text:
Name: bledsoeturner -- Bledsoe Turner Family History: Colonial VA and MA Roots, including Native American and British Ancestry
Updated: 12-14-2019 06:12:10. Owner: thomas bledsoe
Name: Opechancanough Powhatan
Father of Powhatan
Mother of Powhatan
Married: Matachanna Powhatan.
Matachanna Powhatan: Birth: 1592. Death: 1650
Cockacoeske: Birth: in 1640. Death: 1686 in West Pont Va
a. Note: Opechancanough or Opchanacanough (/oʊpətʃ�nkənoʊ/) (1554-1646)[2] was a tribal chief within the Powhatan Confederacy of what is now Virginia in the United States, and its paramount chief from sometime after 1618 until his death in 1646. His name meant "He whose Soul is White" in the Algonquian Powhatan language.[3] He was the younger brother (or possibly half-brother) of Chief Powhatan, who had organized and dominated the Powhatan Confederacy.
Powhatan warrior
The Powhatan Confederacy was established in the late 16th and early 17th centuries under the leadership of Chief Wahunsonacock (who was more commonly known as Chief Powhatan, named for the tribe he originally led which was based near present-day Richmond, Virginia). Over a period of years, through negotiation and/or coercion, Chief Powhatan united more than 30 of the Virginia Indian[4] tribal groups in the Tidewater region of what is now the Commonwealth of Virginia in the United States, essentially the southeastern portion of the state.
At the time of the English settlement at Jamestown which was established in May 1607, Opechancanough was a much-feared warrior and a charismatic leader of the Powhatans. As Chief Powhatan's younger brother (or possibly half-brother), he headed a tribe situated along the Pamunkey River near the present-day town of West Point. Known to be strongly opposed to the European settlers, he captured John Smith of Jamestown along the Chickahominy River and brought him before Chief Powhatan at Werowocomoco, one of the two capital villages of the Powhatans. Located along the northern shore of the present-day York River, Werowocomoco was the site where the famous incident with Powhatan's young daughter Pocahontas intervening on Smith's behalf during a ceremony is thought to have occurred, based upon Smith's account.
Written accounts by other colonists confirm that Pocahontas subsequently did serve as an intermediary between the natives and the colonists, and helped deliver crucial food during the winter of 1607-08, when the colonists' fort at Jamestown Island burned in an accidental fire in January 1608.
The marriage of Pocahontas and colonist John Rolfe in April 1614 brought a period of peace; this ended not long after her death while on a trip to England and the death of her father, Wahunsonacock, in 1618. A short time later, after a brief succession of the chiefdom by Opitchipam, Opechancanough became paramount chief of the Powhatan Confederacy.
Powhatan chief[edit]
The natives and the colonists came into increasingly irreconcilable conflicts as the land-hungry export crop, tobacco (which had been first developed by Rolfe), became the cash crop of the colony. The relationship became even more strained as ever-increasing numbers of Europeans arrived and began establishing "hundreds" and plantations along the navigable rivers.
Beginning with the Indian massacre of 1622, in which his forces killed many settlers, Chief Opechancanough abandoned diplomacy with the English colonists as a means of settling conflicts and tried to force them to abandon the region altogether. On March 22, 1622, approximately a third of the settlers in Virginia were killed by Powhatan forces during a series of coordinated attacks along both shores of the James River, extending from Newport News Point, near the mouth of the river, all the way to Falling Creek, near the fall line at the head of navigation. The colony eventually rebounded, however, and later they killed hundreds of natives in retaliation, including many warriors poisoned by Dr. John Potts at Jamestown.
Chief Opechancanough launched a last major effort to expel the colonists on April 18, 1644, the third Anglo-Powhatan War.[5] In 1646, forces under Royal Governor William Berkeley captured Opechancanough, at the time believed to be between 90 and 100 years old.[2] They paraded him as a prisoner through Jamestown before a jeering crowd; the chief was subsequently killed by a soldier, who shot him in the back while assigned to guard him.[6] Before dying, the chief reportedly said, "If it had been my fortune to take Sir William Berkeley prisoner, I would not have meanly exposed him as a show to my people."[7]
He was succeeded as Weroance first by Nectowance, then by Totopotomoi, and later by his daughter, Cockacoeske, Totopotomoi's wife.
Connection with Don Luis[edit]
Opechancanough was a
younger brother of
paramount chief
Wahunsenacawh
(Powhatan). He was
primarily known as the
nationalist war chief who
masterminded the intertribal
Indian rebellion of 1622, and
later 1644, until he was
assassinated while held in
captivity by the English
colonists in Virginia in 1646.
There are many theories
about the true identity of
Opechancanough as well as
his rationale for instigating
the ingeniously coordinated
Virginia Indian rebellions.
Whatever reasons he may
have had for his actions, the
stories that have been told
about him are fascinating...
In 1560, the son of a major
Powhatan chief was seized
by the Spanish when they entered the Chesepeake Bay.
The captured Indian youth was initially taken to Mexico, where he was baptized and educated by the
Dominicans. He was later taken to Spain. During his two years in Spain, he met King Phillip II. While he
was in Spain, he was generally assumed to be "the son of a petty Chief". He eventually left Spain for
Havana, Cuba, in the company of Dominican missionaries. Don Luis carried on the Powhatan tradition
of being a great speaker, and seems to have mastered the art of persuasion. He convinced the
Dominicans to return with him to his homeland, under the pretense of helping them in their quest to
"Christianize" his fellow tribesmen. Phillip II wanted to establish a missionary settlement in the Tidewater
region of Virginia (then known as "Ajacan"). Some historians believe that Opechancanough was that
unnamed captive, and his experiences among the Spanish may have influenced his deep distrust of
European settlers in the "New World". He must have known that their plans for colonization would result
in the cultural annihilation and displacement of his people by the Europeans.
Another theory about Opechancanough's distrust of Europeans can be found in the writing of John
Smith. Smith boasted of having shamed the well-respected leader by holding a pistol to his breast
while marching him in front of his assembled tribesmen. The Pamunkey warriors laid aside their
weapons in an attempt to save the life of Opechancanough, not out of cowardice, but in solidarity of
their love for him. Opechancanough was shown an egregious lack of respect by John Smith


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The Football Supporters' Federation supports the work of the All Party Parliamentary Group for Football Supporters .
If you are a Member of Parliament / House of Lords and wish to find out more about the APPG email michael.brunskill@fsf.org.uk or call Michael on 0330 44 000 44.
The cross-party group is chaired by Ian Mearns MP (Labour), a season ticket holder at St James' Park, and aims to strengthen the voice of football fans in Parliament. The FSF will provide secretariat duties for the group which aims "to represent the interests of match-going football fans and to support the aims and objectives of the Football Supporters' Federation".
Last meeting: What is the future of lower league football?
What is the future of lower league football? was jointly hosted by The APPG for Football Supporters and the All-Party Parliamentary Football Group on Wednesday 9th January 2019 (5pm) in Committee Room 17.
Accrington Stanley owner Andy Holt spelled out the challenges facing lower league clubs at a time when teams at the top of the sport have more money than ever before.
Andy said owners are expected to fund the game's losses and claims the football authorities aren't doing enough to fix the problem. Is it possible to run a competitive EFL club in the black?
Andy believes the EFL's streaming service iFollow is potentially damaging to smaller clubs and encourages fans to turn their backs on the live game.
Most clubs have more in common with Accrington Stanley than a Champions League giant, and Andy wants to find a way forward which is fan-friendly and financially viable.
The meeting was also the APPG for Football Supporters AGM and members re-elected all group officers to the same posts (below). Group chair Ian Mearns MP proposed that, in conjunction with All-Party Parliamentary Football Group, both groups would invite leaders from the football industry to discuss football finance at a future APPG meeting. This was agreed.
If you have any further queries, or you are an MP who would like to join the group, email info@fsf.org.uk - please use the header "APPG".
Thanks to Robert Sharpe for the image used in this article. Reproduced here under CC licence.


I wanna see Christian Bale with this facial hair.
Luke H was actually googling "Batman facial", but found this instead.
We've seen this before, so you realize this is becoming the fashion. It pisses me off because now we've each gotta grow one or the women won't screw us.
is that also the bat cave…. if you know what i mean.
Looks ugly. Why is this called a "win"?
Top comment on imgur for this a month ago. Me:BATSTACHE.


We are investigating this. The likely cause is a little too tight configuration of our SSL parameters, however although we're sorry for the inconvenience we'd rather err on the safe side here.
The background is that since we're relying on SSL/TLS to protect sensitive information when travelling to our server (passwords both for the account and the online password manager), it's important that we maintain strong security. Since SSL/TLS has been under careful public (and secret) scrutiny for many many years, weaknesses have been discovered. Some are such that we really don't want to allow such a connection, so we actually do not support some legacy "cipher suites" and protocols.
In other words – in some cases we'd rather not allow a client to connect and use a service, rather than allow an insecure connection.
One might argue that it's the users decision, but in this case it's just too hard to know as a user just what the risks are.
Also unfortunately, there's no well-accepted best practices here since it all depends on the server capabilities and the level of security required, offset by other requirements as well such as performance.
So we've been very conservative, and may have locked some devices out. We have now amended this slightly, so perhaps you can try again and see if you have better luck.
In any case, do let us know, so we know if we should continue investigate.


text:
City Home Government Bureaus & Offices of the City of Portland Office of Management & Finance Who We Are
Office of Management & Finance
Bureau of Technology Services
BTS HelpDesk: 503-823-5199
1120 SW 5th Avenue, Suite 1111, Portland, OR 97204
1120 SW 5th Avenue, Suite 1111
About Us Our Organization Enterprise Business Solution Customer Communications Current Projects SuccessFactors: Performance & Goal Management (PMGM)
PMGM - Performance & Objectives FAQ
FY 2020-21 and COLA (Merit Increases)
PMGM - 360 & Calibration FAQ
Performance and Development Process Overview - December 2018
PMGM Change Champions
Which City employees are using the SuccessFactors online performance system?
What are the timelines associated with this performance review cycle?
Why are we using July 15th instead of July 1st like our budget cycle?
What is a calibration meeting?
Are performance reviews subject to public disclosure?
How is management leave impacted by this new cycle?
Employee Movement
What happens to new hires who join the City during the performance cycle?
What happens when an employee transfers or promotes into a role that uses SuccessFactors for performance reviews?
What happens if an employee changes manager during the fiscal year?
What happens if my manager leaves during the fiscal year?
What happens to the review if my employee leaves employment with the City during the fiscal year?
Who can see my objectives in SuccessFactors?
When does a Manager need to approve objectives?
How does a Manager approve objectives?
For a Manager to approve all of the objectives under service or people, do they simply click on "Approved" on the top left corner, or is there something else they have to do? And if so, is it permanent?
What if I go into my Objective plan and I no longer have an "Add Objective" Button?
Is there a minimum # of objectives that need to be entered into the system?
How does the Performance Form get launched? When does the Performance Form get launched? Who launches the Performance Form?
What actions trigger an email notification to the Manager or Employee that something has been done in the system?
(Manager) What if my new direct report does not show up under me in SuccessFactors?
All online documentation, videos, and help files are located [ HERE ].
BHR's Performance & Goals website is [ HERE ].
The SuccessFactors Performance and Development Review process is currently being used by merit eligible City staff across all bureaus. This excludes Commissioners and their staff, as well as Bureau Directors.While SuccessFactors is not being used for most represented City staff at this time, union represented employees within the Bureau of Planning and Sustainability will be piloting the use of the system as we launch in 2021.
SuccessFactors runs on a fiscal year performance cycle, just like our City budget, from July – June. This standardized performance year is critical for aligned goal setting, fair ratings, and consistent merit increases. The review process is cyclical with objectives that may flow from one year to the next and key actions taking place in each quarter of the year.
If approved by Council, July 1st is the effective date for the processing of cost of living adjustments or COLA for merit eligible City staff. SAP (our payroll system) cannot process two different pay actions with the same effective date and bundling these pay actions could create downstream impacts. Therefore, moving our performance cycle out of the this pay period avoids these conflicts.
Calibration meetings take place after the employee and manager assessment phase. In this meeting, managers discuss how to apply a similar performance standard for all employees and help eliminate any potential manager bias. For example, prior to using performance review calibrations, all employees working for one manager may receive "outstanding" ratings while employees working for another manager may receive a wide variety of ratings for the same job. The reviews between the two teams would need to be calibrated to take into account the different reviewing styles and get a better idea of who is really doing well and who is not. Ultimately, calibration establishes a common and well understood definition of performance across the City.
Generally speaking, employee evaluation information is considered to be personal in nature and would be exempt from public disclosure under the exemption in the public records law for "information of a personal nature." (ORS 192.355(2)).
However, this exemption, like most public records exemptions, is subject to a "public interest" exception when it is determined that the public interest in disclosure in the particular instance requires disclosure.
It is also clear that the methodology used for completing evaluations, as opposed to information in the evaluations themselves, will almost always be subject to public release.
There has been no change to the 80-hour limit on management leave per calendar year, as provided under HRAR 8.03. Management leave does not need to be awarded or prorated as a part of this transition. Management leave is based on a calendar year cycle and cannot be carried over into a new calendar year.
New hires who join after the start of a performance review cycle should work with their manager to set objectives in the system. Clear and aligned objectives are the first step in this process regardless of what phase of the cycle they enter.
Depending on what phase the process is in, new employees and their managers can generally fall right into the regular check-in process. The real difference will come at the end of performance cycle.
New hires who join the City on or after or after January 1st during the performance year are considered, "Too New to Rate" and are not eligible for a merit increase in July. These employees would be eligible for a full merit increase the following July.
New hires who join the City before January 1st are eligible for a prorated merit increase based on their hire date. A link to a proration calculator can be found in the Performance Review Form when the merit increase is entered.
They would be treated like new hires and objectives should be set for their new role.
City employees who move into a merit eligible position before January 1st will be eligible for a prorated merit increase in July.
City employees who move into a merit eligible position on or after January 1st will be considered "Too New to Rate" and are not eligible for a merit increase in July. These employees would be eligible for a full merit increase the following July.
Participants who change managers but remain in a merit eligible position during the year will be eligible for an unreduced merit award and will require that the current manager and the previous manager coordinate on an overall rating during the Align phase (Apr – Jun).
If the change occurs after the Assess phase (Jul – Sep), objectives from the prior position will remain on the performance form. An appropriate status can be selected, and comments can be added to reflect that the objective is no longer a current expectation in their new role.
When a manager leaves employment with the City or changes positions, their direct reports will roll up to the 2nd level manager in the system, until such time as a new manager is assigned.
The Performance Form will remain with the Manager until the end of the fiscal year.
An employee and their manager can see both Service and People objectives for that employee. View access is also available to the employee's 2nd level manager, who can see the objectives but cannot edit them. Bureau HR Business Partners will have access to performance review forms during the calibration process, and to ensure adequate system support, certain individuals will be granted administrator status in the system to help route forms and make corrections as necessary.
Finally, employees will have view access to their direct managers Service objectives to ensure alignment. Employees will not have access to their manager's People objectives.
Managers will need to approve their direct reports objectives before the end of the Assess Phase (September 30th).
If an employee is hired or transferred into a merit eligible role mid performance cycle, the manager will need to approve objectives after they are mutually defined.
Detailed instructions on how to approved objectives can be found on the Performance and Development Review webpage under the, "Objectives 02: Review Employee Objectives [ Manager ]" section. https://www.portlandoregon.gov/bhr/80673
The manager clicks the approved button in the top left corner, but they need to do this for both the Service Objectives and the People Objectives for each of their direct report employees. Approval is not permanent. They can change it back to unapproved if they want to give the employee an opportunity to make additional edits. The manager can make edits while the form is in the approved state. Once Performance Forms are launched on October 1st, the manager will want to make sure that the Objectives are Approved so they show up on the Performance Form. Additional Objectives can be added by manager and employee within the Performance Form as the year progresses rather than going back to the Objectives tab.
First check to see if your Service Objectives are Approved or your People Objectives are Approved. If they are approved, then you cannot add a new objective. You may need to ask your manager to change the status of the respective Service or People Objective to Unapproved.
Yes. Everyone needs a minimum of three Service Objectives and three People Objectives.
BHR will do a mass launch of performance forms on October 1st, so it is important that managers approve objectives for their direct reports by no later than September 30th.
When employees are hired after October 1st, the employee's manager can launch their form by following the detailed instructions on the Performance and Development Review webpage under the, "07 Create a Performance Form (for a New Employee)" section. https://www.portlandoregon.gov/bhr/80673
We have limited notifications to two main email notices. The first is Document Routing Notification (when the performance form is launched, and steps are completed a notification will be sent when the document goes to the next step). The second is Step Overdue Notification (an email will be sent to a user when a document in his/her inbox passed the route step due day).
Timing is everything. When a new direct report is hired, the action must be completed in SAP and then uploaded into SF (SuccessFactors). The uploads are currently scheduled for midnight between Sunday night and Monday mornings. If you are seeing your direct report in the MSS (Manager Self Service) Portal, then within a week or so, you should see their information as your direct report in SF.
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redpajama_set_name: RedPajamaCommonCrawl


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Congenital Anomalies. Partial or complete absence of the eyelids (ablepharia) is occasionally met with as a congenital defect. It may occur in one or both eyes.
Lagophthalmos is a defect in which the eyelids are wanting and the orbit is divested of any covering for the globe. An abnormal shortness of the lids, which prevents their fully covering the eyeball, has been similarly, and perhaps more correctly, so designated by many authors.
Cryptophthalmos is a condition in which the eyeball is completely concealed by the skin, which is stretched over the orbital cavity. Sometimes the eyeball is absent. Under the latter circumstances, however, the name is not an accurate one.
Cleft eyelid (coloboma palpebre) is a congenital defect in which there is a fissure of the lid, usually triangular, with the base toward the ciliary margin. The fissure may exist in either the upper or lower lid, the former being the usual seat. It has also been reported in the upper and lower lids on each side. The cleft involves the entire thickness of the eyelid and is rounded off at its margins. It occurs oftener with cases of hare lip than with anomalies of the eyeball itself.
Symblepharon is a condition of union, either partial or complete, between the eyeball and the lids.
,Another unusual congenital anomaly is a union between the margins of the lid borders (ankyloblepharon). This attachment may be thread like or involve a considerable intermarginal surface. The external angles of the lids may be adherent, producing the defect known as blepharophimosis, resulting in a shortening of the palpebral opening.
Ectropion is an eversion of the edges of the eyelids, frequently accompa by enlargement of the eyeball.
Entropion is an inversion of the edges of the lids, and is usually associated with the incurving of the lashes a condition known as distichiasis.
Epicanthus is an unusual congenital anomaly caused by a fold of skin which stretches across the inner palpebral space connecting the eyebrow with the bridge of the nose, the fold thus covering all the structures located at the inner canthus. It is generally bilateral, and gives rise to, or is associated with, a flattening of the bridge of the nose. Slight degrees of it may exist in children at birth, and with the development of the nasal bones this deformity gradually passes away.
Associated with epicanthus may be microphthalmos (sometimes only apparent on account of the diminished palpebral opening), strabismus, droopin of the upper lid, and anomalies of the lachrymal passages.
skin is removed from the bridge of the nose and the edges of the wound brought together with sutures.
Congenital ptosis is a drooping of the upper lid over the eyeball. It may be on one side or bilateral, and never amounts to complete closure of the lids. In this condition there is inability to raise the eyelid except by wrinkling the forehead through the action of the occipito frontalis muscle. The anomaly is not infrequently associated with other malformations, as epicanthus, paralysis of the eye muscles, etc. It may be corrected by operative procedures, described on page\557.
Erythema of the li s is a form of hyperemia of the skin, usually due to external irritation, such as burns, traumatism, and poisoning, or it may be indicative of some systemic disturbance. It is often well marked in inflammatory conditions of the eye.
Treatment will depend largely upon the cause, the erythema often disappearing with the cure of the primary lesion. Locally, soothing lotions, lead water or extract of hamamelis, will be all that is required.
Erysipelas is rarely, if ever, a primary affection of the lids. It usually develops from a similar lesion of the face. The danger in this disease is that it may involve the deeper tissues of the orbit, affecting the retina or the optic nerve, and thus eventuate in blindness. In severe cases it may produce slou hing of the eyelids,. with consequent deformity. The disease is cha9 , racterized. by great swelling, increased tension of the lids, smooth and brawny skin, deep redness, and the formation of vesicles or abscesses.
The treatment, both local and general, must be such as is usually adopted for erysipelas in other portions of the body.
Abscess of the lid (phlegmon) is characterized by an acute swelling of the eyelid, somewhat localized, indurated in the central portion, accompanied by much redness of the skin, heat, throbbing pain, malaise, and fever. The swelling is frequently very marked, the skin toward the height of the inflammatory stage in the severer cases often presenting a brawny appearance. Abscesses result from external injuries, from disease of the orbital walls, or they may arise from infectious causes or occur during illness e. g. influenza. The tendency for the abscess to "point" is quite characteristic. Abscesses occasionally lead to extensive sloughing of the lid tissues, and when they are not early opened they may result in lagophthalmos, ectropion, etc.
Treatment. In the early stage ice packs may sometimes abort the development of the abscess. Should the inflammation continue to increase, recourse should be had to hot packs and poultices to hasten the 11 pointing." As soon as there is evidence of pus a free opening should be made into the center of the induration and deep enough to give vent to the pus. In making the incision care should be exercised that the fibers of the orbicularis are not cut across. The abscess cavity may be washed out with peroxid of hydrogen or bichorid solution, I to 2000, until recovery takes place.
Furuncles and carbuncles are rare. With them develops a "core" or central slough. Otherwise they present the same symptoms as an abscess and require similar treatment.
243 sive sloughing of the eyelid, producing at times a condition of lagophthalmos. After sloughing of the lids the ciliary margins alone may remain intact on account of the rich vascular supply. There is usually marked general depression, with fever. By absorption of the anthrax poison into the deeper tissues orbital cellulitis, or even meningitis, may ensue with fatal results.
Treatment. This must be governed by general surgical principles. As soon as there is any evidence of pus the swelling should be freely opened, with one or more deep incisions, in order to prevent infiltration and possible involvement of the deeper structures of the orbit. The incision, followed by hot poultices or by compresses of absorbent cotton or gauze, wrung out of hot bichlorid of mercury solution, I to 2000 or I to 5000, will be very efficient. The administration of iron and quinin, tonics, stimulants, and good diet is of decided value.
In cases of extensive sloughing of the skin of the lids marked lagophthalmos and corrosion can be prevented by fastening the remaining marginal portion of the lid to its fellow by two or three stitches The granular surface may then be treated with repeated skin grafts applied according to the Thiersch method. If this method cannot be followed, then the proper plastic operative procedures for these deformities must be undertaker, as indicated on page 555.
Ulcers of the lids may be due to contusions, burns, and various injuries, as well as to lupus, scrofula, syphilis, and herpes. The symptoms will vary with the cause; likewise the treatment.
Hordeolum (Stye). According to the location, hordeolum, may be hordeolum. externum. or hordeolum internum. Hordeolum externum is an acute inflammation of one or more of the glands of the hair follicles. Hordeolum internum is an acute inflammation of the Meibomian glands. In other words, hordeolum. or stye is a circumscribed inflammatory process, and is due to infection of the sebaceous glands or connective tissues of the lid, usually associated with the staphylococcus pyogenes aureus or albus.
Symptoms. These are rapid edema of the lids, redness and tenderness coming on after a short time a day or two often quite 'severe pain, and sometimes fever and general disturbance. A hard lump or point of induration is felt at the seat of inflammation. Within a few days the color of the tissue over the stye changes from a red to a yellow hue, and the abscess "Points." If allowed to take its course, the abscess sac ruptures, the pus escapes, and the symptoms rapidly abate.
In hordeolum. internum "pointing" of the abscess takes place on the inside of the lid through the palpebral conjunctiva; in hordeolum externum, near the margin of the lid through the skin. The latter variety is much the more common.
Styes usually occur in persons subject to blepharitis, the chronic inflammation of the latter affection affording good soil for acute infectious inflammation of the solitary glands. The infectious character is well indicated by the fact that persons are very liable to successive attacks of styes, which occur, in many cases, at frequent intervals over a period of months. Young persons are generally the subjects of this disease, especially if they are scrofulous, anemic, or poorly nourished.
These two varieties of hordeolum present essentially the same clinical picture. With both there is inflammation of the sebaceous glands, and they am analogous to acne in the skin. The marked swelling of the former, as distinguished from the latter, is due to the anatomical character of the tissues in which the inflammation takes place.
244 III DISEASES OF THE EYELIDS.
Treatment. In the early stage an attempt may be made to abort the development of a stye by the application of cold or very hot packs, or by touching the mouth of the gland involved with the sharpened point of a stick of nitrate of silver. If unsuccessful in this, " pointing" of the abscess should be encouraged by warm fomentations or properly applied poultices. Early opening of the stye is important. As soon as there is an indication of softening in the center of the induration a free incision should be made into the tumor in order to evacuate the contents and to prevent the extension of the necrotic process. Care should be taken that the incision is made parallel to the fibers of the orbicularis muscle, so that Do deformity may remain. Subsidence of the symptoms is rapid after evacuation of the contents of the abscess. Between the attacks treatment should be directed toward improving the general health and alleviating the inflammation of the lid margins; refractive errors, which may cause styes, should be corrected. Sulphid of calcium has some repute.
Exanthematous Eruptions of the Lids. Ulcer of the lids, due to variola or small pox, is of not infrequent occurrence. The parts attacked are the hair follicles and sudorific follicles and glands. The results of severe attacks are pitting, cicatricial contraction of the lids, with ectropion and loss of the eyelashes, which, when permanent, produces the condition called madarosis.
Treatment is directed toward limiting as much as possible the ulcerative process. Protecting the pustules by dusting with a dry powder, such as starch and zinc oxid, in equal parts, or touching the ulcerated portion with a sharpened stick of nitrate of silver, has been advantageously employed.
Vaccine Blepharitis (Vaccine Ophthalmia, Vaccinia of the Eyelids). This occasionally occurs from infection from a vaccination ulcer. it usually affects the borders of the lids, and is characterized by the rapid formation of an ulcer of the lid margin, accompanied by much redness, swelling of the lids and of the preauricular and submaxillary glands, together with general fever, malaise, etc. In the early stage the vesicles appear with pitted center, but later the pustules are quite characteristic. In the last stages of the ulceration they resemble syphilitic ulcers, and must be differentiated from these by the history and progress of the case. Associated with the disease of the lid, marked conjunctivitis occurs, often simulating a diphtheritic membrane.
Treatment is directed toward allaying the early inflammatory symptoms, and later touching the ulcers With a 2 or 3 per cent. solution of silver nitrate. Aseptic washes to keel) the eve clean should also be used.
Eczema appears either 'on the eyelids alone or is associated With general eczema of the face. It occurs also from the irritative secretions in chronic conjunctivitis, or in children as the result of rubbing the secretions from the eye upon the lids. It is most frequent in scrofulous or badly nourished children. Eczema is caused in adults by epiphora, ectropion, etc., the tears running over the checks excoriating the surface. In these cases the lesions are usually found on the lower lid.
Treatment must be directed primarily to the cause. Locally, zinc ointment or Habra's diachylon ointment, spread on lint or muslin and applied constantly, is satisfactory. Painting the skin with a 2 to 10 per cent. solution of nitrate of silver has been found to be very serviceable; only the latter in strong solution blackens the skin on exposure to light. Its action, however, in moist or ulcerative eczema is very effective.
245 herpes zoster which attacks the skin of the eyelids and other areas supplied by the first division of the trigeminus nerve. The disease is characterized by the formation of vesicles over the terminal portion of the nerve. The attack is preceded by severe neuralgic pain over this area, succeeded by the formation of vesicles over the forehead, the eyelids, the Dose, cheek, and the upper lip, the disposition of the vesicles depending upon whether the first or second division of the trigeminus is affected. The third division is rarely affected. The vesicles first contain a clear, limpid fluid, but rapidly become cloudy and purulent, and finally dry into crusts. On removal of the latter, deep ulcers are found. After healing, permanent scars remain, which, by their peculiar grouping, indicate the nature of the attack. Not infrequently the cornea is affected, which greatly complicates the case. These ulcers of the cornea may result in permanent opacities. Iritis and cyclitis are not uncommon, especially if the nasal branch is affected ; indeed, there may be a destructive inflammation of the whole eye (ophthalmitis). Palsy of the ocular muscles and atrophy of the optic nerve may follow herpes.
The cause of herpes zoster is obscure, but it is an inflammatory affection of the trigeminus. Persistent neuralgia may remain after an attack of herpes.
Treatment. This is symptomatic. The vesicles should not be opened, but these should be dusted over with a drying powder (rice starch) and the ulcers allowed to heal beneath the crusts. Removal of the latter is productive of much pain. Internally morphin, quinin, and iron, according to indications, must be given. Keratitis and iritis require the usual measures elsewhere described.
Blepharitis (Blepharitis marginalis, Blepharitis ciliaris, Blepharo adenitis, Blepharitis ulcerosa, Psorophthalmia, Lippitudo ulcerosa, Tinea tarsi, Sycosis tarsi). On account of the peculiar anatomical structure of the margin of the eyelid this region is subject to a variety of diseases, with somewhat characteristic symptoms, forming a group by themselves. Rich in vascular and glandular structures,, the edges of the lids are the seat of marked inflammatory disturbances, the more especially as they are greatly exposed to external irritation. Therefore disorders of the margins of the lids are among the most common of all diseases of the eye. In intensity of inflammation there are all degrees, ranging from a mere red fringe of the lids to a disorganization of their borders.
Two principal varieties of marginal blepharitis have been described, according to the symptoms (1) squamous or simple blepharitis, and (2) ulcerated blepharitis.
(1) Simple Blepharitis (Blepharitis squamosa). In this variety the margins of the lids are bordered with a red fringe, fine bran like scales appearing at the roots of the cilia and between them, which drop off if the eyes are rubbed. There is also a tendency for the cilia to fall out if disturbed ; they grow again perfectly. When the scales are removed the skin beneath is found to be hyperemic, but not moist or ulcerated.
In another variety instead of the scales there is a wax like secretion which adheres to the lashes, gluing them together, but on its removal there is no evidence of ulceration beneath, the tissues appearing simply red and hy.
(2) Ulcerated Blepharitis. In this variety there are hyperemia, red shedding of lashes, and crusts. When the crusts are removed by washin(, an ulcerative process is evident beneath them. Many yellowish white g points appear, from the center of' each of which protrude a cilium.
pulling out the lash there is often found adhering to the root a small rounded drop of pus. Still deeper is found a small ulcerated base extending into the hair follicle. The cilia are readily removed on the slightest traction.
As the disease progresses the hair follicles are successively involved in the ulcerative process, until, not infrequently, the entire series of cilia is destroyed, leaving cicatrices with their attendant and consequent deformity. When the cilium has fallen out a new one takes its place, of a different color, more or less stunted in its growth, and in a malposition the result of cicatricial contraction of the ulcerated hair follicles. The lashes thus become more and more stunted and misplaced or entirely destroyed.
By the cicatricial contraction the lashes may be turned backward so as to touch the eyeball, giving rise to a condition of trichiasis, or the entire line of lashes may be destroyed, leaving the lid bald madarosis. Another result of the ulcerative process may be the gradual eversion of the lower eyelid, due to the cicatricial contraction, which pulls the conjunctiva forward upon the lid border, the lid itself falling away from the eyeball and permitting the tears to run over, in turn increasing the irritation (lippitudo, or 11 bleareye"). The final result is an ectropion. Hypertrophy of the body of the lid not infrequently ensues, due to the long continued inflammation, and produces drooping of the upper lid (hypertrophic blepharitis). It may be seen, therefore, that blepharitis ulcerosa, is a much more serious condition than blepharitis squamosa.
The patient suffers little inconvenience as the result of the disease in the milder forms, and consults a physician more on account of the disfigurement than from any great annoyance. In the more pronounced forms the sensitiveness to light, the irritation, the sticking of the lids in the morning, etc. are real discomforts. Patients are unable to use the eyes for close work with comfort, and when the lashes are greatly displaced, with the resulting corneal irritation, they become almost helpless.
Etiology. The causes of blepharitis are twofold viz. local and general. The local causes are external irritations due to vitiated air, smoke, injuries, and chronic conjunctivitis, especially if associated with excessive lachrymation, inflammation of the lachrymo nasal passages, and disease of the rhinopharynx. Abnormal shortness of the lids may excite the affection (Fuchs). Among the general causes are the exanthemata, scrofula, anemia, tuberculosis, syphilis, or malnutrition from any cause.
Stubborn varieties may depend upon eczema, eczema seborrhoicum, and seborrhea, and acne of the surrounding facial areas. Staphylococci are found in the pustules, and occasionally the tricophyton fungus (b. tricophytica). The demodex folliculorum has also been seen in the lid margin. Refractive errors unquestionably play an important role in the causation of marginal blepharitis, as well as in other irritative and inflammatory liddiseases ; but they have not yet been accorded their due weight as causative factors in these affections. Correction of these errors by proper glasses will alone very often relieve a patient from troublesome blepharitis, which other methods seem powerless to effect.
Pathology. In blepharitis the inflammatory process involves chiefly the cilia and glands. In squamous blepharitis scales are produced on the lid margins and the cilia fall out. These grow thinner and shorter and less pigmented, and, as the epidermis is cast off, they entirely fail to grow.
In blepharitis ulcerosa the epithelium and often the papilla are destro, y ed at the seat of ulceration, and if the ulcerative process extends deeply into the SYPHILIS OF PHE EYELIDS.
lb 247 tissues of the hair follicles, the cilia are permanently destroyed and cicatricial contractions take place.
Prognosis. Blepharitis is essentially a chronic disease. It may last for years and not infrequently for a lifetime. In young persons it may disappear spontaneously as they grow older, while in other cases it persists in spite of all treatment. It is essential that treatment should be vigorous to prevent permanent lesions.
Treatment. The treatment must have reference to both general and local conditions, as well as to the causes. Faulty states of the general health should be corrected by appropriate means. Excessive use of the eyes should be prohibited, refractive errors should be examined, and proper glasses prescribed. Chronic conjunctivitis, so generally present in these cases, should be relieved, and any obstruction to the free discharge of the tears through the proper channel should be removed.
For the milder forms of blepharitis the non irritating ointments give the most satisfactory results. After carefully removing the scales and crusts with warm water by gently washing them off, an ointment should be well rubbed into the roots of the lashes and along the margin of the lids, usually night and morning. For this purpose a I per cent. ointment of white precipitate, as being especially mild, has been much used. The yellow and red oxids of mercury are also favorite prescriptions in the proportion of one half to two grains to the dram of vaselin or simple cerate. A 5 per cent. solution of chloral hydrate, alternating with a salve of pyrogallol (1 : 8) and a 2 to 3 per cent. sulphur ointment, have been well recommended.
In the severer cases associated with deposits of hard and strongly adherent crusts, which glue the lashes together, the use of a solution of five grains of carbonate of sodium to the ounce of water is most effective in removing them. It is important not to irritate the bases of the ulcers too much by violent means of removing the crusts. A pledget of absorbent cotton, moistened with the above solution, enables the patient or surgeon to remove the crusts effectuallv and without force. After the margins of the lids and cilia have been cleared of crusts the various ointments can be applied thoroughly to the diseased structures. In case of ulceration touching the ulcers with a five to twenty grain solution of nitrate of silver, or with a sharpened point of a silver nitrate stick, acts most favorably. Where abscesses occur the cilia should be epilated with proper forceps, in order to give the remedies an opportunity of acting upon the diseased structures. No hesitation need be exercised about removing the cilia, for new hairs will replace those removed, even if they are repeatedly pulled out. When the disease has resulted in extensive cicatricial disturbances, as trichiasis, etc., proper operative measures alone are to be recommended. For the condition of madarosis no treatment avails.
Phthiriasis (blepharitis pediculosa) is an affection resembling blepharitis, and is associated with it. The ciliary margins present a dark appearance, which is due to the presence of the nits of the pediculus pubis. Close examination with a magnifying glass of the borders of the lid will reveal the bases of the cilia full of the black eggs of the lice, and generally many individual lice clinging to the lashes. Rubbing mercurial ointment into the margins of the destroys the lice and their eggs.
Syphilis of the eyelids is a somewhat rare affection. However, not is the primary ulcer met with in this situation, but also secondary and tertiary lesions. Both soft and indurated chancres occur on the skin of the The former is an ulcer with a ragged edge and with a tendency to.
spread. It appears without history of injury or other cause. The hard, indurated base of the ulcer in the other case is sufficiently indicative of its nature, and in due time secondary manifestations of the disease are likely to appear.
Not infrequently the lids, along with other portions of the skin, are the seat of secondary eruptions. During the third stage, occasionally, ulcers and gummata appear in the lids, the latter often presenting a striking similarity to chalazia. These sometimes develop rapidly and undergo extensive ulcerative changes, producing ectropion, lagophthalmos, etc.
Treatment must include the proper constitutional remedies, while the extension of the ulcerative process must be combated by the use of' the cau (nitrate of silver) and proper washes, or with compresses moistened with bichorid of mercury solution.
Tumors and Hypertrophies. Many benign growths occur in the eyelids, important on account of the disfigurement which they produce. Among these are papillomata, or warts, which grow on the lids and their borders. Occasionally, from irritation, these growths may assume an epitheliomatous type and prove serious. Their early removal, with cauterization of their bases, should be practised.
Angioma (nevus) occurs on the lids or their margins as a congenital growth. A nevus appears as a bright red spot, not elevated, and usually is located near the margin of the lid. Its tendency is to increase in area somewhat rapidly.
The cavernous variety is usually elevated, sometimes gives a pulsatile sensation, and consists of greatly enlarged vessels. It disappears under pressure and becomes much enlarged when the patient stoops over. Sometimes there may be a bruit present if the orbit as well as the lids is involved or if the dilatation of the vessels is extreme. The conjunctiva may also participate in the diseased process. A phlebolith in a varix of the conjunctival veins has been reported by Swan M. Burnett.
Small Devi may be excised or cauterized with nitric acid or with the electro cautery by means of the platinum point. Electrolysis may likewise be employed with advantage. In the larger varieties the growth may be cauterized at numerous points at a little distance from one another, as the cicatricial contraction of the scars will cut off the vascular supply between. As little sear as possible should be aimed at, and frequent sittings may be advisable.
Rare forms of benign growths are fibroma, adenoma, papilloma, enchondroma, neutered, and lipoma. The last named growth may produce a form of ptosis the so called ptosis lipomatosus. All of these growths should be removed if they produce any disturbing effects, and this is, as a rule, not difficult of accomplishment.
Cutaneous horns sometimes attain a considerable size. They arise from the skin of the lids, often near the margin, and sometimes involve a large proportion of the lid area. The excrescence is slow in its development and attains a horn like hardness, especially toward its extremity. The growth should be cut off and a plastic operation replace the lost cutaneous tissue.
Xanthelasina (xanthoma, vitiligoidea) occurs in the form of rounded spots of various sizes on the surface of the skin of the eyelids The patches are often situated on the eyelids near the inner angle, vary in size, and show a tendency to increase in numbers. They have a peculiar dark yellow color, which is their prominent feature. They give rise to no discomfort. They occur mostly in women of advanced years.
The yellow or brownish yellow patches may lie either on the surface of the skin (xanthelasma planum) or rise above it (xanthelasma tuberosum). These new growths of tissue are found to contain cells with granules or globules of oil. Brown or yellow molecules of pigment lie singly or in clusters in the cells and walls of the lymphatic vessels. Ablation may be practised on account of the disfigurement they produce.
Chalazion (Meibomian cyst, tarsal tumor, cystic tumor, tarsal cyst) occurs as a round tumor of variable size, giving the feeling of a shot beneath the finger. The skin over it is freely movable, but the growth has a firm attachment to the tarsus beneath.
Etiology. The cause of chalazion is not well understood. Generally it occurs in persons subject to inflammatory disturbances of the lid margins, frequently successive glands being attacked, one after another, until most of the Meibomian glands of one or more lids have been involved. Refractive errors seem to be an important element in many bad cases of chalazion, especially of the recurring type.
FIG. 172 Vertical section of chalazion (Meibomian cyst); X 10, glycerin: 1, stratified epithelium continued over the surface; 2, connective tissue outside tumor; 3, capsule of fibrous tissue from which septa pass inward, dividing the cyst into lobules; 4, epithelial cells inside capsule; 5, fatty material occupying center of lobules, the outer layers being more opaque (Pollock).
Pathology. Chalazion may be solitary or several chalazia may occur in the lid, and the lower and upper lids of both eyes may be the seat of the growths. They originate in the Meibomian glands, and develop from an obstructive inflammation of the duct of these glands, which prevents the excretion of the sebaceous material. This accumulation aids in the development of an inflammatory action involving the gland and its surrounding tissue. The result is a tumor of considerable size, the contents of which, undergoing a fatty de become soft, and fill the sac with a gelatinous mass of granulation tissue containing giant cells or with pus (Fig. 172). The process is very similar to the formation of an atheroma, except that the inflammatory changes tire more marked. There is no true cyst wall. If allowed to take its Course, the chalazion develops outward, toward the skin (external chalazion), or involves the conjunctiva (internal chalazion). It frequently perforates the latter. extensive granulations springing up on the under surface of the lid, often resembling a neoplasm. Usually a catarrhal conjunctivitis, which infects the Meibomian glands, precedes the chalazion.
except that the tumor is more circumscribed and does not 11 point." The chronic variety grows slowly and causes no uneasiness to the patient, except the feeling of weight in the lid which it gives (Fig. 173). Should the growth perforate the conjunctiva, there may result some conjunctival and corneal irritation, due to the rubbing of the granulations upon these membranes. An acute chalazion is liable to be confounded with a stye, the diffuse appearance and 11 pointing " of the latter, however, serving to distinguish it. The chronic variety has been mistaken for small malignant growths and sebaceous cysts. The firm attachment of the chalazion to the torsos should serve to differentiate it from a cyst. Sarcomata, when small, are difficult to diagnose, and sometimes a microscopic examination becomes necessary to determine the true nature of the growth.
Treatment. The only satisfactory treatment for chalazion is surgical. Some relief, perhaps, may be afforded in the acute variety by frequent hot packs, followed by the use of the yellow oxid of mercury ointment. The proper surgical procedure for its removal is described on page 546.
Sarcoma, as a primary growth, develops in the connective tissue of the lids, and occurs usually in children. In the early stage of its growth the skin moves freely over the tumor, but this rapidly invades the overlying tissues, which break down and become ulcerated. Sarcoma of the eyelids, of the small spindle celled variety, may result from traumatism. It sometimes resembles a chalazion, but careful examination is likely to show a deeper coloring, with diffuse swelling. Microscopical examination alone will sometimes determine the true nature of the trouble.
IIA, CA CINOMA OF THE LIDS.
tissues, and may be of the spindle , large or small round , or mixed Celled variety. Pigmentation of cells or cells and stroma is sometimes seen (melanosarcoma). W. H. Wilmer, who has described a melanotic giant celled sarcoma, has analyzed 35 cases, and finds that 40 per cent. were spindlecelled, 43 per cent. round celled, 17 per cent. mixed, and 11 per cent. presented myxomatous elements.
An early excision of the growth alone offers any hope of protection against a tal outcome of the trouble. Even after thorough removal return of the growth occurs in 40 per cent. of the cases (Wilmer).
Carcinoma. The most usual type of carcinoma of the lid is the epitheliomatous ulcer, commonly called " rodent or Jacob's ulcer." The border of the lid is the favorite starting point for the growth, which occurs in elderly persons. It usually be ns as a small pimple covered with a crust and its FIG. 174. Rodent uleer beginning in the left lower eyelid. (From a patient in Charity Hospital, Cleve growth is often exceedingly slow. As time goes on it gradually develops into a flat ulcer, with indurated, ragged, and elevated edges, attended with only a slight secretion. Eventually it may involve the lids, eyeball, and adjacent structures (Fig. 174). Rodent ulcer may be mistaken for a syphilitic ulcer, but generally the age of the patient, the slow growth of the tumor, and the therapeutic test with iodid of potassium, which rapidly relieves a syphilitic ulcer, suffices to differentiate the epitbelial growth from the latter affection. It is distinguished from lupus, because this disease occurs usually in young subjects, because of the greater inflammatory action of In us and because other portions of the body are at the same time similarly affected.
cell nests may also lie in this layer, together with " epithel ial pearls." The surrounding tissue is usually very vascular and infiltrated with round and from the epidermis or from the epithelial lining of the sebaceou; or sweat glands; rarely from Meibomian glands. At times it appears as a raised ulcer with infiltrated edges. The growth may be very slow, and cicatrization take place in the center as the ulceration progresses at the edges. If the ulcerative process is an elaborate one and extends into the deeper as well as surrounding tissues, a " rodent ulcer" results. The stroma of these epitheliomata is always more or less infiltrated with round cells and presents the appearance of granulation tissue.
Rare forms of cancer of the lid structures having their point of origin in the Meibomian or in Krause's glands may be denominated glandular carcinomata, in contradistinction to the ordinary epitheliomata and rodent ulcers.
Treatment. Radical measures alone give any promise of permanent relief in carcinomata. An early operation for their removal should be performed and the exposed surface covered with suitable skin flaps. In the later stages palliative measures to aid in limiting the rapidity of the growth may be used. To further this end caustic, chloracetic acid, scraping with a curette, or the actual cautery may be employed. As milder measures aristol, chlorate of potassium, and injections of pyoktanin have been recommended. Not infrequently in the advanced cases it may be necessary to remove the eyeball, together with the orbital and periorbital tissues.
Lupus Vulgaris. Associated with lupus of the face or nose the eyelids may become the seat of this affection. The ulcers are formed by several points of infection coalescing and producing ragged, soft edges, which exude an offensive secretion. The disease frequently inflicts much damage to the lid tissue, eventuating in marked cicatricial contraction and deformity. The history of the case, together with the fact that the face and nose are involved in the same disease, will serve to distinguish lupus from the syphilitic ulcer, for which it is likely to be mistaken.
Treatment. Cauterization by means of caustic paste or the actual cautery gives the best results in the early stage of the disease. The ulcers may also be curetted. When the ulcers are large excision may be practised, with the proper plastic operation for covering the denuded surface of the eyelids.
Lepra. Leprosy of the eyelids is very frequent in countries where the general disease is prevalent. Tubercular growths form in the region of the brows and cilia, producing loss of the lashes and eyebrows. Anesthetic patches of a color slightly different from the surrounding skin, with entropion and ectropion, are frequently developed.
Elephantiasis Arabum is characterized by a chronic hypertrophy of the skin and subcutaneous tissue. The lids reach enormou's proportions, and from their mere weight prevent the patient from opening the eyes. The upper lids are the ones usually affected. Elephantiasis occurs congenitally or may result from an injury. According as the hypertropby affects the lymphatics or the blood vessels the names of elephantiasis lymphangiectodes and elephantiasis telanyiectodes have been assigned. Removal of the excessive growth of tissue sufficient to enable the patient to open the eyes offers the most hope of relief.
253 affection the thickening of the lids is often very marked, giving rise to much deformity. It usually occurs in the third stage of syphilis, and assumes the gummatous type of the disease; more rarely an acute form appears.
The symptoms of tarsitis are gradual thickening of the lid, without marked inflammatory disturbance, and the consequent inconvenience to the patient of the bulk of the eyelid, which may droop over the globe. If the lower lid is the seat of the disease, the weight of the lid sometimes pulls it away from the eyeball, producing an corrosion. In severe cases an atrophy of the tarsus may ensue after the subsidence of the inflammation (Fig. 175).
Treatment. The remedies appropriate to blepharitis should be used locally, and any constitutional disturbance corrected by proper means. In tarsitis syphilitica treatment suitable for the specific disease should be instituted. Recovery is slow, but generally perfect.
Blepharospasm is characterized by a cramp like contraction of some or of all of the fibers of the orbicularis muscle.
A frequent condition in many persons is the contraction of a few fibers of the orbicularis muscle in either the upper or lower lid, which is very annoy The twitching of the muscle may readily be seen by an observer. This condition is usually indicative of some local irritation of the eyes or the lids, and is of Do great import.
A more serious and uncomfortable phase of the difficulty is cramp of the entire muscle, when the eyelids close tightly and violently. There are two DISEASES OF THE EYELID & varieties of blepharospasm the clonic and the tonic spasms. In the former the spasm is of momentary duration, and consists of a series of forcible uncontrollable " blinkings ;" in the latter there is a violent closure of the lids, which remain tightly shut for some minutes or for days or months, and the patient is rendered practically blind by the inability to use the eyes. Blindness has occasionally resulted, manifest when the patient has become able to open the eyes, either with or without grave ophthalmoscopic changes.
Blepharospasm may be either a symptomatic condition or an essential disease. Children especially are prone to have slight more or less frequent " blinking " attacks or nictitation, especially when using their eyes in schoolwork. They are generally found to have slight conjunctivitis or an asthenopic condition due to refractive error. Not infrequently associated with this is a choreic or spasmodic affection of the facial muscles. Blepharospasm is essentially due to reflex irritation of the fibers of the trigeminus, and hence occurs in follicular conjunctivitis, with foreign bodies in the eye (when the spasms may be tonic), with blepharitis, refractive errors, and muscular insufficiencies. Depending upon the cause, the attacks are monocular or binocular, the latter form prevailing in all severe cases, the attacks being usually more severe on one side. In hysterical subjects the attacks come on without any known cause, the eyes close tightly, the spasm is persistent, and the patient is rendered helpless. In adults as well as in children the facial muscles may twitch as actively as the orbicularis. In elderly people the spasm is often associated with tic or with chronic conjunctivitis.
Treatment. The treatment of blepharospasm depends upon the cause. In case of local irritation removal of the foreign body, relief of conjunctivitis, blepharitis, or other local inflammation, correction of refractive errors, and gymnastic exercise for insufficiency of the eve muscles are the essential points to be considered. The general health should be looked into, and tonics, especially iron, quinin, and strychnin, should be exhibited, care being taken that the latter does not aggravate the trouble. Antispasmodics, as conium and gelsemium, pushed to their physiological tolerance, may be of benefit.
In many cases medication seems to have no beneficial effect. In some patients pressure on certain points seems to relieve temporarily the difficulty. The patient discovers these and learns to control, in a measure, the orbicularis spasm by pressing upon the point. This point may be situated on the forebead or in some other portion of the head. In such cases galvanism, or, in very bad cases, hypodermic injections of morphin in these regions, may be tried. Complete rest from work, with change of climate, sea bathing, or mountain climbing, have sometimes proved efficacious when other means have failed.
Ptosis (blepharoplosis, blepharoplegia) is a term properly applied to a drooping of the eyelid due to paralysis of the levator palpebrarum muscle. In addition to true ptosis there is a more or less marked degree of drooping of the lid due to its increased weight or bulk, which prevents tile levator from sufficiently raising the lid to expose the eyeball. This often is the case in tarsitis, hypertrophic blepharitis,. granular corjunctivitis, and tumors of various sorts occurring in the substance of the lid. But ptosis proper is due either to paralysis of the oculo motor nerve or to a fault in the development of the levator muscle itself.
The affection may be a congenital or an acquired one. In the congenital cases the ptosis may be associated with other congenital malformations of the lids, eye, or orbit. In some cases of unilateral congenital ptosis. usually on LAGOPHTHALMOS.
255 the left side, while the eyelid cannot be raised voluntarily, it is raised when the jaw is moved during eating, or there is contraction of the levator in association with the external pterygoid. Not infrequently ptosis is the result of injury to the muscle fibers or to the supraorbital branch of the oculo motor (Fig. 176). Paralysis of the eye muscles is frequently associated with ptosis, and it may be found in certain cases of hemiplegia or from lesion of the cortical center. In bilateral ptosis the peculiar pose of the head, which is thrown back to enable the patient to look under the drooping lids, is strikingly characteristic.
other origin which is amenable to medicinal agents. The surgical treatment is described elsewhere (see page 557).
Lagophthalmos manifests itself by an inability of the eyelids to close, the degree of this immobility varying as the cause is a paralytic or a nonparalytic one. The non paralytic causes are shortening of the eyelids, which may be congenital or due to loss of tissue of the lids from burns, ulceration, gangrene, etc. ; corrosion ; loss of reflex sensibility in the eyeball and protrusion of the globes, so that the lids are unable to cover them, as in exophthalmic goiter, orbital tumors, etc.
The most marked cases are caused by paralysis of the orbicularis muscle, usually associated with facial paralysis. The distressing symptoms of lagoph arise in connection with the cornea ' which is exposed to external irritations and suffers the loss of the lubricating and protecting action of the lids. The exposed portions of the cornea and conjunctiva become chronically inflamed, and ulceration and even blindness may be the result.
Treatment should have in view, primarily, the protection of the eyeball from external irritation. Patients are likely to suffer most while asleep from inability to close the lids by voluntary action. Hence in bad cases the lids I 256 DISEASES OF THE EYELIDS.
should be closed with adhesive plaster, a compress and bandage, or by other suitable means. Relief should be directed to the cause of the affection in the paralytic variety, and the operation of tarsorrhaphy (page 547) may be required.
Symblepharon is an abnormal adhesion of the eyelid to the eyeball. It may be congenital, but is usually the result of injuries, especially burns from acids, lime, or hot metal (Fig. 177). It occurs always when the conjunctival structure is destroyed in its sulcus and when the palpebral and bulbar conjunctivae are cauterized in approximate positions. It also results from purulent and granular conjunctivitis, pemphigus, etc. Not infrequently the lid margins become strongly adherent to the cornea by cicatricial bands or the entire body of the lid may be adherent (Fig. 178).
Ankyloblepharon has the same causes as symblepbaron, and likewise may be congenital or acquired. It consists of a union between the margins of the upper and lower lids, and may be partial or complete. In the acquired variety burns are the most common cause.
Biepharophimosis is an agglutination of the eyelids at the outer angle of. the eye, caused usually by chronic conjunctivitis or ulceration at the commissure. The adhesions cause shortening of the palpebral opening.
Treatment. These conditions, generally due to a similar cause, require like treatment. In ease of injury, burns, etc. care should be exercised to keep the lids well separated from each other as well as from the eyeball. In case of extensive burns of both the bulbar and palpebral conjunctive no method will prevent the lid and the eyeball from becoming adherent, with the formation of a more or less complete symblepharon. When the deformity has occurred suitable surgical measures should be employed for its correction (see page 548).
Trichiasis is a term used to describe that condition of the lids where the eyelashes are turned backward so as to rub against the eyeball. A single cilium or the entire row of lashes may be inverted.
II. The most frequent cause of trichiasis is trachoma. The entire conjunctival surface being, as a rule, involved in chronic trachoma, the resulting cicatricial contraction affects the entire border of the lid and occasionally develops more or less complete trichiasis. The more localized affection is likely to be due to burns, blepharitis, injuries, operations, etc. The result of the lashes turning in is marked irritation of the cornea, which often results in ulcers ; thickening of the epithelial covering, somewhat simulating pannus; constant lach ; and, in long continued cases, permanent impairment of vision.
Distichiasis is a term applied to that affection where there are double FIG. Incomplete symblepharon due to burn. (From a case in Western Reserve University, Medical Department.)rows of lashes, one row being directed properly, while the other is turned backward against the eyeball. Some authors consider distichiasis simply one step in the development of trichiasis and assign the term to the congenital affection alone. The causes of the two affections are the same.
Treatment. Should a single lash or a small number of lashes turn in, temporary relief is afforded by epilation of the cilia which are at fault. The lashes grow again, however, and this operation must be frequently repeated. Patients can often remove the lashes themselves with a pair of cilium forceps. For permanent relief electrolysis or some other operative procedure must be employed (see page 545).
trachoma, diphtheritic conjunctivitis, burns, injuries, etc., which lead to cicatricial contraction of the conjunctiva. The effect upon the cornea may be serious on account of the production of ulcers, opacities, etc.
Treatment. Spasmodic entropion is generally relieved by the disappearance of the conjunctivitis, keratitis, or foreign substance which has caused it. Early removal of the bandage is necessary when the entropion occurs after cataract operations. Strips of adhesive plaster applied to the lid margin by one extremity and by the other to the check, or collodion painted over the lid, or strips of gauze fixed with collodion applied in the same manner as the adhesive strips, serve a most useful purpose in case of spasmodic ectropion. The serre fine has been used with advantage by fixing a fold of the skin, thus pulling the lid margin away from the eyeball. The chronic types of entropion require careful surgical treatment. The operations are described on page 548.
Ectropion is a rolling outward of the eyelids, so that the conjunctival portion is exposed to view. This eversion may be partial or complete. It may also be spasmodic or muscular and chronic or organic. In the former case it is due to the over action of the peripheral fibers of the orbicularis muscle. The lower lid sometimes shows a tendency to droop, particularly in elderly people and in persons affected with facial palsy. The tears thus run over the checks and occasion additional irritation.
The causes of organic ectropion are those which produce a cicatricial shortening in the length of the eyelids, as chronic blepharitis, lupus, necrosis of the orbit or malar bone, abscesses, burns, and injuries (Fig. 179). The eye being more or less exposed, the cornea suffers from external irritants.
Treatment. Not infrequently the excessive lachrymation which occurs in ectropion may be cured by slitting up the canaliculus and passing probes through the naso lachrymal duct. Associated inflammation of the cornea and conjunctiva should receive attention. The severer chronic forms of the affection require operative measures for their relief (see page 551).
Seborrhea is characterized by a secretion on the margin of the lids either of an oily fluid or of a sebaceous material, which dries, forming crusts or scales along the cilia. Generally, seborrhea of the face, scalp, or other portions of the body is an accompanying affection. It not infrequently occurs in voung persons about the age of puberty. Conjunctivitis and marginal blepharitis are frequent concomitants.
Treatment must be directed to the improvement of the general health. Removal of the crusts and the application of mercurial or sulphur ointments, together with measures suited to conjunctivitis and blepharitis, are required.
CHROMIDROSIS.259 Milium. Milia are accumulations of sebum in closed sebaceous glands. These growths are about the size of a milletseed, from which they take their name. They present a yellowish white appearance, and are slightly elevated above the surrounding skin, giving the feeling of a pinhead under the finger. They usually indicate improper care of the skin, and occur in persons with some disturbance of digestion, constipation, etc.
Treatment. Hot applications, frequently repeated, together with suitable remedies for indigestion or constipation, will prove beneficial. After removal of the milium with a knife point or needle, hot packs and mild ointments, well rubbed in, will afford relief.
Molluscum contagiosum (molluscum sebaceum) occurs in the lids in the form of small rounded tumors which originate from the sebaceous glands. They attain the size of a pea, have an umbilicated appearance due to the orifice of the gland on the summit of the growth, and have a wax like color. The material from the growths is contagious. The disease not infrequently occurs among children in asylums and schools in the nature of an epidemic. The contagious nature of the disease is supposed to be due to a parasite, and the affection is allied in character to cantagious epitheliomata. The parasite is believed by some authors to belong to the class Coccidia, and to inhabit the epithelial cells and cause the formation of these small prominent epithelial growths. The coccidia multiply in the cells of the epithelia] projections; these are then cast off and accumulate as a mass of epithelial detritus. According to H. Muetze, the molluscum corpuscles are the product of a degeneration of the epithelial cells caused by the contagium, the nature of which is uncertain ; but the corpuscles themselves are not parasites.
Treatment consists of opening each molluscum and scraping out its contents. Cauterizing the sac with nitrate of silver may also be employed.
Ephidrosis (hyperidrosis) is a rare affection of the lids characterized by profuse secretion from the sweat glands. It is associated with excessive sweating of other portions of the face or body, and has been noticed in cases of unilateral facial sweating. Its cause is Dot understood. It may produce excoriations, especially at the angles of the eyes and in the skin folds.
Treatment must be directed to the excoriations of the skin and to the cause if it can be discovered.
Chromidrosis (sometimes called seborrha nigricans') is the formation of various colored secretions on the eyelids, the oily like fluid giving a bluish or blackish color to the affected skin. It usually occurs on the lower lid. The discoloration can readily be removed by wiping. Some authors believe that it is always an evidence of malingering, as it most frequently occurs in hysterical patients, particularly young women. In rare instances it is genuine. It may be caused by a deposit of dust upon a cutaneous surface affected with seborrhea.
Treatment should be directed toward the relief of any general disturbance of the health. The discoloration may be removed with some oily substance ; lead water and glycerin have been recommended.
Sebaceous cysts are small rounded bodies of the size of a pea or of a hazelnut which occur in the thicker portions of the skin of the eyelids, especially in the superior or external orbital portion of the lid (Fig. 180). They develop from the sebaceous follicles of the skin, and contain a sebaceous, oily like material, and frequently fine hairs. They have well formed I For a full account of this affection see a paper by Dr. J. K. Mitchell in the Phila. Ned. journ., 1898, i. 117 119.
260 DISEASES OF THE EYELIDS cyst walls, which enables the surgeon to dissect them out without great difficulty, this being the proper method of treatment. FIG. 180. Sebaceous tumor of the eyelid. (From a patient in the Western Reserve University, Medical Department.) Dermoid cysts likewise occur in the same region and should be removed in like manner.
Cysticercus has been observed a few times under the skin of the eyelids, having the appearance of a sebaceous cyst, only the contents are fluid. On opening the tumor the remains of the parasite are discovered.
The eyebrows may be the seat of eczema or of seborrhea, and are a favorite situation for the development of sebaceous and dermoid cysts. Occasionally these growths extend some distance into the orbit, where by pressure they may produce a depression in the underlying bone.


It's no secret that the weather conditions during the winter can become quite extreme – just look at the record-setting low temperatures that were recently seen in Chicago, for example. Extreme snow or frost can potentially lead to very dangerous situations, especially for wild animals.
A poor red deer managed to get completely stuck in an icy lake in Siberia, Russia. Its life was hanging on a very loose thread. It's unclear how the deer fell into the lake, but what was completely clear, is that he couldn't get out at all.
He was inches away from drowning and his cries could be clearly be heard.
Luckily – those cries were actually heard by people who were in the area. When they spotted this majestic animal in its serious predicament, they realized that he needed urgent help.
The people who found him were animal hunters, and they didn't hesitate for a second to try and rescue the deer.
The situation was severe and life-threatening, and the local hunters did everything they could to get the drowning stag out of the icy and freezing lake. It may sound a bit weird to see animal hunters saving an animal instead of hunting them down and killing them – but they clearly realized that this poor deer needed help.
These people had no intention of being cruel and wanted to make sure that the deer would be able to stand on his own feet again.
The rescue operation didn't go as smooth as they hoped, but the hunters were determined to get him out of the ice.
The frozen lake he was stuck in, the Barguzin which crosses the Ulan-Ude area in Siberia, proved to be very difficult to cut through. There were four hunters in total who did their best efforts to try and cut pieces of ice, in order to create enough room for the deer to maneuver in. They were equipped with a chainsaw, but cutting the ice still proved to be a big obstacle.
When there was finally enough room, they attempted to pull out the heavy animal out of the icy water.
As you can imagine – this animal was heavy, and even four grown men were seriously struggling to get the life-threatened deer back to some drier grounds.
In total, the men spent four hours getting the deer out of the ice.
Some parts of the rescue attempt were filmed by Aleksey Baluev. They checked if the deer had any substantial injuries on the outside, but they also realized that the most dangerous element of all would simply be the cold.
"We need to get it away from the cold, Baluev" says to his friends.
Even before the stag finally made it to the ground, you could see he was quite immobile and still suffering from the freezing temperatures and ice cold water.
The entire hunting crew then furiously started rubbing over the animal's fur with their bare hands to try and get his blood circulation up and running again after they managed to get him out. Luckily, a fire was able to give some warmth that probably ended up saving the red deer's life.
The hunting crew then took the deer to a local garage afterward and continued to take care of him.
The deer, still very much freezing and in peril, needed to warm up even more. Hunters and the garage crew were able to find a large piece of lard to keep him somewhat warm, and they even gave him no less than 150 grams of vodka. They figured that it would warm the deer up from in the inside, and it certainly looks like it didn't hurt.
When the deer was finally able to stand on his own feet again, the hunters knew it was time to release him back into his natural habitat.
Making sure that he was a-okay, they took him to one of the edges of a nearby forest as they watched him depart into the wilderness, once again.
Hunter or not, these people absolutely did the right thing by rescuing this deer – even though the rescue mission itself proved to be almost impossible to pull off safely.


text: After a two-year hiatus, lanky defender Kate Lloyd makes a return to the Tactix and top-flight netball in 2022. Promoted from the Mainland National Netball League team to the Tactix as an injury replacement in 2017, Lloyd made a number of handy cameo appearances throughout that season. She went on to claim the World Youth Cup title with the NZU21 team the same year before heading to the Magic in 2018. The Ashburton-born 1.92m in-circle defender returned to her home franchise in 2019 but has since been turning out for Mainland. She was a Tactix training partner in 2021 and now with more mileage under her belt and the valuable asset of height at the defensive end, Lloyd gets another opportunity to showcase her talents at the elite level.


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Q: Crawler4j with mongoDB I was researching on crawler4j. I found that it uses BerkeleyDB as the database. I am developing a Grails app using mongoDB and was wondering how flexible will crawler4j be to work within my application. I basically want to store the crawled information in the mongodb database. Is it possible to configure crawler4j in such a way that it used mongoDB as the default datastore rather than BerkeleyDB? Any suggestions would be helpful. Thanks

A: There is not configurable dao layer, but you can manipulate it.
There are 3 dao classes. Counters class saves total 'Scheduled' and 'Processed' pages counts (this is just for statistics). DocIDServer class holds url-id pairs for resolving new urls. Frontier class holds queue for pages to crawl. Just keep method logics and trancastion blocks.

redpajama_set_name: RedPajamaStackExchange


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Home Living Body & Soul It's All in Your Head
It's All in Your Head
Renee Garfinkel
Roaring Red
A savvy commercial photographer once shared the secret of his success. "It's simple," he confided. "I always try include something red in every photograph."
Red. It's the color of sunsets, the color of passion and, in China, the color of good luck. Red is the badge of courage, the color of royalty, of power and of sex. Apparently red is more "primary" than the other two colors in its category, yellow and blue.
Here's something new about red: According to the results of a study published in the latest issue of the Journal of Experimental Psychology, women find men in red to be more attractive, more powerful and more sexually desirable.
In the study, women were asked to rate the status and sexual desirability of men pictured wearing different colored clothing. They rated the men wearing red as being higher status and more likely to earn a better living, as well as more appealing.
Even when the comparison was made between pictures of men merely surrounded by a red matte with those of men surrounded by a white matte, the women rated the men surrounded by red to be more pleasant and more attractive. The difference was small —just one point on a nine-point scale — but it was statistically significant. Remarkably, the appeal of red held true for women in the U.S. and England, as well as in Germany and China.
The authors speculate about why women might prefer red. It seems other female primates do, too. The authors say that the red preference goes even further down the evolutionary scale, with some red-roaring crustaceans, fish and birds!
Are women just hardwired to be attracted to red by the blind call of biology? Or is it culture that draws their attention, having taught us to associate red with power and status and fame? Who hasn't watched the glamorous stars walk the red carpet to get to the coveted prize, the Oscar?
Men write songs about women in every color. Their Devil can have a Blue Dress On. But if these researchers are to be believed, women have eyes for red.
So, men, if you're planning to buy something new for the new season, keep science in mind when considering your wardrobe choices. That shade of brown may bring out your eyes, and black may make you look slimmer, but a little touch of red is where you want to be; it will get her attention and make you look your best.
Although we can't be sure of the reasons, we now know this to be true: women go for the guy in the red tie.
Love Potion #9: The Dark Side of Love
Oxytocin is the original love potion.
Oxy (it's the "love hormone," so I'll give it a friendly nickname) has its way with us by working down deep, below consciousness, beneath intuition. When oxy speaks to us, we "just know" it's true. Released in the brain, this love hormone generates trust and empathy and promotes bonding throughout our lives. It encourages intimacy. It increases altruism. Oxy makes us act generously to strangers, and romantically toward lovers.
Oxytocin is released during childbirth. It was first identified by its association with lactation, and the deep, adoring bond of mutuality between a mother and her breastfeeding infant. The discovery of the love hormone made the magic of mother-infant bonding just a little less mysterious, but no less marvelous. Not just for moms and little babies, oxy also plays a role in sex, friendship and social ties of many kinds. Oxytocin is the organic love potion we make ourselves.
The more we learn about the love hormone, the better it looks. It promotes monogamy. It makes us feel secure. It brings us contentment in our relationships. As they once used to say in L.A., it's all good.
Or is it? Centuries of poetry warned us of something that biological research recently confirmed: love has a dark side, too.
When subjects inhaled oxytocin before playing a competitive game they became more envious when their opponent won, and more gloating when they were ahead. Although it may not seem like a match made in heaven, love and jealousy are the conjoint oxytocin twins.
The hormone plays a role in international affairs as well, a recent Dutch study suggests. Even as it influences people toward self-sacrifice on behalf of their own group, it also encourages them to be aggressive against a threatening outgroup. Oxytocin is why conflicts between groups escalate when the other group is perceived as threatening. Happily, when physical barriers or other means of separation makes them feel less threatened, conflict escalation is less likely.
Here in D.C., where politics rule, we ignore biology at our peril. Biology is not essentially political, and it does not take sides. But it does help point a way. What are our bodies telling us, and what does science say, when it comes to playing it right in love, in friendship, even in international relations?
Since I have no wish to be a guru, I will warn you that the answer is deceptively simple: it's more of a direction than a destination.
The answer is balance. Philosophers and poets would agree, yes, being close is good — oh yes, very good — but closer is not always better. We each need to keep our balance with the light and dark sides of love. We need to season oxytocin's closeness with the right amount of distance. The very same hormone that inspired Shakespeare's sonnets of love is the one that reminds us to heed Robert Frost's wise advice, as well: Good fences make good neighbors.
Renee Garfinkel, Ph.D. is a clinical psychologist practicing short-term, solution-oriented psychotherapy in downtown D.C. She is affiliated with the Institute for Crisis, Disaster and Risk Management at The George Washington University. For more information, check out therapists.psychologytoday.com/rms/69148 or www.sleep-dc.com.
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package org.rioproject.impl.util;

/**
 * Interface allowing ascii banner to be displayed
 */
public interface BannerProvider {
    /**
     * Get an ascii banner for display
     *
     * @param name service name to include in the banner return
     *
     * @return An ascii banner
     */
    String getBanner(String name);
}

redpajama_set_name: RedPajamaGithub