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The turbid aqueous It is applicable also in those ulcers due to becomes clearer. The trifling pain following the entrance of foreign bodies.
When we the operation soon ceases. If there is hypo-adopt the expectant plan of treatment in order pyon it is speedily absorbed. The zone of to test the efficiency of the ordinary therapeuinfiltration rapidly recedes and fades. And in tic means, the hypopyon being insignificant, many cases within the next twenty-four hours yet the ulcer is extending slowly, and delay such an improvement will be manifested as to often leads to considerable destruction of corshow the destructive process to be at an end, neal tissue in depth and breadth. With the and the process of repair already begun. galvano-cautery we can promptly destroy the However, if after twenty-four hours the ulcer poisonous intruder, and induce a new, fresh shows a tendency to extend, a similar “touch- reaction in the entire tissue. ing" should be again resorted to.
And, lastly, in the chronic indolent ulcer, The loop should be applied until the masses painless and apparently lifeless, showing no of detritus clinging to the floor and sides of tendency towards a reparative process, the the ulcer are destroyed. The bordering in- galvano-cautery is an efficient agent to stimufiltration for a short distance should also be late and bring about a healing process. destroyed: none of this parasitic material As naked facts and not general commendashould be allowed to remain; it should be tions are to be expected, I shall now take completely sterilized. If this be done a recur- leave to present six cases, all of which came rence need not be feared, for it is a fact now under my observation and treatment, in the universally admitted, that the development of past three months. spores becomes impossible on sterilized soil. Case 1. Austin S. -, age 16, after a six
The treatment by the galvano-cautery, as weeks' siege of intestinal obstruction, reducing outlined, secures benefit to the tissues in a him from 150 pounds to a mere skeleton of 95 threefold way :
pounds, and being scarcely able to walk, was 1. It separates rapidly and thoroughly the brought to our office June 2, 1890, with the parts already involved from the yet healthy lower half of the cornea white, as the family tissue.
called it, which they said came on during the It averts the extension of the infection, last week of his illness. and makes the adjacent tissues aseptic.
Examination showed an indolent suppurat3. It stimulates the tissues to take on a ing ulcer extending transversely, almost enhealthy reparative process.
tirely across the lower half of the cornea. The Especially applicable is the galvano-cautery infiltrated zone covering fully one-half of the in the treatment of rodent ulcers, in which corneal area; also hypopyon, accompanied every new point of infection demands its with intense photophobia, lachrymation and prompt destruction. Here we require a white pain. After securing local anæsthesia, the hot tip sufficiently delicate to allow of the entire surface involved was thoroughly cautnice manipulation necessary for working in erized with the platinum loop, and the debris a district of no more than a millimetre in ex- was completely cremated. This was repeated tent. And this is only possible with the gal- every other day, but much lighter each time, vano-caustic loop, which is brought to a red for one week. heat at the exact moment when it is needed, Fearing an increase of tension and liability and cools as quickly, and produces no annoy- of rupture, owing to the thinness of the coring light effects by the glowing of the wire. neal walls, a week solution of atropia was
It is also highly serviceable in scrofulous used every two or three hours to secure mydulcers of the cornea, which show a deep riasis, and prevent possible prolapsus of the ciater-shaped excavation, with sharply cut iris and synechiæ, should perforation occur. edges, accompanied by a light grade of cil. To render support to the thin walled globe, a iary irritation and muco-purulent conjunctival roller bandage and compress were applied, secretion, and which defy all therapeutic and he was directed to maintain a reclining agencies.
posture as much of the time as possible.
Notwithstanding his debilitated and emaci- tion treatment was tried, but its effect was ated condition, and the meagre allowance of only temporary; then sulphate of copper food yet apportioned him for fear of a return pencil was applied, but this only increased the of his intestinal trouble, in two weeks he was hyperæmia, the ciliary injection and pain. permitted to go home with the eye free from Finally the galvano-cautery was applied, folpain ; surface of ulcer smoothed over with lowing the entire route of the ulcer. This new epithelium. A leucoma marks the site had the prompt and desired effect. The inof the battle-ground, but the eye is a useful flammatory symptoms subsided almost as rapone.
idly as they had appeared. Authorities are Case 2.
Mrs. H. - Nickerson, Kansas, pretty generally agreed that this form of ulcer while disinfecting a bedstead with a mixture is due to mycotic fungi, and we know no betof kerosene oil and concentrated lye, was ter germicide than heat. A single application struck in the left eye with some of this fiery was all that was necessary in this case. Vo liquid. Destruction of the corneal epithelium 'opacity remained. ensued, necrosis and infection of the under
Case 4. Sammy L-, of Garfield, Kansas, lying lamina followed. She suffered excruci- August 4, while herding cattle thought he was ating pain, intense photophobia and lachry- struck in the eye by an insect or bug of some mation, continuing three weeks. When sort. An unpleasant sensation was all that brought to our office June 15, 1890, the lower was felt at the time, and was soon forgotten. half of the cornea was involved, presenting a In a few hours the eye became very painful, yellowish, dirty appearance. Infiltration of accompanied with intense photophobia and the remainder of the cornea was rapidly tak- lachrymation. A semi-lunar whitish yellow ing place and there was deep scleral in- discoloration along the lower border was soon jection.
noticed ; this rapidly increased in size and exAfter cocanizing and applying the galvano- tent until the third day, when the whole eye cautery thoroughly, with an occasional drop was thus covered and suppurating profusely. of a weak solution of atropia and hot water Poultices of various kinds were applied in baths she passed a comfortable night, the first rich measure to hasten (?) recovery, as his since the injury.
friends thought, but only to hasten the deThe cautery was re-applied a few times struction of the ocular tissue. On the fifth whenever the surface of the ulcer appeared day after the injury, August 7, 1890, he was roughened. At one time, while using the brought to our office. Extensive sloughing cautery, the cornea perforated, the aqueous of the cornea was then taking place; sheets of escaping with a hissing, spurting sound. This fibrinous pus was fast escaping from between is a cause for alarm, but usually it is an ad- the lids; palpebral and ocular conjunctiva vantage, if there be an increase of tension and deeply injected; Some extravasation of blood hypopyon, as the then diminished tension will had occurred in the palpebral conjunctiva: prevent the possible formation of a staphylo- lids cedematous; palpation of ciliary region matous cornea, and the opening will give free gave pain; light imperceptible. egress of the pus from the anterior chamber;
The eye was thorougly washed with a hot also, the aqueous in passing through the per- saturated solution of boracic acid. After coforation, if it be in the site of the abscess will canizing, the galvano-cautery was most thorwash out its contents.
oughly and effectually applied, keeping well In about two weeks the infiltration became over the centre of the cornea, taking care not circumscribed, the denuded surface smoothed to burn the limbus of vessels near the scleroover, pain ceased, dread of light absent, and corneal junction. This was repeated every simply an opacity below the pupillary range day for a week. Much to our surprise, at the remained to mark the site of the ulcer.
expiration of one week, we had the pleasure Mr. W—, of Topeka, presented of seeing the dim outlines of the pupil and the himself with ulcer serpens of the cornea, grayish cast of the iris. August 3, 1890. At first the calomel insuffla- Sloughing of the cornea had ceased, and
though somewhat hazy, yet he could discern he had to be led about. Thinking possibly objects as they passed before the eye. At the the destructive process had not been entirely expiration of three weeks he was discharged. destroyed, the cautery was reapplied but with Case 5. Mrs. P-, farmer's wife, fifteen no better results than before.
The eye was miles north of Topeka, about 35 years of age. irrigated with a weak carbolized solution Had some trouble with her eye for several 1-100, also a boracic acid hot solution. Not days, when she noticed a white speck in the seeing much of any improvement on the folleft eye. April 26, 1890, she called on us, and lowing day the ulcerated surface was touched examination showed a small, circular corneal with concentrated carbolic acid from the end abscess at the upper and outer margin of the of a probe. pupil, 3 m. m. in diameter. At this time there The eye appeared to be growing worse dewas no pain, and although circumscribed and spite all efforts at cauterization. These were involving the corneal tissue proper, we ad- then discontinued. Hot bi-chloride fomentavised the use of hot fomentations for fifteen to tions, 1-5000 were directed io be used every twenty minutes, three or four times a day. hour, with frequent irrigation of the conjuncThere was a decrease in the amount of pus tival sac with boracic acid, saturated solution, for two days. On the morning of the third and the occasional use of a mydriatic. day onyx appeared, and the abscess was open- This procedure has been kept up for three ed; but the pus was thick and tenacious, and weeks, during which time all pain has ceased, the hot applications were continued. The pus vision is slowly returning to the eye as the inbroke through the posterior wall of the cornea; filtration disappears from the cornea. A leuhypopyon ensued and a paracentesis was done coma marks the site of the ulcer. letting out the pus, and the hot water was
CONCLUSION. continued for twenty-four hours.
The galvano-cautery is always indicated The ulcer showed no signs of healing. The in those ulcers which take their origin in myeye was then cocanized, and the whole ulcer- cotic infection. In such cases it gives the ated surface was cauterized, opening the an- most thorough disinfection of the floor and terior chamber. The next day a marked im- sides of the ulcer, and at the same time stimuprovement was noticed.
lates the process of repair. Three or four applications were all that 2. Repair is shown almost at once after the were required, and in three weeks she was application, in the clearing of the aqueous well, with a useful eye, but a small opacity in humor, dilatation of the pupil is more easily the site of the ulcer.
obtained, absorption of the hypopyon and inCase 6. Frank B-, age 20, has had gran- creased diffusion of the corneal tissue. ulated lids for two years; had an ulcer on the 3. In most cases it does away with the neright eye about eighteen months ago. Five cessity of the corneal (Saemisch’s) incision; weeks ago came to our office with trouble in because when the evacuation of the contents his left eye; photophobia and lachrymation in- of the anterior chamber is required, it can best tense, accompanied with severe pain. Exam- be effected by means of the heated loop for the ination showed a row of ulcers, some three or reasons I have before mentioned. tour in number in the upper half of the cor- The operation causes but slight painnea, extending transversely across it; a heavy no assistant is necessary. pannus covered the intervening space between 5. The healing process is considerably the row of ulcers and the periphery of the shortened, and the final result shows a much cornea above. This eye was his visual organ, less extensive and dense opacity of the affecthis right being totally and heavily covered ed corneal tissue. with pannus. After cocanizing, the galvano- 6. Dr. Noyes, in his recent work on Discautery was applied to the row of ulcers, fol- eases of the Eye says: “It is in the early lowing which pain increased; infiltration of and progressive stage that the cautery may the remainder of the corneal tissue ensued, most confidently be employed." In case 3 it and light became almost imperceptible, so tha. I was employed in the early stage, but in cases
1, 2, 4 and 5, it was employed late in the dis- By this latter term we understand that at one ease, when destruction of the eye seemed cer- or more spots within the urethra, the epithetain, and with gratifying results.
lium has become so damaged, by the prolong7. The pain following the application of ed inflammation, that it ceases to make the the galvano-cautery is less and of shorter du- canal urine-tight, and a slow process of escape ration than that of any other caustic.
of some of the constituents of the urine into 8. The extent and limitation of cauteriza- the tissue comprising the urethra and around tion can be definitely measured—not so with it, takes place. As a consequence of this and to any other caustic.
prevent urine soaking further into the tissue, 9. The mode of applying the heated gal- inflammatory exudation is excited and barriers vano-caustic is exceedingly simple and easy of lymph, which eventually become organized to master.
are thrown out opposite the places where the
leakages take place. Thus splints of plastic tisThe Formation of Urethral Stricture,
sue are formed where the spot or spots of epithelium have been denuded by the persisting inflammation. In this strengthening of the ure
thra we recognize, in the first instance, a conRead before the Golden Belt Medical Society, servative action. But, eventually, however, as October 2, 1890.
in all other compensating processes, it consti
tutes an independent disease. Though the BY F. B. BROWNE, M. D., SALINA, KAS.
mucous membrane is the tissue chiefly invol
ved in the primary inflammation, it is, as a A stricture of the urethra is generally con- rule, only secondarily implicated in the stricsidered to be due to more or less prolonged ture-forming process.
ture-forming process. In many instances it inflammation, specific or otherwise, of the will be found after death that the dimensions lining membrane of the canal, which ulti- of the mucous membrane are not altered. mately leads to the deposition of organized The plastic exudation which makes up a strielymph in the peri-urethral tissues. · This ulti- ture differs from exudation provoked in other mately is converted into a dense connective parts of the body by inflammation, in the detissue, which subsequently shows a remarka- gree of its density and tendency to contract. ble tendency to contract.
I known of no tissue in the human bodyThus the escape of urine from the blad- except perhaps that found after scalds and der is interfered with by the degree to which burns, where the original tissues are entirely these contractile masses encroach upon the destroyed-which is so tenacious and resistcalibre of the canal.
ing as that constituting the usual form of This contraction becoming a source of an urethral stricture. Here we have a cicatrix noyance, either by causing gleet, if of large formed, which of all strictures is the most calibre, or by interfering with free flow of resisting and contractile. Cicatricial tissue urine if small. Now, all this may be true on manifests this tendency to contract and oblitthe whole, but it does not enter into details erate the canal more strongly than tissue with which we must be familiar for the pre- formed by cell-proliferation after ordinary invention and treatment of the disorder.
It flammation. One cannot help thinking and will be convenient to take an illustration for wishing that it were possible to transplant this the purpose of tracing more gradually the process of tissue-thickening and contraction, process of stricture, making as a consequence as observed with the formation of traumatic of specific urethritis or gonorrhoea, which is urethral strictures, to the parts constituting admitted to be the common cause of urethral the weak points we are desirous of consolistricture.
dating in the abdominal parietes for the radiThe acute form of this disorder, unless care cal cure of hernia. is taken, is very apt to merge into the condi- Here it would be serviceable instead of tion known as chronic granular urethritis. detrimental. The form in which stricture tissue is deposited, and ultimately exercises to the value of boracic acid as a prophylactic contractile pressure on the urethral passage, against urethral fever. These observations is strongly suggestive that in the first instance indicate to me, that the kind of contact beit served the purpose of strengthening the tween fresh urine and a recently made wound wall of the canal, and thus preventing further was in itself sufficient to cause urine fever. leakage of some of the constituents of the What these toxical products are my chemistry urine taking place at points where the epithe- does not inform me. Let me quote from an lial coat had been more or less permanently essay of one of the most original thinkers the damaged.
medical world ever produced : I refer to the Having referred several times to urine-leak- late Dr. Austin Flint, “ Analytical Chemistry" age as being a potent factor in the causation he observes, "carries investigation beyond the of urethral stricture, I come to speak of limits of microscopical observation. The what to my mind seems incontrovertible latter at the present moment, both in patholoevidence in its favor, namely, urine fever. gy and physiology, seems to promise most;
In surgical practice we have long been ac- but is it not a rational anticipation to look for customed to recognize, after injuries and future results from chemical analysis of the operations, a form of excitement generally components of the body in health and disease, known as wound or traumatic fever. It varies which in brilliancy and practical utility may in degree according to circumstances, attend surpass those of the labors in this field ed by slight elevation of temperature, and of investigation during the past half century? usually declines without proving either serious “The medical centenarian can recall the enor fatal.
In striking contrast with this we thusiasm aroused by the labors of Liebig. have a distinctive form of fever, not unlike Histology is now in the ascendant, but it is ague, which is alone seen in lesions involving safe to predict that before the lapse of another the urinary tract. Let us take for example, half century there will be another era in and many times have I observed in my own organic chemistry, and that light will pene. limited experience, the simple introduction of trate dark recesses which histology cannot a catheter or a sound, and even during an at-reach. The supreme objects of study in tack of gonorrhea, where the patient urinates pathology at the present time are the discovvery frequently over the extensively abraded ery of micro-organisms and their natural hisurethral surface, that in a few hours, he is tory. But these agents, it is probable, are seized with a rigor, which terminates in fever pathogenetic, not directly, but indirectly, by and an elevation of temperature. Cases are means of the toxical products of their activion record where the operation of internal ty. What are these products, and how do urethrotomy has been followed by rigors, they give rise to the phenomena of disease? convulsions, suppression of urine and speedy We may ask the same question of certain of death, post-mortem examination failing to the poisons introduced from without the body. discover any reasonable or recognized expla- “How is it that fractional quantities of mornation.
phia, hyoscyanin, strychnia, aconitia, atropia, Since the due recognition of those principles and other alkaloids produce their lethal efupon which Listerism is based, I found that fects? It conveys ŋo adequate information to certain antiseptic precautions, directed toward say that they act upon the nervous system. the wound as well as the bladder, for the pur- This is merely the statement of a fact, not an pose of acting upon the urine tended to pre-explanation. For the latter we must look to vent it undergoing changes and yielding pro- the organic chemistry of the future." ducts which were calculated by absorption to There are a few practical points relative to produce this special kind of fever, and consid- the treatment of stricture and injuries of the erably reduced, both the frequency of these urethra, arising out of what I have thus venattacks as well as their severity. I have tured to bring under your notice, to which I reference to corrosive sublimate locally and would like to refer. There are at present four quinine internally. Writers bear testimony different methods of treatment, namely, grad