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.

    44/1282 (page 32)
    during which the power of vision manifestly dimi- nishes, without the slightest defect being percep- tible either in the eye itself, or its surrounding parts. The patient, however, is always marked by an athletic constitution, or at all events, by such symptoms of general and local plethora, and of a phlogistic diathesis, as cannot be mistaken. Upon the advance of the disorder into its se= cond stage, the headach becomes irregular, being less violent at some periods than others; the patient feels as if there were before his eyes, a thick net, or gauze, which, in a bright light, appears quite black, but in the shade, fiery and shining. This net or gauze, when there is any temporary determination of blood to the head and eyes, as in straining at stool, is immediately rendered considerably more dense; and when such determination of blood is often repeated, or long maintained, the density at length remains much greater than before, and consequently, the patient suddenly grows more blind, and is very quickly entirely bereft of vision. ‘This complete loss of sight, in the second stage, if efficient as- sistance be not given, is ultimately produced by the progress of the disease, even without any accidental determination of blood, though never quite suddenly. At last, all power of discerning the light is abolished, under incessant stupifying headachs, which are sometimes weaker, sometimes stronger, and attended with a sensation, as if the dimensions of the eye were increased, and indeed, it really feels harder, than in the healthy state. All those circumstances, which produce a long and repeated determination of blood to the head and eyes, must be considered as the principal eauses of thiskind of amaurosis. Beer especially adverts to the habit of sleeping at night with the head low, in individuals who retire early to rest, and with their arms extended above their head. Here also the observations are nearly all applica- ble, which have been already delivered respecting the effects of immoderately exerting the eye-sight and intellects, and concerning the too great irri- tation of the eye by the light in typhoid fevers. Nor, in the etiology of this species of amaurosis, should what has been stated about idiosyncrasies be forgotten. (Lehre von den Augenkr. p. 483- 85.) While the first stage has not yet terminated, and consequently while the power of vision is not obliterated, if the patient can and will put himself without delay into the requisite condition for the eure, a favourable prognosis may invariably be given. But, the prognosis is much less promising, when the second stage has already begun, or is threatening to begin, and consequently when the power of seeing is either completely or nearly destroyed, notwithstanding the blindness may not be of more than two days’ standing ; particularly, if the patient cannot immediately have the best assistance. However, some slight hope of the re- establishment of sight may always be entertained, even though the amaurosis be complete, if it be not of long standing. But when the disorder has existed several months, it is hardly ever practicable to do more, than restore a very partial degree of vision. When, in typhus fever, this amaurosis has been brought on altogether by the immoderate irritation of the light, Beer has constantly found the case quite irremediable, the general debility, which often lasts so long after typhus, having no slight share in the prevention of a cure. The prognosis is most favourable, when the amaurosis depends upon some idiosyncrasy which is known, and can be at once removed; and very discoura- ging is the prospect of relief, when many different causes are concerned in the production of the éomplaint ; while that true sympathetic amaurosis, which arises not merely from over exertion of the eye, but also from great and immoderate mental application, is very serious, both with respect to the fate of the eye itself, and the life of the patient, amaurosis, under these circumstances, being not unfrequently the forerunner of impairment of the intellects, or absolute mania. (Beer, vol. cit. p. 486.) As in this species of amaurosis, a determination of blood to the head and eyes is never altogether absent, and has generally had a great share in the first production of the complaint, it must be self- evident, that during the whole course of the dis- ease, every thing should be rigorously avoided which can tend to bring on such determination of blood, or disturbance of the circulation; and when these states already exist, no pains must be spared to lessen andremovethem. Hence, when general plethora prevails, venesection is the ear- liest indication; and, if this be not effectual, and the local plethora in the head and eyes still con- tinues, topical bleeding with leeches, &c. must be practised. But, if no signs of universal ple- thora exist, and there be merely a determination of blood to the head and eyes, local bleeding will be sufficient. At the same time, bathing the feet in lukewarm water, containing salt, or mustard, or applying sinapisms of mustard to the calves, and using gentle opening clysters, aperient me- dicines, cooling drinks, and a strict vegetable diet, will very much contribute to lessen the determi- nation of blood, and any prevailing impetuosity of the circulation. These antiphlogistic curative means must be aided by keeping the eyes in a natural, yet complete state of rest, and in parti- cular by keeping the whole body quiet in the re- cumbent posture, with the irritation of what would otherwise be only an ordinary degree of light, constantly diminished. Nay, in typhoid patients, attacked with this form of amaurosis, the inter- ception of the light by blinds and eye-screens, or . a light fine linen bandage, will be of itself effectual to arrest the disorder at once, and prevent blind-~ ness, unless the first stage be already too far ad- vanced. When the most careful adoption of the foregoing means is only followed by an imperfect and slow return of vision, the treatment is to be aided by cold bathing of the eye, in practising which care must be taken not to let the patient’s head lean forwards. According to Beer, the sympathetic amaurosis, unaccompanied ‘by any appearance of organic disease, and brought on by, immoderate exertion of the brain, always demands, in its first stage, not only local, but general anti- phlogistic treatment, even though no particular plethora may be present. What is named by Mr. Travers the proper func- tional amaurosis, belongs to the class of cases: here considered by Beer: the extreme states of light and temperature, and too much exertion of the organ, are the chief causes of it. The re-: mission, or removal, of these hurtful cireumstances even of itself, Mr. Travers remarks, will do much towards the cure. The continuance of them