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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
Snydacker EF. THE EARLY RECOGNITION OF MULTIPLE SCLEROSIS. JAMA. 1917;LXIX(17):1462. doi:10.1001/jama.1917.02590440072024
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