AN EXAMINATION, UNDER ATROPINE, OE THE RE- 
ERACTIVE STATE OE EYES WITH NORMAL VISION 
(fft), AND WHICH HAD NEVER BEEN AFFECTED 
WITH ASTHENOPIA OR INFLAMMATION. By D. B. 
St.John Rqqsa. M.D. 
It will be at once seen that it is a very difficult thing to procure 
for examination many eyes that answer to the above-named con- 
ditions ; and when is added to them another, that is, that the subjects 
shall be between twenty and forty years of age, the difficulties are 
not diminished. The importance of such an examination is, how- 
ever, I think, considerable, for it has been claimed by some that 
latent hypermetropia and astigmatism are the causes not only of 
asthenopia, conjunctivitis, blepharitis, etc., but also of chorea and 
lachrymal disease, while on the other hand, as good an authority as 
Dr. E. Hansen, of Copenhagen, is very sceptical as to the uni- 
versal or even general value of the correction of hypermetropia 
for the relief of asthenopia. In a conversation with Dr. Hansen, 
last summer, he informed me that he found that glasses in very many 
instances seemed to utterly fail to afford relief to asthenopia asso- 
ciated with and apparently caused by hypermetropia. Dr. Hansen 
has peculiar opportunities for observation upon this subject, for he 
enjoys almost a monopoly in ophthalmic practice in the Danish cap- 
ital ; and patients have not the same liberty that is enjoyed in Amer- 
ican, English, or German cities, of roaming about from one oculist to 
another when their glasses do not suit, or their eyes do not get well. 
We have had abundant statistics as to the existence of myopia and 
as to the apparent refraction of unatropinized eyes. I have thought 
it desirable, however, to learn the refraction of those that have been 
classified as emmetropic. It is claimed, however, that there is a 
source of error in drawing conclusions from this kind of an examina- 
tion. It has been said that we almost invariably flatten the lens in 
putting an eye under the full influence ofatropia. If this be true, we 
always either diminish myopia under such circumstances, or convert 
emmetropia into hypermetropia. 
My statistics show that there was a certain proportion of cases 
among those examined that continued to reject even the weakest 
convex glasses, after atropia had been thoroughly used. Besides, I 2 
think every one of us had seen cases of myopia which were not at 
all reduced in degree, after the drug had been employed long enough 
to test the matter. I cannot, in the face of these facts, assent to the 
view that atropia flattens the lens except in so far as it acts by par- 
alyzing the ciliary muscle, and thus brings out the true length of the 
eyeball in a state of rest. Apart from this view, however, there is 
another importance to such an examination as I have made. 
It has been generally, if not universally conceded, that, if atropia 
reveals hypermetropia in cases of inability to use the eyes for con- 
tinued work, glasses are to be given somewhat in accordance with 
those taken when the eyes are atropinized. Some authorities 
even advise full correction. Now, if we find that a large pro- 
portion of eyes that have never suffered from asthenopia take 
convex glasses which were rejected before the mydriatic was used, 
we may suspect that the mere existence of lessened refraction or 
latent hypermetropia is no positive proof that asthenopic eyes are 
to be cured by positive glasses—in other words, that there may be 
other factors producing the trouble. The amount of latent hyperme- 
tropia revealed in these cases thus rigorously selected is in many 
instances equal to that for which oculists all over the world, ever 
since the publication of Bonders’ book, have been prescribing glasses. 
Indeed, I think it has been pretty generally assumed that the cause 
for a given case of asthenopia had been found if atropine revealed 
hypermetropia. In later times it has been claimed that the etiology 
of headaches, of chorea, of lachrymal disease, has been very largely 
traced to latent and uncorrected refractive errors. Whatever the 
subjoined statistics may be worth, they at least show, few as they are, 
that a decided amount of latent hypermetropia is entirely consistent 
with uninterrupted and painless use of the eyes. This, however, is a 
fact that I commented upon some two years since, having deduced 
it from other grounds, namely, that we were quite often called upon 
to fit presbyopes who were also hypermetropes, with glasses for the 
first time when their accommodation began to fail, they never before 
in all their lives having had any necessity for glasses. 
We cannot any longer assume, I think, that latent hypermetropia 
is necessarily the sole factor in the production of asthenopia, much 
less of troubles of the head and nervous system. That hypermetro- 
pia does often produce many of these things, and that its correction 
will often relieve them, I am of course very far from denying. But 
I am unable to say why it does not in all of them, especially when in 
looking over my statistics I find that, in some of the cases that have 3 
never suffered for an instant from asthenopia, all the conditions for 
the injurious influences of strain of the accommodation have existed 
in feeble organizations and weak muscular systems. 
Had I not had the facilities afforded by a large class of medical 
students, who are very ready for physiological experiments, I should 
never have succeeded in getting the cases that I now present. I 
must here present my grateful acknowledgments to the members of 
the Class of 1877-78 in the University of the City of New York, who 
so kindly submitted to the troublesome tests. It of course goes 
without saying, that all the cases now about to be quoted conform 
to the conditions stated in the foregoing, i. <?., the patients were not 
presbyopic ; they had also passed the age during which, in the opinion 
of some authorities, hypermetropia is always found ; they had V. gg-, 
that sight was blurred by convex glasses of + and in some cases 
of still weaker power, they had never in all their lives suffered from 
asthenopia or ocular inflammation, and their accommodation was 
paralyzed by a four-grain solution of sulphate of atropia. 
Observation. 
I. —Dr. S., tet. 30. V. R. E. = f-g ; L. E., fg. After a four-grain 
solution of the sulphate of atropia had been used four times in twenty- 
four hours, the vision of the right eye was reduced to -|g-. It became 
gg- with + fa O fac 9°°' This gentleman used atropia for four 
days, and had some marked constitutional symptoms. The final ex- 
amination showed H. fa with H. as + fa axis 90°. 
II. —J. C. M., set. 21. Began to go to school at seven, and has 
used his eyes as a student nearly ever since ; V. = -fg- +. All posi- 
tive glasses blur. After the use of atropia, gr. four solution, three 
times in two days, vision with the right eye became fg with + fa; 
L.E., fg without glasses, and gg with + fa. 
III. —W. H., set. 34. After atropia four times in twenty-four 
hours, L.E. having been atropinized, V. = -fg + before atropia, -fg 
with -f fa; two days after, fg — with + fac go° §g. 
IV. —H. J. H., set. 29. Has used his eyes as a student and 
teacher since he was six or seven years old ; is thin and pale, only 
moderately well developed; right eye examined after atropia in- 
stillation twice a day for two days. Accepts -f -fa on the second day 
the day after + fa with which V. = g-g. Left eye of same patient was 
tested in the same way a month before ; vision was gg under atropia 
without a glass, and fg with + fa. The subject is antemicand thin ; 
has bronchitis every winter; one member of family died of phthisis. 4 
V. —W. H., aet. 32. Has not been a very constant student; never 
the slightest trouble with his eyes, except occasionally after reading 
very fine print by gaslight for several hours, eyes have felt tired and 
he has been inclined to rub them ; never obliged to stop work on 
account of his eyes. Is in good health and of robust appearance. 
After the use of atropia three times a day for three days, V. = fg 
and all glasses are rejected. 
VI. —W. F. C., aet. 27. School at an early age; has studied 
medicine for a year. Interval of ten years, when his eyes were used 
only in ordinary reading. “ Fatigue ” of eyes after three hours’ 
work. Is robust and in good general health, V. = fg R.E., accepts 
+ fa, rejects + fa > L.E., fg + fa, blurs ; atropia two days, L.E.V. 
— i w'th + TtT’ = to- 
VII. —H. R. D., mt. 21. At school until eighteen ; writing for a 
year after ; has studied medicine since. V. := fg + blurs ; after 
one use of atropia, V. was not fg unless with + 
VIII. —R. D. B., ait. 22. Has always been a student; = fg, rejects 
+ fa. Atropia for three days, V. = fg, declines + fa. 
IX. —C. A. V. R., ait. 22. At school regularly in Germany from 
sixth to seventeenth year; studied medicine three years; never 
the slightest asthenopia. L.E., V. = |g, all convex glasses 
blur. 
Four-grain solution atropia four times in eighteen hours. V. = fg, 
with + fa, = fg. 
X. —D. M., aet. 26. Has been a student since five years of age. 
V. fg ; atropia in left eye for two days. V. = fg, with + fa, = §g ; 
third day fg ; with + fa, f g. 
XI. —W. A. W., aet. 24. Always a student. V. = fg ; -f- fa blurs. 
Atropia in left eye for two days. V. = -ffa; with + fa, \ g — (it 
is a dark day), and the observer’s vision is also §g —-. 
XII. —G. M. 13., aet. 23. Went to school from five till eleven ; 
then salesman and bookeeper ; has studied medicine two and a half 
years. R.E., V. = fg : L.E., f g ; all convex glasses blur ; atropia 
one day. KE., V. = „ ; with'+ *, = «. 
XIII. —B. W., aet. 27. Went to school four months a year until 
fifteen; then to an academy two years for eight months in a year; 
taught school for four years; has been studying medicine for three 
years. V. = |g, + fa, blurs ; atropia one day in each eye. V. = $g, 
each eye, with + fg. 
XIV. —Dr. S., aet. 22. V. = fg, each eye. Was for two weeks 
under the influence of a four-grain solution of sulphate of atropia ; 5 
suffered from great dryness of the throat; atropia did not alter vision, 
and + -gty blurred before and after its use. 
To these fourteen cases 1 will add one of a lady thirty-two years 
of age, who consulted me on account of neuralgic pains about the 
eyeball and orbits. There was also asthenopia, and she complained 
of muscae. She had been unable to do fine work for the past two 
months. The patient is a nervous lady who is somewhat overworked 
with household cares. The refraction seemed to be H. by the oph- 
thalmoscope. V. = -|(j-, and all glasses blur; after atropia was used 
for six days the vision was and the patient still rejected all 
glasses. 
Summary.— Total number, 14. 
Emmetropia, 3. 
Hypermetropia, 11. 
Degrees of H.: 
_s1oc a 9°°- 
L.E., 31o- 
eV* 90°. 
R.E., 0-, and L.E., fc. 
HV- 
■3V 
■3V 
3*0* 
TT- 
■sV* 
■34 •