United States. Navy Dept. Bureau of Medicine and S.

Annual of the universal medical sciences and analytical index. A yearly report of the progress of the general sanitary sciences throughout the world. [1888-1896.] ... online

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Annual of the Universal Medical
Sciences and Analytical Index

Charles E de M Sajous



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ANNUAL



Universal Medical Sciences



A YEARLY REPORT OF THE PROGRESS OF THE GENERAL
SANITARY SCIENCES THROUGHOUT THE WORLD.

EDITED BY

CHARLES E. SAJOUS, M. D.,

I^BCTUBEB ON LABYNOOLOGY AND RHIMOLOGY IN JEFFERSON MEDICAL COLLEGE, PHILADELPHIA, ETa,

AND

SEVENTY ASSOCIATE EDITORS,

ASSISTED BY

OVER TWO HUNDRED CXJRRESPONDINO EDITORS, COLLABORATORS,
AND CORRESPONDENTS.

|[lln»ir»ied with ^hrcmc^'^Hhc^Tnifhn, ||ngrairing» »nil ^pn.



voLui>d:E: III.




1888.

PHILADELPHIA AND LONDON:

F, A. DAVIS, PUBLISHBR.



The OcBAKic Pub. Co., | ^gbnciki. / J

Sydney. N.S.Wales. / \ Capel



A. AlKBN,
Town, Cape Colony.



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Entered according to Act of Congress, in the year 1888, by

F. A. DAVIS,

In the Office of the Librarian of Congress at Washington, D.C.



Philadelphia :

Tb« Medicftl Bulletfii Printing HouM.

No. 1231 Filbert Street



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OPHTHALMOLOGY.

By WILLIAM THOMSON, M.D.,

PHILADELPHIA,
ASSISTED BY

GEO. M. GOULD, M.D.,

PHILADELPHIA



SECTION L

EMBRYOLOGY, ANATOaCY, PHYSIOLOGY, ETC.

1. Tlie Pineal Gland and Eye. — The discover}^ of the nature
of the pineal gland in man, and its relation to the median or pineal
eye of certain amphibia and lizards, is one that may have no prac-
tical significance; but it is one of decided scientific interest. Mr.
Baldwin Spencer's beautifully illustrated paper^ clearly demonstrates
that the pineal gland (held by the philosopher Descartes to be the
chief seat of the soul) is in all mammaUa the rudiment of what
was once a functional eye in the Ichthyosaurus, Plesiosaunis, and
many other now extinct animals. In certain species of hzards, e,g.^
the New Zealand Sphenodon, the process of extinguishing the median
eye seems only partially carried out at the present time. At the
vertex of the head there is a modified central scale covering a gap,
the parietal foramen, in which lies the eye, connected by its stalk
or optic nerve, with the epiphysis or pineal gland. The eye has
all the essential ocular structures, retina, lens, transparent media,
etc. In one species the pineal nerve does not exist, though the eye
and gland are present. In yet others the eye is wholly within the
skull, the parietal foramen having closed. The extreme vasculari-
zation of the human gland, and the presence in it of sabulous
particles may, perhaps, lead to the demonstration of some function
now useful to the oi^nism.

2. Introrocular Muscles of Mammals and Birds. — The results
of Mr. Jessop's experiments on mammals and birds^ show that the
iris is supplied by the short ciliary ner\'es producing pupillary con-

1 (1)

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2 OPHTHALMOLOGY. [^'"Ma^i^'K^.'"''*

traction, and by the long ciliary nerves producing dilatation. In
mammals the short ciliary nerves contract the ciliary muscle and the
long ones relax it. These facts correlate the unstriped intra-ocular
muscles of mammals with the involuntary muscidar fibre of the
heart, vessels, intestines, etc. The author concludes there is no
distinct dilator muscle of the pupil, — a matter about which there
is no unanimity of opinion among investigators. Those denying
the dilator suppose the constrictor fibres overcome the inherent
elasticity of the iris.

3. Central Origin of the Ocular Fibres of the Facial Nerve. —
Proceeding from the commonly observed fact that in cases of hemi-
plegia residting from cerebral apoplexy the muscles of the lower
part of the face may be paralyzed, whilst those muscles supplying
the structures about the eyes that are innervated by the facial pre-
serve their normal activity, Herr Mendel* has made an extended
and painstaking series of investigations to determine the nuclear
origin of the nerves of these parts. He proceeds on the method
of Gudden, removing muscles, however, instead of nerves, in
young rabbits and guinea-pigs, and some months thereafter local-
izing the atrophied centres. It is foimd that the upper muscles
about the eye suppUed by the facial do not, as heretofore supposed,
originate in the nuclei of either the general facial or the abducens,
but in the posterior division of the oculomotorious nucleus. It is
therefore highly desirable that in cases of pure ophthalmoplegia
externa in man the normality of the orbicularis, etc., should be tested,
and, if possible, a post-mortem examination should locate the central
lesion. The pubhshed cases, being deficient in one or more of
these particulars, are thrown out of the count by Mendel. Bird-
sail's case^ is the only one confirmatory of the supposition that in
man the same law holds as in animals. The author reminds us
that there are other instances of fibres having a common origin
proceeding to their peripheral distributions by different routes.
By experiments upon kittens, Nussbaum® finds the nucleus of the
oculomotorius connected by crossed fibres with the longitudinal
fibres from the aqueduct of Sylvius, and thus eventually with the
abducens nucleus of the opposite side.

4. Const itntio)ial Diseases of the Eye in the Light of Emhry-
ology. — Tweedy*^ points out many highly suggestive and interesting
facts in this connection. He first emphasizes the intimate corre-



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*"pS32I2i^^B&"'''] OPHTHALMOLOGY. 3

spondence between the development and functions of the brain
and those of the optic nerve and retina, since these last are geneti-
cally direct and early outgrowths of the brain. It is also notable
that the eye and its appendages receive the whole, or parts, of six
out of the twelve pairs of cranial nerves, and the concurrence of
ocular development in organic evolution with the development of
powers of locomotion receives a side-light from pathology in the con-
nection between locomotor ataxia and visual failure. These things
point to the intimate relationship existing between the eye and the
rest of the body. No other organ of the body contains so many
different kinds of histological elements or textures of so high a
quality as the eye. Hence the immediate participation of the eye
in general or constitutional diseases. The embryological origin
of the various structures of the eye from the layers of the blasto-
derm is thus represented schematically on the following page.

It is thus seen that there is a histological and physiological
relationship between the epiblastic elements of the eye and the epi-
blastic tissues in the rest of the body, and between the mesoblastic
tissues of the eye and all other mesoblastic tissues. The patho-
logical relationship is none the less intimate and exact; the cutaneous
eruptions of strumous children, the eczemas, herpes, impetigos, etc.,
are concomitants of the phlyctenulae of the epitheUal layers of the
cornea. In ophthalmic herpes the corneal change is likewise epi-
blastic. Syphilis, on the other hand, is a disease of mesoblastic
textures, and ocular syphihtic affections are foimd to be of meso-
blastic origin. The notched, pegged, and stunted teeth of inherited
syphilis are not faults of the epiblastic enamel, but of the mesoblastic
dental papillae. Though epiblastic portions of the eye may become
secondarily involved, the lesion begins in the mesoblastic structures.
These and other analogies are valuable not only for diagnostic pur-
poses, but also for therapeutic uses. Certain drugs have a special
affinity for particular tissue-elements, and this fact mav be utilized
in prescription.

5. Monocular and Binocular Closure of the Lids. — ^When in
man one eye is threatened by an approaching object, the other eye
clofles as piomptly as the one in danger. In rabbits, birds, guinea-
pigs, and frogs it requires an extremely strong stimulus to produce
the closure of the non-endangered eye. Langendorff ® explains this
as arising from the fact that in man the eyes being directed for-



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OPHTHALMOLOGY.



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Pbyalology, Kto.



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wards and the visual fluids overlapping, there is a common "danger-
field," and injury is thus obviated by the closure of both eyes. In
the above-mentioned animals the "danger-field," except in great
possibilities of injur) , do not overlap and therefore but a single

eyeUd closes in ordinary stimula*-
tion. Electric stimulation of the
brain of the rabbit with a weak
current produced closure of the
opposite eye alone; only by very
strong discharges did both Uds
close.

6. The Motor ApparcUns of
(lie Eye in Man and Vertebrates —
The extensive studies of M. Mo-
tais^ present many points worthy
of notice; but that relating to the
nature of the capsule of Tenon
is particularly valuable. This
structure is held to be the com-
mon aponeurosis of the muscles
of the orbit, forming a complete
diaphragm or funnel about the
circumference of the orbit of
which the tendons form an integ-
ral non-detached portion. At
the point of reflexion a subcon-
junctival fascia extends from the
aponeurosis to the cornea. Be-
neath the muscular aponeurosis
or external capsule there is a thin
membrane enveloping the bulb of
the optic ner\'e and extending to
the muscles. This is called the
capsule of the bidb or the inter-
nal capsule, and is the serous
membrane of the eye. The sepa-
ration of the serous and muscidar
aponeurosis and the imiting of
the tendons of all the external



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■^FlSSoBi^BtS:*"^'] OPHTHALMOLOGY. 6

muscles in a common aponeurosis, thus has important bearings,
not only upon the physiological functions of these muscles, but
has also much to do with the surgery of these muscles in cases
of strabismus and paresis. As Powers^ says, every one must have
experienced unexpected and unexplained instances of failure in the
treatment of cases of squint. For those interested in the subject
there is to be found nowhere else so complete an exposition of
the anatomy of these structures in all species of animals.

7. Cerebral Centres of Vision. — In Ferrier's new edition^^
the visual centre is now located in the occipito-angular region in-
stead of in the angular gyrus. Blindness of the opposite eye
caused by destruction of one angular gyrus lasts only one day,
whilst destruction of both gyri does not produce binocular bUnd-
ness for over four days. Ferrier^s recent view is shown by the an-
nexed figure.



T' —




A the right, A' the left angular gyrus ; C optic chiasma ; E the right, and E' the left
eye ; N the right, stnd N' the left optic nerve ; O the right, and O' the left occipital
lobe ; T the right, and T' the left optic tract ; the thin continuous line represents the
retinal relations of O ; the thick continuous line represents the retinal relations of O' ;
the interrupted line indicates the retinal relations of A, and the dotted line the retinal
relations of A' ; the relations of A and A' with the eye on the same side are Indicated
by finer interrupted and dotted lines respectiyely.

Ferrier concludes that the corpora quadrigemina are not vis-
ual centres properly speaking, but are probably coordinating cen-
tres between retinal and other sensory impressions and motor
adjustments. Ferrier^s conclusions are based on experiments upon
animals, and are interesting as furnishing proof (if it were needed)
of the much-more-satisfying and conclusive researches of Seguin^^



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6 OPHTHALMOLOGY. V^t^^^^'S^'^'

upon the results of clinical and post-mortem studies in man. From
tliese the conclusion seems indisputable that the cortical centre of
vision in man Ues in the cuneus of the occipital lobe. Dr. Mooren'^
places the color-sense on the most exterior cortex of the cuneus;
beneath this is another layer, the centre for acuteness of vision ;
whilst in a third layer, lying yet deeper and next to Gratiolet's vis-
ual radiations, is the visual or light centre, the centre for visual
field. Destruction of the upper or color-centre may exist without
affecting the other layers. Bouveret*^ gives the details of a case
of total blindness without noteworthy impUcation of other senses,
caused by atheromatous posterior cerebral arteries with softening of
the cunei. Hun^^ reports a case where there was during Ufe a
defect in the lower left quadrant of the visual field of each eye.
From the post-mortem examination of this and a case reported by
Monakow it is concluded that the fibres from the right upper quad-
rant end in the lower half of the right cuneus; thut those from
the right lower quadrant end in the adjacent part of the right
median occipito-temporal convolution ; that the terminals of the
homonymous retinal halves are in the lower half of the cuneus and
the neighboring median occipito-temporal convolution ; that simple
visual sensation is carried on in the median surface of the occipital
lobe, and complete visual perceptions on the convex surface.

8. Coexcitatioii of Homonymmis Visual Fields. — Schiele's
remarkable study^* shows a complete interdependence of the visual
fields. The late Professor Randolph, of Philadelphia, preved by
an extended series of experiments that the fatigue of a certain set
of muscles — ^finger, hand, etc. — took place much earlier after the
corresponding muscles of the other side of the body had been tuxHl
than if they had been exhausted prior to the others. Schiele's ex-
periments upon neurasthenic patients with contracted fields show
that fatigue of one eye, with consequent contraction of the field, is
followed by a proportional and concurrent contraction of the field
of the non-used eye. The fatigue is therefore not retinal, but cere-
bral. The experiments with limited divisions of the retina, which
were followed by synchronous reductions of the limited correspond-
ing portions of the field of the resting eye, are particularly striking.
One wonders, however, if the concentric reductions are not alto-
gether too exact and mathematical to correspond to the actual
facts. If so, it is of course wholly unintentional on the author's



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^T&SiX^"^'''] OPHTHALMOLOGY. 7

part. We give herewith reproductions of the perimetrical obser-
vations: —



y. ^. BergynaMM, JViesdaden.

ScHiEiJE*s Homonymous Visual Fields.



Figures 5 and 6 illustrate Case 2, in which the fatigue was
concentric and equal in both. Figs. 11 and 12 illustrate cases



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8 OPHTHALMOLOGY. ["^""pSS^Ei^BS!"^'

of neurasthenia and hysteria in wliich correspondmg halves were
fatigued. Figs. 13 and 14, a case of hysteria, show contraction



) V tamuun. n. ^^

ScHiELE, Homonymous Visual Fields.

of one eye induced contraction of one half of the field of the other.
Figs. 15 and 16, Ukewise a case of hysteria, show dilatation of one



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'^SSWi^tJS'"^'] OPHTHALMOLOGY. 9

half of a visual field, whilst the other half is contracted ; the same
condition is induced in the homonymous halves of the other eye.



I ^4

AicnvES^ V OnnuLMOLn

y. F. BtrgmanHf Wiesbaden.

ScHiELR, Homonymous Visual Fields.



The same irritation diminished the function in one half of the
field, whilst acting as an excitant in the other. Figs. 17 and



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10 OPHTHALMOLOGY. V^v'S^lSS^^^^

18 show the degree of excitation as uniformly increasing or de-
creasing in the adjacent meridians of one half of the field, but



n<r» ^^



y. /♦'. Berg-mann, fVus^adt-n.

ScHiELE's Homonymous Visual Fields.



remaining unchanged in each single meridian. Figs. 7, 8, 23, 24,
19, 20, 21, 22, 25, 26, 27, 28 illustrate cases where the fatigue of



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"^PlSSl2Eiy^l5S:"'''] OPHTHALMOLOGY. 11

one half of the field aflfects the homonymous half of the other m a
similar way. Figs. 29 and 30 represent the contractions obtained



*' AflCMDrcs or OnrriULMOL.M

y. F. Bergmann^ Wiesbaden.

SoHiELE's Homonymous Visual Fields.



when first the outer limit only is determined; but the extent of
each meridian is measured by carrying the visual object from one



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12 OPHTHALMOLOGY. [""pSSSSfSi^^B^"^'

side of the meridian to the other. The Umitation of homonymous
retinal fields is incompatible with Wemicks' views on the pro-



y. F. Bergntann^ Wiesbaden.

Hcui£LE*s Homonymous Visual Fields.



jection of the visual centre, according to which there is in eacli
occipital lobe a demarkation-line of the homonymous halves of



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^'"'piSSaSii^B^"'^'] OPHTHALMOLOGY. 13

the retinae corresponding to the vertical lines of separation of the
two visual fields.

9. Retinal Studies. — Boiysiekiewicz's investigations^^' of the
ultimate construction of the retina comprise studies of human eyes,
together with those of elephants, tigers, leopards, cats, etc. Among
the conclusions reached are the following: The fibres of MiiUer
begin at the membrana Umitans interna and end as rods and cones.
In all probability they proceed uninterruptedly through all the
retinal layers. The rods and cones represent the ends of the radical
fibres, and do not therefore correspond to nerve-endings proper.
The rods and cones are not the regularly arranged and isolated
bodies commonly pictured, but are stretched apart or crowded
together irregularly by the intrusion of granular cells. The light-
perceiving or transforming organs must be placed between the inner
and outer granular layers, within the Miiller's tubules. Angelucci's
experiments^'^ with electric currents upon frogs lead him to con-
clude that the rods and cones are as certainly the direct inter-
mediates of light and color-perception. Charpentier's researches"
give greater precision to the relations and reactions of the retina
to the etherial stimulation. There is an exact relation between the
duration of excitation and the intensity below which perception
does not arise. There is also a maximal duration above which the
luminous intensity does not vary. A luminous sensation is com-
posed of the cumulation of elementary sensations of exceedingly
brief duration, and the resultant intensity is proportional to the
number of elementary sensations produced during the interval of
time under consideration. The persistence of the luminous im-
pression is governed solely by the intensity of the sensation, whether
the stimulus be short or long. •Color influences the persistence of
retinal impression, not by its pecuUar characteristic, but by its
intensity. The persistence of luminous impressions diminishes
with augmentation of illumination, and vice versd. In weak illu-
mination, and for luminous excitations of brief duration, the
persistence of the impression varies in inverse ratio to the square
root of the illumination. (The interested student may profitably
compare these results with Uthoff 's researches, and those of Du-
Bois-Keymond, in Graefe's "Archiv," xxxii., 1886). Wertheim,^^
repeating DuBois-Eeymond's conclusions (1881), finds that they
are correct as r^ards the equahty, at the centre of the fovea, of



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1 4 OPHTHALMOLOGY. ["^"pgSloSiit^!^"'''

the number of cones, and the number of sensitive points. He
fiirther asks if this proportion holds for the outlying portions of
the retina, where the visual acuity and the number of the cones
gradually decreases. At the border of the macula (not calculated
by DuBois-Reymond), the proportion is preserved, but beyond
this point it does not obtain if the rods be considered as sensitive
elements. This necessitates the conclusion that if the rods par-
ticipate in vision they do so, not singly, but in groups. According
to Salzer's observation, the number of cones is seven or eight times
the number of optic nerve-fibres ; and the supposition is therefore
made that the fibres are unequally divided among the cones so
that every cone of the fovea has an optic-nerve fibre, but beyond
the fovea there is but one fibre to several cones. The enlarged
area of sensitiveness beyond the fovea would in this way corre-
spond to the single nerve-fibre. Knies^* proposes a theory of color-
perception midway between that of Hering and Helmholtz, and
which therefore seeks to combine the advantages of both. Four
primary colors are supposed, — ^red, yellow, green, and blue, —
because, firstly, spectra that are successively conjoined persistently
produce one of these colors. Two of these belong to the more
refrangible half of the spectrum, and the others to the less re-
frangible half, and they are complementary in pairs. The author
believes his theory harmonizes the facts of physiology and pathology
(color-blindness) better than others ; but, of the making of color-
theories there is no end! Mr. Wherry '^^ adds to his case of
uniocular diplopia, reported in 1883, a patient troubled with
imiocular triplopia. The first was an astronomer, the last a
microscopist, though (as if to add to the confusion of the physio-
logical philosopher) it is noted that the eye multiplying the
images was not the one used in microscopic work. Gunn^^ thinks
the phenomenon of the "watered or shot-silk" appearance of the
retina is caused by the reflected light of the mirror fix)m unequal,
sloping, or curved surfaces (caused by vessels, fovea, etc.), that
illuminates an area of the neighboring retinal surface, and thence
is again reflected through the pupil into the observer's eye.



Online LibraryUnited States. Navy Dept. Bureau of Medicine and SAnnual of the universal medical sciences and analytical index. A yearly report of the progress of the general sanitary sciences throughout the world. [1888-1896.] ... → online text (page 1 of 54)