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Title: Notes and observations on opthalmic work
Author: Grant, Lachlan
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1896
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Most of the following 'Notes and observations on ophthalmic work' were taken by me during the summer of 1894 whilst acting as non-resident house surgeon to Dr Argyll-Robertson at the Eye Wards of the Royal Infirmary, Edinburgh. Dr Robertson kindly granted me permission to make use of the large and varied number of ophthalmic patients under his care for this thesis. Some of the notes are taken from the ward journals where I recorded reports of the cases; others are extracts from my own note book. Before passing to consider in detail the number and nature of the various diseases of the eye which came unuer my observation, it may be worth noting that the Census Returns for the last thirty years show a gradually diminishing number of cases of blindness in the population of Scotland. In the Census of 1871, the total number of inhabitants returned as blind was 3,019, or one in every 1,112, of the population. In 1881 the total blind was 3,158, or one in every 1,182, and in the last Census, viz, that of 1891, the total blind inhabitants was only 2,797 or one in every 1,439 of the population. This improvement is very gratifying, and is no doubt largely uue to the great progress that was, and is being, made in the medical and surgical treatment of the various eye diseases and the successful carrying out of these measures by our ophthalmic surgeons. The number of fresh cases which I noted specially at the eye wards was eleven hundred and twenty six, besides upwards of a thousand old patients. Of these patients as a whole I would wish to state two important facts which struck me very forcibly. First, out of the total number, not one single case was positively diagnosed as being directly due to the action of the tubercle bacillus. There were two cases of a doubtful tubercular nature. One of these occurred in a girl affected with lupus vulgaris of the face. The centre of her right cornea had a peculiar clear bleb like elevation, which it was thought might possibly be a lupoid affection of that tissue. The other case occurred in a girl also. Her selerotic was much injected and swollen at parts, especially underneath the upper eyelid. This condition had lasted for over a year, and instead of improving under the ordinary treatment for inflammation of the selerotic, was getting steadily worse. It was thought to be of a tubercular nature. But although I was constantly on the watch, no case of tubercular disease of the conjunctiva, or of the iris, or miliary tubercles of the choroid, or optic neuritis sometimes seen in tubercular meningitis was met with. No doubt some of the cases had the prefix "strumous" applied to them, such as strumous ulcers of the cornea, and strumous blepharitis. This term, however, was applied in a general way as in other affections, meaning rather an inflammatory condition occurring in individuals of weakly looking appearance, and having an apparent predisposition to the development of the tubercle bacillus, but the bacillus not causing, so far as is known, the actual inflammation present. This fact shows the great immunity which the eye enjoys from tubercular disease, and the strong natural resisting power which the tissues of the eye present to the invasion of the tubercle bacillus. This power of resisting the attacks of the bacillus of tubercle must be much more highly developed in the eye than in the majority of the other organs and tissues of the body. In the other departments of surgery tubercular diseases are met with very frequently, such as diseases of glands, bones and joints. Then tubercular ulceration of the larynx is not so very uncommon . In fact, diseases, the result of tubercular infection, fill a good half of the beds on the surgical side, and not a few also on the medical side of all general hospitals. Why then, one may ask, is tubercular disease of the eye so rare? This is not an easy question to solve. Tubercle bacilli along with other micro-organisms are present in the air in many places;- for example, the atmosphere of our hospital wards. In all likelihood these bacilli frequently come in contact with the external surface of the healthy eye, landing on its conjunctival cul-de-sac. This immunity then probably does not depend on the absence of the infecting agent. Even although the cornea and conjunctiva have their vitality lowered by a trauma or an inflammatory condition, the bacillus very rarely effects a development. A probable important factor in hindering the growth of micro-organisms, and especially the tubercular organism, is that the eye is exposed to much bright sunlight and abundance of fresn air, which agents prevent to no small extent the development of micro-organisms generally. These potent agents, will, no doubt, have the same effect here.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available