Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jellife and William A. White.

  • Jelliffe, Smith Ely, 1866-1945.
Date:
1929
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jellife and William A. White. Source: Wellcome Collection.

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    The field of vision should be tested with avoidance of suggestive factors. This may be done with a perimeter (which frequently intro¬ duces the error of suggestion) or the rapid finger test employed. The patient sits about three feet from the examiner. Each eye is tested separately. The patient puts his hand over his left eye, and looks fixedly at the examiner’s left eye, the right eye being closed. With the left hand held midway between patient and examiner some distance to one side, it is then gradually brought toward the middle line, the fingers being waved slightly. The patient is directed to say “now” as soon as he catches sight of the slightly waving fingers. Four axes should be tested. Variations from the examiner’s own fields can be noted. A square of white paper (1 cm.) on a gray card may be used instead of the fingers. For a general test of the color fields squares of different colors may be used. The most striking features to be sought for are hemianopsia, temporal or nasal; concen¬ tric limitations, irregular limitations, quadrant hemianopsias, psychic blindness and scotomata. Hemianopsia should always be searched for. It may be done rapidly by use of the usual finger-sight test and if there are any anomalies careful chartings by a perimeter should be made. Scotomata are sought for in the same manner. Single peri¬ metric tests are usually not sufficient. Frequent examinations, espe¬ cially for the different color fields are necessary, especially to trace advancing changes. For careful perimetric work the methods of Bjerrum should be followed out.1 A useful method of making peri¬ metric charts is by means of a modified Bjerrum screen. A large sheet of white paper 12 to 15 inches is covered with a thin black cloth or black paper and both fastened to a board. A small thumb-tack in the center can serve as a fixation-point for the patient’s eye. The test object is carried on the blunt end of a steel pen, 0.5 cm. in length which is fixed transversely across the dark end of a metal bar so that its point projects about 1 mm. on the opposite side. The test object thus fixed on the end of the rod is moved slowly from the blind region across the screen until the patient sees it, then the carrier is simply pressed against the board so that the pin penetrates the cloth and marks the paper beneath it. A large number of observations can thus be quickly made and they can be easily transferred to a perimeter chart. Perimetric plotting of the macula fields may be desired. In all cases the fundus should be examined. A knowledge of the eye-ground changes is essential for good neurological investigation. Works on ophthalmology must be consulted for the many anomalies, but the most important to be observed are signs of pressure, of atrophy, of retinal hemorrhage or congestion, and irregular pallors (temporal pallor in multiple sclerosis), edema, choroiditis, retinitis, venous congestion, arterial occlusions, etc. Optic atrophy may exist without 1 See Walker: Arch, of Ophthalmology, 1915, p. 369. Cushing and Walker: Brain, 1915, p. 341. Cushing, H.: Brain, 1921, 44, 341 (for Temporal Lobes).