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The American Journal of Ophthalmology
EDITORIALS portunities, well arranged and utilized. It is time for Americans and Englishspeaking medical men throughout the world to recognize the enormous op portunities for ophthalmic education that are offered in Great Britain. E. J. PHLYCTENULAR OPHTHALMIA Before the discovery of the tubercle bacillus, phlyctenular disease was known as a form of scrofulous ophthal mia, and occupied an important place in the statistics of conjunctival and corneal diseases. The leading mani festations of "scrofula", tuberculosis of the bones and of the lymph glands, have been accorded their place in the bacterial classification of diseases; but uncertainty and confusion still prevail as to the etiology and essential charac ter of phlyctenular ophthalmia. Long search by skilled bacteriolo gists shows that the tubercle bacillus is only rarely, and by accident, present in the characteristic lesions. The histopathology of the phlyctenule is not that of a tubercle. The occurrence of a tuberculin reaction is not constant in children who suffer from phlycten ular conjunctivitis or keratitis; perhaps not more general among them than among children of similar circumstan ces who do not have phlyctenules. The phlyctenule frequently contains staphylococci, is very often associated with eczema of skin surfaces, and re sembles some eczematous lesions. A form of rhinitis is very generally asso ciated with phlyctenular ophthalmia, and treatment of the rhinitis often cures the eyes. Errors of diet figure very largely in the etiology of this dis ease, and a correct diet and general hy giene commonly cure it. Even relief from eyestrain has done little to cure or throw light on this obscure disease. Here is a problem in pathology and treatment that has not been solved by investigation along the usual scientific lines. Yet the condition is common and important enough to challenge re peated clinical and statistical research by a large number of practising oph thalmologists. Such a research has
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been undertaken in the clinic of Profes sor Gronholm in Helsingfors, Finland, by Werner, who publishes his results in the Acta Ophthalmologica, volume 6, page 132. Parallel studies were made of phlyctenular eye diseases and of tra choma, both as to seasonal frequency and as to the number of cases which presented themselves in the course of twenty-five years. The material in cludes 3405 cases, or 5.7 per cent of those seen at the clinic referred to. Werner concludes that the frequency of the phlyctenular eye diseases in Fin land increases toward spring, after the long winter, and decreases during the summer and autumn. The favorable effects of the summer make themselves felt even as late as February of the following year. This corresponds to the seasonal variations of tuberculosis. The frequency of trachoma is not sub ject to seasonal variations. During the last twenty-five years, phlyctenular eye diseases seem to be diminishing in Finland. Both the ab solute number of cases and the rela tive frequency show an important de cline, and this decline corresponds fairly accurately to the decline in tra choma cases. But while the trachoma percentage has fallen continuously, the falling off in the number of phlyc tenular cases has been interrupted by a moderate increase, partly due to a severe influenza epidemic. As a cause of amblyopia the phlyctenular eye dis eases are probably at least as impor tant as trachoma, but as a cause of blindness they are much less important. Similar studies made in other places and with regard to other aspects of such diseases would probably improve our understanding of them. Studies of this kind are not spectacular, but they may be permanently helpful and very creditable. E. J. T H E AMERICAN JOURNAL OF OPHTHALMOLOGY At Saint Louis, just before the re cent annual meeting of the American Academy of Ophthalmology and Oto-
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BOOK NOTICES
laryngology, the directors of the Oph in 10 (91 per cent) good, in 1 (9 per thalmic Publishing Company met to cent) bad; of seven cases of secondary consider, among other matters, whether glaucoma, in 57 per cent good, in 43 any change of policy on their part was per cent bad. Four globes enucleated called for by the decision of the Ameri on account of expulsive hemorrhage, can Medical Association to assume sympathetic ophthalmia, lens subluxapublication of the Archives of Ophthal tion, incarceration of ciliary processes, mology founded by Dr. Herman Knapp and painful iridocyclitis are described and hitherto continued by his son Dr. anatomically. Arnold Knapp. The directors decided Iridencleisis is indicated in all forms that no change in the policy of the of chronic primary, but especially in American Journal of Ophthalmology inflammatory, glaucoma; while it is was necessary or advisable, and that contraindicated in glaucoma with iri the various departments of the Jour docyclitis, extensive posterior synechiae, nal should be continued on their pres ent basis. Later in the same day a or narrow iris, and in all secondary well attended meeting of the stock glaucoma. It is superior to Elliot's holders of the Ophthalmic Publishing trephining and Lagrange's sclerectomy Company was held, and at this meet by giving less freely fistulizing scars ing the decision of the directors was and thus essentially diminishing the danger of late infection. Its action con approved by unanimous resolution. sists in creating a new outlet for the (See also statement on the last page aqueous along the incarcerated iris, and of the present issue.) perhaps freeing the lower sinus by drawing the iris upward. C. Zimmermann. BOOK NOTICES Studien zur Wirkungsweise der Filtrationsnarben bildenden Glaukom- Die Lichtbehandlung in der Augenheil operationen, mit besonderer Bekunde (Light treatment in oph riicksichtigung der Iridenkleisis thalmology). A. Birch-Hirschfeld, antiglaukomatosa Holth. (Studies director university eye clinic, as to the mode of action of glau Konigsberg, and W. Hoffmann, coma operations which develop chief of clinic. 112 pages, thirtyfiltration scars, with special refer four illustrations, partly multience to Holth's antiglaucomatous chrome. Berlin, Urban and irididencleisis). By Arnold Pillat. Schwarzenberg, 1928. Price 12 Sixty-five pages, four illustrations. marks. 1928, S. Karger, Berlin. Paper This book will be heartily welcomed. cover, price 3.80 marks. as it embodies the experience of the This reprint of part nine of the Ab- authors, gained within the last ten handlungen aus der Augenheilkunde years, on a very large clinical material und ihren Grenzgebieten gives a very after careful preliminary experimental careful analysis of 170 cases of glau and pathological studies. It is mainly coma, operated upon by iridencleisis intended as a guide and adviser to with meridional iridotomy, observed the ophthalmologist in the therapeutic during a period of from at least one field. Hence the points of more theore to seven years, with description of tical and scientific interest are briefly technique, accidents, and late sequels, discussed in an introduction on physical in which there was not one case of late processes as basis for the investiga infection. Out of 72 eyes with chronic tions of light therapy, and on the bio glaucoma, in 64 (87 per cent) the re logical, physiological, and pathological sults were good, in 8 (13 per cent) effects of light, while everything im poor; of 9 cases of absolute glaucoma, portant for practical application of the in 6 (66 per cent) good, in 3 (33 per method is very elaborately treated, cent) bad; 11 cases of acute glaucoma e.g. technique, chiefly as developed by
913
been undertaken in the clinic of Profes sor Gronholm in Helsingfors, Finland, by Werner, who publishes his results in the Acta Ophthalmologica, volume 6, page 132. Parallel studies were made of phlyctenular eye diseases and of tra choma, both as to seasonal frequency and as to the number of cases which presented themselves in the course of twenty-five years. The material in cludes 3405 cases, or 5.7 per cent of those seen at the clinic referred to. Werner concludes that the frequency of the phlyctenular eye diseases in Fin land increases toward spring, after the long winter, and decreases during the summer and autumn. The favorable effects of the summer make themselves felt even as late as February of the following year. This corresponds to the seasonal variations of tuberculosis. The frequency of trachoma is not sub ject to seasonal variations. During the last twenty-five years, phlyctenular eye diseases seem to be diminishing in Finland. Both the ab solute number of cases and the rela tive frequency show an important de cline, and this decline corresponds fairly accurately to the decline in tra choma cases. But while the trachoma percentage has fallen continuously, the falling off in the number of phlyc tenular cases has been interrupted by a moderate increase, partly due to a severe influenza epidemic. As a cause of amblyopia the phlyctenular eye dis eases are probably at least as impor tant as trachoma, but as a cause of blindness they are much less important. Similar studies made in other places and with regard to other aspects of such diseases would probably improve our understanding of them. Studies of this kind are not spectacular, but they may be permanently helpful and very creditable. E. J. T H E AMERICAN JOURNAL OF OPHTHALMOLOGY At Saint Louis, just before the re cent annual meeting of the American Academy of Ophthalmology and Oto-
914
BOOK NOTICES
laryngology, the directors of the Oph in 10 (91 per cent) good, in 1 (9 per thalmic Publishing Company met to cent) bad; of seven cases of secondary consider, among other matters, whether glaucoma, in 57 per cent good, in 43 any change of policy on their part was per cent bad. Four globes enucleated called for by the decision of the Ameri on account of expulsive hemorrhage, can Medical Association to assume sympathetic ophthalmia, lens subluxapublication of the Archives of Ophthal tion, incarceration of ciliary processes, mology founded by Dr. Herman Knapp and painful iridocyclitis are described and hitherto continued by his son Dr. anatomically. Arnold Knapp. The directors decided Iridencleisis is indicated in all forms that no change in the policy of the of chronic primary, but especially in American Journal of Ophthalmology inflammatory, glaucoma; while it is was necessary or advisable, and that contraindicated in glaucoma with iri the various departments of the Jour docyclitis, extensive posterior synechiae, nal should be continued on their pres ent basis. Later in the same day a or narrow iris, and in all secondary well attended meeting of the stock glaucoma. It is superior to Elliot's holders of the Ophthalmic Publishing trephining and Lagrange's sclerectomy Company was held, and at this meet by giving less freely fistulizing scars ing the decision of the directors was and thus essentially diminishing the danger of late infection. Its action con approved by unanimous resolution. sists in creating a new outlet for the (See also statement on the last page aqueous along the incarcerated iris, and of the present issue.) perhaps freeing the lower sinus by drawing the iris upward. C. Zimmermann. BOOK NOTICES Studien zur Wirkungsweise der Filtrationsnarben bildenden Glaukom- Die Lichtbehandlung in der Augenheil operationen, mit besonderer Bekunde (Light treatment in oph riicksichtigung der Iridenkleisis thalmology). A. Birch-Hirschfeld, antiglaukomatosa Holth. (Studies director university eye clinic, as to the mode of action of glau Konigsberg, and W. Hoffmann, coma operations which develop chief of clinic. 112 pages, thirtyfiltration scars, with special refer four illustrations, partly multience to Holth's antiglaucomatous chrome. Berlin, Urban and irididencleisis). By Arnold Pillat. Schwarzenberg, 1928. Price 12 Sixty-five pages, four illustrations. marks. 1928, S. Karger, Berlin. Paper This book will be heartily welcomed. cover, price 3.80 marks. as it embodies the experience of the This reprint of part nine of the Ab- authors, gained within the last ten handlungen aus der Augenheilkunde years, on a very large clinical material und ihren Grenzgebieten gives a very after careful preliminary experimental careful analysis of 170 cases of glau and pathological studies. It is mainly coma, operated upon by iridencleisis intended as a guide and adviser to with meridional iridotomy, observed the ophthalmologist in the therapeutic during a period of from at least one field. Hence the points of more theore to seven years, with description of tical and scientific interest are briefly technique, accidents, and late sequels, discussed in an introduction on physical in which there was not one case of late processes as basis for the investiga infection. Out of 72 eyes with chronic tions of light therapy, and on the bio glaucoma, in 64 (87 per cent) the re logical, physiological, and pathological sults were good, in 8 (13 per cent) effects of light, while everything im poor; of 9 cases of absolute glaucoma, portant for practical application of the in 6 (66 per cent) good, in 3 (33 per method is very elaborately treated, cent) bad; 11 cases of acute glaucoma e.g. technique, chiefly as developed by