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NOTES, CASES AND INSTRUMENTS 137 Our first cases were treated with rest in bed, cold compresses, cocain for the first day, once or twice; atropin twice daily. These cases remained in the hospital for from three to six weeks, depending on the severity of the reac- tion. Latterly we have been using cocain for only one instillation, and for its im- mediate quieting effect. Atropin, three times daily for its continued phys- iologic effect, cold compresses, boric acid flushing, iodoform powered into the eye twice daily, yellow oxid of mercury salve to the lids and a Lie- ' breich bandage for from three to seven days, or longer as the case requires. Under this plan of treatment, the stay of patients in the hospital has been de- creased to seven to fourteen days, with rapid amelioration of all symp- toms. It is our opinion that the deleterious effects of dichlorethylsulphid upon the eyes, can best be treated by anti- phlogistic measures, ignoring to a con- siderable extent the chemical composi- tion of the affecting gas. To look for a chemical antidote to neutralize its action in the eye, would more than likely lead to a substance as severe in reaction as the poison itself, whereas, by treating the inflammatory symp- toms, immediate relief is obtained, in- sofar as pain, lacrimation, photophobia and swelling are concerned. Previous to the use of the mercurial salve ex- ternally, about five (5%) per cent of our cases developed chalazia, hordeola and small multiple abscess of the lids; but since its introduction into our routine treatment, we have had no such complications. SCLERITIS AND EPISCLERITIS. HUGH MILLER, M. D. KANSAS CITY, MO. These notes were read in connection with the presentation of a case before the meeting of the Kansas City Eye, Ear, Nose and Throat Club, October 17th, 1918. The etiology is somewhat obscure and probably from a constitutional disturb- ance rather than a local affection. We find in literature that the following are causative factors: Rheumatism, tuber- culosis, syphilis, menstrual disturbances and others. Rheumatism itself has been obscure in etiology. We now attribute as a caus- ative fact of rheumatism toxic absorp- tion principally from the oral cavity, pyorrhea and tonsils. So we would at this time say simply toxic absorption. It is a question whether we have true scleritis and episcleritis from tubercular bacilli. As to syphilis I have been unable to find any literature definitely showing characteristic scleritis except where it is secondary to iritis or keratitis. That it may be from menstrual dis- turbances I have doubts. I have had but three cases in my experience, two in men and one woman; in the latter there were no indications of genital disturbances. The tonsils and dental pyorrhea are the places where we should seek for an ex- planation of these conditions. I am quite confident that scleritis is a local manifes- tation of constitutional absorption of tox- ins. Our most recent observations in toxic absorptions are explaining many pathologic conditions that previously were obscure. Objective Symptoms.—We find some millimeters from the cornea a hyperemic area with an elevated slate colored cen- ter. There may be one or more of these areas at the same time, on the same eye- ball. Seldom are both eyes involved at the same time. These areas are variable in size and shape, depending upon the in- tensity of the disease. It may be simply episcleritis, involving only the tissue covering the sclera, or it may extend thru the entire thickness of the sclera, in fact include the choroid as has been shown by microscopic investigation. Subjective Symptoms.—Dull, heavy ache is the usual nature of the pain. Sometimes sharp shooting pain. The pain is produced principally by pressure, as I desire to show further on. There is lac- rimation and slight photophobia. The diagnosis is made by the inspection of the eye, where we find the characteristic areas. Progress.—The healing of one area re- quires from two to six weeks. Often- times before the first has recovered, a second or third inflammatory area has

LET'S TAKE A HARD, COLD LOOK AT ACRYLAMIDE

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