On retinal embolism : with two cases in which a normal standard of central visual acuity was retained / by C. O. Hawthorne.

  • Hawthorne, C. O. (Charles Oliver), 1858-1949.
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: On retinal embolism : with two cases in which a normal standard of central visual acuity was retained / by C. O. Hawthorne. Source: Wellcome Collection.

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

    7/12 (page 3)
    be made to apply as readily to an embolus as to a thrombus, as the cause of obstruction of the retinal artery in a patient free from all evidences of cardiac and vascular disease. Granted this, it may be asked whether any cause for such primary thrombosis can be suggested. Now the examination of the patient reveals no sign of disease other than an anaemia of the chlorotic type. But, although perhaps not very frequent, thrombosis is a recognised complication of chlorosis. Occurring mostly in the veins, or in the intracranial venous sinuses, it does sometimes happen in the arteries. There can thus be little hesitation in admitting that it may also be possible in the chambers of the heart. But a thrombus formed in the heart may be detached, and, if swept from the left auricle or ventricle, may be carried, for example, into the central artery of the retina. Hence there is no reason why a block m this artery, occurring in association with anaemia, should not be due to embolism. In the absence of endarteritis, the block must mean either embolism or thrombosis. And, on the whole, it is perhaps easier to believe that anaemia, with a resulting measure of cardiac dilatation, should give rise to an intra-cardiac thrombosis, than that it should produce an arterial thrombosis apart from primary disease of the vessel wall. In a previous paper,^ two cases, exactly similar in this respect to Case II. (p. 8), have been reported, and whichever of the two views stated above may be accepted, it is manifest that, among the thrombotic possibilities of anaemia, must be reckoned the occurrence of obstruction of the central artery of the retina, with the clinical consequences associated with the diagnosis of retinal embohsm. In the individual case now under discussion (Case II.), the description of the onset of the visual loss, though far from conclusive, may be said to favour thrombosis in situ rather than embolism. This com- ment, however, does not touch, or at least is less appropriate to, the previous records, and, in any event, it must be judged together with the general rebutting evidence already related. Hence the balance of evidence, though allowing some room for uncertainty, seems to favour the diagnosis of embolism, and it is certain that, for ordinary clinical classification, the present case exactly accommodates itself to that diagnosis. ' The Practitionbr, December 1904.