A case of toxic amblyopia : with autopsy and microscopical examination of the specimens / by G. E. de Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: A case of toxic amblyopia : with autopsy and microscopical examination of the specimens / by G. E. de Schweinitz. 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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    the walls of the major vessels, and, moreover, not only in those supply- ing the retina and optic nerve, but in others which happen to be shown in the tissues outside of the dural sheath of the nerve. The vena postica, which has been particularly described by Sachs as giving evi- dence of an endo- and periphlebitis, could not be identified in any of the sections. Briefly, then, the changes in this case of central scotoma, which, so far as the history and the perimetric examinations are concerned, seems to belong to the group of the so-called intoxication-amblyopias, are: degeneration of the papillo-macular bundle from the tract, through the chiasm and along the nerve until it reaches the nerve-head; marked thickening of the connective tissue of the affected area, with degenera- tion of the nerve-fibrils, and hypertrophy of the walls of vessels, asso- ciated with a moderate increase in nuclei within the fasciculi; some narrowing of the temporal nerve-fibre layer in the neighborhood of the papilla, and in the same region imperfections in the processes of the ganglion-cells, which, however, in the macular zone are of normal construction. With reference to the pathological process present in the optic nerve in cases of this description, there is some difference of opinion, and, as has been well stated, the descriptions of the optic nerves in the recorded cases agree quite as well with an inflammation of the connective tissue of the nerve causing secondary atrophy of the nerve-fibres as with a primary atrophy of the latter associated with secondary interstitial changes following in its track. The same doubt obtains in the present instance, although taking into consideration the marked thickening of the interfascicular septa, the vascular changes and the increase in the nuclei, both upon the edge of the degenerated area and within the fas- ciculi, even if this increase in nuclei cannot be said to be a marked one, the appearances correspond closely with those usually assigned to an interstitial sclerosing inflammation, which Samelsohn compared with the same pathologic process visible in interstitial hepatitis. As my specinaens show extensive typical tract-atrophy far advanced, and the retinal sections from the same case only a moderate thinning of the nerve-fibre layer on the affected side, without any special change in the ganglion-cells, which, indeed, in the macular zone appear practically unaltered, it is difiEicult to assume that these cells should be regarded as the starting-point of this affection. In other words, this case fails to confirm the recent contention of Nuel,^ that central toxic scotoma is not primarily a neuritis of the macular bundles, but a disease of the macular lutea causing degeneration of its cells, and that the optic-nerve changes 1 Archives d'Ophtalmologie, October, 1S95; March and August, 1896. The macular origin of central scotoma was advocated more than twenty years ago by Schoen, and later by Bayer and Treitel, who believed that it indicated a functional weakness of the centre of the retina due to toxic agents.