Value is attached to the improvement produced by the separate use of the
squinting eye. According to my experience no higher visual acuity can be
attained by use of the amblyopic eye, than that which is best detected
by the aid of eserine in the first examination, if it is only carried
out thoroughly enough. No doubt if we proceed otherwise, and rest
content with whatever statements the patient likes to make, without
giving ourselves any more trouble, we may expect the most superficial
diagnoses to show the most astonishing therapeutic results, as, indeed,
often happens. And now, talking of strychnine injections! When two
celebrated ophthalmologists occupy themselves simultaneously with the
therapeutics of strychnine, one of whom obtains the most astonishing
results in atrophic troubles of the optic nerves, but, on the other
hand, obtains no real improvement in "amblyopia from non-use," while the
other can show brilliant success in the last-named form of defective
vision, and, on the other hand, none in atrophy of the optic nerves, we
may perhaps conclude that both are right, if even really on the negative
side, and that the circumstances are the same in the tests of vision.
Again, we must examine more closely some of the cases, in which
strychnine injections showed a brilliant result. (Anyone interested in
the original work can read up the 'Vienna Weekly Medical News' for the
year 1873.)
"1. Wilhelm H--, a strong healthy boy, æt. 12, complains of defective
vision. Right eye has nothing abnormal in its outward appearance, and
just as little in the fundus. V. 16/100, H. 2·5 D., Snellen IV-I/II; is
the smallest type he reads at 3 to 7 inches. With + 10, I-I/II is read
at 4 to 6 inches. Left eye V. 16/70. H. 2·75 D. II-I smallest type
legible at 3 to 12 inches. With + 4 D. I-I/II is read at 4 to 6 inches.
On March 14th, 1872, first injection of strychnine with 0·002 gr. in the
temples. An hour later V. of right eye 16/70, left unchanged. On March
23rd, 1872, after one injection daily, V. of each eye is 16/50."
Patient shows then in the right eye visual acuity 16/100, with manifest
hypermetropia 2·5 D.; in all probability the total hypermetropia really
present was higher, and was scarcely corrected by means of convex 4 D.
If the patient now reads No. I-I/II Snellen with + 4 D. at 6 inches,
this proves a visual acuity of 1/3 during the first investigation before
the strychnine injection, and shows that the estimate of 16/100 was
inaccurate. At the close of the treatment, only a visual acuity of 16/50
(almost exactly 1/3) is specified for distance. The result seems to me,
then, to be this, that the patient during repeated examinations has
gradually learned to make more accurate statements, indeed, with a boy
twelve years old one can scarcely expect it to be otherwise.
Public-domain text, read in full here on John Shaqi.
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