Volume 48 · Issue 09 · 1934

Ophthalmology in China has developed in three successive phases. From the arrival of Dr. Peter Parker in Canton one hundred years ago until the last two decades, emphasis was laid on the curative phase of ophthalmology. Within the last two decades, earlier efforts in ophthalmic research have been coordinated and some notable research work on ophthalmic problems has been done. Although various problems in ophthalmology have been considered from the public health viewpoint, it is only recently that the preventive phase of ophthalmology has attracted the attention that it merits.

Dr. J. Heng Liu in a graduation address delivered at the P.U.M.C. on June 8th, 1934, made the statement that there is only one physician to every 70,000 persons in China. For most of Europe and the United States there is at least one eye specialist for 70,000 people.

A female Chinese (Hosp. No. 2992) 22 years of age was admitted to the Chengtu E. E. N. & T. Hospital on Feb. 23, 1932.

According to the bacteriologic studies made in chronic dacryocystitis by different investigators, the organisms found in the secretion of the tear sac may be noted as follows: Pneumococci, Hemolytic streptococci, B. influenzae, Diplobacilli Morax-Axenfeld, Staphylococci, Bacillus pneuwzoniɶ Friedländer, B. subtilis, B. proteus vulgaris, B. fusiformis, B. typhoid., B. coli, Gram-negative Rods, Micrococcus catarrhalis, Xerosis bacilli, Sarcina Spirochaetes, Sporotrichun, Actinomyces, and Aspergillus fumigatus. Of these the Pneumococcus is most frequently met clinically, either in pure culture or at times with other organisms like the staphylococcus, Diplococcus Morax-Axenfeld, etc. The Xerosis bacillus on the other hand, is one of the rarest organisms that has ever been isolated in the secretion of the tear sac. A search of lilerature reveals that up to the present time only two cases have been recorded, one by Marx (6), the other by Fage (2), in both of which a pure culture was isolated. Due to the unavailability of Marx's original report the source of infection of his case cannot be ascertained, but in Fage's case it was clearly stated to be non-virulent bacillus of the diphtheric type. According to the latter, the result of inoculation on rabbit's eye was negative; the inoculation in the pharynx of a pigeon produced a small, false membrane containing the same organism; and 3 cc of Bouillon culture injected subcutaneously into a guineapig did not kill the animal. The writer has observed another case which may be reported as follows.

Epicanthus is the name applicd to a fold of skin which juts out on both sides of the dorsum of the nose and projects over the inner angle of the eye so as to partly cover it (1). Because it is one of the characteristics of the eyes of the Mongolians it is also, called the Mongolian fold. Ammon (2) was the first to call attention to this condition and to name it. According to Manz (3), Schön had noticed and mentioned it in his "Pathological Anatomy" long before Ammon did but he did not seem to have named it and his description was apparently lost sight of. Ammon (4) differentiated three kinds of epicanthus: (1) Epicanthus supraciliaris bilateralis, which begins from the eyebrows and extends downwards towards the tear sac or further towards the nostrils without reaching them however. (2) Epicanthus palpebralis, generally the biggest and broadest form of epicanthus, arises in the skin of the upper lid above the tarsal fold and extends to the lower orbital margin where it ends in the cutis. (3) Epicanthus tarsalis, which originates always in the tarsal fold of the upper lid and loses itself in the skin close to the inner canthus.

Medical practitioners in China who have to trcat trachoma and its complications are greatly indebted to those, who work in communities whcrc. the incidence is high, for contributions on the subject, especialIy on the operative treatment of entropion and tricHiasis. During the past year, in our eyc clinic, we have becn using the operative procedure advocated bv Cuenod ancl Nataf for trichiasis and entropion. We have founcl their opcration practical ancl have had very few failures with it. Having used other proccclures for several years we are convinced of thc superiority of this methocl and believe in pass- ing it on to our fellow workers in China. We I.alve thought wise to sct down the steps of the operation by free translatjoji from the originators ruonograph (2) in French. Cuenod and Nataf state that they have used the operation with excellent rcsults, for more than twenty yeari, on more than 25,000 patients.

Opinions concerning the etiology of entropion in the newborn have so far been very diverse. Dimmer considered it to be due to epicanthus and hypertrophy of the skin which had, therefore, become less intimately attached to the tarsus.

The main feature of membranous conjunctivitis is the formation of a membrane. This kind of conjunctivitis is usually divided into two distinct forms: the diphtheric and the pseudomembranous. The first one is met with in a case of diphtheria and the membrane upon the conjunctiva is firmly adherent to the underlying tissue, for it is formed by exudate within the tissue itself. Klebs-Loeffler bacilli are found in the membrane but mostly mixed with staphylococci and streptococci. In the case of the pesudomembranous conjunctivitis the membrane may easily be removed, because it is composed of coagulated exudate. This form may be found in severe infiammation produced by various germs: Koch-Weeks bacilli, pneumococci, gonococci, staphylococci and strept ococci (Schieck (9) Saemisch (8) and Herrenschwand (3)

Trachoma is a peculiar disease of the conjunctiva characterized by hypertrophy, folliculitis and cicatrization of the conjunctiva and pannus formation of the cornea. It is present all over the world, but its distribution is very uneven.

Loehlein (1) divides tubercular lesions of the conjunctiva into three groups: (1) plastic type, (2) lupus conjunctivae and (3) miliary type, often fugative, met with in patients affected by general tuberculosis.

Among the various manifestations of syphilis, papular syphilide of the bulbar conjunctiva is an exceedingly rare condition. In a period of over five years onIy one case with this form of ocular disease was seen among 4000 patients admitted to the syphilis clinic of the Peiping Union Medical College Hospital. Because of its rarity and the importance of its recognition, it is worthwhile to report this case.

A Chinese male (Case 3727) aged twenty eight yearsm first came to the Chengtu Eye, Ear, Nose and Throat Hospital on October 3, 1932 for swelling and redness of the bulbar conjunctiva on month ago and gradually spread over the rest of the white part of the left eye-ball. There a slight irritation of the inner corner of the left eye and some muco-purulent discharge.