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 |   Related post: salts from their use in parenchymatous keratitis and in chorioiditis, and Rogman agrees with him. Pflueger [Ann. d'oc, August, 1893), on the contrary, has abandoned the use of mercurials by subconjunctival in- jections, but alleges equally good results from solutions of trichloride of iodine, in the strength of 1 to 2,000. Among those authors who do not believe in the effi- cacy of subconjunctival injections of mercurials, or are op- posed to their use, may be mentioned the following : Wecker and Masselon have not found that they pro- duced any favorable result when used alone without the aid of other means. Laqueur found that sublimate injections were borne well enough, but produced no effect on the course of the disease, and he has abandoned them. Both Dianoux and Deneffe agree in the main with these conclusions. Haab has employed them in cases of interstitial kerati- tis without any beneficial result. Michel is of the opinion that the method of subconjunc- tival injections does not accord with the principle of ocular asepsis. Cohn objects to them on account of the severe irrita- tion and reaction induced b\' their employment. Samlsohn, Landolt, and Panas all object to their use on theoretical grounds. The latter asks if it is supposed that the injections produce their effect by chemical action, which he considers impossible in the homoeopathic dose in which they are administered, and furthermore, if so, it would be necessary to prove absolutely that the drug penetrates the eyeball, and this has never been done. The most recent and important criticism on the thera- peutical value of these subconjunctival injections has been made by Mutermilch Buy Desogen (Ann. rf'oc, September, 1894). He does not believe that the sublimate solution reaches the dis- eased focus more readily when injected beneath the con- junctiva than when instilled into the conjunctival sac, while it does cause certain disagreeable complications which may lead to disastrous results. lie quotes the work of Bellar- minoflE to prove that solutions instilled into the conjunctival sac pass immediately through the cornea in quantities much larger than if these same solutions were injected beneath the conjunctiva. Up to the present time we have no suffi- cient facts to prove the diffusion of sublimate solutions through the coats of the eye. The diffusion of different soluble substances varies within wide limits, and some of these solutions never penetrate into the Desogen Price anterior chamber at all. The experiments of Tichomeroff with sublimate gave a negative result. If we admit the bactericidal power of sublimate solutions, we must assume that they actually reach the diseased focus — that is, that they must penetrate all the membranes and fluids of the eye uniformly. This would eventually end in such extreme dilution as would be deprived of all antiseptic action. The advocates of the subconjunctival plan of treatment usually inject one twen- tieth of a milligramme at a time. A part of this passes into the general circulation and is lost as far as the eye is concerned; another portion is eliminated into the conjunc- tival sac through the conjunctiva itself. This leaves scarce- ly one third to penetrate into the interior of the eye, or about one sixtieth of a milligramme, which is too minute to possess any antiseptic power. Hence the claims of the partisans of the method by subconjunctival injection, that under its use hypopyon is absorbed very rapidly from the anterior chamber, can not be accepted, for its bactericidal power has been lost by dilution. More can be expected from instilling the solution into the conjunctival sac, espe- cially in cases of corneal ulceration, for the penetration of soluble substances through the cornea is materially favored by loss of its epithelium. In regard to the use of this method in the treatment of sympathetic ophthalmia, its partisans, Darier, Gepner, Pjeunoff, and others, accept Deutschmann's theory as to the parasitic nature of this dis- ease. But it must be remembered that this theory does not explain all the clinical signs nor the mode of develop- ment of sympathetic ophthalmia, and that it is opposed by scientific facts generally accepted, and which can not be re- futed. Deutschmann's theory can not be regarded as sub- stantiated until we can prove that the micro-organisms which cause sympathetic ophthalmia can transport them- selves from place to place, and even travel against the cur- rent of the fluid in which they float. Up to the present time no actual observation has been made of the metastasis of an ocular neoplasm from one eye to another. .Hence sympathetic ophthalmia can not be regarded as due to micro- organisms, but rather as dependent upon certain other factors as yet unknown. Mutermilch sums up his criticism in an epigrammatic way by asserting that, in treating sym- pathetic ophthalmia by subconjunctival injections, we are guilty of a double mistake in trying to destroy organisms 80 BULL: SUBCONJUNCTIVAL INJECTIONS OF MERCURIC BICHLORIDE. [N. Y Med. J«ub., which do not exist by a remedy which has no bactericidal power. He also thinks that Gepner has been guilty of a great error in attributing the success of his treatment of myopic chorioiditis to subconjunctival injections by for- o-etling the conditions in which these patients were, and in neglecting the most powerful of all the factors which favor- ably influence the progress of the disease — viz., the absolute repose of the eye. My own experience has Desogen Cost not been very extensive. Dur- ing the past year I have employed subconjunctival injections of sublimate solutions in the treatment of various diseases of the eye in forty-eight cases, which were classified as fol- lows : Interstitial or parenchymatous keratitis, six eases ; abscess of the cornea with hypopyon, eight cases ; scleritis and episcleritis, two cases ; syphilitic iritis, ten cases ; irido- chorioiditis, syphilitic and non-syphilitic, fifteen cases; traumatic orbital cellulitis, three cases; sympathetic oph- thalmia, two cases; syphilitic neuro-retinitis, two cases. The solution employed was of the strength of 1 to 1,000 and the amount injected at each operation was one twen- tieth of a milligramme, as recommended by Darier. Of the six cases of parenfhyjnatous keratitis, four were instances of unilateral inflammation of the cornea and two were bilateral. The youngest patient was nine years of age and the oldest seventeen. Of the eight eyes involved, three were of the vascularized variety. All were chronic and resisted more or less markedly the usual methods of treatment employed in such cases. The number of injec- tions varied from three to ten at intervals of a week. In three of the eight eves there was severe reaction following the first injection, lasting from four to eight days, but this did not occur after the subsequent injections and not at all in the other cases. In all, the pain caused by the injections was severe and lasted several hours in spite of the free use of cocaine before and afterward. In none of the cases was there any material effect produced by the remedy, either in lessening the severity of the symptoms or in shortening the duration of the disease. Allowing for the marked reaction in three of the eyes, none of the cases were made materi- ally worse by the injections, and all eventually got well on Related links: Albendazole 400 Mg Tablet, Price Erythromycin Gel, Fosamax 70 Mg Daily, Duphaston 10mg Tablet, Purchase Mometasone Online, Diphenhydramine Online, Quetiapine Online, Moxifloxacin Hydrochloride Ophthalmic, Buy Rabeprazole Online, 40 mg cymbalta
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