Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Science
Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Glaucoma
I am firmly convinced that every glaucomatous patient, and I now refer
to those who are the subjects of chronic progressive glaucoma, should be
carefully studied from the general standpoint by the oculist with the
aid of an expert internist, just as I am convinced that the modern
expert internist should not study his cases of cardio-vascular disease
without the help of the oculist. Perhaps I am going a little far afield,
but in justification of my statement I want to quote the opinion of Dr.
Hobart Hare, one of America's most expert clinicians, on blood pressure,
because it seems to me much harm has been done by the more or less
brutal knocking down of blood pressure simply because blood pressure
above the normal existed. "Concerning the matter of high blood
pressure," writes Hare, "independent of cerebral lesions, the longer I
study the matter the more convinced I am that this blood pressure is
devised by nature to compensate for fibroid changes in peripheral
vessels, in order that tissues which would otherwise be cut off from
adequate blood supply may receive plenty of blood, and I consider it one
of the most vital points to ascertain whether a pressure is what may be
called the patient's pathological norm, that is, the pressure which is
required in the face of vascular changes, or whether this pressure is in
excess of his pathological norm. If it is in excess, measures directed
to bring it to the pathological norm should be instituted, but if the
pressure found proves to be the pathological norm it is a bitter mistake
to lower it, be the pressure what it may. If it is lowered below the
pathological norm, all manner of disturbed cardiac action, etc., may
result. There is no more reason for reducing a blood pressure below his
pathological norm than there is for reducing it below his physiological
norm. The adjustment of a man's blood pressure to his pathological norm
often has to be as correctly done as the adjustment of a watch which is
losing or gaining time."
I shall not quote Hare's elaborate methods for determining these various
points because they do not belong to a paper of this character, but I
quote his admirable advice because it emphasizes what I believe to be an
essential in the treatment of chronic glaucoma, exclusive of operative
work, that is, the intelligent co-operation of the oculist and the
internist.
Public-domain text, read in full here on John Shaqi.
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