THE USE OF THE OPHTHALMOSCOPE IN THE DIAGNOSIS OF BRAIN DISEASE
Journal of the American Medical Association
Our knowledge of the physiology and pathology of the central nervous system is so limited, the diagnosis of brain lesions so difficult, the well known conditions of the eye in those lesions so unmentioned or dubiously mentioned by the text-books on medicine, as to afford me some excuse for urging the claims of the ophthalmoscope in the study of the intra-ocular end of a brain nerve, during its structural changes which are connected with intra-cranial di sease. As the subject embraces a limited
... embraces a limited personal experience, I freely admit the testimony of such authorities as Drs. Allbut, Jackson, Gowers, and incidentally many others. While the nature of many diseases within the chest and abdomen is revealed to touch and the ear, the maladies of that most inaccessible part of the body\p=m-\the cranium\p=m-\give out no certain sound, and will not disclose themselves to any wizard touch; so it remained for the genius of von Graefe and Sichel, the patient and skilful labors of Saemisch, Liebreich, Schweigger, Soelberg Wells, Jackson, Allbut, Gow¬ ers, and others, to illuminate with the ophthalmoscope the dawning light, through which men were eagerly striving to discover the connection between ambly¬ opia and intra-cranial disease. The popular idea that the oculist has, and perchance needs, no knowl¬ edge of general medicine to successfully treat the eye, is no less false than the, I fear, professional belief that the general practitioner can gain little from the ophthalmoscope. With the herculean task of gaining a fair knowledge of the structure, working, derangement, and repair of the general system, it is not to be expected that even a Hercules could also keep abreast of the information and experience in regard to any special organ. Yet, since the whole is made up of all its parts, and the parts are inter¬ dependent, and dependent upon the whole, any ap¬ proach to a comprehension of the whole organic system must involve some familiarity with every part. No more striking illustration of this can be cited than the evidence of cerebral lesions that may be elicited by an ophthalmoscopic examination of the intra¬ ocular end of the optic nerve, called the optic disc or papilla. In the pre-ophthalmoscopic period (prior to the great invention of Helmholtz in 1851), there certainly had been something done to trace in atrophy of the optic nerve, the connection between amauroris and brain disease, but the ophthalmoscope first re¬ vealed an inflammation of the optic nerve accom¬ panying brain disease. It frequently happens that patients having symptoms of encephalic disease accompanied by perhaps very considerable optic neuritis, which mav not impair vision, have no dispo¬ sition to consult an oculist, and while so few men in. general practice use the ophthalmoscope, one of the most unequivocal signs of encephalic disease, viz. : optic neuritis, is frequently overlooked. The appear¬ ance of the optic disc, the first time I succeeded, with the aid of a mirror and lens, in getting a view of it, struck me as resembling a diminutive cream rose full moon, about the size of a large split pea, ris¬ ing in a pink sky of surrounding choroid, which, by its contrasting color, gave a well-defined sharp border to. the disc. The changes in the optic papilla, produced by cerebral disease, are congestion, inflammation, and atrophy. The congestion of the papilla may be a simple hyperaemia; if attended by oedema, it is the stauungs papilla of von Graefe; the choked disc of Allbut, or, congestion papilla. In optic neuritis, the papilla alone may be affected; in other cases the neuritis occupies the length of the optic nerves, as has been shown in autopsies by Allbut, Gowerst Hulke, Virchow, etc.