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Congress of the Pan-American Medical Association
SOCIETY PROCEEDINGS Edited by DR. H. ROMMEL HILDRETH CONGRESS OF THE PAN-AMERI CAN MEDICAL ASSOCIATION March 21-25, 1933 The fourth congress of this asso ciation was held at Dallas, Texas, March 21 to 25, 1933. The three con gresses preceding this were held at Ha vana, Panama, and Mexico; and, in 1893, before the Spanish-American War, such a congress had been held in Washington. At each congress there has been a section on ophthalmology. At Dallas the chairman of this section was Dr. Thomas B. Holloway, of Phila delphia. The secretary was Dr. Conrad Berens, of New York. The president of the congress was Dr. J. O. McReynolds, of Dallas, and the president of the as sociation was Dr. Francisco M. Fernan dez, of Havana. Dr. Fernandez was for merly engaged in the practice of oph thalmology, but in recent years has de voted his attention to public health. Leber's disease, hereditary optic atrophy Dr. Arthur J. Bedell, of Albany, New York, read a paper on this subject, il lustrated by photographs of the fundus oculi. The pictures showed the pallor and indistinct outlines of the optic discs. There were also field charts illustrat ing the central defect of the fields. Blindness usually appeared quite sud denly, sometimes vision was partly restored. But generally there remained in the end an absolute central scotoma. The hereditary character was illus trated by a family tree, including five generations. He said the nature of the case might be overlooked, unless it was followed throughout its course. Tuberculosis of the cornea Dr. Enrique Avalos, of Guadalajara, Mexico, reported a case, believed to be primary. The diagnosis was based on the appearance of a typical tubercle on the surface of the cornea ; with no dis coverable evidence of tuberculosis in any other part of the body ; and on the
subsequent healing under treatment with old tuberculin. Spasm of accommodation Dr. Louis Bothman, of Chicago, read a paper on this subject. He gave a wide review of the literature, and a broad view of the condition, based on ex tended statistics and reports of cases. Glaucoma Dr. Edward C. Ellett, of Memphis, drew lessons regarding this disease, from his large experience with it. He felt that when untreated, or inadequate ly treated, the end was certain blind ness. Even cases that seemed to be held in check for a time by medical treat ment, if they lost ground so that they required operation, had a bad prognosis. There was no operation that could be relied upon to check the disease, when done as a last resort. Intraocular tension Dr. Juan Luis Torroella, of Mexico, had previously observed and pointed out, "The intraocular tension is not the same in the anterior and posterior chambers, either from a theoretical, or a practical point of view." On account of the difference in curvature, between the surfaces of the cornea and sclera, the tonometric observations were not comparable, and the coefficients of elas ticity of these membranes were differ ent. He described a special modification of tonometry to meet these difficulties. He considered the eye divided into two parts ; an anterior containing the aque ous, and a posterior the vitreous. These were separated by a strong membrane, the ciliary processes, the zonule of Zinn, and the crystalline lens, enclosed in its anterior and posterior capsule. The fact that Petit's canal could be inflated, by air blown into it, opposed the idea that the fibers of the suspen sory ligament permitted the free pas sage of fluid between them; and the idea must be rejected that the mem brane between the aqueous and vitreous
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permitted liquid interchanges between them. Tables were given showing dif ferences between the anterior and the posterior tensions of the eye ; and cases illustrating the condition. Two cases were cited in which increased anterior tension did not impair the results of cataract extraction; and permitted op erative relief of severe glaucoma symp toms. Etiology of glaucoma Dr. J. F. Hardesty, of St. Louis, said that doubt was expressed that primary glaucoma was a disease per se, and overproduction of aqueous was consid ered to be as important as obstructed outflow, in the etiology. The result of microscopic examina tion of the ciliary body in many eyes with glaucoma simplex was summar ized and slides presented to show that a condition of increased capillary per meability had probably existed. Clinical experiments and charts were presented to show that adrenalin, pilocarpin, physostigmin, pituitrin, thy roid extract, and alkalies given sys tematically, lowered the intraocular tension in primary glaucoma. There was no change in the size of the pupil or in the systemic blood pressure, and the belief was expressed that primary glaucoma was a local manifestation, in a predisposed eye, of some systemic dis order, independent in the main, of the general blood pressure. Visual field changes following division of the optic chiasm Dr. Henry C. Haden, of Houston, Texas, reported a case in which, to give relief from pressure of a cranio-pharyngeal cyst, it was necessary to divide the optic chiasm in the median line. A careful study had been made of the subsequent changes in vision, the visual fields, and the changes that occurred in the color of the optic discs. Under pituitary feeding there had been marked improvement of the fields and central vision. The pallor appeared after some weeks, in the nasal quadrants of the discs; and extended until only a small sector at the upper and lower margins of the discs remained normal in color.
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Changes in astigmatism Dr. Edward Jackson read a paper on this subject which will be published in this Journal. Influence of allergy and immunity on syphilitic ocular lesions Dr. Alan Woods, of Baltimore, said the evidence regarding these influences was based on animal experiments and clinical observations. The tendency of early specific treatment to prevent the development of natural immunity was pointed out, and the confusion brought into experimental work by failure to recognize the spirochete of rabbits, that resembled in form the treponema pal lida. Ocular lesions of syphilis were among the later manifestations that va ried with the early history and treat ment of such infections. Causes of blindness Dr. Conrad Berens, of New York, called attention to the endeavor of the National Society for the Prevention of Blindness to form a list of the causes of blindness. They used, as the basis for such a list, the recently published Re port of the National Conference on the Nomenclature of Diseases. It was im portant that all who were interested in the matter should contribute to the compilation of such a list, which would be widely useful in the work of prevent ing blindness, and the diseases causing it. Reported by Edward Jackson. MINNESOTA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Section on Ophthalmology December 9, 1932 Dr. H. J. Rothschild, president Ophthalmic surgery in India Dr. W. I. Lillie (Rochester) gave a talk on this subject, illustrated by sev eral reels of motion pictures. In reply to a number of questions he said that in the medical schools in Bom bay, Dr. Duggan ; in Calcutta, Dr. Kerwood; and in Madras, Dr. Wright, worked throughout the entire year.
subsequent healing under treatment with old tuberculin. Spasm of accommodation Dr. Louis Bothman, of Chicago, read a paper on this subject. He gave a wide review of the literature, and a broad view of the condition, based on ex tended statistics and reports of cases. Glaucoma Dr. Edward C. Ellett, of Memphis, drew lessons regarding this disease, from his large experience with it. He felt that when untreated, or inadequate ly treated, the end was certain blind ness. Even cases that seemed to be held in check for a time by medical treat ment, if they lost ground so that they required operation, had a bad prognosis. There was no operation that could be relied upon to check the disease, when done as a last resort. Intraocular tension Dr. Juan Luis Torroella, of Mexico, had previously observed and pointed out, "The intraocular tension is not the same in the anterior and posterior chambers, either from a theoretical, or a practical point of view." On account of the difference in curvature, between the surfaces of the cornea and sclera, the tonometric observations were not comparable, and the coefficients of elas ticity of these membranes were differ ent. He described a special modification of tonometry to meet these difficulties. He considered the eye divided into two parts ; an anterior containing the aque ous, and a posterior the vitreous. These were separated by a strong membrane, the ciliary processes, the zonule of Zinn, and the crystalline lens, enclosed in its anterior and posterior capsule. The fact that Petit's canal could be inflated, by air blown into it, opposed the idea that the fibers of the suspen sory ligament permitted the free pas sage of fluid between them; and the idea must be rejected that the mem brane between the aqueous and vitreous
624
SOCIETY PROCEEDINGS
permitted liquid interchanges between them. Tables were given showing dif ferences between the anterior and the posterior tensions of the eye ; and cases illustrating the condition. Two cases were cited in which increased anterior tension did not impair the results of cataract extraction; and permitted op erative relief of severe glaucoma symp toms. Etiology of glaucoma Dr. J. F. Hardesty, of St. Louis, said that doubt was expressed that primary glaucoma was a disease per se, and overproduction of aqueous was consid ered to be as important as obstructed outflow, in the etiology. The result of microscopic examina tion of the ciliary body in many eyes with glaucoma simplex was summar ized and slides presented to show that a condition of increased capillary per meability had probably existed. Clinical experiments and charts were presented to show that adrenalin, pilocarpin, physostigmin, pituitrin, thy roid extract, and alkalies given sys tematically, lowered the intraocular tension in primary glaucoma. There was no change in the size of the pupil or in the systemic blood pressure, and the belief was expressed that primary glaucoma was a local manifestation, in a predisposed eye, of some systemic dis order, independent in the main, of the general blood pressure. Visual field changes following division of the optic chiasm Dr. Henry C. Haden, of Houston, Texas, reported a case in which, to give relief from pressure of a cranio-pharyngeal cyst, it was necessary to divide the optic chiasm in the median line. A careful study had been made of the subsequent changes in vision, the visual fields, and the changes that occurred in the color of the optic discs. Under pituitary feeding there had been marked improvement of the fields and central vision. The pallor appeared after some weeks, in the nasal quadrants of the discs; and extended until only a small sector at the upper and lower margins of the discs remained normal in color.
625
Changes in astigmatism Dr. Edward Jackson read a paper on this subject which will be published in this Journal. Influence of allergy and immunity on syphilitic ocular lesions Dr. Alan Woods, of Baltimore, said the evidence regarding these influences was based on animal experiments and clinical observations. The tendency of early specific treatment to prevent the development of natural immunity was pointed out, and the confusion brought into experimental work by failure to recognize the spirochete of rabbits, that resembled in form the treponema pal lida. Ocular lesions of syphilis were among the later manifestations that va ried with the early history and treat ment of such infections. Causes of blindness Dr. Conrad Berens, of New York, called attention to the endeavor of the National Society for the Prevention of Blindness to form a list of the causes of blindness. They used, as the basis for such a list, the recently published Re port of the National Conference on the Nomenclature of Diseases. It was im portant that all who were interested in the matter should contribute to the compilation of such a list, which would be widely useful in the work of prevent ing blindness, and the diseases causing it. Reported by Edward Jackson. MINNESOTA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Section on Ophthalmology December 9, 1932 Dr. H. J. Rothschild, president Ophthalmic surgery in India Dr. W. I. Lillie (Rochester) gave a talk on this subject, illustrated by sev eral reels of motion pictures. In reply to a number of questions he said that in the medical schools in Bom bay, Dr. Duggan ; in Calcutta, Dr. Kerwood; and in Madras, Dr. Wright, worked throughout the entire year.