Case of Amaurosis, with Partial Loss of Memory, successfully treated: With Remarks

H. R. Oswald
1842 BMJ (Clinical Research Edition)  
in Douglas, aged fifty-two, was suddenly attacked with total blindness. He sent for me about two, a.m., of the 28th, when I found him sitting up in bed, straining and rolling about his eyes in search of the light. The pupils of both eyes were much dilated, and looked darker and more brilliant than usual. He felt no pain, except a slight uneasiness across the eyes and forehead, and along the nose. Upon a lighted candle being held close to the eye, he said he was sensible of nothing but " total
more » ... thing but " total darkness." Skin cool and natural; pulse not accelerated, but rather full; tongue white and loaded; manner composed, and mind collected. On further inquiry, I was informed that my patient had retired to bed about eleven o'clock, in good spirits, and free from every apparent exciting cause of the disease, and that about one o'clock, or some time after it, Mrs. D. was aroused by Mr. D. making efforts to grope about the bed, and complaining that he did not know where he was; but he immediately recognised his wife's voice and manner. Mrs. D. could not, however, make him comprehend that he was in his own house and bed-room; and when I arrived, he repeated to me that he was not only blind, but could not recollect anything at all about where he was, the locality of his bed-room, the form of the room, or of the house generally, with the exception that he was aware that the bank was below stairs, but in what part of the house he could not say. In every thing else his mind was quite collected, and he was particularly anxious about preparing the bank accounts for a public meeting, which was to take place in a few days. I take particular notice of this peculiar loss of memory regarding the locality of places, because it has proved an interesting symptom of the case in all its stages, and has been concomitant with the most prominent symptoms in their greatest degree of severity, as well as in their progress towards amelioration. In reference to the predisposing causes of this attack, I found that Mr. D. had been, for fourteen days or more, unusually inattentive to the state of the primae vit, troubled with erratic pains in various parts of the body, and complained of loss of appetite and foulness of tongue; his breath was often offensively fbetid, and it is very probable that his anxiety to have his banking accounts ready for the general audit, which was near at hand, might have had some effect as an exciting cause. I found also that for many years he has been very subject to catarrhal No. 97. affections, which have had a strong tendency to occasion a pink-colored suffusion of the tunical sclerotice ever since he had the small-pox when a boy, by which he is severely marked. About ten years ago he first began to be sensible of a permanent weakness or falling off in tlle power of vision, and occasionally to see objects imperfectly, for which he began the use of spectacles, and has continued them ever since without interruption. About three years ago he experienced a dangerous attack of the influenza then prevalent, which impaired Ilis general health, and left him less able for activc exertions, both in mind and body, than before. His habits of life have always been very regular and active. It may be added, that besides the pinky tinge of the selerotica, some observers have remarked his having a mode of straining and winking the eyelids, especially 'when he had a catarrhal affection. Such being the history of the case, I shall proceed to give an abstract of the method of treatment pursued for its cure. I immediately took upwards of a pound of blood from the arm, administered six grains of calomel and six of scammony, and directed the patient to use a hot mustard bath for the lower extremities as soon as possible, and a stimulating application of tincture of camphor and sulphuric tether to the forehead and temples. Six hours afterwards, when his bowels had been evacutated by the purgative, an emetic mixture, containing the tartarised antimony and ipecacuanha, was exhibited, which, being slow in operating, a teaspoonful of powdered mustard was administered with excellent effect. At mid-day, 28th of June, ten leeches were applied to the temples, and the calomel and scammony were repeated soon after, with directions to assist their operation by a dose of castor oil in the evening if necessary. By these meanis the primie vie were well cleared out the first day of the attack; and as my patient complained much of thirst and nausea, and foulness of the mouth and palate, effervescing draughts, made of the volatile alkali and citric acid, were prescribed to be taken every hour, in order to obviate the necessity of loading the stomach with much liquid, and to mitigate the febrile heat of the surface, which set in towards evening of the first day. June 29. Has passed a restless night; no improvement of symptoms; alvine evacuations extremely feetid, and mixed in color; the saline effervescing draughts are found very refreshing. Repeat the calomel and scammony immediately, and in four hours carry the dose off by the infusion of senna and sulphate of magnesia; cupping glasses to the neck. Seven, p.m. During the cupping, which lasted half an hour, and by which about one pound of blood was obtained, the pupils of both eyes were observed, for the first time, to contract on being exposed to a strong candle light. Having had no sleep since the attack,
doi:10.1136/bmj.s1-4.18.343 fatcat:e4ovdqx5pzcxlbrmihonpjh6ru