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THE KING.
832 GLAUCOMA SECONDARY TO IRITIS.
Annotations.
CASES of iritis or irido-cyclitis which develop high tension are among the most difficult that the prac"Ne quid nimis." titioner has to encounter. On the one hand, an eye with raised tension is glaucomatous, and the first bhing to be done in cases of glaucoma is to instil THE KING. eserine. On the other hand, the remedy for iritis is WE published in THE LANCET of April 6th the atropine, and eserine is distinctly harmful. What, official bulletin issued from Craigweil House on then, should be done ? At a discussion on the causes March 29th. Another bulletin was issued from the and treatment of irido-cyclitis with raised tension at the 1928 Congress of the Ophthalmological Society (the same residence on Sunday, April 14th, as follows : " His Majesty the King continues to make satisfactory report1 of which appears in advance of the present three types of cases were distinguished by progress, and the rheumatism of the right shoulder Congress) is yielding to treatment." The bulletin was signed by Mr. W. H. McMullen. In the first type increase of tension occurs soon after the onset of acute inflammaSir Stanley Hewett and Lord Dawson of Penn. In these cases there are usually abundant tion. keratic precipitates and the anterior chamber is usually deep, or at any rate not shallow as in primary acute THE LOCAL GOVERNMENT ACT. glaucoma. Some authorities have advocated the use of miotics in these cases, but the weight of As a forerunner of the detailed memoranda to be is decidedly against them and in favour of issued to local authorities on the different parts of the opinion atropine as in ordinary cases of acute iritis. pushing new Local Government Act, the Minister of Health Atropine keeps both iris and ciliary muscle at rest has promulgated a general introductory circular, and it prevents the formation of synechiae. To combat from which extracts are printed on p. 841 of this the inflammation is the best means of preventing the The circular summarises with remarkable increase of tension due to it. If, however, the tension issue. lucidity the principles of the new law ; it sets out the does not come down, and especially in cases where defects of our present system, and it names the the anterior chamber is shallow, the difficulties of remedies which the Act provides. It explains the deciding on the line of treatment are great. In transfer of the functions of poor-law authorities proportion as the case approaches in character to to the councils of counties and county boroughs, one of primary glaucoma the temptation to use the readjustment of the cost of roads, the proposed eserine becomes strong. Mr. Harrison Butler, while - survey of the areas of county districts, the derating advocating the pushing of atropine in these casesarrangements, and the distribution of consolidated the higher the tension the more he would push itgrants according to the needs of the areas concerned. admitted that in some cases this would not do. In While drawing attention to the actual administrative some doubtful cases he used homatropin alternating and financial changes in prospect, the Minister takes with pilocarpine, by which method he avoided this early opportunity of emphasising the importance adhesions and yet prevented the iris from bunching of the spirit in which the Act is operated ; he asks up in the angle of the anterior chamber, mechanically for the fullest collaboration from local authorities, raising the tension. The question of operation was their officers, and the general public in the task of discussed but it was generally agreed that with acute developing a scheme of sound local government, and irido-cyclitis it should, if possible, be avoided. Iridecparticularly the protection and improvement of the tomy, involving trauma of a structure in a state of health of the people. The Local Government Bill, acute inflammation, is obviously contraindicated. which received the Royal Assent before the Easter Trephining is liable to be followed by blocking of .adjournment, had a fairly smooth passage through the trephine hole by exudation. The simplest Parliament. Based on past recommendations to procedure is the best, but tapping the anterior chamber which members of all parties had committed them- by paracentesis has only a very temporary effect and selves, advocated in the House of Commons with it may not be feasible to repeat it many times. Some masterly skill and team-work, its principles were but form of sclerotomy is probably the safest procedure little shaken by political opponents. But there are in case of necessity, and some surgeons speak well of -still difficult days ahead. Duties cannot be taken Herbert’s " small flap sclerotomy." It is impossible from hands which have discharged them with pride to lay down any general rule for these cases, each of -and fidelity, nor can the traditional boundaries of which must be judged on its own merits. For the the English countryside be altered, without umbrage general practitioner the chief moral is the necessity and irritation. There is no need to take notice of of being able to distinguish between primary and the facile and unworthy criticism of those who, secondary glaucoma, so as to make no mistake in themselves shirking the necessary study, protested taking the emergency measures called for when a that the proposals were too complicated to be com- specialist cannot at once be consulted. mended to modern democracy. The Act is now Mr. McMullen’s second type of cases comprises upon the statute book, and the citizens to whom its those resembling acute or subacute glaucoma in administration will be confided can examine it before which careful examination reveals signs of uveal its main provisions take effect in April next year. inflammation. These differ from the first type in Evidently the Ministry will give all possible assistance, that the signs of iritis or cyclitis are not nearly so though at this point two observations may perhaps be obvious or so severe. The keratic precipitates may permitted. The first is that departmental memoranda be so slight that they can only be detected by the are not a complete substitute for the actual text of slit-lamp. In these cases, to quote Mr. McMullen, the statute ; even if the week-end of Easter inter- " it is probable that the irido-cyclitis is not the vened, it is disappointing that an important Act of essential factor but that we have to deal with eyes Parliament passed on March 27th should be still that were predisposed to glaucoma by anatomical or unpublished more than a fortnight later. The second other changes, eyes in which the mechanism for reguis that the Minister can earn the gratitude of all lation of pressure allowed a very small margin of medical officers of health and members of local safety, and that the occurrence of a slight iridoauthorities if he will set the official draftsmen (who’ cyclitis upset the delicate balance and determined will have unusual leisure in the next few months) the onset of glaucoma." Indeed, these cases approxito work on the re-statement of our local government’ mate to true glaucoma, and before the general use of enactments in an orderly code. The consolidationthe slit-lamp and corneal microscope passed as such. - of those enactments involves neither political con- It has even been asserted that most cases of so-called troversy nor a charge on the public purse. They’ primary glaucoma are really of this type, but here were notoriously in a tangle before ; their state is fai ’
worse now.
1
Transactions, vol. xlviii., pp. 45-82.
Annotations.
CASES of iritis or irido-cyclitis which develop high tension are among the most difficult that the prac"Ne quid nimis." titioner has to encounter. On the one hand, an eye with raised tension is glaucomatous, and the first bhing to be done in cases of glaucoma is to instil THE KING. eserine. On the other hand, the remedy for iritis is WE published in THE LANCET of April 6th the atropine, and eserine is distinctly harmful. What, official bulletin issued from Craigweil House on then, should be done ? At a discussion on the causes March 29th. Another bulletin was issued from the and treatment of irido-cyclitis with raised tension at the 1928 Congress of the Ophthalmological Society (the same residence on Sunday, April 14th, as follows : " His Majesty the King continues to make satisfactory report1 of which appears in advance of the present three types of cases were distinguished by progress, and the rheumatism of the right shoulder Congress) is yielding to treatment." The bulletin was signed by Mr. W. H. McMullen. In the first type increase of tension occurs soon after the onset of acute inflammaSir Stanley Hewett and Lord Dawson of Penn. In these cases there are usually abundant tion. keratic precipitates and the anterior chamber is usually deep, or at any rate not shallow as in primary acute THE LOCAL GOVERNMENT ACT. glaucoma. Some authorities have advocated the use of miotics in these cases, but the weight of As a forerunner of the detailed memoranda to be is decidedly against them and in favour of issued to local authorities on the different parts of the opinion atropine as in ordinary cases of acute iritis. pushing new Local Government Act, the Minister of Health Atropine keeps both iris and ciliary muscle at rest has promulgated a general introductory circular, and it prevents the formation of synechiae. To combat from which extracts are printed on p. 841 of this the inflammation is the best means of preventing the The circular summarises with remarkable increase of tension due to it. If, however, the tension issue. lucidity the principles of the new law ; it sets out the does not come down, and especially in cases where defects of our present system, and it names the the anterior chamber is shallow, the difficulties of remedies which the Act provides. It explains the deciding on the line of treatment are great. In transfer of the functions of poor-law authorities proportion as the case approaches in character to to the councils of counties and county boroughs, one of primary glaucoma the temptation to use the readjustment of the cost of roads, the proposed eserine becomes strong. Mr. Harrison Butler, while - survey of the areas of county districts, the derating advocating the pushing of atropine in these casesarrangements, and the distribution of consolidated the higher the tension the more he would push itgrants according to the needs of the areas concerned. admitted that in some cases this would not do. In While drawing attention to the actual administrative some doubtful cases he used homatropin alternating and financial changes in prospect, the Minister takes with pilocarpine, by which method he avoided this early opportunity of emphasising the importance adhesions and yet prevented the iris from bunching of the spirit in which the Act is operated ; he asks up in the angle of the anterior chamber, mechanically for the fullest collaboration from local authorities, raising the tension. The question of operation was their officers, and the general public in the task of discussed but it was generally agreed that with acute developing a scheme of sound local government, and irido-cyclitis it should, if possible, be avoided. Iridecparticularly the protection and improvement of the tomy, involving trauma of a structure in a state of health of the people. The Local Government Bill, acute inflammation, is obviously contraindicated. which received the Royal Assent before the Easter Trephining is liable to be followed by blocking of .adjournment, had a fairly smooth passage through the trephine hole by exudation. The simplest Parliament. Based on past recommendations to procedure is the best, but tapping the anterior chamber which members of all parties had committed them- by paracentesis has only a very temporary effect and selves, advocated in the House of Commons with it may not be feasible to repeat it many times. Some masterly skill and team-work, its principles were but form of sclerotomy is probably the safest procedure little shaken by political opponents. But there are in case of necessity, and some surgeons speak well of -still difficult days ahead. Duties cannot be taken Herbert’s " small flap sclerotomy." It is impossible from hands which have discharged them with pride to lay down any general rule for these cases, each of -and fidelity, nor can the traditional boundaries of which must be judged on its own merits. For the the English countryside be altered, without umbrage general practitioner the chief moral is the necessity and irritation. There is no need to take notice of of being able to distinguish between primary and the facile and unworthy criticism of those who, secondary glaucoma, so as to make no mistake in themselves shirking the necessary study, protested taking the emergency measures called for when a that the proposals were too complicated to be com- specialist cannot at once be consulted. mended to modern democracy. The Act is now Mr. McMullen’s second type of cases comprises upon the statute book, and the citizens to whom its those resembling acute or subacute glaucoma in administration will be confided can examine it before which careful examination reveals signs of uveal its main provisions take effect in April next year. inflammation. These differ from the first type in Evidently the Ministry will give all possible assistance, that the signs of iritis or cyclitis are not nearly so though at this point two observations may perhaps be obvious or so severe. The keratic precipitates may permitted. The first is that departmental memoranda be so slight that they can only be detected by the are not a complete substitute for the actual text of slit-lamp. In these cases, to quote Mr. McMullen, the statute ; even if the week-end of Easter inter- " it is probable that the irido-cyclitis is not the vened, it is disappointing that an important Act of essential factor but that we have to deal with eyes Parliament passed on March 27th should be still that were predisposed to glaucoma by anatomical or unpublished more than a fortnight later. The second other changes, eyes in which the mechanism for reguis that the Minister can earn the gratitude of all lation of pressure allowed a very small margin of medical officers of health and members of local safety, and that the occurrence of a slight iridoauthorities if he will set the official draftsmen (who’ cyclitis upset the delicate balance and determined will have unusual leisure in the next few months) the onset of glaucoma." Indeed, these cases approxito work on the re-statement of our local government’ mate to true glaucoma, and before the general use of enactments in an orderly code. The consolidationthe slit-lamp and corneal microscope passed as such. - of those enactments involves neither political con- It has even been asserted that most cases of so-called troversy nor a charge on the public purse. They’ primary glaucoma are really of this type, but here were notoriously in a tangle before ; their state is fai ’
worse now.
1
Transactions, vol. xlviii., pp. 45-82.