Medical diagnosis : with special reference to practical medicine. A guide to the knowledge and discrimination of diseases / By J. M. Da Costa ... Illustrated with engravings on wood.

  • Jacob Mendes Da Costa
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine. A guide to the knowledge and discrimination of diseases / By J. M. Da Costa ... Illustrated with engravings on wood. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    beyond the corpora qnadrigemina or not. If beyond, the pupil- lary reflex will be retained, despite the loss of sight. Lesions of the sj^inal cord and sympathetic produce results the reverse of the preceding. Irritative lesions dilate, paralytic lesions contract. In this connection the phenomenon called the Argyll-Robertson pupil—the light-reflex lost, the accommodative reflex retained, of a myotic pupil—is of value as indicating, often early, scle- rosis of the posterior columns of the cord. Paralysis of the accommodation may exist independent of pupillary involvement, and its significance is that of paralysis of other branches of the third nerve. II. Abnormal changes in the fundus of the eye may be of great diagnostic value, and in almost every case of circulatory or nervous disease the routine use of the ophthalmoscope would give valuable hints of general disorder. This is rendered exceptionally true by the fact that these changes are most frequently symptomatic, and, with few exceptions, do not arise from local disease. We should invariably examine with the ophthalmoscope the eyes of patients suspected of having disease of any part of the cerebro-spinal nervous system. Changes in the eye, indeed, often occur early enough to be the first certain sign of disease, and this, too, without any impairment of sight; on the other hand, lesions indicating cerebral or other organic affection have been found in cases in which failure of sight was alone complained of, the cause being inisuspected. But ]iarticularly is the ophthal- moscope valuable in enabling us to differentiate organic from functional affections. It tells us of extension of congestion or of inflammation of the brain to the internal structures of the eye, or of the amount of resistance offered to the circulation within the cranium. This resistance may either arise from a marked coarse lesion, or may make itself felt through the sympathetic nervous system. The changes in connection with organic disease have been ob- served chiefly in the retina, the optic disk, and the choroid. In using the ophthalmoscope for medical diagnosis we pay particular attention to these structures; especially do we note the disk, its color and size, and the pigment around its edges, the region of the macula, the size and appearance of the arteries and veins, whether diminished, enlarged, or tortuous, whether there are