A PECULIAR AFFECTION OF THE NEURO- 
RETINAL CIRCULATION. 
By W. CHEATHAM, M. D. 
( With a wood-cut.') 
May H., age fifteen, a rather well-developed girl, anaemic in 
appearance, presented herself October 17, 1889, with the following 
history : On awaking on the morning of October 17th she dis- 
covered she was blind in her right eye. She has had frequent 
attacks of so-called follicular tonsillitis, having just recovered from 
a severe attack. When sick reads lying in bed ; has done a great 
deal of it lately. She has never menstruated. V : R = o, L = 
|-{f, with a -f- axis vertical = §#. The nerve and retina present 
such an appearance (except the vessels) as seen in embolism of 
central artery of retina. There is extensive exudation into nerve 
and retina, with a cherry-red spot at macula lutea. The retinal 
vessels present a very peculiar appearance. The arteries near the 
nerve were normal in color and size ; some of them about the 
equator of the eye appeared plugged with very dark blood ; one 
branch given off from a main artery below Was entirely empty ; 
most of the arteries on the nerve, and for a short distance off, had 
white streaks along each side. The veins from the periphery to 
the equator were filled with clotted blood, as the arteries were, so 
it was difficult to distinguish between them. A piece of the clot, 
about two or three lines in length, would break off from the large 
clot in the vein above, wash down some distance, disappear under 
a small exudation, and appear on the other side as a fine dust or 
powder, carried by a yellowish fluid, and washed out by this fluid 
into the central vein. As this piece of clot disappeared, the large 
clot did not apparently decrease in length, so it must be slowly 
moving. Most of the veins below had apparently no current, but 
were filled with small clots as they neared the optic nerve. I 
Reprinted from the Archives of Ophthalmology, Vol. xix., No. i, 1890. 62 
W. Cheatham. 
ordered Flexner’s syr. albuminate iron, with quinine and strych- 
nia, and pot. iod. There was no heart complication. Mr. J. A. 
Flexner examined her blood in my office, and found the corpuscles 
normal in quantity, but carrying only 67 # of haemoglobin. He 
also found her urine deep yellow in color ; sp. gr. 1,015 J no 
albumen ; oxalate calcium present ; Indicans and pus present ; 
reaction acid ; sediment abundant ; sugar, uric acid, phosphates, 
bile, blood, and mucus absent ; pavement-epithelium abundant ; 
hyaline casts present, but not numerous ; urea only r.6 $. 
October iZth.—The exudation has increased, the outlines of the 
nerve very much less distinct, and the cherry-red spot at macula 
is nearly gone ; the retinal circulation is better ; the artery below, 
which was better yesterday, now fills every few minutes, then 
again empties ; both arteries and veins pretty well filled, but the 
current can still be seen in the veins flowing slowly, and now the 
current in the arteries can be seen distinctly. No pulsation in 
either arteries or veins ; the clots in the extremities of the vessels 
are nearly gone ; the blood in both veins and arteries appears 
finely granular. 
October igth.—Exudation still increasing ; current in vessels 
can still be seen ; artery, which was empty, now full. 
October 21 st.—Exudation increased ; two small hemorrhages 
near macula, vessels all full, and no current discernible, Peculiar Affection of the Neuro-Retinal Circulation. 
63 
October 2$d.—Exudation much less. R V = o. L V = f{, with 
correcting-glass. 
November 20th.—Nerve and retina atrophied. 
This case does not appear to me to have been embolic in 
character in the beginning, but more like one in which a 
diseased condition of the vessels themselves was the 
original cause; it answers more closely to some of the 
series of cases reported by Dr. Ole Bull, under the title, 
“ Pathological Alterations of the Retinal Vessels,” at the 
Ninth International Medical Congress.