It may be sometimes quite impossible to discover the cause of disease, and it is not always easy to determine whether a lesion is dependent upon some other morbid process, or of primary origin. I have hesitated to believe it possible for atrophy of the retina to come on as a primary condition, without any discoverable preceding inflammation, or even hyperplasia; but, it is certain that, whatever disturbances may have preceded the beginning of atrophic changes in the two cases herein reported, there was no manifest hyperemia before failure of sight. I am not sure that some occult inhibition of the functions of the vasomotor nerve force may not cause primary atrophy.
Miss M. B. J., aged 19, came to me July 12, 1882, with a note explaining that she had been unable to pursue her studies without headache. After suspending her accommodation, I found that, with +1/30 C. ax.
REYNOLDS DS. ATROPHY OF THE RETINA.. JAMA. 1901;XXXVII(22):1446–1447. doi:10.1001/jama.1901.62470480016002c