Dr. J. Madison Taylor.
Bar Harbor, Maine
1994 Hereditary Eye Defects Journ. AMA
June 29 1914
Abstract of Discussion
Col. Frank C. Todd, Minneapolis; Dr. Curdy especially relates this subject to the treatment of glaucoma, and calls attention to the fact that even where the sphincter has been cut, some contraction of the pupil takes place. It is well known that miotics, such as escrin[?], produce the maximum contraction of the pupil, and a maximum contraction of the pupil could not be produced unless two things take place, namely, a paralysis of the fibers that dilate the pupil, and a stimulation of the fibers - that is, of the sphincter - that contract the pupil. So it has this combined action. That is further confirmed by the fact that in the case of paralysis of the sphincter, the use of escrin will produce medium but not maximum contractions of the pupil, because it relaxes the dilator fibers. Then why should we not expect the same effect if the sphincter fibers are cut, when we have a coloboma[sp.?]? that is, a relaxation of the dilator fibers may take place.
This brings us to the practical point of the wisdom of producing a complete coloboma in the operation of trephining for glaucoma. I have thought that I have made some failures to permanently reduce tension where I have made too small an opening in the iris. Perhaps you remember that Elliot considered that iridectomy was of no value in his glaucoma operations, and when the iris did not present he was not in the habit of cutting the iris out. My experience has been that in some of those cases in which a sufficient amount of iris was not removed, the plugging of the hole might take place more readily afterward, and I have preferred to have a large coloboma than to have a very small one. But I do think that ideally the wide coloboma, produced with the Elliot operation, with the retention of the pupil, is more advantageous if only for the fact that we can get more of a contraction of the pupil later by the use of a miotic, if that seems necessary. That is to say, if we can get a coloboma like this (illustrating by means of the blackboard), leaving intact the marginal fibers, we then have an opportunity to produce a maximum contraction of the pupil, if it seems wise, for after treatment to further reduce the tension.
Dr. Robert J. Curdy, Kansas City, Mo.: It is true, as Dr. Todd says, the maximum contraction of the pupil cannot be produced if the sphincter is interrupted, but in the treatment of glaucoma with miotics, we are not trying to produce contractions of the pupil; we are trying to cure the glaucoma, and it is the purpose of this paper to show that miotics can be effective in the treatment of glaucoma notwithstanding the interruption of the sphincter of the iris.
Infant Mortality in the Philippines. - Sixto Y. Orona, M.D. in an article in the November number of Revista Filipina de Medicina y Formacia gives the results of his study of 334 families in Jolo, with a population of 8,287, with reference to infant care and mortality. He shows that the average family has three children, one of whom dies. With reference to feeding, out of 1,117, 924 were breast fed, 109 bottle fed and 84 given mixed feeding. Of the 924 children breast fed 632 lived, 68 per cent; 292 died, 30 per cent. Of 109 bottle fed, 86 lived, or 78 per cent; and 23 died, or almost 21 per cent. Of the 84 given mixed feed, 50 lived, or nearly 60 per cent, and 34 died, or 34 per cent. Thus, he says, notwithstanding the ignorance of the average mother, the percentage of deaths of those artificially fed was 21 or 22 per cent, as against 30 per cent for the breast fed. The bottle fed also had less deaths than those given mixed feeding. Condensed milk is generally employed in artificial feeding. Out of 349 deaths, 163 occurred before the age of 1 month, or nearly 50 per cent; 286 occurred before the child reached the age of 5, or 82 per cent, and 336 deaths occurred before the child reached 15 years, or over 97 per cent. Infantile convulsions is among the chief and first causes of death in infants, and their mothers usually show signs of beriberi, The infant becomes blue and is seized with convulsions. The condition is called "alperesia." Intestinal diseases, malaria and respiratory diseases follow in order of importance as causes of death, and syphilis and malaria are important causes of abortion, of which there are many cases.
The Relation of Hereditary Eye Defects to Genetics and Eugenics*
Lucien Howe, M.D.
Of late years, while trying to learn something about ocular muscles, I have been confronted often by questions concerning heredity. I have found, as others doubtless have, three, four, or even more persons in the same family with a similar form of heterophoria, heterotropia, predisposition to ocular fatigue, or similar abnormal muscular conditions. It seemed impossible to study these anomalies satisfactorily without first halting to learn something about that mystery which we call heredity.
It is understood that "genetics" is a general term including everything that pertains to generation. Heredity is more specific, dealing with "the organic relationship between generations." As defined by Davenport, "it is the phenomenon of the recurrence of traits in blood relatives due to persistence of their determiners in the germ plasm." Eugenics refers, of course, to the improvement of a race by selected breeding.
It is not possible here to give any systematic account of the studies already made of hereditary eye defects, except to mention the classic work by Groenouw[superior]1[end superior], the interesting histories collected by Nettleship, the more recent bibliography by Loeb, the exhaustive articles by him, or those by Libby and others. The point is that we ophthalmologists have been content thus far with reporting family histories without attempting to relate those histories to other facts, now well established by geneticists.
Meanwhile, the science of modern genetics has come into being and has developed rapidly, especially in its relation to defects of the eyes.
Davenport[superior]2[end superior] includes the following conditions: degeneracy of the cornea, anomalies of the iris, glaucoma, displaced lens, cataract, pigmentary degeneration of the retina, atrophy of the optic nerve, night blindness, color blindness, reduction in size of the eyeball, megalophthalmus, myopia, astigmatism, paralysis or imperfect development of the muscles of the eye and lids and mystagmus.
In view of the vastness of the subject and the brevity necessary in our transactions, my object here are to:
1. Formulate a plan by which we may relate our clinical facts to the data of genetics and eugenics.
2. Show how each ophthalmologist can contribute something to ur common fund of knowledge concerning it.
3. Give the results of my own studies thus far in the form of exhibits with the presentation of the paper, and publish those results later, separately. That saves time at the meeting and space in our transactions, but still gives credit, if any there be, to our section for priority in the work shown by the exhibits.
4. Suggest a plan which may prove practical for preventing to some extent heredity blindness.
* Read before the Section on Ophthalmology at the Sixty-Ninth Annual Session of the American Medical Association, Chicago, June 1918.
[superior]1[end superior] Groenouw, in Handbuch der [illegible] Augenbe[illegible], Graefs-Soendbuch, Ed. 2, Part I, pp. 413.
[superior]2[end superior] Davenport, C.B.: Heredity in Relation to Eugenics, New York, Henry Holt & Co., 1911.