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.

    33/1282 (page 21)
    mechanically: disordered, ‘or the ciliary nerves palsied, the pupil is inactive, independently of the state of vision. In the first of these cases, it is evident, vision will be lost ; but, we continually see useful vision, combined with the second and third, as after operations, in which the iris has been half destroyed, or has become preternatu- rally adherent, or in malformations, where it is half wanting; and in paralysis of the ciliary nerves, accompanying ptosis. (Synopsis, p. 188.) Frequently, in amaurosis, when the sight of only one eye is lost, and the other retains its full power of vision, not the slightest defect can be discovered, as long as the patient keeps both of them open; but, the instant the sound eye is completely covered, the iris becomes perfectly motionless, its pupillary margin assumes an an- gular shape, and the pupil expands, being some- times evidently drawn towards the edge of the cornea, (Beer, Lehre von den Augenkrank. B. 2, p. 438.) Besides the above appearances of the pupil and iris, amaurosis is attended with other cha- racteristic phenomena, which occur under certain circumstances, in the form, texture, and state of other parts of the eye, and adjoining organs. Thus, the patient often complains of a peculiar troublesome dryness of the eye, or of a sensation as if the eye-ball were about to be pressed out of its socket; and, indeed, says Beer, one may sometimes hear a grating noise, and distinguish a fluctuation in the orbit behind the eye-ball, when this organ is pressed upon by the finger, or moved in various directions, though neither its circumference be enlarged, nor any tendency to exophthalmia be really present. Nor is it very uncommon to find the affected eye preternaturally hard, soft, or even quite flaccid; but it is less common to find the dimensions of the globe of the eye increased, or the organ aflected with atrophy. (Beer, vol. cit. p. 438.) However, in organic amaurosis, as Mr. Tra- vers notices, a peculiar bluish, gray tint of the sclerotic coat is frequently remarkable; and sometimes even a degree of bulging on one or more sides of the eye, or simply a loss of spheri- city, its tides appearing flattened. A turgescence of the superficial vessels, espe- cially of the long fasciculi of conjunctival veins, is likewise another symptom frequently observed in cases of organic amaurosis. (See Travers’s Synopsis, p. 146.) The same gentleman also gives the particulars of a dissection, in which a case of amaurosis was attended with a collapse of the retina from absorp- tion of the vitreous humour, (Op. cit. p- 150.) The principal subjective morbid effects, which appertain to amaurosis, have been already de- scribed in speaking of the several defects of vision, which accompany an amaurotic weakness of sight. Besides these, however, there are others, which merit attention. For instance, the patient feels in the eye and surrounding parts an irksome sensation, without any actual pain, and complains of a remarkable sense of fulness, or weight in the organ. Amaurotic patients are also frequently attacked with sudden violent gid- diness, usually ending in aconsiderable diminution of the eyesight, and sometimes in severe general headach. Occasionally, they fancy that small atoms of dust are lodged under the eyelids, and 21 are fearful of moving these parts, or the eye. It is also well known, that many persons become amaurotic, while labouring under severe hemi- crania, extending from, or to, the diseased eye; while, on other occasions, the most violent pains are contined, particularly to the region of the eye- brow, and have the appearance of being stricthy periodical. In certain other cases, the pain is wandering, and shoots in every direction about the eyebrow. These painful feelings often pre. cede the amaurotic blindness a considerable time, and often first take place when one or both eyes are already blind ; but, the pains and loss of sight are not unfrequently produced together. Lastly, some patients are met with, in whom the worst pains only last until the amaurosis is perfectly formed, when they gradually and permanently cease. In all these painful cases of amaurosis, the pain and the blindness chiefly depend upon the same cause, and one is seldom the occasion of the other. Sometimes amaurotic patients ex- perience such violent pain, that they lose their senses, and grow delirious ; but, in these cases, if we can credit the assertion of Beer, important morbid changes in the bones of the skull, or the brain itself, are invariably noticed after death. (See Lehre von den dugenkr, B. 2, p. 439.) In some amaurotic patients, lethargic symptoms inay be remarked; in others, restlessness ; and, more rarely, delirium in all its degrees, either as a transient, or permanent affection. According to the observations of Mr. T. ravers, pain, affecting the forehead and temples, is a pre- cursory symptom of amaurosis, diminishing in proportion as the dimness increases. When the amaurosis is perfect, it usually ceases altogether, if the disease has its seat in the eyeball. But, when the pain is severe, remits imperfectly, and is quickly rendered worse by exercise, it is usually connected with organic disease of the brain. In this case, derangement and torpor of the primae vize, loss of strength and flesh, disposition to stu- por, occasional confusion of intellect, inaptitude to exertion, and paralysis of one or more muscles, will be concomitant symptoms. (Synopsis,&c. p. 167 my Paralytic appearances may precede amaurosis, either in the vicinity of the eye, or in the muscles of the face, or, in a distant situation, as the ex- tremities. Sometimes they accompany the dis- ease, and sometimes closely follow the weakness of sight, being not unfrequently the forerunners of a fatal attack of apoplexy. In the same way, convulsive symptoms may be conjoined with amaurosis, and when they first occur in the complete stage of the latter disease, Beer pronounces them a very unfavourable omen for the patient’s life, But, according to the same experienced oculist, when, in a case of perfect amaurosis, several of the other external senses are affected ; and lastly, when the internal senses begin to suffer, when, tor instance, the hearing, and then the smell, and taste are lost, and afterwards the memory and other intellectual powers fail, the patient’s speedy dissolution may be expected. (See Lehre von den Augenkrankh, B.2, p. 441, Wien. 1817.) As Professor Beer correctly observes, age cannot be considered a predisposing cause of amaurosis, as it is of cataract; for, there are many more blind persons, who have been deprived of their sight by amaurosis in their best days,