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 THE 
 
 AMERICAN 
 ENCYCLOPEDIA AND DICTIONARY 
 
 OF 
 
 OPHTHALMOLOGY 
 
 EDITED BY 
 
 CASEY A. WOOD, M. D., C. M.. D. C. L. 
 
 Professor of Ophthalmology and Head of the Department, College of Medicine, University of Illinois; 
 
 Late Professor of Ophthalmology and Head of the Department, Northwestern University 
 
 Medical School; Ex-President of the American Academy of Medicine, of the American 
 
 Academy of Ophthalmology, and of the Chicago Ophthalmological Society; 
 
 Ex-Chairman of the Ophthalmic Section of the American Medical , 
 
 Association; Editor of a "System of Ophthalmic Therapeutics" and 
 
 a "System of Ophthalmic Operations"; Mitglied der Oph- 
 
 thalmologischen Gesellschaft, etc.; Ophthalmic 
 
 Surgeon to St. Luke's Hospital; Consulting 
 
 Ophthalmologist to Cook County 
 
 Hospital, Chicago, 111. 
 
 ASSISTED BY A LAF^GE STAFF OF COLLABORATORS 
 
 FULLY ILLUSTRATED 
 
 Volume I — A to Azoviolett 
 
 CHICAGO 
 
 CLEVELAND PRESS 
 
 1913
 
 Copyright 1913 
 
 BY THE 
 
 CLEVELAND PRESS 
 All Rights Reserved.
 
 INTRODUCTION 
 
 In adopting the strictly alpliabetical sequence of subject-headings it 
 has been necessary to review for the tirst volume practically the whole 
 range of tlie literature of Ophthalmology and its related sciences. It 
 will, as a consequence, easily be understood how difficult it has been 
 to collect and treat with complete satisfaction all the subjects com- 
 mencing with the first letter of the ali^habet, that directly and indi- 
 rectly relate to the eye and its diseases. However, it is the belief of the 
 Editor and his collaI)orators that no topic of importance has been neg- 
 lected. When a heading that quite evidently should have been noticed 
 has been omitted or, more likely, if new topics of interest arise' after 
 the publication of the volume to which they belong, alphabetically, they 
 will receive due attention in the appendix. 
 
 In addition to the attempt to write and edit a comprehensive 
 Encyclopedia of Ophtlutlmology the editor has made an effort to com- 
 bine with it a Dictionary of sucli English, Latin, French, German and 
 Italian words and phrases. as will be most useful to students of ophthal- 
 mology in general. This has l)een a heavy task, beset with many 
 difficulties. In the first place it is not an easy matter to decide whether 
 a particular word or phrase is of ophthalmic interest, or not. Broadly 
 speaking, the majority of medical and scientific subjects in the lan- 
 guages referred should be interesting and valuable to the educated 
 ophthalmologist l)ut, if most of the words and phrases utilized in gen- 
 eral medicine and surgery were so included, the additions would pad 
 this work to an unseemly degree. Even as it is, the inclusion of some 
 of the terms already chosen (although they were all taken from ophthal- 
 mic text-books) may give rise to criticism and to the imputation of 
 mere "filling." 
 
 It will, in this connection, be noticed that the array of German 
 words is much larger than those in other languages. There are sev- 
 eral reasons for this. In the first place, the German language occupies 
 a pre-eminent position in the world of science, and many English- 
 speaking ophthalmologists have received a considerable portion of their 
 foreign education in Germany and from Germans. Consequently, 
 the excess of German words naturally represents the largest proportion 
 of foreign literature accessible to the average English reader. Again, 
 
 5
 
 6 INTRODUCTION 
 
 it has not been considered necessary to insert in the Dictionary foreign 
 words that closely resemble their English equivalents; and, since our 
 English scientific words and terms are mainly derived from the Latin 
 and the Romance languages, it necessarily follows that many of these 
 have been omitted. For example, Ablepsie (P.) and Ablepsia (L.) 
 have not been entered in the dictionary list, as it is quite evident that 
 they have exactly the same meaning as our English word Ablepsy, or 
 Ablepsia, blindness. For the same reason it does not seem desirable to 
 include such expressions as Abrasione della cornea (It.), as the 
 ophthalmic reader will at once recognize its English equivalent. 
 
 It will be readily seen how inevitable it is that certain repetitions 
 occur in a work of this kind and magnitude; and it may at once 
 be said that at least the majority of them in this Encyclopedia are 
 intentional. References to a section, a cut or a plate on another 
 page, or in another volume, are often found with some difficulty, 
 and even when the search has been successful the effort much inter- 
 feres with the concentration of thought required to grasp the matter 
 under consideration. In the interest of the reader, therefore, this draw- 
 back has, in certain instances, been avoided by duplication. For a 
 similar reason the Editor has plentifully supplied ample cross-references, 
 intended to aid the student in his search for information. 
 
 Since writing and editing two Systems, the Editor has seen no good 
 reason to change his opinion as to certain orthographic rules, and he 
 therefore repeats that in his humble judgment the spelling of words 
 used by English peoples throughout the globe properly varies in dif- 
 ferent continents, and even in small subdivisions of these continents. 
 It has long been his profound conviction that the English language — 
 obviously a living, vigorous ,and progressive one, not reduced to the 
 uniformity of certain other dead and dying dialects — in the very nature 
 of things nmst exhibit transitional and evolutionary stages in different 
 parts of the Anglo-Saxon world. Consequently, any spelling that can 
 show a recognized authority, whether that authority be American, 
 Canadian, British, Australasian or South African, is acceptable to him 
 and is employed indifferently throughout this work. He contends that 
 it is useless to lay down arbitrary rules for spelling or pronunciation, 
 especially in a work intended to circulate among English-speaking peo- 
 ple generally. In consequence of this belief he has decided not to 
 attempt uniformitj^ of spelling either on the part of his collaborators 
 or of himself. In any event, it strikes him as unimportant whether 
 cocaine is spelled with or without an '^e," whether one wi'ites it "physiol- 
 ogic" or "physiological," whether or not the second syllable of anes- 
 tJiesia is spelled with a diphthong, whether tumor terminates in or
 
 INTRODUCTION 7 
 
 or our or center in re or er. Each contributor is allowed to do as he 
 pleases in this regard. 
 
 At first it seemed possible to adopt and apply some one of the vari- 
 ous methods of pronunciation to ophthahnic terms, but the difficulties 
 encountered were so great (for reasons that it is not necessary to elab- 
 orate) and the benefits to be derived so small that the attempt was 
 abandoned. 
 
 In the preparation of a work of this kind the Editor and his collab- 
 orators are much indebted to ophthalmic literature of all times and all 
 countries, but especially to those two principal monuments of ophthal- 
 mic industry, the Graefe-Saemisch Handhuch der gesamten Augenheil- 
 kunde and the Encyclopedie franqaise d'Ophtalmologie; and, while 
 they have endeavored to produce a work that will be of even greater 
 value to English-reading ophthalmologists, yet they acknowledge a large 
 debt of gratitude to the collaborators of these two Encyclopedias. The 
 EncyMopddie der Aiigcnheilliundc, although not yet completed, has 
 also been of considerable service to the Editor. In addition to these 
 the Editor is especially indebted to Norris and Oliver's System of 
 Diseases of the Eye, the Traite complet d'Ophtalmologie, Czermak 
 and Elschnig's Die AugendrtzUche Operationen, Beard's Ophthalmic 
 Surgery, Terrien's Chirurgie de VOeil, Lewin and Guillery's Die Wirk- 
 ungen von Giften auf das Auge, and to many other Monographs, Peri- 
 odicals, Year-Books, Transactions and Manuals of Ophthalmology, par- 
 ticularly the Nagel-Michel Jahresbericht, the Ophthalmic Y ear-Book, 
 Modern Ophthalmology, and the Italian Edition of Fuchs' Textbook. 
 The Editor has also utilized much of the material, duly revised, con- 
 tributed to Wood's System of Ophthalmic Therapeutics and System of 
 Ophthalmic Operations. 
 
 Both the Editor and Publishers of this Encyclopedia and Dictionary 
 of Ophthalmology wish to acknowledge, with thanks, the permission of 
 Messrs. P. Blakiston's Son & Co., Messrs. Wm. AVood & Co., Messrs. 
 Longmans, Green & Co., Messrs. J. B. Lippincott & Co. and Messrs. "W. 
 B. Saunders Co. to reproduce, with modifications, some of the cuts used 
 in copyright works owned by them. Messis. Hardy & Co. have kindly 
 supplied some of the illustrative "electros." The Editor is also under 
 obligations to so many other friends for assistance that it is hardly pos- 
 sible even to mention their names. He once more acknowledges the 
 valuable services of the illustrator, Dr. Charles G. Willson of Chicago, 
 as well as of Dr. A. Arkin, Miss Lillian Hummel and Miss H. A. Fox 
 for their assistance while the proof-sheets were passing under review. 
 The initials of collaborators are signed to topics more than a few
 
 8 INTRODUCTION 
 
 lines in length ; for unsigned rubrics the Editor is alone responsible. 
 In addition, a few friends have, on invitation, written some parts and 
 to their contributions the full name has been appended. 
 
 Casey A. Wood.
 
 INITIALS USED IN VOLUME 1, TO IDENTIFY 
 INDIVIDUAL CONTRIBUTORS* 
 
 A. A.— Adolf Alt, M. D., M. C. P. and S. 0., St. Louis, Mo. 
 
 Clinical Professor of Ophthalmology, Washington University, St. Louis, Mo.; 
 Author of Lectures on The Human Eye; Treatise on Ophthalmology for the 
 General Practitioner ; Original Contrilmtions Concerning the Glandular Struc- 
 tures Appertaining to the Human Eye and its Appendages. Editor of the 
 American Journal of Ophthalmology. 
 
 A. C. C. — Alfred C. Croftan, Ph. D., M. D., Chicago, III. 
 
 Author of Clinical Urinology and of Clinical Therapeutics. Member of the 
 General Staff of the Michael Eeese Hospital, Chicago. Formerly Physician-in- 
 chief at St. Mary's Hospital; Physician to St. Elizabeth's Hospital; Physician 
 to the Chicago Post-Graduate Hospital; Pathologist to St. Luke's Hospital. 
 Late Professor of Medicine at the Chicago Post-Oraduate College and the 
 Chicago Polyclinic; Assistant Professor of Clinical Medicine, College of Physi- 
 cians and Surgeons (University of Illinois) ; Member of the American Thera- 
 peutic Society. 
 
 A. N. M. — Alfred Nicholas Murray, M. D., Chicago, III. 
 
 Ophthalmologist, New Lake View Hospital. Formerly Clinical Assistant in 
 Ophthalmology, and Assistant Secretary of the Faculty, Eush Medical College. 
 Once Voluntary Assistant in the Universitaetes Augeuklinik, Breslau. Author 
 of Minor Ophthalmic and Aural Technique. Secretary, Physicians' Club of 
 Chicago. Mitglied der Ophthalmologischen Gesellschaft, Heidelberg. 
 
 A. S. R. — Alexander Sands Rochester, ;M. D., Chicago, III. . 
 
 M. D. Jefferson ^Medical College; Ex-Chief, San Lazaro Contagious Hosi>ital, 
 Manila, P. I.; Adjunct Ophthalmologist to St. Luke's Hospital, Chicago. 
 
 C. A. 0. — Charles A. Oliver (Deceased). 
 
 Joint Editor of A System of Diseases of the Eye; Writer of numerous mono- 
 graphs oir ophthalmic subjects. 
 
 C. F. P. — Charles F. Prentice, M. E., New York City, N. Y. 
 
 President, New York State Board of Examiners in 0})tometry; Special Lecturer 
 on Theoretic Optometry, Columbia University, New York. Author of A Treatise 
 on Ophthalmic Lenses (1886) ; Dioptric Formulce for Combined Cylindrical 
 Lenses (1888); A Metric System of Numbering a)id Measuring Prisms (the 
 Prism-dioptry) (1890); The Iris as Diaphragm and Photostat (1895), and 
 other optical papers. 
 
 C. H. B. — Charles Heady Beard. 
 
 Surgeon to the Illinois Charitable Eye and Ear Infirmary (Eye Department) ; 
 Oculist to the Passavant Memorial Hospital and the North Star Dispensary 
 (Chicago) ; Member and Ex-president of the Chicago Ophthalmological Society; 
 Member of the American Ophthalmological Society, Etc. Author of Ophthal- 
 mic Surgery (1910); and of Ophtludmic Semiology and Diagnosis (1913). 
 
 * A complete list of the contributors to this work will appear in the final 
 volume.
 
 10 INDIVIDUAL CONTRIBUTORS 
 
 D. H.— D'Orsay TIecht. 
 
 Assistant Professor of Nervous and Mental Diseases, Northwestern University 
 Medical yehool; Consulting Neurologist to the Cook County Institutions for 
 the Insane at Dunning, Illinois ; Attending Neurologist to the Michael Eeese 
 and St. Elizabeth 's Hospitals, Chicago. 
 
 E. C. B. — Edward C. Bull, Pasadena, Calif. 
 
 E. C. E. — Edward Coleman Ellett, B. A., M. D., Memphis, Tenn. 
 
 Professor of Ophthalmology, University of Tennessee, College of Medicine. 
 
 E. E. I. — Ernest E. Irons, M. D., Ph. D., Chicago, III. 
 
 Assistant Professor of Medicine, Ensh Medical College; Assistant Attending 
 , Physician, Presbyterian Hospital; Attending Physician, Cook County Hospital; 
 
 Consulting Physician, Durand Hospital of the Memorial Institute for Infec- 
 tious Diseases, Chicago. 
 
 E. J. — Edward Jackson, C. E., M. A., M. D., Denver, Colo. 
 
 Professor of Ophthalmology in the University of Colorado ; Former Chairman 
 of the Section on Ophthalmology of the American Medical Association; For- 
 mer President of the American Academy of Ophthalmology and Oto-Laryngol- 
 ogy; The American Ophthalmological Society, and The American Academy 
 of Medicine. Author of Skiascopy and Us Practical Application ; Manual of 
 Diseases of the Eye ; Editor of Ophthalmic Year-BooJc (nine volumes) ; Oph- 
 thalmic Review; Ophthalmic Becord; and OphtJialmic Literature. 
 
 E. S. T. — Edgar Steiner Thomson, M. D., New York City, N. Y. 
 
 Surgeon and Pathologist, Manhattan Eye, Ear and Throat Hospital; Professor 
 of Ophthalmology, New York Polyclinic Medical School and Hospital; Con- 
 sulting Ophthalmologist to Perth Amboy and Ossining Hospitals; Member of 
 the New York Academy of Medicine, New York Ophthalmological, and Ameri- 
 can Ophthalmological Societies. Author of Electric Appliances and Their Use 
 in Ophthalmic Surgery, in Wood 's System of Ophthalmic Operations, and 
 various monographs. 
 
 F. A. — Frank Allport, M. D., LL. D., Chicago, III, 
 
 Ex-Professor, Ophthalmology and Otology, Minnesota State University; Ex- 
 President, Minnesota State Medical Society; Ex-Chairman and Secretary, 
 Ophthalmic Section, American Medical Association; Ex-Professor, Ophthal- 
 mology and Otology, Northwestern University Medical School; Ex-President, 
 Chicago Ophthalmological Society. Author of The Eye and Its Care; Co- 
 Author of An American Text-Boole of Diseases of the Eye, Ear, Nose and 
 Throat; A System of Ophthalmic Therapeutics, and A System of Ophthalmic 
 Operations. Eye and Ear Surgeon to the Chicago Board of Education and 
 to St. Luke's Hospital, Chicago. 
 
 F. P. L. — Francis Park Lewis, M, D., Buffalo, N. Y. 
 
 President American Association for the Conservation of Vision; President 
 Board of Trustees N. Y. State School for the Blind; President N. Y. State 
 Commissions for the Blind (1903 and- 1906); Chairman Committee on Preven- 
 tion of Blindness, American Medical Association; Ophthalmologist Buffalo 
 State Hospital and Buffalo Homeopathic Hospital; Consulting Ophthalmologist 
 J. N. Adam Memorial Hospital; Fellow Academy Ophthalmology and Oto- 
 Laryngology. 
 
 H. B. W. — Henry Baldwin Ward, A. B., A. M., Ph. D., Champaign, 
 III. 
 
 Professor of Zoology, University of Illinois; Ex-Dean of the College of Medi- 
 cine, University of Nebraska. Author of Parasitic Worms of Man and the 
 Domestic Animals; Data for the Determination of Human Entosoa; Icono- 
 graphia Parasitorum Hominis; Human Parasites in North America.
 
 INDIVIDUAL CONTRIBUTORS 11 
 
 H. S. G. — Harry Searls Gbadle, A. B., I\I. D., Chicago, III. 
 
 Professor of Oplithalmology, Chicago Eye and Ear College; Director of Oph- 
 thalmic Clinic, West Side Free Dispensary; ^Member of the Ophthalniologische 
 Gesellschaft, American Medical Association, American Academy of Ophthal- 
 mology and Oto-Laryngology. 
 
 H. V. W. — Harry Vanderbilt Wurdemann, ■M. D., Seattle, Wash. 
 
 Managing Editor, Oplitlialmology, since 1904; Editorial Staff of the Opldlial- 
 mic Becord since 18f)7; jNIanaging Editor, Annals of OiihihalmnJomi, 1897- 
 
 1904. Mend)er American Medical Association; Ex-Chairimni Section on Oph- 
 thalmology, American Medical Association; Hon. Mcmlier, Socieilnd Cientifica, 
 Mexico; N. W. Wisconsin Medical Society and Philosophical Society. Fel- 
 low American Academy of Ophthalmology and Oto-Laryngology. Author of 
 Visual Ecovomics (1901); Injuries to the Eye (1912); Brir/ht's Disease and 
 the Eye (1912); and numerous monographs on the eye and its disenses. Col- 
 laborator on many other scientific books- 
 
 J. G., Jr. — John Green, Jr., A. B., iM. D., St. Louis, jMo. 
 
 Assistant in Ophthalmology, Washington University Medical School ; Ophthal- 
 mic Surgeon to St. Louis Children's Hospital; Ophthalmic Surgeon to St. Louis 
 Eye, Ear, Xose and Throat Infirmary; Consulting 0]ihthalmic Surgeon to St. 
 Louis Maternity Hospital; Consulting Ophthalmic Surgeon to St. John's Hos- 
 pital, St. Louis. 
 
 J. L. I\I.— John L. Moffat, B. S., M. D., 0. et A. Chir., Ithaca, N. Y. 
 
 Editor Jonimal of Ophtlialmoloflfi, Otology and Larjinf/ology. Consulting 
 0|dithalmic Surgeon, Cumberland Street Hospital, New York; MemV)er (v.-j). 
 
 1905, 1908) American Homoeopathic Oidithalmological, Otological and Laryn- 
 gological Society; Member American Medical Editors' Association; Member 
 (Senior) American Institute of Homoeopathy; Senior Member (ex-pres.) New 
 York State Homceoi)athic Medical Society; Senior Memlier (ex-pres.) Kings 
 County (N. Y. ) Homreoiiathie Medical Society; Honorary Memlier N. Y. County 
 Homoeopathic Medical Society. 
 
 J. M. B. — James ^Ioores Ball, AI. D., LL. D., St. Louis, ]\Io. 
 
 Dean and Professor of Ophthalmology, American Medical College of St. Louis, 
 Medical Department of National University of Arts and Sciences. Author of 
 Modern Ophthalmology ; Andreas Vesalius the Eeformer of Anatomy. 
 
 J. R. C. — James Raley Cravatii, B. S., Chicago, III. 
 
 Electrical and Illuminating Engineer, Chicago; Vice-President, Illuminating 
 Engineering Society; foinierly associate editor Electrical Wor-ld ; joint author 
 Practical Illumination by Cravath and Lansingh ; joint nuthor Light — Its Use 
 and Misuse. ]ire]iared by committee of the Illuminating Engineering Society; 
 author of Illnmination and Vision ; Tests of the Lighting of a Small Eooni ; and 
 numerous other monographs. 
 
 L. H.— LuciEN Howe, M. A., M. D., Sc. D., Buffalo, N. Y. 
 
 Professor of Ophthalmology, LTniversity of Buffalo ; ]\Iember of the Royal Col- 
 lege of Surgeons of England; Fellow of the Eoyal Society of Medicine; Mem- 
 ber of the Ophthalmologische Gesellschaft and of the Societe Frangaise 
 d'Ophthalmologie. Author of The Muscles of the Eye. 
 
 M. S.— Myles Standish, A. M., M. D., S. D., Boston, Mass. 
 
 Williams Professor of Ophthalmology, Harvard University; Consulting Oph- 
 thalmic Surgeon, Massachusetts Charitable Eye and Ear Infirmary and Carney 
 Hospital, Boston, Mass.
 
 12 INDIVIDUAL CONTRIBUTORS 
 
 N. M. B.— Nelson M. Black, Ph. G., M. D., Milwaukee, Wis. 
 
 Author of Tlie Development of the Fusion Center in the Treatment of Strabis- 
 mus; Examination of the Eyes of Transportation Employes ; Artificial Illumina- 
 tion a Factor in Ocular Discomfort, and other scientific papers. 
 
 P. A. C— Peter A. Callan, M. D., New York City, N. Y. 
 
 Surgeon, New York Eye and Ear Infirmary; Ophthalmologist to St. Vin- 
 cent 's Hospital ; Columbus Hospital and St. Joseph 's Hospital, New York. 
 
 P. G. — Paul Guilford, M. D., Chicago, III. 
 
 Ex-Eesident Surgeon, Wills Eye Hospital, Philadelphia; Attending Oculist and 
 Aurist, St. Luke's Hospital; Attending Oculist and Aurist, Chicago Orphan 
 Asylum ; Consulting Oculist and Aurist, South Side Free Dispensary. Co- 
 Author of A System of Ophthalmic Operations. 
 
 T. H. S.— Thomas Hall Shastid, A. B., A. M., M. D., LL. B., F. A. C. S., 
 Superior, Wis. 
 
 Honorary Professor of the History of Medicine in the American Medical Col- 
 lege, St. Louis, Mo. ; Late Editorial Secretary of The Ophthalmic Becord. 
 Author of A Country Doctor; Practising in Tike; Forensic Belations of 
 Ophthalmic Surgery (in Wood's System of Ophthalmic Operations) ; Legal 
 Belations of Ophtlialmology (in Ball's Modern Ophthalmology) ; A History of 
 Medical Jurisprudence in America (in Kelly's Cyclopedia of American Medical 
 Biography). 
 
 W. C. p. — Wm. Campbell Posey, B. A., M. D., Philadelphia, Pa, 
 
 Professor of Ophthalmology in the Philadelphia Polyclinic Hospital and 
 Graduate Medical School; Ophthalmic Surgeon to the Wills, Howard and 
 Children 's Hosj^itals ; Chairman of the Pennsylvania Commission for the 
 Conservation of Vision; Chairman of Section on Ophthalmology, College of 
 Physicians, Philadelphia. Editor of American Edition of Nettleship's Text- 
 book of Ophthalmology; Co-Editor, with Jonathan Wright, of System of Dis- 
 eases of the Eye, Ear, Nose and Throat; Co-Editor, with Wm. G. Spiller, of 
 The Eye and the Nervous System. 
 
 W. F. H.— William Frederic Hardy, M. D., St. Louis, Mo. 
 
 W. H. W, — William Hamlin Wilder, A. M., M. D., Chicago, III. 
 
 Professor and Head of Department of Ophthalmology, Eush ^Medical College 
 (in affiliation with University of Chicago) ; Professor of Ophthalmology, Chi- 
 cago Polyclinic; Surgeon, Illinois Charitable Eye and Ear Infirmary; Ophthal- 
 mic Surgeon, Presbyterian Hospital; Member American Ophthalmological So- 
 ciety. 
 
 W. 0. N. — Willis Orville Nance, M. D., Chicago, III. 
 
 Ophthalmic Surgeon, Illinois Charitable Eye and Ear Infirmary; Late Oculist 
 and Aurist to Cook County Hospital; President, Chicago Ophthalmological 
 Society. 
 
 W. R. — Wendell Reber, M. D., Philadelphia, Pa. 
 
 Professor of Diseases of the Eye in the Medical Department of Temple Uni- 
 versity; Professor of Diseases of the Eye in the Philadelphia Polyclinic and 
 College for Graduates in Medicine; Ofihthalmic Surgeon to the Samaritan 
 Hospital, to the Philadelphia General Hospital, to the Garretson Hospital ; Con- 
 sulting Ophthalmologist to the Friends ' Asylum for the Insane ; Member of the 
 Council of the Oxford Ophthalmological Congress ; Past President of the Ameri- 
 can Academy of Ophthahnology and Oto-Laryngology; joint author of a Hand- 
 hook on the Miiscidar Anomalies of the Eye.
 
 LIST OF LEADING SUBJECTS IN THIS 
 
 VOLUME 
 
 Abadie's ciliarotomy operation 
 
 Aberration 
 
 Abrus precatorius 
 
 Abscisson 
 
 Accommodation 
 
 Achromatism 
 
 Acid, Boric 
 
 Acids (various) 
 
 Acromegaly, Eye symptoms op 
 
 Actr'e immunization in bacterial infection 
 
 Acuteness of vision 
 
 Adaptation of the retina 
 
 Adrenalin 
 
 Advancement 
 
 After-cataract and its treatment 
 
 After-image 
 
 After-treatment of ophthalmic operations 
 
 Agnew, Cornelius Rea 
 
 Air, Therapeutic uses of 
 
 Albinism 
 
 Albuminuria, Diseases of the eye in 
 
 Alcohol (ethyl) 
 
 Alcohol (methyl) 
 
 Aleppo button 
 
 Alexia 
 
 Ali ben Isa 
 
 Allergy 
 
 Allport 's operation for enucleation 
 
 Allport 's operation for ptosis 
 
 Alphabets and literature for the blind 
 
 Alypin 
 
 Amanita 
 
 Amaurosis 
 
 Amblyopia from hemorrhage 
 
 Amblyopia, Hysterical 
 
 13
 
 14 LIST OF LEADING SUBJECTS 
 
 Amblyopia, Toxic 
 
 Amblyoscope, The 
 
 Ametropia 
 
 Ammab 
 
 Ammon, F. a. von 
 
 Ammon-Agnew cantholysis, The 
 
 Amyloid degeneration 
 
 Anaphylaxis 
 
 Anatomy of the human eye and appendages 
 
 Anel, Dominique 
 
 Anesthesia in ophthalmic surgery 
 
 Anesthesia, Local 
 
 Aneurysm 
 
 Angioma venenosum of the orbit 
 
 Angles (various) 
 
 Aniline, Oculo-toxic symptoms from 
 
 Animals ' eyes, Uses of, in ophthalmology 
 
 Aniridia 
 
 Ankylostomiasis 
 
 Anophoria 
 
 Anterior sclerotomy 
 
 Antibodies 
 
 Antigen 
 
 Antipathy to binocular single vision 
 
 Antipyrine 
 
 Antisepsis and antiseptics 
 
 Apparent size of objects 
 
 Aqu^ (various) 
 
 Arc lights and their effect on the eye 
 
 Argyll-Robertson pupil 
 
 Argyrol 
 
 Aristotle 
 
 Arlt-Jaesche operation for trichiasis 
 
 Armitage, Francis Rhodes 
 
 Army, Visual requirements for the 
 
 Ar-Razi 
 
 Arsenical amblyopia 
 
 Arterio-sclerosis 
 
 Artrio-sclerosis, Ocular 
 
 Artificial eyes and similar devices 
 
 Artificial ripening of immature cataract 
 
 Aspiration of cataract
 
 LIST OF LEADING SUBJECTS 15 
 
 As-Sadili 
 
 Asthenopia 
 
 Astigmatism 
 
 Astringents, Ocular 
 
 Atrophy op the optic nerve 
 
 Atropine 
 
 Auto-intoxication 
 
 Auto-ophthalmoscope 
 
 Ajsis 
 
 Axis, The, in refraction 

 
 AMERICAN ENCYCLOPEDIA AND 
 DICTIONARY OF OPHTHALMOLOGY 
 
 A. Just as in modern times one often uses the initial letter of the 
 name of a patient whose identity one desires to conceal, so the an- 
 cients occasional l.y employed the same device. This practice is 
 exemplified in the abbreviated name of a classical patient, whose 
 anamnesis and case-report are both very interesting on account of 
 their ''local color. '' They ap])ear on a marble votive-tablet, exhumed 
 in 1883, together with similar tablets, from the ruins of the temple of 
 Asklepios at Epidaurus. A 's tablet, which dates back nearly to the 
 time of Hippocrates, reads as follows: "A. Was healed in the 
 eyes. This man Avas struck in battle by a spear, and became blind 
 in both eyes, and carried about w4th him the point of the lance in 
 his face for an entire year. But, in the temple-sleep, he beheld a 
 vision. It seemed to him that the god drew out of him the weapon, 
 and placed back between the lids what is called the sight. As it 
 became day, he went forth from the precincts, wholly cured." 
 
 For temple-sleep as a means of treatment, see History of ophthal- 
 mology.— (T. H. S.) 
 
 A. Abbreviation for accommodation. 
 
 Abadie's ciliarotomy operation in glaucoma. Abadie (Section de la 
 zone ciliaire ou ciliarotomies. Arcliiv. (ropliiulm., May, 1910, p. 262) 
 under the supposition that irritation of the rich circular nervous 
 plexus which covers the ciliary zone immediately behind the inser- 
 tion of the iris, may induce glaucoma, undertakes to relieve the con- 
 dition liy division of the ciliary zone, or as he terms it, by "ciliaro- 
 tomy.'' The technique of the operation is as follows: 
 
 ''A fold of the bulbar conjunctiva is raised by means of forceps 
 towards the supero-external quarter of the cornea. The conjunctiva, 
 raised with fine dull-pointed scissors, is divided in the direction 
 of the corresponding meridian of the eye for about li/o centimetres. 
 The conjunctiva being thus cleft, one takes the superior flap and 
 Avith ordinary strabismus scissors detaches it from the sclera while 
 raising it up, taking care, in order to disengage it well, to liber- 
 ate its attachment to the sclero-corneal limbus by small cuts of the 
 .scissors. The inferior flap is treated in a similar way. By these 
 means a large triangular surface of the sclera is bared, the base of 
 which is formed by the cornea and the apex by the terminal point 
 
 Vol. 1—2 
 
 17 .
 
 18 ABADIE'S OPERATION FOR ELECTROLYSIS. 
 
 of the conjunctival opening made in the first instance. A coirple of 
 sutures are now passed through the two conjunctival flaps, whereby 
 they may be brought together in order to cover the wound which 
 is about to be made in the ciliary region. 
 
 The sutures once in place, both are pulled outward in such a 
 way as to expose the field of operation. Then, seizing with fixation 
 forceps the conjunctiva and the episcleral tissue at the level of the 
 inferior conjunctival flap, so as to keep the eye perfectly steady, 
 the point of Richter's triangular knife is inserted just at the junc- 
 tion of sclerotic and cornea, immediately behind the insertion of 
 the iris. It is gently plunged, so to speak, into the globe, its point 
 being directed towards the centre, and its blade in the correspond- 
 ing sense of the eye. In consequence of its triangular form, its 
 propulsion towards the centre of the eye causes its cutting edge 
 to divide the ciliary zone. By slight sawing movements of the blade, 
 this section is enlarged in such a way that it attains a length of 
 from 7 mm. to 8 mm. — that is to say — about the extent of the ciliary 
 nervous plexus. The knife is then withdrawn. Contrary to what 
 might be expected, only one or two drops of vitreous issue from 
 the incision, which is only a mere slit. 
 
 Then, by tying the two sutures previously placed in the con- 
 junctival flaps, the conjunctiva is brought together, thereby cov- 
 ering the scleral surface and the incision that has just been made." 
 
 Abadie asserts that his procedure is especially adapted to cases 
 of glaucoma which persist despite iridectomy. The results have been 
 uncomplicated, without luxation of the lens, or intraocular hemor- 
 rhage.— (W. C. P.) 
 Abadie 's operation for intravitreous electrolysis. Abadie (Desorgani- 
 cation du corps vitre ; electrolyse ; restitution de la vision. Annales 
 d'Oculisiique, 114, August, 1895, p. 126) has used electrolysis for 
 the dispersion of vitreous opacities. He introduces a platinum- 
 iridium needle 8 mm. long into the depths of the vitreous. The 
 needle is connected with the positive pole of a galvanic battery, the 
 negative electrode being placed on the arm. A stream of three or 
 four milliamperes is applied for five minutes. In a case described 
 by him there was marked improvement in the local condition and 
 in the eyesight. 
 Abadie 's operation for iridoectomy. Two corneal incisions are made at 
 opposite sides of the same corneal diameter, each about 5 mms. in 
 length, with lance knives. Then the pince-ciseaux, one blade of which 
 has a sharp point, are entered with this blade through the one cor- 
 neal section into the iris diaphragm, which is cut by two divergent
 
 ABADIE'S SIGN 
 
 19 
 
 Abadie Iridoectomy (after Beard). 
 
 incisions. Entering a hook or iris forceps through the opposite 
 corneal incision, the iris flap is seized at its ai)ex, drawn out and 
 cut off.— (A. A.) 
 
 Abadie 's sign. Spasm of the levator palpebras superioris in exoph- 
 thalmic goitre, elicited by simple inspection. 
 
 Retraction of tlie upper eyelid in Graves' disease, due, according 
 to some, to spasm of all the fibres of the levator i)ali)el)ra' superioris 
 muscle, according to others, of the unstriped fibres only, i. e., the 
 so-called IMiiller's muscle. The presence or absence of this sign is 
 determined by simple inspection. The sign is present intermittently 
 in the beginning of the disease (clonic spasm) but is apt to be con- 
 tinuous in the later stages (tonic spasm). Abadie 's sign ought not 
 to be confounded, on. the one hand, with Graefe's sign, whiclL con- 
 sists of lagging of tiie upper lid when the patient looks down; or, 
 on the other hand, with Stellwag"s sign, Avhich consists of infre- 
 quency and slowness of winking. 
 
 Abaissement. (F.), n. A lowering, as of the eyelids. Couching for 
 cataract. 
 
 Abaisseur de la paupiere. (F.), n. An instrument for depressing the 
 lower lid. 
 
 Abaisseur de la pupille. (F.), n. The rectus inferior muscle. 
 
 Abaisseur de I'oeil. (F.), n. The inferior rectus muscle. 
 
 Abart. (G.) A degenerate; degeneracy. Also a variety or varia- 
 tion. 
 
 Abasie. (G.) Restlessness. 
 
 Abatio retinae. Detachment of the retina. 
 
 Abatzen. (G.), tr. v. To remove with caustic; to cauterize. 
 
 Abaxial. Not situated in the line of the axis. 
 
 Abbacinate. To deprive of sight by placing a red-hot copper basin 
 close to the eyes: a mode of punishment employed in the middle ages. 
 Also spelled abaciiiaie. 
 
 Abbacination. The act or process of blinding a person by placing t. 
 red-hot copper basin close to the eyes. Also spelled ahacinafion 
 
 Abbaden. (G.) To cleanse bj^ bathing ; to bathe.
 
 20 ABBAGLIAMENTO PER OPACITA CORNEALI 
 
 Abbag-liamento per opacita corneali. (It.) Interference with vision 
 from corneal opaeitj^ 
 
 Abbahen. (G.) To foment thoroughly. 
 
 Abbalg-en. (G.), tr. v. To enucleate. 
 
 Abbau. (G.) Breaking up; decomposition. 
 
 Abbeizen. (G.), tr. y. To remove by means of cauterants. 
 
 Abbe's intrinsic magnifying power. In optics, the ratio of the visual 
 angle subtended at the eye by the image viewed through the in- 
 strument to the corresponding linear dimension of the object. — 
 (C. F. P.) 
 
 Abbe's measure of the indistinctness of the image. In optics, a meas- 
 ure of the lack of detail in the image, which shows that the "indis- 
 tinctness, ' ' on account of the spherical aberration, is proportional to 
 the cube of the aperture of the bundle of object rays. — (C. F. P.) 
 
 Abbeugen. (G.) To turn away. 
 
 Abbeugen die Augen. (G.) To avert the eyes; to turn them to one 
 side. 
 
 Abbiegung. (G.), n. Abduction. 
 
 Abbinden. (G.) To ligate ; especially to tie off or remove with an 
 ecraseur. 
 
 Abbindewerkzeug. (G.) Instruments for ligating parts. 
 
 Abbindung. (G.) To tie off; or removal by ligature. 
 
 Abbiss. (G.) A biting off; the part bitten off. 
 
 Abblassen. (G.) To fade; to turn pale; to lose color. 
 
 Abblattern. (G.), intr. v. To exfoliate. 
 
 Abblatternd. (G.) Exfoliative. 
 
 Abblatterung. (G.) Exfoliation. 
 
 Abblatterungsmittel. (G.) An exfoliative. 
 
 Abbott, Frank Wayland. This well-known otologist and ophthalmolo- 
 gist, son of Rev. E. L. Abbott, missionary to Burmah, was born at 
 Sandoway, Aracan, Burmah, Dec. 24, 1841. He was educated at 
 Falley Seminary, Fulton, N. Y., at the University of Rochester, 
 Rochester, N. Y., and at the medical department of the University 
 of Buffalo. His medical degree he received in 1866. Devoting him- 
 self exclusively to diseases of the eye and ear, he settled in Buffalo. 
 He was an active member of a number of medical societies, con- 
 tributed numerous articles to various medical journals, and pro- 
 duced an excellent translation of Helmholtz's "Recent Progress in 
 Theory of Vision." He was attending ophthalmologist and aurist to 
 the Buffalo General Hospital and to the Charity Eye and Ear Hos- 
 pital of Erie Co., N. Y. 
 
 He married June, 1869, Julia H. Baker, of Buffalo, New York.
 
 ABBRAND 21 
 
 Dr. Abbott Avas a very religious man and regarded as an ideal 
 citizen. Concerning these salient aspects of his character, a 
 friend writes as follows: " 'We loved Abbott for the things he 
 would not do.' lie was incapable of a mean action and many can 
 testif}^ to the kind things he Avould do for a younger man : the 
 writer Avas such a beneficiary on more tlian one occasioji. If Dr. 
 Abbott AA'as not a great man in Ihc sense of being Avidely knoAA'n, 
 he was at least great in lieing an honest man. He enjoyed a good 
 story, and could tell one, and got considerable comfort from tobacco. 
 He gave much time and energy to charitable Avork. and was greatly 
 interested in the Charity Eye and Ear Hospital, of Avhich he Avas 
 one of the founders." 
 
 Dr. Abbott died at Bufit'alo, x\. Y., April 0. 1001, after an illness of' 
 about three months.— (T. H. S.) 
 
 Abbrand. (G.) The oxide formed Avhen a metal is heated in the 
 air; the loss of material in the process of testing by heat. 
 
 Abbrechen. (G.) A tearing apart; a rupture. 
 
 Abbrennen. (G.), tr. v. To burn off or out. 
 
 Abbrennzange. (G.) Cautery clamp or forceps. 
 
 Abbruciamento. (Tt.) A burn. 
 
 Abbriihung. (G.) A scalding. 
 
 Abcede. (F.), adj. Having formed an abscess. 
 
 Abceder. (F.), intr. v. To discharge (as of an abscess). 
 
 Abces. (F.), n. An abscess. 
 
 Abces de I'oeil. (F.), n. Panophthalmitis. 
 
 Abd. Abbreviation for abduction. 
 
 Abdachung". (G.) A decline; a doAA'UAvard slope. 
 
 Abdampfapparat. (G.) An apparatus for a Avater-bath. 
 
 Abdampfen. (G.) To evaporate; to cause to evaporate. 
 
 Abdampfkessel. (G.) An evaporating basin. 
 
 Abdampfriickstand. (G.) The residue after evaporation. 
 
 Abdampfschale. (G.) An evaporating pan or vessel. 
 
 Abdampfung. (G.) Evaporation; vaporation. 
 
 Abdestillieren. (G.) To distill. 
 
 Abdrehen. (G.) To tAvist olT; to remove by torsion. 
 
 Abducens. (L.), n. The external rectus muscle, Avhose action it is to 
 rotate the globe outAvard. It arises by two heads, one from the outer 
 margin of the optic foramen ; the other from the loAver margin of 
 the sphenoidal fissure. The tendon is inserted into the sclera near 
 the outer margin of the cornea. See Muscles, Ocular. 
 
 Abducens. (L.), adj. Abducting. Acting as an abductor. 
 Abducenskern. (G.) Abducens nucleus.
 
 22 ABDUCENSLAHMUNG 
 
 Abducenslahmung-. (G.) Paralysis of the rectus externus. 
 
 Abducensnerve. (G.) Abducens nerve. 
 
 Abducens paresis or paralysis. This term is generally regarded as 
 sjaionynious with paralysis of the rectus externus. On account of 
 its long course from the base of the skull and its intimate relation 
 with the carotid artery, the abducens is often subject to paralysis, 
 especially of basal origin. Paralysis of the nucleus occurs occasion- 
 ally in processes that involve the rhomboid fossa in the fourth ven- 
 tricle, while peripheral paralysis of rheumatic, syphilitic or traumatic 
 nature also occurs. Paralysis of both abducentes occurs. occasion- 
 ally, and may be found in tal)es, neoplasms about the base of the 
 skull, basal meningitis, etc. See Muscles, Paralysis of the ocular. 
 
 Abducent, adj. Abducting. Relating to an abductor. 
 
 Abducere. (L.), tr. v. To abduct or draw a part away from the 
 median line. 
 
 Abduciren. (G.), tr. v. To dra^v a part away from the median line 
 of the body or of a limb. To abduct. 
 
 Abducirend. (G.) Abducent. 
 
 Abducirende Prismen. (G.) Abducting prisms, i. e.. those whose 
 apices are directed towards the temples. 
 
 Abduct, tr. v. To draw a part away from the median line of the 
 body. 
 
 Abducteur. (F.), adj. and n. Abducting. Acting as an abductor. 
 An abductor. 
 
 Abducteur de I'oeil. (F.), n. See Abducens. The external rectus 
 muscle of the eye. 
 
 Abduction is a drawing of the eye outward, in the horizontal plane. 
 It is produced primarily by the action of the external rectus. Under 
 normal conditions, however, the eye is turned outward by the exter- 
 nal rectus acting with the superior and inferior oblique. It is under 
 control of the sixth nerve, of the branch of the third — Avhich goes to 
 the inferior rectus, and of the fourth nerve. It is consequently a 
 complicated movement, involving three nerve centers. 
 
 The extent of abduction, as measured with a reliable form of the 
 tropometer (q. v.), varies within certain limits. Volkmann gives it 
 as 38° in the horizontal plane, ^lost other observers place normal 
 abduction at about 42 to 45°. It not only ditt'ers somcAvhat in differ- 
 ent individuals, but also possibly in the same individual at different 
 times. — (L. II.) See Muscles, Ocular. 
 
 Abduction, Voluntary. A term (willkiirliche Abduction) introduced 
 by V. Graefe to indicate the efforts of the muscles and movement of 
 the globe necessary to overcome abducting prisms.
 
 ABDUCTOR 23 
 
 Abductor, n. A muscle or nerve whose action it is to abduct a part, 
 or draAv it from the median line of the body. 
 
 Abductor oculi. (L.), n. See Abducens. The external rectus muscle. 
 
 Abduktion. (G.) Abduction. 
 
 Abduktionsbeweg-ung'. (G.) Movement of abduction. 
 
 Abduktoren. (G.) Abductors. 
 
 Abduktorsmass. (G.) An abductor's measurement of. 
 
 Abdul fudail b. Naqid. A Jewish ophthalmologist of the Arabian 
 period, who practised in Cairo, and died A. D. 1158. 
 
 Abdunsten. (G.) To evaporate. 
 
 Abdunstung-. (G.) Evaporation. 
 
 Abduttore. (It.), adj. Acting as an abductor. 
 
 Abduttore dell' occhio. (It.), n. See Abducens. The external rectus 
 muscle (abductor) of the eye, whose action rolls the globe outward. 
 
 Abduzieren. (G.) To abduct. 
 
 Abduzierung. (G.) Abduction. 
 
 Abduzione. (It.), n. Movement from the median line of the body. 
 Abduction. 
 
 Abeng'efit. One of the Ifitcr Spanish-Arabian oi)bthalmologists who 
 lived and practiced during the eleventh century. See Abenguefit. 
 
 Abenguefit. Abul ]Mutarrif Abd ar-Raiimax b. Muhammed b. Abd al- 
 Kabim b. Jaiija IbnAVafid ai.-Lahmi. Also called by his Latin trans- 
 lators Abengefit. One of the later Spanish-Arabian physicians, 
 born of a distinguished Arabian family which settled in Spain, at 
 Toledo, A. D. 998 (997?) He was noted in politics as well as in 
 medicine, and became vizier to the Prince of Toledo as well as phy- 
 sician to the chief hospital in that city. The best of his works were 
 those on general medicine: Dc medicament is simplicibus and De 
 baUieis serm,o. He wrote, also, a book on ophthalmology, entitled 
 Book of tlic Exact Consido-ation of the Diseases of the Sense of Sight. 
 This was not without influence in Spain for several centuries, but 
 is not now extant in any language. Abenguefit died A. D. 1070 or 
 1074.— (T. H. S.) 
 
 Aberrancy of curvature. In inatheinalics, the angle between the nor- 
 mal to a curve at any })oint and the line from that point to the mid- 
 dle point of the inthiitesimal chord i)arallel to tlie tangent. 
 
 Aberratio chromatica. (L.) See Aberration, Chromatic. Unequal re- 
 fraction of color ra3^s. 
 
 Aberration. In optics, a deviation in the direction of rays of light 
 when unequally refracted (by a lens) or reflected (by a mirror), 
 so that they do not converge to a common point or focus, produc- 
 ing a distorted or indistinct image, with more or less color.
 
 24 ABERRATION 
 
 Coma dberraUon, is an unsymmetrical aberration of the image of 
 a fairly extensive object demanding the incidence of wide-angle 
 bundles of rays, these being differently deviated in the right-angled 
 co-ordinate sections of the refracted bundle. For instance, the 
 light-pattern projected by an objective upon a screen some times 
 presents the api:)earance of a comet, with its tail turned either 
 towards or away from the optical axis, which accounts for the 
 origin of the name "coma." 
 
 Chromatic aberration in a lens is due to the decomposition of 
 white light produced by the inherent variable prismatic power of 
 the lens, w^hich is greater near its edge. The red rays of the spec- 
 trum being less refrangible than the violet rays cause the latter to 
 
 Lateral Aberration. 
 
 cross the optical axis nearer to the lens, so that the more remote 
 focussed image is fringed with color, usually blue. The focal 
 length of a lens is shorter for blue than for red rays, or the two 
 principal foci for blue rays are nearer to the lens than those for 
 red rays. The chromatic aberration for incident parallel rays is 
 equal to the mean focal length of the lens, multiplied by the 
 chromatic dispersive power (q. v.) of the substance of which the 
 lens is made. 
 
 A lens may be constructed to be tolerably free from this defect, 
 when it is called achromatic, (q. v.) and when an optical system is 
 brought to its highest possible state of perfection, in this respect, it 
 is said to be apochromatic (q. v.). 
 
 Lateral aberration, the radius of that circle (inside of which all 
 the rays of the bundle cross the perpendicular image-plane at the 
 cusp) which is produced by intersections of the extreme edge-
 
 ABERRATION 25 
 
 rays Avith the image-plane. Abbe employs this radius, ]\rV', as the 
 so-called lateral ahcrralion of the extreme ray; and he defined the 
 Magnitude of the LaUral AJx rraiion as being equal to M'L'/N'L'X 
 N'V^'. Here M'L' is the distance between the image-point (cusp) 
 and the axial intersection, L', of the extreme ray; N'L', the dis- 
 tance between the least circle of aberration (q. v.) and the point 
 L'; and M'V, the radius of the lateral aberration. (For extended 
 formula^, see Southall, Principles of Geometrical Optics, Chapter 
 XH.) 
 
 Longitudinal aherration, also commonly called sphericcd aberration, 
 is due to a curvature of the lens or mirror, which Avhile effecting 
 a more or less sharj^ly defined focus for the central rays, causes 
 those rays which are refracted or reflected near the edge of the 
 lens or mirror, respectively, to cross each other before reaching 
 the focal point. These consecutive points of intersection generate 
 in any principal axial plane a caustic curve (q. v.) whose cusp is 
 at the focus. Consequently the refracted or reflected rays envelop 
 a surface called the caustic which is the evolute of the refracted 
 or reflected wave. Even actual point-images which are neces- 
 sarily formed by bundles of rays of finite aperature (a narrow 
 zone immediately surrounding the optical axis) are, in general, 
 more or less associated with longitudinal aberration which is un- 
 detectable by the eye, owing to its comparatively poor resolving 
 power. Furthermore, the rays of an isolated bundle which are 
 obliquely incident upon a very small surface-element at the 
 peripheral part of a lens or mirror are transformed by refraction or 
 reflection, at a surface of any form, into a non-homocentric or 
 astigmatic bundle of rays, all the rays of which, at least to a first 
 approximation, intersect two infinitely short lines, the so-called 
 image-lines of the bundle. This phenomenon is explained by 
 Sturm, the originator of the theory of astigmatism (q. v.). A 
 single lens is not ftee from this defect, but, through suitable com- 
 binations of lenses, it has been found possible to construct optical 
 SA^stems which, by means of wide-angle bundles of rays, will give 
 a true image of an axial objeet-i^oint or of a small surface-element 
 placed at right-angles to the optical axis. Such systems are called 
 aplanatic (q. v.). The longitudinal aberration is measured along the 
 optical axis, being the distance between the focus of the paraxial 
 rays and the nearer point of axis-intersection of the rays that emerge 
 from the periphery of the aperture, and upon whose magnitude 
 the aberration depends.
 
 26 ABERRATION 
 
 Longitudinal aberration of a thin lens, exposed to an object-point 
 situated at infinity, is expressed by Prof. Southall's equation: 
 
 b-p ( (n-1) (n+2) c- e n^ 
 
 2(n-l) ( n 0- ' ' ' ' n-1 
 
 wherein the value Avithin the major brackets is the factor by which 
 
 h- ( 1 1 ] h2 h-> 
 the thickness, -—-, i=-7r (c - c') = -r— — of the lens 
 
 2 ( rj r. ^ 2 ' ^ 2 (n - 1) 
 
 has to be multiplied in order to obtain the longitudinal aberra- 
 tion, E'L', along the axis. In the above equations, he represents the 
 serai-diameter of the lens; = 1/f, the reciprocal of its primary 
 focal length; n, the index of refraction; and c = l/r^ and c' =- 
 l/r.,, the curvatures of the bounding surface of the lens in air. For 
 instance, practical application of the above formula to a plano- 
 convex lens reveals that the longitudinal aberration is greatest when 
 its plane side is turned towards, and least when its plane side is 
 turned away from, the object-rays. Since it is not practically feas- 
 ible to entirel.y abolish longitudinal aberration in an infinitely thin 
 lens that is exposed to an object-point situated at infinity. Prof. 
 Southall gives the following etjuations for the curvatures c^, and c^/ 
 of the surfaces : 
 
 n (2n + 1) 2n2 - n - 4 0, 
 
 and c,/ = 
 
 " 2 (n - 1) (n + 2) ' " 2 (n - 1) (n + 2) 
 
 which meet the requirement of minimum aberration (E'L') as 
 
 n (4n-l) 
 expressed by the eciuation: (E'L')^ = — g u-^ . 1)2 (^ 1 2)l i20 
 
 In order to secure this minimum degree of aberration in a thin lens 
 exposed to an object-point at infinity, the curvature c„ and c,/ must 
 bear the folloAving relation to each other: 
 
 n (2n + 1) 
 
 "^^ ■ ^"' ^ 2n2 - n - 4 '• 
 Through the above equations, and the choice of an index ^= 3/2 it can 
 be shown that a bi-convex lens has the least longitudinal aberration 
 when the curvature of its front surface (c,,) is six times as great as 
 the curvature (C(/) of its back surface. Within rational limits it 
 is also feasible to vary the relative curvatures of the surfaces with- 
 out altering the focal length; this procedure being called, "bend- 
 ing the rays," (q. v.). 
 
 Least circle of aberration, a circle perpendicular to the axis, lo- 
 cated within the amplitude of the longitudinal aberration, whose 
 diameter is determined by intersections of the edge-rays with the
 
 ABERRATION, CHROMATIC 
 
 •27 
 
 caustic surface after these rays have crossed tlie axis. The dis- 
 tance of the least circle of aberration from the image-point is ap- 
 proximately e(iual to % of the longitudinal aberration of the ex- 
 treme outside ray. 
 
 Least circle of chromatic aberration, the circle of colored light ob- 
 served in experiments with convex lenses, and Avhich lies between 
 the points where the red and violet rays separately focus. 
 
 Spherical aherrafion, see longitudinal aberration above. — (C. F. P.) 
 Aberration, Chromatic. Xkwtoman aberration. Inequality in the re- 
 
 Chiomatic Aberration. 
 
 fraction of the rays of different colors, so that colored images are pro- 
 duced about the focus of the lens. 
 
 Aberration chromatique. (F.), n. Deviation of the rays of light from 
 the principal focus of a curved lens or mirror, thus producing a col- 
 ored image at the focal point. 
 
 Aberration of light. In optics, comprises an extensive series of phe- 
 nomena, one of which, discovered by Bradley in 1728, is the variation 
 in the apparent position of a star, due to the motion of the observer 
 with the earth.— (C. F. P.) 
 
 Aberration, Spharische. ((1.) Spliciictil iiberration. 
 
 Aberrazione. (It.), n. See Aberration. Any deviation from the 
 normal course. 
 
 Aberrazione cromatica. (It.) See Aberration, Chromatic. 
 
 Aberroscope. Tscherning has constructed this instrument, for de- 
 termining the presence or absence of aberration in the human eye, 
 
 Tscherning 's Aberroscope.
 
 28 ABFALL 
 
 (see figure) consisting of a plano-convex lens which, on its plane 
 side carries a micrometer in the form of little squares. One looks, 
 in making the test, at a distant luminous point through the lens, 
 moving it 10 to 20 centimeters from the eye in order to observe 
 whether the lines then appear curved or not ; if the latter there is 
 no perceptible aberration. 
 
 Abfall. (G.) Subsidence; depression. 
 
 Abfallen. (G.) To fall off; to fall away. 
 
 Abfeg-end. (G.) Detergent. 
 
 Abfegung (G.). Depuration. 
 
 Abfeuchten. (G.) To moisten or wet. 
 
 Abfiltrieren. (G.) To separate by filtration; to strain. 
 
 Abflecken. (G.) To stain by losing a color; or to make stains. 
 
 Abfliessen. (G.) To flow oft'; to drain. 
 
 Abfluss. (G.) An outflow, a discharge. 
 
 Abflusschnur. (G.) A seton. 
 
 Abflusswunde. (G.) A wound i^iade by a seton-needle; the tract 
 of a seton. 
 
 Abfiihrende Muskeln, (G.) Abductor muscles. 
 
 Abfiihrgang (G.). Eft'erent duct. 
 
 Abgeblasst. (G.) Pallid. 
 
 Abgeflacht. (G.) Flat, shallow. 
 
 Abgegrenzt. (G.) Circumscribed. 
 
 Abgeheilt. (G.) Healed. 
 
 Abgesackt. (G.) Encysted, saculated. 
 
 Abgeschlagen. (G.) Fatigued, worn out. 
 
 Abg-eschlagenheit. (G.) Exhaustion. 
 
 Abgeschwacht. (G.) Weakened, mitigated, diluted. 
 
 Abg-esondert. (G.) Secreted (in the sense of being separated by 
 secretion). 
 
 Abg'espannt. (G.) Weakened, faint, relaxed, debilitated. 
 
 Abgespanntheit. (G.) Exhaustion. 
 
 Abgestorbenheit. (G.) Apathy, no feeling, deadness. 
 
 Abg-estumpft. (G.) Blunted, dulled. 
 
 Abgestumpftheit. (G.) Bluntness, mental dullness. 
 
 Abgliederung. (G.) Disarticulation. 
 
 Abgrenzung-. (G.) Limitation; demarcation. 
 
 Abhaaren. (G.) To epilate, or depilate. 
 
 Abhandeln. (G.) To discuss, treat of. 
 
 Abharten. (G.) To harden, temper, inure. 
 Abhartung. (G.) Hardening.
 
 ABHARTUNGSMITTEL 29 
 
 Abhartungsmittel. (G.) IlatHlcniug or stiTngtliciiing agent or 
 
 remedy. 
 Abhauten. (G.) To excoriate; to strip off the pelicle or cuticle. 
 Abhebeln. (G.) To displace by leverage. 
 Abhebelimg'. (G.) Displacement by leverage. 
 Abheilen. (G.), tr. and intr. v. To heal. 
 Abheilung-. (G.) Healing. 
 
 Abheilungsperiode. (G.) The period of healing or of convalescence. 
 Abhelfen. (G.),tr. v. To remedy. 
 Abhelflichkeit. (G.) Remediable. 
 Abheilen. (G.) To clarify. 
 Abheilung'. (G.) Claritication. 
 Abimercn. The most distinguished representative of Spanish-Arabian 
 
 medicine. See Avenzoar. • 
 Abirrung". (G.) Aberration, deviation. 
 Abirrung der Glaser. (G.) Dioptric aberration. 
 Abirrungskreis. (G.) Circle of aberration. 
 Abirrungsweite. (G.) Amplitude of aberration. 
 Abirrungswinkel. (G.) Angle of deviation. 
 Abkapseln. (G.) To become encapsuled. 
 Abkapselung. (G.) Encapsulation. 
 Abklaren. (G.) To clarify. 
 Abklarung. (G.) Clarification. 
 
 Abklatschen. (G.) To slap or flip with wet towels. 
 Abklatschung. (G.) Wet-packing. 
 Abklopfen. (G.) To percuss. 
 Abknallen. (G.) To fulminate. 
 Abknicken. (G.) To bend; to flex; to kink. 
 Abkommling-. (G.) A derivative (in chemistry). 
 Abkrankeln. (G.) To be weakened from long illness. 
 Abkratzen (G.). To scrape. 
 Abkratzung-. (G.) Abrasion. 
 
 Abkiihl-Apparat. (G.) A refrigerating apparatus. 
 Abkiihlen. (G.) To refrigerate; to cool. 
 Abkiihlend. (G.) Refrigerating, cooling. 
 Abkiihlung. (G.) Cooling, refrigeration. 
 Abkiihlungsmittel. (G.) A refrigerant ; cooling remedy. 
 Abkiirzung. (G.) Shortening: partial removal. 
 Ablagern. (G.) To deposit. 
 
 Ablagerung. (G.) Deposit, infiltration ; a metastasis. 
 Ablassung, Temporale. (G.) Temporal pallor. 
 Ablatio. (L.), n. The removal of a part by cutting. Ablation.
 
 30 ABLATIO CHORIOIDE^ 
 
 Ablatio chorioideee. (L.) Detachment of the choroid. 
 
 Ablation, n. Cutting out or off a part, often used in connection with 
 corneal operations. See Abscission of the cornea. 
 
 Ablation scissors, Brig-gs'. Wm. Ellery liriggs' ablation scissors 
 (Archives of Ophthal., Vol. XVI, No. 1) consist of two curved 
 scissors, placed parallel so as to enable one to cut a section of the 
 optic and ciliary nerves without cutting any of the ocular muscles. 
 In 1894 Briggs modified his ablation scissors by adding a pair of 
 claws between the two scissors to insure the removal of the cut 
 section of the nerves. (See Trans. Sec. Ophth., A. M. A., 1894, p. 
 177.)— (P. G.) 
 
 Ablauf. (G.) Running off; course; end; outlet. 
 
 Ablaufen. (G.) To flow off. 
 
 Ablauf end. (G.) Decurrent, running. 
 
 Ablaiitern. (G.) To clarify. 
 
 Ablaiiterungf. (G.) Clarifying. 
 
 Ablazione. (It.), n. The removal of a part by cutting. Ablation. 
 
 Ableben. (G.) Death; to die. 
 
 Ablefaria. (It.), n. Congenital absence of all or part of the eyelid. 
 
 Ableiten. (G.) To draw off; to derive; to act as a derivative. 
 
 Ableitend. (G.) Derivative. 
 
 Ableitende Gefasse. (G.) Afferent vessels. 
 
 Ableitung. (G.) Derivation, revulsion. 
 
 Ableitungskur. (G.) Treatment by revulsives or derivatives. 
 
 Ableitung-smittel. (G.) A revulsive remedy. 
 
 Ableitungsorgan. (G.) A derivative organ. 
 
 Ablenker. (G.) An abductor. 
 
 Ablenkung. (G.) Diversion, turning aside. 
 
 Ablenkung bei Lahmung. (G.) Deviation in paralysis. 
 
 Ablenkung bei Schielen. (G.) Deviation in strabismus. 
 
 Ablenkung des Augens durch Prismen. (G.) Deviation of the eyes 
 b}" means of prisms. 
 
 Ablenkung, Primare und secondare. (G.) Primary and secondary 
 deviation. 
 
 Ablenkungswinkel bei Prismen. (G.) Angle of deviation as meas- 
 ured by prisms. 
 
 Ablepharia. (L.), n. f. This is a term used to designate a congenital 
 condition characterized by the absence of lids, wholly or in part. 
 When completely absent the name total ablepharia is used, and w^hen 
 parts of the lids are present it is spoken of as partial or incomplete 
 ablepharia. Whether the processes of the ectoderm, which spring 
 from above and below and which go to and from the lids, fail to de-
 
 ABLEPHARUS 31 
 
 velop or, having developed, are destroyed by the pressure of amni- 
 otic bands, one is unable to state in the light of present knowledge. 
 The condition is very rare. The inconii:>lete forms are usually de- 
 scribed under the heading of micro-blepharon in which cases the 
 incomplete lids may take the form of nodules or narrow folds of skin 
 surrounding an ill developed or rudimentary eyeball. Where micro- 
 blepharon is present one frequently finds concomitant defects in the 
 eyeball, clefts in the lids of the opposite eye or anomalies in other 
 parts of the body.— (W. F. H.) 
 
 Ablepharus. (L.), n. m. One afflicted with ablepharia (q. v.). 
 
 Ablepsia. n. Blindness. 
 
 Ablepsie. (G.) Blindness. 
 
 Ablepsy. n. Blindness. 
 
 d 'Abie's optophone. This is an instrument intended to enable totally 
 blind persons to recognize, locate, and even measure light by means 
 of the ear. It is based upon well-known property of selenium of 
 changing its resistance under the action of light. The principle 
 on which the optophone is constructed is the following: A cur- 
 rent from a small battery is sent through a network of four con- 
 ductors known as a "Wheatstone bridge." Two of these conductors 
 are wire resistances of a few hundred ohms each, the third is a sele- 
 nium "cell" (now more appropriately termed a "selenium bridge"), 
 and the fourth is an adjustable resistance, made of graphite de- 
 posited on ground-glass or unglazed porcelain. When the first two- 
 resistances are in the same ratio as the last two, then no current 
 will flow across the network. But a current will flow as soon as 
 one of the resistances changes, as does that of selenium under the 
 action of light. It is this current, made audible in a telephone, 
 which is utilized in the optophone. The instrument consists of two 
 parts, is light and portable and requires verj' little current, a sin- 
 gle pocket "refill" sufficing for days of working. It is believed 
 that great possibilities of aid to the blind may lie in this instru- 
 ment. 
 
 Ablosen. (G.), tr. v. To resolve, disperse. 
 
 Ablosend. (G.) Resolvent. 
 
 Ablosung. (G.), n. A detachment (as of the retina). 
 
 Ablosung der Netzhaut. (G.) Detachment of the retina. 
 
 Abmagerung. (G.), n. Emaciation; atrophy. 
 
 Abmatten. (G.) To fatigue or tire. 
 
 Abmeisseln. (G.), tr. v. To remove with a chisel. 
 
 Abmessen. (G.) To measure; to measure exact. 
 
 Abmessung. (G.) Measuring, measurement, adjustment.
 
 32 ABNAHME 
 
 Abnahme. (G.), n. Ablation or removal of a part by a cutting opera- 
 tion. 
 
 Abnahme der Netzhaut. (G.) Ablation or detachment of the retina, 
 
 Abnahme der Staphylom. (G.) Ablation of a staphyloma. 
 
 Abnorm. (G.) Abnormal, irregular. 
 
 Abnormalities, Cong-enital, in the ocular org-ans and appendages. See 
 Congenital anomalies of the eye. 
 
 Abnormitat. (G.) Abnormality, deformity, perversion. 
 
 Abplatten. (G.) To flatten. 
 
 Abplattung. ( G. ) Flattening. 
 
 Abpraparieren. (G.) To dissect otf. 
 
 Abquellen. (G.) To boil. 
 
 Abrasieren. (G.) To shave off; also, to scrape off. 
 
 Abrasieren der Cornea. (G.) Abrasion or scraping of the cornea, 
 
 Abrasio cornese. (Lat.) Abrasion or contusion of the cornea. Scrap- 
 ing away of a superficial opacity of the cornea with a knife. These 
 opacities may result from mechanical irritation (trichiasis), calcium 
 deposits, etc. 
 
 Abrasion. The rubbing or other superficial removal of tissue, e. g., of 
 the corneal epithelium. 
 
 Abrauchschale. (G.) Evaporating vessel. 
 
 Abregeln. (G.) To regulate. 
 
 Abreibung", (G.) A rubbing oft', an abrasion. 
 
 Abreissen. (G.) To tear off. 
 
 Abreissfraktur. (G.) Fracture by tearing oft'. 
 
 Abreissung. (G.) Tearing off, avulsion. 
 
 Abric, An old Arabic term for sulphur. 
 
 Abrichten. (G.) To measure exactly, to regulate, to adjust. 
 
 Abrin, This is the active principle of the jequirity bean, Abrus pre- 
 catorius (q. v.). It is really a compound agent, composed of an al- 
 bumose and a globulin, both of them poisonous. These may be 
 separated from the bean by appropriate means. Any temperature 
 above 122° F, weakens the action of abrin; exposure to a tempera- 
 ture of 185° F. destroys both component agents, the globulin being 
 rendered inert at 176° F. 
 
 Abrin is used almost entirely in the treatment of clu'onic trachoma 
 with pannus. Lapersonne claims that a one per cent, aqueous solu- 
 tion produces the best results. After cocainizing the conjunctiva 
 the internal surface of the upper lid is thoroughly rubbed with a 
 cotton wad soaked in the solution. This is repeated on the second 
 and (perhaps) folloAving days. On examining cases months after
 
 ABRINDEN 33 
 
 a cure has thus been wrought by the drug the conjunctiva shows 
 scars from the remedial inflammation. Lapersonne re-echoes the 
 cUiims of many writers that as a remedy for pannus in trachoma it 
 is unequaled. 
 
 Abrinden. (G.) To peel, to remove the surface. 
 
 Abrinnen. (G.) To run off, to run down, to flow down. 
 
 Abrus precatorius. Jequirity. PRxVyer-beads. Crab's-eyes. Love- 
 peas. This species is indigenous to tropical Asia and Africa, al- 
 though it has also been grown in America. It belongs to the Legu- 
 minosffi and all its parts are poisonous. The seeds onlj- (see Abrin) 
 are used in ophthalmic therapy. 
 
 Jequirity was first recommended b}' de Wecker in a half per cent, 
 infusion for the treatment of trachoma and pannus. Infusions 
 should be freshly prepared before use, as they readily undergo de- 
 composition ; or they should be made with a saturated solution of 
 boric acid (four per cent.). 
 
 When instilled into the conjunctival sac it causes edema of the 
 parts, followed by a serous and eventually a muco-purulent dis- 
 charge. Swelling of tlie preauricular and submaxillary glands is 
 frequently noticed, wliik' corneal ulcer and even panophthalmitis 
 have been recorded. For this reason jequiritol and the jequirity 
 serum are safer and to be preferred when abrus preparations are 
 indicated. The method of using these two remedies will be found on 
 the containers and is fully described under the proper headings in 
 this Encyclopedia. 
 
 Masselon reminds us of this ancient remedy for pannus trachom- 
 atosus, that it should be used only in those cases where granulations 
 are unaccompanied by marked secretion ; that it should never be 
 applied where there is suppuration. It is especially indicated in old 
 trachoma with pannus and sclerosis of the cornea; it should be thor- 
 oughly pulverized and applied to the conjunctiva with a camelhair 
 brush, the lids being everted so that the cornea is protected. The 
 powder is allowed to remain in contact with the lids two to five min- 
 utes, and is then brushed off. If the reaction is not marked, this 
 application should be repeated next day. The subsequent inflamma- 
 tion should be treated by cold applications and mild antiseptic 
 washes. 
 
 In America, Cheatham, many years ago, strongly advocated the use 
 of this remedy, both powder and infusion, as the most efficacious 
 agent we have for the clearing of pannus, and it is at this date used 
 and recommended by many responsible ophthalmologists. 
 
 Although there can be no doubt but that abrus and the various 
 
 Vol. 1—3
 
 34 ABSACKEN 
 
 preparations derived from it ( jequirity powder, jequiritol, jequirity 
 serum, etc.) are extremely valuable and reliable in selected cases of 
 trachoma — especially cicatricial trachoma with pannus^yet it must 
 ever be borne in mind that there have been many serious results and 
 some disastrous consequences following its applications, even in ex- 
 perienced hands. For this reason it is well to begin treatment w4th 
 a weak dose of a watery mixture of the powder or, better perhaps, 
 of some definite percentage of the active principle. 
 
 So far as the toxic or destructive effects of jequirity are concerned, 
 in a few recorded cases superficial destruction of epithelium occurred, 
 as well as ulcer and clouding of the cornea, followed by scars, 
 diminution of vision, and even panophthalmitis, with total loss of 
 sight, either from phthisis bulbi or because of a necessary enuclea- 
 tion. 
 
 Of 50 cases of jequirity therapy diphtheria of the conjunctiva oc- 
 curred tW'ice. One of these cases fortunately recovered with corneal 
 nebula but good visual acuity ; the other, who had %oo vision before 
 treatment, suffered loss of both eyes from atrophy of the globe. 
 Dacryocystitis has also been observed, not to mention concurrent 
 periostitis of the nasal and lachrj-mal bones, infiltration of the cornea, 
 iritis, symblepharon, exophthalmos, lid abscess, hypertrophy of the 
 upper lid, gangrene of the lid, facial erythema and erysipelas. 
 
 Absacken. (G.) to become encysted. 
 
 Absackung. (G.) Encystment, sacculation. 
 
 Absaubern. (G.) To clean, to cleanse. 
 
 Abscedieren. (G.) To form an abscess, to suppurate. 
 
 Abscedierung-. (G.) The formation of an abscess; abscess formation. 
 
 Abscediren. (G.),intr. v. To suppurate. 
 
 Abscessanhlich. (G.) Abscess-like. 
 
 Abscessbildung. (G.) The formation of an abscess. 
 
 Abscess, Brain. This condition occasionally gives rise to ocular (focal) 
 symptoms, as hemiopia. blindness, more or less complete, j)tosis, con- 
 jugate deviation of the head, eyes or both. 
 
 A brief reference to the conduct of these cases may be in order. 
 Great importance attaches to proper asepsis in the treatment of all 
 scalp wounds, infections and head injuries, adequate drainage of 
 otitic and mastoid suppuration, careful attention to purulent nasal 
 discharge, inquiry into possible infection of the accessory nasal sin- 
 uses, and the assurance of the best hygiene and sanitation for chil- 
 dren convalescing from the acute infectious diseases, particularly 
 scarlet fever, measles and pertussis. 
 
 Palliation as it applies to brain tumor and meningitis is hardly
 
 ABSCESSCHEN 35 
 
 worthy of a trial, except for a special effort directed at the control of 
 vomiting by the nse of ice pellets taken by month or mustard poul- 
 tices applied to the epigastrium, thus reducing the liability of the 
 abscess to rupture. 
 
 Starr has summed up the question of operative interference as fol- 
 lows: "When a cerebral abscess seems probable from the history of 
 the case and from the symptoms which have developed, and the gen- 
 eral progress of the case demonstrates the existence of an increasing 
 and serious focal disease of the brain, it is advisable to operate, even 
 though the symptoms may not be absolutely typical and may present 
 many variations from their usual form. As to the surgical prognosis, 
 Macewen says: *In uncomplicated abscess of the brain operated 
 upon at a fairly earl}' stage recovery ought to be the rule.' " 
 
 Whether the focal symptoms, referable to the visual tract or else- 
 where in the brain, Avill be favorably influenced by operation, and to 
 what extent, can only be determined by the factors governing each 
 case, and may not be categorically stated. — (D. II.) 
 
 Abscesschen. (G.) A little abscess. 
 
 Abscess der Augenlider. (G.) Abscess of the eyelids. 
 
 Abscess der Bienhaut. (G.) Al)scess of the periosteum. 
 
 Abscess der Eindehaut. (G.) Abscess of the conjunctiva. 
 
 Abscess der Linse. (G.^ Al)scess of the lens. 
 
 Abscess des Glaskorpers. (G.) Abscess of the corpus vitreum. 
 
 Abscessen der Netzhaut. (G.) Abscesses of the cornea. 
 
 Abscessentwickelung. (G.) Development of an abscess. 
 
 Abscesseroffnung. (G.) Tlie ojxiiing of an abscess. 
 
 Abscesshaut. (G.) Membrane; lining or Avail of an abscess. 
 
 Abscessherd. (G.) Focus of an abscess. 
 
 Abscesshohle. (G.) Abscess-eavily. 
 
 Abscess Lanzette. (G.) Abscess lancet. 
 
 Abscessmembrane. (G.) Skin, membrane, integument, pellicle, tunic. 
 
 Abscess of cornea, lids, orbit, and of other tissues of the eye will be 
 discussed under headings descriptive of diseases of the parts in 
 ((uestion. 
 
 Abscessoflfnung. (G.) Mouth of an abscess. 
 
 Abscess, Prelachrymal. Abscess lying in front of the lachrymal sac. 
 It has nothing to do, as a rule, with disease of the lachrymal appa- 
 ratus, but occurs spontaneously or as the result of injurj^, generally 
 to the bone, at the inner angle of the eye. The treatment is mostly 
 surgical, but as the condition sometimes presents itself in luetic 
 patients and does not very (piickly heal the fact that general meclica-
 
 36 ABSCESSREIFUNG 
 
 tion is sometimes needed to bring about resolution should be borne 
 in mind. 
 
 Abscessreifung'. (G.) Ripening of an abscess. 
 
 Abscess, Ringformig. (G.) Annular abscess. 
 
 Abscesssack. (G.) Abscess sac. 
 
 Abscessus cerebri. (L.) Abscess of the brain. 
 
 Abscessiis siccus. (L.) A name given by the older ophthalmic sur- 
 geons to a condition resembling disk-like keratitis, in which although 
 there is something like om^x or a circumscribed purulent deposit in 
 the otherwise clear cornea yet no suppuration is noticeable — i. e., a 
 ''dry" abscess. 
 
 Abscessverkalkung. (G.) Calcification of an abscess. 
 
 Abscessverkasung. (G.) Caseation of an abscess. 
 
 Abscessverkreidung. (G.) Calcification, calcination. 
 
 Abscesswand. (G.) Wall of an abscess. 
 
 Abschaben. (G.) To scrape off. 
 
 Abschabung. (G.) A scraping off, an abrasion. 
 
 Abschabung des Tarsus. (G.) Curreting or scraping of the tarsus. 
 
 Abschalen. (G.) Excoriate. 
 
 Abschalung. (G.) Excoriation, decortication. 
 
 Abschaumung. (G.) Desquamation. 
 
 Abscheiden. (G.) To separate, to elimiuate, to divide. 
 
 Abscheidung. (G.) Separation, elimination, division. 
 
 Abscheren. (G.) To clip: to cut off with scissors. 
 
 Abschiefern. (G.) To exfoliate. 
 
 Abschieferung. (G.) Exfoliation, desquamation. 
 
 Abschilfernd. (G.) Exfoliative. 
 
 Abschleifen. (G.) To grind oft". 
 
 Abschleifung-. (G.) Attrition. 
 
 Abschliessung. (G.) Occlusion, obstruction. 
 
 Abschliff der Hornhaut. (G.) A corneal facet. 
 
 Abschneiden. (G.) To cut off, amputation. 
 
 Abschneidung. (G.) Cutting off, amputation. 
 
 Abschnitt. (G.) Section, segment, part. 
 
 Abschniiren. (G.) To ligature, to snare, to remove by ligature, to 
 
 constrict, to undergo segmentation. 
 Abschniirung". (G.) A tying off, ligation. 
 Abschniirung des Linsenblaschens. (G.) Eeraseuring or snaring off 
 
 a vesicle. 
 Abschniirungscysten der Orbita. (G.) The retention of cysts of the 
 
 orbit. 
 Abschniirungsfalte. (G.) Segmentation fold.
 
 ABSCHNURUNGSVORGANG 
 
 37 
 
 Abschniirung'svorgang-. (G.) The process of segmentation. 
 
 Abschuppend. (G.) Scaling, desqnamating. 
 
 Abschuppung'. (G.) Des(iuamation. 
 
 Abschwachung-. (G.) i^ttenuation, weiakenimg, mitigation, modifi- 
 cation. 
 
 Abschwaren. (G.) To separate by ulceration. 
 
 Abschwellung". (G.) Shrinking, to decrease. 
 
 Abschwitzen. (G.) To sweat on1. 
 
 Abscindern. (G.) Abscission. 
 
 Abscissa. In optics, a dimension used to designate the position 
 of the point where a ray crosses the principal optical axis of a re- 
 fracting or reflecting surface with respect to the vertex or pole of 
 the surface as origin. In the ease of reflection at a plane mirror the 
 abscissai are equal, but of opposite signs, or v' ^ — v, called the 
 abscissa-equation for reflection ; v, being the distance in front, v' 
 the distance behind the plane mirror; the positive direction being 
 that which the light pursues in its propagation. 
 
 The abscissa-equation for refraction of paraxial rays at a plane 
 n' 
 surface is: u' = — u, wherein u in the distance in front, and u' 
 
 n 
 the distance behind the surface, n the refractive index of the first, 
 and n' the index of the second medium. — Southall, Principles of Geo- 
 metric Optics § 50-53.T-(C. F. P.) 
 
 Abscissio bulbi. (L.) Abscission of the globe (cornea). 
 
 Abscission by Critchett's method. The needles are in position. Showing iioitiou of 
 
 the eyeball to be removed. 
 
 Abscission of the cornea. A term applied particularly to an operation 
 upon a staphyloma corner. The more prominent portion is excised,
 
 38 
 
 ABSCISSION OF THE CORNEA 
 
 Abscission. Method of Lagrange. The eircumcorneal incision has been made the 
 tendon raised on the hook and the suture passed through the tendon. ' 
 
 Abscission. Method of Lagrange. Diagram showing the muscles all sutured and 
 
 the i)urse-string suture applied. 
 
 Abscission. Method of Lagrange. Showing the purse-string sutures holding the 
 
 muscles protruding from the opening.
 
 ABSCISSION OF THE EYE 39 
 
 the cut edges sutured and the reinaiiiing glohar tissues form a pad 
 for an artificial eye. The operation was first proposed by Saint Ives 
 in the 18th century, but since that time many operators have favored 
 various forms of abscission (of the cornea), combined or not Avith 
 evisceration of the globar contents. Two well-known operative pro- 
 cedures are by Critchett and Lagrange. 
 
 Critchett passed three curved needles, armed with sutures, through 
 the sclera above and below the cornea, a little back of the area to 
 be removed. The needles were left in position until an elliptical seg- 
 ment of the eyeball was cut out with knife and scissors. The seg- 
 ment included the cornea, iris, lens and some sclera. The needles hin- 
 dered the escape of vitreous. After the amputation had occurred, 
 
 Abscission. Method of Lagrange. The relative positions of the sutures. 
 
 the needles were drawn through and the wound was closed by tying 
 the sutures. 
 
 Lagrange modified the operation by making, first, the regular 
 sclero-corneal incision and exposing the recti muscles, each one of 
 which was secured Avith a suture before being severed. A purse- 
 string suture Avas then passed around the conjunctival opening. 
 Amputation of the anterior portion of the globe followed, after which 
 the superior and inferior recti muscles were tied together and then 
 the internal and external recti muscles. The purse-string suture 
 Avas then tied and the operation completed. — (F. A.) 
 
 Abscission of the eye. See Enucleation of the eyeball and substitutes 
 for that operation. 
 
 Abseifen. (G.) To remove or cleanse by soap. 
 
 Abseihen. (G.) To filter. 
 
 Abseihung. (G.) Filteration. 
 
 Absetzcisterne. (G.) In chemistry, a settling cistern. 
 
 Absetzen. (G.) A set apart, to remove; in chemistry, to percipitate, 
 to deposit. 
 
 Absetzung. (G.) To set apart, to remove. 
 
 Absieden. (G.) To boil, to make a decoction of.
 
 40 ABSINTHE, OCULO-TOXIC SYMPTOMS FROM 
 
 Absinthe, Oculo-toxic symptoms from. Absinthe is one of the most 
 injurious of the liqueurs, cordials, and other perfumed alcoholic 
 drinks. Besides the oil of absinthe many other poisonous agents 
 enter into its composition. 
 
 Animals poisoned with absinthe oil are affected with tonic convul- 
 sions, dilated pupils and a congestion of the papillary and retinal 
 vessels, which disappears at death. 
 
 A female absinthe drinker suffering from alcoholic epilepsy, 
 showed almost the same symptoms noticed in poisoned animals, 
 especially dilation of the pupil, which remained long after the con- 
 vulsions had disappeared. 
 
 Absolute glaucoma. An advanced form of the disease in which all 
 the usual signs, including total blindness and a high degree of intra- 
 ocular tension, are present and well marked. See Glaucoma. 
 
 Absolute heterophoria. The total amount of muscle balance defect 
 (see Muscles, Ocular) is, in contradistinction to the manifest amount, 
 only to be measured after repeated examinations, especially by the 
 wearing or use of prisms, and complete rest of the eyes of the 
 patient. 
 
 Absolute Pupillenstarre. (G.) Absolute loss of pupil-reflexes, espe- 
 cially of light. 
 
 Absolute range of accommodation. This expression was introduced by 
 Donclers to indicate the monocular range or amplitude of accommo- 
 dation as opposed to the binocular range. 
 
 Absolute scotomata. Defects in the visual field for both fozmi and 
 color. See Field of vision. 
 
 Absonderened. (G.) Secretory. 
 
 Absondern. (G.), tr. v. To secrete. 
 
 Absondernd. (G.) Secreting, excreting. 
 
 Absonderung. (G.), n. Secretion or excretion. 
 
 Absonderung'sapparat. (G.) A secretory apparatus. 
 
 Absonderung-sdriise. (G.) A secreting gland. 
 
 Absonderungsfliissigkeit. (G.) A secretory fluid; secretion. 
 
 Absonderungsgefass. (G.) A secretory vessel. 
 
 Absonderungsmittel. (G.) Agent or remed^y^ for exciting secretion. 
 
 Absonderungsorgan. (G.) A secretory organ. 
 
 Absonderungsstoffe. (G.) Secretions. 
 
 Absonderungsstorung. (G.) A disturbance of secretory function. 
 
 Absonderungsvermogen. (G.) The power of means of secretion. 
 
 Absonderungsvorgang. (G.) The process of secretion, 
 
 Absonderungsweg. (G.) The secretory chanu*»V
 
 ABSONDERUNGSWERKZEUG 41 
 
 Absonderiing-swerkzeug". (G.) An organ of secretion; a secretory 
 ajipai-atus. 
 
 Absorbierend. (G.) Absorbent. 
 
 Absorbiren. (G.) To absorb, to imbibe. 
 
 Absorption. Tn physics, a taking in or reception of molecular or 
 chemical action : as, absorption of gases, light, heat. Absorption 
 hands, in spectrum analysis (q. v.), dark bands in the spectrum more 
 or less broad and in general not sharply defined. Ahsorption of 
 color, the phenomenon observed when certain colors are retained 
 or prevented from passing through certain transparent bodies. 
 Thus, pieces of colored glass are almost opaque to some parts of 
 the spectrum, while allowing other colors to pass through freely. 
 This is merely a special case of the absorption. Absorption of light, 
 that action of an imperfectly transparent or opaque body by which 
 some portion of an incident pencil of light is stopped within the 
 body, while the rest is either transmitted through it or reflected 
 from it. It is OAving to this action that, for example, a certain 
 thickness of pure water shows a greenish color, of glass a bluish- 
 green color, etc. Absorption lines, in spectrum analysis, dark trans- 
 verse lines produced in a continuous spectrum of the absorption of 
 incandescent vapors through Avhich light has passed, as in the solar 
 atmosphere ; they are in general sharply defined, and are referred 
 to by letters of the alphabet, as a means of identification first sug- 
 gested by Fraunhofer. In general, absorption-lines are seen only 
 when the substance examined is in the form of a vapor and very 
 highly heated, while absorption-bands (see above) may be produced 
 by liquids and solids, as well as by vapors, and at low temperatures. 
 Absorption-spectrum, a spectrum with absorption-lines. — (C. F. P.) 
 
 Absorptionsbefordernd. (G.) Promoting absorption. 
 
 Absorptionsfahigkeit. (G.) Capability of absorbing. 
 
 Absorptionsfarbe. (G.) Absorption color. 
 
 Absorptionskraft. (G.) Power of absorption. 
 
 Absorptionsstreifen. (G.) Absorption lines. 
 
 Absorptionsvermogen. (G.) Faculty, ability, power. 
 
 Abspalten. (G.) To split up. 
 
 Abspaltung. (G.) Splitting up. 
 
 Abspannen. (G.) To relax. 
 
 Abspannung. (G.) Eelaxation, lassitude, debility. 
 
 Abspiegelung. (G.) Reflection. 
 
 Abspritzen. (G.) To syringe, to remove by syringing. 
 
 Abspiilen. (G.) To rinse, to w^ash off. 
 
 Abspiilung. (G.) Rinsing, washing off.
 
 42 ABSTAMMEN 
 
 Abstammen. (G.) To descend from, to be derived from. 
 
 Abstammung-. (G.) Descent, derivation. 
 
 Abstammungslehre. (G.) Theory of descent. 
 
 Abstand. (G.) Distance, interspace. 
 
 Absteig-end. (G.) Descending. 
 
 Absterben. (G.) To die, to be benumbed, to become gangrenous or 
 
 necrosed. 
 Absterge. (G.) To wipe away. 
 Abstergieren. (G.) To cleanse. 
 Abstergierend. (G.) Cleansing. 
 
 Abstinenzerscheinung. (G.) Phenomenon of abstinence. 
 Abstufung-. (G.) Gradation. 
 Abstumpfen, (G.) To blunt, to dull or deaden, to neutralize; to 
 
 become deadened or dulled. 
 Abstumpfend. (G.) In chemistry, to neutralize. 
 Abstumpfimg. (G.) Blunting, dulling or deadening, neutralization. 
 Absiissen. (G.) A precipitate wash. 
 Abszess des Gehirnes. (G.) Abscess of the brain. 
 Abszess des Glaskorpers. (G.) Abscess of the vitreous. 
 Abszess der Hornhaut. (G.) Abscess of the cornea. 
 Abszesse, Periostale, der Orbita. (G.) Periosteal abscess of the orbit. 
 Abtasten. (G.) To palpate, to examine with the hand. 
 Abtauchen. (G.) To clean by submerging or dipping. 
 Abtoten. (G.) To kill, to destroy. 
 Abtotung. (G.) Killing, destruction. 
 Abtragen. (G.) To remove, excise, extirpate. 
 Abtragung. (G.) Ablation; to remove, excise, extirpate. 
 Abtragung des Ciliarbodens. (G.) To extirpate the ciliary part of 
 
 the lid. 
 Abtragung des Haarzwiebelbodens. (G.) Excision of the base of the 
 
 hair \n\\h. 
 Abtragung des Staphyloms. (G.) Exsection of a staphyloma. 
 Abtrennen. (G.) To separate, to dismember. 
 Abtrennung. (G.) Separation, dismemberment. 
 Abtrocknen. (G.) To wipe off, or dry by wiping. 
 Abtupfen. (G.) To cleanse or remove by mopping. 
 Abu Bekr Mohammed ibn Badjeh. An Arab-Spaniard philosopher and 
 
 oculist ^^■ho lived mostly in Fez, about 1172. See Avempace. 
 Abu-Belcr Muhammed b. Zacharijah ar-Razi. One of the names of the. 
 
 celebrated Arabian philosopher and medical teacher — Rhazes — who 
 
 flourished during the ninth century of the Christian era. See 
 
 Ar-Razi.
 
 ABUBERTUS 43 
 
 Abubertus. One of the many names of Riiazes, the famous Arabian 
 physician, and ophthalmic writer who lived during the ninth cen- 
 tury of the Christian era. See Ar-Razi. 
 
 Abubeter. One of the numerous names of the celebrated Arabian 
 physician and ophtlialmic writer, Rhazes, who flourished about 
 A. D. 880. See Ar-Razi. 
 
 Abu Gafar b. Harun at-Targali. A Spanish- Arabian oculist, who prac- 
 tised at Seville in the 12th century. In his later years he became 
 paralysed, but continued to give advice. He left no writings. — 
 
 (T. i-i. S.) 
 
 Abiil Barakat al-Katai. Body physician to Saladdin ; died at Cairo, 
 59cS. He was a distinguished operator on the eye, but wrote nothing 
 concerning that organ. — (T. H. S.) 
 
 Abulcasis. A distinguished Arabian physician and ophthalmologist. 
 See Abul Kasim ben Abbas al-Zarav^^i. 
 
 Abulfadl Abdalmumin b. Omar al-Andalusi. A Spanish-Arabian poet 
 and ophthalmologist, who removed from his native country to Da- 
 mascus at the beginning of the 13th centmy. He was called The 
 Physician of His Epoch, yet practically nothing is known to-day con- 
 cerning him. — (T. H. S.) 
 
 Abul Farag b. at-Tajjib. A Nestorian priest and philosopher of the 
 11th century, known to have composed a book On the Diseases of the 
 Eye.— (T. H. S.) 
 
 Abul Haggag Jusuf. An oculist of the Arabian period at Cairo. He 
 was known to have taught the father of Usaibia. — (T. H. S.) 
 
 Abulkasim. A distinguished Arabian physician and ophthalmologist. 
 See Abul Kasim ben Abbas al-Zarawi. 
 
 Abul Kasim ben Abbas al-Zaravd (also known as Abulkasim, Abul- 
 casis, Albucasis, Bucasis, Alzaharavius, etc.). This author, the 
 greatest of all the Arabic writers on surgery, was a Spaniard. The 
 place and date of his birth are not known, but he died, exiremely old, 
 at Cordova, Spain, A. D. 1013. His surgery formed only a part of his 
 great general work on medicine, al Tasrif (The Explanation). Based 
 chiefly on the teachings of the Greeks, especially Paulus of Aegina, 
 it exhibits, nevertheless, considerable evidence of a rich personal ex- 
 perience and the keenest powers of observation. The illustrations 
 of surgical instruments in this work are particularly interesting. 
 Like many another prophet, Abul Kasim was largely without honor, 
 not merely in his own land but even in his OAvn age. A much belated, 
 but Avell deserved, recognition was, however, accorded to hira, ulti- 
 mately, throughout Western Europe; and, indeed, it was chiefly 
 owing to the fact that the masterful and comprehensive al Tasrif
 
 44 ABUL MUTARRIF ABD AR-RAHMAN 
 
 was translated into excellent Latin and then widely circulated in 
 mediaeval Christendom that the attention of European scientists was 
 eventually directed to the highly valuable writings of Arabian oph- 
 thalmologists. Even at the present day, al Tasrif constitutes easily 
 the most copious and most valuable fountain of knowledge concern- 
 ing Arabic surger}^ ophthalmic and general, and its distinguished 
 author must be accorded a place in Arabic medicine second perhaps 
 only to those of Rhazes and Avicenna. 
 
 The ophthalmic parts of the great book are scattered more or less 
 throughout the surgical division. The surgical section falls into 
 three books : the first of these relates to cauteries, the second to 
 incisions and bloody operations in general, the third to the setting 
 of dislocated bones. In the second book occur most excellent descrip- 
 tions of the following operations on the eye, as these were performed 
 about 1000 A. D. 
 
 Chap. 8. Removal of Lid-Warts. 
 
 Chap. 9. Treatment of Chalazion. 
 
 Chap. 10. Operation for Hydatids. 
 
 Chap. 11 and 12. Five Operations for Diseases of the Cilia. 
 
 Chap. 13. Operation for LagojDlithalmos. 
 
 Chap. 14. Operation for Ectropion of the Under Lid. 
 
 Chap. 15. Operation for ►Symblepharon. 
 
 Chap. 16. Extirpation of Pterygium and of Swollen Caruncle. 
 
 Chap. 17. Operation for Wild Flesh and Chemosis. 
 
 Chap. 18. Pannus. 
 
 Chap. 19. Operation for Lachrymal Fistula. 
 
 Chap. 20. The Reposition of Prolapsed Eyeballs. 
 
 Chap. 21. The Excision of Prolapsed Iris. 
 
 Chap. 22. The Treatment of Hypopion. 
 
 Chap. 23. Cataract Operation. 
 
 Though all these operations are described very briefly, the Ian- 
 gauge is simple and clear. Abul Kasim as an ophthalmologist is 
 only excelled, among the Arabs, by Ammar and by Ali ben Isa. — 
 (T. H. S.) 
 
 Abul Mutarrif Abd ar-Rahman b. Muhammed b. Abd al-karim b. Jahja 
 Ibn-Wafid al-Lahmi. The Arabian name of a distinguished Spanish- 
 Arabian physician and ophthalmic author who lived during the elev- 
 enth century of our era. See Abenguefit, 
 
 Abul Qasim Hibat-Allah b. Fadl. A physician and poet of Bagdad, 
 (1086-1162 A. D.) who is said to have made a specialty of diseases 
 of theeye.— (T. H. S.)
 
 ABUMERON 45 
 
 Abumeron. One of the name.s of an illustrious Jewish oculist who 
 lived in Spain at the end of the eleventh century. See Avenzoar. 
 
 Aburchung". (G.) Ses'mentation. subdivision. 
 
 Abu Ruh. bin Mansur bin Abi Abdallah bin Mansur alyamani. He was 
 also known as zarrix-dast, or '•Goldhand"— not, probably in allusion 
 to his earning-power, but to his gentleness and skill. A distinguished 
 Persian ophthalmologist of the 11th century, born at Gurgan on 
 the Oxus, and educated both in his native Persian and in Arabic. 
 His work, The Light of the Eyes, constituted the standard ophthal- 
 mologic text-book in Persia for many centuries. The title of the 
 volume was selected, according to the author himself, l)ecause he 
 who reads and understands the work Avill preserve the light of his 
 own eyes and never require the services of the ignorant physician. 
 The book is written in a prolix style and in (piestion-and-answer 
 form, after the fashion of the work of Hunain ((]. v.). 
 
 The Light of the Eyes consists of ten chapters, or books. The 
 first treats of the Anatomy of the Eyes ; the second, of Ocular Diseases 
 Perceptible by the Senses; the third, of Ocular Diseases not Percep- 
 tible by the Senses ; the fourth, of the Treatment of Curable Dis- 
 eases of the Eye ; the fifth, of the Incurable ; the sixth, of Ocular 
 Hygiene ; the seventh, of Ocular Surgery ; the eighth, of Glaucoma ; 
 the ninth, of Simple, and the tenth of Compounded Medicines for 
 the Treatment of Ocular Disease. 
 
 In the seventh (the surgical) book of his work, Zarrin-Dast pre- 
 sents the following list of operations, which, in his day, were per- 
 formed upon the eye — a list wliich is especially valuable, because 
 by far the most complete now extant from the Arabic middle ages: 
 
 1. The Scratching Out of Granulations. 
 
 2. The Removal of Chalazia. 
 •'5. The Removal of Calculi. 
 
 4. The Separation of Symblepharon. 
 
 5. The Trussing-Up of Superfluous and of Incurving Hairs, and 
 
 the Operation for Entropion. 
 
 6. The Transplantation of Superfluous Hairs, when These are not 
 
 Numerous, by means of the Needle. 
 
 7. The Burning of Superfluous Hairs Avith Chemical Caustics and 
 
 wdth Fire, and the Gluing [fixing] of the Hair with Mastieh. 
 
 8. The Eradication of Hydatids. 
 
 9. The Removal of Excresences from the Lid. 
 
 10. The Removal of the Ant-Like Ulcer. 
 
 11. The Relief of Lagophthalmos. 
 
 12. The Removal of Warts.
 
 46 ABU ZAKARIJA JUHANNA B. MASAWAIH 
 
 3 3. The Removal from the Lid of Encysted Tumors. 
 
 14. The Cure of Furuncles. 
 
 ■ 15. The Shaving Off of Lid-Scabs. 
 
 16. On the Opening of Tear-Abscesses in the Beginning. 
 
 17. The Burning Out of Tear-Abscesses and the Scraping-Out and 
 
 Shaving-Off of the Carious Bone. 
 
 18. The Trephining of Bone Become Carious as a Result of a 
 
 Tear- Abscess. 
 
 19. The Removal of the Lachr.ymal Papilla. 
 
 20. The Removal of Pannus. 
 
 21. The Removal of Pterygium. 
 
 22. The Removal of Proud Flesh. 
 
 23. The Removal of Foreign Bodies from the Conjunctiva. 
 
 24. The Relief of Prolapse [Exophthalmos]. 
 
 25. The Removal of Hypopion. 
 
 26. The Cataract Puncture with the Cataract Needle, either Solid 
 
 or Hollow. 
 
 27. The Drawing Out of the Temporal Artery. 
 
 28. The Burning of the Temporal Artery. 
 
 29. The Excision of the Temporal Artery. 
 
 30. On the Letting of Blood, which, in the case of Diseases of the 
 
 Eyes, must be Performed Either in the Veins by the Cor- 
 ners of the Eyes, or of the Forehead, or of Both Temples, 
 or of the Wings of the Nose, or of the Upper and Lower 
 Margins of the Orbits. 
 This book, because of its richness and fullness and its highly prac- 
 tical character, is (despite its prolixity and the question-and-answer 
 form plainly indispensable to a complete understanding of the 
 ophthalmology of the Arabian middle ages. Only two other ophthal- 
 mographers of the time are worthy to be ranked with Zarrin-Dast — 
 Ali ben Tsa and Ammar.— (T. H. S.) 
 Abu Zakarija Juhanna b. Masawaih. (He was also called filius-mesue^ 
 because of his sonship to Masawaih Abu Juhanna). This rather un- 
 important Arabian ophthalmographer (777-857 A. D.) is known to us 
 chiefly because of the numerous references made to him in the 
 Continens of Razes; also because of his two books: Knoidedge of the 
 Exam Ivaf ion of Oculists and Alteration of the Eye. — (T. H. S. ) 
 Abversion. The turning of one or both eyeballs outward. 
 Abwaschen. (G.) To wash off. 
 Abwaschung. (G.) Lotion. 
 Abwechseln. (G.) To alternate, to intermit. 
 Abwechselnd. (G.) Intermittent, alternating.
 
 ABWEG 47 
 
 Abweg. (G.) A divei-tieulum. 
 
 Abwehrmittel. (G.) A prophylactic. 
 
 Abweichen. (G.) To deviate, to soften. 
 
 Abweichend. (G.) Abnormal, deviating, irregular, aberrant. 
 
 Abweichung:. (G.) Anomaly, deviating, deflection. 
 
 Abweichimgswinkel. (G.) Angle of deviation. 
 
 Abweinen. (G.j To expiate by tears, by weeping. 
 
 Abzapfen. (G.) To tap, to drain. 
 
 Abzapfer. (G.) A trocar, a catheter. 
 
 Abzapfimg. (G.) Tapping, drawing, draiiiing, paracentesis, para- 
 centesy. 
 
 Abziehaugenmuskelnerv. (G.) Trochlear nerve. 
 
 Abziehen. (G.) To draw away, to abduct. 
 
 Abziehend. (G.), adj. Abducting. Functionating as an abductor. 
 
 Abziehender Augenmuskel. (G.) The external rectus muscle. 
 
 Abziehermuskel. (G.) Abductor muscle. 
 
 Abzieher. (G.j An abductor. 
 
 Abziehung'. (G.), n. Movement from the median line of the body, or 
 of an extremity. Abduction. 
 
 Abziehungsvermogen. (G.) Power of obstruction, abstractive fac- 
 ulty. 
 
 Abziehmuskel des Auges. (G.), n. See Abducens. The external 
 rectus, the action of which is to roll the globe outward. 
 
 Abzug. (G.) Drain. 
 
 Abzugskanal. (G.) A drain, a conduit. 
 
 Acacalis. (L.), n. f. An Egyptian" shrub mentioned by Dioscorides, 
 the seeds of which were used by the ancients as a remedy for ophthal- 
 mia. It has been supposed to be a variety of Acacia arabica. 
 
 Acacia. Gum arabic. This is the dried exudate from various spt^eies 
 of the leguminose acacia, obtained mostly from Egypt and the Sou- 
 dan. It is seen in commerce in the shape of rounded tears or irregu- 
 lar fragments. 
 
 It consists chiefly of compounds of arabic acid with calcium and 
 other bases. The adulterations are mostly starch and inferior or 
 cheaper gums. 
 
 Gum acacia has a soothing action on mucous membranes and is 
 generally employed as a mucilage. In this form it has an occasional 
 use in burns of the eyeball from most agents. In the form of fine 
 powder it is occasionally used as a vehicle for other poM^ders. It is 
 now and then employed in collyria. 
 
 Academisch. (G.) Academical, academic. 
 
 Acahi. An old name for alum water.
 
 48 ACANTHOPE 
 
 Acanthope. (F.), adj. An animal whose eyes are furnished with 
 spinous processes. 
 
 Acanthosis nigricans. This condition presents superficial papillomat- 
 ous outgrowths on the intermarginal space of the eyelids, as de- 
 scribed by Birch-Hirschfeld. 
 
 Acaro. (It.) Acarus or louse. 
 
 Accessoire. (F.), adj. and n. Accessory. 
 
 Accessoires de roeil. (F.) The appendages of the eye, i. e., eyebrows, 
 lids, lachrymal apparatus, etc. 
 
 Accessorisch. (G.) Accessory. 
 
 Accessory sinuses. See Cavities, Neig-hboring-, Ophthalmic relations of. 
 
 Accidental colors. In optics, complementary colors seen Avhen the eye 
 is turned suddenly to a white or light-colored surface, after it has 
 been fixed for a time on a bright-colored object. If the object is 
 blue, the accidental color is yellow ; if red, green, etc. Thus, if 
 we look fixedly at a red wafer on a piece of white paper, and turn 
 the eye to another part of the paper, a green spot is seen. 
 
 Accidental light. In paiiiiing, a secondary light which is not accounted 
 for by the prevalent effect, such as the rays of the sun darting 
 through a cloud, or between the leaves of a thicket, or the effects 
 of moonlight, candle-light, or burning bodies, in a scene which does 
 not owe its chief light to such a source. 
 
 Accident insurance in ocular affections. See Injuries to the visual 
 apparatus; also. Legal relations of ophthalmology. 
 
 Accidents, Prevention of ocular. See Injuries of the eye; Railway 
 employees, Eyes of ; Hyg-iene of the eye. 
 
 Accommodation, n. The process by which the refractive condition 
 of the eye is changed in accordance with the distance at which an 
 object is to be viewed, so as to secure effective focusing of the 
 image on the retina. 
 
 When an eye is at rest rays coming from a distant object (20 
 feet) are practically parallel, and are focused on the retina. Rays 
 from a point nearer than 20 feet are more divergent and are 
 focused behind the retina, causing a blurred image. In order that 
 these divergent rays may be brought to a focus on the retina the 
 eye must so increase its refractive power that the image of a near 
 object focuses exactly at the macula lutea and forms a clear and 
 distinct picture. The change that in this way takes place is called 
 the accommodation. According to the theory of Helmholtz it is 
 brought about by a contraction of the ciliary muscle which relaxes 
 the suspensory ligament and alloAvs the crystalline lens to become 
 more convex.
 
 ACCOMMODATION. AMPLITUDE OF 49 
 
 There are other alterations in tlie ocuhir apparatus that accom- 
 pany this lenticular change. The ciliaiy fibrilhe which are attached 
 posteriorly to the choroid by fibres, known as the tensor choroideaj 
 contracts, drags the choroid forward; the pupil at the same time 
 becomes narrow (thus reducing aberration) and the internal rectus 
 muscle draws the eye inward, so that a proper relation between 
 convergence and accommodation is secured. The crystalline lens, 
 being soft and elastic, tends, as a passive process, to bulge forward 
 anteriorly and assume a more spherical shape during this act. In 
 consequence of the pushing forward of the whole lens-sj^steni in 
 this way the iris approaches the posterior surface of the cornea and 
 the anterior chamber becomes slightly more shallow. 
 
 The lens is most elastic and flexible during early childhood. 
 Each year it loses a certain amount of elasticity until about 60 
 years of age it fails to respond to the contractions of the ciliary 
 muscle at all and all power of accommodation is lost. As will be seen 
 by reference to the headings that follow, the theory of Helmholtz 
 is not the only one that ofit'ers an explanation of the method by which 
 the visual apparatus adjusts itself for clear vision at different dis- 
 tances. See Accommodation, Schoen's theory of. Accommodation, 
 Tscherning-'s theory of. See Refraction and accommodation; Physio- 
 logical optics. 
 Accommodation, Amplitude of. See Amplitude of accommodation. 
 Accommodation, Apparent. Pseudo-accommodation. It was long ago 
 noticed that aphokir individuals can see almost equally well at dif- 
 ferent distances. This was explained by action of the extrinsic eye- 
 muscles, which M'ere supposed to lengthen the axis of the eyeball 
 and thus, to a certain degree, replace the accommodation of the lens. 
 Investigations by Sattler and others have shown that this view is 
 not correct. Such "accommodation" can be better explained by 
 comparing it with the reading of very fine print, which we can still 
 read even if the image does not fall directly upon the retina, l)ut is 
 seen more or less in diffusion-circles. Furthermore, the different 
 parts of the cornea do not liave the same refractive index, which may 
 vary several diopters about the pupillary region. Thus, at different 
 distances of the object dift'erent parts of the refracted cone of rays 
 may come to a focus upon the retina and be sufficient for vision, 
 giving the impression of accommodation. 
 
 Kroner rejects the explanations that have generally been given 
 for apparent accommodation in aphakic eyes, such as elianges 
 in the cornea, lens remains in the pupil, elianges in the curvature 
 of the vitreous, index of refraction, length of optic axis, or in the 
 
 Vol. 1—4
 
 50 
 
 ACCOMMODATION, BINOCULAR RANGE OF 
 
 position of the spectacle glasses. He does find some connection 
 between such accommodation and astigmia, but the latter is not 
 the only factor, for some astigmic eyes do not accommodate, while 
 some anastigmatic ones do. And it is not in Bonders' sense that the 
 eye makes use now of one of the foci and then of the other, for the 
 region of such accommodation does not correspond to the optical 
 distance between these two points. It is generally greater in eyes 
 with little astigmia and less in the highly astigmatic. Irregular 
 astigmia, imperfect centration, and especially spherical aberration 
 (q. V.) which is largely compensated by the lens in the normal con- 
 dition, are all contributing factors. In general it results from 
 influences which by diminishing visual acuity lessen the necessity 
 of exact focussing, but the phenomenon seems independent of the 
 size of the circles of diffusion so far as the latter are capable of 
 exact measurement. {Ophthalmic Year Booh, Vol. VIII, p. 59.) 
 
 Changes in the Lens During Accommodation. 
 Dotted lines show swelling of anterior surface during accommodation. 
 
 Accommodation, Binocular range of. Douders distinguished between 
 binocular and monocular (or absolute) range of accommodation. 
 He believed that Avith the ordinary methods the monocular near- 
 point is nearer to the eye than the binocular. He explained this on 
 the assumption that in monocular vision the lens is more strongly 
 curved because the ciliary muscle contracts more strongly, owing 
 to the stronger convergence. 
 
 According to Hess, the monocular near-point is only apparently 
 nearer to the eye than the binocular near-point because, with the 
 ordinary methods of examination, the pupil is more decidedly con- 
 tracted in the former case than in the determination of the binocular 
 near-point. If all these errors are eliminated — by instruments based 
 on the Scheiner experiment, for instance — it is found that the 
 monocular and binocular near-points are equidistant from the eye. 
 
 Accommodation, Cramer's theory of. Cramer attributed the accom- 
 modation of the eye for near vision to the contraction of the iris. 
 He believed that in a state of repose the organ became greatly
 
 ACCOMMODATION, CARMONA Y VALLE'S THEORY OF 51 
 
 swollen in front, while during the accommodative act there was a 
 simultaneous contraction both of the dilator and sphincter iridis. In 
 this way pressure is exerted on the periphery of the lens. The cil- 
 iary muscle at the same time contracts, exerts contraction on the 
 choroid, and these combined influences push the vitreous forward. 
 The lenticular tissues, tlius subjected to pressure throughout their 
 whole mass except in the pupillary area, swell up at this central 
 point. The theory of Cramer was accepted in many quarters until 
 von Graefe published an account of his well-known case of complete 
 aniridia in which he demonstrated that the amplitude of accommo- 
 dation was, even in the entire absence of the iris, completely intact. 
 
 Accommodation, Carmona y Valle's theory of. The act of accommoda- 
 tion is accomplished by the compression of the periphery of the 
 crystalline lens through the action of the circular fibers of the ciliary 
 muscle. This compression acts upon the anterior fibers of the zonula, 
 squeezes the soft portion of the lens and crowds it toward the cen- 
 ter where it produces a sort of lenticonus. As the lens is supported 
 posteriorly by the vitreous the anterior surface is necessarily mostly 
 afiPeeted. — {Annates d'OcuUstique, March, 1900.) 
 
 Accommodation, Field of. See Amplitude of accommodation. 
 
 Accommodation, Grossmann's theory of. Grossmann was able to ob- 
 serve in a case of congenital aniridia the following changes during 
 the accommodative act: The diameter of the lens equator becomes 
 smaller; the antero-posterior diameter of the lens increases; the 
 anterior pole of the lens moves forward, and its posterior pole back- 
 ward; both the anterior and posterior surfaces of the lens form a 
 lenticonus; the lens in toto moves upward and inward. — (deSchwei- 
 nitz.) 
 
 Accommodation,, Line of. The line of accommodation is that distance 
 in space along which an object is distinctly seen, even though the 
 image-rays do not fall accurately upon the percipient retina. The 
 length of this line depends upon the width of the pupil, the capacity 
 of the retina, the refractive power of the optical apparatus, etc. It 
 corresponds to a dioptric value of 0.066 D. for the lens-containing 
 reduced eye ; that is, if two points can be seen distinctly when their 
 distance apart on the retina is 0.004 mm. For an aphakic eye the 
 same conditions would correspond to 0.043 D. These figures hold 
 good only if it is assumed that all parts of the macular region are 
 of the same refraction ; but as this is seldom true, the line of accom- 
 modation is usually greater than that of the reduced eye. See 
 Refraction and accommodation. Physiological optics. 
 
 Accommodation, H. Muller's theory of. After he had discovered what 
 he regarded as circular fibres in the ciliary muscle this scientist be-
 
 52 ACCOMMODATION, NEGATIVE 
 
 lieved that the changes in form which we know the lens undergoes 
 during the act of accommodation might be brought about by direct 
 pressure of the muscle. This hypothesis was, of course, abandoned 
 when it was known that the ciliary does not come in contact with 
 the crystalline body. 
 
 Accommodation, Negative. In this condition all the structures that 
 take part in the act of accommodation (q. v.) are supposed to be at 
 rest ; both eyes gaze into infinity and there is no effort to fix an 
 object. HoAvever, the nearest approach that can be made to realiz- 
 ing absolute negative accommodation is when not only these condi- 
 tions prevail but when the eyes are also thoroughly atropinized. 
 
 Accommodation, Painful, of Bonders. This is a name given to an 
 hysterical disorder of accommodation — probably the most common 
 eye symptom of hysteria. It is of the nature of spasm and the 
 patient is often unable to make any use of the eyes for near-work. 
 See Amblyopia, Hysterical. 
 
 Accommodation phosphenes. An entoptic phenomenon occurring dur- 
 ing strong voluntary accommodation. The most frequently observed 
 phenomenon of this kind is that of Purkinje — a dark spot in the 
 region of the point of fixation, especially when one regards an object 
 on a white background. Czermak's phosplienc is the appearance of 
 a bright border around the visual field during a sudden relaxation 
 of accommodation in the dark, said to be due to dragging on the 
 retina about the ora serrata. 
 
 Accommodation, Pseudo. See Accommodation, Apparent. 
 
 Accommodation, Range of. See Amplitude of accommodation. 
 
 Accommodation, Relative range of. By this term is meant the faculty 
 of increasing or diminishing the accommodation in correspondence 
 with the convergence. Curves of relative range of accommodation 
 have been constructed repeatedly. Hess has advanced the following 
 law intended to express the relation between convergence and ac- 
 commodation : with each convergence-innervation there goes an 
 accommodative effort of a certain extent which, with fixed con- 
 vergence, can be increased or decreased within certain limits. The 
 extent of the increase or decrease is about the same for all degrees 
 of convergence, if the accommodation is manifest. In other words, 
 the margin within which the accommodation can be separated from 
 the medium convergence is independent of the absolute extent of 
 the convergence. The same relations which exist between con- 
 vergence and manifest accommodation most likely exist between 
 convergence and contraction of the ciliary muscle. 
 
 Accommodationsbreite. (G.) Range of accommodation. 
 
 Accommodationsbreite, Binocular and monoculare. (G.) Range of 
 accommodation, binocular and monocular.
 
 ACCOMMODATIONSBREITE, RELATIVE 53 
 
 Accommodationsbreite, Relative. (G.) Relative accommodalioii. 
 
 Accommodation, Scheinbare. ((J.) A])parent aeeouunodMtion. 
 
 Accommodation, Schoen's theory of. The contraction of the ciliary 
 muscle produces the same effect on the lens as it does on a rubber 
 ball when the latter is held in both hands and compressed with 
 the fingers. See Refraction and accommodation ; Physiological 
 optics. 
 
 Accommodationslahmung". (G.) Paralysis of accommodation. 
 
 Accommodationslinie. (G.) Accommodation lines. 
 
 Accommodationskrampf. (G.) Spasm of accommodation. 
 
 Accommodationsmuskel. (G.) Ciliary muscle. 
 
 Accommodation, Spasm of. Accommodative cra^mt. Under this head- 
 ing a number of i)henomena have been included. Tlie most common 
 is apparent myopia in young persons, Avliich partly or entirely dis- 
 appears after the use of atropine. Several authors believe that this 
 form of spasm (that is nearly always accompanied by short sight) 
 is quite common (20 per cent, to 40 })er cent, of all school children) 
 and that it may develop into true, axial myopia. The reported cases 
 can partly be explained by the known decrease in the refraction 
 of the periphery of the cornea and lens, parts that become visually 
 active after atropine applications. The typical picture of accom- 
 modative spasm can be produced by eserine instillations. If the 
 pupil is much contracted, the near-point approaches the eye, and 
 the range of accommodation is apparently increased. Generally, 
 however, the near-point is not nearer to the eye than it can be 
 brought by strong voluntary effort at accommodation. The far- 
 point, in such cases, approaches the near-point more or less, and the 
 range of accommodation is shortened, and this certainly suggests 
 myopia. 
 
 Other causes of acconnnodative cramp are hysteria, irritation of 
 the eye from injury, intlammatory changes, etc. 
 
 Accommodationsschwache. (G.) Accommodative weakness. 
 
 Accommodationsvermbg'en. (G.) The poAver of accommodation. 
 
 Accommodation, Tscherning-'s theory of. By the contraction of the 
 anterior part of both the radiating and circular fibers of the ciliary 
 muscle the ciliary processes are draw^n backward, the suspensory 
 ligament is pulled backward and outward, and the pressure ex- 
 erted by the anterior portion of the muscle brings about an in- 
 creased convexity of tlie lens. See Refraction and accommodation; 
 Physiological optics. 
 
 Accommodation, Weakness and paresis of. This comlition is, in eff'ect,
 
 54 ACCOMMODATIVE 
 
 a decrease in the power of the ciliary muscle resulting in the re- 
 cession of the near-point. As Hess points out, the old idea that a 
 normal near-point indicates normal function of the ciliary muscles 
 is not necessarily true, since paresis of the ciliary muscle is not 
 noticed in accommodation until it is greater than the latent accom- 
 modation. Owing to the fact that the latter increases wi.th advancing 
 age, old people may be afflicted with a considerable paresis of these 
 muscles, and still the near-point ma}' be normal. This fact has been 
 frequently overlooked, and for this reason it has been erroneously 
 stated that cocaine does not aifect the accommodation. After an 
 instillation or subconjunctival injection of cocaine the near-point 
 invariably recedes from the eye in young persons, while the recession 
 is difficult to detect in older people. Just as atropin maj^ not have 
 any influence upon the near-point of a man of seventy, regardless 
 of the fact that it paralyzes the ciliary muscle, a weak cocaine solu- 
 tion may not appreciably att'ect the accommodation of a man 40 to 
 50 years of age. If we read that a patient 50 or 60 j^ears old has a 
 normal near-point, and from this draw the conclusion that he has a 
 normal accommodation, we must see at once that such a conclusion 
 is not tenable, since the ciliary muscle may be completely paralyzed 
 regardless of the fact that the accommodation is normal. It is for 
 this reason that subjective disturbances resulting from ciliary paresis 
 or Aveakness must in young persons be more pronounced than ceteris 
 paribus in older people. IMoreover. such disturbances are less marked 
 in myopes than in emmetropes, and less in the latter than in hyper- 
 metropes. Common to all these disturbances is this recession of the 
 near-paint while the far-point remains in its normal locality. 
 
 The most common clinical cause of accommodative paresis is 
 diphtheria, Avhich aft'ects the ciliary muscles only, the iris muscula- 
 ture remaining intact. The paresis usually occurs in from 2 to 3 
 wrecks after the diphtheric infection, and in most cases recovery is 
 complete after 3 to 4 Aveeks. Among other causes of paretic accom- 
 modation are : partial or total paresis of the third nerve, various 
 cerebrospinal diseases, hysteria and a number of intoxications — 
 ptomaine poisoning, for example. 
 
 The prognosis depends upon the nature and curability of the 
 primary disease ; as far as diphtheria is concerned the ciliary paresis 
 as a rule gets well. The so-called hysterical paresis of accommoda- 
 tion is, of course, purely psychic. (See Excijllopddie der Angen- 
 Ju'ilkuHde. A. B., p. B.) 
 Accommodative, adj. Pertaining to the function of accommodation 
 (q. v.).
 
 ACCOMMODATIVE ASSOCIATED MOVEMENTS 
 
 DO 
 
 Accommodative associated movements. Tliis term is sometimes applied 
 to the movements of convergence and divergence, accompanying 
 binocular fixation and focussing at varying distances, which involve 
 a corresi)onding eluaigc in the accommodation. 
 
 Accommodative asthenopia. Asthenopia due to congenital weakness 
 in or to an overworked ciliary muscle. This weakness is mostly due 
 to errors of refraction and accommodation and the consequent strain 
 on the ciliary muscle in its efforts to overcome tho defects. 
 
 Accommodative Augenbewegimgen. (G.) Accommodative ocular 
 movement. 
 
 Accommodazione. (It.), n. Accommodation; i. e. the process by 
 which the refractive condition of the eye is changed in accordance 
 with the distance at Avhich an object is viewed. 
 
 Accommodometer. Also called, Punctumeter and Rod-optometer. An 
 instrument, devised by Adam, for measuring the region and the 
 
 
 BE^^BtO 
 
 Accommodometer. 
 Counter Form. 
 
 range, or amplitude, of the accommodation. Its construction is suffi- 
 ciently obvious from the annexed illustrations, one of wiiich shows 
 the hand-, the other the counter-form. The little object-carrier 
 slides to and fro on a graduated scale, and the object which it carries
 
 56 ACCOMPAGNEMENT DE LA CATARACTE 
 
 is either a bit of fine print or some conventional device — e. g., two 
 fine threads stretched at right angles across the carrier's aperture. 
 
 Aeeonmiodometer. 
 Haud Form. 
 
 The eye-piece may or may not be furnished with lenses. The pur- 
 pose of the instrument is to determine, with or without lenses, the 
 distance at Mdiich the objects are most plainly seen, and f^o the 
 refraction for near. Accommodometers were formerly much used, 
 especially by opticians, but of late have almost entirely disappeared. 
 — (T. IT. S.) 
 
 Accompagnement de la cataracte. (F.) An obsolete term for a whit- 
 ish, viscid substance supposed to occupy the place of the crystalline 
 lens after the removal of cataract. 
 
 Accompaniment (of the cataract). An obsolete term for secondary or 
 recurrent capsular cataract; opacity of the capsule following an 
 operation for cataract ; or for a Adscid substance supposed to take 
 the i^lace of the extracted lens. 
 
 Acconamosali. Said to have been an Armenian. This man was the 
 author of a celebrated Avork in Arabic on the diseases of the eye. 
 See Canamusali de Baldach. — (T H. S.) 
 
 Accrescenz. (G.) Accretion. 
 
 A. C. E. mixture. An inhalant compound containing one part of 
 alcohol, two of chloroform and three of ether. It is supposed to be 
 indicated in general anesthesia when neither ether nor chloroform 
 can be taken alone. See Anesthesia in ophthalmic surgery. 
 
 Aceognosia. (L.), n. f. A knowledge of remedies. 
 
 Aceology. n. Therapeutics in general, especially operations and 
 mechanical appliances. 
 
 Acetaldehyd. (G.) Acetaldehyde. 
 
 Acetameisensaure. (G.) Acetoformic acid. 
 
 Acetanilid, also called antifebrin and phenylacetamid, occurs as white, 
 shining, crystalline scales. It is odorless and has a slightly burning 
 taste. It is soluble in about ISO parts of cold and 18 parts of boiling 
 water. Antifebrin has but a slight application in ophthalmology 
 but has been recommended as a dusting poAvder after operations
 
 ACETESSIGESTER 
 
 01 
 
 (as a snbslitule for iodol'o]-))! ), but, is not as effective as that ill- 
 smelling drug-. Taken in toxic doses it has produced temporary 
 blindness with retinal anemia. 
 
 Antifebrin (as it is commoidy called) in toxic doses not infre- 
 quently causes mucous and dermal erui)tions, from which the lids 
 and ocular conjunctiva are not exempt. No doubt when severe 
 symptoms, as tempoi-ary blindness with retinal anemia, follow a 
 relatively small dose it is due to an idiosyncrasy. After taking 0.60 
 gram of antifebrin a patient had an erythematous eruption over the 
 entire body, including the conjunctiva. In one recorded case a 
 woman had a conjunctival exanthem from taking half a gram of 
 the remedy, the eruption being accompanied by a pricking sensation 
 in the eye as well as lachrymation. 
 
 The pupils are also affected in some examples of poisoning. In 
 one instance after a dose of 3 grams they did not react to light : in 
 another case the same result folloAved a 4-gram dose. In still another 
 case, 2i hours after 7 grams were administered, the pupils were very 
 small and had also lost the usual reflexes. Occasionally mydriasis 
 has been noticed. Rarely double vision and marked amblyopia 
 occur. 
 
 In many cases the poison acts like a quinine intoxication. Thus. 
 after the ingestion of 3 grams of antifebrin, some patients experi- 
 ence vertigo and tinnitus, and in more than one ease the visual acuity 
 sank to a minimum in both eyes and the patient was unable to tind 
 his way about the room. 
 
 In another instance of intoxication the pupils were dilated and 
 lost their reflexes while hand-movements were perceived with diffi- 
 culty at a few feet. The field of vision was greatly restricted, the 
 papillae were pallid, and the caliber of the vessels narrowed. Amyl 
 nitrite was administered, followed after the first inhalation by 
 improved vision. The face reddened, the pulse increased, and the 
 improvement in sight continued during the two hours of inhalation. 
 The cause of these serious visual disturbances is probably an acute 
 anemia of the nerve centers from vascular spasm, as are paleness of 
 the face and the blanching of the raucous surfaces. The effect of 
 the amyl nitrite treatment also indicates such a process as directly 
 affects the end vessels as Avell as the central vascular suppl.v. 
 
 The retinal veins have in a few instances been described as dilated 
 after the ingestion of large amounts of antifebrin. but in most cases 
 this was not observed. See Toxic amblyopia. 
 Acetessigester. (G.) Aceto-acetic acid. 
 Acetessigsaure. (G.) Aceto-acetic acid.
 
 58 ACETIC ACID 
 
 Acetic acid. HCoHoO.> or CII-.COOH. The acid of common vinegar. 
 Almost all the acetic acid of commerce is obtained by the destruc- 
 tive distillation of wood, although domestic vinegar is derived from 
 the acetous fermentation of grain. 
 
 Dilute vinegar is of some value in neutralizing burns of the con- 
 junctival sac and eyeball from caustic soda, potash and lime. Of 
 course it should be applied at once, preferably warmed and used 
 Avith an undine or medicine dropper to wash out the deleterious sub- 
 stances, at the same time converting them into less destructive com- 
 pounds. 
 
 Warts of the palpebral skin may be removed by the application 
 of the glacial acetic acid. This is an anhydrous, crystalline form of 
 the acid which liquefies at 60 °F. into a colorless fluid with a strong 
 vinegar odor and a pungent, acid taste. It should be applied with 
 care, as it is a powerful caustic and may involve a wider area than 
 the diseased growths. For the removal of warty exeresences the 
 fuming nitric acid is to be preferred. - 
 
 G. C. Savage advises in corneal ulcer the application to the lesion 
 of one drop of acetic acid in five to seven drops of water once in 
 twenty-four hours. His method is to touch the ulcer gently with a 
 piece of absorbent cotton (wrapped around a tooth-pick) and satur- 
 ated with the above solution. The advantage of acetic acid over 
 other agents is that while it destroys germs, as the other agents do, 
 it does not destroy cell life, connective tissue or the epithelium. 
 Acetomilchsaure. (G.) Acetolactic acid. 
 Aceton. (G.) Acetone. 
 
 Acetozone. Benzosoxe. This compound, whose formula is (Cp,H-,CO.- 
 COCH3) Oo, occurs in colorless crystals that melt at 98° F., and 
 are soluble in 1 to 10,000 to 1000 of water (according to its tempera- 
 ture) and 35 parts of oil. It resembles hydrogen dioxide in struc- 
 ture and, like it, is a valuable antiseptic, germicide and oxidizing 
 agent. It has been recommended in corneal ulcer, purulent blennor- 
 rhoea and gonorrhceal ophthalmia in watery or oily solvents, 1 :1000 
 or stronger. Ointment of acetozone is available as strong as 1 per 
 cent, although it is best to begin with a 1 :1000 mixture. 
 
 J. G. Roberts uses this remedy in 1-1000 solution in all purulent 
 affections of the eye, preceding operation and (in strength of 1-3000) 
 to irrigate the anterior chamber during cataract extraction. 
 Acetylchloriir. (G.) Acetyl chloride. 
 Acetyloxyd. (G.) Acetic acid. 
 Acetyloxydhydrat. (G.) Acetic acid. 
 Acetylsalicylic acid. C.,Hs04. Another name for aspirin. This
 
 ACETYLSAURE 59 
 
 compound is obtained by heating acetjd chloride in a flask to 302° F. 
 (150° C). It is found as small, acidulous, colorless crystals, slightly 
 soluble in water, more so in alcohol and ether. 
 
 It is a willow preparation, allied to salicin and salicylic acid, and 
 in gram doses three or four times daily, is of decided value in severe 
 cases of iritis and other uveal affections. It is best administered in 
 capsules, with or without sodic bicarbonate. "Wicherkiewicz has 
 employed it with success in chronic conjunctivitis due to long stand- 
 ing gonorrheal infections, in iritis, iridocyclitis, scleritis and epis- 
 cleritis, rheumatic choroiditis with vitreous exudations and glauco- 
 matous manifestations. It is less prone to produce tinnitus, and gas- 
 tric disturbances than the salicylates. 
 
 Wm. G. Craig employs aspirin, generally in doses of 15 grains 
 night and morning, in all such painful eye diseases as iritis, keratitis, 
 corneal ulcer, glaucoma, and after injuries and operations. He is 
 so impressed with the value of this drug that he uses it to the exclu- 
 sion of all other anodynes. 
 
 Acetylsaure. (G.) Acetic acid. 
 
 Acetylwasserstoff. (G.) Aldehyde. 
 
 Achicolum. (L.), n.n. The sweating-room of an ancient bath. 
 
 Aching-, as an ocular symptom. This is a symptom often complained 
 of by ophthalmic patients, ai)art from headache or acute neuralgic 
 pains due to such intraocular diseases as glaucoma, iritis, etc. Jack- 
 son describes it as a sort of extreme spontaneous soreness, as in 
 inflammatory disease with swelling and tension of sensitive parts ; 
 or it may be a nerve pain of the same character as headache, some- 
 times described as "a headache in the eyes." The inflammatory 
 ache may be spoken of as burning, especially where there is con- 
 junctival or corneal disease present. Its significance is mainly as 
 evidence of severe tension of the parts from inflammatory exudate. 
 It may be quite marked in corneal disease, but is more apt to be 
 most severe in iritis, cyelitis or glaucoma. Aching of the eyes, inde- 
 pendent of infiammatiou, most frequently arises from eye-strain : but 
 sometimes it occurs through choroidal congestion, and sometimes 
 through cramp or tire of the ciliary muscle. 
 
 It is frequently stated by the patient that the eyes are free from 
 pain, but that there is "aching or pain back of them." This fre- 
 quently means that the pain is really in the eyeball; and not upon 
 its surface or in the lids; that it has ;i different location from that 
 produced from something getting into the eye. 
 
 But, in some cases it seems fair to refer such pain to the region 
 of the orbital muscles or their attachments. Any severe pain affect-
 
 60 ACHLOEOPSIA 
 
 ing the eyeball is likely to be referred to adjoining parts. Thus in 
 glaucoma or iritis, the pain may be complained of as situated mainly 
 in the brow or cheek. In such cases, however, the history generally 
 shows that it started in the eye and then spread to the adjoining 
 parts. 
 
 The pai)i of acute conjunctivitis ma}^ be spoken of as aching, 
 though probably true aching when present is connected with con- 
 siderable swelling of the neighboring parts, or involvement of the 
 deeper tissues of the eyeball. 
 
 Achloropsia. Green-blindness. 
 
 Achloropsie. (G.) Green-blindness. 
 
 Achlys. (Obs.) Cloudiness of the cornea. 
 
 Achne. (Obs.) Mucus upon the eye. 
 
 Achorion Schoenleinii. The fungus of favus, a dermal infection found 
 in both man and domestic animals, several subspecies of which 
 have been described. This fungus is readily grown on ordinary 
 media at body-temperatures. Its incubation period is from three 
 to four days. Mass-like processes form at the periphery of the 
 growth and extend downward. The color of the culture is at first 
 gray ; later yellowish. Microscopically, one sees a radiating mycelium' 
 whose hypha^" are of different size and bifurcate. The characteristic 
 yellow, sharply defined favus colonies are occasionally seen on the 
 eyelids. 
 
 Achroma. Absence of color, especially of physiologic pigment ; a con- 
 dition also known as achromasia, achromatia, achromatosis, achro- 
 modermia. and leukoderma. 
 
 Achroma. (G.) Achromasia. 
 
 Achromasia. Freedom from chromatic aberration (q. v.). Achro- 
 matism. All common spherical lenses show chromatic aberration. 
 Therefore, achromasia can be obtained only by the union of several 
 (generally two) spherical lenses. The common achromatic lenses 
 are made by a biconvex lens of crown glass and a concavo-convex 
 lens of flint glass. The adjacent surfaces of the two lenses have the 
 same radius and thus fit into each other accurately and completely. 
 Flint glass refracts color-rays much more strongly than crown 
 glass, so that a proper combination of the two naturally furnish an 
 achromatic compound lens. Achromatic dispersion-lenses are com- 
 posed of a bi-concave lens of crown glass and a compound meniscus 
 of flint glass. 
 
 Absolute achromatism is, however, never realized in lenses be- 
 cause each system is always achromatic for only one pair of com- 
 plementary colors (usually blue and orange).
 
 ACHROMATIC 61 
 
 Attempts have been made to manufacture heavy achromatic spec- 
 tacle lenses for high degree hypermetropes and persons operated 
 on for cataract, but it is questionable whether these patients are much 
 more benefited by them than by the ordinary form of lens. 
 
 Achromatic, adj. Non-productive or devoid of color. Achromatic 
 lenses consist of a combination of lenses of different material and 
 shape so that, instead of the unequal refraction of the rays of va- 
 rious colors, which either alone would produce, all the rays combine 
 in a single focus, and the image of an object seen through such a 
 lens is free from coloration. 
 
 Achromatic. Achromatic lens, a lens consisting of superposed spherical 
 convex and concave lenses, usually united by means of balsam and re- 
 spectivel}^ made of glass having different refractive and dispersive 
 poAvers, with their curvatures so accurately determined that the 
 chromatic aberration (see Aberration) produced by the one is 
 counteracted by the other, thus effecting absence of color in the 
 image produced by the multiple lens. Achromatic prism, a prism 
 composed of a combination of prisms made of different substances 
 having unequal powers of refraction and dispersion (see Chromatic 
 dispersive power), superposed, with their bases placed opposite to 
 each other, and their angles so relatively proportioned as to still 
 obtain deviation without any appreciable amount of dispersion or 
 decomposition of light into its spectral colors. It is also possible to 
 produce prisms that will produce dispersion of the rays without de- 
 viation. See Achromatism. 
 
 Achromatic cells of the retina. The retinal ganglion cells were found 
 by Dogiel to contain two distinct substances, one readily stained 
 (which he called chromophilous) and another {achromatic cells) un- 
 affected by staining material. 
 
 Achromaticus. (L.), adj. Devoid of color. 
 
 Achromatique. (F.), adj. Achromatic. 
 
 Achromatisch. (G.) Achromatic. 
 
 Achromatism. In optics, the state of being achromatic (([.v.). New- 
 ton discovered that solar rays arc separated through refraction by 
 a prism into rays of different color and direction, as shown in the 
 solar spectrum (see Spectrum analysis). This phenomenon is called 
 "dispersion of light" or "chromatic dispersion." Newton consid- 
 ered that it was impossible to produce achromatism, since, in his 
 opinion, it necessarily involved also tlio abolition of ray-deviation. 
 Seventy-fiA^e years Inter Euler, basing liis argument upon the errone- 
 ous assumption that the human eye is an achromatic combination 
 of lenses, theoretically deduced that similar combinations were pos-
 
 62 ACHROMATISM 
 
 sible. However, nothing j^ractical was accomplished until 1757, when 
 Dolland, an optician in London, found that the dispersion could be 
 corrected without destroying the refraction, and constructed an 
 achromatic telescope by the use of two kinds of glass called "crown 
 glass" and "flint glass," of which the former is the weaker in respect 
 to both refraction and dispersion. In this combination the convex lens 
 was made of crown glass and the concave lens of flint glass. Dolland 's 
 success revived interest in the subject, but no further material prog- 
 ress was made until Fraunhofer an optician in Munich, in 1814 
 independently re-discovered the dark bands of the solar spectrum 
 that had been detected by Wollaston in 1802. The spectrum of solar 
 light is not continuous, as Newton supposed, but is crossed by a 
 number of dark lines irregularly distributed over the entire ex- 
 tent of the spectrum, and although their actual position is altered 
 by substitution of a prism of different material, the order of the 
 lines and of the colored intervals between them is always the same, 
 so that anj^ particular line may be readily recognized. Fraunhofer, 
 perceiving that each of these fixed lines, about 600 in number, cor- 
 responds to a definite wave-length of light, employed them to de- 
 termine the refractive index of any substance for such wave-length. 
 For this purpose he designated the more conspicuous lines with cap- 
 ital letters of the alphabet from A to H ; the violet end of the spec- 
 trum, as nearly as he could locate it, being designated by the letter J. 
 Therefore, until the kind of light that is being used is specified, the 
 so-called refractive index of a medium is ambiguous, since a medium 
 has just as many indices of refraction as there are different kinds 
 of glass. Achromatism, therefore, depends upon the selection of two 
 different kinds of glass of different dispersion identified by the lines 
 of the spectrum. Although Fraunhofer and others had tried to pro- 
 duce new kinds of glass, it was not until Abbe and Schott, of Jena, 
 succeeded in making a variety of pairs of different kinds of crown 
 and flint glass, such that the dispersion in the various parts of the 
 spectrum is for each pair as nearly as possible proportional, that it 
 has been possible to take the fullest advantage of Fraunhofer 's dis- 
 covery. 
 
 An optical system which produces two colored images of a given 
 object at the same place and of the same size is said to be completely 
 achromatic for these two colors. The images of other colors will, 
 however, generally be different as to both size and position, and the 
 effect on the resultant image usually appears in a colored margin or 
 "secondary spectrum." Usually the best that can be done is to ob- 
 tain a partial achromatism of some sort, and especially one of the two 
 following- kinds: achromatism with respect to place (so that the two
 
 ACHROMATISM 63 
 
 colored images, although of unequal sizes, are both formed in the 
 same image-plane), or achromatism as to magnification (so that the 
 two colored images, although differently situated, are of equal size). 
 As a rule, it may be stated that for an optical system Avhicli produces 
 a real image, it is more desirable to have achromatism with respect 
 to the place of the image; whereas if the image is virtual, achrom- 
 atism with respect to the magnification is likely to be the more im- 
 portant requirement. 
 
 In creating an achromatic combination of lenses it depends upon 
 whether the lens is to be exposed to centrally or obli(|uely incident 
 rays. In the former case the pencils of different colors into which 
 an incident pencil is separated have a common axis in which their 
 points of divergence or convergence lie, and the combination is 
 achromatised by making as many as possible of these points coincide. 
 But in an obliquely incident pencil the axes of the refracted colored 
 rays have different directions, so that there is an angular separation 
 of their points of divergence or convergence — as seen by an eye in 
 a given position — and the condition of achromatism will be that 
 which will render the axes of as many as possible of these colored 
 pencils parallel — since rays which enter the eye in a state of paral- 
 lelism afjPect the eye in the same wa.y as if they were coincident — or 
 very nearly so. 
 
 Condition for achromatism of two thin lenses when exposed to 
 paraxial (centrally incide-nt) rays, the stipulation that the sum of the 
 products of the despersive powers and reciprocals of focal lengths 
 shall be zero : in other words, when the following equation is sat- 
 isfied: 
 
 Ub - n,. 1 n\ - n',. 1 
 ~^7T ■ F + n'-l ■ f^ = ^■ 
 
 This, and the eiiuation ^ -TT+jf / make it possible to determine the 
 
 focal distances f and f of two thin lenses that constitute an achro- 
 matic combination whose focal length is F. In practice it is found 
 that the best results are obtained when the yellow 1) rays, and the 
 bluisli-green F rays of the spectrum, are brought to a focus at the 
 same point. Then n,. and n^ signify the refractive indices of the 
 first lens for the D and F rays respectively, while n,' and ut' have 
 a similar significance with regard to the second lens. The indices 
 for the middle of the spectrum are n and n' for the lenses whose
 
 64 ACHROMATIZE 
 
 foci are f and f , respectively. The radii i\ and r„ of curvature are 
 determinable through the equation : 
 
 1 1-1 
 
 -==(n-l) (— ^). 
 
 1 ^2 
 
 f ~ r, r. 
 
 Condition for achromatism of two prisitis, the stipulation that is 
 satisfied by the equation : 
 
 (Ub-Ur) Z= (Ub'-n/) Z'. 
 This determines the angles Z and Z' of the combined prisms, in order 
 that the transmitted light shall be approximately free from color. 
 The deviation of the transmitted light is equal to: 8 - 8' = (n - 1) 
 Z - (n' - I) l\ 
 
 In these equations the indices (n, n', etc.) have the significance previ- 
 ously mentioned. — (C. F. P.) 
 
 Achromatize, tr. v. To render achromatic. 
 
 Achromatopsia. (L.), n. f. Total color-blindness. All colored objects 
 appear gray to achromatoptic individuals. See Color-blindness. 
 
 Achromatosen. (G.) Affections of the skin characterized by absence 
 or deficiency of pigment. 
 
 Achromatosis. Any disease characterized by deficiency of pigmenta- 
 tion in the integumentary tissues. 
 
 Achse. (G.) An axis. 
 
 Achse des Auges. (G.) Optic axis. 
 
 Achsendrehung- des Sehnerven. (G.) Axial torsion of the optic nerve. 
 
 Achsenfiigung. (G.) Axial articulation. 
 
 Achsenhypermetropie. (G.) Axial hypermetropia. 
 
 Achsenmyopie. (G.) Axial myopia. 
 
 Achsenstellung der Cylinderglaser. (G.) Notation of the axis of 
 cylindrical lenses. 
 
 Achse, Optische. (G.) Optic axis. 
 
 Achtaugig. (G.) Octonocular. Having eight eyes. 
 
 Achtertour. (G.) A figure-eight bandage. 
 
 Achttagig. (G.) Occurring every eight days. 
 
 Achttaglich. (G.) Occurring every eight days. 
 
 Acid, Bichloracetic. See Acid, Dichloracetic. 
 
 Acid, Boracic. Boric acid. H3BO3 or B (OH).}. This acid was dis- 
 covered in 1702 by Homburg and for over a century went under the 
 name Sal sedativum Hombergi until its composition was demon- 
 strated. 
 
 Its comraercial origin is borax. It is obtained hy treating that 
 
 salt wdth hydrochloric acid and allowing the crystals to separate. 
 
 Boric acid occurs in white, translucent, six-sided, pearly scales 
 
 that are greasy to the touch, odorless^ and of a slightly acid, acrid
 
 ACID, BORACIC 65 
 
 taste. It is soluhlf in 15 parts of alcohol, 4 parts of glycerine, 25 
 l)arts of cold and 3 parts of boiling Avater. 
 
 This agent is a mild and non-irritating antiseptic. A number of 
 official and proprietary preparations are nsed in eye diseases. The 
 chief of these is the glycerite of boroglycerin, U. S. or ointment of 
 boric acid, T>r. This form of the ointment is not so commonly em- 
 ployed as a simple mixture of the finely divided powder with vase- 
 line or some similar excipient. t 
 
 No remedy is as largely prescribed by the ophthalmic surgeon or 
 so widely known to the laity as boric acid, with whom it has dis- 
 plaj^ed, as a popular eyewash, many well authenticated virtues. This 
 is doubtless due to its main qualities — that of a soothing detergent 
 and mild antiseptic. In virtue of these actions it is utilized alone and 
 in combination with other drugs, in solution, as an ointment and 
 in the form of powder. 
 
 In solution it is prescribed in strengths var3ang from ^/^ per cent, 
 to the point of saturation (4 per cent.). These mixtures are used 
 for sub-con junctival injections (generally 2 per cent.), sprays (1 
 per cent, to 3 per cent.), douches (2 per cent.), large irrigations (1 
 per cent, to 4 per cent.), and as hot or cold compresses (1 per cent.). 
 
 One of the most ett'ective (because both soothing and mildly anti- 
 septic) of the collyria is the combination with borax and corrosive 
 sublimate: — borax, boric acid, of each 2 grms. ; solution of corr. subli- 
 mate (1:10,000) 60 grms. 
 
 This solution is intended for use in all forms of hyperemia of the 
 conjunctiva and the less severe forms of conjunctivitis wdiere a non- 
 irritating, antiseptic and cooling wash is indicated. It may also be 
 used, like the simple solution, in the irrigator and undine for wash- 
 ing out, disinfecting and removing toxins, mucus, and other dis- 
 charges from the conjunctival sac. Of the numerous combinations so 
 Avidely prescribed as simple collyria the following is also a fair 
 sample: boric acid, 2 grms.; bitter almond water, 40 grms.; rose 
 water, 100 grms. 
 
 Boric acid is also a (weak) preservative of alkaloids and other 
 compounds prone to decomposition. For this purpose it should be 
 used as a saturated solution. 
 
 Boric acid is often used in ointments, in which case petroleum or 
 yellow vaseline furnishes a good excipient. There is no reason for 
 prescribing in salves a larger proportion of the acid than one or 
 two per cent, as even less than that amount is soluble in the water of 
 the vaseline or in the secretions of the eye. Much larger (piantities 
 (5 to 25 per cent.) are, however, recommended for various com- 
 
 Vol. 1—5
 
 66 ACID, BORIC 
 
 plaints. Rabow, for example, has this formula, a 10 per cent, mix- 
 ture : boric acid, 5 grms. : lanoline, 20 grms. ; petrolatum, 30 grms. 
 
 When applied in ointments only the finest powder should be used 
 and all the constituents thoroughly mixed. Probably boracic 
 salve is an inferior form of ointment and is not the equal of other 
 preparations of the kind. 
 
 As a finely divided, dry powder boracic acid has been applied to 
 the conjunctivae and to the dermal surface of the lids as an antiseptic 
 and protective. When the powder is of the impalpable variety it 
 answers the purpose very well since it is free of odor, does not irri- 
 tate and is not likeW to "cake." At the same time it is questionable 
 whether it takes the place of calomel and iodoform in most of the 
 uses to which these remedies are put. For dusting on the conjunc- 
 tiva and palpebral skin it is occasionally combined with iodoform : 
 powdered iodoform, ]0 grms.: powdered boric acid, 1 grm. 
 
 ]\Iix in a mortar. (Ed.^ 
 Acid, Boric. See Acid, Boracic. 
 
 Acid, Carbolic. The most important uses of this agent are described 
 under its more correct name, phenol (q. v.). It may be said here 
 that it is best known in ophthalmic practice as a valuable and 
 effective application to the minor varieties of corneal ulcer and to 
 the margins of infected wounds, especially to infiltrated incisions 
 after cataract operations. The eschar formed by this cauterization 
 can easily be limited to the diseased area on the cornea or sclera by 
 a fine glass or wooden point, which should hold very little of the 
 fluid. If a single application is not sufficient it may be repeated 
 until the diseased area appears uniformly white. If necessary the 
 treatment can be repeated the following day. The patient must keep 
 the eye steadily fixed so as to confine the cauterant to the ulcerated 
 surface. The acid takes effect iipon the living tissue in a few sec- 
 onds, and it is advisable to hold the lids apart in order to prevent 
 the acid from coming in contact with any part of the conjunctival 
 sac. 
 
 In ulcus serpens, the effect of the phenol may be much increased 
 by applying to the previously carbolized surface the point of a 
 wooden tooth-pick soaked in 80 per cent, nitric acid; or the acid may 
 be further fortified by the addition of tincture of iodine or iodine 
 crystals. See, also, Phenol. 
 Acid, Chromic. Chromium trioxide. CrO.o. This agent, obtained by 
 the action of sulphuric acid on potassium dichromate, occurs as 
 small, purplish needles of a metallic lustre. They are odorless, de- 
 liquescent in moist air and very destructive of animal tissues. It is
 
 ACID, CHRYSOPHANIC 67 
 
 very soluble in water and decomposes hi the presence of ether, alco- 
 hol and glycerine. It fuses at 380° F. into a glass-like, black mass. 
 The watery solution is of an orange color. 
 
 As a caustic application to corneal ulcer this agent is of consider- 
 able value. The acid, fused on the tip of a silver probe, should be 
 carefully applied to the cocainized eye so as to destroy as little as 
 possible of the healthy tissues. The ulcer must be previously stained 
 with fluorescein and afterwards gently irrigated with a 2 per cent, 
 sodium chloride solution. The crystals, applied by means of an iris 
 forceps, are also used in Hungary for the removal of trachoma 
 granules, the cauterization being followed by immediate cleansing 
 Avith sterile water. 
 
 Acid, Chrysophanic. There are two forms of this acid; a so-called 
 "medicinal" acid, better known as chrysarobin, also called purified 
 Goa powder, a substance deposited in the wood of Vouacoupoua 
 araroba. Chrysarobin is an orange-yellow, crystalline powder, 
 turning brownish on exposure and yielding true chrysophanic acid 
 on oxidation. In the form of powder it is exceedingly irritating to 
 the eyes and if allowed to enter them may set up a violent kerato- 
 conjunctivitis. As an ointment, 1 to 3 per cent., it is occasionally 
 used in palpebral eczema. 
 
 The second form of this acid is rhein or rhubarb-yellow, the 
 coloring matter of rheum officinale. It closely resembles chrysa- 
 robin, and like it, is in-escribed in diseases of the lid skin in 2 to 5 
 per cent, salves. The powder (yellow, microscopic crystals) should 
 be kept from the eyes and not exposed to light. 
 
 Acid, Citric. H3C0H5O7 or C3H4(OH) (COOH3). 
 
 The acid of lemon and lime juice is made in large quantities from 
 these and other fruit juices, as well as from grape-sugar. It crys- 
 tallizes in colorless prisms of an agreeable, acid taste. It is very 
 soluble in water and alcohol. Its uses in diseases of the eye are 
 (luite limited. 
 
 Although citric acid is rarely employed as a topical remedy, 
 lemon juice, substantially a dilute form of the acid, has been recom- 
 mended in several pathological eye conditions, de Schweinitz men- 
 tions it as one of the local applications to the exudate in diphtheria 
 of the conjunctiva. In this and similar affections the fresh juice is 
 said to be preferable to dilute solutions of the acid or of the citrates. 
 Simi, of Florence, has advised the instillation of a strong (50 to 
 75 per cent.) solution of this drug as an absorbent in nebulae and 
 leucomata corneas. He claims that, dropped into the sac daily for
 
 68 ACID, DICHLORACETIC 
 
 a number of months, it will accomplish the purpose in the majority 
 of eases. 
 
 Eversbuseh freely treats all forms of membi'anous conjunctivitis, 
 including both the so-called croupous, i3seudomemI)ranous and diph- 
 theric varieties with fresh lemon juice filtered through paper and 
 instilled with a glass rod from one to three times daily. The juice 
 does not irritate bat seems to act merely as an astringent. For ex- 
 ample, if to the acid juice a small quantity of i)ure glycerine is 
 added, it penetrates the false membrane more easily. The addition 
 of a 1 per cent, solution of morphia prevents the otherAvise dis- 
 agreeable burning sensations set up by the acid and glycerine. 
 When the diphtheric infiltration of the conjunctiva is deep it is 
 better to appl}' the lemon juice directly on the everted lids or affected 
 area, rubbing it in while the patient is under a general anesthetic. 
 Acid, Dichloracetic. Uichloracetic acid. Urner's liquid chloracetic 
 ACID. C2H2CI2O2. A colorless liquid, soluble in water and alcohol. 
 Like the other chloracetic acids it acts well when applied undi- 
 luted as an escharotic for the removal of warts and other groAvtlis 
 from the lids. In corneal ulcer it has been found very useful as a 
 cauterant, applied by means of a tooth-pick soaked in it, after stain- 
 ing and cocainization. 
 Acid, Digallic, See Tannin. 
 Acid, Diiodosalicylic. See Sanoform. 
 
 Acid, Formic. This peculiar agent, whose formula is H., CO,, occurs 
 naturally in red ants [hence its name (formica), an ant] in muscle, 
 in stinging nettles and in some mineral waters. It is a colorless, 
 sharp-smelling liquid, vchich crystallizes at 0"C., melts at 8.6"C., and 
 boils at 100.8'^C. It mixes freely with water, ether and alcohol. It 
 readily decomposes and forms salts called formates. 
 
 Formic acid is rarely used in ophthalmic practice, but A. S. Per- 
 cival {Ophthalmic lievieic, Nov., 1910) has reported good results 
 from its internal administration in miner's nystagmus, even in pa- 
 tients who continue their work underground. M. Ohlemann gives 
 his observations on this sidjject based upon his experience in the 
 mining districts near Bochum, Westphalia. He chose twelve cases, 
 all men Avho Mere otf work, and treated all of them with formic acid 
 in doses similar to those mentioned by Percival, for a period of three 
 weeks ; but the treatment was unsuccessful in every instance. He 
 believes that in every case in which improvement is noted in this 
 anomaly the change is due to giving up underground work, and the 
 enjoyment of a period of rest, followed by work above ground. In 
 examining patients in this stage (after complete cessation of mining
 
 ACID, GALLOTANNIC G9 
 
 work) the nystagmns maj' not be noticeable excei)t "when the eyes are 
 directed upwards, and sometimes only in a darkened room. 
 
 After a rest of varying duration, depending on the length of time 
 the disease has been present, the age and strength of the patient, and 
 perhaps his habits as to alcohol and tobacco, some patients are able 
 to resume work underground. Generally, however, a return to work 
 in the mine is followed by a relapse of the disease. The writer has 
 also treated these cases witli strychnine, but Avithout success, and he 
 believes that no drug has yet been shown to be capable of curing the 
 condition, and that rest is the real cause of the improvement noted 
 in many cases. 
 
 Schwarz has used this agent in the treatment of trachoma. After 
 cocainization, he washes out the conjunctival sac and very lightly 
 rubs the conjunctiva with a cotton tampon moistened with a 5 per 
 cent, solution. This treatment may be repeated daily or at intervals 
 of a day or two, as the case requires. Jn pannus and trachomatous 
 infiltration it is better to rub the diseased area Avitli the solution for 
 several seconds, avoiding the normal tissue as much as possible. 
 The lid should then be kept everted for several seconds while the 
 patient looks in the opposite direction. This will prevent the cornea 
 from coming in contact with the treated conjunctiva ; it also prevents 
 the otherwise unpleasant burning sensations. Tlie remedy loses its 
 effect to some extent after prolonged treatment. The secretion from 
 the trachomatous eye is at first slightly increased the morning after 
 each treatment, but in a short time a diminution of the discharge is 
 noticed. Home-treatment with the conventional remedies may be 
 continued while the formic acid applications are going on. In long- 
 standing cases applications should be made once every week for a 
 long period, even after all visible follicles have disappeared as this 
 will prevent relapses. — (Ed.) 
 
 Acid, Gallotannic. See Tannin. 
 
 Acid, Glycerite of boric. See Glycerite or giyceride of boric acid. 
 
 Acid, Hydrochloric. Muriatic acid. Hydric chloride. IICl. This 
 valuable article of commerce is made by the action of sulphuric acid 
 on sodium chloride. The official acid is a colorless liquid, emitting 
 white vapor when in contact with the air. The strong acid is a 
 powerful eseharotic and poison. It should be applied to the human 
 tissues with great care. 
 
 As a cautery agent in corneal ulcer this acid has been used in 
 10 to 20 per cent, watery solution, but in our judgment it is more 
 likely to damage the surrounding tissues than most other applica- 
 tions. Birnbacher recommends, for the removal of calcareous de-
 
 70 ACID, HYDROCYANIC 
 
 posits in the cornea, that the chalky infiltration be touched with a 
 5 per cent, solution which should be at once neutralized by the same 
 strength of sodium carbonate. 
 
 Acid, Hydrocyanic. Prossic acid. H("X. The dilute acid of the U. S. 
 P. contains about 2 jDer cent, of the strong, anhydrous acid and is a 
 colorless liquid, having an odor of oil of bitter almonds. It oc- 
 curs in the free state in the various almond trees, the cherry laurel 
 and in other plants. It is a rapid and powerful poison for which 
 there is no competent antidote. 
 
 Instead of using cherry laurel water some ophthalmic surgeons 
 prefer a collyrium made up Avith dilute hydrocyanic acid, of which 
 the following is a fair example, useful in conjunctival hyperemia : 
 dilute hydrocyanic acid, one drop ; boric acid, half a dram ; borax, 40 
 grains; water, two fluid ounces. 
 
 Lawson suggests the following as a soothing application to the 
 conjunctiva3 : liquid extract of opium, one fluid ounce ; dilute hydro- 
 cyanic acid, 30 minims : distilled water to eight fluid ounces. 
 
 Acid, Iodic. HIOo. Iodic acid is found as colorless, rhombic crys- 
 tals, soluble in one part of water but less soluble in alcohol. It 
 forms numerous iodates, some of which are important and are 
 detailed elsewhere under respective headings. 
 
 This remedj' has been employed as an application in trachoma and 
 other eye diseases, in the form of pencils and has been made up for 
 that purpose in sticks containing 15 per cent, of the pure acid. In 
 from one to three per cent, solutions it is recommended as a colly- 
 rium in indolent corneal ulcer. 
 
 In trachoma, where lunar caustic or copper sulphate pencils are 
 contraindicated, Schiele strongly advises the use of the solid stick 
 and claims that it does not produce scarring. 
 
 Acid, Lactic. HCoHsOy. This acid, obtained from cheese, sour milk, 
 ' ' sour-krout ' ' factories and other sources, is a syrupy, odorless, color- 
 less fluid, of a strongly acid taste. It mixes in all proportions with 
 water. 
 
 As a cautery in rodent and other ulcers of the cornea it has been 
 used to advantage although, in our experience, it is not equal to 
 phenol or the actual cautery. Dolschenkow recommends it for this 
 purpose, diluted one-half with water. It is applied by means of a 
 pointed glass rod or with a wooden toothpick soaked in the fluid. 
 
 Acid, Monochloracetic. CoHoClOo. This is a very deliquescent, color- 
 less, crystalline mass. It is decidedly caustic and cauterant and 
 should be handled with care. It is very soluble in water and is gen- 
 erally applied as an escharotic, almost pure, to warts and other
 
 ACID, MURIATIC 71 
 
 growths. It is also employed like trichloracetic acid in 50 per cent, 
 solution to corneal ulcers. 
 
 S. B. Muncaster advises the use of monochloracetic acid for the 
 removal of xanthoma. A solution of one part to two of water is 
 applied by means of a piece of cotton on the end of a tooth-pick. In 
 a few seconds after the application the yellow discoloration becomes 
 white; on the second day there is swelling; in about a week a scab 
 forms and falls off, about ten days thereafter, leaving a clean sur- 
 face without any scar. In some cases it is necessary to make a sec- 
 ond or, perhaps, a third application at intervals of four to six 
 weeks. 
 
 Acid, Muriatic. See Acid, Hydrochloric. 
 
 Acid, Nitric. HNO3, or NO2, OH. Pure nitric acid is a colorless, fum- 
 ing liquid, staining animal tissues yellow. The so-called "fuming 
 nitric acid" is of a brown-red color, emitting suffocating vapors of 
 the same color. All the strong acids are powerful cauterants and 
 poisons. 
 
 The ''fuming" acid forms an effective escharotic for the removal 
 of palpebral warts. When properly applied there is little or no scar- 
 ring and the method is decidedly superior to the use of cutting in- 
 struments, glacial acetic acid, citric acid and the like. The papil- 
 loma should first be well disinfected and dried. Soak a match or 
 wooden toothpick in the acid and remove all excess of fluid with blot- 
 ting paper. Carefully tattoo the top of the wart Avith the wooden 
 point. Some burning follows that soon subsides. At each applica- 
 tion, which may be made every two or three days but only when 
 there is no soreness, repeat the disinfection and drying of the growth 
 until the wart dries up or crumbles away. 
 
 Solitary "wild hairs" may be effectually destroyed by first en- 
 larging, with the aid of a loup and the end of a sharp-pointed hard- 
 wood toothpick, the hair follicle and thrusting into the opening the 
 same toothpick subsequently soaked in strong nitric acid. The 
 preliminary boring is made by a careful rotary motion of the wooden 
 "drill." There is no bleeding; pain is prevented by cocainizing the 
 eye and the globe is protected by thoroughly swabbing the lid after 
 this procedure with a 5 per cent, solution of soda. The eyelash 
 generally drops out within twenty-four hours and if the operation 
 is skillfully performed the follicle is entirely destroyed at one sit- 
 ting. 
 
 Some surgeons use 5 per cent, to 10 per cent, solutions of nitric 
 acid for cauterizing corneal ulcers, but the editor much prefers 
 other agents as less painful and quite as certain.
 
 72 ACID, NUCLEOTINPHOPHORIC 
 
 Acid, Nucleotinphophoric. See Solurol. 
 
 Acid, Ortho-oxybenzoic. See Acid, Salicylic. 
 
 Acidosis. A condition in which a group of toxic substances, largely 
 acetone bodies, are circulating in the body tissues. Although no 
 direct eye-symptoms arise from this condition, yet asthenopia and 
 other evidences of "weak"' eyesight may result, as from any other 
 intestinal toxemia. 
 
 Acid, Phenic. See Phenol. 
 
 Acid, Phenylic. See Phenol. 
 
 Acid, Picric. Carb azotic acid. Picrinic acid. Trinitrophenol. This 
 agent is obtained by the action of nitric acid on such organic com- 
 pounds as salicin, indigo, etc., and occurs as inodorous, yellow 
 needles of an acid, bitter, acrid taste. It forms a bright yellow 
 solution in 90 parts of water — more soluble in ether and alcohol. 
 
 It is incompatible with all alkaloids, is explosive with sulphur and 
 phosphorus and is a deadly poison. It stains all tissues a bright 
 yellow and is rarely used in ophthalmology. 
 
 A saturated aqueous solution is used by E. M. Alger in burns of 
 the lids and herpes zoster ophthalmicus. 
 
 With some surgeons picric acid is a favorite remedy for paint- 
 ing the lid edges in ulcerative forms of blepharitis. For this pur- 
 pose it is used as a 1 per cent, solution, afterward wiping it off with 
 a cotton swab dipped in a 5 per cent, salt solution. 
 
 Salem advises the use of picric acid lotion in the treatment of 
 blepharitis, acute infective conjunctivitis, phlyctenular disease of 
 the conjunctiva and cornea, trachoma and ophthalmia neonatorum. 
 He employs the following collyrium : picric acid, one decigram ; 
 glycerine, distilled water, of each, 5 grams. 
 
 Businelli and A. Fortunati found that picric acid may be used 
 with advantage in burns of the eyes, from fire or chemical sub- 
 stances. It is said to be of special benefit in burns produced by 
 quicklime. For this purpose the following ointment may be ap- 
 plied two or three times a day: 
 
 Acid, picric. 0.20 (gr. 3) 
 
 Vaselin. alb. 10.00 (gr. 150) 
 
 A little cocaine solution may be instilled previously, to prevent 
 pain. 
 Acid, Prussic. See Acid, Hydrocyanic. 
 
 Acid, Salicylic. Ortiio-oxybenzoic acid. HCjIL-.O;-. Although sal- 
 icylic acid occurs free and in combination in the flowers and leaves 
 of several plants it is mostly prepared from phenol. It is seen as
 
 ACID, TANNIC 
 
 ro 
 
 small, white, odorless needles, of a sweetish astringent taste, slightly 
 soluble (1:450) in water, but very soluble in alcohol and ether. It 
 is a local antiseptic and astringent. 
 
 Of all the willow conii)ounds this agent, among the earliest and 
 most frequently used, is now rarely heard of in ocular therapy. It 
 is not so well borne internally as aspirin, salicin or its sodic and 
 potassic salts, and locally is more irritating than sodium salicylate. 
 Hirschberg is not enthusiastic over its local employment. Fick has 
 recommended a salve formula with zinc oxide in which some zinc 
 salicylate is probably formed. His formula is as follows : zinc oxide, 
 1 grm. ; salicylic acid, one decigram ; vaseline. 10 grms. 
 
 He uses this in the s(|uamous form of blepharitis. 
 
 As a disinfectant lotion for use with Anel's syringe in lachrymal 
 infections the following prescrij^tion may be employed: boric acid, 
 10 grms. ; salicylic acid, two and a half grms. ; distilled water, 500 
 grms. 
 
 Salicylic acid in solution 1 to -'AS is also recoiumended by Evers- 
 busch as a preservative for collyria. 
 
 E, M. Alger uses the following prescription in the scaly forms of 
 blepharitis: salicylic acid, 5 grs. ; yellow oxide of mercury, one lo 
 five grains ; j^etrolatum to make up half an ounce. 
 
 In Germany it has been prescribed in one per cent, solutions as a 
 collyrium in simple catarrh of the conjunctiva (and in xerosis) with 
 warm chamomile tea as a solvent. It is also the active ingredient 
 in Sattler's solution. 
 Acid, Tannic. See Tannin. 
 Acid, Thyminic. See Solurol. 
 
 Acid, Trichloracetic. HC2CI3O2. This agent is prepared by the ac- 
 tion of nitric acid on chloral. It is found as colorless, rhombic 
 crystals that are very deliquescent, possess a weakly pungent odor 
 and are very soluble in alcohol and water. 
 
 It is an effective cauterizing agent for corneal ulcers, to be applied 
 pure on the end of a wooden toothpick or pointed match soaked in 
 it, any excess of acid to be removed from the applicator before the 
 cautery is begun. It forms an efifective agent in the removal of warty 
 growths from the lids, producing a dry eschar that falls off in a 
 few days leaving a smooth surface, 
 
 In diplobacillary infections of the cornea Homer E. Smith has 
 used locally a 20 per cent, solution of this remedy associated, of 
 course, with other treatment. 
 Acide azotique. (F.), n.n. Nitric acid. 
 Acide borique. (F.), n.n. Boric acid.
 
 74 ACIDE PHENIQUE 
 
 Acide phenique. (F.), u.n. Carbolic acid (phenol) purified for 
 medicinal use. 
 
 Acidiren. (G.) To acidify. 
 
 Acido azotico. (It.), n.n. Nitric acid. 
 
 Acido borico. (It.), n.n. Boric acid. 
 
 Acido cromico. (It.), n.n. Chromic acid; chromium trioxide. 
 
 Acido fenico. (It.), n.n. Carbolic acid (phenol) purified for medic- 
 inal use. 
 
 Acidology. The science of surgical instruments and appliances. 
 
 Acidum boracicum. (L.) Boric acid. 
 
 Acidum boricum. (L.), n.n. Boric acid. 
 
 Acidum chromicum. (L.), n.n. Chromic acid; chromium trioxide. 
 
 Acidum nitricum. (L.), n.n. Nitric acid. 
 
 Acidum pyrogallicum oxidatum. See Pjnraloxin. 
 
 Acidum spiricum. See Salicylic acid. 
 
 Acidurgia. (L.), n.f. An obsolete term for operative surgery. 
 
 Acier. (F.), n.f. Keenness of vision. The pupil of the eye. 
 
 Acies. (L.), n.f. Keenness of vision. The pupil of the eye. 
 
 Acies diurna. See Hemeralopia. 
 
 Acies vespertina. See Nyctalopia. 
 
 Acinal. Like a racemose gland. See Acinous. 
 
 Acine. (F.), n.m. The cavity, or saccule, of the finest lobule in a 
 racemose gland. 
 
 Acineux. (F.),adj. Pertaining to an acinus. Resembling a racemose 
 gland. 
 
 Aciniform. adj. Like a cluster of grapes. A term applied by In- 
 grassias to the choroid coat of the eye, and by other writers to the 
 layer of pigment on the posterior surface of the iris. 
 
 Aciniforme. (F.), adj. Resembling a cluster of grapes. 
 
 Acino. (It.), n.ni. The cavity, or saccular recess, in a lobule of a rac- 
 emose gland. 
 
 Acinose. See Acinous. 
 
 Acinous, adj. Having acini; like a conglomerate or compound race- 
 mose gland. 
 
 Ackerkamille. (G.) Wild chamomile. 
 
 Aclastic. adj. Transmitting rays of light without refracting them. 
 
 Acne, Ciliary. Inflammation or infection of the sebaceous glands of 
 the hair follicles close to the margin of the eyelid. It presents the 
 appearance of one or more small nodules. 
 
 This disease may be defined as an acne vulgaris of the margin of 
 the lids, with inflammation of the glands of Zeiss, the hair follicles 
 and periglandular tissue — all followed by the formation of small
 
 ACNE DER AUGENLIDRANDER 75 
 
 nodules about the free border. According to Stellwag von Carion, 
 the disease seems to be caused by the l>acillus of I'nna and Ilodara, 
 and it may be solitary or diffuse. It nuiy accompany a facial acne 
 or comedones and is generally subject to relapses. The nodules may 
 disappear gradually or pass into the indurated form of acne ciliaris 
 (cicatricial hardening of the nodules), or they may be affected by 
 pus cocci, when small abscesses appear in the shape of suppurating 
 styes. 
 
 Treatment includes the removal of all sources of infection, 
 thorough epilation, the strictest cleanliness and disinfection of the 
 lid margins. Apply an emollient ointment, e. g., .") per cent, oint- 
 ment yellow oxide. If pus forms it should be evacuated. 
 
 Acne der Aug-enlidrander. (G.) Inflammation of the glands of the 
 hair follicles causing one or more small nodules along the ciliary 
 margin of the lid. Ciliary acne. 
 
 Acne mentagra. (L.) This disease may be regarded as one of the 
 varieties of ciliary acne. It is also called sycosis vulgaris, and is a 
 confluent folliculitis and perifolliculitis with a tendency to suppura- 
 tion, generally caused by ])urulent cocci or, occasionally, b}^ molds. 
 It may affect the eyebrows, the epidermis of the eyelid or the border 
 of the eyelid. The first signs are reddish-white nodules (which 
 eventually become yellow) around the hair-follicles. If tlie sebaceous 
 glands and the periglandular tissues are affected, it may result in 
 suppuration of the hair-follicles with loss of both the cilia and super- 
 cilia. It is not uncommonly associated with various forms of con- 
 junctivitis, chronic dacryocystitis, etc. Mentagra hyphormjcctica may 
 be confined to the eyelid or it may spread to it from the surrounding 
 structures, but it is seldom found alone on lid margins. From the 
 nodules, the favus fungus, acliorion Schonleinii (q. v.), may be iso- 
 lated, but the tricliophyion tonsurans is more frequently the morbific 
 agent. The latter disease is related to the trichophytomatous in- 
 fections of animals, especially cattle. In this latter form the border 
 of the eyelid is covered with a heavy layer of scales which, when 
 removed, exposes small abscesses that surround broken and degen- 
 erated cilia. Examination of these cilia reveal the spores of tri- 
 chophyton that, according to some investigators, groAV more often 
 within the hair sheath than on the outside of them. 
 
 The treatment is the same as for blepharitis in general : epilation, 
 
 disinfection with mercuric chloride (1 to 5,000) and inunction with 
 
 yellow oxide ointinent. {EncyJdopddie der Augenhcilkunde, p. 9.) 
 
 Acne of the cornea. An eruption, that generally goes under the 
 
 name of phlyctenules (q. v.), may accompany and be a part of acne
 
 76 ACNE ROSACEA DER LIDHAUT 
 
 of the cheeks, face, and nose. Corneal acne is found only in per- 
 sons who have passed the period of adolescence. These papules are 
 accompanied by marked redness of the edges of the eyelids, are 
 extremely rebellious to treatment, and are likely to relapse. The 
 systemic condition should be treated in such cases ; while the local 
 therapy is that of phlyctenular keratitis. 
 
 Acne rosacea der Lidhaut. (G.) Acne rosacea of the palpebral skin. 
 
 Acne rosacea of the palpebral skin. This form of lid infection is 
 usually secondary to, or at least a part of, facial acne rosacea. It 
 is a chronic erj'thema with dilation of the superficial veins, in which 
 the skin affected shows a network of vessels. Infection with puru- 
 lent organisms (which enter the mouths of the sebaceous glands) 
 leads to papular or acneform eruptions, which in turn form pustules. 
 Generally, this is the limit of the disease, as far as the eyelids are 
 concerned. The form which affects the eyelids is often observed 
 in women suft'ering from dysmenorrhea, those who are at the meno- 
 pause, or those who have other stomach or uterine disturbances. 
 In general, people who are inclined to auto-intoxication (q. v.) are 
 quite susceptible to the disease. 
 
 Treatment must include the elimination of possible stomach, in- 
 testinal and uterine disturbances. So far as local applications are 
 concerned, a good formula is : precipitated sulphur, glycerine, of 
 each, 10 grams; spirits of camphor, 10 to 15 grams; distilled water, 
 160 grams. If irritative symptoms are complained of, apply in the 
 morning an ointment of benzoated lard 80.0, with zinc oxide, 10 
 to 15.0 grams. 
 
 Acne tarsi. An inflammatory affection of the Meibomian glands. 
 
 Acne vulg"aris of the eyelids. Acne vulgaris palpebrarum, or inflamma- 
 tion of the sebaceous glands and lanugo hair follicles, is the result 
 of infection with the bacillus of Unna and Ilodara. It appears as 
 hard, raised nodules, each surrounded by a circumscribed swelling. 
 The disease may progress into a pustular form should an infection 
 with staphylococcus pyogenes mireus or alhus occur. This may lead 
 to tlie formation of small abscesses — acne suppurativa. Acne vul- 
 garis of the lid margin is elsewhere described as acne ciliaris (q. v.), 
 which is accompanied by styes and a disseminated facial form of 
 the disease in young, pale and anemic persons, who also suffer from 
 intestinal disorders. The treatment is the same as of acne ciliaris, 
 that is, attention to the digestive tract and the usual local salves 
 and watery disinfectants. 
 
 Acoin. This local anesthetic and substitute for cocaine is a synthetic 
 hydrochloride of dipara-anisyl-mono-phenetyl-guanidine.
 
 ACONITE, OCULO-TOXIC SYMPTOMS FROM 77 
 
 It produces local anesthesia about as quiekl}' as cocaiu or eucain 
 but it is much more irritating than either of these remedies. On the 
 other lumd it does not increase the intra-ocular tension, dilate the 
 pupil or paralyze the accommodation. It is commonly used in 1 :300- 
 400 solution. It is said to be more satisfactory than cocain for sub- 
 conjunctival injections. 
 
 From the experiments of Randolph and Hirsch we know that 
 acoin is a satisfactory substitute for cocaine in certain cases. 
 
 It is claimed that mixtures of acoin and cocain act much more 
 satisfactory as anesthetics than either agent alone. For instance, 
 Krauss speaks very enthusiastically of aeoin-cocain anesthesia and 
 advises this formula : 
 
 Acoin. 0.025 (gr. 0.4) 
 
 Cocain. 0.05 (gr. 0.833) 
 
 Sol. sod. clilor. (0.75 per cent.) ad. 5.0 (gr. 75) 
 
 C. Barck employs the following subconjunctival injection when 
 indicated: acoin and potassium iodide, of each, one and a half deci- 
 grams ; distilled water, 15 grms. 
 
 It is painless, not irritating and its absorption into the interior of 
 the globe has been proved by von Pflugk. 
 
 He strongly recommends a one per cent, solution of acoin in oil 
 as the best analgesic for painful eyes from any cause. It is non-irri- 
 tant and a few drops relieve the pain for several hours. The mix- 
 ture is also non-toxic and does not affect the cornea, the accommoda- 
 tion, the pupil or the intraocular pressure. He has used it in hun- 
 dreds of miscellaneous cases and it has never disappointed him. 
 
 Perhaps the most satisfactory' use of acoin as a local analgesic is 
 shown in combination with mercuric c.yanide or oxycyanate. Solu- 
 tions of these remedies, 1 .-2,000 to 1 :40,000. when used subconjunc- 
 tivally, are of signal value in hypopyon ulcer and other purulent or 
 deep-seated infections of the eye. but, even in the profoundly cocain- 
 ized eye, are unbearably painful; so much so that many surgeons 
 felt obliged to abandon their use in this fashion. When combined 
 with one per cent, acoin solution, however, tlie pain is trifling, 
 although the palpebral and conjunctival chemosis are generally 
 marked. 
 Aconite, Oculo-toxic symptoms from. H('i)orts of aconite poisoning 
 besides hytn[)loms of cerebral origin speak of various visual dis- 
 turbances. These are dependent neither upon respiratory nor car- 
 diac intoxication, but upon the action of the poison on the central
 
 78 ACONITINE 
 
 nervous system. It is also possible that in those cases in which there 
 is a subacute aconite poisoning from small amounts of the agent 
 and the toxic action on the respiratory center does not disguise all 
 other symptoms, visual disturbances can occur from functional 
 retinal changes, because aconitin, after a transient stimulation, par- 
 alyzes the end-apparatus of the sensory and motor nerves. No' 
 ophthalmologic observations to explain these visual disturbances 
 seem to have been made. 
 
 The use of an English make of aconitin in the form of a salve on 
 one eye of animals brought about contraction of the pupil in three 
 minutes. After five minutes it was hardly one-sixth as large as the 
 other eye. When the contraction Avas most marked the reaction to 
 light disappeared: as long as it w^as incomplete the pupil still re- 
 tained its motility. The myosis persisted for nine hours. It was 
 also produced by an alcoholic solution of aconitin. The absorption 
 of the (German) drug from local applications or from long con- 
 tinued internal use, produces the following ocular symptoms : itch- 
 ing of the eyelids, lachrymation, dilation of the pupils, more rarely 
 miosis and rigid pupil, disappearance of the corneal reflex, photo- 
 phobia, diplopia, dimming of vision, and transitory blindness. 
 
 A criminal, who took 4 grms. of radix aconiti, presented among 
 other symptoms dizziness, convulsions (in which the eyes partici- 
 pated) cyanosis and three attacks of transitory blindness. He re- 
 covered. Persons to whom aconite was given by mistake exhibited 
 dizziness, headache, feeling of anxiety, cyanosis and dilated pupils. 
 Aconite leaves may also cause ocular changes. A seven year old 
 boy who ate the leaves showed congestion of the brain and delirium, 
 followed by a comatose condition for several days, during which the 
 pupils were immobile. — (licwin and Guillery.) 
 
 Aconitine. This alkaloid, as well as extract of aconite, has been em- 
 ployed as a miotic, but neither of them has ever been seriously ad- 
 vocated as a rival to eserine, pilocarpine or arecoline (q. v.). 
 
 Aconitinsalbe. (G.) Aconitine salve. 
 
 Acopia. (L.), n.f. Freedom from fatigue. 
 
 Acorea. (L.), n.f. Absence of the pupil. 
 
 Acorie. (F.), n.f. Absence of the pupil of the eye. 
 
 Acorus. (L.) A genus of perennial herbs of the natural order Aro- 
 idefp. The name is said to be derived from a priv., and kopn, the 
 pupil, because (in ancient times) it was supposed to be useful in 
 eye diseases. 
 
 Acqua. (It.), n. Water. 
 
 Acqua antiottalmica di Loche. (It.) A lotion for chronic ophthalmia^
 
 ACQUA OFTALMICA DI YVES 79 
 
 epiphora, etc., containing 96 parts, each, of melilotus-water and dis- 
 tilled Avater, 4 of alcohol, 1, each, of alum and sulphate of zinc, and 
 0.60 of tincture of aloes. 
 
 Acqua oftalmica di Yves. (It.) A collyiium made by digesting 8 parts 
 of zinc sulphate, 3 of copper sulphate, and 9, each, of saffron and 
 camphor in 1,000 of water. 
 
 Acqua zefiirina. (It.) Jin astringent and resolvent coUyrium contain- 
 ing 300 grams of lime-water, 1 gram of ammonium chloride, and 0.30 
 of verdigris. 
 
 Acrania. This is a division of the animal kingdom (acraniata or head- 
 less animals) whose members do not possess eyes in the ordinary 
 sense. The worm-like cniii)hioxns ((j. v.) is a typical member of the 
 class. See, also. Comparative ophthalmolog'y. 
 
 Acrel, Olaf af. This famous Swedish surgeon, sometimes called The 
 Father of Swedish Surgery, was born in 1717. He studied at Got- 
 tingen, Strassburg, and Paris ; and, returning to his native country, 
 was soon appointed surgeou-in-eluef to the Seraphim Hospital at 
 Stockholm. His most important work is Chirurgiska handclser, 
 (Surgical Cases.) He was widely known as an operator on the eye, 
 but, inasmuch as he wrote xery little concerning ophthalmic sub- 
 jects, he has nearly been forgotten in his capacity as an oculist. He 
 died in 1806.— (T. H. S.) 
 
 Acrel's pterygium operation. Acrel {Die Kianhhciien unci Mishildun- 
 gen des mcnschlichcn Augcs und deren Heilung, p. 13) cut through 
 the pterygium on the cornea, and according to Richter, was the first 
 surgeon to advocate and practise removal of the head. — (W. T. S.) 
 
 Acridinsaure. (G.) Acridic acid. 
 
 Acritochromacy. Colour-blindness. 
 
 Acrochordon. (L.), In. A small soft tumor, often pendulous, of 
 areolar or glandular structure, occurring on the eyelids and else- 
 where. It is an obsolete term. 
 
 Acroesthesia. (L.), n.f. Exaggerated sensibility, forming one of the 
 l)henoniena of hysteria. 
 
 Acroisa. Blindness. 
 
 Acromatico. (It.), adj. Achromatic, i. e. free or non-productive of 
 color. 
 
 Acromatopsia. (It.), n.f. Color-blindness. 
 
 Acromegaly, Eye symptoms of. (Marie's disease), hi accordance 
 Avith neurologic literature acromegaly has tentatively been clas- 
 sified with other disorders supposedly of trophoneurotic origin 
 and without known anatomic basis. It is an affection regarding the
 
 80 ACROMEGALY, EYE SYMPTOMS OF 
 
 probable nature of which many theories have been advanced. Marie, 
 in his ' ' theorie hypophj^saire, ' ' expressed the belief that all the phe- 
 nomena of the disease, constituting as they do a systematized dys- 
 trophy, are caused by primary changes in the pituitary body, von 
 Recklinghausen and others have maintained that the disease is first 
 a trophoneurosis with secondary changes in the pituitary body and 
 thyroid, causing a perversion or absence of secretion in these glands. 
 Benda's vieAV of over-activity of the cells in the anterior lobe of 
 the hypophysis has led to a conclusion that the gland may be the 
 ' ' growth center. ' ' These few opinions are cited merely to emphasize 
 the fact that in acromegaly the hypophysis has nearly always been 
 found diseased and hypertrophied, but all else concerning patho- 
 genesis and etiology remains obscure. 
 
 An enlarged pituitary gland is capable of exerting pressure symp- 
 toms in all respects analogous to those of brain tumor in the same 
 location, compressing the chiasm, optic nerves and other adjoining 
 areas. From this it must follow that bitemporal hemianopsia, ocular 
 palsies and optic atrophy (40 per cent.) occur as important physical 
 findings in a symptom-complex further characterized by headache, 
 vomiting, vertigo, glycosuria, sexual disturbance and enlargement of 
 the face, hands, trunk and feet. 
 
 So long as we are in doubt or ignorance as to the pathogenesis 
 of acromegaly, we must be content to rely upon such remedial meas- 
 ures as will palliate but in no sense cure. The disease to date has 
 acquired no promising surgical aspect. Some isolated instances are 
 recorded in which osteoplastic resection was done for relief of pres- 
 sure headache or peripheral neurectomy for neuralgia (Keen-Hins- 
 dale). Extirpation has been undertaken in cases of tumor of the 
 hypophysis (Caton, Paul, Horsley), but no deductions should follow 
 from a few single instances with negative results. For the closely 
 related condition of coutiasis ossea Kanavel, in an excellent and com- 
 prehensive discussion of treatment, advocates a palliative opera- 
 tion for relief of "cerebral compression and encroachment upon the 
 orbital and nasal cavities." It would seem rational therefore to 
 advise a decompressive operation as palliative for choked disc and 
 chiasmic symptoms due to enlargement of the pituitary (See Brain 
 tumor). 
 
 Animal extracts have been suggested for this condition, but the 
 slight transitory relief afforded in only a few cases warrants mere 
 mention of their questionable utility. Thyroid extract, when pushed 
 to its physiological and even toxic effect, has been of benefit in min- 
 imizing such subjective symptoms as headache, nervousness and in-
 
 ACROMEGALY, EYE SYMPTOMS OF 81 
 
 somnia (Putnam). It may be given in dry powdered gland form, 
 beginning Avitli gr. i, three times a da}', after meals, and increased 
 until grs. xv are given daily or every second day. 
 
 The pituitary extract is best given in tablet form, gr. iii t. i. d., 
 but in one case under my personal observation the cephalalgia was 
 so intensified by its use that after several trials it had to be discon- 
 tinued. Its therapeutic value, of which we know almost nothing, 
 will remain indifferent, until more knowledge of the physiological 
 value of the hypophysis will be forthcoming. 
 
 Mercury and iodide are said to have a good effect in some cases 
 admittedly not of syphilitic origin. 
 
 For the relief of headache, which may be agonizing and intract- 
 able, acetanilid or phenacetine and similar coal tars in larger dosage 
 than ordinarily given, gr. vi to xv, are indicated and do much good. 
 
 When the disease begins to seriously impair the general health, 
 weight and strength, tonics, good food and conservation of energy 
 are necessary. — (D. H.) 
 
 The operative treatment of hypophysis tumor has been a matter 
 of gradual development. As late as 1905, Gushing was led to say 
 that in the near future operations on the hypophysis cerebri might 
 be carried to a successful issue. 
 
 A brief review of the steps that have led to our present tech- 
 nique may be of interest in tracing the progress of this most recent 
 triumph of modern surgery. 
 
 Of the operations proposed, two principal routes have been chosen 
 to reach the hypophysis: first, the intracranial; second, the extra- 
 cranial or trans-sphenoidal. Through the former the hypophysis 
 may be reached either by Avay of the anterior or the middle cranial 
 fossa. Tlie major part of the operation may l)e accomplished by 
 working outside of the dura, or the dura may be opened in the be- 
 ginning and tlie work done entirely' within its cavity. 
 
 The possibility of reaching the hypophysis through the middle 
 cranial fossa was first proposed by Caton and Paul, but was not car- 
 ried out by them. Ilorsley is generally quoted as following this 
 route. 
 
 Stumme quotes a personal communication from Petrien, in which 
 he credits Dahlgren with an operation conducted through the middle 
 fossa. In this the dura was opened and the hypophysis reached by 
 retracting the brain. Nothing is said of the details of the operation 
 or of the result. 
 
 Krause suggested what appears to be the most rational intra- 
 cranial method of reaching the hypophysis. He proposed to open 
 
 Vol. 1—6
 
 82 ACROMEGALY, EYE SYMPTOMS OF 
 
 the cranial cavity by an osteoplastic resection of the frontal bone 
 and to proceed, extradurally, through the anterior cranial fossa until 
 the lesser wing of the sphenoid is reached, and then to open the dura 
 and remove the tumor by means of a small, hook-shaped knife de- 
 vised for that purpose. Krause, from his experience gained only 
 by operation on the cadaver, believed that by following this extra- 
 dural route all or most of the obstacles which other operators had 
 encountered would be eliminated. 
 
 Borchard attempted to remove a tumor of the hypophysis by the 
 Krause method, and was forced to abandon it because of the hem- 
 orrhage. Later, he operated successfully on the same patient by the 
 trans-sphenoidal route, as practiced by Schloffer. 
 
 Killiani, in discussing tumors of the chiasm, suggests an opera- 
 tion which is similar to that of Krause, excepting that the dura is 
 opened immediately after entering the cranial cavity. The longi- 
 tudinal sinus is ligated, the frontal lobe lifted from the base of the 
 skull, and the tumor attacked above the chiasm and the transverse 
 sinus by means of a sharp spoon. 
 
 Silbermark suggests a temporal intracranial method similar to 
 that employed by Paulesco and Gushing, in their experimental work 
 on dogs. This consists in a bilateral craniectomy, the counter open- 
 ing being made to permit of the temporal lobe being dislocated with- 
 out the risk of serious compression. The operation proposed by Sil- 
 bermark and by him performed on the cadaver has never been tried 
 on the living subject. 
 
 The relative merits of the intracranial method, as compared to 
 the trans-sphenoidal, is still a matter for discussion. — (A. E. H.) 
 
 The history of a patient, sixty-five years of age, with bi- 
 temporal hemianopsia and well-marked features of acromegaly is 
 given by S. D. Risley {Oph. Record, Sept., 1912). The symptom- 
 complex pointed to disease in the pituitary region and x-vsiy study 
 showed an enlargement of the sphenoid, the anterior and posterior 
 clinoid processes bending toward each other, forming an incomplete 
 foramen, but left the presence of any enlargement of the soft parts 
 or the presence of a tumor in doubt. The patient regarded herself 
 in good health, had no pain, but suffered an uncontrollable drowsi- 
 ness. She was first seen in October, 1910. In December, 1911, and 
 February, 1912, there was no notable change in her condition. In 
 March, 1912, she died of an intercurrent lobar pneumonia. An au- 
 topsy showed at the base of the brain a large tumor 5 cm. in length 
 and 5 cm. in width and 3i% inches thick, oval in shape, resting on the 
 frontal lobes, anterior to the optic chiasm and compressing both
 
 ACRYLATHYLESTER 83 
 
 optic nerves, making a distinct concavity in the mesial aspect of the 
 frontal lobes. Lying in front of the chiasm, it was slightly separated 
 from it. On the lower snrface of the tumor, near its middle, was a 
 smooth, cnp-sliai)ed depression 2x2i/> cm. in depth caused by the pro- 
 jecting posterior ethmoidal cells. The tumor was well encapsulated, 
 finely nodular on the surface and the capsule very vascular. In the 
 anterior fossa in front of the sella turcica the floor of the skull was 
 raised in an irregular manner, in an area the size of a small walnut. 
 The bone here was thin, porous, dark in color and when chiseled 
 away the posterior ethmoid cells were found to contain a large 
 amount of thick, yellow, i)urulent material. The tumor seemed to 
 have entirely re})laced the pituitary body. The brain otherwise 
 shoAved nothing abnormal. The tumor proved to be, on examination, 
 a highly vascular spindle-celled sarcoma. In the sections made no 
 trace of the pituitary body was found. — (Ed.) 
 
 Acrylathylester. (G.) Ethyl acrylate. 
 
 Acrylsaure. (G.) Acrylic acid. 
 
 Actina. This is a nostrum whose activity depends upon the exposure 
 of the eye in a cup to the fumes of oil of mustard. The counter- 
 irritation set up by it sometimes relieves asthenopic symptoms, but 
 as "one end is used for the ear and the other for the eye" it does 
 not need much penetration to assign its proper place in ocular 
 therapeutics. 
 
 Actinic lens. In optics, a lens system so constructed that its chemical 
 and luminous foci coincide. 
 
 Actinic process. A generic name for any photographic process ; spe- 
 cifically any photo-engraving process. 
 
 Actinic rays. In optics, rays that produce chemical combinations and 
 decompositions. A pencil of rays when decomposed by refraction 
 through a prism is knowai to possess three properties, immely, the 
 heating, the luminous and the chemical or actinic. — (C. F. P.) 
 
 Actinism. The radiation of heat or light, or that branch of physics 
 which treats of the radiations of heat or light. The property of the 
 sun's rays which, as seen in photography, produces chemical decom- 
 positions. — (C. F. P.) 
 
 Actinium. One of three chemical elements found in pitchblende. The 
 others are polonium and radium. All three substances continuously 
 emit radiations which affect photographic plates. 
 
 Actinograph. An instrument for measuring and registering the vibra- 
 tions of actinic or chemical influence in the solar rays. The inten- 
 sity of this influence bears no direct relation to the quantity of light, 
 but varies at different periods of the day and year. There are
 
 84 ACTINOLOGY 
 
 several forms of actinograph, all of them using the same test, namely, 
 the depth of the blackening effect of chemical rays allowed to fall 
 on a sensitive piece of paper for a given time. 
 
 Actinology. That branch of science which investigates the chemical 
 action of light. 
 
 Actinometer. An instrument for measuring the intensity of the sun's 
 heat-rays. 
 
 Actinometry. The measurement of the intensity of solar radiation. 
 
 Actinomyces. (L.), n.m. A genus of parasitic organisms probably 
 belonging to the Fungi. 
 
 Actinomycosis of the ocular structures. Lumpy .jaw. Holdfast. 
 Gould defines this to be a parasitical, infectious, inoculable disease 
 first observed in cattle, and also occurring in man, and characterized 
 by the manifestations of chronic inflammation, with or without sup- 
 puration, often resulting in the formation of granulation tumors. 
 He further says that it is due to the presence of a characteristic 
 micro-parasite, the ray fungus, Actinomyces bovis, which is composed 
 of fine mycelial threads and club-shaped bodies. The most frequent 
 and most curable type is when the abscesses form about the jaws 
 and teeth. The best mode of staining the threads is by Gram's 
 method. To stain the clubs as found in man is difficult; the best 
 results have been obtained with orange rubin or eosin. The only 
 treatment of the disease is removal of the infected tissue. "When the 
 parasite has found a nidus in the lungs or digestive tract, all treat- 
 ment is so far useless. It rarely attacks the human eye but has 
 been found in the lachrymal canals. Bach in the EncyMopddie der 
 Augenheilkundc says that this organism forms peculiar granules 
 containing pus, which by German writers have long been called 
 "Driisen," of gray, yellowish, reddish, or occasionally greenish color 
 and varying consistency. The individual granules are composed of 
 rosettes in which three structures can be isolated: (1) a central core 
 of branching filaments, irregularly disposed, but with a general 
 radial arrangement; (2) at the periphery club-shaped bodies: (3) 
 spherical coccus-like bodies. The filaments, but not the clubs, stain 
 with Gram, while the club-shaped bodies take a counter-stain, such 
 as saffranin or carmine. Cultures may be successfully obtained on 
 most media and at ordinary temperatures. The best cultures result 
 from growths on serum or serum-agar. The contents of actinomy- 
 cotic abscesses shovild be first crushed in a mortar. Diagnosis is 
 generally possible without cultivation. 
 
 Actinomyces colonies have been found mostly in the lower lach- 
 rymal canals — more frequently than in the upper. In the canaliculi
 
 ACTINOMYKOSE 85 
 
 a greenisli-yellow eoiicrelioii of the si/e of a i)e<i lias also l)eeii dis- 
 covered. The fungus of these deposits was formerly ealled shrpto- 
 thrix Foersteri, but later investigations point to aetinomyces. 
 
 Actinomycosis of the eyelids with the characteristic symptoms is 
 not infretpient. Actinomycosis of tlie orbit (as a primary infection) 
 has also been reported. Recently a fungoid infection of the con- 
 junctiva in the shape of small, yellowish-white, raised dots, with a 
 smooth surface, has been described as belonging to the same species. 
 
 Actinomykose. (G.) Actinomycosis. 
 
 Actinomykose der Thranenrohrchen. (G.) Actinomyces of the can- 
 aliculus. 
 
 Actinophone. An apparatus for the production of sound l)y actinic 
 rays. See Radiophone. 
 
 Actinophthalmic. adj. Having eyes whose ehorioidal tapetum 
 strongly reflects light. 
 
 Actinotherapy. The therapeutic use of actinic rays. 
 
 Active convergent strabismus. This term was given by Ponders to 
 those cases of esophoria or, more correctly, to cases of excessive 
 convergence in patients who are able to mask their asthenopia by 
 strong adduction ett'orts. lie regarded the typical convergent 
 strabismus of hyperopes as an active form of that anomaly. 
 
 Active immunization in bacterial infection. The chronic pus infec- 
 tions of the skin, such- as acne and furunculosis, offer one of the best 
 fields for the demonstration of the value of bacterial therapy. Cer- 
 tain of these cases, intractable to other methods of treatment, have 
 yielded to injections of killed cultures of the associated organisms. 
 In some cases good results are obtained with stock vaccines, but it 
 is usually found of advantage to prepare the vaccine from the auto- 
 genous organism. Different strains of staphylococci, even though 
 resembling each other in cultural characteristics, may differ wadely 
 in toxicity and in their power of producing immunizing responses 
 in a given individual and it is hence desirable to use for immuniza- 
 tion a culture obtained from the lesion under treatment. Two or 
 more organisms may be associated in a lesion, such as a sinus, and 
 here we may immunize against one organism, and then the other, 
 causing each to disappear in turn. Thus favorable results are re- 
 ported in chronic suppurations of the accessory sinuses of the fron- 
 tal and ethmoid bones, 
 
 Grey-Edwards found staphylococcic A^accine of value in 3 cases 
 of hypopyon ulcer, and Maddox reports good results from vaccine 
 in a staphylococcus infection after cataract operation.
 
 86 ACTIVE PLANE 
 
 Immunization in pneumocoecus infections has so far not been at- 
 tended with any permanent benefit. Romer has suggested the com- 
 bination of active immunization with passive serum immunization in 
 serpiginous ulcer, but no conclusive data are at hand as to the value 
 of the method. 
 
 In ulcerative endocarditis of staphylococcus, streptococcus and 
 pneumocoecus origin, injections of vaccines prepared from the auto- 
 genous organisms have so far not been successful in curing the dis- 
 ease. One case is reported by Wright in which the injections of vac- 
 cines was followed by recovery, but there is some question as to 
 whether the symptoms were not due to sepsis, without active ulcera- 
 tion of the heart valves. There seems to be no doubt however that a 
 temporary period of clinical improvement follows the injections in 
 some instances, so that we are justified in adopting the treatment in 
 this class of cases, so hopeless under other therapy. 
 
 In chronic gonococcus infections, gonocoecus vaccines have ap- 
 parently been of value in hastening the healing of arthritis and other 
 metastatic lesions. In gonococcus infections of the mucous mem- 
 branes, vaccines have usually been of little value, although Allen re- 
 ports successful cases in conjunctivitis in adults. — (E. E. I.) 
 
 Active plane. In optics, the principal section of a prism or cylindric 
 lens in which the chief refraction occurs, and as distinguished from 
 the parallelogram-section, or passive plane, which is indifferent to 
 refraction and at right angles to the active plane. — (C. F. P.) 
 
 Activity, Optic. The property of certain molecules to rotate the plane 
 of polarization. 
 
 Actol. Silver lactate. Aktol. C;{H5l);{Ag. It occurs as brownish 
 or colorless, acicular crystals, soluble in fifteen parts of water and 
 easily aflPected by light. 
 
 This is one of the best of the germicidal inorganic silver salts used 
 in ophthalmic practice and was introduced by Crede. It makes 
 satisfactory antiseptic solutions, as for instance in the drying and 
 sterilizing of catgut sutures, and is employed as a substitute for 
 silver nitrate in solutions of 1 :500 to 1 :2000. 
 
 Actual cautery. See Cautery, Actual. 
 
 Actual rest. This term is generally employed in connection with the 
 extrinsic ocular inuscles to describe their complete relaxation. "When 
 it occurs there is often a tendency to deviate from the primary 
 position. The condition is also known as apparent rest. 
 
 Actuarius, John. Actuarius was not really a surname though it has 
 generally been so treated in the case of this man — but an official title, 
 meaning Court-Physician. A Graeco-Christian physician and phi-
 
 ACUITAS 87 
 
 losopher of the 14th century (the son of one Zaehariah), actuarius at 
 the court of the Paleologi, and author of a number of valuable medi- 
 cal works. Of these the most important are Materia Mcdica and 
 Therapeutics. In the first-named work there is some ophthalmologic 
 matter, but none of great importance. Another well-known work 
 is the treatise On the Urine, in which the author distinguishes, as 
 scientifically perhaps as was possible in that day, the various sorts 
 of urinary sediments, and in which, furthermore, he speaks of grad- 
 uated glasses for the purpose of measuring the amount of such de- 
 posits. A work On the Animal Spirits was highly valued in its day, 
 but, being wholly of a speculative nature, is no longer of use. — 
 (T. H. S.). 
 
 Acuitas. This term is proposed by Sikloss}^ who while studying the 
 so-called normal visual acuteness found, as others have done, a large 
 proportion of eyes Math better than "normal" vision by the Snellen 
 types. He proposes a new unit of visual acuteness, estimated by 
 which normal vision of the Snellen scale would be designated as A 
 (acuitas) =35 (or more exactly 34,376). In general the acuity of 
 vision would be indicated by whole numbers. The use of such a 
 scale would serve to emphasize the differences actually presented in 
 eyes that are commonly all classed together as having "normal" 
 vision. (Ophthalmic Y ear-Book, 190(3, p. 39.) 
 
 Acuita visiva. (It.) Visual acuity. 
 
 Acuite visuelle. (F.) The keenness or perfection of vision at the 
 macula lutea. 
 
 Acuity, n. Acuteness. 
 
 Acuity of vision for points. This is one of the two common varieties 
 of central visual acuity, the best known being that for form — as 
 made with ordinary test types. The second variety is that deter- 
 mined by the ability to distinguish a single, small point from its 
 surroundings, termed acuteness of vision for points. 
 
 Acuity of vision, Methods of determining the. Sec Examination of 
 the eye. 
 
 Acuity, Visual. Acuteness of sight in the perception of small or 
 distant objects. It is generally intended to refer to the kind of 
 (central) vision obtainable at the fovea or macula. See Examina- 
 tion of the eye. 
 
 Acupressure, n. A method of arresting hemorrhage from divided 
 blood-vessels by means of pressure exerted by a needle passed into 
 the tissues. 
 
 Acus. (L.), n.f. A needle.
 
 88 ACUS AD CATARACTAM 
 
 Acus ad cataractam. (L.) See Cataract needle. 
 
 Acus cataractaria. (L.) See Cataract needle. 
 
 Acus ophthalmica. See Cataract needle. 
 
 Acusticustumoren. (G.). Tumors of the auditory nerve. 
 
 Acutenacle. (F.), n.m. A needle-holder. 
 
 Acutenaculum. (L.), n.m. A needle-holder. 
 
 Acuteness of vision. Practieallj^, this is the power the eye possesses 
 of observing the shape, form (hence form sense), color and size of 
 objects. 
 
 When a clear image of an object is desired, the individual looks 
 directly at it so that the raj's of light fall on the retina at the macrila 
 lutea, that being the point of most acute vision. This is called 
 central vision. The acuity of central vision is tested for both dis- 
 tant and near objects. 
 
 Eelative Size of Snellen 's Test Letters. 
 
 To determine the distant vision the patient is placed six meters 
 or twenty feet from and facing the test types, with his back to the 
 window, if the illumination be from that source, although artificial 
 light is usually employed and arranged in such a way that it falls 
 directly upon the test letters. The letters used are of various sizes 
 and are known as Snellen's test types. They consist of square let- 
 ters so constructed as to subtend an angle of five minutes at the 
 distance at which they should be seen, by the normal eye. Each part 
 of the letter and each space are equal to one-fifth of the whole and 
 subtend an angle 'Of one minute. 
 
 The reason the test types are situated tAventy feet or six meters 
 in front of the patient is that rays of light Avhich enter the eye from 
 this distance are practically parallel. The largest letter is of such 
 a size that it should be read at 200 feet, or sixty meters, and those 
 following decrease in size from above downwards, and should be 
 read at 100, 70, 50, 40, 30, 20 feet, or their corresponding valuer in 
 meters, respectively.
 
 ACUTENESS OF VISION 
 
 89 
 
 Each eye should be tested separately, and the result expressed by 
 a formula in which V stands for vision. This is expressed by a frac- 
 tion in which the numerator corresponds to the distance the patient 
 
 S A 
 
 » 
 
 F X E 
 
 E F O L 
 
 H B T V Z 
 
 N S P L H 4 
 
 r E O D G Z 3 
 
 x> s X. sr H 4 
 
 10 
 
 c c 2 r o o 3 
 
 Snellen 's Test Tj'pes.
 
 90 ACUTENESS OP VISION 
 
 is seated from the test types and the denominator the distance at 
 which the letters should be read by the normal eye. 
 
 A Single Test Letter. 
 
 If the patient seated at twenty feet from the test tj^pe reads the 
 letters numbered 20, then 
 
 20 
 
 or is normal. If he cannot read smaller leiters than those numbered 
 50 (letters which should be seen by the normal eye at 50 feet) 
 
 Y 20 
 
 ~50" 
 
 If the patient seated at twenty feet is unable to read the large let- 
 ter which should be seen at 200 feet, he walks toward the chart 
 until the distance is reached at which he reads this largest letter. 
 If, for example, it is ten feet, then 
 
 200 
 
 the numerator being the farthest distance from the chart at which 
 he can read the largest letter. 
 
 When the patient's vision is so jjoor that he is unable to recog- 
 nize the large letter at any distance, the distance is obtained at 
 which he is able to count the examiner's fingers held against a 
 black background. Suppose he is able to do this at ten inches or 
 twenty-five centimeters, then V = "counting fingers" at that dis- 
 tance. If he is unable to count fingers, the hand is moved in dif- 
 ferent directions in front of the eye, and the patient required to 
 tell in what direction it is moved. If he is able to do this, Y= hand 
 movements. If there is inability to distinguish hand movements, 
 . the eyes are alternately covered and uncovered, and if he is able 
 to perceive the difference between light and darkness, V= light 
 perception (p. 1.). 
 
 If the patient is illiterate, test types are used in the form of E's, 
 in which the openings are turned in various directions and the
 
 ACUTENESS OF VISION 91 
 
 smallest row where he is able to detect the openings indicates the 
 visual acuity. 
 
 o-t: 
 
 3 bJ 
 
 o-io> 
 
 E lU 3 
 
 E ui 3 m 
 
 ki 3 u E m 
 
 a E m a uj PI 
 
 e a m m ill E ui 
 
 Test Types for Illiterate Patients. 
 
 Jn testing near vision the patient is seated in a good light and 
 each eye is also tested separately. Useful test types consist of the 
 various sizes of ordinary printer's type, technically called Jaeger's 
 test types, the smallest corresponding to diamond print. More 
 scientific and accurate are those corresponding with Snellen's dis- 
 tance types. The former are numbered 1, 2, 4, etc., according to 
 the size of the type. If these are used and the patient reads the 
 finest print at the ordinary reading distance, 10-1-3 inches, Y= Ji ;
 
 92 ACUTEZZA VISUALE 
 
 if he reads that iininbere.l 4, V=Jiv, etc. See, also, Examination 
 of the eye; Physiological optics. 
 Acutezza visuale, (It.) The keenness of vision at the macula lutea. 
 Acyanoblepsia, (L.). n.f. Acyanopsia or blue-blindness (q.v.). 
 Acyanopsia. Inability to distinguish blue colors. Blue-blindness. 
 Acyoblepsia, Same as Acyanoblepsia. 
 Adacrya. (L.), n.f. A deficient secretion of tears. 
 Ada-Kodien. The Malabar name of a plant, supposed to belong to 
 the Apocvnaeeag, used in India as a general astringent and in eye 
 diseases. 
 Adam's accommodometer. An instrument for the measurement of 
 the amplitude of accommodation, and of the refraction for an 
 indicated near point. See Accommodometer. 
 Adams, Edward C. This Avell-known ophthalmologist, born in 1858, 
 received his professional degree at the Northwestern Medical Col- 
 lege, St. Joseph, Mo., in 1886. Making a specialty of diseases of the 
 eye and ear, he settled in St. Joseph, where he practised until his 
 death, which occurred as the result of cerebral hemorrhage. May 15, 
 1910. 
 
 Adams was a small, dark man, a bachelor and a ventriloquist of 
 no mean ability. — (T. H. S.) 
 Adams, George A. A famous London optician, who was born in 1750,. 
 and died August, 1795. A tireless worker, he devoted all his ener- 
 gies to optics and mechanics, and acquired a world-wide reputation 
 as a maker of spectacle and microscope lenses. He w^as also a writer 
 of note. Among his most celebrated works are : History of Vision,. 
 Explaining the Fabric of the Eye and the Nature of Vision (London, 
 1789 ; German trans, by Kries, Gotha, 1794, 2d ed. 1800) ; Essays on 
 the Microscope (London, 1787). — (T. H.S.) 
 Adams, Sir William. A famous London ophthalmologist, born in Corn- 
 wallis, 1760, and died in February, 1829. He became Physician to 
 the Greenwich Hospital, and Oculist to the Infirmary for the Eye 
 at Exeter. He invented what he conceived to be a new and valuable 
 method for treating trachoma, and, in consequence of this, Lord 
 Palmerston, then Secretary of War, "created a new place for him; 
 that of ophthalmic surgeon to the army, with a salary of £1,500 a 
 year; which has given much offence to the regular military sur- 
 geons." {Pantheon of the Age, vol. I., p. 14.) 
 
 He wrote a number of books and articles dealing for the most part 
 with keratoconus, cataract, ectropion, and formation of the artificial 
 pupil. His chief work is entitled Practical Observations on Ectropion, 
 or Eversion of the Eyelids, ivith the Description of a New Operation 
 for the Cure of that Disease (London, 1812).~(T. H. S.)
 
 ADAMS' OPERATION FOR ARTIFICIAL PUPIL 
 
 93 
 
 Adams" operation for artificial pupil. Adams {Treatise on Artificial 
 Pupil, 1819, p. 34) modified Cheselden's operation by using a small 
 iris scalpel of his own design, which had a straight, dull back, a 
 
 Adams' Iris Knife-Needle. 
 
 long, straight cutting edge and a rounded point. With this he 
 made his puncture back of the limbus on the temporal side, passed 
 it directly through the iris from behind into the anterior chamber, 
 across to the nasal side, keeping the edge of the knife turned back 
 against the iris throughout the whole maneuver. He was thus able 
 
 Adams' Operation for Eotropion. (After Beard.y) 
 
 by the most delicate pressure to make a horizontal incision. If the 
 incision was too short he again carried the knife forward and again 
 partially withdrew it, always cutting in the same plane. — (M. S.) 
 Adams' operation for atonic ectropion. Adams boldly excised from 
 the center of the lid a wedge that included conjunctiva, skin and 
 tarsus. He then closed the resulting notch by means of fine, iuter- 
 
 VJJ^^JJJJ j^j^^j-.>-..t. j.-.^r" 
 
 '''-''' ^-^-^--Jr^ 
 
 Adams' Operation for Artifit'ial Pui^il. 
 
 rupted sutures and a hare-lip pin. This operation removed the 
 excessive tissue of the sagging lid but always left a prominent scar 
 which frequently failed to heal properly at the lid margin, resulting 
 in a disfiguring cleft.— (C. H. B.) 
 Adams' operation for conical cornea. Adams (On the Restoration of
 
 94 ADAPTATION DER NETZHUT 
 
 Vision Avhen Injured or Destroyed in Consequence of the Cornea 
 Having Assumed a Conical Form. Journal of Science mid Art. Vol. 
 11, 1817, p. 402) advocated the "breaking up of the crystalline lens 
 in order that the rays of light might fall upon the retina and not 
 be brought by the increased refractive power of the cornea and lens 
 to a point far short of the sentient apparatus of the organ of 
 vision." This procedure undoubtedly consisted of the so-called 
 "needling operation," and appears to be the first surgical procedure 
 employed in conical cornea. (W. 0. N.) 
 
 Adaptation der Netzhut. (6.) Adaptation of the retina. 
 
 Adaptation of the retina. The faculty possessed by the retina of ac- 
 commodating the vision to the amount and quality of the illumina- 
 tion. Thus one speaks of an eye as being "dark adapted" or ad- 
 justed to diminished light, as in a darkened room. Per contra, a 
 "light adapted" eye is one adjusted to a more brilliant illumination 
 or to ordinary daylight. 
 
 Aubert found that sensitiveness to light is 25 times greater than 
 normal after 10 minutes, and 35 times greater after 2 hours' confine- 
 ment in the dark. 
 
 That adaptation of the retina which occurs upon the exclusion of 
 light (dark adaptation) has been tested by Horn in various diseases 
 affecting the ocular fundus. In myopia, even high degrees, he finds 
 it is not altered. Where it is disturbed this disturbance must be 
 ascribed to the accompanying choroidal changes. In cases of con- 
 genital amblyopia there was a marked departure from the normal, 
 which was particularly well demonstrated in squinting eyes. The 
 disturbance of adaptation, both as to amount, time and character, 
 was marked in the hemeralopia of chronic alcoholism, nephritis, dia- 
 betes without ophthalmoscopic changes, atypical retinitis pigmentosa, 
 hereditary syphilitic chorio-retinal changes, and tabetic optic 
 atrophy. Severe choked disk or detachment of the retina can occur 
 without disturbance of adaptation. But glaucoma lowers it, and 
 this may be an early symptom. Choroiditis, recent or old, and com- 
 motio retinae afi^ect it. In color blindness adaptation seems not to 
 reach the normal. 
 
 The adaptation of the retina to varying degrees of light and shade 
 has been utilized for the diagnosis and prognosis of ocular diseases. 
 The following review of the subject is extracted from the Ophthal- 
 mic Year Book, Vol. VIII, p. 195: Behr has used Piper's apparatus 
 in a series of investigations as to adaptation processes, especially for 
 dark, and their relation to various diseases of the optic nerve chiasm 
 and tract. As regards the physiology of the test he finds that the 
 increase of sensitiveness in the dark is much influenced by synchro-
 
 ADAPTATIONSSTORUNGEN 95 
 
 nous continued illumination of the other eye, the final adaptation 
 value being reduced by about half. The function of the rods ap- 
 pears to be greatly disturbed in optic atrophy (even with normal 
 visual acuity) ; and in chiasmal disease in the non-affected halves of 
 the field. The function of the rods can be affected in complete rela- 
 tive tracthemianopsias; but this disturbance is lacking in such 
 hemianopsias due to intracerebral causes. ]\losso found the adapta- 
 tion process most disturbed in chronic amblyopias and tabetic atro- 
 phy ; whereas in retinal detachment it persisted more or less for 
 various periods of time. Best oft'ers some modifications in Piper's 
 "adaptation rule." He finds that if adaptation is severely af- 
 fected the process occupies much more time than with a normal eye, 
 falls short of normal maximum, and in unfavorable cases is finally 
 lost altogether. Best does not believe that examination of pericentral 
 and peripheral retinal areas offers a means of distinguishing between 
 rod and cone adaptation. 
 
 Wolfitlin says that not merely one point of the retina should be 
 tested, but many and over a large area. For this purpose he uses an 
 arrangement by which the eye fixes a luminous red jDoint, the dis- 
 tance and direction of which in relation to the white light used for 
 the test can be varied at will. He finds normally a decided decrease 
 of adaptation at 20 to 22 degrees to both the nasal and the temporal 
 side of the fovea. In two cases of hemianopsia homonyma dextra, 
 clinically proved to be due to lesions beyond the primary optic cen- 
 ter, there was in the affected half of the visual field a complete lack 
 of light sensation after an hour of adaptation for dark. Adapta- 
 tion was absent in a case of retinal detachment and did not recur 
 in the area of the lesion after reattachment. AVolfflin thinks that the 
 fovea has moderate power of adaptation for dark, and points out that 
 this would be in opposition to the view that the visual purple is 
 closely associated with such adaptation. Stargardt finds that the 
 Fukala lens operation for myopia appears to lessen dark adapta- 
 tion. In anisometropia the dark adaptation of the two eyes more 
 commonly dift'ers. Squint amblyopia is sometimes attended by re- 
 duction, sometimes not. The author thinks disturbance of dark 
 adaptation in retinitis pigmentosa to be due to choroidal disease. lie 
 also offers the view that a normal visual field for dark adaptation 
 safely excludes a diagnosis of retinal detachment. 
 
 Wolfflin has investigated the influence on adaptation of strychnin 
 and hrucin. He finds that they exert a notable influence, increasing 
 the sensitiveness of the retina in eyes adapted to darkness. 
 Adaptationsstorung-en. (G.) Adaptation disturbances. 
 Adaption. An obsolete form of adaptation.
 
 96 ADAPTOMETER, NAGEL'S 
 
 Adaptometer, Nag'el's. An instrument for determining the quality 
 and measuring the relative amount of dark and light adaptation 
 (q. v.). A full description of the instrument, its application to 
 ophthalmology, theoretical and practical, is fully set forth in the 
 third edition of the Helraholtz Handbnch der physiologischen Optih, 
 1911. 
 
 Adattamento. (It.), n. The adjustment of the size of the pupil to 
 the amount of light that reaches the eye. By some authors, the term 
 refers to the accommodation. 
 
 Adattamento della retina. Dark and light adaptation (q.v.) of the 
 retina. 
 
 Addario's trachoma operation. This operator has modified the usual 
 method of excision of the tarsus in chronic trachoma by removing 
 the upper two-thirds of the tarsal mucosa, and upper third of the 
 tarsus and transjilants healthy conjunctiva from the eyeball to fill 
 the gap. — (J. G.) 
 
 Addison's disease, Ocular symptoms of. With the exception of a 
 few pigmented areas in the sclera and conjunctiva no complications, 
 so far as the eyes are concerned, have been observed in this disease. 
 The tendency toAvard degenerative and inflammatory alterations 
 in the organs supplied by the sympathetic, that usually appear in 
 the later stages of Addison's disease, may affect the eye, but as its 
 secretory and vasomotor disturbances, as well as the ocular papillary 
 changes, are so slightly marked they are easily overlooked. As 
 might be expected, the general debility occurring during the progress 
 of the disease may also be responsible for such functional disturb- 
 ances of the visual apparatus, as Aveakness of the accommodation 
 and insufficiency of convergence. Should the pathologic process 
 seriously affect the kidney structures, oci^lar complications involved 
 in the renal changes may also arise. 
 
 Adducens oculi. (L.) The internal rectus muscle. 
 
 Adducirende Prismen. (G.) Adductive prism. 
 
 Adducirender Augenmuskel. (G.) The internal rectus muscle. 
 
 Adducteur de Toeil. (F.) Internal rectus muscle. 
 
 Adduction is a drawing of the eye iuAvard in the horizontal plane. 
 This movement is produced principally by the action of the internal 
 rectus, but the eye is also turned inward by the internal acting 
 together wath the superior and inferior recti. This act is therefore 
 entirely under control of the third nerve. 
 
 When the extent of adduction is measured by the tropometer
 
 ADDUCTIVE POWER, WEAKNESS OF 97 
 
 (q. V.) i1 is found to vary a little within physiologic limits. ]\Iost 
 students have placed the limit of this iuward rotation at about 45°. 
 Schnurmann gives it 45, Volkmann 42, Hering 44, Kuster 45, Schnel- 
 ler 52 to 56, Landolt 44, Duane 51. 
 
 It must be confessed, however, that many difficulties arise in the 
 exact measurement of this arc, principally because the observer can- 
 not see distinctly the reflection from the cornea on account of the 
 projecting bridge of the nose. In all measurements of adduction 
 this element of doubt must be taken into account. — (L. H.) See 
 Muscles, Ocular. 
 
 Adductive power. Weakness of. Defective convergent ])ower may be 
 due to a number of causes, but prominent among them is any sys- 
 temic w^eakness, especially that due to defective nutrition, anemia, 
 loss of blood, parturition, influenza, typhoid fever, etc. Defective 
 development of any or all the adductor muscles will account for an 
 unknown percentage of cases of insufficient convergence. It is to 
 be remembered that two or more of the foregoing causes may com- 
 bine to bring about weakness of adduction. 
 
 Adductor oculi. (L.) Internal rectus muscle. 
 
 Adduktion. (G.) Adduction. 
 
 Adduzione. (It.), n. Drawing a part towards the median line of the 
 body. Rotating the eyeball toward the nose. 
 
 Adelmann, George F. B. A distinguished Russian surgeon and oph- 
 thalmologist, born at Fulda, June 28, 1811, died June 16, 1888. He 
 studied at Marburg and Wiirzburg; then for a time engaged in 
 general practice at Fulda. In 1837 he returned to Marburg, in order 
 to become assistant in the Surgical Clinic of Ullman. In 1841 he was 
 called to the combined chairs of Surgery and Ophthalmology in the 
 University of Dorpat, and, in this double capacity, he officiated till 
 1871 — 30 years. He wrote prolificall.y and in four languages — Latin, 
 German, Russian, and Italian. Among his best known writings is 
 one entitled "Uher cndcmischc Augenkrankheiten der Esten in Liv- 
 land und verwandter Stdmme im. Russischen Reiche." 
 
 Adelmann was a man of warm and generous disposition, and most 
 courteous demeanor. His kindness to the younger men of his pro- 
 fession was extreme. — (T. H. S.) 
 
 Adelmann, Heinrich A. Son of a well-known German jurist and 
 nephew of the surgeon Yineenz Adelmann, this oculist-to-be was 
 born Aug. 17, 1807. He received his medical degree in 1830 at 
 Wiirzburg, and, in 1837, was appointed docent, in 1840 extraordinary 
 professor, at the same institution. He taught theoretic ophthalmol- 
 ogy and gave ophthalmic operation courses on the phantom and 
 
 Vnl. 1—7
 
 98 ADENEMPHRAXIS 
 
 the cadaver. He invented, in 1852, a snction instrument for liy- 
 popion. Being an excellent artist, he furnished the illustrations for 
 Textor's Elementary Principles for the Teaching of Surgical Opera- 
 tions (1834-36), and, to this day, the eye-clinic at the University of 
 AViirzburg has preserved a collection of water-color pictures by Adel- 
 maim, showing the external diseases of the eye. 
 
 Adelmann was retired in 1879. He died Nov. 8, 1884.— (T. H. S.) 
 
 Adenemphraxis. That condition in which a duct or a gland is ob- 
 structed. 
 
 Adenite. (It.), n.f. Adenitis, i. e., the inflammation of a gland, espec- 
 ially of a lymphatic gland. 
 
 Adenite contagieuse des paupieres. (F.) Purulent or contagious 
 conjunctivitis. 
 
 Adenite contagiosa delle palpebre. (It.) Purulent conjunctivitis. 
 
 Adenitis, inflammation of a gland, especially of a lymphatic gland. 
 
 Adenitis der Thranendriise. (G.) Adenitis of the lachrymal gland. 
 
 Adenoid, adj. Resembling the structures of a gland. 
 
 Adenoide. (P.), adj. Resembling a gland in structure. 
 
 Adenoides Ge^^ebe. (G.) Adenoid tissue. 
 
 Adenoids, Ocular symptons in. May names among these in children 
 epiphora, blepharitis, dacryocystitis, congestion of the conjunctiva, 
 phlyctenular conjunctivitis and keratitis, subacute and chronic con- 
 junctivitis, certain forms of which resemble trachoma. He regards 
 the adenoids as predis^^osing to these conditions or aggravating 
 them, a connection explained by the congestion of the neighboring 
 parts produced by th(^ adenoids. — (Ophthalmic Year-Bool:. 1909, p. 
 75.) See Cavities, Neighboring. 
 
 Adenologaditis. Obsolete term for ophthalmia neonatorum. 
 
 Adenoma. (^L.), n.n. A tumor with a glandular structure. 
 
 Adenom der Meibomschendriisen. (G.) Adenoma of the Meibomian 
 glands. 
 
 Adenomthranendriise. (G.) Adenoma of the lachrymal gland. 
 
 Adeno-myxoma. An adenoma having its stroma invaded by myxoma. 
 
 Adenophthalmia. (L.), n.f. An inflammation of the lining of the 
 Meibomian glands, or of their excretory ducts, or of both. Also 
 called ophthalmia tarsi. 
 
 Adenophthalmitis. (L.),n.f. See Adenophthalmia. 
 
 Adeno-sarcoma. (L.), n.n. An adenoma infiltrated with sarcomatous 
 elements ; or a sarcoma wdiich has developed in a gland. 
 
 Adeno-synchitonitis. (L.), n.f. A term used by von Graefe to desig- 
 nate inflammation of the Meibomian glands ; formerly applied to 
 ophthalmia neonatorum.
 
 ADEPS 99 
 
 Adeps. S<M' Lard. 
 
 Adeps benzoatus. See Benzoated lard. 
 
 Adepsin oil. A name given to one ol' the soft, or lii|ui(l, paraffins, used 
 
 as a iiKMisl I'liiini for various tlici-apful ic ayenls employed in oplithal- 
 
 niie pi'aetiee. 
 Adeps lanse hydrosus. See Lanolin. 
 Adeps petrolei. See Cosmoline. 
 Adeps suillus. See Lard. 
 Ader. (({.i Vein, Ijlood-vessel. 
 Aderbeschreibung-. (G.) Angeiology. 
 Aderbruch. ((i.j Kuptnre of a vein. 
 Aderentziindung'. (G.) Phlebitis. 
 Adererweiterimg-. (G.) Phlebectasis. 
 Aderfalten. (G.) 'i'he valves of the veins. 
 Aderformig'. (G.) A^einy, veined, in the form of a vein. 
 Adergebaude. (G.) The vascular system. 
 Aderg^eflecht. (G.), n. A venous plexus; the chorioid plexus. 
 Aderg-eflechtschlag-adern. (G.) The choroid arteries. 
 Adergeschwulst. ((i.) A venous tumor, varix, thromlius, an aneurism. 
 Aderg-ewachs. (G.) A vascular growth, polypus. 
 Adergewebe. (G.) Choroid plexus; plexus of veins. 
 Aderhaut. (G.) The chorion; the choroid. 
 Aderhautangiom. (G.) Angioma of the clioroid. 
 Aderhautatrophie. (G.) Choroidal atrophy. 
 Aderhaut bei Myopie. (G.) Choroidal changes in myopia. 
 Aderhautbildungsfehler. (G.) Error or defect of development or 
 
 malformation of the choroid. 
 Aderhautcarcinom. (G.) Choroidal carcinoma. 
 Aderhautchen. (G.) The chorion. 
 Aderhauteinrisse. (G.) Choroidal fissure. 
 Aderhautentziindungen. (G.) Choroidal inflammation. 
 Aderhauterkrankungen. (G.) Diseases of the choroid. 
 Aderhautgefasse. (G.) Vascular choroid. 
 Aderhautgeschviriilste. (G.) Choroidal tumors. 
 Aderhautgumma. (G.) Choroidal gmunia. 
 Aderhautiridochorioiditis. (G.) Choroidal iridoclioroiditis. 
 Aderhautkolobom. (G.) Choroid coloboma. 
 Aderhautmangel. (G.) Defect in the choroid. 
 Aderhautmuskel. (G.) The ciliary muscle. 
 Aderhautnerven. (G.) The choroid nerves. 
 Aderhautpigment. (G.) Choroidal pigment.
 
 100 ADERHAUTRUPTUR 
 
 Aderhautruptur. (G.) Choroid lupture. 
 
 Aderhautsarkom, (G.) Choroidal sarcoma. 
 
 Aderhautschwinden. (G.) Choroidal atrophy. 
 
 Aderhautschwund. (G.) Choroidal atrophy. 
 
 Aderhautspalt. (G.) Coloboma of the choroid. 
 
 Aderhautspanner. (G.) The ciliary muscle. 
 
 Aderhautsyphilis. (G.) Choroidal syphilis. 
 
 Aderhauttuberkulose. (G.) Choroidal tuberculosis. 
 
 Aderhauttumoren. (G.) Choroid tumors. 
 
 Aderhohle. (G.) A venous sinus. 
 
 Adericht. (G.) Resembling veins. 
 
 Aderig". (^.) Veiny, veined. 
 
 Aderknoten. (G.) A varix. 
 
 Aderkropf. (G.) A varix. 
 
 Aderlass. (G.) Venesection. 
 
 Aderlassbausch. (G.) A compress applied after venesection. 
 
 Aderlassbauschen. (G.) Bloodletting compress. 
 
 Aderlassbinde. (G.) The bandage used in bloodletting. 
 
 Aderlasseisen. (G.) A lancet. 
 
 Aderlassen. (G.) To bleed. 
 
 Aderlasser. (G.) A bleeder. 
 
 Aderlasskunst. (G.) Phlebotomy. 
 
 Aderlasslanzette. (G.) A lancet for venesection. 
 
 Aderlasslehre. (G.) The science of bloodletting. 
 
 Aderlassschnapper, (G.) A scarificator, a spring-lancet for plile- 
 
 botoni}-. 
 Aderlassthrombose. (G.) Venous thrombus following venesection. 
 Aderlassverband. (G.) The dressing applied after venesection. 
 Aderlasswunde. (G.) A venesection wound. 
 Aderlasszeug. (G.) Instruments for bloodletting. 
 Aderlos. (G.) Veinless, non-vascular. 
 Adernetz. (G.) The choroid plexus. 
 Adernetzpulsadern. (G.) The choroid arteries. 
 Adernetzschlagadern. (G.) The choroid arteries. 
 Aderreich, (G.) Venous, full of veins, veiny. 
 Aderschen. (G.) Veinlet, venule. 
 Aderschlag-. (G.) The pulse, a pulsation. 
 Adersystem. (G.) Vascular system. 
 Aderwasser. (G.) Serum. 
 
 Adhasiv. (G.) Having the power of, or causing, adhesion. 
 Adherent leucoma. Union between the iris and the cornea, generally 
 
 due to perforating ulcer (q. v.) operation on or deep injury to the
 
 ADHESION OF EYELIDS 101 
 
 coruea. It is almost always associated with a white, opa(|ue sear 
 that causes disfigurement and greatly reduces vision. See Cornea, 
 Ulcer of. 
 
 Adhesion of eyelids. This condition is sometimes congenital and some- 
 times due to burns, injuries and other lesions of the eyelids and 
 conjunctival sac. See Symblepharon and Ankyloblepharon. 
 
 Adhib. An Arabic name for the plant Eye-bright. 
 
 Adiactinic. Impervious to the actinic or chemical rays of liglil. 
 
 Adipid. (G.) Fat. 
 
 Adipide. (G.) Fatty products of animal substances. 
 
 Adipidieren. (G.) To grease. 
 
 Adipinsaure. (G.) Adipinic acid. 
 
 Adipoma. (L.), n.n. A term for lipoma. 
 
 Adipose, adj. Fatty. 
 
 Adipose capsule of the eye. Also called, adipose body of the orbit. 
 These expressions are employed to indicate the pad of connective 
 tissue enclosing masses of fat that practically fills the orbit behind 
 the eyeball. 
 
 Adjoining sinuses, Ocular relations of. See Cavities, Accessory. 
 
 Adjunct treatment of ametropia. See, also. Eyestrain. Chloretone is 
 for this purpose used with cocain and other alkaloids, generally in 
 the proportion of 2 per cent. It is a favorite remedy for the relief of 
 the burning and smarting that so often accompany the lid hj^pere- 
 mias of eye-strain. The following makes an excellent mixture : 
 chloretone, seven-tentlis of a grain ; borax, seven grains and a half, 
 distilled water, one fluid ounce. 
 
 Theobold prefers the oleate of veratrine in 10 per cent, strength 
 to any other preparation of the kind in asthenopia and frontal head- 
 ache due to accommodative strain. He also employs it to lessen the 
 irritability of the ciliary muscle preparatory to testing errors of re- 
 fraction. A little is to be rubbed upon the forehead and temples 
 once a day, preferably in the morning. None of it should be allowed 
 to enter the eye, as it causes severe and persistent irritation. 
 
 For the hyperemia of the conjunctiva and the irritative symptoms 
 that accompany refractive errors, and that occasionally i)ersist 
 after they have been properly corrected, Hanford ]\IcKee prescribes a 
 collyrium containing one-sixteenth of a grain of zinc sulphate to the 
 ounce of water. To the same end he often uses iodoform powder on 
 a homatropin and cocain disc, or a little ointment of iodoform — 
 ten per cent, strength. 
 
 As a ciliary tonic in asthenopic cases C. R. Gardner advises the 
 following collyrium, a few drops to be put into the eye three times
 
 102 ADJUNCTUM CATARACTS 
 
 daily : eserin sulphate, one forty-eighth of a grain, holocain, 20 drops 
 of a one per cent solution, boric acid, six grains, rose water, half a 
 fluid ounce. 
 
 For painful eyes in neurasthenic patients, where the irritation con- 
 tinues after the correction of the refractive error W. 0. Moore 
 advises the instillation of a few drops three times a day of a 1 per 
 cent, solution of antipyrine. 
 
 Adjunctum cataractae. (L.) An obsolete term for the whitish, viscid 
 substance supposed to occupy the place of the crystalline lens after 
 extraction of cataract. 
 
 Adler's test. In the optical forms of aphasia (q. v.) the patient may be 
 regarded as color-blind, especially as he cannot give a name to a 
 color, although he, as a matter of fact, recognizes it. Such a person 
 should be asked to match colors, as in the Holmgren (q. v.) method, 
 which he may be able to do quite readily though affected by aphasia. 
 
 Adnephrin. This is the trade (Stearns). name of a preparation that 
 closely resembles adrenalin, suprarenalin and similar extracts of 
 the suprarenal gland. It occurs in the market in the usual 1-1000 
 solution, as well as in the form of oil spray, emollient, suppositories, 
 etc. From our experience of it, it appears to be a reliable vaso-con- 
 strictor and to be useful in all those ophthalmic operations and eye 
 diseases for which suprarenin, etc., are advised. 
 
 Adnexa. (L.), n.n. Appendages, or accessory parts. 
 
 Adnexa bulbi. (L.) The appendages of the eyeball. 
 
 Adolescence, Cataract of. Although there is clinically almost always 
 a decided difference between those opacities in the lens that form 
 in early adult life and the genuine senile type, yet their physical 
 characters may not ditt'er greatly. The main (practical) diff'erence 
 lies in the fact that cataract forming before the age of fifty is 
 likely to be due to more or less active changes in the uveal tract — 
 especially in the choroid — to diabetes or to some other intercurrent 
 affection, and should be dealt with accordingly. Earl^y cataract 
 undergoes more rapid secondary changes than does the translucent 
 lens of old age. It is more difficult to deal Avith, as a rule, and its 
 extraction should be conducted Avith especial care. See the major 
 heading, Cataract. 
 
 Adonidin. In two to four per cent solution this glucoside of Adonis 
 vernalis produces anesthesia of the lid, cornea and sclera, the pupil 
 being unaffected. The anesthesia extends to the lower layers of the 
 cornea, and to a slight extent affects the conjunctiva. 
 
 This local anesthetic was initially employed as a substitute for 
 cocaine but there are too many disadvantages encountered during its
 
 ADORBITAL 103 
 
 employment. At least one per cent, strength is required to anes- 
 thetize the anterior ocular segment. Two drops of this solution 
 instilled during five minutes produces complete anesthesia after 
 twenty-five minutes, but it also sets u[) almost at once a marked 
 reaction, headaches, cloudy' vision, conjunctival hyperemia and a 
 bitter taste in the mouth. Tension and accommodation are not 
 affected but it acts as a mild miotic and analgesic. SchiedloAvsky 
 demonstrated its therapeutic value before the St. Petersburg Oph- 
 thalmological Society in November, 1906, and showed that while 
 adonidin has not much practical value as a local anesthetic it 
 promptly relieves the pain in glaucoma, iritis and iridocyclitis. For 
 this purpose one-quarter of one per cent, solution is sufficient and, 
 like dionin, whose action it resembles, it may be used in conjunc- 
 tion with eserine, pilocarpine, atropine or any other of the miotic 
 or mydriatic alkaloids. 
 
 Adorbital. n. The name employed by Geoffroy for the laehr,ymal 
 bone of fishes. 
 
 Adorbital. adj. Pertaining to the orbit. 
 
 Adram. An Arabic alchemical name for sodium chloride. 
 
 Adrenal. C10H15NO3. This is a crystalline l)ase from the suprarenal 
 capsule and belongs to the same category as suprarenine, (q. v.) 
 suprarenaline, adrenaline and other hemostatics of that order. 
 Although it is not readily soluble in water its salts are. It is used 
 in /4o,ooo to Kooo solutions. 
 
 Adrenaline. EriNEPiiRiNE. CioHi-,XO;.. This compound, with its 
 congeners, forms one of the most valuable remedial agents we have 
 at our command. It is a crystalline substance isolated in 1901 by 
 Takamine and Aldrich in the suprarenal body of the ox. It is a 
 grayish-white, minutely crystalline substance, having a bitter taste 
 and imparting a numb feeling to the tongue. It is very soluble in 
 hot, but less so in cold water. Even the 1 :1000 preparation of Parke, 
 Davis & Co. turns pinkish on exposure to air and light, but this 
 change does not affect its activity. 
 
 Although a number of preparations derived from the suprarenal 
 capsules are on the market, this remedy, especially as adrenalin 
 chloride (preserved by the addition of 0.05 per cent, of chloretone), 
 in solutions of 1 to 1000-5000, seems still the favorite, its action being 
 substantially that of other adrenal agents. Cocaine seems to rein- 
 force its astringent or blanching action, thus making it a valuable 
 adjunct in operating on the eyeball. 
 
 In a few minutes after the use of the solution the conjunctiva 
 tui'us marble white, the tissues at the inner canthus shrink and the
 
 104 ADRENALINE 
 
 palpebral conjimctiva becomes pallid. A few more instillations and 
 the lid skin begins to whiten and in some patients this pallor extends 
 quite to the cheeks, the nose and the eyebrow. Some surgeons claim 
 that post-operative bleeding in such procedures as the advancement 
 of an ocular tendon is more marked than when no suprarenal agent 
 is employed, but as a clear field during the operation is the all-im- 
 portant consideration and the subsequent bleeding of small moment, 
 the post-operative hemorrhage may be ignored. 
 
 Many suprarenal gland extracts are almost identical chemically, 
 physiologically, and clinically with adrenalin. They are supplied to 
 the profession by various manufacturing chemists in this country 
 and abroad. Most of these hemostatics will be more or less fully de- 
 scribed under separate headings. A few of the recent ones are 
 hemisine, renaglandin, suprarenin, adnephrin, paranephrin and re- 
 nostyptin. 
 
 Sydney Stephenson {Ophthalmoscope, Oct., 1908) believes that 
 adrenalin is of no value in the treatment of superficial eye diseases, 
 although it has been of service in glaucoma and spring catarrh. On 
 the other hand it is most valuable as an adjuvant to atropine, eserine 
 and fluorescine and as a local hemostatic in operations on the eye, 
 especially on the eye muscles. 
 
 Darier (Therapeutique Ociilaire, p. 152) uses the following mix- 
 ture with cocaine (which he calls coca-renaline) : cocain hydro- 
 chlorate, one decigram ; sol. of adrenalin, 1 :1000, twenty drops ; 
 distilled water, 10 grams. 
 
 A single drop of this collyrium is sufficient to blanch the con- 
 junctiva and dispel all scleral congestion. He has found it of great 
 service to actors and others who feel obliged to appear with their 
 eyes as brilliant as possible and the sclera as white as it can be made. 
 With this mixture the desired result is obtained without dilating the 
 pupil. 
 
 A. Duane believes that its use is indicated in engorgement of the 
 conjunctival and scleral vessels and the feeling of irritation accom- 
 panying that condition, but does not think the remedy should be 
 applied for any length of time and that this method of utilizing it 
 is not justifiable except in cases of lachrymal diseases and in some ex- 
 amples of spring catarrh. 
 
 Under the name codrenin (q. v.) a mixture containing 4f grains 
 of cocaine hydrochlorate, ^^2 grain adrenaline chloride and 2:^ 
 grains chloretone is for sale that seems well adapted for subcon- 
 junctival use. 
 
 Venable {Ophthalmic Year-Bool-, 1908, pp. 36, 37) has used ad-
 
 ADRENALINEMIA 105 
 
 reiialin to modify the action of ether when employed in general anes- 
 thesia (q. v.). He sprays a 1/1000 to 4/1000 solution upon the towel or 
 inhaler and depends upon its being carried into the air passages 
 with the vaporized ether, suffieientl}'- to produce the desired effect. 
 The spraying is repealed once in six or eight minutes, and from one- 
 half to one ounce of the solution is used for an ordinary operation. 
 The adrenalin seems to contract the vessels of the respiratory tract, 
 lessen the secretion of mncus, and thus secure better aeration in 
 the bronchial and pulmonary vessels. 
 
 Theobald (ibid.) was led to use adrenalin with cocain, at first to 
 lessen hemorrhage ; but found it also increased the anesthetic effect 
 of cocain. It also facilitates the passage of probes in the lachrymal 
 canal, by diminishing the swelling ; facilitates the removal of foreign 
 bodies by diminished hemorrhage and swelling ; and serves as an 
 antidote to the toxic action of cocain. — (Ed.) 
 Adrenalinemia. An excessive amount of adrenaline in the blood. 
 Adreucaine. A preparation similar to eudrenine (q. v.). It is suitable 
 for ordinary hj'podermic use in inducing local anesthesia. Each 
 cc. contains {■ of a grain (0.01 gm.) of eucaine with adrenaline 
 ^000 grains (0.03) mgr.). The hypodermic dose is ^ to 1 cc. 
 When this mixture is diluted with four volumes of normal salt 
 solution it forms an injection suitable for local infiltration-anes- 
 thesia. 
 Adrin. By this trade name is known epinephrine hydrate, one of 
 the numerous suprarenal capsule extracts. It is probably identical 
 with adrenalin chloride and is used in the same dose, as a hemo- 
 static and astringent. 
 Adrovaine. This is a compound of a hemostatic with a local anes- 
 thetic and contains adrenalin 0.00025 gm. (%5o grain) with stovaine 
 (q. V.) 0.02 gm. (^ grain). It may be used with the hypodermic 
 syringe or dissolved in sterile water as a local application in opera- 
 tions on the eye. 
 Adstringierend. (G.) Astringent. 
 
 Advancement, n. An operation whereby the tendon of an ocular 
 muscle is separated from its insertion, and attached at a point 
 farther removed from its original attachment. In this Avay the 
 muscle acquires increased power over the -excursions of the eye. 
 There are numerous operating methods, but in all cases the tendon 
 of the impaired muscle is loosened and, by means of sutures, is 
 drawn forward to a point in advance of its original insertion. Sec- 
 tion of the opposing muscle may precede or follow the operation. 
 Advancement operations differ from each other as to whether
 
 106 ADVANCEMENT 
 
 the muscle is advanced upon the eyeball, along with the other 
 tissues with which it is related (musculo-capsular advancement), 
 or whether the attempt is made to partly separate the muscle from 
 the related structures and bring it forward alone. They differ 
 also as to whether the sutures used to secure reattachment are 
 introduced simply into the episcleral tissue, or whether they are 
 made to take hold of the firm tissues of the sclera, or the stump 
 of the insertion of the advanced muscle. Then an indefinite variety 
 
 Critchett's Method of Advancement. Tissue excised and sutures introduced ready- 
 to tighten. 
 
 of operations is produced by the use of one, two, three, or more 
 sutures ; and by the different ways in which these sutures have been 
 placed or tied by different operators. The attempt to designate 
 by the proposer's name each slight variation in the mode of per- 
 forming an advancement operation is a source of confusion. The 
 more valuable the operation, the more widely it is used or modified, 
 the less definite is the meaning conveyed by such names. This is 
 illustrated by the questions that have arisen as to hoAV Graefe did a 
 tenotomy, or what is a de Wecker advancement. Operations for the 
 shortening of a muscle by exsection of a part of its tendon; or fold- 
 ing the tendon, "tendon-tucking," are in effect to be classed with 
 advancements. 
 
 It is of great practical importance whether an advancement opera- 
 tion is done without other disturbance of the muscular attachments 
 of the eyeball, leaving the advanced muscle to contend with the 
 unhampered activity of its opponents ; or whether b}^ over-stretch- 
 ing or tenotomy, its chief opponents have been temporarily weakened 
 or rendered powerless in a combined operation. It influences espec- 
 ially the kind of anchorage that must be secured for the sutures 
 and the probability of the first result remaining unchanged. But 
 the general discussion of this matter is reserved for the section on 
 the general indications for and effects of different muscle opera- 
 tions (q.v.). — [E. J.]
 
 ADVANCEMENT OF THE CAPSULE 107 
 
 Advancement of the capsule. An operation by moans of which a 
 portion of the capsule of Tenon, generally with the overlying con- 
 junctiva, is loosened from its bed, brought forward and attached 
 nearer the corneal margin. See Extrinsic ocular muscles, Operations 
 on. 
 
 Advancement operations on the extrinsic ocular muscles. See Extrinsic 
 ocular muscles, Operations on the. 
 
 Advancement with anchor stitch. See Extrinsic ocular muscles, Opera- 
 tions on. 
 
 Adventitia oculi. (L.) The oeuhtr ai)peiidages. 
 
 Adverse prism. This term is used by ]\Iaddox who defines it as mean- 
 ing a prism with its apex set in the opposite direction from a "re- 
 lieving" prism; for example, if the internal recti muscles are to be 
 affected, the prism is placed base out; but base in, if the externi are 
 to be exercised. See Ocular muscles. 
 
 Adversion. The turning of one or both eyeballs inward. 
 
 Adynamia. Loss of vital force or muscular power. 
 
 Adynamie. (G.) Weakness. 
 
 Adynamisch. (G.) Weak, adynamic. 
 
 Aegias. (L.), n.f. An ancient term for a spot or speck on the eye. 
 
 Aegidion. (L.), n.n. The name of an ancient collyrium or eye Avash, 
 said to have been so called on account of the prevalence of eye 
 troubles in goats. 
 
 Aegilops. (L.), n.f. An obsolete term for a lachrymal fistula or an 
 abscess that has opened externally. 
 
 Aegyptische Augenpest. (G.) Egyptian ophthalmia; trachoma. 
 
 Aegyptische Augenentziindung. (G.) Egyptian ophthalmia. 
 
 Aeolotrop. (G.) Doubly refracting. 
 
 Aelotropic. In physics, not having the same properties in all direc- 
 tions ; non-isotropic ; anisotropic : said of a body with reference to 
 the action upon it of light. Iceland spar is an aelotropic biaxial 
 crystal in consequence of its strong double refraction. — (C. F. P.) 
 
 Aelotropy. In physics, the state or quality of being aelotropic (q. v.). 
 
 Aequator des Auges. (G.) Equator of the eye. 
 
 Aequatorialebene. (G.) Equatorial plane. 
 
 Aequatorialplatte. (G.) Equatorial plate. 
 
 Aequator oculi. (L.), n.m. Equator oculi. The circumference of the 
 eyeball that bounds its central transverse vertical plane, correspond- 
 ing to that narrow zone which lies immediately behind the ciliary 
 region. 
 
 Aequilibriemethode. (G.) Method of equilibration. 
 
 Aeramie. (G.) Air in the blood-vessels.
 
 108 AERHAMOKTONIE 
 
 Aerhamoktonie. (G.) Death due to air entering the blood-vessels. 
 
 Aerial image. In optics, (1) the image formed in the air by a convex 
 lens or concave mirror, and which is made visible when the eye is 
 in line with the image and in accommodation for it. (2) An image 
 of terrestrial objects that is formed through light being conver- 
 gently reflected or refracted by strata of different atmospheric densi- 
 ties, the image appearing suspended in the air, as the different kinds 
 of mirage.— (C.F. P.) 
 
 Aerial perspective. In painting, the art of giving due diminution to 
 the strength of light, shade and colors of objects according to their 
 distances, to quality of light falling on them, and to the atmosphere 
 or medium through which they are seen. — (C. F. P.) 
 
 Aerial tints. In painting, the tints or modifications of color by which 
 the expression of distance is attained. 
 
 Aeroben. (G.) Aerobic bacteria. 
 
 Aerobian. See Aerobiotic. 
 
 Aerobic. Aerobiotic (q. v.). 
 
 Aerobiontisch. (G.) Aerobic. 
 
 Aerobiotic. adj. Pertaining to the life of an aerobion, i. e. one requir- 
 ing free oxygen or atmospheric air for the maintenance of life. 
 
 Aerobisch. (G.) Aerobic. 
 
 Aerostatisch. (G.) Aerostatic. 
 
 Aerotherapie. (G.) Air-treatment. 
 
 Aerotonometer. (G.) An instrument for measuring gas-tension in 
 the blood. 
 
 Aerztekammer. (G.) Representative body of medical men. 
 
 Aerztetag. (G.) Meeting of medical men. 
 
 Aerztlich. (G.) Medical; relating to medical men or medical af- 
 fairs. 
 
 Aeschinas. This classical patient deserves a place here as he pre- 
 sents for modern readers an especially interesting history. His 
 record is preserved on a votive-tablet, more than twenty-two hun- 
 dred years old, exhumed in 1883-85 from the ruins of the Asklepieion 
 at Epidauros. It reads as follows: "Aeschinas climbed a tree, when 
 those seeking help were already sleeping in the temple, and gazed 
 across the sanctuary in the holy of holies. Then he fell from the 
 tree, and wounded his eyes on a number of stakes. In this deplor- 
 able condition, and wholly blind, he supplicated the god, slept in 
 the temple, and became healed." — (T. H. S.) 
 
 Aescorcin. See Escorcin. 
 
 Aesculus hippocastanum, Oculo-toxic symptoms from the. The fruit 
 of the common horse chestnut, now and then eaten by children,
 
 AESTCHEN 109 
 
 seems to produce jjoisoning which is followed by dilation of the 
 l)upil. It is very (juestioiiable whether aeseiilin is eoiieerned in this 
 symptom. It is more likely due to saponins. A boy ate the green 
 rind of the fruit. He vomited a portion of it, the pupils became 
 dilated, the face reddened, the i)ulse high, Avhile nervous symptoms 
 with sleepiness developed. Recovery resulted after adminis- 
 tration of an emetic. Similar symptoms showed themselves in a 
 girl, six years old, who had eaten the green fruit. She developed 
 pains in the abdomen, nausea, thirst, delirium and fright. The 
 pupils dilated and the eyes "looked" glassy. 
 
 Aestchen. (G.) A little branch. 
 
 Aesthesiometer. n. An instrument for measuring the acuteness of 
 tactile sensation. It consists of two hair-like, movable points, which, 
 placed upon the skin, are approximated until the two tactile sensa- 
 tions thus obtained blend into one. The distance between the two 
 points, indicated by a scale attached to the instrument, is in inverse 
 
 proportion to the degree of tactile sensibility. An esthesiometer. 
 Aesthesioneurosen. (G.) Atfeetions of sensory nerves. 
 
 Aesthesodisch. (G.) Aesthesodic; conducting sensory impulses. 
 
 Aestig". (G.) Branched, racemose. 
 
 Aethehart. (G.) A kind or variety of ether. 
 
 Aetherauszug". (G.) Ethereal extract. 
 
 Aetherbespriihung. (G.) Spraying Avith ether. 
 
 Aetherbetaubung-. (G.) Ether narcosis. 
 
 Aetherbildung-. (G.) , Etherification. 
 
 Aetherdampf. (G.) Ether vapor. 
 
 Aetherdarreichung. (G.) The administration of ether. 
 
 Aetherdouche. (G.) An ether spray apparatus. 
 
 Aetherdusche. (G.) An ether spray apparatus. 
 
 Aethereinatmung". (G.) The inhalation of ether. 
 
 Aethereinspritzung. (G.) The injection of ether. 
 
 Aethereinwirkung. (G.) The action or eflPect of ether. 
 
 Aether, Eye symptoms from the inhalation of. See Ether. 
 
 Aetherisch. (G.) Ethereal; essential. 
 
 Aetherisiren. (G.) To administer ether, to etherize. 
 
 Aetherisirung. (G.) The administration of ether. 
 
 Aetherismus. (G.) Etherism, after-effects of ether. 
 
 Aethermuskelstarre. (G.) Muscular rigidity under ether. 
 
 Aethernachwirkung. (G.) The after-effect of ether. 
 
 Aethernarkose. (G.) Narcosis by ether. 
 
 Aetheromanie. (G.) Etheromania. 
 
 Aetherscheintod. (G.) Collapse or asi)hyxia luider ether.
 
 110 AETHERSCHWEFELSAURE 
 
 Aetherschwefelsaure. (G.) Ethylsulphuric acid. 
 Aetherweingeist. (G.) The spirit of ether. 
 Aetherwirkung. (G.) The action or effect of ether. 
 Aetherzerstauber. (G.) An ether spray apparatus. 
 Aetherzerstaiibung. (G.) The act of spraying with ether. 
 Aethiops aJbus. (L.) A term applied originally by the Portuguese 
 to albinotic negroes. Subsequently it was given to human albinoes 
 in general, i. e., to anyone in whom the proper pigmentation of the 
 skin, hair, iris and choroid is congenitally deficient. In them the 
 eyes are pink and usually affected with photophobia ; there is more 
 or less blepharospasm, and often nystagmus. See Albino, 
 Aethomma. (Obs.) Ambrose Fare's term for pigment deposits in 
 the humors and tunics of the eye. It has also been employed as a 
 synonym for phosphenes, or flashes of light or sparks before the 
 eye. 
 Aethyl. (G.) Ethyl. 
 Aethylaldehyd. (G.) Ethyl aldehyde. 
 Aethylalkohol. (G.) Ethyl alcohol. 
 Aethylather. (G.) Ethyl ether. 
 Aethylchloriir. (G.) Ethyl chloride. 
 Aethylen. (G.) Ethylene. 
 Aethylenjodid. (G.) Ethylene iodide. 
 Aethyliden. (G.) Ethylidene. 
 
 Aethylidendimethylather. (G.) Ethylidene dimethyl ether. 
 Aethyloxyd. (G.) Ethyl oxide. 
 Aethylschwefelsaure. (G.) Ethylsulphuric acid. 
 Aethylviolett. (G.) Ethyl violet. 
 Aetiologisch. (G.) Etiological. 
 
 Aetius of Amida (In Mesopotamia). This somewhat slavish, but most 
 exhaustive, ophthalmologic compiler was born at Amida (now 
 Diarbekir) A. D. 502 and died about 575. Educated at the Univer- 
 sity of Alexandria, he very soon settled in Byzantium, where he 
 seems to have passed the remainder of his days. He was a devout 
 . Christian, became comes obsequii, or lord high chamberlain, to 
 the great Justinian — compiler of the Institutes, Code, and Digest — 
 aud was also body-physician to the same potentate. His Sixteen 
 Bools on Medicine was a kind of Encyclopedia of the healing art as 
 known and practised in his day. After Aetius 's time, his sixteen 
 "books" were grouped into four Tetrabilia, each of four Sermones. 
 A later name of the work was, in consequence of this arrangement, 
 T etrabiblon. 
 
 Though Aetius was, in general, a scientific writer, sometimes he
 
 AETIUS'S OPERATION FOR ENTROPION 111 
 
 abandoned the strictly scientific view-point ; when ho did so, he 
 exhibited somewhat typically the spirit of his age. Thus, when 
 making salves, he declared that one ought continually to repeat this 
 incantation: "The Cod of Abraham, the God of Isaac, the God of 
 Jacob, give virtue to this medicament." When a bone has stuck 
 in the patient's throal, tlic physician should seize him l)y the 
 neck, and cry in a voice of loud couniuind: "As Jesus drv^v 
 Lazarus from the grave, and Jonah out of the Avhale, thus Blasius, 
 the martyr and servant of God, commands, 'Bone, go up or down.' " 
 Much of the Tetrabiblon is mere compilation from the earlier 
 Greeks — Archigenes, Aspasia, Leonides, Philagrius, Soranus, et al. 
 Yet there is also original matter, part of which, at least, is of high 
 value. Moreover, Aetins has preserved the doctrines of many an 
 ancient ophthalmologue, who, but for this mediaeval writer would 
 never have remained in view till the 20th century. Neuberger de- 
 clares the ophthalmologic portion of the Tetrabiblon to be "the 
 best and most exhaustive" of antiquity. This praise may be a little 
 too high for a treatise which does not even mention the cataract 
 operation (very commonly performed in Aetius's time and for centu- 
 ries earlier) and which lays but little stress on any ophthalmo-sur- 
 gical procedure. Nevertheless, in the matter of the therapeutics of 
 the eye, the work in (juestion is undoubtedly important. It de- 
 scribes, in fact, with great detiiil the therapeutics of sixt.y-one dis- 
 tinct ocular affections. 
 
 An important and memorable passage of the work is the follow- 
 ing : ' ' On the treatment of the new-born. According to Severus. 
 A terrible aft'ection occurs in the eyes of the new-born. Commonly, 
 the lids swell by reason of the abundance of pus. For moist and 
 warm by nature are the newly born. [An allusion to the so-called 
 "humoral theory" of disease.] The collyria for this disease must 
 be cooling and drying, as well as astringent, in order to mitigate 
 the floAv of ocular secretion." Though an extremely early, this 
 is not the very earliest, passage extant on the subject of ophthal- 
 mia neonatorum. For two much earlier passages, see Soranus. 
 — (T. H. S.) 
 
 Aetius's operation for entropion. There can be no doubt but that 
 this sixth-century surgeon advocated and performed an entropion 
 operation quite similar to that of Burow ((]. v.). At any rate, in 
 addition to the removal of a longitudinal piece of palpebral skin 
 the section went deeper and included the tai'sus. 
 
 Aetz. (G.) Caustic, corrosive. 
 
 Aetzammoniak. (G.) Caustic ammonia.
 
 112 AETZAMMONIAKFLUSSIGKEIT 
 
 Aetzammoniakfliissig'keit. (G.) Liquor ammoniae; a solution of caus- 
 tic ammonia. 
 
 Aetzbar. (G.) Corrodible, irritable. 
 
 Aetzbaryt. (G.) Caustic baryta. 
 
 Aetzeinwirkung. (G.) The action or effect of caustics. 
 
 Aetzen. (G.) To cauterize, to corrode. 
 
 Aetzend. (G.) Caustic, corrosive. 
 
 Aetzgift. (G.) A caustic poison. 
 
 Aetzkali. (G.) Caustic potash. 
 
 Aetzkalilaugfe. (G.) A solution of caustic potash. 
 
 Aetzkalilosung. (G.) A solution of caustic potash. 
 
 Aetzlauge. (G.) A solution of caustic potash. 
 
 Aetzniittel. (G.) A caustic or escharotie remedy. 
 
 Aetzmitteltrager. (G.) A caustic holder. 
 
 Aetzmittelzange. (G.) A caustic holder. 
 
 Aetznatron. (G.) Caustic soda. 
 
 Aetznatronlauge. (G.) A solution of caustic soda. 
 
 Aetznatronlosung'. (G.) A solution of caustic soda. 
 
 Aetzpinsel. (G.) A caustic brush or pencil. 
 
 Aetzschorf. (G.) Eschar or slough from caustic. 
 
 Aetzsonde. (G.) A caustic sound. 
 
 Aetzstabchen. (G.) A caustic point. 
 
 Aetzstein. (G.) Potassa fusa. 
 
 Aetzstiff. (G.) A caustic point. 
 
 Aetzsublimat. (G.) Corrosive sublimate. 
 
 Aetztrager. (G.) A caustic holder. 
 
 Aetzung. (G.) Cauterization, corrosion. 
 
 Aetzvergiftung. (G.) Poisoning by caustics. 
 
 Aetzwunde. (G.) A wound produced by caustics or corrosives. 
 
 Aeusser. (G.) Outer, external, externus. 
 
 Aeusserlich. (G.) External, superficial, outer. 
 
 Aeussere Augenhaut. (G.) The cornea: a term mostly used by the 
 older anatomists. 
 
 Aeusserer Augenmuskelnerv. (G.) The sixth cranial nerve. 
 
 Aeusserer Augenwinkel. (G.) The external angle of the orbit; the 
 external canthus. 
 
 Aeusserer gerade Augenmuskel. (G.) The external rectus muscle. 
 
 Aeusseres Augenleistenloch. (G.) Infra-orbital foramen. 
 
 Aeusseres Augenwinkelband. (G.) External tarsal ligament. 
 
 'Afachia. (It.) Aphakia or absence of the crystalline lens. 
 
 Affektion. (G.) Emotion, morbid change. 
 
 Affektionslosigkeit. (G.) Apathy.
 
 AFFERENS 113 
 
 Afferens. (G.) Afferent vessel. 
 
 Affizieren. (G.) To affect. 
 
 Affusio. (L.), n.f. (Obs.) A cataract. 
 
 Affusio oculi. (L.) Obsolete name for cataract. 
 
 Afterbildungf. (G.) Pseudoplasm, neoplasm, secondary growth, 
 malformation, deterioration. 
 
 After-cataract. The importance of a definite understanding of this 
 subject, not only from the operative form but from the non-operative 
 standpoint, cannot be overestimated by the ophthalmologist, al- 
 though it is generally considered from the viewpoint of the operat- 
 ing surgeon. 
 
 An after-cataract is an}- membrane stretched across the area of 
 the pupil after a cataract extraction, which obscures vision. 
 
 These opacities vary from a loose, clear capsule which, hanging 
 in folds, disperses light and obscures vision, to a dense, inflammatory 
 membrane on which is superimposed the iris, the lower pupillary 
 border of which may be drawn up into, or into the neighborhood of 
 the cicatrix resulting from the incision in the cornea made for the 
 extraction of the cataractous lens. 
 
 Much has been written about the dangers of operation on after- 
 cataract, and even at the jDresent time many surgeons never operate 
 unless it is absolutely necessary to secure useful vision. Much of 
 this dread has come down to us from pre-aseptic times. Iritis was 
 then a much more common complication during convalescence from 
 cataract extraction, and the resulting cyclitis produced a condition 
 which was easily aggravated by any subsequent operation. The pre- 
 ceding iridocyclitis also produced a matting together of the tissues 
 at the root of the iris which increased the predisposition of such 
 eyes to a glaucomatous cyclitis. Septic infection at the point of in- 
 cision in the operation for after-cataract was also a much more 
 common accident. At the present time these dangers are much less 
 than formerly and some operators, notably Knapp, have advocated 
 the use of the method in every case in which vision could be dis- 
 tinctly increased. But that there is real danger is evidenced by 
 Marshall's report during the five years from 1889 to 1893. During 
 this period there were 404 operations for after-cataract in which 
 number there were five cases of suppuration and ten cases of glau- 
 coma giving 1.02 per cent, cases of suppuration and 2.08 per cent, 
 of glaucoma. His explanation of the method of infection is that 
 when the needle is withdrawn a tag of capsule, or vitreous, may fol- 
 low it up to the corneal puncture and even be drawn through it and 
 project exteriorly, which affords a very ready means of infection of 
 
 Vol. 1—8
 
 114 AFTER-CATARACT 
 
 the interior of the globe. When a percentage as high as this is re- 
 ported by so eminent an authoritj^, it is obvious that aseptic pre- 
 cautions should be as thoroughly observed in everj^ case of after- 
 cataract as in the original operation. 
 
 The simplest form of after-cataract is that in which the loose pos- 
 terior capsule throws itself into folds or ridges upon which are min- 
 ute dots. This membrane will often produce an amount of obstruc- 
 tion to the vision entirely out of proportion to its apparent opacity, 
 as seen when looking into the eye with the ophthalmoscope. The 
 reduction of vision is due to the di.spersal of the rays of light by 
 the corrugations of the membrane. 
 
 The next and more serious condition is that in which the obstruc- 
 tion is due to opaque masses or bands of tissue lying upon the 
 anterior surface of the capsule. These arise from a variety of causes, 
 being largely due to the fact that the epithelial lining of the pos- 
 terior capsule which produces the lenticular fibres continues under 
 the new conditions to produce abortive lenticular cells. This is es- 
 pecially true where the anterior capsule overlies the posterior, these 
 cells subsequently becoming sclerosed and opaque. 
 
 Another frequent source of after-cataract is small masses of 
 cortical lens-matter that remain behind wdien the lens is extracted. 
 These subsequently undergo absorption but at their seat there is 
 found a dense connective-tissue-like material. Bates, from experi- 
 mental work upon rabbits, drew the conclusion that the fluid which 
 replaced the normal aqueous humor not only contained albumin, but 
 would clot, and that such clots when stained and examined b.y the 
 microscope showed the structure to be of fibrin. He deduced from 
 these experiments that probably a fibrinous connective tissue process 
 followed on the capsule from loss of the aqueous humor during 
 cataract extraction. It is well known that when the Avound of a 
 cataract extraction does not close promptly, so that there is a con- 
 siderable leakage of aqueous for a number of days, these opacities 
 on the posterior capsule are much more likely to occur, which would 
 seem to confirm Bates' deductions. These opacities very often take 
 the form of bands stretching across the pupil in a direction approach- 
 ing vertical. The capsule itself is elastic, and these bands tend to 
 contract and draAv the elastic membrane tensely across the area of 
 the pupil. 
 
 Another variety of simple after-cataract is due to former disease 
 of the capsule itself, in cases of old and complicated cataract. 
 
 "When, following cataract extraction, we have an iritis or an 
 iridocyclitis, the result complicates the simple after-cataract by
 
 AFTER-CATARACT J 15 
 
 pouring out upon the surface of tlic enpsule an exudate from the iris. 
 This exudate forms dense opa(jue masses at the border of the pupil, 
 attaching it to the capsule at such places, and if the iritis has been 
 . profound the whole margin of the iris may in this manner be agglu- 
 tinated to the capsule. Tlie pupillary area becomes much diminished, 
 and if the iritis is complicated with ciliary inflammation in the 
 neighborhood of the original wound, the iris may be drawn up and 
 attached by inflammatory material in such a manner that the lower 
 border of the pupil is dragged to the upper margin of the anterior 
 chamber. The consequent stretching of the iris tissue approximates 
 it to the capsule to which it becomes firmly adherent, M'ith the re- 
 sult that a dense, inflammatory membrane of iris tissue, connective 
 tissue and posterior capsule is stretched across the anterior chamber. 
 
 The intent of the operation is to obtain a clear opening in the 
 pupil for the purpose of giving distinct vision. In a simple after- 
 cataract the size of the opening is of less importance than its posi- 
 tion. A very small opening in a fairly transparent capsule often 
 gives us good, or better, vision than a large one, provided this open- 
 ing is centrally placed. Most operators have laid stress on the 
 statement that the important factor is a wide horizontal slit. It is 
 probable that too much stress has been laid upon this point and 
 that a vertical slit giving a clear area through which the lower part 
 of the field of vision is clear is even more useful than a wuder open- 
 ing whose main dimension is horizontal. 
 
 The principal difficulty encountered in this operation is often 
 the inability of the operator to see exactly what he is doing. This 
 is chiefly due to alterations in the illumination and the refraction of 
 the light. First, after the needle is introduced into the anterior 
 chamber a slight amount of traction on the cornea is produced b.y 
 the movements of the needle, which alters the curvature of the 
 cornea. Second, while the membrane may be perfectly distinct as 
 it is stretched across the posterior portion of the anterior chamber, 
 the moment the point and cutting edge of the needle depresses the 
 center of the membrane, the reflection of the light from its surface is 
 thrown in such a manner as to make it quite, or almost, invisible. 
 Jackson urges that every operator should use a binocular magnifier, 
 and while his advice has not been generally followed, it serves to 
 emphasize this particular difficulty in the operation. A good Nernst 
 or electric light, employed as the oblique illumination, set on a 
 standard, or used as a head-lamp, acts excellently in outlining with 
 vivid distinctness even the smallest strand or filament in the anterior 
 chamber. The advantage of an oblique or sideways illumination is 
 that it rids one of the annoying corneal reflexes.
 
 116 AFTER-CATARACT 
 
 Most operators have agreed that it is necessary iu these opera- 
 tions to avoid traction upon the ciliary body through the attachment 
 of the posterior capsule. The chief difficulty that this presents is 
 » because it is only with the greatest care that the small knife-needles 
 used in the operation can be made and kept sufficiently sharp to do 
 their work without dragging on the capsule during a discission. 
 
 Infection of the corneal ivound is often due to the fact that insuf- 
 ficient precautions have been taken before the operation. But many 
 operators believe that the point of incision is of importance in this 
 respect, and if the needle be entered well back at the limbus, or 
 even subconjunctivally, and then through the limbus into the an- 
 terior chamber, the vascular blood supply of this region is a safe- 
 guard against infection. 
 
 The second danger is that the traction on the after-cataract may be 
 sufficient to produce a recurrence of an iridocyclitis, and that 
 this inflammation may pursue a very slow, inactive course with the 
 loss of the physiological function of the ciliary body Aveeks or months 
 afterwards, with consequent loss of vision. 
 
 The third danger is that if there has been much inflammator}' ex- 
 udate poured out upon the capsule, this may send out proliferations 
 which may subsequently close the opening made by operation. 
 
 Most of the early operations for after-cataract were designed for 
 use in those cases in which the pupil had become occluded by inflam- 
 matory products, but in recent years operations are also done for 
 after-cataracts which are much less formidable, and now the great 
 bulk of operations for after-cataract are upon the posterior capsule 
 on which opaque masses have appeared. These vary widely in their 
 translucency, from the simplest form, in which the j^osterior capsule 
 of the lens is hanging loosely in folds upon which are deposited 
 minute points of opacity, through the various grades in which these 
 opacities occur in larger areas, and not infrequently in the form of 
 opaque stria?, or bands approximately vertical, to those cases still 
 more troublesome in which in addition to areas and bands of opacity- 
 on the capsule, there are points of attachment to the iriS, opposite 
 which masses of opaque material have extended onto the capsule. 
 
 Wheii it is expedient and proper to operate for simple after- 
 cataract has been much discussed. Knapp, who stated, "I perform 
 extractions with a view towards the necessity of a subsequent dis- 
 cission," naturally operated earlier than others who fear the results 
 of secondary operations. It is his custom to operate within a few 
 weeks after the extraction in cases of simple after-cataract. Sur- 
 geons who have never performed the operations, except in cases
 
 AFTER-CATARACT 117 
 
 where llic vision is jiircnl ly ()])scui'e(l. ojx'i'jitc. ns ;i i-nle, upon more 
 coniplicalccl after-eat.U'aels lliat have Ixmmi Ihr suli.jeet ol' au iridocy- 
 clitis, and have iiatui*ally maintained tlial eai-ly oi)ei"ations are inad- 
 visable. Success undei- these circumstances is al)solutely de])endcnt 
 upon the entii'e subsidence of tlie oi-iginal inflamiiiat ion. and even 
 then sutflcient time must l)e allowed for the circulatory api)aratns 
 of the eye to recover its noi-mal function so completely that even 
 the slight traumatism produced by the operation is nol sufficient to 
 cause a recurrence of the infiammatory j)rocess. ()l)vi()usly, in these 
 cases, a considerabb' period of time must elapse befoi-e the secondary 
 operation is undertaken. Careful oi)eratoi-s often wait thi-ee or 
 four months before again exposing the eye to the traumatism of an 
 operation. 
 
 When an operation for after-cataract is performed soon after the 
 extraction of the lens, there is danger that the t<msion caused by 
 pressure of the needle in one direction, and the |)ulling caused by the 
 fixation forceps in the o])posite direction, may be sufficient to reopen 
 the original wound, therefore the prompt healing of the wound wdth 
 a flat and firm cicat]'ix is a condition precedent to an early secondary 
 operation for after-cataract. 
 
 Before operation study the ai'ea of the capsule when the pupil is 
 undilated. This is necessary to make sure that the opening in the 
 capsule resulting fi'om the opei-ation shall be exactly in the center 
 of the i)U])il. The danger in operating upon a membrane with a di- 
 lated ])U{)il is that, owing to some inelasticity of the iris on one side, 
 or because it is adherent to the capsule, the oi)erator nmy select the 
 center of the capsule as exposed, and when the mydriatic is omitted 
 he finds to his chagrin that the opening is at one side of the pnpil, 
 or, in extreme cases, even behind the iris. Another reason for this 
 preliminary study is that the elasticity of the capsule often allows 
 it to be pushed before the blade of the knife and th.e opening is then 
 made a considerable distance from the true center of the i)upil in 
 which the operator thinks he is operating. 
 
 In this preliminary study it is necessary to d(» 1a\-o things. First, 
 locate the center of the pui)il by means of the relationship of such 
 opacities as appear upon the capsule, so that it is easily recognized 
 after the pupil is dilated. Second, observe whetluM- the capsule is 
 stretched more tautly in one direction than in othei's. so that advan- 
 tage of this tension may be takeii in making the incision and the 
 opening remain widely extended. 
 
 Cutting instruments used in these operations are knife-needles, 
 knives, scissors, spear-i)ointed needles and i)nnches. The opei-ation
 
 118 AFTER-CATARACT 
 
 for simple after-cataract at the present time is more often done 
 with some form of knife than b}" any other instrument. 
 
 The first requisite of a knife-needle for after-cataract discission is 
 that it should he very sharp. This is a condition of the instrument 
 not easily obtained and maintained, owing to the mechanical dif- 
 ficulties of sharpening the instrument, and the care necessary to 
 keep it sharp during the aseptic preparation and the subse(iuent 
 
 Cheseklen 's Knife-Needle. (After Sharp.) 
 
 manijDulations. If such a blade is drawn only once or twice across 
 a piece of the finest linen the cutting edge is practically destroyed. 
 
 Secondly, the blade should make an opening in the cornea no 
 larger than is entirely filled by the shank of the instrument. This 
 is necessary to prevent the evacuation of the aqueous early in the 
 operation and to avoid an advance of the vitreous and its inevitable 
 wide laceration during the maneuvers to cut the after-cataract. 
 
 The third requisite of a proper knife-needle is that the cutting 
 edge shall be so placed that it will incise the membrane when it is 
 drawn back and forth upon its surface, or, if entered more obliquely, 
 that the edge shall cut without wide excursions into the vitreous, in 
 
 Hays' Knife-Needle. 
 
 the sawing movement which is necessary to do these operations, and 
 without undue tension upon the ciliary attachment of the capsule. 
 
 The fourth requisite is that if the point is to be used in punctur- 
 ing the membrane, it shall be sufficiently sharp and thin to puncture 
 it easily, without pushing the capsule before the blade. 
 
 The first knife for secondary cataract was described by William 
 Cheselden. It consisted of a long narrow shank with a knife blade 
 at the end 11 mm. in length, and was used by nuiking a puncture 
 through the anterior portion of the sclera and approaching the mem- 
 brane of the after-cataract from the posterior chamber. Ziegler 
 draws attention to the fact that it was very similar to Hays' knife- 
 needle, which was used by Isaac Hays in his surgical work at the 
 Wills' Eye Hospital in Philadelphia. Pa., and has been in constant 
 use by the staff of that institution for half a century. It was de- 
 scribed by the inventor as follows: "This instrument from the 
 point to the head near the handle is six-tenths of an inch, its cutting
 
 AFTER-CATARACT 119 
 
 edge nearly four-tenths of an inch. The back is straight to near 
 the point where it is truncated so as to make the point stronger, but 
 at the same time leave it very acute. The edge of this truncated 
 portion is made to cut. The remainder of the back is simply rounded 
 otf. The cutting edge is jierfectly straight and is nmde lo cuj) up 
 
 Ziegler's Knife-Needle. 
 
 to the part where the instrument becomes round. This portion re- 
 quires to be carefully constructed so that as the instrument enters 
 the eye, it shall fill up the incision aiul thus prevent the escape of 
 aqueous humor." 
 
 Ziegler has described a knife-needle as follows: "The form of 
 this needle is the falciform knife and the bistoury and possesses the 
 advantages of both. It has a delicate point Avhich punctures easily 
 and an excellent cutting edge of sufficient length (7 mm.) and if 
 
 Knapp 's Knife-Xeedle. 
 
 the shank is properly rounded it can be used with a sawing motion, 
 sliding backwards and forwards through the corneal puncture with- 
 out injuring the cornea and without allowing the escape of aqueous." 
 
 Knapp designed a knife-needle Mdiich has been much used and 
 consists of a narrow shank with the point opposite to the center of 
 the shaft and the cutting edge somewhat bellied. The blade is 5 mm. 
 long. 
 
 Sichel's iridotome is very similar to Knai)p"s knife-needle with 
 the exception that the rounded back of the blade is straight and the 
 blade is 11 mm. in length. 
 
 Falciform Knife-Needle. 
 
 The falciform knife which Graefe reeonnnends and Galezowski 
 employs has a straight blade with a slight falciform point. 
 
 Risley described a knife which he designed, and drew attention 
 to the fact that a cross section through most knife-needles presents 
 too often an almost equilateral triangle which he avoids by having 
 a spear-shajjed knife, sharp at both edges, beaten out on the end of 
 the shank. The midrib of the spear is very thin and tai)ers grad-
 
 120 AFTER-CATARACT 
 
 iially to the point and to either edge. The amount of metal in the 
 spear or blade of the knife is the same as contained in the shank, less 
 the lost sustained in grinding and polishing. He thought the ad- 
 
 Eisley *s Knife-Xeedle. 
 
 vantage of sueh an instrument was that it could be readily and satis- 
 factorily sharpened from the fact that a cross section through the 
 blade is not a triangle, but a very flat ellipse. 
 
 Post described a knife-needle Avhich he designed, as follows: 
 ''The blade is 6 mm. long and li/t mm. wide at its widest part. It 
 has a back straight and dull and a rounded cutting edge extending 
 its entire length. The shank is cylindrical and of a diameter suffi- 
 
 Post 's Knife-Needle. 
 
 cient to prevent the escape of acpieous during the operation. The 
 width of the blade is sufhcient to admit of its cutting edge being 
 ground very sharp." 
 
 Weeks devised a curved knife-needle shaped something like a 
 sickle, the length of the blade varying from 5 to 3i4 mm. A hooked 
 extremity is formed by a curve Avhich extends from the middle of 
 the blade to its point. The curve of the blade brings the extreme 
 point 2.5 mm. away from a line projected from the axis of the shaft. 
 The blade is about 2/3 mm. Avide and the shaft is just large enough 
 to fill the opening made by the blade. The concave edge and point 
 of the blade are made as sharp as possible, and the convex edge, to a 
 point 1 mm. up, is also sharpened. 
 
 Levinsohn described a similar curved knife-needle. 
 
 There has been much controversy for over 100 years as to the 
 proper place to pierce the globe on making an incision in an after- 
 cataract. Cheselden, Avhose knife has been described, made his 
 puncture back of the sclero-corneal junction on the temporal side 
 behind the iris, carried the knife across the posterior chamber, and 
 cut through the iris from behind forward. In recent years Da Gama 
 Pinto entered his knife still farther back, from 6 to 8 mm. from 
 the sclero-corneal junction. The point Avas then carried back 
 toward the center of the globe, but after it Avas entered he brought it 
 gradually forAvard so as to transfix the after-cataract near the pupil-
 
 AFTER-CATARACT 121 
 
 lary margin of the same side from behind forward. He then pushed 
 the knife forAvard across the anterior surface of the membrane to 
 the opposite side of the i)upil and subsequently withdrew the knife 
 by the reversal of the procedure from entering the globe. 
 
 Da Gama Pinto at the Luzerne Congress in 1904, stated that he 
 had abandoned the operation because he had observed two cases of 
 detachment of the retina after the procedure. With these exceptions 
 all operators have entered the knife either anterior to, or at the 
 sclero-corneal margin. That the point of entrance should be at or 
 near the limbus of the cornea has been insisted upon by many opera- 
 
 Weeks' Knife-Needle. 
 
 tors. One of the principal advantages of the peri})heric ^juncture 
 lies in the fact that wnth the blade of the knife introduced parallel 
 to the plane of the iris, the curve of the cornea forms a valve-like 
 opening which is closed, upon the withdrawal of the knife, by intra- 
 ocular pressure. Many operators believe that, owing to the great 
 vascularity of the limbus, there is much less danger of infection in 
 making the wound at that point, and others have thought that they 
 obtained still greater safety from infection by drawing forward the 
 conjunctiva and entering the knife through that, thence passing it 
 through the limbus into the anterior chamber. These advantages of 
 a peripheric incision have been strongly urged by many operators, 
 and Jackson emphasizes the necessity of this method of entrance 
 to the anterior chamber and mKiualifiedly condemns all other meth- 
 ods. He gives as one of the reasons that one can obtain with a 
 peripheral puncture a sweep of 8 mm., Avhile with a corneal puncture 
 he can get only a sweep of 4 mm. 
 
 As all incisions in the after-cataract must be made with a saw- 
 ing motion, the length of the portion of the blade which is cutting at 
 a given time must be greater Avith a very oblique position of the 
 knife, and the p.enetration of the vitreous is apt to be less than if the 
 knife approaches the after-cataract more perpendicularh^ 
 
 The loss of the aqueous from the anterior chamber previous to 
 the incision in the after-cataract greatly increases the extent of lac- 
 eration of the vitreous and the difficulties of the operation. The 
 dangers of infection from a puncture of the cornea anterior to the 
 limbus, under proper aseptic precautions, have been greatly exag- 
 gerated, and it may often happen in a given case that the position of
 
 122 AFTER-CATARACT 
 
 the opacities iu the capsule may make the probabilities of success 
 much greater when the knife is entered more anteriorly. 
 
 When the incision is made in the clear cornea, the knife should 
 still be entered in such a manner as to make a valve-like incision in 
 order to prevent the loss of the aqueous upon the withdrawal of the 
 knife, which always happens if the knife is thrust perpendicularly 
 through the cornea directly towards the after-cataract. These es- 
 sentials in the entrance of the knife are equally valuable whatever 
 form of instrument is used. 
 
 The dangers of non-success from a single incision in simple after- 
 cataract are two : First, that the wound may not open widely 
 enough to give good vision, and, second, that the opening may sub- 
 sequently close as the result of a low, inflammatory process. The 
 precautions necessary to avoid failure are, first, to make the incision 
 transverse to the principal line of tension in order that the opening 
 may be broadened by the release of this tension ; and, second, not 
 to do an early operation in a case in which there has been a con- 
 siderable inflammatory process following the extraction. 
 
 The direction of the incision should be carefull,y selected. Mc- 
 Gillivray, who used a knife not unlike that described by Post, stated 
 that the preferable incision in the capsule was one running diago- 
 nally across the whole extent of the dilated pupillary area, from 
 above downwards and inwards, and, other things being equal, such 
 an incision undoubtedly has great practical advantages, neverthe- 
 less, a small vertical incision centrally placed in the pupil in a not 
 very opaque capsule, will often give the highest possible vision, even 
 when its length is not more than 2 or 3 mm. 
 
 The horizontal incision has undoubtedly been used b}' more oper- 
 ators than any other in operations for after-cataract. Its principal 
 advantage is ease of technique. 
 
 A brilliant illumination of the after-cataract is absolutely neces- 
 sary for successful operation. This can never be obtained while 
 operating in diffused daylight. The dispersal of the rays of light by 
 a slight change in the curvature of the cornea, due to pressure of the 
 knife, will often make an after-cataract, which -is entirely visible 
 before the operation is begun, quite invisible at the moment of the 
 incision. Often again, the after-cataract is depressed by the point 
 of the knife in such a manner that its visibilit.v is entirely lost. This 
 condition will be obviated by focal illumination, and for many years 
 operators have had light focalized upon the after-cataract by means 
 of a hand lens held by an assistant. This method, although pursued 
 in a dark room with a single light is often unsatisfactory because
 
 AFTER-CATARACT 
 
 123 
 
 the operator may have very juiiioyiiig reflections between himself 
 and the point of operation, wlien the fiekl is perfectly illuminated 
 from the point of view of the assistant holding the focalizing lens. 
 A much better method is to illuminate the anterior chamber by a 
 
 Chandler's Electric Illuininator Attached to Fixation Forceps. 
 
 small, shaded electric light, but when this is held by an assistant 
 not infrequently the. operator does not have the best point of view. 
 To obviate this annoyance Chandler devised a small electric light 
 enclosed in a shield with a focalizing lens in front. This instrument 
 
 Electric Spud-Handle Used as Illuminator for Knife-Needle. 
 
 was attached to the forceps with which the eye w;is held, thus plac- 
 ing the control of the illumination entirely within the hands of the 
 operating surgeon. He suggested that it could also be used upon the 
 knife-needle, and recently I have had my knife-needle constructed 
 Mdthout handles and use them in the electrically illuminated spud 
 handle. This can be so arrfinged that the condensation of the light 
 through the small lens in front of il can be brought exactly to 
 bear upon the cutting portion of the needle, and therefore the illu- 
 mination is always perfect. Small lights have also been devised
 
 124 AFTER-CATARACT 
 
 which can be attached to the handle of any knife-needle, which 
 would seem to be a desirable arrangement. 
 
 In preparing for the operation on after-cataract, first, see that 
 aseptic precautions are as thoroughly followed out as for an extrac- 
 tion of the lens. Second, study the after-cataract -with undilated 
 pupil. Locate by landmarks the portion of the after-cataract which 
 is central. Determine, if possible, lines of tension, and whether the 
 elasticity or tension of the membrane is such as to make probable 
 a successful opening after a single incision. Third, determine 
 whether in a given case it is desirable to use a straight-pointed 
 knife, a sickle-shaped knife or a curved knife ; or a full-bellied 
 knife which cuts without preliminary puncture with the point. This 
 choice will be largely governed by the amount and direction of the 
 dense opacities in the capsule, and the tension of the globe. Alter- 
 nate areas of thin capsule and dense bands are perhaps more easily 
 incised with a knife which has some form of falciform point and a 
 considerable length of cutting blade. Less dense capsules, especially 
 when present in rather soft eyes, or eyes known to have fluid, or 
 semi-fluid vitreous, are more easily cut with a knife which has con- 
 siderable belly to the cutting edge. Fourth, measure the length of 
 the cutting blade of the needle over the area to be operated on and 
 be sure that its edge is of sufficient length, and see that the knife is 
 sharp. Fifth, dilate the pupil with atropine before the operation. 
 Sixth, darken the room and see that the electric illumination is in 
 good working order and trustworthy. 
 
 The techni(iue of operation upon simple after-cataract by single 
 incision is as follows : 
 
 The eye having been cocainized, a speculum is introduced whicli 
 opens the lids without great pressure. The conjunctival and epi- 
 scleral tissues are seized by fixation forceps opposite to the point of 
 puncture. This point should be selected so that the cut in the after- 
 cataract can be easily made along the line decided upon. The knife 
 blade, being held parallel to the plane of the iris, is thrust through 
 the cornea at the point selected, preferably at the limbus, thence it is. 
 carried directly across the anterior chamber to a point a millimeter 
 or two beyond that where it is necessary to make the counter-punc- 
 ture. The edge of the blade is then turned toward the membrane, 
 and thrust through the after-cataract within a previously deter- 
 mined, thin area. Then the knife should be drawn back and forth 
 across the line of incision, making as little pressure as possible tO' 
 achieve the object and absolutely avoiding any prying motion which
 
 AFTER-CATARACT 125 
 
 uses the eoriieji ;is ;i fulcrum as lliis procedure tends to evacuate the 
 antei-ior chamber and produce strain upon the ciliary attachment 
 of the capsule. It often happens that after the counter puncture 
 has been made with the point of the knife the elastic capsule recedes 
 before the knife, Avhich does not cut. In this event, the sawing 
 motion must be persisted in until it is obvious that the method will 
 not succeed. Under these circumstances it is wise to depress the 
 point of the knife so as to produce the maximum of cutting across 
 the thickness of the capsule without tearing or dragging its way 
 through the membrane. Upon the conclusion of the incision the 
 , knife blade is turned to its original position, the handle is carefully 
 placed in the plane of the iris and the knife is withdrawn. If this 
 is done skillfully there ought to be a minimum loss of the atiueous, 
 intraocular j^ressure promptly closing the wound. 
 
 Post describes the method of using his knife-needle as follows : 
 "The point is entered near the periphery of the cornea with the flat 
 of the blade parallel to the plane of the iris and is carried well across 
 the pupil to the place where it is proposed to pass it through the 
 membrane. The blade now^ cuts its way to an extent equal to its 
 own width. Having passed it still farther it is pressed in the direc- 
 tion of the cutting edge so that in Avithdrawing it, the sharp heel of 
 the blade divides the membrane as far as may be necessary." 
 
 Many operators have used an exceedingly narrow, but stiff cat- 
 aract knife to make the incision above described. The disadvantage 
 of this instrument is that in making the sawing motion necessary to 
 cut the capsule, the operator has his attention drawn away from 
 the corneal incision and is apt to enlarge the corneal incision during 
 the operation with consecpient loss of aiiueous. This loss of aqueous 
 is followed by the i)ushing forward of the vitreous, and makes the 
 second incision, if such is necessary, exceedingly difficult, while con- 
 siderable laceration of the vitreous is inevitable. Some surgeons 
 dull the edge of the cataract knife from the heel almost to the point 
 for the purpose of avoiding this enlargement of the incision, but a 
 eapsulotomy with a Graefe knife by any method is rarely done with- 
 out losing practically all the aqueous. 
 
 In the secondary operation with Weeks' knife-needle, the passage 
 of the knife into the anterior chamber is not so easilj' effected as 
 with the Knapp knife-needle. The operator should staiul behind 
 the patient, using the right hand to operate on the right eye, and 
 the left hand to operate on the left eye. The puncture is made in 
 the cornea at a point in its horizontal meridian midway betw^een
 
 126 AFTER-CATARACT 
 
 the center and the periphery of the cornea on its temporal side. 
 The curve of the knife must be followed in the passage through the 
 cornea to avoid making an incision too large to be filled by the 
 shaft. The knife is entered on the flat, the sharp edge toward the 
 upper margin of the cornea. After entering the anterior chamber 
 the point of the knife is passed to the opposite margin of the iris ; 
 it is then turned so that the cutting edge presents toward the cap- 
 sule, and the point is made to pierce the capsule. The knife is so 
 held during the time of making the incision that only the thickness 
 of the capsule j^resents against its edge. The resistance is thus 
 reduced to the lowest possible degree and the danger of destroying 
 the membrane and of making too much traction on the ciliary body 
 is avoided. It is seldom that this knife will divide successfully a 
 tough capsule or firm bands without undue traction on the ciliary 
 attachment of the membrane : it must be exceedingly sharp to divide 
 even a thin membrane satisfactorily, and is difficult to remove from 
 the eye if the patient becomes unruly. On withdrawing the knife 
 it should be turned on the flat as when entered and the curve of the 
 blade followed. Weeks thinks that on account of the dull convex: 
 edge of its curved extremity, the knife is much more easily manipu- 
 lated, and that the vitreous is less liable to injur\^ by this method. 
 
 Of operations upon simple after-cataract by more than one incision 
 there are three principal methods, which have in common a depend- 
 ence upon the elasticity of the capsule to curl back the tongues of 
 the tissue which are included between the incisions. 
 
 The first method consists of tAvo incisions which meet at their 
 proximal ends and form a Y. The point of entrance is selected in 
 the lower margin of the cornea at a point which is determined by 
 the position of the opacities and the line of tension in the capsule. 
 The knife, with the flat of the blade in the plane of the iris, is thrust 
 through the cornea near or at the limbus, and carried across the 
 pupillary area obliquely to its inner (or outer) upper margin. The 
 cutting edge of the blade is then turned toward the capsule, the 
 point thrust through the membrane and the incision extended to the 
 inferior edge of the pupil by a sawing motion. The knife is then 
 turned so that the blade is in the plane of the iris, and is carried 
 forward to the upper margin of the pupil and swept across to the 
 opposite side. Thence a second incision is made across the pupillary 
 area to meet the first incision below, the two incisions forming the 
 'etter V. The difficulty in this operation consists in cutting the 
 last portion of the second incision, because when the tissue between
 
 AFTER-CATARACT 127 
 
 the two incisions becomes narrow its elasticity is greatly exaggerated 
 and it is with considerable difficulty that the second incision is 
 carried into the line of the first. This operation can also be done 
 by entering the knife above the resulting incisions making an in- 
 
 iSweep of Needle to Follow Curve When Piercing Cornea. (Weeks.) 
 
 verted letter V. Some operators, however, prefer not to have the 
 puncture at the site of the cicatrix resulting from the incision made 
 in the operation for the extraction of the lens. 
 
 The second method is by a T-shaped incision. The puncture is 
 the same as in the operation just described. An incision is made 
 across the upper portion of the pupillary space, after which the 
 blade is carried back to the center of the first incision and the 
 second incision is made from that point to the lower margin of the 
 pupil perpendicular to the line of the first incision. The difficulty 
 with this method is that after the tension of the membrane has been 
 relaxed by the first incision, the second is made with so much diffi- 
 culty that the pressure required to make the incision will depress 
 the membrane and is apt to cause considerable laceration of the 
 vitreous. 
 
 The third method of double discission is by a cross incision. In 
 this operation the knife, having been entered as before, is carried to 
 the center of the upper portion of the pupillary space, thence ver- 
 tically down and an incision is then made from the margin of the 
 pupil on either side to the incision already made. 
 
 The amount of traction made upon the ciliary body at the inser- 
 tion of the capsule has been much dreaded by operators and in order
 
 128 
 
 AFTER-CATARACT 
 
 to avoid it Bowman devised an operation which was formerly much 
 practised. He used two spear-pointed stop-needles with sharp cut- 
 ting edges. The eye being fixed wdth forceps, one of the needles is 
 thrust through the tissues of the limbus at one end of the transverse 
 
 Bowman's Stop -Needle. 
 
 diameter, the breadth of the spear-head point being parallel to the 
 plane of the iris. Then, putting down the fixation forceps and 
 steadying the eye with the needle already introduced, a second 
 needle is introduced in the same manner through the limbus directly 
 opr>osite the point of the incision of the first needle. Both points 
 
 Contact with Capsule When Curved Needle is Employed. (Weeks.) 
 
 are then carried on until they reach the middle of the pupillary area. 
 Both needles are then plunged through one opening in the capsule, 
 being careful that no tissue intervenes between the blades of the 
 needles. The needles are then turned so that their cutting edges lie 
 in the transverse diameter and the handles of the needles are approxi- 
 mated. By this movement the membrane wall be divided by the 
 two needles. If this is insufficient, fhe needles are carried back to 
 the first position, and second slits made at right angles to the first. 
 The needles are then rotated so that their blades are in the same 
 plane as when first introduced and withdrawn. If skillfully done, 
 there need be no loss of aqueous. 
 
 Panas recommended extraction of the after-cataract. He con- 
 sidered it necessarv to wait a considerable number of months after
 
 AFTER-CATARACT 129 
 
 the primary oiDeration ])efore attempting this procedure. He ex- 
 amined the eye very carefully to determine the presence or absence 
 of adhesions between the membrane and the iris. If found, he 
 divided the synechia' by means of a narrow, curved knife. He made 
 an incision 8 or 10 mm. long in the upper corneal margin and then, 
 using special forceps, with the sharp blade backward, he passed 
 them doAvn into the anterior chamber, perforated the after-cataract 
 with the sharp blade until the upper blade was in the lowest part 
 of the anterior chamber. He then closed the forceps, grasping the 
 tissues between the blades. In the withdrawal traction Avas made 
 at first vertical, followed by slight lateral movements which broke 
 down the small adhesions. The membrane generally came out whole, 
 but occasionally it was held by a sort of pedicle at the upper part 
 of the coloboma. This pedicle was cut off with the scissors and the 
 prolapse reduced. 
 
 Major Smith states that in his hands the removal of the posterior 
 capsule has been eminenth^ satisfactory. He does an iridectomy 
 above, if it has not already been done, reaches in, somewhat beyond 
 the center of the pupil, with a rather stout pair of iridectomy for- 
 ceps, allows the blades to separate, drives them through the after- 
 cataract wide apart, closes the forceps firmly and withdraws the 
 after-cataract. He adds that there may be an escape of a bead of 
 vitreous, but this he considers of no importance. 
 
 Partial avulsion has also been done by various surgeons in which 
 the membrane was drawn out of the anterior chamber with a Tyrell's 
 hook and cut off. 
 
 In eases of a thick membrane with firm adhesions, Agnew per- 
 formed an operation which is described by Noyes. At the upper 
 edge of the cornea a broad needle pierces the capsule and is held 
 steady. At the opposite side, on the margin, a wound is made for 
 the introduction into the anterior chamber of a small, sharp hook 
 whose point is engaged in the wound in the capsule made by the 
 broad needle. Securing a good hold the hook tears down the mem- 
 brane and is resisted by the needle in the operator's other hand, 
 which also defends the ciliary region from traction. As much of 
 the tissue is drawn out of the wound as possible. It is then cut off 
 with scissors by an assistant.* 
 
 Complicated after-cataracts are always due to an iritis or an 
 iridocyclitis following the extraction of the lens. This complication 
 may be due either to traumatism at time of operation, or to irrita- 
 tion resulting from small fragments of the lens left after the extrac- 
 tion ; to prolapse of the iris following an extraction either with or 
 
 Vol. 1—9
 
 130 
 
 AFTER-CATARACT 
 
 without iridectomy; to infection at time of operation, or it may 
 have its origin in some constitutional condition, as syphilis, rheu- 
 matism, diabetes, or tuberculosis. Whatever the etiology the result 
 is a small pupil firmly tied down along the greater part of its mar- 
 gin, and a firm, dense membrane oecuiDying the pupillary area. 
 
 A second condition is an incomplete prolapse of the iris, so that 
 it, or the pillars of the coloboma (when an iridectomy has been 
 
 Entrance Through the Sclera for Division of After-Cataract. (Meller.) 
 
 done), become attached to the cicatrix of the incision made for the 
 purpose of extracting the lens. In these cases the tendency is for 
 the iris to become more and more firmly attached above, and as this 
 progresses the iris tissue below the pupil is dragged up to the seat 
 of the wound. Occasionally the lower margin of the pupil is attached 
 directly to the corneal cicatrix. Then the whole area visible through 
 the cornea is occupied by the tightly stretched iris. Practically in 
 all recent cases the slightest traumatism may produce a violent re- 
 turn of the cyclitis and nullify the operation. Consequently it is 
 wise to postpone operation for a considerable period — three or four 
 months — until all ciliary tenderness has disappeared and the eye 
 has become white and quiet. 
 
 Iridotomy operations with single incisions were among the early 
 operations for complicated after-cataract. They consisted in mak- 
 ing an incision horizontally through the membrane. Cheselden's 
 original procedure was of that character. He entered his knife- 
 needle through the sclera back of the sclero-corneal junction on the 
 temporal side. He then passed his knife across the posterior cham- 
 ber, made his counter-puncture in the iridic membrane near the nasal
 
 AFTER-CATARACT 
 
 131 
 
 margin. He then cut throogb the iris from behind forward for Iwo- 
 thirds of its extent. This made a horizontal slit which resulted in 
 a more or less oval opening, according to the elasticity of the 
 membrane. The after result with this operation was ai)t to be 
 much modified by traumatic iritis with consequent obliteration of 
 the pupil, or by the formation of a membrane in the new pupil. 
 
 Adams modified Cheselden's operation by using a small iris scalpel 
 of his own design, which had a straight, dull back, a long, straight 
 cutting edge and a rounded point. With this he made his puncture 
 back of the limbus on the temporal side, passed it directly through 
 the iris from behind into the anterior chamber, across to the nasai 
 
 Kuhiit's Operation. 
 
 side, keeping the edge of the knife turned back against the iris 
 throughout the whole maneuver. He was thus able by the most 
 delicate pressure to make a horizontal incision. Tf the incision was 
 too short he again carried the knife forward and again partially 
 withdrew it, always cutting in the same plane. 
 
 Kuhnt, in order to make the opening more permanent, devised 
 an operation in which a piece of the iridic membrane is removed. He 
 uses a narrow-bladed, stiff linear cataract knife for his incision. 
 This knife he plunges through the cornea and underhnng membrane 
 at a point about midway between the horizontal diameter and the 
 inferior end of the vertical diameter of the cornea. As soon as .the 
 point perforates the after-cataract, he depresses the handle and 
 passes the knife across the posterior chamber until the point has 
 reached a corresponding position on the opposite inferior (piadrant 
 of the cornea. He then depresses the handle of the knife still more 
 and makes a counter-puncture through the membrane and the cornea. 
 He continues his incision, emerging in the clear cornea just above 
 the limbus. The upper lip of the wound in the after-cataract is 
 then seized, drawn forward and a piece excised with scissors by 
 means of two incisions meeting above, so that a triangular piece of
 
 132 AFTER-CATARACT 
 
 the inembl'ane is freed and removed from the eye. He advises pro- 
 tecting the wound by means of a large conjunctival flap which is 
 brought forward and stitched in such a manner as to cover the lower 
 half of the cornea. 
 
 Knapp's iridocystectoniy in closed pupil is performed and de- 
 scribed by him as follows: "Under cocaine anesthesia a Beers' 
 cataract knife pierces the cornea about 3 or 4 mm. above the lower 
 corneal margin, opposite the scar from the extraction, and transfixes 
 the iris or pupillary pseudo-membrane by an opening 3 or 4 mm. 
 
 Ziegler's Iridotomy for After-Cataract. The Knife-Needle is in the Anterior 
 
 Chamber. 
 
 long. The knife is withdrawn. With a blunt hook the lower lip 
 of the iris wound is seized, drawn out of the eye and abscised close 
 to the cornea. There are scarcely any accidents. The healing is 
 usually prompt and yields most surj^risingly good visual results. 
 Prolapse of the vitreous is not infrequent during this operation." 
 
 Ziegler's operation is a V-shaped iridotomy with his modification 
 of Hays' knife-needle. His own description of the procedure is as 
 follows: "First Stage. With the blade turned on the flat, the 
 knife-needle is entered at the corneo-scleral junction, or through the 
 upper part of the cornea, and passed completely across the anterior 
 chamber to within 3 mm. of the apparent iris periphery. The knife 
 is then turned edge downward, and carried 3 mm. to the left of 
 the vertical plane. Second Stage. The point is now allowed to rest 
 on the iris-membrane, and with a dart-like thrust the membrane is 
 pierced. Then without making pressure on the tissue to be cut, the 
 knife is drawn gently up and down with a saw-like motion until the 
 incision has been carried through the iris tissue from the point of 
 the membrane puncture to just beneath the point of the corneal 
 puncture. This movement is made wholl.y in a line with the axis of 
 the knife, the shank passing to and fro through the corneal punc-
 
 AFTER-CATARACT 
 
 133 
 
 ture, and the loss of any a()ueous being carefulh* avoided. Tliird 
 Stage. The pressure of the vitreous will now cause the edges of the 
 incision to immediately bulge open into a hm^' oval through which 
 the knife blade is raised upward, until above the iris-membrane, and 
 then swung across the anterior chamber to a corresponding point 
 on the right of the vertical plane, which, owing to the disturbance in 
 the relation of the parts made by the first cut, is now somewhat dis- 
 placed and the second puncture must be made at least 1 mm. farther 
 over, i. e., 4 mm. to the right of the vertical i)lane. Fourth Stage. 
 With the knife point again resting on the membrane, a second punc- 
 ture is made by the same quick thrust, and the incision rapidl.y car- 
 
 Ziegler's Operation, 
 a. Plan of First Incision, 
 b. First Ineision Completed. Plan of Second Incision. 
 c. Pupil Eesulting from V-Shaped Iridotomy. 
 
 ried forward by the sawing movement to meet the extremity of the 
 first incision, at the apex of the triangle, thus making a converging 
 V-shaped cut. Care must be taken at this point that the pressure 
 of the knife blade on the tissue shall be most gentle, and that the 
 second incision shall terminate a trifle inside the extremity of the 
 first, in order that the last fibre may be severed and thus allow the 
 apex of the flap to fall down behind the low^er part of the iris mem- 
 brane. If the flap does not roll back of its own accord it may be 
 pushed downward with the point of the knife. When the opera- 
 tion is completed, the knife is again turned on the flat and (piickly 
 withdrawn." 
 
 It sometimes happens, as in cases wdiere there has been a long 
 continued irido-c.yclitis, that the retraction of the triangular piece of 
 the after-cataract included betw^een the V-shaped incisions is insuf- 
 ficient to leave a central ojiening. Ziegler then advises that the 
 V-shaped flap be pushed dowuAvard with the point of the knife and 
 if this maneuver is not successful the knife is turned so that the 
 blade is parallel to the surface of the iris and by a quick thrust is
 
 134 AFTER-CATARACT 
 
 pushed through the base of the triangular flap and then by means 
 of a sawing motion cut across its fibres in which case it will fall back 
 upon the pedicle that remains. If b}^ this procedure the desired 
 result is not obtained, he withdraAvs the knife-needle and re-intro- 
 duces it far enough awaj^ from the apex to secure proper leverage, 
 and again makes an incision across the base of the triangular flap. 
 The technique of this operation is difficult, but in the hands of 
 skilled operators has been very satisfactory. 
 
 Ziegler sometimes modifies his operations by making two punc- 
 tures and a cross incision in the after-cataract. 
 
 Operations for complicated after-cataract bj^ the use of scissors, 
 arose from the difficulty experienced by many operators in attempt- 
 ing to split the iris with a knife in complicated after-cataract. It 
 
 Maunoir's Scissors. 
 
 caused them to turn to some form of operation in which the incisions 
 in the after-cataract are made with scissors. Owing to the fact that 
 the opening of the blades in ordinary iridotom^^ demands too large 
 an incision in the cornea a special form of scissors is needed. The 
 essential requirements in scissors for this purpose are that the 
 blades shall be thin and narrow, so that when closed they can pass 
 through a comparatively small opening in the cornea, and that the 
 blades shall be able to separate within the globe without materially 
 widening the diameter of the instrument at the point where it passes 
 through the cornea. The first instrument of this sort was described 
 by Maunoir of Genoa, in 1802. He used a pair of scissors with very 
 thin, narrow blades which when closed were not thicker than a 
 common probe. The blades were seven-tenths of an inch long and 
 bent so as to form at the joint an angle of 140°. The extremity of 
 the superior blade was blunt or round-pointed for use in the anterior 
 chamber, and the inferior blade sharp at the point for the distance 
 of one line on the back as well as on the cutting edge. The scissors 
 
 vere intended to be introduced flat, and then turned so that the 
 
 harp point should pass through the membrane.
 
 AFTER-CATARACT 135 
 
 deWecker's scissors have been much used. They differ from 
 Maunoir's in that the handles resemble in shape tliose of an ordinary 
 pair of iridectomy forceps Avhich have been hinged at the side and 
 end, to open laterally. When the handles are in this position the 
 blades are open. At the point at which the blades cross they are 
 bent anteriorly to an obtuse angle. The original instrument had 
 both blades rounded on the ends, but in recent models one blade is 
 pointed. A spring holds the handles apart on the side opposite the 
 hinge. These scissors are an admirable instrument, but are often 
 clumsily made. 
 
 Ferguson's scissors resemble deWecker's in general shape but the 
 blades are turned in the opposite direction and lie closed instead of 
 open when the scissors are at rest. The blades are sharp on the 
 
 Noyes ' Iridotomy Scissors. 
 
 outer as well as inner edges so that they cut when the blades are 
 opening, and in the usual manner when the spring is allowed to 
 close them. They are separated by the same action that closes 
 deWecker's scissors to an amount that, before operating, can be 
 regulated by a screw. 
 
 Noyes' iridotomy scissors are perhaps the easiest to use of any 
 which have been devised. The handle is in every respect similar to 
 that of an ordinary cataract knife and the scissors consist of a fixed 
 blade (with a rounded point) that is inserted into the end of the 
 handle. This blade is crossed 12 mm. from its point by another 
 which has a sharp point. The proximal end of the movable blade 
 extends to the handle of the instrument and is broadened, thickened 
 and corrugated in order that the finger shall not slip when it is 
 pressed down to close the blade. The blades are very delicate and 
 narrow, only 1 mm. broad, and are held apart by a spring. Its 
 advantages are that with the thumb placed on the end of the lever, 
 the instrument is grasped precisely as the operator is accustomed 
 to hold his Graefe cataract knife. The bulk of the blades is so small 
 and their length so short that the incision can be made in the after- 
 cataract with the pivot practically in the corneal wound. This 
 enables them to be used easily through the smallest possible incision. 
 
 deWecker, in his scissors operation, made his corneal incision 4 
 mm. in length and with a stop-keratome. He then partially with-
 
 136 , AFTER-CATARACT 
 
 drew the knife, allowed the aqueous to escape slowly and when the 
 iris came forward thrust the knife forward again, and made an 
 opening in the iris 2 mm. in length. Withdrawing the knife he 
 introduced the scissors, with the sharp point through the opening 
 in the membrane, and cut obliquely from either extremity of the 
 incision toward the apex of a triangle. He then grasped the triangu- 
 lar flap with forceps and removed it. 
 
 Instead of the above operation deWecker sometimes used the fol- 
 lowing procedure : He made the corneal incision and opening in 
 the iris membrane as above described, then introducing his scissors 
 as before he cut from the center of his opening in the iris at an 
 
 deWecker 's Iridotomy Scissors. 
 
 oblique angle; then swinging the scissors about he made an incision 
 in the opposite direction, thus forming an inverted V. If the flap 
 thus formed did not retract sufficiently, he grasped it with forceps 
 and tore it across. 
 
 A small incision is made in the cornea with a lance-shaped knife 
 through which Ferguson introduces his scissors closed and pierces 
 the capsule at the center of the desired opening. The blades are 
 then separated and their sharp outer edges cut the capsule to the 
 required extent without dragging on the ciliary processes or on any 
 adhesions that may be present. If it is desirable to make other 
 incisions to get a good opening, one blade can be placed behind the 
 membrane and the other in front and the scissors used in the same 
 manner as deWecker 's instrument. 
 
 The operation with Noj'es' scissors has often been performed by 
 the writer, and is done in the following manner: The corneal in- 
 cision is made just anterior to the limbus, above, Avith a Graefe 
 iridotomy knife. The blade of this knife is bent upon the shank at 
 the end of its cutting edges. It has a sharp point and the cutting 
 edges are long and parallel to each other. The Avidth of the blade 
 is 1 mm. The point of the k]iife is inserted parallel to the plane of 
 the iris and after it has entered the anterior chamber to the width 
 of the blade, the point is depressed and thrust through the after- 
 cataract until the full width of the blade is engaged in the mem- 
 brane. It is then withdrawn, the blade returned to the plane of 
 entrance and gently withdrawn from the cornea. If this is done 
 carefully the anterior chamber need not be evacuated. Noyes' scis-
 
 AFTER-CATARACT 137 
 
 sors, with the blades closed and the thumb or forefinger upon the 
 movable handle, is introduced through the wound, the pressure 
 relaxed so that the spring separates the blades, the sharp point of 
 the movable blade is carried through the opening in the capsule, the 
 rounded point of the fixed blade passed anteriorly to the after- 
 cataract downward and inward to the distance necessary, and the 
 blades closed by pressure upon the movable blade. Pressure is again 
 relaxed, which opens the blades of the scissors, and the instrument 
 
 The Two Forms of Iridotuniy by Means of deWecker's Iridotomy Scissors. 
 
 (deWecker.) 
 
 swung to a similar position downward and outward, and the incision 
 repeated in this direction. If the triangular flap freed by this V- 
 shaped incision does not retract sufficiently the scissors can be turned 
 so that the blades are in the plane of the iris and an incision made 
 entirely or partially across the flap which will produce a large, free 
 opening. The instrument is then closed and withdrawn. The ad- 
 vantage of this operation wnth the Noyes instead of the deWecker 
 scissors is that the blades are so narrow they can be opened to a 
 
 Graefe Iridotomy Knife or Bent Broad Needle. 
 
 width sufficient to make the required incision in the capsule through 
 a corneal opening of 2 mm. or less, thus avoiding the danger of 
 prolapse of vitreous into the Avound and insuring prompt closure 
 of the corneal incision. 
 
 When the secondary membrane is very thick and inelastic the 
 writer has often successfully operated wnth Noyes' scissors as fol- 
 lows: The incision is made with a Graefe iridotoni}' knife (broad 
 needle) as before described and is extended by use of the cutting- 
 edge of the instrument to 4 mm. The opening in the after-cataract 
 is made approximately of the same width. The Noyes' scissors are 
 then introduced, as above described, at one end of the incision and a 
 vertical cut in the membrane made of the desired length. The scis-
 
 138 AFTER-CATARACT 
 
 sors are then withdrawn and reintroduced at the other end of the 
 incision in tiie cornea and after cataract and a parallel, vertical 
 incision is made. The scissors are then turned and an oblique in- 
 cision made across the tongvie of cajDSule, the free portion of the 
 membrane is removed either by gently grasping it between the blades 
 of the scissors or by the introduction of a pair of iridectomy forceps. 
 The triangular, free flap remaining eventually contracts. A good 
 opening, which does not readily close, is obtained by this firocedure. 
 The operation is best performed under general anesthesia. 
 
 A number of instruments have been devised for the purpose of 
 punching out a piece of the after-cataract and withdrawing it from 
 the wound. The corneal incision is made with a broad keratome at 
 
 Stevenson's Capsule Punch. 
 
 the limbus and the point of the keratome is carried through the 
 membrane in the same manner as has been described in operations 
 with scissors. The punch is then introduced through the wound, 
 the lower blade carried behind the after-cataract and the upper 
 blade passed in front of it, as in an operation wnth scissors. The 
 punch is then closed and Avithdrawn. The objection to most of 
 these instruments is that they require a large opening in the cornea 
 and, unless they are very sharp, are apt not to make a clean cut 
 through the membrane, so that when they are withdrawn consider- 
 able traction has been made on the ciliary body by dragging on an 
 uncut tag of the after-cataract. 
 
 Hemorrhage folloiving operations for after-cataract is not infre- 
 quent. The absorption of the blood in the anterior chamber con- 
 taining an after-cataract is much slower than in a normal eye. 
 Hemorrhage is said to be much more profuse when the iris is cut 
 transversely than when it is split in the direction of its radial fibers. 
 This fact should be borne in mind when planning an operation 
 involving the iridic tissues. 
 
 After-care in operations for secondary cataract is important. Atro- 
 pin should be instilled after the operation, and if there has been 
 much hemorrhage a pressure bandage ought to be applied. The 
 patient should be placed in bed and kept quiet for 24 hours, after 
 which the bandage can be removed and the patient allowed to sit
 
 AFTERGEBILDE 139 
 
 up ill a shaded room. After the wound is closed if the effused blood 
 does not absorb promptly, the process can be hastened by instillation 
 twice a day of a 10 per cent, solution of dioniii. The atropin should 
 be continued for two weeks at least. — (M. S.) 
 
 Aftergebilde. (G.) Formation, development, structure, organiza- 
 tion, training, culture, cultivation, texture, growth. 
 
 Afterhaut. (G.) Pseudo-membrane. 
 
 After-image. A retinal impression that remains after the light or 
 object visualized has been removed. It is called a positive after- 
 image when the sensation is prolonged. A negative, colored or 
 positive-complementary after-image occurs when the image api)ears 
 tinged or outlined in complementary colors. 
 
 Cattell, in the System of Diseases of the Eye, gives a most inter- 
 esting account of these retinal impressions, from which the fol- 
 lowing is quoted. In order to observe a positive after-image, a 
 bright object, as the sun or the globe of a lamp, should be looked 
 at for a short time, say one-half second. This can be done con- 
 veniently by holding a black screen (pierced in order to secure a 
 point of fixation) before the eyes and uncovering the object for a 
 moment. The eyes should be rested (closed and covered) for from 
 one to five minutes previously, so that traces of previous after-images 
 may disappear and nothing be left in the field of vision excepting the 
 light chaos or "own light" of the eye. Care should be taken to 
 avoid movements of the eye or body. 
 
 The positive after-image maintains the same relations of light and 
 shade as the original objects, and the colors may be the same at 
 first, but these quickly change. When the eyes are covered after 
 exposure to a bright object, nothing is seen at first by most observers, 
 but after a couple of seconds the after-image appears in the light 
 chaos of the field of vision, v. Helmholtz holds that the delay in the 
 appearance of the after-image is due to movements of the eyes and 
 body; but this can scarcely be the case, as the after-image does not 
 appear at once, even when no appreciable movements are made, and 
 does not appear in due time, although movements be purposely made. 
 In the after-image details can often be noticed which, owing to 
 lack of time or to intense brightness, were not seen in the original 
 object. Thus, the twigs of a tree may be imperceptible when they 
 are between the eyes and the sun, but may become apparent in the 
 after-image. As the image fades, the relations of light and shade 
 change, the brighter parts lasting the longer. The further course 
 of the positive after-image become complicated with the results of 
 fatigue or exhaustion.
 
 140 AFTER-IMAGE 
 
 When an object is not very bright and is looked at for several 
 seconds or longer, the positive after-image can be perceived with dif- 
 ficulty or not at all, but the stimulation leaves effects which are called 
 negative after-images. In these, as in the negative plate of a photo- 
 graph, the relations of light and shade are reversed, so that a bright 
 object on a dark background becomes a dark object on a bright back- 
 ground. They can be seen in the field of vision when the eyes are 
 closed, or can be projected on any surface. 
 
 The color of the negative after-image is in normal cases comple- 
 mentary to the color of the original object. It is a curious and im- 
 portant fact that in the case of red the after-image may he positive 
 and complementary. Feclmer has made the most careful study of 
 the color of negative after-images, considering the background on 
 which the object is exhibited and the color of the field on which it is 
 projected. 
 
 While the color of the negative afer-image may be said to be com- 
 plementary to the color of the original light, it is not established that 
 the relation is exact, and cases have been recorded in w^hich it does 
 not hold at all. Hilbert has recently described his own case, in 
 which the color of the after-image is entirely altered when he is 
 fatigued. It is possible that the nature and course of after-images 
 may prove unexpectedly useful in the diagnosis of certain diseases 
 of the eye and of the nervous system. 
 
 The complementary color of negative after-images is accounted for 
 in a general way by fatigue ; the eye has become exhausted for the 
 color at which it has been looking, and the complementary com- 
 ponents of w^hite light produce relatively greater effects- When the 
 after-image is projected on a colored field complementary to the orig- 
 inal light, the color (even of the sun's spectrum) appears brighter and 
 more saturated than otherwise. Colors more intense and beautiful 
 than can be imagined may be seen by looking for one-fourth second 
 at a part of the spectrum early in the morning after the night's rest, 
 the eyes having previously been exposed for one minute to the com- 
 plementary color. 
 
 The longer the time of fixation the longer does the negative after- 
 image last; indeed, Purkinje goes so far as to state that there is an 
 exact proportion, each additional second of fixation (of a candle) 
 increasing the duration of the after-image twenty seconds. Aubert 
 found that when the sun was regarded for three seconds the after- 
 image lasted two-thirds of a minute ; when the time of regard was 
 five seconds the image lasted about five minutes; w^hen eight seconds, 
 it was about ten minutes. The afterimage also lasts longer the
 
 AFTER-IMAGE 141 
 
 brighter the light of tlie original object. In the writer's laboi'atory 
 exact measurements are being made of the duration of after-images 
 regarded as a function of the time, intensity, and area of stimulation. 
 The average duration of the after-image increased from eight to 
 fourteen seconds as the time of exposure was increased from three to 
 twent}' seconds, and from eight to sixty seconds as the intensity of 
 the light was increased three-hundred-and-twenty-fokl. 
 
 The course of the after-image is not so simple and regular as might 
 be supposed from reading the accounts usually given in the text- 
 books of psychology and ph3%siology. If a bright white light be 
 looked at for a moment, according to v. Helmholtz, there will be a 
 white after-image which passes quickly through a green-blue to a 
 brilliant indigo-blue and then into violet or rose. Then follows a 
 gray-orange, the after-image usually disappearing or becoming nega- 
 tive. In the latter case the orange may be followed by a dim yellow- 
 green. The order and nature of the colors vary according to the 
 time of exposure and the intensity of the light. Admitting light or 
 projecting the image- on a brighter field advances the course of the 
 image, and, conversely, decreasing the light brings it back to an 
 earlier stage. Tf the sun be viewed for an instant, similar results fol- 
 low, but there are concentric rings of color which proceed from the 
 outside towards the centre. 
 
 The descriptions of Fechner and v. Helmholtz seem largely to 
 ignore oscillations of the after-image, ascribing such as occur to 
 accidental movements, pressure, and changes of illumination. The 
 oscillations have, however, been properly described by Purkinje, 
 Plateau, and Aubert, and are to the writer the most striking of all 
 the phenomena. These authors have noted four or five oscillations 
 from positive to negative, the after-image lasting in all al)0ut five 
 minutes. The writer has made the unexpected observation that an 
 after-image may last indefinitely, the oscillations from positive to neg- 
 ative being innumerable. The writer obtained (after restiiig the 
 eyes five minutes and exposing them for one minute) an after-image 
 of the clear sky and the bars of a window, which can be seen at the 
 present writing, after an interval of eight months. During the first 
 hour the oscillations occurred continually, at first at intervals of about 
 ten seconds, the panes and bars displaying brilliant and l)eautiful 
 colors, mostly greens and purples. In the course of the first month 
 the after-image became gradually less distinct. On closing the eyes 
 it always appeared positive, becoming negative after a few seconds, 
 and passing through a series of oscillations which could be continued 
 indefinitely bv altering the illumination. Since that lime the after-
 
 142 AFTERMASSE 
 
 image has become continually less distinct. On closing the eyes it 
 always appears positive, becoming negative only so far as lines of 
 light appear along the dark bars. The colors of the panes are dim 
 yellow and violet. When projected on a bright surface, as the sky^ 
 the after-image is negative. 
 
 Aftermasse. (G.) Pseudoplasm, neoplasm, secondary growth. 
 
 After-treatment of ametropia. Too little attention is paid by ophthal- 
 mologists to this important subject, many practitioners believing 
 that Avhen refractive errors and muscular anomalies are corrected 
 their Avhole duty is done. Because of this neglect the work of the^ 
 refractionist is often in vain and the effects of otherwise well- 
 directed efforts are partially or entirely nullified. It is the concern 
 of an educated ophthalmologist to see that the general condition of 
 his patient is carefully scrutinized, that systemic dyscrasias are 
 treated and that all vicious moral and physical habits are abandoned. 
 It should not be necessary to add that the treatment of eye con- 
 gestions and inflammations (the result perhaps of the eye-strain for 
 which glasses, etc., were ordered) should be- continued until cured, 
 that needed ocular rest should be insisted upon and that all the other 
 axioms of ophthalmic hygiere should be heeded by the patient. 
 Last, but not least, the ametrope should report to the oculist a week 
 or tAvo after the correction of his errors for further advice and tO' 
 make sure that earlier directions have been carried out. 
 
 After-treatment of ophthalmic operations and of their complications. 
 In many particulars the after treatment of ophthalmic opera- 
 tions differs in no important detail from that of other surgical 
 operations, and with these the ophthalmic surgeon is presumably 
 familiar. There are, however, some points of difference, largely 
 dependent on the anatomical and physiological peculiarities of the 
 tissues involved, and also on the extreme delicacy and great func- 
 tional importance of these tissues, which make a section on the 
 particular after-treatment of ophthalmic operations not only de- 
 sirable but indispensable. 
 
 Upon the completion of any operation on the eye or its append- 
 ages, the necessary steps preceding the application of a dressing 
 are the arrest of hemorrhage, and the cleansing of the wound. The 
 procedures differ somcAvhat according as the operation has to do 
 with the lids, or the lachrymal sac, as after a blepharoplasty, or 
 with the tissues of the orbit, as after a tenotomy, advancement, 
 enucleation, exenteration of the orbital contents, etc., or with the 
 eyeball itself, as after an iridectomy or cataract extraction. 
 
 In general the arrest of hemorrhage during or after ophthalmic
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 143 
 
 operations does not present a problem of any moment. The loose- 
 ness of the tissues permits the retraction and contraction of the 
 blood vessels, and hemorrhage usually ceases spontaneously. Proper 
 preparation of the patient and field of operation will also contribute 
 to lessening the tendency to bleed. The administration of a lax- 
 ative sufficiently long before the operation to secure an evacuation 
 of the bowels, contributes, among other things, to the patient's 
 comfort, lowered blood pressure and quiet. A good night's rest, 
 the prone position in bed, the avoidance of excitement or stimulating 
 drinks, with the administration, if it seems advisable, of a sedative, 
 
 Halstead 's Mosquito Forceps. 
 
 all contribute to the composed mental and circulatory condition, 
 which bears directly on the question of post-operative bleeding. 
 If the operation is done in a hospital, all these things are more con- 
 veniently arranged if the patient appears at least a day before the 
 operation. 
 
 In the presence of vascular disease or nephritis additional pre- 
 cautions as to rest, condition of the bowels, sedatives, and the ad- 
 ministration of certain drugs, such as the calcium salts, will tend to 
 lessen bleeding. In certain operations, as on the conjunctiva, 
 muscles, and iris, bleeding can be further prevente<J by the local 
 use of one of the preparations of the suprarenal gland. The instilla- 
 tion of this substance into the conjunctival sac suffices for opera- 
 tions on the conjunctiva, such as for pterygium, but for operation 
 on the muscles and iris the action is much more certainly obtained, 
 together with infinitely better anesthesia, by injecting sub-con- 
 junctivally or along the muscles, a solution of cocain and adrenalin, 
 as advised by Robin and Bruns. (The solution consists of one part 
 of 4 per cent, solution of cocain, one part of 1-1000 solution of adren- 
 alin chloride, and two parts of normal salt solution.)
 
 144 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 It should be remembered that hemorrhage is apt to be more free 
 from an operation performed on a woman during menstruation, or 
 on a jDatient suffering from sepsis. 
 
 In operations on the lids and lachrymal sac bleeding can usually 
 be controlled by pressure, best made with little pads of gauze, which 
 may be wet in a hot antiseptic solution, and pressed directly into 
 or on the wound, and held for a minute or two. Should this fail 
 to control the bleeding, the point whence it comes should be sought 
 for and grasped with suitable hemostatic forceps. Since the wounds 
 are usually small, delicate forceps are advisable, such as Halstead's 
 mosquito forceps or serrefines. If after the application of such 
 
 Snellen's Lid Clamp 
 
 means of compression for a minute or two the bleeding continues 
 when the forceps are removed, a ligature of silk or catgut should 
 be applied, or a suture, employed in closing the wound, should be 
 so passed as to include and occlude the bleeding point. In general 
 it is not well to close a wound that is still bleeding, as the blood 
 clot that collects between the wounded surfaces interferes with 
 their proper approximation, and also furnishes a medium for bac- 
 terial growth which plainly increases the risks of wound infection. 
 
 In 7nany operations on the lids the field can be rendered blood- 
 less, or nearly so, by the application of a lid clamp before beginning 
 the operation. After the completion of the operation and removal 
 of the clamp it may be necessary to resort to some of the measures 
 just mentioned to control bleeding. 
 
 In bleeding after cnucleaiion of the eye-hall or exenteration of the 
 orbit, the conditions are not always so simple. As a rule pressure 
 with gauze sponges, wet in a hot antiseptic solution, and the appli- 
 cation of a firm compress and bandage will control the hemorrhage, 
 but after these operations the bleeding may be free and prolonged. 
 If this is apparent at the time of operation, ligatures should be 
 applied to the bleeding vessels, or the bleeding may be checked
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 145 
 
 by use of the actual cautery. If, however, the tendency is only 
 manifested after the patient has recovered from the anesthetic, 
 removal of the saturated dressings Avili reveal tissues so swollen 
 and infiltrated Avith blood tliat the location of the bleeding point, 
 situated deep within the orbit, is very difficult. Packing with 
 gauze, pressure, and the internal administration of sedatives should 
 be resorted to. These failing, the patient should again be anes- 
 thetized and the bleeding point located and tied. 
 
 In operations Avhere excessive hemorrhage is anticipated, as in the 
 removal of lal'ge malignant growths of the orbit, it might become 
 necessary to expose the internal carotid artery, and pass a loop of 
 ligature around it preparatory to tightening it if necessary to con- 
 trol the bleeding, or it might even be advisable to ligate it before 
 beginning the oj^eration. 
 
 In operations on the eye-ball the principal sources of bleeding 
 are the conjunctiva and the iris. Unless the conjunctiva is much 
 inflamed, the instillation of some preparation of the suprarenal 
 gland will prevent bleeding from that membrane. The iris, when 
 wounded, nearly always bleeds,- and sometimes bleeds very freely. 
 This is objectionable in so far as it obscures the contents of the 
 anterior chamber and embarrasses manipulation on the lens and 
 other structures. The anterior chamber may fill quite full of blood, 
 when the pressure of the blood on the cut iris will arrest the bleed- 
 ing. Allowing a little time for this to occur, the blood may be 
 expelled from the anterior chamber by the same manipulation that 
 is employed in freeing the chamber of cortical debris after cataract 
 extraction (q. v.). It is rarely that such measures will not insure 
 . at least a sufficiently clear anterior chamber to permit the com- 
 pletion of the operation, though it is conceivable that the inability to 
 secure it might necessitate postponement of further steps. At the 
 completion of the operation it is a mistake to submit the eye and 
 patient to much manipulation or disturbance in an eft'ort to free the 
 anterior chamber of blood. In case the dressings are applied to 
 an eye whose anterior chamber is completely filled with blood, 
 it will usually be found in twenty-four hours to be entirely clear, 
 so rapidly is the blood absorbed. 
 
 Before dismissing the question of hemorrhage some mention should 
 be made of the hemorrhagic diathesis and secondary hemorrhage. 
 
 The hemorrhagic diathesis (hemophilia) is fortunately seldom en- 
 countered. A patient subject to this disease may have an uncon- 
 trollable hemorrhage as an oozing from an insignificant ocular 
 wound. Inquiry into the family history may put one on his guard, 
 
 Vol. I— 10
 
 146 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 and in the presence of this diathesis nothing but a question of life, 
 or possibly that of vision, would justify a surgical operation. Pres- 
 sure is perhaps the best local means to combat such a hemorrhage, 
 while as far as general treatment is concerned, the injection of 
 normal blood serum, of man, rabbit or horse, is the best measure 
 to increase the coagulability of the blood. Twenty to thirty cubic 
 centimeters should be given subcutaneously or intravenouslj-. If 
 normal blood serum is not to be had, ordinary diphtheria antitoxin 
 can be given instead. A detailed description of this condition may 
 be found in most works on general medicine and surgery. 
 
 Secondary hemorrhage arises from the dislodgment of the clots by 
 which nature has arrested the hemorrhage primarily. It is usually 
 due to sloughing, following infection. Here too, pressure is the 
 most efficient single means of controlling the bleeding. 
 
 Price's Suture Plate, actual size 
 
 Hemorrhage having been arrested, the wound and surrounding 
 parts should be carefully cleansed of blood. Such clots as cannot 
 be readily removed by irrigation and gentle wiping with gauze or 
 cotton sponges, should be picked out with fine forceps, such as 
 iridectomy forceps. This is generally the best way to remove clots 
 from the conjunctival sac, since it can be done with least disturb- 
 ance to the patient. Sponging or wiping in this situation may 
 excite "squeezing" on the part of the patient, with disastrous 
 results, a circumstance which would be particularly deplorable 
 after the completion of the operation. 
 
 A word should be said here in regard to sutures, since their pres- 
 ence and their removal constitute one of the important problems in 
 the after-treatment of ophthalmic operations. 
 
 Of the material for sutures and its preparation suffice it to say that 
 silk and cat-gut are the materials most used, and both should be 
 black (iron-dyed) or otherwise colored to facilitate easy recogni- 
 tion for removal. This is assisted in the case of conjunctival sutures, 
 by the use of the suture plate devised by Geo. Price, of Nashville. It 
 consists of a small silver plate, oval in shape, and about 9x5 m.m. 
 in size, with two holes in it, through which the ends of the suture
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 147 
 
 are passed and the knot tied on the plate, which in turn lies smoothly 
 on the ball. lu certain muscle operations, where a bunching up of 
 the tissues included in the suture is not desirable, the suture plate 
 serves to hold them fiat. 
 
 After operations involving incision in the skin in the region of the 
 eye, accurate apposition of the edges of the wound should be secured, 
 as early healing is thereby i)romoted and the subsequent scars are 
 rendered much less conspicuous. In case the sutures are used to 
 secure apposi^tion only, and little if any tension is put on them, 
 they should be removed in twenty-four hours, as they have by that 
 time served their purpose and their further retention c;in only lead 
 to irritation. 
 
 It should be remembered that the use of sutures is to secure appo- 
 sition, while bandages give support. Sutures are foreign bodies, 
 and should be dispensed with at the earliest possible moment. Where 
 
 The Interrupted Suture 
 
 they are intrusted with the holding of parts in place that would 
 otherwise tend to be displaced, as after blepharoplasty, pterygium 
 operations and advancement of muscles, they must be left in position 
 longer. Under these circumstances three days for the conjunctiva 
 and six to ten for muscle and skin will be found to be the proper 
 time. GifPord believes that if skin sutures are touched daily with 
 a 4 per cent, solution of nitrate of silver they can be left in place 
 longer without exciting suppuration. 
 
 Of the various kinds of sutures generally used, three eonnnon 
 forms might be briefly mentioned here. 
 
 The interrupted suture is, as its name implies, composed of -a 
 series of single loops of suture material passed across the wound 
 from side to side. The number and distance between these sutures 
 is determined by what is found necessary to produce accurate 
 apposition of the edges of the wound. In tying the units of this 
 suture the ends are crossed to make a single or double knot, which 
 is drawn down to the surface of the tissue by pulling on the two 
 ends. Both ends are then drawn rather forcibly to one side, and 
 the second knot tied. This maneuver places the knot just at the
 
 148 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 point of entrance of the suture into the skin, and not in the line 
 of incision. 
 
 The continuous suture, as shoAvn in the cut, is less often used, 
 and consists in first passing a loop across the line of incision. This 
 may be tied or not. Subsequent loops are similarly passed, the 
 suture being carried from one to the other without being cut to 
 form single units. This suture is more difficult to remove than the 
 
 The Continuous Suture 
 
 interrupted suture, as no part of it can be removed or loosened 
 without interfering with the whole. 
 
 Tension sutures are used for support, as in holding flaps in place 
 after certain plastic operations. They are generally deeply-placed 
 
 Tension Suture 
 
 sutures of heavj^ material, introduced well back from the wound 
 edges, in pairs, the adjoining ends on the same side of the wound 
 being tied over a piece of gauze or glass bead to prevent their cutting 
 into the tissues. In addition to these, one of the other forms of suture 
 is used to secure apposition of the wound. 
 
 In removing sutures the thread should be grasped with the points 
 of small smooth-pointed forceps at one side of the knot and drawn
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 149 
 
 out a little from its bed. It is then eut Avitli scissors as close to the 
 point of its emergence from the tissue as possible, and then entirely 
 removed. In this way one avoids drawing through the tissues any 
 portion of the thread that has been exposed, and i)Ossibly contam- 
 inated, so that the risks of wound infection are materially lessened. 
 
 The materials used for dressing the eye after operation are prin- 
 cipally gauze and cotton, held in place by bandages, adhesive 
 plaster, shields, masks, patches and shades. 
 
 Surgical gauze is usually ])lain, not impregnated with any medi- 
 
 Smooth Pointed Forceps for Eemoviiig Sutures 
 
 cament, but sterilized by heat. A piece of suitable size and shape 
 and two or three layers thick is applied next to the wound. If wet 
 with a non-irritating antiseptic sohition, such as boric acid, it will 
 adapt itself more perfectly to the irregularity of the part, and thus 
 be less apt to shift its position, though this renders it less absorbent 
 than if applied without Avetting. Some surgeons tease out absor- 
 bent cotton into a thin layer, with the fibers all running one way, 
 and apply this, wet, next to the skin. Whether gauze or cotton be 
 used in this way, over it is placed a pad of absorbent cotton. The 
 size of the pad must vary Avith the object to be attained, varying 
 according to whether we do or do not wish to make any pressure 
 on the parts. In case there are cavities left in the tissues after 
 operation, as after removal of the lachrymal sac, additional pads 
 of gauze are so disposed as to close, by pressure, these cavities so 
 far as possible. 
 
 It Avas formerly the custom with many surgeons, and is still the 
 practice with some, to use, instead of plain gauze, that which is im- 
 pregnated with some antiseptic. The ones most commonly used 
 were the bichloride of mercury, the cyanide of mercur\% carbolic 
 acid, boric acid and iodoform. It is probably unnecessary to use 
 any of these, in other Avords the dressing should be aseptic and not 
 antiseptic, in the event of clean Avounds. In the ease of sloughing 
 Avounds, or surfaces, and particularly cavities, Avhich are healing 
 by g)'anulation, an antiseptic gauze for dressing may have some
 
 150 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 advantages. Iodoform gauze is objectionable on account of its odor, 
 but is thought by many to be of special value in sloughing wounds 
 or to stimulate the granulation of bone wounds. 
 
 The variety known as absorbent cotton is used exclusively for 
 dressings, and should be tested as to its absorbability by placing 
 a loose piece of it on the surface of the water in a glass or bowl. 
 If properly prepared the piece will almost at once absorb water 
 and sink; if not, it Avill resist the solution and float for some time on 
 
 Monocular Eye Bandage 
 
 the surface. While the lack of absorbent (jualities is not so import- 
 ant in the making of dressings, its usefulness as sponges and for the 
 purpose of protection while irrigating is seriously interfered with if 
 it is not properly prepared, and such a sample should be discarded. 
 
 Cotton in the packages in which it comes has been repeatedly 
 shown not to be sterile. It can be sterilized by heat (baking) if 
 desired, but as it is often applied outside of the gauze, it is not more 
 necessary to have it sterile than it is to have the bandage sterile. 
 
 The best bandages for use in ophthalmic surgery are flannel and 
 gauze. Flannel bandages possess a degree of elasticit,y which makes 
 them very serviceable for pressure bandages, but the difference 
 between flannel and gauze in this respect is not very great. On 
 the Avhole, gauze bandages which can be obtained ready made in 
 any width, are perhaps the best. Consideration of economy may 
 prompt the use of muslin, or even calico, in hospital wards and 
 dispensary work. Mosquito-netting of the cheapest variety and .con- 
 taining much starch is recommended by H. D. Bruns. This is
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 151 
 
 applied wet, and avIhmi dry forms a stiff but \Gvy light east. Ocular 
 bandages should be one-and-a-half inches wide. 
 
 An eye bandage is eonnnonly ajjplied in the form of a figure 
 8, and is made to cover one or both eyes according to cir- 
 cumstances. The monocular bandage is applied as follows: The 
 end is fixed at the center of llic forehead and the first turn encircles 
 the head passing just above the eye-brows in front and just below 
 the occipital protuberance behind. For the i-ight eye the first turn 
 
 Binocular Eye Bandage 
 
 crosses the forehead from the patient's right to left and for the 
 left eye, from the left to right. The second turn follows the 
 first as far as the occipital protuberance when it drops lower, 
 passes below the ear and comes up across the pad of gauze 
 and cotton with which the eye is covered, crosses the first turn 
 obliquely and rests on the parietal eminence of the opposite side. 
 Subsequent turns ma^' be made in the same manner, and by each 
 over-lapping its predecessor, cover the whole dressing, or turns 
 may be made alternately around the head like the first turn, and 
 then oblique like the second. 
 
 A binocular bandage is started like a monocular. The first turn 
 encircles the head, the second passes below the occipital protuber- 
 ance and ear and up across one eye. The third turn, after passing 
 the occipital protuberance, goes upAvard, crosses the parietal emin- 
 ence and then comes down obliquely across the first turn, across 
 the second eye and below the ear on the same side. Succeeding
 
 152 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 turns may be oblique, alternating from one eye to the other, or one 
 may vary these with a horizontal turn. 
 
 A single turn bandage that is secure and quickly applied is made 
 by taking a piece of bandage about three feet long and placing the 
 center of it over the dressing which lies on the eye. The ends are 
 
 A Simple Single Turn Bandage 
 
 passed around the head in opposite directions and looped around 
 each other at the occiput, each end then going forward by the same 
 route it followed in going backward. The tAvo ends are then tied 
 on the forehead. 
 
 For greater security,, especially in children, the finished bandage 
 may be covered with a single strip of adhesive plaster, half an inch 
 wide. This is very effective in preventing slipping, a tendency 
 which is extremely great on certain shapes of heads. 
 
 Before applying a head bandage to a woman, the hair should be 
 plaited in one or two braids behind. 
 
 While bandages have a certain sphere of usefulness, especially 
 where it is desired to make pressure, more and more is adhesive 
 plaster being used instead of the roller bandage. A good quality 
 of fresh plaster holds admirably and is much more comfortable 
 to the patient than a bandage. Adhesive plaster, into the adhesive 
 layer of which a certain amount of zinc oxide is incorporated, can 
 be used with much less irritation of the skin than the plain variety,
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 153 
 
 Monocular Dressing with Adhesive PJaster 
 
 and is in other resjDects more satisfactory. To secure a dressing 
 on one eye, two parallel strips may cross the dressing obliquely, 
 being fixed on the cheek and brow, or a strip can be run along each 
 edge of a triangular pad as advised by Casey Wood. The latter is 
 supposed to give better protection than the former, as the eye is 
 
 Monocular Dressing with Adhesive Plaster
 
 154 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 Binocular Dressing with Adhesive Plaster 
 
 Fixation of the Lids with a Vertical Strip of Isinglass Plaster
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 155 
 
 less apt to be disturbed by the fingers of the patient and others. 
 For applying a dressing to both eyes, a long strip is [)assed across 
 both ocnlar regions from temple to temph'. Two additional shorter 
 strips cross each dressing obli(iuely from check to brow. The plaster 
 strips should be i/o inch wide. Fixation of the dressing with adhesive 
 plaster has the advantage, among others, over the roller bandage, 
 of being applied and removed with much less disturbance of the 
 patient, especially when the latter is lying in bed. 
 
 A Patch of Black Felt for Eetaining a Dressing and Protecting the Eye 
 
 In place of zinc oxide plaster, isinglass plaster ("court plaster") 
 is sometimes used in the same way. Some surgeons apply a strip 
 of this directly to the lids after cataract extraction, either passing 
 the strip across the palpebral fissure to fix both lids, or horizontally 
 on the upper lid, to fix it, as by a splint. If one will close the iids 
 and grasp the eye-ball as firmly as possible with the finger tips 
 and attempt to restrain its movements, he will be convinced of the 
 futility of attempting to fix the eye and render it immovable by 
 any dressing applied to the closed lids. The belief in the efficiency 
 of a bandage, then, to fix the eye, is a fallacy, and the best we can 
 do is to secure quiet and immobility 1)y closing both eyes and 
 removing the incentive to movement. This will be reverted to 
 presently. 
 
 Besides bandages and plaster strips a variety of patches, binders
 
 156 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 and shields are used to retain eye dressings. A very convenient one 
 is made of black felt, with tapes attached to each end. This is also 
 adaptable to both eyes and answers the purpose of the old Liebreich 
 bandage, of which it may be said to be an imitation. 
 
 A little point that should be mentioned in the application of 
 patches, shields and masks to the eyes, especially when the patient 
 is in bed, is to tie the ends of the tapes so that the knot will be on 
 
 Ring's Mask 
 
 the side of the patient's head, and not at the back. In the latter 
 position it is a discomfort to the patient lying on his back, and is also 
 inaccessible. As a hint to the nurse it might be well when first ad- 
 justing the dressing to cut one tape fairly close to the patch. The 
 two then can be tied only at one side. 
 
 Patches of celluloid and covered pasteboard are better adapted 
 for shading the eyes from light than for retaining a dressing. 
 
 Shields and masks are used for the double purpose of retaining 
 dressings and protecting the eye from injury, or for the latter pur- 
 pose alone. They are made of pasteboard or similar material, like 
 King's mask, or of wire, and may be used with or without any eye
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS If)? 
 
 dressing, and cover one or both eyes. Metal plates are at times 
 incorporated in the dressings for the same purposes. 
 
 The sponges -which are used for this and other purposes are made 
 by wetting a pledget of absorbent cotton, somewhat smaller than 
 an egg, in a boric or other antiseptic solution, and rolling it be- 
 
 Cotton Spindles for Sponges, about 2" long and i/^" thick 
 
 tween the palms into a little spindle with two pointed ends, and 
 squeezing it almost dry. In this form and shape it proves most 
 useful, and when freshly made and well squeezed is sufficiently dry 
 to be absorbent. As Beard so aptly expresses it, the tip will "drink 
 up" secretions and excess of solution in a most satisfactory manner. 
 
 Sponges may also be made of gauze, the edges being turned in so 
 as to leave no raw edge exposed to fray out and deposit threads on 
 the wound. 
 
 Applicators wound with cotton are used for making applications 
 to the lids and eye. For making an application to the conjunctival 
 aspect of the lids or to other similar surface, the applicator should 
 be wound as shown in the figure. The grasp of the tuft of cotton is 
 made at its proximal end only, and the result is a tufted applicator, 
 which, when wet, spreads out like a little brush. It is sometimes 
 desired to apply a stronger solution, such as carbolic acid, tincture
 
 158 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 of iodine or other substance of this character, to a limited area of 
 the eye or lid. For this purpose the applicator is wound in such a 
 manner that the whole of the cotton pledget is applied tightly to 
 
 Wf^ 
 
 W-:,,. >'~"\ 
 
 
 Gauze "Bird Nest" Sponges. No Edge is Exposed. These are 1 to I14 inches 
 
 in Diameter 
 
 the shaft of the applicator. The finger grasps the cotton for this 
 purpose throughout the entire extent. With the applicator pre- 
 pared in this manner a small quantity of a very active solution can 
 be applied exactly where it is desired, as for instance to the surface 
 of an infected wound. 
 
 Colored glasses are used in the after-treatment of oi^hthalmic oper- 
 ations to protect the eyes from light, especially during convalescence 
 after operation on the globe. A variety of colors is to be had, not- 
 ably green, blue, amber and amethyst, but the most useful are 
 "smoked" glasses in varying shades. If well-fitted as to pupillary 
 distance and relation to the lashes, they offer considerable protec- 
 tion. The flat instead of the co(|uille-shaDed lens should be used, as 
 the latter, unless carefully ground, are found to possess refractive
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS ino 
 
 ^ 
 
 ^'■^• \ 
 
 m 
 
 Method of Wrapping Cotton to Make an Applicator 
 
 \ 
 
 i 
 
 The AVay in whidi the ('otton "Wrapped as Shown in the Previous Figure Spreads 
 
 Out to Form a Brush When Wet
 
 160 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 powers equivalent to varying combinations of concave spheres and 
 cylinders, which may be objectionable. 
 
 In considering the after-treatment of operations on the eye, the 
 question whether to occlude one or both eyes must be decided in at 
 least two instances, namely, squint operations and cataract extrac- 
 tion. In all these operations the occlusion of both eyes is advocated 
 to secure immobility and, by a period of rest, to favor the proper 
 
 Method of Wrapping Cotton to Make Applications of Acids and Caustic Solutions 
 
 initiation, at least, of the healing processes. It has already been 
 stated that no dressings applied to the closed lids can prevent move- 
 ment of the ball, but there is no doubt that with the lids of both 
 eyes closed, one will keep the eyes more quiet than with one or both 
 eyes open. This is the argument for including both eyes in the 
 dressing. In opposition to this practice it is argued that inflamma- 
 tion of the conjunctiva and secretion from that membrane are cer- 
 tainly increased, if not caused, by an occluding dressing, and the 
 risks of infection of the wounds are increased. Furthermore, the 
 covering of both eyes is said to exert at times a very disturbing 
 effect on both the mental and physical condition of the patient, and 
 for that reason should not be practised. In the case of an operation 
 for squint, an additional reason for omitting all dressings is that 
 we expect, by practice, to secure the co-operation of the two eyes 
 in the visual act, and the sooner this is begun the better, since the
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 161 
 
 union of the muscles nuiy to some extent be induced in llu- manner 
 most suitable for these conditions. 
 
 In reply to these arguments it may be said that many patients 
 who are operated on for cataract are blind in both eyes, and whether 
 one or both eyes are covered cannot concern them much. Even in 
 the case of a blind eye, covering it with a dressing is apt to make 
 it more quiet. Mental disturbance that follows this practice is not 
 very common. Should it occur it is usually relieved b}' uncovering 
 the sound eye, or both eyes, or by the use of sedatives. It can 
 usually be prevented by not leaving the patient alone, and a bell 
 cord or bell, placed in easy reach, so that he can summon some one 
 at will, is often as quieting in its influence as the presence of an 
 attendant. In squint, if a tenotomy only has been performed, it is 
 probably never advisable that both eyes be covered, and many sur- 
 geons advise that no dressing at all be applied after this operation 
 (Jackson), but that the eyes be left open to assume the best pos- 
 sible position for binocular vision. If an advancement has been 
 done the case is different. Here some writers advise closing both 
 eyes for five or six days, while others, Bruns, for instance, advise 
 that no dressing or bandage be applied. The practice of most sur- 
 geons lies between these two. Closing both eyes for twenty-four 
 hours, and the one operated on for a longe-r time (usually till the 
 stitches are removed, if any are to be removed) has proven a satis- 
 factory practice, and the operative failures that have occurred could 
 not fairly be attributed to the manner of dressing. In passing, it 
 might be said that nmny squint operations are undertaken, and 
 properly, for the correction of a deformity, when little in the way 
 of improvement of visual acuity and attainment of binocular vision 
 can be expected. 
 
 Something remains 1o l)e said of the practice, which has many 
 advocates, of applying no dressing at all after cataract extraction. 
 This ''open" treatment has been advocated by a number of sur- 
 geons recently, and is the extreme position among advocates of 
 freedom from restraint for cataract patients. It is usually advised 
 that the eye be protected only by means of a shield or wire mask, 
 or hollow bandage. Heimann argues that this practice is less irri- 
 tating to the patient, less apt to cause psychic disturbance, and that 
 inspection of the eye is easier. The hollow bandage referred to is 
 made of parchment paper, dipped in glycerine and molded closely 
 to the border of the temples, forehead, nose and cheeks, glycerine 
 jelly being used as an adhesive. Glycerine jelly is composed of five 
 parts of tragaeanth, two of glycerine and 100 of water. J. W. 
 
 Vol. I— 11
 
 162 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 Single Wire Mask 
 
 Scales does not apjn'ove of tlie bandage becanse (1) it interferes 
 with the natural drainage of the eye and brings about a retention 
 of secretion; (2) it interferes with uniform pressure, which the lid 
 would exert; (3) it creates a feeling of discomfort; (4) it tends to 
 
 Double Wire Mask
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 163 
 
 cause entropion and (5) it causes conjunctivitis. His practice, which 
 is adapted from Sattler, of Lei])sic, is to close the eye after opera- 
 tion and lay on i1 a dou1)l<* hiyci- of moist bieliloride gauze. Over 
 this a wire mask is ])laeed. In six hours the gauze is removed, and 
 not replaced. C Hess rcpoi-ts '"ahoul a lliousaiid cases treated Avith 
 the open method, and the rcsuHs were at least as good as, or better 
 than, with the bandage." He bar ^Iteiiiplfd to secure tixation of 
 
 Metal Plate Iiic(irpoi;ite<l in an Eye Dressing 
 
 the eye by putting over it a cai)sule with an aperture in the center. 
 The patient must look thl-ough this to see. On the whole it would 
 seem that the following (juotation from Hotz pretty w^ell expresses 
 the views of most ophthalmic surgeons, at least in America, today 
 on this subject. 
 
 "While we fully indorse the laudable desire to cater to the pat- 
 tient's comfort, we ai-e not prepared to go in this direction as far 
 as Hjork, of Christiania, who, in a recent issue of the Centralhlatt 
 fiir Augenheilkundc, very strongly pleads for the omission of all 
 bandages after operations upon the eye-ball. His reasons are that 
 winking serves to cleanse the eye and carry all the micro-organisms
 
 164 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 with the tears through the normal tear passages; bandages, there- 
 fore, stopping the movements of the eye-lids, favor rather than pre- 
 vent the contamination of the wound. From October, 1895, to 1896, 
 he used a bandage, but during the first 24 hours only, and since 
 October, 1896, he has discarded bandages altogether. During this 
 period 112 operations by which the globe was opened were done 
 (extractions, iridectomies, sclerotomies, needle operations), and in 
 all cases the healing was favorable." 
 
 "We do not doubt that the puncture of a needle and the linear 
 incisions of a keratome heal kindly under the open treatment, and 
 even that a sclerotomy wound, unless unusually extensive, will do 
 well without bandages, for these wounds have no disposition to 
 gape, but close up tightly as soon as the instrument is withdrawn. 
 But when it comes to the large curved incision of cataract extrac- 
 tion, we hold that kind healing requires something more than the 
 aseptic condition of the wound; it requires in addition that the ac- 
 curate apposition of the wound-edges shall be protected against 
 disturbance by winking. The edges of these flap-wounds are easily 
 Separated by the slightest pressure of the Avinking lids, hence, if 
 no bandage is used, the sealing up of the wound is retarded and the 
 chances for prolapse are considerably increased. Hjork proves this 
 by his own cases; for in 24 simple extractions. performed during this 
 period of the open wound treatment iris prolapse occurred four 
 times, or in 16 per cent, of the cases. In other words, the accident 
 is likely to occur twice as frequently under the open wound treat- 
 ment as under protective bandages. This is not a favorable show- 
 ing for open wound treatment, and surely cannot induce ophthalmic 
 surgeons to abandon protective bandages. We would advise the 
 bandage as the safest treatment until somel)ody invents a cement 
 by which a fresh wound can be firmly sealed up directly after the 
 extraction. Then the movements of the lids could not disturb the 
 edges of the wound, and of course, bandages could be safely 
 omitted. ' ' 
 
 It must not be forgotten, however, that pressure on the eye ball 
 after corneal section should be avoided, as it cannot produce fixation 
 of the eye and may cause a disturbance of the lips of the corneal 
 wound. Fixation of the eye is favored by closing the fellow eye, 
 and guarding against startling the patient by sudden noises, etc. 
 A dressing which closes the lids and keeps them gently closed is 
 desirable. A bandage which maintains its position only when it 
 exerts pressure, should be avoided. 
 
 Tlie practice in regard to the restraints placed upon a patient after
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 165 
 
 cataract extraction has changed materially in recent years. The 
 deleterious effects, both mental and physical, of confinement on old 
 people is well known. The most conservative methods in practice 
 are set forth by Lawson. He bandages both eyes for two or three 
 days, the eye operated on for a week or ten days, and is careful not 
 to let the patient Avalk to his bed or elsewhere after the operation. 
 The hand on the side of the operation should be hobbled with a piece 
 of bandage to prevent its reaching the eye, and the patient is kept 
 in bed for a few days. The diet should be one that needs little or no 
 chewing. At the other extreme, Lopez thinks these patients need 
 not be confined to bed at all, and that recovery is not impeded if 
 they walk about, eat and smoke in their ordinary way. Only the 
 eye operated on is covered by the dressing. Bruns bandages but one 
 eye unless both are entirely blind, or some serious accident renders 
 their immobilization highly desirable. He is also more and more 
 inclined to allow patients to return to their homes after operation 
 and report to the clinic daily, and is well satisfied with the results. 
 The majority of American ophthalmic surgeons follow about the 
 practice indicated by Casey Wood. A light dressing of gauze and 
 cotton is applied to the eye (usually to both eyes), and held in place 
 by a triangle of adhesive strips. The patient is transported to his 
 bed with the least possible disturbance and ett'ort, or if possible, he 
 should be operated on the bed on Avhich he is to lie. Complete rest 
 for the next 24 hours is now in order. lie should be warned not to 
 talk more than is absolutely necessary, not to make any sudden 
 movement of his body, and to refrain absolutely from blowing his 
 nose, squeezing his eye-lids together, turning over or getting up 
 suddenly, and above all to abstain from sneezing and coughing. If 
 both eyes are closed it is customary to remove the dressing from the 
 non-operated eye and to allow the patient to sit up when the lips 
 of the corneal wound have adhered and the anterior chamber has 
 reformed. This time can be definitely determined, while to say when 
 the corneal wound is "healed" is not easy. In another tAventy-four 
 hours the dressings can be left off the eye operated on and dark 
 glasses or a shade Avorn by day; at night a dressing with a mask or 
 other protection is to be apjilied. 
 
 While this Avill be decided in each case on its OAvn merits, most 
 ophthalmic operations require daily dressing. Since it is usual for 
 the conjunctiva to become congested and secrete freely under an 
 occlusive dressing, the patient's comfort,. as Avell as the safety of the 
 Avound, is promoted by daily cleansing and airing, and this is true 
 of all operations on the ball or adnexa Avhen the CA^e is coA^ered by
 
 166 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 the dressing. While many surgeons do not advise this plan, and 
 allow some cases to go three or four days or a week, before changing 
 the first dressing, the more common practice is for earlier dressing, 
 and the almost universal custom includes daily dressing after the 
 first one is changed. 
 
 It must be remembered that we have to do with a sensitive and 
 conspicuous field of operation, so that not only are an excess of 
 secretion and a dry and stiff dressing sources of particular discom- 
 fort, but the head is not easily kept still and dressings about it are 
 readily disarranged. The surgeon's aesthetic regard for the appear- 
 ance of his own work prompts him to keep the dressing clean and 
 
 Allporfs Treatment and Dressing Tray for Bedside Use 
 
 in order — a state of affairs no less satisfactory to the patient and 
 others concerned. 
 
 The hands of the surgeon should for the removal of dressings be 
 prepared exactly as for operation, and the patient's hair and face 
 and the pillow be covered with sterile towels. It may not be neces- 
 sary for the surgeon to put on a sterilized gown, but if he has several 
 patients to dress, as in a hospital round, it is best to adopt this 
 precaution. 
 
 A convenient tray for holding the necessary solutions and dress- 
 ings at the bedside is shown in the figure. 
 
 If bandages have been used they should be cut through, and gently 
 removed. Let it be said, once for all, that no disturbing sight, sound, 
 touch, application (especially of hot, cold or painful substances) or 
 sudden movement should be permitted, lest the patient be excited to 
 some act, such as "squeezing," that might work to his detriment. 
 As at the operation, one person should do all the talking and give
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 167 
 
 directions to the i:)atient. If adhesive piaster has been used to secure 
 the dressing, cotton sponges (wet in alcohol for plain plaster, in 
 ether or benzine for zinc oxide plaster) should be applied, first to 
 wet the plaster where it adheres to the skin, and then with these 
 same cotton sponges to wipe oft' the plaster, working towards the 
 eye. The pulling oft' of the plaster, if done forcibly, is especially 
 apt to excite "squeezing." 
 
 If patches or shields have been applied, the retaining cords should 
 be untied and the patch gently removed. 
 
 The dressing itself should then be liberally wet with a warm solu- 
 tion of boric acid, till it is thoroughly softened, and can be easily 
 taken away in successive layers. The excess of solution which may 
 run fi'om the dressing should be caught in a pus basin or similar 
 dish, or by means of a pad of dry absorbent cotton. Basins and 
 dishes are with difficulty held so that they will thoroughly protect 
 the patient and bedding from a wetting, and for this reason a pad 
 of absorbent cotton seems preferable. What was said about the ab- 
 sorbent qualities of the cotton applies especially to that used for this 
 purpose; unless it is of good quality water will flow over it and not 
 be absorbed by it. 
 
 The dressings having been removed, the margins of all skin in- 
 cisions should be wiped with wet cotton sponges to remove secre- 
 tions or blood clots from the edges of the wound. Pledgets of gauze 
 may be used, but the cotton sponges, just described, will be found 
 to be more satisfactory. 
 
 Attention is next directed to the palpebral fissure, the eyes being 
 kept closed in the meantime. A stream of warm boric solution is 
 directed over the lids to soften any secretion that may be on them, 
 and the patient allowed to open the eye without assistance, if pos- 
 sible. Any secretion clinging to the lashes may be removed by 
 gentle stroking with the pointed end of a cotton sponge. The pat- 
 ient should then be directed to look up while the surgeon draws 
 down the lower lid and flushes the cul-de-sac with warm boric acid 
 solution. 
 
 It is well to say here that in patients Avho tend to "squeeze" 
 the eye, this tendency can be controlled by drawing doAvn the lower 
 lid with the thumb or finger as the first step in attempting to get 
 the eye open, and hold it till the patient voluntarily and quietly 
 closes the eyes. The force of the orbicularis muscle can be so broken 
 by pulling the loAver lid strongly down, that it is not likely that 
 any harmful contraction of it could take place. As the lid is apt at 
 this time to be moist and slippery, it may be necessary to protect
 
 168 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 the end of the finger ^vith a layer of gauze or cotton to prevent 
 
 slipping. 
 
 The solution used in this way. should be warm and non-irritating 
 to avoid shock in its application, which might otherwise cause the 
 patient to start or "squeeze." A boric acid solution fulfills these 
 conditions and is the one most used, although some surgeons prefer 
 a one per cent salt solution, a half per cent sodium bicarbonate 
 solution, etc. A convenient plan is to keep a "stock solution" in a 
 large' bottle, containing such an excess of boric acid that a layer of 
 the undissolved acid covers the bottom of the vessel to the depth of 
 
 ' ' Ear and Ulcer Syringe, ' ' Convenient for Irrigating the Eye 
 
 half an inch or an inch. A sufficient quantity of this solution diluted 
 with an equal quantity of hot sterile water gives a warm solution 
 which answers all the requirements. 
 
 Ordinary glass finger bowls make convenient vessels for holding 
 the solutions for dressings, being sufficiently large and easily 
 sterilized. 
 
 The solution is applied to the eye in one of several ways. Pledgets 
 of cotton or gauze may be thoroughly wet with it and squeezed onto 
 the eye. This is a convenient and gentle method, though minute 
 particles of cotton fiber may thus be forced into the eye and act as 
 foreign bodies. A dropper of glass and rubber, a rubber syringe, 
 undine or other form of irrigator, may be used. A favorite method 
 with many surgeons is to use a bottle for the solution with a large 
 rubber dropper fitted to it as a stopper. Whatever method is em- 
 ployed it is important to remember that it must be used gently. The 
 solution should flow on the lids or into the eye, and should not be 
 squirted into it with any force. At the conclusion of the irrigation 
 any excess of the solution should be taken up with a cotton sponge. 
 
 Inspection of the eye should be made, as with all other manipula- 
 tions, as gently as possible. It will usually be necessary, at least at
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 169 
 
 the first few dressings, to oi^eii the eye with the assistance of the 
 fingers. Great care must be taken not to make any pressure on the 
 eye-ball, and to direct the patient's actions so that he co-operates 
 with, rather than opposes, the surgeon. A most important matter 
 
 One Form of UndiDe, for Irrigation 
 
 in this connection pertains to llie opposite eye. If it is first cleansed 
 and the patient be told to keep it open and look this way or that, 
 the eye operated on will be found to follow the movements, and a 
 heli)ful relaxation of the lids is the result. This simple means of 
 securing the patient's co-operation is often neglected. Its value can 
 readily be demonstrated to patients and to students by comparing 
 the associated movements of the eyes to those of the fingers. It is 
 very easy to extend or flex all the fingers of one hand together, but 
 it is difficult to extend one and flex the others, or vice versa. 
 
 If an application is to be made to the eye, especially if it be pain- 
 ful, the patient should first be warned, lest an unexpected unpleasant 
 sensation make him jump or squeeze the eye, with the possibility of 
 disastrous results. Most solutions are distinctly less irritating if 
 applied warm, and this applies to "drops." A very good way to 
 warm these is to first fill the dropper Avith hot water, or better -with 
 a hot antiseptic solution, expel this, and then draw up with the 
 dropper the desired quantity of "drops." By this means they are 
 sufficiently warmed and are distinctly more grateful to the patient's 
 eve than are cool or cold solutions.
 
 170 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 In the after-treatmeiit of ophthalmic operations wet or dry forma 
 of hot applications maj'^ be used, the former being preferable, as a 
 greater deg^ree of heat can thus be obtained. 
 
 Todd 's Irrigator 
 
 Another Form of Irrigator 
 
 Dry heat is applied with a hot water bag or bottle, Leiter's coil, 
 with a Japanese hand warmer (hot-box), with a bag of sand or salt 
 heated in an oven, or with an electric pad or electric lamp. The 
 latter is apt to get too hot if an ordinary 10 or 16 C. P. lamp is used, 
 but a lamp of smaller candle power, or one with a regulating attach- 
 ment, like night lamps, and "Hylo" lamps, can be so regulated as 
 not to get too hot. In applying dry heat with a hot water bag it is
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 171 
 
 well, on account of the weight, to have the patient lie with his face 
 on the bag, rather than to lay the bag on his eye. Dry heat may be 
 applied continuously. 
 
 Moist heat is applied by wringing a towel, pad of gauze or other 
 cloth, out of hot water and applying it to the eye and surrounding 
 parts. A cloth or pad only large enough to cover the eye would not 
 
 Leiter's Coil for Hot or Cold Applications 
 
 be so easily handled nor retain heat so well as a larger one. In the 
 presence of a wound an antiseptic or sterile solution should be used 
 instead of plain water, and the whole application made with due 
 regard to surgical cleanliness. The pad should be renewed often 
 enough to keep it hot, and it should be as hot as the patient can 
 bear. Various devices have been arranged to keep the water hot at 
 the bedside, particularly by means of a Bunsen burner or alcohol 
 lamp and tripod, but hot water in a kettle will usually keep hot as 
 long as needed, especially if it be phiced on a fire in the room, or i!i 
 a room nearby. Hot applications should be retained in place on the 
 eye for ten or fifteen minutes at a time, or even longer if the effect is 
 pleasant to tlie patient. They should be repeated every three to six 
 hours. This all sounds somewhat empirical, but the desired effect is 
 usually obtained when the applications are made in this manner. 
 Just as hot applications may be either wet or dry, so may cold.
 
 172 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 Dry cold applications are made by means of an ice bag or Leiter's 
 coil. The ordinary form of ice cap as used for applying- cold to the 
 head may be used, and has in its favor the fact that being of large 
 size the ice does not melt quickly and the bag will remain cold a 
 relatively long time. Smaller ice bags fit the ocular region more 
 accurately, but the small amount of ice they hold quickly melts and 
 
 Dropper Fitting into the Mouth of the Bottle 
 
 must be frequently replenished. Dry cold is generally applied 
 continuously. 
 
 Moist cold applications are made by preparing half a dozen pads 
 of gauze, two inches square and six layers thick, and by placing 
 these on a block of ice. The block of ice should rest on a towel or 
 cloth so arranged in a basin as to keep the ice free of the water 
 which collects beneath it, and which would hasten the melting of the 
 ice. The pad applied to the patient's eye is replaced by a fresh one 
 as soon as it becomes the least warm. The number provided will 
 insure a cold one being ready. These applications are usually kept 
 up for 24 or 36 hours at a time, or longer. 
 
 Leeches are often used for the abstraction of blood from the temple 
 in certain post-operative inflammatory conditions and the value of
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 173 
 
 the i^rocedure is very great. Leeches are either natural or artificial. 
 Natural leeches, when the}^ can be procured, are very efficient. 
 The leech is removed from the water in which it is kept, and placed 
 in a test tube or roll of paper, by which means the head is directed 
 just where the surgeon wishes to apply it, the skin being previously 
 cleansed. The application is usually made to the temple. If the 
 leech does not readily take hold, it can be made to do so by putting 
 a drop of milk on the skin, or by pricking the skin and drawing a 
 drop of blood. From four to six leeches are applied and allowed to 
 remain till they drop ofif, usually in half an hour. The little wound 
 
 Artificial Leech 
 
 ma3' be permitted to bleed aAvhile, or the bleeding, which is some- 
 times quite free, can be stopped wdth pressure. Occasionally it is 
 necessary to insert a suture to stop the bleeding. Leeches should 
 not be used a second time, but fresh ones applied if the blood-letting 
 is to be repeated. 
 
 Artificial leeches consist of two parts, a spring lancet or other de- 
 vice for making an incision, and a glass cylinder and a screw piston 
 for making suction. Under antiseptic precautions the skin is incised 
 and the cylinder applied over the wound. It is often difficult to 
 secure sufficient blood with the artificial leech, and this, together 
 with the fact that the glass cylinders are easily broken and the 
 plunger of the piston apt to dry up and become useless, makes the 
 artificial leech rather a troublesome instrument. 
 
 In addition to the remedies already mentioned, the principal drugs 
 used in the after-treatment of ophthalmic operations are sedatives, 
 laxatives and antiseptics. 
 
 The drugs used as sedatives vary with the absence or presence of 
 pain. In the latter case it is generally better to give at once a full 
 dose of morphine hypodermically, or codein, or some liquid prepar- 
 ation of opium internally. In case of restlessness, nervousness, or 
 sleeplessness from other causes than pain, potassium or sodium bro- 
 mide in 20-grain doses, with or without chloral ; or trional. or 
 veronal, should be given. If the psychic disturbance is of an hys-
 
 174 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 terical nature, valerian is a most effective remedy. The patient's 
 idiosyncrasies should always be inquired into, and if there is some 
 favorite remedy on which he is accustomed to rely, it had better be 
 given unless contraindicated. The sedative value of alcohol and 
 tobacco under some circumstances should not be lost sight of. 
 
 In the case of laxatives it is well to consult the habits of the pa- 
 tient, especially if he be an adult. Most people need laxatives when 
 confined to the house, and from the large number of salines, w^hen it 
 is decided to use this form of cartharsis, it is easy to select one. 
 Epsom salts, Rochelle salts, Seidlitz powder, citrate of magnesia or 
 any of the various aperient mineral waters may be employed, be- 
 sides castor oil, compound carthartic pills, etc. Particularly agree- 
 able to the taste, as well as efficient in action, are compound licorice 
 powder and citrate of magnesia. Calomel should only be given for 
 particular reasons, not merely as a laxative. 
 
 Antiseptic (q.v.) and cleansing solutions best adapted for use in the 
 after-treatment of ophthalmic operations include : 
 Normal saline solution, .6 per cent. 
 Boric acid, 2 per cent. 
 Sodium biborate, 2 per cent. 
 Sodium bicarbonate, i/o per cent. 
 Bichloride of mercury, 1-1,000 to 1-10,000. 
 Formalin, 1-1,000 to 1-50,000. 
 Argyrol, 10-50 per cent. 
 Permanganate of potash, 3 per cent. 
 Carbolic acid, i/o per cent. 
 Thiersch's solution (salicylic acid, gr. xv, 
 boric acid, gr. lix to a pint). 
 All solutions should be made with hot sterile water, and filtered. 
 They should be kept in closed sterile containers, preferably glass 
 bottles or 'flasks. 
 
 Solutions used as drops should be dissolved in a sterile 2 per cent 
 solution of boric acid, or, better, dissolved in the boric acid solution 
 by boiling. This would not apply to any drug that would be injured 
 by boiling, or to any drug not compatible with boric acid. 
 
 Powders, usually antiseptic in character, are sometimes used. 
 Iodoform is not popular on account of its disagreeable and clinging 
 odor, and less objectionable substances are preferable. Xeroform, 
 aristol and acetanilid are satisfactory in their therapeutic properties 
 and unobjectionable otherwise. 
 
 In speaking of the treatment of complications after ophthalmic 
 operations in general it may be said that the signs of unfavorable
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 175 
 
 progress after operations are subjective or objective. We usuallv 
 mean by "unfavorable progress in a wound," infection. 
 
 • The subjective signs of operative complications are chiefly the 
 presence or absence of pain. While more or less discomfort will 
 follow any cutting operation on the eye, it is not usual, after the 
 operations most commonly performed, for the patient to complain, 
 or to require any special means for the relief of pain. Patients differ 
 very much in their ability and willingness to stand pain, and equally 
 as much in their conception of what constitutes pain, so that it is 
 only exceptionally that any value can be attached to subjective signs 
 as indicative of the unfavorable progress of a wound. 
 
 The objective signs, however, are definite and easily determined. 
 In the case of incision of the skin and in operations requiring skin 
 flaps, redness and swelling of the edges of the wound are the prin- 
 cipal indications of unfavorable i)rogress. It may be said here that 
 owing to the rich l)lood sup])ly of the region of the eye, wounds of 
 the skin in its neighborhood heal quickly as a rule, and Avith little 
 reaction. 
 
 The signs first seen, then, to indicate that the wound is not doing 
 well, are redness and swelling of the edges of the wound. Unless 
 checked, these processes will go on to suppuration, which more or 
 less interferes with the objects sought by the operation. In the case 
 of flaps and grafts, the implanted tissue may not live. This 
 is indicated by the flap or graft assuming a dark or yellowish-gray 
 hue, with subse(iuent loss of a part of it by sloughing, or by a drying 
 or shrivelling process, usually the former. The general symptoms 
 that accompany infection of a wound of the skin and soft parts vary 
 very much. Usually they are moderate or absent, but if the infec- 
 tion is severe, or if erysipelas should develop, the general disturb- 
 ance may be great. A peculiar danger that attends infected wounds 
 of this locality is that of the infection traveling by Avay of the 
 ophthalmic vein and its branches to the cavernous sinus. 
 
 The treatment of infected post-operative wounds of the skin and 
 soft parts near the eye consists in the removal of sutures, the evacua- 
 tion of pus and the application of a wet dressing consisting of gauze 
 soaked in one-half of one per cent solution of carbolic acid. This 
 should be covered with a layer of oiled silk to keep it moist, and 
 changed daily or oftener. At each dressing pus and sloughs should 
 be removed. When these have ceased to form, the wet dressing 
 should be discontinued, and a dry one, composed of sterile gauze 
 and cotton, used instead. The local treatment alone is usually nil 
 that is needed, but if there is any constitutional disturbance a
 
 176 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 calomel purge, followed bj' supporting treatment of tonic drugs 
 (iron and quinine) and nourishing diet, should be carried out. 
 
 Much is promised in the treatment of local infections from the 
 use of injections of dead micro-organisms, the vaccines and bacte- 
 rines. The subject is too extensive for discussion in detail here, 
 especially as it is, at this time, scarcely beyond the experimental 
 stage. The vaccine should be made of the same organism that is the 
 cause of the infection, and is said to be most effective when made 
 from cultures derived from the infected area itself. For further 
 information on this subject the reader is referred to the admirable 
 articles of Jno. E. Weeks, and under the heading Seropathy in this 
 Encyclopedia. 
 
 If infection should follow an operation on the conjunctiva or 
 muscles it should be treated on the same principles. After these 
 operations, however, infection is extremely rare. 
 
 The occurrence of infection following an operation involving the 
 opening of the ball is the most depressing and disastrous calamity 
 that can befall patient or surgeon. The necessity for the early 
 detection of this unfortunate complication, that measures to combat 
 it may be instituted, constitutes a potent reason for earlj^ removal 
 of the dressing and inspection of the wound after cataract extraction 
 and other operations involving opening of the globe. The subjec- 
 tive symptoms are so variable as not to be reliable, and when to this 
 is added the personal equation of the patient, w^ho may complain 
 bitterly of a little discomfort or not at all of a great deal, it will be 
 seen how little we can depend on subjective symptoms to warn us 
 of even serious trouble. This statement is to a certain extent true 
 of the appearance of the lids ; the degree of swelling in them is no 
 positive index of trouble within the ball. The safest plan therefore 
 is to remove the dressing and inspect the eye twenty-four hours 
 after operation on the globe. 
 
 The lids, when exposed by removal of the dressing, will usually 
 appear swollen and there will be some discharge from between them. 
 it is thought that swelling of the lids near the inner cauthus is par- 
 ticularly significant of intra-ocular infection or intense reaction, 
 but it is seen quite often with only a moil^erate amount of reaction. 
 On separating the lids a considerable quantity of thin, turbid secre- 
 tion will usually escape. There is a moderate amount of conjunc- 
 tival secretion as a rule, and abundant lachrymal secretion, which 
 gives the discharge a thin consistency. The conjunctiva is found 
 to be intensely injected and swollen. As a rule it projects around 
 the edge of the cornea to a greater or less degree. The edges of the
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 177 
 
 incision, if in the cornea, show a grayish or yellowish infiltration, 
 the whole cornea has a cloudy look, the aqueous is turbid and the 
 iris discolored. The infection is usually derived from the lachrymal 
 and conjunctival secretions, or from other extraneous sources, but 
 if from within (an infected instrument or foreign body) the signs 
 may at first consist in a deep-seated, yellowish discoloration in the 
 vitreous, with intense injection of the conjunctiva. Later the iris 
 becomes discolored, the aqueous turbid, and, finally, the cornea is 
 infiltrated. As the infective process advances the cornea becomes 
 more and more opaque and finally melts away or separates in a 
 more or less consistent mass, as a slough. 
 
 The involvement of all the tissues within the eye in a purulent 
 inflammation (panophthalmitis) is a most serious complication of 
 operations. If the infection starts within the ball the cornea may 
 resist and remain to the last, or it may become infiltrated and sof- 
 tened, starting from the wound and spreading across the cornea; 
 or the infiltration may spread around the circumference rather than 
 toward the center. 
 
 Since the treatment of such a condition is not encouraging, it 
 might be well to dwell for a moment on the measures used to pre- 
 vent it. First among these is careful inspection of the conjunctiva 
 and the lachrymal apparatus, especially the latter, before under- 
 taking any operation necessitating opening of the ball. Any disease 
 of either should be cured if possible. If incurable lachrymal disease 
 exists, the lachrymal sac should be removed, or the canaliculi may 
 be tied off by passing a suture through each lid so as to include the 
 canaliculus, as advised by Knapp, BuUer and Casey Wood. In the 
 presence of incurable conjunctival disease, with secretion, the con- 
 junctiva may be incised all around the cornea, dissected loose from 
 the ball, and after the completion of the operation proper, the cut 
 edge can be caught up with a purse-string or other suture and 
 brought up to cover completely the cornea. In four or five days the 
 sutures can be cut, when the conjunctiva will resume its normal posi- 
 tion. In the meantime the corneal wound will have firmly closed. 
 
 Redness and roughness of the conjunctiva are of much less im- 
 port in this connection than the presence of secretion, whose bac- 
 terial contents should be carefully scrutinized. Besides attention to 
 these points, the usual antiseptic precautions as to instruments, 
 operator and field of operation should be minutely observed. 
 
 In order to guard against infection after cataract extraction J. 
 A. White advises a careful routine, which is indorsed by others who 
 have followed it. The most important feature of this preliminary 
 
 Vol. I— 12
 
 178 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 treatment is the use of a bichloride vaseline, 1-3000 (See White's 
 ointment), with which the conjunctival sac is filled for twelve hours 
 before the operation and the eye is dressed with the same prepara- 
 tion each time the bandage is removed. 
 
 Following the cataract extraction, iritis is not uncommon, as evi- 
 denced by pericorneal injection or more general redness, and by 
 adhesion of the iris to the capsular remains. To combat this form 
 of inflammation the pupil should be dilated with atropine as soon 
 as the anterior chamber is reformed, and the atropine continued 
 
 Galvano-Cautery Handle for Use in Ophthalmic Surgery 
 
 at such intervals as may be necessary to maintain maximum dila- 
 tion of the pupil. Dionin, with or without general remedies, is also 
 of signal value. Post-operative iritis varies much in severity. 
 
 Irido-eyclitis, indicated by the severity and long duration of the 
 inflammation, sometimes occurs, usually due to roughness in hand- 
 ling the eye at the time of operation. A healthy condition of the 
 cornea and wound and the absence of pus in the anterior chamber 
 should enable one to differentiate plastic inflammation from that 
 due to infection, although some observers regard every post-opera- 
 tive uveitis as infective in character. The treatment is much the 
 same as that employed for iritis, although in this connection one 
 should bear in mind full doses of aspirin or the salicylates, given in 
 the manner described by Gifford. 
 
 Another condition that is especially apt to disconcert an inex- 
 perienced operator is Avhat is known as "striped" keratitis. This 
 is a deep-seated corneal infiltration, manifesting itself as parallel 
 gray lines and running from the wound towards or even beyond the 
 center of the cornea. It is caused by traumatism to the cornea, and 
 is probably always due to the operator making too small a corneal 
 wound, and bruising its edges in the delivery of the lens. 
 
 When infection of the wound of operation develops, the question 
 of treatment is important and urgent. The dressings should be 
 permanently removed from the eye. It is a well-known fact that an 
 occlusive dressing applied to an eye will increase or cause conjunc- 
 tival secretion, and this is the reason for dispensing with the 
 dressing. 
 
 Ice compresses should be applied continuously for at least 36
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS lid 
 
 hours. This will require the eutii-e time of one person and should be 
 carried out as already described in this section. If at the end of 36 
 hours some arrest of the infectious process seems to have occurred, 
 the cold applications may be continued, but this is a matter for the 
 surgeon to decide. Cold applications are preferable to hot, in that 
 the lowered temperature exerts an inhibiting intiuence on bacterial 
 growth, though hot applications are preferred by some. The latter 
 should be applied, as described elsewhere, for ten minutes at a time, 
 every three hours. 
 
 The eye should be irrigated with an antiseptic solution at least 
 every hour. Boric acid is probably the best, but bichloride and 
 other salts of mercury, 1-5,000 to 1-10,000; permanganate of potash 
 
 ^Illiffi^^lWI 
 
 Galvano-Cautery Points for Use in Ophthalmic Surgery 
 
 1-10,000 ; carbolic acid i/o of 1 per cent ; formalin 1-1,000 ; have all 
 been recommended. The last named is apt to prove too irritating. 
 
 The wound should be cauterized throughout its entire extent. 
 The actual cautery is best, using the galvano-cautery or a simpler 
 device, such as the Wordsworth-Todd cautery. A strabismus hook 
 or probe heated in the flame of an alcohol lamp can be made to 
 answer the same purpose. 
 
 In addition to these measures some antiseptic should be frequently 
 instilled as "drops" into the eye. Argyrol, as a freshly prepared 
 fifty per cent solution, is probably the best for this purpose. It is 
 not irritating, and while laboratory tests do not give it high rank 
 as an antiseptic, it is clinically one of the most efficient. It should 
 be dropped into the eye after each irrigation. 
 
 The introduction of iodoform into the anterior chamber of vitre- 
 ous is a measure advocated by Haab, Ostwalt and others. Experi- 
 mental study carried out by the writer has not been very convincing 
 in its testimony, but it seems worthy of trial. The iodoform is in- 
 corporated with gelatin, and made into little rods to facilitate its 
 introduction into the eye. This is accomplished by means of forceps, 
 either through the operative wound, or other opening, and should 
 be repeated when the first rod is seen to be absorbed.
 
 180 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 The injection of antiseptic solutions into the eye-ball, into the 
 orbit, and under the conjunctiva, has been advised. The solutions 
 are generally of some salt of mercury — preferably the cyanide 
 [always associated with one per cent acoin (q. v.)] in the proportion 
 of 1-3,000 to 1-1,000. This procedure is to be recommended, since 
 it does not interfere with other treatment and some good results 
 have been reported from its use. E. L. Jones injects under the con- 
 junctiva 2 c.c. of 1-1500 cyanide of mercury in which is dissolved 
 .03 of a powder composed of one part acoin, one part boric acid and 
 four parts sodium chloride. This solution is said not to be painful, 
 and its therapeutic virtues are highly praised. Bourgeois prefers the 
 oxycyanate, 1-1,000. 
 
 Wordsworth-Todd Cautery, The Ball is of Copper and Eetains the Heat. By- 
 Means of the Two Projecting Points the Application Can Be Accurately Made 
 
 It is unfortunately true that when infection involves an eye after 
 the extraction of cataract, an iridectomy, or removal of a foreign 
 body from the vitreous, the eye is nearly always destroyed in spite 
 of all our efforts to prevent it. Therefore when the infective process 
 has advanced to a point where, in the judgment of the surgeon, the 
 destruction of the eye is certain, much time and suffering can be 
 saved by evisceration or enucleation. It requires no small degree 
 of moral courage to advise the enucleation of an eye on which one 
 undertook a cataract extraction but a few days before, with every 
 prospect of restoring the function to the eye, and possibly for this 
 reason the operation is frequently not done under these circum- 
 stances. It is a question too, as to how much risk there is under 
 these circumstances of enucleation being followed by meningitis 
 from infection of the sheath of the optic nerve, but Randolph has 
 recently shown that the risk is very small. 
 
 Although the complications that arise during or following the 
 performance of ophthalmic operations in general will be dealt 
 with under their appropriate headings, it is deemed advisable, even 
 at the risk of repeating some of the matter detailed in other sections 
 of this work, to mention here at least some of the special accidents 
 and complications of the more common operations, and the measures 
 at our command to combat them. 
 
 In the operations for enucleation of the eye (q. v.) it is usually 
 advised to have the stump of one of the eye muscles, generally the
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 181 
 
 internal rectus, left long enough to afford a grasp for the forceps, 
 whereby the ball may be subsecpiently steadied. If this is not done on 
 this muscle, some other should be so left. Should this hold not prove 
 sufficient the ball may be grasped with the thumb and finger, or it 
 may be dislocated forward after the miiscles are all cut, allowing the 
 lids to close behind and hold it. Or a spoon, with a fissure in the 
 bowl, may he passed under the ball and the nerve fitted into this 
 fissure. In the case of phthisical eyes the best fixation is secured by 
 passing a strong suture through the ball before beginning the opera- 
 tion and controlling the ball by means of it. 
 
 The eye ball may burst in removing it, especially if its coats are 
 ulcerated or otherwise thinned. More careful dissection is called for 
 to insure a clean removal, and if the contents of the ball are septic, 
 infection of the operative field is more apt to occur. Extraordinary 
 eft'orts at disinfecting the wound should be used. 
 
 Especially when the ball is collapsed, but even under ordinary 
 conditions, the scissors may button-hole the sclera in dividing the 
 muscles, or in cutting the optic nerve. Except that the subsequent 
 steps of the operation are more difficult and tedious, no special harm 
 is apt to follow, though a bungling operation is a source of chagrin 
 to the operator. If a piece of sclera is cut out from the posterior 
 pole of the eye in attempting to sever the nerve, it had best be 
 searched for and removed, together with a section of the nerve. 
 
 It may happen that in tenotomy and advancement of ocular mus- 
 cles the surgeon fails to penetrate the capsule of Tenon and to pass 
 the hook beneath the tendon of the muscle, but pushes it between 
 the conjunctiva and capsule, where it meets little or no resistance. 
 "With the bloodless field made possible by the suprarenal prepara- 
 tions this is not apt to happen, but it is a possibility to be borne in 
 mind by the beginner. 
 
 The most common complications in muscle operations pertains to 
 the stitches cutting out of both muscles and sclera. Many ingenious 
 methods exist for placing sutures in the muscular tissues so they will 
 not cut out, the best being some plan of tying the suture, as in the 
 "Worth operation. Scleral anchorage is more of a problem. Sutures 
 passed deeply and at right angles to the line of traction are most 
 secure. By bringing the muscle forward and attaching it to the 
 scleral stump of the tendon, a secure fastening is easily obtained, 
 and in the proper' position on the ball. Many operations (e. g., 
 Hulen's) prepare for the contingency of the suture cutting out by 
 having additional or secondary ones placed to tie in case of need. 
 Some such plan is very desirable until a method is devised that 
 will prevent this complication from arising, as without it the only
 
 182 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 thing is to watch the eye slowly return to its original faulty position 
 to be corrected by a fresh operation. 
 
 The tearing out or breaking of a suture at the time of operation 
 may be avoided bj' care or remedied by the introduction of fresh 
 sutures. 
 
 It is important in these and other operations where sutures are 
 employed that no knot or end should touch the cornea, as corneal 
 ulceration may be thereby induced, with the possibility of most dis- 
 astrous results. 
 
 Operations involving corneal incisions may be complicated by a 
 variety of accidents. 
 
 "Wrinkling of the cornea may occur in old people. When the 
 chamber refills the cornea resumes its normal shape, and this accident 
 need occasion no alarm. 
 
 A bubble of air may enter the chamber. It will disappear, or may 
 be stroked out with a spatula just as blood and cortical matter are 
 removed. If let alone it will be absorbed. 
 
 Prolapse of iris into the wound may occur, either with the iris 
 simpl.v engaged in the wound or projecting through it. If let alone 
 this condition may result in a distorted pupil, irregular healing of 
 the wound, iritis, infection, immediate or remote, glaucoma or sym- 
 pathetic ophthalmia. An attempt therefore should be made to replace 
 the iris by manipulation with a spatula. In this way the iris can 
 often be replaced, and a round pupil and a free wound secured. 
 If from the size or position of the wound, or other reason, the iris 
 will not remain in place, but continues to prolapse, it should be 
 grasped with forceps, drawn out a little from the wound, and then 
 cut off. Unless it is drawn out from the chamber a little it may be 
 found that the pillars of the coloboma (cut edges of the iris) are as 
 unruly as the original prolapse, and cannot be replaced within the 
 chamber. 
 
 Should this be the case, or should an excision of the iris have 
 been the original operation, and prolapse of the cut edges appear, 
 the edges should be repeatedly replaced by passing a spatula through 
 the wound and onto each half of the iris in turn at as near right 
 angles as possible with the edge of the iris wound. By moving the 
 spatula toward the center of the pupil the iris is unfurled and spread 
 out smoothly, and will usually remain so. Otherwise additional 
 pieces must be removed from the pillars until they will rem.ain in 
 place. 
 
 If some of the iris remains in the wound, we have the condition 
 resulting as hernia or "healed-in-iris. " Sometimes this causes a 
 permanent dark spot in the line of the wound, and sometimes the
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 183 
 
 scar is white tlirougliout, as if no iris was caught iu the wound. 
 Such a scar is firm, not unsightly, and not a cause of trouble, and 
 can result from a very considerable prolapse. On account of the 
 possibility of this favorable termination, a prolapse of the iris that 
 cannot be cleanly excised or satisfactorily replaced on account of 
 adhesions that have formed between the iris and the edges of the 
 wound through which the knuckle of iris protrudes, may be let 
 alone. Other alternatives are incision of the prolapse with a knife, 
 or cauterization with the actual or chemical cautery, both of which 
 plans tend to produce a flat white scar. 
 
 There may be delay in the closure of the wound. This is usually 
 due to the inclusion of a portion of iris or lens capsule or lens 
 matter between the lips of the incision. Careful toilet of the wound 
 should prevent this, or if it occurs some such cause should be care- 
 fully searched for with a magnifying lens and good illumination, 
 and removed. Occasionally a corneal wound will be slow to unite 
 without apparent cause. 
 
 The wound, once closed, may reopen. This may occur as the re- 
 sult of increased intra-ocular tension, or from pressure on the eye. 
 The dangers of such au accident are hemorrhage, prolapse of the 
 ocular contents and infection. Rest is the principal agent in bringing 
 about a closure of the reopened wound. 
 
 In making a corneal incision the knife may not penetrate the 
 whole thickness of the cornea, but pass between the layers, splitting 
 the membrane. The incision nuist be made over. 
 
 The incision may be made too short for the performance of the 
 contemplated operation. It may either be enlarged with scissors 
 or a blunt-pointed knife, or the operation postponed. 
 
 Besides the complications enumerated as occurring with in- 
 cisions of the cornea, there are a few others that pertain to an iri- 
 dectomy. Hemorrhage into the anterior chamber has been men- 
 tioned. 
 
 Detachment of the iris may occur, usually as the result of some 
 unexpected movement of the eye after the iris is grasped with the 
 forceps. As clean an excision of the fragments as possible must 
 be made, and especial care exercised to see that no tags remain in the 
 corneal wound. 
 
 The iris may be button-holed, and the sphincter left, instead of a 
 section of the whole width of the iris being removed. This can be 
 avoided by grasping the iris at the pupillary margin with the iris 
 forceps preparatory to its excision. Should the little bridge be left.
 
 184 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 it can be engaged with a blunt hook, and either broken or drawn 
 out and cut off. 
 
 Premature escape of the aqueous may in cataract extraction not 
 interfere much with the operation, but if it occurs before the counter- 
 puncture is made it may be necessary to postpone the operation 
 until the anterior chamber reforms. 
 
 The iris may be caught on the point or edge of the knife blade. 
 If it cannot be disengaged the incision should be completed regard- 
 less of injury to the iris, which can be subsequently trimmed up to 
 make a neat iridectomy. 
 
 The knife may be entered upside down. If the blade is narrow 
 it can be rotated to the proper position, or it can be withdrawn and 
 the operation postponed. 
 
 Choroidal hemorrhage may occur at any time after the corneal 
 incision. It is due to rupture of the choroidal vessels when their 
 support is removed following the emptying of the anterior chamber. 
 The patient experiences pain, depression, shock and sometimes vomit- 
 ing. The wound gapes and vitreous and then blood flow from it. 
 This may immediately follow the corneal incision, or may come on 
 several hours later. Treatment is of no avail and the eye is always 
 lost. 
 
 Prolapse of the vitreous may occur, either before or after delivery 
 of the lens. If before the delivery of the lens, the vitreous (and 
 iris) which has prolapsed should be excised, and the delivery of 
 the lens effected with as little pressure on the ball as possible. It 
 is usually best to deliver the lens under these circumstances with a 
 wire loop or lens scoop. 
 
 If the lens has been delivered and the vitreous prolapses, the 
 speculum or lid elevator should at once be removed, the lids closed 
 and eye left quiet for a moment. Loss of vitreous is often due to 
 muscular spasm, in which event the recti participate, and if all 
 disturbing influences are removed the spasm may subside, and the 
 prolapsed vitreous recede. Otherwise it should be excised as close 
 to the ball as possible, and the toilet of the wound gently completed. 
 
 The lens may be dislocated during extraction, especially in cases 
 of fluid vitreous. Should this occur it is usually best to wait a while, 
 and if the lens does not reappear in the pupillary space, to close the 
 eye and apply a dressing. It is said that the cataract will sooner 
 or later reappear in the pupillary space, and may then be extracted. 
 
 The lens may be expelled by the patient "squeezing" — orbicular 
 spasm — at any time after the corneal section. Often this is accom- 
 panied by prolapse of the vitreous.
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 185 
 
 The accidents most apt to happen in connection with excision of 
 the lachrymal sac are failure to locate the sac and rupture of the 
 sac durmg its extraction. The lirst can be avoided by locating the 
 lachrymal crest and cutting down on it. It is a sharp ridge of bone 
 that forms the anterior boundary of the groove in which the sac 
 rests. 
 
 Rupture or iJiincture of the sac during the exposure is an un- 
 pleasant accident, as the contents thereof, often purulent, may 
 infect the wound, and the clean removal of the sac is made less 
 easy. If any of the mucous membrane lining the sac is left behind, 
 a new sac will form from it. It should be the surgeon's object, 
 therefore, to remove the sac intact, which is accomplished by care- 
 ful dissection, and with dull dissectors. Should rupture occur, 
 thorough disinfection of the wound is necessary, and after as clean 
 a removal of the sac as possible, the whole cavity should be curetted. 
 It will jDrobably then he best to pack the wound with gauze and 
 have it heal by granulation. 
 
 It may be stated here that w^ounds of the eye and its appendages 
 (operative and other) are treated on the same principles of surgery 
 that should govern the treatment of all wounds, namely, cleanli- 
 ness, restoration of parts to their normal positions and fixing them 
 there, and the removal of hopelessly damaged parts. 
 
 The post-operative conduct of the removal of foreign bodies is 
 fully described in the section on Injuries to the eye. 
 
 For the treatment, primary and secondary, of lid wounds, if they 
 are extensive or when they occur in children, it may be best to 
 give a general anesthetic especially if it is necessary to apply dress- 
 ings. The parts should be thoroughly washed with soap and water, 
 applied with gauze or cotton and not with a brush, and if greasy, 
 as after some accidents in factories, a preliminary cleansing with 
 sweet oil should be carried out. It has been pointed out by Crile 
 that the hands of those working in grease and oil require much 
 effort to cleanse them, and since the grease and oil are not in them- 
 selves particularly objectionable, it is best not to try to remove 
 them at all, as the tissues will be subjected to further bruising and 
 the end sought wall probably not be attained. This might be borne 
 in mind when similar conditions are present about a wound of the 
 lids. In cases where such a state of affairs exists, the antiseptic 
 qualities of tincture of iodine can be employed to great advantage. 
 The free application of this substance to w^ounded and lacerated 
 tissues where infection is feared, is easily made, not objectionable 
 in any way, and most efficient. It is to be highly recommended.
 
 186 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 
 
 Careful search is to be made for foreign bodies in the lids, espe- 
 cially when the nature of the injury renders the presence of one 
 possible. 
 
 It is rarely necessary to condemn and remove any flap or tag 
 of the wounded lid tissues ; all parts should be carefully cleansed 
 and replaced. The wounds should be closed with silk, using either 
 the interruted or the continuous stitch. The former stitch is 
 preferable, as being more adaptable and permitting of a part of it 
 being removed without affecting the whole line of suture. If the 
 wound involves the lid margin, especial care is necessary to secure 
 accurate apposition of the wound edges. It is better to employ a 
 stitch which will penetrate the lid substance from its free border 
 and lie, when tied, parallel to and just within the row of lashes, 
 rather than to rely on stitches passed through the skin of the lid. 
 The importance of using fine needles and suture material is appre- 
 ciated by ophthalmologists, but general surgeons are prone to en- 
 danger good cosmetic results by the use of material that is too clumsy 
 for delicate work. Stitches should be removed early, that is in 
 24 or 36 hours. Thej^ are foreign bodies, a source of irritation and 
 infection, and should be dispensed with at the earliest possible 
 moment. Their use can sometimes be dispensed with by employing, 
 instead, narrow strips of adhesive plaster. 
 
 Wounds of the conjunctiva and sclera are treated on the same 
 principles. It is often possible by suturing the overlying conjunc- 
 tiva to avoid scleral stitches, but Avheu necessary a fine suture, not 
 passing entirely through the sclerotic, can be used to advantage. 
 In general the margins of linear scleral wounds, like corneal wounds, 
 are kept in apposition by the action of the lids, and do not need 
 sutures. Especial care should be exercised in the case of scleral 
 wounds to see that none of the ocular contents remain in the wound. 
 If portions of the iris, vitreous humor or ciliary body should be so 
 engaged, they ought to be replaced with a spatula, or if this is not 
 possible, the prolapsed part should be excised. If the wound of the 
 sclera tend to gape and expel the vitreous, or if the vitreous has 
 prolapsed or presents in the wound, the scleral wound should under 
 such circumstances be closed with a stitch or a conjunctival flap. 
 This is important on account of the great danger of infection of 
 the vitreous occurring when it is exposed. 
 
 Corneal wounds are apt to be accompanied by prolapse of the 
 iris. This hernia should be carefully replaced with a spatula. By 
 manipulation with the same instrument the edges of the wound
 
 AFTER-TREATMENT OF OPHTHALMIC OPERATIONS 1^7 
 
 should be brought into the best possible apposition. If a prolapsed 
 iris is torn, or will not remain in position when replaced, it should 
 be drawn out a little from the wound and cut off. The iridic stump 
 is then replaced. 
 
 Ordinarily one must rely on the lids to keep, by their pressure, 
 the edges of a corneal wound in position, as it is seldom wise to 
 suture a corneal wound. Corneal stitches should be made with a 
 fine suture and a round needle, but if the corneal wound is very ex- 
 tensive and tends to gape, it is best to free the conjunctiva over a 
 sufficiently large area and make a flap, which can be drawn over 
 the cornea. By freeing the conjunctiva all around the edge of the 
 cornea, it can be raised and brought together so as to completely 
 cover the cornea and without undue tension. When the stitches are 
 removed the conjunctiva will resume its normal position, there being 
 little tendency for it to adhere to the corneal wound. 
 
 In wounds affecting the eye-ball cleanliness should be secured 
 on the lines laid down. 
 
 The eye is often injured by burns of hot metal, powder, etc., and 
 by caustics (chemical burns), such as lime (mortar) and acids. 
 These injuries are always the cause of anxiety, since vision may be 
 impaired from the resulting scar if the cornea is burnt, while scarcely 
 less unfortunate are the results produced by cicatricial contraction 
 after burns of the conjunctiva and lids. 
 
 The treatment consists in the removal of the off'ending substance, 
 and its neutralization in the case of caustics. If a caustic alkali 
 is the cause, the eye should be washed with milk. If lime, the eye 
 should be flooded with oil, and then a solution of cane-sugar dropped 
 into it. Acids should be neutralized with alkalies. When this is 
 thoroughly done and all foreign substances removed, the treatment 
 is along the usual antiphlogistic lines. If the cornea is deeply burned 
 an opacity will result, and if the conjunctiva is burned, an adhesion 
 of the lid to the ball (symblepharon) is to be feared. If the fornix 
 conjunctiva? is involved in the burn, a symblepharon is almost sure 
 to follow. It can be subsequently remedied by operation. 
 
 In dealing with the important matter of post-operative dietetics 
 we are not confronted with such i)roblems in the post-operative 
 feeding of ophthalmic patients as are met with in abdominal oper- 
 ations, for instance, and the question is, on the whole, simple. If 
 the patient has taken a general anesthetic, no food or drink should 
 be given until the stomach is (juiet and the nausea and vomiting 
 have ceased. The stomach can then be tested with a teaspoonful
 
 188 AFTER-VISION 
 
 of ice water, and if this is retained, water may be more freely given, 
 as well as milk, broths, etc. Solid and semi-solid food should be 
 withheld for 24 hours. After that time, or from the completion of 
 the operation if a general anesthetic has not been required, the 
 patient should be put on a light diet, such as milk, cereals, eggs, 
 soup, etc., with a few vegetables, and little or no meat, until he 
 resumes his usual activity. In case the operation has involved the 
 interior of the eye-ball, food that requires much chewing is usually 
 to be avoided until the wound in the ball has closed, since the motion 
 of chewing may disturb the eye and lids a little. Except for such 
 precautions as are usually taken in the way of avoiding articles 
 known or apt to cause gastro-intestinal derangement, and in the 
 temperate employment of all kinds of food, the question of a post- 
 operative dietary calls for no special consideration. 
 
 A question one is often called on to consider is that of the use 
 of tobacco and alcohol after operations on persons addicted to 
 their use. This decision should largely rest upon the amount of 
 disturbance their withdrawal is likely to produce. If the craving 
 is great, it is better to allow the stimulant and let it be used openly, 
 safely and moderately, than, as may be the case, secretly, immoder- 
 ately and in a clumsy or otherwise unsafe manner. The same may 
 be said of the use of narcotic drugs by patients who are habituated 
 to them.— (E. C. E.) 
 
 After- vision. Perception of an after-image (q. v.). 
 
 Agamodistonum. This is a small, trematode worm that is occasionally 
 found in the human body, and may affect the eyes. See Ocular 
 parasites. 
 
 Aganoblepharon. (L.), n.n. (Obs.) Cello's name for abnormal 
 adhesion of the eyelids. 
 
 Agar-Agar. n. A substance resembling isinglass made from a sea- 
 weed found in India. It appears in commerce as colorless strips, is 
 very soluble in water and forms a thick jelly, which is used as an 
 article of food in the East Indies. It is largely employed in labora- 
 tory work as a medium for cultivating certain bacteria. 
 
 Gifford and Suker have used agar-agar injected into either the 
 eviscerated eyeball or into the orbit after enucleation. Both ob- 
 servers agree that the advantage — that of providing a pad or stump 
 for an artificial eye — is only temporary. 
 
 Agaric, n. A genus of fungi, including mushrooms and toad-stools. 
 
 Agaricus stercorarius, Oculo-toxic symptoms from. Reports of cases 
 of poisoning with this fungus are rare ; detailed accounts of eye symp-
 
 AGASTYA 189 
 
 toms are still rarer. The following case history resembles that of 
 intoxication from Amanita muscaria (q. v.). One-half hour after 
 eating a meal containing this agaricus, nausea, frontal headache, and 
 dizziness occurred. When the patient tried to walk he looked 
 toward the ground and walked with difficulty. Consciousness re- 
 mained, but attempts to read failed, because the print could not be 
 recognized. More than three hours after eating the mushrooms a 
 soporose condition set in, accompanied by wide, fixed pupils, and 
 then the patient walked about as if he were intoxicated, and he did 
 not seem to recognize his surroundings. Recovery in a day or two. 
 
 Agastya. An ancient East Indian physician of unknown date, who is 
 said to have written 38 treatises, "embracing the wdiole sphere of 
 medicine."— (T. H. S.). 
 
 Agate-glass. A variegated glass made by melting together waste 
 pieces of colored glass. 
 
 Agati grandiflora. An East Indian tree, whose flower juices are used 
 for. dimness of vision. 
 
 Age, Changes in the eye due to old. There are many senile changes in 
 the eye that are not generally indicated, at least not by marked 
 functional disturbances. Without special importance from this 
 standpoint are gradual loss of the luster of the cornea, formation of 
 the arcus senilis, shallowing of the anterior chamber, contraction and 
 decreased motility of the pupil (due to rigidity of the iridic tissues), 
 a stronger light reflex from the lens, yellownsli tinge of the lenticular 
 nucleus (due to increasing density of the fibres), as well as colloid 
 deposits on Descemet's membrane, on the anterior capsule of the 
 lens and on the vitreous lamella of the choroid. Of still greater 
 moment are decreased transparency of the vitreous humor (with 
 occasional floating opacities) as well as fluid vitreous with detach- 
 ment and contraction of the latter. 
 
 Weakness of the zonula may lead to displacements of the lens, 
 and there may set in cystoid degenerations of the inner granular 
 layer of the retina, and other changes that are necessarily accom- 
 panied by decrease in visual acuity. The defect in vision is, of 
 course, more strongly marked if decided opacities of the lens 
 develop, or if sclerosis of the retinal and choroid vessels sets in, 
 and especially if a degeneration of the choroid and retinal tissues 
 supervene. It must not be forgotten that the cerebral portions of 
 the visual apparatus may be damaged by arterio-sclerosis and that, 
 finally, paralysis of the eye muscles, due to lesions about the nuclei 
 of the motor nerves, may occur.
 
 190 AGENESIA 
 
 Agenesia. (L.), n.f. Defective development of a portion of the body. 
 
 Agenesis corticalis. See Amaurotic family idiocy. 
 
 Agerasia. (L.), n.f. A hale old age, i. e., without the feebleness 
 usually accompanying it. 
 
 Agilops. (F.), n.f. An obsolete term for lachrymal fistula or an 
 abscess that has opened externally. 
 
 Aglaukopsia. Achloropsia. Green blindness, or as Hering more prop- 
 erly puts it red-green blindness. 
 
 Aglia. (Obs.) A speck or spot upon the cornea or sclera. 
 
 Aglobulie. (G.) Diminution of red blood-corpuscles. 
 
 Agnew, Cornelius Rea. This well-known surgeon was born in New 
 York City, Aug. 8, 1830, and died there April 18, 1888. He per- 
 formed in that city the greater portion of his work. His ancestors, 
 Huguenot, Irish and Scotch, came to America from time to time 
 during the eighteenth century. His father was William, his mother, 
 Elizabeth Thomson, Agnew. 
 
 When fifteen years of age, he entered Columbia College — an insti- 
 tution which, in after years, was to owe much to his labors — 
 and, at the age of nineteen, received therefrom the degree of bache- 
 lor of arts. In the same year he began to study medicine — after the 
 fashion of the time — with a preceptor. Dr. J. Kearney Rogers, who 
 for many years was surgeon to the New York Hospital and to the 
 New York Eye Infirmary, as well as Professor of Anatomy in the 
 College of Physicians and Surgeons. In the last-named institution 
 the subject of this sketch attended the regular course, and, in 1852, 
 received his professional degree. Serving for a year or more as 
 house surgeon in the New York Hospital, he proceeded, in 1854, 
 to what were then the western wdlds south of Lake Superior. There 
 for about a year he practised in a village which is now Houghton, 
 Michigan. 
 
 Receiving without solicitation the apiDointment of surgeon to the 
 Eye and Ear Infirmary of New York City, he returned to his native 
 town early in 1855. Soon, however, he sailed for Europe to prepare 
 himself still further for the arduous duties of his new position. This 
 he did solely on his own initiative, and because of the deep con- 
 scientiousness for which he was ever noted. 
 
 He did not, however, while abroad, confine his attention exclu- 
 sively to the study of ophthalmology and otology. In Dublin, for 
 example, though he studied under William (afterwards Sir William) 
 Wilde, deviser of "Wilde's Incision" for mastoid abscess, he be-
 
 AGNEW, CORNELIUS REA 
 
 191 
 
 came, at the same time, a resident pupil of the Ijnng-in asylum. In 
 London, a little later, though he studied under William Bowman 
 and George Critchett, he devoted much attention to general 
 medicine and general surgery. Finally, in Paris, where his masters 
 in ophthalmology were no less personages than Sichel and Desmarres, 
 he found time to attend the clinics of Velpeau and Ricord. 
 
 Cornelius Eea Agnew. 
 
 Returning to New York late in 1855, he entered upon a career 
 as general practitioner, and soon was appointed surgeon general of 
 the state. Three years later, he was appointed medical director of 
 the New York Volunteer Hospital. 
 
 In 1856 he married Mary Nash, daughter of Lora Nash, a New 
 York merchant. 
 
 In his later years Agnew devoted himself exclusively to diseases 
 of the eye and ear. 
 
 Dr. Agnew was a man of strongly marked and wholly natural 
 executive ability. Hence it was that, first and foremost, he was 
 a founder of institutions. He was one of four to start the Union 
 League Club of New York City. He assisted, in 1864, in organizing 
 the School of Mines of Columbia. In 1866, at the request of the 
 entire faculty, he established an ophthalmic clinic in the College of 
 Physicians and Surgeons of New York. Two years later he brought 
 into existence the Brooklyn Eye and Ear Hospital, and, the follow- 
 ing year, the Manhattan Eye and Ear Hospital of New York. He
 
 192 AGNEW, CORNELIUS REA 
 
 was also one of the founders of the New York Ophthalmological 
 Society. 
 
 In 1869 he was elected to the clinical professorship of diseases of 
 the eye and ear in the College of Physicians and Surgeons — a posi- 
 tion which he held till his death. 
 
 Agnew's contributions to ophthalmic literature and his inven- 
 tions are numerous and valuable. He devised, for example, an ex- 
 cellent operation for divergent strabismus, which he described in 
 detail in the Transactions of the American Oplithalmological Society, 
 for 1886, p. 31, under the title, "A Method of Operating for Diver- 
 gent Squint." His "operation for thickened capsule" is also an 
 important procedure, often described today by European ophthal- 
 mologists even in their smaller manuals. 
 
 As a lecturer, Agnew was always simple, clear and interesting. 
 According to one of his assistants, Chas. H. May, of New York, 
 "In his first lecture, I remember, he always laid stress upon the 
 necessity for the ophthalmologist being observant, and he regu- 
 larly illustrated the difference between seeing and observing by the 
 following anecdote: A man was preparing to end his day's work 
 one summer afternoon and found that he had allowed comparatively 
 little time for catching the boat which connected with his train. 
 He hastily closed up his office, and rushed to the pier. He saw the 
 ferry boat in the slip, with a space of one or two feet between the 
 boat and the slip. He made up his mind that he could just catch 
 the boat by running. He ran, and, giving a final jump, landed on 
 the boat, knocking down one or two passengers at the same time. 
 Picking himself up, he was accosted by one of the passengers whom 
 he had inconvenienced, with the remark: 'You big goose, the ferry 
 boat is coming in, not going out.' Agnew used to lay stress upon 
 the anecdote, saying that the man saw the ferry boat and the fact 
 that it was not in the slip, but he failed to observe that it was 
 coming in and not going out." 
 
 Dr. Agnew was a man of slender build and middle height, dark- 
 eyed, dark-complexioned, and, when the present writer knew him, 
 with the remains of a raven blackness still lingering in his rapidly 
 whitening hair. He was gently dignified in manner and, even in 
 serious conversation, had a way of smiling softly from time to time, 
 as if a pleasant undercurrent of thought were playing beneath the 
 more immediate matter. The present writer recalls with a kind 
 of poignant gratitude the fact that his own fast-failing, but after- 
 wards excellent, eyes, were tested for the first time by this careful 
 and courteous physician. He recalls especially the manner in which,
 
 AGNEW, D. HAYES 193 
 
 when he had received from Dr. Agnew's hands the folded bit of 
 paper containing the results of the test, he was taken gently by the 
 shoulders, while a pleasant voice observed: "Young man, be there 
 in you much or little, the glasses which you will get in accordance 
 Avith this prescription will certainly prove to be a kind of turning- 
 point in your life." Then — that characteristic smile. 
 
 Agnew was a very religious man, and took an abiding interest in 
 things pertaining to the welfare of the church. He was never in- 
 tolerant, howerer, but, as in his scientific labors, was thoughtful, 
 earnest, careful never to offend and more attentive by far to the 
 duties which he himself had to perform than to looking up defects 
 in the services of others. 
 
 He was a tireless worker, a successful organizer, a profound scien- 
 tist, a truly great man.— (T. H. S.) 
 Agnew, D. Hayes. One of the greatest of American surgeons, and, for 
 one engaged in general work, an excellent ophthalmologist. He was 
 born in Nobleville (now Christiana) Penna., Nov. 24, 1818. He stu- 
 died medicine with his father, a physician of considerable import- 
 ance locally, entered in 1836 the Medical Department of the Univer- 
 sity of Pennsylvania, and in 1838 received his degree from that in- 
 stitution. In 1844 he entered commercial life, made therein an ex- 
 ceedingly dismal failure, as those of scientific tendencies are wont 
 to do, and, in 1847, returned to the practice of medicine. His rise 
 to general jjopularity, as well as to renown among his fellows, ar- 
 rived very slowly, but came, as a matter of course, to stay. Unri- 
 valled as an operator, he was also an impressive teacher and a 
 clear and forceful writer. "Brilliant" is hardly the word for any 
 of the accomplishments of Dr. Agnew. Though all he did was in- 
 teresting and though he possessed an extremely attractive person- 
 ality, yet the salient characteristic of his performances in every 
 division of his work was thoroughness, solidity. 
 
 His magnum opus was ''TJte Principhs aud Practice of Surgery," 
 in three volumes — which appeared from 1878 to 1883. Concerning 
 this work Agnew 's greatest (but sincere and outspokenly generous) 
 rival, Samuel D. Gross, remarked to its author, "You have pro- 
 duced a great and noble work, one creditable alike to yourself, your 
 profession, and your country." 
 
 Ophthalmology received in this masterpiece of Agnew 's, a clear 
 and comprehensive treatment, one that attracted the favorable at- 
 tention of all the ophthalmologists of the day. In addition to this 
 memorable service in his chosen field, Agnew was undoubtedly one 
 of the past masters of operative oculists. Few have ever performed 
 
 Vol. 1—13
 
 194 
 
 AGNEW, D. HAYES 
 
 an operation on an eye with better judgment, greater gentleness, 
 or more extreme precision. He was one of the surgeons to the 
 Wills Eye Hospital from 1866 to 1868. 
 
 Dr. Agnew was straight, tall, and impressive. His heigkt he is 
 said to have had in common with other members of his family. 
 His father is declared on good authority to have been the shortest of 
 seven brothers, though he was six feet two, the tallest being six 
 feet seven. Agnew was (piiet and unobtrusive in his ways, 
 but forever cheerful, sometimes actually genial, and invariably col- 
 
 D. Hayes Agnew. 
 
 leeted and calm. Nothing, in fact, ever disturbed the cool placidity 
 of Agnew, unless it Avas, when manufacturing a gentle, friendly 
 joke- — a sly, cunning, good-natured dig, that left behind a feeling 
 of endearment rather than any sort of hurt. 
 
 In the operating room Dr. Agnew wore, as a rule, a very old linen 
 duster, buttoned close up in front, and, as a matter of course, very 
 clean, but, even in front, very patchy, and ragged and disreputable- 
 looking behind. Former students of the great surgeon inform me 
 that their luemory of the man is inseparable from his "operating 
 duster. '" ' 
 
 Agnew came before the country prominently as one of the phy- 
 scians in the case of President Garfield. 
 
 Agnew died Mar. 22, 1892.— (T. H. S.)
 
 AGNEWS ADVANCEMENT OPERATION 195 
 
 Agnew's advancement operation. In this procedure the opei-ator made 
 a horizontal incision beginning 2 mm. from the nasal margin of the 
 cornea, and extending to the semilunar fold. This Avas carried down 
 to the sclera and muscle to be advanced. A strabismus hook, with 
 an eye drilled in its free extremity, and armed with waxed silk, 
 Avas then swept beneath the upper edge of the tendon, going far 
 enough back to include every straggling band; and the ligature so 
 introduced Avas tied close to the insertion in the sclera. A free 
 tenotonn^ Avas done on the opposing external rectus muscle. The 
 tendon to be advanced Avas raised by the ligature placed around it, 
 and Avas divided at its insertion. Taa-o retenti\'e sutures Avere noAv 
 introduced through the tendon far enough back to produce the ad- 
 A^ancement desired, and to take a firm hold rather deep in tin; mus- 
 cle. The needles Avere passed from the conjunctival to the scleral 
 surface of the tissues, one near the upper, the other near the loAver 
 margin of the tendon. After these Avere placed, the end of the 
 tendon included in the ligature Avas cut off. The ligature serA^ed 
 to hold the tendon, AA'hich can be more conveniently done by the 
 Prince's advancement forceps. 
 
 Then each needle Avas carried beneath the conjunctiA^a, above or 
 beloAv the cornea respectively, so as to take a firm hold in the sclera 
 and emerge about 2 mm. from the corneal margin in the A^ertical 
 meridian. Both sutures Avere draAvn up before either Avas tied. 
 — (E. J.) 
 
 AgneAv's bident. For the extraction of lenses freely floating in the 
 vitreous humor, A^arious methods have been proposed. AgncAv (An 
 
 Agnew's Bident for the Extraction of Dislocated Lenses. 
 
 Operation AA'ith a Double Needle, or Bident, for the Removal of a 
 Crystalline Lens dislocated into the Vitreous Chamber. Trans. Am. 
 Oph. Soc, 1885, p. 69.) used a bident (see the figure), passed 6 mm. 
 from the limbus through the sclera, Avitli Avhich he harpooned the 
 lens. The latter AA'as tlien pushed into the anterior chamber and 
 extracted through a corneal section made beloAv AA-ith a keratome. 
 AgneAv's procedure Avas imitated successfully by Webster and
 
 196 
 
 AGNEW'S ENUCLEATION OPERATION 
 
 Pomeroy. Noyes placed the patient on a table, resting on his chest 
 and abdomen, face downward. He then passed a cataract needle 
 through the sclera, transfixed the lens and extracted it. — (P. A. C.) 
 
 Agnew's enucleation operation. Agnew's method of enucleation, as 
 described by Beard, is essentially as follows : 
 
 After making the circum-corneal incision, and undermining the 
 conjunctiva, the superior rectus is caught by a strabismus hook and 
 cut. Before freeing the point, however, another hook is passed 
 under the internal rectus tendon, thus keeping the globe fixed from 
 time to time by the hooks instead of forceps, as muscle after muscle 
 is severed. Enough of the external rectus is left attached to the 
 globe to serve as a handle, to be held by the forceps, so that the eye 
 may be pulled toward the nose, in order to bring the optic nerve 
 and oblique muscles into prominence, to facilitate their severance 
 by the scissors. — (F. A.) 
 
 Agnew's chalazion operation. The eye is cocainized, and Avith a 
 fine hypodermic needle a drop or two of 1 per cent cocain solution 
 
 C^^^^ 
 
 Agnew's Operation for Chalazion. 
 
 is injected into the growth and the tissues at the margin of the lid 
 where the incision is to be made. The injection will be facilitated 
 by the use of a Wilder 's U-shaped clamp, placed on the lid over the 
 chalazion after the eye has first been cocainized. After the clamp is 
 fixed, the fine hypodermic needle can be passed between the blades 
 into the tissues of the lid margin. The clamp prevents the cocain 
 from getting into the general circulation and limits its action to
 
 AGNEW'S OPERATION FOR SECONDARY CATARACT 197 
 
 the part to be operated on. in two or three minutes the tissues are 
 completely anesthetized, and if the growth is in a part of the lid that 
 can be seized between the thumb and finger, the clamp may be 
 removed; if not, it may be left in place as a means of holding the 
 lid and giving a bloodless field. (See figure.) 
 
 Holding the lid between the finger and thumb so as to give a clear 
 view of the lid margin, a Graefe cataract knife, or a Beer's knife, is 
 then passed through the middle of the lid margin into the tumor. 
 The margin of the tarsus must be accurately split, the incision being 
 of such a length as to include all the diseased Meibomian glands. 
 The knife is then withdrawn and most of the contents of the chala- 
 zion follow it, but the lid should still be held firmly between the 
 finger and thumb. A small curette with serrated edges is then in- 
 troduced into the wound, and the walls of the cavity are thoroughly 
 curetted. During the incision and the curettement, the surgeon's 
 finger and thumb form a perfect guide, as they can feel every mo- 
 tion of the instruments in the tissues. 
 
 When all the contents have been removed, light pressure over the 
 cavity is maintained for a few minutes to prevent it from filling with 
 blood. A light pressure bandage is then applied which may be re- 
 moved the next day. 
 
 The operation, when performed in this manner, is painless and no 
 visible scar remains. — (W. H. W.) 
 
 Agnew's operation for secondary cataract. See After-cataract and its 
 treatment. 
 
 Agnew's peritomy operation for pannus. The severed portions of the 
 conjunctiva are pushed backward to a distance of five millimeters 
 by means of a convex-edged scalpel. With the same instrument, the 
 episcleral tissue is also scraped away till the sclera is quite bare, and, 
 where practical, the scrapings are excised. The larger trunks of the 
 corneal vessels are gently scratched longitudinally with the point of 
 the knife, or, what is perhaps better, each of them is touched where 
 it crosses the limbus with a small, red hot, bulbous electrode. No 
 clots of blood nor shreds of fibrin should be left about the field of 
 operation. — (C. A, 0.) 
 
 Agnivesa. An ancient East Indian physician and priest, of unknown 
 date. From him it is said that Charaka (one of our two chief author- 
 ities for ancient East Indian medicine — including, of course, ophthal- 
 mology) drew the material for his medical treatise, entitled "Ayur- 
 Vida,'"' or "Science of Life."— (T. H. S.) 
 
 Agnoea. (L.), n.f. Loss of perceptive power from disease. Also 
 written agnoia.
 
 198 AGNOSIA 
 
 Agnosia. Loss of the power or ability to recognize persons and otlier 
 objects. 
 
 Ag-o. (It.), n.f. A needle. 
 
 Agrammatism, n. A form of aphasia in which the person is unable 
 to form words grammatically and to arrange them properly in 
 sentences. 
 
 Agrandissement. (F.), n. Magnification or amplification with a 
 lens. 
 
 Agraphia. (L.), n.f. Inability to write, as a result of disease of the 
 central nervous system. The patient may form lines, in the attempt 
 to write, or may be able to fashion single letters but rarely words 
 or sentences. 
 
 Agraphia literaUs. A variety of agraphia due to a disease of the 
 central nervous system, in consequence of which the patient cannot 
 form letters, but writes only "pot-hooks" or other meaningless signs. 
 
 Agraphia verbalis. A variety of agraphia (q. v.) in which letters 
 may be correctly formed, but the words out of which they are 
 fashioned are fanciful or without meaning. 
 
 Ague tree. See Sassafras. 
 
 Aguilonius. The author of a large, but, for the most part valueless, 
 Latin folio, entitled "Opticonim Libri Sex," (Antwerp, 1613). The 
 work should, however, be remembered by ophthalmologists because 
 of its introducing to the scientific world the terms, "horopter" and 
 "radius communis," as well as the conceptions which these terms ex- 
 press.— (T. H. S.) 
 
 Agyptische Augenentziindung. (G.) Trachoma. 
 
 Agyrias. (L.), n.f. (Obs.) Cloudiness of the crystalline lens. 
 
 Ahmad b. Junus al-Harrani. A distinguished Cordovan physician, 
 chiefly remembered to-day because of the fact that, together with 
 his brother Omar, he studied the diseases of the eye under Ibn Wasif 
 at Bagdad for almost 22 years— 941 to 963 A. D.— (T. H. S.) 
 
 Ahnlichkeit. (G.) Similitude, analogy. 
 
 Aiguille. (F.), n.f. A needle. 
 
 Aiguille. (F.), adj. Needled. 
 
 Aiguille a acupuncture. (F.) Acupuncture needle. 
 
 Aiguille a appareil. (F.) A sewing-needle used in making band- 
 
 ages. 
 
 Aiguille a cataracte. (F.) Cataract needle. 
 
 Aiguille a injection hypodermique. (F.) Hypodermic needle. 
 
 Aiguille arrondie. (F.) A rounded needle. 
 
 Aiguille droite. A straight needle. 
 
 Aiguille emmanchee. (F.) A needle with a handle.
 
 AIGUILLE EXPLORATRICE 199 
 
 Aiguille exploratrice. (F.) Exploring needle. 
 
 Aiguille plate. (P.) A flat needle. 
 
 Aiguille thermo-electrique. (F.) Thermo-electric needle. 
 
 Ailerons ligamenteux. (P\) Cheek ligaments; adventitious tendons. 
 
 Aimant. (F.), n. A magnet. 
 
 Aimantation. (F.), n. The use of a magnet for any medical or 
 surgical purpose. 
 
 Aimante. (F.), adj. Magnetized. 
 
 Aimantin. (F.), adj. Magnetic. 
 
 Aiming, Participation of the eyes in the act of. See Marksmanship, 
 Ocular factors in. 
 
 Air. Atmospheric aik. As is well known our atmosphere contains, 
 by volume, free oxygen, 21 parts, carbonic dioxide 0.03 parts, watery 
 vapor and a small percentage of other gases and floating impurities, 
 all largely diluted with free nitrogen, 78 parts. What influence, 
 if any, is exerted by these gases in the rare uses made of air in 
 ophthalmic therapy is unknown. 
 
 A current or blast of hot air is recommended by some surgeons 
 for the relief of iritis, glaucoma, corneal ulcer and other painful 
 diseases of the eye but in all of them it is probably the heat that 
 is the essential factor in this treatment. 
 
 Koster has recommended intraocular injections of sterile air in 
 tubercle of the iris, ciliary body and choroid tract. Later, Terson 
 suggested the subconjunctival use of sterilized air in corneal ulcer 
 and other external diseases of the eye. 
 
 Caralt has made use of subconjunctival injections of sterile air 
 in many ocular maladies. He believes their action to be due to an 
 increased leucocytosis, set up by the presence of oxygen in the sub- 
 conjunctival tissues, and feels justified in making the following con- 
 clusions : 
 
 The injections are harmless, painless, analgesic ; and remove adhes- 
 ions of the subconjunctival space. They stimulate leucocytosis, and 
 hasten the removal of the products of inflammation. 
 
 They have little or no antiseptic power, and are therefore inferior, 
 in presence of virulent infection, to the injections of mercurial 
 solutions. 
 
 Their lymphagogic and osmotic power is less than that of injec- 
 tions of sodium chloride, and the latter should be used in intraocular 
 infections. 
 
 In scleritis, and sclerosing keratitis, and also in tuberculous and 
 filamentary keratitis, they are the treatment of election. 
 They seem to be specific in tuberculous iritis.
 
 200 AIROFORM 
 
 They are the best treatment known in hypertrophy of the limbus 
 in spring catarrh, and in bulbous keratitis dependent on herpes or 
 traumatism. 
 
 They are of value as an adjuvant method in various forms of 
 ulcer. 
 
 Very good results with hot air were obtained by Koll {Zeitschr. /. 
 Augenheilk., April, 1912), in a number of cases, especially children,, 
 with impetiginous and squamous eczema of the face, as shown by a 
 few illustrative clinical histories. The action of the heat and rela- 
 tively dry air current consists at first in a superficial drying of the 
 secreting surfaces and with this and the intense heat a destruction of 
 the superficially located bacteria; secondarily it produces a con- 
 siderable hyperemia, with its beneficial effect of promoting the heal- 
 ing and alleviating the pain and itching. Hot air is best furnished 
 by the electric hot air douche and the technic is very simple. From 
 a distance of from 10 to 15 cm. the hot air current is directed to the 
 diseased parts until a visible drying and hyperemia is produced. 
 Caution is necessary to avoid burns. This can be easily done by a 
 rotary movement of the applicator and by increasing the distance 
 • from the face. 
 
 The experience at the Nancy clinic in the treatment of corneal 
 ulcer with the hot air douche is recorded by Kozet. The air-stream 
 was well borne at a temperature of 65 to 70 C. and was followed by 
 improvement of acute ulcerative processes within one day, while 
 chronic processes were healed within four weeks. 
 
 In sterilizing air it is only necessary to draw it into the container 
 (generally the barrel of a syringe) by placing the needle point in 
 the center of a good-sized alcohol flame and "sucking" the air 
 through the flame while slowly withdrawing the piston. 
 Airofomi. See Airol. 
 
 Airol. Bismuth oxyiodo-subgallate. Airoform. This compound is a 
 light, odorless, tasteless, grayish-green powder slowly changing ta 
 red on exposure. It is insoluble in water or alcohol, contains 24 
 per cent, of iodine, is used as a substitute for iodoform and has been 
 employed as a 10 per cent, ointment, which must be free of water,^ 
 that decomposes it. 
 
 Airol is used in the treatment of both infective and interstitial 
 keratitis. As a substitute for iodoform it is also useful as a dry 
 dressing in plastic operations on the lids and as a disinfectant dust- 
 ing powder in the treatment of corneal ulcer. 
 Airy, Sir George Biddell. This scientist, British Astronomer Royal, 
 was born at Alnwick on the 27th of July, 1801, and died in 1892. He
 
 AKAMATHESIA 201 
 
 is well known for his contributions on optics to the Royal Society 
 and other scientific associations. It is said that he re-discovered the 
 optical condition which we know as astigmatism. 
 
 Akamathesia. (L.), f.n. Blunting or blurring of the perceptive 
 faculties. 
 
 Akamathesia optica. (L.) Psychic blindness. 
 
 Akbari. An Arabian ophthalmologist of the IMiddle Ages, whose 
 name is mentioned in Halifa's Book of Sufficiency in Ophthalmology. 
 Nothing else is known about him. — (T. H. S.) 
 
 Akeidopevirastik. (G.) The employment of needles or trocars for 
 diagnostic purposes. 
 
 Akeratodiaphanie. (F.), n. A corneal opacity. 
 
 Akestoma. (L.), n.n. A new growth formed of granulation tissues. 
 
 Akestom. (G.) Cheloid. 
 
 Akinesia iridis. (L.) An obsolete term for rigidity or immobility of 
 the iris. 
 
 Akinesie. (G.) Akinesia paralysis, motor paralysis. 
 
 Akinesie de I'iris. (F.) (Obs.) Rigidity or immobility of the iris. 
 
 Akiurgie. (G.) Operative surgery. 
 
 Akiurgisch. (G.) Relating to operative surgery. 
 
 Akklimatisiren. (G.) To acclimate. 
 
 Akklimatisirung. (G.) Acclimation. 
 
 Akkommodation. (G.) Accommodation. 
 
 Akkommodationsabnahme im Alter. (G.) Accommodative loss in 
 the aged. 
 
 Akkommodationsanstrengung. (G.) Effort of accommodation. 
 
 Akkommodationsapparat. (G.) Accommodation apparatus. 
 
 Akkommodationsauspannung. (G.) Tension of accommodation. 
 
 Akkommodationsbediirfnis. (G.) Necessity of accommodation. 
 
 Akkommodationsbereich. (G.) Range of accommodation. 
 
 Akkommodationsbestimmung. (G.) Determining accommodation. 
 
 Akkommodationsbreite. (G.) Range of accommodation. 
 
 Akkommodationsbreite, Relativ. (G.) Relative range of accommo- 
 dation. 
 
 Akkommodationsfahigkeit. (G.) PoAver of accommodation, faculty 
 of adaptation. 
 
 Akkommodationsgebiet. (G.) Accommodative range. 
 
 Accommodationskraft. (G.) Power of accommodation, faculty of 
 adaptation. 
 
 Akkommodationskrampf. (G.) Spasm of the ciliary muscle. 
 
 Akkommodationslahmung. (G.) Paralj^sis of accommodation. 
 
 Akkommodationslahmung bei Diphtherie. (G.) Paralysis of the ac- 
 commodation in diphtheria.
 
 202 akkommodationslahmung bei lues 
 
 Akkommodationslahmung bei Lues. (G.) Paralysis of the accommo- 
 dation in lues. 
 
 Akkommodationslinie. (G.) Line of accommodation. 
 
 Akkommodationsmuskel. (G.) Ciliary muscle. 
 
 Akkommodationsphosphen. (G.) Accommodation phosphene. 
 
 Akkommodationsruhe. (G.) Relaxation of accommodation. 
 
 Akkomraodationsschwache. (G.) Weakness of accommodation. 
 
 Akkommodationsstorung". (G.) Disturbance of accommodation. 
 
 Akkommodationstheorie. (G.) Theory of accommodation. 
 
 Akkommodationsvermogen. (G.) Accommodation, ability, capabil- 
 ity and capacity of. 
 
 Akkommodationveranderung-en im Alter. (G.) Changes in accom- 
 modation in the aged. 
 
 Akne. (G.) Acne. 
 
 Akog'nosie. (G.) Acologie; therapeutics; operative surgery. 
 
 Akoin. (G.) Acoine. 
 
 Akologie. (G.) Knowledge of surgical instruments and their use. 
 
 Akribometer. (G.) Instrument for measuring minute objects. 
 
 Akrisie. (G.) Absence of crisis; doubtful nature of a disease. 
 
 Akroblast. (G.) Term applied by J. Kollmann to tissue of germinal 
 wall. 
 
 Akrochordon. (G.) A pedunculated tumor ; mollusc or wart. 
 
 Aktinogramm. (G.) Skiagram, 
 
 Aktinomyces. (G.) Actinomyces. 
 
 Aktinomycesdriisen. (G.) Actinomycotic granules. 
 
 Aktinomycesfaden. (G.) Actinomyces thread. 
 
 Aktinomycesg'eschwulst. (G.) Actinomyces tumor. 
 
 Aktinomykose. (G.) Actinomyces. A parasitic micro-organism of 
 animals and man forming rosettes of minute club-shaped elements, 
 whence its name of the ray-fungus. 
 
 Aktinomykose der Orbita. (G.) Actinomyces of the orbit. 
 
 Aktinomykosemiliare der Choroidea. (G.) Miliary actinomyces of 
 the choroid. 
 
 Aktol. See Actol. 
 
 Akyanopsia. Another spelling of acyanopsia, or blue-blindness. See 
 Color sense and Color vision. 
 
 Akyanopsie. (G.) Blue-blindness. 
 
 Alactocus. (L.), adj. Bringing forth the young blind, as in the case 
 of the lower animals. 
 
 Al-Akfani, Sams ad-din Muh. b. Ibrahim b. Said as-Singari al-Misri b. 
 This exceedingly late Egypto-Arabian ophthalmologist (died at
 
 ALAUN 203 
 
 Cairo 1348 A. D.) is the author of an extant work upou tlie eye, 
 entitled The Discovery of Filth in Eye-Diseases, which is partly 
 scientific and partly superstitious in character. In the 15th century 
 a commentary on the book was written by Nur ad-din Ali al-Munawi 
 e'alled Protection of the Eyes. Otherwise it seems to have made but 
 little impression either on the Eastern, or on the Western, ophthal- 
 mologic world. — (T. H. S.) 
 
 Alaun. (G.), n. Alum. 
 
 Alaunerde, (G.) Alumina. 
 
 Alaunicht. (G.) Alumish. 
 
 Alaunig. (G.) Aluminous. 
 
 Alaunkuchen. (G.) Aluminium sulphate. 
 
 Alaunmehl. (G.) Impure alum. 
 
 Alaunmolken. (G.) Alum whey. 
 
 Alaunstein. (G.) Alunite. 
 
 Alaunstift. (G.) An alum stick or point. 
 
 Alaunwasser. (G.) Alum water. 
 
 Albargin. Gelatose silver. Coarse, yellowish, shining powder, very 
 soluble in water; is a compound of silver nitrate with gelatose, 
 containing 14 per cent, of silver. It is found in the market only in 
 the form of 0.2 grm. (3 gr.) tablets. 
 
 In the absence of distilled water, dilute solutions of albargin may 
 be made with the ordinary water supply. It is advisable, however, 
 to prepare concentrated and stock solutions with distilled water and 
 to protect them from light by storing the solutions in brown glass 
 bottles. To dissolve albargin even boiling water may be used with- 
 out decomposition, as is the case with other albumen compounds of 
 silver. If ordinary spring water is employed it should be added 
 gradually to the albargin with occasional shaking, as with the con- 
 trary order turbidity may be caused ; when distilled water is used 
 however such a precautionary measure is not necessary. 
 
 Albargin stains on clothing are easily washed out with soap and 
 water when fresh. Old stains, which have been exposed to light, are 
 easily removed with hyposulphite of sodium, by steeping the articles 
 of clothing in a warm 10 to 20 per cent, solution until the stains have 
 disappeared. 
 
 For treatment of the eye 10 to 20 per cent, albargin solutions in 
 glycerine are used. Twenty per cent, albargin glycerine solutions 
 are also sold under the name of "Prophylactol." 
 
 This silver compound is regarded by Barnemann and others as 
 superior to all other argentic salts in the treatment of infectious 
 diseases of the eye. It is non-irritant but soon kills the various
 
 204 ALBASIR 
 
 pathogenic cocci. It does not decompose o-n exposure to light and 
 its solution gives a neutral reaction. It is used in 2 per cent, solu- 
 tions wherever silver nitrate or protargol is indicated. It is sold in 
 3-grain tablets, 50 in a glass tube. 
 
 A. C. Bartholomew finds albargin less irritating than and quite 
 as satisfactory a germicide as argyrol and protargol. 
 
 Albasir. The Latin name of an Arabian ophthalmologist, cited, or ap- 
 parently cited, in the Contineus of Rhazes. Nothing else is known 
 about him, and his very existence has been questioned. — (T. H. S.) 
 
 Albedo retinse traumatica. (L.) This is a term applied by Hirsch- 
 berg to simple contusion of the retina (commotio retince); in other 
 words to that condition of temporary (in some instances permanent) 
 loss of vision due to direct or indirect trauma of the eyeball. The 
 lesion of the retina is comparable to the changes (molecular and 
 other) that occur in the cerebral substance after concussion of the 
 brain. 
 
 Alberti, Salomon. (1540-1600.) This anatomist was a professor at 
 Wittenberg, German}', who is remembered by ophthalmologists solely 
 because of his discovery of the lachrymal sac, and his invention of 
 the Latin name by Avhich that structure is still universally known — 
 lacus lachrymalis. — (T. H. S.) 
 
 Albiduria. (L.), n.f. Albuminuria. 
 
 Albinism. Also known as congenital achroma and congenital leuco- 
 DERMA. Congenital absence of dermal pigment but unaccompanied 
 by organic clianges in the skin. This condition also involves the 
 choroid coats and the irides. It is most frequently found in dark 
 skinned races. The deficiency of pigment may be in slight or very 
 pronounced degree. As regards its etiology it is considered by some 
 to he due to heredity, consanguinity, or the admixture of alien blood. 
 No proof can be furnished to substantiate any of these theories. By 
 others it is helcl to be a disease. It is evidently an evidence of ar- 
 rested development Avith an hereditary tendency. All the members 
 of a family may be affected or some may escape, those affected being 
 in other respects normal individuals. 
 
 Ocular defects, hoAvever, may be present, such as corectopia. poly- 
 coria, ectopia lentis and congenital cataract. Pigment is lacking 
 from all pigmented tissues of the body. The skin is light, delicate 
 and thin appearing; the hair soft, fine, downy, Avhite and usually 
 scant. The iris is pinkish, the fundus reflex brilliant. The facial 
 expression characteristic, due to squinting Avhieh results in a cor- 
 rugated broAV. 
 
 Photophobia, nystagmus and amblj'opia are almost constant ac-
 
 ALBINISM 205 
 
 conipaniments of albinism. The entrance of light from many points 
 and angles results in dazzling reflections and lack of definition, giv- 
 ing rise to the three above-named symptoms, viz., photophobia, 
 nystagmus and amblj^opia. The fields of vision and color perception 
 are usually near normal. In a subdued light the albino finds his 
 greatest comfort and consequently is able to get along quite well at 
 night. 
 
 Complete albinism is a permanent condition. Incomplete albinism 
 may improve as the child grows older, the eyes becoming a grayish 
 l)lue or blue color. 
 
 Partial, absolute albinism may occur in both eyes or be limited 
 to one or part of one. All the membranes of the eye are never 
 •completely without pigment. A tendency to disease, especially cat- 
 aract, has been accorded to the lighter eye where one eye is relatively 
 or absolutely albinotic. 
 
 The refraction may be myopic, hypermetropia or astigmatic ; but 
 no one of these conditions predominates and is not in itself the only 
 ■cause of the usual amblyopia, which has been explained as being due 
 in great part to the dazzling and consequent lack of definition. — (W. 
 F. H.) 
 
 Lagleyze {Ophthalmic Year Booh, 1908, p. 155) finds that the im- 
 portant causes of this congenital condition are consanguineous mar- 
 riages and, to a less extent, heredity. Cordoba, a portion of the Ar- 
 gentine Republic, was for more than half a century almost com- 
 pletely isolated, on account of political dissensions. The inhabitants 
 became almost all related to one another; and this population fur- 
 nished a relatively large proportion of albinos. Of his 27 cases, 
 which represented 13 families, Lagleyze found 13 patients in 5 fami- 
 lies who were children of consanguineous parents, first cousins or 
 uncle and niece. The parents of 9 were not related, and in about 5 
 this point was not known. In Levy's case the parents were first 
 •cousins. Nance reports a case in which no consanguinity or heredity 
 could be traced. 
 
 With reference to symptoms Lagleyze notes that deficient intelli- 
 gence, sometimes mentioned in connection with albinism, seems to 
 have no essential relation to it. Nystagmus is rarely absent. Acute- 
 ness of vision is always diminished. Astigmia of about 4 D. is mostly 
 present. But the preponderance of myopia over hyperopia, men- 
 tioned by some authors, was not observed. Strabismus was present 
 in one-third of the cases. 
 
 For the jyre vent ion of albinism Lagleyze would rely on preventing 
 the marriages of persons affected with it, and all marriages between
 
 206 ALBINO 
 
 blood relations. Komoto has sought to give relief by injecting India 
 ink under the conjunctiva, and into the edges and inner surface of 
 the lids. He tried to get the same benefit, without the disfigurement, 
 by using lead carbonate. But while this caused only a slight tem- 
 porary inflammation and little disfigurement, it produced very little 
 improvement in the jjatient's vision. lie reports a ease in which he 
 practised the injection of India ink. Previously the patient could 
 only count fingers at 5 feet. By repeated injections, vision was 
 brought up to 20-50 in each eye. The deformity caused by this pro- 
 cedure might be rendered less noticeable by narrowing the palpebral 
 fissure.— (Ed.) 
 
 Albino. A person affected with albinism. 
 
 Albinotic. Pertaining to an albino ; affected with albinism. 
 
 Albinisraus. (G.) Albinism. 
 
 Albinoismus. (G.) Albinism. 
 
 Albinotisch. (G.) Albinotic. 
 
 Albinuria. (L.), n.f. Albuminuria. 
 
 Albinus, Bernhard. This illustrious surgeon and body-physician to 
 the first King of Prussia, as well as father of the still more famous 
 Bernhard Siegfried Albinus, was born at Dessau, Germany, in 1653. 
 He was, for a time, professor at Frankfort a. 0., and, for 19 years, 
 at Leyden. He is remembered by ophthalmologists because of a 
 cataract-needle, proposed, though not invented, by him. It was a 
 highly elaborate aft'air, the operative extremity of which, though 
 a needle, when introduced into the- eye, became, on the pressure 
 of an outside spring, a delicate pair of forceps. The instrument 
 seems never to have been actually employed by Albinus himself. 
 He died Feb. 27, 1721.— (T. H. S.) 
 
 Albinus, Bernhard Siegfried. This w^orthy son of Bernhard Albinus 
 [the renowned professor of surgery, first at Frankfort a. 0. and 
 later at Lej^den; also body-physician to the first King of Prussia] 
 was born at Frankfort a. 0. in 1697. At the age of 5 he accom- 
 panied his father to Leyden, and, when only 24, succeeded him as 
 professor of anatomy and surgery in the University at that place. 
 He was a very patient investigator, teacher and operator. He was 
 a well known student and teacher of anatomy ; in fact he has been 
 called "The Reformer" of that subject. He is chiefly remembered 
 b}' ophthalmologists because he was the first to furnish an illustra- 
 tion of congenital coloboma of the iris. 
 
 He died, after many years of ill-health — borne without complaint 
 —in Leyden, Sep. 9, 1770.— (T. H. S.)
 
 ALBIZZIA LEBBEK :2U7 
 
 Albizzia lebbek. The sirissa tree of India, whose leaves are used in 
 oplithalmia. 
 
 Albolene. A bland excipient of the vaseline class, marketed as a pro- 
 prietary remedy and sold both in the liquid and solid forms. 
 
 H. Mel. Morton in all affections of the eye with secretion uses 
 the following application at night time along the interpalpebral 
 margin to prevent adherence of the lids and so permitting drainage 
 of the sac: 
 
 Acid, boracic. gr. x. 
 
 Albolene (solid.) "^iv. 
 
 Albrand's test-types. See Examination of the eye. 
 
 Albucasis. A distinguished Arabian physician and ophthalmologist. 
 See Abul Kasim ben Abbas al-Zarav^d. 
 
 Albuginea del occhio. (It.) The sclerotic. 
 
 Albuginea oculi. (L.) The sclerotic coat of the eye; the sclera. 
 
 Albuginee de roeil. (F.) The sclerotic. 
 
 Albug'ineous. adj. Pertaining to the sclerotic. 
 
 Albuginitis. (G.) Inflammation of tunica albuginea. 
 
 Albugo. (Obs.) A white spot, as upon the cornea. 
 
 Albumen. White of egg. There is also dried egg albumen, official 
 in the P. G. as albumen ovi siccum; serum or blood albumen; Tata- 
 albumen, a translucent, gelatin-like modification of egg albumen 
 and "Tropon, •' a proprietary powder said to contain 90 per cent, 
 of albumen. 
 
 Among the few uses of this agent in ocuhir therapeutics is making 
 alum (q. v.) and copper sulphate curds or poultices for recent 
 eechymoses, acute conjunctivitis and the bites and stings of insects, 
 ulcerative blepharitis and other diseases of the lids. 
 
 Albuminoid, adj. Resembling albumen. 
 
 Albuminuria, Disease of the eye in. Apart from the well-known rdinal 
 and optic changes (albuminuric retinitis, retinitis gravidarum, renal 
 vascular retinitis), about to be described, albumen in the urine has 
 been found in various forms of association with other ocular lesions, 
 notably with paralysis of the ocular muscles, iritis, cataract, cyclilis, 
 several forms of choroiditis and retinal angiosclerosis. 
 
 In 1827 Bright called attention to the loss of vision accom|)anyiiig' 
 renal diseases; in 1856 the retinal changes were first observed in llie 
 living eye by Heymann ; and in 1859 Liebreich gave an accui'ate 
 description and an ophthalmoscopic picture of the fundus changes 
 of albuminuric retinitis.
 
 208 ALBUMINURIA, DISEASE OF THE EYE IN 
 
 Of 935 cases of kidney disease, tabulated by Groenanw and Uht- 
 hoff, albuminuric retinitis was present in 209, or 22.4 per cent. ; 
 Wagner met it in 6 per cent, of his cases, while in Galezowski's cases 
 31 per cent, showed albuminuric retinitis. While the disease has 
 been observed a few times in children, as a rule the patients are 
 over 40 years of age, and the majority are between 40 and 50 
 years old. Men are more frequently affected than women, in the 
 proportion of about 7 to 3. As regards the form of kidney 
 lesion present in albuminuric retinitis, the small contracted 
 kidney is the most frequent; chronic diffuse parenchymatous 
 nephritis (large white kidney) forms a close second; the nephritis 
 of scarlatina is third; and the least frequent are the rare cases of 
 amyloid degeneration. As a rule, both eyes are involved in the 
 retinal changes, and it rarely happens that the second eye remains 
 entirely well for the period of a year. 
 
 According to Porter, in the majority of cases of renal disease 
 there is no disease of the retina ; and a majority of renal cases show- 
 ing retinal changes also show changes in the blood-vessels. He con- 
 cludes that the eye disease does not depend so much on the existence 
 of the renal affection as on the fact that the vessels are diseased. 
 Almost without exception the cases of albuminuric retinitis which 
 he observed were found in syphilitics. Owing to vascular changes 
 incident to syphilis, hemorrhages and fatty degenerations are to be 
 expected in the retina. In nearly four thousand post-mortem exam- 
 inations he has never seen one-sided nephritis. Some foreign 
 authors have contended that in unilateral albuminuric retinitis only 
 one kidney is diseased. 
 
 Persons with nephritis often complain of morning headache, 
 nausea, vomiting, etc. The defect of vision is an early symptom, 
 but comes with a late stage of the renal disease, and often with a 
 dilated left cardiac ventricle. Albuminuric retinitis comes after 
 vascular tension has been long increased and elimination begins to 
 fail, and, although appearing as a late sign, it is often the first symp- 
 tom which leads to a correct diagnosis. 
 
 The ophthalmoscopic signs of albuminuric retinitis include vas- 
 cular changes, hemorrhages, Avhite spots, exudations and optic 
 neuritis. These changes are found chiefly in the posterior pole. 
 The optic-nerve head' is reddened, its boundaries are ill defined, the 
 veins are broadened and tortuous, and the arteries are narrowed. 
 The retina about the papilla looks grayish and opaque and small 
 hemorrhages are visible. The arteries often show white streaks on 
 both sides of the red blood-column. In some cases papillitis occurs
 
 ALBUMINURIA, DISEASE OF THE EYE IN 209 
 
 either in the beginning of the ocular disease or long after the appear- 
 ance of the retinal changes mentioned above. In these cases proba- 
 bly there is often a coexistent brain lesion with increased intracranial 
 pressure, and a fatal result is to be expected. Papillitis, however, 
 can occur in albuminuric retinitis without brain lesion. 
 
 If, as is often tiie case, the preliminary stage of hyperemia is 
 absent or is not observed, glittering white patches form the first 
 sign in the retina. They are often arranged in groups surrounding 
 the papilla like a ring and coalescing form large white spots. The 
 inexperienced observer may mistake this condition for opaque nerve- 
 fibres in the retina. Both present large white plaques passing from 
 the papilla, but in the congenital condition (opaque nerve-fibres) 
 signs of inflammation are absent. The exudation of a recent cho- 
 rioiditis is to be distinguished from albuminuric retinitis by the less 
 brilliant whiteness of the patches, and by the fact that they are 
 accompanied by vitreous opacities and pigment collections, w^hile 
 hemorrhages are absent. In the macular region the white spots 
 frequently form a stellate figure. Hemorrhages are found in 
 great variations. In some rare instances the retinal change is pres- 
 ent as a retinitis hemorrhagica, and the white spots are either 
 entirely absent or are present in small numbers. In other rare 
 cases the spots are found in the chorioid as well as in the retina, 
 and pigmentation is present. These are cases of primary inflamma- 
 tion of the uveal tract. The frequency of involvement of difii'erent 
 portions of the retina has been estimated by Schlesinger. He found- 
 hemorrhages and typical lesions in 77 per cent, of all cases of 
 albuminuric retinitis, white spots alone in 14 per cent., and involve- 
 ment of the papilla alone in 7 per cent. The ophthalmoscopic pic- 
 ture is thoroughly typical when both the disseminated white spots 
 and the stellate figure at the macula are present, but an exactly 
 similar picture is sometimes seen, together with papillitis, in some 
 eases of sarcoma of the brain without kidney lesions. According 
 to Laqueur, the same is true of some cases of diabetes mellitus, and 
 also of patients whose urine never contained albumin. A similar 
 picture may be found in poisoning, anemia, and syphilis. The white 
 stellate figure at the macula is not always characteristic of kidney 
 lesion. On the other hand, it may be absent in albuminuric retinitis, 
 and, on the other, it is sometimes seen in cases where albumin is 
 never present in the urine. 
 
 The visual disturbances of this disease comprise a greater oi* less 
 loss of visual acuity, without, as a rule, contraction of the 
 field of vision and without loss of the color- and light-senses. Cen- 
 
 Vol. I— 1 4
 
 210 ALBUMINURIA, DISEASE OF THE EYE IN 
 
 tral scotoma is often present. The loss of vision is usually slow, 
 rarely rapid, complete blindness being seldom observed. If it sud- 
 denly occurs in both eyes, it is suggestive of uremic amaurosis; if 
 unilateral blindness or great loss of vision occurs rapidly, the case 
 is likely one of embolism of the central retinal artery. 
 
 Albumiiuiric retinitis may show improvement or even complete 
 cure, but many patients die before the retinal disease undergoes 
 retrogressive changes. If the kidney lesion improves, the surgeon 
 may hope for improvement in the ocular condition. In some cases 
 the retina improves regardless of the extension of the renal affec- 
 tion. Retinal improvement, when it occurs, is slow, and the stellate 
 appearance of the macula is the last to disappear. The optic nerve 
 head may become Avhitish and atrophic and useful vision may remain. 
 Some cases show alternating loss and improvement of vision for a 
 long period. Complete blindness as a result of this disease is 
 extremely rare. Complications are not common, and include detach- 
 ment of the retina, hemorrhage into the vitreous humor, hemorrhagic 
 glaucoma and embolism of the central retinal artery. 
 
 The anatomic changes in albuminuric retinitis are found chiefly 
 in the posterior pole, rarely reaching forward as far as the equator, 
 and never involving the ora serrata. They consist of edema and 
 inflammatory deposits. The edema accounts for the diffuse cloudi- 
 ness which is visible ophthalmoscopically. The blood-vessels, not 
 only of the retina, but also of the iTveal tract, frequently show 
 sclerotic or hyalin changes in their walls. The radial fibres of 
 Miiller undergo proliferation, and their interstices are filled with a 
 fibrinous deposit. In the retinitis albuminurica of pregnancy 
 changes in the retinal vessels are occasionally absent. 
 
 Hemorrhages occur into the retina and at times break through into 
 the vitreous humor. The white spots, which are visible with the 
 ophthalmoscope, depend on granular or fatty degeneration of the 
 supporting tissue, upon fatty degeneration of cells, particularly in 
 the two granular laj^ers ; or upon the presence of foci of varicose 
 hypertrophied nerve-fibres. The stellate figure in the macular 
 region depends chiefly upon fatty degeneration of Miiller 's support- 
 ing fibres, which radiate from the fovea centralis, and here do not, 
 as in other places, push through the retina. "Weeks questions this 
 explanation. His researches lead him to believe that the changes in 
 Miiller 's fibres are due to post-mortem alterations. The chorioid on 
 microscopic examination shows similar changes, viz. : lesions of the 
 vessels and inflammatory changes.
 
 ALBUMINURIA, DISEASE OF THE EYE IN 211 
 
 In Ihe optic nerve, togetlier witli hypertrophy of the connective 
 tissue, there is edem;i or ])r()iiounced ijifianiniation. Generally the 
 inflaniniatory ciianges involve only the papilla and end at the lamina 
 cribrosa, without further extension eentrall}'. Gurwitsch found 
 hyalin bodies in the liead of tlie oj)tic nerve and in the granular layer 
 of the retina. 
 
 The cause of retinal detachment in albuminuric retinitis is ex- 
 plained by Leber and Nordensen in this manner : the small eleva- 
 tions, especially around the papilla, depend upon a primary exuda- 
 tion into the subretinal space, while further detachment can be attrib- 
 uted to shrinking of the vitreous humor. 
 
 In typical cases the diagnosis of albuminuric retinitis is not dif- 
 ficult, but it must be rem.embered that, while the ophthalmoscopic 
 picture is highly suggestive, it is not pathognomonic, similar fundus 
 changes being met with in rare instances in cases of intracranial 
 tumor, lead encephalopathy, pachymeningitis hemorrhagica, anemia, 
 syphilis, and diabetes mellitus. 
 
 Tumor of the brain, as a rule, is easily distinguishable from 
 Bright 's disease. HoAvever, in some cases of cirrhotic kidney there 
 is little or no dropsy, headache and vomiting are often prominent and 
 distressing symptoms, and pain may be most severe in the back of 
 the head; epileptiform convulsions and even hemiplegia may be pres- 
 ent, while the ophthalmoscopic changes may be similar to those 
 found in cerebral tumor. 
 
 In the differential diagnosis it will be necessary to give attention 
 to the following points: 
 
 The condition of the urine. While the finding of albumin and 
 tube-casts will clear the diagnosis, in some cases of cirrhotic 
 nephritis albumin may be scanty or entirely absent and tube-casts 
 may be so fcAv as to escape detection. 
 
 In all forms of Bright 's disease, except possibly in the pure form 
 of waxy kidney, the blood-pressure is high, the arteries are athero- 
 matous, and the left ventricle is hypertrophied. In the absence 
 of a valvular lesion these symptoms are highly suggestive of renal 
 disease. 
 
 The ophthalmoscopic changes, per se, can never be taken as an 
 absolutely certain guide, for the appearances typical of one condi- 
 tion are, in some rare and exceptional cases, met with in the other. — 
 (J. M. B.) 
 
 The treatment of albuminuric retinitis is practically the treatment 
 of the underlying conditions that give rise to it. These are fully
 
 212 ALBUMINURIC RETINITIS 
 
 discussed elsewhere, especially under Systemic conditions in their 
 relation to ocular symptoms. 
 
 Albuminuric retinitis. Degeneration of the retinal elements associ- 
 ated with albumen in the urine. The aft'ectiou begins with either 
 a neuropapillitis or wath a diffuse peripapillary edema combined 
 later with hemorrhagic placques. The hemorrhage is brought about 
 by the increased vascular tension, and by arteriosclerotic changes 
 of the bloodvessels ; the neuropapillitis is brought about by the in- 
 creased tension of the cerebrospinal fluid. The beneficial effect of 
 lumbar puncture in these eases is, Chauft'ard {Wien. Klin. Wochen- 
 schr., July 18, 1912), says, easily explained by the above theory. The 
 origin of the placques which are also sometimes found in diabetic 
 retinitis and in retinitis gravidarum is more difficult to explain. 
 
 Recently the retention of nitrogen and hypercholesterinemia were 
 considered to be the cause of the formation of the placques. The 
 placques show the characteristic lipoid reaction. For the formation 
 of hypercholesterinemia the suprarenal gland is probably responsi- 
 ble. The suprarenal gland compensates the impermeability of the 
 kidneys. The adrenalinemia causes increased cardiovascular tone 
 with hypertension of the blood and cerebrospinal fluid. As the kid- 
 neys become less permeable the nitrogen and chlorids are retained. 
 The pathogenesis and the character of the albuminuric retinitis are 
 dependent upon the cholesterinemia, and the prognosis is influenced 
 by the retention of the nitrogenous material. 
 
 The treatment of acute albuminuric retinitis is by lumbar punc- 
 ture, and that of the chronic form is with appropriate diet. See 
 Retinitis, Albuminuric. 
 
 Albuminurie. (G.) Albuminuria. 
 
 Album oculi. (L.) An obsolete term for the sclera or white tunic 
 of the eye. 
 
 Alcalescenz. (G.) Alkalescence. 
 
 Alcalescirend. (G.) Alkalescent. 
 
 Alcali. (G.) Alkali. 
 
 Alcalimeter. (G.) Alkalimeter. 
 
 Alcalinisch. (G.) Alkaline. 
 
 Alcalinitat. (G.) Alkalinity. 
 
 Alcalisch. (G.) Alkaline. 
 
 Alcalissiren. (G.) to render alkaline. 
 
 Alcanamusali. This physician is said to have been an Armenian ; he 
 Avas at all events the author of a celebrated work in Arabic on the 
 diseases of the eye. See Canamusali de Baldach. 
 
 Alcmaeon of Crotona. A pupil of Pythagoras and a famous philoso-
 
 ALCOATI -213 
 
 pher and i)hysiciaii, \\li() tlourislu'd 500 B. C. 'Vo him has been at- 
 tributed tlie diseovery of the optic nerves and the Eustachian tubes. 
 His belief in llie existence of these structures, howevei-, would seem 
 to have been arrived at by speculative reasoning, not by actual 
 anatomical investigation. — (T. H. S.) 
 
 Alcoati. ITis name in full is Salomo filius dk Arit. Alcoati, or, Alco- 
 ATi .Salomonis filius; improperly, Alcoatim and Alcoatin. An un- 
 importa)it Spanish-Arabian ophthalmologist, whose one book is, 
 with the exception of a single chapter, extant in Latin translations 
 only. The work is entitled, Lihcr de Oculis qucm Compilavit Alcoati, 
 Christianus Toletanus, anno D. J. MCLIX. The style of llic book 
 is prolix and obscure, and the contents inaccurate and highly egotis- 
 tical. For example, the author takes great credit to himself for 
 making the handles of his cataract-needles of wood. — (T. H. S.) 
 
 Alcoatim. An unimportant Spanish-Arabian ophthalmologist. See 
 Alcoati. 
 
 Alcoatin. An unimportant Spanish-Arabian o])hthalmologist. See 
 Alcoati. 
 
 Alcohol. Ethyl alcohol. Spirits op wine. C2H5HO. Commercial 
 alcohol contains varying proportions of ethyl alcohol, from 95 per 
 cent, in alcohol, U. S. P., 90-95 per cent, in cologne spirits, to 50 per 
 cent, in proof spirit and other mixtures. 
 
 In addition to the use of this remedy as a disinfectant of instru- 
 ments, for the hands of the operator and the dermal field of opera- 
 tion, it is by some surgeons added in small quantities and for its 
 stimulating qualities, to sprays, douches and even to collyria. Prob- 
 ably a number of popular proprietary remedies owe their value to 
 the slightly disinfectant and vascular tonic effects of the alcohol 
 (and essential oils) in these preparations. In this way we have 
 known bay rum, French brandy, rose water, violet water, eau de 
 cologne, spirit of lavender, spirit of camphor, whiskey and other 
 alcoholic fluids used in the proportion of ^00 to V)(M), with relief in 
 simple hyperemia of the conjunctivje. They are generally presented 
 as aqueous collyria in, say, a teaspoonful to a pint of warm, boiled 
 water. Doubtless, also, the remedial effects of that popular remedy 
 Pond's extract (tincture of hamamelis) is mostly due to the alcohol 
 it contains. 
 
 German oculists frequently order stimulating eye waters contain- 
 ing 5 to 10 per cent, of a useful alcoholic mistura oleoso-balsamica, 
 official in their pharmacopeia. Its formula is: boric acid, two and 
 one-quarter grms. ; bitter almond water, 5 c. c. ; rose water 100 c. e. 
 Ohlemann gives several alcoholic prescriptions suitable as eye-
 
 214 ALCOHOL 
 
 washes, douches and collyria in simple hyperemia and conjunc- 
 tivitis. Among them are: mercuric chloride, 3 grains; fennel water, 
 rose water of each six fluid drams ; oleobalsamic mixture three and a 
 half fluid ounces. 
 
 Sig. Use a teaspoonful to a glass of water. 
 
 Spt. melissge co. 100.0 c. c. (5iiiss) 
 
 Spt. lavandulffi 25.0 c. c. (fovi, mxv) 
 
 Spt. camphora? 3.0 c. c. (mxlv) 
 
 Spt. ether nit. 2.6 c .c. (mxl) 
 
 Olei rosa? 0.1 c. c. (mjss) 
 
 Sig : Eye spirits — to be rubbed into forehead and temples. 
 Or this : oleobalsamic mixture, 10 c. c. ; spirits of lavender, 20 
 c. c. ; fennel water, 70 c. c. 
 Sig: Eye drops. 
 
 Mittendorf recommends an alcoholic mixture under the caption 
 Spiritus Ophthalmicus, which, from personal experience, we have 
 found of considerable value. It is intended to be well rubbed into 
 . the eyebrows, forehead and temples for the relief of ocular head- 
 ache and other reflex asthenopic symptoms. The formula is : 
 B 
 Sjjirits lavender, 
 Brandy, of each 3 fluid ounces, 
 Spirits of camphor, 1 fluid ounce. 
 We have also found effective, employed in the same way: chloro- 
 form, one fluid ounce; camphor, two drams; tincture of aconite, two 
 fluid ounces; oil of peppermint, 20 minims; alcohol, two fluid ounces. 
 Sig : Shake well and apply every two or three hours. Do not 
 allow anj^ of the liniment to get into the eyes. 
 
 Alman has published a paper favorable to the use of alcohol com- 
 presses in the treatment of eye diseases. Recently it is also recom- 
 mended as hypodermic injections in supraorbital and other forms of. 
 neuralgia. 
 
 Some of the ocular effects of poisoning by ethyl alcohol are con- 
 junctival injections and swelling, both in acute and in chronic in- 
 toxication. In chronic poisoning, there is present, in addition, a 
 paresis of the orbicularis palpebrarum, combined with anesthesia 
 of the cornea, so that involuntary winking is almost entirely abol- 
 ished; hence, "the fixed, unwinking stare" of the hard drinker, 
 when sober as well as when drunk. The chief ocular lesion in 
 chronic alcoholism is, however, a retrobulbar neuritis of the central
 
 ALCOHOL, METHYL 215 
 
 fibres of the optic nerve, constituting one of tiie principal signs of 
 this common form of toxic amblyopia {([. v.) — (T. E. S. and Ed.). 
 Alcohol, Methyl. AVood spirit. Cologne scirits. Colonial spirits. 
 Columbian spirits. Wood alcohol. Cll^O. Tliis fluid is obtained 
 by the destructive distillation of woody fibre. It has (when unpuri- 
 fied) a nauseous spirituous taste and odor, has a sp. gr. of 0.7995, 
 boils at 55.1° C. and mixes freely with water, ether and ethyl alco- 
 hol. In its "deodorized" or "purified" state it is known by various 
 names (see synonyms) and, although a virulent poison, has been 
 widely sold in America as a substitute for ordinary or ethyl alcohol. 
 
 The symptoms of poisoning from wood si)irit, drunk, inhaled or 
 rubbed in, either as "pure" Columbian spirits or as a common wood 
 alcohol are definite, yet the exact manner and the ultimate form in 
 which it destroys or cripples the internal organs are not well under- 
 stood. Once absorbed, from either the stomach or the lungs, into 
 the blood, it is not so easily eliminated or burned up as is ethyl 
 alcohol. This peculiarity of methyl alcohol is of considerable im- 
 portance and interest because, becoming cumulative in the system, 
 small and frequent doses of the poison in the form of quack medi- 
 cines, hair-tonics, cheap whiskey, or essences, rubbing the body after 
 Turkish and other baths, burning in "alcohol" lamps, varnishing 
 pianos, beer-vats, small rooms, etc., insidious and often unsuspected 
 but serious damage to the digestion, sight and nervous system may 
 be ijiduced. The injury to the eyesight consists ehiefiy of a destruct- 
 ive inflammation of the optic nerve fibers or retinal elements (or 
 both), followed by their atrophy. 
 
 The symptoms of acute poisoning are gastro-intestinal disturb- 
 ances, more or less severe, accompanied by abdominal pain, general 
 weakness, nausea, vomiting, vertigo, headache, dilated pupils and 
 blindness. If recoverj^ does not occur, there is marked depression 
 of the heart's action, sighing respiration, cold sweats, delirium, 
 unconsciousness, coma and death. 
 
 The blindness is bilateral and may set in a few hours after the 
 contact with the poison, or it may be delayed for several days. It 
 is generally complete, with a subsequent improvement, and finally, 
 a' relapse into permanent blindness. 
 
 The diagnosis can hardly be mistaken. Methyl alcohol poisoning 
 presents a jiicture unlike that of any other intoxication. Acute ab- 
 dominal distress, followed by blindness, should always awaken sus- 
 picion of methyl alcohol poisoning. 
 
 The prevention of poisoning by this insidious drug can only be 
 brought about by prohibiting [or rendering unprofitable] the sale
 
 216 ALCOHOL, METHYL 
 
 of "deodorized" wood alcohol in all its foi-ms; possibly by encour- 
 aging the use of "denatured" (ethyl) alcohol in its stead. The 
 number of deaths may, meantime, be limited by putting all methy- 
 lated preparations on the list of poisons and prosecuting all persons 
 adulterating foods and drinks with it. Labeling it "Poison," or 
 with the notice, "This fluid, taken internally, is likely to produce 
 blindness," will certainly have a deterrent effect. 
 
 Methyl alcohol intoxication is an example of idiosyncrasy. As in 
 the case of several other poisons, some persons are largely immune 
 so far as permanent damage to the organism is concerned. If ten 
 persons drink, say, 4 ounces of Columbian spirits within three hours, 
 all will have marked abdominal distress and probably four will 
 die, two of them becoming blind before death. Six will eventually 
 recover, of whom two will be permanently blind. With still larger 
 doses, the proportion of death and blindness will be greater. Pois- 
 oning by inhalation of the fumes of methyl alcohol generally occurs 
 when the exhalations are mixed with rebreathed air, as in varnish- 
 ■ ing the interior of beer-vats, closets or small rooms, etc. It is also 
 highly probable that in susceptible subjects repeated or even single 
 methylated "alcohol rubs" may produce poisonous symptoms, 
 through absorption of the spirit by the skin. Chronic (or partial) 
 poisoning from methyl alcohol (in the shape of "nips" of methy- 
 lated Jamaica ginger, bay rum, punch made with Columbian 
 spirits, etc.) is the most insidious and probably not an uncommon 
 form of intoxication. Its symptoms are not so pronounced or so 
 easy of recognition as in the acute form, but the eyes, digestive 
 apparatus and nervous system undoubtedly suffer. The use of 
 ethyl or grain alcohol in the arts, as in the manufacture of varnishes, 
 as a burning fluid, for "stift'ening" hats, lacquering brass, etc., 
 is without danger to life or eyesight. If a small percentage of 
 naphthalin, for example, w^ere added to it, the fluid would be 
 undrinkable. A combination of ethylic alcohol with 10 per cent, 
 of wood spirit (a.s in our denatured alcohol) would answer the 
 same purpose. Such a mixture is the "methylated spirits" of 
 Great Britain, where not a single case of acute poisoning or blind- 
 ness from methyl alcohol is recorded, in spite of the extensive use 
 of methylated preparations in the British Isles. 
 
 The treatment of methyl alcohol intoxication consists chiefly in 
 getting rid of the poison from the stomach and intestines by means 
 of the stomach-pump and rectal injections; stimulants, especially 
 ethyl alcohol, strychnin and coffee; heat to the body and extremi- 
 ties. The treatment of the blindness is unsatisfactory. (Ed.).
 
 ALCOHOLAMBLYOPIE 217 
 
 Sec Toxic amblyopia. 
 
 Alcoholamblyopie. ((i.) Alcoholic amblyopia. 
 
 Alcoholisiren. (G.) To alcoholize. 
 
 Alcoholisining-. (G.) Alcoholization. 
 
 Alcoholism. The various signs and symptoms due, or traceable to 
 the influence of alcoholic liquors upon the system. 
 
 Alcoholophilia. (L.), n.f. Inordinate craving for alcoholic beverages. 
 
 Alcoholvergiftung", (G.) Alcoholic poisoning. 
 
 Alcol. (It.), n. Alcohol. 
 
 Alcool. The Arabic name for antimony (or its trisnl])hide) used in 
 the East to color the eyebrows. Hence any fine powder used as an 
 application to the eyes. 
 
 Alcool. (It.), n. A name for antimony or its trisulphide (used in 
 the East as a pigment for the eyebrows). A fine powder used as 
 an application to the eyes. 
 
 Alcoolat. (F.), n. A class of alcohol preparations, corresponding 
 to the Spirits of the U. S. P. 
 
 Alcoolisme. (F.), n. Alcoholism (q. v.). 
 
 Aldehyd. (G.) Aldehyde. 
 
 Aldehydgriin. (G.) Aldehyde green. 
 
 Alder, Striped. See Hamamelis. 
 
 Alembrothsalz. (G.) Chloride of mercury and ammonium. 
 
 Aleppobeule. (G.) Aleppo boil. 
 
 Aleppo button. This curious disease, although also called Oriental 
 button, is not confined to the near and far East, but is found in 
 such widely separated countries as Algiers, the Crimea, Panama, and 
 Natal. According to W. B. Adams, of the Syrian Protestant Col- 
 lege, the true cause of the disease "has been demonstrated to be a 
 curious oat-shaped microbe belonging to the animal kingdom. The 
 'button-makers' have been named Leishman bodies. How these 
 germs invade the human system, and lower animals as well, is as yet 
 unknown. Occasionally domestic animals are affected, and I recall 
 an instance where a friend of mine had a dog afflicted with a large 
 button on the end of his nose as badly as any resident of Aleppo." 
 Altounian of Aleppo, Avho has published a monograph on the 
 disease, thinks that the mosquito is the carrier and implanter, and 
 many observers agree with him, but not all. One thing is certain; 
 the button always occurs on an exposed part or on a part covered 
 so thinly that biting insects could pierce through to the skin. After 
 enumerating some ten or a dozen remedies that have held the disease 
 in check, Adams reports the cure of the button both in the Crimea 
 and at Panama by freezing with ether.
 
 218 ALEUKEMIC PLASMOMA 
 
 "It was right here I saw a light. If ether has cured by freezing 
 then carbon dioxid snow ought to cure the button quicker, easier, 
 more effectually, for it is so much easier managed than an ether 
 spray, and it produces a much more intense cold, as it has a tempera- 
 ture of -80 deg. C. Soon after reading Darling's article, a patient 
 appeared with a button on his lower eyelid. As he was a college 
 student it is obvious how serious it was for him to have one eye 
 practically put out of commission for a 3'ear, with possible damage 
 to it and a disfiguring scar on his face. The student had come from 
 Aleppo within three or four months and it began just as he w^as 
 about to depart for college. This patient required two freezings, 
 because the button was so close to the eye I feared injury to the 
 eyeball and consequently froze it for 20 seconds, allowed the papule 
 to thaw, and repeated the freezing twice, making 60 seconds alto- 
 gether. ' ' 
 
 "In my case histories I have notes on 20 cases of Aleppo button 
 treated with carbon dioxid snow since Jan. 20th, 1912. I have 
 treated the buttons in all stages, from small papules of two or three 
 months duration to enormous ones as large as a dollar, and some 
 have been in the late stage of suppuration and crusting. I freeze 
 the whole surface of the button thoroughly, giving at least 60 seconds 
 of firm pressure with the carbon dioxid snow crayon. There is a 
 slight stinging sensation, quite bearable, and the button remains as 
 hard as wood for a minute or two, then it swells ver.y considerably, 
 and in half an hour to one hour the surface blisters, oozes serum 
 freely for two or three days, crusts over, and in ten days to two 
 weeks this crust falls off and reveals the button healed. There is no 
 button there. As recorded in my notes on the first case treated, 'It 
 is cleared entirely, faded, melted, disappeared.' In the cases that are 
 from two to four, or five months old, that is, buttons that have not 
 reached the stage of mixed infection, w^hich is responsible for the 
 suppuration, the treatment leaves a scarcely discernible scar. The 
 suppuration buttons naturally are the longer in healing and leave 
 more of a mark, because there has been more or less destruction of 
 tissue by the process of suppuration ; but even so, the after mark is 
 far less than if the button goes through its long course of a year's 
 suppuration and slow healing." 
 Aleukemic plasmoma. This term uas introduced in 1908 into oph- 
 thalmologic literature by Pascheff with a description of three cases. 
 Eund published a similar case, which he classed under the group 
 of aleukemic heteroplastic lymphomas. An identical case is re- 
 ported by Deutschmann. It Avas characterized by a chronic thick-
 
 ALEURITESdL 219 
 
 ^eniijjy; oT the coiijunctua ul llic uppci' liil witlioul symploni.s of irri- 
 tation. The surface was smooth, with a velloMish shiue from tlie 
 depth. Tlie tumor was fixed to the tarsus and extended from one 
 canthus to tlie other, without involving the retrotarsal fold. Ex- 
 <3ision was easy ; it was detached from the tarsus without difficulty. 
 Microscopically it consisted of plasma cells, which showed no de- 
 pendence on the adventitia of the vessels. There was no hyper- 
 trophy of the submucous tissue, and the tumor did not present an 
 adenoid structure. Therefore Deutschmann {■^eitschr. f. Augenklk. 
 Mar., 1912) considers it as a true tumor, not an inflammatory irri- 
 tation. Clinically, the affection coidd not be distinguished from 
 hyalin and amyloid degenerations of the conjunctiva, which also 
 shows histologically an enormous formation of plasma cells and 
 more or less marked new formation of vessels. The author pro- 
 poses to designate all these tumors plasmomas, because they are 
 real ne^v formations and all consist of plasma cells. 
 
 Aleuritesol. ''G.) Candle-nut oil. 
 
 Aleuronoid particles. In certain amphibians, birds and fishes the 
 outer zone of retinal pigment contains brightly-colored particles 
 (in association with fat droplets), to which this name has been 
 given. They are not found in mammals, including man. 
 
 Alexander Benedictus. An excellent plastic surgeon, ophthalmic and 
 general, who flourished in the latter half of the loth century." See 
 Benedetti.— (T. II. S.) 
 
 Alexander de Spina. The re-discoverer of spectacles, a monk who 
 dwelt in the Dominican cloister of St. Catherine at Pisa for many 
 years, and who died in 1318. The following passages from the 
 ChronicJc of iJiv Cloister show that he was not (as has sometimes 
 been supposed) the first, but only the second, discoverer of "eye- 
 glasses": "Brother Alexander de Spina, a good and modest person, 
 understood how to make whatever he saw, or any restorative that 
 he happened to hear about. Eyeglasses, which Avere first made by 
 somebody" w^ho, however, would communicate nothing about them, 
 he prepared by himself, and then communicated to others concern- 
 ing them with a willing and joA^ful heart." Alexander, though not 
 a physician, was, plainly enough, qualified by nature to be a good 
 and true one. The second passage runs: "Brother Alexander de 
 Spina, of Pisa, could make with his hands whatever he would, and 
 was wont to communicate his arts to others out of good-hearted- 
 ness. As, at that time, somebody had first invented "peepers," 
 (as the people called "ej^eglasses"), by means of a certain beauti- 
 ful, new and useful discovery, and no oiu^ would communicate the
 
 220 ALEXANDER OF TRALLES 
 
 art of their preparation, then did this good man and artist, after 
 he had seen, at once and withont any teacher, proceed to learn it, 
 and he thenceforth taught it also to others, whoever wished to 
 know." 
 
 For the sake of completeness, it ought to be added that the name 
 of the "first" inventor of "eyeglasses" is to this day unknown. 
 It should also be expressly stated that the view so commonly held 
 to the effect that spectacles were known to the ancients, is wholly 
 erroneous. The commonly cited passage from Suetonius relating 
 to Nero and his emerald has, in fact, nothing at all to do 
 with spectacles; for Nero's emerald was a concave mirror, not a 
 lens of Ruy sort. Equally fallacious are the conclusions which at- 
 tribute the invention of spectacles to the Chinese. — (T. H. S.) 
 Alexander of Tralles. A most distinguished physician of the Greek 
 Middle Ages (A. D. 525-605) was born at Tralles, in Lydia. His 
 father, Stephen, and one of his brothers, Dioscurus, were famous 
 physicians. Other notable brothers were : Metrodorus, the gram- 
 marian ; Olympius, the jurist ; and Anthemius, one of the 
 architects of St. Sophia. Alexander studied medicine at first with 
 his father, then with the father of the Indian traveller, Cosmas, and 
 afterwards with many another well known instructor. For the pur- 
 pose of rendering more complete his medical education, he travelled 
 in Cyrene, Spain, Gaul, Italy and Greece. Then he settled in Rome, 
 where he lived until his death. Some years before his death, how- 
 ever, he became unable to practice, and, from that time forth, de- 
 voted himself exclusively to the composition of his immortal Tivelve 
 Books on Medicine. In this Avork, which, for the most part, must 
 be conceded to be only a compilation, the author affords, none the 
 less, evidence of great powers of observation and original reflec- 
 tion. Over and over again, Alexander "warns his contemporaries 
 against the blind acceptance of authority — an admonition greatly 
 needed in that day, and one which its giver took thoroughly to 
 heart himself. He was an excellent diagnostician, and gave much 
 time to inspection, palpation, percussion, etc. He would seem to 
 have made a number of dissections — a remarkable fact for the time. 
 He mentions rhubarb, and is said to be the first in history to have 
 done so. (The "rhubarb" mentioned by Dioscorides — A. D. 40-90— 
 was only the garden variety, or pie-plant.) 
 
 Great as was the Trallean Alexander in general medicine, he 
 possesses for ophthalmologists rather a slight importance. The 
 ophthalmic portion of his Twelve Books is, in fact, little more than
 
 ALEXIA 221 
 
 a collection of prescriptions, with wliicli the compiler would seem 
 to have had but little experience. — (T. II. S.) 
 Alexia. AVord-blindness. A form of aphasia (and psychic blindness) 
 in which the patient does not recognize ordinary printed or written 
 words or letters. 
 
 As an example of this condition, a woman, aged 32, without con- 
 stitutional affections, suddenly became blind after being delivered 
 of triplets. Gradually some improvement took place, leaving a com- 
 plete right-sided, and incomplete left-sided, homonymous hem- 
 ianopsia, with wa-ong projection and faulty conception of the size 
 of objects, amnesic aphasia, alexia and agraphia, and visual hal- 
 lucinations. The preserved visual field had the shape of small cen- 
 tral islets. The ophthalmoscopic condition and pupillaVy reaction 
 being normal and other symptoms wanting, there were in the 
 opinion of Endelnmnn {ArcJiiv f. Augenhcilk., 1912, p. 177), only 
 two possibilities with regard to the etiology, viz., thrombosis of the 
 cerebral arteries and encephalitis from autointoxication during the 
 puerperal state. The marked i^sychie sjaniDtoms seemed to favor the 
 second hypothesis. 
 
 The affection was, according to the symptoms, localized in the 
 parieto-occipital lobe and the left angular gyrus, the center for 
 letters. The alexia alone could be attributed to a lesion of the 
 white subcortical substance, but the simultaneous agraphia indicated 
 that also the cortex was affected and that it was a cortical alexia. 
 In similar cases of Bauer, Chevallereau, and Meyer, the labor was of 
 greatest importance for the origin of the disease, but the immediate 
 causes of the cerebral aft'ection varied, viz. nephritis, acute anemia 
 of some portions of the brain after profuse hemorrhages, and the 
 assumption of an embolic process in the brain. The faulty apprecia- 
 tion of the size of objects and the wrong projection were explained 
 by disturbance of the constant relation between centripetal excita- 
 tion and cortical perception of motion by the hemianopsia. 
 
 Souques reports a case of acquired alexia, in wdiich the autopsy 
 showed destruction of the association fibres connecting the visual 
 cortex with the left bridge convolution between the first and second 
 occipital convolutions. Ball reports, also, a case of developmental 
 alexia. A boy of 15 was kept back in school because of his reading, 
 which was that of a child of 7, although his vision was good, and 
 in other respects he was bright in his studies. The defect was 
 noticed from the time he entered school, at (! years of age. Shortly- 
 before this he had a series of eight epileptiform convulsions, with- 
 out complete unconsciousness. Ball says of his patient: "The ef-
 
 222 ALEXIA, OPTICAL 
 
 forts of the last 9 years to teach him to read and spell have, for the 
 most part, been useless." These efforts were chiefly the school 
 training, which, after the first year, he had to take with younger 
 children. 
 
 Hinshelwood says that the oldest of his patients, a boy of 18, 
 after he had spent 7 years in school, had learned less than he was 
 able to teach himself in the four years that had elapsed since leaving 
 school, in his attempts to spell out the results of football matches 
 from the newspapers. It should be recognized that children Avith 
 this defect even in slight degree, never get a fair opportunity in 
 ordinar}^ school classes. 
 
 Alexia, Optical. Inability to recognize either written or printed words. 
 
 Alexia, Subcortical, of Wernicke. That form of alexia or literal alexia 
 in which the patient is unable to recognize any letter in a word is 
 very unusual; in any event, alexics are usually capable of the 
 recognition of numerals. Although the patient cannot copy either 
 written or printed words he is able to write from dictation or 
 spontaneously, but cannot read what he has just written — even his 
 own signature. He can, however, recognize the writing if he be 
 allowed to follow the written lines with the point of his pen. Apart 
 from written Vv'ords he recognizes and names objects he sees, and 
 apparently is, except in the particular mentioned, in good mental 
 condition. This condition constitutes the subcortical alexia of 
 Wernicke — the "pure"' word-blindness of Dejerine. 
 
 Alexie. (G.) Alexia; word-blindness. 
 
 Alexipharmakom. (G.) Antitoxin, protective drug. 
 
 Algarothpulver. (G.) Algaroth's powder; basic chloride of anti- 
 mony. 
 
 Algen. (G.) Algeous. 
 
 Algesimeter. (G.) Instrument for testing sensibility to pain. 
 
 Alginsaore. (G.) Alginic acid. 
 
 Algometer. An apparatus for testing or measuring the degree of 
 sensibility of a part to pain. 
 
 Alg-ue de Java. (F.) Agar- Agar (q. v.). 
 
 Alhazen. The full form is, Abu Ali Muhammad b. Al-Hasax ibx Al- 
 Haitam al-Basri. He is to be confounded neither with the physi- 
 cian, Abd ar-Rahman b. Ishaq b. al-Haitam, who came later, nor 
 with another Alhazen — he who, in the 10th century, translated 
 Ptolemy's Almagest. This personage was not a doctor, but a 
 mathematician, Avhose great importance to ophthalmologists arises 
 from his services in the field of physiologic optics. He was born at 
 Bassora, A. D. 965, and died at Cairo in 1038. Having boasted his
 
 ALI ABBAS 223 
 
 ability to construct an apparatus Avhereby the inundations of the 
 Nile could be controlled, he was summoned to Egypt for the purpose 
 by the Caliph Ilakem. Knowing his inability to make good his 
 words, Alhazen pretended to become insane. On the Caliph's death, 
 he promptly recovered his reason. 
 
 He was a hard student, and is said to have copied three books — 
 The Elements of Euclid, The Maihcmatics and the Almagest of 
 Ptolemy, once a year. This he did for 150 denarii, on which amount 
 he managed to support himself. 
 
 As a stylist, he is always prolix and often obscure. lie was, how- 
 ever, the greatest writer on oi)ties between Ptolemy (who flourished 
 A. D. 150) and Kepler, who published his revolutionizing optical 
 work in 1604. None of the Arabic manuscripts of Alhazen 's great 
 book are extant, and we know it solely in its Latin translation, 
 Opticae Thesaurus Alhazeni Libri vii. To Alhazen, as to Galen (who 
 died 210 A. D.) the principal organ of sight was the crystalline 
 humor. The image of any object seen was supposed to fall on the 
 anterior surface of this body, and the impression thereon produced 
 to be carried by the retina (whose foremost parts were thought to 
 be very closely united with the edges of the lens) backward to the 
 optic nerve, and then, by that intermediary, to the brain. From each 
 and every point on the external object, a single ray was supposed 
 to proceed to the eye and to fall upon the lens. The old-time theory 
 that the act of vision was carried on hj rays of pneuma (or in- 
 nervation) which, coming from the optic nerve, passed out from the 
 eye to the object looked at and returned with information, was by 
 him rejected utterly and given its final (piietus. — (T. 11. S.) 
 All Abbas. His full name is Ali tbn al-Abbas al-Majus — i. e., the 
 magician, or fire-worshipper; he was also called Haly Abbas. 
 This distinguished Persian physician of the Arabic period was born 
 some time in the 10th century and died 994. He was body-physician 
 to the Emir, Adhad ed-Dauda. Ilis chief work is al-Maliki, Liher 
 Regis, or The Kingly Book, so called because of its dedication to 
 the Emir above-mentioned. This Avork is divided into two parts — 
 a theoretical and a practical, of ten books each. He declares his 
 intention in the composition of the work to have been the pro- 
 duction of something which should constitute a kind of golden 
 mean between the extremely prolix and ill-digested Continens of 
 Rhazes, on the one hand, and the over-condensed and much too 
 highly systematized "Liber ad IMansorem" of the same distin- 
 guished writer, on the other. The result is decidedly satisfactory.
 
 224 ALI BEN ISA 
 
 for all historians of ophthalmology agree that The Kingly Book 
 is a model of completeness combined with conciseness. 
 
 In The Kinglj^ Book diseases of the eye are treated, first, in the 
 13th chapter of the 10th book of the 1st part. The subjects are 
 all discussed, as one might readily suppose, in exact anatomical 
 order: Diseases of the Conjunctiva; Diseases of the Cornea; Dis- 
 eases of the Ciliar}^ Region; Diseases which Arise between the 
 Pupil and the Lens [in this department, following the fashion of 
 the time, he included cataract] ; Diseases of the Lids; Diseases of 
 the Corner of the Eye ; Diseases of the Optic Nerve ; Diseases of the 
 Other Nerves and of the Muscles which Move the Eye and the Lids. 
 In the second (the practical) Division, he speaks for the most part 
 of the cataract oiDeration, as it was practised in his day. 
 
 For an account of the cataract operation, as practised among 
 the Arabs, see History of ophthalmology; also, Tabari and AH 
 ben Isa.— (T. H. S.) 
 All ben Isa. He was also called Jesu Haly. This famous writer, the 
 most important of the Arabian ophthalmologists, flourished at 
 Bagdad in the first half of the eleventh century. His Memorandum 
 Book for Eye-Doctors was the earliest special work on ophthalmology 
 which has been preserved entire, and it stood, furthermore, as 
 the standard text-book on its subject not only in Islam but also 
 throughout Christendom for several centuries. We may add that, 
 even todaj", it is in use among the Arabs. It underwent, soon after 
 its first appearance, two Latin and one Hebrew translation. The 
 only complete translation, however, into a modern European tongue 
 is that of Hirschberg and Lippert (Ali ben Isa, Ernnerungshuch 
 filr Augendrzte, aus arahischen Hanclschriften ubersetzt und er- 
 lautert. Leipzig, 1904.) 
 
 Because of its classical character and historical importance we 
 shall consider the Memorandum book in considerable detail. The 
 work is divided into three books, the subjects of which are as 
 follows: (I) The Anatomy and Physiology of the Eye, (II) The 
 Diseases of the Eye which are Recognizable by the Senses, (III) The 
 Diseases of the Eye which are not Recognizable by the Senses. We 
 shall review each of these books in its order.* 
 
 Book I. THE ANATOMY AND PHYSIOLOGY OF THE EYE. This book 
 
 follows Galen (2d century A. D.) very closely. After a few pre- 
 
 * I have followed verj closely the exposition of Hirschberg, as needs must be 
 in a case like this. Until the monumental labors of this distinguished writer had 
 been completed the Memorandum-Book of Ali ben Isa (as well as numerous other 
 important \Yritings from the Arabic middle ages) were practically inaccessible 
 to the writers and workers of the west.
 
 ALI BEN ISA 225 
 
 limiiiary generalities concerning the needs and nature of the eye, 
 the author proceeds to describe and discuss the various parts of 
 that organ, and, incidentally, their functions. The crystalline humor, 
 he says, is the essential organ of vision. It is wholly devoid of 
 color, in order that it may be the more easily affected by all hues 
 and tints. It is somewhat curved, which renders it less susceptible 
 to injury, yet, at the same time, moderately flattened, in order that 
 numerous objects of sight may at any one time stand opposite to it. 
 Behind this body lies the vitreous humor, on which the crystalline 
 lens depends for its nourishment. Then comes the retina, made up of 
 blood-vessels and the terminal expansion of the optic nerve. The 
 retina feeds the vitreous humor, and, through this humor, carries the 
 power of vision to the crystalline. The most anterior parts of the 
 retina are closely united with the equator of the lens. The optic 
 nerve is covered by both the membranes of the brain, the hard one 
 being for protection, the soft one, however, for nourishment. Prom 
 the optic nerve itself proceeds the retina, from the softer covering 
 thereof, the choroid. The choroid, as well as the retina, is closely in- 
 corporated with the equator of the lens, and, all along the way from 
 the nerve to the crystalline body, it provides nourishment to the 
 retina. The sclera is simply a prolongation of the harder covering, 
 or coat, of the nerve. It protects the whole eye. 
 
 In front of the crystalline humor, lies the arachnoid membrane 
 [anterior capsule of the lens] ; in this, if you peer within another's 
 eye, you see the image of yourself. In front of the arachnoid lies 
 the aqueous humor, which keeps both the uvea and the crystalline 
 moist. It also serves to conduct the visual power from the lens to the 
 outer world, and, in return, the inward-entering image of the object 
 that is looked at. In front of the aqueous humor lies the uvea.* 
 
 It is shaggy on its rear, smooth on its anterior, surface. It nourishes 
 the aqueous humor, as well as the cornea, which has no vessels of 
 its own. Further, it separates the crystal from the cornea, and its 
 central perforation collects the visual pneuma (or spirit). Next 
 forward comes the cornea, transparent, hard, and composed of four 
 layers. The conjunctiva binds the eye together from without. 
 
 The eye possesses nine muscles. Of these, the one in the greater 
 corner of the eye moves the globe in the direction of the nose ; the 
 one in the smaller corner, however, moves it toward the temple. An 
 upper muscle directs the eye upward, and a loAver one turns it down. 
 
 * Here, as Hiischberg points out, is plainly to he perceived the (of course 
 mistaken) view of the Arabs, as well as of the ancients, that the iris lies snugly 
 in contact with the cornea. 
 
 Vol. I— 15
 
 226 ALI BEN ISA 
 
 A 
 
 Two are oblique, and rotate the eye. Three are seated at the root of 
 the oj^tic nerve, and hold it tense. [We may here remark that Ali 
 ben Isa shared the common error of his and all preceding days, to 
 the effect that the ocular musculature of man is identical with that 
 of the herbivora — an error which very naturally arose from the fact 
 that dissections were practised chiefly on cattle, swine, apes, etc., 
 and seldom, if at all, on human beings.] 
 
 These muscles are set in motion by the second pair of nerves [to- 
 day called the "third" pair]. These nerves originate in the brain, 
 behind the optic nerves. 
 
 The upper lid has a muscle to raise it, on the upper margin of the 
 eye-cavity; and two to lower it, in the two corners of the eye. The 
 under lid has no muscle. 
 
 The optic nerve arises from the two sides of the posterior portion 
 of the anterior ventricles of the brain. As the two nerves pass for- 
 ward, they curve toward the median line, until they come together 
 and unite. Thus the hollow spaces in the two nerves mutually com- 
 municate. Thus, too, arises the figure of the Greek letter X, or chi. 
 The nerves then separate, and each proceeds to the eye correspond 
 ing to the side of the brain from which the nerve in question had its 
 origin. 
 
 It can be proved that the hollow spaces in the two nerves com- 
 municate, the one with the other, and in this way : If a person closes 
 one e.ye only, the pupil of the open eye enlarges. There are two 
 advantages of this arrangement: (1) When either eye is lost, the 
 total (piantity of light is directed to the other. (2) With two eyes, 
 a person is enabled to behold each object singly. 
 
 The manner in which the visual pneuma (or spirit) has its origin, 
 is as folloAvs: In the liver is formed the natural spirit. The clearer 
 part of this, after passing to the heart, becomes the vital spirit. 
 The clearer part of this, again, after mixing with the air of the 
 breath, reaches the brain, and there is formed into the soul-spirit. 
 This presses through the hollow passages of the optic nerves to the 
 eyes. Then sight takes place in this manner. The visual spirit runs 
 out from the eye, unites with the external air, and proceeds to sur- 
 round the object at which the eye is looking. Then it goes back into 
 the eye through the cornea and the pupil, and prints an impression 
 on the crystalline humor. [It will be especially noted that, accord- 
 ing to Ali ben Isa, as w^ell as according to the ancients, the picture is 
 formed on the anterior surface of the lens, not on the retina.] 
 
 Book IT. THE VISIBLE DISEASES OP THE EYE, AND THEIR TREATMENT. 
 
 There are four periods of a disease : Beginning, increase, height.
 
 ALI BEN ISA -22 
 
 ZZi 
 
 and abatement, la the beginning should be employed repressive 
 remedies; in tlie end, those whieh are solvent. Ocuhir remedies come 
 from all the three imtnral kingdoms. In (-(niiliined remedies, simple 
 medicines are joined together, either against the disease, or for the 
 strengthening of the medicine, -or for their better penetration into 
 the ocular membranes, or to make them hold fast, or for the preser- 
 vation of their medicinal vii'tues, or for the lessening of their 
 severit3^ 
 
 The after-effect of a severe medicine must have ceased before that 
 medicine can be employed again. 
 
 Of diseases of the lids there are twenty-nine Of these the most 
 important is trachonm, of which there are four stages. The first 
 stage exhibits little grains in the inner surfaces of the lids. The 
 treatment is by evacuation and the rubbing-in of the red, sharp col- 
 lyrium. A radical cure is produced by the sprinkling-in of poAvdered 
 galls. The second stage is distinguished by a greater rawness. Here, 
 too, the rubbing is the principal thing. But, first, any accompanying 
 ophthalmia and ulceration nuist be removed. A collyrium of ver- 
 digris is good, if preceded by vigorous rubbing with the sound. The 
 third stage is still worse, and exhibits on the inner surface of the 
 lid the picture of a burst fig. The treatment consists of evacuation 
 and the rubbing with king's-salve and green collyrium. The fourth 
 stage is even worse; there are pain and hardness and often disease 
 of the hairs. The chief renied}^ is rubbing with the instrument which 
 is called the rose [see sketch, herein, of Halifa] and with the scalpel. 
 Generally, when the trachoma has become chronic and inveterate, 
 nothing at all is of any use, except the rubbing with sugar and the 
 iron ; but so long as it is still thin and in the beginning, it can be 
 corrected b,y sharp medicines. 
 
 Chalazion is treated with salves, and, in necessary eases. l)y in- 
 cision. So, too, calcifications. Growing together [symblepharon] 
 presents itself (1) between lid and cornea (2) between lid and con- 
 junctiva (3) between the two lids. The first two should be care- 
 fully separated, the latter split upon the sound, or with the sickle. 
 [Ali ben Isa's treatment of symblepharon. it will be obsei'ved. was 
 not A'^ery well developed.] 
 
 Superfluous lashes are situated behind the natural lashes, and lean 
 away from them. They can be cured in five ways: (1) By strong 
 medicines, or by rubbing in rock-salt or frog's blood, after pulling 
 out the hairs. (2) Through glueing the hairs with mastich and the 
 like, when the misplaced lashes are few in number. (3) Tn this case, 
 also, by burning Avith a thin-headed iron. (4) By the 1hreading-in
 
 228 ALI BEN ISA 
 
 of the hair, or of the few hairs. (5) When the false hairs are numer- 
 ous, the tucking-up of the lid should be considered — that is, by 
 the splitting of the edge of the lid, folding the lid-skin, and then re- 
 moving the requisite portion. 
 
 The inturning of the natural hairs requires the same treatment as 
 the superfluous lashes. 
 
 For lice in the lid, one should work-in an oil containing alum and 
 louse-wort. 
 
 Of chemosis, the first variety is caused by bloody matter. It re- 
 quiries blood-letting. If the patient be an infant, the venesection 
 should be performed on the nurse. [Then follows a list of local 
 applications.] The second variety is caused by bilious blood, and 
 its color varies even to greenish. 
 
 Inflammation of the lid margins produces, in the region of the 
 lashes, thickening, reddening, the formation of ulcers, and, if it be 
 chronic, the falling out of the lashes. The treatment is chiefly with 
 the mild red salve. Itching in the lids requires frequent bathing and, 
 locally, dross of zinc. 
 
 The hydatid is a fatty-sticky body, seated externally on the upper 
 lid, near the brow, elastic, a'nd occurring chiefly in children and 
 those in whom the moist element preponderates. The lid is heavy, 
 the eyes weep and are fearful of the light. One must thin the diet, 
 let blood, cup, and remove the hydatid by operation. 
 
 The mulberry consists of red, relaxed flesh, which hangs down, 
 mostly in the under lid, occasioiially also in the upper. Sometimes 
 blood runs out of it. The treatment consists in purification of the 
 body and in the eradication of the tumor, in necessary cases with 
 after-treatment by caustics. 
 
 The cystic tumor is not, like the abscess, accompanied by inflam- 
 matory swelling and pain, but it has an envelope peculiar to itself. 
 There are four varieties: (1) the honey sack (2) the water-gruel 
 ■ sack (3) the flesh sack (4) the tallow sack. During the extirpation 
 one must exercise care to destroy the sack, because otherwise a 
 particle remains. Such a particle should be treated with caustics. 
 
 Relaxation of the lid is lengthening of the upper lid, so that the 
 lashes curve against the eyeball. One should anoint the lid with 
 drying remedies; in necessary cases perform a lifting operation. 
 Dead blood in the lid occurs in consequence of injury and of vomit- 
 ing. If the lid is hot, one should cool it with sandal and the like ; 
 afterwards, one should bathe it with lukewarm salt and water. 
 
 Diseases of the tear-corner are of three kinds: Tear-fistula, 
 caruncle-swelling, and overfloAv of tears. Tear-swelling is an abscess
 
 ALI BEN ISA 229 
 
 between the greater eanthiis and the nose. Sometimes it opens, and, 
 if neglected, becomes a fistula and threatens even the eyeball. There 
 is also a second kind of tear-swelling, which does not open, under 
 pressure throws out no pus, now enlarges and now gets smaller. The 
 treatment is with medicines for the lighter eases; for the others, 
 cautery and trepannation. 
 
 Treat this disease, like the abscess, with blood-letting and purga- 
 tion, and rub the place with celandine, satfron, myrrh, and the like. 
 When it has opened, bind it up with a verdigris pad. iUit it is best 
 to hasten with the surgical treatment. The form which inclines 
 outwa]"dly is the easier to cure. One must split it, remove the cor- 
 rupted flesh, and rasp the bone. If the sound indicates rawness, the 
 bone is diseased and cauterization is necessary. This should be per- 
 formed with small burners. The perforation (trepannation) is 
 carried out, while turning, with a solid, three-cornered sound, until 
 blood presents itself in the mouth and nose. If the site of the fistula 
 is hidden from thee, then do not press out [the contents of the 
 swelling] for two or three days, till the pus has collected therein. 
 
 The caruncle, which lies on the upper end of the canal between eye 
 and nose, sometimes undergoes an enlargement, and then prevents 
 the tears from pouring themselves into the nose; wherefrom orig- 
 inates a lachrymal abscess. Treat the enlarged caruncle with strong 
 medicines, like verdigris ; however, one must leave the normal 
 amount of caruncle, or epiphora would follow in consequence. 
 
 Epiphora is based upon wasting of the caruncle, so that that organ 
 no longer suffices to prevent the overflow of tears. If the caruncle 
 is entirely atrophied, there is no cure. If it is only diminished in 
 size, it can be enlarged by celandine, saffron, and alum. 
 
 The blood-spot consists of blood which has escaped into the con- 
 junctiva as a result of tearing in the bloodvessels; either from in- 
 jury, or from vomiting, or without perceptible cause. In order to 
 avoid inflammation, one should let blood and drop in woman's milk. 
 
 Pterygium [zafara-finger-nail] is a tendinous elevation of the con- 
 junctiva, proceeding as a rule from the larger corner of the eye to 
 the cornea, and even on into that membrane. It restrains the move- 
 ment of the eye, and sometimes deteriorates the sight. The kind 
 Avhieh is in the beginning and is still thin, is treated with strong 
 medicine, as with burnt copper, ammoniated salt, and the like, also 
 with lid-cosmetic. If, however, it is large and hard and in-rooted, 
 nothing helps but an operation. If it permits of elevation with a 
 little hook, then one can easily peal it of¥ with a lancet. If, however, 
 it has grown tight, then one should incise it a little at the sides with
 
 230 ALI BEN ISA 
 
 the points of the scissors, iu order to assist the lancet in getting 
 under it. On the cornea operate with the utmost gentleness; in the 
 larger corner of the eye cut away the pterygium with the scissors, 
 however in such a way that the caruncle is left behind. Often 
 the pterygium holds the conjunctiva fast. This membrane should 
 not be cut away, otherwise squint will ensue. 
 
 Pannus [a disease not mentioned by the writers of antiquity] is 
 a net of thick, blood-filled vessels, which spread themselves over the 
 eyeball and also covers the cornea, and makes itself red and thick, 
 and is accompanied by tears, redness, and itching. One kind is 
 deeply seated. It requires evacuation of the body and purification 
 of the head, as well as also inunction with black collyrium and lid- 
 cosmetic. The second kind is superficial. One sees in the conjunc- 
 tiva red vessels, and upon the cornea something like a smoke, and 
 therein red vessels. With these are heat, pain, and fear of light. If 
 the pannus is chronic, nothing helps but an operation. 
 
 The phlyctenule is a solid elevation in the conjunctiva ; now red, 
 now white ; now in the larger now in the smaller corner of the eye ; 
 also multiple, like a string of pearls, near the margin of the cornea ; 
 now accompanied by a red, and now by a white, eyeball. Strew 
 queen-powder [made of Persian gum, white sugar, coral, etc., finely 
 powdered] into the eye. If redness of the ball is present, precede 
 the strewing of the powder by the use of the white salve. 
 
 Of diseases of the cornea there are thirteen. Of ulcers there are 
 seven kinds, four of which are superficial. The first is called 
 ' ' smoke. ' ' The second is ' ' cloud, ' ' which is whiter and smaller than 
 the first kind. The third is called "argemon," and is seated on the 
 rim of the cornea, and is red on the outer, but white on the inner 
 side. The name of the fourth is "nicoma, " that is, '"branching." 
 For its depth, the first variety is called "bothrion, " that is, "ditch." 
 The second is called ' ' f aluma, ' ' that is, ' ' the painful ; " it is broader 
 and less deep. The third is called "fieauma, " that is, "the burn- 
 ing;" it is a dirty, crusty ulcer, which, in long-standing cases, causes 
 the flowing-out of the humors of the eye. 
 
 At first, one should bleed and purge ; after that employ upon the 
 eye what restrains and numbs, like the white salve composed of lead 
 and opium. The patient should sleep upon the side of the ulcer, in 
 order that the pus may not consume the ocular membranes. Thin 
 the diet, but, in cases of long duration, not too much. If the opening 
 of the ulcer delays, drop into the eye buck-horn decoction. After 
 the opening, cleansing remedies are proper, like the white salve 
 which contains cadmia, etc.
 
 ALI BEN ISA 231 
 
 The pustule of the coruea arises by exudation between two of its 
 four layers. The one behind the uppermost is the lightest; it is 
 black and clear. Tliat behind the tliird layer is the worst, and 
 appears white. Not all pustules discharge, sometimes their contents 
 are absorbed. The treatment of pustules is the same as that of 
 ulcers; only when the pustide becomes chronic and does not open, 
 then must thou treat it with sharp, opening remedies — wolf's milk, 
 asafoetida, etc. Of corneal scars there are two varieties — the little 
 cloud and the white spot. For these the evacuation of the body is 
 not indicated, but only the local emi)loyment of purifying remedies. 
 
 Cancer in the cornea arises from the black-bile humor, with most 
 intense pain and is as incurable as the leprosy. However, one ought 
 to try to lessen pain : one should give the patient fresh milk and 
 lamb's meat, purify the body and put into the eye a })owder of 
 cadmia and haematite. 
 
 Of pus behind the cornea there are two varieties. The one has 
 the form of the section of a nail, and occupies a very small place. 
 The other occupies a larger space, so that sometimes the matter 
 covers the entire black, and it is the more unkindly. 
 
 The arching forward of the cornea, which, indeed, should be dis- 
 tinguished from i)ustule, is treated by bandaging and by astringent 
 remedies. 
 
 Of diseases of the iris there are four. The enlargement of the 
 pupil is bad, if congenital; worse, if acquired; for it occasions a 
 scattering of the sight. The cause is either (1) dryness of the uvea; 
 (2) inflammation of the uvea, as a result of injury or of inflamma- 
 tion of the brain with headache (o) increase in the egg-white humor 
 [aqueous]. In the latter form, there follows complete blindness; in 
 all the others, the complete or partial escape of the visual power is 
 peculiar: the patient sees all objects smaller. 
 
 The narrowing of the pupil is also either congenital, and then to 
 be commended ; or acquired, and then very bad. The latter arises 
 from six causes: (1) moist relaxation of the uvea (2) dimiiuition 
 of the egg-white humor [aqueous] (3) earthy, hard obstruction of 
 the pupil; so that one no more can see the hole (4) excessive heat, 
 which draws the hole together, in consequence of inflammation of 
 the brain-membrane or of a hot abscess (5) a very large abscess, 
 which presses the pupil together (6) dryness of the mixing of the 
 uvea, especially in old men. In narrowing of the pupil, one sees 
 things larger; the cause is thickening of the visual spirit. 
 
 Of prolapse of the uvea there are four kiiuis. In the first, the 
 cornea is torn ; there presents itself an appearance which resembles
 
 232 ALIBENISA 
 
 the head of an ant. In the second, the formation is larger, and is 
 called the tly's-head. The third is still larger, tonches the lashes, 
 injures the eye and is called the grape-shaped elevation [staphy- 
 loma] . The fourth is scarred over, and, according to Paulus, carries 
 the name of "the nail-head." "Before the lips of the corneal wound 
 get thick, thou shouldst bind up strongly. Bestrew the eye with 
 hfematite, ashes of zinc, etc. Let the bandage stay on, and, in the 
 3rd and 4th varieties, let into the compress a lead plate of a weight 
 of 5-10 drachmas. If, however, the prolapse is already old, in case 
 more than two years have gone by, then do not attempt any treat- 
 ment, thou wilt not effect a cure. If thou wouldst merely improve 
 the appearance of the eye, then treat it with the iron — but not with 
 the expectation that any sight will return. Pass a needle under the 
 prolapse, underbind it, and cut it oft*. A few physicians reject the 
 cutting off: they underbind the prolapse until it dries up and falls 
 oft' with the threads." 
 
 The tearing of the pupil, that is, the solution of continuity in the 
 uvea, is either small and not complete — when the vision is but little 
 affected ; or it is large and complete, when the egg-white humor 
 [aqueous] flows away and out through the cornea; the crystal is not 
 protected, and the visual radiation cannot collect itself. 
 
 The cataract is an exudation, which hardens in the anterior plane 
 of the pupil ; it sets a partition-wall between the crystal and the out- 
 going light. [The reader Avill here observe the implied reference to 
 the predominant ancient and medieval theory of vision, which was 
 that a visual spirit — here called "the outgoing light" — passed from 
 the brain, forward through the supposedly existent hollow passage 
 in the optic nerve to the eyeball, then, via the retina to the margin 
 of the lens (with which the terminal retinal filaments were supposed 
 to be intimately incorporated) thence, through the lens, and out of 
 it via its anterior surface, on through the pupil and into the outer 
 atmosphere, where, mingling either with the air or with certain 
 elements therein, it proceeded to the object looked at, surrounded 
 it, and returned via pupil, lens, retina and nerve, to the brain with 
 the visual informatioii so secured.] Its beginning is difficult to 
 recognize. However, the physician sees in the patient 's pupil a kind 
 of fog or cloud, and the patient complains of seeing things like flies 
 or gnats. If the cataract has become confirmed, it is easy to rec- 
 ognize: the sight is lost and the pupillary color is changed. There 
 are eleven colors of cataracts (1) air-color (2) glass-color (3) 
 white (4) sky-blue (5) green (6) yellow (7) red, or gold-color (8) 
 blue (9) gypsum-color (10) black (11) quicksilver-like.
 
 ALI BEN ISA 233 
 
 Causes of cataract-formation are wounding, old age, long- 
 continued illness, chronic headache, moist and thick diet. 
 
 The cataract-exudate lies between uvea and cornea. [The reader 
 will recall in this connection that, until the absolute demonstrations 
 of B'Hsseau and Maitre-Jean in 1705, it was wholly unknown that a 
 cataract is really an opaque crystalline lens, and not an exudate 
 into a space — absolutely imaginary, of course — between the crystal- 
 line and the pui)il, or between the pupil and the cornea.] Not all 
 cataracts are cured by operation, the air-colored, however, of a 
 verity, if it is not complicated with stoppage of the optic nerve or 
 sight-disturbing contraction of the pupil and when it has arrived at 
 ripeness. 
 
 Testing for an operable cataract. "(1) The unripe cataract be- 
 comes wdder, if thou rubbest thy thumb for a moment against the 
 lid. (2) The color of the easily operable cataract is that of steel or 
 lead, that of the almost hardened, however, like gypsum or a hail- 
 stone. (3) If one closes the other eye, the pupil of the cataract-eye 
 enlarges. (4) The cataract eye retains the perception of light. (5) 
 Lay a bunch of wadding on the eye, blow against it, and take it 
 away immediately. In case the cataract moves and is clear, an oper- 
 ation is required. 
 
 Take care not to perform the operation when the body is over- ■ 
 filled, or when there exists a corruption of the bodily humors, or 
 headache, cough, cold, or the like ; and w^heu the pupil does not widen 
 and contract, even though the cataract seem clear. Cataract from 
 an injury thou needest not operate upon, because a piece thereof 
 will remain in the hole of the pupil." [Probably the author has in 
 mind the capsular involvement.] 
 
 Treatment : In the beginning of a cataract, purify body and brain 
 by purgation and phlebotomy. Forbid moist, thick foods. Stroke 
 the eye with gall-remedies, etc., but this diet helps only in the be- 
 ginning of the affection. When, however, the cataract has become 
 confirmed, and has formed itself into a favorable one, then proceed 
 to the operation with foresight and care. Have the patient sit in the 
 shadow, with his face to the light. "Sit thou correspondingly 
 higher. Bandage the other eye, in order that it may not, by its 
 movemeiit, excite movement in the eye w^hich is under operation, 
 and in order that thy testing, after a resultful operation, may be 
 with one eye only. The assistant, behind him, should hold his head. 
 Lift his upper lid, let him look toward his nose. Remove the tail- 
 end of the cataract-needle by its own breadth tempi ewards from the 
 margin of the cornea — a little higher than the center of the pupil — •
 
 234 ALI BEN ISA 
 
 and make therewith a puncture in the conjunctiva. Then turn the 
 instrument round, set the three-cornered point upon the marked 
 spot, and press hard until thou feelest that it has arrived in a roomy 
 space. Thereupon, let the point be a little inclined toward the tem- 
 poral side, while the thumb and forefinger of thine other hand, be- 
 tween the lids, hold fast the ball of the eye. The extent of the in- 
 ward pushing should be the distance of the point of perforation from 
 the margin of the pupil. [Here again comes in the mediajval— -as 
 well as ancient — ^misconception of what it is that constitutes a cat- 
 aract.] Then, too, the needle should rest firmly on the thumb. At 
 this point speak kindly to the patient, that his anxiety may be al- 
 layed. [Ali ben Isa seems to have been a gentle and thoughtful man, 
 as well as an experienced and skilful operator.] Now lay upon the 
 eye a pad of new cotton, and blow upon it with warm breath. Then 
 turn the needle a little until thou seest it above the cataract, for the 
 copper is visible on account of the clearness of the cornea. [For a 
 description of the instruments employed in ocular surgery during 
 the Arabic middle ages, see the sketch of Halifa.] The uvea [iris] 
 is, in that moment when thou turnest the needle, thrust back and not 
 perforated. If the needle has not come to the place of the cataract, 
 then push it a little f orAvard ; if it has gone past, draw it back a little, 
 until it rests exactly above the cataract. Then raise the handle of 
 the cataract-needle a little upward; immediately the cataract sinks 
 downward : The velvet-body of the iris draws upon it by means of 
 its tufts. Do not hasten to withdraw the needle at once. 
 
 If the cataract stays down, it is well. If it mounts again, press it 
 once more down. If it still returns, thou oughtest to scatter it in 
 different directions. If, however, it has gone down, then draw the 
 needle out, and, indeed, very gradually, the while turning it. Band- 
 age, bed the patient in the dark, let him lie as if dead, with attentive 
 service, and take only liquid diet. On the third day, bandage anew, 
 and let him sit up. Bandage until the seventeenth day." 
 
 Now and then the conjunctiva is lax, so that the needle does not 
 enter well : then make first the perforation with a lancet, and after- 
 ward introduce the needle. 
 
 Book III. THE INVISIBLE DISEASES OP THE EYE. 
 
 The visual appearances produced by cataract and those proceed- 
 ing from stomach and brain should be distinguished. If the appear- 
 ance be alike in the two eyes, as to color, size and time, they arise 
 from disease of the stomach. If different in the two eyes, or occur- 
 ing in one eye only, this indicates the presence of a cataract. So, 
 too, when one of the two pupils is the cloudier. If three or four
 
 ALI BEN ISA 235 
 
 months have already passed since tlie beginning of the visual ap- 
 pearances, without they being able to detect a trace of fog in the 
 patient's eye, then the trouble arises from disease of the stomach. 
 Likewise, when it is made Avorse by indigestion. The pathogno- 
 monic sign of visual appearances proceeding from disease of the brain 
 is simultaneous inflammation in the head, while the eyes appear to 
 be sound. 
 
 If it comes from the stomach, purify with the bitter remedies, if 
 from the brain, give to drink of barley-water and make cooling ap- 
 plications to the temples; if from sharpness of the sense-perception, 
 give benumbing remedies ; if from the beginning of a cataract, then 
 employ the remedies already mentioned. 
 
 Of diseases of the egg-white humor [aqueous] there are: color 
 change, dryness, dryness of the separate parts of the structure, en- 
 largement [increase in quantity] thinning, thickening. 
 
 If the egg-white humor become too plentiful, there forms a com- 
 plete partition wall between the pupil and the light ; on the other 
 hand, an insul^icient separation if it becomes too scanty. If its in- 
 spissation be moderate, that hinders vision in the distance ; if ex- 
 cessive, it results in the formation of cataract. If the egg-white 
 becomes gray, the person sees as if in a fog; but red in case it be 
 tinctured with blood, and yellow in case of jaundice. The discolora- 
 tion of the egg-white sometimes occurs only at certain times, because 
 of vapors from the stomach; or only in certain of its parts. Also the 
 drying can occur either in parts or throughout the whole humor; in 
 the latter case the eyeball diminishes in size and is blind. In thicken- 
 ing, enlargement, and liquefaction, the cataract-treatment is proper ; 
 in the drying out and the diminution, that of wasting of the ej'eball. 
 
 Of diseases of the crystalline humor there are sixteen. Shifting to 
 right or left causes in children squint, that upward or downward, 
 double vision. Discoloration (according to one of the four kinds) 
 causes a corresponding colored vision. Dislocation forward makes a 
 blue, backward, a black, eye : this causes no harm to the power of 
 vision. Enlargement produces smaller-vision, diminution, on the 
 other hand, larger-vision. Drying up of the crystal causes a blue 
 condition (glaucoma) and blindness, liquefaction, on the contrary, 
 water-eye. Hardening and thickening annihilates the visiml power. 
 
 The visual spirit sufifers injury in relation either to its quantity or 
 its quality, and both, always, in one of two ways. If it is copious, 
 the person sees far and near. If it is scanty, only things near are 
 seen. If it is thick, then the sight is dull. If it is thin, then is seen 
 distinctly only that which is near. Whoever sees only in the dis-
 
 236 ALI BEN ISA 
 
 tance and not in the near, like an old man, on account of the thick 
 or moist visual spirit, he must be evacuated, avoid warm food, and 
 place in the eye styptic medicine or lid-cosmetic. Whoever sees in 
 the near and not in the distance, on account of dryness or scantiness 
 of the visual spirit, is hard to cure ; one should order moist food and 
 moistening remedies. 
 
 Nightblindness arises either from moistness of the egg-white, or 
 from thickening of the visual spirit, or from liquefaction or cloud- 
 ing of the •crystal, or from continually remaining in the sun. One 
 must make the diet thin, and rub into the eye sharp medicines. 
 While goat-liver is being roasted, have the patient lean over its. 
 steam, rub the eye with the broth, and eat up the roasted liver. 
 
 Dayblindness arises from dryness or scantiness of the visual spirit. 
 These patients should be treated with that which moistens head and 
 brain, and be directed to bathe frequently in luke-warm fresh water. 
 
 Of diseases of the vitreous humor there are twelve : Alteration, 
 of the color into reddish, yellowish, blackish, whitish ; liquefaction,, 
 dessication ; increase, diminution ; hardening, thickening ; solution of 
 continuity. Every injury which befalls the vitreous humor, affects 
 also the crystal. The treatment should be according to the pre- 
 dominant mixture in the body and in the head. 
 
 The diseases of the retina arise either from an improper mixture 
 [dyscrasia] or from a solution of continuity. In the latter case^ 
 vision ceases, because of the light pouring out over the entire eye. 
 
 The diseases of the optic nerve are of three kinds : the first kind 
 includes the eight diseases of its homogeneous parts, besides ex- 
 pansion and contraction, likewise evaporation of the visual spirit- 
 the second kind comprises the organic diseases, like obstruction, com- 
 pression, inflammatory swelling and the like ; the third is the separa- 
 tion of continuity. All diseases of this nerve impair the visual 
 power — either strongly or moderately or little. Sometimes the visual 
 power disappears as a result of disease of the brain. That is rec- 
 ognized by a good diagnosis. 
 
 The expansion, or scattering, of the light arises either from dila- 
 tation of the pupil ; or from tearing of the retina — then sudden ; or 
 from dilatation of the light-nerves. Dilatation is a disease, expan- 
 sion the symptom. Hasten with the treatment of the head pain; 
 stroke the eye with the styptic collyrium and all the remedies of 
 use in the beginning of cataract. 
 
 Obstruction, compression, inflammatory swelling of the optic 
 nerves. The first comes from cold, moist secretions, which pass down 
 from the brain to the optic nerve, fill it up, and hinder completely
 
 ALI BEN ISA 237 
 
 the exit of the visual si^irit. Diagnosis: On closui'e of the sound 
 €ye, the i)upil of the diseased eye does not enlarge. Obstruction and 
 inflammatory swelling arises from abundant moisture, which pours 
 into the nerve itself. [The anatomical supposition was that the optic 
 nerve contained a hollow space or way, for the i)assage of the 
 "visual spirit'' — which, supposedly, passed out from the eye for the 
 purpose of examining objects and returning with information. 
 Our author bases on the anatomical supposition the pathological 
 suppositions (1) that obstruction of the nerve is caused by cold and 
 moist secretions blocking up the passage-way, or lumen, of the nerve, 
 while (2) compression and inflammatory swelling in the nerve are 
 caused by an exudation, or extravasation, of moisture into the nerve- 
 tissue itself.] Tn these two conditions the eye sees a little, the 
 patient has a feeling of w^eight in the depth of the eye-cavity. [As 
 the reader has probably already noticed, "obstruction" is our 
 ■"atrophy," and the other two forms of trouble are "neuritis."] 
 
 In tearing [dilaceration] of the optic nerve the eye lies deep, 
 ^fter it has been driven forward, and is blinded. This is the conse- 
 quence of a thrust or a blow, and is incurable. If spasm attacks the 
 muscles at the place of disemboguement of the optic nerve, then this 
 fastens the e.ye ; if paralysis, then results ocular prolapse. 
 
 Prolapse of the eye arises either from paralysis of these muscles or 
 from an attempt at throttling, or in consequence of the pain of grief. 
 [Had he in mind Basedow's disease?] In the first variety, purify the 
 I)ody, stroke the eye -with binding and strengthening remedies, and 
 temple, forehead, and front-head Avith labdanum. In the second 
 variety, blood-letting is proper, in the third, the evocation of the 
 monthly purification. For the eye employ astringent remedies and 
 the bandage, also with a lead plate. Wasting is diminution and 
 flattening of the entire eye. Gj^mnastics, massage, oily food, a light 
 ■collyriura of the dross of zinc, cadmia, etc., are to be advised. 
 
 Diseases of the choroid are: corruption of the mixture [dyscrasia] 
 — either a simple, as the warm, cold, moist, dry, or a comi)ound, as 
 the warm-dry, cold-moist — besides thickening, overfilling, inflam- 
 matory swelling and the like. Alwaj's the crj'stal sutfers fi'om these, 
 and, in the case of inflammatory SAvelling, the optic nerve also. 
 
 The sclera too is attacked by corruption of the mixture or solution 
 of continuity. The diagnosis of the former rests on supposition, ac- 
 cording to the predominant mixture in the body, and in accordance, 
 with that too the treatment is arranged. 
 
 The muscles of motion fall into spasm oi- paralysis. If the upper 
 muscle cramps, it draws the eye upward; if it is ]iaralysed, the eye
 
 238 ALIBENISA 
 
 goes downward. In a similar way in the case of the lower muscle. 
 Through both of these arises that kind of squint which sees a thing 
 as two. 
 
 If the muscle which lies in the larger angle of the eye is paralysed, 
 the eye draws back into the smaller angle. In a similar w^ay it hap- 
 pens with the muscle Avhich lies in the smaller angle. This is the 
 squint of children. 
 
 Paralysis of one of the two turning-muscles (obliqui) occasions an 
 oblique position of the eyes. 
 
 The squint of children which exists from birth is treated by di- 
 recting (training) the vision straight. [How old, after all, is this 
 new procedure!] The kind of squint which is later acquired, arises 
 from heat and dryness [i. e., of the bodily humors, not the environ- 
 ment] from diseases of the head, and is treated by the cure for 
 hyphema. 
 
 Weakness of vision results from many causes, from obstruction 
 of the optic nerve, narrowing and widening of the pupil, etc. But 
 also on the side of the brain — then shouldst thou treat this. The 
 treatment of \veak sight is that of cataract in its beginning. Keep 
 the patient aAvay from saltj^, sour, thick, vaporous foods. Give him 
 wormwood syrup or vinegar of sea-onion. Bleed from the veins of 
 the forehead or from those of the corners of the eyes, employ col- 
 lyria of sagapen, opopouax, benjamin gum, and the like. The weak- 
 ness of siglit produced by continual w^eeping and by drying out, 
 demands moistening. The visual weakness of the convalescent, one 
 generally does not treat — except by strengthening the patient. 
 
 The preservation of the health of the eye is effected by the way 
 of living. The healthful way of living is different for every person, 
 according to his temperament. The health of the eye is preserved 
 by the giving up of everything w-hich has a weakening effect on the 
 sight ; and by the rubbing of such medicines as hinder moistures 
 — dross of zinc, cadmia, etc. The collyrium called "clarifier of the 
 eyes of sculptors" consists of pomegranate juice, aloe, pepper, and 
 rocksalt: the older the better. 
 
 Headache and migraine, which follow pain in the eyes, belong to 
 the w^orst symptoms. Sometimes the pain radiates to the roots of 
 the eyes. In hot inflammation of the head occur, simultaneously, 
 madness and protrusion of the eyeballs. The different kinds of 
 headache are discriminated by fine diagnosis. Hast thou correctly 
 recognized the cause, then do not quickly change the treatment, 
 even though results are not secured immediately. 
 
 By excision of the temporal arteries and their cauterization are
 
 ALIZARIN 239 
 
 treated headache and sliar]), biting catarrhs and heat with abscess 
 in the tempor.d muscles and chemosis. As to the treatment of the 
 matters which tiow down inio th(! eye, those which come down into 
 the eye from tlie outer surface of tlie skidl heal easily with salve, 
 together with the abstraction of blood from the head-veins and the 
 cauterization of these vessels: but those matters which descend from 
 the inner surface of the skull are difficult to heal. 
 
 Much space has been given to Ali ben Isa and his wonderful 
 Mono rand urn-Book for Eije-Doctors, because in the opinion of the 
 Avriter, he is the most important ophthalmologist, or at all events, 
 ophthalmographer, between the beginning of time and the 18th 
 century A. D.— (T. H. S.) 
 
 Alizarin. (G.) Alizarine. 
 
 Alkalescenz. (G.) Alkalescence. 
 
 Alkaliblau. (G.) Alkaline-blue (litmus). 
 
 Alkalien. (G.) Alkaline. 
 
 Alkaline antiseptic. See Dobell's Solution. 
 
 Alkalisch. (G.) Alkaline. 
 
 Alkalisiren. (G.) To make or render alkaline. 
 
 Alkalisirimg. (G.) Alkalization. 
 
 Alkalitat. (G.) Alkalinity. 
 
 Alkalizitat. (G.) Alkalinity. 
 
 Alkaloide. (G.) Alkaloids. 
 
 Alkanamusali. Said to have been an Armenian. This man was the 
 author of a celebrated work in Arabic on the diseases of the eye. 
 See Canamusali de Baldach. — (T. H. S.) 
 
 Alkanna. (G.) Alkanet. 
 
 Alkannarot. (G.) Anchusin. 
 
 Alkannawurzel. (G.) Alkanet root. 
 
 Alkannin. (G.) Anchusin. 
 
 Alketas of Halikos. The votive-tablet of this classical patient Avas 
 exhumed in 188.'^ from the ruins of the temple of Asklepios at 
 Epidaurus. It presents the following tj^Dical case-record from the 
 pre-Hippocratic period: "Alketas of Halikos. This person was 
 blind, and saw a vision. It appeared to him as if the god came 
 to him, and opened his eyes with the fingers, Avhen, for the first time, 
 he beheld the trees in the sanctuary. As it became day, he left 
 the temple, healed."— (T. H. S.) 
 
 Alkohol. (G.) Alcohol. 
 
 Alkoholauszug. (G.) Alcoholic extract. 
 
 Alkoholbestimmung-. (G.) Estimation of alcohol. 
 
 Alkoholdampfe. (G.) Alcohol vapor.
 
 240 ALKOHOLFREI 
 
 Alkoholfrei. (G.) Non-alcoholic. 
 
 Alkoholgarung-. (G.) Alcoholic fermentation. 
 
 Alkoholg-ehalt. (G.) Amount of alcohol contained. 
 
 Alkoholg-emische. (G.) Alcohol diluted. 
 
 Alkoholhaltig-. (G.) Containing alcohol. 
 
 Alkoholhartung-. (G.) Alcoholic hardening, or to indurate. 
 
 Alkoholiker. (G.) One who drinks too much alcohol. 
 
 Alkoholisch. (G.) Alcoholic. 
 
 Alkoholismus. (G.), n. The various phenomena resulting from the 
 ingestion of alcoholic liquors. Alcoholism. 
 
 Alkoholkrankheit. (G.) A disease from alcohol. 
 
 Alkoholmesser. (G.) Alcoholometer. 
 
 Alkoholmissbrauch. (G.) Abuse of alcohol. 
 
 Alkoholometer. (G.) Alcoholometer. 
 
 Alkoholpsychosen. (G.) Mental diseases due to alcohol. 
 
 Alkoholreich. (G.) Rich in alcohol. 
 
 Alkoholverband. (G.) Alcohol or spirit dressing. 
 
 Alkoholvergiftung'. (G.) Alcoholic poisoning. 
 
 Allantiasis. (L.), f.n. Botulism. An intoxication produced by eat- 
 ing decomposed sausages. Among the sj^mptoms are constipation, 
 nausea, vomiting, imperfect vision, vertigo, muscular impairment, 
 cardiac depression and coma, sometimes terminating in death. See 
 Toxic amblyopia. 
 
 Allantoin. A proprietary remedy said by W. H. Bailey to stimulate 
 cell growth and promote healing, especially in indolent ulcers of 
 the cornea. 
 
 Allentesi. (It.), n. The presence of a foreign body in some part of 
 the human organism. 
 
 Allenthese. (F.), n.f. The entrance of foreign bodies into, the hu- 
 man organism. 
 
 Allenthese. (G.), n.f. Penetration of foreign bodies into some por- 
 tion of the human organism. 
 
 Allenthesis. (L.), f.n. Penetration of a foreign body into some part 
 of the human organism. 
 
 Allergy. Recent work done along the lines of immunity em- 
 phasizes the fact that advances made in one specialty in medicine 
 almost invariably have an important bearing on others. This ap- 
 plies particularly to the recent work done on anaphylaxis, or, more 
 properly, allergy. 
 
 Anaphylaxis, or allergy, may . be defined as a state of hyper- 
 sensitiveness due to the introduction into an animal of some foreign 
 protein. Though anaphylaxis was first observed in animals, recent
 
 ALLERGY 241 
 
 work indicates that the factors producing this condition in animals 
 probably play an important role in the causation of diseases in 
 human beings. 
 
 In order that the reader may have a clearer conception of some 
 of the phenomena of anaphylaxis, it might be well to review briefly 
 the method of producing this condition in animals, particularly 
 guinea-pigs, because of the readiness and characteristic manner in 
 which they react. If we inject into a normal guinea-pig a small 
 amount of horse serum, egg-albumin, or some other protein, the ani- 
 mal presents no untoward symptoms. But if this animal is re-inocu- 
 lated after 12 to 14 days with a small amount of the same protein, 
 it quickly develops symptoms of respiratory failure and dies within 
 a few minutes. If the animal is re-inoculated within 10 days of the 
 first dose, it fails to develop any symptoms and is immune for sev- 
 eral weeks to further inoculation with the same protein. The first 
 dose of the protein is called the "sensitizing dose" and the neces- 
 sary period of time which must elapse before the second dose will 
 produce symptoms, the "incubation period." 
 
 In the few acute cases reported in human beings, the symptoms 
 resemble those seen in guinea-pigs. In man there is another form 
 of allergy, the so-called "serum disease." This differs from the 
 type I have just described in that the symptoms do not appear until 
 8 to 12 days after the serum has been given and are not so severe. 
 
 Most of the recent work on anaphylaxis indicates that the symp- 
 toms developing after the second inoculation are due to toxic sub- 
 stances liberated by the action of specific ferments on the foreign 
 protein. 
 
 Abderhalden and others have shown that the serum of the in- 
 jected animal contains a specific ferment capable of splitting the 
 protein used for inoculation. Vaughan and his students have shown 
 that toxic substances capable of causing symptoms similar to those 
 observed in anaphylaxis can be obtained from any protein by hydro- 
 lysis. It has also been found that similar toxic substances can be 
 obtained from various j^roteins if the ferment of pus is allowed 
 to act upon them. The work done with bacterial proteins indicates 
 that many of the sjanptoms observed in infections are probably due 
 to poisons set free as the result of the action of specific ferments 
 on the protein of the bacteria. 
 
 For purposes of diagnosis there are several tests to which the 
 general principles of anaphylaxis apply. The first is the Calmette, 
 or tuberculin reaction. Koch, in the early part of his work on 
 tuberculosis, observed that if tubercle bacilli were injected beneath 
 
 Vol. I— IC
 
 242 ALLERGY 
 
 the skin of a normal guinea-pig there was little, if any, local 
 reaction though the neighboring lymph glands became greatly en- 
 larged and caseous, but, if a tuberculous animal were inoculated 
 beneath the skin with tubercle bacilli, there was a very severe local 
 reaction accompanied by the separation of a slough. In other 
 words, the animal was now hypersensitive to the protein of tubercle 
 bacilli. Trudeau found the same held true for the eye. If tubercle 
 bacilli were injected into a normal rabbit's eye, there was very little 
 immediate reaction, but if they were injected into the eye of a tuber- 
 culous animal, the reaction was immediate and very severe. As 
 the result of the above work Calmette has evolved his well known 
 test for tuberculosis. The violent reaction accompanying a positiv^e 
 test is due to the poison liberated as a result of the action of the 
 specific ferment on the protein of the tubercle bacilli contained in 
 the test fluid. 
 
 Kecently a similar test has been highly recommended by Meyer 
 for glanders. He claims it is more accurate than any of the other 
 laboratory tests. Here again a positive result indicates that the 
 body contained a specific ferment capable of producing a strong 
 poison when brought into contact with the protein of the Ijacilli 
 of glanders. 
 
 Dunbar demonstrated conclusively that hay fever is caused by 
 the pollen of various plants. He found that pollen introduced into 
 the eye of a susceptible individual produced an intense irritation, 
 whilst normal individuals were entirely unaffected by such a pro- 
 cedure. Clowes has recently found that the reaction is strictly 
 specific, and that ^20 c. c. of a solution of one in five thousand of 
 the pollen injected into the eye would produce flushing. With these 
 aqueous solutions he was also able to produce definite skin re- 
 actions Avhen rubbed into small abrasions. Here again we are deal- 
 ing with poisons set free by the splitting of the proteins contained 
 in the pollen. 
 
 It has been stated that the animals made sensitive to the protein 
 obtained from the crystalline lens of beef react to lens-protein made 
 from animals of widelj^ different species. If this is true it differs 
 from any other known protein and lends added weight to the view 
 that sympathetic ophthalmia is due to hypersensitiveness of the 
 uveal tissues. Many hypotheses have been advanced to explain this 
 condition, but here we shall only discuss the possibility of its being 
 due to hypersensitiveness of the uveal tissues of the other eye. Ab- 
 derhalden has shown that ferments can be produced in the body 
 which are able to attack some specific tissue protein of the host.
 
 ALLGEMEIN 243 
 
 He foniul, and his observations have been amply eonfirmed, that the 
 serum of a pregnant woman contains a ferment which will digest 
 placental tissue. 
 
 In order that a ferment capable of attacking the normal eye may 
 be produced, it would be necessary that the uveal tissues of the in- 
 jured eye be destroyed, broken down and then absorbed. The hyper- 
 sensitiveness would not appear until 10 to 12 days after the absorp- 
 tion of the broken down tissue, probably 14 days or more after the 
 injury had been sustained. This conforms with the history of sym- 
 pathetic ophthalmia. Of course, sensitization would not occur if 
 the injured eye were removed before absorption of the. broken down 
 tissue had occurred. According to this view the changes in the other 
 eye are due primarily to injury to the cells of the uveal tissues 
 caused by the action of a specific ferment. The injury to the tissues 
 is then followed by the usual non-septic inflammatory reaction as 
 indicated by the rather extensive round cell infiltration. (J. AY. Job- 
 ling). Additional treatment of this subject will be found under 
 Anaphylaxis. See also, Ocular anaphylaxis. 
 
 Allgemein. (G.) General, constitutional. 
 
 Allgemeinansteckung-. (G.) Constitutional infection. 
 
 AUgemeinbefinden. (G.) General condition. 
 
 AUgemeinbehandlung. (G.) General or constitutional treatment. 
 
 Allgemeinerkrankung. (G.) General or constitutional affection. 
 
 Allgemeinerscheinung. (G.) General phenomenon or appearance. 
 
 Allgemeinerscheinungen. (G.) General symptoms. 
 
 AUgemeingefiihl. (G.) General condition. 
 
 Allgemeingesundheit. (G.) General health. 
 
 Allgemeinkrankheit. (G.) General or constitutional disease. 
 
 AUg-emeinkrankheiten und Organerkrankungen. (G.) General or 
 constitutional and organic diseases. 
 
 Allgemeinstorung. (G.) General disturbance. 
 
 Allgemeinveranderung. (G.) General or constitutional change. 
 
 Allgemeinvergiftung. (G.) Poisoning of the whole system. 
 
 Allgemeinv^rkung. (G.) General or constitutional effect. 
 
 Allgemeinzustand. (G.) General state or condition. 
 
 Allheil. (G. ) Panacea; cure all; a sovereign remedy. 
 
 Allmahlig. (G.) By degrees. 
 
 Allochirie. (G.) Allochiria, a perversion of sensation in which an 
 impression received on one side is referred to the opposite side. 
 
 Allochroe. (F.), adj. Capable of a change in color. Lacking uni- 
 formity of color.
 
 244 ALLOCHROIC 
 
 Allochroic. adj. Changeable iu color. Not of uniform color. 
 
 Allochroism. Variation in or diversity of color. 
 
 Allochromasia. (L.), n.f. Color-blindness. 
 
 Allochromatic. adj. Varying in coloration. 
 
 Allocromasia. (It.), n.f. Color-blindness. 
 
 Alloeopathic. Pertaining to or relating to alloeopathy (q. v.). See, 
 also, Allopathy. 
 
 Alleopathy. A term used by Hahnemann to designate cure by inciting 
 disease "of another kind," and said by him to be preferable to "Allo- 
 pathy," which term really means "another disease." 
 
 Allometropia. According to Matthiessen, this is the variation of 
 refraction for outer areas of the retina from the refraction at the 
 macular region. 
 
 Allopathy. This is the term applied by Hahnemann to the school or 
 schools of medicine opposed to homeopathy, and was intended to 
 indicate that method of treating disease by the use of remedies 
 whose action upon the healthy body produces symptoms different 
 from those of the disease under treatment. To some extent the 
 term has been adopted by the so-called regular school of medicine, 
 although those who study and treat disease in a scientific manner 
 belong to no sect, "-ism" or "-pathy" of any kind whatever. 
 
 Allophansaure. (G.) Allophanic acid. 
 
 AUorrhythmie. (G.) Allorrhythmia ; morbid change in the cardiac 
 rhythm. 
 
 AUotriophagia. Tunnel anemia. Tunnelanamie. Dirteater's anemia. 
 Hookworm disease. See Ankylostomum duodenale. 
 
 Allotropie. (G.) Allotropism. 
 
 AUotropisch. (G.) Allotropie. 
 
 AUoxansaure. (G.) AUoxanic acid. 
 
 Alloys of steel. As is well known, steel is frequently alloyed with 
 other metals, and this is an important point in magnet operations. 
 W. M. Sweet has written upon the subject, and refers to the in- 
 creasing use of nickel, manganese and other metals in steel-making, 
 the employment of alloyed steel in the manufacture of tools, etc., 
 for industrial operations. Now the effect of these alloys is to de- 
 crease the magnetic property of the steel, therefore to render the 
 extraction of splinters from the eye by the magnet less certain. 
 
 Allport's operation for enucleation. This enucleation operation is 
 the same as the Ferrall or Bonnet operation up to the step where 
 the tendons are separated from the eyeball; at this juncture, instead 
 of cutting off the tendons and allowing them to retract into the
 
 ALLPORT'S OPERATION FOR ENUCLEATION 
 
 245 
 
 socket, Olio proeet'ds as follows: TJie su|)erior rectus is eaug'ht on a 
 strabismus hook and pulled away from the eyeball. Another hook 
 is then passed beneath the muscle and while one hook pulls the 
 muscle from the eyeball the other is passed backAvard and forward 
 between the eyeball and muscle to free entirely the muscle from any 
 fibers connecting the muscle and globe. The second strabismus 
 hook is then withdrawn, leaving the first in place. One blade of 
 a strong pair of Prince's advancement forceps is then placed be- 
 tween the tendon and sclera, taking the place of the remaining 
 strabismus hook, Avhich is now withdrawn. The edge of the con- 
 
 Enucleation of the eyeliall. Allport 's method. 
 
 junctiva lying over the muscle is seized by a pair of forceps and 
 pulled forward, together with the capsule of Tenon, and the outside 
 blade of the Prince's forceps brought down upon them and locked. 
 The bent ends of the forceps now contain the tendon, capsule of 
 Tenon and overlying conjunctiva. The tendon is separated from 
 the e,yeball bj^ scissors passed between the forceps and the sclera, 
 being careful not to wound the latter structure. 
 
 A needle and catgut suture should now be passed by means of a 
 needle-holder through the conjunctiva, capsule of Tenon and tendon 
 from without inwards and then back again from within outwards. 
 This quilts the entire mass together by means of a firm, solid stitch 
 that will not pull out ; after Avhich the two ends of the suture are 
 carefully laid aside so as not to interfere with the next step in the
 
 246 
 
 ALLPORT'S OPERATION FOR PTOSIS 
 
 operation. The external rectus is then picked up, liberated, en- 
 gaged in the Prince's forceps together with the conjunctiva and 
 capsule of Tenon, cut away from the sclera, quilt-stitched with the 
 same needle and suture, etc. The same steps are taken (in their 
 order) with the inferior and the internal rectus, after which the 
 needle may be withdrawn from the suture. The purse-string suture 
 and its two free ends should be laid carefully aside to facilitate 
 the subsequent steps of the operation which are exactly the same 
 as in the Ferrall or Bonnet operation just described. The operation 
 
 a ^ 
 
 Enucleation of the Eyeball. (Allport.) 
 
 is completed by pulling the continuous suture containing the recti 
 muscles, the capsule of Tenon and the conjunctiva together and 
 tying the mass in a firm, hard knot. Great care should be exer- 
 cised when the scissors are introduced to sever the optic nerve, 
 that the suture is not cut in the process, an accident which is not 
 at all impossible. If, however, this misfortune should occur the 
 muscles should be painstakingly picked up and the continuous, 
 purse-suture re-introduced as before. 8ee, also. Enucleation of the 
 eyeball.— (P. A.) 
 Allport 's operation for ptosis. The chief features of this operation 
 are a thorough denudation of the tongue flap so that it may grow to 
 the raw surface of the bridge, and removal of the corners of the 
 lateral flaps on the lid surface, to make them fit more accurately 
 and thus avoid puckering of the lid. 
 
 The incisions are made like those described by Panas. (Modifica- 
 tion of Panas' Operation for Ptosis. Jour. Am. Medical Ass^n, 
 April, 1903; also personal, note.) Allport however, making first
 
 ALLPORT'S OPERATION FOR PTOSIS 
 
 247 
 
 the incision abovf the brow, the h'ngtli ol' the i)al|)ebral fissure 
 and extending to the bone, a, h. The second incision, c, d, is made 
 about the same length as the first, as in the figure, just below the 
 eyebroAv, and should also extend to the bone. Two parallel, vertical 
 incisions extend from this incision to points about on a level Avith 
 the superior border of the tarsus. Horizontal incisions, e, f, and 
 g, h, are then made from these, as in the Panas procedure. The 
 
 Allport 's Operation for Ptosis. 
 
 A. Diagram of the Incisions. 
 
 B. Field of Operation showing the Sutures in Position. 
 a, b, incision above the eyebrow, extending to the bone. 
 c, d, incision below the eyebrow. 
 
 g, h, superior border of the tongue flap, separated from its original posi- 
 tion along the line of incision, c, d. The cutaneous surface is denuded of 
 epithelium. 
 
 X, X lateral flaps, undermined and made pointed by cutting off the corners. 
 
 bridge is then undermined from one end to the other, and in ad- 
 dition to this it is everted, and all the soft tissues removed, making 
 this flap, consisting mostly of integument, as thin as possible. The 
 tongue flap should be dissected up, and this he also makes as thin 
 as possible, dissecting away the muscle fibers. The cutaneous sur- 
 face of the flap is thoroughly scarified (if possible denuded of 
 epithelium) to make it adhere to the under surface of the bridge 
 fiap. This is a distinct advantage. The lateral flaps on the side of
 
 248 ALLTAGLICH 
 
 the vertical incisions are also undermined and their corners cut off, 
 as indicated in the figure, giving them a pointed appearance. Sut- 
 ures are introduced, as in the Panas operation, three serving to 
 hold the tongue flap in position under the bridge and uniting it 
 to the upper lijj of the superior incision; and two lateral ones, 4 
 and 5, double-armed sutures that pass from the conjunctival side 
 of the lid outward through the fascia, the loop remaining on the 
 conjunctival side. 
 
 These lateral sutures, as in the Panas operation, serve to prevent 
 ectropion. Four superficial sutures unite the skin at the angles made 
 by cutting off the lateral flaps, as indicated in the drawing. All 
 sutures, except those of the tongue flap, are removed in four days; 
 the others are allowed to remain about ten days, to insure union of 
 theparts.— (W. H. W.) 
 
 Alltagflich. (G.) Quotidian; daily. 
 
 Allyl alcohol, Oculo-toxic symptoms from. AVorkers who handle allyl 
 alcohol [CoHgO, made by distilling glycerine with oxalic acid; a 
 limpid liquid, with a pungent ordor] and breathe its vapor show 
 marked secretion. from the eyes and nose, the conjunctiva becomes 
 reddened, followed by pressure pains in the head and the eyes. 
 Farsightedness is said to occur after long-continued exposure to 
 the action of this poison, and this refractive error is thought to be 
 due to accommodative changes. 
 
 Allyl sulphocarbamide. See Thiosinamine. 
 
 Allyl thiourea. See Thiosinamine. 
 
 Almond Oil. See Almonds, Sweet oil of. 
 
 Almonds, Sweet oil of. Oleum amygdal.e expressum. Almond oil. 
 A fixed oil expressed from the kernels of prunus amygdalus, bitter 
 or SAveet. It should be nearly colorless, odorless and with a nutty 
 taste. It is slightly soluble in alcohol ; very soluble in ether and 
 chloroform. The pure oil consists mostly of triolein with some 
 tripalmitin. 
 
 The pure oil makes a good base for eye ointments, especially 
 when mixed with "cold cream," paraffin, wax or other firmer ex- 
 eipient. As a solvent for such alkaloids as atropia, cocaine, eserine, 
 etc., it is probably inferior to castor oil or even olive oil. Like other 
 oils it may be employed as an antidote in burns by lime and strong 
 alkalies. 
 
 Al-Muwaffiq b. Saua al-Israili. A Jewish physician, archiater, or prin- 
 cipal physician, to Saladdin, concerning whom, according to Hirsch- 
 berg, Usaibia relates that he was "renowned for the sureness of 
 his art and his superior knowledge in medical science, including 
 ophthalmology and surgerj^" — (T. H. S.)
 
 ALOGIE 249 
 
 Alogie. ((t.) Apliasia. 
 
 Alone glaucomatoso. (It.). The halo seen about single lights by- 
 persons affected with glaucoma. 
 
 Alopecia. Baldness. Loss of hair; e. g. alopecia of the ej^ebrow or 
 eyelashes. 
 
 Alopecia areata. When this disease affects the eyelids or the eye- 
 lashes the latter may drop out, leaving the surrounding skin soft, 
 smooth, and of a dull-white color. This disease is most commonly 
 found in children and young adults, in which case the hair generally 
 returns after three or four months. The new hair at first is color- 
 less and downy, but later on presents a normal appearance. Fox 
 (Diseases of the Eye, p. 52) advises in the way of treatment the ad- 
 ministration of arsenic in varying doses according to the age of 
 the patient, and the local application of the faradic current. The 
 close proximity to the cornea eontra-indicates the local application 
 of alcohol, capsicum, cantharides and similar irritating preparations 
 usually advised for this aft'ection in the scalp. 
 
 Alopecia of the eyelashes. By this condition is understood the partial 
 or entire absence of the cilia due to disease. It may be part of a 
 general alopecia or may be caused by lepra, pityriasis, etc. Some 
 eases of nervous origin are recorded, as, for instance, in Basedow's 
 disease. ]\Iore commonly, ciliary alopecia is observed with syphil- 
 itic alopecia of the scalp and eyebrows. Himly observed ciliary 
 alopecia in scarlet fever; Rosenthal in leukoderma. Carrons de 
 Villars and Cornaz also describe an alopecia ciliorum congenita. 
 
 Alopecie. (G.) Alopecia. 
 
 Alopecie der Wimpern. (G.) Alopecia of the eyelashes. 
 
 Alpha, Angle, n. See Angle alpha. 
 
 Alphabets and literature for the blind. We know there have always 
 been attempts among the more ambitious of the blind to devise meth- 
 ods of communication with each other and with their seeing friends 
 beyond the range of speech. Among the early peoples conventional 
 objects to Avhich an arbitrary value was assigned were used for 
 this purpose. The Peruvians employed knotted strings (each knot 
 having its meaning) which were passed like a rosary through the 
 fingers. 
 
 The earliest authentic record of tangible letters used by the blind 
 dates back to the sixteenth century; it is ascribed to Francesco 
 Lucas, of Spain. Evidently no further use Avas made of his inven- 
 tion until Rampezzetto, an Italian, carved letters in wood ; but as 
 these were on a solid surface and could be used only after the man- 
 ner of our stereotyped plates they were of value oidy in making the 
 blind familiar with the letters of the alphabet.
 
 250 
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 In 1640 Peter Moreau, a notary, succeeded in casting letters in 
 lead for the blind which gave him a name and a place among the 
 earliest typographers. 
 
 It remained, however, for the idealist and philanthropist, Valentin 
 Haiiy, Frenchman and the brother of the creator of crystallog- 
 raphy, through an accidental circumstance, which he regarded as 
 providential, to make tangible letters practically available for the 
 blind and to establish the first school for the training of those with- 
 out sight. 
 
 String-Writing Alphabet. 
 
 The Fair at St. Ovids was being held in 1771 where great crowds 
 gathered daily. In one of the booths a man named Valindin had 
 collected a group of blind men whom he had dressed in a fantastic 
 way, and who by making sport for the crowd, attracted patrons to 
 his cafe. The men wore long pointed hats. On their noses were 
 huge paste-board spectacles without glasses. Behind their leader 
 the expanded tail of a peacock and on his head the head-dress of 
 Midas. Placed before a desk on which were music and lights they 
 executed a monotonous chant in which the tenor, basses, and violins 
 all took the same part. 
 
 Haii.y was profoundly moved by this sight. That men, strong 
 and able-bodied, should be reduced by the loss of sight to the neces- 
 sity of earning their bread by making a ridiculous spectacle of 
 themselves, as the only alternative of beggary, touched him deeply, 
 and the more so when he saw that their condition did not appeal to 
 the pity of the populace. The isolation and loneliness in which these 
 men must live came to him so strongl^y that he was roused to devote
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 251 
 
 1 
 
 ii 
 
 jgssssS;-^*-:'' ■ 
 
 IP® 
 
 r 1, 
 
 u 
 
 r. 
 
 (] 
 
 NCI-K I li .\\ U.l 
 - 'y)i l\/l ■•\'lN(;i ■-. 
 
 IMAi.l. roll [ \1M 
 
 A Fair at St. Ovids.
 
 252 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 his own sight and his own strength to ameliorate their pitiable con- 
 dition. His first thought was "if only they could read music and 
 make harmony instead of the horrible discordant sounds that now 
 offend the ear!" and with the thought came the determination that 
 he would teach them to do so. 
 
 "Yes," he said, "I shall substitute the truth for this mocking 
 parody. 1 shall make the Mind to read. I shall put in their hands 
 volumes printed hy themselves. They shall trace the characters and 
 shall read their own ivriting, and they shall he enabled to execute 
 harmonious concerts." 
 
 x^csetTg^n 
 
 
 Specimen of Type Used at tbe Paris Institute. 
 
 More than ten years passed during wdiich Haiiy, with a sense of 
 the practical rare with enthusiasts, gathered a few blind people 
 about him and devoted his time to studying the methods employed 
 by the few privileged blind Avho had succeeded in acquiring 
 instruction. Among his pupils was one, a bright, intelligent lad, 
 who had been a beggar, and whose name was Francois Le Sueur. 
 One day while Le Sueur was sorting papers on his master's desk 
 he came across a card of invitation which, strongly indented by the 
 types in the press, had obtained in relief an imprint of certain char- 
 acters. Proud of his work the blind lad called his master and 
 showed him that he could deciper several letters on the card. It 
 was a ray of light to the ever wakeful mind of Haiiy. Immediately 
 he traced with his pen some signs upon the same page. Le Sueur 
 recognized them without hesitation. Impressions in relief, the great- 
 est of Haiiy 's discoveries, was made. He did not rest until he had 
 completed, after much groping, the practical application of his
 
 ALPHABETS AND LITERATURE FOR THE BLIND 253 
 
 process, but the search for the accessories and tiie perplexities of 
 the inventor are not recounted in history. 
 
 Haiiy had succeeded to such a point, however, that in 1784 he took 
 his pupil to Paris, where he was exhibited at the Academy of Science 
 as an example of the possibilities of training for the blind. The 
 interest of the Pliilosophical Society was such that funds were pro- 
 vided by which he was enabled some years later to establish the 
 
 abc8e/glxLJItLTuri 
 oparstaooox^x 
 1 2 3/1.067800 
 TTippLme' a braqes 
 
 Facsimile of Type Used by Valentine Haiiy. 
 
 Institution for the Young Blind, which was the first educational 
 institution for the blind founded in Europe. The work which he 
 accomplished was looked upon as phenomenal and excited the in- 
 terest of Louis XVI, on whose invitation a group of his pupils were 
 taken to Versailles and their skill exhibited. Then came the Revolu- 
 tion. His school was broken up, and Haiiy fled to Russia, on invita- 
 tion of the Emperor Paul, stopping in Berlin long enough to found 
 a school for the blind there. Several years were spent in St. Peters- 
 burg, where, with great difficulty, he managed to start a school, 
 returning to Paris in 1817, where he found the institution that he 
 had established, remodeled and improved under the directorship 
 of Dr. Guillie. 
 
 In an essay on the Education of the Blind, dedicated to the King 
 of France, in 1786, Haiiy tells of the desolate condition of the blind 
 of his time, whose lot, indeed, seems to have been but little better
 
 254 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 than that of the insane of the same period. In his essay on the 
 subject of reading, he says: '"Before our time various ineffectual 
 experiments had been tried, sometimes bv means of characters 
 
 .<]><«f<?kl 
 
 -4 jKimAoHr 
 
 UWVWXYZ. 
 
 ABCDEFDHIJKLM 
 al^on{NOP(1RSTVWXYZ2o_ 
 1Z34567890,;:.J?() 
 
 ABCDETGHI 
 JKLMNOPQR 
 
 -I ^ %r/i-* 
 
 STUVWXYZ 
 
 LUCAW 
 
 Specimen of Alphabet Used by Gall, Alston and Lucas. 
 
 moved upon a board and raised above its surface, at other times by 
 the use of letters formed upon paper by the puncture of a pin, and 
 in that way the characters of the alphabet had been taught. Al- 
 ready something had been accomplished in teaching the blind to 
 write. But the imperfect means which had been available had 
 served only to open up to the blind possibilities of reading which 
 they had not been able to realize.
 
 ALPHABETS AND LITERATURE FOR THE BLIND 255 
 
 "It had been observed that on the opposite Side of a printed leaf 
 coming from the press, the letters were sometimes raised above the 
 surface but reversed in their positions and order. Characters were 
 cast therefore, not as used in printing, but as they appear to the eye, 
 and by pressing wet paper on these the first example of raised type 
 which could be distinguished by the sense of touch was obtained. 
 After having successively employed characters of different sizes, 
 the form which could be most readily distinguished was determined 
 upon, and this was employed for the printing of the earliest books. 
 
 The types used by Haiiy, it will be seen, were of the italic form 
 and were soon adopted in other institutions of like character. 
 
 In 1834 Mr. Gall, a printer of Edinburgh, attempted to improve 
 the Hauy letters by use of an angular, Roman type. Notwithstand- 
 ing the enthusiastic claims made for this type by its inventor "that 
 the blind could skim over the letters with great rapidity," that "so 
 great is the facility with which the blind are able to feel the letters 
 that already they can read books printed with the common English 
 size of type, the same as is used in papers printed for the Courts 
 of Law," this was not borne out in fact. 
 
 A contemporary writer assures us that "even under Mr. Gall's 
 own direction his pupils were able only to make out letter by letter 
 and a few short words," and, "as for reading it was quite out of the 
 question." 
 
 After Mr. Gall had published the Gospel of St. John in tactile 
 letters the interest in the subject excited such general attention that 
 between the years 1832 and 1835 no less than twenty different styles 
 of letters were submitted to the Director of the Society of Scottish 
 Arts, by whom a prize had been offered for the best method which 
 should be proposed. Many of these showed much similarity in form, 
 while others were impracticable, but at this time various types 
 rapidly came into use and we learn that seven forms were employed 
 in diff'erent parts of the world. Mr. Gall's angular letters were 
 replaced at the Asylum at Glasgow by the ordinary Roman letter 
 in relief, introduced by Alston and known by his name. At this 
 time there were several attempts made to introduce stenographic 
 forms, of which that of Lucas only attained any degree of popu- 
 larity. It was adopted by the London Society for Teaching the 
 Blind to Read, and has been discontinued only within recent years. 
 
 In America the most dominant figure in work for the blind is 
 that of Samuel Gridley Howe, who in 1830 was made superintend- 
 ent of the then recently incorporated School for the Blind in Massa- 
 chusetts, and was sent abroad to study foreign methods for teaching
 
 256 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 the sightless. From a manuscript on the Boston Line Type, written 
 in 1906 by Miss Gazella Bennett, and loaned by the superintendent 
 of the Perkins Institution for the Blind, the foUoAving facts are 
 gleaned. 
 
 "Dr Howe at once became greatly interested in books for the 
 blind and devoted much thought and time to devising a less bulky 
 and less expensive method for printing and binding embossed books. 
 When the Perkins Institution and Massachusetts School for the 
 Blind was scarcely three years old, Dr. Howe had set up a press in 
 which only lowtr-case letters were used; the lines of the letters 
 were Tiarrow and clear cut, hence most easily" understood by touch; 
 the interlinear space was decreased by slightly modifying the let- 
 ters that fall below the line ; the height of the face of the type was 
 considerably diminished; and then paper especially prepared was 
 used. The books were bound in single sheets, with the embossed 
 surface of one left against the depressed surface of the preceding. 
 In 1836, Dr. How(! published the New Testament in two volumes, 
 subject matter which would have required twelve volumes in the 
 French style of printing and binding. He sent out books in quick 
 succession for the use of the school. In the years 1835 to 1837, in- 
 clusive, he printed the Psalms, New Testament, a grammar, a geog- 
 raphy, an atlas, diagrams and a philosophy. In 1839 appeared 
 Viri Bomce. 
 
 The Institution for the Blind in Philadelphia adopted the capital 
 letter for the entire word, but made each letter quite small; and in 
 the years 1838-9, from this press were issued the books of Ruth and 
 Proverbs, some works in German, a library of selections, and a 
 magazine of several volumes entitled the Student's Magazine. 
 
 In the years 1837 to 1839, inclusive, Glasgow sent out, also in 
 small capitals, the Neiv Testament, Shorter Catechism, Liturgy, Selec- 
 tions from Eminent Authors, and a reader. 
 
 In 1847 Staunton, Virginia, printed in French a book of Colloquial 
 Phrases, two years later a collection of French Fables and in 1871, 
 a Little Story Book. These were all in small capital letters. 
 
 In 1849, New York published a book of mathematics. The Double 
 Rule of Three. 
 
 The press at Philadelphia continued its work with the book of 
 Esther, and Dictionary of the English Language. 
 
 As often as Dr. Howe could secure money for the work he added 
 valuable books to the library for the blind. We find jMilton's Para- 
 dise Lost printed in 1855, and Old Curiosity Shop in 1869. Dickens
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 257 
 
 himself selected llu; book and gave fifteen liiuidred dollars that it 
 might be embossed. 
 
 In 1856 a printing press was set up in Raleigh, North Carolina, in 
 the School for the Deaf, Dumb and Blind. The deaf boys were em- 
 ployed in printing books both with ink and with embossed type. 
 The work was discontinued in 1871. The lower-case letter was 
 used, and the embossed books contributed by North Carolina were 
 a hymn book, a reader, a grammar. Selections from Virgil's Acneid, 
 and Scott's Lady of the Lake. 
 
 In 1857, Mississippi and Kentucky appropriated money for print- 
 ing embossed books and recommended the establishment of a na- 
 tional printing house. Later, Kentucky granted a charter to a 
 body of trustees for tlie purpose of establishing a printing house for 
 embossed literature. The first volume was issued from this press 
 in 1865. 
 
 Napoleon Kneass, Junior, came forward in 1867, and gave em- 
 bossed books proper literary form by uniting the capital and lower 
 letters in printing. In due time all the printing offices adopted the 
 combinations. Kneass published from his own press in the city of 
 Philadelphia a few text books, Kneass' PliiladelpMa Magazine, and 
 a music journal. 
 
 The American Bible House supplied Dr. Howe with funds for 
 printing the Bible in embossed form early in the history of his w^ork, 
 and since then it has supplied Bibles to all blind persons asking for 
 them. 
 
 The Society for providing Evangelical Religious Literature for 
 the Blind, New York City, was incorporated in 1879, and has fur- 
 nished a number of books and published the International Sunday 
 School Weetdy for at least twenty-five years. 
 
 The National Association for printing Musical Works for the 
 Blind was united with the Printing House in Kentucky in 1873. 
 Shortly after this an annual appropriation from Congress for pro- 
 viding tangible apparatus and literature for the blind was assigned 
 to the same place, and the printing house at Louisville, Kentucky, 
 became the American Printing House for the Blind. From its press 
 the sightless reader has received sixty-three books of biography and 
 general literature, forty-four text books, and nineteen readers. Its 
 records show that from 1870 to 1879, inclusive, eleven thousand 
 four hundred and sixty-six books w^ere distributed. No books have 
 been printed in line-type at the American Printing House since 1892. 
 
 In 1879, three years after Dr. Howe's death, Mr. ]\I. Anagnos had 
 a new printing press constructed for the Perkins Institution. It 
 
 Vol. I— 17
 
 258 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 had all the modern improvements in machinery, and the shape of 
 the letter was brought still more in conformity with the letters of 
 standard print. The new press was styled the Howe Memorial 
 Press. Then, Avitli indefatigable zeal, and a courage inspired by 
 the great need, Anagnos set himself the task of securing a printing 
 fund of one hundred thousand dollars. Sixteen months later his 
 purpose was more than accomplished, and since then uninterrupted 
 work has gone forward in the printing office. As books began to 
 be issued from the press, Anagnos asked the libraries in some of the 
 larger cities and towns in New England to take, free of charge, as 
 many embossed books as they could accommodate for the use of 
 sightless readers in their vicinity. Under this arrangement em- 
 bossed publications have been sent to Portland, Maine ; Concord, 
 New Hampshire ; Boston, Lowell, Lynn, Somerville, Worcester, 
 Fitchburg, and New Bedford in Massachusetts; Providence, Rhode 
 Island; and Hartford, Connecticut. Numerous books were also sent 
 to the Society for the Relief of Destitute Blind, New York City; the 
 Working Home for Blind Men, and the Pennsylvania Industrial 
 Home for Blind Women. 
 
 Since 1903, when the new postal law went into effect (which per- 
 mits embossed books to pass through the mail free of expense) less 
 use has been made of local libraries, as in most cases it is more 
 convenient for the blind persons to get books from the post office 
 than from a library. 
 
 During the year 1906, the circulating library of Perkins Institu- 
 tion distributed a few less than nine hundred books printed in line 
 type. These were sent in response to applications from blind people 
 whose homes represent the New England States, New York, Penn- 
 sylvania, Ohio, North Carolina, Georgia, Alabama, Tennessee, Illi- 
 nois, Missouri, Wisconsin, Michigan, Minnesota, Dakota, Nebraska, 
 Texas, Oklahoma, California and Canada. Some of these blind peo- 
 ple read no other type and are wholly dependent upon the press and 
 library at Perkins Institution for reading matter. During the spring 
 months of 1907, the Howe Memorial Press prepared a memoir of 
 Michael Anagnos, its founder and the far-seeing educator of the 
 blind. Up to the present date, July, 1907, the Perkins Institution 
 printing office has sent out one hundred and twelve books of biog- 
 raphy and general literature, thirty-one text books of biography 
 and general literature, thirty-one text books, and twenty-seven 
 readers. As many of the books of general literature are in two, 
 three, or even five volumes (David Copperfield requires five vol- 
 umes), and several have passed through two and more editions it is 
 conservatively estimated that since the year 1835, the press of
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 259 
 
 Perkins Institution has issued in line letter two hundred thousand 
 volumes.'' 
 
 In the year 1840 a young man, William Moon (afterwards Dr. 
 William Moon), of Brighton, England, who was studying for the 
 ministry, became blind at the age of twenty-one years. Having 
 made himself thoroughly acquainted Avith all the types then in vogue, 
 he endeavored to instruct other blind persons in reading, but whilst 
 
 READING FOR TH^ BLIND, BY W. IVIOON, LL.D. 
 
 
 ttHEM .atttJbvr f« Ml IM B^j igtla^l. U f 1^1 w. Itu« 
 
 ROR — T^ ••'W ••vtf ■> IM U>a rrmiMWurar.^a4 r^t a» i<^>^i^tm wtiafut.iu it 
 
 A 
 
 A 
 
 b C D E f G H 
 
 J K L m N 
 
 Q. J3 R ^ T U V .V X Y Z S 
 
 CLASSIFIED ALPHABET. 
 
 Aa 
 
 C C 
 
 b _ 
 
 E - 
 
 1 
 
 N ,; 
 
 Q- — 
 
 EVEN NITMERALS. 
 
 V ^ 
 
 D :: 
 
 J L 
 
 m-_ 
 
 T- 
 
 z~_ 
 
 Ji _ 
 
 •y V ' 
 
 K<: 
 
 u ^ 
 
 f "• 
 
 L _ 
 
 /} 
 
 S ' 
 
 ?-. 
 
 on) NUMKUll.S. 
 
 i x> 
 
 Wr. 
 
 G 
 
 Y_, 
 
 R 
 
 o : 
 
 H^ 
 
 5 / \ I, 
 
 3 
 
 D II 
 
 THE LORD'S PRAYER. 
 ? -A T H K a W a J C H ART IN HEAVEN' 
 
 - :- .. .- . - .'^j] 
 
 S H I , » a A N 7 a T E B II B W O t 1, A n 
 
 '■ M E .. T H T WILL BE O O S E : .-i 
 
 : ->- - - ---W 
 
 U 
 
 Moon Aljjhabet. 
 
 he found it possible to teach children with sensitive fingers, he dis- 
 covered that about eighty per cent, of the blind Avere adults and that 
 the different forms of the ordinary letters were too complicated for 
 them to decipher, and the shorthand and phonetic systems were too 
 difficult to understand and remember. 
 
 With no intention of introducing a new system, he gave careful 
 consideration to these facts for five years, and ultimateh^ devised 
 a new^ type which is now known as the Moon type. It Avas found to 
 be so simple in construction that the blind of all ages and capacities 
 could feel it and read it, even after having failed to learn any of the 
 older systems. In the Moon alphabet nine of the Roman letters are 
 retained in their entirety; thirteen are ordinary letters simplified 
 by removing portions of them to make them clearer to the touch ; 
 and only for the remaining four have entirely ncAV characters been
 
 260 
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 introduced. The alphabet consists of nine characters placed in 
 various positions. It is composed of the simplest geometric forms, 
 such as the straight line, the acute and right angle, the circle and the 
 semicircle. In order that the reader shall not lose his place, the first 
 line is read from left to right and the second from right to left. The 
 finger is guided by a curved bracket from the end of the line to the 
 one below. 
 
 For half a century Moon devoted himself with untiring energy to 
 the preparation of embossed literature in English and many foreign 
 
 Win. Moon. 
 
 Miss Moon. 
 
 Eobeit Moon. 
 
 languages. At the present time 75,000 stereotyped plates are care- 
 fully preserved at the Moon Institution for the Blind, at Brighton, 
 which, since Moon's death, has been conducted by his daughter. 
 Miss Moon. The literature in the Moon type comprises, in addition 
 to the books of the Bible in English and several foreign languages, 
 many volumes of an educational and entertaining character, and 
 astronomical works. There are many thousands of the blind in all 
 parts of the world who are finding pleasure in reading these em- 
 bossed books, which are an inexpressible comfort to them in their 
 dreary and lonesome hours. Many of the readers are ninety years 
 old, some are ninety-five, and a large proportion of them had previ- 
 ously tried, in vain, to learn the dotted and Roman letter systems. 
 
 In making it possible, by the introduction of the Moon type, to 
 teach the adult blind to read, Mr. Moon (who later received the 
 honorary degree of L.L.D. in appreciation of his work for the blind) 
 in 1856 organized in London the first Home Teaching Society for the 
 Blind, with a circulating library of embossed books in the Moon 
 type. This Society at once proved to be a great success, and similar
 
 ALPHABETS AND LITERATURE FOR THE BLIND 261 
 
 societies were soon started in other places. In various parts of Great 
 Britain and Ireland, America, Australia and other countries, there 
 are at the present time about eighty home teaching societies and free 
 lending libraries of the Moon books; and teachers (many of 'them 
 blind) are engaged in visiting the blind in their own homes — teach- 
 ing them to read and exchanging their books. 
 
 Home teaching for the blind was introduced into America in 1862 
 when "William ]\Ioon, accompanied by liis daughter, visited the 
 United States and was instrumental in organizing home teaching 
 societies in Philadelphia, New York, Boston, and Chicago. The one 
 in Philadelphia, under the title of the Pennsylvania Home Teach- 
 ing the Society and Free Circulating Library for the Blind, is the 
 pioneer institution of its kind in America, and it now employs five 
 teachers in different parts of Pennsylvania to visit and teach the 
 blind in their homes. During the year 1912 no less than 20,924 of 
 the Society's embossed volumes were circulated amongst the blind, 
 not only in Pennsylvania, but in many of the other states of the 
 Union. Books in all the embossed types are on the Society's shelves, 
 but of the total number circulated 15,425 were in Moon type. The 
 circulation of books amongst the blind has been greatly promoted 
 in the United States and Canada by the granting of free transporta- 
 tion through the mails of embossed books loaned from public libra- 
 ries. The introduction of the free-lending library in conjunction with 
 the home teaching in Philadelphia has led to a very general pro- 
 vision of a department for the blind in other leading libraries 
 throughout the' United' States. 
 
 Moon's type has already been adapted to some four hundred 
 foreign languages and dialects, and of late years the publishing of 
 the Scriptures in these has been taken up by the British Bible 
 Society. 
 
 In the United States the Moon type, as it is much more easily 
 acquired by elderly readers, is used by the Pennsylvania Home Teach- 
 ing Society and Free Circulating Library for the Blind at Phila- 
 delphia, of which Robert C. IMoon is secretary. Through this 
 Association embossed books are loaned to blind readers throughout 
 the United States. 
 
 The Frere alphabet somewhat resembles that of ]\Ioon. 
 
 It was to a blind man that the world owes the form of tactile print 
 which is now almost universally employed throughout the world. 
 Louis Braille was a musician and a teacher in the Institution Na- 
 tionale des Jeunes Aveugles, founded by Haliy. 
 
 It had for a long time been known that raised dots were more
 
 262 
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 readily recognized by the finger tips than lines. A French officer 
 by the name of Barbier, who was deeply interested in the blind, and 
 
 LL SS FF TH SHmCHNGWHGH &;c. 
 
 J 2 3 456 7 8 9 
 
 ALcorn O I 
 
 ABCDEFGHI 
 
 J<LrMO<^^ \ 
 JRLMNOPQ R 
 
 STUVW XYZ & 
 
 MOON-i 
 
 ERER& 
 
 A B D E FG HI 
 
 JC U D-^^ / 
 JRLMNOP R 
 
 OIZ A . V 
 
 S TU V Z 
 
 Alphabets of Moon and Frere. 
 
 of a philanthropic character, had invented and in 1820 had intro- 
 duced a system consisting of twelve dots, susceptible of almost 
 limitless combinations. The number of points made it extremely 
 clumsy and unwieldy, and Braille modified it by reducing the num- 
 ber to six, not too many to be easily covered by the ball of the
 
 ALPHABETS AND LITERATURE FOR THE BLIND 263 
 
 finger. The following is a brief description of the liraille alphabet 
 as given by the late Dr. Arniitage of England. 
 
 ''The group of six points is divided into upper, middle and lower 
 pairs and the alphabet into three rows of letters, i. e., the first ten 
 letters, from a to j, exhaust all possible combinations of the ui)per 
 and middle points ; the next ten, from k to t, are formed from the 
 first by adding a lower back point to each, thus 'a' becomes 'k,' 
 'b' becomes '1,' etc. The third row is similarly formed by add- 
 ing two lower points; thus 'a' becomes 'u,' 'b' becomes 'v,' 'c' 
 becomes 'x, ' 'd' becomes 'y' and 'e' becomes 'z.' The fourth row of 
 letters is formed from the first by adding a front lower point to the 
 
 ABCBLTGHIJ 
 
 KLMNOPQRST 
 
 U V X Y Z 
 
 Braille Alphabet. 
 
 first row. The only letter of the ordinary alphabet in this row is 
 'w. ' It will be observed that 'w' comes out of its place in the 
 alphabet. This is because the original French alphabet has been 
 adhered to, 'w' being a letter not used in genuine French words. 
 As originally arranged it was the last of the front row and has been 
 there retained, as placing it out of position was considered a far less 
 evil than altering the four last letters of the alphabet." 
 
 The Braille is admirably suited for music, of which an immense 
 amount has been published and is now available. 
 
 "At present there is not an institution in the United Kingdom 
 where the Braille system is not more or less used. In the best schools 
 it is employed almost exclusively, and the extent to which it is used 
 forms a pretty good rough test of the quality of teaching in a school. 
 Some idea may be formed of the spread of the Braille system since 
 the formation of the Association by the fact that since that time
 
 264 
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 it has sold about 20,000 styles, or instruments used for writing. 
 The greater part of these have been used in the United Kingdom, 
 though about 1,000 have been sent to France and Germany. Ger- 
 many has at last realized the importance of Braille as an educa- 
 
 I WILL MAKE DARKNESS 
 M3HT 3510"=Ha THOU 
 
 Frere 's Method. 
 
 tional system. In 1873 the first Congress of the Instructors of the 
 Blind was held at Vienna. I there exhibited specimens of Braille 
 writing, printing, and maps; and strongly urged the claims of 
 Braille as a universal educational system for the blind. The sub- 
 
 I WILL MAKE DARKNESS 
 
 MEHT EROFEB THGIL 
 
 It 
 
 IjJ 1 U CJL\5 T 
 
 lis F J62; ibi ■ T 
 lif JCoojr 1 
 
 lir ffciJbi if 
 Iv Xooir T 
 
 A 
 
 lir Jtoojj- '£3 
 
 Ijt Jtoojr j-?- 
 
 n 
 
 ]ju Jtoojr (Jj 
 
 Ij: JCooir 'Y' 
 1m Jtooar J 
 
 Ji i:oojr 
 
 Moou's Method. 
 
 o{ 
 
 C{ 
 
 o{ 
 
 til Lt!CX]3 'P' 
 
 lis FjbiJe/£ X 
 
 li: Jiloojir '0' 
 
 I jir 1 u c A)J J) 
 
 lis Jto ojT 'G 
 
 I-ir t UCA^J 'JT' 
 
 lis M.OOSS Y" 
 
 lis i UCXJJ X" 
 
 lis ^R,lStjl 'P' 
 
 \is ilooir -IT" 
 
 ject was referred to a committee, and at the next Congress, held in 
 1876 in Dresden, it was decided to adopt a modified Braille, in 
 which, though the Braille frame was retained, the letters were 
 altered in such a way that those letters which occurred most fre- 
 quently in the German language were represented by the fewest 
 points. The most experienced of the German teachers strongly 
 objected to this decision, and it was reversed at the Congress held
 
 ALPHABETS AND LITERATURE FOR THE BLIND 265 
 
 in Berlin in 1879, which recommended the old Braille system for 
 universal adoption. This was confirmed at the Congress held in 
 Frankfort in 1882. At the International Congress held in Paris 
 in 1878 the same conclusion Avas unanimously come to. There is 
 now probably no institution in the civilized world where Braille 
 is not used, except in some of those in North America. In all of these, 
 however, the great value of writing is recognized by using some 
 form of point system. Though the blind have much reason to be 
 satisfied with this progress, much still remains to be done. In China, 
 Japan and other parts of the world there is an immense amount of 
 work to be done. I believe that not only would it be of the great- 
 est possible advantage to the blind of these countries to receive 
 a good elementary education, but that the blind, when taught to 
 read, and when instructed in the Christian religion, would make 
 most valuable native missionaries and colporteurs." 
 
 The New Testament is now printed in Chinese, and many of the 
 dialects of India, China and other Eastern countries have been 
 reduced to Braille. 
 
 At the time that the English were considering the adoption of the 
 Braille form, America was also studying point print. 
 
 The arrangement made by Louise Braille, it will be remembered, 
 was based upon the arbitrary placing of the points in accordance 
 with a prearranged plan. In 1878 J. W. Smith, one of the teachers 
 of the Perkins Institution, and later editor of the Mentor, a magazine 
 in black print published in the interest of the blind, rearranged 
 the plan of the dots so that fewer points were used in the letters 
 most commonly employed. 
 
 This latter system is now used in 23 of the 49 schools for the 
 blind, including Boston, Philadelphia, Jacksonville, 111., and Batavia, 
 N. Y., which are the largest schools in the United States. In the 
 latter both systems are employed. 
 
 In America the only system competing with the Braille except the 
 Moon, (which now has replaced the Boston line and will always be 
 in demand for those who lose their sight late in life) is the New 
 York point print. 
 
 In the year 1870 Doctor Russ, then living in New York, devised 
 a modification of the Braille based upon the following objections 
 to the older system : As each Braille letter even when it consists 
 of but a single point occupies an entire cell he proposed that the 
 long diameter of the full letter should be horizontal, so that when 
 fewer points are required less space is used. He objected to the 
 arbitrary arrangement of the Braille letters by which they are
 
 266 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 divided into rows iu which the number of dots is regulated by rule 
 and, as Smith did for American Braille, assigned fewer points to the 
 letters more frequently employed. 
 
 His sA^stem was placed in the hands of Wm. B. Wait, then 
 Superintendent, and now Principal Emeritus of the New York 
 Institution for the Blind, who greatly improved it; writing a com- 
 plete system of musicography, capitals, small letters, contractions, 
 punctuation marks, adaptations from the Greek, signs of abrevia- 
 tion, etc., and enthusiastically urged its general adoption. 
 
 A B C D E r 
 
 ®m m m m • € 
 
 G H I J R 
 
 M N OP Q R 
 
 New York System of Point Type, 
 
 The follovring is a partial illustration of the system. Base forms 
 of the New York Point System and the number of signs of each : — 
 : = 3 : : = 9 : : : = 27 : : : : = 81 ::::: = 243 :::::: = 729 
 
 Upper points are designated by odd numbers, lower points by 
 even ones. 
 
 1 13 135 1357 
 
 2 24 246 2468 etc. 
 
 The subject excited an animated discussion, and a careful inves- 
 tigation of the proposed system was conducted by the British and 
 Foreign Blind Association extending over a period of two years. 
 As the members of the Committee were all either partiall.y or wholly 
 blind they were peculiarly well fitted to decide the relative merits 
 of the two systems of tangible print. The conclusions published by 
 Dr. Armitage were finally in favor of the Braille system and are 
 sufficiently interesting to reproduce here. 
 
 "1. The gain in space of New York over Braille is said theoretic- 
 ally, to be 30 per cent. Practically this was found to be somewhat
 
 ALPHABETS AND LITERATURE FOR THE BLIND 267 
 
 overestimated. This gain in space is the principal advantage, 
 though there seems also to be a slight gain in rapidity of writing. 
 There are, however, some serious disadvantages to compensate for 
 this gain in space. 
 
 "The New York system does not lend itself so well to interlining 
 as the Braille, in consequence of the difficulty in distinguishing the 
 characters, which are composed entirely of upper or entirely of 
 lower points. 
 
 '•In distinguishing such characters from each other the reading 
 finger is guided, to a considerable extent, by the interval which 
 occurs between the upper or lower points, as the case may be, and 
 the next line and, as this is not possible with wide lines, it follows 
 that interlining is not well suited to the New York characters ; and 
 if we compare the interlined Braille with the close-lined New York, 
 it will be found that the gain in space of the New York has disap- 
 peared, while the Braille is far more legible. 
 
 "2. The New York system is poorer in signs than the Braille, 
 unless characters four points in length are used, and these are too 
 long to be covered at once by the finger, which is inconvenient ; hence, 
 probably, the omission of many punctuation signs in the New York 
 books, which produces inaccuracy and ambiguity. 
 
 "3. The correction of written or printed matter is very much 
 more difficult in the New York than in the Braille system — a point 
 of very great practical importance. 
 
 '•'4. As the letters in Braille are formed from each other by a 
 simple rule, this system is more easily learnt than the New York, 
 Avhere there is no such aid to memory. 
 
 "5. As the different letters occur with varying frequency in 
 different languages, it follows that, if the New York system were 
 generally adopted, each language would have a different alphabet, 
 and the difficulty of reading foreign languages would thereby be 
 greatly increased. 
 
 "6. The Braille system is too firmly rooted in England ever to be 
 changed ; and it would be a great calamity to the blind to have two 
 point systems, unless the new were greatly superior to the old. 
 This objection applies with still greater force to the musical nota- 
 tion, which ought to be as universal among the blind as it is among 
 the seeing. Great numbers of valuable musical works have already 
 been published in Paris, London, Copenhagen, and elsewhere. These 
 would be illegible by and useless to the pupils of an institution using 
 the New York system for musical notation, the adoption of which 
 could only be excused by great superiority, and it is by no means
 
 268 ALPHABETS AND LITERATURE FOR THE BLIND 
 
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 Arithmetic Board Used for Geometrical Designs.
 
 ALPHABETS AND LITERATURE FOR THE BLIND 269 
 
 proved that the New York luusieai iiolalion is even as good as the 
 Braille." 
 
 Unhappily the battle of the types has continued unceasingly since 
 the several systems were introduced. And now another Committee, 
 representing the American Association of Workers for the Blind, 
 is making a tour throughout the country and conducting further 
 investigations and tests. "When the work is finished the ladies 
 will have traveled about 10,000 miles and conducted experiments 
 in 30 residential schools and 12 centers for adults, and will have had 
 some of their sheets read by approximate!}' one thousand blind 
 people." 
 
 ''But," the question has been asked, "will not Braille people 
 continue to use Braille and New York Point people continue to use 
 point?" The investigators think not. "If only the managers of 
 the printing houses and the heads of institutions could be made to 
 feel the need," says one of the investigators, "as those who go out 
 from these institutions into the colleges and universities do, the 
 inconvencience that they must suffer from having to learn a second 
 or possibly a third system in order to get books that they can use, 
 the problem would be an easy one. The majority of blind people 
 themselves are willing and anxious to settle the question. We also 
 believe that there is not a superintendent or printer in the country 
 who can fail to see the advantages that would accrue from having 
 all of the literature for the blind printed in one type." 
 
 One of the greatest- advantages of the various point systems is the 
 readiness Avith which they lend themselves to writing by the blind. 
 A writing frame consists of a wooden frame of the size and shape 
 of the frame of a child's slate. This is hinged and fits over a metal- 
 grooved bed on which the paper designed to receive the impressions 
 is placed. Extending across the frame is a ])rass guide punched 
 with a double row of parallelograms of the height of three dots for 
 the Braille and two dots for the New York Point. These spaces 
 indicate the shape of the letters to be formed which are made by 
 pressing a blunt pointed instrument, termed a style, into the paper, 
 thereby making a depression on the one side and raising a little ele- 
 vation on the other. These prominences are readily felt and dis- 
 tinguished by the finger of the reader. Many of the blind acquire 
 such facility in deciphering these dotted forms that they read as 
 rapidly and as frequently as those who see. 
 
 Several systems of shorthand for the use of the blind have been 
 devised and are in general use, many persons becoming exceedingly 
 expert in taking dictation, which they reproduce upon the typewriter
 
 270 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 with a degree of aceurac}^ and rapidity not exceeded by those who 
 see. 
 
 The Ziegler Magazine is the only publication in raised print issued 
 for the blind of this country. The magazine was founded in March, 
 1907, by Mrs. William Ziegler, of New York City. It is issued in 
 two editions, one in New York Point and one in American Braille^ 
 the reader receiving the edition in the type he prefers. Nearly two- 
 thirds read the Ncav York Point edition. 
 
 Mrs. Ziegler spends about .$20,000 a year on the magazine, main- 
 taining it entirely at her own expense. About 8,000 copies are 
 printed each month, but this does not represent the number of 
 readers. For instance, there are nearly five thousand blind children 
 attending the schools in the country, and a few hundred copies 
 sent to these schools supply the wants of all the pupils. Again, 
 many are inmates of homes for the blind and a few copies suffice 
 for each of these homes. Again, many, after they read the magazine, 
 pass it on to those in other countries. About three hundred readers 
 send their magazine each month to persons in another English- 
 speaking country. One girl in Australia, who receives her maga- 
 zine each month from one reader, writes that she passes it along to 
 seven other blind people in the United States and Canada who can 
 read either of the types in which the magazine is printed. A free 
 copy is also supplied to all the schools for the blind and libraries 
 for the blind in English-speaking countries. 
 
 The magazine is published monthly and the matter it contains 
 is about the same as that found in the ordinary magazines of the 
 day. About one-fourth of the magazine is devoted to comments 
 on current items, and this is a very popular feature, especially with 
 those who have little opportunity to keep up with current topics in 
 any other way. Another very popular department is entitled Ex- 
 periences and Suggestions for Success. In this column letters from 
 successful blind people are printed, and there are doubtless many 
 engaged in various lines of work today who would not be so em- 
 ployed but for the help received through this department. 
 
 In addition to the work of the magazine, it buys at wholesale 
 rates watches, typewriters, knitting yarns and wools, ribbons, etc., 
 and supplies them to the blind of the United States at actual cost. 
 The magazine has also for several years had charge of a department 
 for the sale of goods made by the blind in the store of R. H. Macy 
 & Co., New York City. Goods made by a blind person anywhere in 
 the United States can be sent to the Ziegler Magazine, which in turn 
 lists, tags and sends on to the department at Macy's, and when these
 
 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 271 
 
 goods are sold the whole amount of the sale is remitted to the blind 
 maker. Macy & Co. charge no commission for the sale. I*ractically 
 the same plan has been adopted and carried out by Kothschild and 
 Co., Chicago, Illinois. 
 
 All the work of assembling the sheets of the magazine is done 
 by blind girls, fourteen of them giving about a week each month 
 to this work. They receive $1.25 a day for their services, and their 
 w^ork is done as well as seeing girls could do it. These girls call it 
 their week of happiness when they are at Avork. A piano is pro- 
 vided for them which they enjoy at the lunch hour. All the proofs 
 of the plates are read by the blind. 
 
 
 Ameriean Printing: House for the Blind. 
 
 After the American Printing House for the Blind in Louisville, 
 Kentucky, the Perkins Institution and Massachusetts School for the 
 Blind has been the most important agent in publishing books, music, 
 etc., in tactile print. From a report submitted to the Massachusetts 
 State Board of Education on October 1, 1910, and from a Library 
 Report of 1912 the following facts have been gathered: 
 
 "The collection of embossed books at this institution, both in 
 number and in variety, is large ; 17,911 pieces or volumes, 1,373 
 titles. These have come from two main sources, the Howe Memorial 
 Press, connected with, the Perkins Institution, and the American
 
 272 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 Printing House for the Blind at Louisville, Ky. The former is a 
 foundation (by private endowment) for the purpose of providing 
 the blind with reading; the latter, an institution subsidized by 
 government to manufacture embossed books and to distribute them 
 to schools for the blind in proj)ortion to the number of their pupils. 
 This American Printing House has furnished books to the Perkins 
 Institution since 1871. Thence has come the main supply of school 
 text-books. The Press of the Perkins Institution, though at work 
 ever since 1833, has necessarily published fewer books and in less 
 variety, limiting itself almost wholly to general literature. More- 
 over, until recently, it has put forth but one kind of print, the 
 so-called Boston line-type, whereas the Louisville press has printed, 
 first, in the same line-type, then largely in point-type. Line-type is 
 the common Roman letters, enlarged and made palpable to the 
 touch; but by no means all the blind, even of school age, have been 
 able to read it. Because this Avas the case and because the system 
 was unpractical for the blind to write in, the use of arbitrary char- 
 acters, made up of points which are readily tangible to every normal 
 blind person and writable by him, has gradually prevailed. Today 
 no new books are printed anywhere in line-type. 
 
 This special reference library has been increased by 53 new books 
 in English, French, German, Italian and Latin, making a total of 
 3,922 volumes. A large number of pamphlets, magazine and news- 
 paper clippings have also been collected. Every quarter a list of 
 the most important magazine and newspaper articles has been sent 
 to the Outlook for the Blind. 
 
 It would seem probable that books in the so-called Moon type for 
 the blind would always be in demand for the use and encourage- 
 ment of those adult readers who are either too old to acquire a finer 
 type or too lacking in health and courage to be willing to make the 
 attempt to do so. Of these books there is an excellent supply, some 
 651 in all. They were purchased from the Moon Society for the 
 Blind, Brighton, England, where such books are still made. 
 
 The slow and costly means of printing from movable type, pre- 
 vailing for over half a century, has now been supplanted by appli- 
 ances to punch metal plates directly from the press. By means of 
 an appliance known as a stereotypemaker, devised and made in the 
 state of Illinois, brass plates, bearing some 224 words each, can be 
 made at an average cost of about 35 cents, and books reproduced 
 in indefinite numbers and fastened in stiff covers, at a total cost 
 of about one cent a page. Embossed books are, therefore, no longer 
 the expensive luxuries they once were. 
 
 Last year a single operator, averaging two hours a day at this
 
 ALPHABETS AND LITERATURE FOR THE BLIND 273 
 
 power stereotypeniaker, produced 1,798 finished plates, which were 
 fewer than usual. From these the Howe Memorial Press printed 
 107,144 pages and stapled most of them into books. Many have been 
 sold and given aw^ay, and 721 placed in the Institution library; the 
 rest remaining for future distribution. 
 
 Books embossed for finger reading expand usually from four to 
 six times over the same matter as commonly printed. Those in 
 Moon's type expand much more; the Bible to 58 big books. Com- 
 paratively speaking the few thousands of volumes belonging to the 
 institution library demand enormous shelf room; indeed, it would 
 be hard to stack them, if all of them were called in. Everyone knows 
 the quarto size of books for the blind. This size is still standard, 
 though a few presses, the Howe Memorial Press included, now prefer 
 to issue smaller and less cumbrous volumes. Both the readers and 
 librarians prefer them so. 
 
 The books which have been put into raised type have been care- 
 fully chosen ; those in the Boston line-type represent a particularly 
 choice lot of literature, and blind people who have read and reread 
 them have not failed to be influenced and affected by such a course 
 of university extension education. However, very few so-called 
 text-books are in this type. Most of these appear in the point books, 
 having been prepared to meet the demand of schools for the blind 
 throughout the country. Considering how fast ordinary text-books 
 multiply and change, it is remarkable how comprehensive, excellent 
 and modern the supply is which has already been embossed. This 
 is due partly to boards of education of a few cities but mostly to the 
 half-dozen institutions which, for fifteen or more years, have been 
 plate-making at individual expense, some of them distributing the 
 books as gifts or at actual cost, others sending the plates to the 
 general printing house at Louisville, whence any one can order 
 books made for them. General literature is also pretty well repre- 
 sented in point print. No country in the w^orld has such a mass 
 and variety of matter embossed from metal plates as America. The 
 large collections in European countries are chiefl,y made up of books 
 handwritten by people of the leisure class; and, while the variety 
 is often splendid, the number of copies of each selection is neces- 
 sarily very limited. 
 
 When the Howe Memorial Press ceased printing in line-type, 
 which has been a type almost wholly limited to the blind who either 
 liad been or were at school, it undertook to meet the reading hunger 
 of a much larger public, and issued in rapid succession short stories, 
 essays, descriptions having contemporary interest, and ])oetry. This 
 
 Vol. I— IS
 
 274 ALPHABETS AND LITERATURE FOR THE BLIND 
 
 mass and variety of reading is in American Braille, which is not 
 difficult to learn to read and write. Printed lists of all the books 
 in the Perkins Institution library, in the several embossed types, are 
 
 U V W X 
 
 Y 
 
 abcdefohi 
 
 •• ••• •• •• • ••• ^« •• • 
 
 • • • ••• ••• • 
 
 j k 1 m n o p q r 
 ••• ••• • •• • • • • 
 
 s t u V w X y 
 
 abcdefohi jkim 
 • • • •• •• •• • ••••••• 
 
 no pq rstuvwxyz 
 
 American Modified Braille. 
 
 sent to anyone on request; also embossed lists of fiction appearing 
 in American Braille. As a result of such advertising, the calls for 
 books have enormously increased. By special act of Congress, era-
 
 ALPHOZONE 275 
 
 bossed books are carried by mail free between libraries and readers. 
 The same concession exists in Canada. Thus the Perkins Institution 
 can and does send books to blind readers all over the continent north 
 of Mexico. Six thousand and ninety-four Avere sent out last year." 
 The most important publication in black print now issued in the 
 interest of the sightless is the Outlook for the Blind, published quar- 
 terly, under the able editorship of Chas. F. F. Campbell of Columbus, 
 Ohio. It was originally established in 1907 under the auspices of the 
 Massachusetts Association for the Blind, but is now supported by 
 voluntary contributions and by an annual subscription. The pur- 
 pose of the magazine is to make it a medium of exchange between 
 all Avorkers for the blind, and its pages are open for the discussion 
 of all subjects having a bearing on or reference to the work of the 
 blind. Recently an Advisory Board has been formed consisting of 
 representatives from State Schools and Institutions for the blind. 
 Somewhat similar magazines are published in Great Britain and 
 France.— (F. P. L.) 
 
 Alphozone. Succinyl peroxide. A whitish powder, soluble in 30 
 parts of water, presented as a germicide and antiseptic and used 
 as such both externally and internally. 
 
 F. B. Eaton relies upon this agent in most acute forms of con- 
 junctival and corneal affections, including the various types of 
 phlyctenular infection. He prefers one grain of alphozone to three 
 fluid ounces of water, of which from 3 to (! drops are to be put into 
 the eye three times a day. 
 
 Homer E. Smith uses it as a collyrium in conjunctivitis of the 
 catarrhal type, in the proportion of %oo- 
 
 Al-Qaisi, Qadi Fath ad-din Abul Abbas Ahmad b. al-qadi Gamal ad-din 
 Abu Amr Utman. One of the latest and most famous of Egyi)to- 
 Arabian ophthalmologists. His single known writing, entitled Work 
 Concerning the Result of Iteflection about the Treatment of Ocular 
 Diseases, still extant, is simple, clear, and practical, but not to be 
 compared for thoroughness with the works of such earlier Arabian 
 writers as Amnuir and AH ben Isa. — (T. H. S.) 
 
 Al-Qasim b. Halifa. The father of the much more famous Arabian 
 ophthalmologist, Usaibia, he was himself well known as an oculist 
 at Damascus about the year 1200.— (T. IT. S.) 
 
 Alquie, Alexis Jacques. This distinguished surgeon was born of in- 
 digent parents in 1812 at Perpignan, France. He received his medi- 
 cal degree, despite ill health and many other hardships, at the 
 University of Montpellier in 1838 and, in 1851, was appointed to the 
 chair of clinical surgery in the same institution. The most important
 
 276 ALSOL 
 
 of his writings is the Traite de Chirurgie Conservatnce et Moyens de 
 restreindre I'Utilite des Operations, which appeared at Moutpellier in 
 1850, and in which, as a representative of the French conservative 
 school, he strongl3" opposed the extirpation of the lachrymal gland 
 for the relief of otherwise incurable epiphora and the section of 
 ocular muscles in myopia. He died in 1864. — (T. H. S.) 
 Alsoi BuROw's SOLUTION. This salt occurs in shining, colorless masses 
 with a vinegar odor and an astringent taste. It is the proprietary 
 name of a 50 per cent, solution of aluminum acetotartrate, and in 
 ocular therapeutics is generally used in the form of compresses of 
 5 per cent, strength; one teaspoonful to a cup of boiled water. 
 Alsol is said to have the advantage over boric acid and sublimate 
 of not causing eczema of the lids when used as a local application. 
 It is, therefore, especially valuable for compresses in blennorrhea 
 neonatorum, in conjunctivitis, granular and scrofular ophthalmias, 
 and, in warm solution, in chronic cases ; also in hordeolosis, in 
 corneal ulcers and iritis but in such case in solutions of %oo ^i^d 
 ^000- It forms an acid solution with water but is insoluble in 
 alcohol. 
 Alston, John. A Scotchman, treasurer of the Glasgow Blind Asylum 
 who, about 1834, invented a form of raised Roman type for the 
 use of the blind. See Alphabet for the blind. 
 Alt. (G.) Old, senile, age. 
 Alter. (G.) Age. 
 
 Alternating squint. See Muscles, Ocular, 
 
 Alternating- strabismus. This condition is present when the deviation 
 occurs alternately, or perhaps indifferently, in each eye. The visual 
 acuity is generally equal in both eyes but the change of squint from 
 one eye to the other is sometimes in the sense that the patient may 
 continually use one eye for the distance and the other for near. On 
 the other hand, many strabismics use sometimes one, sometimes the 
 other organ for all purposes. 
 
 Duane's rule for the detection of this muscular and nervous 
 anomaly cannot be improved upon. Using the cover- or screen-test 
 and the excluded e^'e uncovered, if either both eyes move or, in 
 spite of there being an evident deviation, both eyes remain steady, 
 squint exists. In the latter case, if, when the left eye is uncovered, 
 the eyes behave in the same way as they do when the right eye is 
 uncovered (both alike moving or both alike remaining steady, no 
 matter which eye is uncovered), the scjuint is alternating. 
 
 Coulter {Ophthalmic Year Book, 1908, p. 107) considers that the 
 best course in dealing with permanent alternating squint, a matter
 
 ALTERNIRENDES SCHIELEN 277 
 
 whicli has been niidiily neglected and upon "which the opinions of 
 authors are contradictory, is to correct the deformity at once by op- 
 eration : and then, in spite of the failure of previous orthoptic 
 treatment, every effort shoukl be made with the amblyoscope (q. v.) 
 or steroscope to develoi:) binocular vision. Between 12 and 16 years 
 is the most suitable age for undertaking such treatment. See 
 Muscles, Ocular. 
 
 Alternirendes Schielen. (G.) Alternating squint. 
 
 Alters. (G.) Senile, weakness of old age. 
 
 Altersabschleifung. (G.) Senile attrition; wearing aAvay by friction. 
 
 Altersanlage. (G.) Senile predisposition. 
 
 Altersatrophie. (G.) Senile atrophy. 
 
 Altersbogen. (G.) Arcus senilis. 
 . Altersbrand. (G.) Senile gangrene. 
 
 Alterschwund. (G.) Senile atrophy. 
 
 Altersdisposition, (G.) Senile i3redisposition, aptitude, tendency. 
 
 Altersemphysem. (G.) Senile emphysema. 
 
 Altersentartung-. (G.) Senile degeneration. 
 
 Alterserscheinung-. (G.) Senile phenomenon. 
 
 Alterserweiterung-. (G.) Senile dilatation. 
 
 Altersfrische. (G.) Green old age. 
 
 Altersklasse. (G.) Class or order of age. , ; 
 
 Alterskreis. (G.) Arcus senilis. 
 
 Alterslordose. (G.) Senile lordosis. 
 
 Alter smarasmus. (G.) Senile marasmus. 
 
 Altersnachweis. (G.) Age certificate. 
 
 Altersniere. (G.) Atrophic kidney of old age. 
 
 Altersring. (G.) Arcus senilis. ' 
 
 Altersschwach. (G.) Decrepit. 
 
 Altersschwache. (G.) Decrepitude. 
 
 Alterssichtig. (G.) Presbyopic. 
 
 Alterssichtigkeit. (G.) Presbyopia. 
 
 Altersstaar. (G.) Senile cataract. 
 
 Altersstaarenstehung. (G.) The nascence or origin of a senile cat- 
 aract. 
 
 Altersstaarformen. (G.) Senile cataract formation. 
 
 Altersstaarintranuclearer. (G.) An intranuclear senile cataract. 
 
 Altersstaar Kernstaar. (G.) A senile nuclear cataract. 
 
 Altersstaar klinisches Bild. (G.) Senile cataract, clinical presen- 
 tation. 
 
 Altersstaar, Subcapsularer. (G.) Subcapsular senile cataract. 
 
 Altersstufe. (G.j Stage or order of age.
 
 278 ALTERSVERaNDERUNG DES AUGES 
 
 Altersveranderung" des Auges. (G.) Senile changes in the eye. 
 
 Altersverknocherung". (G.) Ossification due to age. 
 
 Altersversorgungsanstalt. (G.) An institution for the care' of the 
 aged. 
 
 Alterszittern. (G.) Senile tremor. 
 
 Altheus. (L.), n.m. (Obs.). A phj^siciau or surgeon. 
 
 Althof, Herman. This distinguished German-American ophthalmolo- 
 gist, born at Horn, in the province of Lippe-Detmold, Germany, 
 Aug. 8, 1835, came to America three times. His first arrival took 
 place in 1847, when, with his father, he visited his brother, a resi- 
 dent of New York City. Returning to Germany, he first completed 
 his academic education, after which he began his medical studies 
 at Wiirzburg. Continuing these at Zurich, Vienna, and Prague he 
 received his medical degree at Berlin in 1857. In the Prussian capi- 
 tal young Althof attracted the favorable attention of Alfred von 
 Graefe, who ofiTered him a position as one of his assistants. Re- 
 fusing this position, however, Althof proceeded to Paris, where he 
 studied ophthalmology exclusively and was a favorite of Desmarres. 
 In 1858 he came again to America, practising as an ophthalmo- 
 logist in New York City. 
 
 At the end of two years, he returned to Europe, staying for a 
 time with Heinrieh Midler, in Wiirzburg, and, later, with Graefe 
 again, in Berlin. 
 
 Returning once more, in 1861. to New Yorli, he became connected 
 with the German Dispensary, the German Hospital, and the New 
 York Eye and Ear Infirmary. 
 
 He was one of the founders of the New York Ophthalmological 
 society and of the American Ophthalmological Society, and was 
 once the president of the former association. 
 
 His writings are few but important. They appeared, some in 
 
 English, some in German. Among the latter were a number of 
 
 Kliriische Notizen {Graefe' s Archiv, Bd. viii, Abthl. 1.). Among the 
 
 former were CantliopJasiy : a Clinical Study {Trans, of ihe Am. Oph. 
 
 Snc, vol. II. part 2.). 
 
 He was a gentle, kindly,^ and utterly unselfish man. yet, Avithal, 
 very frank and sincere. 
 
 He died in XeAv York of erysipelas, Jan. 14, 1877. — (T. H. S.) 
 
 Altiscope. An instnnnent consisting of an arrangement of lenses 
 and mirrors in a telescope tube, extensible vertically, by means of 
 which it is possible to look over objects intervening between the 
 observer and the object seen. Wben the sections of the tube are 
 extended, the view is received upon an upper mirror placed at an
 
 ALTITUDINAL HEMIANOPSIA 279 
 
 angle of 45°, and reflected tlienee doMii the tube to the lower mir- 
 ror, where it is seen h\- the observer. 
 
 Altitudinal hemianopsia. This is a term intended to indicate both 
 superioi' and inferior hemianopsia, as opposed to the (lateral) 
 homonymous or heteronymous varieties. Wil brand (Xorns and 
 Oliver, A^ol. H, p. 2T-i) says that binocular superior or inferior 
 hemianopsia theoretically is conceivable; but few cases, carefully 
 studied, have appeared in literature. Uhthotl' {Bcihiige zur Path- 
 ologie cles Sehnervcn) reported inferior hemianopsia in a case of 
 tabes dorsalis, in which he suspected the field defect was caused by 
 symmetrical disease of the optic nerves. 
 
 Some writers claim that the loss of the upper or lower half of 
 the field of vision, if not due to detachment of the retina or other 
 lesion within the eye, may generally be regarded as a symptom of 
 hysteria. On the other hand, it is sometimes present in genuine 
 organic disease of the brain (e. g.,) it may result from a lesion of 
 a limited area of the visual centers. 
 
 According to Peters {Ophthalmology, April, 191;^, p. •^'JO), who 
 reports two examples of the disease, unilateral cases are rare, but 
 more frefiueYltiy observed than bilateral cases. In 1893 Russell 
 {Medical Times and Gazette, Vol. II, p. 91) reported a case show- 
 ing unilateral superior hemianopsia caused by a basilar bone tumor. 
 It was associated with paralysis of the eye muscles. More recently, 
 in 1893, Sailer reported a similar case, which he attributed to retro- 
 bulbar neuritis of rheumatic origin {Medical Xcns, April 25, 1893), 
 and in 1910 {Annals of Ophthalmology, April, Vol. XIX), Frederick 
 Krause reported an instance of monocular altitudinal hemianopsia, 
 due to ethmoidal disease. 
 
 Altmann'sche Methode. (G.) Altmann's method. 
 
 Altmann's method. This is a staining method mostly employed in 
 the examination of the corneal tissues. See Histology of the eye. 
 
 Alttuberkulin. (G.) Old tuberculin. 
 
 Alum. Alumen. ALUiJiNii et potassii sulphas. KA1(S04)2+12H20. 
 Common "potash" alum, although there are several other double 
 sulphates with an aluminum base, especially the ammonium "alum." 
 All the alums are manufactured in enormous quantities for com- 
 mercial purposes from native minerals. They occur as colorless, 
 inodorous octahedrons and cubes, with a sweetish astringent taste. 
 Fused, it loses all its water of crystallization and is converted into a 
 whitish mass. (See Alum, Dried.) The alums are very soluble in 
 w^ater but insoluble in alcohol. 
 
 Alum, Dried. Alumex exsiCcatum. P>irxt alfm. KA1(S04)2.
 
 280 ALUM, GLYCERITE OF 
 
 When 100 grms. of ordinary alum are exposed to a heat slightly under 
 400° F. (295° C.) it loses its water of crystallization and a dry, 
 white, porous mass results. This, when dried, forms a mild escha- 
 rotic and powerful astringent and, as such, has been used on granu- 
 lar masses and fungating wounds of the lids, globe and orbit. 
 
 Alum, Glycerite of. See Glycerite of alum. 
 
 Alumen. See Alum. 
 
 Alumen exsiccatum. See Alum, Dried. 
 
 Aluminated copper. See Lapis divinus. 
 
 Aluminii et potassii sulphas. See Alum. 
 
 Aluminum acetate. Al2(CoIl302)2- -^ gum-like mass with an acid 
 reaction and an astringent taste. 
 
 In eye diseases it is commonly used as Burow 's solution, a 7 to 8 
 per cent, solution of the acetate in water. This mixture is, in its 
 turn, again diluted with five to twenty times its bulk of water before 
 its employment as an astringent eollyrium. 
 
 In cases of chronic dacryocystitis, Avith or without marked muco- 
 cele, the following constitutes an excellent form of lachrymal lavage 
 with the Anel or similar syringe is a three per cent, solution in sterile, 
 distilled water. 
 
 There is also a liquor alumini acetatis, a clear, colorless liquid, 
 having an acid smell and reaction with an astringent, sweetish taste. 
 See, also, Lenicet. 
 
 Aluminiumacetat. (G.) Acetate of aluminium. 
 
 Aluminum acetotartrate. This salt is found as colorless crystals, 
 slowly soluble in water; insoluble in alcohol. It is occasionally 
 used in chronic conjunctivitis in 0.20 to 0.50 solution, as well as a 
 substitute for Burow 's solution (q. v.). See Alsol. 
 
 Aluminum carbonate. Ah,(C03)o. This salt is found as tasteless, 
 chalk-white lumps, easily powdered. It is a mild styptic and as- 
 tringent, and i;sed as a dusting powder in chronic forms of con- 
 junctivitis. 
 
 Aluminiumchlorid. (G.) Chloride of aluminium. 
 
 Aluminumnaphtholsulphonate. See Alumnol. 
 
 Alumnol. Aluminumnaphtholsulphonate. A dry, colorless powder, 
 easily soluble in water, less soluble in alcohol. It is an astringent 
 and antiseptic and has been recommended as a eollyrium, particu- 
 larly in cases of gonococcus conjunctivitis, in 0.5 to 4 per cent, 
 solutions. (See Zinc acetate and Zincol.) 
 
 Alypin. This agent, derived from glycerin, is closely relat.ed to 
 stovaine (q. v.) and has been strongly recommended as a substitute 
 for cocain as a local anesthetic.
 
 ALYPIN 281 
 
 Alypin is the proprietary name given to one of tliose numerous, 
 complicated, organic compounds (mostly of German oi-igin) that 
 have in recent years flooded the market. In 4 per cent, solution it 
 acts as a valuable and safe anesthetic for oi)hthalmic practice, as it 
 has the same action as cocain without causing mydriasis, disturb- 
 ance of accommodation, increase of tension, drying of the cornea 
 or intoxication. It is a white, crystalline powder, soluble in water. 
 We are indebted to Impens for its discovery. 
 
 True has compared the effects of both alypin and cocain of the 
 same strength and is unable to ffii'd-^ny appreciable difference, the 
 toxic effect being less from alypin than cocain. With alypin there 
 is no mydriasis, even with strong solutions. Tonus and accommo- 
 dation are not changed by alypin. It is important that the solutions 
 should be fresh, neutral; old or acid ones being irritating. 
 
 When this anesthetic is used in conjunction with silver nitrate, 
 alypin nitrate is to be preferred to the alkaloid. Owing to the fact 
 that alypin is incompatible with silver nitrate it is not well adapted 
 for anesthetizing mucous membranes to which nitrate of silver is 
 afterward to be applied, as it may to some extent neutralize the 
 effect of the latter through chemical decomposition. Alypin nitrate 
 overcomes this difficulty, and is therefore recommended in such cases. 
 Its chemical characters, solubility, and strength of solutions corre- 
 spond essentially to those of alypin. 
 
 ]\Ierck's Reports for 1906 quote the experience of Landolt that 
 the anesthetic action of alypin is somewhat greater than that of 
 cocaine, but comes on more slowly. As with the latter, the author 
 has observed, after the instillation of drops of alypin, a transitory 
 yet troublesome turbidity of the corneal surface with shedding of 
 epithelium. An important point, however, is the fact that alypin 
 is practically without influence on the pupil and on the accommoda- 
 tion. Kauffmann therefore recommends the use of alypin whenever 
 dilatation of the pupil is to be avoided, and whenever the accom- 
 modation is to be preserved unimpaired ; and again when the intra- 
 ocular tension is raised, or when it would be dangerous to risk a 
 rise of tension. It is also indicated, hoAvever, according to the 
 author, when the tissue cells need special care, and when consider- 
 able changes or defects are present in the corneal epithelium, and 
 when, further, there is no objection to hyperemia at the corneal 
 border, or in the conjunctiva. To produce anesthesia for the re- 
 moval of foreign bodies, a § per cent, solution of alypin usually 
 answers. The author gives the following as special indications for 
 the use of alypin : Operations on the eye-ball, operations for uncom-
 
 282 ALZAHARAVIUS 
 
 plicated lenticular cataract, operations for glaucoma, herpes, kera- 
 titis bullosa, defects due to injury, infective separation of the con- 
 junctiva and abscess of the lachrymal sac. 
 
 Sydney Stei^henson makes the following emphatic statement re- 
 garding it : That he had never seen a bad result from 2 per cent, 
 alypin, despite the fact that from 1905 to August, 1908, it had dis- 
 placed all other local, anesthetics in his practice. 
 
 Sendral had good results with alypin anesthesia in operations 
 for senile cataract and secondary cataract. In operations for chal- 
 azion where he both instilled alypin solution and also applied it 
 subconjunctivall}^ he did not obtain complete immunity from pain, 
 because the anesthesia was slow to extend into the tarsal tissues. 
 In operations for squint, also, the anesthesia was incomplete. 
 
 Alzaharavius. A distinguished Arabian physician and ophthalmolo- 
 gist. See Abul Kasim ben Abbas al-zarawi. 
 
 Amacratic. Properly haniacratic. Same as amasthenic (q. v.). 
 
 Amacrine cells. This term is applied by Ramon y Cajal to a certain 
 form of spongioblasts found within the plexiform layer of the 
 retina. See Histology of the eye. 
 
 Amalgamiren. (G.) To amalgamate, to amalgamize. 
 
 Amalgamirung. (G.) Amalgamation. 
 
 Amanita. A genus of the mushroom family, mostly poisonous, whose 
 ingestion occasionally produces ocular symptoms. Examples of 
 oculotoxic disturbances are reported by several observers. G. 
 Valenti gives the history of a man, 26 years of age, who exhibited 
 signs of poisoning during the night after the day when the mush- 
 rooms were eaten. He was barely able to perceive light and the 
 pupils were much dihited. The ophthalmoscope showed the papilla 
 to be "off" color, the arteries diminished in size and the veins 
 relatively dilated. At the end of eight days vision began to 
 improve and in two weeks the patient was able to read large type. 
 At the end of a month vision had risen to about one-third, after 
 which there was no further improvement. In this instance the 
 toxic condition was due to a subacute, retrobulbar neuritis similar 
 to that produced by tobacco-alcohol. 
 
 It not infre(|uently happens that when these poisonous fungi 
 are mistaken for edible mushrooms and have been thoroughly 
 cooked and seasoned, it is difficult for the ordinary observer to 
 detect, by the sense of taste alone, the difference between the toxic 
 and the non-toxic fungi ; although their appearance Avhen fresh, 
 their method of growth and other indications, easily di^stinguish 
 most poisonous plants from the innocent varieties. 
 
 ■\
 
 AMANITA MUSCARIA 283 
 
 The most lethcil of tliis gt-iius is Amaiiild phuUoidi h, also known 
 as Amanila v<rn<i. 'IMie synii)lonis are cliiefly those relating to the 
 size of the pupil which is often widely dilated. Diminution of the 
 visual acuity, amomiliiiy now and then to lilindncss, has heen 
 reported. For example, sevei-al people who, one evening, ate a 
 dish containing these mushrooms in milk, became sick at daybreak 
 "with slight and then with severe symptoms of gastro-intestinal 
 irritation, exhaustion, increased ])ulse, and rise of temperature. 
 The pupils at first reacted to light, but blindness eventually set in. 
 Subcutaneous injection of atropin result<Ml in some improvement. 
 
 In another complicated case with Cheyne-Stokes respiration, 
 mydriasis was present. 
 
 Pupillary contraction also occurs. In each of three cases of pois- 
 oning related by Lewin and Guillery the pupils varied; in one case 
 they were normal, in the second the eyes were sunken, expressionless, 
 and both were reduced to pin-points, while in the thii-d they were 
 contracted but une(|ual. The right was extremely contracted but 
 the left was much dilated. In four days both became almost normal. 
 
 The pupils usually react promptly to light and accommodation, 
 but in one case there was a slight sluggishness in the light reflex, 
 and the action failed completely after repeating the test a number 
 of times. In another case the patient, who had but slightly dilated 
 pupils, complained of pliotophobia. See, also. Toxic amblyopia and 
 Amanita muscaria. 
 Amanita muscaria. This fungus is one of the poisonous mushrooms, 
 sometimes mistaken for an edible variety. It was from the Agaricus 
 muscarius that the alkaloid timscarin was first obtained. From 
 experiments with it on animals Lewin and Guillery found that 
 while it is an energetic agent — acting as an antagonist of atropia — 
 yet the poisonous species of Amanita must have other powerful 
 agents combined with them. Both its local and general employ- 
 ment induces contraction of the pupil and spasm of accommoda- 
 tion. The local application to the eye of the cat causes an energetic 
 contraction of the i)upil, but after instillation of 0..') per cent, solu- 
 tion of muscarin chlorid, or even after placing a crystal of the sub- 
 stance in a bird's eye, the action on the iris is nil. The explanation 
 probably is that the iridic muscle in mammals is of the non-striated 
 variety, but in birds is striated and more or less under the control 
 of the will. In man larger amounts are required to produce con- 
 traction of the pupil. Even with 1.5 per cent, solution miosis is 
 absent, though the refraction is changed. On the other hand, miosis 
 may be well developed in an eye free of ciliary spasm. As a rule.
 
 284 AMANITA MUSCARIA 
 
 contraction of the pupil occurs later than spasm of accommodation 
 and the miosis increases even Avhen the near-point again begins to 
 recede and lasts from three to twenty-four hours. A solution of 
 atropin, strong enough to induce mydriasis and to overcome the 
 contracted pupil, does not prevent the spasm of accommodation. 
 For this stronger solutions are necessary when an additional dilata- 
 tion of the pupil occurs. The pupil under the influence of muscarin 
 reacts well to light. 
 
 When the effects of muscarin are produced by instillation, they 
 occur in the form of an accommodation spasm associated with a 
 rapid onset of false myopia. The accommodation spasm begins, as 
 a rule, after five to ten minutes, reaches a maximum in fifteen to 
 thirty minutes, and disappears in one to two and one-half hours. 
 Thus the return to normal requires about twice as much time as its 
 appearance. On subcutaneous administration the opposite, is ob- 
 served. Complete disappearance of the range of accommoc!*Mion 
 has not been accomplished with this agent, except by the empldy-- 
 ment of such strong solutions that marked irritation of the con- 
 junctiva results. The action on the far-point is the first and most 
 active; but a similar effect on the near-point cannot be produced. 
 Physostigmin (eserin) acts more strongly on the pupil than on the 
 accommodation, but with muscarin the reverse is the case, but when 
 the effect of muscarin on the pupil appears it lasts longer than it 
 does after eserin. 
 
 The subcutaneous injection of muscarin does not cause (for the 
 reason before given) miosis in birds, but severe general intoxica- 
 tion may set in. In rabbits the eff'ect is inconstant, Avhile in cats a 
 miosis appears in one to two minutes; after three to five there is 
 an increased secretion of tears. 
 
 In man, subcutaneous injection of 0.005 grm. of muscarin induces 
 an insignificant miosis and slow light reaction, while much smaller 
 doses act on the salivary secretion and intestine; and 0.001 to 0.003 
 grm. causes accommodative spasm. Muscarin miosis is evidently 
 the result. of a peripheral stimulation of the sphincter mechanism. 
 The poisoning of people with amanita muscaria causes contrac- 
 tion of the pupils, as a rule. In a boy there were at first contracted 
 pupils and lost reaction to light ; later the pupils w^ere markedly 
 dilated. Frequently dilatation and loss of reaction occur, and even 
 in fatal cases the pupils have remained normal in size from the 
 beginning, reacting promptly to light and accommodation. Dis- 
 turbances of vision have rarely been noticed. People who have 
 eaten the amanita have visual hallucinations and generally see
 
 AMANITA PHALLOIDES 285 
 
 objects enormously enlarged. Although sucli persons are able to 
 walk without staggering yet objects appear unsurmountably large. 
 Writers relate a joke sometimes played on tlie unfortunate of 
 laying a small obstacle, a cane, for example, in his path. The 
 poisoned patient stands still, examines the cane, and finally 
 jumj)S over it ! In such cases of megalopsia it has been noticed of 
 the size of the pupils that at first they are dilated, later contracted. 
 
 Amanita phalloides. For an account of the ocular symptoms in pois- 
 oning from this fungus, see Amanita. 
 
 Amanite. (F.) The generally poisonous fungus, Amanita (q. v.). 
 
 Amarant. (G.) Amaranthus. 
 
 Amaranth. (G.) Amaranthus. 
 
 Amasthenic. In optics, a term applied to a lens photographically per- 
 fect, or which unites all the chemical rays into one focus. Also 
 amacratic— (C. F. P.) 
 
 Amaurose. (G.) Amarosis. 
 
 Amaurosi parziale fugace. (It.). Scintillating scotoma. 
 
 Amaurosi uremica. (It.). Blindness due to uremic poisoning. 
 
 Amaurosis. The distinction commonly made between amhlyopia and 
 mnaufosis lies in the degree of blindness in each instance. In the 
 former case the defect of vision is not as marked as in the latter. 
 Amaurosis conveys the idea of complete blindness, or a defect in 
 the eyesight closely approaching it. 
 
 This expression was formerly employed to indicate a clinical 
 entity and to constitute a diagnosis per sc, but it is now obsolete 
 in that sense, since in most forms of amaurosis (blindness) the 
 tissue alterations and the character of the various disorders pro- 
 ducing the loss of eye-sight are now known to vary and in many 
 instances to be entirely distinct from one another. 
 
 Amaurosis, Epileptiform. Attacks of partial or total blindness in 
 epilepsy experienced by the still conscious patient, corresponding 
 to concentric contractions of the field of vision and the arterial 
 and ciliary spasm so often elicited on examination. The perimeter 
 is consequently of great value in the diagnosis of this disease and 
 in cases of suspected malingering. Dilation of the retinal veins 
 has been observed during the seizures, and to this condition has 
 been given the name retinal epilepsy. 
 
 Amaurosis exanthematica. Blindness attending or following eruptive 
 diseases. 
 
 Amaurosis ex hemorrhagia. Amaurosis ex hyperopsia. A serious fonn 
 of blindness occurring after various hemorrhages, especially hema-
 
 286 AMAUROSIS EX HYPEROPSIA 
 
 temesis and other bleedings from the intestinal tract. The amaurosis 
 is often permanent and results from anemia and atrophy of th^ 
 optic nerve. See Amblyopia from hemorrhage. 
 
 Amaurosis ex hyperopsia. See Amaurosis ex hemorrhagia. Blind- 
 ness following excessive bleeding. 
 
 Amaurosis from mercuric methyde. See Toxic Amblyopia. 
 
 Amaurosis from uremia. Unless there are alterations in the retina or 
 optic nerve accompanying this symptom — temporary blindness in 
 persons suffering from chronic or acute renal disease and similar 
 conditions — the prognosis is quite favorable. The attacks of blind- 
 ness rarely last longer than from 12 to 24 hours and a return to 
 normal vision is the rule. During the period of recovery, temporary 
 defects in the visual field have been noticed. The treatment should 
 be directed to the underlying diseases. Sometimes, as in the uremia 
 of pregnancy and scarlet fever, this can be cured in vs^hich case the 
 amaurosis eventually disappears. 
 
 Amaurosis in malaria. See Malaria, Eye disease from. 
 
 Amaurosis in scarlatina. See Scarlatina, Ocular Symptoms of. 
 
 Amaurosis, Narcotic. Blindness folloAving the use of narcotics. 
 
 Amaurosis partialis fugax. TEicHorsiA. Scintillating scotoma. Mi- 
 graine. Sick headache. Attacks of this disease have certain clinical 
 affiliations with epilepsy but are not to be regarded as indicative 
 of disease of the eye, although ocular disturbances form an import- 
 ant part of the symptom-complex. Apart from the scintillations, a 
 "fortification" scotoma is the most common experience. This irreg- 
 ular, cloud-like appearance, usually edged wdth colors, shows itself 
 in some part of the visual field and gradually spreads until the 
 patient is blind. This is followed in its turn by severe, unilateral 
 headache, lasting for a few hours or for a whole day, to be appar- 
 ently relieved by vomiting. The attacks of migraine become less 
 frequent or less violent after 45. until they generally disappear, 
 with advancing years. The elasticity of the vascular walls dimin- 
 ishes with age, thus interfering with that spasm of the cerebro- 
 cortical vessels upon which the disease probably depends. As in 
 epilepsy, treatment (especially the prescription of glasses) directed 
 to the eye occasionally relieves or cures this troublesome affection, 
 but it is not to be relied upon. 
 
 Amaurosis pellagrosa. (L.). Blindness due to pellagra (q. v.). 
 
 Amaurosis, Progressive. Blindness resulting from a progressive^ 
 atrophy of the optic nerve-endings. 
 
 Amaurosis, Quinine. See Toxic amblyopia. 
 
 Amaurosis, Rachialglc. Blindness due to disease of the spinal cord.
 
 AMAUROSIS, SIMULATED . 287 
 
 Amaurosis, Simulated. Feigned blindness, or ocular malingering. 
 Amaurosis, Spinal. Atrophy of the optic nerve due to lesions of the 
 
 cord, such as lateral or multiple sclerosis. 
 Amaurosis, Sympathetic. Permanent or temporary blindness of one 
 eye due to llic trjuisuiission of disease from the fellow eye. See 
 Sympathetic ophthalmia. 
 Amaurosis, Trifacial. Blhidness due to irritation or disease of the 
 
 trigeminus nerve. 
 Amaurosis venerea. Blindness due to syphilis. 
 
 Amaurotic cat's-eye. An obsolete term formerly applied to various 
 intraocular conditions observed through the pupil, especially to 
 glioma of the retina, vitreous deposits, exudative choroiditis, etc. 
 Amaurotic family idiocy. Arrested cerebral development. Infan- 
 tile cERERRAL DEGENERATION. Agenesis c^rticalis. A rare discasc 
 characterized by the gradual onset of paresis or paralysis, mental im- 
 pairment leading to absolute idiocy, defective vision terminating in 
 absolute blindness, marked marasmus and death invariably before the 
 third year of life. No form of treatment has had the least etifect in 
 these cases. Since it is wholly untenable that the disease is of syphi- 
 litic origin, the routine administration of mercury and iodides is not 
 justified, and need not be advised. Kingdon tried pituitary gland 
 and eerebrine without effect. On the assumption that the disease 
 may result from the elaboration of some toxin by the mother, King- 
 don and Russel suggest that the children in the family be hand and 
 not breast fed. In the presence of a hopeless disease this maj^ 
 prove worth while.— [D. H.]. 
 
 Cases of this condition are reported by I>uchanan, Cohen and 
 Dupuy-Dutemps, the latter case being the first recognized in France. 
 All these were of Jewish parentage, as have been all but six of the 
 instances so far reported, numliering now over 80. In Cohen's 
 case the deviation from health was noticed at 5 months and death 
 occurred at 17 months. In the other cases special weakness Avas 
 noticed at the age of three months. They were still living at 11 
 and 15 months; but an older brother of the patient of Dupuy- 
 Dutemps had died at 2^2 years, apparently of the same disease. 
 In Cohen's case the microscopic examination showed no true edema 
 of the retina, but supported the view that the disease was essen- 
 tially a degeneration of the ganglion cells. There was also begin- 
 ning atrophy of the optic nerve. (Ophthalmic Y ear-Book, 1908,. 
 p. 228). 
 Amaurotic idiocy. See Amaurotic family idiocy. j 
 
 Amaurotisch. (G.) Amaurotic.
 
 288 AMAUROTISCHE PUPILLENSTAARE 
 
 Amaurotische Pupillenstaare. (G.) Amaurotic pupil cataract. 
 
 Amaurotisches Katzeauge. (G.). Amaurotic cat's eye. Pseudo- 
 glioma. 
 
 Amaxophobie. (G.) Amaxophobia 
 
 Amber glass. Material for the manufacture of protective lenses, 
 coquilles, etc., intended to defend the eye, especially from the vio- 
 let and ultraviolet rays of light. The protection thus afforded, 
 even by light shades of amber glass, is very marked. In the various 
 forms of intraocular disease of which photophobia is a symptom, or 
 when normal eyes are exposed to glare or dazzling light, brilliant 
 reflections, etc., this color is probably the most satisfactory one 
 that can be prescribed. Instead of the yellow-red (amber), a green- 
 yellow euplios glass (q. v.) is preferred by some authorities. 
 
 Ambidexterity. The ability to use either hand equally well, especially 
 in operative surgery. Seldom will an operator acquire the same 
 skill for the left hand that he possesses in the right, and the advant- 
 ages of ambidexterity in ophthalmic operations have usually been 
 greatly over-rated. The right-handed operator Avill always realize 
 that when it comes to certainty, quickness and delicacy of action 
 his right hand is the more reliable, no matter how much training 
 he may give the left, and it is a duty he owes to himself and to the 
 patient to operate in a manner which holds out the best hope of 
 success under any circumstances which may arise. 
 
 It may be true that the person who has been trained from child- 
 hood to use one hand as much as the other may learn to operate as 
 well with one hand as the other, but this will not hold good with the 
 average person who has been single-handed up to the time that his 
 operative experience begins. To him the best results under all con- 
 ditions will come from the hand that is used to the most exacting 
 Avork, and whose natural function has been increased by appropriate 
 training. It sounds very well for an operator to say that he makes 
 his corneal section in cataract extraction with the right hand when 
 operating upon the right eye, and with the left hand when operating 
 upon the left eye, and the practice may look well to an audience, but 
 the operators are exceedingly few in number Avho can use one hand 
 as well as the other, and it is a sacrifice of some of the chances for 
 the highest type of success when the operator fails to use the hand 
 which he knows is the one with which he can do best under any and 
 all conditions. 
 
 Many operators are apparently ambidexterous and operate suc- 
 cessfully and skillfully with the left hand, but it may be seriously 
 questioned if such operators in an emergency could be depended
 
 AMBIOPIA 289 
 
 upon to do as expert work with the left hand as the right, and one 
 never knows when an emergency may arise which will tax to the 
 utmost the suppleness, promptness and delicacy of action sometimes 
 required of an operator, and it is then that it is the heiglit of absurd- 
 ity to claim that the left hand can be depended u[)on to the same 
 extent as the right, which from birtli has been trained to do all 
 the exacting work. — [E. C. E.] 
 
 Ambiopia. Double vision. See Diplopia. 
 
 Ambliopia alcoolica. (It.). Blindness from the ingestion of alcoholic 
 liquors. 
 
 Ambliopia congenita. (It.). Congenital amblyopia. 
 
 Ambliopia da anopsia. (It.) Amblyopia from non-use of the eye. 
 
 Ambliopia isterica. (It.). Hysterical amblyopia. 
 
 Ambliopia nicotinica. (It.) Tobacco amblyopia. 
 
 Ambliopia notturna. (It.). Ilemeralopia. 
 
 Ambliopia tossica. (It.). Toxic amblyopia. 
 
 Amblyopia. The term amblyopia, like amaurosis, formerly defined a 
 clinical diagnosis and entity, but modern methods of examination 
 have relegated it to the ophthalmic limbo, although it is still em- 
 ployed, by consent, to indicate some definite and some ill-defined 
 organic lesions. As his knowledge of pathology increases the 
 ophthalmologist should use the word less and finally discard it as a 
 relic of the pre-ophthalmoscopic era. 
 
 Amblyopia, Alcoholic. See Alcoholic amblyopia; also, Toxic ambly- 
 opia. 
 
 Amblyopia amaurotica. (L.). Obsolete term intended to express 
 total loss of vision from optic or central disease. 
 
 Amblyopia and heterotropia. See Amblyopia ex anopsia. 
 
 Amblyopia, Arsenical. See Arsenical amblyopia; Atoxyl; Salvarsan; 
 Toxic amblyopia. 
 
 Amblyopia, Astigmatic. Astigmatism is sometimes accompanied by 
 a conus at the oi)tie disk, a white, sickle-like figure which corre- 
 sponds to a Avidening of the sclerotic ring at the lower edge of the 
 optic nerve. Abnormalities in both the lens and cornea may also 
 be discovered on examination. In other words, some forms of this 
 refractive anomaly are accompanied by organic changes in the eye, 
 so that it is not to be wondered at that in high degrees of astignm- 
 tism, even after correction of the anomaly of refraction, the visual 
 acuity never reaches normal. Such a defect, of vision may properly 
 be termed amhhjopia asfigmatica. 
 
 Amblyopia, Cachectic. Defective vision due to the absorption of the 
 products of some chronic, wasting or malignant disease. Two cases 
 
 Vol. I— 19
 
 290 AMBLYOPIA, CENTRAL 
 
 of this form of chronic intoxication associated with complete blind- 
 ness not being caused by alcohol or tobacco are reported by Tojoda, 
 who states that in the first case there was a suddenly developed 
 central amaurosis imposed on a partial retrobulbar neuritis of long 
 standing, i^robably the result of chronic nephritis, cirrhosis of the 
 liver and empyema of the gall bladder. The second case was a toxic 
 amblyopia to which a rapidly developing complete amaurosis was 
 added, due to cachexia from carcinoma. Similar cases of blindness 
 due to carcinoma cachexia have been reported by Deutschmann and 
 Miura. Microscopically, the nerves showed typical interstitial neu- 
 ritis, with ascending and descending atrophy. In the first case the 
 lesion began 8 to 10 mm. behind the optic nerve entrance, showing 
 that the process started in the nerve itself, and not primarilj^ in 
 retina or the papilla. {The Ophthalmic Year Book, 1908, p. 236.) 
 
 Amblyopia, Central. By this term is specifically meant the disease 
 that Leber (Greiefe-Saemisch- Handbucli) described as hereditary optic 
 neuritis or atrophy — neuritis optica hereditaria. 
 
 It also indicates any symptom-complex depending on a lesion of 
 the central area of the retina, i. e., the fovea, or macular region, or 
 of the nerve bundles that supply this region, e. g., in tobacco-alcohol 
 intoxication, retrobulbar neuritis, etc. 
 
 In Leber's cases the male members of one fanjily were affected 
 about their twentieth year. Diminution of the visual acuity, due 
 to a central scotoma, developed in the course of a few weeks; and 
 recovery was rare. Ophthalmoscopic examination revealed, first, 
 an optic neuritis and, later, atrophy of the optic nerve. Consider- 
 ing these objective findings the disease thus described by Leber 
 should not be called an amblyopia. 
 
 Amblyopia crapulosa. (L.). Alcoholic amblyopia. 
 
 Amblyopia, Crossed. This symptom was probably first mentioned by 
 Charcot, although Gowers and other have since accepted the defini- 
 tion, viz. : a marked visual defect with a very contracted field of 
 vision in the eye opposite the central cerebral defect (in the angu- 
 lar gyrus or internal capsule), associated with a perimetric con- 
 traction in the eye on the side of the central disease. The objec- 
 tion to this hypothesis is that it assumes a double crossing of the 
 optic fibres as well as two distinct centres — one for unilateral and 
 the other for bilateral vision. 
 
 Amblyopia ex anopsia, argamblyopla. Defective vision from lack of 
 education or use of the visual apparatus, or of some portion of it. 
 When one eye is excluded from the visual act this inability may be 
 due to an opacity in the dioptric media, as in congenital cataract,
 
 AMBLYOPIA, FEIGNED 291 
 
 pupilhn'v meiiibraiie, leneouia or iiel)ula of the eonioa, etc. More 
 often it is congenital and due to some form of strabismus. Sometimes 
 strabismic eyes that possess fair vision eai-ly in life may lose the 
 power of fixation al'tci' lony-eont inued non-use. 
 
 Treatment of this form of amblyopia is liic i-ciiKtval at as early 
 a stage as possible of the obstacles to good centi-al vision and the 
 subsequent exercise of the affected eye. In cases of strabismus that 
 anomaly should be relieved eilhei' by operation or the prescription 
 of glasses, or by both means. 
 
 There has been much controversy as to whether blindness or very 
 poor vision from non-use or lack of education of an eye really occurs. 
 A ease reported by G. H. Mathewson, for example, gives proof that 
 one does meet with eyes which do iiot see because they have not 
 been trained to do so. 
 
 A boy, 13 years of age, was brought with a badly danuiged e^'e, 
 having been struck a violent blow by a large stone. Both the boy 
 and the mother stated that the vision in the eye which was damaged 
 had never been good. On examination, the injured eyeball was 
 found to be ruptured and disorganized, with absolutely no vision. 
 The damaged eye was enucleated one week later, and after an un- 
 eventful convalescence vision in the patient's remaining eye was 
 ability to count fingers at 12 feet, and with the addition of a plus 
 4 sphere it improved to 6/xxxvi. He was unable to read even very 
 coarse print with the glass. Refraction under homatropine showed 
 his refraction to be about the same as without a mydriatic and con- 
 sequently his full correction was prescribed. Five weeks later when 
 he was brought back it was found that his vision was 6/ix and he 
 could read the finest print with ease. 
 
 Although the term itself has fre(iuently been loosely applied, es- 
 pecially in connection with the amblyopia (usually unilateral) of the 
 various forms of strabismus, yet there seems to be no reason why 
 congenital lesions of the nerve centres, or even of the nerve tissues 
 themselves, as yet undiscovered by laboratory investigation, ma.y 
 not explain the irremediable or but slightly improvable forms of 
 amMyopia ex anopsia. Tliis condition, on the other hand, entirely 
 diflfers from that giving rise to "defects of function" (whatever 
 that may imply) which are capable of considerable improvement or 
 complete cure after the neglected eye has been converted into a 
 functionating organ. A better classification of these forms of am- 
 blyopia from non-use based on careful and extended examination, 
 is much needed. — (Ed.) 
 Amblyopia, Feigned. Sec Malingering.
 
 292 AMBLYOPIA FROM BOTULISM 
 
 Amblyopia from botulism or ptomaine poisoning. See Toxic ambly- 
 opia. 
 
 Amblyopia from dental disease. In a number of well-known cases 
 through irritation of the branches of the nerves supplied to the 
 teeth, decided defects in vision have been produced. 
 
 Amblyopia from drugs and allied agents. See Toxic amblyopia. 
 
 Amblyopia from excessive light. See Day-blindness, Functional. 
 
 Amblyopia from hemorrhage. Temporary or permanent reduction in 
 visual acuity due to loss of blood from one or several organs, was 
 noted at a remote period in medical history. The affection, which 
 is found more often after than before the fortieth year, is of unusual 
 occurrence; it is rarely seen in healthy subjects who have been 
 accidentally wounded (e. g., soldiers in battle) ; and, as a rule, it 
 involves both eyes in about the same degree. 
 
 The careful study of this subject which was made by Fries,^ in 
 1876, after searching the literature of the preceding 235 years, has 
 furnished the following statistics: — Of 106 cases of visual disturb- 
 ance following hemorrhage, .36 per cent, were from the stomach; 
 25 per cent, from the uterus ; 7 per cent, from the nose ; 5 per cent, 
 from accidental wounds; 25 per cent, from intentional loss of blood 
 — venesection, leeching, or cupping; and 1 per cent, from pulmonary 
 and urethral bleeding. Carlini - states that thesg percentages have 
 not been changed by cases reported since 1876. 
 
 The age of the recorded patients has ranged from 2 to 77 years. 
 When the condition is bilateral, rarely is one eye entirely blind 
 and the other only slightly affected. In onl^' 10 to 15 per cent, 
 of cases is one eye alone involved (Groenouw).^ Blindness following 
 gastric hemorrhage is twice as frequent in men as in women 
 (Pergens)."' 
 
 That extensive hemorrhage, per sc, is not a factor in the produc- 
 tion of amblyopia is undisputed. Thus, in the Franco-Prussian war 
 de Wecker and Knies did not observe a single case of amaurosis 
 following wounds, and only 5 of the 106 cases tabulated by Fries 
 can be attributed to pure traumatism. Nor is there any relation 
 between the extent of the hemorrhage and the gravity of the ocular 
 symptoms. Hence it must follow that, in cases of visual disturb- 
 ance following hemorrhage, a pre-existing factor or condition is 
 of supreme etiologic importance. 
 
 The case reported by Stirling ^ may be cited as typical of predis- 
 posing conditions. A boy, aged 6 years, a victim of hemophilia, 
 suft'ered a transient complete blindness sequent to a profuse hemor- 
 rhage following the extraction of a tooth.
 
 AMBLYOPIA FROM HEMORRHAGE 298 
 
 Disorders of vision following hemorrhage occur, almost without 
 exception, only in persons who previously were not healthy. 
 
 Loss of vision from hemorrhage may come quickly or slowly. 
 In 25 per cent, of cases the loss of sight appeared either during, 
 or immediately following the hemorrhage ; in 20 per cent, within 
 the first 12 hours; in more than 50 per cent, the blindness appeared 
 within 3 weeks — and in most of these between 3 and 6 days after the 
 loss of blood (Groenouw). As regards blindness following gastric 
 hemorrhage, the statistics of Pergens, based on 43 cases, show the 
 following: immediate loss of vision, in 21 per cent; loss within the 
 first 24 hours, in 9 per cent. ; later, but within the first week, 51 
 per cent.; in the second week, 14 per cent.; and in the third week, 
 5 per cent. 
 
 Amblyopia from intentional blood-letting comes, as a rule, within 
 a few hours; whereas that following accidental hemorrhage appears 
 after several days. 
 
 The patient may suffer severe hemorrhage Avithout visual dis- 
 turbance, only to have his vision much reduced or entirely lost 
 after a recurrence of the bleeding. In repeated hemorrhages vision 
 may become less after each attack, while improvement or entire 
 restoration is noticed during the intervals. 
 
 If a severe hemorrhage has caused unconsciousness, the patient, 
 on awakening, will notice the blindness, or may think that he is in 
 the dark ; i. e., that it is night-time. Cerebral symptoms — syncope, 
 cardiac palpitation, headache, pain in the back of the neck, or at 
 the base of the skull — are often present. 
 
 Following less severe bleedings, and having recovered from the 
 resulting anemia, the patient may think himself entirely well when, 
 suddenly, there is a loss of vision. 
 
 The external ajipearance of the eyes is not far removed from the 
 normal. In complete blindness the pupils will be dilated and irre- 
 sponsive to light. In unilateral cases, the pupil of the blind eye will 
 contract synergistic with that of the normal eye. This is in accord 
 M'ith the well knoAvn facts that in unilateral blindness due to disease 
 of the optic nerve or retina, the pupil of the affected side will be 
 dilated provided the other (normal) eye is covered; Avhile light 
 striking the seeing eye will cause both pupils to contract. 
 
 The ophthalmoscopic findings in cases of amblyopia from hemor- 
 rhage may be: 1 — entirely negative; 2 — slightly positive: or, (3) 
 of marked degree. In only a few instances has the ophthalmoscopic 
 examination been made within a few hours after the advent of the 
 blindness (cases of Lift en, ^ Schweigger,^ Hirschberg,^ and Horst-
 
 294 AMBLYOPIA FROM HEMORRHAGE 
 
 mann).^ lu these patients the optic nerve head presented a washed 
 api^earanee, with very slight or not any swelling; and the area sur- 
 rounding the nerve showed a faint opacity, extending to the macula 
 lutea and diminishing toward the periphery of the retina. Small, 
 brilliant spots and minute hemorrhages were seen in the retina. 
 
 While in the majority of cases ophthalmoscopic signs are either 
 negative, or are present as slight neuro-retinal changes, there remains 
 the small number in which the fundus changes are markedly prom- 
 inent. The cases of Groenouw,'^ Ulrich,i*^ Stirling,-"^ and Theobald,^ ^ 
 may be cited as examples. Such severe cases will show the nerve- 
 head of chalk}^ whiteness ; the contour indistinct ; the retinal arteries 
 narrowed and the veins — by contrast — of normul size. Hemor- 
 rhages may be present in the retina. 
 
 The changes mentioned above may be permanent, or there may be 
 an improvement in some of them. Thus, for example, Groenouw "^ 
 cites a case in Avhich, after an interval of three months, the blurred 
 disc had regained its contour; the attenuated vessels were of normal 
 calibre; visual acuity and the visual field had become normal — but 
 the chalky Avhiteness of the nerve-head remained. 
 
 The ophthalmoscopic findings do not correspond with the degree 
 of loss of vision. With pronounced fundus changes good visual 
 acuity may be present, and vice versa. 
 
 In those j^atients who have retained vision of an amount sufficient 
 to permit an examination of the fields, the perimetric findings have 
 shown great variations. The narrowing may be slight and concen- 
 tric, or so great that only a small island remains. Often the field is 
 irregular and it may assume a hemianopic form, or, only one 
 quandrant may be missing. In a case cited by Uhthoff i- the nasal 
 half of the field was preserved, the color-fields for blue and red 
 were much contracted, and in the blind temporal half of the retina 
 two small islands were functionating. A normal peripheral field 
 with a central scotoma was observed by Mandelstamm.'"^ 
 
 hi general terms, the field is contracted but its form is not 
 characteristic. 
 
 Few photometric examinations have been made in the class of 
 cases under consideration. Pergens ^ found the light-sense abolished. 
 
 Only three post-mortem examinations have been made: — the 
 first one by Hirschberg, in 1882 ; the second by Ziegler,i^ in 1888 ; 
 and the third by Raehlmann,!^ in 1889. The findings of Hirschberg 
 and Raehlmann are of little value, since their cases belong to the 
 latter stages of the disease. Ziegler's case, which was studied 23 
 days after the advent of amblj^opia, is important.
 
 AMBLYOPIA FROM HEMORRHAGE 295 
 
 IJirschberg's specimens were studied o'-.' years after the onset 
 of blindness. The right eye was totally blind, and its sections 
 showed a complete atroph}' of the optic nerve. The left eye had 
 presented, ophthalmoseopicaliy, a neuro-retinitis and had regained 
 vision of 20/4U. In it a circumscribed atrophy of the outer layers 
 of the optic nei've was found. 
 
 Ziegler's studies showed a fatty degeneration of the optic nerve 
 and retina, the process reaching its acme in the nerve fibres adja- 
 cent to the lamina cribrosa. 
 
 Raehlmann's patient was a female, aged 23 years, who became 
 blind on the second day after a severe hemorrhage and died eight 
 M^eeks later from edema of the brain. Microscopic examination 
 disclosed a marked narrowing of the lumina of the retinal arteries 
 from endarteritis fibrosa ; and the veins presented a similar process. 
 In some areas tlie arteries were obliterated. The retina was ede- 
 matous. 
 
 It would be unprofitable to enter into a discussion of the numerous 
 theories which have been advanced in explanation of this form of 
 blindness. As Carlini - has said: "only the hypothesis based on 
 the accurate clinical observation of each case can be of true value." 
 
 A few of the hypotheses which have been considered seriously 
 are: hemorrhage into the optic-nerve sheath (von Graefe,^'' Leber; ;'"' 
 stasis in the retinal veins (Ulrich) ;^'^ thrombosis of the central retinal 
 artery (Theobald) ;'^ inflammation of the optic nerve with subse- 
 quent atrophy (Horstmann, and Hirschberg) ; a lesion, i)robably 
 an edema, of the visual centres (Samelsohn) ;i^ anemia of the brain. 
 
 Amblyopia from hemoi'rhage is a serious condition which calls 
 for a guarded prognosis. There seems not to be any relation between 
 the amount of blood lost and the degree of possible improvement 
 in vision; nor has the date of the appearance of blindness any 
 bearing on the prognosis. Recovery is possible even after percep- 
 tion of light has been abolished for several days, provided the pupil- 
 lary reaction to light is retained. In the more favorable cases the 
 duration of the andjlyopia will vary from a few minutes to many 
 hours. In the majority of patients the improvement, if it comes at 
 all, is noticed not immediately but after several days, weeks, or even 
 months (Groenouw).'^ As has been mentioned above, the ophthal- 
 moscopic findings do not furnish a basis on which to predicate the 
 prognosis. 
 
 The degree of the impairment of vision, existing early in the his- 
 tory of these cases shows great variations. Singer,^'' Avho collected 
 198 cases from the literature (including 106 noted previously by
 
 296 AMBLYOPIA FROM HEMORRHAGE 
 
 Fries)/ reports 58.8 per cent, of complete blindness; 32.4 per cent, 
 of partial blindness ; and 8.8 per cent, in which blindness was com- 
 plete in one eye and partial in the other. 
 
 The ultimate results, as given by Singer, were : no improvement, 
 in 45.9 per cent. ; improvement in 39.1 per cent. ; complete recovery 
 in 13.5 per cent.; with subsequent failure in 1.5 per cent. These 
 statistics practically confirm the statement of Groenouw,^ that, 
 "In almost one-half of all cases vision does not improve; in about 
 one-third there is improvement; and in about one-fifth complete' 
 restoration of central vision, with — in many cases — defects in the 
 visual field, is to be expected."' 
 
 In amblyopia following gastric hemorrhage, the percentage of 
 cures is small. Per gens •* has collected 50 such cases which ended 
 as follows : 6 per cent, died ; 36 per cent, were blind in both eyes ;. 
 18 per cent, were blind in one eye ; 18 per cent, suffered a marked 
 reduction in visual acuity in both eyes ; 14 per cent, obtained use- 
 ful vision ; and in 8 per cent, there was a complete cure. 
 
 The treatment of amblyopia following hemorrhage must be con- 
 ducted along broad and general lines — bleeding should be checked, 
 rest enforced, a nutritious diet supplied, and iron and strychnia be 
 administered. Local treatment of the eyes is not required, and such 
 radical procedures as paracentesis of the anterior , chamber and 
 iridectomy should not be considered. (J. M. B.) 
 
 BIBLIOGRAPHY 
 
 1 Fries : Beitrag zur Kentnis der Amblyopien uiid Amaiirosen nach Blutverlust, 
 Inaugural Dissertation. Tubingen, 1876. 
 
 2 La Clinica Oculistica, Feb. 1906. 
 
 sGroenouw: Beziehungen der Allgenieinleiden des Sehorganes. Graefe-Saemisch 
 Eandbiich, XI. Band, 1 Abtheihmg, Seite, 305, Leipzig, 1904. 
 
 ■iPergens: L 'amaurose et I'aniblyopie apres hemateniese. Ami d'ocul. 1876.. 
 
 5 Stirling: Bilateral Amaurosis following severe Hemorrjiages after Extraction 
 of a Tooth. OphthaJmic Review, August, 1904. 
 
 eLitten: Berliner IJini^che Wochenschrift, No. 49, 1880. 
 
 ^Schweigger: Eandbuch d. spe,~. Augenheilkunde, 1873. 
 
 sHirschberg: Ueber Amaurose nach Blutverlustung. Sitzungsbericht d. ophth. 
 Versamml., 1881. 
 
 sHorstmann: JahresbericM der AugenMinilc: Neuroretinitis nach Haematem- 
 esis. Charite-Ann., 1877. 
 
 10 Ulrich : Ein neuer ophthalmoskopiseher Befund nach Blutverlust. KUn. 
 Monatsbl. f. Augenheill'unde, 1883. 
 
 11 Theobald: A case of Atrophy of the Optic Nerves following Heemorrhage- 
 from the Stomach. American Jour, of Ophthalmology, May, 1899. 
 
 isllhthoff: Beitrag zur Sehnervenatrophie. Archiv. f. Ophth., xxvi, S. 275, 1880. 
 
 13 Mandelstamm: Zur Aetiologie des central Skotoms. Centralhl. f. prakt. 
 Augenheilli', 1879. 
 
 n Ziegler : Zur Kenntnis der Entsteliung der Amaurose nach Blutverlust. 
 Beitraege z. path. Anat. xi. Phys., II, S. 57, 1888.
 
 AMBLYOPIA FROM HEMORRHAGE 297 
 
 !■'> Rnehlmann : Ueber Sklerose der Netzhautatorien als Ursache ploetzlicher 
 beiderseitiger Erblindiingen. Forischr. d. Med., VII., S. 928, 1889. 
 
 16 von Graefe: Faelle von ploetzlicher und incurabiler. Aniaurose nach Haema- 
 temesls. Archiv. f. Ophth., VII., 2. S. 143, 1860. 
 
 17 Leber: Die Aniaurose nach Blutverlusten. Graefe- Saemisch Handhucli, V., 
 •S. 901, 1877. 
 
 18 8anielsohn : Ueber Amaurosis nach Haematemesis und Blutverlusten. Arch. 
 f. Ophthl, XVIII., 2, S. 225, 1872. 
 
 I'J Singer: Bcitraege zur Augenlieilkunde. Heft 53, 1902. — (J. M. B.) 
 
 Zentinayer {OpJithalmic Record, Aug., 1912) expresses the opinion 
 that these cases are of comparatively rare occurrence. In a very 
 considerable percentage there is marked contraction of the superior 
 and inferior halves of the fields, simulating hemianopsia ; true iioni- 
 onymous hemianopsia, central scotoma and peripheral contraction 
 are also seen. There may be no ophthalmoscopic changes, or there 
 may be optic atroi:)hy, neuritis and papilledema. The prognosis is 
 grave. These symptoms most frequently follow hemorrhage from 
 the stomach and bowels, and .uterine hemorrhage. The condition 
 of the patient at the time of hemorrhage is an important factor. The 
 pathogenesis is varied. Probably in a majority of cases it is due 
 to degeneration. Treatment should be prophylactic. Hypodermo- 
 clysis and intravenous injection of blood-serum are advised. 
 
 Commenting on this paper Hiram Woods says that the essayist 
 properly insists upon carefully noting all conditions present and 
 shows how this leads to the use of modern laboratory methods of 
 diagnosis, and examination of the patient by trained specialists in 
 all departments of medicine. This is necessary because blindness 
 from distant hemorrhage is very rare, and profuse hemorrhage very 
 frequent; consequently there must be something beside the hemor- 
 rhage. Toxemia is to be considered, because (1) toxic symptoms are 
 noted in all the troubles producing the hemorrhagic duodenal ulcer, 
 uterine disease, etc.; (2) toxemia is common in, the disorders for 
 which venesection is done, and venesection has been followed by 
 blindness; (3) the variety of blindness observed is such as we see 
 in toxic conditions — central scotoma, field scotoma, hemianopsia, 
 etc. It is not claimed that this is entirely satisfactory, but it is 
 suggestive. Even in cases of blindness following hemorrhage from 
 tooth extraction, when the individual was thought to be in normal 
 condition, there is still no explanation of the reason for the hem- 
 orrhage. We know very little about the causes of profuse bleed- 
 ing after such slight injuries ; but its occurrence certainly means 
 that something is wrong, that the individual cannot be given a clean 
 bill of health. 
 
 Regarding the pathology of the blindness, the essayist quotes
 
 298 AMBLYOPIA FROM HEMORRHAGE 
 
 Gowers and DeLapersonne to the effect that the pathogenesis is 
 not the same in all cases; Wildebrand and Sanger — that we know 
 nothing definitely abont it. lie also lays stress npon the work done 
 on animals by Holden. This demonstrated atrophy of the ganglion 
 cells of the retina ; but llolden himself is not satisfied with the evi- 
 dent failure of this to explain all cases. Weeks gives as the only 
 explanation ''degeneration of the ganglion cells, primarily because 
 of interference with their nutrition, ' ' and says it is to-day fully rec- 
 ognized that this is the cause of blindness. Diagnosis of this degen- 
 eration is impossible. Atrophy of the retina, on the other hand, 
 affords evidence in narrowing of the vessels, their conversion into 
 white strands, etc. Fuchs gives, as causes, protracted inflammation, 
 embolism, thrombosis. In such cases the nervehead itself shows 
 secondary atrophy. It is worthy of note that Fuchs does not men- 
 tion profuse distant hemorrhage as a cause of retinal anemia or 
 atrophy. In other words, Fuchs puts the primary ocular manifes- 
 tation of the distant hemorrhage in the nerve. Since the optic nerve 
 is affected by intracranial lesions, cortical, basal, nuclear, etc., we 
 are often forced to wait for focal symptoms before we can explain 
 a papillitis or atrophy. When they come we may see visual defects 
 characteristic of toxemia or of one of several focal troubles. If we 
 assume degeneration of the retinal ganglion cells as the cause, we 
 can, of course, explain the secondary nerve atrophy, thread-like 
 vessels, etc. But we do not explain the clinical character of the 
 blindness in a number of the reported cases. In this connection the 
 views of von Graefe, Carlini, Leber and others, as embodied in the 
 paper, reinforced, as they seem to be, by Fuchs' classification, point 
 to intracranial or optic nerve lesion as the starting point. Twenty- 
 four cases are ai)pended from the literature to the paper. The oph- 
 thalmoscopic findings are not given in 3 cases, and in one they were 
 normal, but in the other 20 there was definite nerve lesion-papillitis, 
 l^ostneuritic atrophy and simple atrophy. This, to his mind, 
 strengthens the essayist's hypothesis that retinal ischemia, with de- 
 generation of the retinal cells, may account for cases showing periph- 
 eral contraction, and possibly some of the cases of central sco- 
 toma; but that retro-bulbar neuritis, or neuritis with secondary 
 atrophy, due to a variety of intracranial lesions, more thoroughly 
 explain clinical findings. 
 
 Another hypothesis is possible, and it corresponds somewhat 
 closely with the theory of cell degeneration from ischemia — the only 
 explanation based on animal experimentation. There is no reason 
 why the cortical cells should not suffer from ischemia as well as the
 
 AMBLYOPIA FROM POISONS 299 
 
 retinal. Case histories indicate that in a certain luimber the nerve 
 lesion is observed late. 
 
 Sauielsohn's explanation of optic neuritis is given by the essayist. 
 With a refilling of the cerebral vessels the fluid is forced into the 
 lymph spaces — causing an optic neuritis, with an increase in the 
 interstitial tissue and pressure on the central vessels, and finally 
 optic atrophy. This order of pathological changes might explain 
 the hemiopic cases on the theorj' of ischemia. Some vision was 
 spared because the secondary atrophy was slight, while the cortical 
 cells w^ere killed by lack of nutrition. Again, degeneration of retinal 
 cells would be explained by cutting oft' of nutrition through pressure 
 on the vessels during the atrophic process in the nerve. — (Ed.) 
 
 Amblyopia from poisons. See Toxic amblyopia. 
 
 Amblyopia, Functional. See Amblyopia, Hysterical. 
 
 Amblyopia, Hereditary. See Amblyopia, Central. 
 
 Amblyopia, Hysterical. The functional amblyopia, retinal anesthesia, 
 neurasthenic, or nervous asthenopia of the hysterical individual 
 may be so marked that the patient has to be led about the room, or, 
 more usually, it may pass unnoticed by the patient. It is not 
 improper to regard the visual defect as due to an anesthesia of the 
 perceptive elements of the retina in correspondence with that loss 
 or perversion of sensation exhibited by the skin and mucous mem- 
 brane in other phases of hysteria. This visual defect is almost 
 alwaj^s present, and when the central acuity of sight, as determined 
 by test-types, is nearly or quite normal it will be found on careful 
 inquiry that peripheral vision, measured by the perimeter, is uni- 
 formly affected. 
 
 The peculiarity of an hysterical field is, that Avhile in every other 
 disease where peripheral limitations occur, the color field is affected 
 in greater proportion than the field for white, in hysterical ambly- 
 opia the field is less affected for colors than for white. Even where 
 the field for white is still the largest it can usually be shown (where 
 there is no perimetric defect) that the visual field for red is larger 
 than that for blue, and these measurements should always be taken 
 in doubtful cases. This reversal of the order and extent of the 
 fields for white and colors is, when present, positive evidence of 
 the existence of hysteria ; it cannot be simulated, and is caused by 
 no other ocular disorder. It is readily determined and possesses a 
 diagnostic value equal to the anesthesia of the glottis and pharynx 
 so frequently referred to as pathognomonic of this neurosis. 
 
 Although contracture and spasm of almost every member of the 
 oculo-muscular system have been observed in hysteria, many of
 
 300 
 
 HYSTERICAL AMBLYOPIA 
 
 these are differentiated from true paresis and insufficiencies Avith 
 some difficulty. A few, however, are so evidently functional dis- 
 orders, and their detection is so comparatively easy, that we do not 
 hesitate to refer to them as hysterical stigmata with which every 
 one should be acquainted. 
 
 Even before the days of modern ophthalmology it was noticed that 
 spasm of the orbicular muscles was frequently associated with 
 amaurosis and amblyopia, although there was no apparent struc- 
 tural disease of the ocular apparatus. Such a state of affairs should 
 make us suspect, and further examine the patient for, hysteria. 
 All such forms of spasm of the orbicularis — winking or blinking, 
 
 RIGHT 
 
 166 
 
 10') '"TrnL ^ DO ^ .yfg^'v 'liO 
 
 ; / V" r'i'i' V \ 
 
 K5 I 100 
 
 Eing scotoma in a hysteropic boy. 
 
 tonic, clonic, transitory or permanent, unilateral or bilateral — are 
 probably hysteric. If central or peripheral excitants competent to 
 produce the spasm can be excluded and if other hysterical stigmata 
 be present the possibility becomes a certainty. 
 
 Monocular polyopia or diplopia is often noticed in hj^steropes 
 although this symptom will have to be developed in the majority of 
 eases because the patient is unconscious of it as such. 
 
 It commonly appears to him as part of his visual defect. Tests 
 should be made both in a lighted and darkened room. One eye 
 being covered, a white match is held vertically three or four inches 
 in front of the uncovered eye. The patient is then asked to observe 
 whether the object appears double, as it is slowly moved from its 
 first position to a point three feet awa3^ In most cases the match will 
 present a double image when held quite near the face; the images 
 approach one another and become fused as they are removed, to
 
 AMBLYOPIA, HYSTERO-TRAUMATIC 301 
 
 ■separate again, more and more, until the metre distance is reached. 
 The match is again from tliis point graduall}' brought close to the 
 eye when the same phenomenon, but in reverse order, will be mani- 
 fested. 
 
 The second eye is similarly examined and finally tlie room is 
 •darkened and a further (control) test is made with a candle flame. 
 Sometimes three or more images (polyopia) are observed, and it is 
 usually possible to exclude one or more of these by carefully inter- 
 posing a card so as to cover various segments of the pupillary area 
 during the examination. 
 
 Hysterical photophobia, not necessarily associated with spasm of 
 the lid muscles, is a common experience in hysteria and, Avhen 
 present at all, may be so marked as to give rise to a suspicion of 
 organic disease. The absence of all signs of vascular congestion is 
 usually sufficient to exclude the latter. The patient often asserts 
 that the light hurts the eyes even when these organs are covered 
 with a heavy bandage, an exaggeration that should excite the sus- 
 picions of any one conversant with the hysterical character. 
 
 Pseudo-paralytic ptosis is another purely hysterical stigma. This 
 rather unusual symptom, unlike organic paralysis, is almost always 
 accompanied by other signs of hysteria, especially reflex photo- 
 phobia and blepharospasm. The eye closes quickly when the hys- 
 terical lid is raised; slowly in true paralysis. In unilateral hyster- 
 ical ptosis, as Charcot observed, the eyebrow is lower on the healthy 
 side; higher in true paralysis. — (Ed.) 
 
 Amblyopia, Hystero-traumatic. See Hysterical amblyopia. 
 
 Amblyopia, Malarial. According to deSchweinitz [Diseases of the Eye, 
 p. 64!;)}, in addition to the amblyopia in malarial cachexia with lesions 
 apparent in the fundus, one sees cases Avithout such lesions, due to 
 a special action of the malarial poison upon the optic nerve and 
 retina. These appear in tlu' form of a transient loss of vision, or 
 as complete blindness, lasting from several hours to some days or 
 even months. The affection disappears under antiperiodic treat- 
 ment. In most of the instances ophthalmoscopic findings are nega- 
 tive, or the descriptions are included in vague terms applied to 
 the retina and optic nerve — "congestion," "hyperemia," and 
 "redder than normal." The affection may be unilateral or bilateral. 
 
 Amblyopia of the visual field. See Anesthesia retinae. 
 
 Amblyopia, Peripheral. The term is occasionally employed to indi- 
 cate a rapid fatigue of the peripheral parts of the retina, as in 
 hysterical or asthenopic amblyopia, but Sammuelsohn, in 1892,
 
 302 AMBLYOPIA, POST-MARITAL 
 
 applied it to a disorder induced by lead intoxication (q. v), wliieli 
 is characterized by a peripheral defect in the visual field. 
 
 Amblyopia, post-marital. Amblyopia due to sexual excess ; also called 
 Burn's amaurosis. 
 
 Amblyopia, Pretended, malingering. When the patient desires to 
 escape troublesome duties, to excite sympathy, to draw sick bene- 
 fits, or to obtain damages from corporations, he may resort to a 
 pretense of partial or total blindness in one or both eyes. Numer- 
 ous plans have been devised to expose this deception, and these 
 will be fully described under Legal relations to ophthalmology. 
 Meantime, it may be stated that one of the best tests is that de- 
 vised by Priestley Smith and Edward Jackson : A lighted candle 
 is placed in front of the patient; hold a six degree prism before 
 one eye. If there is vision is both eyes, the one behind the prism 
 will move inward, and on removing the prism, will move outward, 
 the otlier eye remaining in the fixed position. 
 
 Amblyopia, Reflex. Partial or total blindness due to irritation or 
 other causes in distant portions of the bodj^ 
 
 Clinical reports contain many descriptions of diminution of visual 
 acuteness caused by irritation of sensory nerves, especially of the 
 branches of the trigeminus, dental amblyopia, for example. Priest- 
 ley Smith advances the hypothesis that the irritation is transferred 
 to the sympathetic nerve which leads to the contraction of the 
 choroidal blood-vessels and thus to interference with tlie chorioret- 
 inal functions. 
 
 Amblyopia, Sympathetic. See Amblyopia, Reflex. 
 
 Amblyopia, Thyroid. In this connection Raimondi's case of double 
 amblyopia with perineuritis attributed to absorption of thyroid 
 gland is of interest. His patient was a woman Avho had taken 
 tablets of thyroid gland for the purpose of reducing her weight. 
 At the expiration of three weeks, with a reduction of vision to 
 I -10, central scotomas appeared in the center of each visual field, 
 while the discs were discolored, as they are in tobacco-alcohol am- 
 blyopia. The abuse of these agents, however, was eliminated, as 
 were also syphilis, albuminuria and diabetes. The author attrib- 
 utes the visual disturbances in his patient to a disturbance of gen- 
 eral nutrition, originated by the thyroid, and not to a direct action 
 of the drug on the optic nerve. After a month of treatment with 
 quinine and arsenic there was complete recovery. 
 
 Amblyopia, Tobacco. Toxic amblyopia from tobacco alone is evidence 
 of idiosyncrasy against that poison and is a very rare condition, 
 mainly because of the fact that the patient who indulges to excess
 
 AMBLYOPIA TOXIC 80;] 
 
 ill l<)l);icco usiiiilly di'iiiks alcoliol, so tluit we generally fiml llie 
 ocular defects due 1o 1liis mixed cause. The vai'ious ijiiestions coii- 
 neelcil \\itli llic rclalioiis ol' llicsc two iuloxieauls to llie eve s\"iii|j- 
 toius of Toxic (iiiiltli/opid will 1»(' discussed under that heading; it 
 will ])erlia|>s suffice to say hei-e llial aint)lyo|)ia fi-oni tobacco alone 
 differs in no essential I'l^oni that set uj) by alcohol alone, or by 
 alcohol ])lus tobacco, eithei- in syinjttonis. the character of optic 
 nerve lesion, or in its treatnient. 
 Amblyopia, Toxic. 'roB.vcco-ALcujioL a.mblyoi'ia. Amblvoi-ia from 
 
 DRUGS AXI) ALLU:i) AGENTS. QuiNINE AMAUROSIS. ToXIC RETROBULBAR- 
 NEURITIS. TXTOXICATIOX AMBLYOPIA. ToBACCO A-MBLYOPIA. AMBLY- 
 OPIA FROM BOTULISM OR PTOMAINE POISONING. 
 
 Included in this category are numerous agents, among wdiich, in 
 addition to those just referred to, may be mentioned methyl or wood 
 alcohol, bisulphide of carbon, salicylic acid, malefern, mercurial 
 preparations, naphthalin, santonine, gelsemium, benzine, aniline dyes, 
 iodoform, thyroidin, lead salts, the venom of snakes, tea, coffee, 
 chocolate, oil of wintergreen, ergot, phosphorus, carbolic acid, 
 cocaine, strychnia and arsenical preparations. 
 
 Although the general and ocular symptoms set up b}" these various 
 forms of toxic amblyopia differ greatl}^ yet their treatment is much 
 the same in many if not in most of them. By far the larger number 
 of cases occur from chronic poisoning by alcohol, tobacco, quinine, 
 Columbian spirits and various preparations made from this form of 
 methyl alcohol. 
 
 The drug or toxic agent should be discontinued and eliminated 
 from the system. The patient should be put upon a proper diet and 
 should strictly conform to all the requirements of personal hygiene. 
 As a rule, pilocarpine sweat baths with or without the exhibition 
 of potassium iodide should be used in the early stages, especially 
 if there is any hyperemia of the optic disc or engorgement of the 
 vessels. Later strychnia, both by the mouth and hypodermically, 
 should be given in full doses. 
 
 The diagnosis, prognosis and treatment of tobacco-alcohol ambly- 
 opia are so important that they are introduced into this brief review 
 of the subject which is intended only to introduce the major heading. 
 (See Toxic amblyopia), tliat will be fully considered later on. 
 
 Both eyes are affected, the patient complaining of foggy or misty 
 vision. He almost ahvays applies for glasses to assist his failing 
 sight and, as the disease is entirely painless and presents no external 
 sign, he rarely suspects the true cause of his visual defect. The
 
 304 AMBLYOPIA TOXIC 
 
 acuity is lowered to at least % or 77 of normal, and the reading 
 of fine print is difficult or impossible with any glass. 
 
 There are also to be noted a well marked tobacco, or ethereal, 
 odor to the breath, a general atonic condition, some insomnia, anor- 
 exia, and there may be dull frontal pain. 
 
 This condition is due to a central color (relative) scotoma, espec- 
 ially for red and green. The examination to determine this sign 
 may be made with the perimeter or with a strand of red and green 
 wool. Double a single thread between the thumb and finger of the 
 right hand, holding it so that only a quarter of an inch of the loop 
 projects and is seen. Cover the patient's left eye with a bandage 
 and ask him to look steadily at the pupil of the examiner's right 
 eye at a distance of two feet. Now, interpose the small loop of red 
 wool in the common line of vision at a point a few inches in front 
 of the examiner's eye. In alcohol-tobacco amblyopia the patient 
 will not then recognize the loop as red, or it will appear redder 
 when removed an inch or two to the right, left, up or down frpm 
 the line of sight, than it does when placed directly in front of the 
 pupil. The same result will be obtained from the green wool, but 
 probably not from white, blue or yellow, unless the disease is far 
 advanced and the visual acuity has fallen below I'y. 
 
 Taken in time a perfect recovery generally "follows (1) total and 
 immediate abstinence from tobacco and alcohol; (2) good food, 
 fresh air, sufficient sleep, tri-weekly Turkish baths; (3) the admin- 
 istration of medicinal doses of iron and strychnia by the mouth, 
 for which the following is an efficient formula : 
 
 Quinin. sulphat. gr. v. 
 
 Tincture ferri chlor. 
 
 Acid, phosphoric dil. aa f. ovi, 
 
 Liq. strychnine. f. oi, 
 
 Syr. simp. f. Sviii- 
 
 A teaspoonful in water before meals; (4) the hypodermic injec- 
 tion of increasing doses of strychnia daily or every other day. 
 
 Probably the temporary improvement in vision from nitrite of 
 amyl inhalations indicates the employment of some form of Bier's 
 congestion cure in those cases of intoxication in which the lesion 
 is an optic nerve atrophy and this remedy might well be used as 
 soon as anemia of the nerve head is discovered. In addition to the 
 "hyperemia" treatment full doses of digitalis might be employed 
 to stimulate the heart's action and insure a larger blood supply to 
 the starved nerve fibres.
 
 AMBLYOPIA, TRAUMATIC , 305 
 
 The diagnosis once correctly made this routine treatment can be 
 prescribed with the assurance that, if faithfully followed, a cure may 
 be confidently expected in from one to three months. 
 
 The treatment of methyl alcohol amaurosis and amblyopia is quite 
 unsatisfactory. Some cases improve under free catharsis from jalap, 
 calomel and salines, combined with diaphoresis from hypodermics of 
 pilocarpin. This treatment, however, mvist be given during the first 
 fcAv days of the acute inflammatory stage if any beneficial results are 
 to be expected. When atrophy begins to show itself strychnine is 
 given hypodermicall}' in increasing doses until the point of tolerance 
 is reached. Potassium iodide has also been used, but it must be 
 remembered that the prognosis is very bad when signs of atrophy 
 begin to appear. In most cases the affection goes on until complete 
 blindness results, regardless of treatment. 
 
 The treatment of lead amblyopia is sometimes more satisfactory. 
 Wirsing reports the case of a woman, aged 30, who took, instead 
 of bicarbonate of soda, a teaspoonful of red lead oxide with some 
 water. After about two weeks, symptoms of lead intoxication de- 
 veloped: colic, headache, tinnitus, palpitations of the heart, profuse 
 perspiration, vomiting, vertigo. About two months after the acci- 
 dent her memory failed and visual disturbances set in with diplopia 
 and micropsia. Then she became drowsy and could not recognize 
 anybody. 
 
 Examination of the eyes six weeks after admission to the hospital, 
 revealed: V. R.= 5/v, V. L.= 5/vi. Left mydriasis, reaction of 
 both pupils sluggish, paresis of left superior oblique, contraction of 
 left visual field about 15° to 20°, color perception normal, optic 
 neuritis, with commencing atrophy, in left eye. 
 
 Under pilocarpin-instillations, warm baths and iodide of potas- 
 sium a rapid improvement took place in the general condition as 
 well as the eye symptoms, and the paresis of the left trochlearis was 
 eventually cured. 
 
 For a complete treatise on the whole subject see Toxic ambly- 
 opda. — (Ed.). 
 
 Amblyopia, Traumatic. In the absence of a lesion that will account 
 for the blindness, one has a right to suspect hysteria in cases of 
 injury, associated with complete or partial blindness; and the 
 stigmata of that disorder (see Amblyopia, Hysterical) should be 
 searched for. 
 
 Amblyopiatrics. The therapy of amblyopia. 
 
 Amblyopic. (G.) Dimness of vision, or double vision. 
 
 Amblyopie, Angeborene. (G.) Congenital amblyopia. 
 
 Vol. 1—2
 
 306 AMBLYOPIE DURCH NICHTGEBRAUCH 
 
 Amblyopie durch Nichtgebrauch. (G.) Amblyopia oii account of 
 non-usage of vision; dimness of vision or double vision on account 
 of non-usage of the eyes. See Amblyopia ex anopsia. 
 
 Amblyopie, Hereditare. (G.) Hereditary amblyopia. 
 
 Amblyopie, Hysterische.- (G.) Hysterical amblyopia. 
 
 Amblyopie, Nachtliche. (G.) Hemeralopia. 
 
 Am-blyopie, Peripherische. (G.) Peripheral amblyopia. 
 
 Amblyopie, Reflectorische. (G.) Keflex amblyopia. 
 
 Amblyopie, Rei^ende. (G.) (Obs.) Asthenopia from hyperesthesia 
 of the genital organs. 
 
 Amblyopie, Sympathische. (G.) Sympathetic amblyopia. 
 
 Amblyopie, Tagliche. (G.) Nyctalopia. 
 
 Amblyopie, Toxische. (G.) Toxic amblyopia. 
 
 Amblyopie, Transitorische. (G.) Transitory amblyopia migraine. 
 
 Amblyopie, Traumatische. (G.) Traumatic amblyopia. 
 
 Amblyopsa, Amblyopsia. Synonyms of amblyopia. Defective vision, 
 due neither to ametropia (q. v.) nor to visible organic lesion of the 
 ocular tissues. See Amblyopia. 
 
 Amblyoscope, The. This instrument was devised for the purpose of 
 determining the presence or absence of binocular vision, as well as 
 to exercise and educate those eyes not possessing the ability to ac- 
 quire the fusion faculty without extrinsic assistance. 
 
 It was invented by Claud Worth and, although several modifica- 
 tions of the original have been made, the instrument in use to-day 
 is much the same as the first model. It consists of two L-shaped 
 tubes, attached at their apex by a movable joint, so as to admit of 
 being converged and diverged through a considerable arc. (See 
 the figure.) At one end of each tube is placed a convex lens of the 
 proper focal distance, so that no accommodation is necessary by 
 the eye focusing on the picture at the opposite end of the tube. 
 These pictures are mounted on translucent celluloid and are held 
 in receptacles which admit of their being easily changed. At the 
 bent portion of each tube is placed a mirror which enables the patient 
 looking through the eye-piece to see the picture with the correspond- 
 ing eye. 
 
 Black has contributed an improvement which allows one of the 
 tubes to be raised or lowered, giving a more perfect adaptation to 
 eyes which are not on an exact level. An added feature is one 
 suggested by Duane, which consists of having a graduated arc fitted 
 to the two tubes which shows always the exact amount of deviation, 
 de Schweinitz has devised an arrangement by which prisms to cor- 
 rect vertical deviations may be inserted.
 
 AMBLYOSCOPE, THE 807 
 
 The great advantage of the amblyoseope lies in its arrangement 
 for ilhirainating the pictures. The latter being mounted on trans- 
 lucent celluloid, the light is allowed to shine through them, the 
 illumination usually being furnished by two small electric lights, 
 one at the back of each picture. Hy the use of a rheostat it is pos- 
 sible to accentuate one picture by making its light burn brighter and 
 to make the opposite picture less prominent by dimming its light. 
 By this method the picture seen by the amblyopic eye is made to 
 stand ou4 prominently and the patient finds it much harder to dis- 
 regard this image. He therefore more readily fuses the two pictures. 
 
 The amblyoseope finds its greatest use in the treatment of con- 
 comitant strabismus of children. 
 
 The following directions for the use of the amblyoseope, were 
 written for de Schweinitz's Diseases of the Eye, by H. Maxwell 
 Langdon, who has devoted much attention and study to this instru- 
 ment. 
 
 The child's vision should be tested, if types or other signs cannot 
 be utilized, with small, white ivory balls, each with a diameter 
 varying from i inch to 14 inches. Each eye is tried separately, and 
 the child is required to pick up the ball, which is rolled with a 
 twisting movement. If this test reveals that one eye is amblyopic 
 and possesses one-sixth or less of visual acuity, some form of blinder 
 exercise should be instituted to improve the defective visual acuity. 
 Preceding the exercises with the amblyoseope, the angle of strabismus 
 should be measured according to the methods elsewhere described, 
 the refractive error having been carefully and fully corrected, and 
 the glasses being in position, and during all of these exercises the 
 glasses must be worn. Amblyoseope training should be begun as 
 soon as the child is old enough to look at ordinary pictures and to 
 talk about them, because deviation yields far more readily to these 
 exercises in young children than in older ones, and, moreover, after 
 the sixth year it is usually practically impossible to make any 
 satisfactory impression upon the defective fusion-faculty. A child 
 of three years is well able to take part in these exercises, especially 
 if they are so conducted that they represent to him a game in 
 Avhich he may readily be interested. Usually one or two sittings a 
 w^eek, each occupying half an hour, are sufficient. The child should 
 be seated on a chair, between the surgeon's knees, and the angle of 
 the tubes approximated to the angle of strabismus. Next, the illumi- 
 nation, which may consist of two electric-light bulbs, two lamps, or 
 two candles, equally distant from each tube, are arranged, and an 
 object-slide is placed in each holder. These object-slides should
 
 308 AMBLYOSCOPE, THE 
 
 consist of pictures familiar to young children, but the ones used at 
 first should be quite dissimilar; for example, the picture of a bird 
 and the picture of a cage. The child is now required to look into 
 the tubes, and is asked what he sees. If one eye is amblyopic to any 
 considerable degree, it is probable that the image of the object be- 
 fore the better or fixing eye will be the only one which is visible. 
 Hence, the illumination must be altered before the other object-slide 
 can be seen by diminishing the light before the fixing or better eye, 
 and increasing that before the amblyopic or squinting eye, continu- 
 
 The Worth Amblyoscope. 
 
 ing with this regulation of lights until both objects are visible and 
 can be described by the child. This alteration in the lights can be 
 accomplished in various ways ; for example, by changing the dis- 
 tance of the lights, as Worth suggests, or by adapting to the ambly- 
 oscope, as the writer has done, a revolving wheel, which contains 
 smoked lenses of different densities, and which can be turned be- 
 fore the nou-amblyopic eye. Each object should be seen clearly, 
 and the exercise should be varied with several pairs of object-slides. 
 Next, the child is required to place one hand on each of the sur- 
 geon's knees and to tap that knee on the side on which the picture 
 of the bird is seen. If the angle of the tubes is rapidly altered a 
 position will be found where the slightest movement of the tubes 
 causes the picture of the bird to pass directly through from one side 
 of the picture of the cage to the other. But, after continuing the 
 exercises, the l>ird apparently will go directly into the cage, indi- 
 cating that the child is acquiring a certain amount of fusing power. 
 If one object is above the other, this vertical deviation must be 
 overcome by means of prisms suitably placed in the grooved slides 
 back of the focussing lenses. As soon as the child can easily merge
 
 AMBOCEPTOREN 309 
 
 the two objects, more difficult tasks are set, -witli slides deniaiidiiig 
 accurate and complete fusioii, and by gradually widening the angle 
 of the tube, a range of fusion which varies from o to 15° may be 
 acquired by the patient. 
 
 Finally, a series of stereoscopic i)ic1ui'es, intended to teach the 
 child the sense of perspective, are employed. During these exer- 
 cises, by Avhich the fusion-faculty is stimulated and developed, the 
 strabismus may do one of three things: it may disa])pear after a 
 few^ days of training; it may gradually lessen; or it may not alter 
 at all, and operative procedures are re(juired to produce parallelism 
 of the visual axes. 
 
 Amboceptoren. (G.) Amboceptors. 
 
 Ambozeptor. (G.) Amboceptor. 
 
 Ambrosia. This interesting classical eye-patient, dead these twenty- 
 two centuries, has recorded her own case on a marble votive-tablet 
 to the folloAving effect: "Ambrosia, of Athens, blind in one eye. 
 She came to the god [Asklepias] seeking help. Walking about in 
 the sanctuar}', she ridiculed many of the histories of healings, de- 
 claring it to be incredible and impossible that the lame and the 
 blind should have been cured merely by means of a dream. But, 
 in her own temple-sleep, she beheld a face. Apparently the god 
 came to her and said that Jie would make her well again ; that, 
 hoAvever, she should install in the temple a silver pig, as a memo- 
 rial of her folly. After these words the god grazed the diseased 
 eye with a knife, and instilled a healing remedy. As it became day, 
 Ambrosia departed from the temple wholly sound." — (T. H. S.) 
 
 Ambrosia artimisifolia. See Pollantin. 
 
 Ambulanz. (G.) Ambulance. 
 
 Ambulatorische. (G.) Ambulatory. 
 
 Ambulatorische Behandlung. (G.) Out-patient treatment; also the 
 treatment of p.nsoning by making the patient walk about. 
 
 Ambulatorische Klinik. (G.) Out-patient department. 
 
 Ambulatorische Praxis. (G.) Out-patient practice. 
 
 Ameba coli. (L.) See Amoeba coli. 
 
 Ameisensaure. (G.) Formic acid. 
 
 Amethyst glass. When certain kinds of white glass are exposed for 
 many years to the sun's rays they assume a light purplish (ame- 
 thyst) color, and are then useful in the manufacture of tinted 
 lenses and other forms of eye protectives. The amethyst color in 
 the glass (due to chemical changes in its constituents) is also jjro- 
 duced in a short time artificially, as it were, and is doubtless quite 
 as efficient for the purpose as the variety first described.
 
 310 
 
 AMETHYSTVIOLETT 
 
 Amethystviolett. (G.) Amethyst violet. 
 
 Ametrometer. An iustriimeut for measuring ametropia, or errors of 
 refraction. 
 
 Ametrometer, Thomson's. This instrument has two small gas-flames 
 about live millimeters in diameter, one stationary and the other 
 movable on a metal arm, which can be changed or revolved to any 
 meridian. Each eye is tested separatel.y at a distance of twenty 
 feet, preferably under a cycloplegic. The method of the test is to 
 move one flame along the metal arm until the two lights appear to 
 fuse. The scale, as marked on the arm, gives the approximate 
 
 Thonisou "s Ametrometer. 
 
 strength of lens necessary to correct the ametropia. By raising or 
 low^ering the arm any meridian may be tested. It is a most ingen- 
 ious test, but not in common use. (Thorington.) 
 
 Ametropia, Adjunct treatment of. See Adjunct treatment of ame- 
 tropia. 
 
 Ametropia, or abnormal refraction. When the eye is in a state of 
 rest, parallel rays of light come to a focus not on but at some point 
 behind or in front o'f the retina and instead of presenting a clear 
 image of the object looked at, vision is blurred and indistinct and 
 the eye has to exert its accommodative power to see clearly, thereby 
 causing fatigue and other symptoms of discomfort, setting up a 
 condition known as asthenopia. 
 
 Ametropia is divided into 1. Hypermetropia, 2. Myopia, 3. Astig-
 
 AMETROPIA, OR ABNORMAL REFRACTION 311 
 
 matism, which Edward Jackson jji-efcrs to call astigmia. In the 
 first, wlien tlie eye is at rest, parallel rays of liolit from distant 
 objects come to a focus at some point behind the retina, while 
 divergent rays from near objects focus at a point still farther back 
 of the retina. 
 
 In other words, the hypermetropic eye is an eye that is smaller 
 than it ought to be — an undeveloped eye. 
 
 In an emmetropic eye it is uiulerstood that no accommodative 
 efit'ort is required to see distant objects distinctly and the accom- 
 modation is but slightly called upon when we wish to do near work. 
 In far sight such is not the case, as the course of the rays of light 
 entering the eye must be altered by an increased eft'ort of accom- 
 modation before they focus exactly on the retina and give distinct 
 vision for distant as well as for near objects. A greater effort is 
 required for the latter than for the former. The accommodation 
 being constantly called upon the ciliary muscle is in a continual 
 state of contraction and becomes hypertrophied. Such a condition 
 of affairs may lead to symptoms of discomfort not onh' in the eye, but 
 in the structures surrounding it. 
 
 A slight amount of farsightedness may not cause any unpleasant 
 symptoms, especially in youth when the general health is good and 
 the eyes are not used for much near work. Children at birth are 
 usually hypermetropic ; this condition generally becomes less marked 
 and may, as it often does, pass into a state of normal refraction. 
 
 The persistent and -excessive demand made upon the accommoda- 
 tion for the purpose of giving clear and distinct vision frequently 
 produces a sort of cramp of the ciliary muscle, causing pain and 
 congestion in and around the eyes and inability to use them for any 
 length of time for near work. 
 
 This is especially true of a farsighted eye, because a part of the 
 accommodative power having already been used up in obtaining 
 clear vision when looking in the distance, there is much less to fall 
 back upon, and a greater effort is required to see clcaily when the 
 eyes are called upon to do prolonged reading, sewing, bookkeeping, 
 etc. The vision soon becomes blurred and the eyes have to be rested 
 before the work can be continued. 
 
 If much near work is persisted in complaint is made of pain, 
 fatigue, a sensation of weight, frontal headache, and other symp- 
 toms of discomfort about the eyes, a complex of symptoms commonly 
 called eyestrain (q. v.). The conjunctiva becomes congested and 
 frequently the margins of the lids are red and inflanu'd. Soon there
 
 312 AMETROPIA, OR ABNORMAL REFRACTION 
 
 is a feeling of sand in the eyes, with burning and smarting of the 
 lids and eyeballs and an increased secretion of tears. 
 . Where the strain is kept up for some time styes and other affec- 
 tions of the lids are frequently met with. When this strain is not 
 relieved by appropriate treatment the effort even to see distant 
 objects distinctly also causes marked discomfort until eventually 
 the patient is no longer able to use his eyes for any purpose, even 
 for a few moments, with comfort. This condition is known as 
 accommodative asthenopia. 
 
 A farsighted eye, as has just been noted, is a small eye and this 
 abnormal state is due in the majority of instances to shortening of 
 the antero-posterior diameter of the eyeball, to Avhich is given the 
 name axial hypermetropia. Less frequently it depend upon some 
 deficiency in the curvature of the cornea or lens, (curvature hyper- 
 metropia) or upon the absence of the lens (aphakia). It is almost 
 invariably' a congenital and rarely an acquired condition. 
 
 For the correction of farsightedness it is necessary that parallel 
 rays of light should be brought to a focus on the retina without the 
 aid of the accommodation. This is accomplished by means of a 
 convex lens in front of the eye, of sufficient strength to make the 
 rays as they enter the eye, more convergent. The greater the 
 amount of hypermetropia the stronger the convex lens must be. 
 
 When there is spasm of the ciliary muscle (and this condition is 
 more or less present in a large percentage of the cases) a variable 
 amount of the error is masked and in some cases the cramp of the 
 muscle is so great that the eye presents a condition of false myopia, 
 due to such strenuous efforts of the accommodation (in the endeavor 
 to focus the rays on the retina) that it is overdone and the rays 
 apparently focus in front of the retina. 
 
 In determining the true or total amount of farsightedness, as well 
 as of the other forms of ametropia, the power of accommodation 
 should be relaxed and the ciliary muscle paralyzed by the use of 
 one of the many cycloplegics at our disposal, e. g. : One per cent, 
 atropia. 
 
 One drop into each eye three times daily for two days; or by a 
 mixture containing hydrobromate of homatropine and hydrochlorate 
 of cocaine, of each, -4 grains in half a fluid ounce of distilled water. 
 
 One drop into each eye every 10 minutes for one hour. In suit- 
 able cases full, but transient, cycloplegia occurs in an hour and a 
 half after the first drop. 
 
 Better still is the use, every twenty minutes for an hour, of a
 
 AMETROPIA, OR ABNORMAL REFRACTION 313 
 
 gelatin disc coiitaiiiin<r each ^f,,, grain of lioniatroi)in(' and cocaine 
 alkaloids. (See Cycloplegics. i 
 
 F. A. ]\Ioi'rison prefers the following mixture, instead of a solu- 
 tion or the gelatine discs, for the purpose of insuring prolonged 
 contact of the cycloplegic with the eve-ball. 
 
 Coeain. liydrochlor. 
 
 Homatropin. hydrobrom. a a gr. iss 
 
 Pulv. acacia? oii 
 
 A little to be placed on the eye-ball, or in the sac, near the outer 
 canthus. Keep the eye closed. 
 
 F. B. Eaton prefers hyoscin gelatine disks, lioou to ^.500 gi'- each, 
 to atropin or any other cycloplegic. 
 
 When gelatine lamelhe with hyoscin (gr. ^4ooo) ^I'e employed and 
 a single disc put into the sac five minutes after the instillation of 
 a single drop of a 2 per cent, solution of cocaine hydrochloride and 
 homatropine hydrochloride one obtains the maximum cycloplegia 
 with the minimum expenditure of time, provided the patient can 
 afford to have ciliary rest for seventy-two hours. An important 
 consideration in this procedure is that the cocaine benumbs the 
 conjunctiva and cornea, and one does not experience the foreign 
 body sensations and other discomforts arising from the introduction 
 of discs into the conjunctival sac. 
 
 D. M. Griffith finds that the most marked cycloplegic effects can 
 be obtained from small doses of atropine combined with dionin. 
 He also believes that the addition of dionin inhibits the toxic effects 
 of the atropine. He generally uses this formula: One grain of atro- 
 pin sulphate, and five grains of dionin in two fluid drams of distilled 
 water. 
 
 Two drops in each eye three times a day for four days. 
 
 Alexander Randall prefers hyoscyamine (2 grains to the fluid 
 ounce) as a cycloplegic. He has found it prompt and vigorous, 
 holding the ciliary muscle firmly in its grasp for 72 hours, mean- 
 time giving complete, enforced rest. The cycloplegic effects prac- 
 tically disappear in 150 hours after the initial instillation. 
 
 Other o])hthalmologists prefer one grain of hyoscin hydrobromate 
 to the fluid ounce of distilled water, of which one drop is to be put 
 into each eye thrice daily for tAvo days. 
 
 AVendel Reber uses homatropin semi-occasionally, and atropin 
 infrequently. For a number of years past he has used a 
 iV per cent, solution of hyoscin hydrobromate, containing also i 
 per cent, cocaine. In about one case in fifty there is rather marked
 
 SU AMETROPIA, OR ABNORMAL REFRACTION 
 
 flushing of the face, quickening of the pulse and some slight vertigo, 
 but not more than is sometimes seen with homatropin. Not once 
 was pronounced "toxemia" noticed. Compression of the canaliculi 
 immediately after instillation will prevent even the slightest con- 
 stitutional reaction. The solution is instilled once or twice the 
 evening before, and twice the morning of the examination. For 
 office use cocaine solution, 2 per cent., warmed, which is instilled, 
 and the hyoscin dropped in, also warm, twice at intervals of a half 
 hour. An hour later the testing may begin. Accommodation is 
 sufficiently re-established for ordinary purposes at the end of 48 
 to 60 hours. It is not wise to attempt to hasten this by instilling 
 eserin, as the benefit of the rest under a mydriatic is thus forfeited. 
 The ideal would be to completely paralyze accommodation and put 
 the internal ocular structures at perfect rest by atropin prior to 
 testing the refraction, but this is often impracticable. 
 
 Alexander Duane believes that a cycloplegic should be employed 
 for determining the refraction in practically all cases, not glaucoma- 
 tous, below 48 years of age and in some cases above this limit. 
 
 Homatropine in 2 per cent, solution, provided it is used with or- 
 dinary precaution, is a safe cycloplegic, and if properly used is 
 effective in the vast majority of cases. 
 
 It should be repeatedly instilled and the examination made not 
 less than an hour after the first instillation nor until a test of the 
 accommodation has shown that the latter is as completely abolished 
 as possible. 
 
 The cases in which homatropin proves inefficient are few. Thej' 
 are marked b}^ varjdng vision and varying acceptances, discrepan- 
 cies between the subjective tests and the skiascopic findings, and 
 the persistence of an undue amount of accommodation (more than 
 one D) even after prolonged action and repeated instillations. 
 
 In such cases atropin should be used. 
 
 Macklin prefers atroscine to other cycloplegics for determining 
 refractive errors, and uses it as a one per cent, solution in castor oil. 
 He says it acts as a rapid and powerful mydriatic and cycloplegic, 
 is as potent and reliable as atropine sulphate, while the power 
 of accommodation returns in five days. Of course, with homatropine 
 the ciliary paresis ceases in 24 hours, which is undoubtedly a great 
 advantage in many cases, yet homatropine has disadvantages which 
 must be apparent to all who use it. IMydriasis with atroscine begins 
 in ten minutes and is complete in twenty. Cycloplegia begins in 
 ten minutes and is complete in about fifty. — (Ed.)
 
 AMETROPIE 315 
 
 See, also, Refraction and accommodation of the eye; Physiological 
 optics. 
 Ametropie. (G.) Ametropia. 
 Ametropisch. (G.) Ametropie. 
 
 Ametropometer. An iiistfumeiit for (letei-miiiiiig the character aiul 
 the degree of anu'tropia or refractive anomalies. 
 
 This instrument, Avhich is founded on Scheiner's experiment, 
 (q. V.) has been perfected by Frouiaget. He employs a lantern giv- 
 ing an especially brilliant light, and before each of the holes of the 
 Scheiner disk places a colored glass, one red the other green. The 
 luminous opening of the lantern is rectangular in form, its width 
 being variable. The plate carrying this luminous opening is capa- 
 ble of rotation to any meridian. 
 
 The principal meridians of astigmia are a.scertained by placing 
 before the eye a disk with pin-hole openings arranged in the form 
 of a cross. Each of these openings gives an elongated image ; and 
 Avhen the cross is turned so that one arm takes the direction of great- 
 est elongation, it indicates the meridian of greatest ametropia. The 
 slit aperature of the lantern is then turned to one of the principal 
 meridians and the line joining the pin-hole openings of the Scheiner 
 disk is placed perpendicular to it. Until the ametropia of this 
 meridian is corrected, a red and a green inmge of the light are 
 seen, homonymous for myopia and crossed for hyperopia. Lenses 
 are placed before the eye until these two images fuse into a single 
 rectangle light. The lense doing this corrects the ametropia of that 
 meridian. 
 
 To measure hyperopia or myopia without astigmia, the lantern 
 aperture may be placed in any meridian and the two images 
 larought together by lenses. Even for astigmia only spherical 
 lenses are recjuired, and P'ronuiget has employed for the purpose 
 the lens disk of Kalt's ophthalmoscope. 
 
 This is a good subjective method for children, illiterates and those 
 who do not possess, or will not acknowledge, good acuteness of 
 vision. But like others based on the Scheiner experiment it really 
 measures the refraction of only two points in each principal me- 
 ridian. If the error of refraction were capable of complete correc- 
 tion by a spherical or sphero-cylindrical lens, the method would 
 be theoretically and practically perfect. l>ut the fact is, that in all 
 eyes we find aberration and astigmia. The actnal retVaction of 
 the eye does not conform to the theory, and for that reason such 
 methods must always be inferior to those, like skiascopy and the
 
 316 AMIANTHINOPSY 
 
 trial lenses, which deal to some extent with the refraction in all 
 parts of the pnpil. {Ophthalmic Year Book, 1904, pp. 15, 16.) 
 
 Amianthinopsy. Violet-blindness, or inability to distinguish violet 
 shades. 
 
 Amidin. See Holocaine. 
 
 Amidon. See Starch. 
 
 Aminoalcohol. See Arterenol. 
 
 Ammar. Fnll name, Abul Qasim Ammar b. Ali-al-Mausili. He is 
 one of the most distinguished, and by far the most original, of the 
 Arabian ocnlists. Ammar * was born at Mosul, in Mesopotamia, in 
 the latter half of the 10th century. He made a number of pilgrim- 
 ages, both for the purpose of study and for that of practising oph- 
 thalmology, dwelt for a time in Irak, and finally settled for the 
 practise of his profession in Egypt. In this land it was, during the 
 reign of the Sultan Hakim (996-1020 A. D.) that Ammar composed 
 his highly original book, and, possibly, invented his suction method 
 for the extraction of cataract. At all events, the suction method is 
 undoubtedly Ammar 's and his great treatise, entitled "Book of the 
 Selection of Eyc-Disca\s€s/' is the most important work on ophthal- 
 mology now extant from the Middle Ages, with the single exception 
 of the ''Memorandum. Book for Oculists" of Ammar 's great con- 
 temporary, Ali ben Isa. 
 
 The most decidedly interesting passage in the book is that re- 
 lating to the suction-operation for cataract. Having made an in- 
 cision in the conjunctiva 2/3 of a barleycorn behind the corneal 
 limbus, and, after that, a puncture in the sclera with a little knife^ 
 exactly as if preparing for a reclination, Ammar proceeds to intro- 
 duce through the opening, instead of the solid needle (the kind 
 employed in reclination) a hollow affair of his own devising ''until 
 it is felt to be within a void space." Then he continues: "But the 
 handling [of the instrument] is [now] different [i. e., from the 
 handling of the solid instrument employed in reclination]. As soon 
 as the needle has reached the interior of the eye, thrust the cata- 
 
 * Practically all we know of Ammar (as of many another— great or small — 
 Arabian) we owe to the industry of Hirsehberg. In many of the biographical 
 and historical articles of this work, similar acknowledgment is made of our 
 obligation to this brilliant, as well as indefatigable, Teutonic investigator, but 
 it is absolutely impossible to make appropriate acknowledgment on every other- 
 wise proper occasion, and it therefore must, in default of a better method, 
 suffice to acknowledge at this opportunity that Hirschberg is well-nigh the 
 creator of the Historv of Ophthalmology. . 
 
 Hirsch, Magnus (especially for antiquity), Sichel, Pansier, Leclerc, Klem^ 
 ■ Anagnostakis, and others have also done good work in this field,^ and to them we 
 are also indebted.
 
 AMMAR 317 
 
 ract down, in the customary fashion. ^VlM'll now the cataract goes 
 down, and the half of the pupil is clear, and to thee the needle in 
 the interior of the eye becomes visible — it is indeed not visible to 
 thee before the pupil gets clear — then notice on which of the three 
 sides of the needle the eye of the needle lies. Cause this side to 
 ride upon the cataract. Then command the assistant that he suck 
 vigorously. Then look ! the cataract has a thick body, and around 
 it is a membrane like that encompassing the white of an egg. When 
 now^ the assistant sucks, and tlie cataract hangs on the eye of the 
 needle; then command him to suck hard: thou thyself, however, 
 watch the cataract Avith thine eyes ; and when the cataract has 
 arrived inside the needle, then draw the needle out, while the as- 
 sistant keeps on sucking till the needle is out of the eye. Then has 
 the cataract come out with it. After this it is not necessary that 
 the patient lie down. One has only to l)ind up the eye, for seven 
 days, until the place of operation is fast healed. The assistant 
 must, however, take care at the time of suction that nothing of the 
 membrane returns into the eye — for then would the eye become 
 staring; and that the needle does not act upon the egg-white 
 [aqueous] humor, nor, at the time of the sucking, draws in much 
 thereof — for then the eye would shrivel." 
 
 "After the operation, the patient must guard against light and 
 clearness, till forty days are passed; and against coitus, and against 
 vomiting and against weeping and against constipation. This be- 
 longs to the healing of the operation. Had I leisure, I would treat 
 this matter more in detail." 
 
 In another place Ammar describes the needle wdtli which he per- 
 formed his suction operation. In view, however, of the fact that, 
 in describing the hollow needle, he assumes on the part of the reader 
 an understanding of the solid needle, we first subjoin his descrip- 
 tion of the latter instrument: "This is the picture of the needle, in 
 order that the inquirer may learn it. Its length measures 11/2 
 handbreadths, without the point, with which the operation is car- 
 ried out. The length of the point [operative extremity] which 
 enters into the eye, should be as large as the nail-part of the thumb. 
 A ring should be placed on the needle, which S(iparates its body from 
 its point. Let the end of the point be triangular, in order first that 
 the place of puncture be given a triangular form, and therefore the 
 wound heal more quickly; and in order second, when the point has 
 pressed in, that it will ahvays be possible, that one of the three 
 sides, whichever one it may be, may fall upon the cataract and 
 depress it, without the necessity for troubling oneself to give the
 
 318 AMMAR 
 
 needle a turn."' Now, then, follows the description of the hollow 
 instrument: "The form of the hollow needle is, necessarily, exactly 
 the same as that of the solid instrument ; only the hollow instrument 
 should be thicker. The hollow extends from the one end to the 
 other. The place with which the cataract is sucked should be a 
 (lateral) perforation on one of the three surfaces. This is the picture 
 of the hollow needle. It is prepared of copper or of gold." 
 
 O^ 
 
 Ammar "s Xeedle. 
 
 The necessity, or at least the advantage, of having the needle made 
 of copper or of gold, arose (as exj^lained by another Arabian, Salah 
 ad-din) from the fact that needles manufactured of these substances 
 were, by reason of their color, much more plainly'' visible against the 
 pupillary blackness and the cataractous whiteness than if made of 
 other metals. 
 
 Long before Ammar 's time, certain attempts had undoubtedly been 
 made (e. g., by the ancient Greek, Antyllus) to remove soft cataracts 
 by suction. These endeavors, however, had been hesitating, and half- 
 hearted, as well as awkward and probably without success. All 
 had been performed (so far as that word is applicable) by the cor- 
 neal route, and the escape of aqueous humor had been looked 
 upon, both in antiquity and in the Middle Ages, as an irreparable 
 disaster. Further, the attempts at suction had, in these early in- 
 stances, been made by means of a glass tube. Ammar avoided ' ' the 
 aqueous calamity" bj^ entering the eye by way of the sclera, and 
 then, as above related, had removed the cataract by suction through 
 a hollow needle of his own invention. 
 
 Ammar 's suction procedure was a more important matter in his 
 land and day than Avould appear to us on first consideration. Cata- 
 racts were frequent there and then, and, in the great majority of 
 instances, were soft. However, the operation did not by any means 
 receive the recognition which it so manifestly merited. Favored 
 sufficiently by the .operators of the Orient, it nevertheless did not 
 secure in "Western Islam more than a bare recognition. Thus, in 
 Spain, it was really never adopted to any considerable degree. In 
 Christendom the excellent little procedure fared even worse. Merely 
 mentioned by Guy de Chauliac and one or two other authorities 
 of the Christian Middle Ages, it was laid aside for centuries (al- 
 most a millenary) until, 1846. In that year, the procedure was re- 
 vived by Blanchet.— (T. H. S.)
 
 AMME 
 
 319 
 
 Amme. (G.) A wet-nurse. 
 
 Ammenbrust. (G.) A wet-nurse's breast. 
 
 Ammenmilch. (G.) A wet-nurse's milk. 
 
 Ammensprache. (G.) A nurse's language. 
 
 Ammeter. A galvanometer that measures the value of an electric 
 current in amperes. 
 
 Amjnon, Filaments of. A name given to certain histological elements 
 of the ciliary body. It has been known since the days of Galen that 
 at the border of the ora serrata are found certain striations resemb- 
 ling hairs. These are really minute capillaries arranged meridian- 
 ally along with faint folds of the surface. See Histology of the 
 eye. 
 
 Ammon, Frederich August von. This immortal ophthalmologist — son 
 of the famous theologian, Professor Christopher Friederich von 
 
 Frederich August vou Amniun. 
 
 Ammon — Avas born at Gottingen, 'Germany, Sep. 10, 1799. In 1818 
 he accompanied his father to Dresden, and from 1814-18 he attended 
 the Schulpforte, leaving this institution to begin the study of med- 
 icine at Leipzig. Later, he continued his professional studies at 
 Gottingen, where he was intimately associated with Blumenbach, 
 Langenbeck, Sr., Himly, and other celebrated instructors. When he 
 had studied at Leipzig only a year and a half, he received the prize 
 of the George-Augustus University for his work on the " Senieiologij 
 of Sleeping and Waldng." Aug. 25, 1821, he graduated, presenting 
 as his Dissertation "The History of Ophtlialnw-Paracentcsis." 
 After a brief sojourn in Paris and another in Southern Germany,.
 
 320 AMMON, FREDERICK AUGUST VON 
 
 von Amnion settled (1822) in Dresden, where he devoted especial 
 attention to surgery and ophthalmology. 
 
 In 1824: he was appointed physician to the Dresden Institute for 
 the Education of Blind Children — a position in which he displayed 
 extraordinary ability. In 1828 he was made Professor of General 
 Pathology, Materia Medica, and Clinical Medicine and Surgery in 
 the Medico-Chirurgical Academy at Dresden. He had an extensive 
 practice, especially in diseases of the eye, and seemed to be abso- 
 lutely tireless in his work. 
 
 The universal testimony is that, as a man, von Ammon was dis- 
 tinguished above all things by conscientiousness. Nothing that he 
 did was done badly, or, to all appearances, in haste. The sole ex- 
 ception, perhajDS, in this regard, is his literary work. In this, marks' 
 of haste do now and then appear. 
 
 His services to surgery in general are very great, much greater, 
 however, are those to ophthalmology. He is said to have written 
 65 important articles, and his books, 7 in number, are valua- 
 ble without exception. He was also the cause of much original and 
 highly excellent work being performed by others — chiefly, of 
 course by his own associates and pupils. Among these latter may 
 be mentioned, Gescheidt, Leclila, Bech, Winimer, Warnatz, Schon, 
 Klemmer, Beger, Froebelius, and Zeis. 
 
 Amnion's most original work was done in relation to iritis, 
 strabismus, symblepharon, and congenital ocular defects and mal- 
 formations. His work on Iritis is so thorough and so carefully based 
 on anatomical and pathological considerations as to make all pre- 
 vious investigations into the nature of this disease appear elemen- 
 tary. His treatise on Ocular Defects and Malformations was not, con- 
 trary to what has been suggested "the first upon this subject;" 
 but it was certainly the best upon this subject, and, at the present 
 day, it has not been superseded entirely. Aside from the "poste- 
 rior scleral protruberanee of Ammon," Avhicli. presumably, will al- 
 ways continue to bear the name of ,its distinguished discoverer, 
 what ophthalmologist, without thinking of this brilliant investiga- 
 tor, can call to mind such ocular malformations as epicanthus, the 
 very name of which he invented, blepharo-ptosis, eoloboma of the 
 iris and of the lens, ankyloblepharon, blepharophimosis, and 
 microphthalmus ? 
 
 von Amnion's books (it is simply out of the ({uestion to attempt 
 a list of his articles) are as follows : 
 
 1. Oplithalmoparacenteseos historia. Spec, medico-histor. quo 
 commentatur in varias hujus operat. ad cataract, sanand. methodos
 
 V. AMMON-AGNEW CANTHOLYSIS, THE 321 
 
 hueusque institutas et in instrumeiita liuiic in usiiui inventa. Cum 
 tab, aer. incisa. Gottingae 1821. 
 
 2. Kurze GcscMchle dcr Augcnlieilkundc in SacJisen. Eine med.- 
 hist. Skizze bei Erofl'nung der neuen Erziehiings-und Arbeits-Anstalt 
 flir Blindc in Dresden. Leipzig 1824, 
 
 3. Bninncndiateii/,- odcr Amceisung zum zweclmassigen Gebraiiche 
 der nat'urUchen und lunstlichcn Gcsundhrunnen- und Mineralhdder 
 (Dresden 1825, 1828, 1835, 1841, 1854; Polish edition, 1827). 
 
 4. Die ersten Midler pflicktcn und die erste Kindespflege zur Be- 
 Ichrung jiinger Frwuen und Milttcr (Dresden 1827, 1835, 1839, and 
 so on even to the 13th edition). 
 
 5. Quaestio anatoinico-plujsiol. de genesi et usu maculae luteae in 
 retina oculi humani obviae. Aeced. tab. in aes incisa. Vinariae 1830. 
 
 6. Dc Iritidc. . . . Lips. 1838. 
 
 7. Klinische Darslellungcn dcr Kranhheitcn und Bildungsfehler 
 des mcnschlichen Augrs, der Augenlidcr und dcr Thrdnenwerkzeuge 
 nach eignen BeohacJitungcn unci Unfersnchungcn. Hierzu 55 Tafeln 
 mit 965 ophthalmoklinisclien Abbildungen. Berlin 1847, Fol. 
 
 von Amnion died May 18, 1861, in consequence of prostatic hyper- 
 trophy.— (T. H. S.) 
 
 . Ammon-Agnew cantholysis, The. Agnew's cantholysis is a modi- 
 fication of the operation devised by von Amnion in 1839. It is the 
 simplest method and the one chiefly in vogue among American sur- 
 geons. 
 
 Agnew's Cantholysis, or Modification of the von Ammon Canthoplasty. 
 
 The instruments employed are large and small straight, blunt 
 scissors, mouse-tooth forceps, needle-holder, and two or three fine 
 curved needles. General anesthesia is resorted to only when abso- 
 lutely necessary. Local anesthetics help slightly. The patient lies 
 on the table. 
 
 The cantliotomy. The outer commissure is held moderately open 
 by the left thumb and index finger; one blade of the large scissors 
 is slid into the outer cul-de-sac as far as it will readily go, its 
 
 Vol. 1—21
 
 322 V. AMMON-AGNEW CANTHOLYSIS, THE 
 
 edge exactly beneath the angle of the lids and in line with the 
 closed palpebral fissure. The other blade is closed down until it 
 touches the skin, a good grip is taken on the handles, so that the 
 blades will not "buckle," and with one firm snip the cut is made. 
 The skin incision should be from one to one and a half centi- 
 meters long, according to the demands 6f the ease ; the conjunctival 
 cut should reach to the bottom of the cul-de-sac. Although the cut 
 is usually made in a perfectly horizontal direction, in many indi- 
 viduals the scar conforms better to the natural topography of the 
 outer canthus if it be given a somewhat downward inclination. 
 
 One should bear in mind that a part of the accessory lachrymal 
 gland lies in this region and strive not to injure it wantonly. 
 
 There will be some bleeding, but it usually ceases spontaneously. 
 
 Division of the external canthal ligament. The free border of the 
 upper lid is grasped by the left thumb and index, pushed slightly 
 up to open the spaces between the severed skin and conjunctiva, 
 and the small scissors, closed, are put into the upper opening to 
 feel for the ligament. The lid is now pulled forward toward the nose, 
 so as to make the ligament taut, Avlien the scissors are opened 
 slightly, the blades are pushed up astride the ligament about mid- 
 way of its length, and it also is cut with a single snip, and at right 
 angles to the primary incision. Some authors state that the con- 
 junctiva is unavoidably incised in dividing the ligament; such is 
 not the case, for with delicate scissors and a little care, neither 
 the skin nor the conjunctiva need be wounded. If the snip is suc- 
 cessful the lid at once gives way under thumb and finger. If it 
 fails to yield, another and more careful effort must be made. The 
 same procedure is repeated on the lower section of the ligament. 
 
 Placing and tying the sutnres. An assistant opens wide the ex- 
 tended commissure. It will be observed that the cut in the skin 
 is longer — often very much longer — than that in the conjunctiva. 
 Now, all the descriptions of the operation that I have ever read, 
 and all the many cuts th/it 1 have seen illustrative of it, teach that 
 the angle of the conjunctival opening should be joined to that of 
 the skin. This is precisely what Agnew insisted should not be done, 
 and with substantial reasons ; for, because of the inequality in the 
 length of angles alluded to, thus to unite them means the oblitera- 
 tion of the external cul-de-sac ; not only this, but it also means 
 undue stretching of the conjunctiva to force it to meet the skin 
 at this point, hence, the formation of an unseemly bridle or band 
 that is particularly noticeable and restricting when the globe is 
 in adduction. Instead, therefore, following Agne^v, after picking
 
 V. AMMON S OPERATION FOR ECTROPION 
 
 323 
 
 u}) the roiijujiclival aiijilc with the needle, it is carried outward 
 as far as it will <io without any stretehiug and is joined to the 
 upper lip of the iiicisiou. See tlie tigure. 
 
 Another suture is placed to unite the lower skin and mucous 
 lips, and sometimes a third to perform the same office above, and 
 the operation is tinished — unless, perchance, one chooses to put in 
 a fourth or superficial suture to close the small skin angle thus 
 left unclosed. Care must ))e exercised not to include the canthal 
 ligament in suturing. As each suture is put in, if it he not tied 
 at once, the two ends of thi'ead ai'e laid together on the temple 
 where an assistant places a finger on them to insure keeping each 
 pair to itself. Tliey are tied with the canthus stretched open, in 
 order to see that they ai'e true, and not tied too tight lest they 
 cut out of the conjunctiva. — {(!. IT. B.) 
 
 Ammon's operation for ectropion. This operation (see figure) 
 strives to remove a ])ai't of the free border of the lid and still leave 
 
 von Ammon's ■Modification of Adam's Operation for Ectropion. 
 
 the remainder intact. To this end a gore is cut from the entire 
 thickness of the lid from the outer canthus, and the wound closed 
 •with pin and sutures. — (C. H. B.) 
 V. Ammon's operation for epicanthus. The fact that by pinching up 
 a vertical fold of skin on the nose the deformity Avill disappear 
 suggested the operation, called by von Amnion ''rhinorraphy." 
 (See the figure.) 
 
 cl 
 
 von Ammou 's Operation for Epicautlnis. (Rhinorraphy.)
 
 324 AMMON S POSTERIOR SCLERAL PROTUBERANCE 
 
 He pinched up a fold of skin on the bridge of the nose sufficient 
 to uncover the inner canthus, marked out the line of incision with 
 ink and then excised an oval piece of skin, von Amnion brought 
 the lips of the wound together with surgical pins around which 
 were placed figure-of-eight sutures, but in place of these the wound 
 can be directly closed with silk or silk-worm-gut sutures. The re- 
 sulting scar is a linear one and not very noticeable if healing by 
 primary union follows. — (W. H. W.) 
 Ammon's posterior scleral protuberance. A variety of posterior 
 
 ectasia of the sclera. 
 Ammoniacum, Oculo-toxic symptoms from. It has for more than a 
 century been known that certain resinous substances, especially' 
 ammoniacum and galbanum, i)roduce disturbances of vision if they 
 are used internally for a long time. After the employment of these 
 therapeutic agents in pill form for several months, some patients 
 have developed a complete and incurable amaurosis. 
 
 The disease develops slowly and the dimness of sight is the first 
 toxic symptom of which patients complain. The pupil is dilated and 
 its motility is impaired. Two short case histories ( E ncyklopddie der 
 AugenJieilkunde) are t.ypical of this form of intoxication. A man, 
 after taking daily about 8 grams of galbanum in emulsion for some 
 time, complained of a peculiar dimness or cloudiness of vision, 
 which almost approached blindness. The symptoms disappeared on 
 stopping the medicine. A woman, after taking galbanum resin, 
 became almost completely blind ; on stopping its use she recovered. 
 In a third patient the same result was noticed, whether the resin 
 was taken in emulsion or in pills. This patient also saw "stars 
 and fiery spots" before the eyes. 
 
 We are unable to throw much light upon the action of these 
 substances, except that it is similar to some ethereal oils that are 
 depressants of the central nervous system, and that the resinous 
 acid anhydrides which have similar effects belong to this group of 
 resinoids. There is no evidence, as has been suggested, that these 
 substances are carried in the circulation in solution or as an emul- 
 sion and deposited in insoluable form in the eye or optic nerve and 
 thus produce visual disturbances for a longer or shorter time. 
 Ammonia, Oculo-toxic symptoms from. Ammonia, like other alkalies, 
 forms soluble albuminates and destroys living tissues. Its great 
 volatility assists it to penetrate loosely-arranged cellular tissue, as 
 well as to spread over its surface. After burns of the eyeball by 
 the gas or gaseous solutions a peculiar false membrane forms, of
 
 AMMONIAK 325 
 
 the same character but less proiionneed than that produced l\v other 
 corrosives. 
 
 Some idea of the reaction in ammonia burns can be obtained from 
 attempts to clear up leucomata in a cocainized eye with ammonia. 
 The application destroys the epithelium over the scar and it be- 
 comes a sort of colorless pulp which afterwards becomes opalescent. 
 The leucomatous area is included in the destroyed area. Tlie 
 application produces swelling of the lids, chemosis of the conjunc- 
 tiva, photophobia, and blepharospasm. 
 Ammoniak. (G.) Ammonia, ammonium, ammoniacum. 
 Ammoniakgas. (G.) Ammonia pis. 
 Ammoniated copper. See Cuprum ammoniatum. 
 Ammoniated mercury. See Mercury, White precipitate of. 
 Ammonium acetate. Solution of. Spirits op jMindererus. This solu- 
 tion contains (U. S.) not less than 7 per cent, of the salt. It is a 
 colorless, fainth^ acid liquid, and is occasionally employed as a 
 eollyrium Avith tincture of opium in subacute and chronic forms 
 of simple conjunctivitis. 
 Ammonium, Acid tartrate of. See Ammonium bitartrate. 
 Ammonium bitartrate. Acid tartrate of ammoxium. NH4HC4H4O0. 
 This salt occurs as white crystals, soluble in water; mostlj'' used as 
 a baking powder. 
 
 Guillery and zur Nedden advise the employment of 5 to 10 per 
 cent, solutions of this salt, neutralized by the addition of liquor am- 
 monige, in removing opacities of the cornea produced by lime burns. 
 The solution is applied in an eye-cup three times daily. A little co- 
 caine may be used in conjunction with the treatment, although the 
 pain is not severe. To be efifective the treatment must be applied 
 early before the deposits take on the form of the carbonate. 
 
 For recurrent attacks of styes Lanvole finds the following mix- 
 ture of decided value : Ammonium chloride, one gram ; precipitated 
 sulphur. 3 grms. ; spirits of camph.. 20 grms. ; rose water, 50 grms. 
 
 The lids are to be regularly bathed with this wash two or three 
 times daily for several weeks. 
 Ammonium chloride. Sal ammoniac. NH4CI. This well-known salt, 
 now mostly derived from the so-called coalgas liquor, when pure, 
 is a white, granular, crystalline powder, soluble in 2 parts of water 
 and 50 of alcohol. It has a cooling but strongly saline taste. 
 
 Ammonium chloride is rarely used in ocular therapy, and then 
 generally in conjunction with other remedies as a mild astringent, 
 as in the f olloAving eollyrium :
 
 326 AMMONIUMCHLORID 
 
 r> 
 
 Sulphur, sublimat. 3.0(gr. xlvj) 
 
 Ammonii chloridi 1.0 (gr. xv) 
 
 Aquse rosse 50.0 (foJ,fov) 
 
 Spiritus camphorae 10.0 (foiiss) 
 
 In filamentary keratitis a 2 per cent, solution of this salt is said 
 to be beneficial as a coUyrium. 
 
 Pick has used, in an eye cup, a 2 to 5 per cent, solution for corneal 
 opacities, 
 Ammoniumchlorid. (G.) Chlorid of ammonia. 
 Ammonium ichthyol. See Ichthyol. 
 Ammonium ichthyolate. See Ichthyol. 
 Ammonium ichthyolsulphonate. See Ichthyol. 
 Ammoniummolybdate (G.) Ammonia molybdate, ammonium molyb- 
 
 date. 
 Ammoniumpersulfat. (G.) Persulphate of ammonia. 
 Ammoniumpikrat. (G.) Picrate of ammonia. 
 Ammoniumsauere. (G.) Acid of ammonium. 
 Ammoniumsulfat. (G.) Sulphate of ammonia. 
 Ammoniumvanadinat. (G.) Ammonium vanadinate. 
 Ammonshorn. (G.) Hippocampus major; cornu ammonis. 
 Amnesia, Visual. Another term for this central disease is "mind- 
 blindness." The patient sees an object correctly but has no mem- 
 ory of it. By closing the eyes it may be recognized by touch or by 
 the other senses. This symptom is present when the lesion is in the 
 centre for visual memory or in the path connecting the centre for 
 vision with the centre for visual memory. In these higher visual 
 centres both eyes are represented in each hemisphere. They are 
 situated in the angular gyri of the parietal lobes, and communicate 
 with each other through the callosal crossway. A lesion in this 
 region does not cause hemianopsia. 
 
 In amnesic color-hlindness (q. v.) the patient cannot name the color 
 of an object, although he distinguishes color and can perform color- 
 tests perfectly.— (J. M. B.) 
 Amnestia optica. (G.) Mind-blindness. See Amnesia, Visual. 
 Amnestic color-blindness. This condition consists, as stated by Wil- 
 brand, (System of Diseases of the Eye, Vol. 2, p. 301) in the patient's 
 not being able to name, or in his naming wrongly, colors that are 
 held before his eyes. When examining with the perimeter, this 
 circumstance might easily lead to the assumption that an alteration 
 of the color-sense is present. Such patients are merely not in con- 
 dition to find spontaneously the word which belongs to the color
 
 AMoBE 327 
 
 set before their eyes. If bundles of colored wools are placed before 
 them, and they are set to sort the colors Avhich belong together, 
 they do it without hesitation or fault, thus proving that the color- 
 sense is normal and that the disturbance is one that belongs to the 
 aphasic symptom-complex. Wilbrand has described such cases. 
 
 Amobe. (G.) Amoeba. 
 
 Amoeba coli. (L.) Bacterium or bacillus coli. The bacillus of 
 dysentery. See Bacteriology of the eye. 
 
 Amorphie. (G.) Malformation. 
 
 Amorphisch. (G.) Amorphic. 
 
 Amorphismus. (G.) Amorphism. 
 
 Amotio retinae. See Retina, Detachment of the. 
 
 Amperage. The number of amperes (electrical units) that pass 
 through a given circuit. 
 
 Amphibia, Oculo-toxic symptoms from poisonous. In the epidermis of 
 toads there are both mucous and poison glands. The latter are 
 found only on the animal's back and legs, but the mucous glands 
 are scattered over the entire body. 
 
 An alkaline toxin, phrynin, was easily isolated from the poison- 
 gland secretion, while from the skin of Biifo vulgaris, an acid, 
 amorphous principle called hufotalin, five parts of which are soluble 
 in 2,000 parts of water. In addition to these two is a similar but 
 weaker agent, hufonin. Bufotalin is very irritating locally and, 
 when absorbed, as after subcutaneous injection, acts like digitalis; 
 it sets up salivation, vomiting and diarrhea. 
 
 Fresh toad poison causes an active inflammation of the lids. They 
 become swollen, while phlyctenules may form and a purulent con- 
 junctivitis set in. 
 
 Some toads, especially one from Guatemala, are said to inject a 
 stream of corrosive fluid into the faces of those handling them 
 This liquid causes pain when it enters the eyes. Biifo ictericus is 
 said to secrete the poisonous fluid (which produces cardiac paralysis 
 in animals) in the glands of the neck. However, the consistency of 
 
 , the poison, which is present in the epidermis of the toad, speaks 
 against the possibility of its being expelled the necessary distance 
 to reach the eyes. As for the origin and character of the expelled 
 fluid it may, in some instances, be a poisonous urine or secretion of 
 the oral glands. 
 
 According to Lewin and Guillery, a watery solution of bufotalin 
 placed in the eye causes conjunctivitis. A more noticeable result 
 is a persistent, local anesthesia of the cornea and conjunctiva, when 
 the toad poison in solution of 1 to 100 is placed in the human con-
 
 328 AMPHIBIANS, EYES OF 
 
 junctival sac. The anesthesia begins in about 15 minutes and lasts 
 about 5 hours ; even after 24 hours the sensitiveness of the cornea 
 is still reduced. This anesthesia, as well as the inflammatory 
 changes set up by it, agree very well with its digitalis-like action, 
 empirically known for almost two hundred years. It seems to be 
 a law that digitalis-like substances, with few exceptions, act as 
 irritants and anesthetics when applied to the conjunctiva. 
 
 There are a few other creditable reports of the injurious effect of 
 toad poison on the eye. For example, P. Frank saw a very rapid 
 and severe swelling of the eyelids in a young girl, who, while cut- 
 ting grass, grasped a toad and then rubbed her hand over her eye. 
 Amphibians, Eyes of. Amphibia, as the name implies, are capable of 
 life both beneath and above water. These terraqueous vertebrates- 
 exhibit two stages of development — the larval, in which they are 
 aquatic and breathe with gills — and the adult form with lungs. 
 Their eyeballs are small and structurally resemble the eyes of fishes. 
 (See Fishes, Eyes of.) However, the tapetum (q. v.), the argentea 
 (q. v.), the campanula of Haller (q. v.), the processus falciformis 
 (q. V.) and the so-called "choroid gland," well represented in pis- 
 cian species, are lacking in amphibian eyes. 
 
 The globe itself is nearly round and the cornea is decidedly con- 
 vex. The pupil is generally circular, although in a few instances 
 — Bombinator, for example — it is triangular. The crystalline lens 
 is large, and more convex on its inner than on its outer surface. 
 Amphibia accommodate chiefly by movement of the lens towards and 
 away from the cornea and probably not by altering the shape of the 
 crystalline. This action is brought about by the ciliary muscle. In 
 the frog and other amphibian species there is a protractor lentis 
 muscle that aids this movement, and it may be the homologue of 
 the retractor of the lens in fishes. 
 
 Ciliary processes are seen in several amphibian species, while 
 the iris has well-developed muscles. Hyaline cartilage — often pig- 
 mented — is found in the scleral coat although, unlike the sclerotic 
 of birds, these are never ossified. It serves the same purpose as the 
 bony plates in the bird's sclera. 
 
 The visual apparatus of this vertebrate class is arranged for 
 seeing — not very distinctly, however — both in air and under water. 
 See, also. Comparative ophthalmology.— (Ed.) 
 
 Amphiblestroid apoplexy. (Obs.) Retinal apoplexy or hemor- 
 rhage. 
 
 Amphiblestroiditis. (G.) Inflammation of the retina.
 
 AMPHICELOUS, OR AMPHICOELOUS 
 
 329 
 
 Amphicelous, or amphicoelous. Concave on both sides or ends; bi- 
 concave. 
 
 Amphidiplopia. (G.) That condition in which each eye exhibits 
 double vision. 
 
 Amphikranie. (G.) Bilateral headache. 
 
 Amphioxus, Eyes of. Amphioxus (lancelet) is a genus of inverte- 
 brate animals that are destitute of eyes in the sense that these 
 organs occur in vertebrates. They have, in addition to an unpaired 
 pigment-spot in the front wall of the cerebral vesicle (which is 
 supposed to serve as a light-perceiving organ), a series of simple, 
 
 ' Eyes " 
 
 A 
 
 DotmX zone cj "optic edls ' 
 
 Ar.'erior pigment-ipol 
 
 St 
 
 K i~... 
 
 GK 
 
 A. — The Anterior Portion of Amphioxus lancelatus. 
 
 (Modified from H. Joseph.) 
 B. — One of the Eye-Like Organs in A. (After H. Joseph.) 
 GE, capsule, with neuroglia elements; K, nucleus of optic cell; N, its nerve 
 process, and f, its granular border; Fig, pigment-cell, showing three layers; 
 iSt, striated border of optic cell. 
 
 cup-like structures, somewhat resembling the eyes of flat worms, 
 situated on either side of the spinal cord. (See the figures.) These 
 structures are arranged in groups, corresponding to the myomeres, 
 and gradually becoming less numerous in passing backwards to 
 the tail. Each of these Ijodies is described as consisting of a sin- 
 gle optic cell M'ith a nerve fibre, and is partly surrounded by a 
 pigment cell. More dorsally, above the oral region, somewhat sim- 
 ilar, but pigmentless, bodies have been observed. — (Wiederscheim). 
 
 Ampiezza dell 'accommodazione. (It.) Amplitude or amount of ac- 
 commodative effort of which the eye is capable, from its far to its 
 near point. 
 
 Amplitude of accommodation. The amount of accommodative effort 
 of which the eye is capable, from its far point (punctum remotum)
 
 330 AMPLITUDE OF ACCOMMODATION 
 
 to its near point, or punctum proximum. It is often referred to 
 as the field or range of accommodation. "It is expressed by the 
 I I 
 
 formula in which P represents the near point and the R 
 
 P E, 
 the far point ; and may be taken as the difference in refractive power 
 of lenses of which the foci are respectively P and R. The binocular 
 range of a. is the a. from the farthest point (r2) to the nearest 
 point (P2), for both eyes at once. The relative range of accommoda- 
 tion is the range over which we have control at a given convergence 
 of the visual lines. It represents the degree in which accommoda- 
 tion is independent of convergence. The positive-relative range of 
 a. represents the amount of a. of which a person is capable nearer or 
 closer than the point of convergence of the visual lines of the eyes. 
 The negative relative range of a. is that amount of convergence 
 which is required in order that a person may clearly see an object 
 lying beyond the point of convergence of the visual lines." — Foster. 
 
 This condition is dependent upon alterations in the curvature of 
 the lens, the age of the individual, the condition of the ciliary 
 muscle, etc. Hess calls it "latent ciliary muscle contraction" in 
 contra-distinction to ' ' manifest ciliary muscle contraction, ' ' i. e., 
 that which produces alterations in the curvature of the lens. The 
 range of accommodation is measured by determining both the 
 "near" and "far" point of vision. By "far point" is understood 
 the distance from the eye at which an object is placed to be dis- 
 tinctly seen with the least curvature of the lens. The "near" 
 point is the distance at which an object can be seen distinctly with • 
 the greatest curvature of the lens. In practice, fine print (Jaeger 
 I or the corresponding Snellen type) is used to determine the near- 
 point. These tablets are brought near to the eye until the print 
 appears blurred. The size of the object and the width of the pupil 
 are important factors to be considered, and as the above method 
 deals with a narrow visual field only, not the real near-point but a 
 "pseudo" near-point is obtained, which, in general, is nearer to 
 the eye than the true punctum proximum. 
 
 To determine the positive near-point, it is, however, best to 
 employ some method depending upon the Scheiner experiment. 
 Looking with one eye at a small point of light through two small 
 holes close together in a disc, the point fixed will be seen double 
 if the eye is not sharply focussed ; single if it is. With the least 
 error in focussing two points will be seen instead of one. Again, if 
 a pointed object is gradually brought near to the eye, it is not
 
 AMPLITUDE OF FUSION 331 
 
 difficult to say at what point the object begins to be seen double 
 with strong accommodation, and the '"near-point'' is positively 
 found. The optometers of Porterfield- Young, Stampfer and others 
 are constructed on the base of tiiis experiment. The two small 
 holes are replaced by two fine parallel slits. 
 
 Recently, it has been asserted that the range of accoiniuodation 
 in hypermetropia is greater and in myopia less than in emmetropia, 
 and this was explained by the difference in action of the ciliary 
 muscles. If this assumption Avere correct the different range of 
 accommodation in ametropia could be explained only by differences 
 in the crystalline lens of each form of refraction. As a matter of 
 fact, however, the range of accommodation is essentially the same 
 in all. 
 
 As is well known, the increasing hardness of the lens as age 
 advances prevents the action of the ciliary muscle. The near-point 
 consequently' recedes (and the amplitude of accommodation dimin- 
 ishes) from the eye, whereas, up to the age of fifty, the far-point 
 does not change. The accommodation at the age of ten is about 
 14 D, at twenty about 10 D, at thirty about 7 D, at forty about 
 4I/2 D, at fifty about 2V2 D. As soon as the near-point has so far 
 moved away from the eye that reading at 30 cm. distance is 
 impossible, visual disturbances, known as presbyopia, appear. Such 
 disturbances are not due to a functional weakening of the ciliary 
 muscles but merely to an increasing density of the lenticular sub- 
 stance; and no efforts (hoAvever strong) on the part of the ciliary 
 muscle can increase the curve of the lens past a certain point. 
 
 This state of affairs distinguishes presbyopia from the hyper- 
 metropia of youth. In the latter instance increased ciliary con- 
 traction is followed by increased curvature of the lens and approach 
 of the near-point of distinct vision. It also explains why (emme- 
 tropic) presbyopes do not suffer from asthenopic symptoms and 
 why they have no dynamic convergence. With advancing age the 
 manifest range of accommodation decreases while the latent in- 
 creases correspondingly. When the lens has become so hard that 
 form changes are entirely lost, the entire amplitude of accommoda- 
 tion becomes latent. 
 
 See Physiological optics; Refraction and accommodation. 
 Amplitude of fusion. This expression indicates the extent to which 
 fusion of the images of the tAvo eyes (and binocular vision) are 
 maintained during extreme variations of the angle of convergence 
 in the amblyoscope, or similar instrument. The number of degrees 
 covering the arc thus described is the measure of the amplitude of
 
 332 AMPLITUDE OF VIBRATION 
 
 fusion, which may also be regarded as the extent to which the 
 fusion faculty has been developed. 
 
 Amplitude of vibration. In physics, the length of the perpendicular 
 between the summit of a wave and the line of its propagation. The 
 perpendicular is located midway between the nodes (q. v.). 
 
 Ampullae. These containers are small, specially constructed glass 
 bottles for liquids likely to be injured by contact with the air or 
 light. Generally they are opened by breaking their slim neck at 
 a file mark in the glass. 
 
 Amtsarzt. (G.) District physician. 
 
 Amtsphysikus. (G.) A physician connected in a jurisdiction of a 
 state. 
 
 Amylalkohol. (G.) Araylic alcohol. 
 
 Amylnitrit. (G.) Nitrite of amyl. 
 
 Amyl nitrite. Amylo-nitrous ether. Amyl nitris Cr.HnNOo. 
 Ethereal, yellowish liquid, of a pungent aromatic taste and a peculiar 
 fruity odor ; very volatile and inflammable. It is never used locally 
 in eye diseases, but is generally inhaled as a cardiac stimulant. Small 
 doses stimulate the heart muscle, increasing the force and rapidity 
 of the heart, while overdoses produce the opposite effect. It also 
 increases the amount of urine and sometimes sets up a temporary 
 glycosuria. Pearls made of very thin glass are on the market, 
 each containing a dose — 2 to 5 minims (0.20-0.30 cc.) — of the drug. 
 One of these is crushed in a piece of gauze or handkerchief and 
 slowly inhaled. Flushing of the face, slight tinnitus, and even ver- 
 tigo accompany the rush of blood to the head, which it is the pur- 
 pose of the drug to accomplish. 
 
 It is used in tobacco-alcohol amblyopia partly as a remedy and 
 partly to determine whether a temporary improvement in vision 
 will follow the improved suppl}^ of blood to the starved optic nerve. 
 If this occurs the prognosis is decidedly more favorable than when 
 no such improvement follows. It is also used in quinine amblyopia 
 and in forms of optic atrophy as an adjunct to other treatment; 
 also as a heart stimulant in cocaine poisoning. 
 
 Amyloform. This condensation product of the action of formalde- 
 hyde on starch is a white, odorless powder eminently adapted as 
 an antiseptic application to the ocular structure in lieu of iodo- 
 form. 
 
 Amyloid degeneration of the external eye. This tissue alteration is a 
 local one, unconnected with general disease. Its etiology is 
 unknown, and its occurrence is rare, except, perhaps, in countries
 
 AMYLOID DEGENERATION OF THE EXTERNAL EYE 
 
 like riidia, Egy])t and the Russian Ualtie provinces where trachoma 
 is common. Tt is most fre(iuently met with between the ages of 20 
 and 25, and l)otli sexes are e(|ually affected. Usually only one eye 
 is afit^'ected and the course of Hie disease is a very chronic one. In 
 the conjunctiva it is generally found about the region of the fornix 
 and superior arcus tarseus ((j. v.). Hence the process extends to 
 other parts of the conjunctiva, but it rarely attacks the eyeball or 
 ■deep tissues of the eyelid. The thickened mucous meni})rane later 
 on forms heavy folds which may project more or less into the 
 conjunctival sac. Their surface is smooth and of a yellow color. 
 At this stage of the disease hemorrhages into the parenchyma of 
 the swollen tissue may occur. The upper eyelid is now drawn 
 down, and on account of the gradually increasing extent of the 
 swelling, the lids are more and more pushed away from the eyeball 
 till they seem puffed out — almost globular. The lid, how^ever, 
 remains normal. Beneath the epidermis hard, knotty elevations 
 appear, which have sometimes smooth, sometimes uneven surfaces, 
 so that eversion of the upper eyelid is difficult or impossible. Sub- 
 jective disturbances are almost entirely absent in the beginning 
 while later on patients complain of the disfigurement and of defects 
 in vision. 
 
 The process, localized at first in the conjunctiva proper finally 
 invades the submucosa and may even extend into the deeper tissues. 
 
 Pathologically, we find the formation of peculiar granulation 
 tissue (adenoid cells according to some authors), intercellular con- 
 nective tissue bundles and fibrilla?. Mast-cells are encountered 
 occasionally. The amyloid substance is deposited in these tissues 
 and may appear in irregular, isolated areas or in large interconnect- 
 ing jnasses. Some of the single areas are enveloped by an 
 endothelial layer. Usually, the bloodvessels are also strongly 
 affected, show^ing thick walls and narrowed or obliterated lumina. 
 In progressive cases all the palpebral glands and muscles undergo 
 degenerative changes. Lime salts may also be deposited in the 
 diseased tissues and ossification of the amyloid tumors may result. 
 
 It is the common idea that the amyloid substance is deposited in 
 the connective-tissue network of the granulations and their blood- 
 vessels, and that cellular elements are secondarily alifected by 
 pressure atrophy. 
 
 The symptoms are characteristic, although in the early stage 
 they might be mistaken for the signs of diffuse trachoma. Absence 
 of follicles and pannus aid the diagnosis. The prognosis is ordin- 
 arily favorable unless the process has already spread very much.
 
 334 AMYLOID DISEASE OF THE CONJUNCTIVA 
 
 In this case the prognosis Avill be doubtful because after operative 
 measures adhesions may occur between the globe and the eyelids. 
 Efifective therapy consists in excision of the tumors with the great- 
 est possible preservation of the mucous membrane. Repeated and 
 partial excision of the larger of the tumors is to be recommended, 
 since the other swellings may disappear spontaneously after the 
 operation. Relapses may also occur after operation. 
 
 Amyloid degeneration of the cornea is thought to be a colloid or 
 hyalin change, and outside of the color reactions (Avith iodine and 
 iodic acid) has little in common with amyloid degeneration of the 
 eyelids (q. v.). It occurs in eyes suffering from leucoma, staphy- 
 loma or irido-corneal scars, or is seen in eyes blind from glaucoma 
 or irido-chorioiditis, (ribbon-shaped keratitis). The histological 
 changes take place in the superficial layers of the corneal (scar) 
 tissue, and may extend into the epithelium. The degeneration con- 
 sists of a highly refractive, glossy substance which appears in the 
 form of very small granules, or droplets, or in larger, irregular 
 masses, often complicated by calcification. Opinions differ as to 
 the origin of this substance. Some investigators connect it with 
 a degeneration of the cells of the cornea or of more recent young 
 scar-tissue in it. The substance itself is insoluble in alcohol, ether 
 and chloroform, is not attacked by inorganic acids and concentrated 
 alkalies, and often gives the color-reactions (iodine and its com- 
 pounds) characteristic of the amyloid or hyaline substance. Clin- 
 ically, the affected parts of the cornea show a marked yellowish 
 tinge. — (Encyklopadie der A ugenlieilhunde.) 
 
 Amyloid disease of the conjunctiva. According to Fox {Diseases of 
 the Eye, p. 132), this is a rare affection of the conjunctiva, charac- 
 terized by amyloid infilration of that structure. It is most fre- 
 quent in young adults, and is often first noticed by the drooping 
 of one or both lids. Redness, hemorrhages, and protrusion may 
 become marked, and often render the eye useless. The condition 
 is not unlike trachoma in appearance, but diff'ers from that disease 
 in that it is yelloAv, waxy, and transparent. The cause is unknown. 
 The treatment consists of excision. 
 
 Hyaloid degeneration of the conjunctiva has also been observed, 
 but is usually considered a forerunner of amyloid changes. 
 
 Amyloide degeneration der Bindehaut. (G.) Amyloid degeneration 
 of the conjunctiva. 
 
 Amyloide degeneration von Hornhautnarben. (G.) Amyloid degen- 
 eration of scars of the cornea. 
 
 Amyloidentartung. (G.) Amyloid degeneration.
 
 AMYLOIDENTARTUNG DER BINDEHAUT 335 
 
 Amyloidentartung der Bindehaut. (G.) Amyloid conjunctival 
 degeneration. 
 
 Amyloidentartung' der Conjunctiva. (G.) Amyloid degeneration of 
 the conjunctiva. 
 
 Amyloidentartung der Conjunctiva des Tarsus. (G.) Amyloid de- 
 generation of the eonjuiictiva of the tarsus. 
 
 Amyloidentartung- der Hornhaut. (G.j Amyloid degeneration of the 
 eornea. 
 
 Amyloidentartung innerer Organe. (G.) Amyloid degeneration of 
 
 the internal organs. 
 Amylo-nitrous ether. See Amyl nitrite. 
 
 Amylum. See Starch. 
 
 Amyotrophische. (G.) Amyotrophic. 
 
 Amyotrophische lateralsklerose. (G.) Amyotrophic lateral sclerosis. 
 
 Anabolic change. A term used in describing llering's theory or 
 explanation of color perception. The theory assumes that different 
 colors affect different color-substances in the retina. Red light, for 
 example, induces a catabolic eluinge (Dissiinilirung) in the red- 
 green substance, producing a sensation of red. Green light, on the 
 other hand, brings about a constructive or (iiiaholic change (Assim- 
 ilirung) in the same substance, thereby producing a color sensation 
 of green. See Color sense. 
 
 Anacamptic. Causing a reflection, as of light or sound. 
 
 Anacaraptics. That part of optics which treats of reflection. Same 
 as catoptrics (([. v.J. 
 
 Anacamptometer. An instrument for measuring the reflexes. 
 
 Anaclasis. A refraction or reflection of sound or light. 
 
 Anaclastic, adj. In optics, pertaining to or produced by the refrac- 
 tion of light; refracted. Anaclastic curves, the apparent curves at 
 the bottom of a vessel of water, caused by the refraction of light. 
 Anaclastic glass or vial, a glass with a narrow mouth and a wide 
 convex bottom of such thinness that when a little air is sucked out 
 it springs inward with a smart crackling sound, and when air is 
 blown in it springs outward into its former shape with a like noise. 
 — (0. F. P.) 
 
 Anaclastics, n. Plural of anaclastic. That part of optics which treats 
 of the refraction of light. Same as dioptrics. 
 
 Anaerobe Kulturen. (G.) Anaerobic cultures; a micro-organism ca- 
 pable of living Avithout free oxygen or which is destroyed by it. 
 
 Anaeroben. (G.) Micro-organisms capable of living without free 
 oxygen or wdiich are destroyed by it. 
 
 Anaesthesia. See Anesthesia. 
 
 Anaesthesie der Bindehaut. (G.) Anesthesia of the conjunctiva.
 
 336 ANAESTHESIE DER HORNHAUT 
 
 Anaesthesia der Hornhaut. (G.) Anesthesia of the cornea. 
 
 Anaesthesie der Lidhaut. (G.) Anesthesia of the palpebral skin. 
 
 Anaesthetica. (G.) Anesthetic. 
 
 Anagenesis. A term used in connection with the photo-chemistry of 
 the retina to indicate a certain form of regeneration of the pre- 
 viously lileached or (exhausted color-elements of the retina. See, also, 
 Rhodog-enesis and Neogenesis. 
 
 Anaglyph. An experimental figure, composed of two superimposed 
 designs, one drawn in red and the other in blue. If this be ob- 
 served through a red glass, only the blue lines are visible, and 
 vice versa. If, however, a red glass be placed in front of one eye 
 and a blue glass in front of the other, a stereoscopic effect is ob- 
 tained. Changing the glasses gives a reversal of the relief, if the 
 anaglyph be drawn in such a manner as to permit of this interpre- 
 tation. 
 
 Anagnos, Michael. This well-known philanthropist was for many 
 years Superintendent of the Perkins Institution for the Blind. 
 He was born in.Epirus, Greece, in 1837. At eighteen he entered the 
 University of Athens and devoted himself especially to the study 
 of philosophy and languages. Later he studied law, which he fol- 
 lowed for three years. He was shortly afterward drawn into the 
 political movement of the time having for its aim the freeing of 
 the Greek provinces from the domination of Turkey. His activi- 
 ties and vigorous articles against the political policy of the then 
 reigning King Otto caused his imprisonment. After the dethron- 
 ing of King Otto and the establishment of a liberal government 
 under King George, he resumed his journalistic pen. He took an 
 active part in the agitation in Greece during 1867, when the Cretans 
 rose against their Turkish oppressors, and assisted the struggle on 
 the part of the Greek people to unite in one nation all their com- 
 patriots, — an effort that excited the general sympathy of the world. 
 Dr. S. G. Howe, who had made several previous visits to Athens, 
 was at this time in Greece, bringing with him money and encourage- 
 ment from American sympathizers. There he met the young patriot 
 and between these men a warm friendship soon developed. 
 
 Urged by Howe, Anagnos accompanied the former to America. He 
 soon became deeply interested in the work for the blind and was 
 appointed secretary of the Perkins Institution for the Blind. Later, 
 he married the eldest daughter of Dr. Howe, Julia Romano, and in 
 1876, on Howe's death, he became in his turn Director of this, one 
 of the oldest and most important of the Institutions for the blind 
 in America. His wife was his never-failing inspiration and support:
 
 ANAGNOS, MICHAEL 
 
 337 
 
 Following the remarkable experimental work in the training of 
 the blind deaf as exemplified in the case of Laura Bridgeman, Anag- 
 nos received and trained in the Listitution at South Boston, four 
 
 r 
 
 / '•" r- I 
 
 i I f - ^ 
 
 
 Michael Anagnos. 
 
 children who could neither see, hear, nor sjjeak. Of these the most 
 remarkable was Helen Keller (q. v.). 
 
 Anagnos gave great attention to the building up of a library both 
 of the oldest and most important of the Institutions for the Blind 
 This has been continued and enlarged by his successor, E. E. Allen, 
 and it is now one of the most complete to be found anywhere in the 
 world. 
 
 Anagnos wrote a number of valuable papers on the Education of 
 the Blind.— (F. P. L.) 
 
 Vol. I— 2 2
 
 338 ANAGNOSTAKIS, ANDREAS 
 
 Anagnostakis, Andreas. This distinguished modern Greek oculist was 
 born in Crete in 1826 and died in Athens in 1897. He studied at 
 the Universities of Athens, Berlin, and Paris, receiving his degree 
 in 1849 at the last-named institution. Returning to Athens for the 
 practice of ophthalmology, he was appointed Director of the Oph- 
 thalmiatric Institute in 1854, and Professor of Ophthalmology at 
 the Athens University in 1856. In 1877 he became University Rector. 
 From 1854 until his death he was one of the collaborators of the 
 Annalcs (VOculistique, and, from 1850 to 1860, was one of the editors 
 of the Journal Medical d'AtJiencs. 
 
 His numerous writings, some published in modern Greek, are espe- 
 cially, though not alone, valuable for the history of ophthalmology. 
 Among the most important are : Remarques pratiques sur le Traite- 
 ment Chirurgical de I'Entropion et du Trichiasis (1857) ; De I'Oph- 
 thalmologie pm Grecc et en Egypte (Bruxelles, 1858) ; Melanges 
 Ophthalmologiqncs (Athenes, 1861) ; Contribntions a I'Histoire de la 
 Chirnrgie Ocnlaire chez Ics Anciens (1872) ; Encore deux Mots sur 
 VExtraciion de la Cataracte chez les Anciens (1878). 
 
 Many of his statements concerning the ophthalmolog}' of the 
 ancients, though long believed in absolutely, have been overthrown 
 by the later investigations of Hirschberg. — (T. H. S.) 
 
 Anagnostakis' operation for entropion. Anagnostakis {Annales 
 d'Oculistique 1857, XXXIII, p. 5) was probably the first to call at- 
 
 ■ tention to the principle contained in the Hotz operation, viz., at- 
 taching the cilia border to the upper margin of the tarsus by 
 means of a skin flap. 
 
 He made the incision nearer (about 3 mm.) the lid border, by 
 which the everting effect is considerably increased, and also ex- 
 cised the muscle fibers from the anterior surface of the tarsus. 
 With sutures he then united the lower skin flap to the upper border 
 of the tarsus.— (W. H. W.) 
 
 Analgesine. See Antipyrine. 
 
 Analyse. (G.) Analysis. 
 
 Analysiren. (G.) To analyze; analyzer, analyst. 
 
 Analysis, spectrum. Determination of the composition of a luminous 
 body by ol)servation of its afferent light-rays with the spectroscope. 
 See Spectrum analysis. 
 
 Analytik. (G.) Analytics. 
 
 Analytisch. (G.) Analytic. 
 
 Anamie. (G.) Anemia. 
 
 Anamie nach Blutverlusten. (G.) Anemia following a hemorrhage. 
 
 Anamie, Perniciose. (G.) Pernicious anemia.
 
 ANaMIE PERNIZIoSE 339 
 
 Anamie perniziose. (G.) reiJiicious aiicmia. 
 
 Anamie Retinitis. (Q.) Retinitis from anemia. 
 
 Anamie und Chlorose. (G.) Anemia and chlorosis. 
 
 Anamnese. (G.) The history of a ease. 
 
 Anamnesis. The clinical history of a ease as obtained from the patient 
 himself, from his relatives or from others. It is sometimes written 
 anamnesia. 
 
 Anamorphism. Same as anamorphosis (((. v.). 
 
 Anamorphoscope. An optical toy consisting of a vertical eylindric 
 mirror ^^■hich gives a correct image of a distorted picture drawn at 
 the base on a plane at right angles to the axis of the mirror. See 
 Anamorphosis. 
 
 Anamorphose, v. t. To represent by anamoi-phosis ; to distort into a 
 monstrous projection. 
 
 Anamorphosis, n. In perspective, a method of drawing which gives a 
 distorted image of the object represented Avhen it is viewed directly 
 or nearly so, but a natural image Avhen it is viewed from a certain 
 point, is reflected b.y a curved mirror, or is seen through a poh^- 
 hedron.— (C. F. P.) 
 
 Irregular or anomalous development. In a gradual change of 
 biologic form in successive members of a group. 
 
 Anamorphosy, n. Same as anamorphosis (q. v.). 
 
 Anamorphous, adj. Distorted ; out of shape. 
 
 Anamorphosis, Catoptric. The correction of a distorted image by 
 the employment of a cylindrical mirror. 
 
 Anaphoria. A form of heterophoria ((]. v.) in Avhich there is an up- 
 Avard tendency of the eyes and visual axes. 
 
 Anaphylaxis. (Gr., against protection). This term is used to denote 
 a condition of hypersensitiveness of an animal to certain substances. 
 Among the earlier observations on anaphylaxis were those of 
 Theobald Smith, who noted in testing antitoxin by injecting the 
 serum into guinea-pigs, that animals which had previouslj^ received 
 an injection, sutfered after the second injection from a rather 
 characteristic train of symptoms. Within a fcAV seconds or minutes 
 after the injection of the second dose, the animals begin to sneeze, 
 become restless and breathe more rapidly. Convulsions may occur 
 Avith the passage of urine and feces, and respiration ceases. Post 
 mortem, the lungs remain in permanent distension. The smaller 
 bronchi are contracted and many of the alveolar Avails are ruptured. 
 Multiple hemorrhages are found in the lungs and in other tissues 
 of the body. These symptoms of anaphylactic shock A'ary in dif- 
 ferent animals. The guinea-pig has l)een used in most of the expe-
 
 340 ANAPHYLAXIS 
 
 rimental work as it has been found more sensitive to anaphylactic 
 shock than are other laboratory animals. The amount of albumen 
 required to sensitize a guinea-pig may be extremely small, one 
 millionth of a gram of pure albumen being sufficient to sensitize a 
 guinea-pig so that death follows a second injection of a larger 
 amount. 
 
 A definite interval must elapse between the first and second injec- 
 tions. This interval is usually from seven to ten days. In a sensitized 
 animal, the rapidity with which the symptoms follow the second 
 injection and the severity of these symptoms varies with the mode 
 of injection. The intravenous injection is followed within a few 
 seconds by characteristic and severe symptoms. When the intra- 
 peritoneal or subcutaneous methods are employed, a somewhat 
 longer time elapses before the symptoms appear. 
 
 If the serum f^-om a sensitized animal is introduced into a normal 
 animal, the symptoms of anaphylaxis appear in the second animal 
 on the introduction of the substance used to sensitize the first 
 animal. 
 
 This condition is known as passive anaphylaxis. 
 
 The condition of anaphylaxis is specific, that is, an animal sen- 
 sitized to horse serum shows anaphylactic shock on a second injec- 
 tion of horse serum but not after an injection of bovine serum. 
 
 In addition to the serums and other substances derived from 
 animal sources, the proteins obtained from various plants and 
 bacterial products may be used to sensitize animals. 
 
 The phenomena of anaphylaxis are of great importance from a 
 medical point of view. In man, certain eases of severe reactions 
 following the injection of sera such as diphtheria antitoxin have 
 been noted. In some instances where these symptoms have fol- 
 lowed the first injection of serum, it has been assumed that the 
 individual had been sensitized through the ingestion of horse meat. 
 In other cases such an explanation has not been tenable and many 
 of the instances of anaphylaxis of this sort remain without adequate 
 explanation. In a number of individuals in whom severe reactions 
 have been noted, there has been a history of previous asthmatic 
 tendency. 
 
 The phenomena of "serum disease" which are frequently seen 
 after the injection of diphtheria antitoxin are regarded as a form 
 of anaphylaxis. The urticaria appears usually on the eighth to 
 the tenth day and it is believed that the reaction is due to the 
 presence of a portion of the serum which has remained unchanged 
 in the body and which produces the reaction as soon as sufficient
 
 ANASTOMOSES OF THE RETINAL VESSELS 841 
 
 time has elapsed for the formation of antibodies. In persons who 
 have received horse sernin in previous years, the giving of a second 
 dose may cause no immediate symptoms but the serum disease 
 appears at a considerably earlier date, perhaps the fourth or fifth 
 day or earlier. This an accelerated reaction is ascribed to the 
 increased facility with which the body forms antibodies to the 
 serum. The serum disease is not duv. to the antitoxic property of 
 the serum; it follows as well the injection of noriiuU horse serum. 
 In giving antitoxin, it is im))ortant to incpiire as to previous injec- 
 tions and whether the individual is subject to asthma. If such is 
 the case then a very small dose, a few drops, of serum should be 
 given first, and if no serious reaction occurs the full dose may be 
 given in a few hours. The fear of anaphylactic shock should not 
 be allowed to outweigh positive indications for antitoxin in a case 
 of diphtheria. 
 
 Many of the familiar reactions used in the diagnosis of disease 
 such as the tuberculin reaction, including the Calmette reaction in 
 the eye and the cutaneous reactions to various other bacterial prod- 
 ucts are clearly of anaphylactic nature. In the incubation period of 
 several of the exanthemata, such as measles, a marked similarity 
 to the phenomena of serum disease and anaphylactic shock in 
 animals may be traced. Hay fever has been regarded as an anaphy- 
 lactic reaction on the part of the sensitized individual to the pollens 
 of certain plants. Sympathetic ophthalmia and eclampsia have 
 also been explained on the basis of anaphylaxis. — (E. E. I.). See, 
 also, Allergy, under Avhich caption will be found additional infor- 
 mation on this subject. Also Ocular anaphylaxis. 
 Anastomoses of the retinal vessels. Cilio-retinal vessels. The re- 
 establishment of the retinal circulation by the communication some- 
 times existing between the ciliary and retinal circulation, or by the 
 development of anastomosing branches, after obstruction of the 
 central retinal artery is a not uncommon occurrence. A case in point 
 is reported by Gonin. Three months after the obstruction occurred, 
 there were found small vessels emerging near the margin of the disk 
 and forming a series of loops, or network about it, commencing 
 with the branches of the central retinal artery. These branches 
 were thread-like, or had quite disappeared from the disk; but be- 
 yond the junction of the anastomotic vessels they presented their 
 normal appearance and approached the normal size. 
 
 Gonin regards it as probable that these anastomotic vessels have 
 resulted from the development of fine communications, which usually
 
 342 ANATOM 
 
 exist in and about the head of the optic nerve before the central 
 artery has been obstructed. This seems to him more probable than 
 the supposition that these vessels were anomalous and peculiar to 
 this particular case ; or that they existed fully developed and ready 
 to take up the circulation as soon as the obstruction of the main 
 trunk occurred ; for in spite of the anastomotic vessels the eye 
 became and remained entirely blind. 
 
 Anatom. (G.) Anatomist. 
 
 Anatomiren. (G.) To dissect. 
 
 Anatomisch. (G.) Anatomical, anatomically. 
 
 Anatomy, Microscopical, of the eye. See Histology of the eye. 
 
 Anatomy of the eye, Comparative. See Comparative ophthalmology. 
 
 Anatomy (gross) of the human eye and of its appendages. In the 
 folloAving pages both the histology, or microscopical anatomy, of the 
 ocular apparatus and of its jihysiology will be incompletely consid- 
 
 Eyelids Naturally Open, Horizontal Plane Passes Through the Inner Canthus. 
 
 ered; a few details of the latter will be given. As is Avell knoAvn 
 there is no strict line of demarcation between the two subjects; 
 and the same may. in anotiier sense, be said of the microscopical 
 anatomy and the physiology (q. v.) of the same organs, though no 
 attempt is made in this section to cover the latter subject Avhich 
 M'ill, with the histologj' (q. v.) be elsewhere described. 
 
 The eyelids [palpehra superior; palpebra hiferior] which cover 
 and protect the eyeball, are formed from upper and lower folds of 
 embryonic skin. Their margins become joined at the third month 
 of fetal life by union of the conjunctival epithelium. Shortly before 
 birth rupture of this union occurs and the lids become separated 
 from each other. In many animals this separation does not take 
 place until several days after birth.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 343 
 
 The skin of the eyelids is of the thinnest found covering the human 
 body ; it becomes quite thick, however, as it nears the eyebrow — 
 a thickened, arched eminence of skin surmounting the upper margin 
 of the orbit, and covered by closely-placed, thick, short hairs grow- 
 ing mostly in a lateral direction. It is very loosely attached about 
 the margins of the orbit, but close to the free margin of the lid 
 the attachment is very firm. A'ery delicate, short hairs cover the 
 surface. 
 
 c.s 
 
 The Orbicularis Palpebraruiu aud its Attachments (Heule). 
 
 The upper lid extends as far as the e.yebrow. In this location are 
 attached the orbicularis palpebrarum, corrugator supercilii, and 
 occipito-frontalis muscles; the function of the latter muscle being 
 to raise the e.yebrow well on the forehead, of the former to depress 
 the eyebrow and protect the eye, to a certain extent, against the 
 entrance of light or harmful agents. 
 
 The loiver lid has no well-defined boundary, being directly con- 
 tinuous with the skin of the cheek. 
 
 On the upper lid a deep furrow in the skin, running from one 
 canthus to the other with its convexity upward, indicates the upper 
 border of the upper tarsus, and the chief insertion of the levator 
 palpebra' superioris; it is called the sulcus orhito-palpehraUs su-
 
 344 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 penor. As age advances the fold of tissue above often overlaps the 
 groove beneath it. This furrow forms a landmark for the surgeon 
 in operations on the lid. 
 
 A somewhat similar grooA^e— the sulcus infra-palpehralis — is seen 
 on the lower lid. Beginning a little to the nasal side of the inner 
 eanthus, it extends downward and laterally, and terminates about 
 the middle of the lid just above the infra-orbital margin. As age 
 advances it becomes deeper, and may be continued on up to the 
 outer eanthus. 
 
 In addition to the integument, the lids are made up of areolar, 
 muscular, glandular, and connective tissue (the tarsal plates), and 
 a lining mucous membrane — the conjunctiva. 
 
 X'-—e 
 
 Muscles of the Right Eyelids (from front), 
 a. Palpebral portion of the orbicularis muscle; b. Orbital portion of the orbicu- 
 laris muscle; c. Eyebrow; d. Corrugator muscle; e. Medial palpebral ligament; 
 f. Lachrymal portion of the orbicularis muscle. 
 
 The upper lid is the larger of the two, and is the more freely 
 moveable. 
 
 Between the lids is the lid-fissure, or palpebral opening, follow- 
 ing the curve of the lid-margins. It averages about 30 mm. in length, 
 is more curved above than below, and exposes nearly the entire 
 cornea and a portion of the sclera equal to one-fifth of the globar 
 surface. It is longer in childhood than in adult life, and shortest 
 in old age. The palpebral fissure terminates in an inner and an 
 outer eanthus, or angle. The latter is the lower of the two, and has 
 a sharper angle. If the lids are put on the stretch, there will be 
 seen at the outer eanthus a delicate fold of skin called the outer 
 commisure, which connects the upper with the lower lid.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 B45 
 
 The iiDier eaiithus presents an outline somewhat similar to a 
 horseshoe, at the i'ree ends oi' which are situated the puneta laehry- 
 malia; these are directed a little backward, and are closely applied 
 to the eyeball. Here, also, is found a small, pink body — the lachry- 
 mal caruncle — which is set down in the concavity of the "horse- 
 shoe" against the eyeball; it is composed of skin and conjunctiva. 
 
 The width of the lid-fissure varies greatly in different individuals. 
 Usually, when looking directly forw'ard, the upper portion of the 
 cornea is covered for about 1.5 mm. by the upper lid, while the lower 
 portion remains exposed. The narrow, free margins of the lids 
 are closely in apposition when the lids are closed. An oily secretion 
 from the Meibomian glands prevents an overflow of tears, except 
 when they are formed greatly in excess of the normal. 
 
 Muscles of Eight Eyelids (from behind). 
 
 a. Corrugator muscle; b. Upper border of superior tarsus (dotted line) ; c. Lat- 
 eral palpebral raphe; d. Lower border of inferior tarsus (dotted line) ; e. Cavity 
 of nose; f. Ethmoidal cells; g. Lachrymal portion of the orbicularis muscle; 
 h. Frontal sinus. 
 
 The cilia, or eyelashes, which project in two or three rows from 
 the margin of the upper lid, curving slightly upward, are larger, 
 longer, and more numerous than those of the low'er lid, Avhich arise 
 from its anterior margin and grow downw^ard and forw\ird. In 
 both lids they are longest in the middle ; tow^ard the nasal side they 
 reach only to the recess in which the caruncle is placed. 
 
 The chief muscle of the lids is the orhicularis palpehrarum, a pow- 
 erful voluntary sphincter, consisting of an orbital, a palpebral, and 
 a lachrymal portion. It is a thin, flat muscle which lies immediately 
 under the skin, spreading out and mingling its fibres with the
 
 346 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 muscles of the brow (eorrugator siipercilii), forehead, and cheek; 
 its fibres are also attached to the tarsus and to the lachrymal ap- 
 paratus. It has its origin at the inner canthus from a short, firm, 
 fibrous band, which is attached to the nasal process of the superior 
 maxilla — the ligamentum palpebrie mediate ; at the extreme inner 
 angle of the inner canthus this ligament becomes divided into two 
 parts, one being attached to the upper and one to the lower tarsal 
 plate. At the outer canthus is the raj^he palpehralis lateralis, which 
 connects the ends of the tarsal plates to the orbital margin. A small 
 slip of the orbicularis is distributed to the upper lid margin between 
 the eyelashes and the conjunctiva, where it receives the name 
 "muscle of Riolan. " By the action, consequently, of different parts 
 of the orbicular muscle and its direct connections, the lids may be 
 partly and gently closed (^vithout wrinkling the skin) ; or they may 
 be tightly squeezed together, with wrinkling of the surrounding skin, 
 or accompanied by contortions of the face and forehead. 
 
 The levator palpebrje superioris acts in opposition to the orbicu- 
 laris, and elevates the upper lid. (This muscle will be considered in 
 detail under a subsequent heading.) The under lid sinks slightly 
 by virtue of its own weight. 
 
 The lids are well supplied Avith blood — most richly at the free 
 lid-margin. The chief source of supply is from the superior and 
 inferior palpebral branches of the ophthalmic artery on the nasal 
 side, and from the lateral palpebral branches of the lachrj^mal 
 branch of the ophthalmic on the temporal side ; together, these ves- 
 sels anastomose and form the arciis tarsciis superior and arciis tarseus 
 inferior. In addition, the lids are supplied by branches of the orbital 
 and transverse facial branches of the temporal, the anterior temporal 
 branch of the temporal, and by the angular branch of the facial. All 
 of these vessels anastomose freely on the surface of the lids. 
 
 The veins are more numerous and larger than the arteries, and 
 are tributary, in part, to the veins of the face, in part to the vena 
 ophthalmica. They form a thick plexus underneath the conjunc- 
 tiva of the superior and inferior fornices. In their course to the 
 orbit they pass through the fibres of the orbicularis. 
 
 The lids are rich in lymphatics, which are connected with the 
 vessels covering the face, with the parotid system, and perhaps with 
 the submaxillary glands. Some infections of the conjunctiva are, 
 for this reason, accompanied by soreness and swelling of the pre- 
 auricular gland. 
 
 The sensor}^ supply to the upper lid tissues is from the first divi- 
 sion of the fifth nerve, through the supra-orbital and supra-troch-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 347 
 
 lear branches of the nasal; and through the hiehrymal, the latter 
 at the outer angle. The lowei' lid is supplied l)y the infra-orbital. 
 The facial is the motor nerve of the orbicularis; while the oculo- 
 niotorius controls the levator palpebra- siipcrioris. Fibres of the 
 fifth supply the nuiseles of ^Mueller, which will be considered later on. 
 Close to the palpebral border the nerves form a rich marginal 
 plexus. 
 
 f.conj.i 
 
 Lid Plates of the Kiglit Eye Dissected out. Viewed from in Front. 
 
 (After Spalteholz.) 
 
 The insertion of the ni. levator palpebnv superior has l)een removed, and 
 the conjunctival sac has been opened from in front, aljove and below the lid 
 plates. 
 
 s. with t.c.b., sclera with tunica coniunctivte; g.l.i.. glandula lachrynialis in- 
 ferior; r.p.l., raphe palpebraiis lateralis; t.s., taisus superior; t.i., tarsus inferior; 
 f.conj.s., fornix conjunctiva? superior; l.p.s.in., levator palpebral sujierior; t.m.o.s., 
 tendo ni. obliqui superior; l.]).ni., lif^ament, palpebra' median.; s.l., sai-cus laehry- 
 malis; m.o.i., m. obliqus inferior.; f.conj.i., fornix conjuuctiviu inferior.
 
 348 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 In addition to the hair and sebaceous follicles found in dermal 
 tissue everywhere, there are to be seen at the lid-margins the so- 
 called glands of Moll, which are modified sweat-glands. 
 
 Underneath the conjunctiva, and imbedded in perpendicular 
 grooves in the substance of the tarsus, are the acinous Meibomian 
 glands, w^hich are identical in structure with the sebaceous glands. 
 Of these glands there are, in the upper lid, some thirty or f orty^ 
 placed parallel to one another; in the lower lid there are about 
 twenty-five. The longest glands are in the center of the upper 
 lid; they become gradually shorter as they approach the ends of 
 the tarsus. These tubules open on the intermarginal space, and 
 secrete the fatty substance that lubricates the lid-margins. They are 
 well developed in infants, hence the large amount of yellow secre- 
 tion in their eyes. By everting the lids, particularly the lower, they 
 
 The Lachrymal Gland and its Eelations. 
 a, superior portion of gland; b, inferior portion; d, lachrymal ducts; e, upper 
 eyelid, skin partially removed; p, p, puncta; c, c, eanaliculi; s, lachrymal sac; 
 n, nasal duct. 
 
 can be seen through the conjunctiva as faint parallel streaks be- 
 ginning at the lid-margin and running at right angles to it. 
 
 The tarsus, or tarsal cartilage (improperly so-called, since it ex- 
 hibits no cartilage cells), is a thin, fibrous, connective-tissue plate; 
 of these there are two : that in the upper lid is quite large, while that 
 in the lower lid is considerably smaller. Two margins of the tarsal 
 cartilage are designated, viz. : an upper, or convex, margin, and a 
 lower, or free, margin ; there are also two surfaces, an anterior and 
 a posterior. These plates are highest at the center and taper off to- 
 ward the ends. The tarsus gives form to the upper lid; and, when 
 both lids are closed, forms a shield for the eyeball. They are attached 
 to the frontal process of the superior maxilla by the tendo oculi, or 
 ligamentum palpebral mediale, and are united to the margins of the 
 orbit by the tarso-orbital fascia. The levator palpebrae superioris is 
 attached to this fascia and to the upper edge of the tarsal plate.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 349 
 
 Opening on the conjunctival surface are the glands of Waldeyer, 
 acino-tubular structures, secreting a modified mucus. A constant 
 mucous secretion from the various conjunctival and other glands, 
 moistens and lubricates the anterior ocuhir structures. The cornea, 
 particularly, is kei:)t clean and Ijright from this source, aided by the 
 
 Lymphatics of the Head aud Eye. 
 
 approximation of the lid-edges in winking. This closing of the lids 
 acts like a ' ' window-scraper ; " it gently removes all deleterious mat- 
 ter from the front of the eyeball, and pushes it toward the lachrymal 
 puncta, through which it is drawn, by the action of that curious suc- 
 tion apparatus formed by Horner's muscle, into the lachrymal sac, 
 and thence into the nose. The detritus entering the puncta is partly 
 pressed and partly floated along tlie canaliculi until it reaches the 
 lachrymal sac.
 
 350 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 The lachrymal apparatus may be divided into a secretory and an 
 excretory portion. The former includes not only the lachrymal 
 glands, but the mucous glands of the conjunctiva. As a matter of 
 fact, the moisture that commonly cleanses the ocular and conjuncti- 
 val surfaces is contributed by the mucous follicles of the conjunctiva, 
 while more copious supplies of tears are furnished by the lachrymal 
 gland. The latter is of the salivary variety, of a reddish-gray color, 
 and consists of an upper and lower lobe, incompletely separated 
 from each other by the anterior tendinous expansion of the levator 
 palpebrcB superioris. The upper lobe is larger, and more compact 
 than the lower; it is oval in shape, and measures about 20 to 25 mm. 
 
 Lachrymal Apparatus. 
 
 in length, and 12 to 14 mm. in thickness. The gland is situated in a 
 depression beneath the external angular process of the frontal bone ; 
 its upper surface, which is convex, lies close to the periosteum of 
 the orbit, to which it is attached by loose connective tissue ; the under 
 surface rests upon the eyeball at the superior fornix toward the 
 external canthus. This gland secrets a slightly alkaline fluid con- 
 taining much sodic chloride, which is "sprayed" onto the globe 
 through a fan-shaped array of from seven to twelve ducts opening 
 at the outer aspect of the superior fornix. 
 
 The blood supply of the lachrymal gland is from the lachrymal 
 branch of the ophthalmic artery. 
 
 The sensory nerve supply to the lachrymal apparatus is from the 
 lachrymal branch of the ophthalmic or first division of the fifth; 
 the secretory function of the gland is regulated by the sympathetic. 
 
 The excretory portion of the lachrymal apparatus consists in the
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 351 
 
 canaliculi, the lachrymal sac, and the nasal dnet which is continuous 
 with the sac. 
 
 The canaUculi have their origin in minute whitish elevations — the 
 puncta lachrymalia — which, as before mentioned, are situated on the 
 lid-margins about 6 mm. from the angle of the inner canthus, or at 
 the inner termination of the tarsal cartilages. The first millimeter 
 of their course is in a vertical direction — upward in the upper lid, 
 and downward in the lower lid ; after this they turn at an acute angle 
 and run 5 or 6 mm. in the direction of the nose. They either meet 
 
 
 '- •';■■• 
 
 ^^:^ W^0£' 
 
 The Lachrymal Apparatus Showing the Nasal Eelations. (After Quain.) a. 
 The Upper and Lower Canalieiili; c, Xaso-Laehrymal DiK-t ; b, e, f, Tiirbinal 
 Bones; g, Antrum of Highniore. 
 
 and form a common canal, or empty separately into the lachrymal 
 sac ; generally the former. They are lined by pavement epithelium. 
 
 The lachrymal sac is 12 mm. long and 6 mm. wide ; it opens directly 
 into the nasal duct. Its upper extremity, which has no outlet, lies 
 behind and a little above the ligamentum palpebr^e mediale, the en- 
 tire sac completely filling a groove in the lachrymal bone in which 
 it rests. The epithelium of its lining mucous membrane is of the 
 cylindroid variety, and is continuous with that lining the nasal duct. 
 
 The nasal duct is directly continuous with the lachrymal sac. It 
 is about 21 mm. long, and 4 to 6 mm. wide, but by no means uniform 
 in its diameter. There is a slight constriction Avhere it joins the sac, 
 and a somewhat expanded orifice where it enters the nose ; its nar- 
 rowest portion being about the middle. Regurgitation from the nasal
 
 352 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 cavity is prevented by a fold of raucous membrane — the plica lachry- 
 malis, or valve of Hasner — situated at the opening of the duct into 
 the inferior meatus just underneath the attachment of the anterior 
 third of the inferior turbinate bone ; also by irregular folds of mucous 
 membrane forming imperfect valves along the course of the tube. 
 
 
 m n 
 
 r s 
 
 p^ 
 
 Orifices of Nasal Duct and Accessory Air Chambers of Nose. 
 
 a, Frontal sinus; b, Twine in infuudibulum; c, Middle turbinal (cut) ; d, Orifices 
 of anterior ethmoidal cells; e, Bulla ethmoidalis; f, Orifices of posterior ethmoidal 
 cells in superior meatus; g, Superior turbinal (cut); h, Twine in orifice of sphe- 
 noidal cell; i, Sphenoidal cell; j, Diaphragmia sella?; k, Cavum sellae; 1, Hiatus 
 semilunaris; m, Twine in nasal duct; n, Additional orifice of antrum of High- 
 more; p, Middle turbinal (cut); q, Middle meatus; r, Inferior turbinal; s, 
 Inferior meatus; t, Orifice of Eustachian tube. 
 
 The epithelium is ciliated. The direction of the nasal duct is down- 
 ward, outward, and backward ; it is enclosed in a canal formed by the 
 lachrymal, superior maxillary, and inferior turbinate bones. 
 
 The mucous membrane lining the sac and the nasal duct is attached 
 to the surrounding periosteum by loose areolar tissue which supports 
 a rich venous plexus. 
 
 As a congenital anomaly (q. v.) the puncta lachryraalia or the 
 canaliculi may be double, or may be absent altogether.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 353 
 
 The tears are drawn into the sac by suction, the motor power be- 
 ing supplied by the tensor tarsi, or Horner's muscle. This is a small, 
 thin muscle about 6 lines in length, and 3 lines in width; it lies be- 
 hind the ligamentum palpcbr;e mediale near the inner canthus. 
 
 Muscle of Homer, a, a.i (After Poirier and Charpy.) 
 
 Spiral fibres of this muscle surround the canaliculi ; they compress 
 the tubules many times during the act of winking, thus sucking the 
 secretion through the puncta, which are closely applied to the sur- 
 face of the eyeball. In this Avay, corneal and conjunctival debris — 
 epithelium, microbes, mucus, tears, dust, etc., — is scraped oft' the 
 whole globar surface and pushed toward the lachrymal outlet, the 
 cleansing action of Horner's muscle being kept up as long as neces- 
 sary. Tears and other fluids may to some extent collect in the lach- 
 
 Vol. 1—2 3
 
 354 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 rymal sac before they percolate through the nasal duct into the 
 inferior meatus. 
 
 The conjunctiva, a most important mucous membrane, joins, as 
 
 L f,_. ■? I 
 
 Eight Eye (lids forcibly spread at inner canthus). 
 
 C, Cornea; s, Sclera with tunica conjunctiva bulbi ; s. f. of c, Semi-lunar fold of 
 conjunctiva; L. p.-P. 1., Lachrymal papilla with punctum lacrimale; L, Lacus lac- 
 rimalis; Car., Caruncula lacrimalis; A. o. ni., Angulus oculi medialis; P. 1. p., 
 Posterior limbus palpebralis; A. 1. p., Anterior limbns palpebralis; M. g., Mei- 
 bomian glands; I. f. c, Inferior fornix of conjunctiva. 
 
 Vascular Network of Superficial (visible) Conjunctival Branches of the Epis- 
 cleral vessels; also of the deep anterior ciliary vessels in^^isible to the naked eye 
 in normal states. (Leber.) 
 
 its name implies, as well as covers most of the parts in the front of 
 the ej^e. It is a loose, lymphoid structure, continuous with the 
 epidermis at the margin of the lid, and lining the inner surface of 
 the lid, in which location it is known as the palpebral conjunctiva.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 355 
 
 Upon leaving the lids it forms the superior and inferior palpebral 
 folds, and is then reflected onto the eyeball, when- it bears the name 
 of ocular conjunctiva. This phice of i-efleetion is known as the fornix 
 conjunctiva^ or suhnis, ol' which there are two, namely, a superior 
 and an inferior. Tpon the abundance and looseness of the mem- 
 brane in this position, (h^pends the free movement of the eyeball. 
 When the e3^elids are closed the free margins of this membrane come 
 together and form the conjunctival sac. 
 
 u.t. 
 
 Contents of Eight Orbit (from above). 
 
 U. t., Upper tarsus; L. g., Lachrymal gland; L. p. s., Levator palpebrte su- 
 perioris; E. s., Eeetns superior; P. t., Periorbital tissue; I. c. a., Internal carotid 
 artery; O. n., Optic uerve; P. c. a., Processus clinoideus anterior; F. o., Foramen 
 opticum; A. of Z., Annulus of Ziun ; A. t.. Adipose tissue; L. c, Lamina eribrosa; 
 S. 0., Superior oblique; T. s. o., Trochlea superior oblique; F. s., Frontal sinus. 
 
 The palpebral coiijuiiclifn })i'esents a smooth surface, and is inti- 
 mately and immovably connected with the underlying tarsus. On 
 the uppei- lid it receives its blood supply from two arterial loops, the 
 arcus tarseus superior and the areas tarsnis inferior. The latter lies 
 on the anterior surface of the superior tarsus, and sends branches 
 through its entire thickness to the palpebral conjunctiva. The line 
 where the vessels emerge from the tarsus is called the sulcus suhtar- 
 salis, and is recognized as a shallow groove on the surface of the 
 conjunctiva about 2 to 3 mm. from the free lid-margin. The arcus 
 tarseus superior lies somewhat above the convex margin of the supe-
 
 356 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 rior tarsus upon the fascia tarso-orbitalis, through which structui'e 
 branches pass to the conjunctiva. The under lid has but one arterial 
 loop. 
 
 The ocular conjunctiva is paler and less vascular than that of the 
 palpebral. It covers the entire surface of the globe, including the 
 cornea, and may be divided into two sections, viz. : the conjunctivse 
 sclera and the conjunctiva cornese. The conjunctiva of the cornea 
 
 d c j 
 
 Coronal Section through Eight Eye and Orbit. 
 
 a. Levator palpebrse. 
 
 b. Superior rectus. 
 
 c. Inferior rectus. 
 
 d. Internal rectus. 
 
 e. External rectus. 
 
 f. Inferior oblique. 
 
 g. Superior oblique. 
 
 h. Supra-orbital nerve, 
 i. Supra-trochlear nerve, 
 j. Infra-trochlear nerve, 
 k. Lachrymal gland. 
 1. Temporal muscle. 
 m. Lachrymal nerve. 
 
 is extremely transparent, and so intimately a part of the cornea that 
 it' may properly be regarded as its outer layer. The conjunctiva 
 covering the sclera is very thin, and so loosely attached to this struc- 
 ture by connective tissue fibres (the episcleral tissue) as to permit 
 of free and independent movement of the eyeball. 
 
 The conjunctiva covering the sclera is always stretched during 
 wide excursions of the eyeball. Near the sclero-corneal margin, or
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 357 
 
 limbus, the attachment is very secure ; this point is taken advantage 
 of by surgeons who seize the membrane here with catch forceps for 
 the purpose of steadying the globe during operative procedures. 
 
 In adults, there may be seen at each side of the corneal margin in 
 the line of the lid-fissure, a sftiall, yellowish elevation of triangular 
 form, with the base toward the cornea; this is called the Pinguecula, 
 and is present as a result of a fatty tissue-change in the conjunctiva 
 
 External Muscles of the Eje. 
 
 where it is exposed to the infiuence of the air, namely, in the zone of 
 the lid-fissure. 
 
 The whole membrane is covered with pavement epithelium, which 
 is continued over the cornea ; it also lines the canaliculi as far as the 
 lachrymal sac. 
 
 At the inner canthus between the caruncle and the eyeball, is a 
 delicate fold, or reduplication, of the conjunctiva, called the plica 
 semilunaris conjunctiva'; it is analagous to the nictitating membrane 
 (q. v.) found in birds. 
 
 The blood supply of the ocular conjunctiva is derived chiefly from 
 the posterior conjunctival branches of the vascular arches of the lids, 
 by Avay of the f ornices ; also from the anterior ciliary vessels, wdiich 
 come out of the four straight eye-muscles. These latter course under- 
 neath the conjunctiva up to near the limbus, where they suddenly 
 disappear and pass through the sclera into the interior of the eyeball ; 
 before doing this, however, they give off anterior conjunctival 
 branches which anastomose with the posterior conjunctival vessels 
 to form a network of vascular loops close up to the margin of the
 
 358 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 cornea. From this network the cornea derives the major portion 
 of its nourishment. Other branches of the anterio*' ciliary vessels 
 run backward to anastomose with those of the forniees. 
 
 Muscles of Orbit as Viewed from Above and Behind. 
 
 a. Internal rectus muscle. 
 
 b. External rectus muscle. 
 
 c. Superior rectus muscle. 
 
 d. Elevator of the upper lid (severed). 
 
 e. Superior oblique muscle. 
 
 f. Pulley of superior oblique. 
 
 g. Superior oblique tendon. 
 
 h. Inferior oblique muscle (insertion). 
 
 1. Optic nerve. 
 
 j. Laehrvmal gland. 
 
 k. Orbital fat. 
 
 i. Eyeball. 
 
 The vessels run loosely in the conjunctival tissue, so that it is 
 always possible to differentiate them from the deeper vessels by
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 359 
 
 virtue of the fact tliat thej' can easily be moved to and fro with the 
 membrane itself. 
 
 The veins of the conjunctiva, both palpebral and ocular, pursue 
 very nearly the same course as the accom[)anying arteries, and are 
 tributary to the ophthalmic vein. 
 
 Branches of the ophthalmic division of the fifth cerebral nerve 
 furnish the sensory supply to the conjunctiva, these nerve-endings 
 terminating- in rich plexuses. 
 
 The extra-ocular, or orbital muscles (({. v.)— also called the ex- 
 trinsic, or external eye-muscles — are seven in number, as follows: 
 
 Diagram Showing Relative Attachment of the Extrinsic Muscles to the Eyeball. 
 
 levator palpebra? superioris, rectus sui)erioris, rectus internus, rec- 
 tus externus, rectus inferioris, superior oblique, inferior oblique. 
 
 With one exception all of these muscles arise from, or near, a 
 funnel-shaped, tendinous ring (annulus tendineus communis), which 
 surrounds the sphenoidal fissure and the optic foramen. The excep- 
 tion is the inferior oblique, which has its origin from the orbital 
 plate of the superior maxilla. The inferior rectus is attached to the 
 lower part of this ring; the external rectus, strengthened by an addi- 
 tional head, is attached to the outer side ; while from the inner side, 
 and above, arise the internal and supenor recti, the superior ohlique, 
 and the levator palpchree superions. The levator, superior rectus and 
 superior oblique are attached close together, as shown in the diagram.
 
 360 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 The levator palpehrce superioris is a long, thin, flat, triangular mus- 
 cle, which lies, for the most part, immediately underneath the upper 
 wall of the orbit, above the superior rectus, and so close as to make 
 them appear almost as one muscle. The superior rectus separates 
 from the levator at the equator of the eyeball into which it becomes 
 inserted, while the levator continues on forward, bends down in the 
 form of a bow, expands and divides into two layers; the stronger, or 
 
 Elev. 
 
 LR. 
 
 5.0 
 
 Int.R. 
 
 S.R. ' 
 
 Eelations of the l^xtrinsic Ocular Muscles to the Connective Tissue Structures of 
 the Orbit as Viewed from Above and Behind (after Motais). Note the lateral 
 expansion of the tendons and the delicate membranous connections of the mus- 
 cle sheaths. Elev. Elevator of upper lid. E. E. External rectus. S. E. Superior 
 rectus. Inf. E. Inferior rectus. Int. E. Internal rectus. S. O, Superior oblique. 
 
 posterior layer is attached to the anterior surface of the superior 
 tarsus at its upper margin ; the anterior layer passes in front of the 
 tarsus to the posterior surface of the orbicularis, through which a 
 few bundles are sent to the skin of the lids ; it is also attached later- 
 ally to the walls of the orbit. This expansion of the levator is inti- 
 mately attached to, and forms a part of, the tarso-orbital fascia. The 
 action of the levator is to elevate the upper lid.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 361 
 
 Lying on the under surface of the expansion of the levator, and 
 attached to the upper margin of the tarsus, is a group of involuntary- 
 fibres under the control of the sympathetic, to which is applied the 
 name rausculus tarsalis superioris, or muscle of Mueller. The func- 
 tion of this muscle is to keep the lid skin and the palpebral conjunc- 
 tiva smooth when the upper lid is raised. An analagous bundle, 
 called the musculus tarsalis inferioris, is to be found in the lower lid 
 on the under surface of the inferior rectus muscle, and likewise 
 attached to the tarsus. 
 
 The four straight muscles are long and flat, narrow at their origin, 
 and growing broader toward their insertion into the sclera. They 
 diverge as they pass forward, forming an irregular, cone-shaped space 
 the base of which is formed by the eyeball ; the apex is at the optic 
 foramen, and in it lie the optic nerve and the ophthalmic vessels 
 These muscles are attached to the eyeball in front of the equator. 
 Their attachment, as is the case with all of the extrinsic muscles, is 
 by thin, broad, tendinous expansions, which enter into and form a 
 part of the scleral tissue. They differ from one another in shape and 
 size. The superior rectus is the longest and thinnest; the internal 
 rectus somewhat shorter; the external rectus still shorter; the in- 
 ferior rectus the shortest of the four. 
 
 The superior rectus arises from the tendinous ring at the optic 
 foramen. On its way to its attachment to the sclera it passes for- 
 ward, and also somewhat outward. Its direction does not, therefore, 
 correspond exactly with, the saggital axis of the eyeball, but forms 
 with it an angle of about 25 degrees opening backward and toward 
 the nasal side. It is attached to the sclera 7.7 mm. from the corneal 
 margin, the width of the tendon at its line of insertion being 10.8 mm. 
 From its origin to its attachment to the eyeball, it lies immediately 
 under the levator palpebrsB superioris. This muscle draws the an- 
 terior pole of the eye upward and toward the median line; it also 
 inclines the upper pole toward the median line. As will be seen in 
 the illustration the tendon of the superior rectus, and of some of the 
 other muscles as well, is not attached parallel to the corneal margin. 
 Most of the attachment of the superior rectus is to the outer half of 
 the globe with its inner edge in advance of the outer. 
 
 The internal rectus is the heaviest (0.747 grammes), and strongest 
 of the extra-ocular muscles, and has the longest tendon. The width 
 of the tendon at its line of insertion is 10.3 mm. As its attachment 
 is nearest the corneal limbus (5.5 mm.), it has a greater "pull" upon 
 the eyeball, and greater power of rotation. This is as it should be, 
 since the inner rotation of the globe is the most important and the
 
 362 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 most frequent one, and calls for the greatest expenditure of muscular 
 energy, the larger portion of which is supplied by this the chief of 
 the adductor muscles. The other adductors are the nasal fibres of 
 the superior and inferior rectus, and, perhaps, the superior oblique. 
 The external reetus is the other extreme, it being the weakest of 
 the straight muscles, although one of the most important of the or- 
 bital muscles. It has an average weight of 0.514 grammes. The 
 tendon is 5.8 mm. long, and at its line of insertion has a width of 
 9.2 mm. It arises by two distinct heads from the margin of the optic 
 foramen, and passes forward and outward to be inserted into the 
 
 Tensor Tarsi and Corrugator Supercilii Muscles. 
 
 a, Superior rectus muscle; b. Inferior reetus muscle; e, Tendon of superior 
 oblique muscle; d, Pulley; e, Inferior oblique muscle; f. Orbital fat; g, Cor- 
 rugator supercilii muscle; h, Puncta lachrymalia; i, Meibomian glands; j, Con- 
 junctiva; k, Tensor tarsi muscle. 
 
 sclera 6.9 mm. from the margin of the cornea. It is the principal 
 abductor muscle, its action being to turn the anterior pole laterally. 
 The other abductors are the temporal fibres of the superior and in- 
 ferior rectus, and, perhaps, the inferior oblique. 
 
 The inferior rectus arises from the common tendon at the optic 
 foramen, and passes forward and dowmvard in such a manner as to 
 form an angle of about 25 degrees with the direct visual line. It is 
 attached to the sclera 6.6 mm. from the margin of the cornea by a 
 tendon 9.8 mm. broad at its line of insertion. Forward in the orbit 
 it is separated from the lower orbital wall by the inferior oblique 
 muscle. Its action is to turn the anterior pole downward and toward 
 the median line, and to incline the upper pole laterally.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 363 
 
 Processes from the orbital fascia, called cJicck-liganients, are in- 
 serted into the sclera near the tendons of the straiglit muscles — espe- 
 cially near the insertion of the rectus internus and externus. They 
 serve the useful purpose of preventing the overaction of the orbital 
 muscles; they also prevent the eyeball from protruding from the orbit 
 following tenotomy of the recti. 
 
 The inferior ohlique is the shortest of all the extra-oCular muscles. 
 It arises from the orbital plate of the superior maxilla, close to the 
 beginning of the naso-laehrymal duct, and passes laterally, upward, 
 and backward, crossing underneath the tendon of the inferior rectus. 
 It is inserted into the sclera back of the equator mostly below the 
 horizontal meridian. It forms an angle of about 50 degrees with the 
 straight visual line. The tendon, Avhich is the shortest of all the 
 eye muscle tendons, is about 10 mm. wide at its line of attachment. 
 By the action of this muscle, the anterior pole is turned ui)ward and 
 outward, and the upper pole is inclined outward. 
 
 The superior ohlique, which is the longest and thinnest of the eye- 
 muscles, arises from the common tendon at the orbital apex, and 
 passes forward close to the wall of the orbit along its upper and 
 inner aspect. The belly of the muscle is round. At the internal 
 angular process it loses most of its muscular fibres and becomes ten- 
 dinous; while still retaining its rotundity, it passes through a pulley, 
 and, taking an angle of about 50 degrees to its former direction, turns 
 backward, outward, and downward to its insertion into the sclera 
 back of the equator, on the upper half of the eyeball. At its point of 
 attachment the tendon is about 10 mm. broad. Before becoming at- 
 tached to the sclera it passes underneath the superior rectus. Its 
 action is to turn the anterior pole outward, and laterally, and to in- 
 cline the upper pole toward the median line. This muscle is often 
 called the trochlearis, from the trochlea, that remarkable, curved 
 pulley of hyaline cartilage, through which its reflected tendon passes. 
 
 The fourth cerebral nerve (trocJileans) supplies the superior 
 oblique; the sixth cerebral nerve (ahducens) the external rectus; the 
 other. ocular muscles, including the levator palpebral superioris, the 
 sphincter pupilhr, and the ciliary muscle, are innervated by the 
 oculomotorius, or third cerebral nerve.* 
 
 The center about ivhich the eijehaJl rofale.^ is situated in the line of 
 its visual axis, about 14 ram. behind the cornea. Six muscles turn (not 
 
 *A useful mnemonic that will assist in rememberinfj these innoivations is tlie 
 radical SO^, meaning the superior oblique is innervated by the fourth nerve. Then 
 all one has really to recollect is that the 6th nerve supplies the e.xternal rectus, 
 and the 3rd nerve the remainder of the orbital muscles.
 
 364 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 draw) it in every possible direction, as well as give it a sort of wheel 
 motion on its axis. If ix were possible for these muscles to operate 
 separately we might regard the external rectus as rotating the globe 
 directly outwards, the internal rectus as turning it directly inwards, 
 the superior rectus as rotating it directly upwards, the inferior rectus 
 as turning it directly downwards, while more complicated movements 
 in various directions would be effected by the combined action of 
 these muscles with the superior and inferior oblique. As a matter of 
 fact, no movement of either eyeball— to say nothing of their com- 
 bined movements — is effected by less than two or three muscles; 
 probably every rotation is attended by the contraction or relaxation 
 of all of them. 
 
 When the eyelids are closed in sleep, or during narcosis, the globe 
 rotates upward and slightly inward. 
 
 The eyeball at bii-th is small and nearly round, although it varies 
 considerably in size as well as in form. The average antero-posterior 
 diameter is 17.3 mm. The period of most rapid growth, involving 
 chiefly the anterior segment, is during the first years of life ; this is 
 followed by a period of slower growth, although the eyeball steadily 
 increases in size up to the age of puberty. From the 14th to the 20th 
 year there is still another period of rapid growth, which involves the 
 posterior segment. The cornea reaches its maximum measurement 
 at the third year, although even during the first year of life the aver- 
 age diameter is not much less than that in the adult eye. 
 
 The apparent size of the eyeball depends more upon the width of 
 the space between the lids than upon the length of its diameters. 
 The prominence of the globe varies with the amount of orbital fat, 
 but may be affected by disease. 
 
 The adult eyeball is a more or less spheroidal body, measuring 
 about one inch (24 mm.) in its antero-posterior, or long diameter. 
 In women all of its dimensions are about 0.5 mm. smaller than in men. 
 The posterior one-half of the eyeball is, in general, of more uniform 
 curvature than the anterior *one-half. Three coats, or tunics, are 
 designated, viz. : an external, a middle, and an internal coat. 
 
 The external tunic, or tunica fibrosa, is composed mainly of dense, 
 unyielding connective-tissue. It gives shape to the globe, protects 
 the delicate inner structures, and resists intra-ocular pressure. About 
 one-sixth of this coat is transparent, and is called the cornea; the 
 remaining five-sixths, opaque and dull-white, are known as the sclera, 
 or "white of the eye." With the exception of a round hole, the 
 foramen opticum sclera, near the posterior pole of the eyeball, incom- 
 pletely closed by a sieve-like, perforated plate (the lamina cribrosa),
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 365 
 
 this capsule is closed on all sides — disregarding, of course, the minute 
 perforations for the transmission of vessels and nerves to the middle 
 
 -^1 
 
 'SectioD of the Eyeball to Show the Crystalline Lous System and Its Bulbar 
 
 Eelations. (After Quain). 
 
 a. Cornea. 
 
 b. Iris. 
 
 e. Lens. 
 
 <i. Zonula of Zinn. 
 
 f. Ciliary body. 
 
 g. Canal of Schlenim. 
 h. Eetina. 
 
 j. Choroid. 
 
 k. Sclera. 
 
 H, C. Hyaloid canal. 
 
 1. Macula. 
 
 o. Optic nerve. 
 
 w. Anterior capsule. 
 
 coat. Some authors, notably Thomson, of Oxford, refer to the cornea 
 as an entirely separate structure imbedded in an anterior aperture 
 of the sclera (foramen sclerie anterius).
 
 366 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 The middle coat of the eyeball, or the tunica vasculosa, carries the 
 vascular, nervous, and nutritive supply to the bulbar contents; it 
 contains the muscle of accommodation, and is well furnished with 
 pigment that lines the dark chamber of the globe and prevents reflec- 
 tions within it. In front, it forms a delicate curtain — the iris — 
 pierced by an aperture — the pupil ; posteriorly this membrane is 
 known as the choroid. The tunica vasculosa, although lying close 
 up against the sclera, is not actually connected Avith it, except at two 
 
 Tlie Chambers, Lymph Spaces ami Humors of the Eye. (Fuchs, Ball.) 
 1, anterior chamber, and 2, posterior chambers filled with aqueous humor ; 3, 
 canal of Schlemm; 4, (hyaloid), canal of Cloquet; 6, Tenon's capsule about an 
 ocular tendon; 7, lymph space around a vena vortieosa; 8, perichoroidal space; 
 9, sujiravaginal space ; 10, intervaginal space. 
 
 places, i. e., at the opening of the optic nerve (posterior insertion 
 ring), and at the corneo-scleral margin (anterior insertion ring). 
 The capillary space extending between the two rings is called the 
 perichoroidal space. A few blood vessels and nerves cross it, and it 
 is bridged by extremely delicate tissue lamellae. 
 
 The inner coat is composed entirely of nerve tissue, and is called 
 the retina. 
 
 The larger spaces, or chambers, Avithin the eyeball are filled with
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 >iQ'i 
 
 fluid. That lyiiiji; iininediately behind tlie cornea is known as the 
 aqueous cJutnilxr, and contains the acjueons hnmor. In fetal life a 
 delicate membrane covers tlie i)ni)il, completely subdividing the 
 aciueous space into an anlei-ioi- and posterior chamber; after birth 
 the pupillary membrane (iisai)pears, and the two spaces communicate 
 through the jtupil. Tlie large space back of the lens is filled with a 
 gelatinous fluid called the vitreous humo]-. 
 
 The anterior chamlx r is bounded in fi-ont l)y the inner, concave 
 surface of the cornea ; l)eliind by the antei'ior surface of the iris and 
 that portion of the crystalline lens exposed in the pupillary area. 
 Although it varies in de])th in different individuals, and under vari- 
 
 Sectiou of the Auterior Layers of the Cornea. 
 
 ous conditions, normal and abnormal, its average depth is about 2.2 
 mm., measured from the posterior surface of the center of the cornea. 
 It is shallower in youth than in old age ; shallower in hyperopic than 
 in myopic eyes; and is subject to a certain amount of variation in 
 depth through changes in the volume of the lens. At the extreme 
 periphery of the aiiueous chamber is the so-called filtration angle, 
 or angle of the iris, an area of great importance, which wall be con- 
 sidered in connection Avith the sclera. 
 
 The posterior aqueous chamher, as described by Salzmann, is a more 
 extensive and complicated space than that of the older anatomists. 
 who applied this name to the space limited by the posterior surface 
 of the iris, anterior extremities of the ciliary processes, anterior 
 fibres of the zonule of Zinn, and the anterior surface of the lens cor- 
 responding to the uudilated pupil. According to Salzmann, the pos-
 
 368 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 terior boundary of the chamber is formed by the anterior border- 
 layer of the vitreous up to the ligamentuni hyaloideo-capsulare, and 
 from there on by the circumference and anterior surface of the lens ; 
 the anterior border is formed by the pigment epithelium of the iris 
 and the ciliary epithelium; toward the median line the space com- 
 municates with the anterior chamber; posteriorly (or peripherally) 
 it terminates in a narrow cleft-formed space between the orbiculus 
 ciliaris and the corresponding anterior border-layer of the vitreous. 
 The posterior chamber, therefore, according to these boundaries, 
 contains the ciliary processes and the zonule of Zinn. 
 
 There are four subdivisons, according to the new nomenclature, 
 namely, the orbicular space of Salzmann, or most posterior portion. 
 
 Normal Cornea, Magnified Thirty-six Times. Note the Increased Thickness 
 
 towards the Limbus (A'erhceff). 
 
 which is almost wholly filled with zonular fibres; the space lying 
 between the ciliary bodies, or system of ciliary valleys; the circum- 
 lental space, lying between the anterior extremities of the ciliary 
 bodies and the equator of the lens ; and the posterior chamber proper 
 (pre-zonular space of Czermak). This latter space is bounded in 
 front by the posterior surface of the iris ; behind by the anterior sur- 
 face of the lens underneath the iris, and the anterior layer of the 
 zonule of Zinn; laterally by the anterior extremities of the ciliary 
 processes. 
 
 The more interesting part of the external fibrous coat of the eye- 
 ball is the glass-like cornea, which, in the adult, makes up about one- 
 sixth of the whole tunic. At birth it constitutes about one-fifth of 
 the circumference of the globe. Viewed from the side, it is easy to 
 demonstrate the fact that it forms a segment of a smaller circle 
 superimposed upon the surface of a larger one. The radius of curva- 
 ture for the central one-third of the anterior surface is 7.8 mm. 
 
 The normal cornea is not absolutely circular, being 12 mm. in its 
 horizontal, and 11 mm. in its vertical, diameter. It weighs 180 mgr. 
 It is thin in the center (0.8 mm.) and comparatively thick (1.10 mm.)
 
 ANATOMY (GROSS) OF THE HUMAN EYE 369 
 
 at its junction (limbiis corneae) with the sclera (margin of the fora- 
 men sclera anterius). In the latter situation, the white sclerotic 
 coat overlaps the transparent cornea; the inner, concave surface of 
 the latter is greater than the outer convex surface, producing a 
 bevelled effect. In other words, the cornea extends, to a slight de- 
 gree, beneath the sclera, being partially hidden by the opaque, white, 
 tissue with which it is intimatel}^ blended. It is attached to its 
 scleral border much as a watch-glass is set into its case. In the 
 newborn, this does not hold true, for here the corneal margin seems to 
 occupy a groove in the scleral substance. 
 
 Nerve Supply of the Cornea. 
 
 The stroma of the cornea and Descemet's membrane become con- 
 tinuous with the iris at its angle, by means of the meshwork of the 
 iris angle, which will receive separate consideration. 
 
 The cornea attains its full growth early in life, and, unless the eye 
 be attacked by some intrauterine or infantile disease that stretches 
 the eye-coats, such as buphthalmus (congenital glaucoma), its diam- 
 eters are not much affected by subsequent diseases. This is why the 
 stretching of the tunic in axial myopia, and in the various forms of 
 adult glaucoma, acts chiefly on the posterior segment of the eyeball. 
 
 The narrow^ yellowish-gray, crescentic ring, sometimes seen at 
 the upper part of the cornea, is known as the arcus senilis (geron- 
 toxon). It may extend completely around the corneal margin; or 
 there may even be two rings, one inside of the other, on the other- 
 wise transparent surface. It is generally a sign of senility, but may 
 occur at all ages, and without other evidence of vascular degenera- 
 tion. It is a hyaline and not a fatty metamorphosis of the corneal 
 fibres. 
 
 Vol. 1—24
 
 370 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 The composition of the cornea and sclera is very similar ; it is 
 chiefly the arrangement of the fibres that makes the one transparent 
 and the other opaque. The substantia propria of both is made up 
 of closely-woven bundles of connective tissue fibres arranged in 
 layers. 
 
 The cornea is made up of five layers, or laminte, viz. : the anterior 
 epithelial layer ; Bowman 's membrane ; the substantia propria ; Desce- 
 met's membrane; and an endothelial layer. 
 
 The anterior lamina consists of from five to ten layers of epithe- 
 lium, continuous, and almost identical with the epithelium of the 
 conjunctiva covering the globe. This is the only layer of the cornea 
 which is regenerated after having been destroyed. The cells lying 
 next to Bowman's membrane are cylindrical in shape, becoming more 
 and more flattened as they approach the external surface, Avhere they 
 are seen as stratified pavement epithelial cells. The arrangement 
 of this epithelium is the most regular of any in the human body, and 
 necessarily so, in view of the function of the cornea as a part of the 
 optic system. 
 
 Bowman's membrane (lamina clastica anterior), the anterior limit- 
 ing layer, is of homogeneous structure, without cell-nuclei or fibrilla- 
 tion ; its thickness is almost uniform throughout. It does not extend 
 clear to the margin of the true cornea, but ceases, in most eyes, about 
 1 mm. from it. It is intimately connected with the corneal stroma, 
 from which it cannot be detached. Numerous minute openings, or 
 "pores," for the transmission of the corneal nerves — the rami per- 
 forantes — are occasionally to be found. 
 
 The true corneal substance {suhsiantia propria) consists of a lace- 
 work of intersecting connective-tissue fibres, containing corneal cells 
 within lymph spaces (lacunfe). This layer constitutes the great mass 
 of the cornea, comprising about 90 per cent, of its entire thickness. 
 At the sclero-corneal margin, it becomes greatly thickened near the 
 posterior surface, owing to the increased number of lamelhi?. Fixed 
 cells of the cornea lie in the spaces of the stroma ; aside from these, 
 there are the so-called wandering cells (leucocytes), some of which 
 are also found in the anterior epithelial layer near Bowman's mem- 
 brane. From this layer of the cornea the tissue forming the mesh- 
 work of the iris angle is chiefly derived. 
 
 Dcscemet's memhrane, the posterior limiting membrane, is a thin, 
 highly refractile, transparent, homogeneous structure, very firm and 
 elastic. By virtue of its structure it is a typical so-called "glass 
 membrane." At its periphery it becomes greatly thinned out and 
 enters into the formation of the meshwork of the iris angle.
 
 . ANATOMY (GROSS) OF THE HUMAN EYE 
 
 371 
 
 The endothelial, or inner, layer of the cornea is made up of a sin- 
 gle layer of transparent, flattened, hexagonal cells, continuous over 
 the meshwork of the iris angle, and over the anterior surface of the 
 iris. 
 
 Section of the Cornea. 
 
 The bloodless cornea forms the "object glass" of the ocular photo- 
 graphic apparatus. It is so well supplied with nerves, lymph spaces, 
 etc., that it is remarkable how perfectlj^ transj)arent it is. The cor- 
 neal elements are so arranged that there is no irregular refraction 
 of the light rays passing through them. Many abnormal conditions, 
 such as increased intra-ocular pressure, as in glaucoma ; congestion 
 of the blood-vessels at the limbus corneae, as in iritis ; decrease of
 
 372 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 tension, as in atrophy of the globe ; and chronic uveitis, may disar- 
 range these closely packed tissues and bring about either a temporary 
 or permanent loss of transparency. In health no vessels are to be 
 found in the cornea itself. 
 
 The capillary loops which form a vascular network about the cor- 
 neal margin, take the place of Bowman's membrane at the sclero- 
 corneal junction. The deeper of these capillaries (derived from the 
 anterior ciliary vessels), are not seen in the normal eye, but when 
 engorged with blood, as the result of irritants, they constitute the 
 condition known as ciliary or pericorneal congestion, and may be 
 recognized with the naked eye. 
 
 An intricate system of inter-communicating spaces affords a cir- 
 culation of nutritive fluids throughout the entire substance of the 
 cornea. These fluids, derived chiefly from the marginal vessels, nour- 
 ish the anterior epithelium and the superficial layers of the sub- 
 stantia propria, while the deeper layers and endothelium absorb the 
 aqueous humor, a portion of which may filter through the spaces 
 between the hexagonal cells; 
 
 The nerves of the cornea are derived from the ciliary plexus ; some 
 of the fibres join those supplying the conjunctiva, while others pro- 
 ceed directly to the cornea. About 70 principal branches are sup- 
 plied to the corneal tissue ; they lose their medullary covering 3 to 5 
 mm. from its margin. Of these branches about 50 are distributed to 
 the anterior epithelium, and the remainder supply the posterior 
 layers ; those of the latter group being somewhat coarser in structure 
 than the former. 
 
 The sclera {tunica fibrosa, or sclerotic coat) forms about five- 
 sixths (in the newborn, about four-fifths) of the fibrous covering of 
 the eyeball, and is continuous with the cornea. Indicating the point 
 of blending of the sclera and cornea is a superficial, shallow, circular 
 furrow, the sulcus sclerae externus, which is usually filled out with 
 scleral conjunctiva. The fibrous bundles which compose the sclera 
 are generally disposed at right angles to one another, forming a 
 strong, closely-woven structure, still further strengthened by elastic 
 and other fibres which run at all angles between the other bundles. 
 Fixed nucleated cells lie between the bundles, particularly in the 
 angles formed by their crossing. The spaces of the sclera resemble 
 those of the cornea, although the scleral organs and components are 
 not so regularly placed. 
 
 The thickness of the tunic varies greatly with the individual, being 
 generally thinner in youth and in the female. In the newborn it 
 does not vary so much as in the adult, although it is inclined to be
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 373 
 
 proportionally thicker near the sclero-corneal margin. At the pos- 
 terior polo it measures 1 mm. or a little more, and gradiiallx- decreases 
 toward the ecpiator to about 0.3 mm. The minimum thickness is, 
 therefore, attained immediately underneath the recti muscles, close 
 to the insertion of their tendons; immediately beyond this point, how- 
 ever, the thickness becomes doubled (0.6 mm.) since the muscle 
 tendons at the line of insertion are often as thick as the sclera itself. 
 As a rule, the tendons course obliquely inward into the sclera and 
 disappear farther forward among its fibres. As the sclero-corneal 
 margin is approached the thickness increases until it measures 0.9 
 mm. At this point, on the inner surface, is located the scleral spur, 
 or annular ligament, composed of circular fibres. It is a wedge- 
 
 L'ultur f--?Cja, 
 
 .L 
 
 Basilar 'bei::18 
 
 Section of Sclera and Choroid Showing the Interlacing Warp and Woof of the 
 
 Scleral Coat (Dwight-Testiit). 
 
 shaped process of scleral tissue which assists in the formation of the 
 sulcus sclera? internus, and serves as the point of attachment of the 
 meridional fibres of the ciliary muscle, and meshwork of the iris 
 angle; it also forms the posterior limit of Schlemm's canal. 
 
 At tbe posterior pole of the eye, 1 mm. below the horizontal 
 meridian, and about 3 mm. to the inner side of the vertical meridian, 
 is the opening for the optic nerve {foramen opficum sclera', porus 
 opticus, optic entrance, optic canal). Internally the diameter of this 
 opening is about 2 mm. ; externally it measures a little over 3 mm. 
 The inner fibres of the sclera are continued across the nerve, between 
 the nerve bundles, forming the lamina cribrosa ; the outer fibres are 
 continuous with the dural sheath of the optic nerve. 
 
 In addition to the opening for the optic nerve, the sclera is pierced 
 by minute canals, or emissaria, through which pass the vessels and 
 nerves supplying the uvea. These canals vary both in size and direc- 
 tion, being in some instances straight, in others (piite obliciue. Those 
 through which pass the long posterior ciliary' arteries, the ciliary
 
 374 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 nerves, and the vortex veins, course very obliquely ; the canals for 
 the latter are about 3 mm. in length. The venge vorticos^e, usually 
 four in number, are arranged in pairs, upper and lower ; they leave 
 the sclera 6 to 8 mm. behind the equator, and their points of emer- 
 gence are about 90 degrees apart. Loose connective tissue binds the 
 vessels and nerves to the walls of the canals. The oblique direction 
 of these canals prevents bending and tearing of the structures pass- 
 ing through them, during motions of the eyeball, or in the shifting 
 of the choroid during the act of accommodation. 
 
 The scleral layer next the choroid is called the lamina fusca. It 
 is a dirty -brown layer, and is probably an extension into the scleral 
 tissue of the choroidal pigment. It shows through the sclera as a 
 bluish discoloration, when that coat is abnormally thin, in some 
 
 Showiug the Fibres of the Sclera Joining Obliquely Those of the Cornea and 
 
 Forming the Limbus Cornea?. 
 
 young children, in brunettes, and in most dark races. The sclera 
 itself but rarely contains any pigment, except for the slate-gray 
 spots often seen about the perforations for the anterior ciliary ves- 
 sels (congenital melanosis of the sclera). 
 
 Sattler and others believe that the human lamina fusca is analogous 
 to the tapetum, a peculiar layer of the choroid found in lower animals. 
 It is composed chiefly of connective tissue in the pachyderms and 
 ruminants, and is known as the tapetum fibrosum. Irregular patchy 
 deposits of pigment in these layers cause rays falling upon the retina 
 of such animals to be irregularly reflected, and produce a sheen such 
 as one sees on the surface of '"mother-of-pearl." This retinal reflex 
 is also seen in the ej^es of children. 
 
 The inner surface of the sclera is much smoother than the outer. 
 ToAvard the front of the eye it has an almost silky lustre ; posteriorly 
 it is duller, and of a brownish color. On the inner surface, close to 
 its anterior limit, is situated the scleral furrow, or sulcus sclerse in-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 375 
 
 tei'Jius, a shallow groove about 0.7 mm. broad, lis posterior bound- 
 ary is the scleral spur, previously referred to ; its anterior boundary 
 is formed by thickened stroma of the cornea which projects slightly 
 above the level of the surface near the sclero-corneal margin. Occu- 
 pying a part of the floor of the furrow, close to its posterior margin, 
 is the canal of Schlemm ; the remainder is occupied by tlie meshwork 
 of the iris angle. 
 
 The canal of Schlemm is a slit-like space, or cleft. It is not one 
 uninterrupted canal, as the name indicates, but is divided, at various 
 places in its course, into one, two, or more, luminal. Its outer wall 
 is formed by dense scleral tissue ; its inner wall by the mesliAvork of 
 the iris angle. It is lined by endothelium continuous Math that lining 
 the aqueous chamber. Vessels are given off at intervals, thus estab- 
 lishing a free communication with the venous system; they unite in 
 the scleral tissue with the anterior ciliary veins. Through the me- 
 dium of this canal of Schlemm the aqueous chambers are in com- 
 munication with the general lymph system. 
 
 The iris angle, or circumference of the anterior chamber, is occu- 
 pied by an open meshwork, or trabecular structure composed of 
 fibro-elastic tissue derived from the stroma of the iris and Descemet's 
 membrane. Its first point of attachment is the scleral spur, after 
 leaving which it fills out the extreme periphery of the aqueous cham- 
 ber, and passes on around to become continuous with the stroma of 
 the iris. According to the nomenclature of H. Virchow, that portion 
 of the meshwork forming the inner wall of Schlemm 's canal is called 
 the scleral meshwork (trabeculum sclero-corneale of the old nomen- 
 clature) and forms the greater bulk of the structure; that portion 
 extending from the scleral spur to the root of the iris is called the 
 uveal meshwork (ligamentum pectinatum of the old nomenclature). 
 In the latter structure are the spaces of Fontana, which communi- 
 cate with the anterior chamber, through minute channels of Avhich 
 the structure is chiefly made up. The surface directed toward the 
 anterior chamber, the spaces of the meshwork, and Schlemm 's canal, 
 are all lined by a continuation of the endothelial layer of the cornea ; 
 after leaving the angle of the iris, it is continued over the iris proper 
 as the anterior endothelial layer. 
 
 As the chief function of the scleral coat is not only to serve as a 
 protecting envelope about the delicate structures Avithin, buf to pre- 
 serve the shape and size of the eyeball, its fibrous framework is very 
 tough, and capable of resisting pressure both from without and from 
 within. The weak points in this protecting coat are the cornea in 
 front (most ruptures from direct violence taking place at the selero-
 
 376 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 corneal junction), the optic entrance behind, and the points at which 
 the nerves and arteries enter, and the veins (especially the four venas 
 vorticosae) leave the eyeball. The entrance of the optic nerve (optic 
 canal) is strengthened by the lamina cribrosa. 
 
 Aside from an occasional capillary in the sclera, it can be said 
 that this tissue is devoid of vessels which supply it directly. 
 
 Branches of the ciliary nerves supply the sclera; their distribution 
 being similar to that found in the cornea. Sensory endings only 
 have been found in the human eye. Many minute nerves perforate 
 the tunic in its anterior part to supply the cornea. 
 
 n to 11.6 
 
 Weak Areas in the Sclera Measured in Millimeters. (Testut.) 
 
 Covering the sclera is a thin layer of tissue of much looser structure 
 than the sclera itself. This is called the episcleral tissue. The 
 bundles composing it are delicate and tortuous, except on the side 
 near the sclera, where they become thicker, firmer, and more closely 
 interwoven ; they graduate OA'er into the scleral tissue. This layer is 
 very vascular. It is readily differentiated when the eyes are in- 
 flamed. Its vessels are branches of the anterior and posterior ciliary 
 arteries, which are, as usual, accompanied by veins. Near the limbus 
 cornea? there is a thick capillary and venous net, which, when over- 
 filled with blood, produces that which is recognized as ciliarj' injec- 
 tion. 
 
 The aqueous humor is mostly secreted by the vessels of the ciliary 
 processes. It is a transparent, colorless, watery lymph of alkaline re- 
 action, and is very quickly replaced when lost. Its solvent powers 
 are great, and through its medium many active agents are brought 
 into contact with the interior of the eye. Atropia, either taken in 
 large doses internally, or dropped into the conjunctival sac, is soon 
 found in the aqueous humor; the aqueous, when thus impregnated, 
 will dilate the pupils of other subjects when instilled into their eyes. 
 The aqueous dissolves the crystalline fibres, if, through injury of the 
 lens capsule, it is allowed to come in contact with them. Its refrac-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 377 
 
 tive index and specific gravity are slightly greater than distilled 
 water. The average amount of human aiiueous in the adult is about 
 280 cnbic mm., and its weight is less than one-third of a gramme. 
 
 The vitreous body, the most transparent of the refractive media, 
 lies between the lens and the retina, and occupies about four-fifths 
 of the ocular cavity. It is a colorless, almost homogeneous, transpar- 
 ent, jelly-like mass, of firm consistency, with a framework of ex- 
 tremely fine, soft, fibrilhe. It receives the lens in its patellar fossa in 
 front, and forms a general support to the retina, from which it is 
 separated by a delicate layer of transparent tissue called the hyaloid 
 membrane, or membrana limitans interna retina?. Normally, there 
 are no blood-vessels, nerve fibres, or living fixed-cells in the vitreous 
 body. It is readily separable from the retina, except at its attach- 
 ment to the ciliary epithelium at the ora serrata, which is very firm; 
 and at the optic nerve head, and ligamentum hyaloideo-capsulare, 
 where it is quite intimatel}' attached. The ligamentum hyaloic^eo- 
 capsulare of Wieger, is a ring-form attachment of the anterior bortler- 
 layer of the vitreous to the lens, 8 or 9 mm. in diameter, concentric 
 with its margin. Within the ring, the vitreous is separated from the 
 lens by the post-lenticular space of Berger. 
 
 Unlike the acpieous, the vitreous body is rarely, if ever, regener- 
 ated ; when destroyed its place is taken by other fluids and tissues. 
 
 The presence of a canal (fetal vestige) in the vitreous body, has 
 been demonstrated; it runs from the optic papilla to the posterior 
 surface of the lens, close to the axis of the vitreous toward the nasal 
 side, and is from 1 to 2 mm. Avide. This is the canal of Cloquet. In 
 the human fetus (and in some animals) the retinal system of vessels 
 supplies a branch — the hyaloid-artery — which passes through this 
 canal to the lens and iris. Under the name of persistent hyaloid 
 artery, this vessel may fail to be absorbed before birth and so inter- 
 fere, to some degree, with distinct vision. 
 
 The vitreous depends upon the uveal vessels for its nutritional 
 supply. Hence it is often implicated in diseases of the uveal organs 
 — especially of the ciliary body and choroid. 
 
 The crystalline lens is an interesting intra-ocular organ being a 
 circular, biconvex, transparent, glass-like body, lying between the 
 iris and the vitreous humor. It fits accuratelv into the shallow, 
 saucer-shaped, patellar fossa of the vitreous, from which it is sepa- 
 rated 1)3' the post-lenticular space of Berger. It is held in i)laee by a 
 suspensory ligameni, the zonula (or zonule) of Zinn, and by the 
 ligamoihon hyaloideo-capsulare. The equator, or edge, of the lens, is 
 about 1 mm. from the ciliary processes.
 
 378 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 An anterior and posterior pole of the lens are designated, each be- 
 ing in the center of the corresjDonding surface. An imaginary line 
 drawn between the two is called the axis of the lens. 
 
 The lens is enclosed in a delicate, structureless, elastic envelope, 
 lined in front by endothelial cells, which are wanting on the pos- 
 terior surface. Owing to this and other differences, and, for the 
 purpose of reference, this covering of the crystalline lens has been 
 called the anterior and posterior capsule, although there is no dis- 
 tinct line of separation between them. The capsule is quite strong 
 
 Central Portion of Anterior and Posterior Lens Stars Showing Lines of Union of 
 
 Sectors. (Babuchin.) 
 
 and elastic, though brittle. When cut through it tears irregularly, 
 and the incised edges curl up in a roll with the inner surface out- 
 ward. The minimum thickness of the capsule is at the posterior 
 pole. Each surface shows a zone of maximum thickness occupying a 
 position concentric with the equator toward the periphery of the 
 lens. 
 
 The lens substance is formed by the invagination of the ectoderm, 
 and is, consequently, an epithelial structure — the capsule being de- 
 rived from the mesoderm. For this reason the lens grows (by con- 
 version of the marginal cells of the anterior capsule into young 
 lenticular fibres) larger, heavier, thicker, and harder, as age ad- 
 vances. Lens substance in process of formation can be found at all 
 ages of life. 
 
 The hardening j^rocess begins in childhood, and affects chiefly the 
 central portions, so that in the adult a distinct condensation of the 
 tissues occurs, and a nucleus can be demonstrated. Later the differ-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 379 
 
 ence between the cortex and nucleus can generally be demonstrated 
 with the mirror. In old age, the whole lens increases so much in 
 hardness that changes in its form are with difficulty brought about 
 
 1 2 
 
 Parts at Equator of Lens Showing the Growth of Its Epithelial Cells Into 
 
 Lens Fil)res. (Schultze.) 
 
 b}^ the ciliary muscle, and the loss of accommodative power is very 
 marked. Moreover, the denser nucleus reflects more light, and the 
 outline of the lens is seen through the pupil, which does not appear 
 as black as in youth. This appearance generally deepens, until, by 
 reflected light, it may show a distinct opalescence, not uncommonlj' 
 giving rise to a suspicion of cataract, even when no true opacity is 
 present. 
 
 The adult lens is about 9 mm. in its transverse diameter, and is 
 from 4 to 6 mm. thick. The posterior surface is somewhat flattened; 
 the anterior surface has more the outline of a sphere. These, and 
 other measurements vary with the state of the accommodation, with 
 age, and with stature — very tall individuals having large lenses. 
 The specific gravity of the lens is greater than that of the vitreous, 
 so that on rupture of its attachments it settles to the bottom of the 
 globe. 
 
 After removal of the capsule, the lens readily separates into a 
 number of concentric lamina* much like the lavers of an onion, ex-
 
 380 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 cept that they do not extend entirely about the organ. Examined 
 microscopically, the lenticular layers are found to consist of long 
 ribbon-like fibres, some of them with nucleated cells and serrated 
 
 Single Lens Fibres, Longitudinal and in Transverse Section. (Arnold-Ball.) 
 
 edges, but when the ribbon fibres are seen in cross-section they rep- 
 resent a prismatic or honeycomb appearance. The saw-like edges of 
 
 Separation of Layers of Lens Following Treatment with Dilute Alcohol. After 
 
 Arnold. (Schwalbe.) 
 1. Nucleus or central portion. 2. Layers of Cortical Substance. 
 
 the fibres do not always closely fit into one another, but are bound 
 together by a cement substance, a semi-fluid albuminous material. 
 
 The cement substance not only binds together adjacent fibrils of 
 the lens, but joins the sectors into which the whole mass is divided. 
 The non-symmetrical stellate figures thus formed show on both the 
 anterior and posterior surfaces of the lens. The lens star always 
 has three, but may have as many as six or more rays. When one 
 looks at a distant street lamp, the rays of light tliat appear about the
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 381 
 
 central part of the flame are generally the result of unequal refrac- 
 tion of the light by the various sectors into which the human crystal- 
 line lens is divided. This is true even of normal eves. 
 
 Schematic Eepresentation of the Course of Lens Fibres and the Arrangement of 
 Lens Stars in the Foetus and Newborn. (Schwalbe. ) 
 
 The zonule of Zinn, or suspensory ligament of the lens, is a collec- 
 tion of delicate fibres,* a few of which originate as far back as the 
 ora serrata; the majority spring from the valleys between the ciliary 
 
 Meridional Section Through Lens Margin — Eabbit 's Eye. (Schwalbe.) 
 1. Lens capsule; 2. Epithelium of the lens; 3. Transformation of epithelium into 
 lens fibres; 4. Lens fibres. 
 
 processes, and pass forward as separate layers, to the margin of the 
 lens ; here they are attached to a zone about 2 mm. broad, concentric 
 with the equator of the lens — one layer in front, and the other behind. 
 A few fibres pass directly to the extreme circumference of the lens. 
 By the divergence of these layers from their origin to their attach- 
 ment, a wedge-shaped cavity is formed, which is called the canal of 
 
 *Thonisou, with good corroborative evidence, regards the zonular fibres as the 
 shredding of a delicate membrane blended posteriorly with the layers of the 
 pars ciliaris retinae. This view is not held by other authors, most of whom do 
 not specify their derivation, but merely their point of origin.
 
 382 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 Petit. This space can be injected with air. The zonule of Zinu is 
 concerned in the mechanism of accommodation. 
 
 The lens has no blood-vessels, but is nourished by the imbibition 
 of fluids supplied by the ciliary body ; these probably enter it at the 
 equator, and circulate between the fibrillae. 
 
 The elasticity of the lens may be demonstrated by gently squeez- 
 ing it and then suddenly removing the pressure — it at once springs 
 back to its original shape. 
 
 The so-called Purkinje-Sanson images, or lens-reflexes, are best 
 elicited in a dark room. By placing a lighted candle in front, and 
 a little to the side of, the dilated pupil, three images of the candle 
 are produced. One is large, upright, and brilliant, and is the corneal 
 reflex. The second is also bright, but is very minute, and must be 
 searched for; in this case the image of the candle is inverted, and is 
 the reflex from the posterior surface of the lens. The third image 
 is from the anterior surface of the lens ; it is upright and larger than 
 the other two, but is very faint, and rather difficult to see. 
 
 The uveal tract, or uvea, comprises the choroid, the ciliary body, 
 the ciliary processes, and the iris. This collection of pigmented and 
 highly vascular tissues forms, anatomically, physiologically, and 
 pathologically, a rather definite section of the intraocular apparatus. 
 It derives its name from the fact that when the outer covering, com- 
 posed of the cornea and sclera, is removed from the globe, a middle 
 coat is exposed that closely resembles a purple (uvea) grape. The 
 anterior segment of the uvea is composed of the iris, pierced by the 
 pupil. The iridic tissue extends to the sclero-corneal junction, where 
 it is continued inward as the ciliary body, a meridional, circular 
 organ, that still farther backward sends out ciliary processes and 
 joins the choroid, which, in its turn, lines the ocular interior back to 
 the optic nerve entrance. 
 
 The whole tract is soft and readily breaks down. The choroidal 
 elements are composed chiefly of connective tissue, bearing blood- 
 vessels and lymph spaces, intended to afford nourishment to most 
 of the organs within the eyeball. The ciliary body is made up of 
 the muscle that regulates the focusing apparatus (accommodation) 
 of the eye, as well as of numerous vascular and nervous bundles, 
 that are concerned in intraocular secretion and excretion. These 
 constituent organs will be considered separately. 
 
 The iris, which is continuous with the choroid, is a circular, colored 
 curtain, or diaphragm, lying in front of the lens. It has a circular 
 opening of varying width — the pupil — which lies slightly to the nasal 
 side of the center, and acts chiefly as a regulator of the amount of
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 383 
 
 light admitted into the interior of the eye; in conjunction with the 
 other parts of the dioptric apparatus, it assists in giving sharp defini- 
 tion to fundus pictures. It separates the anterior from the posterior 
 aqueous chamber. The pupillary margin of the iris is bevelled at the 
 expense of the outer surface, and is finely crenated. Until the 
 seventh month of fetal life the pupil is closed by a thin, semi-trans- 
 
 The Immediate Eelations of the Crystalline Lens System. (After Qxiain). 
 a, Cornea; f, Canal of Scblemm; g, Iridic angle; h, Iris; k, Posterior pigment 
 layers (detached); m, c, Zonular fibres; n, Interfibrillar spaces; p, r, s, t, Ciliary 
 body; 1, 2, Conjunctiva; 3, Sclera; 4, Choroid; s, Eetina. 
 
 parent membrane, which occasionally persists, in part or in whole, 
 after birth, under the name of persistent pupillary membrane. When 
 the iris is contracted its pupillary margin rests lightly on the anterior 
 surface of the lens. At its periphery, or root, at the sclero-corneal 
 junction, it turns abruptly backward and becomes continuous with 
 the ciliary body; this is called the ciliary border. The diameter of 
 this border is 12 mm. and does not vary. When the pupil is dilated
 
 384 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 the iris hangs (or floats) free in the aqueous humor, and does not 
 touch the lens. The average width of the pupil is 4 mm. ; a slight 
 difl'erenee in the size of the pupils is not necessarily pathologic. 
 This thickness of the iris varies ; when contracted it measures 0.3 mm., 
 when dilated 0.75 mm. The point of minimum thickness is at the 
 ciliary border, where it measures 0.2 mm. 
 
 Seen from in front, the iris presents a great number of patterns, 
 as well as all sorts of colors, from light-blue to deep-brown ; the 
 variation in color being due chiefly to the difl^ering quantity and 
 arrangement of tho dull brown pigment deposited on its anterior 
 surface and viewed through the corneal and aqueous media. 
 
 A zig-zag line near the pupillaiy margin serves to separate the 
 anterior surface into tAvo zones — a narrow pupillary zone (annulus 
 iridis minor, Merkel) ; and a broad ciliary zone (annulus iridis major, 
 Merkel). The shallow cavities or spaces seen on the surface of the 
 iris near the pupillary margin are formed by the spreading apart of 
 elevated trabecule, or ridges, extending between the zig-zag line and 
 the periphery. They are called the ''pupillary crypts." 
 
 Running concentrically with the ciliary border of the iris are the 
 so-called contraction furrows. They deepen when the pupil dilates, 
 and are almost obliterated when it contracts. 
 
 In albinos pigment is lacking, not only in the stroma of the iris, 
 but in all other portions of the uveal tract as well; in negroes, the 
 amount is relatively large. The pigment deposit, whether large or 
 small in amount, does not appear until after birth ; hence all babies 
 have light blue eyes for the first few weeks. Irregularities may 
 occur in this deposit, so that an iris may be partly blue and partly 
 brown (heterochromia). When this happens the parents are gen- 
 erally of different complexions. 
 
 The iris stroma is made up chiefly of blood-vessels and nerve- 
 plexuses, supported by a very loose, spongy network of connective 
 tissue. The vessels run in a radial direction from the ciliary to the 
 pupillary border. They show a thick adventitia, and their course is 
 more or less winding, to allow for contraction and dilatation of the 
 pupil. At the ciliary and pupillary borders the vessels form irreg- 
 ular circles, called respectively circulus arteriosus major, and 
 circulus arteriosus minor. 
 
 Contraction of the pupil is brought about by the sphincter pupill* 
 muscle, a narrow band of fibres about 0.9 mm. broad, which en- 
 circles the iris near the free border of the pupil. This muscle is sup- 
 plied by branches of the third (oculomotorius) nerve. 
 
 Dilatation of the pupil is accomplished by relaxation of the sphinc-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 385 
 
 ter pupillge, contraction of the muscular coat of the iridic arteries, 
 and by contraction of an irreguhir layer of unstriped muscle fibres 
 called the dilator pupilhi% derived from the stratum pigmenti. These 
 fibres radiate from the margin of the pupil to the ciliary body. The 
 last two sets of muscle fibres are controlled by the sympathetic. 
 
 A deeply pigmented layer, a continuation of the pigmented layer 
 of the retina, thickly covers the posterior surface of the iris, and 
 extends as far forward as the anterior margin of the pupil, about 
 which it is slightly turned. Like the anterior surface of the iris it 
 is readily thrown into folds, to allow of easy expansion and con- 
 traction of the pupil. The iris pigment is easily detached, and may 
 adhere to the anterior capsule of the lens during an attack of iritis; 
 such adhesions are called posterior synechia. On this surface near 
 the pupillary margin is a zone about 1 mm. in width, presenting 
 radial folds, (contraction folds of Schwalbe). This area corresponds 
 to the situation of the sphincter pupilhe muscle. 
 
 The ciliary body (corpus ciliare) is that portion of the uveal tract 
 which extends from the root of the iris to the ora serrata, or zig-zag 
 anterior border of the retina. This area is from 5 to 6 mm. broad, 
 and may be divided into two zones, viz. : a broad, flat zone, approx- 
 imately 4 mm. wide, situated in front of the ora serrata and known 
 as the orbiculus ciliaris; and a narrower zone, the corona ciliaiis 
 (corona radiata), occupying the remaining 2 mm. of the space. From 
 the latter zone arise the ciliary processes. These are a number of 
 curious club-like elevations, arranged meridionally, and composed 
 almost entirely of anastomosing blood-vessels. There are, in all, 
 about 70 of these processes; they rest upon the non-striated fibres 
 of the ciliary muscle. Separating each process from its neighbor is 
 an interspace, or depression, called a "ciliary valley." The pigment 
 of the ciliary body is much darker than that of the choroid, although 
 the free borders of the processes contain less pigment than the un- 
 derlying surface — hence, they appear lighter against the dark back- 
 ground. The rounded anterior ends of the ciliary bodies are 
 separated from the lens by a space about 1 mm. in width — the cir- 
 cumleutal space. 
 
 It is to be noted that the blood from the ciliary arteries flows 
 directly into the veins without intervening capillaries, as in the 
 glomeruli of the kidney. The analogy probably also holds good as 
 to their function, since they both readily allow the watery portions 
 of the blood to escape through their pervious walls. The ciliary 
 processes secrete the aqueous humor in the same manner that the 
 renal vessels excrete the urinary fluid. 
 
 Vol. I— 2 5
 
 386 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 The extreme vascularity of the ciliary region makes it susceptible 
 to inflammatory attacks, especially following injury; it constitutes 
 the "dangerous zone" of Nettleship. 
 
 The ciliary muscle was first demonstrated microscopically in 1835 
 by an American, named Wallace; although Eustachius actually pic- 
 tured it about 1570. On cross section it appears as a triangular band 
 
 Section of Uveal Tract, with Details Showing the Plexuses of the Vascular Ciliary 
 body. (Sappey.) d, e, i, 1, 2, 2, ciliary processes; 4, 4, veins from iris discharg- 
 
 ing into the ciliary processes; 3, 
 vorticose. 
 
 3, veins connecting the processes with the venae 
 
 of unstriped muscle fibres, inserted directly into the anterior inser- 
 tion ring (scleral spur) ; and lies between the ciliary processes and 
 the sclera. The base of the triangle is near the anterior insertion 
 ring, and the muscle extends from this region as a gradually thin- 
 ning layer to its insertion into the choroid (tensor choroidae), where 
 it blends with the choroidal stroma. There are three sets of fibres 
 making up this muscle, which run in various directions. On the 
 outer side toward the sclera are seen long muscle bundles lying par- 
 allel to the surface, which are called meridional fibres. Inw^ard from 
 these are muscle bundles disposed in a radial manner — the radial 
 fibres. The third set, a group of fibres located far forw^ard in the 
 ciliary body, run in a circular direction and form the so-called 
 Mueller's muscle, or compressor lentis. ■ 
 
 There is no doubt but that the proportion of these muscle fibres
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 387 
 
 varies with the requirements of accommodation ; the circular fibres 
 that govern active changes in the lens are absent in myopic subjects, 
 who do not often require an extensive accommodation; in hyperopic 
 individuals, however, they are greatly increased, and may amount to 
 one-third of the whole muscle. 
 
 On the temporal side the ciliary muscle occupies an area about 
 6 mm. Avide : in the nasal side it is but 5 mm. wide. 
 
 Organs of Uveal Tract and Their Eelations. (Fuchs.) 
 
 The ciliary nerves are both sensory and motor in character. Those 
 containing sensory fibres alone are derived from the nasociliary 
 branch of the ophthalmic division of the fifth cerebral nerve ; those 
 containing a mixture of fibres — sensory, sympathetic, and motor — 
 derive their motor fibres from the ciliary ganglion. About ten of 
 the larger trunks, varying greatly in number and size, enter the eye-
 
 388 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 ball near the posterior pole, run f orAvard in the perichoroidal space, 
 send off branches to the sclera and choroid en route, and terminate 
 chiefly in the ciliary plexus (plexus gangliosus ciliaris) Avhich lies 
 external to the orbiculus ciliaris and the ciliary muscle ; from this 
 latter source the ciliary processes, iris, and deeper layers of the 
 cornea receive their nerve supply. Perforating branches, lying 
 farther back, supply the superficial layers of the cornea. 
 
 The perichormdal space lies between the lamina fusca of the sclera 
 and the outer layer of the choroid — the lamina suprachroidea. It is 
 a slit-like lymph space, which, in extent, is almost equal to the sclera 
 itself. It is traversed throughout by numerous delicate lamellae 
 fused together here and there, thus subdividing the space into 
 smaller, intercommunicating portions. Binding the two surfaces 
 intimately together, in places, are nerves and blood-vessels passing 
 from the sclera to the choroid, and vice versa. The posterior ciliary 
 arteries and the ciliary nerves pass forw^ard through this space. 
 
 The choroid (chorioid), a portion of the middle tunic, covers about 
 two-thirds of the interior of the globe. Near the optic nerve entrance 
 it measures 0.1 mm., becoming gradually thinner as it approaches the 
 ora serrata, where the thickness is about 0.06 mm. It is a soft, 
 brownish membrane, extending from the optic nerve entrance to the 
 ora serrata — about 7 mm. from the corneal limbus, externally. At 
 this point it becomes continuous with the ciliary body. It is rather 
 loosely attached to the sclera, a condition that allows of its easy 
 adjustment to variations in position and size, caused by the action 
 of the ciliary muscle and the changes in volume of its many blood- 
 vessels. It is, however, quite firmly adherent at the papilla, where 
 it sends many connective tissue fibres and vessels to the optic nerve. 
 When the fundus oculi is examined Avith the ophthalmoscope the 
 color of the background is determined chiefly by the amount of 
 pigment in the stroma, and the volume of blood in the choroidal 
 vessels. 
 
 The choroid may be divided into four layers, viz. : the lamina 
 supra-choroidea. the lamina vasculosa, the lamina choriocapillaris, 
 and the lamina basilis. 
 
 The supm-cJioraidea, or external layer, is formed chiefly of elastic 
 fibres and pigment corpuscles, loosely arranged. It contains lymph- 
 atic spaces lined with endothelium, but has no vessels. 
 
 The lamina vasculosa forms the mass of the choroid. It con- 
 sists of arteries and nerves, and of a stroma of elastic fibres and 
 pigment cells, Avhich supports the large venous whorls known as the 
 veufe vorticosae. This layer contains many lymphatic spaces, Avhich
 
 ANATOMY (GROSS) OF THE HUMAN EYE 389 
 
 are iiarticiilarly well developed around the blood vessels. The larger 
 vessels are found in the outer layers toward the sclera. 
 
 The sclera demands but little nourishment, hence the large ves- 
 sels which take small part in nutritive processes are placed in this 
 position. This arrangement is, in at least one sense, a distinct dis- 
 advantage; when inflammation or other changes attack the choroid 
 they generally att'ect the minute capillaries, and are consequently 
 liable to damage the retina. 
 
 The veuffi vorticosaa remove most of the blood from the choroid 
 and the interior of the eyeball. The main trunks of these whorl-like 
 veins pass obliquely backward through the sclera, and empty into 
 tliQi ophthalmic vein. Fuchs says that their compression, by the 
 action of the superior oblic^ue and other muscles in sustained near 
 work, may, by interfering with the ready exit of blood from the 
 eyeball, distend the globe. He further believes that such a continual 
 obstruction to escape of blood from the eye may bring about a 
 stretching of the sclera in young subjects, whose tissues are not as 
 unyielding as they become later in life. This elongation of the 
 antero-posterior diameter constitutes the common form of myopia. 
 
 The lamina vhorio-capillans is a layer of fine capillaries, supported 
 by an almost homogeneous, non-nucleated stroma. This layer oc- 
 cupies that part of the choroid (inner aspect) which constantly re- 
 quires an outpouring of nutritive fluids for the retinal elements that 
 lie close to it. l->y referring to the description of the retina, it will 
 be seen that the most active layer of that membrane — the layer of 
 rods and cones — is super-imposed upon the chorio-retinal epithelium, 
 and that all of these structures are entirely dependent for nutritive 
 fluids upon the vessels of the chorio-capillaris. As a matter of fact, 
 this capillary network forms the richest vascular plexus in the whole 
 body, being better supplied with blood than the pulmonary alveoli, 
 or than the pia mater, which membrane the whole structure of the 
 choroid resembles. The capillaries in this layer are very broad ; so 
 broad, in fact, that several blood corpuscles can pass through them 
 side by side. They do not form a meshwork, but a net — that is, they 
 occupy one plane. This net is especially thick in the region of the 
 fovea centralis retinae. 
 
 The inner layer, or lamina hasilis, separates the lamina chorio- 
 capillaris from the retina. It consists of an inner and outer layer ; 
 the former homogeneous, the latter exhibiting very delicate elastic 
 fibrilla?. It is firmly grown to the stroma of the capillary layer, and 
 is highly refractile. 
 
 The principal arteries of the choroidal coat are the recurrent
 
 390 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 branches of the long posterior ciliary and anterior ciliary arteries, 
 which supply the anterior part of the membrane, and about 20 
 branches (short posterior ciliary) of the ophthalmic artery that pene- 
 trate the sclera near the optic entrance, and constitute the major 
 part of the chorio-capillaris. 
 
 The retina, or "sensitive plate"' of the human visual apparatus, 
 lies betAveen the choroid and the vitreous. Its attachment to the 
 choroid in general is very delicate ; at the entrance of the optic nerve 
 and at the ora serrata, however, the union is quite firm. It may be 
 
 
 Layer of Eods and Cones and Outer Nuclear Layer — Schematic. (Schwalbe.) 
 1. Outer pleiform layer; 2. Membrana limitans externa; 3. Inner member of 
 
 rod ; 4. Outer member of rod ; 5. Rod granule with nucleus ; 6. Rod fibre ; 7. Inner 
 
 member of cone; 8. Outer member of cone; 9. Cone granule with nucleus; 10. 
 
 Cone fibre; a. Longitudinal striations of inner member of cone; a'. Longitudinal 
 
 striations of inner member of rod. 
 
 divided into two sections, viz. : a large posterior section called the 
 pars optica retime, containing the expansion of the optic nerve fibres, 
 and extending forward to the ora serrata where it ends abruptly; 
 and a small anterior portion, the 2^0.^'s ciliaris retinm, which is con- 
 tinued forward from the ora serrata over the ciliary processes. This 
 latter section is made up almost entirely of the pigment layer of the 
 retina (stratum pigmcnti).
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 391 
 
 The ora scrrala, which reaches farther forward on the nasal than 
 on the temporal side, marks the anterior limit of the light and form 
 perceiving elements. The pars optica retinas is shorter on the nasal 
 than on the teniporal side, owing to the position of the optic nerve. 
 At the nerve head it measures 0.56 mm. in thickness ; at the equator 
 about 0.18 mm. : while at the ora serrata it thins out to about 0.1 mm. 
 
 The retina is a delicate, complex, inelastic membrane, semi- 
 transparent during life, but becoming clouded and opaque imme- 
 diately after death. It is made up of a large number of layers, nine 
 in all. It is thickest about the entrance of the optic nerve, especially 
 above and below it (0.4 mm.) ; it thins out to about 0.14 mm. at the 
 periphery, at first rapidly, and then more gradually'. 
 
 The blood supply of this membrane is derived almost entirely 
 from the central retinal artery, which, with the accompanying vein, 
 
 OptCc 'n,&rue, Macula. Lu,tea, 
 
 Magnified View of Innermost Layer of the Eetina. 
 
 runs in the inner layers; the outer layers, next the choroid, are 
 nourished by the chorio-capillary plexus. In the macular region no 
 vessels are to be seen with the ophthalmoscope. The retinal circu- 
 lation is a terminal one ; there are no anastomoses with collateral 
 branches (except with the ciliary vessels at the papilla), so that 
 when thrombosis or embolism occurs, the area supplied by the oc- 
 cluded artery remains blind. 
 
 The following consideration of the retinal layers applies to the 
 extra-foveal region ; the foveal region itself will be taken up 
 separately. 
 
 The various layers of the retina are bound together by a system of 
 supporting fibres, or elongated cells, of purely mechanical nature, 
 called the fibres of Mueller; these begin as closely apposed conical 
 expansions, at the inner surface of the retina, and pass, perpen- 
 dicular to the surface, through all the layers between the limiting
 
 392 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 membranes; they terminate in fine fibrillre in the layer of rods and 
 cones. An oval nucleus is to be seen in each fibre near the center of 
 the inner nuclear layer. These fibres take part in the formation of 
 the framework of the various layers through which they pass, par- 
 ticularly the plexiform layers, in which they give off many fine 
 extensions parallel to the surface. 
 
 The most important layer of all is the layer of rods and cones. In 
 this portion of the retina, light, form, and color are perceived. Prob- 
 ably color perception is the chief function of the cones; light and 
 form are mostly recognized by the rods. In birds the proportion of 
 cones to rods is much greater than in the human retina. 
 
 The rods, which are more numerous than the cones, are solid, 
 cylindrical structures, composed of an inner and outer portion, or 
 member. The outer portion, which is somewhat longer than the 
 inner one, is a slender, highly refractile body, made up of a number 
 of thin, superimposed discs held together by a cement substance. 
 It has the appearance of being transversely striated; it also shows 
 very faint longitudinal markings. The inner portion, which rests 
 upon the membrana limitans externa, is shorter than the outer one, 
 and somewhat thicker. The outer third of this member shows dis- 
 tinct longitudinal striations; the inner portion is indistinctly gran- 
 ular, and shows, also, very fine longitudinal striations near the 
 membrana limitans externa; these latter striations represent the 
 terminal threads of the fibres of Mueller. Each rod is connected by 
 a fibre with the outer nuclear layer adjoining. Visual purple is 
 found in the outer member of the rods, except in a zone 3 to 4 mm. 
 wide at the ora serrata. 
 
 The cones are flask-shaped structures, the bases of which rest upon 
 the 7nemhrana limitans externa. Like the rods they are made up of 
 two members, an outer and an inner one. The outer member is 
 tapering, and not cylindrical like the corresponding portion of thft 
 rod; the inner one is broader in the center, and resembles the inner 
 member of the rods in-so-far as that it has an outer striated and an 
 inner granular appearance. Each cone connects by a fibre with the 
 outer nuclear layer adjoining. The cones contain no visual purple, 
 and vary a great deal in form, size, and number, in dift'erent 
 locations. 
 
 The membrana limitans externa is a very delicate supporting mem- 
 brane, containing perforations corresponding exactly to each rod and 
 cone, and separating them from the layer beneath. 
 
 The outer nuclear layer consists mainly of nuclei, which are so 
 numerous and thickly placed as to appear to constitute the whole
 
 ANATOMY (GROSS) OF THE HUMAN EYE 393 
 
 layer. Each rod is prolonged into this layer as a delicate, tortuous, 
 varieosed rod-fibre, which distends into a rod granule, containing 
 one of the nuclei ; from liore it passes on to the outer plexiform 
 layer in which it terminates in a small bud. In a similar manner, 
 each cone is prolonged into the outer nuclear layer as a cone-fibre, 
 which expands into a spindle-shaped cone-granule containing a 
 nucleus; it is shorter and thicker than the rod-fibre. These fibres 
 also terminate in the outer plexiform layer — in this case as a cone 
 swelling or cone foot, which gives off short lateral branches. 
 
 The outer plexiform layer consists of a reticulum of fibrous elements 
 interwoven and crossing, both parallel and at right angles to the 
 surface of the retina. These fibres are derived from the layer of 
 rods and cones, from the supporting fibres of Mueller, and from the 
 inner nuclear layer. An outer and an inner portion may be distin- 
 guished. The former is the thicker portion, making up about two- 
 thirds of the layer; the latter shows a fine reticular structure, being 
 made up of delicate extensions from the inner nuclear layer. 
 
 The inner nuclear layer, while much thinner than the outer nuclear 
 layer, is the most complicated of all the retinal structures. It con- 
 sists almost entirely of cell nuclei ; these give ofiE processes, which 
 vary in number as well as direction. In this layer are found, among 
 others, the so-called horizontal, and bipolar cells, as well as the nuclei 
 of Mueller's supporting fibres. Capillary branches of the arteria 
 centralis retina; are to be seen in this layer. 
 
 The inner plcxiform_ layer is similar to the inner portion of the 
 outer plexiform layer, in that it has a fine reticular appearance. 
 Several secondary or sublayers are recognized, although they are not 
 very distinct in the human retina. This layer is crossed by retinal 
 vessels. 
 
 The ganglion cell layer shows, on the nasal side, a single row of 
 ganglion cells, while on the temporal side, in the extra fovea! region, 
 the cells are superimposed. Lying between the cells, are the sup- 
 porting fibres of Mueller. Neuroglia cells are also present. This 
 layer varies in thickness in certain portions. The cells, which have 
 a round, clear nucleus, vary greatly in appearance and in size ; they 
 are multipolar, and are provided with dendrites, which broaden out 
 in the inner plexiform layer. They are, in general, provided with 
 axis cylinders which go over into the nerve fibres of the adjoining 
 layer. 
 
 The nerve- fibre layer is thickest about the optic nerve entrance, 
 except on the temporal side. It decreases in thickness toward the 
 periphery, first rapidly, and then more gradually. This layer shows
 
 394 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 a delicate fibrous structure. On the nasal side its elements are ar- 
 ranged radial to the optic nerve entrance ; on the temporal side this 
 arrangement is disturbed, in that the fibres bow away from the 
 foveal region. Grouping in small bundles is characteristic of the 
 nerve-fibres everywhere in the retina. They are non-medulated, and 
 are, in general, spread out in one plane, except at the disc, where the 
 fibres are superimposed. In addition to the nerve fibres and Mueller's 
 supporting fibres, this layer contains neui'oglia, consisting of cells 
 and fibres, which form a meshwork between the nerve fibres. Here 
 also are found the branches of the arteria and vena centralis retinae, 
 which are imbedded among the fibres, and, in part, in the ganglion 
 cell laj^er. The vessel wall is but slightly developed — this is par- 
 ticularly true of the muscularis. 
 
 Section through the Human Macular Eegion. (Graefe-Saeniisch.) 
 
 The memhrana limitans interna is a structureless, homogeneous 
 layer, previously referred to as the hyaloid membrane; it separates 
 the vitreous from the retina. By some authorities it is regarded as 
 a layer of the retina, while others consider it an independent 
 structure. 
 
 The macular region includes the macula lutea, which is the most sen- 
 sitive part of the retina, is a circular region about 2 mm. in diameter, 
 lying directly in the axis of vision. It is about 1 mm. below, and 
 3.5 mm. from the center of the nerve head, toward the temple. 
 
 Occupying the center of this region is a minute pit or depression, 
 called the fovea centralis retinae, which varies slightly in size, but 
 usually measures 0.5 mm. across. With the ophthalmoscope it shows 
 as a brownish-red spot, somewhat lighter than the surrounding 
 retina. Here visual impressions are most acute ; it is this point that 
 is directed toward the object which one M'ishes to see distinctly. 
 
 The layer of rods and cones attains its greatest thickness in the 
 macular region. The rod element, however, disappears at the margin 
 of the fovea centralis, the floor of which is occupied mainly by 
 elongated cones, and by the thickened outer nuclear layer. The 
 membrana limitans externa continues to separate these two layers 
 as in the extra-foveal region. As the foveal region is approached,
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 395 
 
 the rods and cones assume an obliiiue direction. The supporting 
 fibres of MueHer also become obliciue as the fovea is approached, and 
 disappear at its margin. 
 
 The outer plexiform layer becomes modified into an outer fibre 
 layer of Henle; it becomes very thin as it passes over the floor of the 
 fovea. 
 
 The inner nuclear layer and the layer of ganglion cells increase 
 markedly in thickness at the margin of the fovea, but almost dis- 
 appear in the center of this region. 
 
 Transverse Section of Optic Nerve in Front of the Entrance of the Central 
 artery showing dural, subarachnoid and pial sheaths, enclosing corresponding 
 lymph spaces. The shaded portion shows the nerve fibres supplied to the macular 
 region. (Merkel, Ball.) 
 
 The inner i)lexiforni layer and the nerve fibre layer apparently 
 cease at the margin of the fovea, although, according to Dogiel, a 
 wide-meshed plexus of fibres extends over the floor. 
 
 The membrana limitans interna continues unchanged over the floor 
 of the fovea. 
 
 The optic nerve proper is divided into an orbital and an intra- 
 cranial portion. The nerve pierces the eyeball at the posterior end 
 of the optic axis, about 3 mm. to the inner or nasal side, and about 
 1 mm. below the horizontal meridian. Here it forms the nerve-head, 
 optic papilla, or optic entrance. It is made up of nerve bundles 
 separated by connective tissue and lymph spaces. 
 
 The orbital portion of the nerve extends from the optic foramen 
 to the papilla. It is a round, S-shaped, whitish cord, 30 mm. in
 
 396 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 length, and about 5 mm. in diameter. The donbh curve permits of 
 free movement of the eyeball during its rotations. 
 
 This nerve has three sheaths, all derived from the Drain coverings. 
 The outer, or durol slicaili^ continuous with the dura mater, loosely 
 covers the nerve and at the globe blends with the sclera. The pial 
 sheath, an extension of the pia mater, directly encloses the nervo 
 bundles as a whole, and gives off the septa that divide them from 
 one another, thus forming part of the nervous framework. Between 
 
 Tiasai 
 
 temjwral 
 
 The Optic Nerve Entrance, Showing the Appearances by the Ophthalmoscope, and 
 
 a Sectional Yiew. (Fuchs.) 
 
 these two coverings is the arachnoid sheath, a delicate septum closely 
 joined to the dural sheath, with which it fuses near the globe ; some 
 of the fibres are recognizable in the tissues of the sclera. The 
 ■intervaginal space lies between the dural and pial coverings; it is 
 incompletely divided into two subpaces by the arachnoid sheath, 
 viz. : a sub-dural and a sub-arachnoid space, both of which com- 
 municate directly with the corresponding intracranial spaces. The 
 walls of these spaces are lined with endothelium, and are probably 
 true lymph channels. From the j^ial sheath and its septal prolonga- 
 tions into the optic nerve proper, numerous capillaries are supplied 
 to the nervous tissue, supplemented by twigs from the central retinal 
 vessels. 
 
 The existence of spaces Avithin the optic coverings, that com-
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 397 
 
 municate so directly with the brain, explains the lesions of the nerve 
 tissues in so many intracranial diseases. 
 
 If one examine a transverse section of the optic nerve, it will be 
 found to be made up of about 800 distinct medullated nerve fibres, 
 separated from one another by connective tissue septa, derived, as 
 just explained, from the pial sheath. 
 
 At the optic entrance, the outer layers of the sclera are continued 
 as the outer nerve sheath ; while the inner layers cross the nerve, 
 interlacing with the bundles to form a sieve-like opening called the 
 lamina cribrosa. At this point the fibres lose their medullary cover- 
 ing, and pass into the eye as naked, transparent axis-cylinders. 
 
 N N 
 
 Optic Chiasm. 
 
 a, Anterior cliiioid process; b, Medial cerebral vein: c. Carotid artery; d, 
 Posterior clinoid process; e, Oculomotor nerve; f. Trochlear nerve; g, Abducens 
 nerve; h, Superior petrosal sinus; i, Internal auditory meatus; j, Inferior petrosal 
 sinus; k, A'eins of basilar plexus; 1, Dorsum sellse; m, Sinus intercavernosus; n, 
 Infuudibulum; o, Ophthalndc vein. 
 
 Occasionally, however, the medulla is retained, producing in the 
 fundus oculi a dazzling white sheaf of opaque nerve fibres spreading 
 out from the disc. 
 
 A vascular circuit of nutrient vessels (circle of Zinn) surrounds 
 this region, and penetrates all of the coats of the eyeball. The canal 
 through Avhich the optic nerve enters the globe is the weakest part 
 of the eye coats, and is generally the first part to give way under 
 increased intraocular pressure, as, for instance, in glaucoma. 
 
 An optic nerve from each eyeball joins its fellow at the chiasma,
 
 398 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 which is situated in the optic sulcus of the sphenoid bone. One-half 
 of the fibres of each nerve pass over, join the opposite nerve, and 
 proceed toward the occipital lobe as an optic tract. These wind 
 around the crura cerebri, making connections with practically every 
 central neuron and Avith one another, until they reach and form the 
 parts surrounding the calcarine fissure of the occipital lobe, which is 
 known as the cortical center of cerebral vision. Thus each retina is 
 connected by nerve fibres with the great centers of both sides of the 
 brain. 
 
 The temporal or outer half of the right retina, and the nasal half 
 of the left retina are supplied by right sided fibres ; the nasal half 
 of the right retina and the temporal half of the left retina are in- 
 nervated from the left side of the brain. 
 
 The optic papilla (optic disc, porus opticus, nerve-head) rises above 
 the general level of the fundus 1.5 mm., as a result of the nerve fibres 
 becoming superimposed. This is the locality where the axis cylinders 
 and other tissues of the optic nerve enter the eyeball, bend over the 
 scleral margin, and are afterwards displayed upon the fundus oculi 
 as part of the retina. Seen by the ophthalmoscope, the nerve-head 
 is a pinkish, almost circular area from 1.5 mm. to 1.75 mm. in di- 
 ameter. It is situated about 3.5 mm. to the nasal side and about 
 1 mm. above the level of the fovea centralis. The central (or cen- 
 tral-nasal) four-fifths (or a larger portion in many instances) of the 
 disc is occupied by a funnel-shaped depression called the physiolog- 
 ical "cup,'" or excavation; this is to be distinguished from depres- 
 sions in the nerve-head due to diseased conditions. 
 
 It is here that the artcria centralis retime enters, and the corre- 
 sponding vena centralis retinae leaves, the eyeball. These vessels enter 
 the nerve 20 mm. from the sclera, and run between the nerve bundles 
 to the center of the disc, where they divide and subdivide dichotom- 
 ously until they disappear as minute capillaries. After leaving the 
 disc the chief branches are called the superior and inferior temporal, 
 and the superior and inferior nasal, arteries and veins. In addition 
 to these, fine branches run toward the macular region, and also 
 toward the nasal side. 
 
 The whitish or light pink appearance of the papilla, as seen with 
 the ophthalmoscope, is due to the fact that the lamina cribrosa and 
 the medullated fibres beyond it, are seen through the translucent 
 axis-cylinders that make up the substance of the papilla itself. Out- 
 lining the disc is the edge of the sclera ; when seen with the ophthal- 
 moscope it appears as the white scleral ring. In many cases, one may 
 also distinguish at the margin of the papilla some of the underl.ving
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 399 
 
 choroidal pigment, which shoAvs as a crescentic line, partially or com- 
 pletely surrounding the disc. Within all of these is the light-pink 
 color of the nerve itself. 
 
 Optic nerve fibres compose most of the papillary substance and do 
 not perceive light : hence we find with the perimeter that the disc 
 corresponds to a blind area or scotoma, called in this instance the 
 blind spot of Mariotte. 
 
 ITF 
 
 f \J^F_ 
 
 The Path of Light Impressions from the Eetina to the Occipital Lobe. 
 
 (Visual Center.) 
 
 In their course from the calcarine fissure in the brain the optic 
 radiations send fibres to almost every large center — both cerebral 
 and spinal — thus demonstrating anatomically Avhat the ophthalmolo- 
 gist has long known from clinical observation, viz. : that almost 
 every lesion of the brain or cord is sooner or later followed by morbid 
 alterations in, or functional disturbances of, some portion of the 
 visual mechanism. 
 
 To follow again and briefly the path of the optic fibres: — In the 
 occipital lobe they occupy a narrow area and rather shallow position 
 about the edges of the calcarine fissure. Passing forAvard and down- 
 ward toward the base of the brain from the calcarine fissure and 
 euneus, the optic fibres from each hemisphere dip beneath the angu- 
 lar gyrus, receiving numerous radiations from all the basal neurons, 
 especially from the oculomotor nuclei, external geniculate bodies, 
 the anterior corpora quadrigemina, the optic thalmus, the medulla,
 
 400 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 and the spinal cord. They then wind around the crus cerebri to 
 form the tractus opticus, and, meeting a similar collection from the 
 opposite side, join to form the chiasma or optic commisure. A semi- 
 decussation of the fibres now takes place; about one-half of the optic 
 fibres in each tract cross over and, uniting with half from the oppo- 
 site tract, become one of the two optic nerves. 
 
 Although many animals possess a chiasma, it is those that habit- 
 ually see with both eyes together, and obtain stereoscopic or binocu- 
 lar single vision (for example, birds, man and the higher monkeys) 
 that exhibit distinct crossed and uncrossed fibres in the chiasma, 
 optic nerve and retina. Such animals realize the height, breadth, and 
 depth of objects, and one readily attributes these three dimensions 
 to them. To accomplish these desirable ends, the light rays must 
 fall upon the corresponding points of each retina, and especially upon 
 
 The Eye as a Photographic Camera. (Baker.) 
 
 similarly placed areas of the macular region. At birth the two human 
 eyes do not see together; the infant expends from six months to a 
 year in acquiring binocular vision ; in the course of time he learns, 
 mostly by experience, to judge of the distance and locality of ob- 
 jects, as well as their physical characteristics. Should the individual 
 be born blind, and late in life obtain fair vision (as in the removal of 
 congenital cataracts) he must "learn to see" just as he would have 
 been obliged to do had he come into the world wdth a normal visual 
 apparatus. In many cases of earl}'^ squint, wdien the squinting eye 
 has been straightened, the patient must laboriously strain the cor- 
 rected eye to see and Avork with its fellow before binocular vision 
 can be attained. 
 
 The similarit}^ between a photographic camera and the human eye 
 is quite apparent. The light rays, having been properly focused by 
 the dioptric apparatus (cornea, iris, lens, ciliary muscle, etc.), fall 
 upon, and filter through, the various internal layers of the sensitive 
 plate called the retina, until they reach the rods and cones ; the tips 
 of the former are covered with a layer of eight-sided pigmented
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 401 
 
 epithelial cells. Here the incident imag-es are actuall}^ photo- 
 graphed; the rods and cones probably recognizing white light and 
 the form of objects ; the cones perceiving colors. The simile may be 
 carried still further, because the chemical changes that produce the 
 photographic picture take place equally in the retinal pictures and 
 in the sensitized films of the camera. It is well established that it 
 is due to actual photo-chemical changes in the visual purple (rhodop- 
 sin) Mdthin the choroido-retinal epithelium, and upon the tips of the 
 retinal rods, that visual images are photographed upon the back- 
 ground of the human eye. The visual sensations are then conducted, 
 by means of the optic nerve and optic tracts, to the psychic center 
 for vision in the posterior aspect (calcarine fissure) of the occipital 
 lobe, where, in conjunction with other neurons with which it is 
 joined, they are variously interpreted by the individual as the senses 
 
 Photograpbic Camera. (Baker.) 
 
 of light, form, color, optical memories, etc. If the rays of light fall 
 on corresponding portions of both retinse, a single image is the re- 
 sult; if they do not, double images (diplopia, or double vision) are 
 produced. The upper part of the retina sees objects in the lower 
 part of the field of vision ; the lower part perceives objects in the 
 upper part of the field of vision. In the same way the nasal half of 
 the retina perceives objects on the temporal side of the fovea, while 
 objects on the nasal side of the fovea are seen by the temporal half 
 of the retina. 
 
 The eyeball and its external appendages are placed within the 
 orbital cavity, which is pyramidal in shape. The walls of this cavity 
 are formed by no less than seven bones, namely, the superior maxilla, 
 frontal, sphenoid, malar, palate, lachrymal, and ethmoid. The inner 
 wall, which is very thin, separates the orbital cavity from the ethmoid 
 cells and the sphenoid sinus; it is formed by the nasal process of the 
 superior maxilla, the internal angular process of the frontal, the os 
 planum of the ethmoid, the lachrymal bone, and the body of the sphe- 
 
 Vol. 1—26
 
 402 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 noicl. The orbital roof, in front, is the orbital plate of the frontal 
 bone at the ajDex, behind, it is the lesser wing of the sphenoid. It 
 sometimes happens that a portion of the roof of the orbit, which is 
 always thin, is lacking, in which case the periosteum and dura are in 
 close apposition. Stabbing injuries of the orbit may easily be fatal 
 owing to this ready access to the brain cavity. On the other hand, 
 very large foreign bodies may be retained in the cavity of the orbit 
 
 Horizontal Section of the Orbit, Showing the Central Artery and the Seat of 
 Lesions in Both Bulbar and Retrobulbar Optic Neuritis. 
 
 a. Optic Nerve; b, Eyeball; c, Extraneural portion of the central artery of the 
 retina; c, The intraneural portion; d. External wall of the orbit; e, Ethmoid 
 cells; f. Internal carotid; 1, Possible situation of optic lesions in bulbar neuritis; 
 2, Possible situation of optic lesions in retrobulbar neuritis. 
 
 without raising a suspicion of their presence, owing to the compara- 
 tively wide space existing between the globe and the orbital walls. 
 The outer wall of the orbit is formed behind by the greater wing of
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 403 
 
 the sphenoid; in front by the orbital ])rocess ot tlie niahir bone, and 
 the external angular process of the frontal bone. The floor of the or- 
 bit, which slopes downward, forward, and outward, is composed of 
 the orbital plates of the superior maxilla and the palate bone, and the 
 orbital process of the malar bone. It forms the roof of the antrum 
 
 n.s. 
 
 / V 
 
 A 
 
 S.o 
 
 .^^ '^ / n. ■'5 up. I . 
 
 r.p 1- — 
 
 , n.inf. 
 
 
 - S.rtL 
 
 ip 
 
 nt 
 
 - r. 10. 
 
 an 
 
 Septum Orbitale, Viewed from in Front. The m. orbicularis oeuli has been 
 
 dissected oft'. (After Sjialteholz.) 
 
 S.O., septum orbitale; t.s., tarsus superior; r.p.l., raphe palpebralis lateralis; 
 t.i., tarsus inferior; o.z., os zygomaticum; n.s., n. supraorbitalis; o.f., os fron- 
 tale; r.f., n. f., n. frontalis; n. sup. t., n. supratrochlearis ; n. inf., n. iufratroch- 
 learis.; p.f.m., proc. frontalis; s.m., saccus lachrynialis ; l.p.in., ligament, palpebral, 
 median.; r.p., rima palpebrarum; cm, cori)us maxilla^; n.i., n. iufraorbitalis. 
 
 of Highmore. The margins of the orbit are composed of a hard, and 
 very strong, bony ring, well calculated to resist blows and other 
 forms of injury from blunt weapons. The depth of the cavity, when
 
 404 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 not covered with soft parts, is about 1% inches ; at its anterior open- 
 ing, or base, the vertical diameter is about 1^/4 inches, and the trans- 
 verse diameter about li4 inches. 
 
 Of the nine openings into the orbit, the most important ones are 
 the optic foramen and the sphenoidal fissure at the apex of the cavity. 
 
 Through the former pass the optic nerve and the ophthalmic artery, 
 a branch of the internal carotid. The latter foramen gives passage 
 to the motor nerves of the eyeball (the third, fourth, and sixth 
 cranial nerves) ; to the three branches of the oplithaln:ic division of 
 the fifth cranial nerve ; to filaments from the cavernous plexus of the 
 sympathetic ; the" orbital branch of the middle meningeal arterj" ; a 
 recurrent branch from the lachrymal artery to the dura mater; and 
 to the ophthalmic vein. 
 
 Nerves and Vessel Passing thiougli the Sphenoidal Fissure. 
 
 a. Lachrymal nerve; b, Frontal nerve; e, Fourth cranial nerve; d, Superior di- 
 vision of third cranial nerve; e, Nasal nerve; f, Inferior division of third cranial 
 nerve; g, Sixth cranial nerve; h, Ophthalmic vein. 
 
 In addition to these openings, are the supraorbital and infraor- 
 bital foramina (through which pass like-named filaments of the oph- 
 thalmic division of the fifth nerve), and the bony canal for the nasal 
 duct. The last named canal runs downward, outward, and backward, 
 as a rule ; although its direction varies somewhat even in normal 
 skulls. It opens into the inferior meatus of the nose underneath the 
 inferior turbinate bone. 
 
 The orbital contents, forming a soft, cone-shaped mass that accu- 
 rately fits the cavity, consist of the eyeball with its envelopes, the 
 extra-ocular muscles, blood vessels, lachrymal apparatus, optic, cili- 
 ary, and other nerves and numerous ganglia, with considerable
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 405 
 
 adipose and connective tissue, which fill out the interspaces. These 
 various structures are held together by prolongations of the orbital 
 fascia, which is a continuation of the dura mater. 
 
 Blood Vessels of Eyeball. 
 
 a. Long posterior ciliary artery, 
 
 b. Vena vorticosa. 
 
 c. Short posterior ciliary arteries. 
 (1. Conjunctival artery. 
 
 e. Conjunctival vein. 
 
 f. Anterior ciliary artery. 
 
 g. Anterior ciliary vein. 
 
 h. Central artery of retina. 
 i. Central vein of retina. 
 s. Canal of Schlemm. 
 
 The orbital fascia linos both the optic foramen and the sphenoidal 
 fissure, and gives oft' coverings to all the important nerves and ves- 
 sels that pass through them. It is prolonged forward as a covering
 
 406 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 of the extra-ocular muscles, and also forms the thin, tough periosteum 
 of the orbit. As this latter structure, it continues forward to near 
 the margin of the orbit, where it divides into two layers — one is con- 
 tinuous with the periosteum of the orbital margin, the other joins 
 the fascia of the lids connected with the tarsal cartilages, and forms 
 the fascia tarso-orbitalis, or orbital septum. When the lids are 
 closed, a temporary anterior wall of the orbit is formed. 
 
 Arteries of Bight Orbit from Al>ove. 
 
 a, Supraorl)ital artery; b, Anterior meningeal artery; c, Frontalis artery; d, 
 Superior oblique muscle; e, Anterior ethmoidal artery; f. Posterior ethmoidal 
 artery; g, Posterior ciliary arteries; h, Muscular ramus; i, Optic nerve; j, Oph- 
 thalmic artery; k, Optic chiasm; 1, Internal carotid artery; m, Anterior clinoid 
 process; n, Lachrymal artery. 
 
 The fascia also forms the capsule of Toion, a thin, translucent, 
 fibrous membrane, which covers the posterior two-thirds of the globe 
 from the tendinous insertion of the straight muscles which pass 
 through it, to the optic nerve, with the external sheath of which it is 
 identical. A second layer separates the ej'eball from the bed of fat 
 upon which it rests. The two layers form a closed sac {Tenon's 
 space), lined, in part, by flat, endothelial cells. This sac is thought 
 by some to constitute a true lymph space, and to communicate with 
 the arachnoid and dural spaces of the optic sheath. Tenon's capsule 
 also forms, with the tendons and part of the bellies of the orbital 
 muscles, a sort of cup-like receptacle, which not only cuts off im- 
 portant organs of the orbital cavity from the outside world, limiting
 
 ANATOMY (GROSS) OF THE HUMAN EYE 407 
 
 the danger from external agents, ])n1, at the same time, enables the 
 globe to be rotated by the extra-ocular muscles, without friction. 
 
 Lymphatic vessels and glands are not found in the orbital cavity. 
 
 The oplilhalmic artrri/, a branch of the internal carotid, enters the 
 orbit b}^ way of the orbital foramen, below, and on the outer side of 
 the optic nerve. It crosses over the nerve and passes forward along 
 the inner Avail of the orbit Ix'low the superior oblitjue muscle, ter- 
 minating in a frontal and a nasal branch; the latter gives off a 
 branch to the upper part of the lachrymal sac. 
 
 The lachrymal, or first bi-anch of the ophthalmic artery, is given 
 off near the optic foramen, and passes forwai'd along the upper bor- 
 der of the external rectus to the lachrynud gland; after leaving the 
 gland its terminal branches sup])ly the lids and conjunctiva, aiuisto- 
 mosing with the palpebral arteries. 
 
 The superior and inferior muscular, and the long and short pos- 
 terior ciliary branches, are given oft' a little farther forward. 
 
 The supei-ior muscular branch supplies the levator palpebrae superi- 
 oris, the superior rectus, and the superior oblique, but is not con- 
 stant. 
 
 The inferior muscular branch passes forward between the optic 
 nerve and the inferior rectus ; it supplies the external, internal, and 
 inferior recti, and the inferior obli(iue. From the muscular branches 
 — chiefly the inferior — are derived the anterior ciliary arteries, which 
 pierce the sclera near the corneal limbus to supply the interior of the 
 eyeball. Before entering the eyeball, however, they give off branches 
 Avhich terminate in the vascular plexus sun-ounding the cornea. 
 
 Both the long and sliort posterior cilianj arlerics run directly 
 forward to the eyeball, and pierce the sclera near the entrance of the 
 optic nerve. The short posterior ciliary arteries (arteriaj ciliares 
 posteriores breves) are from six to twelve in number: they pass di- 
 rectly into the perichoroidal space and sui)ply the ])()8teri()r half of 
 the uveal tract, and the optic nerve, about which a few of the 
 branches form a circle of anastomosis — circulus arteriosus nervi 
 optici. The long i)osterior ciliary arteries (arteria' ciliares 
 posteriores longa^), two in number — one on the nasal side and one on 
 the temporal side — are of large calibre. They run forward in the 
 perichoroidal space to the front of the eyeball, without giving oft' any 
 intermediate branches, supply the ciliary muscle and terminate in 
 the arterial circles of the iris, aiuistomosing with the anterior ciliary 
 arteries. 
 
 The central artery of the retina {arlcria ccnfraJis relink) is one 
 of the smallest branches of the ophthahnie. It arises near the origin
 
 408 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 of the branches just described, and pierces the optic nerve obliquely 
 about 20 mm. from the sclera. Upon entering the eyeball through the 
 optic disc it is distributed over the retina as previously described. 
 
 Horizontal Section of Orbit. 
 
 a. Tarsus. 
 
 b. Orbicularis. 
 
 e. Muscle of Horner, 
 d. Outer palpebral ligament. 
 6. Inner check ligament. 
 
 f. Attachment of Tenon's capsule to 
 
 conjunctiva. 
 
 g. Outer check ligament. 
 h. Capsule of Tenon. 
 i. Space of Tenon, 
 j. Conjunctival sac. 
 
 The supraorbital branch, after leaving the main artery, passes up- 
 Avard above all the orbital muscles, and courses forward between the 
 levator palpebrre superioris and the periosteum of the orbit to its 
 
 k. Iris. 
 
 1. Ciliary process. 
 
 m. Septum orbital. 
 
 n. Lachrymal gland. 
 
 0. Optic nerve. 
 
 p. Lateral wall of orbit. 
 
 q. Mesial wall of orbit. 
 
 rr. Orbital fat. 
 
 s. Internal rectus. 
 
 t. External rectus.
 
 ANATOMY (GROSS) OF THE HUMAN EYE 409 
 
 point of exit at the supra-orbital foramen. It supplies the levator 
 palpebral superioris, and the superior rectus muscle; also parts of 
 the inner canthus. 
 
 The palpebral, arteries, superior and inferior, are given off from 
 the ophthalmic artery near the pulley of the superior oblique. They 
 are distributed to the eyelids, where they form a superior and in- 
 ferior tarsal arch. The superior palpebral anastomoses at the outer 
 angle of the orbit Avith the orbital branch of the temporal, and with 
 a branch of the lachrA^mal artery ; the inferior palpebral anastomoses 
 at the outer angle of the orbit with the transverse facial and a 
 branch of the lachrjanal — on the opposite side of the lid with a 
 branch of the angular artery from the facial. From the latter 
 anastomosis a branch is supplied to the nasal duct, and is found 
 ramifying in its mucous membrane as far as the opening of the duct 
 into the inferior meatus of the nose. 
 
 Other branches of the ophthalmic, which do not directly supply 
 the eyeball or the orbit, are the anterior and posterior ethmoid 
 arteries, and the malar branches of the lachrymal. 
 
 The ophtJialmic vein pursues a course similar to that of the artery. 
 Corresponding to the posterior ciliary arteries are the venee vorticosje, 
 of which there are ordinarily four. The tributaries of the ophthalmic 
 vein converge into a short, single trunk, leaving the orbit b}^ way of 
 the sphenoidal fissure, and empty directl}^ into the cavernous sinus. 
 The veins from the floor of the orbit may collect into a separate 
 trunk known as the inferior ophthalmic vein. When present, it 
 either joins the ophthalmic vein, or opens directly into the cavernous 
 sinus; or it may leave the orbit through the spheno-maxillary fissure. 
 
 The nerves of the orbit include the third nerve (oculomotorius) 
 which enters the orbit through the sphenoidal fissure between the 
 two heads of the external rectus muscle. It has two divisions, a 
 superior and an inferior. The superior division is the smaller, and 
 supplies the superior rectus and the levator palpebral superioris. 
 The inferior division has three branches which supply, respectively, 
 the internal rectus, inferior rectus, and the inferior obli(iue; the 
 latter branch is the largest of the three, and gives off a short, thick 
 branch to the lower part of the lenticular ganglion, forming its in- 
 ferior, or motor, root. 
 
 The fourth nerve (trocJilearis) enters the orbit by way of the 
 sphenoidal fissure, passes above all of the other nerves, and supplies 
 the superior oblique muscle. 
 
 The ophthalmic, or first division of the fifth {trigennnns), which 
 is the smallest of the three divisions, furnishes the sensory supply to
 
 410 
 
 ANATOMY (GROSS) OF THE HUMAN EYE 
 
 the eyeball, the lachrymal gland, and the conjunctiva. It enters the 
 orbit through the sphenoidal fissure, after first dividing into three 
 branches — the lachrymal, frontal, and nasal. 
 
 The lachrymal branch enters the orbit in a separate tube of dura 
 mater, and accompanies the lachrymal artery along the superior 
 border of the external rectus. It gives off filaments to the lachrymal 
 gland, and, continuing on forward, terminates in the skin of the 
 upper lid. 
 
 Ciliary Nerves. 
 
 a, Short ciliary nerve j b, Long ciliary nerve; c, Vena vorticosa; d, Sclera; 
 e, Choroid; f, Ciliary muscle; g, Cornea; h, Iris. 
 
 The frontal branch, or largest division of the ophthalmic, enters 
 the orbit through the sphenoidal fissure above the muscles, and, in 
 its course through the orbital cavity to the brow, lies between the 
 levator palpebne superioris and the periosteum. 
 
 The nasal branch enters the orbit between the two heads of the 
 external rectus ; it passes obliquely across the orbit beneath the leva- 
 tor palpebne superioris and the superior rectus to its point of exit 
 from the orbit. This division of the fifth nerve has three branches — 
 ganglionic, long ciliary, and infratrochlear. 
 
 The ganglionic branch forms the superior or long root of the len- 
 ticular ganglion, and is a sensory root. 
 
 The lo)ig ciliarii nerves, of which there are two or three, are derived 
 from the naso-ciliary branch of the ophthalmic division of the fifth 
 cerebral nerve. They pierce the sclera on the medial side of the 
 optic nerve near its entrance into the eyeball, unite with the short 
 ciliary nerves inside the sclera, and pass forward in the perichoroidal
 
 ANATOMY (GROSS) OF THE HUMAN EYE 411 
 
 space, to the eiliary j^lexus, from wlieiiee they are distributed to the 
 ciliary niuscle, iris, and cornea. In llicir course, they give oft' 
 branches to the sclera and choroid. 
 
 The infratrochlear bi-aiich is given oft' just before tlie nasal branch 
 leaves the oi-bit. It su|)[)lies the skin of the lids at the inner angle; 
 also the conjunctiva, lachrymal sac, and lachrymal caruncle. 
 
 The lenticular, or ciliary ganglion, which lies at the back of the 
 orbit between the external rectus muscle and the optic nerve, is about 
 the size of a ])in-]u'a(l. It is (|uadrangular and flattened in shape, 
 and has a grayish-red color. There are three roots or branches of 
 communication, namely, a long sensory root from the nasal branch 
 of the ophthalmic, a short motor root from a branch of the third 
 nerve supplying the inferior oblique, and a third or sympathetic root 
 from the cavernous plexus of the sympathetic. Its branches of dis- 
 tribution are the shoi-t ciliary neryes previously described. 
 
 The sixtli {ahduccns) nerve enters the orbit through the sphenoidal 
 fissure, passing between the two heads of the external rectus muscle, 
 which it enters and supplies. 
 
 It will have been noticed that most of the ocular sijsliyns appear in 
 gronps of three. 
 
 First of all, there are tJiree ehi(f vascular sijstems: (1) the retinal 
 supply from the central artery and vein of the retina — branches of 
 the ophthalmic vessels; (2) the posterior ciliary vessels (long and 
 short), including the four venae vorticosae; and (8) the antei'ior ciliary 
 vessels. The accompanying diagram shows the parts nourished by 
 each system, and illustrates the fact that the choroid is the chief in- 
 termediary through which the vascular supply of the external and 
 anterior portions of the eye is connected with the optic nerve, retina, 
 and other organs in the posterior segment of the globe. Infective 
 and other agents absorbed by the vessels of the external ocular ap- 
 pendages may thus be carried to the iris, ciliary body, choroid, retina, 
 optic nerve, or even into the general circulation. 
 
 Another diagram still further illustrates this circulation of the 
 ocular fluids, and explains the intimate connection, by means of its 
 lymph channels, not only between the internal and external tissues 
 of the eyeball, but between all parts of the globe and the general 
 lymphatic system. The same statement holds true of the sympathetic 
 nerve supply to the eyeball and its appendages; so that it is easily 
 understood not only why, for example, eye-strain may produce head- 
 ache, brain-fag, nausea, vertigo, and many other distant reflexes, 
 but also why functional diseases of the organs of the body so fre- 
 quently att'ect the visual apparatus.
 
 412 ANATRIPSIE 
 
 There are three optic nerve sheaths, corresponding to the cerebral 
 coverings — dural, i)ial, and arachnoid. The optic spaces also com- 
 municate with the three brain spaces. 
 
 It may be added that this intimate connection between the blood- 
 vessels and the lymph sj^aces of the eyeball, and those of other or- 
 gans of the body, is largely responsible for many organic lesions of 
 the ocular structures. The causes that underly a number of the 
 . commoner diseases of the eye are really systemic in character, and 
 very often originate in quite distant tissues. 
 
 The coats, or tunics, of the eyeball are three — (1) the cornea and 
 sclera; (2) the iris, choroid and ciliary body; and (3) the retina. 
 
 Furthermore, there are three principal chambers — (1) anterior 
 chamber; (2) posterior chamber; and (3) vitreous chamber. 
 
 There are also three refractive media— (1) the aqueous humor; 
 (2) the crystalline lens with its capsule; and (3) the vitreous humor. 
 
 Another ocular study in "threes," — the three motor nerves 
 which supply all the muscles of the eyeball. These are (1) the fourth 
 nerve, supplied to the superior oblique; (2) the sixth nerve to the 
 external rectus; and (3) the third nerve — the oculo-motor proper — 
 supplying every other muscle, extra- or intra-ocular. 
 
 The orbicularis palpebrarum, or sphincter muscle of the lids, is, 
 of course, not a true globular appendage; it is innervated by motor 
 fibres from the facial nerve.- — (A. N. M.) 
 Anatomy of the intra-cranial portion of the visual apparatus. See 
 
 Neurology of the eye; also Intracranial organs of vision. 
 Anatripsie. (G.) Friction. 
 Anatropia. Also written anotropia. Upward squint. See Muscles, 
 
 Ocular. 
 Anaxagoras (surnamed "mind"). This celebrated philosopher, as- 
 tronomer, and speculative physician was born at Clazomenae in Asia 
 Minor, B. C. 500, and died at Lampsacus, 428. Friend and teacher 
 of Pericles, he was a man of great influence, but, merely because he 
 insisted on regarding the planets and the moon as bodies very similar 
 to the earth, he was forthwith convicted by the Eumolpidie of 
 impiety, and compelled to flee for his life. Contrary to the received 
 opinion of his time he taught that, instead of four primary sub- 
 stances — or, as we might say today, "chemical elements" — namely, 
 earth, air, fire, and water, there were just as many elementary sub- 
 stances as there are kinds of matter evident to our senses. Thus, 
 he thought that, in all sorts of food — bread, water, flesh, fruit — 
 there existed infinitely minute particles of bone, hair, skin, muscle, 
 etc., which the corresponding tissues of the body sought out from
 
 ANBOHREN 413 
 
 the food (after its digestion) and appropriated to themselves. As- 
 similation, therefore, was, with him, merely appropriation. The 
 cause of disease, he taught, was the penetration of the bile into the 
 blood-vessels, the pleura and the lung. Eye diseases, of course, were 
 so produced, as well as diseases of the other parts of the body. 
 
 Ophthalmologieally, however, Anaxagoras is of interest chiefly 
 because of his theory of the nature of vision. This philosopher be- 
 lieved (in common with Alcmaeon and Democritus) that from every 
 illuminated object minute pictures, or casts, of that object are con- 
 tinually being detached, and that, of these casts, some, passing into 
 the pupil, are there fixed, and so perceived by the soul. This we can 
 verify, as he believed, by gazing into another person's eye, where 
 we can easily discern the image of ourselves in the pupil. A very 
 different view of the visual act was that held by Empedocles, 
 Diogenes, and Plato. These theorists believed that rays of energy 
 proceed both from the object and from the eye, and that, meeting 
 at some point between the eye and the object, they beget a third 
 variety of rays, i. e., the so-called picture-rays. These picture-rays 
 are those which are finally perceived by the soul. More like the 
 modern explanation of light and vision was that of Aristotle. His 
 view, however, did not obtain general acceptance in antiquity. — 
 (T. H. S.) 
 
 Anbohren. (G.) To puncture. 
 
 Anbohrung. (G.), n. Paracentesis, trephining. 
 
 Anchiloblefaro. (It.) Ankyloblepharon. 
 
 Anchilops. (L.), m.n. (Obs.) Lachrymal abscess. 
 
 Anchyloblepharon. See Ankyloblepharon. 
 
 Anchylops. (Obs.) Incorrect spelling of anchilops, a lachrymal 
 abscess. 
 
 Ancients, Ophthalmology among the. See History of ophthalmology; 
 Charlatanism in ophthalmic practice. 
 
 Ancubitus. (L.), m.n. An obsolete term denoting an irritable or 
 irritated eye. 
 
 Anderfarbig. (G.), adj. Changeable in color. Not of uniform color. 
 
 Andersartig. (G.) Heterogeneous. 
 
 Andrade, Eduardo Penny. This well known specialist in diseases of 
 the eye, ear, nose and throat, as Avell as excellent bacteriologist, was 
 born at Maracaibo, Venezuela, Feb. 2, 1872, and there received his 
 early education. He entered the Medical Department of the National 
 College of Maracaibo in 1888, migrated next year to the University 
 of Caracas, and finally received his professional degree at George- 
 town Universitv in 1895.
 
 414 ANDRANG 
 
 He was then a member for two years of the Venezuelan Legation 
 at Washington. While in this city he studied bacteriology in the 
 hygienic laboratory of the Marine Hospital Service. Next he de- 
 voted himself to diseases of the eye, ear, nose and throat. In 1901 
 he entered upon a course of study at the New York Ophthalmic and 
 Aural Institute. In 1902 he went to Cuba, and graduated there at 
 the University of Havana. Shortly afterAvard, he proceeded to Jack- 
 sonville, Fla., where he became director of the state bacteriological 
 laboratory^ — a position which he held until his death, which occurred 
 Sept. 20, 1906. 
 
 Andrade was a very versatile man, spoke several languages, was a 
 fine extemporaneous orator and made many friends. 
 
 He is said on good authority to have been the first to discover the 
 existence of Malta fever in Venezuela and the first "to find and re- 
 port" a case of filariasis in the State of Florida.— (T. H. S.) 
 
 Andrang-. (G.) Congestion, fluxion. 
 
 Andreae, Augnst Wilhelm. This highly distinguished oculist and his- 
 torian of ophthalmology was born at Neuhaldensleben, Germany, 
 May 27, 1794, and died Mar. 7, 1867. His father before him was a 
 physician of some prominence. Graduated in 1814 at the University 
 of Berlin, August Wilhelm entered at once on the performance of 
 his professional duties in the Chief Field Hospital of the Prussian 
 Body Guard. In this capacity he accompanied the army on the 
 second and the last expedition against Napoleon. Returning from 
 the wars in 1815, he studied ophthalmology for two years at Vienna, 
 under Beer and Jaeger. In 1817 he settled at Magdeburg for the 
 practise of his specialty. 
 
 However, like many another distinguished oculist, he was not 
 merely an eye-doctor. At the College of Medicine and Surgery at 
 Magdeburg, he delivered lectures not only on ophthalmology but 
 also on general pathology and on therapeutics, and, it would seem, 
 with remarkable success in all three of these branches. He became 
 also a director of the College, as well as medical adviser to the gov- 
 ernment, and, in addition to the very exacting activities implied by 
 these positions, he performed the still more exhausting functions of 
 a prolific and interesting general medical and special ophthalmologic 
 writer. 
 
 Among his medical works may be mentioned the following: 
 Grundriss der gcsamten Augenheilkunde (in two parts, 1834 and 
 1837, 2d ed., 1846). This is not a large treatise but is a clear, exact 
 and interesting monograph. It has been pronounced by no less an 
 authoritv than Magnus "the best ophthalmic text-book of the pre-
 
 D'ANDRES TEST 415 
 
 ophthalmoscopic period." Othei's tire. Aus <l<n Vortragcn iiber 
 specielle AugoiJuilkHiidc, Prograiiini IH.'U. ['Ixr die Augenentzibi- 
 dung i)h AUg< hk iii( )t, Prograimn, IS:}."). Z iir (iHcsten (Jcschwhte der 
 Augeyiheill'undc Progrannii. 1841. 'IMie woi-k last named, though to 
 some extent suix-rscdcd by later treatises, is still of very gr-eat inter- 
 est to all who delight in the history of ophthalmology. It may be 
 said of his Die AugenheiUninde d(s JUppocrahs, Progrannn, 1843, that 
 it is a work of monumental scholai-ship (the tirst of its kind after 
 Wallroth's Syntagma dc OpliiJiahnologia, Vctcnun). llirschberg de- 
 clares "it deserves high praise, because it brings carefully together 
 every passage of the great Hippocratie collection wdiich deals either 
 wnth the eye or with ocular diseases, or with the treatment of these 
 affections, and lias thereby rendered lighter the task of all subse- 
 quent workers in the same field, myself included." — (T. H. S.) 
 d 'Andre's test. This is a test box for detecting simulation of unilateral 
 blindness, a modification of the instrument of Fles, w^hich is in- 
 tended to induce the malingerer to see w-ith his pretended blind 
 eye an object which he thiidvs he is seeing witii his sound eye. It 
 is fully described in the Fecueil dc Nemoires de Medicine, 1882, p. 4. 
 Andrew's intracapsular cataract operation. Andrew (On the Extrac- 
 tion of Senile Cataract in its Capsule. Brit. Med. Jour., 1883, Vol. 
 I, p. 41-44) has described the folloAving operation, which was per- 
 formed under an anesthetic : Through an upper section with iri- 
 dectomy, no speculum being used, the lens is detached with a piece 
 of stiff ware one inch in length mounted on a handle having a point 
 smooth and rounded, and a line to a line and a half of its extremity 
 bent at a right angle. An instrument has been formed to be used 
 in the following manner. 
 
 Either before or after the section a minute opening is made in tlie 
 cornea close to the margin by a small bent broad needle. The insrru- 
 ment is passed into the anterior chamber sidewise over the lens aud 
 under the iris until it reaches its margin. The point is now turned 
 downward and the ligament appears with ease. Following the edge 
 as a guide it may be torn to any extent that the operator may desire. 
 If after the section the instrument is introduced through any part of 
 the opening found most convenient and wdiicjiever course it follows 
 being under the iris, that structure is scarcely touched. The en- 
 deavor is to tear the ligament wdthout the slightest injury to the 
 vitreous body, and to accomplish this in the manner above men- 
 tioned the bent portion is of different length in order to adapt it to 
 an arched or flat cataract. The lens, on slight pressure by a tortoise-
 
 416 ANDREWS' INTRAOCULAR SYRINGE 
 
 shell curette, may be gently eased through this one opening without 
 the aid of any extraction instrument. — (D. W. G.) 
 
 Andrews' intraocular syringe. Joseph A. Andrews' syringe to remove 
 cortical matter in cataract extraction is simply a half-ounce bottle, 
 fitted with a hollow ground stopper drawn out into a tube which 
 terminates in a smooth point and is slightly curved. A rubber nipple 
 serves to draw up and inject the fluid contained in the bottle. 
 (Trans. Am. Oph. Sac, 1892, p. 455.) — (P. G.) 
 
 Andrew's operation for closing the interpalpebral space. When the 
 patient cannot or will not wear a prothesis it is better to close the 
 socket than have him wear an unsightly patch or other eye-cover all 
 his lifetime. For this jDurpose Andrew, in 1885, suggested the fol- 
 lowing improvement on the Streatfeild operation: 
 
 "An incision is made with scissors into the ocular conjunctiva, half 
 an inch from the corneal margin, and this incision is carried around 
 the ball; the conjunctiva is now freely detached all around, until 
 the edges of the lid-cartilages are reached, when the conjunctiva at 
 the inner angle of the eye, with the caruncle, etc., is most carefully 
 removed, as this is the only part where some difficulty of healing 
 sometimes takes place ; the conjunctiva of the outer angle is now 
 similarly dealt with, the edges of the palpebral angles pared, the 
 cartilages entirely dissected away, and a sufficient strip of the free 
 borders of the lids removed, to include all the roots of the lashes, 
 and lastly the ball is excised ; the lids are merely brought into apposi- 
 tion, or the palpebral opening may be lessened by one or two sutures 
 at each end, leaving the centre for drainage. It is advisable that the 
 various steps of the operation should be carried out in this order, so 
 that the bleeding may less obscure these manipulations." See, also. 
 Orbit, Operations on. 
 
 Andrieu, von. A celebrated itinerant quack, who, in 1748, announced 
 himself in Paris as "the celebrated eye-operator from Lyons." His 
 services were much in request for a time, but little else is known 
 about him.— (T. H. S.) 
 
 Anectasia. (L.), n.f. Lack of normal size in an organ. 
 
 Aneignung. (G.) Assimilation. 
 
 Anekkrisie. (G.) Absence of secretion. 
 
 Anel, Dominique. This distinguished ophthalmologist was born at 
 Toulouse in 1769. According to Pansier, he was an Italian, but, as 
 Hirschberg has pointed out, this is undoubtedly a mistake. 
 
 When a mere boy he became a kind of menial assistant to a sur- 
 geon in the St. Jacques Hospital at Toulouse, and, while serving in 
 this capacity, made some slight discovery in connection with osteo-
 
 ANEL, DOMINIQUE 417 
 
 malaeia. The discovery was reported in a journal, and, by this inci- 
 dent, the young man's surgical ambitions became thoroughly aroused. 
 After a short period of study he was accepted as surgeon on a French 
 man-of-war. Returning from the navy he betook himself to Paris, 
 where he exj^ected preferment through the intervention of a rich 
 and powerful relative. Various events, however, conspired to dis- 
 arrange his plans, and the result was that, for three years and a 
 half, he studied in the Jardin Royal, the School of Medicine, the 
 Amphitheatre of St. Come, the Hotel Dieu and the Charite. Then, 
 for a very short time, he served as surgeon major to a regiment of 
 infantry. During this period, however, he made a number of poAver- 
 ful friends, and, at its close, by special invitation from the Viennese 
 Court he journeyed to the capital of Austria to consult with the 
 famous de Tondeur, Surgeon to the Emperor. The two j'ears next 
 succeeding he spent in Vienna. Then we find him, at the invitation 
 of a friend, a German nobleman, accepting a position with the army 
 in Italy. He accompanied the troops on three expeditions, and also 
 spent much time in Rome, Bologna and Florence. All the while he 
 was studying, observing, investigating. 
 
 In Mantua he was made Doctor of Surgery. 
 
 In Turin he was appointed body-physician to the queen. 
 
 On the way back to his native town — Toulouse — he was taken ill 
 in Genoa, and there — in consequence, it seems, of the illness — he 
 spent three years. 
 
 In 1716 he went to Paris, where he limited his practice to diseases 
 of the eye and became famous. 
 
 He died about 1730, at the age of 51, immortal j yet, as it would 
 seem, with his work not half accomplished. 
 
 His greatest services lay, of course, in the field of ophthalmology, 
 especially in the surgery of the lachrymal apparatus. It was in 
 1712 — 200 years ago — that he performed the first of his long series 
 of operations for the relief of lachrymal fistula — the nature of which 
 will be indicated in this sketch a little later. This was in the case of 
 the Abbe Fieschi, who was sound and well of his double-sided lachry- 
 mal troubles in exactly six weeks — a remarkable result for those 
 days. 
 
 A brief review of the surgery of the lachrymal apparatus, as this 
 slender branch of the healing art existed (one cannot say flourished 
 or developed) from the earliest times until the day of Anel, will help 
 us to appreciate the debt which we OAve to this man of most un- 
 doubted genius. 
 
 In ancient Babylonia, as we learn from the Code of Hammurabi 
 
 A'ol. 1—2 7
 
 418 ANEL, DOMINIQUE 
 
 (2250 B. C.) the method of treating "an abscess of the eye" con- 
 sisted simply and solely in the use thereon of a knife. From Hip- 
 pocrates (300 B. C.) — even from Father Hippocrates — we learn prac- 
 tically nothing whatever concerning the subject in question. From 
 the "De Medicina" of Aulus Cornelius Celsus (first century A. D.) 
 we ascertain that "lachrymal fistulaB" were treated in three ways — 
 viz., by excision, by cauterizing with chemicals, and by the actual — 
 i. e., hot metal — cautery. A century later came Galen. From him, 
 the ruling spirit, medically, of the Middle Ages, we learn of three 
 more or less novel means of treatment, as follows: (1) Excision of 
 the canthus, followed by the drilling of several small holes through 
 the bone into the nose, and then the application of caustic medicines. 
 (2) Denudation of the bone, followed by the application of the actual 
 cautery. (3) Incision down to the bone, followed by the insertion of 
 a metallic funnel and the pouring down on to the bone, through 
 the funnel, of molten lead. From Paulus Aegineta, who lived in the 
 7th century A. D., just before the destruction of the great Alexan- 
 drian library, and who undoubtedly summed up in the ophthalmic 
 portion of his " ' C cnnpendin m of the Healing Art" the oplrthalmologic 
 learning of antiquity, we find absolutely no further advance in lach- 
 rymal medicine or surgery. Among the Arabs — whom we mention 
 in this connection merely for the sake of completeness — we find, as 
 to lachrymal affairs, merely a repetition of Paulus Aegineta. In 
 medical Christendom still no more improvements. Coming to the 
 modern era, one would naturally suppose that the anatomical dis- 
 coveries of Vesalius and Fallopia would have resulted in correspond- 
 ing surgical advances. Yet such was not the ease, that is as regards 
 the lachrymal apparatus. 
 
 It was only in the 18th century that any decided improvement over 
 the lachrymal surgery of antiquity began to be apparent. This was, 
 in part, the result of the anatomical discoveries of Morgagni (Advers. 
 Anat. 1706). It was, however, due in very much greater degree — 
 not speaking of Anel as yet — to the improvements in lachrymal 
 theory and practice made by Georg Ernest Stahl, whose little book, 
 entitled Programm. dc Fistula Lacrimale (1702) Avas the first work of 
 consequence on the subject in question since the time of Claudius 
 Galen. The theory which Stahl laid down was, in brief, that the so- 
 called "lachrymal fistula" was not — as all had hitherto supposed 
 from the earliest ancients down to Stahl's time — owing to some affec- 
 tion — swelling or atrophy — of the lachrymal caruncle, but, very dif- 
 ferently, to disease of the canaliculi, the lacus lachrymalis, or the 
 lachrymo-nasal canal, resulting in stenosis, complete or partial, of 
 one or another of these passages. The procedure which Stahl de-
 
 ANEL'S LACHRYMAL SYRINGE 
 
 419 
 
 scribes in liis little book is very ingenious. It consists in the intro- 
 duction, through the upper punctum, of a catgut violin string into 
 the lacus lachr^^malis, then the making of an incision obliquely into 
 the wall of the sac, and, lastly, the introduction into the sac of tents, 
 or plugs, of lint saturated with certain balsamic preparations. By 
 this method Stahl succeeded in curing <i number of otherwise incur- 
 able cases. 
 
 Now appeared upon the stage Anel — the subject of our sketch. 
 His procedure — the most important ever devised for the treatment 
 of these parts — was carried out as follows: Through the upper 
 canaliculus he daily passed into the sac, and on down into the nose, 
 a golden, or silver, sound, of Hl)out the thickness of a hog's bristle 
 
 Anel's Syringe for irrigation of the Naso-laclirymai Duct. 
 
 and furnished at its distal end with an olive-shaped button, or knob. 
 Then, through the loM'er canaliculus, he injected by means of his 
 syringe an astringent preparation into the sac, and, when possible, 
 on down into the nose. The procedure was repeated, as already 
 stated, daily, until the fluid ran into the nose with ease. Then, as a 
 rule, the patient was entirely cured. 
 
 The importance of Anel's discovery does not need to be emphasized 
 to ophthalmologists. The Anel sound, the Anel syringe, and even the 
 Anel procedure are (of course with numerous modifications) in use 
 at the present day.- — (T. H. S.) 
 Anel's lachrymal syringe. In acute and sub-acute cases, permanent 
 changes in the sac and duct may be prevented by systematic cleans- 
 ing with antiseptic and astringent solutions, injected by Anel's lach- 
 rymal syringe. The canaliculus is split, as in the preliminary de- 
 scribed for the passage of probes, and tlie canula inserted as far as 
 the wall of the sac, brought to the vertical position and the fluid 
 injected. Too much force should not be employed, otherM'ise the 
 fluid may be driven out through the upper canal, or a false passage 
 created, Avith its attendant injurious complications. (H. F. H.)
 
 420 ANEL'SCHE PROBE 
 
 Anel'sche Probe. (G.) A delicate probe for insertion into the puucta 
 laehrymalia. It was invented about 1710 by the surgeon whose 
 name it bears. 
 
 Anel'sche Sonde. (G.) A delicate probe for insertion into the puncta 
 laehrymalia. 
 
 Anel'sche Spritze. (G.). Anel's syringe; fine-pointed syringe for in- 
 jecting fluids through the puncta laehrymalia. 
 
 Anemia appilacas. Tunnel anemia. Dirteater's anaemia. Hook- 
 worm DISEASE. >iee Ankylostomum duodenale. 
 
 Anemia dope perdite di sangue. (It.) Anemia from loss of blood. 
 
 Anemia in eye diseases. Chlorosis. Progressive pernicious anemia. 
 These signs of a general blood change are most commonly associated 
 with insufficiency of accommodation — inability to read, fatigue of 
 and pains in the eyes, etc. Deposits in the retina and choroid, and 
 even neuro-retinitis with hemorrhages are also seen now and then. 
 
 The specific new formations in the lymph glands and spleen, par- 
 ticularlv those that mark the so-called leukemia, furnish another 
 example of intoxication, with definite ocular changes. A bilateral 
 retinitis, with numerous hemorrhages (resembling the albuminuric 
 form) is the most important of these, due to fatty and other altera- 
 tions in and about the minute retinal capillaries. Fundus and vitre- 
 ous changes have also been discovered in the advanced stages of the 
 disease. See General diseases and ophthalmology. 
 
 Anemia intertropicalis. Tunnel anemia. Dirteater's anemia. 
 Hookworm disease. See Ankylostomum duodenale. 
 
 Anemia latericia. Tunnel anemia. Dirteater's anemia. Hookworm 
 disease. See Ankylostomum duodenale. 
 
 Anemia montana. Tunnel anemia. Dirteater's anemia. Hook- 
 worm disease. See Ankylostomum duodenale. 
 
 Anemia perniciosa. (It.) Pernicious anemia. 
 
 Aneritroblepsia. (It.), n.f. Anerythroblepsia, anerythropsia, or color 
 blindness for red. See Color sense and color blindness. 
 
 Anerythroblepsia. (L.), f.n. Color blindness for red or for red and 
 green. 
 
 Anerythropsia. Defective color perception of red. 
 
 Anerythropsie. (G.) Color-blindness, red-blindness. 
 
 Anesin. Aneson. Trade names given to a 2 per cent, aqueous solu- 
 tion of chloretone (q. v.) or acetone-chloroform (CHo)2 rCOH.CClg, 
 which has been recommended as a substitute for cocain. It is much 
 less anesthetic than a 5 per cent, cocain hydrochloride solution, 
 but is non-toxic and not irritating to the ocular structures. 
 
 Aneson. See Anesin. 
 
 Anestesia. (It.) Anesthesia.
 
 ANESTHESIA 
 
 421 
 
 Anesthesia (general) by inhalation. See Anesthesia in ophthalmic 
 surgery. 
 
 Anesthesia (general) by scopolaniine-morphia injections. See Anes- 
 thesia in ophthalmic surgery. 
 
 Anesthesia, Infiltration. S( iiLEicirs local anesthesia method. See 
 also. Anesthesia in ophthalmic surgery. 
 
 Anesthesia in ophthalmic surgery. The pi-oblem of anesthesia for 
 ophthalmic operations is in many respects totally different from 
 that of anesthesia for all other surgical procedures. The disagree- 
 able and, at times, formidable after-effects of general anesthetics 
 (such as retching, vomiting and straining) would seem too well 
 known to need more than mention. Nevertheless they are the very 
 
 Four-hottle Junker Vaporizer as ^Modified. 
 
 phases of general anesthesia that make the ophthalmic surgeon long 
 for the day when all of his operations may be done under local 
 anesthesia. But it is when we stop to consider the relation of pa- 
 tient and surgeon in the intraocular operations done under local 
 anesthesia, that the difference from general surgery becomes most 
 apparent. The psychic state of the patient under these circum- 
 stances is the factor generally overlooked. Imagine a patient with 
 cataract who is not only conscious but keyed to the highest point of 
 anxiety as to the outcome. Naturally the blood pressure is corre- 
 spondingly increased anywhere from 10 to 20 mm. of mercury, which 
 of itself predisposes to complications and difficulties in the per- 
 formance of an operation. The problem is not only to negotiate the 
 operation successfully, but at the same time to quiet and calm the 
 patient, so as to bring him under control that he shall not become pan- 
 icky; in short temporarily to dominate his mental condition and
 
 422 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 thus avert the calamities that usually attend bad behavior during 
 the operative ordeal. The whole situation is much more dramatic 
 than usually obtains in general surgery, except, perhaps, in grave 
 emergency operations. 
 
 The ophthalmic surgeon is at the outset confronted with the ques- 
 tion whether he shall choose the besetting difficulties of general 
 anesthesia or the distressing mental state incident to an operation 
 under local anesthesia. The choice is sometimes difficult indeed, 
 and compels consideration of numerous factors to ensure a success- 
 ful issue. 
 
 Principal among these are the patient's age, general condition, 
 the circulatory status (especially in cataract and glaucoma), the 
 factor of elimination, the vital resistance, the state of the nasal and 
 
 lusufflation Apparatus for Ether Anesthesia. 
 
 lachrymal passages, the temperament of the patient, his environ- 
 ment, the condition of the eye, etc. Thus it will be seen that the 
 operator, in making his choice of an anesthetic method, must be 
 first the all-wise medical man and then the surgeon who can soothe 
 an over-excitable patient with reassuring voice cadences, or control 
 a contrary one with a sharp word spoken in season. 
 
 Inhalation anesthesia. Prior to 1846 ophthalmic operations were per- 
 formed without any form of analgesia whatsoever. The result of 
 the operation turned largely upon the marvelous swiftness and dex- 
 terity in operating possessed by the ophthalmic surgeons of that 
 time. Morton's demonstration, in 1846 at the Massachusetts Gen- 
 eral Hospital, made modern narcosis possible and the ophthalmic 
 surgeon of today may choose his agent for general anesthesia or
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 423 
 
 narcosis from the following list : Ether, chloroform, ethyl chloride, 
 ethyl bromide, nitrous oxide, somnoform and, lastly, scopolamin- 
 morpliin, cither alone or in combination with ether or chloroform. 
 
 The question has been raised as to whether "anesthesia" or "nar- 
 cosis" should be the term applied to loss of sensation induced by 
 whatsoever method. We prefer to retain the term anesthesia, first 
 coined by Oliver Wendell Holmes in 1846. Various qualifications of 
 
 Ether Anesthesia by Pharyngeal Insufflation. 
 
 the term easily follow, e. g., inhalation anesthesia, infiltration anes- 
 thesia, local anesthesia, regional anesthesia, mucous anesthesia, etc. 
 
 There is a certain group of ophthalmic operations that will prob- 
 ably always be done under some form of general anesthesia, such 
 as iridectomy for glaucoma, exenteration, evisceration, enucleation 
 (although many enucleations are today being performed under 
 local or regional anesthesia), plastic lid operations, orbital and 
 orbito-sinus explorations, as Avell as most operations on nervous pa- 
 tients and on children. 
 
 The choice of an anesthetic is more or less a matter of caprice witli 
 each individual surgeon, but we (\dll consider seriatim the list just 
 mentioned.
 
 424 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 Ether. Among general surgeons the country over ether is prob- 
 ably the anesthetic of choice, especially for prolonged surgical inter- 
 ventions and for abdominal operations, largely because of its rela- 
 tive safety and the familiarity of the general profession with its 
 proper administration. This is evidenced by the report of the Com- 
 mittee on Anesthesia presented to the 1910 meeting of the American 
 
 ssa9 
 
 Easy Way of Applying Nasopharyngeal Airway. 
 
 Medical Association. This committee was commissioned to make re- 
 search on the best anesthetic to use under varying conditions. In 
 
 Nasopharyngeal Airway. 
 
 the report alluded to they insisted on the wide distinction between 
 anesthetics proper for use by the general practitioner and anesthetics 
 employed by experts. They finally recommended that for the gen- 
 eral practitioner not especially skilled or experienced, ether 
 administered by the open, or drop, method should be the anesthetic
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 425 
 
 of choice, and that the use of chloroform, particular!}^ for so-called 
 minor operations, should be discouraged, unless given by an expert. 
 
 Hare (Keen's System, of Surgery, Vol. V, 1910) observes that there 
 is probably only one state which distinctly contra-indicates a gen- 
 eral anesthetic, namel}', diabetes mellitus, in which diabetic coma 
 nearly always ensues. 
 
 Disadvantages of ether a)iesthesia from ihe ophthalmic view. From 
 the standpoint of the ophthalmic surgeon, ether has some marked 
 disadvantages, chief of which is the vomiting that so frequently 
 follows its use. The .straining that goes with the vomiting may 
 
 Glass Nasal Tubes for General Anesthesia in Head-surgery. 
 
 be fraught with the direst consequence as far as the eye is con- 
 cerned. We have knowledge of several cases in which there occurred 
 a large intraocular hemorrhage during the vomiting following ether- 
 ization for cataract extraction in nervous individuals. Boskerville 
 (Jour. Am. Med. Assocn., Nov. 23, 1912) wisely says, "Idiosyncrasy 
 has served to account in large part for untoward after-etfects of 
 anesthetics (such as nausea) and interference with some of the 
 normal organic functions such as glycosuria and albuminuria. These 
 have often been regarded as natural results of anesthesia and taken 
 for granted. They may now largely be obviated and in many cases 
 entirely avoided by the use of anesthetics that are free from impuri- 
 ties and by improved methods of administration. These statements 
 are based on clinical evidence." 
 
 Next in importance to this objection is the possibility of the vom- 
 itus reaching the field of operation and infecting it, which is always 
 a nasty complication at best. There is also the Aveighty objection 
 that with any inhalation anesthetic the anesthetist and gauze are 
 very much in the way of the operator ; and, not infrequently, the an-
 
 426 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 esthetist inadvertently allows the anesthetic to drop or flow into the 
 
 patient's eye. This has happened several times in our experience. 
 
 To avert both difficulties, numerous extension masks have been 
 
 devised of which Lefever's is quite as good as any we have seen. 
 
 Glass Nasal Tubes for General Anesthesia in Use. • 
 
 The claims of this inventor are: 1, that it removes the anesthetist 
 from the field needed by the operator and his assistant ; 2, that it as- 
 sures an aseptic field ; 3, that it does away with the ether fumes that 
 often arise in the operator's face; 4, that it lessens the amount of 
 ether used ; 5, that the breathing of the patient is perfectly registered 
 by the continual movement of the light aluminum valve, so that the 
 
 Lefever's Device to Permit the Use of a General Anesthetic and at the Same Time 
 Afford the Ophthalmic Surgeon the Greatest Possible Free Field.
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 427 
 
 surgeon may always know just how the patient is breathing without 
 asking the anesthetist. 
 
 All these claims we endorse from personal use of the device, with 
 the exception of No. 2. No operator can ever be absolutely sure 
 that any patient may not vomit during the operation, no matter 
 what the anesthetic agent may be. 
 
 
 
 Tubes for Moutli Airway. 
 
 jMiller's {Jour. ^Imer. Med. Associi., Vol. LIIl) apparatus, we have 
 also used but we do not look upon it with as much favor as Lefever's. 
 
 Finally, we are obliged to consider the objections brought for- 
 ward by Crile {Southern Med. Jour., Jan., 1910) who in discussing 
 the effects of ether on the vital forces, contends (a) that it contrib- 
 utes to post-anesthetic depression, and (b) that it impairs immunity. 
 
 Nasal Catheters in Use. Mouth Tube Also Shown. 
 
 The most recent statistics as to general anesthesia are those offered 
 by Gwathmey (Jour. Amer. Med. Assocn., Nov. 23, 1912) avIio quotes 
 Hewitt's European statistics as follows: — In over 1,000,000 adminis- 
 trations the death rate equalled one in 16,302 for ether and one in 
 3,162 for chloroform. At St. Bartholomew's Hospital (London) in 
 the years 1875 to 1900 there were 80,255 administrations of ether and 
 chloroform, showing a fatality of one in 9,319 for ether and gas- 
 ether, and one in 1,300 for chloroform. Hewitt considers these re- 
 liable figures, concluding that ether is about seven times as safe as
 
 428 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 chloroform. American statistics collected by Gwathmey from 99 
 hospitals show that in 278,945 administrations the fatalities from 
 
 Mouth Tube in Position. 
 
 ether were one in 5,623 and from chloroform one in 2,048, with one 
 in 6,905 for the nitrous oxid-ether sequence, to which reference will 
 be made later on. 
 
 Eubber Ether Holder and Elastic Mask Holder. 
 
 It is our own feeling that if all the circumstances surrounding 
 many cases that die within 24 to 48 hours after operation were 
 searchingly analyzed, the corrected mortality percentage would be 
 much higher. 
 
 Tlie use of chloroform in opJifhalmic operations. In most of the large 
 Continental and British clinics, chloroform is still resorted to largely 
 for inhalation anesthesia when a general effect is needed. In this 
 country, however, a strong sentiment against chloroform has sprung 
 up in the last few years, due, perhaps, to the insistence of the East-
 
 ANESTHESIA IN OPHTHALMIC SURGERY 429 
 
 em schools on the danger of chloroforiu. The statistics quoted by 
 H. A. Hare (Keen's System of Surgery, Vol. V, 1910) are as follows: 
 
 Chloroform 1 ■ death in 2,500 
 
 Ether 1 death in 16,000 
 
 Nitrous oxide 1 death in 200,000 
 
 Hare (loco cit.) goes on to say, however, that there are times when 
 chloroform, because of its known physiologic effects, is often the 
 agent of election, as in arterial spasm with high tension and cardiac 
 hypertrophy. Also in nephritis, new or old. it is the drug of choice 
 in most instances. He pleads for the most careful examination of 
 the urine and the circulatory apparatus before administering any 
 inhalation anesthetic. When it .is remembered that the average oph- 
 thalmic operation seldom requires more than 20 minutes for its per- 
 formance, it can be readily understood why many ophthalmic sur- 
 geons who enjoy the services of an expert assistant, prefer chloro- 
 form for their operative work. So high an authority as Ilaab 
 {Ophihalmoscope, Feb., 1905) has urged that inhalation anesthesia 
 should be used very little in ophthalmic surgery because of his con- 
 viction that local anesthesia whenever in any way possible, is much 
 to be preferred by reason of its safety. Chaldecott {Opliihalmo- 
 scope, Aug., 1905, p. 386) agrees with Haab that it is not justifiable 
 in minor eye operations to take the risk of chloroform, yet he thinks 
 that "M'lien anesthesia is induced by gas or ether, and continued by 
 ■chloroform, the risk in skillful hands is so infinitesimal that it is not 
 worth taking into account." Just why ether should be used to 
 induce anesthesia that is to be continued under chloroform does not 
 appear clear to us. Gwathmey {Jour. Amcr. Med. Assocn., Nov. 23, 
 1912), after reviewing the European statistics embracing 1,000,000 
 administrations and the American ones embracing 278.945 adminis- 
 trations, makes the following trenchant suggestions: — ^''In full har- 
 mony with the report of the Committee on Anesthesia of the Ameri- 
 can Medical Association just published and from a careful study of 
 the accompanying table (see his communication in full) 1 would 
 recommend that those using the drop method of ether should im- 
 prove their technique and statistics by (a) preliminary medication 
 of morphin and atropin or some similar drug or combination: (b) 
 commencing the anesthesia with 2 to 4 drops of essence of orange 
 (25 per cent. U. S. P.) ; (c) the drop method of anesthol. This agent 
 was first described by Meyer {Jour. Amer. Med. Assocn., Feb. 28, 
 1903) and is a chemical combination of ethyl chlorid, chloroform and 
 ether. Anesthol should be continued until the patient reaches sur- 
 gical anesthesia and then a change taken to the drop method of
 
 430 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 ether, (d) The drop method of anesthesia by some form of vapor 
 anesthesia. This last recommendation is made because judging from 
 statistics this method would be safer and more satisfactory than the 
 straight use of ether as practised in some of our leading clinics." 
 
 Ethyl chloricle anesthesia in ophthalmic operations. Within the last 
 decade ethyl chloride has been heralded as the agent that would 
 solve the problem of general anesthesia for the ophthalmic patient. 
 But the testimony as to its safety and efficiency is very conflicting. 
 Albert E. Miller {Jour. Amer. Med. Assocn., Nov. 23, 1912) collected 
 43 reported deaths from this agent, showing a death rate varying 
 from one in 2,000 (Hare) to one in 150,000 (Luke). At present it is 
 difficult to calculate its mortality rate, although one in 13,265 is the 
 closest compromise estimate. In some of the British clinics it has 
 largely replaced nitrous oxide and to some extent chloroform. Ilird 
 {Ophthalmoscope, Mar., lOOG) claims for it rapid anesthesia, quick 
 recover}^ and slight after-effects and believes its use will steadily 
 increase. He reports one case of death from it, but it must be ad- 
 mitted that the patient could hardly have been in a worse condition 
 for the use of any inhalation anesthesia. He was a man of 67, suf- 
 fering from epithelioma of the cheek, with a swelling in the neck 
 causing severe dyspnea and general distress; to relieve which the 
 operation was undertaken. Kayser {Klin. Monatshl. filr Augenhlk., 
 Sept., 1905, p. 300) says that of 16.000 narcoses thus induced this is 
 the only fatal case; and, although it has been but little used in Ger- 
 many, he strongly recommends it. 
 
 Because of the fatalities attending the use of chloroform for oph- 
 thalmic operations, Gendron and Servel .{Clin. Ophthal., ^lay 25, 
 1906) have resorted to ethyl chloride, followed by chloroform. About 
 3 ce. of ethyl chloride are placed in a rather small, close cone and 
 more added, (hoAv much not mentioned) until general anesthesia is 
 produced, when tlie change is quietly made to chloroform. Ab- 
 sence of the stage of excitement, less chloroform and diminished un- 
 pleasant effects seem to them the advantages of the combination. 
 We can see no reason why chloroform alone would not be as effi- 
 cient as the foregoing combination. As to ethyl chloride alone, we 
 have seen one person so near death's door under the influence of 
 ethyl chloride (and that in the hands of a very careful anesthetist) 
 as to make us forever apprehensive of it. 
 
 Ethjd bromide has been used instead of the chloride by some, on 
 the assumption that it is superior because of its bromide content, 
 but there seem to be no facts to substantiate these claims. 
 Somnoform in ophthalmic surgery. Somnoform is a combination
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 431 
 
 of 60 per cent, ethyl chloride, 35 per cent, methyl eldoride and 5 per 
 cent, eth^d broiiude. The reports thus far to hand indicate that 
 under proper precautions it is a safe anesthetic. Iless {Colorado 
 Medicine, May. 1905) reports its use in 62 operations, including 2 
 enucleations, the remainder being rhinologic operations. Usually, 
 it induces a narcosis of from two to three minutes, with subsequent 
 analgesia. Occasionally the narcosis is simply transitory. Hess has 
 had the anestliesia torininate in less than a minute, necessitating the 
 
 Ohio Monovalve (automatic) Nitrous Ohio Monovalvc fseuiiautomatic) Nitro- 
 Oxide and Oxygeu Apparatus. ous Oxide and Oxygen Apparatus 
 
 use of chloroform to complete an enucleation. The dose is usually 5 
 cc, but this must be increased for large, robust i)ersons and for 
 alcoholics. The anesthesia can be prolonged only by repeating the 
 dose, but this robs it of its safety and freedom from unpleasant after- 
 effects. Our own comment is that, judging from the unsatisfactory 
 manner in which the human economy bears methyl compounds and 
 its greater tolerance to ethyl compounds, somnoform will in the 
 end be found an undesirable agent. This conclusion voices the 
 opinion of Peterson (See Wood's Sysicm of Ophthalmic Therapeu- 
 tics, p. 381), who says of this anesthetic in ophthalmic operations that:
 
 432 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 ''It is not suitable for ophthalmic operations, as the ocular muscles 
 (especially the powerful orbicularis palpebrarum) are among the 
 last to yield to its influence and to become thoroughly relaxed. 
 When this necessary condition is finally obtained, the patient has 
 inhaled so much somuoform that he has entered the dangerous stage. 
 Even then the duration of the anesthetic is not more than 90 seconds. 
 Vomiting is a frequent sequel, thus rendering it still more unsatis- 
 factory for ophthalmic operations." 
 
 ^'^¥#ls 
 
 Teter Apparatus for the Administration of Xitrous Oxide and Oxygen. 
 
 Nitrous oxide in ophthalmic surgery. Nitrous oxide, discovered in 
 1776 by Joseph Priestly, was the first gas found to have the property of 
 suspending consciousness; but for many years it was used only in 
 chemistry, before its valuable anesthetic properties were appreciated 
 and put to practical application. Since the publication of Colton's 
 series of 20,000 successful cases (Keen's System of Surgery, Vol. 5, 
 1910), the whole dental world has made daily use of this agent. Pres- 
 ent day statistics, showing only one fatality in 200,000 dental admin- 
 istrations, mark it as easily the safest inhalation anesthetic in use 
 for brief operations. Miller (Jour. Amer. Med. Assocn., Nov. 23, 
 1912) records 32 deaths from nitrous oxide of which 19 seem to 
 have been directly due to the anesthetic. Within the past few years
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 433 
 
 surgeons have also been much attracted by the safety of this anes- 
 thetic. 
 
 Crile {Jour. A)ncr. Med. Assocn., June 11, 1910), who with his asso- 
 ciates, has been pursuing the research on nitrous oxide (with and 
 without scopolamin-morphin) under the Committee on Anesthesia of 
 the American ^Medical Association, reports the use of nitrous oxide 
 
 Gatch's Apparatus for the Use of Nitrous Oxide by Eebreathing. 
 
 combined with oxygen in 1,130 cases, of which 1,000 Avere major 
 operations. Of these 1,000,139 had nausea (9 of them severe, and 
 of these 9, nausea lasted 2 to 3 days in 4 of them). He is satisfied 
 that in the hands of highly skilled anesthetists the method is the 
 best yet devised. Haggard is practically of the same opinion. 
 
 The Teter apparatus is primarily a nitrous oxide-oxygen appa- 
 ratus (see, also, Jour. Anier. Med. Assocn., Nov. 23, 1912). It may 
 also be used for ether and chloroform, either alone or with nitrous 
 oxide and oxygen or in sequence. As all vapors pass through the 
 
 Vol. 1—2 8
 
 434 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 vapor warmer, there is an added factor of efficiency with any agent 
 used. 
 
 Gatch (Joiir. Amer. Med. Assocn., March 5, 1910) has recently de- 
 vised a nitrous-oxide-oxygen apparatus for anesthesia by rebreath- 
 ing, which has been used in Halstead's clinic in 700 cases. It has 
 not only proved its usefulness as an apparatus, but has shown 
 that in many cases rebreathing is beneficial in that it causes deeper 
 respiration, slower pulse and rise of blood pressure. The cost is 
 about 11/2 cents per minute of anesthesia. 
 
 It seems rather strange that so safe an inhalation anesthetic has 
 not found its way more into ophthalmic practice. For transitory 
 anesthesia involving such minor precedures as the slitting of a canal- 
 iculus, opening a hordelum or a lachrymal abscess, passing a probe, 
 etc., in nervous or apprehensive patients we have utilized a dental 
 surgeon's assistance in the use of nitrous oxide and have been highly 
 gratified with the results. A brother ophthalmic surgeon has long 
 since employed it in the same way. It is our own feeling that the 
 nitrous oxide-oxygen apparatus may yet become a portion of the 
 ophthalmic surgeon's armamentarium. 
 
 The various views above set forth simply emphasize what we have 
 previously said, that the choice of an inhalation anesthetic is today 
 • (and in all likelihood will continue to be) largely a matter of caprice 
 with each individual surgeon. There is no gainsaying the fact that 
 it is well for a surgeon and his assistant to become expert with some 
 one form of inhalation anesthesia and to hold fast to that method as 
 the safest for him and his staff. 
 
 Scopolamin-morphi)! amsthesia in ophthalmic surgery. The plan of 
 inducing general anesthesia by repeated hypodermic injections of 
 scopolamin-hydrobromate and morphin sulphate has been used more 
 or less extensively by certain general surgeons. 
 
 Suker {Annals of Ophth., Jany., 1907) has resorted to it in acute 
 glaucoma, cataract extraction, keratectomy and enucleation. He 
 notes absence of excitement either before or after the operation, ab- 
 sence of muscular rigidity, with sufficient consciousness on the part 
 of the patient to obey the surgeon's orders. Insufficient anesthesia 
 was supplemented bj^ eocain or chloroform, of w^iich but very little 
 was needed. Three injections of scopolamin, ^150 grain, and mor- 
 phin, ^/Q grain, are made one hour apart, beginning 2% hours before 
 the time set for the operation. This method seems safer than either 
 chloroform or ether anesthesia in patients with renal or cardiac 
 lesions, but it is not entirely free from danger, 6 deaths in 3,000
 
 ANESTHESIA IN OPHTHALMIC SURGERY 435 
 
 anesthesias having been reported. His feeling is that sliould the 
 first injection develop any idiosyncrasy against the drugs, the others 
 should not be given but some other plan adopted. 
 
 Segelken {Klin. Monatshl. fiir AugenMk., July, 1907, page 75), 
 from an experience extending over four years, is convinced of the 
 value of this method in cases in which ether or chloroform anesthesia 
 portends especial danger. In the preparation of the patient, Segel- 
 ken allows them to have fluids freely. 
 
 Stuelp's {Klin. Monatshl. fiir Augcnhlk., July, liJUIJ, page 74), 
 experience Avith this method in 100 cases leads him to state that 
 despite occasional failures, it is to be recommended. In glaucoma, 
 iridectomies, complicated cataract and other operations on the eye- 
 ball, it makes the operation easier by quieting the patient. No bad 
 effects on the general condition were observed even in systemic dis- 
 eases in which inhalation anesthesia was undesirable ; and where 
 chloroform was subsequently found necessary, it seemed to act very, 
 favorably in the presence of the scopolamin-mori)hin state. He also 
 used ^150 scopolamin and ]q morphin three times one hour apart. In 
 the cases in which successful narcosis was obtained, consciousness 
 was much obscured but not abolished, so that correct answers were 
 given to energetic questions. After the instillation of cocain in infil- 
 tration anesthesia (which was never omitted) no expression of pain 
 occurred during corneal incision, iridectomy, cutting the muscles or 
 inserting sutures. On the other hand the movements of the eye- 
 balls were usually carried out correctly and in a quiet and certain 
 manner. 
 
 In Stuelp's 100 cases, good narcosis obtained in 45; in 29 it Avas 
 incomjjlete but sufficient to carry out the operation; and in 26 it 
 failed. In some cases it produced slight mental excitement and 
 marked increase of sensibility so that chloroform Avas required to 
 finish the operation. 
 
 Hare (Keen's System of Surfjcrij, Vol. Y, 1910) insists that this 
 anesthetic is not devoid of danger and its use alone for surgical 
 narcosis is not justifiable, Avhile II. C. Wood. Jr., (Quoted in the 
 Annals of Ophlhalm., Jan., 1906) goes so far as to say that "the 
 method is scientifically irrational, and inasmuch as it has sIioaaui a 
 mortality of one per 1,000, and that in 69 per cent, of the cases the 
 anesthesia has been unsatisfactory, Ave think it must either be a ver}^ 
 bold or a very ignorant surgeon who will persist in its use." This 
 is an extreme statement, however. AVe do not knoAv Avliere "Wood 
 gathered his statistics but neither Stuelp nor Segelken, both of Avhom 
 have used it in over 100 cases, report any untoAvard results Avhatever.
 
 436 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 We have ourselves used this method iu 15 eases, either alone or in 
 combination Avith ether. The first case was a patient with senile 
 cataract, an apprehensive German, aged 68. Instead of anesthesia, 
 a mental excitement was produced, and cocain was needed to com- 
 plete the extraction. Even then it was a most difficult operation to 
 negotiate. All the subsequent cases were done under scopolarain- 
 morphin narcosis with enough ether to relax the patient (verj^ little 
 being usually needed) and these patients were absolutely quiet, for 
 a 20 to 30 minute operation, without any further ether — an advan- 
 tage not to be lightly regarded. We have also used the method for 
 iridectomy in glaucoma, for enucleations and for lid operations 
 (ptosis, entropion, etc.) and recently in about a dozen trephining 
 operations (Elliott's) for glaucoma, combining morphia and scopola- 
 min subcutaneously with cocain locally, and with conspicuous suc- 
 cess. ]\Ioreover, the fact that the patients fall peacefully into deep 
 slumber in their beds before being removed to the operating amphi- 
 theater is no small matter in dispelling all the apprehension attend- 
 ant on the operation. This is a factor that compels the consideration 
 of all serious-minded ophthalmic surgeons. We feel that in combina- 
 tion with just enough ether to relax the patient the method may 
 prove of much value in ophthalmic surgery. 
 
 Preparatio)) of patients for general anesthesia in eye operations. 
 Before dismissing the subject of general anesthesia by inhalation it 
 is necessary to emphasize the wisdom of reckoning with the psy- 
 chologic phases of the subject. Nervous, apprehensive people need 
 careful managing. Tactful assurance and calming measures (a little 
 preliminary bromide, etc.) are of untold value in securing a success- 
 ful issue. No patient should be anesthetized in an operating room, 
 with all the preparations for the operation going on about him. 
 For years some of our most prominent surgeons have been in the 
 habit of giving a hypodermic of a quarter of a grain of morphia (and 
 sometimes atropia) one-half hour before the operation, wholly with 
 the idea of calming the patient and "removing the hypertension de- 
 pendent upon apprehension." Moreover, any patient who is to 
 have inhalation anesthesia should have been submitted previously to 
 thorough examination of the urine and circulation and should have 
 a perfectly empty gastro-intestinal tract. The latter condition is the 
 best known preventive of post-operative nausea. 
 
 Regional anesthesia. . Within a tew years foreign ophthalmic sur- 
 geons, especially those on the Continent, have been searching for means 
 and methods that will enable them to dispense with general or inhala- 
 tion anesthesia. The reason for this patient search is that the ad-
 
 ANESTHESIA IN OPHTHALMIC SURGERY V.H 
 
 vantages of local anesthesia are man.y, despite the fact tliat general 
 anesthesia is attended with little dangei'. IliTlzlcr 'Anur. Jour, 
 of Stirgd-jj, July, 1910) well says that "recent knowledge oi' the late 
 effects of chloroform cause us to inquire anew if ether also may not 
 have delayed deleterious eflf'ects hitherto unsuspected. One death in 
 16,000. now accepted as the fatality range for ether, may not express 
 the danger if the remote effects are considered. This is not the place 
 to enter into an inquiry as to the dangers of inhahition anesthesia, 
 but if operators interrogate tiieir own knowledge of fatalities after 
 the use of ether in their own practice, or that of their friends, faith 
 in the accuracy of the statistics above quoted will be much shaken. 
 When we add to this list those instances in which death occurs, from 
 causes not perfectly clear, after the patient is returned to berl. the 
 doubt is increased. If in addition to this the operator notes the 
 results in a large series of operations under local anesthesia charac- 
 terized by freedom from such unpleasant experiences, he becomes 
 convinced that ether is not the innocent agent statistics would have 
 us believe." 
 
 Evidently moved by similar considerations, Elschnig {Enzijklopiidie 
 der pra/.t. Medizin. Schirmer and Vierordt, AVien. 1905, p. 1195) has 
 made some preliminary anatomic studies, with the idea of employing 
 what he calls ganglion or regional anesthesia. The sensitive nerves of 
 the eyeball are the long ciliary from the naso-eiliary nerve, and the 
 short ciliai'y from tlie ciliary ganglion. The long ciliary nerves 
 arise from the naso-ciliary nerve shortly after the long root to the 
 ciliary ganglion branches off. These sensitive nerves are gathered 
 together at a point, and if a few drops of a properly prepared anes- 
 thetic solution are introduced in the region of the ciliary ganglion, 
 anesthesia of all the structures of the orbit sujiplied by these nerves 
 ensues. There is no final evidence at hand in the matter. I)u1 the 
 probability is that the ganglion must 1)e bathed in the anesthetic 
 solution. 
 
 Elschnig's method is as follows: After cocainization of the con- 
 junctiva in the ordinary Avay, the external canthus is stretched 
 toward the temple and a needle {% of an inch long) introduced 
 through the conjunctiva close to the external orbital margin, slightly 
 below its middle point along the lower border of the external rectus 
 muscle, just escaping the external orbital wall. Finally, the tip of 
 the needle is carried inwards until the end next the barrel of tli6 
 syringe is l)arely visible, when one-half of the syringeful is injected. 
 By slight lever motions one guards against engagijig the needle in 
 the optic nerve or large blood vessels. The anesthesia, which ought
 
 438 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 to be established in two minutes, is tested by slight pressure on the 
 globe. If it is not anesthetic the needle is withdrawn about 1 cm. 
 (^6 of ail inch) and again pushed back the same distance but in 
 another direction and the remaining contents of the sj'ringe driven 
 toward the ganglion. Subconjunctival injections of cocain are made 
 about 15 mm. from the limbus at four points in inflammatory cases. 
 Most patients are given }q grain of morphin half an hour previously, 
 which generally has a beneficial psychical effect. In quiet or slightly 
 inflamed eyeballs the pain was practically nil. and in most of the 
 inflamed eyeballs (11 out of 13) complete anesthesia was obtained. 
 
 Elsehnig {Klin. Monatshl. fur Augenhlk., June, 1908, p. 592) 
 and Loewenstein have thus performed 23 enucleations, 7 exentera- 
 tions, 2 cyclodialyses, and 1 staphyloma excision. 
 
 J. E. BroAvn, Columbus, 0., (p. c.) writes that the folloAving are 
 the customs and rules observed in Fuehs' clinic in Vienna : 
 
 "General anesthesia is not used for enucleation save in children. 
 A syringe containing 1 cm. of the anesthetic solution is employed 
 for injection with a needle not less than 5 cc. long. One-fourth of the 
 contents of the syringe is injected over or slightlj^ back of the in- 
 sertion of the superior, inferior, internal and external rectus. Later, 
 one-half a syringeful is injected in the region of the ciliary ganglion, 
 just as Elsehnig advises. This method of enucleation is used in 
 cases of inflammatorj- glaucoma and iridocyclitis, as well as in non- 
 inflammatory enucleations. 
 
 At Siegrist's clinic at Berne, 1 per cent, novocain solution is used, 
 the injection being made over the four recti muscles, making a very 
 much deeper one over the external rectus. Later one-half a syringe- 
 ful is injected in the region of the ciliary ganglion, just as does 
 Elsehnig. Siegrist does not so much emphasize the importance of 
 getting the needle near the ciliary ganglion as do Fuchs and others 
 in Vienna." 
 
 Brown goes on to say: "Personally I have found this method 
 very satisfactory in a few enucleations and feel that it can be rec- 
 ommended as the method of choice when there are no special contra- 
 indications." 
 
 Seidel's moditication of Siegrist's uiethod (KJiii. Mo}iatsh. f. 
 Augcnlieilk., p. 329. 1911) lies in the greater quantity of the injected 
 anesthetic and its distribution all around the eyeball, not simply 
 behind it. He lays stress upon the fact that infiltration of the tissues 
 with large quantities of the anesthetizing fluid is much more impor- 
 tant than the application of more concentrated solutions. Not more 
 than 10 drops of adrenalin solution should be used.
 
 ANESTHESIA IN OPHTHALMIC SURGERY 439 
 
 H. D. Bruns (New Orleans Med. and Surg. Jour., Dec, 1909) states 
 that for some years all enucleations in his clinic have been done 
 under ''ganglion" anesthesia, except on children and very excitable 
 or timorous j^eople. He employs the following combination: 
 4 per cent, cocain solution 10 mm. 
 
 1 to 1,000 adrenalin solution 10 mm. 
 
 Normal saline solution 20 mm. 
 
 After the usual cocainization of the conjunctival sac, one-quarter 
 of the above solution is injected along each rectus muscle, .\fter 
 eight minutes (two minutes saj^ Fuchs, Elschnig and Siegrist) anes- 
 thesia should be complete. 
 
 E. A. Robin {New Orleans Med. and Surg. Jour., Dec, 1907) has 
 used this same method in 34 eases. He prefers to supplement the 
 four injections of Bruns b.y an additional one about the optic nerve, 
 before severing. He claims entire absence of pain during the opera- 
 tion and absolute safety as against the risks of general anesthesia. 
 
 D. T. Vail (Journal of OphfJialm. and Otolanjng., Aug., 1911) 
 records 4 enucleations under this method, claiming as advantages: 
 1. No agonizing delay after the patient has made up his mind to 
 operation. 2. No dieting necessarj^ before or after the operation. 
 3. Speedy convalescence and absence of shock. 4. Dangers of 
 general anesthetic avoided. 5. No danger of removing the wrong 
 eye. 
 
 Three enucleations under 4 per cent, cocain by the foregoing 
 method are recorded liy Ellis and Langworthy (Archives of Oph- 
 ihalm, Jan., 1907, p. 39) who use a curved needle to carry the final 
 injection back to the optic nerve. All other investigators have found 
 the straight needle quite satisfactory and there seems every reason 
 therefore why it should be used. 
 
 Zimmerman (Klin. Monaishl. fi'ir AugcnJdk., Sept.. 1906. p. 262) 
 prefers for enucleations 5 per cent, alypin with adrenalin 1 to 1.000, 
 two syringefuls being injected over the recti muscles. Absolutely 
 no complaint was made by any of the patients. 
 
 Stutzer (Zeiischr. fiir Augcnld-l;., June, 1907), on the other hand, 
 feels that this method should not be resorted to for enucleation unless 
 the globe is free from pain and irritation, or the contra-indications 
 to general anesthesia are very strong. But Schleuter (Klin. Monatshl. 
 fiir Augenhlh., Sept., 1907, p. 198) in a comparative study of the 
 anesthetics, enthusiastically endorses Zimmerman's claims, although 
 he prefers 1 to 2 per cent, solutions of novocain with adrenalin. 
 
 Our own feeling is that if we essayed enucleation b^' this method 
 (and it appeals strongly) we should resort to novocain (which can
 
 440 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 be boiled with impunity) rather than to cocain. The latter cannot 
 be boiled without impairing its anesthetic properties and none but 
 boiled solutions should be forced back into a closed cavity which, 
 after the nerve is severed, communicates, by way of its sheaths, with 
 the intracranial cavity. 
 
 Nerve trunk regional anesthesia. Utilizing the principal of "nerve 
 block, as Crile calls it, Chevrier {Gaz. des Hopitaux, Dec. 9, 1909) 
 and Cantonnet, produce local anesthesia by injections in the region 
 
 Points of lutrodiietion of the Needle Over the Infratroehlear, Lachrymal and 
 Infraorbital Nerves. (Chevrier and Cantonnet.) 
 
 of a nerve trunk, which the.y think has a decided advantage over 
 injections directly or about the site of an operation, 1st, because less 
 anesthetic is required, and 2nd, because there is less deformity of 
 the part produced by the injection. 
 
 Oberst (Keen's System of Surgery, Vol. Y. 1910) deserves credit 
 for having introduced paraneural infiltration in 1885 ; while Corning, 
 later, modified the method by injecting the nerve trunk itself with 
 1/2 to 1 per cent, cocain solution. Any of the anesthetics may be 
 used (cocain, in % per cent., stovain 1 per cent., alypin 1 per cent.),
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 441 
 
 but Chevricr iiiid Cantoiinct i)r('f\'r 1 per cent, novocain solution, to 
 which is added a little adrenalin (how much not stated). Fifteen' 
 minutes is required to penetrate thoroughly the nerve trunk with 
 the anesthetic solution. They poiiil out that the upper lid derives 
 
 1 
 
 5L 
 
 Areas of Anesthesia (regional) Produced by the Introduction of Anesthetic 
 Solutions over the Trunk of the (1) Supraorbital Nerve; (2) the Lachrymal 
 Nerve; (3) the Infraorbital Nerve; (4) the Infra- or Subtrochlear Nerve (Can- 
 tonnet). 
 
 most of its sensitive nerve filaments from the supraorbital — a nerve 
 that can be easily located. Sometimes these filaments are given of¥, 
 however, before the nerve emerges from the orbit. It is necessary, 
 therefore, to approach the nerve in the orbit. The inner fourth of 
 the upper lid is supplied by the supratrochlear, therefore one injec- 
 tion made along the roof of the orbit above and just external to the 
 pulley for the superior oblique will affect both nerves. The external 
 fourth of the upper lid is supplied by branches of the lachrymal
 
 442 
 
 ANESTHESIA IN OPHTHALMIC SURGESY 
 
 nerves. The lower lid receives its sensitive filaments from the 
 ascending ramifications of the infra-orbital nerve. These anatomic 
 considerations show the necessity of three injections to control the 
 three sources of innervation. For anesthetizing the supratrochlear 
 and supraorbital nerves the needle is inserted above and a little to 
 the inside of the pulley (which is located by the finger) and passed 
 
 Proper Technique for the Production of Infiltration Anesthesia (Hertzler). 
 
 along the roof of the orbit upward and outward 1 to II/2 cm., push- 
 ing on the piston as the syringe is inserted in order to have the fluid 
 in advance of the needle. The injection for the lachrymal nerve 
 (not sac) is made about two centimetres {l» of an inch) from the 
 external canthus. carrjdng the needle after entrance upwards and 
 inwards three or four cm., when the anesthetic is deposited between 
 the periosteum and the lachrymal gland. 
 
 The injection for the infraorbital, according to the authors, is made 
 at the level of the infraorbital foramen with the needle of the syringe 
 in the axis of the canal, and anesthesia of the lachrymal sac 
 is obtained by the subtrochlear injection. The pulley having been 
 located, the needle is inserted below and a little to the inner side of 
 it until the internal wall of the orbit is felt. 
 
 They have applied this method in 21 cases, embracing trachoma 
 operations, lachrymal sac extirpations, Panas' operation for entro-
 
 ANESTHESIA IN OPHTHALMIC SURGERY 443 
 
 pion. chalazia, tarsorrliapliy and cauterization. The results were 
 uuiforml}' excellent. The method really stands about half way be- 
 tween regional and infiltration anesthesia. 
 
 Infiltration anesthesia. By infiltration anesthesia we mean the intro- 
 duction of any anesthesia solution into the skin itself (intracutaneous 
 anesthesia) ; or directly under it (subcutaneous anesthesia j. 
 
 Local anesthesia thus induced has been tried by many surgeons 
 and abandoned, mainly because they did not thoroughly learn the 
 technique of infiltration anesthesia. Being accustomed to 
 the total anesthesia of ether and chloroform, they chafe under the 
 restrictions imposed by the infiltration method, which calls for a 
 more accurate conception of the finer steps of the operation and for 
 better knoAvledge of the anatomy of the parts. Tiie prime requisite 
 is a well-made glass syringe and clean sharp needle, both of which 
 should be boiled before using. 
 
 In 1889 Schleich {Uebcr schmcrzlose Opcrationcn, Berlin, 1889) dis- 
 covered that by adding normal saline solution to the ordinary cocain 
 solution much less cocain w^as required to desensitize a part. Indeed 
 a few investigators went so far as to use normal saline only. In 
 some instances this sutfices ; but a small percentage of cocain insures 
 the effect. All infiltration solutions should at least be made isotonic 
 with the tissues by carrying sodium chloride in the proportion of 0.92 
 per cent. Latterly, it has become the custom to add 1 to 1,000 ad- 
 renalin. Hare {loco cit.) points out that the reason adrenalin so greatly 
 augments and prolongs the paralyzing effect of the cocain on the 
 nerves and the organs, is that, like freezing, a stasis bandage or an 
 Esrnareh bandage, it temporarily arrests the circulation and so ''in- 
 carcerates the cocain," to adopt Coming's expression. Indeed, this 
 very effect may be carried too far and result in localized gangrene, 
 as shown l)y Foisy (Tribune Mtdicale, Sept. 18, 1904), Luke {Scottish 
 Med. and Surg. Journal, Aug., 1905), and Stragardt {Klin. Monatshl. 
 fiir. Angenhlk., Feb.-I\larch, 1!)09. p. 213). The last named author 
 used suprarenalin and cocain; Foisy and Luke stovaine and adrena- 
 lin. Recently the subject has been thoroughly worked out on the 
 lower animals, for which see Le Brocq's report farther on. 
 
 It would seem to be safer not to resort to any mixture of a local 
 anesthetic with preparations of the suprarenal gland for injection 
 into the tissues, unless they are used in very small amount and dilute 
 solutions. 
 
 Various methods of securing, infiltration anesthesia tvith cocain. To 
 Wiirdemann {Jour. Med. Assocn., Oct. 29, 1904, and Nov. 16, 1905) is 
 ascribed the credit of introducing infiltration anesthesia into ophthal-
 
 444 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 mic practice in this country. [See also, in this connection, Cholewa 
 (Casey Wood), {Jour. Med. Assocn., May 26, 1894, p. 778), Schleich's 
 solution proving in his hands most satisfactory.] 
 
 For operations on trachoma, J. Guttman {Arch, of OphtJialm., May, 
 1904, p. 302 j first uses cocain or holocain in the conjunctival sac, 
 following this up Avith injections under the conjunctiva of the upper 
 lid and well back into the fornix, of sodium chloride 0.2, cocain 0.5, 
 distilled water 100. Not more than four to five drops of the solution 
 are necessary. He has thus desensitized the tissues in 52 consecutive 
 excisions or "rollings" for trachoma, the age of the patients ranging 
 from 6 to 52 years. Thirty-six had no pain, 13 whimpered, and 8 
 were quite painful. As advantages over general anesthesia he claims : 
 1, no hospital accommodations are necessary; 2nd, no assistant is 
 needed. 
 
 H. D. Bruns {Trans. Amcr. Ophthal. Soc, Vol. XI, part 1. 1906) and 
 Robin employ for lachrymal sac extirpations the same solution they 
 use for "ganglion'' anesthesia, namely 4 per cent, cocain solution, 10 
 minims, 1 to 1,000 adrenalin solution 10 minims, normal saline solu- 
 tion 20 minims. They would not think of resorting to general anes- 
 thesia for this operation. 
 
 After ten years' experience with the same solution Stitzer (Zeitsch. 
 filr AugenJill\, June, 1907) is of practically identical opinion with 
 that of Bruns and Robin. In all operations on the lid and lachrymal 
 sac this is the method of selection, in his opinion. 
 
 ^uhstitutes for cocain in infiltration anesthesia. Holocain, because of 
 its toxicity when used subcutaneously, is not to be thought of in this con- 
 nection but alypin, novocain, acoin and stovaine have all been rather 
 extensively employed. 
 
 After systematic use of alypin (5 per cent, solution), Zimmermami 
 {Klin. Monatshl. fiir Aiigenhlk., Sept., 1906. p. 262) feels that it is un- 
 doubtedly the best substitute for cocain. Its vasodilator properties, 
 so much dreaded by several authors, may easily be controlled by ad- 
 mixture with adrenalin. Moreover, it is cheaper than cocain and 
 can be boiled with impunity. These claims of Zimmerman are sup- 
 ported by Sydney Stephenson {The Ophthalmoscope, Nov., 1905). 
 True {Revile Generale cVOphtal., March 31, 1906), on the other hand 
 has combined the effect of both alypin and cocain of the same strength' 
 for interstitial anesthesia, but could find no appreciable difference 
 save that the tendency to toxemia is less with alypin. 
 
 As to novocain, Schleuter {Klin. Monatshl. fiir Augenhlk., Aug.- 
 Sept., .1907) places it first for this purpose, in 1 per cent, solution. 
 One fact he emphasizes is that too concentrated solutions, (especially
 
 ANESTHESIA IN OPHTHALMIC SURGERY 445 
 
 in combination with adrenalin) may induce local gangrene, while too 
 dilute solutions, on account of the greater quantity of infiltration 
 fluid, may distend the parts and disturb one's ideas of the anatomic 
 relations. Wickerkiewicz {Wochcnsdi. f. TJicrap. u. Ilijg. des Auges., 
 Feb. 14, 1, 1907. p. 153) also favors novocain for interstitial anes- 
 thesia but believes its anesthetic eft'ect is inferior to that of cocain. 
 
 Stovain in 2 per cent, solution is the favorite drug with Santos- 
 Fernandez {lieviic Gen. d'OpJtIal., ]\Iarch, 1906, p. 99) for lid opera- 
 tions, as he secures an especially wide area of anesthesia with it. 
 Fifty CCS. of the solution are used along the lines of the incisions. 
 Krauss, (Muench, Medicin. WochenscJn:, 1902, No. 34), (Marburg) 
 and Marin (Arch, dc Oftal Hispano-Aincr., Sept., 1907, p. 487) both 
 combine stovain and acoin as follows : acoin 0.025, cocain 0.05, normal 
 saline solution 5.00; about 2 ccs. are used about the field of operation 
 at each puncture point. 
 
 A special report on the local anesthetics recommended as substi- 
 tutes for cocain in infiltration-anesthesia has been submitted by Le 
 Brocq {British Med. Jour., i\farch 27, 1909), who conducted an ex- 
 perimental investigation on animals in the Pharmacologic Laboratory 
 at Cambridge, England, under the auspices of the Therapeutic Com- 
 mittee of the British ^Medical Association. He investigated stovain, 
 novocain, tropacocain, beta-eucain, alypin, beta-eucain lactate, nir- 
 vanin, holocain hydrochlorid, acoin, orthoform (new) and anes- 
 thesin, and has presented a report that commands the attention of all 
 ophthalmic surgeons. It has been found that all of them are general 
 protoplasmic poisons having a special predilection for nervous struc- 
 tures; if used in sufficiently strong solutions they depress and ulti- 
 mately destroy every form of living tissue. 
 
 The points to which special attention have been paid are those laid 
 down by Braun as essential in comparing local anesthetic action. 
 They are: (1) a lower degree of toxicity than cocain in proportion 
 to its local anesthetic power. (2) Sufficient solubilit}- in water. The 
 solutions should be stable, that is, they should keep without deteriora- 
 tion and be capable of sterilization by boiling. (3) Absence of any 
 sign of irritation. There should be no injury to the tissues, the local 
 anesthetic should be easily absorbed without causing any after- 
 effects, such as hyperemia, inflammation, infiltration, or necrosis. 
 (4) Compatibility with adrenalin. (5) Rapid penetration of the 
 mucous membrane, and suitability for medullary anesthesia. The 
 only exception made to these postulates is that dealing with absorp- 
 tion, it is not obvious that easy absorption is desirable ; if absorbed 
 slowl}', the drug produces more prolonged action. For this reason
 
 446 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 adrenalin is injected with these substances, producing local vaso- 
 constriction and thus giving the anesthetic a longer time for action. 
 If a drug can be obtained which fulfills the above conditions, it may 
 safely be said that it will supersede cocain. 
 
 A drug which is not soluble in water to the extent of 2 per cent, 
 has been regarded as unworthy of competing with cocain. This 
 throws out acoin, holocain, anesthesin, orthoform (new) and beta- 
 eucain. 
 
 Cocain, stovain, novocain, tropacocain, beta-eucain lactate, alypin, 
 and nirvanin are freely soluble in water; their solutions are stable, 
 and as a 2 per cent, solution they will keep for a short time without 
 deterioration. Cocain cannot be boiled, as decomposition occurs, 
 and the drug loses its activity and is gradually destroyed. Stovain, 
 novocain, beta-eucain lactate, tropacocain, alypin and nirvanin can 
 be sterilized at 115° C, if necessary, as they withstand this tem- 
 perature without change and are as active after as before steriliza- 
 tion. 
 
 Regarding local anesthetic properties, it was found that stovairt 
 has a more powerful anesthetic action, weight for weight, than any 
 of the other local anesthetics. Alypin, beta-eucain lactate, novocairt 
 and tropacocain have anesthetic properties about equal to cocain. 
 Nirvanin as a local anesthetic is inferior to cocain. 
 
 "Concerning toxicity, as determined by the smallest dose which 
 will kill frogs, mice and rabbits, it was found that alj^pin has anes- 
 thetic powers equal to cocain, but a higher toxicity, and so does not 
 comply with the conditions enunciated by Braun. Nirvanin has not 
 the anesthetic power of cocain, and it is only slightly less toxic. As, 
 however, we have found four drugs equal to or stronger than cocain 
 in anesthetic power, and considerably less toxic than nirvanin, no 
 further experiments with this drug were deemed necessary. From 
 this it will be seen that onh' four drugs, namely, stovain, novocain, 
 tropacocain and beta-eucain lactate, have complied with the first two 
 conditions. With these four drugs further experiments were per- 
 formed to discover how they fulfill the other conditions laid down 
 for the perfect infiltration anesthetic. 
 
 Next, the irritant action on the tissues was investigated, and it 
 was found that the irritant action of stovain, beta-eucain lactate and 
 tropacocain is far greater than that of cocain ; novocain is the only 
 drug which is superior to cocain in this respect. 
 
 All the local anesthetics are compatible with adrenalin if the solu- 
 tions are fresh and kept only for a short time. After a day or two-
 
 ANESTHESIA IN OPHTHALMIC SURGERY 447 
 
 the adrenalin decomposes unless it is kept in a stoppered, opaque 
 bottle. 
 
 The main conclusion reached is "that of the drugs which have been 
 investigated, novocain is most satisfactory for general use. Its an- 
 esthetic action is equal to that of cocain, and its toxicity and general 
 destructive power on the tissues are very much less." 
 
 If this laboratory result, which apparently has been very carefully 
 and very definitely arrived at, is supported by practical everyday 
 work, it seems probable that in novocain we have nearly the ideal 
 anesthetic for infiltration anesthesia. 
 
 Quinine and urea bimuriate is among the latest aspirants for local 
 anesthetic honors. It is soluble in its own weiglit of water and is non- 
 irritating hypodermically. E. J. Brown {Jour. Amer. Med. Assocn.,. 
 Aug. 8, 1908) experimented with 3 per cent, solution for the removal 
 of tonsils and secured perfect anesthesia for a number of hours. 
 Severe sloughing after deep infiltration was observed by J. A. Wyeth 
 {New York Polyclinic Jour., Jan., 1908) and he is now experimenting 
 with a different formula. McCampbell's {Jour. Amer. Med. Assocn.,. 
 Oct. 23, 1909) experiments indicate its power to induce temporary 
 paralysis in animals. Ilertzler {Jour. Amer. Med. Assocn., Oct. 23^ 
 1909), Brewster and Rogers confirm Thibaut's {Jour. Amer. Med. 
 Assocn., Sept., 1907) claims, but they feel that 1 per cent, solutions- 
 delay healing somewhat and suggest i^ to % V^^ cent, solutions for 
 hypodermic use. They all agree that 10 per cent, solutions may be 
 applied locally to mucous membranes, and prefer sterile water as a 
 vehicle because of the more lasting anesthesia. 
 
 Intracutaneous anesthesia. A remedy that was in great favor with the 
 older surgeons but that has practically fallen into disuse, is the local 
 application of carbolic acid solution (2 to 10 per cent.) over the 
 cutaneous areas to be attacked. That it does the work and does it 
 well cannot be denied. Its ease of use and accuracy of application 
 commend it as a method that might w^ell be revived. To create a 
 starting point for the hypodermic needle in subcutaneous anesthesia 
 it is ideal. 
 
 Freezing mixtures. From time to time meagre reports have come to 
 hand concerning various freezing mixtures that may be used in 
 ophthalmic surgery, such as the rhigoline spray introduced- by Rich- 
 ardson. This method has been variously modified, but because the 
 vapor liquefies and easily runs into the eye it is not practical for 
 ophthalmic operations. Freund (quoted by Elschnig) has employed 
 liquid air for local anesthesia and a few surgeons have tried the
 
 448 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 "carbon dioxid snow," in the form of ice pencils, but the 
 office apparatus for the production of the pencils is rather costly and 
 may make it prohibitive. However, it has been found of value in 
 the desensitizing and removal of cutaneous growths and may become 
 useful in the treatment of rodent ulcer. 
 
 The Grossman Company's Office Apparatus for the Preparation of Pencils of 
 
 ' ' Carbon Dioxid Snow. ' ' 
 
 Mucous anesthesia. This is the phase of local anesthesia that is of most 
 interest to all ophthalmic surgeons. And the same caprice that mani- 
 fests itself in the choice of a general anesthetic is even more in evi- 
 dence in the choice of a local one. Ever since Koller's {Bericht der 
 Oplitkal. Gesell., 1884) epoch-making discovery in 1884 of the local 
 anesthetic power of cocain upon the eye, it has retained its place as 
 the anesthetic of election with the majority of ophthalmic surgeons 
 the world over, in spite of its drawbacks and the host of later dis- 
 covered anesthetics. 
 
 As cocain is the type of all the other anesthetics we shall treat of 
 it first.
 
 ANESTHESIA IN OPHTHALMIC SURGERY 449 
 
 Cocain. The anesthetic action of cocaiu upon the tissues of all warm- 
 blooded animals is due to its paralyzing actio] i on the terminals 
 of the sensitive nerves. Tlie eye, because of its large sensory nerve 
 supply, represents a most perfect tissue for the action of cocain. In 
 consequence of this action anesthesia usually appears V-2 to 1 minute 
 after the instillation of a 2 to 4 per cent, solution. 
 
 If 2 or 3 instil hitions ai-e employed, the cocain (by its influence on 
 the inter-epithelial cement substance; diffuses througli the cornea 
 and in about ten minutes produces moderate mydriasis by stimulat- 
 ing the fibres of the sympathetic nerve in the iris. About this same 
 widening of the inter-palpebral fissure is noted, probably due to the 
 stimulating effect of the cocain upon the fibres of Miiller's muscle. 
 In many individuals a more or less transitory reduction in the ampli- 
 tude of accommodation accompanies the mydriasis above noted. 
 AA'^ithin two minutes the eye is quiet enough to permit the removal of 
 foreign bodies from the cornea or conjunctiva, or to allow inspection 
 of the same as well as the fornix of the conjunctiva, and in sensitive 
 persons to make any kind of application to the palpebral conjunctiva 
 or cornea. Surgical anesthesia, however, is usually not established in 
 less than five or more minutes after the instillation. 
 
 The usual method of application in this country is to use two drops 
 of a 2 to 4 per cent, solution in the conjunctival sac every three min- 
 utes for four or five instillations (0 to 12 minutes), by which time the 
 deep-lying intraocular tissues are generally pretty well desensitized. 
 The eye should be kep.t closed during all this time to prevent as 
 much as possible the desiccation of the corneal epithelium that often 
 constitutes one of the contra-indications to the use of cocain. 
 
 The- chief advantages of cocain are : 1, ease of obtaining it any- 
 where ; 2, its cheapness ; 3, prompt, trustworthy anesthesia, because 
 of its dift'usibility through the cornea; 4, hemostatic action on all 
 the blood vessels of the eye; 5, it is perhaps less irritant when in- 
 stilled (warm) than any of the other anesthetics. 
 
 The disadvantages of cocain are: 1, its deleterious action on the 
 corneal epithelium, Avliich is said by some to favor post-operative in- 
 fection, and by others to delay the healing of the wound. (At the 
 same time it must be remembered that all local anesthetics are more 
 or less protoplasmic poisons and if used in sufficiently strong solu- 
 tions are almost sure to affect the corneal epithelium unfavorably.) 
 2, its accompanying mydriasis, o, the occasional partial cycloplegia, 
 (none of the foregoing objections, however, seem to us to weigh very 
 heavily when surgical anesthesia is sought). 4, reduction of the 
 intraocular tension. This may sometimes prove an annoj'ing com- 
 
 Vol. 1—2 9
 
 450 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 plication by disturbing the operator's tactile sense with the instru- 
 ments. 5, its solutions cannot be boiled. This is thought by many 
 a grave objection, particularly as to its use in intraocular operations, 
 but if solutions freshly prepared from sterile water are used, little 
 danger need be apprehended. For some years we have had our co- 
 cain solution prepared with sterilized saturated boric solution, which 
 . is filtered after the solution is made. Such solutions have remained 
 free from penicillium as long as three months at a time and for all 
 office operations are safe. 
 
 For intraocular operations freshly prepared solutions, as just 
 specified, are safest. Cocain solutions might well be made isotonic 
 with the ocular tissues, as urged by Cantonnet {Arch. d'Ophtal., Oct. 
 1908, p. 617), who employs 11 parts of sodium chloride per 1,000 parts 
 of water as the basis of all solutions. 
 
 To avoid desiccation of the cornea often produced by cocain 
 and to render the solution less irritating Scrini {De I'emploi des al- 
 caloides en solution huileuse, Paris, 1906) has for some years past re- 
 sorted to oily solutions of the pure alkaloids and claims longer anes- 
 thesia wath the same strength solution. He prefers olive oil, first 
 washed for several days with half its volume of 95 per cent, alcohol 
 to free it from fatty matter. It is next decanted and filtered, and then 
 sterilized with a sand bath for about 10 minutes at 120 degrees. 
 Darier and v. Pflugk endorse every claim Scrini has made for the oily 
 solutions. 
 
 We have personally tried the oily solutions only recently. Un- 
 fortunately they almost immediately cause a thin oily film to form 
 over the cornea that may well obscure the fine details in any opera- 
 tion. 
 
 Suhstitutes for cocain. Holoeain, the first substitute offered for 
 cocain, was introduced into ophthalmic work in 1896. It is a synthetic 
 derivative of phenetidin. The alkaloid is feebly soluble in water (1 to 
 160) and is of neutral reaction. 
 
 The hydrochloride, which can be boiled without affecting its anes- 
 thetic qualities, is soluble to almost 2 per cent, in water, and has quite 
 displaced the alkaloid for surgical purposes. Anesthesia of the eye 
 supervenes in one to three minutes after one drop of a 1 per cent, 
 solution, and lasts ten minutes. 
 
 J. Hirschberg {Ccntrahl f. pral-f. AugcnhJJ,-., June, 1899) in 1899 
 performed several hundred major and minor operations under holo- 
 eain without accident and preferred it for all operations save enuclea- 
 tions. In the same year the elder Knapp {Archives of Ophthalni., May, 
 1899, p. 315) announced that he Avas using holoeain almost entirely in
 
 ANESTHESIA IN OPHTHALMIC SURGERY 451 
 
 all operations on the anterior part of the eye, instead of cocain, and 
 recently we have been favored with a personal communication from 
 Arnold Knapp to the effect that they "are still using 1 per cent, holo- 
 cain with satisfaction on account of its antisepsis, its slight effect on 
 the corneal epithelium, and the absence of effect on the pupil." 
 
 In 1898 R. L. Kandolph {Jour. Amcr. Med. Assocn., May 14, 1898) 
 conducted elaborate laboratory experiments with various bacilli and 
 showed that 1 per cent, holocain solutions not only have an inhibi- 
 tory effect upon these organisms but kill them after a certain length 
 of time. Since then this drug has grown steadily in oplithalmic 
 favor, having been endorsed by many foreign and home investigators, 
 who have used it in a large series of cases, and are entirely satisfied 
 with it as an anesthetic and as an agent superior to cocain. There are, 
 however, a few dissenting voices; among them Ilaskett Derby. 
 [Derby. Holocain in Ophthalmic Surgery; Its Superiority over Co- 
 caine; Its Therapeutic Value. {Archives of Ophthalm., Jan., 1899, p. 
 45) and Holtz {Auk r. Jour. Med. Sciences, Feb., 1898), who insist 
 that it is painful and much more irritating' and less benumbing to the 
 deeper structures.] 
 
 Eiicaiii and beta-cucain. A rival to both cocain and holocain was 
 brought out by Schering in 1896 and called eucain-b. It was clinically 
 reported on by Silex {Deufsch Med. Wochensch. No. 6, 1897), who 
 found it: 1, 4 to 5 times less toxic than cocain ; 2, unchanged by boil- 
 ing; 3, solutions kept perfectly four months; 4, possessing a feeble 
 bactericidal power; 5, without effect on the pupil and accommoda- 
 tion; 6, cheaper than cocain. 
 
 Befa-eucain lactate has recently been brought forward as an im- 
 provement on eucain-b, and has been tried by two or three investi- 
 gators with indift'erent results thus far. 
 
 Tropacocain was discovered by Giesel in 1891 and was soon after 
 prepared synthetically. According to various investigators its vir- 
 tues (in 3 per cent, solution) consist in its slight toxicity, its more 
 rapid and enduring anesthesia, its slight influence on the pupil and 
 accommodation, the permanence of its solutions and its improved 
 qualities when made isotonic by the addition of sodium chloride. We 
 have never tried it. 
 
 Stovain. This solution belongs chemically to the benzol group. 
 It crystallizes readily, is extremely soluble in water, and its aqueous 
 solutions show no alteration after prolonged boiling. Four per cent, 
 solutions produced considerable smarting (we should say a good deal 
 more than cocain from its use in our own eyes) and anesthesia occurs 
 in from two to five minutes. Stephenson {loco cit.) thinks the dis-
 
 452 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 comfort is no greater than after cocain, and finds it without effect on 
 the blood vessels. In his hands the duration of the anesthesia was 
 from 10 to 30 minutes. He observed slight dilation of the pupil but 
 no effect on the accommodation. It is used chiefly in 2 to 4 per cent, 
 solutions, de Lapersonne having resorted to the latter strength for 
 18 cataract extractions and 4 iridectomies. Slight disturbance of the 
 corneal epithelium Avas noted by him several times. 
 
 Alypin. We are indebted to Impens {Deutsch. 3Iedicin. Woch- 
 enscliv., No. 29, 1905) for the introduction of alypin. It is a glycerin 
 derivative, extremely soluble in water, not precipitated by the alka- 
 line fluids of the body and can be boiled indefinitely. It is less toxic 
 than cocain, and is employed in 2 per cent, solution conjunctivally. 
 Sydney Stephenson {loco cit.) believes there is less smarting with 
 alypin than with cocain, but Jacques, using alypin in one eye and 
 cocain in the other, says that patients complained more of the alypin. 
 
 Xovocain. Braun (Die Lokalanesthcsis, ihre ivissenscliafUiclie 
 Gnindlage and prald Auiccndung, Leipsig, 1905) offers this agent as 
 another addition to our list of local anesthetics. It occurs in needle- 
 like cr,ystals. soluble in their weight of water. The hydrochlorate is 
 the best for ophthalmic use. Yerderame's {Zeitschr. fiir Augenhlk., 
 Sept., 1907) tests on the corneas of rabbits show that 2 to 10 per cent, 
 solutions produce irregular erosions of the epithelium and in the 
 stronger solutions extensive loss of corneal substance. The evidence 
 seemed to be that strength for strength the deleterious action of novo- 
 cain is greater than that of cocain, while the anesthesia is less in- 
 tense. 
 
 In our own hands novocain has proven fairly satisfactory for anes- 
 thesia of the mucous surfaces. 
 
 Acoin was introduced in 1899 by TroUdenier and in the same year 
 was investigated by R. L. Randolph {0 phthahnic Record, July, 1899, 
 p. 401). With Ifi to 1 per cent, solutions he secured satisfactory 
 anesthesia in uninflamed eyes in about the same time as with cocain. 
 He also noted no influence on the pupil, the accommodation or the 
 cornea. Darier {La Cliniquc OphfaL, Oct., 1899) has been its chief 
 advocate, but more for subconjunctival than for conjunctival use. 
 
 Led by his favorable experience in a painful erosion of the cornea, 
 V. Pflugk {Wiener Medicin. Pressc, March 17, 1907) employed 1 per 
 cent, solutions of acoin in olive oil in over 100 cases, and cannot speak 
 too highly of its properties. At times patients did not knoAV it had 
 been instilled. The effect of two to three instillations varies in dura- 
 tion for one-half hour to 5 to 6 hours. Along with Darier, Scrini 
 and others, he lays great stress on the way the olive oil is treated
 
 ANESTHESIA IN OPHTHALMIC SURGERY 453 
 
 before being used as the vehicle. "It should first be cashed for sev- 
 eral days with half its volume of 95 per cent, alcohol, to free it from 
 fatty matter, then decanted and filtered and lastly sterilized over a 
 sand bath for ten minutes." 
 
 Some years ago we experimented with 1 per cent, solutions of 
 acoin (base) and were very favorably impressed with it. 
 
 Yohimbin. Chief among the less known substitutes is yohimbin, 
 introduced by Magnani of Turin. The alkaloid is derived from the 
 yohimbehe tree of AVest Africa. It is soluble in water onl}- to 2 per 
 cent, but freely so in alcohol. The hydrochlorate (now procurable 
 and more soluble in water) will doubtless prove more popular than 
 the base. Unfortunately^ its solutions deteriorate ver}^ raj^idly. Clai- 
 borne {Medical News^ July, 1904) and Coburn observed that the con- 
 gestion produced by yohimbin must label it inferior to cocain as an 
 anesthetic in all operations on the eye. 
 
 Frynin. This is an alcoholic extract obtained from the parotid 
 glands of toads, which Popow {Ophihalmic h'eview, Jan., 1906) has 
 employed for optical iridectomies and discission of cataract. One 
 per cent, solutions set up considerable irritation and hyperemia and 
 some disturbance of the corneal epithelium. 
 
 Aneson has been employed by Sternberg in 2 per cent, solutions 
 for various ophthalmic operations. 
 
 Oil of guaiac, as a 6 per cent, solution in olive oil, is reported by 
 Bellencoutre {Journal dc Medicine de Paris, Dec. 22, 1895) as pro- 
 ducing sufficient anesthesia for all operations save those of opening 
 the anterior chamber. 
 
 Quinine and. iirea himuriate. Lastly, we refer to this preparation, 
 recently brought forward as an ideal agent for subcutaneous anes- 
 thesia. On mucous surfaces, hoAvever, it does not seem to work so 
 well. Solutions weaker than 5 per cent, do not produce trustworthy 
 mucous anesthesia, and 5 to 10 j^er cent, solutions are extremely 
 irritant (proved by instillations in our own eyes) and induce a hy- 
 peremia of 15 minutes to one-half hour's duration. The anesthesia 
 of the anterior structures seems of about 1 hour's duration, but our 
 observations only embrace a few cases. 
 
 Recently, Unger {Scmaine Medccale, Jan. 22, 1913) has drawn at- 
 tention to some of the new derivations of quinine, such as hydro- 
 cjuinine and cupreine. Cupreine is an alkaloid occurring naturally 
 in the so-called "false" cinchona tree, Remijia pedunculata, and is 
 closely related to quinine, from which it difi^ers in containing one less 
 methyl group. The following derivatives have been prepared arti- 
 fically : Ethyl-hydro-cupreine, iso-jDropyl-hydro-cupreine and iso-
 
 454 
 
 ANESTHESIA IN OPHTHALMIC SURGERY 
 
 amyl-hydro-cupreine. Unger claims that the last named alkaloid is 
 no less than 32 times as strong a local anesthetic as cocaine, and that 
 it is the most powerful substance of this class at present known. 
 These statements are based upon experiments made on the conjunc- 
 tivas of rats and mice. The procedure was to ascertain the lowest 
 percentage of solution which would cause local anesthesia lasting 
 from 30 to 90 minutes. The experiments indicated that with cupreine 
 derivatives, the anesthesia appeared less rapid than with cocaine but 
 that it was possible by using high concentration to secure anesthesia 
 lasting several days. 
 
 Modification of the "Undine," both for the Sterilization and Keeping Sterile of 
 
 Anesthetic Solutions. 
 
 Thus it will be seen that the ideal local anesthetic for mucous sur- 
 faces, a non-toxic, non-irritating substance that can be boiled, whose 
 only action would be to paralyze the terminals of the sensory nerves 
 without influence on the tension, the corneal epithelium, the pupil 
 and accommodation — has not yet been found. No one anesthetic 
 meets all these requirements. Holocain seems to approach the 
 ideal most nearly and yet cocain in 2 per cent, solution presents so 
 few disadvantages and so many excellent qualities that it is today, 
 as before remarked, probablj^ the local anesthetic of election among 
 ophthalmic surgeons the world over. 
 
 A receptacle for sterile, local, anesthetizing solutions is pictured, 
 herewith. Its purpose is evident at a glance and we believe it to 
 be one of the best containers in the market. 
 
 ComMned mucous and suh-conjunctival infiltration anesthesia. This 
 method, which is of use mainly in operations on the ocular muscles, 
 deserves much wider acceptance than has yet been accorded it. Until 
 the last few years advancement operations have been done largely 
 under general anesthesia, one disadvantage of which is the subse-
 
 ANESTHESIA, LOCAL 455 
 
 quent vomiting. ]\[uch strain was thus laid upon the sutures which 
 would sometimes tear out during this straining. The chief disad- 
 vantage, however, of general anesthesia during muscle operations is 
 that the normal innervation of the muscles is set aside and the sur- 
 geon is thus much disturbed in his estimate of how much effect to 
 produce by the operation. Under local anesthesia the most precise 
 adjustment of the muscles is feasible and the method about to be 
 described affords such an opportunity in all patients over 12 to 14 
 years of age. 
 
 Adopting the method of Siegrist, conjunctival anesthesia is se- 
 cured by the ordinary method of instilling 1 drop of 4 per cent, 
 cocain solution every 3 minutes for 5 instillations. The conjunctiva 
 is then picked up by forceps and the needle of a hypodermic syringe 
 filled with a solution of cocain, normal saline solution and adrenalin, 
 introduced over the insertion of the muscle or muscles to be attacked. 
 Three to 5 mm. of the solution should be used over each muscle inser- 
 tion, after which constant hard pressure with massage is employed 
 through a piece of sterile gauze. In this way the anesthetic solution 
 is diffused all about the muscle insertion and the anterior expansion 
 of the capsule of Tenon. In about 8 minutes the tissues can be manip- 
 ulated with ease and little if any disagreeable sensation to the pa- 
 tient, so that the operation may be approached with the greatest 
 confidence. It must be understood that the slight chemosis produced 
 by the infiltration of the anesthetic solution under the conjunctiva 
 may at first disturb the surgeon's ideas of the topographic anatomy 
 of the parts but due alloAvance in this regard will be learned easily 
 in the first operation thus attempted. 
 
 With this combined anesthesia there are few advancements which 
 cannot be j^erf ormed under local 'anesthesia even on the most phleg- 
 matic adults. The formula for the usual anesthesia solution is : 
 
 Sol. cocain muriate, 4 per cent., 2 fluid drams. 
 
 Normal saline solution, 1 fluid dram. 
 
 Solution adrenalin, 1 to 1,000, 1 fluid dram. 
 For the cocain any of the local anesthetics may be substituted, 
 such as novocain, stovaine, alypin or beta-eucain. Novocain is of 
 the least toxicity and has been used with the most complete success. 
 If prolonged anesthesia is required 1 per cent, acoin solution may be 
 resorted to. In one case anesthesia for one hour and a quarter was 
 thus induced. For the adrenalin, any preparation of the suprarenal 
 glands may be used — such as supraeapsulin or suprarenin. — (W. R.) 
 Anesthesia, Local. Although this subject w-ill, in several of its phases 
 be considered under Anesthesia in ophthalmic surgery (q. v.), it will
 
 456 ANESTHESIA, LOCAL 
 
 not be out of jDlace to give here a list of the better known (local) 
 anesthetic agents. These include acoin, al^'pin, anesin, brenzcain^ 
 cocaethyline, cocaine, eegonine and its other salts, erythrophleine, 
 eucaine with its salts Alpha-eucaine and Beta-eucaine, the latter 
 being more effective, Beta-eucaine lactate, helleboreine, holocaine, 
 homocaine, nirvanin, novocaine, stovaine, tropacocaine, yohimbin^ 
 orthoform, subcutin, anesthesin, and strophanthin. 
 
 Keichmuth {Zeitschr. fiir Augenheilkunde, September, 1906) has 
 investigated most of the local anesthetics and concludes that cocaine 
 is the least harmful of them all. Dropped on to the cornea they pro- 
 duce similar appearances — all more intense than cocaine. Tropa- 
 cocaine resembles cocaine most in this respect ; cocaine alone con- 
 stricts the blood vessels, all the others dilate them. For subconjunc- 
 tival injections and washing out the anterior chamber, cocaine does 
 least damage to the epithelium and tissues, while acoin and holocain 
 in the rabbit produces severe inflammatory and necrotic processes^ 
 from which the eye is sometimes lost. 
 
 Darier {Therapeutique Oculaire, p. 90) employs in every case 
 Avhere an anesthesia of short duration is required alypin or stovaine 
 (q. v.). Indeed, he believes these anesthetics to have identical thera- 
 peutic powers. If he desires anesthesia by infiltration he combines 
 one of these agents, or both of them in equal doses with cocaine. He 
 also prefers cocaine in cataract extraction, and, on the whole feels 
 sure that when cocaine is employed with proper knowledge of its 
 advantages and disadvantages it is the best local ajiesthetic for sur- 
 gical purposes. 
 
 Before the discovery of stovaine and alypin as local anesthetics, 
 Schmidt arranged the principal local anesthetics in order of merit 
 from the following points of view : First, rapidity of anesthetic 
 action. Of these he places first in order tropacocaine, then holocaine,. 
 then cocaine, then eucaine A., then eucaine B., and finally orthoform. 
 Second, duration of the anesthesia : — orthoform, cocaine, eucaine B.,^ 
 eucaine A., holocaine, tropacocaine. Third, intensity of the anes- 
 thesia: — cocaine, tropacocaine, eucaine B., eucaine A., orthoform. 
 Fourth, analgesia when the eye is inflamed: — cocaine, tropacocaine, 
 eucaine B., eucaine A., orthoform. Fifth, mydriatic action : — cocaine 
 tropacocaine, eucaine A., eucaine B., holocaine. Sixth, blanching of 
 the conjunctiva: — cocaine, tropacocaine, eucaine A., eucaine B., holo- 
 caine. Seventh, scleral congestion: — eucaine A., eucaine B., tropaco- 
 caine, holocaine. Eighth, amount of local irritation : — orthoform, 
 eucaine A. and B., cocaine, tropacocaine. Ninth, antiseptic proper- 
 ties: — Orthoform, holocaine, eucaine B., tropacocaine, cocaine.
 
 ANESTHESIA, LOCAL 457 
 
 Tenth, poisoj)ous (]iialities: — holocaiiie, cocaine, eucaine A., tropa- 
 coeaine, orthoform. 
 
 As intradermie, subcutaneous or subconjunctival injections, Darier 
 uses a weak (one per cent, solution) of cocaine with or without acoin. 
 The latter agent being non-toxic he has found this combination very- 
 effective and has never seen any complications from its use. 
 G. E. de Schweinitz refers to ocular anesthetics as follows : 
 "The ocular anesthetics with Avhicli one is best acquainted are 
 cocaiu, holocain and eucain. Cocain is very advantageous for tem- 
 porary anesthesia, but not good for continuous use, as it is apt to 
 produce drying and wrinkling of the corneal epithelium, and, if any- 
 thing, tends to increase the corneal ulceration if it is too constantly 
 used. Holocain is an admirable anesthetic in a 1 per cent, solution. 
 It causes anesthesia in from fifteen seconds to one minute, and main- 
 tains this anesthesia for about ten to fifteen minutes. Its instilla- 
 tion is followed by a temjDorary burning sensation. It differs from 
 cocain inasmuch as it does not enlarge the pupil, increase intraocular 
 tension, and is distinctly bactericidal. Its direct application to cor- 
 neal ulcers has often in my hands proved most beneficial. I fre- 
 quently add it to the various antiseptic collyria — for example, boric 
 acid lotion — and sometimes apply it directly, by means of a cotton 
 mop, to the ulcerated surface, and have never had occasion to regret 
 a practice of this character." 
 
 Although numerous local anesthetics, especially eucaine (q. v.) 
 and holocaine (q. v.), have been advised as substitutes for cocaine 
 it is still the favorite agent in operative procedures. I prefer (as 
 giving the maximum anesthesia with the least cocain) for the aver- 
 age ophthalmic operation the following formula: 
 
 Cocain. hydrochlor. gr. xx. 
 
 Holocain. hydrochlor. gr. v. 
 
 Aquae dest. et steril. oj. 
 
 Instil one drop every three minutes for 12 minutes. 
 
 Although several observers believe that the anesthetic action of 
 solutions of cocain, both of the alkaloid and of the salts, is lessened 
 or destroyed by boiling, this view is not held by C. R. Holmes, who 
 always sterilizes his solutions in this way, and has used it for opera- 
 tions upon the eye, ear and nose thousands of times. In his experi- 
 ence it is the rarest thing to find that the drug is not efficacious, and 
 in these rare cases he has attributed its lack of action to the idiosyn- 
 crasy of the patient. 
 
 The combination of cocaine, eucaine and other anesthetics with
 
 458 ANESTHESIA, LOCAL 
 
 adrenaline, suprarenine and other hemostatics to obtain the local 
 effects of both without the inconvenience, especially during opera- 
 tions on the eye, of instilling these agents separately, is not to be 
 forgotten. To supply the demand for them a number of compounds 
 have been marketed by various chemists, although it seems hardly 
 worth while to have dignified them with trade names. It may be 
 observed, in passing, that Darier {Therapeutique Oculaire) set the 
 example by giving the name cocarenaline (q. v.) to a mixture of 
 cocaine and adrenaline and a very effective compound it is, anes- 
 thetizing and blanching the conjunctiva and other ocular tissues, 
 thus clearing and keeping clear the field of operation. 
 
 Verderame found that the rabbit's cornea Avas decidedly affected 
 by 2 to 10 per cent, solutions of novocain (q. v.). Not only did the 
 anterior epithelium become irregular but there were distinct erosions 
 with marked loss of corneal substance. He found the injury to the 
 cornea to be greater than with the use of cocain and believes its 
 anesthetic eft'ect to be less. 
 
 I. Frank speaks favorably of his experience of alypin. He finds 
 it in 4 per cent, solution, free of many of the drawbacks one experi- 
 ences in the use of cocain; it does not dry the cornea, there is no 
 mydriasis and no impairment of accommodation. 
 
 Sydnej^ Stephenson makes the following emphatic statement re- 
 garding alypin : That he had never seen a bad result from 2 per 
 cent, alypin, despite the fact that from 1905 to August, 1908, it had 
 displaced all other local anesthetics in his practice. 
 
 Subcutin is an ethyl ester or para-amidobenzoic acid and occurs 
 as a white crystalline powder soluble in 100 parts of cold and 40 parts 
 of hot water. As a local anesthetic it is employed — generally in hypo- 
 dermic form — in twelve and a half per cent, strength, dissolved in 
 physiological salt solution. 
 
 Anesthesin is a white, odorless, tasteless powder, very slightly 
 soluble in water but easily dissolved by alcohol and olive oil. As a 
 local anesthetic it is valuable and employed as an ointment and in 10 
 per cent, strength is used as a dusting powder. In a limited way it 
 is empolyed hypodermically in minor ophthalmic surgery. 
 
 Snellen {Graefe-Saemisch Handhuck) regards the following sub- 
 stitutes for cocain as comparatively useless in practice, owing to de- 
 fects in their action: Arecoline (q. v.), carpeine, convallarine, 
 drunine, erythrophleine (q. v.), haya poison, helleborein (q. v.), 
 stenocarpin and strophanthin. The majority are mostly the results 
 of laboratory experimentation and are either very irritating to the 
 ocular structures or their anesthetic action is not as lasting or as
 
 ANESTHESIA, MEDULLARY 459 
 
 prompt as that of the cocaine salts. On the other haud, he puts for- 
 Avard the following claims of eucaine (({. v.) : It is 4 to 5 times less 
 poisonous than cocaine; it is not decomposed by boiling; the solu- 
 tions remain fresh and active for months; it is slightly germicide; 
 it produces neither accommodative paresis nor mydriasis; it ls 
 cheaper than cocaine. 
 
 Bruns and Robin {Annals of Ophthahnology, October, 1906), em- 
 ploy a mixture containing 10 drops each of a 4 per cent, solution of 
 cocaine and of adrenaline chloride (1:1000), and 20 drops of normal 
 saline solution for inducing anesthesia in painful operations, espe- 
 cially excision of the eyeball. Each 40 drops of the mixture there- 
 fore contains f grain of cocaine. Ten drops of the mixture are 
 injected deeply, behind the equator of the eyeball, along each rectus 
 muscle. An interval of five minutes is then allowed to elapse before 
 the operation is commenced. The method, however, is not entirely 
 devoid of pain. Three of Bruns and Robin's patients only evinced 
 no evidence of suffering throughout the entire operation. Those 
 who complained of pain referred it to the last stage of the enuclea- 
 tion — that is to say, the division of the optic and ciliary nerves. The 
 authors noticed that robust and full-blooded men appeared to suffer 
 more than the frail and delicate. According to Bruns and Robin, the 
 advantages of local over general anesthesia are : — the consciousness 
 of the patient, thereby affording a safeguard against removing the 
 wrong eye ; the safety to life ; and, finally, the fact that most of 
 patients seem to prefer local anesthesia.— (Ed.) 
 
 Anesthesia, Medullary. Spinal anesthesia. See Anesthesia in oph- 
 thalmic surgery. 
 
 Anesthesia, optical. Hysterical or functional amblyopia, or amauro- 
 sis. 
 
 Anesthesia retinae. This is a form of amblyopia of the visual field due 
 to some general neurosis — almost always hysteria. 
 
 Anesthesin. Paraamidobenzoic-acid ethylester. This compound is a 
 white, odorless, tasteless powder, very slightly soluble in water, 
 but easily dissolved by alcohol and olive oil. As a local anesthetic 
 it is valuable and is employed in 10 per cent, strength as an oint- 
 ment, and used as a dusting powder. In a limited way it is em- 
 ployed hypodermically in minor ophthalmic surgery. See Subcutin. 
 
 Anesthol. A clinical combination of chloroform, ethyl cloride and 
 ether, used for general anesthesia (([. v.). 
 
 Anestile. A proprietary mixture for use as a general anesthetic; 
 probably a mixture of ethyl and methyl chlorides. 
 
 Aneurysma der Netzhautgefasse. (G.) An aneurysm of the retinal 
 vessels.
 
 460 ANEURYSMA DER NETZHAUTARTERIEN 
 
 Aneurysma der Netzhautarterien. (G.) An aneurysin of the retinal 
 arteries. 
 
 Aneurysm of the aorta, Eye symptoms of. Becker observed in these 
 eases pulsation of the retinal vessels similar to that occurring in 
 aortic insufficiency. Among other signs noted by authors are slight 
 ptosis, pupillary contraction, and slight enophthalmus. 
 
 Treatment of the eye-symptoms is involved in that of the under- 
 lying disease. 
 
 Aneurysm of the cavernous sinus, Eye symptoms of. Of the two 
 forms of cavernous aneui'ysm, the genuine, in which there is spon- 
 taneous rupture of a previously degenerated vessel-wall, is the 
 rarer. The commoner variety is due to traumatism in connection 
 with cranial injuries. In this instance the aneurysm is the direct 
 result of rupture of the internal carotid within the sinus itself. 
 This severe trauma is folloAved by dilation and pulsation of the 
 orbital veins, with protrusion and pulsation (pulsating exophthal- 
 mus) of the eye. Aside from neuritis optica, with subsequent 
 atrophy of the optic nerve and congestion of the retinal veins, 
 paresis and paralysis of those nerves may occur which run in the 
 wall of the sinus, i. e., the oculomotor, abducens, trochlear and 
 trigeminus. These nerves suffer according to the amount of pres- 
 sure exerted upon them. The same is true of the chiasma and optic 
 tracts, so that various forms of hemianopsia and atrophy of the 
 nervus opticus may occur. Finally, papillitis of one or both sides 
 may be caused by increased intracranial pressure. 
 
 The treatment of this serious condition is mainly surgical and 
 operative. Therapy depends upon the ijeculiarities of each case. 
 Sometimes compression, digital or other, may diminish the exoph- 
 thalmus. If temporary digital compression proves beneficial, it is 
 well to continue it daily (once or twice for a few minutes to sev- 
 eral hours) over a period of weeks until recovery is obtained. If 
 this is not successful, ligature of the corresponding internal or com- 
 mon carotid is called for, if all the other indications for such an 
 operation are present. 
 
 Spontaneous recoveries of pulsating exophthalmus (q. v.) are 
 known, but they occur so seldom that surgical intervention should 
 not be too long delayed, while waiting for it to supervene. See 
 Exophthalmus, Pulsating. 
 Aneurysm of the internal carotid artery and the ocular symptoms 
 dependent upon it. True aneurysm of the internal carotid occurs 
 within the cranium. The dilated and pulsating sac, through pres-
 
 ANEURYSM OF THE OPHTHALMIC ARTERY 461 
 
 sure upon the surrounding structures, induces amblyopia and 
 amaurosis from atrophy of the optic nerve, and hemianopsia from 
 interference with the functions of the chiasma and optic tracts. 
 Paresis and paralysis of the eye-muscles (trochlearis, abducens) and 
 nerves (oculomotor and trigeminus) may occur. Striimpell found 
 that a severe, chronic trigeminal neuralgia resulted fi'om an 
 •aneurysm of the internal carotid, which })i-essed ui)on the Gas- 
 serian ganglion. 
 
 If the tumor reaches a certain size it may set up a choked disk 
 on one or both sides. In the differential diagnosis of this disease 
 from basal intracranial tumors, the stethesco])c is of great value 
 and attention should be paid to the sounds propogated from the 
 arterial vessels. (See Auscultation.) 
 
 The prognosis is unfavorable unless it is possible to bring about 
 recovery through compression or ligature of the vessels themselves 
 or of the common carotid. Otherwise the therapy is purely symp- 
 tomatic. The continued use of such remedies as iodide of jjotassium 
 in large doses, ergot, injection of gelatine, etc., may occasionally 
 result in complete recovery, through the formation of thrombosis in 
 the dilated sac. When the lesion of the arterial wall is probably 
 due to S3^philis anti-luetic medication may give good results. — 
 (Encyklopddie der AugenheilJcunde.) 
 Aneurysm of the ophthalmic artery, Eye symptoms of. This is a rare 
 condition, but when it does occur we tind it in one of two situa- 
 tions, either Avithin the orbit or in the cranial cavity just before the 
 artery enters the foramen rotundum. Saltier 's monograj)!! on 
 pulsating exophthalmus (Graefe-Saemisch ■Ha)idbuch) , speaks only 
 of two cases of the first and one of the second form. Since then a 
 few additional examples of the disease, verified b\- anatomical 
 investigation, have been reported. The first is that of a woman, 
 aet. 22, who after parturition developed the symptoms of orbital 
 aneurysm, and who died of hemorrhage after several unsuccess- 
 ful operations had been performed in an attempt to relieve her. 
 The autopsy showed an aneurysm of the internal carotid, begin- 
 ning at the cranial entrance and extending to the origin of the 
 ophthalmic artery at the clinoid process. The latter vessel was 
 found dilated to about four times its normal diameter. In the 
 orbit there w'as a saccular enlargement of the same vessel to the 
 size of an orange. The other case is that of a man who. after a 
 fall, developed exophthalmus, for \vhich an orbitnl exenteration 
 was done. The post-mortem examination revealed an aneurysm 
 of the ophthalmic artery of the size of a walnut. The vascular
 
 462 ANEURYSM OF THE RETINAL ARTERIES 
 
 tumor was entirely within the orbital cavity. The symptoms, treat- 
 ment, etc., of this disease will be discussed under Exophthalmus, 
 Pulsating. 
 
 Aneurysm of the retinal arteries may be single or multiple. It. may 
 occur in spindle-shape or saeular form, or as a cylindrical dilata- 
 tion of the arteries of the papilla or retina. Occasionally it is of 
 the pulsating variety ; while miliary aneurysm has also been 
 observed. The causes are pathological changes in the vessel walls, 
 especially arterio-sclerosis. 
 
 Aneurysm, Retinal arterio-venous. In this vascular anomaly there 
 is direct communication between the arteries and veins of the 
 retina with a marked dilatation of the intervening capillary sys- 
 tem. This may appear in the form of an aneurysmal varisc, when 
 the anastomosis occurs without an intervening sacculation between 
 artery and vein ; or it may show itself as a varicose aneurysm in 
 which the artery and vein communicate bj^ means of new-formed 
 blood-sacules. The former type is nearly ahvays congenital ; the 
 latter mostly of traumatic origin. 
 
 Anevrysme. (F.), n. Aneurysm. 
 
 Anfall. (G.) An attack, a relapse or shock. 
 
 Anfressen. (G.) To corrode. 
 
 Anfrischen. (G.) To refresh. 
 
 Anfrischung, (G.) Animation. 
 
 Angeboren. (G.) Congenital. 
 
 Angeborne Anomalien. (G.) Congenital anomalies. 
 
 Angeborene Anomalien der Bindehaut. (G.) Congenital anomalies of 
 the conjunctiva. 
 
 Angeborene Anomalien der Chorioidea. (G.) Congenital anomalies of 
 the choroid. 
 
 Angeborene Anomalien der Cornea. (G.) Congenital anomalies of 
 the cornea. 
 
 Angeborene Anomalien des Glaskorpers. (G.) Congenital anomalies 
 of the vitreous. 
 
 Angeborene Anomalien der Iris. (G.) Congenital anomalies of the 
 iris. 
 
 Angeborene Anomalien der Lider. (G.) Congenital anomalies of the 
 lids. 
 
 Angeborene Anomalien der Linse. (G.) Congenital anomalies of the 
 lens. 
 
 Angeborene Anomalien der Muskeln. (G.) Congenital" anomalies of 
 the muscles. 
 
 Angeborene Anomalien der Netzhaut. (G.) Congenital anomalies of 
 the retina.
 
 ANGEBORENE ANOMALIEN DES SEHNERVAEN 463 
 
 Angeborene Anomalien des Sehnerven. (G.) Congenital anomalies of 
 
 the optic nerve. 
 Ang-eborene Anomalien der Sklera. (G.) Congenital anomalies of the 
 
 sel<'i-;i. 
 
 Angeborene Anomalien der Thranenorgane. (G.) Congenital ano- 
 malies of llic lai'lirymjil appaeatus. 
 
 Angeborene Ptosis. (G.) Congenital ptosis. 
 
 Angeburt. (G.) Hereditary quality. 
 
 Angegrififen. (G.), adj. Attacked. 
 
 Angeienchyma. (L.), n.n. A tissue composed entirely of blood- 
 vessels. 
 
 Angeiokeratodeitis. (L.), n.f. An old name for keratitis vasculosa. 
 
 Angeioma. [L.), n.n. An angioma, or tumor made up chiefly of 
 blood-vessels. 
 
 Angell, Henry C, one of l>oston\s noted (>i)litha]moh)gists and one of 
 the first to practice that specialty in Ihe United States, was born 
 in Providence, Rhode Island, January 27, 1829. lie M-as a graduate 
 of Hahnemann Medical College, Philadelphia, class of 185:1, and 
 later studied three years at Vienna University, after which he 
 settled down to special practice in Boston at 16 lieacon street, 
 where he died fi-om a complication of diseases on IMay 28, 1911, in 
 his 83d year. 
 
 Angell joined the American Institute of Homeopathy in 1853, 
 the year of his graduation in medicine, thus making his jiei-iod of 
 membership the phenomenal one of fifty-eight years. 
 
 He became a member of the ]\Iassachus(^tts Homeopathic Med- 
 ical Society in 1856, his name being on its i-oll at the time of his 
 death. His loyalty to and interest in the cause of homeopathy as 
 well as his literary tastes and qualifications are shown l)y liis assum- 
 ing the editorship of the New England Medical Gazette in 1866. 
 He thus became the first editor of this journal, although he later 
 relinquished the post to Dr. I. T. Talbot ami devoted liimself to 
 his specialty. For many years he Avas a member of the slaft* of the 
 Massachusetts Homeopathic Hosi)ital as its first ophthalmic 
 surgeon. 
 
 He was one of the small band of liotiieopalhists interested in 
 the evolution and establishment of Boston University School of 
 Medicine. He was a member of its first Faculty and i-eniained its 
 Professor of Ophthalmology until 1893, a period of twenty years, 
 when he was succeeded by his associate in the department. John 
 H. Payne. Those who were privileged to sit under his instruction 
 well remember his perfect ease and grace as a lecturer. He seemed
 
 464 ANGELL, HENRY C. 
 
 to take his students into his confidence, assuming that they were 
 as interested in the eye and knew as much about it as he did. 
 
 In person he Avas small and slight, with piercing, twinkling eyes 
 full of kindliness and alertness. He wore a full beard trimmed to 
 a point, and was especially neat in his attire. He was very urbane, 
 never showed impatience and was always ready with his counsel 
 and kindly advice. Withal he was nature's gentleman. 
 
 His interest in art was a real and vital thing, and was due to 
 the possession of considerable artistic skill, particularly in water 
 colors, though his works in oils were full of tender feeling, espe- 
 cially in the portraying of landscapes. He was a considerable col- 
 lector of paintings, and a visit to his home was like going into 
 a choice art gallery. 
 
 He was in fact not only well known to the medical profession 
 but was prominent in the artistic and literary circles of Boston 
 when the Hub was in its prime as an artistic and literary centre. 
 His chief contribution to medical literature was a text book on 
 Diseases of the Eye, for students and general practitioners, 
 which went through at least seven editions and was noteworthy as 
 being the first on the homeopathic treatment of these diseases. 
 
 "With all his culture and his general and special ability, he was 
 modest, quietly positive and attractive, and his influence was that 
 of the scholar and connoisseur rather than that of the man of 
 affairs. 
 
 The following appreciation indicates the regard in which he was 
 held by those who were fortunate enough to know him intimately. 
 It was written by his close and long-time friend. Professor Arlo 
 Bates, of the Massachusetts Institute of Technology, in response 
 to an inquiry as to the details of his life : 
 
 "I knew Dr. Angell for many years, and was very fond of him. 
 He was a man of marked character, of the greatest refinement, of 
 strong artistic bent, of most charming humor, and of an upright- 
 ness which bound all these together. 
 
 "Of the details of his early life I know nothing. I knew him 
 at first as the friend of William Hunt and that set of painters, as 
 the generous friend of musicians and the appreciative critic of 
 literature. Howells was among his warm personal friends. He 
 was a collector of paintings, and one of the richest outside of 
 France of the Avork of the Barbazon School is in that queer, little 
 brown house on Beacon Hill. Indeed, few in Paris approach it. 
 The French Government tried, half a dozen years ago, to buy a 
 number of his pictures, but he said he bought them for his pleasure 
 and not to speculate in, and refused their handsome offers.
 
 ANGELUCCI FIXATION METHOD 
 
 465 
 
 ■'He went abroad fretiuently when I first met him, ])ut of late 
 years he lias i)assed his life between Boston and Medfield, where 
 he had a cottage. Many years ago he suffered severely from menin- 
 gitis, and he never fully recovered from the attack. For the past 
 ten years he had been so delicate that only his wife's devotion and 
 constant watching kept him alive, yet he has always been cheery, 
 always interested and interesting. We who knew him and loved 
 him can only feel that the memory of such a friend is more vital 
 and lasting than the companionship of the many." — (John H. 
 Payne.) 
 Angelucci fixation method. A mode of fixation of the eyeball de- 
 vised by Angelucci. (See the figure.) 
 
 Angelucci 's Method of Fixing the Eyeball. 
 During the Corneal Incision. During Delivery of the Lens. 
 
 This surgeon rotates the eyeball downwards and seizes with 
 strong fixation forceps the tendon (with the overlying structures) 
 of the superior rectus. By this means the globe is not only per- 
 fectly fixed but the upper lid is held out of the way. In sunken 
 eyeballs, or when the patient attempts to squeeze the lids to- 
 gether or to rotate the eyeball upwards, these efforts do not cause 
 gaping of the wound. Moreover, the grasp of the forceps can be 
 loosened in an instant at any critical moment during the operation 
 and the lids closed at once. This method is very useful in sev- 
 eral forms of cataract and is extensively employed. . 
 
 Ang-esicht. (G.), n. The face or countenance. 
 
 Angewachsen. ((I.) Adherent, attached. 
 
 Angewachsenes augenhautchen. (G.) Ocular conjunctiva. 
 
 Angewohnheit. (G.) A piactical habit, habitually. 
 
 Angioeremia of the retina. Atrophy of the retinal vessels is a sign 
 of certain previous or concurrent atrophic diseases of the retina 
 and, generally, of the optic nerve. 
 
 Angioid streaks in the retina. This condition is also known as "retinal 
 
 Vol. 1—3
 
 466 ANGIOMA 
 
 pigment striee,'' that occur as black-brown areas behind the central 
 vessels of the retina. Ward Holden considers them the remains of 
 hemorrhages diffused in a linear direction through the layers of the 
 retina. According to Lister, they are vestiges of new vessels along 
 whose course exudates (that have undergone secondary pigmenta- 
 tion) are arranged. 
 
 In a case of Zentmayer's the ophthalmoscope showed in both fundi 
 ramifying and anastomosing pigment bands, dark red to black, ex- 
 tending throughout the fundus in each eye. In the right eye there 
 was also a horizontal extravasation of blood. 
 
 Pagenstecher reports two cases showing the same ophthalmoscopic 
 appearances, including in one eye streaks of bright red hem- 
 orrhage, which subsequently developed into typical pigment streaks. 
 He favors Lister's ex;planation of these lesions, viz., that they are 
 connected with new-formed vessels. These vessels may be devel- 
 oped in connection with a chronic inflammatory process in the retina 
 or choroid. 
 Angioma. See Angeioma. 
 
 Angioma conjunctivae. Angioma of the conjunctiva. 
 Angioma venenosum of the orbit. Although this important neoplasm 
 will be further described elsewhere (See Tumors of the ocular ap- 
 paratus; Orbit, Operations on the) it may be said here that it is a 
 benign neoplasm although it may be converted into a malig- 
 nant form of sarcoma. Indeed, these blood-vessel tumors may form 
 combinations wath other neoplasms producing, for example, angio- 
 carcinoma, angiosarcoma, angioadenoma, angiofibroma or angio- 
 lipoma. They may disappear after various forms of inflammation 
 affecting the tumor mass; or, on the other hand, may give rise to 
 septic phlebitis and end fatally from pyemia. An orbital angioma 
 may destroy vision and even bring about caries of the orbital bones 
 by pressure. According to Moores Ball excision is the more desir- 
 able treatment of angioma. This, in deep-seated orbital angiomata, 
 is often impossible without an amount of destruction which might 
 be considered scarcely justifiable in dealing with a tumor the natural 
 tendency of which is innocent. 
 
 Such means as wall cause coagulation of the blood and oblitera- 
 tion of the tumor are to be considered. With these comes the great 
 danger of septic thrombophlebitis. As coagulating injections should 
 never be employed without ligature, their use in the treatment of 
 orbital angiomata is to be condemned. Repeated electrolysis is of 
 value in the treatment of superficial angiomata, and might be suc- 
 cessfully tried in certain of the more deeply situated ones. Igni-
 
 ANGIOMA VENENOSUM OF THE ORBIT 467 
 
 puncture, or puncture with a red-hot Paquelin cautery-ueedie, is 
 excellent treatment for superficial angioniata which are readily 
 accessible to the needle. 
 
 Ligation of the arteries supplying the tumor, or of the main trunks 
 going to the part of the body containing the tumor, has not proven 
 satisfactory. The collateral circulation soon causes a return of the 
 growth. In excising an angioma care should be taken not to cut into 
 the tumor, as troublesome lienion-hage is apt to follow sueli a 
 procedure. 
 
 Inasmuch as it involves the therapy of these new growths the 
 following account of a case by J. F. Klinedinst {OpliUialmology, April, 
 1911) is reported: M. R., aged 31, an employe in a wall-paper fac- 
 tory, gave a history of marked swelling of his right lower eyelid 
 Avhenever he stooped forward to tie his shoe-laces or for any other 
 purpose. The swelling also occurred when he lay on his right side 
 or carried a heavy Aveight on his left shoulder and bent the neck to 
 the right, thus compressing the right jugular vein. Examination 
 by palpation showed a soft, compressible tumor of the external half 
 of the low^er, right eyelid, including the external canthus, with 
 obliteration of the conjunctival sac, due to a bluish swelling like an 
 enlarged vein, about one-fourth of an inch in diameter. There was 
 no ^bruit nor any pulsation perceptible. There was some slight 
 exophthalmus when the tumor was swollen, but no enophthalmus. 
 Vision of both eyes was 15/xx,, there being a low grade of liyper- 
 metropia. An ophthalmoscopic examination revealed nothing 
 abnormal ; neither was there any heterophoria. The patient had had 
 no constitutional diseases and enjoyed good health. The nose, throat 
 and rhinopharynx were normal. 
 
 An operation for excision of the veins was positively declined. 
 Electrolysis was then tried, five treatments being given ; the needle 
 Avas plunged about one-half inch into and along the floor of the orbit 
 toward the outer canthus. The negative current being used during 
 the first three treatments without anj^ efifect upon the tumor, the 
 positive current was then tried during the last two treatments, also 
 without effect. These treatments were followed by some soreness 
 which lasted several days. The author then conceived the idea that 
 if an inflammation could be produced in the vessel walls, the vascular 
 tumor might be obliterated. Alcohol was selected as a drug that 
 would produce a periphlebitis, as well as for its antiseptic qualities, 
 and because it is non-toxic in small doses. After anesthetizing the 
 conjunctiva wnth cocaine, three drops of absolute alcohol Avere in- 
 jected into the orbit by means of a hypodermic syringe. The needle
 
 468 ANGIOM DER BINDEHAUT 
 
 was plunged through the conjunctiva, close to the floor of the orbit, 
 under the vascular tumor, (so as to avoid puncturing the veins) to- 
 ward the external canthus, to the depth of half an inch, and the 
 contents quickly injected. There was a sharp pain felt in the orbit 
 for a few seconds, which soon subsided without any reaction, fol- 
 lowed by a feeling of soreness for a few days. One week later the 
 swelling was not so great when the patient stooped forward. A 
 second injection of five drops was given at this time in the same 
 manner as the previous one. This injection was followed by sharp 
 pain, with slight swelling of the tumor; this subsided in a day, fol- 
 lowed again by soreness within the orbit for several days. 
 
 One week later the tumor did not seem to bulge so much as for- 
 merly, and was slowly becoming smaller. A third injection of six 
 drops was given ; this was f oUoAved by pain for a few seconds, which 
 lessened before the patient left the writer's office. He returned in 
 about three hours, complaining of some soreness in the orbit and of 
 severe, intermittent pain. There was great swelling and bulging of 
 the whole lower right eyelid from the outer to the inner canthus, with 
 obliteration of the tarso-orbital sulcus; the conjunctiva and skin of 
 lid were of a bluish color; there Avas some exophthalmus, but no 
 impairment of vision. Under applications of ice the swelling sub- 
 sided the following day, but there was continued soreness wit^iin the 
 orbit for several days. One week later there were no signs of the 
 tumor. The patient could then bend or stoop forward without bring- 
 ing on swelling or bulging of the eyelid. To make a more thorough 
 cure Klinedinst gave another injection of five drops of alcohol into 
 the same region of the orbit, which was followed by the usual pain 
 and soreness. 
 
 It is now more than a year since the writer gave the injections, 
 and he feels reasonabl.y sure that a cure has been effected without 
 any impairment of the functions of the eye. A recent examination 
 of the patient showed no evidence of the former tumor. — (Ed.) 
 
 Angiom der Bindehaut. (G.) Angioma of the conjunctiva. 
 
 Angiom der Orbita, (G.) Angioma of the orbit. 
 
 Angiomegaly. According to deSchweinitz (Diseases of the Eye, p. 
 221), this disease is characterized by an increase in the volume of 
 the skin of the lid. The palpebral skin becomes folded and falls 
 over its margin, but appears atrophic and may be transiently red, 
 like the color of the cheek. It symmetrically affects the upper lids, 
 and has been attributed to a structural or functional anomaly of 
 the vascular system. 
 
 Angiomi delle palpebre. (It.) Angiomata of the eye-lids.
 
 ANGIOPATHIA RETINAE TRAUMATICA 469 
 
 Angiopathia retinae traumatica. A name given by Purtscher to pe- 
 ciiliai- fundus changes in which there is (probably) extravasation 
 and organization of lymph in the retinal tissues as the result of 
 severe injury — generally fracture of the skull. 
 
 Angiosclerosis. Arteriosclerosis; liardening or degeneration of the 
 blood-vessels. 
 
 Angiosclerosis, Ocular. Alterations in slructure of tlie blood-vessels of 
 the eye. See Arteriosclerosis, Ocular. 
 
 Angioscope. Aji instrunicul for rxainining the Cfipillary vessels of 
 animals and phmts. 
 
 Ang"le' In geomdrij, the space includeil belween two intersecting 
 lines. The point where the lines meet is called the vertex of the angle. 
 Angle of chromatic deviation, the angle througli which the refracted 
 ray of definite wave-length (color) has to be turned in order to 
 bring it into coincidence Avith the normal to a surface at the point 
 of refraction. See Achroraatisni. 
 
 Angle of deviation, the angle through which the refracted ra^^ has 
 to be turned in order to bring it into coincidence with the corre- 
 sponding incident ray. Tlu^ angle of deviation (8) of rays that are 
 perpendicularly incident to one face of a prism is dependent upon 
 the apex-angle (6) of the prism and the index (u) of refraction, these 
 
 bearing the following relation to each other: n == ^^ : — 'Ins 
 
 ^ ° sm a 
 
 sin 8 
 equation nuiy also be given the convenient form: tan li = ^^ ^^^g •• 
 
 The angle of deviation produced by any pi'ism of the dioptral system 
 (q. V.) is found in the table of goniometrical tangents, simply through 
 dividing the power of the prism by 100. For instance, to find ac- 
 curately the angle of deviation that is produced by a prism of 9 
 • prism-dioptres, when exposed to perpendicular incidence, the tangent 
 value is equal to 0.09. The nearest tangent value in llic table is 
 0.08749, so that 0.09000 less the tau ."v" = 0.08749 gives a difference 
 in the tangent value = 251. In the table, between the tangents for 
 5° and 5° 10', is found a difference of 29.:3 produced by V. Hence, 
 251 is to be divided by 29.3 in order to ascertain the number of min- 
 utes contained in the tangent difference of 251, and which gives 
 8.56'. This must be added to 5 . Hence, 5= 8.56' = 5° 8'+0.56 
 -j_60" = 5° 8' So. 6''. (\)nse(iuently 9A produces an angular devia- 
 tion of 5" 8' 83"+. Angle of incidenvi , the angle through which the 
 incident ray has to be turned in order to bring it into coincidence 
 with the normal to a surface at Ihe point of incidence. When rays 
 are reflected at a surface, the angle of reflection is always equal to
 
 470 ANGLE ALPHA 
 
 the angle of iucideuce, but if the rays are refracted at a surface, the 
 angle, (r) of refraction depends upon the index (n) of refraction of 
 the medium and the angle (i) of incidence, when sin i/sin r == n. 
 Angle of minimum deviation, the least deviation sustained by a ray 
 in passing through a prism. It is known to be minimum when the 
 incident ray and the refracted ra.y form equal angles with the line 
 that bisects the apex-angle of the prism, in other words, when the ray 
 traverses the prism symmetricalh'. The ray itself is then also called 
 the ray of minimum deviation. The critical value of the angle 8 of 
 minimum deviation is dependent upon the angle 6 of the prism and 
 the index n oE refraction, which bear the following relation to each 
 other : 
 
 . B+8 
 sin - - 
 
 11 = -. See also Prism. 
 
 6 
 sin - 
 
 Angle of p ol a ri cation, the angle of incidence giving the most com- 
 plete polarization of light (q. v.) for any given substance. Also called 
 polarizing angle. Angle of pri.s/)j, the angle included between the re- 
 fracting surfaces of a prism (q. v.). Also called the refracting angle; 
 the apex-angle; the apical angle. Angle of reflection, the angle through 
 which the reflected ray has to be turned in order to bring it into coin- 
 cidence with the normal to a surface at the point of reflection. The 
 angle of reflection at a surface is always equal to the angle of inci- 
 dence. Angle of refraction, the angle through which the refracted ray 
 has to be turned in order to bring it into coincidence with the normal 
 to a surface at the point of refraction. The angle (r) of refraction and 
 the angle (i) of incidence are connected by the relation sin i/ sin 
 r = a constant (the index of refraction), this relation being known as 
 Snell "s Law, from its discoverer, Willibrod Snellius. — Angle-true, see 
 Orthoscopic. Critical angle, the limiting angle of incidence which, 
 within a medium more dense than air, separates the totally reflected 
 rays from those which, at least partially, escape into air. (C. F. P.) 
 Angle alpha. This angle, generally' written angle a measuring from 5' 
 to 7°, is formed by the junction of the visual axis and the optic 
 axis. The visual axis, or visual line, is the ray which passes through 
 the first nodal point of the eye to the fovea after having been re- 
 fracted so as to pass through the second nodal point. The location 
 of this axis is not constant, being dependent upon the varying fixing
 
 ANGLE, BI-ORBITAL 
 
 471 
 
 point of the fovea. Noi- is the oplie axis a constant, for this is the 
 line passing through at least three of the four centers of curvature 
 of the cornea and lens. Congenital anomalies of these structures 
 
 L \limi 
 
 LIVE 
 
 
 /8 ofnc 
 
 AKti 
 
 
 o^ - ANCLE ALPHA 
 
 
 c, ■ CBHTRE 
 
 Of tDM/Arute Of ^niT ivtri^ci 
 
 Of CODNE A 
 
 c, 
 
 ■■ flUiT 
 
 
 c,- 
 
 ■■ /{N7 
 
 LiNi 
 
 C-- •■ 
 
 Angle Alpha. 
 
 ■■ 
 
 displace the linear position of the points; consequently this decenter- 
 ing must be neglected. — (H. G.) 
 
 Ang^le, Bi-orbital. The angle subtended by the axes of the orbits. 
 
 Angle, Co-orbital. In craniometry^, the angle made by the anatomical 
 plane, where it crosses the bi-orbital plane. 
 
 Angle epsilon. Landolt's name for the angle included between the 
 macular axis and the papillaiy axis. It is usually greater in hyper- 
 opes than in myopes. 
 
 Angle gamma. This term, usually written, angle y, is merely another 
 name for the angle alpha (q. v.). It is also known as the 
 angle beta, (B), according to the individual author's definition. See 
 Physiological optics. 
 
 Angle, Great, of the eye. The inner canthus, or angle formed by the 
 junction of the upper and lower lids. 
 
 Angle kappa. In pliysiologic optics, the angle between the line of fix- 
 ation and the normal to the cornea that passes through the pupillary 
 center. As the latter is usually nearer to the nasal side of the center 
 of the cornea, the angle kappa (y) is not e(iual to the angle ganima 
 (y), but being nuicll easier to measure tlian y, is far more convenient 
 to make use of in the measurement of strabismus. — (C. F. P.)
 
 472 ANGLE KAPPA 
 
 Landolt describes it in the Traite coniplet d'Ophtalmologie, iii., 
 p. 815, 1887; and the System of Diseases of the Eye, Vol. 4, p. 46, 
 In the latter work he gives its measnrement, and refers to the 
 method of determining it as follows: The affected eye being placed 
 at the centre of the perimeter, Ave cover the sound eye, and have 
 the patient fix the flame at the summit of the arc. In this case the 
 visual line is necessarily directed towards this zero-point. If the 
 visual line coincided with the pupillary axis, the reflex of the flame 
 would appear to be at the centre of the pupil, when we look at the 
 
 ^ 
 
 
 
 \ 
 
 
 / 
 
 ' / ' 
 
 1 
 
 \ 
 
 X 
 
 / 
 
 '' / / 
 
 
 
 X 
 
 / 
 
 'i / / 
 
 
 
 \ 
 
 /• 
 
 1 / ' 
 1 / 
 
 
 
 \ 
 
 / 
 
 M / ' 
 
 
 
 \ 
 \ 
 
 / 
 
 ' / / 
 
 
 
 \ 
 
 / 
 
 ' /' 
 
 
 
 \ 
 
 / 
 
 '7/ 
 
 
 
 \ 
 
 / 
 
 
 
 
 \ 
 \ 
 
 1 
 1 
 1 
 
 4 
 
 Landolt 's Angle Kappa. 
 
 observed eye from the summit of the arc. This maj" occur, but it 
 is not the rule; in general, the i^upillarj" axis passes to the outside 
 or to the inside of the visual line. 
 
 To find at once the direction and the degree of the angle kappa, 
 we leave the flame immobile at the zero-point, and we move our eye 
 along the arc until we have found the point at which it is neces- 
 sary to view the observed eye in order that the reflex of the flame 
 may appear at the centre of the pupil. The corresponding degree 
 on the arc then represents twice the angle kappa. 
 
 The explanation of this is very simple: If 4 — 1 (See the figure) 
 be the visual line of the eye and 5 — 2 the pupillarj^ axis, then 
 1 — 5 ^ — ^2 will be the angle kappa. If the flame remain at 1, I am 
 obliged to move my eye to 2 ^ in order to see, at the centre of the 
 pupil, its reflex formed by the portion 3 of the cornea. Now, the
 
 ANGLE LOUCHANT 473 
 
 angle 1 — 'S — 2^ represents the sum of tlie angle of incidence 
 1 — 8 — 2 and the angle of reflection 2 — '.] — 2', Avhich are e(iual. 
 The angle of incidence 1 — 8 — 2, being nearly ecjual to the angle 
 kappa, may be regarded as the double of the angle kappa. 
 
 It might seem that it would be sim])U']' to liave the [)atient tix 
 the zero-point of the arc, and to carry the candle along the arc, 
 in order to find, at 2, directly, the angle kappa. iJnt this angle 
 is usually so snutll that we are glad to possess, for its rapid deter- 
 mination, a method which gives a precision double that of this 
 direct method. 
 
 Usually the pupillary axis passes without — that is to say, at the 
 temporal side of — visual line (positive angle kappa, -j- X). This 
 condition produces for the spectator (Avho has for his guide only 
 the pupils which he sees, and not the visual lines which he does 
 not see) the appearance of a divergent strabismus, even when the 
 eyes of the person observed are normally directed. Thus, in case 
 of positive angle kappa, a real divergence appears exaggerated, 
 wdiile a convergent strabismus is apparently diminished — indeed, 
 often entirely concealed. 
 
 To find the real angle of strabismus it is, therefore, necessary to 
 subtract the positive angle kappa from the apparent divergent 
 strabismus, and to add it to the apparent convergent strabismus. 
 
 The angle kappa takes the negative sign ( — X) when the pupil- 
 lary axis passes to the inside — to the nasal side — of the visual line. 
 In this case there is an apparent convergence during the normal 
 direction of the gaze. Hence the negative angle kappa ought to 
 be added to the angle of the apparent divergent strabismus, inas- 
 much as the lines of sight diverge even when the eyes' have the 
 appearance of being parallel. It ought to be subtracted from the 
 angle of the apparent convergent strabismus, Avhich it causes to 
 appear unduly great. 
 Angle louchant. (F.) Squinting angle, as measured on the perimeter. 
 Angle, Metre. The meter, or metre, angle is the expression of an 
 attempt by Javal and Nagel to standardize the measurement of 
 convergence, analogous to the dioptric measurement of refraction. 
 If both eyes fix for an infinite distance, the visual lines are parallel. 
 If the eyes then fix a point one meter distant along the visual line 
 of one eye, the visual line of the other eye will form an acute angle 
 "with the visual line of that same eye wdien fixing for infinity. This
 
 474 ANGLE, NASAL 
 
 is the meter angle, although the term is now nearly obsolete. The 
 value of this angle is about 3i/^°. — (H. G.) 
 
 |/V\En?E 
 
 V^^ 
 
 INnMlTV 
 
 The Metre Angle. 
 
 Angle, Nasal (of the eye). The inner angle, or internal eanthus. 
 
 Angle of aperture. In optics, the angle formed by lines joining two 
 opposite and peripheral points of a lens with the lens focus. 
 
 Angle of deviation. This term indicates the angle made by the visual 
 lines of both eyes in cases of heterotropia. It is usually determined 
 by employing the perimeter arm, to the carrier of which is attached 
 a small light, behind which the surgeon stands. The patient regards 
 the fixation point of the perimeter (in the examination for near) 
 with the fixing eye, while the light reflex from the cornea is observed 
 by the examiner. The carrier is moved back and forth until the 
 reflex is seen in the centre of the deviating pupil, the amount of 
 deviation being read off the perimetric arc. The patient now looks 
 at an object 6 metres distant, and directly in front, and a similar 
 observation is made. 
 
 Worth {Ophthalmic Y ear-Book, 1904, p. 52) also uses the corneal 
 reflex. He employs a "deviometer" which consists essentially 
 of a horizontal arm that can be swung either way, carrying a slide 
 with a white spot towards which the child is induced to look. An 
 electric lamp opposite the pivot of the arm can be flashed on or off, to 
 give the corneal reflex. The surgeon watches the cornea from just 
 above the electric light, and a tangent scale on the back of the arm 
 indicates the amount of deviation. See Examination of the Eye; 
 Muscles, Ocular. 
 
 Angle of incidence. The angle at which light striking a denser 
 medium becomes reflected or refracted. (See figure.)
 
 ANGLE OF REFLECTION 
 
 475 
 
 Angle of reflection. The angle whicli a reflected sound or light-wave 
 makes with a perpendicular let fall upon the reflecting surface at 
 
 B 
 
 The Angles of Kefleetiou and Incidence. 
 
 the point of reflection. The angle of reflection is always equal to 
 the angle of incidence (q. v.), (See figure.) 
 Ang"le of refraction. The angle made by a refracted ray of light with 
 
 The Angle of IJefraction.
 
 476 
 
 ANGLE OF THE EYE 
 
 a prolonged perpendicular let fall iipon the surface at which the 
 
 point of refraction. (See figure.) 
 Angle of the eye. See Canthus, 
 Angle of vision. The angle of vision is formed by the rays that pass 
 
 from the terminal points of an object through the nodal point of the 
 
 eye to the retina. Thus, in the figure, the angle AOB, or simply X, 
 
 0- MODAL TOIMT 
 X- VISUAL At^CLE. 
 
 Angle of Vision. 
 
 is termed the visual angle. Snellen utilizes this angle in construct- 
 ing his test types, and empirically placed the value of this angle for 
 normal vision at five minutes (5'), although its minimum value is 
 approximately one minute (I')- — (H. G.) 
 
 Angola seeds, n.pl. Jequirity beans. See Abrus precatorius. 
 
 Angolo alpha. (It.) Angle alpha. 
 
 Angolo gamma. (It.) Angle gamma. 
 
 Angolo metrico. (It.) Metre angle. 
 
 Angolo ottico. (It.) Optic angle. 
 
 Angolo stralunato. (It.) Angle of squint. 
 
 Angolo visivo. (It.) Visual angle. 
 
 Angular. In geometry, having an angle or angles; measured by an 
 angle ; subtending an angle ; having a divergence expressed in degrees, 
 minutes, and seconds: as aufinlar distance; angular velocity. Angular 
 aperture of a lens. (See Aperture.) Angular distance, the angle of 
 separation included by the directions of two objects from a given 
 point. Also called apparent distance. 
 
 Angular intervals, in astronomy, those arcs of the equator which are 
 intercepted between circles of declination passing through the objects 
 observed. They are measured by means of the transit instrument
 
 ANGULAR CONJUNCTIVITIS 477 
 
 and clock. A)igular laagnificaiioii, in opiics, the ratio of conjugate 
 slope-angles, in which the tangent of the slope-angle of the image-ray, 
 divided by the slope-angle of the object-ray proceeding from the 
 conjugate axial object-point, is a constant. Also called the "Con- 
 'vergence ratio," which is an important magnitude in the theory of 
 optical instruments. Angular measure, the system of units employed 
 for measuring angles. It is based on the measurement of the cir- 
 cumference of a circle described with the vertex of the angle at its 
 center. The circumference is regarded as divided into 360 equal 
 parts called degrees; a right angle is thus the angle subtended at 
 the center by the fourth part of the circumference, or is 90 degrees. 
 The table is: 
 
 60 seconds (60") =1 minute (!') 
 60 minutes ^^1 degree (1°) 
 
 360 degrees = 1 circumference or circle. 
 
 Angular motion, in pliysics, the motion of any body which moves 
 about a fixed or relatively fixed point : as, the angular motion of a 
 pendulum or a planet : so called because such motion is measured 
 by the angle contained between lines drawn from the fixed point to 
 the successive positions of the moving body. Angular perspective, 
 in drawing, that kind of perspective in which neither of the sides of 
 the principal object is parallel to the plane of the picture, and there- 
 fore, in the representation, the horizontal lines of both converge to 
 vanishing-points. Also called oblique perspective. Angular velocity, 
 in mechanics, the angle which a line perpendicular to the axis of 
 rotation sweeps through in a given unit of time : the speed or rate 
 of revolution of a revolving body: usually expressed in circular or 
 angular measure (q. v.). — (C. F. P.) 
 
 Angular conjunctivitis. See Morax-Axenfeld conjunctivitis. 
 
 Angulometer. Also called Crest Mpivsurer. An instrument for 
 measuring the "angle of crest" — i.e., the inclination wdiich the 
 dorsal plane of a patient's nose (at the so-called "normal posi- 
 
 Angulometer.
 
 478 ANGULUS IRIDIS 
 
 tion") makes with the plane of the horizon, or with the "plane of 
 average inclination."' The operation of the instrument is suffi- 
 ciently obvious from the accompanying illustration. — (T. H. S.) 
 
 AngTilus iridis. The space between the cornea and the iris near the 
 iridic ligament. It is generally called the irido-corneal angle, or 
 angle of the iris, or angle of the anterior chamber. See Anatomy 
 of the eye. 
 
 Ang-ulus ocularis. (L.) Canthus. The angle formed by the junction 
 of the upper and lower lids. 
 
 Angulus oculi extemus. (L.) The external canthus or outer angle 
 of the eye. 
 
 Angulus oculi internus. (L.) The internal canthus or inner angle 
 of the eye. 
 
 Angulus oculi lateralis. External ocular canthus. 
 
 Angulus oculi medialis. Internal canthus. 
 
 Anhalonium Lewinii, Oculo-toxic symptoms from. In Northern Mex- 
 ico, especially in the state of Tamaulipas, a common cactus, called 
 "Mescal (or Miiscal) buttons," is used by several native tribes in 
 the preparation of an intoxicant. The plant contains a strychnia- 
 like alkaloid, mihalonin, together Avith a depressing substance, 
 pellotin. After using two to five of these cacti, for the purpose 
 stated, rapid dilation of the pupils occurs, which lasts from twelve 
 to tw^enty-four hours and is accompanied by ptosis and loss of 
 accommodation. Visual hallucinations follow, Avhich are said to 
 be even more remarkable than those produced by haschisch. These 
 consist of distinct panoramic color etfects and rapid kaleidoscopic 
 color changes. The mind is clear and the intoxicated person is 
 able to concentrate his thoughts. Those addicted to this habit 
 describe the sudden ai^pearance in the field of vision of "tubes of 
 glistening lights which carry green or red balls that roll about 
 continually." Other forms — letters, figures — show themselves, 
 lighted by the most brilliant colors of the spectrum. Objects at 
 first appear violet, then green and golden yelloAv ! By gas illumina- 
 tion there is an increased percej^tion of light, and shadows are 
 violet colored ; in electric illumination there are peculiar wavelike 
 movements of objects. — (Lewin and Guillery.) 
 Anhalten. (G.) To stand still, to hold on, to submit without inter- 
 ference. 
 Anhaltungsmittel. (G.) An astringent. 
 Anhanglich. (G.) Slight attachment; adherence to. 
 Anhaufung. (G.), n. An accumulation in or congestion of a part. 
 Anheftung. (G.), n. Attachment.
 
 ANHEILEN 479 
 
 Anheilen. (G.) To heal on, to heal by adhesion. 
 
 Anilin. (G.) Aniline. 
 
 Anilinblau. (G.) Aniline blue. 
 
 Anilindampfe. (G.) Aniline vapors or gases. 
 
 Aniline colors. See, also, Pyoktanin, Toluidine blue, Methyl violet. 
 These brilliant color derivatcs are highly complex, mostly hydro- 
 carbon componnds obtained by the destructive distillation of coal or 
 lignite and associated with tar products. A number of them have 
 been used for various ophthalmic purposes, especially in ocular ther- 
 apeutics. They will be described under their various headings. 
 
 Most of the aniline coloring compounds afford a good example 
 of a combined stain and cauterant, and while some are (with equal 
 staining powers) more irritant and poisonous than others, yet 
 remarks of the oculo-toxic relations of one color hold fairly true 
 of the others. The biological effect is determined by the penetra- 
 bility of the dyes into the tissues, and that varies with dift'erent 
 dyes. 
 
 Anilin black, on account of its insolubility, is not used as a dye, 
 but is precipitated on the threads of cloth from mixtures contain- 
 ing aniline. Thus, any insoluble aniline compound may affect in 
 a similar fashion any living tissues or surface Avitli which it comes 
 in contact. 
 
 Vogt gives the results of an elaborate series of researches upon 
 the action of the aniline colors upon the conjunctiva. 
 
 His experiments, made upon rabbits, embraced over seventy dif- 
 ferent colors. He came to the following conclusions: If a small 
 quantity of an acid, neutral or mordant color, or colors insoluble in 
 water, be placed on the conjunctiva, little or no inflammation of the 
 mucous membrane results, but if an equal quantity of a basic color 
 is applied, intense inflammation, which may even lead to panoph- 
 thalmitis, results. The various basic colors differ as to the intensity 
 of the inflammation set up. 
 
 As regards relief, his experiments showed that the action of even 
 the most caustic basic colors may be neutralized by irrigating the 
 conjunctival cul-de-sac with a 5 per cent, tannin solution. If solu- 
 tions of sodium chloride, boric acid, or sodium bicarbonate (the 
 very solutions most likely to be at hand) are used, they only in- 
 tensify the caustic action, and do more harm than if nothing at all 
 be used. These practical points are important, for with the modern 
 development of the aniline industries, these accidents are becoming 
 more frequent. 
 Aniline, Oculo-toxic symptoms from. Of 35 employees in a wool-
 
 480 ANILINE, OCULO-TOXIC SYMPTOMS FROM 
 
 dyeing factory, 17 showed no changes in the eyes. Of these, 11 
 were under 30 years of age and had not worked more than 4i/^ 
 years in that occupation. The other 6 were from 50 to 60 years 
 old and had nothing to do with the dyes directly. Ten of the 
 workers exhibited only conjunctival irritation, and one man, who 
 was employed for 10 years, had conjunctivitis and corneal changes. 
 Aniline amblyopia usually occurs in those who have been employed 
 in dyeing houses for a long time and are over 50 years of age. 
 
 The direct cause of the corneal disease is the hot vapors rising 
 from the dyeing troughs at the end of the dyeing process, to 
 which the workers are exposed several times during the day. Cor- 
 rosive substances are produced while the yarn is being drawn 
 through the dyeing material, which is very hot and steaming. 
 These chemicals are chiefly color mixtures of anilin hydrochloride, 
 copper chloride, potassium chlorate, etc., that act powerfully on 
 the eyes. The resulting compounds are oxidation products of 
 aniline — quinones. They are deposited in the eyes of the work- 
 men at the sclero-eorneal junction ; they abrade the sensitive epi- 
 thelium of the cornea and produce minute epithelial defects which 
 form roughened areas upon which additional chemical material 
 settles, or into which the Avorkman, under the influence of the 
 itching and other ocular discomfort, rubs dye-stuff from his hands. 
 Accompanying this injury is staining of the cornea. In the course 
 of a year or two the corneal epithelium is undermined and the 
 parenchyma, cloudy and stained, becomes a sepia brown. Vision 
 is reduced and all the symptoms of a severe corneal inflammation 
 result. In some cases corneal swellings resembling vesicles, with 
 a brown base, appear. The bulbar conjunctiva itself may also 
 become intensely yellowish-brown at the intermarginal space. In 
 one patient the corneal epithelium, over an area of 2i/2 by 6 mm., 
 showed small vesicles; the vision was 0.2 in the right and 0.45 in 
 the left eye. 
 
 After a change of occupation and treating the corneal disease 
 in the usual manner, the keratitis slowly improves. In from a few 
 months to a year the epithelium regenerates, the staining becomes 
 less marked and the vision improves. 
 
 Lewin and Guillery (Die Wirkungen von Giften auf das Auge) 
 say that aniline when taken internally is, like nitrobenzol, an 
 active blood poison, chiefly .because of the formation of methemo- 
 globin from the oxyhemoglobin. The disturbances of the visual 
 apparatus, like its general eft'eets, are readily understood and may 
 be deduced from our knowledge of the blood changes. When the
 
 ANILINE, OCULO-TOXIC SYMPTOMS FROM 481 
 
 skin appears ''cyanotic," as it is iniproperly called (it is really 
 colored a grey-violet) in cases of aniline poisoning, and the blood 
 
 , is found to be darker than normal, one of the decomposition 
 products of the blood can be detected by the si)eetroscope (q. v.). 
 Ocular disturbances occur most frequently among aniline workers. 
 The local action in-oduced by the fumes of aniline or l)y contact 
 with the fingers i)roduces ciliary injection and photophobia. Tf 
 the changes in the blood are very severe, as, for example, after 
 drinking aniline oil, then the eye-vessels themselves contain methem- 
 oglobin, which produces a brownish-yellow discoloration of the 
 conjunctiva and sclera. This is one source of the discoloration, 
 but from our observation not the most important. The other 
 results from a hematogenous icterus. In a 44-year-old aniline 
 worker such a coloration was seen on the lids and cornea, with 
 a slight reduction of vision. 
 
 Aniline has a mydriatic action after a local application to the 
 eye of solutions of 1 to 500. It is also found, associated with the 
 systemic symptoms after poisoning with aniline oil, or after 
 
 . exposure to aniline vapors. If the pupils are of medium size at 
 the beginning of the intoxication, they dilate sometimes during 
 the course of the poisoning. There is, however, no uniformity in 
 the action of this intoxicant on the pupils. A distinct contraction 
 of the pupil can be made out after cases both of internal, cutaneous 
 and aniline-vapor poisoning of workers. Other eye symptoms have 
 been noted, among tiiem weakness of accommodation and hem- 
 eralopia. 
 
 The therapeutic use of aniline oil, formerly much in vogue, 
 resulted in glaucoma in a case of hypopyon-keratitis. After sev- 
 eral paracenteses the eyesight improved until fingers could be 
 
 counted at 1 m. 
 
 In an aniline Avorker there was noticed a bilateral iritis with 
 amblyopia. Accommodative fatigue, blurring for near-work, and 
 some slight reduction in distant vision have been frequently 
 observed among aniline workers; but a more serious derangement 
 of the visual apparatus also occurs. The cause of this is, in our 
 opinion, a more or less acute disturbance of nutrition of the 
 posterior portion of the eye, due to inability of the poisoned blood 
 to nourish the tissues. While numy of the acute symptoms of 
 poisoning, due to the same cause, disappear with the passing of 
 the methemoglobin, the eye changes may remain. The first to 
 suffer in such a case is the optic nerve. 
 
 A dyer was obliged to weigh aniline sails in a poorly ventilated 
 
 Vol. 1—3 1
 
 482 ANILINE OIL AMBLYOPIA 
 
 room. He developed narrowing of the field of vision for white 
 and colors, and a triangular scotoma for red and green, the apex 
 central, the base 20° to the periphery. The mirror showed an 
 optic neuritis, the margins of the papilla and the arteries were 
 obliterated and the veins swollen. In another case, a dyer, 35 
 years of age, Avhose Avork was with aniline oil, took no precau- 
 tionary measures. He became dizzy, had headache, faintness and 
 paleness of the skin (methemoglobinemia). Fifteen days later, 
 a marked narrowing of the field of vision showed itself in the 
 temporal half, with green and blue blindness. The contour of the 
 papilla was obscured, the veins somcAvhat swollen and the arteries 
 empty. 
 
 Aniline oil amblyopia. Only a few cases are on record, and these 
 have resulted from inhalation of aniline oil in factories where that 
 agent is made or used. Its effects on the eye are asthenopia, photo- 
 phobia and a form of amblyopia associated with narrowing of the 
 visual field, with peripheral scotomata. Discoloration of the con- 
 junctiva has also been seen. The prognosis is generally favorable. 
 
 Anilinfarben. (G.) Aniline dyes. 
 
 Anilinfarben, Einfache. (G.) Simple aniline colors. 
 
 AnilinfarbstofP. (G.) Aniline staining material. 
 
 Anilingelb. (G.) Aniline yellow. 
 
 Anilingriin. (G.) Aniline green. 
 
 Anilinolvergiftung. (G.) Aniline oil poisoning. 
 
 Anilinroth. (G.) Aniline red. 
 
 Anilinschwarz. (G.) Aniline black. 
 
 Anilintriibung der Hornhaut. (G.) Aniline staining of the cornea. 
 
 Anilinvlolett. (G.) Aniline violet. 
 
 Anilinwassergentianaviolett. (G.) Gentian violet in aniline water. 
 
 Anilinxylol. (G.) Aniline xylol. 
 
 Animal (lower) eyes, Operations on. See Veterinary ophthalmology. 
 
 Animals, Domestic, Eye diseases of. See Veterinary ophthalmology. 
 
 Animal eyes. Uses of, in ophthalmology. Apart from the use of the 
 rabbit's cornea in the treatment of blindness from leucoma (see 
 Transplantation of the cornea) and for the reduction of an outer 
 staphyloma (q. v.) whole eyes of the pig, dog, rabbit, etc., are em- 
 ployed both in the living and dead animal, as well as when removed 
 from the body, for the teaching and learning of ophthalmology and 
 the steps of operations. The method employed for all these pur- 
 poses will be described elsewhere in this Encyclopedia. 
 
 The transplantation of the whole of a rabbit's eye into the human 
 orbit has up to the present time resulted in little more than the ex-
 
 ANIMO 483 
 
 ploitatioii of a surgical curiu!sil\', but extuiidiug some slight encour- 
 agement for future investigation. AVliile a few experiments have 
 produced movable, and more or less prominent, stumps by such 
 procedures, no case lias as yet been reported where vision has been 
 produced and in the very nature of things it is exceedingly improb- 
 able that such a result Avill ever be attained. It must be mentioned, 
 however, that S. Zervos, (Grcce Medicale, Vol. XII, Xo. 1 and 2, 
 1909) narrates some Avonderful results in transplanting testicles, 
 kidneys, spleens and eyeballs from one animal to anothei'. He 
 claims that eyes from young animals can be successfully trans- 
 planted and that they will resume their functions. Certainly, fur- 
 ther proof is necessary before such astounding claims will be ac- 
 cepted. It is dit^cult to see how the stump-producing results of 
 these experiments are i-eally superior to a well-performed enuclea- 
 tion, where the muscles, conjunctiva, etc., are all sutured together, 
 since under the most favorable circumstances the implanted eyeball 
 shrinks to one-half or one-third of its original volume. The results 
 certainly cannot be compared in their cosmetic (luality to a Mules' 
 operation. 
 
 Some operators merely adjust the rabbit's eyeball into the space 
 just vacated by the human globe and attach the muscles, conjunctiva, 
 etc., to the implanted sphere ; others also unite the ends of the two 
 optic nerves. See Enucleation of the eyes. — (F. A.) 
 Animo (cecita dell'). (It.) Psychic blindness. 
 
 Aniridia. Irideremia congenita. Angeborener Irismangee. One of 
 the most interesting of all congenital defects is that of aniridia or con- 
 genital absence of the iris. It is in this condition that hereditary ten- 
 dency in its relation to congenital defects most prominently reveals 
 itself. It is strange and utterly unintelligible why this is so. 
 
 As clinically seen it is generally complete, though less frequently 
 partial aniridia is met with. The defect is as a rule bilateral. An- 
 atomical investigation always reveals a stump of iris even where clinic- 
 ally a diagnosis of complete aniridia had been made. 
 
 Total aniridia may occur in one eye simultaneously with a large iris 
 coloboma of the other eye. 
 
 The very large, apparently black, pupil on close insi)ection gives a 
 grajnsh reflex. The edge of the lens can be clearly distinguished. As 
 a rule the ciliary processes are not visible, due either to poor develop- 
 ment or to the fact that they are pulled backwards. The ciliary muscle 
 may show perfect development, and accommodation as a consequence 
 be up to the normal. The antei-ior chamber may be normal, or abnor- 
 mally deep. Less freciuently it is shallower than normal. Acuity of
 
 484 
 
 ANIRIDIA 
 
 vision is generally much reduced. There is, as is obvious, a strong 
 aversion to bright light. Complications are frequent accompaniments ; 
 among them may be mentioned anterior and posterior polar cataract, 
 total cataract, dislocation of the lens, atrophic choroidal spots, vit- 
 reous opacities, and detached retina, the latter three conditions of 
 less frequency than the others. 
 
 Aniridia Section through Cornea and remains of Iris. 
 
 The cornea may show anomalies of shape and transparency. It is 
 impossible to sa.y whether any cloudiness of the cornea is congenital 
 or acquired. Often nystagmus and, less fre(iuently, strabismus occur 
 as a complication. Dislocation of the lens, which is usuall}^ upwards, 
 may be present at birth or occur subsequently. The fibres of the sus- 
 pensory ligament are usually intact, but may be missing wholly or in 
 part. They may be overlooked as it is difficult to distinguish them un- 
 less thickened. 
 
 Aniridia. 
 
 The most interesting and seemingly paradoxical complication is 
 glaucoma, to which these eyes are more or less predisposed. Anatomical 
 investigation reveals the fact, however, that in these cases the iris stump 
 is closely adherent to the posterior corneal surface at the iris angle, 
 which effectually shuts off Schlemm's canal and thereby prevents the 
 normal filtration of intra-ocular fluids. In other cases the concomitant 
 lens luxation is a contributing factor in the causation of glaucoma. 
 Aniridia may be looked upon in a way as a total coloboma of the 
 iris.
 
 ANIRIDIA, GLASSES FOR 485 
 
 Aniridia lias been desei-ibed as a congenital mydriasis. This view 
 has, however, been abandoned. The cause of aniridia is also explained 
 by the theory that the lens remaining unduly long in contact with the 
 cornea prevents the ingrowth of tlie iris tissue. This must be held as 
 unproved, since the pi-oeess of ciubi-yoiud d('V('b)piiient at thi' time 
 of the formation of llie ii'is is sucli as to make this view ([uite 
 doul)tful. 
 
 The theory tliat aniridia is due 1o iiifiammatory causes is unten- 
 able, as sliown 1)\- X'on llipprl. Inasimicli as the defect is nearly 
 always bilateral and the tendency to hereditary transmission so 
 prominent, these militate against the acceptance of intlammation as 
 the causative factor. — (W. F. 11.) See Injuries of the ocular ap- 
 paratus. Congenital defects. 
 
 Aniridia, Glasses for. Konigshofer {CUnique OpJital., October, 
 1901.) describes glasses for eyes that have been deprived of the iris. 
 These are fitted with an iris diaphragm by means of which the 
 amount of light entering the. eyes may be controlled, thus avoiding 
 the ditficulties that are incident to sudden changes in the amount of 
 illumination. 
 
 AnisGchromatic. Lacking in uniformity of color; of unec[ual colora- 
 tion. 
 
 Amsochromia. Of une(|ual or irregularly distributed color; in ophthal- 
 mology this term is generally associated with the coloration of the 
 iris. 
 
 Anisocoria. Inequality in the diameter of the tAvo pupils. 
 
 Anisokorie. (G.) Anisocoria; ineipiality of pupils. 
 
 Anisometric, adj. Of unequal measurement: a term applied to crystals 
 which are developed dissimilai'ly in the three axial directions. 
 
 Anisometropbrillen. (G.) This is a new form of cataract glasses 
 recommended for nnilateral aphakic patients when one wishes to 
 obtain binocular vision. ITegenor (Uber ein neues Brillensystem zur 
 Korrektion einseitiger Aphakic. Klinische Monatshlattcr filr Augen- 
 hcilkiDtde, 1912, (2), Heft 13, p. 237-278.) and Wolff (Korrektion 
 der Anisometropie bei Aphakie mittels eines Zeissschen zweiglied- 
 rigen Linsensystems, Zciiscltrifi fur Augcnh< Ulnoule, Bd. XX\'1T1. 
 Heft 2 und 3.) have fully described them. 
 
 Anisometropia. (L.), n.f. Inequality of the refraction of the two 
 eyes. Jackson l)olieves that anisometroi)ia will always have, in prac- 
 tical use, a somewhat indefinite significance. At best, it is used to 
 designate a condition with variable limits. "We do not in practice 
 speak of eyes as anisometropie when they differ but slightly in re- 
 fraction : if we did so nearly all our refraction cases Avould be cases
 
 486 ANISOMETROPIA, GLASSES FOR 
 
 of anisometropia. Nor can we set a limit, as 1, D., above which 
 the term should be applied, while for smaller diflt'erences it should 
 not. Such a difference would in one case give rise to those phe- 
 nomena which require the use of this special term; while in other 
 cases it would not. Neither is diifereuce of refraction an essentially 
 different thing when the two eyes happen to fall on opposite sides 
 of emmetropia, from what it is when both are hyperopic or myopic 
 See Refraction and accommodation of the eye. 
 
 Anisometropia, Glasses for. See Anisometropbrillen, and Refraction of 
 the eye. 
 
 Anisometropie. (G.) Dissimilar refraction in both eyes. 
 
 Anisopia. Difference in the visual acuity or power of the two eyes. 
 
 Anistropic, adj. In optics, not having the same properties in all di- 
 rections with respect to light — a characteristic of all crystals of the 
 isometric system; aelotropic. 
 
 Ankilops. (Obs.) Incorrect spelling of anchilops, a lachrymal 
 abscess. 
 
 Ankleben. ,(G.) To stick to, to adhere. 
 
 Ankyloblepharon. In this condition there is an adhesion of the eye- 
 lids along the palpebral margin, Avhich may be partial or total. It 
 results from the growing together of two raw surfaces. It is rarely 
 congenital. See Ankyloblepharon adnatum. As an acquired affec- 
 tion it follows ulcerations, burns and other injuries. It is sometimes 
 observed after croupous conjunctivitis. Anklyloblepharon may exist 
 alone, but more frequently symblepharon also is present. The prog- 
 nosis is favorable in uncomplicated ankyloblepharon, an operation 
 (cutting the adhesions) serving to restore the palpebral opening. 
 When associated with symblepharon the case will require also one of 
 the symblepharon operations (q. v.). — (J. M. B.) 
 
 Ankyloblepharon adnatum. (L.) Congenital ankyloblepharon. 
 
 Ankyloblepharon adnatum. Congenital ankyloblepharon is a union 
 of the eyelids at their edges throughout part or all of their extent. 
 In the former case it is designated as a blepharophymosis ; in the 
 latter as a true ankyloblepharon. Where the union is simply a failure 
 of the normal separation of the lids to occur in the latter part of 
 intra-uterine life, such union is purely epithelial. 
 
 Where the lids are firmly adherent it is usually the result of a 
 pre-existing ulcerative condition. In blepharophymosis there is 
 diminution in the breadth of the palpebral fissure, as a rule at the 
 expense of the outer angle. It is worthy of note that in the latter 
 condition enophthalmos and nonophthalmos are frequently present. 
 It is manifestly improper to confuse ankyloblepharon and cryptoph-
 
 ANKYLOBLEPHARON FILIFORME 487 
 
 thalmia, for in the case of cryptophtliabnia there is no differeutiatiou 
 of the lids exeei)t, possibly, a thin horizontal line or depression mark- 
 ing the site where the lid margins should have been. No Meiboniiau 
 glands or cilia are present in cryptophthalniia. 
 
 Occasionally there is found a string or thread of varj'iug size and 
 length connecting the margins of the u{)per and lower lids, to which 
 the name of a)ikyloblcpliaron filiforme adnatum has been applied. 
 These bands are usually extensile, but may limit, more or less, the 
 movements of the lids. Such bauds are made up of connective tissue 
 and blood vessels with a covering of epithelium and have been proven 
 to be of undoubted inflammatory origin.— (W. F. II.) 
 Ankyloblepharon filiforme. (L.) An incomplete form of aukyloble- 
 
 ..jsr 
 
 Ankyloblepharon Filiforme. 
 
 pharon in which union has taken place by a thread-like band, the 
 lids being elsewhere free from adhesion. 
 
 Ankylops. (Obs.) Incorrect spelling of anchilops, a lachrynuil ab- 
 scess. 
 
 Ankylostomiasis. AVurmkrankheit. The ocular and general symp- 
 toms of this disease (as seen in Europe) are due to the Anktjlosto- 
 mum duodcnalc (q. v.), or, often written, the Ankylostoma duodc- 
 nalis, a parasite havinu close aftinities witli tlie lioohirovm (Uncinarm 
 americana). The presence of this nematode in the human body 
 sets up almost identical signs and symptoms. Uncinariasis (q. v.) is 
 the term nsed to indicate the conditions brought about by the action 
 of the hookworm in and on its hunmn host. In the adnnrablc 
 report, 1911, by Ashford and Tgaravidez (Members of the Porto 
 Rico Anemia Commission) to the United States Senate on hook- 
 worm disease in Porto Rico, the eye-symptoms of uncinariasis and 
 ankylostomiasis are in part referred to as folloAvs: 
 
 '"In the Ponce series of 1902, 15 compIaincMl of 'colored images 
 before the eyes,' 11 of blurred vision. Of this series 16 gave symp- 
 toms referable to the eye. 
 
 Tn the Utuado series of 1904, 4-3 had visual disturbances, 84 
 blurred vision, 7 blurred vision with excessive dilatation of the
 
 488 ANKYLOSTOMIASIS 
 
 pupil, 1 of excessively dilated piipil, blurred vision, and night 
 blindness, and 1 of blurred vision and night blindness. 
 
 In the Rio Piedras series of 1906, 5 had blurred vision. 
 
 Thus, of 92 cases, 64, or 69.5 per cent, had more or less serious 
 disturbances of the eyes. We cannot doubt that much of this was 
 due simply to the degree of anemia, but there remains a consider- 
 able percentage both of these cases and among a large number 
 seen in the clinic who had more or less marked visual affections 
 with very little anemia. 
 
 Maj. W. F. Lippitt, United States Army, examined the eye 
 grounds of 10 of our cases in 1904 and found evidence of old 
 retinal hemorrhages in 2, which he very kindly demonstrated to 
 us. The fundus is generally very pale and the retinal arteries 
 small. 
 
 Loebker and Bruns remark on the pallor of the eye grounds and 
 state that there may be pulsation of veins, lowered intraocular 
 pressure, pronounced convolution of veins, and, commonly, retinal 
 hemorrhages. 
 
 Siccardi notes nystagmus, diplopia, amblyopia, muscular and 
 accommodative asthenopia and restriction of the field of vision. 
 He states that Rampoldi, who first called attention to the changes 
 in the eye grounds, found exudative retinitis of the same variety 
 as that described by Liebreich in leucemia. Rampoldi observed 
 a case of sudden blindness in a young subject (19 years of age) 
 with the usual signs of atrophy of the papilla. 
 
 Lutz mentions, as a rare sign, chemosis of the bulbo-palpebral 
 fold. He had 3 such in 25 cases. 
 
 Fuchs found small, whitish spots, due probably to old retinal 
 hemorrhages. 
 
 Siccardi, from an observation of his cases, comes to the con- 
 clusion that the changes he saw speak loudly for a nephritis. He 
 admits the possibility of a simple anemia being the cause of pallor 
 of the retina, edema, and hemorrhages, and likewise acknowledges 
 the reason for attributing functional disturbances of vision to the 
 reflex action on the eye from the irritation caused by the attached 
 worm in the intestinal canal, but there are, he thinks, other changes 
 that cannot be explained by reflex stimulation or by simple 
 anemia, and such are those demonstrated by a retinitis. Where 
 retinitis is found with atrophy of the optic papilla a general afilec- 
 tion is to be considered; in other words, a circulating poison. He 
 avers that it is his belief that the changes of this nature are pro-
 
 ANKYLOSTOMIASIS 489 
 
 duced by a toxin, just as alcohol, lead, iodol'onn, etc., cause such 
 lesions. 
 
 Niglit blindness is not a symptom to 1)0 ignored. Thoi'iibill 
 reports that he found it in 9.5 per cent of his cas(?s, and Swan and 
 Nell in 24 per cent of theirs ( !) Only our special cases were ({ues- 
 tioned on this point, but three of onr genci-al series volunteered the 
 information that they suffered from it. 
 
 Case 15 of the Ponce series of 1902 suii'ered from night blind- 
 ness and partial amaurosis, and G and 8 from night blindness alone, 
 a total of 3 in 80 cases, or a i)ercenlage of 3.7 in 80 cases. 
 
 Nystagmus is a rarer symptom which we have several times 
 observed. Case 15, cited above, is a good example. 
 
 A most interesting observation is the great prevalence of cat- 
 aract in Porto Rico, not only in the old, but sometimes in the 
 young. Maj. Lippitt, whose experience is large, states that fully 
 three-fourths of his cases in Porto Rico were anemic. A. W. Cal- 
 houn {Ophihalmic Record, Vol. XII, April, 1904) calls attention 
 to the occurrence in several of his cases of a double, chalky-white 
 cataract, beginning a short while (one year) after the establish- 
 ment of uncinariasis. One was a boy 14 years of age, Avhere the 
 condition began eight months after the disease, and another a boy 
 16 years old. 
 
 Corneal ulcers are also rojiorted. One such case was observed 
 in the Ponce series of 189i). 
 
 We made a special effort to corroborate Stiles "s observations on 
 the pupil, and found, indeed, a decided tendency to its dilatation. 
 But the patient is weak, dizzy and sick, and although we have not 
 seen that writer demonstrate how he obtains the phenomenon 
 described, Ave cannot believe it to be diagnostic. The fact is. in 
 trying to demojistrate this symptom, we nearly hyi)notized some 
 of our patients. Stiles says: "If the patient is directed to stare 
 intently into the observer's eyes, there Avill be noticed a symptom 
 which it is difficult to describe, but which I have found more con- 
 stant than almost any other noticed, namely : After a moment, the 
 length of time apparently varying slightly, according to the degree 
 of the disease, the pupils dilate and the patient's eyes assume a 
 dull, blank, almost fish-like or cadaveric stare very similar to that 
 noticed in cases of extreme alcoholic intoxication." He states that 
 he does not go to the extent of considering the stare diagnostic 
 of uncinariasis. We certainly do not consider this a prominent 
 symptom per se, but the dilatability of the pupil is noticeable and 
 goes to make up the tout ensemble of the facies which is very
 
 490 ANKYLOSTOMUM DUODENALE 
 
 suggestive of iineiiiariasis. The expression in moderate and marked 
 cases, as will be noticed by the cuts in this report, is habitual and 
 need not be elicited in this manner. Not only this, but we may 
 consider ready' dilatability of the pupil a symptom of infestation 
 by many varieties of intestinal parasites." 
 
 When the section on the subject of Uncinariasis americana is 
 taken up, the exact relation of these ocular signs and symptoms 
 to the so-called hookworm disease will be considered, and an effort 
 will be made to differentiate those that are probably accidental 
 from those that are undeniably a part of the disease. See Anky- 
 lostomum duodenale. 
 Ankylostomum duodenale. Sometimes written Ankylostoma duode- 
 NALis. LususPARASiT. A ncmatoid worm, one-third to one-half an 
 inch long, that infests the intestinal tract of man and some of the 
 lower animals. In view of the recent interest in the "hookworm" 
 (almost identical with this parasite) excited in the United States, 
 it will be valuable to have before one the admirable account (trans- 
 lated by the Editor of this Encyclopedia for TJie Ophthalmic Rec- 
 ord, VI, pp. 644-650) by Nieden of this parasite and the effect of 
 its presence on the eye. (See, also. Ankylostomiasis and Uncinari- 
 asis.) He says that the actual presence of the ova of the parasite 
 in the feces of living subjects was first demonstrated in the years 
 1877-78 by the Italians Grassi and Parona. Following these came the 
 more extensive investigations of Perroncitto, explaining the actual 
 cause of the so-called "tunnel anemia" that affected the workmen 
 employed in the underground borings of the St. Gotthard railroad. 
 Although it is true that in 1838 Dubini of Milan frequently found 
 a parasite in the intestines of patients who had died of anemia, and 
 which Theodor von Siebold correctly diagnosed as belonging to the 
 genus Strongylus, it was not until the investigations of Bilharz in 
 1853 and Griesinger in 1854 that the parasite was recognized as the 
 cause of "Egyptian chlorosis." After the diagnosis had thus been 
 placed on a firm basis, the various modifications of this form of 
 anemia, which up to that time had been attributed to manifold causes, 
 jvere readily diagnosed, as reports from Brazil, Japan, the East In- 
 dies, Louisiana, etc., from the end of the '60s will show. It was 
 noticed in this connection, firstly, that people addicted to the pecu- 
 liar habit of dirt-eating were easily attacked by this disease of the 
 blood and, secondly, that workmen in brickyards, mines, tunnels 
 and charcoal furnaces also readily fell victims to the parasite. This 
 gave rise to the various synonyms. Anemia intertropicalis, oppilacas, 
 latericia or montana, allotriophagia, maladie de terre and Tunnel-
 
 ANKYLOSTOMUM DUODENALE 491 
 
 (Utaniit. 'I'lic (liscoveiy of tlie aiikylostonnm in the intestines of 
 miners in Sardinia, France (St. Etienne) and Hungary (Krenmitz 
 and Schemnitz) by Baccelli and Perronoitto furnished the clue to 
 the etiology of all the eases of chlorosis among miners reported since 
 the beginning of the century, the lirst of these occurring among 
 workers in the mines of Valenciennes in France. Tliis finding is 
 further substantiated by the investigations of Masius, Francotte, 
 van Beneden, etc., in Belgium. It is very probal^le that the parasite 
 was brought by Belgian miners to the Rhenish and Westphalian 
 coal mines, and the recent studies of Leichtenstern, Lobker and Ten- 
 holt show that, to a greater or less extent, the entire population of 
 these collieries, the largest in Gernumy, is afflicted with the disease. 
 
 In consequence of numerous opportunities for studying the nature 
 of this disease in its various phases, and as examinations of organs re- 
 mote from the initial seat of the malady ])ecaiue more frequent, it 
 was discovered that the eye often shows pathologic changes which 
 must be regarded as entirely due to tiie parasitic disorder. Rampoldi 
 (1887) and Fischer (Dortmund, 1892) first called attention to these 
 complications, but on account of the small amount of material at 
 their command they were unable to form any definite conclusions 
 regarding their cause. Inasmuch as I have had occasion to examine 
 several hundred cases, I take this opportunity of briefly recounting a 
 few of the chief points of interest. I may say, to begin willi, that 
 the ankylostomum duodenale is a nematode, belonging to the family 
 of the strongylidtti (Dochmius), and that it derives its name from 
 the fact that the body has a peculiar angular bend and that the 
 duodenum was formerly looked upon as its habitat. The latter view 
 has not been borne out by autopsies, the upper portion of the small 
 intestines (jejunum) having been found to be the favorite resort of 
 the parasite. The male worm is lighter in color, shorter {6-S mm.) 
 and narrower than the female, which is of a yellowish-])rown color 
 and 10-12 mm. in length. The head exhibits a wide mouth that opens 
 into a capacious oral cavity. The latter is supplied with six tooth- 
 like projections. The oral cavity communicates with the gi'adually 
 widening esophagus, which in turn terminates in the chylific in- 
 testine. The latter ends, in the female, in a cone-shaped tail, in the 
 uuile in the cloaca, which contains the genital opening with its conical 
 penis and t"svo long spicuhe. The spicula' hold the female during the 
 act of coition. From the female genital opening a short vagina 
 leads into an anterior and a posterior tubular cavity which contains 
 the countless convolutions of the ovaries and tubes. * 
 
 The ripe ova deposited in the human intestine are oval in form,
 
 492 ANKYLOSTOMUM DUODENALE 
 
 0.04 — 0.06 mm. long, 0.03 mm. wide and are, without exception, when 
 discovered, found to be undergoing segmentation. The latter process 
 does not continue, however, within the human intestine until the 
 complete development of the embryo, on account of a lack of oxygen. 
 For this latter purpose it is necessary that the ova find suitable sur- 
 roundings (moisture and warmth) outside the body. In three days 
 after leaving the intestine the embryo emerges from its capsule. 
 The number of ova found in the human host is enormous. Leichten- 
 stern found 19,000 in one gram of feces. If we divide the number 
 of ova found in one gram of feces by 47, we obtain approximately the 
 number of parasites that have found their way into the intestines. 
 The proportion of males to females is as 1 :3-6. The embryo be- 
 comes encapsulated at the end of four days in a transparent covering 
 and remains thus encysted until it is introduced into the human 
 body. The cyst wall is then dissolved by the gastric juices and the 
 liberated embryo enters the small intestine where it soon develops 
 into a full grown worm. As such it now fulfills to the fullest ex- 
 tent the two purposes of its existence, viz : nourishing itself by suck- 
 ing inordinate quantities of blood from its host and propagating its 
 kind* in the most extensive fashion. The ova may be discovered in 
 the feces four to five weeks after the ingestion of the parasite, the 
 life of the latter being from six to eight years. 
 
 The ankylostomum derives its nourishment from the plasma of the 
 blood and does not assimilate the corpuscular elements, which pass 
 through almost unchanged. It takes in much more food than it 
 actually needs and for this reason Leichtenstern has properly given 
 it the name of ''Lususparasit." The loss of blood to the host is often 
 augmented by secondary hemorrhage from the bites. The direct 
 result of this constant loss of blood, which is at times very great (fre- 
 quently 3,000 worms are found in one intestine), is excessive anemia 
 of all the organs. The early symptoms are manifested in disturb- 
 ances of the intestinar tract (especially loss of appetite and vomit- 
 ing) and to these are soon added the sequelae of the increasing 
 anemia — weakness, dizziness, palpitation, dyspnea, etc. The face 
 exhibits a yellowish tint, characteristic of the disease. The mucous 
 membranes are waxy and the sclera has a peculiar glistening appear- 
 ance. The blood is bright red while the corpuscles are pale and 
 granular. Leucocytosis is found, especially in those cases where 
 Charcot-Robin crystals are present in the feces. The hemoglobin is 
 greatly diminished. The urine shows albumen in rare cases. 
 
 Unless proper and prompt treatment is carried out, or a sponta-
 
 ANKYLOSTOMUM DUODENALE 493 
 
 neous cure results, Ihr ullinuite outcouii' ol tin- eou.slanl loss of blood 
 is general marasmus and death. 
 
 As far as the special m()r))id ehang'cs iu tlu' eye are concerned, T 
 liavt' been able to demonstrate that fi'oiii 7 to 8 jx-r cent of all pa- 
 tients show affections of the fundus oculi. IVFy observations extend 
 ovei- 180 patients, all of wliom had the eharaeteristic symptoms of 
 aid\ylostomiasis. 
 
 Xo esj^ecial importance was attached to the appearance of the fun- 
 dus due simply to the great anemia — such as more or less pale color 
 of all the capillary vessels, diminished calibi-e of the arteries and 
 their occasional pulsation under noi'inal intraocular pressure, a tort- 
 nous course of the veins, and often a porcelain-colored appearance 
 of the iiapilla. such as is seen in the eye after death. 
 
 The hemorrhages in the fundus, similar to those already described 
 Ijy von Biermer in pernicious anemia, ai'e the nu)st characteristic 
 signs. According to my observations these occur more frequently 
 ^nd at an earlier stage of the disease in the peripheral i)arts of the 
 retina than near the papilla or the nmcula. They are often in groups, 
 ■dotted, and lie close together without being confluent. Occasionally, 
 they precisely follow the course of the vessels and seem to be sit- 
 uated in the sheaths of the latter, thus forming striated hemorrhages 
 which accompany the vessels almost to the papilla and fre(iuently 
 render their contour indistinct. 
 
 In addition to these signs Ave find in serious cases extensive hem- 
 orrhages into the retinal tissues. They are of the size of the papilla 
 or even larger, aiul present irregulai' edges. I have seldom had occa- 
 sion to notice the peculiar hemorrhages fre(|uently found in leukemia 
 and scurvy, in which a whitish spot is found in the center of the hem- 
 orrhage, indicating a beginning resorption. On the other hand, I 
 could usually distinguish the regulai'ly oeeui-ring fatty degeneration 
 of the blood-spot, which showed the well known typical i)ictui'e. I 
 liave never seen th(> stellate appearance of the nuicular region char- 
 acteristic of retinitis albuminurica. As already mentioned above, the 
 nrine contained albumen only in vei'y rare cases. 
 
 Postmortem examinations reveal the peculiar changes in the fun- 
 dus with even greater distinctness than does the ophthalmoscope, 
 the bright red blood-spots being very conspicuous in the pale yellow 
 background of the retina. The microscope shows sclerotic and fatty 
 degeneration of the intima of the blood-vessels. The same condition 
 is found in the endocardium and larger vessels, aiul in the mucous 
 membraiies and other tissues of the various organs of the body sim- 
 ilar hemorrhages are detected. These phenomena are analogous to
 
 494 ANKYLOSTOMUM DUODENALE 
 
 those described in 1894 by Natanson and in 1895 by Tschemolosow in 
 four typical cases of pernicious anemia caused by bothriocephalus 
 latus. In these cases the blood extravasations were grouped about 
 the papilla and the macula and had also caused aneurysmal hernias 
 as a result of rupture of the adventitial sheath of the vessels. 
 
 The disturbances of vision are caused not so much by these retinal 
 changes as by the constitutional condition. When, however, the 
 extravasations occur in the region of the macula a scotoma is likely 
 to result. In most cases in which I could detect extensive altera- 
 tions in the fundus tlie patient had no intimation of the pathologic 
 condition of the eye. 
 
 Accommodative weaknesses, inability to use the eyes any length 
 of time and other forms of asthenopia are, on the other hand, readily 
 noticed. Slight, intermittent paresis of the extrinsic and internal eye- 
 muscles, with double vision and vertigo, is likcAvise a not infrequent 
 occurrence, and where predisposing conditions, such as working in 
 collieries, are present, nystagmus is a common complication. 
 
 Furthermore, we observe a retinal weakness in consequence of the 
 anemia and malnutrition, evidenced by photophobia and hemeralopia, 
 a condition often found in this part of the country during the Easter 
 fast-days. In these cases we notice a slight concentric contraction of 
 the field of vision, especially after a long-continued examination of 
 the eyes. Emigration of the parasite into other organs has not been 
 so far demonstrated, because favorable conditions for further devel- 
 opment are present in the intestines only. The parasite cannot 
 possibly occur, therefore, as an entozoon in the eye. 
 
 It is still a moot question what gives rise to the peculiar changes 
 in the fundus, such as Ave notice in this disease and in pernicious 
 anemia. It is doubtful Avhether the great loss of blood and the con- 
 stant drain from the intestinal tract can alone account for them, 
 especially when we remember that in similar acute and chronic 
 hemorrhages from other causes no such retinal alterations occur. 
 Even in excessive anemia and chlorosis we do not find analogous 
 degenerations. It is very probable that one must look for the causa- 
 tive factor in the toxic products introduced into the body by the 
 parasite. In like manner we must explain the fatty degeneration of 
 the retinal fibres, with or without hemorrhages, that is observed in 
 the cachexia of cancer. Whether these toxins, as Fischer believes, 
 are contained in the Charcot-Eobin crystals, future investigations 
 must decide. It is a fact that these crystals are found most abun- 
 dantly in those sections of intestine that contain the largest number 
 of worms. If the above theory be correct we maA' also assume that
 
 ANNESLEA GRANDIFLORA 495 
 
 the tuxijis destroy tlie red eorpuscle.s and are responsible i'or the 
 forinatioii of eosinophile cells (according to Leiehtensteru, as high 
 as 60 per cent) Avhicli in liii-n give rise to blood extravasations. 
 
 As for the ther;ij)v I may state that the disease is fortunately 
 readily amenable to treatment in all cases in which the anemia or 
 cachexia has not become too marked or has not lasted too long. A 
 positive cure can be brought about by the administration of 10 grams 
 of extractum fiiiris iiuiris rccciilc parahon, a nutritious diet and a, 
 course of tonics — especially of ferruginous preparations. 
 
 It is interesting to note that during the ])rocess of expulsion of 
 the Avorms, the males are exi^elled sooner and in greater numbers 
 than the females. This may possibly be explained by the fact that the 
 males change their location more frequently (for purposes of copula- 
 tion) while the female is more likely to remain tixed to the intestinal 
 wall. 
 
 It is, finally, important from the standpoint of diagnosis to note 
 that the ophthalmoscope demonstrates ])ositively the dift'erences be- 
 tween changes occurring in chlorosis and simple anemia and those 
 brought about by the so-called pernicious aiu'inia dependent upon 
 the presence of infectious parasites. — (Ed.) 
 
 Anneslea grandiflora. (L.) A Mexican shrub whose flowers are 
 used in eye diseases. 
 
 Annexes. (F.), u.n. Appendages. 
 
 Annidalin. See Aristol. 
 
 Annular conus. Sehnabel (Norris and Oliver. Syslcm of Diseases of 
 the Eye, III, p. -iOO) contrasts this anatomical condition with that 
 of the crescentric conus (posterior staphyloma) commoidy seen in 
 myopia and remarks that the diameter of the sclero-chorioidal 
 canal and of the part of the 0})tic nerve surrounded by it is 
 unusually large; the diameter of the pa])illa. howevei*. is normal. 
 When the intra-choi-oidal portion of the oi)tic nerve has a diameter 
 of, for example, three millimetres, and the inlra-rclinal portion 
 (i.e., the jjapilla) a diameter of one and five-tenths millimetres, 
 a white zone is seen between the edge of the papilla and the 
 peripheral portion of the connective tissue (or of the choroidal 
 ring, as the case nuiy be) ; and it is this that forms the amiular 
 conus observed by the ophthalmoscope. The amiular conus. then, 
 is not situated in the region of the ocular membranes, but in that 
 of the optic nerve — its Avhite color coming not from the sclera that 
 has become visible, but from the lamina cribrosa. The pei'ii)heral 
 limits of the coiuis are formed by the choroidal ring. As the layer 
 of pigment epithelium begins at this ring, there can b(» wo pig-
 
 496 ANNULAR LIGAMENT 
 
 meiit epithelium within the area included b}^ the annular conus. 
 The pigment epithelium has not disappeared; on the contrary, it 
 has never existed in the part of the fundus in which the conus is 
 situated. 
 
 The annular conus forms a part of the transverse section of the 
 optic nerve seen by the ophthalmoscope, and belongs, therefore, in 
 its entire extent to the blind spot. The choroid over the staphyl- 
 omatous area is thinner than normal, but the part of it immedi- 
 ately surrounding the optic nerve does not differ from the part 
 situated behind the fovea centralis or the parts which cover the 
 other portions of the scleral staphyloma. It is, therefore, out of 
 the (luestion that the stretching of the choroid due to stretching 
 of the sclera could occasion choroidal atrophy of such a degree 
 as to be scarcely distinguishable from the absence of that mem- 
 brane, in the vicinity of its insertion. 
 
 Annular ligament. At its circumference the posterior corneal limit- 
 ing membrane is thickened and forms a ring-like margin. This is 
 called the annular ligament or annulus tendinosus. From it three 
 distinct sets of bundles pass: (1) to the tendon of the ciliary 
 muscle, (2) to the sclera and (3) to the iris. See Histology of the 
 Eye. 
 
 Annular reflex. A reflection sometimes seen about the macular region 
 during an ophthalmoscopic examination. 
 
 Annular synechia. Excluded Pupil. Exclusion of the pupil. It 
 occasionally happens in an ffttack or attacks of iritis that the entire 
 margin of the pupil is bound down to the lens behind it. When 
 this occurs we have, as Jackson observes {Manual of Diseases of 
 the Eye), the usual effects of broad adhesions. The escape of fluid 
 from the posterior to the anterior chamber is interrupted, and 
 other grave conditions arise. The fluid behind it pushes the iris 
 forward, causing it to bulge, as in the figure. This is spoken of 
 as ballooning of the iris, or iris bonibe. The iris rises up on either 
 side of the pupil, usually not equally all round, but in swellings 
 separated by depressions where it is bound down by adhesions. 
 In the midst of these elevations of the iris the pupil appears 
 depressed and is spoken of as crater-like pupil. With the absence 
 of its normal movements, and under the pressure to which it is 
 subjected, the iris generally undergoes atrophy. Its forward dis- 
 plscement at the periphery is liable to brnig it in contact with the 
 cornea, closing the angle of the anterior chamber and causing a 
 secondary glaucoma.
 
 ANNULAR ULCER 497 
 
 Such an eye, if left to itself, is almost certain to undergo degen- 
 erative changes that will render it hopelessly blind. Iridectomy 
 should be done upon it as soon as possible, and repeated, if neces- 
 sary to establish a free permanent communication between the 
 
 Irii 
 
 Iris Bonibe. 
 
 anterior and posterior chamber; indeed, a portion of the iris should 
 be excised even though the excluded pupil be perfecth' clear, and 
 the vision still good. 
 
 Annular ulcer. See Cornea, Ring ulcer of the. 
 
 Annulus. A ring-shaped or circular opening or margin. 
 
 Annulus arthriticus. (L.) A complete, closed circle formed by 
 enlarged anterior ciliary veins around the cornea ; seen in absolute 
 glaucoma. 
 
 Annulus conjunctivae. (L.) The limbus or sclero-corneal junction. 
 
 Annulus iridis major. Ciliary zone of the iris. 
 
 Annulus iridis minor. Pupillary zone of the iris. 
 
 Annulus of Zinn. The common tendon at the orbital apex, about 
 the optic nerve, from which the straight muscles of the eye arise. 
 
 Annulus senilis. The ring of fatty degeneration of the tissues about 
 the (upper) periphery of the cornea, generally seen in elderly sub- 
 jects and commonly known as the arcus senilis. 
 
 Annulus tendineus communis. (L.) A synonym of the conjoined 
 tendon, the origin of the four recti muscles, at the apex of the 
 orbit. 
 
 Annulus tendinosus. (L.) A synonym of the annular ligament — the 
 continuation of the posterior limiting membrane of the cornea. 
 
 Annulus Zinnii. (L.) Another name for the funnel-shaped "con- 
 joined tendon" at the apex of the orbit from which arise the four 
 recti muscles. 
 
 Vol. 1—3 2
 
 498 ANODE 
 
 Anode, n. The positive pole of a galvanic battery. 
 
 Anodynes, Ophthalmic. Ocular analgesics. Agents that relieve pain 
 in the eye or eyes. The most important of these are alypin, atro- 
 pine and most of the eycloplegics, chloretone, cocaine, codeine, 
 conium, dionin, eucaine, gelsemium, hypnol, lupulus, opium prepara- 
 tions, orthoform, phenacetine, phenazone and stovaine, Arlt's salve, 
 cherry laurel water, brenzcain, chloral hydrocyanate, chloral hy- 
 drate, euphorin, veratrine, as well as most of the other local anes- 
 thetics. 
 
 Anomalie. (G.) Anomaly. 
 
 Anomalie congenite degli organi lagrimali. (It.) Congenital de- 
 fects of the lachrj^mal apparatus. 
 
 Anomalie congenite dei muscoli oculari. (It.) Congenital defects of 
 the ocular muscles. 
 
 Anomalie congenite del corpo vitero. (It.) Congenital anomalies of the 
 vitreous. 
 
 Anomalie congenite della congiuntiva. (It.) Congenital defects of 
 the conjunctiva. 
 
 Anomalie congenite della lente. (It.) Congenital defects of the 
 crystalline lens. 
 
 Anomalie congenite dell' iride. (It.) Congenital defects of the iris. 
 
 Anomalie congenite delle palpebre. (It.) Congenital anomalie of the 
 eyelids. 
 
 Anomalie congenite del nervo ottico. (It.) Congenital defects of the 
 optic nerve. 
 
 Anomalien der Akkommodation. (G.) Anomalies of the accommo- 
 dation. 
 
 Anomalien der Refraktion. (G.) Anomalies of the refraction. 
 
 Anomalies, Congenital. These prenatal defects have been observed 
 in all parts of the eye and its related structures. They generally 
 occur with malformation of other parts of the body. Some of 
 them are caused by arrest of development, abnormal closure 
 of some of the fetal fissures, or by intra-uterine inflammations. In 
 other cases the causes are not known. A few of these congenital 
 eye anomalies are anophthalmus, cryptophthalmus, microphthal- 
 mus, aniridia, megalophthalmus, cyclopia, ankyloblepharon, sym- 
 blepharon, microblepharon, epicanthus, ptosis congenita, coloboma 
 bulbi, coloboma of the eyelids, ablepharia, absence of iris, corecto- 
 pia, persistent pupillary membrane, nevus, ectopia lentis, persistent 
 hyaloid arterj'', dermoid tumors, orbital cysts, and congenital 
 paralysis of eye-muscles. The various anomalies will be defined
 
 ANOMALIES OF DEVELOPMENT 499 
 
 under their sepjii-jile liejuliiiys : more fully uiuler tlie section Con- 
 genital anomalies of the eye. 
 Anomalies of development. These include eongenilal defects and 
 anomalies of every i)ortion and organ of Ihe oeuhii- apparatus — 
 from the eyelids to the cerebral centres. All of these will be found 
 discussed under such individual and separate headings as able- 
 pharia, congenital cataract, coloboma, acoria Icnliconus, symhle- 
 pharon adnaiuni, Injaloid arlciij, etc., etc. A more complete major 
 heading, Cong-enital anomalies, will treat the subject as a whole. 
 To these captions the ]-eader is further referred. 
 Anomalisch. (G.) Anomaly, abnormal. 
 
 Anomaloskop. (G.) This is an instrument devised by Xagel for the 
 determination of the kind and amount of the various color-sense 
 anomalies. Lenz {Berlin Klin. Wockenschr., 1910) recommends it 
 as a means of making an exact diagnosis (piickly and surely. 
 Anomalous dispersion, Chromatic. See Chromatic dispersion. 
 Anommatous. adj. Destitute of eyes. 
 
 Anonymous, Mediaeval. The unknown author of a work entitled 
 Tmctatus dc Egriiudinibus Ocidorum ex Dictis Sapientium Velenim, 
 the MS. of which was discovered by Pansier in the Bibliotheque de 
 1 'Arsenal. His work is a mere compilation from Ar-Razi, Avieenna, 
 and other Arabian o))hthalmologic writers.— (T. H. S.) 
 Anonymus I of Casiri. This unknown, mediaeval Spanish- Arabian 
 physician is the author of a book of little value, entitled, Anonymi 
 tractatus cle oculonim morhis, in fine mutilus, etc. Leclerc's conjec- 
 ture that this work comprises, or contains, the missing ophthalmic 
 treatise of Abenguefit, has been shown by Hirschberg to be entirely 
 erroneous. — (T. H. S.) 
 Anonymus II of Casiri. This unknown, mediaeval Spanish-Arabian 
 physician is the writer of several pages of manuscript which are still 
 extant and which present an imperfect collection of Arabian ophthal- 
 mic prescriptions, of very little value historically or otherwise. 
 — (T. H. S.) 
 Anoopsia. That form of strabismus in which the eye is turned upward. 
 Anoopsia. (L.), n.f. (Obs.) A form of strabismus or squint in which 
 
 the eye is turned upward. 
 Anophoria. This Avord is occasionally written anajjlioria. The more 
 usual form, how'ever, is anophoria, this being used by Weeks, 
 de Schweinitz, Duane, and most American writers. It means a 
 tendency of both visual axes to rise above the horizontal plane. 
 The term was first proposed by Stevens when he described the 
 other phorias. As it is certain that one or both of the visual axes
 
 500 ANOPHORIA 
 
 often do tend to turn in, out, up or. down, therefore it was natural 
 to suppose that both axes might also together tend to turn upward 
 or downward. The condition is seldom referred to by Continental 
 or English writers, and it is doubtful if they acknowledge its exist- 
 ence. 
 
 From one or two authors ,it might be inferred that anophoria is 
 quite common, and also of importance. The vast majority, how- 
 ever, treat it only incidentally or ignore it entirel.y. For example, 
 in the last edition of Fuchs, edited by Duane, anophoria is referred 
 to only in a few lines. It is disposed of in practically the same 
 way by Weeks and de Schweinitz. 
 
 The most apparent symptom to a casual observer is the ten- 
 dency of the individual to bend the head down while the eyes turn 
 upward in order to bring the visual axes into the horizontal plane. 
 Undoubtedly we do see persons occasionally who have this peculiar- 
 ity. It is also true that those who possess this peculiar poise of 
 the head in the most notable degree are not always those avIio suffer 
 from asthenopic symptoms. If, therefore, this peculiarity is a 
 symptom of anophoria we must infer that the condition itself is 
 of no great importance. 
 
 While a general idea can be obtained by the position of the 
 head, any exact diagnosis must of course be placed upon the arc of 
 rotation as measured with a suitable tropometer (q. v.). When 
 any such tendency does exist for the eyes to turn upward, the arc 
 of rotation extends several degrees higher than usual. On the 
 other hand, the excursions downward are proportionately limited. 
 
 The diagnosis is difficult. It is almost impossible to say in a 
 given case whether the peculiar position of the head is due to the 
 ocular muscles or to the muscles of the neck, or even to a mal- 
 position of the vertebrae which was developed in early childhood, 
 and which has been allowed to conthiue uncorrected. 
 
 Concerning the treatment much has been Avritten. Numerous 
 operations have been described, in which by gradual division of 
 the tendons of the superior rectus the visual plane has been low- 
 ered a certain number of degrees. Undoubtedly that has been 
 done and could be done again. But any one who has had experi- 
 ence in making operations upon the vertical muscles has also found 
 that the diplopia or deformity which resulted from these experi- 
 ments is, on the average, quite as annoying as the original con- 
 dition. 
 
 In a word, anophoria is a subject better known theoretically 
 than practically. — (L. II.) See Muscles, Ocular.
 
 ANOPHTHALMIA 501 
 
 Anophthalmia. (L.), n.f. Absence of the eyes. 
 
 Anophthalmia. This congenital condition denotes absence of an eye 
 or eyes. In over 70 per cent of cases it is bilateral. Wliere it is uni- 
 lateral the other eye may be normal or the subject of some defect, 
 especially microphthalmia. Hasner observed in one case a coloboma 
 of the lid and a nevus of the conjunctiva on the side of the absent 
 eye. 
 
 
 \ 
 
 :•* *»,< 
 
 1 
 
 
 .-4!^ 
 
 \ 
 
 -v^ 
 
 \ 
 
 Anophtlialmos. 
 
 Anophthalmia is a condition clinically diagnosed as such, a true 
 anophthalmia very rarely existing, as sliowii by painstaking anatom- 
 ical and microscopical investigations, in a strict sense it really does 
 not exist. Clinically, however, anophtliahnia is said to be present 
 where an eyeball is not macrosco])ically demonstrable or capable of 
 being palpated. Tissues of mesoblastic origin can usnally be found. 
 The ocular muscles may be more or less developed and find insertion 
 in the subconjunctival connective tissue or in the soft mass at the 
 apex of the orbital cavity i-epresenting the rudimentary eyeball. 
 Their differentiation however is poor.
 
 502 ANOPHTHALMIA CYCLOPICA 
 
 The orbit is usually diminished in size, often quite small; the lids 
 short, ill-formed, sometimes absent or with their margins turned in 
 (entropion). The palpebral fissure is quite narrowed. The optic 
 nerve may in places be fairly well developed, but is generally re- 
 duced to a fibrous cord. Epiblastic elements may be wholly missing, 
 giving credence to the theory of non-budding or non-development of 
 the primary optic vesicle. 
 
 ^lany cases of so-called anophthalmia are in reality high grade ex- 
 amples of microphthalmia. Especially is this true of orbitopalpe- 
 bral cysts, in which a rudimentary eyeball is always found. 
 
 It is rather the rule to find associated with anophthalmia serious 
 defects in the head, brain, and other portions of the body, such as 
 asymmetry of face and head, defects and malformations of the ear, 
 hare-lip, spina bifida, as well as malformations of the heart and other 
 internal organs. 
 
 Frequent observations have been made of a purulent discharge 
 from the conjunctiva at birth and its presence has been thought in 
 some way to be associated with the destruction of the globe, but just 
 how important a role inflammation plays one is unable to state. 
 
 The frequency of defects in the development of parts of the brain, 
 especially of those structures vital to the integrity of a sound eye, the 
 absence at times of the olfactory lobes, failure of evidence of epi- 
 blastic elements, and the very small size and even absence of an 
 orbit point to developmental faults as the most logical explanation 
 of the great majority of cases of anophthalmia. — (W. F. H.) 
 
 Anophthalmia cyclopica. A congenital malformation both of the or 
 bit and of its contents. 
 
 Anophthalmie. (G.) A person without eyes. 
 
 Anophthalmohemie. (F.), n. Anemia of the eye. 
 
 Anophthalmos. (G.) . One without eyes. 
 
 Anophthalmus. (L.), m.n. One affected with anophthalmia. 
 
 Anopia. (L.), n.f. Congenital absence or defective development of 
 the eye. 
 
 Anopsia. (G.) Upward strabismus, blindness. 
 
 Anopsia. (L.), n.f. 1. Congenital absence of both eyes or of the or- 
 bits and eyes. 2. Non-use of the eye, generally as the result of con- 
 genital conditions. 
 
 Anopsia, Ambliopia da. (It.) Visual deficiency from non-use of the 
 eyes. 
 
 Anopticonervie. (F.), n. An obsolete term for amaurosis.
 
 ANORTHOPIA 503 
 
 Anorthopia. When the eyes fire liiriied away from parallelism; i.e., in 
 strabismus. 
 
 Anorthoscope. An instrument for producing a peculiar kind of optical 
 illusion by means of two disks rotating rapidly one behind the other. 
 The posterior disk is transparent, and has cei'tain distorted figures 
 painted upon it; the anterior disk is opaque, but pierced with a 
 number of narrow slits, through which the figures on the posterior 
 disk are vicAved. The effect depends on the persistence of impres- 
 sions on the retina, the principle being the same as in the chromos- 
 troboseope, zoetrope and kinetoscope. — (C. F. P.) 
 
 Anotropia. Upward squint. Also written anatropia. See Muscles, 
 Ocular. 
 
 Anottalmo, (It.) Anophthalmus. 
 
 Anpassung\ (G.) Accommodation, adaptation. 
 
 Anpressen. (G.) To" press against, to squeeze against. 
 
 Anquetschen. (G.) To squeeze against. 
 
 Anreiben. (G.) To begin to rub; as rubbing one's eyes. 
 
 Anreiz. (G.) Incitation; causing to incite, or to irritate. 
 
 Anreizung. (G.) Inciting, incitement, instigation; to cause. 
 
 Ansatz. (G.) An apophysis ; an insertion. 
 
 Anschielen. (G.) To sipiint at. 
 
 Anschoppung". (G.) Passive hyperemia, engorgoniont. 
 
 Anschwellung. (G.) A swelling, tumefaction. 
 
 Ansieden. (G.) To begin to boil, to prepare by boiling. 
 
 Anspannen. (G.) Strain ; tension. 
 
 Anspanner. (G.) A tensor. 
 
 Anstechen. (G.) To puncture; paracentesis. 
 
 Anstecken. (G.) To infect, to inoculate. 
 
 Ansteckend. (G.) Infectious or contagious. 
 
 Ansteckende Augenentziindung-. (G.) An infectious ocular inflam- 
 mation. 
 
 Ansteckendekrankheit. (G.) An infectious disease. 
 
 Ansteckende Liddriisenentziindung. (G.) Purulent conjunctivitis. 
 
 Ansteckender. (G.) Contagious. 
 
 Ansteckendes. (G.) Contagion. 
 
 Ansteckung'. (G.) Infection. 
 
 Ansteckungs- (G.) Contagion. 
 
 Ansteckungsfahig. (G.) Contagious, liable to contagion. 
 
 Ansteckungsfahigkeit. (G.) Power of being contagious. 
 
 Antagonism of ocular muscles. According to Savage (OpJithahnic
 
 504 
 
 ANTAGONISM OF OCULAR MUSCLES 
 
 Myologij, pp. 41, 42), "the helping of one muscle by other muscles 
 is synergism; the opposing of one muscle by other muscles is antag- 
 onism. The following table furnishes a list of both assistants and 
 antagonists of the chief extrinsic ocular muscles. 
 
 Internus . 
 
 Synergists. . 
 Antagonists . 
 
 Superior rectus. 
 Inferior rectus. 
 
 External rectus. 
 Superior oblique. 
 Inferior oblique. 
 
 Externus , 
 
 Superior rectus in 
 superversion 
 
 subversion 
 
 Inferior rectus in 
 
 Synergists . . 
 Antagonists . 
 
 Synergists . 
 
 Antagonists. 
 
 Synergists . 
 
 Antagonists . 
 
 Superior oblique. 
 Inferior oblique. 
 Internus. 
 Superior rectus. 
 Inferior rectus. 
 
 Inferior oblique. 
 
 A too high internus, or 
 
 A too high externus. 
 
 Inferior rectus. 
 
 Superior oblique. 
 
 A too low internus, or 
 
 A too low externus. 
 
 Superior oblique. 
 
 A too loAV internus, or 
 
 A too low externus. 
 
 Superior rectus. 
 
 Inferior oblique. 
 
 A too high internus, or 
 
 A too high externus. 
 
 Superior oblique . . ., 
 
 Sj^nergists . 
 
 Antagonists . 
 
 Superior rectus. 
 
 A too high internus, or 
 
 A too low externus. 
 
 Inferior oblique. 
 Inferior rectus. 
 A too low internus, or 
 A too low externus.
 
 ANTAGONISM OF THE VISUAL FIELDS 
 
 505 
 
 Inferior oblique . 
 
 Synergists . 
 
 Antagonists . 
 
 Inferior rectus. 
 
 A too low internus, or 
 
 A too high externus. 
 
 Superior oblique. 
 
 Superior rectus. 
 
 A too high internus, or 
 
 A too low externus. 
 
 It will be noticed that every ocuhir iiiiiscle has one more antago- 
 nistic muscle than synergistic." 
 
 Antagonism of the visual fields. This condition results when the 
 images of the two visual fields are of such a nature that they cannot 
 be fused. Using a blackboard as a ground, let vertical lines be 
 drawn in one field and horizontal in the other. One field will pre- 
 dominate to the exclusion of the other until some external influence 
 (winking of the lids, changing position of the eyes) be brought to 
 bear, when the second field will come into the foreground. There is 
 no way of determining which field will predominate. 
 Antagonismus zwischen Trachom und Pneumokokken. (G.) Antag- 
 onism between trachoma and pneumococcus. 
 Antagonistische Farben. (G.) Antagonistic colors. 
 Anteorbital. In front or in advance of the orbit or eyes. 
 Ante-partum ophthalmia. An infiammation or infection of the eye 
 occurring before the birth of the child. Thirty-five eases have been 
 collected from the literature and arranged in table form by Stephen- 
 son. Seventeen additional cases have been similarly disposed in 
 a second table (which have not before been reported) in Avhich 
 the ophthalmia developed within 24 hours after the birth of the 
 child. This period of inciil)alio!i l)eing too short for infection at 
 or after birth, i)oints to ante-partum infection. Stei)licnson 
 holds the belief that these instances of ante-partum ophthalmia 
 are not so uncommon as hitherto believed, and tliat about one- 
 half of the cases (44.5 per cent.) are satisfaetorilj' accounted for 
 by a premature rupture of the membranes, allowing access of micro- 
 organisms to the baby's conjunctival sac. As regards the remaining 
 cases (55.5 per cent.) a slight injury to the membranes may deter- 
 mine access of micro-organisms, or infection througli tlie uninjured 
 membranes must be assumed to liave taken place. Further, increased 
 temperature of the conjunctival sac in utero, enhanced virulence 
 of the causative micro-organism, feebleness of the babies, slight 
 lateral tears of the membranes, position of the fetus in tlie maternal 
 passages, and the condition of the placenta cannot l)e sliown to be
 
 506 ANTERIOR CHAMBER 
 
 connected with the causation of ante-partum ophthalmia. Several 
 of the so-called 'congenital' anomalies of the eyes, as corneal opaci- 
 ties, staphyloma, microphthalmos, cryptophthalmos and lachrymal 
 abscess, are probably to be explained on the theory of an intro- 
 an intra-uterine infection. Six of Wharton's cases showed con- 
 junctivitis at birth ; in the others the disease appeared up to the 
 seventeenth day, the largest number of cases, 27, 2v and 13 respec- 
 tively, on the second, third and fourth days. Additional cases of 
 ante-partum ophthalmia are reported by Nance. (1.), Eobinson. 
 (3), and Ford (2). The latter is strengthened in the conclusion 
 that infection may take place through the injured membranes. This 
 view is also strongly supported by a remarkable case reported by 
 Terson, in which the child was delivered by Cesarean section. When 
 the head appeared in the uterine incision the assistants noted that 
 the eyes were red, swollen and discharging. The ease ran the 
 course of a severe purulent conjunctivitis, recovering under silver 
 nitrate, with potassium permanganate irrigation. The bacteriologic 
 examination revealed staphylococci and diplococci which took well 
 the Gram stain, characterizing them as the micrococcus tetragenus. 
 The treatment of these infections does not differ from that proper 
 to post-partum ophthalmia. 
 Anterior chamber. The space between the cornea and iris. In fcetal 
 life a delicate iridic membrane covers the pupil, subdividing the 
 aqueous space into an anterior and posterior chamber; after birth 
 the pupillary membrane disappears and the two spaces communi- 
 cate through the pupil. The anterior chamber is really a lymph- 
 space which varies in size with individuals. The contained fluid is 
 also subject to considerable alteration, both in character and amount. 
 According to Jackson, it is most shallow in early infancy from the 
 undeveloped condition of the eye, and in old age from the increased 
 size of the crystalline lens. It is deep in aphakia and still deeper 
 in keratoglobus, both from prominence of the cornea and from flat- 
 tening of the iris. 
 
 It ij often rather deep in myopia. It may also be deep in plastic 
 inflammation causing shrinking of the vitreous and retraction of the 
 lens. It appears deeper when there is any opacity in the cornea. 
 The anterior chamber is shallow in glaucoma, in cataract during 
 the stage of swelling of the lens, during parenchymatous inflammation 
 of the iris, or from bellying forward of the iris after exclusion of 
 the pupil. After injury of the. eye it may be shallow from traumatic 
 cataract, and it is quite obliterated so long as a perforation wound 
 permits the free escape of the aqueous humor. In degenerated
 
 ANTERIOR DICHOTOMY 507 
 
 shrunken eves it niav be very shallow. The anterior chamber is of 
 unequal depth in different symmetrical parts, from dislocation or 
 partial absorption of the lens, unequal swelling of the iris, or from 
 partial synechia. Sec Anatomy of the eye. 
 Anterior dichotomy. A name given to the condition existing in con- 
 genital malformations when supernumerary organs are found in the 
 head or anterior end of the animal, e. g., four eyes in the human 
 subject. 
 Anterior focal line, or first focal line, represents the line in the dift'usion 
 area (in considering astigmie lenses) along which a pencil of rays is 
 collected. 
 Anterior homogeneous lamina. A name for Bowman's nunnbrane. 
 This corneal layer is also called anterior elastic lamina, membrane 
 of Keichert and anterior or external basement membrane. 
 Anterior iridolysis. An operation intended to free the iris, which may 
 have become adherent to the cornea after an ulcerative or a trau- 
 matic perforation. Such an adhesion may have the shape of a small 
 thread only, or be broader, or it may even concern a large portion 
 "of the iris, as is usual in adherent leuconia and in corneal or corneo- 
 scleral staphyloma. The operation, if successful, removes the 
 attachment of the iris and has a beneficial influence on the bad con- 
 dition due to it, and maj- open up a useful pupil. Numerous opera- 
 tive measures have been devised by various operators and numer- 
 ous different instruments have been recommended for their pe^^- 
 formance. Yet every case will have to be studied and handled on 
 its own merits. 
 
 Bowman, having made a small corneal incision, entered a blunt- 
 pointed Weber's lachrymal knife and cut the iris off the corneal 
 scar by pressing the edge of the knife against the latter. 
 
 Meyer used a small sickle-shaped knife and cut the adhesion in 
 the direction from the cornea toward the pupillai-y margin. 
 
 Kerschbaumer is reported by Schulek to have used a narrow von 
 Oraefe knife for the same purpose. 
 
 Walker also used a vou Graefe cataract knife with which he 
 entered the cornea peripherally at a point opposite to the synechia. 
 By sweeping lateral movements he cut the adhesion without allow- 
 ing the aqueous humor to escape, until the knife was withdrawn. 
 
 Lang used two Knapp's knife-needles, one with a sharp point, 
 the other with the point rounded off'. With the pointed knife- 
 needle he pierced the cornea at a point lying sufficiently far to the 
 side of the corneal sear, so that the blunt knife, being entered after 
 the quick withdrawal of the first one, could be easily introduced
 
 508 ANTERIOR LENTICONUS 
 
 between the iris and cornea. AVith this second knife, the aqueous 
 humor not having escaped, he could then easily cut the adhesion off. 
 The chief difficulty seems to have been to find the small opening of 
 the first knife-needle to enter the second one through it, though this 
 defect in the technique is somewhat lessened by making it over or 
 in front of a plainly visible scleral vessel. 
 
 Others have used de Wecker's pince-ciseaux successfully to cut 
 off such anterior synechias. — (A. A.) 
 
 Anterior lenticonus. A more or less conical projection of the anterior 
 surface of the lens. In posterior lenticonus a similar cone is found 
 at the posterior pole. See Lenticonus. 
 
 Anterior polar cataract. This opacity of the lens is, as the name im- 
 plies, found at the anterior pole of the crystalline. It is generally 
 produced (and it may be congenital) by the deposit of an inflamma- 
 tory exudate on the anterior capsule while the lens presents at an 
 
 • opening in the cornea, the result of a perforating ulcer. See 
 Cataract. 
 
 Anterior sclerotomy. This operation was first introduced by de 
 Wecker in 1867. He aimed to establish by its means a cicatrix in 
 the angle of the anterior chamber through which the intraocular 
 fluids could filter out of the eye. In the following year Stellwag 
 von Carion practised this operation on the living subject, and two 
 years later, in 1871, Quaglino reported five cases of glaucoma Avhich 
 he had successfully treated by sclerotomy. During this year de 
 AVecker modified his original operation somewhat to avoid the pro- 
 lapse of the iris which had attended some of his earlier incisions. 
 This modification of the operation, which has been widely practised 
 by others, is performed as folloAvs : After the pupil has been con- 
 tracted ad maximum witli a miotic, and the eye cocainized, the lids 
 are separated with the speculum, and the globe steadied by grasping 
 the bulbar conjunctiva a few mm. distant from and below the lower 
 limbus of the cornea. A narrow von Graefe cataract knife is intro- 
 duced 1 mm. from the outer corneal limbus, as represented at a 
 (see the figure) and made to emerge at h, at the other side of the 
 anterior chamber. The incision is then continued upwards with 
 sloAV sawing movements, the cutting edge of the knife being directed 
 somewhat anteriorly, until only a bridge of tissue, about 2 mm. 
 broad remains at c, this being left undivided to prevent iris prolapse. 
 After the aqueous has been permitted to escape from the eye by 
 cautiously tilting the edge of the knife slightly forward, the knife 
 is slowly withdrawn. If the pupil is round, eserine is instilled and 
 a bandage applied, but if it be oval or irregular, indicating a ten-
 
 ANTERIOR SCLEROTOMY 509 
 
 dency of the iris to prolapse, the membrane sliould be gently stroked 
 by a spatula and attempt made to restore the pupil to its normal 
 form. In the rare cases that actual prolapse of the iris occurs, the 
 prolapsed portion should be excised at once, and the sclerotomy 
 converted into an iridectomy. AViegman recommends nuiking the 
 incision with a double keratome which he designed for llie purpose. 
 
 Anterior Sclevotoisiy. hho\Miig the ])()siti()n of the knife in tlio eye ihiring 
 the incision of the sclera. It lies at least 1 mm. away from the liml)us in the 
 sclera. 
 
 In addition to prolapse of the iris which has just been referred 
 to, when the chamber is very shallow, the operator may fail to enter 
 the anterior chamber, the knife being inserted instead into the 
 deeper layers of the cornea. To avoid this accident and also its 
 converse of making the incision too far posteriorly and thereby 
 wounding the lens, the best of illumination is necessary and the oper- 
 ator Avill do well to resort to the condensation of artificial light. In 
 case the operator gives a wrong direction to his knife and splits the 
 cornea or makes what is known as the interlamellar incision, the 
 knife may be withdrawn and re-entered at a better angle. Should, 
 hoAvever, the chamber have been opened and aqueous permitted to 
 escape, the knife should be withdrawn and the operation postponed 
 until the chamber has reformed. The same delay is advised if the 
 operator realizes in time to desist, that the counter-puncture has 
 been made too posteriorly. 
 
 After the toilet of the eye and the instillation of a miotic, a band- 
 age is applied, the dressing being removed at the end of 24 hours. 
 The lips of the wound may be found coaptated, and healing may be 
 perfected so that the thin cicatrix is barely visible. Oftener per- 
 haps there is a gaping of the wound and the condition described by 
 de Wecker as a filtration-cicatrix forms. This is less pronounced 
 than the cystoid cicatrix which is observed after the prolonged and 
 imperfect healing of incisions and wounds of the eyeball, and consists
 
 510 ANTERIOR SCLEROTOMY 
 
 of a broadening and elevation of the sear with a slight bulging of 
 the conjunctiva, de Wecker claims that such a cicatrix affords the 
 maximum amount of drainage for the intraocular fluids, though he 
 also asserts that a considerable degree of leakage may be attained 
 through even a closely united scar. 
 
 According to de "Wecker, anterior sclerotomy is particularly indi- 
 cated prior to iridectomy when the tension is very high and the 
 anterior chamber shallow. In chronic glaucoma in combination with 
 miotics, he considered it to be the operation of choice. He also rec- 
 ommends it in hydrophthalmus, in hemorrhagic glaucoma, and in 
 cases of absolute glaucoma to lessen pain. Finally, he commends its 
 performance in the prodromal period of inflammatory glaucoma 
 when miotics are without effect. 
 
 After operating on a large number of cases, Panas concluded that 
 anterior sclerotomy occupies the middle place between a large peri- 
 pheral iridectomy and repeated paracentesis of the cornea. In 
 chronic glaucoma, he found that it was a useful supplement to mio- 
 tics. In hydrophthalmus, however, it was as valueless as all forms of 
 operation, and in his opinion did not remove the necessity of enuclea- 
 tion in absolute glaucoma. Although at one time extensively prac- 
 tised especially by French surgeons, sclerotomy has now but few 
 advocates, as iridectomy with a scleral section has been shown to 
 possess all the advantages of sclerotomy, while affording at the 
 same time a possibility of re-establishing a communication between 
 the anterior chamber and the canal of Sehlemm. 
 
 Some operators have modified the operation as follows : Quaglino 's 
 incison was much the same as is usually employed for iridectomy and 
 was made with a large triangular keratome, the knife being entered 
 2 mm. behind the limbus. During the withdrawal of the keratome, 
 the handle was tilted back to raise the blade and prolapse of the 
 iris guarded against by permitting the aqueous to flow slowly off. 
 Despite this precaution, however, and the use of eserine, prolapses 
 were frequent, necessitating excision of the prolapsed portion of the 
 iris. 
 
 Snellen adopted Quaglino 's method, as he found it less liable to 
 induce prolapse of the iris. He treated a series of cases of bilateral 
 glaucoma by iridectomy on one eye and sclerotomy on the other and 
 found that the better vision was obtained by the latter. He, there- 
 fore, recommended sclerotomy, repeated if necessary as the initial 
 operation, resorting to iridectomy only when the sclerotomy failed 
 to prevent a rise of tension. 
 
 Bader followed de Wecker 's method in its essential details, but
 
 ANTERIOR STAPHYLOMA 511 
 
 aimed at making the corneal puncture and counter-puncture as near 
 as possible to and in front of the insertion of the iris. lie endeav- 
 ored to leave a large bridge of conjunctiva, stretching across tlie 
 sclerotic incision, and, witli this in view, divided an extent of 
 sclerotic equal to nearly a third the circumference of the cornea. 
 
 Martin precedes sclerotomy by paracentesis M'ith a Desmarres 
 needle introduced into the cornea at the vertical meridian 1 mm. 
 from the limbus. If aqueous still remains after -withdrawal of the 
 needle, he permits it to drain oft' by the aid of a lance. The wound 
 is then enlarged with one or two cuts of the iris scissors. 
 
 Both Panas and de Weeker advocated the operation of cica- 
 trisotomie or outetomie when rise of tension persists after iridectomy. 
 This consists in incising the cicatrix witli a narrow Graefe knife, in 
 order to divide the attachments of the iris in the angle of the cica- 
 trix, the conjunctival bridge being left undisturbed. The writer has 
 found this procedure of value in the several cases in wliich he has 
 resorted to it. 
 
 In cases of glaucoma simplex of a suspected malignant type, 
 Pfliiger incises the cornea as if for a broad iridectomy, but with- 
 draws the linear knife with which the incision is made before the 
 section is completed. If no decrease in tension occurs after the 
 escape of aqueous, he considers the operation completed. Should, 
 however, the tension fall, the incision is finished and the iris excised. 
 — (W. C. P.) 
 Anterior staphyloma. After extensive ulcer of the cornea the result- 
 ing cicatricial area, being thin or less resistent than normally of the 
 intraocular pressure, may bulge so that an anterior staphyloma is 
 the result. When perforation has also occurred with extensive 
 prolapse, in — healing of the iris associated with wide-spread 
 organization of inflammatory exudates there is a total anterior 
 staphyloma. 
 
 In 9 cases of complete, or almost complete, anterior staphyloma, 
 transplantation of animal cornea produced a permanent flattening of 
 the cornea in five recorded cases. Of the two eyes in which the 
 result was bad, one was eviscerated and the other enucleated. Both 
 these were cases of total anterior staphyloma which would probably 
 have required this treatment if transplantation had not been at- 
 tempted. Transplantation is scarcel}^ to be thought of as a method 
 of improving vision, but it may in some cases improve the condition 
 of the sightless globe, and do away with the necessity for enuclea- 
 tion or one of its substitutes. 
 
 The Editor operated ten years ago, with success, so far as relieving
 
 512 ANTERIOR SYMBLEPHARON 
 
 the staphylomatous condition of the cornea is concerned, on a young 
 girl for bulging of the anterior segment of the globe. The trans- 
 planted rabbit's cornea became fully incorporated in the corneal 
 surface and helped to flatten the front of the eye and preserve the 
 organ intact — at least until recently. 
 
 Anterior symblepharon. Union between the eyelids, involving the 
 conjunctiva*, but not so far back as the fornix. 
 
 Anterior synechia. Adhesion of the iris to the cornea, generally due 
 to operative, traumatic or ulcerative perforation of the latter and 
 hernia of the former. In those instances where the early use of 
 atropia, eserin, etc., is insufficient to reduce the hernia, the attach- 
 ment may be cut loose with Lang's twin knives or by other operative 
 methods. See Cornea, Ulcer of; Iris, Diseases of. 
 
 Anthracosis oculi. (L). Malignant ulcer of the eye. 
 
 Anthrax. Anthrax pustule ]\Ialignant pustule. This disease 
 arises in man by inoculation of the hacillus mithracis from the lower 
 animals. The eyelids are the ocular structures most commonly af- 
 fected, and the infection is found among persons who are employed 
 in the care of animals and among those who handle hides and wool. 
 The infection is carried by the hands, by dirty instruments, or by 
 the bites of insects which have fed on infected cadavers. The disease, 
 which fortunately is rare in this country, begins as a small vesicle 
 surrounded by an areola. Soon a livid-red papule develops, followed 
 by a bulla or pustule, and this, in turn, by a black eschar. There is 
 a broad area of edematous infiltration of a violet color. The gan- 
 grene may spread rapidly and terminate fatally, or a localized slough 
 may be thrown off, leaving an ulcer, which heals by granulation. 
 When the eyelids are involved there may be extensive destruction, 
 only the ciliary margins remaining. The constitutional symptoms 
 are those of sepsis. The diagnosis will rest on the history of the 
 case, the appearance of the lesions, and the finding of the anthrax 
 bacillus. The prognosis is serious, from 30 to 50 per cent, of the 
 cases ending fatally. The treatment will embrace general supportive 
 measures, incisions, the us6 of the galvanic cautery to destroy the 
 infected area, and the application of bichlorid solutions. After re- 
 covery a plastic operation may be required. Where there is exten- 
 sive loss of tissue, it will be advisable to suture the marginal portion 
 of the lid to its fellow to prevent lagophthalmos and ectropion.— 
 (J. M. B.) 
 
 Antibodies. Substances, such as antitoxins, formed in the blood and 
 fluids of the body antagonistic to bacteria and their poisonous prod- 
 ucts. We recognize the presence of antibodies in the sera of animals
 
 ANTIBODIES 513 
 
 b}' certain charactL'i-i.stic reactions wliich they produce under care- 
 fully controlled conditions. In chemistry, chemical substances and 
 elements are recognized by their physical character, form, color, 
 weight. Knowing one chemical substance or element, we recognize 
 a second unknown by the changes Avhicli occur when it is mixed with 
 the known. These changes we call reactions. Antibodies, however, 
 are easily destroyed by the ordinary physical processes and methods 
 of chemical examination. AVe are accordingly limited in our study 
 of antibodies to the observation of the reactions which they produce 
 when combined with other substances and cells. Thus antitoxins in 
 a serum are demonstrated by the neutralization of toxin by the serum 
 as shoAvn by the failure of the toxin-antitoxin mixture to produce 
 death in the test animal. Bactericidins are recognized by their 
 lethal action on bacteria. Hemolysins i)roduce hemolysis of red 
 blood cells. 
 
 The number of possible antibodies is limited only by the number 
 of substances which can act as antigens. In general, antibodies fall 
 into several classes distinguished by the character of their reactions. 
 Chief among these classes are the bactericidins, antitoxins, precipi- 
 tins, agglutinins, hemolysins and opsonins. Usually the antibodies 
 with which we have to deal in the study of immunity are those which 
 appear in response to the artificial introduction of antigens. These 
 antibodies are known as immune antibodies. In certain instances, 
 however, antibodies which produce the same reaction as immune 
 antibodies may be demonstrated in normal serum, that is, the serum 
 from nninoculated animals. Thus we recognize that in normal 
 serum there is a certain amount of opsonin which, when mixed with 
 a bacterial suspension, so modifies the bacteria that they may be 
 taken up by leucocytes. The inoculation of suitable quantities of 
 bacterial substance may greatly increase the opsonin contained in 
 this serum, thus adding the action of the immune opsonin to that of 
 the normal opsonin alread}^ present in the serum. 
 
 Ehrlich has classified antibodies into groups distinguished by the 
 reactions which they show in various combinations. This complete 
 system of classification is known as the side-chain theory, and sup- 
 poses that immune bodies consist of a central fragment to Avhich are 
 attached special groups having special functions and special struc- 
 ture, so that they combine with other substances. The combining 
 groups fit each other as a key in a lock. Briefly, on this theory, 
 Ehrlich classifies antibodies according to their supposed molecular 
 structure. Antitoxin is supposed to possess a single combining 
 group or receptor, Avhicli fits the corresponding toxin. Agglutinins 
 
 Vol. 1—3 3
 
 514 ANTIDIPHTHERIC GLOBULINS 
 
 and precipitins have one combining group and a second group which 
 facilitates agglutination or precipitation. Other more complex anti- 
 bodies such as the hemolysins are supposed to have a combining 
 group for the red cells and a second group for the complement or 
 alexin. Those of this latter class are called amboceptors, that is, 
 they form a means of union for the red cell and the complement. 
 Substances of this class are also known as sensitizers in that they 
 sensitize the cell to the action of complement. As pointed out by 
 Bordet, the phenomena observed in these reactions are attributed 
 by Ehrlieh to the properties in the antibody rather than to those in 
 the antigen and the complement. The side-chain theory of Ehrlieh 
 has had enormous influence on the development of our knowledge of 
 immunity, but it is possible that many of the reactions which require 
 a complicated series of explanations on this theory may be in the 
 future much more easily and satisfactorily explained on the basis of 
 colloidal reactions by physiochemical methods. 
 
 It must be remembered too that we are able to recognize a rather 
 limited number of classes of antibodies only, because a limited num- 
 ber of methods have been devised hy which their presence can be 
 demonstrated. These methods consist chiefly in changes produced 
 in suitable reagents, such for instance as the laking of red blood 
 cells by hemolysins, the agglutination of bacteria or other cells, the 
 formation of a precipitate in a mixture of sera, the taking up of 
 bacteria by leucocytes, etc. As other methods by which character- 
 istic reactions can be produced and adequately controlled are de- 
 veloped, other types of antibodies may be demonstrated. The reac- 
 tion knoAvn as the fixation of complement enables us to demonstrate 
 the presence of antibodies in the serum of animals inoculated with 
 various bacteria. 
 
 In addition to the antibodies already mentioned we know of others 
 such as the leucotoxins, neurotoxins, and nephrotoxins. Some of 
 these are specific for their corresponding antigens. In others, the 
 specificity of the antibodies has been called in question. Antifer- 
 ments have also been demonstrated. — (E. E. I.) See, also, Seropathy. 
 
 Antidiphtheric globulins. See Antidiphtheric serum; also, Seropathy. 
 
 Antidiphtheric serum. Serum antidiphthericum, Antidiphtheric 
 GLOBULINS, Diphtheria antitoxin. The serum of horses immunized 
 to the toxin of the diphtheria bacillus, to which is added after filtra- 
 tion some antiseptic such as tricresol or chloroform. The concen- 
 trated diphtheria antitoxin is obtained by the precipitation of the 
 globulin fraction which contains most of the antitoxin by the addi- 
 tion of neutral salts. The serum is marketed in syringe packages
 
 ANTIFEBRIN AMBLYOPIA 515 
 
 ready for use. It is also supplied by some firms in dry form. The 
 diphtheria antitoxin sold in interstate commerce in tlie United States 
 is required to conform to tlie standard established by the United 
 States Health and ^Marine Service, and must contain the number of 
 antitoxin units claimed on the label. 
 
 The dose required for a case of diphtheria will vai-y Avitli the age of 
 the patient and the extent ajul duration of the disease previous to 
 the treatment. If administered on the iirst or second day of the 
 disease in a mild case from 2,000 to 5,000 nnits is often sufficient. 
 The longer the disease has proceeded the more heroic should be the 
 dosage. The general tendency in recent years is to use larger and 
 frequently repeated doses of antitoxin. 
 
 The immunizing dose is from 500 to 1500 units. It should be 
 remembered that passive immunity in this disease after a dose of 
 serum is of relatively short duration, perhaps two to three weeks. 
 — (E. E. L) 
 
 This preparation is unquestionablj^ the most successful and 
 widely known of the specific sera, the general employment of which 
 has reduced so remarkably the mortalitj^ in diphtheria. Its use in 
 diphtheric infections of the eye has been attended w4th the same 
 favorable results as in eases of the ordinary pharyngeal and nasal 
 infections. Antidiphtheric serum has been used also, empirically, 
 in the treatment of various suppurative lesions not due to the diph- 
 theria bacillus, such as corneal ulcer of pneumococcal origin, puru- 
 lent conjunctivitis, hypopyon, etc., Avith reported benefit. See 
 Seropathy in ophthalmology. 
 
 Antifebrin amblyopia. Antifebrin (Phenyl.a.cetamid; Acetaxilid) pois- 
 oning has been followed by dilation of the pupil, with decreased or 
 lost light-reaction, together with other more or less severe general 
 disorders. Ililbert observed, after a three gram dose, visual weak- 
 ness, with narrowing of the visual field, constriction of the retinal 
 vessels, and pallor of the papilla. A case accompanied by strong 
 cyanosis showed blueness of the conjunctiva. See Toxic amblyopia; 
 also Acetanilid. 
 
 Antifebrinvergiftung. (G.) Antifebrin poisoning. 
 
 Antigen. This is a substance which when introduced into th.- living 
 body gives rise to antibodies, the presence of Avliicii is recognized by 
 various characteristic reactions. The toxin of the bacillus of diph- 
 theria Avhen injected into the horse in successively increasing doses 
 produces changes in the animal such that at length it can withstand 
 a dose of toxin many times as great as would have caused death 
 before the treatment. The serum of this horse, when injected in
 
 516 ANTIGEN 
 
 proper amount into another animal, will protect the second animal 
 from an otherwise fatal dose of the toxin. The protective substance 
 in the serum of the treated horse we call antitoxin, an antibody to 
 a toxin. The toxin which stimulates the production of the antitoxin 
 we call antigen. 
 
 Another familiar example of the production of antibodies by an 
 antigen is found in typhoid fever. The serum of an individual Avho 
 has passed through the disease will cause the agglutination of 
 typhoid bacilli (Gruber-AYidal reaction). Here the typhoid bacillus 
 and its products act as antigen giving rise to the formation of anti- 
 bodies (in this case agglutinins), the presence of which is recognized 
 by the phenomenon of agglutination. 
 
 The principal antigens with which we have to do in the treatment 
 of disease are of bacterial origin. In some cases bacteria produce 
 soluble products such as the toxins of diphtheria and tetanus, Avhich 
 when introduced into suitable animals produce antibodies (antitox- 
 ins). Certain other bacteria produce little or no soluble toxin. 
 Suspejisions of these bacteria, however, when introduced into animals 
 give rise to various antibodies which are recognized by their char- 
 acteristic reactions with their respective antigens (see Antibodies). 
 The action of each antigen as demonstrated by the action of its anti- 
 body is specific for that antigen. That is, the typhoid bacillus pro- 
 duces antibodies which react with the typhoid bacillus (agglutinin 
 etc.) and not with other organisms such as the staphylococcus and 
 streptococcus. Two closely related antigens may give rise, how- 
 ever, to antibodies some of which are common to both immune sera. 
 This fact is made use of frequenth' in determining the relationship 
 of bacterial species. 
 
 Other substances such as the tissues or serum of animals will act 
 as antigen when introduced into the body of animals of another 
 species. Thus precipitins, agglutinins (such as the hemagglutinins), 
 hemolysins, etc., can be demonstrated in the serum of animals after 
 the injection of these antigens. 
 
 Certain substances of vegetable origin also have antigenic prop- 
 erties. Some of the vegetable poisons such as abrin and ricin are 
 well known examples of vegetable antigens. 
 
 The chemical structure of antigens as well as of the antibodies to 
 which they give rise is as yet unknown. AVith very few exceptions, 
 substances the chemical structure of which we know do not give rise 
 to antibodies. One exception to this statement, however, may be 
 noted, that of cobra venom which has been obtained in pure crys- 
 talline state as lecithid (cobra lecithid) and which produces demon-
 
 ANTIGONOCOCCIC SERUM 517 
 
 strable antibodies -when injected into animals. Tn general, substances 
 having antigenic pi'operties are proteids. 
 
 The term antigen is also used in a somewhat modilied sense in 
 discussions of the complement fixation test as applied to the diagnosis 
 of syphilis (AVassermann test). Here the term antigen is applied to 
 the extract of syphilitic liver, ])resnmably containing the products of 
 the spiroclupta pallida, the eausi- of syphilis. In Ihe various mod- 
 ifications of the Wassermann test, it lias been found that extract of 
 guinea-pig heart and other substances may be used to replace the 
 extract of syphilitic liver. These substances are referred to as 
 antigen, although it is obvious that tlu'y have no specific relation to 
 the anti-substances in the serum which it is designed to detect. — 
 (E. E. I.) See, also, Seropathy. 
 
 Antigonococcic serum. The serum pre])ared from the l)l()()d of rams 
 or horses immunized against the gonococcus. In certain cases the 
 serum has been thought to give favorable results in the treatment of 
 gonococcal arthritis. It has also been used in the treatment of cer- 
 tain cases of gonococcal iritis. It is of comparatively little value in 
 the treatment of infections of the mucous membranes. — (E. E. I.) 
 
 Antikdrper. (G.) Antibodies. 
 
 Antimeningococcus serum. The serum prepared from the blood of 
 horses immunized with cultures of the; diplococcus intracellularis. 
 It has been used quite extensively and with favorable results in the 
 treatment of epidemic meningitis, due to the diplococcus intracel- 
 lularis. It is best given intraspinally by lumbar puncture. Given 
 subcutaneously, it has little if any demonstrable curative effect. The 
 dose in the adult is from 15 to 30 ecm., repeated at intervals of a 
 few hours. Great care must be exercised in the injection of the 
 serum to avoid too rapid increase in the intraspinal pressure. Care- 
 ful observation of the pulse and blood pressure during the injection 
 will assist in the avoidance of unfavorable symptoms.— (E. E. I.) 
 See, also, Seropathy. 
 
 Antimeristem-Schmidt. A proprietary vaccine for the cure of cancer 
 and sarcoma. 
 
 Antimeter. An antiquated optical instrument for measuring small 
 angles. 
 
 Antimetropia. (L.), n.f. That refractive condition in which there is 
 myopia in one eye and hyperopia in the other. See Refraction and 
 accommodation. 
 
 Antimony. The salt of this metal in which the oplithalmologist is 
 mostlj^ interested is "tartar emetic," whose application to the eye, 
 either as a powder or in solution, produces a pustular conjuneti-
 
 518 ANTIMYDRIATIC 
 
 vitis and pericorneal injection. Still stronger compounds, like 
 "butter of antimony" (antimony chloride), act as caustics (by 
 forming albuminates with the tissues) and have, when applied to 
 the lid, accidentally brought about destruction of the cornea. 
 Probably, also, the free hj^drochloric acid in the "butter" adds 
 to its destructive action. Except for their rare employment as 
 cauterants for ulcers antimonial compounds have no place in ocular 
 treatment. 
 
 A boy who was given a teaspoonful of antimony chloride solu- 
 tion (Liquor stibii chlorati, G. P.) by mistake, suffered from symp- 
 toms of gastritis, associated with widely dilated pupils that did not 
 respond to either light or accommodation. 
 Antimydriatic. A drug or other agent that arrests or reduces dila- 
 tion of the pupil. 
 Antinode. In optics, a point in a vibrating string where the amplitude 
 of vibration is greatest. It is the middle of the loop, the summit of 
 oscillation, and half way between two adjacent nodes. See Nodes. 
 Antinosin. Nosopiien-sodium. Sodium TETRAiODOPHENOLPHTH.y:,EiN. This 
 compound appears as a blue powder, and is recommended as an anti- 
 septic to replace iodoform. It is soluble in water and used in from 
 one-half to one per cent, solutions. It is also employed as a gargle 
 in pharyngeal diphtheria. 
 
 In cases of simple cartarrhal conjunctivitis and hyperemia of the 
 conjunctiva W. 0. Moore uses a few drops of a one per cent, solu- 
 tion instilled into the eye three times a day. Solutions of antinosin 
 should be kept in a dark bottle and in a cool place. 
 Antipathy to binocular single vision. It is well known to observers 
 that, in squint especially, it is not always possible, even by the use 
 of the stereoscope, amblyoscope (q. v.) and other devices to induce 
 both eyes to see together; in other words, to secure any form of 
 binocular vision. In this case some central or other defect in inner- 
 vation or in the fusion faculty is assumed. Savage (Ophthalmic 
 Myology, pp. 426-430) defines this condition as one in which it is 
 impossible to fuse the two images of an object. Such cases were 
 observed by Graefe, who defined the condition as "antipathy to 
 binocular single vision." The cause of this antipathy, in all prob- 
 ability, is that the macula of one eye is connected with one side of 
 the brain, while the macula of the felloAV eye is connected with the 
 other side of the brain. To fuse images on the two maculas their 
 impressions must be carried to the same side of the brain, which 
 cannot be accomplished unless the nerve fibres passing from the 
 two maculas find their way into the same optic tract and thence go
 
 ANTIPATHY TO BINOCULAR SINGLE VISION 519 
 
 to the same cuneus. If tlie luaculas fail tu liave a comuiun connec- 
 tion with the brain, other retinal points that ought to correspond 
 cannot do so, and there must be diplopia in all parts of the field. 
 The condition, if it exists, is congenital, and the only reason why 
 there is not annoying diplopia must be due to the habit of mental 
 suppression acquired in infancy. Esotropia due to such a cause 
 must occur earlier in life than is usual, possibly within the first few 
 weeks after birth. 
 
 Pathology points to the possibility of such a cause for esotropia. 
 A disease involving the center of sight in one cuneus, or a disease 
 involving all the nerve fibers as they pass from one cuneus in their 
 course to the optic chiasm, whether in the tract or farther back, 
 must cause hemianopsia, involving corresponding halves of the two 
 retinas, the temporal half of one retina and the nasal half of the 
 other. Many such cases have been observed. In some cases the line 
 dividing the blind part from the seeing part of each retina has been 
 vertical, passing down through the macula; in other cases, while 
 these lines were vertical, they missed the maculas, passing a few 
 degrees either to the right or to the left of both, the two maculas 
 falling either in the blind or in the seeing parts, in either case show- 
 ing that both were connected with the same side of the brain ; in 
 other cases the dividing lines have not been vertical, the obliquity 
 being sometimes as much as ten degrees, but the same in the two eyes. 
 The oblique lines have passed, in the reported cases, either through 
 the maculas or have fallen on corresponding sides. No case, so far 
 as the author knows, has ever been reported showing that the blind- 
 ness in the temporal half of one retina included the macula, while the 
 blindness in the nasal half of the other retina did not include the 
 macula, else no further argument would be necessary. That pathol- 
 ogy has shown no cases of faulty connection of the maculas with 
 the brain is probably due to the rarity of the condition — certainly as 
 rare as is "antipathy to binocular single vision," for the one must 
 be a synonym of the other. If the lines dividing the retinas into two 
 halves pass, in some cases, down through the maculas, while in. 
 other cases both these lines pass either to the right or to the left of 
 the maculas, it must be conceded as a possibility that the dividing 
 line in one retina may pass to the right of the macula, Avhile the 
 dividing line in the other retina may pass to the left of the macula. 
 In this case disease of one cuneus or of one tract would destroy the 
 perceptive power of one macula, while the other macula would be 
 uninvolved. There being no disease in such a case, the impress of 
 an image on one macula would be conveyed to one side of the brain,
 
 520 ANTIPHORIA 
 
 while the impress of the image on the other macula would be sent 
 to the other side of the brain, and there would be no fusion of the 
 two. So far as the author can see, nothing else can account for 
 "antipathy to binocular single vision." 
 
 Every surgeon of much experience with esotropia has had cases 
 that he could not cure, however skilled as an operator. Each at- 
 tempt to correct the error in such a case makes the patient worse,^ 
 for the reason that, under the old condition, the power of suppres- 
 sion of images in one eye had been acquired, while under the new 
 condition, the images fall on new parts of the retina of the eye 
 operated upon, and diplopia is at once made manifest. The more 
 nearly the readjustment of the muscles brings the eyes straight — to 
 exactly straighten them is impossible — the more annoying becomes 
 the diplopia. If the patient is mature at the time the operation is 
 done, his diplopia will always be annoying, for he can never re- 
 acquire the power of mental suppression. To have let such a patient 
 alone would have been a mercy. 
 
 Fortunately, esotropia due to the cause under discussion is rare. 
 That the mistake of operating on such cases may not be made, the 
 operator should give most careful study to every ease. When there 
 is great amblyopia of the esotropic eye, one may feel fairly sure that 
 the case is not of this character; for usually a case of this kind has 
 fairly good vision in either eye when the other is excluded, for the 
 esotropia is alternating. But all cases of alternating esotropia, with 
 fairly good vision in each eye, do not belong to this hopeless class. 
 In any case of esotropia the fusion test should be applied ; but in 
 alternating estropia this test becomes absolutely essential. When 
 the images can be fused, the case can be cured; if the images cannot 
 be fused, a cure is impossible, and should never be attempted. 
 
 Antiphoria. A form of heterophoria in which t]ie directions of the 
 main tendencies of the two eyeballs are opposed to one another. 
 
 Antipneumococcic serum. Antipneumococcic serum, as at present 
 prepared, has received an extensive trial in pneumococcal infec- 
 tions. In lobar pneumonia and other general infections the results 
 have not been encouraging. Isolated cases and in some instances 
 small series of cases have been reported in which recovery followed 
 the use of the serum, but the consensus of opinion is that in this 
 class of cases its value has not been demonstrated. 
 
 Romer has made an extensive study of antipneumococcic serum 
 in serpiginous ulcer of the cornea. In his first series of cases in 
 which he used a polyvalent serum, he obtained somewhat better 
 results than in a control series in which the serum was not used.
 
 ANTIPNEUMOKOKKENSERUM 521 
 
 Later he supplemeiiled the injections of s^niiii by active iiiiiim- 
 uizatioii, using for this purpose vaccines ])repared from pneumo- 
 coccus cultures. The suspension of killed pneuniococci was given 
 preferably first, followed in a few hours by Ihr scniin. Using this 
 teehni(|ue Romer was able to cheek the advance of the ulcer and 
 obtain healing in 20 out of 24 eases. In 2 cases he liad to resort to 
 the galvanocautery, and in the remaining 2 cases ]:)an()phthalmitis 
 developed. Some observers have been incdined to regard Romer 's 
 last series as made up of uiuisually favorable cases, and claim that 
 if the infections had been of average virulence, his results would 
 have been no better than those following ordinary symptomatic 
 treatment. — (E. E. I.) See, also, Seropathy. 
 Antipneumokokkenserum. (G.) Anti-pneumococcie serum. 
 Antipyonin. This is a proprietary mixture mostly composed of sodic 
 tetraborate, used as a dry powder for dusting over corneal ulcers 
 and wounds and into the sac for the relief of conjunctival afifections. 
 It is a substitute for iodoform, calomel, xeroform, etc., in lesions 
 where these remedies are indicated. See, also. Boro-borax and 
 Boricin. 
 Antipyrin. (G.) Antipyrine. 
 
 Antipyrine. Phexazone. Analgesine. Parodyne. CuHi^NoO. 
 A mildly bitter, whitish, odorless powder, solul)lt' in one part of 
 water, alcohol or chloroform. Internally it is a poisonous anti- 
 pyretic drug; locally it contracts the blood vessels with which it 
 comes in contact. 
 
 It is incompatible with spirit of nitrous ether, iodine, and prepa- 
 rations containing iodine, mercuric chloride, tannic acid, phenol, 
 thymol, phenyl salicylate, calomel, and the alkaline salicjdates. 
 
 Although the use of this remedy in therapeutics is mostly internal 
 it is on occasions employed topicall3^ For example, AVicherkiewiez 
 recommends it in from 5 to 10 per cent, aqueous solutions as a coUyr- 
 ium in a number of conjunctival diseases. 
 
 For the relief of the smarting and occasional pain following the 
 use of collyria made with zinc sulphate, zinc chloride and other sol- 
 uble zinc salts H. V. AViirdemann advises the addition of 4 per cent, 
 antipyrine to these mixtures. 
 
 AV. K. Butler believes that antipyrine has an anesthetic effect 
 in certain mixtures and uses it in conjunctival catarrh Avith irri- 
 tative sjanptoms. He thinks that it may be substituted for the 
 objectionable cocaine so commonly prescribed. Either of the follow- 
 ing may be used, as indicated: aiitipyi-in, 6 centigrms. ; boric acid, 6 
 decigrms. ; distilled water, 32 grms. ; or, zinc sulphate, 3 centigrms. ;
 
 522 ANTIPYRINE 
 
 autipyrin, 6 centigrms. ; boric acid, 6 decigrams ; distilled water, 32 
 grms. 
 
 As a cooling and detergent wash in ordinary cases of conjunctival 
 catarrh or hyperemia Nelson Black prescribes one of the following 
 formula, directing that a few drops be put into the eye three or 
 four times daily: 
 
 R 
 
 Cocain. hydrochlor, 0.030 
 
 Antipyrin. * 0.10 
 
 Acidi borici 0.40 
 Aquaj camph. 
 
 Aqu£e borici dest. aa 15.00 
 
 B 
 
 Zinci sulph. 0.030 
 
 Antipyrin. 0.10 
 
 AquEe camph. 
 
 Aquge dest. aa 15.00 
 
 Antipyrin. 0.10 
 
 Acidi borici 0.40 
 
 Aquae camph. 
 
 Aquaj dest. aa 15.00 
 
 Antipyrin has also been recommended by Kozlowski and 
 Wicherkiewicz in a 10 per cent, to 25 per cent, solution for 
 w^ashing out the lachrymal sac after probing in suppuration of 
 the lachrymal sac. It is further recommended by the latter in a 
 3 to 5 per cent, solution in all forms of conjunctivitis (except acute 
 trachoma) especially after influenza, and in a 25 per cent, solution 
 in chronic trachoma. The instillation causes violent burning and 
 stinging at first, but the sensation disappears quickly. In chronic 
 inflammatory glaucoma the pains were lessened by instillation of a 
 few drops of a 25 per cent, solution into the respective nasal canal. 
 Vigues reported good results after spraying in some forms of 
 pannus, and keratitis and in peripheral phlyctenular. For clearing of 
 corneal scars spraying antypirin (after cocainization) has been 
 employed successfully. In neuritic atrophy of the optic nerve it 
 was employed by Valude on account of its action upon the vaso- 
 motor system. He recommends subcutaneous or gluteal injections 
 of a 50 per cent, solution, every second day 1.0 and later 2.0 ccra. 
 with a little cocain. 
 
 Internally it is of benefit in doses of 0.5 to 1.0. 3 times a day, in 
 the treatment of subacute or chronic inflammatory glaucoma, if the
 
 ANTIPYRIN AMBLYOPIA 
 
 oZi 
 
 pains reappear after operative treatmont. Tt is also recommended 
 in absolute glaucoma. Iritic pains are also relieved by antipyrin 
 but aspii-iii is a belter remedy for tins pui'posc. 
 
 Antipyrin amblyopia. The eye is larely att'ectod, in the toxie sense, 
 by this agent. When it is, the sym})toms form part of a general 
 dermal inflammation, i. e., eruptions and infective processes in the 
 buccal and nasal mucous mendjranes. In a few cases conjunctivitis 
 (with considerable edema of the conjunctiva), eruptions on the lids 
 and conjunctiva as well as lachrynuition occur. The lids, taking 
 part in the lid-skin infection, may become so swollen as to shut 
 one or both eyes; or the lids alone may show an eruption, such as 
 urticaria or eczema. 
 
 Dilatation of the pupil does not take place in these cases unless 
 the antipyrin poisoning is so severe as to end in collapse or epilepti- 
 form convulsions. 
 
 Definite visual disturbances also occur. A woman who took one 
 gram of antipyrin became sick after five minutes with fever, fol- 
 lowed by an urticaria of short duration. The heart action was 
 strong and there was great irritation. Amaurosis of one minute 
 duration followed, with edema of the face. Recovery occurred 
 after three days. While the amaurosis in this case was transient, 
 in another patient it lasted half an hour. A woman, after taking 1 
 gram after a meal, had pressure-pains in the back of the head, 
 buzzing in the ears, dizziness, feeling of anxiety, palpitation of the 
 heart (200 per minute), cold sweat on the face and dyspnea. After 
 twenty minutes everything became black before her eyes and in a 
 few minutes she became blind for thirty minutes. The conjunctiva 
 bulbi was hyperemic, there was an increased floAv of tears, all asso- 
 ciated with a slight exophthalmos. 
 
 Even after small doses (one gramme) the patient may have 
 blepharo-conjunctivitis with sAvelling of the face, lachrymation, and 
 catarrh of the respiratory passages. Less frequently one encounters 
 dilated pupil, decrease of central vision, and still more rare is an 
 attack of complete but temporary blindness. These symptoms are 
 in general seen in cases of idiosyncrasy against antipyrin. 
 de Schweinitz, Avho tried the eflPect of the drug on himself, noticed 
 scintillations followed by bright spots before his eyes. See Toxic 
 amblyopia. 
 
 Antipyrinvergiftung'. (G.) Antipyrin poisoning. 
 
 Antirrheoscope. J. J. Oppel's apparatus for observing and testing 
 vertigo of ocular origin. 
 
 Antisepsis and antiseptics. Agents that act as germicides are called
 
 524 ANTISEPSIS AND ANTISEPTICS 
 
 antiseptics, while the germ-free condition with the methods em- 
 ployed to realize it is designated antisepsis. To this end both in 
 general surgery and in ophthalmic therapeutics, we employ those 
 agents that are found bj^ experience to act best as bactericides. The 
 delicate structures of the ocular apparatus require, however, the 
 kind of care that is not called for elscAvhere, so that it is not always 
 compatible with safety to employ the same anti-bacterial remedies 
 (or at least not in the same dosage) that are indicated in wounds or 
 other lesions of more resisting tissues. For example, mercuric 
 bichloride and carbolic acid are well tried and useful antiseptics, 
 but they cannot be properly used in the conjunctival sac in anything 
 like the strong solutions which one would apply to the tissues of 
 the arm or leg. The desire to kill all the pathogenic bacteria that 
 infest the eye — as in a laboratory experiment — induced early clin- 
 icians to use the most powerful and effective germicides, but it 
 was soon demonstrated that it is not only impossible to sterilize 
 completely the conjunctival sac and the surrounding tissues, but 
 that the attempt to do so is likely to bring about vascular disturb- 
 ances and other changes that are more productive of harm than the 
 disinfection of the ocular tissues does good. This is especially true 
 of operative procedures; strong antiseptics destroy the vitality of 
 the wound edges, delay healing and actually invite infection. 
 
 One is prone to forget, also, in drawing conclusions from labora- 
 tory experiments made on the conjunctiva and other ocular organs 
 of the lower animals that these may be more sensitive to or less af- 
 fected by the drug in question, than are human eyes. Thus, it by 
 no means follows that because a certain agent brings about this 
 or that alteration, or produces certain symptoms in the eyes of the 
 rabbit, giiinea pig or dog that the same results will necessarily fol- 
 low the identical experiments on the eye of man. 
 
 The most that can, after all, be said in favor of laboratory experi- 
 meiils of this kind is that the simian ocular apparatus is much better 
 adapted for the purpose than are the ocular organs of the small 
 mammals. At the same time the man-like apes and higher monkeys 
 are difficult to obtain for experimental purposes and their cost alone 
 is almost prohibitive, ytill it is better to make the best use of clin- 
 ical observation on human beings and rely on them alone than to 
 be led astray by misleading comparisons and unjustifiable deduc- 
 tions. In the opinion of the writer the great majority of thera- 
 peutic experiments on the eyes of the lower animals, especially of 
 the guinea pig, are valueless, if not positively deceptive — so far as 
 they claim to possess virtue in ophthalmic therapy.
 
 ANTISEPSIS AND ANTISEPTICS SSj 
 
 The importance as well as the difficulties of rendering the con- 
 junctival sac aseptic is illustrated by the calculation of Novy that 
 thirty billions of bacteria contain about ^/4oo gi'ain of organic mat- 
 ter, an amount too small to be appreciated by our unaided senses. 
 
 As the various antiseptics used in ophthalmic surgery are sei^a- 
 rately dealt with and their comparative value as microbicides else- 
 where discussed, we give here only a small list of the preparations 
 usually included in the category'. Among them are boric acid, picric 
 acid, airol, airoform, alphozone, amyloform, lotio nigra, aqua sub- 
 limatis, most of the silver salts, aristol, aseptol, berberine and liydra- 
 stine with their salts, betanaphthol, blenol, boro-borax, borol, boro- 
 glycerite, oil of cade, calomel, calomelol, cerevisine, chloral hydrate, 
 chlorine water, copper sulphocarbonate, creolin, europhen, formalin, 
 gold chloride, gujasanol, Guthrie's salve, hydrastine, hydroquinone, 
 ichthyol, iodine and its preparations, most of the soluble salts of 
 mercury, the bichloride, benzoate, cj'anide, oleate, oxycj^anide, 
 iodides and oxides, raonochlorophenol, phenoalyl, several potassium 
 salts, including the chlorate and chloride, protargol, pyoktanin, blue 
 and yellow, (iuinine and its salts, quinosol, radium, resorcin, salol, 
 sodium benzoate, benzosulphinide, borate, chloride, saccharate, sali- 
 cylate, sozoiodolate, sulphate and chlorinated soda, sophol, sozoio- 
 dole-zinc and mercury, sublamine, thigenol and trikresol. 
 
 It may be well to say a few words about some of the most im- 
 portant of the foregoing list. 
 
 First are several salts- of mercury. In tliis connection it has been 
 noticed the more mercury a j^reparation contains the more powerful 
 its disinfectant action. The best known of these salts are the bichlo- 
 ride and oxyc3^anide (q. v.). Schlosser advises its use in 1 to 2 
 per cent, watery solution and says that it may be used in any 
 capacity to which sublimate is adapted and that it is not so irritat- 
 ing to the o('iilar tissues. The sul)conjunctival employment of the 
 cyanide has already been alluded to in conjunction with acoin ((|. v.) 
 and it must be repeated that in solutions of 1 to 2,000 to 4.000 it is 
 about the most reliable agent we possess in deep (purulent) infec- 
 tions of the e^'cball. 
 
 Formalin, '/looo ^o ^,5000 salicylic acid (3 per cent.;, pyoktanin, 
 boraeic acid (3.5 per cent.), chlorine water (2 to 5 per cent.), potas- 
 sium permanganate (/looo t<3 /4000). sodic benzoate (five per cent.) 
 and a saturated solution of hydrogen peroxide in water, to which 
 may be added various antiseptic preparations of salts of metals, 
 (iodine, silver, copper, zinc) and many organic compounds also 
 iDclong to the class of astringents or caustics. A third class of anti-
 
 526 ANTISEPSIS AND ANTISEPTICS 
 
 septics are such neutral bodies as vaselin, paraffin, castor oil, glycer- 
 ine, etc., that act indirectly as antiseptics by furnishing a soil but 
 poorly adapted to the growth of some pathogenic bacteria. 
 
 Preparations of certain aniline dyes were, as germicides, intro- 
 duced into the local treatment of eye diseases by Stilling. They 
 were very popular for a time, especially the yellow and blue pyok- 
 tanin, both of which in the solid form and in all their watery solu- 
 tions were widely used. Interest in them has been more recently 
 revived by Rudini and others but it has again waned. Methylene 
 blue and toluidine blue are also employed by some ophthalmic 
 surgeons in corneal ulcer and in infective conjunctivitis. 
 
 Zinc permanganate, as dark violet-brown, hj^groscopic, crystalline 
 granules, similar in appearance to permanganate of potassium is, 
 like it, used as an antiseptic and astringent wash. It is employed as 
 a bactericidal collyrium in ^looo to ^-,00 solutions and should from 
 its chemical composition be very useful clinically. I have prescribed 
 it with much benefit as a %ooo solution for the home irrigation of the 
 nasal duct following operation for the relief of lachrymal stricture. 
 
 The problem of obtaining the complete antiseptic action of sub- 
 limate upon the ocular tissues without disturbing unduly the vascu- 
 lar supply of the parts and without inducing discomfort, is solved 
 by the use of a formula proposed by J. A. White. He found that 
 while it is impossible to use, especially in operative work, such 
 decided germicide solutions as %ooo in water that strength might 
 be employed as an ointment with vaselin. His formula is : 
 
 I? 
 
 Hydrarg. bichlor. gr. ^ 
 
 Sodii chlor. gr. f 
 
 Alcohol dil. q. s. 
 
 Petrolati 5J 
 
 Dissolve the sublimate and the common salt in a few drops of 
 dilute alcohol and mix with the vaselin, which has been previously 
 kept at a temperature of 212° F. for half an hour. Stir until cool. 
 This may be put into soft capsules for individual use, or kept as an 
 antiseptic base for atropine and other ointments. 1 have prescribed 
 this salve and used it extensively in private, dispensary and hospital 
 work and can recommend it as a most useful application to the sac 
 when a reliable antiseptic is desired. It is my practice to fill the sac 
 with the ointment twice in 24 hours as one of the preliminaries to 
 major operations on the globe. I also prescribe it extensively alone 
 and in conjunction with other remedies for the home treatment of 
 several forms of blepharitis.
 
 ANTISEPTIC-CREDE 527 
 
 J. A. Lippincott, advises a modification of the ointment, espec- 
 ially in infected ulcers of the cornea, by the addition of lanoline, 
 which takes up the watery solution of the bichloride better than 
 vaselin alone. Ilis formula is as follows : 
 
 llydrarg. bichlor. gr. i 
 
 Sodi chlor. gr. vi 
 
 Petrol at i . 3ii 
 
 Lanolin. ^iii 
 
 As the result of several years' trial of both the original and the 
 modified formula of White's ointment there seems reason to believe 
 that the former is the preferable. 
 
 Clarence P. Franklin reports of toluidine blue (q. v.) that "after 
 ten years' use of this drug the statement seems Avarranted that 
 it is a most efficient remedy in muco-purulent conjunctivitis and is 
 practically a specific for the Koch-AVeeks and Xeisser forms of the 
 disease. The usual ten days to two weeks' discharge of "pink 
 eye" is reduced to four to six days and with this treatment there 
 seems to be less chance of a fresh infection : at least the writer 
 has never seen a return in any instance among many cases. 
 
 In ophthalmia neonatorum and gonorrheal ophthalmia of the 
 adult the purulent process is markedl}^ and rapidly lessened. 
 
 It is to be used three times a day (in ^ooo solution, dropped into 
 the conjunctival sac) and alternated with solutions of adrenalin 
 and boric acid. This treatment has given uniform results with no 
 untoward symptom except that, rarely, a patient of pronounced 
 susceptibility complains of slight stinging on its first instillation." 
 —(Ed.). 
 Antiseptic-Crede. A trade name for silver citrate (q. v.). 
 Antiseptisch. (G.) Antiseptic. 
 Antiseptus. (G.) Antiseptic. 
 
 Antistreptococcic serum. A preparation of streptococci and their 
 toxins. In the case of the streptococcus and some other bacteria 
 the toxins are to a large extent intracellular, and difficulty is 
 experienced in obtaining their corresponding immune sera. ]\Iore- 
 over, different strains of streptococci vary greatly in virulence 
 among themselves for the same animal, and different species of 
 animals may exhibit wide variations in susceptibility to infection 
 by any one strain. Several strains of virulent streptococci are 
 usually employed in the immunization of animals, and the antistrep- 
 tococcic serum produced is thus polyvalent. Antistreptocoecus 
 serum has been used in a large number of cases of cellulitis and
 
 528 ANTISTREPTOKOKKENSERUM 
 
 other streptococcus infections, and many favorable clinical results 
 following its use are on record, including severe infections about 
 the face and eyes. There is a constant tendency, however, to report 
 favorable cases, while the large number of cases not responding to 
 treatment pass unnoticed. Moreover, the clinical course of strepto- 
 coccus infections is proverbially uncertain, and, as in pneumonia, 
 this fact has led clinicians to attribute cures to the most diverse 
 empirical remedies. For this reason it is advisable to exercise cau- 
 tion in accepting the favorable reports on the use of antistrepto- 
 coccic serum, although it must be admitted that the serum has a 
 certain claim for recognition as a scientific attempt at specific 
 therapy.— (E. E. I.) . 
 
 Antistreptokokkenserum. (G.) Anti-streptococcic serum. 
 
 Antitetanic serum. This preparation, similarly to antidiphtheric serum, 
 is obtained from horses immunized to increasing doses of the tetanus 
 toxin. The greatest value of antitetanic serum lies in its prophy- 
 latic use in lacerated and deep puncture wounds in which experience 
 shows that tetanus infection is likely to occur. Cases in which 
 tetanus develops following lacerated or other wounds when the 
 early prophylactic injection of a suitable dose of tetanus antitoxin 
 has been made, are extremely rare. In cases which come under 
 treatment after the symptoms of tetanus have appeared, the injec- 
 tion of the serum locally, intraneurally or by lumbar puncture is 
 indicated. Many cases have undoubtedly been saved by its use, the 
 beneficial results depending on the early neutralization of the toxin, 
 before it has become widely diffused throughout the nervous 
 system. — (E. E. I.) 
 
 Antithyroidine-Moebius. Serum axtithykoideum, (Merck). An am- 
 ber colored liquid, with a faint odor and taste of carbolic acid, com- 
 posed mostly of the blood-serum of sheep from which the thyroid 
 gland has been removed at least six Aveeks before. The fluid is pre- 
 served by the addition of 0.50 per cent, of phenol. It is administered 
 in initial doses of half to one cc. (8 to 15m.) three times daily, to be 
 increased as required. 
 
 Commenting on this and other antithyroid preparations, the 
 Editor of New and Non-Official Remedies (3rd edition) says: 
 
 "The use of these preparations is based on the theory that, the 
 thyroid gland secretes products which are toxic but which neutral- 
 ize and are neutralized by other toxic substances produced else- 
 where in the body. Removal of the thyroid glands, therefore, leads 
 to the accumulation of these second toxic substances, as evidenced 
 by the phenomena cachexia strumipriva and myxedema. On the
 
 ANTITUBERCLE SERUM 529 
 
 other hand the blood or milk of such animals is claimed to be 
 capable of preventing the effects of a hypersecretion of thyroid 
 substance, such as is supposed to occur in Basedow's disease (exoph- 
 thalmic goiter). 
 
 These views are still largely hypothetical ; but many clinical 
 observers report distinctly beneficial results in the milder forms of 
 the disease and in obscure nervous disorders which are supposedly 
 connected with thyroid hypersecretion. The effects are less pro- 
 nounced in the iiwre severe forms. The action is merely palliative 
 and other measures of treatment should not be neglected. 
 
 Improvement occurs in two or three weeks and is indicated by 
 an amelioration of the nervous symptoms, tremors, })alpitation, in- 
 somnia and excitability. 
 
 The administration must be long continued. Oral and hypodermic 
 administration are equally effective, but the former is usually pre- 
 ferred. These preparations are not toxic, even when very large 
 doses are used." 
 
 Antitubercle serum. A serum prepared by immunizing horses with 
 toxic substances derived from the tubercle bacillus. The dose is 
 1 to 4 ccm. given daily. The value of the serum is problematic and 
 is not yet clinically or conclusively demonstrated. — (E. E. I.) See, 
 also, Seropathy, 
 
 AntitjTJhoid serum. Derived from horses immunized with cultures 
 of the typhoid bacillus. Favorable results in the treatment of typhoid 
 are reported after the use of this serum, particularly in the reports 
 of Chantemesse. The serum has not come into general use and clin- 
 icians are not yet agreed as to its curative value. — (E. E. I.) See, 
 also, Seropathy. 
 
 Antityphoid vaccination. The immunization of persons against typhoid 
 fever by the injection of suspensions of dead typhoid bacilli. The 
 immunizing injections are made subcutaneously at intervals of about 
 ten days, and are usually three in number. The dose for an adult 
 is 500 millions for the first injection and 1000 millions for the 
 second and third. The method when employed with due regard to 
 surgical cleanliness, using a properly prepared vaccine, is devoid 
 of danger. Usually there is but little reaction beyond a slight feel- 
 ing of malaise and headache, and rise of temperature appearing from 
 six to eighteen hours after the injection. Occasionally more severe 
 reactions are met with, in which the temperature rises somewhat 
 higher and the constitutional symptoms are more severe. The reac- 
 tion passes away, however, in a few hours and no permanent harm 
 results. Occasionally after the second injection a more marked reac- 
 
 Vol. 1—3 4
 
 530 ANTLITZ 
 
 tion is observed than after the first. This may in part be ascribed 
 to the increase in dosage but is also probably due to changes caused 
 by the first injection whereby the individual is sensitized to the 
 action of typhoid protein. 
 
 The efficacy of this method of immunization against typhoid is 
 proved by the statistics of armies in which the method has been exten- 
 sively practised. By this method of immunization typhoid has been 
 practically eradicated from the United States Army even in the case 
 of those bodies of troups encamped in regions where typhoid is 
 widespread among the civilian population. Statistics of other armies 
 such as those of the German Army in South Africa, the French Army 
 in Algiers, the Japanese Army, and the British Army in India 
 indicate the value of this form of immunization. In civilian life, 
 statistics are less readily available but there seems to be no doubt 
 of the prophylactic value of the method. — (E. E. I.) 
 
 Antlitz. (G.), n. The face or countenance. 
 
 Antlitzarterie. (G.) The facial artery. 
 
 Antlitznerv. (G.) The facial nerve. 
 
 Antlitzpulsader. (G.) The facial artery. 
 
 Antlitzschlagader. (G.) The facial artery. 
 
 Antocular. Having a location in front of the eye. 
 
 Antonelli's peripheral iritomy. Antonelli's {Uevue generate d'Ophtalm.^ 
 1896, p. 385) peripheral iritomy (iritomie peripherique) should per- 
 haps only be attempted on blind eyes, because of the liability of pro- 
 ducing a traumatic cataract. Antonelli employed a double-edged 
 lance, Avhich he introduced in the sclero-corneal region nearly per- 
 pendicular to the surface of the globe, but slightly obliquely. The 
 point of the knife is thrust into the chamber, into the tissue of the 
 iris, and its base incised by sweeping the knife around the periphery 
 of the chamber to the extent of 5 to 6 mm.— ("W. C. P.) 
 
 Antonius Feuer. (G.) Erysipelas. 
 
 Antophthalmic. Efficacious in the treatment of ophthalmia. 
 
 Antorbital. In front of the orbit. 
 
 Antrace. (It.) Anthrax. 
 
 Antropfeln. (G.) To trickle, drip, or drip on. 
 
 Antrophose. A pliosphene (or subjective light or color sensation) hav- 
 ing its origin in the optic centers. 
 
 Antrum, maxillary, Diseases of, producing- eye symptoms. See Cavi- 
 ties, Neig"hboring. 
 
 Ants, Poison of. There can be no doubt but that a bite from most 
 varieties of Formica, through the introduction of formic acid beneath 
 the palpebral skin or the mucous coverings of the eye, may set up
 
 ANTYLLUS 531 
 
 considerable edenia aiid other signs of inflammation of the affected 
 eye, but it does this probably in common with the insults of certain 
 spiders and some flies. In several cases of ant-bite tlie local irrita- 
 tion did not subside for several Aveeks. 
 Antyllus. A distinguished physician of the 3d century A. D., con- 
 cerning Avhose life next to nothing is known. It was even supposed 
 for a time that he lived in the early half of the 2d century, but this 
 is now conceded to have been erroneous. 
 
 Of the writings of this excellent surgeon, nothing but fragments 
 have descended to our liiiic Thesf, however, proclaim a man of 
 very great ability — at least in general surgery and medicine. Not 
 only, in fact, was he the first to describe aneurysm in detail, but he 
 invented the excellent operation for this condition which is still in 
 use and which is still customarih' called "the Antyllic operation." 
 This procedure, as is well known, consists in tying the vessel al)ove 
 and below the sac, and then opening the sac in order lo remove its 
 contents. 
 
 Antyllus seems to have been an economical i)erson, for he recom- 
 mends that leeches, when sucking, should l)e cut in two, in order 
 that they may continue at their work without undergoing repletion. 
 
 Ophthalmologically, Antyllus is of some importance, because it 
 has been claimed repeatedly that he is the inventor of cataract ex- 
 traction. This, however, as Hirschberg has shown, is indubitably a 
 mistake. The former opinion rested not on any extant passage from 
 Antyllus, but on an obscure quotation made b,y Salah ad-Din from 
 Khazes. It is possible that certain physicians of antiquity really 
 attempted the extraction of what we call a cataract — as to this we 
 cannot be absolutely certain. However, it is more than probable 
 that all that was ever extracted by way of the anterior chamber of 
 an eye in all ancient times was simply what we call hypoi^yon. The 
 suction method of removing cataracts from young eyes was invented 
 in the Arabic Middle Ages by Ammar, or Omar (born in Missoula, 
 and practised in Egypt) while the extraction of senile cataract was 
 introduced by Daviel in 1748. For the sake of completeness Ave may 
 add that the universal supposition in early times Avas that a cataract 
 is a film, or inspissated "humor," lying in a supposedly existent 
 chamber, or space, betAveen the pupil and the lens, and that this 
 error Avas not remoA^ed till 1705. Avlien Urisseau and ^lailre-Jean 
 showed beyond all question that a cataract is not a pathologic prod- 
 uct situated in front of the lens, but the lens itself which has l)e- 
 come opaque. — (T. H. S.) 
 Antyllus-Kuhnt operation. A procedure for the relief of paralytic
 
 532 ANWACHS 
 
 ectropion. A wedge-shaped section of the conjunctiva and tarsus, 
 with its base at the free border of the lid, is excised from the lid for 
 the purpose of shortening the latter. A keratome is inserted be- 
 tween the skin and tarsus and the triangular piece of tarsus and 
 conjunctiva thus liberated removed without cutting the skin. The 
 edges of the cartilage and conjunctiva are then brought together and 
 sutured, a proceeding that produces a fold in the skin at that point ; 
 and therein lies the weakness of the operation. See Ectropion, 
 Operations for. — (C. H. B.) 
 
 Anwachs. (G.) A swelling, an accretion. 
 
 Anwallung. (G.) A paroxysm. 
 
 Anwaschen. (G.) To begin to wash. 
 
 Anwassern. (G.) To irrigate, to wet with water. 
 
 Anwendung. (G.) An application, a use. 
 
 Anwinken. (G.) To wink; to wink at. 
 
 Anwuchs. (G.) An accretion; grown to. 
 
 Anwull. A tree whose parts are used in India as a remedy for oph- 
 thalmia. 
 
 Anzeichen. (G.), n. A symptom or sign. 
 
 Anziehender Angenmuskel. (G.) The internal rectus muscle. 
 
 Anzieher. (G.) An abductor. 
 
 Aorasia. (L.), n.f. Blindness. 
 
 Aorta, Aneurysm of. See Aneurysm of aorta. 
 
 Aortic insufficiency, Eye symptoms of. Pulsation of the papillary and 
 retinal arteries, due to a marked hypertrophy of the left ventricle, 
 has been observed in this cardiac lesion, although rhythmic move- 
 ments are, as a rule, not so strongly marked as in some forms of 
 glaucoma. 
 
 The capillary pulsation at the optic disk changes the color of the 
 papilla from red to white alternately. While this form of arterial 
 pulsation seldom extends over the boundaries of the papillary reg- 
 ion, the venous pulsation, usually present to a ^rreater or less 
 degree, may extend far into the periphery of the retina. This 
 venous phenomenon is said to be characteristic of insufficiency of 
 the aorta. 
 
 Edema of the eyelids also appears with insufficiencies of the cardiac 
 valves ; it is part of a general venous congestion, the result of defec- 
 tive compensation. 
 
 The interference with the circulation from cardiac insufficiencies 
 easily causes nutritive disorders of the vessel walls, which in its turn 
 often leads to thrombus-formation in the peripheral veins — especially 
 thrombosis of the vena centralis retina? — and in the heart itself.
 
 APANASTEMA 533 
 
 Embolic i)rocesses being a direct conse(|uence of tbrouibosis. may 
 affect the visual organ. It is especially the eml)olism of the arteria 
 centralis retinae which is of first importance; other changes in the 
 visual a])paratiis may result from thrombosis or embolism in the 
 central nervous system. These changes are analogous to those fol- 
 lowing hemorrhages (apoplectic attacks) which, due to greatl}' 
 increased blood pressure, occur more frei|ucii1ly in insufficiency 
 of the aorta than in other cardiac lesions. "Scintillating scotoma" 
 or phosphenes is not infreciuently a prodromal symptom of a cere- 
 bral apoplexy. The prognosis of the ocular disturbances that 
 result from aortic insufficiency is unfavorable. Their successful 
 treatment (see Embolism of the central artery of the retina,) depends 
 upon possible improvement in the local conditions and, secondarily, 
 upon cure or amendment of the cardio-vascular alterations that 
 originally produced the eye changes. 
 Apanastema. (L.), n.n. (Obs.) A wart-like outgrowth on the con- 
 junctiva. 
 Apertometer. According to Gould, an "optical device for determin- 
 ing the angle of aperture of microscopic objectives. The aperto- 
 meter of Abbe, which is mostly used, consists of a semicircular piece 
 of thick glass with the straight- edge beveled at 45 degrees. Light 
 entering the curved edge is reflected upward by the beveled edge. 
 This is received by the objective of the microscope. By means of 
 two metal slides moving on the curved edge the exact angle of the 
 light required to fill the back lens of the objective is indicated on 
 the curved edge and can be read oft' directly." 
 Apertor oculi. (L.) The levator palpebral muscle. 
 Aperture. In optics, the diameter of the exposed part of a lens or 
 object glass in an optical instrument. Aperture Angle, of a micro- 
 scope objective, is often expressed in degrees; and in this case the 
 so-called angular aperture, that is, the angular breadth of the pencil 
 of light Avhich the objective transmits from the object or point 
 viewed: as an objective of 100° aperture. Aperture-stop, the dia- 
 phragm or stop placed with its center on the optical axis at some 
 point between two consecutive lenses of an optical system, which is 
 thereby divided into two parts, a front component Lj, consisting 
 of the part of the lens-system in front of the interior stop, and a 
 hinder component (LJ consisting of the remainder of the lens-sys- 
 tem lying on the other or far side of the stop. It is called a front 
 stop when it is placed in front of the entire system, and a rear 
 stop when it is placed behind, or towards the image-side of the opti- 
 cal system. Numerical ap< rlurr, according to Abbe, the product of
 
 534 APEX-ANGLE 
 
 the refractive index (ii) and the size of the aperture angle (0), or 
 n.sin0.— (C. F. P.) 
 
 Apex-angle. See Angle. 
 
 Apex of prism. This is formed by the convergence of the plane sur- 
 faces at one extremity ; the thin edge of the prism. 
 
 Apfelauge. (G.), n. Staphyloma of the iris. 
 
 Apfelbein. (G.) The cheek-bone. 
 
 Aphakia. Absence of the crystalline lens, whether as the result of 
 operation, absorption, or dislocation. The refractive power of the 
 crystalline being equal to about ten diopters, the eye is made hyper- 
 opic to that extent, and after cataract operations, as is well known, 
 this has to be taken into consideration and suitable glasses ordered. 
 
 I f 
 
 U 
 
 Images of Purkinje. 
 
 b. and e. Absent in aphakia, a. Eefleetion from the cornea, b. From the 
 anterior surface of the lens. c. Inverted image from the posterior surface 
 of the lens. 
 
 Moreover, as aphakia necessarily involves a loss of accommodation 
 power a second glass, for reading and other near work, is required 
 in addition to the distance lens. 
 
 Aphakisch. (G.) Being without the crystalline lens. 
 
 Aphakous. Affected with aphakia. 
 
 Aphasia. (L.), f.n. Interference with the expression of ideas, 
 although the apparatus of expression and perception, as well as the 
 intellect seem unimpaired. 
 
 Aphasia Optical. See Optical aphasia. 
 
 Aphemesthesia. A form of aphasia, known as word-blindness or word- 
 deafness. 
 
 Aphorama. With projecting eyes, so that one may see in the distance 
 on either side without turning the head. Also written Aphorema. 
 
 Aphorema. Having projecting eyes, so that one may see in the dis- 
 tance on either side without turning the head. Also written 
 Aphorama. 
 
 Aphose. A subjective sensation of shadow or darkness.
 
 APHRASIA 535 
 
 Aphrasia. (Tj.), f.n. An aphasic disease of the central nervous system 
 in which there is inability to form phrases, and the command of 
 words is small. 
 
 Apical. Pertaining to the apex. 
 
 Apical ang-le. Sff Angle. 
 
 Apiol, Oculo-toxic symptoms from. This derivative from the fruit 
 of the i^arsley plant was formerly used as a substitute for quinine. 
 In doses from one-half to one gi'ain, it produces a stimulating effect 
 like that of coffee, l)ut in larger (juantities — 2 to 4 gi-ams — induces 
 an intoxication accompanied by ocular symptoms, such as, phos- 
 phenes; deafness; tinnitus; frontal headache; etc., like large doses 
 of quinine. 
 
 Aplanasia. Aplanatism, or the absence of spherical aberration. 
 
 Aplanatic. Formerly applied to an optical system that was merely 
 free from spherical aberration ; but, according to Abbe, in order 
 that an optical system may be aplanatic, it must fulfil each of two 
 requirements, namely : It must be free from spherical aberration 
 for a definite pair of conjugate axial points, and these must also 
 satisfy the stipulation that the ratio of the slope-angles of each pair 
 of corresponding incident and emergent rays must be a constant — ■ 
 (the Sine-condition, q. v.) — when they are called aplantic j^oints. 
 (See Southall, Principles of Geometric Optics.) It is impossible to 
 design even a multiple lens of wide aperture, which shall bring all 
 the rays falling upon it from a)nj ])oint on the axis to a point-focus 
 
 on the axis; but an aplanatic system may be constructed which will 
 
 cause all incident rays from a particular point on the axis to focus 
 at a point upon the axis. — (C. F. P.) 
 Aplanaticism. The same as aplanatism. 
 
 Aplanatisches System. (G.) Aplantic system. 
 
 Aplanatism. n. Absence of spherical aberration. 
 
 Apoatropine. Atropamine. C17H2NO21HCI. A cycloplegic alkaloid 
 made from atropine by loss of water. Both this alkaloid and its 
 salts — the sulphate and hydrochloride — are white crystals that are 
 soluble in water and alcohol. They act like atropia but are not much 
 used in ophthalmology. 
 
 Apochromatic, adj. In optics, applied to an improved form of lens de- 
 vised by Abbe of Jena, constructed of a new kind of glass which 
 alloAvs of a more perfect correction of chromatic and spherical aberra- 
 tion than was formerly possible. The condition 1)\- which these 
 properties are obtained in the ucav objectives depends upon the 
 elimination of those erroi's which originate mainly in the une(|ual 
 behavior of different colored rays; in fact, the elimination of such 
 errors secures an achromatism of higher order than has hitherto
 
 536 APOCHROMATISM 
 
 been attained. Therefore, objectives of this construction may be 
 distinguished from achromatic lenses, in the old sense of this specific 
 quality, by the term apochromatism, and may by bailed apochromatic 
 objectives. The greatest freedom from spherical aberration in such 
 systems is secured through aplanatism (q. v.). — (C. F. P.) 
 
 Apochromatism. The condition of being apochromatic (q. v.). 
 
 Apochysis. (L.), f.n. (Obs.) Cataract. 
 
 Apocodein, Oculo-toxic symptoms from. This substance, derived from 
 eodein by dehydration, i)roduces a mydriasis in poisonous doses. 
 
 Apomecometer. An instrument used in measuring heights, constructed 
 on the same principle as the sextant. 
 
 Apomecometry. The art of measuring elevations and distances. 
 
 Apomorphia, Oculo-toxic symptoms from. Apomorphin in 2 per cent, 
 solution produces complete anesthesia of the cornea and conjunc- 
 tiva of animals in about ten minutes. It lasts for about five to ten 
 minutes. The conjunctiva becomes pale and presents a tough, 
 almost leathery appearance, and its anterior epithelium becomes 
 clouded. The pupils are dilated, as they also are after internal or 
 subcutaneous administration. In man one to two per cent, solution 
 of this drug induces dilation of the pupil and xerosis of the con- 
 junctiva with such general symptoms as nausea, a feeling of heavi- 
 ness in the limbs and exhaustion. 
 
 Aponeurosis orbito-ocularis. One of the numerous synonyms for 
 Tenon's capsule (q. v.). Orbital aponeurosis, fascia bulbi, vaginal 
 tunic. Bonnet's capsule, fascia Tenoni, tunica vaginalis oculi vel 
 bulbi are others. 
 
 Apophyllite, n. A crystallized mineral allied to the zeolites, occurring 
 in laminated masses or in tetragonal (four-angled) crystals, and hav- 
 ing a pronounced pearly luster on the surface of perfect cleavage, 
 parallel to which it separates readily into thin rhombic laminte. 
 Named because of its tendency to exfoliate — strip off its leaves. It 
 exfoliates also under the blowpipe. From its peculiar luster it is 
 sometimes called ichthyophthahnitc, that is, fish-eye stone. It is a 
 hydrated silicate of calcium and potassium, containing also some 
 fluorin. 
 
 Apophyllite ring's, n. The rings produced by apophyllite (q. v.) when 
 examined between two crossed Nicol prisms with divergent white 
 light ; the rings are approximately white and black, a slight trace of 
 green being observed inside of each black ring. 
 
 Apoplectiform bulbar paralysis. This condition of hemorrhage, embol- 
 ism or thrombosis of the arteries of the bulb and pons, presents 
 occasional eye symptoms. It is acute in onset, and immediately
 
 APOPLEKTISCH 537 
 
 fatal, or, as the iinderlying vascular pathology would suggest, cap- 
 able of improvement with more or less permanent defect. 
 
 The in'ophylaxis and treatment of the acute stage cited under 
 arteriosclerosis and apoplexy is here indicated. In young individ- 
 uals syphilis is to he thought of as a possible cause, and energetic 
 specific treatment instituted. As in chronic progressive palsy, the 
 difficulties in swallowing and respiratory embarrassment must be 
 guarded against by proper diet. Nothing is to be gained by use 
 of strong drugs. 
 
 Apoplektisch. (G.) Apoplectic. 
 
 Apoplexy, Cerebral. Hemorrhage into the brain tissues, generally 
 due to cerebral endarteritis or softening. See General diseases. 
 
 Apotheke. (G.) An apothecary's shop. 
 
 Apotheker. (G.) An apothecary. 
 
 Apothekerbuch. (G.) A dispensatory, pharmacy, pharmacopoecia. 
 
 Apothekergewicht. (G.) Apothecaries" weight, troy weight. 
 
 Apothekerkenntniss. (G.) Pharmacology. 
 
 Apothekerkunst. (G.) Pharmacy, pharmeceutical. 
 
 Apothekerordnung-. (G.) A dispensatory. 
 
 Apothekerwaaren. (G.) Drugs, articles kept in a drug store. 
 
 Apothekerwissenschaft. (G.) Pharmacology. 
 
 Apparecchio della vista. (It.) The eye and its appendages. 
 
 Appareil de la vision. (F.) The visual apparatus. 
 
 Apparent accommodation. See Accommodation, Apparent. 
 
 Apparent cataract. The appearance of opacity of the crystalline lens, 
 when that organ is viewed by the obliciue illumination or by inspec- 
 tion only, which on the use of the ophthalmoscope proves to be a 
 simple translueency. 
 
 To show the student a gray, senile lens, and after his diagnosis of 
 cataract, to demonstrate its transparency with the ophthalmoscope, is 
 a common method of enforcing the importance of the ophthalmoscopic 
 examination. The sector shadow's of irregular lens astignuitism some- 
 times encountered in skiascopy may bear a startling resemblance to 
 the opacities of commencing cortical cataract. Other lens changes with- 
 out opacity simulate early nuclear cataract. 
 
 Halben has reported an instance of the kind with a careful study of 
 the causes of this phenomenon. To explain these cases, he very care- 
 fully considers the reflections which occur from the surfaces of the 
 lens, and of its different layers; both of the light entering the eye, 
 and of the light emerging from it during the ophthalmoscopic exami- 
 nation. Light entering at certain angles may be turned back by even 
 total reflection, giving the gray appearance seen hy ordinary daylight.
 
 538 APPARENT DISTANCE 
 
 Ou the other hand the light from the fundus may encounter the sur- 
 faces of the different layers of the lens at such angles that it will be 
 largely turned back within the eye, giving the shadow shown in the 
 particular ring of pupil. 
 
 Apparent distance. Same as angular distance (q. v.). 
 
 Apparent magnitude of an object. In physiologic optics, that magni- 
 tude which is measured by the optic or visual angle subtended between 
 lines drawn from the extreme points of the object to the center of the 
 pupil of the eye. This angle may be considered to be inversely as the 
 distance of the object. — (C. F. P.) 
 
 Apparent motion in skiascopy. This expression relates to the play of 
 light and shadow within the pupil area during the skiascopic exam- 
 ination. For example, when a plane mirror is used the real move- 
 ment of the light upon the retina is always in the same direction 
 as the movement on the face, but if the retina be seen in the erect 
 image, the apparent movement of the light in the pupil will be with 
 the light on the face. 
 
 Apparent rest. This phrase is generally used in connection with the 
 extrinsic ocular muscles to describe their complete relaxation. When 
 it occurs there is often a tendency to deviate from the primary 
 position. The condition is also known as actual rest. 
 
 Apparent size of objects. For many years, students of the science of 
 optics have endeavored to explain the apparent size of objects wdien 
 viewed at a distance that must be considered as infinite. The appar- 
 ent size of tlie sun or moon at the horizon as compared with its 
 apparent size at the zenith has long been a problem concerning 
 wdiich merely theoretical explanations have been invoked. 
 
 Of all of the theories advanced to explain this phenomenon only 
 the most prominent need be mentioned. The first and best known 
 accounts for the apparent difference in size at the two points by 
 endeavoring to show that the light rays coming from the moon at 
 the horizon have to penetrate a greater amount of air and hence 
 undergo a greater refraction than when coming from the zenith. 
 Moreover, distant objects, whose size is known, come within the 
 peripheral portions of the visual field and there is consequently a 
 ground for comparison. The greater refraction by a thicker stratum 
 of air must be considered theoretically possible, but comparison 
 plays but a small role. 
 
 The second theory is based upon the same two hypothetical 
 factors, varying from the first only in that it claims that the refrac- 
 tion of the rays at the horizon is due, not to the thicker stratum of 
 air, but to very fine particles of moisture suspended in the air. As 
 is known, this moisture is denser near the surface of the earth than
 
 APPARENT SIZE OF OBJECTS 539 
 
 ill file heij4'lits of the siirroiiiKliiM.;' ;i1 iiiosplit'iT. IltMiee rays passing 
 tangontially to liu' earth's siiri'ac-t' would pass tlu-ougli far more 
 moisture-laden air than rays eoniing radially to the surface. l)Ut 
 here too, \ho (piestion of greatei- refi'aetion is merely theoi-etieal 
 <md no actual proof can he shown. 
 
 The apparent flattening of the sky as iu)tieed hy Young has also 
 been invoked as an aid toward clearing the mystery of this phe- 
 nomenon. If one endeavors to (!i\idr tlir space between the zenitli 
 and the horizon into two e(|iial parts, tlif i-csult is that tlir lower 
 portion is always too small. This is due to aerial [xn'spective. that 
 jnaster of vague terms. The appai'cnt difference of the size of the 
 moon at the horizon and at the zenitli is attributed also to this 
 feature. 
 
 The most satisfactory explanation of this phenomenon is depend- 
 ant upon a very simple experiment that can be performed without 
 the aid of laboratory apparatus. Tt is easier to utilize the rays 
 from the full moon than from the sun as they are not so blinding 
 and the uniforiiiit\' of illumination eliminates any error that might 
 arise from different pupillary diameters. Apart from retinal dis- 
 turbances that might follow observance of the sun at the zenith 
 with the naked eye. the contraction of the pujul would be marked 
 compared witli the size of the ]m\n\ lunler the milder influence of 
 the sun's rays at the horizon. The moon at the horizon seems to 
 have a diameter about double that of the same body seen at the 
 zenith. Let the observer, however, face away from the moon at 
 the horizon and then bend backwards, at the same time bringing 
 the full force of the superior recti into ])lay. i. e.. elevating the 
 eyes as far as possible, until the moon comes into view: the diameter 
 of the moon, though just above the horizon, will seem no greater 
 than M'hen it is at the zenith. The same experiment can be 
 reversed. After noting the size of the nujon at the zenith. let the 
 observer lie flat on the ground and the diameter of the moon will 
 appear to be greater, though not doubled. 
 
 The explanation to be deduced from this expei-iment is depeiul- 
 ant upon the laws of convergence and accommodation. Theoreti- 
 calh^ an emmetropic eye does not accommodate when the rays 
 entering that eye are parallel. This does not take into account the 
 position of the ocular axes nor the infliuMice of tlu^ extrinsic and 
 inti'insic ocular musculature. Tn the ereet position, when the visual 
 lines are parallel to each other and tangential to or slightly in- 
 clined toward the surface of the earth, the internal recti nuiscles are 
 in action. Although this effect mav be verv sliiirht. there is still
 
 540 APPARENT SIZE OF OBJECTS 
 
 some nervous stimulus at -work. This innervation is necessarily 
 coincident with an equally slight innervation of the muscles of 
 accommodation by reason of the coincident action of their cerebral 
 centers. The result of this is that the visual image is somewhat 
 magnified and the greater the distance of the object from the eye and 
 hence the greater the lack of means of size comparison, the greater 
 is the relative enlargement of the image. Moreover, images trans- 
 ferred from the retina to the cerebrum while the center of accommoda- 
 tion is in a condition of stimulation, undergo a cerebral enlargement 
 from force of habit. Because, any object for M^hich we must accom- 
 modate is sufficiently close as to require convergence and our cere- 
 bral image of that object is large. Hence any effort at convergence 
 is coincident with an effort at accommodation, it matters not that 
 the object be at an infinite distance, and the resultant cerebral 
 image will undergo a cerebral enlargement, due to the stimulation 
 of these two centers. Hence the role played by the cerebral centers 
 of vision, by accommodation, and by convergence must not be 
 overlooked, though its importance cannot be estimated. But cer- 
 tain it is that the apparent size of the moon at the horizon is as well 
 a cerebral as an ocular distortion. 
 
 When the eyes are raised as in observing the moon at the zenith, 
 the visual lines are slightly divergent, due to the imperceptible 
 action of the oblique muscles. This physiological divergence is 
 accompanied by an absolute relaxation of accommodation, exactly 
 as physiological convergence is associated with an increased tonus of 
 the muscles of accommodation. Moreover, there is no stimulation 
 of the cerebral center of accommodation and hence the cerebral 
 image appears to be of the normal size. The retinal image is also 
 of normal size. 
 
 Thus it is that habit is of importance in accounting for the appar- 
 ent size of the moon on the horizon and at the zenith. As we are 
 accustomed to observe images enlarged while the center of accom- 
 modation is in action, just so are the images of actual size when 
 this center is at rest. This theory, hoAvever, does not take into 
 account any refraction of the rays by an increased thickness of 
 the air layer traversed, nor does direct comparison with objects of 
 known size play an important role. Whether or not this theory 
 will stand the test of time and further observation remains to be 
 seen.* — H. S. G. See Apparent magnitude and Magnifying power. 
 
 *As far as I know, there is no ai'coiint in the literature of this theory. It was 
 communicated to me personally liy Professor Elschnig.
 
 APPARENT STRABISMUS 541 
 
 Apparent strabismus, or apparent squint, occurs in persons with nor- 
 mal muscle balance but also with a certain type of skull in which 
 the visual axes seem to diverge or converge more than usual, giving 
 the expression, facial and other, of a heterotropia. In some cases 
 this seeming muscular anomaly may be so marked as to deceive 
 even the trained observer, who learns the true state of affairs only 
 by applying w^ell-known tests for squint. 
 
 Appendages of the eye. These are sometimes called the tutamina 
 oGuli, and include the following structures : the eyebrows (supercilia) ; 
 the eyelids (palpehrcc) ; conjunctiva, and lachrymal apparatus. 
 
 Apperception, n. Conscious sensory impressions. 
 
 Appianamento della cornea. (It.) Flattening of the cornea. 
 
 Applanatio. (L.) Flattening. 
 
 Applanatio corneae. (L.) Morbid flattening of the cornea. This 
 condition may result from an interstitial keratitis. It also occurs 
 occasionally after cataract operations and after healing of corneal 
 traumatisms. As a consequence, the anterior chamber is shallow 
 and the visual acuity is markedly diminished, not only because of 
 opacities in it but from irregular astigmatism and decrease in the 
 refractive power of the cornea. 
 
 Applanation. Flattening, as of the cornea. 
 
 Apraxia. (L.), f.n. Complete loss of the power of communication. 
 Mind- and object-blindness; loss of memory for the uses of objects. 
 Lewandow^sky {The Ophthalmic Year Book, 1909, p. 282) observed 
 an instance of ocular apraxia in the inability to close the eyes, al- 
 though the facial nerve acted norniallj' and all the reflexes of the 
 orbicularis were preserved. The patient slept with his eyes closed. 
 In a second ease of typical hemiplegia, with slight paresis of the 
 inferior facial upon one side, the same author observed impossibility 
 of closing the eyes under the influence of the will, wuth conservation 
 of all the reflexes. The patient was unable to keep his eyes open 
 when the hand w^as quickly moved toward them. 
 
 Apron, Congenital, of the palpebral conjunctiva. An enlargement 
 of the semilunar fold, or rather an extensive development of the 
 membrana nictitans has been observed and reported a number of 
 times. This condition is easily observed on everting the upper lid 
 when, at the fornix, there appears a reduplication of the conjunctiva, 
 somewhat resembling a symblepharon fold, wdiich extends the whole 
 length of the lid. An example of this congenital anomaly has been 
 recently reported by Tyson, in a woman 40 years of age. 
 
 Aprosopia. (L.), f.n. Congenital absence of the eyelids, in associa- 
 tion with other facial defects.
 
 542 APUS 
 
 Apus. (L.), adj. The swift (Cypselus apus) bird formerly used in 
 preparing a remedy for weak eyes. 
 
 Apyonin, Yellow pyoktanin. Benzophenoneid. See Pyoktanin. 
 
 Aqua amygdalae amarse. Bitter-almond water. j\Iade by dissolving 
 one part of oil of bitter almonds in 1,000 parts of water. This 
 mixture is by no means a constant medical agent, as its efficacy 
 depends upon the proportion of hydrocyanic acid it contains, a 
 variable quantity in bitter-almond oil. Bitter-almond water is 
 used as an excipient in soothing collyria in much the same manner 
 that cherry-laurel water is employed. 
 
 Brenzcain (q. v.), made by the action of anhydrous hydrocyanic 
 acid on choral, has been used as a substitute for bitter-almond 
 water owing to its exact dosage. One part dissolved in 160 parts 
 of distilled water makes bitter almond water of the same strength 
 as the P. G. The only question that arises is whether in collyria 
 it is as free from irritating effects upon the eye as the best examples 
 of this important vehicle. 
 
 Aqua aromatica. This mixture forms one of several excipients for 
 collyria official in the German pharmacopeia. It is used as a mild 
 astringent and eye-wash in simple conjunctivitis and conjunctival 
 hyperemia. 
 
 r> 
 
 Mistune oleoso-balsamicae 
 
 Aqua? aromaticaj aa 60.0 (oii) 
 
 Aqua? fceniculi 100.0 (foiij.foiss) 
 
 Aqua calcaria, P. G. See Lime water. 
 
 Aqua calcis. See Lime water. 
 
 Aqua camphorse. Camphor water. Approximately 8 parts of refined 
 camphor can be dissolved, by the aid of talc and other agents, in 
 1,000 parts of Avater. This solution forms one of the oldest eye- 
 waters in the pharmacopeia and acts as a soothing and mildly 
 stimulating astringent application, according to the amount of 
 dilution and the other remedies prescribed with it. 
 
 J. A. Spalding complains that druggists follow no particular 
 rule in preparing this important vehicle for collyria. He points 
 out that formerly it Avas compounded by dissolving an ounce of 
 camphor in an ounce of alcohol and then mixing the resultant 
 powder with magnesia carbonate. The latest pharmacopeia sub- 
 stitutes talcum (which is inferior to magnesia carbonate) in place 
 of the magnesia, and there is no explicit direction that the alcohol 
 should be allowed to completely evaporate before the resulting 
 powder is dissolved in the water and ample time (a month) allowed
 
 AQUACAPSULITE 543 
 
 to get a perfect solution. For use as a diluent of other agents or as 
 one ingredient of eye-waters there is, after all, no more satisfactory 
 method of preparation than that of placing a few pieces of gum cam- 
 phor in a bag which is immersed in a gallon bottleful of sterile, dis- 
 tilled water. Shake the bottle half a dozen times a day for a week, 
 after which the supernatant liquor will be found sufficiently impreg- 
 nated with camphor to be efificient for the purposes mentioned. 
 
 Aquacapsulite. (It.) ' Punctate keratitis. 
 
 Aqua chlorata. Aqua chlori. See Chlorine water. 
 
 Aqua chlori. See Chlorine water. 
 
 Aqua destillata. See Water. 
 
 Aqua fontana. See Water. 
 
 Aqua hamamelidis. Extract of witch hazel. This official preparation 
 contains 15 per cent, of alcohol and although more popular with 
 the laity than with the medical profession, makes a fairly useful 
 constituent of evaporating lotions and stimulating collyria. 
 
 Aquala. (L.), f.n. The crystalline lens; also a term applied by Cel- 
 sus to prolapse of the membrane of Deseemet through an ulceration 
 of the cornea which has not led to perforation. 
 
 Aqua laurocerasi. Ciierry-laurel water. This is a well-known ex- 
 cipient tor ocular remedies, its curative virtues being chiefly due to 
 the very small and variable amount of hydrocyanic acid in its com- 
 position. 
 
 J. A. Spalding found that no rule prevailed among the drug- 
 gists in his neighborhood (and presumably in other localities) as 
 regards the mode of preparing cherry-laurel water. Some followed 
 the U. S. dispensatory and used the essential oil ; others followed 
 the French Codex. The cherry-laurel water made according to 
 the dispensatory from essential oil of bitter almonds, cherry-laurel 
 or peach-pits, is inferior in purity to the imported French water, 
 and is very irritating to the eye. He states that if we are to expect 
 good results from the use of these valuable excipients, we must 
 either direct our patients to a druggist who prepares them properly, 
 or prepare our own lotions, or complain to the editors of the stand- 
 ard works in question, urging them to print proper directions in 
 the making of these valuable waters for eye lotions. It would seem 
 a matter of regret that medicines of so much comfort to irritated 
 eyes should have to be laid aside owing to differences in preparation 
 and without some proper substitute at hand. 
 
 Aqua ophthalmica. (L.) A variety of liquid applicalions for the 
 eyes, i. e., '"eyewaters," is included in this category.
 
 544 AQUA OPHTHALMICA ADSTRINGENS 
 
 Aqua ophthalmica adstringens. (L.) See Aqua ophthalmica alumi- 
 nosa and Collyrium adstringens zinci. 
 
 Aqua ophthalmica alba. (L.) A mixture of 5 parts, each, of zinc 
 sulphate and zinc oxide, 20 of tincture of opium, 40 of alcohol, and 
 1,000 of rose-water. 
 
 Aqua ophthalmica aluminosa. (L.) A preparation official in several 
 old pharmacopeias, consisting of alum and water in varying pro- 
 portions. 
 
 Aqua ophthalmica cserulea. (L.) Solutio cupri ammoniacalis. 
 
 Aqua ophthalmica Comradi. (L.) See Collyrium ex hydrargyro muri- 
 atico corrosive. 
 
 Aqua ophthalmica fceniculata. An eyewash very popular through- 
 out Germany for the various forms of chronic conjunctivitis, which 
 consists of the tinctura and aqua foeniculi. 
 
 Aqua ophthalmica Lanfranci. (L.) See Mixture catheretique. 
 
 Aqua ophthalmica mercurialis. (L.) Collyrium ex muriate hy- 
 drargyri oxygenato. 
 
 Aqua ophthalmica nigra. Lotto nigra. See Black wash. 
 
 Aqua ophthalmica nigra Graefi. (L.) A mixture of 3 parts of calo- 
 mel, 5 of extract of hyoscyamus, 150 of rose-water, and 500 of lime- 
 water. 
 
 Aqua ophthalmica Odhelii. (L.) See Decoctimi rutae zincatum. 
 
 Aqua ophthalmica pragensis. (L.) A mixture of 1 part zinc sul- 
 phate, 1 part of mucilage of gum arable, and 50 parts each of rose- 
 water and elder-flower-water. 
 
 Aqua ophthalmica resolvens. (L.) A preparation, official in the 
 Hamburg Codex of 1835, containing 1 part of antimony and potas- 
 sium tartrate, 60 parts of laudanum, and 240 of water. 
 
 Aqua ophthalmica Romerhauseni. (L.) Aqua ophthalmica fcenicu- 
 lata (q. v.). 
 
 Aqua ophthalmica Saturnii (seu saturnina). (L.) A mixture of 1 
 part of acetate of lead, 15 parts of mucilage of quince-seeds, and 
 240 of rose-water. 
 
 Aqua ophthalmica vitriolica. (L.) Collyrium astringens zinci. 
 
 Aqua plumbi P. G. See Lead water. 
 
 Aqua pura. See Water. 
 
 Aqua rosae. Rose Water. 
 
 Aqua sambuci. See Sambucus. 
 
 Aqua saturnina. See Lead water. 
 
 Aqua sublimatis, P. G. Liquor hydrargyri perchlor. Sublimatlosung. 
 One of the most valuable solutions we possess in the treatment of 
 external eye diseases.
 
 0.1 gm. 
 
 (gr. iss) 
 
 5.0 c. c. 
 
 (f3U). 
 
 0.1 gm. 
 
 (gr. iss) 
 
 10.0 c. c. 
 
 (foiiss). 
 
 AQUA ZEOZONI 545 
 
 In the P. Br. the solution of corrosive sul)liiiiate is a colorless 
 liquid, with a strong metallic taste, containing half a grain of bi- 
 chloride to the imperial fluid ounce. In Germany it is frequently 
 employed as an antiseptic with other agents, as in the following: 
 
 Scopolamini liydrobrom. 0.003-0.01 giu. 
 
 Coeaina^ hydrochloratis 0.1 gm. 
 
 Atropinai sulphatis 0.05 gm. 
 
 Aqua' sublimatis (/.5000) '"'-^ ^- c- 
 
 Scopolamini hydrobrom. 0.005-0.01 gm. 
 
 Aquag destillatii' 
 
 (Or aquas sublimatis, /.r,ooo)- ^-^ 
 
 Coeainae hydrochloratis 
 
 Aquae destillatte 
 
 (Or aquae sublimatis, %ooo)- 
 
 Atropinge sulphatis 
 Aqufe sublimatis (^/iooo)- 
 
 Aqua zeozoni. This is a solution of a monoxj^derivative of esculin 
 (from the horse chestnut) and is the same agent as employed by 
 Unna for the protection of the skin. It is also sold under the trade 
 name of zeozon or ultrazeozon. It has recently been recommended 
 in solution as a substitute for tinted glasses to relieve both normal 
 and diseased eyes from the dazzling effects of ultra-violet rays. 
 It accomplishes this end by staining the cornea. Ruhemann reports 
 that instillations into the conjunctival sac three or four times daily 
 cause no irritation or damage to the cornea even Avhen used for 
 months or a year : that such employment prevents continuously the 
 dazzling effects of bright light, doing away with the necessity for 
 Avearing protective glasses, veils, etc., and preventing the disagree- 
 able symptoms due to dazzling, such as head pressure, dizziness, 
 headache, etc., when the pupils are widely dilated by atropine. He 
 reports good results in 40 cases and concludes by saying that a 
 0.3 per cent, solution of acjua zeozoni is able to dissipate the dazzling 
 caused by light which contains too many ultra-violet rays, especially 
 sunlight, aiul in consequence is of great value in high altitudes, 
 at sea, in blinding snowlight, and may therefore be used prophy- 
 lactically in the different industries which use very bright light and 
 cause electric ophthalmia, glass blowers' cataract, etc. It may be 
 
 Vol. T— 3 5
 
 546 AQUEOUS CHAMBER 
 
 necessary when working in very bright light to use a 0.5 per cent, 
 solution. 
 
 The remedy is also valuable when diseased and inflamed eyes 
 are to be saved from the dazzling and other noxious influences of 
 ultra-violet light, as in various affections of the conjunctiva, iris, 
 retina and in aphakia and opacities of the lens. 
 
 Alt has also experimented {American Journal of Ophthahnology, 
 Sept., 1911) with this solution and although the time is too short to 
 warrant a detailed report he is convinced of its value which by the 
 absorption of the ultra-violet rays adds to the comfort of eyes in 
 many instances. 
 
 Aqueous chamber. See Chamber, Aqueous; Anterior chamber. 
 
 Aqueous humor. The anterior or aqueous chamber is a lymph-space 
 filled with a clear liquid, like distilled water. This fluid is secreted 
 by the vessels of the uvea, especially of the ciliary body, and is 
 quickly renewed when evacuated from the aqueous space that con- 
 tains it. The humor is in constant movement within the anterior 
 chamber, and this continual motion probably prevents deposits from 
 forming on the walls of the anterior chamber. The drainage of the 
 interior of the eye is involved in the lymph stream of which the 
 aqueous forms a large part. Secreted mostly by the uveal body it 
 collects in the anterior chamber and after a time leaves it by way 
 of the sponge-like tissues of the spaces of Fontana and through 
 the lymph-crypts of the iris. Its index of refraction — an important 
 matter — is stated by Helmholtz to be 1.3365, that of distilled water 
 being 1.33354. According to von Michel the aqueous of the pig con- 
 tains 0.89 of inorganic matter; 0.107 of albumen; 0.293 of other 
 organic substances, and of water 98.71. 
 
 The aqueous is a good solvent, as witness the test for belladonna 
 poisoning. A drop of aqueous humor from the eye of a person pois- 
 oned by this drug, or by atropine, will dilate the normal pupil of 
 a second subject. 
 
 According to Dwight, the tension of the eyeball is kept up mainly 
 by the active secretion of the aqueous humor, and, as this tension 
 amounts to the force exerted by a column of mercury twenty-six milli- 
 metres in height, it is not surprising that when the cornea is punc- 
 tured the fluid should rush with some force towards the avenue of 
 escape. This rush is, in fact, so great that it sweeps the iris with it : 
 hence great care must be taken, in operations on the cornea, to pre- 
 vent the iris from being carried into the lips of the wound and 
 becoming incarcerated there. The decrease in the intra-ocular ten- 
 sion which necessarily occurs when the humor is evacuated causes
 
 AQUO CAPSULITIS 547 
 
 the blood to pour in increased quantity into the iris and tin- ciliary 
 body, ■wiiieli greatly aids the transudation of fluid. See, also, 
 Anatomy of the eye. 
 
 Aquo-capsulitis. See Keratitis, Punctate. 
 
 Arabic ophthalmology. Scr History of ophthalmology. Also. Ali b. 
 Isa; Ammar; As-Sadili. 
 
 Arabs, Ophthalmology among- the. Sim- Arabic ophthalmology. 
 
 Arachis, Oil of. See Oil of arachis. 
 
 Arachnoidal sheath of the optic nerve. Scf Anatomy. 
 
 Arachnoidealschneide. (G.) The araehnoid shejitli. 
 
 Arachnoid of the eye. An obsolete term for a serous iiiein])rane sup- 
 posed to cover the cornea, iris, ciliary body, and choroid. It was 
 applied to the supposed lining membrane of the Ijanph space be- 
 tween the choroid and sclera. Both the Arabian and the mediaeval 
 Christian ophtluilmologists applied this term also to tlie anterior 
 capsule or surface of tlie ci'vstalline lens. See Lamina fusca. 
 
 Aranzio, Giulielmo Caesare. (I.")o0-1589). Pie was ;i pupil of Maggi, 
 and Professor of Anatomy and Medicine at Bologna. He discovered, 
 or at all events first accurately described, the pes hippocampus. He 
 undoubtedly discovered the coracobrachialis muscle, the foramen ovale, 
 the ductus arteriosus, and the corpora Arantii. In our special field, 
 he discovered the levator i)ali)el)r;e superioris muscle. ;iiul, it is some- 
 times said, the retinal image. As to this latter averment, however, 
 there is much doubt. Aranzio "s experiment was this: In the posterior 
 wall of an ox's eye, he cut a hole of the width of the optic nerve. Then, 
 in a dark room, he turned this hole (which extended as far as the 
 vitreous humor) toward a student, then struck a light, and, holding 
 the flame exactly before the pupil of the eye, he directed the student 
 to look with one eye into the artificial opening. The student, so doing, 
 did not even profess to behold the retinal image, but (it would seem) 
 only the upright flame itself, through the pupil and the cornea. — 
 (T. H. S.) 
 
 Arbeitersschutzbrillen. (G.). Protective spectacles for workmen. 
 
 Arc. Any ])art of a cui'ved line. 
 
 Arc lights and their effect on the eye. Arc lighting is the teini used 
 to describe artificial lighting by means of lamps in which the light 
 is obtained from the electric arc. Imitations of the electric arc lamp, 
 also called arc lamps by their manufacturers and pi-omoters, are 
 in common use, as for example the "gas arc," consisting of a 
 cluster of gas burners which somewhat resemble the electric arc 
 lamp in exterior appearance and (|uantity of light.
 
 548 
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 When an electric circuit carrying sufficient electric current (am- 
 peres) and pressure (volts) is opened or interrupted, and if the 
 opening is short, the current continues to flow across this opening, 
 forming what is known as the electric arc and producing an intense 
 light. The points between which the electric arc flows are called 
 
 Open Carbon Arc Lamp 
 A — Positive carbon. 
 
 B — Positive crater of boiling carbon from which most of the light is emitted. 
 C — The arc, which is a distinct flame and is surrounded by a burning carbon flame. 
 D — White-hot tip of negative carbon, also source of considerable light. 
 E — Negative carbon. 
 
 electrodes. In the early experiments with the electric arc these 
 electrodes were mounted horizontally with the result that the heat 
 of the arc caused rising air currents which carried the flame of the 
 arc upAvard and made it assume the shape of the arc of a circle. 
 Hence the name of electric arc was applied to it and has been used 
 ever since to describe all phenomena where electric current floWs 
 across a gaseous space between two electrodes in sufficient quantity 
 so that it is something more than merely a series of spark discharges. 
 The electric arc produces such intense heat that electrodes of metal 
 are both melted and vaporized. For this reason electrodes of car- 
 bon in the form of pencils Avere employed in earlier commercial arc
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 549 
 
 lamps and are still in extensive use. Carbon electrodes are used 
 
 because they do not melt, and burn without objectionable fumes. 
 
 The electric are lamp in its various forms is a very useful illurai- 
 
 nant if properly equipped, properly placed and properly main- 
 
 J 
 
 I 
 
 : 
 
 Enclosed Carbon Are in Which the Arc is Enclosed by a Small Glass Globe Pre- 
 venting Eapid Combustion of the Carbon Tips 
 
 F — Positive carbon. 
 
 G — Crater from which most of the light is emitted. This shifts from time to 
 
 time around the tip of the carbon, causing light fluctuations. 
 H — Arc flame. 
 I — Hot tip of negative carbon. 
 
 Note that the ends of both carbons are blunt because of the restriction of 
 
 combustion due to the enclosing globe. This bluntness also interferes with 
 
 the emission of light and renders the enclosed arc less efiicient as a light 
 
 producer than the open arc. 
 
 tained. It has, however, some characteristics which may render it 
 a very unsatisfactory source of illumination if proper precautions 
 are not taken. Tn order that the difficulties may be understood, it 
 is necessary to describe briefly the characteristics of the different 
 forms of arc lamp now in common use. 
 
 Open carhon arcs. Open carbon arc lamps (See figure) maintain 
 the arc between pure carbon electrodes with a free, unobstructed 
 circulation of air around the arc, except that there is usually a 
 single globe to protect the arc from the wind and to diffuse or
 
 550 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 soften the light when used indoors. As the tips of the carbon 
 electrodes burn away the carbons are fed together by a machine 
 that operates automatically by means of electro-magnets. These 
 release a clutch or clockwork mechanism allowing the carbons to 
 feed together. Such open arc lamps usually give a very unsteady 
 light. The arc wanders somewhat around the ends of the carbon 
 tips. The feeding mechanism never gives a perfect feed and cur- 
 rents of air have some effect on the arc, all tending to create un- 
 steadiness. 
 
 Enclosed carbon arc lamps. In this improvement over the open 
 carbon arc lamp, (See figure) there is a glass globe around the 
 arc which is tightly enough closed to keep the free oxygen of the 
 air away from the arc. This prolongs the life of the carbons and 
 reduces the expense of trimming or putting in new ones. It also 
 tends to make a steadier light without the frequent fluctuations of 
 the open arc ; nevertheless it is subject to considerable variation 
 from one hour to another, as the arc wanders around the ends of the 
 carbons. 
 
 The intensified arc, is a modification of the enclosed arc lamp, has 
 recently been used to a limited extent for interior lighting where it 
 is desirable to have light of a color resembling daylight. The 
 principal difference between the intensified arc lamp and the older 
 types of enclosed carbon arc lamps is in the use of much smaller 
 carbons for a given current. This results in a steadier and more 
 efficient light, because the light-giving carbon tips or craters (from 
 which most of the light comes in a common arc lamp) are not 
 shielded and do not have their heat conducted away by the mass 
 of surrounding carbon, as they do when larger carbon pencils are 
 used. 
 
 Arc lamps using pure carbons are at present writing being rapidly 
 driven out of use because the tungsten incandescent electric lamp 
 offers a steadier and more economic source of light. Previous to 
 the introduction of the tungsten lamp, carbon arcs were used in 
 constantly increasing numbers where large lamps were wanted be- 
 cause they were more economical than incandescent electric lamps. 
 
 Flame-arc lamp using impregnated carbons. Tn this lamp carbons 
 are used containing certain salts which give a large increase in the 
 amount of light given by the arc. In the open and enclosed carbon 
 arcs before described, most of the light comes from the intensely
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 551 
 
 heated carbon tips and a relatively small percentage from the flame 
 of the arc. In the flame-are lamp with impregnated carbons, the 
 flame of the arc is the chief source of the light. These flame arc 
 lamps are iiuide in various forms, some with vertical electrodes 
 and others with electrodes inclined at an angle and pointing down- 
 ward, as in the figure. In the latter ease the flame which would 
 naturally rise in the form of an arc by the force of the heated air 
 
 Flame-Are with Impregnated Carbons. Inclined Carbon Type 
 
 K — Positive carbon. 
 
 L — Positive crater. 
 
 M — Electro-magnet to deflect the arc downward and keep the arc-flame in good 
 
 position to emit light. 
 N — Flame of arc, which in this type of lamp is the principal source of light, due 
 
 to salts impregnated in carbons. 
 O — Negative carbon. 
 P — Negative tip. 
 
 currents, is blown or deflected downward by a magnet placed just 
 above the arc. The color of the light from these flame-arc lamps 
 depends on the kind of material used in impregnating the carbons. 
 That most commonl.y used gives it a yellow tinge. Such arcs are 
 likely to be rather unsteady on account of their flaming character. 
 In some cases the arc is so enclosed that it prolongs the life of the 
 electrodes. These flame-arc lamps as ordinarily used are of much 
 higher candlepower than the ordinary carbon arcs. On account of 
 their fumes they are not suited to some kinds of interior lighting. 
 
 Luminous-arc lamps n'ith electrodes of metallic salts. In the lumi- 
 nous-arc lamp the electrodes usually consist of one relatively heavy 
 metallic electrode, which is consumed very slowly, and one made 
 from metallic salts or oxides. In the luminous arcs now in most
 
 552 
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 common use (see the figure) the positive electrode is a piece of 
 copper while the negative is a steel tube filled Avith black magnetic 
 oxide of iron, called magnetite. Such arcs are commonly, known as 
 magnetite arcs. Much of the light in these is obtained from the 
 luminous-arc flame caused by the magnetite electrode. The light 
 from such lamps shows sudden fluctuations due to the shifting of 
 the flame of the arc from one side to another. They also give off 
 fumes and are therefore used mainly for outdoor lighting and the 
 
 Luminous Arc 
 
 Q — Negative electrode consisting of sheet steel tube filled with magnitite (black 
 
 magnetic oxide of iron) and other metallic oxides. 
 U — Heavy copper electrode kept cool by its size and radiating surfaces. 
 S — Arc flame which is principal source of light due to the peculiar characteristics 
 
 of the metallic oxides used in negative electrode "Q." 
 
 illumination of such large interiors as foundries and machine shops. 
 
 The general external appearance of electric arc lamps, already 
 described, varies considerably with the different types and makes, 
 but generally consist of a lower globe (see the figure) surrounding 
 the arc and supported from a case which contains the mechanism 
 for automatically feeding both electrodes at the proper rate. In 
 flame-arc lamps provision must be made for either carrying away 
 the fumes or, if the arc is of the enclosed type to condense the fumes 
 in some unobjectionable place w^here they will interfere least with 
 the cleanliness of the globes. 
 
 Mercury-vapor arc lamps. With these lamps an arc is maintained
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 553 
 
 through the vapor of mercury confined in u long tube. A mercury- 
 vapor tube lamp, as shown in the illustration, consists of a glass 
 tube, from which the air has been exhausted to a high vacuum, and 
 electrodes at each end of the tube between which the current passes 
 
 Typical Electric Arc Lamp; Electro-Magnetic Feeding Mechanism in Upper Case, 
 Underneath Which is a Globe Surrounding the Arc. 
 
 when the mercury-vapor arc is formed. The lower electrode con- 
 sists of mercury in a small bulb. To start the arc a high voltage 
 discharge is passed between the electrodes, or the lamp is tipped to 
 allow the mercury to make a momentary contact between the elec- 
 trodes. In either event sufficient mercury is vaporized to allow 
 the electric current to pass through the mercurj^ vapor and form 
 a mercury vapor arc through the tube. This mercury vapor arc 
 fills the tube and gives a greenish light in which there is an entire
 
 554 
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 absence of red rays so that red objects under this light appear black 
 or violet. Mercury vapor arcs in quartz tubes may be operated at 
 higher temperature than glass will permit. They furnish a light 
 more nearly white, although of a decidedly greenish tinge. The 
 light from mercury -vapor lamps, when the mercury bulb is concealed 
 as in commercial lamps, is yery steady. 
 
 As to the effect on the eyes of these various lamps, it will be seen 
 from the foregoing description that all of the lamps except the mer- 
 cury vapor arc are inherently unsteady. This makes them undesir- 
 able for use where close work, such as writing or reading, is to be 
 performed. The less detailed the work the more opportunity for em- 
 
 Mercury- Vapor Arc Lamp with Straight Glass Tube 
 
 AB — Form for supporting tube. 
 
 C — Upper electrode. 
 
 D — Glass tube in which mercury vapor arc is formed. 
 
 E — Lower electrode with bulb partly filled with metallic mercury from which 
 
 the mercury vapor is obtained to form the arc. 
 F — Chain to pull for tilting tube to start lamp by allowing mercury to flow and 
 
 establish a circuit from one electrode to the other. 
 
 ploying an unsteady light without particular damage to the ej^esight. 
 The enclosed-carbon arc lamp, when in good condition and supplied 
 with a steady source of current, is the least objectionable of the 
 first three types mentioned for interior illumination. Flickering 
 and unsteadiness, of course, brings constant work on the muscles of 
 the eye, Avhich if too long continued, at frequent intervals causes 
 eye strain and nerve tire. 
 
 Another characteristic of the three types of arc lamps which 
 should have serious consideration as to its effect on the eye is the 
 glare which is received from the arc if it is not properly enclosed 
 with a diffusing globe of opal glass. Such diffusing globes have 
 the effect of spreading out a source of light so that the discomfort 
 of looking at it is reduced. 
 
 Arc lamps being the most powerful illuminants used and the arc 
 being the most concentrated form of artificial light the danger to 
 the eyes directly exposed to them is greater than with most other
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 555 
 
 illuminaiits. When used for interior lighting tliey should be placed 
 high, out of the ordinary range of vision, and equipped with opal 
 diffusing globes, unless an indirect system of lighting is employed, in 
 which latter case the light is reflected to the ceiling and thence 
 down into the room, so that no direct light from the lamp reaches 
 the eyes. 
 
 Temporary damage to the eyes is almost sure to result from con- 
 tinuous looking at, or even facing at close range, common com- 
 mercial arc lamps ; while permanent damage to the ocular apparatus 
 has frequently been caused by powerful (accidental) arcs or flashes 
 forming about power house switchboards and other places where 
 heavy electric currents are handled. (See Injuries to the eye.) 
 
 The mercury-arc lamp is, however, a very different illuminant 
 from other arc lamps. The light being distributed evenly through 
 the tube, it is comparatively easy on the eyes. The chief objection 
 is its color, M^hich makes all reds appear as violet or black, and 
 gives a ghastl}^ appearance to persons. There are places, however, 
 where the color is not an objection and the economy of this lamp 
 has frequently made it possible to secure better illumination for 
 working purposes than would have been furnished with other 
 illuminants at a cost which the user would pay. There has been 
 much speculation as to whether the unusual color of this liglit 
 would not have some bad effect on the eyes of those working under 
 it, but as yet none has been detected and reliably reported after 
 nine years of use. 
 
 Dr. Louis Bell of Boston, as a result of extensive experiments, 
 lias reached the conclusion that with the mercury-vapor light vis- 
 ual acuity is better and the perception of detail easier on black 
 and white surfaces than with other common artificial illuminants. 
 This is ascribed to the mercury-vapor light being more nearly 
 monochromatic than others, so that there is less chromatic abbera- 
 tion in the optical system of the eye. M. Luckiesh of Cleveland, 
 on following up this investigation Avith others along the same line, 
 confirms Bell's conclusions. 
 
 As there are some ultra-violet rays in the spectrum of the mer- 
 cury vapor arc, it is always wise to have glass between such arcs 
 and the eye. This is accomplished by the tube in itself in the case 
 of the low-temperature arcs now most commonly used in the United 
 States. Where high-temperature arcs in quartz tubes are used, a 
 glass outer globe should be employed. The danger of such ultra- 
 violet rays even without the glass glohe has however, been much 
 over estimated, as has been shown both bv Bell and Luckiesh.
 
 556 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 Powerful electric arcs are noAv in common use for various indus- 
 trial processes requiring intense heat ; these processes include 
 electric welding, electric furnace work and the burning or melt- 
 ing of steel work with the electric arc. In all of these processes it 
 is very important to jjrotect the eyes of the workman from the direct 
 rays of such powerful arcs. This is usually best done by a helmet or 
 box placed over the head, with plenty of ventilating space at top 
 and bottom. The workman looks out through a window of dark 
 glass in the front of the helmet and in order to be of much practical 
 use the glass must be so dark that little can be seen through it under 
 ordinary daylight conditions. Ordinary dark glasses are insufficient 
 unless they are of several thicknesses, and even then there is risk 
 that the workman will look over or under them at the arc. Strange 
 as it may seem, it is possible for a man working with arcs of con- 
 siderable magnitude to become accustomed in a few minutes to the 
 powerful light, so that looking directly at the arc is possible with- 
 out serious discomfort at the time. Herein lies the chief danger 
 of such operations, because there is occasionally a strong tempta- 
 tion to look at the arc without the intervention of dark glasses be- 
 cause the dark glass is a hindrance to seeing some parts of the work. 
 Care should also be taken in all such work that the arc is shielded 
 from the eyes of nearby workmen or curious visitors who may be 
 damaged by looking at such arcs without realizing the risk. Such 
 temporary exposures to the direct light of these powerful industrial 
 arcs, unless very brief, is almost certain to be followed after several 
 hours by intense pricking and stinging pains in the eyes. — (J. R. C.) 
 
 The action of the direct rays of the sun and of a powerful electric 
 light is at first a thermic change of the outer portions of the retina 
 later followed by chemical and atrophic changes which destroy the 
 finer structures of the rods and cones, with resultant atrophy, even 
 to the percipient cells of the brain. The thermic and light rays also 
 cause disturbances of function, from opacities of the cornea or 
 media to destruction of the retinal cells, the fibres of the optic 
 nerves and tracts, and atrophy of the visual centers. (Parsons.) 
 
 Schanz and Stockhausen show that ultra-violet rays in artificial 
 lights produce erythropsy and electric ophthalmia. There is a ten- 
 dency to constantly increase the intensity of the light by the amount 
 of ultra-violet rays, and the injurious effect of artificial light is also 
 increased. Common glass, out of which eye-glasses and lamp globes 
 are made, absorb only the very short rays (0-300 u.u.) ; these rays, 
 however, do not penetrate the eye; they produce only irritation of 
 the external parts of the eye. Rays of 300-350 u.u. in length are
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 Di)( 
 
 absorbed by tlie lens; rays 350-400 ii.u. long; cause fluorescence of the 
 lens and reach the retina. 
 
 The above mentioned authors were able to make a glass (eui)hos- 
 glass) which absorbed all ultra-violet rays up to 400 u.u. and the 
 visible spectrum became dimmer only 5 per cent. Their investiga- 
 tions show that the greatest amount of light that the human eye 
 •can stand is a surface brightness of 0.73 of a Hefner candle to the 
 square centimeter. 
 
 Experimenting with the ultra-violet or chemic rays, Stroebel 
 found that the media of the eye alloAV them free passage. It is 
 possible with them to induce a circumscribed inflammation of the 
 retina. Under their influence the iris became hyperemic, inflamed 
 and pigmented, but it is stated that the iris is able to exclude their 
 influence from the deeper tissues. 
 
 C. Hess tried the efl:'ect of the uviol lamp upon the lens and found 
 ■degenerative changes in the epithelium of the lens cajisule, with pro- 
 liferation of the cells near the equator. These changes were observed 
 in frogs, rabbits, guinea-pigs, and monke^ys. "While the degenerative 
 changes did not set in more rapidly in the warm-blooded animals 
 than in the cold-blooded ones, in the former they seemed to be fol- 
 lowed by more active proliferation of the cells. The author dis- 
 cusses the bearings which these observations have upon the etiology 
 of glass-blowers' cataract. He thinks it possible that the long expos- 
 ure of the eyes of these men to rays of short-wave length leads to 
 degeneration and proliferation of tlie cells of the lens capsule; that 
 ultimately the regenerative changes are not able to keep pace with 
 the degenerative processes, and so cataract formation begins. He 
 observed that the changes described above did not appear when an 
 ordinary sheet of glass was placed between the animal and the lamp, 
 and so he suggested that glass-blowers' cataract might be prevented 
 by suitable spectacles. 
 
 Birch-IIirsclifeld opposes the statement of Best, that the ultra- 
 violet rays of our artificial sources of light are perfectly irrevelant 
 for the eye, and maintains that, besides the luminous, the ultra- 
 violet rays may injure the retina, not only in intensities which can 
 only be employed in experiments, but also under ordinary condi- 
 tions. The smoke-colored coquilles are sufficient for most practical 
 purposes, but not the little blue ones, Avhicli Best ranks in the same 
 order, not only because their absorption of short-waved rays is less 
 than that of the smoke-colored, but also because they transmit the 
 very active luminous blue rays. He says the authors who attribute 
 senile cataract to the detrimental influence of ultra-violet light go
 
 558 ARC LIGHTS AND THEIR EFFECT ON THE EYE 
 
 mneh too far, lacking any proof. The etiological part of ultra-violet 
 rays in inflammations of the anterior segment of the eye (ophthalmia 
 electrica) is undoubted. For the disturbances of the retina (central 
 and peri-central scotomas, imiaairment of color sense), through glar- 
 ing by lightning, short circuit, arc light, light of mercurial vapors,^ 
 etc., besides the ultra-violet rays between 400, 350, and 330 mm., the 
 violet and blue rays play a part, as well as in erythropsia. Against 
 this former opinion Birch-Hirschfeld opposes quite another view, 
 that only the ultra-violet rays be detrimental to the eye. 
 
 Randolph {Ophthalmic Record, VI, pp. 322, 323) reminds us that 
 in 1888 Terrien reported a number of cases of intense inflammation 
 of the conjunctiva, together with great swelling of the lids and 
 profuse lachrymation in those who worked at electric experimenta- 
 tion. Then Terrien spoke of the affection as electric ophthalmia 
 (rophtalmie electrique) and he made his report to the Surgical 
 Society of Paris in December, 1887. His observations have been 
 confirmed by Rockliff and Emrys-Jones, both of whom report cases 
 of the so-called electric ophthalmia. Maklakoff, of Moscow, in 
 1889 reported a number of cases where electric light of great inten- 
 sity had produced not only severe eye symptoms but also an eruption 
 upon the exposed portions of the body, as the hands and face, in 
 workmen in a large factory near Moscow. All these observers were 
 able to demonstrate the fact that the injurious effects were produced 
 by the luminous and the chemical rays and that the heat rays played 
 no part. This latter is an important point, as showing that it is the 
 peculiar illuminating quality of the electric light to which injurious 
 effects are to be attributed. So much for the effect of the electric 
 light at short range. Some few cases are recorded where the retina 
 has been seriously and permanently injured by exposure to the arc 
 light located farther off than in the class of cases just mentioned, 
 but there is nothing in the literature of the subject which bears 
 exactly upon the point under discussion, namely, as to whether the 
 arc light at a raihvay crossing is a source of danger to those at the 
 crossing. 
 
 That the effect of such a light is trying to the eyes, there is no 
 difference of opinion among ophthalmologists. The arc light is not 
 only too intense a light, but too white a light, and is more like light- 
 ning. The effect of such a light upon the retina is to exhaust it and 
 to blunt its sensibility, and after the exposure of the eye to such a 
 light and until the retina has recovered from the effects of the 
 powerful stimulus, the person will not get correct impressions (i.e., 
 as to distance and character) of other objects and particularly of
 
 ARC LIGHTS AND THEIR EFFECT ON THE EYE 559 
 
 less luiniiious objects, as for instance of the headliglit on an approach- 
 ing locomotive. According to the observations of FuUerton and 
 Cattell, when two lights of equal intensity are viewed in succession 
 the second light appears the fainter. How much more intensified 
 this effect would be when the first light excelled the second in 
 luminosity, or, in other words, Avlien the transition is from the arc 
 light to the headlight ! One can understand for oneself what this 
 means by looking at an arc light for a few moments and then turn- 
 ing aw^ay and trying to take in surrounding objects. The latter will 
 appear very indistinct. The period during which tlie ictina is recov- 
 ering from the efit'ect of the light is known as the i)eriod of adapta- 
 tion, and it is evident that during this period (of variable length) 
 a person would be poorly equipped to avoid an aj)i)roaching danger 
 which under other circumstances is promptly appreciated. This is 
 what happens to some degree when the arc light shines directly 
 into the eyes of the street traveler, as it would undoubtedly do if 
 placed at a crossing. Bicyclists are constantlj- complaining of 
 the uncertainty of traveling along roads lit by arc lights, and com- 
 plaints are not wanting to show that the light on the Statue of 
 Liberty, instead of rendering objects clearer in New York harbor, 
 has rather the opposite effect and so dazzles the eyes of the pilots 
 (in other words, exhausts the sensibility of the retina) that lesser 
 lights, as signals, are seen imperfeetl3^ Some years ago a cluster of 
 powerful arc lamps was suspended at Hell Gate, at the instance of 
 the Sound steamer lines. This light was intended to aid in navigat- 
 ing the crooked and dangerous channel in that vicinity, and it was 
 hoped that it would approximate to daylight conditions by lighting 
 up the wdiole area of the water. The navigators, however, found that 
 the light was a distinct disadvantage and they pronounced it a fail- 
 ure, and it was abandoned. 
 
 Widmark has shown by numerous experiments that disturbances 
 in the eye due to intense light are caused by the ultra-violet rays 
 acting upon the fixed elements of the anterior part of the eye. This 
 does not include the influence of direct sunlight upon the retina and 
 choroid. These rays are largely intercepted by the sclera and entirely 
 absorbed by the iris. Of the transparent media the lens absorbs 
 a large proportion. The dark heat-rays are especially absorbed by 
 the fluids of the eye; perhaps, partly, by the cornea. They have but 
 little influence on the ocular tissues. 
 
 It would seem from all this that the electric light under certain 
 conditions produces structural changes in the eyes, these changes 
 showing themselves in inflammation. Under other conditions the
 
 560 ARCHIGENES 
 
 effect of the light is manifested chiefly in subjective symptoms known 
 as dazzling and retinal exhaustion, causing the person to see indis- 
 tinctly less luminous objects, and it is quite reasonable to conclude 
 that these last conditions exist in some degree in the case of the street 
 traveler at the railway crossing lit by the arc light, so that such a 
 light in such a location might prove a source of danger to those at the 
 crossing. 
 
 Of course prevention is better than cure in this important matter. 
 "Workmen and others exposed to the intense glare of electric furnaces 
 and other sources of high-power, violet-rayed light should wear deep- 
 tinted amber (q.v.) or euphos (q.v.) lenses, while the lights them- 
 selves, or the "peep-holes" that reach them, should be guarded by 
 similarly colored glass. 
 
 Inasmuch as yellow or amber tints interfere with the definition in 
 the "open hearth" and other processes a deep-blue glass is preferred; 
 the amber tint is satisfactory for Bessemer and some other processes, 
 that depend largely on flame changes. 
 
 There is no specific treatment for the ocular lesions produced by 
 high-power lights; rest, atropia, dark tinted lenses, and soothing 
 (local) applications, are commonly prescribed. 
 
 Archig-enes. A distinguished Roman eclectic physician, who was born 
 at Apamea, A. D. 48, and died in the Eternal City in 117. He seems 
 to have passed most of his life at Rome, for he is often mentioned by 
 the satirist Juvenal. His writings undoubtedly exercised a great and 
 lasting influence over Galen (A. D. 131-210) the greatest physician of 
 antiquity after Hippocrates. As an ophthalmologist he is not of much 
 importance, for his only writing on the eye is a brief section on 
 oplithalniic remedies in a work on materia medica. — (T. H. S.) 
 
 Architecture of school-buildings. See Hygiene of the eye, and School 
 hygiene, Ocular relations of. 
 
 Arch, Orbital. The superior margin of the orbit. 
 
 Arco senile della cornea. (It.) The arcus senilis. 
 
 Arcus juvenilis. A congenial opacity of the cornea, also called 
 sclero'phthaimns, and macula arcuata. It is generally within the clear 
 cornea and is usually associated with other ocular defects. 
 
 Arcus senilis. The degenerative band that forms, generally in elderly 
 people, around the upper half of the sclero-corneal ring. It is occa- 
 sionally seen in young adults and may (but rarely) affect the whole 
 circumference of the cornea. 
 
 Arcus senilis der Cornea. (G.) Arcus senilis of the eye. 
 
 Arcus tarseus inferior. (L.) A blood-vessel lying between the tarsal 
 cartilage and the orbicularis muscle on the free border of the lower
 
 ARCUS TARSEUS SUPERIOR 561 
 
 eyelid. It is formed by a branch of the inferior palpebral artery 
 and the palpebral branch of the nasal artery. See Anatomy of the 
 eye. 
 
 Arcus tarseus superior. (L.) Anastomosing branch of the superior 
 palpebral artery with the palpebral branch of the lachrymal 
 artery. See Anatomy of the eye. 
 
 Ardi-Nana. Physician to Esarhaddon, king of Assyria, who reigned 
 B. C. 681-668. Two of the letters of this verj' ancient ophthalmologist 
 (both directed to the king) are still extant. The more interesting runs 
 as follows: 
 
 "To the king, my lord, thy servant, Ardi-Nana. May it be peace 
 in the highest degree to the king, my lord ; may Ninip and Gula give 
 cheer of heart and health of body to the king, my lord. It is extremely 
 well with that poor man whose eyes are diseased. I had applied a 
 dressing to him ; it covered his face. Yesterday, at evening, I undid 
 the bandage which held it, I removed the dressing which was upon 
 him. There was pus upon the dressing as much as the tip of the 
 little finger. Thy gods, if any of them has put his hand to the matter, 
 he has indeed given his order. It is extremely well. Let the heart of 
 the king, my lord, be cheered. In seven or eight days he will be w^ell." 
 Ninip and Gula were the Assyrian gods of healing. — (T. H. S.) 
 
 Area centralis. (L.). According to Mueller, the area centralis is that 
 part of the retina where, during the period of development, the for- 
 mation and dilferentiation of rods and cones first takes place and 
 where the further differentiation of the retinal layers occurs. The 
 area centralis of man forms in the 17th W'eek; and its center, the 
 fovea centralis, — wnthout any relation to the choroid fissure — ap- 
 pears during the 8th month. This area has been found in almost all 
 vertebrates; its absence determines the absence of the fovea cen- 
 tralis. The area centralis of birds often appears double, or even 
 triple in some species. 
 
 Area, Macular. That part of the retina most sensitive to light and 
 form impressions. See Histology of the eye. 
 
 Area Martegiana. The region of dilation of the posterior segment of 
 the hyaloid canal in the vitreous humor of human fetal existence, 
 and in many mammals during adult life. 
 
 Area of critical definition. That portion of an optical image within 
 which details are clearly defined. 
 
 Area, Visual, of the cerebral cortex. See Intracranial portion of the 
 visual apparatus. 
 
 Arecaidinethyl ester. See Homoarecoline. 
 
 Arecaine. One of the inactive alkaloids from Arccha catechu — the betel- 
 
 Vol. 1—3 C
 
 562 ARECOLINE 
 
 nut. The miotic, arecoUne (q. v.), is derived from this same tall. East 
 Indian palm. 
 Arecoline. This is a poisonous, miotic alkaloid derived from the 
 areca nut — Arecha catechu (betel-nut), a tall. East Indian palm. 
 In its general action arecoline somewhat resembles pilocarpine. It 
 was prepared as a hydrobromide (CsIIi3N02lIBr) by Merck in 
 1894. It occurs in the form of colorless, acicular prisms readily 
 soluble in water and alcohol; slightly in ether and chloroform. 
 The areca nut also contains three other alkaloids — pelletierine, 
 arecaine and guvacine — but only arecoline seems active. It is 
 used as an eyewater in 1 per cent, solution. 
 
 According to Lavagua, a drop of 1 per cent, solution of the h^vdro- 
 bromate produces a maximal miosis in 10 minutes, which decreases 
 after 15 minutes, and disappears in 45 minutes. Arecolin is easily 
 sterilized, does not produce headache or pains in the eye, and in cases 
 where eserin is not tolerated, it may replace the latter. 
 
 The observations of Lewin and Guillery show that one drop of a 
 watery one per cent, solution of the hydrobromate causes a feeling 
 of warmth in the eye, lachryraation, and blepharospasm, but this 
 discomfort lasts only for a minute. A hyperemia of the bulbar con- 
 junctiva and a slight pericorneal injection then follow — signs that 
 disappear in a few minutes. About two minutes later there occurs 
 (as the result of clonic contractions of the iris muscle) contrac- 
 tion of the pupil. This is. noticeable after 5 minutes, reaches its 
 maximum after 10 minutes, and lasts 25 to 30 minutes. These 
 changes are accompanied by more or less macropsia (q.v.). 
 
 A one-half per cent, arecoline hydrobromate solution affects the 
 pupil and the accommodation almost as much as a one per cent, 
 solution. Without preliminary ciliary or conjunctival injection and 
 after a transient pricking and itching there occurs (in 2 to 3 min- 
 utes) a contraction of the pupil, which reaches its maximum in 10 
 to 12 minutes, lasts about 30 minutes, and then disappears. 
 
 Although the pupil dilated by atropine is said not to be contracted 
 by arecoline, yet the reverse does not hold. 
 
 Arecoline acts on the ciliarj^ muscle in much the same way in 
 individuals with various refractive errors. The ciliary contraction 
 always precedes that of the iris, just as with physostigmine ; but 
 arecoline acts more rapidly than eserine, and its action lasts a shorter 
 time. The near-point draws nearer to the extent of from 3 to 5 D. 
 This limitation of accommodation disappears in about an hour. 
 
 The intraocular pressure tension is lowered by arecoline so that in 
 the treatment of glaucoma it may on occasions replace physostigmine ;
 
 ARECOLINE-ESERINE 563 
 
 indeed, in some patients it produced miosis where physostigmine had 
 failed. -i 
 
 Arecoline-eserine. This is a mixture (Merck) of equal parts of 
 arecoliue hydrobromide and physostigmine (eserine) sulphate. 
 The combined action of these two miotics is greater than either of 
 them exhibited separately. 
 
 Areolar choroiditis. This disease is sometimes called "Foerster's 
 choroiditis," from the name of the ophthalmologist who first de- 
 scribed it. It occurs in the form of bilateral changes in the macular 
 region and the disk which consists of well defined, mostly discrete, 
 punched-out, round patches of choroidal atrophy, rather larger than 
 the papilla. They are closely disposed, and sometimes coalesce. 
 The atrophy of the choroid within the affected patches is usually 
 complete, shoAving the whitish filamentous sclera, occasionally 
 bordered with a narrow margin of coal-black pigment. 
 
 Argamblyopia. Weakness of vision from disuse of the eye. 
 
 Arganon. A white powder said to contain 4 per cent, of silver casein, 
 soluble in hot water. It is used locally as an antiseptic and astring- 
 ent. The ordinary strength of the aqueous solution, employed es- 
 pecially in mucopurulent discharge from the eye, is 2 per cent, 
 gradually increased to 10 per cent. 
 
 Arg^anon, New. This is a light-yellowish powder slightly soluble but 
 quite stable in water. It contains about the same percentage of 
 silver as arganon (q. v.) and is employed in strengths of from 
 /^oo to ^00 ill purulent and mucopurulent conjunctivitis. 
 
 Argema. (L.), n. Obsolete name for a white spot appearing at the 
 margin of the cornea, as the result of a phlyctenular ulcer. 
 
 Arg"enol. An argentic albuminoid containing about 10 per cent, of 
 metallic silver. It is found as brown crystals, easily soluble in 
 water and glycerine. As a substitute for the nitrate it is b}' some 
 observers preferred when silver compounds are ordered. The usual 
 aqueous solution employed is from 1 to 10 per cent. 
 
 Argentamine. Liquor argentamini. This is a colorless 8 per cent, solu- 
 tion of silver nitrate or phosphate in a 15 per cent, solution of ethy- 
 lenediamine, and corresponds to a 10 per cent, solution of the silver 
 salt. It is astringent and antiseptic, like other silver salts, but is 
 said to be less irritating and more penetrating than the nitrate and 
 
 ' is used wherever it is indicated. 
 
 Daxenberger was one of the earliest ophthalmologists to advise 
 its use. He commends it in all cases of conjunctivitis, brushing a 
 5 to 10 per cent, solution over the everted lids. In addition to this a 
 3 per cent, solution is to be instilled. The writer prefers it in oph- 
 thalmia neonatorum; also in 3 per cent, solution as a prophylactic.
 
 564 ARGENTATION 
 
 He considers its value to be due to the fact that its bactericidal 
 action is upon the sub-conjunctival tissues ; that it is not superficial 
 in action like most other silver salts. - 
 
 Argentation. Argyria or argyrosis (q. v.). 
 
 Argentea. In comparative anatomy (q. v.) the silvery or more gen- 
 erally, the green and gold iridescent membrane that, in the eyes of 
 fishes (see Fishes, Eyes of) lies external to the choroid and internal 
 to the supra-choroid lymph space. It sometimes covers the whole 
 interior of the globe. 
 
 Arg-entic acetate. See Silver acetate. 
 
 Argento (nitrate di). (It.) Silver nitrate. 
 
 Argentol. Silver quinaseptalate. Silver oxiquinoline-sulphonate. 
 This agent is a yellow powder, sparingly soluble in water and alco- 
 hol, and readily affected by light. It is recommended, in 34ooo to 
 ^300 solutions, in purulent diseases and catarrh of the conjunctiva. 
 
 Argentose. A soluble compound of silver and a nucleoproteid, con- 
 taining 30 per cent, of the former. It is an effective germicide and is 
 used like silver nitrate in acute conjunctivitis and as a prophylactic 
 in ophthalmia neonatorum. 
 
 Argentmn colloidale. Collargol. Argentum crede. Argentum solu- 
 BiLE. An allotropic form of silver, said to consist of 86 parts of me- 
 tallic silver, some silver oxide, and albumen. It is made by the ac- 
 tion of sodium citrate and ferrous sulphate on nitrate of silver. 
 Collargol occurs as black, scale-like pieces, soluble in twenty parts 
 of water. It has been used in blennorrhoea neonatorum and other in- 
 fective processes, but its chief use is in the preparation of Crede 's 
 ointment which is composed of collargol 15 parts, water 5 parts, 
 white wax 10 parts and benzoated lard 70 parts. In ophthalmic sur- 
 gery it is a valuable antiseptic counterirritant, to be applied as a 
 poultice to the lids in most serious cases of intraocular inflammation. 
 The ointment is smeared on the closed lids and eyebrows at night, a 
 bandage is applied and the greasy mixture washed off with warm 
 water in the morning. This application may be repeated many times 
 without producing any serious abrasion or other lesion of the skin 
 and without impairing its analgesic counterirritant and resolvent 
 action. 
 
 Argentum Crede. See Argentum colloidale. 
 
 Argentum solubile. See Argentum colloidale. 
 
 Argilla. White clay. Kaolin. Bolus alba. China clay. Terra 
 siGiLLATA, TURiCA siVE LEMNiA. White clay cousists essentially of 
 aluminum silicate, being mostly a decomposition product of felspar. 
 It sometimes contains silicate of iron, which, when present in con- 
 siderable quantities, makes with the former holus rubra, bolus
 
 ARGIN oOf) 
 
 ar)itciia, or red clay. Argilla forms earthy cluiiii)s whii-li with water 
 are transformed into a ])aste. It is prepared for pliarmaeeutical 
 purposes by treatment with hvdi'ic chloride and washing (»nt sand. 
 Until a few years ago, it was employed as a)i exeipient in pills, in 
 tooth{)Owder, powder for moist eczemas, and for baths. In popular 
 medicine it is often employed in the treatment of sAvellings, eczema 
 and Avounds. Jn 1898, Julius Stumpf directed the attention of the 
 profession to its strongh^ drying properties, as well as to its anti- 
 septic and deodorizing qualities. Megele confirmed Stumpf s reports. 
 Woltfberg subsequently reconnnended a forma lin-argilla-i)astc for 
 advanced cases of serpent ulcer of the cornea and in the gonorrheal 
 conjunctivitis of adults. If used alone, llie bolus alba should be 
 heated to 150° C. to sterilize it and at the same time to increase its 
 desiccating properties. An admixtui-e of 5 drops of 1 per cent, 
 formalin with five to ten grams of argilla gives one a highly' antisep- 
 tic paste which impregnates ulcerated corneal tissues and intimately 
 covers and disinfects a conjunctiva poisoned by gonorrhea. Accord- 
 ing to AVollfberg this paste is not only of therapeutic but also of 
 diagnostic value. Although it spreads out like thick cream and is 
 soon washed out by the tears when applied to the healthy con- 
 junctiva, it adheres like a membrane to the gonorrheal eye, as long 
 as the infection remains. It gives notice, after a fashion, of a prob- 
 able implication of the cornea when it adheres to the tissues at the 
 limbus. If the case is a light one, or when recovery begins, the 
 membrane is removed in toto and without ditficulty, although not as 
 easily as in the normal eye to which it does not adhere at all. It 
 is better to prepare the paste fresh for each case and vary its con- 
 sistency by diluting it more or less according to the character and 
 progress of the case. 
 
 AVhite clay is also used in v. Bruns' and Ilerrnheiser's Airol (q. v.) 
 paste. — {Encijldopadie (h r AitgenhciU.inKjr.) 
 
 Argin. This is one of the less known substitutes for silver nitrate 
 and contains about ten per cent, of metallic silver combined with 
 protalbin. It is generally used in ten per cent, watery solution for 
 the same ophthalmic purposes as other soluble argentic salts. If 
 applied to the eye for protracted periods it may set up an argyrosis 
 of the conjunctiva. 
 
 Argirosi. (It.) Argyrosis. 
 
 Arg-onin. Silver sodio-caseinate. Prepared by adding silver nitrate to 
 the sodium compound of casein. It is a fine white powder, contain- 
 ing about 4 i)er cent, of silver and is but slightly soluble in water. 
 Like argentamine {([. v.) it penetrates more deeply than silver
 
 566 ARGYLL-ROBERTSON'S ADVANCEMENT OPERATION 
 
 nitrate and does not coagulate the albumen. In ophthalmia neona- 
 torum and allied diseases it is used in 3 per cent, solutions; smaller 
 quantities in milder infections of the conjunctiva where silver 
 nitrate is indicated. 
 
 According to Snellen argonin 1. (losliches argonin), a newer 
 preparation freely soluble in water, is found as a light-yellow 
 powder and contains 10 per cent, of metallic silver. According to 
 Sellink it is markedly bactericidal. 
 
 E. C. Ellett, Trester Smith, Horace Bigelow and others have re- 
 ported the satisfactory^ employment of this agent, in 5 and 10 per 
 cent, solutions, instead of silver nitrate in the treatment of purulent 
 ophthalmia — especially in gonococcal infections. The last-named 
 observer believes that its easy solubility, deep penetration of the tis- 
 sues, germicidal qualities and the fact that strong solutions do not 
 require neutralization make it an ideal remedy in the treatment of 
 both infantile and adult gonorrheal ophthalmia. 
 Argyll-Robertson's advancement operation. Argyll-Robertson (On a 
 Modification of the Ordinary ^Method of Operating for Advancement 
 
 Advancement with Suture Carried Around the Coinea. (Argyh-Rohertson.) 
 
 of the Tendon of a Rectus Muscle. Brit. Med. Jour., 1891, Vol. II, 
 p. 471), after dividing and isolating the tendon, in much the same 
 manner as Williams and Beard, used a double-armed waxed silk suture, 
 one end of which was passed in and out through the tendon or muscle 
 parallel to the corneal margin, and a sufficient distance back from the 
 insertion to give the desired advancement. The needle was then passed 
 beneath the conjunctiva, around the cornea, well beyond its opposite 
 margin. The second needle was then similarly passed in and out 
 through the conjunctiva around the other half of the cornea to emerge 
 near the first needle. See the figure. After excision of so much of 
 the tendon as it was desirable to remove, the parts were brought into 
 apposition and the suture tied. This suture was allowed to remain 4 
 or 5 days. — (E. J.)
 
 ARGYLL-ROBERTSON'S OPERATION FOR ECTROPION 5G7 
 
 Argyll-Robertson's operation for ectropion. It is perhaps an unusual 
 tiling for an out-curving- of the tarsal cartilage to be the cause of 
 ectropion or even to be a contributing agent of sufficient importance to 
 demand attention. For the correction of those few cases where such a 
 deformity does seem to be a pronounced feature Argyll-Robertson has 
 performed the following operation, which is a modification of the 
 Snellen sutures. A double-armed ligature of No. 2 braided silk, pre- 
 viously prepared by boiling in paraffin, is passed from the front 
 
 Argyll-Eobeitson 's Operation for Mechauieal Ectropion. 
 
 straight through the entire thickness of the lid, 2 mm. below the ciliary 
 margin and about 6 mm. from the middle. It is carried free over the 
 conjunctiva and reinserted at the bottom of the cul-de-sac, passing 
 diagonally down and out so as to emerge 32 mm. below the lid margin. 
 The other end of the suture is similarly placed 6 mm. to the other side 
 of the midline. This arrangement leaves two vertical loops of thread 
 crossing the palpebral conjunctiva about a centimeter apart. Beneath 
 these loops is now inserted a lead plate (25x6x1 mm.) whose edges 
 have been carefully smoothed and rounded off and which is bent to fit 
 the curve of the globe. A roll of gauze is placed beneath the horizontal 
 loop on the outside of the lid and the sutures are secured over its lower 
 end. The sutures are allowed to remain in position seven days. If the 
 lead plate is covered with paralYin it is less apt to cause irritation. — 
 (C. H. B.) 
 Argyll-Robertson pupil, or reflex iridoplegia, is a condition in which 
 both the direct and indirect reactions of the pupil to light are lost, 
 but reflex contraction remains intact which is brought about by the 
 associated actions of accommodation for near vision and the con- 
 vergence of the visual axes. 
 
 It is not always easy, especially when the pupils are much con-
 
 568 ARGYLL-ROBERTSON PUPIL 
 
 tracted, to elicit this phenomenon. Probably the best plan is to 
 seat the patient before a well-lighted windoAv and direct him to 
 gaze at an object in the distance. Then cover the eye with a black, 
 opaque object (a book forms a good obturator) and again warn the 
 patient to still look as if he were gazing in the distance. Wait two 
 minutes with the patient's eyes still covered; then suddenly remove 
 the opaque cover. If the light retlex is present it will almost cer- 
 tainly be shown by narrowing of the pupil ; if not, no change in the 
 diameter of the pupil will occur. Then, shade the eyes by partially 
 covering them, with the book but not so fully but that the pupils 
 can be observed. Again tell the patient to gaze for fully half a 
 minute in the distance. Then, without removing the shade, suddenly 
 tell him to fix the end of a finger thrust in front of his eyes about 
 six inches away,. The pupils will contract, it matters not how small 
 they were previously, if the accommodation-convergence reflex arc is 
 intact. 
 
 Miosis is frequently associated with the phenomenon, and in some 
 cases the pupils are found oval or pointed. AVhile both eyes are in 
 nearly all cases affected, still we occasionally see individuals in which 
 the condition is more marked in one eye than in its fellow, or where 
 it may be completely unilateral. Many cases begin unilaterally (13 
 per cent., Rochon-Divignaud and J. Hettz), remaining so for some 
 time, but finally becoming bilateral. 
 
 Reflex iridopiegia is never seen in perfectly healthy persons. It is 
 observed in several diseases, but by far most frequently in those 
 conditions caused by syphilis, particularly tabes. Some authors 
 (Dejerine, Dufour and Uhthoff) have stated that they believe all 
 cases to be due to syphilis. 
 
 As an aid in diagnosing these diseases it is of inestimable value, 
 for it often precedes all other characteristic symptoms. The oculist 
 is often the first to discover that the unfortunate patient is in the 
 incipient stage of locomotor ataxia. 
 
 In 166 eases of Argyll-Robertson pupil reported by Uhthoff, 67.6 
 per cent, were associated with tabes ; 8.8 per cent, with dementia 
 paralytica; 8.17 per cent, with syphilis without tabes; 5.87 per cent, 
 with other cerebral diseases; 1.-4 per cent, with multiple sclerosis; 
 2.0 per cent. Avith raihvay spine and injury of the head ; 0.7 per cent, 
 with congenital feeble-mindedness ; 0.7 per cent, with hystero- 
 epilepsy; 0.7 per cent, wnth abuse of tobacco; 0.7 per cent, with 
 hemianesthesia dextra and 3.6 per cent, with no assignable cause. 
 
 The statistics of Maeli, Siemerling, and Thomsen, embracing 4,000 
 cases of disease of the nervous system have been collected by Uhthoff
 
 ARGYLL-ROBERTSON SCHES PHANOMEN 569 
 
 and sliow lliat in 492 tlio pupillary light reflex was lost. The diagno- 
 sis of those eases in wliieli the loss was noted was as follows : Pro- 
 gressive paralysis, 85.5 pvr eent. ; tabes, 4.25 i)er eent.; syphilis, l.sy 
 per cent.; multiple sclerosis, 1.2 per cent.; injui'v 1o liead, U.(j per 
 cent. ; paranoia and epilejisy, 2 per cent. 
 
 As to whether genuine examples of Argyll-Robertson pupil may be 
 only temporary in some instances is a question Avhich is in dispute. 
 The fact that it nearly always accompanies diseases of the nervous 
 system, which are in their nature progressive, leads us to believe 
 that it is, as a rule, permanent. Sulzer states that in observing 
 the pupillary light retlex in 53 cases in the early stages of syphilis, 
 11 were found to be aft'ected. Some of these were carefully followed 
 and, later, the eyes returned to the normal condition. 
 
 The seat of the lesion causing Argyll-Robertson pupil has been 
 placed in different locations by different investigators. Pathological 
 changes in the floor of the aqueduct of Sylvius were found by 
 Peneles, Zeri and others on microscopical examinations of the brains 
 of tabetics. Kostenitsch also found round-cell infiltration in this 
 locality. Schutz reported finding pathological changes in the nerve 
 fibres of the gray substance on the floor of the aqueduct in twenty 
 cases of progressive paralysis, which during life had exhibited the 
 Argyll-Robertson phenomenon. Some writers have assigned the 
 cervical portion of the spinal cord as the region aff'ected. Wolf states 
 that in loss of light reflex in certain cases of tabes and general 
 paralysis, Mdiich retained the knee-jerk intact, lesions had been 
 found in the posterior columns of the cervical cord. Cases with 
 retained pupillary light reflex and lost knee-jerk shoAved lesions of 
 the cord below the third or fourth dorsal vertebra. Cases with the 
 pupillary light reflex and knee-jerk both gone showed the entire 
 cord affected. 
 
 Marina is of the opinion that the seat of the lesion is in the ciiiaiy 
 ganglion and ciliary nerves, and states that he has found changes in 
 their structure in every case examined. 
 
 Neither pathological nor clinical investigations up to the present 
 time have absolutely established the location of the lesion causing 
 Argyll-Robertson pupil. — (A. S. R.) 
 Argyll-Robertson 'sches Phanomen. (G.) Ai-gyll-Robei-tson i)heiioin- 
 
 enon. 
 Argyria conjunctivae. Argyrosis of the conjunctiva. Staining of the 
 conjunctival tissues by one of the silver salts. See Argjrrosis oculi.
 
 570 ARGYROL 
 
 Argyrol. Silver vitelline. This is a proteid salt of silver containing 
 from 20 to 25 per cent, of the metal. The v^^atery solution is yellow- 
 ish or black according to its strength. It stains the skin and, like 
 other silver salts, may produce a permanent or at least lingering 
 argyrosis (q. v.). The same statement may with truth be made of 
 most silver salts. This staining quality is, so far as it goes, an evi- 
 dence of the effect produced on the albuminous constituents of the 
 ocular tissues and, by inference, on invading bacteria. A number 
 of instances of argyrosis from argyrol and other recent silver prep- 
 arations could be quoted. It is claimed that the staining in the case 
 of argyrol is largely due to the use of old or decomposed solutions. 
 It is well known that arg3'rol solutions are prone to deteriorate on 
 standing. 
 
 These experiences emphasize the need of using always perfectly 
 fresh solutions kept from the light and air in, if possible, a cool or 
 quite cold place. It should also be remembered that applications to 
 abraded surfaces of even unaltered solutions are not without danger 
 of argyrosis. Argyrol is nontoxic and possesses distinctly antiseptic 
 qualities. 
 
 It was first described (and recommended) by Barnes and Hille 
 as occurring in dark-brown or black-glistening flakes readily 
 soluble in water and glycerin. Twenty per cent, solution is entirely 
 non-irritating to the normal conjunctival sac. In from 5 to 25 per 
 cent, watery solution it has been widely recommended as a substitu- 
 tute for silver nitrate. Both argyrol and its companion salt, pro- 
 targol, have a therapeutic value all their own and, when properly 
 employed, are superior to other organic salts in any dose. 
 
 From an extended study and experience Bruns believes that the 
 best results in severe cases of blennorrhcea are to be obtained by 
 erecting a dam of wax or paraffin about the margin of the orbit and 
 immersing the eye in a strong solution for periods of an hour or two, 
 day and night. As the agent is non-irritating its full effects can 
 thus be secured without pain or damage to the eye. McGillivray gives 
 a full account of the therapy of argyrol as follows : — 
 
 Judged from the bacteriological standpoint, argyrol would seem 
 to rank inferior to nitrate of silver as a germicide, and to be of little 
 real value as a substitute for this time-honored preparation. Be 
 that as it may, those who have given argyrol an extensive clinical 
 trial, and who are thereby able to judge of its therapeutic value, are 
 enthusiastic in its praise. 
 
 It is verj^ soluble in water, but incompatible with cocaine hydro-
 
 ARGYROL r)71 
 
 chloride and other alkaloids. AVe liavc used it eliietly in 10 and 25 
 per cent, aqueous solution, and have found that its instillation into 
 the eye is not onl.y painless, hut it is followed by a feeling of com- 
 fort and relief. When the solution is kept for some time, and es- 
 pecially in the light, it decomposes, and is then liable to cause irrita- 
 tion. It should therefore always be freshly prepared, and kept in 
 the dark or in non-actinic bottles. 
 
 The chief objection to the use of this drug from the patient's 
 standpoint is that it stains the skin and handkerchiefs a deep choc- 
 olate-brown color. This objection, however, is trifling, for the skin 
 stains can be readily Avashed awa,y with water, while linen stains are 
 instantly removed by dipping the fabric in 1 in 1000 bichloride of 
 mercury solution. We have not had a single case of argyrosis — 
 permanent staining of the conjunctiva — with argyrol. One com- 
 plaint one frequently hears is that the drops pass down the tear 
 duct into the nose and pharynx, and may alarm the patient, unless 
 previously cautioned, owing to their brown color and metallic taste. 
 This objection is really a merit, as will be seen when we come to 
 discuss the treatment of lachrymal affections. 
 
 The great advantage argyrol possesses over nitrate of silver 
 lies in the fact that its application is painless, even in strong solu- 
 tion, and that it can be used freely and frequently by the patient 
 without any risk. Nitrate of silver is, as you are aware, a danger- 
 ous remedy, except in the hands of the surgeon, and its application, 
 even in 2 per cent, solution, is attended with such excruciating pain 
 as to make the strongest shudder. 
 
 In ophthalmia neonatorum, after the discharge has been re- 
 moved by the free use of the douche and saline solution, some half- 
 dozen drops of a 25 per cent, argyrol solution are instilled into the 
 eye, the chin meanwhile being held higher than the forehead. This 
 is again repeated every half hour during the da3% and the margins 
 of the lids are kept smeared with vaseline during the night. If 
 the discharge be copious, the saline douching is repeated every half 
 hour or so. This method of treatment has given us admirable results, 
 for all our cases have done well, and corneal ulceration has not been 
 seen since we systematically adopted it three years ago. If the treat- 
 ment just described be properly carried out, the discharge will be 
 found to become speedil.y diminished, and recovery will be more 
 rapid than if the lids be everted, their conjunctival surface brushed 
 daily with a 2 per cent, solution of nitrate of silver, and mild anti- 
 septic douchings employed at frequent intervals. In applying the 
 argyrol solution it is not necessary to evert the lids, as in the ease
 
 572 ARGYROL 
 
 of nitrate of silver. This proceeding in the hands of the unskilled 
 is a source of grave danger to the cornea. With argyrol all that 
 has to be done is to remove the discharge thoroughly with the 
 saline douche, then instil some half dozen drops of the solution in 
 the eye. 
 
 During the acute stage of simple catarrhal conjunctivitis and in 
 milder types there is no remedy that we have tried to compare 
 with frequent instillation of a 10 per cent, argyrol solution. In the 
 severer types, 25 per cent, solution should be employed, especially 
 in those cases that are on the borderland of purulent conjunctivitis. 
 The discomfort experienced in these cases is relieved instantly after 
 the instillation, the discharge becomes rapidly checked and recovery 
 is obtained, as a rule, without the least discomfort to the patient. 
 The treatment should be applied every two or three hours, or oft- 
 ener if the discharge is plentiful. If the affection does not go on to 
 complete recovery, as sometimes happens, but passes into the sub- 
 acute or chronic stage, where there is little or no discharge, argyrol 
 is useless, and its place should at once be taken with any of the 
 older colly ria. It is during the catarrhal or purulent stage of con- 
 junctival affections that argyrol is not precipitated by the sodium 
 chloride of the tears, so that simple instillation is all that is neces- 
 sary, provided the patient holds the chin higher than the forehead,, 
 to enable the fluid to find its way into the upper cul-de-sac by gravi- 
 tation. The head should be held in this position for a full minute 
 or so after the instillation, during which time the patient should 
 wink freely, to allow the solution to become diffused over the 
 whole conjunctival surface. When the patient sits up it is a good 
 plan to get him t.o bloAv the nose freely, so as to flush out the tear 
 ducts. 
 
 When a chronic, slow-going form of conjunctivitis is attended 
 with discharge, argyrol solution is useful only in checking the dis- 
 charge and preparing the eye, so to speak, for more suitable treat- 
 ment. If there be little or no accompanying discharge, argyrol is 
 practically useless. AAHien the condition is associated with hyper- 
 trophy of the palpebral conjunctiva and e version of the eyelids, 
 2 per cent, nitrate of silver solution, applied daily by the surgeon 
 with a camel's hair brush to the everted eyelid, is by far the best 
 non-operative treatment. 
 
 In the simple variety of corneal ulcers argyrol and atropine drops 
 are very useful, in 10 and i/o per cent, solutions respectively, in- 
 stilled three times a day, the atropine drops being applied half 
 an hour or so after the argyrol. In catarrhal ulcers this treat-
 
 ARGYROL 573 
 
 ment is also very satisfactory, but in sloughing ulcers of the cornea, 
 with hypopyon, it is disappointing, even although freely and fre- 
 quently applied in 25 per cent, solution. When the condition is due 
 to pneumo-coccal infection it is also a failure, and no time should 
 be lost in applying the cautery. In phlyctenular keratitis, wi1li or 
 without voscularisation, argyrol solution is of no use ; yellow oxide 
 of mercur}^ ointment, with cocaine and atropine, is certainly the best 
 treatment we know of. 
 
 We have found argyrol of very little use also in follicular, gran- 
 ular, and diplo-bacillary conjunctivitis, except as an adjuvant in 
 cheeking the discharge. 
 
 In the more common forms of epiphora, due to inflammatory 
 swelling of the lachrymal passages, argyrol is most beneficial. We 
 treat these cases with instillations of a 10 per cent, solution, teach- 
 ing the patient to press over the lachrymal sac with the finger while 
 the head is held well back and turned slightly to the opposite side, 
 the idea being to get the fluid. into the sac and down the nose on 
 the principle of the filling and emptying of a ball syringe. Should 
 this fail after a fortnight or three weeks' trial, we pass a No. 2 
 Bowman's probe down the duct into the nose without dividing the 
 canaliculus. The probe must be passed with the greatest care, so 
 as to avoid injuring the lining membrane of the duct. The instilla- 
 tions of argyrol, etc., are continued three times a day for a few 
 weeks. Improvements will be found on the second or third day 
 if the treatment is to be successful. ^Ve have tried this method of 
 treatment in this troublesome afl^ection for nearly three years with 
 very gratifying results. In chronic dacryocystitis, or mucocele, after 
 dividing the lower canaliculus and passing the largest Bowman's 
 probe, the patient is instructed to empty the sac by pressing over it 
 with the finger, and to instil a 25 per cent, solution of argyrol solu- 
 tion over the inner canthus, the same manipulations for getting the 
 solution down into the nose, as described in the management of sim- 
 ple epiphora, being adopted. Under this treatment the discharge 
 from the sac soon becomes arrested, and fewer probings are neces- 
 sary. The same treatment is adopted in dealing with tear duct 
 obstruction where a style is employed. The use of an Anel 's syringe, 
 with argyrol solution, in the treatment of lachrymal affections may 
 be attended with unpleasant consequences. It sometimes happens, 
 especially with a restless patient that the mucous membrane of the 
 duct becomes abraded, when the fluid may pass into the subcutane- 
 ous tissue, and leave a slight permanent staining of the eyelids. 
 
 In preparing the eye for operation, such as for cataract extrac-
 
 574 ARGYROSIS OCULI 
 
 tion, when there is evidence of discharge, as shown by staining of 
 the dressing, or by obscuration of the ophthalmometer mirror by 
 mucus, w^e have used argyrol solution in the strength of 25 per cent, 
 solution, to diminish the activity of the conjunctival flora. The 
 results obtained are thoroughly satisfactory, for we have not seen 
 a case of suppuration folloAving operations since this method of 
 treatment has been adopted some three years ago. 
 
 The treatment of the simple or squamous form of blepharitis 
 by argyrol is, in our experience, inferior to that with yellow oxide 
 of mercury ointment. In ulcerative blepharitis the best results we 
 have had have been with nitrate of silver in 2 per cent, solution, 
 applied to the margin of the eyelid after the crusts have been care- 
 fully removed with a weak, tepid solution of baking soda. The 
 nitrate should be applied daily till the ulcerative condition has 
 healed up, when the treatment with simple yelloAv oxide of mercury 
 ointment, applied three times a day, should be adopted. The oint- 
 ment should be continued for a few w^eeks after the lids appear well, 
 to prevent a relapse, and any refractive error should at the outset 
 be corrected and suitable glasses be worn constantly. 
 
 During the past few months we had three most typical cases of 
 dendritic corneal ulcers under treatment about the same time in the 
 hospital. Each case, to begin with, was treated with 25 per cent, 
 solution of argyrol every hour or two, but without the least benefi- 
 cial result. On applying the galvano-cautery, however, recovery 
 soon took place. 
 
 In addition to these observations and experiences of ]\IcGillivray 
 it is to be noted that — 
 
 A. Duane uses argyrol in all forms of acute conjunctivitis. He 
 employs it especially when there is much secretion both for office 
 and home treatment. The patient is instructed to apply it as fol- 
 lows: First wash out the eye freely with an indifferent solution 
 (saline or boric acid) ; then drop in the argyrol; then after 5 minutes 
 wash out this with the coagula that it has produced; then instill 
 argyrol again, and this time let it remain. This prevents the dis- 
 agreeable sensation of a foreign body that is produced if the argyrol 
 and coagula are left in. He also uses argyrol (preceded by adren- 
 alin) in lachrymal disease ; but now only by instillation — ncA^er by 
 injection into the sac. 
 
 Many physicians prefer to use this remedy as an ointment rather 
 than in solution, and it may be employed in this way in all strengths. 
 Lanoline, petrolatum and cold cream form good excipients. 
 Argyrosis oculi. Argyrosis of the conjunctiva is a permanent, dirty-
 
 ARGYROSIS OCULI 
 
 Ot'O 
 
 grey discoloration of the conjunctiva, especially of the lower fornix 
 (occasionally affecting the border of the lids), dne to precipitation 
 of silver oxide and silver albuminate after prolonged local applica- 
 tion of silver nitrate and other silver-salt solutions. This stainins: 
 of the conjunctival tissues also occurs from other silver salts that 
 do not form a precipitate with albumen, like protargol and argyrol. 
 
 Silver workers are occasionally affected. An arg^^ria limited to 
 the caruncle and semilunar folds has also been found in photog- 
 raphers. The condition may occur quite quickly ; a solution of 
 silver nitrate as weak as 1 to 500 has j^roduced argyrosis as early 
 as the tenth day. In general argyrosis from prolonged internal use 
 the conjunctiva is also affected. 
 
 A bluish-grey discoloration of the eyelids is one of the symptoms 
 of general argyrosis after internal, more rarely after external, 
 applications of silver salts. It is a local phenomenon that appears 
 only after long continued exhibition of argentic preparations. 
 
 Lewin and Guillery gave some interesting reports of argyria and 
 its effects on the external ocular apparatus. The conjunctiva of a 
 man Avho used a solution of silver nitrate in the eye and wdio applied 
 it for about four months, showed as a result an intense bluish, 
 almost black discoloration. The silver had so penetrated the tissues 
 that the surface appeared a light yellowish color, but in the deep 
 tissues there was a more noticeable deposit, especially in the fine 
 elastic fibres. The intercellular substance Avas unaffected. Argy- 
 rosis of the conjunctiva was also seen in a man Avho had dyed his 
 beard and hair with silver nitrate for 25 or 30 years. Tt also 
 resulted from swabbing the larynx twice daily for 10 years. In this 
 case the conjunctiva, the face, neck and gums were discolored. In 
 cel'tain occupations it is likely to occur, as in workers wdio silver 
 glass pearls. These w^orkmen draw up a silver solution into 3 to 4 
 em. long glass tubes held in the mouth; during this occupation some 
 silver solution gets into the mouth. After varying lengths of time 
 (3 to 4 years) a general argyrosis appears on the lids, conjunctiva, 
 etc. In one case a discoloration of the iris was observed, with a 
 beginning double-sided cataract. 
 
 The danger of argyrosis is especially great in those Avho use 
 silver nitrate internally. In the course of a year one patient took 
 34 grams of silver nitrate in pill form. In nine months a greyish- 
 black coloration of the face appeared and became graduallj^ Avorse. 
 The patient died, and it was found that not only the skin but the 
 mucous and serous surfaces, the vessels and glands, choroid plexus, 
 etc., contained silver. In the epithelium there was no pigment, nor
 
 576 ARGYROSIS DER LIDHAUT 
 
 was there in the substance of the brain and cord, pia and arachnoid, 
 but there was a deposit on the internal surface of the dural sheath 
 of the optic nerve. There was a granular deposit in all the connec- 
 tive tissue regions of the eyeball, except in the nerves and retina. 
 Silver deposits were demonstrated in the sclera, conjunctiva, the 
 subconjunctival tissue, Tenon's capsule, the tendons and the inter- 
 stitial tissue of the muscles. In the choroid the demonstration was 
 impossible on account of the pigment, but silver was found in the 
 ciliary vessels ; in fact the tissues richest in vessels were most 
 affected, indicating that the silver is imported by way of the vas- 
 cular system. 
 
 Visual disturbances are produced by silver nitrate, especially a 
 true intoxication amblyopia with central scotoma. This symptom 
 was present in a man who had for years dyed his beard with silver 
 nitrate solution. He showed a light, grey-blue coloration of both 
 cheeks, and of the buccal mucous membrane. He also complained 
 of general symptoms, weakness, reduced mental power and some 
 disturbance of hearing. On removal of the cause of the argyria the 
 symptoms disappeared. 
 
 Terlinek (Ophthalmic Year Book, 1909,) reports two instances 
 of argyrosis of the conjunctiva from long-continued applications of 
 silver nitrate solutions. An attempt was made to remove the stain 
 from one eye by instilling sodium hyposulphite, as recommended by 
 zur Nedden. After two months there was distinct lightening of 
 the stain, but further treatment was unavailing. Microscopical ex- 
 amination of excised tissue showed that the subepithelial granules 
 had been greatly reduced in number, but those deposited on the 
 elastic fibers deeper in the tissues were unaffected. 
 
 Argyrosis der Lidhaut. (G.) Argyria: a grayish discoloration of the 
 eyelid, occurring in silver-workers. 
 
 Arhinencephalie. (G.) Cyclopia. 
 
 Aridura bulbi. (L.) An old term for atrophy of the eyeball. 
 
 Arimaspi, The. A mythical people, supposed to dwell in the north of 
 Scythia and to be by nature monocular. According to Aristeas, an 
 epic poet of Proconnesus (whose date is quite uncertain) the Arimaspi 
 fought with the griffins for the gold of the Ural mountains. — (T. H. S.) 
 
 Ariovistus. A Gallic physician whose name appears upon one of the 
 ancient oculistic seals. He probably flourished in the second or 
 third century, A. D. Nothing further is known about him. — 
 (T. H. S.) 
 
 Aristol. Thymotol. Thymol iodide. Thymodin. Iodistol. Iosol.
 
 ARISTOTLE 577 
 
 loDOSOL. Annidaijn-. Dithymol diiodide. C2(Jl2402T2. Iodide of 
 thymol (U. S. P.) is a yellow-red powder with faint aromatic odor, 
 insoluble in water, slightly soluble in ether, very soluble in chloro- 
 form, containing 45 per cent, of iodine. It is made by the action 
 of iodine, potassium iodide and sodium hydroxide on thymol. 
 
 This remedy was much exploited as a substitute for iodoform 
 but, in eye cases at least, has failed of expectation. It is, how- 
 ever, a mild, and, in every regard, inoffensive preparation worthy of 
 trial where a simple, antiseptic, iodine, dry dressing is needed. 
 Vignes thinks it does not irritate tlie eye or increase secretion. It 
 has been recommended as an application in interstitial keratitis. 
 
 Daxenburger also recommends its use in lime burns, blepharitis 
 and phylctenular keratitis, of a ten per cent, mixture in oil of 
 sesame. This is a transparent, red-brown fluid which does not throw 
 down a deposit or become rancid. 
 Aristotle. This immortal philosopher, as well as "Father of the Natural 
 Sciences," * was the son of a famous physician, Nicomachus, who was 
 himself descended from another physician, Nichomachus, alleged to 
 have been the grandson of the old G-reek god of healing, Aesculapius. 
 Aristotle was born at Stagira (whence his surname, "the Stagirite") 
 near Mount Athos, H. ('. 384. Twenty yeai's lie spent in company 
 with Plato, at Athens, then three with Hermias, the Eunuch, t^^rant 
 of Atarneus. After that, he was called to Macedonia, where, at the 
 court of Phillip, he was appointed instructor to Phillip's son, Alex- 
 ander, afterwards known as "the Great." While at this court, Aris- 
 totle supplicated Phillip to restore the former's native city, Stagira, 
 which Phillip had destroyed, and his entreat}' was granted. "He also 
 made laws for the citizens." 
 
 Then the great philosopher and founder of modern science went to 
 live at Athens, where, in the covered walks round the temple of the 
 Lycean Apollo, on the east side of the city, he set up his school in 
 opposition to the Platonic school (now under the management of 
 Zenocrates) -which was conducted in the Academia gardens on the 
 west side of Athens. Because of his continually walking up and down 
 in the Lyceum with his disciples, "till the time for anointing them- 
 selves came," as Diogenes Laertius puts it, he was called the "Peripa- 
 tetic," and his philosophy "the Peripatetic philosoi)hy. " His school 
 of philosophy is also often known as ' ' the Lyceum, ' ' while Plato 's, for 
 a similar reason, is called "the Academy." 
 
 Aristotle was a peculiar looking man, according to all accounts, liav- 
 
 ' Thoiigli not the "fatlier" of pliilosopliy, he wtis undoubtedly the father of 
 the history of that subject. 
 
 Vol. I— 3 7
 
 578 ARISTOTLE 
 
 iiig small eyes and very thin legs, as well as, probably, other unpre- 
 possessing physical characteristics. Besides, in the attempt to make 
 himself attractive, he spoke with "a lisping voice," arranged his hair 
 with the utmost extravagance, and even indulged in very conspicuous 
 dress and rings. Very magnetic he was, however, spite of all these 
 adverse circumstances, on account of his abundant flow of new and 
 true ideas, which rapidly produced in the hearer a sweet forgetfuluess 
 of his physical imperfections. 
 
 For thirteen years Aristotle walked and talked in the Lyceum, and 
 it is more than probable that, in the course of this period it was that 
 he wrote the astounding volumes which, though not appreciated ^ully 
 in antiquity, ruled in the middle ages not only supreme among all 
 secular writings, but, one might almost add, alone. 
 
 Of his genuine w^orks, the folloAving, only, are extant; (there were 
 many others) : 1. Topics. 2. Prior Analytics. 3. Posterior Analytics. 
 4. On SopJiistical Refutations. 5. Art of Bhetoric. 6. Nicomachean 
 Ethics. 7. Politics. 8. On the Art of Poetry. 9. A Physical Dis- 
 course. 10. On the Heavens. 11. On Generation and Destruction. 
 12. Meteorologies. 13. Researches about Animals. 14. On Soul. 15. 
 Appendices to Ihe preceding work — (a) On Sense and Sensible 
 Things, (b) On Memory and Recollection, (c) On Sleep and Wak- 
 ing, (d) On Dreams and Prophesying in Sleep, (e) On Longevity 
 and Shortlivedness. (f) On Youth and Old Age. (g) On Life and 
 Death, (h) On Respiration. 16. On Parts ■ of Animals. 17. On 
 Locomotion of Animals. 18. On Generation of Animals. 19. The 
 Metaphysics. ■ 
 
 Though none of the works in this list is devoted exclusively to 
 ophthalmology, Aristotle is, nevertheless, of great ophthalmologic im- 
 portance because of the numerous observations and inferences concern- 
 ing the human and the animal eye, which are scattered about in his 
 various compositions. These can, perhaps, best be grouped as follows : 
 (1) Those Relating to the Human Eye, (a) its anatomy, (b) its physi- 
 ology (including his theory as to the nature of light), (c) its pathol- 
 ogy (to all intents and purposes limited to errors of refraction and 
 senile failure of accommodation). (2) Those Relating to the Animal 
 Eye. Of each of these topics in its turn. 
 
 (1) The human eye. — (a) Anatomy. In "The History of Ani- 
 mals" (Chap, viii, sees. 2 and 5) we find the following mixture of 
 physiognomy and anatomy: "Under the forehead are two eyebrows; 
 if they are straight, it is a mark of a gentle disposition ; the eyebrows 
 bent doAvni to the nose are an evidence of an austere temper ; if they in- 
 cline towards the temples, of a mocker and scoffer ; if they are drawn
 
 ARISTOTLE 
 
 0<1 
 
 down, it is a sign of an envious person. Beneath these are the eyes, 
 which by nature are two in number: the parts of each eye are, first, 
 the upper and under eyelid, the edges of wliit-h are furnished with 
 hair. Within the eye, tlu? moist part, with which we see, is called the 
 pupil ; round this is the iris, and this is surrounded by the white. Two 
 corners of the eye are formed at the junction of the eyelids, one in 
 the direction of the nose, the other towards the temple. If these corners 
 are large, they are a sign of an evil disposition ; if those near the nose 
 are fleshy, and have a swollen appearance, they are an evidence of 
 Avickedness. * * * The eyes of .some persons are large, others small, 
 and others of a moderate size — the last-mentioned are the best. And 
 some eyes are projecting, some deep-set, and some moderate, and those 
 which are deep-set, have the most acute vision in all animals ; the 
 middle position is a sign of the best disposition. Some people have 
 an eye w-hich is perpetually opening and closing, others have an eye 
 always intent, and others a moderately-intent eye : this last is the 
 best disposed ; of the others, the one is impudent, and the other a sign 
 of infirmity." 
 
 Aristotle was the very first to describe the iris specifically, and 
 probably the first to mention the diverse colors exhibited l)y this 
 membrane in different individuals. Thus, "In some it [the iris] is 
 black, in others decidedly gray, in others dark gray, and in some it 
 is the color of the goat 's eye, and this is a sign of the best disposition, 
 and is most to be prized for acuteness of vision. Man is almost the 
 only animal which exhibits a variety of coloring in the eye. * * * " 
 He was also the first to observe that all children are born with blue 
 irides. He mentions once that the eye is filled with fluid, because, 
 when the eye is injured, it sends water out. One passage of Aristotle's 
 about the connection of the eye with the brain is hopelessly obscure; 
 another runs: "The eye is also connected with the brain, and each 
 eye is placed upon a vein." It is not at all likely that "vein" is here 
 intended to refer to the optic nerve. That structure was. in fact, first 
 discovered, so far as can now be ascertained, by Ilerophilus. 
 
 Of the conjunctiva, Aristotle, in common with all his predecessors 
 and contemporaries, knew absolutely nothing. The same may l)e said, 
 w^th perhaps a trifle less of unqualified certainty, regarding the 
 apparatus lachrymalis. Whether or not the great observer knew of 
 the existence of the semilunar fold, or of the caruncula lachrymalis, 
 is in doubt. He assuredly did not know of the existence of the anterior 
 chamber, nor did anybod.y else for many hundred years. 
 
 (b) Physiology. Aristotle's theory of vision and the nature of light 
 was vastly in advance of those of all of his predecessors. Thus,
 
 580 ARISTOTLE 
 
 Alcmaeon, Anaxagoras, and Democritus had taught that colored images 
 were being continually detached from objects, and that these little 
 masks, or easts, pressing into the e3'e, were fixed in the pupil, until 
 the soul was able to take note of them. Eiupedocles, Diogenes, and 
 Plato, on the other hand, had taught that rays of light, running out 
 from the object looked at, were met by other rays which had been 
 emitted from the eye, and that these two varieties of rays, meeting 
 somewhere between the object and the eye, begot, somehow, a third 
 variety of rays, out of which the image was produced, and by which it 
 was, somehow, brought to the soul's attention. Then came Aristotle, 
 with his well-formed, unobscure theory, so greatly in advance of his 
 day as now to seem almost incredibly modern. According to this 
 theory, all the higher sense-perceptions are caused to exist in this 
 way : The object perceived excites a motion, in consequence of which 
 the sense organ is acted upon. What we see of an object is its color ; 
 but this we do not see directly, but only through the medium of the 
 light, which the color sets in motion and causes to produce an impres- 
 sion in the organ. Without the light we can see no color, hence no 
 object either. However, the light is not a body, nor is it anything 
 emitted by a body. Nor does it occur of itself, but it is begotten by 
 the motion which is produced by the color of the object looked at. 
 * * * It is here exactly as in the perception of hearing and smell- 
 ing, for neither the sounding nor the smelling body occasions the sen- 
 sation by touching the respective sense-organ, but it sets in motion, 
 first, a medium, and, through that, the sense-organ; so, out of the 
 changes in the organs thus produced occur the perceptions of the 
 Avoi-ld of the senses. It is hardly necessary to point out here how" like 
 the modern theory- of light and of vision this explanation of old Aris- 
 totle's is. True as was the theory, however, it met with little favor in 
 antiquity, especially among physicians, and, even in the middle ages, it 
 remained without acceptance, save, here and there, by a spirit select, 
 sucli as the late Arabian. Alhazen. and his successor in these matters, 
 Averroes. 
 
 (c) Pathology. Aristotle's ocular pathology is limited well-nigh 
 exclusively — and almost as a matter of course, since he was not a physi- 
 cian but a philosopher — to errors of refraction and senile failure of 
 accommodation. This latter affection — to deal with that subject first — 
 he does not understand for what it reallv is ; indeed the very fact itself 
 of accommodation was wholly unknown in his day. He offers — perhaps 
 with only apparent inconsistency — two entirely different explanations 
 of this weak-sightedness of the aged. One explanation is that the 
 body as a whole becomes, in later life, abnormally dry, and that the 
 ocular tissues (especially those of the inner parts — that is to say, the
 
 ARISTOTLE 581 
 
 riuids) j^articipating in this general dessication, do not permit the 
 rays of light to traverse tlicni so freely as happens in the earlier years 
 of life. The second explanation, however mistaken, is of a truly 
 optical character. It runs to this effect, namely : That the visual 
 rays, emerging from the eye (here he is guilty of following not his 
 own theory of light, but that of other, and more mistaken, philosophers) 
 come together — or, as one would express it toda}^ come to a focus — in 
 the case of an old person, at a greater distance from the eye than in 
 youth, and that from this arises the necessity, in the aged, of holding 
 an object fartlier from the eye than formerly, if it is to be distinctly 
 seen. 
 
 As to errors of refraction, Aristotle speaks both of short-sight and 
 of long-sight, and contrasts the two varieties of visual weakness very 
 thoroughly. It is also noteworthy that he gives as the three most 
 salient concomitants of shortsightedness: (1) prominence of the eye- 
 balls (2) squeezing together of the lids (3) a tendency to write with 
 small letters. He makes, too, as we believe, the earliest attempt in 
 history at a correction of myopia when, for this condition, he recom- 
 mends that the patient look at distant objects through a narrow (of 
 course lensless) tube. In a kind of way, we may regard this rudi- 
 mentary device as the beginning both of spectacles and of the tele- 
 scope. 
 
 (2) The animal eye. — In comparative ophthalmology^ as 
 well as in optics, Aristotle shone as the bright particular star of 
 antiquity. And indeed his achievement in this field can best be ex- 
 hibited by certain of his- own highly condensed passages themselves. 
 From "The History of Animah," then, (Chap, viii, par. 4,) we find 
 the following observation: "]\Ian is almost the only animal which 
 exhibits a variety of coloring in the eye; there are, however, some 
 horses with gi'ay eyes." Not a remarkable passage, perhaps, but ex- 
 hibiting at least the beginnings of a comparative ophthalmology. In 
 the paragraph next succeeding, we run across this, which is absolutely 
 incorrect: "Those Avhieh are deep-set have the most acute vision in 
 all animals." A truer observation occurs in Chap, xii, par. 4: "Man 
 has the eyes closer together, in proportion to his size, than other 
 animals." 
 
 The most important passages, however, of Aristotle's comparative 
 ophthalmology, are found, very much scattered about, ^ in his ''Parts 
 
 1 We may here remind ourselves tliat Aristotle, tliougli the "father" (among 
 so many other desirable offsprincr) of "Rhetoric," was himself almost entirely 
 indifferent to literary form. And of all the "crabbed and obscure" works which 
 the "father" of elearness-in-others composed, the "Parts of Animals" is the 
 most crabbed and the most obscure.
 
 582 ARISTOTLE 
 
 of Animals.'^ By way of preliniination, Ave ought to present, first 
 of all, from this book, Aristotle's view as to the seat of sensation in 
 general. This view we find expressly stated (together with his oppo- 
 sition to the brain-sensation theory) in the second book and tenth 
 chapter, as follows : ' ' These writers see that certain of the senses are 
 located in the head, and are unable to discern any reason for this; 
 they see also that the brain is the most peculiar of all the animal 
 organs; and out of these facts they form an argument, by which they 
 link sensation and brain together. It has, however, already been 
 clearly set forth in the treatise on sensation, that it is the region of 
 the heart that constitutes the sensory center. ' ' This is a very peculiar 
 view, to say the least, to be held by the Father of so many good and 
 scientific gifts. But when we consider the reasons on which his view 
 was based, we are not so greatly astonished. These reasons were: (1) 
 when vivisecting certain animals (especially the chameleon) he had 
 noted that the cerebral hemispheres could be cut, and, in fact, manip- 
 ulated, without the production of pain, or of fear, or of any kind of 
 struggling (2) he could find no brain of any sort or kind in any of the 
 invertebrate animals, excepting alone the Cephalopoda, and yet these 
 animals undoubtedlj' possessed the power of perceiving sensation (3) 
 he had found (as he believed) that the brain was a wholly bloodless 
 organ, and, throughout the body generally, bloodless organs were de- 
 void of sensation (4) "It is manifest, on inspection, that there is no 
 anatomical connection between brain and sense-organs." The "vein" 
 above referred to, which he mentions as connecting the eye with the 
 brain, he had evidently forgotten, when writing the passage just now 
 cited, or else had not (and this is very probable) as yet observed it. 
 
 Eeferring to our more specific subject, Aristotle remarks {"Parts of 
 Animals," ii, 10) : "Now that vision, whenever it exists, should be 
 in the neighborhood of the brain, is but what we would rationally ex- 
 pect. For the brain is fluid and cold, and vision is of the character of 
 water, water being of all transparent substances the one most easily 
 confined." He exhibits a similar passage in his work, "On Sense 
 and the Sensible/' Ch. 2, 12: "The faculty of sight does not belong 
 to the eye because it is of water, but because it is transparent, a 
 quality which exists in air no less than in water. But water is less 
 elastic, and more easily kept in place than air, and on this account the 
 eye is made of it. That the eye is made of it, is manifest from the 
 fact that water runs out of it when it is ruptured. " Both these pass- 
 ages, of course, show very clearly the strong influence of the humoral 
 theory of disease which not only governed like a tyrant the pathologj^ 
 of Aristotle's time, but that of many a long century to follow.
 
 ARISTOTLE 58 
 
 o 
 
 Passing on to comparative ophtlialuiology proper, we find the fol- 
 lowing valuable passages in "The Furls of Animals," Book II : (C'/i. 
 13.) Men, and Birds, and Quadrupeds, viviparous and oviparous 
 alike, have their eyes protected by lids. In the vivipara there are two 
 of these; and both are used by these animals not only in closing the 
 eye, but also in the act ol* blinking; whereas the oviparous quadrupeds, 
 and the heavy-bodied l)irds as well as some others, use only the lower 
 lid to close the eye; while birds blink b}' means of a membrane con- 
 nected with the canthus. The reason for the eyes being thus protected 
 is that nature has made them of fluid consistency, in order to ensure 
 keenness of vision. For had they been covered with hard skin, they 
 would, it is true, have been less liable to get injured by anything fall- 
 ing into them from without, but they would not have been sharp- 
 sighted. It is then to ensure keenness of vision that the skin over the 
 pupil is fine and delicate ; while the lids are super-added as a protec- 
 tion from injury. It is as a still further safeguard, that all these 
 animals blink, and man most of all ; this action (which is not performed 
 from deliberate intention but from a natural instinct) serving to keep 
 objects from falling into the eyes ; and being more frequent in man 
 than iix the rest of these animals, because of the greater delicacy of 
 the skin. These lids are made of a roll of skin ; and it is because they 
 are made of skin and contain no flesh [a mistake, since, by "flesh," 
 Aristotle undoubtedly means "muscle"] that neither they, nor the 
 similarly constructed prepuce, unite again when once cut. [Again a 
 mistake, but an easy one to make in the time of Aristotle, since very 
 great surgical care is required to bring about union of these parts.] 
 
 "As to the oviparous quadrupeds, and such birds as resemble them 
 in closing the eye with the lower lid, it is the hardness of the skin of 
 their heads which makes them do so. For such birds as have heavy 
 bodies are not made for flight ; and so the materials which would other- 
 wise have gone to increase the size of the feathers are diverted thence, 
 and used to augment the thickness of the skin. Birds therefore of this 
 kind close the eye with the lower lid ; whereas pigeons and the like use 
 both upper and lower lids for the purpose. As birds are covered with 
 feathers, so oviparous quadrupeds are covered with scaly plates; and 
 these in all their forms are harder than hairs, so that the skin also to 
 which they belong is harder than the skin of hairy animals. In these 
 animals, then, the skin on the head is hard, and so does not allow of 
 the formation of an upper [movable] eyelid, whereas lower down the 
 integument is of a flesh-like character, so that the lower lid can be thin 
 and extensible: 
 
 "The act of blinking is performed by the heavy-bodied birds [in
 
 584 ARISTOTLE 
 
 fact by; all birds] by means of the membrane already mentioned, and 
 not by this lower lid. For in blinking rapid motion is required, and 
 such is the motion of this membrane, whereas that of the lower lid is 
 slow. It is from the inner canthus, that is from the one nearest to the 
 nostrils, that the membrane comes. For it is better to have one start- 
 ing point for nictitation than two; and in these birds this starting- 
 point is the junction of eye and nostrils, an anterior starting-point 
 being preferable to a lateral one. Oviparous quadrupeds do not blink 
 in like manner as the birds ; for, living as they do on the ground, they 
 are free from the necessity of having eyes of fluid consistency and 
 of keen sight,, whereas these are essential requisites for such birds as 
 have to use their eyes at long distances. This too explains why birds 
 with talons, that have to search for prey by eye from aloft, and there- 
 fore soar to greater heights than other birds, are sharp-sighted ; while 
 common fowls and the like, that live on the ground and are not made 
 for flight, have no such keenness of vision. For there is nothing in their 
 mode of life which imperatively requires it. 
 
 ' ' Fishes and Insects and the hard-skinned Crustacea present certain 
 differences in their ej^es, but so far resemble each other as that none 
 of them have eyelids. [Not quite correct. The shark and a few other 
 fishes do possess eyelids.] As for the hard-skinned Crustacea it is 
 utterly out of the question that they should have any; for an eyelid, 
 to be of use, requires the action of the skin to be rapid. These animals 
 then have no eyelids and, in default of this protection, their eyes are 
 hard, just as though the lid were attached to the surface of the eye, and 
 the animal saw through it. Inasmuch however as such hardness must 
 necessarily blunt the sharpness of vision, nature has endowed the eyes 
 of Insects, and still more those of Crustacea [because their heads are 
 less movable than those of insects] with great mobility (just as she 
 has given some quadrupeds very movable ears), in order that they 
 may be able to turn to the light and catch its rays, and so see more 
 plainly. Fishes however have eyes of a fluid consistency. For all 
 animals that move much about have to use their vision at consider- 
 able distances. If now they live on land, the air in which they move 
 is transparent enough. But the water in which fishes live is a hindrance 
 to sharp sight, though it has this advantage over the air, that it does 
 not contain so many objects to knock against the eyes. The risk of 
 collision being thus small, nature, who makes nothing in vain, has 
 given no eyelids to fishes, while to counterbalance the opacity of the 
 water she has made their eyes of fluid consistency. 
 
 " {Ch. 14.) All animals that have hairs on the body have lashes on 
 the eyelids; but birds and animals with scale-like plates, being hair-
 
 ARISTOTLE 585 
 
 less, have none. [A keen and absolutely correct observation. What 
 appear to be eyelashes in owls, hornbills and parrots are really feath- 
 ers — a fact sufficiently substantiated by the tiny barbs.] The Libyan 
 ostrich indeed, forms an exception ; for, though a bird, it is furnished 
 with eyelashes. This exception, however, will be explained hereafter. 
 Of hairy animals, man alone has lashes on both lids. For in quadru- 
 peds there is a greater abundance of hair on the liack than on the 
 under side of the body; whereas in man the contrary is the case, and 
 the hair is more abundant on the front surface than on the back. The 
 reason for this is that hair is intended to serve as a protection to its 
 possessor. Now, in quadrupeds, owing to their inclined attitude, the 
 under or anterior surface does not require so much protection as the 
 back, and is therefore left bald, in spite of its being the nobler of 
 the two sides. But in man, owing to his upright attitude, the anterior 
 and posterior surfaces of the body are on an equality as regards need 
 of protection. Nature therefore has assigned the protective covering 
 to the nobler of the two surfaces ; for invariably she brings about the 
 best arrangement of such as are possible. This then is the reason that 
 there is no lower eyelash in any quadruped; though in some a few 
 scattered haire sprout out under the lower lid. [Absolutely true. Cer- 
 tain monkeys and antelopes do exhibit "a few scattered hairs" "under 
 the lower lid."] ******* 
 
 " {Ch. 15.) Both eyebrows and eyelashes exist for the protection 
 of the eyes ; the former that they may shelter them, like the eaves of a 
 house, [cf. Shak. "his penthouse lid"] from any fluids that trickle 
 down the head ; the latter to act like the palisades which are some- 
 times placed in front of enclosures, and to keep out any objects wiiich 
 might otherwise get in. The brows are placed over the junction of 
 two bones, which is the reason that in old age they often become so 
 bushy as to require cutting. The lashes are set at the terminations 
 of small blood-vessels. For the vessels come to an end where the skin 
 itself terminates; and, in all places where these endings occur, the 
 exudation of moisture of a corporeal character necessitates the growth 
 of hairs, unless there be some operation of nature which interferes, by 
 diverting the moisture to another purpose." [Aristotle, we need hardly 
 remind ourselves, knew nothing of the circulation of the blood.] 
 
 In the same great work, Book iv, Chap. II, occurs the following : 
 "These animals [reptiles] have no upper eyelid, but close the eye 
 with the lower lid. [The truth, of course, is that reptiles have an upper 
 lid, but use the lower almost, or quite, exclusively.] In this they re- 
 semble birds, and the reason of the peculiarity is the same as was as- 
 signed in their case. Among birds there are some that can not only
 
 586 ARISTOTLE 
 
 close the eye, but can also blink by means of a membrane which comes 
 from its inner corner. But none of the oviparous quadrupeds blink in 
 this manner. [A mistake.] For their eyes are harder than those of 
 birds. The reason for this is that sharpsightedness is of very con- 
 siderable service to birds, flying as they do in the air, whereas it 
 would be of comparatively small use to the oviparous quadrupeds, 
 seeing that they all live in holes. ' ' * 
 
 Finally, near the close of the same great work, Book iv, Chap. 14, 
 we find : "On the other hand it [the Libyan ostrich) agrees with quad- 
 rupeds in having upper eyelashes, which are the more richly supplied 
 with hairs because the parts about the head and the upper portion of 
 the neck are bare. * * * *" 
 
 In spite of the numerous mistakes in the comparative ophthal- 
 mology of Aristotle, that branch of the old philosopher's science is 
 certainly remarkable for its keen and accurate observation, as well as 
 for its profound and wide-sweeping reflection. It is, further, de- 
 cidedly noteworthy because it is in fact the first attempt of its kind 
 in the history of the subject. This fact is w'ell-nigh incredible, when 
 we reflect that dissections, in those days, were practised on the lower 
 animals exclusively. Yet the fact is not to be disputed, and, among 
 so many other subjects, this subject, too, wall have to be set down 
 as one of those to which this very identical old philosopher was mas- 
 culine progenitor. 
 
 There is still another extraordinary fact in the history of com- 
 parative ophthalmology, to wit, that, despite the continued restriction 
 of dissections to the lower animals exclusively, and that not merely 
 in one land but in absolutely every so-called civilized country, the sub- 
 ject in question was scarcely touched upon again till the time of the 
 great Arabian ophthalmologist, As-Sadili, who flourished near the 
 close of the 14th cQptury, A. D. 
 
 * At the risk of seeming ungrateful to tliis old philospher, to whom every 
 individual member of the human race is, ^^dthout exception, indebted deeply, we 
 desire to point out three very conspicuous deficiencies in his ophthalmology — con- 
 spicuous because of the fact that, even in his time, they could so very easily have 
 been supplied. 
 
 1. — He has nothing at all to say about the visual field. (Hemianopia was 
 mentioned by Hippocrates, who lived before Aristotle. The first attempt at 
 measuring the visual field was made by Ptolemy, who flourished A. D. 150. The 
 "blind spot" — corresponding to the entrance of the optic nerve — was discovered 
 by the French physicist, Mariotte, in 1666. Finally, the first exact measurement 
 of the visual field was made by the English physicist, Thomas Young, iu 1801.) 
 
 2. — He did not notice the differences which so manifestly exist in the form of 
 the pupil in various kinds of animals — e. g., cats (vertical), cattle (horizontal), 
 
 dogs (round). 
 
 3. — He did not notice the pupillary light-reflex. (For an observation of this 
 very conspicuous and striking, phenomenon, the world was in fact obliged to 
 wait until the time of ar-Ehazi, or Ehazes, an Arabian physician who lived from 
 850 to 932 A. D.)
 
 ARLT, FERDINAND RITTER VON 
 
 587 
 
 Then, very strange to say, the subject was summarily dropped, 
 and not resumed again till nearly the close of the all-embracing 19th 
 century. 
 
 Even yet there remains a very great deal to be accomplished in the 
 field of comparative ophthalmology. Aristotle, As-Sadili, Beer, 
 Schleich, Wiedersheim, Lindsay Johnson, Iless: thus, by the inves- 
 tigators ' names, we may be able to bear in mind a kind of summary 
 of the history of the subject. — (T. H. S.) 
 Arlt, Ferdinand Ritter von. One of the most distinguished ophthal- 
 moloeists of all tlic ages, Arlt was the son of a humble blacksmith 
 
 Ferdinand Bitter von Arlt. 
 
 at Obergraupen, Bohemia. Here he was born Apr. 18, 1812, and 
 here he spent his boyhood days. He attended the grammar-school at 
 Leitmeritz, and the University at Prague, where he graduated in 
 1839. An ophthalmologic pupil of Professor J. N. Fischer, he acted 
 from 1846 to 1849 as substitute-professor of diseases of the eye in 
 the Prague University, and, from August, 1849, till July, 1856, as 
 incumbent of the same position in his own right. Beginning in 1856, 
 he lectured with world-renowned success on diseases of the eye at 
 the University of Vienna, until July, 1883, when, as a result of the 
 Austrian law, he had reached the age-limit, and so was compelled 
 to retire. From this time on, however, until his death, he continued 
 in active ophthalmic authorship and in private practice. He died of 
 senile gangrene Mar. 7, 1887. 
 
 His writings are very numerous. Aside from journal articles.
 
 588 ARLT'S ENUCLEATION METHOD 
 
 these are: Pflcge dcr Augcn im gesunden und kranken Zuslande, 
 nehst cincrii Anhange iiher Augcngldser (Prague, 1846; improved 
 edition, Prague, 1868). In this little volume, Arlt calls on the medical 
 profession to fit spectacles and eye glasses themselves, instead of leav- 
 ing so important a matter to opticians. Krankheiten des Auges (3 vols, 
 1851, 1853, 1856). Injuries of the Eye (Vienna, 1875). Die Kurz- 
 sichtigkeit, Entstehung und Ursachcn (Wien, 1878). Klinische Dars- 
 tellung der Krankheiten der Binde — , Horn^ — und Lederhaut, dann 
 der Iris und dcs Ciliarkorpers (Vienna, 1881). Opcrationslchre 
 (Graefe-Saemiseh, Handhuch dcr Gesamten Augenlicilkundc, Bd. Ill, 
 2 Teil, Leipzig, 1874). 
 
 In 1855, he became joint editor with Donders of Graefe's Archiv 
 fiir Ophthahnologie. 
 
 Arlt was distinctly and undeniably one of the "path-makers" in 
 ophthalmology. Indeed, in almost every book and article that he 
 vs^rote, he exercised a decidedly formative influence on the entire 
 profession. Thus, it was largely due to his influence that the test- 
 types of Jaeger and of Snellen came into use, that oculists began to 
 fit glasses themselves, that the view that short-sight was produced 
 by lengthening of the antero-posterior diameter of the eye was gen- 
 erally adopted, etc. As a teacher, he was even more successful than 
 as a writer. Those who had the pleasure of attending his lectures 
 have declared that even the dullest student w'ould listen to Arlt's 
 every word Avith almost breathless interest. It was owing to Arlt's 
 influence that Albrecht von Graefe turned his attention to ophthal- 
 mology. A long succession of oculists who afterward became famous 
 were trained by this deeply scientific and yet inspiring teacher. — 
 (T. H. S.) 
 Arlt's enucleation method. Arlt's method of enucleation (1859), de- 
 scribed by H. Knapp, is as follows (he used no strabismus hook) : 
 
 He incises the conjunctiva from 2 to 3 millimeters behind the 
 limbus cornete, and pushes it somewhat back. Standing on the right 
 of his patient, he, in the left eye, divides first the external, in the 
 right the internal rectus, grasping it with toothed forceps, but leaves 
 a small stump to get a firm hold of the globe w-ith the forceps. After 
 division of the inferior and superior recti, he pulls the eye Avith the 
 forceps horizontally tow^ards the inner (or outer) canthus, passes a 
 pair of scissors over the posterior segment of the sclerotic, as far as 
 the optic nerve, opens the branches, advances the scissors, so that 
 the nerve lies between the branches, and cuts it close to the sclerotic. 
 He now^ turns the protruding eyeball to the side of the uncut rectus, 
 divides the insertions of the obliques, and the vessels and nerves, at
 
 ARLT'S IRIS PUNCH 
 
 589 
 
 Ihc posterior half of the globe, and lasll\- drtaehes the insertion of 
 the fourth reetiis, togetlicr with tlie ovei'lying eonjunctiva, from the 
 sclerotic.— (F. A.) 
 Arlt's iris punch. \'oii Arlt fii-sl devised and recommended a punch 
 for cutting out a |)iece of occluding pupiUary membrane and the 
 iris attached to it. After an incision through the cornea and iris 
 Avith a keratonie he entered the anterior chamber with the punch 
 (with closed beakj and allowed it to open far enough to get the iris 
 diaphragm between the two bhides. Then, on closing the blades with 
 
 Arlt's Iris Punch. 
 
 firm pressure, a piece of the diai)hragni is punched out and with- 
 drawn. — (A. A.> 
 Arlt-Jaesche operation for trichiasis. An intermarginal incision is 
 made along the whole length of the lid, following the gray line on 
 • the free border. This incision should be 3 or 4 mm. in depth, and 
 should be so placed that all the lashes will be in the anterior layer 
 which is separated from the tarsus. A fold of skin is next removed 
 from the anterior surface of the lid in the following manner. An 
 incision is made in the skin parallel to the free border and about 
 4 mm. from it; above this and joining it at each end, thei-e is made 
 a curved incision through the skin, which marks out a crescentic 
 area of skin that at its widest part at the middle of the lid is about 
 8 mm. This crescentic piece of skin is then dissected oif with blunt- 
 pointed scissors or scalpel, care being taken not to buttonhole it, 
 and not to remove the subjacent fibers. The gap produced by the 
 excision of this piece of skin is then closed by five or six sutures. 
 Arlt recommends that, in placing them, the needle first pass through 
 the skin of the upper edge of the cilia flap, then include some of 
 the orbicularis fibers over the tarsus and, finally, the skin of the 
 upper lip of the wound. The sutures are not cut off. but are drawn
 
 590 
 
 ARLT-JAESCHE OPERATION FOR TRICHIASIS 
 
 upwards to cause the cilia border to take its new position higher 
 up on the tarsus, and are secured to the forehead over the brow 
 by an adhesive strip. The raw surface below the cilia border is 
 allowed to heal by granulation. This objectionable feature is over- 
 come by the plastic modification suggested by "Waldhauer of plac- 
 ing the excised strip of skin on the raw border, and the operation 
 
 B 
 
 Transplantation of the Bed of Hair Follicles by the Method of Jaesche Arlt. 
 
 A. Cutaneous Incision and Incision in the Intermarginal Zone, m. 
 
 B. After Tying the Cutaneous Sutures, s, and implanting the piece of Skin, h. 
 
 C. Front View after Excision of the Skin has been done, with the Horn 
 Plate inserted. 
 
 is usually practised now Avith this valuable modification. After 
 excising the strip of skin, which should be as thin as possible, it is 
 placed in warm 0.5 per cent. NaCl solution until the wound in the 
 skin has been closed, as described, and the bleeding at the border 
 of the lid has been completely checked. It can then be placed in 
 position on the raw border of the lid, and if necessary trimmed a 
 little to make it fit exactly. This trimming should be done with 
 scissors, only after the flap is in position and held by an assistant. 
 In most cases sutures are unnecessary, but possibly a fine one may 
 be placed at each end and one in the middle, if the flap is not nicely 
 apposed. 
 
 Care should be taken not to excise too wide a piece of skin lest 
 ectropion result. To avoid this, before making the skin incision,.
 
 ARLT'S OPERATION FOR INTERNAL TARSORRHAPHY ..yi 
 
 the operator should estimate the amount required by pinching up 
 a fokl of shin and noting the effect on the lid border. 
 
 As in all cases of transplantation of skin flaps, strips of rubber 
 tissue or oiled silk should be placed over the wounds before apply- 
 ing the dressing. The wound should be dressed each day, and at 
 the end of the second da^- traction on the sutures may be released. 
 The wound should have healed sufliciently by the fourth or fifth 
 day to allow the removal of the sutures. Should the flap slougii, it 
 will be necessary to cover the granulating area with a piece of hair- 
 less skin taken from behind the ear, or with a piece of mucous mem- 
 brane from the inner surface of the lip. — (W. H. W.) 
 
 Arlt's operation for internal tarsorrhaphy. A narrow strip of skin 
 is resected from around the inner canthus, being very careful not 
 to wound the underlying canaliculi, and the two raw edges brought 
 together by means of fine sutures. The incisions should not, of 
 course, be so extensive as to encroach on tlie puncta. At the end 
 of a few days union will be complete and the stitches may be re- 
 moved.— (C. II. B.) 
 
 Arlt's orthoscope. This device is a modification of Czennak's sim- 
 ilar instrument, intended to make the fundus oculi visible by 
 immersing the eye in water and thus neutralizing the refraction of 
 the cornea. Czermak surrounded the eye to be examined with a 
 thick layer of dough. The cup was then filled with water at an 
 agreeable temperature (about 95°), the patient leaned forward and 
 closed the eye and the edges of the cup were pressed into the 
 dough to prevent leakage. After this the eye was opened and a 
 clear examination of the fundus was obtained. 
 
 Arlt modified Czermak 's orthoscope by making it of soft rubber, 
 with one side of glass; this simplified the instrument by eliminating 
 the unwieldly dough, and yet alloMcd it to be closely applied to the 
 eye. Coccius devised a cup, whose bottom was glass and the rim 
 made to fit tightly around the eye. This could be held to the eye 
 close enough to permit an examination. It is claimed that the use 
 of the orthoscope requires less skill than the ophthalmoscope, al- 
 though more disagreeable to the patient. In cases presenting corneal 
 opacities to be studied carefully, or when the fundus is obscured 
 by an irregular astigmatism the examination under water gives the 
 best results. 
 
 Arlt's salve. This ointment is less known and used in America than 
 in Germany. It is prescribed as an analgesic and counterirritant 
 to relieve the bulbar congestion and pain of scleritis, iritis, corneal 
 ulcer, etc., and for the blepharospasm of phlyctenular keratitis. It
 
 592 ARLT'S SCALPEL 
 
 may be rubbed into the temples and forehead three or four times 
 daily. Ohlemann, in Oliver's translation, gives the formula as: 
 
 Ungt. hydrarg. cinerei (P. G.) 5.0 gm. 
 
 Extract, belladonnse 0.5 gm. 
 
 For the first ingredient one may substitute unguentum hydrargyri 
 ammoniati, U. S. P., which it resembles. 
 
 This mixture of a mercurial ointment with belladonna is so com- 
 pounded that the action of the latter drug may prevent or limit 
 symptoms likely to arise from an overdose of mercury. In so 
 limiting the ptyalism and other disagreeable results of the inunc- 
 tion the surgeon is enabled to give his patient larger doses of the 
 antiluetic drug. 
 Arlt's scalpel. This instrument is a modification of the knife used by 
 general surgeons and is well adapted to ophthalmic purposes. 
 
 Arlt's Scalpel. 
 
 Arlt's symblepharon operation. Of the symblephara that include the 
 retrotarsal fohls the commonest form is what is known as the colum- 
 nar type, in which a thin band of adhesion reaches from the fornix 
 for a variable extent up to or involving the cornea. For its relief 
 many operations have been adopted, but that of von Arlt (see the 
 figure) is the one most commonly used. It is performed as follows: 
 If the cornea is involved this portion of the adhesion is grasped with 
 delicate, sharp-toothed forceps and carefully dissected away with a 
 keen-edged scalpel. Some operators prefer first to pass through the 
 apex of the adhesion a double-armed suture by which it may be held 
 instead of with the forceps. This suture should be so inserted as to 
 have the loop lie upon the outside of the adhesion, as it can thus be 
 best utilized when the apex of the cicatrix is buried, in a later stage 
 of the operation. The apex having been freed from the cornea, the 
 adhesion is abscised from the globe by blunt, curved scissors, after 
 which the scar tissue is completely cut out of the loosened bulbar 
 conjunctiva by two incisions made from its apex to its base. This 
 leaves the adhesion a freed tag, or flap, which is turned into the 
 opening at its base and secured by sutures which pass out through 
 the entire thickness of the lids and are tied over a small roll of 
 gauze or piece of rubber tubing. The edges of the bulbar wound are 
 freely dissected loose, or undermined, with blunt scissors, and then 
 united with fine silk sutures. If the corneal involvement has been
 
 ARLT'S TEST 
 
 593 
 
 extensive it may be neeessary to cut the conjunctival flaps free for 
 a short distance around its edge, to secure good coaptation. Especial 
 care should he taken to close the wound in the bulbar conjunctiva 
 well down into the fornix, as it is there that recurrence is most apt 
 
 Arlt's Operation for the Relief of Symblepharon. (After Beard.) 
 
 to take i)lace. The turning of the tag into the lid produces a pro- 
 nounced buneh of scar tissue and conjunctiva which, however, usu- 
 ally disappears in time. — (C. H. B.) 
 
 Arlt's test. This is a test for ocular malingering, by means of weak 
 f-j- 0.25) lenses, with which the simulator pretends that his sight 
 is considerably decreased or improved in the supposed weak eye. 
 It is not as useful as the Fles (q. v.) box, or some modifications of it. 
 
 Armaignac's tattooing method. Armaignac (Nouveau procede pour le 
 tatouage regulier de la cornee. Rccueil (rOphtalmologie, August, 1903, 
 p. 463) has constructed a shield guide which is shaped like a bottom- 
 less saucer that exactly equals the size of the intended pupillary area. 
 It is laid in position and fixed by snuill retaining hooks. It is then 
 filled with the pigment massing, which is brought into direct contact 
 with the area which is intended to be pigmented. The tattooing is 
 performed in the included space. The greatest disadvantage that 
 the contrivance possesses is that the field of operation cannot be 
 made visible without removing the instrument. He has devised a 
 second guide for the corneal size.— (C. A. 0.) 
 
 VjI. I— 3S
 
 594 
 
 ARMAIGNAC'S TEST 
 
 Armaignac's test. This device, like so many instruments for the 
 detection of simulated monocular blindness, is a modification of the 
 mirror arrangement in Fles' (q. v.) box. The malingerer, unless 
 he closes one eye and makes a direct observation, is pretty certain 
 to believe that he is seeing with his admittedly sound eye when 
 he really fixes with the alleged amblyopic eye. 
 
 Armati, Salvino degli. A Florentine of noble family, to whom has 
 been ascribed the invention of spectacles. He died in 1317. 
 
 •>■.)! ; ni \( I- 
 
 \i/IN()-I) ARM \! ■> [')!• ' i \l-\' 
 
 ni FiM \/i 
 
 i 
 
 Modern Bust and Inscription, Copy of Medifeval Tomb of Salvino d 'Armati. 
 
 For the sake of completeness, it ought to be added that spectacles 
 and eyeglasses were wholly unknown to the ancients. All that the 
 weak of sight, whether from age or from any other cause, could do,
 
 ARMATURE 595 
 
 in antiquity, to improve their sorry lot, was (1) to look at letters, one 
 eye at a time, through a little role or tube, innocent of lenses, thus 
 by means of isolation securing a certain amount of distinctness ; and 
 (2) to "strengthen" and "clarify" the eyes with local "collyria" 
 or "purifications" of the body generally. Nero's emerald, so often 
 referred to in this connection, was not a lens of any sort, but a con- 
 cave mirror. Spectacles were really invented by someone, nobody 
 now knows whom, near the middle of the thirteenth century. [Per- 
 haps it was Roger Bacon (q. v.). — (Ed.)] This person would not 
 divulge the secret of their manufacture, and his name has sunk into 
 oblivion. Armati — the subject of this sketch — has been said to be 
 that person, but only on the ground that his relatives, or friends, 
 caused to be engraved on his tomb (a modern reproduction of which 
 is now in the Church of Santa Maria Maggiore, at Florence, Italy) 
 these words : "Here rests Salvino Armato of the Armati of Florence, 
 the Inventor of Eyeglasses. God Pardon him his Sin. In the year 
 of the Lord, 1317." The original tablet (see figure) is preserved 
 in the National Museum at Florence. A writer in 1684, one Leopoldo 
 de Migliore, declares in his ''Florence IllKstrated" (published in 
 that year) that he had in his possession the MS. of another person 
 in which the aforesaid monument and its highly important inscrip- 
 tion are mentioned. To show how valueless this monumental testi- 
 mony from friends and relatives really is Hirschberg relates, with 
 his usual patness, that when on a ship sailing from New York 
 to Bremen, he was approached by an American gentleman, who 
 casually incjuired: "While in New York, did you happen to meet 
 my nephew, the inventor of the ophthalmoscope?" 
 
 A little after the invention of spectacles by "the man who would 
 not tell," they were re-invented by Alexander de Spina, who "com- 
 municated to others concerning them with a willing and joyful 
 heart." See Alexander de Spina. Also, Eyeglasses and spectacles, 
 History of.— (T. H. S.) 
 
 Armature, n. A piece of soft iron attached to the poles of a magnet, 
 TO prevent dissipation of its magnetism. 
 
 Armitage, Francis Rhodes. This philanthropist, with F. F. (now Sir 
 Francis) Campbell, exercised the largest influence of any man in 
 Great Britain on the welfare and education of the blind. Born in 
 1824 he spent the earlier years of his life in Avaranches, in Nor- 
 mandy, and later went to school in Germany, where he acquired a 
 fluent use of German. He lived later in Paris, taking lectures at the 
 Sorbonne. In 1840 he began the study of medicine at King's College, 
 taking his degree in surgery and later in medicine, when he became
 
 596 ARMITAGE, FRANCIS RHODES 
 
 a member of the Royal College of Physicians. He practised medicine 
 very successfully for a number of years until 1860, when he was 
 obliged to relinquish his profession because of failing sight due to an 
 affection which had already seriously interrupted his studies during 
 the period of his studentship. He became painfully aware that 
 those who are unable to use their eyes freely are debarred from 
 many of the pleasures of life ; and when to blindness are added 
 poverty and inefficiency their lot is most unhapp}'. He therefore 
 became actively connected with the Indigent Blind Visiting Society, 
 and through his intelligent reorganization of the Society greatly 
 'increased its usefulness. He had an independent fortune and his 
 private beneficiencies to this charity were not less than seventeen 
 thousand pounds. 
 
 His studies of blind institutions in Great Britain and throughout 
 the conti'tient were as thorough and complete as might have been 
 expected from one of his scientific training. He spent much time in 
 Paris at the Institution for the Blind, and found that by means of 
 the very thorough instruction given there, 30 per cent, of those 
 trained as pianists, organists, or tuners were able to support them- 
 selves very comfortably by their work. In England not more than 
 one per cent, could do this. 
 
 In 1868 he founded the first of his great societies, the British and 
 Foreign Blind Association. At that time there were many forms of 
 raised types in existence, none of which were wholly satisfactory. 
 It became evident to him that most of these were the devices of the 
 sighted rather than of the blind. He therefore invited the assistance 
 of several blind men of judgment and intelligence and together they 
 spent tAvo years in stud.ying the existing types. These were for the 
 most part some form of the raised roman letter. 
 
 Although France had been slow to recognize the value of the 
 punctiform type during the lifetime of Louis Braille it Avas at this 
 time in general use in Paris and upon the r^ontinent. It was evident 
 that this type had a practical value possessed by none of the others. 
 Armitage and his coworkers immediately took steps, through the 
 new association which he had formed, to introduce it in England. 
 Besides other gifts Dr. Armitage gave the association, free of rent, 
 a suite of offices in his town house in Hyde Park, paid for the clerical 
 staff and himself met the deficits year after year. 
 
 Having gotten the machinery with which to do printing and pub- 
 lishing, Armitage devoted himself to propaganda in favor of his blind 
 proteges. He delivered lectures before the Society of Arts, and 
 elsewhere, showing the possibilities of the Braille notation in litera-
 
 ARMY HYGIENE 597 
 
 » 
 
 ture and music, and explaining how greatly their opportunities would 
 be widened by adequate educational methods. 
 
 Just at this psychological moment he met Francis F. Campbell, 
 recently knighted by King Edward VII, a blind young American 
 Avho had been travelling in Europe and studying in Berlin, and \\\\o 
 w^as about to return to the United States. Campbell had been a 
 tutor in the Perkins Institution for the Blind in Boston and was a 
 man of great force of character, marked originality of conception 
 and withal broadly educated and thoroughly trained in music. He 
 had already, wdien in America, demonstrated that the blind are 
 capable of being musically educated, nineteen out of twenty pupils 
 whom he had taught being able to support themselves. 'Having 
 already the same ideals he quickly became imbued with Armitage's 
 enthusiasm. After many discussions it was decided to found an 
 institution for the blind on new lines, and the Royal College of Music 
 was the result. Campbell became the principal in 1872, and after 
 forty years of successful service he resigned to enjoy in his declining 
 years the leisure which he so richly deserved. 
 
 Although Dr. Armitage's money benefactions to the College and 
 to other works for the blind were large and numerous, his greatest 
 gift was his own personal interest and his untiring sympathy and 
 encouragement. [For the above facts the biographer is indebted to 
 inii)fiirnrf]r.<! Tlistorii of flir Ediirafion of ihc Blind.] — {F. P. L.) 
 
 Army hygiene. See Soldiers' eyes, Examination of. 
 
 Army, Visual requirements for the. Although these vary in different 
 countries, yet the following reiiuirements for entering the United 
 States Army are practically identical w-ith those in use elsewhere. 
 Tipler's Manual, the otTicial guide in this country, gives as causes 
 for absolute rejection: 
 
 Loss of either eye; chronic inflammation of the lids, Avhen they 
 are red and swollen with a collection of more or less dried matter 
 on the edges between and around the lashes; the ball of the eye 
 will also be "bloodshot;" myopia (near-sightedness); liyperme- 
 tropia (over-sightedness), except when moderate and free from 
 organic disease ; astigmatism ; inability to read or describe with 
 facility the types or characters on the test cards. This examination 
 requires the greatest care and patience on the part of the recruit- 
 ing officer; it is made with cards bearing the twenty-feet test-types 
 and test-characters. To use the cards, measure off a distance of 
 tAventy feet in a straight line, place the applicant with his back to 
 the light at one end of the line, while the examiner stands at the 
 other and holds the card exhibiting the test types or characters in 
 full view of the applicant so that a good light falls on the card.
 
 598 ARMY, VISUAL REQUIREMENTS FOR THE 
 
 Each eye should be examined separately, one being covered with 
 a card (not with the hand) by the assistant, who, standing behind 
 the applicant directs him to read the types on the card held by the 
 examiner; if he cannot read, the card bearing the characters is 
 presented to him, which he is directed to describe. The types 
 should be read first from left to right; the characters should be 
 described as to the numbers of arms seen on each and the direc- 
 tion in which they are pointed, whether upward or downward, to 
 the right or left. If the applicant should be unable to read the 
 test-types oi- describe the test-characters correctly Avith either eye 
 he must be rejected. 
 
 This standard for vision may be departed from in the examina- 
 tion of candidates for appoinment into the Medical Corps of the 
 Army and in the enlistment of members of the Hospital Corps, and 
 the applicants who are the subjects of refractive errors, viz., myopia, 
 hypermetropia, presbyopia and astigmatism, provided these errors 
 are not excessive, may be entirely corrected by glasses and are not 
 progressive or accompanied by ocular disease. 
 
 The object of this test is to exclude from the service men whose 
 visual defects are such as to prevent them from becoming marks- 
 men. Successful use by the soldier of long-range fire-arms demands 
 that his vision shall be normal or so nearly normal that there need 
 be no ([uestion of his ability to see the target at all ordinary ranges. 
 
 A large percentage of men are the subjects of slight visual 
 defects, not to such extent as to dis'iualify them for military duty, 
 but sufficient to cause a little blurring or indistinctness in some of 
 the letters of the re(iuired test, which may be increased by the 
 nervous apprehension of failure. Ignorance, fear or stupidity on 
 the part of the applicant are factors to be considered in making this 
 examinalion, and unless the recruiting officer exercises sound judg- 
 ment he will probably reject men whose vision is in reality good, 
 hence plently of time should be raken and slight errors such as 
 reading a P or T for an F, provided the majority of the test letters 
 or test characters are read with facility, need not be regarded as a 
 failure of the test. 
 
 The cards used at recruiting stations for testing vision should 
 be kept locked up when not in use, or otherwise protected from 
 access by prospective recruits. In all doubtful eases a small paddle 
 with a hole in it of such size as to expose only one letter at a time 
 should be used; such a device, intelligently used, would make 
 memorizing of no avail. 
 
 In time of war none of the defects mentioned above as disquali-
 
 ARMY, VISUAL REQUIREMENTS FOR THE 599 
 
 fying in time of peace should exeiii[)1 conscripts I'roni service save 
 those caused by extreme i-etVactive ei'rors or organic disease, and 
 as defects of vision are easily feigned the examination of the vision 
 in doubtful eases should be iiuuh' by a medical officer. 
 
 The following niodifications have been made by order of the 
 Secretary of Wai' and were kindly furnished from the Surgeon Gen- 
 eral's office by C'iias. F. J\Tason, IMajor Medical Corps, U. S. Army: 
 
 General Order No. 199. The following methods for determining 
 and recording acuity of vision and color sense are prescribed for 
 the army and will be followed whenever practicable in the examina- 
 tion of applicants for admission to the United States Military Acad- 
 emy and of applicants for commission, promotion and in any case 
 of disease or disability of officers or enlisted men where these senses 
 may be afifected : 
 
 In case of applicants for enlistment the existing methods of 
 examination will be continued at the general recruiting station, but 
 the methods herein prescribed will be applied at the recruit depots, 
 depot-posts, and other gai'risoned posts. 
 
 For determining and recording the visual acuity the test-type 
 should be placed in a good light, about the height of the eye. If 
 the room is not well lighted by daylight, an artificial light with a 
 reflector should be used, as it will be more uniform. Place the 
 candidate or patient with back to the window or source of light, 
 at a distance of 20 feet, or 6 meters, from the type. Examine each 
 eye, covering the other eye with a card or an opaque disc in a trial 
 frame. The hand should not be used for this purpose, as it tem- 
 porarily blurs vision. The right eye should ordinarily be examined 
 first before the candidate becomes familiar with the types. The 
 candidate should be directed to read the test-type from the top of 
 the card down as far as he can see, and his acuity of vision recorded 
 for each eye with the distance of 20 feet as numerator, and the 
 proper distance of the lowest line he can read correctly as the 
 denominator of a fraction. 
 
 If the acuity of vision is less than 20/20 and is corrected by 
 glasses, the acuity without glasses and with glasses is given and the 
 correcting formula is noted as : 
 
 Vision, R. E. 20/40, corrected to 20/20 by— I. D. ey. 180°. 
 
 Vision, L. E. 20/100, corrected to 20/30 by— .50 D. cy. 180°— 
 2.00 D. S. 
 
 If he cannot read the type at any distance, the distance at which 
 he can count fingers is recorded as : Vision R. E. can count fingers 
 at 20 inches.
 
 600 ARMY, VISUAL REQUIREMENTS FOR THE 
 
 If he cannot count fingers, the distance at which a light can be 
 distinguished is recorded. 
 
 If a light cannot be distinguished he is recorded as blind. 
 
 As the types are memorized easily, they should not be left where 
 applicants can read them, and it is well in examining the left eye to 
 direct that the lines be read from right to left and to use new type 
 in case of doubt, or to expose one letter at a time by means of a 
 small opening in a card or sheet of paper. 
 
 A more correct idea ma}^ be obtained by having the candidate 
 read from the top of the card down. Do not direct him to read the 
 lowest line he can see, and always use a card having type from 10 
 feet to 200 feet. 
 
 The distance of 20 feet should not ordinarily be reduced, as a 
 shorter distance leads to some error from the action of the accommo- 
 dation and from the fact that the type may then be within the far 
 point of moderate myopia. 
 
 Color sense is the power which the retina has of perceiving color, 
 or the sensation from the impression of different wave lengths of 
 light. 
 
 Color blindness is the absence of the perception of one or more 
 of the primary colors, red, green and violet. 
 
 Complete color blindness is the absence of the perception of all 
 color. 
 
 Partial color blindness is the absence of the perception of one 
 or two of the fundamental colors, objects of the missing color sense 
 being seen in shades of gray. 
 
 When one of the colors is absent there is said to be complete 
 red, green or violet blindness. Violet blindness is rare, the ordinary 
 forms being red and green blindness. 
 
 The following method of Holmgren is used for the detection of 
 color blindness and the tests should be applied to all persons 
 examined for admission to the army and the result recorded. 
 
 This consists in the power to select various colors in the form of 
 test wools to match certain test skeins. 
 
 In recording the results of the examination the terms, "color 
 sense normal," "color sense feeble," "incompletely color blind," 
 "completely red blind," "completely green blind," "completely 
 violet blind" and "completely color blind" (all colors) will be 
 used. 
 
 Circular No. 4. The following minimum visual requirements for 
 recruits will supersede such requirements of the Epitome of Trip- 
 ler's Manual as are in contiiet herewith :
 
 ARNEMANN, JUSTQS 601 
 
 For the line of the Ai-iiiy and for the Signal Corps: 20/40 for the 
 ])etter eye, and 20/300 for the poorer eye, provided that no organic 
 disease exist in either eye. 
 
 Recruits ma.y be accepted for the line of the Army wlicii unable 
 with the better eye to correctly read all of the letters on the 20/40 
 line, proA'ided thai they arc al)le to read some of the letters on the 
 20/30. 
 
 For the Ordnance Depaiiment and for the Hospital Corps: 20/70 
 in each eye, correctible to 20/40 with glasses provided that no 
 organic disease exists in cither eye. — (N. JM. 1>.) 
 Arnemann, Justus. This moderately well knoAvn surgeon, writer, and 
 medical historian, was born at Liineburg in 1763. A man of highly 
 irritable temperament, he was nevertheless possessed, as some be- 
 lieved, of a charming personality, and, as all admitted, of a brilliant 
 intellect. When only 24 years of age, he was made professor at 
 Gottingen. Nine years later he founded his Private Surgical Hos- 
 pital, and, the year following, his Magazine for Surgical Science. He 
 wrote a System of Surgery, in which he devoted a moderate amount of 
 attention to the eye, and which secured the mild approval of some of 
 the general surgeons of liis day. His Eevicw of flic Best Known and 
 Most Frequently Employed Surgical Instnwients of Ancient and 
 Modern Times fared better. It was, however, severely condemned, 
 the ophthalmic part in particular, by no less a person than Joseph 
 Beer. 
 
 Like many another physician, Arnemann was often in deep finan- 
 cial water. In 1803, because of his debts, he fled to Hamburg. There 
 he succeeded for a time, but, in 1806, in a fit of despondeucj^ he took 
 his life by shooting himself in the Wandsbecker forest.- — (T. H. S.) 
 Arnemann 's intracapsular cataract extraction. Arnemann {Systeme 
 de Chirurgie, Goettingen, 1801, p. 151) extracted the cataract 
 through an upper section made Avith a Beer knife and expelled the 
 lens by a double-ended instrument, one end shaped like a Daviel 
 curette, the other having a spiral tip like a corkscrew for impaling 
 the lens through the pupil and drawing it out of the eye. This opera- 
 tion seems not to have met with favor. It Avas severely criticised by 
 Himly and Schmidt as dangerous to the eye and not based on sound 
 surgical principles. — (D. AV. G.) 
 Arnica, Oculo-toxic symptoms from. The arnica flower contains a 
 principle Avhich is cai)able of producing inflammatory and erysip- 
 elatous changes in a sensitive skin. 
 
 A man, who had a slight inflammation of the eye, was ordered 
 to use a stimulating e^^e-Avash. He used a sponge that had been
 
 602 ARNOLD, FRIEDRICH A. 
 
 employed in making an arnica application, and as a result, the 
 lower lid became livid and edematous, and the upper not only red 
 and swollen but covered with vesicles. The conjunctiva and cornea 
 were normal. After 7 days the swelling subsided, the vesicles 
 ruptured, the skin desquamated, and in 10 days, except some itch- 
 ing, there was a return to normal. 
 
 Arnold, Friedrich A. This well-known anatomist and physiologist was 
 born Jan. 8, 1803, at Edenkoben, near Landau, in the Palatinate of 
 the Ehine, and died July 5, 1890. He received his medical degree at 
 the University of Heidelberg, and was for many years a famous 
 teacher of anatomj^ and physiology in that institution. He is, how- 
 ever, memorable to ophthalmologists only ])ecause of his book, Anato- 
 mische unci Fhysiologisclie Untersuchungen ilher das Auge des Men- 
 schet (Heidelberg and Leipzig, 1832). Most of the original views pro- 
 pounded in this work have since been shown to be erroneous. — 
 (T. H. S.) 
 
 Arnold's fold. Valvula lachrymalis superior. A fold of mucous mem- 
 brane found in the lachrymal sac. 
 
 Arnold of Villanova (near Montpellier). A famous general physician 
 (1235-1313) who became physician-in-ordinary to Peter III of Ara- 
 gon, and who wrote a number of important works of a general char- 
 acter. His only ophthalmologic composition, Libellus Regiminis de 
 Confortatione Visus, written at the request of Pope Clement V, pos- 
 sesses but little value. It treats merely of ocular hygiene, and is 
 nothing but a compilation, chiefly from the Arab, Mesne. — (T. H. S.) 
 
 Arrasi. A renowned Arabian philosopher, physician, and ophthal- 
 mologist, w^ho lived from 850 to 932 A. D. See Ar-Razi, 
 
 Ar-Razi, Mohammed ibn Zakarijah Abu Bekr. He was also called 
 Rhazes, Arrasi, El Razi, Er Raz, Abubater, Abubertus, Abubeter, 
 and BuBiKiR. This great Arabian physician was born at Rai (hence his 
 names, Rhazes, Ar-Razi, Arrasi, El Razi, etc.) A. D. 850. He became 
 at first a cithern-player, later, philosopher, physician, court physician, 
 medical teacher and author. His medical education he received at 
 Bagdad, and there, too, he became a director of the hospital as well 
 as professor in the medical college. In his prime he was one of the 
 most widely known and highly honored of physicians, and patients 
 came seeking his services from the farthest portions of the civilized 
 world. In his old age, however, he fell on evil days, and died, totally 
 blind and in abject poverty, A. D. 932. 
 
 He is thought to have been a teacher of rare endowment and a 
 man of great sympathy for the sick. He was, beyond all question,
 
 AR-RHAZI 603 
 
 not only very learned, but wholly indepeinlcnt in his scientific ob- 
 servations — rarest of (jualitics in mediaeval times. 
 
 Ar-Razi, or liliazes, is chiefly remembered by genei'al practitioners 
 for his little book, De Vanolis et Morhilis (On Smallpox and Measles) 
 which is truly the earliest monograph on, but not exactly "the 
 earliest mention of," smallpox, in the annals of nu'dicine. The work 
 show^s great powers of independent observation and tliouglit. How- 
 ever, Rhazes's magnum opus is Al-Hawi, or Continent (The Content 
 — i. e., of medicine). This encyclopedic treatise does really meet the 
 exactions of its ambitious title, for it ranges over the totality of the 
 science and art of healing as these were known and practised in the 
 author's time. The second book of this work is the one that chiefly 
 concerns the ophthalmologist. This book, indeed, takes up almost, 
 but not quite, every phase of mediaeval oculistic science. Here, 
 however, we will not exhibit Rhazes's ophthalmology, because, in its 
 essence, it is very much the same as that of AH ben Isa, which is set 
 forth fully under the name of that author. It may be mentioned, 
 however, that, in the second book of the Continens, occurs the famous 
 passage on cataract extraction which has been so often referred to as 
 proving that the modern mode of extracting cataract was invented 
 by Antyllus. The passage in question runs as follows (in the Latin 
 translation, the Arabic original being lost): "Dixit Antilos: Et 
 aliqui aperuerunt sub pupilla et extraxerunt cataractam; et potest 
 esse, cum cataracta est subtilis ; et cum est grossa, non poterit ex- 
 trahi, quia, humor egrederetur cum ea. Et alicpii loco instrumenti 
 posuerunt concilium vifreum et sugendo cam suxerunt albugineum 
 cum ea." The fact, is, however, that, until the absolute demonstra- 
 tions of Brisseau and Maitre-Jean in 1705, it was not even known that 
 a cataract is an opaque crystalline lens, the supposition being that 
 the morbid affair consists of an inspissated humor which has "flowed 
 down" (hence the term "cataract") into the space or chamber im- 
 agined to exist between the crystalline lens and the pupil. (See 
 Antyllus; also, History of ophthalmology.) 
 
 A small book of Ar-Razi "s, but even better known, ])erhaps, than 
 the colossal Continens, is the so-called Medical Work [dedicated] to 
 Mansur, Mansur having been, at the time, the Prince of Khorassan. 
 In the ninth "book" of this little work, occur the following "chap- 
 ters," or sections, which deal (in far too brief a manner) with 
 ophthalmologic subjects: (16) Ocular Ulcers, (17) Foreign Bodies, 
 (18) White Spot [Leucoma], (19) Trachoma and Pannus, (20) Itch- 
 ing of the Corners of the Lids, (21) Pter^^gium, (23) Epiphora, (24) 
 Weakness of Vision, (25) Hyphema Conjunctiva? (subconjunctival
 
 604 AR-RHAZI 
 
 eechymosis), (26) Trichiasis, (27) Cataract, (28) Nightblindness^ 
 (29) Enlargement of the Pupil and (30) Lachrymal Fistula. Highly 
 condensed as the ophthalmic jDortion of the Mansurian treatise is, 
 it nevertheless contains perhaps the most important contribution of 
 Rhazes to ophthalmology — namely, the first, absolutely the first, 
 mention in history of the pupillary contraction resulting from the 
 action of light, in other words the pupillarj- light-reflex. The pas- 
 sage in question is as brief as it is memorable : "In the middle of 
 the icy humor (iris) appears a hole which now dilates and now con- 
 tracts, according as the icy humor feels the need of light ; it contracts 
 when the light is strong, and dilates in obscurity. The hole is the 
 pupil, and the membrane is called the uvea." * 
 
 Then, too, besides the great Continens and the little treatise dedi- 
 cated (or rather intituled) to Mansur, Ar-Razi composed a number 
 of medical monographs, some of which are of great ophthalmologic 
 interest. The titles of those of the latter sort are as follows : 
 
 1. WJiy the Pupils Contract in the Light, and Dilate in Obscurity. 
 (Ar-Razi was very miich interested in this highlj^ important subject.) 
 
 2. On the Nature of Vision : Wherein is Shown that the Eyes are 
 not Radiators of Light. (The great independent thinker combatted 
 the prevalent theory that beams of energy proceeded from the eye, 
 mingled then Mith the surrounding atmosphere, and, proceeding to 
 the object of sight, surrounded it, and then returned to the eye with 
 information about the object looked at. HoAvever, this view had been 
 combatted before the time of Rhazes.) 
 
 3. On the Conditions of Sight. 
 
 4. On the Form of the Eye. 
 
 5. The Bool- of the Surgical Treatment of the Eye. 
 
 6. Circular Letter to his Student, Joseph hen Jacoh, an Ocular 
 Medicines, Ocular Treatment, and The Combination of Medicines for 
 Certain- Purposes. — (T. H. S.) 
 
 Ar-Rhazi. A transliterational variant of Ar-Razi (q. v.) (Rhazes), the 
 famous Arabian ophthalmic surgeon who lived and flourished dur- 
 ing the ninth century of the Christian era. See, also. History of 
 ophthalmology. 
 
 Arriere-image. (F.) After-image, i. e., an impression on the retina 
 which remains for a time after the object is withdrawn. 
 
 Arsen. (G.) Arsenic. 
 
 Arsenate of copper, Ocular effects of poisoning by. This chemical is^ 
 employed in the manufacture of artificial flowers and confectioner}'' 
 
 See P. de Koiiing, Trois Trnites d'anatomie cirabes, 1903.
 
 ARSENIC 605 
 
 and in fancy baking. The ocular symptoms produced by it in those 
 who work therewith habitually, are conjunctivitis and swelling of 
 the lids.— (T. H. S.) 
 
 Arsenic. Arsenical liroparatioiis are pjirtieularly useful in ocular 
 diseases of anemic or scrofulous origin, especially in phlyctenular 
 or eczematous corneal inflammations. Arsenious acid is given 
 in doses of 0.001 to 0.005; and as Fowler's solution, beginning with 
 2 to 5 drops daily after meals. 
 
 Arsenical amblyopia. Since the beginning of the eighteenth centmy 
 there have been published isolated records of acute or subacute 
 arsenical poisoning in which weakness of sight was observed with 
 the gastro-intestinal and cerebral symptoms. At the beginning of 
 the nineteenth century one case was observed in wdiicli amblyopia 
 resulted from this form of poisoning. Up to the present time the 
 number of cases exhibiting ocular symptoms has increased so that 
 we are now able to draw a fairly consistent picture of arsenical 
 amblyopia. 
 
 Arsenical compounds, including those insoluble in water, after 
 they once get into the circulation, damage the optic nerve and other 
 tissues regardless of the manner in which, or the part of the body 
 through which, the poison finds its way into the sj^stem. It may 
 occur during the first attack of acute poisoning, but is more fre- 
 quently seen as a late result, or from the chronic absorption of 
 small amounts of the poison. It must be remembered that con- 
 siderable quantities of the metalloid ma}' remain indefinitely in the 
 body, especially in the long bones. 
 
 The disturbances of vision caused by arsenic, which were in pre- 
 ophthalmoscopic times designated as "reduction of the power of 
 vision," or "indistinct vision," or "darkness before the e^^es, " were 
 often described as being accompanied by dizziness and disturbances 
 of hearing. 
 
 The amblyopia affects both e3'es, often uneciually. After acute 
 poisoning the visual defect may be noticeable in a few hours or a 
 few days, and then rapidly disappear, or it may appear after the 
 intoxication and be permanent; while in a case of chronic poison- 
 ing from wine containing arsenic, it increased for about three 
 months and left the patient almost blind, requiring three months 
 more for the visual recovery. The pupils may be normal or dilated, 
 but the pupillary reflexes remain normal. 
 
 Every arsenical preparation, including paints and dyes (e. g., 
 Schweinfurth's green), the cacodylates, etc., is capable of pr(^- 
 ducing, when given in any form, inflammatory conditions in the
 
 606 ARSENICAL AMBLYOPIA 
 
 eye and especially of the conjunctiva. The extent of these changes 
 is generally but not always proportional to individual susceptibil- 
 ity, the amount of poison ingested and the length of time the 
 poison is in contact with the parts. Dermal surfaces in contact 
 with arsenious acid for a considerable time develop an erythema 
 with burning and radiating pains. Later, vesicles, or even gan- 
 grenous areas may appear, which generally remain for 2 or 3 weeks. 
 Mucous surfaces may also be affected in the same way. 
 
 According to Lewin and Guillery the eyes may become inflamed 
 by arsenic, either by direct contact or after systemic absorption. 
 
 The most severe changes occur, naturally, from the dusting of 
 arsenious trioxide (common white arsenic) and similar caustic 
 preparations into the eye. In such cases a suppurative conjunc- 
 tivitis and keratitis are set up. People who handle wall-paper con- 
 taining arsenic, especially those colored with Schweinfurth's green, 
 become affected with protracted conjunctivitis. In the same way 
 girls suffer, who handle paper dyed with arsenical pigments in the 
 manufacture of artificial flowers. People poisoned in this way 
 also have edematous lids bordered by a scaly eruption. 
 
 From remaining in a room from whose walls the green arsenical 
 paper was being removed the absorption affected one patient as 
 follows : depression, hoarseness, irritation of and pain in the eyes. 
 The conjunctiva of the lids was colored a deep red along the tarsal 
 border and at the canthi, the lids were slightly swollen and had a 
 tendency to blepharospasm. Vision was painful. 
 
 Arspuical conjunctivitis may also arise from the therapeutic or 
 other internal use of arsenic, in conse(|uence of the impregnation of 
 the tears by the poison and the subsequent contact of the acrid 
 fluid with the conjunctiva. Such a sequel usually appears on the 
 second or third day. This phenomenon was noticed 9 times in 60 
 cases. 
 
 Edema of the lids ma.y be absent in arsenical poisoning or it may 
 occur on ouly one lid. Sometime^s an erysipelatous reddening 
 shows itself at the edge of the lids, soon healing by desquamation. 
 There is with it itching and burning, especially of the lower lid ; 
 also hyperemia of the parts, lachrymation and photophobia. 
 
 In a patient who swallowed 8 grams of arsenic there appeared 
 a short time afterward a rapid flow of acrid tears that excoriated 
 the eyelids and cheeks ; after recovery there remained a disposition 
 to ophthalmia. 
 
 In England there have been many cases of arsenical poisoning 
 from adulterated beer, followed by a peripheral neuritis and skin 
 eruptions. These individuals also had lachrymation and swelling
 
 ARSENICAL AMBLYOPIA 607 
 
 of the lids. The conjunctiva was chemotic and showed hemor- 
 rhages at times, while pain in the eyes was often present. Arsenical 
 chronic poisoning may occasionally he responsible for a marked 
 mydriasis with loss of reaction. One case of dipjo])!;! with exoph- 
 thalmus has been observed, in which there was exophthalmus from 
 the beginning, not associated with tumor of any kind. 
 
 According to the findings of de Schweinitz (Toxic Amblyopias, 
 pp. 145, 146) the poisonous action of arsenic is mainly local on the 
 skin, or it may be absorbed through the stomach, or reach the blood 
 and tissues by inhalation through the lungs. The extensive use of 
 arsenic in the arts hassled to majiy cases of poisoning; for example, 
 from wall paper or articles of clothing. 
 
 "The widespread pathological lesioiis which occur in arsenical 
 poisoning, namely, fatty degeneration and peripheral neuritis, would 
 seem to indicate that visual disturbances from its prolonged use 
 ought to be frequent, and that arsenic should produce optic neuritis, 
 optic-nerve atrophy, and other changes which are common enough 
 from lead and allied poisons. II. Derby has reported optic neuritis 
 and amblyopia i)ossibly caused by arsenic. Casey Wood refers to 
 the fact that makers of Paris-green, painters, and paper-hangers, as 
 well as those who take the drug for medicinal or cosmetic purposes, 
 are liable to suffer visual disturbance apart from conjunctival hyper- 
 emia and eczema of the lid. ' ' 
 
 The recent use of arsenical preparations in the treatment of syph- 
 ilis has raised the question of the possible involvement of the eye — 
 especially of the optic nerve — as a result of this form of therapy. 
 Steindoriff (Deutsche Med. WocJieuschr., No. 26, p. 1226) states 
 that a year after the first use of salvarsan, when at least ."lO.ODO 
 injections of that drug had been given, there were few, if any, 
 cases in which optic nerve disease could be honestly laid at the 
 door of the remedy. This was in striki]ig contrast to the record of 
 atoxyl and related preparations. 
 
 J. Igersheimer considers as a reason for this that salvarsan is not 
 split up in the body into d»M'ivatives of phenylarsenic acid, as is 
 the case with atoxyl. Hoppe's investigations show that salvarsan 
 has only a slight chemical affinity for nerve tissue ; three days after 
 its exhibition he could not find any trace of arsenic in the brain, 
 spine or optic nerves. See, also, Atoxyl; Salvarsan. 
 
 In a case of spirarsyl toxemia seen by Hegner in a girl 18 years 
 of age (with syphilis) three injections of 0.3 gm. each, of the drug 
 were given at intervals of from three to six days. Headache, vomit-
 
 608 ARSENICAL AMBLYOPIA 
 
 ing, icterus, marked edema of the face and an intense exanthema were 
 present. The pupillary actions were normal. The optic papilla was 
 very vascular and its edges were blurred. Central vision and fields 
 were apparently normal. Death occurred under increasing cardiac 
 weakness. The ocular pathologic findings were limited to the papilla 
 and the anterior portion of the optic nerves. There was slight papil- 
 ledema. The orbital portion of the nerve showed marked nuclear in- 
 crease, and pronounced aggregation of mononuclear lymphocytes in 
 the vicinity of the lamina and especially in the vascular sheaths and 
 in the trabecule. There were no retinal changes. 
 
 Schirmer reports a case of atoxyl poisoning Avith ocular symptoms 
 in a male 58 years of age. The patient had previously been treated 
 with sodium arsenite, but had entirelj^ recovered from symptoms of 
 general intoxication when injections of atoxyl in increasing doses 
 were followed at the end of two months by failing vision. The pupils 
 \vere very large. The vitreous contained fine opacities. The optic 
 papillae were pallid and sharply outlined. The arteries were con- 
 tracted. The visual fields were greatly contracted especially to the 
 nasal side. There was no scotoma. ■ The atrophy progressed until 
 absolute blindness resulted. In a second case in which a male 73 
 years of age was treated for poisoning from sodium arsenite the 
 symptoms and ultimate result were the same. 
 
 Birch-Hirschfeld and Koster record two cases of blindness from 
 atoxyl poisoning. They state that the patient is usually doomed to 
 blindness when the first signs of visual disturbance appear. This 
 was so in forty-five of forty-six cases in the literature. The affec- 
 tion is in the nature of a primary nerve degeneration, not an inter- 
 stitial neuritis. The drug seems to have a selective affinity for the 
 rods, the cones remaining relatively intact. The microscopic findings 
 in animals showed a pure degenerative process in the medullary 
 sheaths of the optic nerve fibres. The cells of the brain are injured 
 but not in one part more than another. They agree with Coppez that 
 this drug should be banished from the therapeutic armament. 
 Hanimes reports the case of a man 66 years of age who had received 
 eight injections of arsacetin in 0.1 gm. doses. In about three weeks 
 blindness set in, probably from retrobulbar neuritis, as the papilli^ 
 were pale and the blood-vessels narrow. He concludes that because 
 of the many reported cases of optic nerve trouble following the use 
 of the newer preparations of arsenic, they are not suited to displace 
 the older methods of giving this drug. Steindorff reviews the litera- 
 ture and concludes that both atoxjd and arsacetin may prove rap-
 
 ARSENSAURE 609 
 
 idly fatal to the ()j)tic' nerve. This we can only explain as an idio- 
 syncrasy, but it calls for great caution in the use of these drugs. 
 
 Clarke records a case of simple optic atrophy in a man 46 years 
 of age following the use of soamin. The arteries were sometimes of 
 normal caliber and at other times Avere markedly attenuated. Vision 
 in the right eye equalled hand movements, and in the left 6/12. The 
 fields were greatly contracted. He reports a similar condition in a 
 man 49 years of age following the use of orsudan. lie cautions 
 against the use of arylarsonates where there is any disease of the 
 arteries, kidney or liver, and doubts whether they should ever be 
 used in individuals over 40 years of age. {Ophthalmic Year-Book, 
 1911, pp. 211, 212). See, also. Toxic amblyopia. 
 
 Arsensaure. (G.) Arsenic acid. 
 
 Arsenvergiftung-. (G.) Arsenic poisoning. 
 
 Art. (G.) Kind. 
 
 Artanthe mollicoma. (L.) A Brazilian plant, the leaves of which 
 are used for the same purposes as jaborandi. 
 
 Artefact, n. An histological term used to describe a structure pro- 
 duced by the means employed in investigation; i. e., an apparent, 
 not a real, structure. 
 
 Artefacta, Ophthalmia. A name given by II. I). Hruns to repeated, 
 self-inflicted injuries of the anterior parts of both eyes by which 
 the patient {Trans. Am. Ophth. Soc, 1913) that exhibited them 
 reduced herself almost to blindness. 
 
 Arterenol. Dioxyphenylethanol.vmin hydrochloride. Aminoal- 
 COHOL. This product is said to be as efficient a vasoconstrictor as 
 suprarenin and from two to three times less toxic. This has been 
 established by experiments on animals ; the fatal dose of suprarenin 
 being 4 mgm. subcutaneously and 0.1 to 0.3 mgm. intravenously per 
 kilogram of body weight in rabbits, while twice this amount of 
 arterenol was necessary' to produce death. While equally efficient 
 as suprarenin synthetic (q. v.) it is qualitatively equal to suprarenin 
 as regards increase of blood pressure and efifeet upon respiration 
 and pupil. 
 
 Arteria angularis. (L.'i One of the arteries of the eyelid. 
 
 Arteria capsularis. (L. > The end-capillaries of the hyaloid artery 
 ((|.vJ, ihat spread ovei" the posterior capsule of the lens. 
 
 Arteria centralis retinae. ( L. ) See Artery, Central, of the retina. 
 
 Arteria, Infraorbital. This vessel is a branch of the internal maxillary 
 artery. It enters the orbit through the fissura orbitalis inferior, 
 and passing forward in the infraorbital canal, makes its exit 
 
 Vol. I— ,3
 
 610 ARTERIA OPTICOCILIARIS 
 
 through the infraorbital foramen to supply a portion of the lower 
 lid and cheek. 
 
 Arteria opticociliaris. (L.) Optico-ciliary artery. See Anatomy of 
 the eye; and Histolog-y of the eye. 
 
 Arterial pressure in ophthalmic practice. Dunn {The Ophthalmic Year- 
 Book, 1909, pp. 69, 70) discusses the practical value of the sphygmo- 
 manometer to the ophthalmologist. He thinks no case of essential 
 glaucoma can be considered fully examined until the pulse-tension 
 has been measured. He cites 5 cases, one of which with tension of 
 140 mm. had the disease checked by iridectomy. Another with ten- 
 sion of 170 mm. ran the usual course of chronic simple glaucoma. 
 Three others with pulse tension of 200 to 220 were not benefited by 
 treatment. In such cases the prognosis is very bad, and the higher 
 the blood pressure the greater the danger from using a mydriatic. 
 In corneal ulcerations the blood pressure may suggest a cause of 
 failure to respond to treatment. In operating for cataract, the nearer 
 the blood pressure to normal the better will the case do. In a case 
 of iritis the blood pressure of 220 called attention to acute nephritis, 
 and suggested local bleeding, which greatly relieved the pain. In 
 cases of hemorrhagic retinitis, and in inflammatory conditions of 
 the optic nerve, the blood pressure may throw important light on 
 the case. In chronic headaches and migraine, for which relief is 
 sought by glasses, the same may be true. See Glaucoma; Sphyg^mo- 
 manometer. 
 
 Arterieatherom. (G.) Atheroma of the arteries. 
 
 Arterieektasie (G.) Arterial dilatation, aneurism. 
 
 Arterieeroffnung. (G.) Arteriotomy. 
 
 Arterieerweiterung. (G.) Aneurism. 
 
 Arteriehaken. (G.) An artery hook. 
 
 Arterien. (G.) Arteries. 
 
 Arterien des Augapfels. (G.) Arteries of the eyeball. 
 
 Arterienkrampf. (G.) Arterial spasm. 
 
 Arterienpuls. (G.) Arterial pulse. 
 
 Arterienverschluss. (G.) Occlusion of the artery. 
 
 Arterienunterbindung. (G.) The ligation of arteries. 
 
 Arterienzange. (G.) Artery forceps. 
 
 Arteries, Anterior ciliary. These vessels are supplied principally to 
 the recti muscles, usually two to each muscle, but, as a rule, only 
 one to the rectus externus ; occasionally one ciliary artery arises 
 from the arteries of the lids, runs back, perforates the sclera, and is 
 supplied to the conjunctiva. Otherwise the anterior ciliary arteries 
 accompany the straight muscles to their tendinous insertions, where
 
 ARTERIES, CILIARY 611 
 
 they perforate tlie sclerotic lU'ai* llic liinlxis and furiiisli superficial 
 branches to the sclera, margin of the cornea, and llie conjunctiva. 
 At the sclero-corneal junction they form with the long posterior 
 ciliary arteries the circulus iridis major. They also send branches 
 to the ciliary muscle and to the anterior portion of the choroid. 
 Their tortuous course can readily be seen since a portion of them 
 is clearly visible on the surface of the eyeball. 
 
 Arteries, Ciliary. These vessels carry the blood for the entire ciliary 
 system of arterial supply, and are divided into three groups: ante- 
 rior ciliary arteries, short posterior ciliary arteries, and long posterior 
 ciliary arteries. Each of these groups are separately described. 
 See, also, Anatomy of the eye ; Histology of the eye. 
 
 Arteries, Conjunctival. 8ee Anatomy of the eye. 
 
 Arteries, Long posterior ciliary. Two of these vessels are supplied to 
 each eye. They arise from the ophthalmic artery precisely like the 
 short posterior ciliary arteries, and pierce the sclera obliquely at 
 the horizontal meridian on the temporal and nasal sides of the 
 optic nerve, slightly in front of the short arteries. The course of 
 one (lateral) artery is slightly above the horizontal meridian; that 
 of the other (medial) artery is slightly below it. After perforating 
 the sclera they run between the choroid and sclera, directly to the 
 ciliary body, entering the ciliary muscle, where each artery branches 
 dichotomously. These branches run diagonally to the anterior seg- 
 ment of the muscle, where they form loops and then join the branches 
 of the other arteries. Horizontal anastomoses connect these arterial 
 twigs with one another. This vascular ring, of which the arterioles 
 of the anterior ciliary form a part, is called the circulus (arterio- 
 sus) iridis major. Before reaching this circle both long posterior 
 arteries furnish branches to the ciliary muscle, as well as recurrent 
 rami to anterior areas of the choroid. See, also, Anatomy of the 
 eye. 
 
 Arteries, Macular. These minute but important arterioles are usually 
 two to four in number. As a rule, they arise as independent branches 
 of the trunk of the central artery of the retina in the papilla, but 
 occasionally from one of its larger branches. They then proceed 
 to the macular region, which they nourish. In a fundus with a 
 macular cilioretinal (q. v.) artery that vessel provides the entire 
 nourishment of the macula. 
 
 Arteries of the orbit. With the exception of the infraorbital artery, 
 which arises from the internal maxillary, all of the orbital arteries 
 are derived from the ophthalmic artery (q.v.), which in its turn 
 arises from the internal carotid and enters tlie orbital cavity (on 
 the lateral aspect of the optic nerve) through the canalis opticus.
 
 612 ARTERIES, PAPILLARY 
 
 All the orbital arteries are characterized by their remarkably tortu- 
 ous course ; they also have heavy walls and are loosely held in the 
 fatty tissues of the orbital cavity. In their origin and course each 
 artery of the orbit shows individual variations. All of them give 
 off small branches that supply the fatt}^ tissues, the muscles, the 
 fascia and the nerves of the orbit. See Anatomy of the eye. 
 
 Arteries, Papillary. The vessels are given off by the arteria centralis 
 retina^ in its course over the papillie. There are two primary 
 branches, the arteria papillaris superior and inferior respectively. 
 The papillary arteries may also include those nutrient twigs that 
 enter the papilla^ from all sides. 
 
 Arteries, Short posterior ciliary. There are from four to six of these 
 small vessels arising either from the ophthalmic artery or its pri- 
 mary branches. As a rule, the ophthalmic gives off an inner and an 
 outer branch and these subdivide into the posterior ciliary arteries, 
 although single ciliary arteries may have independent points of 
 origin. Before reaching the eyeball they frequently divide, pursue 
 a relatively straight course and then pierce the sclera principally in 
 the neighborhood of the posterior pole, although a few of the smaller 
 vessels perforate the globe near and on the nasal side of the optic 
 nerve. After giving off' numerous fine branches, they all anastomose 
 in the choroid. See Anatomy of the eye. 
 
 Arterio-capillary fibrosis. See Arterio-sclerosis. 
 
 Arterioklerose Opticusatrophie. (G.) Atrophy of the optic nerve in 
 arterio-sclerosis. 
 
 Arterioklerose Verschluss der Centralarterie. (G.) Occlusion of the 
 central nerve in arterio-sclerosis. 
 
 Arteriopressur. (G.) Acupressure. 
 
 Arterios, (G.) Arterial. 
 
 Arterio-sclerosis. Loss of elasticity or fragility on the part of the 
 arterial walls is an important element in the production of certain 
 complications about the ocular apparatus. Unfortunately the treat- 
 ment of arterio-sclerosis, when the condition is once fully estab- 
 lished, is very unsatisfactory. It is important, therefore, to recog- 
 nize the early onset of this disorder and to immediately adopt those 
 prophylactic means that can, in many instances, prevent the com- 
 plete development of arterio-sclerotic degeneration of the cardio- 
 vascular apparatus. In the majoritj^ of cases, of course, arterio- 
 sclerosis is merely an evidence of senility, premature or normal, 
 and here any causal treatment is manifestly impossible. A small 
 minority of cases of arterio-sclerosis are, however, due to distinct 
 metabolic disorders as gout and goutiness, diabetes, obesity, to a 
 variety of chronic intoxications and chronic forms of intestinal
 
 ARTERIOSCLEROSIS (313 
 
 derangements, as well as to the abuse of alcohol, tobacco and lead, 
 and, finally, to syphilis. 
 
 Symptomatic treatment must chiefly concern itself with preventing 
 hypertension of the peripheral vessels, in other words, with keeping 
 down the blood pressure. The general dietetic rules to be observed 
 are the following: 
 
 Alcoholic beverages and tobacco, as well as tea and coflt'ee, should 
 be forbidden altogether. Meat should be reduced, and });irticularl.y 
 those varieties of meat and meat preparations known to contain 
 extractives, should be eliminated from the diet. A diet, there- 
 fore, consisting largely of milk, plenty of fresh fruits and vege- 
 tables, cereals and moderate amounts of fats is the best. Above 
 all things, hoAvever, great care must be taken not to chronically 
 underfeed the patient. The ingestion of liquids should be some- 
 Avhat restricted. The same principles should govern the choice of a 
 climate or an altitude, the employment of bathing, or other hydro- 
 therapeutic means in these cases as in cases of valvular heart dis- 
 ease with decompensation. 
 
 The medicamentous treatment of arterio-sclerosis consists first in 
 the use of iodides, either of potash or sodium, preferably adminis- 
 tered in combination with some alkali, as bicarbonate of soda. A 
 very useful routine method of administering iodides and alkalies is 
 the exhibition of 2 to 10 drops of the saturated solution of iodide of 
 sodium in a glass of milk, to which is added one-third of a teaspoon- 
 ful of bicarbonate of soda. Iodides are best given after a meal. 
 They should never be administered together with acid foods nor 
 should they be given patients sufifering from gastric catarrh, and 
 they should never be administered in a metal simoon. In order to 
 prevent the development of iodism the administration of the iodides 
 should be interrupted from time to time. The exact mode of action 
 of the iodides in arterio-sclerosis is not known, and it is useless to 
 discuss the numerous theories that have been advanced to exi)lain 
 their action. 
 
 The nitrites may also be used in order to reduce blood pressure. 
 They are best administered in the form of a nitrate combined with 
 sodium bicarbonate, as the nitrates undergo reduction to nitrites in 
 the body; or nitrite of soda may be given in tablets or solution in 
 the dose of 1 to 2 grains. Heart tonics should be given with care 
 in arterio-sclerosis on account of the inability on the part of the 
 arteries to adapt themselves rapidly to blood pressure changes. In 
 eases of cardiac insufficiency, however, developing later in the dis- 
 ease with low blood pressure, digitalis administered continuously
 
 614 ARTERIOSCLEROSIS, OCULAR 
 
 in small doses, say, for instance, of one drop of the tincture three 
 times a day, is of decided value. — (D. H.) 
 Arteriosclerosis, Ocular. Changes in the ocular blood-vessels, espe- 
 cially of those supplied to the interior of the eye, may be due to local 
 causes, although they are usually part of systemic alterations. 
 
 The importance of these organic changes cannot be overestimated in 
 the diagnosis, prognosis and treatment of the patient exhibiting them, 
 either from the standpoint of the ophthalmologist or of the general 
 practitioner. Although this matter will be fully dealt with elsewhere 
 in this Encyclopedia, it may not be out of place to speak of the 
 ophthalmoscopic appearances usually seen in these cases. de 
 Schweinitz, to whom we are indebted for much information on this 
 subject {Diseases of the Eye, Sixth Ed., p. 592) includes among them: 
 (1.) Alterations in the course and caliber of the retinal arteries, mani- 
 festing themselves as (a) undue tortuosity, which is not significant 
 unless, to quote the words of Mr. Gunn, whose classification is followed, 
 it is associated with other evidence of disease; (b) alterations in the 
 size and breadth of the retinal arteries, presenting, as it were, a beaded 
 appearance. (2.) Alterations in the reflections from, and the trans- 
 luceney of, the walls of the retinal arteries, manifesting themselves 
 
 (a) in increased distinctness of the central lightstreak on the retinal 
 vessel and an unusually light color of the entire breadth of the artery ; 
 
 (b) loss of translucency, so that it is impossible to see, as is possible in 
 the normal state, through the artery an underlying vein at the point of 
 crossing; (c) positive changes in the arterial walls, consisting of 
 whitish stripes, indicating degeneration of the walls or infiltration of 
 the perivascular lymph-sheaths (perivasculitis). (3.) Alterations in 
 the course and caliber of the veins, together with signs of mechanical 
 pressure, manifesting themselves (a) in undue tortuosity, which, as 
 in the case of the arteries, is not significant except in the presence of 
 other disease; (b) alternate contractions and dilatations; (c) an im- 
 peded venous circulation where a diseased artery crosses it. The last 
 is a sign of the utmost importance. Ordinarily, as an artery crosses the 
 vein, as it may be seen by an examination of the normal eye-ground, 
 there is no sign of pressure, and the translucent vein permits a view 
 of the artery beneath it. If the walls of the artery are thickened by 
 disease, then it presses upon the vein, i^ushes it aside, or directly con- 
 tracts its caliber, so that beyond the point of crossing there is an 
 ampuUiform dilatation, (d) Changes in the venous walls, precisely 
 as they occur in the arteries, so that whitish stripes border the vessel, 
 and are indications of degeneration in its walls. Often associated with 
 this one may see varicosities. (4) Edema of the retina, manifesting it-
 
 ARTERIOSKLEROSE 615 
 
 self (a) as a grayish opacity, which may he present in the immediate 
 neighborhood of the papilla, or in spots over the eye-ground and along 
 the course of the vessels, looking like a fine gray haze, or in little 
 fluffy islands far out in the periphery. (5) Hemorrhages, manifesting 
 themselves as linear extravasations along the course of the vessels, 
 roundish infiltrations scattered over the fundus, or sometimes in a drop- 
 like form. 
 
 All these changes have been described by Raehlmann, Friedenwald, 
 Hirschberg, the author, and other observers, and have been especially 
 accurately recorded and classified by Marcus Gunn. See, also, 
 Retinitis, Albuminuric. 
 
 Arteriosklerose. (G.) Arterio-sclerosis. 
 
 Artery. Under this heading a number of important ocular blood- 
 vessels are, for convenience of reference, described, although it is 
 not intended to perform this office for all the arterial branches that 
 supply the eye and its appendages. An account of every ocular, 
 intra-ocular and orbital artery is however, given under Anatomy of 
 the eye; and Histology of the eye. 
 
 Artery, Anterior and posterior ethmoid. Both these vessels originate 
 from the naso-frontal artery and enter the ethmoid foramen. The 
 anterior branch then passes to and through the lamina cribrosa 
 into the nasal cavity. 
 
 Artery, Central, of the retina. This vessel is a branch of the main 
 ophthalmic artery, rarely of one of its branches. Still less frequently 
 is it derived from one of the posterior ciliary arteries. From 15 to 
 20 mm. ])ehind the eyeball it pierces the optic nerve in its inferior 
 medial quadrant, and runs obliquely to the optic axis. The accom- 
 panying vein follows the same course. It sometimes happens that 
 the arteria centralis branches oft' from the ophthalmic artery before 
 the latter has pierced the dura, in which case the retinal branch 
 is enveloped by a separate, fine, dural sheath or lamella of its own, 
 the whole being attached to the optic nerve. 
 
 Together with the vein the artery appears at the center of the 
 papilla and there, (or before it pierces the disk) divides into the 
 arteria papillaris superior and inferior, which again subdivide 
 diehgtomously to supply the whole retina. See Histology of the 
 eye; Anatomy of the eye. 
 
 Artery, Cilioretinal. An ophthalmoscopic examination demonstrates 
 that about one in ten human eyes shows that not all retinal arteries 
 arise from the central artery, but that one or more of tliem, sup- 
 plying the macula, have their origin about and within the ring of
 
 616 ARTERY, HYALOID 
 
 connective tissue in the papilla. These vessels, called "cilioretinal" 
 by Nettleship, originate from the corona of scleral vessels, and thus 
 carry blood from the ciliary arteries. Elschnig distinguishes 3 types, 
 according to their origin and course, (1) a branch of the corona of 
 scleral vessels, that enters the optic nerve and, without relation 
 to the choroid, passes through the nerve-fibres into the retina; (2) 
 a branch from the corona pierces the choroid at the periphery of 
 the nerve, and there divides into several branches, one of which 
 perforates the optic nerve and supplies the retina; (3) that artery 
 which takes its origin from one of the choroidal vessels which, again, 
 is a primary or secondary branch of the corona of scleral vessels. 
 
 The cilioretinal are end-arteries like the other retinal arteries. 
 As mentioned above, they are supplied to the i3apillary and macular 
 regions, but they may take various other courses. Thus the entire 
 arterial supply of the retina maj' be of cilioretinal origin. 
 
 Clinically, the cilioretinal arteries are of great importance in 
 embolism (q. v.) of the central retinal artery. 
 
 Several writers still maintain the theorj^ that the cilioretinal 
 arteries are branches of a centroretinal trunk that is given off from 
 the central artery behind the scleral lamina and appears on the 
 disk isolated from the visible arteria centralis. But there is no 
 clinical or anatomical ground for this assumption. {E)icyklopddie der 
 AugenheUkunde.) 
 
 Artery, Hyaloid, In many mammals an arterial vessel springs from the 
 optic papilla and enters the vitreous. In the human animal it is 
 well developed in the third foetal month and follows a tortuous 
 course to the posterior pole of the lens, after giving off the vasa 
 hyaloidea propria. Here, the vessel divides into 7 or 8 branches, 
 which spread over the posterior surface of the lens forming the 
 membrana capsularis. The obliteration of these vessels begins in 
 the sixth month, and gradually all the vascular branches disappear 
 completely. The point of entrance into the vitreous body corresponds 
 to the area Martegiana (q. v.), whence, after complete degenera- 
 tion of the hyaloid arterj-, a lymph-channel, the canalis hyaloideus, 
 runs through the vitreous, which with the hyaloid vessels is some- 
 times seen in the adult. See Artery, Persistent hyaloid. 
 
 Artery, Lachrymal. A branch of the ophthalmic artery. It follows the 
 lateral orbital wall and is supplied to the lachrymal gland, Avhere 
 it divides into the arteria palpebralis externa superior, and inferior. 
 Occasionally a recurrent branch is given oft' which, by way of the 
 superior fissure, anastomoses with the middle meningeal artery. 
 
 Artery, Nasal. The inferior end-branch of the arteria nasofrontalis,
 
 ARTERY, NASOFRONTAL 617 
 
 which supplies the dorsum nasi and anastomoses with the arteiia 
 angularis. 
 
 Artery, Naso-frontal. This vessel is the continuation of the ophthalmic 
 artery. It runs along the lower border of the superior oblique muscle, 
 passes below its ligament, ascends and divides into the frontal and 
 nasal arteries. On its course through the orbit it gives off the twa 
 ethmoidal arteries and a few (variable) muscular branches. 
 
 Artery, Ophthalmic. The ophthalmic artery arises within the cranium 
 from the internal carotid. Entering the orbit through the optic 
 foramen, it passes along the optic nerve, below and to its outer side. 
 The artery originating within tlie dura, it must necessarily be in- 
 cluded in the dural sheath of the nerve, but it soon pierces the latter 
 and then lies between the nerve and" the origin of the external rectus 
 muscle. It then curves inward and forward, crosses over the nerve 
 below the superior rectus and reaches an upper-inner point in the 
 orbital apex. Thence its course is forward, below the external ob- 
 lique, to the upper lid where it divides into the external oblique and 
 nasal branches. Speaking broadly (Sai^pey), this important artery 
 divides into three sets, those supplied to the eyeball, those to the 
 appendages of the eye and those that pass out of the orbit and do 
 not go to any part of the visual apparatus. 
 
 Meyer gives the following as the origin, in their order, of the 
 branches of the ophthalmic artery ; first, the retinal artery with the 
 inner ciliary; second, outer ciliary; third, lachrymal; fourth, upper 
 an^ outer jnuscular ; fifth, supra-orbital with posterior ethmoidal ; 
 sixth, inner and lower muscular ; seventh, anterior ethmoidal : eighth, 
 final division into palpebral, frontal, and nasal. Variations of the 
 lachrymal artery are often reported. The other important varia- 
 tion is in the course of the oi^hthalmic, which sometimes passes 
 under the optic nerve instead of over it. Dwight (Norris and 
 Oliver's System of Diseases of the Eye, Vol. I, p. 101) describes 
 these branches and their relations mostly as originally described by 
 Meyer. "There are usually two ciliary arteries, an outer and an 
 inner, each of which divides into many branches which pierce the 
 sclerotic near the optic nerve. The number of these secondary 
 branches may reach twenty, but this is uncommon. Two, called the 
 long ciliaries, after entering the globe, run to the anterior part 
 of the eyeball, but they are not easy to distinguish from the other 
 branches while in the orbit, though said to be larger. The anterior 
 ciliary arteries, some half dozen in number, are twigs of the muscular 
 branches and perhaps of the lachrymal and supra-orbital, which, 
 having divided once or twice, pierce the sclerotic in a ring near the-
 
 618 ARTERY, PERSISTENT HYALOID 
 
 margin of the cornea. The two posterior ciliaries and the central 
 artery of the retina are the first branches of the ophthalmic. Accord- 
 ing to Meyer, who has Avritten a very valuable paper on the orbital 
 arteries, the normal arrangement is for the central artery and the 
 inner of the posterior ciliaries to arise in common, very often within 
 the sheath of the Optic nerve, while the outer one arises a little 
 later. The central artery pierces the nerve within 1.5 centimetres of 
 the globe. The next branch is the lachrymal, which arises from the 
 outer side of the vessel to run forward to the gland along the upper 
 border of the outer rectus. It supplies by its terminal branches 
 the outer part of the lids and of the conjunctiva, anastomosing with 
 arteries of the face. It has an important connection soon after its 
 origin with a branch from the middle meningeal which enters the 
 orbit through the sphenoidal fissure. The importance of this lies in 
 the changes in the plan of the orbital arteries which may spring 
 from an early variation in the course of blood through this system. 
 This may lead to the lachrymal arising from the middle meningeal, 
 or, more important still, to the ophthalmic becoming a branch of 
 that artery and reaching the orbit through the fissure, or through 
 a special canal. The muscular branches, two or three in number, 
 are pretty uncertain in their mode of origin. The supra-orbital, 
 which is neither constant nor important, runs in the upper part of 
 the orbit at first to the inner side of the levator palpebrte and then 
 above it to the supra-orbital notch. The two ethmoidal arteries 
 leave the orbit by the little ethmoidal foramina between the frontal 
 bone and the os planum of the ethmoid ; the posterior may be a 
 branch of the supra-orbital, the anterior comes from the main trunk. 
 It remains only to state that they arise either separately or in 
 common, and pass out of the orbit above the internal palpebral 
 ligament." 
 Artery, Persistent hyaloid. This vessel (a vestigial remnant in man) 
 runs from the papilla through the vitreous humor to the posterior 
 surface of the lens where end branches form the membrana capsularis 
 lentis. The central canal which contains the artery is the canal of 
 Cloquet, and in the fully developed eye it follows the course of this 
 vessel. 
 
 The hyaloid artery degenerates and shrinks during the last months 
 of foetal life and finally disappears. In rare cases, however, it per- 
 sists on one or both sides. In cases where the vessel does not dis- 
 appear in this way a thin, gray, vascular cord is seen, which may 
 contain blood and may have branches. This string-like forma- 
 tion may extend from the papilla to the posterior surface of the
 
 ARTERY, SUPRAORBITAL 619 
 
 lens. If the artery persists in part only a mere strand of tissue with 
 club-shaped ends extends from the optic disk to the lens or its 
 neighborhood. Frequently a thread-like formation with fuzzy ends, 
 which extends from the papilla or from the lens a short way into 
 the vitreous humor, is observed floating back and forth with tlie 
 movements of the eyeball. In still other cases a more or less exten- 
 sive, clumpy, gray and gelatinous formation may be seen directly 
 on the papilla; or a grayish membrane of varying extent is seen 
 at the posterior pole of the lens (cataracta polaris posterior), rep- 
 resenting the remains of the arteria hyaloidea, a fact to which 
 Mittendorf some years ago drew our attention. Occasionally, a 
 grayish-white streak is seen in the physiological excavation of the 
 papilla, or at the hilus of the arteria centralis retina. This is most 
 likely a vestige of the hyaloid artery and the canal of Cloquet. Many 
 other variations occur. For example, in some reported cases a 
 complete band extends from the disc to the lens. This may persist 
 during life, but, on the other hand, it may be torn away from the 
 lens during the development of the eye, and may be associated 
 with tent-like detachments of the retina in the neighborhood of the 
 papilla; or it may lead to a rupture of the lens capsule, or to the 
 formation of a posterior lenticonus. 
 
 Along with the persistent hyaloid artery, it is not unusual to see 
 other congenital disorders, as, remains of the pupillary membrane, 
 various colobomata, a microphthalmus, congenital cataract, axial 
 cataract, rudimentary development of the retina, non-formation of 
 the optic nerve, etc. 
 
 The visual acuity may be normal with persistent hyaloid artery, 
 although defective sight is not uncommonly found. 
 
 Artery, Supraorbital. This vessel arises from the bend of the ophthal- 
 mic artery. It curls around and over the margin of the levator 
 palpebral superioris muscle and runs, with the supraorbital nerve, 
 directly beneath the periosteum of the roof of the orbit, through the 
 supraorbital notch or foramen, to the forehead, where it anastomoses 
 with the end-branches of the nasofrontal. See Anatomy of the eye. 
 
 Arthritis. Inflammation (acute, subacute, recurrent and chronic) of 
 the joints, commonly due to the poison of gout, rheumatism, gonorrhea, 
 etc., is frequently associated with ocular changes, especially iritis and 
 other inflammatory diseases of the uveal tract. 
 
 Arthritis in connection with the purulent conjunctivitis of the new- 
 born, is occasionally mentioned in ophthalmic literature. It would 
 probably be more frequently found if carefully looked for and if the
 
 620 ARTIFICIAL BLOOD SERUM 
 
 infant were watched for a longer period after the conjunctivitis had 
 been cured. A tabular statement of 19 cases of the kind has been, 
 collected by Dahlstroem, including one of-his own. These, with a case 
 reported by Neuburger, make 20 cases reported from Europe, of which 
 three, each, had come from two observers, Lucas and Hoeck. The joint 
 affection began at the 8th to the 43rd day. The presence of the 
 gonococcus was fully established in nearly all cases, and most of the 
 causes had other lesions traceable to the same cause. Two of the cases 
 terminated in death. All of the larger joints seem to have been 
 affected, often two or more of them in the same case. 
 
 Kheumatic iritis is rare, although rheumatism is usually placed 
 after syphilis as the next most frequent cause of iritis. Yeld, who 
 analyzed 159 cases of primary iritis, found that in no single instance 
 was the evidence of true rheumatism conclusive. He also found among 
 250 cases of rheumatic fever, and 100 cases of chorea, no case in which 
 iritis had occuri'ed. Nevertheless, he found the association of iritis 
 with joint affections very common ; and he ascribes them to common 
 causes, especiallj^ gonorrhea and septic conditions. The joint condi- 
 tions associated with iritis are usually fixed, not fugitive like those of 
 acute rheumatism. But iritis does occur with acute rheumatism. 
 Forster reports a case, and Jackson another. 
 
 Artificial blood serum. Plasma. Murray McFarlane uses a tablet 
 which contains osmotically active salts of the blood w^hich, added 
 to 1,000 drops of w^ater, makes a solution of the same alkalinity, 
 specific gravity and cryoscopic index as the liquor sanguinis. In 
 diseases of the eye, characterized by increased secretion he uses 
 this plasma solution for irrigation of and cleansing the cul-de-sac. 
 It may also be employed instead of distilled water in collyria con- 
 taining such remedies as are not incompatible with sodium and 
 potassic salts. He has also used it with good results, with or with- 
 out diog,in, mercuric cyanide and other drugs, in subconjunctival 
 injections. 
 
 Artificial daylight. Running around the ceiling of a room at the Bureau 
 of Standards, in Washington, writes Robert Franklin {Technical World 
 Alagazine, Sept. 1912), is a glass tube about three inches in diameter, 
 filled with silvery white light. It throws off a very brilliant 
 illumination, and in color is the nearest approach to the light 
 of the sky that has been obtained up to date. The pipe, nearly a 
 vacuum, contains a small quantity of carbonic acid gas, which is ren- 
 dered luminous by passing a mild current of electricity through it. 
 An interesting point about this kind of light is that it has already
 
 ARTIFICIAL EYES AND SIMILAR DEVICES 621 
 
 come into industrial employment, being used — by reason of its like- 
 ness to daylight — in silk mills and other plciees where textile materials 
 are manufactured oi' handled, to nuikc sure that perfect '"matches" 
 of the goods are obtained. Other gases used there in glass tubes are 
 helium and neon, the latter an ingredient of ordinary air. The new- 
 est idea for obtaining artificial daylight is to combine a mercury 
 vapor tube with the tungsten incandescent lamp. For this purpose the 
 tungsten lamp (which gives off many red rays, wholly absent in the 
 mercury glow) is placed in the middle of a ring-shaped glass tub.- 
 containing mercury vapor. Then both are enclosed in a big ground - 
 glass globe. The effect is that of an enormous luminescent opal, most 
 beautiful as well as agreeable to the eye. Since a high tem])erature is 
 required to get white light resembling daylight, the usefulness of the 
 rare metal, tungsten with a melting-point of over 5,400°, is very great. 
 It gives three times the amount of light for a given power as the carbon 
 filament, and is proportionately more economical. 
 Artificial eyes and similar devices. A substitute for the eyeball is 
 also known as a prothesis, or ocular prothesis. The derivation of 
 the term is not very clear. It is probably not only a synonym but 
 a contraction or corruption of prosthesis, meaning an imitation or 
 substitution. 
 
 The final success of an enucleation, bulbar evisceration or Mules' 
 operation may easily depend upon the shape, size, adjustment and 
 manner of wearing a prothesis — details that only an experienced 
 or, at least, trained surgeon can superintend. 
 
 Not only is it well established that the Egyptians, the Arabians, 
 and the early Greeks were acquainted wnth the fact that an artificial 
 eye can be worn in place of one lost by accident, disease or opera- 
 tive measures, but it is also certain that the oculists of ancient times 
 were generally in the habit of adjusting these cosmetic articles. 
 
 Ambrose Pare (1579) was the first to give a precise description of 
 the artificial eye. His work is illustrated by several drawings of 
 protheses that show both surfaces much like the shell eyes of our 
 own time. He describes these as made of metal, painted and enam- 
 eled to imitate the human eye. Another variety, made of metal and 
 painted leather, was edged with silk, to the outer border of which 
 was attached a cord that passed under the hair and over the ear. 
 By this means the eye could be removed from the orbit any time the 
 "wearer desired. 
 
 At the beginning of the 18th century artificial eyes began to be 
 manufactured of glass. Heister, for example, in his Institutiones 
 Chirurgic(c, 1750, devotes a whole chapter to the artificial eye.
 
 622 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 Pansier quotes the description given by a Nevers jeweler of his 
 method of making (about 1750) artificial glass eyes. It does not 
 much differ from the manufacture of shell eyes in our own day. 
 
 Most of the information regarding artificial eyes, as they were 
 made and used about this time, is derived from the thesis of 
 Mauchart, Tiibingen, 1749. From it we learn that there were at 
 least two varieties worn in his day, ecblephari kept in place by an 
 iron circlet about the head and hypoblephari, the ordinary shell-eye. 
 A third class, the ancient variety, at that date rarely used, was the 
 silver and gold eyes of the Egyptian and Arabian oculists, in more 
 modern times painted or covered with colored enamel, to represent 
 the iris and pupil. 
 
 Mauchart gives explicit and sensible directions regarding the 
 care of the prothesis — how to put it in place, how and when to re- 
 move it, how to cleanse the conjunctival sac or orbit, and how and 
 when to use detergent lotions of most value for the latter purpose. 
 He gives the formula of these collyria; an important one being a 
 warm mixture of rose water; another with "eyebright" — all of 
 them to be applied with a sponge. He fully recognizes the disad- 
 vantages as well as the advantages of the prothesis, the danger of 
 irritation of the socket, as well as the possibilities of harm to the 
 fellow eye. 
 
 For a long time Venice enjoyed a monopoly of the manufacture 
 of glass eyes and the strictest laws were enforced to prevent the 
 secrets of the trade from being carried abroad. Eventually, how- 
 ever, France, Bohemia, and other countries became such rivals of 
 the Venetian artists, that at the end of the 18th century the glass 
 eyes of Murano no longer enjoyed their former commercial su- 
 premacy. 
 
 About this time Storck invented or discovered a successful method 
 of manufacturing glass eyes, and, finally, in 1818, Hazard-^Iirault 
 published his practical treatise on the artificial eye in which most 
 of the details of manufacture, including the rules for closely imitat- 
 ing all the parts in the front of the human eye are plainly set forth. 
 After him (almost with him) came the two Desjardins and Boisson- 
 neau. The last named optician was among those who made Paris 
 the headquarters for artificial eyes for the next half century. 
 
 The manufacture of enameled eyes was introduced into Ger- 
 many by Eitterich in 1850. That country before very long dis- 
 placed France in the output of artificial eyes and at length acquired 
 possession of most of the foreign trade and has held it ever since. 
 At the present day we in America are dependent almost entirely
 
 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 623 
 
 upon the output of Geruiau factories — especially those of ^Vies- 
 baden — for all forms of protheses. The exception is that a few 
 American firms are beginning, Avith imported workmen, to furnish 
 specially designed eyes to suit unusual sockets, as well as eyes spe- 
 cially painted and prepared to imitate exactly the fellow eye. The 
 ordinary protheses, as generally employed, are the old shell-eyes 
 very little changed or improved during the past 100 years, and the 
 new "Reform-Auge," the larger, thicker, solid or hollow eye, intro- 
 duced by Snellen. The latter has the advantage of tilling more 
 completely the conjunctival sac, of pushing forward the upper cul- 
 
 Profile View of an Ordinary 
 Artificial Eye. 
 
 Profile View of a 
 Snellen Eye. 
 
 Profile View of a 
 Snellen Eye. 
 
 de-sac and so removing the sunken appearance (less easily remedied 
 by the shell-eye) at the superior margin of the orbit. The efiPect 
 of the Snellen eye is to produce a better prothesis ; in most cases the 
 eye stands out well. One of the purposes, also, of the "Reform" 
 eye is to render needless such operations as that of Mules, Fox and 
 Lang — the introduction of sponge, gelatine, globes of glass, metal 
 or other foreign substance into the vitreous or orbital cavity or 
 Tenon's capsule for the purpose of forming a more prominent or 
 better stump for the "superimposed artificial eye. There are cases, 
 of course, in which even the thickest Snellen eye cannot take the 
 place, in this respect, of some one of the above mentioned proced- 
 ures but, on the other hand, a specially prepared " Reform- Auge, " 
 suited to the case in hand, will go far to imitate the prominent 
 globe or the receding orbital walls of the opposite eye. 
 
 Apart from the ordinary uses of the artificial eye it must not be 
 forgotten that glass and porcelain shells are occasionally employed 
 to good purpose to prevent symblepharon after wounds, burns and 
 operations on the lids. These are of two kinds ; one sort, almost 
 exactly like the artificial shell but adapted to the particular require- 
 ments of the case ; a second variety, like the first, only pierced with 
 a central aperture for the protection of the cornea, to permit the 
 escape of secretions and to allow the entry of collyria to the globe 
 and sac. 
 
 Other artificial shells, called by the French "contact glasses,"
 
 624 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 of transparent glass, were adjusted closely to the eyeball and were 
 recommended in irregular astigmatism and keratoconus to give a 
 regular contour to the front of the cornea and so improve the visual 
 powers and cosmetic appearance of the eye. In some cases there 
 was a space between the outer layer of glass and the cornea (or the 
 shell was hollow) to be filled with a 50 per cent, glucose solution 
 which is of the same refractive index as the cornea. Sulzer found 
 these non-irritating and of great benefit in improving vision. About 
 1871 Albini invented a plate or cover of aluminum for the front of 
 
 Artificial Eye with Gold Spring. Snellen's Improved Eye. 
 
 the eye, to be held in place by the lids. He called this device an 
 opistoblepharos and claimed that it is useful (a) in staphyloma cor- 
 nese upon which it might exercise beneficial mechanical pressure ; 
 (b) to protect the bulbar conjunctiva from cauterants applied to 
 the lids; (c) as protection to the cornea in ulceration of the latter; 
 (d) when covered with a certain composition it would take the 
 place of the artificial eye ; (e) it might act as a frame to carry minute 
 quartz lenses and thereby be a substitute for ordinary glasses ; (f ) 
 it might be useful as an electrode in applying electricity directly 
 to the globe. Few of tliese claims have been justified in practice. 
 
 The vitreous pro theses of the present day are made of enamel (a 
 fusible, opaqu€ mixture of silicon, potash, lead and tin) colored with 
 various pigments ; they are not prepared of ordinary glass as was 
 once the case. 
 
 Pansier sets forth the advantages of the artificial eye from the 
 social and commercial side. For the well-to-do it conceals what 
 would otherwise be a terrible disfigurement ; for the poor man it 
 also serves to conceal what Avould infallibly prevent him from 
 obtaining most kinds of work, since nobody cares to engage an 
 artisan who presents the appearance of having but one eye. 
 
 The functions it subserves from the medical side are several. (1.) 
 It regulates the movements of the lids. The upper lid deprived of 
 its support by the loss of the eyeball, falls fiat and flaccid; it some- 
 times turns in because the contracting marginal fibres of the orbicu- 
 laris have nothing to oppose their action. (2.) The artificial eye 
 relieves the friction of the lashes upon the lining of the sac due to
 
 ARTIFICIAL EYES AND SIMILAR DEVICES G25 
 
 this form of entropion. (3.) The artificial eye directs the drainage 
 of the sac, especially of the tears. (4.) It protects the walls of 
 the cavity from infection and from foreign bodies. (5.) When 
 the prothesis is worn over a globe still sensitive to light-impressions, 
 the artificial eye may serve to cut off the light rays that, in some 
 instances, are a source of acute annoyance to the patient. (6.) In 
 children a large sized, well-fitting eye is a necessary stimulant to 
 the development of the orbit and face. Deprived of the globe the 
 infantile orbital cavity on the affected side does not increase pari 
 passu with its fellow. The prothesis prevents to a large extent this 
 one-sided growth provided, always, that the artificial eye is as large 
 as possible and is almost constantly worn. 
 
 Practically whenever an eye is removed its place may be taken 
 by an artificial one. Pansier ordered a prothesis for an infant 18 
 months old, and eases where they were worn at two and three years 
 are not uncommon. 
 
 After an enucleation the artificial eye may be fitted as soon as 
 the wound of operation has fully cicatrized. There can be no fixed 
 rule, but the adaptation of the prothesis should not be deferred too 
 long or done too early. An average period of four weeks is about 
 right, although Klaunig, Galezowski and others believe that four- 
 teen days is generally long enough to wait. 
 
 When adjustment of the artificial eye is too long delayed the 
 lid tissues contract, the cul-de-sacs diminish in depth and there is 
 some difficulty in adjusting an eye that is large enough, that is sat- 
 isfactory to surgeon or patient or that, sometimes, is eas}' to retain 
 in its proper place. 
 
 After exenteration of the orbit, especially if any portion of the 
 lid tissues has been involved in the operation, it is extremely diffi- 
 cult to fit a prothesis that will produce a satisfactory cosmetic effect. 
 Since the introduction of the Snellen eye and the possibility of hav- 
 ing artificial eyes specially made and adjusted by competent 
 artisans this difficulty has, in a measure, been overcome. Still, the 
 adjustment of a prothesis after an extensive orbital exenteration 
 remains very unsatisfactory and the majority of patients prefer to 
 cover their deformity with a skin-colored shade — preferably of cel- 
 luloid — adjusted closely to the orbital margins, rather than wear 
 an eye that fails to disguise the defect. 
 
 An artificial eye can generally be worn with satisfaction over 
 an atrophic globe or one from which the intraocular contents have 
 been removed. When the cornea has been preserved it is well to 
 order an eye wlmse margins mainly support the prothesis, thus pre- 
 
 Vol. 1—40
 
 626 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 venting as far as possible undue pressure on the sensitive corneal 
 surface. There are cases in which sympathetic irritation has ap- 
 peared in the fellow eye — a condition commonly calling for com- 
 plete enucleation. It is even possible that an ill-fitting, or even a 
 properly adjusted shell may light up a cyclitis in the underlying 
 globe, an intlammation capable of transmission to the opposite eye. 
 
 The eye, whether it be a shell or a Snellen eye, should exactly 
 resemble the fellow eye in coloration of the sclera and iris, size of 
 the cornea, tint of the sclera, medium dilation of the pupil, in the 
 appearance of anterior chamber, position of the visible blood ves- 
 sels, location of the cornea, and convexity of the globe. Its size 
 should conform as nearly as possible to the conjunctival cavity and 
 orbit. In people with sensitive orbits it is well to first introduce 
 a prothesis somewhat smaller than the one we expect them to wear 
 finally. After an interval of a few weeks adjust the permanent pro- 
 thesis. It may be put down here that the patient, if he can afi:'ord it, 
 ought to be supplied with at least two such permanent eyes in case 
 one is lost or broken. When these eyes are specially made for him 
 two should be ordered. 
 
 Artificial eyes should be perfectly polished, and Avitbout defect; 
 especially should they be free of those pin-point airholes in the glaze 
 one occasionally sees in the cheaper grades of protheses, which are 
 likely to harbor secretions that in a short time render the surface 
 rough and irritant. 
 
 In passing, it may be noticed that worn, scratched or roughened 
 artificial eyes may be polished and their life of usefulness extended, 
 although the newly polished surface does not endure as long as the 
 original glaze. 
 
 The edges of the prothesis ought not to be too thin — at least a 
 millimetre thick — nor should the body of the eye be too delicate; 
 it is then easily broken. 
 
 That the very particular patient may be prepared for most con- 
 tingencies he should have two differently colored artificial eyes, one 
 with a comparatively small pupil for use during the daytime, when 
 he is exposed to a full illumination and the pupil of the healthy 
 eye is somewhat contracted, and the other, with a larger pupil, for 
 evening wear when the pupillary expansion of the seeing eye is 
 greater than during the daytime. 
 
 The artificial eye must necessarily be adapted to variations in 
 the capacity, depth and height of the conjunctival cavity. As a 
 rule, however, the cornea is placed below the horizontal line (because 
 of the greater depth of the superior fornix and width of the upper
 
 ARTIFICIAL EYES AND SIMILAR DEVICES 627 
 
 lid) and towards the inner canthus, where the narrow part of the 
 eye is adjusted. It thus follows that the right eye will not generally 
 receive a prothesis intended for the left socket, and vice versa. 
 This is, however, not always the case ; indeed, Boissonneau sold an 
 "oeil symetrique," to fit either side, but it was not a very satisfac- 
 tory device. 
 
 Vendors of artificial eyes generally keep a few on hand for such 
 anomalies as syniblepharon, partially obliterated or contracted sulci, 
 cicatricial deposits on the floor of the orbit, atrophic globes, etc., 
 but the variations in these respects from the average socket are so 
 numerous that it is generally difficult to secure an accurately fitting 
 prothesis from even a very large stock ; it is much better to secure 
 the services of a competent artisan, who will make a prothesis for 
 the particular case. 
 
 Pansier 's test of a properl}^ adjusted artificial cornea is chiefly 
 that when the patient fixes a point three metres distant the optic 
 axes should both appear to cut that point. That is to say, for the 
 distance there should be a slight, apparent convergence. Better a 
 decided, convergence than the slightest divergence. He also believes 
 that the motility of the prothesis depends as much on its perfect 
 adaptation to the lids and stump as to any other consideration. lie 
 prefers the Bonnet method of leaving the musculature intact, a fact 
 long ago observed by my confrere, Frank Allport, who sutures the 
 tendons of the straight muscles at the medial incision, thus obtain- 
 ing the fullest effect of their action upon the ocular pad, whether 
 it be that resulting from a Lang's operation, an abcission, or an 
 ordinary enucleation. 
 
 The reader is reminded that a very efi^ective method of measur- 
 ing the excursions of the artificial eye is to examine them with the 
 a candle on the carrier of the perimeter, as in determining the 
 angle of squint. If this is done it will be noticed that the most 
 extensive excursion of the shell is downwards, then inwards, then 
 outwards, and least upwards, as True and others have demonstrated. 
 
 Introduction is generally quite simple. Hold the small end of the 
 prothesis between the thumb and finger of the right hand, apply 
 the thumb of the left hand to the eyebrow and raise the upper lid, 
 at the same time asking the patient to look down. Introduce the 
 larger end of the eye well into the upper sulcus. Remove the left 
 thumb from the eyebrow. Rotate the prothesis on its axis so that 
 the smaller end almost corresponds to the inner canthus. With the 
 left forefinger draw down the loAver lid; the artificial eye will slip
 
 628 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 into its place. Further adjust the prothesis by gently separating 
 the two lids for a moment. 
 
 If the patient introduces his own eye he uses the left hand where 
 the surgeon employs his right. As a matter of experience the 
 patient soon learns not only to adjust, but remove, his own prothesis 
 better than anyone can do it for him. 
 
 The majority of artificial eyes may be removed from the socket 
 by drawing down the lower lid with the forefinger and at the same 
 time pushing its point below the edge of the prothesis as it is felt 
 beneath the lid-skin. The eye readily drops out over the margin 
 of the lower lid. This maneuver failing, draw down the lower 
 lid, insert the head of a pin beneath the lower margin of the shell 
 at the inner canthus of the eye, and slowly pass it along towards 
 the middle of the shell ; the prothesis will be readily drawn out 
 over the edge of the lid. 
 
 The patient can easily be taught both procedures and instructed 
 to remove the prothesis over a cushion or other soft object, to 
 avoid the danger of breakage. 
 
 For the first week or two, or until the patient and his orbit 
 become accustomed to the presence of what is to some extent an 
 irritating foreign body, the eye should be worn only for a few 
 hours daily. At first it may be kept in place for an hour at a 
 time, say, three times daily, after which it can be worn for longer 
 periods until it is eventually retained all day. 
 
 The prothesis should be removed on retiring at night. 
 
 I have a number of patients who, for various reasons — generally 
 cosmetic — wear their prothesis day and night, and I cannot see 
 that any harm has arisen from following this plan, but, as a rule, 
 the wearer should be told that it is conducive to the health of the 
 parts to give the orbit a rest during the night. 
 
 After the removal of the shell at night the conjunctival sac 
 should be washed out with a warm, saturated solution of boric 
 acid, or wdth any other simple detergent wash, and the lid edges 
 should be similarly cleansed. 
 
 The materials (enameled glass and glaze) from which the arti- 
 ficial shell is made, undergo chemical changes as the result of 
 friction with the lid edges and exposure to the secretions from the 
 conjunctiva. For this reason it is a mistake to add to these sources 
 of deterioration by keeping the prothesis in solutions of any kind 
 — even water — over night. The eye should be cleansed Math warm 
 water in which a little baking soda has been dissolved, wiped per- 
 fectly dry with a soft, clean and old linen or cotton handkerchief
 
 ARTIFICIAL EYES AND SIMILAR DEVICES 629 
 
 or towel, polished and placed in a small box to protect it from 
 dust until it is ready for use in the morning. Treated in this way 
 it ought to last for one or two j-ears. As soon as it loses its pristine 
 polish, or sets up irritation about the orbit, or loses its motility, 
 or looks as if it were too small or too large, it ought to be changed. 
 The most sensible thing for the patient to do is to return to the 
 oculist ever.y six months for the purpose of having his artificial eye 
 and the socket critically examined; if any change is called for, the 
 surgeon is more likely to perceive it. 
 
 Although, in most instances, the prothesis masks an evident defect, 
 protects the socket and its lining, and insures proper drainage of 
 the eye, there are some possibilities of danger that inhere in the 
 wearing of the shell, especially if it is not carefully selected, prop- 
 erly adjusted and di\\y cared for. 
 
 The depression below the upper margin of the orbit (which is 
 always more or less marked after enucleation or evisceration) is 
 due chiefly to the contraction of the levator palpebral superioris 
 that in the absence of a globe of normal size pulls the upper edge 
 of the tarsus (into which it is inserted) directly backwards instead 
 of upw'ards over the eyeball, as it usually does. In his anxiety to 
 correct this part of the deformity, the surgeon (more frequently 
 the optician) may introduce too large a prothesis, especially if it 
 be of the flat type of artificial eye. This act results in the inordi- 
 nate stretching of the parts, discomfort to the wearer and inter- 
 ference with the proper movement of the lids. 
 
 Several observers have recorded instances of damage to the 
 socket and the remaining eye as the result of the introduction and 
 attempted use of too large or an ill-fitting shell. Among these are 
 sympathetic irritation, migratory ophthalmia, obliteration of the 
 cul-de-sacs, atrophy of the lid muscles, abnormal stretching of the 
 lid skin, symblepharon, chronic catarrh of the conjunctiva and 
 epiphora. 
 
 If the depression caused by the action of the levators is not 
 reinedied by the artificial globe, there are several operations (those 
 of Critchett and deWecker, for example) to which one may have 
 recourse, although it may be said in passing that the Siiellen eye, 
 as w^ell as the specially constructed shells, have much reduced the 
 proportion of these defects. 
 
 Most of the obstacles have been mentioned, but i1 is as well to 
 repeat some of them. As a general rule, when the sac is for any 
 reason too small to admit an artificial eye, it w-ill require, and may, 
 as a rule, have a satisfactory operation performed upon it.
 
 630 ARTIFICIAL EYES AND SIMILAR DEVICES 
 
 Conjunctival bridles may be incised, and conjunctival symblepha- 
 ron treated, while even total adherence of both lids and obliteration 
 of the sac may be remedied in consequence chiefly of the labors of 
 American surgeons — notably Weeks and Hotz. 
 
 In some cases the artificial eye, acting as a foreign body, sets up 
 or perpetuates a perviously existing conjunctivitis, or encourages 
 exuberant granulations along the line of incision. Especially in 
 the case of the shell eye, it may prolong an original vice of the 
 conjunctiva by preventing the escape of secretions. This is espe- 
 cially true of that variety of artificial eye that has a rounded mar- 
 gin with an opening, however large, into the body of the prothesis. 
 The concavity holds fluids that readily undergo decomposition. If 
 the borders or surfaces have been eroded, or have lost their polish, 
 this is all the more likely to happen. It is needless to point out 
 that the eye should not be again worn until the disease has been 
 cured, and that no prothesis should be kept in place that has not 
 perfectly smooth surfaces throughout. 
 
 If the surgeon lives in a city and can send his patient directly to 
 the optician, so that the coloration, prominence and other charac- 
 teristics of the remaining eye may be noted and a selection of, say, 
 twenty protheses returned, that a properly fitting shell can be 
 chosen, it is, of course, the best plan to adopt; but if patient and 
 surgeon reside at some inconvenient distance from the vendor of 
 artificial eyes, some other course must be pursued. To meet this 
 latter difficulty, numerous suggestions have been made and carried 
 out — such as the preparation of models in wax, paraffin, soft tin, 
 lead or aluminum ; or of gutta percha softened in hot water, or 
 carving them out of such materials as ivory, wood and bone. As 
 for the coloration of the remaining eye it was either described or 
 a painting of the eye in pastels or oils accompanied or formed part 
 of the model ; or a large photograph was taken of the eye properly 
 colored. 
 
 In addition, the diameter of the cornea, the length and height of 
 interpalpebral space, the average width of the pupil, the colora- 
 tion of the conjunctiva and the distribution of its vessels, the degree 
 of bulbar prominence and other necessary details were written 
 upon the photograph. As a matter of practice nowadays, most 
 wholesale opticians issue blanks upon which the surgeon writes 
 the information just referred to, as well as a record of otter neces- 
 sary details. On the arrival of a selection of shells he proceeds to 
 choose from the consignment and adjust a properly fitting eye. 
 In the larger cities expert workmen can almost always be found
 
 ARTIFICIAL EYE, IMPROVED 631 
 
 who manufaetui-c on the spot a supply of jn-otheses in exact imi- 
 tation of the remaining eye. This mnking of artificial eyes "while 
 you wait" is, on the wliolc. the most satisfactory method for pro- 
 viding- one or more eyes that not only resemble the living organ, but 
 whose adaptation to the needs of the individuiil case is most cer- 
 tainly secured. 
 
 Owing to the fragile character of enameled eyes, many substi- 
 tutes have been proposed. These have been chiefly protheses of 
 lead, aluminum, ivory, bone, caoutchouc, vulcanite and celluloid. 
 
 Nieden and van Duyse devised protheses of which the l)ody is 
 made of material not readily broken, with a superimposed enameled 
 iris and cornea. The substitutes (of French manufacture) are 
 made of celluloid, but although much cheaper than the vitreous 
 shell, are expected to last only a few months. Moreover, they lack 
 the peculiar brilliancy of the enamel eye, their margins are thin 
 and irritating, they readily corrode and lose their polish, and their 
 single virtue — freedom from danger of breakage — does not com- 
 pensate for these defects. On the other hand, protheses made by 
 a competent workman, of enamel glass, resist the action of the 
 tears and mucoid discharges from the conjunctival cavity, as well 
 as damage from other sources of deterioration for one or two years. 
 
 Practically the same remarks apply to all other substitutes for 
 eyes made of enamel glass. With a large supply both of the irregu- 
 larly ovoid Reform protheses, as Avell as of the older shell plates 
 to choose from, not to speak of the possibility of securing the 
 services of a competent artist to make and adjust artificial eyes 
 to almost every unusual form of socket, no patient can complain 
 that he cannot have a satisfactory companion for his remaining 
 eye.— (Ed.) 
 Artificial Eye, Improved. Grossmann {Ophthalmic Tear Bool\ 1908, 
 p. 297), to remedy the sinking of the lid often seen after enuclea- 
 tion, experimented by molding a piece of wax upon the upper part 
 of the artificial eye, and finally found a maker of glass eyes who 
 carried out the idea in glass. The prominence is situated near the 
 upper edge of eye, and must 1)e especially adapted to each individual 
 case. For this reason Grossmann urges that patients should be 
 sent direct to the maker of the eyes and that in this way a much 
 better fit may l)e obtained. 
 Artificial house and office lighting. The rules that govern this impor- 
 tant department of hygiene are much the same as those applicable 
 to the illumination of school rooms (q. v.). In other v.^ords the 
 illumination should be of proper amount and quality and should
 
 632 ARTIFICIAL HOUSE AND OFFICE LIGHTING 
 
 * 
 shine upon the work to be done and not directly or by reflection 
 
 into the eyes of the observer. For the general illumination of any 
 room the best light is that which imitates diffused daylight — the 
 sort of illumination most satisfactory to the whole visual apparatus. 
 If these facts be borne in mind any form of artificial light ma^^, 
 with proper modifications to suit individual requirements, be em- 
 ployed. The problems involved in many office buildings, stores, 
 banks, etc., are not easy of solution but we may, perhaps, arrive 
 at the best light available by recollecting the following aphorisms: 
 
 (1) Electric arc lights sliould never be used for indoor illumina- 
 . tion ; it is too brilliant, too dazzling and too concentrated; (2) 
 owing to the heat evolved, the danger of fire, and the vitiation of 
 the atmosphere by gas, electric lamps are preferable; (3) the Wels- 
 bach or Auer light is too powerful for near work. If hung well 
 out of range it is a good light for large rooms and show windows ; 
 (4) the naked filament or wire light of the electric lamp gives an 
 irregularly shadowed field of illumination upon the printed page 
 or other near work; it should, in consequence, always be covered 
 by a ground or porcelain glass when employed close at hand; (5) 
 diffusion of this light, as well as that from incandescent mantles 
 with gas of all sorts, has lately been accomplished bj" prismatic 
 globes or holophanes, so disposed that the light rays are mostly 
 deflected downwards; (6) apart from the heat and vitiated air 
 engendered by it, there is probably no better reading light than 
 the old-fashioned argand burner (or "students' lamp") with gas 
 or kerosene. (7) An imitation of the students' lamp has recently 
 been accomplished by using AAnth a 16 c. p. electric lamp a dull 
 aluminum reflector. It acts very well, throws parallel rays on the 
 printed page and does not shine into the reader's eyes. 
 
 Luxfer prisms are a patented device for refracting light into the 
 dark rooms of buildings, especially in eroAvded cities. They are 
 often inserted into sidewalks and used as "batteries" before other- 
 wise badly illuminated Avindows. 
 
 In this connection see also the sections on Illumination and Arc 
 lighting. 
 
 Prismatic panes are of great value Avhen, as in croAvded cities, the 
 loAver stories in buildings are rarely or never reached by direct day- 
 light. These prisms are arranged as ornamental panes or as can- 
 opies in front of the dark AvindoAvs. For basements or cellars thej' 
 are inserted in the pavement, Avith secondary screens beloAv the 
 sideAvalk to assist reflection into rooms beneath. — (Ed.)
 
 ARTIFICIAL ILLUMINATION OF SCHOOL-BUILDINGS ()83 
 
 Artificial illumination of school-buildings. Sec Conservation of vision, 
 and Hyg-iene, School. 
 
 Artificial leech. This form of local bleeding or "wet" cupping is a 
 valuable agent for the reduction of most acute, deep-seated inflam- 
 mations of the eye, such as iritis, iridocyclitis, glaucoma, choroi- 
 ditis, etc. The pressure exerted upon the sensitive nerve-endings 
 by the dilated blood vessels (and increased quantity of blood in 
 the congested tissues) is thereby removed and the severe pain which 
 
 )m)mm}m^ 
 
 Artificial Leecb. 
 
 usually accompanies these abnormal conditions is often promptly 
 relieved. Although there are several methods in use for the abstrac- 
 tion of blood in this neighborhood, such as scarification of the 
 conjunctiva, opening an artery in the temple or the application of 
 the leech, the last named is the most popular. One may use either 
 the living animal or its substitute, the artificial leech. The latter 
 is preferable, as it is not only more certain in its action and more 
 agreeable to the patient, but the amount of blood abstracted can 
 be easily regulated. 
 
 The artificial leech consists of a glass cylinder in which Avorks a 
 piston connected with a thumb screw. This is attached to the 
 piston rod hy means of Avhich it can be raised and lowered. The 
 skin of the temple, half an inch from the outer margin of the orbit, 
 is the most desirable place for its application. Here the skin is 
 first scarified, either with a small instrument containing a punch 
 that cuts tAvo crescentic wounds, or a number of small incisions 
 are made with a fine scalpel. The end of the cylinder is then 
 applied over the wound and the blood withdrawn by exhausting 
 the air in the cylinder. At least half an ounce of blood should be 
 withdrawn if a decided effect is to be produced upon the intra- 
 ocular circulation. 
 
 A rubber "cup," or a glass cylinder attached to one, and a 
 small lancet are all that are needed for cupping. The skin of the 
 temple is highly scarified by criss-cross incisions, or by dermatome, 
 and the blood drawn by suction. The cup of the Victor or other 
 machine, used in giving massage, may also be used. m
 
 634 ARTIFICIAL PUPIL 
 
 Theobald has suggested that the best result from this method 
 of blood extraction is obtained by pinching up a fold of skin with 
 a pair of dressing forceps and, using a Graefe knife, "nicking out" 
 a small, thin disc of tissue, 3 mm. in diameter, involving the epider- 
 mis and superficial layers of the cutis. The suction cylinder was 
 then employed as usual. He found this convenient, practically 
 painless and much more efficient than the scarifier. He also found 
 by experiment that a few drops of a 1^ per cent, solution of ammonia 
 carbonate dropped on to the w^ound or placed in the cylinder of 
 the artificial leech increased considerably the free flow of blood. 
 There was not the usual tendency to the formation of a clot in the 
 instrument. 
 
 The leech may be used every day or two without diminution of its 
 efi'ects but one must not forget that the scarifications are more or 
 less subject to infection. The operative area should be carefully 
 disinfected before each use of the instrument and it may be painted 
 over with collodion when the operation is concluded. 
 Artificial pupil. Originally the operation of iridectomy (q. v.) was 
 designed and performed only to make an artificial pupil, that is, for 
 optical purposes. The object of an optical iridectomy is to permit 
 light to penetrate into the interior of an eye in which the pupillary 
 area for some reason is not sufficiently transparent for this purpose. 
 The obstructing opacity may lie in the cornea, or in the space of the 
 pupil, or in the crystalline lens, and be of a permanent or progressive 
 character. As was later on found, an iridectomy may, also, be a 
 curative agent, especially in eyes with increased intraocular tension, or 
 in cases in which for a time at least it seems useful to reduce the 
 intraocular tension, as for instance, in ulceration of the cornea, in 
 certain sequelte of iritis, and for the removal of tumors of the iris. 
 
 The excision of a piece of iris was practised occasionally in some 
 cases of cataract extraction by Daviel. A kind of iridectomy for 
 purely optical purposes was first introduced by Wenzel. However, he 
 made only subcorneal iridectomies. This led frequently to an injury 
 to the lens and cataract formation. In consequence his advice was to 
 extract the lens at once after iridectomy, whether it was opaque or not. 
 
 Beer was the first to introduce into ophthalmic surgery the abscision 
 of the iris outside of the eye, the precorneal iridectomy. To him be- 
 longs the credit of having invented and practised iridectomy as we 
 still perform it. That since his time the procedure has been improved 
 upon and that its field of usefulness has been greatly enlarged, es- 
 pecially by von Graefe, does not alter this fact. He made a corneal 
 flap with the triangular knife which bears his name, then he drew the
 
 ARTIFICIAL RIPENING OF IMMATURE CATARACT 635 
 
 iris out of the wouiid by means of a sharp cataract hook and quickly 
 snipped it off with scissors, and this, in a general way, is still the 
 method of performing i)recorneal iridectomy nowadays. — (A. A.) 
 Artificial ripening of immature cataract. The nuituration of an 
 "unripe" lens is undertaken that it may be readily extracted with- 
 out leaving remnants Avithin the anterior chamber and so producing 
 a secondary opacity, or setting up inflammatory changes, or giving 
 rise to both these complications. Generally speaking the operation 
 should be confined exclusively to the cortical form, beginning be- 
 tween the fortieth and sixtieth years. In young subjects wdien the 
 nucleus is as yet very small, or non-existent, a discission is quite 
 enough to hasten the process. In senile cataracts, a sharj) distinc- 
 tion should be made betw^een those affecting mainly the cortex and 
 an undue hardening and increase of the nucleus. 
 
 The simplest classification of the different types of cataracts is 
 the one founded on a structural basis, viz. : nuclear, cortical and 
 capsular. All forms of cataracts involve one or more of these 
 structures. The greatest number begin in the cortex as opaque 
 stria? at the perijohery and gradually involve the entire lens. When 
 the process is complete, transmitted light thrown with the ophthal- 
 moscope in the eye, gives no fundus reflex and oblique illumination 
 easts no shadow of the iris on the lens. The patient has light per- 
 ception but if the projection is good the lens is "ripe" and suitable 
 for extraction. However, to apply this standard of "ripeness" to 
 all forms of senile cataracts w^ould lead to serious error, either in 
 advising patients half blind from sclerosis of the lens to await an 
 indefinite number of years for the cataract to become ripe, or to 
 attempt artificial ripening in such a case. 
 
 The nucleus increases in size with age ; even at forty it is an 
 appreciable factor to be considered in cataract extraction. Between 
 fifty and sixty it usually forms the major part of the lens, and later 
 in life it forms no small part of a cataract even when the entire 
 body becomes sclerosed. Here, the usual standard of ripeness fails 
 utterly. Transmitted light in many nuclear cataracts gives a pro- 
 nounced reflex from the fundus. A shadow from the iris is cast 
 on the lens by oblique illumination and shows a gray or browai- 
 yellowish opacity deep in the lens. This condition of affairs is in 
 marked contrast to the brilliant fundus reflex often obtained with 
 the ophthalmoscope. 
 
 The standard of ripeness for a sclerosed lens should be the in- 
 ability to transact ordinary affairs, or the necessity of holding 
 fair-sized type wdthin a lew inches of the eye.
 
 636 ARTIFICIAL RIPENING OF IMMATURE CATARACT 
 
 On the whole, the sclerosed lens can be extracted more com- 
 pletely than the cortical variety which is so apt to leave some 
 imexpelled lens matter to cause future trouble. 
 
 In the past most surgeons had an undue dread of attempting to 
 remove an immature cataract, but at the present time the majority 
 do not hesitate to extract as soon as the amount of vision does not 
 come up to the patient's actual needs. 
 
 McKeown showed that immature cataracts could be safely re- 
 moved. He was the first to advocate washing hard, cataractous 
 masses out of the anterior chamber with a stream of warm normal 
 salt solution. 
 
 Various methods have been advocated for the artificial ripening 
 of cataract and at one time they were extensively employed. 
 
 Muter was the first to advise an operative procedure for the 
 artificial' ripening of cataract, his plan being laceration of the an- 
 terior capsule. He was followed later by von Graefe and other 
 surgeons, but the writings of Forster on artificial ripening awakened 
 most interest and he had a host of followers. 
 
 Among the principal methods employed for the artificial matura- 
 tion of cataract are the following: (a) Paracentesis (T. R. Pooley) ; 
 (b) Paracentesis with massage of the cornea (J. A. White) ; (c) 
 Paracentesis with massage of the anterior capsule; (d) Division 
 of the anterior capsule; (e) Division of the anterior capsule with 
 corneal massage ; (f ) Iridectomy with division of the anterior cap- 
 sule (Mooren) ; (g) Iridectom.y with massage of the cornea (Fors- 
 ter) ; (h) Iridectomy with division of the anterior capsule; (i) 
 Intra-capsular injection of normal salt solution (temperature of 
 100° F.) with a special syringe (McKeown). [To these may be 
 added the method of Homer Smith in Avhich an extensive eapsulot- 
 omy is made from 24 to 36 hours before the extraction. For a com- 
 plete account of this method see Cataract, Senile. — (Ed.)] 
 
 Forster believed that the sudden emptying of the anterior cham- 
 ber and the subsequent rapid change in the shape of the lens would, 
 by a kind of rubbing together of their already partially disorgan- 
 ized fibers, bring about a further opacification of the tissues. He, 
 however, did not rely upon this agent alone but, in his artificial 
 ripening operation, after an iridectomy, firmly stroked the cornea 
 with a strabismus hook for two or three minutes. There can be no 
 doubt but that this massage of the lens through the cornea is 
 effective in many cases. Forster and others have reported many 
 instances where six or eight weeks after corneal massage the imma- 
 ture cataract was found to be quite ready for extraction. Pagen-
 
 ARTIFICIAL RIPENING OF IMMATURE CATARACT 
 
 0() f-' 
 or 
 
 stecher used a glass rod instead of the strabismus hook for making 
 the massage. In any event, after either an iridectomy or a para- 
 centesis the well-cocainized eye should be steadied with fixation 
 forceps and the massage instrument employed to stroke firmly, 
 regularly and slowly, in both radial and circular directions, the 
 whole cornea. The time occupied should not exceed three minutes. 
 As Forster pointed out, the main difficulty of the proceeding is 
 
 Anterior Chamber Irrigator for Use iu the Extraction of Immature Cataract. 
 
 the proper amount of force to be applied to the cornea; if it is too 
 great the zonula of Zinn may be torn and the subsequent extraction 
 be followed by extreme loss of vitreous. If the massage is too 
 gentle the effect is nil, the lenticular fibers not being disturbed by 
 the massage. 
 
 In American literature one finds a number of writers' who have 
 reported their experience of various ripening operations. Among 
 these are Noyes and Mittendorf, who report their experience of 
 Forster 's plan of trituration of the lens; the former rather favor- 
 ably, but the latter has seen iritis follow the procedure and thinks 
 it a dangerous plan. Jackson modified the Forster method by 
 employing indirect massage of the lens with the upper lid, after 
 emptying the anterior chamber. Boerne Bettman was probably 
 the first to introduce a spatula into the anterior chamber and apply 
 "direct" massage to the anterior capsule. 
 
 It is questionable if any of these various methods is necessary. 
 "When one has to deal with an immature cataract one should per-
 
 638 ASAD AD-DIN YAQUB B. ISHAQ AL-MAHALLI 
 
 form a preliminary iridectomy some six weeks prior to the extrac- 
 tion, which generally aids in making the cortex more opaque. Fol- 
 lowing this, at the time of extraction, the corneal section should 
 be made a trifle larger than the usual two-fifths of the limbus, and 
 the capsulotomy should include one-third of the lens periphery. 
 After the expression of the nucleus and opaque part of the cortex, 
 the free use of a warm normal, salt solution injected into the 
 
 The Simple Anterior Chamber Irrigator Eeady for Use in the Extraction of 
 
 Immature Cataract. 
 
 anterior chamber and capsule with a suitable syringe, so as to wash 
 out as much as possible of the unexpelled lens matter will be found 
 very satisfactory. There has long been in use at the New York Eye 
 and Ear Infirmary a round, soft, rubber bulb with a diameter of 
 50 mm., having a capacity of two and a quarter ounces. To this 
 is attached a glass tube 55 mm. long, and having the diameter of 
 an ordinary eye dropper. Towards the end it tapers at an angle 
 of 140°, is contracted at the mouth and flattened, having an open- 
 ing 1 mm. broad. (See figure). 
 
 An iridectomy preliminary to any form of cataract extraction 
 enables the operator to remove leisurely and more accurately a 
 definite amount of the iris. Besides this advantage at the time of 
 extraction, there is less liability of the iris falling over the cutting 
 edge of the knife. This makes the extraction safer and easier, 
 enables the surgeon to estimate the condition of the cataract itself, 
 and indicates how the patient is likely to act during the remaining 
 steps of the operation.— (P. C.) 
 
 Asad ad-dir Yaqub b. Ishaq al-Mahalli. A Jewish physician of MahalK, 
 Egypt, who flourished at the close of the 12th century, and who 
 wrote a work entitled, ''Concerning the Vision." — (T. H. S.) 
 
 Asagroea officinalis. The systematic name of the plant from which 
 the mixture of alkaloids called veratrine is obtained. 
 
 Ascaris lumbricoides. This is a f nematode) round worm, an intes- 
 tinal i)arasite whose presence in the alimentary canal has only the 
 barest relation to ophthalmic practice. Haffner (Bfrl. Klin. Wocli- 
 enscJir., No. 24, 1880) once discovered an ascaris in the lower left
 
 ASCENDING PARALYSIS, EYE-SYMPTOMS IN 639 
 
 canaliciilu.s of a child suffering with whooping-cough. Tlie worm, 
 which was 3 em. long, protruded from the punctum. It is probable 
 that the parasite had reached the postnasal space during vomiting, 
 and thence crawled up the nasal duct to the lachrymal canal. 
 
 Ascending paralysis, Eye-symptoms in. The ocular disturbances in 
 the so-called Landry "s disease are confined to occasional loss of the 
 light reflex, dilated pupil, paresis (or paralysis) of accmniiiodation, 
 and of the extrinsic muscles. 
 
 Ascesso del cervello. (It.) Abscess of the brain. 
 
 Ascesso della palpebra. (It.) Abscess of the eyelid. 
 
 Asclepiades of Bithynia. A famous physician who flourished at Rome 
 in the first century before Christ. lie Avas the founder of the school 
 of "methodists." He composed no work on ophthalmology, but, 
 from a passage in Galen, it would seem that, in a book of his which 
 was devoted to external ren^edies, there was a part, or division, 
 which treated of external remedies for the eye. The passage in 
 (juestion runs as follows: "Asclepiades furnished the best and most 
 complete exposition concerning both dry and fluid remedies, and the 
 collyria of the Asclepiadean Collection, in the first book of External 
 Remedies."— (T. H. S.) 
 
 Asemia, Lack of ability to comprehend or express any sign of 
 thought or feeling. 
 
 Asepsis. Surg-ical cleanliness ; freedom from morbific germs or their 
 toxins. See Antiseptics. 
 
 Aseptin. This compound is an antiseptic and astringent mixture of 
 alum, one \n\vt, and boracic acid, eighteen parts, intended to be 
 used both as a dry powder and as a solution in various diseases of 
 the external eye. 
 
 Aseptol. SozoLic acid. Orthophenolsulphonic acid. Orthosulpho- 
 CARBOLic ACID. C(5H(;04S. The solution marketed by Merck under 
 the trade name of aseptol contains one part in three of sozolic 
 acid and is a clear, yellowish liquid with an odor of carbolic acid. 
 It is very soluble in water; less soluble in ether and alcohol; a 
 disintectant much less toxic yet more efficient than phenol. It 
 should not be exposed to light. In from one to ten per cent, \vatery 
 solutions it may be used as a germicide in most external diseases 
 of the eye. 
 
 Askulap. (G.) Esculapius; a physician. 
 
 Asmus, Sideroscope of. Prior to the discovery of the Roentgen rays, 
 the diagnosis of the presence of a particle of iron or steel, or other 
 foreign substance within the globe, was often a very difficult matter. 
 As the majority of foreign bodies that enter the globe are of mag-
 
 640 
 
 ASMUS, SIDEROSCOPE OF 
 
 netizable material, the magn^^.tic needle has been used m a variety of 
 ways as an "indicator.'' The first to use the magnetic needle for 
 this purpose was Thomas R. Pooley, who performed numerous ex- 
 periments and demonstrated the delicacy of the method. He tabu- 
 lated the deflection of the needle by particles of different sizes at 
 
 ...^ 
 
 The Sideroscope of Asmus. 
 
 various distances from the needle, both magnetized and uumagnet- 
 ized. This was the first use of the method in connection Avith the 
 eye, although it had been used in general surgery. The idea Avas 
 later elaborated by Asmus, who constructed an instrument contain- 
 ing a magnetic needle suspended by a silk thread in a glass tube, as 
 shown in the figure. This apparatus consists of a box of wood 15 era.
 
 ASPERGILLUS FLAVUS 641 
 
 high (d), closed before and behind by a plate of glass sliding in a 
 groove. This box stands upon a disc of iron (a), which is levelled 
 by three screws (v), thus allowing the instrument to be made per- 
 fectly vertical. These screws rest upon a second disc (c), which is 
 fixed to a north and south wall. A fixation screw (b), maintains the 
 position. Above the box of Avood is a tube of glass (e), and in this 
 tube hangs the silk thread which holds the magnetic needle. This 
 thread is attached to a regulating screw (f), which allows one to 
 raise and lower the needle, and also to turn it so that it may hang 
 free. At the lower end of the thread is hung an aluminum tube which 
 supports a small mirror and the magnetic needle (m). The needle 
 is 11 cm. long and extends from the box of wood for a distance of 
 4 cm. on each side. Each end of the needle is enclosed in a tube of 
 glass (k) which is 6 mm. in diameter. — (E. S. T.) 
 
 Aspergillus flavus. One of the moulds which occasionally exhibits 
 a distinct growth on various cutaneous, mucous and other surfaces 
 of the human organism, including the eye structures. 
 
 Aspergillus fumigatus. (L.) This is a mould fungus belonging to 
 the Acomycetes. It forms a greenish, often bluish-grey growth, 
 quite like that of the common mould fungus — Penicillium glaucum. 
 In the cornea it i)roduces a swelling that resembles the compact 
 mass of a corneal slough. Experimental injections of this fungus 
 into the cornea and the vitreous have resulted in suppuration of 
 the surrounding tissues. 
 
 Aspergillus glaucus. (L.) This, like Aspergillus fumigatus (q. v.) 
 belongs to the Acomycetes. It has occasionally been found as an 
 accidental growth on the lid-margins and in the conjunctival 
 glands, but its presence is not a serious source of ocular discomfort. 
 
 Aspergillus keratitis. See Keratitis, Mycotic. 
 Aspidium, Amblyopia from. See Filix mas. 
 
 Aspiration of cataract. Suction operation for the removal of soft 
 cataract. This procedure is mentioned bj' Phazes as the invention 
 of Antyllus, who flourished about the fourth century A. D. Accord- 
 ing to Albucasis, this method was in use in both Persia and Arabia. 
 The operation was not entirely forgotten in the later centuries, 
 as Guillemeau claimed that the lens was not removed thereb}' but 
 simply the aqueous humor. Barbette in the seventeenth century 
 ridiculed the method. 
 
 During the subsequent two centuries it fell into complete disuse, 
 until it w^as revived by Peccholi in 1829. He made a corneal section 
 (after the discission had fully matured the cataract) and through 
 
 Vol. 1—4 1
 
 642 
 
 ASPIRATION OF CATARACT 
 
 the opening introduced a hollow needle by which the soft lens mat- 
 ter in the anterior chamber was drawn off by a pump. 
 
 The next recorded advocate of the operation was Langier, who 
 entered the needle through the sclera, perforated the posterior 
 capsule and removed the soft lens matter by means of a foot-pump. 
 
 Teale 's Suction Operation for the Aspiration of Cataract. 
 
 A, A, A, points to be introduced into the anterior chamber; B, glass 
 tubing; C, rubber tubing and month-piece. 
 
 The operation was adopted in England in 1863, by Teale, Bow- 
 man, Lawson, and Greenway, and for a time was quite in vogue. 
 Teale devised a special canula to which was attached a glass and 
 rubber tube, using the mouth for suction, as seen in the accompany- 
 ing figure. 
 
 Bowman devised a special syringe with which to make suction 
 and thereby avoided aspiration by the mouth. (See figure.) 
 
 ^ 
 
 
 -< 
 
 
 ^m^^^M 
 
 T 
 
 
 
 
 i 
 
 ^ 
 
 ) 
 
 ^ 
 
 
 
 3 
 
 3 
 
 ^^^^^^^ 
 
 
 mimmm 
 
 It 
 
 mm 
 
 ■ 
 
 1 
 
 m 
 
 m 
 
 
 
 
 I 
 
 
 m 
 
 •*• 
 
 r 
 
 
 "*— ^ 
 
 r-t~l 
 
 
 ■•■ 
 
 — 
 
 =sg 
 
 Bowman's Syringe-pump for tha Aspiration of Soft Cataract. 
 
 About ten years subsequent to the revival of the operation in 
 England, it was employed at the Mass. Charitable Eye and Ear 
 Infirmary. Hasket Derby states : "As regards results from the 
 suction operation, the reports of the Mass. Charitable Eye and Ear 
 Infirmary for the last eleven years show the performance of 107 
 operations by suction." In 65 cases the results are as follows:
 
 ASPIRIN 643 
 
 Full suction, 46 ; partial, 18 ; loss, 1. lu five instances the visual 
 result was perfect. In 1887 Coppez in Belgium and Redard in 
 France, called attention to the advantages of the operation. The 
 latter made an improved apparatus on similar lines to Teale's 
 instrument. 
 
 Rograan in 1899, operated on the clear lens in high myopia in 20 
 cases by discission and suction, with no loss. 
 
 Howe and others in America have also extensively employed the 
 method. 
 
 The operation of aspiration should be confined to soft, li(iuid and 
 traumatic cataracts. In old patients, with a hard nucelus, it is 
 unsuitable and in young subjects with partially clear lens matter, 
 as in the perinuclear type, it should not be attempted until a dis- 
 cission has softened the entire lens mass. 
 
 The pupil should be dilated ad maximum. The corneal incision 
 should be made with a keratome 4 mm. from the limbus ; in the left 
 eye in the superior nasal quadrant ; in the right eye at the superior 
 temporal quadrant. Then a large opening is made by the point of 
 the instrument in the anterior capsule. Introduce the canula, with 
 its point towards the cornea, into the anterior chamber through the 
 cut capsule against the substance of the lens. Then, suction is made 
 either by the syringe-pump or by the mouth. 
 
 Care should be taken to retain the end of the canula within the 
 capsular wound and not to push it behind the iris or into the 
 vitreous. — (P. C.) 
 
 AVhile the alternative of irrigation of the anterior chamber to the 
 artificial ripening operation is properly considered in discussing the 
 removal of immature cataract — especially in the unripe cataracts of 
 comparatively young subjects — yet there is a third procedure worthy 
 of consideration, viz. : the SmitJi-Indian nictliod. This procedure 
 fully described elsewhere, seems well adapted to overcome the dif- 
 ficulties of dealing with unripe cataracts. If there is a place in 
 ophthalmic surgery for this operation it is certainly in these very 
 cases in which soft matter remnants and post-operative capsular 
 tags are such a menace to the eyesight of the patient and. as a matter 
 of fact, form the one obstacle to the realization of good post-opera- 
 tive vision. Surely it is worth an effort and the risk accompanying 
 that attempt to get rid of the whole lens with both its capsules. — 
 (Ed.) 
 Aspirin. Acetylsalicylic acid. CgIIs04. A compound obtained by 
 heating acetyl chloride in a flask to 302° F. (150° C). It is found
 
 644 ASPORTAZIONE BELLA MARGINE CILIARE 
 
 as small, acidulous, colorless crystals, slightly soluble in water, 
 more so in alcohol and ether. 
 
 This willow preparation, allied to salicin and salicylic acid, 
 given in gram doses three or four times daily, is of decided value 
 in severe cases of iritis and other uveal affections. It is best admin- 
 istered in capsules, with or without sodic bicarbonate. Wicher- 
 kiewicz has employed it with success in chronic conjunctivitis due 
 to long standing gonorrheal infections, in iritis, iridocyclitis, scleritis 
 and episcleritis, rheumatic choroiditis Avith vitreous exudations and 
 glaucomatous manifestations. It is less prone to produce tinnitus, 
 and gastric disturbances than the salicylates. 
 
 Wm. G. Craig employs aspirin, generally in doses of 15 grains 
 night and morning, in all such painful eye diseases as iritis, kera- 
 titis, corneal ulcer, glaucoma, and after injuries and operations. 
 He is so impressed with the value of this drug that he uses it to 
 the exclusion of all other anodynes. 
 
 In most acute diseases of the uveal tract where the pain is fre- 
 quently reci,irrent or intermittent in character and generally plagues 
 the patient at night the best plan for administering aspirin is to 
 give a large dose, say, 20 grains, half an hour before the usual pain- 
 ful attack, to be followed by a smaller amount — 5 to 10 grains — - 
 every hour until relief is obtained. This agent often acts, in this 
 way, as an innocuous soporific since by the relief of nocturnal pains 
 the suiTerer is able to sleep Avithout the use of opiates. 
 Asportazione della margine ciliare. (It.) Displacement, or trans- 
 plantation, of the ciliary margin of the lid. 
 As-Sadili, Sadaqa b. Ibrahim al-Misri. This author was one of the 
 latest of the Arabian ophthalmologists. He flourished in the second 
 half of the 14th century and was the author of the last Arabian 
 text-book on the eye. This work, which bears the somewhat tauto- 
 logie title, OcuUsiic Aids for Dis<ascs of the Visual Apparatus, is 
 divided into five chief parts, in each of which theory as well as prac- 
 tice is given its appropriate share of attention. The first division 
 treats of the necessity for the functions of the eyes, and of the 
 anatomy of the organ in question : the second, of general medical, 
 as well as oculistic principles ; the third is devoted to such diseases 
 of the eye as are perceptible to the senses, their symptoms and their 
 treatment; the fourth, so far as possible, to ocular diseases not per- 
 ceptible to the senses; Avhil^ the final chapter discusses the names, 
 nature, aiid values of general as well as of ophthalmic medicines. 
 
 Especially interesting, in the fourth section of the first division of 
 this book, is the exposition of the three theories at that time held
 
 AS-SADILI, SADAQA B. IBRAHIM AL-MISRI 645 
 
 regarding the nature of vision. Tliese theories are: (1) The visual 
 object sends in something to the eye. (2) From the eye emanates 
 perceptive power outwards to the object. (3) Emanations take 
 place from both the object and the eye, and then commingle some- 
 where between the two. As Sadili then concludes that, "The third 
 of these views is correct, and comes close to the truth that the air 
 surrounding us, Avhen it is clear and shining, becomes as it were an 
 organ for vision and continues the activity of the hollow nerves in 
 relation to the brain." 
 
 Also interesting is the fact that, in this book, the first brief attempt 
 in all scientific history is made toward a comparative anatomy and 
 physiology of the eye. It constitutes the sixth division of the first 
 "Part" of the book, and runs as follows: On the Differences be- 
 tween the Eyes of Animals Compared with Those of Men, and on 
 the Special Peculiarities of the Latter. 
 
 1. Presence or Absence of the Eyes. The sponges and many of 
 the snails have no eyes at all. 
 
 2. Number of the Eyes. Alone the Moses-fish has only one eye. 
 Nor has any animal more than two eyes, excepting the leech. 
 
 3. Substance of the Eyes. In the crab, the eyes are long-handled 
 and hard; not so in men. 
 
 4. Form of the Eyes. In the mole, both eyes are covered with a 
 skin : thus it comes about that this animal beholds shadoAVS but not 
 forms; thus, too, is tlie manner of its movement and the fact that it 
 seeks for nourishment in the dark. Many birds possess, beneath the 
 lids, a white skin, which is capable of covering the eyes. Hard- 
 skinned animals have neither lashes nor lids, except a few of the 
 fishes. The most of such animals as bring forth their young alive, 
 possess lashes; men, however, more than all. 
 
 5. Compass of the Eyes. The eye of the owl is large ; that of the 
 vulture small, likewise that of the elephant, in spite of the size of its 
 body. 
 
 6. Comparison of the Parts of the Eye. The white of the eye in 
 man is larger than the black ; not so in other animals. 
 
 7. Consistency of the Eyes. In animals with a hard skin the eye 
 is hard, on the other hand soft in those with a soft skin. 
 
 8. Peculiarities in the Form of the Eye. In animals with a hard 
 skin and in those with a white skin the eye is roundish ; in those 
 which bring forth their young alive, almond-shaped. 
 
 9. Color of the Eye. The eye of the lion and of the lynx and of 
 the cat is fire-colored — not the case in men, horses, and other animals.
 
 646 AS-SADILI, SADAQA B. IBRAHIM AL-MISRI 
 
 10. Situation of the Eye. The eyes of the crab are at the sides, 
 on processes, or prolongations — not so in other animals. 
 
 11. Mutual Situation of the Eyes. The two eyes of man are near 
 one another, not so in other animals. 
 
 12. Situation of the Parts of the Eyes. Animals with a hard skin 
 have lids, which close themselves together and possess no motion. 
 
 13. Activity of the Eyes. Most of the birds are strong in vision, 
 the bat weak, the mole still weaker. 
 
 14. Time of Seeing. Bat and owl see by night, the cat by night 
 and by day, differently from nearly all the other animals. 
 
 15. Clearness of Vision. The fish sees better in water than in 
 other media ; the crocodile sees well in water and badly on land. 
 
 16. Manifold Activity of the Eyes. Animals with thin skin have 
 in their eyes, besides the visual power, the power of voluntary move- 
 ment. 
 
 17. Sensitiveness of the Eyes. The eye of the bat suffers great 
 injury from sunlight, in direct opposition to the eye of the chameleon 
 and the swallow. 
 
 18. Strength of the Impression Produced by Eye-Diseases. 
 Pterygium in the eye of the horse exerts a deadly effect upon the 
 latter, not so in the case of man. 
 
 19. The Frequency of Eye Diseases. This is greater in men than 
 in other animals. 
 
 20. Dift'erence in the Eff'ect of Injury to the Eye. When the eye 
 of a swallow is pierced with a needle, whether in the white part or in 
 the black, the wound is merely of assistance to the eye and increases 
 its health. They say that the eyes of the adder behave in a similar 
 fashion. 
 
 "But the eye of man himself offers strange qualities and peculiar- 
 ities. Among such is this, that they possess shading projections from 
 above — the eyebrows. Their lower lids possess lashes, something 
 that no other animal presents in that situation. Further, man's eyes 
 are almond-shaped. Still further, man can move his upper lid, some- 
 thing of which no other animal is capable. Again, his two eyes are 
 set near together. Once more, his eyes possess an especial protection 
 in the strongly forward-projecting nose ; this keeps off many in- 
 juries from the front. Still again, his flow of tears is abundant. 
 Then, too, he is oftener attacked by diseases of the eyes, on account 
 of the multitude of substances which mount aloft to his brain. 
 
 "The brain of man is very convex, in order that room may exist 
 for that which portrays itself for him in that organ. The bones 
 around the brain are porous, in order that the various materies may
 
 ASSALINI'S OPERATION 647 
 
 easily excrete themselves away from it. Many superfluities befall 
 this organ : therefore are diseases numerous — among the most fre- 
 quent, catarrhs, colds, coughs, sneezings, bleedings from the nose 
 and hoarseness. 
 
 "Most of the misciianees wliicli befall the eye come from the brain. 
 For the former has its place of origin in the latter, the parts of the 
 former arise out of the latter. For this reason it is that the eyes of 
 different men are different. 
 
 "The eyes of the negro are goggly and dark on account of the 
 increase in the moisture of their brains, together with the heat, 
 which comes from the hotness of their land and the nearness of the 
 sun to their heads. 
 
 "The eyes of the Turks are narrow-slit, on account of the abun- 
 dance of moisture in their brains, together with the bitter cold of 
 their land; the most of them are flat-nosed. 
 
 "The eyes of the Bedouins are broad, owing to the dryness of their 
 brains, in conjunction with the dryness and scantiness of their food. 
 
 "The eyes of the city-dwellers are like those of the people from 
 Irak and Syria and Egypt ; they are small in spite of the size of the 
 nose, on account of the injuriousness and great variety of their 
 nourishment. 
 
 "The people of Egypt have the most ophthalmias, in comparison 
 with others, on account of the clouds of dust and sand in their coun- 
 try; the frequency of their eye-diseases arises from the weakness of 
 their brains." 
 
 Nor is it so extremely remarkable that the world had had to wait 
 until the time of As-Sadili for its first attempt at a comparative 
 ocular anatomy and physiology, as it is that, after Sadili's time, it 
 had to wait again till the latter half of the nineteenth century for 
 anything more (worth mentioning) on this extremely interesting 
 subject.— (T. H. S.) 
 Assalini's operation. One of the forms of iridodialysis. The iris is 
 
 detached with forceps through a large corneal incision. 
 As-Samarqandi, Abu Hamid Muh. b. All b. Omar Nagib ad-din. This 
 distinguished Arabian physician of the middle ages perished in the 
 conquest of Herat by the Tartars, A. D. 1222. His writings are: On 
 the Causes and Symptoms of Diseases and On the Anatomy of the 
 Eye. As the latter possesses considerable ophthalmologic interest, we 
 subjoin a complete translation thereof : 
 
 "Know that the eye is composed of 7 membranes and 3 humors. 
 
 "When the hollow nerve passes down to the eye, clad in the two 
 membranes of the brain, for its own protection, and arrives at the
 
 648 AS-SAMARQANDI, ABU HAMID MUH 
 
 orbit; then it expands, and, with it, expand the two membranes and 
 embrace the humors of the eye. All then together become three mem- 
 branes of the eye, after the intermingling with the branches of the brain 
 and arteries. The nerve with its two membranes, they are like three 
 layers laid on one another, the head pointing forward and the tail 
 backward. The outermost layer arises from the hard membrane of 
 the brain, which touches the inner surface of the skull; the second 
 from the thin membrane of the brain; the third is the terminal ex- 
 pansion of the optic nerve and lies in contact with the humors of the 
 eye. 
 
 "The first layer of the eye, which touches the bones of the orbit, 
 is called the hard membrane, because it grows forward out of the hard, 
 thick membrane of the brain. The second is called the after-birth 
 membrane, because it is rich in veins and arteries. The third, which 
 touches the vitreous and crystalline humors, is called the retina. 
 
 ' ' From these posterior layers others grow forward, like three dishes 
 set one within another. The hinder ends of the forward are directed 
 toward the forward ends of the hinder, the periphery of each single 
 one of the forward being united with the corresponding periphery of 
 the hinder. Of these three anterior, the first, w^hicli proceeds from 
 the hard membrane, is called the cornea ; its middle is arched in the 
 place which is opposite the pupil. The second, which gi^ows forward 
 out of the after-birth membrane, is called the uvea. The third, which 
 takes its origin from the retina, is called the arachnoid membrane. 
 The uveal membrane is perforated in the middle ; it increases and di- 
 minishes in the light and in the darkness, in order that the appropriate 
 quantity of light may always attain to the interior of the eye — not 
 excessive light injure the eye, and not darkness render the visual 
 power incapable. Its inner surface is formed into numerous tufts, in 
 order that the aqueous humor may be able to cling to it and not pour 
 itself through the perforation opposite the crystalline humor. 
 
 "These, then, are six membranes, with their points of origin and 
 their situation ; and the seventh is the white, -which surrounds the 
 dark of the eye, also the lids of the eye — according to the right con- 
 ception ; it is called the conjunctiva, its origin is outside the skull from 
 that membrane which enwraps the skull upon its outside. 
 
 "Of the humors, that which is next behind the retina is called the 
 vitreous, thereafter follow the crystalline humor, and, in front of this, 
 the egg-white humor. In the middle, between the two latter, lies the 
 arachnoid membrane, which forms a partition between both. The 
 oifiee of the egg-white humor is to moisten the crystalline ; the former
 
 ASSIMILATION 049 
 
 gives the latter to drink because of its purity. God knows it best." — 
 (T. H. S.) 
 
 Assimilation. Hering has applied this teiiii to llie renewal of the 
 visual (purple) substances with the assistance of the oxygen of the 
 blood, a process that continues and conserves the function of the 
 color-perceiving organs. 
 
 Assimmetria. (It.) Asymmetry. 
 
 Associate (conjugate) ocular movements. All normal movements of 
 the eyes are in a sense associated, that is. Ilu'v are so coordinated 
 that they give rise to (correspondingly) (Mjual and symmetrical 
 moveilients of both globes. These associated movements consist 
 chiefly in an ecpial movenuMit of both eyes from any given position 
 to any other. See Muscles, Ocular, and Movements, Ocular. 
 
 Associated movements of eyelid and jaw. Quite a number of these 
 curious co-movements are recorded in the literature of the subject. For 
 example: Harlan reports a case in a boy aged 4 years. The ab- 
 normality was not congenital but had appeared when the boy was 2 
 years old, after an attack of typhoid fever. During mastication ener- 
 getic and rapid winking of the left eye occurred, entirely beyond the 
 patient's control and giving the idea of blepharospasm. Coincident 
 with the opening of the mouth there was contraction of the levator, 
 more decided when the patient looked down. Harlan thinks well of 
 the suggestion of Harman, ascribing "jaw winking" to reversion to 
 an ancestral type similar to the shark, in which the fifth and seventh 
 nerves are closely associated. This seems to best explain this case, 
 which w'as not congenital but arose after sickness, that might have 
 left a w^eakened levator. 
 
 Cases of similar elevation of the upper lid with movement of the 
 lower jaw are reported by Wilkinson and Coburn. In both these 
 cases the condition was congenital. Coburn "s patient was unable to 
 open his left eye, the one affected, except when he opened his mouth. 
 Harlan's patient also presented a slight ptosis. But Wilkinson's- 
 patient was able to open and close the eyes normally, except that when 
 he made an extra effort, the right, or affected eye opened a little wider. 
 Coburn mentions the old explanation of an unusual relation between 
 the levator portion of the nucleus of the third nerve and the pterygoid 
 portion of the nucleus of the fifth. Harlan, however, seems inclined 
 to accept the suggestion of Harman mentioned above. He thinks a 
 relaxation of the orbicularis associated with contraction of the ptery- 
 goid permitted a weak levator to raise the eyelid. 
 
 In Stephenson's case of ptosis of the left eye synkinesic movements 
 occurred of the right upper lid and the lower jaw when the latter was
 
 650 ASSOCIATED MOVEMENTS OF HEAD AND EYES 
 
 opened or shut or moved from side to side. The peculiarity of the case 
 was that the abnormal association involved not the lid with ptosis but 
 the unaffected eyelid. In Sym's case there was partial ptosis of one 
 eye, with excessive elevation of the lid upon depressing the lower jaw, 
 due apparently to some confusion in the joining up fibres and cells be- 
 longing to the fifth and third nuclei. 
 
 Associated movements of head and eyes These consensual or coopera- 
 tive movements are rather rare. Hamill and Posey report three 
 cases in infants. In one the movements did not appear until the child 
 was over three years of age. In the others they were first noticed 
 at three and fourteen months respectively. All the children showed 
 marked evidence of rickets, the probable predisposing cause ; and the 
 gastro-intestinal irritation generally conceded to be an important 
 exciting cause. On closing or bandaging the eyes the movements 
 diminished or ceased. It was not thought, however, that the head- 
 nodding and jerking was an attempt to compensate for the eye 
 movements. The two sets of movements were not synchronous; the 
 eye movements being much the more rapid. Then in some reported 
 cases the head movements have appeared before the eye movements. 
 Hamill and Posey incline to accept the explanation of Hadden, that 
 such movements depend upon a disturbance of the cerebral cortex. 
 "The child has acquired certain voluntary or purposive movements 
 of the head and ej^eballs, but these have not yet become thoroughly 
 organized and fixed in the psychomotor areas of the brain." They 
 therefore become disordered after a weakening of the cortical cen- 
 ters. Relief must be sought in the direction of improved brain 
 nutrition, and subsequent training. 
 
 Associated movements of the eyeballs. See Muscles, Ocular. 
 
 Associated paresis or paralysis of the eye muscles. These are paretic 
 or paralytic defects of muscles associated in the production of cer- 
 tain definite visual movements. Diplopia is usually not a symptom 
 of the disease and there is little or no secondary contraction of 
 the antagonists, because, as a rule, the paralysis is uniform. The 
 cause of this peculiar form of paralysis is an affection of the oculo- 
 motor nuclei or the visual centres in the pons. See Muscles, Ocular. 
 
 Associationslahmungen. (G.) Paralysis of associated muscles or 
 groups of muscles, as of rectus internus of one eye and rectus ex- 
 ternus of the other. 
 
 Associirte Aug-enablenkungen. (G.) Associated deviations of the 
 eye. 
 
 Assorted lig-ht. According to Jackson {Manual of Diseases of the 
 Eye, p. 104) for complete vision each luminous point must make its
 
 ASSOZIATIONSBAHNEN 651 
 
 distinct impression on a single point of the retina, and through it 
 upon a single nerve-cell or group of nerve-cells in the brain. To 
 accomplish this, the light falling on the retina must be assorted or 
 focussed. To support the retina so that it shall properly receive 
 assorted light is the function of the eyeball. The assorting is 
 effected in the human eye by refraction, and the whole function of 
 the eyeball being to support and protect the retina so that it may 
 receive properly refracted rays, the refraction of the eye is of 
 primary importance in its physiolog}^ and pathology. 
 
 Assoziationsbahnen. (G.) The association paths. 
 
 Assoziierte Lahmung-en. (G) Paralysis of associated muscles. 
 
 Assyrians, Ophthalmology of the ancient. See Ardi-Naila and His- 
 tory of ophthalmology. 
 
 Astegiano's test. This device, for detecting simulated monocular 
 blindness, is a modification of the Fles ((j. v.) box. It measures 
 the visual acuity of the pretended blind eye, the malingerer imagin- 
 ing that he is seeing with his admittedly sound eye. 
 
 Astenopia isterica. (It.) Hysterical asthenopia. 
 
 Asterisciis. (L.), m.n. An old name for a star-shaped opacity of 
 the cornea. 
 
 Asterol. A soluble, antiseptic preparation of mercury sulphocarbo- 
 late. used in surgery as a bactericide. 
 
 Asthenie. (G.) Extreme debility. 
 
 Asthenopia. (L.), f.n. Weak or impaired vision. Inability to use 
 the eyes continuously, especially for near work, without one or 
 more symptoms. 
 
 Although this term is not as definite as it miglit be, yet it is gen- 
 erally understood to include all those symptoms that arise from 
 weak accommodation and anomalies of refraction. Prominent 
 among them are blurring of print, pain on attempts to look close 
 at hand, frontal headaches, and such symptoms as burning, smart- 
 ing, or redness of the eyes, brought on chiefly by reading, sewing, 
 painting, or other forms of near-work. Asthenopie symptoms are 
 not confined to the discomfort produced by attempted near-work. 
 Many of them, such as vertigo, nausea, photophobia, indistinct 
 
 / vision, pains in the eyes, frontal headache, lachrymation, etc., appear 
 both as "panorama" symptoms, on visiting the theatre, by gazing 
 at moving pictures, from shopping, riding on railway trains, auto- 
 mobiles, or street cars, and in other occupations where the eye 
 mostly fixes distant o]).jects. These symptoms will be fully con- 
 sidered under Eyestrain, Refraction and accommodation of the eye, 
 Ocular muscles, and under various other sub-headings.
 
 652 ASTHENOPIA, ACCOMMODATIVE 
 
 Asthenopia, Accommodative. When eyestrain is not relieved by 
 appropriate treatment the effort to see even distant objects dis- 
 tinctly causes marked discomfort until eventually the patient is no 
 longer able to use his eyes for any purpose, even for a few moments, 
 with comfort. 
 
 Asthenopia, Heterophoric. This form of asthenopia is due to imbal- 
 ance of the eye muscles, apart from the ametropia or other abnormal 
 condition that may accompany it. Oliver {System of Diseases of 
 the Eye, Vol. IV, p. 404) does not believe that it is as rare as is 
 generally supposed. He thinks that even when emmetropia is 
 found, asthenopic symptoms of the heterophoric type may be pres- 
 sent. Moreover, idiopathic or primary heterophoria, particularly 
 hyperphoria, may not only produce a heterophoric asthenopia, but 
 also provoke an active ametropic one from a latent ametropia 
 which would not have been brought into evidence had there been 
 a normal equilibrium and action of the ocular muscles. 
 
 Considered broadly, asthenopia or eye-strain is a complex 
 symptom-grouping. As a I'ule, it is an expression of the combined 
 workings of the two ocular end-bulbs and their accessories. Granted 
 a manifest esophoria of one, or possibly two, degrees' as the normal 
 average for combined distant vision, each individual, and even the 
 same individual under different circumstances and during varying 
 states of fatigue and health, has dissimilar degrees of physiologic 
 tone and power given to his ocular muscle-series both far and near 
 vision. What may be the normal state of any visual apparatus 
 to-day need not be that of the folloAving day, while the amount of 
 ametropia that in some instances must be considered abnormal may 
 bear a sufficiently harmonious relationship to the muscular por- 
 tion of the visual apparatus to produce temporarily comfortable 
 binocular vision. . Orthophoria, like emmetropia, is a theoretic, a 
 mathematic, and a geometric standard, and is not more expressive 
 of normality of tissue and harmony of action than the latter. 
 Normality can be assumed, no matter Avhat inequality maj^ exist, 
 as long as the two series of ocular muscle-groupings are in balance, 
 and continue so during activity. See Muscles, Ocular. 
 
 Asthenopia, Hysterical. See Amblyopia, Hysterical. 
 
 Asthenopia, Muscular. See Asthenopia, Heterophoric. 
 
 Asthenopia, Neurasthenic. See Copiopia. 
 
 Asthenopie, Akkommo dative. (G.) Accommodative asthenopia. 
 
 Asthenopie, Muskulare. (G.) Muscular asthenopia. 
 
 AstigmagTaph. An iustnmient used to demonstrate the presence of 
 ocular astigmatism.
 
 ASTIGMATIC 653 
 
 Astig-matic. adj. Affected with astigmatism. 
 
 Astig-matisch (G.) Astigmatic. 
 
 Astigmatism. In optics, the failure of rays which are refracted or 
 reflectcfl at a surface to converge to a single point. For iiLStaiice, 
 in ilie ease of refraction of an obli(iU(,' bundle of rays near the 
 periphery of a spherical surface, the meridian rays, of which the 
 chief ray, i, is the center, come to a focus sooner upon the refracted 
 chief ray, f, than the sagittal rays, which suffei- refraction to a 
 lesser degree in a phme at right angles to the meridian plane at 
 the same point, e. 'Phr point F,. wliicli is llie vertex of the meridian 
 rays, is called t!ic pfiiiiai'\- image-point; and the point F„ which is 
 
 Astigmatism. 
 
 the vertex of the sagittal rays in the plane at right-angles to the 
 meridian plane, is called the secondar.v image-point. The lines 
 •diFjdi and doF.d. through both of which all the rays of the refracted 
 bundle pass, and which may be regarded as straight lines in their 
 respective co-ordinate planes, are the two image-lines of the narrow' 
 refracted bundle. In other words, the primaiy image-line lies in 
 the primary principal section, and the secondary image-line lies in 
 the secondary principal section, both of which are at right-angles 
 to each other and perpendicular to the chief ray f of the astigmatic 
 bundle. This principle Avas established by Sturm, the originator 
 of the theory of astigmatism. Matthiessen contends that the image- 
 lines may not be, and, generally, will not be, perpendicular to the 
 chief ray f, but it is more convenient and (piitt' permissible to 
 consider both of the image-lines, according to Sinrm's definition: 
 "perpendicular to the chief ray of the astigmatic bundle."' In 
 fact, they are so located for the cornea of the eye having regular 
 astigmatism, and whose surface at the point oi' incidence, the vertex
 
 654 ASTIGMATISM 
 
 of the cornea, may be considered to be asymmetrical, owing to the 
 difference of curvature in the principal sections or meridians 
 exposed to homocentric rays (those that emanate from one and the 
 same point on the axis) as well as paraxial rays (those that are 
 incident within a very small area around the vertex of the surface). 
 All other rays which do not lie in the principal sections will be 
 refracted so as to intersect corresponding points within the limita- 
 tions of the image-lines (as shown in the description of Ophthalmic 
 lenses and prisms, which see). As the refracted (or reflected) 
 bundle of rays thus formed does not anywhere pass through a 
 point, it is called an astigmatic bundle or pencil. The same prin- 
 ciple applies to a normally incident homocentric bundle of rays, 
 provided the bundle is refracted or reflected by a toric surface , 
 that is to say, a rotary surface in which the meridians of greatest 
 and least curvature are at right-angles to each other. The toric 
 surface is well illustrated through its comparison with the peripheral 
 surface of an inflated rubber tire, which has a greater curvature 
 along the circumference of the wheel than in the transverse plane 
 of a spoke. When incident paraxial and homocentric rays proceed 
 from infinity and are refracted by a toric surface, or its equivalent 
 in form of a sphereo-cylindrical lens, the image-points and image- 
 lines are called focal points and focal lines, respectively. Hence, 
 the primary and secondary focal points on the axis are in their 
 corresponding primary and secondary focal lines, these being located 
 in their correlated primary and secondary focal planes, which are 
 perpendicular to the axis. The distance between the focal lines or 
 planes is known as the ''Focal interval" of Sturm; and a third 
 plane, situated between and parallel to the focal planes, contains 
 a circle, defined by the outermost rays of the astigmatic bundle, 
 Avhich has been somewhat misleadingly called the circle of least 
 confusion, although here perhaps is obtained the image-point hav- 
 ing least distortion. The locus of this circle, if named: The 
 Region of Transition, would more definitely define its character- 
 istic property and position, since it is that place, between the focal 
 planes, where the constantly varying elliptical cross sections of the 
 refracted (or reflected) bundle, on the side of the approaching 
 wave in front of the circle, are again converted into successive and 
 similarly inconstant elliptical cross sections whose diameters are 
 reversed behind the circle, which is, therefore, a characteristic cross 
 section of the astigmatic bundle (see diagrams, Ophthalmic lenses 
 and prisms). The theory of astigmatism also applies to any spheroid 
 surface, that is to say to any rotary surface approaching a spherical
 
 ASTIGMATISM, COMPOUND 655 
 
 foi'iii and that may be generated llirougli rotation of oiu' of tlie 
 conic sections, such as the ellipse, the parabola or the hyperbola, 
 and which are known as ellipsoids, paraboloids, and hyperboloids, 
 respectively. For inslaiiee, a lens of the hi11ei- type is called a 
 hyperbolic lens (rather difficult of production), and is occasionally 
 used, with more or less success, to correct conical cornea, which 
 has an acute curvature near its apex tliat flattens out and steeply 
 approaches the linihus. This shape of the cornea suggested the 
 possibility of correcting the defect by means of a hyperbolic lens, 
 which also has this characteristic form. In practice, however, a 
 difficulty is encountered through the necessary movements of the 
 eye in its orbit, causing the apex of the cornea to wander from the 
 center of the lens, which should at all times be in collimation with 
 the apex of the cornea, in order to make the lenticular correction 
 efficient at the fovea centralis. For this reason hyperbolic lenses 
 can only achieve their greatest efficiency when the apices of both 
 the cornea and the lens are coincident wnth the line of fixation. 
 
 The astigmatism of conical cornea may, therefore, be said to be 
 the dividing line between corrigible regular and irregular stigma- 
 tism, the latter comprising a variety of malformations of the corneal 
 surface, or of the lens itself, that precludes satisfactory correction 
 by lenses. Regular astigmatism is commonly corrected by means 
 of cylindrical or toric surfaces such as are described under Ophthal- 
 mic lenses and prisms. The various types of astigmatism capable 
 of correction by lenses are explained under Astig'matism of the 
 human eye. — (C. F. P.) 
 
 Astig-matism, Compound, is that form of regular astigmatism in which 
 both principal meridians are either myopic or hypermetropic, one 
 of them of greater refraction that the other. If both are myopic, 
 we have compound myopic astigmatism, (AsM]\I). If both are 
 hypermetropic, we have compound hypermetropic astigmatism, 
 (AsHH). 
 
 Astig'matism, Irregular. Irregular astigmatism is generally produced 
 by the cornea ; notably by corneal sears which have remained after 
 superficial ulcerations. It is less frequently due to an anomaly of 
 the lens, as in cases of incipient cataract. Both forms are recogniz- 
 able by transmitted light; corneal astigmatism is demonstrable with 
 Placido's disk or keratoscope, with the ophthalmometer, or by 
 means of skiascopy. 
 
 Astigmatism, irregular, Shells for. See Conical cornea, Shells for. 
 
 Astigmatism, Mixed. This is the most complicated form of astigma- 
 tism. One of the principal meridians is myopic ; the other hyper-
 
 656 ASTIGMATISM OF THE HUMAN EYE 
 
 metropie. This variety of astigmatism was formerly difficult of 
 exact measurement, but since the introduction of skiascopy, it is as 
 easily recognized as any of the others. 
 Astigmatism of the human eye. Astigmia. A state of irregular 
 ocular refraction, usually congenital, in which the rays of light 
 diverging from a single point cannot, owing to an anomaly of the 
 cornea, sometimes of the lens, be brought to a common focus on the 
 retina. 
 
 In irregular astigmatism the rays have different foci in the same 
 meridian. This is usually caused by irregularities of the corneal 
 surface or changes in the lens substance. Corneal ulcers, leaving 
 scars and facets on healing, are the common source of irregular 
 astigmatism. Vision is much impaired and can be very little 
 improved by glasses. 
 
 In regular astigmatism one principal meridian of the cornea has 
 a greater curve than the other. These two principal meridians are 
 always at right angles to one another, the meridian of greater cur- 
 vature being usually situated in the vertical and that of less curva- 
 ture in the horizontal meridian. When this is the case the astigma- 
 tism is said to be "with the rule"; when the reverse the astigmatism 
 is said to be "against the rule." Regular astigmatism comprises: 
 
 The simple form, in which one meridian is ametropic while 
 that at right angles to it is emmetropic. When the rays focus be- 
 hind the retina it is simple hypermetropic, and when in front of 
 the retina simple myopic astigmatism. 
 
 The compound form, in which neither set of rays of light entering 
 the eye focuses upon the retina, but does so either in front of or 
 behind the retina, according as it is a compound hypermetropic or 
 a compound myopic astigmatism. In either form the raj's have a 
 different focusing point for the two principal meridians. 
 
 The mixed form, in which one set of rays of light entering the 
 eye focuses at a point behind the retina (hypermetropic meridian) 
 wdiile those entering through the meridian at right angles focus at 
 a point in front of the retina (myopic meridian). 
 
 Inasmuch as the majority of the forms of astigmatism are due 
 to the abnormal shape of the eyeball it is usually congenital, but 
 in some instances (after operation, injury, etc.) it may be acquired. 
 Astigmatism may be detected and its amount accuratelj^ measured 
 by a number of objective means. 
 
 A highly valuable' subjective test for the presence of this defect 
 is the astigmatic chart, one form of Avhich is pictured herewitn. 
 It is sufficient for the patient to look, with each eye separately, at
 
 ASTIGMATISM OF THE HUMAN EYE 
 
 657 
 
 the figures on the chart. If astigmatism he present one or more of 
 them will appear more blurred (or more distinct) than the others. 
 Astigmatism generally produces discomfort when the patient 
 attempts to use the eyes for reading, sewing, or other forms of 
 near work. All the asthenopic sj^nptoms met with in eyestrain 
 due to hypermetropia or myopia are more or less aggravated by 
 the addition of astigmatism, even of low degree, especially if the 
 patient be in a poor state of health and of a neurasthenic disposi- 
 
 Test Figures for Detecting the Presence of Astigmatism. 
 
 tion. Distant as well as near vision may also be materially inter- 
 fered with and rendered decidedly uncomfortable. 
 
 Astigmatism should be corrected with a cylindrical glass either 
 alone (in simple astigmatism) or in combination with a spherical 
 lens in compound or mixed astigmatism. The axis of the cylinder 
 is placed in the meridian of greater corneal curvature in hyper- 
 metropic astigmatism, and lesser corneal curvature in myopic astig- 
 matism, i. e., the meridian of normal refraction in simple astig- 
 matism, and the meridian of least ametropia in compound astig- 
 matism. Even low degrees of astigmatism should be corrected in 
 the majority of instances and glasses in the form of spectacles 
 should be worn constantly. — (Ed.). See, also, Refraction and 
 accommodation; Examination of the eye. 
 
 Vol. I— 4 2
 
 658 ASTIGMATISMO REGOLARE 
 
 Astigmatismo regolare. (It.) Regular astigmatism. 
 
 Astigmatism, Post- operative. This anomaly, according to Treutler, 
 is due both to vertical flattening of the cornea and to increase in 
 the horizontal curve. In some cases the astigmatism, found a fort- 
 night after the operation, persists or is even increased later. In 
 other cases it diminishes somewhat or may entirely disappear in 
 the course of a few months. This reduction may be ascribed to a 
 readjustment of the wound surfaces which had been displaced by 
 over-riding of the corneal flap. In sclero-corneal sections it may 
 be that the down-growth of epithelium interposes a wedge between 
 the wound edges and keeps them apart. For this reason the abnor- 
 mal curvature is generally greatei in sclero-corneal sections than 
 in those that are made entirely within the clear cornea. 
 
 Jackson found that in 15 per cent, of cases a permanent degree 
 of astigmatism was reached within two months after the operation ; 
 in 20 per cent, regressive changes continued after more than three 
 months. 
 
 Rollet found that in examining 150 cases, five months after the 
 operation, 25 per cent, exhibited no marked astigmatism, while the 
 remainder had an average amount of 2.57 D. A year or more after 
 the extraction there was either complete disappearance of the 
 astigmatism or a small amount (at right angles to the original) 
 had developed. 
 
 Astigmatism, Simple. In this form of refractive error the main merid- 
 ian is emmetropic; the other hypermetropic (simple hypermetropic 
 astigmatism, AsII) ; or the principal meridian is emmetropic while 
 the other is myopic (simple myopic astigmatism, As]\I). 
 
 Astigmia. Jackson prefers this term to astigmatism, (q. v.) and agrees 
 with Burnett who urged the employment of the former word because 
 the derivative meaning as well as brevity and unity argue in its 
 favor. The French equivalent astigmie has been growling in favor, 
 and both in England and America the shorter word has been officially 
 adopted by several journals. J. L. ]\Ioffat has long been an enthu- 
 siastic advocate of "astigmia." 
 
 Astigmatismus. (G.) Astigmatism. 
 
 Astigmatismus, Abnormer unregelmassiger (G.) Abnormal irregular 
 astigmatism. 
 
 Astigmatismus, Einfacher. (G.) Simple astigmatism. 
 
 Astigmatismus, Einfacher hypermetropischer. (G.) Simple hyper- 
 metropic astigmatism.
 
 ASTIGMATISMUS, EINFACHER MYOPISCHER 
 
 659 
 
 Astigmatismus, Einfacher myopischer. (G.) Simple myopic astigma- 
 tism. 
 
 Astigmatismus, Erworbener. (G.) Acquired astigmatism. 
 
 AstigTnatismus, Gemischter. (G.) Mixed astigmatism. 
 
 Astigmatismus, Hypermetropischer. (G.) Hypermetropic astigma- 
 tism. 
 
 Astigmatismus, Irregnlarer. (G.) Irregular astigmatism. 
 
 AstigTnatismus, Linsen. (G.) Mixed astigmatism. 
 
 Eoth's Astigmoseope. ..■-.-- 
 
 Astigmatismus, Myopischer. (G.) IMyopic astigmatism. 
 
 AstigTnatismus, Postoperative. (G.) Postoperative astigmatism. 
 
 AstigTnatismus, Regelmassiger. (G.) Regular astigmatism. 
 
 Astigmatismus Strahlengang. (G.) Astigmatism of the ciliary duct. 
 
 Astigmatismus, Unregelmassiger, (G.) Irregular or abnormal 
 astigmatism. 
 
 AstigTnatismus, Unregelmassiger normaler. (G.) Normal irregular 
 astigmatism. 
 
 Astigmatismus, Zusammengestzter. (G.) Compound astigmatism. 
 
 Astigmatismus, Zusammengesetzter hypermetropiscber. (G.) Com- 
 pound hypermetropic astigmatism.
 
 660 ASTIGMATISMUS, ZUSAMMENGESETZTER MYOPISCHER 
 
 Astigmatismus, Zusammengesetzter myopischer. (G.) Compound 
 myopic astigmatisnj. 
 
 Astigmatometer. An instrument for measuring the amount of astig- 
 matism, especially of the corneal astigmatism, 
 
 Astigmometer. n. An instrument for measuring the amount of the 
 corneal astigmatism by determining the difference in refraction 
 between the least and the greatest meridians of the cornea. Also 
 called an astigmatometer. The term by Avliich astigmometers are 
 most commonly described is ophthalmometer. These instruments 
 will be fully described under that name as well as in the section, 
 Examination of the eye. 
 
 Astigmoscope. An ingenious form of Placido's disk (shown in the 
 accompanying figure) has been suggested by Roth, who calls it the astig- 
 moscope. The black and white rings are painted on a thin plate of 
 elastic steel, which can be bent back by a cord attached to the margins 
 and caught on the notches made upon the arm which supports the disk. 
 The bending back of the plate renders the rings oval instead of circular, 
 and the reflection of these oval rings from an astigmic cornea becomes 
 circular when the plate is bent to the proper amount in the direction 
 of the meridian of least corneal curvature. The degree of astigmia can 
 be read from the notch in which the cord is placed to give the neces- 
 sary curvature. 
 
 Astigmoskop. (G.) Astigmoscope. 
 
 Astringents, Ocular. Agents that contract the tissues of the eye by 
 reducing the size of the vessels in them, by their superficial destruc- 
 tion, by forming chemical combinations with them or, indirectly, by 
 removing one or more irritants that serve to stimulate their growth 
 or to bring about a state of hypertrophy. Many astringents are 
 also germicides, antiseptics, cauterants, etc., under different condi- 
 tions of concentration, locality of application and other considera- 
 tions. 
 
 Indeed, the difference between these agents is largely one of 
 degree since astringents are all more or less irritating and, like 
 cauterants, to some extent destroy or alter the parts to which they 
 are applied. 
 
 Some astringents, especially those insoluble in water or alkaline 
 fluids, exhibit a feeble and transient action on the tissues and are 
 but mildly astringent and irritant ; others are more distinctly irri- 
 tating and cauterant. 
 
 As a rule, astringents of the severer type increase an acute 
 inflammation Avithout exhibiting the distinctive astringent quali- 
 ties for which they are generally prescribed. For this reason they 
 are not nearly so useful in recent as in chronic inflammations and
 
 ASTROSCOPE . 661 
 
 should be ordered Avith considerable hesitation in the former con- 
 ditions. 
 
 The vegetable astringents owe their powers chiefly to the pres- 
 ence of tannic acid, tannins or tannates, substances belonging to 
 an ill-defined group, possessing an astringent action as their best 
 defined property. Other organic acids, even salicylic acid and the 
 salicylates, are but feebly astringent. 
 
 An important group of astringents are zinc salts, especially the 
 acetate, iodide, sulphate and chloride, long used in ^lo to Y-j per 
 cent, solution in the simple forms of conjunctival catarrh and, in 
 recent years, discovered to be a specific in the treatment of (Morax- 
 Axenfeld) diplobacillus-conjunctivitis. 
 
 Alum, either in the solid form (pencil, crystal, powder), as a 
 solution or in combination with other agents, has long been used as 
 a mild astringent in the simple forms of follicular conjunctivitis 
 and trachoma. 
 
 Copper sulphate, citrate and other salts, especially preparations 
 of the first named, form a well known group of astringents. Like 
 alum, they may be applied in ''stick" form. Other astringent 
 copper compounds are the ammoniosulphate, the sulphocarbolate, 
 and cuprol. 
 
 Silver nitrate and some of its substitutes — especially protargol, 
 argyrol, argentamine, itrol, largin, nargol, actol, argentose and 
 collargol — are generally regarded as our most valuable germicide- 
 astringents. The first named has been employed in the treatment 
 of eye diseases since the earliest times and has since held its place 
 as an essential part of our armament. (See Silver nitrate and 
 Silver salts.) The comparative clinical values of argentic prepara- 
 tions are discussed under the foregoing and individual headings. 
 
 Alexander Randall quotes Risley as teaching 30 years ago that 
 it is wise to use astringents early, so as to obtain their good effects 
 and so avoid their irritating (lualities which, later, are pronounced 
 and at times outweigh their good effects. He believes that employed 
 in this manner silver nitrate is still the safest and most effective 
 application in purulent conjunctivitis in its secreting stage, aided, 
 generally, by hot applications. — (Ed.) 
 Astroscope. An astronomical instrument composed of two cones on 
 the surfaces of which the constellations with their stars are delin- 
 eated. Tt was formerly used as a substitute for the celestial globe. 
 Astroscopy. Observation of the stars. 
 
 Asylums and institutions for the blind. See Blind, Institutions and 
 occupations for.
 
 662 ASYMMETRY 
 
 Asymmetry, u. Anomalous development of an organ, a pair of or- 
 gans or of the two sides of the body. 
 
 Asymmetry of the eye. Variations in the ideal form of the refracting 
 surfaces of the eye produce several forms of astigmatism. Irregu- 
 larities in the shape of the lens was the first to be recognized, by 
 means of eutoptic observations of the lens ' ' star. ' ' It was soon real- 
 ized, indeed, that the cornea varies a good deal from the ideal sphe- 
 roid form, as shown by a number of keratoscopic investigations. 
 This fact can also be demonstrated by skiascopic examination 
 through the dilated pupil, as well as by the numerous astigmometers 
 (q. V.) now in common use. 
 
 Asynergia. This term has been used in connection with anomalies of 
 the ocular muscles— especially in treating of heterophoria — to 
 express a condition of antagonism or, rather, lack of assistance 
 (synergism) from the muscles that usually help the action of another 
 muscle. 
 
 Asynergy, n. The lack of proper proportion in the action of two 
 or more related organs or parts. 
 
 Atavism. [From atavns (L.) a great grandfather's grandfather.] 
 This biological term indicates a reversion, as a result of hereditary 
 influence, to ancestral characteristics. The operation of this law is 
 often seen in ophthalmology. For example, as stated in Science, 
 Vol. IV, 367, "of the 11.6 per cent, of children born with eyes of 
 other than the parental color, a part must be attributed to atavism, 
 that is, to intermittent heredity. ' ' 
 
 Ataxia, Friedreich's. See Hereditary ataxia, 
 
 Ataxiagram. The appearance presented by a line drawn by an ataxic 
 patient. It is made with both open and closed eyes, and the devia- 
 tions from a straight line, under both these conditions, are sup- 
 posed to be of diagnostic importance. 
 
 Ataxiagraph. An instrument for determining the amount of sway- 
 ing in ataxic cases. 
 
 Ataxia, Hereditary. Friedreich's ataxia or disease. This condition 
 is an anomally of spinal development, and has little in common 
 with tabes dorsalis. It usually affects several members of the same 
 family and rarely presents any eye signs except nystagmic move- 
 ments when an object is fixed. As nystagmus is not a sign of true 
 tabes and is almost always present in hereditary ataxia, this symp- 
 tom will help to distinguish juvenile tabes from the former disease. 
 
 Ataxia, Locomotor. See Tabes dorsalis. 
 
 Ataxmir. (Arabic). A mediaeval term for the treatment of disti- 
 ehiasis, said to have been first mentioned by Albucasis. 
 
 Ateroma dei vasi sanguigni. (It.) Atheroma of the blood vessels.
 
 ATHENE THE EYE-PRESERVER, TEMPLE TO 663 
 
 Athene the Eye-Preserver, Temple to. Coneeniing this structure, 
 Pausauias, has the following passage: "And on the way to Alpium, 
 as it is called, you come to the temple of Athene the Eye-Preserver, 
 erected they say by Lycurgus, who had one of his eyes knocked out 
 by Alcander, because he did not find Lycurgus' h'.gislation agree- 
 able. And he took refuge at this place, and the Lacedaemonians 
 prevented his losing his remaining eye; so he built a temple to 
 Athene the Eye-Preserver."— (T. H. S.) 
 Atheroma, This term, as its Greek radicles suggest, was first applied 
 to cysts containing soft material; or to any soft, encysted tumor. 
 More recently and properly, however, it describes fatty and other 
 late degenerative changes in the walls of the blood-vessels, especially 
 in the intima of the larger arteries. These alterations are responsible 
 for many intraocular degenerations, especially of the lens system, 
 choroid, retina and, sometimes, of the optic nerve. See Arterio- 
 sclerosis. 
 Atheroma of the choroidal vessels. In this degenerative process the 
 arteries and veins appear thickened and outlined by a white border 
 in certain regions. The blood column is often more or less decreased 
 in width. As the disease progresses the vessels appear as blood- 
 less, whitish lines. Choroidal hemorrhages are not infrequent, and 
 they may even be the only signs that point to choroidal atheroma. 
 This is especially true if the various choroidal elements cannot be 
 made out ophthalmoscopically because of changes in and about the 
 epithelial layer. 
 Atheromatose Degeneration der Aderhautgefasse. (G.) Atheroma- 
 tous degeneration of the choroid vessels. 
 Atheromcysten. (G.) Atheromatous cysts. 
 Atherom der Blutgefasse. (G.) Atheroma of the blood-vessels. 
 Athetosis, Eye-muscle symptoms in. In rare cases the muscles of the 
 eye are the subject of cramp. In their symptomatology', these con- 
 tractions resemble those in the extremities, in the jaw, in the throat 
 muscles, etc. There is the same uncertain, hesitating movement, 
 the same inability to relinquish rapidly any position which has been 
 assumed, the same apparent lack of purpose in the form of the 
 movement and of its execution. The affection is one of true spasm 
 of the external muscles of the eye ; there is a defect in the motor- 
 sensory region coordinated with the affected muscles. The contrac- 
 tions are slow^ and tonic, and do not always involve the intraocular 
 muscles. 
 Athmungsorgane, Erkrankungen der, (G.) Diseases of the respiratory 
 tract.
 
 664 ATMOSPHERIC AIR 
 
 Atmospheric air. See Air. 
 
 Atmotherapy. This is the term given by Golesceano to his method of 
 applying heat directly to the eye by a mixture of hot air and steam. 
 He uses a boiler like that of the steam atomizer and connects it with 
 the outer tube of a double canula ; through the inner tube of which 
 fresh air is forced by a rubber bulb. At the end of this double canula 
 the air, now heated, is mixed with the vapor ; and the mixture conducted 
 to a receptacle in contact with the orbit, somewhat like that used by 
 Ostwalt; or the mixture of vapor and air is projected against the 
 cornea from a distance of 4 cm. The mixture of air and vapor thus 
 brought in contact with the eye has a temperature of from 40° to 50° C. 
 Its application causes conjunctival and pericorneal hyperemia, 
 lachrymation, and increased conjunctival secretion. 
 
 These applications can be made without the use of a local anesthetic. 
 Each one is continued five to ten minutes, and they are repeated from 
 once to four times daily. Beneficial effects are reported in marginal 
 and strumous blepharitis, phlyctenular keratitis, and conjunctivitis, 
 corneal abscess, interstitial keratitis, herpes of the cornea, rheumatic 
 iritis, and chronic diffuse sclerotitis. It is probable that a simple, con- 
 venient and easily controlled method for the direct application of 
 heat to the eyeball will prove a valuable addition to our therapeutic 
 resources. 
 
 Atoleine. A name given to one of the soft, or liquid, paraffins, used 
 as a menstruum for various therapeutic agents employed in ophthal- 
 mic practice. 
 
 Atonia del sacco lagrimale. (It.) Atonic condition of the lachrymal 
 sac. 
 
 Atoniatoublepharon. (Obs.) A relaxed condition of one or both 
 eyelids. 
 
 Atonic ectropion. Too great laxity of the lid tissues so that the bor- 
 der falls aw^ay from the eyeball. In this affection there is 
 manifestly too great laxity of the lid. Operations for its relief 
 have been devised with the idea either of shortening the exces- 
 sively long free border, by excising a V-shaped piece from its cen- 
 ter, elevating and shortening by means of sliding flaps and excising 
 tissue from the outer canthus, or supporting the drooping lid by 
 attaching it to its fellow above. — (W. H. W.) 
 
 Atoxyl. This compound has been successfully employed in the inter- 
 nal treatment of ocular syphilis by several authorities, among them 
 Darier, Gifford, Bargy and others, in iritis, interstitial keratitis, as 
 well as in sympathetic ophthalmia and trachoma. Sydney Stephen- 
 son declares that, after a considerable experience of the drug he 
 has obtained in parenchymatous keratitis results that he had not
 
 ATRABILIN 665 
 
 been able to aceoin})lisli in any other way. In this disease, as well 
 as in other cases, subcutaneous injections of from 0.25 to 0.50 
 grammes are given in the buttocks two or three times weekly until 
 a do;:en injections have been taken, the total dosage not to exceed 
 6 grammes. These exhibits may be presented in conjunction with 
 other treatment. 
 
 Patients stand the treatment very well, though nausea, epigastric 
 pain and vomiting are likely to follow 0.75 to 1.50 grammes — 10 to 
 23 grains. 
 
 I have had some experience with the hypodermic use of this 
 remedy in tubercular iritis and chorioretinitis, and so far as can 
 be judged from its effects in a few cases, the results were decidedly 
 favorable, and no untoward toxic symptoms showed themselves. 
 This has not been, however, the report from all quarters. R. Koch, 
 during treatment of "sleeping sickness," reports 22 cases of blind- 
 ness without ophthalmoscopic signs, while Fehr, Krudener, Nonne 
 and Terrien all report loss of vision from optic atrophy (mostly 
 post neuritic) following its use. Morax gives a complete review 
 of the amblyopia from atoxyl showing that if a powerful and effec- 
 tive remedy it is also a dangerous one, especially when employed 
 in maximum doses. These poisonous effects may be avoided, as 
 the report of Morax teaches, by giving small doses frequently 
 rather than occasional larger ones. No visual disturbances follow 
 the use of half a gramme (or 7^ grains), and this should be regarded 
 as the maximum dose. See Arsenical amblyopia ; Toxic amblyopia. 
 -(Ed.) 
 
 Atrabilin. The name given to the first of the suprarenal extracts to 
 be placed on the market and to Dor and Bates we are indebted for 
 its introduction into ophthalmic surgery. 
 
 This remedial agent is practically identical with adrenalin. It 
 was also warmly recommended by Zimmerman and Wolffberg, who 
 advise that it be used with formalin 1 :5000, as a preservative. 
 
 Darier and Dor both pointed out the advantage of combining 
 cocaine with atrabilin in operations on and affections of the eye. 
 
 Atresia. (L.), f.n. The occlusion or absence of a normal opening 
 or channel of the body. 
 
 Atresia of the lachrymal canaliculi. Imperforation of these duets may 
 be either congenital (See Congenital anomalies') or acquired. The 
 former condition is rare and the defect is generally associated with 
 other ocular deformities. In both instances there is nearly always 
 an epiphora which calls for operative interference. See Lachrymal 
 apparatus, Operations on. 
 
 Atresia pupillse. (L.) An obsolete term for anterior synechias.
 
 666 ATRESIA PUPILL^ CONGENITA 
 
 Atresia pupillae congenita. (L.) Congenital atresia, or closure of 
 the pupil, lias occasionally been observed as the result of an intrau- 
 terine, usually specific iritis or iridochoroiditis. The differential 
 diagnosis of this form of pupil-closure from persistent pupillary 
 membrane depends partly upon the fact that in the latter the play 
 of the pupil, in contrast to cases of true atresia, is not limited in 
 the least. Moreover the bands that produce the atresia arise from 
 points in the iris distinct from those of pupillary membrane. 
 Atresia der Thranenpunkte. (G.) Atresia of the punctum lachrymale. 
 
 Atretopsia. (L.), f.n. Atresia, or imperf oration, of the pupil. 
 
 Atreya. An ancient East Indian physician and priest, of unknown 
 date. Author of the Sanhita, in which are mentioned diseases of 
 every portion of the body. — (T. H. S.) 
 
 Atrofia del bulbo. (It.) Atrophy of the whole eyeball. Phthisis 
 bulbi. 
 
 Atropa belladonna. The belladonna (deadly nightshade, common 
 dwale) is an erect perennial European herb, from three to five feet 
 high, bearing dull-green, ovate, entire leaves having a peculiar 
 heavy odor and a fatty feel, with solitary, axillary, dull-purplish, 
 bell-shaped flowers on drooping stalks. The fruit is a dark, shining, 
 many-seeded berry, resembling a cherry in shape and attached in 
 the base of the permanent calyx. The branches, the inferior sur- 
 face of the leaves, and the peduncles are pubescent. The root is 
 carrot-shaped, branching, dirty-yellow externally, white within. 
 The root and leaves are official. (Foster.) 
 
 Atropamine. See Apoatropine. 
 
 Atrope lines. In physiological optics (q. v.) the lines normal to the 
 axial plane of ocular rotation. 
 
 Atrophia bulbi. (L.) Atrophy of the eyeball (q. v.). 
 
 Atrophie der Aderhaut. (G.) Atrophy of the choroid. 
 
 Atrophie der Netzhaunt. (G.) Atrophy of the retina. 
 
 Atrophie der Sehnerven. (G.) Atrophy of the optic nerves. 
 
 Atrophie, Descendierende. (G.) Descending atrophy. 
 
 Atrophie des Opticus. (G.) Atrophy of the optic nerve. 
 
 Atrophie, Einfache. (G.) Simple atrophy. 
 
 Atrophie, Glaukomatose. (G.) Glaucomatous atrophy. 
 
 Atrophie nach Blutverlust. (G.) Atrophy after hemorrhage. 
 
 Atrophie nach Schadelbruch. (G.) Atrophy after fracture of the 
 skull. 
 
 Atrophie, Neuritische. (G.) Neuritic atrophy. 
 
 Atrophy of the various tissues and organs (optic nerve, choroid, 
 retina, eyeball, iris, conjunctiva, tarsus, etc.) of the ocular apparatus 
 not especially mentioned or described as minor topics will be found
 
 ATROPHY, DESCENDING, VISUAL FIELD IN 667 
 
 under the appropriate major heading's. Thus, for Atrophy of the 
 iris, see Iris, Atrophy of and Iris, Diseases of. 
 
 Atrophy, descending, of the optic tract. Visual field in. See Neurology 
 of the eye. 
 
 Atrophy, Fuchs' optic. Atrophy of the peripheral bundles that com- 
 pose the optic nerve. 
 
 Atrophy of the eyeball. I'hthtsis bulbi. Atrophia bulbi. A reduction 
 in size and contents of tlie eyeball, accompanied by lowered tension 
 and complete blindness. Flattened areas on the sui'faee of the 
 otherwise round eyeball are seen, corresponding to the course of 
 the four straight muscles and, when the atrophy is far advanced, 
 these markings sliow more plainly as deep furrows. As a rule the 
 cornea is reduced in size, is flattened and frequently loses much of 
 its transparency. Sometimes, however, it is proportionately rounded, 
 or exhibits groove-like impressions, if the atrophy is associated with 
 anterior synechia and an up-drawn pupil. The depth of the ante- 
 rior chamber varies; although it is often entirely abolished. The iris 
 is atrophied, and occasionally covered by a membranous or scar-like 
 exudate that fills the entire pupil. The lens is invariably clouded, 
 and frequently shrunken, but not always visibly so. The intra- 
 ocular tension is lowered and occasionally one may feel hardened 
 areas through the sclera, pointing to a possible ossification of the 
 bulbar wall. (See Bone formation in the choroid.) 
 
 Phthisis bulbi develops slowly through a series of months, or 
 years, and then usually stops when a certain degree of shrinkage 
 has been attained. 
 
 The etiology lies in a series of inflammatory infections of the 
 uveal tract, due to such chronic or acute dyscrasia? as syphilis, 
 tuberculosis, typhoid fever, gout, or to injuries, including operations. 
 Sympathetic ophthalmia may also lead to atrophy of the globe. As 
 a rule, atrophied eyeballs the subject of recurrent inflammatory 
 attacks are a constant menace to the sound eye ; they may set up 
 migratory ophthalmitis, and are better excised. 
 
 Eegarding the pathology of this condition, one occasionally finds 
 changes in the sclerotic coat similar to those appearing in band-like 
 keratitis. One further finds proliferation and thickening of the 
 epithelium, accompanied by formation of vacuoles, and newly 
 formed vessels in this coat. The atrophy of the iris involves all of 
 its layers, and the iridic vessels are sclerosed and destroyed. The 
 nerves of the iris also show degeneration to a great extent. The 
 most resistant elements are the sphincter iridis and the retinal pig- 
 ment. The chief new element in the atrophied iris is fibrillar con- 
 nective tissue. The pupil is closed by masses of exudate, which
 
 668 ATROPHY OF THE OPTIC NERVE 
 
 either partially or wholly fill the anterior chamber and are joined 
 to the ciliary processes in the posterior chamber. In the advanced 
 stages the exudates become organized into tough, vascular mem- 
 branes, which tightly surround the lens. Similar changes occur 
 in the ciliary body and choroid, while, as a result of the shrinking 
 of the exudation-membrane, the ciliary processes are thinned and 
 much spread out. The lens becomes cloudy and disintegrated by 
 contact with and penetration by the exudate through the ruptured 
 capsule. 
 
 Ossification of the surrounding tissues may lead to an apparent 
 ossification, but really a hardening, of the lens itself. The vitreous 
 is also infiltrated by the infective exudates and these together form 
 a connective tissue mass which on contracting detaches the retina 
 (and often the choroid coat and the ciliary processes) from the 
 sclera. 
 
 The nervous elements of the retina are atrophied, partly as a 
 result of degeneration of the fibres of the optic nerve. 
 
 The choroid coat and the scar (or connective) tissue of the exudate 
 frequently undergo a genuine ossification, all the elements of true 
 bone being found in the hardened coat. 
 
 The therapy is determined by the causes of the original infec- 
 tion and the stage of the disease. If the eye is quiet it may be 
 allowed to remain in the socket, but a blind, irritable or irritating 
 globe ought to be removed. ^A"here the cause may with relative 
 certainty be assumed to be syphilis, a practically harmless con- 
 dition may be induced and indefinitely maintained by proper treat- 
 ment; and the same may be said, with less confidence however, of 
 tubercle, as well as of any other removable cause. — Encyklopddie der 
 AugcnluUkunde. 
 
 Atrophy of the optic nerve. Although various phases and relations of 
 individual forms of this symptom will also be considered under 
 numerous headings throughout this Encyclopedia it is considered wise 
 to give, as an introduction to them, a general review of the more 
 common forms of the disease. 
 
 The term atrophy of the optic nerve is applied to conditions in 
 which there is a degeneration of the nerve-fibres and an overgrowth 
 of connective tissue. The disease may be primary or secondary. 
 
 Primary optic-nerve atrophy develops without previous visible 
 signs of inflammation. As a rule, both eyes are involved, the process 
 being more advanced in one than in the other. The optic disc is shal- 
 lowed and changed in color, and the disc-margins are clearly defined. 
 Secondary optic-nerve atrophy develops as a result of a previous 
 inflammatory process, which may be located in the brain or its
 
 ATROPHY OF THE OPTIC NERVE 669 
 
 membranes, in the choroid, in the retina, or in the nerve-head. The 
 disc-margins are blurred by the deposition of connective tissue upon 
 them. The distinctions given above are based on clinical appear- 
 ances. Pathologic studies have shown that, in many cases, what 
 clinicians call simple or primary atrophy of the optic nerve is due 
 to parenchymatous neuritis (Nuel). The external appearance is 
 that of the normal eye, except that in total blindness the pupils will 
 be dilated and irresponsive to light. In some cases, particularly 
 those due to tabes, the pupils are small, reacting to accommodation 
 and convergence, but not to light (Argyll-Robertson pupil). Pain 
 and photophobia are generally absent. The disturbance in vision 
 is manifest in a lowering of visual acuity, a contraction of the form- 
 field and a contraction of the color-field. The loss of central vision 
 varies from a slight reduction to complete blindness. Any existing 
 error of refraction should be corrected before deciding that a loss 
 in visual acuity is present. If the atrophy is bilateral, the loss of 
 vision is generally greater on one side. Vision is impaired both for 
 distance and for near. 
 
 Contraction of the field for white is found at an early date. The 
 common defect is a concentric contraction which progresses until 
 only a small central vision-area remains. Quadrant-shaped defects, 
 hemianopsia, and central and ringshaped scotomata have been 
 observed. Contraction of the color-field is an almost constant symp- 
 tom, the colors being lost in the following order: Green, red, blue, 
 yellow. The light sense is diminished. Ophthalmoscopic changes 
 are found in the nerve-head, in the surrounding tissues of the fundus, 
 and in the blood-vessels. In primary atrophy the margins of the 
 optic disc are well defined. The disc itself presents a stippled appear- 
 ance, and is of a grayish or bluish color. The surface of the disc 
 is slightly concave, and the physiologic cup is not filled. The vessels 
 are slightly reduced in calibre. The fundus looks normal. 
 
 In secondary atrophy the disc-margins may be irregular, and are 
 blurred in places. The disc is of a dead-white color. It may show 
 a network of newly formed blood-vessels. The surface of the disc 
 is flat, the physiologic cup being filled. The vessels are diminished 
 in calibre and white streaks accompany them. The fundus has 
 lost some of its brightness. 
 
 Optic-nerve atrophy, which is secondary to retinal degeneration, 
 will show a picture different from those described above. The disc 
 will appear yellowish, or, as Frost says, waxy or of the color of 
 dirty parchment. The surface of the disc will be flat, and often it 
 w411 be surrounded by a narrow ring of atrophic chorioid. 
 
 In embolic atrophy the disc shows a dense, opaque white or yellow-
 
 670 ATROPHY OF THE OPTIC NERVE 
 
 ish-white appearance. Retinal changes are present. Any cause 
 which may produce optic neuritis may also lead to optic-nerve 
 atrophy. Brain-tumors, injuries to the nerve-trunk, congenital 
 malformations of the skull, erysipelas, orbital cellulitis, hemorrhage 
 into the orbit, blows upon the head, spinal injuries, syphilis, tabes, 
 tumors of the pituitary body, disseminated sclerosis, progressive 
 paralysis, cerebral softening, severe hemorrhages, lightning-stroke, 
 internal hydrocej^halus, etc., are among the etiologic factors. The 
 abuse of alcohol and tobacco is responsible for some cases. Others 
 are congenital or possibly may be due to injury during instrumental 
 delivery. In probably 60 per cent, of the cases there is not a dis- 
 coverable cause. Many of these must be attributed to the influence 
 of certain toxic substances which are generated in the system as the 
 result of perverted metabolism. This view of the endogenous origin 
 of certain cases of optic-nerve atrophy was suggested by Horner. 
 Recent studies of the excretions of patients sulfering with tobacco- 
 amblyopia have shown excessive excretion of enterogenous decom- 
 position-products in the urine together with a more or less marked 
 urobilinuria (de Schweinitz and Edsall). 
 
 Of 117 cases of optic-nerve atrophy, Derby found no cause in 71 ; 
 abuse of alcohol and tobacco, 11 ; syphilis, 8 ; injuries to the head, 9 ; 
 brain disease, 6 ; apoplexy, 1 ; epilepsy, 1 ; locomotor ataxia, 1 ; men- 
 ingitis, 2; optic neuritis, 2; erysipelas following lachrymal abscess, 
 1; mumps, 2; tumor of pituitary body, 1; following pregnancy, 1. 
 The pathologic changes will depend upon the etiologic factor. In 
 the atrophy found in tabetic subjects the nerve-fibres lose their 
 medullary coverings and are changed into fine fibrillse. Fatty gran- 
 ular cells are found between the fibrillar. There are no signs of a 
 true inflammatory process. Ilolden believes that the primary change 
 is an atrophy of the retinal ganglion-cells. 
 
 In the post-neuritic type of atrophy there is a formation of con- 
 nective tissue in the nerve-stalk and in the nerve-head. The coats 
 of vessels are thickened. The sheaths or the nerve-fibres show 
 varicosities and either shrink or disappear. In advanced cases the 
 nerve forms a hard, distorted cord. This is always grave, and will 
 depend on the cause of the disease, the stage at which the patient 
 applies for treatment, etc. In primary or progressive atrophy the 
 course of the disease is slow. Several years may elapse before the 
 patient becomes blind. The damage done to vision in the neuritic 
 or secondary form will depend upon the amount of contraction which 
 ensues in the inflamed tissue. A progressive narrowing of the field 
 is a sign of grave import. 
 
 Treatment must be directed in accordance with the cause. Syphili-
 
 ATROPHY OF THE OPTIC NERVE 671 
 
 tic cases will require mercury or potassium iodid, or both remedies. 
 Strychnin must be given by the mouth or hypodermically. It should 
 be administered in rapidly increasing doses and should be pushed 
 to the limits of tolerance. If administered hypodermically the begin- 
 ning dose will be 4/100 grain. Given by the mouth the beginning 
 dose will be 1/60 grain three times a day, increased rapidly until the 
 patient takes 1/6 or 1/5 grain at a dose. According to Derb3^ im- 
 provement follows the strychnin treatment in 30 per cent, of the 
 eases. Nitroglycerin or nitrite of amyl may be used. Other pro- 
 posed remedies are preparations of arsenic, silver, iron, phosphorus, 
 lactate of zinc, hypodermics of antipyrin, and galvanism. Vibratory 
 massage may be tried. 
 
 If no improvement follows the use of such remedies as have been 
 enumerated, the author removes the superior cervical ganglion of 
 the sympathetic nerve, in the hope that an increased blood-supply 
 will bring about improvement in vision. Although it is yet too 
 soon to pass final judgment on this operation, the author has had 
 one successful result out of four advanced cases of optic-nerve 
 atrophy which he has treated by operation. To be of value, the 
 operation should be done while the patient retains vision equal to 
 or better than the counting of fingers at two or three feet. Suker 
 and Eenaud have also reported cases in which sympatheticectomy 
 was followed by improvement in vision. 
 
 Hereditary optic-nerve atrophy. This is a variety of atrophy of 
 the optic nerve, which, as a rule, affects several members of a given 
 family at about the age of twenty years. It has been known to 
 afifect as nmny as six generations (Gould). The disease is found 
 chiefly in the male members, the inheritance being through 
 the unaffected females. About 14 per cent, of the cases re- 
 ported have occurred in females. There are on record 317 cases, 
 occurring in SO families. The onset of the disease is sudden. It 
 begins as an acute retrobulbar neuritis, which reaches its height 
 in five or six weeks. After this period it either progresses slowly or 
 remains stationary. Central scotoma is present, which at first affects 
 colors only and ultimately involves the form-field. Peripheral vision 
 is either normal or slightly altered, thus permitting the patient to get 
 about, while central vision is often so much reduced that reading 
 is impossible. The color-changes are central at first, the periphery 
 becoming involved later. Blue and yellow are seen more clearly 
 than red. In anomalous cases a ring-scotoma or a sector-shaped 
 defect may be found. Nyctalopia is a common symptom. During 
 the stage of inflammation the patient may complain of red vision or 
 of seeing colored stars or flames. Photophobia and headache may be
 
 672 ATROPINA 
 
 present. The ophthalmoscopic signs include hyperemia of the nerve- 
 head with slight haziness of its outline. The arteries are either 
 normal or dilated (Leber). A fine striated appearance of the retina 
 around the nerve-head may be present. In the later stage the 
 papilla becomes white, with slightly hazy borders and an accumu- 
 lation of pigment. The pallor of the disc generally begins in 
 the temporal half. Atrophy always follows the neuritis. Heredity 
 is an undoubted factor. Some cases have been attributed to the 
 abuse of tobacco and alcohol. The tower-shaped skull has been 
 regarded by some writers as a cause, it being supposed that the 
 optic nerve is compressed by the bone. Prognosis is unfavorable. 
 Leber has seen a family in which all the patients recovered their 
 vision. Partial recovery has been noted by several observers. 
 Treatment does not differ from that which is appropriate for other 
 types of retrobulbar optic neuritis. 
 
 IlemorrJiage into the sheath (apoplexy) of the optic nerve. Al- 
 though hemorrhage into the subdural and subarachnoidal spaces of 
 the optic nerve has been described by Magnus, de Wecker, and 
 others, there is no evidence to show that it exists as an idiopathic 
 affection. There are no reasons for believing that hemorrhages 
 situated at the border of the optic disc, or in the vitreous humor, 
 are indicative of apoplexy of the optic-nerve sheath (Gonin). Liter- 
 vaginal hematoma may occur after cerebral apoplexy or following 
 trauma. Li such a case there will be rapid and great loss of vision. 
 Early ophthalmoscopic examination may show nothing abnormal, or 
 may give a picture resembling that which is found in embolism of 
 the central retinal artery. At a later date the disc will be atrophic. 
 — (J. M. B.) 
 
 Those forms of optic atrophy not described above or as individual 
 topics will be found under the major headings, Nerve, diseases of 
 the optic, and Neurology of the eye. 
 
 Atropina. (L.), f.n. Atropine. 
 
 Atropin bei Iritis. (G.) Atropin in iritis. 
 
 Atropine. Atropia. C17H23N3. An alkaloid obtained from atropa 
 belladonna (q. v.) and other plants of the same family. It occurs as 
 colorless or whitish, acicular crystals with a bitter-acrid taste, sol- 
 uble in 450 parts of water, 1.50 parts of alcohol, 17 parts of ether, 
 at 77° F. It is also soluble in glycerin, benzine and olive oil. Its 
 best known salt is the sulphate, but it must be remembered that the 
 alkaloid, the borate, iodate, oleate (for ointments), salicylate, san- 
 toniuate, valerianate and other salts have been used in ocular 
 therapy. 
 
 The alkaloid is obtained from atropa belladonna and other plants
 
 ATROPINE 673 
 
 of the same family and is isomeric with daturin. It is the salt of 
 an organic base called tropin (troj^in tropate), but in ophthalmic 
 practice is generally employed as the sulphate which it closely re- 
 sembles. 
 
 Atropine and most of the other cycloplegics are chemically incom- 
 patible with the alkalies, tannin, the salts of mercury; physiolog- 
 ically incompatible with opium and its derivatives, pilocarpine, mus- 
 carine, aconitine and eserine. 
 
 Atropia is a powerful c.ycloplegic and mydriatic and may act as 
 a poison even when instilled into the conjunctival sac. In toxic 
 doses it causes dryness of the throat, vertigo, frequent pulse, a scar- 
 latinous rash, hallucinations and delirium. A single drop of a one 
 per cent, solution of atropia sulphate produces mydriasis in about 
 15 minutes and cycloplegia in two hours. It stimulates the radiat- 
 ing muscular and sympathetic fibers of the iris while it paralyzes 
 the peripheral cells of the motor oculi supplied both to the iris and 
 to the ciliary muscle. Instilled thrice daily for two days the cyclo- 
 plegia lasts from seven to twelve days — the dilation of the pupil some- 
 what longer. Atropia also increases the intraocular tension, and 
 this fact should always be borne in mind in ^ases of suspected 
 glaucoma. 
 
 Most of its effects have been noted during the internal adminis- 
 tration of belladonna or its derivatives, during its use as a liniment, 
 as an ointment and as a plaster. The tears that flow from an eye 
 under treatment by an atropine collyrium may act as a mydriatic 
 if accidentally introduced into the fellow eye or the eye of an at- 
 tendant. 
 
 Owing to the extreme susceptibility of many patients to the poi- 
 sonous effects of eye-drops I rarely use the drug in stronger solu- 
 tions than one per cent., ordering one drop only to be instilled at 
 a sitting and then, when possible, after meals, when absorption takes 
 place most slowly. The eyelashes are then wiped perfectly dry with 
 cotton from the inner canthus outward. Many surgeons advise 
 pressing the finger over the region of the lachrymal sac at the time 
 of the instillation, but I believe the precautions just mentioned are 
 much more effective and apply with equal force to the use of all poi- 
 sonous collyria. A single drop of a 1 :45.000 solution of the atropin 
 will dilate the normal pupil in less than an hour. 
 
 Michel thinks the toxic danger point is reached when, at one sit- 
 ting, eight drops of a one-half per cent, solution are instilled into the 
 conjunctival sac, but the conditions under which it is used and the 
 idiosyncrasy of the patient chiefly determine the toxic effect. 
 
 Hirschberg in severe cases of acute iritis instills the drug every 
 
 Vol. 1—4 3
 
 674 ATROPINE CONJUNCTIVITIS 
 
 hour or two the first day; afterwards every two hours daily, and 
 night if need be. As Noyes has said, ''atropia is the beginning, the 
 middle and the end of the treatment of all forms of iritis, ' ' and there 
 is much to justify such a sweeping statement. Judiciously exhibited 
 in conjunction with general treatment, hot applications, dionin and 
 cocaine its fullest effects are apparent in relieving the symptoms and 
 preventing the serious sequelae of this disease. It gives rest to the 
 musculature of the inflamed organ, relieves its morbid vascularity, 
 prevents the formation of (or breaks up) posterior synechise and 
 acts as a sedative to the irritated nerve-endings. 
 
 In scleritis, choroiditis, retinitis and the majority of cases of cor- 
 neal ulcer atropia is also indicated. It is contra-indicated in glau- 
 coma and in total (ring) synechia. 
 
 Atropine irritation and conjunctivitis form an idiosyncrasy which 
 may be suspected from the roughness of the palpebral skin, the dry 
 throat and other toxic symptoms following an ordinary dose of the 
 drug. When atropia is thus badly borne, scopolamin or duboisin 
 (in one-tenth or one-twentieth the dose of atropine) may be tried, 
 or the drug in reduced dosage used as an oily solution or in the form 
 of ointment. 
 
 For the double purpose of increasing its cycloplegic effect and of 
 inhibiting its poisonous tendencies D. M. Griffin makes use of the 
 following formula when employing atropine in refraction work: 
 
 Atropia? sulph. gr. iss 
 
 Dionin. gr. ss 
 
 Aquge dest, fl. oii 
 
 When solutions of atropine fail to produce the desired effect H. 
 H. Martin employs finely powdered atropine sulphate, as much 
 as can be picked up on the point of a pen knife, placed in the lower 
 conjunctival sac. The eye is cocainized previous to this application 
 and the patient or nurse directed to exert pressure with the finger 
 over the lachrymal sac for five minutes. — (Ed.) 
 Atropine conjunctivitis. Formerly, every one believed with Kobert that 
 this conjunctivitis is a direct effect of atropine. Now, however, many 
 assume that the toxic symptoms are due to infection of the solution 
 by a mold fungus, and that the atropine, as such, has no effect on 
 the conjunctiva, with the exception of cases of idiosyncrasy (q. v.). 
 However that may be, in some subjects a single application may cause 
 violent irritation ; continued use may result in the development of 
 typical follicular catarrh with a good deal of follicle formation. 
 Replacing' the atropine with duboisin or some other mydriatic, or
 
 ATROPINE GLAUCOMA 675 
 
 regularly sterilizing the solutions before using them in most cases 
 effects an early cure. 
 
 Atropine g-laucoma. The most noteworthy toxic effect of the instilla- 
 tion of atropine is glaucoma. A large number of recorded cases 
 show that a single atropine instillation may not only induce an 
 acute attack in a latent, chronic glaucoma, but may set up in appar- 
 ently normal eyes the same symptom-complex. Some observers 
 assume that such eyes could not have been normal, that at least 
 a definite predisposition must have been present, and that in healthy 
 eyes atropine does not produce such serious changes. Perhaps some 
 of the earlier observations of blindness following the use of bel- 
 ladonna or atropin can be explained by its production of acute 
 glaucoma. 
 
 Of thirty-two cases of glaucoma collected by Myles Standish, nine 
 were believed to be due to atropin, two to homatropin, and one each 
 to scopolamin, duboisin, and cocaine, {Ophthalmic Record, 1902, 
 p. 243). 
 
 No age seems to be exempt from such a possibility. The collected 
 data show that children from 5 to 10 years, as well as adult men and 
 women may be subject to this trouble. The climacteric period is 
 said to predispose to it ; likewise senile changes in the arterial system 
 have been supposed to contribute to the rise of intraocular pressure 
 produced by atropin as well as by glaueonia, l)ut incorrectly. The 
 strength of the atropin solution seems to be unimportauT. for a 
 solution of 1 to 2,500 may produce glaucoma as well as a solution of 
 1 to 100. The time required for the appearance of the glaucoma 
 is variable. In one case it appeared in half an hour; in others in 
 1, 2, 3, 5 hours or even after several days. 
 
 Atropine irritation. This idiosyncrasy against belladonna shows itself 
 in swelling of the conjunctiva and roughness of the palpebral skin. 
 It is never accompanied by pain but generally is attended by some 
 itching and ocular discomfort. It is commonly observed several 
 days after the first instillation of the drug, and may be associated 
 with considerable thickening of the skin surface and a sero-mucous 
 discharge from the eye. It is an alarming sign to one who has not 
 previously encountered it but is not, fortunately, as serious a com- 
 plication as it appears. The form of the mydriatic should be 
 changed to duboisin or hyoscin, the dose reduced to the minimum 
 and a simple ointment applied to the roughened lids. 
 
 Atropine methylbromide. See Methylatropine bromide. 
 
 Atropine methyl nitrate. See Eumydrin. 
 
 Atropine, Ocular signs of poisoning by. These are, swelling of the
 
 676 ATROPINE SANTONINATE 
 
 lids, excessive lustre of the cornea, mydriasis, and paralysis of the 
 accommodation. Exophthalmia has been observed, probably as a 
 result of paresis of the recti muscles, together with a similar con- 
 dition of the orbicularis, permitting the lids to be widely separated 
 by the exophthalmic globe. — (T. H. S.) 
 Atropine santoninate. (Not the "santonate. ") A white powder quite 
 soluble in water. 
 
 This salt is particularly mentioned to draw attention to the fact 
 that while quite equal in solubility and medicinal action to the 
 methylbromide, nitrate, salicylate, sulphate, borate and other favor- 
 ite compounds of atropia used in ophthalmic practice, it does not 
 so readily as they undergo decomposition and if kept in dark bot- 
 tles retains its cycloplegic and other qualities almost indefinitely. 
 
 Atropine, Systemic poisoning from. A too liberal application of 
 atropin or of its related poisons will sometimes produce symptoms 
 that show themselves occasionally after a very few minutes. These 
 are chietiy dryness of the throat, hoarseness, difficulty in swallow- 
 ing, deep redness of the face, and a scarlatina-like eruption. In 
 addition there is noticed quickening of the pulse, headache, vertigo, 
 and delirium of a peculiar, restless, "merry" variety. In one case 
 Raphael observed (1889) glycosuria, which disappeared with the 
 other symptoms. 
 
 If the dose is a fatal one (statistics of lethal doses vary greatly) 
 death takes place in from 2 to 20 hours, preceded by violent quick- 
 ening of the jnilse and respiration, coma and paralysis of the 
 sphincter muscles of the bladder and rectum. 
 
 When serious symptoms of atropia poisoning set in, vomiting 
 should be induced and the stomach washed out. Injections of mor- 
 phia (0.01-0.02) are recommended, and repeated hypodermics of 
 pilocarpin (0.01). This medication should be continued until the 
 mucous membrane of the mouth becomes moist. In cases of cerebral 
 congestion, energetic antiphlogistic treatment is called for. 
 
 The eye signs and symptoms are discussed under Atropine and 
 Toxic amblyopia. 
 
 Atrcpinidicsynkrasie. (G.) Atropine idiosyncrasy. 
 
 Atropinism. Poisoning by atropine. See Toxic amblyopia. 
 
 Atropin Katarrh. (G.) Catarrh produced by the use of atropine. 
 
 Atropinvergiftung'. (G.) Atropine poisoning. 
 
 Atropinwlrkung. (G.) Effects of atropin. 
 
 Atropism. n. Poisoning by atropine or belladonna. See Toxic am- 
 blyopia. 
 
 Atroscine. Iota scopolamine. This cycloplegic alkaloid, found as
 
 AT-TABARI, ABUL HASAN ALI B. SAHL B. RABBAN 677 
 
 transparent, colorless crystals, sparingly soluble in water, is derived 
 from commercial hyoscine or scopolamine. 
 
 Macklin prefers it to other cycloplegics for determining refrac- 
 tive errors, and uses it as a one per cent, solution in castor oil. He 
 says it acts as a rapid and powerful mydriatic and cycloplegic, is 
 as potent and reliable as atropine sulphate, while the power of ac- 
 commodation returns in five days. Of course, with homatropine the 
 ciliary paresis ceases in twenty-four hours, which is undoubtedly a 
 great advantage in many cases, yet homatropine has disadvan- 
 tages which must be apparent to all who use it. Mydriasis with 
 atroscine begins in ten minutes and is complete in twenty. Cyclo- 
 plegia begins in ten minutes and is complete in about fifty. 
 
 The hydrobromide is very soluble in water and for that reason is 
 to be preferred to the pure alkaloid. 
 
 There is an inactive form of atroscine (Merck) with the formula 
 C17H21NO4+H2O, colorless, transparent crystals, very slightly 
 soluble in water, that in one per cent, solution (preferably castor 
 oil) acts as a miotic. 
 
 At-Tabari, Abul Hasan All b. Sahl b. Rabban. This distinguished son 
 of the still more distinguished Jewish physician, Rabban at-Tabari, 
 was the teacher of the immortal Rhazes and body-physician to the 
 Caliphs Mutasim and Mutawakkil. He flourished in the 9th century 
 A. D. He wrote a comprehensive treatise on general medicine, in 
 30 books and 860 chapters. He also made a number of translations, 
 presumably excellent, from Indian works on ophthalmology, but 
 none of these have descended to our day. — (T. H. S.) 
 
 At-Tamuni, Abu Abdallah Muh. b. Abmad b. Said. Tliis famous Ara- 
 bian physieian, who flourished in the latter portion of the 10th 
 century, practised first in Jerusalem ; after A. D. 980, however, in 
 Eg3^pt. His only ophthalmic writing is, A Chapter on the Nature of 
 Ophthalmia, its Kinds, its Causes, and its Cures. — (T. H. S.) 
 
 Attollirender augenmuskel. (G.) The superior rectus muscle. 
 
 Atzmittel. (G.) Phagedenic; corrosive, caustic. - 
 
 Atzpulver. (G.) Corrosive; caustic powder. • 
 
 Atzstoff. (G.) Caustic. 
 
 Atzwasser. (G.) Caustic water. 
 
 Aub, Joseph. This well-known ophthalmologist Avas born and edu- 
 cated in Cincinnati, receiving his professional degree at the Medical 
 College of Ohio in 1866. He then pursued the exclusive study of 
 ophthalmology at Vienna, London and Berlin. Returning to Amer 
 iea, he was for some time assistant to Herman Knapp, at the New 
 York Ophthalmic and Aural Institute. In 1872, settling in his native
 
 678 AUBERT'S BINOCULAR CORNEAL MICROSCOPE 
 
 city, he began the practice of ophthalmology on his own account. 
 An excellent scholar, a skilful operator, and gifted with the faculty 
 of making numerous and steadfast friends, he was very successful 
 from the very beginning of his work. For seventeen years he was 
 ophthalmologist to the Cincinnati Hospital, and, for 5 years was 
 Professor of Ophthalmology in the Cincinnati Medical College. His 
 chief fault was over-application to his practice. As a result of his 
 almost unremitting labors, he became ill and, when it was altogether 
 too late to be of benefit, he journeyed to the South, seeking there the 
 health that could never be his again. Becoming convinced of the 
 uselessness of further endeavors in this direction, he returned to Cin- 
 cinnati, where he died soon after, in May, 1888. — (T. H. S.) 
 
 Aubert's binocular corneal microscope. The inventor presented this 
 instrument at Heidelberg in 1891. It yields an upright picture by 
 double inversion of the image. It produces an enlargement of 
 twenty diameters of the object when it is ten and a half centimeters 
 from the eye. The field is quite large. Concentrated daylight may 
 be used for the illumination. 
 
 Aufatzen. (G.) To open by a corrosive. 
 
 Aufbahen. (G.) Poulticing; to puff up; to inflate; to swell. 
 
 Aufblicken. (G.) To look upwards. 
 
 Aufbrechung'. (G.) An opening, eruption. 
 
 Aufbreiten. (G.) To spread. 
 
 Auffangeglas. (G.), n. In optics, the objective of a microscope or 
 telescope. 
 
 Auffeuchtung. (G.) Moistening. 
 
 Aufgetrieben. (G.) Turgescent. 
 
 Aufhebemuskel. (G.), n. A levator muscle. 
 
 Auflosbar. (G.), adj. Soluble. 
 
 Auflosung-. (G.), n. Solution. 
 
 Auflosung der linse. (G.) Solution or absorption of the crystalline 
 lens, as in soft cataract. 
 
 Auflosung des glaskbrpers. (G.) Synchesis, or fluid vitreous. 
 
 Aufspritzen. (G.), tr.v. To syringe. 
 
 Auftrinken. (G.), tr.v. To absorb. 
 
 Aufwartskehrung der augenlider. (G.) E version of the eyelids. 
 
 Augapfel. (G.), n. The eyeball. 
 
 Augapfelausrottung. (G.) Removal of the eyeball, 
 
 Augapfelbinde. (G.) Fascia of the eyeball. 
 
 Augapfelbindehaut. (G.) The ocular conjunctiva. 
 
 Augapfelbrand. (G.) Sloughing or gangrene of the eyeball 
 
 Augapfeleiterung. (G.) Suppuration of the eyeball.
 
 AUGAPFELENTZUNDUNG 679 
 
 Augapfelentziindung-. (G.) Inflammation of the eyeball. 
 
 Aug-apfelflache. ((jI.) The surface of the eyeball. 
 
 Augapfelhalter. (G.) Ophthalmostat, or instrument for fixing the 
 eyeball. 
 
 Aug-apfelhautchen. (G.) An ocular membrane. 
 
 Aug-apfelkrampf. (G.) Nystagmus. 
 
 Augapfelmuskellahmung. (G.) Paralysis of the external muscles of 
 the eyeball. 
 
 Augapfelschmerz. (G.) A pain in the eyeball. 
 
 Augapfelschrumpfung. (G.) Atrophy or shrinking of the eyeball. 
 
 Augapfelstarrkrampf. (G.) Tetanic contraction of the ocular 
 muscles. 
 
 Augapfelvarikositat. (G.) Varicose condition of the veins of the 
 eyeball. 
 
 Augapfelveranderung. (G.) A change in the eyeball. 
 
 Augapfelvorderflache. (G.) The anterior surface of the eyeball. 
 
 Augapfelvorfall. (G.) Protrusion of the eyeball. 
 
 Augapfelwand. (G.) Wall of the eyeball. 
 
 Augapfelwassersucht. (G.) Dropsy of the eyeball 
 
 Augapfelzucken. (G.) Nystagmus. 
 
 Aug-apfelzuckung. (G.) Nystagmus. 
 
 Auge. (G.) The eye. 
 
 Auge des Neugeborenen. (G.) The eye of the new-born. 
 
 Auge, Fotales. (G.) Foetal eye. See Embryology of the eye. 
 
 Auge, Reduziertes schematisches. (G.) Schematic reduction of the 
 eye. - 
 
 Augen. (G.) The eyes. 
 
 Augenabscess. (G.) Panophthalmitis purulenta. 
 
 Augenabstandsmesser. (G.) This device permits the position of the 
 pupil and interpupillary measurements to be made in asymmetrical 
 faces and, especially, is it valuable in indicating the proper kind of 
 nose-bridge. Hertel (Uber ein neuen Apparat zur Bestimmung des 
 Abstandes der Glasermitten fiir die Pern — und Nahebrille. — v. 
 Graefe's Arch, fiir Ophthalm. LXIV. 176-183. 1906. Beschreibung 
 in der Zentralzeitung fiir Optik und Mechanik. XXVIII. 61 ^. u. 
 74ff. 1907.) more fully describes the use and necessity' for this in- 
 strument. 
 
 Augenachse. (G.) The axis of the eye. ■ - _ ,^ 
 
 Augenader. (G.) Ophthalmic vein. . ,-,/ 
 
 Augenaderhaut. (G.) Choroid. i^H^-i*^ 
 
 Augenaderlass. (G.) Abstraction of blood from the eye. 
 
 Augenahnlich. (G.) Resembling an eye.
 
 680 AUGENAPONEUROSE 
 
 Aug-enaponeurose. (G.) Palpebral fascia. 
 
 Aug-enarterie. (G.) Ophthalmic artery. 
 
 Augenarznei. (G.) Remedy for the eye. 
 
 Aug-enarzt. (G.) Ophthalmologist ; oculist. 
 
 Aug-enarztlich. (G.) Ophthalmiatric. 
 
 Aug-enausfluss. (G.) A discharge from the eyes. 
 
 Augenausrottung. (G.) Eemoval of the eye. 
 
 Augenausschalung. (G.) Enucleation of the eye. 
 
 Augenaxe. (G.) The axis of the eye. 
 
 Augenbad. (G.) Ophthalmic bath or eye-douche. 
 
 Augenbader. (G.) A basin used for bathing or washing the eyes. 
 
 Augenbalsam. (G.) Balsamum ophthalmieura ; eye balsam. 
 
 Augenband. (G.) Tarsal ligament, 
 
 Augenbeben. (G.) Nystagmus. 
 
 Augenbecher. (G.) An optic cup. 
 
 Augenbecken. (G.) The socket of the eyeball. 
 
 Augenbersten. (G.) Rupture of the eyeball. 
 
 Augenbeschreibung. (G.) Ophthalmology. 
 
 Augenbeschiitzer. (G.) An eye-protector. 
 
 Augenbetrug. (G.) An optical illusion. 
 
 Augenbewegend. (G.) Oculo-motor. 
 
 Augenbewegender. (G.) The third cranial (motor oculi) nerve. 
 
 Augenbeweglichkeit. (G.) Mobility of the eyeball. 
 
 Augenbewegung. (G.) Ocular movement. 
 
 Augenbevv'egungen. (G.) Movement or motion of the eyes. 
 
 Augenbewegungen, Accommodative. (G.) Accommodative ocular 
 
 movements. 
 Augenbewegungen, Associirte oder conjugirte. (G.) Associated or 
 
 conjugate ocular luoveincnts. 
 Augenbewegungen, Dissociirte. (G.) Dissociated ocular movements. 
 Augenbewegungen, Einseitige. (G.) Unilateral ocular movements. 
 Augenbewegungen Nervenbahnen. (G.) Eye-movements in the nerve 
 
 tracts. 
 Augenbezirk. (G.) The ophthalmic region. 
 Augenbildung. (G.) Blepharoplasty. 
 Augenbinde. (G.) A bandage for retaining a dressing on, to cover 
 
 or to prevent the use of the eye. 
 Augenbindehaut. (G.) Ocular conjunctiva. 
 Augenbinden. (G.) Eye-bandaging. 
 Augenbinzeln. (G.) Nictitation, blinking. 
 Augenblase. (G.) A vesicle developed from the lateral wall of the 
 
 forebrain, forming the posterior portion of the eyeball.
 
 AUGENBLASE, PRIMARE 681 
 
 Augenblase, Primare. (G.) Primary optic vesicle. 
 
 Augenblase, Secundare. (G.) Secondary optic vesicle. 
 
 Augenblasen. (G.) In ocular embryology, the primitive oj)tic vesicle. 
 
 Aug-enblasengTube. (G.) In embryology, the optic cup. 
 
 Augenblasenspalte. (G.) Foetal ocular fissure. 
 
 Augenblasenstiel. (G.) A protuberance in the brain of the embryo, 
 
 at the extremity of which the optic vesicle is situated. See Embry- 
 ology of the eye. 
 Augenblasenwurm. (G.) The cysticercus cellulosa which has invaded 
 
 the eye. 
 Augenblende. (G.) A blinker, blind, an eye-flap. 
 Augenblennorrhoe. (G.) Gonorrheal ophthalmia. 
 Augenblennorrhoe der Neugeborenen. (G.) Ophthalmia neonatorum. 
 Augenblick. (G.) A wink of the eye; twinkling of the eye; moment; 
 
 instantly ; instantaneously. 
 Augenblicke. (G.) Lucid intervals. 
 Augenblode. (G.) Amblyopia. 
 Augenblodigkeit. (G.) Weakness of the eyes. 
 Augenblutadern. (G.) The ophthalmic veins. 
 
 Augenblutschwamm. (G.) A fimgous (malignant) growth of the eye. 
 Augenblutunterlaufung. (G.) Ilemophthalmia ; suffusion or ecchy- 
 
 mosis of the eye. 
 Augenbogen. (G.) The iris. 
 Augenbraue. (G.) The eyebrow. 
 
 Augenbrauenbogen, (G.) Superciliary ridges (q. v.). 
 Augenbrauengegond. (G.) The superciliary region. 
 Augenbrauenhaar. (G.) The hair of the eyebrow. 
 Augenbrauenhaut. (G.) The skin of the eyebrow. 
 Augenbrauenmuskel. (G.) See Corrugator supercilii. 
 Augenbrauenverlust. (G.) The loss of the hair of the eyebrow. 
 Augenbrauenwulst. (G.) The superciliary ridge. 
 Augenbrauenzache. (G.) Those fibres of the oceipito-frontalis 
 
 muscle that run towards and are attached near the inner canthus 
 
 and at the side of the nose. 
 Augenbraumuskel. (G.) The corrugator muscle. 
 Augenbraunbogen. (G.) The arch of the eyebrows. 
 Augenbraune. (G.) The eyebrow. 
 
 Augenbraunenausfall. (G.) Falling out of the eyebrows. 
 Augenbraunenbogen. (G.) See Superciliary ridges. 
 Augenbraunenbogenloch. (G.) The supra-orbital foramen. 
 Augenbraunenmuskel. (G.) The corrugator supercilii muscle. 
 Augenbraunennery. (G.) The supra-orbital nerve.
 
 682 AUGENBRAUNENRUNZLER 
 
 Aug-enbraunenrunzler. (G.) A name for the corrugator supercilii 
 
 muscle. 
 Augenbraunen-verschdnerimgsmittel. (G.) An ancient application 
 
 for beautifying the eye by darkening the edges of the lids and 
 
 lashes. 
 Augenbraungeg'end. (G.) The superciliary region. 
 Augenbraunhaare. (G.) The eyebrows. 
 Augenbreite. (G.) The space between the eyes. 
 Augenbrennen. (G.) Pain or discomfort in the eyes. 
 Augenbruch. (G.) Exophthalmus. 
 Augenbiirste. (G.) A brush for scarifying the lids and palbepral 
 
 conjunctiva. 
 Augenbutter. (G.) The secretion (normal or increased) of the Mei- 
 bomian glands. 
 Augenbutterdriisen. (G.) Lleibomian glands. 
 Augencatarrh. (G.) Catarrhal conjunctivitis. 
 Augendach. (G.) The roof of the orbit. 
 Augendecke. (G.) Nictitating membrane, or third eye-lid. 
 Augendeckel. (G.) An eye-protector; an eyelid. 
 Augendeckelhaare. (G.) The eyelashes. 
 Augendiat. Augendiatetik. (G.) Ocular hygiene; dietetics with 
 
 reference to the eye. 
 Augendistanz. (G.) The distance between the eyes. 
 Augendouche. (G.) Fomenting the eyes with water. 
 Augendrehpunkt. (G.) The point of rotation of the eyeball. 
 Augendruck. (G.) The tension of the eyeball. 
 Augendriicken. (G.) Pain in the eyes, from undue pressure. 
 Augendriise. (G.) Lachrymal gland. 
 Augendriisen. (G.) The ^Meibomian glands. 
 Augendriisenentziindung. (G.) Inflammation of the lachrymal 
 
 glands. 
 Augendunkelheit. (G.) A diminution or loss of vision. 
 Augenduscher. (G.) Eye douche. 
 Augeneinstiilpung. (G.), n. In the embryology of the eye, ectodermic 
 
 involution. 
 Augeneisen. (G.) Actual cautery; a cautery iron for use on the eye 
 
 or its appendages. 
 Augeneiterung. (G.) Suppuration of the eyeball or its appendages. 
 Augenentziindung. (G.) Any inflammation of the eye. 
 Augenentziindung, Agyptische. (G.) Egyptian ophthalmia. 
 Augenentziindung der Neugeborenen. (G.) Ophthalmia neonatorum. 
 Augenentziindung, Trockene. (G.) Xerophthalmy.
 
 AUGENERKRANKUNG 683 
 
 Augenerkrankungf. (G.) Ocular affection. 
 
 Aug-enermiidung. (G.) Asthenopia, ocular fatigue. 
 
 Augenessenz. (G.) An eye essence. Rihuorhausen's collyriuni. 
 
 Augenfallig. (G.) Manifest; readily seen. 
 
 Augenfarbe. (G.) The color of the eye; glaucoma of the eye. 
 
 Augenfeld. (G.) The field of vision. 
 
 Augenfell. (G.) A corneal opacity; a pterygium. 
 
 Augenfeuchtigkeit. (G.) A term sometimes applied to the aqueous 
 
 or vitreous humor. 
 Augenfistel. (G.) A lachrymal or corneal fistula. 
 Augenflache. (G.) An orbital or ocular surface. 
 Augenflecke. (G.) A pigmented spot on or opacity of the eye. 
 Augenflecken, Weisser. (G.) Leucoma, nebula, the white spot in the 
 
 eye. 
 Augenflimmern. (G.) The swimming of objects before the eyes. 
 Augenfliigel. (G.) The lesser wings of the sphenoid bone. 
 Augenfluss. (G.) Any form of discharge from the eye. 
 Augenfliissig. (G.) Having a discharge, especiallj^ of water, from 
 
 the eyes. 
 Augenfliissigkeit. (G.) Vitreous. 
 Augenfortsatz. (G.) An orbital process. 
 Augenfunken. (G.) Flashes of light, or sparks, in or about the eye; 
 
 phosphenes. 
 Augenganglie. (G.) Optic ganglion. 
 Augengebiet. (G.) The region of the eye. 
 Augengefasse. (G.) The ocular blood-vessels. 
 Augengegend. (G.) The region or neighborhood of the eye. 
 Augengeist. (G.) A name sometimes given to Pagenstecher's spiritus 
 
 ophthalmicus, i. e., Spt. melissae, 100 ; Spt. lavandula?, 25 ; Spt. 
 
 camphor., 3. ; Spt. etheris nitros., 2. ; 01. rosK, gtt. 1. This mixture 
 
 is used as a collyrium when diluted with 5 or more parts of water. 
 Augengeschwulst. (G.) Protrusion of the eyeball. 
 Augengeschwiir. (G.) An ulcer on the cornea or sclera. 
 Augengespenster. (G.) An optical illusion. 
 
 Augengewolk. (G.) A pterygium; also, an opacity of the cornea. 
 Augengicht. (G.) Gout in the eye. 
 
 Augenglas. (G.) The eye-piece of a telescope or microscope. 
 Augenglaser. (G.) Eye-glasses; spectacles. 
 Augenglasschleifer. (G.) An optician. 
 Augengriffel. (G.) The elevator of the upper lid. 
 Augengrube. (G.) The orbit; also, the depression above the eyes 
 
 in some animals.
 
 684 AUGENGRUND 
 
 AugengTund. (G.) Fundus oculi. 
 
 Augenhalter. (G.) Ophthalmostat, or instrument for fixing or 
 steadying the eyeball during an examination or operation, 
 
 Augenhaut. (G.) Any of the coverings of the eyeball. 
 
 Augenhautbraune. (G.) The choroid. 
 
 Augenhautchen. (G.) Opacity of the cornea. 
 
 Augenheber. (G.) Levator palpebrje superioris. 
 
 Augenheftnadel. (G.) A fixation needle for the eye. 
 
 Augenheilanstalt. (G.) An eye-hospital. 
 
 Augenheilkunde. (G.) Ophthalmology. 
 
 Augenheillehre. (G.) Ophthalmology. 
 
 Augenheilmittel. (G.) A remedy for the eye. 
 
 Augenheilwasser. (G.) An eye-lotion. 
 
 Augenheraustreten. (G.) Exophthalmia. 
 
 Augenhintergrund. (G.) Fundus oculi. 
 
 Augenhintergrund, Normal. (G.) The normal fundus of the eyes. 
 
 Augenhintergrundsuntersuchung. (G.) An examination of the fun- 
 dus oculi. 
 
 Augenhohflache. (G.) The orbital surface of the ones forming 
 the orbital cavities. 
 
 Augenhohle. (G.) The orbit. 
 
 Augenhohlen. (G.) The orbits. 
 
 Augenhbhlenarterie. (G.) The arteries of the orbit. 
 
 Augenhohlenast. (G.) The orbital branch. 
 
 Augenhohlenblutadern. (G.) The orbital veins. 
 
 Augenhohlenbogen. (G.) Superciliary ridges. 
 
 Augenhohlendach. (G.) The roof of the orbit. 
 
 Augenhohlendecke. (G.) The roof of the orbit. 
 
 Augenhohlenentziindung. (G.) Orbital cellulitis. 
 
 Augenhohlenfissur. (G.) Sphenoidal fissure. 
 
 Augenhohlenflache. (G.) The inner surface of the bones that 
 enclose the orbit. 
 
 Augenhohlenfliigel. (G.) The lesser, or orbital, wings of the sphenoid 
 bone. A segment of the anterior cerebral lobes rests upon their 
 upper surface, while the lower surface forms the posterior part 
 of the orbital roof. At their base is the foramen opticum. A pro- 
 jection from each near the sella turcica forms the anterior clinoid 
 process. 
 
 Augenhohlenfortsatz. (G.) An orbital process. 
 
 Augenhohlengegend. (G.) The orbital region. 
 
 Augenhohlengeschwnlst. (G.) An orbital tumor. 
 
 Augenhohlenhaut. (G.) The orbital periosteum or aponeurosis.
 
 AUGENHOHLENINHALT 685 
 
 Augenhohleninhalt. (G.) The conteiils of the orbit. 
 
 Augenhohlenkamm. (G.) Orbital crest. 
 
 Augenhohlenkrebs. (G.) Cancer of the orbit. 
 
 Augenhohlenlappen. (G.) The orbital lobes. 
 
 Aug-enhohlenloch. (G.) The orbital foramen. 
 
 Aug-enhohlennerv. (G.) Orbital nerve. 
 
 Augenhohlenolfnung-. (G.) Orbital fossa. 
 
 Aug'enhohlenrand. (G.) The margin of the orbit. 
 
 Augenh6hlenschlag"ader. (G.) Orbital artery. 
 
 Augenhohlenspalte. (G.) Sphenoidal fissure. 
 
 Augenhohlenteil. (G.) Tlu- orbital portion. 
 
 Augenhohlenwagenbreitenindex. (G.) The orbito-malar index. 
 
 Augenhohlenwand. (G.) The wall of the orbit. 
 
 Augenhohlenwandung'. (G.) The orbital wall. 
 
 Augenhohlenwassersucht. (G.) Dropsy of the orbit. Hydrophthal- 
 mia. 
 
 Augenhohlenwinkel. (G.) Orbital angle. 
 
 Augenhornhaut. (G.) The cornea. 
 
 Augenindex. (G.) Orbital index. 
 
 Augeninnere. (G.) Viscera of the eyeball. 
 
 Augenjucken. (G.) Itching of the eyes or eyelids. 
 
 Augenkamm. (G.) The orbital arch. 
 
 Augenkammer. (G.) One of the chambers of the eye. The anterior 
 chamber. 
 
 Augenkammer, Cordere. (G.) The anterior chamber of the eye. 
 
 Augenkammer, Hintere. (G.) The posterior chamber of the eye. 
 
 Augenkammern. (G.) The chambers of the eye. 
 
 Augenkammerwasser. (G.) Aqueous humor. 
 
 Augenkapsel. (G.) The capsule of the eye. 
 
 Augenkatarrh. (G.) Catarrhal conjunctivitis. 
 
 Augenkitzel. (G.) Tickling of the eye. 
 
 Augenklappe. (G.) Eyelid. 
 
 Augenklapperand. (G.) Margin of tlie eyelid. 
 
 Augenklinik. (G.) An eye clinic or infirmary. 
 
 Augenknochen. (G.) The cheek bones. 
 
 Augenknorpel. (G.) The tarsal cartilage. 
 
 Augenknoten. (G.) Ophthalmic ganglion. 
 
 Augenkrampf. (G.) Nystagmus. 
 
 Augenkrank. (G.) Suffering from eye-disease. 
 
 Augenkranke. (G.) A sufferer from eye-disease. 
 
 Augenkrankenanstalt. (G.) An eye infirmary, or hospital. - 
 
 Augenkrankenzimmer. (G.) A room, generally in a clinic or hos- 
 pital, set aj)art for the treatment of eye diseases.
 
 686 AUGENKRANKHEIT 
 
 Augenkrankheit. (G.) Disease of the eyes. 
 
 Augenkrankheitslehre. (6.) Treatise on eye diseases. Ophthal- 
 mology. 
 Aug-enkratze. (G.) Gonorrheal ophthalmia. 
 Augenkratzen. (G.) Scarification of the conjunctiva. 
 Augenkratzer. (G.) Instrument for scarifying the conjunctiva, 
 Augenkrebs. (G.) Cancer of the eye. 
 Augenkreis. (G.) The orbit; the orbital ring. 
 Augenkugel. (G.) The eyeball. 
 Augenlahmung. (G.) Blepharoplegia. 
 Augenlefzen. (G.) The eyelids. 
 
 Augenlehre. (G.) Ophthalmology; ophthalmic science. 
 Augenleiden. (G.) Disease of the eyes. 
 Augenleise. (G.) The orbit. 
 Augenleiste, (G.) The orbit. 
 Augenleistenfortsatz. (G.) An orbital process. 
 Augenleuchten. (G.) Luminosity of the eye. 
 Augenlicht. (G.) Eyesight; vision. 
 Augenlid. (G.) An eyelid. 
 
 Augenlidanschwellung. (G.) A swelling of the eyelid. 
 Augenlidaponeurose. (G.) Palpebral fascia. 
 Augenlidarterien. (G.) Arteries of the eyelid. 
 Augenlidauf halter. (G.) Levator palpebrse. 
 Augenlidaussenflache. (G.) The outer surface of the eyelid. 
 Augenlidband. (G.) A tarsal ligament. 
 Augenlidbandchen. (G.) A band, ligament. 
 
 Augenlidbildung. (G.) Restoration of the eyelid. Blepharoplasty, 
 Augenlidbindehaut. (G.) The palpebral conjunctiva. 
 Augenlidbinzeln. (G.) Nictitation, blinking. 
 Augenlidblutadern. (G.) The palpebral veins. 
 Augenlidbrand. (G.) Sloughing or gangrene of the eyelid. 
 Augenlidcarbunkel. (G.) Carbuncle of the eyelid. 
 Augenlidcolobom. (G.) Defect of the lid tissues. Coloboma of the 
 
 lid. 
 Augenliddriise. (G.) A gland of the eyelid ; a Meibomian gland. 
 Augenliddriisen. (G.) The Meibomian glands. 
 Augenliddriisenentziindung. (G.) Inflammation of the palpebral 
 
 glands. 
 Augenliddriisengeschwulste. (G.) A Meibomian cyst or tumor. 
 Augenlideinwartskehning. (G.) Entropion. 
 Augenlidentziindung. (G.) Inflammation of the eyelid.
 
 AUGENLIDER 687 
 
 Augenlider. (0.) The eyelids. 
 
 Aug-enliderarterien. (G.) Arteries of the eyelid. 
 
 Augenliderauswartskehrung. (G.) Eversion of the lid. Ectropion. 
 
 Aug-enliderbalg-geschwulst. (G.) .Cystic tumor of the lid. 
 
 Augenliderbander. (G.) Papebral, or tarsal, ligaments. 
 
 Augenliderbeule. (G.) A furuncle or boil of the eyelid. 
 
 Augenliderbindehaut. (G.) The palpebral conjunctiva. 
 
 Augfenliderbindehautentziindung". (G.) Inflammation of the lining 
 of the lids. Palpebral conjunctivitis. 
 
 Augenliderblinzeln. (G.) Nictitation ; blinking. 
 
 Augenliderbrand. (G.) Carbuncle or gangrene of the eyelid. 
 
 Augenlidercallositat. (G.) Thickening and infiltration, with subse- 
 quent hardening, of the eyelids. 
 
 Aug-enlidercarbunkel. (G.) Carbuncle of the eyelid. 
 
 Augenliderdriisen. (G.) ]\Ieibomiau glands. 
 
 Augenliderdriisenblennorrhoe. ( G.) Inflammation of and discharge 
 froin the Meibomian glands. 
 
 Augenliderdriisenentziindung (G.) Inflammation of and discharge 
 from the ^[eibomian glands. 
 
 Augenlidereinwartskehrung-. (G.) Inversion of the eyelid. Entro- 
 pion. 
 
 Augenliderentziindung. (G.) Inflammation of the eyelids. Ble- 
 pharitis. 
 
 AugfenUder Erkrankungen. (G.) Diseases of the eyelids. 
 
 Aug"enliderexulceration. (G.) Marginal blepharitis. 
 
 Augenliderflechte. (G.) Excoriation of the intermarginal portion of 
 the lids, produced by long-continued lachrymation and discharge 
 from the inflamed conjunctiva. 
 
 AugenUderg-eschwulst. (G.) Tumor or swelling of the eyelids. 
 
 Aug-enlidergeschwiir. (G.) Ulceration of the eyelids. 
 
 Aug-enliderhaare. (G.) The eyelashes. 
 
 Augenliderhalter. (G.) An ophthalmostat, or instrument used to 
 hold the eyelids at rest during an examination of or operation on 
 the eyeball. 
 
 AugenUderhautentziindung. (G.) Inflammation of the skin of the lid. 
 
 Augenliderhirsekorn. (G.) jMeibomian tumor. Chalazion. 
 
 Augenliderknorpel. (G.) Tarsal cartilage. 
 
 AugenUderknorpelverschrumpfung. (G.) Atrophy or wrinkling of 
 the tarsal cartilage. 
 
 Augenliderkrampf. (G.) Spasm of the eyelids. Blepharospasm. 
 
 Augenliderkrankheiten. (G.) Diseases of the eyelids. 
 
 Augenliderkratze. (G.) Blepharitis ulcerosa.
 
 688 AUGENLIDERKRATZER 
 
 Augenliderkratzer. (G.) An instrument for scarifying the palpebral 
 conjunctiva, or other tissues of the eyelid. 
 
 Augenliderkrebs. (G.) Cancer of the eyelid. 
 
 Aug-enliderlahmung. (G.) Paralysis of the muscles of the eyelids. 
 Blepharoplegia. 
 
 Augenliderlausesucht. (G.) Pediculososis of the eyelashes, the para- 
 sites (lice) depositing their eggs at and being attached to the base 
 of the cilia. 
 
 Augenlidernerv. (G.) A nerve supplied to the eyelid. 
 
 Augenliderrand. (G.) Border of the eyelid. 
 
 Augenliderraude. (G.) Irritation and excoriation of the inter- 
 marginal portion of the lids, due to chronic continual lachrymation 
 and discharge from an inflamed conjunctiva. 
 
 Aug-enliderrauhigkeit. (G.) Granular lids. Trachoma. 
 
 Aug-enliderrodem. (G.) Edema of the eyelids. 
 
 Augenliderrose. (G.) Erj-sipelas of the eyelids. 
 
 Augenliderschaffung-. (G.) Relaxed condition of the eyelids. 
 
 Augenliderschleimfluss. (G.) A profuse muco-purulent discharge 
 from the eyelids. 
 
 Augenliderschwiele. (G.) A thickening of the lid skin, sometimes 
 congenital, i^roducing a whitish, indurated, and horny elevation of 
 the surface, with more or less obliteration of the natural lines of the 
 skin and impairment of the sense of touch. 
 
 Augenliderspalte. (G.) Palpebral fissure. 
 
 Augenlidersteinkrankheit. (G.) A disease associated with chalk de- 
 posits (lithiasis) in the tissues of the eyelids. 
 
 Augenlidertriefen. (G.) Inflammation of the palpebral or the Mei- 
 bomian glands. 
 
 Augenlidertripper. (G.) Gonorrheal ophthalmia. 
 
 Augenliderumkehrung, (G.) Eversion of the eyelid. Ectropion. 
 
 Augenliderumlegung. (G.) Eversion of the eyelid. Ectropion. 
 
 Augenliderumstiilpung. (G.) Eversion of the eyelid. Ectropion. 
 
 Augenlidervenen. (G.) The veins of the eyelid. 
 
 Augenliderverknorpelung. (G.) Thickening and infiltration, with 
 subsequent hardening, of the eyelids. Sclerosis of the lids. 
 
 Augenliderverkiirzung. (G.) Retraction of the lids, so that they can- 
 not be closed over the eyeball. This condition is generally due to 
 paralysis of the orbicularis muscle and a lesion of the facial nerve. 
 
 Augenlidervorfall. (G.) Ptosis; paralysis of the levator muscles of 
 the eyelid. Blepharoptosis. 
 
 Augenliderwassergeschwulst. (G.) Edema of the eyelid. 
 
 Augenliderwassersucht. (G.) Edema of the eyelid.
 
 AUGENLIDERWINDGESCHWULST 689 
 
 Aug-enliderwindgeschwulst. (G.) Emphysema of the eyelids. 
 
 Aug-enliderzellgewebsentziindung-. (G.) Inflammatiou of the pal- 
 pebral tissues. 
 
 Augenliderzusammenwachsung'. (G.) Marginal symhlepharon. 
 
 Augenlidfistel- (G.) Fistula of the eyelid. 
 
 Aug-enlidflache. (G.) The surface of the eyelid. 
 
 Augenlidflechte. (G.) Eczema of the eyelid. 
 
 Augenlidfluss. (G.) A discharge from the eyelids. 
 
 Aug'enlidfollikel. (G.) A palpebral follicle. 
 
 Aug-enlidgeschwulst. (G.) Tumor of the eyelid. 
 
 AugenlidgTiffel. (G.) Instrument for separating and holding apart 
 the eyelids. A lid speculum. 
 
 Aug-enlidhaare. (G.) Eyelashes. 
 
 Aug-enlidhaken. (G.) An eyelid retractor or hook, 
 
 Augenlidhalter. (G.) A lid speculum. 
 
 Augenlidhaut. (G.) The skin of the eyelid. 
 
 Augenlidhautentziindung-. (G.) Inflammation of the skin of the eye- 
 lid. 
 
 Aug"enlidhebemuskel. (G.) Levator palpebral. 
 
 Augenlidheber. (G.) The levator palpebral superioris muscle. 
 
 Augenlidinnenflache. (G.) The inner surface of the eyelid. 
 
 Augenlidkante. (G.) The margin of the eyelid. 
 
 Augenlidkarbunkel. (G.) A carbuncle of the eyelid. 
 
 Augenlidklemme. (G.) An eyelid clamp. 
 
 Augenlidknorpel. (G.) Tarsal cartilage. 
 
 Augenlidknorpelband. (G.) Tarsal ligament. 
 
 Augenlidknorpelentartung- (G.) Degeneration of the tarsal car- 
 tilage. 
 
 Augenlidknorpelentziindung. (G.) Inflammation of the tarsal 
 cartilage. 
 
 Augenlidknorpelgeschw^ulst. (G.) A tumor of the tarsal cartilage. 
 
 Augenlidkrampf. (G.) Blepharospasm. 
 
 Augenlidkratz. (G.) Psorophthalmia. 
 
 Augenlidkratzer. (G.) A brush for scarifying the palpebral con- 
 junctiva and lids. 
 
 Augenlidkrebs. (G.) Cancer of the eyelid. 
 
 Augenlidlahmung. (G.) Paralysis affecting the eyelid. Blepharo- 
 plegia. 
 
 Augenlidlinse. (G.) The crystalline lens. 
 
 Augenlidlos. (G.) Afflicted with absence or defect in one or more 
 eyelids. Ablepharus. 
 
 Vol. 1—4 4
 
 690 AUGENLIDLOSIGKEIT 
 
 Augfenlidlosigkeit. (G.) Absence of one or more eyelids. Able- 
 pharia. 
 
 Augenlidmuskel. (G.) A muscle of the eyelid. 
 
 Augenlidmuskellahmnng. (G.) Paralysis of the muscle of the eyelid. 
 
 Augenlidmuskulatur. (G.) Muscular apparatus of the eyelid. 
 
 Augenlidnakt. (G.) Suture of the eyelid. 
 
 Augenlidnerv, (G.) A nerve supplied to the eyelid. 
 
 Augenlidoberflache. (G.) The surface of the eyelid. 
 
 Augenlidodem. (G.) Edema of an eyelid. Blepharcedema. 
 
 Augenlidplatten. (G.) The tarsal plates or cartilages. 
 
 Augenlidrand. (G.) The border of an eyelid, 
 
 Augenlidrandentziindung- (G.) Blepharitis. 
 
 Augenlidranderentziindung. (G.) Blepharitis marginalis. 
 
 Augenlidrandmuskel. (G.) The ciliary portion of the orbicularis 
 palpebrarum. 
 
 Augenlidrandverwachsung. (G.) The adhesion of palpebral margins. 
 
 Augenlidringmuskel Palpebrarum. (G.) Orbicularis palpebrarum. 
 
 Augenlidrinne. (G.) The primary groove of the eyelid. 
 
 Augenlidrose. (G.) Erysipelas of the eyelid. 
 
 Augenlidrunzler. (G.) The corrugator supercilii muscle. 
 
 Augenlidschlag. (G.) Paralysis of a lid muscle. Blepharoplegia. 
 
 Augenlidschlagadern. (G.) Palpebral arteries. 
 
 Augenlidschliesser. (G.) The orbicularis palpebrarum muscle. 
 
 Augenlidschliessmuskel. (G.) Sphincter, constrictor. 
 
 Augenlidschluss. (G.) Closure of eyelids. 
 
 Augenlidschut. (G.) The protection afforded by eyelids. 
 
 Augenlidschwellung. (G.) Swelling of the eyelids. 
 
 Augenlidschwiele. (G.) Thickening of the eyelid. 
 
 Augenlidspalt. (G.) Coloboma of the eyelid. 
 
 Augenlidspalte. (G.) A palpebral fissure. 
 
 Augenlidspaltenenge. (G.) Blepharophimosis ; congenital narrowness 
 of opening between the eyelids. 
 
 Augenlidspaltenverengung- (G.) Contraction of the eye fissure. 
 
 Augenlidstellung. (G.) Position of the eyelid. 
 
 Augenlidtalgdriisenentziindung. (G.) Adenoblepharitis. 
 
 Augenlidtripper. (G.) Gonorrheal ophthalmia. 
 
 Augenlidumkehrung. (G.) Inversion of the eyelid. Ectropion. 
 
 Augenlidunstiilpung. (G.) Inversion, retroversion, reversal. 
 
 Augenlidverdickung. (G.) Infiltration or thickening of the eye- 
 lid. Pachyblepharosis. 
 
 Augenlidverkriimmung. (G.) Distortion of the eyelid. 
 
 Augenlidverlangerung. (G."* Blepharoplastic operation.
 
 AUGENLIDVERWACHSUNG G91 
 
 Aug-enlidverwachsung. (G.) Adhesion of the eyelids. Symble- 
 pharon. 
 
 Augenlidverwachung'. (G.) Syrablepharon. 
 
 Augenlidvorfall. (G.) Ptosis, or drooping of the eyelid. Blepharop- 
 tosis. 
 
 Augenlidwarzen. (G.) A small soft tumor, often pendulous, of 
 areolar or granular structure, occurring on the eyelids and else- 
 where. 
 
 Aug-enlidwinkel. (G.) Canthus. 
 
 Aug-enlidzellgewebsentziindung. (G.) Inflammation of the palpebral 
 cellular tissue. 
 
 Augenlidzerfressen. (G.) Ulceration or erosion of the lids, espe- 
 cially at their angles. 
 
 Augenlied. (G.) Obsolete form of Augeulid, the eyelid. 
 
 Aug-enliedvenen. (G.) Veins of the eyelid. Palpebral veins. 
 
 Aug-enlinse. (G.) Crystalline lens. 
 
 Augenloch. (G.) The pupil. 
 
 Augenloffel. (G.) A cataract spoon. i 
 
 Augenlos. (G.) Without an eye. Eyeless. 
 
 Augenlosigkeit. (G.) Blindness, or the lack of an eye. 
 
 Augenlust. (G.) Delight of the eye. 
 
 Augenmahl. (G.) A mole on the eye or eyelid. 
 
 Augenmangel. (G.) Absence of the eye. Anophthalmia. 
 
 Augenmass. (G.) Eyesight. 
 
 Augenmattigkeit- (G.) Asthenopia. - 
 
 Augenmauslein. (G.) The ocular muscles. 
 
 Augenmerk. (G.) The visual point. Fixation point. 
 
 Augenmesser. (G.) A knife for operating on the eyes. Also, an 
 ophthalmometer. 
 
 Augenmissbildung. (G.) Malformation of the eye. 
 
 Augenmittel. (G.) A remedy used in the treatment of eye diseases. 
 
 Augenmittellehre. (G.) Ophthalmic therapeutics. 
 
 Augenmuskel. (G.) Abductor oeuli, a muscle of the eye, ocular 
 muscle. 
 
 Augenmuskelausserer. (G.) The abducent nerve. 
 
 Augenmuskel Ausserer gerader. (G.) The external rectus muscle. 
 
 Augenmuskelcentren. (G.) Cerebral centres for the ocular muscles. 
 
 Augenmuskel, Innerer gerader. (G.) The internal rectus muscle. 
 
 Augenmuskelkegel. (G.) A cone formed by the ocular muscles orig- 
 inating around the optic foramen. 
 
 Augenmuskelkerne. (G.) Cerebral centres for the eye muscles. 
 
 Augenmuskelkrampf. (G.) Nystagmus.
 
 692 AUGENMUSKELLAHMUNG 
 
 Augenmuskellahmung. (G.) Paralysis of an ocular muscle. 
 Augenmuskellahmung' bei Arteriosklerose, (Gr.) Arteriosclerosis in 
 
 paralysis of the eye muscle. 
 Aug-enmuskellahmung bei Hemiplegia alternans. (G.) Paralysis in 
 
 alternate hemiplegia of the eye muscle. 
 Augenmuskellahmung, Congenitale. (G.) Congenital paralysis of 
 
 the eye muscle. 
 Augenmuskellahmung, Kernlasionen. (G.) Nuclear lesions in paral- 
 ysis of the eye muscle. 
 Augenmuskellahmung, Kopfhaltung. (G.) Position of the head in 
 
 eye-muscle paralysis. 
 Augenmuskellahmung, Periodische. (G.) Periodical paralysis of the 
 
 muscle of the eye. 
 Augenmuskellahmungen. (G.) Paralysis of the eye muscles. 
 Augenmuskellahmungen, Angeborene. (G.) Congenital paralysis of 
 
 an ocular muscle. 
 Augenmuskellahmungen bei Tabes. (G.) Eye-muscle paralysis in 
 
 tabes. 
 Augenmuskellahmungen, Centrale oder cerebrale. (G.) Central or 
 
 cerebral eye-muscle paralysis. 
 Augenmuskellahmungen, Conjugirte. (G.) Conjugate eye-muscle 
 
 paralysis. 
 Augenmuskellahmungen, Fasiculare. (G.) Fasicular eye-muscle 
 
 paralysis. 
 Augenmuskellahmungen, Hyterische- (G.) Hysterical eye-muscle 
 
 paralysis. 
 Augenmuskellahmungen, Latente. (G.) Latent paralysis of an eye 
 
 muscle. 
 Augenmuskellahmungen, Peripherische. (G.) Peripheral paralysis of 
 
 the muscle of the eye. 
 Augenmuskellahmungenschwindelgefiihl. (G.) The sensation of diz- 
 ziness in eye-muscle paralysis. 
 Augenmuskellahmungensymptome. (G.) The symptoms in eye- 
 muscle paralysis. 
 Augenmuskeln. (G.) The ocular muscles. 
 Augenmuskelnentziindung. (G.) Inflammation of the eye muscles. 
 
 Ocular myositis. 
 Augenmuskelnerv, Oberer. (G.) The trochlear nerve. 
 Augenmuskelnkerne. (G.) The nucleus of the muscles of the eye. 
 Augenmuskelnnerven. (G.) The nerve supply of the ocular muscles. 
 Augenmuskelnphysiologie. (G.) Physiology of the eye muscles.
 
 AUGENMUSKELNSCHLAGADERN 693 
 
 Augenmuskelnschlagadern. (G.) The arteries supplied to the 
 ocnlar muscles. 
 
 Augenmuskel, Oberer gerader. (G.) The superior rectus muscle. 
 
 Augenmuskel, Oberer schiefer. (G.) The superior obliipie muscle. 
 
 Aug-enmuskel, Unterer gerader. (G.) The inferior rectus muscle. 
 
 Augenmuskel, Unterer schiefer. (G.) The inferior oblique muscle. 
 
 Augennadel. (G.) A needle used in operating on the eye, espe- 
 cially on cataract. 
 
 Augennagel. (G.) Pterygium. 
 
 Augennasenfurche. (G.) The oculo-nasal groove running in the 
 embryo from the eye to the olfactory pit. 
 
 Augennebel. (G.) Opacity of the cornea. Leucoma. 
 
 Augenneiv. (G.) An ocular nerve; any nerve supplied to the eye 
 or its appendages. 
 
 Augennervenknoten. (G.) Ciliary ganglion. 
 
 Augennicht. Augennichts. (G.) Zinc oxide; used as an application 
 to the eyes. 
 
 Augenpein. (G.) Pain in the eye. 
 
 Augenpest. (G.) Contagious conjunctivitis. Epidemic ophthalmia. 
 
 Augenpflege. (G.) Hygiene or care of the eyes. 
 
 Augenphantom. (G.) A mask for demonstrating or practising oper- 
 ations on the eye. 
 
 Augenphthise. (G.) Atrophy of the eyeball. 
 
 Augenpigment. (G.) The coloring matter of the ocular tissues. 
 
 Augenpincette. (G.) A forceps for grasping the eye or parts of it. 
 
 Augenpol. (G.) The ocular pole. 
 
 Augenpulsader. (G.) The ophthalmic artery. 
 
 Augenpulver. (G.) Powder used in treating the eye^ or its diseases. 
 
 Augenpunkt. (G.) The visual or fixation point. 
 
 Augenreiz. (G.) An irritant of the eye; tickling of the eye. 
 
 Augenreizung. (G.) Irritation of the eye. 
 
 Augenring. (G.) The pupil. 
 
 Augenringmuskel. (G.) Orbicularis palpebrarum. 
 
 Augenrinnen. (G.) Tearing or watering of the eye. Epiphora. 
 
 Augenrollmuskel. (G.) The trochlear muscle of the eye. 
 
 Augenrose. (G.) Erysipelas of the eye or its appendages. 
 
 Augenrothe. (G.) Xerophthalmia. 
 
 Augensalbe. (G.) An eye-salve. 
 
 Augensalbeblei. (G.) Lead ointment for the eye. 
 
 Augensalbebor. (G.) Boracic ointment for the eye. 
 
 Augensalbe, Gelbe prazipitat. (G.) Precipitate (yellow) eye ointment, 
 
 Augensalbeichthyol. (G.) Ichthyol ointment for the eye.
 
 694 AUGENSALBEKUPFER 
 
 Augensalbekupfer. (G.) Copper ointment for the eye. 
 
 Augensalben. (G.) Eye ointments. 
 
 Augensalberesorzin. (G.) Resorein ointment for the eye. 
 
 Aug-ensalbesalizyl. (G.) Salicylic ointment for the eye. 
 
 Aug-ensalbe unguentmndiachyli. (G.) Diachylon ointment for the 
 eye. 
 
 Augensalbe weisse prazipitat. (G.) Precipitate white ointment for' 
 the eye. 
 
 Aug-ensalbezink. (G.) Zinc ointment for the eye. 
 
 Augensalbe, Zusammengesetzte. (G.) Unguentum ophthalmicum 
 comp. 
 
 Augenscalpell. (G.) A scalpel used upon the eye, 
 
 Augenschau. (G.) Ophthalmoscopy. 
 
 Aug-enscheeren. (G.) Scissors used upon the eye. 
 
 Augenschere. (G.) Eye-scissors. 
 
 Augenschirm. (G.) A screen or shade for the eyes. 
 
 Augenschlagader. (G.) Ophthalmic artery. 
 
 Augenschleim. (G.) IMucous discharge from the eye. 
 
 Augenschleimfluss. ( G.) Discharge from the eye. 
 
 Augenschleimhaut. (G.) Conjunctiva ; ocular mucus membrane. 
 
 Augenschliesser. (G.) Orbicularis palpebrarum. 
 
 Augenschmalz. (G.) Ocular discharge. 
 
 Augenschnierz. (G.) Pain in the eyes. 
 
 Augenschminke. (G.) A cosmetic for coloring the eyebrows. 
 
 Augenschnupfen. (G.) Catarrhal discharge from the lids or eyes. 
 
 Augenschnupftabak. (G.) A pulverized (snuff-like) application for 
 the eyes. 
 
 Augenschropfeu. (G.) Scarification of the palpebral conjunctiva. 
 
 Augenschropfer. (G.) An instrument for scarifying the conjunctival 
 surface of the eyelids. 
 
 Augenschutz. (G.) Protection of the eye. 
 
 Augenschiitzer. (G.) An eye-shade or shield. 
 
 Augenschwache. (G.) Asthenopia. 
 
 Augenschwamm. (G.) A sponge for use upon the eyes; more com- 
 monly a fungus growth of the eye. 
 
 Augenschwarz. (G.) The black pigment, melanin (C26H13N), in the 
 chorioid and the skin of brunettes and negroes in particular. 
 It is found pathologically in the blood, where it constitutes the con- 
 dition known as melanemia and melanosis. The pigment is in- 
 soluble in water, alcohol, ether, chloroform, or carbon disulphide, 
 but is dissolved by solution of potassium hydrate. It is probably a 
 transformation product of hematin.
 
 AUGENSCHWIELE 695 
 
 Augenschwiele. (G.) Pachyblepliaroii. 
 
 Augenschwindel. (G.) An asthenopic symptom-complex of headache 
 Avitli vertigo and impairment of vision. 
 
 Augenschv/inden. (G.) Atrophy of the eyeball; a phthisis bulbi. 
 
 Aug-enschwund. (G.) Atrophy of the eyeball. 
 
 Augenscirrhus. (G.) Scirrhns cancer of the eye. 
 
 Augenseife. (G.) An eye soap. 
 
 Augenseuche. (G.) Contagious eye-disease affecting the eyes of the 
 lower animals. 
 
 Augensichel. (G.) A name proposed by Kraus for the blepharomet- 
 rum of Buzzi. 
 
 Augensieb. (G.) An eye shade or protector made of black hair- 
 cloth, and used by the Tartars. 
 
 Augenspalt. (G.) Coloboma of the eyelid. 
 
 Augenspalte. (G.) Ocular fissure. 
 
 Augenspalte, Untere. (G.) Spheno-maxillary fissure. 
 
 Augensperre. (G.) Obliteration or closure of the pupil. 
 
 Augenspiegel. (G.) An ophthalmoscope. 
 
 Augenspiegelbefund. (G.) The result of ophthalmoscopic exami- 
 nation. 
 
 Augenspiegelbild. (G.) The ocular fundus appearances as seen with 
 the ophthalmoscope. 
 
 Augenspiegel, Binocularer. (G.) A binocular ophthalmoscope. 
 
 Augenspiegeldemonstrations. (G.) Demonstrations of the ophthal- 
 moscope. 
 
 Augenspiegel, Elektrischer. (G.) An electric ophthalmoscope. 
 
 Augenspiegelergebnis or Spiegelbefund. (G.) The result of exami- 
 nation by the ophthalmoscope. 
 
 Augenspiegeluntersuchung. (G.) An ophthalmoscopic examination. 
 
 Augenspies. (G.) An ophthalmostat, for steadying the eyeball dur- 
 ing an examination. 
 
 Augenspritze. (G.) An eye-syringe. 
 
 Augensprosse. (G.) The optic vesicle. 
 
 Augenstaar. (G.) Cataract. 
 
 Augenstaarkrampf. (G.) Spasm of the eye. 
 
 Augenstaupe. (G.) Ophthalmia epizootica. 
 
 Augenstechen. (G.) Pricking or shooting pains in the eyes; reclina- 
 tion of cataract. 
 
 Augenstein. (G.) A name given both to a dacryolith and lapis- 
 divinus (q. v.). 
 
 Augenstellung. (G.) Position of the eye. 
 Augenstern. (G.) The pupil.
 
 698 AUGENSTERNERWEITERUNG 
 
 Aug-ensternerweiterung. (G.) Dilatation of the pupil. 
 
 Augensternhaut. (G.) Pupillary membrane. 
 
 Augensternverengerung. (G.) Contraction of the pupil. 
 
 Augenstich. (G.) Paracentesis oculi. 
 
 Augelstiel. (G.) Optic peduncle. 
 
 Augenstreupulver. (G.) Dusting powder for the eye. 
 
 Augensymptome. (G.) Eye symptoms. 
 
 Augentabak. (G.) An eye-snuff, or powder for applying to the eye. 
 
 Augentalg. (G.) Secretion on or from the lid margins. 
 
 Augentauschung. (G.) An optical illusion. 
 
 Augenthranen. (G.) Epiphora. 
 
 Augentriefen. (G.) An irritating discharge from the eyes. 
 
 Augentriefen an den Lidecken. (G.) A morbid discharge from the 
 corner of the eye. 
 
 Augentriefen des hohen Alters. (G.) A discharge from the eyes of 
 old people. 
 
 Augentriefig. (G.) Blear-eyed. 
 
 Augentripper. (G.) Gonorrheal ophthalmia; purulent conjunctivitis. 
 Blennophthalmia. 
 
 Augentrockenheit. (G.) Xerophthalmia. 
 
 Augentropfen. (G.) Eye-drops or lotion. 
 
 Augentropfglas. (G.) A bottle with pipette for eye-drops, 
 
 Augentropfwasser. (G.) Collyrium, eye-drops. 
 
 Augentrost. (G.) Euphrasia officinalis. The plant eyebright. 
 
 Augeniibel. (G.) Ophthalmia. 
 
 Augeniiberanstrengung. (G.) Overstraining of the eye. 
 
 Augenumkehrung. (G.) Ectropion. 
 
 Augenumstiilpung. (G.) Eversion of the eyelids. 
 
 Augenvene. (G.) Ophthalmic vein. 
 
 Augenverband. (G.) Eye bandaging; eye dressing, eye bandage. 
 
 Augenverbande. (G.) Eye bandages. 
 
 Augenverbrennung. (G.) A burn of the eye. 
 
 Augenverdrehen. (G.) Rolling and turning up of the eyes. 
 
 Augenverdunkelung. (G.) Amaurosis, or amblyopia. 
 
 Augenvereiterung. (G.) Suppuration of the eye. 
 
 Augenvergrosserung. (G.) Enlargement of the eyeball. 
 
 Augenverknocherung. (G.) Ossification of any part of the ocular 
 tissues. 
 
 Augenverletzung. (G.) Injury to the eye or its appendages. 
 
 Augenverletzungen. (G.) Eye injuries. 
 
 Augenverletzungen, Begntachtung. (G.) A formal opinion in eye in- 
 jury- 
 
 Augenverletzungen, Prophylaxe. (G.) Prophlaxis in eye injury.
 
 AUGENVORFALL 697 
 
 Aug-envorfall. (G.) Protrusion of the eyeball. Exophthalmia. 
 Augenwannchen. (G.) A cup or other vessel for bathing the eyes. 
 Aug-enwanne. (G.) Bath for the eye. 
 
 Aug-enwaschwasser. (G.) An eye lotion. 
 
 Aug-enwasser. (G.) A liquid collyrium, or eye-water. 
 
 Augenwasser. Eye waters. These were and are called coUyria, a 
 collyrium originally meaning ''dough" or "cake," i.e. a medica- 
 ment formed by the kneading together of several substances, which, 
 when dissolved in water, were dropped into the eye, and used for 
 irrigating, as eye-washes, eye-waters, eye-douches, and as com- 
 presses. 
 
 Augenwasserartige. (G.) Aqueous humour. 
 
 Augenwasserfluss. (G.) Ocular discharge. 
 
 Augenwassersucht. (G.) Ilydrophthalmia. 
 
 Augenweh. (G.) Pain in the eyes. 
 
 Augenweiss. (G.) The sclera or white of the eye. 
 
 Augenweite. (G.) The visual distance. 
 
 Augenwelle. (G.) The optic axis. 
 
 Augenwimmer. (G.) An eyelash. 
 
 Augenwimper. (G.) Eyelashes. 
 
 Augenwimperdriisen. (G.) Meibomian glands. 
 
 Augenwimperlocherchen. (G.) The follicle into which the eyelash 
 is set. 
 
 Augenwimpern. (G.) Eyelashes. 
 
 Augenwimpernausf alien. (G.) Falling out of the eyelashes. 
 
 Augenwimpernpimkte. (G.) Puncta ciliaria. 
 
 Augenwimpernverlust. (G.) Loss of eyelashes. 
 
 Augenwimperrander. (G.) The margins of the eyelids. 
 
 Augenwindung. (G.) Frontal convolution. 
 
 Augenwink. (G.) A wink. 
 
 Augenwinkel. (G.) Canthus or angle of the lids. 
 
 Augenwinkelabscess. (G.) Abscess at one of the ocular canthi. 
 
 Augenwinkelarterie. (G.) Angular artery. 
 
 Augenwinkelbander. (G.) The tarsal ligaments. 
 
 Augenwinkelblutader. (G.) Angular vein. 
 
 Augenwinkelentziindung. (G.) Inflammation at one of the ocular 
 canthi. 
 
 Augenwinkelfrass. (G.) Ulceration or erosion of the eyelids, espe- 
 cially at the canthi. 
 
 Augenwinkelgeschwulst. (G.) A tumor at an ocular canthus. 
 
 Augenwinkelgeschwiir. (G.) An abscess of the lachrymal sac. 
 Aegilops.
 
 698 AUGENWINKELPULSADER 
 
 Augenwinkelpulsader. (G.) Angular artery. 
 
 Augenwinkelschlagader. (G.) Angular artery. 
 
 Aug-enwinkelschnitt. (G.) Canthotomy. 
 
 Augenwinkelunreinig-keit. (G.) The whitish discharge (sebumej 
 found at the angles of the eyes after sleep. 
 
 Aug-enwinkelvereiterung-. (G.) Lachrymal abscess. 
 
 Aug-enwinkelzache. (G.) Those fibres of the occipito-frontalis muscle 
 that run towards and are attached near the inner canthus and at 
 the side of the nose. 
 
 Aug-enwinken. (G.) Winking of the eyelids or eyes. 
 
 Augenwolk. (G.) Nebula corne^e. 
 
 Aug'enwolkchen. (G.) A pterygium; an opacity of the cornea. 
 
 Augenwolklein. (G.) A pterygium; an opacity of the cornea. 
 
 Aug-enwunde. (G.) Wound of the eye. 
 
 Augenwurzel. (G.) Dandelion or valerian root. 
 
 Augenzahn. (G.) Canine or eye-tooth. 
 
 Augenzergliederimg. (G.) An obsolete term for an anatomical dis- 
 section of the eye ; also enucleation. 
 
 Augenzeugnis. (G.) Ocular proof. 
 
 Augenzirkel. (G.) The iris. 
 
 Augenzittern. (G.) Nystagmus. 
 
 Augenzucken. (G.) Nystagmus. 
 
 Augenzuckung. (G.) Nystagmus. 
 
 Augenzwiebel. (G.) Eyeball. 
 
 Augenzwischenraum. (G.) The space between the eyes. 
 
 Auginos. (L.), m.n. An old name for hyoscyamus. 
 
 Auglein. (G.) A little eye. 
 
 Augsburg eye balsam. A mixture containing 3 parts of red oxide of 
 mercury, 2 each of extract of belladonna and tincture of opium, with 
 28 of some fatty excipient. 
 
 Auramine, Oculo-toxic symptoms from. Auramine is a synonym of 
 yellow pyoktanin. Patients to whom this aniline derivative was 
 administered developed yellow vision [xanthopsia (q. v.)], which 
 in several instances lasted half an hour. Blue vision never 
 occurred. 
 
 Aurantia. A stain used in histology, and not uncommonly in conjunc- 
 tion with eosin. See Histology of the eye. 
 
 Aura, Ophthalmic. Any ocular symptom that precedes a disease or 
 paroxysm, as in migraine or epilepsy. A scintillating scotoma, for 
 example, sometimes ushers in attacks of "sick headache." 
 
 Aureola, (a) In astronomy, the ring of light seen around the moon 
 in total eclipses of the sun. (b) In meteorology, a kind of halo sur-
 
 AUREOLE 699 
 
 rounding a shadow cast upon a cloud or fog-l)aiik or dew covered 
 grass; often observed by aeronauts on llic uijpcr suffaee of clouds. 
 Also called "glory." 
 
 Aureole. A luminous emanation or cloud surrounding a figure or an 
 object; an aureola. 
 
 Auric chloride. See Gold chloride. 
 
 Auri et sodii chloridum. Gold and sodium chloride. In Germany this 
 remedy (probably only a mixture of the two chlorides) is occasion- 
 ally used as an eyewash. 
 
 Sodii boratis 0.5 (g. vii) 
 
 AquEe destillatse 20.0 (fov, mviij) 
 
 Auri et sodii chlor. 0.0;J (gr. -%()). 
 
 To be instilled twice daily in cases of simple conjunctivitis. 
 
 Ausadern. (G.) To dissect or draw out the veins. 
 
 Ausarbeitung. (G.) Elaboration. 
 
 Ausart. (G.) To degenerate ; degeneration, degeneracy. 
 
 Ausarten. (G.) To degenerate. 
 
 Ausartung". (G.) Degeneration. 
 
 Ausatzen. (G.) To cauterize, or destroy by caustics. 
 
 Ausatzung. (G.) Cauterization. 
 
 Ausbaden. (G.) To bathe out; to bathe enough. 
 
 Ausbahen. (G.) To dry up, to dry. 
 
 Ausbauchen. (G.) To swell, or to bulge out. 
 
 Ausbauchung. (G.) Swelling or bulging out; protuberance. 
 
 Ausbeizen. (G.) To remove by corrosives or caustics; to eat out. 
 
 Ausbilden. (G.) To form, to develop. 
 
 Ausbildung. (G.) Development, formation. 
 
 Ausbluten. (G.) To cease bleeding. 
 
 Ausbrauchen. (G.) To use up, to consume. 
 
 Ausbreitung. (G.) Spread, extension, diffusion. 
 
 Ausbrennen. (G.) To apply actual cautery; to destroy by cautery; 
 to cauterize. 
 
 Ausbruch. (G.) Eruption. 
 
 Ausbuchten. (G.) To form a sinus; diverticulum or pouch. 
 
 Ausbuchtung. (G.) Excavation, sinus, diverticulum, pouch, bulging. 
 
 Auscultation, Ocular. This method of examination is mainly 
 employed in connection with pulsating exophthalmos (q. v.). A 
 rushing sound is heard, with the stethoscope or ear alone, over the 
 closed eyelid, at the temple, on the forehead, and frequently over 
 the entire corresponding half of the skull, the bruit being synchron- 
 ous with the arterial pulse. At first it seems to be a distinctly
 
 700 AUSDAMPFEN 
 
 intermittent sound, but close attention usually reveals even during 
 the supposed pauses a continual buzzing or hissing. There is occa- 
 sionally, mingled with this buzzing, a whistling tone, which is heard 
 at irregular intervals, and which is probably caused by temporary 
 acceleration of the pulse. The noises may be diminished or stopped 
 entirely by compression of the common carotids on each side. 
 
 As a result of aneurysm of the basal cerebral artery-vessels, arte- 
 rial murmurs can also be demonstratedv They further occur, 
 though rarely, in cases of pressure on the basal vessels by tumors, 
 and even in highly vascular cerebral tumors themselves. The early 
 appearance of the vascular murmurs would probably indicate 
 aneurysm rather than tumor ; however, it must be remembered that 
 anemic noises caused by circulatory anomalies in the carotids may, 
 by conduction, be heard in the head — a fact that should be con- 
 sidered in the auscultatory diagnosis of these diseases. 
 
 Ausdampfen. (G.), intr.v. To evaporate. 
 
 Ausdauer. (G.) Perseverance; holding out. 
 
 Ausdauern. (G.) To endure, to hold out. 
 
 Ausdehnbar. (G.) Dilatable, distensile, elastic. 
 
 Ausdehnbarkeit. (G.) Dilatability, extensibility. 
 
 Ausdehnen. (G.) To dilate, distend, stretch. 
 
 Ausdehnswerkzeug-. (G.) A dilating apparatus. 
 
 Ausdehnung-. (G.), n. Extension, expansion. 
 
 Ausdehnungsfahigkeit. (G.) Dilatability, extensibility. 
 
 Ausdehimngskraft. (G.) Elasticity, dilatability. 
 
 Ausdehnungsvermogen. (G.) Faculty, ability, capability, power, 
 capacity. 
 
 Ausdehnungswerkzeug. (G.) A dilating apparatus, a dilator. 
 
 Ausdrangen. (G.) To squeeze or press out. 
 
 Ausdruck. (G.) Expression. 
 
 Ausdriicken. (G.) To express, to squeeze or force out. 
 
 Ausdrucksmittel. (G.) Means of expression. 
 
 Ausdulden. (G.) To endure suffering; to suffer to the end; to suffer 
 without consideration. 
 
 Ausdiinstung. (G.) Perspiration, transpiration. 
 
 Ausdiinstungsmesser. (G.) A hygrometer. 
 
 Auseinanderfahren. (G.), intr. v. To diverge, as of light rays. 
 
 Auseinanderlaufend. (G.) Divergent. 
 
 Auseinanderweichen. (G.) To separate. 
 
 Auseitern. (G.) To suppurate, to cease suppurating. 
 
 Ausfall. (G.) A falling out, prolapse. 
 
 Ausf alien. (G.) To fall out.
 
 AUSFLIESSEN 701 
 
 Ausfliessen. (G.) To flow out, to run. 
 
 Ausfluss. (G.) A discharge, flowing or running out. 
 
 Ausflussmengfe. (G.) The amount discharged. 
 
 Ausflussstrahl. (G.) A jet, stream. 
 
 Ausforschen. (G.) To explore, to investigate. 
 
 Ausforschung. (G.) Exploration, investigation. 
 
 Ausfrieren. (G.) Congelation; to congeal. 
 
 Ausftihren. (G.) To evacuate, to purge. 
 
 Ausfiihrend. (G.) Evacuant, excretory, purgative. 
 
 Ausfiihrlich. (G.) Detailed, circumstantial. 
 
 Ausfiihrung. (G.) Evacuation, excretion. 
 
 Ausfiihrungsgang. (G.) The excretory duct. 
 
 Ausfiihrungsmittel. (G.) A purgative. 
 
 Ausgang. (G.) Outlet, termination. 
 
 Ausgangstheil. (G.) Emunctory, region of outlet. 
 
 Ausgaren. (G.) To ferment, to cease fermenting. 
 
 Ausgebreitet. (G.) Difliuse, scattered. 
 
 Ausgebuchete. (G.) Excavated, pouched, sinous. 
 
 Ausgedehnt. (G.) Dilated, difl:"used, widely spread, extensive. 
 
 Ausgefressen. (G.) Eroded, corroded. 
 
 Ausgehohlt. (G.) Excavated, hollowed out. 
 
 Ausgepragt. (G.) Well developed. 
 
 Ausgepresst. (G.) Squeezed out, expressed. 
 
 Ausgesprochen. (G.) Pronounced, marked, decided. 
 
 Ausgetragen. (G.) Mature. 
 
 Ausgetreten. (G.) Extra vasated. 
 
 Ausgiessung. (H.) Effusion. 
 
 Ausgieichswiderstand. (G.) Compensating resistance. 
 
 Ausgleichung. (G.) Compensation. 
 
 Ausgleichungsstromung. (G.) Compensatory current. ■ 
 
 Ausguss. (G.) Effusion. 
 
 Aushalten. (G.) To hold out, to bear, to sustain, to endure. - 
 
 Aushauchung. (G.) Exhalation, expiration. 
 
 Ausheilen. (G.) To cure completely, to heal up. 
 
 Ausheilung. (G.) A complete cure. 
 
 Aushilfsmittel. (G.) House remedies, a temporary or make-shift 
 
 remedy or appliance. 
 Aushohlung. (G.) Excavation, hollow. 
 Ausjammern. (G.) Ceased to lament, through lamenting. 
 Auskeimen. (G.) To germinate, to cease germinating. 
 Auskernen. (G.) To enucleate. 
 Auskernung. (G.), n. Enucleation.
 
 702 AUSKLAREN 
 
 Ausklaren. (G.) To clear up, to make clear. 
 Auskleiden. (G.) To cover, to line. 
 
 Auskleidung". (G.) A covering, lining, lining membrane. 
 Auskranken. (G.) To cease grieving. 
 Auskratzen. (G.) To scrape or scoop out, to curette. 
 Auskratzen bei Trachom. (G.) To scrape out, or curetting in tra- 
 choma. 
 Auskratzung-. (G.) Erasement, scraping out, curetting. 
 Auskultation. (G.) Auscultation. 
 Auskultationsbefund. (G.) The result of auscultation. 
 Auskultationserscheinung. (G.) Auscultation phenomenon. 
 Auskultationslehre. (G.) The science of auscultation. 
 Ausleeren. (G.) To empty. 
 Ausleerungsmittel. (G.) A purgative. 
 Ausleiden. (G.) To cease to suffer. 
 
 Auslosung. (G.) Setting free, disarticulation, enucleate, to loosen. 
 Ausliiften. (G.) To air, to ventilate. 
 Ausliiftung. (G.) Airing, ventilation. 
 Ausmeisseln. (G.) To gouge, or chisel out. 
 Ausnehmung-. (G.), n. Extraction. 
 Auspinseln. (G.) To brush out, to brush in the inside. 
 Ansplatzen. (G.) To rupture, to burst. 
 Auspressen. (G.) To squeeze out, to express. 
 Ausprung. (G.) Scab, crusta lacta. 
 Ausqualmen. (G.) To cease smoking. 
 Ausquetschen. (G.) To squeeze out, to crush out. 
 Ausraumen. (G.) To empty. 
 
 Ausraumung der Orbita. (G.) Evisceration of the orbit. 
 Ausrenken. (G.) To dislocate. 
 Ausrotten. (G.) To eradicate, to extirpate. 
 Ausrupfen der Haare. (G.) Epilation. 
 Aussacken. (G.) To become sacculated, to bulge. 
 Aussackung. (G.) Sacculation, bulging, diverticulation. 
 Aussauern. (G.) To remove or extract acidity. 
 Aussaugen. (G.) Exsuction. 
 Ausschaben. (G.) To scrape out. 
 Ausschabung. (G.) A scraping out. 
 Ausschalbar. (G.) Capable of enucleation or resection. 
 Ausschalen. (G.) To enucleate, to extirpate, to resect. 
 Ausschalung des Auges. (G.) Enucleation of the eyeball. 
 Ausscheiden. (G.) To secrete, to excrete, to eliminate, to extract. 
 Ausscheidung. (G.) Secretion, excretion, disassimilation.
 
 AUSSCHLAG 703 
 
 Ausschlag. (G.) Eruption, breaking-out, efforescence, exanthem rash, 
 
 Ausschlauchen. (G.) To cleanse with a rubber tube irrigator. 
 
 Ausschliessen. (G.) To exclude. 
 
 Ausschliesslich. (G.) Exclusive, exclusively. 
 
 Ausschliessung. (G.) Exclusion, 
 
 Ausschneiden. (G.) To exercise, to cut out, to extirpate. 
 
 Ausschneiden des Auges. (G.) Excision of the eyeball. 
 
 Ausschnitt. (G.) A notch. 
 
 Ausschwaren. (G.) To remove by suppuration, 
 
 Ausschv^^itzen. (G,) To exude. 
 
 Aussehen. (G.) Appearance, looks. 
 
 Ausseihen. (G.) To filtrate, to filter, to strain. 
 
 Aussen. (G.) External, outside. 
 
 Aussenblutung. (G.) External hemorrhage. 
 
 Aussenfalte. (G.) The external fold. 
 
 Aussenflache. (G.) External surface. 
 
 Aussenscheide. (G.) External sheath. 
 
 Aussenschicht. (G.) Extt^rnal layer. 
 
 Aussenseite. (G.) Exterior, outside. 
 
 Aussentemperatur. (G.) External temperature. 
 
 Aussenwinkel. (G.), n. External canthus or angle. 
 
 Aussere. (G.) External, exterior, outer, outward, 
 
 Ausserer Augenmuskelnerv. (G.) The sixth cranial nerve. 
 
 Ausserlich. (G.) Exterior, external, outward. 
 
 Ausserste. (G.) Outmost, extremely. 
 
 Aussetzen. (G.) To intermit, to pause, to stop. 
 
 Aussetzend. (G.) Intermittent, intermitting. 
 
 Aussetzung. (G.) Exposure, intermission. 
 
 Aussonderend. (G.) Secretory, excretory. 
 
 Aussondern. (G.) To secrete, to excrete, to eliminate. 
 
 Aussonderung. (G.) The act of secretion, excretion, elimination. 
 
 Ausspanner. (G.) The extensor muscle, or tensor muscle. 
 
 Ausspannung. (G.) Distension, relaxation. 
 
 Aussparung der Macula. (G.) Dilated or free opening of the macula. 
 
 Ausspritzen. (G.) To wash or cleanse by syringing, to syringe, to 
 inject. 
 
 Ausspritzend. (G.) Ejaculatory. 
 
 Ausspritzung. (G.) Ejaculation, spirting out. 
 Ausspritzungsgang. (G.) Ejaculatory duct or canal. 
 Ausspritzungskanal. (G.) The syringing of a canal or channel. 
 Ausstossung. (G.) Elimination. 
 Ausstrahlen. (G.) To radiate.
 
 704 AUSSTRAHLUNG 
 
 Ausstrahlung. (G.) Radiation. 
 
 Ausstrecken. (G.) To stretch, to disteud, to extend. 
 
 Ausstrecker. (G.) The tensor or extensor muscle. 
 
 Ausstreckmuskel. (G.) The tensor or extensor muscle. 
 
 Ausstreckung. (G.) Extension, stretching, distension. 
 
 Ausstiilpen. (G.) To cause to protrude, to bulge, to extrovert. 
 
 Ausstiilpung. (G.) Protrusion, diverticulum, extroversion. 
 
 Austamponieren. (G.) To place a tampon. 
 
 Austastung. (G.) The act of palpation. 
 
 Austernschalen-Keratitis. (G.) Oyster-opener's keratitis. Oyster- 
 
 shucker 's keratitis. 
 Austernvergiftung. (G.) Poisoning by oysters. 
 Austilgen. (G.) To obliterate, to extirpate, to destroy. 
 Austilgung. (G.) Obliteration, extirpation, destruction. 
 Austreten. (G.) To protrude, to extravasate. 
 Austretung. (G.) Extravasation, protrusion. 
 Austritt. (G.) Extravasation, protrusion. 
 Austrittsstelle. (G.) Place or point of exit. 
 Austrocknen. (G.) To dry up, to exsiccate, to become dry. 
 Austrocknend. (G.) Exsiccant, desiccant, parching. 
 Austrocknung. (G.) Exsiccation, desiccation. 
 Austupfen. (G.) To cleanse, to remove by sponging or mopping. 
 Ausiiben. (G.) To practice. 
 Ausiibung. (G.) Practice, exercise. 
 Auswangen. (G.) To force out. 
 Auswarts. (G.) Outwards. 
 
 Auswartsdrehen. (G.) To supinate, to turn outwards. 
 Auswartsdreher. (G.) The supinator muscle. 
 Auswartsdrehung. (G.) Supination. 
 Auswartsgehen. (G.), n. E version. 
 Auswartskehrung. (G.) E version. 
 Auswartsroller. (G.) A rotator outwards. 
 Auswartsrollung. (G.) A rotating outwards. 
 Auswartsschielen. (G.) Divergent strabismus. 
 Auswartswendung. (G.) Extroversion, a turning outwards. 
 Auswartszieher. (G.) The abductor muscle. 
 Auswartszieher des Augapfels. (G.) The external rectus muscle of 
 
 the eye. 
 Auswaschen. (G.) To wash out, to irrigate, to cleanse. 
 Ausweichung. (G.) Migration. 
 Ausweiden. (G.), tr.v. To eviscerate. 
 Ausweidung. (G.), n. Evisceration or exenteration.
 
 AUSWEIDUNG DER AUGENHOHLE 
 
 705 
 
 Ausweidung der Augenhohle. (G.) Exenteration of the orbital con- 
 tents. 
 
 Ausweidung- des Augapfels. (G.) Evisceration of the eyeball. 
 
 Ausweiten. (G.) To dilate. » 
 
 Auswendig. (G.) Ontside, external, outward. 
 
 Auswischen. (G.) To wipe out, to sponge out. 
 
 Auswuchs. (G.) Excrescence, apophysis. 
 
 Auswurfstoff. (G.) Excretion, ejected matter. 
 
 Auszehren. (G.) To consume, to waste slowly. 
 
 Auszehrung. (G.) Consumption, tuberculosis, phthisis. 
 
 Auszehrungskrankheit. (G.) A wasting disease, consumption. 
 
 Auszeihung. (G.) Extraction. 
 
 Auszeihungsversuch. (G.) Attempted extraction. 
 
 Ausziehen. (G.), tr.v. To extract. 
 
 Auszug. (G.) Extract, decoction, essence, infusion. 
 
 Autoclave. A form of sterilizer. See Hospitals, Equipment of. 
 
 Autocytotoxins. Cytotoxins produced in the body of the individual 
 whose organs secreted them. 
 
 Auto-enucleation of the eye. See Automutilation, Ocular. Also, 
 Avulsio bulbi. 
 
 Autofundoscope. An ophthalmoscope for the self-examination of the 
 fundus oculi. See Auto-ophthalmoscope. 
 
 Autoglas. A trade name for an eye protector made to conform to 
 the shape of the face and nose, so that dust and wind are excluded. 
 
 Autoglas. 
 
 This type of goggles is made entirely of glass, except for a hinged 
 center-piece and the temples. The hinged center-piece, in connec- 
 tion with four different curves of the margins of the lenses, allows 
 exact adjustment to the contour of the individual facial require- 
 ments. It is ground with an inner curve of 6 dioptres and may 
 
 Vol. 1—4 5
 
 706 AUTOGONIE 
 
 be ordered either plane or with the wearer's refractive error cor- 
 rected. It appears on the market in various tints: white, light 
 amber, dark amber and smoke. It is not only of use for motorists, 
 but may with advantage be used by patients requiring complete 
 protection from wind, dust, sunlight, etc. (C. F. Hubbard.) 
 
 Autogonie. (G.) Spontaneous generation. 
 
 Autointoxication. A self -poisoning (occasionally giving rise to eye 
 symptoms) in consequence of the absorption of noxious products of 
 a defective or disturbed metabolism. The character, the composi- 
 tion of the numerous poisons that must be incriminated with pro- 
 ducing some of the ocular disorders herein specified remain 
 for the present unknown or at least undefined; hence no specific 
 (with the exception of a few of the bacterial toxemias), antitoxic 
 treatment can, in the obscurity of our present-day knowledge, be 
 instituted. The source, on the other hand, and the manifestations 
 of these toxins are very well understood, hence a large and success- 
 ful field remains for causal and symptomatic therapy. 
 
 de Schweinitz and Fife {Ophthalmic Y ear-Book, 1909, p. 184) 
 contend that although there is no ocular disease known to be due 
 to intestinal auto-intoxication, and laboratory examinations have 
 thus far failed to isolate any definite toxin to which diseases of 
 the eye can be attributed, it is nevertheless desirable that such 
 examinations be made. A side light is thrown upon this subject 
 by the coincident occurrence of uveal disease with skin lesions. 
 
 The toxins may either be generated within the body (endogenous 
 toxemia) or they may be introduced from without (exogenous tox- 
 emia). In the former case we speak of auto-intoxication and in- 
 clude under this name a group of symptom-complexes attributable 
 in the main to a variety of gastro-intestinal, hepatic and metabolic, 
 or constitutional, disorders. The exogenous toxemias include all 
 forms of poisoning due to unorganized bodies (alcohol, tobacco and 
 other alkaloids, metallic poisons, etc.) introduced from without, and 
 also intoxication by poisons elaborated within the body by parasites 
 (bacteria, taenia, amoeba, etc.). 
 
 Three factors principally determine auto-intoxications of gastro- 
 intestinal origin, viz. : 
 
 1. Stagnation of the contents of the stomach and bowel. 
 
 2. Perversion, qualitative or quantitative, of the gastro-intestinal 
 secretions. 
 
 3. Invasion of the gastro-intestinal tract by abnormal putre- 
 factive bacteria or the unchecked overgrowth of normal species of 
 the intestinal flora.
 
 AUTOINTOXICATION 707 
 
 As a rule several of these factors are combined and the existence 
 of the one directly or indirectly determines the incidence of the 
 others. 
 
 Autointoxication from stagnation of the gaslro-intcslinal contents 
 is quite entirely due to inability on tiie part of the gastro-intestinal 
 wall to propel the contents of tlie digestive canal onward within the 
 normal time. This inability may be due to antony of the gastric or 
 intestinal musculature or to mechanical causes as, e. g., narrowing of 
 the intestinal lumen, malposition or sacculation of parts of the tract, 
 or to both these factors combined. In the case of the stomach we wit- 
 ness the appearance of motor insufficiency, gastric ectasy, gastric 
 atony; in the case of the intestine of intestinal stenosis of various 
 kinds and, broadly speaking, of chronic constipation. 
 
 An immense amount of thought, ingenuity and labor have been 
 expended in devising methods for determining the exact condition 
 of the gastric walls — for recognizing and differentiating ectasy and 
 atony and simj^le dilatation and megalogastria. However valuable 
 and interesting such refinements in diagnosis -may be, they furnish 
 little information in regard to the proper treatment of all these 
 conditions (popularly known as dyspepsia, indigestion, biliousness) 
 that may not be briefly expressed in the following sentences : • 
 
 The three main indications for treatment are (1) to improve the 
 motor power of the stomach, (2) to prevent further dilatation, 
 (3) to adequately nourish the patient despite his stomach trouble in 
 order to maintain the best possible general nutrition. 
 
 The diet, then, should be of such a character that it imposes the 
 minimum of labor on the stomach walls, that it contains none of the 
 articles that can readily undergo acid or gaseous fermentation when 
 they stagnate in the stomach. The state of the gastric secretion 
 must at the same time be carefully taken into consideration, so that 
 the composition of the food must also vary according to the pres- 
 ence or absence of sufficient or over-abundant hydrochloric acid and 
 peptic ferments. 
 
 If the secretion of hydrochloric acid is normal or increased, there 
 is no objection to the use of meats or other albuminous foods, inas- 
 much as these are properly digested in the stomach ; at the same 
 time, especially in the presence of hyperehlorhydria, the ingestion 
 of amylaceous foods should be reduced; for the digestion of the 
 latter is always impeded in the presence of much hydrochloric acid 
 in the sense that amylolysis is interfered with and they undergo 
 abnormal decomposition when they remain in the stomach in an 
 undigested state for an abnormally long time. If on the other hand
 
 708 AUTOINTOXICATION 
 
 the secretion of gastric juice is reduced, no meats at all should be 
 given, hut only eggs, milk and mushy amylaceous foods, i. e., gruels, 
 made of milk with wheat flour, rice, barley, tapioca or sago, milk- 
 toast, vegetable purees, fruit, butter, cream and olive oil and bread- 
 stuffs. 
 
 Large meals should always be avoided and all the above articles 
 should be given in small quantities at frequent intervals. From a 
 practical standpoint it is best to experiment a little in each case, 
 i. e., to determine at frequent intervals by actual removal of the 
 stomach contents after a mixed meal which foods of the different 
 kinds are retained and which evacuated within the normal time 
 limits. In combination with such a motility test a study of the gas- 
 tric secretion can be advantageously made and the selection of the 
 diet regulated accordingly. 
 
 All articles of food that are coarse in texture, that contain indi- 
 gestible parts like tendons, skin, connective tissue in the case of 
 meats, stems, husks, pips, seeds in the case of vegetables, should be 
 forbidden. Carbonated beverages that distend the stomach; alco- 
 holic liquors of all kinds, solutions of albumoses and peptones, very 
 salt and very sweet foods are all forbidden because they all draw 
 water into the stomach and hence overburden the organ. For the 
 same reason the total liquid intake should be reduced. Too dry a 
 diet should, however, be avoided as the propulsion of semi-liquid 
 and mushy foods is easier in motor insufficiency than the propulsion 
 of a "dry" stomach contents. Too great a liquid restriction as 
 advised by some may even lead to dehydration of the tissues and in 
 extreme cases to tetany. 
 
 Sometimes rectal administration of liquids is of aid to supply 
 enough fluid; this measure in combination with complete food ab- 
 stinence for a period of days, with or without rectal feeding, is in 
 severe cases often of signal value. Rest after meals is always indi- 
 cated ; and these patients should be told to lie down for half an hour 
 after each feeding, preferably on the right side, as this facilitates 
 the movement of the food through the pylorus. The evening meal 
 should never be eaten too near bed-time as digestion is less active 
 during sleep and stagnation is favored in this way. 
 
 Lavage of the stomach is probably the most valuable remedy we 
 possess, provided it is carried out persistently. By removing un- 
 digested residue from the stomach after the time for its physiologi- 
 cal removal is passed, stagnation is eft'ectively prevented; moreover 
 the digestion of the next meal is not disarranged by the presence 
 of foul, decomposing material in the stomach; hence nutrition is
 
 AUTOMARGINOPLASTY • 709 
 
 not so seriously interfered with if lavage is performed than if it is 
 omitted. In advanced eases the following plan is the best: Several 
 hours before retiring, i. e., late in the afternooil, the stomach should 
 be washed out ; in this way any residue that may have remained be- 
 hind from breakfast or luncheon is removed and the evening meal 
 is introduced into a clean stomach. The latter should be digestible 
 within three hours and should be composed of material that can 
 undergo such rapid digestion. In case food particles, nevertheless, 
 are still found in the stomach in the morning, then morning lavage 
 must be instituted ; or if the patient suffers much distress during 
 the night, then washing of the stomach before retiring may become 
 necessary besides. In general a daily lavage late in the afternoon 
 is all that is required. The technique of lavage need not be de- 
 scribed in this place. The addition of various drugs to the wash 
 waters, as, e. g., boric acid, resorcin, salicylic acid, hydrochloric acid 
 or bicarbonate of soda as the exigencies of the case may demand, 
 needs only be mentioned; their main sphere of usefulness is to pre- 
 vent fermentation and to stimulate the gastric walls to increased 
 activity — and it is highly problematical whether they really accom- 
 plish this and whether plain water is not equally effective. Douch- 
 ing and spraying the stomach walls with water or with medicated 
 solutions is of subordinate value as compared to lavage. Electricity 
 applied in various ways, in my experience, is of no value whatso- 
 ever. Properly performed massage, and certain simple hydrothera- 
 peutic measures are often highly efficient. 
 
 Drugs have only a very subordinate place in the treatment of 
 motor insufficiency; we are dealing here largely with a mechanical 
 difficulty and hence the most eft'ective means are mechanical in 
 character ; hence surgery, too, may occasionally be useful, especially, 
 of course, in pyloric occlusions producing stagnation of the stomach 
 contents ; here and there drainage of the stomach by gastro- 
 enterostomy, mechanical reduction of the size of the stomach, cor- 
 rection of malpositions of the organ may be indicated. — (A. C. C.) 
 Automarg-inoplasty. A procedure by which disfigurement is avoided 
 and a defect in the lid edge (due to injury or operation) is remedied 
 by filling in the latter by means of tissues from the damaged lid 
 itself. Kuhnt, for example, accomplishes (Zeitschrift fur Augenheil- 
 kunde, March 25, 1911) this by shifting a portion of the tarsus into 
 the defect. When the deficiency is, as it usually is, caused by the ex- 
 section of a malignant growth care in the primary operation is called 
 for. The tumor of the lid, fixed in a clamp, is circumcised in the 
 skin, the lateral cuts slanting towards the healthy skin. Then the
 
 710 . AUTOMATIC SIGHT 
 
 clasp is turned and the diseased part excised from the conjunctival 
 surface by an incision parallel with the border and two incisions 
 at right angles to this. The lateral incisions are extended 1 cm. 
 towards the retrotarsal fold, through the conjunctiva and tarsus, 
 and this piece is dissected from the muscle and skin. After removal 
 of the clasp the marginoplasty is made by lifting this movable 
 remains of the tarsus and uniting it by sutures to the lateral portions 
 of the lid border. One needle of a double-armed thread is introduced 
 into the conjunctiva about 1 mm. from the lid border and a vertical 
 incision made through the whole thickness of the lid; the other needle 
 
 1 mm. from the horizontal and vertical incisions through the con- 
 junctiva and remainder of tarsus and a corresponding point of the 
 orbicularis and skin, but so that this is pierced from about 1% to 
 
 2 mm. from the incision. After the sutures are tied the new portion 
 of the lid border is in faultless position. Sometimes a fine suture in 
 the intermarginal seam may be advantageous. 
 
 The first dressing remains for three or four days. Definite recov- 
 ery occurs after six to eight days. After a few weeks a linear tattoo- 
 ing may be made at the region of the anterior edge of the new part, 
 to represent the cilia. Normal conditions of the skin and conjunc- 
 tiva are necessary, as scars or shrinking processes prevent the lifting 
 of the remaining tarsus. 
 
 Automatic sight. A "sight" connected in such a manner with the 
 elevating gear of the gun, that when it is directed on the water-line 
 of a target at any range the gun will have the proper quadrant ele- 
 vation for that range. 
 
 Automatie. (G.) Automatism. 
 
 Automobile drivers, Vision of. Before the Paris Ophthalmological 
 Society, Sauvineau cited the cases of a man wearing 16 D. lenses 
 which gave him 15-100 vision, and a boy with congenital cataract, 
 who were driving automobiles. Kalt told of another driver whose 
 vision with his strong lenses was in one eye 1-20 doubtful, and in 
 the other 1-6. In order to make its action unanimous the Society 
 contented itself with calling attention to the risk of accident due 
 to the poor vision of chautfeurs, and that risk would be reduced by 
 requiring binocular vision with a normal field, and normal motility 
 of the eyes, and visual acuteness with correcting glasses of not less 
 than I in one eye and | in the other. Lantsherre states that the auto- 
 mobile club of Belgium requires at its school normal vision in one 
 eye, and at least ^ in the other. 
 
 Automobile glasses. Car-drivers' goggles. These are made of cork 
 and mica, celluloid and concave glass, plain and tinted, for the pro-
 
 AUTOMUTILATION, OCULAR 711 
 
 tection of the eyes from wind and dust, that would otherwise injure 
 the delicate corneal and other ocular tissues. They fit snugly about 
 the orbit and are found in great variety at the optician's. 
 
 Probably the best protective, made wholly of glass, is that found 
 in the market under the trade name of "autoglas." It completely 
 shuts off injurious currents of dust-laden air, does not interfere with 
 the proper ventilation of the eye, can be had in all tints of color, and 
 may be ground with the patient's proper correction. 
 Automutilation, Ocular. Axenfeld has recently gathered the litera- 
 ture concerning self-enucleation by insane persons and has pub- 
 lished it, in addition to many of his own observations. According 
 to Axenfeld 's experimental investigations, the injury ma}' be 
 brought about very quickly ; he himself needed barely a minute to 
 do a non-operative avulsion on a cadaver. Berlin, Dehn and Roth- 
 enpieler are of the opinion that lunatics maim themselves by pinch- 
 ing and cutting through muscles, tendons and the optic nerve with 
 their finger-nails. Axenfeld, on the other hand, has demonstrated 
 that this injury may be brought about by simply tearing out the 
 globe Avith the fingers without help from the nails. The fingers, 
 as they force an entry into the orbit, press the muscles back toward 
 the apex of the orbital cavity, and the resulting tension severs the 
 connection between the muscles and their tendons. The force 
 needed to accomplish this lesion may even rupture the eyeball as 
 a result of the strong compression. In dragging and forcing the 
 eye out of the orbit with the fingers, the walls of the orbit furnish 
 leverage. 
 
 Noyes has reported a case of self-enucleation by the fingers. Gifford 
 has given a full account of these cases of self-mutilation (enucleation 
 of the globe) which are usually attempted by insane persons who^^ 
 not infrequently, succeed in gouging out one or both eyes. 
 
 In Henderson's case a young woman inflicted repeated burns 
 with some caustic, possibly carbolic acid, upon the lids and con- 
 junctiva, causing a serious symblepharon. Badal states that the 
 most frequent of such occurrences is self-enucleation with the finger, 
 especially in females. Doret observed pieces of matches voluntarily 
 introduced into the conjunctival sac beneath the lids by a woman, 
 who then claimed that the inflammation was due to ammonia used 
 in washing floors. Vasioutinski states that self-mutilations of the 
 eyes by conscripts in Russia affect the conjunctiva, cornea and lens. 
 He finds that a special form of brownish-yellow spots upon the cornea 
 is caused by silver nitrate.
 
 712 
 
 AUTO-OPHTHALMOSCOPE 
 
 In a case observed by Lafon, an insane patient attempted self- 
 enucleation of the eyeballs by pressing his thumbs forcibly against 
 the globes. Irido-cyclitis occurred, resulting in total blindness. 
 
 Auto-ophthalmoscope. An instrument devised for the purpose of ex- 
 amining one's own fundus. Various forms have been invented, but 
 the first successful one was constructed by Coccius ; since then Hey- 
 mann, Giraud-Teulon, Zehender, Gould and others have described 
 
 . different instruments. One of the simplest and best is that of Giraud- 
 Teulon. Its action is explained by the accompanying diagram. 
 
 Girand-Teulons Auto-ophthalmoscope. 
 
 The instrument consists of two plane mirrors, m m', inclined to one 
 another at an angle of 90°, and placed in front of the observer. A 
 concave mirror (c c') is held obliquely before the left eye (g), so 
 that the rays from a flame (P) are reflected on to m, and thence on to 
 m', which will reflect them into the right eye (d). A double-convex 
 lens, 1, is placed between d and m', by which an inverted aerial 
 image of A is formed, which is situated in reality at a' between 
 the two mirrors, but which will appear to g to be situated beyond 
 the mirror, m, at a". In fact the rays emanating from d, instead of 
 passing straight on, are bent twice at a right angle, and brought 
 back to g, without having undergone any change in their relative 
 positions. 
 
 Another method is described by R. Wessley (CentralM. f. prakt.
 
 AUTO-OPHTHALMOSCOPE 
 
 713 
 
 Augenhcilk., October, 1897.) for which is needed onl}' an angular 
 looking glass, which may be readily improvised by taking two small 
 pieces of mirror glass placed at an angle. Such a glass reflects ob- 
 jects twice, giving doubly-reflected images, one within 120 to 90 
 degrees, the other within 90 to 72 degrees. The head is brought 
 within the angles of the glass and the right eye looks at the image 
 of the left, and vice versa. As the head cannot be brought much 
 
 Wessley 's Auto-ophthalmoscope. 
 
 nearer than reading distance to the glass, the angle of the glass should 
 be about 95 to 75 degrees. (See figure.) 
 
 A candle flame is then brought near the glass and the eye to be 
 observed is shadowed, while the other eye is lighted. Before the 
 latter an ophthalmoscope is held so that the light from its mirror is 
 reflected to the glass and into the pupil of the other eye, which is 
 seen in the looking glass to be lighted, and is fixed by the observing 
 eye. Then a convex lens is placed before the ^xar^.ined eye wlien it
 
 714 AUTOPERIMETRY 
 
 is readily observed that the fundus is clearly seen in the mirror, about 
 the same area as one can ordinarily observe in another person. It is 
 easy to change the angle of the reflecting mirror to bring any part 
 of the eye-ground into the middle of the ophthalmoscopic picture. 
 To see the optic nerve head when the eyes are parallel, the angle of 
 the glass should be 84 degrees. The upper or lower portion of the 
 fundus may be seen by altering the glass to or from the perpendicular 
 George M. Gould (Jour. Am. Med. Assoc, 1898) describes an auto- 
 fundoscope (q. v.), a simple bit of mechanism intended slowly and 
 accurately to revolve a pin-hole through, and placed about two milli- 
 meters from the center of a black rubber disc. The method essen- 
 tially is a very old one of moving a i^in-perforated card held in the 
 hand, before the eye, and observing an illuminated blank space 
 through the perforation. In this way, however, one sees only faint 
 movable, and indefinite images of the retinal vessels, which disap- 
 pear and reappear with provoking rapidity. One may place the 
 instrument, without the tube, five or ten feet from a brilliantly 
 illuminated white cardboard, and thus obtain a very fair and steady 
 image of the macular region and the entire perimacular vascular sys- 
 tem. A little patience and considerable care is needed to hold the 
 eye very steady, at the right angle, and to rotate the disc at exactly 
 the requisite rapidity and uniformity to bring out the image most 
 perfectly and immovably. Gould thinks that it would have been 
 possible to provide an automatic clockwork mechanism much su- 
 perior to the described crude device. (A. B. R.) 
 
 Autoperimetry. The examination of one's own field of vision, inas- 
 much as one must constantly control fixation, demands great atten- 
 tion, especially in determining the limits of the color zones. This 
 is, for example, important in the study of scintillating scotoma in 
 one's own eye. An opportunity for the observation of this migrain- 
 ous symptom in the eye of a patient before the passing off of the 
 attack is wholly a matter of chance. 
 
 Autophakoscopy. Seeing the image of one's own ocular interior or of 
 one's own crystalline lens. IMitchell {0 phihalmic Record, VII, pp. 
 219, 220), who has investigated this phenomenon, says that there is a 
 golden tinge to the luminous disc employed in Darier's experiment 
 that is absent in the more successful one made by him. He saw the 
 outlines of all floating bodies in the vitreous; they could not have 
 been more perfectly defined if placed under the microscope. The 
 strife in the crystalline lens and the movement of drops of mucus 
 and tears across the surface of the cornea are not seen by this ex- 
 periment; it is only possible to watch the movement of muscce voli-
 
 AUTOPLASTIK 715 
 
 tantcs. Just why this is so he is unable to explain. To designate 
 this procedure as autophakoseopy is evidently a misnomer, since the 
 stria in the crystalline lens is not seen ; this body being one part of 
 the eye that escapes our scrutiny when practising this method. But 
 for the want of a better name he decided to publish the account 
 under the old title. 
 
 Autophakoseopy by the Mitchell method may be practised with 
 any lens, provided it is held before the eye in the same position as 
 when used for visual purposes. A globule of water or colorless 
 liquid albolene, adhering to the outer surface of the lens, is the 
 essential part of the apparatus used in the production of this pe- 
 culiar phenomenon, and it is through this globule that the reflections 
 from the interior of the eye are visible. 
 
 Autophakoseopy, however practised, does not seem to possess any 
 features that tend to make it of value to the ophthalmologist in 
 clinical work. 
 Autoplastik. (G.) Autoplasty. 
 Autoplasty. n. The restoration of a part by tissues taken from the 
 
 same organ or organism. 
 Autoptic, adj. Seen with one's own eyes; relating to or based on 
 autopsy or personal observation : as autoptic evidence. Also written 
 autopsic. 
 Autoscope. An instrument invented by Coccius for the self-examina- 
 tion of the eye. See Auto-ophthalmoscope. 
 Autoskiascopy. This is a procedure announced by Jackson by means 
 of which one's own refraction may be skiascopically determined, 
 i. e., the refraction of one eye measured by means of a mirror with 
 the other. In this procedure the refractive state of a portion only 
 of the background, situated on the temporal side, is examined. 
 There is less practical value, according to Elsching, in this plan than 
 in autophthalmoscopy (q. v.). 
 Autosuggestion.. This is a term, originated by Page, for that peculiar 
 mental, or semi-hypnotic condition, in w^hich the will is subordi- 
 nated to suggestion by others or, more properly, by the environ- 
 ment of the patient. It is generally associated with or is closely 
 allied to hysteria. Schmeichler and others have furnished reports 
 of cases where the eye symptoms had this origin, 
 Autotoxin. Any metabolic product of an organism which acts upon 
 that organism in any unfavorable or poisonous manner. Clinically, 
 auto-intoxication may result from the formation of abnormal prod- 
 ucts, or the failure of elimination of substances which normally are 
 excreted without damage to the organism. — (E. E. I.)
 
 716 AUXOMETER 
 
 Auxometef. An instrument for measuring the magnifying power of 
 
 lenses. 
 Available accommodation. This represents that proportion of the 
 amplitude of accommodation available for near-work, and gen- 
 erally is equal to two-thirds of the total range. For example, if 
 at 50 years of age the near-point be at 16 inches, the total accom- 
 modation will be 2.5 diopters. Two-thirds of this amount will be 
 1.67 — the amount of available accommodation. 
 Avanzamento. (It.), n. Advancement, i. e., an operation by which an 
 ocular muscle is detached from its insertion and attached at a point 
 removed from its origin. 
 Avanzamento della capsula di Tenone. (It.) Advancement (q. v.) of 
 
 Tenon's capsule. 
 Avanzamento dell 'elevatore della palpebra. (It.)' Advancement of 
 
 the levator of the eyelid. 
 Avanzamento di un muscolo deirocchio. (It.) Advancement of an 
 
 ocular muscle. 
 Avempace. Also known as Abu Bekr Mohammed ibn Badjeh. This dis- 
 tinguished Spanish-Arabian philosopher, poet and physician was 
 born about A. D. 1138. He lived successively in Saragossa, Seville, 
 Granada and Fez. In the last-named city he became vizier to the 
 Almorawides. Tradition relates that he was poisoned by, or at the 
 instigation of, jealous physicians. His most important writings are 
 those on pharmacology, in which he mentions a number of remedies 
 for diseases of the eye. — (T. H. S.) 
 Avenzcar. He was, in addition, known as Abu Merwan ibn Zohr, or 
 ZuHR; also called Abimeron and Abumeron. This most distinguished 
 representative of Spanish- Arabian medicine, and the most illustrious 
 member of a highly distinguished Jewish family, was born at Penta- 
 tior, near Seville, in the latter part of the 11th century. His father 
 and his grandfather were famous philosophers and physicians. Aven- 
 zoar himself, however, restricted his studies, or, at all events, his 
 professional work, almost exclusively to medicine. He was espe- 
 cially famous as a clinician, and was, it is scarcely necessary to add, 
 a keen observer and a profoundly original thinker. His master in 
 the healing art was plainly Galen, but him the great Arabian, unlike 
 most of the other physicians of the middle ages, did not follow slav- 
 ishly. 
 
 His most important book is al-Teisir (Alleviation by means of Reme- 
 dies). In this book he takes an unusually hopeful view of many 
 diseases, and even (in decided opposition to Galen) declares that 
 amaurosis is curable. Concerning the cataract operation, however,
 
 AVENZOHAR 717 
 
 he is decidedly pessimistic, naively observing: "Extraction is im- 
 possible, reclination permissible only." The ophthalmic portions of 
 his work are not, on the whole, of very great value. 
 
 He left a famous son and grandson, named, respectively,, Abu 
 Bekr Muhammed b. Abd Al-.AIa!ik Ibn Zuhr and Abu Muhammed 
 Abdallah b. Abu P>ekr Muh. Ibn Zuhr. Each of these descendants 
 surpassed his ancestor as an ophthalmologist. 
 
 He died A. D. 11(52.— (T. H. S.) 
 Avenzohar. A celebrated Jewish ophthalmologist who flourished in 
 
 Spain at the end of the eleventh century. See Avenpoar. 
 Averroes. Also known as Ibn Rosii, or Ibn Rusd, and called "The 
 JMoiiAMMEDAN Spinoza." This distinguished contemporary, puj)il. and 
 friend of Avenzoar was born at Cordova, Spain, A. D. 1126. His 
 father and his grandfather Avere judges, and he himself became a 
 Cadi. As a judge he had a wide reputation. In 1196 he was ap- 
 pointed governor of Andalusia. Soon, however, he was accused by 
 his enemies of heresy, and condemned to exclusion from the com- 
 munity of true believers. The place of his banishment was a Jewish 
 colony near Cordova, called an-Nisada. He was soon recalled, how- 
 ever, and sent to Morocco, where he was bitterly persecuted till his 
 death. 
 
 He was a very industrious man, and is said to have spent, in all 
 his adult life, only two nights without working — that of his wed- 
 ding-day and that of the day which followed his father's death. He 
 wrote on a vast variety of subjects — philosophy, philology, as- 
 tronomy, law, and medicine. His chief medical work is generally 
 called by its mediaeval Latin title, Colliget (Kital) al Kullijat, an- 
 glice : The General Principles of Medicine). 
 
 The Colliget soon took rank as a high authority, second, in fact, 
 only to the Canon of Avicenna. In a word, it is a whole system, or 
 encyclopedia, of medicine, rather impractical, however, and thor- 
 oughly saturated with philosophy. 
 
 As an ophthalmologist Averroes is greatly inferior to a number 
 of other Arabians — notably Ammar and Ali ben Isa. He is never- 
 theless important for the history of optics, inasmuch as he wholly 
 departed from the purely theoretical views of the nature of vision 
 which had been laid down by the ancients and, for the most part, 
 by mediaeval writers as well. Thus, for example, he finally over- 
 threw the old-time doctrine that, in the act of vision, emanations 
 pass out from the eye to the object which the mind desires to in-
 
 718 AVEUGLEMENT 
 
 vestigate, and return with information concerning it. See, for fur- 
 ther information on this point, Alhazen. — (T. H. S.) 
 
 Aveugrlement. (F.) Blindness. 
 
 Avicenna. In Arabic, Abu Ali ai.-Husain b. Abdallah b. al-Husain b. 
 Ali as-Saih ar-rais Ibn Sina. This greatest of all Arabian physicians 
 (for this reason generally called by the Arabs simply The Prince or 
 The Chief) was born at Khorassan A. D. 980. At the age of ten he 
 knew (it is asserted) the Koran by heart, and the greatest difficulty 
 which his teachers met in coniiection with the instruction of this 
 wonderful pupil was to keep him supplied with subjects. At the age 
 of 17 he was called in consultation in the case of the Emir, Nuch ben 
 Mansur, and acquitted himself most creditably. 
 
 The death of his father — a high official at Bokhara — having left 
 him rich, Avicenna began a life of dignified and successful wander- 
 ing. He passed from court to court in the various capacities of 
 physician, astronomer, author, teacher, and, finally, vizier — a dignity 
 which he reached in Hamadan. 
 
 Charged with treason, he was imprisoned. He escaped, however, 
 and fled to Ispahan. Being here entertained with great cordiality, 
 he remained for 14 years. 
 
 He was all his life a great student and a wicked man. In his 58th 
 year he died, as a result, it is said, of e«xcessive study and dissipa- 
 tion. Some still unkinder writers aver that he perished because, 
 when sick, he took his ow^n medicine. He was a very prolific and a 
 very interesting writer. His works, declared to amount in number 
 to 105, were in prose and in verse, and treated of law, astronomy, 
 philosophy, mathematics, statesmanship, and medicine. 
 
 Avicenna was not an original medical writer, but was an excellent 
 compiler. His medical Magnum Opus, Kanun (Canon), was only a 
 sort of combined codification and amplification of Galen, Paullus, and 
 others of the Greeks. The literary form, however, was so delightful 
 that the book at once took rank above the Kingly Book of Ali Abbas 
 and even the Hatvi of Rhazes. It became the Canon indeed, not only 
 for its own immediate time and place, but for Western lands also 
 through half a thousand years. 
 
 Though chiefly a general practitioner, Avicenna also deserves 
 high praise as an accurate and logical ophthalmologist. His writ- 
 ings on the eye are comprised in the third division of the third book 
 of The Canon. As an ophthalmologist, however, Avicenna wrote, it 
 would seem, from an inextensive personal experience in the treat- 
 ment of eye-diseases. He has also been severely criticised for paying
 
 AVULSIO BULBI 719 
 
 too little attention to the most important subjects — for example, 
 trachoma and cataract.*— (T. II. S.) 
 
 Avulsio bulbi. (L.) By this term is meant the tearing out of the 
 eyeball, with complete or almost complete severing of the surround- 
 ing softer tissues, conjunctiva, muscles. Tenon's capsule, and the 
 optic nerve. This traumatism is seen most frequently as the result 
 of brawls and in people who, mentally unbalanced, have done an 
 automutilation (q. v.). On the other hand, it is sometimes encoun- 
 tered in other injuries, by forceps delivery and by dull or sharp 
 objects which force their way between the eyeball and the bony 
 orbit, in bullet wounds at the temple, and as the result of sudden 
 compression of the orbit behind the eyeball, as, for instance, where 
 a person is run over. 
 
 Avulsion. A traumatic or operative tearing away of a part, or organ, 
 as, for example, the eyeball from its socket, or the iris from its intra- 
 ocular attachments. 
 
 Avulsion of the bulb. Rupture of the nerves, tendons of the ocular 
 muscles and other contents of the orbit that hold the globe in place, 
 so that the eyeball is torn from its socket. 
 
 Avulsion of the retina. Dragging of the retina from the ora serrata, 
 generally as the result of injury, has been reported in cases of retinal 
 detachment. Hesse reports a case in which it occurred without 
 trauma, but in detached retina associated with very high myopia. 
 
 Axanthopsia. Violet-blindness or blue-blindness. According to the 
 theory of Helmholtz and Young blue- or violet-blindness is due to the 
 blue-substance of the retina being equal to the green- or red-sub- 
 stance. In Holmgren's case of unilateral violet-blindness the red 
 half of the spectrum was separated from the green by a colorless 
 zone in the midst of the yellow. See Akyanopsia. 
 
 Axe anatomique de roeil. (F.) The antero-posterior diameter of the 
 eye. 
 
 Axe du cristallin. (F.) That antero-posterior axis of the eye which 
 passes through the centre of the crystalline lens. 
 
 Axencylinder. (G.) Axis cylinder. 
 
 Axencylinderfortsatz. (G.) Axis-cylinder process. 
 
 Axencylinderscheide. (G.) Sheath of axis cylinder. 
 
 Axendrehung. (G.) Torsion, rotation about a centre, causing twist- 
 ing of a ligament or pedicle. 
 
 * The ophthalmic part of Avicenna 's Tvritirigs is most accessible to modern 
 readers in the excellent German translation: Die Augenheilkunde des Ibn Sinu, 
 aus dem Arabischen iibersetzt und erliiutert von J. Hirschberg und J. Lippert, 
 Leipzig, 1902.
 
 720 AXENEBENE 
 
 Axenebene. (G.) The axial plane. 
 
 Axenfaden. (G.) Central filament. 
 
 Axenfaser. (G.) Axis cylinder. 
 
 Axenf eld's lachrymal sac dilator or retractor. This is one of the first 
 as well as one of the most useful instruments for separating the edges 
 of the wound in the operation for excision of the lachrymal sac. It 
 is operated by a screw attached to movable arms. See Lachrymal 
 apparatus, Operations on. 
 
 Axenhypermetropie. (G.) Axial hypermetropia. 
 
 Axenkanal. (G.) Central canal. 
 
 Axenkorper. (G.) Axis corpuscle. 
 
 Axenmyopie. (G.) Myopia due to too great length of the axis of 
 the eye. 
 
 Axenskelet. (G.) Axial skeleton. 
 
 Axenstab. (G.) Notochord. 
 
 Axenstrang. (G.) Axis cord. 
 
 Axe optique. (F.) Optic axis. 
 
 Axes of the orbits. These axial lines diverge greatly and make rather 
 an acute angle when extended until they meet behind, at the 
 chiasma. Dwight {System of Diseases of the Eye, Vol. I) estimates 
 this angle at from 42° to 45°. He further says tliat they run 
 downward as well as outward in their course from the apex to the 
 base, forming an angle of from 15 to 20 degrees with the horizon. 
 It has been thought that greater divergence is found in shorter 
 skulls, but this is not certain. The roof of the orbit is in the main 
 more nearly horizontal from before backward than the floor. It is 
 not a straight line, but a sinuous one curving upward in the middle. 
 The cavity is more or less overhung by the superior border. The 
 degree of overhang is very uncertain. There is next to none in 
 the Roman skull, and a great deal in others. It is deepest at 
 the outer angle, but it is not unlikely that it is most marked in 
 skulls with large frontal sinuses. 
 Axial. Pertaining to or of the nature of an axis ; situated in the axis. 
 Axial magnification, in optics, the ratio of infinitely small conjugate 
 line-segments of the principal axes in an optical system. It is in- 
 versely proportional to the square of the abscissa on the axes. Also 
 called depth-magnification. Axial plane, in optics, the plane con- 
 taining (1) the principal axis of a lens or mirror, or (2) the plane 
 which is coincident with the axis of a cylindric lens. In crystal- 
 lography, a plane containing (1) two of the crystallographic axes, or 
 (2) the optic axes in the case of a biaxial crystal. Axial point, in 
 optics, a point located upon the axis of a lens or mirror.— (C. F. P.)
 
 AXIAL AMETROPIA 721 
 
 Axial ametropia. This refractive condition results when, in conse- 
 quence of a shortening (hyperopia) or lengthening (myopia) of 
 the antero-posterior diameter of the eye, the light rays do not 
 cross one another i^roperly and are not easily focussed on the 
 macula. 
 
 Axial cataract. Any form of cataract that occurs in the axis of the 
 lens-system, e. g., anterior capsular cataract, posterior capsular 
 cataract, central cataract, or cortical cataract. See Cataract. 
 
 Axial hypermetropia. That form of hypermetropia due to an abnor- 
 mally short antero-posterior diameter of the eye. See Hypermetro- 
 pia; also Refraction of the eye, and Physiological optics. 
 
 Axial myopia. This form of ametropia depends upon a lengthening 
 of the antero-posterior diameter of the eyeball, but, unlike the great 
 majority of cases of axial hyperopia, is an acquired, not a congen- 
 ital, condition. It usually shows itself during the school years. 
 See Refraction and accommodation of the eye. 
 
 Axial neuritis. Inflammation of and changes in the central bundles of 
 optic nerve fibres, such as are observed, for example, in alcohol- 
 tobacco amblyopia. 
 
 Axialstare. (G.) Any form of cataract that occurs in the axis of 
 the lens-system, e. g., anterior capsular cataract, posterior capsular 
 cataract, central cataract, or cortical cataract. See Cataract. 
 
 Axial torsion of the optic nerve. Some investigators, for example 
 Vossius and Strahl, believe that during foetal life the optic nerve 
 and the eyeball gradually revolve about the long axis of the for- 
 mer from below outward, and that this torsion may amount to as 
 much as ninety degrees. Of course this movement would consid- 
 erably alter the ante-partum relations of the ocular organs within 
 the orbit. 
 
 Axillar. (G.) Axillary. 
 
 Axiometer. This device for determining the axis of cjdinders is based 
 on the principle that when a luminous streak is reflected by a cylin- 
 drical surface, the reflected image will have a different degree of 
 obliquity from that of the luminous streak except in two positions, 
 viz., when the streak is parallel to the axis of the cylinder and when 
 it is at right angles to it, the apparent angle of the image and that 
 of the object will coincide. Cooper has devised a box containing a 
 lamp by means of which a luminous streak may be reflected on the 
 spectacles of a patient who is directed to look at the streak ; as the 
 luminous streak is rotated two images will appear as crossed lines, 
 and the rotation is continued until the two lines are parallel or come 
 together. This position is read off on a graduated arc on the front 
 
 Vol. I — 16
 
 722 AXIOPLASM 
 
 of the box and gives the precise axis of the cylindrical lens. Glasses 
 may be tested on or off the face ; in the latter case they are to be set 
 in a holder provided for the purpose. 
 
 Axioplasm. The stroma of rectienlar substance connecting the fibrillae 
 of the axis-cylinders. Also called neuroplasm. 
 
 Axis. In analytical geometry, any fixed line of reference used to deter- 
 mine the position of a point or series of points (line or surface) in 
 space. Axis of a hcam of light, in optics, the middle ray of the beam; 
 also called the chief ray. Axis of a cone, a straight line drawn from 
 the apex to the center of the base. A^cis of a crystal, one of three or 
 four imaginary lines assumed for convenience to define the position 
 of the planes of the crystal, and to exhibit its symmetry. Axis of a 
 curve, a right line dividing a curve into two symmetrical parts, so as 
 to bisect every chord perpendicular to it (See Axis of symmetry). 
 Axis of a cylinder, a straight line drawn from the center of the one 
 end to that of the other. Axis of a cylindric lens, the straight line 
 which is the rectangular intersection of the lens' plane surface with 
 the radial plane whose rotation generates the cylindrical surface. 
 Axis of a lens, a straight line drawn through the optical center of the 
 lens, and perpendicularly to both its surfaces. Axis of a sphere, any 
 straight line drawn through the center and terminated both ways by 
 the surface of the sphere. Axis of a spherical, concave or convex 
 mirror, a straight line which passes through the geometrical and optical 
 centers of the mirror. Axis of a telescope, a straight line passing 
 through the centers of all the lenses in the tube. Axis of an ellipsoid, 
 its maximum and minimum diameters and the diameters and the 
 diameter perpendicular to tliese. Axis of refraction, a straight line 
 drawn perpendicular to the surface of the refracting medium, through 
 the point of incidence at which the refraction takes place. Some 
 crystals have two axes of refraction (See Optic axis, below). Axis of 
 rotation, the imaginary line about which all the parts of a rotating 
 body turn. Axis of symmetry, a line on both or all sides of which the 
 parts of a body or dimension (of line, curve or surface) are sym- 
 metrically disposed. Axis of the eye, a straight line passins: through 
 the center of the cornea, the nodal points, the center of rotation and 
 the posterior pole of the eye. It contains the cardinal points of the 
 entire dioptric system, the principal points, the nodal points and its 
 principal foci. Axis of vision. (See Visual axis, below.) Conju- 
 gate axis, a minor axis said to be conjugate to the superior axis at 
 right angles to it. The axis conjugate to the transverse axis. Co- 
 ordinate axes, fixed lines on which or parallel to which an element 
 (abscissa or ordinate) of the position of a point is measured. Optic 
 axis, as applied to the eye, lenses, or mirrors (see above respectively).
 
 AXIS OF CYLINDRICAL LENSES, NOTATION FOR THE 723 
 
 Also the line in a doubly refracting crystal in the direction of which 
 no double refraction occurs. Crystals belonging lo the tetragonal and 
 hexagonal systems have a single optic axis, coincident with their verti- 
 cal crystallograpliicid axis; hence they are said to be iiniaxial. Crys- 
 tals belonging to the orthorhondjic, monoclinic, and triclinic systems 
 have two optic axes, and hence are biaxial. Principal axis of a lens, the 
 same as above, yet as distinguished from: Secondary axis of a lens, 
 the straight line which connects a point on either side of the principal 
 ■optic axis wath the optical center of the lens. Visual axis, in physio- 
 logic optics, the straight line which connects the point of the object 
 viewed wdth the fovea centralis. It does not coincide with the optic 
 axis of the eye (Sec Angle gamma). Also called visual li)ie, line of 
 fixation, or axis of vision. — (C. F. P.) 
 Axis of cylindrical lenses, Notation for the. Tlie relative position of 
 the axis in cylindrical lenses is ditierently indicated in various 
 countries. In Germany, an exactly horizontal or vertical axis is 
 so indicated, (1. e., | or — ); otherwise it is noted by giving the 
 degrees or deviation of its upper end from the vertical. Thus, 25°t. 
 or 25 n. means a cylinder whose axis deviates 25° temporal-ward, 
 or 25° nasal-ward, from the vertical meridian. This notation has 
 the advantage of pointing out at once whether the principal meridi- 
 ans of both eyes are symmetrically placed, or not. 
 
 In Prance and most other countries, the Javal method is 
 employed, the figures on the ophthalmometer being taken as a 
 basis' Javal placed the point at the horizontal meridian; so that 
 25° cylinder "t" would, for the right eye, be written 115° and for 
 the left eye 65°. 
 
 It is to be hoped that in the near future ophthalmologists the 
 world over will agree upon some conventional method of axis nota- 
 tion. It matters little which is chosen as long as one is selected, 
 so that we shall not have to resort to diagrams and other devices 
 in a prescription or report to indicate just what we mean. So far, 
 the etforts of both local and international societies, as well as of 
 earnest individuals, to bring about the adoption of a common 
 nomenclature seem to have been in vain. 
 Axis of rotation. Savage {Ophtlialmic Myology, pp. 5, 6, 7) gives the 
 following law for finding this: The axis of every possible rotation 
 is in the movable equatorial plane, and is always fixed at right-angles 
 to the plane through which the visual axis moves from the first to 
 the second position. 
 
 To find the axis of any rotation, the rule given by Helmholtz needs 
 no amending. At right-angles to the plane common to the first and
 
 724 AXIS, OPTIC 
 
 second positions of the visual axis, construct two planes in one of 
 which shall lie the visual axis in the first position and in the other 
 the visual axis in the second position. The plane common to the 
 visual axis in the two positions may be named a, the plane passing 
 through the visual axis in the first position may be named 6, and 
 the plane through this axis in the second position may be named c. 
 The line of intersection of planes & and c is the axis about which the 
 eye has rotated in passing from the one position to the other. Planes 
 h and c being everywhere at right-angles to plane a, their line of 
 intersection must also be perpendicular to plane a. A fourth plane, 
 d, may now be constructed through the line of intersection of planes 
 h and c, at right-angles to either plane h or plane c, and necessarily 
 at right-angles to plane a. This plane d is the equatorial plane of 
 the eye. If the rotation has been from the primary position to any 
 secondary position, or from any secondary position back to the 
 primary position, the axis of rotation is in both the equatorial plane 
 which has moved with the eye, and also in the Listing plane, which, 
 passing through the centers of rotation of the two eyes, is fixed 
 vertically in the head and at right angles to the visual axis only 
 when it is in the primary position. This can be true of only one eye 
 at a time, for it is impjossible for both eyes to be in the primary posi- 
 tion at the same time. The primary position of an eye is that in which 
 the visual axis is in the fixed horizontal plane of the head and, at the 
 same time, parallel with the median plane of the head. In a normal 
 state of the ocular muscles the two visual axes can never both be 
 parallel Avith the median plane of the head ; hence, the two equatorial 
 planes cannot coincide, at the same time, with Listing's plane. 
 Strictly speaking, the axes of rotation for the two eyes can be in 
 Listing's plane only when moving in the horizontal plane. In all 
 other rotations (vertical and oblique) either one or both axes is out 
 of the Listing plane ; but both are always in the equatorial plane. 
 In rotation from one secondary position to another secondary posi- 
 tion the axis is in the equatorial plane, but not in the Listing plane. 
 There can be, therefore, no good reason for perpetuating the Listing 
 plane. 
 Axis, Optic. This is a line around Avhich the optic system of the eye 
 may be considered as centered. Theoretically, the centers of curva- 
 ture of the anterior and posterior surfaces of the cornea and lens 
 should lie in this straight line, which does not pass through the fovea, 
 however. Practically these points are decentered, usually in the 
 A^ertical meridian. — (H. G.)
 
 AXIS, OPTICAL 725 
 
 Axis, Optical. A line drawn from the centre of the eye-piece through 
 the tube, objective and stage to the centre of the mirror of a micro- 
 scope. 
 
 Axis, The, in refraction. 
 
 As Walter L. Paiaiell {Ophlhabnology, October, 1912) very prop- 
 erly observes, any means aiding in the objective determination of 
 the axis would seem in order, appreciating the increasing tendency 
 among examiners to attach as much importance and weight to their 
 own findings as to those secured by subjective assistance. Such 
 being the case, the prescription is written only after due considera- 
 tion of both findings, not of the subjective alone. Although, as Jack- 
 son points out, the test card examination is the last court of appeal, 
 this seems to relate more particularly to the quantitive element of 
 the correction than to the details of axis and so on. 
 
 That amount of assistance rendered by the examined eye, or, to 
 be more specific, the average intelligence, does not always measure 
 up to that degree of accuracy desired alike by the examined and 
 examiner. In fact, the burden of attaining this very often rests 
 with the refractionist. Hence the elaboration of objective means' 
 of examination as well as the invention of such optical instruments 
 as will aid the individual under examination to give material as- 
 sistance — scientific assistance through the instruments used. 
 
 The rules laid down for the determination of the axis with the 
 retinoscope are to the effect, generally, that the band of light indi- 
 cates the direction for the correcting cylinder. These rules may be 
 qualified, meaning that the direction is so variable and elusive dur- 
 ing the examination that as an index it is not entirely to be relied 
 upon. A variation as much as thirty degrees may occur in the course 
 of an examination, making it the problem to find the fixed .position 
 for the cylinder, which position alone is the correct one. When the 
 eye is artificially made "spherical," the cylinder used, as already re- 
 marked, has a fixed position, and the shadow shows all the charac- 
 teristics of a spherical one. Using the plane mirror, enough of the 
 sphere is taken out of the correction so that at one meter a shadow 
 of about .50 or .75 D. in a plus case moves "with" the mirror in a 
 circular, vertical or horizontal direction. If the cylinder is altered or 
 in a faulty position, of course the shadow becomes imperfect. 
 
 Some cases show, after the subjective test, that the position of 
 the cylinder, when one eye alone is tested, is not the same as when 
 the two eyes are in use together. For instance, the right eye may 
 seem to require a cylinder at axis 90° when tested alone, the left at 
 75°, but uncovering both eyes together, the cylinders may be favor-
 
 726 AXIS, VISUAL 
 
 ably placed at 95° and 85° respectively; and in these latter posi- 
 tions, the shadow of each eye, both being uncovered, may seem a 
 perfect spherical shadow, while with the cylinders at 90° and 75°, it 
 is not so. 
 
 Not only is the foregoing contention conspicuously true of an un- 
 certain number of cases — uncertain, because no observer has as yet 
 carried to completion the examination of a sufficiently large number 
 of instances to give us the true percentage — but it cannot be too 
 much insisted upon that in looking from the distance to the near 
 point a rotation of the globe may occur in one or both eyes, that 
 will invariably cause asthenopic symptoms if the patient attempts 
 to read with his high-grade cylinders, and not uncommonly some 
 discomfort in lower degrees of astigmatism. In doing perfect re- 
 fraction the eyes should be carefully tested separately and together 
 .not only at six meters but also at the near working distance, what- 
 ever the age or refraction of the patient. Failure to give the patient 
 refractive comfort not infrequently hinges upon care in these par- 
 ticulars. See Refraction and accommodation. 
 
 Axis, Visual. The line drawn from the point of fixation (object) 
 through the nodal point to the fovea centralis. 
 
 Axite. The end filaments of the axis-cylinder. 
 
 Axometer. An instrument used in adjusting the height of the bridge 
 of a pair of spectacles, to bring the centers of the lenses in line hori- 
 zontally with the centers of the pupils of the eyes. 
 
 Axonometer. An annular disk used in the ordinary trial frame to 
 locate the position of one of the chief meridians of astigmatism. 
 
 Axoneuron. The intracranial nerve-cell of the neuron. Axoneurons 
 are divided into endaxoneurons and rhizoneurons. 
 
 Axons of the retina. Long processes of the ganglion cells which pass 
 into the nerve-fibre layer of the retina to the papilla and optic 
 nerve. 
 
 Axoplasm of Schiefferdecker. This is a term applied to the inter- 
 fibrillar matrix found, in small amounts, however, so far as the 
 retina is concerned, along the axis-cylinder. See Histology of the 
 
 eye. 
 Axungia ardeae. (L.) Heron's fat; an ancient remedy once used for 
 
 removing specks from the eyes. 
 
 Axungia balsamica. See Benzoated lard.
 
 AXUNGIA PORCI 727 
 
 Axungia porci. See Lard. 
 
 Ayres' chalazion forceps. This is one of the earliest, simplest and 
 best instruments for the removal of Meibomian cysts. It has a 
 ring at the extremity of one arm, the terminal of the other arm 
 of the forceps being a round plat(> Avliieh cLasps the lid-skin against 
 
 ' i I I I I I I I I I I I 
 
 — ^■■'■■.- — .-.■ 
 
 Ayres' Chalazion Forceps. 
 
 and forces the tumor through the circle, where it is held in place 
 to be operated on. 
 
 Azelainsaure. (G.) Azelaic acid. 
 
 Azimuth. An optico-astronomical term, which assumes that the hori- 
 zontal plane of the eye is comparable to the actual horizon, and 
 the vertical meridian to that form which degrees in longitude are 
 reckoned, as from Greenwich. Plus azimuth is to the right from 
 the centre of the cornea, when that is in the primary position, and 
 minus azimuth to the left. — (L. H.) 
 
 Azoblau. (G.) Azo blue. 
 
 Azocarmin. (G.) Azo carmine. 
 
 Azofarbe. (G.) Azo color. 
 
 Azofarbstoff. (G.) Azo coloring matter. 
 
 Azoflavin. (G.) Yellow azo. 
 
 Azog-elb. (G.) Yellow azo. 
 
 Azoroth. (G.) Red azo. 
 
 Azorubin. (G.) Red azo. 
 
 Azoschwarz. (G.) Azo black. 
 
 Azoverbindung. (G.) Azo compound. 
 
 Azoviolett. (G.) Azo violet.
 
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