the operative treatment of entropion and trichiasis

1
847 taken out their skin was found partially to be decomposed and the blood was abnormally dark in colour. More- over, from the first day of contact with the radium emanations the frogs became radio-active. Mice died sooner than frogs ; after being left for four hours in the vessel where radium emanations had accumulated for 48 hours previously they sickened and died on the third day, although showing no signs of illness previously. Dr. London supposes that they died from an affection of the air passages induced by the action-of the radium. SEEGEN PRIZE. A PRIZE under the above title of 6000 kronen (&240) has been offered by the Vienna Academy of Science for an essay on the following subject: "To settle the question whether or not a portion of the nitrogen of the albumin which has undergone metabolism in the system is excreted in the form of free gaseous nitrogen either by the lungs or through the skin." The essays may be written in the German, French, or English languages and must be sent in to the Chancellor of the University of Vienna before Feb. 1st, 1906. IDIOPATHIC EPILEPSY IN A CANARY. CASES of idiopathic epilepsy are rare in the lower animals. Nearly all such cases previously reported, especially in the bird, where necropsies have been made have proved to be Jacksonian epilepsy of traumatic origin. In the Journal of Nervous and Mental Disease for August a case is reported by Dr. Pierce Clark of New York of idiopathic epilepsy in a canary which presented many features of interest. The bird was a male, one year old, from an apparently healthy brood of four. When it came under observation it was the subject of typical idiopathic attacks of grand mal with irregular attacks of petit mal at intervals of every few days. An attack of grand mal was as follows. The bird uttered an epileptic cry and fell backwards from the perch in a stiff general tonic spasm which lasted about 30 seconds. It lay very still on its left side where it had fallen. Then followed a very short clonic spasm, during which the head was turned to the left side and the legs were fully extended. After this epileptic convulsion the bird exhibited violent excitement of an automatic (subconscious) character. " It flew about the cage and dashed itself against the wires." After a few minutes of this sort of activity it lay quite still in a stage of coma lasting six or seven seconds. " It then began to peep and stagger about the cage, still continuing its auto- matic purposeless acts, such as treating the seed-cup as a water-cup and vice versâ, without partaking of the contents of either." After two minutes the attack gradually wore off and the bird acted normally, although it appeared somewhat dazed and did not sing for the next few days. Treatment was adopted of giving bromide by adding a 1 per cent. solu- tion of potassium bromide to its drinking water. Much im- provement resulted in the next two weeks, the bird again beginning to sing and to act in the normal manner. Symptoms of bromism (apathy and somnolence) appearing, the dose was reduced. During the next four months only weekly attacks of petit mal of a very slight character occurred. Unfor- tunately, owing to accidental omission of the bromide for a fortnight, a violent series of attacks of epilepsy came on with post-convulsive exhaustion paralysis as follows. The bird gave the epileptic cry and fell backwards from the perch as before. Then followed tonic spasm for 30 seconds with retraction of the legs and turning of the head to the left. Clonic general spasms followed with extension of the limbs, including the wings, and fine tremors and jerkings of the same. The eyelids were in rapid nictitation and the mandibles were opened and shut rapidly in clonic spasm. The bird then dashed about the cage as previously described, only more furiously; finally it lay exhausted as though dead at the bottom of the cage (stage of coma). The attacks grew worse daily and the bird, soon exhausted by them, was no longer able to mount its perch. The bromide was again given to note the therapeutic effect and improvement followed. For a period of eight days the attacks ceased and the bird gained steadily in strength and was apparently normal once more, when one day it was discovered in a peculiar position, standing with its toes outspread and resting partly on its tail. Rapid clonic spasms and a rhythmical nodding of the head, as well as fibrillary twitch- ; ings of the body generally, were noticed. It grew worse L and died in a few hours. The necropsy, which was made ten l minutes after death, showed an apparently normal brain in l every respect, the calvarium being also normal. The epi- 1 leptic attacks, the post-epileptic exhaustion paralysis, the r status epilepticus, and mode of death were in many clinical B respects like the same in man. THE OPERATIVE TREATMENT OF ENTROPION AND TRICHIASIS. THE frequency with which trachoma, followed by entropion and trichiasis, occurs in Australia has led to numerous operations being devised and practised for the relief of those unfortunate patients who suffer from these troublesome sequelæ of " granular lids." The Ophthalmoscope for the present month contains an article by Dr. J. W. Barrett and Dr. W. F. Orr, respectively surgeon and assistant surgeon of the Victoria Eye and Ear Hospital in Melbourne, giving an account of a method of operating which they have found to be successful. In the first stage of the operation a long cut is made through the skin of the eyelid down to the tarsus and the skin, subcutaneous tissue, and orbicu- laris muscle are dissected upwards ; gut sutures are then passed through the edge of the skin adjoining the cilia and are secured to the tarsus in its upper portion which effects the eversion of the cilia. The edges of the skin insertion are sutured with horsehair so that the gut sutures are to a great extent buried. If the tarsus is much incurved a V-shaped strip of it may be removed with advantage. In the second stage an inter- marginal incision is made from the puncture to the outer canthus, the incision passing up into the substance of the lid behind the roots of the cilia which are all included in the anterior flap. This incision joins that made in the first stage in many places, but bridges may perhaps be left here and there. It permits of a certain amount of sliding up of the skin carrying the cilia on the tarsus. In the third stage the posterior flap containing the tarsus is sutured to the lower lid by gut sutures, so that not only are the cilia displaced upwards, but the tarsus is temporarily displaced downwards for a period of from two to four days and the gut sutures are then cut. The horsehair sutures- joining the edges of the skin are removed a little later, whilst the gut sutures uniting the ciliary border to the tarsus are either allowed to stay in altogether or are removed when loose. The results are said to be excellent. ____ ON THE FATE OF THE HAIRS IN CICATRICES. IT is a familiar fact that in the process of repair of injuries to the skin, whether produced by traumatic, chemical, or thermal agencies, no regeneration of hair occurs if the hair roots have been completely destroyed. The surface epithelium which in the process of repair spreads over the injured sur- face no longer possesses a capacity for the formation of hair, like that of the epiblast in embryonic life. Other results are obtained, however, when the hair roots remain in their natural relation with the dermis, even though the epidermis

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Page 1: THE OPERATIVE TREATMENT OF ENTROPION AND TRICHIASIS

847

taken out their skin was found partially to be decomposedand the blood was abnormally dark in colour. More-

over, from the first day of contact with the radiumemanations the frogs became radio-active. Mice diedsooner than frogs ; after being left for four hours in thevessel where radium emanations had accumulated for 48hours previously they sickened and died on the third day,although showing no signs of illness previously. Dr.London supposes that they died from an affection of the

air passages induced by the action-of the radium.

SEEGEN PRIZE.

A PRIZE under the above title of 6000 kronen (&240) has

been offered by the Vienna Academy of Science for an

essay on the following subject: "To settle the questionwhether or not a portion of the nitrogen of the albuminwhich has undergone metabolism in the system is excretedin the form of free gaseous nitrogen either by the lungs orthrough the skin." The essays may be written in the

German, French, or English languages and must be sent

in to the Chancellor of the University of Vienna beforeFeb. 1st, 1906.

-

IDIOPATHIC EPILEPSY IN A CANARY.

CASES of idiopathic epilepsy are rare in the lower animals.Nearly all such cases previously reported, especially inthe bird, where necropsies have been made have proved tobe Jacksonian epilepsy of traumatic origin. In the Journal

of Nervous and Mental Disease for August a case is reportedby Dr. Pierce Clark of New York of idiopathic epilepsy in acanary which presented many features of interest. The

bird was a male, one year old, from an apparently healthybrood of four. When it came under observation it was the

subject of typical idiopathic attacks of grand mal with

irregular attacks of petit mal at intervals of every few days.An attack of grand mal was as follows. The bird uttered

an epileptic cry and fell backwards from the perch in a stiffgeneral tonic spasm which lasted about 30 seconds. It layvery still on its left side where it had fallen. Then followeda very short clonic spasm, during which the head was turnedto the left side and the legs were fully extended. After this

epileptic convulsion the bird exhibited violent excitement ofan automatic (subconscious) character. " It flew about the

cage and dashed itself against the wires." After a few

minutes of this sort of activity it lay quite still in a stageof coma lasting six or seven seconds. " It then began topeep and stagger about the cage, still continuing its auto-matic purposeless acts, such as treating the seed-cup as awater-cup and vice versâ, without partaking of the contentsof either." After two minutes the attack gradually wore offand the bird acted normally, although it appeared somewhatdazed and did not sing for the next few days. Treatmentwas adopted of giving bromide by adding a 1 per cent. solu-tion of potassium bromide to its drinking water. Much im-

provement resulted in the next two weeks, the bird againbeginning to sing and to act in the normal manner. Symptomsof bromism (apathy and somnolence) appearing, the dose wasreduced. During the next four months only weekly attacksof petit mal of a very slight character occurred. Unfor-

tunately, owing to accidental omission of the bromidefor a fortnight, a violent series of attacks of epilepsycame on with post-convulsive exhaustion paralysis as

follows. The bird gave the epileptic cry and fellbackwards from the perch as before. Then followedtonic spasm for 30 seconds with retraction of the legsand turning of the head to the left. Clonic generalspasms followed with extension of the limbs, including thewings, and fine tremors and jerkings of the same. The

eyelids were in rapid nictitation and the mandibles were

opened and shut rapidly in clonic spasm. The bird thendashed about the cage as previously described, only morefuriously; finally it lay exhausted as though dead at thebottom of the cage (stage of coma). The attacks grewworse daily and the bird, soon exhausted by them, was nolonger able to mount its perch. The bromide was againgiven to note the therapeutic effect and improvementfollowed. For a period of eight days the attacks ceasedand the bird gained steadily in strength and was apparentlynormal once more, when one day it was discovered in a

peculiar position, standing with its toes outspread andresting partly on its tail. Rapid clonic spasms and a

rhythmical nodding of the head, as well as fibrillary twitch-; ings of the body generally, were noticed. It grew worse

L and died in a few hours. The necropsy, which was made ten

l minutes after death, showed an apparently normal brain inl every respect, the calvarium being also normal. The epi-1 leptic attacks, the post-epileptic exhaustion paralysis, ther status epilepticus, and mode of death were in many clinicalB respects like the same in man.

THE OPERATIVE TREATMENT OF ENTROPIONAND TRICHIASIS.

THE frequency with which trachoma, followed by entropionand trichiasis, occurs in Australia has led to numerous

operations being devised and practised for the relief of thoseunfortunate patients who suffer from these troublesome

sequelæ of " granular lids." The Ophthalmoscope for thepresent month contains an article by Dr. J. W. Barrettand Dr. W. F. Orr, respectively surgeon and assistant

surgeon of the Victoria Eye and Ear Hospital in Melbourne,giving an account of a method of operating which they havefound to be successful. In the first stage of the operationa long cut is made through the skin of the eyelid downto the tarsus and the skin, subcutaneous tissue, and orbicu-laris muscle are dissected upwards ; gut sutures are

then passed through the edge of the skin adjoiningthe cilia and are secured to the tarsus in its upperportion which effects the eversion of the cilia. The

edges of the skin insertion are sutured with horsehairso that the gut sutures are to a great extent buried. If thetarsus is much incurved a V-shaped strip of it may beremoved with advantage. In the second stage an inter-

marginal incision is made from the puncture to the outercanthus, the incision passing up into the substance of the lidbehind the roots of the cilia which are all included in theanterior flap. This incision joins that made in the first stagein many places, but bridges may perhaps be left here andthere. It permits of a certain amount of sliding up of the

skin carrying the cilia on the tarsus. In the third stage the

posterior flap containing the tarsus is sutured to the lowerlid by gut sutures, so that not only are the cilia displacedupwards, but the tarsus is temporarily displaced downwardsfor a period of from two to four days and the gut suturesare then cut. The horsehair sutures- joining the edges of theskin are removed a little later, whilst the gut sutures unitingthe ciliary border to the tarsus are either allowed to stay inaltogether or are removed when loose. The results are saidto be excellent.

____

ON THE FATE OF THE HAIRS IN CICATRICES.

IT is a familiar fact that in the process of repair of injuriesto the skin, whether produced by traumatic, chemical, orthermal agencies, no regeneration of hair occurs if the hairroots have been completely destroyed. The surface epitheliumwhich in the process of repair spreads over the injured sur-face no longer possesses a capacity for the formation of hair,like that of the epiblast in embryonic life. Other results

are obtained, however, when the hair roots remain in theirnatural relation with the dermis, even though the epidermis