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^?A



A TEXT-BOOK ,



ON



DISEASES OF THE EYE



BY

HENRY D. NOYES, A.M., M.D.,

Professor of Ophthalmology and Otology 9i\Bellevue Hotpiial Medical College ; Executive Surgeon to the
New York Eye and Ear Infirmary ; recently President of the American Ophthalmological
Society; Member of the New York Ophthalmological Society; recently Vice-
President of the New York Academy of Medicine ; Permanent Member
of the New York State Medical Society; Member of the
American Medical Association, etc., etc.



ILLUSTRATED BY 6 CHROMO-LITHOGRAPHIC PLATES, 5 PLATES
IN BLACK, AND 236 WOOD-ENGRAVINGS



NEW YORK

WILLIAM WOOD & COMPANY

1890

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IIBRARY

UNlVfRSITY O^

OPTOMETRY UBRART

Copyrighted, 1890,
WILLIAM WOOD & COMPANY.



ILECTROTYPED AND PRINTED BY

THE PUBLISHERS PR.NTINO COMPANY

ao A 32 WEST 13TH STREET

NEW YORK



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PREFACE.



Tras volume is an outgrowth from a treatise on diseases of the
eye, published in December, 1881, in Wood's Library' of Standard
Medical Authors. A similar arrangement of subjects has been ad-
hered to, viz., considering in the first part the general anatomy
and physiology of the eye, with its functional disorders, and taking
up in the second part, inflammations and organic textural changes.
That this order is both scientific and natural seems evident. The
spirit of the book is clinical, but an adequate preparation for clinical
and pi-actical work includes a wide range of preliminary knowledge.
This is true of all branches of medicine. To the preparation and
experience needed in general medicine, must be added for proper
treatment of troubles of the eye, knowledge which comes through
physics, mathematics, and physiological optics; and laboratory
research has won some of its most brilliant triumphs in studies
of the eye.

This knowledge finds its chief application in unravelling func-
tional disorders of sight, viz., such as concern the errors of refrac-
tion and accommodation, and motility. They will always in great
measure constitute a field of special practice, and so likewise will
the operative surgerj'^ of the eye. But the pathological conditions,
and not only the external but likewise the internal diseases of the
organ, constitute a domain which the general physician shares
with the oculist, and which he cannot justlj'^ renounce. Neither
can he refuse to take in hand the ophthalmoscope, because he can-
not afford to lose the benefit of what it can tell him either in dis-
covery or in confirmation of what he wants to know.

In accordance with the practical intent of the book, mathematical
formulae have been omitted; pathology and microscopic anatomy
have been presented so far as seemed helpful to an intelligent ac-
count of morbid processes; the share which micro-organisms have



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iv PREFACE,

in exciting diseases of the eye, has been fully recognized; no little
labor has been spent in setting* forth the relations of the eye to the
brain and nervous system, as both illustrations and descriptions
testify; the participation of the eye in numerous general diseases
or lesions, of remote organs, such as the kidneys, the uterus, the
heaiii, etc., and the reflex influence which the eye can sometimes
exert upon distant parts have been set forth.

The writer has quoted his own cases and experiences, and stated
his own opinions; he has familiarized himself with the work of
others, not only in their writings, but pretty largely by personal
acquaintance, and drawn freely upon their labors, as may be seen
by the references in the text, and by the bibUography.

Of the illustrations many are familiar, while not a few have
either not hitherto appeared in ophthalmic text-books, or are orig-
inal

In depicting diseases of the fundus oculi, black and white have
been used for many of the ordinary' lesions, while colored plates
have been reserved for special conditions, some of which are familiar
and others unusual.

The liberality of the publishers in the number and quality of
the illustrations has been a source of gratification and will be ap-
preciated.

For the compilation of the copious indices acknowledgment is
due to the author^s friend. Dr. D. W. Hunter. In them references
will be found to passages where the connection of general diseases
with eye pathology is mentioned, and one will need only to look
under the head of such diseases for the ocular complication.

To the medical profession, who have greatly honored him with
their confidence, and to the classes of Bellevue Hospital Medical
College whom he has taught and who have rewarded his efforts by
their attention and respect, the author offers this volume as an
attempt to discharge a great debt.



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CONTENTS.



PAET FIRST.
CHAPTER I.

GENBRAIi ANATOMY OF THB GLOBE.

PAGE

Measurements — Component Stractures — Vessels of the Globe and

their Relations to the Diagnosis of Diseases of the Eye, . . 1-11

CHAPTER II.

GENERAL PHYSIOLOGY OF THE EYE.

Refraction—Optic Axis : Visual Line : Line of Fixation : Angle
Alpha : Angle Gamma— Accommodation — Functions of the Ret-
ina—Visual Acuity— Form Sense— Test Types— Visual Field :
Perimeters : Eccentric Vision— Color Sense— Daltonism : Color
Blindness— Light Sense : Photometer of Forster : Phosphenes :
Vascular Image of Purkinje— Visual Purple, .... 12-84

CHAPTER III.

HOW TO EXAMINE THE EYE.

External Inspection— Oblique Illumination — Tension— Mobility —

AnsBsthetics— Functional Examination, 85-39

CHAPTER IV.

THE OPHTHALMOSCOPE.

Instruments, their Principles and Varieties— The Fundus Oculi in

Health, 4(M52

CHAPTER V.

GLASSES.

Spherical : Cylindrio— Arrangement and Nomenclature— Dioptrics, 58-58

CHAPTER VI.

ACCOMMODATION AND ITS ERRORS.

Prewbyopiar-Second Sight — Spasm — Paralysis and Paresis, . . 59-66



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vi CONTENTS. .

CHAPTER VII.

ERRORS OF REFRACTION.

PAflS

Ametropia, viz. : Hypermetropia, Myopia, Astigmatism — DiagnosiB
of Refractive Errors— Subjective and Objective Methods —
Mydriatics— Ophthalmoscopic Optometry— Schmidt-Rimpler's
Method— Shadow Test— Thomson's Method. Hypermetropia :
Anatomical Characteristics : Symptoms : Complications : Diag-
nosis : Prognosis : Treatment : Length of Axis in H. Myopia :
Length of Axis in M. : Causes — Functional Disturbances and
Pathological Anatomy — Anisometropia— Prognosis: Diagnosis:
Prophylaxis : Treatment. Astigmatism : Definition : Vari-
eties : Symptoms : Dr. Thomas Young : Stokes' Lens : Diagno-
sis by Ophthalmoscope — by Shadow Test — by Ophthalmometer
of Javal and Schiotz: Disc of Placido — Incidental Effects of
Glasses, 67-129

CHAPTER VIIL

BINOCULAR VISION.

Anatomy and Physiology of Ocular Muscles— Horopter— Homony-
mous and Heteronymous Images : Pai^alysis of Muscles : Symp-
toms : Diagnosis— Special Paralyses— Etiology : Origin of
Nerves animating Ocular Muscles: their Nuclei— Nuclear,
Basal, Orbital Paralysis — Prognosis, Treatment— Prisms, Ten-
otomy, Advancement — the Oculo-orbital Fascia— Wecker's
Clamp — Method of Agnew, of Prince, of Weber— /fi[pa*m of
MnscleB—Nystagmtts—CoriJugate Deviation, .... 180-165

CHAPTER IX.

STRABISMUS.

Varieties— Measurement — Etiology — Amblyopia ex anopsia — Cause
of Strabismus— Treatment : Atropine. Eserine, Glasses, Opera-
tion: its Mechanism and Ultimate Result — Strabismus deorsum
vergens, and sursum vergens, • 166-185

CHAPTER X.

ASTHENOPIA.

Accommodative — Muscular — the Metre-angle, how Measured, its
Relation to Prisms— Causes — Subjective Symptoms : Objective
Symptoms — Tests by Prisms— The Prism Carrier— Perimetric
Examination— Nasal Disorders— Treatment— Prisms — Opera-
tions, 186-208



PART SECOND.
CHAPTER I.

GKNERAIi CONSIDERATIONS.

General Treatment — Shades— Protective Glasses— Bandages— Asep-
sis : Antisepsis — Anaesthetics : Cocaine — Instruments — Mydri-
atics : Myotics— Collyria, 209-224



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^CcmTMNTS.



vn



CHAPTER II.



THE EYBLID» AND CONJUNCTIVA.



Anatomy — Blephariti«marginalis—Hordeolum — Chalazion — Phleg-
mon— Tarsitis— Eczema — Xanthelasma — Molluscum eontagio-
8um— Heipes zoster Ophthalmicus— Epithelioma^ Lupoid— Naevi
—Diseases of Eyelashes — Entropium — Ectropium— Blepharo-
plasty — Blepharophimosis — Cantholysis — Canthoplasty -In-
juries and Lacerations — Coloboma — Epican thus— Spasm of
Orbicularis — Paralysis of Orbicularis — Ptosis— Burns— Symble-
pharon— Anchyloblepharon, 225-269

CHAPTER III.

THE LACHRTlMAL APPARATUS.

Anatomy— Diseases of Lachrymal Gland — Dacryocystitis — Chronic

—Acute— Lachrymal Fistula, 270-285

CHAPTER IV.

THE CONJUNCTIVA.

Anatomy and 'Physio\o(sy—Co7\fu7ictmtu — Hypersemia Palpebralis
— Conjunctivitis Simplex, Catarrhalis, Symptomatic, Metastatic
— Purulenta, Neonatorum, Gonorrhoica — Plastica: Croupous —
Diphtheritic, Acute and Chronic — Granulosa: Trachoma-
Papillary — FoUicularis — Treatment — Xeroma— Sequelse- Jfo?*-
bid Growths^ Vernal CataiTh — PhlyctemUce: Herpes: Femphi-
gus; Traumatic CovjunctivUis — Ecchymosis^Pterygium^ . 28^-340

CHAPTER V.

THE CORNEA.

Anatomy— Physiology— Pathology— Keratitis : Phlyctenula : Her-
pes : Pemphigus : Keratitis vasculosa— Malarial Keratitis :
Keratitis Interstitialis— Suppurativa — Ulcerativa— Ulcus Cor-
nea Serpens: Neuro-paralytic Keratitis: Kerato-malacia —
Ulcers— Keratitis postica, Dendritica— Mycotica— Sclerosis—
Arcus senilis : Sequels — Opacity, Fistula— Staphyloma, Cor-
nea coniea, 841-391



CHAPTER VI.

THE SCLERA.

Anatomy— Episcleritis— Scleritis—Sclero-keratitis— Staphyloma,



892-897



CHAPTER VIL

THE IRIS.

Anatomy and Physiology — Mydriasis — Myosis — Hippus — Irido-
donesis— Congenital Defects: Albinism— Irideremia— Coloboma
— Membrana pupillaris— Iritis : Serosa, Spongiosa, Plastica,
Suppurativa— Complications : Symptoms— Sequelae — Causes-
Prognosis- Treatment— Varieties : Syphilitic, Rheumatic,
Gouty, Gonorrheal— Tumors— Tubercles— Sarcoma— Cysts, .



898-418



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viii CONTENTS.

CHAPTER VIII.

PAOB

OPERATIONS ON THE IRIS.

Iridectomy— Iridotomy— Iridorhexis— Corely sis— I ridodesis, . . 419-420

CHAPTER IX.

THE CILIARY BODY.

Anatomy— Ciliary Muscle — Cyclitis : Serous, Plastic, Purulent,

Acute and Chronic : Traumatic— Hypotony, .... 427-432

CHAPTER X.

THE CRYSTALLINE LENS.

Anatomy — Development — Images of Purkinje — Arcus senilis

Lentis— Dislocation 488-488

CHAPTER XI.

CATARACT.

Pathology— Symptoms— Examination— Varieties— Diagnosis— Com-
plications— Prognosis— Treatment— Soft Cat€tract— Discission—
Simple Linear Extraction— Extraction of Hard Cataract, with
Iridectomy, without Iridectomy — Secondary Cataract — Glasses
for Aphakia, 43d-469

CHAPTER XII.

THE VITREOUS BODY.

Anatomy— Hyalitis— Persistent Hyaline Artery— Synchisis Scintil-
lans- Mu8C«B Volitantes — Cysticercus — Membranes— Hemor-
rhage— Foreign Bodies, 470-476

CHAPTER XIII.

WOUNDS AND INJURIES.

Contusions and Blows — Wounds — Foreign Bodies — The Magnet-
Burns, 477-487

CHAPTER XIV.

SYMPATHETIC OPHTHALMIA.

Irritation — Inflammation— Causes— Stages— Prognosis — Symptoms
— Neuro-retinitis- Mode of Transmission — Treatment — Iridec-
tomy — Enucleation — Optico-ciliary Neurectomy — Exenteration
—Risk of Enucleation, 488-502

CHAPTER XV.

GLAUCOMA.

Degrees of Tension— Glaucoma Simplex— Symptoms— Development
— Glaucoma Acutum — Subacutuni— Chronicum — Heuiorrhagi-
cum — Secundarium — Buphthalinus — Diaprnosis —Prognosis —



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CONTENTS,



IX



Etiology and Pathogenesis— Pathology— Treatment— Iridec-
tomy— Sclerotomy— Posterior Sclerotomy— Mahgnant Glaucoma
— Cystoid Cicatrijc— Rationale of Iridectomy— Results,



50a-523



CHAPTER XVI.

THE CHOROIDEA.



Anatomy— Albinism— Coloboma— Pathology— Colloid Degeneration
— Symptoms and Subdivisions — Metamorphopsia— Megalopsia
— Micropsia — Treatment — Choroiditis Metastatica — Panoph-
thalmitis Suppu rat ivar— Laceration of the Choroid — Hemor-
rhage—Detachment — Tubercles — Tumors— Ossification, . . 523-541

CHAPTER XVII.

THE RETINA.

Minute Anatomy— Opaque Nerve Fibres— Coloboma of the Macula—
Hyper«mia— Pulsation of Arteries and Veins — Antemiar— Spasm
of Arteries— Ischfemia— Embolism and Thrombosis— Hemor-
rhage— Retinitis Apoplectica— Miliary Aneurisms— Retinitis :
various appearances — Etiology— Pathological Anatomy — Retin-
itis Simplex — Albuminurica during Pregnancy— Glycosurica
— Leucocythaemica— Syphilitica — Proliferans — Punctata Albes-
cens — Pigment Degeneration — Neuro-retinitis-pigmentosa—
Detachment— Pathogenesis — Gh'oma- Pseudo-glioma, . 542-585

CHAPTER XVIIL

THE OPTIC NERVE.

Anatomy and Physiology— Coloboma of Sheath — Opaque Nerve
Fibres — Connective Tissue on Disc — Hypersemia — Antemia —
Hemorrhage— Papillitis— Neuro-retinitis— Neuritis Hemorrha-
gica— Peri-neuritis— Subjective Symptoms — Pathological Anat-
omy— Etiology— Pathogenesis— Prognosis— Treatment— Retro-
bulbar Neuritis : Chronic, Acute, Toxic, Alcoholic, Tobacco —
Atrophy of Optic Nerve — Morbid Anatomy, .... 586-638

CHAPTER XIX.

AMBLYOPIA AND AMAUROSIS.

Traumatic — Concussion of Spinal Cord— By Lightning, from Hem-
orrhage—Toxic : by Quinine, by Salicylic Acid— Urwmic— Gly-
cosuric: by Pregnancy— Hysterical— Dyslexia, Paralexia, Alexia
— Hemeralopia— Snow-blindness— Dental Amblyopia— Hyper-
sesthesia — Hemianopia : monocular, homonymous, binocular,
nasal, bitemporal — Causes — Amaurosis in Young Children-
Undiscovered Monocular Blindness— Simulated Blindness, . 629-652

CHAPTER XX.

THE ORBIT.

Anatomy — Periostitis Orbitae — Cellulitis —Phlegmon— Inflamma-
tion of Oculo-orbital Fascia— Thrombosis of Veins and of Cav-



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X CONTENTS.

PAGE

emous Sinus — Tumors— Tumors of Optic Nerve — Exenteratio
Orbit»— Pulsating Exophthalmus— Empyema of Frontal Binus
— Hemorrhage into Orbit— Wounds and Injuries — Wound of
Optic Nerve— Foreign Bodies in Orbit— Exophthalmic Goitre, 653-694

CHAPTER XXI.

USE OF ARTIFICIAL EYES.

Artificial Vitreous, 695-697

CHAPTER XXII.

STATISTICS OF EYE DISEASES.

Relative Proportion of Eye Diseases — Cohn— Causes of Blindness,

Magnus, etc., 698-703



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LIST OF ILLUSTRATIONS.



FIO. PAOB-

1. Section of Eye, horizontal Heitzmann. 3

3. Ciliary Region Heitzmann. 4

8. Section of Eye showing Uvea 5

4. Blood-vessels of Eye Leber. 7

5. Cardinal Points Landolt. 14

6. Angle Alpha, angle Gamma, etc Landolt. 1&

7. Reflex from Cornea and Lens 17

8. Physical Changes during Accommodation Landolt. 1^

9. Relative Accommodation 20

10. Retina: Macula Lutea Strieker. 21

11. Blind Spot Helmholz. 23

12. Perimeter Priestley Smith. 26

18. Boundaries of Color Sense Landolt. 28-

14. Optogram on Retina Ayers. 84

15. Oblique Illumination Noyes. 86

16. Ophthalmoscopy— direct Method Noyes. 40

17. Ophthalmoscopy — indirect Method Noyes. 41

18. Loring's Ophthalmoscope Loring. 43

19. Loring^ Ophthalmoscope Loring. 48

20. Noyes' Opthalmoscope Noyes. 45

21. Optic Disc in Face and in Section Landolt. 48

22. Blood-vessels of Retina Leber. 49

28. Varieties of spherical Lenses 58

24. Cylindric Lenses Noyes. 54

35. Nachet's Spectacle Frame Noyes. 68

36. Emmetropia, Hypermetropia and Myopia Brown. 67

37. Course of parallel Rays in convex Lens 67

3a Parallax of Vessels in excavated Disc 78

39. Explanation of Shadow Test Nettleship. 75

30. Explanation of Shadow Test Nettleship. 76

81. Scheiner's Test Follin. 79

83. Myopia with Crescent Nettleship. 95

83. Section of Myopic Eye Nettleship. 95

84. Myopia with choroidal Lesions Jaeger. 96

85. Supratraction of Optic Fibres in Myopia Weiss. 96

86. Myopia, Choroidal Crescent Jaeger. 97

87. Myopia, circum-papillary Atrophy Jaeger. 98

88. Myopia, Lesion at Macula Jaeger. 99

89. 40. Course of Rays through cylindric Lens Fick. 110

41, 43, 48, 44, 45. Varieties of Astigmatism Noyes. 112

46, 47. Tests for Astigmatism Green. IIT



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xii LI8T OF ILLUSTRATIONS.

no. PAOB

48. Tests for Astigmatism Green. 118

49. Ophtbalmometer of Javal and Schiotz J aval. 122

60, 51. Images seen by Ophthalmometer Javal. 123

62. Disc of Placido *. Noyes. 124

68. Axes of ocular Muscles Landolt. 131

64. Converging visual Lines Follin. 134

66. Diverging visual Lines Follin. 135

66, 67, 58, 69. Images in muscular Paralysis Zehender. 140

60, 61, 62, 63. Images in muscular Paralysis Zehender. 141

64. Base of Brain to optic Nerves Obersteiner. 142

66. Central Region of Brain in Outline Obersteiner. 144

66. Central Region of Brain • Obersteiner. 145

67. Section of middle Region of Brain Obersteiner. 146

68. Section of middle Region of Brain Obersteiner. 147

69. Transverse Section of Brain Obersteiner. 148

70. Wecker s Clamp Wecker. 159

71. Strabismus Forceps 178

72. Strabismus Hook : 179

78. Metric Angle Nagel. 188

74, 75. Prisms in Combination Noyes. 198

76. Prism-Carrier Noyes. 195

77, 78. Speculum Noyes. 217

79. Tarsi Palpebrarum Schwalbe. 225

80. Exterior of Eye and Lids Schwalbe. 226

81. Section through Globe and Orbit Schwalbe. 227

82. Section of upper Lid Schwalbe. 229

83. Eye-lid Clamp Forceps Noyes. 282

84. Operation for spasmodic Entropium Meyer. 242

85. Hotz/s Operation for Entropium Hotz. 244

86. Green's Operation for Entropium Green. 244

87. Ectropium at inner Can thus Galezowski. 247

88. 89, 90, 91. Operations for Ectropium Meyer. 248

92,93. Blepharoplasty Noyes. 252

94,95,96,97. Blepharoplasty Noyes. 253

98. Blepharoplasty Noyes. 254

99, 100, 101, 102. Blepharoplasty Noyes. 255

108. Laceration of upper Lid LawsoH. 257

104. Wound of lower Lid, etc Noyes. 257

105, 106. Oi>eration for Ptosis Wecker. 264

107, 108. Sy mblepharon Meyer. 267

109. Abscess of lachrymal Sac Noyes. 274

110. Empyema of frontal Sinus Noyes. 275

111. 112, 113, 114. Lachrymal Instruments 278

115, 116, 117. Lachrymai Probes 280

118. Gouge for lachrymal Duct ; .Noyes. 282

119. Abscess of lachrymal Sac Noyes. 284

120. Desmarres' Elevators 302

121. Forceps for follicular Trachoma Noyes. 322

122. Squeezing follicular Trachoma Noyes. 322

123. Pterygium * 338

124. Corneal Corpuscles Strieker. 343

125,126. Keratitis Mycotica Haab. 346



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LIST OF ILLUSTRATIONS xiii

FIO. PAGE

127. Ulcer of Cornea Galezowski. 850

128. Herpes CorneiB Haab. 854

129. 180. Teeth in hereditary Syphilis and from Mal-nutrition. .Noyes. 861

181. Keratitis with Hypopyum (ialezowski. 867

133. Keratitis Postiea Galezowski. 870

138. Keratitis Dendritica Hansen-Grut. 878

134. Tattooing Needle 381

185. 186, 187. Staphyloma Come« 883

188. Operation for Staphyloma Come® Noyes. 886

189. Epithelioma Comeie Noyes. 891

140, 141. Membrana Papillaris perseverans 404

142. Congestion in Iritis 406

143. Posterior Synechi© ; Sichel, Jr. 406

144. Occlusion and Exclusion of Pupil Sichel, Jr. 409

146, 147, 148. Forceps, Tyrrell's Hook, and Lance Knives 420

149. Matthieu's Iris Forceps 421

150, 151. Iridectomy Meyer. 422

152,153. Iridectomy Meyer. 423

154. Wecker's Forceps-scissors Wecker. 424

155,156,157. Iris Cutting-needles 425

158,159. Ciliary Muscle in H. and M Iwanoflf. 428

160, 161, 162. Results of Cyditis Noyes. 481

168. Eye of embryo Calf at third Month K6lliker. 483

164. Images from Cornea and Lens 484

165. Dislocation of Lens Lawson. 435

166. Zonular (laminated) Cataract Meyer. 444

167. Discission of Cataract — Meyer. 450

168. Linear Extraction of Cataract upward ^ . .Wolfe. 452

169. Linear Extraction of Cataract outward Meyer. 453

170. Sectibn of Cornea in various Methods of Cataract Extraction

Sichel, Jr. 455

171. Graefe 8 linear Extraction—making the Section Noyes. 457

172. Graefe's linear Extraction— making the Section Meyer. 458

178. Wire Retractor for upper Lid Noyes. 459

174, 175. Cataract Knives, narrow and wide 461

176,177. Cystitomeand Spatula: Fixation Bident 462

178. Secondary Cataract Galezowski. 466

179, 180, 181. Knife, Needles, and Hook for membranous Cataract. . . . 467

182. Persistent hyaline Artery Little. 471

183. Connective Tissue in Vitreous Jaeger. 472

184. 185. Irido-dlalysis : Rupture of Sclera , Lawson. 477

186. Wound of Cornea, Eyelid and Cheek Noyes. 480

187. Appliance for oblique Illumination Noyes. 481

188. Iridectomy after sympathetic Ophthalmia Lawson. 495

189. Myopia with Glaucoma Jaeger. 504

190. 191. Excavation of optic Nerve : Glaucoma Jaeger. 505

192. Physiological Excavation of Optic Nerve Jaeger. 510

193. Sclerotomy— downward Lawson. 617

194. Colloid Deposits in Choroid MGller. 526

194 bis. Exudative Choroiditis ; peripheral Jaeger.

195. 196, 197, 198. Atrophic Choroiditis . . .Jaeger.

199. Choroiditis atrophica in Myopia Jaeger. 581



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