BY ROBERT S. OGLESBY,
Assistant Demonstrator of Anatomy in the Leeds School of Medicine.
Strumous Ophthalmia, associated with herpes of the face, or as it may be termed the herpetic form of strumous ophthalmia, is a disease so often met with in general practice, and one so little amenable to local treatment, that I venture to say a few words regarding its treatment constitutionally. I should hesitate to occupy valuable time and space with what appears to be a trivial subject, on which much has already been written, did I not believe that by so doing additional light might be thrown upon the subject. For several years past I have been collecting evidence, carefully sifting and placing all well-marked cases aside for special treatment. The results obtained in the earlier batches of cases thus treated, decided me to continue such treatment for a lengthened period. The evidence thus obtained being highly satisfactory, other treatment formerly employed was abandoned.
During the time that has since elapsed, I have continued to employ the same remedy with the same good results.
This form of the disease generally presents itself in fat, red-faced children who have the appearance of robust health. On questioning the parents, they will perhaps inform you that the child was but small and puny at birth, and for the first few months of its life it was sickly and delicate, and not until lately had it become so stout and healthy. They attribute the change to the purer air the child now breathes, for they have removed from a populous and unhealthy district to one less crowded and decidedly more healthy.
In such a child we find traces of constitutional defect in enlarged and rickety joints, a head big and ill-shapen, and an anterior fontanelle not completely closed. We find a thick and prominent lip, conspicuous for the extent of mucous membrane it shows.
The intolerance of light is so intense that the child cannot bear even a moderate degree, but persists in burying its face in its hands, or hiding from the light in some dark corner. But what strikes us so forcibly, and what really is so characteristic of the case, is the fact that the patient’s face is disfigured with patches of herpes,—a fact which makes us hopeful, as these cases are as a rule the most amenable to treatment. To cure the disease of the skin is to cure the disease of the eye in the most rapid and satisfactory manner.
In the majority of the cases which have come under my care, the eruption was confined to one-half of the face below the brow. In a small proportion the side of the nose was not affected, and in several the skin of the upper lip and chin escaped altogether. The vesicles in most of the cases appeared to follow the course taken by those branches of the infra-orbital nerve which supply the skin of the face.
My notes do not supply me with any case where the eruption invaded the brow, although I may have overlooked some such case in my earlier investigations on the subject. The eruption was often accompanied by a febrile condition more intense than I have ever met with in the other forms of strumous ophthalmia.
Before proceeding to active treatment, instructions regarding diet, regulation of the bowels, &c. should be given. The diet should be plentiful, simple, and nutritious; and all articles of food likely to unduly tax the digestive powers (which are as a rule weak in such children) should be carefully avoided. Strict attention should be paid to the bowels, which ought to be opened at least once during each day, but oftener if the appetite be faulty, the tongue loaded, and the fæces light coloured and of bad odour. These preliminary instructions having been attended to, special treatment may be adopted.