Amaurosis

“ Amaurosis is sometimes temporary, occurring at regular intervals; and, during its accession, it often varies in intensity. With some patients strong light is intolerable, and vision is best in the twilight; others court sunshine, finding their eyesight thereby much improved ”

“ When amaurosis develops during some inflammatory or infectious disease, as in parturition fever in cows, the immediate cause may sometimes be found in embolism of the retinal, or cerebral arteries.
Symptoms. The most striking feature of amaurosis is the constant excessive dilatation of the pupil. This is the same in light and darkness, and in fully developed cases the animal may be taken from perfect darkness to the full glare of sunlight or 444electric light without the slightest contraction of the pupil. The pupillary reflex to light is entirely lost. ”

“ The general symptoms of amaurosis are the following. Headache is felt for some time, either constant, or, as is most commonly the case, occasional, and most severe in the forehead: in many cases the pain is at times most excruciating. The eyesight gradually becomes276 weak; distant objects are unusually obscure, or not at all observed; and those which are near cannot be accurately discerned. For a short time vision may seem to be restored, but soon it diminishes more and more, all objects seem to be enshrouded in a mist, at first thin and shadowy, but gradually becoming opaque and impenetrable ”

“ But the state of the pupil cannot be accurately determined in amaurosis, for not unfrequently it is much contracted, and in many cases the iris retains both its natural appearance and the full exercise of its functions. The disease either advances to complete blindness, or stops in its destructive progress, leaving the patient with vision impaired to a greater or less degree. When the disease is established, pain in the head and eyes usually either ceases quickly and entirely, or gradually abates. ”

“ In my opinion, blindness from amaurosis, being not so much a disease as a symptom, or rather the consequence, of many other diseases, is not, in onanists, the result of exhaustion, of asthenia, any more than the debility and paralysis of the lower extremities are, when the spinal marrow is diseased. ”

“ The amaurosis has been known to come on suddenly, and after a very brief exposure to lead, e.g., a man, thirty-four years of age, after working for three days in a white-lead factory, was seized with intense ciliary neuralgia, had pains in his limbs and symptoms of lead-poisoning, and the right eye became amaurotic. ”

“ We know not well what is the office of the optic nerve, nor in what manner it performs that office; but that it hath some part in the faculty of seeing, seems to be certain; because in an amaurosis, which is believed to be a disorder of the optic nerve, the pictures on the retina are clear and distinct, and yet there is no vision. ”

“ I there suggested that it was probable that amaurosis, uncombined with tic-douloureaux, might be removed by applications of a stimulating nature to the branches of the fifth pair of nerves. No notice of this suggestion having been taken by medical men, I determined to put the plan into execution, and employed a surgeon to carry it into effect in St. Giles's Workhouse, where blind cases were given me for that purpose. ”

“ Amaurosis is a very deceptive disease, the nerves alone being affected; the humours and coverings of the eye remaining perfectly transparent and natural, imposes upon the inexperienced observer, but is easily detected by those who have witnessed the disease in others. There is a singular watery appearance and vacant stare about the eye of the dog that cannot be mistaken. This peculiarity is owing, no doubt, to the enlargement of the pupil, as before observed. ”

“ The degrees of inflammation and obstruction are various. In the inveterate stages it may terminate in abscess, ulcers, and caries of the contiguous nasal bone.
Gutta-serena, amaurosis; in one or in both eyes, and in various gradations, from obscure vision to cheerless tenebrosity. To a spectator the eyes appear nearly as in health, only that the pupil is dilated and inanimate ”

“ In not a few cases, both of complete amaurosis, and of vision impaired to such an extent that the patient could merely distinguish light from darkness, I have by this practice succeeded in restoring the sight completely; in others, vision has been very much improved. ”

“ The treatment may consist of rest to the eyes, and ablution of them in cold water, with such other efforts to restore their tone and the general health as are noticed under Amaurosis. The prospect of complete cure, when the cause is not removable, is unfavorable; but even when confirmed the disease is not likely to end in blindness. The use of convex spectacles of very low power will generally be found serviceable. ”

“ Amaurosis of one eye is very often followed by a similar malady of the other, and the same is true of cataract and some other affections. In the natural state there is a perfect agreement between294 the optic axes, produced by the harmonious action of the straight muscles, but when this consent is destroyed, as it is in strabismus, the eyes lose their parallelism, and the distortion in question is the consequence. ”

“ ATROPHY. PARALYSIS OF THE OPTIC NERVE. AMBLYOPIA. AMAUROSIS. Definition. Horses, dogs, cattle, sheep. Amblyopia, Amaurosis. Causes: retinal paresis from brilliant light, of cerebral ganglia, snow blindness, poisons, lead, opium, atropine, lolium, tobacco, carbon bisulphide, cryptogams, mushrooms, “loco” plants, carbon monoxide, illuminating gas, quinine, heat apoplexy, cerebral concussion, brain parasites, exudates, pressure, degeneration, gastric or intestinal disorder, hæmorrhage, anæmia, diarrhœa, diuresis, excessive milk secretion, gestation, embolism. ”

“ They generally agree to regard amaurosis, in onanists, as produced by the exhaustion caused by diurnal or nocturnal pollutions. Beer, and many others, assimilate, in this respect, the loss of semen to that of other fluids; and compares venereal excesses, especially those from onanism, with cholera, diarrhœa, &c., as a cause of amaurosis. This idea of exhaustion probably led Scarpa to remark, that amaurosis, resulting from premature abuses of masturbation or coition, must generally be regarded as incurable. ”

“ Amaurosis, tinnitus aurium, formication, emesis, and, if the disease be high up in the intestinal canal, hæmatemesis, are the common attendants of serious hemorrhage. In the worst cases of sudden effusion the patient may present the appearance of complete collapse, and the intestinal canal be found on autopsy distended with blood throughout a great part of its course, while no blood whatever has escaped from the rectum. ”

“ It is doubtful whether the subjective visual disturbance is always an indication of the extent to which the optic nerve is involved. There are good reasons for believing those amblyopias and limitations of the field of vision which show marked remissions and exacerbations to be due to some dynamic central condition involving the visual centres and tracts. Thus it has been observed that almost total amaurosis occurred after an apoplectiform attack, to disappear later on. ”

“ Magnan observed the development of the characteristic symptoms of disseminated sclerosis fourteen years after an amaurosis which followed typhoid; and Gnauck reports another in which first a right ptosis, and then a right amblyopia, preceded the ordinary symptoms. In exceptional cases this premonitory eye-trouble may, like that of tabes, rapidly lead to extreme amblyopia or even amaurosis. The visual disturbances are remarkable for their rapid changes. They appear within a short period, attain their maximum rapidly, and may occasionally retrograde as quickly. ”

“ Amaurosis suggests disease of the corpora quadrigeminia. Loss of coördination of muscular movement usually implies some lesion of the cerebellum. Vertigo may imply disease of the encephalon (congestion, anæmia, inflammation, dropsy, hæmorrhage, tumor, abscess) ; it may be disease of the internal ear; it may be digestive disorder connected often with cryptogamic poisoning; it may be heart disease with obstruction of the jugular veins; it may be parasites in the nasal sinuses ”

“ A still more serious effect, however, is the impairment of the vision of the affected eye, which, never entirely absent, sometimes amounts nearly to a total loss, from the insensibility of the retina, which is sometimes as complete as in confirmed amaurosis. In another series of cases the person is myopic, or sees objects only at a short distance. In some instances, again, there is double vision, or objects appear indistinct, and run as it were into each other, the image painted on the retina being confused and imperfect. ”

“ It is usually accompanied by dilatation of the pupils. The amaurosis gradually disappears as the other symptoms subside, and with the improvement in sight the pupils contract. Recovery is frequently complete. Occasionally vision does not return with the improved general condition. Norris13 saw, in two cases of lead-poisoning due to the use of white lead as a cosmetic, marked choking of the discs in connection with severe cerebral symptoms. The terminal condition, when recovery does not take place, is that of nerve-atrophy. ”

“ Epileptiform attacks may now follow each other in rapid succession, ending in more or [p. 689] less profound coma. The attacks are sometimes separated by intervals of uneasiness, restlessness, or delirium. These attacks continue several days. If they are very violent and frequent death may rapidly supervene. In favorable cases consciousness is gradually restored, or the patient may awaken suddenly from his drowsiness after some hours or a day.
These attacks are not preceded by an aura.
Amaurosis is among the more important of the symptoms produced by the action of lead upon the nervous system. ”

“ The symptoms produced are pain, heaviness of the limbs, faintness, somnolence, dilatation of the pupil, albuminuria, convulsions, lock-jaw, and collapse. In animals there have also been noticed salivation, amaurosis, unsteady gait, dragging of the hind legs, dyspnœa, and paralysis of the breathing centres. ”

“ Even the bones are unfavorably influenced. A weakened nervous system is subject to a storm of changing nervous troubles, in some cases so severe as to lead to the outbreak of actual psychoses; while mental disorder already present tends, as a rule, to be seriously aggravated during pregnancy. In the eyes, serious disorders may occur, such as retinitis, and atrophy of the choroid with complete amaurosis. ”

“ Squinting (says Richter, the cataract-operator, not the patient--in his Surgical Science. B. III p. 426) is an unmistakable forerunner of amaurosis. How very much I squint, every one can see, because I always look and aim at everything to the right and left at once. Now when I actually become as stone-blind as a mole, then it is all up with my bit of biographical writing....
FORTY-FIRST, OR 3d EPIPHANY, SECTION.
I have a couple of fevers at once, which with other more fortunate persons cannot generally bear each other's company. ”

“ This latter ointment may also be used where, after distemper, a bluish film lingers in the eye. Amaurosis is not [Pg 72] uncommon in the dog. The eyes look perfectly right, but the dog is blind. This may be an hereditary condition, but sometimes comes in as a result of weakness pure and simple. Iron tonics, cod liver oil, nux vomica, etc., may be given, and sometimes prove effectual. Good living is essential. ”

“ Sometimes the shoulder muscles are attacked; also paralysis in the region supplied by the facial nerve and of the lower extremities is observed. It appears plausible that overstrain of single groups of muscles plays a decisive part; this seems proved by the fact that paralysis first affects, among right-handed people, the right hand (especially of painters) , but in the case of left-handed, the left hand; and among children the lower extremities are often attacked first. Disturbance of sight increasing to amaurosis is often an indication of severe brain symptoms. ”

“ But human beings are often called to still greater trials—to total loss of sight—in other words, to perfect blindness. This calamity results from many causes; for example, the cornea may become so opaque as to be incapable of transmitting rays of light into the interior chamber of the eye; or the crystalline lens, also, may become opaque (cataract;) disease of the iris, attended by closure of the pupil, will produce blindness, as will also paralysis, or loss of energy, in the retina or optic nerve, (Amaurosis or Gutta serena.) ”

“ There are sparks before the eyes, giddiness, noises in the ears, and a creeping feeling about the body. There is also very commonly anæsthesia of the fingers and toes, and later of the extremities, of the back, and even of the tongue. Diarrhœa, vomiting, colic, and other signs of intestinal irritation seldom fail to be present; there are also tetanic spasms of the muscles, rising in some cases to well-marked tetanus; epilepsy, faintings, aberrations of vision, amaurosis, and amblyopia are frequent; the skin becomes of a yellow or earthy colour, and is covered with a cold sweat ”

“ A year afterwards she married, and ten months later gave birth to a healthy son. She is now again pregnant.
Case XX. Spinal Irritation, giving rise to Menorrhagia and Amaurosis—Operation—Cure. A single lady, æt. 35, came under my care in 1863. Had been out of health for some years, suffering from continuous menorrhagia, seldom being free more than ten days or a fortnight in the month. Was thin and spare in appearance; often complaining of headache, especially over the brow and orbits ”