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 bones; while, in other cases, the bones appear to be first affect- ed, so that the disease is, in fact, osteo-sarcoma. That the direction of the pressure of a fungus within the antrum, is different in different cases, is a fact of which I am fully convinced, from the'cases which have come within my own observation. In some, chiefly children or adolescents, the principal protrusion is for- wards and outwards, so that the floor of the orbit is less disturbed; in others, the pressure is chiefly inwards, so that the tumour speedily makes its appearance in the nostril, destroys the septum narium, and rises into view at the inner canthus of each eye, covered only by the integuments ; while in a third set, and these chiefly old people, the fungus makes little or no pressure outwards, but proceeds inwards and upwards, causing absorption of the floor of the orbit, destroying the soft parts within that cavity by exciting inflammation and suppu- ration, and lastly affecting the orbitary process of the frontal bone. I cannot better illustrate the effects produced on the orbit by polypus or fungus of the maxillary sinus, than by relating the follow- ing case :— Case 81.—James Macculloch, a^ed 53, who l)ecaine a patient, under my care, at the (Jlasgrow h>ye liiHrmary, in February 18iJ8, stated that he had been sensi- ble of a stuffing of the right nostril for some years ; that six months before his admission, he had been attacked with supra-orbital pain, darting towards the right side of his head ; and in a short time after tliis, with ])ain in the region of the right maxillary sinus, stretching tow'ards the floor of the orbit, and increased w lieu he opened his mouth. This was soon followed by stillicidiurn lacrymarum ; a soft clastic .swelling, in the situation of the right lacryrnal sac; and protrusion of the eyeball forwards, outwards, and upwards, from the orbit. He complained of a want of the sense of taste in the right side of his mouth. He slejit little, on account of the jiain above the eye. t)n c.xamining the jialate, it was found to be yielding and elastic under the right maxillary sinus. For several weeks, the vision had been double, in consequence of the displacement of the right eye. The conjunctiva was inflamed, the eyelids adhered in the morning, and in consequence of the exposed state of the iirotruded eye, a small ulcer existed at the lower edge of the cornea. The right nostril was found to be tilled liy a polypous excrescence, of a white colour, and medullary texture, which bled i)rofiisely on being touched. After clearing aw ay this substance with the polypus-forceps, a carious opening, sufficient to admit the end of the little finger, was found to exist between the nostril and the maxillary sinus. With the finger, introduced through this open- ing, it was ascertained that the sinus was completely filled with the same kind of polypous excrescence w liich had occupied the nostril. The clearing of the nostril w’as performed on the 1‘Jth ; and it is remarkalile, that this had so much relieved the pressure on the orbit, that five days after, when I j)rocecded to open the max- illary sinus, the ulcer of tlie cornea was already cicatrized, evidently in conse- quence of the eyeball having retreated somewhat into the orbit, so as to allow it to be better defended by the lids. On the 24th, I made an incision, oblique in its direction, from above down- wards, and from without inwards, through the cheek, down to the bone, with the intention of oj)ening the sinus, and removing its contents. I found, however, that the polypus had already produced absor|)tion of the outer w’all ot the sinus, to the extent of half an inch in diameter. Through this opening, the polyj)us was broken down and extracted. It resembled brain in colour and consistence. The bony parietes of the sinus were felt throughout to be diseased ; its nasal side much disorganized; the os unguis gone; the orbital side, and indeed the whole interior of the sinus, denuded of its lining membrane. A long dossil of lint w'as introduced into the sinus. In a few days, a jirofuse secretion of white ftetid matter flowed from the whole of the internal surface of the sinus, on removing the dossil ot lint.