Pain great when tension is high. Tender to touch everywhere, except on cornea as noted above. Pain generally slight, increased if tension rises. Tender to touch over some special point in ciliary region. Action of Atropine. Strange as it must appear in view of what has been stated, and to the minds of ophthalmic surgeons, the statement is made in works on materia medica and therapeutics (Potter, 1901, and H. C. Wood, 1906), that atropine diminishes intraocular tension, but Potter inserts an interrogation point, and Wood says "probably." Elsewhere Wood says: "Atropine instilled into the conjunctival sac causes mydriasis by paralyzing the peripheral ends of the oculomotor nerve and probably by stimulating the peripheral ends of the sympathetic." Internally it acts, not centrally, but by being carried by the blood to the eye and there acting precisely as when applied locally. Upon the ciliary muscle atropine acts by inhibiting its action; by putting it at rest. The effect on the zonule of Zinn of a relaxed ciliary muscle is to tighten its fibers, and a further effect, if we accept the Helmholtz theory of accommodation, is to flatten the lens. It would, at the same time and by relaxing the muscle, cause the ciliary processes to be less prominent, and would, theoretically, favor the passage of fluids from the vit reous to the aqueous chamber, except for the incidental enlarged diameter of the lens. However this may be, the final escape of intraocular fluids from the eye is at the angle of the anterior chamber where the action of atropine crowds the iris. On the iris atropine causes contraction; that is, a drawing of the free edge toward the base. By this retraction of the iris the pupil is enlarged. The manner of its action is by paralysis of the sphincter (which is at the pupil edge), and excitation of the radial fibers (under control of the sympathetic nervous system). The effect is to thicken the base, to throw it into folds, and to crowd upon the filtration (Fontana's) spaces of the ligamentum pectonatum at the iritic angle. We can, then, imagine an eye favorable to glaucoma; hyperopic, with narrow space between the ciliary processes and the lensperiphery, and Fontana's spaces, perhaps poorly developed. And, if such an eye can exist, the condition of which would be inimical to the action of atropine, other factors, perhaps among the unknown causes of glaucoma, may also be present. Let us see what the action of atropine would now be; the lens increases in diameter (by a relaxed zonule), presses upon the ciliary processes, enlarges them, interferes with the passage of fluids to the anterior chamber, the supply of fluid secretion to the vitreous is excessive (by failure to escape), the lens advances; and at the same time the dilated iris crowds in folds at the iritic angle and blocks the filtration spaces, which, in turn, would be an exciting cause of similar cycle of pathologic events. All of these conditions were present in a patient who came to my attention at the clinic of the New York Ophthalmic Hospital only the other day, and joined with them was deep ciliary injection, pain, and an eyeball of plus two tension. As if to nail the fact of its failure to diagnosis, the patient exhibited a card (of another clinic), on which was written a diagnosis of "keratitis," and the treatment, "atropine locally, and iodide of potash internally.” Here, even, was the failure of an oculist who ought to know, and who doubtless does know, but who failed in the simple matter of testing with the finger-tips. In order to point the object of this paper let us cite a few cases: (1) A woman of sixty-five years, subject to "bilious" attacks, with spots before the eyes, neuralgia of the temples, and with a subjective sensation of colored lights, has needed her reading glasses changed with unusual frequency. Perhaps she is rheumatic or in reduced physical condition. Some family catastrophy plunges her into deep grief, and is followed by one of her old bilious attacks, with unusual eye symptoms, of which pain, blurred vision and redness are new manifestations. The dark room, heat, rest, and atrophine are ordered by the physician on a diagnosis of iritis. What is the result? This glaucoma case, having passed through the prodromal stage, has reached the first period of inflammation undetected. Tension is not demonstrated, and by the atrophine, a wide lens is further flattened to narrow the scanty space between its edge and the ciliary processes, and an iris already crowding at its periphery (base) upon the filtration spaces at the iritic angle is further jammed into that area by the pupil dilatation. Greater pain, redness, and physical distress supervene, till a visit to the specialist is, perhaps, out of question, and it is, perhaps, not thought of, but the atrophine pushed for its better effect upon the supposedly intractable iritis. And the final and rapid outcome will be blindness of varying degree. You may say that this is too strong a delineation, and so it is, ordinarily, but the fact that it does occur is sufficient excuse' for its presentation. Let us see what should have been done. Her prodromal period passed undetected for one of two reasons: either she consulted an optician for the change of glasses, and herself treated the bilious attack, or the physician consulted failed to diagnose the fault. The important matter of the healthfulness of her eyes should have been in the hands of an oculist, the symptoms noted, vision taken, the depth of the anterior chamber and the tension observed, and the field of vision examined. A diagnosis upon these would have resulted in proper treatment, eserine or pilocarpine locally, or an iridectomy. (2) A woman, 70 years of age, living in the country, perhaps, complains to her physician that she can no longer get glasses that enable her to read the finer types, et cetera, and is advised, per haps, after noting a dusky interpupilary reflex, that when her cataracts are ripe they can be removed. Here is a simple chronic glaucoma, in which tension has never been high enough to cause pain or other symptoms, except loss of vision, and such dilitation of the pupil and shallowness of anterior chamber as may be present has failed of detection. When this patient comes for attention she is past relief. To present a case of glaucoma mistaken for conjunctivitis seems unnecessary; nor shall we dwell upon the culpable futility of the exclusive use of internal symptomatic prescribing. Case 3: To the clinic of Dr. Norton there lately came a woman, presenting an eye which was very much inflamed, with deep ciliary injection, and so exquisitely sensitive and with such blepharospasm that he and others of the surgeons could not positively decide as to the tension. The pupil was dilated, and she presented a history of having had a drop of some solution put in the eye by a physician some hours before. This may have been atropine, and whether it was a case of acute glaucoma, or of iritis, he was unable to decide. An iridectomy was made, however, and a recovery resulted. So far as we have any scientific knowledge glaucoma must be combatted by freeing the iritic angle of pressure; by accepting the theory that secretion continues, and that excretion is obstructed by a crowding of the base of the iris upon Fontana's spaces which is the gateway to Schlemm's canal and the anterior ciliary circulation. In the event of a doubtful diagnosis, and in all cases of glaucoma, the opinion of the specialist should always be secured. Finally, in closing, a few key notes: In glaucoma you have a congested eye, dilated pupil, and increased tension, and the treatment is, pilocarpine or eserine locally, or an iridectomy. Atropine leads to blindness. In iritis you have a congested eye, small pupil, dull and muddy looking iris, and the tension is rarely other than normal. Atropine is the most important feature of the treatment, and to fail to use it, or to use a myotic of any form in its place, leads to blindness. TRIPLETS.-The following is a letter published in the Medical Record of recent date: Sir: Mrs. Catherine Sherwood, at the age of fifty-two, gave birth to triplets, who were named, respectively, Franklin, Francis and Frederick. They all became sea captains and all lived to be more than seventy years old. It is related of the brothers that while in Charleston, S. C., they all went into the same barber shop one day to get shaved, one in the early morning, one at noon, and the other in the evening, and the barber said he never saw a man whose beard grew so rapidly as that man's did. OPERATION ON KING ALPHONSO.-The new King of Spain was recently operated upon for the purpose of removing adenoid growths from the nasopharynx. The operation was performed by Dr. Moure of Bordeaux, and in the presence of the Spanish premier and the grand chamberlain. A NEW METHOD OF TREATMENT FOR TYPHOID FEVER.* DR. OSCAR W. ROBERTS, SPRINGFIELD, MASSACHUSETTS. Mr. President, Members of this Society, and Friends: To even suggest that I may be able to bring to your notice a drug which will abort, and even cure, typhoid fever, doubtless will appeal to you as quite unreasonable, for is it not a disease which has held its iron grasp upon the human race for all past time, killing them by the thousands? Equally true, is it not, that the medical profession has found no reliable remedy, no way to prevent its terrible ravages and its death-dealing progress? Some three years ago I read in the daily papers something of the use then being made of the sulphate of copper to purify pond and reservoir water, especially to destroy the algae and various forms of the uroglena. Also that it would kill the typhoid bacilli. The question at once arose in my mind, why will it not kill the typhoid bacilli in the human body? I determined to investigate. On applying at the office of the water commissioners for information, I learned very little, but found there a copy of the Journal of the N. E. Water Works Association, in which there were published several articles written by experts in reference to water treatment by the copper process. After reading these articles I became fully convinced that the subject was one worthy of the most careful consideration. My first effort will be to show to you that the typhoid bacilli cannot exist when brought into contact with sulphate of copper, even in the most minute quantity. Second, that often repeated minute doses of sulphate of copper can be taken into the human body for a prolonged period of time with perfect safety to both its life and health. Third, having proven these two points, I submit that in a body saturated with the sulphate of copper, the typhoid bacilli cannot longer exist; therefore, I must conclude that it will cure typhoid fever. The proof which I shall present for the correctness of these conclusions will be shown largely in quotations from others' writings. Daniel D. Jackson, Mt. Prospect Laboratory, Brooklyn, New York, says: "The destruction of the germs of typhoid fever in water by means of copper sulphate has been the subject of a considerable amount of discussion during the present year, and no definite decision has been heretofore reached as to the amount of copper sulphate required for the purpose. The differences of opinion on this subject have undoubtedly been largely due to the difference in virulence of the culture employed. The ordinary laboratory cultures which have been resuscitated by growing in beef broth Read before the Homoeopathic Medical Society of Western Massachusetts, September 18, 1907, and before the Massachusetts Homoeopathic Medical Society, October 9, 1907. have been supposed to regain their original virulence, but the experiments which are recited in this paper show that such is by no means the case, and that the highest degree of virulence is only obtained when the typhoid cultures are taken fresh from the human subject directly after death. Resuscitated typhoid cultures obtained from several prominent laboratories were experimented upon to determine the amount of copper sulphate required to destroy them. The following table gives the results obtained when the cultures were treated in distilled water, with various amounts of copper sulphate: Number of typhoid bacteria in water before treatment 1980 24 hours after treatment there remained.... 24 hours after treatment there remained..... 1920 1100 1180 420 980 256 435 It will be seen from this table that the amount required for sterilization of such a culture is one part of sulphate of copper in 2,000,000 parts of water. Another table showing similar results where Brooklyn tap water was used, one part to 2,000,000 water, completed the sterilization of this culture as above. But still another table is given which shows results different from these. Here virulent typhoid bacteria in sterilized Brooklyn tap water were treated with sulphate of copper. Culture showed 82,000 before treatment. Three hours after treatment with sulphate of 23,000 24 hours after treatment there remained.. 12,300 24 hours after treatment there remained... 18,400 |