A practical treatise on the use of the ophthalmoscope : being the essay for which the Jacksonian prize, in the year 1859, was awarded by the Royal college of surgeons of England / by J.W. Hulke.

  • Hulke, J. W. (John Whitaker), 1830-1895.
Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the use of the ophthalmoscope : being the essay for which the Jacksonian prize, in the year 1859, was awarded by the Royal college of surgeons of England / by J.W. Hulke. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    62/96 (page 48)
    came under our notice at an early stage ; but this does not com- monly happen, for the separation creeps on so insiduously, being unattended with pain or any external signs of mischief, that sometimes the lower hemisphere of the retina is stripped off from the choroid before the patient is aware that anything is wrong with his eye ; and indeed the discovery is sometimes made acci- dentally by closing the sound eye. A mutilation of the field of vision corresponding to the size and situation of the detached portion of retina is the first indication. Where the detachment occupies the lowest part of the fundus, objects lying in the upper part of the field of vision are not seen, so that the field is cut through by a horizontal line, which is more commonly sinuous than straight. This limit is not quite abrupt, for there is a band answering to the junction of the floating and unseparated retina, within which the perception of objects progressively fades out. In some cases the separation of the retina remains stationary for a time, but in others it proceeds steadily until the whole tunic is stripped from the choroid, and thrown towards the axis of the globe in the form of a funnel, slender and tapering towards the optic foramen, and expanding along the line of the ora serrata. When the coarctation is very great the retina traverses the axis of the globe as a slender cord, which I have known to be mistaken for a persistent hyaloid canal. The objects which inexperienced observers commonly mis- take for detached retina are waving films of opaque hyaloid membrane, or decolourized blood-clots floating in liquefied vitreous humour; their nature is negatively determined by the absence of the retinal vessels. Where cancer of the choroid has produced retinal detachment, and this I have often seen in dissections, the nature of the original disease is for a time masked.