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D D n n n n D D Coloured pages/ Pages de couleur Pages damaged/ Pages endommagies Pages restored and/or laminated/ Pages restaurdes et/ou pelliculdes Pages discoloured, stained or foxed/ Pages d6colories, tachet^es ou piquies Pages detached/ Pages ditachdes Showthrough/ Transparence Quality of print varies/ Quality inigale de I'impression Includes supplementary material/ Comprend du materiel suppl^mentaire Only edition available/ Seule Edition disponible Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc.. ont ^Xh filmies d nouveau de facon d obtenir la meilleure image possible. 1 s 1 V d e b ri ri n This item is filmed at the reduction ratio checked below/ Ce document est filmd au taux de reduction indiqui ci dessous. 10X 14X 18X «v I I i I I / 12X 16X 20X 24X 28X 32X Th« copy filmed h«r« has b««n raproducad thanks to tha ganarosity of: Medical Library McGill University Montreal Tha imagaa appaaring hara ara tha baat quality possibia eonsidaring tha condition and lagibility of tha original copy and in kaaping with tha filming contract spacificationa. Original copias in printad papar eovars ara fflmad baginning with tha front covar and anding on tha last paga with a printad or illuatratad impraa- sion, or tha back covar whan appropriata. All othar original copias ara fiimad baginning on tha first paga with a printad or illuatratad impras- sion. and anding on tha last paga with a printad or illustratad impraasion. Tha laat racordad frama on aach microficha shall contain tha symbol —^(moaning "CON- TINUED"), or tha symbol V (maaning "ENO"), whichavar appliaa. Maps, piatas, charts, ate, may ba fiimad at diffarant raduction ratioa. Thoaa too larga to ba antiraly inciudad in ona axpoaura ara fiimad baginning in tha uppar iaft hand comar, laft to right and top to bottom, as many framaa aa raquirad. Tha following diagrama illuatrata tha mathod: L'axamplaira fiimi fut raproduit grflca A la g4n4rositi da: Medical Library McGill University Montreal Laa imagaa suivantaa ont tti raproduitas avac la plua grand soin, compta tanu da la condition at da la nattat* da l'axamplaira film«, at 9n conformitA avac las conditions du contrat da fiimaga. Laa axamplairaa originaux dont la couvartura an papiar aat imprimte sont filmte 9n commandant par la pramiar plat at an tarminant soit par la darniAra paga qui comporta una amprainta d'Impraasion ou d'illustration. soit par la sacond plat, salon la cas. Tous las autras axamplairss originaux sont fllmte an commandant par la pramiAra paga qui comporta una amprainta d'Impraasion ou d'illustration at an tarminant par la darniAra paga qui comporta una talla amprainta. Un daa symbolaa suivants apparaitra sur la damiAra imaga da chaqua microficha, salon la caa: la symbols — ^signifla 'A SUIVRE", la symbols V signifia "FIN". Laa cartaa, pianchas, tablaaux. ate, pauvant dtre fiimte ji daa taux dm rMuction diffirants. Lorsqua la documant aat trop grand pour fttre raproduit m un saul cliche, il aat fiimA i partir da I'angia sup4riaur gaucha, da gaucha d droite, at da haut 9n baa, an pranant la nombra d'imagas n^cassaira. Las diagrammas suivants illuatrant la m^thoda. 1 2 3 1 2 3 4 5 6 I'n Re ^5" THE RETROBULBAR NEURITIS OF YOUNG ADULTS. Hy c vsi:v a. wood, m d., ""•'"•>^'an.i.V,ms,totlu.Al..xianHos„i,al 1. ( iiicaL'ii ; Reprint ,.o„ The Oph.h.,„,c Record, N«hvi„., T.nn. N \-^ll\ II. 1. 1:. TKSN.: A. K. i.HK\ \ v,,s. |1,„,K KM, ,|„U I'KINTKH- by J. c2b O Caxnj A. ]\\mi, M.D. I UK KKTkOlU'IJiAR NKURITISOI- VOUNG ADULTS. Wiill.ii l.n llif 0|)|itll;llliiic l:..(ur.| l.y CASKV A. wool I, M.D., rrofeos..! of Ophthalmology in the rost.(;railuate Me.Jic.l School. Chicago ; Oculist and Aurist to the Alexian Hospital. Not very muoli sj)!i('e is devotod to \\\o ahovo sultjoct in most tt'xt Itonks :iii(l yet there are few disoascs uf -^renter interest to the uiihthalniolo^Mst That the nervous humlles su|)i)lic(l to the niaeular region should, in orbital neuritis, suffer to the ahnost eonstant exclusion of those ^'iven oft" to the uiore perijjheral parts of the retina is eertainly a curious fact. It ini;;ht also he ailded that although, thanks to the labors of Sanielsolm, Vossius and others, we know a very great deal about the relations, course, shape, and size (relative and absolute) of the affected fibre-bundles and are thus abl.« to ^-xplain the central amblyopia and scotomata, no rational explanation has, so for as I am aware, been given as to why the acute morbid process should almost invariably first shr»w itself in, and be confined to, these particular bundles. N<» one reading rhthoft"s essay,* wherein the anatomy--normal and pathological — of the macular bundles is thoroughly diseus.sed, can say that either their |)osition, their size, their nutritive supply, or their minute structure W(tuld, from what we know of peripheral neuritis, render them more liable to acute lullanimatory attacks than any of the surround- ing bundles. The writer in the Tr(til<' Com/ilil, or as given by DeWecker and .Masselon.l jtoslulates an increasing poverty of lymph annis. course an.I termin-i tion between the more peripheral forms of the so calle.l Mcll's J.aralysis an.I an ordinary attack of acute orbital optic neuritis Most cases of acute retrobulbar neuritis in youn^^ people .^et well. I am indineil to believe that where an attack termin-.U's in general atrophy and partial (or f.talj blindness, the result is «5S •* Cntey A, Woal M.T). due to pressure upon the nerve for an unusual time, and is asso- elated with dropsy of the nerve shcatli, orbital periostitis or with ^irowths within the orhit. In tliose instances, on the other han«l, (constituting' the ^^reat majority) that end in perfect or almost perfect recovery, the morbid process has either been confined to the body of the nerve itself, or the accoinpsinyinr^ disease in the orbital walls or in the walls of the foramina opening,' into the orbit has not, to any extent, disturbed the nutrition of the delicate optic bumlles. The following' ease presents some peculiarities, especially the implication of the pupillary and inferior rectus branches of the third nerve, and the suspicion of hysteria E. S., school teacher, tet. 2^], consulted me May 'J^jnl, (.f last year. She presents a decidedly auiemic a|)pearance, suffers fr(»m constipation and some loss of appetite, has not now and has never had any disease prior t(t this year but "muscular rheumatism," sleeps very well, always menstruates regularly. Shortly before seeing me she ha.l an attack of la grippe (?), i. c, suffered from severe pain in the head, which soon extcniled to the right eye and affected her vision, which hitherto had been very good; no fever with it. R. \. ._: r^^^ \\ L :. '^^^ . Ordered m.x. of tr. ferri. mur. in a uiorning saline draught, out door exercise, plenty of good food and, as a concession, to the muscular '•rheumatism " aforesaid, medium doses of sodic salicylate Kxamined further the bulbs were both found to be tender on pressure, the tender- ness extending above the supra-orbital notch on either side, and ocular excursions K. are decidedly painful. -Veiling pains occas- ionally in the eye-balls, Scotomata for red and green, and white is seen as grey in the centre of right field. IJjerrum's darkest II type seen by the right eye at 4' only. The left also shows diminished light sense. May 2oth, K. V. = """ XL " Daily at ").30 P. M , pilocarpine mur. gr. i with copious drinks of hot lemonade and retirement for the night This dose whs gra«lually increased until gr. ] was reached on .May 'IX. Then ■jii ill and Jiiger ij: \ . K. and Jiiger xvj. June L'nd. V. L. Stopj»ed sod. salicyl. and began Kl. gr. 7^ t. i. d. increasing it gradually to 20 grs. Some pain in eye-ball, but no tenderness or pain on motion. Kerrated malt, beef steaks, milk, cream and Hdrohulcar N.'urifh of )'.>»„,, A.l„Ifs. g <'Ws. V L with 4- .25 o -I 7o c 7a" - -■" T .l-.i-ti,.., n • • u , •"^•^•' - :,,. Juno Hth, occiisional l»i a niontli returned with V R. -" .,,,,1 v I _ -" '^^^li... vn., well. 8u.h.onl,, ...1 wuiLa warni:,;^,;:;.:, Ihl '•'7''' •'••^•'--•-n,..t eye;- There i.s narked ;re«i. oft cxt. rectu.s; the left ho,„onyn.o..s i,na,e stands a little hi^h.; t a.. li .and at 20', with head in prinKu-v position, is ahont- Hon. other. Ordered KI. .r. xx, and a saline iron nnxt. Julv '» B.>n.e nnproven.ent. Has now decided nun.bness in tips of (h.".-' <'-•« of hoth hands (last year had numbness of for.-head, ; hut tlu^ l'''i"7n«oaI reflex is well preserved, and eannot discover other nni.eafons of hysteria. Ordered candle and red-.h.ss exercise Some nausea. .July 22. IWsis mueh improved, hut symptoms o neur.t.s are now well shown in left eye ,V ^-..- ) with n.ark- e.lunprovcmentinri^ht(V.._-, IMister in "hoth temples •■^'P^>"t-1 several times. Klix. pepsin, his. and strvch. after m.^als' Stopped KI and iron mixture. J,,|y 2:}. Patient now sees only ^,^, L,and R ^IL _. Much pain. 1 cannot di^tin.M.ish .".y letters of Uj.rrun. at any distanc.. with either eye. Next 'l';y N l - fi..;;ersat 4'. 1,. a week he;;an KI in lar^e dose. with plentiful additions to .lii-t Au;,'. 1. V R _ ^" . y I^=--,:l'. Nausea and vomitin-, //->/ after food. Some .sup ra- "'■'»'^='' P-'i". Syrup hypophosphites. Au;,'ust 10, V L = ^;; ; \ li ;'; . Appetit. and sleep good, hut pains in arms and le''".s- weight IDS ||,s. " ■ On Oct. 20th, patient weighed 12.'J lbs. V R =z f _V L ---= '''it'HTcye J. ij slowly, hut with -f O.To /.7.v.,""j j slowly No scotoM.ata, and light sen.se fair. Is looking ami feeling we'll and had s,, continued several months afterwards when she rmsse.l fV'.m my observation. There were absolutely no fundus changes throughout. .'II I'll • 1 30 H Right ('s his brother of the re;.'ular s(dio(d would, in a similar ease, attack the disease with ///.■< incantations but he would probably not lie so certain i>\' tlieir positive efficacy nor have rushed into jirint about it all. i ^ A> 31 f K iji-. si,,i„.,-,'„i- ,i,i, ,.,-,;, ; "'■" ""- '■'"'•'•"tiv n.rlin,l ,.„ ,l,„i , "'»'■•«" an, lar..,- ,„„il l„. .,„.,,„„. ,,;i„ «■»« f.-veri,i, ;,;,'' r'n •"" -'"•"•"'■^i'^'' p-"^* i t"m» w..,-,. s.ill present wluM, I saw hi,,, n ll,,^ ■"!'• -mbolis „l „,C, I, ,,,;"" '"• '^'""' ••vi'l-.cc.,s'„r ':'I>'"-"V outline w.,s obsorvo.l on tie nasul si, ' 7 ly ••'^'"n o'-tl.in,,s eontinu.l fo. six wook l ,, 1: •. Tr'" --'•;- ^;'-''--l -alin.. fixture contai,nJS.::so'KI t^.oet.n.a... nu-a,. toWin.reasea.,.„Ll^^^^ ^i.>-r';,.e:n::;r^i:r;;:;;tr -'".v. Apr, K fi...er.-, ' nl ' ^ " fi"^'ers at O" ocoentri- 'i^'l'i- Apr ,; r.7;'''V!"'';^\'"'I'^«"^-^"^'^«'^'''^^ No color '•>'t per,plu.n.l vision goo.l. Apr 2-> V^-^ %.. />/^//;- *' *^'- — ' * m' (i5ce perimeter /^/S^ 6 ''S 't- 3:i n (W// .1. irood, MD. chart). Apr. 28, V ^J^ and aoiiic wonis of Jii^'cr x Klo.'tiioity. May 3. V ^; _«n,l .l.x. May 0, J.ij and \ May 10, with sph. -f- 1. 1) J.i and \' ■*' — I ii at 125 cm In Tl Iniproviiijj; diii ii- pennu'tric nioasurcMncnts wtM-o both takon for white, in tho final trial red and j;reen wtMo not correctly made nut in an area twice as lar^^e as the scotoma for white which was not (juite ibsolutt (seen a.s grey) towanls the na.sal side I I