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Pittsburgh Ophthalmological Society
814
SOCIETY PROCEEDINGS
cous patches of the pharynx and tongue. A rash which had existed four days was pretty generally dis tributed over the entire body, and there were syphilides on the palms of the hands. Scrapings from the mucous patches viewed on a dark field showed numerous spirochetes. The patient received eight weekly intravenous injections of old salvarsan, 0.4 gms. each, and subsequently re ceived four intramuscular injections of mercury bichloride of one and a half grains each. The lesions responded quickly to the treatment and at present there was no clinical evidence of lues. One per cent atropin sulphate had been used in the left eye three times daily for four days, and at a recent examina tion the fundi and media of both eyes were negative and clear. Metastatic suppurative choroiditis with colon bacillus DR. H. H. TURNER presented the case of Mr. F. T., aged fifty-two years, who, while reading, had had sudden severe pain in the right eye, with immediate and complete loss of vision in this eye. This was followed promptly by a vio lent chill. On admission to the hos pital the patient exhibited a classical picture of suppurative chorciditis, with marked proptosis, and a ring of pus showing in the periphery of the an terior chamber. The patient had an organic heart lesion contraindicating general anesthesia. Under local anes thesia, therefore, a crucial incision was made through the cornea, the day fol lowing admission, and the contents of the globe, with a great quantity of pus, expressed. Several cultures were taken and these were reported by the bac teriological laboratory as pure cultures of Bacillus coli communis. The patient Was at this time under the care of Dr. J. P. Griffith for a se vere fissure in ano, with prolapsing, bleeding hemorrhoids. The question arrse as to the route by which this in fection reached the choroid from such a remote point. It could be explained only on the assumption of a bacillary
embolus so minute as to pass through the pulmonary circulation. H. H. TURNER,
Secretary.
PITTSBURGH OPHTHALMOLOGICAL SOCIETY April 23, 1928 DR. E. B. HECKEL, president
Uveitis DR. J. G. L I N N presented three cases. The first was that of P. P., white, male, aged fifteen years, seen on November 30, 1927, complaining of failure of vi sion in the left eye. This eye showed some ciliary congestion; deposits on the lens from old iritis; string-like vitreous opacities, and several patches of choroiditis with areas of proliferative retinitis. The right eye showed a cystic body of irregular shape, prob ably a hyaloid remnant, near the disc and a patch of choroiditis down and out from the disc. Slit-lamp findings were negative in the right eye. The left eye showed deposits on the pos terior layer of the cornea and a fluid vitreous with many leucocytes. Wassermann reaction was negative; chronic tonsillitis, adenoid hypertrophy, and ethmoiditis were found and corrected. This rendered the eyes quiet. S. M., white, male, aged twenty-one years, was first seen January 25, 1926, at which time he gave a history of iritis in the right eye for the past two months. He had had a detachment of the retina of the left eye one year pre viously, following a blow in the eye. Wassermann was negative. There was a deflected septum and there were en larged turbinates and an abscess of the left tonsil. A submucous resection, tonsillectomy, and adenectomy, re lieved the iritis. Scleral trephining of the left eye for detachment was done, and a large amount of straw colored fluid discharged, with no change in the fundus picture, and the lens became opaque three months later. In March, 1928, there was a recurrence of the iritis in the right eye with nodules on the iris edge, many cells in the aque ous, and some deposits on the posterior
SOCIETY PROCEEDINGS
layer of the cornea. The fundus was not markedly congested. H e was given 5,000 units of antitoxin on alternate days five times, and salicylates and atrophine, but did not improve until put on iodides and mercury inunctions. The third case was of H. B., white female, aged nineteen years, who was in the hospital in August, 1927, with Neisserian infection of both eyes, com plicated by an ulcer at the limbus of the left eye. The ulcer extended to Descemet's membrane and then stopped, healing with prolapse of iris in the area involved in the ulcer. In creased tension developing, a section was made through the staphylomatous area, cutting the external prolapse. There was a recurrence of the staphy lomatous process and increased ten sion. A section was made again by which most of the internal prolapse was removed. A pressure bandage was applied and a flat scar resulted. One month later uveitis developed in both eyes, as shown not by any pain or injection but by deposits on the pos terior layers of the corneas; leucocytes in the aqueous and vitreous, and blur ring of vision. No nodules appeared
815
ous seen with the slit-lamp, opacities of the lenses as seen by ordinary focal illumination, and changes in the retina in the region of the macula. After investigation the conditions of sepsis in the body calling for surgical intervention were found to be appendi citis one case, enlarged septic tonsils two cases, suppurating antrum one case. The cases of dental sepsis were more numerous, forty-two patients be ing referred to their own dentists for treatment at the discretion of the den tist. Of these cases radiographs of the whole mouth were made in thirty-three patients, with the result that the ap pearances which are characteristic of apical abscesses were found in twentytwo of them. Most of these abscesses were shown to have been actually pres ent by extraction of the diseased tooth, though many other teeth were con demned by the dentist which on ex traction were found to have the apices infected. There was also one case of a dental cyst with apical abscesses in which the bone of the mandible was dangerously thin.
The patients were almost entirely drawn from the upper middle class, which made the dental findings much on either iris. JAY G. L I N N , more striking than if they were drawn Secretary. from a hospital clinic. To find twentytwo cases of apical abscess among one OPHTHALMOLOGICAL SOCIETY hundred private patients' who came to an ophthalmic surgeon for glasses OF T H E U N I T E D KINGDOM seemed to indicate the need for an in April, 1928 creased use of radiography by dentists Toxic foci in cases for refraction and increased suspicion of every dead MR. A. F. MACCALLAN reported clini tooth. cal observations on a series of one A detailed description of each of the hundred private patients. The series one hundred cases was appended to the was commenced in August, 1927, and paper, which will be published in the included all private patients examined Transactions of the Ophthalmological who could be improved by glasses to Society which appears in the autumn. the usual standard of normal vision. During the period under survey thirtyPUGET SOUND ACADEMY OF nine other patients were examined OPHTHALMOLOGY A N D whose vision could not be improved to OTOLARYNGOLOGY the normal on account of obvious May 22, 1928 pathological changes in the eyes. The DR. WHEELING presiding ocular changes which have been shown to be associated with conditions of The evaluation of partial losses of focal sepsis are numerous, but those vision noted in this series of cases were bleph MR. SCOTT STERLING, a member of the aritis, episcleritis, opacities in the vitre technical staff of the Bausch and Lomb
SOCIETY PROCEEDINGS
cous patches of the pharynx and tongue. A rash which had existed four days was pretty generally dis tributed over the entire body, and there were syphilides on the palms of the hands. Scrapings from the mucous patches viewed on a dark field showed numerous spirochetes. The patient received eight weekly intravenous injections of old salvarsan, 0.4 gms. each, and subsequently re ceived four intramuscular injections of mercury bichloride of one and a half grains each. The lesions responded quickly to the treatment and at present there was no clinical evidence of lues. One per cent atropin sulphate had been used in the left eye three times daily for four days, and at a recent examina tion the fundi and media of both eyes were negative and clear. Metastatic suppurative choroiditis with colon bacillus DR. H. H. TURNER presented the case of Mr. F. T., aged fifty-two years, who, while reading, had had sudden severe pain in the right eye, with immediate and complete loss of vision in this eye. This was followed promptly by a vio lent chill. On admission to the hos pital the patient exhibited a classical picture of suppurative chorciditis, with marked proptosis, and a ring of pus showing in the periphery of the an terior chamber. The patient had an organic heart lesion contraindicating general anesthesia. Under local anes thesia, therefore, a crucial incision was made through the cornea, the day fol lowing admission, and the contents of the globe, with a great quantity of pus, expressed. Several cultures were taken and these were reported by the bac teriological laboratory as pure cultures of Bacillus coli communis. The patient Was at this time under the care of Dr. J. P. Griffith for a se vere fissure in ano, with prolapsing, bleeding hemorrhoids. The question arrse as to the route by which this in fection reached the choroid from such a remote point. It could be explained only on the assumption of a bacillary
embolus so minute as to pass through the pulmonary circulation. H. H. TURNER,
Secretary.
PITTSBURGH OPHTHALMOLOGICAL SOCIETY April 23, 1928 DR. E. B. HECKEL, president
Uveitis DR. J. G. L I N N presented three cases. The first was that of P. P., white, male, aged fifteen years, seen on November 30, 1927, complaining of failure of vi sion in the left eye. This eye showed some ciliary congestion; deposits on the lens from old iritis; string-like vitreous opacities, and several patches of choroiditis with areas of proliferative retinitis. The right eye showed a cystic body of irregular shape, prob ably a hyaloid remnant, near the disc and a patch of choroiditis down and out from the disc. Slit-lamp findings were negative in the right eye. The left eye showed deposits on the pos terior layer of the cornea and a fluid vitreous with many leucocytes. Wassermann reaction was negative; chronic tonsillitis, adenoid hypertrophy, and ethmoiditis were found and corrected. This rendered the eyes quiet. S. M., white, male, aged twenty-one years, was first seen January 25, 1926, at which time he gave a history of iritis in the right eye for the past two months. He had had a detachment of the retina of the left eye one year pre viously, following a blow in the eye. Wassermann was negative. There was a deflected septum and there were en larged turbinates and an abscess of the left tonsil. A submucous resection, tonsillectomy, and adenectomy, re lieved the iritis. Scleral trephining of the left eye for detachment was done, and a large amount of straw colored fluid discharged, with no change in the fundus picture, and the lens became opaque three months later. In March, 1928, there was a recurrence of the iritis in the right eye with nodules on the iris edge, many cells in the aque ous, and some deposits on the posterior
SOCIETY PROCEEDINGS
layer of the cornea. The fundus was not markedly congested. H e was given 5,000 units of antitoxin on alternate days five times, and salicylates and atrophine, but did not improve until put on iodides and mercury inunctions. The third case was of H. B., white female, aged nineteen years, who was in the hospital in August, 1927, with Neisserian infection of both eyes, com plicated by an ulcer at the limbus of the left eye. The ulcer extended to Descemet's membrane and then stopped, healing with prolapse of iris in the area involved in the ulcer. In creased tension developing, a section was made through the staphylomatous area, cutting the external prolapse. There was a recurrence of the staphy lomatous process and increased ten sion. A section was made again by which most of the internal prolapse was removed. A pressure bandage was applied and a flat scar resulted. One month later uveitis developed in both eyes, as shown not by any pain or injection but by deposits on the pos terior layers of the corneas; leucocytes in the aqueous and vitreous, and blur ring of vision. No nodules appeared
815
ous seen with the slit-lamp, opacities of the lenses as seen by ordinary focal illumination, and changes in the retina in the region of the macula. After investigation the conditions of sepsis in the body calling for surgical intervention were found to be appendi citis one case, enlarged septic tonsils two cases, suppurating antrum one case. The cases of dental sepsis were more numerous, forty-two patients be ing referred to their own dentists for treatment at the discretion of the den tist. Of these cases radiographs of the whole mouth were made in thirty-three patients, with the result that the ap pearances which are characteristic of apical abscesses were found in twentytwo of them. Most of these abscesses were shown to have been actually pres ent by extraction of the diseased tooth, though many other teeth were con demned by the dentist which on ex traction were found to have the apices infected. There was also one case of a dental cyst with apical abscesses in which the bone of the mandible was dangerously thin.
The patients were almost entirely drawn from the upper middle class, which made the dental findings much on either iris. JAY G. L I N N , more striking than if they were drawn Secretary. from a hospital clinic. To find twentytwo cases of apical abscess among one OPHTHALMOLOGICAL SOCIETY hundred private patients' who came to an ophthalmic surgeon for glasses OF T H E U N I T E D KINGDOM seemed to indicate the need for an in April, 1928 creased use of radiography by dentists Toxic foci in cases for refraction and increased suspicion of every dead MR. A. F. MACCALLAN reported clini tooth. cal observations on a series of one A detailed description of each of the hundred private patients. The series one hundred cases was appended to the was commenced in August, 1927, and paper, which will be published in the included all private patients examined Transactions of the Ophthalmological who could be improved by glasses to Society which appears in the autumn. the usual standard of normal vision. During the period under survey thirtyPUGET SOUND ACADEMY OF nine other patients were examined OPHTHALMOLOGY A N D whose vision could not be improved to OTOLARYNGOLOGY the normal on account of obvious May 22, 1928 pathological changes in the eyes. The DR. WHEELING presiding ocular changes which have been shown to be associated with conditions of The evaluation of partial losses of focal sepsis are numerous, but those vision noted in this series of cases were bleph MR. SCOTT STERLING, a member of the aritis, episcleritis, opacities in the vitre technical staff of the Bausch and Lomb