SUBSCRIBERS TO TRANSACTIONS AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-00926A003000050013-1
• Release Decision: RIPPUB
• Original Classification: C
• Document Page Count: 161
• Document Creation Date: December 14, 2016
• Document Release Date: February 26, 2002
• Sequence Number: 13
• Publication Date: January 29, 1951
• Content Type: REPORT

COUNTRY
ApproveOWk2 dM'NOD1188 ; ffl&p ~ , ,1Q 6 40C(~,3 00050013-1
CENTRAL INTELLIGENCE AGENCY ~'~~ REPORT NO
INFORMATION REPORT CD NO.
China/Czechoslovakia/Poland/USSR
2'5X1 A
CASE I I 25X1 A
DATE DISTR. 2 q Jan 1951
SUBJECT Subscribers to Transactions American Academy of NO. OF PAGES
Ophthalmology and Otolaryngology
PLACE
ACQUIRED
DATE
ACQUIRED BY SOURCE
DATE OF INFORMATION
25X1A
NO. OF ENCLS.
(LISTED BELOW)
SUPPLEMENT TO
REPORT NO.
25X1X
The foil owing-is a list of individuals and institutions in China, Czechoslovakia,
Poland and the USSR now subscribing to, F_ I 25X1
regularly receiving, the Transactions American Academy of Ophthalmology and
Otolaryngology:
Dr Louis WS Chang
The Methodist Hospital
Fatshan, Via Canton
Kwangtung, China
Lekarske Knihkupectvi
Sokolska 31
Praha II - Czechoslovakia
Glowna Biblioteka Lekarska
Prof Dr Antonin Precechtel Chocimska 22
Otolaryngologicka Klinika Warszawa, Poland
Karlovy University Prague II
Vseobecna nemocnice USSR Moskva/l97ul, Kominterna
Czechoslovakia 3 Knigoobmen Gosudarstvennoj
Biblioteki SSSR imeni Lenina
Orbis - Newsagency Sect. of International Exchange of the
Stalinova 46, Praha XII All-Union Lenin Library
Czechoslovakia USSR
ZA-vailable on loan from the CIA Library is the November-December 1950 issue
of Transactions American Academy of Ophthalmology and Otolaryngology.7
25X1A
CLASSIFICATION CONFIDENTIAL/US OFFICIALS ONLY
Approved or Release - _ - IUMUOUU13-11
 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
r;ONFICENilAL
OFFICIALS ONLY
THIS IS AN ENCLOSURE I
DO NOT DETACH
TRANSACTIONS
AMERICAN ACADEMY
Of
OPHTHALMOLOGY
and
OTOLARYNGOLOGY
NOVEMBER - DECEMBER
1950
'T j
WEI
LIB ARY
Printed bimonthly, February, April, June, August, October, and December, by the
Douglas Printing Company, 109 North 18th Street, Omaha 2, Nebraska, for the
American Academy of Ophthalmology and Otolaryngology. Editorial and business
office, 100 First Avenue Building, Rochester, Minnesota. Subscription price $5.00
yearly to members, $10.00 yearly to non-members. Entered as Second-Class Matter
November 28, 1938, at the Post Office at Omaha, Neb., under Act of March 8, 1879.
ANNUAL MEETING OCTOBER 14-19, 1951, CHICAGO
25X1A
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 Approved For Release 2002/07/24: CIA-RDP8Q-00926A003000050013-1
new
topical
therapy
SULFAMYLON - 4-aminomethylbenzene-
sulfonamide, a new sulfonamide compound which
is not inhibited by para-aminobenzoic acid -
effectively controls upper respiratory, ocular and
wound infections. Sulfarnylon is bactericidal
for a wide range of gram negative and gram positive-
bacteria including anaerobes (gas gangrene).
Applied topically by swab, instillation,
irrigation, atomizer or wet dressings.
Sulfamylon hydrochloride available in I per cent
solution, bottles of 1 fl. oz. and 8 fl. oz.
Also in combination of 100 cc. vials
of 5 per cent solution with vial
of Streptomycin sulfate 20,000 units.
I
Sulfamylon
EFFECTIVE TOPICAL ANTIBACTERIAL
1
INC.
NewNew YORK, WINUTgI, OM.
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 ~ 7"N
Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1
a
and for INC.
SHURON OPTICAL Co.,
a N. Y.
for Christmas-1"' ' ' ?
ll the months to come t
Genev
Established in 1864
Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1
 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
Authentic Instruments for Otorhinolaryngology
Specialists in all fields of medicine look
to Pilling for new and important in-
struments to facilitate therapeutic pro-
cedures and enhance diagnostic skill.
Since 1814, leading surgeons and
physicians have consulted Pilling-
confident that Pilling craftsmen would
create to their specifications precisely the
instruments they desired.
Of special interest to the otolaryngolo-
gist is the Hollender Pharyngoscope,
drawn in situ above. Designed for use in
both diagnosis and treatment, this
pharyngoscope is long enough for all
HOLLENDER PHARYNGOSCOPE $445.00, BATTERY CORD $4.00
oral cavities ... provides a wide, unob
structed view of the nasopharynx. Place-
ment is comparatively simple and
retention is comfortable for long periods
of time. Preliminary anesthesia is only
occasionally required. Direct or indirect
illumination may be used.
Shown with the Hollender Pharyngo-
scope is the Hartmann Extra-Long
Punch, supplied with circular, oval or tri-
angular bite. These punches feature the,
built-on basket for retaining punched-
out tissue. The lumen of the pharyngo-.
scope permits their ready passage.
Order instruments direct from
weeve 1 . JPI anal 9002 OW9
3451 WALNUT STREET
Philadelphia
PILLING FOR PERFECTION in surgical instruments
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
TRANSACTIONS - NOVEMBER - DECEMBER, 1950 III
TABLE OF CONTENTS
THE OCULAR FINDINGS OF INTRACRANIAL TUMOR: A STUDY OF 358 CASES.. .
MANOUSOS ANGEL PETROIIELOS, M.D., Ann Arbor, Mich.
BY INVITATION
PAGE
89
and
JOHN WOODWORTH HENDERSON, M.D., Ann Arbor, Mich.
NEMATODE ENDOPIITHALMITIS ........................................ 99
HELENOR CAMPBELL WILDER, Washington, D. C.
TIIE CONTAMINATION OF OPERATIVE WOUNDS WITH
COTTON FIBRILS AND TALC ........................................ 110
L. R. DuszvNsKI, M.D., New York, N. Y.
BY INVITATION ?
MALIGNANT LYMPIIOMA OF TIIE UVEAL TR.ACT ........................... 116
EDMOND L. COOPER, M.D., Detroit, Mich.
and
JOHN L. RIKER, M.D., Alpena, Mich.
BY INVITATION
A CONCEPT OF ALLERGY AS AUTONOMIC DYSFUNCTION SUGGESTED AS AN
IMPROVED WORKING HYPOTHESIS ................................. 123
HENRY L. WILLIAMS, M.D., Rochester, Minn.
DIFFUSE EXTERNAL OTITIS: ITS PATHOLOGY AND TREATMENT .............. 147
BEN H. SENTURTA, M.D., St. Louis, Mo.
IN MEMORIAM ..................................................... 160
COUNCIL MINUTES .................................................. 161
ANNUAL BUSINESS MEETING ......................................... 170
COMMITTEE REPORTS ................................................ 179
INDUSTRIAL OPHTHALMOLOGY
MEDICAL CIVIL DEFENSE: THE BACKGROUND ........................ 191
ANDREW C. Ivy, M.D., Chicago, 111.
DISASTER STRIKES-WHAT HAPPENS? ............................. 193
COL. VICTOR A. BYRNES (MC), Randolph Field, Texas
EMERGENCY EYE CARE IN DISASTER: THE LAYMAN WIIO PRECEDES Us. 202
HEDwIG S. KuHN, M.D., Hammond, Ind.
NEWS NOTES ...................................................... XXV
POSITIONS AVAILABLE ............................................. XXIX
DIRECTORY OF OPIITIIALMOLOGIC AND OTOLARYNGOLOGIC SOCIETIES ........ XXX
HEARING AIDS ACCEPTED BY COUNCIL ON PHYSICAL MEDICINE
OF THE AMERICAN MEDICAL ASSOCIATION ...................... XXXVIII
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
in acute lar.rn(I)otracheal
bronchitis
prompt response
with
7 erramrcin
'dN~ ,Jhil. 1I~.
INFECTING 1 TOTAL ADMINIS- CONDITION
ORGANISM TREATED DOSE, GM. 1 AND RESULT
bronchitis in 24 hours,
Recovery
Case report taken from Herrell, W E.; Heilman, F. R., and JVellman, E
E.: Ann. New York Acad. Sc. 53:448 (Sept. 15) 1950.
CRYSTALLINE
er
rarnycin
CHLORIDE jjQ
I?aj idl}? Absorbed
"... produces significant continuous blood levels when 250
mg. are given every six hours."1
Well Tolerated
"... side-effects have not constituted a problem in therapy."'
Uosu1;e:On the basis of findings obtained in over 150 lead-
ing medical research centers, 2 Gm. daily by mouth in divided
doses q. 6 h. is suggested for most acute infections.
Sup1-lied: 250 mg. capsules, bottles of 16 and 100;
100 mg. capsules, bottles of 25 and 100;
50 mg. capsules, bottles of 25 and 100.
1. Welch, II.; Hendricks, F. D.;
Price, C. W., and Randall, W. A.: J. It.
Ph. A. (Sc. Ed.) 39:185 (Apr.) 1950. /p~.zy ^ ACHAS. /L/ll)LOfIC ~~[hGSCO/2
2. Knight, V.: New York State J. Med. l\\ (vJ
50:2173 (Sept. 15) 1950. AS. PFIZER PFIZER V? CO., INC.
Brooklyn 6, N. Y
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 R 9hrdW S71 ERE VlSPARA1OR ? ? ?
the Preferred. Instrument for Investigation
and Visual Training of. 0 .
1 Accommodation and Convergence
Suppressions and Suspensions of Vision
? Amplitude and Facility of Accommodation
Stereopsis
Many Other Functions and Skills
All the functions of the ordinary stereoscope plus many others
are combined in the AO Renshaw Stereo Disparator. In this im-
proved diagnostic and training instrument variable guides permit
movement and setting of targets to maintain the correct re-
lationship between accommodation and convergence, regard-
less of the distance between the stereograms and the lenses.
The targets follow definite paths, stimulating accommodation
and convergence together, as normally at various seeing dis-
tances. Abnormal patterns of viewing may also be provided
for in the instrument by placing emphasis either upon accom-
modation or convergence. Representing a significant advance
in stereoscopic diagnosis and training, the AO Stereo Disparator
OTHER ADVANTAGES
OF THE
STEREO DISPARATOR
Simple adjustment of instrument
to patient
Wide range of prism effect with-
out use cf auxiliary prisms ,
Rapid, simultaneous adjustment
of desired target separations
Adequate range of adjustment to
compensate for vertical
imbalances
Adequate range for stimulating
demands on accommodation
Calibrated central scale for indi-
catina accommodation demand
is unusually effective in producing
efficient binocular vision. Arrange
today for a demonstration at any
AO Branch Office.
 proved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
Lloyd STEREO CAMPIMETER
... the Campimeter that permits
complete plotting of both
central and paracentral fields
under stereoscopic fixation
In many cases showing impairment of vision it is important to make full ce
t
l
d
n
ra
an
para-
central field studies. The "angled mirror septum" in the AO Lloyd Stereo Campimeter permits
field testing up to 47? nasally, 35? temporally, 30? upward, and 30? downward. Even when central
scotomata are present in either or both eyes, single binocular fixation is readily maintained. Lenses
compensate for the. distance from the chart to the eye, thus avoiding accommodation on the
part of the patient. Illumination of test chart and fixation chart is exceptionally even.
More and more professional men are demanding the simplicity of operation, accuracy, and
versatility of application available only in the AO Lloyd Stereo Campimeter. You too will find
it more than worthwhile to ask your AO Representative for further details.
 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1
How the Paredrine Technique'
in refraction saves the physician time and trouble
Ophthalmic Solution
Paredrine Hydrobromide* 1%
with Boric Acid *hydroxyamphetamine hydrobromide, B.K.P.
Advantages :
1. requires only a minimum number of instillations
2. helps achieve rapid cycloplegia
3. permits accurate refraction
4. assures a quick return of accommodation
The `Paredrine Technique' in refraction saves the physician time and trouble
and spares the patient prolonged visual disability. In the words of Harrison,,
it "has the advantage of maximum action with minimum duration."
With children, the whole procedure can be carried out at the office; and
the greatly reduced amount of atropine required for satisfactory cycloplegia
lessens the probability of toxic side effects.
Smith, Kline & French Laboratories, Phila.
1. Harrison, W.J.: Ocular Therapeutics, Springfield, Ill.,
Charles C Thomas.
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
MEDIA
,c ~'+ ern r *r r ~^^ m '~ mm ~ i mp m u~. r, ru
PLEASANT- EFFICIEp1 r
rc -sacra rc~a ue
"S Y-6
S icnt c c zd clinical Data scat o ..
1 1 I I I I
-Also MALLON DIVISION - Makers of RECTALGAN
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
For the Modern
E. N. T. Specialist
Send for descriptive folder il-
lustrating and describing new
Imperial treatment unit com-
plete, consisting of hydraulic
chair designed to accommo-
date Proetz treatment, adjust-
able stool, and cabinet with
enclosed rotary pump (with
footswitch), recessed suction
and pressure irrigating bottles,
stainless steel trays, one spe-
cial drawer to accommodate
Bard-Parker liquid sterilizer,
and National cautery and
transilluminator.
Finish-White Enamel, Cream
White, Brown and Maroon
(solid colors), with upholstery
(black, brown and maroon)
on chair and stool.
C. M. SORENSEN CO., Inc.
Factory, General Office and Showroom
403 EAST 62nd ST. NEW YORK 21, N. Y.
o o,,
ARTIFICIAL iex
The Making and Fitting of Artificial Eyes
Are A Specialty with us-Not A Sideline
THE FINEST IN ARTIFICIAL EYES OF PLASTIC AND GLASS
MADE TO ORDER AND STOCK
? Mail order selection service
? Our technicians travel to most principal cities
? Trained technicians to fit artificial eyes to all motility implants
Write as if you have any artificial eye problems with your patients
CHICAGO
DETROIT
CLEVELAND
KANSAS CITY
MINNEAPOLIS
NEW ORLEANS
ST. LOUIS
S E R V I N G T H E P R O F E S S I O N
SINCE 1 8 5 1
NEW YORK
BALTIMORE
BOSTON
BUFFALO
PHILADELPHIA
PITTSBURGH
WASHINGTON
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
SIMPLE TEST PROVES INSTANTLY
PHILIP MORRIS ARE LESS IRRITATING
Now you can confirm for yourself,
Doctor, the results of the
published studies*
With proof so conclusive ...
with your own personal experience
added to the published
studies* ... would it not be
good practice to suggest
PHILIP MORRIS to your
patients who smoke?
... light up a
PHILIP MORRIS
Take a puff -DON'T INHALE. Just
s-l-o-w-1-y let the smoke come
through your nose. AND NOW...
2 ... light up your
present brand
DON'T INHALE. Just take a puff
and s-l-o-w-1-y let the smoke come
through your nose. Notice that bite,
that sting? Quite a difference from
PHILIP MORRIS!
PHILIP MORRIS
Philip Morris & Co., Ltd., Inc., 100 Park Avenue, New York 17, N. Y.
*Proc. Soc. Exp. Biol, and Med., 1934, 32, 241-245; N. Y. State Journ. Med., Vol, 35, 6-1-35, No. 11, 590-592,
I,amyngoscope, Feb. 1935, Vol. XLV, No. 2, 149-154; Laryngoscope, Jan. 1937, Vol. XLVII, No. 1, 58-60
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
TRANSACTIONS - NOVEMBER -DECEMBER, 1950 XI
RADM
For the Treatment of
Nasopharyngeal Lymphoid Tissue
The original monel metal radium applicator was designed by Radium
Chemical Company according to specifications of Otolaryngologists with
nearly 25 years experience in radiation therapy of the nasopharynx.
This applicator is offered to the medical profession for one purpose only
- the treatment of hyperplastic lymphoid tissue at the orifice of the
eustachian tube or in the fossa of Rosenmuller, which cannot be removed
surgically.
Approximately 1,400 of these applicators have been supplied to spe-
cialists in the United States by Radium Chemical Company. Published
medical papers indicate that radiation in conjunction with antibiotics,
systemically or locally, often relieves the symptoms due to the presence of
hyperplastic lymphoid tissue.
Extensive research covering a period of many years has established the
proper time factor for the 0.3 millimeter monel metal radium applicator.
All important reports from clinics and specialists have been based on the
monel metal applicator of the exact dimensions furnished by Radium
Chemical Company.
No changes will be made in these specifications unless they are re-
quested by medical authorities, and then only after intensive clinical
research.
The physician using a monel metal radium applicator from this Com-
pany can expect the same favorable results as reported in the medical
literature.
RADIUM CHEMICAL CO., INC.
570 Lexington Ave., New York 22, N. Y.
MORE THAN 35 YEARS CONTINUOUS SERVICE TO THE MEDICAL PROFESSION
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
Chronic Asthmatic
A
W FIEN she feels an attack corning on,
she simply reaches into her purse,
takes out the Aerohalor? and takes three
or four inhalations of a bronchodilating
powder called NORISODRINE Sulfate.
The bronchospasm ends quickly.
This take-it-with-you therapy is effective
against both mild and severe asthma,
has restored many chronic asthmatics
to normal activity. Proved by clinical
investiga Lion, 1, 2 NOIIISODRINE has relatively
low toxicity. Few side-effects result when
the drug is properly used and, when
they do, are usually minor.
Before prescribing NORISODRINE, however.
please write for literature which discusses
dosage and precautions. NORISODRINE
Sulfate powder 10% and 25% is supplied
in multiple-dose Aerohalor* Cartridges,
packaged three to an air-tight vial.
Acrohalor is prescribed separately.
Abbott Laboratories, ~_14-
Nor th Chicago, Illinois.
*'rrade Mark for Abbott Sifter Cartrid,o
f'>Abbott's Powder Inhaler
Krasn Iv, , A. C L.(949), T1 a a ala
Inhtlona o1
1- (3', 41T Dlhydroxyphenyll-2-Isopropyl-
aminoetanol (Norisodrine Sulfate Dust),
J. Allorgy, 2'.'. 0:111, March. 2, irrasno, L. R.,
Grossman, nd Ivy, A. C. (1948), The
Inhalation of Norisodrine Sulfate Dust,
science. 108:478, Oct. 29.
NORISOORINES0If3te Powder
(ISOPROPYLARTERENOL SULFATE, ABBOTT)
Always Ready for Use when the Need Arises
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 INE NATURAL vtS
-Approved For Release 2002/07/24: CIA-RDP80-00 B 003000050013-1 "o,
Natural Seeing Habits dictated the design
of this Bifocal Lens .
The bifocal wearer finds in Panoptik a lens designed to
let him see naturally.. . not a lens which requires readjustment
of his seeing habits. That's because the Panoptik is designed to
natural seeing habits ... the segment is widest at the level
of natural reading ... its optical center is at this same
level . . . corners are round to match the round
pupils of the eye. Panoptik is the bifocal lens
easiest to get used to . . . the bifocal lens
that gives natural youthful vision with comfort,
In Soft-Lite, too
# ~ F
# ? 2 ,y F _ x9 ? ? 1 ~ ? t F F ?#F?'F #
FF ? k#F 1
# h5
{
F#
# ?
_
4
~
M tle bifocal legs
M,j
Wlil prides
{? F F ?
~
F
d
y
;
~
iF F
e ? idest# ossible reading area
F ?~? ~,`~FF.t ?; { ~~? a 2 p s s ~ # ~ ~ ?~,tr~a#q~r # ~E cs?a?c?
w th FleestFencroachmentt y #?F
F??~#sq~h~~~r??F~~ra?a~?~~?ti?+ ?>H? ~~? F~i~Fa?~s;~ ,~?.
~a~qp? ? d~f $~ i i ? Y~.?~ # '~SiF F ~`F 4!F #'~F~{y#~ iF3jy ~.? #~i~i3'Sk
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
A COMPLETE TREATMENT ROOM IN A SMALL AREA
The dimensions in the above photograph are 5' 9" along one wall and 4' 2" along the other. In this area,
conveniently arranged, is everything needed to make a complete examination. However, it need not be con-
fined to this limited space. The complete absence of piping and wiring is especially noticeable. A number
of other arrangements will be furnished on request.
Treatment Stand: Covered with stainless steel. Contains: air regulator with gauge, tubing, cutoff and air
filter; nosopharyngoscope rheostat; push button' cautery transformer and rheostat; transilluminator complete
with rheostat, cord, handle, lamps, antrum and frontal tips; seven metal drawers on fiber runners and one
large drawer for towels, waste container; bakelite covered work table; space for six spray bottles, twelve
solution bottles, shelf bor cotton jars; pocket for history card or prescription blanks; and a spray bottle
heater; the whole presents an attractive appearance and will not tarnish and is easy to keep clean. Price
complete without glassware $185.00. Without air but with electrical equipment $155.00. With air equipment
only $140.00. Without either air or electrical equipment $110.00.
Chair: Can be placed in horizontal position, will not tip in this position- raised and lowered by large hand
wheel; paper covered headrest removable; locked with foot-pedal; bakelite armrests removable. Back locks
rigidly in any position. As shown in brown. $130.00.
Turning Chair: By adding a footrest and the necessary handles this chair can be used for turning tests. All
the additional equipment is easily and quickly removable. Add. $25.00.
Combined Suction and Cuspidor: This is an entirely new piece of equipment. It was designed to eliminate
the cost of installing a separate suction. The apparatus is 12" wide and projects 131/4" from the wall. The
flushing rim and the suction is furnished with a vacuum breaker and should meet all plumbing requirements.
Stop and trap not furnished. Available in ivory, green and white. Price $80.00.
Ceiling Light: A telescopic light attached to the ceiling. May also be attached to base board in back of
chair. Available in 4, 5, 6 and 7 ft. (extended). 4 ft. $15.50 (add one dollar per ft.).
Light Shield: Takes an ordinary 100 watt lamp. Will not burst; spot can easily be rotated. $5.00.
Stool: A soft upholstered stool with easy running ball bearing stem casters. $20.00. Stool with back, $26.00.
All Prices are F.O.B. Los Angeles, Calif.
Surgical - Mechanical - Research
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 for rapid
easy
adjustment
to any
treatment
position
A Ritter ENT Motor Chair adds more time to your professional day.
Patients are treated in less time ...with less fatigue. This precision-built
Ritter Chair raises or lowers to any desired position. You merely
exert slight toe pressure on a conveniently located pedal. Patients
are moved quickly, quietly and with no vibration to the desired
position. A motor-operated hydraulic mechanism does the trick.
Easily and quickly adjusted from sitting to supine position, you
are able to examine or treat while comfortably seated or standing.
Patients enjoy the comfort of the wide foam rubber seat and
the exclusive compensating back. The Ritter ENT Motor
Chair can be pre-set to accommodate 90% of your patients.
Ask your surgical dealer,for a demonstration of
the time and energy-saving features of the
A RITTER SURGICAL
CUSPIDOR
A Ritter Surgical
Cuspidor, completely
redesigned provides
greater efficiency at
. , I
effective vacuum volume
control maintained with a
fingertip regulator at the
aspirator handle. Use
Ritter ENT Motor Chair.
instantly positions Ritter
ENT Motor. Chair...
any aspirator ved F Re a e 2002/07/24~??l ~~1 P80- 6 0300
modern equip ~RITiE~K
doctor's-office. I I ROCHESTER 3, N.Y.
 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
TRANSACTIONS - NOVEMBER - DECEMBER, 1950
Corneal Contact Lenses
Their Advantages
and
Disadvantages
Write for Brochure
0:!!! ~ I - Za rv i, a
49 EAST 51st STREET ? NEW YORK,
Manufacturers of all types of Contact Lenses
BRANCHES IN
PHILADELPHIA ........ MONTREAL ........ LONDON
JOHANNESBURG ... SHANGHAI
? Are you
AWL
one of the thousands of Eye Specialists
who
have prescribed more than 150,000
KEYSTONE Home Training Services?
NEW Features:
New Plastic Stereoscope - attrac-
tive, lighter in weight, warp proof,
permanently accurate.
New Manual for Patients has
easily understood directions; rec-
ord form gives the doctor a quick
check on progress.
New Guide for Doctors is a most
comprehensive and direct technical
manual on home-training orthoptic
procedures.
drew Compact Package takes only
half the previous space; easily car-
ried by patient from home to office.
SOLD ONLY ON PRESCRIPTION.
Carried in Stock by Most Optical
Supply Houses.
If so, you will be glad to know
that New Services are now ready
for your prescription, at your
optical supply house.
For strabismus
and chiroscopic
drawing.
Widely prescribed for asthenopia after refraction, and
for discomfort due to near-point work. Many eye special-
ists use them routinely for: Adjustment to Bifocals.
Esophoria and Exophoria. Premature Presbyopia. Low
accommodative Amplitude in younger patients. Slowness
in Changing Fixation from far-point to near-point. Diffi-
culty in Accepting Rx. Ciliary Spasm. Faulty Stereopsis.
Write for circular - or for the new Doctor's
Guide (no charge).
KEYSTONE VIEW CO.,Meadville,Pa.
PIONEERS IN VISUAL TRAINING EQUIPMENT
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TRANSACTIONS - NOVEMBER - DECEMBER, 1950 XVII
A New Vacuum Unit for Cataract Extraction
with an Improved Erisophake
By OSCAR B. NUGENT, M.D.
Chicago
Producing an even, constant vacuum that
can be set at any desired level up to 65
centimeters of mercury, this new little
pump unit with its improved erisophake
assembly provides the ophthalmic surgeon
with a dependable instrument precisely
controlled for utmost delicacy and effec-
tiveness of application. The motor at}d
rotary pump are wholly enclosed, silent
and vibrationless; built for long, care-free
service, they require little attention other
than occasional oiling. The motor has an
automatic thermal overload protector. The
entire unit stands only 6x14x11" high.
A-4 - Nugent Cataract Vacuum Unit - Self-contained in a cast alumi-
num housing with smooth, attractive, easy to keep clean, Crystal Gray finish.
For operation on 110 volts, 60 cycles, AC, complete with erisophake described
below, each ................................................ $129.75
IMPROVED NUGENT-GREEN-DIMITRY ERISOPHAKE
A- 14 - This improved erisophake permits greater ease of application and more
perfect manipulation in extraction procedures than formerly. It makes use of the
Dimitry shallow suction cup, and has Nugent 's oral vacuum control valve-most
simple, efficient means of control of vacuum during cataract extraction. Hand-
piece and oral valve are gold plated. Erisophake, valve and tubing only. . $24.75
Since 1895
Instrument JY)ueller Ma kers to an the and Profession
320-340 S. HONORE STREET CHICAGO 12, ILLINOIS
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
THROAT SPECIALISTS REPORT
ON 30-DAY TEST OF CAMEL SMOKERS...
Yes, these were the findings of throat specialists
after a total of 2,470 weekly examinations
of the throats of hundreds of men and women
MY DOCTOR'S REPORT
('ONFIRMGr) WIaAT I WMI_W
FROM THE START-CAMELS
AGREE WITH MY THROAT.
AND I LIKE CAMELS
RICH, FULL FLAVOR!
:.lawyer is .one of hundreds,
coast to coast Who made, ,
the 3A Day; 'est of Cui ei
Mildness under the;oliwrve
tion of thr"soar spec alists
TRANSACTIONS - NOVEMBER - DECEMBER, 1950
who smoked Camels -and only Camels
- for 30 consecutive days.
Yes, doctors smoke for pleasure, tool In a nationwide survey, three
independent research organizations asked 113,597 doctors what
cigarette they smoked. The brand named most was Camel.
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01
WIDE
ate the extent
t
d
i
ll
r
emons
ons
ustrat
The i
ANGLE of the fields of view (2d) available to
higher myopes and hyperopes. It is
E immediately discernible that the wearer
v I of a strong minus lens has a much
IEW larger field of view than a high hyper-
ope. (The myope must, however, learn
to view objects within a narrower angle.) The 14 D. myope has
a field of view through a 25 mm. aperture Myodisc lens that is
37% larger than the field of view enjoyed by the 14 D. hyperope
wearing a 38 mm. diameter lens. The diagrams stress the im-
portance of placing lenses of higher power as close to the eyes
as possible if the patient is to have a maximum field of view.
Many years of research have resulted in Benson cataract lenses
that provide maximum field of view without the use of aspherie
surfaces. Myopes appreciate the saving in weight and the im-
proved appearance that results from carefully computed, perfect
Benson made Myodisc lenses.
Interpreting your prescription into glasses that DO what
YOU want them to do for the patient is our specialtyl
N. P. BENSON OPTICAL COMPANY
Since 1913
MAIN OFFICE AND LABORATORY: MINNEAPOLIS, MINN.
Branch Laboratories in Principal Cities of Upper Midwest
New Color Slide
LIBRARIES OF THE EYE
from
the private
collections
of recognized
experts
Series
I. Anterior Segment Photographs
II. Anterior Segment Photographs
Ill. Retinal Color Photographs
IV. Gonioscopic Color Photographs
All by H. Saul Sugar, M.D., Detroit
V. Retinal Color Photographs
from the collection of the late
Robert Von Der Heydt, M.D., Chicago
VI. Original Ophthalmological
Photomicrographie Slides
by Julius Weber, New York
Write for booklet listing each slide. Literature also
available on lighting systems and complete camera
units for photographing the eye.
BARNETT Optical Laboratories
1218 Pratt Blvd., Chicago 26, III.
REFRACTION
DIFFICULTIES
A monograph by
Clarence A. Veasey, Jr., M.D.
Send order with remittance to
W. L. BENEDICT, M.D.
100 First Avenue Building
Rochester, Minn.
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
50/1000 Fine Gold. You prescribe "New
Jersey Optical" with complete confidence.
NEW JERSEY OPTICAL CO. ? IRVINGTON, N. J.
THE NEW YORK POLYCLINIC
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EYE, EAR, NOSE AND THROAT
A combined full-time course covering an academic year (9 months). It consists of attendance
at clinics; witnessing operations; lectures; demonstration of cases and cadaver demonstra-
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For information address MEDICAL EXECUTIVE OFFICER: 345 West 50th St., NEW YORK 19, N. Y.
_ito
EQ
INSTRUMENTS used by
HENRY M. GOODYEAR, M.D.
Cincinnati, Ohio, for
INTRANASAL SINUS SURGERY
A. 5418 'Elevator and Curette,
DUNNING ........$ 6.00
B. 5712 `,Perforator, Antrurn,
BISHOP
7.50
C. 5775 *Double Curette, PRATT
7.50
D. 5970 *Forceps, Nasal, GRUEN-
WALD: Size 3 through
cutting ....... each 29.50
E. 5971 *Forceps, Nasal, WEIL:
cup shaped ........ 29.50
F. 6054 Punch, HAJEK-
KOFLER: downward . 37.50
G. 6060 *Handle, Universal .. 29.50
H. 6071 Punch, Antrum,
WAGNER: forward.. 26.50
K. 6076 Punch, Intranasal,
STORZ: right or left,
each 25.00
Designates STAINLESS STEEL
STORZ INSTRUMENT COMPANY
Quality
Frames and We have always produced but one
mountings line - the finest - in which crafts-
manship, quality and inherent worth
of Superb are backed by invariable guarantee of
' EAR
U 1-
OUR NEW NOSE CATALOG SE NT UPON R
St. Louis 10, Missouri
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TRANSACTIONS
AMERICAN ACADEMY
of
OPHTHALMOLOGY
and
OTOLARYNGOLOGY
SCIENTIFIC PAPERS READ AT
FIFTY-FIFTH ANNUAL SESSION
CHICAGO, ILLINOIS
October 8-13, 1950
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
EDITORIAL BOARD
WILLIAM L. BENEDICT, M.D., Editor in Chief, Rochester, Minnesota
W. HOWARD MORRISON, M.D., Associate Editor, Omaha, Nebraska
HENRY L. WILLIAMS, M.D., Associate Editor, Rochester, Minnesota
THE BOARD OF SECRETARIES
PRINTED IN OMAHA, NEBRASKA
Sy
DOUGLAS PRINTING COMPANY
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
American Academy of Ophthalmology and Otolaryngology
THE COUNCIL - 1950
President
J. Mackenzie Brown, Los Angeles, Calif --------- ........................................................????---'-?President-Elect
Derrick Vail, Chicago, Ill- ----------- ------------------------------------------------------------------------ ---------
Vice-President
Edwin B. Dunphy, Boston, Mass. ..................................... ?---??-?????'---?"-""?__??-S First
Second Vice-President
Kenneth L. Craft, Indianapolis, Ind------------------------------------------------- ?--?-???--
............Third Vice-President
James Mason Baird, Atlanta, Ga ................................................... ... ??
Alan C. Woods, Baltimore, Md .....................................Past President, Senior Member of Council
Carl H. McCaskey, Indianapolis, Ind . ........ .................................................................... Past President
Past President
Conrad Berens, New York, N. Y .......................................................................................
Executive Secretary-Treasurer
William L. Benedict, Rochester, Minn..... {Editor and Business Manager of the TRANSACTIONS
Algernon B. Reese, New York, N. Y ......................................... Secretary for Ophthalmology
James H. Maxwell, Ann Arbor, Mich----------------------------------------------Secretary for Otolaryngology
A. D. Ruedemann, Detroit, Mich .............................Secretary for Instruction in Ophthalmology
Secretary for Instruction in
Dean M. Lierle, Iowa City, Iowa ...............................?-?-? ? - - - - - . . - -. Otolaryngology and Maxillofacial Surgery
Secretary for Home Study Courses
Lawrence R. Boies, Minneapolis, Minn .................................
..........................................Secretary for Public Relations
Erling W. Hansen, Minneapolis, Minn.
...................................Councillor
Thomas D. Allen, Chicago, Ill .................................................................
Fletcher D. Woodward, Charlottesville, Va .............................................................................Councillor
..........Councillor
Archie D. McCannel, Minot, N. D ..................................................................................
C. Stewart Nash, Rochester, N. Y. ._...................................................................................... Councillor
COUNCIL COMMITTEES
EXECUTIVE, RESEARCH AND FINANCE
J. Mackenzie Brown, Chairman
Alan C. Woods Derrick Vail
Carl H. McCaskey Thomas D. Allen
Conrad Berens William L. Benedict
RESEARCH AND FINANCE
Research
(Subcommittee fFExecutive,
and
Alan C. Woods, Chairman
J. Mackenzie Brown William L. Benedict
BOARD OF COUNCILLORS
Thomas D. Allen, Chairman
Fletcher D. Woodward C. Stewart Nash
Archie D. McCannel
BOARD OF SECRETARIES
William L. Benedict, Chairman
Algernon B. Reese Dean M. Lierle
James H. Maxwell Lawrence R. Boies
A. D, Ruedemann Erling W. Hansen
ACTIVITIES
Thomas D. Allen, Chairman
Fletcher D. Woodward Derrick Vail
Archie D. McCannel Edwin B. Dunphy
C. Stewart Nash
JUDICIAL
J, Mackenzie Brown, Chairman
Thomas D. Allen Archie D. McCannel
Fletcher D. Woodward C. Stewart Nash
PROGRAM
J. Mackenzie Brown, Chairman
John R. Lindsay, Chicago
General Chairman on Arrangements
Derrick Vail James H. Maxwell
Edwin B. Dunphy A. D. Ruedemann
Thomas D. Allen Dean M. Lierle
William L. Benedict Lawrence R. Boies
Algernon B. Reese Erling W. Hansen
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
STANDING COMMITTEES
ADVISORY COMMITTEE TO THE REGISTRIES PREVENTION OF BLINDNESS
OF PATHOLOGY Ralph I. Lloyd, M.D., Chairman ----- .-.Brooklyn, N: Y.
Brittain F. Payne, M.D., Chairman, New York, N. Y. Lawrence T. Post, M.D- ------------------ St. Louis, Mo.
Col. J. E. Ash, M.C., Ret. ............Washington, D. C. Alan C. Woods, M.D. .......... ---
Baltimore, Md.
William L. Benedict, M.D. _-- --- Rochester Minn
.
Brig. Gen. Raymond O. Dart, M. C. ,
Andrew A. E Washington, D. C. N. Y
Edmund P. Fowler, Jr , kb------------ New New York, ' N. Y.
Jonas S. Friedenwald, M.D- ------------Baltimore, Md.
Hugh G. Grady, M.D- -----.--..----..... Washington, D. C.
Stacy Guild, Ph.D. ----------------- -------------- Baltimore, Md.
Lyman H. Heine, M.D.......... .............. Fremont, Neb.
Michael J. Hogan, M.D. . San ........Francisco, Calif.
Paul H. Holinger, M.D. ___ ........... ---------- Chicago, Ill.
John E. L. Keyes, M.D- ---------- Cleveland, Ohio
A. Edward Maumenee, M.D.....San Francisco, Calif.
John S. McGavic, M.D------- ...- Phoenixville, Pa.
Bernard J. McMahon
M
D
St
L
i
M
,
.................
.
.
ou
s,
o.
Algernon B. Reese, M.D. ---------------- New York, N. Y.
Theodore E. Sanders, M.D. ------------St. Louis, Mo.
LeRoy A. Schall, M.D. Mass.
Herman Z. Semenov, M.D. -. BeverlyB Hills, Calif.
Georgiana Dvorak Theobald, M.D., Oak Park, Ill.
Frederick H. Verhoeff, M.LI- ---------- Brookline, Mass.
Helenor Campbell Wilder ------...---Washington, D. C.
CONSERVATION OF HEARING
Executive Committee
Dean M. Lierle, M.D., Chairman ,...-.Iowa City, Iowa
Gordon Berry, M.D- ------------------------Worcester, Mass.
Lawrence R. Boles, M.D. ............Minneapolis, Minn.
Norton Canfield, M.D---------------------New Haven, Conn.
George M. Coates, M.D. ........ ........... Philadelphia, Pa.
William E. Grove, M.D .....................Milwaukee, Wis.
Gordon D. Hoople, M.D. ................Syracuse, N. Y.
Howard P. HouseM.D - ------------Los Angeles. Calif.
Marvin F. Jones, M.D- ---------- --------- New York, N. Y.
Charles E. Kinney, M.D. Cleveland, Ohio
Julius Lempert, M.D.: ................... New York, N. Y.
Carl H. McCaskey, M.D-----------------Indianapolis, Ind.
Marion R. Mobley, M.D ------------- --Florence, S. C.
Harris P. Mosher MD-----------------Marblehead, Mass.
Werner Mueller, 111. .............. ......Boston, Mass.
C. Stewart Nash, M.D- --------------------Rochester, N. Y.
George E. Shambaugh, Jr., M.D.------------ Chicago, Ill.
Consultants
Raymond Carhart, Ph.D- _.__---------------- -Evanston , Ill.
Eva Thompson Carson ----------------------------Glenview, Ill.
Howard Carter, B.S- -------------------------- --Chicago, Ill.
Stacy Guild, Ph.D. -----------------Baltimore, Md.
Scott N. Reger, Ph.D. .-_--_------------- Iowa City, Iowa
PAN-AMERICAN RELATIONS IN
OTOLARYNGOLOGY
C. L. Jackson, M.D., Chairman --------Philadelphia, Pa.
Norton Canfield, M.D.. ....... Haven, Conn
C. Furstenber .
g, M.D. .... ........ Ann Arbor, Mich.
Paul H. Holinger, M.D . ............... Chicago, Ill.
Gordon B. New, M.D- ----_---_----------Rochester, Minn.
Theodore E. Walsh, M.D- --------------------St. Louis, Mo.
SCIENTIFIC EXHIBIT
Kenneth L. Roper, M.D., Chairman-------Chicago, Ill.
STANDARDIZATION OF TONOMETERS
Jonas S. Friedenwald, M.D., Chairman
Baltimore, Md.
Francis Heed Adler, M.D- -----------------Philadelphia, Pa.
Dry0 e Harrington,, M.D-- -------------------.Boston, Mass.
Peter C. Krotifeld, M.D. -__ San Francisco, Calif.
------- -..-....Chicago, III.
John M. McLean, M.D .....................New York R , Y.
Adolph Posner, M.D - .----New York, N. Y,
Algernon B. Reese, M.D..--..-..--------- New York, N. Y.
Robert N. Shaffer, M.D. _----_.----San Francisco, Calif.
STUDY OF AUDIO-VISUAL INSTRUCTION
Dean M. Lierle, M.D., Chairman ....Iowa City, Iowa
W. L. Benedict, M.D., ex officio-- ---.--Rochester, Minn.
James H. Maxwell, M.D- ------------Ann Arbor, Mich.
Algernon B. Reese, M.D- ------------New York, N. Y.
A. D. Ruedemann, M.D- -------------------- Detroit, Mich.
Representatives of the Academy to :
ADVISORY COMMITTEE TO THE EYE HEALTH
COMMITTEE OF THE AMERICAN STUDENT
HEALTH ASSOCIATION
Lawrence T. Post, M.D. ............__--St. Louis, Mo.
AMERICAN ASSOCIATION FOR THE
ADVANCEMENT OF SCIENCE
M. Elliott Randolph, M.D----------- _--.-Baltimore, Md.
AMERICAN BOARD OF OPHTHALMOLOGY
Algernon B. Reese, M.D. ................New York, N.Y.
Frederick C. Corderses, M.D.......-.San Francisco, Calif.
Robert J. Mast, M.D. .._..........--Indianapolis,Ind.
Derrick T. Vail, M.D--------- ............. ---_-Chicago, Ill.
AMERICAN BOARD OF OTOLARYNGOLOGY
Carl H. McCaskey, M.D-----------------Indianapolis, Ind.
William E. Grove, M.D- --------------------Milwaukee, Wis.
AMERICAN COLLEGE OF SURGEONS
BOARD OF GOVERNORS
H. Marshall Taylor, M.D. ---------...Jacksonville, Fla.
John P. Lordan, M.D- ----------------Beverly Hills, Calif.
Conrad Berens, M.D. ....................New York, N. Y.
AMERICAN COMMITTEE ON OPTICS AND
VISUAL PHYSIOLOGY
Alfred Cowan, M.D........... ------- Philadelphia, Pa.
Kenneth C. Swan, M.D. . Portland, Ore.
Frederick C. Cordes, M.D.
------ ..San Francisco, Calif.
AMERICAN ORTHOPTIC COUNCIL
Kenneth C. Swan, M.D -------------- ---------Portland, Ore.
George D. os enbader,IM.D...-SaWashington, , D.
AMERICAN SOCIETY OF CLINICAL PATHOLOGISTS
CONSULTATIVE PANEL ON TUMOR
TERMINOLOGY
John S. McGavic, M.D- -------------------- Bryn Mawr, Pa.
HELMHOLTZ CENTENARY COMMITTEE
F. Bruce Fralick, M.D;, Chairman, Ann Arbor, Mich.
Nelson Miles Black, M.D- ------------------------Miami, Fla.
Frank E. Burch, M.D----------------------- -St. Paul, Minn.
Herman Elwyn, M.D. ------------------- New York, - N. Y.
W. H. Luedde, M.D. ---------------------- -St. Louis, Mo.
Albert C. Snell, M.D.
--------------------.Rochester, N. Y.
JOINT COMMITTEE ON INDUSTRIAL
OPHTHALMOLOGY
Edmund B. Spaeth, M.D- ---------------- Philadelphia , Pa.
John B. Hitz, M.D----------- ----------------- Milwaukee, Wis.
Col. Victor A. Byrnes, M.C. --- Randolph Field, Texas
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
THE OCULAR FINDINGS OF INTRACRANIAL TUMOR
A Study of 358 Cases
MANOUSOS ANGEL PETROIIELOS, M.D.
BY INVITATION
and
JOHN WOODWORTII HENDERSON, M.D.
ANN ARBOR, MICII.
THE diagnosis and successful local-
ization of intracranial neoplasms should
ideally be the result of close cooperation
between the neurosurgeon, the neurolo-
gist and the ophthalmologist. Such a re-
lationship has been enjoyed at the Uni-
versity Hospital of the University of
Michigan, where the neurosurgery and
neurology departments routinely refer
the great majority of their suspected
cases of intracranial pathology for oph-
thalmologic consultation. There has thus
been afforded a somewhat unique op-
portunity to establish a proper back-
ground upon which the neurologist or
neurosurgeon may rely in reaching his
diagnosis.
It is the purpose of this paper to at-
tempt an evaluation of the signs of in-
tracranial neoplasm which are encoun-
tered by the ophthalmologist from the
standpoint of their significance in diag-
nosis.
A total of 358 cases will be presented.
Of these 344 were operated upon and
the pathologic diagnosis confirmed by
microscopic study. The remaining 14
cases were those in which the diagnosis
was within the limits of certainty but
in which it was felt surgery would not
be advantageous. The latter instances
From the department of ophthalmology, University
of Michigan Medical School. Dr. Petrohelos holds
the position of John E. Weeks Scholar in Ophthal-
mology, and Dr. Henderson that of Walter R. Parker
Scholar in Ophthalmology.
Presented at the Fifty-Fifth Annual Session of the
American Academy of Ophthalmology and Otolaryn-
gology, Oct. 8-13, 1950, Chicago, Ill.
fell mainly under the heading of pinea-
loma. The original series of records was
selected by the Division of Medical Sta-
tistics to include representative series of
each major diagnostic group, either by
location or by type of tumor. These
were tabulated according to ophthalmo-
logic findings. The individual findings
were then analyzed according to tumor
location, as will be noted from the ac-
companying tables. Thus the series pre-
sented does not claim to embrace the to-
tal number of cases observed during a
given period of time, nor does it attempt
to include all the cases of any one tu-
mor type during such an interval. Prac-
tically all of the records studied were of
patients seen within the past ten years.
Where a particular finding was not
noted for a tumor location, it has been
omitted from the appropriate table.
The final selection of cases whose
completeness warranted their inclusion
in this study is presented in table I ac-
cording to location of the tumor. Those
instances listed as "diffuse" involvement
were cases in which the tumor involved
more than two major areas. The re-
maining subdivisions of the table are
self explanatory. This grouping does
not claim any significance with regard
to the relative incidence of brain tumor
by local sites.
The ocular findings to be analyzed are
(1) papilledema, (2) optic atrophy,
(3) visual field changes, (4) pupillary
abnormalities, and (5) disorders of
ocular motility.
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
TABLE I
PAPILLEDEMA
TRANS. AMER.
ACAD. OF O. & 0.
NUMBER OF
CASES
NUMBER WITH
PAPILLEDEMA
PER-
CENTAGE
BILAT- UNI-
ERAL LATERAL
Frontal lobe
T
l
66
30
45.4
29
1
empora
lobe
P
i
t
l l
b
29
15
51.7
15
ar
e
a
o
e
O
i
it
l l
25
13
52.0
13
cc
p
a
obe
F
5
4
80.0
4
rontoparietal
TemporOparietal
18
17
9
50.0
_
7 2
Parieto-occipital
11
10
88.8
10 -
Frontotemporal
7
9
81.8
9 -
Cerebellum
3
42.9 '
3 -
Pi
l
l
58
44
76.2
44
nea
g
and
Third ventricle
16
7
10
62.5
_
10 -
Lateral ventricle
5
71.7
5 -
F
th
i
9
7
77.7
6 1
our
ventr
cle
P
d
d
16
12
75 0
12
ons an
me
ulla
6
5
83
3
Midbrain and pons
10
6
.
5
Posterior fossa
5
4
60.0
5 1
Corpus callosum
Bas
l
li
5
2
80.0
40.0
4
2 _
a
gang
a
Ce
b
ll
i
5
3
60.0
3 _
re
e
opont
ne angle
Diff
6
5
83.3
5
use
O
i
i
10
7
70.0
_
7
pt
c ch
asm and nerve
9
5
55
5
_
3
Pituitary and cranio-
.
2
pharyngioma
11
1
9
1
1
Sphenoidal wing
.
-
meningiorna
7
4
57.1
3 1
Totals
358
213
59.5
205 8
TABLE II
OPTIC ATROPHY
PRIMARY ATROPHY
BILATERAL UNILATERAL
Frontal 2
Occipital -
Frontoparictal -
Cerebellum 1
Pineal 1
Third ventricle -
Lateral ventricle -
Fourth ventricle
Basal ganglia _
Diffuse _
Optic chiasm and nerve. 2
Sphenoidal wing meningioma -
Pituitary and cranio-
pharyngioma 3
Midbrain and pons 1
Cerebellopontine angle --
Foster Kennedy syndrome
f ? Early Foster Kennedy syndrome
M. A. PETROHELOS AND J. W. HENDERSON
SECONDARY ATROPHY
BILATERAL UNILATERAL
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 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
TABLE III
VISUAL FIELD FINDINGS
,t
O
a
0
a
0
-F
d .O.
V
0
8
a d
F W
4
a
wa
xF
a y
d
a
z
U
y z
zw
o
0
ac0~
~
wx
Frontal
40
2 -
1
7 1
Temporal
16
9 -
5
1 -
Parictal
22
5 -
1 -
Occipital
5
3 -
2
Frontoparietal
14
1 -
1
1 -
Temporoparietal
9
5
2
Parieto-occipital
8
4 -
2
Frontotemporal
5
- -
0
Cerebellum
23
1 1
-
-
Pineal gland
10
1
2
Third ventricle
4
- -
-
1
-
Lateral ventricle
7
1 1
1
4
Fourth ventricle
10
-- -
-
3
Pons and medulla
6
- -
-
-
1
Midbrain and pons
8
- -
Posterior fossa
3
-- -
Corpus callosum
5
1 -
Basal ganglia
2
- -
Cerebellopontine angle
4
- -
1 -
Diffuse
7
2 1
1 1
Optic chiasm and nerve
Pituitary and cranio-
8
- -
-
2 (uni-
lateral)
pharyngioma
Sphenoidal wing
9
- -
. meningioma
6
-
OCULAR FINDINGS OF INTRACRANIAL TUMOR
The incidence of papilledema was
59.5 per cent, this finding being reported
in 213 of the 358 cases. Where the
tumors could be classified as located
above the tentorium, papilledema was
evident in 53.3 per cent (137 out of a
total of 257 cases). Those located sub-
tentorially showed papilledema in 76 out
of 101 cases, an incidence of 75.2 per
cent. Papilledema was reported to be bi-
lateral in 205 of the 213 individuals. In
only 14 cases was there a difference in
amount of elevation of the nerve head
between the two eyes sufficient to war-
rant its mention in the hospital records.
The incidence of optic atrophy was
12 per cent among the cases studied.
There were 25 instances in which the
optic nerve changes were classified as
secondary atrophy. Those diagnosed as.
primary optic atrophy totaled 17 cases.
In both types of atrophy the greater
number showed changes in both eyes.
The findings by location of the tumor
are given in table II.
The visual field findings are listed in
table III. A visual field examination
was performed in 231 of the 358 cases.
Changes in the fields of vision were re-
corded in 104 of the 231 examinations,.
or in slightly less than half. The specific
findings for each group of tumors may-
be noted in the table. Almost without
exception there were positive visual
field findings in certain cases regardless.
)f tumor location. Although too few.
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92 M. A. PETROHELOS AND J. W. HENDERSON
cases were found to warrant inclusion
in the table, the incidence of improve-
ment of the visual fields after surgery
was small. It was noted according
to further perimetry or to report in
the records in only 3 cases. The poor
LOCATION OF
TUMOR ,
Frontal
Temporal
Occipital
Temporoparietal
Frontotemporal
Cerebellum
Third ventricle
Fourth ventricle
Pons and medulla
Corpus callosum
Basal ganglia
Cerebellopontine
angle
Diffuse
o r
A
zN
- C
a o
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ACAD. OF O. & O.
prognosis of many of the patients un-
doubtedly is reflected in this finding.
Anisocoria was the only pupillary ab-
normality thought reliable enough for
inclusion in this report. This was men-
tioned in 42 of the records, an incidence
of 12 per cent. The lateralization of the
pupillary size was unfortunately not
mentioned in many cases. The larger
pupil was on the same side as the tumor
in 13 instances, as compared with 6
cases in which it was contralateral to the
lesion. Table IV lists the cases in de-
tail.
The movements of the eyes were
found to be affected in a fairly large
number of the cases studied. Defects of
conjugate movement were noted in 20
cases of the group. These are listed in
table V. Most of these instances oc-
curred in patients in whom the location
of the tumor was such as to involve the
pathways for ocular movement, either
in the frontal lobe or in the brain stem,
with particular emphasis upon the group
of pineal tumors.
niopharyngioma 1 A lack of uniformity of classifica-
- -
Sphenoidal wing tion as well as inadequate description
meningioma 1 - - of particular cases. in detail makes the
evaluation of nystagmus in this series
most difficult. However, it will be
UPWARD GAZE
PALSY
LATERAL GAZE
PALSY
MISCEL-
LANEOUS
TOTAL
CASES
Frontal
Temporal
1 (weakness
2
Cerebellum
Pineal
1
8
all directions)
Diffuse
1
Optic chiasm and nerve
1
-
1
Pituitary and craniopharyngioma
1
-
1
Sphenoid wing meningioma
1
-
1
Midbrain and pons
1 (upward
2
and downward gaze)
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Nov.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 93
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TABLE VI
NYSTAGMUS
MIXED HORI-
ZONTAL AND MISCEL-
"central"
Temporal
--
1
Occipital
-
1
Cerebellum
1
11 1
"ocular"
20
Pineal
1
1
2
Lateral ventricle
-
1 -
1
Fourth ventricle
--
3 1 -
4
Pons and medulla
-
3
3
Diffuse
-
- 1 -
1
Cerebellopontine
angle
-
- 2 -
2
noted from table VI that the major-
ity of the cases were those in which
coordinative mechanism of the cere-
bellum, the brain stem; or the motor
pathways was likely to be involved.
The incidence of nystagmus for the
series was 10.9 per cent.
Individual muscle palsies occurred
in 46 cases of the group. The ab-
ducens nerve or nerves were involved in
35, the oculomotor partially affected in
11, and the trochlear in only 2 patients.
Several other cases could not 'be listed
in this way. These included paralysis of
convergence and complete ophthalmo-
plegias and may be found in table VII.
TABLE VII
EXTRAOCULAR MUSCLE PALSIES
LOCATION OF
TUMOR 6TH PALSY
3RD PALSY 4TP1 PALSY
Temporal
2
1 compl.
Frontoparietal
1
-
Temporoparietal
2
1 inc.
Cerebellum
8
5 inc.
Pineal
5
1 inc.
Lateral ventricle
1
Fourth ventricle
2
1 inc.
Pons and medulla
3
Midbrain and pons
1
-
Basal ganglia
2
1
Diffuse
2
-
Optic nerve and chiasm
2
Pituitary and cranio-
pharyngioma
1
Sphenoidal wing
-
meningioma
1
TOTAL
MISCELLANEOUS CASES
1 ext, ophthal-
moplegia O.U. 3
1 compl. ophth-
almoplcgia O.U. 3
3
2 convergence
palsy 13
6
1 ? convergence
palsy
2 convergence
palsy
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DISCUSSION
The incidence of papilledema found
for this series of cases is distinctly low-
er than that reported in other articles.
Van Wagenen8 found in a series of 145
verified cases of intracranial tumor that
over 88 per cent developed papilledema.
Critchleyl has reported brain tumor to
be associated with papilledema in over
80 per cent of cases. The 59.5 per cent
incidence in the present series seems
low by comparison. Truly comparable
figures are not available, since the high-
er figures are given for series of tu-
mors in children, or for consecutive
cases over a relatively short period of
time. The closest comparison could be
made with the report of Paton,6 who
found that papilledera occurred in 80
per cent of intracranial tumors in a se-
ries of 252'cases.
The discrepancy between the findings
of the present series and those of previ-
ous articles appears to be a direct re-
flection of the remarkable advances
made in the diagnosis and treatment of
brain tumors during the past several
decades. The reports cited above all ap-
peared prior to the period. covered by
the cases herein reported. With the di-
agnostic aids of electroencephalography,
ventriculography, and arteriography,
fewer cases of intracranial tumor are
now allowed to progress to the stage
where papilledema becomes visible to
the ophthalmoscope.
The higher percentage (75.2 per cent)
in the present report for tumors arising
in the posterior fossa of the skull is
much nearer to comparable figures in
the literature. The papers of Critchley,I
of Newman,5 and of others report a
high incidence of papilledema for tu-
mors of the brain in children. It is true
that the greater percentage of brain tu-
mors in childhood are of the subten-
torial variety. This closer correlation of
reports for papilledema between sub-
tentorial tumors for different age groups
appears to reflect the earlier and more
severe interference with the circulation
of the cerebrospinal fluid with resulting
internal hydrocephalus.
The preponderance of bilateral pa-
pilledema in this series serves to verify
the statement of Duke-Elder,3 who
writes that in the great majority of
cases the degree of edema is equal in the
two eyes and that a greater amount of
swelling in one optic nerve head. is not
of lateralizing value.
As would be expected, the majority
of the cases of primary optic atrophy
occurred where the direct action of the
tumor was exerted upon the optic nerve,
the optic chiasm or the optic tract. At
least 13 out of the 17 instances of such
atrophy could. be so classified if one
were to include the frontal, fronto-
parietal, optic chiasm and nerve, sphe-
noidal wing meningioma, and pituitary
groups. All of the tumors so listed are
also much less likely to produce papil-
ledeina until very late in their course.
Nineteen of the 25 instances of secon-
dary optic atrophy occurred in cases in
which the ventricular system could be
easily involved, and thus papilledema
occurs early, to be followed by a post-
papilledema type of atrophic change.
The small number of cases evidencing
the Foster Kennedy syndrome should
be mentioned. None occurred in purely
frontal lobe lesions, but two instances
were found in more extensive tumor
involvements classified as frontoparietal.
The third case was found with a sphe-
noidal wing meningioma. The fourth
instance was equivocal and occurred in
a case with a tumor of the lateral ven-
tricle.
It will be seen from table III that the
most frequent visual field findings were
homonymous hemianopsia and periph-
eral constriction. There were 35 in-
stances of homonymous hemianopsia in
the 231 examinations performed, or
slightly over 15 per cent. As would be
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Nov.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 95
1950
expected on anatomic grounds, the ma-
jority of such findings occurred in cases
with involvement of the cerebral hemis-
pheres. Although recorded in too few
cases to be of great significance, the
relative occurrence of macular sparing
as compared with macular splitting
should be mentioned. There is certainly
no indication in the table to support the
classic view that macular splitting is
more apt to occur with involvement of
the optic tract. On the other hand, the
finding of sparing of the macula ex-
clusively in the tumors of the hemis-
pheres may have some relative value. It
will be noted that the majority of such
cases are recorded for locations where
the optic radiations could be involved.
Therefore it would be logical to assume
that the fixation reflex pathways, the
corticotectal tracts2 which lie just out-
side the radiations, would also be in-
volved. This would lend support to the
view of Verhoeff,9 who believes that
sparing of the macula may be the result
of faulty fixation.
The finding of quadrantanopsia is not
indicative of temporal lobe involvement
in this series of cases. A study of the
table appears to support the view of
Walsh,10 who states, "An homonymous
quadrant defect in the visual fields sug-
gests involvement of the dorsal or ven-
tral band respectively in the optic radia-
tion, and such an involvement may be in
the temporal lobe." There was only 1
case in this series in which quadrantan-
opsia occurred in a proved temporal
lobe tumor. On the other hand, there
were 9 of the group which showed a
homonymous hernianopsia.
Mention should be made of the speci-
ficity of the finding of bitemporal hemi-
anopsia in localizing tumors to the chi-
asmal region. This can be verified from
table III. It is important to note that
not one single instance of bitemporal
hemianopsia was recorded which could
logically be due to dilatation of the third
ventricle, although 54 patients with sub-
tentorial tumors were examined by per-
imetric methods.
There were 56 cases in which either
hemianopsia or quadrantanopsia oc-
curred. Thus, field findings of localiz-
ing value were present in slightly over
25 per cent of the cases in which a peri-
metric examination was performed. The
value of examining the fields of vision
in any case suspected of harboring a
brain tumor therefore should be evi-
dent.
The finding of anisocoria in a case of
suspected brain tumor is said to have
little localizing value, according to
Walsh.10 That inequality of the pupils
with irritative cortical phenomena can
occur has been borne out by Penfield
and Erickson.? However, certain of the
cases listed in the table could well have
been unrecognized instances of Hor-
ner's syndrome. It will be noted that in
the frontal, temporal and temporoparie-
tal tumors, the larger pupil was most
often to the side of the tumor, but the
number of cases is too small to warrant
any definite conclusions.
The small total number of conjugate
palsies (5.6 per cent for the series) in-
dicates how infrequently such a finding
occurs. The greater number of upward
gaze palsies in tumors of the pineal
gland shows a distinct localizing value.
Downward pressure exerted by a pine-
aloma affects the more superficial tectal
layers of the midbrain early. It has been
shown experimentally that the cortico-
tectal fibers which reach the roof of the
midbrain are those having to do with
vertical movement.` It is anatomically
difficult to explain the upward gaze
palsies noted for the 2 cases of frontal
lobe tumor presented in table V.
Nystagmus is said to be present in a
great majority of cases with cerebellar
tumor.10 This statement is substantiated
by the present series, where 20 of 58
cases showed this finding, an incidence
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of 34.5 per cent. As stated earlier in this
paper, the lack of uniform classification
in the records studied makes further
conclusions valueless except to reiterate
that the motor connections for ocular
movement were probably involved in
most of the other cases. The total of 39
cases in which nystagmus was recorded
gives an incidence of 10.9 per cent.
The much greater incidence of ab-
ducens nerve involvement in the cases
studied confirms the fact that the sixth
cranial nerve is relatively less protected
in its long intracranial course. An in-
crease in intracranial pressure alone
may be enough to implicate this nerve
by shifting the position of the brain
stem. There is little localizing value
from abducens palsy, as may be seen in
table VI. A review of the records shows
further that the lateralization of the
palsy has no significant bearing on de-
termining the side of the tumor. The
lesser number of oculomotor and troch-
lear palsies would indicate either a
shorter intracranial course or a more
protected position. It will be noted that
such ocular palsies occurred in only 13.4
per cent of the total series. The conver-
gence palsies noted in the table are diffi-
cult to accept unless one assumes that
these may have been unrecognized cases
of internuclear ophthalmoplegia.
SUMMARY AND CONCLUSIONS
Ina series of 358 cases of intracranial
tumor the following ocular findings
were present:
1. The incidence of papilled.ema was
59.5 per cent. Tumors which were above
the tentorium presented papilledema in
53.3 per cent of the cases, while the sub-
tentorial group had a 75.2 per cent inci-
dence. Almost all the cases were bilat-
eral.
2. Optic atrophy was found in 12 per
cent. The cases with primary optic
atrophy were mainly those in which di-
TRA\S. AMER.
ACAD. OF O. & O.
rect involvement of the nerve, chiasm
or tract was possible. Those with sec-
ondary atrophy occurred. where the
tumor could produce an early rise in in-
tracranial pressure.
3. Abnormal findings were present in
slightly less than half the cases where
the visual fields were examined. The
findings were of localizing type in slight-
ly more than 25 per cent of the cases
tested.
4. The statement of Walsh10 that pu-
pillary changes are of little localizing
value was supported by the present
study. Anisocoria occurred in 12 per
cent of the series.
5. Defects of conjugate movement
occurred in 5.6 per cent of the cases. In-
volvement of upward conjugate gaze in
pineal tumors appeared to have the
greater value for localization.
6. Nystagmus was present in 10.9 per
cent of the series. It was a frequent
finding in cases of tumor of the cere-
bellum.
7. Extraocular muscle palsies were
found in 13.4 per cent of the cases. The
incidence of abducens, oculomotor and
trochlear involvement reflects' their
anatomic arrangement. Such palsies
were of little value in lateralization.
REFERENCES
Critchley, M.: Brain tumors in children;
their general symptomatology, Brit. J.
Child. Dis., 22:251-264 (Oct.-Dec.) 1925.
Crosby, E. C. and Henderson, J. W.: The
mammalian midbrain and isthmus region:
Part II. Fiber connections of the superior
colliculus. B. Pathways concerned in
automatic eye movements, J. Comp.
Neural., 88:53-92 (Feb.) 1948.
Duke-Elder, W. S.: Text-Book of Oph-
thalmology : Vol. III. Diseases of the In-
ner Eye, St. Louis, C. V. Mosby Co.,
1943, p. 2947.
Henderson, J. W.: The anatomic basis
for certain reflex and automatic eye move-
ments, Am. J. Ophth., 32, Part II:
232-238 (June) 1949.
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NOV.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 97
1950
5. Newman, E. W.: Ocular signs of intra-
cranial disease in children and juveniles
a report of 42 cases, Am. J. Ophth.,
21:286-292 (March) 1938.
,6. Paton, Leslie: Diseases of the optic nerve:
optic neuritis in cerebral tumours and its
subsidence after operation, Tr. Ophth.
Soc. U. Kingdom, 25:129-162, 1905.
7. Penfield, W. and Erickson, T. C.: Epilep-
sy and Cerebal Localization, Springfield,
Ill., Charles C Thomas, 1941.
8. van Wagcnen, William P.: The incidence
of intracranial tumors without "choked
disk" in one year's series of cases, Am.
J. M. Sc., 176:346-366 (Sept.) 1928.
9. Verhoeff, F. II.: A new answer to the
question of macular sparing, Arch. Oplith.,
30 :421-425 (Oct.) 1943.
.10.. Walsh, F. B.: Clinical Neuro-ophthal-
mology, Baltimore, Williams & Wilkins
Co., 1947.
DISCUSSION
DONALD J. LYLE, M. D., Cincinnati, Ohio:
Many conditions affect a statistical study of
this nature, especially . in reference to symp-
tomatology which is influenced by three chief
factors:
1. Stage of involvement
2. Rapidity of involvement
3. Nature of involvement
a. By direct pressure of invasion
b. By remote production of general bulk
x. Through tumor development
y. Through production of obstructive
hydrocephalus
Rapidly growing tumors are usually as-
sociated with tumefaction, swelling, or edema,
at first intracellular, then cxtracellular, and be-
cause of the rapidity of. growth there is less
opportunity for compensatory adjustment to
the added bulk, both in the neighborhood of
the tumor and in remote locations. Local
or focal symptoms of intracranial tumors
may be confusing and misleading. The
oculomotor, trochlear, trigeminal and facial
nerves may be stretched by a shifting of the
brain and confuse the location of the lesion
by their implication. For these reasons, one
must pay particular attention to the first symp-
toms as later ones may be misleading in their
localizing and diagnosing value. One must
remember that localizing signs and symptoms
may be produced not only by tumors but by
vascular lesions of various types, injuries and
other conditions. Therefore, the presence of
certain symptoms or syndromes, although
they may be of localizing value, is not nec-
essarily diagnostic of the type of lesion caus-
ing them.
I believe that the differences between the
percentage found by Dr. Petrohelos and Dr.
Henderson and those of other investigators
lie in the fact that their material as a whole,
as they state, was subjected to earlier diag-
nosis and treatment. This applies to all of
the symptoms they enumerate and describe in
which there has been a discrepancy in sta-
tistical figures.
As to the difference in the amount of
papilledema between the two sides, I am in
agreement that there is very little. Perhaps
in tumors of the middle fossa there may be
some dissimilarity of elevation at the disc, but
in these cases one may be dealing with direct
pressure on the ipsilateral side in the pro-
duction of primary optic atrophy and indirect
pressure on the contralateral side resulting in
papilledema. These cases of Foster Ken-
nedy syndrome or Gower -Patton-Kennedy
syndrome were not found by the authors,
probably because they appear usually in ad-
vanced conditions. I am quite sure, however,
that they are occasionally found in the average
clinical practice. This syndrome is produced
by tumors of the base of the frontal lobe, tu-
mors of the middle cranial fossa which include
hypophyseal adenoma and anterior temporal
lobe tumors as well as the meningiomas,
craniopharyngiomas and less common neo-
plasms. In these cases there is, of course, a
difference in elevation as well as in the pallor
of the papilla.
It is unfortunate that the term used to
describe the type of atrophy of the nerve fibers
whose cell bodies are in the ganglion cell layer
of the retina and whose axons pass out of the
eye to form the optic nerve, chiasm and tract
is frequently misleading and inaccurate. The
term "secondary optic atrophy" simply means
that destruction, both physiologic and anatomic,
has followed an earlier involvement severe
enough to kill the optic nerve, but it does not
indicate what or where. If the destructive
process occurs remote from the papilla, one
might say from its appearance as seen with
the ophthalmoscope that primary optic atrophy
is present; if it appears at the papilla with the
production of gliosis and fibrosis, a secondary
optic atrophy is evident.
The essayists in this presentation wish
secondary optic atrophy to mean atrophy
following papilledema. I do not believe that
I am helping to clarify the terminology to any
great extent, but I would like to suggest the
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~J8 M. A. PETROHELOS AND J. W. HENDERSON
use of the term "consecutiv. opts atropi~y"
to mean optic atrophy following papilledema.
This term has been used for this type of optic
atrophy by several neurologists.
There is very little definite information, but
much has been said concerning the sparing and
nonsparing of the macula. The authors' view
is worth consideration.
Homonymous quadrantanopsia is possible if
the lesion involves either the dorsal or ventral
bands of radiation fibers. The difference be-
tween lesions posteriorly where the two bands
of radiations course side by side, and in the
forward temporal area, where they are sepa-
rated by the temporal horn of the lateral
ventricle and other structures, is that a post-
erior lesion frequently overflows into the ad-
joining quadrant fibers, whereas the anterior
lesion shows a sharp horizontal line marking
the lower boundary of the quandrantanopsia.
(This is demonstrated in the charts and cases
illustrating the condition.)
Although bitemporal hemianopsia resulting
from dilatation of the optic recess in the an-
terior end of the third ventricle is an infre-
quent symptom compared with its production
by tumors in the chiasmal region, it does
occur. These conditions are not found in the
authors' series probably because of the ad-
vanced stage, as mentioned above.
Pupillary changes have been noted both
clinically and experimentally as arising from
the stimulation of the (1) basal telencephalon,
(2) midline thalamus, (3) subthalamus,
and (4) midbrain, as well as from certain
cortical areas. I agree with the authors that
until further knowledge is forthcoming,
anisocoria and indeed other pupillary ab-
normalities have merely a conjectural origin
and location.
I might make a similar statement con-
cerning nystagmus, both ocular and vesti-
bular. Nystagmus has very little localiz-
ing significance save that lesions producing
vestibular nystagmus of central origin occur
usually in the posterior fossa. Infrequently,
a temporal lobe tumor is found with the symp-
tom of vestibular nystagmus, which leads me
to the conjecture that there might be a vesti-
bular cortical center in the temporal lobe ad-
jacent to the auditory center.
Conjugate deviation of the eyes, usually
irritative, sometimes paralytic (that is, par-
alysis of lateral gaze), may improve through
a compensatory mechanism so that the symp-
toms which appear early, mos, frequently not-
ed in acute brain conditions, may disappear.
Conjugate deviations remain more perman-
ent when produced by lesions in the brain stem.
If I were to suggest anything in addition
to this comprehensive study, it might be to
include the symptoms resulting from involve-
ment of the trigeminal and facial nerves and
their associated connections.
Tumors occurring in the middle fossa may
produce pain from involvement of the tri-
geminal nerves or the gasserian ganglion
which occurs in their confluence. The gang-
lion is joined with the pons by its sensory
root, from which is given off ascending and
descending fibers. In addition to the symp-
toms of pain, paresthesia and anesthesia with
involvement of the trigeminal, trophic lesions
are found along its course, especially with
serious involvement of the cornea. Pain may
also be found as the result of meningeal
irritation as the dura and larger vessels are
innervated by the trigeminal. Pain and
trophic disturbances are therefore of localizing
value in the presence of brain tumors.
The facial nerve is of great localizing value
in intracranial tumors as its involvement
points to different areas.
1. A difference between supranuclear and in-
franuclear lesions with their flaccidity and
involvement of the eyelids is significant.
2. Infranuclear facial paralysis in association
with abducens paralysis, the Millard-
Gubler syndrome, points to a lesion in the
brain stem in the vicinity of the lower pons.
I do not believe that exact percentages are
authoritative, especially as they concern symp-
tomatology. One must remember that he is
working with living tissues exposed to various
influences and because of the dissimilar factors
at hand, they will not necessarily react in the
same manner in every instance. However,
in a closely studied series such as this,
the statistics are of great interest and con-
siderable importance. 1. wish to compliment
the essayists on this concise and well docu-
mented study.
DR. HENDERSON: Dr. Petrohelos and I wish
to thank Dr. Lyle for his discussion of our
paper. It is obviously very difficult in a some-
what dry statistical presentation such as ours
to include any particulars on individual cases.
We hope in the future to be able to carry
out the analysis more extensively. Thank you.
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FIG. 1-Nematode larva in eosinophilic abscess in vitreous membrane. x400 AFIP
Ace. 198761.
owl-"I", 01111
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NEMATODE ENDOPHTHALMITIS
HELENOR CAMPBELL WILDER
WASHINGTON, D. C.
ROIFTINE examination of eyes at the
Armed Forces Institute of Pathology
disclosed a well-defined group in which
the clinical histories and pathologic le-
sions were strikingly uniform. The
eyes, with few exceptions, were from
children. In most instances observation
of a white papillary reflex by the parents
was the first evidence of ocular disease.
On ophthalmoscopic examination there
was seen behind the lens a pale mass
with the blood vessels coursing over it,
and a diagnosis of retinoblastoma led to
enucleation.
Eosinophilic abscesses, sometimes
surrounded by epithelioid and giant
cells, presented a pathologic picture not
accounted for by the more commonly
recognized granulomatous lesions of the
eye. Special stains failed to demonstrate
bacteria, fungi, inclusion bodies, or or-
ganisms of any kind. As the lesions re-
sembled those seen in helminth infec-
tions elsewhere in the body2,3,i4,i5 and
those described in the eyes of experi-
mental animals,19 it was decided to re-
examine specimens exhibiting a sugges-
tive inflammatory reaction in the hope
of finding the responsible organism.
Forty-six eyes, each from a different
patient, were selected for this investiga-
tion. On the basis of previous micro-
scopic examination, diagnoses of en-
dophthalmitis, pseudoglioma, and Coats's
disease, i.e., external exudative or hem-
orrhagic retinitis, had been made. Serial
sections were prepared on all available
From the Armed Forces Institute of Pathology.
Preli'ninary report presented at the Congress of the
Pan-American Association of Ophthalmology, Miami
Beach. 1950,
Presented at the Fifty-Fifth. Annual Session of the
American Academy of Ophthalmology and Otolaryn-
gology, Oct. 8-13, 1950, Chicago, Ill.
material, which in no case was complete
since the specimens had been sectioned
previously. Notwithstanding this handi-
cap, nematode larvae (figs. 1, 2, 3, 4, 5,
6) or their residual hyaline capsules
(figs. 6, 7, 8)2,14,15 were found in 24
eyes. In one case examination of over
2300 sections resulted in the discovery
of a single larva (fig. 3), the entire
worm being contained within 12 sec-
tions. In another eye, three larvae were
found.
In 9 eyes the larvae were exceptional-
ly well preserved. These were examined
by Dr. B. G. Chitwood,6 who gave the
following report:
So Far as can be determined on the basis
of the material at hand, the specimens are
third stage hookworm larvae. No informa-
tion as to species has been obtained. However,
Ancylostoma sp., Necator sp. and Uncinaria
sp. are possibilities. These specimens are the
same stage but differ very slightly from
Oesophagostomum larvae 24 hours after in-
fection, as seen in sections of a pig's esopha-
gus shown to us by Dr. D. A. Shark, Zoologi-
cal Division, Bureau of Animal Industry.
Furthermore, we are unable to distinguish
between this specimen and a nematode seen
in a pathologic section of a clog kidney.
The fact that the larvae in these
cases have been recognized as hook-
worm does not rule out other nematodes
(Strongyloides, Ascaris, etc.) as pos-
sible causative agents in endophthal-
mitis.
During the course of this study an
unusual coincidence led for a time to
the incrimination of a nematode larva
which had nothing to do with the ocular
lesion. In those eyes which were sec-
tioned in paraffin, filariform larvae,
very different in appearance from the
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-Nov.-DEC. NEMATODE ENDOPIITHALMITIS 101
9950
FIG. 3-Nematode larva surrounded by eosinophils in vitreous chamber. x220 AFIP Ace.
298563.
FIG. 4--Nematode larva in cosinophilic abscess in vitreous cbainhcr. Sar.ial cxctions showed
the body partly extended and the tail coiled. A. x350 AFIP Ace. 69623; 11. x400 AFIP
Ace. 69623.
larvae within the abscesses, were found of the section, it was decided without
apparently within the globe. They were question that they were contaminants,
all complete, unsectioned larvae and probably deposited by a parasitized fly
-were not surrounded by cellular exudate. on the slides while they were drying on
As in a fourth case the larva lay on top the warm plate.
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FIG. 5-Degenerated worm surrounded by necrotic
eosinophils, epithelioid cells, and giant cells. x400
AFIP Ace. 202593.
FIG. 7-Cross section of hyaline capsule surrounding
completely degenerated worm. x400 AFIP Ace.
69623.
CLINICAL DATA
The 24 eyes in which the presence of
larvae was established were all from
children. The youngest was 3 years of
age, the oldest 13, and the majority
were of preschool and early school age :
3 through 5 years, 12 patients; 6
through 9 years, 9; 10 through 13 years,
TRANS. AMER.
ACAD. OF O. & 0.
FIG. 6-Nematode larva, tangential section, sur-
rounded by hyaline material. x450 AFIP Ace.
285189.
FIG. 8-Hyaline capsular fragment in older lesion.
x604 AFIP Ace. 79868.
2. Fourteen of the eyes were from girls,
10 from boys. Twenty-one of the pa-
tients were white and 3 colored. The
specimens included 16 right eyes, 6 left,
and 2 with side unspecified. In 2 in-
stances lesions in the remaining eye in-
dicated bilateral involvement. Although
the majority of the patients were from
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1950
NEMATODE ENDOPHTHALMITIS 103
GEOGRAPHIC DISTRIBUTION
the southeastern United States, they
were by no means limited to this region
(see map). It must -be taken into con-
sideration, however, that the children
from northern and western states may
have lived in or visited other localities.
A preoperative diagnosis of retinoblas-
toma had been made in 20 instances,
pseudoglioma in 3, and in 1 in which
the inflammatory reaction was particu-
larly fulminating the clinical diagnosis
was panophthalmitis. Anderson' ob-
served that glioma (retinoblastoma)
was the usual clinical diagnosis in oph-
thalmomyiasis when the larvae were
located subretinally. Neither helminth
infection nor any systemic disease was
mentioned in the records of 20 patients.
One had a history of old nematode in-
fection. One child was cachectic, one had
frontal headaches at the time of onset
of ocular symptoms, and another, con-
tinued ocular pain and visual loss fol-
lowing meningitis eight years before
enucleation. Usually there were no
clinical signs of local inflammation. In
addition to the 24 proved cases, there
were 22 which were believed, on the
basis of a similar pathologic picture, to
be probable nematode endophthalmitis
although larvae were not found. In gen-
eral the clinical pattern and geographic
distribution closely paralleled those of
the proved cases, although 3 patients
were adults and 1 was from as far west
as the state of Washington.
HISTOPATHOLOGIC OBSERVATIONS
On microscopic examination, an in-
flammatory membrane was generally
seen in the funnel of the detached retina,
but it rarely involved the ciliary body
(figs. 9, 10). In most, although not all,
instances the anterior segment was com-
paratively free from evidences of in-
flammation. Cataract, however, was an
occasional complication, and sometimes
the posterior capsule was perforated,
possibly by the larvae. Retinal, sub
retinal and vitreous hemorrhages were
often present. Serous exudate usually
occupied the subretinal space.
The most characteristic lesion was
the eosinophilic abscess with a center in
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1'T6. 9-Site of larva in retinal fold indicated by
arrow. Delicate vitreous memhrane? Subretinal se-
rous exudate. Retinal detachment. No involvement
of anterior segment. x4 AFTP Ace. 201971.
FIG. 10-Site of larva in vitreous membrane in-
dicated by arrow. Subretinal serous exudate. Retinal
detachment. No involvement of anterior segment.
x4 AFIP Ace. 198761.
which the cytoplasmic granules tended
to become basophilic as a result of
necrosis (fig. 11). Surrounding the ab-
scesses were epithelioid cells, occasion-
ally with giant cells (fig. 5), and in-
flammatory granulation tissue infiltrated
by eosinophils, lymphocytes, and plasma
cells which, frequently were multi-
nucleated, some having as many as five
or six nuclei. There was considerable
variation in the relative number of these
cells in different lesions, apparently de-
pending on duration and on the stage
of disintegration of the larvae. Poly-
mofphonuclear leukocytes were not con-
spicuous except in very early cases.
The eosinophilic abscesses were dis-
tributed on the underside of the retina,
in retinal folds (fig. 9) and in the vitre-
ous membrane (fig. 10). They also
marked the sites of entrance of the
larvae from the choroidal vessels, in-
volving the inner layers of the choroid
and breaking through Bruch's mem-
brane (fig. 12). In many eyes they were
found only on serial sectioning. Al-
though it was in the abscesses that the
larvae were located, every abscess did
not contain a worm. This corresponds
to the experience of O'Connor and
Hulse,15 who in a study of the general-
ized lesions of filariasis observed the
organisms in all stages of degeneration
in abscesses, and who concluded that
failure to find them on serial sectioning
was an indication that the filariae which
had provoked the characteristic reaction
had completely disintegrated. Intra-
ocular lesions were not included in their
investigation. In eyes studied for the
present report the older lesions had
undergone fibrosis but retained their
tubercle-like pattern, and many of them
still contained fragments of hyaline cap-
sule (fig. 13). In case of long standing
inflammation, granulation tissue and
hemorrhage were replaced by dense
fibrous membranes. Scars, which un-
doubtedly marked the tracks of the
larvae, passed from the inner layers of
the choroid and through the retina, in-
terrupting Bruch's membrane and often
forming chorioretinal adhesions (fig.
14). In a few cases calcium deposits
were seen in the lens and retinal folds
and a little bone formation in the cho-
roid, features which might well add to
the difficulty of x-ray differentiation
from retinoblastoma. Cholesterin slits
(fig. 15), masses of mononuclear cells,
and even "ghost cells" beneath the retina
had sometimes led to a diagnosis of
Coats's disease.
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NOV.-DEC. NEMATODE ENDOPITTIIALMITIS 105
1950
FIG. 11-Eosinophilic abscess surrounded by cpithelioid cells and by inflammatory granu-
lation tissue. Note hyaline fragment. x125 AFIP Ace. 79868.
FIG. 12-Eosinophilic abscess destroying the inner laver of the choroid and interrupting
Bruch's membrane. x48 AFIP Ace. 132401.
DISCUSSION
The chance occurrence of nematode
larvae within the eye in nematodiasis is
well known. There are excellent re-
views in the literature of the reported
cases of intraocular nematodes,4,8,13
most of which have been filaria, par-
ticularly Onchocerca volvulus7 and, less
often, Wuchereria bancrofti and Filaria
loa. Generally these parasites have been
observed clinically in the anterior cham-
ber, and nearly all the patients were
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106 HELENOR C. WILDER
FIG. 13--Older lesion undergoing fibrosis. Note hyaline fragment. x125
79868.
FIG. 14-Scar of entrance of the larva from the choroid, through the retina into
the vitreous. x48 AFIP Ace. 293903.
from tropical regions.16,17 Four reported
cases are of particular interest either be-
cause of type of worm or geographic
distribution. Sen and Ghose18 removed
a worm identified as Gnathostoma
spinigerum from the surface of the iris
in the eye of a Siamese. Although there
had been recurrent iritis and hemor-
rhages in the retina and vitreous, re-
covery was uneventful except for the
development of optic atrophy. Jones,
Jordan and Sullivan" reported the case
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1OV.-DEC. NEMATODE ENDOPHTHALMITIS
1950
of a 42 year old white woman who
lived on the West Coast, the last 5 years
in Portland. She had never been in the
tropics. An adult type of round worm
measuring 9 mm. and thought to be W.
bancrofti was observed in the anterior
chamber but unfortunately was lost on
removal so that positive identification
was impossible. Hosford, Stewart and
Sugarman'2 removed 6 worms of The-
lazia californiensis from within the eye
of a 35 year old man. No further trouble
infection. The larval parasites gain en-
try to the host by one of two possible
routes - through the skin or through
the mouth.3'9 If they enter through the
skin, they reach the right heart by way
of the venous circulation whence they
are carried through the lung to the left
heart and so through the carotid, oph-
thalmic and ciliary arteries into the eye.
If they enter by the mouth, they are
probably transported directly to the in-
testine. They may then penetrate the
FIG. 15--Subretinal mass of inflammatory tissue and organized hemorrhage with cholesterin
slits in this case of nematode endophthalmitis (see figures 4 and 7) led to a diagnosis of
Coats's disease. x125 AFIP Ace. 69623.
was experienced. Calhoun4 observed a
living Ascaris larva in the eye of an 8
year old Georgia boy. The larva in-
creased in size during a period of five
weeks, after which it died and was com-
pletely absorbed. Iridocyclitis and sec-
ondary glaucoma, which were present in
the early stages of the infection, sub-
sided.
In nematode endophthalmitis as seen
in the cases from the Institute the loca-
tion of the lesion indicates blood-borne
intestinal wall and be carried by the
venous circulation to the right heart and
thence reach the eye by the same route
as if they had entered through the skin.
In either case migration through the
lung, demonstrated by Fullerborn10 and
others, readily accounts for their pres-
ence in the eye. Choroidal lesions indi-
cate that the metastases are generally
to the choroid, as in neoplasms, rather
than to the retina, and that the larvae
reach the retina and vitreous by direct
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TRANS. AMER.
ACAD. OF O. & O.
invasion. Further proof of this was the
case of Heathy l in which a larva was
seen leaving a choroidal vessel by per-
forating its wall. Cataract associated
with hookworm disease has been ac-
credited to anemia, toxemia, or a com-
bination of the two by Calhoun.s He did
not observe intraocular larvae clinically,
and the eyes did. not come to micro-
scopic examination. He regarded retinal
hemorrhages as the result of toxins,
whereas Fiillebornt? thought it possible
that they resulted from larval emboli.
SUM MARY
Forty-six cases which had been di-
agnosed pathologically as pseudoglioma,
Coats's disease, and endophthalmitis,
and which showed similar inflammatory
reactions, were the subject of special
study. With few exceptions the 46 pa-
tients were children, the greatest num-
ber from the southeastern United States.
In most cases a clinical diagnosis of
retinoblastoma had preceded enuclea-
tion. Nematode larvae or their residual
hyaline capsules were found in 24 eyes.
In 22 others the characteristic reaction
justified a tentative diagnosis of nema-
tode endophthalmitis. In no instance
was a parasite found in the original rou-
tine sections. Serial sections were neces-
sary to demonstrate the larvae in every
case. In 9 eyes the larvae were excep-
tionally well preserved and were identi-
fied by Dr. B. G. Chitwood as those of
hookworm. The exact species remains
to be identified.
CONCLUSION
The finding of intraocular larvae by
serial sectioning and the identification
of the specific pathologic reaction that
they evoke has led to the conclusion
that nematodes play an important and
hitherto unrecognized role in blindness
in children, and particularly in the pro-
duction of pseudoglioma and Coats's
disease in the United States of America.
ACKNOWLEDGMENT
Recognition is given to Dr. Georgiana
Dvorak-Theobald, who, in 1947, on the
basis of a lesion similar to those re-
ported here, suggested the possibility
of helminthiasis as a cause of intraocular
eosinophilia ; to Lt. Colonel Thomas
Carlyle Jones, V.C., USA, who pointed
out the resemblance of the ocular lesion
to that commonly caused by helminths
in other organs of animals; to Dr. Hen-
ry Rappaport, Armed Forces Institute
of Pathology, whose experience in ex-
amining serial sections of an appendix
riddled with lesions and finding only
one nematode larva encouraged me in
a seemingly endless search ; to Dr. B. G.
Chitwood, nematologist and Associate
Professor of Biology, Catholic Universi-
ty, Washington, D. C., who contributed
many hours to the identification of the
parasite ; to Mr. Lawrence P. Ambrogi,
Chief of Laboratories, Armed Forces
Institute of Pathology, and his staff,
particularly Sgt. Evelyn F. Ballou and
Mrs. Aileen Sevier, whose tireless ef-
forts in preparing serial sections made
this study possible.
REFERENCES
1. Anderson, William Banks : Ophthalmo-
tnyiasis : a review of the literature and a
report of a case of ophthalmomyiasis in-
terna posterior, Ani. J. Ophth., 18:699-
705, 1935.
2. Ash, J. E. and Spitz, Sophie: Pathology
of Tropical Diseases: An Atlas, Philadel-
phia and London, W. B. Saunders Co.,
1945, chapters 14 and 15.
3. Belding, D. L.:- Textbook of Clinical
Parasitology, Section TII, New York, D.
Appleton-Century, 1942.
4. Calhoun, F. Phinizy : Intra-ocular inva-
sion by the larva of the ascaris : report
of a case with unusual complications, Arch.
Ophth., 18:963-970, 1937.
5. : Eye complications caused by
hookworm disease, with special reference
to the formation of cataracts, J.A.M.A.,
59:1075-1079 (Sept. 21) 1912.
6. Chitwood, B. G. and Chitwood, M. B.:
An Introduction to Ncmatology, Balti-
more, IVlomnncntal Print_ng Co, 1937.
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NOV.-DEC.
1950
7. Clark, William B.: Ocular onchocerciasis especially in children, Mrs. Wilder has done
in Guatemala : Onchocerca volvulus, Tr. us a great service. I am sure you all realize
Am. Ophth. Soc., 45:461-501, 1947. the tedious effort required to examine serial
8. Duke-Elder, W. S.: Text-Book of Oph- sections of 46 eyes. Since over 50 per cent
thalmology, St. Louis, C. V. Mosby Co., of the eyes selected. for study because they
1941, vol. 3, chap. 41. showed a particular pattern of cellular re-
9. Faust, E. C.: The Phasmid Nematode action yielded positive evidence of parasites,
Parasites of Man. In Human Helmin- this long search was well rewarded.
thology, ed. 3, Philadelphia, Lea & Febi-
ger, 1949, chaps. 15 and 16. During what we would like to continue call-
10. Fiilleborn, F.: Untersuchungen fiber den ing the last war I noticed that we could al-
Infektionsweg bei Strongyloidcs and most always find intestinal parasites in non-
Ankylostomum and (lie Biologic dieser allergic soldiers with an eo:,inophilia of over
Parasiten, Arch. I. Schiffs- u. Tropen- 6 per cent. Although some of these soldiers
hyg., Beih., 18:182-236, 1914. also had choroiditis, the possible causal re-
11. Heath, P.: Personal communication. lationship did not occur to us.
12. Hosford, G. N., Stewart, M. A. and
Sugarman, E. I.: Eye worm (Thelazia During the past two years, I have observed
californiensis) infection in nian, Arch. a man who has had intestinal worms, eosino-
Ophth., 27:1165-1170 (June) 1942. philia of 11 per cent, and recurrent attacks of
13. Jones, Lester T., Jordan, Lewis W. and mild paramacular choroiditis with multiple
Sullivan, Nicholas P.: Intraocular nema- retinal hemorrhages. While no other cause
tode worms : report of a case and review could be found, neither his internist nor I
of the literature, Arch. Ophth., 20:1006- know how to prove or disprove a causal re-
1012 (Dec.) 1938. lationship. Mrs. Wilder's report makes it
14. O'Connor, F. W.: Researches in the seem desirable to look for and eradicate in-
Western Pacific. Research Memoirs of testinal parasites in such cases, as two of the
the London School of Tropical Medicine, 46 eyes were from adults.
London, J. C. Phelp & Son, 1923, vol. 4. We are especially interested these days in
15. O'Connor, F. W. and Hulse, C. R.: Some unraveling the mysteries of retrolental fib-
pathological changes associated with roplasia. In so doing, attention has been
Wuchereria (Filaria) bancrofti infection, focused on other conditions which produce
Tr. Roy. Soc. Trop. Med. & Hyg., 25: the pseudoglioma or leukocoria reflex. This
445-454 (May) 1932. endophthalmitis due to nematode infection
16. Puig Solanes, M., Fontes, A. and Quiroz, explains some cases which we have been
J. A.: Investigacibn oftalmol6gica on la classifying as Coats's disease or as metastatic
zona oncocercosa de Chiapas, Salub. y. retinitis accompanying the exanthematous dis-
asist. (no. 10), 2:69-96 (July-Aug.) 1945. eases of childhood. This is real progress.
17. Scott, J. Graham : Onchocerciasis : a study
of ocular complications in 342 African hookworm infection and malaria have
cases, Am. J. Ophth., 28:624-635, 1945. been the two greatest obstacles to the eco-
18. Sen, K. and Ghose, N.: Ocular gnathosto- nomic development of the Southern States.
miasis, Brit. J. Ophth., 29:618-626 (Dec.) Measures to combat them have been rather
1945. half-hearted. Perhaps the fear that children
19. Suyeuiori, S.: On pathological changes in may lose eyes because they are infested with
the eye during the incipient stage of in- worms will stimulate a more vigorous fight
fection with Ascaris (experimental study), against this common menace to the public
The Taiwan Igakkai Zasshi, 239:1, 1925. health. If so, Mrs. Wilder's report will be
more valuable than ever. I have a feeling that
DISCUSSION more parasitic diseases of the eye will he
demonstrated in the near future.
JOHN S. McGAvic, M. D., Bryn Mawr, Pa.:
In bringing to our attention the fact that nema- It has been a pleasure to discuss Mrs. Wild-
tode infection can cause cndophthalmitis, er's excellent report.
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THE CONTAMINATION OF OPERATIVE WOUNDS
WITH COTTON FIBRILS AND TALC
L. R. DUSZYNSKI, M.D.
NEW YORK, N. Y.
GERMAN2 emphasized that cotton or
talc foreign bodies frequently escape
detection in routine methods of histo-
logic examination but can be easily dem-
onstrated with polarized light. Routine
microscopic sections of globes operated
upon for glaucoma and subsequently
enucleated were examined with a pola-
roid microscope.
Photomicrographs with polarized light
show the location of the foreign bodies.
Routine photomicrographs demonstrate
the tissue reaction present in the for-
eign body field. The relationship be-
tween foreign body and tissue reaction
can be compared by examining the same
field with both technics' (figs. 1 through
8).
Table I indicates the relative inci-
dence of such material in routine sec-
tions of previously operated upon glau-
comatous globes. While the number of
specimens in each group is too small to
permit statistical analysis, the low per-
centage in simple iridectomy would lead
one to suspect that some factor sepa-
rates it as an individual group. This fac-
tor is probably the minimal operative
manipulation in this procedure, i.e., in
the absence of bleeding, sponges are not
introduced into the operative field and
instrument technic limits contamination
from glove talc.
Tissue reaction is dependent upon
the site and nature of the foreign body.4
'The morphologic and optical properties
Presented at the Fifty-Fifth Annual Session of the
American Academy of Ophthalmology and Otolaryn.
gology, Oct. 8-13, 1950, Chicago, Ill.
of the material demonstrated in the
polaroid photomicrographs is that of
cotton or talc. The tissue reaction to
each of these materials is fibroblastic
and proliferative. Many observers have
described this reaction in clinical and
experimental studies. 1,3,5,11 The photo-
micrographs are confirmatory evidence
in support of their previous findings
and will not be elaborated upon at this
time.
T A]SLE I
THE RELATIVE INCIDENCE OF FOREIGN BODY
MATERIAL IN GLAUCOMA SURGERY
OPERATION
NO. OF
SPECIMENS
NUMBER
POSITIVE
PER-
CENTAGE
Cyclodialysis
37
31
84
Cyclodiathermy
5
5
100
Iridectomy
49
23
47
Iridencleisis
3
3
100
Iridotasis
1
0
0
Posterior
sclerotomy
6
5
83
Sclerecto-
iridectomy
9
6
67
Trepanation
106
83
78
TOTALS
216
137
73
The frequent presence of foreign
bodies in eye surgery is significant in
itself, and particularly so when one con-
siders the care taken to prevent wound
contamination with bacteria. "Physio-
logically inert" foreign bodies are not
absorbed and do provoke tissue reac-
tions. The low grade chronic inflamma-
tory response, while apparently innocu-
ous, is a hazard, actually and potential-
ly. McCormick5 reported a talc gran-
uloma occurring fourteen years after
muscle surgery.
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FIG. 1-Iridectomy. (A) Low power photomicrograph by routine technic. Globe sectioned through
lane indicated by identification suture (black), and also passing through operative site. Note giant
p
cells in tissue below identification suture. (B) Same field viewed by polarized light technic. Note
distribution of foreign bodies (white) in the tissue. Compare location of foreign material with dis-
tribution of giant cells in (A). (C) Same field viewed by combined nonpolarized and polarized light
technics. Note birefrineent material in giant cells.
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FIG. 2-Trepanation. (A) Photomicrograph by polar-
ized light technic. Note birefringent material (white)
posterior to opening. (B) Same field by routine
technic. Note tissue response localized to foreign
body material demonstrated in (A).
FIG. 3-Cyclodialysis and trepanation. (A) Photo-
micrograph by polarized light technic. Note bire-
fringent material (white) in tissue above and pos-
terior to operative site. (B) Same field by routine
technic. Note tissue response and compare cellular
reaction to location of foreign bodies demonstrated
in (A).
SUMMARY
Routine sections of globes operated
upon for glaucoma and subsequently
enucleated were examined with a pola-
roid microscope. Photomicrographs
demonstrate the presence of foreign
bodies and the tissue reaction to them.
The morphologic and optical properties
of the foreign material are those of cot-
ton or talc.
FIG. 4-Trepanation with iridectomy. (A) Photo-
micrograph by polarized light technic. Note many
small foreign bodies (white) in tissue and large con-
glomerate foreign body located posteriorly in epi-
scleral tissue. (B) Same field by routine technic.
Note capsule about large episeleral foreign body
demonstrated in (A).
The incidence of wound contamina-
tion by foreign bodies in glaucoma sur-
gery is indicated and the possible sig-
nificance thereof is mentioned.
REFERENCES
1. Derbyshire, R. C.: Cotton as suture ma-
terial, Surg., Gynec. & Obst., 84:31-35,
1947.
2. German, W. M.: Dusting powder granu-
lomas following surgery, Surg., Gynec. &
Obst., 76:501-507 (April) 1943.
3. Gurtler, E.: Wattefaden in der Vorder-
hammcr nach bulbuscr6ffnenden Opera-
tionen [Cotton wool threads in the anterior
chamber after intraocular operations],
Wien. klin. Wchnschr., 61:686-689 (Oct.
21) 1949.
4. Leber, Theodor : On the present position
of otir knowledge of inflammation, with
especial reference to inflammation of the
eye, Tr. Ophth. Soc. U. Kingdom, 12:
1-28, 1892.
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1950
FIG. 6-High power photomicrograph of specimen
in figure 5. Polarized light technic. Note foreign
body material (white) in tissues.
CONTAMINATION OF OPERATIVE WOUNDS
nu
tee mc. o e
h
field by routine technic. Note tissue reaction and compare cellular response in
plane of foreign bodies demonstrated in (A).
FIG. 5-Trepanation with iridectomy. (A) Photomicrograph by polarized light
merous foreign bodies (white) present in tissues. (B) Same
N
FIG. 7-Same field as in figure 6 by routine technic.
One foreign body in focus. Note cellular reaction.
The second foreign body lies in another focal plane
and cannot be demonstrated simultaneously by this
technic.
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TRANS. AMER.
ACAD. OF 0. & 0.
FIG. 8-Nigh power photomicrograph of specimen in figure 2. Routine technic. Note cellular
response in foreign body field.
5. McCormick, G. L., Macaulay, W. L. and
Miller, G. E.: Talc granulomas of the
eye, Am. J. Ophth., 32:1252-1254 (Sept.)
1949.
6. Meade, William H. and Ochsner, Alton :
The :relative value of catgut, silk, linen,
and cotton as suture materials, Surgery,
7:485-514 (April) 11940.
7. Meade, William H. and Long, Carroll H. :
The use of cotton as a suture material,
with particular reference to its clinical ap-
plication, J.A.M.A., 117:2140-2143 (Dec.
20) 1941.
8. Orr, Thomas G.: Granulomas caused by
surgical silk and cotton Sutures, Arch.
Surg., 54:37-40 (Jan.) 1947.
9. Searcy, Harvey B., Carmichael, Emmett
B. and Wheelock, Mark C.: Implant ma-
terial : the production of fibrous tissue
around the fibers of cotton and other for-
eign material implanted subcutaneously in
rats, South M. J., 37:149-150 (March)
1944.
10. Vail, Derrick: Lint in the anterior cham-
ber following intraocular surgery. Pre-
sented at the meeting of the American
Ophthalmological Society, Hot Springs,
Va., June 1950.
11. Wilter, J. A.: Unusual proliferative re-
action to suture material, Arch. Surg., 56:
178-185, 1948.
DISCUSSION
DErtrucx VAIL, M.D., Chicago, Ill.: Like the
ghost of Shakespeare's Hamlet, Dr. Duszynski
has here unfolded a tale "whose lightest word
would harrow up thy soul,
Freeze thy young blood,
Make thy two eyes, like stars, start from
their spheres,
Thy knotted and combined locks to part,
And each particular hair to stand on end,
Like quills upon the fretful porpentine."
W. M. German showed in 1943 that bits
of cotton and talc embedded in tissue can easily
be demonstrated under the microscope by
polarized light, standing out like "an electric
sign at night." Dr. Duszynski has cleverly
adapted this method to a routine study of eyes
operated upon for glaucoma and subsequently
removed. He reveals the astounding fact that
73 per cent of 216 such eyes contain cotton
fibrils and talc and show unmistakedly the
injury these foreign bodies produce. Without
his method o F study these harmful particles had
escaped notice by even the most astute ob-
servers. His photomicrographs are more im-
pressive and convincing than a thousand words.
They sound the tocsin to alert us at once to
this dangerous condition and stimulate us to
take what measures we can to combat it.
At the last meeting of the American Oph-
thalmological Society, I introduced the subject
of lint or cotton threads in the anterior cham-
ber following intraocular surgery and showed
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. CONTAMINATION OF OPERATIVE WOUNDS 115
voa.-DEC
950
that clinically this condition probably was not find it satisfactory, although not perfect.
rare and that these foreign bodies were cap-a- Powder from rubber gloves is another for-
ble of producing harmful reactions within the eign body discussed by the essayist. Starch
eye in spite of some reports in the i'terature powder has replaced the older magnesium talc
to the contrary. I. was alarmed by the enorm- used on hands and rubber gloves, but particles
ous amount of lint from gowns, draperies, of starch powder can easily enter the opened
towels, and sponges that floated around in the anterior chamber and can irritate the intra-
air of the operating room. This lint dust, ocular tissues. This danger can be alleviated
stirred up by the slightest move of anyone by irrigating the newly gloved hands in a
within the room, or entering or leaving it, stream of, sterile saline just before operating.
swirled around and settled tenaciously on ex- However, those of tis who do not wear gloves
posed instruments, solutions, sutures and the for intraocular surgery do not have this prob-
patient's open eye. In the beam of the strong lem, as pointed out by Dr. Verhoeff in his
operating lamp, the lint resembled white discussion of my paper referred to. The as-
swarms of dancing midges. The saline for sistants and the scrub nurse, however, do and
irrigation of. the anterior chamber sucked into they should be instructed to rinse thoroughly
the glass syringe and held tip to the light their gloved hands to wash off all traces of
showed a nauseating quantity of minute pieces powder.
of. lint, like thread worms, waiting to be in- Instruments should be rinsed in sterile saline
jected into the anterior chamber. or dipped in zephiran and wiped with sterilized
The investigation of the problem showed pieces of old fine linen just prior to use.
The fluid used for irrigation of the anterior
that the pieces of free lint were capable of chamber, should be contained in a closed sterile
carrying harmful bacteria picked up in the vessel and sucked into the syringe just be-
air as it floated about. Ordinary measures to fore using.
stop- or reduce the amount of free lint particles Foreign materials of a nature other than
were fruitless. In desperation the advice of Dr. lint are occasionally seen in the anterior cham-
Ralph M. Tovell of the Hartford (Conn.) her after surgery. These may be pieces of
General Hospital was sought. He advised that bbcr ball irrgators or Bell
the laundry use a paraffin-base waterproofin-, ru rubber er (from rbits~iof glass from a broken end
material called Migasol P. J. (Ciba) upon all of a glass tipped irrigator, pieces of rust and
operating room linen not used to absorb moist- scale from plated instruments, oil drops from
ure. The use of this material during the last ophthalmic ointment, and bits of cilia. Methods
four months at my free lint. has That t there a T there to prevent the introduction of these substances,
solved the problem of f f free h while fairly obvious, require more thought.
has been a striking decrease in the amount Whan we see an enlarged motion picture of
floating around is evidenced by the fact that a cataract extraction, for example, or see what
at the end of a day's work in the operating we do when we wear a loupe during the opera-
room there is scarcely any lint seen on the tion, or when we examine with the slit lamp
mirrors of the overhead operating lamp, an eye newly operated upon, we are struck
whereas hitherto a thick layer of it was ob- with horror over the damage we do to the
vious. I am, therefore, able to recommend tender tissues of the eyeball by our manipula-
to you without reservation this method for tions. This depressing situation is bad enough,
prevention of free lint. The method is simple. although perhaps a necessary evil. At least
Migasol P. J. is added to the wash wheel after let us take intelligent measures to obviate as
the laundry machine is loaded for the last far as possible the damage to an operated eye
time. The formula calls for one pint of Miga- produced by things under our control. I shud-
sol P. J. for each 100 pounds of linen in the der to think what we would see if we were to
wash wheel. Linen used to absorb blood, serum use polarized light in the clinical slit lamp
and other body fluids should, of course, not examination of eyes which have been operated
be so treated. upon.
Cotton sponges are another source of lint I am grateful to Dr. Duszynski for proving
that can enter the anterior chamber. The ma- so convincingly in the laboratory what has been
trix of the usual cotton sponge is very easily clinically observed, particularly for showing us
broken by rolling into the shape generally em- how common this serious problem is, for alert-
ployed. Substitutes are used but these arc not ing all of us to its danger, and for bringing
entirely satisfactory. Among them are cellu- up this important subject for thought and dis-
lose and the compact "felt cotton" used so cussion that may result in far reaching bene-
widely by neurosurgeons. I use the latter and fits to our patients.
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MALIGNANT LYMPHOMA OF THE WEAL TRACT
I'.DMOND L. Cooei R, M.I).
DETROIT, MICII.
and `
JOAN L. RIxiR, M.D.
ALPENA, MICT.T.
BY INVITATION
AN interesting diagnostic problem is
presented by a case of malignant neo-
plasm with ocular manifestations. In
the early stages of the disease the lesion
was misinterpreted as inflammatory, and
it was not until the enucleated eye was
examined pathologically that the proper
diagnosis was made. The disease from
which the patient suffered was of a gen-
eral systemic nature; yet for several
months the only signs and symptoms
were ocular, and for this reason the case
should be of interest to ophthalmolo-
gists.
CASE REPORT
The patient was a 27 year old white rnan,
who in November 1947 had begun to have
pain and blurring of vision in the right eye.
He consulted an ophthalmologist who institut-
ed treatment for iritis. When after a month
the iritis had not improved but continued to
progress, he was referred to us. There had
been no attack of pain, no redness or blurring
of vision in either eye preceding the "inflamma-
tory" condition for which he had been receiv-
ing treatment. The past history was negative
except for two significant events. In 1944,
while attending a radar school at Boston, the
patient was hospitalized for an illness charac-
terized by swelling of the lymphatic structures
of the groin, diagnosed "lymphangitis." In
the following year, when he was stationed at
Okinawa, jaundice and severe headaches were
the prominent symptoms in another illness for
which he was sent to the hospital. During this
time his weight, which on induction to the
service had been 199 pounds, dropped to 180,
and from then on he had experienced a very
gradual but persistent loss of weight.
Presented as a Clinicopathologic Case Report at the
Fifty-Fifth Annual Session of the American Academy
of Ophthalmology and Otolaryngology, Oct. 8-13,
1950, Chicago, III.
When the patient was first seen, the left
eye was normal and it remained so throughout
the course of the illness. Vision with the right
eye was 20/25. There was a mild ciliary flush.
Slit lamp examination revealed numerous mut-
ton-fat keratic precipitates on the corneal
endothelium and cells in the aqueous. The iris
was thickened but not nodular, and the blood
vessels were engorged. The pupil was nmocl-
erately dilated, and there were no posterior
synechias. The fundus was easily seen. There
was considerable edema of lire optic nerve head
and the surrounding retina. The retinal veins
were moderately engorged and exhibited peri-
phlebitic changes. Throughout the fundus, but
particularly in the upper temporal quadrant,
were numerous retinal hemorrhages. The
vitreous was free of hemorrhage. The intra-
ocular pressure was 50 mm. Hg (Schiotz).
The diagnosis was neuroretinitis, retinal
pcripltlebitis and retinal hemorrhage (Eales's
disease to be ruled out), iridocyclitis and sec-
ondary glaucoma. The patient was admitted
to Harper Hospital where paracentesis con-
trolled the glaucoma. The inflammatory con-
dition of the eye continued unchecked in spite
of energetic treatment during the ten days
the patient remained in the hospital. The
iris became more thickened, and it was im-
possible to keep the pupil dilated. Poster-
ior synechias developed. Large nodules, 3
or 4 mm. in diameter, began to form in the
iris, and the anterior chamber became shallower
as the thickening of the iris increased. In
general, the appearance of the anterior seg-
ment suggested a chronic granulomatous proc-
ess, and it was thought that the etiologic
factor might prove to he tuberculosis, brucel-
losis, Bocck's sarcoid, or one of the other
chronic granulomas.
While the patient was in the hospital, a
thorough survey failed to provide a clue to
the etiology. No foci of infection were found.
Roentgenograms of the chest were normal.
Skin tuberculin and brucellergin tests, the Frei
test, blood agglutination tests for tularemia
.,nd brucellosis, and smears of the prostatic
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Nov.-DEC. MALIGNANT LYMPHOMA-OF UVEAL TRACT 117
1950
secretion gave no positive information. Kahn
test, urinalysis, and routine blood counts were
normal. The differential leukocyte count was
repeated twice and neither time was it un-
usual. The only abnormal finding in the physi-
cal examination was moderate bilateral in-
guinal lymphadenopathy with no tenderness.
Biopsy of an inguinal lymph node was done,
and the pathologist's report was "chronic
lymphadenitis of undetermined character-no
evidence of sarcoidosis." In short, nothing was
found to which the iridocyclitis or neuroreti-
nitis could be attributed.
Following the patient's discharge from the
hospital the iridocyclitis progressed. The iris
nodules became larger for a time and then
gradually grew smaller. Dense posterior
synechias and a pupillary membrane formed,
so that the fundus could not be examined. In
February 1948 vision was reduced to percep-
tion of hand movements. The intraocular
pressure was subnormal. A course of strep-
tomycin therapy was given without any ap-
parent effect on the disease.
In March, because the eye was hopelessly
blind and was rapidly becoming a cosmetic
defect, and also because it seemed impossible
to establish the correct diagnosis without path-
ologic study, the eye was enttcleated. No diffi-
.culty was experienced except that dissection
of the conjunctiva and isolation of the rectos
muscle tendons were hampered by considera-
the orbit and the testicle but also to all of
the lymph node areas which might constitute
potential foci of metastasis, and to the pelvis,
abdomen and ntediastinutn. Supervoltage roent-
gen rays were employed over all of the areas
except the two axillas, where deep roentgen
therapy was used.
In July 1948, the total leukocyte count was
4,500 and the differential count was normal.
In the terminal stages of the illness the other
testicle became involved, and there was clear-
cut clinical and radiologic evidence of massive
involvement of all the deep lymphatic struc-
tures of the abdomen, thorax, neck, and head.
The patient died in October 1948. Autopsy
was not permitted.
PATHOLOGIC OBSERVATIONS*
The enucleated eye was sent to the
Armed Forces Institute of Pathology,
and a report received in April 1948 gave
the first indication that the lesion was
malignant. The conjunctiva, episclera,
uveal tract, retinal pigment epithelium,
sensory retina and optic nerve were in-
filtrated with closely packed cells (figs.
1 and. 2). These sometimes resembled
lymphocytes, having small round, deep-
ly staining nuclei and scanty cytoplasm
ble thickening and brawny induration of the
conjunctiva, episcleral tissue, and Tenon's cap-
sule. The patient's total leukocyte count dur-
ing this hospital stay did not exceed 9,500,
and the differential count was normal.
During the following six months the pa-
tient's condition gradually declined. In May,
a painless swelling of the right testicle sud-
denly appeared. It was relatively soft and uni-
formly smooth with no nodularity, and at-
tained the size of a peach. This was the first
clinical indication (unless the inguinal lymph-
adenopathy can be considered) of generalized
disease. The testicle was removed and studied
pathologically. At this time the differential
blood count was normal. The liver and spleen
were palpable and there were no indications
of lymphadenopathy. Later the same month
a cervical lymph node was removed and studied.
The treatment of the eye in the early stages
of the disease included all accepted measures,
both local and general, for severe uveitis. It FIG 1__1>iffuse infiltration of the sweat tract, retina,
was not until June 1948, when the pathologic and epibulbar tissues by tumor cells. x4. AFIP
diagnosis of neoplasm in the eye had been Acc. 205905.
further confirmed by examination of the tes 'Patbologic reports furnished by Helenor Campbell
ticular tumor, that deep roentgen therapy was Wilder, Registry of Ophthalmic Pathology, Armed
begun. Irradiation was directed not only to Forces Institute of Pathology, Washington, D. C.
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THA\S. AMER.
ACA,. OF O. & O..
FIG. 2-Dense neoplastic infiltration with thickening of the conjunctiva, iris, and ciliary body.
x16. AFIP Ace. 205FS05.
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Nov.-DEC. MALIGNANT LYMPHOMA OF UVEAL TRACT 119
1950
6IG. 4-Reticulum fibers surrounding tumor cells
in the ciliary body (Wilder reticulum stain). x435
AFIP Ace. 205805.
which was not always discernible. More
often, however, the cells were larger,
with rather abundant, ill-defined cyto-
plasm and large, oval or round, vesicu-
lar, nucleolated nuclei (fig. 3). These
large cells approximated in appearance
the cells of the germinal center of lymph
follicles. A reticulum stain demonstrat-
ed a close association between the retic-
ulum fibers and tumor cells in many
areas (fig. 4). There were anterior and
posterior synechias and a pupillary
membrane. The lens showed subcapsu-
lar degeneration arid wrinkling of the
capsule. The retina was separated and
folded in several places, and there was
almost total loss of normal. retinal archi-
tecture (fig. 5). The diagnosis was lym-
phoid tumor, probably metastatic retic-
ulum cell sarcoma.
The lesion of the inguinal node which
was removed when the patient was first
hospitalized for treatment of the eye
was diagnosed by the Harper Hospital
pathologist as chronic lymphadenitis
(fig. 6). Following the identification of
the ocular neoplasm, a representative
slide of this lesion was forwarded to
the Armed. Forces Institute of Pathol-
FIG. 5--Infiltration of the ehoroid and retina by
tumor cells with partial destruction of retinal archi-
tecture. x48. AFIP Ace. 205805.
FIG. 6-Reactive inguinal lymph node. x76. AFIP
Ace. 205805.
ogy. The diagnosis of lymphadenitis
was concurred in, although it was re-
garded as possible that the process rep-
resented an inflammatory reaction to
adjacent neoplasm.
A microscopic slide of the testicle was
submitted to the Armed Forces Institute
of Pathology. It also revealed malig-
nant tumor composed of small cells with
scanty cytoplasm and round, deeply
staining nuclei (figs. 7 and 8). The tu-
mor in the eye more nearly resembled
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120 E. L. COOPER AND J. L. RIKER
TRANS. AMER.
ACAD. OF O. & O.
FIG. 7-Interstitial invasion of the testicle by tumor cells resembling lymphocytes. x435.
AFIP Ace. 205805.
reticulum cell sarcoma, although that
in the testicle had the appearance of
lymphosarcoma. It is not always pos-
sible to make a definite differentiation
between the two. Cells of reticulum cell
sarcoma resemble the large cells in the
germinal center of the lymph nodes,
whereas a lymphosarcoma is composed
of cells resembling the small cells of the
node. Both have an origin from un-
differentiated cells, and the variation
results from the type of differentiation.
The cervical lymph node, which was
removed after the testicle, was studied
elsewhere. The report stated that there
was entire loss of normal architecture,
the node being invaded by tumor cells
similar to those in the eye.
COMMENT
Lymphoid tumors arising within the
eyeball have seldom been described in
the literature. In a report of 21 verified
cases of lymphoid disease involving the
eye and its adnexa, McGavic3 found
only one within the globe as against 20
which involved the lids, conjunctiva, or
lacrimal gland. In Heath's series2 of 67
ocular lymphomas, the globe was in-
volved in only three. Sugarbaker and
Craver,4 reporting on 196 cases of lyrn-
phosarcoma, stated, "It is logical to sup-
pose that lymphosarcoma is a disease
which in the majority of cases begins
and runs its early course in lymph nodes
alone." In most instances of rapidly dis-
seminating disease, it is impossible to
determine whether a given organic in-
volvement is secondary or primary.
Lymphoid tissues composed of fol-
licles and sinuses do not exist in the
eyeball or within the orbit ; nevertheless,
lymphoid tumors arising within the or-
bit are by no means unknown. They also
occur in other locations where lymphoid
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1950
MALIGNANT LYMPHOMA OF UVEAL TRACT 121
AN-Wii'll".2 #7
FIG. 8-Small tumor cells resembling lymphocytes
in the testicle. x655. AFIP Ace. 205805.
tissues are not found normally, particu-
larly in the skin where they are regarded
as arising from undifferentiated cells
around blood vessels. Possibly this tu-
mor was primary in the eye, but the
early episode of inguinal gland enlarge-
ment cannot be ignored. According to
the pathologic reports from the Armed
Forces Institute of Pathology, it more
probably represented either metastasis
from elsewhere in the body or one man-
ifestation of a tumor arising in dissemi-
nated lymphatic tissue and from undif-
f erentiated cells.
As is often the case, an exact classi-
fication of the tumor in this instance is
impossible; it includes features of both
reticulum cell sarcoma and lymphosar-
coma. However, all malignant lympho-
mas, including Hodgkin's disease and
the lymphoid leukemias, are considered
manifestations of the same disease' and
it is not unusual for them to exhibit a
variable pattern in a single patient. The
neoplastic process may be represented
in one organ as giant follicular lympho-
blastoma and in another as lymphosar-
coma, or a tumor starting as Hodgkin's
disease may terminate as lymphosar-
coma, the transition being readily trace-
able in successive biopsies.
It is impossible to evaluate the causes
which may incite lymphoid tissue to
malignant growth. The history of our
patient presents two episodes, one in
1944, the other in 1945. Although both
were interpreted at the time as infec-
tious, it cannot be proved or assumed
that an inflammatory process preceded
the neoplasm.
There is no specific hemogram in
lymphosarcoma, and usually, when blood
changes do occur, they are late in the
disease and may be ascribed to radia-
tion therapy. The only abnormality in
the blood picture was moderately low
hemoglobin late in the disease, and at no
time did the patient have an. abnormal
leukocyte or differential count, although
the last test was made only two weeks
before his death.
It is agreed by most writers that the
diagnosis of lymphosarcoma cannot be
made clinically but must be established
by biopsy. Early in the clinical course
even biopsy may show what appears to
be a reactive or benign proliferation of
lymphoid tissues. Considering the im-
portant part played in inflammations by
lymphocytes, it is sometimes difficult to
evaluate their significance as part of an
inflammatory or neoplastic process.
As far as treatment is concerned, all
lymphomas are radiosensitive but not
necessarily radio-curable. Obviously.
the earlier treatment is begun, the bet-
ter is the chance of cure, but the prog-
nosis is usually poor.
SUM MARY
The malignant lymphoma involving
the eye in the case presented was prob-
ably either metastatic or part of a wide-
ly disseminated lymphoid activity. The
ocular process presented, symptoms
which simulated typical uveal inflamma-
tion, and the proper diagnosis was
made only upon pathologic examination
of the enucleated eye. In any case of se-
vere uveitis with nodular iritis or re-
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122 E. L. COOPER AND J. L. RIKER
tinal hemorrhages for which no cause is
found and which does not respond to
treatment, it is important to consider
the possibility of malignant lymphoid
disease.
1. Custer, R. P. and Bernhard, W. G.: The
interrelationship of Hodgkin's disease and
other lymphatic tumors, Ani. J. M. Sc.,
216:625-642 (Dec.) 1948.
2. Heath, Parker: ' Ocular lymphomas, Tr.
Am. Ophth. Soc., 46:385-398, 1948.
3. McGavic, J. S.: Lymphumatoid diseases in-
volving the eye and its adnexa, Arch.
Ophth., 30:179-193 (Aug.) 1943.
\ 4. Sugarbaker, Everett D. and Craver, Lloyd
F.: Lymphosarcoma : a study of 196 cases
with biopsy, J.A.M.A., 115 :17-23 (July 6) ;
112-117 (July 13) 1940.
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A CONCEPT OF ALLERGY AS AUTONOMIC DYSFUNCTION
SUGGESTED AS AN IMPROVED WORKING HYPOTHESIS
HENRY L. WILLIAMS, M.D.
ROCHESTER, MINN.
IT is important to remember that al-
lergy has two aspects, the one clinical,
the other immunologic. It is perhaps
unfortunate that some allergists in turn-
ing from the one to the other aspect
appear to insist that treatment of pa-
tients shall be carried on along exclu-
sively immunologic lines although the
diagnosis may have been made entirely
on the basis of a practical clinical em-
piricism. The allergist in his role as im-
munologist has broadened our under-
standing of physiologic mechanisms
that ? have to do with the organism's in-
tolerance to interference from without.
The immunologist in assuming the char-
acter of clinical allergist, however, often
has seemed to be too rigidly insistent on
the immunologic dogma that all the
clinical manifestations that have become
known as the allergies must have an
antigen-antibody mechanism as a back-
ground of etiology and as a basis for
treatment. Relatively recently the value
of a clinical approach to many of the
problems of allergy has received atten-
tion. Study of those factors that alter
the threshold beyond which manifesta-
tion of allergy occurs, as Carryer24 stat-
ed, has proved more fruitful in the care
of many patients than has sole depen-
dence on, an antigen-antibody type of
treatment. Nevertheless, most allergists
insist on including an immunologic
mechanism in the definition of allergy,
although it seems probable that few of
them insist on the demonstration of an
From the Section on Otolaryngology and Rhinology,
Mayo Clinic.
Presented at the Fifty-Fifth Annual Session of the
American Academy of Ophthalmology and Otolaryn-
gology, Oct. 8-13, 1950, Chicago, Ill.
antigen-antibody mechanism in making
a clinical diagnosis of the condition.
I believe that this attempt to play the
dual role of scientist and physician
without separating the two parts suffi-
ciently has caused some of the confusion
in regard to the management of allergy.
It seems to have been forgotten that
the immunologic hypothesis was de-
veloped to explain certain syndromes
whose confines had previously been laid
out not by controlled experiment but on
the basis of knowledge gained through
observation and experience.
Von Pirquet's hypothesis of allergy76
was based on the discovery of hyper-
sensitivity in an immunized organism.
He, however, considered these two
terms to be mutually exclusive. It
seemed impossible to him to consider as
immune an organism which is protected
against a disease, and at the same time
is considered reciprocally hypersensi-
tive to the same disease. This phenome-
non could not be termed a paradox, he
stated, because the word "paradox"
should be applied only to an exceptional
case, whereas the more one entered into
this field of inquiry the more "ac-
cording to lawness" the phenomenon
was recognized to be. He, therefore, sug-
gested a "new, general, nonprejudicial
word" for the change of condition
which the organism accomplishes, per-
haps through the agency of an organic,
living or lifeless toxin. According to von
Pirquet77 all that could be stated with
certainty about a hypersensitive organ-
ism is that its readiness for reaction is,
altered. For this general concept of al-
tered reactivity he suggested the ex-
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124 HENRY L. WILLIAMS
pression, "allergic," Von Pirquet
showed himself willing to alter details
.of the hypothesis as new observations
were presented. Some of his followers,
however, have not exhibited his intellec-
tual adaptability.
Carryer stated that internists vitally
interested in the problems of allergic
disease are keenly aware of the short-
comings of a purely immunologic ap-
proach. He said, however, that inas-
much as the investigative thought over
the past four decades has been greatly
influenced by those whose background
and experience were in the field of im-
munology, it was not difficult to under-
stand why progress has been directed
away from the nonimmunologic aspect
of allergic disease. He recommended a
critical review of the none too gratify-
ing results of current, generally accept-
ed and practiced tenets which have
shortcomings of considerable magni-
tude.
DEFINITIONS AND DESCRIPTIONS
OF ALLERGY
In considering the desirability of sub-
stituting a new and more flexible hy-
pothesis for the antibody-antigen reac-
tion, a review of some representative
definitions and descriptions of allergy
made by proponents of the immunologic
hypotheses may prove useful. Rosten-
berg,87 for instance, recently stated,
"The best definition for allergy is the
following one: `Allergy is an acquired
specific alteration in. the capacity to
react which is predicated on an antigen-
antibody mechanism." " In his opinion
failure to include the antigen-antibody
reaction has been the major reason for
the confusion and lack of clarity which
exist concerning the meaning of the
word "allergy." He wished it to be
clearly understood, however, that in the
majority of allergic reactions an anti-
gen-antibody mechanism is not demon-
strable by conventional technics and in
some cases not demonstrable by any
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known technics. This, he stated, does
not mean that antibodies do not exist in
these states ; it merely means that we do
not have as yet an appropriate indicator
system to reveal their presence. He di-
vided allergy arbitrarily into three im-
munologic patterns, the anaphylactic,
the bacteria], and the eczematous type.
He emphasized that it was important to
realize that no clinical condition corre-
sponds exactly to any one of the im-
munologic patterns listed. Many clinical
conditions represent a combination of
several of these types and, indeed, he
considered that many varieties of al-
lergic reaction do not fit into any of
the three types given, but there is so lit-
tle information about them that they
cannot be set up as immunologic or
allergic entities.
Rostenberg does not give a single in-
stance in which he considered that treat-
ment of cutaneous allergic disorders by
immunologic methods was certainly
beneficial.
Rostenberg then appears to declare
that although factual data in regard to
the presence or absence of an antigen-
antibody reaction are absent in many
of the conditions he considers allergic,
conclusions arrived at by extrapolation
and inference can be depended on to
be correct and that such conclusions
will serve to clear up the confusion and
lack of clarity which exist concerning
allergy. According to Bell,14 however,
extrapolation and inference have been
the chief causes of the major errors in
human thought.
On the other hand, Harley44 stated
that in his opinion the confusion and
lack of clarity in regard to allergy were
due to the tendency of allergists to in-
vent new and perplexing terminology
for phenomena which were fundamen-
tally the same. In the present state of
our knowledge it seemed to him impos-
sible to give an exact definition to the
term "allergy."
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The "unitarian theory" which was
developed to do away with some of the
confusion of terms appears to have
gained wide acceptance. As Zinsser, En-
ders and Fothergi11120 stated, this con-
cept of allergy implies that the injection
of an antigen into the tissues of an an-
imal will lead to the development of a
single antibody capable of producing
the various manifestations of antigen-
antibody union. This formulation has
been further modified so that the vari-
ous antibodies are considered to rep-
resent varied physicochemical changes
in the same globulin.
. Kahn50 embraced the unitarian the-
ory of allergy, but to the previous con-
cepts of cellular immunity suggested by
Metschnikoff,67 and the humoral im-
munity suggested by von Pirquet,76 he
added the concept of the "third type of
immunity" or tissue immunity. He re-
jected the suggestion that specialized
cells would be entrusted with the entire
defense of the body, stating that from
the standpoint of phylogeny it would be
reasonable to suppose that all cells
possessed in some measure the ability
to defend, themselves against environ-
mental stress whether that stress pre-
sented itself in the form of invading
micro-organisms or some other form.
He suggested that immune gamma
globulin should be considered to be of
two types, one of which is insoluble be-
cause it remains fixed in the cell, the
other of which is soluble because it is
dissolved in the blood serum and con-
stitutes the circulating antibody. Kahn
also considered that the differences be-
tween bacterial allergy and allergy in
which circulating antibody can be iden-
tified were in degree rather than in kind.
Allergy in his opinion is merely an in-
stance of hyperimmunity and there are
many examples of overaction of a nor-
mal physiologic mechanism.
In Bronfenbrenner's opinion,16 the
accumulated evidence indicates that
whenever antigen-antibody reactions
occur in vivo there is always a concomi-
tant injury to the tissues of the host, as
evidenced by both local and general
symptoms. It appeared likely to him.
that the very mechanism which causes
this injury to the host is also instrumen-
tal in bringing about such protective ef-
fects as the warding off of infection by
immobilization of antigen by the anti-
body. Basically this injury consists of
an inflammatory reaction which is
evoked by the physicochemical changes
in the enviropment and differs from
ordinary inflammation only by its rapid
onset and relatively stormy course. This
inflammatory process is accompanied by
both local and systemic symptoms re-
sembling those elicited by the adminis-
tration of histamine. Because of this re-
semblance and especially because of the
highly suggestive experimental demon-
stration of the presence of histamine-
like substances at the site of antigen-
antibody union, he believed that the
most widely held view today is that the
inflammatory reaction is actually due to
the liberation of histamine-like sub-
stances from antibody-laden tissues
when they come in contact with the spe-
cific antigen.
Bronfenbrenner'6 also stated that phe-
nomena called "immunity" and "an-
aphylaxis" are in fact merely different
expressions of the same basic process
of antigen-antibody union. Difference
in the final outcome depends only on the
extent and speed of this union and the
consequent intensity of the injury to
the host. Classical anaphylaxis as ob-
served in animals and occasionally in
man in his opinion is a laboratory arte-
fact. Under natural conditions of expo-
sure antigens enter tissues of allergic
animals and of human beings much
more slowly and in extremely small
amounts ; consequently, their union with
antibodies is less explosive and the in-
jury to the host is much milder than in
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126 HENRY L. WILLIAMS
classical anaphylaxis. The symptoms
elicited vary in form depending on the
portal of entry, on the amount of antigen
on one hand and on the relative local
sensitivity of the involved tissues on
the other. When so exposed, some indi-
viduals respond more easily to such im-
munogenic stimulus than others and
these individual differences in reactivity
seem to be determined by inheritance.
The tendency to hyperreact is inherited,
not the specific sensitivity itself.
A new hypothesis has been suggested
by Wiener.116 He stated that experi-
mental work in relation to agglutinin
and blocking antibody was the first defi-
nite demonstration of the incorrectness
of the "unitarian hypothesis" of allergy.
The evidence presented by his own work
indicated that univalent and polyvalent
antibodies are distinct entities as shown
by the fact that they can be separated
by natural means such as placental fil-
tration. He pointed out that Witebsky
and associates118 partially separated
these antibodies by dialysis in cello-
phane bags against distilled water.
While the agglutinin proved to be asso-
ciated principally with the resulting pre-
cipitate which contained most of the
globulins, the blocking antibody or con-
glutinin remained mostly in the super-
natant fluid together with the albumin.
Wiener offered the following criteria
for allergy based on his theory:
1. The normal (nonallergic and non-
immune) state is that in which the body
contains no induced antibodies specific
for the antigen in question. Cognizance
is taken, however, of so-called natural
or normal antibodies.
2. The immune state is one in which
the body has acquired large amounts of
antibodies of the blocking type formed
in response to the introduction of anti-
gen into the body by either natural or
artificial means. In this state an excess
number of univalent antibodies are free
in the plasma and other body fluids.
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3. In the allergic state the body con-
tains sensitizing (bivalent) antibodies
attached to cells, with little or no free
univalent antibodies in the body fluids.
4. Hyposensitization is the process of
converting the allergic state into the im-
mune state by repeated injections of
antigen at sufficiently wide intervals to
stimulate the production of potent
blocking antibodies. This treatment is
successful only when the subject
achieves an adequate level of free uni-
valent antibodies in his or her body
fluids.
5. Desensitization consists in the in-
jection of progressively increasing doses
of specific antigen in rapid succession
in order to saturate antibodies attached
to body cells. This method, besides be-
ing dangerous, is often unsuccessful
and the refractory state that ensues is
only temporary due to the subsequent
production by the body of additional bi-
valent antibody.
This hypothesis appears to combine
Kahn's concept of tissue immunity with
the concept of humoral immunity. Wie-
ner pointed out a number of problems
in immunology, previously unanswer-
able, that can be explained in. the light
of his new hypothesis.
While all these commentators differ
considerably among themselves as to
what constitutes allergy, they all insist
that definition of the term "allergy"
must contain a reference to an antigenic
mechanism.
It is clear from a review of the lit-
erature of allergy, however, that the di-
agnosis of allergy in the clinic depends
not on immunologic tests but on a well-
taken history and careful observation
of the patient . 4,26,35,47,68,79,104, 108 It is ob-
vious that Rostenberg, for instance, in
classifying the various dermatologic al-
lergies is depending on history and ob-
servation, else he would not so carefully
point out that in the majority of such
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ALLERGY AS AUTONOMIC DYSFUNCTION 127
patients immunologic evidence is unob-
tainable.
In discussing skin tests in diagnosis
of allergy Tuft,104 while insisting that
they are of value in diagnosis when they
can be obtained, pointed out that as in
other laboratory tests the results must
be correlated with the history and other
clinical findings before an accurate di-
agnosis is possible. He found that un-
less a positive reaction can be obtained
repeatedly, such a reaction cannot be
considered specific but must be attribut-
ed to faulty technic, contaminated
syringes, or irritating extracts. He di-
vided all specific positive reactions into
(1) nonclinical positive and (2) clin-
ical positive. It seems clear that Tuft
has made the diagnosis of allergy on the
basis of clinical empiricism and merely
hoped for confirmatory and possibly
more specific information from skin
tests.
Hansel`'' tacitly admitted. that as a
rule the diagnosis of allergy is made
from clinical grounds alone whgn he
stated that eosinophilia of the nasal se-
cretions is the most dependable sin of
allergy. The exact role of the cosi ophil
in allergy appears to be unknown. eter-
sen,75 however, stated that he was able
to produce showers of eosinoph is by
causing localized tissue anoxia. This
finding suggests that eosinophili can
hardly be considered an indicator of an
antigen- antibody reaction however valu-
able it may be as a diagnostic tot for
allergy.
Fox, Harned and Peluse37 in iscus-
sing "borderline" allergy obviously
were not considering allergy as ccur-
ring only among those patients who gave
evidence of an antigen-antibody reac-
tion.
Physical allergy. Not all all rgists
have insisted on an antigen-antibo y hy-
pothesis of allergy, however. uke33
stated that in his opinion in only a mi-
nority of patients with asthma, hay fe-
ver, urticaria, eczema and other mani-
festations of allergy can the source of
the illness be traced definitely to contact
with some material substance to which
the patient is sensitive. He found that
in the majority of patients, even after a
most painstaking effort had. been made
through the use of history, physical ex-
amination, skin tests and clinical tests,
the primary source of the disorder could
not be shown to be sensitivity to sub-
stances such as pollen, dander, foods,
drugs, or vapors. He was astonished to
find, on the other hand, that a rather
large proportion of patients with allergic
conditions are sensitive specifically and
solely to the action of a physical agent
such as light, heat, cold, or mechanical
irritation and indirectly to the action of
emotional -perturbation and fatigue. He
termed such reactions "ph.ysical allergy."
There is a tendency among allergists,
however, to deny that "physical allergy"
as defined by Duke should be actually
considered an allergy. For instance,
Bronfenbrenner117 stated that in his
,opinion it is unlikely that any real al-
lergy (production of antibodies) to light
exists. He remarked that although sev-
eral authors have claimed to have suc-
ceeded in transferring light sensitivity
passively, the lack of proper controls
minimizes the significance of such find-
ings.
In studying physical allergy Swine-
ford'?1 stated that in his opinion physi-
cal allergy -usually is an associated al-
lergic condition and not a primary re-
action. It might be pointed out, however,
that the evidence he presented indicates
that the antigen-antibody reaction is
secondary as much as it does that the
physical reaction is secondary. Since this
is the only paper I have found in the
literature purporting to show that physi-
cal allergy in some manner is secondary
to antigen-antibody allergy, and because
there are several reports to the contrary,
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128 HENRY L. WILLIAMS
it would appear that Swineford's find-
ings need confirmation.
Peshkin74 observed that 10 per cent
of normal children reacted to skin tests
with a variety of allergens. He also
found that some of these "immunolog-
ically positive" children were later pre-
cipitated into acute episodes of clinical
allergy by other presumably unrelated
conditions, such as acute infections. He
suggested that clinical reaction patterns,
depending presumably on some other
factor than the antigen-antibody mech-
anism, needed to be developed before
clinical expression of allergy could take
place. He termed such nonclinical sen-
sitivity para-allergy.
Urbach and Gottlieb106 suggested the
term "pathergy" to cover both physical
and antigen-antibody allergy. Physical
allergy was to cover those cases in
which an antigen-antibody mechanism
could not be demonstrated.
It would appear that Peshkin and
Urbach and Gottlieb were trying to es-
cape from the horns of a dilemma posed
by making diagnoses of allergy on a
purely empirical basis, while at the same
time insisting on the strictest adherence
to the antigen-antibody concept of al-
lergy in theory.
Selye,95 however, reviewed the exten-
sive literature that suggests that the or-
ganism could develop specific and non-
specific crossed resistance to various ir-
ritants without an antigen-antibody
mechanism, and White114 recently de-
fined immunity to include resistance to
physical stimuli in which an antigen-
antibody mechanism apparently plays
no part.
INADEQUACY OF THESE HYPOTHESES
Since it appears that allergists in
general make the diagnosis of an al-
lergic condition through history and
physical examination, since the physi-
cal and immunologic allergies cannot be
distinguished from one another by these
means, and since the majority of din-
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ical allergies, according to Duke, fall
into the group of physical allergies for
which clinically significant skin tests
are not obtained, does not insistence on
the antigen-antibody concept of allergy
tend to lead physicians into the error
of unnecessarily doing repeated skin
tests and treatments with various anti-
genic substances in cases in which such
tests and such treatment could not be
expected to be of clinical benefit?
Does not adherence to the antigen-
antibody hypothesis tend to concentrate
therapeutic attention on attempts at hy-
posensitization alone, or at least to meth-
ods by which the manufacture of sensi-
tizing antibodies can be diminished
while increasing the production of block-
ing antibody or to methods which tend
in some manner to influence antibody
formation? Empirically it has been ob-
served that attention to general nutri-
tional factors, the use of vasodilators,
trace minerals and various vitamins as
well as psychotherapy have appeared to
influence allergic manifestations in in-
dividual cases. In cases in which these
measures exert a beneficial influence
and in cases which are set apart as
physical allergy is not the physician at a
loss for a reasonable hypothesis on
which to base treatment?
What can be the reason for this rath-
er blind allegiance to the antigen-anti-
body hypothesis?
It seems to me that this attitude re-
sults from three factors. The first is
respect to the memory of Clemens von
Pirquet. The second is the impression
that no adequate hypothesis for allergy
is available to replace the antigen-anti-
body hypothesis. The third is based on
the second and is the impression of
many allergists that unless there are
some stable reference points to restrain
the diagnosis of allergy within reason-
able bounds, the tendency to define al-
lergy as a distaste for something or oth-
er, as in the lay expression "an allergy
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Nov.-DHC. ALLERGY AS AUTONOMIC DYSFUNCTION 129
1950
to work," cannot be successfully com-
batted. This seems an entirely reason-
able attitude; therefore, let us examine
the second factor carefully.
It would seem from the increasing
acceptance of the unitarian hypothesis
of allergy and the work of Cannon and
Pacheco,21 Cannon and Sullivan22 and
Walsh, Sullivan and Cannon"' that
von Pirquet's hypothesis has outlived
its usefulness. Thus a different hypothe-
sis whose fundamental assumptions are
not in conflict with the knowledge
gained in the forty years that have
passed since von Pirquet. presented his
paper seems to be required. According
to Bell,14 this is the normal orderly prog-
ress of the scientific method of thought.
It might be well, therefore, to exam-
ine the available data to see whether a
foundation can be found. on which a
new formulation can be erected that
avoids the difficulties of the old. It
would appear that the suggestion that
allergy may be a form of autonomic
dysfunction furnishes such a founda-
tion.
RELATION OF AUTONOMIC DYSFUNCTION
TO ALLERGY
The Autonomic System and Functions
Cannon20 observed that the sympa-
thico-adrenal reaction was one of the
mechanisms by which the body tended
to restore physiologic equilibrium or
homeostasis when it was subjected to
stress in either its external or internal
environment. Petersen75 further extend-
ed the concept of the autonomic system.
He stated that while the mechanisms
designed to meet the environmental
stress are manifold, the vast majority
of these reactions are primarily auto-
nomic. Phylogenetically, he considered
that the various means of autonomic in-
tegration must have taken origin in the
following order:
1. The primary method, when the or-
ganism was unicellular or consisted of
a few cells, was chemical and enzymatic.
2. As the organism became more com-
plex and a circulatory system developed,
substances we call "hormones" were
produced which circulate in the fluids
of the body. Their prime purpose is to
speed autonomic reaction.
3.. The third method evolved when
autonomic correlative efforts required
not only speed in the processes of in-
tegration or restoration of physiologic
equilibrium but direction of localization
as well. For this purpose the anatomical-
ly defined autonomic nervous system,
both sympathetic and parasympathetic,
developed.
Petersen pointed out that these three
components of the autonomic system are
functionally inseparable; no disturbance
can occur in any one element without
immediately affecting the other two. He
also noted that whatever autonomic al-
teration took place was immediately re-
flected in the behavior of the peripheral
vascular bed, the arterioles, capillaries
and venules. These reacted to environ-
mental stress in a stereotyped manner,
whether the stress arose in the external
or the internal environment and wheth-
er it was due to physical agents, emo-
tional perturbation, the invasion of
micro-organisms or of nontoxic protein
substances.
The existence of this stereotyped vas-
cular reaction has received abundant
confirmation.
By means of the method of Lom-
bard,61 observation of the functional re-
action of the peripheral vascular bed to
stress has enlightened us as to the fun-
damental functional changes resulting
from the attempts of the organism to
re-establish physiologic equilibrium or
homeostasis. These were completely ob-
scured as long as the pathologist re-
stricted his observations to dead, fixed
tissues.
Ricker and Regendanz,83'84 for in-
stance, found that a typical stereotyped
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130 HENRY L. WILLIAMS
vascular reaction was present in inflam-
mations of all types, and that an inflam-
matory reaction could not take place in
tissue in which autonomic denervation
had been done. They observed that in
mild inflammation there was arteriolar
and capillary dilatation with hyperemia.
In somewhat more severe inflammation
the arterioles were constricted with a
slowing and clumping of the formed
elements of the blood. In severe inflam-
mation they found arteriolar spasm
with dilatation of the contiguous capil-
lary and venule. According to Oertel,71
they gave convincing answers to criti-
cisms of their findings.
Carrier23 observed these same periph-
eral vascular reactions on exposure of
the organism to differing degrees of
cold.
llrownT8 observed this same type of
arteriolar and capillary reaction in Ray-
naud's disease. He stated that this re-
action represented a disruption of the
normal co-ordination between arteriole
and capillary. Krogh57 has shown that
the capillaries have an independent au-
tonomic nerve supply and their caliber
constantly changes. He also brought
forward evidence indicating that the ar-
teriomotor and capillomotor systems are
able to respond in opposite directions
to the same stimulus. Krogh noted that
individuals exhibit a greater or lesser
tendency to react to cold. He stated that
although hyperreactivity may be a nor-
mal tendency in certain individuals, this
tendency can reach an abnormal level.
Brown also had found that in patients
with the vasomotor neuroses the reac-
tions to cold were similar to, but more
marked than, the reactions of normal
individuals and occurred at higher tem-
peratures.
Mygind and Dederding70 noted the
same lack of co-ordination between ar-
teriole and capillary in the skin of pa-
tients with Mcniere's disease. They con-
clude that a similar reaction in the inner
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ear was the probable cause of the signs
and symptoms of this disease. Lewis and
Landis59,6o observed the same arteriolar
constriction with capillary and venular
dilatation in acrocyanosis. Fremont-
Smith and his co-workers38 observed
complete stasis in all visible capillaries
during a chill; this stasis was due to
constriction of the terminal arterioles.
Parrisius72,73 found lack of co-ordina-
tion among arteriole, capillary and
venule in the skin of patients who had
chronic simple glaucoma and Meniere's
disease. Redisch and Pelzer8l and Ken-
nedy53 found that while the premonitory
symptoms of migraine might be due to
vasospasm in larger vessels, the char-
acteristic,headache seemed to be due to
this stereotyped lack of co-ordination
between arteriole and capillary in the
vasa vasorum of the involved extra-
cranial vessels.
A most extensive investigation of the
so-called vasomotor neuroses or dys-
functions has been made by Muller.69 In
many of these conditions including the
allergic states, such as urticaria, vaso-
motor rhinitis, asthma, angioneurotic
edema and the like, he found the same
typical picture in the peripheral vascu-
lar bed. He termed the arteriolar con-
striction with capillary dilatation "the
spastic atonic state," and noted, as oth-
er observers have done, that not all tis-
sue areas were involved but that areas
of arteriolar and capillary dysfunction
would alternate with normal areas. Ile
pointed out that the anoxia in the in-
volved tissue would lead to increased
capillary permeability.
Brown1s observed destruction of the
leukocytes in the involved capillary
loops. Codc27 has shown that most of
the histamine in the body of a human
being is contained in the leukocytes.
Destruction of the leukocytes in the
capillary loop together with more or
less injury to other involved cells would
result in the release of histamine, which
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NOV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 131
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also would increase capillary permeabil- in many arteries. In those instances in
ity. Depending on the type of cell in- which vascular spasm did not occur for
jured, other toxic substances, such as a minute or two, the slowing of the cir-
heparin, or leukotaxine, the leukocyte culation was the most prominent fea-
promoting factor, necrosin and pyrexin, ture. Cells moving in clumps separated
as observed by Menkin,66 might be lib- by plasma, as though they had become
erated. These substances could produce sticky and adherent, could be seen. This
the salve fundamental type of vascular latter phenomenon, which they identi-
change seen in all reactions of the or- fied as sledging of the blood, was ob-
ganism to stress in the internal or ex- served by Timonen and Zilliacus103 in
ternal environment, including those allergic reactions in the human being.
found in the allergies. It has been point- It was their opinion that this did not
ed out repeatedly that allergy is primari- result from an antigen-antibody re-
ly a vascular phenomenon. Rich and action but depended on a more primitive
Follis,12 for instance, found that the resistance mechanism involving the re-
Arthus phenomenon could not be pro- action of the peripheral vascular bed.
duced in an area devoid of blood vessels. The evidence appears convincing
Klinge56 found evidence to indicate that that a typical fixed, unchanging type of
in the pathogenesis of allergic lesions vascular reaction is present and is fun-
produced both clinically and in the lab- damental in that it is an indispensable
oratory, fibrous necrosis of the collagen part of the autonomic reaction to en-
fibrils is the earliest observable organic vironmental stress. It also would appear
pathologic change. Similar changes in reasonable to assume that in phylogene-
the ground substance also were observed tic development the first stress to which
by R6ssle.86 the organism would need to adjust itself
The presence of this stereotyped re- would be physical and chemical changes
action of the peripheral vascular bed in the environment. It remains to be
has been observed in immune reactions suggested, however, how, on the basis
of this stereotyped reaction of the per-
constriction experimental animals. Ba11y7,8,9 found i hero' vasctlla~ bed consisting of ar-
constriction and spasm of the vessels of teriolar constriction with atonic dilata-
the rabbit's ear in histamine, peptone tion of the capillary and venule, we
and anaphylactic shock. Szepsenwol can differentiate the allergies from other
and Witebsky102 showed that three day types of inflammatory reaction result-
old chick embryos contained the Forss- ing from stresses occurring g in either the
man antigen and. that the vessels con- g
internal or external environment. This
strict when Forssman's antiserum is differentiation appears to reside in the
applied directly. In microscopic observa- hypothesis of autonomic dysfunction.
tions on the behavior of the living blood
vessels of the rabbit during anaphylaxis, Hypothesis of Autonomic Dysfunction
Abell and Schenck' observed constric- L in er and IIess36 suggested and
tion of the arterioles. Wittich119 ob- described the hypothesis of autonomic
served the same reaction in the vessels imbalance or dysfunction. This has been
of the chick embryo during active ana- restated by Wen ern3 to bring it into
phylaxis. McMaster and Kruse,64 on in- line with more recent findings.
vestigating the peripheral vascular re-
A. The differential chemical reactivity, and
actions in anaphylaxis, found chiefly
the physiological antagonism of the adrenergic
vasos asm and arrest of the circulation
P and cholinergic branches of the autonomic
in sensitized mice. They found that nervous system permit of a situation in which
sharply localized contractions appeared the action of one branch may predominate
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over that of the other. This predominance,
or autonomic imbalance, may be phasic or
chronic, and may obtain for either the adrener-
gic or the cholinergic system. B. Autonomic
imbalance, when measured in an unselected
population, will be distributed continuously
about a central tendency which shall be de-
fined as autonomic balance.
The Role of Autonomic
Dysfunction in Allergy
Kuntz58 pointed out that some of the
most characteristic manifestations of al-
lergic disease are causally related to
heightened parasympathetic or choliner-
gic activity. He was of the opinion that
the so-called allergic state could not ex-
ist in the presence of a normal function-
al status of the autonomic nerves. It
seemed to him that abnormal functional
states of the autonomic nerves might be
induced by the tissue reactions to the
sensitizing agents in question, but on
the other hand not infrequently the
modified functional status of the auto-
nomic system is a factor in the etiology
of allergic disease: He stated that al-
though many allergic manifestations un-
doubtedly result from the antigen-anti-
body reaction of the tissue elements, the
manifestations of physical allergy can-
not be explained on this basis. In either
case, however, Kuntz noted that the
functional disturbances bear essentially
the same relationship to the autonomic
nerves. These functional disturbances
involve primarily tonic changes in the
musculature of the visceral organs and
especially in the vascular system. The
cholincrgic influence in allergic reactions
of all types is indicated by the fact that
regardless of which tissue is affected,
adrenin affords relief. The general ad-
renergic reaction tends to counteract
the effect of the local cholinergic stim-
ulation wherever the disturbance may
be.
Kennedy53 also pointed out the im-
portance of the autonomic system in
allergic reactions. He observed that a
sensitized person may exhibit allergic
phenomena on emotion only when the
autonomic system is "triggered" by such
emotion and at the same time is in a
reactive state. He felt that in time a
system-habit reaction, referable to an
unstable autonomic mechanism, might
develop in such individuals. In mi-
graine, he noticed the presence of ar-
teriolar spasm with atony of the capil-
lary and venule to be preponderantly on
the same side of the body as the head-
ache which he felt was on the basis of
localized intracranial edema secondary
to increased capillary permeability.
BelAk13 presented evidence which sug-
gested that the production of immune
substances took place secondarily to an
autonomic reaction. This would suggest
that the reaction of the peripheral vascu-
lar bed, which is an integral part of any
autonomic reaction, probably preceded
in phylogenetic development the appear-
ance of an antigen-antibody reaction. In
summarizing his own work and that of
his associates, Belak classified immune
substances in relation to the autonomic
nerves as follows :
1. Sympathergic immune substances
are the essential nonspecific antibodies,
such as the alexins, opsonins and com-
plement which are always present. He
found their production to be increased
by sympathetic stimulation and inhibited
by parasympathetic stimulation.
2. Parasympathergic immune sub-
stances are the essential specific anti-
bodies, such as antitoxin, precipitin, ag-
glutinin and lysine. He found that the
production of these substances is aug-
mented by parasympathetic stimulation.
Kuntzss concluded that undoubtedly
the specific immune substances are re-
lated to cholinergic nerves both of
sympathetic and parasympathetic origin
and that they respond to cholinergic
(parasympathetic) stimulation accord-
ing to a common mode.
Ilalphen and Maduro,39 in studying
spasmodic coryza, stated that when an
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.attack of vasomotor rhinitis is produced Petersen" in his hypothesis of autonom-
by contact with an allergen, the allergen is disintegration, and by Duke33 in his
is unable to produce symptoms unless hypothesis of physical allergy. Selye
the individual has a pre-existing func- noted. particularly that resistance could
tional disorder of the autonomic sys- be developed to specific environmental
tern. They considered that cold, humid- stimuli without the mediation of an an-
ity, physical factors such as sunlight on tigen-antibody reaction. He also pointed
.skin surfaces, and tobacco fumes cer- out the destruction of lymphoid tissue
-tainly could produce vasomotor coryza that occurred during the alarm phase of
:solely by an autonomic mechanism. They the general resistance mechanism. He
were of the opinion that either local or called attention to the work of Sabin,91
;general intolerance was fundamentally McMaster and Hudack,63 Dougherty,
only the reflection of an acquired or Chase and White, Harris and asso-
hereditary autonomic dysfunction.. That ciates,46 Ehrich and Harris34 which in-
this is oversimplification of the problem dicated that the site of antibody forma-
is suggested by the circumscribed area tion may be the lymphocyte, or at least
,of the lesions of allergy. White and the reticulo-endothelial system. Rosten-
Smithwick,115 Kuntz and others have berg and Brunner88 also critically re-
pointed out that the cholinergic fibers viewed the literature on antibody forma-
are the ones giving a localized discharge tion. They favored the hypothesis of
of stimuli. enzymatic adaptation suggested by Bur-
In his hypothesis of the general adap- net,19 and stated that the somewhat di-
tation syndrome Selye95 suggested that vergent experimental findings might be
environmental stress of all types called welded together if it was' considered
up a series of interrelated nonspecific that the primitive reticulum or undif-
:systemic reactions of the body, the pur- ferentiated mesenchymal cell might be
pose of which is restoration of physio- the site of the enzymatic adaptation.
logic equilibrium. These reactions con- Valentine, Craddock and Lawrence107
sist of physicochemical changes in the have suggested that this work requires
tissue fluids, reactions of the peripheral confirmation and that some of these
vascular bed and, especially, hormonal conclusions may be erroneous. However,
reactions. He pointed out that a review it can hardly be denied that this work
,of the literature indicated the control- does suggest that a stereotyped reaction
ling position of hormones of the ante- of the autonomic system takes place
rior pituitary and adrenal cortex in that before an antigen-antibody mechanism
:such resistance reactions could not take develops.
place in the absence of the adrenal cor- Selye divided the general adaptation
tex or the anterior pituitary. mechanism into three stages : the alarm
These reactions did not require an reaction, the stage of resistance, and
antigen-antibody mechanism for their the stage of exhaustion. The stage of
completion. Selye was struck by the the alarm reaction was subdivided into
observation that these reactions were the stage of shock and the stage of coun-
invariably the same no matter what tershock or reaction. The stage of shock
stimulus called them forth. The "alarm- bears much resemblance to the stage of
ing stimuli" which Selye found capable exhaustion. It seems reasonable to as-
of initiating the general adaptation sume, therefore, that a defect in the
mechanism are essentially the same as autonomic -mechanism which calls out
those previously described by Cannon20 the stage of countershock, which even-
in his hypothesis of homeostasis, by tually leads to the stage of resistance,
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might well be considered a fundamental
part of a dysfunction of the autonomic
system. The similarity of the histologic
picture of shock and. allergy has long
been noted,97 For this reason the react-
ing cells have been termed the "shock
organ." The great difference in the two
conditions is the localized or focal part
of the peripheral vascular= bed involved
in allergy as opposed to the generalized
reaction in shock. That allergy might
result from a disturbance of the ante-
rior-pituitary, adrenal-cortical hormone
also is suggested by the work of Ken-
dali51'52 on the physiology of the adrenal
cortex.
In discussing the relation of the ad-
renal glands to immunity, Whiterra
stated that the factors which contribute
to immunity are genetic, cellular, nutri-
tional and hormonal. He stated that
evidence is available that the adrenals
play a significant role in the defense
against physical, emotional and noxious
stimuli. In his opinion elucidation of
the role of the adrenal cortex has been
obscured by studies with the hormone
of the adrenal medulla since epinephrine
has been established as a powerful stim-
ulator of the rate of production of hor-
mones of the adrenal cortex. While in
this paper he emphasized the role of the
adrenal cortex, White pointed out that
the level of functioning of the adrenal
cortex is markedly influenced by nutri-
tion and by stimuli present in the en-
vironment. He favored broad use of the
term "immunity" with a connotation of
increased resistance to both nonantigenic
and antigenic stimuli.
Tuftr05 recently stated that although
the clinical findings of Duke have been
verified repeatedly, no evidence has
been presented as yet to indicate that
the reactions depend on an antigen-anti-
body mechanism. Attempts at antibody
demonstration have been generally un-
successful. For these reasons it seemed
likely to Tuft that the reactions of
TRANS. AMER.
ACAD. OF O. & O.
physical allergy are based on a physico-
chemical rather than an antigen-anti-
body mechanism. He also stated that
there is no definite symptomatology or
clinical picture characteristic of physi-
cal allergy by which it could be readily
differentiated from antigen-antibody al-
lergy.
It seems, therefore, that not only is
"allergy" possible without the mediation
of an antigen-antibody mechanism but
that restriction of the term "immunity"
by such an assumption of an antigen
antibody reaction may be incorrect.
COMMENT
The evidence presented seems to in-
dicate definitely that the hypothesis of
von Pirquet is no longer adequate as a
working hypothesis because too many
conditions recognized clinically as al-
lergy fail to meet the criteria established
by it. It is felt that a more adequate
working hypothesis has been established
by search of the available evidence. This,
evidence indicates that the peripheral
vascular components of an autonomic
reaction are the fundamental factors in
the reactions by which the body attempts
to restore physiologic equilibrium when
subjected to environmental stress of any
type. Allergy occurs when localized hy-
peractivity of this primitive immune re-
action, with a cholinergic preponder-
ance, develops. Consideration of allergy
as a result of a dysfunctional prepon-
derance of the cholinergic portion of the
autonomic system seems to fit the avail-
able evidence better. Since the hormonal
system is an integral part of the auto-
nomic system as defined by Petersen,75
along with the physicochemical reac-
tions at the semipermeable membranes
and in the tissue fluids, and the auto-
nomic nervous system, the hormones of
the anterior pituitary and of the adrenal
cortex would be included.
There seems to be no particular rea-
son for abandoning von Pirquet's term,
"allergic," however. Its retention to
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ALLERGY AS AUTONOMIC DYSFUNCTION 135
cover the conditions empirically di-
agnosed as allergies would serve to re-
tain in our memory his great contribu-
tion to the study of immunologic mech-
anisms. An attempt to replace it with
another word might add to the confu-
sion produced by the tendency to give
different names to identical physiologic
processes, on which Harley44 comment-
ed adversely.
Kahn50 has defined an allergic indi-
vidual (1) as one who may react max-
imally to stimuli that would produce
only a mild autonomic response in a
normal person, (2) as one who has
a tendency to react to stimuli which
would not develop a tendency to re-
action in a normal person, and (3) as
one who reacts to lesser stimuli than
would provoke a similar reaction in a
normal person.
Stiles and Johnston,98 Baajol and as-
sociates,6 Brown'8 and Miiller69 have
presented evidence that this tendency to
develop abnormal reaction to environ-
mental stimuli is inherited.
Duke33 has pointed out that a reflex
type of allergic reaction may involve an
area, a tissue or an organ. Petersen has
spoken of "focal" autonomic dysfunc-
tions.
A NEW WORKING HYPOTHESIS
Allergy may be defined, therefore, as
an inherited predisposition to a localized
type of. autonomic dysfunction mediated
by cholinergic fibers of the auLo'nomic
system. In these localized areas a stereo-
typed reaction of the peripheral vascu-
lar bed occurs consisting of arteriolar
spasm with atonic dilatation of the cap-
illaries and- venules. This picture pro-
duced only by a maximal stimulus in a
normal individual may occur in certain
tissues and organs of an allergic indi-
vidual in response to a normally minor
stimulus. This reaction also may take
place as a result of environmental ex-
posure to stimuli to which a normal
individual would not develop a reaction.
The same degree of reaction may oc-
cur in an allergic individual in response
to a much Jess severe stimulus than
would be required to produce it in a
normal individual. These reactions re-
sult in a greater or lesser degree of
cellular damage and the release of hista-
mine and other toxic substances de-
pending-on the type of cell injured.
The clinical picture of allergy may be
produced by reaction of the peripheral
vascular bed resulting in the produc-
tion of anoxic capillary loops which
may lead to typical allergic edema or
necrosis and be classified. empirically
and clinically as allergy.
An antigen-antibody reaction may be
associated with the vascular reaction
and may aid in damaging the cell, but
it is a secondary phenomenon, phylo-
genetically more recent than the vascu-
lar component of the autonomic reac-
tion. This definition of allergy includes
all types of allergy and yet serves to
differentiate clearly allergic and non-
allergic! processes.
I have considered this focal type of
autonomic dysfunction in a previous
paper.117 The fundamental assumption
was that allergy is a clinical phenome-
non. The diagnosis of allergy is pri-
marily made empirically by observation
of a gross lesion and of changes occur-
ring in the function of organs and tis-
sue in the light of past clinical expe-
rience. Observation may be extended
secondarily by microscopic and immun-
ologic methods. This is the manner in
which the diagnosis of allergy has al-
ways been made, but it is inconsistent
with a strict adherence to the hypothesis
of von Pirquet.
Since von Pirquet and later Kahn
(hyperimmunity) insisted that allergy
is "altered reactivity," it should be pos-
sible to discover the normal prototype
from which in each instance allergy has
diverged. It would seem reasonable,
therefore, to speak of three related but
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not identical types of allergy : (1) phy-
sical allergy, (2) bacterial or tissue al-
lergy, and (3) humoral allergy.
In physical allergy no antigen-anti-
body mechanism is present, cellular in-
jury and the typical. clinical picture be-
ing produced by anoxia. Its normal
physiologic prototype can be considered
the alarm reaction of Selye.
In bacterial or tissue allergy the fun-
damental autonomic (vascular) defense
mechanism is retained, but it is sug-
gested that in the process of phylogene-
tic development this defense mechanism
has been supplemented by the develop-
ment of protective antibodies. These
protective antibodies are primarily at-
tached to certain tissue cells but cir-
culating antibodies may occur as a
sort of by-product of cellular immunity,
as suggested by Cannon. The normal
prototype of tissue allergy could be
considered to be granulomatous inflam-
mation.
In humoral allergy, although anti-
bodies are attached to cells, humoral or
circulating antibodies are the outstand-
ing feature. These may be the "block-
ing" univalent antibodies described by
Cooke and associates28 and Loveless.62
It would appear that circulating anti-
bodies take up some of the impact of
the invading antigen so that less severe
tissue injury is produced in the "host."
The normal prototype of humoral al-
lergy could be considered to be sup-
purative inflammation.
There is nothing in this concept of
allergy to suggest that these three types
of allergy are mutually exclusive. For
instance, perennial vasomotor corvza
which appears to be on the basis of a
physical allergy may be frequently ob-
served, especially in the cold months,
and yet have seasonal exacerbations
that appear to be on the basis of a spe-
cific sensitivity to pollen.
The working hypothesis of allergy as
a type of autonomic dysfunction sug-
gests the gradual growth in the animal
organism of an increasingly more
elaborate defense mechanism and that
the new developments are added to the
primitive stereotyped autonomic de-
fense mechanism rather than replace it.
The concept of allergy as primarily a
hyperfunction or dysfunction of this
stereotyped mechanism does not appear
to be in conflict with any of the observed
facts. It explains the gradual, rather
than the abrupt, transition from one
type to the other and why there may he
a mingling of types. It also explains why,
since the circulating antibody would
appear to be a later phylogenetic de-
velopment, it is not possible to discover
evidence of . circulating or sensitizing
antibodies in so many patients with clin-
ical allergies, nor to give them symp-
tomatic relief by hyposensitization
through the medium of the injection of
specific antigens. Duke pointed out that
in the majority of allergic individuals
the reaction is not to a type of chemical
stimulus (protein) that could reason-
ably be expected to result in antibody
formation. At present there are several
disorders such as Me'niere's disease and
myalgia in which the decision has not
been made as to whether they are really
allergic or not. With the present hy-
pothesis of autonomic imbalance as a
basis of allergy these disorders are read-
ily classified as allergic, and successful
treatment on a logical basis can be
planned. This hypothesis throws the
emphasis on the medical and psycho-
somatic aspect of the treatment of al-
lergy which is receiving increasing con-
sideration, as opposed to the strictly
immunologic aspect.
THE MEDICAL TREATMENT OF ALLERGY
The advantage to be gained by con-
sideration of allergy in the light. of au-
tonomic dysfunction is that all the al-
lergies, whether an antigen-antibody re-
action is present or not, can be treated
from the viewpoint of clinical medicine.
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Moreover, one type of treatment need ough review of the literature and added
not exclude others. many suggestions in relation to the
The effect of nonspecific stress such treatment of disease affecting the eye
as inadequate nutrition, inadequate and its adnexa by vasodilatation..
rest, inadequate amusement and relaxa- Papaverine was one of. the earliest
tion in lowering the threshold of allergic vasodilators suggested for use in Men-
reaction has long been known, but it has iere's disease by Muller.69 Dieh130 sug-
not been featured in allergic treatment gested its use in the common cold. Rus-
because of a seeming reluctance to em- sek and Zohman90 have found papav-
ploy any.but immunologic methods. The Brine useful in the relief of cerebral an-
effects of physical agents in producing giospasm. Eppinger and Hess36 in 1914
allergic reaction have been decried and were among the first to suggest use of
there has been a tendency to deny them the vasodilator histamine for vasomotor
a place in allergy because immunologic neuroses such as angioneurotic edema.
treatment accomplished little. Muller recommended it for similar con-
Vasodilators. The vasodilators, how- ditions in 1922, and Kling55 in 1934 ad-
vised its use for rheumatic affections
ever, have been known for a long time because of its effect as a vasodilator.
to produce favorable effects in physical Horton and his collaborators48,49,96 have
allergy. The traditional form of attack found histamine effective in the treat-
vasodilatation. many of the allergies has been by ment of urticaria and Meniere's disease.
vasodilatation. Many of these conditions Weiss, Robb and Ellisli2 showed that
were treated by the application of heat histamine produced marked vasodilata-
before any concept of allergy had been p
formulated. The treatment of vaso- tion of the intracranial vessels of most
motor rhinitis and the vasomotor stage individuals. These findings were con-
of the common cold by the hot mustard firmed by Wakim and his associates.11?
bath and by the opiates preceded the The therapeutic effect of histamine
use of the antihistaminics by a consider- on the allergies is the relief of vaso-
able period. spasm ; its action is not essentially dif-
Since the principal functional lesion ferent from that of any other similarly
in allergy appears to be vasospasm af- acting vasodilator.
fecting the arteriole, an attempt to cor- Harris and Moore45 were the first to
rect this dysfunction would appear to suggest the use of nicotinic acid for
be the most logical approach. Meniere's disease. Bean and Spies10
The use of vasodilators for treatment found that nicotinic acid and all of its
of the allergies is based on the supposi- pyridine compounds which contained
tion that a vasodilator will release the the free nicotinic acid radical were
spasm of the arteriole, resulting in re- vasodilators. Popkin78 and Abramson,
newed blood flow through the capillary Katzenstein and Senior,2 Crino and
loop which sweeps the contained cellu- Lenzi29 and Malaguzzi Valeri and Pa-
lar ' detritus and released toxic sub- terno65 observed the effects of nicotinic
stances into the general circulation acid to be similar to those of histamine.
where they are immediately metabo- Roniacol (3-pyradine methanol), which
lized. is stated to be converted in the organism
Duggan32 has indicated that many of to nicotinic acid, is a long-acting vaso-
the vasomotor disorders affecting the dilator that can be given by mouth and
eye, both those thought to be allergic has been found effective in the treat-
and those not, are on the basis of ante- ment of the allergies. Wakim and asso-
riolar spasm. He has furnished a thor- ciates709 found priscol (2-benzyl-4,5-
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138 HENRY L. WILLIAMS TRANS. AMER.
ACAD. OF O. & O.
imidazoline hydrochloride) to be an ef- have been found. useful in treatment of
fective vasodilator, and it has been used the allergies both by Stoesser and
in the allergies with success. Cook99,100 and Kern.54
Sympathomimeti.c Drugs. The fact The Effect of Relative Acidity.
that cholinergic nerves are concerned in K.untz58 stated that changes in the auto-
the production of the allergies suggests nomic functional balance associated
that a beneficial effect should be ob- with changes in the acid-base balance
tainable by drugs which stimulate the have been amply demonstrated. Conse-
adrenergic or paralyze the cholinergic quently restoration of the autonomic
system. balance by appropriate therapeutic mea-
White and Smithwick classified the sures designed to restore the acid-base
neurohormones and the most potent balance should not be regarded as be-
drugs which act on the sympathetic yond the range of possibility in allergic
nerves as follows: disease.
Of the drugs acting on the sympathetic Alden,3 Beckman,11 Roberts85 and
nerves, those which produce a stimulating others have reported success in the
effect are epinephrine or adrenalin, sympathin, treatment of allergic disease by the use
ephedrine and amphetamine sulfate; those of acidifying agents to reduce the po-
which produce a depressing effect are ergo- tential alkalosis.
toxine and nicotine. O f the drugs acting on 95
the parasympathetic nerves, those which have Selye also advocated the use of
a stimulating effect are acetylcholine and Pilo- acidifying salts in disorders apparently
carpine ? those which are depressing are atro- provoked by an excess of the "salt ac-
pine and nicotine. tive corticoids" as opposed to the "sug-
The advisability of prohibiting the ar active corticoids" such as the com-
use of tobacco in the, allergies has long pound E (cortisone) of Kendall. In
been debated. The studies of Roth89 in- Meniere's disease ammonium chloride
dicate that smoking promotes vaso- in enteric-coated capsules containing
spasm. Use of tobacco in allergy, there- 0.5 gm., 4 to 6 capsules being given dur-
fore, appears contraindicated.. Ing meals three times a day, appears to
Atropine and epinephrine have long be useful when combined with vasodila-
been found useful in the allergies as tor therapy.
have ephedrine and amphetamine. Ascorbic Acid. It is suggested that in
Extracellular Fluid. Because the typi- some individuals allergic reactions are
cal allergic wheal or edema is produced produced by a relative depletion of the
primarily by increased capillary permea- adrenal cortical hormones. That this
bility with the consequent formation of may be owing to the lack of ascorbic
an area of extracellular fluid collection, acid, the precursor of corticoid hor-
drugs acting to decrease capillary per more, is indicated by the fact that ascor-
meability and to get rid of extracellular bic acid has been reported to be effec-
fluid have been found useful in the med- tive in relieving the symptoms of allergy
ical treatment of the allergies. Allergic in some individuals. Ascorbic acid also
edema has been shown by R6ssle86 to has a direct effect on capillary permea-
differ from cardiac edema only in its bility, its lack being associated with in-
increased content of serum proteins. creased permeability and fragility of
Schemm93 found that extracellular the capillary wall.
edema in cardiac failure could be re- Vitamin P. These substances have
lieved by the elimination of sodium. been found necessary to complement
Therefore, a low salt diet and diuretics the local action of ascorbic acid. The
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absence of both ascorbic acid and vita- clinically useful information in regard
min P appears necessary to produce the to foods, contacts and the like than skin
symptoms of scurvy. Beiler and Mar- tests. In pollenosis and inhalant allergies
tin12 found that in the presence of ascor- in general, however, useful clinical in-
bic acid, compounds having a vitamin P formation may often be gained by skin
activity manifest a well-marked inhibi- testing. When clinically significant posi-
tory action on hyaluronidase. These au- tive results to skin tests are obtained,
thors were unable to demonstrate attempts at hyposensitization are fre-
whether this action was a direct inhibi- quently beneficial. I have found, how-
tion of hyaluronidase by ascorbic acid ever, that supplementary medical treat-
or was due to a potentiation of vitamin ment will often hasten and increase the
P by this substance. symptomatic improvement even of pa-
I have found the combination of tients who appear to be receiving clin-
ascorbic acid. and rutin effective in cer- ical benefit from so-called specific ther-
tain manifestations of allergy, especially apy. The detail of successful specific
as a maintenance therapy to be taken management of the allergies forms a
after the acute symptoms of the dis- literature in itself and will not be con-
order have been relieved by other medi- sidered here. Possibly the best out-
cation. In my hands 250 mg. of both lines of treatment from the immuno-
rutin and ascorbic acid taken three logic viewpoint for conditions in the
times a day tends to prevent the return ear, nose and throat are those furnished
of allergic symptoms. Saylor92 recently by Ashley,5 Hansel,40'42 Black'' and
has reported the effective treatment of Rawlins.8?
allergic vasomotor rhinitis with hesperi- SUMMARY
din chalcone sodium. A theory of allergy based on the au-
Vitamin Therapy. Self ridge94 has em- tonomic vascular reactions is felt to
phasized particularly the effect of. the furnish a better working hypothesis
vitamins of the vitamin B complex on from the standpoint of clinical diag-
lipoid metabolism and vascular func- nosis and treatment than one based on
tioh. I have given vitamin therapy a the antigen-antibody concept. At pres-
trial but I have rarely found evidence ent the diagnosis of allergy is made
of a marked change in a patient's symp- clinically and positive reactions to skin
toms or signs following vitamin ther- tests merely give confirmatory evidence
apy. of allergy. In many such individuals
positive skin reactions cannot be ob-
Fatty Acids. cids. Hansen43 has shown tained. In the entire group, however, it
that lack of unsaturated fatty acids in is possible to obtain confirmatory evi
the diet may lead to allergic conditions. Bence of allergy by studying the capil-
Hansen found. that certain infants with lary bed by biomicroscopy, Treatment
eczema were materially benefited when by specific methods leaves much to be
fats such as lard, corn oil and raw lin desired. Supplementary treatment by
seed oil were added to the diet, nonspecific methods will often produce
I have observed marked relief to a favorable clinical result unobtainable
symptoms of vasomotor coryza, in chi' by specific methods alone. There is evi-
dren who refused to eat the fat of the dente that the typical histologic picture
meats served, by the feeding of the fats of allergy may occur without the inter
recommended by Hansen. vention of an anti gen-antibody mecha-
Specific Allergic Therapy. A careful- nism. A concept of allergy as localized
ly taken history will often reveal more or focal autonomic dysfunction is far
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ACAD. OF O. & O.
more consistent with clinical practice
than the antigen-antibody concept; it
opens tip new avenues of therapeutic
approach to the allergies and offers
greater hope of symptomatic improve-
ment to a patient who has one of the al-
lergies.
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DISCUSSION
REA AsIrr.EV, M.D., San Francisco, Calif.:
Dr. Williams' excellent paper reviews and
analyzes much of the important allergic litera-
ture which has accumulated over the past fifty
years. Upon the basis of his analysis and upon
his personal experience lie presents some of
the newer concepts of allergy.
I am in entire accord with these newer
ideas and believe, as he does, that all aller-
gic reactions cannot be explained according
to the antigen-antibody theory of immunity.
In fact, I believe it most unfortunate that
the terms "antigen," "antibody" and "im-
munity" should ever have been applied to
allergy, since it has never been shown that
allergy and infection bear any relationship
whatsoever. The reactions of the body to
allergic stimuli are entirely different from
those produced by infection. Infections are
the cause of cell injury. Allergic reactions
are the result of cell injury.
Today, instead of considering allergy an
immunologic phenomenon caused only by con-
tact with poisonous proteins, it is believed
that the allergic response is simply the in-
creasing of a normal physiologic process-
namely, relaxation and dilatation of the small
blood vessels-and that the so-called "im-
munologic" mechanism is only one of the me-
diators of allergy. Direct trauma and so-
called psychogenic stimuli can also initiate
allergic attacks.
While Dr. Williams and I are in agree-
ment as to the broad concepts of allergy, I
should like briefly to emphasize some of the
points he has made and to present certain
other phases of the subject from a slightly
different viewpoint.
The normal basic physiologic mechanism of
the body is the constant state of contraction
and dilatation of the small blood vessels with
its attendant effect on the blood vessel walls
and the shift of fluid content from one area
to another. Through this mechanism the cells
receive nourishment and dispose of waste
products.
The small vessels arc regulated in their
state of 'dilatation and constriction by three
general sets of forces : (1) nervous impulses,
(2) chemical stimuli (the usual products of
cellular life, the products of glandular secre-
tions and other environmental factors) and
(3) physical agents-heat, cold, light and
mechanical irritations. We do not know
whether all of these forces act through the
sane agency or independently, but we do know
that the small vessel tone is maintained in a
delicate balance by these forces and that the
most minute changes in any one of them will
affect this balance.
In an allergic reaction the normal body
sympathetic-parasympathetic balance is thrown
out of balance, with the parasympa!hetics
gaining dominance over the sympathetics. Ex-
treme dilatation of the capillaries results,
causing capillary walls to become overpermea-
ble and thus allowing excessive amounts of
serum and electrolytes to escape into the sur-
rounding tissue, causing edema. Edema is
the primary cause of symptoms in all allergic
reactions, and the character of the symptoms
is determined according to the organ or tissue
in which the swelling takes place.
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NOV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 145
1950
It is my belief that allergic manifestations Third, physical agents such as heat, cold,
depend entirely upon disruption or imbalance sunlight and mechanical irritations which act
of the autonomic nervous system caused by directly on the small vessels and indirectly
a lowered autonomic threshold of tolerance through the same pathways as the emotional
to alarm stimuli to which the autonomic sys- group. The allergen-reagen phenomenon is not
tem is constantly being subjected. These stimuli present and hyposensitization is not usually
may arise from within the individual or from possible.
his environment. Any two or all three of these groups may,
The tendency to imbalance or the lowering and often do, coexist and all must be taken
of the autonomic threshold of tolerance may into consideration when outlining treatment.
be influenced by heredity or may be acquired. In our experience, medical treatment through
Frequently both factors operate. the use of drugs, vitamins, hormones and other
The distinction between allergic persons and medical therapeutic agents is helpful espe-
those who are. not allergic can be explained cially in controlling acute allergic symptoms,
by the fact that no two individuals are identi- but to date none of these therapeutic measures
cal in any respect and that the same varia- have been shown to alter permanently the
tion which exists between individuals is also autonomic threshold of tolerance, i.e., to cause
present in the individual cell's reactivity to the sympathetic-parasympathetic balance to be-
stimuli and to injury. come more stable. IIyposensitization alone does
In those individuals in whom cellular activity this, and while it is not always successful, it
is great, hereditary allergy is apt to appear, is nevertheless the most effective treatment
while in those in whom it is of lowest de- which we have today for a large proportion
gree, symptoms of allergy may never occur. of allergic reactions.
Between these two extremes of varying de- I wish to compliment Dr. Williams on the
grees of cellular activity there exist all de- excellence and the timeliness of his most in-
grees of allergic symptom probability. teresting and thought-provoking paper. As a
The threshold of autonomic tolerance based basis for further investigative work, it is a
on cellular activity is individual and is the real contribution and warrants careful read-
primary factor which determines who shall ing and study.
Regardless of what the initiating factor '"""
or factors may be-house dust, chicken feath- Mich.: First I should like to congratulate
Dr. Williams upon his most excellent pre-
ers, tio shell
stress nsect biter el over the same sentation. I do not believe that we can take muli pathways, ess san end travel over e same exception to his splendid concept, since we
and as an en result produce the all appreciate the inadequacy of applying the
same type of allergic reaction. antigen-antibody theory in the treatment of
In general three main types of allergic all allergic patients. Perhaps in part such fail-
stimuli are recognized. ure may be due to the result- of our lack of
First, those proteins, protein-like and pro- sufficiently good tools or technics for demon-
tein-attached substances which come in direct stration of antibodies. On the other hand, I
contact with the shock organs. In this group am inclined to agree with Dr. Williams that
are included the inhalants, the ingestants, the it is more likely that there are other mechanics
injectants, the contactants, the infectants, and for the explanation of symptoms in certain
the ingestants. This is the largest group and allergic people.
the allergen-reagen reaction is present. Hy- The experiments of Selye and a number
posensitization is frequently possible in this of other workers studying the pituitary-adrenal
group. physiology may throw some light on the mech-
Second, the emotional stress - group, which anisms of reaction on all states of hyper-
includes fear, anger and anxiety. It is thought sensitiveness. Fundamentally parenteral ad-
emotional stress initiates allergic manifesta- ministration of adrenocorticotropic hormone or
tions by direct action on the sympathetic- certain adrenal steroids will effectively con-
parasympathetic balance, upon the thyroid-pi- trol the symptoms of any allergic patient re-
tuitary-adrenal glands, and through direct ac- gardless of type and including the types that
tion on the vasomotor center in the brain stem. we have just heard described. The mechan-
The allergen-reagen phenomenon is not pres- ism of such symptom control may possibly
ent and hyposensitization is not possible. be a blocking effect at the tissue cell level.
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146 HENRY L. WILLIAMS
Possibly this may be related to enzyme ac-
tivity or to some other chemical which pre-
vents the chain of events normally produced
by a number of stimuli in allergic persons.
You are all familiar with the fact that a
multiplicity of stimuli may affect at different
points this adrenal-pituitary axis. Perhaps
stimuli arising in the higher motor centers
through the hypothalamus may stimulate the
pituitary gland, which in turn secrets ad-
renocorticotropic hormone, which in turn has
an effect on the adrenal steroids. The opposite
effect may occur, inducing symptoms as well
as initiating symptoms.
On the other hand, certain stimuli may
initiate the secretion of adrenalin, which in
turn stimulates the pituitary, and the circle
continues. The opposite effect may also occur.
Further study along this line may further
clarify the concepts presented today. At least
such mechanisms explain why psychic trauma,
physical agents, antigens and a multiplicity of
stimuli will initiate allergic symptoms, and
conversely can explain relief of symptoms
from a multiplicity of approachs such as we
have heard today. Unfortunately, administra-
tion of substitutes such as adrenocorticotropic
hormone or adrenal steroids is not the answer
to clinical management and, therefore, it ap-
pears to me that Dr. Williams' concept is of
great clinical value.
I am glad that Dr. Williams has emphasized
that there are those individuals who have
allergy related to antigen-antibody mechanism.
TRANS. AMER.
ACAD. OF O. & O.
AS we emphasized a year ago at this meeting,
it is imperative to demonstrate the antigen in
this group of people if we are to obtain bene-
fit by treatment with an antigen. In those
patients in whom allergen cannot be demon-
strated, treatment along epidemiologic lines will
be of no avail.
I believe that Dr. Williams has given us a
greatly improved outline for the care of al-
lergic people, and I have greatly appreciated
the opportunity of reading and listening to
his paper.
DR. WILLIAMS : I am afraid I must apolo-
gize to Dr. Ashley for a certain lack of
clarity in my presentation. The principal
thing which I tried to suggest was that the
body uses the same stereotyped resistance
mechanism in resistance to stress of all types,
which consists fundamentally of arteriolar
constriction with a secondary dilatation of the
capillaries and venules. Even antigen-antibody
reaction appears to be secondary to this fun-
damental reaction. I am sorry that Dr. Ashley
did not note that this was my fundamental
concept.
I want to thank Dr. Sheldon for his very
kind treatment of this paper, and I hope that
some of you in reading it will get some bene-
fit as far as treatment of your clinical pa-
tients is concerned, because even if an antigen-
antibody reaction is present, this should not
prevent physiologic therapy. I think there
is very little more to say.
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DIFFUSE EXTERNAL OTITIS: ITS PATHOLOGY
AND TREATMENT
BEN H. SENTURIA, M.D.
ST. LOUIS, MO.
DIFFUSE external. otitis, which mas- ing organism is usually a Streptococcus
-querades under many other 'names, or may be the Pseudomonas, Plaut-Vin-
has been selected from the conglomer- cent or diphtheria organisms. Lederer20
ation of diseases of the external ear wrote of a low virulence Staphylococcus
for discussion because it has been one pyogenes which infects the hair follicles
.of the least understood symptom coin- and sebaceous glands. Boies7 spoke of a
plexes of the ear canal. Due to its un- diffuse inflammatory process in which
certain pathogenesis, treatment has the causative organism is usually a
been diverse, unreliable and often in- Streptococcus or a Pseudomonas aeru-
effective. ginosa.
In order to understand this disease A brief review of the literature re-
-entity, let us review this problem as pre- veals that W. D. Gill,14 Whalen,42 Dart,10
sented in both textbooks and literature. Trexler,41 and McBurney and Searcy2l
Bezold and Siebenmann4 wrote that emphasized the importance of fungi in
chemical and mechanical influences the car canal. Greaves,16 Syverton,4?
must be named among the causes and Quayle,79 Bettington,3 Senturia,30 Con-
emphasized the importance of the en- ley,8 and E. K. Gill13 emphasized the
trance of water into the canal. They high incidence of gram-negative bacilli
added that "the real causa efficiens in in cultures obtained from the external
all different forms of this disease are mi- car. Swimming and bathing have been
croorganisms, especially saprophytes." described as contributory causes of this
Politzer27 stated that "the cast off epi- disorder,1,8'19 while many authors9,22
dermic scales must be microscopically point out that a high percentage of suf-
examined for micrococci or for the as- ferers are nonswimmers, Morley,22 Pal-
pergillus fungus." Kerrison1S and Mor- mer,25 Daggett,9 and Senturia30 made
rison23 described only cases secondary to reference to hot weather as a possible
trauma and purulent drainage from the contributing factor.
middle ear. W. Gill in "Diseases of the Some attention has been directed to
Nose, Throat and Ear" by Jackson and the character of the secretion. W. Gill15
Jackson17 stated that the most frequent and Conley,8 among others, noted the
causative organisms are fungi, but noted absence of cerumen. Daggett9 was im-
that "a resistant form of infection is pressed with the "desquamated debris"
said to be produced by the Pseudomonas which he described as consisting of
pyocyaneus." Brown in Fowler's "Med- epithelial scales, pus cells and organ-
icine of the Ear"12 stated that the invad- isms. Senturia, Matthews and Adler35
From the department of otolaryngology. Washington noted the myriads of epithelial cells and
University Medical School, St. Louis, Mo. bacteria and the remarkable absence of
This research was aided by grants from the Research neutrophils in this form of external
Study Club of Los Angeles, Calif., and the St. otitis.
Louis Otological Foundation of St. Louis, Mo.
Presented at the Fifty-Fifth Annual Session of the One comes away from such a review
American 'Academy of Ophthalmology and Otolaryn- in much confusion and with many un-
.gology, Oct. 8-13, 1950, Chicago, Ill.
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answered questions. What is the patho-
genesis of diffuse external otitis?
What is the role of fungi? Why are
gram-negative bacilli found in such a
high percentage of cases? Why do
smears of the secretion reveal no neu-
trophils ?
In order to avoid any uncertainty
as to the disease entity which is being
discussed, let us describe the clinical
picture which has been designated as
diffuse external otitis. This is a specific
symptom complex occurring mainly
during hot, humid weather. It may
occur as a mild, moderate or severe dis-
ease and may be acute or chronic accord-
ing to the symptoms and findings.
The mild acute case has only slight
pain on mastication or on manipulation
of the auricle. A thin watery secretion
may be 'found in the lumen. The skin
of the ear canal reveals some edema,
slight redness, and a coating of odorless,
adherent secretion or exfoliated debris.
Some loss of luster of the drum is seen.
In the more severe cases patients
complain of intense throbbing pain on
mastication and on manipulation of the
external ear. Although the auricle ap-
pears uninvolved, there is marked peri-
auricular edema and partial or com-
plete obliteration of the canal lumen by
the edematous walls. Gray or green
serous or "seropurralent" secretions
and sheets of exfoliated debris are seen
in the remaining lumen. The skin of the
canal is thickened, purplish red in color,
and may have a papular or "goose-
flesh" appearance, particularly on the
superior and inferior walls. There is,
characteristically, a smooth, convex
sagging of the superior canal wall ex-
tending to the tympanic membrane.
Under otoscopic magnification, discrete,
raised, milky white papules and flat
grayish vesicles are seen with inter-
vening zones of erythema. Because of
the obliterated lumen the tympanic
membrane cannot be well visualized.
TRANS. AMER..
ACAD. OF O. & O.
The chronic case reveals a variable
thickening of the skin of the auricle and
ear canal and a consequent reduction
of the lumen of the entire canal. Dry,
adherent, exfoliated debris often lines
the canal, or there may be gray-brown
or greenish secretion, with a fetid odor,
coating the skin and filling the tympanic
recess. Papules and vesicles may or may
not be seen. The drum is lusterless,
thickened and shows loss of some detail.
Cultures of the ear canals almost in-
variably show an overgrowth of gram-
negative bacilli, while occasional fungi
are seen. A stained smear reveals my-
riads of bacilli and epithelial cells.
Now that the entity with which we
are dealing has been described, let us
briefly designate its place in relation to
the many other forms of disease involv-
ing the external auditory canal. If we
divide the cases on an etiologic basis,
we may classify them as follows :34
Diseases of the External Ear
1. Malfunction of skin
(etiology unknown)
a. Diffuse external otitis
b. Seborrheic dermatitis
II. Infections
a. Bacterial
b. Fungus
III. Neurogenic
IV. Allergic
V. Primary irritants
VI. Senile changes
VII. Endocrine dyscrasias
VIII. Vitamin dyscrasias
IX. Miscellaneous
glands
In order to understand the pathogene-
sis of diffuse external otitis we must
first examine the skin of the normal ex-
ternal auditory canal (fig. 1).33
In the normal skin there is a constant
exfoliation of the upper layers of the
stratum corneum. The sebaceous and
apocrine sweat glands discharge their
secretions over the surface of the skin
to form a thin, fatty, protective coating
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1950
with a slightly acid pH.5,11 These ele-
ments, which in the ear canal combine
to form the cerumen, have been shown
to have a bacteriostatic and fungistatic
action in other parts of the body.2,6,26 A
culture of these secretions coating the
normal skin of the ear canal shows some
;gram-positive bacteria, rarely a fun-
.gus.32 A smear reveals occasional epi-
thelial cells and bacteria.35
If, now, the normal skin is trauma-
tized or irritated by the prolonged appli-
cation of macerating or noxious sub-
stances, there is produced an increased
hyperkeratosis and plugging of the
pilosebaceous follicles and. ducts of the
sweat glands.24,28,39 These pathologic
changes have been produced in experi-
mental work on prickly heat by the pro-
longed application to the skin of water,
adhesive tape,36,37,38 chemicals,24,37 etc.
It is seen in biopsy specimens of the
skin obtained from the ear canal in
cases of chronic otorrhea.33
It is conceivable that as a result of
FIG. t-Photomicrograph of skin of normal external auditory canal showing stratum
corneum, sebaceous glands, hair follicles and apocrine glands.
prolonged exposure to intense heat and
humidity and poor evaporation within
the ear canal, the skin of the ear canal
is bathed in apocrine sweat which is rel-
atively low, in lipoids. The unprotected
upper layers of the stratum corneum
imbibe the water, become swollen and
macerated, and proper cornification does
not occur.28,39 As a consequence, marked
hyperkeratosis develops (fig. 2).
If, at this time, the patient avoids
further exposure to high temperatures
and humidity, the hyperkeratosis, as
demonstrated in other skin areas,38 will
disappear in approximately two to three
weeks as a result of normal desquama-
tion.
On the other hand, if before this hy-
perkeratosis subsides there is another
prolonged exposure to high tempera-
tures and humidity or the patient trau-
matizes the skin surface, the following
events may occur :
A. As a result of the obstruction of
the ducts of the sweat glands and pilo-
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150 BEN H. SENTURIA
FIG. 2-Photomicrograph of skin of external auditory canal showing hyperkeratosis
and plugging.
sebaceous follicles, the antibacterial and
the antifungus elements are not secreted
onto the skin surface of the canal and
therefore bacterial or mycotic growth,
or both, may occur. This growth would
be determined by the transient flora
present in the environment or intro-
duced by the patient. In tropical areas
there would be a relatively high inci-
dence of fungi; in temperate zones few-
er fungi would occur. In all parts of
the world the widely disseminated gram-
negative bacilli would be cultured.
B. There may be thickening of the
prickle cell layer (acanthosis), reten-
tion of nuclei in the stratum corneum
(parakeratosis), intracellular and inter-
cellular edema. A dense cellular infil-
trate may occur in the subepidermal
areas and occasionally around the tu-
bules of the sweat glands. Marked di-
latation of lymphatics and blood vessels,
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NOV.-DEC. DIFFUSE EXTERNAL OTITIS 151
1950
FIG. 3--Photomicrograph of skin of external auditory canal showing hyperkeratosis,
acanthosis, lengthening of rete pegs, dilatation of blood vessels and lymphatics, and
dense cellular infiltrate in dermis.
and collection of fluid in the interstitial
spaces of the dermis may be observed
(fig. 3).
C. There may be dilatation of the
apocrine sweat ducts as a result of plug-
ging of the ducts and possibly a diffu-
sion of the retained sweat into the epi-
dermis (fig. 4),24
D. There may also occur changes in
the tubules such as dilatation, and vac-
uolization of the epithelial lining cells
(fig. 5).
E. Finally, as a result of the inflam-
matory process plus the failure to elim-
inate the obstruction of the ducts there
may occur a disorganization of the epi-
thelium of the tubules (fig. 6) and a de-
struction of many of the sweat glands
(fig. 7).
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TRANS. AM EA.
ACAD. OF O. & O.
Glands
FIG. 4-Photomicrograph of skin of external auditory canal showing obstructing
keratin plug and dilated duct.
To recapitulate, although all the path-
ologic evidence has not yet been ob-
tained, it is my belief that the preceding
findings justify the following concept of
the pathogenesis of diffuse external
otitis. As a result of excess sweating
during hot, humid weather there is pro-
duced in certain susceptible individuals
a marked hyperkeratosis of the skin of
the ear canal with plugging of the ducts
of the sweat and sebaceous glands. If
recovery is not allowed to occur before
another period of exposure to a hot,
humid environment, these glands are
unable to pour their secretions onto the
skin. As a consequence of the skin
changes produced, a surface infection
may readily develop. If the plugging re-
mains and sweat gland activity persists,
there occur inflammatory and mechani-
cal changes within the epidermis and
dermis.
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1950
DIFFUSE EXTERNAL OTITIS 153
Thus diffuse external otitis is not
caused by swimming or bathing, al-
though these may be factors in produc-
ing the increased hyperkeratosis and
plugging of the glands which initiate
the pathologic cycle of events. It is not
caused by fungi or bacteria but rather
these are secondary invaders resulting
from the loss of skin resistance. Neu-
trophils are not found on smears of the
flow of secretions from the apocrine
sweat glands and sebaceous glands
Treatment, then, should be soothing
and palliative during the acute stage
while active, and curative in the subsid-
ing stage. Thus therapy might be di-
rected as follows :
A. Palliative
1. Remove the patient from the hot,
humid environment. This will re-
afflaomm
FIG. 5-Photomicrograph of skin of external auditory canal showing dilatation of
tubules and vacuolization of lining cells.
secretion since we are not dealing pri-
marily with a pyogenic infection break-
ing through the skin barrier except in
the complicated cases.
If we accept this concept of the path-
ogenesis of diffuse external otitis, ther-
apy, in order to be successful, must ac-
complish three things :
1. Counteract the secondary infec-
tion
2. Restore the depleted lipoid sub-
stances of the skin
3. Modify the stratum corneum
which is acting to obstruct the normal
duce the activity of the apocrine
sweat glands and thereby alleviate
much of the discomfort.
2. Irrigate the ear canal with hyper-
tonic saline" in order to obtain
drainage and to clean away the
keratin plugs, inspissated wax
and debris which have collected
in the ear canal and tympanic
sulcus.
3. Apply into the lumen of the canal
a mild, nonirritating antiseptic in
a fatty vehicle (e.g., 5 to 10 per
cent boric acid in anhydrous lan-
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154 BEN H. SENTURIA
TRANS. AMER.
ACAD. OF O. & O.
FIG. 6-Photomicrograph of skin of external auditory canal showing disorganization
of the epithelium of the sweat gland tubules.
olin) and allow to remain in place
for 12 hours. This will restore the
depleted lipoids and will also tend
to push the pH towards the acid
side, thus aiding- in the inhibition
of bacterial growth.
4. Prescribe antibiotics where spe-
cifically indicated.
5. Give vitamin A to assist in the
restoration of normal keratiniza-
tion.
B. Curative
As soon as the severe acute stage has
subsided, active attempts should be di-
rected towards eradicating residual in-
fection and restoring the normal stratum
corneum. This may be accomplished
with the aid of the following medica-
ments according to the severity of the
residual inflammatory reaction and the
sensitivity of the skin.
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1950
1. Burow's solution, 0.5 per cent, or
similar stable proprietaries
2. Metacresylacetate in olive oil
(one-half strength)
3. AgNO3i 5 to 10 per cent, followed
by 5 to 10 per cent boric acid in
.anhydrous lanolin
4. Streptomycin (5mg/gm) in a
carbowax vehicle32
5. Vitamin A - 10,000 to 20,000
units per day
FIG. 7--Photomicrograph of skin of external auditory canal showing destruction
of sweat gland tubules and peritubular cellular infiltration.
Astringents should be continued for
24 to 72 hours if the agent is tolerated.
The natural healing processes of the
skin should then be allowed to take over.
Further therapy should consist of ade-
quate cleansing of the skin surface with
hypertonic saline and the application of
soothing antiseptic ointments, keratoly-
tics, fungicides or antibiotics as indicat-
ed by individual requirements.
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TRANS. AMER.
AC AD. OF O. & O.
I wish to express appreciation to Dr.
Zola Cooper for advice and assistance
in the pathologic studies, to Mr. Vernon
Fischer and Mr. Wallace Johnson for
technical assistance, to Mr. K. Cramer
Lewis for photomicrographs, and to
Mr. F. Kelly for diagrams.
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1. Anderson, A., Jr., and Steele, C. H.: Use
of nitrofuran therapy in external otitis,
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fied layer and the endogenous bacterial
flora of the skin, J. Invest. Dermat., 5:
207-223 (Oct.) 1942.
3. Bettington, R. H.,: Bilateral acute external
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4. Bezold, Friedrich and Siebenmann, F.:
Textbook of Otology, Chicago, E. H.
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5. Blank, Irvin H.: Measurement of pH of
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6. Burtenshaw, J. M. L.: The mechanism of
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appendages, J. Hyg., 42:184-210 (April)
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7. Boies, Lawrence R.: Fundamentals of
Otolaryngology, Philadelphia, W. B.
Saunders Co., 1949, p. 100.
8. Conley, J. J.: Evaluation of fungous dis-
ease of the external auditory canal, Arch.
Otolaryng., 47 :721-745 (June) 1948.
9. Daggett, W. I.: Desquamative otitis ex-
terna in Malta, J. Laryng. & Otol., 57:
427-446 (Oct.) 1942.
10. Dart, Merrill 0.: Otomycosis : treatment
with silver picrate, Arch. Otolaryng., 31:
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11. Fabricant, N. D. and Perlstein, M. A.:
pH of the cutaneous surface of the ex-
ternal auditory canal, Arch. Otolaryng.,
49:201, 1949.
12. Fowler, E. P., Jr.: Medicine of the Ear,
New York, T. Nelson & Sons, 1947, p.
129.
13. Gill, E. K.: Evaluation of newer drugs
in the treatment of otitis externa, Arch.
Otolaryng., 52:25-30 (July) 1950.
14. Gill, W. D.: Otitis ex:terna mycotica : com-
ments concerning the prevalence, diagno-
sis and treatment of otomycosis, Arch.
Otolaryng., 16 :76-82 (July) 1932.
15. Otitis externa, Ann. Otol.,
Rhin. & Laryng., 51:370-377 (June) 1942.
16. Greaves, F. C.: Phenyl mercuric nitrate
in the treatment of otitis externa and of
the dermatophytoses, U. S. Nav. M. Bull.,
34::527-532 (Oct.) 1936.
17. Jackson, Chevalier and Jackson, Cheva-
lier L., eds.: Diseases of the Nose, Throat
and Ear, Including Bronchoscopy and
Esophagoscopy, Philadelphia, W. B.
Saunders Co., 1945, p. 232.
18. Kerrison, Philip D.: Diseases of the Ear,
ed. 4, Philadelphia and London, J. B.
Lippincott, 1930, p. 117.
19. Kos, C. M.: Evaluation of the diagnosis
and treatment of external otitis, J. Iowa
M. Soc., 39:560-567 (Dec.) 1949.
20. Lederer, F. L.: Diseases of the Ear, Nose
and Throat, Philadelphia, F. A. Davis Co.,
1939, p. 109.
21. McBurney, Ralph and Searcy, Harvey B.:
Otomycosis : an investigation of effective
fungicidal agents in treatment, Ann. Otol.,
Rhin. & Laryng., 45:988-1008 (Dec.)
1936.
22. Morley, George : Otitis externa-"hot
weather ear" : an investigation of 100 cases
and a method of treatment, Brit. M. J.,
1:373-377 (Feb. 19) 1938.
23. Morrison, W. W.: Diseases of the Ear,
Nose and Throat, New York, Appleton-
Century-Crofts, Inc., 1948, p. 100.
24. O'Brien, J. P.: A study of miliaria rubra,
tropical anhidrosis and anhidrotic asthenia,
Brit. J. Dermat., 59:125-158 (April-May)
1947.
25. Palmer, F. J.: Hot weather ear : a clinical
entity, Indian M. Gaz., 69:430-432 (Aug.)
1934.
26. Peck, S. M., Rosenfeld, IT, Leifer, W.
and Bierman, W.: Role of sweat as a
fungicide, with special reference to the use
of the constituents of sweat in the therapy
of fungous infections, Arch. Dermat. &
Syph., 39: 126-148 (Jan.) 1939.
27. Politzer, Adam : A Textbook of the Dis-
eases of the Ear, translated and edited by
M. J. Ballin and C. L. Heller, ed. 4, Lon-
don, Bailliere, Tudall and Cox, 1902, p. 173.
28. Pollitzer, S.: Prickly heat, J. Cut. &
Genito-Urin. Dis., 11:50-56, 1893.
29. Quayle, A. F.: Otitis externa in New
Guinea, M. J. Australia, 2 :228-231 (Sept.
2) 1944.
30. Senturia, Ben H.: Etiology of external
otitis, Laryngoscope, 55:277-293 (June)
1945.
31. - : Discussion of Fowler, Edmund
P., Jr.: Topical applications to the skin
of the ear canal, Tr. Am. Acad. Ophth.,
53:641-642 (July-Aug.) 1949.
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NOV.-DEC- DIFFUSE EXTERNAL OTITIS 157
1950
32. Senturia, Ben H. and Broh-Kahn, R. H.:
The use of streptomycin in the treatment
of diffuse external otitis, Ann. Otol., Rhin.
& Laryng., 56:81-89 (March) 1947.
33. Senturia, Ben 11. and Cooper, Z. K.: Un-
published data.
34. Senturia, Pen H. and Marcus, M. D.:
Classification of external otitis, to be pub-
lished.
35. Senturia, Ben H., Matthews, John I. and
Adler, Benard C.: External otitis : IV.
Cytologic study of secretions, Laryngo-
scope, 60:543-550 (June) 1950.
36. Shelley, W. B. and Horvath, P. N.: Ex-
perimental miliaria in man: H. Production
of sweat retention anidrosis and miliaria
crystallina by various kinds of injury, J.
Invest. Dermat., 14:9-20 (Jan.) 1950.
37. --: Experimental miliaria in man:
III. Production of miliaria rubra (prickly
heat), J. Invest. Dermat., 14:193 (March)
1950.
38. Shelley, Walter B., Horvath, Peter N.,
Weidman, Fred R. and Pillsbury, Donald
M.: Experimental miliaria in man : I.
Production of sweat retention anidrosis
and vesicles by means of iontophoresis, J.
Invest. Dermat., 11:275-291 (Oct.) 1948.
39. Sulzberger, Marion B. and Zimmerman,
H. M.: Studies on prickly heat : II. Ex-
perimental and histologic findings, J. In-
vest. Dermat., 7:61-68 (Feb.) 1946.
40. Syverton, Jerome T., Hess, William R.
and Krafchuk, John: Otitis externa : clini-
cal observations and microbiologic {iota,
Arch. Otolaryng., 43:213-225 (March)
1946.
41. Trexler, Clarence W.: Otomycosis in Ha-
waii, Laryngoscope, 45:106-109 (Feb.)
1935.
42. Whalen, E. J.: Fungous infections of the
external car, J.A.M..A., 111:502-504 (Aug.
6) 1938.
DISCUSSION
FRANCIS E. SCNEAR, M.D., Chicago, 111. (by
invitation) : This has been a very interesting
paper to me because this problem comes to
us very frequently. The etiology of otitis ex-
terna has, of course, been the source of con-
troversy for many years. It has been our
impression that until the past few years the
majority of the otologists have emphasized
chiefly the possibility of mycotic infection as
the most common cause, since patients whom
we have seen after they have previously con-
sulted otolaryngologists have usually stated
that they have been told their trouble was
due to fungus infection, usually without any
microscopic examination having been made.
Dermatologists have in the main been un-
willing to accept this concept due to the fact
that the fungi demonstrable in the ear were
usually of nonpathogenic varieties and rarely
of types giving rise to the usual dermatologic
disorders of mycotic origin. We, on the other
hand, have been accustomed, I think, to in-
criminate seborrheic dermatitis and streptococ-
cic infections as being responsible for most of
these cases, such diagnosis usually being made,
likewise, on purely clinical grounds. In re-
cent years, however, the literature of your
specialty has minimized the importance of fun-
gus infection, relegating it to an infrequent
role and perhaps then considering it as only
a secondary factor. Probably most often it
is regarded as being only a saprophyte. Con-
sequently a number of studies have pointed
out that a variety of bacteria are of etiologic
importance. These opinions with regard to
the organisms responsible for diffuse otitis
externa have not, however, given us any idea
as to'thc basic pathogenesis of the process.
A month or two ago, in looking through
my files on eczema, I ran across an abstract
I had made of an article by Dr. Senturia
published in 1946, in which he discussed eti-
ology from the fungus and bacterial stand-
points, with nothing at all pertaining to what
he has given us today. He is to he congratu-
lated on having introduced a new idea in the
study of this condition.
We in dermatology during the second world
war became aware of the importance of hyper-
keratosis as it developed at the follicular ori-
fices in the tropics during periods of exces-
sive sweating, leading to suppression of per-
spiration through retention rather than the
failure of the glands to produce sweat, namely,
sweat retention anhidrosis. Likewise in re-
cent years we have recognized that in acne
vulgaris, the disturbance in keratinization re-
sulting from the disturbance of the piloseba-
ceous apparatus in adolescence is of primary
importance in preparing the way for patho-
genic organisms to produce the pustular le-
sions of disease.
Dr. Senturia has presented a careful, well
documented study of 'this problem, and while,
as he states, all the pathologic evidence has
not yet been obtained, his application of this
principle that hyperkeratinization furnishes a
soil of lowered resistance upon which organ-
isms may flourish and produce the pathologic
changes, opens a new avenue. I know that
he is continuing his studies in this field, and I
am sure that his work will be received grate-
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158 BEN H. SENTURIA
fully by those in dermatology. The illustra-
tions which he showed you on the screen
today and which I had the privilege of exam-
ining in the photomicrographs lend excellent
support to his thesis that we are going to
have a very good basis upon which to pro-
ceed in the future.
I have enjoyed this paper very much and
want to thank Dr. Senturia.
W V. D. GILL, M.D., San Antonio, Texas :
I am very much impressed with this paper.
I think it is one of the hest presentations
on the subject that I have ever heard. I think
also that I am safe in saying that this is the
first time in the history of otomycosis or dif-
fuse external otitis that we have seen any
histopathologic sections demonstrated. That is
a great step forward. There is a great deal
to be learned from the study of the fixed tis-
sue cell in this condition, and Dr. Senturia has
pointed the way for us.
There has been a great tendency in the
past few years to minimize the importance of
fungi in external otitis. I am not quite ready
to agree with that thesis-with that hypo-
thesis. I believe there has been a marked
decline in the number of fungus infections
in the external auditory canal. Just why that
has come about has not become immediately
apparent, but we know that there has been
in our section, at least, a very marked decline
in the percentage of fungus infections in the
ear, with a corresponding increase in the Ac-
tinomyces and Staphylococcus.
(Slide) My brother, Dr. King Gill, and I
recently had occasion to study the bacterio-
logic flora in the ears of 168 patients with the
following results : We isolated bacteria in
117; bacteria mixed with fungi in 36; bac-
teria and yeast in 12; and bacteria, yeast, and
fungi in 3. To get the total number of ears
in which fungi were present, it is necessary
to add those last three figures together.
(Slide) In a further breakdown, we found
a very high percentage of gram-negative bacilli
-104 cases. Those are the Pseudomonas, and
at the present time these cases are in the as-
cendency. Then we had 6 cases clue to staphy-
lococci. I think that the incidence of Staphy-
lococcus is certainly high enough to make it
a very important factor in the etiology of
diffuse external otitis.
In cleaning the ear I have always just used
a sterile swab rather than irrigation. Oc-
casionally when an ear is irrigated there will
be a marked flare-up with suppuration fol-
lowing, and where it has been necessary to
irrigate an ear to remove plugs of various
TRANS. AMER.
ACAD. OF 0. & 0.
kinds of debris, we have immediately dried
the canal and inserted a wick moistened with
1:100 neutral aqueous solution. That seems
to prevent the onset of suppuration.
Now a word about metacresylacetate. The
pseudomonas respond to drugs containing ace-
tic acid or the acetate radical; therefore, Bur-
ow's solution is effective. Two per cent aque-
ous solution of acetic acid is also effective,
as well as cider vinegar and metacresylacetate.
Metacresylacetate is bactericidal. It is fungi-
cidal. It is analgesic after the first few min-
utes. It is also anesthetic and possesses vary-
ing degrees of keratolytic power, so that the
top layer of the epithelial cells is removed
merely by inserting a wick moistened with
metacresylacetate and allowing it to remain 24
hours. The patient is asked to return at the
end of that period, the wick is removed, and
another one is inserted after cleaning the ear.
The ear may be so acutely inflamed that
it tolerates practically no manipulation on the
patient's first trip to the office. When that
takes place, it has been our practice gently
to induce a very small wisp of cotton into
the canal and to saturate that with metacresyl-
acetate. All of the severe cases immediately
receive roentgen therapy. They are referred
to the radiologist immediately, and the amount
of x-ray that is given is one-third of an
erythema dose. If both ears are involved,
the dosage is divided equally between the two
ears. When a patient has come in to see
you because he is in pain, lie wants quick
relief. The metacresylacetate wick plus roent-
gen therapy is about the quickest way to
get it.
I would implore you to use some type of
sedative in all these cases that are at all
severe. In this respect I should like to say
that I consider codeine about the worst drug
that can be used for sedation. In combination
with some other drug it works fine, but alone
it is practically worthless. One gram of co-
deine combined with 5 grains of amidopyrine,
or 3% grains of antipyrinc, or 5 to 10 grains
of aspirin are all good combinations and they
work. But just remember that the patient
has cone in to see you because he wants re-
lief and if you don't give it to him, Dr.
John Jones across the hall will. At least I
have found it that way.
Cultures have been made in studying the
effect of a lot of the present-day fungicides
that are on the market. There is a plethora
of fungicides that are advertised today for
the treatment of so-called fungus ears. We
have studied a group of some ten or twelve,
with the result that we have found most of
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NOV.-DEC. DIFFUSE EXTERNAL OTITIS 159
1950
them to he practically useless. Sulfamylon This does not mean that the secondary in-
was very effective, however. Except for the fection is a simple problem which one may
burning which it causes, it works very nicely. neglect. One may have to use every thera-
Streptomycin, we hesitated to use, internally peutic aid available, on occasion, to eliminate
at least, on account of the possibility of corn- that superimposed infection. We heartily
plications in the hearing apparatus. agree with the use of metacresylacetate for
I have enjoyed this paper very uuuch. This otomycosis. We found, in our in vitro experi-
is a subject that has been very close to my ments, that it was a potent agent for eradica-
heart for about twelve years. I think we have tion of saprophytic fungi. I would hesitate,
made great strides forward, and now we are however, to use it in the acute inflammatory
glad to have some studies on the fixed tis- state. Thus, I. would imagine that Dr. Senear
sue cells. would shudder at the thought of applying
Personally, I should like to ask Dr. Sen- as strong an agent as full strength metacre-
turia where he gets his specimens for biopsy. sylacetate to the acutely inflamed ear canal
I cannot obtain specimens from my patients. of a patient with severe, diffuse external oti-
They object. How does he persuade them? tis. On the other hand, I am fully aware
that one must offer the patient relief, and
DR. SENTURIA : I should like to thank the that sometimes one must throw caution to
discussers. the wind and utilize an agent which may be
To answer Dr. Gill's question about biop- irritating and caustic if it is to provide re-
sies, we have been very fortunate in having lief from pain.
the cooperation of physicians on various city We have investigated sonic of the acetates,
hospital services. We have had very wonder- with the thought in mind that we desired an
ful patients who have been willing to provide agent with an acid reaction and that these
us with material for biopsies. We have utilized appear to be active against gram-negative
material from autopsies and from mastoidec- bacilli. Acetic acid is well known as one of
tomies. Dr. Theodore Walsh and his staff the best agents against the Pseudomonas or-
have provided us with tissue from mastoidec- ganism, but we advise its use thoughtfully and
tomies performed at McMillan Hospital, St. carefully in conjunction with other thera-
Louis, during the past several years. peutic aids.
I should like to say one word about the I should like to take just one more moment
incidence of otomycosis. At Randolph Field, to tell you about the use of irrigations for
Texas, we found approximately 10 per cent cleansing the car canal. We have trade serial
of infected cases showed fungi in the ear cytologic studies of the secretions of the ear
canal on cultural study of cases of external canals and have noted an absence of neu-
otitis. Despite this low incidence we have trophils in uncomplicated acute, severe, diffuse
continued to feel that otomycosis is an im- external otitis. We have observed the sud-
portant problem. If one neglects this con- den appearance of netttrophils following the
sideration of fungus infestation of the ear energetic cleansing of debris from the ear
canal, these patients will not get well. I canal. Active, thorough cleansing is desira-
should like to emphasize our belief that gram- ble, but not if you are going to traumatize
negative bacilli are not the cause of diffuse the epidermis and push the infection into the
external otitis. In a previous paper we noted sub. pidermal areas. Therefore, it is urged
a 100 per cent incidence of gram-negative that saline irrigations be used to cleanse the
bacilli in severe, acute, diffuse external otitis, ear canal, Exacerbations occur if one irrigates
but we were not able to say that gram-ncga- with water or even with isotonic saline. To
tive bacilli or Pscudomonas organisms were avoid flare-ups, a hypertonic saline solution
the cause of diffuse external otitis. We feel is suggested. For the, past threeyears we
that the findings in this report tend to cor- have used, routinely, a 3 per cent saline douche
roborate,that impression. The gram-negative of the car canal in those cases where there
bacilli occur as a secondary infection. We be- is sufficient lumen so that the water can be
lieve that fungi are implanted secondarily. removed and the ear canal dried.
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160 TRANSACTIONS - NOVEM13E.R - DECEMBER, 1970
In Memoriam
Ephraim Kirkpatrick Findlay............ Chicago, Illinois
September 27, 1950
James Sonnett Greene ............. New York, New York
September 17, 1950
Marcus Ravdin ...................... Evansville, Indiana
September 12, 1950
Burt R. Shurly .......................Detroit, Michigan
October 20, 1950
Edward McColgan Walzl ............ Baltimore, Maryland
August 10, 1950
TRANS. AMER.
ACAD. OF O. & O.
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TRANSACTIONS
American Academy of Ophthalmology and Otolaryngology
Official Publication of the American Academy of Ophthalmology and Otolaryngology
Published under the direction of the Editorial Board
WILLIAM L. BENEDICT, Rochester, Minnesota, Editor
W. HowARD Monism, Omaha, Nebraska, Associate Editor
HENRY L. WILLIAMS, Rochester, Minnesota, Associate Editor
Printed by Douglas Printing Company, 109 North 18th Street, Omaha 2, Nebraska
All communications regarding the TRANSACTIONS should be addressed to William L. Benedict, M.D.,
Executive Secretary - Treasurer, the American Academy of Ophthalmology and Otolaryngology,
100 First Avenue Building, Rochester, Minnesota
COUNCIL MINUTES
FIFTY-FIFTH
ANNUAL SESSION
October 7 and 11, 1950
Palmer House, Chicago
Present:
J. Mackenzie Brown, Derrick Vail, Edwin
B. Dunphy, Kenneth L. Craft, James Mason
Baird, Alan C. Woods, Carl H. McCaskey,
Conrad Berens, William L. Benedict, Alger-
non B. Reese, James H. Maxwell, A. D. Rue-
demann, Dean M. Lierle, Lawrence R. Boies,
Erling W. Hansen, Thomas D. Allen, Fletcher
D. Woodward, Archie D. McCannel, C. Stew-
art Nash.
The meeting was called to order at 9:30
a. in. by Dr. J. Mackenzie Brown, President.
I
The Executive Secretary, Dr. William L.
Benedict, reported on the membership as fol-
lows :
1. Fellowship as of October 1, 1950:
Juniors ----------------------------------------3,907
Seniors --------------------------------------- 150
4,510
2. Candidates :
Complete ----------------------------------- 280
Incomplete ---------------------------------- 7
Some items are omitted from this report. Complete
minutes are on file in the office of the Executive
Secretary-Treasurer.
3. Elevations to Senior Fellowship on January
1, 1951:
Beal, Homer A. ....................Kansas City, Mo.
Birsner, Louis ............................St. Louis, Mo.
Bonner, William F- -------- ........ Childress, Texas
Brown, Albert L . ...................Cincinnati, Ohio
Chapman, S. Jefferson, Colorado Springs, Colo.
Cleff, Oscar ........................................Chicago, Ill.
Daily, Louis ................................Houston, Texas
Daily, Ray K .............................Houston, Texas
Fox, Noah ........................................Chicago, Ill.
Gipner, John F. - .................. ... Rochester, N. Y.
Goar, Everett L .........................Houston, Texas
Gordon, Charles II . ...............Portland, Maine
Hamlin, Fred E .............................Roanoke, Va.
ITands, Sidney G .....................Davenport, Iowa
Hansel, French K. ........................St. Louis, Mo.
Hargitt, Charles A .................Brooklyn, N. Y.
Harrell, Voss_ .....................................Reno, Nev.
Ilartshorne, Isaac ....................New York, N. Y.
Hicks, Vonnie M ................._....--Raleigh, N. C.
Jones, Edmund L. ................Wheeling, W. Va.
Joy, Harold II ...........................Syracuse, N. Y.
Kettelcamp, Fred 0., Colorado Springs, Colo.
Key, Samuel N .............................Austin, Texas
McLaurin, John G. __ .................... Dallas, Texas
McMahon, Bernard J....... ...----- .-St. Louis, Mo.
Minsky, Henry ....................New York, N. Y.
Morrison, W. Wallace ........New York, N. Y.
Myers, E. Lee ..............................St. Louis, Mo.
Packard, Louis A .........................Phoenix, Ariz.
Palmer, Arthur ........................New York, N. Y.
Pember, Aubrey H . .................Janesville, Wis.
Pendexter, R. Stevens ........Washington, D. C.
Reincke, George F... .............. New Ulm, Minn.
Seal, J. Coleman ....................New York, N. Y.
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162 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
Seligstein, Milton B................. Memphis, Tenn.
Sharp, Benjamin S .............. _.Providence, R. I.
Sheahan, William L .............New Haven, Conn.
Stokes, William H_________________ Lake City, Mich.
Wagener, Henry P .................Rochester, Minn.
Wright, Walter W. _.__._...___Toronto, Ont., Can.
Young, Charles A . ........................Roanoke, Va.
4. Elevations to Life Fellowship on January
1, 1951:
Alden, Arthur M. _ ...................... St. Louis, Mo.
Bahn, Charles A. ................New Orleans, La.
Brickley, Daniel W . ....................Marion, Ohio
Brown, Mortimer G .................Syracuse, N. Y.
Buvinger, Charles W......... East Orange, N. J.
Cohen, Samuel .........................Philadelphia, Pa.
Darmer, George A .............................Aurora, Ill.
Dintenfass, Henry ....................Philadelphia, Pa.
Hughes, T. E ....................--.........Richmond, Va.
Husik, David N .....................Philadelphia, Pa.
Jordan, George T .....................Vermillion, S. D.
King, Edward Daniel .............Hollywood, Calif.
Lewis, Fielding O .............................Media, Pa.
Reese, Warren S .....................Philadelphia, Pa.
Schlanser, Adam E......._____Washington, D. C.
Williams, Walton H .............Middletown, Ohio
Zentmayer, William ................Philadelphia, Pa.
S. Deaths Reported since Last Council Meet-
ing:
Arnold, Francis J. ....................Burlington, Vt.
Berry, David Franklin ........Indianapolis, Ind.
Black, William Byron ............Kansas City, Mo.
Brandenburg, Nora B. _............ .....Winnetka, Ill.
Briglia, Frank Joseph ---.....--..Philadelphia, Pa.
Burke, Thomas Aloysius ........Cleveland, Ohio
Butterfield, Elwyn Temple, Las Vegas, N. M.
Carter, Albert Arthur ..................Boston, Mass.
Charles, Joseph W .------------ .--------- St. Louis, Mo.
Donoher, William David ....Los Angeles, Calif.
Durr, Samuel Abraham ..._.__.San Diego, Calif.
Fowlkes, John Winston ........New York, N. Y.
Friedenwald, Harry ....................Baltimore, Md.
Fuller, T. E......... ..... .............Texarkana, Texas
Gale, M. Jean ................. .......------- .Denver, Colo.
Cradle, Harry S...__._...... Sherman Oaks, Calif.
Hewitt, Wright Platt ----.--.Cambridge, Mass.
Higgins, R. P.---------- ...................Cortland, N. Y.
Hill, Emerson Stanley ...... ...Torrington, Conn.
Howard, Joseph William .--...Kansas City, Mo.
Howard, William H .....................Oelwein, Iowa
Hunt, Westley Marshall --- New York, N. Y.
Kayser, Reuben ........................Brooklyn, N. Y.
Kutscher, Charles F. ..--------- ....Pittsburgh, Pa.
Leavy, Charles A . ........................Clayton, Mo.
Lingeman, Edward L. .___.._._.Indianapolis, Ind.
Lore, John M .........................New York, N. Y.
Matthews, Justus ................Minneapolis, Minn.
McAuley, Albert G. __..Montreal, Que., Canada
McDannald, Clyde Elliott, New York, N. Y.
McDowell, Nathan D............Rochester, N. Y.
McLaughlin, Roy Carlyle, Los Angeles, Calif.
Mengel, Sterling F. ____________________Pottsville, Pa.
Nance, Willis O . .............................Chicago, Ill.
Neff, Eugene E .............................Madison, Wis.
O'Connor, Thomas P. __ ........... .... Chicago, Ill.
O'Hora, James T. _ .... __ .............. Detroit, Mich.
Parsons, Joseph G .................Crookston, Minn.
Randel, Harvey 0.........Oklahoma City, Okla.
Ratner, Simon Harry --------- ._Miami Beach, Fla.
Repass, Robert Eldon ....................Miami, Fla.
Rindlaub, John H .........................Fargo, N. D.
Ringle, Charles A .....................La Junta, Colo.
Rubendall, Clarence ....................Omaha, Neb.
Ryan, Maxwell D_---------------- New York, N. Y.
Schoofs, Orlando P. ............Milwaukee, Wis.
Spengler, John Arthur ................Geneva, N. Y.
Stueber, F. G. _____._____.----------------- _____Lima, Ohio
Van Poole, Gideon M.........Honolulu, Hawaii
Walker, Orville J . ............Youngstown, Ohio
Wells, David W. _ ..................... Newton, Mass.
Williams, Horace J .................Philadelphia, Pa.
Woodry, Norman Lee ................Detroit, Mich.
6. Resignations Received :
Constans, George M ................. Bismarck, N. D.
Crowe, Samuel J. __ .................... Baltimore, Md.
Finney, Nancy E . ....................Cincinnati, Ohio
Gubner, Julius ........................Brooklyn, N. Y.
Nebinger, Reid .................... St. Petersburg, Fla.
Neumann, Wm. Henry _..._.._....Sheboygan, Wis.
Odeneal, Thomas H.........Winter Haven, Fla.
Page, John Randolph _.---------- New York, N. Y.
Risdon, Fulton ................Toronto, Ont., Canada
Togus, L. Theodore .......... ..Manchester, N. H.
7. Eight Fellows requested that they be al-
lowed to continue under the status of dues
remitted. Five new requests were received.
9. The motion picture, Embryology of the
Eye, produced by Sturgis-Grant Productions,
Inc., aided by Dr. George W. Corner and Dr.
George K. Smelser, and sponsored by the
Academy, will be exhibited for the first time
on Tuesday, October 10. This is the first
professionally produced motion picture spon-
sored by the Academy and sets a standard for
teaching films in the basic medical sciences
related to ophthalmology and otolaryngol-
ogy. A suitable plaque has been prepared for
each of the principals in the technical produc-
tion of the film expressing the gratitude of the
Academy for their splendid services.
10. At the request of the secretary of the
American Ophthalmological Society, Dr. May-
nard C. Wheeler, a committee of three was
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COUNCIL MINUTES 163
appointed by President Brown to join similar
committees of the American Ophthalmological
Society and the Section on Ophthalmology of
the American Medical Association in soliciting
the next meeting of the International Congress
of Ophthalmology for the United States. Ap-
pointed on July 5 were Dr. Philip M. Lewis,
Memphis, Tenn.; Dr. Erling Hansen, Minne-
apolis, Minn., and Dr. Bernard Samuels, New
York. A report has not been received from
this committee.
11. At the request of the secretary of the
International Organization Against Trachoma,
a representative from the Academy was ap-
pointed by President Brown on July 5. Dr.
R. Townley Paton of New York was ap-
pointed and has submitted his report to the
Council through the Activities Committee.
It was moved and seconded that the report
of the Executive Secretary be accepted as
read. The motion carried.
II
The Treasurer, Dr. Benedict, submitted the
audit for 1949, made by Byers, Wobschall &
Miller, Certified Public Accountants, and the
financial status of the Academy as of Sept.
30, 1950. It was moved and seconded that the
report be accepted. The motion carried. (The
audit for 1949 appeared in the May-June 1950
issue of the TRANSACTIONS. The financial sta-
tus of the Academy as of Sept. 30, 1950, is
published herewith.)
EXHIBIT "A"
AMERICAN ACADEMY OF
OPHTHALMOLOGY AND OTOLARYNGOLOGY
Balance Sheet as of September 30, 1950
AssETS
Current Assets:
Cash, First National
Bank, Rochester -.-...$ 42,354.05,
Cash, Bank of
Montreal .................... 5,726.71
Cash, First National
Bank, Minneapolis.... 22,850.67
Checks for Col-
lection ------------------------ 23.50
Petty Cash Fund 25.00
Membership Dues
Receivable .................. 470.00
Motion Picture-
Embryology Project 26,200.00
Inventory-Ab-
stracts & Manuals .... 11,937.86
Total Current Assets $109,587.79
Investments :
Research Fund -------- 231,738.48
Wherry Memorial
Fund ..........................
4,600.00
236,338.48
Less: Reserve Mkt.
Fluctuations ..............
2,390.53
Fixed Assets:
Furniture & Fixtures
6,623.35
Less : Reserve for
Depreciation ..............
3,344.74
Total Fixed Assets
3,278.61
Prepaid Insurance -....-
273.87
Prepaid Postage -....-...
21.88
Total Assets
$347,110.10
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164 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
LIABILITIES
Current Liabilities:
Accrued Withholding
Taxes .--------------------
Deferred Income :
Membership Ducs ----
Net Worth :
Balance, January
1, 1950 -'---------------------- $278,916.22
Revenues :
205.80
215.00
EXHIBIT "B"
AMERICAN ACADEMY OF
OPHTHALMOLOGY AND OTOLARYNGOLOGY
Statement of Income and Expenses for Month
Ending September 30, 1950, and Year to Date
Excess Income over
Expenses, Year to
Date ----------------- ---------
Interest ........._......... 262.50 6,000.00
Dividends ---------------- 90.00 937.74
Wherry Memorial Fund :
Interest -------------------- 7.50 115.00
Sub-Committee on
Noise in Industry ..... ._.. ----- 4,200.69
Other Income .----....--
Income from Securities :
Research Fund:
September 1/1/50 to
1950 9/30/50
Membership Dues .--.$ 99.00 $ 26,980.00
Membership Applica-
cations -------------------------- 225.00 3,936.00
Abstracts & Manuals 976.00 3,173.55
346,689.30 Transactions -------------- 2,461.31 34,549.72
Home Study Courses 530.00 3,390.00
$347,110.10 Convention .................. 11,576.75 47,189.75
Committee on Stand-
ardization of Tonome-
ters -------- '-------------' ------- 10.00 650.00
Total Revenues ......$16,238.06 $131,277.29
Operating Expenses:
General Adminis-
trative ..........................$ 1,954.26 $ 24,617.51
Transactions .............. 2,275.16 24,582.22
Home Study Courses 1,094.41 5,382.46
Research -_------------------- 1,012.50
Convention and Meet-
ings ---------------'-------------- 984.24 7,909.52
Total Operating
Expenses ----------------$ 6,308.07 $ 63,504.21
Excess Income over
Expenses ....................$ 9,929.99 $ 67,773.08
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COUNCIL MINUTES
American Academy of Ophthalmology and Otolaryngology
Securities Owned as of September 30, 1950
RESEARCH FUND:
BONDS
RATE
MATURITY
PAR VALUE
COST
Canada, Dominion of-Series PS ............
3
10/ 1/63
$ 2,500.00
$ 2,500.00
Citizens Bldg. Co. of Cleveland,
1st Mortgage
..........................................
6
1/ 1/46
5,000.00
5,000.00
..
Savings Bonds-Series F ..............
S
U
1
2/
12/ 1/55
13,500.00
9,990.00
.
.
Savings Bonds-Series G ..............
S
U
2%
8/ 1/53
10,000.00
10,000.00
.
.
Savings Bonds--Series G ..............
S
U
2%
6/ 1/55
4,000.00
4,000.00
.
.
Savings Bonds-Series G ..............
U
S
232
3/ 1/56
6,000.00
6,000.00
.
.
Savings Bonds-Series G ..............
S
U
21/
5/ 1/56
8,000.00
8,000.00
.
.
Savings Bonds-Series G ..............
U
S
2/
7/ 1/56
2,000.00
2,000.00
.
.
Savings Bonds-Series G ..............
S
U
2/
11/ 1/56
25,000.00
25,000.00
.
.
Savings Bonds-Series G ..............
S
U
2/
1/ 1/57
2,000.00
2,000.00
.
.
Savings Bonds-Series G ..............
S
U
2%
7/ 1/58
30,000.0 l
30,000.00
.
.
Savings Bonds-Series G ..............
U
S
2/
12/ 1/58
25,000.00
25,000.00
.
.
U.S. Savings Bonds-Series G ..............
2/
3/ 1/59
15,000.00
15,000.00
(6) U.S. Savings Bonds-Series G
000
$5
00 ....................................................
2/
7/ 1/60
30,000.00
30,000.00
.
,
..........................
Treasury Bond .......
U
S
2%
12/15/72
10,000.00
10,000.00
.
.
.
U.S. Treasury Bond ..................................
2/
12/15/72
15,000.00
15,431.25
Van Sweringen Co., Cert. of
Indebtedness ..............................................
6
12/31/48
3,445.70
3,477.03
$203,398.28
STOCKS KIND
Citizens Bldg. Co. of Cleveland ................
SHARES
50
None
619
00
Commonwealth Edison Company ............Common
100
.
2,
31
2
47
DuPont de Nemours & Co ...................... Common
15
,3
.
00
5
Louisville Gas & Electric Co ....................5% Preferred
200
5,4
0.
9
Massachusetts Investors Trust ................
617
17,923.8
Ophthalmic Publishing Co .........................Capital
5
None
Total Stocks .......................................
$ 28,340.20
Total ------------------------------------------------------
(A)
$231,738.48
WHERRY MEMORIAL FUND:
U.S. Savings Bonds-Series G ...............
(B)
$ 4,600.00
$236,338.48
(A) Held for safekeeping by Trust Dept., First National Bank, Minneapolis, Minn.
(B) Held by Dr. W. L. Benedict, Executive Secretary-Treasurer, Rochester, Minn.
The report of the Editor of the TRANSAC-
TIONS was read by Dr. Benedict, Editor-in-
Chief, as follows :
For the period September 1, 1949, through
August 31, 1950, in addition to the six bi-
monthly issues of the TRANSACTIONS, a sup-
plement containing papers read at the Oto-
sclerosis Study Group meeting in October
1948 was printed and sent out with a regular
mailing. A similar supplement containing pa-
pers from the Study Group's 1949 meeting
will appear soon.
The Academy has also published four man-
uals and one monograph during the past year.
The Syllabus of Audiometric Procedures in
the Administration of a Program for the Con-
servation of Hearing of School Children has
been reprinted. One hundred and forty-one
abstracts have been prepared for the 1950
Instruction Section. A manual by Richard
Scobce and a monograph by Clarence A. Vea-
sey, Jr., are now being processed.
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166 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950
MANUALS
October 1949-Woods, Endogenous Uveitis
March 1950-Leinfelder, Neuro-ophthal-
mology
June 1950-Berens and Loutfallah, Ocular
Surgery
June 1950-Sugar, Extrinsic Eye Muscles
(revised edition)
MONOGRAPH
January 1950-Juers, Hearing Tests
In the coming year we will continue to issue
a supplement of the papers read at the Spe-
cial Scientific Program of the Otosclerosis
Study Group and will also publish a supple-
ment containing papers read. at the Special
Scientific Program of the American Society
of Ophthalmologic and Otolaryngologic Al-
lergy. Papers read at the meeting of the
Committee on Conservation of Hearing
(Sunday night meeting) will appear in one of
the regular issues of the TRANSACTIONS. Most
of the papers read before the Industrial Oph-
thalmology-group will also appear throughout
the year in the Industrial Ophthalmology Sec-
tion of the TRANSACTIONS.
An average of 6092 copies of the TRANSAC-
TIONS was printed bimonthly. Of these, 675
were set aside for bound volumes and an
average of 5373 was mailed, an increase in
circulation of 348 over last year. The fol-
lowing categories are represented :
Members .------------------------------------------
4554
Candidates ........... ----------- ------------------
146
Subscribers .... ----- ----------
411
Libraries --------------------------------------------
103
Exchange & Miscellaneous --------
78
Advertisers ---------------------------------------
52
Complimentary --------------------------------
29
Four hundred and ninety-five orders for the
1949-1950 bound volume have been received
to date.
The average number of pages of paid ad-
vertising was 18.7, representing 29 advertisers.
The revenue from the TRANSACTIONS was as
follows :
Amount set aside from
Fellows' dues ----------------------$19,844.00
Amount set aside from
Candidates' fees -------- ------- 1,202.00
Subscribers (nonmembers) 3,272.00
Bound Volumes ----------------------- 3,018.00
Single issues sold _..--_..---- ---_.. 55.00
Reprints ................................. - 495.00
Advertisers ---------------------------- 9,637.66
Cuts (loaned) ---------------------- 87.55
Total ------------- ----------- ------------ $37,611.96
iixpenditures were as follows :
Printing bimonthly issues ---- $17,704.74
Binding Bound Volumes ___...
1,097.25
Cuts and engravings _.....------
1,664.70
Editor's honorarium ------------
2,000.00
Postage -----------------------------------
423.34
Reprints ....-------------------------- ----
1,518.92
Directory --------------------------------
3,019.92
Salaries ------------------------------------
4,796.00
Supplies (stock, enve- -
lopcs, etc.) ------------------------ . 5,327.73
Total -----------------------------------$37,552.60
Balance ------------------------------- $ 59.36
A motion to accept the report as read was
seconded and carried.
IV
Communications
1. The secretary read a communication from
Dr. James H. Allen of New Orleans regarding
the exemption of medical students, interns and.
residents in their final years of training. Dr.
Derrick Vail moved that the Academy appoint
a committee of ex-medical officers who had.
served in World War II to be known as
the Committee on Armed Forces. The mo-
tion was seconded by Dr. Erling Hansen and
carried. The following committee was ap-
pointed : Dr. James N. Greear, Jr., Washing-
ton, I). C., chairman; Dr. Brittain F. Payne,
New York ; Dr. Gordon D. Hoople, Syracuse,
N. Y.; Dr. Gordon M. Bruce, New York ; and
Dr. Harry P. Schenck, Philadelphia. The
committee is to formulate opinions of policy
regarding exemptions and will represent the
Academy as a liaison committee with the
Armed Forces.
2. Dr. A. F. MacCallan of London wrote to
Dr. R. Townley Paton in regard to the Lon-
don activities of. the International Organiza-
tion Against Trachoma and asked for a dona-
tion from the Academy to assist this organiza-
tion in its work. Dr. Paton, who represented
the Academy at the meeting of the organiza-
tion in June of this year, referred the letter
to the Executive Secretary. The Council voted
to send $25.00 to the organization.
3. The National Society for Crippled
Children and Adults, Inc., requested "the offi-
cial action of the American Academy of Oph-
thalmology and Otolaryngology to create a
formal liaison relationship with the National
Society for Crippled Children and Adults.
The Council approved the request, and Dr.
Dean M. Lierle was appointed to the position
of liaison officer.
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COUNCIL MINUTES 167
4. The Secretary presented a letter written
by Captaih W. L. Berkley, MC, USN, con-
cerning the Sixth Brazilian Jornadas of Oph-
thalmology, which took place in Sao Paulo,
Brazil, September 3-7, 1950. Dr. Berkley par-
ticipated in the program. He praised the ex-
cellence of the scientific program and the mani-
festations of the very warm friendship which
the people of Brazil have toward the United
States. He commented on the importance of a
Good Neighbor policy and urged more par-
ticipation in the ophthalmologic meetings of
Central and South American countries.
5. A communication addressed to the Presi-
dent and signed by Dr. C. E. Kinney, con-
cerning the advertising of cigarette manufac-
turers, was read to the Council. There was
no specific recommendation and, after some
discussion, the matter was laid on the table
for further consideration.
6. A communication was submitted by Dr.
Iledrvig Kuhn as secretary of the Joint Com-
mittee on Industrial Ophthalmology urging
the approval or disapproval of the recommen-
dations of the 1949 meeting of the Joint Com-
mittee relative to monocular aphakia and com-
pensation. Inasmuch as matters of compen-
sation are handled by the American Medical
Association, the Council recommended that the
matter be referred to the Association.
V
Report of the Executive, Research and Fi-
nance Committee-Dr. J. Mackenzie Brown,
chairman.
1. The Committee recommends that the ap-
plication fee shall be $25.00, and that the an-
nual dues for Junior Fellows shall continue to
be $12.00, and for Senior Fellows, $6.00. The
allotment from clues for subscriptions to the
TRANSACTIONS shall remain at $5.00. It was
moved and seconded that this recommendation
be approved. The motion carried.
2. The Committee recommends that the 10
resignations of Fellows from the Academy re-
ported by the Executive Secretary be accepted.
A motion to this effect was seconded and
carried.
4. The Committee recommends that Dr.
George W. Corner, Baltimore, Md., and Dr.
George K. Smelser, New York City, be made
Honorary Fellows of the Academy. This
recommendation was approved.
5. The Committee recommends the follow-
ing appointments to Standing and Joint Com-
mittees :
,To the Advisory Committee to the Regis-
tries of Pathology, Dr. Brittain F. Payne,
chairman.
To the Committee on Conservation of Hear-
ing, Dr. Dean M. Lierle, chairman.
To the Committee on Pan-American Rela-
tions in Otolaryngology, Dr. C. L. Jackson,
chairman; Dr. Norton Canfield; Dr. A. C.
Furstenberg; Dr. Gordon B. New; Dr.
Theodore E. Walsh ; and Dr. Paul H. Hol-
in.ger. At the request of Dr. Jackson, Dr. Vic-
tor Alfaro of Washington, D. C., was added
to the Committee.
To the Committee on Prevention of Blind-
ness, Dr. Ralph I. Lloyd, chairman ; Dr. Law-
rence T. Post; and Dr. Alan C. Woods.
To the Committee on Scientific Exhibit, Dr.
Kenneth L. Roper, chairman.
To the Committee on Standardization of
Tonomcters, Dr. Jonas S. Friedenwald, chair-
man.
To the Committee on the Study of Audio-
Visual Instruction, Dr. Dean M. Lierle, chair-
man; Dr. W. L. Benedict; Dr. Howard P.
House, Dr. Algernon B. Reese; and Dr. A.
D. Ruedemann.
To the Advisory Committee to the Eye
Health Committee of the American Student
Health Association, Dr. Lawrence T. Post.
To the American Association for the Ad-
vancement of Science, Dr. M. Elliott Randolph.
To the American Board of Ophthalmology,
Dr. F. -Bruce Fralick.
To the American Board of Otolaryngology,
Dr. C. H. McCaskey and Dr. W. E. Grove.
To the American College of Surgeons Board
of Governors, Dr. James H. Maxwell.
To the American Committee on Optics and
Visual Physiology, Dr. Alfred Cowan.
To the American Orthoptic Council, Dr.
Kenneth C. Swan.
To the American Society of Clinical Path-
ologists Consultative Panel on Tumor Termin-
ology, Dr. John S. McGavic.
To the Joint Committee on Industrial Oph-
thalmology, Dr. Edmund B. Spaeth, Dr. John
B Hitz, and Col. Victor A. Byrnes (MC).
It was moved and seconded that these ap-
pointments be approved. The motion carried.
6. The Committee recommends that the
Helmholtz Centenary Committee ,be discharged
with thanks for the services rendered. The
recommendation was approved.
7. The Committee nominates Dr. William L.
Benedict as Editor-in-Chief of the TRANSAC-
TIONS. It was moved and seconded that the
nomination be approved. The motion carried.
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168 TRANSACTIONS - NOVEMBER - DECEMBER, 1930
8. The Committee recommends that the next
annual meeting of the Academy be held Octo-
ber 14-19, 1951, at the Palmer House, Chicago.
The recommendation was approved. The Coun-
cil directed the Executive Secretary-Treasurer
to arrange for future meetings of the Acad-
emy.
9. The Committee recommnds the following
appropriations for the calendar year 1951:
To the Advisory Committee to the Regis-
tries of Pathology, a sum not to exceed $8,500
toward the completion of the atlases. This is
to include the services of a fellow in ophthal-
mology and one in otolaryngology.
To the Committee on Conservation of Hear-
ing, a sum not to exceed $9,000.
To the Committee on Standardization of
Tonometers, a sum not to exceed $1,000.
To the American Committee on Optics and
Visual Physiology, $100.
To the American Orthoptic Council, $200
if requested.
To the Joint Committee on Industrial Oph-
thalmology, a sum not to exceed $1,000, if
matched by an equal sum from the American
Medical Association and if the Academy is
accorded proper credit for its participation in
this Committee.
To the National Research Council, $2,500.
To the National Society for Medical Re-
search, $1,000.
On the motion of Dr. Algernon Reese,
seconded by Dr. Erling Hansen, the report
of the Committee was accepted and the recom-
mendations adopted.
VI
Report of the Activities Committee-Dr.
Thomas D. Allen, chairman.
Reports of the following committees were
reviewed and approved by the Activities Com-
mittee :
1. Advisory Committee to the Registries
of Pathology
2. Committee on Conservation of Hearing
3. Committee on Scientific Exhibit
4. Committee on Standardization of To-
nometers
5. Committee on the Prevention of Blind-
ness
6. Committee on the Study of Audio-Vis-
ual Instruction
7. Advisory Committee to the Eye Health
Committee of the American Student
Health Association
8. American Association for the Advance-
ment of Science
9. American Board of Ophthalmology
10. American Board of Otolaryngology
11. American Committee on Optics and Vis-
ual Physiology
12. American Orthoptic Council
13. Helmholtz Centenary Committee
14. Joint Committee on Industrial Ophthal-
mology
15. American Society of Clinical Patholo-
gists Consultative Panel on Tumor
Terminology
16. Representative to the International Or-
ganization Against Trachoma
(Full reports of standing and joint commit-
tees follow the report of the Business Meet-
ing.)
The report of the Committee on Pan-Ameri-
can Relations in Otolaryngology was given
verbally by the chairman, Dr. C. L. Jackson,
who was instructed to submit a written report
to the Chairman of the Activities Committee
before the meeting of the Council on Wed-
nesday.
No reports were received from:
1. American College of Surgeons Board
of Governors
2. Committee on Meeting of the Interna-
tional Congress of Ophthalmology
A motion was made and seconded that the
report of the Activities Committee be accepted
as a whole. The motion carried.
VII
Report of the Board of Councillors-Dr.
Thomas D. Allen, chairman.
1. Nomination of officers :
President-Dr. Derrick Vail, Chicago, Ill.
President-Elect-Dr. James Milton Robb, De-
troit, Mich.
First Vice-President-Dr. Francis E. LeJeune,
New Orleans, La.
Second Vice-President-Dr. Peter Kronfeld,
Chicago, Ill.
Third Vice-President-Dr. Frederick A. Figi,
Rochester, Minn.
Councillor-Dr. John H. Dunnington, New
York, N. Y.
Executive Secretary-Treasurer-Dr. William
L. Benedict, Rochester, Minn.
Secretary for Ophthalmology-Dr. Algernon
B. Reese, New York, N. Y.
Secretary for Otolaryngology-Dr. Howard
House, Los Angeles, Calif.
Secretary for Instruction in Ophthalmology-
Dr. A. D. Ruedemann, Detroit, Mich.
Secretary for Instruction in Otolaryngology
and Maxillofacial Surgery-:Dr. Dean M.
Lierle, Iowa City, Iowa.
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Secretary for Home Study Courses-Dr. Law-
rence R. Boles, Minneapolis, Minn.
Secretary for Public Relations-Dr. Erling
W. Hansen, Minneapolis, Minn.
It was moved and seconded that the recom-
mendations of the Board of Councillors for
the officers of the Academy for 1951 be ac-
cepted. The motion carried..
3. The Board of Councillors recommends
that 285 candidates be accepted for Fellowship
in the Academy :
(The names of candidates for fellowship
approved by the Council are published in the
account of the Business Meeting.)
A motion to accept these recommendations
was seconded and carried.
VIII
Report of the Judicial Committee-Dr. J.
Mackenzie Brown, chairman.
There was no business for the Judicial Com-
mittee and a meeting of the Committee was
not required.
IX
New Business
1. It was moved by Dr. Alan Woods and
seconded by Dr. W. L. Benedict that the fol-
lowing addition be made to Article V, Section
6, of the By-Laws :
(Following identification of Junior Fellows)
Inactive Fellows : Senior or Junior Fellows
who by reason of physical infirmity or re-
tirement from practice may by action of the
Council be classified as "Inactive." Inactive
Fellows shall pay no clues, have no voting
privileges, and shall not receive the TRANSAC-
TIONS.
The motion carried.
2. Dr. Alan Woods moved that the re-
search fund be renamed Educational Fund.
The motion was seconded by Dr. W. L. Bene-
dict and carried.
3. At the January meeting of the Board of
Secretaries, the organization of a Teachers'
Section was recommended. It was moved by
Dr. A. D. Ruedemann and seconded by Dr.
Erling Hansen that the Council create a
Teachers' Section as an Academy function.
The motion carried and Dr. Lawrence R.
Boies was named chairman and given the pri-
vilege of adding to his Committee by ap-
pointment.
4. The management of a special fund to be
known as "The Isabella Wilson Research and
Educational Fund for Frontal Sinus Path-
ology," initiated by Dr. Robert H. Fraser of
Battle Creek, Mich., was accepted by the
Council. The purpose of this fund was set
forth in a letter addressed to the Secretary
under date of October 9, 1950. This is tenta-
tively a fund of $500, $250 contributed from
the estate of Miss Isabella Wilson, and con-
tributions of not over $10.00 to be accepted
from interested physicians and others. A check
for $150 signed by Dr. Robert IL Fraser
accompanied the letter.
5. The secretary of the American Orthoptic
Council, Dr. Frank J. Costenbader, in a com-
munication to the Secretary requested that the
Academy publish certain papers from the
Special Scientific Program of the American
Association of Orthoptic Technicians and the
American Orthoptic Council. It is the hope
of the American Association of Orthoptic
Technicians and the American Orthoptic Coun-
cil that additional material may be combined
with the scientific papers to make up a publica-
tion to be known as the American Orthoptic
Journal. A motion was made by Dr. Alan
Woods and seconded by Dr. Conrad Berens
that the proposal be accepted, the arrange-
ments to be completed by Dr. Derrick Vail
and Dr. W. L. Benedict. The motion carried.
6. Dr. Thomas D. Allen moved that the
Academy have an exhibit at the Meeting of
the Pan-American Congress of Ophthalmol-
ogy in Mexico City in 1952. It was suggested
that the Academy and the American Board of
Ophthalmology might plan a joint exhibit. The
motion was seconded by Dr. Alan Woods and
carried. The Council authorized the expenses
of Miss Maud Givens to accompany the ex-
hibit.
8. The Joint Committee on Industrial Oph-
thalmology presented for endorsement by the
Council the following recommendations of
basic principles, objectives and essentials to
be met by manufacturer, distributor or any
other representative, for introducing an effec-
tive and ethical visual testing program to in-
dustry :
1. The 'manufacturer, distributor or any other
representative to recommend only accepta-
ble and proper instrumentation for the
testing of visual skills.
2. The presentation of currently acceptable
visual testing procedures shall be made to
the medical director and/or professional
eye consultant of plant by the salesmen.
3. Insistence in sales approach that interpre-
tation, evaluation of records and all refer-
ral and correction programs are the re-
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sponsibility of the medical director and/or
professional eye consultant.
4. The presentation of the over-all subject of
instrument testing of visual skills in indus-
try shall be made to local professional
groups and societies whenever at all possi-
ble.
5. At no time shall a salesman of such in-
strumentation indicate to lay personnel of
industry that professional guidance is not
necessary.
6. Any job standards and/or "profiles" pre-
sented to the industry must be based on
research available both to the industry pur-
chasing the instrument and/or the profes-
7. When an instrument as such is sold out-
right to the company without an additional
continuous service, the price of the instru-
ment should be for the instrument alone.
It would be desirable that instrumentation
be sold outright to plants that have profes-
sional eye consultants.
8. The attitude and bearing of any salesman
asking for an interview with a professional
individual shall be in line with accepted
ethical standards.
A motion to endorse these recommendations
was made by Dr. A. D. Ruedemann, seconded
by Dr. Derrick Vail, and carried.
The meeting adjourned.
ANNUAL BUSINESS MEETING
The business meeting of the Fifty-Fifth
Annual Session of the American Academy of
Ophthalmology and Otolaryngology convened
at 5:30 p.m. in the Crystal Room of the Pal-
mer House, Chicago, Oct. 12, 1950. President
J. Mackenzie Brown presided.
Report of the Executive Secretary-Treasurer,
I)r. William L. Benedict
The fellowship in this Academy as of Oct.
1, 1950: Junior Fellows, 3,907; Senior Fel-
lows, 150; Life Fellows, 427; Honorary Fel-
lows, 26; making a total of 4,510. Candidates
to be considered at this meeting, 285.
Elevation to senior fellowship on Jan. 1,
1951, 41.
Elevation to life fellowship on Jan. 1, 1951,
17.
Deaths reported since the last meeting, 53.
Resignations received, 10.
[.See Council Minutes.]
Review of those whose dues have been re-
mitted and who are carried on the member-
ship roll at their request, 13.
On motion of Dr. Alan C. Woods, seconded
by Dr. John J. Shea, the report was accepted
as read.
Report of the Senior Member of the Council,
Dr. Alan C. Woods
Mr. President and Members : The Council
has received and approved the reports of the
Treasurer, the Editor of the TRANSACTIONS,
the Council Committees, and joint and stand-
ing committees. These reports will be pub-
lished in the November-December issue of the
TRANSACTIONS. [See Council Minutes and Com-
mittee Reports.]
Dn. WooDS : The Council recommends that
the application fee for fellowship in the
Academy shall remain at $25.00, and that
annual dues for Junior Fellows shall be
$12.00; for Senior Fellows, $6.00.
A motion to accept the recommendation of
the Council was made by Dr. Carl H. Mc-
Caskey and seconded by Dr. James M. Robb.
The motion carried.
DR. Woods : A request for financial assist-
ance to support the International Organiza-
tion Against Trachoma was directed to the
Academy by Dr. A. F. MacCallan, secretary.
The Council recommends the appropriation of
$25.00 to the organization.
On motion of Dr. Thomas Allen, seconded
by Dr. Shea, the recommendation of the Coun-
cil was accepted.
DR. WOOns : The -Council recommends the
following appropriations for the year 1951:
To the Advisory Committee to the Regis-
tries of Pathology, a sum not to exceed $8,500
toward the completion of the atlases. This is
to include the services of a fellow in oph-
thalmology and one in otolaryngology at the
Armed Forces Institute of Pathology in Wash-
ington, D. C.
To the Committee on Conservation of Hear-
ing, a sum not to exceed $9,000.
To the Committee on Standardization of
Tonometers, a sum not to exceed $1,000.
To the American Committee on Optics and
Visual Physiology, $100.
To the American Orthoptic Council, $200 if
requested.
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ANNUAL BUSINESS MEETING 171
To the Joint Committee on Industrial Oph-
thalmology, a sum not to exceed $1,000, if
matched by an equal sum from the American
Medical Association.
To the National Research Council, $2,500.
To the National Society for Medical Re-
search, $1,000.
On motion by Dr. McCaskey, seconded by
Dr. Allen, the appropriations recommended by
the Council were accepted.
DR. Woons : The Council recommends the
following appointments to standing and joint
committees for the year 1951:
To the Advisory Committee to the Regis-
tries of Pathology, Dr. Brittain F. Payne,
chairman.
To the Committee on Conservation of Hear-
ing, Dr. Dean M. Lierle, chairman.
To the Committee on Pan-American Rela-
tions in Otolaryngology, Dr. C. L. Jackson,
chairman; Dr. Norton Canfield; Dr. A. C.
Furstenberg; Dr. Gordon B. New; Dr. Theo-
(lore E. Walsh; Dr. Paul H. Holinger; and
Dr. Victor Alfaro.
To the Committee on Prevention of'Blind-
ness, Dr. Ralph I. Lloyd, chairman; Dr. Law-
rence T. Post; and Dr. Alan C. Woods.
To the Committee on Scientific Exliibit, Dr.
Kenneth L. Roper, chairman.
To the Committee on Standardization of
Tonometers, Dr. Jonas S. Friedenwald, chair-
man.
To the Committee on the Study of Audio-
Visual Instruction, Dr. Dean M. Lierle; chair-
man; Dr. W. L. Benedict; Dr. Howard P.
House; Dr. Algernon B. Reese ; and Dr. A.
D. Ruedemann.
To the Advisory Committee to the Eye
Health Committee of the American Student
Health Association, Dr. Lawrence T. Post.
To the American Association for .the Ad-
vancement of- Science, Dr. M. Elliott Ran-
dolph.
To the American Board of Ophthalmology,
Dr. F. Bruce Fralick.
To the American Board of Otolaryngology,
Dr. C. H. McCaskey and Dr. W. E. Grove.
To the American College of Surgeons
Board of Governors, Dr. James H. Maxwell.
To the American Committee on Optics and
Visual Physiology, Dr. Alfred Cowan.
To the American Orthoptic Council, Dr.
Kenneth C. Swan.
To the American Society of Clinical Path-
ologists Consultative Panel on Tumor Termin-
ology, Dr. John S. McGavic.
To the Joint Committee on Industrial Oph-
thalmology, Dr. Edmund B. Spaeth, Dr. John
B. Hitz, and Col. Victor A. Byrnes (MC).
On motion by Dr. McCaskey, seconded by
Dr. Allen, the appointments recommended by
the Council were accepted.
DR. WooDS : The Council was requested to
give suggestions and advice regarding the
exemption of medical students and residents
from military service. A committee to be
known as "The Committee on Armed Forces"
was appointed by the President.. The Com-
mittee consists of Dr. James N. Greear, Jr.,
chairman; Dr. Brittain F. Payne; Dr. Gordon
D. Hoople; Dr. Gordon M. Bruce; and Dr.
Harry P. Schenck.
On motion by Dr. Shea, seconded by Dr.
Derrick Vail, the action of the Council was
approved.
DR. Woons : The National Society for Crip-
pled Children and Adults, Inc., has requested
official action of the Academy to create a for-
mal liaison relationship with the Society. The
Council recommends the appointment of Dr.
Dean M. Lierle as liaison officer.
On motion of Dr. A. D. Ruedemann, sec-
onded by Dr. Shea, the recommendation of
the Council was accepted.
DR. Woons : The Council recommends the
organization of a Teachers' Section. The pur-
pose of this section would be to set up a
forum for discussion of problems pertinent
to teaching of the specialties in medicine. The
Council has recommended that Dr. Lawrence
R. Bores be named chairman and be given the
privilege of adding to his committee by ap-
pointment.
Upon motion by Dr. Vail, seconded by Dr.
Allen, the recommendations of the Council
were accepted.
DR. Woons : The Council nominates for
honorary fellowship in the Academy, Dr.
? George W. Corner and Dr. George K.. Smel-
ser. The Council also nominates for active
fellowship the 285 candidates whose names
appear on the sheets handed you when you
came in the door.
On motion by Dr. Carroll Mullen, seconded
by Dr. Allen, the nominations made by the
Council were accepted.
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172 TRANSACTIONS -NOVEMBER - DECEMBER, 1950
iVewlr elected Fellows of the Academy:
Acquarelli, Mario John, Wadsworth Gen-
eral Hospital, Los Angeles 25, Calif.,
ALR.
Albers, George Donald, 81/2 Monroe St.,
Grand Rapids 2, :Mich., ALR.
Anderson, Elam DeMar, Medical & Dental
Bldg., Seattle 1, Wash., OP.
Anderson, Elbert Carl, 201 N. Front St.,
Wilmington, N. C., OP.
Anderson, H. Gordon, 403 Fulton St.,
Troy, N. Y., OP.
Anslow, Robert Elmer, 10 Peterboro St.,
Detroit 1, Mich., OP.
Baers, Harry Arnold, 4063 Radford Ave.,
Studio City, Calif., ALR.
Baldridge, Max N., P.O. Box 778, Texar-
kana, Ark.-Texas, OP.
Barbee, John Young, 1109 State St.,
Bowling Green, Ky., ALR.
Barrere, Luciano Enrique, Tulane Uni-
versity, New Orleans 12, La., OP.
Barton, William Lawrence, 403 Persons
Bldg., Macon, Ga., ALR.
Beasley, Clifton Harold. :1216 Pennsyl-
vania Ave., Fort 'Worth, Texas, OP.
Bergman, Macks Leonard, 8443 Crenshaw
Blvd., Inglewood, Calif., ALR.
Birmingham, Eugene E., 333 W. North
Ave., Chicago 10, Ill., ALR.
Blair, James Robert, 920 Metropolitan
Bldg., Denver 2, Colo., ALR.
Blanford, Sidney Edgar, Jr., 1624 Gilpin
St., Denver, Colo., Pl S.
Blodi, Frederick C., 635 W. 165th St.,
New York 32, N. Y., OP.
Bloomberg, Louis, 506 Central Tower
Bldg., Youngstown 3, Ohio, OP.
Bobbett, Gordon Howard, 125 W. Cheves
St., Florence, S. C., ALR.
Boshnack, Malcolm, 70 Strawberry Hill
Ave., Stamford, Conn., ALR.
Bosworth, Wesley F., E. Main St., Clar-
inda, Iowa, OP.
Boucher, Irvan Andrew, 1221 12th Ave.,
Altoona, Pa., ALR.
Braveman, Bernard Leon, 412 Fifth Ave., .
McKeesport, Pa., CP.
Breff eilh, Louis Andrew, 421 Medical Arts
Bldg., Shreveport, La., OP.
Brown, Kenneth Brien, 131 Fulton Ave.,
Hempstead, N. Y., ALR.
Bryan, John Thomas, 2105 Hayes St.,
Nashville 5, Tenn., ALR.
Burnham, Charles Joseph, 1529 N. 25th
St., Birmingham, Ala., OP.
Burr, Sherwood Petersen, 43 E. Jackson
St., Tucson, Ariz., OP.
Butler, Jay B. V., 919 Taylor Street Bldg.,
Portland 5, Ore., OP.
Cairns, Adrian Bennett, 415 Pere Mar-
quette Bldg., New Orleans 12, La.,
ALR.
Callaghan, Winship C., Union Trust Bldg.,
Greensburg, Ind., ALR.
Callahan, Neil, 315 Medical Arts Bldg.,
Norfolk 10, Va., ALR.
Cammack, Bragg Charles, 6381 Holly-
wood Blvd., Hollywood 28, Calif., ALR.
Capriotti, Octavius A., 404 E. Broad St.,
Souderton, Pa., OP.
Carris, James Vernon, 209 S. Nevada
Ave., Colorado Springs, Colo., ALR.
Casey, Edwin Joseph, 508 N. Grand Ave.,
St. Louis 3, Mo., OP.
Christenberry, Kenneth William, 501 W.
Church Ave., Knoxville, Tenn., OP.
Clark, Archibald Fletcher, Jr., 225 Medi-
cal Arts Bldg., San Antonio 5, Texas,
ALR.
Clay, Richard A., 416 N.W. 13th St., Okla-
homa City, Okla., OP.
Clayton, Sam, 119-05 80th Road, Kew
Gardens 15, N. Y., ALR.
Coleman, Howe Reese, 305 Young Bldg.,
Lynchburg, Va., ALR.
Corgill, Donald Alton, Veterans Adminis-
tration Hospital, McKinney, Texas,
ALR.
Crane, Edward Harrison, Jr., 127 S. Gre-
villea Ave., Inglewood, Calif., ALR.
Crawford, Walter James, 3333 Pachappa
Drive, Riverside, Calif., OP.
Cressman, Frederic E., 102 S. Second St.,
Artesia, N. M., OP.
Crowder, Miles S., 603 W. Main St., Knox-
ville, Tenn., OP.
Daly, Joseph M., 1801 K St. N.W., Wash-
ington 6, D. C., ALR.
DeLuca, Charles Q., 255 S. 17th St.,
Philadelphia 3, Pa., ALR.
Denicke, Ernest Webber, 1010 B St.,
San Rafael, Calif., OP..
Dennis, Richard Hollis, 33 College Ave.,
Waterville, Maine, OP.
Dillahunt, Jack A., Copper Ave. at Mon-
roe, Albuquerque, N. M., OP.
Dorman, Purman, 1215 Fourth Ave., Se-
attle 1, Wash., OALR.
Dryden, James Spencer, 1835 Eye
N.W., Washington 6, D. C., OP.
Duncan, Herbert, 700 Church St., Nash-
ville 3. Tenn., ALR.
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ANNUAL BUSINESS MEETING 173
duPrey, Robert E., 1150 Connecticut Ave.,
Washington 6, D. C., OP.
Dwyer, Gregory Kennedy, Community
Medical Group, Boonton, N. J., ALR.
Edelstein, Isidore S., 259 New York Ave.,
Brooklyn 16, N. Y., OP.
Edwards, Thomas Luther, 507 S. Wash-
ington St., Van Wert, Ohio, OP.
Egdorf, Otto Charles, 420 Hamilton
Bldg., Wichita Falls, Texas, ALR.
Esbin, Leo, 1333 President St., Brook,yn
13, N. Y., OP.
Esposito, Albert Charles, First Hunting-
ton National Bank Bldg., Huntington
1, W. Va., OP.
Eubank, William Richards, 1102 Grand
Ave., Kansas City 6, Mo., OP.
Evans, John W., 325 Franklin St., Hunts-
ville, Ala., ALR.
Failla, Anthony, 3831 Frenchmen St.,
New Orleans, La., ALR.
Fairbanks, Stephen, 1191/2 N. Superior
St., Albion, Mich., OP.
Feher, Alexander, 123 E. 83rd St., New
York 28, N. Y., ALR.
Feldman, John L., 416 S. 24th St., Quin-
cy, Ill., ALR.
Feldstein, Morris, 515 Park Ave., New
York 22, N. Y., OP.
Fields, James Allan, Naval Hospital,
Beaufort, S. C., ALR.
Florentz, Theodore Robert, 109 N. Eighth
St., Boise, Idaho, OP.
Follette, William James, 375 Engle St.,
Englewood, N. J., ALR.
Freeman, David M., McMillan Hospital,
St. Louis 12, Mo., OP.
Friedman, Isadore Edward, 5248 Hob-
man St., Hammond, Ind., ALR.
Friedman, Paul Norman, 1111 St. Paul
St., Baltimore 2, Md., OP.
Fuchs, Jesse, 6363 Wilshire Blvd., Los
Angeles 48, Calif., ALR.
Gardner, James Frank, 11 N. Goodman
St., Rochester, N. Y., ALR.
Garner, Lawrence Lee, 238 W. Wisconsin
Ave., Milwaukee 3, Wis., OP.
Carron, Levon K., 426 17th St., Oak-
land 12, Calif., OP.
Gifford, Edward Stewart, Jr., 1913 Spruce
St., Philadelphia 3, Pa., OP.
Gillman, A. Marvin, 54 E. 72nd St., New
York 21, N. Y., OP.
Girard, Louis Joseph, Centre Island, Long
Island, N. Y., OP.
Glass, Walter Martin, 221 Middle Neck
Rd., Great Neck, N. Y., ALR.
Godwin, Robert William, 117 E. Eighth
St., Long Beach 13, Calif., ALR.
Golden, Samuel Charles, 150 Prichard St.,
Fitchburg, Mass., ALR.
Goldsmith, Charles Porter, 1648 Hamilton
St., Allentown, Pa., OP.
Gooch, J. Oliver, 1203 Hermann Profes-
sional Bldg., Houston 5, Texas, ALR.
Gorin, George, 885 West End Ave., New
York 25, N. Y., OP.
Grayman, Harry Myer, 2900 Fresno Street
Bldg., Fresno 1, Calif., OP.
Greene, Richard W., 32 Johnson Ave.,
Newark 8, N. J., OP.
Greenfield, S. Jerome, 31 Lincoln Park,
Newark 2, N. J., OP.
Greer, Rex E., 203 Fisk Bldg., Amarillo,
Texas, ALR.
Gros, Jose Conrad, Calle 25 no. 960,
Vedado, La Habana, Cuba, ALR.
Guida, Francis Paul, 67 Trumbull St.,
New Haven 10, Conn., OP.
Haight, Whitney James, 9 Exchange
Place, Salt Lake City 1, Utah, ALR.
Harms, Edwin M., 104 W. Douglas St.,
Wichita 2, Kan., OP.
Harper, Donald McCarthy, 1915 New
Hampshire Ave., N.W., Washington 9,
D. C., ALR.
Hatfield, Haskell Doke, 1201 First Na-
tional Bldg., El Paso, Texas, ALR.
Hathcock, William Caldwell, 402 Grand
Theatre Bldg., Atlanta 3, Ga., OP.
Heck, Walter Emil, Stanford University
Hospital, San Francisco, Calif., ALR.
Heller, Morris Freund, 115 E. 61st St.,
New York 21, N. Y., ALR.
Herman, Seymour J., 1601 E. 23rd St.,
Brooklyn 29, N. Y., ALR.
Hirst, William Randolph, 2241 Central
Ave., Alameda, Calif., OP.
Hoch, Carl William, 2904 Wilbur St.,
Rockford, Ill., ALR.
Hoffman, Franklin David, 626 Union
Trust Bldg., Pittsburgh 19, Pa., OP.
Hoffman, Parker M., 134 E. First St.,
Corning, N. Y., OP.
Hogg, Stephen P., 556 Doctors' Bldg.,
Cincinnati 2, Ohio, ALR.
Hosner, James Wesley, 255 S. 17th St.,
Philadelphia 3, Pa., OP.
Hull, Forrest Edgar, Tokyo General Hos-
pital, APO 1052, c/o PM, San- Fran-
cisco, Calif., OP.
Huston, James M., 1280 E. 14th St., San
Leandro, Calif., ALR.
Hynes, Edward Allen, U. S. Naval Acad-
emy, Annapolis, Md., OP.
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Hyslop, Volney Butman, 769 N. Milwau-
kee St., Milwaukee 2, Wis., P1 S.
Ittkin, Paul, 5921 Clark St., Montreal,
Que., Canada, ALR.
Jennings, Edward C., 2650 Wisconsin
Ave., Washington 7, D. C., ALR.
Kant, Alfred, 129 Clinton St., Watertown,
N. Y., OP.
Katz, Jacob, 1807 S. Sixth St., Philadel-
phia 48, Pa., OP.
Keck, William Struble, 122 Main St.,
Greensburg, Pa., ALR.
Kelemen, George, 20 Gloucester St., Bos-
ton 15, Mass., ALR.
Kennon, William G., Jr., 706 Church St.,
Nashville 3, Tenn., ALR.
Kimmelman, David Brown, 10 Downing
St., New York 14, N. Y., OP.
Kirsch, Ralph Emile, 903 Huntington
Bldg., Miami 32, :Fla., OP.
Kirshner, Harold, 20 Park Ave., New
York 16, N. Y., OP.
Knapp, Philip, University Hospitals, Iowa
City, Iowa, OP.
Kolodny, George Robert, 702 Hermann
Professional Bldg., Houston 5, Texas,
OP.
Krishna, Ikbal, 1049 E. Washington St.,
Brownsville, Texas, ALR.
Krug, Joseph Hoffmann, 988 Fifth Ave.,
New York 21, N. Y., OP.
Kunkel, William Howard, U.S. Army Hos-
pital, Camp Atterbury, Ind., ALR.
Lane, Charles Spurgeon, Jr., 205 Mer-
chants National Bank Bldg.,
Smith, Ark., ALR.
Lateiner, Robert, 650 Main St., New
Rochelle, N. Y., OP.
Latella, Peter D., 524 North Ave., New
Rochelle, N. Y., ALR.
Lauren, George Peter, 205 Medico-Dental
Bldg., San Diego 1, Calif., OP.
Lavoie, Roland, 3 Claire-Fontaine, Que-
bec City, Que., Canada, ALR.
Lebo, Charles Phillip, 665 Sutter St.,
San Francisco 2, Calif., ALR.
Lee, Jack Bennett, 607 New Moore Bldg.,
San Antonio 5, Texas, OP.
Lewis, Paul M., 519 N. Highland Ave.,
Pittsburgh 6, Pa., ALR.
Lhotka, Frank M., 6005 Cermak Road,
Cicero 50, Ill., OP.
Liebman, Sumner David, 115 Bay State
Road, Boston 15, Mass., OP.
Linden, Arthur Joseph, Shirlington Thea-
tre Bldg., Arlington, Va., ALR.
Locklin, Walter Kaye, 1410 American Na-
tional Bank Bldg., Kalamazoo, Mich.,
ALR.
Loring, Milton Jack, 304 North IN, St.,.
Midland, Texas, OP.
Love, William Robert, 321 Main St. E.,
Hamilton, Ont., Canada, ALR.
Lovely, David K., 73 Deering St., Port-
land 4, Maine, ALR.
Lowrey, Austin, Walter Reed Hospital,
Washington 12, D. C., O.P.
Loy, David Taylor, 3207 W. 16th St.,
Great Bend, Kan., OP.
Luedde, Fullerton Woods, 35 N. Central
Ave., St. Louis (Clayton) 5, Mo., OP.
Lymberis, Marvin Nicholas, 106 W.
Seventh St., Charlotte 2, N. C., OP.
MacMillan, Charles Wright, 4 Duryea
Road, Upper Montclair, N. J., ALR.
Magnet, Isaac Harry, 130 Rock St., Fall
River, Mass., ALR.
Maloney, Walter Hugh, Green and Coul-
ter Sts., Philadelphia 44, Pa., ALR.
Mandelbaum, Joseph, 101 Lafayette Ave.,
Brooklyn 17, N. Y., OP.
Mannis, Aaron A., 109 N. Wabash Ave.,
Chicago 2, Ill., OP.
Marshall, Alexander Washington, 145-A
Rutledge Ave., Charleston 17, S. C.,
OP.
Mathes, William Thomas, Jr., Jones
EENT Hospital, Johnson City, Tenn.,
ALR.
McFarland, James Jerry, 1150 Connecti-
cut Ave., N.W., Washington 6, D. C.,
ALR.
McGee, Hugh E., 117 Cedar Lane, Tea-
neck, N. J., OP.
McGowan, William Louis, Union Central
Bldg., Cincinnati 2, Ohio, OP.
McKeigue, John E., 94 Pleasant St., Ar-
lington, Mass., ALR.
Medof, Milton I., 130 S. Robertson Blvd.,
Beverly Hills, Calif., ALR.
Merriam, George Rennell, Jr., 635 W.
165th St., New York 32, N. Y., OP.
Merz, Arthur Edgar, 821 Franklin Ave.,
Garden City, N. Y., OP.
Meyer, Eugene A., 427 Cooper St., Cam-
den 2, N. J., ALR.
Michelson, Robin P., 240 Stockton, San
Francisco 8, Calif., ALR.
Mietus, Conrad A., 930 Fillmore Ave.,
Buffalo 11, N. Y., OP.
Milanese, Nicholas Peter, 123 E. 83rd
St., New York 28, N. Y., ALR.
Miller, Jack Barnett, 4212 N.E. Broadway,
Portland 13, Ore., ALR.
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ANNUAL BUSINESS MEETING 175
Miller, William Jacob, 21 E. State St.,
Columbus, Ohio, ALR.
Minnes, James Fortin, 1701 W. Broad-
way, Vancouver, B. C., Canada, OP.
Mishler, Jay Eli, 1616 Pacific Ave., At-
lantic City, N. J., OP.
Mitchell, Howard Lysle, 103 S. Main St.,
Lexington, Va., ALR.
Montgomery, Earl Clifton, 1620 Medical
Arts Bldg., Omaha 2, Neb., ALR.
Moore, Ralph Lewis, 509 N. Broad St.,
Woodbury, N. J., ALR.
Moorman, Victor Reuben, Wiley Bldg.,
Hutchinson, Kan., ALR.
Moreland, Joseph Ivan, 2485 Center St.,
Salem, Ore., OP.
Morgenstern, David Jacob, 433 Eastern
Parkway, Brooklyn 16, N. Y., ALR.
Morrison, Lewis E., 503 Hume Mansur
Bldg., Indianapolis 4, Ind., ALR.
Moulton, Everett Crockett, Jr., 205 Mer-
chants National Bank, Fort Smith,
Ark., OP.
Mulberger, Robert D., 1930 Chestnut St.,
Philadelphia 3, Pa., OP.
Myers, Roland Horace, 1720 Exchange
Bldg., Memphis 3, Tenn., OP.
Nakashima, Victor Katsuhiro, Veterans
Administration, Des Moines 10, Iowa,
ALR.
Nickeson, Robert Warren, 179 Allyn St.,
Hartford 3, Conn., OP.
Nisbet, Alfred Alan, 1110 South Texas
Bldg., San Antonio, Texas., OP.
Noble, Bertha Riveroll, 1430 Tulane Ave.,
New Orleans 12, La., OP.
O'Connell, John D., 50 Farmington Ave.,
Hartford 5, Conn., OP.
Olson, James Albert, Henry Ford Hos-
pital, Detroit 2, Mich., OP.
O'Neill, John Campbell, 205 W. Second
St., Duluth, Minn., OP.
Orzac, Edward Seymour, 460 Rockaway
Ave., Valley Stream, N. Y., ALR.
Parker, Francis William, 1102 Broad-
way, Rockford, Ill., OP.
Parks, Kirtland Garvin, 605 Professional
Bldg., Long Beach 13, Calif., OP.
Paul, Thomas Otis, 2205 Highland Ave.,
Birmingham 5, Ala., OP.
Pedersen, Paul Milton, 2241 Central Ave.,
Alameda, Calif., ALR.
Pendexter, Sidney Eugene, Jr., 11 S.
Arlington Ave., East Orange, N. J., OP.
Perzia, Anthony Peter, 910 Citizens Bldg.,
Tampa 2, Fla., OP.
Peterson, John Hartley, 812 Medical Arts
Bldg., Duluth, Minn., OP.
Plotke, Harry L., 1058 Lowry Medical
Arts Bldg., St. Paul 2, Minn., OP.
Pole, Samuel Boyce, III, 401 E. Com-
merce St., Bridgeton, N. J., OP.
Polisar Ira Allan, 142 Joralemon St.,
Brooklyn 2, N. Y., ALR.
Powell, James Robert, 501 Medico-Dental
Bldg., Stockton, Calif., OP.
Proctor, Malvin, 66 Main St., Tuckahoe
7, N. Y., OP.
Rackwitz, George, 245 E. Broadway, New
York 2, N. Y., OP.
Rambo, John Henry T., 119 E. 74th St.,
New York 21, N. Y., ALR,
Rea, Robert P., Gorgas Hospital, Ancon,
Canal Zone, ALR.
Reagan, Daniel Joseph, 507 Main St.,
Worcester 8, Mass., OP.
Reddy, John Bernard, U. S. Naval Hos-
pital, Annapolis, Md., ALR.
Reitz, Russell E., 446 Linwood Ave.,
Buffalo 9, N. Y., OP.
Reynolds, Garland Alexander, 826 The-
mis St., Cape Girardeau, Mo., ALR.
Richardson, George S., 201 S. Arno St.,
Albuquerque, N. M., ALR.
Richardson, James Mark, 6306 Cottage
Grove Ave., Chicago 37, Ill., OP.
Richardson, Oscar B., 880 Bay St., To-
ronto 5, Ont., Canada, OP.
Rockwell, Albert George, Jr., 300 Homer
Ave., Palo Alto, Calif., ALR.
Romano, John Emil, 4010 W. Madison,
Chicago 24, Ill., ALR.
Rooker, Richard W., 423 Walnut Ave.,
Niagara Falls, N. Y., ALR.
Ross, Maurice E., 535-E Grand, Beloit,
Wis., ALR.
Rothman, Harold, 41 Eastern Parkway,
Brooklyn 17, N. Y., OP.
Russell, William Marler, New Bank Ashe-
ville Bldg., Asheville, N. C., ALR.
Ryan, Robert Emmett, 3903 Olive St.,
St. Louis 8, Mo., ALR.
Sacks-Wilner, Erwin Preston, 225 W.
State St., Trenton 8, N. J., OP.
Sanderson, Bruce A., 2575 E. Eighth St.,
National City, Calif., ALR.
Santamarina, Fernando Garcia, Calle 13
No. 154, entre L y K, Vedado, Havana,
Cuba, ALR.
Saunders, Joseph Hamilton, 288 S. Lime-
stone St., Lexington, Ky., OP.
Scheer, Alan Austin, 522 West End Ave.,
New York 24, N. Y., ALR.
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176 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
Schiff, Maurice, 5459 Diamond St., Phila-
delphia 3, Pa., ALR.
Schillinger, Robert John, 727 W. Seventh
St., Los Angeles 14, Calif., OP.
Schuknecht, Harold :F., 950 E. 59th St.,
Chicago 37, III., ALR.
Schutz, William Jack, 672 Francis Bldg.,
Louisville 2, Ky., OP.
Shafer, Donald McKay, 140 E. 64th St.,
New York 22, N. Y., OP.
Shaffer, Robert Nesbit, 490 Post St., San
Francisco 2, Calif., OP.
Shepherd, Edwin McRae, 1106 Virginia
St., Charleston 1, W. Va., OP.
Sherman, Henry Knapp, 121 University
Place, Pittsburgh 1.3, Pa., ALR.
Shier, Julius Milton, 585 Main Ave., Pas-
saic, N. J., O.P.
Shefstall, William Howard, 300 W. 47th
St., Kansas City, Mo., ALR.
Simmons,'Frederick H., 520 Whites Ave.,
Marion, Ind., ALR..
Simses, John P., 144 Golden Hill St.,
Bridgeport 3, Conn., OP.
Skolnik, Emanuel Mitchell, 55 E. Wash-
ington St., Chicago 2, Ill., ALR.
Smith, Graham Gable, 304 Doctors' Bldg.,
Minneapolis 2, Minn., ALR.
Smith, Hal Waugh, Second & "G" Sts.,
San Rafael, Calif., ALR.
Smith, Joseph George, 490 Post St., San
Francisco 2, Calif., OP.
Smith, Trent W., 345 E. State St., Co-
lumbus, Ohio, ALR.
Spencer, James Avery, 135 Monte Vista,
Watsonville, Calif., OP.
Spencer, James Thomas, Jr., 1112 Vir-
ginia St., E., Charleston 1, W. Va., ALR.
Spiro, Barbara, 7449 Cottage Grove Ave.,
Chicago 19, Ill., OP.
Springer, Kurt C., 504 Arcade Bldg.,
Kankakee, Ill., ALR.
Stack, David Rodney, Jr., 641 David
Whitney Bldg., Detroit 26, Mich., ALR.
Stanfiil, James Rose, Medical Dental Cen-
ter Bldg., Bellingham, Wash., ALR.
Stanfill Charles Mac, Medical Arts Bldg.,
El Paso, Texas, ALR.
Steffensen, Ellis H., Henry Ford Hospital,
Detroit 2,, Mich., OP.
Steiner, Albert, 1308 Eutaw Place, Balti-
more 17, Md., ALR.
Stillerman, Manuel Leon, 109 N. Wabash
Ave., Chicago 2, Ill., OP.
Stone, Vean Melford, 3616 Main St.,
Riverside, Calif., OP.
Stonehill, Alfred A., 6 N. Michigan Ave.,
Chicago 2, Ill., OP.
Stuart, Edwin Alexander, 1390 Sher-
brooke St. W., Montreal, Que., Canada,
ALR.
Sun, Kuei Shu, Box 451, Ames, Iowa, OP.
Tabb, Harold Granberry, 1124 Maison
Blanche Bldg., New Orleans 16, La.,
ALR.
Taylor, George Dekle, 111 W. Adams St.,
Jacksonville, Fla., ALR.
Teitgen, Ralph Emil, Mayo Clinic, Roches-
ter, Minn., OP.
Thompson, Floyd Forrest, 1301 N. Broad-
way, Santa Ana, Calif., ALR.
Thumim, Mark, 121 Main St., Middle-
town, Conn., ALR.
Tibbetts, Otis Benson, 33 Court St., Au-
burn, Maine, OP.
Titche, Leon L., Veterans Administration
Hospital, Tucson, Ariz., ALR.
Trent, Robert Irvine, 708 Medical Arts
Bldg., Oklahoma City 2, Okla., OP.
Trombetta, Alessandro, U. S. Naval Hos-
pital, San Diego 34, Calif., ALR.
Trotter, John H., 212 High St., Morgan-
town, W. Va., OP.
Turley, John C., 899 Madison, Memphis,
Tenn., ALR.
Ulvestad, Harold S., 202 Doctors' Bldg.,
Minneapolis 2, Minn., ALR.
Underwood, Ernest Arthur, 601 Main St.,
Vancouver, Wash., OP.
Virant, John A., 906 Olive St., St. Louis
1, Mo., ALR.
Voorhees, Charles Hammell, 308 College
Ave., Elmira, N. Y., OP.
Wainstock, Michael Allen, 1508 David
Broderick St., Detroit 26, Mich., OP.
Walker, Donald H., Dollar Title Bldg.,
Sharon, Pa., ALR.
Walker, James S., 602 W. University Ave.,
Urbana, Ill., ALR.
Waters, Zack James, 220 Camden Ave.,
Salisbury, Md., ALR.
Weih, Jack E., c/o Dr. J. G. Beall, 118,/2
E. Front St., Traverse City, Mich., OP.
Weinstein, Francis Saul, 840 S. 11th St.,
Newark 8, N. J., ALR.
Weisman, Edward, 2336 Coney Island
Drive, Brooklyn 23, N. Y., OP.
Wells, Aubrey Hanson, 400 Hart-Albin
Bldg., Billings, Mont., ALR.
West, George Brooks, Jr., 9 Race St.,
Cambridge, Md., ALR.
West, Stephen Lewis, 109 W. Main St.,
Taylorville, Ill., ALR.
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ANNUAL BUSINESS MEETING 177
Westsmith, Richard Alan, 30 S. El Ca- DR. WOODS: The Council recommends the
mino Real, San Mateo, Calif., OP. election of the following officers for the year
Wexler, Manuel R., 1917 Wilshire Blvd.,
Los Angeles 5, Calif., ALR.
Whitaker, Charles Frederic, 55 E. Wash-
ington St., Chicago 2, Ill., ALR.
White, Irving Leonard, 812 Pine Ave.,
Long Beach 13, Calif., ALR.
Wiesenthal, Fred, 30-77 36th St., Astoria,
N. Y., OP.
Wiesinger, Warren Edward, 3022 E. 14th
St., Oakland, Calif., ALR.
Wolff, Joachim Berthold, 125 E. 84th St.,
New York 28, N. Y., OP.
Wolkowicz, Michal I., 2959 Richmond St.,
Philadelphia 34, Pa., OP.
Wright, Joseph William, Jr., 301 Hume-
Mansur Bldg., Indianapolis 4, Ind.,
ALR.
Zurik, Samuel, 3706 Prytania St., New
Orleans 12, La., ALR.
DR. Woons : The Council has received a
request from Dr. Frank J. Costenbader, sec-
retary of the American Orthoptic Council,
that the Academy publish the papers from the
special scientific program of the American
Association of Orthoptic Technicians and the
American Orthoptic Council, with certain ad-
ditional material which is to be reprinted and
assembled as the American Orthoptic Journal.
The Council recommends the appointment of
Dr. Derrick Vail and Dr. W. L. Benedict as
a committee to explore the question, with
power to act.
On motion of Dr. Shea, seconded by Dr.
Allen, the recommendation of the Council was
approved.
DR. Woons : The Council recommends that
the so-called Research Fund be renamed "Edu-
cational Fund."
On motion of Dr. Shea, seconded by Dr.
Allen, the recommendation of the Council was
accepted.
DR. WOODS : The Council was requested to
accept the management of a fund to be known
as "The Isabella Wilson Research and Edu-
cational Fund for Frontal Sinus Pathology,"
initiated by Dr. Robert II. Fraser of Battle
Creek, Michigan. The purpose of this fund
is to pay the clerical help in review of case
records from the office of Dr. Likely Simpson
of Memphis. The Council recommends that
this request be accepted.
Upon motion by Dr. McCaskey, seconded by
Dr. Vail, the recommendation of the Council
was accepted.
President : Dr. Derrick Vail
President-Elect: Dr. James Milton Robb
First Vice-President : Dr. Francis E. Le-
Jeune
Second Vice-President: Dr. Peter Kronfeld
Third Vice-President : Dr. Frederick A.
Figi
Councillor : Dr. John H. Dunnington
Executive Secretary-Treasurer : Dr. Wil-
liam L. Benedict
Secretary for Ophthalmology : Dr. Alger-
non B. Reese
Secretary for Otolaryngology : Dr. Howard
P. House
Secretary for Instruction in Ophthalmology:
Dr. A. D. Ruedemann
Secretary for Instruction in Otolaryngology
and Maxillofacial Surgery: Dr. Dean M.
Lierle
Secretary for Home Study Courses : Dr.
Lawrence R. Boies
Secretary for Public Relations: Dr. Erling
W. Hansen
Upon motion by Dr. Mullen, seconded by Dr.
Allen, the nominations were closed and the
nominations recommended by the Council were
accepted.
DR. Woons : The Council recommends that
the next scientific session of the Academy be
held at the Palmer House, Chicago, October
14 to 19, 1951.
Upon motion by Dr. McCaskey, seconded by
Dr. Vail, the recommendation of the Council
was accepted.
DR. Woons : The Council recommends the
following revision of Article V, Section 6
of the By-Laws :
(Following identification of junior Fellows)
Inactive Fellows : Senior or junior Fellows
who by reason of physical infirmity or retire-
ment from practice may, by action of the
Council, be classified as "Inactive." Inactive
Fellows shall pay no dues, have no voting
privileges, and shall not receive the TRANSAC-
TIONS.
On motion of Dr. Vail, seconded by Dr.
Allen, the recommendation of the Council was
approved.
DR. Woons : I have nothing further to re-
port.
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178 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
DR. BROWN: A motion to adopt the entire
report is in order.
On motion by Dr. Allen, seconded by Dr.
Vail, the report of the senior member of the
Council was accepted and the recommendations
of the Council were approved.
New Business
DR. BROWN : Is there any new business?
DR. BENEDICT : No new business has been
presented to this table.
DR. ALLEN : Dr. Silva and Dr. Sanchez
Bulnes from Mexico City have been sent
here as representatives of the Fourth Pan-
American Congress of Ophthalmology which
is to be held in Mexico City, January 7 to
12, 1952, and they wish to extend a cordial
invitation to all members to be present.
DR. BROWN : Thank you.
Since no other new business was presented,
Dr. Brown introduced to the Academy its new
President, Dr. Derrick Vail.
DR. VAIL : Although you may get sick and
tired of hearing me say how much I love the
Academy and how much. I have enjoyed work-
ing all these years for the Academy and for my
friends in the Academy, I feel that I cannot
let this occasion go by without reiteraiuig
what I have already said.
I can promise you that I will do my best
to serve you faithfully and that I will do my
best to make the regime of my office a success
and a pleasurable experience for all of you.
Thank you again for the very great honor
you have bestowed upon me.
DR. BROWN : I should like to present the
President-Elect, my old friend James Milton
Robb.
DR. ROBB : Mr. President and members of
this great organization : You have bestowed
upon me an abiding honor in naming me
President-Elect. I do not know whether any-
body who receives this honor ever really feels
that he deserves it. It is a great honor, for
teaching and education are essential factors
in the whole problem of medicine. I accept
it with all humility.
DR. BROWN : I think we are all grateful
to those who have helped make this meeting
of the Academy a success, but I personally
forgot the Council-men like Dr. Woods, Dr.
McCaskey and the others who have done such
wonderful work and have helped in every way
possible. I want to thank them all for what
they have done.
The meeting is now adjourned.
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COMMITTEE REPORTS
Upon recommendation by the Activities
Committee, the Council voted acceptance of
the following reports of standing and joint
committees.
REPORT OF THE ADVISORY COM-
MITTEE TO THE REGISTRIES
OF PATHOLOGY
BRITTAIN F. PAYNE, M.D., Chairman
Work on the revision of the Atlases of Oph-
thalmology and Otolaryngology has feached
a satisfactory stage and it is predicted that
both will be published before the Academy
meets in 1951.
The advisory mission of this Committee
will be completed with its meeting October
8, 1950. Final suggestions will be discussed
with members of the Armed Forces Institute
of Pathology to accelerate publication of the
volumes. A report of this meeting will be
filed with the secretary of the Academy.
Since the Committee has completed its work
the Council is respectfully requested to dis-
charge it with a letter of appreciation from
the secretary. It is suggested that the chair-
man of the Committee, representing ophthal-
mology, and Dr. Fowler, subchairman for
otolaryngology, be retained for administrative
purposes until the revision is completed. The
advice of former members of the Committee
will be asked as the need arises.
A tentative agreement has been made with
Saunders and Company, through the Secre-
tary of the Academy, to publish the Ophthal-
mic Atlas. With the exception of three chap-
ters, the. text has been written but not com-
pletely edited. The illustrations are being ar-
ranged and prepared according to the pub-
lisher's specifications.
The illustrations for the Atlas of Otolaryn-
gology are being revised by Dr. Muriel Raum
under the direction of Colonel Ash and Dr.
Stacy Guild. Her work is most satisfactory
but she will need almost another year to com-
plete the work, according to Dr. Fowler. Dr.
Raum receives $291.67 each month from the
Academy.
Approximately $5,000.00 will be needed to
complete the work on the two Atlases.
A brief statement of expenditures for the
period from August 31, 1949, to September
1, 1950, follows :
Salaries :
Dr. Muriel Raum .................... $2,508.32
Mrs. Helen Knight Steward 375.00
Marjorie Davig ........................ 372.48
Margaret M. MacFadyen..... .. 252.22
Incidentals ................................ 143.50
Reports from Colonel Ash and Dr. Hugh
D. Grady, Scientific Director, Armed Forces
Registries of Pathology, are submitted for
the information of the Council.
Report of Hugh A. Grady, M.D.:
THE AMERICAN REGISTRY OF PATHOLOGY
Number of cases
December 31, 1949
Registry of
Ophthalmic Pathology 28,855
Registry of
Otolaryngic Pathology 3,375
During calendar year 1949, 292 cases were
deleted from the Otolaryngic Registry and
265 cases were transferred to other Registries.
Publications sold during calendar year 1949:
Otolaryngic Pathology 181
Ophthalmic Pathology 297
Loan sets used during the calendar year 1949:
Ophthalmic Pathology 128
Otolaryngic Pathology 199
REPORT OF THE COMMITTEE ON
THE CONSERVATION OF HEARING
DEAN M. LIERY.E, M.D., Chairman
During the past year the Committee on the
Conservation of Hearing of the American
Academy of Ophthalmology and Otolaryn-
gology held two meetings in Chicago-one
during the Academy convention, October
1949, and the other in April 1950.
? The activities of the Committee are as fol-
lows :
1. Considerable progress has been made in
the research project on noise in industry. We
are enclosing a copy of the reports of Dr.
Grove, chairman of the subcommittee, and Dr.
Wheeler, research investigator, concerning the
work that has been accomplished.
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2. A new motion picture scenario on the
problem of hearing has been written, but the
production has been delayed because of the lack
of equipment.
3. The question of unification of hearing
organizations was discussed and Dr. Canfield
was appointed to make a survey of the eco-
nomic need for unification, for which the
Audiology Foundation granted the sum of
$500. In view of the fact that the Academy's
interests are primarily in the field of educa-
tion and :research, no definite action has been
taken at this time.
4. The committee on the requirements for
training of audiologists formulated by-laws
for the establishment of an "American Regis-
try of Audiometrists" and prepared the "Es-
sentials of an Acceptable School for Audiome-
trists" which were submitted to the Council
on Medical Education and Hospitals of the
American Medical Association at the meeting
in San Francisco in June 1950. A second
hearing before the Council will be held in
Cleveland in January 1951.
5. A number of new projects have been
outlined and work has been started on the
following :
a. Manual for the otolaryngologist which
will have as its aim, "Raising the
Standards of Audiometric Testing and
Selection of the Proper Hearing Aid."
b. Syllabus on the Testing of Hearing
in Young Children.
c. Manual for Organization of State and
Local Conservation of Hearing pro-
grams.
d. Revision of the Newhart Syllabus of
ministration of a Program for the
Audiometric Procedures in the Ad-
Conservation of Hearing of School
Children.
b. Dr. Henry L. Williams of the Mayo
Clinic, Rochester, Minn., has been appointed
as a new member of the Committee to suc-
ceed Dr. Ernest Seydell, who resigned.
7. We feel that marked progress has been
made, and the Committee on the Conservation
of Hearing respectfully recommends that the
American Academy of Ophthalmology and
Otolaryngology continue its financial support
to the extent of granting $0,000 for the next
year in order that Dr. Wheeler may further
pursue the research on noise in industry. In
addition, $3,000 will be needed for expenses
and other activities of the Committee.
During the time since the October 1949
meeting of the Committee on the Conservation
of Hearing, the work of the subcommittee has
been somewhat handicapped by the indisposi-
tion of the chairman. Nevertheless, Dr. Doug-
las Wheeler has been actively working for the
most part on the West Coast in conjunction
with Dr. House, with Mr. Cantor of the
Surgical Mechanical Supply Company, and
with the Navy installations at Terminal Is-
land and Mare Island. In conjunction with Mr,
Cantor, and also with Dr. Reger, consid-
erable work has been done by him on new
types of ear defenders both of the ear plug
type of obturator and of the ear muff or hel-
met type. During the past few weeks Dr.
Wheeler has been working in Milwaukee, first
with the Chain Belt Company, where a pre-
employment hearing testing program has ac-
tually been set tip and is in operation, and
also with the health and safety department of
the Allis Chalmers Manufacturing Company,
where such a program is still in contempla-
tion. While this program at the Allis Chal-
mers Manufacturing Company is not yet in
active operation, it has been ordered by the
higher-ups, and Dr. Wheeler has been re-
quested to return there in June. Dr. Wheeler's
salary is being paid by the Academy. His
working expenses are being paid by a $5,000
grant from the engineering committee of the
Mutual Casualty Association. We hope that
these insurance carriers will continue this sup-
port for the next few years.
A growing interest in the subject of noise
and hearing is being advanced by the public
as evidenced by articles appearing in the lay
press and by inquiries from manufacturers
and their agents reaching the office of the
chairman and also in the mail of Dr. Wheeler.
Our mailing list has expanded from around
1,200 to about 1,700, and in the near future
reprints of papers by Dr. Wheeler and Dr.
Guild will be mailed out.
In February of this year a round table dis-
cussion of the subject of noise and hearing
was set up by the Council on Industrial Health
of the American Medical Association, and at
this conference Drs. Wheeler, Hoople, and
Guild took part.
The American Hearing Society has set aside
one afternoon at its next meeting in Chicago
in June for a symposium on the subject of
industrial deafness on which Dr. Wheeler, Dr.
Nash and I will appear.
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COMMITTEE REPORTS 181
A meeting was held by the Subcommittee
.on Noise in Industry at the Palmer House,
Chicago, Ill., April 30, 1950 at 9:00 a.m.
The following were present, Drs. Hoople,
House, Guild, Wheeler and Grove. Dr. Guild
presented a report of the joint conference
held at the Roosevelt Hotel in New York be-
tween the Council on Industrial Health of
the A.M.A. and the Subcommittee on Noise
in Industry at which he acted as a co-chairman
together with Dr. James Sterner of Rochester,
N. Y., representative of the Council on In-
dustrial Health. This report had originally
been written by Dr. Sterner and briefly re-
vised by Dr. Guild. This report is to be
published and the reprints sent out to industrial
hygienists all over the country. It should be
very good propaganda. Dr. House discussed
the possibility of investigation of the produc-
tion of sound pictures illustrating the hazards
of excessive noise as far as the hearing is
concerned, and it was felt that possibly the
Union Pacific Railroad or some other large
plant employing labor where noise was a
hazard might be interested in financing such
.a project.
It was also suggested by the members of
the subcommittee that 'a letter be drafted and
sent to the otologists of the country outlining
the facts concerning the problem of industrial
loss of hearing that should appear in specific
reports such as otologists address to insurance
carriers. It was believed that at the present
time otologists cannot give any positive au-
thoritative answers to the question of whether
noise has damaged an individual's hearing un-
less
1.
2.
3.
certain factors are known, such as:
The pre-employment status of the hearing
The noise level of the individual's job
The length of daily exposure to that
noise level
The total length of exposure to that
noise level
The protection devices supplied and used
The possibility of other factors in opera-
tion to reduce the hearing
II
Dr. Douglas Wheeler has accomplished a
great deal on the research work on the West
Coast and he has presented the following re-
port :
At the present time, this Committee has
access to organizations representing four di-
visions of industry : (a) aircraft production,
(b) shipyards, (c) railroads, and (d) fabri-
cation of heavy metals.
Aircraft Shipyards
Lockheed, Douglas Terminal Island
North American Mare Island
American Helicopter
Heavy Metals Railroads
Allis Chalmers Union Pacific
Chain Belt
The Lockheed Company has a well organized
hearing conservation program, in which all
new employees are routinely checked by au-
diometry as part of the initial medical ex-
amination and all employees in excessive noise
areas are checked every month or oftener, if
indicated. These data are available to the
Committee. North American is giving us ex-
cellent cooperation. In addition to a hearing
conservation program similar to that at Lock-
heed, this company is welcoming research ;
we have an experimental study in progress
now, with several more to follow. Recently,
arrangements have been concluded with Doug-
las Aircraft to begin research and to assist
in the development of its conservation pro-
gram. American Helicopter, a smaller com-
pany, has invited inspection for the purpose of
determining the seriousness of its noise prob-
lem.
The Terminal Island facilities are now
largely inactive, although a maintenance staff
is still present. The authorities at Mare Is-
land have welcomed the work of this Com-
mittee and made all facilities available for
study. The plan of research originally de-
signed for Terminal Island has been trans-
ferred to Mare Island and an initial survey
of the apprentice group conducted.
Dr. House has made arrangements with
Union Pacific for a study of noise levels pre-
vailing in diesel locomotives under heavy load.
This railroad is also interested in noise and
hearing problems around its freight yards.
Recently two companies in Milwaukee have
undertaken a hearing conservation program.
Chain Belt has added audiometry to the medi-
cal examination of new employees. The Allis
Chalmers Company has submitted a proposed
program, based on recommendations from this
Committee. Their safety engineer hopes to
visit Iowa for instruction under Dr. Reger ;
he will select and have trained a suitable au-
diometrist. Dr. Grove and I expect to visit
Allis Chalmers again in June, at which time
it is hoped that the program will be under way.
This summarizes the locations from which
data either are already available or are to be
expected in the near future. The evidence
from the mailing list indicates, potentially, a
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182 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
more diversified interest. This Committee has
received correspondence from companies rep-
resenting the following divisions of industry:
steel, farm machinery, chemicals, elevators,
automobiles, light metals, arsenals, glass,
mining, food packaging, boiler plate and paper
refining.
In Los Angeles, two agencies have given
evidence of interest in the work of this Com-
mittee. Aircraft Industries Association, which
is composed of management representatives,
engineers, and medical directors from the vari-
ous aircraft companies on the West Coast,
maintains contact with similar companies all
over the country. The general purpose of this
organization is to share information on com-
mon problems, including those involving aero-
medical subjects. A division of this Association
is the Sub-Committee on Noise and Vibration,
a group with which Dr. House and I have
met on several occasions. Through this latter
agency, we have received important data on
noise and vibration in air frames and from
motors. Recently, the AIA held a joint con-
ference with the Air Materiel Command, at-
tended by engineers from every major air-
craft company in the country. The conference
dealt with noise as a nuisance and a public
liability. This Committee was given a place
on the program; acting for Dr. House, I de-
scribed in general the work of the Committee
on Conservation of Hearing through its sub-
committee on noise in industry.
Aircraft Manufacturers Safety Council is
composed of industrial relations officers and
safety engineers from the West Coast aircraft
industry. In January, I presented the views of
the Committee on Conservation of Hearing in
a speech before this group; I have been asked
to return when additional[ data are released
by our Committee.
This Committee now has contact with the
Aero Medical Laboratory at Wright-Patterson
Air Force Base, Dayton, Ohio. The Labora-
tory is studying acoustic mufflers and will also
take up the matter of ear defenders. Dr. H.
0. Parrask, Chief of the Bio-Acoustic Unit,
is prepared to exchange information with this
Committee.
Correspondence with Mr. L. P. Walters, loss
prevention research engineer for Hardware
Mutual, indicates that certain companies in-
sured by this carrier may be willing to enter-
tain research on noise problems. Mr. Walters
has mentioned several specific cases. Dr. Grove
and I expect to confer with him in June.
Through Dr. Grove, I met and talked with
Dr. E. G. Meiter, industrial hygiene director
for Employers Mutual. Dr. Meiter believes
that heavy industry in the Milwaukee area will
soon be more receptive to investigation of the
noise problem. He would like us to meet with
insurance company representatives there and
suggests that such a meeting be arranged
during June.
Predictive Tests
A. Administration
One experimental form of this test has been
administered to apprentices at Terminal Is-
land and Mare Island. These groups were
selected for four reasons:
1. A sufficient number of normally hearing:
subjects could be obtained.
2. These men are studying their trades in
a program which offers the possibility of
some experimental control.
3. Noise exposure is relatively high.
4. There will be very little turnover among
these subjects for at least three years.
The results of the test given indicate that
more information is needed about the applica-
tion of the test principle. The data already
collected will continue to be useful, but it ap-
pears that their interpretation will depend upon
additional data ; these data may best be col-
lected under laboratory conditions. A list of
the suggested experimental data required is
given at the close of this report.
B. Laboratory Studies
There is a good possibility that the necessary
studies can be conducted at the State Univer-
sity of Iowa and at the University of Southern
California. Dr. Reger and I have discussed
the problem at some length; Dr. Charles Light-
foot at the University of Southern California
is also interested. In all probability, some as-
pects of the test development will be improved
by application of the subject-controlled au-
diometer. Dr. Reger has designs for such an
audiometer; a somewhat different form may
be made available by the Allison Laboratories
in Los Angeles.
Ear Defenders
The work on ear defenders may arbitrarily
be divided into research and development.
A. Research
A good deal o f attention has been given
to the study of basic materials and technics
for occluding the ear. Some of this work has
already been reported before this Committee.
Because unusual difficulty has been encountered
in creating effective occlusion, the possibility
arose that some alternate pathway might be
present, by-passing the obstruction in, around,
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COMMITTEE REPORTS 183
or over the meatus. One such pathway might
be the eustachian tube. I spent several days
at the Walter Reed General Hospital in Wash-
ington, and while there Dr. Aram Glorig and
I attempted to measure the relative efficiency
of the eustachian canal in air conduction. The
results of our work indicate that the eustachian
pathway is probably not important to the prob-
lem of occlusion.
The study of basic materials and technics
has, as yet, disclosed no essentially new prin-
ciples. In general, it may be said that the
best occlusion measured to date was obtained
by a technic difficult to apply practically. It
also appears that the effect of mass as
factor in occlusion must be re-evaluated.
B. Development
Board of Secretaries meeting on May 28, both
of which I attended.
Immediately after the meeting of the Pro-
gram Committee in January, application
forms were sent out to prospective exhibitors.
Twenty-four exhibits were accepted for this
year's Scientific Exhibit.
A diagram showing the layout of the en-
tire Scientific Exhibit was prepared, and
printed copies of the layout were ordered
through the Academy office. A copy of this
diagram was sent to each exhibitor along with
a letter of acceptance under date of June 1.
Information regarding these exhibits was for-
warded to the Academy office for publication
purposes.
Eight of the applications for exhibits re-
ceived were not considered. Eight additional
applications for exhibits, while regarded as
worth while, were received too late for con-
sideration and allotment of space and are
to be carried over for consideration by the
Committee on Scientific Exhibit for the 1951
meeting:
The objectives in development of an im-
proved car defender are still, as previously
reported, comfort, effectiveness, and low cost.
It has been possible to improve ear effective-
ness of the standard SMR plug, as will be
shown. A new design, however, produces bet-
ter occlusion and is aimed at meeting some
of the objections brought against plugs.
Research Data Required for Predictive Test
Physical-the exposure stimulus and conditions
a. Simple
b. Complex
c. Length of exposure
d. Level of exposure
e. Continuous or repeated exposure
Psychological-subject response measures
a. The critical frequency or frequencies
b. The rate of onset of threshold shift
c. Maximum shift in decibels required
d. Rate of recovery
Problems-to be resolved by application of
above data
a. The optimum choice among the above
variables
b. Reliability of selected measures on nor-
mal ears
When these facts have been satisfactorily de-
termined, the test may be standardized on a
sample of unexposed (nonindustrial) normal
ears. Validation still depends upon application
in the industrial situation.
REPORT OF THE COMMITTEE ON
SCIENTIFIC EXHIBIT
KENNETH L. ROPER, M.D., Chairman
I was invited to attend the meeting of the
Program Committee which met in Chicago
on January 14 and 15, 1950, and also the
REPORT OF COMMITTEE ON
STANDARDIZATION OF
TONOMETERS
JONAS S. FRIEDENWALD, M.D., Chairman
Testing Stations
Three testing stations have continued in
operation during the past year, directed re-
spectively by Drs. Posner, Kronfeld, and
Harrington. The statistical summary of their
activities is given in Table I.
Certification of Tononaeters
Certification of tonometers by the Electrical
Testing Laboratories, Inc., has been continued.
Two hundred and sixty instruments were test-
ed and certified during the year July 1, 1949
to June 30, 1950.
During the past year arrangements for the
certification of the new model Gradle tonome-
ter have been worked out and a calibration
scale for this instrument supplied to the manu-
facturers.
Special Investigations
Work on the basic calibration of tonometers,
on the effect of general anesthesia on tonome-
try, and on the calibration of tonometers for
buphthalmic and microphthalmic eyes is con-
tinuing.
Exhibits
An exhibit on the methods used in stand-
ardization of tonometers was prepared for the
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Pan-American Conference on Ophthalmology
in Miami and a more extensive exhibit was
presented to the International Congress of
Ophthalmology in London in July.
International Standardization of Tonometers'
Your Committee has recommended to the
Concilium Ophthalmologicum consideration of
the formulation of internationally acceptable
standards for tonometers and has offered its
assistance in working out the technical details.
TABLE I
TONOMETERS SUBMITTED TO TESTING STATIONS
July 1, 1949 - June 30, 1950
1 N W
O
TESTING
W I a W ? I
4
W
STATION Pt ' N a a A a V
z
z a m H a t F a
Dr. Kronfeld
Chicago
188
165
9 14
Dr. Harrington
San Francisco
28
2
16
2 8
Dr. Posner
New York
98
3
75
12
EXPENSES
July 1, 1949 - June 30, 1950
Testing Stations :
San Francisco ...................................... 184.00
New York ....... ............................. --...... 260.16
Part Time Secretary and Technician 460.00
Office Expenses .......... ..................--------- . 22.54
Miscellaneous .................. ...----...--------- ..-. 10.00
REPORT OF THE COMMITTEE ON
THE PREVENTION OF BLINDNESS
RALPH I. LLOYD, M.D., Chairman
Our function is to cooperate with the Na-
tional Society for Prevention of Blindness and
do what we can to further efforts along the
lines of prevention. The first question coming
before us was whether penicillin should be
recommended to take the place of silver ni-
trate instillations at birth. Dr. Post and I felt
that the time had not yet conic when a change-
over from a reliable method should be made.
Dr. Woods felt otherwise. Dr. Post and I
felt that there should be a lot more evidence
available before we could approve of laying
aside a method which had reduced blindness
due to ophthalmia neonatorum to a neglible
quantity.
The National Society for the Prevention
of Blindness held a three-day conference in
New York City which the committee had
endorsed and to which a subscription of $150
was recommended to the Council. I attended
the conference and spoke on behalf of the
Academy.
I represented the Academy at the meeting
of the Lions Club of New York where scholar-
ships for courses in ophthalmology were a-
warded. This is an annual custom started by
Mr. Fryxell of Halpert & Fryxell, opticians.
The courses are given by the New York Uni-
versity Post-Graduate Medical School under
Dr. Braley.
I also attended the meeting of the New
York Society for Service to the Blind, where
the Megil medal was awarded Miss Grace
Harper of the New York State Department
of the Blind.
REPORT OF THE COMMITTEE FOR
THE STUDY OF AUDIO-VISUAL
INSTRUCTION
DEAN M. LIERLE, M.D., Chairman
This Committee has had no meeting since the
1949 Academy convention. There was no busi-
ness pending; consequently, there is no report.
REPORT OF THE ADVISORY COM-
MITTEE TO THE EYE HEALTH COM-
MITTEE OF THE AMERICAN
STUDENT HEALTH ASSOCIATION
LAWRENCE T. POST, M.D.
Academy Representative
There is no report from the Eye Health
Committee of the American Student Health
Association as there was no meeting of this
committee.
REPORT OF THE AMERICAN ASSO-
CIATION FOR THE ADVANCEMENT
OF SCIENCE
M. ELLIOTT RANDOLPH, M.D.
Academy Representative
In my capacity as representative of the
Academy to the American Association for the
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Y COMMITTEE REPORTS 185
Advancement of Science, this is to notify you
that during the year 1949-1950, I have been
in contact with the Administrative Secretary
of the Association. The minutes of the meet-
ing of the Council have been carefully re-
viewed and your representative feels that there
are no matters of sufficient significance to be
brought before the Academy.
REPORT OF THE AMERICAN BOARD
OF OPHTHALMOLOGY
ALCERNON B. REESE, M.D.
Academy Representative
Since the last meeting of the Academy, two
examinations were held by the Board: St.
Louis, October 18-22, 1949, and Boston, May
22-26, 1950. A third examination will be held
before the next meeting of the Academy, and
this will be in Chicago, October 2-6, 1950.
At the St. Louis examination, there were 85
candidates and of these 51 passed, 27 condition-
ed, and 7 failed. At the Boston examination,
there were 149 candidates of which 98 passed,
49 were conditioned, and 2 failed.
A written qualifying test was held on Janu-
ary 13 and 14, 1950, at various places through-
out the country. Three hundred thirty-nine
candidates took the examination, and of these
151 passed, 141 were conditioned, and 44 failed.
The Board is most grateful for the splendid
help of many members of our specialty who
have served as associate examiners. Their
service is, of course, indispensable and the
sacrifice they make is appreciated. Also, the
cooperation of the staffs of the institutions at
which the examinations are conducted is great-
ly appreciated.
The officers for 1950 are: chairman, Dr.
Algernon B. Reese, New York; vice-chair-
man, Dr. John H. Dunnington, New York;
secretary-treasurer, Dr. Edwin B. Dunphy,
Boston.
The examinations scheduled for the future
are San Francisco, March 12-16, 1951 ; New
York, May 31, 1951, and Chicago, October
1951 at the time of the Academy meeting.
A new directory listing all diplomates was
issued January 1, 1950. To those who have
purchased this directory, the annual supple-
ments are sent gratis.
At the Boston meeting, Dr. James H. Allen
of New Orleans, La., was elected to the Board
as representative from the Section on Oph-
thalmology of the American Medical Asso-
ciation to serve until December 31, 1954.
During the fiscal year ending April 30, 1950,
273 applications have been received.
The total number of certificates issued to
date by the Board is 3,035.
REPORT OF TIIE AMERICAN BOARD
OF OTOLARYNGOLOGY
CARL II. MCCASKEY, M.D.
Academy Representative
During the past year the Board has issued
a booklet of information stating the required
qualifications of candidates for examination.
It was necessary to hold one extra examina-
tion in 1950 to care for a part of the large
backlog of applicants who have applied for
examination.
The following is a report on the examina-
tions held during 1949 and 1950, with the re-
sults of each :
1. 84 examined, 19 per cent failures and con-
ditions, Chicago, Illinois, October 4-7, 1949.
2. 76 examined, 12 per cent failures and con-
ditions, New Orleans, Louisiana, January
8-11, 1950.
3. 79 examined, 28 per cent failures and con-
ditions, San Francisco, California, May 16-
19, 1950.
The average percentage of failures and
conditions was 193/3.
The next examination will be held in Chi-
cago, October 2-7, 1950.
REPORT OF AMERICAN COMMITTEE
ON OPTICS AND VISUAL
PHYSIOLOGY
ALFRED COWAN, M.D.
Academy Representative
During the past year, the various subcom-
mittees have been active. The Committee on
the Standardization of Instruments is attempt-
ing to establish standards for the development
of new ophthalmic equipment. It has been the
experience of the .American Committee on Op-
tics and Visual Physiology that when standards
are established by manufacturers without gui-
dance, they are often faulty and difficult to
modify. Also, they are often accompanied by
misleading advertising. The Committee is es-
pecially concerned about the rather careless
way in which ophthalmologists purchase and
use instruments for the application of beta
radiation, with no further idea of their po-
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186 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950
tency than the salesman's word or an unveri-
fied statement of the manufacturer.
This subcommittee is encouraging several
other types of research on new instruments,
e.g., the development or suitable polaroid vec-
tographs for use with standard visual acuity
projectors to aid in determination of the status
of the fusion mechanism in routine examina-
tions.
A study is being made in the Clinic at the
University of Oregon Medical School to de-
termine the suitability of fluorescent .germici-
dal units for darkroom lighting and the pre-
vention of the spread of communicable dis-
eases in ophthalmologists' offices.
It has been called to the attention of the sub-
committee that there is need for develop-
ment of several types of apparatus, e.g., an
improved haploscopic device which will permit
the use of bigger and opaque targets with
better control of interpupillary distances and
a lessened sensation of nearness than is possi-
ble with the presently available major amblyo-
scopes. It is felt by this subcommittee that the
American Committee on Optics and Visual
Physiology can serve an important purpose by
fostering this type of research and encouraging
the development in ophthalmology of 'more
laboratories suitably equipped with optical and
electrical equipment to conduct research in
visual physiology. At present this type of
research is being conducted in only a few
clinics and medical schools.
Another subcommittee is still working on
the contact lens problems. Not only the scien-
tific, but the commercial and the medicolegal
aspects are being discussed at length, so that
a valuable contribution may be made. The
recommendations made by this subcommittee,
which have already been presented, seem ex-
cellent suggestions for regulating the pre-
scribing and fitting of contact lenses. I f their
intent is carefully followed, even if controlling
legislation is not forthcoming, there should be
a minimum of danger to the patient and there
is a good possibility of continuing improvement
in these lenses through well directed research.
The National Society for the Prevention
of Blindness has sponsored a visual screening
test of 1239 school children in the first and
sixth grades of public schools in Saint Louis,
which has been completed. This investiga-
tion was made for the purpose of evaluating
the various rival methods proposed for screen-
ing school children. The data have been col-
lected and are being subjected to statistical
study, upon completion of which and approval
by the Committee they will be published.
The Committee on Research in Visual Acuity
in Myopia has continued the myopia training
project and in the last 27 subjects examined,
the time element in assessing visual acuity has
been introduced, which should help us in the
final evaluation of that method of training.
All orthoptic training and manipulation of the
eyes has been purposely avoided in the hope of
assessing the value of that training in which
the speed of perception is stressed. In the
last group trained, all subjects showed im-
proved visual acuity at the end of the train-
ing period, but it is our belief that a sufficient
number of controls is not yet available so
that final analysis of the data obtained should
not yet be made. We have evidence that the
myopia is not changed.
In conclusion, the Committee believes that
the problem presented commonly requires ex-
tensive research and that this often has to be
done by outside workers. The Committee
recommends that sufficient funds be made
available by the parent societies so that these
needed studies may be made under the direct
supervision of the Committee and more scien-
tific answers may be obtained.
REPORT OF THE AMERICAN
ORTHOPTIC COUNCIL
KENNETH C. SWAN, M.D.
Academy Representative
The fifteenth annual meeting of the Ameri-
can Orthoptic Council was held in Chicago on
October 8, 1949, with Drs. Swan, Campion
and Costenbader representing the American
Academy of Ophthalmology and Otolaryn-
gology.
The outstanding activity of importance for
1949 was the conducting of the second annual
Council-sponsored didactic course for orth-
optic technicians under the leadership of Dr.
Walter B. Lancaster, with the assistance of
some of the lecturers and instructors who
helped with the 1948 course. This was held
in Boston with an enrollment of 20 students.
It is hoped that if. the demand for centralized,
intensive didactic instruction in orthoptics con-
tinues, such courses may become an annual
event. The course for 1950 is coming along
apace and will be held in Boston again for
nine weeks during July and August.
The American Orthoptic Council would
commend the American Association of Orthop-
tic Technicians for their increased activities
during the past year : the technicians arranged
a most attractive booth among the exhibits of
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COMMITTEE REPORTS 187
the American Academy of Ophthalmology and
Otolaryngology. The Association has estab-
lished annual meetings of each of four re-
gions, Western, Midwestern, Southern and
Northeastern. The programs of these regional
meetings were participated in by ophthalmolo-
gists and technicians, the programs being of
great interest and doing a great deal toward
improving the information level of orthoptics.
During the past year certain additional
.activities interested the American Orthoptic
Council :
1. The annual symposium for ophthalmolo-
gists and technicians was held at the time
of the Academy meetings. The speakers
were Dr. Edwin F. Tait, Dr. Robert Hill,
and Miss Marjorie Enos. Discussers were
Dr. Michel Loutfallah, Miss Electra Healy
and Mrs. Louisa Wells Kramer.
2. The following new members were elected
to the Council:
Dr. Frank D. Costenbader from the Ameri-
can Academy of Ophthalmology and
Otolaryngology
Dr. Walter H. Fink from the American
Ophthalmological Society
Dr. Beulah Cushman from the American
Ophthalmological Society (to fill the
unexpired term of Dr. Derrick Vail,
who resigned)
Dr. LeGrand H. Hardy from the Section
of Ophthalmology, American Medical
Association
Dr. Alston Callahan from the American
College of Surgeons
The associate member (technician) elected
by the Council was Miss' Dorothy Bair.
3. Through the combined efforts of the
American Association of Orthoptic Tech-
nicians, the American Academy of Oph-
thalmology and Otolaryngology, and the
American Orthoptic Council, instruction
courses were made available to the tech-
nicians and were well -attended at the time
of the Academy meetings.
4. The Council would again call to the at-
tention of the American Academy of Oph-
thalmology and Otolaryngology the gener-
ous scholarship offered by the Delta Gam-
ma sorority to help train orthoptic techni-
cians and instructors for the blind. These
scholarships have been quite helpful to in-
dividual students.
The following officers of the American
Orthoptic Council were elected in October
1949: president, Dr. Walter B. Lancaster;
vice-president, Dr. Richard G. Scobec; secre-
tary-treasurer, Dr. Frank D. Costenbadcr.
Your committee respectfully recommends :
1. That the American Academy of Ophthal-
mology and Otolaryngology continue its
sponsorship of the American Orthoptic
Council, and that it appoint Dr. Kenneth C.
Swan for a period of three years.
2. That the American Academy of Ophthal-
mology and Otolaryngology continue its fi-
nancial support of the American Orthoptic
Council to the extent of $200 for 1950-51.
The expenses of the Council have material-
ly increased with the establishment of the
annual training course.
REPORT OF THE CONSULTATIVE
PANEL ON TUMOR TERMINOLOGY
OF THE AMERICAN SOCIETY OF
CLINICAL PATHOLOGISTS
JOHN S. McGAVIC, M.D.
Academy Representative
I regret to report that the Consultative Panel
on Tumor Terminology of the American So-
ciety of Clinical Pathologists has taken no
action during the past year.
REPORT OF THE HELMHOLTZ
CENTENARY COMMITTEE
F. BRUCE FRALICK, M.D., Chairman
The Academy's Helmholtz Centenary Com-
mittee has had no formal meeting during the
past year. We have had no correspondence
from Dr. Burton Chance referable to any
further assistance which we might be to him.
Since Dr. Chance and his committee from the
American Ophthalmological Society initiated
this program, it was felt that they should be
the leaders and that we should be ready to
serve in an advisory capacity or to help them
in any way they might suggest.
I have again contacted all of our Commit-
tee members and they have no further sug-
gestions to offer other than those which they
have transmitted to Dr. Chance in the past
year.
REPORT ON THE INTERNATIONAL
ORGANIZATION AGAINST
TRACHOMA
R. TOWNLEY PATON, M.D.
Academy Representative
The International Organization against
Trachoma was founded officially by the Thir-
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188 TRANSACTIONS -NOVEMBER - DECEMBER, 1950
teenth International Congress of Ophthalmol-
ogy in 1929. It provides meetings at which all
matters connected with trachoma may be dis-
cussed.
It was my privilege to attend the last meet-
ing as official delegate from the United States
of America. This meeting was held in Lon-
don on Wednesday, July 19, as part of the
program of the Sixteenth International Cong-
ress of Ophthalmology. The opening paper on
"The Initial Signs of Trachoma" was given by
the President of the Society, Dr. A. F. Mac-
Callan, and he was introduced by Dr. Sedan.
A general discussion followed and then a tium-
her of papers were given on the newer methods
of treating trachoma. Perhaps the most in-
teresting of these papers was given by Dr. Ta-
hone of Malta, who reviewed Dr. Alson E.
Braley's experiences in the use of aureomycin
in treating trachoma and then gave his re-
sults. His results confirmed those of other
workers in this field, although he remarked
that trachoma in the Mediterranean did not re-
spond so dramatically as had been reported by
many previous workers. He summed up his
experiences by saying that aureomycin is per-
haps the most effective drug in trachoma so
far if given in adequate doses. He used aureo-
mycin locally and systemically and feels that
probably a combination of both methods shows
the best response.
Dr. Tabone was inclined to treat trachoma-
tous patients for periods of five days, and cau-
tioned that many patients might require three
or four five-day courses of treatment before
showing optimum results. He also mentioned
that results should not be looked for in less
than two weeks, although in many cases im-
provement subjectively and objectively was
dramatic early in the course of treatment.
Locally he has employed aureomycin borate
instillations as well as aureomycin ointment;
more surprising still, he has used 0.5 per cent
solution aureomycin hydrochloride without
significant signs of irritation. In administer-
ing aureomycin by mouth, he felt that a close
of 500 mg. three times a day should he em-
ployed.
The papers and discussions confirmed Dr.
Maxwell Lyons' observation. Dr. Lyons has
used aureomycin locally and systemically as
well as a combination of the two methods.
He left little doubt in the minds of his list-
eners that aureomycin is effective in the treat-
ment of trachoma. While he is not ready to
give a final opinion, he feels that aureomycin
by mouth may be just as effective as the com-
bined administration of the antibiotic. The
dosage he employed locally was the instilla-
tion of 0.5 per cent solution hourly during
the morning hours and again before the patient
went to sleep ; when administering aureomycin
systemically, he prescribed 50 mg. per kilogram
per clay, divided into two doses. Dr. Lyons
continued treatment for a period of about
ten clays.
It was my good fortune after leaving Lon-
don to go to Iran and set up an extensive
trachoma control program for the country.
One city we visited, Dizfoul, had apopulation
of 60,000 persons. The local eye doctor said
that 90 per cent of the population had had
trachoma or were in the active stages of the
disease. During a two-hour ramble about the
city many persons, young and old, were stopped
on the street, and everyone had evidence of
trachoma as far as one could tell in a cursory
examination.
A method extensively used in Iran in the
treatment of trachoma is electrocoagulation.
The native doctors who use this method claim
that not only are the follicles completely de-
stroyed with a minimum of scar tissue for-
mation, but that the current penetrates the lids
and kills the virus. This method of treating
trachoma did not meet with the general ap-
proval of ophthalmologists at the London Con-
ference. Electrocoagulation for the treatment
of trachoma is an old method, but it is being
kept alive in Iran, as the technic is taught to
all medical students. After personal observa-
tion on several hundred cases, I could only
see that coagulation did destroy the follicles
and was an easy method for mass treatment.
Each and every case after coagulation also re-
ceived a liberal swabbing of copper sulfate
solution.
Anyone interested in keeping abreast of the
latest developments in the field of trachoma
should subscribe to La Revue International dti
Trachome. Articles by members may be sent
to the editor, Dr. Sedan, 94 Rue Sylvabelle,
Marseille. Membership in the Organization is
by annual subscription of thirty shillings ster-
ling.
REPORT OF JOINT COMMITTEE ON
INDUSTRIAL OPHTHALMOLOGY
A. D. RuEDEMANN, Chairman
The three main objectives of the work of
the Joint Committee continue to follow along
the lines of research, education and service to
industry.
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COMMITTEE REPORTS 189
TRANSACTIONS of the American Academy of
Ophthalmology and Otolaryngology
Important papers on industrial eye prob-
lems of interest to members of the profession
continue to be a feature of the Section on In-
dustrial Ophthalmology of each issue. Much
interest has been stimulated through this me-
dium and reprints of the articles published have
been requested by medical directors, nurses,
safety and personnel directors of industry.
Bibliography
The bibliography on industrial eye subjects
to date contain approximately 3000 references
and is enlarged continually in the office of the
secretary. Reference material is available at
all times upon request and is published cur-
rently in the TRANSACTIONS.
Kodachrome Slides (2 x 2)
A library of lantern slides for lecture pur-
poses is being accumulated. A limited number
of duplicate slides is already available for loan-
ing purposes.
Consultation Services
Considerable correspondence is carried on
by the secretary in response to requests for
information in the handling of various prob-
lems which have to do with injuries, path-
ology, medicolegal, testing programs, illumina-
tion and safety eye wear. The requests come
from home and abroad and any unusual prob-
lems are referred to recognized authorities in
their respective fields.
Dr. Andrew C. Ivy, vice-president of the
University of Illinois School of Medicine;
Col. Victor A. Byrnes, and Dr. Hedwig S.
Kuhn, secretary of the Committee, will speak
at a special scientific program during the
Academy meeting. The general subject to he
discussed will be "Eyes and Disaster."
Research
1. Development of a thesis on emergency,
eye care in disaster.
2. A survey of second injury funds in the
48 states in which the National Society for
the Prevention of Blindness and the Pan-
American Association of Ophthalmology are
especially interested.
3. An attempt is being made to evaluate
the opportunities for industrial rehabilitation
of the blind and to work out a practical plan
whereby the ophthalmologist may be better
equipped to assist in this important work.
The secretary and another member of the
Joint Committee are serving on the Armed
Services N. R. C. Vision Committee, a con-
tact which has enriched our awareness of in-
dustrial problems considerably.
A panel program was arranged by the secre-
tary for the American Association of Indus-
trial Physicians and Surgeons during their
annual convention in April, 1950.
During the past twelve months, the Joint
Committee worked directly with the optical
companies in an effort to ensure ethical and
efficient methods of distributing their products.
Much of the work of publicizing the Manual
on Toxic Eye Hazards was handled by the
Committee through the secretary's office and
the response to the 2500 direct contacts made
with ophthalmologists, medical directors and
public health officials was very gratifying.
The work of the Committee has been aug-
mented by the generous increase in the grants
from the Council of Industrial Health of the
American Medical Association and the Ameri-
can Academy of Ophthalmology and Otolaryn-
gology. This will make possible a wider field
of opportunity for the projects that are now
under way and those being formulated.
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Financial Statement :
Joint Committee on Industrial Ophthalmology
September 20, 1950
Balance, Aug. 16, 1949 -------------------------------------------------------------------------------------------------- $ 25.00
Receipts :
Council on Industrial Health, American Medical Association .... ............... ..... 500.00
American Academy of Ophthalmology and Otolaryngology -------------------__-_ 500.00
Sale of Manuals on Toxic Eye Hazards .......... .:............... -_____. 7.00
$1,032.00?
Disbursements :
Secretarial, Convention, October 1949 ---------------------------------------------------------------- 45.36
Toxic Eye Hazards Manuals on hand ---- _--------------------------- _...... _------------------------ 21.00
Clerical help, mimeographing and postage, Blind Project _ ...................... 51.00
Postage -----------------------------------------------------------------------------------__---------------------------------- 203.64
Plastic mountings for magnifying lens ------------------------------------------------------------ 66.45
Reprints ------------------------------------------------------------------------------...--------------------- 47.25
Subscription to industrial publications for English contacts ........................ 50.00
Negatives made from charts for publication (Dr. Peterson's article) .__- 15.00
Lantern slides ------- ----------------------------- ------- ------------ ------- ------- -------- -............ ------ ------- 14.99
Bank service charges .......... .............................................. .--------- .......... ..------- -....... 1.76
Sallye Rosenberg (Gift for Dr. Ivy) ................................................................ 78.80
Expense of Dr. Rieke to American Association of Industrial
Physicians and Surgeons, April 1950 .................................. .------------ .....-... 248.63
Balance, Sept. 20, 1950 $843.88
----------------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -------------------...--- 188.12
12
DIRECTORY OF EYE, EAR, NOSE AND THROAT SOCIETIES
Secretaries of all eye and/or ear, nose, and throat societies - inter-
national, national, regional, state, and local - are requested to aid the
Academy in keeping up-to-date the Directory of Ophthalmologic and
Otolaryngolic Societies, a regular feature of the TRANSACTIONS.
Please supply us with the following information:
Name of society (write out in full) .
Names of current officers (president and secretary or corresponding offices) .
When elections become effective.
Place of meeting (exact if known, or supply to this office when available) .
Date of meeting (exact if known, or monthly, bimonthly, October through May, etc.) .
Send to: W. L. Benedict, M.D., 100 First Ave. Bldg., Rochester, Minn.
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It
INDUSTRIAL OPHTHALMOLOGY
MEDICAL CIVIL DEFENSE:
THE BACKGROUND
ANDREW C. IVY, M.D.
CHICAGO, ILL.
MAN of you know that the Ameri-
can Medical Association and the state
and city medical societies each have had
a committee on civil defense for four or
five years. The medical profession re-
alized at the close of the war,'and it still
realizes, that this country is vulnerable
to atomic attack-to a bacterial warfare
and chemical warfare-and it has only
been in recent years that other people
have developed the same opinion.
After the close of the war, I belonged
to a group in the city of Chicago which
talked about the potential hazards of the
atomic bomb used by direct attack or
used through the medium of sabotage.
We should not forget that it is easy to
assemble parts of an atomic bomb, which
may then be set to go off at a certain
time without being detected. All the
makings can be brought in a box and
the only way one can find out the con-
tents is to open the box. We not only
have to think of that as a possibility but
also have to realize that a plane-guided
missile or sabotage can result in disaster.
The United States Armed Forces warn
us that we can expect an attack by any
means at any time.
A little over a year ago the mayor of
Chicago became concerned over a pos-
sible attack on Chicago, for he felt Chi-
cago or any near city would be a stra-
tegic target. He then sent a directive to
several groups, and one to the Commis-
sioner of Health, Dr, Bundesen, to or-
Vice President, University of Illinois School of
Medicine.
Presented at the meeting of the Joint Committee on
Industrial Ophthalmology, Oct. 10, 1950, Chicago, Ill.
ganize against and prepare for any sort
of disaster that might strike Chicago,
particularly one that might result from
warfare. Dr. Bundeson called together
representatives of the medical profes-
sion, scientific, chemical and other
groups, who had had experience during
World War II with atomic and chemi-
cal warfare. This constituted the Gen-
eral Committee, and I happened to be
selected chairman. In my response to
Dr. Bundesen I wrote that I was in
favor of the Committee and that I felt
it was worthy and in line with my basic
general philosophy-to work and hope
for the best but to be prepared for the
worst. That is the spirit and motive of
the people working in the Chicago
Emergency Medical Service, one of five
divisions.
Of the entire civil defense organiza-
tion with all its divisions, the Public
Health Division has the greatest respon-
sibility in that it has to deal with the
human beings living in the attack area.
This Committee took as its objective,
after studying the problem thoroughly,
a plan to decrease the deaths among the
nonfatal casualties by 75 per cent. Some-
thing can be done about an atomic attack
in the densely populated city of Chi-
cago. I can prove to you that, by work-
ing together and educating and training
the public to cooperate with the medical
profession, we can achieve that goal.
Those two basic conditions are absolute-
ly necessary.
We first set up a committee to de-
velop technics to cover all the problems
that might arise from an attack on the
city of Chicago. In a catastrophe of this
sort, one cannot, outside of hospital
practice, permit any variation in the
type of treatment given. In the first
place, there are not enough physicians
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192 TRANSACTIONS - NOVEMBER - DECEMBER, 1950
to go around-so we have to get optom-
etrists, chiropodists, biochemical stu-
dents, dental students, pharmacy stu-
dents, and so on, who have some knowl-
edge of human anatomy. We have to
prepare specific instructions to be given
in the training of this personnel. We
also will have to train close to 5000 adult
lay persons who will become roving first
aid teams and who for the first time will
be administering drugs such as mor-
phine. Many people don't like to do it;
we have to do a number of things we
don't like to do. This instruction will be
given under Red Cross to first aid
classes by the doctors assigned by vari-
ous branches of the Chicago Medical
Society. Specific instructions will be
outlined as to the sort: of treatment to be
given by the roving first aid team, col-
lecting stations, and hospitals. In the
third place, we have to be very specific
and definite about the treatment that
will be required in order that the neces-
sary supplies will be available. One can-
not get together all varieties of supplies
to take care of various ailments as is
generally considered good medical prac-
tice. Instead, one must get together
basic materials to be put in medical
warehouses. Many of these have to be
found in the community in which you
live. We have a committee surveying
the city of Chicago to find out where
the medical supplies are, as we may
have an atomic attack before we can
stockpile gauze, bandages, etc.
The Council appointed committees
consisting of leading medical persons in
the city of Chicago ; these committees
have drawn up rules for treatment and
have outlined exactly what is to be done
at each of the several locations. In the
same way, we have asked a small group
of ophthalmologists who have had in-
dustrial experience to serve as our ad-
visers, and we are relying on this group
to classify eye injuries, to decide what
is to be done by assistants, and to de-
termine what cases should be sent to
the operating sections. Again one has
to be very specific in the instructions is-
sued. When the report of the joint
Committee on Industrial Ophthalmology
comes in, our Emergency Committee
will meet to consider it and to adopt it
as policy. It will then be taken before
the Chicago Medical Society to be
adopted there. In this way we can avoid
the confusion that would come as a re-
sult of one doctor stating that burns
should be treated in a certain way, while
another may in a newspaper item rec-
ommend another method. All this would
be confusing to the public-something
we have to avoid.
Medical units consisting of a roving
first aid team will be organized under
the leadership of a physician and stir-
geon. For those positions we shall select
doctors who have had experience in
front line combat and who will not be
subject to the draft. Records of all cas-
ualties will be kept ; in the city of
Chicago the accountants are taking over
the responsibility of keeping records in
first aid and collecting stations. Finally,
there must be managers. For those
positions we are selecting presidents and
executive vice-presidents living at the
edge of town who, because of their in-
itiative and resourcefulness, can best
organize the first aid stations to
be located at the street intersections at
the two mile bomb perimeter-i.e., two
miles away from the zone of explosion.
We will have 340 first aid stations with
88 members on each team, including a
carpenter. When we run out of splint
material, a carpenter will take over to
make splints and, as the need arises,
forage lumber from sides of houses or
garages.
We will need 600 casualty stations
with an average bed capacity of 300
each to take care of the approximately
180,000 casualties. For this we will use
public schools, hotels, bowling alleys,
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INDUSTRIAL OPHTHALMOLOGY 193
etc. The professional personnel of the
Chicago Society of Anesthetists will
have to train 6000 people to give and
draw blood. The drug stores will be
manned twenty-four hours a clay by one
or two pharmacists at each store. The
rest of the pharmacists will be part of
the general pool.
The hospitals are now setting up an
emergency organization. They will be
staffed. by a surgeon, assistant surgeon,
anesthetist and an aide-all to be on an
18- to 24-hour schedule. Two sets of in-
struments are to be provided so that one
may be in use when the other is being
sterilized. We have organized the hospi-
tals on the basis of seniority-the doc-
tors and nurses not needed on the basic
teams will become a part of the general
pool.
There will be refugee camps where
simple fracture cases can be sent, as
well. as those suffering from simple
burns and all those who have been ex-
posed to radiation after they have been
decontaminated. Blood counts will be
taken in every case in which there has
been exposure to radiation.
The last units are the outlying hospi-
tals-within a radius of forty miles of
Chicago. These hospitals will also un-
dergo emergency organization, making
it their responsibilty to see that the
houses in the hospital area are evacu-
ated to provide more space.
For casualties requiring skilled sur-
gery, we will need 28,000 hospital beds
in Chicago, and we have asked that
double the capacity be provided, using
beds in nurses homes and nearby
houses.
If there is an attack in the Loop, the
first aid collecting station teams will
move in, with or without instructions by
radio. The chief at each first aid station
will have the job of sorting-if the in-
dividual is contaminated by radiation
and injured he goes to one area, if con-
taminated and uninjured to another,
etc. In that way we will be able to han-
dle within six hours the 180,000 people
who will come out of the bombed area.
This is the World War II principle of
getting the wounded in early and sort-
ing them.
Forty per cent of our doctors will be
drafted. The registered nurses in Chi-
cago will have to train 32,000 nurses'
aides in an eighty-hour course. In this
program the ophthalmologist must take
care of all surgical cases. The minor eye
injuries will have to be cared. for by
lay persons who have been instructed in
regard to treatment and taught to recog-
nize cases that should be referred for
more professional care.
DISASTER STRIKES -
WHAT HAPPENS?
COL. VICTOR A. IBYRNES (MC)
RANDOLPII FIELD, TEXAS
TILE importance of vision in our
highly complex civilization can hardly
be overemphasized. The loss of vision
is a more serious handicap to the indi-
vidual than is the loss of many other
abilities.
The eye is a very critical organ inso-
far as prompt, proper care following in-
jury is concerned. An injury, which if
treated early will give complete restora-
tion of sight, may easily result in loss
of the eyeball if treatment is delayed.
Improper early care of eye injuries by
well meaning friends may also cause
the loss of an eye for a patient in spite
of the best later efforts of a skilled oph-
thalmologist.
While the eye makes up only a small
portion of the body, its relative injury
rate will be high in proportion to its to-
Presented at the meeting of the Joint Committee on
Industrial Ophthalmology, Oct. 10, 1950, Chicago, 111.
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194 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950
tal exposed area. This is true, of course,
because a wound or foreign body in the
eye can be a serious injury, while the
same wound or foreign body would be
an insignificant injury almost anywhere
else on the body.
It is for these reasons that a program
for care of injured eyes in the event of
disaster should be formulated. No pro-
gram can be initiated, however, until
the situation expected to exist following
a disaster is evaluated. One must know
(1) what type of eye injuries will oc-
cur, (2) how many eye injuries there
will be, (3) who will be available to
treat the eye injuries, and (4) what fa-
cilities will be available for use (fig. 1).
OIS i TE
PLANNING"",
L WHAT KIND Ol: INJURIES ,
2 'HOW MANY INJURIES >.3..?
3 . ' CAN TREAT THEM
4. WITH WHAT ...
FIG. 1-Necessary information for planning care of
any type of casualties.
The types of eye injuries will depend
somewhat upon the type of disaster
which occurs. Such disasters can be ex-
plosions within factories, or they can be
larger industrial explosions of the Tex-
as City, Texas, or Amboy, New Jersey,
type. Finally, they can be due to bom-
bardment by an unfriendly nation using
either high explosives or the atomic type
of bombs.
To be prepared adequately for an
emergency one must be prepared for
the most severe disaster which is at all
likely to occur. One is then prepared
for any eventuality and anything less
than the most severe type can be prop-
erly handled. Since the nuclear, fission
type of bomb represents the most severe
disaster that could occur, any program
for eye care should be geared to a dis-
aster of this magnitude.
F. CASUALTY PRODUCING
EFFECTS ,O EXPLOSION
I. BLAST EFFECTS,:
LONG: WAVE RADIATION
3. SHORT WAVE RADIATION
FIG. 2-Casualties produced by any type of ex-
plosion are due to one or more of the above factors.
If one considers the factors in ex-
plosions which produce injuries (fig. 2),
they can be considered under the fol-
lowing headings :
1. Effects of Blast (present in all types
of explosions)
a. Direct blast effects on the eye
b. Secondary effects produced by
falling buildings and scattered de-
bris
c. Displacement effects by which in-
dividuals are thrown violently
against other objects
2. Effects of Long Wave Radiation
(heat, including visible and ultravio-
let light-present in some degree in
all types of explosions)
a. Flash burns, the direct effect of
the radiant energy produced by
the explosion
b. Secondary effects produced by
fires started by the explosion
3. Effects of Short Wave Radiation
(gamma rays, alpha rays, beta par-
ticles and neutrons-present only in
the atomic type of explosion)
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INDUSTRIAL OPHTHALMOLOGY 195
.Injuries Due to Short Wave Radiation
Let us consider the last named head-
ing first-injuries due to short-wave ra-
diation. This is the principal factor in
an atomic explosion which differentiates
it from other explosions. Cogan, Martin
and Kimura2 stated that at Nagasaki
and Hiroshima it produced the follow-
ing effects in the eyes of some of the ex-
posed population :
1. Keratoconjunctivitis with mucopur-
ulent discharge one to three days af-
ter exposure. (Probably due to
ultraviolet radiation.)
2. Keratitis coming on three to four
weeks after exposure.
3. Retinal complications of radiation
sickness occurring 10 to 14 days af-
ter exposure.
4. Radiation cataracts coming on in a
matter of years after exposure.
y
,
leaves, then, the same characteristics as their primary interest the effects of
for all explosions except for a differ- short-wave radiation on the eyes. They
ence in degree. Explosions produce were not designed to study the thermal
acute eye injuries through two mocha and traumatic effects. Flick3 was prob-
nisms-heat and blast. ably the first American to study these
One other point with regard to radia casualties and he states :
tion should be mentioned. It has to do
with residual radiation in the bombed There were large numbers of patients ex-
area and its effects on rescue personnel. hibiting facial burns of the ordinary type with
dense cicatrix. These burns in ,some instances
If an atomic bomb were exploded in the involved the conjunctiva and. cornea to such
air (its position of maximum effective- an extent that the red, inflamed, lacrimating
Hess), the residual radiation after the eyeball had only slight movement and seemed
first minute or two would be well within set in a dense mass of contracting scar.
tolerance limits. It would be perfectly He also stated concerning mechani-
safe for rescue parties to enter these cal injuries:
It is quite obvious that none of these
lesions require any emergency eye care
at the time of a disaster. For purposes
of this discussion we can, therefore,
ignore this group of symptoms. This
bombed areas insofar as radiation is
concerned.
Heat and Blast Effects
With radiation eliminated from con-
sideration in the immediate postexplo-
sion period, the discussion can be nar-
rowed to the heat and blast effects. It
would be very desirable to know the to-
tal number of casualties which would
be produced by an atomic explosion, the
percentage of this total which would be
eye casualties, and the percentage of
these eye casualties which would require
definitive care. We would further like
to know how many would be burned as
compared with how many would have
traumatic injuries.
Unfortunately, figures on these points
are not readily available. In almost all
disasters there is such disruption of ac-
tivities that adequate medical records
are not kept. This was true of most of
the bombing raids on the continent of
Europe in World War H. It is also re-
grettable for this study that accurate
figures on the Hiroshima and Nagasaki
atomic bomb explosions are not avail-
able. This is true because the chaos that
existed following the bombing prevented
any accurate study. Even the total num-
bers of people injured or killed have
only been estimated. These estimated
totals may vary as much as 30,000. Then,
studies which were made had
earl
too
Among those noted were penetrating in-
juries of the globe, leucoma of the cornea,
traumatic cataract, various lid deformities, de-
tachment of the retina, and various syndromes
involving fractures of the skull and walls of
the bony orbit. Many ambulatory casualties'
were ~ecn in the streets wearing eye patches.
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196 TRANSACTIONS - NO VEMIBER - DECEMBER, 1950
Drs. David Cogan, S. Forrest Martin
and Samuel J. Kilnura2 conducted an
ophthalmologic survc~ of atomic bomb
survivors in Japan in 1949. .They as-
sumed their task was "(1) ... to de-
termine qualitatively, by history and ex-
amination, whether or not ocular le-
sions, other than traumatic, resulted
from the atomic bombing...."
The Japanese investigators, Tamura,
tkui, Nakano, I_tiwatashi and Oshio,d,7
Hirose,4 and Shoji,' reported similar
findings. In no instance did they attempt
to estimate the total number of eve cas-
ualties or the percentage of serious eye
injuries in relationship to total eye in-
juries. They, too, were mostly interested
in the radiation effects on the eye and
the fundus changes which occurred as a
result of radiation sickness in the indi-
vidual. Tamura and his associates made
the point that the injuries clue to blast
effects are essentially the same as other
bombardment injuries. The burns of the
eyelids were in general not as severe as
burns on the faces of the individuals.
Perhaps the height of the explosion,
plus the oriental type of eyelids, was re-
sponsible for this fact. Burns of the
cornea and conjunctiva were present
but not as frequently as might be ex-
pected. They tended to heal with only
slight scars. These authors made one
very significant notation. They stated
that of foreign bodies in the eyes, the
most frequent one was window glass.
When one considers the relatively great-
er amount of window glass present in
homes in American cities, this particu-
lar factor becomes very important.
Because of the lack of available sta-
tistical data and because the same fac-
tors are operative (though in different
intensities), an estimate of probable
casualties was attempted by a study of
2. SECONDARY BURNS
I. COWUStON OF TIC GLOBE
4. LAMRATION OP TPE GLOW { LOS
5. INIRAQOt1L.AR lE16N BOMES
rrT E OF
1N
kRIESI
1 FLASH 6URNS
FIG. 3-The types of injuries of the eye which
comprise practically all the eye casualties produced
by explosions.
In the event of disaster from any type
of explosion the following types of in-
j. uries require consideration (fig. 3) :
Flash burns of the eyelids and eye-
hall (high intensity infra-red, visible
light, and ultraviolet radiation)
Secondary burns due to fires started
by the explosion
Contusions of the globe
Lacerations of the globe and lids
Intraocular and intraorhital foreign
bodies
In order to get statistics on the inci-
dence of injuries in smaller comparable
catastrophes, the Texas City disaster of
April 1947 was reviewed. Mocker and
Blocked have made a tabulation of cas-
ualties, which is shown in figure 4.
disasters for which. more accurate fig-
Texas City disaster. (From locker and 131.,ker.1)
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TEXAS OtrY
SEVERE INJURI
HOSPCfALtZ 1 l i
FIG. 5-The number of severe eye injuries in com-
parison with total eye injuries in the Texas City
disaster.
In this series, 30.9 per cent of the eye
injuries were severe (fig. 5).' If only
the 38 severe eye lesions were included
in the 800 hospitalized, they make up
4,75 per cent of all hospitalizations. It
is probable that more than this were in-
cluded, thus raising the percentage of
hospital beds required for eye patients.
It will be noted that eye injuries rank
fourth in the number of severe lesions
requiring hospitalization.
The total of the slightly injured is as-
sumed to be half way between the 3000
to 4000 figure quoted above, or a total
of 3500. Add to this the 800 hospitalized
patients, and. we have a total injured
group of 4300 people. The total number
,of eye injuries was 123. Thus 2.8 per
cent of all individuals injured had eye
injuries (fig. 6). In considering only the
severe eye injuries we find that 0.87 per
FIG. 6-The total number of eye injuries in com-
parison with total of all injuries.
FIG. 7-The number of severe eye injuries in com-
parison with the total number of severely injured
persons.
cent of all individuals injured were in
this category, If the 800 hospitalized
cases can be considered to be the serious
nonfatal cases, then severe eye lesions
make up 4.75 per cent of such seriously
injured individuals (fig. 7).
Dr. Gaynelle Robertson of Texas City
was kind enough to review the records
of all eye patients she could find who
were injured in the Texas City disaster.
Her review showed the totals for these
eye injuries were:
Mild or inadequately recorded ................78
Lacerations ---------------------------------------------------- 3
Burns ------------- ---------------------------------------------- 8
Loss of eye (1 bilateral) ----------------------------11
Concussion of eye (1 bilateral) ------------10
Severe lid or orbital injuries
(2 bilateral) ---------------------------------------------16
Penetrating wounds of eyeball with
glass or other foreign body
(5 bilateral) . ......... ----- ------------------------26
Foreign body in orbit ------- ................. 4
Damage to optic nerve ..... -..---_------------------- 2
Loss of sight, one eye-no details ..-.....-... 2
Severe bilateral injuries ............................10
Mild bilateral injuries ...... ................ .--------- 5
Total with at least 1 severe eye injury----44
Her analysis showed that 44 out of
138 cases had at least one severe eye
condition, a percentage of 31.8 per cent
of all eye cases.
The British made a very careful sur-
vey of their casualties occurring in air
raids. Their results showed that 7 per
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ORDER - OF FREQUEN
FIG. 8--The order of frequency of severe injuries
incurred in the aerial bombardment of London.
cent of the serious nonfatal casualties
had severe eye injuries. Nearly one-
third of these had other serious injuries.
Eye injuries were the fourth most com-
mon cause of serious injury (fig. 8).
They found that 2.7 per cent of all
air raid casualties had eye injuries.
Types of eye injury found in this Brit-
ish study were as follows:
Per-
cent-
age
Foreign bodies in the conjunctival sac-_-31
Lacerations of cornea, sclera and iris ----17
Abrasions of cornea ---_--_------ ---............ ---_-_-12
Subconjunctival hemorrhages --------- .----- ---12
Conjunctivitis -------------------------------------------- 6
Hemorrhage in vitreous chamber --- ------ 5
Blast effects (not serious) ------- ----------- ------ 3
FIG. 9-The direct causes of the eye injuries in-
curred by the population of London under aerial
bombardment.
The causes of these eye injuries are
shown in figure 9.
[n the later bombardment experience
with parachute mines and flying bombs,
the incidence of eye injuries was higher,
being 11.7 per cent of hospital casual-
ties. They took for a planning figure a
total of 10 per cent of hospitalized cas-
tialties to be eye cases.
It is interesting to note the similarity
in the incidence of eye injuries in the
Texas City disaster and in the British
.reports (fig. 10).
SERIOUSLY;
WOUNDED `;
WITH ,SEVERE
INJURIES
FIG. to-A comparison between the British boin-
bardment figures and the Texas City disaster figures.
It is also interesting to note the higher
incidence of eye injuries reported in the
later study on the more powerful bombs
- the parachute mines and the flying
bombs. This same trend would be ex-
pected. with the even more powerful
atomic bombs.
These figures cannot be directly ap-
plied to the prediction of the incidence
of atomic bomb casualties, but there are
two things about them which are impor-
tant. They are essentially injuries due
to blast effect since the thermal effect of
high explosives is not great. Secondly,.
they are the type of casualties produced
in individuals living in essentially the
same types of buildings as those in
which we live. For estimation of casual-
ties which might occur here, these fig-
ures should be useful.
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' INDUSTRIAL OPHTHALMOLOGY 199
Estimation of Eye Casualties
In an Atomic Raid
The British have informed their peo-
ple in the newspapers that if an atom
bomb struck one of their large cities
they would expect not less than 50,000
casualties.
While the Japanese experience is not
entirely comparable, we can get a great
deal of information from a study of the
atomic bomb blast of- Hiroshima. Most
of the Japanese buildings are flimsier
than ours. On the other hand, their bet-
ter earthquake-proof buildings are
stronger than most of our buildings.
Their cities have a great deal less glass
than American cities. The numbers giv-
en in figure 11 indicate the casualties
they received from one of the early
weaker atomic bombs.`'
POPULATION DE
PER SQUARE MILE ,
FIG. 11-Estimated casualties produced by the atom-
ic bombing of Hiroshima.
Characteristics of the Atomic Bomb
Which Must Be Considered
In Casualty Estimation
HEAT PRODUCED:
BY ATOMIC BOMB:
FIG. 12-Heat produced by the explosion of an
atomic bomb. It has been estimated that the bomb
burst at Hiroshima released 21 billion calories.
and that the temperature at the core of
the explosion was 126,000,000 F. (fig.
12). Even as far away as three-fourths
of a mile the temperature for a fraction
of a second was 2,100 F., which is hot
enough to blister tile on roofs. This heat
is due to the production of infra-red
radiation, which travels at the speed of
light. At Hiroshima it produced severe
generalized burns at a distance of 7,000
feet. This amount of heat existed for
only a fraction of a second, and cloth-
ing and the shelter of a building or wall
were sufficient protection from it. These
direct radiation burns, however, were
very severe in unprotected. skin. Direct-
ly under the blast, skin was charred
brown and black by the heat. Serious
third degree burns occurred out to 4,500
feet. The available literature does not
show the percentage of eye and eyelid
burns which one would expect, though
Flick3 mentions severe burns as stated
above. A factor of importance is the
protection afforded by the orbital ridges
diation effects of and the film of moisture on the cornea.
The short wave ra
an atomic blast have already been dis- It is known that about 40 per cent of
cussed and will not be further consid- the casualties had flash burns produced
ered here. The relative amount of heat by infra-red radiation, or had ordinary
produced is greater than with other thermal burns produced by fires. The
bombs. A higher percentage of casual- exact incidence of eye burns, however,
ties will be due to the heat than is true cannot be estimated because there are
with high explosive bombs. In the bomb no figures available for Hiroshima and
burst at Hiroshima it is estimated that no comparable figures in other explo-
21 billion calories of heat were released sions.
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FIG. 13--The damage and destruction caused by
the explosion of the bomb at Hiroshima, which oc-
current at an attitude of 1,500 feet,
Blast Effect
The blast lasted about one second, It
was not sharp, but was very strong. It
didn't punch holes in buildings. It was
much more apt to push them over. Of
the 90,000 buildings in Hiroshima, 62,-
000 were destroyed (fig. 13). The blast
produced flying glass up to 15,000 feet.
Although it produced a relatively small
group of casualties by direct effect, it
produced many by displacement of peo-
ple, flying missiles, falling debris, etc.
About 40 per cent of the injuries were
produced by these forces, although some
authorities estimate as high as 70 per
cent.
The number of casualties which
would be produced in. an American city
would depend upon the time of day the
attack occurred. This would in turn de-
termine the population density in the
area attacked and whether or not indi-
viduals were in or outside of buildings.
In some of our larger cities population
density is as high as 145,000 per square
mile in the daytime. This may drop to
less than 50 per cent of this figure at
night. By comparison the population
density of Hiroshima was 35,000 per
square mile. The Hiroshima bomb de-
stroyed 4.7 square miles.
Various newspaper estimates of cas-
ualties in an American city in event of
an atomic attack vary fr'om 50,000 killed
TRANSACTIONS - NOVEMBER - DECEIMIBER, 1950
r,rt
r - t r INJUP1IES
837
1,863
MILD EYE
WARES
FIG. 14-Planning figures for estimating the num-
ber of eye injuries which might be produced in
all atomic bomb explosion in an American city.
and 50,000 injured to 150,000 killed and
150,000 injured. Suppose, for example,
we take the middle figure of 100,000
dead and 100,000 injured (fig. 14). The
injured is the group with which we
would be concerned. Applying the Brit-
ish and the Texas City figures, we know
that of this number 2.7 per cent, at
least, will have some eye injury due to
blast. Of these 2,700 eye injuries, about
31 per cent will be seriously injured,
giving a total of 837 severe and 1,863
mild eye blast injuries. The total flash
and secondary burn cases would be ap-
proximately 40,000, of which at least
10 per cent would probably have burns
involving the eyelids or eyeballs re-
quiring some type of treatment (fig.
15). The number of these who would be
severely burned cannot at this time be
FIG. 15-Planning figures which might be used
in estimating eye injuries produced by beat. These
are admittedly only guesses since no accurate figures
are available.
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INDUSTRIAL OPHTHALMOLOGY 201
estimated. A total estimate is made, then,
of 4,000 eyelid and eye burns requiring
varying amounts of treatment.
Factors in Planning
Care of Eye Casualties
Now suppose we are faced with this
staggering total 'number of casualties.
Who and what will be available to care
for them?
atoms
ens
FIG. 16--Casualties which occurred in professional
personnel at Hiroshima.
Personnel for care of casualties. The
number of doctors and nurses would
depend upon the time of day the explo-
sion occurred. A higher percentage
would probably be injured in a daytime
attack on the heart of a city than at
night. In Hiroshima, of about 250 doc-
tors, 90 per cent were casualties and
only 30 were able to work at the end of
30 (lays (fig. 16).
There were 1,780 nurses in Hiro-
shima before the bombardment. Of
these, 1,654 were killed or injured (89
per cent casualties). This means, then,
that personnel normally present to care
for eye patients would not be available.
Hospital facilities. Iiroshima had 45
hospitals. Only three were left usable.
Those within 3,000 feet were totally de-
stroyed, Two were 5,000 feet away.
They were of reinforced concrete con-
struction and had 90 per cent casual-
ties because of falling plaster, flying
glass and fire. They could not be used
for a long time. Hospitals between 7,000
and 10,000 feet distant were badly dam-
aged and had many casualties.
Other facilities. In an atomic explo-
sion, facilities other than hospitals
would also be of immediate concern.
Fires would break out immediately, over
a large area. Streets would be damaged,
destroyed, choked with refugees trying
to get out of the area, or blocked by fire.
Telephone and other communication
services would be interrupted. Electric
power would not be available. The water
supply would be cut off. At Hiroshima
there were 70,000 breaks in the water
supply system. The sewage system
would also probably be destroyed.
SUMMARY
To summarize, then, the problem of
proper eye care in the event of atomic
attack :
1. There may be 100,000 total casual-
ties with about 837 severely injured
eye cases, 1,863 mildly, injured eye
cases, and 4,000 burned eye and eye-
lid cases of undetermined severity
requiring immediate eye attention.
2. About 90 per cent of the ophthal-
111ologists and eye 'nurses would
themselves be casualties and, there-
fore, unable to help.
3. Hospitals within 3 miles would be
incapable of being utilized. Their
medical supplies would be destroyed
in most instances.
4. Fires and falling buildings would be
present in the damaged area, with
streets blocked and filled with burn-
ing debris.
5. Electricity, water, food, communica-
tion and sewer systems would be
damaged or destroyed.
6. It would be safe so far as residual
radiation is concerned for rescue
crews to enter the area if it was an
air burst.
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Any plan for the care of eye injuries
which does not take into consideration
these factors would be inadequate. The
ideal treatment for eye injuries probab-
ly cannot be administered. The treat-
ment which will accomplish the most for
the largest number of cases in the hands
of general practitioners and first aid
personnel is probably the one that will
do the greatest amount of good in the
event of an atomic attack. If a good
plan can be formulated for eye care it
should result in better final vision for a
larger number of people in the event of
any future disaster.
1. Blocker, Virginia and Blocker, T. G., Jr.:
The Texas City disaster : a survey of 3,000
casualties, Ani. J. Surg., 78:756-771 (Nov.)
1949.
EMERGENCY EYE CARE IN
DISASTER: THE LAYMAN
WHO PRECEDES US
HEDWIG S. KUHN, M.D.
HAMMOND, IND.
COLONEL Byrnes has shown us that
our concern with injured eyes in case
of disaster (atomic or explosive) is
mainly to be focused on the care of
(1) burns-flash (which here means
infra-red, ultraviolet and high intensity
visible light) as well as burns from fire
itself, (2) contusions and lacerations,
(3) removal of foreign bodies, and
(4) intraocular foreign bodies. Radia-
tion as we think of it in this connection
does not immediately concern the eyes.
Its effects appear days, weeks, or even
years after the disaster as keratitis or
radiation cataract.
2. Cogan, P. G., Martin, S. F. and Kimura,
S. J.: Ophthalmologic survey of atomic
bomb survivors in Japan (an ABCC sur-
vey), November 1949.
3. Flick, John J.: Ocular lesions following the
atomic bombing of Hiroshima and Naga-
saki, Atn. J. Oplith., 31:137-154 (Feb.)
1948.
4. Hirose, K.: Ocular lesions in atomic bomb
disease in Nagasaki, Kurme Igakkai Zos-
shi, 42:26, 1946.
5. Shoji, Y.: Ocular injuries by air attacks,
Gnaka, Y.: Ocular injuries by air attacks,
6. Tamura, S., Ikui, H., Nakano, K., Hiwa-
tashi, R. and Oshio, S.: Injuries of the
eyes by the atomic bomb : clinical observa-
tion Gnaka, Rinsho Iho, 40:90-99, 1946.
7. Tamura, S., Ikui, H.,, Nakano, K. and
Oshio, S.: Patho-histological examination
of the injuries of the eyes in atomic bomb
disaster (radiation sickness). To be pub-
listed in Gnaka, Rinsho Ilto.
In Texas City almost all eye injuries
occurred to office workers or business
people watching the fire from behind
windows and not wearing eye protec-
tive equipment; therefore, only 5 per
cent of all injuries were eye injuries. In
Britain (luring the blitz, as Colonel
Byrnes' figures show, between 7 and 11
per cent of cases of serious injuries
were eye injuries. If we use the low fig-
ure of 100,000 serious casualties in any
major city where an atomic explosion
occurs and use 10 per cent as the num-
ber having serious eye injuries, we have
10,000 serious eye injury cases on hand!
This reiteration is necessary because we
cannot realize the magnitude of these
numbers. They remain fantastic and be-
yond comprehension. Dr. Ivy has been
hammering the "facts of life" into aca-
demic heads for many weary months.
Here, in brief, is the procedure:
Presented at the meeting of the Joint Committee on
Industrial Ophthalmology, Oct. 10, 1950, Chicago, Ill.
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INDUSTRIAL OPHTHALMOLOGY 203
Advance Roving First Aid Teams
1. Fill eye with t Y2 per cent pontocaine
in 1 to 3000 zephiran (packaging
not yet decided on)
2. Tear a piece of sterile cloth from roll
carried on back of first aid man and
cover eye
3. Pain of an eye injury (other than
burns) is not great, therefore hypo-
dermic injection of morphine is not
necessary.
First Aid Collecting Station
1. Cases of severe lacerations, perfora-
tions and obviously badly tratima-
tized eyes
a. In laceration of lids, leave same
bandage on and send to the rear.
1). Casualties with severe injuries of
the globe should be sent to the
rear as stretcher cases if at all
possible. Bandage lightly if neces-
sary.
c. Tag everyone who has not al-
ready received preventive tetanus
antitoxin so as to be sure that it is
given at the next station.
d. If sliver of foreign matter (glass,
metal or wood) extends from eye,
do not touch. Close eye with band-
age and send to rear.
2. Burns in any one of the three 'cate-
gories (thermal, ultraviolet or
chemical)
a. Anesthetize again if necessary
with pontocaine-zephiran solution.
b. Insert hydrosulphosol (made up
in new gelatin capsule form).
c. Close securely with pressure ban-
dage.
d. Hypodermic injection of morphine
if necessary.
3. Foreign bodies
a. If on cornea, anesthetize (same
solution of pontocaine and
zephiran).
b. To remove foreign body use ap-
plicator wound with cotton or
closest substitute available.
c. If very deep, close eye with some
sort of patch and send to rear.
Casualty Station (may or may not
have ophthalmologist)
1. Careful inspection of eye
a. To further separate serious eye
injuries overlooked in panic
b. To pick up any unrecognized dam-
age
c. Lay personnel to use following
findings as guides to serious dam-
age:
Severe pain in cases that are not
burn cases
Change in size or shape of pupil
Blood in anterior chamber
Protrusion of tissue of interior of
eye
2. Treat and re-dress external eye
burns, if necessary, with hydrosul-
phosol as used in collecting stations.
3. Dress minor lid lacerations
4. It is important to accept the use of
medication approved by local com-
munity civil medical defense com-
mittee without argument or regard
for personal preference. Disaster
forces a condition resembling war;
therefore we take orders just like in
the Army.
Hospitals
here is where the ophthalmologist
takes over, but we must ever realize
that we are still with limited means-a
minimum selection of instruments, re-
duced supply of dressings, and a sharp-
ly reduced number of assistants. Our
part, therefore, as ophthalmologists can
be described as follows :
1. To assist directors of local (or re-
gional) civil medical defense organ-
izations ; to implement and formu-
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204 TR.,ANSACTIONS--NOVDM131?R-DECEMBER, 1950
late the programs they set up with
much more "give" than "take."
a. Accept previously agreed upon
medication
b. Accept approved collecting station
technics
c_. Accept approved casualty station
procedures
d. Accommodate to hospital needs
2. Assist those agencies set up to teach
and train not only first aid but also
self help, which is the one construc-
tive good thing about this whole
catastrophe defense effort.
a. Write simple instruction sheet to
be inserted into loose leaf manual
to be used by Red Cross and other
citizens for teaching purposes.
b. Accept teaching assignments when
asked or, better, volunteer.
c. Have ready now your own sepa-
rate bag with all you need to work
with for use at casualty station or
at hospital so that you need not
stand around and wait for some-
one to 'bring you instruments or
supplies.
d. Offer your help and time now.
This whole gigantic potenial task is
real and staggering, but it has been
proved that (1) we can erect safeguards
and prevent human destruction and hu-
man agony; (2) we can as physicians
save lives and prevent permanent in-
jury to legs, arms, and heads; (3) we
can as ophthalmologists set up a proper-
ly trained lay "chain of command" and
gear ourselves to the task of saving eves
also.
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News
Notes
SECTION MEETINGS OF THE
AMERICAN LARYNGOLOGICAL,
RHINOLOGICAL AND OTOLOGICAL
SOCIETY, INC.
The section meetings of the American
Laryngological, Rhinological and Otologi-
cal Society, Inc., will be held in January
1951.
The Eastern Section will hold its meet-
ing on Friday, January 12, in the Belle-
vue-Stratford Hotel, Philadelphia.
The meeting of the Middle Section will
be held in the Hotel Cleveland, Cleveland,
Ohio, on January 15.
The Southern Section will meet at the
Hotel Sans Souci, Miami Beach, Fla., on
January 17.
The Western Section meeting will be
held January 27 and 28 at the San Fran-
cisco County Medical Society Building,
2180 Washington Street, San Francisco.
AMERICAN ORTHOPTIC COUNCIL
The American Orthoptic Council will
present its fourth annual intensive course
in Orthoptics in Boston from July 5,
1951 through Aug. 31, 1951. Tuition is
$150.00. The course is designed to pre-
sent the necessary basic didactic instruc-
tion for students together with some prac-
tical instruction in order to prepare the
student to complete a course of practical
training and experience offered at various
orthoptic centers over the country. The
Council will make an effort to see that
all students enrolled in the course have
places to complete their practical training
following the course. Applicants must
be at least 18 years of age, have had a
high school education and be sponsored
by an ophthalmologist. A few scholar-
ships are available to students from the
Delta Gamma Fraternity Project. In-
quiries and applications should be ad-
dressed to the American Orthoptic Coun-
cil, Dr. Richard G. Scobee, 640 S. Kings-
highway, St. Louis 10; Mo.
ASSOCIATION FOR RESEARCH
IN OPHTHALMOLOGY
The third annual meeting of the Mid-
west Section of the Association for Re-
search in Ophthalmology will be held at
the University Hospitals, Iowa City, Iowa,
on Monday, March 19, 1951. The pro-
gram will consist of the presentation of
scientific papers.
On the two days following the meeting,
a symposium on "External Diseases of the
Eye" will be presented by the Depart-
ment of Ophthalmology, University of
Iowa.
DELTA GAMMA FRATERNITY
PROJECT: SIGHT CONSERVATION
AND AID TO THE BLIND
The Delta Gamma Fraternity has a
$1,500 annual fund and a $2,000 revolv-
ing loan fund from which smaller
scholarship awards are available to those
intending to become (1) orthoptic tech-
nicians, (2) teachers of partially seeing
children, or (3) specialists for blind pre-
school children. Anyone wishing to
specialize in one of these fields may be
eligible for assistance, the amount in each
case to be determined by the particular
need and costs involved. For further in-
formation write to Mrs. Thomas Johnson,
1235 Longfellow, Detroit 2, Mich.
Applications for scholarships should be
filed four months prior to the start of
the desired course. Applicants with basic
preparation in teaching, nursing, social
work, nursery education, or related fields
are eligible to apply. The scholarships
are intended only for the courses directly
relating to the field of sight conservation
and aid to the blind. Candidates are se-
lected with the advice of a professional
committee which has as chairman, Dr.
LeGrand H. Hardy of the American
Orthoptic Council.
THE ISABELLA WILSON RESEARCH
AND EDUCATIONAL FUND FOR
FRONTAL SINUS PATHOLOGY
The American Academy of Ophthal-
mology and Otolaryngology has accepted
the management of a special fund to be
known as "The Isabella Wilson Research
and Educational Fund for Frontal Sinus
Pathology," initiated by Dr. Robert H.
Fraser of Battle Creek, Mich. The pur-
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XXVI TRANSACTIONS - NOVEMBER - DECEMBER, 1950
pose of this fund is to pay the clerical
help in review of case records from the
office of Dr. Likely Simpson of Memphis,
Tenn. The estate of Miss Isabella Wilson
has contributed $250.00 to this fund, and
contributions of not over $10.00 will be
accepted from interested physicians and
others.
OXFORD OPHTIIALMOLOGICAL
CONGRESS
The next meeting of the Oxford Oph-
thalmological Congress will be held in Ox-
ford, July 5-7, 1951. The Doyne Lecture
will be delivered by Dr. John Foster of
Leeds. The two main discussions will be
"Ophthalmology and :Psychosomatic Medi-
cine" and "The Modern Treatment of
Retinal Detachment."
Inquiries should be addressed to Dr.
Ian C. Fraser, Honorary Secretary, 12 St.
John's Hill, Shrewsbury, Shropshire.
DISTRICT OF COLUMBIA
An exhibit honoring Hermann von
Helmholtz, the inventor of the ophthal-
moscope, will be displayed under the
auspices of the Medical Museum of the
Armed Forces Institute of Pathology and
the Army Medical Library in the Armed
Forces Medical Museum at Ninth and In-
dependence Avenue, S. W., for six months
beginning Dec. 17, 1950.
This date marks the hundredth anniver-
sary of Helmholtz' letter to his father de-
scribing the instrument which was to
enable doctors to see the interior of the
human eye for the first time.
The Museum's extensive and compre-
hensive collection of' ophthalmoscopes,
which illustrates the development from
the Helmholtz drawings to the modern
electrified instrument, will be on display.
Included will be the famous Dr. von
Graefe's first instrument made by Sydow
from the original drawing and given to
the Medical Museum by Dr. Harry Fried-
enwald just before his death in the spring
of 1950.
A rare Perrin three-dimensional oph-
thalmic atlas will also be on display. It
was designed and manufactured about
1870 and extensively used at that early
period to train students in ophthalmos-
copy. Only three of these instruments are
known to exist in this country.
The Army Medical Library has loaned
many of the books to be shown. Included
are many rare volumes, some of them
s
found in the United States only at the
Army Medical Library. Especially note-
worthy in this respect are a Russian and
two Japanese atlases of ophthalmoscopy,
as well as the first printed illustration
of the fundus of the eye, prepared by A.
C. van Trigt for use in his doctoral dis-
sertation soon after Helmholtz' report was
made known, and the only published
atlas of stereoscopic paintings of the fun-
dus. A large number of contemporary
American and foreign atlases will also
be displayed.
ILLINOIS
The Chicago Laryngological society
held its first meeting of the season Nov.
6, 1950. The program was given by mem-
bers of the department of otolaryngology
of the Cook County Hospital in Chicago.
It consisted of "Tracheotomy in Tetanus,"
by Drs. Emanuel Herzon and Edwin
Killian; "Otogenic Intracranial Complica-
tions," by Drs. John Elsen, Elmer A.
Friedman, and Norman Leshin; "Sar-
coma of the External Auditory Meatus:
Case Report," by Dr. Hans Von Leden;
"Some Newer Surgical Considerations in
Atrophic Rhinitis: Report of Work in
Progress," by Drs. Maurice H. Cottle,
Jack Allan Weiss, Edward F. Pottorff,
and Emanuel Herzon.
The Chicago Ophthalmological Society
held its regular meeting Nov. 20, 1950.
At the afternoon session an instruction
hour on "Orthoptics" was conducted by
Miss Priscilla Allen, and a clinical pro-
gram was presented by the departments of
ophthalmology of Michael Reese and Mt.
Sinai hospitals. The scientific program in
the evening included "Report on the 16th
International Congress of Ophthalmol-
ogy," by Dr. Derrick Vail; "Optical Com-
ponents of the Eye in Relation to Ame-
tropia and Aniseikonia," by Dr. William
F. Moncreiff; and "Macular Changes in
Children from Maternal Rubella," by Dr.
Samuel S. Blankstein.
Dr. Paul Hurwitz has been appointed
to the faculty of the Chicago Medical
School as assistant professor of ophthal-
mology.
The regular monthly meeting of the
Chicago Laryngological and Otological
Society was held Dec. 4, 1950. The pro-
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NEWS NOTES XXVII
gram consisted of "Experimental Studies
of Negative Pressure Produced by Res-
piratory Cilia," by Dr. John J. Ballenger,
department of otolaryngology, North-
western University; and "Surgical Treat-
ment of Carcinoma of the Esophagus," by
Dr. Charles B. Puestow, department of
surgery, University of Illinois.
KANSAS
Dr. William L. Benedict of Rochester,
Minn., delivered the second E. J. Curran
Lecture in Ophthalmology at the Univer-
sity of Kansas School of Medicine on De-
cember 14, 1950. His subject was "Dif-
ferential Diagnosis of Exophthalmos."
LOUISIANA
The Tulane University of Louisiana
School of Medicine announces a course in
ocular pathology devoted to a study of
tumors of the eye, adnexa, and orbit, to
be given February 12 through 17, 1951.
The fee for the course, which will be lim-
ited to an enrollment of 12, is $100. As-
sisting the regular staff will be Dr. C. S.
O'Brien, Dr. John MeGavic, and Dr. Theo-
dore Sanders.
From February 1.9 through 24, 1951, a
symposium on ocular pharmacology and
therapeutics will be held at the Tulane
University of Louisiana School of Medi-
cine. Enrollment in the symposium will
be limited to 150, and the fee will be
$100. Drs. Alson E. Braley, Parker
Heath, Irving H. Leopold, Robb McDon-
ald, Frank W. Newell, and Alan C. Woods
will assist the regular staff in conducting
the symposium.
For further information regarding
these courses, write to Dr. James H. Allen,
1430 Tulane Avenue, New Orleans, La.
MARYLAND
Dr. S. Rodman Irvine has been appoint-
ed associate professor of ophthalmology
in the Johns Hopkins University School
of Medicine for the year beginning Octo-
ber 1, 1950 and ending June 30, 1951.
MISSOURI
A meeting of the St. Louis Ophthalmic
Society was held Nov. 16, 1950. The
program consisted of "The Role of Hy-
perpyrexia in the Management of Eye
Disease," by Dr. Bennett Y. Alvis, asso-
ciate professor of clinical ophthalmology,
Washington University School of Medi-
cine; "The Treatment of Ocular Syphilis,"
by Dr. Leslie C. Drews, associate profes-
sor of ophthalmology, St. Louis Univer-
sity School of Medicine, and Dr. Gerald
Barton (by invitation) ; and "Hyper-
phoria: Its Evaluation and Management,"
by Dr. Richard G. Scobee, assistant pro-
fessor of ophthalmology, Washington Uni-
versity School of Medicine.
The Washington University School of
Medicine announces a full time course in
orthoptic technology. it will be given
annually. The next course begins Sept.
.17, 1951, and extends to June 15, 1952.
Both didactic and practical training are
given in orthoptic technology and a cer-
tificate is granted upon successful com-
pletion of the course. Tuition is $350.00.
Facilities for instruction include the Mo-
tility Clinic of the Washington University
Clinics and the St. Louis Ophthalmic Lab-
oratory, the latter under the direction of
Miss- Anita Stelzer. The course is limited
to eight students. Applicants must be at
least 18 years of age and high school
graduates, preferably with at least one
year of college. Inquiries and applications
should be addressed to Dr. Richard G.
Scobee, Director of Graduate Training in
Ophthalmology, 640 S. Kingshighway,
St. Louis 10, Mo.
NEW JERSEY
The Section on Eye, Ear, Nose and
Throat of the Academy of Medicine of
Northern New Jersey met Nov. 13, 1950.
Dr. Raymond E. Meek was guest speaker.
He spoke on "Recent Advances in Ocular
Surgery."
The Annual Clinical Conference of the
Academy of Medicine was held at the
Newark Eye and Ear Infirmary, Dec. 11,
1950.
The next meeting of the Section
will be held March 12, 1951. Dr. James
S. Shipman will be the guest speaker.
He will present a paper on "Retinal De-
tachment and Some of Its Problems."
NEW YORK
The regular meeting of the East-
ern New York Eye, Ear, Nose and Throat
Association was held Nov. 2, 1950. It
was "Clinic Day" and a number of in-
teresting eye, ear, nose and throat cases
were reported. The cases were described,
discussed and coordinated by the guest,,
Dr. James W. Babcock, clinical professor
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KXVIII TRANSACTIONS - NOVEMBER - DECEMBER, 1950
of otolaryngology at Columbia Presby-
terian Medical Center', New York City.
At the evening meeting it was decided
to cancel the December meeting, devote
the January meeting to home talent, and
hold the February meeting in Troy. Dr.
Hecker gave a short resume of the E.N.T.
highlights of the recent Academy meeting.
Dr. Holohan then followed with a similar
resume of the eye session there. Dr. Cet-
ner presented a color sound film depicting
an operation for "Tucking of the Superior
Oblique Muscle." Dr. James W. Babcock
showed a film and gave a paper on "The
Effects
of Streptomycin on
the
Lab-
yrinth."
He brought out the
fact
that
persons
taking streptomycin
in
large
quantity
lose the sensitivity of their lab-
yrinths,
have a positive Romberg,
and
cannot
walk straight with their
eyes
closed. This drug has been used success-
fully in treating some cases of Meniere's
syndrome. He described the Hallpike
test. This treatment usually results in
relief from vertigo in about 10 days, but
leaves the patient dependent on his other
senses for sense of position and motion.
The paper was discussed by Drs. Volk,
Hecker, Fierman, Cotner, Freund, and
Sulzman.
PENNSYLVANIA
The thirty-fourth meeting of the West-
ern Pennsylvania Eye, Ear, Nose and
Throat Society was held at Indiana, Pa.,
Oct. 26, 1950. Dr. Raymond E. Jordan
of Pittsburgh spoke on "Chronic Secretory
Otitis Media," and Dr. William Linhart
of Pittsburgh presented a paper on "Com-
plications and Retinal Changes in Sys-
temic Diseases."
Word has been received that Dr. F. B.
Stevenson of Indiana, Pa., died Oct.
31, 1950. Dr. Stevenson was the organizer
and first president of the Western Penn-
sylvania Eye, Ear, Nose and Throat So-
ciety.
A meeting of the Reading Eye, Ear,
Nose and Throat Society was held
Oct. 25, 1950, at the Wyomissing Club.
A study club on "Ocular Therapeutics"
was conducted. Instructors were Dr.
James H. Parker of Reading and Dr.
Joseph V. M. Ross of Berwick. Members
who attended the Academy meeting in
Chicago were invited to present their
impressions of the highlights of the meet-
ing. Reports on courses taken at the
Chicago meeting were given by Drs. Er-
nest H. Dengler, Pottstown; C. Fremont
Hall, Phoenixville; Fred R. Perfect,
Wyomissing; Samuel A. Phillips, Allen-
town; Robert E. Shoemaker, Allentown;
and Benjamin F. Souders, Reading.
The following officers were elected for
the years 1950-51: president, Dr. Roy
Deck, Lancaster; first vice-president, Dr.
William J. Hertz, Allentown; second vice-
president and president-elect, Dr. Harold
L. Strause, Reading; treasurer, Dr. Philip
R. Wiest, Reading; secretary, Dr. Benja-
min F. Souders, Reading; and program
chairman, Dr. John E. Keller, Reading.
The regular meeting of the Reading
Eye, Ear, Nose and Throat Society was
held Nov. 15, 1950. Dr. Harvey E. Thorpe,
chief of the department of ophthalmology
at Montefiore Hospital, Pittsburgh, spoke
on "Management of Intraocular Foreign
Bodies." A study club on the "Manage-
ment of Early Deafness" was conducted
by Dr. James E. Landis of Reading, and
Dr. C. Fremont Hall of Phoenixville.
The Section on ophthalmology of the
College of Physicians of Philadelphia held
a meeting Nov. 16, 1950. Dr. Parker
Heath delivered the thirteenth annual de-
Schweinitz lecture, "Tumors of the Iris:
Pathology and Treatment "
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XXIX
POSITIONS AVAILABLE
POSITIONS AVAILABLE
There is an opening in Washington, D.
C., for a competent ophthalmologist to
be associated with ophthalmologist in
large private practice and with the George
Washington University Medical School.
The appointment comprises private prac-
tice and teaching, and research if so de-
sired by the applicant. Application should
be made to Mrs. R. McKenzie Ross, Room
2166 Department of Ophthalmology,
George Washington University Hospital,
Washington 7, D. C.
The Department of Otolaryngology and
Oral Surgery at the University of Iowa
Medical School will have four residencies
available July 1, 1951. Applications
should be submitted by Nov. 1, 1950,
as the appointments are made Dec.
1, 1950. If you are interested, please
write the Department of Otolaryngology
and Oral Surgery, University Hospitals,
Iowa City, Iowa, for information.
Listing of positions available should be sent to
W. L. Benedict, M.D., 100 First Avenue Building,
Rochester, Minn., by the fifth of the month pre-
ceding publication. They should include (1) type
of physician wanted (ophthalmologist or otolaryn-
gologist; diplomate, resident, etc.) ; (2) type of
position to be filled; and (3) whom to write for
further information. Unless otherwise requested,
listings will be published once only.
The Academy will handle no further correspon-
dence beyond the listing and assume no responsi-
bility. Neither does it endorse or guarantee any
of the published listings.
The staff of the Lewistown Hospital,
Lewistown, Pa., is interested in having a
man certified in ophthalmology locate in
Lewistown. Lewistown has a population
of approximately 16,000 and is located in
central Pennsylvania. Lewistown Hospital
serves a prosperous agricultural area with
a population of approximately 75,000.
New construction is under way which
will give them a total of 186 beds plus
56 newborn bassinets. The medical staff
consists of fourteen active members and
thirty-three courtesy members plus two
consulting and three honorary members.
Write to Mr. Robert A. Kumpf, Adminis-
trator, Lewistown Hospital, Lewistown,
Pa.
Otolaryngologist: A position for a
resident is available at the Episcopal Hos-
pital, Philadelphia, Pa. For details write
Dr. Otto C. Hirst, Episcopal Hospital,
Philadelphia 25, Pa.
A qualified ophthalmologist and oto-
laryngologist is needed in Denison, Texas,
a city of 23,000 located on Lake Texoma.
The area is industrial and agricultural.
A high standard of living is maintained.
There is no competition. Professional co-
operation is assured if qualifications are
adequate. For further information write
Dr. Maurice A. Weisberg, Grayson X-Ray
and Radium Clinic, Barrett Bldg., Deni-
son, Texas.
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DIRECTORY OF OPHTHALMOLOGIC AND OTOLARYNGOLOGIC
SOCIETIES
INTERNATIONAL
INTERN ATIONAI. ASSOCIATION FOR PREVENTION OF BLINDNESS
President: Dr. P. Bailliart, 47 Rue de Bellechasse, Paris, France
Secretary-General: Dr. A. Churchill, 66 Boulevard Saint-Michel, Paris, 6, France
INTERNATIONAL COUNCIL OF OPHTHALMOLOGY
President: Prof. F. W. Nordenson
Secretary: Dr. Halger Ehlers, Rigshospital, Copenhagen, Denmark
INTERNATIONAL ORGANIZATION AGAINST TRACHOMA
President: Dr. A. F. MacCallan
Secretary: Dr. F. Wibaut, P. C. Hoofstraat 145, Amsterdam, Holland
PAN-AMERICAN ASSOCIATION OF OPHTHALMOLOGY
President: Dr. Conrad Berens
Secretary: Dr. Thomas D. Allen, 122 South Michigan Avenue, Chicago 2, Ill.
Tilde and Place: January 7-12, 1952. Mexico City
PAN-AMERICAN ASSOCIATION OF OPHTHALMOLOGY, PUERTO RICO CHAPTER
President: Dr. Luis J. Fernandez, Box 2206, San Juan 10, Puerto Rico
Secretary: Dr. P. Fernandez
Place: San Juan
P,\N-AMERICAN ASSOCIATION OF OTO-RIIINO-LARYNGOLOGY AND BRONCIIO-ESOPHAGOLOGY
President: Prof. Justo Alonso
Secretary: Dr. Chevalier L. Jackson, 255 South 17th Street, Philadelphia, Pa.
Time and Place: Third Pan-American Congress of Oto-Rhino-Laryngology and Broncho-Esophagology,
Havana, Cuba, 1952.
FOREIGN
President: Dr. G. Zachariah ALL-INDIA OPHTHALMOLOGICAL. SOCIETY
Secretaries: Dr. S. N. Cooper and Dr. V. K. Chitnis, Laud Mansion, Queen's Road, Bombay 4, India
AUSTRIAN OTOLARYNGOLOGICAL SOCIETY, VIENNA
President: Prof. Dr. E. Sehlander
Secretary: Doz. Dr. O. Novotny, Vienna IX, Alserstrasse 4, Austria
Time and Place: Annually
Secretary-General:Dr. M. Appelmans, Avenue Ruelens 179, Louvain
Time and Place: January, June and November. Bruxelles
BOMBAY OPHTHALMOLOGISTS' ASSOCIATION
Chairman: Rotated
Conveners: Dr. S. N. Cooper and Dr. B. D. Telang, Laud Mansion 21, Queen's Road, Bombay 4
Time and Place: 7:30 p.m.., third Wednesday of each month. The seven ophthalmic hospitals of Bombay
by rotation
Honorary Secretary: Mr. F. C. W. Capps, 45 Lincoln's Inn Fields, London W. C. 2, England
BRITISH MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY
President: Mr. O. G. Morgan
Secretary: Mr. A. G. Cross, 27 Harley Street, London W. 1, England
CHENGTU OPHTHALMOLOGICAL SOCIETY
President: Dr. Eugene Chan
Secretary: Dr. D. S. Shen, Eye, Ear, Nose and Throat Hospital, Chengtu, Szechuan, China
Place: Eye, Ear, Nose and Throat Hospital, Chengtu, Szechuan, China
CHINESE OPHTHALMOLOGY SOCIETY
President: Dr. C. H. Chou
Secretary: Dr. F. S. Tsang, 221 Foochow Road, Shanghai
CHINESE OPIITIIALMOLOGICAL SOCIETY or PEKING
President: Dr. G. C. Lin
Secretary: Dr. H. L. Chen, Ophthalmological Dept., Peking University Medical School, Peking
Time: Bimonthly
DEUTSCHE OPHTHALMOLOGISCHE GESELLSCHAFT HEIDELBERG
President: Prof. Dr. med. K. Wessely
Secretary: Prof. Dr. med. E. Engelking, Heidelberg, Universitats-Augenklinik
FACULTY OF OPHTHALMOLOGISTS
President: Dr. Frank W. Law, 45 Lincoln's Inn Fields, London, W.C. 2, England
Secretary: Dr. J. H. DOggart, F.R.C.S.
GERMAN OPHTHALMOLOGICAL SOCIETY
President: Prof. W. Lohlein
Secretary: Prof. E. Engelking, Heidelberg
HUNGARIAN MEDICAL TRADE UNION, SECTION OF OPHTHALMOLOGY
President: Prof. I. Csapody
Secretary: Dr. E. Galla, Krisztina Kdrut 139, Budapest, Hungary
Time and Place: Bimonthly. Second Eye Clinic, Budapest
HUNGARIAN OPHTHALMOLOGICAL SOCIETY
President: Prof. G. Horay
Assistant Secretary: Dr. Stephen de Grosz, University Eye Hospital, No. 1, Illesucca 15, Budapest
Secretaries of societies are requested to furnish, the information necessary to make this list complete
and keep it up to date.
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DIRECTORY OF SOCIETIES XXXI
ISRAEL OPHTHALMOLOGICAL SOCIETY
President: Dr. Aryeh Feigenbaum
Secretary: Dr. E. Sinai, 9 Bialik Street. Tel Aviv
MIDLAND OPHTHALMOLOGICAL SOCIETY
President: Dr. F. A. Anderson
Secretaries: Dr. P. Jameson Evans, 51 Calthorpe Road Edgbaston, Birmingham 15 England
Dr. R. D. Weeden Butler, 18 Highfield Road, 'Edgbaston, Birmingham 15, England
Place: Birmingham and Midland Eye-Hospital, Church Street, Birmingham 3, England
NEDERLANDSCH OOGHEELKUNDIG GEZELSCHAP
President: Prof. A. W. Mulock Houwer
Secretary: Dr. T. A. Vos, Laan v. Meerdervoort 394, the Hague
NORTH OF ENGLAND OPHTHALMOLOGICAL SOCIETY
President: Mr. Jr. S. Arkle
Secretary: Mr. W. M. Muirhead, 70 Upper Hanover Street, Sheffield 3, England
Time and Place: October to May. Manchester, Leeds, Newcastle, Liverpool, Sheffield and Bradford
THE NOVA SCOTIA SOCIETY OF OPHTHALMOLOGY, AND OTOLARYNGOLOGY
President: Dr. D. M. MacRae
Secretary-Treasurer: Dr. E. I. Glenister, 513 Barrington Street, Halifax, Nova Scotia
Time: Four times yearly at dates to be arranged by the Executive
OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY OF ALBERTA
President: Dr. C. G. Elder
Secretary: Dr. M. R. Marshall, Wells Pavilion, University Hospital, Edmonton, Alberta, Canada
OPHTHALMOLOGICAL SOCIETY OF AUSTRALIA
President: Dr. Arthur H. Joyce
Secretary: Dr. Arnold L. Lance, 135 Macquarie Street, Sydney, New South Wales
OPHTHALMOLOGICAL SOCIETY OF COPENHAGEN
President: Prof. Dr. Holger Ehlers
Secretary: Dr. Carl Johan Moellenbach, Rigshospitalets oejenafdeling, Copenhagen 0, Denmark
Place: Rigshospitalets oejenafdeling
OPHTHALMOLOGICAL SOCIETY OF EGYPT
President: Dr. Ibrahim Ahmad Mohammad
Secretary: Dr. Mahmoud Lutfi, Ophthalmic Hospital, Giza
Time and Place: Annual meeting during March. Summer meeting during August. Dar El Hekmah,
42 Kasr El Ainy Street, Cairo, Egypt
OPHTHALMOLOGICAL SOCIETY OF HOSPITAL DE NUESTRA SENORA DE LA LUz
Chairman: Dr, Manuel J. Icaza y Dublan
Secretary: Dr. Jorge Meyran, Ezequiel Montes 135 M6xico, D. F.
Time and Place: Second Friday of each month. hospital de Neustra Senora de la Luz
OPHTHALMOLOGICAL SOCIETY OF NEW ZEALAND
President: Dr. L. S. Talbot
Secretary: Dr. W. J. Hope-Robertson,"Kelvin Chambers, 16 The Terrace, Wellington
Time and Place: Annually. Auckland, Wellington, Christchurch and Dunedin alternately
OPHTHALMOLOGICAL SOCIETY OF SOUTH AFRICA
President: Dr. L. Staz
Secretary: Dr. J. Guillaume Louw, 901 Dumbarton Ilouse, Adderley Street, Cape Town, South Africa
Time: Annually
OPHTHALMOLOGICAL. SOCIETY OF THE UNITED KINGDOM
President: Mr. M. H. Whiting
Honorary Secretaries: Mr. A. G. Cross and Mr. A. J. B. Goldsmith, 45 Lincoln's Inn Fields, London
W. C. 2, England
Time and Place: 1951 Congress of the Society, March 29-31, London
OXFORD OPHTHALMOLOGICAL CONGRESS
Master: Dr. F. A. Anderson
Hon. Secretary and Treasurer: Ian C. Fraser, F.R.C.S., Red Roofs, Kingsland, Shrewsbury
Time and Place: First week of July 1951, Oxford
PHILIPPINE OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY
President: Dr. Geminiano de Ocampo
Secretary-Treasurer: Dr. Carlos V. Yambao, Philippine General Hospital, Manila
POLISH OPHTHALMOLOGICAL SOCIETY
President: Prof. Dr. W. Kapuscinski
Secretary: Dr. S. Topolski, Piusa 38, Warsaw, Poland
Time and Place: Every two years-summer. Ophthalmic Clinic, Oczki 6, Warsaw
ROYAL SOCIETY OF MEDICINE, SECTION of OPHTHALMOLOGY
President: Montague Hine, F.R.C.S.
England
H
Secretaries: H. E. Hobbs, F.R.CS., 129 F.R.C.S., Harley I Street , Street, London, London, England
SAO PAULO SOCIETY OF OPHTHALMOLOGY
President: Dr. Durval Prado
Secretary: Dr. Rubens Belfort Mattos, Rua B. Stapetininga, 29 F-3? andar, Sao Paulo, Brazil
SCOTTISH OPHTHALMOLOGICAL CLUB
President: Dr. E. H. Cameron
Secretary: Dr. John Marshall, 11 Clairmont Gardens, Glasgow, C.3, Scotland
Time and Place: Last Saturday of March and October, Edinburgh and Glasgow, in rotation
SOCIEDAD ARGENTINA DE OFTALMOLOGIA
President: Dr. Diego M. Arguello
Secretary: Place: Pedro Third Wednesday Nocito, of every month. Buenos Aireegenos Aires, Argentina
Time and
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XXXII TRANSACTIONS - NOVEMBER - DECEMBER, 1950
President: Dr. Italy Martini SOCIEDAD CHILENA DE OFTALMOLOGIA
Secretar : Dr. Adrian Araya Costa, Renaca, no. 34, Santiago, Chile
Place: Santiago
SOCIEDAD COLOMBIANA DE OFTALMOLOGIA Y DE OTORRINOLARINGOLOGIA
President: Dr. Jorge Suarez-Hoyos, Carrera 5a, no. 13-39, Bogota, Colombia
Secretary: Dr. Francisco krango
Time and Place: Second Tuesday of each month. Club Medico
SOCIEDAD CUBANA DE OFTALMOLOGIA
President: Prof. Lorenzo Comas
Secretary: Dr. Heriberto Buch Granados, Calle B No. 668 ent. 27 y 29 Vedado, Habana, Cuba
Time and Place: First Thursday bi-monthly. Malecon No. 61 Bajos, 1 avana, Cuba
SOCIEDAD MEXICANA DE OFTALMOLOGIA
President: Dr. Teodulo M. Agundis
Secretary: Dr. Jose Luis Arce, Viena 3.5, Mexico D. F., Mexico
Time and Place: 8:30 p.m., first Tuesday of each month, Gral. PRIM 47
SOCIEDAD DE OFTALMOLOGIA DE CORDOBA
Chairman: Dr. Roberto Obregon Oliva
Secretary: Dr. Alberto Urrets Zavalia (hijo), 27 de Abril 255, Cordoba, Argentina
SOCIEDAD DE OFTALMOLOGIA DE GUADALAJARA
President: Dr. Elias Mendoza Gonzalez
Secretary: Dr. Jose Martin del Campo, Av. Juarez 211, Desp. 314, Guadalajara, Jal.
Place: Edificio Lutencia Despacho 101
SOCIFDAD DE OFTALMOLOGIA DEL LITORAL
President: Dr. Juan Manuel Vila Ortiz, Cordoba 1915, Rosario, Argentina
Secretary: Dr. Carlos M. Soto
Time and Place: Last Sunday in every month. Rosario
SOCIEDADE BRASILEIRA DE OFTALMOLOGIA
President: Dr. Natalicio de Farlas
Secretary: Dr. Ismar Pereira? Praca Floriano 55, 5? andar, Rio de Janeiro, Brazil
Time: Third Friday of every month from April to December
SOCIEDADE DE OFTALMOLOGIA DEL NORTE
President: Dr. Jorge Luis Castillo
Secretary Dr. Felix Berman, San Lorenzo 345, Tucuman, Argentina
Place: Mendoza 421, Tucuman
SOCIEDADE DE OFTALMOLOGIA DE MINAS GERAIS
President: Prof. Hilton Rocha
Secretary: Dr. Oswaldo Carvalho
Place: Belo Horizonte, Minas Gerais, Brazil
SOCIEDADE DE OFTALMOLOGIA E OTORINOLARINGOLOGIA DE Rio GRANDE DO SUL
President: Dr. Luiz Assumpcao Osorio
Secretary: Dr. Fernando Voges Alves, Caixa Postal 928, Porto Alegre, Rio Grande do Sul
SOCIEDADE DE OTO-RING-LARINGOLOGIA DO RIO DE JANIERO
President: Dr. Aloysio Novis
Secretaries: Dr. Rubens Cabral, Rua Paissandu 73, Rio de Janeiro, Brazil
Dr. Mairelles Vieira
SOCIEDADE DE OFTALMOLOGIA E OTO-RHINO-LARYNGOLOGIA DE BAHIA
President: Dr. Theonilo Amorim, Barra Avenida, Bahia, Brazil
Secretary: Dr. Adroaldo de Alencar
SOCIETA OFTAI.MOLOGICA ITALIANA
President: Prof. Giuseppe Ovio
Secretary: Prof. E. Leonardi, Piazza degli Eroi, 11 Roma, Italy
Place: Roma Piazza degli Eroi 11
SOCIETE BELGE D'OPHTALMOLOGIE
President: Dr. L. Weekers
Secretary-General: Dr. M. Appelmans, 179 avenue Reulens, Louvain, Belgium
Time: Last Sunday of February, June and November
SOCIETE FBANCAISE D'OPIITALMOLOGIE
Secretary-General: Dr. Edward Hartmann, Hospital Lariboisiere, Paris 10, France
SOCIETY OF SWEDISH OPHTHALMOLOGISTS
President: Prof. S. Larsson
Secretary: Dr. K. O. Granstrom, Sodermalmstorg 4, Stockholm, Sweden
SOUTHERN OPHTHALMOLOGICAL SOCIETY, ENGLAND
President: R. Lang, M.R.C.S.
Hon. Secretary and Treasurer: Nigel Cridland, D.M., D.O., 25 Craneswater Park, Southsea, England
NATIONAL
AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. J. Mackenzie Brown
Executive Secretary-Treasurer: Dr. William L. Benedict, 100 First Avenue Building, Rochester, Minn.
Time and Place: October 14-19, 1951, Chicago
AMERICAN ASSOCIATION OF EYE, EAR, NOSE AND THROAT SOCIETY SECRETARIES
President: Dr. Kenneth L. Craft
Secretary-Treasurer: Dr. Daniel S. DeStio, Highland Building, Pittsburgh 6, Pa.
AMERICAN LARYNGOLOGICAL ASSOCIATION
President: Dr. Gordon B. New
Secretary: Dr. Louis H. Clerf, 1530 Locust, Philadelphia 2, Pa.
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DIRECTORY OF SOCIETIES XXXIII
AMERICAN LARYNGOLOGICAL, RIIINOLOGICAL AND OTOLOGICAL SOCIETY, INC.
President: Dr. Louis H. Clerf
Secretary: Dr. C. Stewart Nash, 708 Medical Arts Building, Rochester 7, N. Y.
EASTERN SECTION
Vice-President: Dr. Harry P. Schenck
Secretary: Dr. Francis W. Davison, Geisinger Memorial Hospital, Danville, Pa.
MIDDLE SECTION
Vice-President: Dr. Clarence W. Engler
Secretary: Dr. Walter H. Theobald, 307 North Michigan Avenue, Chicago 1, Ill.
SOUTHERN SECTION:
Vice-President: Dr. Charles C. Grace
Secretary: Dr. James W. McLaurin, Raymond Building, Baton Rouge 6, La.
WESTERN SECTION:
Vice-President: Dr. Lewis F. Morrison
Secretary: Dr. Harold Boyd, 1136 West Sixth Street, Los Angeles, Calif.
AMERICAN MEDICAL ASSOCIATION, SCIENTIFIC ASSEMBLY, SECTION ON OPHTHALMOLOGY
Chairman: Dr. A, Ray Irvine
Secretary: Dr. Trygve Gundersen, 101 Bay State Road, Boston, Mass.
AMERICAN MEDICAL ASSOCIATION, SECTION ON LARYNGOLOGY, OTOLOGY AND RHINOLOGY
Chairman: Dr. James M. Robb
Secretary: Dr. Sam H. Sanders, 1089 Madison Avenue, Memphis 3, Tenn.
AMERICAN OPHTHALMOLOGICAL SOCIETY
President: Dr. John H. Duunington
Secretary-Treasurer: Dr. Maynard C. Wheeler, 30 West 59th Street, New York 19, N. Y.
Time and Place: Eighty-seventh annual meeting, June 7-9, 1951, Greenbrier Hotel, White Sulphur
Springs, W. Va.
AMERICAN OTOLOGICAL SOCIETY
President: Dr. Kenneth Day
Secretary: Dr. John R. Lindsay, 950 East 59th Street, Chicago 37, Ill.
AMERICAN SOCIETY OF OPHTHALMOLOGIC AND OTOLARYNGOLOGIC ALLERGY
President: Dr. George E. Shambaugh, 7r. May Building, Pittsburgh 22, Pa.
Secretary-Treasurer: Dr. Joseph W. H ampsey, 806
ASSOCIATION FOR RESEARCH IN OPHTHALMOLOGY, INC.
Chairman: Dr. Walter H. Fink
Secretary-Treasurer: Dr. James H. Allen, 1430 Tulane Avenue, New Orleans, La.
CANADIAN MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY
President: Dr. R. G. C. Kelly
Secretary: Dr. J. Clement McCulloch, 380 Medical Arts Building, Toronto, Ontario
CANADIAN OPHTHALMOLOGICAL SOCIETY
President: Dr. it F. Nicholls
Secretary: Dr. J. F. A. Johnston, 174 St. George Street, Toronto, Ontario
CANADIAN OTOLARYNGOLOGICAL SOCIETY
President: Dr. W. J. McNally
Secretary: Dr. Jules Brahy, 361 Sherbrooke Street East, Montreal 18, Quebec
NATIONAL SOCIETY FOR THE PREVENTION OF BLINDNESS, INC.
President: Mr. Mason H. Bigelow
Secretary: Dr. Franklin M. Foote, 1790 Broadway, New York 19, N. Y.
REGIONAL
ARK-LA-TEX OTO-OPHTHALMIC SOCIETY
President: Dr. W. Griffin Jones
Secretary: Dr. Frank L. Bryant, 2622 Greenwood, Shreveport, La.
Time and Place: First Monday of month, October through May. Shreveport Club
HAWAII EYE, EAR, NOSE AND THROAT SOCIETY
Chairman: Dr. Ogden D. Pinkerton
Secretary: Dr. John P. Frazer, 1133 Punchbown Street, Honolulu, T. II.
Time and Place: Third Thursday of each month (dinner meetings). Pacific Club, Honolulu
INTER-MOUNTAIN OTO-OPIITIIALMOLOGI CAL SOCIETY
President: Dr. Homer E. Smith
Secretary: Dr. George B. Ely, 115 East South Temple Street, Salt Lake City, Utah
Time and Place: Third Monday of each month, September through May. University Club, 136 Easl
South Temple, Salt Lake City
LOUISIANA-MISSISSIPPI OPHTHALMOLOGICAL AND , OTOLARYNCOLOGICAL SOCIETY
President: Dr. S. B. Carruthers
Secretary: Dr. Edley H. Jones, 1301 Washington Street, Vicksburg, Miss.
Time and Place: May 14, 1951, Mississippi Gulf Coast
NEW ENGLAND OPHTHALMOLOGICAL SOCIETY
President: Dr. Benjamin A. Sachs
Secretary: Dr. Garrett L. Sullivan, 101 Bay State Road, Boston 15, Mass.
Time and Place: Third Wednesday of each month. November through April. Massachusetts Eye and
President: Dr. Robert L. Goodale
Secretary-Treasurer: Dr. Burton E. Lovesey, 76 Bay State Road, Boston 15, Mass.
Time and Place: Quarterly. Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston
PACIFIC COAST OTO.OPHTHALMOLOGICAL SOCIETY
President: Dr. Augustus B. Dykman
Secretary-Treasurer: Dr. Howard P. House, 1136 West Sixth Street, Los Angeles 14, Calif.
SAGINAW VALLEY ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. William B. Hubbard
Secretary: Dr. Frank A. Ware, 514 Genesee Bank Bldg., Flint, Mich.
Time and Place: Second Tuesday evening of each month, except summer months. Bancroft Hotel, Saginaw
a
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XXXIV TRANSACTIONS - NOVEMBER - DECEMBER, 1950
SIOUX VALLEY EYE AND EAR ACADEMY
President: Dr. James Reeder, Jr.
Secretary-Treasurer: Dr. W. P. Davey, 627-632 Frances Building, Sioux City, Iowa
SOUTHERN MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY
Chairman: Dr. Alston Callahan
Secretary: Dr. Edley H. Jones, 1301 Washington Street, Vicksburg, Miss.
WISCONSIN-UPPER MICHIGAN SOCIETY OF OPIITIIALMOLOGY AND OTOLARYNGOLOGY
President: Dr. James K. Trumbo
Secretary: Dr. G. L. McCormick, 650 South Central Avenue, Marshfield, Wis.
Time and Place: May 1951. Wausau, Wis.
STATE
ARKANSAS STATE MEDICAL SOCIETY, EYE, EAR, NOSE AND THROAT SIECTION
President: Dr. C. G. Hinkle
Secretary: Dr. K. W. Cosgrove, 113 East Capitol Avenue, Little Rock, Ark.
CALIFORNIA MEDICAL ASSOCIATION, EYE, EAR, NOSE AND THROAT SECTION
Chairman: Dr. George F. Keiper, Jr.
Secretary: Dr. Maurice W. Nugent, 2007 Wilshire Blvd., Los Angeles 5, Calif.
COLORADO OPHTHALMOLOGICAL SOCIETY
President: Dr. J. Leonard Swigert
Secretary: Dr. James C. Strong, 227 Sixteenth Street, Denver, Colo.
Time and Place: Every third Saturday. Colorado Medical Center
COLORADO OTOLARYNGOLOGICAL SOCIETY
President: Dr. Guy W. Smith
Secretary: Dr. Terry J. Gromer, 110 Metropolitan Building, Denver, Colo.
Time and Place: 6:30 p.m.;, first Saturday evening of each month. Oxford Hotel, Denver
FLORIDA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. W. Jerome Knauer
Secretary-Treasurer: Dr. Charles C. Grace, 145 King Street, St. Augustine, Fla.
GEORGIA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Lester A. Brown
Secretary: Dr. Braswell E. Collins, 701 Elizabeth Street, Waycross, Ga.
Time and Place: First Friday and Saturday of March. General Oglethorpe Hotel, Savannah, Ga.
INDIANA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. E. W. Dyar
Secretary-Treasurer: Dr. Al. S. Harding, 308 Hume Mansur Building, Indianapolis, Ind.
IOWA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Byron Merkel
Secretary: Dr. Carl A. Noe, 601.611 Highley Building, Cedar Rapids, Iowa
KANSAS STATE MEDICAL SOCIETY, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. N. L. Francis
Secretary: Dr. W. D. Pitman, First National Bank Building, Pratt, Kan.
MICHIGAN STATE MEDICAL SOCIETY, SECTION ON OPHTIIALMOIOGY AND OTOLARYNGOLOGY
Chairman: Dr. J. E. Croushore (Otolaryngology)
Co-Chairman: Dr. J. C. Gemeroy (Ophthalmology)
Secretary: Dr. R. W. Teed, 215 South Main, Ann Arbor, Mich. (Otolaryngology)
Co-Secretary: Dr. F. B. Heckert, 1105 Bank of Lansing Building, Lansing, Mich. (Ophthalmology)
MICHIGAN TRIOLOGICAL SOCIETY
President: Dr. William D. Irwin
Secretary: Dr. V. E. Cortopassi, 324 South Washington Avenue, Saginaw, Mich.
Time: Second Thursday of November, December, March, April and May
MINNESOTA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Malcolm C. Plunder
SecretaryTreasurer: Dr. Frank Adair, 822 Lowry Medical Arts Building, St. Paul 2, Minn.
Time and Place: Second Friday of each month, November through May. Alternating, Minnesota Club,
St. Paul, and Minneapolis Club, Minneapolis
MONTANA ACADEMY OF OTO-OPHTHALMOLOGY
President: Dr. W. L. Forster
Secretary-Treasurer: Dr. F. D. Hurd, Medical Arts Building, Great Falls, Mont.
Time and Place: Semi-annually. Summer, Bozeman; mid-winter, Diamond S Ranchotel, Boulder
NORTH CAROLINA EYE, EAR, NOSE AN)) THROAT SOCIETY
President: Dr. G. M. Billings
Secretary: Dr. MacLean B. Leath, 529 North Main Street High Point, N. C.
Time and Place: Annually, beginning second Monday in September.
OREGON ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Max Simons
Secretary: Dr. Richard S. Fixott, 1020 Southwest Taylor Street, Portland 5, Ore.
Time and Place: Third Tuesday each month September through May. Old Heathman Hotel, Portland
PENNSYLVANIA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Jay G. Linn
Secretary: Dr. Daniel S. DeStio, Highland Building, Pittsburgh 6, Pa.
Time and Place: May 17-20, 1'951. Galen Hall, Wernersville, Pa.
PUERTO RICO MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Luis J. Fernandez
Secretaries: Dr. Ricardo F. Fernandez, P.O. Box 2206, San Juan 10, Puerto Rico (Ophthalmology)
Dr. Carlos E. Munoz MacCormick, P.O. Box 604, San Juan, Puerto Rico (Otolaryngology).
Time and Place: Bimonthly. Puerto Rico Medical Association Building
SOUTH CAROLINA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. William M. Carpenter
Secretary-Treasurer: Dr. Roderick Macdonald, Rock Hill, S. C.
TENNESSEII STATE ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Sam H. Sanders
Secretary-Treasurer: Dr. Roland H. Myers, 1720 Exchange Building, Memphis, Tenn.
Time: Annually
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DIRECTORY OF SOCIETIES XXXV
TEXAS SOCIETY OP OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. V. R. Hurst
Secretary: Dr. John L. Matthews, 414 Navarro Street, San Antonio 5, Texas
Time and Place: December 1950. Dallas
VIRGINIA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Charles A. Young
Secretary-Treasurer: Dr. Peter N. Pastore, Box 25, Medical College of Virginia Station. Rich-
mond 19, Va.
WEST VIRGINIA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Garnett P. Morison
Secretary: Dr. Melvin W. McGehee, 425 Eleventh Street, Huntington 1, W. Va.
ACADEMY OF MEDICINE OF NORTHERN NEW JERSEY, SECTION ON EYE, EAR, NOSE AND THROAT
Chairman: Dr. William F. Krone
Secretary: Dr. Francis J. Grant, 1224 Salem Avenue, Hillside, N. J.
Time and Place: 8:45 p.m., second Monday of the month. The Academy of Medicine, 91 Lincoln Park,
South, Newark
AKRON ACADEMY or OPIITIIALMOLOGY AND OTOLARYNGOLOGY
President: Dr. C. R. Anderson Akron, Ohio
Secretary-Treasurer: Dr. A. L. Peter, 406 Akron Savings and Loan Building,
Time and Place: 6:30 p.m., first Monday in January- March, May and November. Akron City- Club
ATLANTA EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. Lester A. Brown
Secretary-Treasurer: Dr. James T. King, 384 Peachtree Street N.E., Atlanta 3, Ga.
Time and Place: 7:30 p.m., fourth Monday of each month, October to May. Academy of Medicine
BIRMINGHAM EYE, EAR, NOSE AND THROAT SOCIETY
President: Each member, in alphabetical order. Birmingham, Ala.
Secretary: Dr. David A. McCoy, Woodward Building,
Time and Place: 6:30 p.m., second Tuesday of each month, September through May. Thomas Jefferson Hotel
BOSTON CITY HOSPITAL AURAL AND OPHTHALMIC ASSOCIATION
President: Dr. Joseph Nerbonne
Secretary: Dr. Benjamin Riseman, 41 Bay State Road, Boston 15, Mass.
BROOK:.YN OPIITIIAI.MOLOGICAL SOCIETY
President: Dr. Mortimer A. Lasky
Secretary-Treasurer: Dr. Louis Freimark, 256 Rochester Avenue, Brooklyn 13, N. Y.
December, February and April. Medical Society
Time and Place: : 8 p.m., third, 1313 Thursday dn Avenue
of BUFFALO OPIITIIALMOLOGIC CLUB
President: Dr. Arthur L. Bennett
Secretary: Dr. Herbert R. Reitz, 446 Linwood Avenue, Buffalo, N. Y.
Time and Place: Second Thursday of each month, October through May. Park Lane
CENTRAL ILLINOIS SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Harold R. Watkins
Secretary-Treasurer: Dr. Philip R. McGrath, 843 Jefferson Building, Peoria, Ill.
CENTRAL NEW YORK EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. Cecil B. Hert
Secretary-Treasurer: Dr. James L. McGraw, 619 University Building, Syracuse, N. Y.
CIIATTANOOGA EYE, EAR, NOSE AND THROAT SOCIETY
Chairman and Secretary: Dr. Willard 1-1. Steele, Jr., 552 McCallie Avenue, Chattanooga, Tenn.
Time and Place: 6:30 p.m.,,fourth Thursday in each month, October through May. Mountain City Club
CHICAGO LARYNGOLOGICAL AND OTOLOGICAL SOCIETY
President: Dr. Oliver E. Van Alyea
Secretary: Dr. Lawrence J. Lawson, 636 Church Street, Evanston, Ill.
CHICAGO OPIITUAI.MOIOGICAL SOCIETY
President: Dr. J. Robert Fitzgerald
Secretary-Treasurer: Dr. Gail E. Soper, 636 Church Street, Evanston, 111.
Time and Place: 7:30 p.m., third Monday of each month, October to May. Chicago-Illini Union, 715
Presidium: Dr. Donald J. Lyle, Dr. -Karl W. Ascher, Dr. Josef D. Weintraub
Secretary: Dr. Josef D. Weintraub, 715 Provident Bank Building, Seventh and Vine Streets, Cincinnati, Ohio
Time and Place: Second Wednesday night of month, November through May. University Club, Fourth
President: Dr. G. Leslie Miller
Secretary-Treasurer: Dr. Webb P. Chamberlain, Jr., 7405 Detroit Avenue, Cleveland, Ohio
Time and Place: Second Tuesday of November, January, February and April. Statler Hotel, Cleveland
COLLEGE OF PHYSICIANS OF PHILADELPHIA, SECTION ON OPHTHALMOLOGY
Chairman: Dr. Wilfred E. Fry Jenkintown, Pa.
Clerk: Dr. M. Luther Kauffman, Medical Arts Building, J
Time and Place: 8:15 p.m., third Thursday of every month, October through April. College of Phy-
President: Dr. W. B. Wilkinson
1, Texas
Secretary: nd Place: First Tuesday Winborn, of Medical 1 moArts Building, nth. Melrose Dallas
Hotel
Time and MOINES ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. J. H. McNamee Des Moines, Iowa
Secretary-Treasurer: Dr. H. H. Gurau, 213 Bankers Trust Building,
Time and Place: 6:00 p.m., fourth Monday of each month, September through May. Des Moines Club
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XXXVI TRANSACTIONS - NOVEMBER - DECEMBER, 1950
President: Dr. Cecil Lepard DETROIT OPHTHALMOLOGICAL SOCIETY
Secretary: Dr. Arthur P. Wilkinson, 947 Fisher Building, Detroit 2, Mich.
Time and Place: Second Monday of each month, November through April. Wayne County Medical Society
DETROIT OTO-LARYNGOLOGICAL SOCIETY
President: Dr. B. F. Glowacki
Secretary-Treasurer: Dr. John R. Birch, 1010 Maccabees Building, Detroit 2, Mich.
Time and Place: Third Wednesday of each month, September to May. Wayne County Medical Society
Building
EAR, NOSE AND. THROAT CLUB OF ST. Louis
Chairman: Dr. Bernard J. McMahoD
Secretary: Dr. Harry N. Glick, 1504 Grand Boulevard, St. Louis, Mo.
Time and Place: Third Wednesday in November, January, March and May. University Club Bldg.
EASTERN NEW YORK EYE, EAR, NOSE AND THROAT ASSOCIATION
President: Dr. Byron H. Porter
Secretary-Treasurer: Dr. E. Martin Freund, 762 Madison Avenue, Albany 3, N. Y.
Time and Place monthly : 8 p.m., first Thursday of month, October to June. Albany, Troy, Schenectady, rotating
FORT WORTH EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. W. H. McKenzie
Secretary: Dr. C. Keith Barnes, 921 Neil P. Anderson Building Fort Worth 2, Texas
Time and Place: 6:30 p.m., first Friday of each month, except July and August. All Saints' Hospital
HOUSTON ACADEMY OF MEDICINE, OPHTHALMOLOGICAL AND OTO-LARYNGOLOGICAL SECTION
President: Dr. Lyle Hooker
Secretary: Dr. Claude C. Cody, III, 1304 Walker Avenue, Houston 2, Texas
Time: Second Thursday of each month, October through June
INDIANAPOLIS OPHTHALMOLOGICAL AND OTO-LARYNGOLOGICAL SOCIETY
President: Dr. Edwin D. Dyar
Secretary-Treasurer: Dr. J. Lawrence Sims, 809 Hume Mansur Building, Indianapolis 4, Ind.
Time and Place: 6:30 p.m., second Thursday of each month, November to May. Indianapolis Athletic Club
President: Dr. John McLeod KANSAS CITY SOCIETY OF O. O. R. L.
Secretary: Dr. James W. May, 1016 Rialto Building, Kansas City, Mo.
Time and Place: Third Thursday of the month, November through May. Hotel President, 14th and Baltimore
LONG BEACH EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. Edmund D. Godwin
Secretary: Dr. James V. Keipp, 110 Pine Avenue, Long Beach 2, Calif.
Time and Place: 6:00 p.m., monthly, September through May. Seaside Memorial Hospital
Los ANGELES OPHTHALMOLOGICAL SOCIETY
President: Dr. Deane C. Hartman
Secretary: Dr. Daniel B. Esterly, 104 North Madison Avenue Pasadena 1, Calif.
Time and Place: First Thursday of each month, September through June. Los Angeles County Medical
Society Building, 1925 Wilshire Boulevard
Los ANGELES SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Alden H. Miller
Secretary: Dr. Victor Goodhiil, 2007 Wilshire Boulevard, Los Angeles 5, Calif.
Time and Place:. 6:00 p.m., fourth Monday of each month, September through May. Los Angeles
County edical Association Building, 1925 Wilshire Boulevard
MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA, SECTION ON OTOLARYNGOLOGY
President: Dr. Victor Alfaro
Secretary: Dr. Frasier Williams, 1228 North Irving Street, Arlington, Va.
Time and Place: 7:00 p.m., third Tuesday in October, November, March and May. Army and Navy
Club, 17th and Farragut Square, N.W.
MEMPHIS SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
Chairman: Each member, in alphabetical order
Secretary: Dr. Sam H. Sanders 1089 Madison Avenue, Memphis, Tenn.
Time and Place: Second Tuesday in each month, September through May. Memphis Eye, Ear, Nose
and Throat Hospital
MILWAUKEE OTO.OPHTHALMIC SOCIETY
President: Dr. J. P. Wild
Secretary-Treasurer: Dr. Howard High, 324 East Wisconsin Avenue, Milwaukee 2 Wis. 1 Time and Place: 6:30 p.m., fourth Tuesday of each month, October to May. Athletic Club
MONTGOMERY COUNTY MEDICAL SOCIETY, SECTION ON EYE, EAR, NOSE AND THROAT
President: Dr. Robert A. Bruce
Secretary-Treasurer: Dr. L. N. Shroder, 144 West Fourth Street, Greenville, Ohio
Time and Place: First Tuesday of November, February, March and May. Dayton Country Club
MONTREAL OPHTHALMOLOGICAL SOCIETY
President: Dr. Jules Brahy
Secretary-Treasurer: Dr. Leo S. S. Kirschberg, 1390 Sherbrooke Street West, Montreal, Que., Canada
Time: Second Thursday of October, December, February and April
NASHVILLE ACADEMY OF OPIITI{ALMOI.OGY AND OTOLARYNGOLOGY
President: Dr. N. B. Morris
Secretary-Treasurer: Dr. Herbert Duncan, Bennie Dillon Building, Nashville, Tenn.
Time and Place: Third Monday evening of month, October through May. James Robertson Hotel
NEW YORK ACADEMY OF MEDICINE, SECTION ON OPHTHALMOLOGY
Chairman: Dr. Milton L. Berliner
Secretary: Dr. John M. McLean, 525 East 68th Street, New York 21, N. Y.
Time and Place: Third Monday of the month, October through May. New York Academy of Medicine
NEW YORK SOCIETY FOR CLINICAL OPHTHALMOLOGY
President: Dr. Samuel Gartner ry: Dr. Timeta d Place: Leon First ;Monday hof2theCmonth, October eto May. New York N. Y.
Academy of Medicine
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DIRECTORY OF SOCIETIES XXXVII.
NUECES COUNTY EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. C. N. Meador Corpus Christi, Texas
Secretary: Dr. Rex C. House, 228 Medical-Dental Building,
Time and Place: 7:30 p.m., second Monday of each month, October through May. Dusty's, 1739 South
Brownlee Street, Corpus Christi, Texas
OKLAHOMA CITY ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. C. W. McClure
Secretary: Dr. Richard A. Clay, 416 Northwest 13th Street, Oklahoma City Okla.
Time and Place: First Tuesday of each month. University Hospital, 800 Northeast 13th Street, Okla-
homa City
OMAHA AND COUNCIL BLUFFS OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY
President: Dr. Thomas T. Smith
SecretaryTreasurer: Dr. G. T. Alliband, 1020 Medical Arts Building, Omaha, Neb.
Time and Place: Dinner meeting third Wednesday monthly, October to May. Omaha Club
PHILADELPHIA COUNTY MEDICAL SOCIETY, EYE SECTION
Chairman: Dr. Alfred Cowan
Secretary: Dr. John W. Deichler, 301 South 21st Street, Philadelphia 3, Pa.
Time: First Thursday of each month, November through April
PHILADELPHIA LARYNGOI.OGICAL SOCIETY
President: Dr. Thomas F. Furlong, Jr.
Secretary: Dr. John J. O'Keefe, 255 South 17th Street, Philadelphia 3, Pa.
PITTS1IURGII ACADEMY or MEDICINE
President: Dr. John S. Plumer
Secretary: Dr. Samuel D. Evans, 1501-2 Park Building. Pittsburgh 22, Pa.
Time and Place: 8:00 p.m., fourth Monday of each month, October through, May. Pittsburgh Academy,
President: Dr. Daniel S. DeStio
Secretary: Dr. George C. Schein, 634 Washington Road, Pittsburgh, Pa.
Time and Place: Bimonthly
PUGET SOUND ACADEMY OF OPHTHALMOLOGY AND OTO-LARYNGOLOGY
President: Dr. Frank H. Wanamaker
Secretary-Treasurer: Dr. Willard F. Goff, 432 Stimson Building, 1215 Fourth Avenue, Seattle 1, Wash.
Time and Place: Third Tuesday of each month. Medical-Dental Building, Seattle
READING EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. Roy Deck
Secretary: Dr. Benjamin F. Souders, 143 North Sixth Street, Reading, Pa.
Time and Place: Third Wednesday of each month, September to July (dinner meetings). Wyomissing Club
RICHMOND, VIRGINIA, EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. E. W. Perkins
Secretary-Treasurer: Dr. J. Warren Montague, 1001 West Franklin Street, Richmond 20 Va.
Time and Place: First Tuesday of January, March, May and October. Commonwealth dlub
ST. Louis COUNTY MEDICAL SOCIETY, SECTION ON EYE, EAR, NOSE AND THROAT
Chairman: Dr. Anderson C. Hilding Duluth, Minn.
Secretary: Dr. James P. Tetlie, 626 Medical Arts Building,
Time and Place: - 6:00 to 8:00 p.m., preceding the monthly St. Louis County Medical Society meeting.
President: Dr. J. M. Keller
Secretary: Dr. Benjamin Milder, 539 North Grand Avenue, St. Louis 3, Mo.
Time and Place: 8:00 p.m., fourth Friday of each month, October through April, except December. Elliott
Auditorium, McMillan Hospital
E, EAR, NOSE AND THROAT
SAN FRANCISCO COUNTY MEDICAL SOCIETY, SECTION ON Calif.
Chairman: Dr. W. E. Borley, 655 Sutter Secretary: None August and December. San Francisco
Time and Place: Fourth Tuesday of each month, except July,
County Medical Society Building
SPOICANE ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY
President: Dr. Phil Greene
Secretary: Dr. Cornelius E. Hagan, Jr., 508 Old National Bank Building, Spokane, Wash.
Time and Place: Fourth Tuesday of each month, September through May. Paulsen Medical and Dental
Building
SUPERIOR CALIFORNIA EYE CLUB
President: Dr. Theodore Holstein, 523 Medico-Dental Building, Sacramento 14, Calif.
Secretary: Dr. John Berg
Time: Every third Thursday, eight months of the year
TORONTO ACADEMY OF MEDICINE, SECTION OF OPHTHALMOLOGY
Chairman: Dr. A. Lloyd Morgan
Secretary: Dr. Joseph C. Hill, 174 St. George Street, Toronto 5, Ontario, Canada
Time and Place: Second Monday night of November, January, February and March. Academy of Medi-
cine, Toronto
WASHINGTON, D. C. OPHTHALMOLOGICAL SOCIETY
President: Dr. Thomas A. Egan
Secretary-Treasurer: Dr. Joseph Dessoff, 1726 Eye Etreet Northwest, No. 813, Washington, D. C.
Time: January 8, 1951, May 7, 1951, joint meeting with the Baltimore Ophthalmological Society in
March 1951
WESTERN PENNSYLVANIA EYE, EAR, NOSE AND THROAT SOCIETY
President: Dr. C. E. Imbrie
Secretary-Treasurer: Dr. F. E. Murdock, 28% West Scribner Avenue, DuBois, Pa.
Time: Biannually. Third Thursdays of May and October
WILKES-BARRE OPHTHALMOLOGICAL SOCIETY
President: Dr. Vincent Gallizzi
Secretary: Dr, Samuel T. Buckman, 70 South Franklin Street, Wilkes-Barre, Pmber. Luzerne County
Time anddPlace:
cal Society TLibrary, o130each Sou h Flrankklin Streetrough May,
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HEARING AIDS ACCEPTED BY THE
COUNCIL ON PHYSICAL MEDICINE AND REHABILITATION
THE AMERICAN MEDICAL ASSOCIATION
As of December 1, 1950
Aurex Model F
Aurex Model H
Mfr. AUREX CORP.
1117 N. Franklin St.
Chicago 10
Beltone Mono-Pac
Beltone Harmony Mono-Pac
Beltone Symphonette
Beltone Mono-Pac Model M:
Mfr. BELTONE HEARING AID CO.
1450 W. Nineteenth St.
Chicago 8
Cleartone Model 500
Cleartone Regency Model
Mfr. AMERICAN SOUND PRODUCTS, INC.
2454 S. Michigan Ave.
Chicago 16
Dysonic Model No. 1
Mfr. DYNAMIC HEARING AIDS, INC.
1042 Atlantic Ave.
Brooklyn 16
Electroear Model C
Mfr. AMERICAN EARPHONE CO., INC.
10 E. Forty-third St.
New York 17
Gem Model V-35
Gem Model V-60
Mfr. THE GEM EAR PHONE CO., INC.
50 West Twenty-ninth St.
New York 1
Maico Atomeer
Maico UE Atomeer
Maico Quiet Ear Models G & H
Mfr. THE MAICO CO., INC.
21 N. Third St.
Minneapolis 1
Mears Aurophone Model 200
1947-Mears Aurophone Mode]: 98
Mfr. MEARS RADIO HEARING DEVICE CORP.
1 W. Thirty-fourth St.
New York 1
Micronic Model 101 (Magnetic Receiver)
Micronic Model 303
Mfr. MICRONIC CO.
727 Atlantic Ave.
Boston 11
Microtone T-3 Audiomatic
Microtone T-4 Audiomatic
Microtone T-5 Audiomatic
Microtone Classic Model T9
Microtone Model 45
Mfr. MICROTONE CO.
Ford Parkway on Mississippi
St. Paul 1
National Cub Model (C)
National Standard Model (T)
National Star Model (S)
National Ultrathin Model 504
National Vanity Model 506
Mfr. NATIONAL HEARING AID LABORA-
TORIES
815 S. Hill St.
Los Angeles 14
Otarion Model E-1
Otarion Model E-IS
Otarion Model E-2
Otarion Model E-4
Otarion Models F-1 & F-2
Mfr. OTARION, INC.
159 N. Dearborn St.
Chicago 1
Paravox Models VII and VL (Standard)
Paravox Model XT (Extra-Thin)
Paravox Model XTS (Extra-Thin)
Paravox Model Y (YM, YC & YC-7) (Very small)
Mfr. PARAVOX, INC.
2056 E. Fourth St.
Cleveland 15
Radioear Permo-Magnetic Multipower
Radioear Permo-Magnetic Uniphone
Radioear All-Magnetic Model 555
Radioear Model 62 Starlet
Mfr. E. A. MYERS & SONS
306-308 Beverly Road
Mt. Lebanon
Pittsburgh 16
Silver Micronic (Magnetic and Crystal)
Models 202M & 202C
Mfr. MICRONIC CO.
727 Atlantic Avenue
Boston 11
Silvertone Model 103BM
Mfr. NATIONAL HEARING AID LABORA-
TORIES
815 S. Hill St.
Los Angeles 14
Distr: SEARS ROEBUCK & CO.
925 S. Homan Ave.
Chicago 7
Silvertone Model M-35
Mfr. MICRONIC CO.
727 Atlantic Ave.
Boston 11
Distr: SEARS, ROEBUCK & CO.
Chicago 7
Silvertone Model P-15
Mfr. W. E. JOHNSTON MFG. CO.
708 W. Fortieth St.
Minneapolis
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Distr~ SEARS, ROEBUCK & CO.
925 S. Homan Ave.
Chicago 7
Solo-Pak Model 99
Mfr. SOLO-PAK ELECTRONICS CORP.
Linden St.
Reading, Mass.
Sonotone Model 600
Sonotone Model 700
Sonotone Model 900
Sonotone Models 910 & 920
Sonotone Model 925
Mfr. SONOTONE CORP.
Elmsford, N. Y.
Tonemaster Model Royal
Mfr. TONEMASTER, INC.
400 S. Washington St.
Peoria 2. Ill.
Trimm Vacuum Tube Model 300
Mfr. TRIMM DISTRIBUTORS. INC.
400 Lake St.
(P.O. Box 489)
Libertyville, 111.
Unex Model A
Unex Midget Model 95
flnex Midget Model 110
Mfr. NICHOLS & CLARK
Hathorne, Mass.
Super-Fonic Hearing Aid
Mfr. AMERICAN SOUND PRODUCTS, INC.
2454 S. Michigan Ave.
Chicago 16
Televox Model E
Mfr. TELEVOX MFG. CO.
1307 Sansom St.
Philadelphia 7
Telex Model 22
Telex Model 97
Telex Model 99
Telex Model 200
Telex Model 1700
Mfr. TELEX, INC.
Telex Park
Minneapolis I
Vacolite Model J
Mfr. VACOLITE CO.
3003 N. Henderson St.
Dallas 6
Western Electric Model 63
Western Electric Model 64
Western Electric Models 65 & 66
Mfr. WESTERN ELECTRIC CO., INC.
120 Broadway
New York 5
Zenith Model 75
Zenith Miniature 75
Mfr. ZENITH RADIO CORP.
6001 W. Dickens Ave.
Chicago 39
TABLE HEARING AIDS
Aurex (Semi-Portable)
Mfr. AUREX CORP.
1117 N. Franklin St.
Chicago 10
Precision Table Hearing Aid
Mfr. PRECISION ELECTRONICS CO.
5157 W. Grand Ave.
Chicago 39
Sonotone Professional Table Set Model 50
Mfr. SONOTONE CORP.
Elmsford, N. Y.
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 . Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
AVAILABLE SUPPLIES
Pic.
OCULAR SURGERY, Conrad Berens and Michel Loutfallah ................
$1.00
CATARACT TYPES, F. C. Cordes ..................................
1.00
SLIT LAMP BIOMICROSCOPY, E. L. Goar et al ........................
1.00
OUTLINE OF NEURO-OPHTHALMOLOGY, P. J. Leinfelder ..............
1.00
A COMPREHENSIVE DESCRIPTION OF THE ORBIT,
ORBITAL CONTENT, AND ASSOCIATED STRUCTURES WITH
CLINICAL APPLICATIONS, R. E. McCotter et al ..................
1.00
THE INTERPRETATION OF VISUAL FIELDS, C. W. Rucker ...............
1.00
EXTRINSIC EYE MUSCLES, H. Saul Sugar .............................
1.00
ENDOGENOUS UVEITIS, A. C. Woods ................................
1.00
MENIERE'S DISEASE, J. R. Lindsay ................................
1.00
NONSURGICAL COMPLICATIONS OF OTOLARYNGOLOGIC SURGERY,
J. J. Pressman et al .........................................
1.00
MONOGRAPHS
HEARING TESTS, Arthur L. Juers .................................. $0.25
THE EMBRYOLOGY OF THE EAR, NOSE, AND THROAT,
0. E. Van Alyea ........................................... 0.25
REFRACTION DIFFICULTIES,
Clarence A. Veasey, Jr . ..................................... 0.50
ABSTRACTS
Each set contains the available outlines and briefs of instruction
courses as presented at Academy meetings. Unbound.
Ophthalmology: 1937, 1938, 1942, 1948 ...................... . . @ $1.50
1949 ....................... 3.50
1950 ...................................... 5.00
Otolaryngology: 1937, 1938, 1939, 1941, 1942, 1947 ............ @ 1.50
1950 ....................................... 4.00
TRANSACTIONS
Bound Volumes: Record of meetings held in: 1917-18, 1919, 1920, 1921,
1923, 1924, 1925, 1926, 1927, 1928, 1930, 1932,
1934, 1935, 1936, 1937, 1938, 1939, 1940, 1941,
1942, 1943, 1944 ........................... @ $J.50
1948 bound volume .............................. 4.00
1949 bound volume .............................. 5.00
Subscription: Per year, bimonthly publication ...................... 10.00
Single issue: Before January-February 1950, if available .............. .50
Beginning January-February 1950 ..................... 1.00
Beginning September-October 1950 .................... 2.00
SEND ORDER WITH REMITTANCE TO
W. L. Benedict, M.D.
100 First Avenue Building
Rochester, Minnesota
Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1
 aw
* DRA LASMA TO
19 T, DETERGENT;
it BACTERICIDAL, DEODO
* BIBLIOGRAPHY
Arch. Otolaryngol.,
43:605, 1946.
E., E., N., & T. Mo.,
26:27, 1947.
Laryngoscope,
56:556, 1946.
New Eng. J. Med.,
234:468, 1946.
Annals of Allergy,
4:33, 1946.
J. A. Ph., A., (Sc. Ed.)
35:304, 1946.
Literature on request.
Clinical studies concerned with the use of
Glycerite of Hydrogen Peroxide in the treatment of
chronic purulent otitis media demonstrated seventeen
of twenty-nine patients in complete remission in 14
days and the remainder by the 38th day. The pa-
tients studied presented conditions existent for pe-
riods of 2 weeks to over 40 years. Previous treat-
ment by the usual therapeutic means, including
tyrothricin or penicillin, was ineffective in all
cases.
Constituents:
Hydrogen Peroxide 1.446%, Urea (Carbamide) 2.554%, 8-Hydroxyquinoline 0.1%.
Dissolved and stabilized in substantially anhydrous glycerol.. . q.s. ad. 30cc.
Available on prescription in one-ounce bottle with dropper.
Administration: One-half dropperful two to four times daily.
~nlPhna~idna~ PHARMACEUTICAL CORPORATION
Approved For Release 2002/07/2t4fpQf9A~8A0i1,33d09fl~60~4a#
 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1
THE AMERICAN ACADEMY OF
OPHTHALMOLOGY AND OTOLARYNGOLOGY
takes pleasure in announcing
the new motion picture film
THE EMBRYOLOGY OF THE EYE
Based on material made available by
The Carnegie Institution of Washington,
this 16 nun. film in sound and color meets a long-felt need
in the teaching of ophthalmology.
Per Print - $250.00
Available on one reel or in two parts on two reels
W. L. BENEDICT, M.D.
100 First Avenue Building
Rochester, Minnesota
Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1