372
LIPPINCOTT: SmaUl Cavernous Angiomna.
Case Second was a farmer, with twenty-three degrees of exophoria. I started him on the same doses, one-thirtieth of a grain, and steadily increased it. Two months later he had only a few degrees of exophoria, and shortly after, none. I have used it in cases of small degrees of insufficiency, and have had good results, but I think it is the result of toning up the whole system, rather than any specific power of the drug, for since I have used exercising prisms with equally good results in small degrees. DR. H. S. OPPENHEIMER.- I have very little to add in reply, only that in the studies I made I found that strychnia increased the actual dynamic force of the internal muscles, and decreased the strength of the externi; and I think this fact alone would go far to show that strychnia does have a specific effect upon the interni muscles. A patient learns to use the muscles, it is true, from much testing, but my tests were not carried on long enough to be considered an exercise. Wbjle I know that exercise will tone up the muscles, this treatment is so much more simple a way of getting the desired result, that I have found it more satisfactory. The externi were tested each tinie with their opponents, and should have been proportionately strengthened by it. By this mode of treatment the patient needs to come but once a week, while the "gymnastic" treatment is a great expense of time to both oculist and patient.
SMALL CAVERNOUS ANGIOMA OF OCULAR CONJUNCTIVA. BY J. A. LIPPINCOTT, M.D., PITTSBURGH, PA.
Cavernous angiomata involving the conjunctiva of the globe are so rare that I feel justified in reporting the following case: Mrs. J' D. S., aged about 25, consulted me on the 8th of last March in referenice to a swelling on the eyeball which she had first noticed six years ago, when it was about the size of a pinhead, and which, so far as she was aware, had no traumatic cause. The swelling slowly increased in size at first, but of late its development had been more rapid. A few days before her visit to my office, the eye, without being subjected to any direct injury that she knew of, and in the absence of any violent strain as from sneezing or coughing, suddenly became suffused with blood.
LIPPINCOTT: Small Cavernous Angioma.
373
On examination, the extravasation was found to be pretty well absorbed. There was a tumor of the size and shape of a large grain of wheat situated below and to the inner side of the cornea about 2mm from the corneal margin, and with its long axis parallel to the latter. It was freely movable, of a greyishpink color, and its surface was slightly lobulated, but the epithelium covering it was smooth and healthy-looking. To the touch it was soft, and its size could be considerably reduced by pressure. The surrounding ocular conjunctiva, the region of the caruncle and the eyelids, were perfectly normal. The growth was removed by including it in an elliptical incision in the conjunctiva, and the wound, which was closed by two sutures, very soon healed up. The tumor, which was at once placed in formol solution, was examined by Prof. Whitney of Harvard, from whose report I present the following extract: "The specimen shows a small tumor in the conjunctiva, which, on microscopic examination, is found to be made up of a series of cavities separated by narrow bands of connective tissue lined with endothelial cells. These spaces contain blood and serous fluid. The growth lies just. beneath the epithelium, which is perfectly normal. The condition is one of cavernous angioma." The majority of systematic writers do not mention the subject of angioma of the eye. Those who do usually comment on the extreme infrequency of primary angioma of the conjunctiva. The cases* related by Virchow, Roosbroeck, Van Ammon, and Blessig seem to furnish the chief basis for the remarks made by Saemisch,t De Wecker4 Panas,§ and other writers on the subject. Saemisch states that angioma of the conjunctiva is either an extension of a palpebral swelling or it may develop primarily in the mucous membrane. " The latter," he adds, " is rare." The other form is not so rare. According to Fuchs,T primary angiomata are, as a rule, congenital, and increase in size after birth. In regard to treatment, Panas, after relating Blessig's case, which was cured by repeated injections of perchloride of iron, criticizes this method as dangerous and recommends extirpation, electrolysis, or igneous cauterization. * Quoted by Saemisch (Handbuch, IV, 156). t Ibid., IV, I56,1I57. t Traite Complet., I, 423. 6 Maladies des yeux, II, 272, 273. Text-book of Ophthalmology, N. Y. Ed., page I I9.
LIPPINCOTT: SmaUl Cavernous Angiomna.
Case Second was a farmer, with twenty-three degrees of exophoria. I started him on the same doses, one-thirtieth of a grain, and steadily increased it. Two months later he had only a few degrees of exophoria, and shortly after, none. I have used it in cases of small degrees of insufficiency, and have had good results, but I think it is the result of toning up the whole system, rather than any specific power of the drug, for since I have used exercising prisms with equally good results in small degrees. DR. H. S. OPPENHEIMER.- I have very little to add in reply, only that in the studies I made I found that strychnia increased the actual dynamic force of the internal muscles, and decreased the strength of the externi; and I think this fact alone would go far to show that strychnia does have a specific effect upon the interni muscles. A patient learns to use the muscles, it is true, from much testing, but my tests were not carried on long enough to be considered an exercise. Wbjle I know that exercise will tone up the muscles, this treatment is so much more simple a way of getting the desired result, that I have found it more satisfactory. The externi were tested each tinie with their opponents, and should have been proportionately strengthened by it. By this mode of treatment the patient needs to come but once a week, while the "gymnastic" treatment is a great expense of time to both oculist and patient.
SMALL CAVERNOUS ANGIOMA OF OCULAR CONJUNCTIVA. BY J. A. LIPPINCOTT, M.D., PITTSBURGH, PA.
Cavernous angiomata involving the conjunctiva of the globe are so rare that I feel justified in reporting the following case: Mrs. J' D. S., aged about 25, consulted me on the 8th of last March in referenice to a swelling on the eyeball which she had first noticed six years ago, when it was about the size of a pinhead, and which, so far as she was aware, had no traumatic cause. The swelling slowly increased in size at first, but of late its development had been more rapid. A few days before her visit to my office, the eye, without being subjected to any direct injury that she knew of, and in the absence of any violent strain as from sneezing or coughing, suddenly became suffused with blood.
LIPPINCOTT: Small Cavernous Angioma.
373
On examination, the extravasation was found to be pretty well absorbed. There was a tumor of the size and shape of a large grain of wheat situated below and to the inner side of the cornea about 2mm from the corneal margin, and with its long axis parallel to the latter. It was freely movable, of a greyishpink color, and its surface was slightly lobulated, but the epithelium covering it was smooth and healthy-looking. To the touch it was soft, and its size could be considerably reduced by pressure. The surrounding ocular conjunctiva, the region of the caruncle and the eyelids, were perfectly normal. The growth was removed by including it in an elliptical incision in the conjunctiva, and the wound, which was closed by two sutures, very soon healed up. The tumor, which was at once placed in formol solution, was examined by Prof. Whitney of Harvard, from whose report I present the following extract: "The specimen shows a small tumor in the conjunctiva, which, on microscopic examination, is found to be made up of a series of cavities separated by narrow bands of connective tissue lined with endothelial cells. These spaces contain blood and serous fluid. The growth lies just. beneath the epithelium, which is perfectly normal. The condition is one of cavernous angioma." The majority of systematic writers do not mention the subject of angioma of the eye. Those who do usually comment on the extreme infrequency of primary angioma of the conjunctiva. The cases* related by Virchow, Roosbroeck, Van Ammon, and Blessig seem to furnish the chief basis for the remarks made by Saemisch,t De Wecker4 Panas,§ and other writers on the subject. Saemisch states that angioma of the conjunctiva is either an extension of a palpebral swelling or it may develop primarily in the mucous membrane. " The latter," he adds, " is rare." The other form is not so rare. According to Fuchs,T primary angiomata are, as a rule, congenital, and increase in size after birth. In regard to treatment, Panas, after relating Blessig's case, which was cured by repeated injections of perchloride of iron, criticizes this method as dangerous and recommends extirpation, electrolysis, or igneous cauterization. * Quoted by Saemisch (Handbuch, IV, 156). t Ibid., IV, I56,1I57. t Traite Complet., I, 423. 6 Maladies des yeux, II, 272, 273. Text-book of Ophthalmology, N. Y. Ed., page I I9.
