Ophthalmic Hospital reports, and Journal of the Royal London Ophthalmic Hospital. No. XI. April, 1860.

  • Moorfields Eye Hospital
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmic Hospital reports, and Journal of the Royal London Ophthalmic Hospital. No. XI. April, 1860. 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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    The case was in appearance one of those called c< amaurosis with excavation of the optic nerve/’ Michael Giles, able seaman, aged 30, came to me at Moorfields, on March 19th, 1860, complaining of his left eye, in which his vision was so much impaired, that, although he said it did not trouble him himself, as his right eye was sound, the captain of his vessel had discovered it and com- plained of him because sometimes, in a dim light, he could not well see the compass at the binnacle. In the left eye there was a nebula, but only near the inner and lower margin of the cornea; the iris was tremulous; the pupil was circular, of fair size or rather large, responding tolerably to the influence of light; there was no external evidence of inflammation past or present; the globe was of about normal tension: he could only tell fingers or other large objects held near it. The right eye appeared altogether healthy, and with it he could see well at average distances. His history was, that his sight in either eye was quite perfect until six months previously when he had received a violent blow of a shovel on the temporal side of the left orbit; he was stunned and taken to the London Hospital: he had not his right senses, was blistered, and took pills : he had great pain in the head and eye, the latter was very painful, and afterwards very sensitive to light, however he soon left the hospital quite well, excepting occasional headaches which he did not lose for some Aveeks afterwards, and but for indistinctness of vision, of the left eye only, he thought he had quite recovered. He went back to sea for tAAfo months, again for about the same length of time, and made a third voyage of six Aveeks, after Avliich he came to the hospital for the reason I haATe mentioned : he had not remarked that in either voyage his sight had become much worse : he had had no pain and did not seem to be in any trouble about it. Sometimes, especially in the evenings, he had seen “ like sparks,” or a “ cloud ” passing over the eye for a few minutes together. I put atropine to both eyes : the right eye presented nothing noteworthy, but a slight congestion of the entrance of the optic nerve : the left shotved a very deep cup (Plate XT, X, Y, Z) Avith tAvo veins (X, Z) passing out, and one artery passing in by it; the pulse could be detected in the latter by a close examination ; the vessels dipped over the edge and curved doAvn the sides of the cup with a perspective appearance : slight pressure on the globe stopped the circulation in the veins. There Avere two marks, like separations or ruptures of the choroid, showing through them the sclerotic belotv (above) the entrance of the optic nerve: one close to it (a.b.) having a curve corre- sponding to about a quarter of a circle of which the optic nerve was the centre, and another also curved to the same centre but more remote from it, nearer the yelloAv spot, and of less extent. Pulsation being visible and all the vessels somewhat pressed against the margin of the optic nerve, I admitted the patient thinking to perform iri- dectomy. He had the full diet of the hospital, and, of course, complete rest besides belladonna used for the ophthalmoscopic examinations, and before I did the operation the pulsation Avas no longer visible Avithout pressure exerted on the globe, and vision in this eye had improved so that (especially as the indications were never very promising) I did not operate, the patient being contented, and he left the hospital to go to sea again, although I had advised him to engage in some other employment. He never alloAved that at sea he had been Avorkcd very hard, or had lived badly. First—of the illusion.—It is well known that, when a collecting lens is used with the perforated mirror, for an t 2
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