The ophthalmoscopic appearances of the optic nerve in cases of cerebral tumour / by C.E. Fitzgerald.

  • Fitzgerald, Charles Edward.
Date:
1874
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Licence: Public Domain Mark

Credit: The ophthalmoscopic appearances of the optic nerve in cases of cerebral tumour / by C.E. Fitzgerald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    I now pass on to consider briefly the theories which have been put forward to account for this congested condition of the disk in cases of cerebral tumour; and first in order stands that proposed by Von Graefe. According to him, pressure upon the cavernous sinus is the starting- point of the process. “ This pressure,” he says,^ “ necessarily produces a stasis in the retinal veins, which become very large and tortuous. The swelling of the disk from serous effusion and hypertrophy of the cellular tissue, which in course of time follows, is also very easily accounted for by this mechanical hypersemia.” Another very important factor in the production of these conditions, and one which Graefe lays great stress on, is the unyielding sclerotic ring, which, as he expresses it, “ acts the part of a multiplier.” This is the explanation given by Von Graefe as to the mode in which the Stauungs Papilla, as he terms it, is produced, and greatly modified, as it has been lately, by the investigations of Schwalbe and Schmidt, the “ pressure theory,” if I may so term it, still counts the largest number of supporters. The theory which stands next in chronological order is that propounded by Benedict.^ He looks upon the neuro-retinitis as due to a morbid innervation of the sympathetic, which is itself a symptom of the most varied cerebral diseases. A full account of this theory may be found in Dr. Allbutt’s admirable work, already referred to, where it is also criticised in a most able and masterly manner.® Dr. Hermann Pagenstecher, who is an upholder of Benedict’s theory, in an interesting paper on Optic Neuritis,*^ published in the London Ophthalmic Hospital Reports, enumerates the following objections against Graefe’s theory:— “ 1. The cavernous sinus is a blood canal surrounded with such impervious walls as are rarely to be met with, and a pressure sufficient to really compress this must, since the pressure within the cranium must be regarded as equal in all directions, exercise enormous pressure on all the other blood-vessels.” “2. The vena ophthalmica superior, and vena ophthalmica inferior anastomose extensively, both with one another and also with the facial vein. And although the vena centralis retinm empties itself almost immediately into the cavernous sinus, yet it previously anastomoses freely with the vena ophthalmica superior. But besides these anastomoses, it is quite indifferent whether the discharge takes place at the vena ophthalmica or into the cavernous sinus, since both are continuous, and the return of the blood suffers no hinderance so long as the way through the facial vein is patent.” ^ Loc. cit. ^ Elektrotherapie, Wien., 1868, p. 249, et seq. Op. cit., p. 119. ^ The Eoyal London Ophthalmic Hospital Reports, Vol. vii., Pr, ii., p. 160.
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