Oculist

“ The ophthalmoscope has become an instrument of incalculable value to the oculist. Many changes in the retina and interior of the eye, which are due to disease, can be observed and examined by means of the ophthalmoscope ”

“ I am firmly convinced that every glaucomatous patient, and I now refer to those who are the subjects of chronic progressive glaucoma, should be carefully studied from the general standpoint by the oculist with the aid of an expert internist, just as I am convinced that the modern expert internist should not study his cases of cardio-vascular disease without the help of the oculist. ”

“ This will cause a flow of the fluid of the eye which will probably wash away the substance.
If this fails, a friend is not likely to have any trouble in removing the object with the corner of a silk handkerchief. Should he find it impossible to relieve you, go without delay to an oculist.
Sometimes the eyes of children have been weakened by sickness, and it is necessary to use spectacles. When a boy or girl feels any peculiar sensation about 39the eyes, or they seem to act wrongly, the oculist should be appealed to at once. ”

“ About the same time he became oculist in ordinary to Queen Anne. During this same year (1705) a poem entitled ‘The Oculist’ celebrated his skill and magnanimity in fulsome terms. In 1706 he published ‘A short but exact Account of all the Diseases incidental to the Eyes.’ The latter portion of the work is occupied with accounts of his cures and of his invention of ‘styptic water,’ which he proposed in many cases to substitute for the barbarous cauterisations in vogue. He claimed as specialities the treatment of cataract and the removal of cancers. ”

“ That the human eye resents glasses is a fact which no one would attempt to deny. Every oculist knows that patients have to "get used" to them, and that sometimes they never succeed in doing so. Patients with high degrees of myopia and hypermetropia have great difficulty in accustoming themselves to the full correction, and often are never able to do so. ”

“ This invention exercises an influence not only on the peculiar branch of the oculist, but likewise on the broad field of medical investigation, seeing it affords an insight into the optic nerve, a direct process of the brain, and other structures, which, along with their analogies, were hidden from observation in the body.
The dimensions of the eyeball among strong-sighted individuals is more equal than you perhaps imagine. ”

“ An hour later he was talking with the famous oculist in Harley Street ... about the advisability of starting reading-glasses. He found it difficult to relate the rest. A curious shyness restrained him.
“Your optic nerves might belong to a man of twenty,” was the verdict. “Both are perfect. But at your age it is wise to save the sight as much as possible. ”

“ Properly to determine the optical error in astigmatic and farsighted eyes it is essential to place drops in the eye, which dilate the pupil and paralyze the muscles that control the convexity of the crystalline lens, and to use instruments and methods of examination, which can only be properly undertaken and interpreted by one with the general and special medical training possessed by an oculist. ”

“ There are scientific distinctions which the oculist who examines your eyes and the optician who is anxious to sell you a pair of glasses will explain between the nearsightedness which compels you to pore over a book, holding it close to your eyes, and the other form which enables you to read the finest print without glasses, and yet debars you from recognizing your wife or mother-in-law half way across the street. ”

“ But, if it be impracticable to apply the atropia, then the ophthalmoscope [5] must be resorted to, as offering the nearest approach to certainty of results when the accommodating-muscle cannot be paralyzed, because its contraction is not very likely to occur under the operation of that instrument. Thus provided, the oculist proceeds to examine the interior of the eye, and, his own eye being normal, and his own accommodation relaxed, if he sees the retina of the examined eye perfectly, he pronounces the refraction to be correct ”

“ One of the early members of the American Ophthalmological Society, he was known as a prominent oculist and teacher, active and very popular throughout his unusually long life. At his last birthday his friends and colleagues tendered him a great ovation at a dinner. ”

“ If, for some special reason, the oculist fears it would be unwise to tell the patient that blindness is imminent, he should at least urge him to conserve his remaining vision, and advise him to do as many things as possible by touch, and warn him of the consequences of eyestrain. But, whenever possible, it is kinder to prepare the patient for oncoming blindness, so that he may shape his life accordingly, and may be induced to learn to read raised type, and use a writing device, before the light is entirely gone. ”

“ I want to be able to consult an oculist who has done nothing but attend to eyes long enough to know all that is known about their diseases and their treatment,—skilful enough to be trusted with the manipulation of that delicate and most precious organ. I want an aurist who knows all about the ear and what can be done for its disorders. The maladies of the larynx are very ticklish things to handle, and nobody should be trusted to go behind the epiglottis who has not the tactus eruditus. ”

“ When discovered it is well to consult a skilled optician as early as possible, who will, if necessary, recommend an oculist if the case requires one. All the defects mentioned above are remediable by use of spectacles if the constitution of the individual is healthy. ”

“ In cases where the inflammation is very severe, the pain very acute, or the vision in the slightest degree impaired, as well as in those accompanied by a discharge of matter or pus, no time should be lost in seeking the services of the oculist. ”

“ You take your watch to a watchmaker, not a chemist; take your eyes to an oculist, and if you cannot afford to see one privately, get an eye-hospital note. (To allow a chemist or "optician" to try lenses until he finds a pair through which you "see better" is very dangerous.) ”

“ The ophthalmia of Egypt leads us through a diversity of symptoms, from slight inflammation and defluxion, to the total and irrecoverable blindness occasioned by opacity of the Cornea. To enumerate them all correctly, and compare them in a variety of cases, must be the task of an oculist long resident on the spot, and accustomed to numerous patients. A transient observer, however diligent in his inquiries, may more easily prove the falsehood of the assigned causes, than trace the real one. ”

“ Certain forms of glaucoma may be inherited, and children whose parents have had this disease should watch their own eyes very carefully, since, if taken in time, the progress of this disease, in certain forms, may be arrested. Persons who see rings around the lights should heed the danger signal and see an oculist. ”

“ In the country it is more difficult, perhaps, to realize these deficiencies, because the constant outdoor life acts [Pg 291] as an offset to the strain during the time when close work is required, and perhaps the distance from a competent oculist serves to postpone the time of consultation, but no greater folly can be indulged in than to suffer inflamed eyes, persistent headache, and imperfect vision, if it is possible in any way to secure the services of an oculist. ”

“ The procedure may be facilitated if the patient is instructed to look down while the operator is drawing the eye-lid upward.
If the particle cannot be easily removed by any of the above methods it is not safe for an uninstructed individual to go any further. The eye is an exceedingly delicate organ and may be permanently injured by unnecessary irritation. It is always safer and it may be cheaper in the long run to consult a competent oculist in such cases. ”

“ Before discussing the prevention of blindness in adults, I wish to say a few words concerning the attitude of oculists toward patients suffering from eye diseases which, in all probability, will result in loss of vision. ”

“ Oculists say that when with the arrival of middle life the focusing power of the eye declines so far that at the usual distance for reading, a sufficient adjusting force no longer exists, it is the preferable thing to put on WEAK MAGNIFYING GLASSES, to take off strain, rather than to postpone their use as long as possible. ”

“ But the hunchback knew what he was about. Ward said of Ump that, in his field, the land of the horse's foot, he was as much an expert as any professor behind his spectacles. His knowledge came from the observation of a lifetime, gathered by tireless study of every detail. Even now, when I see a great chemist who knows all about some drug; a great surgeon who knows all about the body of a man; or a great oculist who knows all about the human eye, I must class the hunchback with them. ”

“ In a majority of cases the best treatment for any of these troubles is an understanding attempt to go to the root of the matter by bracing up the whole mental tone. The most scientific oculists do not try to correct eye trouble due to muscular insufficiency by any special prisms or glasses. ”

“ The shifting of the eye with normal vision is usually not conspicuous, but by direct examination with the opthalmoscope.* When the optic nerve is observed with the ophthalmoscope, movement can be noted that are not apparent when only the exterior of the eye is regarded, it can always be demonstrated. If one eye is examined with this instrument while the other is regarding a small area straight ahead, the eye being examined, which follows the movements of the other, is seen to move in various directions ”

“ You know that the eye has been called the 'window of the soul'. The phrase is trite; but it contains a germ of truth. I can tell a great deal from the eye, as much as from the palm or the voice. If you don't mind, I'd like to examine yours with the ophthalmoscope. My methods are my own; but I don't hesitate to make use of the instruments known to modern science. After all, the ophthalmoscope merely enables one to see through the cornea into the retina and the optic plexus."
With that he called in Valeska, who darkened the great studio. ”

“ With the left eye he could just distinguish light in the outer upper field of vision. With the ophthalmoscope only the lower fundus of the left eye could be made out, where the retinal vessels were seen up to the lower edge of the optic disk. The disk itself could not be made out, but above it a bulging, detached retina was prominent, with a hemorrhagic spot at its inner margin. In the upper outer fundus another separate bulging detachment of the retina could be plainly seen. ”

“ It is by the aid of the ophthalmoscope that many obscure diseases are diagnosed, and while it is impossible for every young man who obtains a diploma to become thoroughly proficient in the use of this instrument, yet the eye shows to him many conditions which guide him to the road of successful treatment. Think of a case of optic neuritis—inflammation of the optic nerve—going to an optician and fitting one set of glasses after another until the patient suddenly discovers that blindness is inevitable. ”

“ The pupil of an eye appears black to an observer, because the eye of the observer does not receive any of those reflected rays. If, however, we strongly illuminate the retina, and hold a lens in front of the eye, so as to bring the reflected rays to a focus nearer the eye, then a virtual and erect, or a real and reversed, image of the retina will be seen. Such is the principle of the ophthalmoscope, invented by Helmholtz in 1851. Eyes deficient in pigment, as in albinos, appear luminous, reflecting light of a red or pink colour ”

“ The retinoscope is an instrument used to measure the refraction of the eye. It throws a beam of light into the pupil by reflection from a mirror, the light being either outside the instrument—above and behind the subject—or arranged within it by means of an electric battery. On looking through the sight-hole one sees a larger or smaller part of the pupil filled with light, which in normal human eyes is a reddish yellow, because this is the color of the retina, but which is green in a cat's eye, and might be white if the retina were diseased. ”

“ From the crystalline lens to the back of the eyeball, is a space more or less globular in form, containing a gelatinous diaphanous mass somewhat resembling white of egg in appearance, and called the vitreous humour.
Behind the vitreous humour, and immediately opposite the pupil and lens, is the most delicate and important of all the membranes of the eye, the retina, which serves as a screen whereon are received the images of the objects around us. This membrane is an expansion of the optic nerve N leading from the brain, and lines the whole of the interior of the eye. ”

“ The simple fact, however, is that the fitting of glasses can never be satisfactory. The refraction of the eye is continually changing.2 Myopia, hypermetropia and astigmatism come and go, diminish and increase, and the same adjustment of glasses cannot suit the affected eyes at all times. One may be able, in many cases, to make the patient comfortable, to improve his sight, or to relieve nervous symptoms; but there will always be a considerable number of persons who get little or no help from glasses, while practically everyone who wears them is more or less dissatisfied. ”

“ Behind the cornea it forms a curtain, called the iris, which gives to the eye its color. The muscles of the iris contract or relax according to the amount of light received, thus enlarging or diminishing the size of the circular opening called the pupil. The Retina is formed by the optic nerve, which penetrates the sclerotic and choroid and spreads out into a delicate, grayish, semi-transparent membrane. The retina is one of the most essential organs of vision, and consists of two layers. A spheroidal, transparent body, termed the crystalline lens, is situated directly behind the pupil. ”