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.

    40/1282 (page 28)
    the indication is to lessen the quantity of blood, and the determination of it tothehead. For this purpose, the patient may be bled in the arm, tem- poral artery, or, as is often preferred by foreign surgeons, in the foot. This evacuation is to be repeated as often as seems necessary, and it will be better to begin with taking away from twelve to sixteen ounces. The efficacy of bleeding, in the cure of particular cases of gutta serena, is strikingly, exemplified by numerous: well authen- ticated observations. Richter informs us.of a woman who, on leaving off having children, lost her sight ; but, recovered it again by being only once bled in the foot. A spontaneous hemor- rhage from the nose also cured a young woman, who had been blind for several weeks. (An- That bleeding is sometimes hurtfully and wrongly practised in amaurotic cases, is a fact, which admits of no doubt. Mr. Travers particu- larly refers to one description of cases, where the lancet does harm: these are cases of undue de- termination of blood to the organ, which are espe- cially common after deep seated chronic inflam- mation or distress from over excitement, by which its vessels have lost their tone; an effect decidedly increased by depletion.—In one interesting case of this kind, a gradual, but perfect recovery followed a regulated diet, and a course of the blue pill, with saline aperients. (Synopsis, p. 159.) All cases of direct debility and proper paralysis of the retina (says Mr. Travers) are aggravated by loss of blood, and the great prevailing mistake in the treatment of amaurosis, is the indiscrimi- nate detraction of blood. (Synopsis, p. 303.) When in addition to general bleeding, topical is also necessary, leeches may be applied to the temples, or cupping glasses to the back of the neck. Besides bleeding, purgatives, blisters, bath- ing the feet in warm water, &c. are frequently proper. In some cases, the foregoing means fail in producing the desired benefit, even when followed up, as far as the pulse and strength will allow. Here the continuance of the disease may depend, either upon the stoppage of some wonted evacu- ation of blood, or else upon some other cause of the first class. In the first of these cases (says Richter) experience proves, that the disease will sometimes not give way, before the accustomed discharge is re-established. A woman, who (as this author acquaints us) had lost her sight, in consequence of a sudden suppression of the menses, did not recover it again till three months withstanding the trial of every sort of evacuation. He also tells us of another woman, who had been blind half a year, and did not menstruate, and to whose external parts of generation leeches were several times applied. As often as the leeches were put on (says Richter) the menses in part recommenced ; and, as long as they made their appearance, which was seldom above two hours, the woman always enjoyed a degree of vision. (Anfangsgr. der Wundarzn. B. 3, p. 443.) For the amaurosis, arising from suppression of the menses, Scarpa recommends leeches to the pudenda, bathing the feet in warm water, and bined with gummy and saponaceous substances. If these means fail in establishing the menstrual discharge, he says, great confidence may be placed in a stream of electricity, conducted from the loins across the pelvis, in every direction, and thence repeatedly to the thighs and feet. He enjoins us not to despair at want of success at first, as the plan frequently succeeds, after a trial of several weeks. For the amaurosis, proceeding from the stop- page of an habitual copious bleeding from piles, Scarpa recommends leeches and fomentations to the hemorrhoidal veins, then an emetic, and afterwards the same opening pills. (Osservazione sulle principalt malaitie degli occhi, cap. 19.) When the disease does not originate from the stoppage of any natural or habitual discharge of blood, and does not yield to the evacuating plan, Richter thinks, the surgeon justified in con- cluding, that the preternaturally dilated vessels have not regained their proper tone and diameter, and that topical corroborant remedies, particularly cold water, ought to be employed. In this kind of case, he is an advocate for washing and bathing the whole head with cold water, espe- cially the part about the eyes: a method, he says, which may often be practised after eva- cuations, with singular and remarkable efficacy. When the return of sight cannot be brought about in this manner, Richter advises us to try such means, as seem calculated to stimulate the nerves, and remove the torpid affection of the optic nerves in particular. Of these last reme- dies, says he, emetics are the principal and most effectual. We come now to the consideration of that species of the gutta serena, which is regarded as the effect of some unnatural irritation. Here, according to the precepts delivered by Richter, we should endeavour to discover what the par- ticular irritation is, and then endeavour to eflect its removal. When it cannot be exactly de- tected, we are recommended generally to employ such remedies, as will lessen the sensibility of the nerves, and render them less apt to be affected by any kind of irritation. Sometimes the irritation is both discoverable and removable, and still the effect, that is to say, the blindness, continues. In this circumstance, Richter thinks, that the surgeon should endeavour to obviate the impression, which the irritation has left upon the nerves, by the use of anodynes ; or, else, try to remove the torpor of the nerves by stimulants. But, according to Schmucker, Richter, and Scarpa, the curable imperfect amaurosis com- monly depends on some disease, or irritation, existing in the gastric system, occasionally com- plicated with general nervous debility, in which the eyes participate. Hence, in the majority of cases, we are assured, that the chief indications are, to free the alimentary canal from all irrita- ting matter, improve the state of the chylopoietic viscera, and invigorate the nervous system in general, and the nerves of the eye in particular. For an adult, dissolve three grains of anti- monium tartarizatum in four ounces of water, and give a spoonful of this solution, every half hour, until nausea and copious vomiting are produced. The next day some opening powders are to be