Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1879]
Catalogue details

Licence: Public Domain Mark

Credit: Repeated paroxysmal failure of sight in connection with heart disease / by Edward Nettleship. 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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    At the present time (February), she has gained flesh and is suffering less from headaches, under a rather long course of iron and aloes, with Case ii.' Blindness of Left Eye, luith Changes the Restdt of Retinal If.tmorrhas^e; Throm/mis: aftenvards repeated attacks of Transient Blindness of Rii,'ht Eye and Contraction of Visual Field, with small o'^acitics in Vitreous Body: Spontaneous Arterial Pulsation: Severe Aortic Disease.—Alfred F., aged 28, married, a butcher's assistant, pale, spare, nervous manner, with ver>' little facial hair, easily perspirmg, and subject to twitching of the face when spolcen to, was under Mr. Liebreich's care for defeat of the left eye, which had been discovered accidentally early in 1S78. I saw him in June in the following condition. With the left eye, he could only see shadows ; the pupil was of same size as the right, and acted independently, but dilated very quickly to atropine. There was diffuse haze of the disc and retina for a long distance around, including the yellow spot region ; the disc was rather pale. The retinal arteries were diminished in size and pulsated spontaneously on the disc though not to emptiness ; the slightest pressure causes full pulsation. There was abundant pigmentation of the lower and outer part of fundus in a some- what sector-like pattern by spots, rings, and stellate collections, chiefly in the retina ; some brownish patches were seen. I have no doubt the whole of the pigment-changes were the result of hemorrhage, very probably of retinal haemorrhage. The appearances are still nearly the same, and the disc has not become white. These appearances, though suggestive, under the circumstances, of some cause of sudden arrest of circulation, were not such as are left behind in the typical cases of embolism, where the disc after some months or weeks becomes very pale and quite clear. The interest of the case is chiefly in the other eye, which, since the failure of the left, has been subject to attacks of temporary loss of sight. The patient had never had either rheumatic fever or chorea, and did not remember ever being laid up. There was no history of syphilis. Dt. Greenfield was kind enough to make a very careful examination of the heart in August, and reported very marked aortic obstruction and regurgitation ; great dilatation of the left ventricle ; typical Corrigan's pulse . He had been deaf of the left ear for eight or nine years. He was not liable to epistaxis. He never had any fits. He was formerly subject to sick headaches but never had dimness of sight with them. On the evening of May 29th, whilst serving a customer, his right eye suddenly failed, so that he could not finish his sale; and though he could see the gaslights, he was so blind that he had to be led home. In two hours, the sight returned perfectly, and next day he went to work as usual. The only symptom attending the loss of sight was beating in the temples. June 1st, 5 p.m.—He had a similar attack, but not so severe in degree, and lasting only a few minutes. June 3rd, 9 P.M.—He had another attack, followed by pain in both eyes and disturbed sleep. June 7th. Another attack lasted an hour. He had used some blisters to the temples and considered they had relieved the thumping in the head. July 3rd and 4th. He had a severe attack of pain in the head. He had had no eye attack for the last three weeks. August 1st. Dimness again came on in the right eye, and lasted an hour. The headache had been very bad for a week or so before and continued for many days after.