On optic neuritis in intracranial disease / by J. Hughlings Jackson.

  • Jackson, J. Hughlings (John Hughlings), 1835-1911.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: On optic neuritis in intracranial disease / by J. Hughlings Jackson. 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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    It is well known that sight may be good in severe neuritis, and that the neuritis—under treatment, perhaps without—may pass off. Although it is common and con- venient sometimes to speak of optic neuritis as a symptom, it is really a pathological condition. We have just said, in effect, that there may be a pathological condition of the discs without the symptom, amaurosis. Do these cases differ essentially from cases in which sight is defective or lost ? I think not. Some say that the former are cases of choked disc/' and the latter of optic neuritis. Is this an inference from the condition of vision, or is the distinction to be made by the ophthalmoscopical appearances ? I know of no difference in hind of disc betwixt cases in which sight is good and those in which it is defective or lost, but of difference in stage of changes only. It is known that optic neuritis may pass off under treat- ment, leaving sight good, whether there has been any de- fect of sight or not, even when there has been complete blindness. It may be an important question as to dia- gnosis of any present ailment to ascertain that there has been neuritis. I see discs in patients whom I know to have had acute neuritis, which, were I seeing the patients for the first time, I should not dare to declare abnormal. But, supposing that optic neuritis always does leave some traces discoverable by direct examination, I put the question : What are the ophthalmoscopical signs by which we may ascertain in such cases as those alluded to that there has been optic neuritis ? I do not mean only when we are told that the patient has had defect of sight, for there may have been neuritis without any defect of sight. I have seen many cases, and have recorded several, in which the relics of past well-marked neuritis were trifling. As the expression trifling is vague, I will mention a case, choos- ing, for obvious reasons, one in which the examinations were made by an ophthalmic surgeon. On June 12, 1879, Mr. Couper saw a patient of mine who had normal acute- ness of vision, normal accommodation, and normal field. At the same time, there is well-marked double optic neuritis. The state of the discs accurately corresponds to that often associated with brain mischief. About nine months later, Mr. Couper reports :— March 24, 1880: I re-examined yesterday, and found the translucency of both discs perfect. Their colour, although somewhat full, is within normal bounds. By direct examination, the redness of the left disc is seen to be somewhat patchy, and there is a little more projection of nerve-substance than normal. Both these conditions are absent in the right disc. There