The clinical use of the ophthalmoscope, in diseases of the eye / by Laurence Turnbull.

  • Turnbull, Laurence, 1821-1900.
Date:
[1859]
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Licence: Public Domain Mark

Credit: The clinical use of the ophthalmoscope, in diseases of the eye / by Laurence Turnbull. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of its application, I will give the cases in regu- lar order, progressing from the crystaline lens, posteriorly until we arrive at the entrance of the optic nerve. Incipient Cataract.—Case 1. Hannah B, a healthy colored woman, aged 56, a cook; married; has ceased to menstruate; complains of a dimness of vision. An examination of the eye showed a healthy appearance, but from her actions it was supposed to he a case of cataract in the formative stage. To render the diagnosis certain, a solution of atropia was dropped into the eye, and she was requested to wait for ten or fifteen minutes with the eyes closed. Upon opening them, the pupil was found dilated, showing no disease of the iris. She was then placed in a darkened room, with her head a little in front of a gas burner, and was desired to look at the ear’ of the examiner, who was placed on a stool elevated a few inches above her. If it had been a case of true disease of the posterior surface of the eye, no solution of atropia would have been re- quired, as in such cases the pupil is usually dilated. To further test the case, the catop- tric test was resorted to. The light of the gas was reduced, and a lighted candle was then passed with care, up and down, in front of the eye; each of the images was seen, but the in- verted and posterior one was not distinct. The gas light was then increased, and the rays directed, by means of the mirror of the oph- thalmoscope, full upon the eye, so as to pro- duce a red glare, which was concentrated by means of the convex lens placed in front of the mirror, and the whole eye of the patient was presented clearly for inspection. There was found stilated opacity of the lens, more on the left than the right, confirming the diagnosis, and making it certain that nothing could be done but to keep the pupil dilated with a weak solution of atropia, until the cataract was fully formed, when an operation would relieve her. ’ This was done in order to give her something on which to fix her gaze, and thus prevent the eyes from moving about, as will be observed when this precaution is not taken. This principle is observed by daguerreotypists, etc. Dimness of Vision.—Case 2. John K., aged 40 ; a pedlar. Complains of dimness of vision with deafness. An examination having been made, the eyes looked as if there was a slight haziness of the crystaline lens. The pupil was then dilated, and by a careful ophthalmoscopic examination, this haziness was discovered to be in the cornea, with no opacity of the lens or its capsule. A quantity of impacted cerumen was removed from his ear, and he was directed to procure a pair of spectacles, of about 48 inches focal distance. He shortly returned, and reported himself much improved. By means of the spectacles he was enabled to dis- tinguish objects which before were almost in- visible to him. I have found that even with experts in the use of the ophthalmoscope, there is occasion- ally a tendency to confound opacities of the cornea with that of the crystaline lens, and yet there is no opacity, however small, that may not be detected by its use. Dr. Mac- kenzie observes, that “if a patient with in- cipient amaurosis presents himself to a prac- titioner who mistakes the case, and supposes it to be one of incipient cataract, the advice which he will give will be to wait with patience till the disease is fully developed, and then to submit to an operation. Should the patient return, after some months, with a fully de veloped amaurosis, instead of a cataract, the practitioner would necessarily feel that by his ignorance and inattention he had lost the only season for treating an amaurotic affection with success. The opposite mistake would pro- bably lead him to the employment qf deple- tion, mercury, and counter-irritation, by which his patient’s health might be seriously com- promised, but which could have no effect in removing an incipient opacity of the lens.”' The Vitreous Body.—The vitreous humor is a transparent, jelly-like mass, which is evi- dently held together by a delicate membrane. It fills up the posterior and middle part of the interior of the eye-ball. It is concavo-convex in form; the convexity which is posterior is • ’ Mackenzie on Diseases of the Dye, Ametican edition, p. 703.'