Ophthalmologist

“ Settling as ophthalmologist at Chicago in 1886, he soon was widely known as operator and writer. He was one of the surgeons at the Illinois Charitable Eye and Ear Infirmary, oculist to the Passavant Memorial Hospital, president of the Chicago Ophthalmological Society, a member of the American Academy of Ophthalmology and Oto-Laryngology and of the American Ophthalmological Society, and a fellow of the American College of Surgeons. ”

“ An optometrist examines eyes for refractive error, recognizes (but does not treat) diseases of the eye, and fills prescriptions for eyeglasses. The optician is an artisan qualified to grind lenses, fill prescriptions, and fit frames.
The effect of § 2 is to forbid the optician from fitting or duplicating lenses without a prescription from an ophthalmologist or optometrist. In practical effect, it means that no optician can fit old glasses into new frames or supply a lens, whether it be a new lens or one to duplicate a lost or broken lens, without a prescription. ”

“ It does, however, offer the advantage of carrying with it the minimum amount of risk, and the apparently permanent results secured justify the ophthalmologist in acquainting himself with the technique of the operation, for, as pointed out by Sydney Stephenson and others, "the technique is responsible for success or failure." Furthermore, there is no sufficient reason why the field of usefulness of the operation should be confined to the chronic forms of glaucoma, and Col. ”

“ Some patients will even imagine that they see better with glasses that markedly lower the vision. A number of years ago a patient for whom I had prescribed glasses consulted an ophthalmologist whose reputation was much greater than my own, and who gave him another pair of glasses and spoke slightingly of the ones that I had prescribed. ”

“ This patient, who was under the care of one of us at the Philadelphia Hospital, was examined by O. E. Shakespeare, ophthalmologist to the hospital. At his first examination the bulbar conjunctivæ were slightly injected and the cornea clear. The sensibility of the cornea was possibly a little lowered. Ten days later, at a second examination, the central corneal epithelium of the left eye was found to be hazy and the whole bulbar conjuntivæ much congested. ”

“ 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 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 ”

“ Experiment and calculation have gone far to settle the precise mode in which light gives rise to sight, and affects our perception and judgment of external objects, and the condition of the eye during life and health or disease has been brought into view by the ophthalmoscope. The names of Helmholtz and of Donders are inseparably connected with modern advances in the physiology of the eye, while no English name is more conspicuous in regard to the surgery of the eye than that with which we commence this chapter. ”

“ And an optician is just as likely as not to fit a near-sighted man with far-sighted glasses.
A Truss Fitter Should Know as Much About Rupture as an Oculist About the Eyes
But if the man with poor eyesight goes to an oculist—
The oculist finds out what the trouble is—and what kind of glasses are needed—then prescribes that kind of glasses.
And then the optician fits the man according to the oculist's prescription. Just as a druggist fills a physician's prescription. ”

“ In schools where the Snellen test card was used to prevent and cure imperfect sight, the children, after they were cured themselves, often took to the practice of ophthalmology with the greatest enthusiasm and success, curing their fellow students, their parents and their friends. ”

“ Persons, before submitting themselves into the hands of opticians, should know that they are not suffering from any incipient disease of their eyes. I do not, for a moment, claim that a practical optician cannot give you a pair of glasses which will make you see—he does nothing more than hand you a number of pairs of glasses and you select the one pair which you think answers the purpose. How can anyone but a medical man know that the impairment of vision does not arise from diminished sensibility of the retina? ”

“ 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. ”

“ 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. ”

“ 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 ”

“ 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 ”

“ The diversified tastes and talents of physicians cause each to excel in treating some one class of diseases, to which he devotes more attention and study than to others. One medical student manifests great interest in the anatomy, physiology, pathology, and treatment of diseases of the eye. He becomes thoroughly familiar with all the minutest details relative to that organ and its diseases, and so thoroughly qualifies himself in this branch of knowledge that he is able to cure an inflammation or other affection of the eye in a very short time. ”

“ It can be resorted to only in adults, great steadiness on the part of the patient being absolutely necessary. The case, too, must be judiciously chosen. The conjunctiva must be sound, and indeed almost no operation on the eye should be undertaken unless this membrane is in a healthy condition; the cornea should be transparent in every part—the anterior chamber of a proper size—the pupil regular—the iris steady, and not protruded—and the cataract solid; there should be no rolling motion of the eyeball, and no adhesions of the iris. ”

“ On another occasion, when the ophthalmia spread far and wide amongst the soldiery in this country, after the return of the army from Egypt, when the civil part of the population became alarmed for their eyesight, and when an enormous burden had been thrown upon the public by the number of men pensioned for blindness, a distinguished oculist from civil life, the late Sir William Adams, was placed at the head of a large and expensive ophthalmic hospital in the Regent's Park ”

“ Operation.—The surgeon stands behind the patient, who is seated; the lids being fixed, the upper by the surgeon's left hand, and the lower by an assistant, the cornea is punctured a little in front of the sclerotic margin, either with a broad needle, or, what is as good, a well-worn Beer's knife. Care must be taken on entering the knife, on the one hand, not to wound the iris, which is sometimes arched forwards in the cases of commencing glaucoma, and, on the other, fairly to enter the anterior chamber, not merely split up the layers of the cornea. ”

“ 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. ”

“ When cataract is spontaneous, and vision not altogether lost, the patient being able to distinguish bright objects, though unable to direct his steps or follow his avocation—when the pupil is quite sensible to the application or abstraction of light, or to the use of belladonna, &c.,—when all the external parts are sound, the cornea clear, the chambers of the proper size, and no reason to suspect that the retina is affected—the prognosis in regard to the effects of operation is good. ”

“ 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. ”

“ She was an out-patient to one of the Ophthalmic Hospitals for two years, but, instead of getting better, she became worse. She then applied to another Ophthalmic Institution, where she was subjected to treatment for four months, but no improvement took place. Three years ago her sufferings prompted her to visit a third institution, when one of the surgeons cut off the upper eyelid of the left eye, which gave rise to great pain and inflammation, but the opacity was not diminished nor the vision improved. She was obliged, during the eight years, to have her eye-lashes constantly pulled out. ”

“ The room is made perfectly dark; a brilliant light is then placed near the head of the patient, and the rays are reflected by a series of small mirrors into his eye, as if they came from the eye of the observer; then, by looking through the central aperture of the instrument, the oculist can examine the illuminated interior of the eyeball, and perceive every detail of structure, healthy or morbid, as accurately and clearly as we can see any part of the exterior of the body. ”

“ I shall make a point of calling daily, but shall not examine your eyes every time. The excitement and the effort would strain the optic nerve. Our object is to keep the inflammation from striking inwards. I should not tell you all this, but I see that you have much self-command. On that and your constitution, under Providence, the cure depends. One question. I am not a professed ophthalmist, would you prefer to have one? ”

“ A sufficient knowledge of letters and the power of reading is necessary to an accurate trial of vision; the entire bearing of the children must permit of the ophthalmoscopic diagnosis of the weak condition and should raise no scruples as to wearing spectacles which may be necessary after the operation. Under any circumstances no harm is done by deferring the operation until these conditions are fulfilled; the interval may be filled up by practising the mobility of the eyes, which does more good than the customary strabismus spectacles or even tying up the eye. ”

“ IT is not always possible for patients to go to a competent physician for relief. As the method of treating eye defects presented in this book is new, it may be impossible to find a physician in the neighborhood who understands it; and the patient may not be able to afford the expense of a long journey, or to take the time for treatment away from home. To such persons I wish to say that it is possible for a large number of people to be cured of defective eyesight without the aid, either of a physician or of anyone else. ”

“ The ophthalmoscope has laid bare to our view a living nerve of special sense, the highly-developed end-organ in which it terminates, and the blood-columns circulating in them. In no other part of the body has Nature vouchsafed to us so clear an insight into her mysteries. ”

“ Numerous other instruments of precision are now in constant use, among the most wonderful of which perhaps is the ophthalmoscope, whereby we are enabled to subject the retina and the intervening media of the eye to minute visual examination. There is not an organ of the body that is not now interrogated daily in the way of physical diagnosis, and we even examine separately the secretion of each of the two kidneys. ”

“ Having thus obtained the subject's confidence, the physician asks him to look him intently in the eye, and to think of nothing but of going to sleep. The subject should be seated in a comfortable position, preferably with his back to the light. The recumbent position is not usually necessary. While the patient's eyes are still fixed, as just described, upon the operator's eyes, the latter says, in a monotonous but distinct tone: "Your eyelids are getting heavy, very heavy. Your eyes are red and moist. ”