Lectures on diseases of the nervous system / delivered at Guy's Hospital by Samuel Wilks.

  • Wilks, Samuel, Sir, 1824-1911.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on diseases of the nervous system / delivered at Guy's Hospital by Samuel Wilks. Source: Wellcome Collection.

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    on winch, tlie patient lay was always more dilated than the other. But although a difference in the size of the pupils will do little more than denote cerebral trouble, an extreme condition of dilatation or contraction always indicates a very serious affection of the brain. For instance, in ventricular effusion the pupils become, as a rule, widely dilated. This fact you should well bear in mind, because, on visiting a child suffering from head disease, you may be informed by the mother that it is in a “ nice sleep,” but when you raise the eye- lids you find the pupils widely dilated. You know that in sleep the pupils are contracted, and so remarkable is this circumstance that, if you place the child before the window, their size remains unaltered, but immediately you awake him the pupils expand,although the light is still shining upon them. At the same time remember that a con- traction of the pupil is an equally unfavorable sign in many cere- bral disorders and more especially in apoplexy. In those fatal cases where blood has burst into the ventricles, or diffused itself over the base of the brain, the pupils are often found minutely contracted, just as they are in cases of effusion into the pons. In all cases con- tracted pupils denote a grave disturbance of the sympathetic nerve, either in the cervical ganglion, in the course of its fibres, or in the cilio-spinal region of the cord. Thus it is that in many chronic spinal affections myosis is seen. It is thought by some that the state of the pupils will inform us of the nature of the cerebral lesion. Certainly, a well-marked change in the pupils will always indicate something serious, but a natural condition may exist in most important diseases. Thus, I do not know that you can tell concussion of the brain or drunkenness by the pupils. In uraemic coma I have observed the condition of the pupils over and over again, and should say that they are not affected. I have repeatedly seen cases brought into the accident ward where injuries to the brain had occurred with various amounts of effusion of blood, and where the pupils, although at first contracted, afterwards became dilated, sLloav- ing that the slightest change will affect them Avhilst the main lesion remains unaltered. You must also not only observe the size of the pupil, but whether the iris can still be stimulated by the influence of light upon the retina. In recent injury or acute disease, if there be immobility of the pupil when the light of a candle is thrown upon the eye, it generally is an evidence of some affection of the brain in which the optic tracts are implicated. You must also remember the sympathy which exists between the two eyes, and how the perfect susceptibility of the one will influence the other; hence the necessity of examining each eye separately. As regards the state of the pupils after death, I think no conclusion can be formed from their size, as they alter when life departs. We Avant more