once a day

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SEELY: Notes on Ocular Therapeutics.

in iritic cases has become a routine practice, the patient-using the mydriatic in the ordinary manner. Iritis is the only disease in which I employ a mydriatic as the fundamental remedy. In more than one case I have seen adhesions let go under the combined action of the myotic and mydriatic that had resisted the latter alone. In my judgment eserine is the remedy par excellence in corneal affections. In cases in which mydriasis is necessary this latter can be produced perfectly and still the specific effects of the myotic kept up. This is beautifully illustrated in suppurative inflammation after cataract operations, formerly so unsuccessfully treated by heat and atropine. REMARKS.

DR. McKAY said that some years ago he became interested in an article written by Dr. Seely, and published in one of the Western journals, in which the use of the yellow oxide of mercury was spoken of very highly. Since that time he had resorted to its pse in nearly all cases in which an astringent has been considered desirable in conjunctival troubles, and so far had been very favorably impressed with its effects. DR. GRUENING said, with reference to the alternate use of imydriatics and myotics for breaking up adhesions, that the method was not quite new. Hle had seen it resorted to in Paris in I868. With regard to eserine in iritis that was something entirely new, and he should regard it as a most dangerous practice. He could produce iritis with eserine at any time in a healthy eye, and also in a diseafed eye. His experience had been that iritis was aggravated by eserine. He had used eserine after cataract operations and had set up iritis. In cases of suppurative keratitis he had ceased to employ eserine com-

pletely. DR. KNAPP said, with reference'to the use of eserine and atropine, that eserine is apt to produce iritis, and may even be injurious after iridectomy for glaucoma. But there are some forms of iritis, especially the serous variety, where the alternate use of these two remedies is of advantage. Again, in plastic iritis, when there is increase of tension which produces intense pain, the patient sometinies is considerably relieved by the instillation of a drop of eserine. DR. SEELY said he wished to correct what seems to have been an erroneous impression. It was not the alternate use

MITTENDORF: Detachment of the Retina.

513

of eserine of which he wished to speak; not at all. He simply spoke of the use of eserine once a day for the purpose of contracting the blood-vessels, so that the atropine could pass through the corneal tissue more freely. In that way he thought we were able to get up a more free dilatation of the pupil than could be done without the eserine. He had never seen a case in'which eserine had produced iritis, and he had used immense quantities of it. He employed it in conjunctival troubles, always in corneal difficulties, once a day in cases of iritis which came to the dispensary, of course maintaining mydriasis by the use of atropine. DR. KNAPP had given eserine a faithful trial in corneal inflammation since Thalberg published his observations on keratitis from inunction. He had used it in many cases, and at first thought it controlled this process, but later he had not seen that its beneficial action was in any way constant. DR. MCKAY said that in corneal ulcers it had' been his habit recently to use atropine until the inflammation had subsided, and then he used eserine with very good effects, and after such use of eserine he could concur quite fully in what Dr. Seely had said about that drug.

THE TREATMENT OF DETACHMENT OF THE RETINA. BY W. F. MITTENDORF, M.D., NEW YORK.

DURING the last three years I have been called upon to treat several cases of very extensive detachment of the retina, occurring in patients that had only one useful eye, the- other one being entirely blind or absent. The good results obtained by the treatment of these eyes, which were practically blind when I saw them first, encourages me to report them to-day. Although no new remedy or method had been used, it is the combination of the different plans devised for the treatment of this affection and themode of administering the remedies that has led to the success. On account of the uncertainty of operative measures these had not been resorted to.

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