Some recent theories regarding the pathogeny of sympathetic ophthalmia, viewed from a macroscopic standpoint / by Samuel Theobald.

  • Theobald, Samuel, 1846-1930.
Date:
[1884]
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Licence: Public Domain Mark

Credit: Some recent theories regarding the pathogeny of sympathetic ophthalmia, viewed from a macroscopic standpoint / by Samuel Theobald. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    respect, that they declare themselves by abnormal tissue change instead of by abnormal sensation.1 And, lastly, I would point out to them, that though the pathologists of the Cohnheim school contend that the reflex congestion which follows stimulation of sensory nerves is not inflammation, and does not lead directly to it, they admit that when this condition has existed for some time (as in the premonitory stage of sympathetic ophthalmia) it places the cells of the part in a condition of instability, lowers the vitality of the capillary walls, and offers facilities for the emigration of leucocytes ; so that at any moment, upon the slightest prov- ocation, (in the case of the eye, for example, from the irritation caused by overwork or undue exposure to light2) inflammatory changes may be precipitated.3 So that, after all, they may accept the Cohnheim doctrine in its entirety, and at the same time, without being illogical, they may believe what clinical evidence so plainly declares—that sympathetic ophthalmitis is dependent, if not directly, at least secondarily, upon a reflex influence transmitted through the ciliary nerves. Briefly summarized the conclusions which seem to me to be warranted by the facts we have examined are : 1st. That the doctrine that sympathetic ophthalmia is the result of a progressive optic neuritis, which spreads from the primarily to the secondarily affected eye, is supported by no facts worthy of serious consideration, but is the out- 1'' Diseases of the Eye, Am. edition, p. 113. Also compare Noyes : '' Diseases of trie Eye, p. 190 ; and see an interesting article in the Am. Journal Med. Sciences, July, 1881, by Dr. Jas. L. Minor : Anaesthesia of the Cornea, and its Significance in Certain Forms of Eye Disease, in which he makes the sig- nificant statement that ancesthesia of the cornea existed in six [of his] cases without keratitis; and in those cases that presented both ancesthesia and inflammation, complete protection of the eye did not materially alter the course of the disease. 2 Brailey (Trans. London Med. Congress, 1881, vol. iii., p. 38) mentions that sympathetic inflammation frequently occurs shortly after patients leave the hospital ; and he attributes this to the exposure of the second eye to light. He also states that the records of Moorfield's Hospital show that a wound occurring in the summer months is more liable than one in the winter to be followed by sympathetic disease and that sympathetic inflammation is more jikely to break out in summer, irrespective of the time when the first eye was jnjured. 8 See the very interesting (Bradshaw) lecture on The Influence of the Sympa- thetic on Disease, by Dr. Edward Long Fox, British Med. Journal, Aug. 26, Sep. 2, 1882.