SPECIAL SENSES. Hereditary Tendency
to
Cataract.
(Gen-
tralblatt fur pralctische augen heil Icunde, July and September 1897).?It is well-known that, besides cataracts which are congenital, cataracts
also met with in families, the members of whom show a tendency?generally hereditary? for the disease to appear at a certain age. Such cataracts may be hard, senile in form, although The cataracts met with at quite an early age. referred to, as well as congenital forms, may in fact be looked upon as due to a hereditary influence, making itself felt at different periods of the individual's existence. In some this occurs before birth, in others during childhood, in some about 20 years of age, while in advanced life cataract is not uncommon among several members of the same family. The fact, that senile are
Jan.
CURRENT MEDICAL LITERATURE.
1898.]
cataract is met with at an earlier age among o natives of India than 111 Europeans, is perhaps an instance of a complex hereditary influence different races. Some interesting cases affecting O O of this hereditary tendency to cataract are given in the journals above quoted. Dr. Schanz of Dresden, in the September number, relates the history of a family suffering from 'juvenile cataract.' The mother was healthy. The father died, aged 40, of lung disease, during which eyedisease that had troubled him for a few years got worse, and he was informed that an operation would be necessary if he lived. Of their six children, the fourth (male) developed cataract when 26 years old in his right eye. It ripened within six months, and was operated upon. The left eye then began, ripened in six months, and was also operated upon. The fifth child (male) became blind without perceptible inflammation in his 18th year, but was not seen by Dr. Schanz. The brother described the condition, however, as exactly like his own. The sixth child (male) was seen at 23 years of age, giving then a history of only 8 days' dimness. There were delicate opacities in the inner portion of the right lens. Within tivo months the whole lens was a uniform grey mass and was operated upon. The left eye began then, and in a few iveeks' time was also operated upon. None of the brothers ever had fits, and neither of those operated upon had sugar or albumen in their urine. Moreover, they lived widely separated from one another, and were therefore not subject to any common general influence at the time the cataracts developed. Dr. Purtscher, of Klagenfurt, in the July number of the same journal, relates the history of a family, three members of whom had congenital ' grey cataract. The parents were healthy and died without any eye-affection appearing. Of their eleven children the third, seventh and eleventh were affected. The third (male) was born with double cataract, and was operated The upon when 18 mouths old with bad results. seen Dr. the first Purtscher, seventh (female), by was found by him to have double cataract at two months old. Operation was declined then, but was successfully performed by him at 5 years of and age, by simple extraction in the left eye, with iridectomy, on account of stenosis of the pupil, in the right. The child suffered from scrofula and was irritable and quarrelsome; the operation gave her enough sight to move about alone. The eleventh was born blind from cata,
,
o
,
'
ract and died in
infancy.
The Editor, Professor Hirschberg, in the September number, relates some more similar cases : (1) Two children, of healthy parents, born with cataract. Both operated upon successfully, but both died young. (2) Two children born cataractous, parents cousins but healthy. (3) Reference is made to his paper in 1893 describing four cases of zonular cataract in a woman, in her daughter, and in the latter's two children.
37
A father, who became blind at 30 years old from cataract, had three (out of four) children rendered blind at about 28 years of age, each from cataract. Euc.un [n Operations on the Nose, Throat and Eau.?Laurence.Turnbull, M.D., has a practical article in the Medical and Surgical Reporter of September 18th, 1897, discussing the various anaesthetics used, but dealing principally with the action of eucain. He mentions the chief objection to eucain in operations on the nose as being a disposition towards haemorrhage at the time of operation. With cocain the tendency is to haemorrhage after an interval when the anaemia it causes is replaced by hyperemia. This may be obviated by spraying the parts congested after the use of cocain by a solution of 5 to 20 per cent, of antipyrin, used hot, or by using instead of the cocain a solution of 5 per cent, cocain and 2^ per cent, of eucain. Dr. Turnbull says that in the case of hypertrophy of the tonsils, a ten per cent, solution of eucain, applied on cotton and also with a small amount by spray, renders them so insensitive as to enable them to be removed by the knife with free bleeding and but little pain, and it so hardens the surface that the actual cautery can be used with safety. One advantage eucain has is that its taste is bitter an I disagreeable, and patients have no inclination to become addicted to its use, forming A list is given of coma habit as with cocain. with eucain. Among and incompatibles patibles the former sire carbolic acid, salol, ichthyol, for-
(4)
malin, iodoform, vaseline, lanoline, alcohol, ether,
chloroform, morphia, sugars, &c. These can all be used in combination with eucain hydrochlorate without changing it chemically or in any way affectiug its anaesthetic action. Salicylic acid aud corrosive sublimate form with eucain combinations which are sparingly soluble. In the St. Bartholomew s Hospital Journal, August 1897, is a paper on eucain by F. C. Wallis, f.r.c.s., who has used it hypodermically for a considerable number of operations and speaks very highly of it. He has removed nine tumors (including a serocystic tumor of the breast and a sarcoma of the ulnar nerve), performed 44 rectal operations, operated upon an umbilical hernia (with suppurating sac), closed a colotomy wound, besides frequently opening abscesses with eucain, and has found it a most effective anaesthetic without any toxic results. He used a 4 per cent, solution, injecting one to onehalf drachms (4 drachms was the most used and without any ill-effects). Since the paper in the February 1897 issue of this Gazette on eucain in ophthalmic surgery, I have used it in 38 more caturact extractions and in numerous other eye-operations with continued satisfaction. A lipoma of the forehead under the upper eyelid, a sebaceous cyst, both larger than walnuts, have also been removed with it without either of the patients (one a woman of 20) ever
38
?
INDIAN MEDICAL GAZETTE.
or feeling the slightest pain. There is little doubt that eucain will in time displace chloroform and cocain in minor surgery on account of its efficiency, safety, rapidity of action, and cheapness. F. P. MAYNARD, m.b.
flinching
[Jan.
1898.
to
Cataract.
(Gen-
tralblatt fur pralctische augen heil Icunde, July and September 1897).?It is well-known that, besides cataracts which are congenital, cataracts
also met with in families, the members of whom show a tendency?generally hereditary? for the disease to appear at a certain age. Such cataracts may be hard, senile in form, although The cataracts met with at quite an early age. referred to, as well as congenital forms, may in fact be looked upon as due to a hereditary influence, making itself felt at different periods of the individual's existence. In some this occurs before birth, in others during childhood, in some about 20 years of age, while in advanced life cataract is not uncommon among several members of the same family. The fact, that senile are
Jan.
CURRENT MEDICAL LITERATURE.
1898.]
cataract is met with at an earlier age among o natives of India than 111 Europeans, is perhaps an instance of a complex hereditary influence different races. Some interesting cases affecting O O of this hereditary tendency to cataract are given in the journals above quoted. Dr. Schanz of Dresden, in the September number, relates the history of a family suffering from 'juvenile cataract.' The mother was healthy. The father died, aged 40, of lung disease, during which eyedisease that had troubled him for a few years got worse, and he was informed that an operation would be necessary if he lived. Of their six children, the fourth (male) developed cataract when 26 years old in his right eye. It ripened within six months, and was operated upon. The left eye then began, ripened in six months, and was also operated upon. The fifth child (male) became blind without perceptible inflammation in his 18th year, but was not seen by Dr. Schanz. The brother described the condition, however, as exactly like his own. The sixth child (male) was seen at 23 years of age, giving then a history of only 8 days' dimness. There were delicate opacities in the inner portion of the right lens. Within tivo months the whole lens was a uniform grey mass and was operated upon. The left eye began then, and in a few iveeks' time was also operated upon. None of the brothers ever had fits, and neither of those operated upon had sugar or albumen in their urine. Moreover, they lived widely separated from one another, and were therefore not subject to any common general influence at the time the cataracts developed. Dr. Purtscher, of Klagenfurt, in the July number of the same journal, relates the history of a family, three members of whom had congenital ' grey cataract. The parents were healthy and died without any eye-affection appearing. Of their eleven children the third, seventh and eleventh were affected. The third (male) was born with double cataract, and was operated The upon when 18 mouths old with bad results. seen Dr. the first Purtscher, seventh (female), by was found by him to have double cataract at two months old. Operation was declined then, but was successfully performed by him at 5 years of and age, by simple extraction in the left eye, with iridectomy, on account of stenosis of the pupil, in the right. The child suffered from scrofula and was irritable and quarrelsome; the operation gave her enough sight to move about alone. The eleventh was born blind from cata,
,
o
,
'
ract and died in
infancy.
The Editor, Professor Hirschberg, in the September number, relates some more similar cases : (1) Two children, of healthy parents, born with cataract. Both operated upon successfully, but both died young. (2) Two children born cataractous, parents cousins but healthy. (3) Reference is made to his paper in 1893 describing four cases of zonular cataract in a woman, in her daughter, and in the latter's two children.
37
A father, who became blind at 30 years old from cataract, had three (out of four) children rendered blind at about 28 years of age, each from cataract. Euc.un [n Operations on the Nose, Throat and Eau.?Laurence.Turnbull, M.D., has a practical article in the Medical and Surgical Reporter of September 18th, 1897, discussing the various anaesthetics used, but dealing principally with the action of eucain. He mentions the chief objection to eucain in operations on the nose as being a disposition towards haemorrhage at the time of operation. With cocain the tendency is to haemorrhage after an interval when the anaemia it causes is replaced by hyperemia. This may be obviated by spraying the parts congested after the use of cocain by a solution of 5 to 20 per cent, of antipyrin, used hot, or by using instead of the cocain a solution of 5 per cent, cocain and 2^ per cent, of eucain. Dr. Turnbull says that in the case of hypertrophy of the tonsils, a ten per cent, solution of eucain, applied on cotton and also with a small amount by spray, renders them so insensitive as to enable them to be removed by the knife with free bleeding and but little pain, and it so hardens the surface that the actual cautery can be used with safety. One advantage eucain has is that its taste is bitter an I disagreeable, and patients have no inclination to become addicted to its use, forming A list is given of coma habit as with cocain. with eucain. Among and incompatibles patibles the former sire carbolic acid, salol, ichthyol, for-
(4)
malin, iodoform, vaseline, lanoline, alcohol, ether,
chloroform, morphia, sugars, &c. These can all be used in combination with eucain hydrochlorate without changing it chemically or in any way affectiug its anaesthetic action. Salicylic acid aud corrosive sublimate form with eucain combinations which are sparingly soluble. In the St. Bartholomew s Hospital Journal, August 1897, is a paper on eucain by F. C. Wallis, f.r.c.s., who has used it hypodermically for a considerable number of operations and speaks very highly of it. He has removed nine tumors (including a serocystic tumor of the breast and a sarcoma of the ulnar nerve), performed 44 rectal operations, operated upon an umbilical hernia (with suppurating sac), closed a colotomy wound, besides frequently opening abscesses with eucain, and has found it a most effective anaesthetic without any toxic results. He used a 4 per cent, solution, injecting one to onehalf drachms (4 drachms was the most used and without any ill-effects). Since the paper in the February 1897 issue of this Gazette on eucain in ophthalmic surgery, I have used it in 38 more caturact extractions and in numerous other eye-operations with continued satisfaction. A lipoma of the forehead under the upper eyelid, a sebaceous cyst, both larger than walnuts, have also been removed with it without either of the patients (one a woman of 20) ever
38
?
INDIAN MEDICAL GAZETTE.
or feeling the slightest pain. There is little doubt that eucain will in time displace chloroform and cocain in minor surgery on account of its efficiency, safety, rapidity of action, and cheapness. F. P. MAYNARD, m.b.
flinching
[Jan.
1898.
