A manual and atlas of medical ophthalmoscopy.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1890
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Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy. 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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    inadequate explanation for the cases in which both eyes suffer. Moreover in those cases which have been examined post-mortem there has been no evidence of such haemorrhage. To assume, as has been done, that the mischief is at the chiasma, seems unjustifiable, in the entire absence, in all such cases, of other symptoms of mischief at the base of the brain. Forster attributed the slight changes in his case tO' serous effusion. Horstmann^ ascribes the symptoms to in- flammation in the optic nerves. XJlrich regards papillo- retinitis found after great loss of blood as due to disturb- ances in circulation in the papilla, and attributes these latter changes to the establishment of an abnormal relation between the blood and the vitreous-pressures.^ The appear- ances noted by him in the veins immediately after severe haemorrhage (see p. 240) he adduces as a proof of these circulatory disturbances. He believes that there is always a slight hindrance to the circulation in the retinal veins where the latter bend in passing over the edge of the disc, that the influence of the intra-ocular pressure is to increase this hin- cbance, and that it is still further increased by the occurrence- of any reduction in the blood-pressure. Severe loss of blood, then, pioduces a condition favourable to venous stagnation by reducing the blood-pressure markedly, while the intra- ocular pressure is not affected or only slightly diminished. Samelsohn thinks that the nervous connection between the- stomach and the corpora quadrigemina (lesions of which are said to cause gastric haemorrhage) affords the best explanation while von Oettingen^ beheves that he has proved that fatty degeneration of the retinal vessels, quickly following the loss of blood, IS the cause of the extravasations sometimes seen. t IS evident, however, that in the majority of cases there are the signs of inflammation, and there is at present no evidence to show that this is not of intra-ocular origin. It seems probable that the mechanism may vary in different 1 «< 'Kl. Moiiatsbl.,” 1878, p. 147. “Graefe’s Arcliiv,” xxvi. 3, p. 80