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.

    48/1282 (page 36)
    entirely lost. But; when the disorder has acquired its utmost degree, the eye always still retains the power of discerning the light, and it seldom hap- pens, that vision is abolished by the first or se- cond attack. It is different with respect to the characteristic phenomena of this amaurosis, in hysterical or hypochondriacal patients, especially when often affected with spasms, before, during, or after which, the impairment of sight originates 5 for, though the pupil may continue quite clear, it cannot escape the notice of an attentive observer, that, together with a pupil of diminished diameter, there exists a peculiar motion of the iris, a con- stant fluttering of it between expansion and con- traction, technically called hippus pupille. ‘This convulsive state of the iris is mostly accompanied with a similar affection of the eye-lids, namely, with an involuntary blinking, nictitatio, and not unfrequently with an involuntary pendulum-like rolling of the eye-ball, nistagmus. In these patients, the amaurotic injury of sight hardly ever proceeds directly to complete blindness, but more commonly remains as a weakness of vision, cha- racterized during the rest of life by ceaseless oscillations of the eye-ball, aversion to light, and frequent sensations, as if there were shining fiery objects before the eyes. With regard to the symptoms in epileptic pa- tients, in addition to the general effects above enumerated, this case of symptomatic amaurosis is distinguished by an untroubled, but very ex- panded pupil; considerable diminution of the motion of the iris; a dilated state of the pupil even under the stimulus of the strongest light, and tremulous motions of the eye-ball, which continue during life, after the epilepsy and amau- rosis are cured; and the case is further charac- terized by amblyopia, which rarely increases to complete blindness. According to Beer, the amaurosis connected with convulsions, is most frequent in children. The first and most prominent symptom of this incomplete or compiete amaurosis consists in an extremely violent convulsive rotation of the eye- ball, especially upwards, not unfrequently attended with the most violent convulsive motions of the eye-lids. ‘The pupil is excessively dilated, and scarcely the least movement of the iris is di- stinguishable on exposing the eye to the strongest light. When the general twitchings are over, and only an amaurotic weakuess of sight is left, strabismus occurs in both eyes in various direc- tions, though the eyes very seldom deviate from the axis of vision in the direction towards the inner canthus.. When the general convulsions happen frequently, and are violent and of long duration, the amaurotic weakness of sight usually changes into perfect blindness, in which the pupil, though it be regularly clear, and of a shining black- ness,isgreatly expanded,and the eyesconstantly re- tain their faulty positionand pendulum-like motion. it were, in the title of this section: for, whatever tends to bring on hysteria, hypochondriasis, epi- lepsy, or convulsions, in an evidently nervous in- dividual, who either has had from birth weak, irri- table eyes, or has gradually debilitated them by over- exertion, may give rise to this species of amaurosis. With respect to the prognosis, itis observed by Beer, that even when merely an amaurotic weakness remains, the prognosis is always seri- ous ; but it is naturally still more unfavourable, when the blindness is complete, and when the loss of sight has suddenly recurred after violent spas- modic, epileptic, or convulsive attacks, without such attacks themselves ever returning. Under these circumstances, Beer has not hitherto seen more than two instances of such blindness par- tially cured. Generally, some hope of recovery may be entertained, when the amblyopia, or even complete amaurosis, begins with these attacks, but always terminates with them, without leaving any serious impairment of vision. On the con- trary, it is a very bad sign, not only in regard to the removal of this symptomatic amaurosis, but likewise to the cure of the original disease, when the amaurosis invariably precedes these attacks, and lasts a considerable time after their cessation. As yet, Beer says, he has not known any such patients cured, either of their spasms, epilepsy, or convulsions, much less of their blindness: on the contrary, after three or four attacks, perfect amaurosis remains, and some of the patients die in one of these paroxysms. . As this amaurosis is merely a symptomatic effect of the above general disorders, its removal must entirely depend upon the success, with which their treatment is conducted. Were the blindness to continue, however, after the cure of the original disease, the surgeon could do nothing more, than try an empirical mode of treatment, and ascertain what good could be effected with antispasmodic and tonic medicines. (Beer, Lehre von den Augenkr. B. 2, p. 506—10.) 3. Of the symptomatic amaurosis from tn- farction, obstruction, and induration of the ab- dominal viscera. . The following is Beer’s account of the com- plaint: the extremely slow formation of this amaurosis gives it something characteristic, for during ten, twenty, and more years, the patients may have a continually increasing weakness of sight, without becoming completely blind, or quite incapable of following their business. The pupil is invariably found to be dilated, of a pale blackish colour, though very transparent ; the somewhat convex iris moves in the varying degrees of light, but very inertly ; its pupillary edge is not cir- cular, as in the healthy state, but is drawn into an angle sometimes at one point, sometimes at another; and not only the turgescence of the blood-vessels of the conjunctiva, but a reddish, yellowish, rather smutty tinge of the whole white of the eye, are evident to the most common ob- server. As the weakness of sight increases, the patient sees all objects through a thick mist, which, when blindness approaches, seems for a day or two as black as soot, and, for another day or two, of alight gray colour. Hence the pa- In most patients, those phenomena at length take place, which have been described in speaking of the visus interruptus. The purple lips, and wan countenance, correspond to the state of the eyes. A stupifying dull universal headach, depriving the patient of all inclination to employ his eyes or intellects while any Vision is retained ; a con- and, generally, the whole host of complaints con- nected with the morbid state of the abdominal viscera, are the never-failing companions of this