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Brooklyn Ophthalmological Society
1058
SOCIETY PROCEEDINGS
were deepset and showed no signs of injury. Upon examination he claimed to see only hand movements at one foot. However, it was found that he had about ten diopters of myopia in each eye and with the proper correction was able to read Jaeger No. 1. In another case he was successful in detecting malingering with the use of an amblyoscope which so confused the pa tient that he did not know whether his good or bad eye was being examined. DR. P. G. MOORE said that he generally went through his routine examination, demonstrating no suspicion, observing the patient and gaining his confidence. Just before dismissing the case, and after drawing his own conclusions he suddenly switched back to the prelimi nary and caught the patient totally off guard. DR. W. E. BRUNER said that in a re cent industrial case, being positive that the patient was malingering, he had de tected this by the use of a stereoscope. As examiner in the aviation unit dur ing the War, he had always insisted on the soldier coming into his office for examination. Endeavoring to escape service, some of them became suddenly so blind that it was a miracle how they ever found their way in. DR. R. F. T H A W said that the most successful method he had found in the case of malingerers was the read and green glass test, as one could not only tell whether the patient had vision but also the amount. The only difficulty was getting charts at about a distance of 20 feet, as there was either a faint outline of the red letters with the green, or an outline of the green let ters with the red glass. This method was more successful in reading near charts. A standardized chart, easily read, was best for this work as it did not arouse the patient's suspicion. DR. M. P. MOTTO commented on a pa
tient seen about a year ago who had been hit on the right side of the head. The right eye showed no effects of trauma, and he was able to obtain fairly good vision. H e diagnosed the case as traumatic neurosis and was greatly surprised to see the patient
eight months later with a definite optic atrophy. Another case, under the care of Pro fessor Van Szily, claimed loss of vi sion following a factory accident. An apparent lameness also developed ne cessitating a cane for aid in walking. The only ocular abnormality was uni lateral pin point pupil that shifted from eye to eye in repeated examina tions. A bottle of eserine was found in the cane. DR. E. M.. ALGER said, regarding an outline of the red letters through a green glass, this was because the type was pressed on so hard that there was light reflex interference. This could be remedied by rubbing down the sur face to remove the gloss. Also in choos ing the type of glasses used for these tests, adapt the glass to harmonize best with the conditions under which you tested cases of this nature to obtain the best results. M. PAUL MOTTO, Secretary. BROOKLYN OPHTHALMOLOGICAL SOCIETY February 19, 1931 DR. JOHN N. EVANS presiding
Pulsating exophthalmos DR. EDWARD GRESSER presented J. Z.,
male, aged fifty-six years, first seen on November 8, 1924, one month after on set of symptoms. There was slight pain in the left eye, diplopia, and slight proptosis. The left eye was fixed for movement, the vision was good and the eye essentially negative except for moderate chemosis. A retrobulbar tumor was suspected and confirmed by x-ray. Before the positive Wassermann test was received x-ray therapy was instituted ; but with out any appreciable effect. Antiluetic therapy caused a rapid subsidence of the condition, which was then diag nosed as orbital gumma. Eventually primary optic atrophy resulted. A little less than a year later, the pa tient returned with pulsating exoph thalmos of the right eye. No history of trauma was given nor other adequate history. The clinical picture was classi-
SOCIETY P R O C E E D I N G S cal. L i g a t i o n of t h e r i g h t c o m m o n carotoid a r t e r y w a s performed, w i t h s u b s e q u e n t s u b s i d e n c e of t h e p r o p t o s i s and d i m i n u t i o n of t h e head noises. T h e p r e s e n t s t a t u s revealed a t o t a l o p h t h a l m o p l e g i a of t h e left eye, in a d dition t o a p r i m a r y optic a t r o p h y . T h e r i g h t side s h o w e d a sixth nerve pa ralysis, an immature cataract, a nerve head t h a t w a s p a r t i a l l y e d e m a t o u s a n d some retinal h e m o r r h a g e s .
Maitre Jan DR. DAVID BISHOP read a description of the preparation of the patient for cataract operation and of the operation itself, translated from the French of Antoine Maitre Jan's "Treatise on the Diseases of the eye and the proper remedies for the cure," published in Paris in 1722. MAITRE JAN had been called the father of French ophthalmology. His chief claim to fame rested upon his redis covery, in 1682, of the true nature of cataract, which led eventually to the abandonment of the couching operation and the development of the operation of extraction. The doctrines of the real nature of cataract had been announced some thirty or forty years previously by Quarre and its truth demonstrated by a German, Rolfink, by anatomical in vestigation, but in the intervening years it had been completely forgotten. At the time of the rediscovery by Maitre Jan that cataract was an opaque lens, the general belief was that the lens was situated much more deeply in the eye than it is, and that the cata ract was an effusion between the pupil and the lens, which, by coagulation, produced the opacity. GEORGE FREIMAN,
Associate Secretary. COLORADO OPHTHALMOLOGICAL SOCIETY March 21, 1931 DR. W. A. SEDWICK presiding
Detachment of the retina DR. Ff. L. LUCIC presented a Filipino,
twenty-two years of age, who was first
1059
seen in June, 1928, at which time he complained of black specks in front of his left eye. The vision was 20/20. A hurried examination of the fundus re vealed two linear streaks above the macula. He was instructed to return in a few days but failed to do so for two years. On March 11, 1931, the patient re turned. The vision had gradually be come worse since 1928. With the left eye he counted fingers at about 12 inches. There was an extensive detach ment of the retina involving the entire lower half. Transillumination was un satisfactory. Tension was 22 mm. Schiotz in each eye. The case was presented as to the possibility of intra ocular tumor. Discussion. DR. W. A. SEDWICK felt that the detached retina was so un dulating that it pointed against the presence of tumor. DR. W. C. F I N N O F F said that transil lumination had been unavailing in this case for him because of the deep pig mentation. H e would be inclined to watch the tension and if it went up he would enucleate. DR. P. THYGESON said that he had re cently seen a case where the tension had been 8 mm. and later the eye had become mushy and yet the eye con tained a tumor when enucleated. DR. G. L. STRADER mentioned a case in which six months after an apparent ly simple detachment a sarcoma was found breaking through near the limbus. The patient died of sarcoma of the spleen. DR. W. M. BANE suggested the re
moval of the subretinal fluid to see whether the retina would replace tem porarily.
Sympathetic ophthalmia DR. H. L. LUCIC also presented R. S., a girl eight years old. She had been struck in the left eye by a piece of wire in August, 1929. The family physician had treated the injury for about 18 months. An oculist had been consulted at that time who had advised enucleation.
SOCIETY PROCEEDINGS
were deepset and showed no signs of injury. Upon examination he claimed to see only hand movements at one foot. However, it was found that he had about ten diopters of myopia in each eye and with the proper correction was able to read Jaeger No. 1. In another case he was successful in detecting malingering with the use of an amblyoscope which so confused the pa tient that he did not know whether his good or bad eye was being examined. DR. P. G. MOORE said that he generally went through his routine examination, demonstrating no suspicion, observing the patient and gaining his confidence. Just before dismissing the case, and after drawing his own conclusions he suddenly switched back to the prelimi nary and caught the patient totally off guard. DR. W. E. BRUNER said that in a re cent industrial case, being positive that the patient was malingering, he had de tected this by the use of a stereoscope. As examiner in the aviation unit dur ing the War, he had always insisted on the soldier coming into his office for examination. Endeavoring to escape service, some of them became suddenly so blind that it was a miracle how they ever found their way in. DR. R. F. T H A W said that the most successful method he had found in the case of malingerers was the read and green glass test, as one could not only tell whether the patient had vision but also the amount. The only difficulty was getting charts at about a distance of 20 feet, as there was either a faint outline of the red letters with the green, or an outline of the green let ters with the red glass. This method was more successful in reading near charts. A standardized chart, easily read, was best for this work as it did not arouse the patient's suspicion. DR. M. P. MOTTO commented on a pa
tient seen about a year ago who had been hit on the right side of the head. The right eye showed no effects of trauma, and he was able to obtain fairly good vision. H e diagnosed the case as traumatic neurosis and was greatly surprised to see the patient
eight months later with a definite optic atrophy. Another case, under the care of Pro fessor Van Szily, claimed loss of vi sion following a factory accident. An apparent lameness also developed ne cessitating a cane for aid in walking. The only ocular abnormality was uni lateral pin point pupil that shifted from eye to eye in repeated examina tions. A bottle of eserine was found in the cane. DR. E. M.. ALGER said, regarding an outline of the red letters through a green glass, this was because the type was pressed on so hard that there was light reflex interference. This could be remedied by rubbing down the sur face to remove the gloss. Also in choos ing the type of glasses used for these tests, adapt the glass to harmonize best with the conditions under which you tested cases of this nature to obtain the best results. M. PAUL MOTTO, Secretary. BROOKLYN OPHTHALMOLOGICAL SOCIETY February 19, 1931 DR. JOHN N. EVANS presiding
Pulsating exophthalmos DR. EDWARD GRESSER presented J. Z.,
male, aged fifty-six years, first seen on November 8, 1924, one month after on set of symptoms. There was slight pain in the left eye, diplopia, and slight proptosis. The left eye was fixed for movement, the vision was good and the eye essentially negative except for moderate chemosis. A retrobulbar tumor was suspected and confirmed by x-ray. Before the positive Wassermann test was received x-ray therapy was instituted ; but with out any appreciable effect. Antiluetic therapy caused a rapid subsidence of the condition, which was then diag nosed as orbital gumma. Eventually primary optic atrophy resulted. A little less than a year later, the pa tient returned with pulsating exoph thalmos of the right eye. No history of trauma was given nor other adequate history. The clinical picture was classi-
SOCIETY P R O C E E D I N G S cal. L i g a t i o n of t h e r i g h t c o m m o n carotoid a r t e r y w a s performed, w i t h s u b s e q u e n t s u b s i d e n c e of t h e p r o p t o s i s and d i m i n u t i o n of t h e head noises. T h e p r e s e n t s t a t u s revealed a t o t a l o p h t h a l m o p l e g i a of t h e left eye, in a d dition t o a p r i m a r y optic a t r o p h y . T h e r i g h t side s h o w e d a sixth nerve pa ralysis, an immature cataract, a nerve head t h a t w a s p a r t i a l l y e d e m a t o u s a n d some retinal h e m o r r h a g e s .
Maitre Jan DR. DAVID BISHOP read a description of the preparation of the patient for cataract operation and of the operation itself, translated from the French of Antoine Maitre Jan's "Treatise on the Diseases of the eye and the proper remedies for the cure," published in Paris in 1722. MAITRE JAN had been called the father of French ophthalmology. His chief claim to fame rested upon his redis covery, in 1682, of the true nature of cataract, which led eventually to the abandonment of the couching operation and the development of the operation of extraction. The doctrines of the real nature of cataract had been announced some thirty or forty years previously by Quarre and its truth demonstrated by a German, Rolfink, by anatomical in vestigation, but in the intervening years it had been completely forgotten. At the time of the rediscovery by Maitre Jan that cataract was an opaque lens, the general belief was that the lens was situated much more deeply in the eye than it is, and that the cata ract was an effusion between the pupil and the lens, which, by coagulation, produced the opacity. GEORGE FREIMAN,
Associate Secretary. COLORADO OPHTHALMOLOGICAL SOCIETY March 21, 1931 DR. W. A. SEDWICK presiding
Detachment of the retina DR. Ff. L. LUCIC presented a Filipino,
twenty-two years of age, who was first
1059
seen in June, 1928, at which time he complained of black specks in front of his left eye. The vision was 20/20. A hurried examination of the fundus re vealed two linear streaks above the macula. He was instructed to return in a few days but failed to do so for two years. On March 11, 1931, the patient re turned. The vision had gradually be come worse since 1928. With the left eye he counted fingers at about 12 inches. There was an extensive detach ment of the retina involving the entire lower half. Transillumination was un satisfactory. Tension was 22 mm. Schiotz in each eye. The case was presented as to the possibility of intra ocular tumor. Discussion. DR. W. A. SEDWICK felt that the detached retina was so un dulating that it pointed against the presence of tumor. DR. W. C. F I N N O F F said that transil lumination had been unavailing in this case for him because of the deep pig mentation. H e would be inclined to watch the tension and if it went up he would enucleate. DR. P. THYGESON said that he had re cently seen a case where the tension had been 8 mm. and later the eye had become mushy and yet the eye con tained a tumor when enucleated. DR. G. L. STRADER mentioned a case in which six months after an apparent ly simple detachment a sarcoma was found breaking through near the limbus. The patient died of sarcoma of the spleen. DR. W. M. BANE suggested the re
moval of the subretinal fluid to see whether the retina would replace tem porarily.
Sympathetic ophthalmia DR. H. L. LUCIC also presented R. S., a girl eight years old. She had been struck in the left eye by a piece of wire in August, 1929. The family physician had treated the injury for about 18 months. An oculist had been consulted at that time who had advised enucleation.