A physician's notes on ophthalmology. 2nd series / by J. Hughlings Jackson.

  • Jackson, John Hughlings, 1834-1911.
Date:
[1875]
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Licence: Public Domain Mark

Credit: A physician's notes on ophthalmology. 2nd series / by J. Hughlings Jackson. 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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    look at their patient’s optic nerves until sight fails, and thus they overlook the early and remediable stages of neuritis. I believe that we should prevent amaurosis frequently if we always discovered the prse-amanrotic stage of optic neuritis and treated the affec- tion energetically. Those who wait until the patient’s sight begins to fail, may err in taking as an early what is really a late stage of optic neuritis. So far as I know there is but one kind of optic neuritis from intracranial tumour (and other adventitious pro- ducts). The opthalmoscopical appearances vary extremely according to stage. Making conveniently, although arbitrarily, four stages, sight commonly fails in the third stage—a stage which is, I believe, by some called the “ swollen disc.”* The uppermost drawing shows that in speaking of optic neuritis with good sight one does not mean a mere slight change such as might be vaguely called “ congestion.” The more one uses the ophthalmoscope the less confidently one speaks of “ con- gestion,” and “ anaemia.” Sight may be quite good when the disc is very much swollen (and so much altered that there is really no true disc discoverable), when the arteries are scarcely trace- able in the swollen ci-devant disc, when the veins, which are dark and partly concealed, give clear evidence of swelling by knuckling over the edge of the diseased patch: there may be scattered blotches of blood. Those who do not look at the optic discs unless there be failure of sight will not only overlook the earlier stages of optic neuritis, they may overlook it altogether. For sight may not fail. I have seen not a few cases in which sight did not fail.f * I may here refer to a lecture on “ Optic Neuritis from Intracranial Disease” 'which I published in the “ Medical Times and Gazette,” August 26, 1871. The following extract from that lecture refers to stages:— “ 4. The Stages of Optic Neuritis.—I now tell you what you see in cases of optic neuritis at different stages. In the sense that there are abrupt differences, there are no stages; there are gradual changes from the beginning of the process through its ascent to a climax of acute change, and in its de- scent to the permanent change—atrophy. Nevertheless, although the changes are gradual, the appearances are strikingly different at different times, and most unlike at the two extremes—the height of acute change and permanent atrophy. We will make four stages. You will have gathered from what I have just said that this division into four is arbitrary. I used to make two stages only. It is, I think, convenient to make four, for learners, at all events. The following is an account of what is seen at different stages of a severe case. I use the expression ‘ severe ’ advisedly, as cases vary so much in degree and progress that I do not pretend to be able to describe ‘ typical ’ eases. Particularly observe that cases do not always run through these stages. There may be retrocession from either the first or the second stage, and not a progress to atrophy. I speak of what you may see by the indirect method of examination.” + I have recorded a ease showing this strikingly in the “ Medical Times and Gazette,” Dee. 7, 1872. A resume of the chief points of it is given in the “ Roy. Lond. Ophth. Hosp. Rep.,” vol. vii, part iv, Feb., 1873, p. 518, in section 4, “ Recovery from Optic Neuritis.”