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.

    54/1282 (page 42)
    and whose menses have never been very irregular, though profuse. ‘This form of amaurosis is re- stricted to no particular classes of society; it is not, however, so commonly noticed in the higher orders ;° while it is most frequent in the working middle classes, and scarcely ever remarked in the lowest ranks, especially country people. It is remarked by Beer, that, although the second form of gouty amaurosis makes its attack upon males, as well as females, the latter, on the whole, are most frequently affected, particularly about the period when the menses cease. ‘This amaurosis which is seldom formed quickly, that is to say, inva few weeks, or months, but mostly requires years for its production, begins .with cloudy, indistinct vision; an appearance of dif- ferent colours before the eyes; and a peculiar sensation as if insects were crawling over the skin around the eye. The pupil becomes manifestly dilated, and presents a dull greenish-gray colour, which, however, is easily distinguished from the colour ‘seen behind the pupil in. the amaurotic cat-eye, and plainly depends upon some defect in the vitreous humour, (glaucoma). Also the iris, the pupillary edge of which is drawn towards both angles of the eye, as in the first form of the disorder, undergoes an obvious change of colour, first at its lesser circle, which becomes of an uncommonly dark hue, and then at, its greater circle. The alteration of colour, here spoken of, certainly proceeds from a general varicose state of the blood-vessels of the eye, which affection daily augments, and is attended ‘with vehement pain in the organ and surrounding parts, or even in the whole head, or one side of it, whether the blindness attack one or both eyes together. This violent pain, however, which is such as often to distract the patient, is un- steady and irregular, being immediately aggra-. vated by every violent mental emotion, whether of the exalting or depressing kind, every sudden and considerable change of temperature, every quick accession of wet cold weather, or when the patient stays only for a short time near a very heated fire-place, lies on feather pillows, with the affected eye resting upon them, or covered with flannel, or he has been eating any indigesti- ble food. It is very remarkable, that these attacks of pain subside without any medical as- ‘sistance, in the dry warm season of the year, and dn a mild, not too hot, climate are often kept off for several years. Upon every such attack of gouty pain, the glaucoma becomes more evident, ‘the pupil larger and more angular, and the eye- -sight perceptibly weaker. At length, during one _of these painful exacerbations, vision is completely abolished, not the least sensibility to light re. maining; and the pupillary edge of the iris, together with the lesser circle of the same organ, then entirely disappears, being inverted towards the lens. The cirsophthalmia also gets so much worse, that the sclerotica acquires a smutty grayish-blue colour; and, at length, the bluish windings of vessels may be noticed at various points, particularly about the place where the tendons of the muscles are affixed. Afterwards the green, or what may be more properly called, the glaucomatous cataract, is manifestly developed, and the eye then generally wastes under the most violent attacks of pain. The light, which the patient always thinks he sees, but which, according to Beer, is produced of a reddish or bluish colour in the interior of the eye, like galyanism, keeps up the hope of recovery ; but, all consciousness of this luminous appearance ceases as soon as the eye begins to waste. The first degree of gouty amaurosis readily changes to the second, especi- ally in persons who are getting into years, or are near the period of life when menstruation termi- nates. , That in amaurotic patients of the foregoing kind, a certain morbid tendency to gout exists, | may be inferred from what has been already said of the peculiarities of constitution which are noticed. In such individuals, therefore, it is not extraordinary, that the first degree of gouty amau- rosis should originate, and almost uninterruptedly augment to complete blindness, while certain ge- neral and local causes are incessantly operating upon the eyes; such as long grief affecting a very sensible mind; excess in wine; sleepless nights, occasioned by care or fear; straining the eyes, either by too much reading, particularly at candle- light, or by any of the fine kinds of work usually done by women ; bad, unwholesome sorts of food ; and want of good air, and proper exercise. The causes of the second form of gouty amau- rosis, says Beer, are the same as those of gout in general, which, however, are very imperfectly known, Whatever in certain individuals has the effect of promoting, or actually bringing on an attack of gout, may excite this amaurosis, espe- cially, when at the same time hurtful or debili- tating circumstances are affecting or have been affecting the eyes. It is to be recollected, how- ever, says Beer, that just in the same manner as few of the individuals, exposed to the influence of these last circumstances, are attacked with gout, so few gouty subjects are afflicted with this amaurosis, and, consequently, in both cases, a certain predisposition to such disease, already ex- isting in the eyes, seems essential to its produe- tion. According to Beer, such individuals as have been afflicted with scrophula or rickets in their youth are very liable to gout, when they grow older; and, says he, gouty disease more frequently attacks dark, brown, or black eyes, than eyes of a light colour, especially when they have been much debilitated in the earlier part of life by immoderate exertion. In the first degree of gouty amaurosis, Beer observes, that the slightest glance at the etiology of the case must show, how unfavourable the prognosis is; for, notwithstanding the- disease frequently requires many years to be completely formed, and the causes are by no means so ob-- scure, as in the second degree of the disorder, yet, they are generally such as absolutely cannot be removed, because interwoven, as it were, with the constitution. In fact, the surgeon being hardly ever able to check, much less cure, the blindness, is usually obliged to be an inefficient spectator of its progress. According to Beer, the apothecary’s magazines contain no remedies, which are ade- quate to the cure of this amaurosis. A total change of the whole constitution would be requi- site, ere success could be expected, and such change it is not in the power of physic to aeccom- plish. The practitioner-may give advice, and make the attempt; but, notwithstanding every exertion, the patient usvfally falls into a state of complete and irremediable blindness. In one