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The Ocular Movements
American Journal of Ophthalmology Series 3, Vol. 6, No. 2
February, 1923
P U B L I S H E D MONTHLY BY T H E O P H T H A L M I C PUBLISHING
COMPANY
EDITORIAL STAFF EDWARD JACKSON, Editor, 217 Imperial Bldg., Denver, Colo. M. URIBE-TRONCOSO, 143 W. 92nd St., New York City. MEYER W I E N E R , Carleton Bldg., St. Louis, Mo.
CLARENCE LOEB, Associate Editor, 25 E. Washington St., Chicago, 111. CASEY A. WOOD, 7 W. Madison St., Chicago, 111. HARRY V. WURDEMANN, Cobb Bldg., Seattle, Washington.
Original papers, correspondence, and other scientific communications should be ad dressed to the Editor. Books for review may be sent to any member of the editorial staff. Reports of society proceedings should be sent to Dr. Harry S. Gradle, 22 E. Washington St., Chicago, 111. News items should be sent to Dr. Melville Black, Metropolitan Bldg., Denver, Colo. Proof should be corrected, and returned within forty-eight hours to the printers. Re prints may be obtained from the printers, Tucker-Kenworthy Co., 501 S. La Salle St., Chicago, 111., if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. Copy of advertisements must be sent to the Manager by the fifteenth of the month preceding its appearance. Subscriptions, applications for single copies, communications with reference to adver tising or other business, should be addressed to the Manager of Subscriptions and Adver tising, JEAN MATTESON,
Room 1209, 7 West Madison Street, Chicago, 111.
T H E OCULAR MOVEMENTS. The five papers dealing in different ways with these movements, which are published in this issue, indicate that ophthalmologists are still studying the disorder of ocular movements, with the feeling that the problems they present have not yet been fully solved. A close examination of these papers shows widely separated points of view, with corresponding differences in what ap pear to the different writers as the most important facts. Opinions di rectly opposed to one another, on defi nite questions of theory or fact, are still held by thoughtful men of large experience. By these different and opposing views brought into close contrast, we can at least be reminded that the subfeet is broader than any one writer or reader has yet appreciated. Careful thought has lead one in a certain direc tion to facts of value that lie beyond the usual text-book survey of the sub ject. The study and experience of an other have reached a similar result in a wholly different direction. The im portant lesson is forced on our atten tion that the thinking and observation lie
of each individual is carried along on too narrow lines. Each observes some facts that others do not, but he also fails to observe other things, that some of his confreres deem most important. The kind of papers most needed on this subject are papers recording more exact and extended observations. One writer has reported so many hundred cases of squint, with a certain percent age of "cures;" but without any defi nite statement of what constitutes a "cure." How many of these "cured" patients had full fields of fixation; how many habitually used the binocular vi sion that they had? Was the fusion sense dominant in all their ocular movements, or did it only control them at times? To what degree was the power of binocular vision devel oped; could they just become con scious of the double images of a bright light in a dark room, could they just perceive relative "depth" of gross ob jects; or could they show a normal ability to judge relative distance by re fined modern tests for depth percep tion? A few cases reported, with inclusion of all the facts that we have learned to
148
EDITORIALS
recognize as significant with regard to ocular movements, would be worth more than many hundreds of reports of "cures," such as we find in the lit erature; even altho these reported cures are supported by photographs showing that the cosmetic defect, the deviation from the normal appearance of the eyes in human beings, has been removed. In the absence of such reports, the best we can offer in the literature of oc ular movements are the ripened con clusions of colleagues, who have long observed their patients closely, accord ing to the older methods; and have thought deeply about the work they were doing. Such conclusions are the outstanding characteristics of the papers published in this issue. We can try to understand these views from reading, and then we can put them to the test of experiment in actual cases. The careful watching and recording, to the end, of one such case, noting care fully and fully its progress thru many years, as to development both before op eration and afterward, even if such case record is never published, will have a very high educational value for the observer and recorder. The papers on cataract extraction, three of them in this issue, illustrate how it is possible to watch every com plication and outcome of an operation. But the cataract operation is a com paratively standardized operation, done for hundreds of years, generally on old people, with little chance of further development. Squint develops with the developing organism, is oper ated for in early life, when further de velopment and the occupations and oc currences of a lifetime are likely to modify the results. It is more worthy of such minute study as has been given to cataract. Comitant squint is a disorder of co ordination, a fault of the central ner vous system, not of a muscle. The emphasis placed on this by the veteran Landolt may help to correct the error perpetuated by writing about the "squinting eye" or the "contracted" or "weak muscle." Full appreciation of this may carry the student even fur
ther than Landolt has gone. Alexan der's analysis of "vergence" follows lines that differ from the teachings of Stevens, or of most textbooks. They must prove suggestive to all who care fully consider them. The conclusions of McCool and Fox are those of prac tical experience. They suggest that there are still facts that must be har monized with theories before these can be accepted as established. The re view of some things that have actually been done in the way of transferring a particular function from one muscle to another must prove suggestive to any one who carefully considers it. Some of the most advanced work with regard to ocular movements has been done in America, by physiolo gists as well as by ophthalmic surgeons. This is being admitted by the space given in recent European journals to views heretofore considered strictly American, and is indicated by the in vitation of an American to open the discussion of this subject before the Section on Ophthalmology of the Brit ish Medical Association. It is greatly to be desired that the studies and dis cussions and teachings in regard to ocular movements shall still go for ward in America to greater exactness, broader coordination, more definite reasoning, and the test of intelligent, rigid, clinical experiment.
E. J. PASTEUR AND EXPERIMENT IN OPHTHALMOLOGY. The centennial celebration of the birth of Louis Pasteur (December 27, 1922), who laid the foundations for scientific medicine and surgery, should bring to the mind of every student and practitioner of ophthalmology some appreciation of the real character and importance of scientific experiment. Pasteur was trained in physical sci ence; and especially chemistry, at the time when exact experiment had just placed it on a truly scientific basis. He carried over into his biologic investi gations of fermentation, alleged spon taneous generation, putrefaction and disease, a supreme faith in the value
February, 1923
P U B L I S H E D MONTHLY BY T H E O P H T H A L M I C PUBLISHING
COMPANY
EDITORIAL STAFF EDWARD JACKSON, Editor, 217 Imperial Bldg., Denver, Colo. M. URIBE-TRONCOSO, 143 W. 92nd St., New York City. MEYER W I E N E R , Carleton Bldg., St. Louis, Mo.
CLARENCE LOEB, Associate Editor, 25 E. Washington St., Chicago, 111. CASEY A. WOOD, 7 W. Madison St., Chicago, 111. HARRY V. WURDEMANN, Cobb Bldg., Seattle, Washington.
Original papers, correspondence, and other scientific communications should be ad dressed to the Editor. Books for review may be sent to any member of the editorial staff. Reports of society proceedings should be sent to Dr. Harry S. Gradle, 22 E. Washington St., Chicago, 111. News items should be sent to Dr. Melville Black, Metropolitan Bldg., Denver, Colo. Proof should be corrected, and returned within forty-eight hours to the printers. Re prints may be obtained from the printers, Tucker-Kenworthy Co., 501 S. La Salle St., Chicago, 111., if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. Copy of advertisements must be sent to the Manager by the fifteenth of the month preceding its appearance. Subscriptions, applications for single copies, communications with reference to adver tising or other business, should be addressed to the Manager of Subscriptions and Adver tising, JEAN MATTESON,
Room 1209, 7 West Madison Street, Chicago, 111.
T H E OCULAR MOVEMENTS. The five papers dealing in different ways with these movements, which are published in this issue, indicate that ophthalmologists are still studying the disorder of ocular movements, with the feeling that the problems they present have not yet been fully solved. A close examination of these papers shows widely separated points of view, with corresponding differences in what ap pear to the different writers as the most important facts. Opinions di rectly opposed to one another, on defi nite questions of theory or fact, are still held by thoughtful men of large experience. By these different and opposing views brought into close contrast, we can at least be reminded that the subfeet is broader than any one writer or reader has yet appreciated. Careful thought has lead one in a certain direc tion to facts of value that lie beyond the usual text-book survey of the sub ject. The study and experience of an other have reached a similar result in a wholly different direction. The im portant lesson is forced on our atten tion that the thinking and observation lie
of each individual is carried along on too narrow lines. Each observes some facts that others do not, but he also fails to observe other things, that some of his confreres deem most important. The kind of papers most needed on this subject are papers recording more exact and extended observations. One writer has reported so many hundred cases of squint, with a certain percent age of "cures;" but without any defi nite statement of what constitutes a "cure." How many of these "cured" patients had full fields of fixation; how many habitually used the binocular vi sion that they had? Was the fusion sense dominant in all their ocular movements, or did it only control them at times? To what degree was the power of binocular vision devel oped; could they just become con scious of the double images of a bright light in a dark room, could they just perceive relative "depth" of gross ob jects; or could they show a normal ability to judge relative distance by re fined modern tests for depth percep tion? A few cases reported, with inclusion of all the facts that we have learned to
148
EDITORIALS
recognize as significant with regard to ocular movements, would be worth more than many hundreds of reports of "cures," such as we find in the lit erature; even altho these reported cures are supported by photographs showing that the cosmetic defect, the deviation from the normal appearance of the eyes in human beings, has been removed. In the absence of such reports, the best we can offer in the literature of oc ular movements are the ripened con clusions of colleagues, who have long observed their patients closely, accord ing to the older methods; and have thought deeply about the work they were doing. Such conclusions are the outstanding characteristics of the papers published in this issue. We can try to understand these views from reading, and then we can put them to the test of experiment in actual cases. The careful watching and recording, to the end, of one such case, noting care fully and fully its progress thru many years, as to development both before op eration and afterward, even if such case record is never published, will have a very high educational value for the observer and recorder. The papers on cataract extraction, three of them in this issue, illustrate how it is possible to watch every com plication and outcome of an operation. But the cataract operation is a com paratively standardized operation, done for hundreds of years, generally on old people, with little chance of further development. Squint develops with the developing organism, is oper ated for in early life, when further de velopment and the occupations and oc currences of a lifetime are likely to modify the results. It is more worthy of such minute study as has been given to cataract. Comitant squint is a disorder of co ordination, a fault of the central ner vous system, not of a muscle. The emphasis placed on this by the veteran Landolt may help to correct the error perpetuated by writing about the "squinting eye" or the "contracted" or "weak muscle." Full appreciation of this may carry the student even fur
ther than Landolt has gone. Alexan der's analysis of "vergence" follows lines that differ from the teachings of Stevens, or of most textbooks. They must prove suggestive to all who care fully consider them. The conclusions of McCool and Fox are those of prac tical experience. They suggest that there are still facts that must be har monized with theories before these can be accepted as established. The re view of some things that have actually been done in the way of transferring a particular function from one muscle to another must prove suggestive to any one who carefully considers it. Some of the most advanced work with regard to ocular movements has been done in America, by physiolo gists as well as by ophthalmic surgeons. This is being admitted by the space given in recent European journals to views heretofore considered strictly American, and is indicated by the in vitation of an American to open the discussion of this subject before the Section on Ophthalmology of the Brit ish Medical Association. It is greatly to be desired that the studies and dis cussions and teachings in regard to ocular movements shall still go for ward in America to greater exactness, broader coordination, more definite reasoning, and the test of intelligent, rigid, clinical experiment.
E. J. PASTEUR AND EXPERIMENT IN OPHTHALMOLOGY. The centennial celebration of the birth of Louis Pasteur (December 27, 1922), who laid the foundations for scientific medicine and surgery, should bring to the mind of every student and practitioner of ophthalmology some appreciation of the real character and importance of scientific experiment. Pasteur was trained in physical sci ence; and especially chemistry, at the time when exact experiment had just placed it on a truly scientific basis. He carried over into his biologic investi gations of fermentation, alleged spon taneous generation, putrefaction and disease, a supreme faith in the value