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42 HADITJ M
gestion of the eve which are associated with the appearance or grams
such as timothy in the country, and in the congestion and uncomfortable
itching which occurs in types'of vernal catarrh it acts very favorably.
Dr. Hesry K. Pasoust. Philadelphia, Pa.—To us the most important
point in connection with a case at the beginning is the diagnosis.
Personally. I am not competent to make a diagnosis of vernal catarrh
in all cases. I have known of at least one case being diagnosed trachoma
by one ophthalmologist, by another vernal catarrh, and sent to me for
treatment. It was treated for vernal catarrh, but if the condition was
trachoma the treatment might succeed, though more radiation is necessary.
In our early cases inexperience might have resulted in lack of
care in not keeping the radiation distributed evenly over the lid. This
is especially difficult with children who are struggling. The entire lid
wherever involved -hould be treated evenly. The applicator should never
be held in one place unless it is a special one made of the same size and
shape as the lid.
It is practically impossible to assure the patient that the lashes will
not come out following treatment. We all know that hair follicles are
extremely susceptible to radiation. Even erythema doses will cause falling
of hair anywhere, and in case of the eyelid the follicles are extremely
close to the surface and the radiation must reach them. After our first
experience we have always told the patient that the lashes are likely to
fall out. but in our experience they usually grow back. The two cases
that have been mentioned here are the only ones I know of in which
the lashes have not returned.
It is very important not to persist in the treatment too long, because
of the certainty of scarring of the lids, which is undesirable. If we do
not get the result we desire within a reasonable time and with a few
applications, we would rather stop than to treat the case further.
We always prefer to treat patients during the cold season in order
that the reaction, which is unavoidable because of the nature of the
treatment, may not add to the discomfort of the patient during the sea-
>on of activity. The principle of radiation treatment requires a reaction
and if we get no reaction we get no result.
The treatment of the bulbar conjunctiva is something that I always
go about with a great deal of fear and trepidation, because the reaction
in the eyeball, even though it may be slight, causes a great deal of discomfort
to the patient and one never knows how severe that reaction
will be. We never would give the same dose over the eyeball that we
would over the lid. The dosage which Dr. Jackson has given you is
practically the same as is used by everyone, whether it be expressed
in terms of millicurie hours or milligram hours. The whole secret is the
use of the beta radiation with very little filtrationin order that you
may not get too much penetration over a very thin structure.
Dr. Posey i in closing). -It is a great source of satisfaction to hear
from these gentlemen that the results from radium are so favorable.
There is no doubt that the failure to recognize this condition has
been widespread. Twenty years ago. when I sent my letter to 500 ophthalmologists
all over the country asking them how manv cases thev
had seen. I remember the Professor of Ophthalmology in a well-known
medical college sent back word that vernal conjunctivitis was verv common
in his region, and that they saw hundreds of cases in the spring
of every year, he of course mistaking vernal conjunctivitis for acute
catarrhal conjunctivitis.