- Email: [email protected]
The Seeing Eye, Inc.
VOL. 68, NO. 6
1123
CORRESPONDENCE
nerve, neither blepharoptosis nor sinking of the globe results. The paratrigeminal syn drome may occur with aneurysm of the in ternal carotid, tumor, basal skull fracture, herpetic infection spreading from the gasserian ganglion or other inflammatory cause. In Horner's syndrome, miosis is constant but its degree varies with the site of the le sion. The syndrome is most typical when the cervical sympathetic is involved. Diagnostic tests to determine the involved neuron are aided by the responses to cocaine and epinephrine. The instillation of cocaine, 2 % to 4%, dilates the pupil normally or if Neuron I is affected; but when Neurons II or III are involved, no mydriasis results. Epinephrine (1:1000) has no effect on the normal pupil, but dilatation occurs after its sympa thetic denervation. The dilatation is marked when the lesion is postganglionic (Neuron I I I ) , much less when preganglionic (Neuron II) and nil in lesions of Neuron I. The pres ence or absence of perspiration on the face can be objectively demonstrated by the starch-iodine sweat test, or by the resistance of the skin to an electric current. Because of the extended course of the ocular sympathetic fibers, Horner's syn drome may involve almost every field of medicine, as exemplified by its presence in syringobulbia, thrombosis of the inferior cerebellar artery, syringomyelia, spinal tabes, tumor or injury to the spinal cord, cervical rib, osteochondroma of the first rib, apical lung lesions of tuberculosis or cancer, aneu rysm of the aorta or subclavian artery, tumor or enlarged glands in the mediasti num, pathologic thyroid enlargement, Hodgkin's disease, tumor at the superior orbital fissure and the conditions previously noted. Horner's syndrome may even be hereditary. If congenital, heterochromia iridis eventuates from the loss of iris pigment on the affected side. James E. Lebensohn
CORRESPONDENCE T H E SEEING EYE, INC.
Editor, American Journal of Ophthalmology : For the information of colleagues who are interested in the rehabilitation of blind pa tients, I should like to clarify a point that has arisen in recent years concerning waiting lists for those who apply for mobility train ing at The Seeing Eye, Inc., Morristown, New Jersey. This is America's oldest and largest dog-guide school (and the one with which, as a trustee, I am most familiar). For several years now, it appears, there has been a widespread misapprehension about the existence of long waiting lists at The Seeing Eye. The fact is that The Seeing Eye can comfortably accommodate 200 or more men and women per year but, on the average, currently graduates only 165. The average waiting time for men between ac ceptance of their applications and their ar rival in Morristown is less than six weeks; the waiting period is somewhat longer for women. It may also be of interest that round trip transportation from anywhere in the United States and Canada is paid by The Seeing Eye. Our best information—based on a study sponsored by The Seeing Eye and conducted by Columbia University's New York School of Social Work—is that only 2 % of the country's legally blind population (now esti mated at 450,000) are dog-guide users or po tential dog-guide users. In view of this, The Seeing Eye announced 10 years ago that it had sufficient resources for the foreseeable future and that its fund-raising activities would be indefinitely suspended. They have remained suspended ever since. At the same time that it discontinued fund-raising, The Seeing Eye instituted a program of grants-in-aid to other institu tions. Since 1958, more than $3,000,000 has been distributed, with approximately twothirds going to the field of ophthalmology, principally for construction of research fa-
1124
AMERICAN JOURNAL OF OPHTHALMOLOGY
cilities but also for manpower support and research projects. The Seeing Eye also sponsored another study by the New York School of Social Work, "The Role of the Ophthalmologist in the Rehabilitation of Blind Patients." Among the study's many important findings is one which is of particular value here. To use the study's own special language: "The data indicate the possibility that referral ac tivity among ophthalmologists in general is underscaled in relation to the need which ex ists." In other words, many of us ought to be doing more than we are about the rehabil itation of patients who become blind. Ac cording to the study, a brief description of the services of national agencies, such as casework and counseling, vocational rehabili tation, programs of financial assistance, rec reation, low-vision optical aids and other ser vices, including orientation and mobility training programs, should be made available as part of the doctor's professional training. For many years The Seeing Eye has made available a member of its staff to speak to postgraduate classes in ophthalmology and to nurses and groups of professional people who work with blind patients. R. Townley Paton, M.D. Southampton, New York SHAKESPEARE'S OPHTHALMOLOGIC VOCABULARY AND CONCEPTS
tleman from Stratford never lived outside England. It is also my impression that Georg Bartisch, although an itinerant oculist, never traveled beyond the borders of the German states. (See Tower, P . : Arch. Ophth. 56:57, 1956.) The authors suggest that they could have met at court because Bartisch was a "court oculist." Bartisch was indeed a court oculist, but he held his appointment at the court of the Elector of Saxony, not at the royal court of England. Another question: Could Shakespeare read German? He would have had to possess this skill if he read Bartisch's book, because it was written in vernacular German and did not know an English translation during Shakespeare's lifetime. In 1938 the Shakespeare Association pub lished a facsimile edition of "A Discourse on the Preservation of the Sight: Of Melan choly like diseases, of Rheumes, and of Old Age" by M. Andreas Laurentius, translated by Richard Surphlet, 1599. The Association selected this book for republication because they deemed it the best general English work on the eye available in Shakespeare's time. And it well might be. Certainly it can be read with interest and on many points it adds substance to the conclusions reached by Dr. Zekman and Miss Davis. Charles Snyder Boston, Massachusetts *
Editor, American Journal of Ophthalmology: Let me congratulate Dr. Zekman and Miss Davis, as authors, for giving us a most interesting paper, "Shakespeare's ophthal mologic vocabulary and concepts" (Am. J. Ophth. 68:1, 1969). I have one question to ask the authors : What is the source of their information on the meeting of William Shakespeare and Georg Bartisch? (See last paragraph on page 3.) I am not an authority on William Shake speare, but it is my impression that the gen
DECEMBER, 1969
*
*
REPLY TO MR. SNYDER
Editor, American Journal of Ophthalmology : Mr. Charles Snyder's polite and informed "impressions," so far as is known, are cor rect on all counts. We are without rational defense of our tempting but erroneous de duction, to which we succumbed without the sobering habit of verification. Our only source for the regrettably attractive delusion must have been "the foul fiend of flibberti gibbet." It surely blocked our awareness of
1123
CORRESPONDENCE
nerve, neither blepharoptosis nor sinking of the globe results. The paratrigeminal syn drome may occur with aneurysm of the in ternal carotid, tumor, basal skull fracture, herpetic infection spreading from the gasserian ganglion or other inflammatory cause. In Horner's syndrome, miosis is constant but its degree varies with the site of the le sion. The syndrome is most typical when the cervical sympathetic is involved. Diagnostic tests to determine the involved neuron are aided by the responses to cocaine and epinephrine. The instillation of cocaine, 2 % to 4%, dilates the pupil normally or if Neuron I is affected; but when Neurons II or III are involved, no mydriasis results. Epinephrine (1:1000) has no effect on the normal pupil, but dilatation occurs after its sympa thetic denervation. The dilatation is marked when the lesion is postganglionic (Neuron I I I ) , much less when preganglionic (Neuron II) and nil in lesions of Neuron I. The pres ence or absence of perspiration on the face can be objectively demonstrated by the starch-iodine sweat test, or by the resistance of the skin to an electric current. Because of the extended course of the ocular sympathetic fibers, Horner's syn drome may involve almost every field of medicine, as exemplified by its presence in syringobulbia, thrombosis of the inferior cerebellar artery, syringomyelia, spinal tabes, tumor or injury to the spinal cord, cervical rib, osteochondroma of the first rib, apical lung lesions of tuberculosis or cancer, aneu rysm of the aorta or subclavian artery, tumor or enlarged glands in the mediasti num, pathologic thyroid enlargement, Hodgkin's disease, tumor at the superior orbital fissure and the conditions previously noted. Horner's syndrome may even be hereditary. If congenital, heterochromia iridis eventuates from the loss of iris pigment on the affected side. James E. Lebensohn
CORRESPONDENCE T H E SEEING EYE, INC.
Editor, American Journal of Ophthalmology : For the information of colleagues who are interested in the rehabilitation of blind pa tients, I should like to clarify a point that has arisen in recent years concerning waiting lists for those who apply for mobility train ing at The Seeing Eye, Inc., Morristown, New Jersey. This is America's oldest and largest dog-guide school (and the one with which, as a trustee, I am most familiar). For several years now, it appears, there has been a widespread misapprehension about the existence of long waiting lists at The Seeing Eye. The fact is that The Seeing Eye can comfortably accommodate 200 or more men and women per year but, on the average, currently graduates only 165. The average waiting time for men between ac ceptance of their applications and their ar rival in Morristown is less than six weeks; the waiting period is somewhat longer for women. It may also be of interest that round trip transportation from anywhere in the United States and Canada is paid by The Seeing Eye. Our best information—based on a study sponsored by The Seeing Eye and conducted by Columbia University's New York School of Social Work—is that only 2 % of the country's legally blind population (now esti mated at 450,000) are dog-guide users or po tential dog-guide users. In view of this, The Seeing Eye announced 10 years ago that it had sufficient resources for the foreseeable future and that its fund-raising activities would be indefinitely suspended. They have remained suspended ever since. At the same time that it discontinued fund-raising, The Seeing Eye instituted a program of grants-in-aid to other institu tions. Since 1958, more than $3,000,000 has been distributed, with approximately twothirds going to the field of ophthalmology, principally for construction of research fa-
1124
AMERICAN JOURNAL OF OPHTHALMOLOGY
cilities but also for manpower support and research projects. The Seeing Eye also sponsored another study by the New York School of Social Work, "The Role of the Ophthalmologist in the Rehabilitation of Blind Patients." Among the study's many important findings is one which is of particular value here. To use the study's own special language: "The data indicate the possibility that referral ac tivity among ophthalmologists in general is underscaled in relation to the need which ex ists." In other words, many of us ought to be doing more than we are about the rehabil itation of patients who become blind. Ac cording to the study, a brief description of the services of national agencies, such as casework and counseling, vocational rehabili tation, programs of financial assistance, rec reation, low-vision optical aids and other ser vices, including orientation and mobility training programs, should be made available as part of the doctor's professional training. For many years The Seeing Eye has made available a member of its staff to speak to postgraduate classes in ophthalmology and to nurses and groups of professional people who work with blind patients. R. Townley Paton, M.D. Southampton, New York SHAKESPEARE'S OPHTHALMOLOGIC VOCABULARY AND CONCEPTS
tleman from Stratford never lived outside England. It is also my impression that Georg Bartisch, although an itinerant oculist, never traveled beyond the borders of the German states. (See Tower, P . : Arch. Ophth. 56:57, 1956.) The authors suggest that they could have met at court because Bartisch was a "court oculist." Bartisch was indeed a court oculist, but he held his appointment at the court of the Elector of Saxony, not at the royal court of England. Another question: Could Shakespeare read German? He would have had to possess this skill if he read Bartisch's book, because it was written in vernacular German and did not know an English translation during Shakespeare's lifetime. In 1938 the Shakespeare Association pub lished a facsimile edition of "A Discourse on the Preservation of the Sight: Of Melan choly like diseases, of Rheumes, and of Old Age" by M. Andreas Laurentius, translated by Richard Surphlet, 1599. The Association selected this book for republication because they deemed it the best general English work on the eye available in Shakespeare's time. And it well might be. Certainly it can be read with interest and on many points it adds substance to the conclusions reached by Dr. Zekman and Miss Davis. Charles Snyder Boston, Massachusetts *
Editor, American Journal of Ophthalmology: Let me congratulate Dr. Zekman and Miss Davis, as authors, for giving us a most interesting paper, "Shakespeare's ophthal mologic vocabulary and concepts" (Am. J. Ophth. 68:1, 1969). I have one question to ask the authors : What is the source of their information on the meeting of William Shakespeare and Georg Bartisch? (See last paragraph on page 3.) I am not an authority on William Shake speare, but it is my impression that the gen
DECEMBER, 1969
*
*
REPLY TO MR. SNYDER
Editor, American Journal of Ophthalmology : Mr. Charles Snyder's polite and informed "impressions," so far as is known, are cor rect on all counts. We are without rational defense of our tempting but erroneous de duction, to which we succumbed without the sobering habit of verification. Our only source for the regrettably attractive delusion must have been "the foul fiend of flibberti gibbet." It surely blocked our awareness of