Compliments of the Author 
CONTRIBUTIONS 
to 
OPHTHALMOLOGY 
BY 
DR. C. R. AGNEW 
AND 
DR. D. WEBSTER 
REPRINTED FROM THE TRANSACTIONS 
OF THE 
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1878 CASES OF OPHTHALMIC DISEASE IN WHICH EN- 
FORCED EXPOSURE OF THE EYES TO LIGHT AND 
AIR WAS SALUTARY. By Dr. C. R. Agnew, New York. 
It is often a nice question in ophthalmic therapeutics whether the 
sensitiveness of an eye to light and air is to be indulged or resisted, 
and at what point in the progress of treatment exposure to light 
and air must be insisted upon, even though the apparent immediate 
effect may be to induce photophobia, lachrymation, or other indica- 
tions of suffering. The following cases may, in unfolding the subject, 
serve as a basis for some safe and useful practical deductions. It is 
in this hope that we give them to the Society. 
The first case is one of phlyctenular keratitis in a girl six years of 
age. The child had always lived in a salubrious mountain district, 
and had had fair health. The mother stated that there was scrofula 
in the blood on the father’s side. The eyes had been inflamed for 
some weeks before they came under our observation, and during that 
period were constantly closed. For more than two weeks the ex- 
treme photophobia had caused, the child to be confined in a dark 
room and to bury her face in a pillow, both during sleep and when 
awake. Under these circumstances the child was brought to New 
York to be under our care. The photophobia was now so extreme 
that even the most imperfect examination of the parts was difficult, 
and accompanied by violent spasm of the orbicular muscles and 
paroxysms of sneezing. 
It was ascertained, however, that there were small superficial 
ulcers upon both corneae, with delicate vessels starting from the 
coronae, and slight circumcorneal injection. 
Well lighted and airy rooms were got for the patient at a high level 
in a good hotel. A good dietary, including milk, fruit, and a moder- 
ate amount of beef, was prescribed. The amount of exercise and 
exposure to light was restricted, and attention was paid to bathing 
and every other sanitary need. The eyes were treated locally with 
atropia, levigated calomel, and water-baths at the most agreeable 
temperature. Iron and cod-liver oil were given internally, and at 2 
night the entire surface of the body was rubbed to a glow and 
anointed with vaseline. The child improved in color and general 
condition, but not so the eyes ; they remained unchanged. A double 
canthotomy was accordingly done, under ether, hoping thus to relieve 
the extreme spasm of the orbicular muscles. The general tonic 
course was continued after this for a period of seven weeks, without 
any appreciable amelioration of the state of the eyes. Much exer- 
cise in the light was simply impossible, as the child, when taken to the 
streets or park, except at night, would resist with loud crying. The 
eyelids continued to be, as they had been, swollen and red, and 
every attempt to inspect the eyes was resisted and provocative of a 
gush of acrid tears and persistent paroxysms of sneezing. When the 
lids were forcibly opened, the eyes, although not extremely red, were 
moderately so, and the general surface of the scleral conjunctiva and 
cornea had a soaked look. All the appearances impressed an ob- 
server with the idea that the repair of the diseased surfaces was pre- 
vented by the perpetual soaking of those surfaces by the excessive 
and altered secretions, and that the leading indication was to open 
the eyelids forcibly. 
On the 30th of March, to meet this indication, the child was 
placed under ether in a well-lighted room. First one eye and then 
the other was forcibly opened with a spring speculum. The eyes 
were thus, for a moment or two, exposed to the light and air, until 
the corneal surface began to look slightly dry, and the excessive 
secretions were carefully removed from the cul-de-sac with a soft 
linen rag. These proceedings were repeated several times in the 
case of each eye for about fifteen minutes in all. When the full 
flood of diffused light entered each eye as it was held open, it was 
observed that some resistance was made by the child, although at 
other moments the anaesthesia seemed to be complete. The treat- 
ment was repeated on the next day, the 31st inst., and again on the 
3d, 5th, 7th, 9th, and nth of April, in all seven times, and in every 
instance with the effect of lessening the intensity of the photophobia 
and orbicular spasm. On the evening of the 9th inst., after the sixth 
application of the method, the child, for the first time in nearly three 
months, voluntarily opened her eyes. On the 10th she was still 
able to open them. On the nth the effect of the ether was pro- 
longed, although the quantity used was not greater than on previous 
occasions, and there was much vomiting during the afternoon and 
evening, and also the next morning after breakfast. On the 13th 
inst. the eyes were widely opened, the corneal abrasions healed, the 3 
conjunctival congestion almost all gone, and the photophobia and 
lachrymation not annoying. In a few days the patient went away 
well, and on inquiry some months later was reported as being still 
so. Dr. Webster saw the child a year afterwards and reports that 
she was still well. 
It is, we think, fair to suppose that the main agency in the cure 
was the forcible exposure of the badly nourished eye tissues to the 
action of light and air. The influx of light and contact of air would 
naturally awaken the dormant or perverted energies of the tissues, 
and quicken the reparative action. It may be said that the repeated 
effect of the ether would tend to neutralize morbid sensibility and 
harmonize the reparative forces. We are aware of the possibility of 
such an agency, and would not exclude it entirely in this case. In- 
deed, we have often seen, in cases of phlyctenular disease, where ex- 
treme photophobia had induced the use of an anaesthetic to facilitate 
the examination of the offending eye, the distressing symptoms 
greatly lessened on the recovery of the patient from the anaesthesia. 
But in this case the patient had had ether employed and a cantho- 
tomy done without benefit, and subsequently got well as described. 
Moreover, in other instances, in older subjects, we have tried the 
method of forcible exposure, without the intervention of an anaesthe- 
tic, and with good effect enough to make us trust it in otherwise in- 
corrigible cases. The following case, although not retained to its 
end, may illustrate our meaning : O. B., seventeen, was hit in the eye 
with an apple-core in 1874. Superficial inflammation ensued, which 
ran into double trachoma and panniform keratitis. He had had all 
the benefit of treatment by various skilful hands, and ran the gauntlet 
of those who had advised multiform nostrums. He came under oui 
observation March 26, 1878. His photophobia was extreme, and 
it was almost impossible to inspect the eyes on account of violent 
and prolonged paroxysms of sneezing which agitated his head and 
entire body whenever the lids were forcibly opened to admit light. 
The patient was etiolated and very feeble by continuous incarcera- 
tion in the darkened room of a tenement-house. When the attempt 
was made by digital pressure to antagonize the orbicular muscles and 
open the eyes, every muscle in the face and neck seemed to resist, 
and his mouth would open widely in the general grimace. In this 
case we used the method of forcibly opening the eyelids with the 
spring speculum and without any anaesthetic. We placed the patient 
erect with his back against the wall, and facing a north window, and 
introduced the speculum into one eye at a time, and kept it clamped 4 
in place, widely distended, while the patient slowly counted one 
hundred, we having observed that that marked the limit of his en- 
durance. The act of counting diverted his mind and consumed five 
minutes. We then did the same with the fellow-eve. In placing the 
speculum, care was taken to open it as widely as possible and then 
to clamp it, so as to distend the palpebral slit to its utmost. The 
effect of this treatment was so marked and immediate that the patient 
soon left the office able to open his eyes partially, and returned on 
the following day with both eyes more widely opened, and so tolerant 
of manipulation and light as to make an inspection relatively easy. 
Again the speculum was introduced as before, and the palpebral slit 
distended. The improvement went on continuously during the few 
days that this patient was under treatment, but the pannus and the 
old opacities darkened the prognosis, and he soon failed to reappear.* 
We might adduce other cases of this class, but enough have been 
given to impress the lesson that because light produces distressing 
symptoms in certain eye cases we are not, therefore, to indulge the 
patient in his desire to live in the dark or to multiply eye-shades : but, 
on the contrary, to resort to active measures, which, on superficial 
observation, might seem to be opposed to the indications of treat- 
ment. Many so-called indications remind one of the sign-board at a 
cross-roads, which, having been blown down in the night, was replaced 
so that its directions were exactly wrong. We must test indications 
by most careful deduction, to which all the phenomena drawn from 
many related cases yield their true logical value. 
While transcribing the last case, a case of extremely irritable, non- 
specific, interstitial keratitis in an adult came under observation, in 
which out-of-door life, foot exercise, a daily air-bath with friction with 
the hair mittens, and a Turkish bath every other day, inaugurated a 
new action and led to reparative changes. In this case there had 
been acne and a tendency to lay up loose, flabby flesh. 
The following case, which had been kept in the dark for nearly nine 
years, will illustrate the danger of not translating correctly the indica- 
tions for treatment. H. B., 21, was first seen by 11s in his home in 
a distant part of the State. We reached his house in the afternoon 
and were shown into a darkened hall, and thence escorted through 
a darkened ante-room into the dark chamber in which the expectant 
patient was incarcerated. Screens and window-shades, and outside 
blinds had been so cunningly arranged that our limp patient with the 
* Seen some months later and condition of the eyes vastly improved. 5 
moist, flabby hand was invisible until we insisted upon having the 
light of a dim candle. The history of the case was as follows. 
Nearly nine years ago, after reading steadily for three hours, he 
suddenly felt a sense of numbness and formication around the eyes 
and in the forehead between the supra-orbital nerves, and lost the 
power of fixing his eyes steadily even on large objects. Photophobia 
soon supervened, “ amounting almost to agony.” He betook him- 
self to a dark room, in which he remained continuously for nineteen 
months. He then was taken, with eyes so covered as to exclude 
light, to a distant town, where he was treated for some months “ for 
paralysis of the optic nerves.” He grew worse under this treatment, 
and therefore returned home and to the dark room, in which he 
remained for the remainder of the period of nine years, only going 
out occasionally, and then after dark, and always with the precaution 
of a shade of some kind to exclude moon or star light. 
It was obvious that the habits of years could not be changed in a 
domicile in which almost every device suggested by tender solicitude 
for the sufferer was, in our opinion, working against the cure. We 
accordingly suggested his removal to the Manhattan Hospital, New 
York, which was accomplished on November i, 1873. He was 
brought to the hospital with his eyes so covered by black bandages 
as to exclude every ray of light. These were removed in spite of 
fervent protests. The vision was then tested under as much light as 
he would bear, which was, however, of a degree making reading for 
the normal eye difficult. It was found that he could read Snellen 
No. at eight inches. It was with great difficulty that he could be 
persuaded to fix his eyes on any object. The effort to do so caused 
them to roll about in the orbits, and his head to nod and jerk back- 
ward and forward. He would throw his arms about in an aimless 
manner, and exhibit in various other ways the want of self-control. 
AVe could not classify the symptoms with chorea. He was blanched 
in color, through long seclusion from light, and greatly emaciated. 
A few days after his admission we made an ophthalmoscopic examina- 
tion, and found that he was myopic, and that there was slight neuro- 
choroidal hypenemia. As regards the latter phenomenon we were by 
no means certain, however. 
The treatment consisted in gradually increasing the exposure of 
the eyes to light, for which specific directions were given daily, and 
a course of simple calisthenic exercise and stated out-of-door walks. 
We broke up at once the habit of depending upon others for every 
want, and on one occasion, having taken him a little distance from 6 
the hospital, suddenly left him to find his way back alone. It was 
interesting to observe how, in a child-like manner, he regained the 
ability to wait upon himself, having lost the art so thoroughly by nine 
years of dependence upon others, though by no means deficient in 
intellect. 
Nov. 17th.—The vision for the distance was tried and found to be 
f-$ with — ytg-. He was then put upon a course of hypodermic in- 
jections of nitrate of strychnia. 
Dec. 22, 1873.—Vision fjj- with — -fa. He was now sent home, 
with specific instructions to live in the open air and to expose him- 
self to sunlight. Shortly after leaving the hospital psoriasis broke 
out on his forehead, covered the scalp, and spread on to the neck, 
and was so inveterate as to compel him to return to the city for 
treatment. 
In November, 1874, the date of the last notes in his case, the vision 
was as follows : Right, without glass, V. = fa^; with — V. 
Left, without glass, V. = ; with, — fa 5 V* = f <p The eyes 
were no longer sensitive to light or in any way troublesome. 
Some years previously to our seeing this case we had seen another 
case almost the fac-simile of it, both as regards history and recovery. 
That was in the person of a young man from Vermont, who had been 
incarcerated in the dark for more than eight years for an eye affection 
in which photophobia was the ruling symptom. In that case not only 
had the general health been profoundly depressed, but epilepsy had 
been superinduced. In that case also the main element in the treat- 
ment which we employed was the use of light, with regular exercise 
to quicken tissue-change and tissue-building, Formerly it was the 
almost universal practice to immure patients in the dark, not only for 
affections in which photophobia was a symptom, but for any eye dis- 
ease or injury, irrespective of the effect of light. The exclusion of 
light necessarily involved also the exclusion of air, and as the sufferer 
was ordinarily confined to the same room by day and by night, and 
not unfrequently with a number of other victims, an unsanitary state 
was produced, the odor of which is quick in our memory to this day. 
That entity compounded of body odor and darkness has never ceased 
to be repulsive or to impress its lesson upon us, and yet we can look 
back with the conviction that we also have been too prone to exclude 
light in the treatment of our patients. We may adduce the change 
which has occurred in our treatment of cataract cases. We can easily 
recall the time when we shut our patients in darkened rooms, after 
cataract extractions, for a period varying from one to five or six weeks, 7 
with only occasional introduction of daylight. Now, we never shut 
them in the dark. The instructions are to have the apartment light 
enough for the attendant to see to read ordinary print, while we ex- 
clude light from the patient’s eyes by means of a black shade or 
darkened coquilles so long as entire rest of the wounded organ may 
be essential to the cure, watching carefully for the earliest moment 
at which the use of light as a remedy may be adopted. By this 
method the patient lives in an atmosphere so illuminated as to be 
conducive to general nutrition and to the uniform practice of a hy- 
gienic regimen. The quality of the nursing is always better when 
light pervades the sick-room. The attendants are more cheerful, 
and more exact in all their manipulations. Specific directions given 
by the surgeon will ensure the coaptation of the black silk mask over 
the eyes, or the use of the dark coquilles, and make any sudden ex- 
posure of the eyes themselves to the light improbable. 
It may be said that we cannot safely deduce from such cases rules 
to be applied in the treatment of other cases in which photophobia 
exists, or in which rest of the organ of vision is naturally demanded. 
This leads us to ask the questions whether light should ever be en- 
tirely excluded from the room in which an ophthalmic case is, and if 
so, under what conditions, and whether it is not better to use contri- 
vances to exclude light from the eyes, while it is allowed to pervade, 
with its life-giving power, the atmosphere in which the patient is 
kept ? 
These questions involve the sanitary construction and management 
of ophthalmic wards. In answering these questions we would say 
emphatically that we would not shut a patient in a dark room except 
when nature provides the way at night, or for such other and brief 
periods during the day as might be agreeable for sleep or entire quiet, 
or for the temporary application of iced or other dressings incom- 
patible with the use of the black silk eye-mask or coquilles. 
In cases of retinal, neural, or choroidal disease, in which local 
bloodletting should be immediately followed by absolute exclusion 
of light from the eyes for a period varying from twenty-four to thirty- 
six hours, the use of the black silk mask carefully adjusted meets 
the indication fully, and having been applied securely by the surgeon, 
is less likely to be so displaced as to admit light than window-screens 
to which incautious persons have access. 
The value of the local method of excluding light is very great in 
all those forms of cachexia, like gout, rheumatism, syphilis, and scrof- 
ula, in which we have to use every sanitary resource to cure the 8 
patient, to lessen the amount of local damage, or to diminish the 
tendency to recurrence of the local disease. 
The inducement to shut a patient in the dark in iritis, for instance, 
is almost irresistible. The nature of the tissues primarily involved, 
the importance of such related parts as the crystalline lens, the ciliary 
organs, and the choroid, seem to make it the imperative duty of the 
surgeon to put his patient in the dark and to keep him there until he 
is well. We are bound to say, that in our experience, ambulant 
patients with acute iritis get well with as few permanent lesions as 
any other class, and in less time. This fact was early forced upon our 
attention by observing the results of practice in dispensary patients, 
as contrasted with those of patients in the walks of life in which every 
element of rest and seclusion and medical attendance in domicile 
could be commanded. To our surprise, the poor man, exposed to 
many hardships, would get well quickly, while the more luxurious 
patient would linger, and perhaps suffer more and have more relapses. 
Atropia, Turkish baths, and Mercury are the cardinal remedies in 
iritis, and the first-named can never be safely omitted. Over and 
over again we have seen patients with acute iritis far on to convales- 
cence within a week after beginning such a plan of treatment, and 
without any other precaution against exposure to light than would be 
afforded by a pair of smoke-colored coquilles, medium shade. It 
may not be considered a useless digression if we say here that we 
always use a solution of sulphate of atropia at least four grains to the 
ounce, and apply it every ten minutes for six or eight consecutive 
times before we allow the patient to go from observation, and order 
an immediate Turkish bath. We have frequently seen a pupil dilated 
fully after a Turkish bath, which had previously yielded little, if at all. 
Where such baths are not to be had, their effect may be imitated by 
any method which produces free sweating and is accompanied by 
shampooing of the head. 
As we have seen, a few hours of improper incarceration in a dark 
room may give a character to a case which will deceive both patient 
and physician as regards the true indications. We cannot be too 
much alive as to the danger our patients are in of forming habits 
which, although apparently essential to recovery, or to any degree 
of comfort even, are directly in the way of a possibility of cure. 
As an illustration of this principle, we adduce another case in addi- 
tion to those already given. 
Some time ago we were called in to see a lady of middle age, who 
for many months had been confined to a dark room. Not being well, 9 
and being of a very nervous temperament, she had become alarmed 
when her eyes, which had previously been strong and useful for all 
purposes of vision, began to be defective in endurance and to grow 
morbidly sensitive to exposure to ordinary use and common light. 
Instead of throwing otf some of the enervating appliances of luxury, 
she gradually ceased from exercise, and as she grew weaker, 
spent more and more time in bed. Day after day she shut the 
light and air more and more from her apartment, until when we 
called she was existing in a room which was as hermetically sealed 
against light and air as a room with two large windows and three 
doors could be. There were at the windows outside blinds, inside 
shutters, and hanging curtains. All the doors except one were closed, 
locked, and their marginal cracks and key-holes stuffed with cotton. 
The door by which access was had to the chamber was at the end of 
a double-door hall and leading out of an adjoining room, which was 
kept dark. It was difficult to persuade either the attendants or the 
patient that so small a light as a candle would be tolerable. A 
candle was got, however, and after great difficulty an examination 
made. We could find no organic disease of the eyes, nor any 
spinal or cerebral malady to account for the extreme hyperaesthesia. 
The main cause of the aggravated symptoms seemed to be a yielding 
on the part of the patient to the photophobia until all power to resist 
it was in abeyance, and nothing could come in to act as a curative 
except the firm will of the medical attendant subverting the entire 
method of treatment previously employed. In a very few hours we 
had the patient moved into a clean, dimly lighted room, and the 
chamber from which she had been extricated, sunned, ventilated, and 
scrubbed, processes to which it had not been subjected for several 
months. 
We are prepared then to say, in summing up our experience, that 
daylight should not be excluded from apartments in which ophthalmic 
cases are being treated. That it will be frequently necessary to 
oppose vigorously the tendency of a patient to dwell in the dark. 
That, as a rule, the importance of and necessity for the use of light as 
a remedial agent will be in inverse proportion to the inclination of 
the patient. That wre cannot always depend upon the presence of 
photophobia as an indication for the prolonged use of darkness as a 
remedy. That photophobia is not usually a very marked symptom 
in retinal, neural, or choroidal cases in which the interrupted use 
even of darkness as a remedy is demanded, but that the ophthalmo- 
scopic lesions are more to be depended upon as guides. That, as a 10 
rule, corneal and iritic affections do not demand the entire or con- 
tinuous exclusion of light, and that many cases of those diseases are 
either aggravated or made hopeless by such exclusion, and especially 
when they are not traumatic, but the offspring_ of some diathesis or 
cachexia. That under the latter circumstances every hygienic and 
therapeutic consideration is opposed to the exclusion of light. We 
recall, in writing this sentence, a case of syphilitic iritis to which we 
were called in consultation, where the patient had been kept for three 
months in the dark, and during most of that time under the full effects 
of mercury, without saving his eyes, and with the result of a bank- 
rupt constitution. We will not soon forget the wretched appearance 
of the victim as we let the light of day upon his blanched face, and 
saw the drooling of saliva from his flabby lips. 
We believe that it is better to depend upon some opaque covering 
for the eyes when partial or complete darkness is to be used as a 
remedy, and not to exclude light from the apartment, and by such 
exclusion to lessen ventilation and induce etiolation. 
Scarcely a day passes in our practice in which we do not see one 
or more cases where damage has been done, and often of an irrepara- 
ble nature, not only to the general health, but also to the diseased 
eyes, by methods the opposite of those which we are striving to com- 
mend to your favor. A CURVED KNIFE FOR CERTAIN FORMS OF STRIC- 
TURE OF THE INFERIOR LACHRYMAL CANALI- 
CULUS. By Dr. C. R. Agnew, New York. 
All must have encountered cases of lachrymal obstruction in which 
the calibre of the inferior canaliculus is greatly reduced by a stricture 
just where the canal should pass by a free opening into the lachry- 
mal sac. I have long observed that the common strabismus-hook 
would pass such a stricture when a probe or probed knife pressed 
onward in the plane of the canaliculus would be stopped en- 
tirely, or, if unduly pushed, perforate the floor of the canal, and make 
a false passage below the stricture, and between the sac wall and the 
maxillary bone. The curve in the strabismus hook seemed to make 
it comparatively easy to override the stricture and to pass the instru- 
ment forward into the dome of the lachrymal sac. Following out 
this line, it occurred to me to make an instrument shaped somewhat 
like a strabismus-hook, only a little more curved, and upon a smaller 
arc, and to sharpen the inside of the curve, and to make the ex- 
tremity probe-pointed, so that, having passed it into the sac, I might 
incise the upper wall of the canaliculus at the sac entrance, and so 
make way for subsequent instrumental manipulation. The instru- 
ment here delineated may also be made to cut the lower floor of the 
canaliculus near the sac by first introducing it into the sac with the 
convex edge downward, and then sweeping it around before with- 
drawing it, so as to make it cut downward. 
The instrument may not be new ; my colleagues may think it of 
no value. I have only to say that I have used it with benefit to 
patients when other means had failed. 
Note—The bulb on the free end of the knife should not be quite so large as 
the cut shows. THE ./ETIOLOGY OF RETINITIS PIGMENTOSA, WITH 
CASES. By Dr. David Webster, New York. 
Mr. Jonathan Hutchinson, in the Ophthalmic Hospital Reports, 
Vol. VII., page 435, says : “ An ophthalmic surgeon, who may chance 
upon a good example of this rare malady, and may not feel inclined 
to trouble himself about it farther than the limits of his own specialty, 
is bound in the interests of general medicine to hand it over for in- 
vestigation to some naturalist of wider sympathies.” 
In regard to the aetiology, he says : “ There cannot be the slight- 
est doubt that it is remarkably hereditary,” and that “ cases which 
favor the belief that consanguineous marriages may produce a ten- 
dency to it are of special value.” He further states that “ inherited 
syphilis may produce changes exceedingly like those of retinitis pig- 
mentosa, but to be distinguished from the true disease on careful 
examination.” 
Stellwag tells us that “ in a series of cases the disease has proved 
to be hereditary,” and that “ statistics show that it occurs much more 
frequently in children whose parents were blood-relations, than other- 
wise.” 
Schvveigger says: “ Heredity is an important element in the 
ietiology of the disease,” and, without stating the results of his own 
observations, tells us that “ more comprehensive statistics with refer- 
ence to the matter of consanguinity are desirable.” 
Carter has never met with a case of retinitis pigmentosa in which 
any relationship between the parents existed, but generally finds more 
than one in the same family similarly affected. He has never been 
able to connect the disease with syphilis, either inherited or acquired. 
Macnamara informs us that consanguinity of parentage cannot be 
the cause of the disease among the natives of India, as they are 
most scrupulous in observing the restrictions they place upon the 
intermarriage of relations, and yet he has seen some twelve or fifteen 
instances of it among his native patients within a period of one year. 
He says the disease is hereditary, and occurs frequently in several 
members of the same family; he is also disposed to look upon it, in 
some cases, as the result of inherited syphilis. 
Wells says the disease is often hereditary, but seems to found his 
opinions entirely upon the observations of others. 13 
Liebreich was the first who called attention to consanguinity of 
parentage as a cause of retinitis pigmentosa, and we do not wonder 
that he believed he had made a valuable discovery when we are told 
that in fourteen out of thirty-five cases he was enabled to prove a 
descent from blood-relations. 
Mooren noted consanguinity of parentage in nine out of thirty- 
four cases. 
Leber, in “ Handbuch der gesammten Augenheilkunde," Vol. II., 
page 653, reports sixty-six cases of retinitis pigmentosa observed by 
himself. Forty-four were of the usual kind, while twenty-two were 
complicated with congenital atrophy of the retina. He found con- 
sanguinity of parentage in eighteen cases, or 27.3 per cent.; the dis- 
ease affecting other brothers or sisters in fourteen cases, or 21.2 per 
cent. ; heredity in one case, or 1.5 per cent.; hereditary syphilis in 
five cases, or 7.6 per cent.; and in twenty-eight cases, or 42.4 per 
cent., no cause could be ascertained. 
We should infer from the observations of Liebreich, Mooren, and 
Leber, that consanguinity of parentage was one of the most frequent 
causes of the disease, and yet many other observers have failed to 
find it in any case. 
In the report of the Wiesbaden Eye Infirmary for 1861-2, twelve 
cases of retinitis pigmentosa are given, and in not one was any con- 
sanguinity of parentage traceable. 
Lawrence and Moon report four cases in the Ophthalmic Review 
for 1866—three boys and a girl in the same family. There was no 
consanguinity of parentage or traceable syphilis in the family. 
Mr. Hutchinson reports four cases, none of whom showed consan- 
guinity of parentage. In one case there was heredity, two of the 
patients being father and daughter. 
Harlan, of Philadelphia, has reported a case, a girl of eighteen, 
without consanguinity of parentage, heredity, or inherited syphilis. 
My friend, Dr. W. Cheatham, of Louisville, Kentucky, has been 
kind enough to furnish me with the following most extraordinary 
history of a family afflicted with this disease. He says“ I was called, 
lately, to see a case of cataract that had been operated on seven 
weeks previously. On examination I found dark-colored cataract 
of the right eye. The pupil of the left eye was closed, and the eye- 
ball was very tender to the touch, and quite painful. Both visual 
fields, as tested by a lighted candle in a dark room, were contracted 
to almost nothing. 
“ On getting the history of the case, that of the whole family 14 
was given, extending back for a period of over two hundred years. 
Thinking, from the history of the patient, that the eye trouble from 
which the family suffered was retinitis pigmentosa, 1 requested that 
some of them should submit to an ophthalmoscopic examination. 
Two gentlemen of the family called at my office the next day. The 
examination revealed well-marked retinitis pigmentosa in both cases. 
They were kind enough to give me a full history of their family, one 
branch of which can be traced directly to Pocahontas. The dis- 
ease had been in the family for over two hundred years. A pecu- 
liar feature of it, as it existed in them, was that it attacked about 
one-half of them only. It appeared to select about every other 
one. For instance, one member of the family had nine children. 
The first one born had the disease, the second one it missed, the 
third had it, and so on through the whole of the nine children. 
“Another interesting feature is, as soon as twilight sets in, the 
blindness usual in such cases begins, yet, by bright moonlight, 
some of them are able to read the finest print; but the instant 
they get into the slightest shade the hemeralopia again appears. 
Again, there has been but one intermarriage in the family, and the 
children of this couple are the only ones all of whom are entirely 
exempt from the disease, all the others, as I said before, having 
about every other one attacked by it! ” 
Dr. Cheatham informs me that the family whose history is related 
above is “one of the most numerous in the South.” It certainly 
demonstrates, beyond all reasonable doubt, the hereditary nature of 
retinitis pigmentosa. 
I have succeeded in collecting from the case-books of Dr. C. R. 
Agnew, with his kind permission, nineteen cases in which the records 
were tolerably complete, and, adding to these three cases which I 
saw in Massachusetts, I am enabled to present to the Society the 
histories of twenty-two cases, nearly all of which I examined per- 
sonally. 
Inspection of these cases will show that consanguinity of parent- 
age was traceable in only three out of the twenty-two cases, or in 
13.6 per cent. Possibly this does not very much exceed the general 
percentage of intermarriages of blood-relations in the United States, 
and when we observe that in one of the three cases heredity un- 
doubtedly existed, the mother having always seen much worse than 
other people after dark and in darkened rooms, and that in another 
of them a suspicion of heredity exists, the mother having long been 
subject to weak eyes, and that in the third case the patient was a 15 
deaf-mute, we are inclined to the opinion that consanguinity of 
parentage, if at all, is a comparatively weak element in the causa- 
tion. 
Heredity was present in seven cases, or in 31.8 per cent., and 
there was good reason for suspecting heredity in several other cases, 
but it could not be proved. 
Three of the patients were members of the same family, and three 
others had brothers, sisters, or cousins with the same disease. 
One patient had a daughter with an appearance and history which 
would lead one to suspect inherited syphilis. 
One patient attributed the disease to his having been struck by 
lightning at the age of eight. 
Two of the patients were deaf-mutes. 
One or two of the patients had relatives with various diseases of 
the nervous system. 
In six cases no cause was ascertained, there being no heredity, 
no consanguinity of parentage, and no history of nervous diseases 
in their families. 
I append, in full, the notes of the twenty-two cases, as some of 
them contain points of interest aside from the causation. 
CASE I.—Ella P., 16. First noticed night-blindness five or six 
years ago. She sees well in the day-time, and in the night can see 
to read and write by gaslight, but cannot see well enough to get 
about alone. Vision = each eye ; no improvement with glasses. 
Ophthalmoscopic Examination.—Each eye H. -g Retinitis pig- 
mentosa and partial atrophy of optic nerve, both eyes ; slight pos- 
terior polar cataract right eye. 
Her father and mother are first cousins. Her mother has always 
had weak eyes. 
CASE II.—S. Q., 16, deaf-mute. Has vision = -|°, each eye, and 
no improvement with glasses. His visual fields are greatly con- 
tracted. 
The ophthalmoscope shows H. J, each ; retinitis pigmentosa with 
atrophy of optic nerves and retinae. 
His father and mother are cousins. 
CASE III.—Oct., 1868. Frederic S., 20. Since childhood, or as 
far back as he can remember, he has not been able to see well in 
the dark. He has to be led about after dark. He can see by gas- 
light as well as by day. He has never suffered from pain or other 
trouble in the eyes. His parents were first cousins, once removed. 16 
His mother has always seen badly at night, or in a darkened room, 
and has remarked especial difficulty in getting up and down the 
stairs in hall-ways that were not well lighted. She has, however, no 
pigment deposits in her retinae, and seems to be one of those cases 
of “ retinitis pigmentosa without the pigment,” that have lately been 
described. The patient’s grandmother is over 90, and reads the 
finest print without glasses, and yet is said not to be near-sighted. 
Ophthalmoscopic Examination.—Typical retinitis pigmentosa; the 
retina looks hazy, especially near the optic nerve ; the retinal vessels 
are diminished. Vision = (—) with — fac each eye ; acc. = ; 
no insufficiency of ocular muscles. 
Feb. 1, 1878.—V. = •§{{ each, and not improved by glasses. Each 
visual field reduced to an area of about four inches in diameter at a 
distance of one foot. 
The patient was placed upon daily hypodermic injections of a 
solution of nitrate of strychnia, commencing with gr. fa and gradually 
increasing the dose until, on Feb. nth, the physiological effects of 
the drug were produced. Neither central vision nor the visual 
field was appreciably affected by it, and the patient was dismissed 
with an unfavorable prognosis. 
CASE IV.—April 30, 1878. Mrs. T. H. M., 42. Has always had 
poor vision with hemeralopia, and lately it has been growing worse. 
R.V. no improvement with glasses. L.V. = y2^; V. 
= ft with + tV 
The limitation of the visual fields is not concentric, but very 
irregular, and there are numerous scotomata. 
Ophthalmoscopic Examination.—Both eyes H. tV; the right 
retina is loaded with pigment deposits of all sorts, sizes, and shapes ; 
the left shows the same appearances, but in less degree. There is 
partial atrophy of both optic nerves. 
The patient’s father and mother were both of the same name, but 
not related to each other. She has three sisters and a brother living. 
The brother has impaired vision, with eyes which the patient states 
“ are just like hers, only not so bad.” The three sisters see well. 
Her father’s brother married his first cousin and had nine children. 
Three of these became blind and afterwards idiotic; a fourth had 
good sight, but was attacked with scrivener’s palsy, and some years 
later died of a disease of the nervous system. 
Mrs. M. was placed upon injections of nitrate of strychnia, com- 
mencing with gr. fa. 
May 1.—Has had a great deal of pain in left eye since her visit to 17 
us yesterday. There is some deep injection of the eyeball. Ordered 
to bathe the eye frequently, and injected nitrate of strychnia, gr. 
May 2.—The pupil of the left eye is irregular, showing adhesions, 
and there is a moderate amount of pericorneal injection, showing the 
existence of iritis. A solution of sulphate of atropia (gr. iv. ad § j.) 
was dropped into the eye four times while the patient remained in 
the office about an hour, but failed to dilate the pupil regularly. 
Injected strychnia, gr. -fa. 
May 3.—Patient states that after she left the office yesterday her 
mouth and throat became dry, her head felt full and heavy, and she 
“ went sound asleep ” in the horse-car going home, and fell asleep 
in a chair after she got home. The pupil is widely and evenly dila- 
ted, and the redness has disappeared. Injected strychnia, gr. -^ig. 
May 15.—The patient has had a daily injection of strychnia. One- 
ninth of a grain was injected to-day, and produced some stiffness of 
the limbs. Her vision remains unchanged. 
CASE V.—Sept. 12, 1873.—Mrs. E. L. J., set. 53, states that seven 
or eight years ago a blur began in her right eye after a great shock 
to the nervous system in the death of a daughter. During the four 
weeks previously she had been deprived of sleep and constantly in 
the sick-room. Had a second daughter ill who died last summer. 
Has wept much and evidently been greatly shocked in her nervous 
system. Reads J. No. 15 very slowly, picking out letters at 11" 
with glasses. Ophthalmoscopic examination shows retinitis pigmen- 
tosa. Injected strychnia, gr. fa, and a few minutes later patient 
reads J. No. 12. 
Sept. 15.—A few minutes after injecting strychnia, gr. fa, patient 
reads J. No. 5. 
Her husband writes, under date of May 10, 1878 : “My wife died 
two years ago. Her sight continued gradually to fail, until it became 
difficult for her to get about without assistance. Her father and 
mother were not related to each other. Her older brother, who died 
some years ago, was troubled with imperfect vision, more especially 
I think at night. I never knew any other member of her family who 
was affected in that way.” 
CASE VI.—Jan. 13, 1874.—Mr. C. Z. L., set. 25, law student, 
always had an imperfection of vision, near-sightedness, and difficulty 
of seeing in the night. Otherwise, eyes seemed quite strong. In 
Aug., 1871, first noticed clouds floating through visual field; moving 
his eyes would set them in motion, and when the eyes were fixed 
they would settle down and disappear. Soon after waves of light 18 
commenced to sweep across his eyes, and have continued to do so 
up to the present. For more than a year he has had a constant ap- 
pearance as of the flickering of candles. Since last winter he has had, 
once or twice a week, appearances like a ball of fire passing across 
the field of vision. Occasionally a small black spot surrounded by a 
ring of light is seen for a few moments. 
No consanguinity of parentage. Mother died of consumption ; 
father of dropsy. Has two brothers and two sisters. One brother 
and one sister have imperfect sight. 
R. V. = -|$ ; L. V. ; no improvement with glasses. Visual 
fields greatly contracted. Reads J. No. x at 9" with each eye. 
Ophthalmoscopic Examination.—Fundus beautifully besprinkled 
with the characteristic changes. Pigment patches, increasing in size 
and frequency in the periphery, some running over the vessels. 
There is a vessel in fundus of right eye, above the optic disc, which 
is a streak of pigment as far as it can be traced. There is thinning 
of the choroid in places, and the nerves have a somewhat atrophied 
look. 
Injected strych. nitrat., gr. 4-%. Before the injection he read J. D. 
V. and I. in but could not read the four intervening letters with 
each eye; five minutes after, he read all the letters in and T. P. 
and Z. in f-jj with each eye under the same conditions. The injec- 
tion made him dizzy. 
Jan. 14.—Injected strych. nitrat., gr. T but no appreciable im- 
provement of vision followed. 
CASE VII.—A. C., set. 44, manufacturer. Was always subject to 
night-blindness, but only a few years since began to notice impair- 
ment of vision in the day-time. A few years ago he got hot lead 
into his right eye, and has not been able to read with it since. His 
mother is subject to night-blindness. His maternal aunt has two 
children who are subject to night-blindness. His maternal uncle 
has one child with night-blindness. The patient has three sisters, 
all subject to night-blindness, thus making eight in the same family, 
all victims of this disease. R.V. = -pfa; L.V. = fjj ; no improve- 
ment with glasses. Visual fields about circular, and very small. 
Ophthalmoscopic Examination.—Retinitis pigmentosa very marked 
in both eyes ; right eye has also posterior polar cataract and floating 
bodies in the vitreous. 
No consanguinity of parentage. 
CASE VIII.—Miss M. C., set. 16. Has for five years been the 
subject of night-blindness and gradually deteriorating vision. 19 
R.V. — ; L.V. = no improvement with glasses. Fields 
extremely small. No heredity or consanguinity of parentage trace- 
able. 
Ophthalmoscopic Examination.—Periphery of each retina sprinkled 
with the deposits characteristic of retinitis pigmentosa. Optic disks 
and adjacent choroid show evidences of atrophy. 
At the age of eight this patient was struck by lightning, and ren- 
dered insensible for a few moments. 
Ci\SE IX.—George L., set. 14, deaf-mute, and always subject to 
night-blindness. V. = j-g- each ; no improvement with glasses ; 
visual fields concentrically limited. 
Ophthalmoscopic Examination.—Retinitis pigmentosa, with par- 
tial atrophy of optic nerves. No consanguinity of parentage or 
heredity traceable. 
CASE X.—Joseph B., jet. 60, laborer. States that he saw as well 
as he ever saw, but not as well as other people, up to two years ago. 
He has always seen much worse at night and on cloudy days. 
Blindness came on very gradually. R.V. = ; L.V. = ; 
no improvement with glasses. Visual fields reduced to one inch 
each in diameter, at one foot. No heredity or consanguinity of 
parentage. 
Ophthalmoscopic Examination.—Retinitis pigmentosa with atro- 
phy of optic nerve, and polar cataract in both eyes. 
CASE XL—Mrs. W. P. E. M., iet. 40. Has R.V. = with — Jg; 
L.V. ; no improvement with glasses. 
Ophthalmoscopic Examination.—Retinitis pigmentosa of both eyes, 
with atrophy of left optic nerve. No consanguinity of parentage. 
The patient brings her daughter for examination. She is aged 17, 
and has an eroded, moth-eaten look at the angles of her mouth, and 
a constriction around the middle of her forehead. She had keratitis 
following scarlatina at the age of ten. When n months old, she 
had paralysis of her left side, and she still walks heavily on that side. 
She now has opacities of both corneae, staphyloma posticum, and dis- 
seminated choroidal atrophy of both eyes, and floating bodies in left 
vitreous. 
CASE XII.—Ernest G., aet. 24, theological student. States that 
his sight became weak at about 9 years of age. His father and 
mother are not related, and he knows of no heredity. 
R.V. = cannot count fingers correctly, but has a visual field one 
inch in diameter at one foot. 20 
L.V. =2^; visual field two inches in diameter at one foot. Both 
visual fields very nearly circular. 
Ophthalmoscopic Examination.—Retinitis pigmentosa, with pos- 
terior polar cataract, and partial atrophy of optic nerve, both eyes. 
CASE XIII.—Mrs. B. F. F., set. 34. R.V. = f# ; L.V. = . no 
improvement with glasses. Visual fields concentrically contracted. 
Ophthalmoscopic Examination.—Retinitis pigmentosa of both eyes. 
Father and mother were not related, and had only two children, 
both girls. Patient’s sister is very short-sighted. She has one paternal 
uncle who is very short-sighted, but no other relative with defective 
vision in a very large circle of connections. Her mother died sud- 
denly, without previous illness, at the age of 47. 
CASE XIV.—Mrs. J. H. M.,?et. 50. Has been near-sighted from 
childhood; has had asthenopia for two years, and is growing worse. 
She has slight conjunctivitis. 
R.V. V. = U with - *. 
L.V. = f*; V. = |£ with - -4V 
Both visual fields are limited. 
Ophthalmoscopic Examination. — Retinitis pigmentosa, the pig- 
ment deposits being principally in the temporal part of the periphery 
of each fundus. 
No consanguinity of parentage or known heredity. 
CASE XV.—O. L. W., set. 58, machinist. Sight began to fail 
twenty years ago, and he has not been able to read for ten years. 
He never has pain in his eyes, except when out in the wind. He 
sees objects, but fails to count fingers correctly with either eye. 
Ophthalmoscopic Examination.—Retinitis pigmentosa, with atrophy 
of optic nerve, both eyes. 
No consanguinity of parentage, syphilis, or known heredity. 
CASE XVI.—Miss M. C., set. 15. *Has always had rather poor 
vision, and never could see well in the night, or in a darkened room. 
Her sight has failed lately. 
R.V. = -|g-; L. V. = |[J-; no improvement with glasses. Both 
visual fields greatly concentrically contracted. 
Ophthalmoscopic Examination.—Retinitis pigmentosa, with marked 
absence of pigment in its normal position in the retina. 
No heredity or consanguinity of parentage traceable. 
CASE XVII.—M. E., tet. 30, carpenter. Never noticed any trou- 
ble with eyes till five or six years ago, and then first began to have 
difficulty in getting about at night. It increased up to about a year 21 
ago, since which it has been at a standstill. Things began to blur 
about a year ago. 
R.V. = H ; Hm. L.V. = |i (-) E. 
Visual field, right, most of upper half gone ; left, only infero-tem- 
poral quadrant remains. 
Ophthalmoscopic Examination.—Retinitis pigmentosa well-marked 
in both eyes. 
No consanguinity of parentage, and the patient never heard of 
any cases of poor eyesight in the family. 
CASE XVI11.—J. R. P., set. 44, farmer. Lost right eye when a 
boy; when eight years old happened to close left eye, and found 
himself in darkness. Sight in left eye began to fail noticeably fifteen 
months ago, and he has not been able to read for five months. 
There is smarting and stinging of the left eye. 
R.V. = counts fingers in extreme temporal portion of field. 
L.V. = fgq no improvement with glasses. Visual field limited 
concentrically. 
Ophthalmoscopic Examination.—Retinitis pigmentosa, with chor- 
oiditis of both eyes. 
He has been treated with mercurials, leeches to temples, and 
strychnine injections, without benefit. 
No consanguinity of parentage. Maternal grandfather had seven 
children. The families of five have had more or less trouble with 
their sight. Of his father’s eight children, patient’s eldest sister and 
himself are the only ones affected with retinitis pigmentosa. 
CASE XIX.—Mrs. S. W., set. 32. Has had weak eyes for over a 
year, and has not been able to use them to any extent in reading or 
sewing. 
V. = f-g- each ; E. ; no insufficiency. Ophthalmoscope shows deli- 
cate changes about the macula, and an extensive plaque of the 
changes characteristic of retinitis pigmentosa in the periphery infero- 
nasally from disk. No limitation of fields. No consanguinity. 
Mother has atrophy of optic nerves, and a sister is near- 
sighted. 
CASES XX., XXL, and XXII.—In 1876 I became acquainted 
with a family in Massachusetts by the name of B , three mem- 
bers of which were afflicted with retinitis pigmentosa, and possibly 
a fourth, whose eyes I had no opportunity of examining. 
(20). The eldest brother, now 49 years old, having always had 
poor sight, became totally blind at the age of 25. Ophthalmoscopic 
examination showed the characteristic pigmentary deposits scattered 22 
over the whole fundus, atrophy of the optic nerve, and posterior 
polar cataract in both eyes. 
(21) A younger brother, now 30 years old, could see sufficiently 
well to do a farmer’s work up to the age of 15. He can still see to 
find his way about. He has retinitis pigmentosa, with atrophy of 
optic nerve, and posterior polar cataract, of both eyes, the same as 
his brother. Neither of the brothers is married. 
(22) The third is a married sister, 46 years of age. Although the 
subject of marked retinitis pigmentosa in both eyes, she still retains 
sufficient sight to do her own housework. She has neither polar 
cataract nor marked atrophy of her optic nerves. She has had three 
children. The first died at 16 weeks, having always been apparently 
healthy; “ took cold,” and was given an overdose of medicine by 
mistake. The second was apparently healthy, but “took cold,” and 
died suddenly at 11 weeks. The third, always sickly and “ cankered,” 
died at 6 weeks. 
Another brother, now 33, has used glasses some ten years, only 
for reading. He keeps a baker’s shop, and his eyes do not trouble 
him when about his business. The oldest sister, over 50, and the 
brother and sister next younger than the married sister whose case 
is given, have no trouble with their eyes. The three that are said 
to have good eyes are the first, fourth, and fifth. The four that have 
poor eyes are the second, third, sixth, and seventh. 
The parents of this afflicted family were not blood-relations. 
The father’s aunt, blind from youth, died at 60. 
The father’s father had inflammation in his eyes “ from a cold,” 
and was blind for three or four years before his death, at the age 
of 76. A CASE OF SPONTANEOUS CURE OF SUBRETINAL EF- 
FUSION. By David Webster, M.D., of New York. 
At the eleventh annual meeting of this society I reported “ a case 
of spontaneous cure of subretinal effusion” which occurred while the 
patient kept the supine position for a period of ten days. I have 
now a similar case to report. This case, like the former, occurred 
in the private practice of Dr. C. R. Agnew, and was carefully ob- 
served by him as well as by myself. 
April 8, 1876.—W. B. H., jet. 47, clerk, has been very near- 
sighted, in both eyes, all his life. A week ago he first noticed a 
dark spot over his right eye. This dark spot gradually increased in 
size until now there remains only sufficient vision to count fingers at 
a distance of one foot, and that only in the extreme infero-nasal 
periphery of the visual field. Ophthalmoscopic examination shows 
detachment of the retina. 
The left eye has never been of much use to the patient. It is 
myopic over one-half, and has vision less than -g-A-. Inspection 
shows that it is the subject of corneal and lenticular opacities, with 
very extensive staphyloma posticum. 
A trial of the supine position was advised. 
May 16.—The patient states that he went home and lay on his 
back twenty-three days, in a moderated light. He has vision 
with his spectacles, and he feels that his sight is improving every 
day. No separation of the retina can now be seen, but in the 
vitreous are some floating bodies. 
April 8, 1878.—It is now just two years since we first saw Mr. H. 
His right eye now has vision rpfc with — , which he wears all the 
time. The visual field is complete. There are still some floating 
bodies in the vitreous, and large staphyloma posticum. 
Mr. H. gives the following history of his recovery : he had no 
drops put into his eyes, nor were they bandaged when he lay on his 
back. After he lay on his back two or three days, everything looked 
of a beautiful purple color. After that an appearance like steam 
came over his eye, and that kept growing clearer and clearer all the 24 
time, and the last few days there was a little black spot which kept 
going round and round like a pin-wheel, and growing smaller and 
smaller until it finally disappeared. After he got up everything was 
clear, but of a kind of a greenish cast. This greenish tinge lasted for a 
week, and then disappeared. Vision has improved ever since, and 
he believes it to be better now than before the detachment. He has 
been engaged in his business as clerk for the last seven months. 
Dr. Prout remarked that in the treatment of subretinal effusion 
the prolonged recumbent position, as proposed by Samelsohn in 
1875, is to a certain extent illogical, and in very many cases pertur- 
bating. Every one has noticed that cataract patients are sometimes 
injuriously affected by the necessary confinement to bed after extrac- 
tion. A patient with a felon on his finger will not allow it to hang 
down, nor find the greatest degree of comfort for it in the horizontal 
position; he will carry the hand so that the blood may easiest run 
from the affected part. The quiet lying in bed keeps the blood in 
the head and about the orbit, even if it is assumed that the intra- 
ocular blood-pressure remains unchanged, which the speaker by no 
means admits. Why is it that in seriously inflamed eyes and after 
operations it is necessary to forbid mastication? 
The subretinal fluid tends to gravitate to the lowest part of the 
eye. Rest in bed on the back, therefore, would maintain the separa- 
tion where its injurious effects are greatest. Could the patient lie 
prone the fluid would tend to gravitate to the ciliary region, where the 
blood-supply, and consequently, we may assume, the absorbent power 
are greatest, and his chances of recovery would be improved. 
But the real curative agent is rest, as nearly absolute functionally 
and mechanically as possible, and to obtain this great good the 
smaller evil of the faulty position must be tolerated, unless we can find 
a substitute. Very few patients will, while allowed to move about, 
keep the head and eyes at rest. Hence the necessity for the quiet 
rest in bed. I will illustrate this by a case. J. W. P., aged about 
60, before coming to me had already tried for more than two weeks 
the recumbent position. The effect on the eye was beneficial, and 
being a man of robust health and excitable temperament, the bed had 
become excessively irksome to him. The visual field was lost ex- 
cept to the outer side. Still, as nothing else promised any relief— 
the other eye had been lost twelve years before —he wished to try 
this mode of treatment again. He was told that functional and 
mechanical rest was the one thing needful, that the disturbing in- 25 
fluence of lying in bed was prejudicial, and that rest could be 
obtained without its being necessary to keep the horizontal position 
constantly. He could bandage his eye and sit up every day, taking 
great care to avoid sudden movements, etc. He went home, sat in 
an easy rocking-chair, which put his body at an angle of about 
forty-five degrees with the horizon, and went to sleep expecting to 
commence the bed-and-rest treatment on retiring that evening. He 
slept from two to six p.m., and on waking was astonished to find a 
very nearly complete restoration of the visual field, with, however, 
quite dim vision. In order to avoid any motion he continued in the 
chair all night, going to bed next morning. Nearly every day he sat 
up in the chair, avoiding quick movements of the body and keeping 
his head as still as possible. He could not stay all day in bed with 
any comfort, and it was clear that to attempt to maintain absolute 
quiet would very much injure his general health. This course was 
maintained for about three weeks, when he was allowed to go out for 
exercise. 
The condition of the retina has not improved ; the visual field is 
of very nearly normal extent, but vision continues very bad. 
Note.—As a final effort, local depletion, which before did good, but the im- 
provement did not persist, was again resorted to, by means of Heurteloup’s arti- 
ficial leech, but with injurious result.