Ophthalmovascular choke / by George M. Gould.

  • Gould, George Milbrey, 1848-1922.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Ophthalmovascular choke / by George M. Gould. 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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    [ 1.06] opia, with return of normal acuteness, switching of axes, “ asthen- opia,” an alarming development of myopia, followed by a speedy recovery from it, etc. The headaches I had long been able to conquer, but not these other symptoms. In all such cases I have been habited to send for the patients to whom I had failed to give satisfaction in order to re-examine the refraction, to test for subnormal accommodation (this patient had it), to look for spinal curvature, secure urinalyses, etc. All of which in this case were resultless. So when I had got a clear idea of Ophthalmo- vascular Choke, I at once sent for this man. It took only a few minutes to find what I had so long overlooked—all the distinctive symptoms of the disease conjoined. The image faded out in three or four seconds with either eye or with both together; there was frequent constant closing, “ batting ” or “ blinking ” of the lids,— more decisively and longer held than in winking; rubbing of the eyes, “watering” of the same, photophobia, etc.; there wras in- ability to read or write but a very short time and that with discomfort and “ nervousness,” or tiring; and there was the necessity of constant movements of the book, etc. Another symptom was new and startlingly suggestive: if reading was forced the book was held to the right side, and finally so far, that the left eye could not see the page; only the nasal side of the right retina was then used, and the macula region was disused. A glance with the ophthalmoscope made it all clear,—there were the unmistakable proofs of vascular choking. The veins were highly distended, and overfilled with dark blood, and there was a long and labored venous pulsation in both eyes. The crossings over each other of the vessels, on and near the discs, and sharp bendings showed sufficiently numerous and severe obstructions to the flow of the venous blood, to account for the symptoms even without the venous pulses or retrobulbar choking. This patient’s circumstances were such that he could follow the advice to do no “ near-work,” at least for a while. I had not the heart to tell him of my belief that he would never be able to read much or any. These findings, taken as a whole, seem to me to constitute a new and clearly-defined type of ophthalmic disease; to throw a flood of light into the pathogenesis of many ocular diseases hitherto seemingly unrelated, and of unknown origin; to differentiate a source of eye-strain until now unsuspected; and to explain a large number of vague but still most real sys- temic “ nervous ” and mental disorders. As is well understood, the higher, more complex, more neurologic or cerebral the function the greater must be the supply of fresh blood, the more imperative the necessity for quick elimination of the venous blood. Slight denutrition is decidedly weakening, (ie)