60 Deutsches Archiv f. klinische Medizin, 1877, pp. 1-31 (with plate).
61 Quoted by Quincke, loc. cit., p. 23.
62 Med. Centralblatt, 1875, pp. 675-677.
HEMORRHAGE.—Loss of blood may be the cause of impaired vision from transient anæmia of the retina or of the cerebral centres, but not unfrequently, in some manner which we are not yet able satisfactorily to account for, it gives rise to permanent blindness. This failure of sight may come on immediately after the hemorrhage, but it is usually noticed at periods varying from two to fourteen days after the loss of blood. Fries63 has written an admirable monograph on the subject, and gives 26 cases collected from various authors. According to his tables, 35½ per cent. of the cases are due to hemorrhage from the stomach or intestines; 25 per cent. to uterine hemorrhage; 25 per cent. to abstraction of blood; 7.3 per cent. to epistaxis; 52 per cent. to bleeding from wounds; and 1 per cent. each to hæmoptysis and urethral hemorrhage. Many of these cases are preopthalmoscopic, and consequently the exact pathological changes in the retina and optic nerve are necessarily matters of conjecture. Jaeger has given us two most interesting cases of blue degeneration of the optic nerve, with comparatively little change in the calibre of the main vessels of the disc and retina.64 In both, the loss of blood occurred during labor; in the first, two births happened without accident; at the third and fourth labor there was severe hemorrhage, each followed by considerable and lasting impairment of vision, leaving ability to read Jaeg. No. iii. for a short time, and only by close approximation. In the other case there were four confinements, all accompanied by hemorrhage, each leaving the vision more and more impaired, until after the fourth labor there was no light-perception. At this time the ophthalmoscope showed only blue discoloration of the nerve, followed six years subsequently (after recurrent headaches from taking cold) by a more complete atrophy of the disc and retina, the former appearing of a dirty-green color and having acquired a saucer-like excavation, whilst the retinal vessels had undergone great diminution in their calibre. In most recorded cases no examination of the fundus has been made until long after failure of sight, and then there has generally been found some stage of atrophy; but when the ophthalmoscope has been used early in the case the eye-ground seems to have presented various appearances. Thus, Jaeger65 says that soon after the hemorrhage the eye-ground presents a diminution in the calibre of the veins and arteries, with a light-blue discoloration of the optic disc, without any other demonstrable tissue-change. Graefe66 saw slight diminution of the calibre of the retinal arteries and an increased pallor of the disc in a case where blood was vomited and passed by stool fourteen days after the occurrence of the blindness. On the other hand, Schweigger67 (in two cases), Nagel,68 Hirschberg,69 Nägeli,70 Horner,71 and Landesberg72 have all noted the occurrence of neuritis.
63 Sigmund Fries, "Diss. Inaug." in Klin. Monatsblätter f. Augenheilkunde, 1878.
64 Ergebnisse der Untersuchung mit dem Augenspiegel, 1876, p. 87.
65 Loc. cit., 1876, p. 87.
66 Arch. f. Ophth., vol. vii., part 2, p. 146.
67 Handbuch der Augenheilkunde, 1875 (3d ed.), p. 522.
68 Behandlung der Amaurose und Amblyopie mit Strychnine, 1871, p. 51.