A physician's notes on ophthalmology. 2nd series / by J. Hughlings Jackson.

  • Jackson, John Hughlings, 1834-1911.
Date:
[1875]
Catalogue details

Licence: Public Domain Mark

Credit: A physician's notes on ophthalmology. 2nd series / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the first time, a good ophthalmoscopist would hesitate to say that there had ever been any important acute change in that disc. Such a case leads one to study carefully minute changes in the discs (as seen by direct examination), in order to make a retrospective diagnosis of optic neuritis.* It is probable that the case I have related was one of intra- cranial syphilis. But as there was no autopsy it is not worth while commenting on this aspect of the case. I have reported several cases of optic neuritis from syphilitic disease of the brain, as proved post-mortem. (“Medical Times and Gazette,” 1872- 73-74.) I have recorded a marked case in the July number (1874) of the “ Journal of Mental Science.” I will now only say that optic neuritis from syphilitic disease of the brain is not syphilitic optic neuritis. Optic neuritis does not occur in such cases because syphilitic disease affects the optic nerves directly. There is a syphilitic tumour in the brain, and this causes optic neuritis, not in its character as a syphilitic lump, but in its character as a “ foreign body.” Any sort of mass in either the cerebrum or the cerebellum will cause optic neuritis. I showed the original of the chromolithograph Ho. 1 at the meeting of the British Medical Association in August, 1873. The following is cut from the museum catalogue. I extract it to show that I then believed that the neuritis would disappear leav- ing sight good. “ Ophthalmoscopic drawing by Burgess. The patient, a man, could read the smallest type (No. 1| Snellen) on the day (June 30, 1873) the drawing was made. His sight is still (July 21st) good. It is believed that the abnormal change will pass away, and that sight will remain good.—Dr. Hug]dings Jachson.” In looking up this entry I come across the catalogue notes of cases by my colleague, Dr. W. R. Gowers. As Dr. Gowers’ opinion on any point in medical ophthalmoscopy is most valuable, I try to strengthen the position I have taken up by his testimony. I italicise those parts which bear on the point I have been urging. The cases Dr. Gowers relates have numerous other important bearings. The following is cut out of the catalogue. (Drawings 176, 177, 178). “ Dr. Goivers on Optic Neuritis. “1. Optic Neuritis, with preservation of acuity of vision. Left optic disc of a woman, jet. 35, suffering from headache, epilepti- form convulsions, and paralysis of the right arm, due probably to syphilitic disease of brain. The position of the optic disc is * On this matter I have written in the “ Medical Times and Gazette,” Nov. 10, 1872 ; a reproduction of those remarks will be found in the “ Boy. Lond. Ophth. Hosp. Kep.,” vol. vii, part iv, Feb., 1873, in section 5, p. 520, “ Slight Changes in the Optic Discs in cases of Cerebral Disease.”