NOTES, CASES AND INSTRUMENTS 3S3

true of the eyebrows, the loss being almost complete in the medial two-thirds and not so great in the outer. There was continual rapid winking of the lids of both eyes. The eyes were otherwise normal.

Case 2. Man, Mexican, age 73, large, strong, alert. First seen July, 1924. Consulted me on account of total blind­ness of both eyes. He stated that he had noticed the nodules on his face and arms "for many years" and also that his temperature was always above normal, but that these things had given him no concern for worry, and that he was enjoying perfect health except for his blindness. Three years ago he no­ticed for the first time that his sight was failing. In six months he was totally blind in both eyes. He thinks that visual acuity began to diminish in both eyes at the same time. At no time has he been aware of an acute inflam­mation, profuse secretion, pain, or any discomfort, other than that due to loss of vision. His was also of the nodular anesthetic type; the lepra bacillus was found in the na.sal secretion. The blood Wassermann was weakly posi­tive. The arteries were sclerosed.

The skin of the face, nose, ears, and eyelids was greatly thickened. There were deep creases at both external canthi. There were a few nodules on the face, none on the eyelids. Ocular movements were full in all directions. V .O .U .=0 .

R. Palpebral and bulbar conjunc­tiva markedly thickened and chronical­ly inflamed. Cornea and aqueous clear. Anterior chamber of normal depth. The pupil was round and slightly dilated, about 5 mm.; it did not react to light or when the patient was told to look at his finger. I t di­lated fairly well and uniformly under the influence of homatropin of 1% strength. The iris appeared normal; there were no synechiae, depigmented or thinned areas, or other evidence of previous pathology. The anterior cap­sule of the lens was absolutely opaque and gave forth a metallic luster, shiny silvery gray with, at times, green and blue as the angle of the incident rays was varied. The lens trembled when

the patient moved the head, thus giv­ing evidence of a diseased ciliary zone.

Not the least reflex could be ob­tained from the fundus.

L . The palpebral and bulbar con­junctiva were markedly thickened and chronically inflamed. The cornea was white porcelain like in appearance, the sclera seeming to continue into its stroma uninterruptedly. The limbus was obliterated. Large blood vessels traversed the superficial layers of the cornea, continuing from those of the conjunctiva, while smaller ones from the sclera could be faintly made out in its deeper structure. The pupil or iris could not be seen, but when the patient moved the head, the trem­bling lens could barely be distin­guished. The fundus reflex was not ob­tainable.

U S E OF R E D F R E E L I G H T IN T H E E X T E R N A L E X A M I N A ­

TION O F T H E E Y E . JESSE W . DOWNEY, J R . , M . D.

BALTIMORE, MD.

Following the work of Vogt describ­ing the use of red free light in ophthal­moscopy, much has been written re­garding the diflferent lamps devised to obtain a light of this character, the technic of their use and the appear­ance of the eyegrounds, normal or pathologic, under this type of illumi­nation. One use of the light, and a rather helpful one, so far as I have been able to find, has not been particu-uarly stressed; and that is its em­ployment for the external examination of the eye.

Used in conjunction with a good binocular loupe, the blood vessels of the palpebral and bulbar conjunctiva are made to «tand out in bold black re­lief so that they can be followed in detail. The circumcorneal vessels are plainly seen even in the normal eye and on the slightest injection can be traced with beautiful definition. Vas­cularization of the cornea is easily seen and the vessels tho minute can be read­ily traced to their terminations. Epi­scleral and scleral congestions become

384 NOTES, CASES AND INSTRUMENTS

more distinct and easier to differen­tiate. Corneal abrasions or ulcers, when stained with fluorescein, become brilliant in contrast. The study of the iris in health and disease also becomes most interesting in this green light, as compared with the observations made with the ordinary white light.

The light recently described by Jonas S. Friedenwald, (American Jour­nal of Ophthalmology, December, 1924) is, as he says, simple, easy to use and relatively inexpensive. With it one obtains a yellow green light of high but not harmful intensity. I t is a useful and practical addition to the office equipment of any oculist.

529 N. Charles St.

MONOCULAR COLOR B L I N D ­NESS NOTICED A F T E R A

B L O W ON T H E HEAD. J . E. JENNINGS, M . D .

ST. LOUIS, MO. Read before the Ophthalmic Section of the

St. Louis Medical Society, December 12th, 1924.

Mr. J . L. B. , aged 55, was referred to me June 14, 1915, for an examina­tion of his eyes. He gave the follow­ing history. Five months ago he was in a railroad accident. The Pullman coach in which he was riding rolled down a 30-foot embankment. His head struck against the roof of the car. He was dazed for a few moments but managed to crawl out. Altho badly shaken, he did not appear to be seriously injured. In a few days he went about his work as usual. Since the accident he notices something wrong with his color vision.

Examination. There is no evidence of an injury to the skull. The vision of both eyes is normal wfth the same correction: plus 1.75 sph.C—1-00 cyl. ax 90°. The retina, choroid and optic nerve of both eyes are normal. His color sense was tested with the Jen­nings self recording test and he made a perfect record. When told that his color sense was normal he said, "Well, there is something peculiar about it. I am repapering our house and notice

that when I look at the wall paper with the right eye, the colors are not the same as they are when I look at it with the left eye."

This hint caused me to test each eye separately. When the right eye was tested he seemed confused and hesitated quite a time in making his selec­tions. He made 17 mistakes. With the green test, he punched greens, fawns, tans and grays. With the rose test, he punched rose, purple, blue and dark blue-green. In short, he made the characteristic mistakes of the red-green blind. When the left eye was tested he made his selections rapidly and without a single mistake. To be quite sure the case was one of monoc­ular color blindness, I got out a com­plete set of Holmgren's worsteds and spent an hour having him classify col­ors with his right eye. Dark green was matched with blue, green, and pur­ple. Yellow was matched with yellow, orange, and yellow-green. Rose was matched with pink, red, blue and violet. Red was matched with red, violet and brown. The darker shades of red were called brown, and dark brown and maroon were called black.

The field of vision of the right eye was normal for white but confused for colors. The field of the left eye was normal both for white and colors.

Monocular color blindness without fundus changes is an extremely rare condition. The possibility of such a defect was denied until Holmgren re­ported a case in 1880. Later he report­ed another case. In 1888 Becker saw a case of a girl aged 17 in whose family there were color blind males. These three cases were all congenital. So far as I know, there is no satisfactory report of a case of acquired monocular color blindness. Edridge-Green men­tions the case of a young man who de­veloped a color defect of the right eye which was thought to be due to exces­sive work with the spectroscope. Can we assume that the case I report was due to traumatism?

The patient is quite positive he could distinguish colors with one eye as well as with the other before the accident. Notwithstanding his state-