Beschreibung eines Augen-Spiegels zur Untersuchung der Netzhaut im lebenden Auge.

Berlin: A. Förstner, 1851.

First edition, an exceptionally fine copy in original printed wrappers, of this famous work which describes Helmholtz’s announcement of his invention of the ophthalmoscope, one of the most important clinical tools in medicine, which greatly improved the ability of ophthalmologists to diagnose eye disease and revolutionized visual science. The invention of the ophthalmoscope by Helmholtz has been called “the greatest event in the history of ophthalmology, which advanced it toward the goal of independence as a specialty” (Gorin). This invention was a by-product of Helmholtz’s attempt to demonstrate to his physiology students that when the human eye is made to glow with reflected light, the light emitted from the pupil follows the same course it took in entering. Realizing that if the light could be brought to a focus the details of the retina would be made visible, he invented a device to accomplish this objective. “With this instrument it was possible for the first time to examine the interior of the living eye. Although crude attempts had been made earlier to see into the eye, it was Helmholtz’s invention of a workable instrument in 1850 and the publication of his monograph in 1851 that laid the basis of scientific ophthalmology. Helmholtz’s invention of the ophthalmoscope arose from an attempt to demonstrate for his class in Königsberg the nature of the glow of reflected light sometimes seen in the eyes of animals such as the cat. When the great ophthalmologist A. von Graefe first saw the fundus of the living eye, with its disc and blood-vessels, his face flushed with excitement, and he cried ‘Helmholtz has unfolded to us a new world!’ (Hagerstrom Library). The Augen-Spiegel was printed in a very small edition: there are no copies in the Becker, Osler or Cushing Collections. Rare on the market in such fine condition.

“Helmholtz’s invention had its roots in earlier attempts to see the back of the eye, though these were insufficient to permit proper inspection of the human fundus. In 1703, Jean Méry (1645–1722), who worked at the Hôtel Dieu, found that the luminosity of the cat’s eye could be seen when the animal was held under water, showing that it was essentially an optical phenomenon. Philippe de la Hire, 6 years later, thought it was owing to abolition of corneal refraction under water that the incident light rays emerged divergent and were thus seen by the observer’s eye. In the fourth essay in his Oeuvres (2 volumes, Leiden, 1717), Edmé Mariotte (1620–1684), who was both physicist and priest, observed that a dog’s eye is luminous because its choroid is white; and the darker choroid in man and animals allowed no clear image. Richter provoked further interest when it was found that luminosity could still be present in a blind eye, and in 1792 Georg Joseph Beer had observed the luminosity of the fundus in aniridia. However, spontaneous luminosity in man remained unexplained.

Bénédict Prévost, Professor of Philosophy at Montaubon in France (1755–1819), repeated Mariotte’s experiments, examining the eyes of a cat in the dark, and explained that the retina was invisible: ‘It is not the light which proceeds from the eye to an object that enables the eye to perceive that object, but the light which arrives in the eye from it.’ This was an important discovery that dispelled the accepted notions that light came from within the eye to permit animals to see in the dark.

“In 1821, the Swedish naturalist Karl Asmund Rudolphi (1771–1832) shone a light into a decapitated cat’s eyes and showed that the reflecting eye emitted light along the same line as the direction of the in-going rays. Twenty-seven years before Helmholtz’s work, in 1823, Jan Evangelista Purkinje (1787–1869), Professor of Physiology at Breslau, had observed that under certain illumination human eyes could be made luminous: in 1825 Purkinje started to use lenses to examine the back of the eye. His crucial work, published in Latin, was unrecognized for many years: ‘I examined the eye of a dog by using the spectacle lens of a myope and placing a candle behind the dog’s back … I found the light as the source, which is reflected from the concavity of the spectacle lens into the interior of the eye. From there it is again reflected. I immediately repeated the experiment on a human eye and found the same phenomenon’.

“The pupil too appeared black. The ‘beautiful orange glow was reflected when light was thrown into it’. Unnoticed, this was rediscovered independently by William Cumming in England, who, in 1846, wrote ‘On a luminous appearance of the human eye and its application to the detection of disease of the retina and posterior part of the eye.’ He explained that the axis of illumination and observation had to be coincident to view the fundus. A year later, the Berlin physiologist Ernst Wilhelm Ritter von Brücke (1819–1892) made the same observation: ‘A short time ago in the evening as I was standing between the chandelier and the door in the auditorium of this university, I saw a young man whose pupils were illuminated with a bright red light as he turned to close the door through which he had just passed … If one wishes to see this reflex in human eyes … Take the usual oil lamp with its cylindrical wick and the glass chimney, … and regulate the wick in such fashion that it burns with a short, intense flame. Then set the lamp close to you, but place the subject 8 to 10 feet away, … If [the subject] then looks with widely opened lids towards the darkness adjacent to the lamp, or if he slowly moves his eyes to and from, then the pupils will be illuminated with a reddish light, while the iris, in contrast, will appear slightly greenish.’ Helmholtz was later generously to say: ‘Brucke himself was but a hair’s breadth away from the invention of the ophthalmoscope. He had only failed to ask himself what optical image was formed by the rays reflected from the luminous eye. Had it occurred to him, he was the man to answer it just as quickly as I did and to invent the ophthalmoscope.’

“Adolf Kussmaul (1822–1902) attempted to see the fundus in 1845. He applied a plano-concave lens of the same power as the cornea to the eye, ‘in an effort to see the human optic nerve.’ Although Kussmaul failed to view the living fundus, he did show in vitro that removal of the cornea and lens rendered the fundus visible, but lack of illumination thwarted his efforts.

“There is also a British claim for precedence. Three years before Helmholtz announced his discovery, Charles Babbage FRS (1791–1871) invented an instrument consisting of a piece of plain mirror, with the silvering scraped off at 2 or 3 small spots in the centre, held within a tube at an angle so that rays of light falling on it through an opening in the side were reflected into the patient’s eye. The observer looked through the clear spots from the other end of the mirror. As Helmholtz noted, Babbage’s instrument would have worked if a concave lens of 4 or 5 dioptres had been inserted to correct the convergent rays. Babbage used a plain mirror with a central opening, the first for looking into the eye through an aperture. When he showed it to the ophthalmologist Thomas Wharton Jones, the retina was not adequately seen. Babbage, however, did not pursue his invention. In 1854, Wharton Jones, in his ‘Report on the ophthalmoscope’, said: ‘It is but justice that I should here state, however, that 7 years ago [i.e. 1847] Mr. Babbage showed me the model of an instrument that he had contrived for the purpose of looking into the interior of the eye.’ However, Hirschberg has disputed his claim. The major and lasting achievement came when Helmholtz announced the invention of an ‘eye-mirror’ in December 1850.

“Helmholtz was born on 31 August 1821 at Potsdam. His father, Ferdinand, was a teacher of philology and philosophy, while his mother was a Hanoverian, a lineal descendant of the great Quaker William Penn. He graduated in Medicine from the military medical school in Berlin in 1843, greatly influenced by Johannes Mueller, who had devised the Law of Specific Nerve Energies. Mueller had also trained Henle, Schwann and Du Bois-Reymond. Helmholtz recalled: ‘I recall my student days and the impression made upon us by a man like Johannes Mueller, the physiologist. When one feels himself in contact with a man of the first order, the entire scale of his intellectual conception is modified for life; contact with such a man is perhaps the most interesting thing life has to offer’.

“Helmholtz’s graduation thesis described the anatomic connection between neurones and nerves. He wrote in 1847 what has been described as one of the great scientific papers of the 19th century: Über die Erhaltung der Kraft [On the conservation of energy]. In this he showed mathematically that all forms of energy can be transformed from one form to another, but energy cannot be created or destroyed. He served as physician to the army for several years, before following an academic career in the physical sciences.

“In his researches Helmholtz noticed that the pupil normally appeared black, but under certain conditions seemed red and emitted light. This convinced him that the emitted light was no more than reflected light. However, advancing from his predecessors, he analyzed how the emitted rays formed optical images. He tried to obtain an optical image of the fundus by devising an instrument that would allow his own eye to be placed directly in line with the light rays entering and leaving the eye. He used 3 microscopic cover glasses as a mirror to reflect light, but they had to be transparent to allow him to see the retina; this he achieved and thus saw the retina in detail.

“The announcement was made in a paper presented by his friend Du Bois-Reymond to the Berlin Physical Society on 6 December 1850. However, the text was lost, and on 17 December 1850, Helmholtz, with ill-concealed excitement, wrote to his father: ‘I have made a discovery during my lectures on the Physiology of the Sense-organs, which may be of the utmost importance in ophthalmology … It is, namely, a combination of glasses, by means of which it is possible to see the dark background of the eye, through the pupil, without employing any dazzling light, and to obtain a view of all the elements of the retina at once, more exactly than one can see the external parts of the eye without magnification, because the transparent media of the eye act like a lens with magnifying power of twenty. The blood vessels are displayed in the neatest way, with the branching arteries and veins, the entrance of the optic nerve into the eye, etc. … My discovery makes the minute investigation of the internal structures of the eye a possibility. I have announced this very precious egg of Columbus to the Physical Society at Berlin, as my property, and am now having an improved and more convenient instrument constructed to replace my pasteboard affair. I shall examine as many patients as possible with the chief oculist here, and then publish the matter’.

“Helmholtz’s first public announcement of the ophthalmoscope was on 11 November 1851 at the Society for Scientific Medicine of Königsberg. His 43-page monograph was also published in 1851 [as the offered work]. Helmholtz called his new instrument ‘Augenspiegel’ (eye mirror). It comprised a lens and a mirror for reflecting light. The instrument was used for examining the retina and adnexa of the eye. He recognized 3 essential components: a light source, a mirror to direct light toward the eye and a device to focus the image on the retina. This instrument was known in England as an ‘eye speculum’, but Maressal de Marsilly of Calais in 1852 called it the ‘ophthalmoscope’ …

“Von Graefe facilitated the introduction of the ophthalmoscope to clinical ophthalmology. Some held it might harm the eye. Anagnostakis, in 1854, popularized the instrument in France, whilst in England, it was used and developed by W. Spencer Watson and William Bowman, though many remained sceptical and at first it was utilized infrequently in many countries …

“Fundal changes in disease were soon recognized by Albrecht von Graefe (1828–1872), undoubtedly the greatest German ophthalmologist of the 19th century, who founded the Archiv für Ophthalmologie and the eye hospital in Berlin. In 1855, von Graefe described albuminuric retinitis. By 1860 he had also shown fundal changes in glaucoma and in retinal arterial embolism; he introduced iridectomy and cataract extraction and described papillo-oedema and its neurological significance. Coccius in 1853 illustrated both retinal detachment and retinitis pigmentosa. Liebriech recognized central retinal venous thrombosis in 1855. However, practising physicians were still slow to appreciate the benefit of ophthalmoscopy. Clifford Allbutt wrote in 1871: ‘The number of physicians who are working with the ophthalmoscope today in England may, I believe, be counted on the fingers of one hand.’ Allbutt did much to change this with his book On the Use of the Ophthalmoscope in Diseases of the Nervous System and the Kidneys, published in 1871, as did A Manual and Atlas of Medical Ophthalmoscopy compiled by his friend Sir William Gowers” (Pearce).

Albert 1032; Garrison-Morton 5866; Gorin, History of Opthalmology, 1982 (pp. 125-6); Grolier/Medicine 65; Heirs of Hippocrates 1886; Lilly, Notable Medical Books, 205; Norman 1041; Waller 4294. Pearce, ‘The Ophthalmoscope: Helmholtz’s Augenspiegel,’ European Neurology 61 (2009), pp. 244-249.

8vo (224 x 137 mm), original yellow printed wrappers, uncut and unopened, [1-3] 4-43 [5] pp. Engraved plate by Afinger after Helmholtz. A very fresh and untouched copy. Rare in such condition.

Item #4855

Price: $14,500.00

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