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Nervous Affections of the Eye.
Where the patient " sees double " persistently, and in fact, as
a general rule, in all cases of supposed head affection, where
the patient sees double, or sees only half of an object at a time,
this is to be considered as a very bad symptom, and death may
be feared or expected from effusion into the substance of the
brain, sooner or later. True, we do meet with many cases in
which some shade of this abnormal state of vision is temporary,
and is then only indicative of some functional derangement;
but mark, where it is of longer standing, or other evidence of
cerebral mischief impends, it is always a suspicious symptom,
and should be closely watched. (See p. 231, and App. D, 3.)
The state of the iris, in diagnosticating " cerebral lesions," is
of importance. We should perhaps look first to the mental
condition, but next to the state of the pupils of the eyes. If
the eye itself is diseased, the dilated pupil indicates more or less
pressure on the retina by some cause within the globe, such as
turgid choroid. But when the eye is healthy, and the brain has
received some supposed injury, we usually find a dilated pupil
as a sign of some grave pressure or injury to the optic nerves
within the skull, or of the ganglia in which they terminate.
The contracted pupil, on the contrary, indicates an irritability,
or inflammatory state of the brain,— an exalted excitement of
the natural function, — but not an obliteration of it. " Some-
times," says M. Solly, " we may see, as in the case of injury of
the brain, dilatation of one pupil, and contraction of the other;
when this is the case, you will find the most severe injury of the
brain on the same side with the dilated pupil."
A seamstress came under my care for a blindness that came
on very suddenly in one eye, after sewing on black satin by gas
light. The pupil was dilated and immovable; she was totally
unable to distinguish even light from darkness. The case ap-
pearing to be one of idiopathic palsy of the iris, I therefore
proceeded at once to apply electro-magnetism, directed to the
opposite sides of the naked cornea, by very small ivory and
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