The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde.

  • Collins, William Job, 1859-1946.
Date:
1891
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Licence: Public Domain Mark

Credit: The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde. 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.

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    place. It is obvious that disease affecting the nucleus of origin or the nerve in its continuity or termination, whether such disease be intrinsic or extrinsic, may be productive of results difficult to separate. Dis- ease of the second nerve alone of all cranial nerves is recognizable by other means than those having reference to disturbance of function. The magnified image of the optic disc exhibiting, in the case of optic neuritis, increased vascularity, lymphatic engorgement, intra-neural hem- orrhage, proliferation of fibres, gives us an insight into what may be going on in other nerves during life when they are the seats of neuritis, whose evidence is only rendered visible by the less precise method of post-mortem examination, or inferred by reason of disordered function. It is now well recognized that what is called sclerosis, or some other equally precise, more acute, and more truly inflammatory process, is liable to overrun on definite lines, both centripetally and centrifugally, the cerebro-spinal system, and that the same may be scattered sparsely over the brain and cord, or localized in certain parts. It follows that the symptoms may be as diversified as the sites of this degeneration are various, and it is impossible to understand aright the effects resulting from a lesion affecting the deep origin of any one nerve, or group of nerves, without taking a survey sufficiently broad to cover similar lesions affecting neighboring areas. It was at one time argued that a group of oculo-raotor paralyses occurred which was sufficiently distinct from the previously recognized single-nerve palsies or single-muscle palsies, on the one hand, and from symptoms indicating invasion of the spinal cord or brain on the other, to warrant their collection into a separate category, and their being dignified with the exclusive application of the term ophthalmoplegia. This appears to have been the view of Hutchinson when he communicated his paper on Ophthalmoplegia Externa, or Symmetrical Immobility (partial) of the Eyes with Ptosis to the Medico-Chirurgical Society in 1879. He therein states that cases of single muscle paralysis, occurring in syphilis and in locomotor ataxia, are to be distinguished from the class for which he ventured to propose the name of ophthalmoplegia externa upon the three following grounds : 1. By the fact of non-symmetry of the former. 2. By the early completeness of the paralysis. 3. By the ease with which very frequently they are cured. He, however, admits that symmetry is not invariable; indeed, one of his fifteen cases was unilateral, and several others exhibited less sym- metry than mere bilaterality. As to the absence of early completeness of the symptoms, it may be true that the affection of the various muscles may be progressive, but the invasion may be sometimes sudden, as in his eighth case; and it is difficult to understand why the cause which he suggests of the unilateral