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.

  • Cooper, Samuel, 1780-1848.
Date:
1844
Catalogue details

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.

    51/1188
    before he makes up his mind about any empirical method of treatment, because he will there find many cautions and instructions given by Beer, respecting the remedies for amaurosis in general. To his remarks, I have also annexed such others, on the same topic, as appeared to me interesting. Cat-eye amaurosis. This species of the disorder, of which Beer met with but one form, rarely increases to complete blindness; it occurs chiefly in very old persons, and it is perhaps this affection to which some oculists have given the unmeaning name of amblyopia senilis. Sometimes, however, this kind of amaurosis takes place in young persons and children : and one circumstance that de- mands particular notice in its nosology is, that it al- ways takes place either in thin, dwindled, old, gray- headed subjects, nearly in the state of marasmus senilis, in whom consequently the exchange of organic matter is carried on but tardily, or else in young subjects, who are unhealthy, and disposed to consumption, hectical adults, emaciated children, and as a consequence of severe injuries of the eye. While this amaurosis is not perfectly formed, the iris retains its mobility, and the pupil is neither preternaturally dilated nor con- tracted ; but when once the patient is quite bereft of vision, the motions of the iris are slow, and the pupil larger than in a healthy eye in an equal degree of light. At the bottom of the eye, very far behind the pupil, a concave pale-gray, bright-yellowish, or variegated red- dish opacity is developed. By this the eyesight is not merely weakened, but rendered quite confused, since all objects, but especially smallish ones, appear to be confounded together, particularly when the patient tries to inspect closely any determinate body. The far- ther the disease advances, the brighter and more visible is the bottom of the eye, the paler is the colour of the iris (a thing very conspicuous in dark-eyed persons); and when once the amaurosis is complete, so that no susceptibility of the impression of light is left, then, upon an attentive examination of the eye, one can mostly perceive, at the troubled deeper part of the eye, a very slender vascular plexus, which merely consists of the ordinary ramifications of the central artery and vein, which are now visible at the pale-coloured bot- tom of the eye. In a half-darkened place, such an eye presents a shining yellowish or reddish appearance, but only in certain positions of the eyeball; and, in this respect, it is somewhat similar to the eye of a cat, whence Beer chooses to term the complaint cat-eye amaurosis. The disorder is also not accompanied with any other essential morbid appearances, except the dc- ' cline of vision or complete blindness.—>Lehre von den Augenkr. b. 2, p. 496.) Beer, in fig. 1, tab. 4 of his second vol.. has given from nature an admirable repre- sentation of this very remarkable species of amaurosis. The differences in the appearances at the bottom of the eye, in this case, from those presented in the early stag3 of fungus hasmatodes of that organ, will be best understood by referring to the article Fungus Heema- todes. On this point, however, I may here briefly state, that in the cat-eye amaurosis, there is no projec- tion, but, on the contrary, a concave depression in the axis of vision. Cat-eye amaurosis may be known from incipient cataract, by the opacity being more deeply situated, and having a shining, pearly lustre — (See Journ. of Foreign Med. vol. 4, p. 168.) Beer observes that the causes of this species of amau- rosis are so obscure, that whatever is offered upon the subject can be received only as conjecture. After what has been said in the foregoing paragraph is considered, about the particular individuals who are liable to be affected, and the change of the iris to a pale colour, as a constant symptom of this case, a suspicion may be entertained that a deficiency of the pigmentum nigrum and of the tapetum of the uvea, in consequence of the stoppage of this secretion, may be the cause of the dis- ease Beer justly remarks that mucn might be learned on this point from the dissection of eyes thus affected; but he has never met with the opportunity The prognosis cannot but be very unfavourable for as ,'he surgeon is ignorant of causes, he cannot know tat nSourtt to be adopted for their removal. It Is fortunate, however, that this amaurosis rarely attains i s highest degree, but almost constantly remains in the form of a mor°e or less considerable ambly opia Just as little is yet known respecting any well-regu- lated mode of treatment; but the disease may some- times be kept from getting worse by the careful em- ployment of such general remedies, regimen, ana met, as are calculated to improve the health. However, in the most fortunately managed cases, Beer never knew a step made towards the removal of the disease. (Lehre von den Augenkr. b. 2, p. 497, 498.) Amaurosis produced by bitters, certain articles of food in particular constitutions, or the poison of load. The reality of the first alleged cause is sometimes doubted in this country. The following treatment is recommended byJieer. In the first stage he advises gentle antiphlogistic means. When plethora exists, a few ounces of blood may be taken away by venesection or leeches applied behind the ears, when after bleeding a determination ofblood to the head and eyes still continues in full habits, or there is any tendency to inflamma- tion. The same topical bleeding without venesection, but with lukewarm pediluvia, containing salt or mus- tard, is proper when no general plethora exists; and merely a determination of blood to the head and eyes and some acceleration of the circulation prevail. Inter- nally, lemon-juice or the liquor ammonia? acet. has ex- cellent effects; and externally, poultices composed of bread-crumb and vinegar, or fomentations containing oxycrat, are the means which Beer has found most suc- cessful in the first stage of this form of amaurosis. As in the first stage, a moderate antiphlogistic gene- ral or local treatment is the only one which can be adopted, and which in urgent cases may yet save ihe patient from blindness, so in the second stage the in- ternal and external employment of fluid stimulants is of great service; for example, naphtha combined with camphor inwardly, liniments to the eyebrow, and the vapours of ether to the eye. The amaurosis produced altogether by the poison of lead, and complicated with lead-colic and ileus, will require, in addition to the fore- going means, such remedies as are Known to be of service in these latter disorders.—(Beer, Lehre von den Augenkr. b. 2, p. 499—503.) Symptomatic amaurosis in individuals affected with hysteria, hypochondriasis, epilepsy, and convulsions. This amaurosis is rarely permanent, and usually subsides as soon as the spasmodic, epileptic, or convul- sive attack is over. However, the complaint may be- gin at two periods, viz. either during such an attack, or (what is more uncommon) afterward, and it never loses its symptomatic character. The pupil always remains perfectly clear, and of a shining blackness, even when the disease has induced entire blindness; but a slight dull pain in the forehead, especially about the eyebrow, constantly preceding and accompanying the blindness, generally lasts a good while after the amaurosis has completely subsided. Besides the foregoing general symptoms, the follow- ing characteristic appearances present themselves in hysterical and hypochondriacal patients, who suffer frequent attacks of violent spasm. The pupil is much dilated, and the iris, wliich is immoveable, seems evi- dently to project in a convexity forwards, when the eye is inspected sidewise; consequently, the anterior chamber is lessened. The eye itself does not move freely in its socket, the patient experiencing an annoy- ing and sometimes a truly painful sensation, as if the eyeball were forcibly compressed (Ophthalmodynia). Every attempt which the patient himself makes to move the eye, or the surgeon to push it out of the position which it has assumed, is unavailing and excessively painful. The eyelids arc either painfully shut, or in- capable of being shut at all; the eyesight is very weak,' but seldom quite impeded; and at the termination of each attack vision returns, though every paroxysm leaves it more and more debilitated, until at length the spasmodic attacks of blindness frequently occurring, and lasting a long while, it is entirely lost. But when the disorder has acquired its utmost degree, the eye always still retains the power of discerning the light, and it seldom happens that vision is abolished by the first or second attack. It is different with respect to the characteristic phenomena of this amaurosis, in hysterical or hypochondriacal patients, especially when often affected with spasms, before, during, or after which the impairment of sight originates ; for though the pupil may continue quite clear, it cannot escape the notice of an attentive observer, that, together with a