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.

    53/1282 (page 41)
    { racteristic symptoms. The perfectly black, clear motionless, its pupillary edge forming here and there a very small, hardly distinguishable angle ; the amaurotic eyes, for they are constantly both affected, are either prominent and fixed in a life- less way, the muscles of these organs evincing little propensity to contract, or they are in a state of continual oscillation in various direc- tions, never, however, in the line of the straight muscles; but, the appearance is rather as if there were an incessant struggle between these last and the oblique muscles. In the sclerotica around the cornea, an extraordinary bluish tinge may be noticed. Children never hold their heads up, but incline it to one side or the other; and, if they are old enough to walk, they tread very insecurely, hobble along, and frequently tumble down. Lastly, the os frontis projects in a re- markable degree, and the child, completely be- reft of vision, at length dies with convulsive, or apoplectic symptoms. The cause of this amaurosis, which is merely a symptom, depends upon the principal disease, namely, the hydrocephalus, and it would appear, indeed, that the blindness, which does not ac- company every case of internal hydrocephalus, is -particularly attendant upon collections of water in the ventricles. And Beer informs us, that, in two cases, in which he saw this amaurosis as a symptomatic effect of spina bifida, he found, after death, a prodigious quantity of water in all the four ventricles. . As hydrocephalus, especially the internal species, and collections of water in the ventricles, are almost always incurable, it is plain enough what expectation can be entertained of a recovery of the eyesight. Yet, when the amaurosis is truly a symptom of water in the ventricles, the stage of the disorder is known, and the practitioner has not been consulted too late, something may yet be done, as Beer has learnt from experience. The surgeon, however, will rarely be able to render any benefit, because his services. are usually not required until the last stage, and it only remains for him to foretel the melancholy fate both of the patient’s eyesight and life. In the very uncommon case of amaurosis, which is a symptomatic effect of external hydrocephalus, if the health be not too much reduced, there is always more hope. Medical treatment will sometimes do good, if not administered too late. The period, when the oculist is consulted, says Beer, is never that in which inflammation of the brain exists, and, what- ever good can now be done, is generally to be done with calomel and digitalis. (See Lehre von den Augenkr. B. 2, p. 539—41.) Beer’s Fourth Species of Amaurosis and its Varieties. 1. Traumatic amaurosis. Beer applies the epithet traumatic to such cases of amaurosis as are the consequence of a considerable wound of the eye itself, its surround- ing parts, or the skull. Here consequently is first arranged the amaurosis produced by lacera- tion and stretching of the branches of the frontal nerve from irregular sears about the eye-brow. 4l Secondly, Beer reckons: the amaurosis arising from external violence, directed in such a degree against the upper or lower side of the orbit, that the retina is torn, and many of the internal softer textures of the eye forced out of their natural situations. Thirdly, Beer includes every weak- ness of sight, or perfect amaurosis, which is the result of such injuries of the eye-ball itself as extend to the retina, so as either violently to bruise or lacerate it, or cut or pierce it. For the prognosis and treatment of all these cases, he refers to his observations upon ophthalmy. Nor does he choose here to treat of the perfectly complicated amaurosis, which is a direct con- sequence of a coup-de-soleil, because it, never happens unpreceded by a violent general in- flammation of the eye-ball, and therefore is to be regarded as an eflect both of the injury and the inflammation together; but which, like the symptomatic amaurosis, following common and genuine internal ophthalmy, may be easily known by the total insensibility to light, and the evident changes in the texture and shape of the eye; and is quite as incurable as the other example, to which we have alluded. (Lehre von den Augenkr. B, 2, p. 542.) 2. Gouty amaurosis assumes two forms. According to Mr. Travers, gout attacks the eye, through the inedium of the stomach. Vomiting occurs with pain: in. that organ, on the subsidence of an inflammation in the extremities, and is succeeded by violent pain in thehead. ‘The loss of sight, he adds, is sudden and permanent. (Synopsis, &c. p. 163.) The gouty amaurosis, described by Beer, is perhaps badly named: at all events, there are some cir- cumstances in its history which must create doubts on the subject. Gouty amaurosis, he says, has two forms: the first is characterized by a very considerable dilatation and angular dis- placement of the pupillary edge of the iris towards the canthi; a continually increasing slowness in the movements of the iris, and final immobility of this organ; an actual change of colour at both its circles; a dull, glassy blackness of the pupil,'and even a tarnish in the lustre of the cornea; an alternate appearance of. the gray and black cloudy substances, described in the account of the general symptoms of amaurosis, which effect lasts while the patient is not totally blind. The disorder is further indicated by a fleeting, wandering, irri- tating, yet not very severe pain, all about the vicinity of the eye; a manifest tendency to a varicose enlargement of the blood-vessels of the conjunctiva and sclerotica; a very transient me- lioration of sight after meals, or any accidental excitement or stimulus ; a considerable temporary decrease of it after the operation of any causes, which depress the spirits; the excessively slow formation of the disease, for which several years are usually required; and, lastly, by the nature of the patient’s constitution. For, in general, this amaurosis (if we are to believe Beer) always attacks both eyes at once, and is confined to fa- weak, maiden females, who either have suffered from scrophula in their childhood, or from severe acute or chronic diseases at a later period of their lives; who are not yet far advanced in- years;