The ophthalmoscope : its varieties and its use / translated from the German of Dr. Adolf Zander by Robert Brudenell Carter ... with notes and additions by the translator.

Adolf Zander

Date:: 1864

Credit: The ophthalmoscope : its varieties and its use / translated from the German of Dr. Adolf Zander by Robert Brudenell Carter ... with notes and additions by the translator. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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$these operations have not been very brilliant; and such procedures could only be attempted with propriety by an ophthalmic surgeon of great exjierience. Dr. Licbreich has extracted a cysticercus, by means of canula forceps, through a scleral incision, aided by an ophthalmoscope fixed to his head, so that he was able to illuminate, and observe, both the parasite and the instrument. He mentions that the base of the neck of the parasite, which is less transparent than the rest of its stmctui-e, and ia dotted with fine white calcareous pai-ticles, is the part that is most resistent, and that affoi'ds the most secure hold to the forceps. Sclerectasia Posterior is a disease that may be chosen to illustrate the general management required by chronic ocular inflammation. Its treatment has been very well described by Mr. Soelberg Wells, in his treatise on Long, Short, and Weak Sight; and the description may be summed up as embracing rest, protection from strong light, and from the red and yellow rays of the spectrum, by means of blue spectacles, depletion, derivatives, improvement of the general health, the use of the eye douche, general tonics, corrosive sublimate, and iodide of potassium. To this I may add, that the action of the internal recti seems to increase the protrasion of sclerectasia; and that it is therefore often desirable to provide the patients with Aveak prismatic spectacles, the bases of the prisms being tui'ued towards the nose. Such glasses render pencils of light less divergent, and hence diminish the con- vergence of the eyes that would otherwise be reqm-ed in order to direct both oi^tic axes upon a near object. Opacities of ilie Vitreous Body, when recent and diffuse, are usually inflamma- tory, and may require mercurial treatment; membranous opacities are visually the results of former inflammation; and flocculent opacities, when not the remains of blood clots, are mostly dependent uj^on impaired nutrition. Ann L., aged 2-i, domestic servant, consulted me on the 26tli of October, 1863. She was a well-formed young woman, somewhat anoemic, with light hair and blue iridcs; and she stated that she had become suddenly blind of her right eye on the day before. The same eye had been bad two years previously; and she had been two months under medical treatment, but the sight had never been entirely restored. To external appearance, both eyes were perfectly healthy. The vision of the left eye was perfect, but that of the right eye was limited to qualitative perception of light. Ophthalmoscopic examination showed that the vitreous body of the right eye was tiniversally tui-bid. It presented the appearance of a white fog, through which no trace of the papilla or the retinal vessels was discernible. The patient was ordered to rest the eyes, and to take gr. j of blue pill, with gr. \ of opium, every night and morning; and gr. iv. of ammonio-citrate of iron, with gr. V. of iodide of potassium, and gr. ijss. of chlorate of potash, three times a day, after meals, in half a. tumbler of barley water. Fo\ir days later, she reported slight improvement; with some trouble, she could decipher No. 200 of Snellen's test types. Four days later still, her gums showed a mercurial line, and she could read No. 50 with facility. The vitreous humour had cleared sufficiently to allow details of the fundus to be obscurely seen ; and it became manifest that the outline of the ]:)apilla was iiTcgular. The mercurial pill was ordered to be taken at night only, and the mixture to be continued. By the end of the following week, the vitreous humour was perfectly cleai-, and the patient could read No. 2. No further improvement was obtained ; and the irre- gular appearance of the papDla was found to be due to a patch of choroidal atrophy, probably the result of the disease two years before. The patient said that her sight was quite as good as before the last attack. Membranous opacities, left behind by inflammation, are not only in themselves impediments to \'ision, but they involve danger of producing, by their contraction, separation of the retina. Yon Grafe records a case of extensive membranous opacity, in which the patient,$