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HEYL: Spontaneous Rupture of the Choroid Coat.

photographs, however, you can see the outer segment of the cone or rod running up into the pigment layer and in some instances, veiling it so slightly that you can still follow the loop around. DR. J. E. WEEKS. The terminal parts of the rods and cones are so delicate that any interference with them may easily lead one astray. Has S. Ramon Y. Cajal, in his extensive stidy of the retina, made any mention of terminal loops ? I have examined his work carefully, and, as I have not found mention of terminal loops, am surprised that such a careful observer should have failed to note such an important fact if it existed. DR. 0. F. WADSWOR1 H of Boston. -Dr. Norris's communication is certainly very interesting. Formerly I gave considerable study to the rods and cones, but I never saw anything like terminal loops where the rods and cones could be supposed to be in their normal positions. I must confess that, in the brief opportunity I have had to look at these photographs, I still cannot see them. DR. W. F. NORRIS. - I have only to say that I have spoken of this matter with considerable diffidence, knowing that it was an extremely difficult subject, and that many able observers have worked over it with different results, and I should not have any hope of convincing this society but for the photomicrographs. If you look at these carefully and follow any one cone or rod up into the pigment layer you can convince yourself that the outer member of a cone in this situation curves and becomes continuous with the adjacent rod.

SPONTANEOUS RUPTURE OF THE CHOROID COAT. By ALBERT G. HEYL, M.D., OF PHILAI)ELPHIA.

Spontaneous rupture of the choroid coat is one which occurs through the agency of forces set in operation by the eye itself, and differs from the traumatic rupture both in the direction of the tear and in the application of the forces by which it is brought about. The patient, Barbara Bohner, ae. 65, applied at the eye department of the Episcopal Hospital Sept. 7, I893. Has always been short-sighted, but less so in the R. E. than in the

HEYL: Spontaneous Rupture of the Choroid Coat.

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L. E. Has never worn glasses steadily. About nine days ago noticed a spot in front of the R. E., and that in walking in the garden the boards of the fence seemed crooked. Status praesens, R. E., M. I.5 D.; L. E., M. 6 D. Media cloudy in each. In the R. E. there was a choroidal rupture starting at

SPONTANEOUS RUPTURE OF CHOROID.

the macula lutea and running practically in a horizontal direction toward the equator of the ball. There was eccentric fixation and a central scotoma. I saw the patient a week later and thought the rupture was beginning to close at the end nearer the equator. A glance at the picture will show the peculiarities of the rupture. It is, in shape, like the longitudinal section of a pear, the base involves the macula lutea, and thence the rupture tapers out toward the equator. The macular end of the lower lip of the rupture has adjacent to it a triangular collection of pigment, the base joining on to the lower lip, while slightly

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HEYL: Spontaneous Rupture of the Choroid Coat.

above the upper lip is an oblong collection of disturbed retinal pigment. Toward the equator and below the rupture is a large collection of disturbed pigment. This disturbed condition of the retinal pigment is a very common lesion in the traumatic rupture and indicates that the breaking force is largely expended on the pigment coat of the retina. The triangular collection of disturbed pigment on the lower lip is peculiar in form, and, evidently, indicates that the macula lutea was exposed to the traction of two vertical forces, the one pulling directly up and the other directly down. The upper portion gave way and the rupture was extended out toward the equator, the lower remained fast, but the force of the traction was sufficient to stretch the pigment at the macula end sufficiently to cause the disturbed pigment to assume the triangular shape. The direction of the rupture should be noted. L. E. nearly horizontal. A traumatic rupture in this position . would be almost vertical, indicating that the mechanism in the two cases is entirely different. The traumatic rupture tends to be crescentic, the curve being more or less concentric with the margin of the optic disc; the latter has evidently something to do with its formation. The spontaneous rupture has an entirely different position, as may be seen from the drawing. The traumatic rupture may occur in any quadrant of the fundus. The spontaneous rupture, so far as my experience as yet has gone, has its seat in the macular region. I believe the reason for this, as well as the peculiar direction of the rupture, is to be found in the action of the external rectus muscle. Remarks. I. It is possible that the rare condition delineated in figure 96, Jaegar's Hand Atlas, represents what had originally been a spontaneous rupture. The details of the case are somewhat meagre, but defective sight had been noticed four years previous to the time when the drawing was made. The drawing suggests that originally a horizontal rupture had existed, which finally had partially closed, leaving two gaping ends. 2. It seems probable that a sudden spasmodic action of the external rectus was the cause of, the spontaneous rupture. The sclera posterior to the insertion of the externus was relaxed to

HEYL: Albuminoid(?) Deposit in Optic Disc and Retina. 3 55 such an extent that horizontal rupture occurred. It is interesting to note that the traction seems primarily to have been at the macula lutea and in the vertical meridian. If, instead of one sudden snap-like contraction of the externus, we conceive of a large number of minute spasms constantly recurring for months and years, we might have, instead of a rupture, simply pigmentary changes occurring in the macular region, and, perhaps, such macular changes as are seen in certain cases of myopia, are to be referred to the abnormal action of the externus. 3. The more accurate designation of choroidal rupture is retino-choroidal rupture. How far, indeed, the choroid coat is involved seems to be unknown, but, undoubtedly, it is the splitting the pigmentary layer of the retina, which is the conspicuous feature of the lesion.

ALBUMINOID (?) DEPOSIT IN THE OPTIC DISC AND RETINA. BY ALBERT G. HEYL, M.D., OF PHILADELPHIA.

The term albuminoid, as descriptive of the rare lesion described in this paper, is used with hesitation, owing to the absence of chemical proof of its existence. The general appearance of the deposits, as observed with the ophthalmoscope, seemed to indicate them to be a derivative of the albumen of the blood. The history of the case is as follows: Mrs. , Oe. 49, applied at the eye dispensary of the Episcopal Hospital Feb. 25, I895, for glasses for near work, 0. D. 20/15, 0. S. 20/20. A glance in the 0. D. revealed the condition shown in the drawing. The optic disc was covered with a series of round bodies, many of them of a diameter slig,htly greater than that of a retinal vein. They were apparently flattened and piled one upon the other; those immediately adjacent to the periphery being overlapped by those more centrally located. The ring-like limit

Spontaneous Rupture of the Choroid Coat.

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