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.

    55/1282 (page 43)
    single example, Beer succeeded in checking the disease, by persuading the patient to observe a strict regimen, not a grain of medicine being given; but the patient still remains weak-sighted, though various medicines have latterly been tried. The following are Beer’s observations on the prognosis in the second stage of gouty amaurosis. If in the first stage, there is scarcely any hope of preserving the sight, where the causes of the dis- ease are apparently known, how little expectation of success can be entertained in the second stage, where the causes are involved in perfect ob- seurity, and are probably in some measure de- pendant upon a propensity to gout existing in the constitution from childhood. Indeed, when the patient is living under the influence of such cir- cumstances, as are known to promote gout, cer- tain blindness may be predicted. The same ter- mination may also be foretold, without any chance of error, when glaucoma is evidently present ; and, though a weak power of vision be yet left, this will soon be for ever lost. It is doing a great deal in these cases to free the patient from into- lerable pain, and, by active resistance to gout, perhaps, still preserve the other eye, where this is not yet affected, or not in a serious degree. But if the practitioner find, when he is first consulted, that the green or glaucomatous cataract is al- ready formed, there is then not the slightest chance of obviating the pain, which ordinarily continues, until the eye is completely wasted away, and the fissure of the eye-lids has perma- nently sunk in the orbit and closed. With respect to the treatment of the second stage of gouty amaurosis, Beer observes, that it should be like that of gouty iritis. In parti- cular, attention must be paid to the attacks of pain, and palliative means adopted. The patient should not lie upon feather beds, nor especially feather pillows, but only employ articles of this kind, which are stuffed with horse hair. Neither must he expose himself to an atmosphere, which is at the same time both cold and damp; and, if he cannot altogether take care of himself in this respect, at all events, let him keep his head and feet warm and dry; shun every thing which tends.to impede the functions of the skin; and avoid pork-meat, every thing cooked with hog’s lard, and very acid salt dishes, like herrings. With what are usually considered as gout-medi- cines, the practitioners should act very circum- spectly ; and, as in gouty iritis, he should pay close attention to the state of the constitution, rather seeking to afford relief by means of a well-regulated diet, than by the employment of much physic. With arthritic amaurosis, says Beer, is to be classed an amaurotic, rapidly-formed, complete blindness of both eyes, which is the immediate result of a sudden violent fright; but only takes place in such individuals as are excessively ner- vous and irritable, and more or less prone to, or actually affected with, gout. The most striking effect, characterizing this consequence of arthritic amaurosis, is that change, which is instantaneously produced in the structure and form of the eye at the moment when the patient recovers from his fright, and comes to his senses again, of which defects in the interior structure and form of the eyes there was not previously the smallest vestige, 43 and these organs, if not quite healthy, could only be termed weakish. These changes are indi- cated by a considerable dilatation of the pupil, which is drawn into an angle upwards and down- wards ; by the complete immobility, and the pro- jection of the iris towards the cornea; by the manifest appearance of vessels fully distended with blood, on the greater circle of the iris; by all the symptoms of a beginning glaucoma; and by a general varicose affection of the blood- vessels: which two laiter effects from this period incessantly continue, attended with violent pain in the head and eyes. (Lehre von den Augenkr. B. 2, p. 544, &e.) 8. Of the amaurosis occasioned by the sudden cure of particular cutaneous diseases, and of old ulcers of the leg. Most of the cases, which appertain to this class, are said to have a great resemblance to the second form of gouty amaurosis. According to Beer, when psora, porrigo, old ulcers of ihe leg, &c. are suddenly healed, a consequence -more frequent than amaurosis, is a sympathetic oph- thalmy, which indeed may easily be removed by judicious treatment, but, if unskilfully managed, may prove very obstinate and dangerous. _ ‘This eminent oculist thinks, that, in children, amau- rosis is very rarely produced by the indiscreet cure of crusta lactea, and, with one single excep- tion, the blindness has appeared to him to be a symptomatic effect of water in the ventricles of the brain, formed (as he perhaps too credulously Supposes) in consequence of the injudicious re- pulsion of the cutaneous disorder. When this amaurosis assumes its ordinary form, Beer has not yet been able to remark in it any peculiar characteristic symptoms, by which it can be effectually distinguished from the se- cond form of gouty amaurosis, excepting, first, that it originates and increases very suddenly, while the true arthritic amaurosis is a long time, and for the most part several years, in forming. Secondly ; that, at its commencement, it is never attended with violent pain in the eyes, or head. Hence, the diagnosis will depend very materially upon a correct recollection of circumstances. But, according to Beer, there are some cases, in which, besides the complete blindness, unattended with the slightest power of perceiving light, there is no characteristic symptom, but extraordinary enlargement of the pupil, total immobility of the iris, and an inanirhate projection of the eye. Respecting the causes of this amaurosis, Beer says, that he has nothing important to offer. He owns, that, after the sudden cure of certain cutaneous diseases, and of old ulcers of the legs, an amaurotic blindness does not always ensue; and he believes, that the reason why the bad effects take place in other organs, sometimes the brain, the lungs, or the bowels, &cémay probably depend upon this or that organ happening to be most predisposed to disease. Here the discerning reader will not require me to point out to him, that such a mode of accounting for things is en- tirely hypothetical, and destitute of proof: it is it admits of being extended to all diseases, with- out exception. Ifwe are to believe Beer, the prog- nosis is very uncertain, and, in many cases, highly unfavourable; first, because an organic part, name-