The ophthalmoscopic appearances of the optic nerve in cases of cerebral tumour / by C.E. Fitzgerald.

  • Fitzgerald, Charles Edward.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: The ophthalmoscopic appearances of the optic nerve in cases of cerebral tumour / by C.E. Fitzgerald. 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.

    12/14 (page 12)
    This theory has very recently been called in question by Dr. Forlanini, in the Italian- Annals of Ophthalmology.*^ Dr. Forlanini has repeated Schmidt’s experiments frequently, but without success. Pagenstecher says,^ “ one would be inclined to accept this theory as soon as one became convinced of the existence of such a system of canals in the lamina cribrosa as are presupposed; ” but, he adds, that hitherto he has been unable to demonstrate it. Such are the theories held regarding the mode in which the Stauungs Papilla is produced. It will be seen that the question is far from being definitely settled yet. Perhaps I ought to mention one practical point in connexion with the subject, which may possibly be urged in favour of Schmidt’s theory. At the meeting of the International Ophthalmological Congress, held in London the year before last. Dr. de Wecker, of Paris, read a paper on an operation he had devised for the treatment of neuro- retinitis. It consists in making an incision in the sheath of the optic nerve and sclerotic ring, and so giving exit to the contained fiuid. He had performed this in only two cases, both of them supposed to be cases of tumour in the cerebrum. The neuro-retinitis was regressive in both cases. Nevertheless though there was little or no improvement in the vision, the intense head-ache was in one case relieved; and in the other case the patient, who, before the operation, was affected with weakness of the legs, was afterwards able to stand more firmly and answer ques- tions promptly. He appeared greatly pleased with the result himself. An account of the operation will be found in the report of the Congress.^^ In the last volume of the St. Bartholomew Hospital Reports, Mr. Power records an interesting case of optic neuritis,^ in which he per- formed this operation. He states, that “ it seemed to relieve the pain, which was intense.” In concluding, I would wish to correct a rather widely spread, but most erroneous impression, which is this—that Von Graefe regarded the Stauungs Papilla as absolutely diagnostic of the presence of a cerebral tumour. Such is not the case. Graefe looked upon this condition of the optic disk as merely the expression of increased intra-cranial pressure, and, consequently, that whatever caused an increase of the pressure would also produce this swollen state of the disk. That it may be present in cases where there is no intra-cranial tumour there is no possible doubt, and Graefe did not deny it. This drawing, which I made from a case under Dr. Gordon’s care, exhibits the prominence and swelling of the disk in a very high degree; yet, I believe there is no ^ Annali di Ottalmologia. Pt. I. 1871. ^ Loc. cit. ^ Report of the Fourth International Ophthalmological Congresf^, held in London, August 1872, p. 11. ^ St. Bartholomew’s Hospital Reports. Vol. IX. 1873. p. 196.