REPRINT FROM- 
Pacific Medical Journal. 
Von. XXXIV. San Francisco, May, .1891. No. 5. 
Original Article. 
REPORT OF COMMITTEE ON OPHTHALMOLOGY AND 
OTOLOGY. 
By GEO. H. POWERS, M. D., Prof. Ophthalmology and Otology, Medical 
Department, University of California, Chairman. 
(Read before the Medical Society of the State of California, April 21, 1891.) 
While the past year has not been marked by any striking dis- 
coveries in the fields of ophthalmology and otology, that can be 
ranked with the introduction of cocaine for instance, steady and 
earnest work has brought about improvement in individual methods 
and a general advance toward the solution of many undetermined 
problems. 
The movement of return to the old-fashioned flap operation 
without iridectomy in the extraction of cataract has become more 
pronounced and general, and to my mind the greatest modern im- 
provement in method has been in relation to the after treatment. 
Those who, like myself, have adopted Chisolm's plan of discarding 
the dark room and bandage, will not readily return to them. I 
will not weary you with a tabulated statement of cases, but simply 
report that I have found entire satisfaction with the extrusion of 
the cataract through the normal pupil after an upward incision in 
the upper third of the cornea, followed by closure of the lids by a 
wide strip of isinglass plaster. When only one eye is operated 
upon I leave the sound eye untrammeled, directing the patient to 
keep it closed quietly when he has no real need of using it until 
the plaster is removed from the operated eye. 282 
Report of Committee on Ophthalmology and Otology. 
In only three cases during the past year have I had any pro- 
lapse of iris disturbing the healing, and in none of these has the 
eye been lost. I allow the patient to sit up and to move about his 
room moderately, and allow light enough to enable the attendants 
to read easily at all times. The comfort of the patient is in this 
way immeasurably enhanced, and I have seen no case in which the 
result has not been at least as good as could have been obtained by 
the old method 
The appearance and rapid growth of intraocular tumors during 
the progress of other disease may well be brought to the notice of 
the general practitioner, as he has charge of the cases before the 
specialist is consulted. I remember five such cases, but will intro- 
duce to you only one of them. An elderly gentleman while suffer- 
ing from typhoid fever had severe pain in his left eye with partial 
loss of vision. At the suggestion of the attending physician, an 
oculist, one of the most accurate observers in San Francisco, was 
called in to examine the eye, and after very thorough investigation 
he declared that no serious lesion existed; and as the patient was 
very feeble the condition of the eye did not receive much more 
attention for a time. Some six weeks later the patient being some- 
what stronger and feeling troubled about the loss of vision, I was 
asked to see him. 
Since the visit of my colleague the pupil of the affected eye had 
become entirely occluded by inflammatory exudation from the iris, 
vision was entirely lost, the tension of the eye somewhat increased 
and there was intermittent pain, with the tortuous enlarged scleral 
veins which are seen in glaucoma. Careful observation of the case 
for a few days brought me to the conclusion that the changes 
which had taken place were to be charged to intraocular tumor 
rather than to simple inflammatory glaucoma, and I strongly ad- 
vised immediate enucleation of the diseased globe. Permission 
being reluctantly granted, I removed the eyeball and submitted it 
to Prof. D. W. Montgomery for examination. 
He found a sarcoma of the choroid at the equator of the globe, 
completely localized, no trace of it being discovered by careful 
search in the other tissues, and was able to assure the patient that 
in all probability the early removal of the diseased eye had saved 
him from the horrors of death from orbital cancer. 
In otology, I would call your attention to the remarkable num- 
ber of cases of otitis media which have accompanied and followed 
the epidemics of la grippe. Many cases have begun during the Report of Committee on Ophthalmology and Otology. 
283 
attack of grippe, but I think I have seen a still larger number 
which have commenced after the other symptoms had disappeared 
or subsided. Many of the cases have been light, and of short dura- 
tion, but a considerable proportion have been of serious import. 
They do not differ from ordinary catarrhal inflammations of the 
middle ear except perhaps in a more than usually sudden onslaught 
and greater persistence. 
The cases to which I have been called early in the attack have 
generally been cut short by a free paracentesis of the membrana 
tympani followed by catheterization through the Eustachian tube, 
inflation by the method of Politzer, suction through the Siegel 
speculum, and the free use of peroxide of hydrogen. 
I have found in almost all cases that antikamnia in doses of 
five to ten grains gave the most satisfactory relief from pain, and I 
no longer give morphia or opium for this purpose. 
In many cases suppuration continues for a time, and polypi or 
granulations appear outside the membrana tympani or exist behind 
it unseen through the small perforation in the membrane. I 
remove those which are visble by the suave or sharp spoon, cleanse 
the ear thoroughly by repeated washings with hydrogen peroxide 
then instill a 20 per cent solution of cocaine followed by a few 
drops of alcohol. 
Introducing then the Siegel speculum by alternate suction and 
inflation the alcohol is forced through the perforation into the 
middle ear and often into the Eustachian tube. When there is 
profuse suppuration I have found great benefit in the use of the 
new agent, styrone, a combination of styrax and balsam Peru. 
When I first saw a notice of the use of styrone in an Eastern 
journal there was none in our market, but at my request Prof. 
Lengfeld made for me an aqueous solution of the two substances 
named, which I used with much satisfaction until the formally pre- 
pared styrone could be obtained, and in comparing results I find 
no marked advantage in the use of the latter except in the greater 
durability of its solution. 
In one case some deep pain, not very severe, not long continued, 
always followed instillation into the meatus, in all other cases it 
was painless. 
In two cases of ophthalmia neonatorum immediate and marked 
diminution of the purulent discharge from the eyelids followed the 
use of Lengfeld's aqueous preparation, and it caused no pain in 
either case. Report of Committee on Ophthalmology and Otology. 
284 
In one case of inflammation of the middle ear following la 
grippe, mastoid abscess followed and compelled operation. 
Perforation of the drum membrane had occurred, and suppura- 
tion was abundant before I saw the case, and although at first it 
seemed that the usual treatment would be effectual, the case proved 
obstinate, and after many fluctuations in condition symptoms of 
intracranial pressure appeared, together with tumefaction over the 
mastoid and in the tissues of the neck. I operated at St. Mary's 
Hospital, evacuating through the preliminary incision a large 
amount of pus from among the muscles of the neck, then opening 
the mastoid by chisel and mallet and releasing a considerable quan- 
tity from its cavity. 
After breaking up the walls of the mastoid cells by Volkmann's 
spoon a stream of water was forced through the meatus from the 
wound. All antiseptic measures were carefully observed. From 
the day of the operation the previously profuse purulent discharge 
from the ear entirely ceased, a steady and painless convalescence 
followed, and in six weeks the patient returned to his duty as a 
police sergeant able to hear the ticking of my watch a half inch 
from his ear without contact.