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New England Ophthalmological Society
SOCIETY PROCEEDINGS Edited by DR. H. ROMMEL HILDRETH NEW ENGLAND OPHTHALMOLOGICAL SOCIETY January 19, 1937 DR.JAMES J. REGAN, presiding LACARRERE DIATHERMY NEEDLE DR. EDWIN B. DUNPHY said that this type of needle could be used for any diathermy operation.
Dr. Kazanjian showed slides of patients upon whom he had made skin grafts for early carcinoma of the lower lids for which he used membrane from the mouth. He retained good cul-de-sacs in these cases. William P. Beetham, Secretary.
NEW ENGLAND OPHTHALMOLOGICAL SOCIETY
PARINAUO'S CONJUNCTIVITIS DR. VIRGIL G. CASTEN presented a 40year-old housewife who found that she had enlarged glands on the neck and around the ear. She was seen by Dr. P. H. Thompson, who made the diagnosis of Parinaud's conjunctivitis, and was referred to the Massachusetts Eye and Ear Infirmary for study and treatment. Bacteriology studies confirmed the diagnosis. Dr. Verhoeff stated he had never seen the glands break down. The patient was presented because she showed a typical condition of the disease. THE UTILIZATION OF MUCOUS-MEMBRANE GRAFTS IN OPHTHALMIC PLASTIC SURGERY DR. EDMUND B. SPAETH read a very interesting paper on this subject which was published in this J ournal (September, 1937, p. 897). Motion pictures and Iantern slides were shown in conjunction with the presentation of the paper. Discussion. Dr. V. H. Kazanjian stated that there are bound to be some degenerative changes when the skin graft comes in contact with the membrane. He further stated that one can obtain a good deal of mucous membrane from the mouth. The color of the mucous-membrane graft on the eyeball is, of course, objectionable.
February 16, 1937 DR. JAMES J. REGAN, presiding THE AUTONOMIC PHARMACOLOGY OF THE HUMAN EYE DR. ABRAHAM MYERSON said that four drugs had been used in a routine research on the autonomic pharmacology of the eye. This research had followed along the lines which had been utilized in the laboratory (Research Laboratory, Boston State Hospital) for the investigation of the functions of other organs (sweating, . bl00d lacrimation, flush ing, heart action, pressure, gastrointestinal motility, gastric secretions, gall bladder, and urinary bladder action). The drugs were the following: mecholyl (acetyl-beta-methylcholine chloride), benzedrine sulphate (benzylmethyl carbamine or beta-phenylisopropylamine), atropine sulphate (mandelic ester of tropine), and prostimin (dimethylcarbamic ester or oxyphenyl-trimethylammonium methyl sulfate). The general principles of the use of these drugs were outlined briefly to the effect that mecholyl is a cholinergic drug, benzedrine adrenergic; prostigmin by paralyzing or inhibiting the esterases is a synergist of mecholyl; atropine by par549
550
SOCIETY PROCEEDINGS
alyzing or inhibiting the action of the cholinergic substances upon the reacting cell is in large measure a synergist of benzedrine. Mecholyl (I to 10 percent rconstricted the pupil of the eye. The reaction to light was preserved until miosis was reached. The intraocular tension was diminished. The accommodation of the lens was increased for the proximal point; the palpebral fissure, narrowed; and there seemed to be enophthalmos, although this has not yet been confirmed. Prostigmin (l to 10 percent) had the same general effect as mecholyl. It operated, however, more markedly on the presbyopic eye to increase the accommodation of the lens for the near point. A subminimal dose of prostigmin and a subminimal dose of mecholyl produced marked effects, indicating the synergism of these drugs. Benzedrine sulphate (l to 10 percent) widened the pupil in sufficient concentration to the point of mydriasis. The reaction to light diminished with the strength of the solution used. The reaction to flashlight disappeared, but the reaction to sharp daylight was present, although this reaction was slow. The accommodation of the lens was definitely impaired for the proximal point and, in general, the effects upon the accommodation resemble those of atropine, although they were less marked. On the presbyopic eye benzedrine markedly impaired accommodation in dilute solution. The intraocular tension was increased. The palpebral fissure was definitely widened and this occurred before the pupil became dilated. Dr. Myerson further stated that the effects of atropine are well known. and were not considered in detail here. However, atropine will completely check the effects of mecholyl. Given in advance, it prevents them. In subminimal doses (1 :1000) it will produce a marked effect with asub-
minimal dose of benzedrine. These experiments definitely indicate its antagonism to the cholinergic drugs on the functions of the eye and the lid and its definite synergism with benzedrine sulphate. ACCOMMODATION AND THE AUTONOMIC NERVOUS SYSTEM DR. EDITH 1. COGAN said that on examining a number of cases of unilateral Horner's syndrome, it was found that accommodation for near on the pathologic side was greater than that on the normal side, while distance adjustment was maintained least well on the accommodating side. It appeared, therefore, that lesions of the cervical sympathetic system enhanced near accommodation and interfered with distance adjustment. Accordingly, a certain amount of experimental evidence including electric and pharmacological excitation of the cervical syrnpathetics was presented and tended to show that in the normal eye the sympathetic system was responsible for the mechanism of distance accommodation as the parasympathetic is responsible for near accommodation. William P. Beetham, Secretary.
NEW ENGLAND OPHTHALMOLOGICAL SOCIETY March 16, 1937 DR. JAMES J. REGAN, presiding SOME LESS USUAL CORNEAL CONDITlONS DR. SANFORD R. GIFFORD discussed Mooren's ulcer or chronic serpiginous keratitis, ring ulcer occurring in trachoma, recurrent erosion of the cornea, and epithelial dystrophy of the cornea with especial reference to the mild type. . :The two methods of treatment used
Dr. Kazanjian showed slides of patients upon whom he had made skin grafts for early carcinoma of the lower lids for which he used membrane from the mouth. He retained good cul-de-sacs in these cases. William P. Beetham, Secretary.
NEW ENGLAND OPHTHALMOLOGICAL SOCIETY
PARINAUO'S CONJUNCTIVITIS DR. VIRGIL G. CASTEN presented a 40year-old housewife who found that she had enlarged glands on the neck and around the ear. She was seen by Dr. P. H. Thompson, who made the diagnosis of Parinaud's conjunctivitis, and was referred to the Massachusetts Eye and Ear Infirmary for study and treatment. Bacteriology studies confirmed the diagnosis. Dr. Verhoeff stated he had never seen the glands break down. The patient was presented because she showed a typical condition of the disease. THE UTILIZATION OF MUCOUS-MEMBRANE GRAFTS IN OPHTHALMIC PLASTIC SURGERY DR. EDMUND B. SPAETH read a very interesting paper on this subject which was published in this J ournal (September, 1937, p. 897). Motion pictures and Iantern slides were shown in conjunction with the presentation of the paper. Discussion. Dr. V. H. Kazanjian stated that there are bound to be some degenerative changes when the skin graft comes in contact with the membrane. He further stated that one can obtain a good deal of mucous membrane from the mouth. The color of the mucous-membrane graft on the eyeball is, of course, objectionable.
February 16, 1937 DR. JAMES J. REGAN, presiding THE AUTONOMIC PHARMACOLOGY OF THE HUMAN EYE DR. ABRAHAM MYERSON said that four drugs had been used in a routine research on the autonomic pharmacology of the eye. This research had followed along the lines which had been utilized in the laboratory (Research Laboratory, Boston State Hospital) for the investigation of the functions of other organs (sweating, . bl00d lacrimation, flush ing, heart action, pressure, gastrointestinal motility, gastric secretions, gall bladder, and urinary bladder action). The drugs were the following: mecholyl (acetyl-beta-methylcholine chloride), benzedrine sulphate (benzylmethyl carbamine or beta-phenylisopropylamine), atropine sulphate (mandelic ester of tropine), and prostimin (dimethylcarbamic ester or oxyphenyl-trimethylammonium methyl sulfate). The general principles of the use of these drugs were outlined briefly to the effect that mecholyl is a cholinergic drug, benzedrine adrenergic; prostigmin by paralyzing or inhibiting the esterases is a synergist of mecholyl; atropine by par549
550
SOCIETY PROCEEDINGS
alyzing or inhibiting the action of the cholinergic substances upon the reacting cell is in large measure a synergist of benzedrine. Mecholyl (I to 10 percent rconstricted the pupil of the eye. The reaction to light was preserved until miosis was reached. The intraocular tension was diminished. The accommodation of the lens was increased for the proximal point; the palpebral fissure, narrowed; and there seemed to be enophthalmos, although this has not yet been confirmed. Prostigmin (l to 10 percent) had the same general effect as mecholyl. It operated, however, more markedly on the presbyopic eye to increase the accommodation of the lens for the near point. A subminimal dose of prostigmin and a subminimal dose of mecholyl produced marked effects, indicating the synergism of these drugs. Benzedrine sulphate (l to 10 percent) widened the pupil in sufficient concentration to the point of mydriasis. The reaction to light diminished with the strength of the solution used. The reaction to flashlight disappeared, but the reaction to sharp daylight was present, although this reaction was slow. The accommodation of the lens was definitely impaired for the proximal point and, in general, the effects upon the accommodation resemble those of atropine, although they were less marked. On the presbyopic eye benzedrine markedly impaired accommodation in dilute solution. The intraocular tension was increased. The palpebral fissure was definitely widened and this occurred before the pupil became dilated. Dr. Myerson further stated that the effects of atropine are well known. and were not considered in detail here. However, atropine will completely check the effects of mecholyl. Given in advance, it prevents them. In subminimal doses (1 :1000) it will produce a marked effect with asub-
minimal dose of benzedrine. These experiments definitely indicate its antagonism to the cholinergic drugs on the functions of the eye and the lid and its definite synergism with benzedrine sulphate. ACCOMMODATION AND THE AUTONOMIC NERVOUS SYSTEM DR. EDITH 1. COGAN said that on examining a number of cases of unilateral Horner's syndrome, it was found that accommodation for near on the pathologic side was greater than that on the normal side, while distance adjustment was maintained least well on the accommodating side. It appeared, therefore, that lesions of the cervical sympathetic system enhanced near accommodation and interfered with distance adjustment. Accordingly, a certain amount of experimental evidence including electric and pharmacological excitation of the cervical syrnpathetics was presented and tended to show that in the normal eye the sympathetic system was responsible for the mechanism of distance accommodation as the parasympathetic is responsible for near accommodation. William P. Beetham, Secretary.
NEW ENGLAND OPHTHALMOLOGICAL SOCIETY March 16, 1937 DR. JAMES J. REGAN, presiding SOME LESS USUAL CORNEAL CONDITlONS DR. SANFORD R. GIFFORD discussed Mooren's ulcer or chronic serpiginous keratitis, ring ulcer occurring in trachoma, recurrent erosion of the cornea, and epithelial dystrophy of the cornea with especial reference to the mild type. . :The two methods of treatment used