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I make a continued report of the case because I think her recovery of sight under this simple line of treatment has been rather remarkable; she has almost perfect vision in the injured eye, showing, or the next line to what we call perfect vision. There is a little depressed tension of the eye, and it is possible there may be further atrophy. In discussing the previous report Dr. Cheatham said he thought we would have atrophy, but I am inclined to think it will remain where it is with only a slight loss of bulk.

Since reporting the above case I have seen three others of injury to the ciliary body; two, being made with dirty instruments and causing immediate blindness, demanded prompt enucleation; another is now under treatment. One was a little boy who was shot with an arrow which penetrated underneath the conjunctiva, the missile then passing into the ciliary zone of the eye, then apparently turned in some way as the wound through the sclera did not exactly correspond to the wound in the conjunctiva. It had slit up the conjunctiva, and then apparently turned inward. At my first examination I was in hopes that there had not been a perforation. Upon later and closer investigation I found tension of the eye was very much depressed, and carrying a thoroughly aseptic probe under the conjunctiva at the wound of entrance I found the arrow had gone deeply into the globe and that the eye was utterly destroyed, so that immediate enucleation was the only measure to be considered. This was carried out, and the boy made a good recovery.

The other case was a man who was injured in the Jeffersonville ship-yards. A small piece of iron was driven into the ciliary region of the eye; the sight was completely destroyed.

In addition to these cases I have one under my care at the present time, a little boy whom I saw in consultation for the first time a few weeks ago. He had been injured, as many of these cases are, by the explosion of gunpowder. It is the only case I have seen of powder explosion where the powder was thrown into the interior of the eye. I have seen a great many such cases, as have others who do work in this. line, and it is very common to have grains of powder driven into the cornea and into the sclerotic coat of the eye. It is exceedingly difficult to remove this powder, as much so I imagine as it is to remove it from the skin. In this patient, the boy is ten years of age, some of the powder was driven through the cornea and lodged in the iris, probably some in the lens also, because when I saw the patient there was already

a traumatic cataract, and considerable iritis had occurred. He had been under treatment for two weeks, and although there was considerable iritis there was almost no pain. Tension was a little below the normal, which I considered an unfavorable symptom. The pupil was semi-dilated, and the doctor had very wisely been using atropine in strong solution frequently applied.

In these cases it is extremely difficult sometimes for the oculist to decide whether enucleation should be practiced when a foreign body of this character has penetrated the interior of the eye. If we have a large wound through the ciliary zone, the indications would be clear, we would not hesitate to practice enucleation; but where we have a wound through the cornea, where we have reason to believe that the foreign body has not penetrated further than the lens, and where the foreign body is aseptic the case becomes exceedingly puzzling. In this case I have decided so far at least to retain the eye. I think it will be safe in this case to leave the powder in the iris, and keep the patient under careful observation until the traumatic cataract has been absorbed, then perhaps do an iridectomy.

I mention the case as one of those troublesome ones in which the question of enucleation is extremely difficult to decide.

Discussion. Dr. Wm. Cheatham: I congratulate the doctor upon his result in the first case mentioned, but he doubtless realizes that he is not yet out of danger in that case. Wounds of the ciliary region are recognized as being likely to be followed by sympathetic trouble in the opposite eye.

I have seen several cases where powder was thrown into the lens, and have never had to enucleate an eye because of such an accident. There usually develops iritis and synechia, but enucleation does not become necessary.

Like Dr. Dabney I have had a great many cases of traumatic injuries to the eye recently, some of which have recovered vision, others in which enucleation was necessary.

There is nothing to be added to what the doctor has said about the management of such cases.

Puerperal Eclampsia. Dr. J. G. Cecil: I have recently been associated in the management of two cases of puerperal eclampsia with other physicians, and inasmuch as I believe I am on record in this society with reference to the management or treatment of such cases, I will

report the two recently seen. They are not only interesting in themselves, but I also desire to place myself on record as having somewhat modified my views in regard to the treatment.

In one of these cases the woman was young and unmarried, she was quite fleshy, and in labor with her first child. At the time I saw her she had had a great number of convulsions, just how many I do not know, and had several after I saw her. The treatment adopted at that time was to purge her with any thing we could use that would be effective; calomel, cream of tartar, jalap, and croton oil were used. In addition to that she was given large doses of bromide and chloral, the exact quantity I do not remember. After she had been purged we then concluded - and this constitutes what I wish to record as being a modification of what I formerly believed in regard to the management of these cases to give her some morphine. The labor, however, dragged, she did not seem to make any progress, the convulsions continued, and the outlook was very bad, and it was agreed in consultation that accouchement forcé should be brought about. This I accomplished after one and a half hours dilatation with my fingers until forceps could be applied, which was done without any great difficulty, and the child extracted. It was premature. Notwithstanding the large number of convulsions the mother had suffered, and the traumatism which was necessary in accomplishing delivery, not only traumatism in forcing the cervix open but also in the use of the forceps, one blade having caught the child over the nose and the other over the occiput, and it was literally dragged through the canal, both the child and the mother made a good recovery. The child's nose was straightened and did not seem to suffer very much deformity afterward. The mother had one severe convulsion after delivery was completed, and has had none since.

In the other case a young woman, perhaps thirty years of age, the mother of two children, at seven and a half or eight months pregnant, was seized with convulsions; she had one severe convulsion; her physician was sent for, she had a second one under his care, and before she had the third one I was called to see her. After I saw her she had only one convulsion. The treatment adopted in this case was quite similar to that followed in the first case, and the one I wish to advocate as being what I think best, purging as rapidly as can be done with any means at hand; croton oil was used in this case, three, four or five drops, large doses of bromide and chloral given by the rectum in this instance as the stomach was rejecting every thing. After purging the patient

thoroughly she was still in a very serious condition, appearing as if she would go into a convulsion at any time, rolling and tossing from side to side, extremely restless and unconscious. The only convulsion I had seen in this case was of such a severe nature that I was satisfied another one would end her life, and I agreed to a dose of morphine, which was afterward repeated, and which acted charmingly.

In this case the labor was not forced, it came on spontaneously in twelve hours after the last convulsion, and she was delivered of a dead premature child. She made a good recovery also.

The only modification I wish to record is the use of morphine in this connection. I am sure Dr. Anderson will remember a case he saw with me at one time in which we followed this same plan, and it has been my practice in recent years to use morphine in such cases only under these circumstances, that is after free purgation has been accomplished.

Discussion. Dr. J. A. Ouchterlony: What was the condition of the kidneys in these cases?

Dr. J. G. Cecil: In both cases the urine was highly albuminous, and there were tube casts and every other evidence of kidney involvement. There was very little edema in either case.

Dr. T. H. Stucky: In this connection I would like to ask if any members of this society have had any experience with the use of elaterin hypodermatically as a means of rapid purgation?

Dr. J. A. Ouchterlony: I have been very much interested in Dr. Cecil's report, especially in view of the successful results. His remarks recall to my mind some cases of puerperal eclampsia I have met with; but different in character, however. One was the case of a married woman who had given birth to several children. On this occasion she had had a somewhat protracted and violent labor. It had come on all of a sudden. After labor she began to have convulsions. Her husband was an overseer of a friend of mine on a farm a few miles out in the country, and at his request I went out to see her. Of course I did not know what I might find, and took nothing in the way of instruments with me-I was simply asked to go out and see a very sick woman. When I reached the sick-room I found a plethoric, powerfully built woman, very muscular; she had had several convulsions; her pulse was full and bounding. I got a sample of the urine and with a very inadequate test, which was the best that could be done under the

circumstances, I found that there was no albumin in the urine, but there were very violent convulsive paroxysms, and as I thought the indication was to subdue the vascular excitement, I bled her. I drew off a pint of blood with great relief to her, and told the doctor in charge if there should be a recurrence of the paroxysms to bleed her again, but no recurrence took place. We gave her also full doses of bromide. afterward.

Another case was in the person of a young negro girl who was in labor with her first child; she had a very long labor, and whether I was correct in my diagnosis or not I am not sure at the present time, but I thought there was premature ossification of the cranial bones, and I perforated them and delivered her afterward with some difficulty; she was a rather small woman. Several hours after the birth of the child I was sent for in great haste to come back. The statement was that she had had a convulsion, which recurred a number of times before I could get there. In that case I concluded that, in view of the fact that there was no indication of renal disease, it was due to excessive peripheral irritation, and I gave her chloroform and then administered bromide per rectum, and she made a very good recovery.

I think the treatment of convulsions incidental to the puerperal state of course must be looked upon according to the etiology. I believe in some of the cases there can be no better treatment than that of bleeding. But I have very serious doubts as to the safety of the administration of full doses of morphine where there is any evidence of disease of the kidneys. I would feel very slow to form any general decision based upon a small number of cases. Now it is possible, and I can well conceive that we may have albumin and casts in cases where there is a considerable amount of renal disease, and the kidneys may be still competent to perform eliminative work, and that after elimination has been brought about by purgation it might be safe to administer morphine; but we have other cases, for instance such as with each recurrent pregnancy have had puerperal convulsions. In such cases we have reason to believe that the kidneys are very extensively diseased (the disease of the kidneys having lasted for a long time), and in such I should think the administration of morphine would be very unsafe. Dr. Turner Anderson: This subject has been up so frequently before the Medico-Chirurgical Society that I think we are all on record. It is pretty well known how we stand in regard to the management of puerperal convulsions. I think there is a consensus of opinion among

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