Fee. '1904-]
CHOLERA IN PIUBI TOWN ‘AND DIsPRict.
No one even dares to bathe in the Sweta- gangar, but each one of the other three tanks would then have a rest of two weeks in every three, and the action of the sun and air would considerably reduce the number of cholera germs and allow the bacteria in the water time to ehange the harmful organic matter present into harmless inorganic.
4th.—That it ba impressed upen the temple authorities the importance of supplying good ‘* Mahaprasad ;” the water used in boiling the rice should be beyond suspicion.
5th.—The immediate notification of a ease of cholera to the Health Officer, so that measures for disinfection of the place and removal of the patient to the cholera hospital may be effected.
At the Cholera Hospital patienta were placed © on straw mattresses, which could afterwards be burnt; every precaution to prevent dissemi-. nation was rigidly carried out, vomited matter : and stools were destroyed in an incinerator, hoe-. pital blankets, &e., were regularly. steeped in per- ehloride and boiled, and the floors were frequens- ly washed with lime-water, whilat the clathing of patients on discharge was burnt and new clothing given them. SS
During the first stage and previous to col- lapse setting in, patients are ordered the fallow- ing mixture:—
,
By Acidi Sulphurici dil. ... m. 20 Chiorodyne . «. m. 20 Tinct. Capsicj ... win, 5
Aquam Menth, Pip. ad 3j
Bie. One dose every two hours. —
During collapse, heat is supplied by means. of warm blankets, and hot battles are applied to the feet, thighs and sides of the chest; an injec- tion of ether and strychnine is given when, required, and the following mixture ordered :—
BR ! Tinct. Nucis Vomice - - mm 5 Spiritus Btheris Sulpharici ...m. 20 Rum wee va. oo. Si] Aquam Chloroformi ad . } M
Big.
One dose every two hours, During the stage of reaction, the following mixture is given :—
Tinct, Digitalis om. 5 Spiritus Etheris Nitrosi .. m, 10 Tinct. Capsici m 6 Inf. Chiratee ad a M
One dose every four hours.
In convalescence, patients are again ordered the sulphuric acid mixture and a powder containing lead acetate, opium and grey powder, which gives a good result. Light nutritious food, such as milk, sago and arrowroot, is given frequently in small quantities, whilst barley water is given to the patients when thirsty at any time during the attack.
SYMBLEPHARON AND ITS TREATMENT : TWO CASES TREATED SUCCESSFULLY BY TRANSPLANTATION OF FLAPS OF MUCOUS MEMBRANE FROM THE MOUTH.
By HARRY GIDNEY, F.R.C.S, (EDIN.). D.P.H. (CAMB.), CAPTAIN, I.M.S.
SYMBLEPHARON, ag is well known, is a disease which consists of a pathological adherence of one or both eyelids either partial ov complete to the eye-ball, The cornea may or may not participate in this adhesion but it usually is somewhat implicated, and this adhesion, between the eyelid and cornea, is called by some “Traumatic Pterygiam.” When, besides this eondition of affairs, the two eyelids adhere to each other it is called anklyoblepharon.
This disease is usnally the result of some very ‘strong irritant, or caustic, gaining access to the eye, and is generally accidentally produced, such ag by molten lead, caustic alkalis, strong »ijneral acids, lime, boiling water, ete. It may also result from a severe burn of the eye, ar the cayeless and injudicious use of very strong astringent applications as nitrate of silver, &e. Diffuse uloeration and consequent sloughiug of the internal aspect of the eyelid may be the exciting cause, or a trauma to the eye which produces a complete denudation of the conjunc- tiva of the part.
The amount of destruction of the conjunctiva, in this disease depends on three factors chiefly, viz. (a) the strength of the irritant or trauma for the stronger the irritant the more fatal and complete the destruction; and (0) the length of time the irritant has had to act on the parts. Even very powerful irritants and caustics if removed at once from the eye produce very little destruction, and that only of a superficial nature. And (c) the extent or area of the conjunctiva that has been acted on by the irritant.
Before adhesion can take place between the _ eyelid and eyeball at any part, there must be total and complete destruction and disappear- ance of the conjunctiva of the part. The pro- cess is generally as fullows:—The oeular and palpebral conjunctives being destroyed or burnt (where the action is slight and superficial the epithelium is thrown off, and regeneration takes place), a slough forms which in time separates and granulations spring up from the opposing raw surfaces, These unite and in the course of time develop into fibro-cicatrical tissue which produces a firm attachment of the lid to the eyeball. The train of events is similar to that which occurs in healing by second in- tention of any other wound of the body.
Should the adhesions be confined ta only a | small area it results in the development ofa band
or bands, narrow or broad, stretching from the lid to the eyeball.
When the cornea is included in the adhesions, the dangers are increased and the prognosis less
