REPORT 
07 
TWENTY-FOUR CASES 
07 
|uib treated tig Jquiritg, 
BY 
MYLES STANDISH, M. D. 
Reprint prom the Fifty-eighth Annual Report to the Massachusetts 
Charitable Eye and Ear Infirmary for the Year 1883. 
BOSTON: 
ALFRED MUDGE & SON, PRINTERS, 24 FRANKLIN STREET. 
1884. REPORT OF CASES OF GRANULAR LIDS 
TREATED BY JEQUIRITY. 
BY MYLES 8TANrDISH, M. D. 
First Ophthalmic and Aural Interne. 
The treatment of granular lids and chronic conjunctival in- 
flammations with jequirity promises to be a great relief to the 
wards of charitable ophthalmic institutions, for by it the time 
necessary for the cure of a large proportion of such cases is 
shortened from several months to a few weeks. And inas- 
much as the same result is obtained by a smaller expendi- 
ture on individual patients, insomuch is the usefulness of such 
institutions extended. 
The drug is called jequirity from its Brazilian name, but 
the botanical name is Abrus precatorius. The portion of 
the plant used is the seed, a small, round red bean or pea, 
having a round black mark at the point of attachment to the 
pod. It is found in all tropical countries, but is supposed to 
have been indigenous to India. 
For medicinal use the seeds should not be old, but have a 
bright shining surface. When absolutely fresh the seeds 
have a waxlike, glistening appearance, and the older they 
become the more they lose this gloss. 
Jequirity has for many years been a popular remedy among 
the negroes of Brazil and of the West Indies, but until recently 
has not attracted the attention of the medical profession, 
although in Rosenthal’s Synopsis Plantarum Diaphoricarum, 
published in 1862, on page 1022, an allusion is made to the 
treatment of diseases of the eye by means of this drug. To 
De Wecker, however, is due the credit of bringing this treat- 
ment prominently to the attention of the profession. His 2 
Report of Cases of Granular Lids. 
articles published in the Klinische Monatsb?'utter attracted 
universal attention, and many favorable reports have been 
made by different observers in various countries. A number 
of cases have also been reported in which the drug has had 
no action whatever. These latter cases are, undoubtedly, 
due either to the lact that the seeds were not fresh enough or 
to an error of preparation. Such an error occurred in a scries 
of cases at this institution which will bo spoken of later, in 
which no result was obtained. 
The drug is prepared by macerating the powdered bean 
in water in the proportion of ten grammes of the bean to live 
hundred grammes of water. This must be done with cold 
water and in a large, open-mouthed jar, to allow the free 
access of air. This maceration is continued twenty-four 
hours ; the solution is then filtered and is ready for use. The 
preparation must be freshly made. Chemists have succeeded 
in extracting no active principle which is capable of producing 
the characteristic inflammation of the drug. In a prepara- 
tion made as above described, if examined within a few days, 
there will be found large quantities of a bacillus, and Prof. 
H. Sattler in a paper published in the Klin. Monatsbl. fur 
Augenheilkunde, June, 1883, attributes the inflammation to 
the bacilli, and the spores produced by them. Temperatures 
above 36° C. interfered with the development of the bacillus, 
and boiling makes the infusion useless. If, however, it is again 
exposed to the air, a weak and not very effective crop of 
bacilli develop themselves. The infusion, if allowed to stand, 
becomes thick and the odor changes from that proper to the 
jequirity to one of putrefaction, and then purifies itself, and 
if then used upon the conjunctiva is inocuous. Sattler suc- 
ceeded in cultivating the bacillus in various soils, such as gel- 
atinized blood serum, etc., and the cultivated bacilli after 
several generations produced an ophthalmia resembling in all 
particulars that produced by the original jequirity infusion. jReport of Cases of Granular Lids. 
3 
A jequirity infusion made entirely free from spores, an ordi- 
nary jequirity infusion, and a pure crop of the specific bacil- 
lus, were each injected under the skin by this observer. In 
the first instance there was a mere temporary local swelling, 
but in the other two cases an abscess was produced contain- 
ing cheese-like matter and large quantities of the bacillus. 
Thymol one part to 1,100 rendered the infusion useless. 
Corrosive sublimate one part to 1,100 prevented the develop- 
ment of the bacillus, but did not destroy the spores nor pre- 
vent the ophthalmia. Iodoform had no antiseptic action what- 
ever. A somewhat similar bacillus is found in an infusion of 
peas, but it has not the action upon the conjunctiva produced 
by the jequirity infusion, and Sattler’s conclusion is that 
there exists a widespread bacillus which acquires from the 
jequirity its specific action and retains this activity through 
succeeding generations. A series of eight cases occurred at 
Co o 
this institution in which the drug either produced no inflam- 
mation, or a very slight one, and it was afterwards discovered 
that the apothecary had made the infusion in each case in a 
closed jar. These cases are not included in the table which 
follows. The method of application at this institution has 
been to give the patient a few drachms of the infusion and 
have him sop the eye with it for fifteen minutes, then the 
attendant would evert the lids and pass a camel’s-hair brush 
wet with the infusion rapidly two or three times across the 
conjunctiva of both lids but this latter application after the 
ophthalmia has somewhat advanced is a painful operation, and, 
moreover, seems to be entirely unnecessary. The applica- 
tions were made three times a day. Dr. Fourcher in U Union 
Med. du Canada, No. 9, 1883, advocates using the powdered 
drug dusted into the eye, but admits if any of the particles 
are allowed to remain in the eye disastrous results sometimes 
follow. 
Jequirity ophthalmia, while resembling to a certain extent 4 
lieport of Cases of Granular Lids. 
an ordinary purulent ophthalmia, has some distinct differences. 
About three hours after the tirst application a watery dis- 
charge commences, and in the course of twelve hours this has 
very materially increased and become of a grayish color; at 
the end of twenty-four hours a delicate, smooth, thin, white 
membrane will be found spread over the palpebral conjunctiva 
and reflected somewhat upon the globe ; this becomes thicker, 
and at the end of forty-eight hours peels off in thick shreds 
and patches. The membrane appears to be of a croupous 
character. Where no previous pannus existed the cornea 
frequently becomes covered with a thin, transparent gray 
film. The discharge is at this time profuse and thick with 
clotted pus. There is considerable oedema of the eyelids, 
often accompanied by photophobia and pain which latter 
often spreads up over the temporal region. The local inflam- 
mation is accompanied by a fever, having a rise of tempera- 
ture of one degree Fahrenheit, and often connected with loss 
of appetite and dizziness. Immediately upon the discontin- 
uance of the applications the severity of the symptoms abates, 
and the patient is generally very comfortable, both as to local 
and general condition, at the end of twenty-four hours. The 
ophthalmia is never communicated from one eye to the other. 
The recovery is progressive and at the end of ten days the 
lids are smooth and patients report that the feeling of rough- 
ness is all gone. If then discharged from the institution they 
invariably do well and report themselves six months after- 
ward as perfectly well. If, however, they are retained in 
the institution five or six weeks longer they acquire what 
seems to be an entirely new crop of fresh exuberant granula- 
tions. The use of atropine seems to have a tendency to 
induce a return of the granular condition. The marked 
superiority of jequirity ophthalmia over inoculated purulent 
ophthalmia is due to the fact that in the former we require the 
stimulus of repeated applications to continue the inflamma- jReport of Cases of Granular Lids. 
5 
tion, and that upon the discontinuance of these applications 
the onward course of the disease is immediately checked. 
De Wecker and other writers on this subject state that 
there is no danger to the cornea from the use of this drug. 
This does not seem to be strictly true, if the drug is used 
upon all cases of granular lids, as they present themselves. 
The experience at this institution is, that out of twenty-four 
cases of jequirity ophthalmia treated in the year which this 
report covers, seven cases were followed by ulcerations of 
the cornea of a more or less serious character. These ulcer- 
ations, it is true, did not come on during the applications of 
the drug, but as they followed invariably in the cases in 
which there was the largest amount of corneal disturbance, 
and in those cases in which there was the largest amount of 
peri-corneal conjunctival chemosis, I think that the jequirity 
inflammation may be fairly assigned as the cause. These 
ulcers appeared in from two days to two weeks after the dis- 
continuance of the applications, they were generally in 
groups, and marked by deep loss of substance, with clear- 
cut, clean facets; sometimes — although this- was excep- 
tional — they were preceded by grayish points of infiltra- 
tion ; they were generally above, and somewhat peripheral in 
situation, and in one case the ulcers perforated. They in 
each and every case yielded to treatment, after a protracted 
course, without any disastrous consequences. The perforat- 
ing ulcers were the only ones that left any dense corneal 
opacities. From an analysis of the cases, the causes of this 
corneal complication woidd seem to be, — 1st, A previous 
ulcerative tendency of the cornea of a serious character. 2d, 
Granulations of such an exuberant character that when the 
oedema of the lids is superimposed, the fulness of the lids 
produces a decided pressure upon the globe. and especially 
upon the cornea. 3d, When the ophthalmia produces excess- 
ive chemosis of the ocular conjunctiva. 4ih, When the 6 
Report of Cases of Granular Lids. 
cornea has received previous injuries from burns, lime, acids, 
etc. The above conclusions are in part drawn from a consid- 
erable number of cases treated in the house since Oct. 1, 
and consequently not included in this report. It would 
be well, in this connection, to remember that experiments 
upon rabbits are reported in which, by the continued use 
of strong infusions, necrosis of the cornea has been 
produced. 
Cases 14 and 15 are second trials on cases previously enu- 
merated as cases 4 and 5. Our experience of the repeated 
use of the drug is certainly not favorable. Cases 4, 5, and 
6 had previously experienced burns of the cornea. It will 
be noticed in the above table that chronic cases were much 
more improved by the use of this drug than acute cases or 
chronic cases in a stage of acute exascerbation. If the cases 
which have been treated since Oct. 1 had been introduced 
into the table, the percentage of complete recoveries would 
have been very much higher, as latterly acute cases have 
been excluded from this method of treatment. All the cases 
that were discharged, well or improved, were written to 
six months after leaving the house ; and, so far as heard from, 
reported themselves as well and engaged at their usual occu- 
pations. Benefit seems to be derived from this treatment by 
nearly all cases of true granulations, pannus, and papillary 
hypertrophy, following chronic inflammations. The cases in 
which it seems undesirable to use it are those in which 
danger to the cornea is apprehended from previous injuries or 
serious ulcerations; also in cases of acute florid granulations, 
with gre it fulness of the upper lid, as viewed externally. In 
these cases there is not only danger to the cornea from the pres- 
sure of the lids produced by the inflammation, but also this 
very pressure seems to prevent the inflammation from extend- 
ing up the entire surface of the conjunctiva of the upper lid, 
for when the oedema has abated a border extending about Report of Cases of Granular Lids. 
7 
four millimetres from the edge of the lid will be found to he 
smooth, and from there back to the retro-tarsal fold the 
granulations will be seen to be untouched. Jequirity 
ophthalmia is certainly a very rapid method of clearing up 
a thick chronic pannus, and produces a satisfactory and 
permanent cure of chronic granulations and old papillary 
hypei trophy. No. 
- Age. 
Occupation. 
Duration of 
Disease. 
Time in house after 
applications of Je- 
quirity. 
Condition of Con- 
junctiva. 
Pannus. 
Vision before Treat- 
ment. 
Vision after 
Treatment. 
No. of 
Appli- 
cations. 
Corneal Complications. 
Pain, Lachrymation, and other 
acute symptoms before ap- 
plication or Jequirity. 
Result on Conjunctiva. 
Result on Pannus. 
1 
39 
years. 
Domestic. 
15 years. 
21 days. 
Fine red granula- 
tions. 
Entire cornea opaque. 
Vod. 
= 0.01 
Vod. = 0.1 
10 
None. 
None. 
Smooth. 
Nearly disappeared. 
2 
13 
it 
School-girl. 
9 “ 
21 “ 
Large rough gran- 
ulations. 
Upper half of cornea 
opaque. 
Vod. 
Vos. 
= 0.016 
= 0.05 
Vod. = 0.2 
Vos. = 0.3 
9 
it 
A few sharp granula- 
tions. 
Entirely “ 
3 
14 
tt 
Domestic. 
1 “ 
Developed rubeola 
in house. 
Fine red granula- 
tions. 
Thin grayish pannus of 
entire cornea. 
Vod. 
Vos. 
= 0.1 
= quantitative. 
Vod. = 0.1 
Vos. = 0.1 
9 
ft 
Considerable. 
Smooth. 
Nearly “ 
4 
21 
ft 
Rubber-worker. 
6 “ 
Retained in house 
for a second trial. 
Coarse red granu- 
lations 
Thin grayish pannus of 
upper half of cornea. 
Vos. 
= 0.1 
V os. = 0.05 
10 
ft 
Considerable, with swell- 
ing of upper lid. 
Granulations remained. 
Increased. 
5 
34 
tt 
Mason. 
15 months. 
Retained in house 
for a second trial. 
Fine red granula- 
tions. 
Thin grayish pannus of 
upper half of cornea. 
Vos. 
Vod. 
= 0.3 
= 0.1 
Vos. = 0.3 
Vod. = 0.1 
9 
Great. 
Not improved. 
Not improved. 
6 
38 
ft 
Shoemaker. 
6 “ 
30 days. 
Coarse granulat’ns. 
Vascular pannus, upper 
half of cornea. 
Vod. 
= 0.016 
Vod. = 0.02 
9 
Small ulcer. 
* 
Granulations remained, 
but reduced in size. 
Nearly disappeared. 
7 
34 
tt 
Baker. 
16 “ 
35 “ 
Coarse and fine 
granulations. 
Upper half of cornea 
opaque. 
Vos. 
= 0.1 
Vos. = 0.6 
9 
None. 
None. 
Smooth. 
Entirely 
8 
26 
tt 
Laborer. 
4 years. 
30 “ 
Coarse granulat’ns. 
Thin gray pannus over 
entire cornea. 
Vod. 
= 0.01 
Vod. = 0.08 
12 
Slight. 
ft 
tt it 
9 
22 
tt 
Domestic. 
2 “ 
21 “ 
Fine “ 
Thin pannus, upper half 
of cornea. 
Vod. 
Vos. 
= 0.1 
= 0.008 
Vod. = 0.4 
Vos. = 0.1 
9 
tt 
None. 
tt 
tt it 
10 
10 
tt 
School-girl. 
4 “ 
14 “ 
ft tt 
Dense pannus over up- 
per half of cornea. 
Vod. 
Vos. 
= 0.3 
= 0.1 
Vod. = 0.4 
Vos. = 0.3 
9 
it 
tt 
ft 
Nearly “ 
11 
60 
tt 
Housewife. 
3 “ 
15 “ 
Coarse “ 
Thin grayish pannus 
over up’r half of cornea. 
Vod. 
= 0.08 
Vod. = 0.4 
8 
ft 
ft ft 
12 
38 
it 
Shoemaker. 
7 months. 
60 “ 
Fine red “ 
Thin grayish pannus of 
upper third of cornea. 
Vod. 
= 0.1 
Vod. = 0.3 
8 
Ulcer of cornea. 
Great. 
Some granulations re- 
maining. 
tt tl 
13 
34 
tt 
Baker. 
6 “ 
3 months. 
<< ft it 
Slight pannus above. 
Vod. 
= 0.3 
Vod. = 0.3 
8 
do. do. 
tt tt 
14 
21 
a 
Rubber-worker. 
6 years. 
5 “ 
Coarse red “ 
Thick pannus over centre 
of cornea. 
Vos. 
= 0.05 
Vos. = 0.05 
8 
it ft 
Considerable. 
Granulations remained. 
Not improved. 
15 
34 
tt 
Mason. 
15 months. 
3 “ 
Fine red “ 
Vascular pannus over 
upper half of cornea. 
Vos. 
Vod 
= 0.3 
= 0.1 
Vos. = 0.1 
Vod. = 0.05 
9 
Many ulcers of cornea, one 
of which perforated. 
Great. 
tt ft 
Vascular pannus ex- 
tended. 
16 
21 
tt 
Weaver. 
8 “ 
11 days. 
Coarse whitish 
granulations. 
Thin gray pannus, up- 
per half of cornea. 
Vod. 
= 0.1 
Vod. = 0.3 
9 
None. 
None. 
Smooth. 
Entirely disappeared. 
17 
18 
19 
22 
18 
16 
tt 
tt 
tt 
Dyer. 
Mason. 
Orphan. 
1 year. 
18 months. 
1 year. 
15 “ 
13 “ 
25 “ 
Old granulations. 
Fine “ 
Old 
Thin gray pannus, up- 
per third of cornea. 
None. 
None. 
Vos. 
= 0.1 
Vos. = 0.2 
9 
9 
9 
it 
tt 
tt 
No pannus. 
tt it 
20 
50 
tt 
Pauper. 
5 years. 
20 “ 
tt tt 
Thick whitish pannus 
over upper half. 
Vod. 
Vos. 
= 0.1 
= 0.05 
Vod. = 0.2 
Vos. = 0.2 
9 
9 
ft 
Pannus much thinner. 
21 
32 
a 
Housewife. 
3 “ 
3 months. 
Large, profuse red 
granulations. 
Old granulations. 
Vascular pannus, upper 
half of cornea. 
Vod. 
= 0.1 
Vod. = 0.01 
9 
Several severe ulcers of 
cornea. 
Great. 
Granulations still re- 
main. 
Thickness and vascularity 
of pannus increased. 
22 
33 
tt 
Mill hand. 
2 “ 
19 days. 
Thin gray pannus, up- 
per third of cornea. 
Vos. 
Vod. 
= 0.1 
= 0.2 
Vos. =03 
Vod. = 0.4 
9 
None. 
None. 
Smooth. 
Entirely disappeared. 
23 
18 
n 
Diver. 
2 “ 
19 “ 
“ “ 
do. do. 
Vod. 
= 0.2 
Vod = 0.4 
9 
“ 
it 
tt tt 
24 
51 
n 
Domestic. 
1 “ 
In house. 
Large, profuse red 
granulations. 
do. do. 
Vod. 
= 0.2 
Vod. = 0.1 
9 
Several small ulcers of 
cornea. 
Great. 
Granulations still re- 
main. 
Increased.