On granular disease of the conjunctiva and contagious ophthalmia / by Edward Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1874-1875]
Catalogue details

Licence: Public Domain Mark

Credit: On granular disease of the conjunctiva and contagious ophthalmia / by Edward Nettleship. 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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    at all. These exceptional cases are all the more puzzling because sometimes it appears that the same treatment which did harm at one time does good some weeks or months later, or vice versa, without any apparent change having taken place in the mean time. The effects to be expected from local treatment.—One of the most important rules to be remembered here is that (excepting as regards the cure of acute conjunctivitis) there is no uniform state of improve- ment to which all cases of granular disease of the same severity can be brought by treatment. In this respect every case has its own standard beyond which it cannot be carried, and this can be found with safety and certainty only by experience in each instance. In some patients the congestion and roughness can be entirely removed 1 from the upper lids, and almost from the lower, and this state be maintained indefinitely by treatment. Below this point of excellence are all degrees of variation down to the point at which the most powerful treatment that seems safe has no effect at all beyond causing transient irritation; this complete want of effect seldom if ever occurs except in very old cases. Running parallel with cases that are benefited are a few others in whom the symptoms point to the necessity of treatment but which are positively injured by treat- ment of any activity ; these are not numerous. Duration of Treatment.—This also can be determined only by experience in each case. It can seldom be measured by anything less than months, and many cases require it at intervals for years. It is of much importance not to omit treatment entirely until several weeks (four to eight) after the case has reached the greatest amount of improvement of which it is capable. This should be done gradually, i. e. by increasing the intervals between treatment; and after its entire omission the lids should be examined at intervals of about a week, so that any gradual sprouting of the conjunctiva may be detected early. I attribute some relapses in the cases under my care to a partial neglect of this rule, for scarcely any relapses occurred when all the worst cases were under treatment without any experimental omissions. It does not seem likely that anything will be found equal to nitrate of silver and sulphate of copper as local applications. When pro- perly used they give results which, taking the nature of the disease into consideration, leave little to be desired. Tor general purposes there is nothing equal to a solution of nitrate of silver of ] 0 grains to the ounce of water, in which strength it is chiefly or wholly astringent. Ridgway, in 1812, came to the conclusion that this strength was the best, and precisely the same solution was strongly 1 I believe, however, that the normal brightness can never be restored to a conjunctiva which has once been granular, probably because it does not really regain the smoothness of health.