ATROPIA POISONING.

BY A. K. BELL, MADISON, GA.

I also have a case of accidental poisoning by atropia, which I would like to report:

Mrs. T., aged twenty-five, delicate constitution, highly educated. Drug clerk made mistake and filled prescription with 1-6 grain sulp. atropia; dose was taken at 7 p.m.; in fifteen minutes began feeling queer and dizzy; constriction in throat and fauces; she was conscious that the medicine was wrong and tried to vomit, but could not. Becoming alarmed, she sent at once for me; in the meantime, with wonderful fortitude, she kept moving about all the time, feeling that if she were to be still her senses would be overcome and she would become unconscious. At 8:30 I saw her, she was very much excited and feared that she would soon die. I found pulse about 180, thready and feeble, face pale, pupils dilated to their utmost, very excited and talkative; respiration hurried and shallow. tried to produce vomiting but could not; realizing I had only a short time to work in, I at once gave two ounces of cognac brandy, followed in five minutes by 1-4 grain of morphine hypodermically; in five minutes more she be came unconscious with low muttering delirium, sense of hearing paralyzed, could not swallow, eyes wide open and no response to strong light whatever; after remaining quiet for four hours, she became violent; morphine 1-4 grain was administered again, which had the desired effect of quieting her; surface was cold and moist; she was wrapped in blankets and hot bottles were used. The capillary vessels

I

filled again, warmth and color returned, pulse improved; she lay unconscious for twelve hours and then regained consciousness. The after-effects were prostration of respiratory muscle and heart; was confined to her bed for two months, but made recovery to normal condition.

KERATITIS PARENCHYMATOSA: A REVIEW

OF SEVEN CASES.

BY T. E MITCHELL, M.D., COLUMBUS, GA.

As an introductory to what we are about to say a brief reference to the anatomy of the cornea may not be out of place. The cornea, together with the sclera, forms the outer tunic or envelope of the eyeball. It is perfectly transparent, and is composed of a fibrous, tough, unyielding and inelastic substance identical in structure with that of the sclera with which it is continuous. The average thickness of both the cornea and the sclera is about one millimeter. The cornea forms the anterior segment of the globe and is equal to one-sixth of the whole. Its radius of curvature is eight millimeters while that of the sclera is twelve. The cornea and sclera being segments of different spheres the former fits into the latter not unlike a watch crystal fits in its case. From without inward the cornea may be studied as consisting of three layers: first, the conjunctival or epithelial; second, the scleral; and third, the uveal layer. The epithelial layer is a continuation of the conjunctival epithelium upon the cornea and is exceedingly thin and quite transparent. The scleral layer or substantia propria of the cornea includes the anterior basal (Bowman's) membrane. and the corneal tissue proper. Its thickness is equal to ninety-five per cent. of the entire cornea. The true corneal tissue is composed ultimately of delicate fibrillæ of connective tissue; these are united into bundles and these in turn are arranged into lamellæ fifty to sixty in number. The fibrillæ, bundles and lamellæ are joined together by a

cement-like substance in which are left numerous corneal spaces or lacunæ intercommunicating by narrow canals. These lacunæ, with their canals, form the lymph system of the cornea through which circulates its nutrient material. The lacunæ contain also the fixed corneal corpuscles. The uveal layer includes the posterior elastic (Descemet's) membrane together with its endothelium.

The cornea is abundantly supplied with the ciliary nerves through the nasal branch of the ophthalmic division of the fifth cranial nerve. In order to maintain the perfect transparency of the cornea its nerve supply is of the non-medullated variety.

The cornea is a non-vascular structure receiving its nutrient material in the form of blood-plasma from the anterior ciliary arteries where they form a network of marginal loops at the sclero-corneal junction. Inflammation of the cornea may be divided into-(A) keratitis suppurativa, and (B) keratitis non-suppurativa. Keratitis non-suppurativa may be further subdivided into (a) the superficial forms and (b) the deep forms. Among the deep forms of keratitis non-suppurativa belongs the subject of this paper, keratitis parenchymatosa.

Parenchymatous keratitis, as its name implies, is a diffuse inflammation of the corneal tissue proper, and usually progresses until the inflammatory deposit gives to the entire cornea a milky or hazy appearance.

All cases do not run a prescribed course, nor present a typical picture, and yet in the vast majority of cases the course is sufficiently characteristic to enable it easily to be recognized.

Preceded by a few days of pericorneal injection, lachrymation and photophobia variable in intensity, spots of haziness appear at some part of the cornea. By focal illumination these are found to be situated in the deep tissues. of the cornea rather than on either surface.

In a few weeks these points of inflammatory deposit have so far advanced and coalesced as that the entire cornea is uniformly cloudy, and its epithelial surface presents the so-called steamy or ground-glass appearance. When the inflammatory process has reached its acme a careful inspection by focal illumination will disclose blood-vessels extending from the sclera into the deep layers of the cornea, and because of their depth and the inflammatory deposit they present a dull salmon-colored red appearance. The opacity, which to the unaided eye appeared uniform, is found to have spots of different degrees of density.

Coincident with the conditions above described there is a variable amount of pain, quite a good deal of lachrymation and photophobia, and the iris is more or less involved; in some instances merely congested; in others positively inflamed with anterior synechia. More rarely the choroid, retina and ciliary body are involved.

Parenchymatous keratitis runs an eminently chronic

'course.

The inflammatory symptoms gradually increase to from four to six weeks when the disease has reached its height. At this state the iris is, in many instances, scarcely recognizable through the opacity, and vision is reduced to coarse objects or the recognition between light and dark

ness.

The process of absorption and recovery now begins slowly but surely at the margin of the cornea and continues steadily until the entire deposit is quite completely removed and the vision restored approximately to its former degree of acuteness, the only permanent remains of the opacity being a fine diffuse cloudiness and a few minute blood-vessels visible only with the magnifying glass and causing but little or no impairment of sight. It takes from six to eighteen months for a case of interstitial keratitis to run its course, and, since the center of the cornea is the last point to regain its transparency, the vision is not restored till very