REPO RT 
on 
OPHTHALMOLOGY 
F O R 1 8 7 0. 
BY 
HENRY D. NOYES, M. I)., 
NEW YORK. 
[REPRINTED FROM THE N Y. MEDICAL JOURNAL, FEBRUARY\ 3871.] 
NEW YORK: 
D. APPLETON & COMPANY. 
5 49 & 55 1 BROADWAY. 
1870. D. APPLETON & CO., New York, 
Have just Published, 
! T- 
A Text-Book of Practical Medicine, 
; WITH PARTICULAR REFERENCE TO 
PHYSIOLOGY AND PATHOLOGICAL ANATOMY. 
By Dr. FELIX V.ON NIEMEYER, 
Trofessor of Pathology and Therapeutics ; Director of the Medical Clinic of the University of Tubingen. 
TRANSLATED FROM THE SEVENTH GERMAN EDITION, BT SPECIAL PERMISSION OF THE AUTHOR, 
By GEORGE H. HUMPHREYS, M. D., and CHARLES E. HACKLEY, M. D. 
In two volumes, octavo. 1,500 pp. Price, in cloth, $9.00; in sheep, $10.50. 
“The sciences of Pathology and Therapeutics have made vast strides within the last ten years ; and, 
for very many important researches and discoveries in both these branches of medicine, we'ure indebt- 
ed to Germany. Professor Niemeyer’s volumes present a concise and well-digested epitome of the re- 
sults of ten years of carefully-recorded clinical observation by the most illustrious medical authorities 
of Europe, together with many valuable and practical deductions regarding the causes of disease and the 
application of remedies, such as we believe have not yet been assembled in any single work. 
“ The rapidity with which it has passed through seven German editions, the last two of triple size, 
and the tact that it has been translated into most of the principal languages of the old continent, aftord 
ample proof of its appreciation in Europe.” 
Extract from the Author's Preface to the Seventh German Edition. 
“Nearly ten years have elapsed since the first appearance of my text-book. Meanwhile, clinical meal 
cine owes a rich accession of knowledge to investigations made, not only in her own province, but in '.ho 
provinces of physiology,, pathological anatomy, and physiological and pathological chemistry. Impor- 
tant questions have been settled; obscure points rendered clear; false theories corrected, and errors 
recognized. ... In the present edition, but few portions of the work remain unaltered ; ar.d even 
those few have nearly all undergone revision on previous occasions. Most parts of it have received valu- 
able emendations, and have been enriched by copious additions. I have everywhere paid particular 
attention to the important results obtained in the domain of therapeutics by recent investigations, partly 
because I wish my book to maintain the honorable confidence which it has won for itself among practical 
■ physicians ; partly because I regard the happy progress which therapeutics has made as the most impor 
taut acquisition of the last ten years.” 
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in the foremost minds devoted to it, is scarcely to be found elsewhere in so convenient a form. Pro- 
fessor Von Niemeyer writes for special students; and neither an analysis of his work, nor extracts from 
it,, would be of interest to the general reader. It is enough in this place to point out its general charac- 
teristics. It is founded on the conviction that “ therapeusis,” or the art of healing diseases, is to be 
studied independently, by the same methods of experiment and observation by which all the natural 
sciences arc built up; and that it cannot be reduced to a series of corollaries from other branches of 
learning, such as pathological anatomy or physiological chemistry. But in the pursuit of this study he 
insists upon the most rigid adherence "to scientific method, and pays little regard to unverified impres- 
sions, or the mere dicta of authority. Ilis book is, therefore, in harmony with the prevailing sentiment 
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moters of their art. One of its pleasing features is that truly catholic spirit which marks the genuine 
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Von Niemeyer welcomes facts from all quarters; and does not disdain suggestions even from schools 
of practice which many medical men will not name with toleration. On the whole, the adoption of this 
book as the outline of a medical course, around which the student may gradually group bis fuller acqui- 
sitions, cannot fail to aid the cause of sound, sensible, and efficient healing art.” 
From the Medical and Surgical Reporter. 
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French jealously style their rivals across the Rhine, lie has long been kno.vn for his advanced views 
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cine, as well as the liberality of his views. The fact, that, in less than ten years, a large work on prac- 
tice passes through seven editions in Germany, stamps it at once as one of unusual merit. But this is 
guaranteed by the name of the author alone. ... This work of Niemeyer will go far to bring about 
this result: it teaches sound doctrine and sound practice. The translation is well made, and the natter 
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severe blow at uihilism in this country.” 
New York: D. APPLETON &. CO,, Publishers. REPORT 
0'S 
OPHTHALMOLOQY 
FOR 1 8 7 0. 
BY 
HENRY D. NOYES, M. D., 
NEW YORK. 
[REPRINTED FROM THE N. T. MEDICAL JOURNAL, FEBRUARY.\ 1871.] 
NEW YORK: 
D. APPLETON & COMPANY, 
549 & 55 1 BROADWAY. 
1871. REPORT ON 
OPHTHALMOLOGY FOR 1870. 
1.—Anatomy of the Orbital Veins. [Archiv f. Anatomie und Physiologie, 
s. 154, Taf. v.] Dr. Seseman. 
Tite superior and inferior ophthalmic veins do not empty the largest 
quantity of their blood into the sinus cavernosus, but into the facial veins. 
Thrombosis of the sinus, therefore, cannot seriously obstruct the orbital veins. 
For a similar reason, so numerous are the anastomoses of the v. centralis 
retinae with the v. ophthalmica superior that thrombosis of the sinus, or its 
compression by tumors, cannot be a cause of retinitis, as has been asserted— 
superior and inferior ophthalmic veins freely anastomose with each other. 
When symptoms of obstruction occur, viz., oedema of the lids, fulness of the 
frontal veins, exophthalmus, impaired sight, they are to be explained not by 
simple thrombosis of the sinus cavernosus, but by the presence of thrombi 
at the same time in the ophthalmic or facial veins. 
ORBIT. 
2.—Ectropium; Exophthalmus; Extirpation; Plastic Operation. By 
Henky D. Noyes, M. D., New York. [Trans. Am. Ophth. Soc.., 1870, pp. 
129-133, with 3 woodcuts.] 
A remarkable case of deformity, the consequence of necrosis of the mar- 
gin of the orbit. The patient was sixteen years old, and the primary dis- 
ease occurred in infancy. 'While removal of the eye was inevitable, the 
condition of the orbit would not permit the substitution of an artificial eye. 
Hence, besides enucleation, the conjunctiva was dissected away, the retracted 
state of the lids corrected, and finally flaps slidden in from the adjacent 
skin to completely cover in the front of the orbit. All these steps -were 
accomplished at one operation, and the patient, notwithstanding an attack 
of erysipelas, did well. 
Although she still was afflicted with a deformity, the operation relieved 
her from much distress, and restored to her the comfortable use of the 
other eye, which had been very troublesome. Woodcuts show the state 
of parts before and after the operation. 
3.— On Certain Peculiarities in the Construction of the Orbit. By IIap.- 
p.ison Allen, M. D., Philadelphia. [American Journal of Medical Sci- 
ences, January 7, 1870, pp. 116-119.] 
Among several interesting varieties described, the modifications which 
may occur in the lachrymal hone may be quoted. It may be reduced to 
a rudiment; it may be absent, a small irregular space indicating the posi- 
tion it should occupy ; it may be absent, and there be no interspace; there 
may be an accessory lachrymal bone found lying between the lachrymal 
proper and the nasal process of the superior maxilla; a small ossicle may 
be seen at the anterior-inferior region of inner wall of orbit, wedged in 
between the nasal process of superior maxillary, lachrymal, and nasal bones. 4 
OPHTHALMOLOGY. 
4.— Orbital Aneurismal Disease, and Protrusion of the Eyeball from. Ve- 
nous Obstruction. By D. T. G. Mortox, of Philadelphia. [Am. Jour. 
Med. Sciences, July, 1870, pp. 36-46.] 
Case of Traumatic Aneurism of Orbit treated by Compression. By Dr. G. 
C. Harlan, of Philadelphia. [Am. Jour, of Med. Sci., July, 1870, pp. 
46-48.] 
Dr. Morton narrates four new cases of the disease, one of them treated 
by ligation of the common carotid, and successfully. Dr. Harlan’s case 
was treated by compression for eight hours without cessation, and afterward 
for four to six hours daily for five weeks. The veratrum viride was also 
administered until its effect on the pulse was obtained and kept up. Pa- 
tient’s condition was so much improved, that he was able to resume his 
work as brakeman on a railroad, but after a time the disease returned. 
He expected to return to the hospital for ligature of the carotid. 
5.—Aneurism of the Orbit; Exophthalmus. By Dr. Scttiess-Gemuseus. 
[Klin. Monats. fur Augenheilkunde, February, 1870, pp. 56-64.] 
A woman, aged forty, was kicked in the face by a horse ; a year or more 
afterward an orbital aneurism formed. In treatment two injections of 
ergotin in the lid were tried, without good effect. Intermittent digital com- 
pression kept up nine days in May, and, after a week, seven days in June. 
Then the common carotid was tied. Secondary haemorrhage occurred three 
times. Pulsation not abolished, and after two weeks it was evident the aneu- 
rism was not cured. Five months afterward tfye enlarged frontal artery 
was sought to be tied, but was so surrounded by small arteries that only 
three of these could be seized. The sac was much reduced in size, and 
two months afterward was exceedingly small, although showing light pul- 
sation. The whole left side of the face was abnormally vascular, and the 
question was raised whether this was a true aneurism or a cyrsoid, but 
the former opinion was adhered to. The variety of treatment, and its com- 
parative inefficiency, are noteworthy. 
MUSCLES. 
6.—The Operation for Strabismus. By S. J. Halbertsma. Inaugural 
Dissertation. Utrecht, 1869. [Zehender Monatsblatter, January, 1870, 
p. 29.] 
This paper sets forth the methods of operating done by Dr. Snellen, at 
Donder’s Clinique, in Utrecht. For extreme degrees of deformity Lie- 
breich’s mode is adopted. He makes one remark, that, if the capsule of 
Tenon be incised too near the bulb, bleeding may be so free as to cause 
serious embarrassment, which may be avoided by keeping nearer to the 
inner surface of the conjunctiva. The usual mode of operating is with pa- 
tient lying on the back, chloroform not given, the conjunctiva opened by a 
wound in the horizontal meridian, pretty long; the wound separated and the 
conjunctiva dissected from subjacent parts both above and below by probe- 
pointed scissors. The caruncle also is raised. The tendon is next seized 
with the forceps and securely grasped; one blade of the scissors is pushed 
beneath it closely as possible to the sclera, and the insertion clipped. Inci- 
sions may be made as needful above and below, and the blunt hook used to 
ascertain whether any fibres remain undivided. On behalf of this method 
it is claimed that it is easier, that it is less painful, that thrombi do not so 
readily occur, and the operation can be exactly regulated. Sutures may or 
may not be employed. 
When operating for insufficiency, the tendon is exposed in the same 
manner, but for a greater distance backward. When cut, a little bit is left OPHTHALMOLOGY. 
5 
attached to the sclera, and two sutures are put in so as to bring forward 
the muscle, in the following manner: The first begins at the upper and 
inner edge of the conjunctival wound, then through the stump of the tendon, 
then deep as the case may require into the muscle, which is dragged for- 
ward, and finally into the conjunctiva, and tied. The other suture takes 
a similar course for the lower border of the conjunctival wound, and the 
effect of both is to drag the muscle forward. The conjunctival wound may 
be united if needful by a suture from above downward. This operation has 
special application for insufficiency with paresis of the antagonist. 
7.—A Case of Strabismus Concomitans Convergers Intermittens. By Dr. 
W. Wagner. [Klin. Monats. f. Aug., April, 1870.] 
A child, six years old, with convergence of 3J"' which, for two months, 
appeared every four or five days, and lasted twenty-four hours ; these re- 
curred regularly every other day for two months. During six months 
more the case was observed and antiperiodics given in vain. There was 
no error of refraction or accommodation. A very careful and restricted 
setting back of one internus cured the malady—which was regarded as 
coming from disturbed innervation. 
8.—A Case of Monolateral Nystagmus, in which the Oscillations are verti- 
cal. By Dr. Zehender. [Klin. Monats. f. Aug., April, 1870.] 
The affected eye was perfectly blind, except at the periphery of the 
field, and the nerve showed signs of atrophy; the other eye normal; patient 
a girl nine years old. 
9.—A Contribution to the Subject of Strabismus. By Dr. 0. R. Agnew, 
M. Y. [Trans. Am. Oph. Soc., 1870, p. 148.] 
An advancement of the inferior rectus, to correct deformity produced 
by a faulty operation on account of converging squint. 
EYELIDS. 
10.— Clonic Spasm of the Eyelids ; Section of the Supra-orbital Nerves. 
By Dr. J. Talkow, of Tiflis. [Klin. Monats. f. Aug., May, 1870, pp. 
129-145.] 
The spasms affected both eyes, had lasted seven years, and wrinkled 
the eyelids in deep furrows; the cause could not be assigned. A sur- 
geon had excised a strip of skin from the lids, with the production of harm 
rather than good. Injections of morphia and atropine in the temple were 
fruitless. Extensive splitting of the outer canthus to the temple was of 
temporary benefit. On the other eye subcutaneous myotomy was of no 
avail. 
Several similar cases are quoted, and the treatment by neurotomy com- 
mented upon as performed by Graefe and Wecker, and recommended by 
Romberg. The left supra-orbital nerve was cut by subcutaneous section 
under the influence of local anajsthesia. Immediately, spite of a thrombus, 
the size of a pigeon’s egg, the patient could open his eye. Three weeks after, 
he had neuralgia in this region. Electrization was proposed, but patient re- 
fused, and left the hospital. After nearly a year the patient had acute 
rheumatism, which might be considered the cause of his trouble. The 
side where neurotomy had been done was insensible and free from spasm, 
but the other eye suffered as before. 
11—A Case of Xanthelasma Palpebrarum. By Dr. Arthur Geissler. 
[Klin. Monats. f. Aug., February, 1870, p. 64.] 
A discoloration of the skin of the lids, also called vitiligoidea, in a wom- 6 
OPHTHALMOLOGY. 
an aged forty-four, which was in the form of a horseshoe, and of a straw- 
yellow color. 
12.—Xanthelasma Palpebrarum. By Mr. Jonathan Hutchinson. [Oph- 
thalmic Hospital Keports, vol. iv., pp. 265, 275, 282.] Three cases are 
given—the patients being forty-five, fifty-seven, and fifty-eight years old. 
13.—Favus on the Lids and in the Canaliculi. By Dr. Narkiewicz-Jodko. 
[Gazeta Lekarrka, Warsaw, March 14, 1869.] Two cases are quoted in 
Zehender. 
14.— Three Cases of Herpes Zoster Frontalis. By Dr. B. J. Jeffries, 
Boston. [Trans. Am. Opli. Soc., 1870, pp. 100-103.] 
15.—A Case of Xanthelasma Palpebrarum. By Dr. J. Hirschberg, of 
Berlin. [Klin. Monats. fur Aug., May, 1870, p. 167.] 
CONJUNCTIVA. 
1G.— The Use of Acetic Acid in Affections of the Conjunctiva and Cornea. 
By Dr. B. A. Pope, of New Orleans. [Archives of Ophthal. and Otol., 
vol. i., part ii., pp. 446-458.] 
Dr. Pope employed acetic acid of sp. gr. 1,041 (No. 8), which he says 
is a mild escharotic when of this strength. With it he treated a rebellious 
case of warty degeneration of the palpebral conjunctiva for which ordinary 
caustics and excision had very slowly effected a cure, but could not pre- 
serve against relapse. The second attack was cured by the acid in less 
time, and finally. It was applied by a very fine camel’s-hair brush once 
every day, and only to the spots to be destroyed. Other cases thus treated 
were the relaxed and hypertrophied state of the conjunctiva in the cul-de- 
sac following chronic conjunctivitis—some cases of trachoma in the stage 
of development, as an occasional application, and strictly confined to the 
granulations—an inflamed pinguecula which the patient refused to have 
excised—hypertrophy of the caruncle and semilunar fold in pterygium 
—in two cases of calcareous degeneration of the epithelial layer of the 
cornea sometimes combined with excision—in a case of dense opacity of the 
cornea, the result of partial sloughing after ophthalmia neonatorum. When 
put upon the cornea the acid will cause an ulcer after two or three applica- 
tions, and care must be taken not to let this process make unmanageable 
progress—with such vigilance the new tissue which repairs the ulcer was 
found to have a gratifying degree of transparency. It needs to be repeated 
a number of times to attain the best result, and is a remedy which only a 
skilful hand should apply, and an experienced eye watch, but doubtless it 
may do good service in some intractable cases, as enumerated. 
17.—A Peculiar Case of Conjunctival and Corneal Infla mmation. By Dr. 
D. B. St. John Roosa, New York. [Transactions American Ophthalm. 
Society, 1870, pp. 88-91.] 
An inflammation in some respects like herpes corneas, accompanied by 
partial ptosis, which recurred every week for nine months, seldom failing to 
appear at its expected time. Its severe pain lasted a few hours, and its 
duration was about two days. Local and general treatment of little avail 
—no important change of tissue—the other eye perfectly well. 
18.— Cantlioplasty in the Treatment of Diphtheritic Conjunctivitis. By 
Dr. 0. M. Allin, New York. [Trans. Am. Oph. Soc., 1870, pp. 91-93.j 
Pressure of the swollen lids relieved more effectually by stitching the OPHTHALMOLOGY. 
7 
conjunctiva to the edges of the wound at the outer angle, than by merely 
slitting without introducing the stitches. The ordinary treatment by iced 
compresses, and nitrate of silver applied in addition. 
CORNEA. 
19.— Quinine as a Local Remedy in Certain Forms of Conjunctival and 
Corneal Disease. By Dr. J. S. Prout, Brooklyn. [Trans. Am. Oph. 
Soc., 1870, pp. 114-117.] 
Two cases of trachoma with pannusare reported as having been treated 
by application of dry quinine, and of quinine in solution, to the lids, 
with beneficial results, which appear to be owing to the special effects of 
the remedy. Similar good results are narrated from daily application of 
solution of muriate of quinia D ij and § j in a case of traumatic and spread- 
ing ulceration of the cornea. At the meeting of the Ophthalmological 
Society in Heidelberg in 18G9, Prof. Nagel brought this subject forward, 
and there is sufficient evidence in behalf of the efficacy of this treat- 
ment to induce its being thoroughly tried. We would suggest its special 
fitness in ulceration and suppuration of the cornea in addition to the usual 
remedies. 
20.—The Nerves of the Conjunctiva and Sclera. By Feiedich IIeleebioh. 
[Wfirzberg, pp. 35, 1870.] 
21.— Ulcus CornecB serpens and its Treatment. By Dr. Saemisch. [Bonn. 
1870.] 
Under the above title is indicated an ulcerative keratitis whose tendency 
is to spread in extent and in depth, which occupies the central part ot‘ the 
cornea, which in about sixty per cent, of the cases is accompanied by hypo- 
pion. Frequently there is severe ciliary neuralgia, sometimes almost none ; 
there is always coincident iritis. This disease often occurs in children, is often 
traumatic. The usual treatment, by atropine, warm fomentations, paracen- 
tesis and iridectomy, saves a certain number of such eyes; but Dr. Saem- 
isch announces a much more successful plan, which he has adopted in 
thirty-five cases. He has cured, he says, thirty-four out of the thirty-five. 
If this he not too warm a statement of results, we certainly have reason to 
accept the proposed method. It consists in making an incision across and 
through the ulcer from one side to the other, and keeping the wound open 
by repeatedly separating its lips until cicatrization begins. The wound 
begins and ends in healthy cornea, and is best made by transfixion with 
Graefe’s knife. The wound is at first reopened twice daily, afterward once 
daily suffices, and Weber’s probe-pointed lachrymal knife is the instrument 
Dr. S. uses. The instillation of atropia is kept up, and the eye protected. 
The cut generally relieves the pain at once, and the ordinary dangers of 
prolapse of iris and staphyloma are completely avoided, while the risks of 
mischief in the operation are easily guarded against by a skilful surgeon. 
22.— The Regeneration of the Epithelium of the Cornea. By Dr. O. T. 
Wadswoeth, Boston. [Boston Medical and Surgical Journal, vol. vi., 
No. viii.] 
23.— Versuche uber Hornhaut-Entzundung. By W. F. Nobeis, of Phila- 
delphia, and S. Steickeb, Wien, 1869. 
24.— Ueber die Grundsubstanz und die Zellen der Ilornhaut des Auges. 
By Drs. Schweiger and Seidel. [Bericht der Mathernat.-Phys. Classe 
der Konigl.-Sacs. Gesellschaft der Wissenschaften, 1809, pp. 305-359. 
Monatsbliit. f. Angen., June, 1870.] 8 
OPHTHALMOLOGY. 
25.—Melanoma der Cornea. By Dr. Langhaus. [Virch. Archiv, Bd. 49, 
p. 117.] 
26.— Ueber ein Cancroid der Cornea und Sclera, ein Beitrag zur Entwicke- 
lunqs-qesehichte der Carcinoma. By Dr. A. Classen. [Virch. Archiv, 
Bd 50, Heft, i.] 
IKIS AND CIIOEOID. 
27.—Granulation Tumors of the Iris. By Dr. J. Hieschbebo, of Berlin, 
and Dr. Steiniieim, of Bielefeld. [Archives of Ophthal. and Otol., vol. 
i., part ii., pp. 647-658.] 
The case on which this paper is built is that of a peasant, aged twenty- 
one, who was wounded in the left eye by a splinter of wood. Some 
months after a growth appeared on the lower half of the iris; it was yel- 
lowish or flesh-colored, and slightly nodular, and filled the lower half of 
the anterior chamber; pupil adherent, fundus visible, sight good, field not 
abridged. A year later the tumor had invaded the corresponding part of 
the cornea, attained the size of a small hazel-nut, and overlapped the sclera. 
A little of the iris visible above, pupil covered by exudation. At the 
section, the lens was missing, and the tumor sprang from the ciliary body 
and iris. The microscope revealed “ a vascular fibrous, parvi-cellular mass. 
The stroma of parallel fibres is ricldy developed. The cells are roundish 
and irregular (shrivelled hy alcohol), occasionally short spindle-shaped, 
with distinct nuclei, a little larger than red blood-corpuscles; here and there 
some with many nuclei (myeloplaxes), but no giant-cells.” 
The tumor pronounced a granuloma, and without danger of recurrence. 
“ The relatively youthful age of the patient, the yellow or reddish, decid- 
edly not melanotic color, the uneven surface, and the microscopic vas- 
cularity, the very slow increase of the growth which projects quite gradu- 
ally from the iris tissue, might argue for the existence of granuloma, while, 
in an indubitable case of sarcoma of the iris, the neoplasm presented a 
smooth, uniformly bluish-black surface.” 
28.— Choroiditis after Relapsing Fever. By Dr. J. Estlandee. [Archiv 
f. Opthalmol., B. xv., ii., pp. 108-143. 1869.] 
Two epidemics of relapsing fever occurred in Finland, between 1865 
and 1869, and among other complications it was not rare to have disease 
of the interior parts of the eye. Dr. E. had seen twenty-eight cases. 
They appeared mostly between the second and fourth week after convales- 
cence, sometimes two to five months afterward, seldom during the acute 
progress of the malady. Vision becomes clouded, but outwardly there is 
nothing abnormal, while by the ophthalmoscope the vitreous is seen to he 
turbid. The opacity, wrhich is at first diffused, condenses slowly into small 
gray specks, like mucous floating in water, and with black irregular masses. 
At first they float about constantly, hut at a later period they settle by 
gravitation, and only float up when the eye is moved. This condition lasts 
about four weeks, and perfect recovery may ensue. But more often iritis 
takes place after some days or weeks, announcing itself by pain, hyper- 
semia, contracted pupil, posterior synechise, exudation, hypopyum and 
chemosis. There is not much photophobia; tension is more likely to be 
abated than increased. If the exudation do not exceed posterior synechia, 
entire recovery is possible; but after hypopyum the pupil is apt to remain 
occluded, and even suppuration of the cornea, followed by atrophy of the 
globe, may ensue. 
One case of the last sort was microscopically examined, and the lesions 
found to originate in the ciliary body, which was converted into a brawny OPHTHALMOLOGY. 
9 
mass, and pervaded by pus-cells. The vitreous opacities were composed of 
cells with processes, of pus cells, of fine fibres and detritus. In the lentic- 
ular fossa the hyaline membrane was covered with exudation. Only the 
anterior part of the retina contained pus. The choroid was free from 
morbid changes, but the iris was in a condition similar to the ciliary body. 
Decided antiphlogistic treatment was soon found to he improper, and 
atropine alone was most effectual in controlling the iritis; the adhesions 
would give way suddenly, the aqueous humor clear up, and the hypopyum 
be absorbed. Vitreous haziness was treated by invigorating diet and 
tonics. Sight would return in about six weeks. 
29.—Contributions to the Pathology and Therapeutics of Glaucoma. By 
Prof. A. yon Gkaefe, Berlin. [Archiv f. Ophthal., Bd. xv., abth. 3, s. 
108-252. 
Introducing first the subject of acute inflammatory glaucoma, Prof. 
Graefe considers the point, whether the loss of sight is due to disease of the 
retina, and states that it is sufficiently accounted for by the opacity of the 
media, except in the most severe cases; in which the retina must itself bo 
damaged. The ecchymoses which so often follow iridectomy lead us to sup- 
pose an unusual brittleness (softening) of the retinal tissue, and this ac- 
cords with that theory of the loss of sight which refers it greatly to paral- 
ysis by ischaemia, because of the hindered arterial supply. The prognosis 
of acute glaucoma after iridectomy is good, and that when the rules of the 
operation are not strictly observed. Iridectomy on one eye, for the acute 
inflammatory disease, is quite likely to be followed by an outbreak in the 
other eye. Especially if the other have already begun to show symptoms, 
this is likely to happen in twenty-five to thirty per cent, of the cases. 
If the second have had no prodromata, the liability is about ten per cent., 
and the attack takes place usually from the second to the fourteenth day. 
The subject of secondary glaucoma is treated in extenso ; the disease 
takes its rise from some precedent ocular affection, such as various forms 
of keratitis, of iritis, displacements of the lens, choroidal disease, poste- 
rior staphyloma, intraocular tumors, etc. 
Then glaucoma simplex is discussed, and he concludes with some ob- 
servations on the method of the operation, and on the hereditariness of glau- 
coma. Out of this long discussion we may select a few points. 
Pannus of the cornea is not infrequently complicated by glaucoma. So 
long as this depends on serous iritis, as is indicated by the irritability of the 
eye to caustic applications, paracentesis may suffice—when glaucoma is 
fully declared, iridectomy alone is effectual. In the latter case the opera- 
tion may sometimes aggravate the pannus, but soon this subsides. If, 
however, paracentesis were more frequently resorted to in the cases of bad 
pannus with deep anterior chamber, iridectomy would seldom be needful. 
Corneal cicatrices, when attended by adhesions of the iris, often demand 
iridectomy—as well for optical as therapeutic reasons. So urgent is this 
necessity that when a prominent leucoma adherens (partial staphyloma), fol- 
lows ophthalmia neonatorum, Graefe would at once operate; and, if the 
diameter of the cornea begin to enlarge, and the anterior chamber to grow 
deep, the operation cannot be deferred. 
The condition known as cornea globosa or hydrophthalmus congeni- 
tus, which begins in utero, is not suitable for the operation. A form of 
chronic keratitis in which an opacity runs across the cornea at the pal- 
pebral fissure, is attended by very moderate irritation, is composed of mi- 
nute yellowish or brownish points, and progresses for months or years, is 
apt to end in iritic complication and glaucoma. For better understanding 
of this disease in its various stages, four pictures, three of them in color, are 
given. One, Fig. 4, shows a case of twelve years’ duration, and the whole- 10 
OPHTHALMOLOGY. 
globe in glaucomatous degeneration. Iridectomy should be done at an 
early period of this trouble, certainly immediately upon the occurrence of 
obscurations or limitation of the field. This affection has met the eye of 
every ophthalmic surgeon, but has never been so carefully described, and 
its natural history so fully followed out. Now that its tendencies to evil 
have been so well pointed out, the remedy which can arrest some of the 
mischief will not fail to be applied. 
As to complications of the iris, not much need be quoted. Great stress 
is laid upon the importance of iridectomy when there is complete posterior 
synechia, and that in spite of the fact that at the time vision may not be 
much injured, and besides that by the operation a small fraction of visual 
acuteness may be sacrificed. The ulterior dangers of this condition are too 
serious to admit of parley. A curious fact is noted, that congenital colo- 
boina iridis is no protection against secondary glaucoma, in case there 
should be displacement of the lens, or chronic choroiditis as sometimes 
happens; and such cases do not refuse to yield to the beneficial effect of 
iridectomy. 
The irritation excited by dislocation or reclination of the lens into the 
vitreous is a difficult condition to treat. Sometimes when the lens touches 
the iris, iridectomy gives relief, but at other times nothing but extraction 
of the lens can do good, while this is extremely perilous because of loss of 
vitreous, cyclitis, etc. Wounds of the capsule in old people are followed 
by much more irritation of the eye than in children. In the latter, Graefe 
thinks it not needful to be so ready to do the operation as has of late years 
been the general disposition, because young eyes bear intraocular press- 
ure remarkably well. He regards pushing forward of the iris a better 
index for iridectomy than mere augmented tension. This remark upon 
the intolerance of pressure in eyes of old persons bears unfavorably upon 
the attempt to hasten the maturity of imperfect cataract by discission. 
Why serous choroiditis should sometimes lead to softening, and even 
phthisis bulbi, and in other cases to glaucoma, can only be conjectured. Age 
certainly exhibits the latter tendency, but we cannot account for the dif- 
ferences which we witness. If subretinal effusion have occurred, we 
very seldom see glaucoma. The chronic forms of choroiditis with pigment 
alterations very seldom result in glaucomatous tension. They are fre- 
quently complicated by vitreous opacities, especially in the equatorial vari- 
ety of choroiditis, and the important remark is made, that paracentesis of 
the anterior chamber often has a decided effect in causing their disappear- 
ance. 
Staphyloma posticum is frequently complicated by secondary glaucoma. 
The media remain clear, but tension increases, the nerve becomes ex- 
cavated, the visual field contracted. There may be evidences of inflam- 
matory action, in opacities of the vitreous, and of the aqueous humor, but 
most usually the symptoms are those of glaucoma simplex. The form of 
optic-nerve excavation deserves notice. It most usually does not exhibit 
the abruptness which belongs to pressure excavations, but, because of the 
precedent distention of the sclera, has on one side a sloping margin, and 
may not reach quite to the edge of the papilla. But, when, by light palpa- 
tion, arterial pulsation is produced, and the vessels show irregular disten- 
tion, and the visual field begins to be impaired, we must regard these excava- 
tions as glaucomatous. It is, moreover, peculiar to these cases that central 
vision long remains relatively intact, when peripheral vision has seriously 
failed. The limitation of the field often assumes the usual form beginning 
in the nasal side, but sometimes advances so as to surround the middle of 
the field by a zone of blindness, leaving beyond to the temporal side a 
region capable of sight. The peculiarities of this limitation are made clear 
by diagrams. The excavation above described may subsist for a long time OPHTHALMOLOGY. 
11 
without disturbance of function. But, if this do occur, iridectomy is im- 
perative. If sight has been so much damaged that defect of field comes 
close to the centre, iridectomy does sometimes impair the central vision. 
The effect of iridectomy on the progress of staphyloma cannot be stated— 
that in young myopes it improves the range of accommodation is positive. 
The only form of retinal disease liable to be complicated by glaucoma 
is retinitis hfemorrhagica; this belongs to people beyond middle life, is 
attended by sclerosis of the vessels, and not seldom is succeeded by cere- 
bral haemorrhage. This form of secondary glaucoma Graefe has seen 
twenty-two times. In five cases the other eye suffered an attack of retini- 
tis apoplectica after a few months; in six cases the second eye went 
through the same succession of symptoms as the first, viz., haemorrhages, 
glaucoma, total loss. Unhappily, treatment by iridectomy or any other 
means does not help these cases. When, on account of persistent pain, an 
operation is to be considered, and the other eye to be protected, extirpa- 
tion rather than iridectomy will claim preference. 
That the essential feature of glaucoma consists in increase of ocular 
tension, Graefe finds fully confirmed in the case of glaucoma simplex, 
which name he accepts, and to which he devotes twenty pages. The 
difficulty lies in detecting the cause which provokes the hypersecretion. 
That it lies within and not outside of the eye, he thinks most probable ; 
also, that rigidity of the sclera has much to do with it, whether this be a 
primary or secondary condition ; that the effect is to be looked for in irri- 
tation of the secretory nerves, rather than in obstruction to the venous 
circulation; in this last point Graefe does not accord with the views 
of Stelwag. In these cases the results of iridectomy are peculiar. More 
than one-half of the cases are permanently benefited. In one-fourth the 
ocular tension is not completely reduced to the normal standard, and, 
though vision is longer retained than without operation, after a time the 
globe becomes harder, and a second operation is demanded. 
In another quota, the benefits of the operation are of still shorter dura- 
tion, and a second interference avails nothing, or only little. In five cases, 
two per cent, of all, iridectomy was followed by destructive inflammation 
and total loss of the eye. The behavior of the eye immediately after the 
operation gives indications for ulterior prognosis. If it continue hard, the 
anterior chamber not reestablished within two days, permanent good is 
not to be expected; if tension is not abnormal, nor pericorneal irritation 
and neurosis increased, while the anterior chamber becomes filled in three 
or four days, the result may be good. But even though inflammatory re- 
action does not arise, if the globe continue hard, the neurosis remain, the 
iris and lens pressed against the cornea, and sight extinct, the case gives 
no hope. If there be any undue tension, the pressure-bandage must be 
omitted, and the plaster-strips applied; then atropine not to be used— 
the slightest pain controlled by morphia injections, calomel given as a pur- 
gative, and warm fomentations applied. 
In some cases for which an iridectomy does little good, a second one on 
the opposite side of the iris has been found to be far more effectual than 
when done alongside of, and increasing the first excision, and, by careful 
comparisons, Prof. Graefe became convinced that this may be accepted as 
a general rule. 
30.— Contributions to the Anatomy of the Ciliary Muscle. By Dr. A. 
Iwanoff. [Archiv fur Ophthah, Bd. xv., Abth. ii., s. 284-298.] 
In addition to his former researches into the anatomy of the ciliary 
muscle, contained in a previous number of the Archives, Dr. Iwanoff has 
undertaken to discover what differences it may have in myopic and hyper- 
metropic eyes. That the difference of refraction involves a great difference 12 
OPHTHALMOLOGY. 
in the accommodative function has long been maintained, and a correspond- 
ing variety in the ciliary muscle is to he expected. It has been maintained 
that in hypermetropia the muscle would be found large and greater in 
bulk, while in myopia it would be thin and smaller. The examination re- 
vealed quite another state of facts. In twelve myopic eyes, whose axes 
were from 28 to 34 mm. in length, in all myopia being over one-quarter, 
there was no atrophy of the muscle, but it was thicker and longer than 
in emmetropia. 
The muscle is composed of two sets of fibres—one external and running 
in the meridians of the globe, pointed out by Bowman and Briicke; the 
other set internal, at the anterior part circular in direction, and described 
by Arlt and II. Muller. 
In myopic eyes the circular fibres were almost entirely wanting, and 
the meridional fibres unusually numerous. 
In four hypermetropic eyes, whose axes were from 19 to 20 mm., the 
ciliary muscle was found thin and pushed forward, while in myopia it was 
thick and shoved backward. In hypermetropia, the posterior portion of 
the muscle was atrophied, the anterior part hypertrophied ; that is, the cir- 
cular fibres were in excess. The difference, then, in the structure of the 
muscle in myopia and hypermetropia is that in myopia the meridional fibres 
are most numerous, in hypermetropia, the circular most numerous. 
The large development of circular fibres in hypermetropia affords a 
better starting-point for the action of the longitudinal fibres, and enables 
them to make the great effort to which the refractive condition compels 
them. Their line of traction is thus made more oblique from before, back- 
ward and outward—that is, coincides less with the surface of the globe, 
and more efficiently relaxes the zonula of Zinn. 
The ciliary muscle of myopes must exert a greater traction on the cho- 
roid than of hypermetropes; and in this is the reason why the former have 
so much more frequently the atropic choroidal crescent at the optic nerve, 
because the pulling of the ciliary muscle on the choroid terminates at the 
latter’s fixed point—the nerve. A similar effect occurs occasionally in hy- 
permetropes, but far less frequently. Undoubtedly other factors have a 
part in the perineurotic choroidal atrophy of myopes, but the character of 
the ciliary muscle and its action are to be taken into account. 
The above anatomical differences are important items in explaining 
with exactness the physiology of accommodation. 
31.— Cyst of the Iris. By Dr. H. Knapp, of New York. 
A Case of Cyst of the Iris. By Francis Simrock, M. D., of New York. 
Cyst of the Iris cured by Operation, Zinn’s Membrane forming its Ante- 
rior Wall. By Charles M. Allin, M. D., of New York. [Trans, of 
the Am. Ophth. Soc., 1870.] 
Of the above, two cases are new. Dr. Knapp reported the good con- 
dition of the eye on which he operated a year ago, and which he narrated 
to the Society. 
32.—Results of Thirteen Passavant's Operations for breaking up Attach- 
ments of the Iris to the Capsule of the Lens. By Dr. B. J. Jeffries, 
Boston. [Trans, of the Am. Ophth. Soc., 1870.] 
There were four eyes operated on—one eye eight times within a month, 
another eye three times within a week; two Other eyes each once. In all 
cases ether was given, and the results were satisfactory. Sketches are 
given of the outline of the pupils at various stages of the proceeding. OPHTHALMOLOGY. 
13 
33.— The Musculus Dilatator Pupillce, in Mammalia, Men, and Birds. 
By Johann Dogiel. [Archiv fur Mikroskop. Anat., Bd. vi., Heft i., pp. 
89-99.] 
The existence of the muscle is demonstrated by long treatment of the 
iris in weak acetic acid, and subsequent coloring by an acidulated mixture 
of carmine and glycerine. 
34:.—The Effect of Atropia on Intra-ocular Pressure. By Dr. Adamiuk, of 
Kazan. [Annales d’Oculistique, Ixiii., p. 108, March and April, 1870.] 
Intra-ocular tension is the result of the lateral pressure on the walls of 
the vessels, the fluid contents of the globe being regarded as products from 
the vessels. 
Atropia, by experiment, has .been shown to diminish the exosmosis of 
fluids from the vessels. If a fine trochar is inserted into the anterior cham- 
ber, about five drops of aqueous humor escape; but, if the eye is under 
the influence of atropia, only about three drops escape. The pressure in a 
cat’s eye stood at 23 of the manometer, and rose to 33, after irritating the 
conjunctiva by spirits of ammonia. In the other eye to which atropia was 
applied, the manometer indicated only 28 under the same irritation. In 
the first eye, after cessation of the irritation, the manometer fell to 28; in 
the second eye, it fell to 21, proving that atropia had hindered the exos- 
mosis. 
The effect of atropia on the vessels is not to paralyze them, but, on the 
contrary, it stimulates them to contraction. If the sympathetic be cut, the 
quantity of filtrate from the vessels is doubled. Finally, it is shown that 
the filtrate from the vessels, when affected by atropine, is less plastic than 
at other times. This has a direct influence on the exudation of inflamma- 
tion. 
LENS AND VITREOUS. 
35.— Communication to the Editor upon the Peripheral Linear Section 
for Cataract. By Prof. A. von Gkaefe. [Monatsblat. fur Augenheil- 
kunde, January, 1870.] 
In this article Prof. Graefe comments on the objections which Stetfan 
made to his mode of operating. Among other things, ho asserts the wound 
which he makes to be 5'" in length, which is about 11 mm., or T7-g- of an Eng- 
lish inch. He says that he was at this time, the latter part of 1869, in the 
eleven hundredth of his operations by peripheral linear section. Of his 
last four hundred he had yet made no report, and of them there was little 
to be said. But, as to opening the capsule, he had adopted a plan which 
A. Weber employed—to make two vertical cuts in the side of the pupil, 
then a transverse cut below, and another transverse one above, within a 
millimetre of the upper border of the lens. Thus a square piece is in- 
cluded, and may sometimes be brought out, but always leaves a clearer 
pupil. 
Considerable space is given to the after-treatment. The padding over 
the eye to be soft, uniform in pressure, and the whole dressing comfortable 
to the patient. He expresses himself decidedly against leaving the dress- 
ing unchanged for several days, having, he says, experimented carefully 
enough to be satisfied on this point. 
Having operated in the afternoon, the bandage is removed in the even- 
ing, and again next morning, and afterward daily, or, without harm, twice 
daily. On the first evening, sufficient opening of the lids to let out clots 
or lens-matter, and to see with a candle the lower part of the cornea, is 
useful, and not dangerous. 
He lays the greatest stress on the importance of preventing pain. He 14 
OPHTHALMOLOGY. 
operates usually without anaesthetic; if the pain of the wound do not sub- 
side soon, but rather tends to increase, he gives a hypodermic injection of 
sulph. morphias in the temple. If this do not give relief, the bandage is 
taken off, and a soft, moist sponge applied for a few minutes to the eye. This 
relates to the period up to three hours after the operation. After six hours 
have passed there should be no specially unpleasant feeling about the eye: 
if there be, it must not be lightly regarded, but met either by a second 
morphia-injection, or, if the pulse is excited, by taking four to five ounces 
of blood. 
To insure good sleep, if it be uncertain, give 40 grains of chloral—this 
to depend on the effects of morphia already, perhaps, administered, and 
may require to be repeated. 
The time of reaction of the wound is from the twelfth to the twenty- 
fourth hour. If there be any pain toward morning of the first night, the 
bandage should bo taken off; if there be no chemosis, or swelling of lids, 
the wound need not be inspected, and the freshening of the eye and addi- 
tional morphia will suffice. But, if the secretion of tears be copious, the 
upper lid puffy, energetic means must be adopted. The wound to be in- 
spected to know if suppuration threatens. The skin of the lid to be touched 
with lapis mitigatus; the bandage to be more snugly applied, and from 
robust patients a venesection of six ounces, to be followed in half an hour 
by a morphia-injection in the temple. A free calomel-purge is given soon 
after the venesection. With weakly persons, the bleeding is omitted, and 
the dose of calomel made moderate. Usually in six hours afterward a de 
cided improvement is found in the symptoms. The utility of the bleeding 
is limited to a very early, and that the initial, period; when suppuration 
has begun it is useless. For this, the caustic to the outer surface of the 
lid is his chief reliance, and the bandage changed every six hours. To 
feeble patients he gives quinine. If there be gastric irritation on the sec- 
ond day, he does not hesitate to give an emetic, and continues the cauteri- 
zations and bandage. For suppurations he uses warm fomentations only for 
a short time when the bandage is changed, not now resorting to them so 
much as formerly. Iritis he treats in the usual way. 
38.— Graefe's Peripheral Linear Section. By Dr. Steffan. [Monatsblat. 
fur Aug., February and March, 1870. 
The author, who took exception some time ago to certain assertions about 
this section, now concedes that, as Graefe says, it is possible- to bring out 
the largest lens through a peripheral linear section, whoso internal length 
shall be 4.5'", and the height of the flap 0.5'" ; but he asserts that this sec- 
tion is much more difficult than to make a flap on the periphery with a 
height of IV" to 2'". He finds the latter yields him better results than 
the former, and thinks the directions Graefe gives must be adhered to in 
the minutest particulars in order to secure a success approaching what he 
gives. 
37.—RemarJcs on some Practical Points concerning Cataract-Extraction. 
By Dr. H. Kxapp. [Trans. Am. Oph. Soc., 1870, pp. 143-147.] 
38.—Beitrdge zur Normalen und Pathologischen des Auges. Contributions 
to the Normal and Pathological Anatomy of the Eye. By Dr. Iwanoff, 
with 5 plates. [Archiv fur Ophthalmologic, Bd. xv., Ab'tb. 2, s. 1-105.] 
The principal part of the paper is a discussion of the occurrence of de- 
tachment of the vitreous. 
A distinction is first made between dissolution of the vitreous body and 
its detachment from the retina. The former has long had a place in text- 
books, under the name of svnchysis—the latter has not been obseevrd OPHTHALMOLOGY. 
15 
until within a few years. The pathology of synchysis consists in fatty de- 
generation of the cells and stroma of the structure. It begins at the deepest 
parts of the substance, spreads gradually to the remaining parts, and occurs 
most frequently in old people. This change belongs to the series of senile 
involutions, like arcus senilis, the condensation of the lens, etc. Dissolu- 
tion and detachment of the vitreous are much more emphatically morbid 
in tbeir character, and often the precursor of detachment of the retina. 
The cases in which this change is described are those of penetration of 
the eye by foreign bodies, of extraction of cataract, of contusion, of ex- 
treme myopia, and of glioma. The morbid appearances are given in detail, 
and the conclusions are as follows: That the hyaline membrane is nothing 
more than the membrana limitans interna retinte—and not an indepen- 
dent structure—a view which Henle has already declared. Sometimes this 
attaches itself to the vitreous and sometimes to the retina, and has thus 
received distinct names, according to its relationship. 
How detachment of the vitreous occurs in myopia, in staphyloma of the 
cornea, or after extraction of cataract with loss of vitreous, is not difficult 
to understand. The vitreous either does not completely fill up the eye, or 
there is a sudden relief of tension of the globe—it is not surprising that 
a serous transudation should occur, as it were, ex vacuo. The vitreous may 
for a long time remain but little changed in contact with this fluid, or it 
may undergo extensive transformation into connective tissue, with shrink- 
ing of its bulk. 
A most interesting process is detachment of the vitreous after penetrat- 
ing -wounds by foreign bodies. It usually becomes funnel-like in form 
the apex at the optic nerve, the base at the equator. This condition is very 
slow in being developed, and depends on what many observers have de- 
scribed, viz., the change of the vitreous into connective tissue. Around the 
foreign body cells first appear of rounded forms; they become stellate, fu- 
siform, etc., and extend into other portions of the vitreous; fibres soon 
appear, and, by absorption of the more fluid parts, the whole becomes con- 
verted into connective tissue, with condensation and shrinkage. How the 
retina becomes detached by effusion behind it, or the effusion may simply 
fill up the space between the vitreous and the retina. A similar explana- 
tion may be given in cases of irido-choroiditis, without the presence of a 
foreign body. To this category also belong many of the cases of blindness 
following the operation of reclination of the lens. 
And, in extracting cataract, the mischief which may possibly follow the 
loss of vitreous is not confined exclusively to the period of healing, but may 
appear at a later time, after months or years, in consequence of similar 
changes in the vitreous. 
In enucleated eyes detachment of the vitreous is now more frequently 
seen than formerly, because this is to be looked upon as a stage preliminary 
to detachment of the retina, and the enucleation is done at a much earlier 
period in the symptoms than before. 
89.—History of the Corpus Vitreum and its Forms of Inflammation. By 
Prof. v. Hasnek, Prague. [Vierteljahrschrift fiir die praktische Heil- 
kunde, Band ii., 1870, s. 1-12.] 
A brief review is given of tbe views, ancient and modern, of the anat- 
omy of tbe vitreous, and the nature of its morbid processes. Stilling, by 
means of carmine staining, was able to show that there is a central body 
or nucleus situated rather forward, and a peripheral substance having a 
laminated character; also that there is a central canal from which fis- 
sures proceed in a threefold direction. The nucleus is intersected by a 
net-work of anastomosing cells. These cells, with long, delicate processes, 16 
OPHTHALMOLOGY. 
have been described by Iwanoff and others, while Finkbeiner, Hannover, 
and Ooccius, found large flat epithelium. The latter forms would seem to 
exist in the outer layers, while the irregular and anastomosing cells occupy 
the interior. The gelatinous transparent substance surrounds and contains 
them. From the undoubted fact of the presence of cell-forms, a theory 
of inflammation of the vitreous may be built up, and Prof. Hasuer subdi- 
vides it into serous or hydrops vitrei, plastic or hypertrophic, and purulent. 
The condition formerly called synchysis he would designate as hydrops 
of the nucleus. Let this condition be exaggerated so as to cause increased 
tension and its results, and then the author finds the etiology and symp- 
tomatology of glaucoma fully accounted for. Holding, as he says, this view, 
which is returning to the pathological notions of centuries past, the author 
does not attempt to explain the various phases of glaucoma, nor meet the 
many objections which would at once be raised. Hydrops of the outer 
layers was anatomically discovered by II. Muller in 1856, and has been more 
recently investigated by Iwanoff, under the name of detachment of the vit- 
reous. He shows how this may be the origin of subretinal effusions, as 
well as of shrinking of the vitreous body. The presence of opacities in the 
vitreous is explained by the products of cell-metamorpliosis, and crystals 
of cholesterine may be expected to occur in any collection of serum which 
contains protein substance or fat—this readily explains the old synchisis 
scin til Ians. 
Inflammatory action will further produce connective tissue under its 
various forms of membranes, fibres, etc., while blood-vessels and pigment 
may also appear. In this way we are able to account for a large part of the 
flocculent and other floating bodies seen in the vitreous, without invoking 
the intervention of the choroid and ciliary body. From these sources we 
have haemorrhages and products of inflammation effused into the vitreous, 
but can always find other evidence of their action besides the effusions. 
40.— On the Pathology of the Vitreous. By Dr. Hermann Pagensteciier, 
of Wiesbaden. [Archives for Ophthal. and Otol., vol. i., No. 2, pp. 
500-552.] 
A series of thirty-two experimentsupon rabbits’ eyes forms the basis of 
this attempt to settle the question whether the ATitreous is capable of pri- 
mary idiopathic inflammation. The evidence of inflammation is assumed 
to be the presence of pus, or lymphoid cells, or the development of con- 
nective tissue. 
To excite inflammatory action in the vitreous, irritating substances like 
croton-oil, or hits of wire, etc., were introduced into it, and the resulting 
changes minutely observed during life by the ophthalmoscope, and the eyes 
submitted to microscopic inspection after death. 
In his statement of the normal anatomy of the vitreous, the author 
agrees in the main with Iwanoff, but prefers to regard the several kinds of 
cells which may be discovered in it as varieties of only one primary form. 
It is characteristic of these cells that, while in their simplest form they are 
simply round, and have one or two nuclei, they undergo remarkable alter- 
ations, by shooting out irregular processes and projections; they become 
stellate, fusiform, filamentous; and frequently, by long threads, form con- 
nections with neighboring cells. They are contractile, slightly granular, 
and as closely resemble, in their primitve state, lymph-cells as the latter re- 
semble white blood-globules. By their property of contraction and out- 
growth, as well as by subdivision, they become transformed into the irregu- 
lar types which may always be seen under the microscope. Even the phy- 
saliphorous cells of Iwanoff, in which one vesicle is contained within an- 
other, have been seen to proceed by successive modifications from the sim- 
ple round cell. Hence, admitting the correctness of the description of the 17 
OPHTHALMOLOGY. 
many kinds of cells in the vitreous, the author prefers to trace them hack 
to one form, of which all the irregular forms are but modifications. 
Dr. Pagenstecher does not find epithelium on the surface of the vitreous 
any more than does Iwanoff. 
The effect of the experiments was, of course, to cause opacities in the 
vitreous, and inflammatory changes also in other structures. As is already 
well known, the opacities exhibit lymphoid cells, and contractile round 
cells, with various modifications and connective tissue. But the lymphoid 
cells Dr. Pagenstecher believes are not generated in the vitreous, but make 
their way into it, as Coknbeim announced, from the enveloping membranes. 
He thinks this is so, because the connection of the cloudiness of the mem- 
brane around could always be anatomically proven. The details arguing in 
favor of this opinion are given in full. Hot only did he always trace a con- 
nection of the lymphoid elements with the surrounding tissues, but the 
filamentous and membranous opacities he asserts also proceeded from the 
place of puncture. In one rabbit two fine glass tubes remained floating 
eight days in perfectly clear vitreous, until at last one came in contact with 
the wall of the eye, and opacity began. 
The conclusion drawn from his experiments is in the following state- 
ment : 
“ That, in the vitreous, neither the gelatinous substance nor the elements 
contained in it, of whatever kind, are capable of inflammation from irritat- 
ing causes sufficient to produce it elsewhere, nor of forming lymphoid cor- 
puscles by morphological changes.” 
That is to say, the vitreous reacts sluggishly to irritating causes, and, 
when pus appears, it comes from an external source. A second and third 
formula are merely repetitions of the substance of the above, while the 
fourth conclusion is an assertion that “the vitreous cannot be said to be 
susceptible of inflammation in the same sense in which we use that phrase 
of other organs; but that every so-called inflammation of it is to be con- 
sidered as a secondary state, depending on the changes in surrounding 
tissues.” 
This fourth conclusion in its first clause hardly needs to be stated, be- 
cause the fact is self-evident; but the latter clause is not likely to be ad- 
mitted merely on the proof which the author’s reasoning and experiments 
afford. So long as lymphoid or pus cells only are to be the visible evi- 
dences of inflammation, his cases have weight, and coincide with clinical 
experience, for we know nothing of spontaneous suppuration of the vit- 
reous. But he attempts to show that connective tissue cannot originate in 
a primary hyalitis, but that this must always be excited by an irritation of 
the neighboring tissues. How, he describes how connective tissue results 
from metamorphosis of the normal histological elements or cells of the 
vitreous; and he admits that cell-growth and connective-tissue growth are 
facts of inflammation. That these cannot appear in the vitreous except 
through irritation of the surrounding membranes may yet be shown, but 
we cannot convince ourselves that these experiments prove it, notwith- 
standing the author’s arguments, because every one of his experiments in- 
volved a wound of the surrounding membranes or tissues. 
The present stand-point of pathology decidedly favors the view that 
every tissue possessing cells has inherent in it not only the power of self- 
maintenance through the office of these cells, but by their, perverted and 
exaggerated activity can call forth true inflammatory action: hence, we 
wait to be convinced that a primary hyalitis is impossible.. 
The paper concludes by a description of the various kinds of opacity 
found in the vitreous: 1. Inflammatory; 2. Blood; 3.. Such as may be called 
coagulations. The first disappear in part through fatty degeneration. The 
second are absorbed by enclosure of the blood-corpuscles in the contractile 18 
OPHTHALMOLOGY. 
cells which are furnished from the surrounding membranes. li The latter 
(viz., the contractile cells) change the coloring matter of the same (mean- 
ing the blood) to pigment, and may by further metamorphosis transform 
themselves into the cells of connective tissue in the vitreous. This hints at 
a very interesting process of absorption. 
The third kind of opacities, the coagulations, result from contact with 
air or chemical reagents. The author suggests that the cloudiness seen 
sometimes about foreign bodies in vitreo may not be inflammatory, but the 
effect of coagulation. The opacity which soon occurs in prolapsed vitreous 
is thus easily explained. 
41.— Gases of Foreign Bodies in the Vitreous Ilumor. By Henry D. 
Hoyes, hi. D., Hew York. [Trans. Am. Ophth. Soc., 1870, pp. 104- 
108.] 
One case is notable because the foreign body had remained two months 
within the eye, plainly visible by the ophthalmoscope, without causing any 
irritation. 
The other case is remarkable from the occurrence of total detachment 
of the vitreous humor, after its conversion into connective tissue, while 
the retina remained in its proper relations, and but little diseased. The 
bit of percussion-cap which had caused this mischief had been in the eye 
sixteen months. A woodeut aids in the explanation of the lesion. 
42.—Foreign Body in the Eye diagnosticated "by Limitation of the Visual 
Field. By Dr. T. R. Pooley, Hew York. [Trans. Am. Ophth. Soc., 
1870, pp. 108,109.] 
The case was seen four hours after the injury. There was a wound in 
the upper and inner corneal margin, 3wlong; the lens clear; blood pre- 
vented the use of the ophthalmoscope. Examination of the field of vision 
by a candle-flame discovered the upper and inner quadrant to be blind. 
On this symptom the presence of the foreign body in the eye was diagnos- 
ticated. Tins point was first brought forward by Dr. Berlin, of Stuttgart. 
Next day, severe inflammatory symptoms having set in, the eye was re- 
moved. A piece of steel was found in the lower and outer part of the 
eye, and around it was considerable haemorrhage. 
REFRACTION. 
43.—Apparent Form of Inverted Ophthalmoscopic Image of Optic Dish in 
Astigmatism. By Dr. Gr. IIay, of Boston. [Trans. Am. Ophth. Soc., 
187Q, pp. 86-88.] 
It has been stated that the inverted image of the optic disk of an astig- 
matic eye, viewed by the ophthalmoscope, is elongated, so that the long 
axis corresponds to the meridian of least refraction. Dr. Hay shows that 
this is not uniformly true; that the form of the nerve-image 'depends on 
the distance at which the objective lens is held from the eye. If we sup- 
pose the lens to be of three inches’ focus, and held about three inches from 
the eye, the nerve will appear circular notwithstanding the astigmatism; 
that if the lens be held nearer than three inches, the image will be oval, 
and the long axis correspond to the meridian of least refraction; if the 
lens be held farther than three inches, the image will be oval, and its long 
axis correspond to the meridian of greatest refraction. This was shown 
experimentally by glasses, and is demonstrated in the article by mathemati- 
cal formulae OPHTHALMOLOGY. 
19 
44.—A BemarJcahle Case of Triplopia. By Dr. Dufotjb, of Lausanne. 
[Klinisch Monatsbl. fill* Aug., February, 1870.] 
The patient was twenty years old, myopic J, at the age of twelve re- 
ceived a blow with the fist in the left eye. 
This cornea was unusually large; pupil and lens decentred inward 
about one mm., and at temporal side of iris was a slit in the direction of 
the radiating fibres, by which light could enter the eye. The edge of the 
lens came to the middle of the slit. Rays would enter the eye, first, by 
the natural pupil; second, by the inner half of the slit, and, because of the 
myopia, they would cross in front of the retina, and give two images; 
third, rays would enter by the outer half of the slit, and not pass through 
the lens at all, but beyond its rim, and form a third image on the retina— 
hence the triplopia. 
The interesting features of this case, and the alteration in the relative 
positions and distinctness of the images produced by various convex and 
concave glasses, are fully detailed. The changes caused by accommodation 
and by various prisms are curious. If a prism were held vertically before 
the other eye, then the patient saw four images. 
45.—A New Ophthalmoscope, by Dr. E. Jayal, is alluded to in the pro- 
ceedings of the Academie de Medeeine. [Gazette Hebdomadaire, May 
6, 1870, p. 278.] 
The mirror is a plate of glass covered by a thin layer of platinum, and 
the lenses which serve to correct the refraction of the patient or the ob- 
server are replaced by a small Galilean telescope. This, by a simple 
mechanism, is made to act as an optometer, and is exact as well as conve- 
nient. A greater magnifying power is attained by this contrivance than 
by ordinary instruments, while the remark is made that the instrument is 
capable of improvement in some details. It is a great desideratum to be 
able to correct hypermetropiaand myopia, in all degrees, without the trouble 
of changing the glasses, and to gain a greater amplification of the fundus, 
and we hope this new ophthalmoscope may be perfected. 
46.—A New Method of Producing Stereoscopic Effect. By Listing. [Quoted 
in Zehender’s Monatsblat., January, 1870, p. 29.] 
This new experiment of Listing, who has already done so much in 
physiological optics, brings out stereoscopic effect with only one picture, 
which consists of figures arranged in a peculiar way, and seen with vertical 
double images. The simplest experiment is to view two lines crossing each 
other at an angle of about 80°, with a prism of 4° or 5°, 
its base vertical before one eye. No effort must be made 
to correct the vertical diplopia. If the prism be put 
before the left eye, its base upward, the line B B' seems 
nearer to the eye than A A'. If the prism be turned 
with its base downward, and before the same eye, the 
line A A! seems nearer, and B B' more remote. I find 
with the base downward the prism must be weaker than 
when turned with the base upward. In gaining the 
effect by prisms so weak as these, no double vision is 
produced except for horizontal lines—the oblique lines 
appear to be only two. The same phenomenon may be produced in a com- 
mon stereoscope by having two similar figures, and pushing one alternately 
up and down. Two rows of the same letters are arranged on a page like 
the limbs of the letter X, and viewed as above stated with a vertically de- 
flecting prism; a sudden removal of one now takes place to a considerable 
depth, while this appearance is at once reversed on turning the prism 20 
OPHTHALMOLOGY. 
around 180°. These curious effects can only be produced and understood 
by means of the diagrams accompanying the article. 
47.—Do the Eyes perform any Rotation on the Optic Axes in Lateral In- 
clinations of the Head? By Dr. JosEpn Aub. [Archives of Ophthal. 
and Otol., vol. i., part ii., 659.] 
By a method of experiment suggested by Dr. Knapp, Dr. Aub was able 
to prove that the eyes turn in the same way and to the same degree as the 
head when it bends sidewise—that is, the vertical meridians preserve their 
relation to the median plane of the head. This comprises in detail what 
was asserted by Donders twenty years ago. 
48.— The Influence of Spectacles on the Optical Constants and Visual 
Acuteness of the Eye. By Dr. H. Knapp. [Archives of Ophthal. and 
Otol., vol. i., No. ii., pp. 377-410.] 
Among the interesting deductions which are brought to light in this paper 
is the statement that “spectacle-glasses held half an inch before the eye do 
not change the situation of its anterior cardinal points, nor its anterior and 
posterior focal lengths, but the situation of each of the posterior car- 
dinal points is altered in such a manner that convex lenses make them ad- 
vance, and concave glasses recede by the same quantity. This result 
comes about, because the spectacle-glass occupies the place of the first focal 
point of the ocular system, which is 12.918 mm. from the surface of the 
cornea—and this is almost an exact half inch. The change of place of the 
second nodal point of course alters the visual angle and the apparent size of 
objects. This fact has long been understood with reference to normal eyes, 
and is of daily experience in presbyopia. But the author proceeds to dis- 
cuss the effect of glasses on hyperopic and myopic eyes for purposes of dis- 
tant vision. As these errors are due to shortening and lengthening respec- 
tively of the visual axis, the author assumes that the number of percipient 
elements is the same in hypermetropic, myopic, and emmetropic eyes, the 
difference being merely one of condensation or dispersion. 
Taking this hypothesis for granted, it is shown that in hypermetropia 
and myopia glasses do not alter the visual angle, but do alter the size of the 
retinal image, because in hypermetropia, by advancement of the nodal 
point, the image covers more retinal elements than in emmetropia, and 
in myopia by the recession of the second nodal point the image covers 
fewer retinal elements than in emmetropia, these elements being crowded 
into a smaller area in hypermetropia, and scattered over a larger area in 
myopia. The degree of visual acuteness proper to various degrees of hy- 
permetropia and myopia is next calculated, and put into tabular form— 
the distance being given at which Snellen XX should be read when the 
myope or liypermetrope is armed with suitable glasses, and showing how 
much should be added to the average reading-distance for hypermetropia, 
and how much may be subtracted from it in myopia, and still vision be 
reckoned normal. 
In comparing Dr. Knapp’s figures with some examples given by Mauth- 
ner, page 227, in which he calculates the length of the visual axis for ame- 
tropia, some discrepancies are to be seen ; and if Dr. Knapp’s table on page 
397 be compared with Dr. Boring’s in the American Journal of Medical 
Sciences for April, 1870, page 335, and which is calculated from Mauthner’s 
formulae, there will be found to be scarcely any agreement between them. 
Dr. Knapp asserts that the amount of displacement forward or backward 
in equal degrees of hypermetropia or myopia is the same. Dr. Mauthner, 
and after him Dr. Loring, figures out decided differences. Thus, says Dr. 
Loring, HJ equals a shortening of the visual axis of 3.96 mm.; equals OPHTHALMOLOGY. 
21 
a lengthening of the visual axis of 8.6. Dr. Ivnapp says that both H|- and 
indicate a shortening or lengthening of the visual axis of 5.4544mm. 
Evidently some mistake has been made in somebody’s calculations. 
Dr. Knapp’s assumption that hyperopic eyes contain the same number 
of percipient retinal elements as do emmetropic eyes may be well enough 
admitted for his purposes; but, as hyperopia is an arrest of development, 
and, when of great degree, is accompanied by a decided amblyopia, we 
may be justified in suspending our acceptance of the assertion he makes 
until anatomical investigation has proved it. Of course, the only mode of 
proof is by counting the number of rods and cones in a given area of an 
emmetropic eye, and also of a hypermetropic eye. 
The whole paper is interesting, and masterly in its discussion, and con- 
cludes by giving similar calculations for visual acuteness in eyes operated 
for cataract, and furnished with suitable glasses. 
49.—An Additional Test for the Diagnosis and Correction of the Optical 
Defects of the Eye. By William Thompson, M. D., Philadelphia. [Am. 
Journal of Medical Sciences, January, 1870, pp. 76-80.] 
An Additional Method to determine the Degree of Ametropia. By 
William Thompson, M. D. [Am. Journal of Medical Sciences, Octo- 
ber, 1870, pp. 414-420. Transactions of American Ophthalmological 
Society for 1870.] 
The above papers relate to the experiment, first made by Schemer, in 
1019, by which an object, seen through two or more small boles in close 
proximity, forms a double or multiple image on the retina in case the retina 
is not placed accurately at the focus of the refractive media. Scheiner 
called attention to this in reference to the function of accommodation; 
Dr. Thompson shows how the same fact maybe made to apply to the diag- 
nosis of errors of refraction in general. He puts in front of the eye a 
blackened screen perforated with pin-holes one-eighth of an inch apart, and 
views a gas-flame as an object. If the eye be in any sense ametropic, the 
flame appears double : by putting a red glass over one hole, say the right, 
the red flame appears in bypermetropia to be on the left side, in myopia on 
the right side. The object is placed at a distance, and in hypehnetropia the 
accommodation must be relaxed. As Dr. Thompson remarks, this method 
becomes practical in the case of extreme amblyopia, where test-types may 
not be distinguishable. In these cases, however, we may reach the diag- 
nosis by the ophthalmoscope. A special case alluded to, in which there was 
considerable opacity of the lens, making diagnosis by the ophthalmoscope 
unreliable, does afford scope for the exercise of Dr. Thompson’s ingenious 
suggestions. But we can scarcely believe that they will very often be re- 
sorted to. 
In the second paper the method is more fully wrought out, and a simple 
rule of calculation is given, by which the distance of separation of the 
double images affords the means of deciding the degree of ametropia, and 
prescribing glasses. This is applied to astigmatism as well as to other re- 
fractive defects. The calculation is easy, and the elements are only those 
of simple proportion. A patient sits at five metres, about seventeen feet, 
from a gas-light turned low, he looks through two holes, in a disk placed 
close to his eye, which are five mm. in diameter and four mm. apart. He 
sees two flames; the surgeon, placing himself by the gas-light, brings a 
candle-flame into a position coinciding with the false image, and measures its 
distance from the gas-flame. Take a case—a patient operated for cataract 
saw the double lights ten inches or 250 mm. apart; his glass is obtained by 
the problem 5-°f >hr“t — 80 mm. The distance of patient from the object, 22 
OPHTHALMOLOGY. 
5,000 millimetres, multiplied by the distance between the perforations, viz., 
four millimetres, and divided by the separations of the images he sees, 
gives the needful glass, whose focal length is 80 mm. or 3.2 inches. The 
distance of the nodal point from the spectacle-frame, which is half an inch, 
must he alloAved for. 
That this method of determing ametropia will supersede the usual 
test-types and glasses the anthor does not expect, nor do we see that it is 
likely to have a considerable degree of utility, but we must commend the 
success of the endeavor, and the ingenuity of the devices employed. It is 
at any rate an interesting study in physiological optics. 
RETINA AND OPTIO NERVE. 
50.— Upon the Termination of the Optic-Nerve Fibres in the Retina. By 
Max ScnuLTZE. [Archiv. fur Microscop. Anatom., Bd. v., pp. 379-403.] 
The chief point is the discovery of minute hair-like fibres standing on 
the outer surface of the membrana limitans externa. They are seen Avith 
a magnifying poAver of one thousand diameters, and lie between the rods 
and cones. Max Schultze thinks they may be the terminal portions of the 
optic-nerve fibres, and be in connection with the primitive flbrillai into 
which he finds the inner members of the rods and cones divisible. 
51.— Upon the Macula Lutea of Man and the Ora Serrata of some Mamma- 
lia. By Dr. Fr. Merkel. With 2 plates. [Leipsic, 1870, pp. 20 inlto.] 
52.—The Light Streak seen in the Centre of the Retinal Vessels with the 
Ophthalmoscope. By Dr. E. G. Loring, Kew York. [Trans. Am. Oph. 
Soc., 1870, pp. 122-128. With 2 woodcuts.] 
The explanation hitherto given of this light streak, and which has been 
generally accepted as it is stated by Jaeger, is that it is the effect of reflec- 
tion from the column of blood in the vessel. Dr. Loring, by a simple ap- 
paratus of a glass tube filled with red fluid, placed at the bottom of a 
box, demonstrates that the light streak does not come by reflection from 
the column of fluid, but by reflection from the surface behind the tube, 
transmitted through the fluid. As the surface behind the tube has greater 
or less reflecting property, the light streak is more or less intense or is 
wanting. The apparatus imitates sufficiently well the conditions which 
exist in the fundus oculi, and makes his reasoning clear and indubitable. 
The absence of the light streak in the choroidal vessels is stated by 
Jaeger to be due to the greater thickness of the walls of these vessels, 
by which their transparency is abated so much that they become visible as 
opaque objects in their entire diameter. This explanation agrees equally with 
Dr. Loring’s explanation—it being conceded that the walls of the retinal ves- 
sels are so thin as to be practically transparent. It is readily understood 
that, where the blood is very dark, the reflex must be diminished, although 
perhaps not abolished—hence the fainter streak seen in the retinal veins. 
53.— The Channel by which in Cases of Neuro-Retinitis the Exudation 
proceeds from the Brain into the Eye. By Dr. II. Knapp, New York. 
[Trans. Am. Oph. Soc., 1870, pp. 118-120.] 
While the anatomical studies of Schwalbe and Schmidt have shown us 
that exudation may travel along the intervaginal space of the double 
sheath of the optic nerve from the arachnoid to the lamina cribrosa, Dr. 
Ivnapp makes a farther suggestion as to its progress into the interior of the 
eye. He thinks it percolates through the lamina cribrosa and spreads out 
into and around the head of the nerve. Finding extreme neuro-retinitis in OPHTHALMOLOGY. 
23 
two cases of brain-disease with very little damage to sight, he measured the 
size of Mariotte’s blind spot and found it increased in one patient two and 
a half times, in the other four times its proper size. To quote the Avords 
of the article: 
“This enlargement of Mariotte’s blind spot can, to my mind, only be 
explained thus : The exudation—fluid and white blood-corpuscles—travels 
from the arachnoidal cavity into the inter-vaginal space, oozes through the 
periphery of the lamina cribrosa, and expands into the soft tissues around 
the margin of the optic disk, the suprachoroid, choroid proper, and retina. 
The optic-nerve fibres of the latter, situate farthest from the origin of the 
exudation, will be attacked least and last. The rods and staves, however, 
the percipient layer*of the retina, will be affected sooner, and have their 
function either destroyed or, in case of recovery, kept in abeyance. The 
enlargement of Mariotte’s blind spot, which I found to correspond to the 
extent of the exudation visible with the ophthalmoscope, proves this Conclu- 
sively. In addition, I may strengthen this theory by the following facts: 
The rods and staves are delicate organs, and more easily destroyed than the 
nervous fibres. The exudation, seen through the ophthalmoscope, has its 
summit at the margin of the optic disk. Extending in both directions, be- 
tween the fibres of the optic-nerve entrance, and into the choroid and ret- 
ina, the most destructible parts it meets on its Avay are the rods and staves, 
the nutrition of which, moreover, is dependent rather on the choroid than 
on the retina. If the exudation passed through the optic nerve itself, there 
would be, in consequence of a like pressure on all the nervous fibres, an 
equal diminution of visual acuteness over the whole field of vision. The 
anatomical study of specimens alone can fully explain this process. But 
since this has not yet been done, and specimens are exceedingly difficult to 
obtain, I thought it well to present my views on this subject before the 
members of this Society, thereby calling their attention to it, in ordor that 
no opportunity may be lost, both with regard to the clinical observation 
and the anatomical investigation of neuro-retinitis.” 
54.—Some Curious Phenomena resulting from Reflex Nervous Action in 
consequence of Traumatic Lesion of the Eye. By Dr. 0. A. Robert- 
son, Albany. [Trans. Am. Opb. Soc., 1870, pp. 110-113.] 
A man, aged forty-one, received a severe blow on the left eye at the 
time when Dr. Robertson saw him. Staphyloma of the sclera and cornea had 
formed, globe very hard, cornea insensitive to touch, very little pain—no 
perception of light. After two months, staphyloma increased greatly, and 
spontaneous rupture took place, and was repeated two or three times after- 
ward. Patient refused enucleation. After several additional months, Dr. 
Robertson was called to see him, suffering from symptoms thought to be 
precursory of typhoid fever, or due to some kidney-trouble. 
“ The patient was exceedingly weak, and without appetite. Pulse was 
full and soft; skin moist; but sometimes (as stated to me) dry and hot; 
tongue moist, coated white; urine scanty and bowels constipated. A fre- 
quent twitching or spasm of the body occurred. Expression of the face 
dull, almost stolid. The fingers of one hand were constantly rubbing or 
working on the ala of the left nostril. Patient made no remark, except 
when questioned, or when startled by a sudden noise. In answer to ques- 
tion, he said his eye did not hurt him, but he had darting-pains in the 
head. The staphyloma was larger than I had seen it before. Ilis manner 
was listless, and his mind enfeebled rather than delirious, although he was 
sometimes decidedly delirious at night, as his wife stated. lie would wake 
frequently, as if from a frightful dream, and spring up excitedly in bed, 
trembling with terror, and it would be long before he regained his corn- 24 
OPHTHALMOLOGY. 
posure. Even when awake, and in the daytime, a sudden noise in the 
house or street would startle him and make him exclaim, while shaking 
with fear, ‘ What’s that ? ’ 
“On consulting with the attending physician, I stated my opinion to be 
that all the symptoms were due to perverted action of the reflex nervous 
system, and that the diseased eye was the exciting cause of all this pertur- 
bation. I urged the immediate abscission of the front of the globe, since 
the patient had previously refused to have the entire ball removed. He 
smiled at what seemed to him the absurdity of my opinion. He concurred 
with me that the eye was a hideous deformity, and that the patient could 
endure an operation for its removal, and with that view he would not op- 
pose an operation as an experiment to confirm or shbvert my opinion. 
Accordingly, chloroform was procured and the patient anesthetized. A 
liberal abscission was made, according to the method of Mr. Oritchett, of 
London. 
“All perverted nervous action ceased after the operation. During the 
first night the sleep was refreshing and bnt little disturbed. In a week 
after removal of sutures the patient came to my office to show himself, 
having travelled eight miles. All local irritation had subsided, and an ex- 
cellent stump existed for the support of an artificial eye. He called him- 
self a well man. 
“ The nervous phenomena of this case are exceedingly interesting. From 
the appearances presented by the eye, it was evident, as before said, that 
the cliief violence of the blow was expended upon the superior portion of 
the ciliary region of the eyeball, and not upon the brow. The iris and 
ciliary region, and to some extent the cornea, are supplied by filaments cf 
distribution from the ophthalmic or ciliary ganglion of the great sympa- 
thetic nerve, situated on the outer aspect of the optic nerve in the posterior 
chamber of the orbit. A few of the ciliary nerves are derived from the 
naso-ciliary nerve. This ganglion serves as a medium of connection be- 
tween the trifacial (branches of which are largely supplied to the cornea) 
and the oculomotor, or third pair. The nasal nerve is a branch of the 
frontal, and, besides its ciliary relations, is also joined by a filament of the 
sympathetic. 
“ These nervous connections will account for the irritation about the nose, 
the head-pains, and the cerebral symptoms, while the spasms and other 
constitutional disturbances were doubtless caused by irritation of terminal 
branches of the great sympathetic nerve.” 
55.—Pulsation of the Vena Centralis Retina, in Cases of Epilepsy and 
kindred Affections. By Prof. Kostt and Dr. Niemetschek. [Viertel- 
jahrschrift fur die praktische Heilkunde, part ii., pp. 81-93, part iii., 
pp. 1-50, 1870.] 
This article purports to be an extract from a work upon the uses of the 
ophthalmoscope in appreciating diseases of the insane. It consists of a 
series of thirty-six observations recorded in detail, followed by conclusions 
drawn from these and other cases, which amount to 250 individuals and 
468 eyes examined. 
The cases given in detail are well stated, and the ophthalmoscopic ex- 
amination shows familiarity with the instrument. The degree of vision is 
seldom noted, and the visual field appears not to have been attended to. 
In many patients it would not have been possible to ascertain these facts, 
but it is certainly desirable to have them. Forty-six closely-printed pages 
are devoted to the detail of thirty-six cases, which we cannot attempt to 
analyze. In all of these, and in sixty-six eyes, there was a venous pulse. 
The cases are put into three categories: 1. Twelve who were decided OPHTHALMOLOGY. 
25 
epileptics and maniacal as well. 2. Seventeen having clear epileptiform 
symptoms. 3. Seven in whom these symptoms had existed, and passed away. 
Out of the thirty-six cases, four had opacities of the lens, and eleven 
were hyperopic—a defect of development which in this connection has 
special meaning. The optic disk showed no alteration of form in fifty-four 
cases ; in nine it was oval, five times vertically, four times transversely— 
the oval shape in some cases produced by astigmatic refraction. In twelve 
eyes the nerve was excavated to a greater or less degree, and in this cir- 
cumstance there is no special importance. Anomalies in the color of the 
nerve deserve careful attention. Its normal hue the author calls a grayish 
red and this is deeper on its nasal side, because the fibres and capillaries are 
thicker than on the outer half. In anaemia the outer or temporal side of 
the nerve becomes more pale and transparent, so as to permit us to discern 
deeper parts, as the lamina cribrosa. In six cases only one-half of the nerve, 
and in nine cases only one-third of the nerve, exhibited the proper grayish 
red. Most of these patients were strikingly anaemic. In five of these 
fifteen cases there was goitre, and the large supply of blood going from 
the carotids into the thyroid gland abates materially the quantity fur- 
nished to the brain. In other cases the force of the intra-cranial circula- 
tion was weakened by heart-disease, such as stenosis-of the aorta, dilatation 
of the ventricle, feeble contraction, etc. From these facts the author con- 
cludes that epilepsy results from anfemia of the brain. Loss of conscious- 
ness first takes place, then spasms, irritability, and perhaps maniacal seiz- 
ures. This stage implies cerebral hypersemia, which may become so great 
as to cause fatal sopor, as in case three. Now, while in the anaemic condi- 
tion the optic nerve is pale, in the subsequent stage of cerebral hyperaemia 
it grows red. In a few patients the nerve was gray or even white—one 
was an old epileptic, and two had indications of cerebral atrophy. 
Another symptom to which the authors call attention is the succulence 
of the retina. The glistening reflex which appears in young children, and 
in some robust adults, and especially the silvery elliptical areola which sur- 
rounds the bright red fovea centralis retinaa in such persons, is said to be 
due to the abundance of fluid in the tissue. The absence of this lustrous 
reflex indicates a lack of moisture, and in only ten cases was its presence 
seen. These were young, but decidedly anaemic; and this feature was in 
some noticed during the stage of reaction and consequent turgescence. It 
is stated to be characteristic of incurable epilepsy to find enlargement of 
the central retinal arteries, narrowing of the veins, and absence of retinal 
reflex. One patient examined during an attach exhibited slight enlarge- 
ment of the arteries, extreme thinness of the veins, and disappearance of 
the retinal reflex. At previous inspections of this patient, the veins were 
moderately large; and one seems warranted therefore in putting the 
emptiness of the veins and collapse of the retina into close relation with 
the unconscious stage of the attack. A frequent repetition of this state 
leads to pigment maceration of the choroid. The retinal arteries and veins 
are found in various and usually opposite conditions; that is, arteries large 
and veins small, or arteries small and veins large—the former state indi- 
cates an obstinate and severe disease, the latter, belonging to the reactive 
period, has a relatively better prognosis. Where, as in some cases, both 
arteries and veins are large, the circulation is becoming healthier. Small 
arteries and small veins indicate ancemia with regressive metamorphosis. 
Pulsation of the retinal veins is the symptom which this article makes 
most prominent. It can be caused in every eye by gentle pressure with 
the finger. The vein widens with the heart systole, which is the time of 
arterial diastole. Pressure on the eye hinders arterial circulation, and 
favors venous outflow. Every thing which abates the pressure on the in- 
ternal carotid may give occasion to venous pulse. In the cases cited, this 26 
OPHTHALMOLOGY. 
may originate in general antenna, or in some local cause which favors anae- 
mia of the head. Whatever promotes venous outflow from the head in- 
creases cerebral anaemia, and therefore a deep inspiration makes a venous 
pulse stronger. When pressure on the eye puts an entire stop to the arterial 
circulation, the retina can no longer see—every thing becomes dark. The 
effects of prolonged pressure are well seen in glaucoma. 
“Anaemia of the whole eyeball is seen in pallor of the papilla, anaemia 
of the retina in venous pulsation; increased pressure is shown in arterial 
pulsation.” 
Venous pulse did not occur in both eyes, in all the thirty-six cases; in 
twenty it was stronger, or present only in the left eye. No reason is as- 
signed for this preponderance. 
The conclusions of the paper are put into the following four statements: 
1. Venous pulsation appears when, by pressure either from within or 
from without, the eye is made anaemic. 
2. Anaemia of the eye, whose special manifestation is pallor of the pa- 
pilla, may occur from general poverty of blood, or from imperfect filling 
of-the internal carotid ; from both causes a venous pulse may take place. 
Hence this phenomenon appears in epilepsy and kindred affections, which 
depend on cerebral anaemia. 
3. Diminution of circulation impairs the nutrition and function of an 
organ. In slight degrees of brain-anaemia, patients suffer temporary obscu- 
rations of sight, giddiness, and loss of consciousness. 
The more serious the anaemia, the greater the debility of the organ. 
The eye loses sight, the brain loses sensation, will, and thought. Nothing 
but a reestablishment of the circulation can restore the organ to its func- 
tion and prevent death. 
4. Hence in anaemic persons we may find the papilla reddened, the retinal 
veins turgid, and the retinal tissue swollen. This is the hyperaemia which 
succeeds to the anaemic state. In slight degrees of this reaction we have 
pain, spasms, increased irritability, and excitement. In higher grades we 
have general convulsions, exaltations, hallucinations, and mania. The man 
is then insane. 
56.—The Simultaneous Occurrence of Aneurisms in the Retina, and En- 
largements of the Small Arteries of the Brain. By Dr. IIexki Lion- 
yille. [Gazette des Hbpitaux, 36, 1870.] 
The above lesions were noticed by Bouchard and Charcot in 1868, after- 
ward by Bouehereau and Magnan, and another similar observation is now 
made by Lionville in the person of a woman, seventy-two years old, who 
died of apoplexy. The vessels of the brain were atheromatous, and in- 
numerable miliary aneurisms were found in the vessels of the cerebrum, 
cerebellum, and meninges. In the retina, similar dilatations were found, 
from the size of a grain of powder to a large pin-head; the smallest re- 
quired a magnifying power of ten to twenty times, to be seen by the naked 
eye. These lesions may he put alongside of retinal apoplexies, in their 
significance as to the state of the cerebral vessels. They have not yet 
been seen during life by the ophthalmoscope, but may perhaps be ob- 
served. 
57. —Two Cases of Embolus of the Arteria Cen tralis Retinae. By Dr. L. 
Grossman, Pesth. [Vierteljahrschrift fur die praktische Ileilkunde, 
Band ii., 1870, s. 94-100.] 
58. —Asthenopia and other Ocular Affections produced by Petroleum- 
Light. By Prof. Cesake Paoli. [La Speriinentale, xxv., 2, p. 108, 3, 
p. 228, 1870, Schmidt’s Jahrb., B. 147, 7, 432.] 
Without quoting the theoretic reasons given for the alleged hurtful OPHTHALMOLOGY. 
27 
effects of petroleum as a source of light, some of the cases may he re- 
peated which are given in proof. All have the character of retinal hy- 
peresthesia. The first, a young French student who was thus attacked, is 
not so undeniably to be referred to this cause as to he received without 
hesitation. He simply had extreme intolerance of light, and impaired 
vision, how much impaired is not stated. By ophthalmoscope, the fundus 
appeared pale, the arteries and veins very thin, nerve normal. After two 
years the patient was in a measure restored, so as to read fifteen to twenty 
minutes at a time. Ilis treatment consisted in iron, cold water to the eyes, 
gymnastics, sea-bathing, travelling, etc. 
The second case or group of cases respects six girls who were accus- 
tomed to sew together in the winter evenings hy a very bright petroleum- 
lamp. For two months none had any trouble, then two who worked the 
longest were attacked hy severe asthenopia; they could fix upon a near ob- 
ject for only a few minutes at a time, and could not work at all in the 
evening. Two others were affected with similar retinal symptoms, though 
in a less degree; a fifth had conjunctival and retinal congestion, only one 
entirely escaped. The entire giving up of work hy petroleum-light pro- 
cured recovery after several months. 
3. A student of mathematics, of delicate structure, worked at night hy 
a large petroleum-lamp. After a time he found that he could not see as 
well as before, and added another lamp, until he became unable even to 
discern large objects—on a cloudy day he could not walk the street alone. 
The eyes were externally of normal appearance, the pupils a little en- 
larged—conjunctival vessels slightly varicose. The optic nerve was con- 
gested ; the veins much distended, and the blood seemed as if coagulated in 
them ; the arteries enlarged. By confinement for several weeks in a dark 
room, the patient was restored. 
59.—A Case of Retinitis Leuccemica, by Dr. M. Both. [Virchow’s Archiv, 
Band 49, pp. 441-446.] 
A man, aged fifty-five, died with marked sign of leucaemia, and his eyes 
had during life been examined by Prof. Schirmer with the ophthalmo- 
scope. There was no impairment of sight, but still there was decided re- 
tinitis, with gray exudation, and a few apoplexies; the color of the eye 
ground and of the retinal veins was quite normal. 
At the examination of the retina, post mortem, the exudation was 
found to be due to hypertrophy of the fibres of Muller in the external 
fibrous layer and their granular degeneration. At a few spots there were 
hypertrophied nerve-fibres. In the periphery and in the outer layers were 
numerous small extravasations. The choroid extremely hypersemic; the 
large vessels charged with masses of white blood-corpuscles, the capillaries 
contain about equal parts of red and white blood-disks. Bods and cones 
well preserved. The vessels in the periphery of the retina had undergone 
fatty degeneration to a great extent. The lymphoid infiltration of the 
retina and chorid was precisely like the lymph-cells in the vessels, and a 
process of emigration was the most natural suggestion. 
60.—The Similarity between the Neuro-Retinitis produced by a Cerebral 
Tumor and by Bright's Disease. By Dr. Hekm. Schmidt and Dr. Weg- 
ner, Berlin. [Archiv f. Ophthal., Bd. xv., Abth. Ill, s. 253-275.] 
Two cases are fully detailed, which are of themselves highly important, 
but whose value is greatly enhanced by their comparison with each other. 
Both cases were fully observed during life, and the appearances, post mor- 
tem, were studied in a thorough and competent manner, The broad facts 
are that a girl, aged twenty-three, exhibited in both eyes the appearances 28 
OPHTHALMOLOGY. 
which belong to the most complete picture of Bright’s disease, had no al- 
bumen or other evidence of kidney-trouble, and not until a short time be- 
fore death had she any symptoms to cause suspicion of brain-trouble. The 
autopsy disclosed a tumor at and in the region of the septum lucidum. 
Another girl, aged fifteen, had the same ophthalmoscopic symptoms, with 
clear signs of Bright’s disease, and, having died, gave opportunity for micro- 
scopic examination of the retina and optic nerves. 
The features common to both cases, in the ophthalmoscopic picture, were 
great swelling of both optic nerves, redness and infiltration, edges indistinct, 
vessels swollen—in the case of tumor there was ecchvmosis of one papilla; 
near the nerve, opaque white patches of the rounded form, and dotted 
edges, seen in nephritic retinitis; at the macula the usual radiating figure, 
extravasations of blood in various places. Both cases were as similar as 
two cases of the same disease could be, and were studied by Graefe and 
others. 
In the tumor patient, the ocular lesion was confined strictly to the eye 
—the optic nerve-trunks, close up to the globes, possessed a normal struct- 
ure as seen by the microscope. The lesions in the retinae in both cases 
were extremely alike, making the diagnosis by the microscope almost as 
impossible as by the ophthalmoscope. There were in both cases sclerosis 
of the fibres of the optic-nerve layer—the ganglion cells atrophied or scle- 
rosed—the granular layers studded with or almost transformed into fat 
granule-cells—hypertrophy of the connective tissue of the nerve and 
retina—blood-disks, and brownish pigment—the choroidal vessels were 
somewhat sclerosed. The only difference in the two cases was that, in 
the patient with cerebral tumor, the swelling of the retina belonged more 
to hypertrophy of the inner retinal layers and papilla, while in the 
patient with Bright’s disease the swelling affected principally the radiating 
fibres of the external granular layer. In neither case could the rods and 
cones be well examined, because of cadaverous changes. 
The amount of the matter is, that we cannot any longer assert the in- 
fallibility of diagnosticating Bright’s disease by the ophthalmoscope. Many 
good observers have denied the possibility of mistake, and have recorded 
their opinion {vide Liebreich, Mauthner, etc.), but the retinal pictures may 
be completely simulated by neuro-retinitis from cerebral tumor, and from 
diabetes mellitus. Graefe records a case of cerebral tumor producing the 
retinal lesions in question (Archiv f. Oph., B. xii., 2, 120), and states some 
minutiae for differential diagnosis, but these points are renderd valueless by 
the two observations above recorded. 
We are therefore compelled to examine the urine as well as the eye, 
and to study the signs of cerebral disturbance, however obscure they may 
in some cases be. But it x-emains true that the retinal lesions do belong 
in the large majointy of instances to Bright’s disease. A point to be studied 
is, what causes the neuro-retinitis in some cases of Bright’s disease ?—Can 
there be any analogy to the incarceration which belongs to the pathogenesis 
of the Stanung's papilla in neuritis descendens ? 
61.—Acute Neuritis Optica from Tumor of the Brain—Autopsy. By- 
Dr. Schiess Gemusetts. [Monatsbliitt. f. Augenheilkunde, viii., p. 100, 
April, 1870.] 
A silk-dyer, forty-three years old, after a fit of anger, was seized in Au- 
gust, 1868, with heat in the head, mental excitement, and epileptic convul- 
sions. His memory grew feeble, he had occasional headache, and toward 
the close of the year the epileptic attacks returned—his legs became weak, 
he fell into apathy, and complained of frontal pain. He would answer a 
question only after a long pause ; there was slight ptosis of the left eye ; 
hearing of the left ear had been defective for years, and he had had a blow 29 
OPHTHALMOLOGY. 
on this side of the head four years before. His eyes were examined in 
January, 1869, by the ophthalmoscope, although his vision was perfect. The 
examination, which was very troublesome, revealed in both eyes extreme 
oedema of the papilla and its surrounding parts, besides small extravasa- 
tions. Soon after, the patient died. The section showed in the skull rough- 
ness of the inner surface of the bones, especially in the right middle fossa. 
The right hemisphere tense, the convolutions flattened, the falx pushed to 
the left side, the left ventricle enlarged, the right narrowed. A tumor grew 
from the apex of the right anterior lobe, reaching back to the limit of the 
posterior lobe, which proved to he a sarcoma partially softened, and with 
some recent and old apoplexies. The optic papillae were elevated to a 
prominence of mm., the optic fibres in the retina were spread asunder 
by abundant growth of connective tissue—at the borders of the swelling 
were masses of fatty degeneration—there were no new vessels developed. 
There is no account of the state of the orbital portion of the optic nerve. 
This case adds to the observations already become numerous, where intra- 
cranial disease produces visible changes in the fundus oculi without causing 
injury to sight. 
62.— On the Mode of Occurrence of Neuritis Optica Intraocularis (Sta- 
mm g's Papilla) in Cerebral Disease. By Dr. Hekm. Schmidt, Berlin. 
[Archiv fur Ophthal., Bd. xv., Abth. 2, s. 193-197.] 
In view of the anatomical fact stated above, and of the relations be- 
tween the arachnoid cavity and the sheath of the optic nerve, to which 
Schwalbe has called attention, Dr. Schmidt attempted to discover how the 
head of the optic nerve becomes swollen from intra-cranial pressure. He 
removed a small piece of the skull and dura matter from an animal which 
was bled to death, and then injected a solution of Berlin blue, with slow 
and steady pressure, into the arachnoidal cavity. The coloring matter 
passed freely into the space between the outer and inner optic-nerve sheath, 
but never penetrated between the fibres of the nerve-trunk. When the 
nerve reached the globe the fluid was in greater quantity, but did not ex- 
tend to the connective tissue about the sclera, nor into the space between 
the choroid and sclera. It did penetrate directly into the lamina ci'ibrosa, 
making this tissue a deep and brilliant blue, but not coloring the head 
of the nerve. Thus a direct communication is proven between the 
arachnoidal cavity and the net-work of the lamina cribrosa, by which 
pressure of fluid may be conveyed, and in consequence the head of the nerve 
suffer strangulation, while the rest of the trunk may be unaffected. 
In case the communication between the nerve-sheath and the arachnoid 
should, by a tumor or adhesive inflammation, or otherwise, be closed, we 
might have, instead of the oedematous papilla, simple atrophy of the nerve. 
G3.— Case of Temporary Blindness, in a Young Man. By Dr. J. Ilinscn- 
beeg. [Med. Chir. Bundschau, Mai, 1870.] 
A young man, eighteen years old, who had recently had gonorrhoea and 
afterward angina, became suddenly blind during the night of November 
19th. For two days he had complained of severe headache, which was 
much worse on that night. His vision was reduced to mere perception of 
light; the pupils, of medium size, acted slowly in response to light. The 
optic nerve and fundus entirely normal. The urine contained a noticeable 
quantity of albumen. There were no other symptoms. 
The artificial leech was twice applied to each temple, a decided purga- 
tive administered, and mercurial treatment begun. By the succeeding night 
the patient stated that he could see again, and on the following day 
vision was fully restored, aud the pupils became again actively contractile. 30 
OPHTHALMOLOGY. 
64.—Anaesthesia of the Retina. By Dr. A. SicnEL. [Annales d’Oculist., t. 
lxiii., Mai et Juin, 1870.] 
Two cases are reported, the first elaborately and the second briefly. 
The author regards this condition of retinal anaesthesia as not due to want 
of perception in the special sense, but want of appreciation by the brain. 
The disease begins suddenly after some violent mental or moral impres- 
sion. It attacks persons of a nervous or hysterical temperament. The eyes 
present no abnormal appearances either within or without. Sight ranges 
from moderate amblyopia to utter blindness. The visual field exhibits the 
greatest possible variety of form, as the accompanying cases show. Cu- 
taneous anaesthesia and hyperaesthesia occur in various parts of the body. 
The disease is obstinate and wearisome, but usually ends in recovery. The 
most interesting case is the first, viz.: 
A merchant, aged twenty-eight, very near-sighted, had an attack of 
blindness in the right eye in 1856, which lasted a year and a half; another 
attack in 1861, lasting eight months; and in the autumn of 1868 a third 
took place. While on a pleasure-excursion in the country, he was overcome 
by the extreme heat—the next day was taken with loss of consciousness, 
vomiting, and diarrhoea—five days afterward violent headache took place, 
quickly followed by injury to sight. The right eye totally blind, the left 
partially; reads Jaeger 1 at seven centimetres (less than three inches.) The 
left visual field notably contracted above and below. The next day the field 
had contracted inward and outward, and slightly expanded upward and 
downward. The remarkable and fantastic variations in this respect are 
indicated by no less than seventeen diagrams, taken during a period of 
nine months. For most of the time it was central and very small—for in- 
stance, in January it measured, at thirty-five centimetres’ (about fourteen 
inches) distance from the point of fixation, less than three inches vertically, 
and a little less horizontally. The perception of color was defective; some- 
times he would recognize only yellow, and all other tints would appear green; 
again, he would call carmine orange, at other times all deep tints appeared 
black, and light ones gray. In snow light he saw prismatic colors, blue, 
red, etc. There was anaesthesia of the skin of the knees, the elbows, and 
of the right lumbar region: and hyperajstliesia in the right orbital region, 
in the left lumbar region and shoulder; sometimes the pain in the right orbit 
was exquisite, and accompanied by most severe photophobia. At a later 
period there were insomnia, loss of memory, perversion of all sensorial func- 
tions, extreme sexual propensity. The case was seen by Prof. Graefe, who 
agreed with the diagnosis of retinal anesthesia. The treatment consisted 
in the use of tonics and nervines, hydrotherapeutics, change of scene, fresh 
air, abundant exercise; the oxide of zinc was tried, at Graefe’s suggestion, 
half a grain to two grains, three times a day. Finally, the patient recovered 
perfect sight and health. The intra-ocular symptoms were negative, except 
pallor of the nerve. 
A second case, in a young woman twenty-six years old, presented fea- 
tures similar to the above, and recovered in three months. 
G5.— On Color-blindness in Diseases of the Eye, and EemarJcs on Certain 
Forms of Amblyopia. By Dr. Tn. Leber. [Achiv fur Ophth., Bd. xv., 
Abth. iii., s. 26-107.] 
The ability to discern colors is injured in various affections of the eye, 
and has been a matter of attention by many observers, but we yet do not 
possess exact information on its relation either to the healthy or morbid states 
of the organ of sight. The most common cases in which this defect appears 
are those of atrophy of the optic, nerve. Dr. Leber lias investigated thirty- 
six cases of this kind, all of which had amblyopia and limitation of the OPHTHALMOLOGY. 
31 
visual field, and in all but three there were anomalies in the perception 
of color. This defect occurs under every form of nerve-atrophy, the sim- 
ple, the inflammatory, and the glaucomatous, as well as in every degree of 
amblyopia. Even where sight is not much injured, color-blindness may be 
very marked. The prognosis of the nerve-affection is not modified for 
better or for worse, by the loss of color-perception. The color to which 
patients are most frequently insensitive is red, while blue is best preserved : 
green appears yellowish or gray; rose and violet, bluish; yellow com- 
monly appears yellow. In the later stages of the malady only the bluish 
shades are apt to be recognized, all others appearing whitish, gray, or dark. 
This corresponds closely with what is true of the normal eye during deep 
twilight. 
In three cases of hemiopia there was no defect of color-perception in 
the sound half of the field. In one of these cases vision was nearly re- 
stored, but on the blinded side the color-sense remained defective. Quag- 
lino and Boys de Loury published each a case of hemiopia in Avhich there 
was absolute color-blindness for the remaining field. 
An extremely interesting class of cases are those of amblyopia and cen- 
tral scotoma without ophthalmoscopic lesions. The amblyopia occurs with- 
out central scotoma; and in three cases there is little derangement of the 
perception of color. Out of twenty-one cases of amblyopia without 
scotoma, only three were unable to distinguish red. These patients ac- 
quire their amblyopia from abuse of alcohol, tobacco, and other toxic 
substances, a few from anaemia and mal-nutx-ition. The truth of this asser- 
tion appears from the fact that, out of eighty-one cases of amblyopia, in 
which there were no ophthalmoscopic lesions and no central scotoma, there 
were seventy-five men and six women. 
But cases of amblyopia without visible lesion, but with central scotoma, 
present marked impairment of sense of color. At an early stage of these 
cases is to be found sometimes a faint, striated haziness of the border of 
the papilla and neighboring retina, which resembles syphilitic retinitis, 
but, unlike the latter, extends only a little distance into the retina. Twice 
there were evidences of diffused retinitis; in several cases there were 
isolated haemorrhages; but generally no changes could be seen by the 
ophthalmoscope. At a later period the papilla is apt to show alteration of 
tissue in pallor or slight bluishness of its outer half—a sign of partial 
atrophy at least in some of the cases. Of this class of cases fifty-six were 
seen, and in thirty-one the perception of color tested; of which in all there 
was a discernible impairment. So uniform was this fact that it may be 
taken as a means of diagnosis of the existence of central scotoma. The 
cases may be subdivided into several categories: 1. Central scotoma not de- 
monstrable by the usual test, but only by the loss of color-perception, 
while the periphery of the retina is able to recognize colors—eight cases. 
2. Scotoma may be determined in the usual way, and only within its limits 
is the sense of color impaired, while in the periphery the sense of color con- 
tinues—nine cases. 3. In the scotoma there is absolutely no perception of 
color, and in the periphery there is a slight impairment, while eccentric 
vision is perfectly good—fourteen cases. 4. Another set of cases not com- 
ing under the class we are considering are those which have, in addition, 
impairment of eccentric vision, and which pass over into nerve-atrophy; 
of these there were three, and were not included in the above thirty-one. 
These several categories are not to be sharply defined, but shade into each 
other, and often advance from one to another. For example, a scotoma 
which at one period was only to be made out by the color-test, may after- 
Avard be manifest to ordinary examination. The third class are usually 
the most unsatisfactory, and belong to an advanced stage of the disease, 
when prognosis is unpleasant. 32 
OPHTHALMOLOGY. 
A peculiar form of amblyopia is that in which there is central scotoma, 
outside of it, a zone of nearly normal perception and the periphery affected 
by color-blindness. A case of this condition in both eyes is given; but the 
patient did not remain for treatment. 
Central scotoma generally affects both eyes, though to unequal degrees, 
and simultaneously. It is a disease of men almost exclusively—there have 
been but three women to fifty-three men. It affects those above twenty 
years of age, and increases in frequency to forty years. Abuse of alcoholic 
drink and of tobacco-smoking are often to be assigned as causes, while 
exposure to cold and wet also have a part. In one case there was syphilis, 
and in another it was also the probable cause. 
There are strong reasons for believing that the seat of the disease is 
not in the retina nor the brain, but in the trunk of the optic nerve between 
the chiasm and the globe, and that it is a veritable neuritis. This is not 
to be asserted of all cases, such as amblyopia potatorum, where hypersemia 
and nutritive disturbance of the nerve-elements are to be supposed. In the 
case of neuritis it is to be assumed that only a part of the nerve is inflamed 
or atrophied. There are anatomical and pathological reasons for the asser- 
tion that the fibres which go to the rods and cones at the macula lutea are 
situated on the superficial parts of the nerve-trunk and those which belong 
to the periphery lie nearer the centre of the nerve. A perineuritis would, 
therefore, explain the symptom of central scotoma. 
The results of treatment are always much less favorable in amblyopia 
with central scotoma, than in amblyopia without scotoma. If the color- 
blindness reach to the periphery of the field, and the nerve show manifest 
signs of atrophy, treatment will be almost fruitless. The therapeutics must 
be suited to the state of the individual, but in general they are blood- 
letting, sudorifies, purgatives, and tonics. In some cases iodide of potas- 
sium in small doses has proved of unexpected value after other things had 
been tried in vain. The scotoma in amblyopia potatorum is more obstinate 
than in other cases. Entire blindness is not to be feared in even bad cases, 
if the visual field remain perfectly free for a longtime. 
A disease wholly differing from the above is acquired color-blindness 
without amblyopia. Such cases have been described in literature before 
the use of the ophthalmoscope by Wartmann, Euete, Mackenzie, Tyndall, 
and others. One case has fallen under my own notice, in a merchant, 
twenty-one years old, who was employed by a silk manufacturing firm, and 
disoovered that in a brief time his power of discerning shades of color was 
abolished. He called light-green, yellow; dark-gray violet, red; scarlet 
and brown, green; red, gray; while some tints of green, blue, and yellow, 
he gave correctly. Visual acuteness normal, fundus normal, rather darkly 
pigmented. A second examination, two years later, gave almost the same 
results. The color-blindness embraced the whole field; there was no scoto- 
ma whatever; could read Jaeger from four seconds to one minute fluently. 
Probably the seat of the disease was in the brain. 
66.—Tumors of the Retina. By Dr. Edwaed Delafield, New York. 
[Trans, of Ain. Oph. Soc. for 1870.] 
In this paper, which gives the results of a careful study of five cases of 
intra-ocular tumors, the author endeavors to discover the exact point in 
the retina from which gliomatous tumors spring, and the relation between 
the elements of the retina and of the tumors. After rehearsing the views 
which have been held, he proceeds with the detail of the cases. He finds, 
it may he said in parenthesis, five cases of cure by operation—that is, the 
disease had not recurred within periods varying from one to six years. 
Conclusions derived are that the elements of these tumors, when not OPHTHALMOLOGY. 
33 
-changed by preservative fluids, do not correspond to the normal elements 
of the retina, but to those of connective-tissue cellular new growths ; that 
these new growths having the character of permanent new growths, the 
shape and arrangement of their elements correspond exactly to those of the 
round-celled, medullary sarcomata of other regions. The final conclusion 
is that, since these tumors correspond closely to the definition which Vir- 
chow gives of sarcomata, they ought properly to be classed among these, 
and may be distinguished by the special name of glio-sarcoma. 
67.—A Case of Retinal Glioma operated on at a very early Period, and 
showing some New and Peculiar Anatomical Conditions. By Dr. H. 
Knapp, New York. [Trans, of Am. Oph. Soc., 1870, pp. 84-86.] 
The growth took origin, at the anterior part of the retina, developing 
from the inner granular layer, and, as it increased, it detached the retina, 
and finally became enveloped or invaginated in it. 
68.—A Case of Supposed Glioma. [Trans. Am. Oph. Soc., 1870.] 
An infant, five months old, in whose eyes the father had noticed at 
birth a yellowish reflex, who at two months had an attack of inflamma- 
tion, leaving a little opacity in one cornea—at the time of examination to- 
tally blind in both eyes. In both eyes there had been iritis; in one the 
pupil contracted ; irides pushed forward ; a yellow reflex in the interior of 
both eyes; in the one what appeared to be a tumor, with nodular surface, 
and some vessels. A number of good observers regarded the disease as 
glioma: and both eyes were extirpated, 
The notes say nothing about the state of tension of the globes—a fact 
of some value. 
On anatomical examination, no glioma found; simply the results of 
general internal inflammation; retina totally detached ; behind it a thick 
reddish fluid, and a firm brownish mass, composed of shrivelled blood-glob- 
ules and granular matter; choroid in place—much of its epithelium hy- 
pertrophied. 
A case worth remembering, and a mistake of diagnosis which others 
have made in 1859, committed the same error, as we were wit- 
nesses). The harm done by operating was not serious, but it was an un- 
pleasant thing certainly. 
69.—Rough Notes of a Case of Glio-sarcoma. By B. J. Jeffries, M. D., 
Boston. [Trans. Am. Oph. Soc., 1870.] 
The subject was a healthy man, aged twenty-seven. The tumor had 
come through the sclera, and infected the optic nerve, but did not occupy 
the interior of the globe. It was seated principally in the superior and in- 
ternal recti muscles, while the ciliary body and choroid were infiltrated 
with the disease. The retina adherent, but not thickened. The micro- 
scopic elements were the rounded glioma-cells in the optic nerve and 
muscles, and, in the choroid, spindle-shaped cells. 
70.— The Diagnosis of Intra-ocular Sarcomata. By Dr. Otto Beckek, of 
Heidelberg. [Archives of Oph. and Otol., vol. i., part ii., pp. 694-715.] 
In this highly-interesting paper seven cases are described. In three, a 
small tumor was detected at the region of the macula lutea, and in two 
the retina was not detached; in the other, vitreous opacities made it diffi- 
cult to decide upon the position of the retina. In a fourth and fifth case, 
a tumor grew from the inner and outer side of the fundus; in a sixth, 
and in a seventh also, from the outer side. In the fourth, fifth, and sixth, 
the retina was in contact with the surface of the tumor, but, near its base, 34 
OPHTHALMOLOGY. 
was a little detached; but tbe tumor bad a pedunculated, gourd-like shape, 
and this alone Dr. Becker deems sufficient to fix the diagnosis of choroidal 
sarcoma as against sub-retinal effusion. The diagnosis between these two 
conditions is or is not to be made out, Dr. Becker thinks, according to tbe 
situation of the choroidal sarcoma. If it originate from the ciliary body, 
Dr. Knapp showed that it does not or may not cause any sub-retinal effu- 
sion. If at the region of the macula lutea, they show less disposition to 
grow into the interior of the eye, as the first three cases demonstrated, but 
pushed through the sclera, and developed largely in the orbit. 
When the tumor within the eye is larger, its appearance varies accord- 
ing to its situation on the upper, lower, or lateral parts of the globe. In 
these cases the retina is usually to some degree detached. If the tumor be 
below, the retina will lie in contact with its summit, and spread out on all 
sides in a broad detachment. As the tumor grows and adheres to the reti- 
na, if vessels are perceived in the neoplasm, it may be diagnosticated, but 
otherwise it will be likely to escape notice. If the tumor be growing from 
above, the detached retina will hang down like a pouch, and no detach- 
ment be visible at the base. If the growth spring from the lateral wall, 
the retina never fails to become somewhat detached about its base. Some- 
times the outline of the tumor can be traced through the detached retina; 
this depends on the depth of the superjacent fluid. 
Another point deserving special mention is, that ag a sarcoma grows it 
exhibits a vascular net-work on its surface, and these vessels grow rapidly. 
They may at first be faint, and afterward strongly marked. Two well- 
executed chromos illustrate one of the cases. 
For the examination of the tumors which reach forward to the middle 
of the eye, Dr. Becker suggests that the highest magnifying power is gained 
by holding a strong convex lens close to the eye, and the mirror as near to 
and behind it as may be consistent with proper illumination. 
71.—An Atrophied Globe which contained a Choroidal Sarcoma partly 
softened and partly ossified. By Dr. II. Berthold. [Klinische Mo- 
natsblat. fur Augen., January, 1870, s. 19-24.] 
MISCELLANEOUS. 
72.—Investigations into the Lymphatics of the Eye, and their Distribution. 
By Dr. G. Schwalbe. [Archiv f. Mikroskop. Anat., Bd. vi., pp. 1-61; 
also Bd. vi., pp. 261-362. Monatsblat. f. Augen., April, 1870,117, July, 
August, 1870, 227.] 
This investigation has been conducted with the utmost labor'and com- 
pleteness. The lymphatic circulation of the eye is divisible into an anterior 
and posterior region. To the latter belong the perivascular spaces of the 
retina, the perichoroidal space with its outlets, and the space between the 
outer and inner optic nerve-sheath,, which does not communicate with the 
other two systems, but directly with the arachnoid cavity. The tissue be- 
tween the choroid and sclera, which was formerly called lamina fusca, and 
afterward considered unworthy of designation as a special membrane, 
again assumes its former dignity as a serous sac, and is called by Schwalbe 
the supra-choroidea. In it he finds an endothelium. It consists of elastic 
fibres, flat cells, and nuclei. It appears only in eyes of adults, and in later 
years, under the influence, it is believed, of the accommodation. The space 
within this membrane reaches forwards to the ciliary processes and back 
to the nerve-sheath. It does not connect with the lymph-vessels in the 
stroma of the choroid. Neither has it any communication with the anterior 
chamber. But it does communicate with the surface of the globe, that is, 
with the space beneath the capsule of Tenon, at the four orifices by which OPHTHALMOLOGY. 
35 
the venae vorticosse emerge from the hnlb. The outlet of the supra-choroi- 
dal lymph-space is therefore a perivascular one. 
Within the capsule of Tenon, too, there is a lymph-space where the 
characteristic endothelium may easily be recognized. After hardening by 
Muller’s fluid, a delicate membrane with elliptical nuclei may be taken from 
the exterior of the sclera, and it is entirely similar to the supra-choroidal 
endothelium. An attempt to push an injection from the cavity of-the 
capsule in other directions did not succeed, but, by beginning in the eavity 
of the arachnoid, not only was the cavity of the capsule of Tenon injected,, 
but also the lymphatic vessels and glands of the neck, by which complete 
proof was afforded that the perichoroidal and Tenonian cavities are true 
lymph-spaces. 
It is also shown that the space between the two sheaths of the optic 
nerve is a lymph-cavity, and opens directly into the arachnoid, while it also 
communicates with the lymphatics of the neck. It has an endothelium. 
This space does not connect with the cavity of the capsule of Tenon, which 
is supra-vaginal, nor with the perichoroidal cavity, although the injection 
comes very close to it, at the entrance of the nerve into the eye. » 
In a second part of the above paper, the lymphatic circulation of the 
anterior part of the eye is considered. It is impossible to condense the 
hundred pages of this description into the limited space we can occupy, 
and do justice to the laborious investigations of the author. 
First, is studied the anterior chamber and its outlets; second, the canal 
of Petit, and the ciliary zonula. By injection of Berlin blue into the an- 
terior chamber under a pressure of thirty to fifty mm. of mercury, soon a 
blue ring appears in the vicinity of the border of the cornea and the 
surface of the sclera, from which anastomosing vessels run in various 
directions. By careful study it was shown that the vessels thus injected 
were not perivascular lymphatics, but veins, which are in open communi- 
cation with the anterior chamber. 
The relations and surroundings of the canal of Fontana, the pillars of 
the iris (ligamentum pectinatum), and the canal of Schlemm, are then taken 
up, with the view of more particularly learning how fluid injected into 
the anterior chamber finds its way into the veins. He finds the ligamen- 
tum pectinatum, the canal of Fontana, which lies more peripherally, and 
the canal of Schlemm, to be distinct structures, although in close contiguity. 
The inner wall of the canal of Schlemm is made by a prolongation of the 
membrane of Descemet, and from the inner surface of this wall, which is 
freely fenestrated, spring the septa and fibres which compose the net-work 
of the canal of Fontana. The openings in the walls of these canals have 
their long axes parallel to the equator of the eye. The outer wall of the 
canal of Schlemm is made by the sclera, and from its posterior angle the 
ciliary muscle originates. The author does not agree with Leber, that it is 
only a venous sinus, or part of the ciliary plexus—he states that the ciliary 
plexus of Leber is a wholly different thing. The canal has an endothelium 
of a peculiar reticulated appearance. From the above it is plain how fluid 
may pass from the anterior chamber into the canal of Schlemm, and may 
reach the blood-vessels, because numerous veins open directly in the canal. 
Under ordinary circumstances the canal is a lymph-vessel, but by an excess 
of pressure in the blood-vessels it may be filled with blood. It is not part 
of the ciliary plexus, but connects with it by a few venous twigs; and these 
twigs may, under different circumstances, carry blood or lymph. If the 
tension in the anterior chamber be diminished by paracentesis, an injection 
into the arteries easily passes into the anterior chamber, but, with the usual 
equilibrium, this cannot occur. 
The canal of Petit is also capable of being filled by injection from the 
anterior chamber. To account for this, there were found five fissural 36 
OPHTHALMOLOGY. 
openings, in the anterior wall, close to the border of the lens, and vice versa, 
by these, the anterior chamber maybe filled from the canal. But the canal 
cannot be injected from the vitreous chamber, which shows that the pos- 
terior wall is entire. 
It is thus shown that the anterior chamber, the posterior chamber, and 
the canal of Petit, constitute a continuous lymph-space. Most of this fluid 
comes from the vessels of the iris and ciliary body, through the reticulations 
of the canal of Fontana into the anterior chamber. The outlets of the 
latter are the ciliary veins, through the canal of Schlemm. Pressure in the 
part of the eye behind the lens causes a partial escape of the aqueous humor 
through the veins. This was proven by direct experiment with colored 
fluid injection. The slow increase of pressure which takes place in glau- 
coma is well known to have this effect, and how the shallowness of the 
anterior chamber occurs may thus be understood. 
We are tempted to conclude our resume by a quotation of the conclud- 
ing pages which relate to the changes that take place in accommodation, 
but any thing less than complete rendering would be unsatisfactory, while 
our space is already occupied. 
73.—Statistics of Operations in Dr. Wocher's Clinique, Paris, for 1869. 
[Schmidt’s Jahrbuch, No. 5, 1870, s. 190.] 
Cataract extractions by peripheral linear section 109. 
Of these— 
69 read Snellen No. 1 — vision = | to 1. 
10 “ “ No. 1 — “ = f. 
7 “ “ Nos. 3 and 4. 
2 “ “ No. 5. 
16 could count fingers at 20 feet. 
5 were failures. 
Prolapse of vitreous at the operation happened .. 6 times. 
Discissions 2 “ 
Iridectomy—for artificial pupil 13 “ 
“ as therapeutic operation 117 “ 
Strabismus operations 90 “ 
Puncture of detached retina \ 12 “ 
Enucleation ' 5 
In only one of the six patients on whom the puncture of detached retina 
was performed did useful results follow. Iu three cases Wecker performed 
an operation first suggested by himself—the tattooing of leucoma of the 
cornea, to conceal or remove the unsightliness of its appearance—and with 
satisfactory result. 
74.—Description of a New Exophthalmometer. By Dr. Emil Emmert. 
Another New Exophthalmometer. By Dr. W. Zehender. [Klinische Mo- 
natsblat. filr Augen., February, 1870.] 
Of the two instruments above described for measuring the degree of 
prominence of the globe, that of Dr. Zehender appears to be the more 
simple, and to be both accurate and easily available. We must refer to the 
articles for adequate description. 
75.—A New Iris-Forceps. By Dr. Liebreicii. [Monatsblat. far Augen., 
June, 1870, p. 183.] OPHTHALMOLOGY. 
37 
Our report has become so lengthy that we may not venture to present 
any thing of the last number of the Archives for Ophthalmology (Bd. xvi., 
Abth. i.) 
But we cannot forbear alluding to the sad announcement which, with 
emblems of mourning, its first page makes of the death of Prof. Graefe, on 
the night of July 20, 1870. The scientific world suffered a heavy loss—to 
ophthalmic science there could be no loss so heavy. So genial was his 
temper and so brilliant his gifts, so unwearied and energetic his labors, that 
both young and old accorded him the highest place in ophthalmic surgery. 
The debt which humanity owes to him, in what he did personally and 
through those whom he taught and stimulated both by word and pen, 
will never be fully estimated. The editors of the Archives, Profs. Arlt 
and Donders, announce their purpose to continue the journal, and close 
their tribute to his memory with the words— 
“ Amicissime, requiescas in 'pace.'1'' 
BOOKS AND PAMPHLETS. 
Pathologic Iconographique du fond de l’CEil—traits d’Ophthalmoscopie— 
par A. de Montmeja. Paris, 1870. The cliromo-lithographs are crudely 
done. 
Atlas d’Ophthalmoscopie et d’Optometrie, par M. Maurice Perrin. 
Traite pratique d’Ophthalmoscopie et d’Optometrie, par M. Maurice Perrin. 
Paris, 1870. 
A work of considerable merit. The plates are small, and not finished 
in the highest degree, but have real value. 
Atlas d’Ophthalmoscopie, par R. Liehreich. 2me edition. Paris, 1870. 
This second edition of a classical work has been modified in important 
respects by adding new plates, as well as substituting some in place of 
others. It is to be presented in an English dress by Messrs. Churchill, 
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Ueber dasVerhalten der Doppelbilder bei Augemnuskeln-Iahmungen von 
Dr. M. Woinow. Wien, 1870. 
This is a series of tables indicating the appearances of double images 
in all possible cases of paralysis of ocular muscles, and is eminently 
instructive. 
Ein Wort ziir Erinnerung an Albrecht von Graefe, von Prof. Alfred Graefe. 
Halle, 1870. 
A eulogium on Prof. Graefe by his cousin. 
Die Augendiatetik oder die Kunst des Sclivermogen zu erhalten und zu 
verbessern von Dr. J. Ch. Jiingken. Berlin, 1870. 
Die Ophthalmia militaris sive granulosa von modernen Standpunkte, von 
Dr. Max Peltzer. Berlin, 1870. 
Traite des Operations qui se pratiquent sur l’CEil, par E. Meyer et A. de 
Montmeja. Premier partie. Paris, 1870. Accompagnd d’un Atlas 
photographique. ME I) 1 C AL W OEKS 
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