A STUDY 
OF 
THE EYES OF MEDICAL STUDENTS. 
BY 
B. ALEX. RANDALL, A.M., M.D., 
OPHTHALMIC AND AURAL SURGEON TO THE EPISCOPAL AND CHILDREN’S HOSPITALS, PHILADELPHIA. 
Reprinted from Transactions Pennsylvania State Medical Society, 1885. A STUDY 
OF 
THE EYES OF MEDICAL STUDENTS. 
BY B. ALEX. RANDALL, A. M., M. D., 
OP PHILADELPHIA. 
In giving a course of demonstrations of the Physiology of Vision, 
last Autumn, in the Physiological Laboratory of the University of 
Pennsylvania, the writer endeavored to furnish a practical applica- 
tion of the methods of study brought forward, by instituting an 
examination of the eyes of each of the students composing the 
class. The determinations were carefully made and the results 
systematically recorded upon schemes prepared for the purpose; 
and as now given, their accuracy in almost every point can be 
vouched for. As the examination was a means, however, and not 
an end, the same care could not be given to secure its completeness; 
and of about 120 students examined, records are at hand as to the 
refraction of but 90. As the study could not always be finished 
upon the same day that it was begun, some of the examinations 
remain incomplete; while not a few of the records have been 
mislaid, as they were unwisely entrusted in the interval to the 
individuals concerned. Since we have data, however, as to the 
refraction of 90 of the 135 students in this second-year class, it 
has seemed on some grounds worth while to put even this small 
number upon record; especially when Prof. Cohn, after making 
examinations embracing many thousands of individuals, has thought 
the results of his study of the eyes of 108 medical students worth 
recording. 
As to the details of the examinations some remarks seem in 
place. Each eye was, of course, separately tested, although some 
binocular tests were also made. The vision was determined in 
good daylight, in the laboratory, at a distance of 6 metres—the 
positions of test-card and individual being shifted, when necessary, 
so as to secure at the different times the most uniform illumination. 4 
A STUDY OF THE EYES OF MEDICAL STUDENTS. 
Snellen’s metrical card or that of the writer was the test employed— 
often both; and the easy recognition of all of the letters of the 
VI metre line, with the easier ones of the line below, was demanded 
to constitute V = yi—any hesitation or uncertainty being noted. 
The accommodation was tested with No. 1 of Jaeger’s type, and 
the near-point noted was always (unless in a few cases not tested 
under the writer’s own eye) that of the nearest perfectly sharp 
vision—a noteworthy point, since type of this size can be read 
easily when considerably blurred. The hue dot-tests of Burchardt 
were occasionally used as control-tests. Subjective recognition of 
astigmatism was sought by revolving the narrow parallel band of 
Green’s series. The test for manifest refraction was begun with very 
weak glasses (= 0.25 D.), and carried on to that glass which gave 
the best visual result, or that convex glass through which the best 
visual result was still attainable. The muscular relations were 
studied by noting the movements of the eyes by alternate covering 
with a card—the fixation object being never the finger, but a fine 
point demanding accurate accommodation to see it clearly at the 
30 c.m. distance employed. This method has been employed by 
the writer for about five years, and can be unhesitatingly recom- 
mended as giving iu careful hands results as accurate as to the 
presence and degree of insufficiency of the interni or externi as 
the test of v. Graefe. As, however, a certain amount of repetition 
of any test is needed to uncover the full amount of insufficiency 
of the interni, which time did not in this case permit, the figures 
given are almost always somewhat of an underestimate of the 
degree, as was often shown when the Graefe-test was employed 
later. In making the latter test a very.fine “dot-and-line” was 
used, and the measurement made with a 6° prism vertical and the 
revolving prism of Herschel (Cret£s). In the ophthalmoscopic 
investigation the improvised dark-room was not always fully satis- 
factory, and a few contradictory results were obtained, some of 
which could be cleared up only in the dark-room of the eye-clinic. 
The examinations were all made by the writer himself (sometimes 
with the confirmation of other ophthalmoscopists of skill), with the 
instrument of Loring. The refraction was measured at a point 
about midway between the optic disk and the macula, looking 
through the inner part of the corneal reflex, i. e., almost exactly 
iu the axis of the eye. The examiner’s H == 0.75 I)., which has 
been accurately measured under mydriaties by I)r. Risley, was A STUDY OF THE EYES OF MEDICAL STUDENTS. 
5 
always allowed for or corrected by his glass; (hence the rather 
frequent occurrence of H == 0.75 in the records, which means that 
the finest details of the fundus near the macula were sharply seen 
with + 1.5 D.). Retinoscopy with the plane mirror from a dis- 
tance of 2-3 metres was also often employed as a controlling test. 
Further, when the individuals had been corrected previously under 
a mydriatic, the result was ascertained and noted ; as also in case of 
some who were so examined at a shortly subsequent time. 
That independence of the various details of the examination, 
which has been made much of by some examiners, was neither 
desired nor sought. To work thus in the dark is doubtless well 
for those who cannot trust themselves to obtain unbiased results, if 
they are aware of conflicting findings. Whenever possible, all the 
other data Avere before the examiner as he made the ophthalmo- 
scopic measurement, and he permitted himself neither to force his 
reading of the refraction into accord with other findings, nor to be 
shamed out of noting his failures to obtain with this means the 
results which were evidently the correct ones. The newer ophthal- 
moscope of Loring is probably the most perfect instrument in exist- 
ence for the measurement of the refraction; and more than five 
years’ incessant use of it under all circumstances has given the 
writer a confidence in its readings that work with atropinized eyes 
and the artificial eye does not show to be overweening. Yet any 
concealment of its fallibility would be utterly unjust, and would 
tend to weaken the fair claim that this method is the one which, in 
the absence of complete paralysis of the accommodation, will most 
frequently approximate accuracy. Since no single test can be en- 
tirely relied on, however, so here the ophthalmoscopic reading must 
often be revised in the light of the other data, in order to obtain the 
aim of this investigation—the true refraction of the eye. No. 
NAME. 
Degree 
AGE. 
VISION. 
MANIFEST R. 
0PHTHALM0SC. R. 
MYDRIATIC R. 
P.p. 
P.r. 
Lines 
at 
FUNDUS. 
Insuf. 
1 
1 
II. W. A. 
19 
fO.D. 8 + 
It0.8. | + 
14. 
12. 
55. 
60. 
= } 
4° 
2 
J. W. B. 
19 
fO.D.i? 
\O.S. 1?? 
Em. 
Em. 
Em. 
+ 1.5 (V.V., H.v. + 1.) 
9. 
10. 
66. 
66. 
90° 
90° 
Conus out. 
0° 
J. G.C. 
19 
fO.D. *? 
—.25 8 
Em. 
8. 
62. 
90° 
Conus out. 
0° 
10.8. |4? 
-•9| 
Em? (—.25?) 
7. 
55. 
180° 
Conus out. / 
D. T. L. 
19 
fOD.a 
Em. 
+ .75 (V.V.) 
11. 
45° 
1 
? 
1 O.S. * 
Em. 
+.75 (V.V.) 
11. 
J 
5 
J. G. S. 
19 
fO.D. | + 
to.S. 1 + 
+ .75 
+.75 
12. 
14. 
70. 
75. 
45° 
:::::: } 
3° 
6 
w. s. s. 
B. A. 
19 
(O.D.A 
t 0.8. * 
Em. 
— 2. 
Em. 
— 1.5 
11. 
8. 
45. 
40. 
20° 
Conus} Choroid in bad condition. 
? 
W. H. T. 
19 
fO.D. | 
+ .6 
+ 2. (V.V.,H.v. + 1.?) 
10. 
47. 
) 
0° 
io.S. J 
+ .5 
+ 2. (V.V., H.v. + 1.?) 
10. 
43. 
J 
8 
E. M. 
B. A. 
19 
(O.D.J? 
+.5 8 
+ 1. (V.V.) 
10. 
40. 
Conus. ) 
IO.S. 8? 
+.5 8 
-t- 1.25 (V.V.) 
10. 
40. 
Conus. J 
9 
E. T. W. 
B. A. 
19 
f O.D. 8 + 
IO.S. 8 + 
— 
. +.75 (V.V.) 
+.5? (V.V.) 
13. 
12. 
58. 
52. 
180°? 
180°? 
= ) 
4° 
10 
W. C. A. 
20 
fO.D. 8 
Em. (+.5?) 
Em. (+.5?) 
9. 
65. 
Conus in and out. ) 
0° 
io.s. 8 
+ .5fH 
+.5 (As?) 
8. 
65. 
Conus in and out. j 
11 
J. N. B. 
- 
20 
fO.D 
to.S. 8 + 
+ 1.25 
+ 1.25 
12. 
11. 
80. 
90. 
90° 
90° 
:: } 
5° 
12 
G. H.C. 
20 
fO.D. TS, 
to.S. A 
1 J 
“4 
Em? (—.5?) 
Em? (—.5?) 
11. 
11. 
45. 
45. 
165° 
165° 
Conus out. 1 
Conus out. / 
4° 
13 
W.A.H.D. 
B. A. 
20 
fO.D. 8? 
io.s. 1? 
+ .5 
120° 
Conus, bad Choroid. > 
5° 
-.5(1) 
+.5 
75° 
Slight Conus. j 
14 
C. W. 0. 
20 
fO.D. 8 
to.S. 8 
9. 
36. 
90° 
Conus. 1 
+.5 
8. 
37. 
90° 
I 
15 
J. L. H. 
20 
fO.D. 8? 
+.75 
+ .75 
+.75 
13. j 
50. 
75° 
1 
0° 
io.s. 1? 
+.75 
+ 1.25 (V.V.) 
+.75 
13. 
52. 
105° 
; 
16 
K.C.J. 
20 
/O.D. 8? 
— 5 
+.5 
22. 
47. 
? 
Slight Conus. 1 
5° 
to.S. 8 
-.5(1) 
+.5 
24. 
42. 
? 
Slight Conus. j 
fO.D.?H 
to.S. * 
—.5 
—.5 
10. 
45. 
10° 
Slight Conus, Chorid disturb. ) 
0° 
17 
J. W. L. 
20 j 
Em? 
Em.? 
11. 1 
20. 
170° 1 
Slight Conus. J No. 
NAME. 
Degree. 
LU 
O 
VISION. 
MANIFEST R. 
OPHTHALMOSC. R. 
MYDRIATIC R. 
P.p. 
P.r. 
Lines 
at 
FUNDUS. 
Insuf. 
18 
R. L. 
20 
/O.D. |? 
—.5 
+.5 
13. 
49. 
120° 
1 
3° 
(O.S. 1 
Em. 
Em. 
12. 
51. 
60° 
/ 
19 
W. E. S. 
20 
/O.D. j? 
Em. 
Em. 
11. 
44. 
SI. Conus. 1 
6° 
1 o.s. 1? 
—.5? 
Em. 
10. 
49. 
SI. Conus. / 
20 
T. L. S. 
20 
f O.D. § 
+.5 + 
+ 1.5 (V.V., H.v. + 1.) 
20. 
45. 
90° 
Slight Conus. ) 
5°G. 
(O.S. fH?? 
+.65 + 
+ 1.5 (V.V.,H.v. + 1.) 
13. 
36. 
105° 
Conus. Choroido-retinal disturb. / 
21 
W.C.McF. 
20 
{ O.D. | 
+ .75 
11. 
55. 
90° 
X 
0° 
lo.S. s 
+ 1* 
10. 
52. 
75° 
f 
22 
J. W. 
20 
{ O.D. | 
lo.S. 1 
+.5 (V. at 60°) 
+ .75 (V.V.) 
180° 
? 
j- Retina striated and vess. tortuous. 
3° 
23 
W.W.W. 
B. A. 
20 
/O.D. | 
+ .5 
+ .5 
12. 
60. 
Conus, atrophic. ) 
3° 
lo.S. 1 
Em. 
+ .5 
12. 
60. 
SI. Conus. ) 
24 
W. Z. 
/O.D. |? 
+.65 
+ 1.5? 
9. 
45. 
Conus, Choroid bad. 1 
0° 
lo.S. 
+ .75 
+ 1. + 
9. 
45. 
SI. Conus. ) 
26 
G. F. B. 
B. S. 
21 
ISP” 
— 1. 
—.5 
9.5 
45, 
40° 
Conus. 1 
6° 
lo.S. 
—.5 
Em. 
10.5 
45. 
Conus. j 
26 
T. D. 
21 
{ O.D. | 
—.25 
—.51 
13. 
32. 
90° 
l 
0° 
lo.S. g 
Em. 
+.5 (V.V.) 
11. 
35. 
1 
27 
E. W. J. 
21 
ro.D.f^ 
+ 1. 
12. 
55. 
60° 
1 
? 
lO.S. 
+ 1- 
11. 
55. 
120° 
/ 
28 
I. L. 
B. S. 
21 
|0.d.?h? 
—.5 
+ 1.5 (H.y. + 1.) 
10. 
42. 
90 
X 
0° 
lo.S. 1? 
—.5 
+ 1.5 (H.v. + 1.) 
10. 
50. 
10 
) 
29 
S. G. T. M. 
21 
{O.D. | 
Em? 
+.75 
11. 
Conus, atrophic. 1 
0° 
(O.S. | 
Em? 
+ .75 
10. 
Conus, atrophic. / 
30 
J. R. McC. 
Phar. G. 
21 
jO.D.s* 
Em. 
+ 1. (H.v. +.5) 
13. 
65. 
Slight Conus. ) 
6° 
lo.S. hA 
Em. 
+ 1.? (H.V. +.5) 
14. 
55. 
Slight Conus. / 
31 
E. T. N. 
21 
rO.D.?M 
+ .6 (V.V.) 
13. 
37. 
30° 
Conus. l 
4° 
lo.S. 
+ .5 (V.V.) 
11. 
37. 
Conus. / 
32 
0. E. S. 
21 
{O.D. 8? 
Em? (—.25 f) 
11. 
52. 
SI. Conus. ) 
0° 
lo.S. 8? 
Em. 
+ .5 (H.v.V.V. higher) 
10. 
52. 
SI. Conus. J 
33 
A. J. S. 
B. A. 
21 
{0Dt* 
8. 
70. 
90° 
j 
lo.S. 1 
10. 
43. 
120° 
34 
E. K. W. 
21 
{O.D. 8 
+ .65 8 + 
+ .75 
10. 
65. 
150° 
SI. Pigment Conus. \ 
5°(6°G.) 
lo.S. 8 
+.75 8 + 
+ .75 
10. 
60. 
150° 
SI. Pigment Conus. J No. 
NAME. 
Degree. 
LU 
C3 
VISION. 
MANIFEST R. 
OPHTHALMOSC. R. 
MYDRIATIC R. 
P. p. 
P.r. 
Lines 
at 
FUNDUS. 
Insuf. 
36 
W. H. B. 
22 
roi).f? 
10.8. V 
—.5 
+.5 
Em. 
Em. 
16. 
17. 
53. 
55. 
Semiatroph. Conus, down and out.) 
Pigm. Conus. j 
2° 
36 
W. H. Br. 
B. Phil. 
22 
/O.D. §?? 
—.5 
+ 1.1 
+ .75 
11. 
90° 
(O.S. 
Em. 
+.75 
+.750+.5 c. ax. 70° 
11. 
90° 
2° 
37 
W. A. C. 
22 
;o.d.a 
+.75 
+ 2.? (Y.V., H.v. + 1.) 
+.90+.9 c. ax. 90° 
10. 
44. 
180® 
lo.s. a 
+ .75 
+ 2.? (V.V,, H.v. + 1.) 
+.90+.9 c. ax. 90° 
10. 
44. 
180° 
3° 
38 
J.C. C. 
22 
/ O.D. | dif. 
(O.S. gdif. 
Km. 
Em. 
Em. 
Em. 
12. 
12. 
55. 
55. 
180°? 
? 
Choroid wooly. 1 
Conu8 out. Choroid wooly. / 
0° 
39 
E. M. G. 
B. A. 
22 
/ O.D. f^dif. 
+.5? (V.V.) 
14. 
48. 
45° 
(O.S. JMdif. 
+ .5 (V.V.) 
14. 
48. 
135° 
Conus. ) 
8° 
40 
L. J. H. 
22 
/O.D. 8? 
+ .5 
14. 
48. 
135° 
10.8. |? 
—.5 
14. 
48. 
90° 
x } 
7° 
41 
J. H. H. 
22 
/O.D. § 
\0.S. g 
Em. 
Em. 
+ .5 
+.5 
15. 
15. 
45. 
50. 
30° 
150° 
Choroid disturbed throughout. 1 
Conus out. J 
0° 
42 
E. J. M. 
B. A. 
22 
/O.D. g 
Em. 
Em. 
15. 
50. 
lo.s. i 
Em. 
Em. 
15. 
55. 
} 
0° 
43 
P. J. S. 
B. A. 
22 
/ O.D. | 
lo.s. 
+.5 
+ .5 
Em. ? 
Em. ? 
13. 
12. 
50. 
53. 
135° 
Conus (pigment). 1 
Conus (pigment) out and in. J 
) 
4° 
44 
A. N. T. 
22 
/O.D. I? 
+.75 
10 5 
90° 
lo.s. | 
+ 1.5 
11. 
105° 
} 
0° 
45 
T. S. W. 
B. A. 
22 
/ 0 D . A —3.5 
— 4.5 
— 45 
— 4.0—.65 c. ax. 120° 
6. 
23. 
150 
10° 
( O.S. 3.6 
— 5. 
— 4.5 
— 4.0—.65 c. ax. 80° 
7.5 
26. 
30 
/ Conus in each. ’ / 
46 
u. w 
B. A. 
22 
/ O.D. | 
Em. 
Em? 
13. 
40. 
75° 
Conv. 
lo.s. g 
—.65 
—.9 
9. 
45. 
105° 
Conus. Choroid wooly. 
47 
F. A. A. 
23 
/O.D. J 
lo.s. * 
—.75 § 
— 1.258 
—.5 
— 1.5? 
9. 
10. 
48. 
44. 
120° 
60° 
Conus. Choroido-Ret. disturbance.) 
Slight Conus. J 
0° 
48 
C. W. B. 
B. S. 
23 
/O.D. A 
—1.0—.75 c. ax. 165 A + 
+ 1. (V. at 50° at 140° M ?) 
12. 
32. 
60° 
lo.s. a 
—1-5 A + 
+ 1.25 + (V. at 120°) 
14. 
23.5 
165° 
::::: } 
0° 
49 
E. W. C. 
23 
/O.D. | 
Em. 
Em. 
12.5 
81. 
... 
lo.s. 8? 
Em. 
+.75 
10. 
75. 
} 
50 
S. P. C. 
B. A. 
23 
/ O.D. | 
+ .5 
10. 
60. 
180°? 
Slight Conus. 
0° 
(O.s. 8 + 
Em. 
10. 
60. 
180°? 
Slight Conus. f 
) 
51 
W. D. G. 
B. A. 
23 
Em? 
+.65 
+.75 c. ax. 10° 
14.5 , 
29. 
100° 
lo.s. 8 
+.5 « 
+ .75 (V.V., H.v. +.5) 
+.75 c. ax. 75° 
15. 
38. 
75° 
} 
0° 
52 
II. H. K 
B. A. 
23 
/O.D. g 
- 2.75 § 
— 2.5 (V.V., H v. — 3.) 
— 2.5 8.0—.75 c. ax. 100° 
12. 
30. 
90° 
Conus } Choroido-Ret. disturbance. 
lo.s. g 
— 2.75 | 
— 2.5 )V.V.,H.v.— 3) 
— 2.5 8.0—.75 c. ax. 180° 
!2. j 
37. 
90° 
5° No. 
NAME. 
Degree. 
UJ 
o 
< 
VISION. 
MANIFEST R. 
OPHTHALMOSC. R. 
MYDRIATIC R. 
P.p. 
P.r. 
Lines 
at 
FUNDUS. 
Insuf. 
53 
W. P. L. 
23 
JO.D.g 
to.s. 
+ .65 
Em. 
+ .75? 
+ .5 
15. 
13. 
53. 
66. 
o o 
15 
Ret. vess. tortuous. ) 
Conus. J 
? 
54 
C. B. M. 
23 
JO.D.g 
Em. 
+.75 (V.V.) 
10. 
38. 
90° 
Conus. ) 
3° 
to.s. | 
Em. 
+ 1. (V.V., H.v. +.75) 
12. 
38. 
90° 
Conus. J 
65 
H. B. M. 
G. Phar. 
23 
JO.D. ?H + 
Em. 
+ 1. (V.V.) 
+.750+.25 c. ax. 90° 
10. 
84. 
90° 
| Choroid in bad condition. 
5°(8°G.) 
lo.s. + 
Em. 
+ .5 (Y.Y.) 
+.250+.75 c. ax. 90° 
10. 
80. 
75° 
5C 
J.M. 
23 
fO.D. |Hdif. 
Em. 
+ .5 + (V.V.) 
10. 
61. 
180°? 
1 
? 
to.s. g dif. 
Em. 
+ .5 + (V.V.) 
11. 
54. 
90° ? 
J 
67 
E. E. P. 
23 
JO.D.g 
to.s. g? 
Em. 
+ .5 
+ .75 (V.V.) 
+.75 (V.V.) 
10. 
10. 
60. 
60. 
180° 
165° 
flight Conus } Choroid disturbed. 
58 
T. G. L. 
23 
JO.D.g? 
Em. 
Em. 
13. 
65. 
Slight Conus. ) 
to.s. g 
Em. 
Em. 
13. 
65. 
Slight Conus. J 
59 
F. D. 
24 
|O.D.^ 
-1-1 
+.5 (V.V., H.v.M ?) 
15. 
42. 
10? 
Slight Conus. 1 
? 
to.s. g 
—.5 
— 1. (V.V.,H.v. — 1.5) 
14. 
43. 
90? 
Conus. J 
60 
C. J. H. 
24 
JO.D.g? 
Em. 
+.5 (V.V.) 
13. 
75. 
180° 
Slight Conus | Choroid in bad condi- I 
3°G. 
to.s. g? 
—.5? 
+ .5 (V.V.) 
13. 
75. 
180° 
Slight Conus J tion. J 
61 
J. H. H. 
24 
JO.D.g? 
—.5 
+.5 (V.V.) 
10. 
40° 
Conus. \ 
? 
to.s. g? 
—.5 
+ .5 
10. 
180° 
J 
62 
J. H. K. 
B. A. 
24 
J0D'V 
+.5 
+ .75 (V. at 75°) 
11. 
28. 
Conus. 1 
3° 
to.s. 
+ .5 
+ .5 (V.V.) 
8. 
37. 
Conus. J 
63 
A. M. L. 
24 
+ .75 
7.5 
60. 
180° 
X 
to.s. 
+ .75 
(7.5 
60.) 
180° 
J 
64 
G. A. L. 
B. A. 
24 
fO.D.g 
Em. 
+ .5 + (V. at 60°) 
18. 
44. 
135° 
Pigment Conus. 1 
(Conv.) 
to.s. 1 
+ .5 
+ .5 + (V. at 120°) 
20. 
43. 
135° 
Pigment Conus. J 
65 
T. S. E. 
24 
fO.D.g 
Em. 
+ .5? 
6.5? 
53. 
75° 
Slight Conus. ) 
(Conv.) 
to.s. g 
Em. 
+ .5 
9. 
54. 
100° 
Slight Conus. J 
66 
A. V. S. 
B. A. 
24 
f O.D. g dif. 
Em. 
+ .5 + 
14. 
65. 
Slight Conus out. ) 
0°(G.) 
tO.S. g dif. 
Em. 
+.5 
12. 
55. 
Slight Conus. J 
67 
J. B.T. 
24 
JO.D.g + 
+ .5 
+.75 + 
+.9 
15. 
60. 
180? 
Conus out and in. ) 
5°(12°G.) 
to.s. g + 
+•6 
+.75 + 
+.9 
16. 
65. 
180? 
Conus out. J 
68 
w. s. w 
24 
JO.D.g? 
Em (—.5?) 
+ .75 (V.V., H.V.+.5) 
12. 
40. 
Slight Conus out. 1 
2°(1°G.) 
to.s. g? 
Em (—.5?) 
+ 1.5 (V.V., H.V. + .75) 
13. 
40. 
Slight Conus out. J 
09 
S. T. W. 
B. A. 
? 
JO.D.g 
+.65 
+ .75 
12.5 
60. 
40° 
l 
to.s. 
+ .65 
+ .1 
12. 
60. 
90° 
J No. 
NAME. 
Degree. 
LU 
O 
< 
VISION. 
MANIFEST R. 
OPHTHALMOSC. R. 
MYDRIATIC R. 
P.p. 
P.r. 
Lines 
1 at 
FUNDUS. 
! Insuf. 
70 
W. J. H. 
B. A. 
? 
JO.D. 
+ .75 (V.V.) 
) 
3° 
(0.8. 
+ .75 (V.V.) 
} 
71 
P. Y. 
? 
os ii 
— 5. 
—.5 
8. 
27. 
90° 
Conus. ) 
1 O.S. ft 
— 3. 
—.3 
7. 
32. 
90° 
Conus. / 
72 
L. M. 
B. 8. 
? 
/ o.l>. £ 
+ 1.(V.V.) 
15. 
28. 
30° 
) 
(0.8. J 
+ 1.5 (V.V.) 
15. 
33. 
120° 
} 
73 
J. R. C. 
25 
JO.D ft 
-.5 8? 
+.5 (V.V.+ 1.?) 
12.5 
39. 
90° ? 
10°G. 
(O.S. ft + 
—.6 I?? 
+ .5 (V.V. + 1.?) 
12.5 
38. 
90° ? 
Slight Conus. / 
74 
R. F. B. M. 
B. A. 
25 
/O.D. I 
+ .5 
+.5 
13. 
48. 
120° 
? 
(O.S. g 
—.6 
Em. 
12. 
51. 
60° 
Conus. j 
75 
J. H. 0. 
B. A. 
25 
/9D-A 
? 
—.9 (H.V.) 
—.9 c. ax. 180° 
10. 
20. 
90° 
5° 
(O.S. g 
+.5 
+ 1.25? (V.V., H.V.+.5) 
+.75 c. ax. 105° 
14. 
54. 
90° 
Underlying Conus down. / 
76 
A. S. 
B. A. 
25 
f O.D. | 
(O.S. g 
/0 D V 
+.5 
+ .5 
+ .5 
+.75 
10. 
10. 
70. 
65. 
Conus) / Large, atrophic and with > 
Conus/ ( aberrant vess. / 
0° 
77 
L. I. S. 
B A 
25 
—.5 | 
+ .75 (H.v., V.V.+ .5) 
10. 
57. 
75° 
) 
3° 
(O.S. I?? 
-•6 | 
+ 1. (II.v., V.V.+ .5) 
10. 
60. 
105° 
/ 
78 
S. W. B. 
26 
/O.D. g? 
—.5 
Em. 
9. 
0° 
(O.S. g? 
—.5 
Em. 
10. 
Conus. / 
79 
C. E. E. 
26 
/O.D. | 
Em. 
+ .5? 
18. 
52. 
(O.S. 1 
Em. 
Em? 
16. 
54. 
Conus. / 
? 
80 
G. M. M. 
B. A. 
26 
/ O.D. 
+ 1.25 (V. at 75°) 
10. 
57. 
180° 
5° 
+ .5 (1 .V.) 
11. 
53. 
150° 
Slight Conus. / 
81 
J. H. K. 
27 
/O.D. A? 
—.75 
+ 2. (V.V., H.v.+ 1.) 
+.650+ 1.5 c. ax. 90° 
13. 
30. 
180° 
0° 
(O.S. ft? 
—.75 
+ 2. (V.V., U.V. + .75) 
+.750+ 1-5 c ax. 90° 
12. 
25. 
180° 
Large Conus. f 
... . ) 
82 
W. L. M. 
27 
/O.D. g 
+ .5 
+ .75 
13. 
60. 
15° 
(O.S. 1 
+ .65 
+ .75 
13. 
60. 
165° 
} 
83 
A. T. W. 
27 
/0.1).V 
—.9 
—.5 
11.5 
35. 
Conus. ■» 
0° 
(O.S. 
—.1 
— 1.5? 
10.5 
51. 
Conus. / 
84 
C. B. McC. 
28 
/°D ?* 
+ .65g 
+.5 
13. 
37. 
150°? 
Underlying Conus out. ) 
5°(5°G.) 
• 
(O.S. f 
-.5g? 
+.5 
11. 
35. 
120° 
Conus below. Chor. disturb. / 
85 
II. E. F. 
29 
,0.D. f4dif. 
Em? 
13. 
38. 
105° 
Conus. ) 
3° 
(O.S. dif. 
+.5 (V.V., 
14 
41. 
75° 
Conus. / 
86 
F. G. II. 
B. A 
29 
/O.D. g 
(o.s. ft? 
+.5 
+ 1.5 
11 5 
Conus ont, underlying Conus down.) 
0° 
—.5 ft 
+ 1.5 
+ 1.5 
12.5 
15° 
Slight Conus, down and out. / Summarizing the above results, we find in the column of ophthalmoscopic refraction :— 
90 individuals. Em. 11 = 12.2$; Em. and M. 4 = 4.4$; M. 6 = 6.6$; M. and H. 3 = 3.33$; H. 55 = 61.$; H. and Em. 11 = 12.2$. 
180 eyes. Em. 37 = 20.5$; M. 21 = 11.6$; H. 122 = 67.7$; (Astigmatic: H. 64 = 35.5$; M. 5 = 2.8$). 
In 6 cases, however (aside from minor variations of 0.25 or less, in the degree of ametropia), the ophthalmoscopic measurement 
cannot be accepted as correct (Nos. 26, 29, 35, 43, 59 and 83), and making the necessary corrections, we find:— 
180 eyes. Em. 32 = 18.8$; M. 17 = 9.5$; H. 131 = 72.8$. 
No. 
NAME. 
Degree. 
AGE. 
VISION. 
MANIFEST R. 
OPHTHALMOSC. R. 
MYDRIATIC R. 
P.p. 
P.r. 
Lines 
at 
FUNDUS. 
Insuf. 
87 
D. A. 
Phar. G. 
30 
10DV? 
—.5 
+ .5 
17. 
50. 
90° 
1 Retinal disturbance. 
6°(8°G.) 
lo.s. t4?? 
—.5 
+.75 
18. 
50. 
180° 
/ 
88 
L. M. H. 
30 
/ O.D. | 
—.5? 
Em. 
14. 
49. 
X 
4° 
lo.s. 1 
—.5? 
Em. 
14. 
52. 
/ 
89 
E. J. K. 
30 
/ O.D. | 
Em. 
+ .5 
10. 
65. 
Slight Conns. 1 
3° 
lo.s. 1 
Em. 
Em. 
10. 
65. 
Slight Conus. J 
90 
J. Y. F. 
31 
f 0 D- 
+ .5 (V.V.) 
15. 
51. 
90o 
Conus. 1 
lo.s. s 
Em. 
15. 
49. 
120° 
Conus. / 
91 
E. T. 
B. A. 
32 
fO.D.f? 
—.5? 
11. 
60. 
105° 
} 
7° 
lo.s. |? 
-•75 f j* 
—.5? 
11. 
45. 
15° 
1 
92 
S. G. D. 
33 
/O.D. ft + 
—.75“ 
+ 1. ? (H.v.) 
18. 
30. 
45° 
Slight Conus. 1 
3° 
lo.s. 
Em. 
+ .5 
17. 
50. 
Slight Conus. J Comparing, now, the results as to the frequency and the degree of refraction-error, as found by the ophthalmoscope, and 
by the subjective measurement, we obtain the following:— 
Age. Eyes. 
Em. 
+ 0.5 
+.65 
+.75 
+ .1 + 
1.25 +1.5 
+ 2. 
H. 
Av.H. 
-0.25 
—.5 —.65 —.75 
—.9 -.1 
—1.25 
—1.6 
—1.75 -2. 
-2.75 
-3. 
-4.6 
-5. 
M. 
Av. M. 
19-20 34 
f Manifest 
a 
7 
2 
3 
... 
... 
12 
0.59 
1 
6 ... 2 
1 ... 
... 
... 
1 
... 
— 
... 
... 
11 
0.69 
(Oplithalm. 
it 
8 
... 
3 
2 
2 4 
2 
21 
0.97 
... 
1 
... 
1 
... 
... 
... 
... 
2 
1.0 
21-22 30 
( Manifest 
13 
3 
1 
3 
... 
... 
7 
0.63 
1 
5 1 
... 1 
... 
... 
... 
... 
1 
1 
10 
1.39 
\ophthalm. 
10 
5 
... 
3 
3 
2 
2 
15 
0.98 
... 
2 
1 ... 
... 
... 
... 
... 
2 
5 
2.20 
23-24 44 
(Manifest 
21 
7 
3 
... 
... 
... 
10 
0.54 
... 
4 ... 1 
... 1 
1 
1 
1 
2 
1 
... 
1 
13 
1.67 
(Ophthalm. 
3 
16 
2 
10 
4 
1 1 
... 
34 
0.69 
... 
1 
... 
2 
... 
3 
... 
1 
7 
2.28 
> 24 34 
1 Manifest 
6 
6 
2 
... 
... 
... 
8 
0.54 
... 
13 ... 5 
1 1 
... 
... 
... 
... 
... 
... 
20 
0.61 
\ophthalm. 
7 
8 
... 
5 
5 
1 1 
2 
22 
0.88 
... 
3 
1 ... 
... 
1 
... 
... 
... 
... 
5 
0.78 
Total, 142 
( Manifest 
51 
23 
8 
6 
... 
... 
37 
0.57 
2 
28 1 8 
2 3 
1 
1 
1 1 
2 
1 
1 
2 
54 
1.03 
\ophthalm. 
31 
37 
2 
21 
14 
4 8 
6 
92 
0.85 
... 
7 
2 ... 
... 
4 
... 
3 
2 
1 
19 
1.89 
Total, 180 in all 
32 
55 
2 
34 
18 
6 10 
6 
131 
0.82 
... 
7 
2 ... 
... 
2 
2 
1 
2 
1 
17 
1.80 
The degree of ametropia given is that of the most ametropic meridian. A STUDY OF THE EYES OF MEDICAL STUDENTS. 
13 
The cases where the refraction, as determined under a mydriatic, 
is known are, unfortunately, too few to need any summarizing. 
Case No. 45 was measured under atropine, and cases 55 and 86, 
by the writer, under hyoscyamine, shortly after the other examina- 
tion; the others had been previously tested, generally at the Uni ver- 
sity clinic, under atropine. 
Study of the range of accommodation shows the results to ac- 
cord well with the figures of Donders. Of 174 eyes tested, but 20 
had more than 11 D. of accommodation, and only 26 less than 
7.5 D. (the refraction being always taken into account). Several of 
the high results are of questionable accuracy : most of the low fig- 
ures are to be ascribed to astigmatism. The average range among 
those 19 years of age was A.=10.5 ; among the oldest men (28-33 
years), A.=7.8 D.: among all examined, A.=9.17 D. 
The astigmatic lines were selected with more or less definiteness 
by 173 eyes as best seen in some one direction. Of these, 54 
seemed astigmatic by other tests, while 15, which did not select 
lines, appeared to be none the less really astigmatic. This anomaly 
is therefore noted in 69 cases, exclusive of doubtful ones, as present 
in measurable degree (0.51), or more). Insufficiency of the con- 
vergence for the near (30 cm.) was recorded in 42 cases, the esti- 
mated degree varying from 2° to 12°. In ten individuals it was 
hardly measurable (“?”), in 26 it seemed absent, while in 9 data 
are lacking. The ophthalmoscope showed a large amount of intra- 
ocular trouble, generally of no high grade; yet more marked than 
could be set down as the retinal striation, etc., due to hard work— 
i. e. the typical “student’s eye-ground,” by which tradition says 
someGerman'“ savants” gauge the diligence of their pupils. Not- 
able absorption of pigment at the nerve-entrance, comprising all 
forms of so-called “ conus,” was found in 116 eyes. Where the 
pigment in the choroid ring was dense, and the irregularity of its 
distribution was apparently, yet not certainly, due to pathological 
absorption, the condition was set down as “ pigment conus.” 
Narrow crescents, whether seini-atrophic or atrophic, are generally 
noted as “slight,” until the breadth of the retinal vein is exceeded. 
When more than one-fourth of the diameter of the disk, they are 
termed “ large.” In 17 cases the disturbed condition of the choroid 
is noted, the condition being sufficiently marked to call for treat- 
ment without delay: in several others the tortuosity of the retinal 
vessels and the blurring of the nerve margins prompted to a careful 14 
A STUDY OF THE EYES OF MEDICAL STUDENTS. 
search for extravasations or splotches, and the eyes had to be looked upon as diseased and demanding medical 
care. Of the few approximately healthy eye-grounds, almost all were in students who had been under treatment at 
the clinic, or who seemed, by all tests, emmetropic. 
As to the vexed question of anisometropia, the results are balanced, and negative in their showing. The relation 
of conns to the refraction is not very definite—so far as it goes, apparently in conflict with the accepted views. It was 
noted in 25 = 79.% of the Em. eyes, in 11 = 78.5% of the M., in 5 = 100.% of the M. As., in 35 = 53.8% of the 
H., and in 40 = 62.5% of the H. As. As with the question of the apparent emmetropia, full confidence cannot be 
asked for results in this matter not obtained under full action of a mydriatic. 
Four previous studies of the refraction in medical students are on record: Cohn, Breslau, 1867; Cohn, 
Breslau, 1881 ; Collard, Utrecht, 1881, and Van Anrooy, Leyden, 1884. Of the two examinations of Cohn full 
details are lacking, and only the following data can be given :— 
Age. Indiv. Eyes. Em.;*. M.jf. —0.25—1. —1.25 — 2. —2.25 — 3. —3.5 — 4. —4.5 — 5. —6.5 — 6. > —6. 
17-36 71 ... 26 37. 40 =- 56. ... ... ... ... ... ... ... (5 = 7.) 
108 I 216 81 — 37.5 116 = 64. 25 22 12 18 18 11 8 19 = 8.8 A STUDY OF THE EYES OF MEDICAL STUDENTS. 
15 
AGE. 
EYES. 
Em.$. 
+.25 +.5 +.65 +.75 
+ 1 
+ 1.25 +1.5 +1.75 +2. +2.25 
+ 2.5 
+ 2.75 
+ 3. +6.5 
Av. H.m. 
18-20 
94 
42 = 44.7 
5 ... 6 
2 
... 4 1 ... 1 
1 1 
21 = 22.3 
1.31 
21-22 
46 
17 = 37. 
1 
5 
2 
1 
1 
10 = 21.7 
1.35 
23-24 
38 
20 = 62.6 
1 
2 
3= 8. 
0.92 
> 24 
62 
34 = 54.8 
3 ... 4 
2 
11 2 
1 
1 
15 = 24.2 
1.20 
Total, 
240 
113 -= 47.1 
8 ... 12 
11 
3 5 3 ... 1 
2 
2 
1 1 
49 = 20.4 
1.25 
—.25 —.5 - 
-.75 
-.1 —1.25 —1.5 — 
1.75 
-2. —2.25 —2.5 —2.75 —3. —3.5 
— 3.75 
— 4. — 
4.5 -5. >5. 
M.jS. 
Av. M. 
16 
3 
112 
1 
1 1 ... 1 
1 
2 
2 
31 - 33. 
1.52 
2 
1 
113 
2 
1 
1 
2 
5 
19 = 41.3 
1.93 
1 
4 
2 
1 
2 
13 1 
15 - 39.9 
3.18 
4 
5 ... 2 
2 
13 - 21. 
4.21 
18 
12 
7 2 7 
3 
1 2 ... 1 2 
3 
6 
1 3 10 
78 = 32.5 
2.39 
Ill each of the Hollandish investigations, the individual results are given in full, and the following 
data are obtainable. Collard, among the 550 students in the University of Utrecht, examined 410— 
testing 120 of the total 136 medical matriculates. His results were:— 16 
A STUDY OF THE EYES OF MEDICAL STUDENTS. 
AGE. 
EYES. 
Em.*. 
+ .25 + 
.5 +.65 
+.75 
+ 1. 
+ 1 25 
+ 1.5 
+ 1.75 
+ 2. 
+ 25 
+ 3. 
+ 3 5 
+ 4. 
+ 4.5 
+ 5 
H.m.*. 
Av. H.m. 
17-20 
160 
83 = 56.3 
... 
. 
16 
2 
4 
,, 
... 
tM 
... 
... 
... 
... 
22 = 14.6 
1.11 
21-22 
118 
70 = 69.9 
... 
. 
2 
4 
... 
1 
1 
2 
1 
2 
... 
2 
2 
2 
19 = 16.1 
2.59 
23-24 
86 
48 = 65.8 
... 
. 
6 
11 
... 
... 
... 
... 
1 
2 
2 
... 
1 
1 
23 = 26.7 
1.74 
>24 
70 
43 = 61.4 
1 
. 
... 
4 
... 
... 
... 
... 
... 
... 
... 
... 
... 
... 
5= 7.1 
0.85 
Total, 
424 
244 = 67.6. 
1 
• 
7 
35 
2 
5 
1 
2 
2 
4 
2 
2 
3 
3 
69 = 13.9 
1.69 
—.25 —.5 - 
.75 
—1. 
—1.25 
-1.6 - 
-1.75 
— 2. 
-2.5 
-3. - 
3.5 
— 4. - 
4.5 
-6. — 
5.5 
— 6. >6. 
M.*. 
Av. M. 
4 
3 
9 
... 
6 
... 
... 
5 
2 
1 
6 
3 
2 
2 
2 
45 = 30. 
2.66 
4 
1 
... 
... . 
5 
... 
... 
... 
3 
3 
5 
... 
... 
2 
... 
6 
29 = 24.6 
3.95 
2 
... 
5 
... 
1 
... 
3 
1 
... 
1 
1 
... 
... 
... 
1 
... 
15 = 17.4 
1.97 
3 
... 
3 
1 
2 
... 
4 
1 
1 
... 
2 
... 
1 
2 
... 
2 
22 = 31.4 
2.74 
13 
4 
17 
1 
14 
... 
7 
7 
6 
5 
14 
3 
3 
4 
3 
10 
Ill = 26.2 
1.91 
Of 740 matriculates, in the various departments of the University of Leyden, 470 were examined by Van 
Anrooy, 213 of them being: medical. Among these he found :— A STUDY OF THE EYES OF MEDICAL STUDENTS. 
17 
Similarly stated, the results of the investigation in Philadelphia 
are for the manifest refraction :— 
AGE. 
EYES. 
Em 
+.5 
+.65 
+.75 +1 
+ 1.25 
+ 1.5 
+ 1.75 
+ 2 
Av. H.m. 
19-20 
34 
11 = 32.4 
7 
2 
3 
12 = 35.3 
0.59 
c 
21-22 
30 
13 = 43.3 
3 
1 
3 
7 = 23.3 
0.63 
23-24 
44 
21 = 47.7 
7 
3 
10 = 22.7 
0.54 
> 24 
34 
6 = 17.6 
6 
2 
8 = 23 5 
0.54 
Total, 
142 
51 = 35.9 
23 
8 
6 
37 = 26.+ 
0.57 
—.25 —.5 
-.65 — 
75 
-.9 
—1. —1.25 - 
-1.5 
—1.75 
— 2. — 
2.75 —3. 
— 4.5 
5 
M.% 
Av. M. 
1 6 
2 
1 
1 
11 = 30.4 
0.69 
1 5 
1 
1 
1 
10 - 33.3 
1.39 
4 
1 1 
1 
1 
2 1 
1 
13 - 29.6 
1.67 
13 
5 
1 
1 
20 = 59. 
0.61 
00 
CM 
1 8 
2 
3 1 
1 
1 
1 
2 1 
1 
2 
54 = 38. 
1.03 
The contrast in the greater frequency and higher grade of the 
myopia among the Breslau students is very apparent; but close 
comparison is impossible. The results in the Universities of 
Utrecht and Leyden are strictly comparable to those in the Univer- 
sity of Pennsylvania in almost every point; the smaller number in 18 
A STUDY OF THE EYES OF MEDICAL STUDENTS. 
the latter ease, and the fact that they constituted about one-half of 
the second year class alone, instead of fully representing the entire 
school, being the only notable differences. As to the determina- 
tion of the manifest refraction in the Philadelphia study, while 
the writer freely concedes that he laid less stress upon it as a means 
to accurate results as to the true refraction of the eyes tested, and 
not infrequently omitted it, he can none the less justly claim that 
the test, when applied, was employed with the utmost care. In 
age, the students quite nearly correspond in all the studies. In 
Germany, all students must have passed through the Gymnasium 
before entering the University, and the same probably holds good 
for Holland. Such is, of course, not the case here; but, as will be 
seen, at least 30 per cent, of the medical matriculates of the Uni- 
versity of Pennsylvania have already received a Bachelor’s degree 
in arts, science or philosophy; while many others have passed 
through elective collegiate courses and obtained proficiency grades 
not recorded. For the remainder, the entrance examination, 
though not stringent, presupposes a fair academic education; so 
that the educational standard is in a considerable proportion higher, 
and, on the average, certainly no lower, than in the European 
schools. • 
It is probable that among larger numbers of American students 
higher grades of ametropia would have been occasionally found ; 
yet in the present study it is notable that by the glass-test there were 
found no cases of hypermetropia higher than + 0.75 D., nor of 
myopia above —5. D.; only ten eyes being above —1. D. The 
ophthalmoscope and other methods show the existence of higher 
grades of H., but none above + 2 D.; while among the myopes 
the low grades only of myopia seem to have been simulated or 
increased by spasm. The proportion of apparent emmetropes 
agrees closely with Cohn’s results; but the other tests show that 
real emmetropes were not more than half as frequent, in spite of 
every eye being called emmetropic which was not definitely proven 
otherwise. 
That controlling tests with the ophthalmoscope and other 
methods would have had a similar effect upon the statistics of the 
foreign observers in decreasing the array of myopes and increasing 
the proportion and grade of hypermetropia cannot be absolutely 
asserted; yet large numbers of more or less comparable cases give 
great confirmation to such an assumption. Thus, Conrad, in the A STUDY OF THE EYES OF MEDICAL STUDENTS. 
17 
Gymnasium of Konigsberg, found among 3036 eyes, Em. 55 per 
cent., M. 33 per cent., and H.m. 11.7 per cent, by the glass-test; 
and by the ophthalmoscope, Em. 30 per cent., M. 22.3 per cent., 
and H. 47.5 per cent.—the results among the oldest pupils corres- 
ponding well with those for the whole school. In like manner, 
Durr found in the II. Lyceum of Hanover, among 318 pupils, 
Em. 28.3 per cent., M. 38. per cent., and H.m. 33.6 per cent. (?) by 
the glasses, and after Homatropine, Em. 7.8 per cent., M. 31.7 per 
cent., and H. 60.4 per cent. Among the older pupils in a seminary 
the results similarly obtained were: Em. 29.5, M. 33.3, and H.m. 
37.5 per cent., as against Em. 9.4 per cent., M. 33.3 per cent., and 
H. 57.3 per cent., after the mydriatic. 
Before presuming to draw, in closing, any conclusions from such a 
limited study, a few remarks seem called for. The foregoing data 
are offered as a small contribution to a large series of investigations, 
all more or less imperfect, with the hope that they may form a 
beginning which can be amplified and improved later. Imper- 
fect as they are in many respects, they will compare only too well 
with most similar work on record. The general questions involved 
in these investigations are elsewhere discussed; suffice it to say here, 
that of about 125 investigations, of which the records are before 
the writer, only 20 seem at all comparable in the methods employed 
to secure approximate accuracy, and many of these are studies of 
the eyes of infants. The introduction of elaborate detail in ex- 
tended investigations may be practically impossible; if so, it is time 
to let such sweeping statistics alone, and limit the examinations to 
numbers commensurate with the fullest care and completeness of 
detail. Studies without a mydriatic are confessedly imperfect; but, 
practically, a mydriatic can be very rarely employed, and a critical 
comparison of the results of the various methods in the same cases 
will do much to show their relative accuracy and whether average 
corrections may be used with advantage. The practical hygienic 
possibilities of such examinations are enormous, as is being more 
and more clearly recognized in Germany, where the evil is most 
pressing; and they will be eventually recognized everywhere. Yet 
scientific accuracy is the first requisite to their obtaining any respect for 
their findings and teachings, for then only will they cease “ to vary 
like the wind,” as an eminent student of the subject has put it. A plea 
for more careful work in the future seems most distinctly in place, 
and is not wholly negatived by the imperfections of the work here 18 
A STUDY OF THE EYES OF MEDICAL STUDENTS. 
set forth. It should be remembered that the prime object here was 
the instruction of the students of the class, and that the data set 
forth are such as the writer could incidentally obtain. Less than 
ten hours were devoted to the examination of upward of one hun- 
dred individuals and the explanations called for by it; and in the 
absence of special assistance, the records are often incomplete. Yet, 
for the accuracy of the record in almost every point given, the 
writer can vouch. 
In conclusion, the following points may be cited as noteworthy:— 
Of the 90 students, 8 = 9. per cent, appeared emmetropic; all 
the rest being ametropic, generally in low degree, in one or both 
eyes. Of 180 eyes, 32 = 18.8 per cent, were set down as emme- 
tropic; although several of these had normal vision only with a 
concave glass, and defective vision, functional discomfort, and 
intraocular disturbance were but little less frequent among them 
than among the ametropic eyes.* Myopia of one or both meri- 
dians was met in 11 individuals, in 5 of whom it was monoc- 
ular. In no case was the condition of the fundus fairly good, all 
presenting disturbance of the choroid demanding medical care. 
Astigmatism was found in the five myopic eyes measured under a 
mydriatic, and was probably present in most of the others. Ilyper- 
metropia was the preponderating condition of refraction, consti- 
tuting 71.6 per cent, of all the eyes studied; although but 26 per 
cent, manifested their hypermetropia by the glass-test. At least 
one-half of these presented a notable degree of astigmatism, while 
many more were doubtless really astigmatic. 
* Partially explained by insufficiency or by ametropia of the other eye.