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

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1890
Catalogue details

Licence: Public Domain Mark

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

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    regarding some points wliicli are of special importance may be of service. A first requisite in medical ophthalmoscopy is familiarity with the direct method of examination. The disc is then seen magnified many times; and this method may show minute changes of the highest significance, which cannot otherwise be detected, or the true nature of appearances which, seen by the indirect method, are obscure. But both methods should always be employed. Not only has each its special advantage, but the two together often give information which neither alone affords. A-nother requisite is skill in the examination without dilatation of the pupil. In most eyes much can be seen with the pupil undilated—often all that is necessary, and ahnost always enough to determine whether or not there is more to be learned by dilatation. The coincident paralysis of accommodation is a source of annoyance, and is especially resented by patients when there is no disease of the eye itself. If the sight has not been previously affected, it often happens that in brain diseases there is a subsequent failure of sight, due to changes, nemitis, atrophy, &c., which after- wards progressed. The failure of sight in such cases is often ascribed by the patient, not unnaturally, to the effect of the mydi^atic.i -pov the same reasons one pupil only should be dilated at a time, unless the sight of both eyes is already impaired. If it is a matter of indifference which is chosen, an eye, the sight of which is impaired, should be chosen in preference to the other. These disadvantages have been lessened by the use of other mycbiatics than atropine, or by using eserine when the examination is over, to contract the dilated pupil. Homatropine, however, has largely superseded atropine as a dilator, since the paralysis of accommodation passes off in a few hours, and the 1 u If nse the ophthalmoscope, or if we use atropine, or J/;^^^ ^ , -u A n,1nnt anv new kind of treatment, the patient may Mister to the ^ea , J -^op new ^^^^^^ ^ ■blame us for his ^^^n^ J ^ ^s his sight to be good, may have