The following is an excerpt from a paper published in the Journal of Ophthalmology, Otology and Laryngology, November, 1917, but which really is of interest to the general practitioner of medicine as well as to the eye specialist. “Iritis is a local manifestation of a constitutional condition.” (The causes are syphilis, gonococcal infection, tuberculosis, dental infection, tonsillar infection, sinus infection, genito – urinary, non – venereal, combined infections, etc. In a very few per cent, of cases can no cause be found.)
“A report on 500 cases of iritis from the records of Wills Eye Hospital is given by C.W. Jennings and Emory Hill (Ophthalmology, April, 1909). Report shows that syphilis, rheumatism and gonorrhoea caused 92 per cent. of the cases.
“This is where your careful history taking will show itself. A man may have a gonorrhoeal discharge and a sore eye at the same time, but will never connect the two unless the ophthalmologist is keen enough to find it out.
“In so far as the different laboratory returns are at hand, I govern my treatment accordingly, but until everything has been reported upon I withhold my final opinion and prognostication in the case.
“I do not treat syphilis or gonorrhoea or rheumatism or infected teeth; in fact, I do not consider any oculist capable, regardless of what his reputation, experience and ability may be in his chosen line of work, of caring for properly and scientifically the complicating factors which we find in every case of iritis.
“If my patient has a plus Wassermann I send him to a man who specializes in the treatment of syphilis; if he has gonorrhoea or prostatitis or cystitis he is referred to a genito – urinary specialist for treatment; if a rheumatic condition is proven to be present a physician who treats such cases is called in. Of course, it goes without saying that a dentist is always required to care for any, faulty family condition found in the teeth.
“I would like to report just one case to illustrate:
“NAME: G.G. ADDRESS: Illinois. AGE: 25 years. DATE: February 5, 1917. OCCUPATION: Prize fighter. HISTORY: Has had eye trouble for several weeks with almost unbearable pain for the past ten days. Recurrent attacks of iritis and irido – cyclitis, which had been treated at different times by different specialists (men of reputation) in different parts of the country with no results. FINDINGS: Pterygium in both eyes towards the internal canthus; marked tenderness over ciliary body; contracted pupil which did not react to light and accommodation.
“My routine examination was carried out and I found the man suffering from a gonorrhoea which had been improperly treated, in fact, had never been cured. As soon as the assistance of a competent genito – urinary man was obtained the eye began to get well, and he has had no recurrence to date of any kind whatsoever.
“This patient stated that in no instance did any oculist ever suggest any general examination or ask if he had ever had gonorrhoea, to say nothing of questioning him as to the present condition of his sexual organs.
“The question night be raised as to the probable expense placed upon the patient in these numerous laboratory and other examinations required. I will say this, that I have never yet asked a favor from laboratory or consultants which has not been freely granted which makes it possible to obtain this service for the deserving patient either gratis or for a very small consideration.
“CONCLUSIONS.- No physician who limits his field of work to the eye, ear, nose and throat should undertake to treat constitutionally anyone suffering from iritis without the assistance of the general practitioner or specialist who cars for the contributory factors in the case. Team work is absolutely essential, both in diagnosis and treatment, and without it very unsatisfactory results are obtained both from physicians and patients standpoint.
“Systematize and standardize your examination; do not prognosticate until your search for etiological factors is complete. Take the proper time to care for each individual and that combined with a very small amount of research ability will save you many embarrassments.