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Traumatic Cataract. Lens Absorbed without Operation
682
SMALL-HEREDITARY CATARACT IN CALVES
mental department of the College of Agriculture, University of Illinois. The youngest animal examined was a heifer, four months old; the oldest a heifer, one year and eleven months old. Two bulls, about six months old, and a heifer, seven months old, completed the number. With the exception of the youngest animal, both eyes of all the others presented mature cataracts. Small chalky dots of further degeneration in the lens substance were seen in most of the cases. Because of the oval shape of the pupil, it was possible to view the fundus thru the clear opening between the edge of the opaque lens and the nasal border of the iris. I n several of the eyes the lenses, apparently undeveloped in size, were seen thruout their entire circumferances, giving the appearance of a glass marble suspended in the clear vitreous. The other ocular conditions were practically identical in all the animals. Intraocular tension, so far as could be judged, was normal. There was no ciliary nor conjunctival congestion. Light perception and a good degree of light projection was found in all cases. The pupils responded readily to light. Both atropin and homatropin were employed, similarly to its use in the human eye, to observe the mydriatic effect. Full mydriasis was obtained in about one hour. In most of the eyes, dilatation of the pupil was uniform; in a few eyes there were slight points of posterior synechiae. The fundi were examined by an electric ophthalmoscope. The normal tapetum was seen, but very faintly or not at all. In other respects they appeared normal. In the case of the four months old animal, the cataract was apparently soft; there was a loss of transparency, and the opaque radiating striae were faintly in evidence. Thru the courtesy of Professor J. A. Detlefsen, of the Laboratory of Genetics, and his associate Mr. W . W . Yapp, who have in preparation a paper on the genetic aspects of this condition. It may be stated that their observations thus far carried out, correspond very closely to the Mendelian theory. Eleven blind
calves have been observed, where they might have expected to find 9.375. Of the five animals reported here, four came from a mating of the son of "Old Homestead" to his own half sisters, which were daughters of "Old Homestead." That is "Old Homestead" was mated to a number of unrelated females. The daughters from this mating were mated to a son from this mating. The youngest animal was derived from a "daughter of "Old Homestead," mated back to "Old Homestead," her sire.
TRAUMATIC CATARACT. LENS ABSORBED WITHOUT OPERATION. JAMES H .
MCKELLAR, M.
D.
LOS ANGELES, CALIFORNIA.
Believing that in some cases of traumatic cataract, operation is advised too readily, I present the following three cases, showing what nature will at times do, unassisted by operative interference. This is in no way a criticism of operation when absorbtion does not take place otherwise within a reasonable time; or when complications clearly indicate it. In such a case as I I , I believe operation should always be advised. These cases are of interest also, in that they differ essentially in character from one another. The first case is one of subconjunctival dislocation of the lens. The second of traumatic cataract, due to contusion; the third of traumatic cataract, due to punctured wound. In each of these cases, practically the only treatment used was rest and instillation of atropin solution, with iced compresses at intervals at first, (if we except Christian Science treatment in 'the second case) ; yet in each case the ultimate result was as good as it could possibly have been, had the operation been resorted to. CASE I. Negro bootblack, age 45, came to my office in April, 1909. History—The night before he had engaged in a fist fight, and was struck on the right eye. Had not been able to see plainly with that eye since.
683
NOTES, CASES AND INSTRUMENTS
Examination — Lids swollen. Globe rather soft. Mass under conjunctiva temporal to limbus, which apparently consists of iris and cataractous lens. Conjunctiva unbroken. Break in the continuity of iris, corresponding to the portion seen under the conjunctiva. Eye aphakic, media fairly clear, fundus normal. Diagnosis—Traumatic dislocation of lens and iris subconjunctivally. Iridodialysis. Rupture of globe. Treatment—Rest and atropin. Result—Eye was soon quiet, and tension normal. Dislocated lens became entirely absorbed. Dislocated iris shrunk. I was able to follow this case for a number of years. He had no complications of any kind during that time, and vision was good with correcting lens. CASE II. Sept., 1913. Boy aged 10. History—Stated that he had been struck on the left eye, the day before, by a schoolmate. Had not been able to see with that eye since. Examination — Conjunctiva injected. No wound of cornea or conjunctiva. Lens cataractous and swollen. Tension normal. Diagnosis—Traumatic cataract. Treatment—Rest and atropin. Iced compresses at intervals. This case progressed favorably for several days, then I saw him one day,
with marked pericorneal injection, and exceedingly high tension. I advised operation, which advice was refused. The case passed from my observation for several months, then one day the mother brought the boy to see me (partly, no doubt, that I might be enlightened as to the beneficent effects of Christian Science treatment, which she stated the boy had been receiving). The eye was entirely free from irritation. The pupil was clear, the tension normal, and the vision was approximately normal with correcting lens. *CASE III.
Jan.,
1918.
Boy, age
6.
History—Mother stated that several days before he had been playing with a hat pin, which had struck him in the right eye, since which time he had not been able to see with that eye. Examination — Pericorneal injection. Punctured wound of cornea. Lens swollen and cataractous; tension normal. Iris uninjured. Treatment—Rest and atropin. Iced compresses at intervals for first few days. Result—Lens became absorbed uneventfully, and by October, 1918, pupil had entirely cleared. The eye was quiet, and with correcting lens vision was approximately normal. ♦This case has been reported in the California State Journal of Medicine.
SMALL-HEREDITARY CATARACT IN CALVES
mental department of the College of Agriculture, University of Illinois. The youngest animal examined was a heifer, four months old; the oldest a heifer, one year and eleven months old. Two bulls, about six months old, and a heifer, seven months old, completed the number. With the exception of the youngest animal, both eyes of all the others presented mature cataracts. Small chalky dots of further degeneration in the lens substance were seen in most of the cases. Because of the oval shape of the pupil, it was possible to view the fundus thru the clear opening between the edge of the opaque lens and the nasal border of the iris. I n several of the eyes the lenses, apparently undeveloped in size, were seen thruout their entire circumferances, giving the appearance of a glass marble suspended in the clear vitreous. The other ocular conditions were practically identical in all the animals. Intraocular tension, so far as could be judged, was normal. There was no ciliary nor conjunctival congestion. Light perception and a good degree of light projection was found in all cases. The pupils responded readily to light. Both atropin and homatropin were employed, similarly to its use in the human eye, to observe the mydriatic effect. Full mydriasis was obtained in about one hour. In most of the eyes, dilatation of the pupil was uniform; in a few eyes there were slight points of posterior synechiae. The fundi were examined by an electric ophthalmoscope. The normal tapetum was seen, but very faintly or not at all. In other respects they appeared normal. In the case of the four months old animal, the cataract was apparently soft; there was a loss of transparency, and the opaque radiating striae were faintly in evidence. Thru the courtesy of Professor J. A. Detlefsen, of the Laboratory of Genetics, and his associate Mr. W . W . Yapp, who have in preparation a paper on the genetic aspects of this condition. It may be stated that their observations thus far carried out, correspond very closely to the Mendelian theory. Eleven blind
calves have been observed, where they might have expected to find 9.375. Of the five animals reported here, four came from a mating of the son of "Old Homestead" to his own half sisters, which were daughters of "Old Homestead." That is "Old Homestead" was mated to a number of unrelated females. The daughters from this mating were mated to a son from this mating. The youngest animal was derived from a "daughter of "Old Homestead," mated back to "Old Homestead," her sire.
TRAUMATIC CATARACT. LENS ABSORBED WITHOUT OPERATION. JAMES H .
MCKELLAR, M.
D.
LOS ANGELES, CALIFORNIA.
Believing that in some cases of traumatic cataract, operation is advised too readily, I present the following three cases, showing what nature will at times do, unassisted by operative interference. This is in no way a criticism of operation when absorbtion does not take place otherwise within a reasonable time; or when complications clearly indicate it. In such a case as I I , I believe operation should always be advised. These cases are of interest also, in that they differ essentially in character from one another. The first case is one of subconjunctival dislocation of the lens. The second of traumatic cataract, due to contusion; the third of traumatic cataract, due to punctured wound. In each of these cases, practically the only treatment used was rest and instillation of atropin solution, with iced compresses at intervals at first, (if we except Christian Science treatment in 'the second case) ; yet in each case the ultimate result was as good as it could possibly have been, had the operation been resorted to. CASE I. Negro bootblack, age 45, came to my office in April, 1909. History—The night before he had engaged in a fist fight, and was struck on the right eye. Had not been able to see plainly with that eye since.
683
NOTES, CASES AND INSTRUMENTS
Examination — Lids swollen. Globe rather soft. Mass under conjunctiva temporal to limbus, which apparently consists of iris and cataractous lens. Conjunctiva unbroken. Break in the continuity of iris, corresponding to the portion seen under the conjunctiva. Eye aphakic, media fairly clear, fundus normal. Diagnosis—Traumatic dislocation of lens and iris subconjunctivally. Iridodialysis. Rupture of globe. Treatment—Rest and atropin. Result—Eye was soon quiet, and tension normal. Dislocated lens became entirely absorbed. Dislocated iris shrunk. I was able to follow this case for a number of years. He had no complications of any kind during that time, and vision was good with correcting lens. CASE II. Sept., 1913. Boy aged 10. History—Stated that he had been struck on the left eye, the day before, by a schoolmate. Had not been able to see with that eye since. Examination — Conjunctiva injected. No wound of cornea or conjunctiva. Lens cataractous and swollen. Tension normal. Diagnosis—Traumatic cataract. Treatment—Rest and atropin. Iced compresses at intervals. This case progressed favorably for several days, then I saw him one day,
with marked pericorneal injection, and exceedingly high tension. I advised operation, which advice was refused. The case passed from my observation for several months, then one day the mother brought the boy to see me (partly, no doubt, that I might be enlightened as to the beneficent effects of Christian Science treatment, which she stated the boy had been receiving). The eye was entirely free from irritation. The pupil was clear, the tension normal, and the vision was approximately normal with correcting lens. *CASE III.
Jan.,
1918.
Boy, age
6.
History—Mother stated that several days before he had been playing with a hat pin, which had struck him in the right eye, since which time he had not been able to see with that eye. Examination — Pericorneal injection. Punctured wound of cornea. Lens swollen and cataractous; tension normal. Iris uninjured. Treatment—Rest and atropin. Iced compresses at intervals for first few days. Result—Lens became absorbed uneventfully, and by October, 1918, pupil had entirely cleared. The eye was quiet, and with correcting lens vision was approximately normal. ♦This case has been reported in the California State Journal of Medicine.