COLOR-BLINDNESS, 
AND ITS 
ACQUIS ITIO JV TH ROU G H THE ABU S K 0 F 
ABC OHO L ANO TOBA C C 0. 
BY 
RICHARD 11. DERBY, M. I)., 
LATE ASSISTANT-SURGEON OP PROP. VON GRABPE, AT BERLIN. 
{REPRINTED FROM THE N. 7. MEDICAL JOURNAL, MARCH, 1871.] 
NEW YORK: 
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549 & 551 BROADWAY. 
1871. D. APPLETON & CO., New York, 
Have just Published, 
I. 
A Text-Book of Practical Medicine, 
WITH PARTICULAR REFERENCE TO 
PHYSIOLOGY AND PATHOLOGICAL ANATOMY. 
By Dii. FELIX YON NIE MEYER, 
Professor of Pathology and Therapeutics; Director of the Medical Clinic of the University of Ttlhiugen. 
TRANSLATED FROM THE SEVENTH GERMAN EDITION, BY SPECIAL PERMISSION OF THE AUTHOR, 
By GEORGE H. HUMPHREYS, M. D., and CHARLES E. HACKLEY, M. D. 
In tivo A'olumes, octavo. 1,500 pp. Price, in cloth, $9.00 ; in sheep, $10.50. 
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From the Medical and Surgical Beporter. 
New York: D. APPLETON & CO., Publishers. COLOR-BLINDNESS, 
AND ITS 
ACQUISITION THROUGH THE ABUSE OF 
ALCOHOL AND TOBACCO. 
BY 
RICHARD H. DERBY, M. D., 
LATE ASSISTANT-SUEGEON OP PBOP. VON 6EAEFE, AT BERLIN. 
[REPRINTED FROM THE N. Y. MEDICAL JOURNAL, MARCH 5871.] 
HEW YORK: 
D. APPLETON & COMPANY, 
549 & 551 BROADWAY. 
1871. COLOR-BLINDNESS. 
Achromatopsia, akyanopsia (Goethe), anerythropsia, or 
Daltonism, are but a few of the names that have at various 
times been applied to color-blindness. 
In the text-books we find cases of this affection cited as 
literary curiosities. It was believed to be nearly always con- 
genital, and not amenable to treatment. 
o y 
Modem investigators have immensely enriched this previ- 
ously barren field. Color-blindness has been found an almost 
constant accompaniment of certain diseases of the optic nerve 
and retina. Excessive use of alcohol and tobacco is now 
known to produce color-blindness over a portion or the entire 
extent of the visual field. Exposure to wet and cold may lead 
to the same condition. 
In many cases of amblyopia, an examination of the per- 
ception of color reveals functional changes most marked, and 
indeed in many cases, where the ordinary tests would indicate 
no pronounced difference in the acuteness of vision in various 
portions of the visual field, we find a most clearly-defined cen- 
tral color scotoma. 
The question may be asked, If color-blindness is so con- 
stant a symptom in certain forms of amblyopia, why is it that 
patients so rarely complain of it ? The explanation is undoubt- 
edly in the fact that “the simultaneous*falling off of the 4 
COLOE-BLIKDKESS. 
acuteness of vision appears to them relatively a far more 
grievous affection, and a disturbance in their perception of 
color seems natural. They are apt too to compare their pres- 
ent amount of vision with what their normal vision was by 
poor light. 
“With deficient illumination at a certain point we lose 
the power of recognizing not only the outline but the color of 
objects: we distinguish only light from darkness. Conse- 
quently the attention of the patient is only drawn to his color- 
blindness in those cases where it is very pronounced, and where, 
on the other hand, the amblyopia is slight. 
“ The fact that color-blindness and amblyopia are not neces- 
sarily associated together is reason enough that the condition 
of the perception of color should be especially examined in 
affections of the eye; such an examination may reveal us facts 
striking and unexpected, of importance for our diagnosis and 
prognosis.”1 
A brief resume of accepted doctrines with reference to 
the perception of color may aid us in the- appreciation of de- 
partures from the normal standard. 
According to the theory of Young, the retina contains three 
varieties of nerve-fibres. Irritation of the first produces the 
sensation of red, irritation of the second that of green, and 
irritation of the third that of violet. 
Homogeneous light excites these three classes of fibres with 
an intensity proportioned to the length of its undulations. 
The one class is particularly impressionable to the most ex- 
cursive undulations—to the rays which produce the subjective 
sensation of red. 
The second class is impressionable to the less excursive un- 
dulations, which cause the subjective sensation of green. Fi- 
nally, the last class is impressionable to the least excursive un- 
dulations, which give the subjective sensation of violet. 
Still, every spectral color excites each class of fibres, but 
with different degrees of intensity. 
The simple red excites intensely the red percipient fibres, 
and weakly both the other classes, the sensation being red. 
1 Leber, Arcbiv f. Ophtb. xv,, 3, p. 28. COLOE-BLIADNESS. 
Simple yellow excites moderately the red and green, and 
weakly the violet percipient fibres, the sensation being yellow'. 
Simple green excites strongly the green percipient fibres, 
and much more weakly the twro other classes ; the sensation is 
green. 
Simple bine excites moderately the green and violet, and 
weakly the red percipient fibres; the sensation is blue. 
Simple violet excites intensely the percipient and weakly 
the other classes of fibres, the sensation being violet. 
The idea of white is produced by an irritation equally 
intense of all the varieties of fibres, and that of black by an 
absence of all irritation. 
Benedikt1 was the first to draw attention to the great fre- 
quency of anomalies in the perception of color in amblyopia 
and amaurosis. Schelske2 subsequently analyzed a case of 
atrophy of the optic nerve, and found red-color blindness. 
At the last meeting of the Ophthalmological Congress at 
Heidelberg, Leber presented a paper on the occurrence of 
anomalies in the perception of color in disease of the eye; and 
later still, in the Archiv fur Ophthalmologies the same author 
has published a more extended treatise on the subject, with the 
details of a large number of cases observed at Yon Graefe’s 
clinique, at Berlin. 
In atrophy of the optic nerve, Leber found color-blindness 
an almost constant symptom. Out of thirty-six cases the per- 
ception of color remained intact in only three. 
In simple amblyopia, without limitation of the visual field, 
where no ophthalmoscopical changes were observed, and where 
there was absolutely no central scotoma, color-blindness was 
very rare. 
In amblyopia, with clearly-defined central scotoma, Leber 
found color-blindness a constant symptom, and he gives the 
following excellent description of this affection : 
(It is hardly necessary to say that this is not the form of 
scotoma caused by changes in the outer layers of the retina in 
the region of the macula. It is a common form of amblyopia, 
: Wiener Med. Chir., Eundschau, December, 1862, p. 211. 
2 Archiy f. Ophth. xi., 1, pp. 171-178. 
3 Archiv f. Ophth. xy., 3, p. 26. 6 
COLOR-BLINDNESS. 
and up to tlie last stage of the affection absolutely no changes 
are to he seen in the yellow spot.) 
In the earliest stage the ophthalmoscope often shows no 
change in the fundus, or, at the most, hypersemia of the disk 
and retina. Hot infrequently at this period a slight, some- 
what striped cloudiness of the boundaries of the papilla and 
the circumjacent retinal zone appears, not unlike a specific 
retinitis ; occasionally isolated retinal haemorrhages in the re- 
gion of the disk appear. Often there are little bright, white 
opacities on the papilla or on its edge, which either conceal 
the point of emergence of the vessels or accompany them, 
sometimes covering them over, and again extending along the 
edge of the papilla. These opacities Yon Graefe regarded as 
evidences of a retrobulbar neuritis of the optic nerve, which 
leaves but its last traces on the papilla. 
At a later stage, and in some cases soon after the beginning 
of the disturbance of vision, the disk has a light-blue atrophic 
look, which is nearly always limited to its outer half. If hy- 
persemia and opacity have previously existed, they now both 
disappear. The inner half of the disk remains of its normal 
color and appearance and so characteristic is this ophthalmo- 
scopic appearance, that from it alone the central scotoma may 
he diagnosed. [Since my attention was first drawn to this fact 
I have had frequent occasion, at Berlin and elsewhere, to rec- 
ognize the truth of Leber’s statement, and I have repeatedly 
traced out upon the blackboard a large central color scotoma in 
patients where the ophthalmoscope had revealed this partial 
-atrophy of the papilla.] The examination of the perception 
of color now is a most convenient and sure method of recog- 
nizing this central amblyopia. In many cases the ordinary 
method of examination shows nothing abnormal, whereas the 
; color-test reveals instantly a clearly-defined scotoma. 
Leber’s method is as follows : The patient is placed before 
a black-board at a distance of perhaps one foot and a half—one 
eye closed and the other fixing a white cross, traced upon the 
centre of the board. From the point of fixation now as a cen- 
tre a small piece of colored paper (mounted upon a short rod) 
is moved, and the point at which the patient first recognizes 
the color is noted upon the board. In this way the region COLOE-BLINDHESS. 
7 
over which the color is not recognized is mapped out. The 
most striking results are obtained from bright green and rose- 
red, the first appearing either white, gray, or yellow, and the 
last, blue. 
In the less severe cases Leber found simple red-color blind- 
ness, while in the more advanced cases, as in those of atrophy of 
the nerve, the ability to distinguish colors diminished from the 
red to the violet end of the spectrum, and finally ceased alto- 
gether. 
Leber found, further, if the cases are left to themselves, the 
affection for a considerable time grows worse, then remains 
stationary ; all the time the partial atrophy of the papilla be- 
comes more pronounced. The degree of the amblyopia varies, 
but in the majority of cases a moderate vision remains, suffi- 
cient to recognize large letters. 
Almost always both eyes are affected. This form of am- 
blyopia occurs almost solely in men; out of fifty-six cases only 
three were women. It is a disease of adults; its frequency 
increasing from the twentieth to the fortieth year. In a por- 
tion of the eases abuse of alcohol was certainly the cause of 
the affection, and in others the excessive use of tobacco un- 
doubtedly contributed to produce the disease. Forster,1 in a 
paper on the injurious action of tobacco on the vision, attaches 
still greater importance to this agent as a cause of amblyopia, 
supporting the views of Mackenzie, Sichel, Hutchinson, Lu- 
reiro, and others. The author cites twenty cases, in which 
there was a central scotoma, with a horizontal diameter of 
18° to 25°, within which large letters could still be recognized. 
All of these patients suffered from some affection of the diges- 
tive and nervous system. Loss of appetite, constipation, loss 
of sleep, were common symptoms. Each one of the twenty 
patients was a strong smoker, and in eleven of these cases a 
very marked improvement was observed when the use of to- 
bacco was given up. 
In other cases, exposure to the cold and damp seemed 
the efficient cause of the disease. The frequency with which 
certain professions were affected with central scotoma gives 
1 Ein Jabresber. tl. schles. Ges., p. 1868. 8 
COLOR-BLINDNESS. 
support to this theory, for, amongf the cases that Leber enu- 
merates where an. excessive use of alcohol could be proved, 
were three woodmen, a forest-inspector, a railroad-laborer, an 
engine-driver, and a turnpike-inspector, all of whom in the 
discharge of their duties were repeatedly exposed to such inju- 
rious influences. 
From the absence of any complication with diseases of other 
organs, this is believed to be an idiopathic affection of the eye. 
Moreover, there is little or no doubt that the optic nerve, and 
not the retina or cerebro-spinal system, is the seat of the disease, 
for in these cases there are no changes observed in the macula 
as invariably are found in the later stages of chorio-retinal 
processes. The subsequent constant partial atrophy of the 
nerve, and especially the signs of inflammation on the papilla, 
as is found in some cases from the outset, point to an affection 
of the optic nerve. 
“As to the nature of the process. Those cases that present 
the above-mentioned changes on the papilla are undoubtedly 
cases of neuritis, which gradually leads to atrophy of the optic- 
nerve fibres, an inflammation of the optic nerve between the 
chiasma and the eye. On the intra-ocular end of the optic 
nerve the last traces of the neuritis appear in form of loss of 
transparency of the edges of the papilla, signs of exudation 
along the vessels, and haemorrhages. 
“ The partial white coloration, limited to the outer half of 
the papilla, is evidence of only partial disease of the optic 
nerve. To be sure, there is the same appearance in the first 
stages of progressive atrophy where there is no central scoto- 
ma, but it is much less pronounced. The explanation of this 
is that, in the outer portion of the papilla, toward the macula, 
there are only a small number of nerve-fibres, and therefore the 
disk at this point is less prominent; and commencing atro- 
phy, even when it affects the entire thickness of the optic 
nerve, will, for this very reason, appear more marked and 
at an earlier date on the outer half of the papilla. In the 
pronounced cases of partial coloration of the papilla, as one 
almost invariably finds where there is a central scotoma, the 
difference between the inner and the outer half of the papilla 
is so great that there is no longer any doubt that the affection COLOE-BLIFDKESS, 
9 
is a partial atrophy of th’e optic nerve. The nerve-fibres 
which terminate in the region of the macula and between it 
and. the papilla must lie in the outer half of the disk, for those 
fibres ending on the other side of the macula curve in the 
papilla itself obliquely upward and. downward, and take a di- 
rection in the retina_bow-shaped about the macula.” .. . . 
The nerve-fibres going to- the macula are the most superfi- 
cial fibres of the optic, whereas, the nearer the periphery the 
retinal elements lie, just so much nearer the axis of the optic 
nerve are the fibres supplying them.. 
u If we now regard the central scotoma as dependent upon 
an affection of the superficial layers of the optic nerve or 
upon a perineuritis, which penetrates only to a limited depth 
in the nerve, we have an explanation of the precise limitation 
and central position of the scotoma; this theory would har- 
monize with the partial or complete recovery from the affec- 
tion and its infrequent rheumatic origin.” 
If the periphery of the visual field in these cases has re- 
mained a long time intact, there is absolutely no danger of 
complete blindness ; on the other hand, if the scotoma is greater 
in one direction, and if there is a peripherical defect in the 
visual field, then the case is one of atrophy of the optic nerve, 
and there is every reason to fear total loss of sight. 
As for the prognosis in these cases of central scotoma, we 
cannot always hope for a restitutio- ad integrum. The results 
attained by treatment are less favorable in general than in cases 
of simple amblyopia where there is no central scotoma.. In 
the severer cases we can hope for a great improvement, and 
this may be of various kinds—the patient learns to see eccen- 
trically,. or, as we sometimes see, small breaks occur in the sco- 
toma, and it is changed into a u ring; scotoma,” and this last 
Jo o ' 
issue is far better than where the vision is eccentric. 
The treatment consists in local bloodletting and diaphoretics. 
lodide of potash Leber found of service in cases where other 
measures had failed. Yon Graefe applied a seton to the nape 
of the neck if there was a congestive disposition, and, when the 
inflammatory processes were over, the.eyes were exercised with 
convex glasses and prisms.. Tll K 
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