846 PETER BASSOE 



frequently postneuritic atrophy and rarely papilledema and non- 

 prominent optic neuritis. 



3. Alterations in the visual field for form and colors, concentric 

 contraction, unstable defects, quadrant defects, homonymous and 

 heteronymous hemianopsia and scotomas central, paracentral and 

 peripheral. 



4. Other ocular symptoms which have been described are as fol- 

 lows : visual hallucinations ; chromatopsia, especially cyanopsia ; per- 

 sistent photophobia ; palsy of various exterior ocular muscles ; nystag- 

 mus ; exopthalmus ; thickening and pigmentation of the eyelids with 

 hypertrophy of the palpebral glands." 



De Schweinitz agrees with Gushing that in the bitemporal hemianop- 

 sia of hypophysis tumor the boundary line is hardly ever regular or ver- 

 tical and he also has not infrequently encountered homonymous hemianop- 

 sia. In all cases the defect for colors preceded that for form. It is impor- 

 tant to map the field for all of the usually selected primary colors blue, 

 red, green as the defect may at first be present with only one of these 

 colors. In the majority of cases the temporal fields tend to be lost from 

 above downward, the so-called "temporal slant." This is corroborated by 

 Josefson who adds that he has observed that restitution of the fields takes 

 place in the opposite order. The rarity of choked disc in comparison with 

 the frequent optic atrophy is testified to by de Schweinitz, who only once 

 has observed the former in connection with hypophyseal tumor. Rhein 

 found choked disc recorded in four of 169 cases of hypophyseal tumor, 52 

 of which were instances of acromegaly. Gushing has observed choked disc 

 as a late sign engrafted on the atrophy when the intracranial pressure had 

 reached a high degree. 



Of 148 cases of such tumors with disordered fields, studied by Walker 

 and Gushing, 47 had bitemporal hemianopsia, 22 homonymous hemianop- 

 sia, and the remaining 79, blindness in on ye. The important lesson 

 from these figures is that bitemporal hemianopsia is by no means the only 

 kind of hemianopsia met with, and that it is only twice as common as the 

 homonymous form. In three cases with homonymous hemianopsia ex- 

 amined post mortem by Gushing it was found that the glandular struma, 

 had burst its capsule and extended upward along one side of the chiasma. 

 The hemiopic papillary reaction of Wernicke has been observed by Dodg- 

 son, E. Schlesinger, Thomas, and others, but Gushing, on the whole, has 

 found it disappointing. Binasal hemianopsia has been observed by Bittorf 

 and by Fisher. It can hardly be explained by lesion of the chiasma but 

 only by pressure on the outer part of each optic nerve such as might result 

 from bony change about the optic foramina, or rupture of the tumor 

 through its capsule on both sides anteriorly. 



The now frequently observed restoration of vision after operation on 



