A manual and atlas of medical ophthalmoscopy / by W.R. Gowers.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    IDIOPATHIC EPILEPSY. 17;>> of the fundus was such as is presented by persons not epileptic. Now and then an unduly red disc is to he seen, hut not more frequently than in persons not epileptic, and in most cases it is explicable by the ocular conditions—a point too little attended to in medical ophthalmoscopy. The only deviation from the normal state of the fundus which has seemed to me frequent, is an unusual equality in size of the retinal arteries and veins. The latter are not, as a rule, larger than normal, and the arteries appear as if large from a lax state of wall. Spontaneous pulsation in the veins has been described by Kostl and Niemetschek1 as especially frequent in epileptics : it is certainly not more frequent in them than in individuals who are not epileptic. During the paroxysm the appearance of the fundus has been described variously by different observers. For obvious reasons, the difficulties in the examination are great, and opportunities are rare. The only change which seems well established, is that the retinal veins, during the stage of lividity, become much distended. Eegarding the state of the arteries, there is considerable doubt. On theoretical grounds, because contraction of the cerebral arteries is supposed to be the immediate cause of a fit, it has been expected that contraction of the retinal arteries would also be seen, and De Wecker has described a sensible diminution in the size of the arteries during the pallor, but Kostl and Niemetschek thought that they recognized in one case dilatation of the arteries during an attack. Observation, however, of the size of the vessels by the indirect method, is of small value. In a case of convulsions from meningeal haemorrhage, in which there was, however, no initial pallor of face, and also in a case of severe one-sided fits, I have been able to keep a retinal artery and vein under (direct) view through the whole of a severe fit, from before its commencement until after its close. In neither case did the retinal artery present the slightest change in size. During the stage of lividity, the vein became large and dark. In a case of chronic local