A manual and atlas of medical ophthalmoscopy / by W.R. Gowers.

Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    bounding the blood column, and any white connective tissue which smTOunds them at the point of emergence is also un- duly conspicuous (PI. I. 2). The appearance is suggestive of the white tissue being a pathological result of the hyper- aemia. It is probable that it is, so, but it is too common as a physiological condition for its presence to have much value. Its distinctness possesses a little significance, as due to the invasion of the middle of the disc by the hypersemia. Occasionally, when the hyperaemia of the disc is the expres- sion of graver changes behind the eye, the vessels may be narrowed in consequence of retro-ocular pressure. The condition thus described as simple congestion of the disc is usually a chronic state, and corresponds, probably, to the condition which has been described by Dr. Chfford Allbutt as chronic neuritis. The evidence that there is actual inflammation does not seem sufficient to warrant the application to this state of the term neuritis, especially as there are forms of true neuritis characterized by extreme chronicity. It is rare, I think, that such simple hypersemia is the first stage of an actual neuritis. In the latter, swelling comes on pari passu with the hypersemia—i.e., congestion with oedema, rather than simple congestion, is the first stage of neuritis. The simple congestion is seen as a substantive condition in many cases, commonly preceding atrophy. It is sometimes the expression of a state of congestion and degeneration in the whole optic nerve, but is sometimes apparently limited to the optic disc. It may occur as a consequence of injuries, blows, &c., in the neighbom-hood of the eye, and may constitute the fixst stage of the condition described by Mr. Hutchinson as tobacco amaurosis. It occurs also, probably, from other toxic agents, as lead. It has been observed by Dr. Allbutt in general paralysis of the insane ; and, although some other observers have failed to find it, one case imder my observation presented it very distinctly. It has also been desciibed by Dr. Allbutt as accompanying atrophy in locomotor ataxy ; but in that disease, although often looked for, it has not been found by others or by myself. It is sometimes present in cases in which there is