Medical diagnosis : with special reference to practical medicine: a guide to the knowledge and discrimination of disease / by J.M. Da Costa.

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1881, ©1880
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Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine: a guide to the knowledge and discrimination of disease / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    81/936 (page 75)
    The causes of choroiditis, with the exception of the syphilitic form, are obscure. The disorder appears most frequently as cir- cumscribed white patches in the choroid, over which the retinal vessels may be seen coursing. The syphilitic form is by far the most common, and is distinguished by the presence of patches of many colors at the back of the eye, some of a brilliant white, others of darker tints, such as red or brown. Tubercles of the choroid are a manifestation of the tubercular diathesis. In eighteen cases of the miliary disease Cohnheim found tubercles in the choroid of one or both eyes in every in- stance. They appear in the form of small circumscribed spots, of a pale rose-red color or grayish-white tint, chiefly in the vicinity of the optic disk. The sight may remain unimpaired. In the retina and choroid the existence of tubercles indicates either tu- bercular meningitis or general tuberculosis. If, with tubercular granulations of the choroid, fever and disturbances of intellect, of movement, and of sensation be present, the existence of tuber- cular meningitis may be determined. Yet tubercular meningitis is revealed chiefly by choked disk or neuritis, and even then only when it invades the anterior and inferior parts of the encephalon ; for the disks may be normal throughout. The changes are always double, although, as Gowers* points out, more advanced on one side than on the other. As regards the sense of hearing, the same may be said as of vision. It, too, is perverted and impaired in various cerebral affections. Yet, to be certain that the cause of the difficulty is cerebral, the ear must first be examined with reference to any physical imperfection; and in doing so we may by means of the otoscope get an idea of the vascularity of the drum, and be led from this to infer the condition of the vessels of the brain. Great acuteness of hearing and intolerance of sound are gen- erally symptoms of extreme nervous irritability, or of beginning cerebral inflammation. Deafness may be owing to softening of portions of the brain ; but Ferrier tells us that it is not met with in destructive lesions of the cortex. Deafness is also found as a temporary and by no means unfavorable symptom in the continued fevers. Imaginary sounds and ringing noises in the ear, or tinnitus * Medical Ophthalmoscopy, London, 1879.