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On March 19, 1884, twenty-eight days from the last visit, I was again called to see her and found her suffering with the old trouble. Here was a case of gastric, intestinal, and nervous disturbance of great severity, without any known cause. A general examination was made of the premises, food, water, etc., and nothing was found that would account for the illness. A request was made that the precise date of her bad feelings be stated. She replied that "I was never well since the impression for my teeth was taken."
On further inquiry, I learned that a plate was worn in the mouth night and day, except when removed for cleaning. During the first illness, the plate was removed, but it was replaced and worn again when she recovered from this attack. This seemed to be the cause of the trouble, and my first impression, that there was arsenical or other metallic poisoning, was strengthened. There was the bloating, and the nervous, gastric, and intestinal disorders which characterize the physiological action of arsenic. These abated when the patient was in bed and not wearing the plate, but immediately returned when the plate was replaced. I ordered the plate to be removed, and the patient gradually improved and is now completely restored to health.
Her weight during her illness decreased from one hundred and thirty-six to one hundred and eighteen pounds. The circumference of the abdomen, since the cause of illness was removed, has decreased one third.
The plate was sent to Professor Lattimore, of the Rochester University, for analysis, and his report I append:
STATE BOARD OF HEALTH OF NEW YORK, BUREAU OF CHEMICAL ANALYSIS,
Dr. C. Buckley, 363 N. St. Paul Street, city:
DEAR SIR: I have carefully tested for arsenic the sample of urine and the hard-rubber plates of the two sets of teeth, which you submitted to me a few days ago. None of these contain arsenic. The rubber plates yield small quantities of mercury, as a matter of course, when treated with proper solvents.
Very truly yours,
S. A. LATTIMore.
I was surprised to find that my patient was suffering from
the poisonous effects of mercury, as the symptoms strongly indicated arsenical toxæmia.
It will be observed, from the history reported, that one of the first and most common of the effects of mercury was absent in this case; viz., salivation. Instead of attacking the gums, the metal concentrated its effects upon the nervous system, stomach, and bowels.
Since my experience with this case, I have seen a number of patients who were chronic office-cases-some for months, others for years-whom I looked upon as nervous or semi-hysterical, and whose symptoms were quite similar to those observed in Mrs. K.'s case, but not so severe. They all wore the hard redrubber plates. I ordered them removed, and in every instance there has been marked improvement in health. It is my opinion, derived from experience during the past year, that as a sanitary measure the wearing of red-rubber teeth-plates, those in which a preparation of mercury is used for the coloring, should be discontinued, and that patients wearing them should be requested to have the articles changed.
PYEMIA AND DEATH AFTER OPERATION FOR
By J. J. A. BURKE, M. D., of Monroe County.
THAT Pуæmia is not, strictly speaking, a disease of rare occur rence, every general practitioner will readily admit. But, so far as my personal knowledge and experience of the exciting causes of this disease are concerned, I have yet to hear of a case arising from so simple an operation as that required for the correction of squint. I therefore take the liberty of calling the attention of the profession to the following unfortunate case in my own experience:
The patient, a spinster, thirty years of age, cheerfully submitted to the operation, notwithstanding the strong opposition that came from two sisters. The degree of ametropia (O. D. 15 D. S. V; 0. S. amblyopic) having been ascertained, I first operated on the left, or amblyopic eye. Five days after, the tendon of the right eye was divided. Three or four days after the last operation, my patient was seized with well-pronounced symptoms of pyæmia, notwithstanding the strict antiseptic precautions taken at each operation.
The instruments used had been carefully cleansed and disinfected in alcohol.
The offending eye was apparently doing as well as its fellow, until after symptoms of pyæmia had become well developed. The contents of the orbit soon began to grow hard and became painful to the slightest touch, and there were then evidences of serious mischief. The eye-ball was rapidly pushed forward, as in an extreme case of exophthalmic goitre, and my patient succumbed before I could fully realize that she was dangerously ill.
ERRORS OF REFRACTION; THE IMPORTANCE OF THEIR RECOGNITION AND CORREC
TION IN EARLY LIFE.
By H. E. MITCHELL, M. D., of Rensselaer County.
By errors of refraction, are meant those anomalous conditions of the eye technically known as myopia, hypermetropia, and astigmatism. These, while forming a large percentage of the cases which the eye-specialist is called upon to treat, are but little known to the laity and but indifferently understood by the medical profession at large. Were the public better acquainted with these conditions, it is safe to say that we should see far less frequently than we do the rounded shoulders and contracted chests that are so common among the school-children of the present day and which owe their origin largely to the stooping posture rendered necessary by imperfect vision. That defective eyesight, due to refractive errors, is markedly on the increase, is a fact beyond question. I need not occupy your time in inquiring why this is true. The practical question of to-day is, What can we, as physicians, do to check this growing evil? In this brief paper, I desire to present certain points, bearing upon this subject, for your consideration.
In order that we may clearly comprehend what a refractive error really is, let us consider the anatomy of the eye sufficiently to enable us to understand and recognize any departure from its normal condition.
The perfect, or emmetropic eye is, as you know, nearly round, and, for five sixths of its extent, covered by three coats, or
tunics. The outermost, or sclerotic coat, is a dense, fibrous, opaque, unyielding membrane that serves to maintain the eyeball in its proper shape, and, at the same time, to afford protection to the more delicate structures within. Upon its integrity and unvarying shape, depends the nice relationship of the various parts which make up this most complicated organ. The middle tunic, the choroid, is vascular and pigmented and is connected with the inner surface of the sclerotic by a fine cellular tissue. From its rich blood-supply, is derived the nourishment necessary for the support of the transparent media within, while its dark pigment serves, not only to prevent the entrance of light except through the pupillary opening, but to absorb any excess that may have there entered. The innermost coat is the retina; and it is upon this delicate nervous membrane that all images of external objects are formed.
At the anterior portion of the eyeball, and continuous with the sclerotic, is the cornea, which, though fibrous, tough, unyielding, and of uniform thickness, is yet perfectly transparent. A short distance behind this, is suspended the iris, which acts as a curtain and is intended to permit only a proper amount of light to enter the eye through its central opening, or pupil. Immediately behind the pupil, is the crystalline lens. This is a double-convex body, measuring nearly a quarter of an inch in its antero-posterior diameter, and retained in position by its suspensory ligament. It is elastic and capable of having its focal power increased by the action of the ciliary muscle, producing what is known as accommodation. The ciliary muscle is firmly attached to the sclerotic at the junction of the iris and choroid and possesses contractile powers in a marked degree. The remainder of the globe is occupied by the vitreous body, a jelly-like, albuminous fluid, inclosed in a hyaloid membrane. Between the cornea and lens, is a space containing the aqueous humor, divided by the iris into an anterior and a posterior chamber which communicate with each other through the pupil. The optic nerve, the special nerve of the sense of sight, together with the retinal vessels, enters the orbit from behind. The opening thus formed in the sclerotic is funnel-shaped, and,