Double optic neuritis with paralyis of olfactory nerves, and sensory division of right fifth nerve / by John B. Story.

  • Story, John B.
Date:
1884
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Licence: Public Domain Mark

Credit: Double optic neuritis with paralyis of olfactory nerves, and sensory division of right fifth nerve / by John B. Story. 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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    points to which I would especially like to draw the attention of the members present, as upon it hangs the possibility of localising the cerebral affection, and as I myself am quite unable to arrive at any satisfactory conclusion upon the question. It is to me highly imorobable that the disease, which I am inclined to consider a new growth, could be situated in or near the nuclei of the affected nerves, for the new growth is most likely large, as it has existed now for nearly a year and a half, and has caused such severe constitutional and cerebral symptoms, and if it were of any size it must have affected the nuclei of otner nerves in close proximity. It is also to me inconceivable how a growth at the base of the brain, which implicated the right fifth nerve and both olfactory bulbs, could avoid affecting the third and fourth nerves of the same side, and indeed I might add the sixth nerve of that side too; so that although I consider the case to be one of cerebral tumour, I ana utterly unable to assign any definite position to the new growth. There is no question connected with ophthalmic surgery that is of more general interest than the much-debated one as to the existence and nature of neuro-paralytic keratitis. Oculists have for long been familiar with the fact that after paralysis of the fifth nerve on one side the cornea on that side is liable to undergo a destructive inflammation, and little doubt was felt as to the neuro- paralytic nature of the inflammation until Snellen's experiments upon rabbits some years ago. He succeeded in producing com- plete insensibility of the cornea by dividing the fifth nerve, and, by careful protection of the eyeball from external irritants after- wards managed to keep the cornea free from inflammation. He therefore concluded that the so-called neuro-paralytic keratitis is not a trophoneurosis at all, but an inflammation caused by exposure—the anaesthetic cornea being easily injured, and without the patient's notice. Now, my case harmonises very well with this theory; for although the paralysis has been in existence for some eight months, the frequent winking that occurs simultaneously with that of the other eye, and the tendency the woman has to keep her lids half closed, must have protected this eve to an extent unusual in these cases,