himself that the one reflected from the front of the lens became considerably smaller during accommodation.
Subsequently Helmholtz, working independently, made a similar observation, but by a somewhat different method. Like Donders, he found the image obtained by the ordinary methods on the front of the lens very unsatisfactory, and in his "Handbook of Physiological Optics" he describes it as being "usually so blurred that the form of the flame cannot be definitely distinguished.9 So he placed two lights, or one doubled by reflection from a mirror, behind a screen in which were two small rectangular openings, the whole being so arranged that the lights shining through the openings of the screen formed two: images on each of the reflecting surfaces. During accommodations, it seemed to him that the two images on the front of the lens became smaller and approached each other, while on the return of the eye to a state of rest they grew larger again and separated This change, he said, could be seen "easily and distinctly."10 The observations of Helmholtz regarding the behavior of the lens in accommodation, published about the middle of the last century, were soon accepted as facts, and have ever since been stated as such in every text-book dealing with the subject.
"We may say," writes Landolt, "that the discovery of the part played by the crystalline lens in the act of accommodation is one of the finest achievements of medical physiology, and the theory of its working is certainly one of the most firmly established; for not only have "savans" furnished lucid and mathematical proofs of its correctness, but all other theories which have been advanced as explaining accommodation have been easily and entirely overthrown.... The fact that the eye is accommodated for near vision by an increase in the curvature of its crystalline lens, is, then, incontestably proved."11
Fig. 10. Diagram by Which Helmholtz Illustrated His Theory of AccommodationR is supposed to be the resting state of the lens, in which it is adjusted for distant vision. In A the suspensory ligament is supposed to have been relaxed through the contraction of the ciliary muscle, permitting the lens to bulge forward by virtue of its own elasticity.
"The question was decided," says Tscherning, "by the observation of the changes of the images of Purkinje during accommodation, which prove that accommodation is effected by an increase of curvature of the anterior surface of the crystalline lens."12
Fig. 11. Thomas Young (1773-1829)English physician and man of science who was the first to present a serious argument in support of the view that accommodation is brought about by the agency of the lens.
"The greatest thinkers," says Cohn, "have mastered a host of difficulties in discovering this arrangement, and it is only in very recent times that its processes have been clearly and perfectly set forth in the works of Sanson, Helmholtz, Brucke, Hensen and Volckers."13
Huxley refers to the observations of Helmholtz as the "facts of adjustment with which all explanations of that process must accord,"14 and Donders calls his theory the "true principle of accommodation."15
Arlt, who had advanced the elongation theory and believed that no other was possible, at first opposed the conclusions of Cramer and Helmholtz,16 but later accepted them.17
Yet in examining the evidence for the theory we can only wonder at the scientific credulity which could base such an important department of medical practice as the treatment of the eye upon such a mass of contradictions. Helmholtz, while apparently convinced of the correctness of his observations indicating a change of form in the lens during accommodation, felt himself unable to speak with certainty of the means by which the supposed change was effected,18 and strangely enough the question is still being debated. Finding, as he states, "absolutely nothing but the ciliary muscle to which accommodation could be attributed,"19 Helmholtz concluded that the changes which he thought he had observed in the curvature of the lens must be effected by the action of this muscle; but he was unable to offer any satisfactory theory of the way it operated to produce these results, and he explicitly stated that the one he suggested possessed only the character of probability. Some of his disciples, "more loyal than the king," as Tscherning has pointed out, "have proclaimed as certain what he himself with much reserve explained as probable,20 but there has been no such unanimity of acceptance in this case as in that of the observations regarding the behavior of the images reflected from the lens. No one except the present writer, so far as I am aware, has ventured to question that the ciliary muscle is the agent of accommodation; but as to the mode of its operation there is generally felt to be much need for more light. Since the lens is not a factor in accommodation, it is not strange that no one was able to find out how it changed its curvature. It "is" strange, however, that these difficulties have not in any way disturbed the universal belief that the lens does change.
When the lens has been removed for cataract the patient usually appears to lose his power of accommodation, and not only has to wear a glass to replace the lost part, but has to put on a stronger glass for reading. A minority of these cases, however, after they become accustomed to the new condition, become able to see at the near-point without any change in their glasses. The existence of these two classes of cases has been a great stumbling block to ophthalmology. The first and more numerous appeared to support the theory of the agency of the lens in accommodation; but the second was hard to explain away, and constituted at one time, as Dr. Thomas Young observed, the "grand objection" to this idea. A number of these cases of apparent change of focus in the lensless eye having been reported to the Royal Society by competent observers, Dr. Young, before bringing forward his theory of accommodation, took the trouble to examine some of them, and considered himself justified in concluding that an error of observation had been made. While convinced, however, that in such eyes the "actual focal distance is totally unchangeable," he characterized his own evidence in support of this view as only "tolerably satisfactory." At a later period Donders made some investigations from which he concluded that "in aphakia21 not the slightest trace of accommodative power remains."22 Helmholtz expressed similar views, and von Graefe, although he observed a "slight residuum" of accommodative power in lensless eyes, did not consider it sufficient to discredit the theory of Cramer and Helmholtz. It might be due, he said, to the accommodative action of the iris, and possibly also to a lengthening of the visual axis through the action of the external muscles.23
For nearly three-quarters of a century the opinions of these masters have echoed through ophthalmological literature. Yet it is to-day a perfectly well-known and undisputed fact that many persons, after the removal of the lens for cataract, are able to see perfectly at different distances without any change in their glasses. Every ophthalmologist of any experience has seen cases of this kind, and many of them have been reported in the literature.
In 1872, Professor Forster of Breslau, reported24 a series of twenty-two cases of apparent accommodation in eyes from which the lens had been removed for cataract. The subjects ranged in age from eleven to seventyfour years, and the younger ones had more accommodative power than the elder. A year later Woinow of Moscow25 reported eleven cases, the subjects being from twelve to sixty years of age. In 1869 and 1870, respectively, Loring reported26 to the New York Ophthalmological Society and the American Ophthalmological Society the case of a young woman of eighteen