Remarks on the routine use of the ophthalmoscope in cerebral disease / by J. Hughlings Jackson.

  • John Hughlings Jackson
Date:
1879
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Licence: Public Domain Mark

Credit: Remarks on the routine use of the ophthalmoscope in cerebral 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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    Cerebral Disease {Med. Times and Gazette, J\ine 3, 1871), I say, Another error as bad as, or even worse than, over- looking striking ophthalmoscopic appearances, is to attach undue importance to slightly abnormal intra-ocular appear- ances, which may be only abnormal in the sense of being physiological peculiarities. Curiously, this is the fault, not of those who have used the ophthalmoscope much, but of those who have used it little. It requires much practice to give true clinical value to congestion of the optic nerves or to congested retinae, to slight changes about the edge of the disc or to alterations in the course and calibre of the veins. In the paper referred to, I spoke on this matter, and from it I quote the following :—I have never laid stress on slight alterations in the colour of the discs, or on slight abnormalities in the size or course of the large retinal vessels. . . . We may get as far wrong by attaching too much importance to slight appear- ances as by altogether overlooking decided pathological changes. I certainly did not speak too strongly. Professor Liebreich, at visits to the Hospital for the Epileptic and Paralysed, has frequently pointed out strik- ing peculiarities in the fundus, which he declares to be really physiological variations. Speaking of the import- ance of ophthalmoscopical examinations of many normal eyes, Professor Liebreich remarked at the Clinical Society {see Lancet, November 5, 1870): En effet, Taspect du fond presente a I'etat normal, on pourrait dire autant de variations que la jBgure humaine, et il faut I'etudier inde- finement si on ne veut pas dbre expose a prendre quelque- fois pour une alteration pathologique ce qu n'est qu'une modification individuelle d'un oeil sain. Obviously, then, whilst the student may observe any case he likes as minutely as he can do with precision, he should not dare