A MIRROR OF HOSPITAL
PRACTICE.
SELECTIONS FEOM OPIITIIALMIC PEACTICE IN THE COWASJEE JEIIANGIIEEK OPIITIIALMIC HOSPITAL, BOMBAY.
By Assistant-Surgeon
George
"Waters, Bombay Army,
(Continued from page 90.^ Case III,?Irido choroiditis; duration 2 months. J. S. , aged 30; was formerly in hospital with Irido choroiditis ; now returns. The sclera is much injected, and the pupil irregular, the iris being only dilated at the upper and inner margin; had
syphilis years ago. Ophthalmoscopic Examination.?Media hazy ; disc very hyperccmic and its outline obscure ; veins of fundus, especially on the disc, are gorged and tortuous; the retina appears thickened, and dull, white spots are observable here and there on on its surface, evidently the result of syphilis. Two small tags of iris adhere to the lower portion of the lens. Treatment:?Guttcc Atropiae grs. iv-^i 5ss \]o Liquor Ilydrarg Perchloridi Potass Iollidi gr3. v Decoc. Cinchonae siss m To be taken three times a day, Pil. Plummeri grs. v. at night. 4th day.?Three leeches to outer angle of each eye. Continue Atropine, Mist., and Pill. 6th day.?Ciliary body tender. Continue former treatment, and Extract. IJelladonme to the orbital region. 7th day.?Continue Mist., Pill and Atropine. 8th day.?Continue. 9th day.?The eye appears worse this morning, there being pain and much lachrymation. Fly blister to right temple. Continue Mist. Pill, and Guttoo Atropine. 10th day.?Much better to-day. Continue; dress blistered -
..
,.
.
..
..
..
surface. 11th day.?Daily improvement; very little redness remains. 13th day.?Discharged, much improved in vision, as well as relieved from pain and redness. Remarks.?The sudden occurrenco of bad symptoms, or it may be merely a re-accession of the original disease, is frequently due to atmospheric changes: for instance, wq often find cases which are progressing favorably, suddenly grow worse whenthei M'eather becomes moist and cloudy. This explains the slight relapse of the above case on the 9 th day of treatment; indeed, it would appear, affections of the eye are more acted upon by changes in weather than most other diseases. 30 ; Case IY.?Keratitis ; duration uncertain. N. , aged in hospital some months ago, and discharged, cured, with but slight opacity remaining; now returns, having an opacity extending in the form of a haze over the lower half of the cornea; there is also a small very superficial ulcer on the upper and inner half of the cornea; lachrymation and conjunctival was
injection.
Treatment:?Guttaj Atropioe and Lotio Belladonna). 2nd day.?Atropine, compress and bandage. mx I]a Acid. Nitrici Dil. Decoct. Cinchona) 5iss To be taken three times a day. ..
..
..
?
?
4th day.?Much better ; continue. The same treatment was the patient was adopted for the following four days, after which discharged well. The ulcer having healed and the opacity diminished in size, the rest insured by the compress, placed the ulcer under favorable circumstances for healing. Case V.?C/iro>f{e OphtJiqlmia; duration uncertain. D.W. , 30 ; upper lids red and swollen ; palpebral surfaces covered with loose spongy granulations; cornea hazy, and its surface and dyspnoea; lachrymation. uneven; complains of cough Treatment.?Apply pencil of Sulphate of Copper to tho
aged
granulations. 2nd day.?Apply camel hair pencil. "
Fulv. Plumbi Acctatis to Mist. Pectoralis 3iss. Three times daily.
granulations with
118
THE INDIAN MEDICAL GAZETTE.
3rd day.?Continue Mist, 4th day.?Still complains 5th day.?Continue Mist. 6th day.?Continue Mist.
7th day.?The ceugh tinue.
and Pulv. Plumbi Acetatis. of cough and dyspnoea. Continue. Pecttralis and Sulphate of Copper. Pulv. Plumbi Acetatis. is better, and the cornea clearer. Con-
8th day.?Continue Mist. Sulphate of tion. 11th day.?Cornea continues to clear,
Copper
day.?p,
Pulv. Jalapaj Co. Calomelanos
Continue Sulphate of Copper
5*
..
grs. iv.
..
..
there
;
being
now
7th day.? Continue Atropine and
..
much
At once. no
cough,
omit Mist. Pectoralis. 13th day.?Instil into the eye Guttoe 01. Terebinth et 01. Eecini partes equales. This treatment was continued for the following five days, after -which the patient was discharged, very much improved: the cornea having become much clearer, and the granulations reduced, the former being a sequence of the latter. Remarks.?The history of this case was, most probably,?first an attack of granular conjunctivitis, which by friction on the The treatment illustrates the indirect cornea induced keratitis. benefit which often accrues to the cornea from removal of the primary cause of its pathological condition. Granulations like haz|ness of the cornea, in our experience, are most quickly reduced by alternating and frequently changing the astringent agents used for that purpose. It is needless to observe, that cough being a troublesome complication in eye affections, its removal becomes a matter of primary importance. Lastly, turpentine and oil drops have of late been much used in this hospital for chronic ophthalmia and kindred affections, and on the whole deserve to be favorably spoken of. Case VI.?Keratitis ; duration uncertain. C. G. , aged 20. opaque, save at the lower and inner margin of the cornea; vessels pervade the latter, entering it all around ; the cornea ls also slightly prominent, and there is pericorneal injection; intolerance of light; granulations on palpebral surface of upper lid; left eye,?cornea more prominent than the other, and the eye is in every respect worse. Treatment.?Mist. Potass Iodidi ?i.: three times a day. Guttoe Atropia), three times. 2nd day.?Apply mitigated Nitrate of Silver to granular surfaces, and drop in solution of Atropine, 1| hour afterwards.
Eight eye,?wholly
Syrupi
Ferri Iodidi 01 Morrliuas
Aqua)
.,
..
5iss.
...
,.
5^S3*
giss.,
..
..
three times
a
Case VII.? Ulcer of the Cornea; duration 6 weeks. A. D. aged 22; deep ulcer in the cornea of left eye, surrounded by a halo of partially organized lymph; much photophobia, frontal headache, and lachiymation. Treatment.?Gutta; Atropioe grs. ii-^i 01 Morrhuse 5^ Three times a day. 2nd day.?Atropine to be frequently instilled into the eye; ,
..
..
..
..
Extract. Belladonna; to the orbit. 3rd day.?Atropine; compress and bandage. Continue Codliver Oil. 4th day.?Ulcer is beginning to heal. Continue. 5th day.?Continue Atropine and Cod-liver Oil, and Pulv.
Jalapaj Comp.
Calomelanos
..
?
,.
..
?
3*
gr. iv.
..
behind the
ear.
16th day.?No better : there is still laehrvmation and redness. Mist. Quinse Ji., to be taken 3 times a day. Artificial leech. 17th day.?Continue Guttse Atropise and
J&
Decoc. Aloes Comp. Mist. Ferri. Comp. ,, Three times a day.
a.a.
,,
?33.
18th day.?Continue. 19th day.?To-day the eye is very irritable, there is asmia of the lids and lachrymation; paracentesis cornese. tinue Mist, and Atropine. 21st day.?Continue Atropine and bandage. Arsenicalis Ammonise Carb.
Liquor
rn.
..
..
Aquae Comp. Dose ^iss., three times a day. 22nd day.?Much pain, and intolerance ,.
Mist, and Calomel insufflation.
of
Con-
xii xv
.,
gr.
.,
givss
light.
hyper-
Continue
day.?Continue Mist. Guttoe vini opii. day.?Somewhat improved this morning. Continue Guttse vini opii and Mist. 27th day.?Scarcely any intolerance; left cornea brighter. 24th 2oth
Continue.
30th day. Continue Mist. Drop solution of Nitrate of Silver into the eye, grs. i-?i. 33rd day.?Photophobia and lachrymation again present. Guttse Atropise grs. iv-^i) Tincture of Iodine to lids as a counterirritant.
IJj
Tine. Ferri. Perehloridi Acidi Hydrochlorici Dil.
Aqua)
..
..
a.a.
..
..
wt
x
5is3
To be taken three times daily. day.?Continue all. day.?All the symptoms more intense ; paracentesis cornese. Atropine and bandage. Continue Mist. 3Gth day.?Pain much less" to-day. 37th day.?Omit bandage; wear a shade. Continue Mist, and Guttse Atropise. 38th day.?Pain and lachrymaticn much less since the paracentesis was performed. Continue. 40th day.?Lachrymation Mist, increased. Continue again and Guttce Atropioe. 41st day.?Much better to-day. This treatment was continued during the remaining 9 days the patient was in hospital, after which he was discharged. When he was discharged, his eye appeared in a fair way to recovery, and merely needed the instillation of mild stimulant solutions for a few days to complete the cure. Remarks.?This case affords a very good example of an obstinate disease resulting from general debility which baffles the utmost skill, and wears out the greatest patience. In such cases the great point is to discover the particular constitutional remedy best suited for giving tone to the weakened powers of assimilation; good nourishment, such as the patient can use with relish, being also indispensable to success. 34th 35th
Jivss. day. 3rd day.?Left eye : the cornea is now occupied by one large central deposit of lymph ; photophobia diminishing. Continue. 6th day.?Continue Mist, and Atropine, Sulphate of Copper to granulations. 7th day.?Granulations considerably reduced, drop in solution of Lapi3 Divinus. Continue Mist. 12th day.?Drop in solution of Nitrate of Silver grs. ii-^i. Continue Mist. In short, the patient was discharged after being five weeks under similar treatment, decidedly improved ; the granulations having been subdued at an early stage of the treatThe main object to be attained was to improve the ment. cornea ; this was accomplished by the daily instillation of various stimulant solutions, such as Nitrate of Silver, Lapis Divinus, Turpentine and Oil, and Liquor Chlori, these being used interchangeably. Dose
..
ihxv Syrupi Ferri. Iodidi 3^ mix* Thrice daily". Aqua) 8th day.?A halo of new cornea is now forming around the ulcer; very little pain. Continue. 10th day.?Continue Mist. The irritation having now ceased, drop in solution of Lapis Divinus instead of Atropine. 14th day.?Slight return of photophobia and lachrymation; bowels confined. Guttae Atropise. Ji> Mist. Colochici si. Three times a day. 15th day.?Continue Mist, and Guttse Atropine; apply a blister ..
granula-
granulations
reduced. 12th
to
1871.
[j^ne 1,
At once.
Case VIII.?Staphyloma; duration 4 months. T. M. , aged 20 ; outer part of right cornea stapliyloinatous. lower part clear; behind the latter an artificial pupil had bden made by excision The pupil is still perfect, but the staphyloma is some tims ago. prominent and painful, though not increasing. Treatment.?Guttse Belladonnse, to lessen the sensibility of the morbid tissue, and facilitate removal of the staphyloma. 2nd day.?Operation: Sylvester's modification of Borelli's of operation for staphyloma, under chloroform, (for description which see paper by Surgeon J. H. Sylvester, Indian Medical Gazette, July, 1870.) Gutta; Atropine; compress end bandage, the latter loosely applied; the Mist. Quinae ?i, three times a day. ? The Liquor Morphise hydrochloratis n\xx at night, if necessary.
June 1, 1871.]
A
MIRROR OF HOSPITAL PRACTICE.
229
9th day.?Patient lias now two excellent pupils. Continue. 3rd day.?A good deal of pain followed the operation, but the 10 th day.?Slight pain in right eye. Unguent Belladonna; Co. patient slept well after taking the draught, and is now easier. Continue pad and Atropine. Continue Mist. Quince. llth day.?Guttoe Belladonna). 5th day.?Very little pain; needles not yet separated; conti- 14th day.?Slight injection and pain to-day. Gutta; Atropine Hue Mist. Atropiae, compress and loose bandage. and bandage. fth day.?Needles separated; complains of pain in the eye. 15th day.?Continue Atropine and bandage, and AtroPia3 aQd compress. in.x. 9th day.?There is now no pe Acidi ITydrochlorici Dil. pain; staphyloma completely .. mx. Tine. Ferri. Perchloridi gone; bowels constipated. Continue treatment and
a?
..
Aqua;
01 Eicini. Aquce Menth.
Pip a.a. ^ss at once. day.?Bowels opened. Continue Atropine and 12th day.?Continue Atropine and compress. 10th
Acidi Nitrici Dil Decoct. Cinchonse Three times a day.
..
..
111
a.a.
..
Jiss. daily. Gutta) Atropioo. ..
n.
To be taken three times
day.?Continue Mixture and day.?Redness almost gone. Continue Mixture and Guttaa Atropia). 18th day.?Right eye,?counts No. 2 Jaeger; left,?counts No. 8 with difficulty. Discharged.
compress.
x
siss
16th 17th
The treatment of this case and the result which followed is good example of the great benefit that a trifling operavery 13th day.?Cornea healing rapidly; tion on the eye, when attended with success, often confers on to cornea the 18th day.?Lower heal the promises portion of prospects of a patient. sufficiently to justify making an artificial pupil by-and-bye. In recording the above cases I have thought it better to mention the number of days under treatment, than to confuse the mind of the reader with dates. It must also be remembered Case IX.? Ulcer of the cornea ; duration 15 days. G. M. ?, that the duration of disease and age of the patient as given aged 25; an unhealthy looking ulcer at the lower edge of the above must often be considered as merely approximative ; the cornea nearly through ; much conjunctival injection; lids tumid; patients being very often deficient in intelligence or heedless, so pupils well dilated by Atropine. that their statements cannot be relied upon. Generally speakTreatment.?Mist. Quinaj giss three times a day. Guttaj ing, the years of the patients who come to this hospital hang Atropiae, Unguent Belladonna) Co. heavily upon them. It is certainly not too much to say, that 2nd day.?Continue. who are but in the prime of life so far as age is concerned, 3rd day.?Nitrate of Silver drops gr. i-Ji, followed by atro- many have the careworn weird appearance whicn occasionally is seen pine. Continue Mist. Quinae. in those greatly advanced in life. 5th day.?To day there is pain and increased redness; ulcer Having taken up considerable space in two former papers on smaller. cataract extraction, and having few cases from which to select 6th day.?Ulcer almost closed. Nitrate of Silver drops; conti- at present?October being the minimum month for operations? nue mixture. I deem it needless?indeed superfluous?to touch upon that sub7th day.?Iris prolapsed during the night. Continue drops ject in this report. The total number of patients who attended and mixture. the "out-door" department during the month of October was 9th day.?Calabar bean, in order to withdraw the protruded 638 ; the average daily attendance being about 100. As usual, iris as much as possible by contracting the pupil. diseases of the conjunctiva and cornea furnished the greatest 10th day.?The vascularity has much subsided since evacua- number of cases; diseases of the fundus oculi were also very tion of the aqueous; the protrusion (niyocephalon) baing more numerous, aud of these I shall report in a future paper. is now excised calabar the the than a match for bean, ; aqueous again evacuated, and the freshly cut iris with the adjacent a of touched with of Nitrate corneal tissue delicately pencil Silver. Continue calabar bean ; apply compress and bandage. 11th day.?Continue calabar bean and compress. 12th day.?Corneal wound is now cicatrising around a very small prolapse; very little pain ; redness diminishing. Continue. 15th day.?Iris tissue almost gone from centre of the cicatrix. Instil Guttae Atropine alone. This treatment was persevered in until recovery which occurred seven days afterwards, when the patient was discharged with a small albugo occupying the site of the ulcer; the former not obscuring the pupil, required no further interference. Eemarks.?Had the protrusion occurred over the pupillary area instead of near the margin of the cornea, of course atropine would have been the most serviceable for withdrawing tne prolapsed portion of iris. a
continue treatment.
Discharged.
Case X.?Sequela of Iritis ; duration one year. J. W , aged 42 ; both irides adherent to the lens capsule, and pupils
occluded;
Counts No. 14 Pica with either eye; had
syphilis
16
years ago.
Treatment.?Guttae Atropiae gr. iv.-gi.
day.?Artificial pupil made in left eye. The iris having Undergone degeneration and become very brittle in consequence, tore off Tyrrell's hook before being excised, but nevertheless a sufficient opening was left in the iris for a pupil. Atropine, compress and bandage. 3rd day.?No redness ; beautifully clear pupil to the inner side of, and joining the old one. A piece of organised lymph islanded on the lens is now visible through the new pupil. Continue Atropine and bandage. 5th day.?Shade and Atropine. No redness; no trace of the operation, save the pupil, which is slightly contracted. Continue f shade and Atropine. 6th day.?Eight eye operated upon for artificial pupil, which was made by excision. The lens had a slightly hazy appearance when exposed. Atropine compress and bandage. 7th day.?No irritation ; no redness; the lens capsule is seen through the coloboma to be decidedly opaque. Continue. 8th day.?Pad, Atropine and bandage. 2nd
;
PRACTICE.
SELECTIONS FEOM OPIITIIALMIC PEACTICE IN THE COWASJEE JEIIANGIIEEK OPIITIIALMIC HOSPITAL, BOMBAY.
By Assistant-Surgeon
George
"Waters, Bombay Army,
(Continued from page 90.^ Case III,?Irido choroiditis; duration 2 months. J. S. , aged 30; was formerly in hospital with Irido choroiditis ; now returns. The sclera is much injected, and the pupil irregular, the iris being only dilated at the upper and inner margin; had
syphilis years ago. Ophthalmoscopic Examination.?Media hazy ; disc very hyperccmic and its outline obscure ; veins of fundus, especially on the disc, are gorged and tortuous; the retina appears thickened, and dull, white spots are observable here and there on on its surface, evidently the result of syphilis. Two small tags of iris adhere to the lower portion of the lens. Treatment:?Guttcc Atropiae grs. iv-^i 5ss \]o Liquor Ilydrarg Perchloridi Potass Iollidi gr3. v Decoc. Cinchonae siss m To be taken three times a day, Pil. Plummeri grs. v. at night. 4th day.?Three leeches to outer angle of each eye. Continue Atropine, Mist., and Pill. 6th day.?Ciliary body tender. Continue former treatment, and Extract. IJelladonme to the orbital region. 7th day.?Continue Mist., Pill and Atropine. 8th day.?Continue. 9th day.?The eye appears worse this morning, there being pain and much lachrymation. Fly blister to right temple. Continue Mist. Pill, and Guttoo Atropine. 10th day.?Much better to-day. Continue; dress blistered -
..
,.
.
..
..
..
surface. 11th day.?Daily improvement; very little redness remains. 13th day.?Discharged, much improved in vision, as well as relieved from pain and redness. Remarks.?The sudden occurrenco of bad symptoms, or it may be merely a re-accession of the original disease, is frequently due to atmospheric changes: for instance, wq often find cases which are progressing favorably, suddenly grow worse whenthei M'eather becomes moist and cloudy. This explains the slight relapse of the above case on the 9 th day of treatment; indeed, it would appear, affections of the eye are more acted upon by changes in weather than most other diseases. 30 ; Case IY.?Keratitis ; duration uncertain. N. , aged in hospital some months ago, and discharged, cured, with but slight opacity remaining; now returns, having an opacity extending in the form of a haze over the lower half of the cornea; there is also a small very superficial ulcer on the upper and inner half of the cornea; lachrymation and conjunctival was
injection.
Treatment:?Guttaj Atropioe and Lotio Belladonna). 2nd day.?Atropine, compress and bandage. mx I]a Acid. Nitrici Dil. Decoct. Cinchona) 5iss To be taken three times a day. ..
..
..
?
?
4th day.?Much better ; continue. The same treatment was the patient was adopted for the following four days, after which discharged well. The ulcer having healed and the opacity diminished in size, the rest insured by the compress, placed the ulcer under favorable circumstances for healing. Case V.?C/iro>f{e OphtJiqlmia; duration uncertain. D.W. , 30 ; upper lids red and swollen ; palpebral surfaces covered with loose spongy granulations; cornea hazy, and its surface and dyspnoea; lachrymation. uneven; complains of cough Treatment.?Apply pencil of Sulphate of Copper to tho
aged
granulations. 2nd day.?Apply camel hair pencil. "
Fulv. Plumbi Acctatis to Mist. Pectoralis 3iss. Three times daily.
granulations with
118
THE INDIAN MEDICAL GAZETTE.
3rd day.?Continue Mist, 4th day.?Still complains 5th day.?Continue Mist. 6th day.?Continue Mist.
7th day.?The ceugh tinue.
and Pulv. Plumbi Acetatis. of cough and dyspnoea. Continue. Pecttralis and Sulphate of Copper. Pulv. Plumbi Acetatis. is better, and the cornea clearer. Con-
8th day.?Continue Mist. Sulphate of tion. 11th day.?Cornea continues to clear,
Copper
day.?p,
Pulv. Jalapaj Co. Calomelanos
Continue Sulphate of Copper
5*
..
grs. iv.
..
..
there
;
being
now
7th day.? Continue Atropine and
..
much
At once. no
cough,
omit Mist. Pectoralis. 13th day.?Instil into the eye Guttoe 01. Terebinth et 01. Eecini partes equales. This treatment was continued for the following five days, after -which the patient was discharged, very much improved: the cornea having become much clearer, and the granulations reduced, the former being a sequence of the latter. Remarks.?The history of this case was, most probably,?first an attack of granular conjunctivitis, which by friction on the The treatment illustrates the indirect cornea induced keratitis. benefit which often accrues to the cornea from removal of the primary cause of its pathological condition. Granulations like haz|ness of the cornea, in our experience, are most quickly reduced by alternating and frequently changing the astringent agents used for that purpose. It is needless to observe, that cough being a troublesome complication in eye affections, its removal becomes a matter of primary importance. Lastly, turpentine and oil drops have of late been much used in this hospital for chronic ophthalmia and kindred affections, and on the whole deserve to be favorably spoken of. Case VI.?Keratitis ; duration uncertain. C. G. , aged 20. opaque, save at the lower and inner margin of the cornea; vessels pervade the latter, entering it all around ; the cornea ls also slightly prominent, and there is pericorneal injection; intolerance of light; granulations on palpebral surface of upper lid; left eye,?cornea more prominent than the other, and the eye is in every respect worse. Treatment.?Mist. Potass Iodidi ?i.: three times a day. Guttoe Atropia), three times. 2nd day.?Apply mitigated Nitrate of Silver to granular surfaces, and drop in solution of Atropine, 1| hour afterwards.
Eight eye,?wholly
Syrupi
Ferri Iodidi 01 Morrliuas
Aqua)
.,
..
5iss.
...
,.
5^S3*
giss.,
..
..
three times
a
Case VII.? Ulcer of the Cornea; duration 6 weeks. A. D. aged 22; deep ulcer in the cornea of left eye, surrounded by a halo of partially organized lymph; much photophobia, frontal headache, and lachiymation. Treatment.?Gutta; Atropioe grs. ii-^i 01 Morrhuse 5^ Three times a day. 2nd day.?Atropine to be frequently instilled into the eye; ,
..
..
..
..
Extract. Belladonna; to the orbit. 3rd day.?Atropine; compress and bandage. Continue Codliver Oil. 4th day.?Ulcer is beginning to heal. Continue. 5th day.?Continue Atropine and Cod-liver Oil, and Pulv.
Jalapaj Comp.
Calomelanos
..
?
,.
..
?
3*
gr. iv.
..
behind the
ear.
16th day.?No better : there is still laehrvmation and redness. Mist. Quinse Ji., to be taken 3 times a day. Artificial leech. 17th day.?Continue Guttse Atropise and
J&
Decoc. Aloes Comp. Mist. Ferri. Comp. ,, Three times a day.
a.a.
,,
?33.
18th day.?Continue. 19th day.?To-day the eye is very irritable, there is asmia of the lids and lachrymation; paracentesis cornese. tinue Mist, and Atropine. 21st day.?Continue Atropine and bandage. Arsenicalis Ammonise Carb.
Liquor
rn.
..
..
Aquae Comp. Dose ^iss., three times a day. 22nd day.?Much pain, and intolerance ,.
Mist, and Calomel insufflation.
of
Con-
xii xv
.,
gr.
.,
givss
light.
hyper-
Continue
day.?Continue Mist. Guttoe vini opii. day.?Somewhat improved this morning. Continue Guttse vini opii and Mist. 27th day.?Scarcely any intolerance; left cornea brighter. 24th 2oth
Continue.
30th day. Continue Mist. Drop solution of Nitrate of Silver into the eye, grs. i-?i. 33rd day.?Photophobia and lachrymation again present. Guttse Atropise grs. iv-^i) Tincture of Iodine to lids as a counterirritant.
IJj
Tine. Ferri. Perehloridi Acidi Hydrochlorici Dil.
Aqua)
..
..
a.a.
..
..
wt
x
5is3
To be taken three times daily. day.?Continue all. day.?All the symptoms more intense ; paracentesis cornese. Atropine and bandage. Continue Mist. 3Gth day.?Pain much less" to-day. 37th day.?Omit bandage; wear a shade. Continue Mist, and Guttse Atropise. 38th day.?Pain and lachrymaticn much less since the paracentesis was performed. Continue. 40th day.?Lachrymation Mist, increased. Continue again and Guttce Atropioe. 41st day.?Much better to-day. This treatment was continued during the remaining 9 days the patient was in hospital, after which he was discharged. When he was discharged, his eye appeared in a fair way to recovery, and merely needed the instillation of mild stimulant solutions for a few days to complete the cure. Remarks.?This case affords a very good example of an obstinate disease resulting from general debility which baffles the utmost skill, and wears out the greatest patience. In such cases the great point is to discover the particular constitutional remedy best suited for giving tone to the weakened powers of assimilation; good nourishment, such as the patient can use with relish, being also indispensable to success. 34th 35th
Jivss. day. 3rd day.?Left eye : the cornea is now occupied by one large central deposit of lymph ; photophobia diminishing. Continue. 6th day.?Continue Mist, and Atropine, Sulphate of Copper to granulations. 7th day.?Granulations considerably reduced, drop in solution of Lapi3 Divinus. Continue Mist. 12th day.?Drop in solution of Nitrate of Silver grs. ii-^i. Continue Mist. In short, the patient was discharged after being five weeks under similar treatment, decidedly improved ; the granulations having been subdued at an early stage of the treatThe main object to be attained was to improve the ment. cornea ; this was accomplished by the daily instillation of various stimulant solutions, such as Nitrate of Silver, Lapis Divinus, Turpentine and Oil, and Liquor Chlori, these being used interchangeably. Dose
..
ihxv Syrupi Ferri. Iodidi 3^ mix* Thrice daily". Aqua) 8th day.?A halo of new cornea is now forming around the ulcer; very little pain. Continue. 10th day.?Continue Mist. The irritation having now ceased, drop in solution of Lapis Divinus instead of Atropine. 14th day.?Slight return of photophobia and lachrymation; bowels confined. Guttae Atropise. Ji> Mist. Colochici si. Three times a day. 15th day.?Continue Mist, and Guttse Atropine; apply a blister ..
granula-
granulations
reduced. 12th
to
1871.
[j^ne 1,
At once.
Case VIII.?Staphyloma; duration 4 months. T. M. , aged 20 ; outer part of right cornea stapliyloinatous. lower part clear; behind the latter an artificial pupil had bden made by excision The pupil is still perfect, but the staphyloma is some tims ago. prominent and painful, though not increasing. Treatment.?Guttse Belladonnse, to lessen the sensibility of the morbid tissue, and facilitate removal of the staphyloma. 2nd day.?Operation: Sylvester's modification of Borelli's of operation for staphyloma, under chloroform, (for description which see paper by Surgeon J. H. Sylvester, Indian Medical Gazette, July, 1870.) Gutta; Atropine; compress end bandage, the latter loosely applied; the Mist. Quinae ?i, three times a day. ? The Liquor Morphise hydrochloratis n\xx at night, if necessary.
June 1, 1871.]
A
MIRROR OF HOSPITAL PRACTICE.
229
9th day.?Patient lias now two excellent pupils. Continue. 3rd day.?A good deal of pain followed the operation, but the 10 th day.?Slight pain in right eye. Unguent Belladonna; Co. patient slept well after taking the draught, and is now easier. Continue pad and Atropine. Continue Mist. Quince. llth day.?Guttoe Belladonna). 5th day.?Very little pain; needles not yet separated; conti- 14th day.?Slight injection and pain to-day. Gutta; Atropine Hue Mist. Atropiae, compress and loose bandage. and bandage. fth day.?Needles separated; complains of pain in the eye. 15th day.?Continue Atropine and bandage, and AtroPia3 aQd compress. in.x. 9th day.?There is now no pe Acidi ITydrochlorici Dil. pain; staphyloma completely .. mx. Tine. Ferri. Perchloridi gone; bowels constipated. Continue treatment and
a?
..
Aqua;
01 Eicini. Aquce Menth.
Pip a.a. ^ss at once. day.?Bowels opened. Continue Atropine and 12th day.?Continue Atropine and compress. 10th
Acidi Nitrici Dil Decoct. Cinchonse Three times a day.
..
..
111
a.a.
..
Jiss. daily. Gutta) Atropioo. ..
n.
To be taken three times
day.?Continue Mixture and day.?Redness almost gone. Continue Mixture and Guttaa Atropia). 18th day.?Right eye,?counts No. 2 Jaeger; left,?counts No. 8 with difficulty. Discharged.
compress.
x
siss
16th 17th
The treatment of this case and the result which followed is good example of the great benefit that a trifling operavery 13th day.?Cornea healing rapidly; tion on the eye, when attended with success, often confers on to cornea the 18th day.?Lower heal the promises portion of prospects of a patient. sufficiently to justify making an artificial pupil by-and-bye. In recording the above cases I have thought it better to mention the number of days under treatment, than to confuse the mind of the reader with dates. It must also be remembered Case IX.? Ulcer of the cornea ; duration 15 days. G. M. ?, that the duration of disease and age of the patient as given aged 25; an unhealthy looking ulcer at the lower edge of the above must often be considered as merely approximative ; the cornea nearly through ; much conjunctival injection; lids tumid; patients being very often deficient in intelligence or heedless, so pupils well dilated by Atropine. that their statements cannot be relied upon. Generally speakTreatment.?Mist. Quinaj giss three times a day. Guttaj ing, the years of the patients who come to this hospital hang Atropiae, Unguent Belladonna) Co. heavily upon them. It is certainly not too much to say, that 2nd day.?Continue. who are but in the prime of life so far as age is concerned, 3rd day.?Nitrate of Silver drops gr. i-Ji, followed by atro- many have the careworn weird appearance whicn occasionally is seen pine. Continue Mist. Quinae. in those greatly advanced in life. 5th day.?To day there is pain and increased redness; ulcer Having taken up considerable space in two former papers on smaller. cataract extraction, and having few cases from which to select 6th day.?Ulcer almost closed. Nitrate of Silver drops; conti- at present?October being the minimum month for operations? nue mixture. I deem it needless?indeed superfluous?to touch upon that sub7th day.?Iris prolapsed during the night. Continue drops ject in this report. The total number of patients who attended and mixture. the "out-door" department during the month of October was 9th day.?Calabar bean, in order to withdraw the protruded 638 ; the average daily attendance being about 100. As usual, iris as much as possible by contracting the pupil. diseases of the conjunctiva and cornea furnished the greatest 10th day.?The vascularity has much subsided since evacua- number of cases; diseases of the fundus oculi were also very tion of the aqueous; the protrusion (niyocephalon) baing more numerous, aud of these I shall report in a future paper. is now excised calabar the the than a match for bean, ; aqueous again evacuated, and the freshly cut iris with the adjacent a of touched with of Nitrate corneal tissue delicately pencil Silver. Continue calabar bean ; apply compress and bandage. 11th day.?Continue calabar bean and compress. 12th day.?Corneal wound is now cicatrising around a very small prolapse; very little pain ; redness diminishing. Continue. 15th day.?Iris tissue almost gone from centre of the cicatrix. Instil Guttae Atropine alone. This treatment was persevered in until recovery which occurred seven days afterwards, when the patient was discharged with a small albugo occupying the site of the ulcer; the former not obscuring the pupil, required no further interference. Eemarks.?Had the protrusion occurred over the pupillary area instead of near the margin of the cornea, of course atropine would have been the most serviceable for withdrawing tne prolapsed portion of iris. a
continue treatment.
Discharged.
Case X.?Sequela of Iritis ; duration one year. J. W , aged 42 ; both irides adherent to the lens capsule, and pupils
occluded;
Counts No. 14 Pica with either eye; had
syphilis
16
years ago.
Treatment.?Guttae Atropiae gr. iv.-gi.
day.?Artificial pupil made in left eye. The iris having Undergone degeneration and become very brittle in consequence, tore off Tyrrell's hook before being excised, but nevertheless a sufficient opening was left in the iris for a pupil. Atropine, compress and bandage. 3rd day.?No redness ; beautifully clear pupil to the inner side of, and joining the old one. A piece of organised lymph islanded on the lens is now visible through the new pupil. Continue Atropine and bandage. 5th day.?Shade and Atropine. No redness; no trace of the operation, save the pupil, which is slightly contracted. Continue f shade and Atropine. 6th day.?Eight eye operated upon for artificial pupil, which was made by excision. The lens had a slightly hazy appearance when exposed. Atropine compress and bandage. 7th day.?No irritation ; no redness; the lens capsule is seen through the coloboma to be decidedly opaque. Continue. 8th day.?Pad, Atropine and bandage. 2nd
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