A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones.

Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    The turbinated and cellular apparatus on the left side of the nose were destroy- _ ed ; the septum nasi was pushed towards the right side, so us nearly to obliterate ■ the right nostil; and the left orbit was thrust outwards. After a time, the tumour displaced the inner wall of the orbit ; and the globe of the eye, being thus subjected to pressure, became the seat of most excruciating pain, though vision was very little impaired. Wlien the patient was about the age of 19, the eye, yielding to the pressure, burst, and discharged its fluid contents. In less than an hour after this took place, the patient, who had been deprived of rest during several weeks, was buried in profound sleep. He awoke nearly free from pain ; and this comparative ease continued. When he had reached the age of 30, the tumour was observed to bo somewhat loosened, and to be becoming detached by ulceration of the surrounding soft parts. The process of detachment was alleviated by coj)ious suj)puration, and occasion- ally by profuse hsemorrhagy from the vessels of the adjacent structures. For a time, the tumour was retained merely by bands of integument, which it would have been easy to divide. At length, several small irregular portions of bone came away; but the large mass continued to be maintained in its situation until the i transverse bands were divided by ulceration, when to the patient’s astonishment, S the whole tumour fell from his face. Neither pain nor bleeding attended this i separation ; but a large chasm was left, between the nose and the orbit, bounded below by the nasal surface of the hard palate, and the floor of the left antrum, ; above by the left frontal sinus and left half of the cribriform plate of the eth- i mold bone, internally by the septum nasi, which presented a concave surface, with a small opening through its lower part, communicating with the right nos- ' tril, and externally by the left orbit. Posteriorly, the chasm opened into the jjharynx. When Mr Hilton drew up his account of the case, the roof, the outer wall, ; and part of the inner wall were covered with granulations. On comparing the ■ distances from the median line of the face to the malar edge of-oach orbit,that on S the left side was found to l>e nearly an inch greater than that on the right. The f left eyebrow was elongated in the same direction for about half an inch; and the » cerebral cavity appeared to be encroached upon by the pressure of the tumour 'J_ upwards. .B The tumour weighed 14J oz. Its specific gravity was 1.80. Its greatest cir- B cumference measured rather more than 11 inches, and its least 9 inches. Exter- B nally it was undulated, and its posterior surface concave. A section of it presented S a very hard surface resembling that of ivory, with lines, to the number of 50, B arranged in concentric curves, enlarging as they proceeded from the posterior ]>art B of the tumour. Dr Hodgkin regarded it as referrible to the type of compound |B serous cysts.'® ;i Case 72.— Cvp-like exostosis of the edge of the orbit. Acrel relates a case of this sort under the title of spina ventosa of the right orbit. The bones forming p that cavity,especially the frontal and superior maxillary, were so much protruded, as to present the appearance of a blunt cone, 4 fingers’ breadth high, and about the same in diameter at its basis. He compares it to a small cup inverted, in the bottom of which, or end which was turned outwards, was the eye. This was not completely sound and clear, and was smaller than the left eye; it had eyelids, which were moveable, and the other parts belonging to it, and even served to dis- tinguish large objects pretty well. Acrel considered the case incurable. He mentions that he had seen another case of the same sort, for which also he regard* ed it useless to attempt any operation.''^ § 4. Osteosarcoma. Osteo-sarcoma, by some called fibrous exostosis, and by Sir Astley P. Cooper fungous exostosis of the medullary membrane, sometimes attacks the skull, and involves the bones of the orbit. The disease consists in the development of a fleshy tumour, in- volving the substance of a bone; taking its rise sometimes from the surface, but more frequently within the spongy tissue of the bone t