J. A. (Joel Asaph) Allen.

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lem that has not been satisfactorily solved. His conclusions are
** that the pus in the hypopyon comes, in the majority of cases,
from the uveal tract, the iris and the vessels adjacent to Fontana's
spaces, while that in the cornea is derived either from the deep
-ciliary vessels or the anterior border-loop vessels. So much is
positive. As to the source of the pus-cells, which appear in the

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exudate on Descemet's membrane very early in most cases, we are
still uncertain. The pus in the cornea may be derived from the
conjunctival sac, and may originate from the cornea itself. At
least it has not been proven that it does not."


Dr. Adolf Alt, of St. Louis, (Journal of Ophthalmology ^ Novem-
ber, 1893,) describes a form of iritis which he terms "croupous."
It is that form which Knapp has designated as "spongy iritis,"
and is scarcely mentioned in the tex^book8. The literature of
the subject began with Schmidt, who reported two cases in 1871.
Since then it has been noted by Gunning, Gruening, Kipp, Knapp^
Alt, and S. M. Burnett. This is an inflammatory disease of the
iris, ushered in by severe pain in and about the eye, edema of the
lids and conjunctiva, and circumcorneal injection. This inflam-
mation leads to a peculiar exudation into the anterior chamber,
but which is in no way distinguishable from croupous exudation
elsewhere. It forms rapidly, and is first seen as a grayish, gray-
ish-yellow, or grayish-green semi-transparent substance (showing
sometimes stripes and dots), which, when the patient is seen,
usually fills the anterior chamber to its full extent. After a period
varying from a day to a week, and even much more, during which
time hemorrhages into the anterior chamber not infrequently take
place, the exudation becomes transparent in its periphery, and is
liquified and gradually absorbed. This change is visible usually
at first in the upper part of the anterior chamber, where a small
strip of iris-tissue becomes uncovered, the exudation sinking by
gravitation. It then presents a sharp, well-defined, sometimes
perfectly round, sometimes jagged edge upward, and has at this
stage an appearance much like that of a cataractous lens, dislo-
cated into the anterior chamber. This resemblance is the more
striking, as the anterior chamber is usually very deep. Gradually
the absorbing and melting process goes on, till later only a small
piece is seen lying at the bottom of the anterior chamber, and
finally after ten to twenty-five days it entirely disappears. The
eye then quickly recovers, only one or more posterior synechia
remaining to mark the disease. In uncomplicated cases not even a~
synechia may remain.

It seems highly probable that we have to deal with a special
form of infection which is worthy of further study. In treat-
ment the same measures may be used as in plastic iritis.

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Mr. Work Dodd read a paper on this subject before the Ophthal-
mological Society of the United Kingdom, [Medical WeeJc^ Octo-
ber 27, 1893,) which was the outcome of a study of 100 cases.
The refractions were worked out under mydriatics with every
care, under the following conditions: (I) The total refraction
under a mydriatic was taken ; (2) hypermetropia of 0.75 D was
reckoned as emmetropia ; (3) astigmatism of 0.25 D was not

The following are the results of his researches : Emmetropia,
7 ; simple hypermetropia, 42 ; simple myopia, 6 ; total astigma-
tism, 42, of which there were simple hypermetropic astigmatism,
3 ; compound hypermetropic astigmatism, 24 ; compound myopic
astigmatism, 2 ; mixed astigmatism, 6 ; marked anisometropio
astigmatism, 7 ; other cases of marked anisometropia, 3. If we
compare this table with a classification of percentages of refrac-
tion, obtained from fifty cases of apparently normal eyes, which
were worked out under mydriatics in the same manner, we find
emmetropia, 6 ; simple hypermetropia, 70 ; simple myopia, 2 ;
total astigmatism, 16. It will be seen that the most marked dif-
ference is in the amounts of the simple hypermetropia and of
simple astigmatism, there being twenty-eight cases per cent, less
in the epileptic than in the apparently normal class. Of astigma-
tism of all kinds there are twenty-six cases per cent, more in the
epileptic division than in the normal one, chiefly made up by the
large amount of compound hypermetropic astigmatism existing in

Of the 100 consecutive cases of epilepsy, seventy-five were
ordered to wear glasses ; of these there were twenty-three who
either did not wear them, or failed to report themselves later and
could not be found. Of the remaining fifty-two cases there were :
(1) Thirteen who had no fits since using the glasses, during periods
varying from four months to one year ; (2) three patients whose
condition had not apparently altered ; and (3) thirty-six patients
whose condition had improved since wearing glasses ; in the
majority of these the improvement had been marked. In all the
cases the ordinary treatment was continued for some time. Several
oases in which patients who had ceased to have fits since wearing
the glasses, had suffered from them again through some other form
of irritation, but in no case had the fits been as severe as before.

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Mr. Dodd thinks that we may deduce from the foregoing facts
that, given a certain condition of instability of the nervous sys<
tem, errors of refraction may excite epilepsy, and their correction,
with other treatment, may relieve and even cure it.


DbWbckeb (Annales d^ Oculistiqtie, Jaly> 1893,) has practised
curetting and antiseptic irrigation of corneal ulcers and abscesses
for some time with surprising results, of which the following are
the most marked :

1. The suppression, sometimes instantaneous, of pain and

2. The clearing up of the surrounding parts, followed by a
cure infinitely more rapid than is obtained by the employment of
various antiseptics and particularly the actual cautery.

3. Keparation by a more transparent tissue is better obtained
by this method than by any other mode of treatment.

He operates by using sharp curettes of small dimensions, and of
various forms, of which one differs but little from that of Critchett,
except that it is one-third as wide and its edgie is sharp. He
endeavors as much as possible to remove from the bottom and
edges of the ulcer all the adherent whitish parts in such a way
that, under the jet of the irrigator (charged with a four per cent,
solution of boric acid), the parts of the cornea not attacked by
the curette appear feebly opaline, but uniformly transparent.

He does not hesitate to affirm that the curetting {raclage)^ joined
with irrigation, should be used by all clinicians until the progress
of our therapeutics furnishes something better.


Valude, of Paris, {Annales d"" Ocufistique^ July, 1893,) has been led
to study the antiseptic properties of formic aldehyde, and believes
he has found in this a powerful antiseptic, and, being but little
irritating, one that is particularly suited to the eye. He recom-
mends it in cases to be operated upon, in post-operative infection,
in purulent affections of the eye, and in the sterilization of colly-
ria, as it does not precipitate the alkaloids (atropine, eserine,
cocaine,) as does bichloride of mercury. He uses it in the eye in

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solutions of 1 to 100 to 1 to 500, and to preserve coUyria
1 to 2000.

Finally, as it does not attack metals — steel, silver, or alnminum
— it may be used for washing and disinfecting instruments, in
solution, for example, of 1 to ^00.


Db. Clabence J. Blake, of Boston, {Archives of Otology, 1893,) has
recorded his experience in the removal of the stapes for chronic,
non-suppurative catarrh of the middle ear. His conclusions
are so important that they are here presented in full :

" In reviewing the cases reported, . . . it is very evident,
so far as conclusions can be drawn from a small number of cases,
that the operation of the removal of the stapes does not answer
the purpose which might be hoped from it in cases of chronic non-
suppurative disease of the middle ear. This conclusion is one in
which the clinical and operative observations are entirely in accord
with the pathology of this class of cases as set forth by numerous
observers, and lastly and most clearly by Politzer. For all this
class of cases, therefore, I should, as the expression of a personal
opinion and as the result of experience, advise an exploratory
tympanotomy with local and without general anesthesia, as a pre-
liminary to, or as the first part of, an operation having in view any
form of interference with the middle ear, from simple mobiliza-
tion of the ossicular chain to the removal of the stapes.

" The exploratory tympanotomy, especially where the incision is
made, as it should be, close to the periphery of the membrana
tympani and of sufficient extent, affords an opportunity for a
better determination of the condition of the middle ear in chronic
non-suppurative' disease than can be obtained in any other way^
and after the exploratory incision, if it seems advisable not to
operate more extensively, the opening in the membrana tympani
can be closed by a simple paper dressing, with the prospect of
speedy healing. If, however, the exploratory operation and coin-
cident tests show that it is advisable to perform an operation in
the middle ear, whether synectomy, tenotomy, incudectomy, incudo-
stapedectomy, or stapedectomy, the opening suffices for the

" In the great majority of the cases of stapes fixation, conse-

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quent upon chronic non-suppurative disease of the middle ear, the
operation . . . was ineffectual, so far as the removel of the stapes
was concerned, the fixation of the base-plate at least being such as to
result in fracture of the crura instead of the removal of the ossicle
entire. In all the cases of non-suppurative disease in which the
stapes was extracted entire, the hearing was definitely and practi-
cally improved in one only ; and of the two other cases in which
definite improvement in hearing resulted from the operation, there
was one in which the mobilization of the base-plate, incident to
the fracture of the crura, gave an improvement for high tones,
and for the voice in ordinary conversation only to the extent of
about twenty per cent.

" When we take into consideration the secondary changes which
may have occurred in the internal ear in the course of a non-sup-
purative disease of the tympanum, and the injury to the delicate
structures in the labyrinth, which might result from the force
exerted in the extraction of the stapes, coupled with the
inadequate results as set forth in the experience tabulated, it may
be justly said that stapedectomy does not afford a promising out-
look for this class of cases."


Theobold {New York JfediccU Jiecord, July 29, 1893,) reports the
case of a female, aged 42, who had suffered for six months with
an annoying cough and with spells of inability to swallow food.
These symptoms were increased on manipulation of the right ear.
Examination showed a piece of wax which had been forced against
the drum-membrane by attempts at removal. 'It was removed by
syringing, and the difficulty in swallowing and other symptoms

The hostess who sends a pitcher of ice water to her guest's room
should use as large a lump of ice as will fit the pitcher, and not too
much water ; then set the pitcher in the center of a large news-
paper, gathering the ends up at the top and place a strong rubber
band around them, to exclude the air. Treated in this way, the
water will remain real ice water all night, and a lump of ice as
big as one's fist will not be entirely melted by the next morning.
— Buffalo Commercial,

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J. BuBNET Yeo, [Boston Medical and Surgical Journal^ after dis-
cassing the known modes of causation of attacks of angina pec-
toris, sammarizes the indications for treatment as follows :

1. To maintain or improve, when defective, the general nutri-
tion ; to avoid all strain, physical and emotional ; and so to relieve
cardiac feebleness and excessive effort.

2. To relieve dyspeptic conditions and flatulent or fecal
distension of the stomach and intestines.

3. To forbid tb# habitual consumption of agents which may
exercise a toxic action on the heart, such as tea, coffee, tobacco,
alcohol, etc., or that may introduce or develop toxines in the
alimentary canal.

4. To avoid and remove all gouty and other blood con-

5. To give such tonic remedies as may improve the cardiac
tone and lessen existing tendency to cardiovascular degeneration.

6. To relieve the paroxysmal attacks by sedatives and

1. Under the first indication, Dr. Yeo speaks of the necessity
of careful attention to hygienic measures ; the life of the patient
must be one of complete repose of mind and body — a repose
alternated with gentle exercise. Life in the open air and in a
mild climate is also beneficial. The diet must be carefully looked
after, and sometimes be almost exclusively of milk. If the diges-
tive powers are greatly weakened, it may be necessary to have
recourse to pre-digested foods, or to give with the food some
artificial digestive agent. The writer mentions a number of
dishes that may be easily assimilated, and then goes on to say
the physician should see that a sufficient quantity of water is
taken, both for eliminative and assimilative purposes, a point
often overlooked.

2. The coexistence of dyspeptic states must be treated in
accordance with general principles — an alkaline bitter stomachic,
composed of sodium bicarbonate, nux vomica, and columbo, an
hour before the two principal meals, will be found valuable.
Regular evacuation of the bowels of fecal accumulations is most
essential — checking as it does the formation of injurious toxines

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in the intestines, eliminating waste substances, and relieving
abdominal disturbance. Dr. Yeo here suggests various remedies
as aperients.

3. This indication is also an important one, for certain of the
slighter forms of angina are no doubt dependent on, and the
more serious forms may be provoked by, the habitual use of
certain substances which come, in course of time, to exercise a
toxic action on the heart. The action of these toxic agents is all
the more subtle because they may be taken for many years with-
out apparently producing any injurious effect. This is particu-
larly the case with tobacco, the toxic effects of which on the heart
are often delayed until, or even after middle age, when they will
perhaps somewhat suddenly make themselves felt. The toxic and
degenerating influence of alcohol falls upon different organs in
different individuals ; but whenever anginal symptoms arise,
complete abstinence from alcohol should be insisted on or its very
sparing use in very dilute form. Tea and coffee are often provo-
cative of the slighter manifestations of cardiac pain and discom-
fort, and they are prone to be aggravated by any emotional dis-
turbance. All these toxic agents must be forbidden so long as any
tendency to anginal attacks exists.

4. The next indication is to remove and avoid all gouty and
other blood contamination. The importance of elimination in the
treatment of angina pectoris is universally admitted. When renal
elimination is defective from the coexistence of renal degeneration,
the bowels and the skin must be acted on. When the kidneys are
sound, the free use of pure water, or some suitable mineral water
having some slight stimulating action on the kidneys, may avoid
the necessity of free purgation ; but, in all cases, a thorough daily
evacuation of the bowels should be procured, and free action of
the skin should be maintained by warm baths and frictions. In
gouty cases, and in all cases of defective elimination, the diet
should be sufficient, but careful and spare, avoiding all excess.
Animal food should be taken only in great moderation, and fresh
vegetables and fruit carefully prepared, and cooked so as to be
made easy of digestion, should take its place. All alcoholic stimu-
lant should be avoided, and, if acceptable to the patient, a few
weeks of exclusive milk diet may be advantageous.

5. Dr. Yeo considers next the medicinal treatment of these
oases, and first, the appropriate treatment in the intervals — that
is, of the constitutional condition underlying the paroxysmal
attacks. He points out in certain cases the value of the milder

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preparations of iron, combined with small doses of digitalis, in
other cases of the greater valae of arsenic ; the asef alness of
strychnine as a cardiac tonic, of potassium iodide, when angina
pectoris is associated, with obvious signs of cardiac vascular
degeneration and of the gouty state, etc.

6. Those who see in the causation of the anginal paroxysm
the predominating influence of vaso-motor spasm, consider that the
main indication for the relief of the paroxysm is to administer
medicinal agents which are known to have the power of relaxing
the arterioles ; they therefore advocate the use of the nitrite^,
such as the nitrite of amyl, nitro-glycerine, and sodium nitrite.
That these agents do relieve the paroxysm in many cases of
angina, is certain ; that they do so wholly by their action as vaso-
dilators, is extremely doubtful. In the first place, they are capable
of relieving the anginal attack when there is no certain evidence
of the existence of vaso-motor spasm. Dr. Douglas Powell says
he has found them << far more reliable in the graver cardiac cases
than in the purer vaso-motory," but it is in*the latter that they
should prove most efficacious if the prevailing theory of their
action were true. Balfour and Grainger Stewart both believe that
they act as direct analgesic agents, and that they have the power
of relieving pain in other as well as in cardiac neuralgias, inde-
pendently of their relaxing action on the bloodvessels ; and this
view Dr. Yeo adopts as the most consistent with the clinical
history of the disease.

The effect of sodium nitrite is said to be more lasting than
that of nitrite of amyl or nitro-glycerine. It is given in tablets
ot 2^ grains ; one to four of these may be given for a dose. At
the onset of an attack, in addition to the inhalation of the nitrite
of amyl, which, owing to the rapidity of its action, is the most
suitable remedy to start with, some warm diffusable stimulant
may be given, such as thirty minims of sulphuric ether or a
drachm of nitrous ether, with a drachm of sal volatile, or a little
brandy in an ounce or two of peppermint water. Feet and hands,
if cold, may be placed in hot water. Balfour has been disap-
pointed in action of nitro-glycerine, and prefers inhalations of
nitrite of amyl ; and when these fail — as they often will — he
resorts unhesitatingly to chloroform inhalations ; sulphuric ether
may be used, but it is not rapid enough. Chloroform may be
poured on a sponge in a smelling bottle, and the patient is told to
breathe it through his nose as deeply as possible. <* In this way

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relief is obtained in a few seconds, and so soon as the narcotic
influence is produced, the smelling bottle drops, and with it rolls
away all risk of any overdose." In severe and protracted attacks
it may be necessary to have recourse to hypodermic injections of


Bt S. C. AYRES, M. D., of Cincinnati, O.

The treatment of blepharitis marginalis is often unsatisfactory
and disappointing. Relapses frequently occur, and remedies seem
to lose their effect, and at times even to act unfavorably. It is
true that much of our success depends on the faithfulness of the
patient, or of his parents, in carrying out the treatment at home.
Much also depends on the physical condition of the patient, and
this should always receive careful attention. Anomalies of refrac-
tion seem to play an important r61e in perpetuating the disease,
and these also should be carefully corrected. But aside from
these considerations, the treatment is often prolonged, taxing the
patience of the physician as well as of the client.

The remedies prescribed for the relief of this disease are num-
erous, and all have met with more or less success. During the past
year I have used, with great satisfaction, hydrogen dioxid in the
treatment of this disease. I was led to its use by some experi-
ments in cases with suppurating rings round the cilia. After
removing the crusts and applying the dioxid, there was a bubbling
and boiling effect for a while, which soon subsided, leaving the
ulcerated surface whitened, as if a solution of silver nitrate had
been used upon it. The application was almost painless, and the
lid was left clean and free from pus or scales.

These experiments were followed by a general adoption of
this method in nearly all cases, but especially in those with ulcer-
ations along the lid margin.

In the method advised, a clean remedy is used, which acts
promptly and efficiently. By its chemio action it destroys the
germs which cling so closely to the edges of the lids. It is not a
cure-all or a specific, but I certainly have had the happiest results
from its use. — ^ledical News^ Dec. 23, 1893.

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All oommunloations, whether of a literary or business character, should be addressed
to the managing editor: 884 Framklim Stbebt, Buitalo, N. Y.

Vol. XXXIV. JANUARY, 1894. No. 6.


The importance of physical exercise for the body is universally
admitted ; thinking men of all ages have recognized its value
also as a factor in expanding and strengthening the intellect. A
healthy mind in a healthy body is a proverbial phrase, but it is
t>nly within the last few decades that this somewhat worn dictum
has been found to have a scientific base.

Late investigations have proved beyond cavil that not only
does the mind depend upon the body, but that the most satisfac-
tory condition of the body cannot coexist with what is called a
diseased mind. Whether there be or not, that which we call the
soul, to sit in judgment on the actions or operations of the mind^
it is certain, from investigations made and still making, that the
latter not only acts upon the body, but is itself subject to the
condition of the brain, governing and being governed by the
movements and changes of its cells, and that health or disease
depend on their normal or abnormal state.

There is an old story about a quarrel between the pendulum
and the hands of a clock, and, if our memory is not at fault, the
stomach and heart were once at loggerheads about the relative
value of their tasks. Nothing was said, we believe, by the patient
and silent nerves, that, after all, had to keep the whole in working
t)rder. These have at last found a voice, and their claim is not
likely to be ignored in the future.

If mind and body are so inseparably connected, then it follows
that proper physical exercise aims at the equal development and
strengthening of all parts of the body. Various have been the
means by which this object has been sought. There is difficulty in
t^hildhood, and but little in the early stages of adolesence. Runnings

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skating, swimming, rowing, with all the movements of the body
and diversions of the mind accompanying them, will, with proper
diet, develop all that heredity or disease does not prevent; but
there comes a time when the future citizen, on whose virtue and

Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 36 of 78)