- Email: [email protected]
Clinical Ophthalmology in Paris, Zurich and Munich
426
EDITORIALS
few of South America, not forgetting Habana and Mexico, the material sup port for such leadership exists and can be turned to this worthy purpose. There are universities with the es sential departments, that can be de veloped in a single generation to greatness equal to any reached in Europe. There are groups of ophthal mologists, with their local organiza tions, who have profited by the best culture that European ophthalmology had to offer. All that is needed is men who are willing to devote their lives chiefly to teaching; and who have the vision and persistence to carry their purpose to fruition. There are indica tions that in most of these American centers such men are not lacking; and they can be recruited from European teachers, whose search for opportunity turns their eyes toward the New World. E. J. CLINICAL OPHTHALMOLOGY IN PARIS, ZURICH A N D MUNICH. Upon request, I submit a brief ac count of some clinical impressions from my recent European trip. At Paris I revisited the large Clinique Nationale Ophtalmologique des QuinzeVingts, well known to me from my former journeys. I was very glad to be greeted again by Drs. Valude and Kalt. Dr. Valude very skillfully ex tracted a piece of iron from the in terior of the eye. The patient was lying down, and the giant magnet, placed over him, drew the piece into the anterior chamber. Thence it was extracted thru an incision with the lance shaped knife, by the small tip introduced' into the anterior chamber and brought in contact with the large magnet. Then he presented a case of spasm of the left facial nerve, and demonstrated the place where the needle had to be inserted to strike the nerve for the injection of pure alcohol. This was done with immediately fol lowing paralysis of the facial nerve, which will soon disappear. Generally the clinics are held from one o'clock until late in the afternoon. Dr. Chaillous, however, devoted a
whole morning to his many operations. There are two operating tables, one facing the large window of the spacious operating room with the right, the other with the left side; alternately used for operations on the right and left eyes. Cyanid of mercury is still used as an antiseptic. Lids and ciliary margins are painted with tinctur of iodin and glycerin. For orbital anes thesia, injections are made into the upper and lower lids and along the temporal wall into the depth of the orbit. They produce anesthesia of the ciliary body and guard against blepharospasm. Dr. Chaillous performs cystotomy before iridectomy, so that the vision of the operator is not inter fered with by hemorrhage from the iris. A secondary cataract was re moved with the forceps of Panas (sim ilar to Mathieu's forceps) and de Wecker's pince-ciseaux. Prolapse of the iris after a cataract extraction was galvanocauterized and covered by a conjunctival flap. This conjunctival covering also was done in a case of sloughing of the cushion after Elliot's trephining on the eighth day. Pterygium was abscised, cauterized, and the conjunctiva sutured. A man, aged 18, had an intracranial metastasis after a spontaneous fracture of the left humerus due, as revealed by microscopic examination, to sarcoma. He had exophthalmus of one eye, and the most typical choked discs of both eyes. I was sorry not to find Dr. C. Abadie at home, but I was told by his assist ant, that at the clinic Abadie's methods of dry sterilization of the instruments and intravenous injections of cyanid of mercury, are still practised with great success. Professor Sidler-Hugenin, the suc cessor to Professor O. Haab in the directorship of the eye clinic at Zu rich, was absent on account of illness; but his assistant showed me around. Professor Haab, who now confines himself to his private clinic, told me at a former visit that ophthalmoscopy is such a beautiful art that it deserves adequate quarters. And indeed, to mention only one feature of the ideally located University eye clinic, the very large room devised by him for oph-
EDITORIALS
427
thalmoscopic courses fulfills the high sion is hard hit, one cannot but ad est demands for efficiency and comfort. mire the indomitable scientific spirit In approaching the medical quarters still prevailing. After returning to our great country, of the University of Munich, the visitor is favorably impressed to see the I was very anxious to see the new Her memories of the great men of medi man Knapp Memorial Eye Hospital cine and science, who taught there, at New York. The excellent plaque honorably perpetuated by the city in of Herman Knapp in the lobby of this the naming of the streets, e. g., Frau- magnificent structure welcomed one enhofer, von Pettenkoffer, von Nuss- like home, and around were many dear baum, von Ziemssen streets. The eye remembrances of the time of our asclinic is an immense building, with sistantship to this great master. It spacious rooms and an abundance of was most gratifying to see, in the light. One is at once aware of the splendid work of his son, the spirit of scientific atmosphere imparted to this the illustrious father rejuvenated under great institution by its celebrated di the best facilities in modern surround rector, Professor C. von Hess. Thanks ings. to his early training at the physio ■In concluding this brief report of logic laboratory of Ewald Hering, he some of my impressions at the differ has preserved his love for physiology, ent clinics I visited, I wish to repeat as attested, aside from his ophthalmo- my grateful appreciation of the kind logic achievements, by his admirable ness and fraternal welcome with which original investigations on the physi I was received by these eminent rep ology of the visual organ, which he resentatives of ophthalmology. continues to enrich by valuable, exact CHARLES ZIMMERMANN. contributions. It was most interesting to see his COURSES IN VIENNA. work rooms, with the many forms of apparatus of his own device. One During the period of the recent war, space is devoted to the examinations graduate teaching of ophthalmology with his differential pupilloscope, ceased in Vienna. Following the ces which allows one to recognize dis sation of hostilities, the economic turbances of the pupillary reaction not status of Austria was in such a de only much earlier than previously pos plorable condition, that it was only sible, but also to ascertain numerical after great effort that teaching was ly the degree of disturbance. Many revived. cases from the neurologic clinic are The American Medical Association sent there for diagnostic purposes. At of Vienna, which is composed of for the clinic one saw numerous cases of eign graduate students who are study intracranial war injuries, with various ing in the city, was brought to life disorders of the visual fields. The again, after the declaration of peace binocular corneal microscope with and with the return of foreign stu slit lamp illumination is in constant dents. Prior to 1914, most of the grad use. An immense lecture hall is pro uate courses were arranged by the As vided with all kinds of appurtenances sociation, and the courses available for demonstrations. There is a large were published in the organization's room for ophthalmoscopic courses, and blue book. Incompatibility in the in the basement, with plenty of light, points of view of students and instruc are splendid laboratories for anatom tors made it difficult for a harmonious ic and histologic researches. The teach understanding between the Associa ing facilities are wonderful, and it is tion and the various graduate units; only natural that not only a large num and the quality of work suffered from ber of students, but also ophthalmolo misunderstandings. Conditions, how gists from all parts of the world, flock ever, have undergone a decided change to this great institution. Under the for the better; and at the present time present unfortunate economic condi harmony exists on both sides, with few tions, by which the medical profes exceptions.
EDITORIALS
few of South America, not forgetting Habana and Mexico, the material sup port for such leadership exists and can be turned to this worthy purpose. There are universities with the es sential departments, that can be de veloped in a single generation to greatness equal to any reached in Europe. There are groups of ophthal mologists, with their local organiza tions, who have profited by the best culture that European ophthalmology had to offer. All that is needed is men who are willing to devote their lives chiefly to teaching; and who have the vision and persistence to carry their purpose to fruition. There are indica tions that in most of these American centers such men are not lacking; and they can be recruited from European teachers, whose search for opportunity turns their eyes toward the New World. E. J. CLINICAL OPHTHALMOLOGY IN PARIS, ZURICH A N D MUNICH. Upon request, I submit a brief ac count of some clinical impressions from my recent European trip. At Paris I revisited the large Clinique Nationale Ophtalmologique des QuinzeVingts, well known to me from my former journeys. I was very glad to be greeted again by Drs. Valude and Kalt. Dr. Valude very skillfully ex tracted a piece of iron from the in terior of the eye. The patient was lying down, and the giant magnet, placed over him, drew the piece into the anterior chamber. Thence it was extracted thru an incision with the lance shaped knife, by the small tip introduced' into the anterior chamber and brought in contact with the large magnet. Then he presented a case of spasm of the left facial nerve, and demonstrated the place where the needle had to be inserted to strike the nerve for the injection of pure alcohol. This was done with immediately fol lowing paralysis of the facial nerve, which will soon disappear. Generally the clinics are held from one o'clock until late in the afternoon. Dr. Chaillous, however, devoted a
whole morning to his many operations. There are two operating tables, one facing the large window of the spacious operating room with the right, the other with the left side; alternately used for operations on the right and left eyes. Cyanid of mercury is still used as an antiseptic. Lids and ciliary margins are painted with tinctur of iodin and glycerin. For orbital anes thesia, injections are made into the upper and lower lids and along the temporal wall into the depth of the orbit. They produce anesthesia of the ciliary body and guard against blepharospasm. Dr. Chaillous performs cystotomy before iridectomy, so that the vision of the operator is not inter fered with by hemorrhage from the iris. A secondary cataract was re moved with the forceps of Panas (sim ilar to Mathieu's forceps) and de Wecker's pince-ciseaux. Prolapse of the iris after a cataract extraction was galvanocauterized and covered by a conjunctival flap. This conjunctival covering also was done in a case of sloughing of the cushion after Elliot's trephining on the eighth day. Pterygium was abscised, cauterized, and the conjunctiva sutured. A man, aged 18, had an intracranial metastasis after a spontaneous fracture of the left humerus due, as revealed by microscopic examination, to sarcoma. He had exophthalmus of one eye, and the most typical choked discs of both eyes. I was sorry not to find Dr. C. Abadie at home, but I was told by his assist ant, that at the clinic Abadie's methods of dry sterilization of the instruments and intravenous injections of cyanid of mercury, are still practised with great success. Professor Sidler-Hugenin, the suc cessor to Professor O. Haab in the directorship of the eye clinic at Zu rich, was absent on account of illness; but his assistant showed me around. Professor Haab, who now confines himself to his private clinic, told me at a former visit that ophthalmoscopy is such a beautiful art that it deserves adequate quarters. And indeed, to mention only one feature of the ideally located University eye clinic, the very large room devised by him for oph-
EDITORIALS
427
thalmoscopic courses fulfills the high sion is hard hit, one cannot but ad est demands for efficiency and comfort. mire the indomitable scientific spirit In approaching the medical quarters still prevailing. After returning to our great country, of the University of Munich, the visitor is favorably impressed to see the I was very anxious to see the new Her memories of the great men of medi man Knapp Memorial Eye Hospital cine and science, who taught there, at New York. The excellent plaque honorably perpetuated by the city in of Herman Knapp in the lobby of this the naming of the streets, e. g., Frau- magnificent structure welcomed one enhofer, von Pettenkoffer, von Nuss- like home, and around were many dear baum, von Ziemssen streets. The eye remembrances of the time of our asclinic is an immense building, with sistantship to this great master. It spacious rooms and an abundance of was most gratifying to see, in the light. One is at once aware of the splendid work of his son, the spirit of scientific atmosphere imparted to this the illustrious father rejuvenated under great institution by its celebrated di the best facilities in modern surround rector, Professor C. von Hess. Thanks ings. to his early training at the physio ■In concluding this brief report of logic laboratory of Ewald Hering, he some of my impressions at the differ has preserved his love for physiology, ent clinics I visited, I wish to repeat as attested, aside from his ophthalmo- my grateful appreciation of the kind logic achievements, by his admirable ness and fraternal welcome with which original investigations on the physi I was received by these eminent rep ology of the visual organ, which he resentatives of ophthalmology. continues to enrich by valuable, exact CHARLES ZIMMERMANN. contributions. It was most interesting to see his COURSES IN VIENNA. work rooms, with the many forms of apparatus of his own device. One During the period of the recent war, space is devoted to the examinations graduate teaching of ophthalmology with his differential pupilloscope, ceased in Vienna. Following the ces which allows one to recognize dis sation of hostilities, the economic turbances of the pupillary reaction not status of Austria was in such a de only much earlier than previously pos plorable condition, that it was only sible, but also to ascertain numerical after great effort that teaching was ly the degree of disturbance. Many revived. cases from the neurologic clinic are The American Medical Association sent there for diagnostic purposes. At of Vienna, which is composed of for the clinic one saw numerous cases of eign graduate students who are study intracranial war injuries, with various ing in the city, was brought to life disorders of the visual fields. The again, after the declaration of peace binocular corneal microscope with and with the return of foreign stu slit lamp illumination is in constant dents. Prior to 1914, most of the grad use. An immense lecture hall is pro uate courses were arranged by the As vided with all kinds of appurtenances sociation, and the courses available for demonstrations. There is a large were published in the organization's room for ophthalmoscopic courses, and blue book. Incompatibility in the in the basement, with plenty of light, points of view of students and instruc are splendid laboratories for anatom tors made it difficult for a harmonious ic and histologic researches. The teach understanding between the Associa ing facilities are wonderful, and it is tion and the various graduate units; only natural that not only a large num and the quality of work suffered from ber of students, but also ophthalmolo misunderstandings. Conditions, how gists from all parts of the world, flock ever, have undergone a decided change to this great institution. Under the for the better; and at the present time present unfortunate economic condi harmony exists on both sides, with few tions, by which the medical profes exceptions.