- Email: [email protected]
General Pathology
DIGEST OF THE LITERATURE moved. In the case of the lower lid the loss of substance should be covered by a pedicled flap.from the temple, in the upper lid with a nonpedicled cutaneous flap. The pedicled flap should be carefully fixed in the central portion, so as to form a slight swelling above the level of the surrounding tissues. The writer gives special directions for fitting the extremity of the flap into the internal angle. Tarsal coloboma not over 1 cm. in width may be repaired by direct union. In case the entire width of the lid is involved, the anterior layer should be separated from the tarso-orbital fascia as far as the border of the orbit, and sutures placed in rows after displacing toward the nose the external flap, wherever there is considerable loss of substance. In cicatrices adherent to the bone the cicatricial mass should be carefully removed, the palpebral border shortened and a fatty graft inserted, and the lid supported as far as possible by a suture. For restoration of the entire lid, Kuhnt adds to Fricke's method, flaps with two pedicles taken from the lid and cheek; in case of the upper lid he makes the transplantation from the lower one. In symblepharon, to cover !he loss of bulbar tissue, he makes a
217
bridge shaped flap, or covers it with conjunctiva; in some cases, he takes conjunctiva from the other eye or a bit of mucous membrane from the mouth. To replace the palpebral conjunctiva he takes a pedicled flap from the cheek, or skin from the lower lid, or buccal mucous mebrane or conjunctiva from the other eye. In case of anophthalmia, he recommends May's procedure, but he also employs that of Czermak and Grunert. In cicatricial depression of the internal or external canthus, the lid is divided at the orbital margin, the periosteum stripped off for two or three mm. in area, the orbital contents brought forward and solidly fixed. Finally he gives directions for the closure of extensive naso-orbital openings, the restoration of loss of substance at the orbital margin, and the method of filling the cavity of the orbit. Krusius describes his technic of dealing with the conjunctival plastic of the cornea, sclera; and a method of evisceration of the eyeball with retention of the cornea. The immediate results in the prevention of infection were excellent as well as for rendering the wounded man fit for transportation.
GENERAL PATHOLOGY. H A N S BARKAN, M.
D.
SAN FRANCISCO, CALIFORNIA.
This section notices general theoretic and experimental studies of. the subject, covering the literature from January, 1917, to September, 1918. HEREDITY IN E Y E CONDITIONS.—Sto-
ren, Ewart and Howe have all published articles on the general subject of the influence sex, growth, and age of parent have on hereditary eye diseases, and on the transmission of the pigmentation of eyes. Storen examined the color of the eyes of individuals of the same sex in three consecutive generations. In 7 families in which both parents had brown eyes, 5 boys had blue, 17 boys had brown, 6 girls had blue, and 10 girls had brown eyes. In
families in which both parents had blue eyes, in quite a series of cases children with brown eyes were not infrequent, although in 1 case both parents and all 4 grandfathers and grandmothers had blue eyes. Storen concludes that there is no constant factor in any possible hereditary transmission of eye color. Ewart has collected with great care a large number of statistics in an attempt to find a hereditary factor concerning eye color. In this relation the
218
GENERAL PATHOLOGY
influence of the age of the parent at the birth of the child was one of the factors studied. The material was collected in Middlesborough and consisted of females only. He selected as the standard the number of blue eyed in groups of different ages, and examined 1,000 eyes at birth finding the blue percentage 100. In the sixth year, of 387 the blue percentage was 54; at the ninth year, of 488 the blue was 4 1 ; between 15 and 29 of 80 examined the blue was 32, and between 31 and 40 of 543 examined the blue was 30 per cent. The eyes of all infants are blue of varying shades at birth and change to other colors gradually. They change a little as late as the 20th to 30th year, and a distinct tendency of the eye to darken exists thruout life, irrespective of any factors that could be considered, that is, age of parent at birth, color of pigment of eyes, etc. The results of the examination, however, suggest that children born of young mothers tend to blue eyes; or at least that changes in the darker pigmentation dependent upon age are delayed in these children. On the whole Ewart regards his results as purely negative, a number of his carefully worked out statistical series showing no association between the age of the parent at birth and the eye color of the adult. He concludes as far as the age of the parent at the birth of the child is concerned (1) that the average length of life of the offspring decreases; (2) the fertility of the offspring increases; (3) the offspring react less characteristically to zymotic infections; (4) the number of males born increases, and finally, that the intellectual grade of the offspring as defined by scholastic standards, rises. Howe, in studying ocular muscles, has often noted that 3 or 4 persons in the same family show similar heterophorias, heterotropias, predisposition to ocular fatigue, etc. This has brought him to a study of the Mendelian law, of which he gives a very lucid explanation accompanied by a chart. He urges ophthalmologists to familiarize themselves with the simpler elements of the
law, as, for instance, the characteristics of inheritance; the terms "dominant" or "recessive" factors, claiming that in the study of certain ocular diseases, as for instance, retinitis pigmentosa, familial optic nerve atrophy, etc., the probability of the offspring being affected can be judged only by the ophthalmologist acquainted with the laws of Mendelian inheritance. Howe raises a very interesting point in referring to another principle of heredity, namely, that of sex linkage, this being the tendency of certain characteristics to develop exclusively and predominantly in the male members of the family, as optic nerve atrophy, color blindness and night blindness. Howe urges the study of a few useful books among which he mentions Herbert's "Fundamental Principles of Heredity"; Castle's "Genetics and Eugenics"; and Davenport's "Heredity in Relation to Eugenics." The practical application of this knowledge in our specialty is stated by Howe to be illustrated by the advice we may be asked to give to persons desiring to marry, in whose family there may be a history of eye defects, such as coloboma of the iris, glaucoma, displaced lens, retinitis pigmentosa, optic nerve atrophy, etc. DEGENERATIVE CHANGES. — Lewis draws attention to the ease and beauty with which ophthalmologists can see directly, and study at their leisure, pathologic changes, especially the advance of degenerative processes which occur before our very eyes. In support of his plea and in the course of an excellent review of the general subject of slow degenerative changes in the eyeball, he speaks of the formation of lime salts in an uninjured cornea and in an otherwise healthy eye, the author concluding that that particular part of the cornea had lost its vitality. In his case a solid lime deposit came away in the form of a perfect cast on probing underneath. Another interesting case quoted is that of calcareous degeneration in the deeper layers of the cornea; in which, during removal of cataract, the tissues grated during the incision as though filled with ashes. The cor-
DIGEST
OP THE
nea was littered with small opaque spots in the deeper layers, and Lewis believes the condition to be allied to nodular opacity. Lewis proceeds to review briefly the occurrence in the eye of calcareous and osseous degenerative processes so often seen in the degenerated eyeball at microscopic examination. After an interesting discussion regarding the biology of the cell from a broad point of view, Lewis "takes the physiologic chemical point of view in regarding the complexity of the degenerative changes as being the logical retrograde processes, just as in the upbuilding the complexity of these processes is as great. CICATRICIAL CHANGES.—Steyn's
pa-
per deals with an anatomic description of cicatricial changes of the eye, especially the development of the trachomatous entropion, the occlusion of the angle of the anterior chamber and the ectropion of the pigment layer of the iris in glaucoma; and ends with a critic of the observations of Schnabel regarding the glaucomatous caverns of the optic nerve. He finally presents a theory of his own concerning the causation of retinal detachment. CHOLESTERIN IN THE EYE.—Vuse fed
rabbits with cholesterin and olive oil, the rabbits developing a high grade permanent lipemia. Very early, before any opalescence of serum takes place, an opaque ring is formed about the corneal margin, resembling in every par-. ticular the arcus senilis of the human. The ring is independent of any vascular changes and is solely an infiltration of the cornea with cholesterin fat mixtures. Albarenque finds the deposit of cholesterin in the eye is favored by the normal supply of this substance to the organ, the nutrition of the media dependent on the osmotic circulation, and their passive function. He traces the effects of these conditions in arcus senilis, cataract, retinitis, and xanthelasma. INFLUENCE OF X-RAY.—Pagenstecher
has investigated the question of retinal rosettes, and has shown that when pregnant rabbits were irradiated typical rosettes could afterward be demonstrated in the retina of the living fe-
LITERATURE
219
tus. X-rays can therefore produce congenital rosettes of the retina in certain animals. [The reviewer speculates as to whether the rosettes found by Lilienfeld in t h e ' h u m a n embryo eyes in Axenfeld's and Fuchs' clinics, described as misplaced embryonic retinal elements and as the starting point of glioma, may not have been obtained from children whose mothers were subjected to abdominal X-ray exposure. This point has never been stated in the publication of these cases.—H. B.] DIFFERENTIATION OF DIPLOBACILLI.—
Scarlett gives the histories of two cases of corneal ulceration due to two diplobacilli resembling morphologically the Morax diplobacillus and the diplobacillus of Petit, but differing in cultural and "staining characteristics. One of these Scarlett has named diplobacillus nonliquefaciens, as it does not liquify agar or coagulate serum. This organism causes a severe painful ulcer with hypopyon. The second organism was distinguished from other members of the group by being gram positive. A table is appended showing the characteristics of these organisms in smear and culture. CHEMISTRY OF OCULAR
PIGMENT.—
Lo Cascio by painstaking chemical researches presents the chemical constituents of the choroid of the ox, stating that it contains carbon and nitrogen, and sulphur as high as 1.77 per cent, iron in 0.10 per cent which may come from a trace of blood, phosphorus in 0.24 per cent, oleaginous substances, butyric acid and xilitone. Of chief interest is his statement that the retinal pigment does not differ in its chemic composition from the choroid pigment; and that the human choroid pigment does not differ from that of the ox. ANAPHYLAXIS.—An editorial in
the
New York Medical Journal, vol. 106, p. 1187, on ocular anaphylaxis, takes up briefly the main theories of sympathetic ophthalmia, stating that the explanation accepted by most observers today is that the condition is an anaphylactic uveitis. A short and clear explanation of the theory 'of the anaphylactic process is then given; namely, that the disintegrating uvea in
220
GENERAL PATHOLOGY
the exciting eye is reabsorbed as antigen, and leads to a hypersensitization of homologous tissue, namely uvea of the second eye. Absorption beyond this point becomes intoxication and is manifested clinically by the well known inflammatory signs. See O. Y. B., v. 13, p. 367. Woods, in a second contribution on the same subject of ocular anaphylaxis discusses the theories held, up to the present; the mycotic theory, the bacterial origin, both of which he discards, and then refers to the cytotoxic theory of Golowin. This theory first brought the subject into the serologic state; and Elschnig, whose first work appeared in 1910, enunciated the theory of the anaphylactic origin of sympathetic ophthalmia with a report of his experimental work. There follows a clear and minute description of Elschnig's work and that of Fuchs, Meller and von Szily; all of whom 'worked along these lines, altho in many ways their view has been that of skepticism regarding the antigen properties of chemically pure uveal pigment. The work undertaken by Woods has been with the idea of simulating as closely as possible the conditions under which sympathetic ophthalmia occurs clinically, and to this end the eyes of sensitized animals were perfused with specific antigens. The plan of work has been to determine the following points: (1) the antigenic properties of homologous uvea; (2) the ability of one eye to react to perfusion in animals previously sensitized by intraocular injection of the other eye; (3) the constituent of the uveal tract responsible for such antigenic properties as are possessed by the homologous uvea. The technic of the experiments is too detailed to be reviewed, but the discussion in Woods' paper leads to the following conclusions: (1) Homologous uvea has the power of acting as antigen and producing an ocular hypersensitiveness: (2) Homologous uvea possesses a strong organ specificity: (3) Intraocular injection of a small amount of either homologous or heterologous uveal emulsion can
produce a hypersensitiveness in the second eye. (4) It seems probable that the peculiar antigen properties of uveal emulsions are due to the pigment epithelium. ACCIDENTAL
SOMATIC
CHANGES. —
Landolt engages in a discussion and presentation of some letters between Donders and Brown-Sequard of a rather amusing character. It seems that Brown-Sequard in section of the restiform body in guinea pigs noted opacity of the cornea and lens in the descendants of these, as well as changes in the vitreous and aqueous consisting of white or rose colored flakes. Donders in a letter to Brown-Sequard questions the effect of the section of the restiform body; and explains the eye lesions found in these lively little animals as the result of the guinea pig running about in the cage, fighting with his neighbor and thereby injuring his eye, and also asks whether Brown-Sequard acted as the accoucheur of the guinea pigs and could, be positive that they were really born with these defects. Brown-Sequard in answer stated that all of these lesions came from one pair of guinea pigs that had been operated upon. With our present knowledge of heredity, eye defects and close mating in the production of a chain of eye defects, it appears probable to the reviewer that section of the restiform body in this particular pair of guinea pigs had no influence on the ocular defects of their descendants. EYE OF THE NEGRO.—Kollock has had
an experience of over 30 years with the eye of the negro, and 23 years ago published his first paper on the defects of the eye peculiar to this race. In his experience syphilis is responsible for the great majority of all ocular lesions of negroes. For instance, 45% of all ocular nerve lesions consist of primary optic nerve atrophy. He wonders at the present date whether, or no, the adulteration of the cheap liquor used with wood alcohol may not be responsible for a good many of these atrophies. In general, negroes are relatively immune to chronic inflammations of the conjunctiva, particularly to trachoma.
DIGEST
OF
THE
The latter, curiously enough, has never occurred in an epidemic form, in spite of the dirty surroundings of the average southern negro. Cataract and glaucoma are said to be about as prevalent in the negro as in the white. Kollock here refers to the improbability of eye strain as a factor in the production of cataract, as of the negroes he has seen during these years the majority do not read. As regards refraction he finds very few myopes, although the highest grade myopia, a man of 26 D, happened to be a negro. A short discussion follows on the effect of civilization in the production of myopia in which discussion Kollock quotes the remarks of St. John Roosa and S. D. Risley on this subject. Only one case of uncomplicated strabismus in the pure negro has been observed by the author. Kollock concludes that the eye of the pure blooded negro is, with one exception, and that the increase of myopia, practically in the same condition as in his first report of 1892. EYES OF RETARDED CHILDREN.—Bar-
kan divides the mentally retarded children in whom ocular defects are found into two clinical groups: (1) those whose retardation is due to physical handicap which can be removed,—tonsils, adenoids, high grade myopia, or other marked errors of refraction; (2) those where in the absence of any marked general or local physical faults, a certain degree of mental retardation is present; evidenced often not only by negative inability to learn as others of. the same age do, but also by positive traits. These children are unruly, disorderly, disobedient, petty thieves, constant truants from school, and confirmed liars. In this second class of which he particularly speaks, he states that the visual tests display as the most common abnormality a marked difference in vision of the two eyes', or low vision in both equally; the first being slightly
LITERATURE
221
the more frequent. Muscular balance tests seldom even approximate the normal, but show marked degrees of exophoria or esophoria, usually the former. By far the great majority are hypermetropic and also markedly astigmatic, a very small number are myopic. Barkan finds that the vision of a certain number cannot be improved by proper glasses, and in these the fundus usually shows one of the following 5 pictures: (1) Fundus without or with very little pigment. (2) Excessively hyperemic discs, margins not distinguishable, veins dark and dilated. (3) Veins and arteries, normal in caliber, forming many small curves in their course over the fundus. (4) Discs of normal color and outline, but vessels branching off fan-shape, ("sprawling" off the disc is the descriptive phrase most applicable). (5) Excessively pale discs, vessels of normal size. Barkan does not find anatomic congenital malformations, such as coloboma of the iris and choroid, dermoids of the conjunctiva, epicanthus, micropthalmus, aniridia, etc., more frequent among these children than among mentally normal ones; but they are more frequent in idiots and imbeciles than in mentally normal children. A certain relation between ocular defects and the general appearance of the children is striking. They form a group distinguished by being shorter, thinner, sallower and less active physically than their companions; but exceptions, of course, occur frequently. In conclusion, he urges thoro ocular examinations of mentally retarded children, stating that a small number will be remarkably improved by proper glasses. In those not amenable to visual improvement, we obtain by examination an index of the kind of work they may be expected to do in the future, as far as their vision is a factor; and can proceed to educate them accordingly.
217
bridge shaped flap, or covers it with conjunctiva; in some cases, he takes conjunctiva from the other eye or a bit of mucous membrane from the mouth. To replace the palpebral conjunctiva he takes a pedicled flap from the cheek, or skin from the lower lid, or buccal mucous mebrane or conjunctiva from the other eye. In case of anophthalmia, he recommends May's procedure, but he also employs that of Czermak and Grunert. In cicatricial depression of the internal or external canthus, the lid is divided at the orbital margin, the periosteum stripped off for two or three mm. in area, the orbital contents brought forward and solidly fixed. Finally he gives directions for the closure of extensive naso-orbital openings, the restoration of loss of substance at the orbital margin, and the method of filling the cavity of the orbit. Krusius describes his technic of dealing with the conjunctival plastic of the cornea, sclera; and a method of evisceration of the eyeball with retention of the cornea. The immediate results in the prevention of infection were excellent as well as for rendering the wounded man fit for transportation.
GENERAL PATHOLOGY. H A N S BARKAN, M.
D.
SAN FRANCISCO, CALIFORNIA.
This section notices general theoretic and experimental studies of. the subject, covering the literature from January, 1917, to September, 1918. HEREDITY IN E Y E CONDITIONS.—Sto-
ren, Ewart and Howe have all published articles on the general subject of the influence sex, growth, and age of parent have on hereditary eye diseases, and on the transmission of the pigmentation of eyes. Storen examined the color of the eyes of individuals of the same sex in three consecutive generations. In 7 families in which both parents had brown eyes, 5 boys had blue, 17 boys had brown, 6 girls had blue, and 10 girls had brown eyes. In
families in which both parents had blue eyes, in quite a series of cases children with brown eyes were not infrequent, although in 1 case both parents and all 4 grandfathers and grandmothers had blue eyes. Storen concludes that there is no constant factor in any possible hereditary transmission of eye color. Ewart has collected with great care a large number of statistics in an attempt to find a hereditary factor concerning eye color. In this relation the
218
GENERAL PATHOLOGY
influence of the age of the parent at the birth of the child was one of the factors studied. The material was collected in Middlesborough and consisted of females only. He selected as the standard the number of blue eyed in groups of different ages, and examined 1,000 eyes at birth finding the blue percentage 100. In the sixth year, of 387 the blue percentage was 54; at the ninth year, of 488 the blue was 4 1 ; between 15 and 29 of 80 examined the blue was 32, and between 31 and 40 of 543 examined the blue was 30 per cent. The eyes of all infants are blue of varying shades at birth and change to other colors gradually. They change a little as late as the 20th to 30th year, and a distinct tendency of the eye to darken exists thruout life, irrespective of any factors that could be considered, that is, age of parent at birth, color of pigment of eyes, etc. The results of the examination, however, suggest that children born of young mothers tend to blue eyes; or at least that changes in the darker pigmentation dependent upon age are delayed in these children. On the whole Ewart regards his results as purely negative, a number of his carefully worked out statistical series showing no association between the age of the parent at birth and the eye color of the adult. He concludes as far as the age of the parent at the birth of the child is concerned (1) that the average length of life of the offspring decreases; (2) the fertility of the offspring increases; (3) the offspring react less characteristically to zymotic infections; (4) the number of males born increases, and finally, that the intellectual grade of the offspring as defined by scholastic standards, rises. Howe, in studying ocular muscles, has often noted that 3 or 4 persons in the same family show similar heterophorias, heterotropias, predisposition to ocular fatigue, etc. This has brought him to a study of the Mendelian law, of which he gives a very lucid explanation accompanied by a chart. He urges ophthalmologists to familiarize themselves with the simpler elements of the
law, as, for instance, the characteristics of inheritance; the terms "dominant" or "recessive" factors, claiming that in the study of certain ocular diseases, as for instance, retinitis pigmentosa, familial optic nerve atrophy, etc., the probability of the offspring being affected can be judged only by the ophthalmologist acquainted with the laws of Mendelian inheritance. Howe raises a very interesting point in referring to another principle of heredity, namely, that of sex linkage, this being the tendency of certain characteristics to develop exclusively and predominantly in the male members of the family, as optic nerve atrophy, color blindness and night blindness. Howe urges the study of a few useful books among which he mentions Herbert's "Fundamental Principles of Heredity"; Castle's "Genetics and Eugenics"; and Davenport's "Heredity in Relation to Eugenics." The practical application of this knowledge in our specialty is stated by Howe to be illustrated by the advice we may be asked to give to persons desiring to marry, in whose family there may be a history of eye defects, such as coloboma of the iris, glaucoma, displaced lens, retinitis pigmentosa, optic nerve atrophy, etc. DEGENERATIVE CHANGES. — Lewis draws attention to the ease and beauty with which ophthalmologists can see directly, and study at their leisure, pathologic changes, especially the advance of degenerative processes which occur before our very eyes. In support of his plea and in the course of an excellent review of the general subject of slow degenerative changes in the eyeball, he speaks of the formation of lime salts in an uninjured cornea and in an otherwise healthy eye, the author concluding that that particular part of the cornea had lost its vitality. In his case a solid lime deposit came away in the form of a perfect cast on probing underneath. Another interesting case quoted is that of calcareous degeneration in the deeper layers of the cornea; in which, during removal of cataract, the tissues grated during the incision as though filled with ashes. The cor-
DIGEST
OP THE
nea was littered with small opaque spots in the deeper layers, and Lewis believes the condition to be allied to nodular opacity. Lewis proceeds to review briefly the occurrence in the eye of calcareous and osseous degenerative processes so often seen in the degenerated eyeball at microscopic examination. After an interesting discussion regarding the biology of the cell from a broad point of view, Lewis "takes the physiologic chemical point of view in regarding the complexity of the degenerative changes as being the logical retrograde processes, just as in the upbuilding the complexity of these processes is as great. CICATRICIAL CHANGES.—Steyn's
pa-
per deals with an anatomic description of cicatricial changes of the eye, especially the development of the trachomatous entropion, the occlusion of the angle of the anterior chamber and the ectropion of the pigment layer of the iris in glaucoma; and ends with a critic of the observations of Schnabel regarding the glaucomatous caverns of the optic nerve. He finally presents a theory of his own concerning the causation of retinal detachment. CHOLESTERIN IN THE EYE.—Vuse fed
rabbits with cholesterin and olive oil, the rabbits developing a high grade permanent lipemia. Very early, before any opalescence of serum takes place, an opaque ring is formed about the corneal margin, resembling in every par-. ticular the arcus senilis of the human. The ring is independent of any vascular changes and is solely an infiltration of the cornea with cholesterin fat mixtures. Albarenque finds the deposit of cholesterin in the eye is favored by the normal supply of this substance to the organ, the nutrition of the media dependent on the osmotic circulation, and their passive function. He traces the effects of these conditions in arcus senilis, cataract, retinitis, and xanthelasma. INFLUENCE OF X-RAY.—Pagenstecher
has investigated the question of retinal rosettes, and has shown that when pregnant rabbits were irradiated typical rosettes could afterward be demonstrated in the retina of the living fe-
LITERATURE
219
tus. X-rays can therefore produce congenital rosettes of the retina in certain animals. [The reviewer speculates as to whether the rosettes found by Lilienfeld in t h e ' h u m a n embryo eyes in Axenfeld's and Fuchs' clinics, described as misplaced embryonic retinal elements and as the starting point of glioma, may not have been obtained from children whose mothers were subjected to abdominal X-ray exposure. This point has never been stated in the publication of these cases.—H. B.] DIFFERENTIATION OF DIPLOBACILLI.—
Scarlett gives the histories of two cases of corneal ulceration due to two diplobacilli resembling morphologically the Morax diplobacillus and the diplobacillus of Petit, but differing in cultural and "staining characteristics. One of these Scarlett has named diplobacillus nonliquefaciens, as it does not liquify agar or coagulate serum. This organism causes a severe painful ulcer with hypopyon. The second organism was distinguished from other members of the group by being gram positive. A table is appended showing the characteristics of these organisms in smear and culture. CHEMISTRY OF OCULAR
PIGMENT.—
Lo Cascio by painstaking chemical researches presents the chemical constituents of the choroid of the ox, stating that it contains carbon and nitrogen, and sulphur as high as 1.77 per cent, iron in 0.10 per cent which may come from a trace of blood, phosphorus in 0.24 per cent, oleaginous substances, butyric acid and xilitone. Of chief interest is his statement that the retinal pigment does not differ in its chemic composition from the choroid pigment; and that the human choroid pigment does not differ from that of the ox. ANAPHYLAXIS.—An editorial in
the
New York Medical Journal, vol. 106, p. 1187, on ocular anaphylaxis, takes up briefly the main theories of sympathetic ophthalmia, stating that the explanation accepted by most observers today is that the condition is an anaphylactic uveitis. A short and clear explanation of the theory 'of the anaphylactic process is then given; namely, that the disintegrating uvea in
220
GENERAL PATHOLOGY
the exciting eye is reabsorbed as antigen, and leads to a hypersensitization of homologous tissue, namely uvea of the second eye. Absorption beyond this point becomes intoxication and is manifested clinically by the well known inflammatory signs. See O. Y. B., v. 13, p. 367. Woods, in a second contribution on the same subject of ocular anaphylaxis discusses the theories held, up to the present; the mycotic theory, the bacterial origin, both of which he discards, and then refers to the cytotoxic theory of Golowin. This theory first brought the subject into the serologic state; and Elschnig, whose first work appeared in 1910, enunciated the theory of the anaphylactic origin of sympathetic ophthalmia with a report of his experimental work. There follows a clear and minute description of Elschnig's work and that of Fuchs, Meller and von Szily; all of whom 'worked along these lines, altho in many ways their view has been that of skepticism regarding the antigen properties of chemically pure uveal pigment. The work undertaken by Woods has been with the idea of simulating as closely as possible the conditions under which sympathetic ophthalmia occurs clinically, and to this end the eyes of sensitized animals were perfused with specific antigens. The plan of work has been to determine the following points: (1) the antigenic properties of homologous uvea; (2) the ability of one eye to react to perfusion in animals previously sensitized by intraocular injection of the other eye; (3) the constituent of the uveal tract responsible for such antigenic properties as are possessed by the homologous uvea. The technic of the experiments is too detailed to be reviewed, but the discussion in Woods' paper leads to the following conclusions: (1) Homologous uvea has the power of acting as antigen and producing an ocular hypersensitiveness: (2) Homologous uvea possesses a strong organ specificity: (3) Intraocular injection of a small amount of either homologous or heterologous uveal emulsion can
produce a hypersensitiveness in the second eye. (4) It seems probable that the peculiar antigen properties of uveal emulsions are due to the pigment epithelium. ACCIDENTAL
SOMATIC
CHANGES. —
Landolt engages in a discussion and presentation of some letters between Donders and Brown-Sequard of a rather amusing character. It seems that Brown-Sequard in section of the restiform body in guinea pigs noted opacity of the cornea and lens in the descendants of these, as well as changes in the vitreous and aqueous consisting of white or rose colored flakes. Donders in a letter to Brown-Sequard questions the effect of the section of the restiform body; and explains the eye lesions found in these lively little animals as the result of the guinea pig running about in the cage, fighting with his neighbor and thereby injuring his eye, and also asks whether Brown-Sequard acted as the accoucheur of the guinea pigs and could, be positive that they were really born with these defects. Brown-Sequard in answer stated that all of these lesions came from one pair of guinea pigs that had been operated upon. With our present knowledge of heredity, eye defects and close mating in the production of a chain of eye defects, it appears probable to the reviewer that section of the restiform body in this particular pair of guinea pigs had no influence on the ocular defects of their descendants. EYE OF THE NEGRO.—Kollock has had
an experience of over 30 years with the eye of the negro, and 23 years ago published his first paper on the defects of the eye peculiar to this race. In his experience syphilis is responsible for the great majority of all ocular lesions of negroes. For instance, 45% of all ocular nerve lesions consist of primary optic nerve atrophy. He wonders at the present date whether, or no, the adulteration of the cheap liquor used with wood alcohol may not be responsible for a good many of these atrophies. In general, negroes are relatively immune to chronic inflammations of the conjunctiva, particularly to trachoma.
DIGEST
OF
THE
The latter, curiously enough, has never occurred in an epidemic form, in spite of the dirty surroundings of the average southern negro. Cataract and glaucoma are said to be about as prevalent in the negro as in the white. Kollock here refers to the improbability of eye strain as a factor in the production of cataract, as of the negroes he has seen during these years the majority do not read. As regards refraction he finds very few myopes, although the highest grade myopia, a man of 26 D, happened to be a negro. A short discussion follows on the effect of civilization in the production of myopia in which discussion Kollock quotes the remarks of St. John Roosa and S. D. Risley on this subject. Only one case of uncomplicated strabismus in the pure negro has been observed by the author. Kollock concludes that the eye of the pure blooded negro is, with one exception, and that the increase of myopia, practically in the same condition as in his first report of 1892. EYES OF RETARDED CHILDREN.—Bar-
kan divides the mentally retarded children in whom ocular defects are found into two clinical groups: (1) those whose retardation is due to physical handicap which can be removed,—tonsils, adenoids, high grade myopia, or other marked errors of refraction; (2) those where in the absence of any marked general or local physical faults, a certain degree of mental retardation is present; evidenced often not only by negative inability to learn as others of. the same age do, but also by positive traits. These children are unruly, disorderly, disobedient, petty thieves, constant truants from school, and confirmed liars. In this second class of which he particularly speaks, he states that the visual tests display as the most common abnormality a marked difference in vision of the two eyes', or low vision in both equally; the first being slightly
LITERATURE
221
the more frequent. Muscular balance tests seldom even approximate the normal, but show marked degrees of exophoria or esophoria, usually the former. By far the great majority are hypermetropic and also markedly astigmatic, a very small number are myopic. Barkan finds that the vision of a certain number cannot be improved by proper glasses, and in these the fundus usually shows one of the following 5 pictures: (1) Fundus without or with very little pigment. (2) Excessively hyperemic discs, margins not distinguishable, veins dark and dilated. (3) Veins and arteries, normal in caliber, forming many small curves in their course over the fundus. (4) Discs of normal color and outline, but vessels branching off fan-shape, ("sprawling" off the disc is the descriptive phrase most applicable). (5) Excessively pale discs, vessels of normal size. Barkan does not find anatomic congenital malformations, such as coloboma of the iris and choroid, dermoids of the conjunctiva, epicanthus, micropthalmus, aniridia, etc., more frequent among these children than among mentally normal ones; but they are more frequent in idiots and imbeciles than in mentally normal children. A certain relation between ocular defects and the general appearance of the children is striking. They form a group distinguished by being shorter, thinner, sallower and less active physically than their companions; but exceptions, of course, occur frequently. In conclusion, he urges thoro ocular examinations of mentally retarded children, stating that a small number will be remarkably improved by proper glasses. In those not amenable to visual improvement, we obtain by examination an index of the kind of work they may be expected to do in the future, as far as their vision is a factor; and can proceed to educate them accordingly.