A NEW METHOD OF TREATING EPISCLERITIS, BY David Webster, M.D., PROFESSOR’ OF OPHTHALMOLOGY IN THE NEW YORK POLYCLINIC SURGEON TO THE MANHATTAN EYE AND EAR HOSPITAL, ETC. NEW YORK. Reprinted from the International Journal of Surgery and Antiseptics. For January, 1888. A NEW METHOD OF TREATING EPISCLERITIS, BY David Webster, M.D., PROFESSOR OF OPHTHALMOLOGY IN THE NEW YORK POLYCLINIC SURGEON TO THE MANHATTAN EYE AND EAR HOSPITAL, ETC. Reprinted from the International Journal of Surgery and Antiseptics, For January, 1888. ■ Press of E. P. Coby & Co., 93 and 95 William Street, New York. A NEW METHOD OP TREATING- EPISCLERITIS. It is not my purpose, in this paper, to discuss the etiology of episcleritis, nor shall I undertake to throw any new light upon its pathology. The physi- cian will find these sufficiently, if not satisfactorily, enlarged upon in the numerous text-hooks upon dis- eases of the eye. Episcleritis is a well known and easily recognized disease. DeWeckcr’s description of it is as good as any. ITe says, it “ appears as a series of circum- scribed centers, around the cornea, forming bulgings, the deep colored injection of which is an important diagnostic sign, enabling us to distinguish episcleritis from other circumscribed inflammations of the con- junctiva, as phlyctenular or pustular conjunctivitis. The bulgings of episcleritis have a dull purple hue, and their greatest elevation is generally at a distance of some two or three millimetres from the corneal margin.” The name, episcleritis, would seem to imply that only the tissues overlying the sclera were inflamed, but the sclera itself is frequently involved in the disease and hence the names scleritis and sclerotitis are often applied to the affection. When the cornea is involved, as is too often the case, the disease may he called sclero-Jceratitis. The disease is generally believed to he due to a rheumatic or gouty diathesis, and runs a course of months or even years. Wells says, “ though not a dangerous affection, 4 episcleritis often proves extremely troublesome on ac- count of the protracted and obstinate course which it runs, and also on account of the tendency to fre- quent recurrence which it often manifests.” The same authority tells us it is “ a rare disease and, as a rule, does not attack both eyes and occurs oftenest in middle life.” He also says “the disease is not only very protracted and obstinate in its course but also very little influenced either by general or local treat- ment.” For the treatment of this disease we find recommended, locally, eye drops of atropine, collyria of chloride and of sulphate of zinc, warm poppy fomentations, the insufflation of calomel and the use of the red precipitate ointment; internally, mercury, iodide of potassium, guiacum, colchicum and the tincture of aconite. The muriate of pilocarpine lias been used hypodermically with good results, and the duration of the disease has been greatly abridged by removing the bulging mass with a sharp spoon. Local massage is said to have effected a cure in some cases. The new method of treatment referred to in the title of the paper is that by the actual cautery. I have applied the actual cautery in three cases with the apparent effect of aborting the disease, or at least, of greatly abreviating its duration. I was led to apply the cautery in a case of episcleritis because of the happy results of its application in ulcers of the cornea and in some cases of vascular keratitis. The result of my first trial of the method of treatment was so unexpectedly good that I employed it in the only other two cases that have since come under my care, and with equally rapid cure of the disease. The 5 importance of a method which cures, in a few weeks, cases of a disease which lingered along for months, and sometimes for years, under former methods of treatment, is such that I need not offer an apology for reporting with some prolixity the cases so treated. Case I.—Mrs. C. E. W., widow, aged 50, came under my care at the clinic at the Manhattan Eye and Ear Hospital in December, 1886. She stated that she had granular lids four yeays previously. In November, 1883, her left eyeball became very red. This redness recurred from time to time until Janu- ary, 1886, when there came a blur before the eye. Since then the eye has never got Avell. She was treated for several months by an “ oculist,” but kept on with her work, except for a few days at a time. When I first saw the patient her left eye presented a marked “bulging” or swelling on its temporal as- pect The cornea had evidently been invaded by the inflammation and there was a large opacity of that portion of its area ad jacent to the episcleral swelling. There was also trichiasis of the left lower lid, R. V.= ; E.; L. V=T2T°o-; no improvement with glasses. I treated Mrs. W. for a time as an out-patient. She was put upon atropine and bathing with hot water locally and iodide of potassium internally. I hoped also, that the change of climate from Colorado to New York would do her more good than medicine. After a few weeks of this treatment she seemed not to have made any progress toward recovery and I therefore caused her to enter the hospital as an in- patient on January 3, 1887. She was then put upon a course of salicylate of soda sweats. She was put to 6 bed once a day, or once every other day, and a solu- tion of salicylate of soda in hot lemonade given her, the dose being repeated every half hour until free diaphoresis set in. The first sweat was produced by no less than one hundred grains of the drug. At each sweat thereafter the quantity of salicylate of soda necessary to produce the desired effect became less until, finally, a single dose of twenty grains in a tumblerful of hot lemonade was sufficient. These sweats were kept up until January 12th, a period of nine days, with a good deal of apparent benefit, but the patient complained so of cramps in the stomach and bowels, palpitation of the heart, and general ner- vousness and prostration that we were compelled to stop them. She was kept in the hospital, and various applications made locally and various remedies given internally until January 29th, when, as the eye had evidently not improved any for a week or two, it was decided to resort to hypodermic injections of muriate of pilocarpine. Three or four of these injections were given her, each producing free sweating and salivation lasting half an hour or more, and each pro- ducing a week or two later an abscess at the point of injection. On February 7th, having rendered the eye insensible by cocaine, I applied the platinum cor- neal cautery at red heat very freely over the summit of the swelling. The eye was then kept bandaged for a few days, and after that, a solution of pilocarpine was dropped into it several times daily and the brow was painted with tincture of iodine. On February 21st, two weeks after the first burning, I reapplied the cautery still more thoroughly, heating it three or four 7 times and laying it on flat-wise so as to burn over a larger area. On February 28th the eye had so nearly recovered that the patient was discharged from the hospital to be again treated as an ont-patient. I saw her once or twice more and dismissed her as cured. On April 1st some weeks after being dismissed, she turned up again, this time with an episcleritis of the right eye. She said that one night about a week pre- viously, she had pain in the head and sneezing and awoke in the morning with both eyes red. The red- ness of the left eye had passed off; but in the right was the