THE RELATION OF THE CIRCUMLENTAL SPACE TO THE CAUSATION OF GLAUCOMA AS SHOWN BY THE WURDEMANN LAMP

JOHN A. TENNEY
1907 Journal of the American Medical Association (JAMA)  
in the diffusion of knowledge, and this it can not do without a closer investigation of problems that come within its sphere. Municipal and state laboratories have a further duty than the making of routine examinations, and should engage in some form of investigation. In the perfect organization of the clinical departments affiliated with European hospitals our confrères across the sea further illustrate the tendency of the newer medicine. The clinical chief with his broad grasp on the bearing
more » ... asp on the bearing of pathology, physiology and chemistry on clinical medicine has associated about him a corps of laboratory workers who, by well-directed investigation, give to the German clinic particularly the prominence which it enjoys to-day. It is generally recognized that the many interesting problems confronting the medical investigator to-day permit of elucidation and study often better in the living, at the bedside, than by autopsy study or other pathologic methods, and in this connection it can be stated that the most significant advances in pathology are being made in the study of the nature and mode of action of the causes of disease. There is reason to believe that the contributions to pathologic and physiologic knowledge during the next decade will come as freely from the clinical worker as the purely laboratory investigator. It is but a matter of recent memory when our entire conception of pathology consisted of the study of morbid anatomy or histologie lesions. As the scientific viewpoint of pathology has enlarged physiology and physiologic chemistry have been accorded their due recognition as most important factors in advancing the knowledge of the nature of disease processes, the latter, in fact, having largely overshadowed the former. It is a further significant fact that in a process like diabetes with an unknown morbid anatomy our knowledge of the pathologic physiology or the metabolic and functional disturbances is more complete than in many disease conditions with definite lesions. An alliance of pathology with experimental therapeutics opens up a field for interesting and profitable research for specific chemical studies. Physical chemistry offers an encouraging prospect of shedding new light on many obscure biologic phenomena. Giving to pathologic and physiologic study a broader meaning but indicates the wider application of the methods of true science in all lines of medical work; it is suggestive of that greater seeking for truth, to get at the root of problems which is so peculiar to our time, all with the common goal to learn more of the nature, prevention and the cure of disease. It is gratifying to note how with each year the range of problems of successful attack by the American laboratory is increasing, yet there is need to emphasize that continued medical cooperation is essential in all investigative work if we would keep scientific medicine in America on a par with that of the old world. Tuberculosis.-Tuberculosis is a house disease. The battle is in our own hands. We must meet it squarely and bravely, like men. It is not to be overcome by fear, and we use the word advisedly, by fear either of the disease or of loss of income from our investments, should we build suitable habitations for those who must, from force of circumstances, live in the evermore crowded districts of our great cities. In these localities men have deemed life of less value than money, and such views mean dark, ill-ventilated dwellings and disease.-Journal of ilie Outdoor Life. It is obvious that this disease is caused either by excessive secretion in the eye, or by obstruction in its outlets, or both. Hippocrates applied the term glaucoma to all opacities behind the pupil. Taught by dissection, Brisseau1 was the first to announce in 1709 that, while cataract was an opacity of the lens, glaucoma was a similar affection of the vitreous humor; therefore, no operation could afford relief. Mackenzie early in the last century recognized the disease as one of pressure, stating that:2 A morbid secretion, of the origin of which we can give no accurate account, fills the cavity of the retina, but, like other morbid productions, is not furnished with the apparatus of removal, necessary for keeping its quantity in equilibrio. Hence the unnatural firmness of the glaucomatous eye, a symptom that often increases to such a degree that the organ is felt to be of a stony hardness. Von Graefe believed the pressure was due to a chorioiditis with exudation. When the invention of the ophthalmoscope showed that the chorioid did not show any anatomic changes in this tissue he assumed that there was a serous exudation present. Donders ascribed the increased pressure to irritability of the ciliary nerves, causing excessive secretion from the chorioidal vessels. Stellwag believed the starting point of the disease to be an increased pressure in the intraocular blood vessels, obstructing the vortical veins where they make a sharp turn at their exit from the globe. In support of the exudation theory Beltman3 recently reported a case of chronic glaucoma associated with an enormous telangiectasia of the face, and dilatation of the external blood vessels of the eye, narrowing of the field of vision, increased tension and pain. The glaucomatous pressure was most severe just before the menstrual period, when the blood pressure is known to be the greatest. He held that a corresponding dilatation of the chorioidal vessels increased the secretion of fluids in the eye. In 1873 Leber4 showed that the path of the aqueous humor is from the ciliary processes through the pupil to the spaces of Fontana, called the filtration angle of the eye. Three years later Knies and Weber5 independently found closure of the filtration angle, and of the canal of Schlemm in most cases of chronic glaucoma. This discovery gave a great impetus to the retention theory. It should be noted that in most cases of acute glaucoma these outlets are unobstructed. Ring8 saw glaucoma lighted up by the instillation of euphthalmin solution into the eye. We are told not to use atropin, cocain or even adrenalin in solution where there is a tendency to glaucoma, through fear of compressing the filtration angle; but only recently I
doi:10.1001/jama.1907.25320040002002 fatcat:rongaabafjhoxotndtppqbsi4a