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.

    39/1282 (page 27)
    Recent, sudden cases, in which the pupil is not excessively dilated, and its circle remains regular, while the bottom of the eye is of a deep black colour; cases unaccompanied with any acute, continual pain in the head and eye-brow, or any ‘sense of constriction in the globe of the eye it- deep sorrow, fright, gastric disorder, general plethora, or the same partial affection of the head, suppression of the menses, habitual . bleedings from the nose, piles, &c. great loss of blood, nervous debility, not too inveterate, and in young subjects, are all, generally speaking, curable. Amaurosis is also mostly remediable, when pro- duced by convulsions, or the efforts of difficult parturition ; when it arises during the course, or towards the termination of acute, or intermittent fevers; and when it is periodical. (Scarpa, Venez. 1802.) According to Mr. Travers, it is rather the degree, than the nature and origin of the sym- ptomatic functional amaurosis, that should in most vases influence our prognosis; yet, the latter cir- cumstances, it is equally clear, afford more or Jess encouragement, in proportion as the pre-ex- isting states of disease ordinarily admit of relief, or not. ‘Thus, says he, the amaurosis from gas- tric diseases, from plethora, from irritation, are all of them relievable, and if treated at an carly period, remediable. Whereas paralysis, the sequel of fever, or of epilepsy, or severe constitutional diseases, whether acute, or chronic, or depending upon habitual cerebral congestions combined with orgarfic visceral disease, or induced by the opera- tion of noxious agents on the system, is a hope- fess form of the malady. (Synopsis, p. 296. ) In general, when the treatment proves suc- cessful, the return of the power of vision is ac- companied with a regression of the same charac- teristic effects, which were disclosed in the gra- dual advance of the disorder, viz. appearances as if there were before the eyes flashes of light, a cobweb, network, mist, or flaky substances. ( Beer, Lehre von den Augenkr. b. 2. p. 460. Wien. 1817.) Upon the commencement of the cure, there is also a return of the obliquity of sight; one of the most constant symptoms of imperfect amau- rosis. This is a circumstance, which Hey took particular notice of in some cases, which fell under his observation many years ago: he says, that it was mos! remarkable in those persons who had the most oblique rays of light seemed to make the first perceptible impression upon the retina ; and, in proportion as that nervous coat regained its sensibility, the sight became more direct and natural. (See Med. Obs. and Inq. vol. 5.) TREATMENT OF AMAUROSIS, When amaurosis is to be fundamentally cured, not upon empirical, but scientific principles, all the causes of the disorder must be ascertained, and, if possible, removed, as in the treatment of every other complaint. How often, however, it is impossible to accomplish cither the one or the other of these objects, must be clear enough from the preceding observations, particularly those con- cerning the etiology of the disease; and hence, it is not surprising, that amaurosis should so frequently resist every endeavour to cure it. The plan of treatment is to be regulated, first by the number and kinds of circumstances, which determine the form of the disorder; secondly, by its presence, degree, and duration. When only the chief causes can be ascertained, a scientific mode of treatment may always be instituted ; though here it is very necessary to pay the ut- most attention to those morbid effects in the constitution, and in the eye in particular, which appear to have no connexion with the causes of amaurosis, and merely exist as accidental contem- porary defects, If no particular circumstances can be assigned as the cause of amaurosis, the surgeon has no alternative but the adoption of some empirical method of treatment; but, exclaims Beer, woe to the patient whose surgeon, under these cir- cumstances, draws from a heap of what are con. sidered remedies for amaurosis, as from a lottery, the first as the best! In order to avoid this erroneous method, and not render a half-blind person completely blind, instead of improving, or at least preserving, what- ever remnant of vision there may be, the surgeon should act with great caution, and constantly bear in his mind, first, the constitution, sex, and age of the patient; secondly, his ordinary employ- ments, and general mode-of living ; and thirdly, the principal morbid appearances, under which the amaurosis originated and was developed. (Beer, Lehre von den Augenkr. b. 2. p. 462.) But, what will be of the greatest assistance, is a correct acquaintance with the remedies for amau- rosis in general, and the circumstances, under which the use of this or that particular means is likely to be useful or detrimental. I know of no writer who has been so minute on this part of the subject as Beer, whose sentiments (be it also remarked) are here in many respects different from those of Richter and Scarpa; for, like the surgeons of this metropolis, he rarely employs the emetic plan of treatment, which, according to his principles, is not only y ineffectual, but hurtful, whenever the blindness is attended with determination of blood to the head and eyes, ple- thora, an accelerated circulation, or (what is un- derstood by) a phlogistic diathesis. Beer’s opi- nions, respecting the employment of emetics, and other means for the cure of amaurosis, may be partly collected from the sequel of this article, but, more especially, from the fuller statement which will be made at a future opportunity. Sce Gutta Serena. In the mean time, I shall en- deavour to offer a general account of the practice recommended by Schmucker, Richter, Scarpa; and Travers, according to the arrangement of causes adopted by the second of these valuable writers; for I need not repeat that, whenever the method of cure can be directed against the causes of the disease, it is the most proper and scientific. The present article will, then, close with a de- scription of the four forms, into which professor Beer divides amaurosis, and a history of their varieties, symptoms, and treatment, according to the doctrines and experience of this eminent oculist. In that species of amaurosis, which arises from the first class of causes, or those which induce the disease, by means of a preternatural fulness and