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.

    52/1282 (page 40)
    perience) such treatment is apt to fail, and do more injury, than benefit. The steam of warm water is first to be directed up the nostrils; se- condly, warm emollient, mucilaginous decoctions, especially that of mallows, are to beinhaled within the nose; and, lastly, a warm, weak solution of manna in milk. Yet, says Beer, even with these applications, one must proceed with caution ; for, when they are made too strong, the headach and At most, half a scruple of manna canellata is to be dissolved in from four to six ounces of milk; and for children and irritable females, the mixture should be still weaker. When the mucous mem- brane of the nose is soft and somewhat tumid, when the dryness of the nose is in some measure lessened, when the patient feels as if his nostrils were constantly filled with thick mucus, which he endeavours to get rid of by blowing his nose; when the sense of heaviness about the root of the nose increases, and the violent headach changes into a dull heavy feel; the precise crisis has ar- rived, when great benefit may be derived from the powder of mild aromatic herbs, blended with a small proportion of calomel. After this has been employed some time, brisk sternutatories may be tried, like those composed of aromatic vegetable powders mixed with black hellebore, or the vapour of strong volatile smelling salts, caustic ammonia, &c. These means frequently bring about a profuse discharge of thick, fetid mucus, after which the disagreeable sensations about the root of the nose, and eyebrow, gradually cease, the nose is left moister than usual, and the eye- sight is at length completely restored. ‘The only thing, which it is necessary for the patient most strictly to avoid, during the whole of the treat- ment, is cold air, exposure to which (according to Beer’s observations) may be the means of frus- trating every endeavour to complete the cure. (Beer, Lehre von den Augenkr. B. 2, p. 530-34.) 8. Of the genuine paralytic amaurosis. This is not an unfrequent case; it ,always originates very suddenly, attended with a mani- fest contraction of the pupil, which. opening has not lost any of its natural clearness; and there is complete immobility of the iris, the pupillary margin of which does not present the slightest irregularity. However, either some muscle of the globe of the eye, the levator of the upper eyelid, or the orbicularis palpebrarum, nay, several of these muscles, and sometimes all of them to- gether, are affected with paralysis; while the blindness itself is almost always not only com- plete, but not unfrequently so complete, that every vestige of sensibility to light is lost. The functions of the puncta lachrymalia are also more or less impeded, whence a greater or lesser de- gree of epiphora usually accompanies the dis- diminished absorption and conveyance of the generally occurring whenever the orbicularis palpebrarum is paralytic. A completely amau- greatest possible resemblance to a dead eye. When all the muscles of the globe are palsied together, the eye can no longer preserve its situa- tion in the orbit, but protrudes, as it were, lifeless (Ophthalmoptosis paralytica) 3 while’ the whole tunica conjunctiva is commonly cedematous, or very blood-shot; and it is not unusual to find this amaurosis conjoined either with paralysis of certain muscles of the face, or even with hemi~ plegia. The causes of the true paralytic amaurosis comprise violent concussions of the eye-ball itself, unaccompanied with any solution of continuity, or any displacement of the internal parts of this organ; concussions of the upper and lower mar- gins of the orbit, especially the eyebrow, and neighbouring part of the forehead, without any laceration of the frontal and infraorbitary nerves ; and concussions of the whole brain, or spinal marrow: sometimes, however, the disorder is only a symptomatic effect of apoplexy. In the three latter cases, the blindness regularly extends to both eyes. When the amaurosis: is only the momentary consequence of a simple concussion of the eye- ball, without any breach in its internal texture, if the retina be not wounded, and none of the inner parts of the eye displaced, the case always admits of a perfect cure by proper treatment; and, says Beer, it is incredible, how much may here be accomplished, by beginning the treatment judi- ciously, even when the eyesight has been nearly or quite abolished, and theconcussion of the eye- ball has been so serious, as to produce an effusion of blood in the chambers of the aqueous humour. Beer owns, however, that cures of the latter. de- scription, of which the ophthalmic hospital at Vienna has afforded many examples, are only to be considered as extraordinary occurrences, and therefore should not form any general inference for the prognosis. But,when this amaurotic loss of sight is the effect of a severe concussion of the brain or spinal marrow, and the case is unequi- vocally denoted by its general well-known cha- racteristics, and its history; or when the disorder is the symptom of an apoplectic fit; the prognosis is very unfavourable, not merely with respect to the restoration of sight, but the patient’s life it- self. . In cases of paralytic amaurosis, even where it proceeds from a concussion of the eye itself or its vicinity, a complete cure cannot always be expected from merely local remedies. The treat- ment, however, should regularly begin in this manner, and the surgeon first try whether it will answer, or not. For this purpose, Beer par- ticularly recommends the employment of all those nervous remedies, the cautious gradual use of which in the empirical treatment of amaurosis is particularly praised by that author. (See Gutta Serena). Should local means fail, gradual recourse must be had to antiparalytics and tonics. (Lehre von den Augenkr. B. 2, pe 535, &c.) 9. Of ihe symptomatic amaurosis from hydro- cephalus. According to Beer, this amaurosis may occur, as a symptomatic effect, not merely in interna} hydrocephalus and collections of water in the ventricles of the brain, but also in external hy- drocephalus and spina bifida. In the two latter cases, the diagnosis is easy ; but, in the two first, it is more obscure, though it may generally be made out by attention to the following chaz