Page:A manual and atlas of medical ophthalmoscopy.djvu/276

260 small hæmorrhages, and in the retina, near, were several whitish spots. Left disc similar, but swelling less and hæmorrhages fewer. Vision: right, No. 18 Jäger; left, No. 19 Jäger. Considerable hypermetropia. Fields of vision much limited peripherally; sight only in a small area around central point; limitation in each eye greater on inner than on outer side of field.

At the end of a week (mercury being given) there was less headache, less swelling of disc; vision had improved to R. No. 10 and L. No. 12 Jäger, but the fields were still more contracted. A fortnight later (June 25) sight had improved to R. No. 8 and L. No. 6 Jäger; fields of vision the same. Both discs were much paler and less swollen; the hæmorrhages almost disappeared. July 7, sight rather less acute, each No. 12 Jäger. During the following week he had two fits, each with loss of consciousness and general convulsion. Acuity of vision lessened to R. No. 16, and L. No. 19 Jäger. Fields of vision difficult to ascertain, but seemed confined to a small area around centre, chiefly on outer side, the inner halves of the fields being almost gone. He had several transient attacks of extreme dimness of sight, in which he could scarcely discern objects in the room. Discs still paler and less prominent: each presenting a soft-edged swelling, nearly double the normal diameter of the disc and rather paler than the adjacent fundus. Veins still larger than natural; arteries perhaps a little smaller, but numerous, and tortuous on the disc. Minute extravasations and dotted streakings in each eye, but no large hæmorrhages. The sense of smell was again lost; camphor, nutmeg, or peppermint could not be recognized; sugar and quinine were at once distinguished as sweet and bitter.

In a few days more, about July 18, sight failed completely so that he ceased to be able to distinguish light from darkness. Headache, severe, chiefly on right side, and increased by lying on the back. Ophthalmoscopic appearances nearly the same. During the next month there was no improvement in the sight; the swelling of the discs slowly subsided. On August 29 the ophthalmoscopic appearances were:—Right disc, moderate swelling, having a diameter of about a disc and a half; pale in centre, red on peripheral portion; edge very soft; veins not much above normal size, curve down the side of the swelling; arteries concealed upon the swelling, normal beyond its edge. Left optic disc had a similar appearance but presented several vessels in process of obliteration (see Plate IV. 5, and its description). At this time no subjective flash could be obtained with constant current, even with as much as twenty cells; giddiness and pain were caused but no flash.

In the beginning of September there was transient perception of light, chiefly in the outer part of the right field. He had several subjective spontaneous flashes of light. The swelling of the discs was subsiding, and the new vessels on them were less numerous and smaller. The arteries on the disc became more distinct; several formerly lost at the edge could be traced up to their junction with the larger trunks. During the next few weeks he had much less headache; no return of