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A. (Alexander) Duane.

Classification of the motor anomalies of the eye : based upon physiological principles together with their symptoms, diagnossis and treatment online

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BERKELf Y

LIBRARY

owvERSHY or

CAUfO«WIA .




fntm TMl 0*TOMIT«IC LiailARY
Of

MONROE JEROME HIRSCH



A' V3




THE LIBRARY

OF

THE UNIVERSITY

OE CALIEORNIA



GIVEN WITH LOVE TO THE

OPTOMETRY LIBRARY

BY

MONROE I. HIRSCH, O.D., Ph.D.




CLASSIFICATON

OF THE

Motor Anomalies of the Eye

BASED UPON PHYSIOLOGICAL PRINCIPLES
TOGETHER WITH THEIR

SYMPTOMS, DIAGNOSIS AND TREATMENT



ALEXANDER DUANE, M.D.

ASSISTANT SURGEON OPHTHALMIC AND AURAL INSTITUTE, NEW YOFK




Nbw York

WILLIAM R. JENKINS CO.

PUBLISHERS

851-853 Sixth Avenue
1910



(a

OPTOMETRY



PREFACE,






The following brochure respresents the result of some
ten years' labor and- study expended upon the subject of
muscular anomalies. Whatever merit it may have is due
to the fact that it stands for original investigation in a field
still full of difficulties and obscurities. The author's
clinical experience has convinced him that the classifica-
tions propounded furnishes an adequate working basis for
the diagnosis of these conditions. And his experience as
a teacher at the Ophthalmic and Aural Institue has led
him to believe that the principles here laid down, and the
means and methods of examination here recommended,
have been found by others also to be both intelligible and
practicable. Many of these principles and methods have
been enunciated in lectures given to successive classes of
practitioners, and have been demonstrated in their prac-
tical application upon patients before the same gentlemen ;
the auhor's constant attempt being to present clearly and
in a way suited to general comprehension the rules for the
diagnosis and management of the muscular anomalies.
That this attempt was not unsuccessful he has had some
reason to believe from the assurances of those that he has
taught; and it is, therefore, with th- hope that the result
of his work may be useful to others as well that he now
offers it to the public.

Alexander Duane, M. D.

4ii East Thirtieth tit.. New I'orh.
April 'jy, 1S97.



EBBATUM.

Page 23, line 11: For •'•-!2," read -'L^'/:."



Reprinted from Annals of Ophthalmology and Otology, October,



A NEW CLASSIFICATION OF THE MOTOR ANOMA-
LIES OF THE EYE, BASED UPON PHYSIO-
LOGICAL PRINCIPLES.

THE PRIZE ESSAY OF THE ALUMNI ASSOCIATION OF THE COLLEGE OF I'llY-
SICIANS AND SURGEONS, NEW YORK, FOR 1S96.

By Alexander Duane, M. D.,

NEW YORK.

ILLUSTRATED.

Introduction. — Sketch of previous classiflcatious. — Development of
the idea of an etiological^ as opposed to a simple anatomical classiti-
cation.

I. Nature of the problems that have to be solved in under-
taking a physiological classitication.

II. The Movements of the Normal Eye. — Actions of the indi-
vidual muscles. — Movements of eacii eye individually and the mus-
cles by which they are performed. — Amount of these movements. —
Field of tixatiou. — Author's experiments. — Power of the individual
muscles. — Coordinated movements of the two eyes. — Table of asso-
ciated parallel movements and the muscles producing them. — Asso-
ciated antagonists. — Field of binocular single vision and of binocular
fixation. — Author's experiments. — Movements of convergence. —
Power of convergence. — Convergence near-point. — Prism-conver-
gence. — Movements of divergence. — Nature of divergence action. —
Movements of sursumvergence. — Rotation movements. — Ap-
pendix. — Diagrammatic representation of the movements of the eye.

III. The Tests Employed and Their Significance.— Object of the

tests. — Tests for l)inocular distant fixation. — Inspection. — Fixation
and diplopia tests. — Equilibrium tests — Screen test. — Parallax test. —
Tests for associated parallel movements. — Tests for convergence. —
Tests for divergence. — Tests for sursumvergence. — Way in which
the tests are applied in practice.

INTRODUCTION.

The nomenclature and classification of the muscular anomalies
of the eye have been passing through the same stages that have
been noted in the evolution of the nosology of other parts of the
body. In the progress of our knowledge in regard to any given



2 XKW CLASSIFICATION OF MOTOK ANOMALIES.

set of ailments, the first classification has always been based upon
that which first strikes the eye of the observer, namely, the out-
ward appearances and symptoms. Thus, many cases of renal dis-
ease were first classified as drbpsy, and dropsy formerly figured
among physicians, as it does still among the laity, as a substantive
disease, and to be treated as such. But, as medical science pro-
gressed, and the underlying causes of disease were more and
more brought to light, it became evident that dropsy is a symp-
tom only and to be treated as a symptom, and that the principles
of a rational pathology require us to search for the causes of the
dropsy and to institute treatment addressed to the removal of
these causes rather than to the direct relief oi the dropsy itself.
In this way a pathological classification is gradually substituted
for one that is purely symptomatic, and a scientific, casual treat-
ment for one that is empirical, or based solely on the. appearances
presented.

This conception of disease as a symptom of a pathological pro-
cess, and the consequent conviction that our therapeusis must
be based ultimately upon an etiological foundation, could not
have developed, or at all events, could not have become anything
more than a plausible theory, barren of practical application, were
it not constantly fortified by a steady increase in the number and
precision of our means of diagnosis. In this way only can we
make those fine discriminations between symptoms that enable
us to form accurate inferences as to the diverse origin of phenom-
ena which, to a cursory observation, seem identical. For exam-
ple, our knowledge of the symptomatic nature of dropsy and of
the necessity of treating it from an etiological standpoint, how-
ever true it might be, would be a theory only, unprovable and
practically inapplicable, were it not for the refijied means we now
possess for examining the chest and abdomen and for analyzing
the urine. These diagnostic means have enabled us to convert
theory into fact, and to redeem our treatment from the charge
of empiricism.

A similar process of evolution has taken place in regard to the
motor anomalies of the eye. These were formerly (and to a
great extent still are) classified simply according to the appear-
ances presented, i. e., as inward, outward, upward, or downward
deviations. And. to recur to our former illustration, just as
dropsy usc


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Online LibraryA. (Alexander) DuaneClassification of the motor anomalies of the eye : based upon physiological principles together with their symptoms, diagnossis and treatment → online text (page 1 of 11)