THE INDIAN MEDICAL GAZETTE.
210 A
MIRROR OF HOSPITAL PRACTICE.
SELECTIONS FEOM OPHTHALMIC PEACTICE IN THE COWASJEE JEHANGHEER OPHTHALMIC HOSPITAL, BOMBAY. Ey Assistant Surgeon George Waters, Bombay Army.
(Continued from page 182.) Condition on 30. Case X.?Syphilitic iritis?S. L , aged admission :?" Had syphilis some time ago. The cornea of the right eye is hazy, the stroma of the iris muddy, and the pupil contracted and closed by a small piece of organised lymph. Has quantitative perception of light only. Tension of the globe slightly increased; gums spongy from taking mercury. Has occasional pains in the limbs." Treatment:?Artificial pupil by excision was made at the lower and inner edge of the cornea, and atropine solution having been instilled, a compress and bandage was applied, and a mixture composed of iodide of potassium and decoct, cinchona, prescribed. Thus the advantage of iridectomy was added to that of
artificial pupil. 2nd day.?The anterior chamber is filled with blood to onethird of its extent: no pain. Continue. 4th day.?There is still some blood in the anterior chamber. Continue. 5th day.?The blood is commencing to disappear, globe slightly red. Guttoe atropiaj, ungt. belladonna}. Continue mixture. 6th day.?The hsemopthalmos is still diminishing. Continue treatment. 8th day.?The pupil is now visible, but not so large as when first made ; vascularity of the globe much less ; no pain. Continue treatment. 11th day.?The pupil is partially occluded by neoplastic matter, only permitting vision sufficient to count miniature bull's eyes. 22nd day.?Pupil is now clear, so that patient can read No. 14 Jaeger. Discharged. The result of this case is illustrative of the good effects of iodide of potassium as an absorbefacient, and we find its usefulness as such greatly enhanced by previously exhibiting small doses of a mercurial preparation for a few days, not, however, allowing the gums to become affected, as this man's had been, from treatment received prior to admission into hospital. an
Case XI.?Retinitis?E. It Condition on admis, aged 35. sion :?" Ophthalmoscopic examination,?vitreous slightly hazy; fundus foggy, and disc soft in appearance. Neither the choroidal nor sclerotic rings are seen, nor are there any arteries observable on the fundus, whilst the veins are distinctly gorged and tortuThe retina has a thickened appearance. At the apparent ous. upper portion of the fundus oculi some choroidal epithelium is wanting, so that the choroidal vessels are seen unusually distinct, and in the same situation there are several small, brownish pink effusions (patches of choroiditis.) Patient had syphilis some time ago, and now complains of pains in the brow aud
temple.
Treatment:?I& Liq. hyd. perchloridi
Jss.
Potass, iodidi ... grs. v. Decoct, cinchonae giss. m. Calabar bean to be applied in tissue. 2nd day.?Continue mixture and calabar bean, the latter to contract the pupil previously dilated by atropine, for ophthalmoscopic examination. Apply a blister behind the ear. 3rd day.?Continue mixture and calabar bean, and dress the blistered surface with ungt. sabinsc. 4th day.?Vision improving. Continue. 8th day.?Pain in the right eye. Continue mixture, calabar bean, and pil. plummer., grs. v at night. 9th day.?The pupils have regained their natural size. Omit ...
...
bean.
11th
eye counts No. 14 Jaeger; left eye counts Continue mixture and pill. 16th day.?Eight eye now counts No. 8 with difficulty. Omit pill, continue mixture. 18th day.?The right eye is much improved now, patient being able to count No. 4 Jaeger. Omit mixture; substitute the
No. 2.
day.?Eight
_
following:?
Tinct. ferri perchloridi Acidi. hydrochlorici dil Aquae ad Take one-third thrice daily. ...
in xxx. ...
...
jss. =iVss. Mix.
1871.
[Octobeb 2,
24th
day.?Both eyes count No. 2. Discharged." Unfortunately an ophthalmoscopic examination of this patient's fundi oculi was omitted before he was discharged from hospital. We presume, however, they would have presented something like the normal appearance, excepting that the discs might have been rather paler, and the spots affected by choroiditis ?would have been known by exposed capillaries and atrophied choroidal epithelium. The calibre of the retinal arteries, moreover, would remain permanently diminished. If great care be not taken to preserve this patient's eye from strong light, and husband it from prolonged reading or writing, the disease will almost to a certainty recur and possibly terminate in hazy vitreous and greatly impaired vision. The treatment adopted in this case is what we almost invariably make use of (having found it superior to every other) when syphilis is present in the constitution. A thickened sclerosed retina and diminished transparency of the vitreous are the most constant pathological conditions of the fundus resulting from the introduction of syphilitic virus into the system. In ordinary non-syphilitic retinitis, we seldom have
recourse to the use of mercury in any form. Case XII.?Cyclitis?J. C Condition on admis, aged 40. sion :?" Has injection of the ciliary body, with tenderness on and nebula on a patch of the cornea; pupil %ths dilated, pressure,
by atropine. Treatment.?Guttse atropioe gr. ii to ?i., to be instilled thrice
not
daily;
ext.
belladonnas around
fomentations.
the
orbit; apply
chamomile
3rd day.?Continue former treatment. Bowels confined. Mist, 3 times daily. aperiens cum rheo 5th day.?Redness less, pain worst at night. Continue. 6th day.?Decided re-accession of pain and redness. Bowels freely purged by the mixture. Omit it substituting? 5ss. Liquor hydrarg. perchloridi ..
Potass, iodidi Decoct, cinchonoe
.. ..
gr. v.
siss.
m.
To be taken thrice daily. Continue atropine instillation, and apply three leeches to outer canthus. 7th day.?Pain and redness relieved. Continue all except leeches. 9th day.?Ophthalmoscopic examination :?Media somewhat hazy; discus opticus smaller than normal, of a woolly appearance and vertically oval; arteries of the fundus gone; veins gorged and crooked. Continue treatment. 11th day.?Counts No. 10 Pica. Continue treatment. 15th day.?Very much better. Omit mixture. 17t'n day.?Discharged well, vision being very good. Case XIII.?Pustular ophthalmia.?J K ?. Condition on admission :?" Has pink-coloured circum-corneal injection, the vessels slightly encroaching on the cornea, whilst small phlyctenular are seen on its lower and inner margin j lachrymation and pain." The only remedial agents used were ungt. hydrarg. ox. flavi applied every morning, and a very mild zinc lotion every four hours. The patient was discharged well at the end of a week. in the treatment of unHaving used this ointment very
largely complicated pustular ophthalmia, we are so thoroughly convinced of its good effect as to have no hesitation in pronouncing it the one sine qua non for the cure of that epidemic ocular lesion, so
far as local remedies are concerned but it is too ; strong a stimulant to be used when the cornea has become ulcerated, or even when it is very irritable. In such cases, the local treatment
must commence with anodyne applications, whilst cod-liver oil or some kindred agent is administered internally. The ointment we use is composed of gr. xv of the yellow oxide to an ounce of cold cream. Having recently been the subject of a mild attack of pustular ophthalmia myself, and having experienced the marvellous benefit which accrued almost immediately after Dr. Partridge applied the ointment to my eye, I am enabled to speak I observed From what in my own in its praise. feelingly eye, I am inclined to think the amelioration wrought by this ointment is due to its cutting off the supply of blood which feeds tlie inflamed spot by causing the walls of the turgid conjunctival vessels to contract. Von Graefe showed this to be the way. nitrate of silver acts in resolving ordinary conjunctival injection, but nitrate of silver is too much of an irritant to be used when phlyctenulte threaten to form. And besides contracting the distended vessels, I am constrained to think the ointment of the yellow oxide of mercury possesses some specific anti-purifacient property. To those interested in ophthalmic practice, the number, nature and object of operations performed in a large hospital specially
October 2,
A MIRROR OP HOSPITAL PRACTICE.
1871.]
set apart for the treatment of eye diseases, together with the number and variety of diseases therein treated, are always matters of not a little importance. Indeed, records of these must he replete with interest to the profession at large, for they contain the only data from which to come to conlusions regarding the eye diseases most prevalent in the locality in which the hospital is situated; whether they are epidemic or otherwise : their probable causation; the seasons at which certain affections are most common, and lastly, they may lead health officers to adopt measures with a view to the prevention of those o.cular lesions which are due to neglect or ignorance of the laws of hygiene. Indeed, bad ventilation, smoky dwellings and carelessness in ablution are among the most fruitful sources of eye disease, and especially of those affections which originate in the conjunctiva. Accordingly, we will proceed to give a condensed statement of the hospital work for the month of November, commencing with the operations.
Operation. For ?
Entropium
Method.
...
Trichiasis
Pterygium
...
...
...
...
Fistula lachrymalis ...
Solution of the lens
,, ?
...
...
Ligature
...
Bowman's Excision Iridectisis
-i
Scoop
Extraction of ditto
1 2 4 4 1 3
... ... ...
1 2 1 1 9
Staphyloma
?
Syndectomy
...
?
...
Critchett's Borelli's
... ...
1 2
| Three. Forty-six.
...
"
^Eleven. One.
Total number of operations during the month of Nov.
The cases treated
| Three. One. Five. Two.
...
?
| Three. | Eight. j Four. Five.
...
...,
Suction Yon Graefe's
Removal of foreign bodies Puncture of the globe
...
Von Graefe's Haynes Walton Dissection of cilia Excision
? ?
~
Artificial pupil
Canthoplasty
j
...
Number.
in-door"
during
the month of November
follows:?Disease of the cornea, 25 ; of the lens and capsule, 20; of the iris (mostly of syphilitic origin) 11; of the conjunctiva, 8 ; of the choroid and retinae, 6; general affections of the eye, 6 ; disease of the lachrymal apparatus, 1; and of the eyelids, 1; total 78. The out-door patients numbered 679 for the same period, were
as
disease of the
conjunctiva,
of the cornea, of the choroid and
retinas, of the eyelids (chiefly ophthalmia tarsi), of the iris, and of the lens and
capsule,
in the order
common.
mentioned, being
most
Affections of the conjunctiva thus appear to be most prevalent. The preponderance of lesions of the cornea amongst the in-door patients, is accounted for by the fact that the severity of corneal affections compels many high caste people to throw caste prejudices temporarily into abeyance, in order that the best possible measures may be carried out for the recovery of their sight. They come into hospital in defiance of all religious conventionalities; whereas conjunctival lesions are seldom severe enough to force them to commit such a sin against religious constitutionalism, and it is chiefly owing to this that conjunctival affections head the list of diseases treated in the out-door department of the Cowasjee Jehangheer Hospital.
Deaths in
Punjab.?The
death-rate for June was,?per
1,000?cholera 0'00, small-pox 0'19, fevers 0"87, bowel complaints 010, injuries 0 03, all other causes 0-41; total 1-60. There were 29 deaths from suicide (12 males and 17 females); 22 from wounds (16 males and 6 females); 420 from accident (273
males and 147 females); 133 from snake-bite and wild animals (75 males and 58 females.) Population 17,481,189.
Deaths in the North-Western Provinces.?The deathrate for June was,?per 1,000?cholera 0*01, small-pox 0'26, fevers 075, bowel complaints 0-14, injuries 0'04, all other causes 0'10 ; total 1*33. There were 132 deaths from suicide (55 males and and 46 females); 722 77 females); 103 from wounds (57 males from snake-bite from accident (405 males and 317 females); 518 and wild animals (235 males and 282 females.) Population
29,575,003.
211
210 A
MIRROR OF HOSPITAL PRACTICE.
SELECTIONS FEOM OPHTHALMIC PEACTICE IN THE COWASJEE JEHANGHEER OPHTHALMIC HOSPITAL, BOMBAY. Ey Assistant Surgeon George Waters, Bombay Army.
(Continued from page 182.) Condition on 30. Case X.?Syphilitic iritis?S. L , aged admission :?" Had syphilis some time ago. The cornea of the right eye is hazy, the stroma of the iris muddy, and the pupil contracted and closed by a small piece of organised lymph. Has quantitative perception of light only. Tension of the globe slightly increased; gums spongy from taking mercury. Has occasional pains in the limbs." Treatment:?Artificial pupil by excision was made at the lower and inner edge of the cornea, and atropine solution having been instilled, a compress and bandage was applied, and a mixture composed of iodide of potassium and decoct, cinchona, prescribed. Thus the advantage of iridectomy was added to that of
artificial pupil. 2nd day.?The anterior chamber is filled with blood to onethird of its extent: no pain. Continue. 4th day.?There is still some blood in the anterior chamber. Continue. 5th day.?The blood is commencing to disappear, globe slightly red. Guttoe atropiaj, ungt. belladonna}. Continue mixture. 6th day.?The hsemopthalmos is still diminishing. Continue treatment. 8th day.?The pupil is now visible, but not so large as when first made ; vascularity of the globe much less ; no pain. Continue treatment. 11th day.?The pupil is partially occluded by neoplastic matter, only permitting vision sufficient to count miniature bull's eyes. 22nd day.?Pupil is now clear, so that patient can read No. 14 Jaeger. Discharged. The result of this case is illustrative of the good effects of iodide of potassium as an absorbefacient, and we find its usefulness as such greatly enhanced by previously exhibiting small doses of a mercurial preparation for a few days, not, however, allowing the gums to become affected, as this man's had been, from treatment received prior to admission into hospital. an
Case XI.?Retinitis?E. It Condition on admis, aged 35. sion :?" Ophthalmoscopic examination,?vitreous slightly hazy; fundus foggy, and disc soft in appearance. Neither the choroidal nor sclerotic rings are seen, nor are there any arteries observable on the fundus, whilst the veins are distinctly gorged and tortuThe retina has a thickened appearance. At the apparent ous. upper portion of the fundus oculi some choroidal epithelium is wanting, so that the choroidal vessels are seen unusually distinct, and in the same situation there are several small, brownish pink effusions (patches of choroiditis.) Patient had syphilis some time ago, and now complains of pains in the brow aud
temple.
Treatment:?I& Liq. hyd. perchloridi
Jss.
Potass, iodidi ... grs. v. Decoct, cinchonae giss. m. Calabar bean to be applied in tissue. 2nd day.?Continue mixture and calabar bean, the latter to contract the pupil previously dilated by atropine, for ophthalmoscopic examination. Apply a blister behind the ear. 3rd day.?Continue mixture and calabar bean, and dress the blistered surface with ungt. sabinsc. 4th day.?Vision improving. Continue. 8th day.?Pain in the right eye. Continue mixture, calabar bean, and pil. plummer., grs. v at night. 9th day.?The pupils have regained their natural size. Omit ...
...
bean.
11th
eye counts No. 14 Jaeger; left eye counts Continue mixture and pill. 16th day.?Eight eye now counts No. 8 with difficulty. Omit pill, continue mixture. 18th day.?The right eye is much improved now, patient being able to count No. 4 Jaeger. Omit mixture; substitute the
No. 2.
day.?Eight
_
following:?
Tinct. ferri perchloridi Acidi. hydrochlorici dil Aquae ad Take one-third thrice daily. ...
in xxx. ...
...
jss. =iVss. Mix.
1871.
[Octobeb 2,
24th
day.?Both eyes count No. 2. Discharged." Unfortunately an ophthalmoscopic examination of this patient's fundi oculi was omitted before he was discharged from hospital. We presume, however, they would have presented something like the normal appearance, excepting that the discs might have been rather paler, and the spots affected by choroiditis ?would have been known by exposed capillaries and atrophied choroidal epithelium. The calibre of the retinal arteries, moreover, would remain permanently diminished. If great care be not taken to preserve this patient's eye from strong light, and husband it from prolonged reading or writing, the disease will almost to a certainty recur and possibly terminate in hazy vitreous and greatly impaired vision. The treatment adopted in this case is what we almost invariably make use of (having found it superior to every other) when syphilis is present in the constitution. A thickened sclerosed retina and diminished transparency of the vitreous are the most constant pathological conditions of the fundus resulting from the introduction of syphilitic virus into the system. In ordinary non-syphilitic retinitis, we seldom have
recourse to the use of mercury in any form. Case XII.?Cyclitis?J. C Condition on admis, aged 40. sion :?" Has injection of the ciliary body, with tenderness on and nebula on a patch of the cornea; pupil %ths dilated, pressure,
by atropine. Treatment.?Guttse atropioe gr. ii to ?i., to be instilled thrice
not
daily;
ext.
belladonnas around
fomentations.
the
orbit; apply
chamomile
3rd day.?Continue former treatment. Bowels confined. Mist, 3 times daily. aperiens cum rheo 5th day.?Redness less, pain worst at night. Continue. 6th day.?Decided re-accession of pain and redness. Bowels freely purged by the mixture. Omit it substituting? 5ss. Liquor hydrarg. perchloridi ..
Potass, iodidi Decoct, cinchonoe
.. ..
gr. v.
siss.
m.
To be taken thrice daily. Continue atropine instillation, and apply three leeches to outer canthus. 7th day.?Pain and redness relieved. Continue all except leeches. 9th day.?Ophthalmoscopic examination :?Media somewhat hazy; discus opticus smaller than normal, of a woolly appearance and vertically oval; arteries of the fundus gone; veins gorged and crooked. Continue treatment. 11th day.?Counts No. 10 Pica. Continue treatment. 15th day.?Very much better. Omit mixture. 17t'n day.?Discharged well, vision being very good. Case XIII.?Pustular ophthalmia.?J K ?. Condition on admission :?" Has pink-coloured circum-corneal injection, the vessels slightly encroaching on the cornea, whilst small phlyctenular are seen on its lower and inner margin j lachrymation and pain." The only remedial agents used were ungt. hydrarg. ox. flavi applied every morning, and a very mild zinc lotion every four hours. The patient was discharged well at the end of a week. in the treatment of unHaving used this ointment very
largely complicated pustular ophthalmia, we are so thoroughly convinced of its good effect as to have no hesitation in pronouncing it the one sine qua non for the cure of that epidemic ocular lesion, so
far as local remedies are concerned but it is too ; strong a stimulant to be used when the cornea has become ulcerated, or even when it is very irritable. In such cases, the local treatment
must commence with anodyne applications, whilst cod-liver oil or some kindred agent is administered internally. The ointment we use is composed of gr. xv of the yellow oxide to an ounce of cold cream. Having recently been the subject of a mild attack of pustular ophthalmia myself, and having experienced the marvellous benefit which accrued almost immediately after Dr. Partridge applied the ointment to my eye, I am enabled to speak I observed From what in my own in its praise. feelingly eye, I am inclined to think the amelioration wrought by this ointment is due to its cutting off the supply of blood which feeds tlie inflamed spot by causing the walls of the turgid conjunctival vessels to contract. Von Graefe showed this to be the way. nitrate of silver acts in resolving ordinary conjunctival injection, but nitrate of silver is too much of an irritant to be used when phlyctenulte threaten to form. And besides contracting the distended vessels, I am constrained to think the ointment of the yellow oxide of mercury possesses some specific anti-purifacient property. To those interested in ophthalmic practice, the number, nature and object of operations performed in a large hospital specially
October 2,
A MIRROR OP HOSPITAL PRACTICE.
1871.]
set apart for the treatment of eye diseases, together with the number and variety of diseases therein treated, are always matters of not a little importance. Indeed, records of these must he replete with interest to the profession at large, for they contain the only data from which to come to conlusions regarding the eye diseases most prevalent in the locality in which the hospital is situated; whether they are epidemic or otherwise : their probable causation; the seasons at which certain affections are most common, and lastly, they may lead health officers to adopt measures with a view to the prevention of those o.cular lesions which are due to neglect or ignorance of the laws of hygiene. Indeed, bad ventilation, smoky dwellings and carelessness in ablution are among the most fruitful sources of eye disease, and especially of those affections which originate in the conjunctiva. Accordingly, we will proceed to give a condensed statement of the hospital work for the month of November, commencing with the operations.
Operation. For ?
Entropium
Method.
...
Trichiasis
Pterygium
...
...
...
...
Fistula lachrymalis ...
Solution of the lens
,, ?
...
...
Ligature
...
Bowman's Excision Iridectisis
-i
Scoop
Extraction of ditto
1 2 4 4 1 3
... ... ...
1 2 1 1 9
Staphyloma
?
Syndectomy
...
?
...
Critchett's Borelli's
... ...
1 2
| Three. Forty-six.
...
"
^Eleven. One.
Total number of operations during the month of Nov.
The cases treated
| Three. One. Five. Two.
...
?
| Three. | Eight. j Four. Five.
...
...,
Suction Yon Graefe's
Removal of foreign bodies Puncture of the globe
...
Von Graefe's Haynes Walton Dissection of cilia Excision
? ?
~
Artificial pupil
Canthoplasty
j
...
Number.
in-door"
during
the month of November
follows:?Disease of the cornea, 25 ; of the lens and capsule, 20; of the iris (mostly of syphilitic origin) 11; of the conjunctiva, 8 ; of the choroid and retinae, 6; general affections of the eye, 6 ; disease of the lachrymal apparatus, 1; and of the eyelids, 1; total 78. The out-door patients numbered 679 for the same period, were
as
disease of the
conjunctiva,
of the cornea, of the choroid and
retinas, of the eyelids (chiefly ophthalmia tarsi), of the iris, and of the lens and
capsule,
in the order
common.
mentioned, being
most
Affections of the conjunctiva thus appear to be most prevalent. The preponderance of lesions of the cornea amongst the in-door patients, is accounted for by the fact that the severity of corneal affections compels many high caste people to throw caste prejudices temporarily into abeyance, in order that the best possible measures may be carried out for the recovery of their sight. They come into hospital in defiance of all religious conventionalities; whereas conjunctival lesions are seldom severe enough to force them to commit such a sin against religious constitutionalism, and it is chiefly owing to this that conjunctival affections head the list of diseases treated in the out-door department of the Cowasjee Jehangheer Hospital.
Deaths in
Punjab.?The
death-rate for June was,?per
1,000?cholera 0'00, small-pox 0'19, fevers 0"87, bowel complaints 010, injuries 0 03, all other causes 0-41; total 1-60. There were 29 deaths from suicide (12 males and 17 females); 22 from wounds (16 males and 6 females); 420 from accident (273
males and 147 females); 133 from snake-bite and wild animals (75 males and 58 females.) Population 17,481,189.
Deaths in the North-Western Provinces.?The deathrate for June was,?per 1,000?cholera 0*01, small-pox 0'26, fevers 075, bowel complaints 0-14, injuries 0'04, all other causes 0'10 ; total 1*33. There were 132 deaths from suicide (55 males and and 46 females); 722 77 females); 103 from wounds (57 males from snake-bite from accident (405 males and 317 females); 518 and wild animals (235 males and 282 females.) Population
29,575,003.
211
