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A New Dropper Bottle
NOTES,
GASES AND
Sept. 24. V . both eyes — 2 0 / 5 0 . Fields normal for form and color. Blind spots normal. Pupils fully di lated, and reflexes absent. Examina tion of nose showed considerable swelling of the middle turbinates, and an acute bilateral ethmoiditis. After cleaning and shrinking the nasal cham bers, negative pressure was used, and a large amount of mucopus withdrawn. Sept. 25. No pain in eyes or head, pupils not so widely dilated, but still mactive. V. O. U.=20/20-2. Sept. 26. Pupils almost normal in size, and react sluggishly to light. V. O. U.=20/20. Reading = Jaeger 5 at 20 inches. Sept. 29. v., normal, for both dis tance and reading. Pupils normal in size and reaction. Refraction under homatropin shows 1. D. of hyperopia in each eye. No heterophoria present. No eye treatment was employed in this case, but her nose and nasal sinuses were treated daily for a week. It is not unusual to see ciliary spasm associated with acute nasal sinusitis, but cycloplegia, I believe, is exceed ingly rare. D Y S T R O P H Y O F T H E CORNEA. H.
L.
HiLGARTNER,
M.
D.
INSTRUMENTS
236
sulting blebs making the surface very uneven. A t the "two-o'clock" point of the cornea a narrow elliptical hemor rhagic infiltration lay radially from the periphery toward the center. The cornea was insensitive to touch. T h e bulbar conjunctiva was mildly con gested. T h e anterior chamber was very deep. T h e tension of the eyeball to finger palpation was strongly plus. No inflammatory involvement of the in terior eyeball could be discerned. V i sion had been reduced to counting fingers at two feet. The differential diagnosis between the condition before us and glauco matous corneal haze, interstitial kera titis, or other forms of corneal opacity, seemed to be decisive and we diagnosed the case as dystrophy of the cornea—the rare degenerative affection of the cornea first described by Fuchs in 1910. According to Dr. Lloyd B . Whitham, of
Baltimore, in
the
AMERICAN JOUR
NAL OF OPHTHALMOLOGY, October 1924,
only nineteen cases of dystrophy of the cornea have been reported. I have not yet had an opportunity to study this case with my Gullstrand Slit Lamp, but I am in hopes that the patient will give me an opportunity to do so.
AUSTIN, TEXAS.
This case came under my observa tion on October 26th, 1924, in a con sultation invited by Dr. S. C. Apple white, San Antonio, Texas. History: Mr. N., aged fifty-five, had suffered for several years and had been treated for parenchymatous keratitis. The condition had fluctuated during these years. The X-ray examination showed sinuses negative, and some teeth needing removal on account of pyorrhea. T h e general physical exam ination also gave negative answer. Examination of the cornea revealed circumcorneal engorgement of blood vessels. Centrally the cornea showed disappearance of the upper epithelial cells with the deeper portions clear, this area being about one-quarter inch in diameter. Surrounding this des quamated central area there was a swollen condition, caused by infiltra tion between underlying layers, the re
A N E W DROPPER BOTTLE. CONRAD B E R E N S , M.D., NEW
F . A. C . S.
YORK CITY.
The dropper bottle to be described is a container and dropper combined.
Fig. 1. A new dropper bottle ( B e r e n s ) . Above rubber bulb for expelling contents. Below bottle and beak thru which drop is expelled.
It is composed of a cylindrical con tainer 9 centimeters in length and 13 mm. in diameter, drawn out at one end to a dropper tip at an angle of 45° to
226
NOTES, CASES AND INSTRUMENTS
the container. An opening in the cylinder is made on the side opposite the dropper tip at the junction of the upper and middle thirds, into which a half inch glass tube is fused at an angle of 4 5 ° to the container. Method of Using the Dropper. The tip of the index finger is applied to the rubber nipple and the thumb and fore finger grasp the cylinder. The container is tilted until the solu tion fills the tip of the dropper; gentle pressure is then applied to the nipple and the drop, drops, or stream of fluid are forced out. Advantages. 1. The medicine dropper and container are combined. 2 . T h e dropper can be held more firmly than the ordinary dropper and as there is no wobbling, the drop can be more accurately placed. 3. The container and nipple are easily sterilized, and the bottle can be refilled without resterilization, by re moving the rubber nipple. 4 . Solutions keep sterile longer than they do in the ordinary bottle, for when the cork is removed from an or dinary bottle, the dust around the
mouth of the bottle drops in. I t is also much more sterile and safer than a bottle with a glass stopper and drop per combined, for the dropper in this type of bottle is exposed to the air and possibly touches the patient's eye, eye lid or eyelashes, and is then put back in the bottle. 5. The device is economical of solu tions for two reasons, first because they are seldom contaminated; second, because the dropper containing the solu tion is not thrown away if the patient's lids are touched; it is only necessary to express a drop and wipe the tip with alcohol. 6. I f ordinary care is used, the solution will not get into the rubber nipple, thus lessening the possibility of contamination and the entrance of foreign particles into the eye. Uses of the Dropper. I. Keeping and applying solution in office and hospital practice. 2 . Keeping and applying solution in the operating room. 3. Dispensing drops for the use of the pa tient at home. T h e droppers may be obtained from 1·:. B. Aleyrovvitz, 520 Fifth Ave., New York City.
SOCIETY PROCEEDINGS Reports for this department should be sent at the earliest date practicable to Dr. Harry S. Gradle, 22 E. Washington St., Chicago, Illinois. These reports should present briefly scientific papers and discussions, include date of the meeting and should be signed by the Reporter or Secretary. Complete papers should not be included in such reports; but should be promptly sent to the Editor as read before the Society.
MINNESOTA ACADEMY OF OPHTHALMOLOGY. Meeting of December 1 2 , 1 9 2 4 . D R . J O H N S . MACNIE, President. Coloboma of the Macula. D R . J . A . WATSON.
Mrs. C. V . con
sulted me first on February 2 2 , 1915, complaining of aching of the eyes and blurring of the vision on near work. I prescribed for her at that time: R.-f-0.75S.C+0.75x60°: L.-i-0.75S.C+0.75x80°.
The refraction of the right was, how ever, determined entirely by the use of the retinoscope, as her vision in that eye amounted only to the discerning of fingers at 10 ft. and was not improved
by lenses. The eye really showed hyperopia of about three diopters. The vision in the left eye was and is normal. T h o she was then 2 8 years old she had never been conscious of any de ficiency of vision in the right eye, until I drew her attention to it. T h e opthalmoscope showed in the fundus of that eye, a circular white area in the macula nearly twice the diameter, of the papilla. It had a faint bluish green tint. T h e edges were distinct and sharply defined. There was a good deal of pigment around the borders, es pecially around the lower and tempo ral borders. There were several whitish spots and a good deal of pigment in the surrounding fundus. There was
GASES AND
Sept. 24. V . both eyes — 2 0 / 5 0 . Fields normal for form and color. Blind spots normal. Pupils fully di lated, and reflexes absent. Examina tion of nose showed considerable swelling of the middle turbinates, and an acute bilateral ethmoiditis. After cleaning and shrinking the nasal cham bers, negative pressure was used, and a large amount of mucopus withdrawn. Sept. 25. No pain in eyes or head, pupils not so widely dilated, but still mactive. V. O. U.=20/20-2. Sept. 26. Pupils almost normal in size, and react sluggishly to light. V. O. U.=20/20. Reading = Jaeger 5 at 20 inches. Sept. 29. v., normal, for both dis tance and reading. Pupils normal in size and reaction. Refraction under homatropin shows 1. D. of hyperopia in each eye. No heterophoria present. No eye treatment was employed in this case, but her nose and nasal sinuses were treated daily for a week. It is not unusual to see ciliary spasm associated with acute nasal sinusitis, but cycloplegia, I believe, is exceed ingly rare. D Y S T R O P H Y O F T H E CORNEA. H.
L.
HiLGARTNER,
M.
D.
INSTRUMENTS
236
sulting blebs making the surface very uneven. A t the "two-o'clock" point of the cornea a narrow elliptical hemor rhagic infiltration lay radially from the periphery toward the center. The cornea was insensitive to touch. T h e bulbar conjunctiva was mildly con gested. T h e anterior chamber was very deep. T h e tension of the eyeball to finger palpation was strongly plus. No inflammatory involvement of the in terior eyeball could be discerned. V i sion had been reduced to counting fingers at two feet. The differential diagnosis between the condition before us and glauco matous corneal haze, interstitial kera titis, or other forms of corneal opacity, seemed to be decisive and we diagnosed the case as dystrophy of the cornea—the rare degenerative affection of the cornea first described by Fuchs in 1910. According to Dr. Lloyd B . Whitham, of
Baltimore, in
the
AMERICAN JOUR
NAL OF OPHTHALMOLOGY, October 1924,
only nineteen cases of dystrophy of the cornea have been reported. I have not yet had an opportunity to study this case with my Gullstrand Slit Lamp, but I am in hopes that the patient will give me an opportunity to do so.
AUSTIN, TEXAS.
This case came under my observa tion on October 26th, 1924, in a con sultation invited by Dr. S. C. Apple white, San Antonio, Texas. History: Mr. N., aged fifty-five, had suffered for several years and had been treated for parenchymatous keratitis. The condition had fluctuated during these years. The X-ray examination showed sinuses negative, and some teeth needing removal on account of pyorrhea. T h e general physical exam ination also gave negative answer. Examination of the cornea revealed circumcorneal engorgement of blood vessels. Centrally the cornea showed disappearance of the upper epithelial cells with the deeper portions clear, this area being about one-quarter inch in diameter. Surrounding this des quamated central area there was a swollen condition, caused by infiltra tion between underlying layers, the re
A N E W DROPPER BOTTLE. CONRAD B E R E N S , M.D., NEW
F . A. C . S.
YORK CITY.
The dropper bottle to be described is a container and dropper combined.
Fig. 1. A new dropper bottle ( B e r e n s ) . Above rubber bulb for expelling contents. Below bottle and beak thru which drop is expelled.
It is composed of a cylindrical con tainer 9 centimeters in length and 13 mm. in diameter, drawn out at one end to a dropper tip at an angle of 45° to
226
NOTES, CASES AND INSTRUMENTS
the container. An opening in the cylinder is made on the side opposite the dropper tip at the junction of the upper and middle thirds, into which a half inch glass tube is fused at an angle of 4 5 ° to the container. Method of Using the Dropper. The tip of the index finger is applied to the rubber nipple and the thumb and fore finger grasp the cylinder. The container is tilted until the solu tion fills the tip of the dropper; gentle pressure is then applied to the nipple and the drop, drops, or stream of fluid are forced out. Advantages. 1. The medicine dropper and container are combined. 2 . T h e dropper can be held more firmly than the ordinary dropper and as there is no wobbling, the drop can be more accurately placed. 3. The container and nipple are easily sterilized, and the bottle can be refilled without resterilization, by re moving the rubber nipple. 4 . Solutions keep sterile longer than they do in the ordinary bottle, for when the cork is removed from an or dinary bottle, the dust around the
mouth of the bottle drops in. I t is also much more sterile and safer than a bottle with a glass stopper and drop per combined, for the dropper in this type of bottle is exposed to the air and possibly touches the patient's eye, eye lid or eyelashes, and is then put back in the bottle. 5. The device is economical of solu tions for two reasons, first because they are seldom contaminated; second, because the dropper containing the solu tion is not thrown away if the patient's lids are touched; it is only necessary to express a drop and wipe the tip with alcohol. 6. I f ordinary care is used, the solution will not get into the rubber nipple, thus lessening the possibility of contamination and the entrance of foreign particles into the eye. Uses of the Dropper. I. Keeping and applying solution in office and hospital practice. 2 . Keeping and applying solution in the operating room. 3. Dispensing drops for the use of the pa tient at home. T h e droppers may be obtained from 1·:. B. Aleyrovvitz, 520 Fifth Ave., New York City.
SOCIETY PROCEEDINGS Reports for this department should be sent at the earliest date practicable to Dr. Harry S. Gradle, 22 E. Washington St., Chicago, Illinois. These reports should present briefly scientific papers and discussions, include date of the meeting and should be signed by the Reporter or Secretary. Complete papers should not be included in such reports; but should be promptly sent to the Editor as read before the Society.
MINNESOTA ACADEMY OF OPHTHALMOLOGY. Meeting of December 1 2 , 1 9 2 4 . D R . J O H N S . MACNIE, President. Coloboma of the Macula. D R . J . A . WATSON.
Mrs. C. V . con
sulted me first on February 2 2 , 1915, complaining of aching of the eyes and blurring of the vision on near work. I prescribed for her at that time: R.-f-0.75S.C+0.75x60°: L.-i-0.75S.C+0.75x80°.
The refraction of the right was, how ever, determined entirely by the use of the retinoscope, as her vision in that eye amounted only to the discerning of fingers at 10 ft. and was not improved
by lenses. The eye really showed hyperopia of about three diopters. The vision in the left eye was and is normal. T h o she was then 2 8 years old she had never been conscious of any de ficiency of vision in the right eye, until I drew her attention to it. T h e opthalmoscope showed in the fundus of that eye, a circular white area in the macula nearly twice the diameter, of the papilla. It had a faint bluish green tint. T h e edges were distinct and sharply defined. There was a good deal of pigment around the borders, es pecially around the lower and tempo ral borders. There were several whitish spots and a good deal of pigment in the surrounding fundus. There was