Table Of ContentPapillœdema or " choked disc " due to raised intracranial tension. In
this instance the papillœdema was due to a frontal lobe tumour. See also
Plate TIT. (Case in the care of Dr. L. R. Yealland.)
Frontispieoe.
NEURO-OPHTHALMOLOGY
BY
R. LINDSAY REA
B.Sc, M.D., M.Ch., F.R.C.S.
Ophthalmic Surgeon to West End Hospital for Nervous
Diseases ; Surgeon to Western Ophthalmic Hospital ;
Ophthalmic Surgeon to London Lock Hospitals; Con
sulting Ophthalmic Surgeon to Finchley Memorial
Hospital and to British Hospital for Mental Disorders
and Nervous Diseases
WILLIAM HEINEMANN
(MEDICAL BOOKS) LTD.
1938
Printed in Great Britain by
The Whitefriars Press Ltd., London and Tonbridge.
PROFESSOR JOHNSON SYMINGTON
THIS BOOK IS AFFECTIONATELY
DEDICATED TO THE MEMORY OF THE LATE
PROFESSOR JOHNSON SYMINGTON
M.D., F.R.S.,
WHO OCCUPIED THE CHAIR OF ANATOMY
IN THE QUEEN'S UNIVERSITY OF BELFAST
A GREAT ANATOMIST, A GREAT TEACHER
AND A TRUE FRIEND
PREFACE
AT the request of the Fellowship of Medicine I have given from
time to time demonstrations on the fundus oculi and lectures on
neuro-ophthalmology at the West End Hospital for Nervous
Diseases. Both from my own experience in preparation for these
lectures and from questions put to me by the students, I have
become aware of the need for a book which, while keeping to
moderate proportions, will supply an answer to the queries regarding
those subjects which form a connecting link between ophthalmology
and neurology. As the subject-matter grew one learnt to under
stand why previous writers found it necessary to fill volumes or make
large editions. In this book a bibliography has been appended
containing the names of authors many of whom have added to their
writings complete lists of references. The use of such a bibliography,
I hope, will fill the want created by the necessity of keeping this
volume within reasonable limits.
The invention of the reflecting ophthalmoscope by von Helmholz
in 1851 brought in its train a considerable addition to our know
ledge of medicine which was still further increased by the extensive
observations of von Graefe and many others. It may be recalled
that when von Graefe for the first time saw the back of the eye, with
its nerve entrance and its blood vessels, his cheeks reddened and he
called out excitedly " Helmholz has unfolded to us a new world."
In justice it should be remembered that in 1847 Charles Babbage, a
distinguished mathematician at Cambridge, invented an ophthalmo
scope which consisted of a mirror with some spots of silver scraped
off. Its worth was not then recognised. In Gowers' preface to the
4th Edition of " Medical Ophthalmology," he says : " When this book
was written 25 years ago (1879), the subject with which it dealt was
more familiar to physicians who constantly used the ophthalmoscope
than to ophthalmic surgeons." The first reported case by A. H.
Bennett of the removal of a brain tumour, on November 25th, 1884,
which was performed by Sir Rickman J. Godlee, at the Hospital for
Epilepsy and Paralysis, Maida Vale, contains a meticulous account
vii
viii PREFACE
of the patient's signs and symptoms, including the state of the fundus
oculi before and after the operation. Bennett mentions that optic
neuritis was present in both eyes and after the operation the optic
neuritis was distinctly improved. Hughes Bennett did not seem to
have called in the aid of an ophthalmic surgeon. It was true,
physicians did then depend on their own ophthalmic observations.
F. E. Batten, at Queen's Square Hospital for Epilepsy, in con
junction with Mayou, described " Familial Cerebral Degeneration
with Macular Changes." This aroused in the mind of his brother
Rayner Batten an interest in the ophthalmoscopic appearances of
various macular conditions, and he in his turn has shown the value
of an accurate appreciation of the state of the macula in fundus
examinations.
Since the invention of the perimeter by Forster, in 1857, the
quantitative method of estimating the field of vision has come to be
widely known due to the efforts of Bjerrum, Roenne, Peter and
Traquair. Knowledge of the anatomy, physiology and pathology
of the visual paths has thus gradually been unfolded and has
brought to light the fact that there must be co-operation between the
ophthalmic surgeon and the neurologist ; the one cannot do without
the other and although progress has reached the stage when the
location of tumours of the brain may be discovered by the electro
encephalogram (Walter), yet this fundamental knowledge concerning
visual paths can never be dispensed with. In every hospital for
diseases of the nervous system an ophthalmic clinic has been estab
lished. The surgeon must be aware, although in a limited degree, of
what is in the mind of the physician when a case is referred to him,
and it is the personal experience in such a clinic that the author
has drawn upon. It is his earnest hope that this book may be of
value to many of the younger ophthalmic surgeons taking up work
in such clinics as well as to students of neurology.
I desire to acknowledge the help which I have received from
Dr. J. Purdon Martin, who has kindly read the book in proof stage.
It was impossible to carry out all his suggestions but some have been
incorporated in the text. The index has been carefully prepared by
Mr. R. Mclver Paton. The help provided by my secretary, Mrs. B.
Pierce-Jones, M.A., in the work of translation, reference finding and
as an amanuensis is deeply appreciated. Many of the illustrations,
both in colour and black and white, have been executed by Mr. E. A.
Place, whose services have been freely put at my disposal by Messrs.
PREFACE ix
Clement Clarke Ltd. Those authors who have kindly permitted me
to use illustrations are acknowledged in the text. Standard text
books on neurology such as those by Grinker, Brain, Wechsler,
Thomson and Riddoch, Gehuchten, also " Recent Advances in
Neurology " by Brain and Strauss, have been freely consulted. I
would like to place on record the unfailing courtesy and helpfulness
of those in charge of the Library of the Royal Society of Medicine.
Finally, I wish to thank the publishers, Messrs. William Heinemann
(Medical Books Ltd.), for their patience and encouragement in the
preparation of this volume.
R. LINDSAY REA.
HARLEY STREET, LONDON, W.
ACKNOWLEDGMENTS
The author is indebted to the following for permission to publish
various illustrations :—
"Transactions of Ophthalmology," Figs. 59, 100, 126, 128, 129, 141.
Journal of Mental Science (Churchill), Figs. 12, 13, 14, 15 (McGrath's
paper).
Messrs. Longmans, Green & Co., Figs. 16, 16A, 21, 23, 58, 83 (Quain's
" Anatomy "). Plate 1.
Oxford University Press, Figs. 18, 19, 26, 61, 62 (modified from
Cunningham's " Manual of Practical Anatomy "), 69, 120, 121
(Harrison Butler's Slit-Lamp).
Miss M. E. Rea, Fig. 21.
Messrs. H. K. Lewis & Co., Figs. 24 (Wolff's " Anatomy of Eye and
Orbit"), 51, 52, 112 (Rea's " Affections of Eye"), Plate 2,
Plate 3, Plate 7, Fig. 1, Plate 14.
Masson & Cie., Fig. 28 (Manuel de Neurologie oculaire).
British Journal of Ophthalmology, Figs. 34, 43, 57, 59, 81, 139.
Proceedings of the Royal Society of Medicine, Figs. 35, 36, 72, 91, 93.
Brain, Figs. 40, 63, 64, 116.
Archives of Ophthalmology, Figs. 47, 95, 110.
Messrs. Burroughs Wellcome & Co., Plate 19.
Messrs. Lea & Febiger, Figs. 55, 117, 136 (Peter's " Perimetry ").
Archives of Surgery, Fig. 66.
Edinburgh Medical Journal, Figs. 70, 73
Governors of the Hospital for Sick Children, Great Ormond Street,
Fig. 71.
" Medical and Biological Research," Fig. 74.
Journal of Neurology and Psychopathology, Figs. 75, 76.
Kegan Paul, Trench, Trübner & Co., Fig. 77 (Crookshank's " Mongol
in our Midst ").
Post Graduate Medical Journal, Fig. 79.
Messrs. Wm. Heinemann (Medical Books) Ltd., Fig. Ill (Collins and
Mayou's " Bacteriology "), Fig. 119 (Hewer & Sands' " Nervous
System ").
xi
xii ACKNOWLEDGMENTS
Lancet, Fig. 118.
Oxford Medical Press, Figs. 133, 135 (Rawling's " Surgery of the
Skull ").
Julius Springer, Berlin, Zeitschrift.f. d. ges. Neur. and Psych., Fig. 138.
Messrs. Henry Kimpton, London, Fig. 140 (Atkinson's " External
Diseases of the Eye ").
Oxford Medical Publications, Plate 18 (E. Clarke's " Fundus of the
Human Eye.")
