294 research outputs found
Notes and observations on ophthalmic work
Get PDFMost of tine following ' 'Notes ana observations on ophthalmic
work'1 were taken by me ouriug the summer of 1894 whilst
i
acting as non-resiaent house surgeon to Br Argyll-Hubert son
at the bye War us of the Hoyal Infirmary, Eulnburgh. Dr
Robertson kindly granteu me permission to make use of the
large anu varied number of ophthalmic patients unuer his care
for this thesis. Some of the notes are taken from the ward
iournals where I recorueu reports of the cases; others are
extracts from my own note book.Before parsing' to consider in detail the number arid nature
of the various diseases of the eye which came unuer my observ¬
ation, it may be worth noting that the Census Returns for the
last thirty years shew a gradually diminishing number of cases
of blinoness in the population of Scotland. In the Census of
lb 71, the total number of inhabitants returned as blind was
3,019, or one in every 1,112, of the population. In 1881
the total blind was 3,158, or <rie in every 1,182, anu In the
last Census, viz, that of 1891, the total blind inhabitants
was only 2,797 or one in every 1,439 of the population.
This improvement is very gratifying, aim is no doubt largely
uue to the great progress that was aim is being muue in the
meaieal anu surgical treatment of the various eye' diseases
arm the successful carrying out of these measures "by our ophthalmic
s urgeons.The number of fresh cases which I noted specially at the eye wards was eleven hundred and twenty six, besides upwards
of a thousand old patients. Of these patients as a whole
I would wish to state two important facts which struck rue very
forcibly. First, out of the total number, not one single
case was positively diagnosecl as being directly due to the
action of the tubercle bacillus. There were two cases of a
douhtful tubercular nature. One of these occurred in a girl
affected with lupus vulgaris of the face. The centre of her
right cornea had a peculiar clear bleb like elevation, which
it was thought might possibly be a lupoid affection of that
tissue. The other case occurred in a girl also. Her
selerotic was much injected and swollen at parts, especially
underneath the upper eyelid. This condition had lasted for
over a year, and instead of improving under the ordinary
treatment for inflammation of the selerotic, was getting stead-
-ily worse. It was thought to be of a. tubercular nature.
Hut although I was constantly on the watch, no case of tuber¬
cular disease of the conjunctiva, or of the iris, or miliary
tubercles of the choroid, or optic neuritis sometimes seen in
tubercular meningitis was. met with. No doubt some of the
cases had the prefix " strumous11 applied to them, such as
strumous ulcers of the Cornea, and strumous blepharitis..This term, however, was applied in a general way as in other
affections, meaning rather an inflammatory condition occurring
in individuals of weakly looking appearance, and having an apparent predisposition to the development of the tubercle
bacillus, but the bacillus not causing' so far as is known,
the actual inflammation present.This fact shews the great immunity which the eye enjoys
from tubercular disease, and the strong natural resisting
power which the tissues of the eye present to the invasion
of the tubercle bacillus. This power of resisting the
attacks of the bacillus of tubercle must be much more highly
developed in the eye than in the majority of the other organs
and tissues of the body. In the other departments of surgery
tubercular diseases are met with very frequently, such as dis-
-eases of glands, bones and joints. Then tubercular ulcer-
-ation of the larynx is not so very uncommon . In fact,
diseases, tne result of tubercular infection fill a good half
of the beds on the surgical side, and not a few also on the
medical side of all general hospitals. Why then, one may
ask, is tubercular disease of the eye so rare? This is
not an easy question to solve. Tubercle bacilli along
with other micro-organisms are present in the air in many
places;- for example, the atmosphere of our hospital wards.
In alJ likelihood these bacilli frequently come in contact
with the external surface of the healthy eye, landing on its
conjunctival cul-de-sac. This immunity then probably does
not depend on the absence of the infecting agent. Even
although the cornea and conjunctiva have their vitality lowered by a trauma or an inflammatory pondition, the bacillus very
rarely effects a development. A probable important factor
in hindering the growth of micro-organisms, and especially
the tubercular organism, is that the eye is exposed to much
bright sunlight and abundance of fresn air, whion agents pre-
-vent to no small extent the development of micro-organisms
generally. These potent agents, will, no doubt, have the
same effect here
- …
