Reprinted from 
Codex Medicus, November, 1805. 
A Clinical Study of Three Hundred and Fifty-Four Cases of 
Foreign Bodies Situated on and in the Cornea. 
By Charles A. Oliver, A. M., M. D. 
Attending Surgeon to Wills Kye Hospital; Ophthalmic Surgeon to the Philadelphia and Presbyterian 
Hospitals; Honorary Member of the Northern Medical Association, etc. 
THE following study of this type of common, yet by no means insigni- 
ficant, cases has been made by the writer in the belief that it may 
(as it has to him) prove of interest, not only to the ophthalmic 
surgeon who is more often called upon to treat them, but to the general 
practitioner who frequently has to assume the charge and care of this one of 
the most ordinary.of eye affections. 
Without attempting to study the literature of the subject, with which 
he is fairly well conversant, he has, through the kindness of one of his friends 
and assistants, Dr. Samuel J. Gittleson, of this city, made an analysis of 
three hundred and fifty-four cases, that he has personally seen at Wills Eye 
Hospital, thus offering a sufficient number of instances for some important 
and useful generalizations. These analytical tables, with their conclusions, he 
here presents in brief, as expressive of his individual findings, and with- 
out a word of comment upon the more extended and better work of others in 
the same direction, he offers the following findings as his contribution to the 
subject. This he does with the hope that others who may be better 
equipped than he, may help to bring the subject-matter, as here given, to a 
fixed certainty. 
Table I, showing the occupations of the patients, divides itself into 
thirty-nine classes. Of these, it soon will be seen by careful study, the 
greatest percentages, as might be expected, exist amongst those whose busi- 
ness exposes them to flying pieces of metal, stone and dirt. 
OCCUPATION OF CASKS. 
TABLE I. 
Machinists, 72 
Laborers, 33 
Blacksmiths, 23 
Stone Cutters 21 
Houseworkers, 19 
Carpenters, 16 
Drivers, 14 
Schoolchildren, 12 
Sheet Iron makers, 12 
Boiler makers 11 
Mechanics 9 
No occupation (adults) 9 
Brakemen, 8 
Brass fitters, 7 
Engineers, 7 
Operators, 7 
No occupation (children), 6 
Plumbers, 6 
Buttonmakers 5 
Conductors 5 
Trimmers, 5 
Clerks, 4 
Grinders, 4 
Moulders, 4 
Sailors 4 
Weavers 4 
Cooks, 3 
Glass workers, 3 Last makers, 3 
Pipe fitters, 3 
Printers, 3 
Barbers, 2 
Bar tenders, 2 
Lawyers 2 
Music Teachers, 2 
Bootmakers, i 
Confectioners i 
Milliners, i 
Sawyers, i 
Total number of cases 354 
Here it will be seen that machinists, who comprise more than twenty 
per cent, of the cases are closely followed by ordinary day laborers with 
over nine per cent., blacksmiths with nearly six per cent., and stone cutters 
almost six per cent. As the exposure-series of occupation lessen, so in direct 
proportion do the number of cases. 
Table II which shows the average number of males and females affected, 
TABLE II. 
SEX OF CASKS. 
NUMBER OF CASES. 
Males, 
321. 
Females, 
33- 
Total No. of cases, 
354- 
is of great interest as graphically illustrating the vast preponderance of 
males over females ; the proportion between the two being almost ten times 
greater for the males. 
To attempt to throw additional light upon the assertion of previous 
investigation—that by reason of preponderant riglit-liandness, etc., the left 
cornea is the one that is the more frequently injured,—Table III has been 
constructed. 
TABLE III. 
CORNEA INJURED. 
NUMBER OF CASES. 
Right, 
153- 
Left, 
201. 
Total No. of cases, 
354- 
A glance at this shows that the left cornea, as proved by Cohn, Ottinger 
and others, has been the one that is more frequently affected ; the injury 
to the left cornea having occurred in four-sevenths of the total number of 
cases. 
Study of the position of the foreign body upon the corneal membrane 
gave rise to Table IV. 
TABLE IV. 
POSIT’N OF FOREIGN BODY. 
NO. OF CASES 
Up and in, 
34- 
Up and out, 
16. 
Down and in, 
162. 
Down and out, 
91- 
Central, 
Si. 
Total No. of cases, 
354- This distinctly shows that nearly one half of the foreign bodies were 
situated down and in ; the next point of election being down and out, then 
central, followed by up and in and up and out. 
Thinking that a study of the seasons when the greatest and the least 
number of cases appeared at the clinical service, might be of some interest to 
the practical clinician, the writer has arranged Table V. 
TABLE V. 
SEASON OF YEAR. 
NUMBER OF CASES. 
Spring, 
77- 
Summer, 
155- 
Autumn, 
23- 
Winter, 
99- 
Total No. of cases, 
354- 
As was to be expected, the summer months gave the largest proportion 
of cases. Curiously, these were followed by the winter months ; the spring 
and autumn months coming last. 
The conclusions that these tables teach us may be summarized as follows : 
1. Occupations, such as those of machinists, day laborers, black- 
smiths, stone cutters, etc., where there is the greatest exposure to small and 
dense flying objects, as chips of metal and bits of stone, give the greatest 
number of patients with foreign bodies situated on and in the corneal mem- 
brane. 
2. As their various occupations subject males to greater risks of injury 
to the cornea than is the case with females, the former furnish by far the 
greatest number of patients with foreign bodies situated on and in the corneal 
membrane. 
3. Probably by reason of preponderant right-handedness and on 
account of the angle at which the escaping particle is driven off the broken 
substance, the left cornea is in the majority of instances the one which is the 
most frequently injured by the receipt of a foreign body on or in its tissue. 
4. By reason of reflex action operating to suddenly close the eyelids 
and roll the eye-ball upwards and outwards, when the corneal membrane is 
struck by some foreign object, in association at times, with an immediate 
hypersecretion of tears which would necessarily carry any foreign sub- 
stance, which has not penetrated the membrane down and in towards the 
canaliculi, the lower inner corneal quadrant is the portion of the cornea 
which is usually injured by the stroke of a foreign body on or in its 
substance. 
5. Probably by reason of more constant out-of-door living and employ - ment and the prevalence of dry and dusty weather during this season, the 
summer time of the year gives the greatest number of cases of injury to the 
cornea from foreign substances situated on or in its membrane. The crisp, 
clear atmosphere of winter, as contrasted with the rainy season of spring and 
the dampness and slush of fall which render fewer the number of flying 
particles in the air, affords possibly one of the most important reasons why 
the number of cases of injury to the cornea from foreign substances situated 
on or in its membrane, is greater during this season than it is during the 
other two seasons.