Directory_and_Chronicle_1841 — Page 480

1841.

Report of M. M. S. Hospital at Chusan.

461

The cases of entropium were operated upon in the usual mode of removing a fold of skin from the upper lid and dividing the tarsal cartilage. This was, generally speaking, completely successful, and the state of the eye much improved in most of the cases; in others the cornea had become so opaque from the long continuance of the disease that, although the constant pain and irritation caused by the inverted lids were removed, the power of vision was little increased.

The Chinese surgeons adopt a plan of operating for this disease, which is common in Canton as well as in Chusan. The object is to inclose a fold of the upper lid, between two narrow strips of bamboo, which are then bound tightly together at their ends by thread; the fold of skin sloughs and falls off, and the contraction that occurs dur- ing the healing of the wound everts the edge of lid. But this is objectionable; in the first place, on account of the pain caused during the separation of the slough, and still more so, from the circumstance that when the disease is thus treated, considerable transverse con- traction of the lids takes place, which induces a shortening of the tarsal cartilage, and if this condition of the lid exists to any extent, it is almost as prejudicial to the eye as the original disease, and if it have continued for a length of time, is not remediable by a surgical operation.

During the northerly monsoon, and especially at its commence · ment, several cases of severe catarrhal ophthalmia presented them- selves; in some of these the disease had existed for several days, extensive destruction of the cornea had taken place, and in a few cases, one or both eyes were lost; but when the disease was recent, al- though very severe, it was in most cases speedily relieved. The plan of treatment adopted was that which is now generally followed; namely using the strong solution of nitrate of silver (10 grains to an ounce of water). This was dropped into the eye, blisters were ap- plied to the temples, and active purgatives administered. The strong solution was applied daily for three or four days, and then changed for one of 5 grains, and occasionally fresh blisters were applied after the first had healed. The success of this practice was on the whole very gratifying; and in no case that can be remembered, did loss of the eye, or deep ulceration of the cornea ensue, when the case had come early under treatment. And it would appear, as the result of the cases met with at Chusau, that the use of the nitrate of silver was much more beneficial in removing the disease, than depletion would have been under the same circumstances. Granular lids prevail to à great extent, and are the result of long continued irritation of the

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