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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    by a special alteration of the blood re- sulting from interference with tlie he- patic functions. 5th. It is of grave sig- nificance. 77. Heyl’s paper on intra-ocular lip- cemia is interesting, though his conclu- sions must still he regarded as hypo- thetical. After a preliminary account of lipaemia as a physiological and as a pathological phenomenon, and of the two forms of lipaemia, he reports a case in which he was fortunate enough to he able to make a careful ophthalmo- scopic examination. The patient was a man, aged twenty, in whom the chief ophthalmoscopic appearance was an abnormal color of the blood-vessels of the retina, the blood in both arteries and veins being of a light salmon color. The caliber of the vessels was also ap- parently increased, and the fundus ap- peared very light. He calls this intra- ocular lipaemia, and proceeds to differ- entiate it from intra-ocular leucaemia. In leucaemia the color of the fundus is an orange-yellow, while in lipaemia it is of a light salmon-red color. In leucae- mia the veins are pale, of a bluish-red, while the arteries are of a pale yellow. In lipaemia arteries can scarcely be dis- tinguished from veins, and both have nearly the same color as the fundus. In lipaemia the retinal vessels are ap- parently of about double the size of those of a normal eye, and this Heyl thinks is due to the presence of the mo- lecular fat in the plasma of the blood, thus causing the fall width of the ves- sel to appear. In leucaemia all agree that the veins appear unusually large and the arteries very narrow. [Ileyl’s explanation of the apparent size of the retinal vessels will not be accepted by all.] With regard to the pathological effect of intra-ocular lipaemia of the molecular form, as manifested in dia- betes mellitus, Heyl calls attention to the fact that the extra-ocular complica- tions in this disease are all characterized by necrosis of tissue. This necrosis of tissue is probably the result of inter- rupted circulation, and, Heyl thinks, may be caused by occluding masses of fat. He concludes that there is a strong presumption in favor of fatty obstruct- ing masses in the intra-ocular blood- vessels as a cause of diabetic cataract, provided, as he says, there exists rea- sonable ground for supposing that such a cause would produce cataract at all. 78. Bresgen reports a case of diabetic amblyopia without any ophthalmoscopic sign. The characteristic symptom was the appearance of a pericentric scotoma, within the limits of which the form- sense or perception was at first dimin- ished, with, at the same time, partial diminution of the color-sense, which afterward became total, and, finally, diminution of the light-perception, while the peripheral parts of the retina per- formed their normal functions unim- paired. The case resembled the ordi- nary cases of alcoholic and tobacco am- blyopia, at least from a pathological standpoint. 84. Ilughlings-Jackson’s paper upon optic neuritis in intra-cranial disease is very long, and of exceptional interest. The frequent putting of questions for the purpose of eliciting subsequent dis- cussion makes it almost impossible to give a fair idea of its scope in an ab- stract. He thinks there is but one kind of optic neuritis from intra-cranial dis- ease. Considering it ophthalmoscopi- cally, the most trustworthy localizing symptoms helping the diagnosis of tu- mor are such as convulsions beginning unilaterally, and paralyses of cranial nerves. He doubts whether he has ever seen double optic neuritis from clot, though he has seen the two coin- cidently. In tubercular meningitis he believes that swelling of the disk comes on at a time when the diagnosis of meningitis is made frern other evi- dence; it is slight, even, and merges into the fundus, like the earliest stage of optic neuritis from intra-cranial tu- mor. But he also admits the clinical difficulty, that intra-cranial tumor some- times produces an acute illness, not distinguishable by its symptoms from meningitis, tubercular or traumatic. He does not recognize any difference in the kind of disk between cases in which sight is good and those in which it is defective or lost, but only a dif- ference in the stage of changes. He recognizes the difficulty of determin- ing whether a patient has had neu- ritis from the appearance of the disks at a later period, especially if the pa- tient has never been seen before. lie calls attention to the fact that, in some cases of atrophy from neuritis, the pu- pils do not contract under the stimulus of light, while they do during the act of accommodation. When the author comes to speak of clinical facts, lie ex- presses his conviction that the diagnos- tic value of optic neuritis is not depend- ent upon whether the sight be good or