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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    i umbrella point had pierced the intervening parts to the left crus cerebri, which was quite destroyed. Beyond this, it had passed into the right lateral ventricle, i and must have jjenetrated the central parts of the brain to the dejith of at least I two inches. The sphenoidal cells were extensively fractured. The quantity of I blood effused at the basis of the brain was by no means great; and although the igradually increasing extravasation was probably one great cause of the patient’s lideath, the incoherence and excitement which marked the few hours that he sur- '■vived the accident, must be ascribed to the irritation and inflammation arising t from the extensive laceration of the brain and its membranes.'® , 3. Suppuration—Convulsions. The case which I am now about t to quote, serves at once to confirm what is proven by the preceding i’ cases, namely, that at the first there may be nothing alarming, I except the suspicious situation of the wound; exemplifies a symptom which has ever been regarded as an exceedingly dangerous, if not ■ fatal one, in injuries of the brain, namely, convulsions; and illustrates, in accidents of this kind, both the date and the eft’ects of suppuration. : The earliness with which matter is formed by the tunica arachnoidea, in cases of wounded brain, is a remarkable circumstance, and is - strikingly proven by the case already quoted from Sir G. Ballingall’s Clinical Lecture. With regard to the convulsions which arc caused by irritation of the brain, and which, not unfrequently, appear immediately or very ' soon after a severe injury of the head, it may be observed, that they are probably the effect rather of pressure from fractured pieces of bone or effused blood, than of any change in the cerebral structure, and are attended with comparatively less danger than those caused by disorganization of the brain, consequent on inflammation. The 1 latter usually occur along with strabismus and coma, some time after ■ the setting in of the symptoms called secondary, from their occurring days or weeks after the injury, and are almost invariably the fore- runners of death. Case. 19—A soldier was brought to the hospital at Brest, at eleven o’clock in the evening, having been wounded with a jntchlbrk, at the middle of the left upper eyelid. The wound was oblique, about three lines in length, and appeared to implicate only the skin and orbicularis ])alpebrarum; there was very little blood discharged; the eyelid was distended, and the conjunctiva inflamed. The apparent simi)licity of the wound, the goodness of the pulse, and the free exercise of all the functions, led to a favourable jmognosis ; the patient asserted that he had experi- enced nothing particular at the moment of the injury, and liad scarcely been stuj)ified by it. Compresses dipped in brandy and water, were applied over the wound. The patient rested during the night; next day, he was quite lively, walking about in the wards, complaining only of slight jiain in the wound, and even eating with appetite. The same day, at seven in the evening, he was seized with convulsions, which were supposed by his attendants, to be epileptic. Tlie ^ ay alter, he was kept from food, and bled at the arm ; the convulsions returned, and lie was bled at the loot. Vomiting, uneasiness, agitation, and delirium came on ; the jmlse became small and contracted ; cold sweats succeeded, and the patient died at two o clock next morning. ' On dissection, the eyelids were found mdeinatoiis, and the wound had already closed. On cutting through the upper eyelid and orbicularis palpebrarum, a circumscribed collection of pus was found in the orbit, between its roof and the levator palpebne superioris. This collection of pus communicated with the cranium, through the orbitary plate of the frontal bone, which had been penetrated by one of the prongs of the fork. After removing the eyeball, the interior wall of the orbit was found fractured, and depressed almost complctelv