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.

    109/978
    ;! sr’rom the opening to the orbitary process of the frontal bone, it measured three j Gaelics; to the frontal sinus of the opposite side, and to the posterior wall of the ipavity/three inches and a half. With the finger the posterior wall of the sinus jL’as distinctly felt. The anterior wall was thin and spongy. The cyst was thick, iirnd where it had been attached, almost cartilaginous. Internally it formed several itibbcs, containing a yellowish fluid. ii The sinus was filled with lint, and after some days discharged a quantity of ;.hain ichorous matter, for w’hich injections of willow' bark decoction, with myrrh, :»t?ere employed. After a time injections containing corrosive sublimate were used, ,»uut, bringing on salivation, they were omitted. The internal treatment w'as at ji-rst antiphlogistic, but when the ichorous discharge came on, bark was given, jrrhe swelling subsided only in an inconsiderable degree when the patient left the ^I'ospital. In the winter 1819-20 she returned, with the swelling in the same i: tate, and the discharge of matter still as abundant. Langenbeck now passed j-.wo setons througb the sinus, by wdiich means the discharge and the swelling ji iminished.9 ii Case 76.—A ploughboy, of 20 years of age, 11 years before his admission ^ nto the hospital, had, while playing at tennis, received a stroke with a racket i n the left side of the nose, and on the left eye, the consequence of which was I .great degree of sw'clling, which, after a time, completely disappeared. Two ; ears afterwards, he began to feel pain in the part, and observed a protuberance 5 t the inner angle of the eye. i When the patient came to the hospital, Langenbeck found the eyeball natural b 1 form, the power of vision not affected, and the pupil lively. The eyeball, how- p ver, was pressed outwards and downwards, by a considerable sw'elling at the iii iner angle of the eye. Tlie swelling had exactly the appearance and the if ituation of a greatly distended lacryinal sac, but was considerably bigger than w'e ielmost ever find the sac, even in its state of greatest enlargement. That this ij'welling did not consist in an enlarged lacryraal sac, Langenbeck concluded from ip. is not being able to empty it, no mucus or tears being evacuated from the puncta i n pressure, and the tears being duly conveyed into the nostril, without dropping (ji;pon the cheek. The patient’s voice was similarly affected as that of one with ii' lolypus in the nose. The swelling communicated an obscure impression of fluctua- t: ion. At the inner side of the swelling, or towards the nose, it was bounded by (>. sharp edge of bone, which was felt exactly where the nasal process of the upper i : naxillary bone rises by the inner side of the orbit. As the surface of the swelling t vas not covered by any layer of bone, but felt soft and fluctuating, it was not easy ! o form a jiroper judgment regarding its seat, and one might have readily fallen |: nto the error of supposing it to be an enlarged lacrymal sac. Against such a r upposition, no doubt, there was the remarkable displacement of the eye outwards |i ind downwards. As the swelling also extended from the inner angle upwards jimd towards the frontal sinus, Langenbeck concluded that that cavity was the ii eat of the disease. i; An incision being made from above downwards, close to the sharp edge of bone ipvhich was felt at the inner side of the swelling, and in such away as to avoid both jl he lacrymal sac and lacrymal canals, after the soft parts were sufficiently divided, |» I white glistening sac came into view. On touching this with the finger, it was b ivident that it contained a soft mass. Langenbeck separated the swelling as much IS ])ossible ; but as he found that it extended deep into the nostril, he opened it, I vhereupon there issued from it a greyish-white tenacious substance. He cut away j-' vith the scissors as much as he could of the sac, and introduced his finger into its h ;avity. Its depth amounted to 3 inches. With the point of his finger he reached ik'is far as the floor of the nostril. He could not reach the orbit, nor touch the •hyeball. He felt from the diseased cavity the inner wall of the orbit, formed by he os planum of the ethmoid, a part of the orbitary plate of the frontal, and the os unguis. This wall of the orbit, along with the lacrymal sac, and nasal duct, ■^vas pressed outwards; hence arose the displacement of the eyeball, while the i'joassage of the tears into the nose continued uninterrupted. Langenbeck intro- jMuced his forefinger up into the frontal sinus. He decided, therefore, that the (tfisease had originated there, and had descended by the side of the nostril. He 1 f ;ould now see into a large cavity filled with a greyish-white tenacious mass, which