Quarterly report on ophthalmology and otology. No. VI / by Charles Stedman Bull.

  • Bull, Charles Stedman, 1844-1912.
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: Quarterly report on ophthalmology and otology. No. VI / by Charles Stedman Bull. 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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    inflammation or tumor, he considers the affection as nothing more than the consequence of progressive, descending inflammation, proceeding from the cen- ter toward the periphery ; the same in nature as, but much more rapid than, the gray degeneration in locomotor ataxy. This alteration may follow the course of the optic tracts without in- volving any nerve of sense or motion if the intra-cranial tumor at its orgin and point of implantation is at a dis- tance from these nerves; for the degen- erative process follows but one direc- tion and one course, namely, that of the optic-nerve fibers. A meningitis situated at the base of the brain, near the chiasm, may setup an inflammation in the substance proper of the chiasm, which, little by little, will extend to the optic papilla. On the contrary, a men- ingitis occupying the cerebral hemi- spheres might run through all these phases, and even end fatally, without there being any apparent change de- monstrable in the optic papilla. 93. In his paper on the duration of the act of accommodation of the lens, Angelucci conies to the following con- clusion, based upon careful investiga- tions and mathematical measurements of his own: The difference in time which elapses between accommodation lor the near point and that for the far point is not in accord with the duration of the emigration of the luminous im- age upon the lens, for the lens changes its radius of curvature with the same rapidity in both accommodative acts; but, instead, with the muscular force, which does not induce at once that de- gree of sphericity of the lens demanded for the dioptric conditions. 96. Doench endeavors to account for congenital dislocation of the lens. He finds that it always affects both eyes, generally in a symmetrical manner. The direction of the displacement is almost always either upward, upward and inward, or upward and outward. The lenses are generally transparent; sometimes their size is below the mean. The suspensory ligament is sometimes found, sometimes not. In about one fourth of all the cases there is myopia. The position of the lenses may remain unchanged throughout life, but spon- taneous dislocation may also result. Heredity has been proved in some of the cases. 102. Watson advises opening the cap- sule before malting the corneal section 7 in the operation for cataract. The ad- vantages of this preliminary step he thinks are four, viz.: 1. The dilated pupil allows of the free and visible movements of the cystitome. 2. The margin of the pupil is less liable to in- jury than in the old method. 3. The relative bulks of the nucleus and cortex can be ascertained before making the corneal section. 4. The operation is thus rendered easier and safer. [This is questionable.] 103. Pagenstecher’s paper upon the extraction of cataract with the capsule is an admirable discussion of an impor- tant and very interesting branch of oph- thalmic surgery. He thinks the diffi- culties of introducing the flat, shallow spoon for the removal of lens and cap- sule, and the dangers arising from pro- lapse of the vitreous, have been greatly overestimated. The advantages he claims for this method are as follows: 1st. The gain of a perfectly clear pupil. 2d. The absence of plastic and recur- rent iritis. 3d. There is no danger ot any diminution of the resulting vision through clouding of the capsule, and consequently no necessity for any sec- ondary operation. 4th. The very best degree of visual acuity. 5th. Recur- rent haemorrhages are much rarer than when the capsule is left behind. 6th. The dazzling sensations due to diffusion of light through the caps ale are done away with. 7th. There is no prolapse and cicatrization of the capsule in the wound. The disadvantages which be enumerates are as follows: 1st. The healing of the wound is in some cases somewhat slower than by the other methods. 2d. Vitreous opacities are more frequent. 3d. The average re- sulting astigmatism is somewhat greater than after extraction without the cap- sule. 101. Fort’s paper upon the latest im- provements in the operation for cataract consists really in describing the opera- tion as it is done in Paris. A modified Listerism is carefully carried out in all cases, the antiseptic fluid used being generally phenie acid. The incision employed is the superior keratotomy, and, as a rule, an anaesthetic is not em- ployed. As soon as the lens has been extruded, the blepharostat is removed and a solution of eserine is instilled. Fort lays great stress upon what he calls the toilette of the anterior chamber, which consists in carefully and patiently removing the extravasated blood, the
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