The 16Th International Congress of Ophthalmology

AMERICAN JOURNAL OF OPHTHALMOLOGY Published

Monthly

by the Ophthalmic

Publishing

Company

EDITORIAL STAFF DERRICK V A I L ,

S. RODMAN IRVINE

Editor-in-Chief

9730 Wilshire Boulevard, Beverly Hills, California

700 North Michigan Avenue, Chicago 11 W I L L I A M H . CRISP, Consulting

Editor

J A M E S E. LEBENSOHN

1276 Emerson Street, Denver 3 LAWRENCE T. POST, Consulting.

4010 West Madison Street, Chicago 24

Editor

DONALD J. LYLE

601 Union Trust Building, Cincinnati 2

640 South Kingshighway, Saint Louis 10

W I L L I A M A. M A N N

W I L L I A M L. BENEDICT

30 North Michigan Avenue, Chicago 2

The Mayo Clinic, Rochester, Minnesota

J O H N V. V. NICHOLLS

FREDERICK C. CORI>ES

1414 Drummond Street, Montreal

384 Post Street, San Francisco 8 SIR

STEWART

ALGERNON B. REESE

73 East Seventy-first Street, New York 21

DUKE-ELDER

P H I L L I P S THYGESON

63 Harley Street, London, W . l

87 North 6th Street San Jose, California

E D W I N B. D U N P H Y

243 Charles Street, Boston 14

M. U R I B E TRONCOSO

F. HERBERT HAESSLER

500 West End Avenue, New York 24

561 North 15th Street, Milwaukee 3

A L A N C. WOODS

Johns Hopkins Hospital, Baltimore 5

PARKER H E A T H

243 Charles Street, Boston 14

K A T H E R I N E FERGUSON CHALKLEY, Manuscript

Lake Geneva, Wisconsin

Editor

Directors: W I L L I A M L. BENEDICT, President; FREDERICK C CORDES, Vice-President; W I L L I A M M A N N , Secretary and T r e a s u r e r ; W I L L I A M H . CRISP, LAWRENCE T . POST, DERRICK V A I L .

A.

Address original papers, other scientific communications including correspondence, also books for review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins. Exchange copies of medical journals should be sent to Dr. F. Herbert Haessler, 561 North 15th Street, Milwaukee 3, Wisconsin. Subscriptions, application for single copies, notices of changes of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 664 North Michigan Avenue, Chicago 11, Illinois. Copy of advertisements must be sent to the manager by the 15th of the month preceding its appearance. Change of address notice should be received not later than the 15th of the month prior to the issue for which the change is to go into effect. Both old and new addresses should be given. Author's proofs should be corrected and returned within forty-eight hours to the Manuscript Editor, Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Twenty-five reprints of each article will be sup­ plied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip Street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. THE

16THINTERNATIONAL

CONGRESS

T h e 1 6 t h I n t e r n a t i o n a l C o n g r e s s of O p h t h a l m o l o g y w a s h e l d i n L o n d o n , J u l y 17th t o 21 st, u n d e r t h e p r e s i d e n c y of S i r S t e w a r t D u k e - E l d e r . M o r e t h a n 1,200 full m e m b e r s a n d 8 0 0 associate m e m b e r s r e g i s t e r e d ; 65 countries were represented. I t is n o t g e n e r a l l y u n d e r s t o o d t h a t t h e c o n ­ g r e s s is s p o n s o r e d b y t h e I n t e r n a t i o n a l C o u n ­ cil of O p h t h a l m o l o g y o f w h i c h P r o f e s s o r N o r d e n s o n of S t o c k h o l m h a s b e e n p r e s i d e n t . T h e I n t e r n a t i o n a l C o u n c i l of O p h t h a l m o l o g y is c o m p o s e d of r e p r e s e n t a t i v e s o f 16 n a t i o n a l o p h t h a l m o l o g i c societies a n d is c o n c e r n e d ,

OF OPHTHALMOLOGY

apart from the international congress, with administrative a n d academic ophthalmic mat­ t e r s of i n t e r n a t i o n a l c h a r a c t e r . I t h e l d s e v ­ eral meetings d u r i n g the congress. T h e c o n g r e s s , w h i c h is t h e o l d e s t e s t a b ­ l i s h e d m e d i c a l e v e n t of i t s k i n d , is h e l d n o m i n a l l y e v e r y f o u r y e a r s . T h e last t o b e h e l d w a s i n C a i r o , in 1937. A n y a t t e m p t t o d e ­ s c r i b e i n detail t h e e x c e l l e n t scientific p r o ­ g r a m a n d t h e w a r m t h of h o s p i t a l i t y e x t e n d e d by o u r British colleagues would be doomed t o failure.

1610

The

o u t s t a n d i n g , detailed, perfectly e x -

EDITORIALS

ecuted arrangements were a tribute to the executive direction of Sir Stewart DukeElder and the organizing ability of Mr. Frank W. Law, the secretary-general. Quite obviously they had excellent cooperation from their committees. The carefully planned and entertaining events for the wives and children of the delegates were carried out under the direction of the charming and evergracious Lady Duke-Elder and her commit­ tee. On the Sunday preceding the opening of the congress, a most impressive and inspiring memorial service was held for Sir William Bowman, at which Prof. J. W. Nordenson, the president of the international council, laid a wreath at the memorial tablet to Bow­ man in what remains of the bombed St. James's Church in Piccadilly. The congress was opened formally on Monday morning by His Royal Highness, the Duke of Gloucester. Following the read­ ing of greetings from Their Royal High­ nesses, the King and Queen, the Duke of Gloucester reviewed what ophthalmology has done in the past and expressed hope that ever greater advances would be made in the future. At the conclusion of the Duke of Glou­ cester's address, the first Gonin Medal was presented to Dr. H. Arruga of Barcelona by Professor Nordenson as president of the In­ ternational Council. Following Sir Stewart Duke-Elder's ad­ dress of welcome, there were inaugural ad­ dresses of the representatives of the six con­ tinents : Dr. Edward Hartman, speaking for Europe; Dr. John H. Dunnington, for North America; Prof. R. Argafiaraz, for South America; Sir Jenrshedji Duggan, for Asia; Dr. Abdel Fattah El Tobhy, for Africa; and Dr. J. Ringland Anderson, for Australia. The scientific sessions were held in Friends House and in University College. Two of the outstanding features were the round-table discussions on "The role of the sympathetic system in the genesis of vascular hyperten­ sion and its effect upon the eye," and on

1611

"The clinical and social aspects of heredity in ophthalmology." In each of these roundtable discussions, 20 ophthalmologists par­ ticipated. In addition, 131 individual papers were read, these being presented in three dif­ ferent halls. Space does not permit the listing of these excellent presentations. Beside the scientific papers, there were more than 60 scientific films. The most spec­ tacular of these was the one of Amsler of Switzerland, showing the reaction of cells from the aqueous to bacteria. In this film, the organisms were shown entering the cells and were followed in their work of destruc­ tion of the individual cells. The official languages of the congress were English, French, and Spanish, with extensive arrangements having been made for translat­ ing and interpreting. In some instances, the speaker made announcements in all of the of­ ficial languages. Operative and other demonstrations were arranged, as well as exhibitions under the headings—clinico-pathologic, histologic, in­ dustrial, illuminating, scientific, and trade. The various exhibits were housed in the Wellcome Research Institution, the London School of Hygiene and Tropical Medicine, and St. Pancras Town Hall, all within easy walking distance of the registration office and bureau in the British Medical Association House. During the congress, in addition to the meeting of the international council, there were meetings of the International Associa­ tion for the Prevention of Blindness and the International Organization against Tracho­ ma. As is usually true, the social aspect of the congress was one of its features, and our British hosts arranged many unusual events. Preceding the congress, there were many tours in England and Scotland, and, during the congress, there were daily excursions about London. On Sunday afternoon there was a recep­ tion at the Royal College of Surgeons and, on Monday night, the reception and dance

EDITORIALS

1612

of the congress took place. On Tuesday night there was a reception by His Majesty's Gov­ ernment at Tate Gallery. This was preceded by a cocktail party at the American Embassy for the visiting Americans. On Wednesday evening, a selected number of the delegates were entertained at dinner in the 400-yearold Apothecaries Hall in Blackfriars Lane by the officers of the Ophthalmological So­ ciety of the United Kingdom and the Faculty of Ophthalmology. Following this, at a reception of the Royal College of Surgeons of England, Honorary Fellowships in the Royal College of Sur­ geons were conferred upon Jean-Pierre Bailliart of France and Derrick Vail of the United States. On Thursday afternoon, a group of nine delegates was invited to a garden party at Buckingham Palace. The social activities ended with the official banquet of the con­ gress on Thursday night. From this brief account, it is quite ap­ parent that the 16th International Congress of Ophthalmology will always be remem­ bered as one of the most outstanding of all congresses and we, who had the privilege of attending, will always remember with a great deal of pleasure the warmth of hospitality and, above all, the graciousness of our Brit­ ish hosts. Frederick C. Cordes. THE PINHOLE TEST The pinhole is one of the most ancient, use­ ful, and instructive of optical devices. The pinhole camera, invented by Porta nearly 400 years ago, is still the only means by which architects can obtain details of buildings entirely free from distortion. In ophthal­ mology the simple pinhole often rapidly indi­ cates the basis of faulty vision. This important screening test, though neg­ lected by older authorities such as Roosa and Alger, is discussed in all recent texts on re­ fraction but in insufficient detail. Duke-Elder, with characteristic accuracy and conciseness,

states in his Textbook of Ophthalmology (volume I V ) : "In general, the stenopeic hole improves to a great extent visual defects due to refractive anomalies, to a less extent those due to abnormalities in the media, but does not ameliorate and may even aggravate those due to faulty perception." In normal ocular refraction the pupillary area is filled with rays from each point of the object which, in turn, are refracted to a corresponding point on the retina. If the ocu­ lar refraction is not true, the retina truncates the image cone of rays and the sequential blur is in proportion to the diameter of the diffusion circles that now represent each point of the object. The prescribed lens lessens the diameter of the diffusion circles in accordance with the efficiency of the cor­ rection. The pinhole, in contracting the base of the image cone, likewise reduces the diffusion circles. If the correction worn, although im­ perfect, improves the acuity, the pinhole over the glass gives better results than when placed before the naked eye since the glass has already aided in changing the slant of the image rays. Good vision with the pinhole merely shows that the macula has normal function but does not imply that the perceptive apparatus is intact. I have observed a myope with 20/20 pinhole vision in an eye that had a detachment with hole in the superior tempo­ ral quadrant. The reduction of light produced by the pinhole must be compensated by supple­ mental lighting of the chart to assure the fullest pinhole acuity. Bane demonstrated that the intensity of illumination normally determines the optimum-size pupil for best vision. With eyes under full mydriasis and cycloplegia but accurately corrected, the best acuity with high illumination was obtained with a 2.0-mm. artificial pupil but for low illumination the most efficient aperture was 8.0 mm. The minimal useful diameter of the stenopeic hole is set by diffraction. At 2.0 mm. this complicating factor is slight but,