Intra-ocular operations in Egypt.

The last-named may also be due to purulent ophthalmia, which is more prevalent in Eastern countries (Egypt, Palestine, Syria, India, etc.). In Egypt many patients are also affected by cataract, glaucoma with sunken globes, narrow palpebral fissures, and narrow or obliterated fornices. The sphincter iridis in brown and black eyes is stronger than that in green or blue eyes, and the extra-ocular muscles are also stronger, so that " squeezers" during operations are more often found in the East, and the pupil sometimes does not attain full or even half dilatation, even under strong mydriatics. Trachoma, which affects about 95 per cent. of the population in Egypt, is mainly responsible for these complications, but gonococcal infection, and KochWeeks, Morax-Axenfeld, pneumococcal, and other bacterial infections cause many complications in secondary cataract. In the summer the majority of hospital out-patients (46 per cent.) attend on account of gonococcal infection, and 23 per cent. on account of Koch-Weeks and Morax-Axenfeld infection. These provoke such complications as perforated ulcers, nebulae, and glaucoma with secondary cataract. In 1950, I visited a number of hospitals in Pa-is, and there happened to see a smear taken from a small child who was being treated for conjunctivitis. When I asked the laboratory assistant about the percentage of cases affected with gonococcal and Koch-Weeks ophthalmia or other micro-organisms, she replied that she did not expect to see a single case infected with gonorrhea during the whole year. The child in question was suffering from a mild pneumococcal infection, and the assistant added that these were also very few. In Egypt, gonococcal infection is prevalent throughout the whole year and becomes epidemic from June to November (MacCallan, 1916). In 1922 certain cases of diphtheritic conjunctivitis (Girgis, 1923) were complicated with gangrene of the orbit leading to the death of the patient, or to nebulae and leucoma