On the cerebro-spinal origin and the diagnosis of the protrusion of the eyeballs termed anaemic / by Thomas Laycock.

  • Laycock, Thomas, 1812-1876.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On the cerebro-spinal origin and the diagnosis of the protrusion of the eyeballs termed anaemic / by Thomas Laycock. 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.

    16/20 (page 694)
    Sources of Fallacy in Diagnosis.—It is probable, however, that in a certain class of cases both kinds of nerves are involved, and then the diagnosis will be doubtful. For, when this takes place, there will probably be a remarkable modification of the phenomena as caused by either singly. If, for example, congestion, a lower temperature, defective nutrition, and other changes, have occurred in the eye from injury of the fifth nerve, a lesion of the cervical sympathetic will relieve the congestion and restore the temperature, or, in other words, will antagonize the morbid influence. Claude Bernard found that the temperature of the left ear of a dog fell 3° C. below the right ear after division of the fifth on the left side; but, when he divided the left cervical sympathetic, the temperature of the left ear rose 6° C., while that of the right fell 6° C.1 If, therefore, a case were met with in which both kinds of nerves were involved, the pathognomonic signs of neither the one nor the other class of lesions would be manifested, and thus the singular result would follow of serious nerve-injuries so antagonizing each other as to remain totally obscured. Another source of fallacy in cases of centric origin will be found in a physiological fact almost wholly, if not altogether, overlooked by physiologists, but which I have seen so often illustrated by disease, that I am satisfied it is of frequent occurrence, and that is the crossed action of the sympathetic nerves and ganglia, owing to decussation of their fibrils and com- missures in the cerebro-spinal centres.2 I have seen remarkable examples of this crossed action in anasarca; as, for example, in a woman in the clinical wards in November 1861, who had valvular disease and the most extreme oedema of the extremities. She had an attack of hemiplegia of the left side, which was due, as the post-mortem examination proved, to plugging of the right middle cerebral artery. Now, there was increased oedema of the right or non-paralyzed leg and arm, but the left leg, which was wholly useless, ceased to be anasarcous, and became quite small. Here the injury to the right hemisphere plainly led to the change in the left limb. To what extent these central changes in the vaso-motor system influence the states of the circulation in distant parts is as yet wholly uninvestigated, but I am inclined to think they modify the production of exophthalmos and the vascular changes in at least certain cases of general paralysis. Ptosis or Droojnng Eyelid.—The condition of the eyelid, as dis- tinct from that of the eyeball, is of importance in diagnosis; there may be a staring eye without a protruding globe. Now, taking the results of Professor Claude Bernard’s experiments as a guide, I think it may be inferred that the drooping or partially closed eye- lids may be as pathognomonic as the widely open; nay, perhaps more conclusive, inasmuch as paralysis of the cervical sympathetic is much more likely to occur as a morbid state than that half- 1 Lemons, etc., tom. ii. pp. 480-482. 2 bee this question mooted in my “Mind and Brain,” vol. ii. pp. 400and 405.