Progressive Muscle Chart

182

NOTES, CASES, INSTRUMENTS

pathetic ophthalmia a year or so previously was found and three intramuscular injections of this patient's whole blood were given with no results. Artificial fever by means of a General Electric diathermy unit was resorted to on May 4th. The temperature rose to 105 to 107 degrees rectally and was sustained over a period of three hours. On May 6th the fundus was more clearly visible than for several weeks. On May 8th, the patient could count fingers at 15 feet ancl was discharged for a consultation with Dr. Frank E. Burch, who reported a favorable prognosis. He was readmitted six days later, the vision having fallen to finger counting at eight feet; the fundus was not visible because of a cloudy vitreous and there was an increase in the number of K.P. He was given more intravenous injections of typhoid vaccine, atropine, and heat, along with phototherapy with no improvement. On May 18th, another diathermy treatment was given and two days later the fundus could again be fairly well seen and vision had improved. Three more such treatments were given and the patient was discharged on June 19, 1935, with a fairly quiet eye and improved vision. His course of progress was followed in the dispensary and improvement was steady. A refraction test on November 7, 1935, enabled the patient to obtain 20/20-3 vision with -5.50 D. sph, =C= -.75 D. cyl. ax. 165°. Examination of the eye revealed KP. still present on the cornea, some vitreous floaters, normal fundus, normal tension,. and a reactive pupil. The visual fields were normal for form and colors. The patient was seen at intervals of one month and the vision remained 20/20 until January 29, 1936, when he was readmitted to the hospital com-

plaining of some dimming of V1SiOn. The fundus was not visible, there were vitreous floaters, and the vision was 20/40 with glasses. Atropine was used for four days but discontinued when it was noticed that its use seemed to irritate the eye. Diathermy treatments were given on February 4th, l l th, and 19th, the temperature reaching 105, lOS, and 106 degrees, respectively. No other medication, either local or general, was employed. On February 5th the floaters had almost disappeared and on February 16th the fundus detail could be seen. The patient was discharged February 28, 1936, with vision of 20/20 with glasses. At the last examination July 24, 1936, the vision was 20/20-1, and the media were clear. 1039 Lousry A1cdical Arts Building. PROGRESSIVE MUSCLE CHART WILLIS

S. KNIGHTON, M.D. B. W. KELLY, B.S.

AND

New York City

The Following chart is offered as a concise and graphic method of recording ocular-muscle deviations. Provision is also made for the plotting of successive changes; in this sense the chart is progressive. The ordinate represents the deviation in prism diopters and the abscissa records the dates.* The deviation is recorded by drawing a line from the center of the squinting eye to the space on the chart representing the prism diopters 0 f deviation. In the example shown the right

*

Theoretically, the lateral spacings should represent equal time intervals, but when the patient does not report regularly, that would necessitate leaving many of the squares blank and the chart would become unwieldy. It has been found more expedient simply to record successive findings in successive squares, regardless of the scale of the time element.

183

NOTES, CASES, INSTRUMENTS

The cover test (screen test) is recommended as the most accurate measurement of the deviation. In any event, the same test should be employed each time. The wearing of glasses, the performance of an operation, and other pertinent remarks may be made directly upon the chart. 40 East Sixty-first Street.

eye converged 12 prism diopters for distance and 2S prism diopters for near, at the first examination. If the squint is monocular, the other eye is shown to be straight by drawing a line along the zero line. In the case of alternating squint, the total deviation is best shown as belonging to one eye and checking the word "alternating." LATERAL

Red-distance

creen-near

.6.

VERTICAL

35 30 Z5

Blue-distance Blac.k-near

a--f

20

~IOIS

20

ZS

eo

~I

~ ;§

'!O

30

~

10

35 30

Z5

20

~~_:~

15

50

5

~

10

15 20

25

.'

,

-

I

50

CI.I

Phor i a Tropia

r;/

0

E AlternatinQ 0

3\ 10 15 50

z'"

Fig. I (Knighton and Kelley). A muscle-balance graph. Because of the difficulty of reproducing colors the chart is recorded in ink. The solid line represents the lateral deviation for distance and the broken line that for near. The fusion amplitude for distance is shown by the extent of the vertical line running through the dot which represents the esophoria of the right eye; the amplitude for near runs through the dot which represents the near imbalance.

A red mark is used to show the lateral imbalance for distance, and green for near. Vertical deviations can be shown in blue and black for distance and near respectively. The amplitude of fusion (prism convergence and divergence) is easily shown by a vertical line of red for distance and green for near. These colors were chosen because they are provided in the Norma 4--color pencil.]

t The chart and

pencil may be obtained from Street,

J. Hayden Twiss, ISS East Forty-second New York City.

THE HISTORY OF OPHTHALMOLOGY JAMES

E.

LEBENSOHN,

Chicago

M.D.

Ophthalmic achievements are adequately understood only in terms of their evolutionary story. The earlier concepts were mainly the results of empiricism and speculation. The experimental method began to take form about three centuries ago, but it is only in the last hundred years that institu-