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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    Case 24. —A robust labourer, aged 51 years, while eutting wood iu a forest, on rithe morning of the 2d April, stumbled over the root of a tree, and with the whole v.weight of his body drove the end of a file, which he held in his hand, against his ;deft°eye. The file broke across, and a portion of it remained in the orbit. The i patient was carried, in a state of insensibility, to a small town some miles off, where rlthree surgeons tried by turns, but in vain, to extract the foreign body,which, with tithe ])robe and the forceps, they felt distinctly, through the wound, beneath the ■tmidtlle of the eyebrow. They enlarged the wound with the knife, and during ■ ithree days made reiterated attempts at extraction ; but the foreign body continued immoveable. On the 4th day, the patient was brought to the surgical clinic at Prague. The . eyelid was greatly swoln, and in the middle of it there was a triangular wound, i with inverted edges. The eyeball was motionless, and was so j)ushed downwards and i. outwards that it almost lay on the cheek, carrying the lower eyelid before it. The cornea presented a more than ordinary degree of lustre. The patient was almost 1,' comatose. Professor Fritz endeavoured, by means of strong pincers and polypus-forceps, • to withdraw the foreign body, but these instruments bent under tlie pressure. At last, with a pair of small but very strong lithotomy-forceps, which ha grasped with both his hands, he succeeded in extracting the piece' of the file. It was triangular, measured an inch and a half in length, and was denticulated to its point, which •• was blunt. The i)atient answered questions very slowly, or not at all; his face was pale . and sunk, his eyes were shut, aud he lay motionless, except that he often raised ihis left hand to the left side of his head. Respiration slow ; pulse oppressed and hhard. The wound gaped widely ; the eyelid, almost completely divided into two ■ lateral halves, was of a dark red colour, and so much swoln as to allow only a -small portion of the displaced eyeball to be seen. Notwithstanding the repeated use of venesection and of leeches, and constant ■ cold applications to the eyes, the cornea filled with ])us,and giving way about the : 12th day, allowed the iris to protrude. The cornea was ultimately left in an opaque and atrophied state. The wound suj)purated abundantly, and for some time a probe could be passed along it, in a direction backwards and inwards, be- neath and through the orbitary portion of the frontal bone, to the depth of five inches, without causing pain. At length the wound closed, the upper eyelid re- maining palsied. The patient’s general health was j)erfectly restored. Case 25.—A girl, 10 years of age, playing along with other children, near a cotton-spinning machine, fell upon one of the pointed iron spikes, 5 or 6 inches long, on which the bobbin is placed. This instrument penetrated to the depth of about 2 inches into the orbit, between the inner wall and the globe of the eye, and then broke across, so that 2 or 3 lines’ length of it projected above the level of the skin. Attempts were made to remove it,but so much difficulty was experienced that these attempts were not persisted in. Tendays afterwards the piece of iron was found protruded to the length of 9 or 10 lines ; a month afterwards, it was still more protruded; in fact, it now held apparently so slightly, that it was laid hold of with the fingers and extracted. Scarcely had this been done, when the child was seized with convulsions, and died in a quarter of an hour. The sight had not been affected during the residence of the foreign body in tlie orbit, nor had its presence there excited any very marked symptoms. The child had always been able to go about. 7. Eyeball dislocated. It is important to observe that mention is made by difterent surgical authors, of the eyeball being dislocated, or pushed out of its socket by a foreign body thrust into the cavity, or traversing the sides of the orbit. Now, in such cases, it is neces- ■ sary not only to remove the foreign body, but to reduce the eye. This has sometimes been done with complete restoration of vision. By being dislocated, or pushed out of its socket, is to be under- stood, that the eyeball is extruded beyond the fibrous layer of the