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Due to an Exogenous Infection Suchas Br J Ophthalmol: first published as 10.1136/bjo.30.6.324 on 1 June 1946. Downloaded from 324 HOWARD. REED AETIOLOGY OF IRIDOCYCLITIS IN THE AFRICAN* 'BY HOWARD. REED MEDICAL OFFICER, TANGANYIKA TERRITORY WHILST statibned at Mwanza in Lake Province in 1944, I saw 42 cases of iridocyclitis in Africans. As soon as a d'iagnosis of iridocyclitis was made I attempted to persuade the patient to stay in hospital so that he could be under. continuous observation and treatment. I often failed to gain acquiescence, and occasionally 'the patie-nt took fright at the' mere suggestion and I never saw him again. Nevertheless,' I was able to investigate and treat 28 cases fairly thoroughly. The other 14 cases were not investigated fully and are not included. This unwillingness to stay in hospital is readily understood. In the case of a man it means that his wife and family are alone and unprotected, a very real factor in Mwanza where thieving is so common. Moreover, " white" medicine is strange and the.native is apt to regard disease as "shauri. ya Mungu " (Fate or will of God) so that holding over his head the threat of losing his sight has little effect. Faith in the witch doctor .dies hard. White " medicine is tried only after native medicine has failed. I found one native just after he had been admitted to the ward chewing with great determination and discovered on close questioning that it was native medicine to protect him from harm whilst in hospital. For the purpose, of this article cases which would be diagnosed http://bjo.bmj.com/ clinically as iritis or as cyclitis have been included under the one term iridocyclitis for convenience and also because, even when the inflammation appears to be confined to either the ciliary body or the iris, the other is bound to be affected. Iridocyclitis may be: (1) Secondary to a local injury, inflammation or toxic process on October 1, 2021 by guest. Protected copyright. e..g., a keratitis or scleritis or an intra-ocular pathological process such as a neoplasm or haemorrhage. (2) Due to an exogenous infection such as a perforating injury or intra-ocular parasites. (3) Due to an endogenous infection e.g., syphilis, gonorrhoea, relapsing fever or a septic focus. The aetiology of the first two groups gives rise to no difficulties but the last group of causes i's far 'from being understood and it is with this last group that this article is concerned. * Received for publication, November 15, 1945. Br J Ophthalmol: first published as 10.1136/bjo.30.6.324 on 1 June 1946. Downloaded from IRIDOCYCLITS1IN THE AFRICAN 325 All the observations on the cases were made with focal illumnina- tion, a corneal' loupe. and an. ophthalmoscope. A slit-lamp was not available-. The microscopic examinations were carried out as shown in Table II and no negative finding was accepted until several specimens had been examined on separate occasions but it was not possible to make more elaborate investigations such as cultures of the aqueous, urine, septic..material from tooth sockets and swabbings from tonsils and sinuses, etc. Comments on tables of cases Although in each case I have recorded the period which the patient gave as the duration of the disease' before he consulted me, I do-not place great reliance upon these statements. The African lives from day to day with little thought for to-morrow or, perhaps it is truer to say, an indifference to the future. He is rarely really well and he is unlikely to notice a slight blurring of the vision of one eye and still more unlikely to come to hospital unless the pain. is severe or the vision markedly diminished. Quite'often the patient came complaining merely.of 'pain and was most sur- prised to find during the examination that he was unable to see with the affected eye. I think it is probable, therefore, that the periods given. in the. table of the duration of the disease before treatment are considerably under-estimated. The dearth of female cases of iridocyclitis in the above series is most noticeable. There was only one female patient (case No. 7) whom I was able to investigate at all fully, and there were two other female cases amongst the 14 patients who refused to http://bjo.bmj.com/ stay in hospital. In one, an adult, the.disease was almost cer- tainly due to syphilis, and in the other, a young child,. it was probably due to tick-fever since she said she had had a high fever a few weeks'before and ticks were later discovered in her house. It is difficult to explain the preponderance of males. Undoubtedly the native woman's fear of'leaving her-husband and family plays on October 1, 2021 by guest. Protected copyright. a large part but this would explain the unwillingness to stay in hospital rather than the small number of women with.iridocyclitis who were seen. Notes on treatment A brief account -of the main lines of treatment may prove of interest. All treatment was made as routine as possible to avoid confusion because few of the African dressers were able to read very well and their capacity for forgetting to do any treatment out of the usual routine was extraordinary. On admission the following treatment was given to every patient until the results of the investigations were received. Br J Ophthalmol: first published as 10.1136/bjo.30.6.324 on 1 June 1946. 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