RISLEY: Cassaripe.
A23
Therefore, in the case before us, there is no rotation of the globe about the line of sight. The inclination of the prime vertical meridian outward, as shown by the apparent position of the after-image in the familiar experiment, may be explained, without supposing a rotation of the globe as a whole about the line of sight, by the relative positions of the prime vertical meridian and the secondary vertical plane in the globe, the former having a relative rotation outward with reference to the latter, and by the fact that the latter cuts the plane of projection in a vertical line. Suppose when the eye is in a primary position, a linear image is received at the macula, where the primary vertical meridian intersects the retina, and that the eye is then moved upward and outward by a Listing rotation. Assuming that the after-image is mentally projected outward and along the line of sight and located where the primary vertical plane intersects the plane of projection, it would be inclined at its upper part outward, as it actually appears. CASSARIPE: A NEW REMEDY FOR THE TREATMENT OF CORNEAL ULCERS AND OTHER INFECTIOUS DISEASES OF THE EYE. BY S. D. RISLEY, A.M., M.D.
Through the courtesy of Dr. H. B. Chandler of Boston, my attention was called to " Cassaripe," in a conversation at Washington last year during the meeting of this society. He subsequently sent to me a supply of the preparation, a IO per cent. ointment, which I have used with most gratifying results in a large series of cases of ulcers of the cornea, and a large group of cases of purulent disease of the conjunctiva. The following letter from Dr. Chandler gives the information he had gained about the drug, and explains his reasons for its employment. To him belongs the credit for calling attention to what promises to be a useful addition to our means of treating those dangerous and often rebellious forms of disease.
424
RISLEY: Cassari:pe.
After employing the drug as noted above and recognizing its value, I wrote to Dr. Chandler for further information about it, as I could find no satisfactory account of it except a mere mention of the name cassareep or cassaripe in the Century Dictionary, as the juice of the Black Cassava. In reply, Dr. Chandler wrote me the following letter: DEAR DOCTOR: " In reply to yours regarding cassaripe, I would say that it is obtained from the bitter cassava plant. The natives in making cassava bread, grate the root, and a milky juice exudes; this is acid, and is supposed to be very poisonous. The juice is concentrated to a semi-solid known as cassaripe, heat destroying its poisonous qualities. Its use, by me, was suggested while in the tropics, by learning that it was used commonly as a preservative; a solution poured over meat seems to preserve it indefinitely. Theodore Metcalf & Co. imported some for me two or three years ago, as none could be found in this country. In using it I often incorporate atropin or pilocarpin, with happy results. In large sloughing corneal ulcers, in old personis. it has given more satisfaction to me than anything I have ever used. I have written nothing regarding it." Later, in conversation with my friend, Dr. J. T. Rothrock, Commissioner of Forestry for Pennsylvania, he kindly consented to look up the matter from the standpoint of its botany. I am indebted to him for the following facts: Cassareep is the inspissated juice of the cassava, which is highly antiseptic and forms the basis of the West India pepper pot. The cassava belongs to the Euphorbiaceae or Spurge family, and is extensively cultivated in tropical America and the 'West Indies for the large fleshy root, which contains an abundance of farina. Two principal varieties are cultivated, the Manioc, or Maniihot utilitissima, or bitter cassava, and the Manihot aipi, or sweet cassava. The former contains a juice of highly poisonous nature, while the latter is wholesome and used as a vegetable. While they both produce a large quantity of farina, the Utilitissima is more productive, and is, therefore, more extensively cultivated. The farina is obtained by grating the root to a pulp, after which the poisonous juice is expelled by pressure and washing. The mass is then pounded into a coarse meal resembling bread-crumbs, which are made into
RISLEY: Cassaripe.
425
cakes and subjected to heat, which drives off or destroys what may remain of the poisonous juice. This forms the cassava bread, which is an important article of food throughout tropical America. There seems to be not a little confusion regarding the botanical features of different species of the Euphorbiaceae, which contains many poisonous varieties, even the natives often mistaking the poisonous for the innocent species in preparing Their food. The Genus Manihot is shrubby or herbaceous, or shrubby below and herbaceous above. Male and female flowers are distinct, though on the same plant. The seed vessels are threecelled and three-seeded. Petals none, but the calyx of the male flowers are often colored. The flowers are in racemes, each one under a bract. Muller, in DeCandolles Prod., Vol. I5, Part 2, page I062, considers Manihot aipi, or sweet Manihot, as merely a variety of Manihot palmata, and says that the leaves are usually five, parted with tlte lobes obovate lanceolate or elliptical lanceolate, and more or less covered with a wihitish bloom on the lower surface. He adds that this species differs from the Manihot utilitissima or bitter Manihot, the poisonous species, not only in the reddish non-poisonous root, but also in its ovaries, capsules, and stipules; also that the leaves of the utilitissima are deeply palmated, three to five parted division,s about ten to fifteen centimeters long and one to five broad, covered with glaucous bloom beneath and brownish above. But Griseback, in his " Flora of the British West India Islands," page 37, regards the forms above mnentioned as belonging to the same species, and adds that the tubers, both sweet and bitter, are found, but this difference is not accompanied with trustworthy specific characters. Dr. Rothrock agrees with this statement, and adds " that the plants are so much alike that even in the tropics deaths occur from eating the wrong plant by mistake." He himself witnessed a death from this cause in I890, while at Governor's Harbor, Island of Eleuthera, one of the Bahamas. Lindley, in his " Vegetable Kingdom," page 280, says: " M. utilitissima is a shrub about eight feet high, cultivated fcr food all over tlle tropical parts of the world. Of this
426
RISLEY: Cassaripe.
plant, the large root, weighing as much as thirty pounds, is full of a venomous juice, which if taken internally produces death." An intoxicating beverage is made from it called Piwarrie, which is prepared by women chewing the cassava cakefs, and ejecting the masticated substance into a wooden bowl, where it is allowed to ferment for some days, and then boiled. It is a common drink with the natives, and is said to have an agreeable taste; the mode of preparation, however, is repugnant to Europeans, notwithstanding this one who used it reports thus, " In my opinion, it is very agreeable and wholesome, for I drank it in large quantities at the different Indian settlements I visited." In preparing the cassava as above stated, the poisonous expressed juice is put into water, the starch which it contains falls to the bottom, the water is poured off and the starch placed on hot plates; this causes the starch grains to swell and burst, forming the tapioca or Brazilian arrowroot of the * shops. It is this poisonous juice or waste product from which the cassaripe is prepared, its poisonous properties being destroyed by the heat employed in its preparation. The coolies, in preparing the cassaripe used for cooking purposes, especially in preparing meat, mix red pepper and spices with the cassava juice, which they boil to the thickness of syrup. It is then cooled, bottled, and a quantity exported. It is this cassaripe which makes the renowned West India pepper pot. One teaspoonful of it put into a vessel containing a number of pounds of mixed meats and boiled will preserve the meat for an indefinite time, notwithstanding the perpetual summer of those tropical climes. A few points in its employment need to be emphasized. I have at no time used it stronger than a IO per cent. ointment. It causes no irritation, however, and I see no objection to employing it in much stronger preparations. The ointment was applied freely between the lids, and the eye subjected to massage so as to distribute it thoroughly into the retrotarsal folds; and in the corneal cases, a protecting bandage applied. When the patients were in the hospital, this was repeated three times daily. In the outdoor cases, morning and evening. No other treatment was employed except atropia, and a wash of boracic acid. In a
Discussion.
427
few minutes after the application of the ointment in new cases, the discomfort was much diminished, and the improvement was usually rapid as compared to other modes of treatment. In a case of qphthalmia neonatorum, the eye was thoroughly cleansed, the ointment of cassaripe applied, and a supply given to be used three times daily at home, after the usual wash. In two days the purulent discharge had entirely ceased. My observations seem to show the cassaripe to be a powerful vegetable antiseptic, which promises to be a useful addition to our means of treating infectious forms of eye disease. DISCUSSION. DR. JOHN GREEN. - About forty years ago it was my good fortune to visit Surinam in the company of the late Professor Jeffries Wyman of Canmbridge. I observed there the mode of preparation of the cassava plant, including the expression of the juice from the freshly grated roots, and the making of cassava bread. In most cases the juice was thrown away, but occasionially it was saved and concentrated by boiling to a dark-colore(I fluid extract, resembling mushroom catsup, to be used as a condiment. It was there known as cassaripo, and it was said to have the property of preserving meat from becoming tainted. The poison in the fresh root seems to be dissipated by heat, as well in the baking of the bread as in the boiling of the juice. The odoL of the fresh juice recalled that of the bitter almond; it has been stated that the presence of hydrocyanic acid has been demonstrated by chemical analysis. DR. MYLES STANDISH. -This ointment of cassaripe which Dr. Chandler originally introduced has been in use four or five years at the Massachusetts Charitable Eye and Ear Infirmary by some of the men. It is my habit in ordering it to give to the patients directiotis to use it three or four times a day, usually insisting that they use it at night before going to bed. Sufficient of it then remains in the sac during the night to leave some of the brownish-like mass along the edge of the lids in the morning. There has been no complaint in its use, and in my experience it has proven a useful drug. The most serious objection to the preparation is that it is not always reliable, for while one series of cases will do well, other cases, having apparently the same conditions, are not improved by it. When it was first used, Dr. Chandler thought that it had
428
SUTPHEN: Sympathetic Inflammation.
the property of leaving a less dense scar after corneal ulcerations. I have not heard Dr. Chandler advocating it very strongly on that account of late, and perhaps he has given up that idea. I have thought and believe at present that if the ointment be used fo,r some time after the healing has occurred, the scar is less dense than if treated by other means. Of course, it is difficult to estimate how dense a scar will be in a given case, but if I personally had an ulcer of the cornea at the present time I should treat it with cassaripe for a considerable length of time after the ulcer had apparently healed. DR. E. E. JACK. -I am rather surprised that neither Dr. Risley nor Dr. Standish have seen any irritation fro,m the use of cassaripe. So far as I know, I have used the same strength of preparation, but I remember one or two cases distinctly where it produced a great deal of discomfort. DR. STANDISH. - Almost any application to the eye will be very bitterly complained of by some patients, but I think the rule is that it is only an occasional patient that complains of this. DR. RISLEY. - That the opacity of the cornea following repair in corneal ulcers may be lessened by use of this preparation is possible, but I do niot think I have ever noticed the slightest difference in that respect as compared to other modes of treatment. I am sure that the amount of opacity remaining must depend largely upon the destruction of corneal tissue by the disease. I have not found a case in which there was the slightest irritation produced by the drug, but, on the other hand, the comfort which follows its use is very striking. The preparation I have used has usually been made up with cosmoline or white vaseline. CASE OF SYMPATHETIC INFLAMMATION FROM ADHESION OF EYELID TO STUMP -RECOVERY. By T. Y. SUTPHEN, M.D., NEWARK, N. J.
On July 4, I893, I was called by Dr. Underwood of New-ark to see Thomas G., a boy nine years of age, who had been injured in the left eye, two hours before, by the explosion of a blank cartridge. A large piece of the shell had gone completely through the upper eyelid and had made an extensive and ragged wound
A23
Therefore, in the case before us, there is no rotation of the globe about the line of sight. The inclination of the prime vertical meridian outward, as shown by the apparent position of the after-image in the familiar experiment, may be explained, without supposing a rotation of the globe as a whole about the line of sight, by the relative positions of the prime vertical meridian and the secondary vertical plane in the globe, the former having a relative rotation outward with reference to the latter, and by the fact that the latter cuts the plane of projection in a vertical line. Suppose when the eye is in a primary position, a linear image is received at the macula, where the primary vertical meridian intersects the retina, and that the eye is then moved upward and outward by a Listing rotation. Assuming that the after-image is mentally projected outward and along the line of sight and located where the primary vertical plane intersects the plane of projection, it would be inclined at its upper part outward, as it actually appears. CASSARIPE: A NEW REMEDY FOR THE TREATMENT OF CORNEAL ULCERS AND OTHER INFECTIOUS DISEASES OF THE EYE. BY S. D. RISLEY, A.M., M.D.
Through the courtesy of Dr. H. B. Chandler of Boston, my attention was called to " Cassaripe," in a conversation at Washington last year during the meeting of this society. He subsequently sent to me a supply of the preparation, a IO per cent. ointment, which I have used with most gratifying results in a large series of cases of ulcers of the cornea, and a large group of cases of purulent disease of the conjunctiva. The following letter from Dr. Chandler gives the information he had gained about the drug, and explains his reasons for its employment. To him belongs the credit for calling attention to what promises to be a useful addition to our means of treating those dangerous and often rebellious forms of disease.
424
RISLEY: Cassari:pe.
After employing the drug as noted above and recognizing its value, I wrote to Dr. Chandler for further information about it, as I could find no satisfactory account of it except a mere mention of the name cassareep or cassaripe in the Century Dictionary, as the juice of the Black Cassava. In reply, Dr. Chandler wrote me the following letter: DEAR DOCTOR: " In reply to yours regarding cassaripe, I would say that it is obtained from the bitter cassava plant. The natives in making cassava bread, grate the root, and a milky juice exudes; this is acid, and is supposed to be very poisonous. The juice is concentrated to a semi-solid known as cassaripe, heat destroying its poisonous qualities. Its use, by me, was suggested while in the tropics, by learning that it was used commonly as a preservative; a solution poured over meat seems to preserve it indefinitely. Theodore Metcalf & Co. imported some for me two or three years ago, as none could be found in this country. In using it I often incorporate atropin or pilocarpin, with happy results. In large sloughing corneal ulcers, in old personis. it has given more satisfaction to me than anything I have ever used. I have written nothing regarding it." Later, in conversation with my friend, Dr. J. T. Rothrock, Commissioner of Forestry for Pennsylvania, he kindly consented to look up the matter from the standpoint of its botany. I am indebted to him for the following facts: Cassareep is the inspissated juice of the cassava, which is highly antiseptic and forms the basis of the West India pepper pot. The cassava belongs to the Euphorbiaceae or Spurge family, and is extensively cultivated in tropical America and the 'West Indies for the large fleshy root, which contains an abundance of farina. Two principal varieties are cultivated, the Manioc, or Maniihot utilitissima, or bitter cassava, and the Manihot aipi, or sweet cassava. The former contains a juice of highly poisonous nature, while the latter is wholesome and used as a vegetable. While they both produce a large quantity of farina, the Utilitissima is more productive, and is, therefore, more extensively cultivated. The farina is obtained by grating the root to a pulp, after which the poisonous juice is expelled by pressure and washing. The mass is then pounded into a coarse meal resembling bread-crumbs, which are made into
RISLEY: Cassaripe.
425
cakes and subjected to heat, which drives off or destroys what may remain of the poisonous juice. This forms the cassava bread, which is an important article of food throughout tropical America. There seems to be not a little confusion regarding the botanical features of different species of the Euphorbiaceae, which contains many poisonous varieties, even the natives often mistaking the poisonous for the innocent species in preparing Their food. The Genus Manihot is shrubby or herbaceous, or shrubby below and herbaceous above. Male and female flowers are distinct, though on the same plant. The seed vessels are threecelled and three-seeded. Petals none, but the calyx of the male flowers are often colored. The flowers are in racemes, each one under a bract. Muller, in DeCandolles Prod., Vol. I5, Part 2, page I062, considers Manihot aipi, or sweet Manihot, as merely a variety of Manihot palmata, and says that the leaves are usually five, parted with tlte lobes obovate lanceolate or elliptical lanceolate, and more or less covered with a wihitish bloom on the lower surface. He adds that this species differs from the Manihot utilitissima or bitter Manihot, the poisonous species, not only in the reddish non-poisonous root, but also in its ovaries, capsules, and stipules; also that the leaves of the utilitissima are deeply palmated, three to five parted division,s about ten to fifteen centimeters long and one to five broad, covered with glaucous bloom beneath and brownish above. But Griseback, in his " Flora of the British West India Islands," page 37, regards the forms above mnentioned as belonging to the same species, and adds that the tubers, both sweet and bitter, are found, but this difference is not accompanied with trustworthy specific characters. Dr. Rothrock agrees with this statement, and adds " that the plants are so much alike that even in the tropics deaths occur from eating the wrong plant by mistake." He himself witnessed a death from this cause in I890, while at Governor's Harbor, Island of Eleuthera, one of the Bahamas. Lindley, in his " Vegetable Kingdom," page 280, says: " M. utilitissima is a shrub about eight feet high, cultivated fcr food all over tlle tropical parts of the world. Of this
426
RISLEY: Cassaripe.
plant, the large root, weighing as much as thirty pounds, is full of a venomous juice, which if taken internally produces death." An intoxicating beverage is made from it called Piwarrie, which is prepared by women chewing the cassava cakefs, and ejecting the masticated substance into a wooden bowl, where it is allowed to ferment for some days, and then boiled. It is a common drink with the natives, and is said to have an agreeable taste; the mode of preparation, however, is repugnant to Europeans, notwithstanding this one who used it reports thus, " In my opinion, it is very agreeable and wholesome, for I drank it in large quantities at the different Indian settlements I visited." In preparing the cassava as above stated, the poisonous expressed juice is put into water, the starch which it contains falls to the bottom, the water is poured off and the starch placed on hot plates; this causes the starch grains to swell and burst, forming the tapioca or Brazilian arrowroot of the * shops. It is this poisonous juice or waste product from which the cassaripe is prepared, its poisonous properties being destroyed by the heat employed in its preparation. The coolies, in preparing the cassaripe used for cooking purposes, especially in preparing meat, mix red pepper and spices with the cassava juice, which they boil to the thickness of syrup. It is then cooled, bottled, and a quantity exported. It is this cassaripe which makes the renowned West India pepper pot. One teaspoonful of it put into a vessel containing a number of pounds of mixed meats and boiled will preserve the meat for an indefinite time, notwithstanding the perpetual summer of those tropical climes. A few points in its employment need to be emphasized. I have at no time used it stronger than a IO per cent. ointment. It causes no irritation, however, and I see no objection to employing it in much stronger preparations. The ointment was applied freely between the lids, and the eye subjected to massage so as to distribute it thoroughly into the retrotarsal folds; and in the corneal cases, a protecting bandage applied. When the patients were in the hospital, this was repeated three times daily. In the outdoor cases, morning and evening. No other treatment was employed except atropia, and a wash of boracic acid. In a
Discussion.
427
few minutes after the application of the ointment in new cases, the discomfort was much diminished, and the improvement was usually rapid as compared to other modes of treatment. In a case of qphthalmia neonatorum, the eye was thoroughly cleansed, the ointment of cassaripe applied, and a supply given to be used three times daily at home, after the usual wash. In two days the purulent discharge had entirely ceased. My observations seem to show the cassaripe to be a powerful vegetable antiseptic, which promises to be a useful addition to our means of treating infectious forms of eye disease. DISCUSSION. DR. JOHN GREEN. - About forty years ago it was my good fortune to visit Surinam in the company of the late Professor Jeffries Wyman of Canmbridge. I observed there the mode of preparation of the cassava plant, including the expression of the juice from the freshly grated roots, and the making of cassava bread. In most cases the juice was thrown away, but occasionially it was saved and concentrated by boiling to a dark-colore(I fluid extract, resembling mushroom catsup, to be used as a condiment. It was there known as cassaripo, and it was said to have the property of preserving meat from becoming tainted. The poison in the fresh root seems to be dissipated by heat, as well in the baking of the bread as in the boiling of the juice. The odoL of the fresh juice recalled that of the bitter almond; it has been stated that the presence of hydrocyanic acid has been demonstrated by chemical analysis. DR. MYLES STANDISH. -This ointment of cassaripe which Dr. Chandler originally introduced has been in use four or five years at the Massachusetts Charitable Eye and Ear Infirmary by some of the men. It is my habit in ordering it to give to the patients directiotis to use it three or four times a day, usually insisting that they use it at night before going to bed. Sufficient of it then remains in the sac during the night to leave some of the brownish-like mass along the edge of the lids in the morning. There has been no complaint in its use, and in my experience it has proven a useful drug. The most serious objection to the preparation is that it is not always reliable, for while one series of cases will do well, other cases, having apparently the same conditions, are not improved by it. When it was first used, Dr. Chandler thought that it had
428
SUTPHEN: Sympathetic Inflammation.
the property of leaving a less dense scar after corneal ulcerations. I have not heard Dr. Chandler advocating it very strongly on that account of late, and perhaps he has given up that idea. I have thought and believe at present that if the ointment be used fo,r some time after the healing has occurred, the scar is less dense than if treated by other means. Of course, it is difficult to estimate how dense a scar will be in a given case, but if I personally had an ulcer of the cornea at the present time I should treat it with cassaripe for a considerable length of time after the ulcer had apparently healed. DR. E. E. JACK. -I am rather surprised that neither Dr. Risley nor Dr. Standish have seen any irritation fro,m the use of cassaripe. So far as I know, I have used the same strength of preparation, but I remember one or two cases distinctly where it produced a great deal of discomfort. DR. STANDISH. - Almost any application to the eye will be very bitterly complained of by some patients, but I think the rule is that it is only an occasional patient that complains of this. DR. RISLEY. - That the opacity of the cornea following repair in corneal ulcers may be lessened by use of this preparation is possible, but I do niot think I have ever noticed the slightest difference in that respect as compared to other modes of treatment. I am sure that the amount of opacity remaining must depend largely upon the destruction of corneal tissue by the disease. I have not found a case in which there was the slightest irritation produced by the drug, but, on the other hand, the comfort which follows its use is very striking. The preparation I have used has usually been made up with cosmoline or white vaseline. CASE OF SYMPATHETIC INFLAMMATION FROM ADHESION OF EYELID TO STUMP -RECOVERY. By T. Y. SUTPHEN, M.D., NEWARK, N. J.
On July 4, I893, I was called by Dr. Underwood of New-ark to see Thomas G., a boy nine years of age, who had been injured in the left eye, two hours before, by the explosion of a blank cartridge. A large piece of the shell had gone completely through the upper eyelid and had made an extensive and ragged wound
