A MIRROR OP HOSPITAL PRACTICE. SELECTIONS FROM OPHTHALMIC PRACTICE IN" TIIE COWASJEE JEHANGHEEIl OPHTHALMIC HOSPITAL, BOMBAY.
By Assistant-Surgeon
George Waters,
Bombay Army.
During the month of October 61 patients were under treatment in the "in-door" department of this hospital. Twentytwo of these were in hospital at the beginning, 39 admitted and 35 discharged during the month, leaving 26 with which to commence the work of November. Diseases of the lens and capsule, of the conjunctiva and of the iris, in the order mentioned, furnished the greater number of cases. This is pretty generally the case. Diseases of the iris were almost entirely of syphilitic origin. For the probable causes of the preponderance of the above diseases, I beg a reference to my paper for the last month. The total number of operations performed during the month of October was 53, as follows :? Operations. For ? ? ?
Entropium Ectropium
Trichiasis Tumour Strabismus
Method.
Number.
Haylies Walton One.
I Yon Griicfe
One. Five. Three. One.
90
THE INDIAN MEDICAL GAZETTE. Operations.
Method.
Number.
[Mat 1, 1871.
Potass Iodidi grs. xxx Mist. Camph. givss m Dose 51SS., three times a day. This treatment was continued for 13 days longer, after wmcn the patient was discharged, well, being able to count No. 25th
day.?]?,
..
..
..
.
For i>
? ? ,,
,, ,,
Pterygium Ditto Fistula
By ligature
Two. One.
Bowman's Excision
Nine. Three. Four. Four.
Excision
laclirymalis
lachrymal obstruction Artificial pupil
and ..
Iridectomy
....
Extraction of the lens Yon Graefo Extraction of foreign bodies .... Puncture of the globe ....
..
Borelli's
Staphyloma
Twelve. Four. Three.
The operation for pterygium by ligature being
a recent invention, and not extensively practised, short description of it may A silk thread, about 14 inches in length, not be unserviceable. tolerably fine, after being well waxed, i3 mounted with two curved needles, each being placed about 43 inches from the end of the thread. The pterygium is then grasped with a pair of spring forceps near its apex, and lifted up from the sclera so as to allow the needles being properly inserted between the two structures, after which one of them is to be drawn through until the middlo of the portion of thread between it and the end lies beneath the pterygium. The other needle being similarly inserted near the base of the pterygium, and drawn through to the same extent, both are to be cut away, leaving three threads, having two ends on one side of the pterygium and four on the other. The two outer* ends are first tied, then the two inner, and lastly the two ends of the central loop, which completes the operation. Tho threads cut through in from 8 days to 3 weeks, completely destroying tho vascular supply, and then follows atrophy of tho remaining segments of redundant tissue. It remains to be seen, however, whether this method possesses any advantages over the old plan of transplantation. I will now proceed to give a few cases in detail.
Brilliant.
10 Case IT.?Sclerotitis; duration 10 days. A. D. , aged years; has been attending the "out-door" for some time without much benefit. Sclera much injected and of a purple hue; I"13 swollen ; at first there was much pain, but it has been recently relieved by the application of leeches; cornea clear; pi'P'1
dilated; bowels constipated. Treatment:?Gutta) Atropice applied frequently. Hydrarg c. Creta Pulv. Rhei. Co.
a
Case I.?Syphilitic iritis ; ten days' duration. J. S. , aged 20 ; complicated with spots of lymph precipitated against posterior walls of both cornea, and all the symptoms of a very aggravated case of syphilitic iritis. Treatment:?Guttoc Atropia) grs. iv-^i instilled 3 times a day. Mist. Terebinth ?i 3 times a day. 2nd day.?Apply fly blisters to both temples, about the size of a penny ; continue atropine and mixture. 3rd day.?.Continue atropine and mixture ; dress blister with savine ointment. 4th day.?Continue all. oth day.?Continue all. 6th day.?13= Potass Bromidi. Potass Iodidi .. a.a. grs. v .. Decoct. Sarzaa Comp. 3iss m. ft. haust. Three times daily. Tho turpentine was discontinued as it produced slight irritation of the urinary passages, and moreover is found to be less beneficial in syphilitic than the rheumatic form of iritis. Continue atropine and savine ointment. 7th day.?Slightly better to-day. Continue. 9th day.?Circumcorneal redness less; no pain ; intolerance of light diminished. Continue Mist. Atropine and grs. v of Plummer's Pill every night. 12th day.?Complains of circumorbital pain. Apply Unguent. Belladonna) Comp. around the orbit. Continue Mist. Atropine and pill. 13th day.?Pain gone. Omit Unguent. Belladonna). 14th day.?Continue rest of treatment. 15th day.?Circumcorneal zone of redness is now very slight ; pupils freely dilated ; no pain. Continue. 17th day.?Continue Mist, and Pill. The pupil having been dilated for a sufficient length of time, strong mydriatics are no longer necessary, therefore substitute Gutta; Belladonna) for tho Atropine solution, 20th day.?Cornea much clearer; circumcorneal injection -almost disappeared. This treatment was persevered in for four ..
days.
24th day.?Ccrnea very hazy from interstitial keratitis. Counts Continue Gutta; Belladonna;, Mist, and eyes. J Pill.
miniature Bull's
....
* I think it convenient to call the base of the pterygium its outer portion.
2nd
grs.
Fotus Papavcrts
iv-Ji.
..
..
..
..
grs. v grs. vii _
To be taken twice
day.?Bowels
not
daily. yet opened; pain of
the
Continue Atropine and Fotus.
globe
less.
Subcliloridi .. grs. i Pulv. Rhei. Co. grs. xx. one at once, the other afterwards, if
Hydrarg
..
..
Mix, make two powders,
necessary. 3rd day.?Scleral redness less; slight pain; bowels still constipated. Continue Fotus and Atropine. Omit Pulv. 01. Recini ?33. .. gss. Aquce Menth. Pip Mix, take at once. 4th day.?Freely purges; redness continues ,to diminish ; no ,.
.,
..
paiu.
Continue Atropine.
Omit Fotus.
01. Morrhuco ., Syrupi Ferri Iodidi To be taken three times a
..
n
day.
5th day.?Scleral .redness all but gone; mation. Continue Mist, and Atropine. 6th
5'!
..
..
day.?Rapidly approaching recovery.
no
pain
or
lachry*
7th day.?All the symptoms have disappeared. Substitute Guttse Belladonna) for Atropine Solution (drops), it being unnecessary?indeed unadvisable?to keep the [pupil any longer bo ?widely dilated. 12th
day.?Discharged perfectly (To
well.
be continued.)
By Assistant-Surgeon
George Waters,
Bombay Army.
During the month of October 61 patients were under treatment in the "in-door" department of this hospital. Twentytwo of these were in hospital at the beginning, 39 admitted and 35 discharged during the month, leaving 26 with which to commence the work of November. Diseases of the lens and capsule, of the conjunctiva and of the iris, in the order mentioned, furnished the greater number of cases. This is pretty generally the case. Diseases of the iris were almost entirely of syphilitic origin. For the probable causes of the preponderance of the above diseases, I beg a reference to my paper for the last month. The total number of operations performed during the month of October was 53, as follows :? Operations. For ? ? ?
Entropium Ectropium
Trichiasis Tumour Strabismus
Method.
Number.
Haylies Walton One.
I Yon Griicfe
One. Five. Three. One.
90
THE INDIAN MEDICAL GAZETTE. Operations.
Method.
Number.
[Mat 1, 1871.
Potass Iodidi grs. xxx Mist. Camph. givss m Dose 51SS., three times a day. This treatment was continued for 13 days longer, after wmcn the patient was discharged, well, being able to count No. 25th
day.?]?,
..
..
..
.
For i>
? ? ,,
,, ,,
Pterygium Ditto Fistula
By ligature
Two. One.
Bowman's Excision
Nine. Three. Four. Four.
Excision
laclirymalis
lachrymal obstruction Artificial pupil
and ..
Iridectomy
....
Extraction of the lens Yon Graefo Extraction of foreign bodies .... Puncture of the globe ....
..
Borelli's
Staphyloma
Twelve. Four. Three.
The operation for pterygium by ligature being
a recent invention, and not extensively practised, short description of it may A silk thread, about 14 inches in length, not be unserviceable. tolerably fine, after being well waxed, i3 mounted with two curved needles, each being placed about 43 inches from the end of the thread. The pterygium is then grasped with a pair of spring forceps near its apex, and lifted up from the sclera so as to allow the needles being properly inserted between the two structures, after which one of them is to be drawn through until the middlo of the portion of thread between it and the end lies beneath the pterygium. The other needle being similarly inserted near the base of the pterygium, and drawn through to the same extent, both are to be cut away, leaving three threads, having two ends on one side of the pterygium and four on the other. The two outer* ends are first tied, then the two inner, and lastly the two ends of the central loop, which completes the operation. Tho threads cut through in from 8 days to 3 weeks, completely destroying tho vascular supply, and then follows atrophy of tho remaining segments of redundant tissue. It remains to be seen, however, whether this method possesses any advantages over the old plan of transplantation. I will now proceed to give a few cases in detail.
Brilliant.
10 Case IT.?Sclerotitis; duration 10 days. A. D. , aged years; has been attending the "out-door" for some time without much benefit. Sclera much injected and of a purple hue; I"13 swollen ; at first there was much pain, but it has been recently relieved by the application of leeches; cornea clear; pi'P'1
dilated; bowels constipated. Treatment:?Gutta) Atropice applied frequently. Hydrarg c. Creta Pulv. Rhei. Co.
a
Case I.?Syphilitic iritis ; ten days' duration. J. S. , aged 20 ; complicated with spots of lymph precipitated against posterior walls of both cornea, and all the symptoms of a very aggravated case of syphilitic iritis. Treatment:?Guttoc Atropia) grs. iv-^i instilled 3 times a day. Mist. Terebinth ?i 3 times a day. 2nd day.?Apply fly blisters to both temples, about the size of a penny ; continue atropine and mixture. 3rd day.?.Continue atropine and mixture ; dress blister with savine ointment. 4th day.?Continue all. oth day.?Continue all. 6th day.?13= Potass Bromidi. Potass Iodidi .. a.a. grs. v .. Decoct. Sarzaa Comp. 3iss m. ft. haust. Three times daily. Tho turpentine was discontinued as it produced slight irritation of the urinary passages, and moreover is found to be less beneficial in syphilitic than the rheumatic form of iritis. Continue atropine and savine ointment. 7th day.?Slightly better to-day. Continue. 9th day.?Circumcorneal redness less; no pain ; intolerance of light diminished. Continue Mist. Atropine and grs. v of Plummer's Pill every night. 12th day.?Complains of circumorbital pain. Apply Unguent. Belladonna) Comp. around the orbit. Continue Mist. Atropine and pill. 13th day.?Pain gone. Omit Unguent. Belladonna). 14th day.?Continue rest of treatment. 15th day.?Circumcorneal zone of redness is now very slight ; pupils freely dilated ; no pain. Continue. 17th day.?Continue Mist, and Pill. The pupil having been dilated for a sufficient length of time, strong mydriatics are no longer necessary, therefore substitute Gutta; Belladonna) for tho Atropine solution, 20th day.?Cornea much clearer; circumcorneal injection -almost disappeared. This treatment was persevered in for four ..
days.
24th day.?Ccrnea very hazy from interstitial keratitis. Counts Continue Gutta; Belladonna;, Mist, and eyes. J Pill.
miniature Bull's
....
* I think it convenient to call the base of the pterygium its outer portion.
2nd
grs.
Fotus Papavcrts
iv-Ji.
..
..
..
..
grs. v grs. vii _
To be taken twice
day.?Bowels
not
daily. yet opened; pain of
the
Continue Atropine and Fotus.
globe
less.
Subcliloridi .. grs. i Pulv. Rhei. Co. grs. xx. one at once, the other afterwards, if
Hydrarg
..
..
Mix, make two powders,
necessary. 3rd day.?Scleral redness less; slight pain; bowels still constipated. Continue Fotus and Atropine. Omit Pulv. 01. Recini ?33. .. gss. Aquce Menth. Pip Mix, take at once. 4th day.?Freely purges; redness continues ,to diminish ; no ,.
.,
..
paiu.
Continue Atropine.
Omit Fotus.
01. Morrhuco ., Syrupi Ferri Iodidi To be taken three times a
..
n
day.
5th day.?Scleral .redness all but gone; mation. Continue Mist, and Atropine. 6th
5'!
..
..
day.?Rapidly approaching recovery.
no
pain
or
lachry*
7th day.?All the symptoms have disappeared. Substitute Guttse Belladonna) for Atropine Solution (drops), it being unnecessary?indeed unadvisable?to keep the [pupil any longer bo ?widely dilated. 12th
day.?Discharged perfectly (To
well.
be continued.)
