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Nashville Academy of Ophthalmology and Otolaryngology
SOCIETY PROCEEDINGS that infection was washed away by se cretions, such as tears, was not ade quate, the antiseptic power of these secretions providing the key to the process. The process of intercellular digestion of microbes in the process of getting rid of them had not yet been minutely worked out. MR. LESLIE PATON described the cir cumstances which had led him to in duce Mr. Ridley to undertake the re search, and spoke of the far reaching effect of the knowledge on medical work. Col. A. E. Lister and the Presi dent also spoke, and Mr. Ridley replied. N A S H V I L L E ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Meetings of May 16 and June 18, 1928 J. LESLIE BRYAN, chairman
Pituitary tumor DR. M. M. CULLOM presented the case of Mrs. J. I., aged forty-six years, who had had continual headache for four teen years and failing vision for more than five. Vision in the right eye was too poor to be recorded, and that in the left was 20/200, with complete destruc tion of the nasal field. X-ray showed a large pituitary tumor which had de stroyed the anterior and posterior clinoid processes. Operation was refused. Hereditary retinitis pigmentosa and impaired hearing DR. HILLIARD WOOD reported three consecutive generations in one family which included several cases of retini tis pigmentosa and impaired hearing with other congenital defects. In the first generation was W . H. J., with ex tremely poor hearing. H e had a niece who was a dwarf in size. His wife, L. J., while herself normal, had one sister who was deaf in old age; a broth er who was deaf and had a cataract in one eye; and two nieces who had bad vision. Of the six children born to the J. couple three showed pronounced re tinitis pigmentosa and almost total loss of hearing, with better air than bone conduction. Routine laboratory work, including blood Wassermanns on these
905
three, was negative. One of these three had a daughter, now aged fourteen years, who had been a cretin since in fancy. Dr. Wood presented the three defective members of the second gen eration. Discussion. DR. M. M. CULLOM said that the interesting features were the association of deafness with the retini tis pigmentosa and that there were de fects on both sides of the family. Where both sides have defects the chances for the offspring being afflicted are doubled. H e believed the cases shown to be clearly cases of retinitis pigmen tosa. DR. GUY MANEES asked if there was any history of intermarriage. DR. HILLIARD WOOD replied that there was none. DR. ROBERT SULLIVAN said he thought the wise thing from a social standpoint for these people was never to marry as the succeeding generation's defects were likely to be multiplied progres sively. Ocular contusion followed by glau coma DR. W. E. WILKERSON presented the
case of C. W., white male aged thirtyeight years, who had come to his office with a record of having been flipped thirty minutes previously with a rubber band which struck him on the lids of the right eye. Examination showed the lids of the right eye to be swollen and red. Only a moderate amount of pericorneal injection was present. The cornea had a steamy appearance and the lower third of the anterior chamber was filled with blood. Just above the hyphema a grayish-white irregular mass was seen, apparently protrud ing from the lower portion of the an terior chamber. The pupil was irregu lar in size and was pulled upward. The patient was sent to the hospital for treatment and observation. T w o hours later the hyphema had disappeared, and the mass in the eye proved to be iris torn from its attachment between the positions of six and one o'clock. Injections of aolan were given, and one per cent of atropine sulphate solu-
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SOCIETY PROCEEDINGS
tion and hot compresses were pre scribed. The following day the eye was looking much better than one rea sonably could have expected. T h e im provement continued for four days, after which more hyphema was noted, and there was a marked increase in pericorneal injection. Hot compresses were discontinued and cold compresses were substituted. A saturated solution of potassium iodide was prescribed, be ginning with eight drops after each meal. On the fifth day after the acci dent the patient was complaining of se vere pain in the eye. The anterior chamber was completely filled with blood, and a marked increase in ten sion was noted. On the sixth day, with the pathological picture unchanged, Dr. Hasty was called in consultation. He advised discontinuing the cold com presses and giving calcium lactate. This was done, but the pathology of the eye did not change. Nine days after the injury the anterior chamber was en tirely filled with blood. At this point he changed doctors. The treatment subsequently used was not known, but in a few weeks the eye was removed. From a pathological examination of the globe at the Army Medical Mu seum, the summarized report w a s : "Injury; intraocular hemorrhage; subacute endophthalmitis; secondary glau coma." It was interesting to note that so seemingly insignificant an unusual in jury could have been so destructive to an eye which had been perfectly nor mal, so far as the patient knew. Cases of this type proved the inadvisability of positively prognosticating the end results in supposedly minor eye in juries. HERSCHEL EZELL, Secretary. T H E MEMPHIS SOCIETY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY June 12, 1928 DR. C. D. BLASSINGAME presiding
Essential atrophy of the iris ( i ) DR. P. M. LEWIS presented C. W.,
colored female aged twelve years, who
had been seen in the clinic of the Memphis Eye and Ear Hospital on March 13, 1928. She complained of failing sight of the left eye for the past year. Both eyes were inflamed when she was a baby, and the sight of the right entirely lost. Her mother stated that there had been no change in the appearance of the left eye for the past five or six years. It was at that time she had first noticed the moth-eaten spot on the iris of the left eye. Examination: The right eye was a degenerated globe, having no percep tion of light. The left eye had a central corneal opacity, and an anterior capsular cataract. In spite of these condi tions, the vision was 20/50. Lenses caused no improvement. The pupil was round, regular, and centrally lo cated, and reacted normally. The ten sion of the eye was normal. There was a large area of iris having a motheaten appearance, down and in from the pupil. It looked as if the anterior layers of the iris down to Bruch's mem brane had disappeared, leaving a gray ish-yellow base stippled with numerous spots of iris pigment. This gave it something of the appearance of a but terfly's wing. The patient had been under frequent observation for the past two months and no change had taken place in the eye. The general condition of the pa tient was excellent. The blood was negative for syphilis. The eccentricity of the pupil and the increase of intra ocular tension met with in cases of socalled essential progressive atrophy of the iris were not present. (2) DR. E. C. ELLETT showed photo graphs and drawings of a typical case of essential atrophy of the iris which had developed secondary glaucoma and bullous keratitis, wiith loss of vision. He had reported the early history ana findings of this case in the Transac tions of the American Ophthalmogical Society, 1926, page 140. The eye was enucleated February 15, 1927, and he presented a section of the eyeball, the pathological report on which from Dr. E. Verhoeff was as follows: "The specimens submitted consist of
Pituitary tumor DR. M. M. CULLOM presented the case of Mrs. J. I., aged forty-six years, who had had continual headache for four teen years and failing vision for more than five. Vision in the right eye was too poor to be recorded, and that in the left was 20/200, with complete destruc tion of the nasal field. X-ray showed a large pituitary tumor which had de stroyed the anterior and posterior clinoid processes. Operation was refused. Hereditary retinitis pigmentosa and impaired hearing DR. HILLIARD WOOD reported three consecutive generations in one family which included several cases of retini tis pigmentosa and impaired hearing with other congenital defects. In the first generation was W . H. J., with ex tremely poor hearing. H e had a niece who was a dwarf in size. His wife, L. J., while herself normal, had one sister who was deaf in old age; a broth er who was deaf and had a cataract in one eye; and two nieces who had bad vision. Of the six children born to the J. couple three showed pronounced re tinitis pigmentosa and almost total loss of hearing, with better air than bone conduction. Routine laboratory work, including blood Wassermanns on these
905
three, was negative. One of these three had a daughter, now aged fourteen years, who had been a cretin since in fancy. Dr. Wood presented the three defective members of the second gen eration. Discussion. DR. M. M. CULLOM said that the interesting features were the association of deafness with the retini tis pigmentosa and that there were de fects on both sides of the family. Where both sides have defects the chances for the offspring being afflicted are doubled. H e believed the cases shown to be clearly cases of retinitis pigmen tosa. DR. GUY MANEES asked if there was any history of intermarriage. DR. HILLIARD WOOD replied that there was none. DR. ROBERT SULLIVAN said he thought the wise thing from a social standpoint for these people was never to marry as the succeeding generation's defects were likely to be multiplied progres sively. Ocular contusion followed by glau coma DR. W. E. WILKERSON presented the
case of C. W., white male aged thirtyeight years, who had come to his office with a record of having been flipped thirty minutes previously with a rubber band which struck him on the lids of the right eye. Examination showed the lids of the right eye to be swollen and red. Only a moderate amount of pericorneal injection was present. The cornea had a steamy appearance and the lower third of the anterior chamber was filled with blood. Just above the hyphema a grayish-white irregular mass was seen, apparently protrud ing from the lower portion of the an terior chamber. The pupil was irregu lar in size and was pulled upward. The patient was sent to the hospital for treatment and observation. T w o hours later the hyphema had disappeared, and the mass in the eye proved to be iris torn from its attachment between the positions of six and one o'clock. Injections of aolan were given, and one per cent of atropine sulphate solu-
906
SOCIETY PROCEEDINGS
tion and hot compresses were pre scribed. The following day the eye was looking much better than one rea sonably could have expected. T h e im provement continued for four days, after which more hyphema was noted, and there was a marked increase in pericorneal injection. Hot compresses were discontinued and cold compresses were substituted. A saturated solution of potassium iodide was prescribed, be ginning with eight drops after each meal. On the fifth day after the acci dent the patient was complaining of se vere pain in the eye. The anterior chamber was completely filled with blood, and a marked increase in ten sion was noted. On the sixth day, with the pathological picture unchanged, Dr. Hasty was called in consultation. He advised discontinuing the cold com presses and giving calcium lactate. This was done, but the pathology of the eye did not change. Nine days after the injury the anterior chamber was en tirely filled with blood. At this point he changed doctors. The treatment subsequently used was not known, but in a few weeks the eye was removed. From a pathological examination of the globe at the Army Medical Mu seum, the summarized report w a s : "Injury; intraocular hemorrhage; subacute endophthalmitis; secondary glau coma." It was interesting to note that so seemingly insignificant an unusual in jury could have been so destructive to an eye which had been perfectly nor mal, so far as the patient knew. Cases of this type proved the inadvisability of positively prognosticating the end results in supposedly minor eye in juries. HERSCHEL EZELL, Secretary. T H E MEMPHIS SOCIETY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY June 12, 1928 DR. C. D. BLASSINGAME presiding
Essential atrophy of the iris ( i ) DR. P. M. LEWIS presented C. W.,
colored female aged twelve years, who
had been seen in the clinic of the Memphis Eye and Ear Hospital on March 13, 1928. She complained of failing sight of the left eye for the past year. Both eyes were inflamed when she was a baby, and the sight of the right entirely lost. Her mother stated that there had been no change in the appearance of the left eye for the past five or six years. It was at that time she had first noticed the moth-eaten spot on the iris of the left eye. Examination: The right eye was a degenerated globe, having no percep tion of light. The left eye had a central corneal opacity, and an anterior capsular cataract. In spite of these condi tions, the vision was 20/50. Lenses caused no improvement. The pupil was round, regular, and centrally lo cated, and reacted normally. The ten sion of the eye was normal. There was a large area of iris having a motheaten appearance, down and in from the pupil. It looked as if the anterior layers of the iris down to Bruch's mem brane had disappeared, leaving a gray ish-yellow base stippled with numerous spots of iris pigment. This gave it something of the appearance of a but terfly's wing. The patient had been under frequent observation for the past two months and no change had taken place in the eye. The general condition of the pa tient was excellent. The blood was negative for syphilis. The eccentricity of the pupil and the increase of intra ocular tension met with in cases of socalled essential progressive atrophy of the iris were not present. (2) DR. E. C. ELLETT showed photo graphs and drawings of a typical case of essential atrophy of the iris which had developed secondary glaucoma and bullous keratitis, wiith loss of vision. He had reported the early history ana findings of this case in the Transac tions of the American Ophthalmogical Society, 1926, page 140. The eye was enucleated February 15, 1927, and he presented a section of the eyeball, the pathological report on which from Dr. E. Verhoeff was as follows: "The specimens submitted consist of