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.

    43/1282 (page 31)
    ventures too far, are those relating to the etiology of the several cases; a subject, in which he displays the usual credulity of the continental surgeons. With his observations, I have taken the liberty to blend a few additional remarks, not caring about the length of the article, where the matter seemed new and interesting. 1. OF THE DIFFERENT FORMS OF AMAUROSIS IN GENERAL, Beer reckons four species of amaurosis. The first is a genuine uncomplicated amauresis, the characteristic symptom of which consists pe- culiarly and entirely in an impairment or loss of vision, without any morbid change in the organic matter of the eye. To this case, the epithets proper functional, used by Mr, Travers, would be quite applicable. Secondly; there is an amaurosis, which, be- sides being attended with a diminution, or total loss of vision, is also accompanied with appear- ances of disease in the organic matter of the eye. Thirdly ; there is another amaurosis, in which, together with the above principal symptom, viz. weakness, or loss of sight, there are also morbid phenomena exhibited in the form of the eye in general, or its particular textures, and especially in the action of the irritable parts. Lastly ; Beer says, he can often point out an amaurosis, in which all the characteristic sym- ptoms of the three preceding cases are more or less combined, (See Lehre von den Augenkr. B. 2, p- 478.) “Professor Beer’s First Species of Amaurosis. The genuine uncomplicated amaurosis, consist- ing ofa mere diminution or loss of sight, without the appearance of any other defect, is one of the most ‘uncommon forms of complaint, not only because singly operating causes are few, but be- eause they can rarely operate directly upon the optic nerves, In the true uncomplicated amaurosis, merely the vital qualities of the optic nerve and retina are affected, and after death, nothing preterna- tural can be traced in those parts, either within or on the outside of the eye-ball. It is in short the case, in which the functions of the retina have become imperfect, or destroyed, the eye appearing in. other respects sound. According to Beer, this simple unmixed form of amaurosis is subdivisible into that amaurotic weakness of sight, or blindness, which depends upon the vitality, or rather sensibility of the optic nerve and retina being too highly raised, and into another case, the proximate cause of which is pe- culiarly and entirely referrible to depression of such vitality or sensibility. The first example is much less common than the second. ' The general symptoms of the simple uncom- plicated species of amaurosis, putting out of con- sideration the morbid increase, or diminution of the sensibility of the optic nerve, are thus described by Beer. In the first place, all morbid appear- ances are absent, which might be produced in the amaurotic eye by any one preternatural change in the texture, form, or state of that organ. Hence Wwe are obliged to trust almost exclusively to:the patient’s assertion, that his sight is bad, or quite ol gone; and not unfrequently, it is necessary, especially, in judicial cases, to employ political artifices, in order to determine whether such as- sertion be true, particularly when the patient af- firms that the blindness is restricted to one eye, Secondly ; when the amaurosis is indeed nearly, or quite formed in one eye, a slight degree of strabismus is at most perceptible, arising from the circumstance of the patient’s not fixing the eye affected upon any object. This degree of stra- bismus is noticed by Ackermann and Fischer, as the surest sign of amaurosis, (See Klinische Annalen-von Jena \st. p. 144.) And it is par- ticularly pointed out by Richter, as an invariable attendant upon amaurosis. The patient, says he, not only does not turn either eye towards any object, in such a manner, that the object looked at is in the axis of vision; but, he does not turn both his eyes towards the same thing. This was regarded by Richter, as the only symptom, which we can trust, where implicit confidence should not be put in the mere assurance of the patient, that the eyes present their natural appearance. (See Anfungsgr. der Wundarzn. B. 3. Kap. 14.) Provided this observation be correct, it must be highly interesting to the military surgeon, amau- rosis being a common affliction of soldiers, many of whom, however, endeavour to avoid service by pretending to labour undera disqualification, which they well knew does not necessarily produce any very considerable alteration in the natural appear- ance of the part affected. Thirdly; while the disorder is only in the stage of amblyopia, the patient always complains of continually multiplying muscze volitantes, or of the visus reticulatus, or nebulosus. Fourthly; luminous forms appear before the eyes, especially in the dark, even when the patient is entirely blind. Fifthly; the de- erease of vision goes on to complete blindness, without any material interruption, or retrogres- sion. Sixthly; when only one eyeis quite blind, and the eyesight on the other side is perfectly un- disturbed, there is one infallible symptom of this amaurosis, namely, if the sound eye be very care- fully covered, the pupil of the blind one imme- diately expands, and the iris becomes quite mo- tionless, notwithstanding the diseased eye be ea= posed to the strongest light possible. However, this criterion is mostly wanting, because the amaurosis, unattended with any perceptible defect, except loss of vision, is seldom confined to one eye, but usually affects both. (See Lehre von den Augenkr. B. 2, p» 481-82.) 1. Of the genuine wncomplicated amaurosis, dependent upon what Beer terms preternaturaily high vitaliiy, or rather, as we should. say, a@ morbid increase of sensibility im the optic nerve. This form,of amaurosis is described by Beer as having two stages: in the first, the patient never becomes blind; the eye-sight not being lost till the end of the second stage. The disease always forms with great quickness, so that the limits be- tween the two stages are frequently very indistinct. The first stage commences with a peculiar sensation of fulness in the eye-ball, joined with continually increasing, violent, and annoving, luminous appearances, and. a remarkable weak- ness of sight... These symptoms are soon followed by a stupifying, constantly increasing headach,