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OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. ANNUAL CONGRESS.
1042
injure the health or reduce the efficiency of those remaining at home. The figures published in the census report give a clue to the amount of relief to housing thus achieved.
whose numbers are tabulated and other Poor-law institutions, homes for lunatics, &c., homes for cripples, blind, deaf and dumb, hospitals and convalescent homes, prisons and reformatory schools, and some others. Only some of these are enumerated in Table V.
The
institutions
comprise workhouses
TABLE V.—Proportion per 10,000 of the Total Population of England and Wales who at the Census were Resident in Institutions (Innzates only). BVorkhouscs and other Poor-law institution:-
..
Lunatics, &:c............. Hospitals and convalescent homes ...... Homes for cripples, blind, deaf and dumb Reformatory schools ..........
..
49 32 28 2-2 4.2
In addition prisoners comprised 3 per 10,000 of the population. The age-distribution of inmates of these institutions has much social interest, and we may in conclusion give this distribution for the most important of these (Fig. 3).
FIG. 3.—Age-distribution per 1000 Males at all Poor-law Iostitutions and
in
Ages
Asylums.
500
1. At ages uuder 5.
2. 5-15.
3. 13—40.
4. 40-65.
5. Over 65.
OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. ANNUAL
CONGRESS.
(Concluded from
p.
992.)
THE Thursday evening session was opened by a paper, read by Dr. GORDON HOLMES, on Tumours involving the Chiasma, excluding Pituitary Tumours. He said that when meeting with cases of intracranial tumour suggestive of a lesion of the chiasma it was usual to think of a new growth of the pituitary body. He had noted that in a considerable proportion of these cases the tumour did not take origin in the pituitary itself ; indeed in his experience 40 per cent. of tumours causing these symptoms did not do so. The other tumours which might compress the chiasma. or otherwise interfere with its functions included tumours growing from the pedicle of the pituitary, and of these there were two types: (1) simple cysts of Radcliffe’s pouch, (2) adamantinoma, a variety of epithelial tumour characterised by a peculiar arrangement of epithelial cells.’ Or there might be tumours growing from the base of the brain, teratomata being common in this situation, or primary tumours of the choroid plexus, and of the third ventricle involving the chiasma. Another type of tumour was that which arose from the meninges, the commonest being the endotheliomata. Tumours might spring from the basisphenoid and involve the chiasma, or the basisphenoid might be the seat of malignant growths, such as primary sarcomata or metastatic carcinomata. Or tumours--e.g., aneurysms—might grow from vessels. Dr. Holmes quoted a number of cases in each group. Dr. A. W. MULOCH HOUWER read a paper on Keratitis Filamentosa and Chroreic Arthritis, in which he drew attention to the association between a form of conjunctivitis (later becoming keratitis) and arthritic disability of a chronic and lasting character, which proved very resistant to treatment. Mr. J. GRAY CLEGG discussed the paper, and said he had generally used for the condition a mild application of borax and salt, with drops of paroleine. When there were definite adhesions of the cornea he used ammonium chloride. One of his patients had peliosis rheumatica, and there was an absence of tear secretion.
Colonel H. HERBERT read a paper on Glass Membrane Formation in Iridocyclitis. It dealt with the question of the formation of a glass membrane in the anterior chamber, which he considered took place by means of cells which had migrated from the ciliary epithelium. It could only be found in very chronic cases of iridocyclitis. The paper was illustrated by a large number of micro-
In the first set of columns is shown the age-distribution of the male population of England and Wales scopical slides. Mr. TREACHER COI,Li-,;-s discussed the paper and at five periods of life ; in the second the same is Colonel Herbert replied. shown for Poor-law institutions, and in the third Mr. G. F. ALEXANDER sent two papers which were for homes for lunatics. It is clearly seen that the read, one on a new method of controlling the eye majority of patients in asylums is at ages 15-65, in the operation for cataract, the other on a factor in while the majority of occupants of Poor-law institutions the causation of keratitis striata. are over 40 and especially over 65 years of age. Old ’, age pensions have reduced the proportion in instituEdward Nettleship Prize. tions at these higher ages, but it still remains true The PRESIDENT presented this prize to Mr. C.’. that Poor-law institutions serve chiefly for the care of Howard Usher in recognition of his original work, disabled with combined by age infirmity. persons ’, which of value not he
was, said, only to ophthalmology but also in a wider sphere. If in the future should become a science it would be largely DUBLIN VICTORIA EYE AND EAR HOSPITAL.—A new eugenics such through spade-work as that which had been done wing is being added to this institution and it will be opened by Mr. Usher. It is the only hospital in Dublin devoted a few months hence. exclusively to the treatment of diseases of the eye and ear. Ætiology and Treatment of Hypopyon Ulcer. and the annual report shows that last year there were 1620 The discussion of this subject occupied the whole of in-patients and 9995 new out-patients in addition to 2836 out-patients receiv ing further treatment. Friday morning.
1043 Mr. J. GRAY CLEGG said that in 27 years on theSaemisch section, which lowered the tension and staff of the Manchester Royal Eye Hospital lie had ensured a long-continued drainageof the anterior had 160,000 patients under his care, 9576 cf whom chamber, making it easy to deal with the hypopyon.
Of the in-patients, 4 per cent.With regard to treating complications, iritis called of hypopyon ulcer, and uf the whole numberfor the vigorous nse of atropine in the form of watery ( 0.24 per cent. Of the 399 cases. 77 per cent. were males ; or oily drops. If a case was going: on well the hypopyon 23 per cent. were between 51 and 60 years of age ; ’or pus needed no special treatment, but. if it was 19 per cent. were over 61 ; 18 per cent. were between large and fibrinous it must be evacuated. In many tl and 50, whilst 12 per cent. were under 10. Between cases the tension was raised, and then the aqueous the ages of 21 and 30 the percentage was 8. In should be allowed to escape very slowly ; prolapse 53 per cent. there was a definite history of trauma. of the iris might occur if it liiners and labourers were by far the chief sufferers, Prophylaxis.—It could not be too much irnpressed the miners accounting for 20 per cent. of the cases upon workers that a watery or discharging eye was a and the labourers for 15 per cent. The condition was serious affair, and that an ophthalmic surgeon should not found in pit ponies, and was not caused by infec- be seen at the first sign of trouble after an injury, tion from underground stables, as the of however slight. Risk of damage to the eye was largely
had been in-patients. were cases
escaped quickly.
draughts
always forced towards those stables. In the opinion of Maitland Ramsay, ulcus serpens formed 3 per cent. to 4 per cent. of all underground non-fatal accident cases. Most of the subjects of this condition seen by Mr. Clegg were below par in general health, and addiction to alcohol had t distinct influence in lowering resistance to infection, while it also hindered recovery. The large number of cases in children he thought was accounted for by septic infection in debilitated subjects. Such ulcers might be associated with infectious disease, but these cases seldom came to an eye hospital. Conjunctivitis was present in 26 per cent. of his cases, dacryocystitis in 13 per cent. (MacNab gave the proportion of dacryocystitis as 40 per cent.). All ulcers with hypopyon were due to the action of micro-organisms, and mostly the - culprit was the capsulated pneumococcus of Frankel and Weichselbaum, though others could air
were
reduced by wearing
goggles.
Mr. S. H. BROWNING dealt with the subject from the bacteriological standpoint. Ile said lie had always found the pus of hypopyon to be sterile, and it had remained so until the time of perforation. It was possible to imagine an infection so acute as to paralyse the defensive mechanisms of the eye, so that no hypopyon arose ; and it might be such a low infection, and the response might also be so low, that hypopyon resulted. Arguing thus, it seemed that hypopyon could be regarded as a sign of good response to the toxic stimulus. He had asked ophthalmic surgeons of his acquaintance whether they considered the presence of a hypopyon in an ulcerated cornea as of serious prognostic significance. Of 17 who were asked, 11 said thev considered it made the condition a more dangerous one, four said it did not matter, two were doubtful. The organism most frequently associated cause the condition. with hypopyon ulcer was the pneumococcus, and in Treatment.—General treatment, said Mr. Clegg, Diet should be simple and order that it could become established on the corneal was very important. surface must have sustained some damage. nourishing, mild purgatives being given, and morphia surface, that the body causing the injury did not infect ; or codeia might be needed to relieve pain. Anv Probably defective teeth must be put right or extracted. With inrection was caused by utie eitury OL the organisms already in the conjunctival sac. It was of interest regard to local treatment, if there was a definite that it was rare for ulcers to occur in cases of acute a retarded bandage recovery purulent discharge or in its Jess acute form pneumococcal by retaining the secretions and thereby bathing the seen in babies.conjunctivitis, Cultures should be taken from the ulcer region in toxic fluid. Among the lotions which had been used were 1 in 10,000 hydrarg. perchlor., advancing edge of the ulcer. Ile suggested that a zinc. suplh. gr. 1 ad. z i, mercurophen I in 8000, bacteriological examination should be made of all formalin 1 in 2000 or weaker. Ai-n(-)ng the drops used ulcers ; this step might save many corneæ from drastic treatment later. He had never seen the were argyrol, 10 per cent. to 50 per cent., protargol 5 per cent. to 10 per cent., dionin in strengths up to diplobacillus concerned in an intraocular infection. Of powders, The most virulent cases of hypopyon ulcer he had 10 per cent., adreiialiii 1 in 1000. iodoform, xeroforna, nosoplien, and airol had been ever seen were due to the Bacillus pyocyameus, and he it to be the worst organism which could employed. Hydrarg. perchlor. had been used up to believed affect the eye. In some of the cases of pyocyaneus even 1 in 100 for direct application to the ulcerated surface only. The consequent burning sensation, it infection of the eves he was able to trace the source to was found, could be alleviated by instilling drops of discharge from the ear. Streptococci did not now holocain. Another preparationhaving the same seem to affect the eyes so often as formerly, and hypoeffect was trichloracetic acid in a 10 per cent. or pyon ulcer due to staphylococci was, in his experi20 per cent. solution. Others were solutions of ence, rare, though he had seen a panophthalmitis nitrate of silver, absolute alcohol, pneumococcal due to Staphylococcus c.itreus. Ulcers caused by the ICe had not The application of pneuniobacillus were not uncommon. serum, and hydrogen peroxide. had success in treatment of hypopyon to heat the lids of any great means the Maddox electric dry by pad, or nioist heat by hot pads of lint repeatedly ulcers by bacteriological methods except in gonococcal wrung out in hot water to which had been added a infections in the adult. He was not convinced that In little starch, was beneficial. Or heat could be directly autogenous vaccines produced improvement. applied to the ulcer by a cautery knob or loop at a conclusion. he referred to the magnesium sulphate and dull red heat being held near the ulcer, thus drying ’, hexarnine treatment of hypopyon ulcers, the latter its surface repeatedly. For caustic effects, carbolic drug being given internally in doses of gr. 10 thrice acid liquefactum was a favourite agent, as it did not daily. If irritation of the bladder developed the dose penetrate the tissues too deeply. A very accurate of hexamine was reduced. method was by means of a Paquelin’:, benzol vapour Mr. M. S. MAYOU showed a slide depicting a very cautery. Dacryocystitis when present must be dealt early stage of pneumococcal corneal ulcer, which with. When it was mild. in might suffice to wash out followed the of a foreign body. The ulcer the. lacrymal passages twice or thrice daily ; or was cauterisedentry with pure carbolic and did not spread. argyrol might be introduced into those passages. The smear preparation was filled with pneumococci. But when there was much discharge, or pressure on He described, means of a series of slides, the the sac, the best way of preventing reinfection of the development of by these ulcers. ulcer was by total excision of it or by complete Mr. W. H. MCMULLEN said thes ulcers were now When the destruction of the mucous membrane. tension was raised paracentesis was indicated. less common than 25 years ago. In most cases this Frequently the necrotic mass was scraped from the disease was preventable, therefore prophylaxis should surface of the ulcer, especially at its advancing edge. have the first consideration. It was especially importA more heroic method was to make the Guthrie- ant to protect the eyes from accidents in industry,
1044 and also that treatment for even slight injuries to them should be skilful. He now employed the galvano-cautery in all hypopyon ulcers, except in The cases of slight ulceration with little hypopyon. lotion he used was a half-saturated solution of magnesium sulphate, used as an eye-bath for five minutes every two or three hours. He preferred not to bandage these eyes, as the warmth and immobility favoured bacterial growth. The discussion was continued by Mr. A. C. HUDSON, Dr. FREELAND FERGUS, Mr. EDGAR STEVENSON, Mr. H. MACNAB, Colonel A. F. MCCALLAN, Mr. M. HEPBURN, Colonel H. HERBERT, Mr. CHRISTIE REID, Major R. E. WRIGHT, Mr. A. L. WHITEHEAD, Sir ARNOLD LAWSON, Mr. J. HOWAN, and Dr. HLTGH JONES. In the afternoon a large number of clinical cases demonstrated at the Eye and Ear Hospital, and on Saturday morning the following papers were read and discussed :Mr. M. S. MAYOU: Distension of the Neural Canal in the Embryo in relation to Microphthalmos. Miss IDA C. MANN: The Mature and Boundaries of the Embryonic and Adult Vitreous Humour. Mr. FRANK JuLER : A case of Lid Sarcoma with Secondary Growth, apparently cured by Radium. Mr. T. C. SUMMERS: A case of Papillcedema in a were
Pedigree Bull. Members dined together at the Adelphi Hotel, and Mr. BERNARD CHAVASSE organised an ophthalmic museum, which remained open during the Congress
sittings. MEDICINE AND THE LAW. Education of Defective Child. MAJSTY years ago it was decided by the law courts that, when a husband was away at sea, his wife might be liable for neglecting the parental duty of sending her daughter to school. Lord Coleridge, Chief Justice, pointed out that any other decision would mean that the children of a seafaring population might be left entirely without education. Now there has arisen a further question of parental responsibility when the child is a mental defective and the father is in prison. Under Section 53 of the Education Act of 1921 the normal duty of a parent to cause the child to receive sufficient elementary education is converted, when the child is defective or epileptic, into the duty to cause the child to attend a special class or school if there is one within reach of the child’s residence ; the section goes on to say that a parent is not to be excused from this duty by reason only that a guide or conThe following veyance to the school is necessary. section enacts that the local education authority, after consultation with the parent of a defective or epileptic child over 7 years of age, if satisfied that the parent is not making suitable provision for the child’s education, may require the parent to send the child to a certified class or school of a suitable kind ; if the parent fails without reasonable excuse to do so the local authority may apply to the magistrates for an order. Last October complaint was made by the Somerset County Council that a woman living at Burnham-on-Sea had failed without reasonable excuse to send her defective daughter to a special school provided at Bishops Lydeard. The child, a girl of 12, was at all material times residing with and was in the actual custody of the mother, an important fact, because the Education Act defines the ’’ parent " of a child as including every person who is liable to maintain or has the actual custodv of the child. The mother was stone deaf ; the father was serving a sentence of penal servitude in Maidstone gaol. The mother said she refused her consent because she thought the child would be better off at home in her own charge than at a school where she would be liable to punishment ; she said the child could do housework Parental
Responsibility for
and she believed the child was by reason of defective intelligence incapable of benefiting from instruction in a special school. In this belief she was confirmed by her doctor who gave evidence that the child waa feeble-minded, of an emotional temperament, better kept at home in her mother’s care, and more likelv to benefit bv association with normal children than with other defective childen at a special school. The medical officer had certified the child to be defective and the magistrates, being satisfied that the certificate was correct, ordered the child to be sent to the speciaf school at Bishops Lydeard. A number of ingenious points were then taken on behalf of the mother on appeal. It was argued that the parent meant the father if he was alive and his address was known, that the father had never been consulted by the local authority, had not been required to send the girl to the school, and had not refused consent or unreasonably withheld it. It was also argued that the mother was acting with the bona fide intention of benefiting the child, that the mother had not unreasonably withheld consent, and that the medical officer’s certificate was wrong. The main argument that the father, though undergoing penal was servitude at Maidstone, was the " parent " for the purpose of the Act. He was in prison, it was said, but he had not ceased’to be a father. The King’s Bench Division, however, was not impressed by this contention. The local authority had to be satisfied under the Act that the parent was not making suitable provision for the child’s education. The Lord Chief Justice said it would be grotesque if this father were allowed to say that to his regret he was in a place where it was not possible for him to comply with the reqmirenient of the statute. The child’s education could not be left neglected while the father completed his term of penal servitude. Thus common sense prevailed, and the decision of the magistrates was
upheld.
Meat and Malt TVine. The same court on the same day gave an important decision on the sale of " Extract of Meat and lTalt Wine." An inspector under the Sale of Food and Drugs Acts had prosecuted1 a defendant at Salford for selling him a bottle of extract to the prejudice of the purchaser, and not being of the nature, siibc3tince, The bottle, which cost and quality demanded. 4s. 6d., was labelled " Extract of Meat and Malt Wine-Guaranteed prepared from Liebig’s Extract of Meat—This wine will be found invaluable as a stimulant to digestion-A tonic and a food-nonalcoholic." The citv analyst of Salford certified that the sample contained 81-2 per cent. of water, 16.4 per cent. of total sugars, and 2-4 per cent. of other extractive matter ; in this last item was 0-06 per cent. of phosphoric anhydride, indicating the possible presence of not more than 2 per cent. of a mixture of equal parts of meat and malt extracts. The certificate further stated that no change had taken place in the article which would interfere with the analysis, that a genuine meat and malt wine should contain at least 5 per cent. of a mixture of equal parts of meat and malt extracts with a wine basis, and that the sample was not a meat and malt wine. As in similar cases heard in the courts before, the magistrate seems to have been misled by the fact that no standard of quality is officially fixed for extract of meat and malt wine. IIere was a sample certified to be 60 per cent. deficient of the minimum amount of meat and malt extract as well as being entirely deficient of wine ; but, as there was no statutory prescribed minimum, it was possible to argue that the meat and malt ingredient was present however disproportionately small and that its sufficiency or insufficiency was a mere matter of opinion. Taking this view, the magistrate dismissed the information. The King’s Bench Division, however, decided that the magistrate was wrong. The magistrate erred in supposing that, merely because there was 1 See THE LANCET, 1926, ii., 972.
injure the health or reduce the efficiency of those remaining at home. The figures published in the census report give a clue to the amount of relief to housing thus achieved.
whose numbers are tabulated and other Poor-law institutions, homes for lunatics, &c., homes for cripples, blind, deaf and dumb, hospitals and convalescent homes, prisons and reformatory schools, and some others. Only some of these are enumerated in Table V.
The
institutions
comprise workhouses
TABLE V.—Proportion per 10,000 of the Total Population of England and Wales who at the Census were Resident in Institutions (Innzates only). BVorkhouscs and other Poor-law institution:-
..
Lunatics, &:c............. Hospitals and convalescent homes ...... Homes for cripples, blind, deaf and dumb Reformatory schools ..........
..
49 32 28 2-2 4.2
In addition prisoners comprised 3 per 10,000 of the population. The age-distribution of inmates of these institutions has much social interest, and we may in conclusion give this distribution for the most important of these (Fig. 3).
FIG. 3.—Age-distribution per 1000 Males at all Poor-law Iostitutions and
in
Ages
Asylums.
500
1. At ages uuder 5.
2. 5-15.
3. 13—40.
4. 40-65.
5. Over 65.
OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. ANNUAL
CONGRESS.
(Concluded from
p.
992.)
THE Thursday evening session was opened by a paper, read by Dr. GORDON HOLMES, on Tumours involving the Chiasma, excluding Pituitary Tumours. He said that when meeting with cases of intracranial tumour suggestive of a lesion of the chiasma it was usual to think of a new growth of the pituitary body. He had noted that in a considerable proportion of these cases the tumour did not take origin in the pituitary itself ; indeed in his experience 40 per cent. of tumours causing these symptoms did not do so. The other tumours which might compress the chiasma. or otherwise interfere with its functions included tumours growing from the pedicle of the pituitary, and of these there were two types: (1) simple cysts of Radcliffe’s pouch, (2) adamantinoma, a variety of epithelial tumour characterised by a peculiar arrangement of epithelial cells.’ Or there might be tumours growing from the base of the brain, teratomata being common in this situation, or primary tumours of the choroid plexus, and of the third ventricle involving the chiasma. Another type of tumour was that which arose from the meninges, the commonest being the endotheliomata. Tumours might spring from the basisphenoid and involve the chiasma, or the basisphenoid might be the seat of malignant growths, such as primary sarcomata or metastatic carcinomata. Or tumours--e.g., aneurysms—might grow from vessels. Dr. Holmes quoted a number of cases in each group. Dr. A. W. MULOCH HOUWER read a paper on Keratitis Filamentosa and Chroreic Arthritis, in which he drew attention to the association between a form of conjunctivitis (later becoming keratitis) and arthritic disability of a chronic and lasting character, which proved very resistant to treatment. Mr. J. GRAY CLEGG discussed the paper, and said he had generally used for the condition a mild application of borax and salt, with drops of paroleine. When there were definite adhesions of the cornea he used ammonium chloride. One of his patients had peliosis rheumatica, and there was an absence of tear secretion.
Colonel H. HERBERT read a paper on Glass Membrane Formation in Iridocyclitis. It dealt with the question of the formation of a glass membrane in the anterior chamber, which he considered took place by means of cells which had migrated from the ciliary epithelium. It could only be found in very chronic cases of iridocyclitis. The paper was illustrated by a large number of micro-
In the first set of columns is shown the age-distribution of the male population of England and Wales scopical slides. Mr. TREACHER COI,Li-,;-s discussed the paper and at five periods of life ; in the second the same is Colonel Herbert replied. shown for Poor-law institutions, and in the third Mr. G. F. ALEXANDER sent two papers which were for homes for lunatics. It is clearly seen that the read, one on a new method of controlling the eye majority of patients in asylums is at ages 15-65, in the operation for cataract, the other on a factor in while the majority of occupants of Poor-law institutions the causation of keratitis striata. are over 40 and especially over 65 years of age. Old ’, age pensions have reduced the proportion in instituEdward Nettleship Prize. tions at these higher ages, but it still remains true The PRESIDENT presented this prize to Mr. C.’. that Poor-law institutions serve chiefly for the care of Howard Usher in recognition of his original work, disabled with combined by age infirmity. persons ’, which of value not he
was, said, only to ophthalmology but also in a wider sphere. If in the future should become a science it would be largely DUBLIN VICTORIA EYE AND EAR HOSPITAL.—A new eugenics such through spade-work as that which had been done wing is being added to this institution and it will be opened by Mr. Usher. It is the only hospital in Dublin devoted a few months hence. exclusively to the treatment of diseases of the eye and ear. Ætiology and Treatment of Hypopyon Ulcer. and the annual report shows that last year there were 1620 The discussion of this subject occupied the whole of in-patients and 9995 new out-patients in addition to 2836 out-patients receiv ing further treatment. Friday morning.
1043 Mr. J. GRAY CLEGG said that in 27 years on theSaemisch section, which lowered the tension and staff of the Manchester Royal Eye Hospital lie had ensured a long-continued drainageof the anterior had 160,000 patients under his care, 9576 cf whom chamber, making it easy to deal with the hypopyon.
Of the in-patients, 4 per cent.With regard to treating complications, iritis called of hypopyon ulcer, and uf the whole numberfor the vigorous nse of atropine in the form of watery ( 0.24 per cent. Of the 399 cases. 77 per cent. were males ; or oily drops. If a case was going: on well the hypopyon 23 per cent. were between 51 and 60 years of age ; ’or pus needed no special treatment, but. if it was 19 per cent. were over 61 ; 18 per cent. were between large and fibrinous it must be evacuated. In many tl and 50, whilst 12 per cent. were under 10. Between cases the tension was raised, and then the aqueous the ages of 21 and 30 the percentage was 8. In should be allowed to escape very slowly ; prolapse 53 per cent. there was a definite history of trauma. of the iris might occur if it liiners and labourers were by far the chief sufferers, Prophylaxis.—It could not be too much irnpressed the miners accounting for 20 per cent. of the cases upon workers that a watery or discharging eye was a and the labourers for 15 per cent. The condition was serious affair, and that an ophthalmic surgeon should not found in pit ponies, and was not caused by infec- be seen at the first sign of trouble after an injury, tion from underground stables, as the of however slight. Risk of damage to the eye was largely
had been in-patients. were cases
escaped quickly.
draughts
always forced towards those stables. In the opinion of Maitland Ramsay, ulcus serpens formed 3 per cent. to 4 per cent. of all underground non-fatal accident cases. Most of the subjects of this condition seen by Mr. Clegg were below par in general health, and addiction to alcohol had t distinct influence in lowering resistance to infection, while it also hindered recovery. The large number of cases in children he thought was accounted for by septic infection in debilitated subjects. Such ulcers might be associated with infectious disease, but these cases seldom came to an eye hospital. Conjunctivitis was present in 26 per cent. of his cases, dacryocystitis in 13 per cent. (MacNab gave the proportion of dacryocystitis as 40 per cent.). All ulcers with hypopyon were due to the action of micro-organisms, and mostly the - culprit was the capsulated pneumococcus of Frankel and Weichselbaum, though others could air
were
reduced by wearing
goggles.
Mr. S. H. BROWNING dealt with the subject from the bacteriological standpoint. Ile said lie had always found the pus of hypopyon to be sterile, and it had remained so until the time of perforation. It was possible to imagine an infection so acute as to paralyse the defensive mechanisms of the eye, so that no hypopyon arose ; and it might be such a low infection, and the response might also be so low, that hypopyon resulted. Arguing thus, it seemed that hypopyon could be regarded as a sign of good response to the toxic stimulus. He had asked ophthalmic surgeons of his acquaintance whether they considered the presence of a hypopyon in an ulcerated cornea as of serious prognostic significance. Of 17 who were asked, 11 said thev considered it made the condition a more dangerous one, four said it did not matter, two were doubtful. The organism most frequently associated cause the condition. with hypopyon ulcer was the pneumococcus, and in Treatment.—General treatment, said Mr. Clegg, Diet should be simple and order that it could become established on the corneal was very important. surface must have sustained some damage. nourishing, mild purgatives being given, and morphia surface, that the body causing the injury did not infect ; or codeia might be needed to relieve pain. Anv Probably defective teeth must be put right or extracted. With inrection was caused by utie eitury OL the organisms already in the conjunctival sac. It was of interest regard to local treatment, if there was a definite that it was rare for ulcers to occur in cases of acute a retarded bandage recovery purulent discharge or in its Jess acute form pneumococcal by retaining the secretions and thereby bathing the seen in babies.conjunctivitis, Cultures should be taken from the ulcer region in toxic fluid. Among the lotions which had been used were 1 in 10,000 hydrarg. perchlor., advancing edge of the ulcer. Ile suggested that a zinc. suplh. gr. 1 ad. z i, mercurophen I in 8000, bacteriological examination should be made of all formalin 1 in 2000 or weaker. Ai-n(-)ng the drops used ulcers ; this step might save many corneæ from drastic treatment later. He had never seen the were argyrol, 10 per cent. to 50 per cent., protargol 5 per cent. to 10 per cent., dionin in strengths up to diplobacillus concerned in an intraocular infection. Of powders, The most virulent cases of hypopyon ulcer he had 10 per cent., adreiialiii 1 in 1000. iodoform, xeroforna, nosoplien, and airol had been ever seen were due to the Bacillus pyocyameus, and he it to be the worst organism which could employed. Hydrarg. perchlor. had been used up to believed affect the eye. In some of the cases of pyocyaneus even 1 in 100 for direct application to the ulcerated surface only. The consequent burning sensation, it infection of the eves he was able to trace the source to was found, could be alleviated by instilling drops of discharge from the ear. Streptococci did not now holocain. Another preparationhaving the same seem to affect the eyes so often as formerly, and hypoeffect was trichloracetic acid in a 10 per cent. or pyon ulcer due to staphylococci was, in his experi20 per cent. solution. Others were solutions of ence, rare, though he had seen a panophthalmitis nitrate of silver, absolute alcohol, pneumococcal due to Staphylococcus c.itreus. Ulcers caused by the ICe had not The application of pneuniobacillus were not uncommon. serum, and hydrogen peroxide. had success in treatment of hypopyon to heat the lids of any great means the Maddox electric dry by pad, or nioist heat by hot pads of lint repeatedly ulcers by bacteriological methods except in gonococcal wrung out in hot water to which had been added a infections in the adult. He was not convinced that In little starch, was beneficial. Or heat could be directly autogenous vaccines produced improvement. applied to the ulcer by a cautery knob or loop at a conclusion. he referred to the magnesium sulphate and dull red heat being held near the ulcer, thus drying ’, hexarnine treatment of hypopyon ulcers, the latter its surface repeatedly. For caustic effects, carbolic drug being given internally in doses of gr. 10 thrice acid liquefactum was a favourite agent, as it did not daily. If irritation of the bladder developed the dose penetrate the tissues too deeply. A very accurate of hexamine was reduced. method was by means of a Paquelin’:, benzol vapour Mr. M. S. MAYOU showed a slide depicting a very cautery. Dacryocystitis when present must be dealt early stage of pneumococcal corneal ulcer, which with. When it was mild. in might suffice to wash out followed the of a foreign body. The ulcer the. lacrymal passages twice or thrice daily ; or was cauterisedentry with pure carbolic and did not spread. argyrol might be introduced into those passages. The smear preparation was filled with pneumococci. But when there was much discharge, or pressure on He described, means of a series of slides, the the sac, the best way of preventing reinfection of the development of by these ulcers. ulcer was by total excision of it or by complete Mr. W. H. MCMULLEN said thes ulcers were now When the destruction of the mucous membrane. tension was raised paracentesis was indicated. less common than 25 years ago. In most cases this Frequently the necrotic mass was scraped from the disease was preventable, therefore prophylaxis should surface of the ulcer, especially at its advancing edge. have the first consideration. It was especially importA more heroic method was to make the Guthrie- ant to protect the eyes from accidents in industry,
1044 and also that treatment for even slight injuries to them should be skilful. He now employed the galvano-cautery in all hypopyon ulcers, except in The cases of slight ulceration with little hypopyon. lotion he used was a half-saturated solution of magnesium sulphate, used as an eye-bath for five minutes every two or three hours. He preferred not to bandage these eyes, as the warmth and immobility favoured bacterial growth. The discussion was continued by Mr. A. C. HUDSON, Dr. FREELAND FERGUS, Mr. EDGAR STEVENSON, Mr. H. MACNAB, Colonel A. F. MCCALLAN, Mr. M. HEPBURN, Colonel H. HERBERT, Mr. CHRISTIE REID, Major R. E. WRIGHT, Mr. A. L. WHITEHEAD, Sir ARNOLD LAWSON, Mr. J. HOWAN, and Dr. HLTGH JONES. In the afternoon a large number of clinical cases demonstrated at the Eye and Ear Hospital, and on Saturday morning the following papers were read and discussed :Mr. M. S. MAYOU: Distension of the Neural Canal in the Embryo in relation to Microphthalmos. Miss IDA C. MANN: The Mature and Boundaries of the Embryonic and Adult Vitreous Humour. Mr. FRANK JuLER : A case of Lid Sarcoma with Secondary Growth, apparently cured by Radium. Mr. T. C. SUMMERS: A case of Papillcedema in a were
Pedigree Bull. Members dined together at the Adelphi Hotel, and Mr. BERNARD CHAVASSE organised an ophthalmic museum, which remained open during the Congress
sittings. MEDICINE AND THE LAW. Education of Defective Child. MAJSTY years ago it was decided by the law courts that, when a husband was away at sea, his wife might be liable for neglecting the parental duty of sending her daughter to school. Lord Coleridge, Chief Justice, pointed out that any other decision would mean that the children of a seafaring population might be left entirely without education. Now there has arisen a further question of parental responsibility when the child is a mental defective and the father is in prison. Under Section 53 of the Education Act of 1921 the normal duty of a parent to cause the child to receive sufficient elementary education is converted, when the child is defective or epileptic, into the duty to cause the child to attend a special class or school if there is one within reach of the child’s residence ; the section goes on to say that a parent is not to be excused from this duty by reason only that a guide or conThe following veyance to the school is necessary. section enacts that the local education authority, after consultation with the parent of a defective or epileptic child over 7 years of age, if satisfied that the parent is not making suitable provision for the child’s education, may require the parent to send the child to a certified class or school of a suitable kind ; if the parent fails without reasonable excuse to do so the local authority may apply to the magistrates for an order. Last October complaint was made by the Somerset County Council that a woman living at Burnham-on-Sea had failed without reasonable excuse to send her defective daughter to a special school provided at Bishops Lydeard. The child, a girl of 12, was at all material times residing with and was in the actual custody of the mother, an important fact, because the Education Act defines the ’’ parent " of a child as including every person who is liable to maintain or has the actual custodv of the child. The mother was stone deaf ; the father was serving a sentence of penal servitude in Maidstone gaol. The mother said she refused her consent because she thought the child would be better off at home in her own charge than at a school where she would be liable to punishment ; she said the child could do housework Parental
Responsibility for
and she believed the child was by reason of defective intelligence incapable of benefiting from instruction in a special school. In this belief she was confirmed by her doctor who gave evidence that the child waa feeble-minded, of an emotional temperament, better kept at home in her mother’s care, and more likelv to benefit bv association with normal children than with other defective childen at a special school. The medical officer had certified the child to be defective and the magistrates, being satisfied that the certificate was correct, ordered the child to be sent to the speciaf school at Bishops Lydeard. A number of ingenious points were then taken on behalf of the mother on appeal. It was argued that the parent meant the father if he was alive and his address was known, that the father had never been consulted by the local authority, had not been required to send the girl to the school, and had not refused consent or unreasonably withheld it. It was also argued that the mother was acting with the bona fide intention of benefiting the child, that the mother had not unreasonably withheld consent, and that the medical officer’s certificate was wrong. The main argument that the father, though undergoing penal was servitude at Maidstone, was the " parent " for the purpose of the Act. He was in prison, it was said, but he had not ceased’to be a father. The King’s Bench Division, however, was not impressed by this contention. The local authority had to be satisfied under the Act that the parent was not making suitable provision for the child’s education. The Lord Chief Justice said it would be grotesque if this father were allowed to say that to his regret he was in a place where it was not possible for him to comply with the reqmirenient of the statute. The child’s education could not be left neglected while the father completed his term of penal servitude. Thus common sense prevailed, and the decision of the magistrates was
upheld.
Meat and Malt TVine. The same court on the same day gave an important decision on the sale of " Extract of Meat and lTalt Wine." An inspector under the Sale of Food and Drugs Acts had prosecuted1 a defendant at Salford for selling him a bottle of extract to the prejudice of the purchaser, and not being of the nature, siibc3tince, The bottle, which cost and quality demanded. 4s. 6d., was labelled " Extract of Meat and Malt Wine-Guaranteed prepared from Liebig’s Extract of Meat—This wine will be found invaluable as a stimulant to digestion-A tonic and a food-nonalcoholic." The citv analyst of Salford certified that the sample contained 81-2 per cent. of water, 16.4 per cent. of total sugars, and 2-4 per cent. of other extractive matter ; in this last item was 0-06 per cent. of phosphoric anhydride, indicating the possible presence of not more than 2 per cent. of a mixture of equal parts of meat and malt extracts. The certificate further stated that no change had taken place in the article which would interfere with the analysis, that a genuine meat and malt wine should contain at least 5 per cent. of a mixture of equal parts of meat and malt extracts with a wine basis, and that the sample was not a meat and malt wine. As in similar cases heard in the courts before, the magistrate seems to have been misled by the fact that no standard of quality is officially fixed for extract of meat and malt wine. IIere was a sample certified to be 60 per cent. deficient of the minimum amount of meat and malt extract as well as being entirely deficient of wine ; but, as there was no statutory prescribed minimum, it was possible to argue that the meat and malt ingredient was present however disproportionately small and that its sufficiency or insufficiency was a mere matter of opinion. Taking this view, the magistrate dismissed the information. The King’s Bench Division, however, decided that the magistrate was wrong. The magistrate erred in supposing that, merely because there was 1 See THE LANCET, 1926, ii., 972.