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150 Years Since
Babbage's Ophthalmoscope
C. Richard Keeler
of the ophthalmoscope in 1851 is rightly attributed to Hermann
von Helmholtz. However, 4 years earlier, in 1847, Charles Babbage nearly invented
the instrument that was to revolutionize ophthalmological examination so
Arch Ophthalmol. 1997;115:1456-1457
Babbage was born in Walworth, En¬
gland, in December 1791 to well-to-do
parents. He went to Cambridge Univer¬
sity, Cambridge, England, and received
his master of arts in 1817, having been
elected a Fellow of the Royal Society the
year before at the age of 25 years. By this
time he had moved to the West End of
London, England, where he spent the
rest of his life. Between 1828 and 1839,
Babbage occupied the Lucasian Chair of
Mathematics at Cambridge—the chair of
Sir Isaac Newton.
Babbage is best known for his pio¬
neering work on the calculating engine, the
forerunner of today's computer. He was a
polymath of extraordinary diversity and tal¬
ent. He designed a "black-box" recorder for
monitoring the state of railway lines, the¬
lights using colored filters, hinged flap
shoes for walking on water, and, among
dozens of other devices and ideas, an oph¬
There is little information about his
ophthalmoscope and what there is comes
from a single source, Thomas WhartonJones. There is no mention of an ophthal¬
moscope in the 11-volume essay review of
"The Works of Charles Babbage."2 Even
in Charles Babbage's autobiographical
book, Passages From the Life of a Philoso¬
pher,3 his ophthalmoscope is only re¬
ferred to in the appendix.
Wharton-Jones, a prominent oph¬
thalmologist, was a lecturer at Charing
Cross Hospital, London, in 1847 when
Babbage first showed him his ophthalmoFrom Keeler Ltd,
a myope and
that he was
unable to use the instrument. Babbage did
not persist with the development of his
ophthalmoscope and seemed to accept
Wharton-Jones' verdict that it would not
One has to ask oneself why Babbage
constructed an ophthalmoscope in the first
place. Perhaps there is a clue from the fact
that Babbage was afflicted with bilateral
monocular diplopia.4 A man as inquisi¬
tive and brilliant as Babbage may well have
attempted to diagnose the source of his af¬
fliction, resulting in the construction of his
Wharton-Jones was
it was
Wharton-Jones described the instru¬
in the
following way
it consisted of a bit of plane mirror with the
silver scraped off at 2 or 3 spots in the middle
fixed within a tube at such an angle that the
rays of light falling on it through an opening
in the side of the tube were reflected to the eye
to be observed.
Ironically Babbage's concept was es¬
sentially the same as that used by Ep-
kens, Donders, Coccius, Meyerstein, and
many others to follow. However, von
Helmholtz's ophthalmoscope was diffi¬
cult to use and was soon abandoned.
The history of ophthalmology might
well have been different if Babbage had
taken his invention to a young 25year-old house surgeon at the Royal
Ophthalmic Hospital, Moorfields,
don, England, by the
of William
Cumming had come close to discov¬
ering the ophthalmoscope the previous
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work. As with his
the principle on
which he based his calculating
machine was sound, and this was
proved to be the case 150 years
later when the Science Museum,
Figure 2. Reconstruction of Babbage's
ophthalmoscope (photograph courtesy of
Professor Hans Remky).
don at the time. Harvey Frieden¬
wald in 1902 wrote,
Figure 1. Daguerreotype of Charles Babbage
year in 1846. He presented a paper
titled "On a Luminous Appearance
of the Human Eye."6
In this paper he described
how a reflex could be obtained
from the fundus of the human
eye under certain conditions of
illumination—that essentially
being the axis of illumination and
observation sharing a similar path.
He had noted that
approaching within a few inches of
the eye, the reflection is not visible for
before our eye can be brought within
range of the reflected rays, the incident
rays are excluded.6<p287)
Cumming would have
diately recognized the answer to his
problem in Babbage's ophthalmo¬
scope. Babbage and Cumming were
working a mere 3 miles apart in Lon-
pity that Babbage did not de¬
little more time to his invention!
He could hardly have missed being the
inventor of an instrument whose value
is a thousand times greater than that of
all the calculating machines ever in-
vote a
blame, however, lies
heavily Wharton-Jones' shoul¬
ders. He must have been sorely
tempted to keep quiet about his ap¬
proach from Babbage, which re¬
sulted in "the monumental folly of
condemning the instrument," a com¬
ment made by Robert Brudenell
Carter, FRCS, in a letter written late
in his hfe.8<P5%)
Babbage died in 1871, a mis¬
erable, bitter man. Babbage felt
that he was never given the recog¬
nition that his genius deserved.
He was at odds with the establish¬
ment and was frustrated that he
was never able to make his "differThe
London, successfully
structed his machine.
Perhaps the sesquicentennial of
the invention of the Babbage oph¬
thalmoscope provides the opportu¬
nity to recognize this remarkable
man's achievement.
Accepted for publication July 3,1997.
Corresponding author: C. Rich¬
ard Keeler, 1 Brookfield Park, Lon¬
don NW51ES, England.
Babbage and His Calculating
Engines. London, England. Science Museum,
1. Swade D. Charles
2. Swade D; Campbell-Kelly M, ed. Charles Babbage and mechanical contrivances: essay review
of the works of Charles Babbage. Bull Sci Instrument Soc. 1991:28;22-23.
3. Babbage C. Passages From the Life of a Philoso-
pher. London, England: Longman, Green, Longman, Robert & Green; 1864:496(item 65).
4. Albert DM, Edwards D. The History of Ophthalmology. Cambridge, Mass: Blackwell Publishers; 1996.
5. Wharton-Jones T. Br Foreign Med Chir Rev. October 1854.
6. Cumming W. On a luminous appearance of the
human eye. Med Chir Trans. 1846;29:283\x=req-\
7. Friedenwald H. The history of the invention and
development of the ophthalmoscope. JAMA. 1902;
8. McMullen WH. The evolution of the ophthalmoscope: communications Br J Ophthalmol. 1917;
Complications of the Transconjunctival Approach:
A Review of 400 Cases
J. Byron Mullins, MD; John B. Holds, MD; Gregory H. Branham, MD; J. Regan Thomas, MD
Objective: To review the intraoperative and postoperative complications of the transconjunctival approach, as well as their
prevention, management, and outcomes.
Design: A retrospective study of the complications in 400 patients who underwent the transconjunctival approach to the
lower eyelid or orbit for treatment of orbital trauma or the aging face.
Setting: Academic tertiary referral medical center.
Results: There were 8 cases of conjunctival granuloma, 2 cases of entropion, and 1 case each of hematoma, ectropion, pro¬
longed chemosis, conjunctival inclusion cyst, lower eyelid laceration, and avulsion with lacrimal system injury.
Conclusions: Complications of the transconjunctival approach are uncommon. When
results in a successful outcome. Arch Otolaryngol Head Neck Surg. 1997;123:385-388
Corresponding author: J. Byron Mullins, MD, 8005 Bay St, Suite 3, Sebastian, FL 32958.
Downloaded From: by a New York University User on 06/02/2015
they do occur, proper management