Remarks on the routine use of the ophthalmoscope in cerebral disease / by J. Hughlings Jackson.

  • Jackson, J. Hughlings (John Hughlings), 1835-1911.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the routine use of the ophthalmoscope in cerebral disease / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ant stage of the case, the third symptom (optic neuritis), ■as I have said, would not exist for those who do not use the ophthalmoscope by routine. Without it the diagnosis would have been erroneous. It is true that from mry severe headache and vomiting we may grwess intra-cranial tumour, but who would ever guess it in a perfectly healthy-look- ing blooming girl, who was in good flesh, and occasionally apparently absolutely well. This indeed, is the heazt-ideal of a case to be mistaken early in its course for disease of the liver. How often do we hear of amaurosis caused by bilious fever ? To encourage such a mistake was the fact that the girl had always been subject to bilious attacks. Another mistake would be hysteria. Neither of these mistakes could be made in such a case if the patient's optic discs were looked at. We did look at them, and from what we saw we were absolutely certain that there was intra-cranial disease, and we predicted tumour. But we may overlook the neuritis altogether. The patient may die of intra-cranial disease before his sight begins to fail, or the neuritis may pass off, leaving sight quite good. It is obviously a serious matter to overlook so striking a pathological condition. In cases of loss of speech (aphasia), there may occasionally be discovered severe optic neuritis when there is nothing in the patient's bearing to suggest that his sight is defective. In young children it is absolutely necessary to use the ophthalmoscope when they suffer from severe cerebral dis- ease. We occasionally discover optic neuritis in a child whose parents have never noticed anything the matter with his sight. In cases of acute cerebral disease, the patient may be too ill to take any notice of our attempts to test his sight. Here, again, we must use the ophthalmoscope.