some traumatic surgery resulting from local accidents, alcoholic excess, assaults, and the acts of fools.In June, 1942, and the few anxious months which followed and preceded General Montgomery's offensive at Alamein, it was my privilege to command a rifle company in defence of the hospital against attack from parachutists, fifth columnists, and any nativre rioting, should this arise. Much attention was paid to key points, fields of fire, and other features of such co-ordinated aggression as we could bring to bear against any opponents.Such things are temporarily interesting distractions from-the small but very pleasant field of eye surgery.I am indeed grateful to Cpl. W. Buyers, the eye department orderly, -whose industry, resourcefulness and constant good humour did so much for our patients and the efficiency of the team.I thank Brigadier G. I.
A WORKER in a pharmaceutical laboratory presented himself complaining of bloodshot eyes which had existed for six days. He hardly felt any discomfort apart from an occasional slight itching; no lacrimation or secretion were present.On examination both eves were found to be bloodshot, the bulbar conjunctiva being injected only in, the area exposed to the air. Neither the palpebral conjunctiva nor the bulbar conjunctiva normally covered by it-shoked any changes. The line of demarcation between the hy,peraemic and -the normal bulbar conjunctiva was rather sharply defined. The cornea was normal. Apart from the hyperaemia, the slightly oedematous conjunctiva had a peculiar opaque aspect, the superficial vessels only being clearlv visible. Especially on the slit-lamp this opaqueness of the bulbar conjunctiva was striking.A conjunctival smewr did not show any organisms. A drop of adrenalin solution 1: 1000 reduced the congestion considerably and the conjunctiva took the aspect of a opaline glass.The clinical picture-hyperaemia and infiltration of the exposed bulbar conjunctiva-together with the iuiformation as to the occupation of the patient, suggested a chemical agent as the cause for the condition. This substance would probably be present in the atmosphere in the form of a vapour or fume; dust would be washed into the inferior fornix and exert its irritating action there, while the fornix was entirely normal.The patient had been engaged in work entailing the use of dimethyl-sulfate, a substance which is used to introduce the methyl group into certain chemical compounds.Dimethyl-sulfate (CH3)2S04, is, a colourless, heavy oil which has a boiling-point of ca. 1880 C. Direct application to the skin produces a very intensive reaction, and its vapours are known to have an irritative effect on the mucous membranes. Prolonged exposure to it may cause serious nervous symptoms.The noxious effect of dimethvl-s'ulfate on the eyes has been subject to a number of publications at the beginning of this century.Weber' was the first to recognize its toxicity and published three cases: two were workers who had been exposed to dimethyl-sulfate fumes in the course of their work; one of them died from lung
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