OPHTHALMOLOGY. Two years ago when the Rontgen rays had but recently been discovered it was predicted that, amongst other uses, they would be a help in determining the presence of foreign bodies in the eyeball. Attempts at first were unsuccessful, but during the past year considerable success has been achieved. De Schweinitz3 related a case before the Ophthalmic Section of the College of Physicians, Philadelphia, in which he had twice attempted the extraction of a piece of steel with the electromagnet and failed: on the twelfth day after the injury the fragment was located by the X-rays, extracted, and good vision resulted. Two cases are recorded4 of the presence of a foreign body in the lens being determined by this means, and A removed with good results some months after the injury. 3
Am.
J.
M. Sc.,
1897,
cxiii. 566; abstract in Ophth. Rev., 4 Ophth. Rev., 1897, xvi. 396.
1897,
xvi. 94.
OPHTHALMOLOGY.
v^llar
case
is
in which
one
a
chip
51
of steel had been in the
chamber for no less than eighteen months. It is welljv.nreous ?Wn how easily foreign bodies become "lost" in the orbit. a^a^n we records of the successful use of skiagrams ; a l^arf6 a fragment of a percussion cap, and a piece 1of steel et 1 6^^et> Kibbe relates thr 6 Caseseight months are examples of this. *n which a foreign body was diagnosed, located, and rem
' and a fourth case in which the fragment had glanced cornea and lodged in the eyelid. Owing to the oedema 0f m'?ht otherwise have escaped detection for an ind Period. Considering that it is frequently impossible to la?nose the presence of a foreign body in the globe by ^ nS ophthalmoscope, and the immense importance of an diagnosis, all the skiagrams that can be obtained will va^ue- ^ would undoubtedly be of service if all ^
off
,,le
fi6
?
^-ni^e
thos
Cj^Ura*:e 111
whom there
probability of there being a fragment might have been quiet for months cou^ be subjected to the Rontgen rays under the lrnproved conditions : radiography would make further acj Ces> and with the increased statistics, the risk of a foreign kQcj in the eyeball could be more correctly estimated. It w 0u^d r^ma^ning not of course follow that if a fragment were detected an
jn
?6 ^ exisrarSlnS
or
e' even
was a
though
it
would be advisable. that ?|^era^on there are many cases in which
everif^6'
syrtipt(^
anc^
a
diagnosis was owing to the unexpected
subsidence of
the process various methods have been a rapid plate on the
^ec^111^(lue
adont
chip
correct
abandoned
can be little doubt of steel has entered originally made, but
There
a
Some have simply bandaged ?P0nchng temple and then projected hut
c0rr
plate
the rays transversely, have used a narrow as far as possible into the inner canthus and ? rays from the corresponding temple. But by far the ?d is that of Mackenzie Davidson2 by which not only Sltl0n but the approximate size of the foreign body can
lre?ted
aimecj^ys^ed best.
slightly
backwards
; others
the J11? be a ascertained.
ave seen
reports of some twenty-five cases in which the used with success. Though in some CeS was loss of hair on the exposed temple, there Was i CaS6 an7 ser^0lls result;. Chalupecky3 has made some S^ experiments on this subject. Up to a certain point there ls an between the ultra-violet rays and those of analogy R5nt &nc^ thought it likely that the latter would have ct has upon been ?Unc^ that the sensitive structures of the eye. It though the cathode rays are invisible in the 0rdin they still produce a sensation of light. This is ,Sense? ^ ^Ue' n?t to interruption of the rays by the lens and ?re fluorescence of that structure, but to the retina being
Ront insta
rays there
were
intere1^0 sornebGff' r
aPparar^ theref6
^r?h. Ophth., 1897, 3
See
xxvi. 517.
Q
Brit. M. J., 1898, i. xvi. 336.
Ophth. Rev., 1897,
10,
372.
OF THE MEDICAL SCIENCES.
PROGRESS
.52
rendered fluorescent and so stimulating itself. Chalupecky's experiments on rabbits in May last show that prolonged exposure ?some twenty-four hours?to the X-rays produced congestion and inflammation of the superficial structures; succeeded in a few days by baldness of the side of the head towards the
Crookes's tube, and acute inflammation of the cornea followed by dense grey opacity. The effect, in short, was similar to that of some active chemical irritant. The other side of the head was in no way affected and the general health of the animal remained good. Casey Wood refers1 to an instance in which a patient's head was submitted to the rays for about an hour, with the result that he lost a portion of his scalp and most of I cannot, however, find any single the surrounding hair. instance recorded of any serious injury being done in the attempt to radiograph a foreign body in the eyeball.
The literature of Glaucoma still grows apace. Czermak suggests that the increase of tension may in some cases be due a to shallow anterior chamber which is consequent on diminished secretion of the aqueous. In favour of this view he adduces the fact that the ciliary processes (which secrete the aqueous), are atrophied in the senile eye. Priestley Smith, reviewing Czermak's paper2 points out the fact that the anterior chamber is very slowly re-established after iridectomy for glaucoma; that blood in the anterior chamber is very slowly absorbed under such conditions; and that the deterioration of vision after operation without further increase ot A good of the secreting organs. been recorded in which taxis has beneficial. Several observers have seen serious harm from the use of cocaine in glaucoma ; but Groenouw (Breslau) advocates its use, not as a substitute for iridectomy, but as a remedy in
tension many
points
cases
to
degeneration
proved
have
He related three cases of acute in which eserine fails. and two of absolute glaucoma, in which cocaine was successful. I have never ventured to rely on it in acute or subacute glaucoma, but a weak solution of it in conjunction with weak eserine often acts better than eserine alone. ln absolute glaucoma it is of course perfectly safe to use cocaine, and I have frequently found it beneficial. Its good effect is probably partly due to the temporary contraction of the vessels of the iris and ciliary region which it produces. Weill, ?* of in rabbits! the to set Zurich,3 attempted eyes up glaucoma but, like the experiments of Mauthner, his results were negative, yet his theory remained unshaken. Assuming, therehe is due to irritation of the that
those
cases
rglaucorna
glaucoma
fore,
advocates excision of 1
a
sympathetic, sympathetic*
of the cervical
2 vii. 44. Ophth. Rev., Am'. J. Ophth.,' 1898, xv. 12.
Ophth. Rec., 1898, 3
portion
1897,
xvi. 201.
OPHTHALMOLOGY.
Th
recent
the6]^0^
statistics show that *
Attempts
53
early iridectomy
still
gives
*
if
conjunctival sac aseptic have not Randolph (Baltimore)1 found germs in the Sac *n ^?' out 0 Of these 100 healthy subjects. 80 J!!niCftiVal * were half with and treated with aseptic irrigation j The irrigation corrosive sublimate solution. Wa-? ^00? q ? thorough and was repeated three times in each case.. were then made, and it was found that the aseptic an, Ures. treatment were equally futile. an^seP^c Only about 20 per Cent. of the conjunctival sacs were rendered sterile. In aj case the micro-organism found was one closely every rel to the staphylococcus pyogenes albus, but with much less ,Pa*hogenic activity, and identical with the staphylococcus 6pby Welch as a regular inhabitant of the skin and ^ri^^^s.^escr^e
Am.
J.
M. Sc.,
1897,
cxiii. 566; abstract in Ophth. Rev., 4 Ophth. Rev., 1897, xvi. 396.
1897,
xvi. 94.
OPHTHALMOLOGY.
v^llar
case
is
in which
one
a
chip
51
of steel had been in the
chamber for no less than eighteen months. It is welljv.nreous ?Wn how easily foreign bodies become "lost" in the orbit. a^a^n we records of the successful use of skiagrams ; a l^arf6 a fragment of a percussion cap, and a piece 1of steel et 1 6^^et> Kibbe relates thr 6 Caseseight months are examples of this. *n which a foreign body was diagnosed, located, and rem
' and a fourth case in which the fragment had glanced cornea and lodged in the eyelid. Owing to the oedema 0f m'?ht otherwise have escaped detection for an ind Period. Considering that it is frequently impossible to la?nose the presence of a foreign body in the globe by ^ nS ophthalmoscope, and the immense importance of an diagnosis, all the skiagrams that can be obtained will va^ue- ^ would undoubtedly be of service if all ^
off
,,le
fi6
?
^-ni^e
thos
Cj^Ura*:e 111
whom there
probability of there being a fragment might have been quiet for months cou^ be subjected to the Rontgen rays under the lrnproved conditions : radiography would make further acj Ces> and with the increased statistics, the risk of a foreign kQcj in the eyeball could be more correctly estimated. It w 0u^d r^ma^ning not of course follow that if a fragment were detected an
jn
?6 ^ exisrarSlnS
or
e' even
was a
though
it
would be advisable. that ?|^era^on there are many cases in which
everif^6'
syrtipt(^
anc^
a
diagnosis was owing to the unexpected
subsidence of
the process various methods have been a rapid plate on the
^ec^111^(lue
adont
chip
correct
abandoned
can be little doubt of steel has entered originally made, but
There
a
Some have simply bandaged ?P0nchng temple and then projected hut
c0rr
plate
the rays transversely, have used a narrow as far as possible into the inner canthus and ? rays from the corresponding temple. But by far the ?d is that of Mackenzie Davidson2 by which not only Sltl0n but the approximate size of the foreign body can
lre?ted
aimecj^ys^ed best.
slightly
backwards
; others
the J11? be a ascertained.
ave seen
reports of some twenty-five cases in which the used with success. Though in some CeS was loss of hair on the exposed temple, there Was i CaS6 an7 ser^0lls result;. Chalupecky3 has made some S^ experiments on this subject. Up to a certain point there ls an between the ultra-violet rays and those of analogy R5nt &nc^ thought it likely that the latter would have ct has upon been ?Unc^ that the sensitive structures of the eye. It though the cathode rays are invisible in the 0rdin they still produce a sensation of light. This is ,Sense? ^ ^Ue' n?t to interruption of the rays by the lens and ?re fluorescence of that structure, but to the retina being
Ront insta
rays there
were
intere1^0 sornebGff' r
aPparar^ theref6
^r?h. Ophth., 1897, 3
See
xxvi. 517.
Q
Brit. M. J., 1898, i. xvi. 336.
Ophth. Rev., 1897,
10,
372.
OF THE MEDICAL SCIENCES.
PROGRESS
.52
rendered fluorescent and so stimulating itself. Chalupecky's experiments on rabbits in May last show that prolonged exposure ?some twenty-four hours?to the X-rays produced congestion and inflammation of the superficial structures; succeeded in a few days by baldness of the side of the head towards the
Crookes's tube, and acute inflammation of the cornea followed by dense grey opacity. The effect, in short, was similar to that of some active chemical irritant. The other side of the head was in no way affected and the general health of the animal remained good. Casey Wood refers1 to an instance in which a patient's head was submitted to the rays for about an hour, with the result that he lost a portion of his scalp and most of I cannot, however, find any single the surrounding hair. instance recorded of any serious injury being done in the attempt to radiograph a foreign body in the eyeball.
The literature of Glaucoma still grows apace. Czermak suggests that the increase of tension may in some cases be due a to shallow anterior chamber which is consequent on diminished secretion of the aqueous. In favour of this view he adduces the fact that the ciliary processes (which secrete the aqueous), are atrophied in the senile eye. Priestley Smith, reviewing Czermak's paper2 points out the fact that the anterior chamber is very slowly re-established after iridectomy for glaucoma; that blood in the anterior chamber is very slowly absorbed under such conditions; and that the deterioration of vision after operation without further increase ot A good of the secreting organs. been recorded in which taxis has beneficial. Several observers have seen serious harm from the use of cocaine in glaucoma ; but Groenouw (Breslau) advocates its use, not as a substitute for iridectomy, but as a remedy in
tension many
points
cases
to
degeneration
proved
have
He related three cases of acute in which eserine fails. and two of absolute glaucoma, in which cocaine was successful. I have never ventured to rely on it in acute or subacute glaucoma, but a weak solution of it in conjunction with weak eserine often acts better than eserine alone. ln absolute glaucoma it is of course perfectly safe to use cocaine, and I have frequently found it beneficial. Its good effect is probably partly due to the temporary contraction of the vessels of the iris and ciliary region which it produces. Weill, ?* of in rabbits! the to set Zurich,3 attempted eyes up glaucoma but, like the experiments of Mauthner, his results were negative, yet his theory remained unshaken. Assuming, therehe is due to irritation of the that
those
cases
rglaucorna
glaucoma
fore,
advocates excision of 1
a
sympathetic, sympathetic*
of the cervical
2 vii. 44. Ophth. Rev., Am'. J. Ophth.,' 1898, xv. 12.
Ophth. Rec., 1898, 3
portion
1897,
xvi. 201.
OPHTHALMOLOGY.
Th
recent
the6]^0^
statistics show that *
Attempts
53
early iridectomy
still
gives
*
if
conjunctival sac aseptic have not Randolph (Baltimore)1 found germs in the Sac *n ^?' out 0 Of these 100 healthy subjects. 80 J!!niCftiVal * were half with and treated with aseptic irrigation j The irrigation corrosive sublimate solution. Wa-? ^00? q ? thorough and was repeated three times in each case.. were then made, and it was found that the aseptic an, Ures. treatment were equally futile. an^seP^c Only about 20 per Cent. of the conjunctival sacs were rendered sterile. In aj case the micro-organism found was one closely every rel to the staphylococcus pyogenes albus, but with much less ,Pa*hogenic activity, and identical with the staphylococcus 6pby Welch as a regular inhabitant of the skin and ^ri^^^s.^escr^e
