A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese.
- Samuel Cooper
- Date:
- 1844
Licence: Public Domain Mark
Credit: A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese. Source: Wellcome Collection.
Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.
48/1188
![33 but the adoption of some empirical method of treat- ment ; but, exclaims Beer, wo to the patient whose surgeon, under these circumstances, draws from a heap of what are considered remedies for amaurosis, as from a lottery, the lirst as the best! In order to avoid this erroneous method, and not render a haff-bllnd person completely blind, instead of improving, or at least preserving, whatever remnant of vision there may be, the surgeon should act with great caution, and constantly bear in his mind, first, the con- stitution, sex, and age of the patient; secondly, his ordinary employments, and general mode of living; and thirdly, the principal morbid appearances under which the amaurosis originated and was developed.— (Beer, Lehre von den Augenkr. b. 2, p. 4G2.J But the desired benefit, even when foiiowed up as far as the pulse and strength will allow Here the continu- ance of the disease may depend either upon the stop- page of some wonted evacuation.of blood, or else upon some other cause of the first class. In the first of these cases (says Richter) experience proves, that the disease will sometimes not give way before the accus- tomed discharge is re-established. A woman, who (as this author acquaints us) had lost her sight in conse- quence of a sudden suppression of the menses, did not recover it again till three months after the return of the menstrual discharge, notwithstanding the trial of every sort of evacuation. He also tells us of another woman, who had been blind half a year, and did not menstruate, and to whose external parts of generation what will be the greatest assistance is a correct leeches were several times applied. As often as the acquaintance with the remedies for amaurosis in leeches were put on (says Richter) the menses in nart general, and the circurristances under which the use of tliis or that particular means is likely to be useful or detrimental. I know of no writer who has been so minute on this part of the subject as Beer, whose sen^ timents ibe it also remarked) are here in many respects different -from those of Richter and Scarpa; for, like the surgeons of this metropolis, he rarely employs the emetic plan of treatment, which, according to his prin- ciples, is not only ineffectual, but hurtful, whenever the blindness is attended with determination of blood to the head and eyes, plethora, an accelerated circula- tion, or , what is understood by) a phlogistic diathesis. Beer's opinions, respecting the employment of emetics and other means for the cure of amaurosis, may be partly collected from the sequel of this article, but more especially from the fuller statement which will be made at a future opportunity.—(See Gutta Serena.) In the mean time, I shall endeavour to offer a general account of the practice recommended by Schmdcker, Richter, Scarpa, Travers, and Lawrence, according to the arrangement of causes adopted by the second of these valuable writers; for I need not repeat, that whenever the method of cure can be directed against the causes of the disease, it is the most proper and sci- entific. The present article will, then, close with some practical observations, chiefly taken from Professor Beer. In that species of amaurosis, which arises from the first class of causes, or those which induce the disease, by means of a preternatural fulness and dilatation of the blood-vessels of the brain or eye, the indication is to lessen the quantity of blood, and the determination of it to the head. For this purpose, the patient may be bled in the arm, temporal artery, or, as is often pre- ferred by foreign surgeons, in the foot. This evacua- tion is to be repeated as often as seems necessary, and it will be better to begin with taking away from twelve to sixteen ounces. The efficacy of bleeding, in the cure of particular cases of gutta serena, is strikingly exemplified by numerous well-authenticated obser- vations. Richter informs us of a woman, who, on leaving off having children, lost her sight; but reco- vered it again by being only once bled in the foot. A spontaneous hemorrhage from the nose also cured a young woman, who had been blind for several weeks. —(Anfangsgr. der Wundarzn. b. 3, p. 442.) That bleeding is sometimes hurtfully and wrongly practised in amaurotic cases, is a fact which admits of no doubt. Mr. Travers particularly refers to one descrip- tion of cases where the lancet does harm: these are cases of undue determination of blood to the organ, which are especially common after deep-seated chronic inflammation or distress from over-excitement,by which its vessels have lost their tone; an effect decidedly in- creased by depletion. In one interesting case of this kind, a-gradual but perfect recovery followed a regu- lated diet, and a course of the blue pill, with saline aperients.—(Synopsis, p. 159.') AH cases of direct de- bility and proper paralysis of the retina (says Mr. Tra- vers, are aggravated by loss of blood, and the great prevailing mistake in the treatment of amaurosis, is the indiscriminate detraction of blood.—.Synopsis, d. 303.) ' When, in addition to general bleeding, topical is also necessary, leeches may be applied to the temples, or cupping-glasses to the back of the neck, or temples. Besides bleeding, purgatives, blisters, bathing the feet in warm water, low diet, repose of the organs, &c. are frequently proper. recommenced: and as long as they made their ap- pearance, which was seldom above two hours, the wo- man always enjoyed a degree of vision.—(Anfangsgr. der Wundarzn. b. 3, p. 443.) For the amaurosis arising from suppression of the menses, Scarpa recommends leeches to the pudenda, bathing the feet in warm water, and afterward exhi- biting an emetic, and laxative pills, made of rhubarb and tartrate of antimony, combined with gummy and saponaceous substances. If these means fail in esta- blishing the menstrual discharge, he says, great confi- dence may be placed in a stream of electricity, con- ducted from the loins across the pelvis, in every direc- tion, and thence repeatedly to the thighs and feet. He enjoins us not to despair at want of success at first, as the plan frequently succeeds after a trial of several weeks. For the amaurosis proceeding from the stoppage of an habitual copious bleeding from piles, Scarpa recom- mends leeches and fomentations to the hemorrhoidal veins, then an emetic, and afterward the same opening pills.— Osservazioni sulle principali Malattie deglt Occhi, cap. 19.) When the disease does not originate from the stop ; page of any natural or habitual discharge of blood, and does not yield to the evacuating plan, Richter thinks the surgeon justified in concluding, that the preterna turally dilated vessels have not regained their proper tone and diameter, and that topical corroborant reme- dies, particularly Cold water, ought to be employed. In this kind of case, he is an advocate for washing and bathing the whole head with cold water, especially the part about the eyes; a method, he says, which may often be practised after evacuations, with singular and remarkable efficacy. When the return of sight cannot be brought abcut in this manner, Richter advises us to try such means as seem calculated to stimulate the nerves, and remove the torpid affection of the optic nerves in particular. Of these last remedies, says he, emetics are the princi- pal and most effectual. The principle on which Mr. Lawrence directs the treatment, is that of putting a stop to vasciUar excite- ment, with the view of preventing the permanent in- jury of altered structure, and impaired function of the retina. Hence he is a zealous advocate for the anti- phlogistic treatment, in the early stage of amaurosis. '• But, says he, if this treatment be not found to remove the change which has been produced in the re- tina, we must have recourse to mercury, which appears to be as decidedly beneficial in these cases as in iritis, or general internal inflammation. The remark which I made respecting the use of mercury in those affec- tions, applies also to the present case; namely, that its good effect mainly depends upon the promptitude with which it is employed. The alterative form is in- sufficient ; we give it with the view of arresting in- flammation in the structure, which is the very seat of vision; that structure is easily changed by the inflam- matory process; our only remedy is to push the mer- cury in a decided manner, and if we do so, we shall put a stop to the affection. When the antiphlogistic treatment and a fair trial of mercury have failed, Mr. Lawrence contents himself with recommending such management as is most conducive to general health • as a residence and frequent exercise m a pure air' plain nutritious diet; mild aperients, with the occa- i sional use of an active purgative; and repose of the affected organ. He mentions also a trial of a seton nr I.i so::u' ffases, the foregoing means fail in producing ] repeated blisters behind the ears, or at the site or back C2](https://iiif.wellcomecollection.org/image/b2103719x_0048.jp2/full/800%2C/0/default.jpg)
