The ocular complications of typhoid fever / by G. E. de Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: The ocular complications of typhoid fever / by G. E. de Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    doubtful whether they would have revealed any micro- organisms except those which are commonly present in the milder types of conjunctivitis and which prob- ably have no specific relation to their development. During convalescence, and sometimes in the later stage of the disease, a true phlyctenular conjunctivitis ap- pears, associated probably with more or less rhinitis. A phlyctenule may break down and form an ordinary phlyctenular ulcer, or without this origin ulcerative kera- titis may arise, and if unchecked may develop into severe sloughing ulcers with hypopyon and secondary iritis, and may be followed by entire destruction of the eye. The pathogenesis of these purulent ulcers may be twofold : (1) An infection may be carried through the blood-streams to the eye, that is, there is an autoinfec- tion; or, as Hubbell suggests, (2) the physical depres- sion of the patient may be so great that the resisting power of the cornea, this structure being slightly anes- thetic, is lessened, and some small abrasion of the epithelium permits an inoculation of pathogenic germs. In bad cases of typhoid fever, when the patient has lain for days in a comatose condition, with half closed eyelids, rapid melting down of the cornea, or kerato- malacia, may occur, precisely as this takes place in cholera, dysentery and meningitis. Fortunately, sloughing keratitis is a rare phenomenon in this disease (it appeared only twice in two thousand cases recorded by Hoelscher) ; but its prognosis is bad, especially when the general condition and surroundings of the patient are poor. Prompt treatment, however, may prevent disastrous consequences, as in a case reported by Veasey. The treatment of the conjunctivitis of typhoid fever is that which is suited to any mild type of catarrhal in- flammation of the conjunctiva—a collyrium of boric acid or common salt; washing the edges of the closed lids with tepid water and castile soap, and if there is free secretion of muco-pus, eversion of the lids and the application of silver nitrate (5 grains to 1 fluidounce), or of a 10% solution of protargol. Sloughing corneal ulcers call for atropin drops (4 grains to 1 fluidounce), with sufficient frequency to maintain mydriasis and