The ophthalmoscope : its varieties and its use / translated from the German of Adolf Zander by Robert Brudenell Carter ; with notes and additions by the translator.

Date:
1864
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Licence: Public Domain Mark

Credit: The ophthalmoscope : its varieties and its use / translated from the German of Adolf Zander by Robert Brudenell Carter ; with notes and additions by the translator. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    peratnre against all external conditions, and it absorbs discharges with great rapidity. It has the disadvantage of being somewhat heating, and of placing a difficulty in the way of inspection of the eye. From the above description it follows that the compress should be applied after almost all eye operations—especially after cataract extraction and iridectomy, and the removal of staphylomatous corneas—in all cases, in short, in which there is danger of intra-ocular haemorrhage. It is also indicated in cases in which such haemorrhage has occurred spontaneously; in ulcerations, wounds, and abrasions of the cornea; and, as a protection to the eye, in corneal anaesthaesia, and in paralysis of the orbicularis. It is contra-indicated in all disorders attended by elevation of temperature, and wherever other kinds of local treatment are required. For further information on the subject I must refer the reader to the essay by von Grafe, already mentioned in a foot-note. The foregoing general remarks have been intended to supersede the necessity of any detailed account of the methods of treating many of the morbid conditions described in the Fourth Section. The surgeon will find it desirable to bear in mind the observations, already cited, of Dr. Liebreich, upon the more idiopathic and acute character of the disorders of the choroid, as contrasted with the constitutional character, and comparatively chronic course, of the diseases affecting the retina. The former will manifestly demand a more active and local, the latter a more per- sistent and general plan of treatment; modified, of course, in either case, by the special symptoms, condition, and requirements, of the individual sufferer. Indeed, it may even be worth while to remark that philosophical medicine, which aims at curing the patient, differs from empirical medicine, which aims at curing the disease, more widely perhaps, in ophthalmic practice, than in any other department of the healing art. The display of physical changes effected by the ophthalmoscope, and the attention given, of late years, to the evil consequences of intra-ocular pressure, have some tendency to lead the student to the belief that, in the eye, he can see and feel the whole of the forces against which he is required to strive. It is impossible to learn too soon, or to remember too continuously, that intra-ocular physical changes are something more than mere deviations from the physiological status of a single organ. They form, in every case, a pathological superstructure, resting upon some special foundation of diathesis, of temperament, or of acquired dyscrasia; and, although this may be true in a greater degree of the retina than of the choroid, or of one patient than of another, it is true in some degree of each and all; and is never more conspicuously manifested than in the different results that, in two apparently healthy persons, may follow from the infliction of similar wounds or injuries upon both. In order, therefore, to treat ophthalmic diseases with success, it is necessary to look for something more than even the most exact physical diagnosis, and to study the subjective and the constitutional symptoms with as much care and accuracy as the objective. Thus much being premised, I may pass on to a brief notice of some of the morbid changes described, a few of which appear to demand the mention of special therapeutic indications. Excavation of the Papilla, when acquired, must always be regarded as a mechanical result of increased intra-ocular tension, and as a reason for the perform- ance of iridectomy. Upon this subject, and upon the signs and effects of morbid tension, sufficient has already been said elsewhere. Atrophy of the Optic Nerve is a condition against which all the resources of treatment have been exhausted in vain. The perusal of Dr. Alfred Grafe's case of ischaemia retinae (page 139) has determined me to perform iridectomy in any case of apparently idiopathic atrophy that I may see at a sufficiently early stage. At present, I have tried the operation in a single case only, in which the disease was already far advanced. For a short time the patient declared that his sight was improved, but I could never satisfy myself that it was so; and the improvement, if it ever took place, has certainly not been maintained. Among the methods of treat-