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October 27, 1917


JAMA. 1917;LXIX(17):1462. doi:10.1001/jama.1917.02590440072024

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To the Editor:  —Neither in a paper read at the last session of the American Medical Association on this subject nor in the discussion, was mention made of a symptom which, if observed early and correctly interpreted, helps very materially in the early recognition of the disease.When either a chronic or an acute retrobulbar neuritis occurs which cannot be explained by the ordinary causes, especially in a youthful person, a suspicion of a beginning multiple sclerosis must be aroused even though none of the other cardinal symptoms are present. The first symptom of a chronic retrobulbar neuritis is usually an impaired vision; a most characteristic symptom is better vision at night than in the daytime. The cause of this impairment is a central scotoma, at first only for red or green, later absolute, due to the involvement of the papillomuscular bundle of nerve fibers.Ophthalmoscopically it is possible at

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