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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    Sir Astley concludes this case by observing, than an exostosis on the external table of the skull, growing slowly, very little vascular, unattended with any considerable pain, may safely be made the subject of an operation; but that a swelling of more rapid growth, red upon its surface, showing signs of considerable vascularity, and attended with great j)ain shooting through the brain, is one for which he shoidd hesitate again to pei’form an operation. These latter characters belong not to simple exostosis, but to osteo-sarcoma. Case 74.—Sir Philij) Crumpton was consulted by a lady of about 55 years of age, on account of dimness of sight uffccting the right eye ; the eye felt exceed- ingly hard to the touch, was aftected with strabismus, and projected in some de- gree from the orbit; the pupil was immoveable, but vision was not altogether destroyed. She complained of severe shooting pains in the head and in the right arm ; her general health was much atfected, and her aspect almost cadaverous ; lier memory seemed much impaired, and there was a general insensibilitj' to ex- ternal impressions ; she was depressed in her spirits, yet she made but little com- plaint. On an attentive examination it was jilain that there was some fulness in the situation of the temporal fossa, but the tumour was perfectly indolent and in- compressible. Sir Philip did not sec the lady again for four or five weeks, when he found her nearly comatose; the swelling on the temple had increased to a considerable degree, and the eye was still farther protruded from the orbit. She expired in a few days, and on the day follow ing her death, the head was examined. On raising the aponeurosis of the temporal muscle, the temporal fossa was found to be occHjiied by a greyish-coloured substance, of the consistence of brain ; the muscle itself had completely disappeared ; numerous osseous spicuhe proceeding from the frontal and temporal bones, jiassed into the tumour, of which they con- stituted a considerable j)art. On opening the head, a tumour of jireciscly the same description, beset in the same manner by bony spicula;, w as found lodged between the dura mater and the internal orbital process of the frontal bone. On macerating the bone, it exhibited the most ]>erfect s^iccimen Sir Philip had seen of fibrous exostosis. The spiculse proceeding both from the outer and from the inner table of the cranium were each about as thick as a hog’s bristle, and Jfhs of an inch in length ; they were set as closely together as the hairs of a brusli, and extended in an undulating line over a space of about 2 scpiare inches in extent. The tables of the skull were slightly separated from each other in the part corresponding to the exostosis, and the diploe seemed to contain some of the same brain-like matter which formed the bulk of the tumour. Sir Philip thinks it impossible to decide whether the disease commenced in the soft parts, or in the bone; although it seemed probable that it commenced in the bone, because the spiculm were furnished by the bone itself, and not by the periosteum or dura mater, which were se])arated by the tumour to the distance of nearly an inch from the outer and inner tables of the skull respectively. Sir Philip observes that, in malignant osteo-sarcoma, it is more usual to find a deficiency than an excess of bony matter, for altbough spiculaj of bone are interspersed tbrough the brain-like substance which forms the bulk of the tumour, the bone itself is usually divested of its earthy basis, and is converted into a steatomatous or cartila- ginous substance. Sometimes, however, the tendency to secrete })hosphate of lime is surprisingly increased, and then large and sin- gularly-shaped masses of bony matter are thrown out from the sur- face of the diseased bone. The presence or absence of bony matter in an osteo-sarcomatous tumour will probably depend. Sir Philip thinks, on the relative activity of the secreting and absorbing sys- tems in the diseased bone, lie is also of opinion, that the varieties