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Saint Louis Ophthalmic Society
782
SOCIETY PROCEEDINGS
the form of adjunct apparatus to the slitlamp. Louis A. Feldman, Transaction Editor.
SAINT LOUIS OPHTHALMIC SOCIETY October 14, 1938 DR. ROY E. MASON, president OCULAR FACTORS IN POOR READERS IN THE SAINT LOUIS PUBLIC SCHOOLS DR. F. O. SCHWARTZ read a paper on this subject which will be published in this Journal. PAREDRINE AS A CYCLOPLEGIC DR. ALAN D. CALHOUN read a paper on this subject. Discussion. Dr. John Green said that paredrine (B-4 hydroxylphenylsopropylamine) is not a new drug. It was orig inally entered in the German Patent Office in 1913, and belongs to the class of sympathomimetic drugs; its chemical structure is closely allied to that of epinephrine and ephedrine. A recent pharmacologic study by Abbot and Henry (Amer. Jour. Med. Sci., 1937, p. 661) disclosed the following: 1. It increases the blood pressure (10-20 mg. subcutaneously, 20-40 mg. by mouth) ; 2. The central nervous system is stimulated, probably due to increased flow of blood to the brain; 3. By topical application (3-percent solution) it is as effective in relieving congestion of the nasal mucosa as a 3-percent solution of ephed rine. It has, however, the disadvantage of not being soluble in oil. In percentages varying from 0.15 to 2, it acts as a mydriatic, but not as a cyclo plegic; that is, these authors found no loss of accommodation following the in stillation of the drug alone. There was no
conjunctival nor ciliary congestion and no increase in intraocular pressure. A recent study by Sudranski (Arch, of Ophth., 1938, v. 20, no. 4, p. 585) indi cates that benzedrine (a drug closely al lied to paredrine) is totally lacking in cycloplegic effect. He questions the synergistic effect of the two drugs in combina tion, believing that a 5-percent solution of homatropine alone uncovers 90 percent of the hyperopia and is efficient alone in the production of transitory, but clinically efficient, cycloplegia. Further studies are needed to get at the truth of the matter. Dr. Lawrence Post said that they had been using paredrine for a few months, but not in the critical manner of Dr. Cal houn. They did take the near point and found some residual accommodation, the near point being 29 cm. to 30 cm. instead of 33 cm., which was not very different from that in a group of patients in whom they used five instillations of 2-percent homatropine. Their method was to use a drop of 5-percent homatropine and three minutes later a drop of paredrine. The method has the advantage of quick recovery. It is simpler in children be cause of the fewer instillations and is of advantage to the group of patients who must use their eyes the following day. Dr. Calhoun said that he would like to test how much cycloplegic effect was ob tained with a drop of 5-percent homat ropine. It is true that Drs. Abbott and Henry did say there was no cycloplegic effect with paredrine alone. He intends to study a series of cases using 5-percent homatropine alone. SULFANILAMIDE THERAPY IN OCULAR DIS EASES DR. J. M. KELLER read a paper on this subject. Discussion. Dr. Lawrence Post said he had recently returned from a conference
SOCIETY PROCEEDINGS
of the Indian Service. There were en thusiastic reports of the use of sulfanil amide among the Indians. One was a re port of 112 cases followed for six months in which all but eight were reported as cured or arrested. They were talking of the possibility of the elimination of the disease among the Indians in a few years' time. They use one-third grain per body weight, per day. It can be obtained in tablet form. The usual course used in Indian children originally ran for three w£eks. They decided to give it a little more intermittently after the first week and ran it to six weeks' time. Patients were cautioned to take things easy during the course of the treatment. The blood picture was carefully observed. Soda bi carbonate was given in equal amounts with the sulfanilamide. Dr. Max W. Jacobs stated that he re cently saw a patient who suffered severely
783
as a result of exposure to sunlight while taking sulfanilamide. This case showed how essential it is to know how the blood is behaving and that there are risks in giving the drug to ambulatory patients. Dr. Keller said that older patients were carefully examined before sulfanilamide was administered. In one trachoma case in which he used sulfanilamide the vision after two days had certainly improved. The case, however, is one complicated with keratitis. In the other case of tra choma there was a black conjunctiva from the use of so much silver. He be lieved it not necessary to use the high dosage of sulfanilamide. Such cases will respond to small doses as well. If the condition does not show any improve ment in a week, sulfanilamide will do no good. H. Rommel Hildreth, Editor.
SOCIETY PROCEEDINGS
the form of adjunct apparatus to the slitlamp. Louis A. Feldman, Transaction Editor.
SAINT LOUIS OPHTHALMIC SOCIETY October 14, 1938 DR. ROY E. MASON, president OCULAR FACTORS IN POOR READERS IN THE SAINT LOUIS PUBLIC SCHOOLS DR. F. O. SCHWARTZ read a paper on this subject which will be published in this Journal. PAREDRINE AS A CYCLOPLEGIC DR. ALAN D. CALHOUN read a paper on this subject. Discussion. Dr. John Green said that paredrine (B-4 hydroxylphenylsopropylamine) is not a new drug. It was orig inally entered in the German Patent Office in 1913, and belongs to the class of sympathomimetic drugs; its chemical structure is closely allied to that of epinephrine and ephedrine. A recent pharmacologic study by Abbot and Henry (Amer. Jour. Med. Sci., 1937, p. 661) disclosed the following: 1. It increases the blood pressure (10-20 mg. subcutaneously, 20-40 mg. by mouth) ; 2. The central nervous system is stimulated, probably due to increased flow of blood to the brain; 3. By topical application (3-percent solution) it is as effective in relieving congestion of the nasal mucosa as a 3-percent solution of ephed rine. It has, however, the disadvantage of not being soluble in oil. In percentages varying from 0.15 to 2, it acts as a mydriatic, but not as a cyclo plegic; that is, these authors found no loss of accommodation following the in stillation of the drug alone. There was no
conjunctival nor ciliary congestion and no increase in intraocular pressure. A recent study by Sudranski (Arch, of Ophth., 1938, v. 20, no. 4, p. 585) indi cates that benzedrine (a drug closely al lied to paredrine) is totally lacking in cycloplegic effect. He questions the synergistic effect of the two drugs in combina tion, believing that a 5-percent solution of homatropine alone uncovers 90 percent of the hyperopia and is efficient alone in the production of transitory, but clinically efficient, cycloplegia. Further studies are needed to get at the truth of the matter. Dr. Lawrence Post said that they had been using paredrine for a few months, but not in the critical manner of Dr. Cal houn. They did take the near point and found some residual accommodation, the near point being 29 cm. to 30 cm. instead of 33 cm., which was not very different from that in a group of patients in whom they used five instillations of 2-percent homatropine. Their method was to use a drop of 5-percent homatropine and three minutes later a drop of paredrine. The method has the advantage of quick recovery. It is simpler in children be cause of the fewer instillations and is of advantage to the group of patients who must use their eyes the following day. Dr. Calhoun said that he would like to test how much cycloplegic effect was ob tained with a drop of 5-percent homat ropine. It is true that Drs. Abbott and Henry did say there was no cycloplegic effect with paredrine alone. He intends to study a series of cases using 5-percent homatropine alone. SULFANILAMIDE THERAPY IN OCULAR DIS EASES DR. J. M. KELLER read a paper on this subject. Discussion. Dr. Lawrence Post said he had recently returned from a conference
SOCIETY PROCEEDINGS
of the Indian Service. There were en thusiastic reports of the use of sulfanil amide among the Indians. One was a re port of 112 cases followed for six months in which all but eight were reported as cured or arrested. They were talking of the possibility of the elimination of the disease among the Indians in a few years' time. They use one-third grain per body weight, per day. It can be obtained in tablet form. The usual course used in Indian children originally ran for three w£eks. They decided to give it a little more intermittently after the first week and ran it to six weeks' time. Patients were cautioned to take things easy during the course of the treatment. The blood picture was carefully observed. Soda bi carbonate was given in equal amounts with the sulfanilamide. Dr. Max W. Jacobs stated that he re cently saw a patient who suffered severely
783
as a result of exposure to sunlight while taking sulfanilamide. This case showed how essential it is to know how the blood is behaving and that there are risks in giving the drug to ambulatory patients. Dr. Keller said that older patients were carefully examined before sulfanilamide was administered. In one trachoma case in which he used sulfanilamide the vision after two days had certainly improved. The case, however, is one complicated with keratitis. In the other case of tra choma there was a black conjunctiva from the use of so much silver. He be lieved it not necessary to use the high dosage of sulfanilamide. Such cases will respond to small doses as well. If the condition does not show any improve ment in a week, sulfanilamide will do no good. H. Rommel Hildreth, Editor.