Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

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    morbid action from another organ of the body ; as, for example, fromthe skin, the testicle, &c. 3dly, the Proper, or that which depends upon a peculiar condition of the retina; as, for example, the visus nebulosus, muscee volitantes. (Synopsis, pe 189-155.) | On the whole, genuine local amaurosis, that is to say, a diminution or total loss of the eyesight, unattended with any other apparent local or con- stitutional defect, may be said to be a very rare case, the disorder being usually more or less complicated. To the local complications, says Beer, belong the. cataract ; glaucoma; a general varicose state of the eyeball (cirsophthalmia ;) exophthalmia ; atrophy of the eye; spasms in the organ and surrounding parts; paralysis of one or more muscles of the eye (ophthalmoplegia ;) paralysis of the eyelids; ophthalmia in general, and in- ternal ophthalmia in particular ; a scorbutic blood- shot appearance of the eye; (ypoema Scorbu- ticum ;) and, finally, wounds or contusions of the eye, or adjacent parts. With these cases should also be mentioned that important case, fungus heematodes of the eye. From this simple enu- meration of local complications, one may see how frequently amaurosis is only a symptomatic effect of another disorder of the eye, with which it is conjoined, and how often it is connected with the same common causes, which pertain to another or several other diseases of the eye. Amongst’ the general complications, Beer ‘enumerates those which are purely nervous; im- pairment of the health in various forms by infec- tion, contagion, or miasmata; a bad habit of body ; typhoid fevers ; asthma ; internal and ex- ternal hydrocephalus ; organic defects of the ab- dominal viscera: worms; chlorosis ; consump- tion; old ulcers of the legs; organic disease of the brain and skull; complaints arising from pregnancy ; hemorrhage, &c. In these general complications, Beer remarks, that the casual con- nexion between amaurosis and some remote dis- ease of-another organ, or of the whole constitu- tion, cannot be mistaken; and, in these cases, we often see the disease of some other distant part from the eye, suddenly or gradually dimi- nish, and immediately appear again as a sympa- ’ thetic action in the form of amaurosis, of which the most remarkable instance is seen after the sudden healing of old ulcers of the legs. (Beer, Lehre, von den Augenkr. B. 2, p. 433.) From the above general remarks upon amau- rosis, it is quite manifest, that the objective and subjective symptoms of the disease vary. con- ‘siderably according to the violence of its causes, and of the local and general complications, though proximate cause of the loss of vision, be in the optic nerve; and it depends especially on the Nature of the causes, whether this or that morbid appearance take place in the eye. ' One may consiaer as the only real inseparable subjective symptom of amaurosis, that weakness of sight (Ambiyopia) or that complete blindness, in-which neither with the unassisted nor assisted eye the least defect can be perceived in the struc- ture and shape of the affected organ. Hence, Beer names such impairment of vision, or blind- 19 symptom of amaurosis exists alone, and how frequently it is obscured by some other defect in the structure and form of the eye, is proved by daily experience. Hid The objective symptoms of amaurosis have hitherto been set down as merely consisting of a considerable dilatation of the pupil, and immobility of the iris, because these appearances are indeed the most frequent ; but, as Beer observes, this is another proof what ignorance has prevailed re- specting the true nature of that disease of the eye, and its modifications, which are usually termed amaurosis ; the objective symptoms of the complaint being, according to the nature of the causes, as numerous as the subjective. First; the objective symptoms of amaurosis may consist in the faulty size and shape of the pupil. In many cases, the pupil is very much dilated, immoveable, and possesses its natural black colour, and usual transparency. It cannot be denied, that this is the state of numerous cases, but, it is equally true, that there are many exceptions, Sometimes, according to Richter, in the most complete and incurable cases, the pupil is of its proper size, and even capable of very freemotion ( Twrtés, Récueil Periodique, &c. ZT. 2; p.319.); and, occasionally, it is actually smaller, and more contracted, than natural. This aperture often continues extraordinarily large in the strongest light; but, in some in- stances, it is unusually small in every kind of light. (Arrachard, Récueil Period. &c. T. 1, p- 273.—Richter, Anfangsgr. &c. B.3, p. 424. cer, Lehre, &c. B. 2, p. 435.) » According to the latter writer, the pupillary edge of the iris rarely has its primitive shape, being generally more or less angular3-either at some indeter- minate point; or above and below, so as to re- semble in some measure the pupil of the‘cat-race ; or towards the nose, or temple,'so' as to have some similitude in its form to the pupil of ruminating animals. These ‘appearances are highly important, having great induence over the diagnosis. } Frequently not only the size ‘and shape of the pupil are faulty, but the position of that opening is quite unnatural, being inclined either upwards or downwards, or outwards or inwards ; but, most commonly, in a diagonal line between inwards and upwards, and, in these cases, the pupillary mar- gin of the iris never describes a regular circle, but is always more or less angular. (Beer, Vol. cit. p. 436.) The pupil of an eye affected with amaurosis (as Richter remarks) frequently does not exhibit the clear shining blackness, which is seen in a healthy eye. In general, it is of a dull, glassy, hornlike blackness, which symptom alone is fre- quently enough to apprize a ‘well-informed prac- titioner of the nature of the disease. It is in the words. of Mr. Travers,: “little more,’ than the healthy appearance of the humors in the eyeof a horse.” (Sywopsis, p. 146.)' Sometimes the colour of the pupil has an inclination to green; - while, in other’ examples, this aperture seems to. be dense, white, and cloudy, so that the complaint might easily be mistaken for the be- ginning of a cataract. This error, into which inexperienced surgeons are liable to fall, may generally be avoided by attention to the follow- ing circumstances, The misty appearance C2
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