On the use of the ophthalmoscope as a help to diagnosis in diseases of the nervous system / by John Ogle.
- Ogle, John W. (John William), 1824-1905.
- Date:
- 1860
Licence: Public Domain Mark
Credit: On the use of the ophthalmoscope as a help to diagnosis in diseases of the nervous system / by John Ogle. 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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![few cases, the motor branches appear endowed with it in their turn: this singular fact requires an explanation! W hen a sensitive nerve has been divided, its central extremity retains its own peculiar faculties, while the peripheric portion of the nerve is totally deprived of feeling and remains insensible to the most powerful agents. The reverse takes iplace with respect to the motor fibres ; after dividing the trunk which has been laid bare, its peripheric extremity alonelretains the property of chawing cries from the animal, when excited, while the central part remains deprived of all] sensation. This extraordinary property of the motor fibres hp received the name of Recurrent Sensibility, and is generally attributed to certain sensitive fibres, which, bending back towards their primitive source, follow the track of the motor nerves, but in the opposite direction ; for as soon as the corresponding posterior root has been destroyed, all sensibility disappears in the motor fibres. Such is the contrivance (so to speak) which enables the motor nerves to borrow the properties of their congeners, and connect, in the morbid state, distint parts of the body with each other. It may be inquired, how the impressions transmitted by the sensitive nerves succeed in producing so extensivi a disorder as to superinduce anatomical injuries on various points; and physiological observations furnish us with the reply. Let the common carotid artery be laid bare in a dogj let a car- diometer be adapted to the vessel, and as soon as a sensitive nerve is excited, the rise of the liquid in the glass tube, and the sudden increase in the quickness of the pulse, sufficiently testify to the general influence exerted by the sensitive nerves over the whole system. Now let us suppose that (as in the case of local inflammation), a per- manent cause of excitement exists: a constant accelera* tion of the pulse will be the result, and fever, with all its ordinary consequences, will shortly make its appearance. [But in the case of sores and open wounds, an additional; source of irritation is found; you are of course aware that when exposed for a certain time to atmospheric action, a nerve swells, becomes hard and shining, and possesses during a certain lapse of time an exaggerated amount of sensibility. Such, no doubt, is the real cause of the excruciating pains which, in the course of certain diseases, assail tendons, insensible n wounds ir ; during ligaments, fibrous membranes, and other equally parts. A similar process no doubt takes place : recently laid open, and exposed to the contact of a the first few moments, the lips of the wound not having yet been modified by the unusual irritation brought to bear upon them, no increase of pain is felt, no febrile reaction takes place. But after a short space of time,—a few hot rs in some cases, a few minutes in others,—when the extremities of the divided nerves have grown irritable and tumefied, all the symptoms of a general disorder break forth at oncer ORIGINAL COMMUNICATIONS OX THE USE OE THE OPHTHALMOSCOPE AS A HELP TO DIAGNOSIS IN DISEASES OP THE NERVOUS SYSTEM. By JOHN OGLE, M.D. F.H.C.P. Assistant-Physician to St. George’s Hospital. Daily observations recorded in various periodicals, are Bin*. mS. this mstrument into 'well-merited notice, as a means of assistance in clinical research ; and as I have for some time been attempting to avail myself of its services in the inves1 i gation of certain disordered conditions of the brain (amon» v/ H°sP*tal Patios, and with the valuable aid of my friend Mi. Holmes), I read -with very considerable interest the remarks made in your Journal of May 26, pa*e 523 as to the use of this instrument by Mr. -Wordsworth, iil a case of Hemiplegia. Whether the instrument is destined to occupy any really high position (rendering in its way such services as does the stethoscope, for example) as respects our inqumes into disease which is not primarily that of the eve itselt, frequent and continued use thereof in a multitude of cases alone can show. It has, howrever, for some time appeared to me, that this may eventually be said of it; but I confess, that although my present experience is certainly such as to give encouragement to the above idea, yet I have hitherto been unable (doubtless it may be from inexperience and imperfect manipulation of the instrument) to obtain by its use such effective views of the interior chambers of the eye even in a natural condition, as I have seen picturesquely pourtrayed in various works devoted to ophthalmoscopic considerations. If it be, however, that extended experience clearly proves that the deeper vessels and structures of the eye can be with facility explored by this instrument, then we have, I think, fair and plausible grounds for anticipating that it may materially subserve the interests of Diagnosis in the case of disease of the nervous system. That the condition of the deeply-seated and delicate vessels of the eyeball may be, as it were, to a great extent (at least in some instances) a criterion of the state of the vessels of the brain structure may be with reason inferred from what we know of their anatomicalrelationship, their origin from the same arterial sources, and the innervation which for obvious physio- logical reasons, they enjoy in common •with each other. And that the condition of the extra-cranial vessels may be regarded as a fair index of intra-cranial ones under certain conditions, is patent from the ecchymosis of the vessels of the conjunctiva, or of the skin of the forehead and temple, -which is by no means infrequently witnessed after severe attacks of epilepsy, hooping-cough, or even as I have seen it, after pro- tracted vomiting ; in which cases, owing to violent muscular spasm, the return of blood from the inner parts of the bead has been delayed or prevented simultaneously with impedi- ment to its return from the face and outer parts of the head. Especially may we, I think, expect that a deranged condi- tion of the cerebral circulation may he, as it were, mirrored forth by the ascertained condition of the vessels and inner coats of the eye in those cases wherein this disorder is depen- dent upon disturbance of vaso-motor influence by reason of interference writh distant parts of the sympathetic nervous system. The probability of this view presented itself to my mind three or four years ago when considering the various cases to which I alluded in a paper upon the Influence of the Sympathetic on the Eye (a). I then suggested that most likely the giddiness, dimness of vision, deafness, and other such symptoms often coincident with intra-thoracic aneurisms and other tumours about the neck, chest, etc., are in many cases quite independent of any true cerebral change, but merely result from interference with sympathetic nerve influence to the intra-cranial capillaries. This supposition appeared highly feasible as well from clinical cases as from the results of accidental injuries and experimental operations upon the sympathetic system. Another instance of the relationship between intra and extra-cranial structures is afforded by the well-known con- nexion between a certain state of the cornea of the eye (known as arcus senilis) and certain conditions of the cerebral vessels. No doubt this state of the cornea also affords an insight into the condition of the general textures of the body, and the same may, no doubt, be said of tbe vessels of the choroid and retina, inasmuch as they have been found affected in certain cases of albuminuria (albuminous amau- rosis so called) in which, most likely, all the capillaries of the body, as well as the blood itself, are in a morbid condition. Nevertheless, that fact does not invalidate the supposition that from the deep-seated vessels of the eye, a knowledge of the cerebral ones may be gleaned, inasmuch as in many cases there seems no doubt that both these sets of vessels, as well as others in the body, are equally affected as part of a univer- sally morbid state of the vascular system. Knowing, then, how exposed to view the beautiful and minute vessels of the choroid and retina may become by means of tbe ophthalmoscope, how easily any escape of their contents might be apparent, — knowing, also, how prone the cerebral capillaries are, under certain circum- stances, to permit extravasations of blood, etc. to take place and bearing in mind the probability of the condition of the ophthalmic vessels being as it were a reflex of those within the cranium, I was led, as I before said, to seek the aid of the ophthalmoscope in cases of disorders of the nervous system, I will now proceed to adduce one or two cases (all of which are still under my care) in which, in accordance -with expecta-](https://iiif.wellcomecollection.org/image/b22435979_0004.jp2/full/800%2C/0/default.jpg)
