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sketch of the history of o[ihthalmology. Immediately after the discovery of the ophthalmoscope it was taken up by men of great mental calibre — A. von Graefe, in Berlin, E. Jaeger, in Vienna, and others. At that time every look into the eye was a discovery, but the scope of the instrument is so great that even at the present time it is still the most powerful means of oph- thalmological research. With it we can study, better than with anything else, pathological anatomy in the living. Hemorrhages and their changes, embolism, in- farctions, thrombosis, inflammations of all kinds, foreign bodies, cleocin 100 mg and a multitude cleocin 2 of other anomalies, we can follow up with a precision that even surpasses that afiorded by the post mortem table. Moreover, we do not only see the disease in one given condition ; we watch its beginning, course, and termination ; we have the natural history of the disease before us. The cleocin 900 mg possibility objectively to de- termine with the ophthalmoscope the refractive condition of the eye and its many anomalies and degrees, is one of the finest accomplishments of the well educated physician. Professor Helmholtz, however, did not stop at the invention of the ophthalmoscope. He went over the whole field of physiological optics. There was not the remotest corner that cleocin antibiotic he did not personally cultivate, criticising, verifying, correcting, and cleocin 600 mg broadening every branch of this immense and exceedingly beautiful depart- ment of cleocin suppositories natural science. The outcome is a classical treatise which I pass round, a whole storehouse of knowl- edge to which your teacher and a great many other re- tailers daily go to buy and borrow. I will mention some of the most remarkable discov- eries in optics, and advances made in ophthalmology, which, besides the invention of the ophtl almoscope, we owe to Helmholtz. One is the discovery of the mech- anism of accommodation — that wonderful faculty by which the healthy eye is enabled to see objects near by and immediately afterward, with the velocity of lightning, others at an immense distance. The mechanism of this faculty was not understood, 770 MEDICAL RECORD. [December i6, 1893 though discussed for centuries, till Professor Helmholtz solved it through another instrument of his invention which you see here, the ophthalmometer. Up to that time it was thought that the e.^trinsic muscles of the eye compressed the eyeball and made it more spherical. This view had to be given up, because, though possible, it was not true. Some thought that the crystalline lens moved to and fro and changed the focus, just as the focus is changed in the photographer's camera. This view had also to be given up because cleocin cream acne it was not true. Profess- or Helmholtz found that accommodation was due to the action of the muscles called the muscles of accommoda- tion, rendering the crystalline lens more convex, so that its refractive power becomes nmch greater. An image reflected from a convex surface is smaller than the original object, the reduction in size being in proportion to the degree of convexity of the refracting surface. Professor Helmholtz measured the sizes of the images reflected from the lens when the eye was at a state of rest, and then again when it was under the strain of accommodation, and found that they had become smaller. As there had been no change of distance of the object from the eye, the difference in size between the images could be accounted for only by a change in the refrac- tive power of the mirror, that is, the anterior surface of the crystalline lens. This proved true, and all discussion on this question was ended. It was a truth which, when once recognized, is a truth forever. Professor Helmholtz not only discovered the law of accommodation, its existence, I may say the quality of this phenomenon ; cleocin tablets but, like a true natural philosopher, went on to ascertain its quantity. He measured how much smaller that image had become, and from the small- ness of the image he could judge of the radius of curva- ture of the surface which produced it. This change of radius of curvature in the refractive power represented a quantity which was equal to what we call the range of accommodation. This was the solution of this very obscure phenomenon which had occupied the best minds a long time. It was as fruitful as it was brilliant. With the ophthalmometer, Helmholtz and his follow- ers found the remarkable and very important fact that the eye is not a sphere : that its horizontal and vertical diameters are not equal. In other words, the eye is an ellipsoid, and therefore produces a very peculiar kind of refraction. It gives a dispersion image which terminates in two straight lines at right angles to each other. This peculiarity was soon recognized as a defect in all eyes, diminishing the acuteness of vision more or less. Its recognition enables us, by the use of cylindrical glasses, to correct defective vision in multitudes of people. By a modification of Helmholtz's ophthalmometer, made by Javal and Schiotz, the difference between the vertical and horizontal meridians can now be determined in a very short time — several minutes — and the correcting glasses prescribed. Gentlemen, I might go on in this way, but I do not want to consume too much time. I only beg to say a few words still with regard to the usefulness of the ophthal- moscope as applied to practical medicine. I have here a few drawings to illustrate what can be done with the in- strument. The examples in which the ophthalmoscope has proved useful, count by hundreds. Here, on the wall, you see a picture of the normal background of the eye, and another in which the course of the blood-vessels is interrupted at the margin of the optic disk. This second picture cleocin topical gel represents the eyeball under increased tension, a disease which is called glau- coma. The eyeball being too tight, the pressure acts upon that part which is most feeble, most yielding — that is, the cribriform membrane through which the fibres of the optic nerve pass. This disease is not infrequent, and up to 1858 was ab- buy cleocin t solutely incurable. Then came Professor Albrecht von Graefe, of Berlin, who found for it a remedy, iridec- tomy, the cutting out a piece of the iris, whereby the cleocin topical solution in- creased intra-ocular tension was relieved and the disease cured. From that time forth every oculist has saved by this operation dozens of eyes every year. It was a great stride. Here also the diagnosis depended upon the oph- thalmoscope. The ophthalmoscope is the best, the most accurate, and the most practical diagnostic instrument to which thousands of our fellow men owe the preserva- tion of sight. Professor von Graefe with his astonish- ing clinical penetration, made many discoveries with the ophthalmoscope which were landmarks in the progress of ophthalmology. Let me cite but one example. In 1858, Professor R. Virchow said in one of cleocin iv his lectures, it must be possible with the ophthalmoscope to see embolisms in the liv- ing, just as he and most other pathologists had seen them, on the post-mortem table. He said the retinal artery lies open to our view ; it divides into two branches, and the time is probably not very far distant when this condition, embolism, will be directly seen, and then it can be studied with all its consequences. I was a student at the time when Virchow made that statement. A week later \on Graefe diagnosed the case at his clinic. He examined the eye by means of the ophthalmoscope, described the con- ditions present, and his description of embolism is still classical. Von Graefe was not only an excellent diag- nostician and pathfinder, but also a great operator. His name ought to be mentioned as one of the first, if not the first, in practical ophthalmology. Dr. Knapp continued his remarks by demonstrating ophthalmoscopic pictures of glioma of the retina and sarcoma ; he dwelt upon the importance the anomalies of refraction and motility had gained of late, and con- cluded with a graceful tribute cleocin t acne to the merit of a young oculist, Dr. Carl Koller, now in our midst, for having, in 1884, introduced the local anaesthetic cocaine into ophthalmic practice. Professor Helmholtz then rose, and, greeted by the students with the most enthusiastic applause, spoke essen- tially as follows : Gentlemen, Professor Knapp asked me to tell you the story of the invention of the ophthalmoscope. In com- plying with his request I must beg your pardon, first, for being obliged to speak of myself; secondly, for my in- sufficient command of order cleocin online the English language. At the time when I devised the ophthalmoscope I was professor of physiology and general pathology in the University of Koenigsberg. My career before had been somewhat erratic. When at school my ardent desire had been to study physics, but physics at that time was a branch of science that did not promise its followers a good livelihood. It is different nowadays. My father told me that he cleocin cost did not see how it was pos- sible to maintain me in the study of physics or inorganic natural science alone, but if I would also take up the biological department, or practical medicine, he could help me, so I went to become a medical man. What for the time was a great disappointment to me, afterward turned cleocin suspension out to be a very lucky event, for it en- abled me to become professor of physiology in the Uni- versity of Koenigsberg. I lectured on all parts of physi- cleocin t pads ology, and so came also to tell my hearers what was known of the human eye and of the eye of animals. I think that no physiologist doubted, until the end of the last century, that the eyes of cats, dogs, oxen, and other mammals, and of birds, developed light of their own which shone forth at night. It seemed to them to be the same process as was observed in the luminosity of insects in the water, etc. Prevost discovered, at the beginning of this century, that the eyes of mammals which appeared luminous pos- sessed a peculiar anatomical structure, that is, what by anatomists is called the tapetum, situated on the back- ground of the eye. This tapetum has a very resplendent surface, is composed of a peculiar kind of very fine fibres, of very regular thickness, which throw off colors like a layer of thin plates, as was discovered by New- ton long ago. This light shone forth from the eye of December i6, 1893] MEDICAL RECORD. 771 the dissected animal just as it did during life, so that it became very probable that the light of the living eye was really not light originally produced by any influence of the nervous system on this organ, but that it was reflected light. At first, however, physiologists who had to speak of these things were rather at a loss to explain how the light could get into the living eye. I must remark that the intensity of the light coming back from such a cleocin oral lu- minous eye is often very surprising. Even if there is no great amount of light in the neighborhood of the ani- mal, the observer can sometimes see the eyes of the ani- mal luminous in a very high degree. From the time of Prevost, say about iSio, at least, doubt awoke as to whether this was not only reflected exterior light. Professor Briicke, of Vienna, made mi- croscopical examinations of the tapetum and its relations to the retina, and endeavored to show that the animal having such a tapetum could get a stronger luminous im- pression from its retina than another without the tape- tum. He said that if there is a tapetum and the light cleocin phosphate is reflected from the background of the eye through the

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