NOTES, CASES, INSTRUMENTS A HAMMER LAMP*

OTTO BARKAN, M.D. San Francisco, California

A hand slitlamp (focal illuminator) was reported in 1946.+ It proved so satisfactory that a larger lamp or hammer lamp made of plastic and of similar design was devised for surgery and general purposes. This lamp (fig. 1) is 5.5 inches in length, weighs 10.5 ounces, and furnishes brilliant illumination, free from color.

Fig. 1 Fig. 2

Figs. 1 and 2 (Barkan). (1) Hammer lamp. (2) Hammer lamp attached to plastic rod.

The light source is a bulb operating on eight volts, the transformer being a free unit when the lamp is used with a handle or built into the base of the flexible goose-neck stand when used in this manner. Various acces­sories are made for it, such as transillumina-tors and suitable filters.

The light weight, relatively small size, and comparative freedom from heat of this lamp, combined with its illuminating powers, have made it particularly satisfactory for use

* These lamps may be obtained from Parsons & Company, 518 Powell Street, San Francisco, Cali­fornia.

t Barkan, Otto: A new focal illuminator. Am. J. Ophth. 24:439 (April) 1941.

in the operating room, as well as in the office. For surgery, the lamp may be attached to

a plastic rod four feet long which affords facility and ease in holding and positioning.

490 Post Street (2).

PHOTOGRAPHY OF THE EXTERNAL EYE

A SIMPLE, INEXPENSIVE TECHNIQUE

IRA A. ABRAHAMSON, JR . , L I E U T . ( M C ) U.S.A.

Camp Gordon, Georgia

Photographic reproduction of the anterior segment of the eye has become a practical and efficient aid to the ophthalmologist. It is one of the best methods for recording clini­cal ocular pathology both for research, teaching, and medicolegal illustrations.

The method to be described is especially adaptable for taking pictures, of pre- and postoperative squint cases, enucleations, implants, cataracts, lid cases, and so forth. The advocated technique provides stability of the apparatus and patient, accuracy of aim, good depth of focus, inexpensive, non-irritating illumination, and a rapid, easy, efficient mode of operation.

Many articles have appeared on this subject in the past 12 years. Those by Knighton,1 Bedell,2 Bogart,3 Irvine,4

Katzin,5 Landers,8 Callahan,7 Sysi,8 Knight,9

Hansell,10 Douvas,11 Chace,12 and Donald­son,13 have been particularly instructive. Some of the methods described are quite good but most are too expensive or compli­cated, with handicaps of instability and lighting disadvantages.

The following is a description of the apparatus used.

APPARATUS (Figs. 1 and 2) 1. Slitlamp table with chinrest. Almost

every eye clinic or ophthalmologist's office has a slitlamp. The type used by me is the

NOTES, CASES, INSTRUMENTS 387

Bausch and Lomb universal slitlamp table. The chinrest aids in stabilizing the patient and can be elevated and depressed to the desired height to maintain alignment. It should be noted that the apparatus (fig. 2) herein described does not have to be fastened to the slitlamp table, but may be used on the wards or in the operating room with the only defect being instability.

Block of wood. This is 7% by 3 ^ by 3^4 inches in dimension. It is screwed into the under surface of the slitlamp table and left permanently in place to support the arm.

2. Arm. This is made out of a broomstick handle and is 12 inches long. There is a screw two inches long inserted into one end of it (a) . This fastens into the block of wood, described above, projecting from the under edge of the slitlamp table. It is held firm by a fly wing bolt (b) .

3. Light cross bar. This contains the light source and supports the camera. It fastens to the upper end of the arm and is left perma­nently in place. The type used is a Multi-Lite, Jr., manufactured by Mayfair Com­pany, Brooklyn, New York.

Light source. Two 100-watt, 120-volt bulbs are used. They are inexpensive, non-irritating to the eye, and provide adequate illumination.

4. Camera. An Argus C-3, Leica, Contax, or any type may be used.

Adapter. This fits over the lens mount and supports the portrait lens.

A portrait lens fits over the camera lens and is essential for close-up photography. A plus 3.0D. meniscus lens may be used for objects 11 and one-half inches away.

Extension cable. This aids in stabilizing the camera.

Film. The camera is always loaded, ready for use, with either black and white Kodak Panatomic-X or Kodachrome Indoor Type A 35-mm. film.

TECHNIQUE

The patient is seated facing the apparatus with his chin on the chin rest. Figure 3

Fig. 1 (Abrahamson). Slitlamp table and apparatus.

Fig. 2 (Abrahamson). Apparatus alone.

demonstrates the operation of the apparatus. The arm (2) and cross bar (3) , which are permanently attached, are fastened into place on the block of wood ( l a ) .

The camera (4), whose speed is constant on "bulb" and whose lens aperture is fixed

388 NOTES, CASES, INSTRUMENTS

Fig. 3 (Abrahamson). Photographic technique.

Fig. 4 (Abrahamson). Preoperative and post­operative photographs in a case of esotropia.

at F4.S, is mounted on the light cross bar and screwed into place.

The lens is lined up with the bridge of the patient's nose by adjusting the chinrest. The patient's eyes are under constant ob­servation for blinking and, in a matter of seconds, the picture is taken. Figures 4 and 5 show the size of field and depth of focus obtained.

Only a few minutes are required to mount the apparatus on the slitlamp table and take the picture. The technique is so simple, that a nurse, corpsman, or secretary can operate it easily.

Fig. S (Abrahamson). Preoperative and post­operative photographs in a case of ptosis.

S U M M A R Y

A simple, inexpensive technique for photographically reproducing the anterior segment of the eye is described. The method provides stability of the apparatus, accuracy of aim, good depth of focus, inexpensive, nonirritating illumination, and a rapid, easy, efficient mode of operation.

EENT Clinic, U. S. Army Hospital.

REFERENCES

1. Knighton, W. S.: A simple set-up for external eye photography. Am. J. Ophth., 21:300 (Mar.) 1938. 2. Bedell, A. J.: Colour photography in Ophthalmology: In Ridley, F., and Sorsby, A.: Modern

Trends in Ophthalmology. London, Butterworth, 1940, pp. 213-233. 3. Bogart, D. W.: Clinical photography with special reference to photography of the anterior seg­

ment of the eye. Am. J. Ophth., 25 :61-66, (Jan.) 1942. 4. Irvine, R., and Stimson, R.: A method of ultra close up photography in ophthalmology. Arch.

Ophth., 23:161-163 (Jan.) 1940. 5. Katzin, H. M.: Photography of the external eye. Arch Ophth., 35 :S14-518,1946. 6. Landers, P. H.: Simplified external eye photography. Am. J. Ophth., 31:1624-1626, 1948.

NOTES, CASES, INSTRUMENTS 389

7. Callahan, A.: Photography of the eye. Med. Radiog. 24:46-53,1948. 8. Sysi, R.: Simple device supplementary to slitlamp to photograph parts of eye. Acta Ophth.,

27:403-408, 1949. 9. Wright, E. S.: Survey of anterior segment photography. Am. J. Ophth., 32:124S-12S1, 1949. 10. Hansell, P., and others: Discussion of ophthalmic photography. Proc. Roy. Soc. Med. (London),

42 :451-458, 1949. 11. Douvas, N., and Allen, L.: Anterior segment photography. With Nordenson retinal camera.

Am. J. Ophth., 33 -.291-292,19S0. 12. Chace, R., and Lafayette, J.: A lighting system for photography of the eye. Arch. Ophth., 43 :371-

373, 19S0. 13. Donaldson, D.: Camera for sterioscopic photography of anterior segment. Arch. Ophth., 43:1083-

1087, 1950.

SENSITIVITY TESTS OF STAPHYLOCOCCUS CULTURES*

USING 30-PERCENT SODIUM SULFACETIMIDE

HORACE W. SHRECK, LIEUT. COL. (MC) U.S.A.

Ancon, Canal Zone

In conjunction with a clinical study of sulfacetimide in staphylococcal infections, I have made a laboratory survey of sensitivity tests on staphylococcal cultures with Dr. Joel Shrager, chief of the bacteriology section, Board of Health Laboratory, Gorgas Hospi­tal. Two hundred staphylococcal cultures were tested for sulfacetimide sensitivity. The tests were performed with sodium sulfacetimide, using discs saturated with a 30-percent solution, which was also applied to blood-agar plates that had been plated with the staphylococcus being checked. The cup technique was also used in which the 30-percent sulfacetimide was in direct con­tact with the media. In all instances one method checked the other. Both coagulase-positive and coagulase-negative cultures were used.

In the 200 staphylococcal cultures the following types were seen:

Staphylococcus albus—nine, of which one was coagulase positive and eight were co-agulase negative.

Staphylococcus albus-hemolyticus—five, of which one was coagulase positive and four were coagulase negative.

* From the Department of Ophthalmology, Gorgas Hospital.

Staphylococcus aureus—11, of which three were coagulase positive and eight were coagulase negative.

Staphylococcus hemolyticus—175, of which 51 were coagulase positive and 124 coagulase negative.

Of the 200 cultures, 18 were sensitive to sulfacetimide (30 percent) ; of the 18, three were coagulase positive and 15 were coagu­lase negative.

The results of these sensitivity tests, which followed rather closely those of our clinical study, were disappointing; 30-per­cent sulfacetimide had given better clinical results in the states.

Dr. Joel Shrager, the chief of bacteri­ology, Board of Health Laboratory at Gorgas Hospital (whom I wish to thank for invaluable assistance), with whom I dis­cussed possible explanations for the lack of sensitivity, felt that definitely different strains of staphylococcal organisms are present in the Canal Zone. He felt that the climate, humidity, and so forth did not affect the organisms and that they were not factors to be considered.

Gorgas Hospital.

ACUTE GLAUCOMA DURING CORTISONE THERAPY

JOHN J. STERN, M.D. Utica, New York

The response of secondary glaucoma in uveitis to systemic cortisone or ACTH treat­ment seems to be unpredictable, some cases actually react with an increase of intra-