- Email: [email protected]
Cod-Liver Oil in the Treatment of Corneal Opacities
NOTES, CASES, INSTRUMENTS COD-LIVER OIL IN T H E TREAT MENT OF CORNEAL OPACITIES CHARLES
M.
STILES,
M.D.
P H I L A D E L P H I A
I wish to call the attention of eye physicians to the g^eat value of codliver oil, combined with mercury, as the local treatment par excellence for corneal opacities of every description. I first became familiar with this very valuable remedy througfh reading an article written by Casey Wood under the caption of "brown ointment" in "A system of ophthalmic therapeutics," edited by the same distinguished oph thalmologist, also from a subsequent article in the same work, under the heading of "follicular conjunctivitis." After reading the articles mentioned, I at once ordered this remedy from my local druggists*, to be prepared in accordance with the instructions given by Dr. Wood (see the articles men tioned), and placed it on my treatment table to be used from time to time, as suggested by Wood, in the treatment of chronic blepharitis and so on. After successfully using the prepara tion in this way for some time, it oc curred to me that cod-liver oil, used for many generations with marked benefit as a general health builder for debili tated individuals, could be used equally effectively, especially when combined with the stimulating and alterative ac tion of mercury, to help nature restore, as far as possible, a weakened and de bilitated cornea, after the various forms of attack to which t h a t most useful part of the human eye had been sub jected. Acting on this thought, I began to prescribe "brown ointment" in suitable dilutions for various forms of corneal disease, including active ulcerations, traumatic and systemic keratitis, but more especially in opacities following such pathological conditions. On my former service as ophthalmologist to the Frankford Hospital, I also had the * Campbell Bros.
remedy prepared and kept in stock, using it frequently as occasion arose, and I believe my successor at the hos pital continues so to do. In recent cases I have found it very eflScacious indeed, clearing up moder ate corneal opacities in a short time. In chronic conditions, it has also proved very useful; and I have also prescribed it with encouragement alike to patient and physician in old, long standing con ditions of corneal disease, especially where further degenerative processes due to advancing age and other causes have developed, with apparent arrest of the degenerative conditions. The combinatwn of ood-liver oil with mercury for clinical use is now strong ly supported by our comparatively re cent knowledge of the presence in codliver oil of vitamins A and D, these vitamins being now considered in medi cal chemistry as two of the most im portant agents in sustaining and pro moting healthy bodily functions. In my opinion, therefore, this preparation of Casey Wood's should displace, to a very large extent, the commonly used yellow oxide ointment, for it is obvious that cod-liver oil, in contradistinction to petrolatum, stands out preeminently as a builder of bodily tissue, and, prop erly diluted according to the needs of the patient it causes no more local irri tation than the mineral oil derivative.
423
The definition of brown ointment as described by Casey Wood is as follows: "This is the name I have given to the dilute citrine ointment of the British pharmacopoeia (unguentum hydrargyri nitratis), when prepared with unre fined or brown cod-liver oil, instead of the neat's foot oil of the British or the lard of our own pharmacopoeia, and this again diluted with from thirty to fifty percent of refined cod-liver oil. When thoroughly mixed, it should be exposed to the air in a protected jar for at least three weeks, stirring it every day or so, etc., etc." (Wood's "System of oph thalmic, therapeutics", pages 436 and 682.)
N O T E S . CASES A N D I N S T R U M E N T S
424
It may be useful to add the following further quotation from Casey Wood's articles: "In the course of a month after prepa ration, mercuric iodide (or a still more complex organic compound) is formed which joins with some constituent of the oil to convert the mixture into a smooth, oily, seal-brown mass of the consistence of molasses and a decided odor of fish. In winter, or if in full strength it proves too irritant, I am in the habit of reducing it with addi tional cod-liver oil. For all these pur poses, I generally keep on my treat ment table three strengths of brown ointment, the strong, undiluted; a weaker, reduced with ten percent of its bulk of cod-liver oil; and a very weak mixture, made with twenty percent of cod-liver oil. "This salve I almost always use my self as an office application in most forms of chronic blepharitis and blepharoconjunctivitis, and invariably in conjunction with massage Most cases of simple hypertrophy of the lid tissues and chronic blepharitis begin to improve after the daily use of this agent for a week or two." Additional instructions are also given by Dr. Wood for the treatment of folli cular conjunctivitis with brown oint ment. I occasionally dilute this preparation further with lanolin, as it gives a little more consistency to the remedy, which is otherwise of a decided liquid ten dency. To obtain still greater firmness, my druggist added a very small quan tity of paraffin, which apparently had no deleterious effect and was nonirritating. But this latter combination I never prescribe for the patient to use at home. 1130 Spruce street.
CYSTIC DEGENERATION OF CORNEA A N D SCLERA W.
A.
HuBER,
M.D.
TUI-SA, O K L A H O M A
This case was presented before the Tulsa Academy of Ophthalmology and
Otolaryngology in Xovember, 1929. J. Y., Okmulgee, Oklahoma, thirteen years of age, white male, was brought to me October 18, 1929. He seemed apparently in good health. Blood and urine were negative. He gave a history of something growing on the left eye since three years of age. This growth seemed to be getting larger and sight was gradu ally failing in this eye. There was no history of injury to the eye. Right eye vision was 20/20 and looked essentially normal. Left eye vision was 10/200. There was no red ness or any sign of irritation in this eye. It showed a very interesting phenomenon. There was a horizontal lobulated cystic tumor formation about ten millimeters long and four milli meters wide at the nine o'clock posi tion, half in sclera and half in cornea. The scleral part only of the tumor formation was lobulated. The tem poral end of the growth terminated in the outer part of the pupillary area as a yellow hazy opacity. The opacity was 1.5 millimeters wide, and did not stain with fluorescein. The growth looked like a big blister with quite clear transparent fluid in it. October twenty-third, under morphine-scopolamin narcosis and cocain, I removed the anterior layer of this growth, which seemed to involve onehalf the thickness of sclera and cornea ; and fluid drained out. The hazy corneal area was dissected away in the line of cleavage without perforation of the cornea. The exposed area was covered with a conjunctival flap. The patholo gist reported cystic degeneration of cornea and sclera. November eighteenth, vision in this eye was 15/100, which was some im provement. In looking through textbooks and literature the condition seemed to be quite rare, hence my excuse for report ing the case. 1113 Medical Arts Building.
M.
STILES,
M.D.
P H I L A D E L P H I A
I wish to call the attention of eye physicians to the g^eat value of codliver oil, combined with mercury, as the local treatment par excellence for corneal opacities of every description. I first became familiar with this very valuable remedy througfh reading an article written by Casey Wood under the caption of "brown ointment" in "A system of ophthalmic therapeutics," edited by the same distinguished oph thalmologist, also from a subsequent article in the same work, under the heading of "follicular conjunctivitis." After reading the articles mentioned, I at once ordered this remedy from my local druggists*, to be prepared in accordance with the instructions given by Dr. Wood (see the articles men tioned), and placed it on my treatment table to be used from time to time, as suggested by Wood, in the treatment of chronic blepharitis and so on. After successfully using the prepara tion in this way for some time, it oc curred to me that cod-liver oil, used for many generations with marked benefit as a general health builder for debili tated individuals, could be used equally effectively, especially when combined with the stimulating and alterative ac tion of mercury, to help nature restore, as far as possible, a weakened and de bilitated cornea, after the various forms of attack to which t h a t most useful part of the human eye had been sub jected. Acting on this thought, I began to prescribe "brown ointment" in suitable dilutions for various forms of corneal disease, including active ulcerations, traumatic and systemic keratitis, but more especially in opacities following such pathological conditions. On my former service as ophthalmologist to the Frankford Hospital, I also had the * Campbell Bros.
remedy prepared and kept in stock, using it frequently as occasion arose, and I believe my successor at the hos pital continues so to do. In recent cases I have found it very eflScacious indeed, clearing up moder ate corneal opacities in a short time. In chronic conditions, it has also proved very useful; and I have also prescribed it with encouragement alike to patient and physician in old, long standing con ditions of corneal disease, especially where further degenerative processes due to advancing age and other causes have developed, with apparent arrest of the degenerative conditions. The combinatwn of ood-liver oil with mercury for clinical use is now strong ly supported by our comparatively re cent knowledge of the presence in codliver oil of vitamins A and D, these vitamins being now considered in medi cal chemistry as two of the most im portant agents in sustaining and pro moting healthy bodily functions. In my opinion, therefore, this preparation of Casey Wood's should displace, to a very large extent, the commonly used yellow oxide ointment, for it is obvious that cod-liver oil, in contradistinction to petrolatum, stands out preeminently as a builder of bodily tissue, and, prop erly diluted according to the needs of the patient it causes no more local irri tation than the mineral oil derivative.
423
The definition of brown ointment as described by Casey Wood is as follows: "This is the name I have given to the dilute citrine ointment of the British pharmacopoeia (unguentum hydrargyri nitratis), when prepared with unre fined or brown cod-liver oil, instead of the neat's foot oil of the British or the lard of our own pharmacopoeia, and this again diluted with from thirty to fifty percent of refined cod-liver oil. When thoroughly mixed, it should be exposed to the air in a protected jar for at least three weeks, stirring it every day or so, etc., etc." (Wood's "System of oph thalmic, therapeutics", pages 436 and 682.)
N O T E S . CASES A N D I N S T R U M E N T S
424
It may be useful to add the following further quotation from Casey Wood's articles: "In the course of a month after prepa ration, mercuric iodide (or a still more complex organic compound) is formed which joins with some constituent of the oil to convert the mixture into a smooth, oily, seal-brown mass of the consistence of molasses and a decided odor of fish. In winter, or if in full strength it proves too irritant, I am in the habit of reducing it with addi tional cod-liver oil. For all these pur poses, I generally keep on my treat ment table three strengths of brown ointment, the strong, undiluted; a weaker, reduced with ten percent of its bulk of cod-liver oil; and a very weak mixture, made with twenty percent of cod-liver oil. "This salve I almost always use my self as an office application in most forms of chronic blepharitis and blepharoconjunctivitis, and invariably in conjunction with massage Most cases of simple hypertrophy of the lid tissues and chronic blepharitis begin to improve after the daily use of this agent for a week or two." Additional instructions are also given by Dr. Wood for the treatment of folli cular conjunctivitis with brown oint ment. I occasionally dilute this preparation further with lanolin, as it gives a little more consistency to the remedy, which is otherwise of a decided liquid ten dency. To obtain still greater firmness, my druggist added a very small quan tity of paraffin, which apparently had no deleterious effect and was nonirritating. But this latter combination I never prescribe for the patient to use at home. 1130 Spruce street.
CYSTIC DEGENERATION OF CORNEA A N D SCLERA W.
A.
HuBER,
M.D.
TUI-SA, O K L A H O M A
This case was presented before the Tulsa Academy of Ophthalmology and
Otolaryngology in Xovember, 1929. J. Y., Okmulgee, Oklahoma, thirteen years of age, white male, was brought to me October 18, 1929. He seemed apparently in good health. Blood and urine were negative. He gave a history of something growing on the left eye since three years of age. This growth seemed to be getting larger and sight was gradu ally failing in this eye. There was no history of injury to the eye. Right eye vision was 20/20 and looked essentially normal. Left eye vision was 10/200. There was no red ness or any sign of irritation in this eye. It showed a very interesting phenomenon. There was a horizontal lobulated cystic tumor formation about ten millimeters long and four milli meters wide at the nine o'clock posi tion, half in sclera and half in cornea. The scleral part only of the tumor formation was lobulated. The tem poral end of the growth terminated in the outer part of the pupillary area as a yellow hazy opacity. The opacity was 1.5 millimeters wide, and did not stain with fluorescein. The growth looked like a big blister with quite clear transparent fluid in it. October twenty-third, under morphine-scopolamin narcosis and cocain, I removed the anterior layer of this growth, which seemed to involve onehalf the thickness of sclera and cornea ; and fluid drained out. The hazy corneal area was dissected away in the line of cleavage without perforation of the cornea. The exposed area was covered with a conjunctival flap. The patholo gist reported cystic degeneration of cornea and sclera. November eighteenth, vision in this eye was 15/100, which was some im provement. In looking through textbooks and literature the condition seemed to be quite rare, hence my excuse for report ing the case. 1113 Medical Arts Building.