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 most excruciating pain; he was continually moaning, and rolling his head from one side to the other, or holding it fixed in a state of apoplectic insensibilitv. His pulse was 140, small, irregular, feeble; bowels acting imperfectly; skin of variable temperature. He had been bled to the utmost verge of j)rudence, and the only means that could be judiciously ein])loycd were merely palliative. His respiration became hurried ; and at times laborious and stertorous, presenting nearly an a|)oplectic character. Mlood was taken, after his a<lniission, from the temporal artery, but no inii)rovement was observable. The affected eye and its appendages were much swoln, but the wound was scarcely, perceptible. He died on the 12th. Much interest was felt in this case, for it was imagined the pipe must have broken the orbitary process, and penetrated the anterior lobe of the cerebrum. On raising the calvaria, the membranes were found a little more injected than natural, but no other morbid a|)])earance was discovered in the whole cerebral mass, save a little o|)acity of the j)ia mater covering the pons Varolii. This was I found to be ojjpositc a portion of discoloured dura mater, extending over the left ' cavernous sinus. An oj)cning was made into this cavity, and a piece of pipe, an > inch long, was discovered thrust between the nervus abducens and the carotid artery. Extensive disorganization of course prevailed throughout the whole sinus ; and the existence of a foreign body of such size, in such a centre of nervous syinj)athy, was considered not inadequate to account for the severity of the symp- toms. No extravasation, however, had taken place, no penetration of the dura( mater, nor any fracture of the orbitary plate. The pipe had passed under the roofof the orbit, and entered the cavernous sinus, by the spheno-orbitary fissure. ‘ The carotid, though contracted a little in diameter at its point of contact with 1 the intruded body, was vet sufficiently pervious.^6 J ( § 8. Incised JVounds of the Orbit. t Sabre wounds of the liead have sometimes been attended by a cleavinir of the orbit; and, in some rare instances, tlie orbit has • been laid open, by an entire separation of part of its parietes, so as to expose its contents to view. The following cases illustrate this class of injuries of the orbit:— CrtAC.31.—Marchetti shortly states the case of a German soldier, who was wounded in the forehead with a broad and heavy sword. The frontal bone and^ the brain were divided, down to the eyes, and the patient was immediately deprived of sight. In two months, he recovered from the wound, but continued blind, with the pupils clear.^ Case 32.—Edward Power received a desperate wound with a back sword, ex- tending from the toj) of the frontal bone to the orbit of the left side, terming an extended and frightful chasm, in which were included the bone, membranes, and brain. The wound bled considerably, and was for nearly three hours exposed to the open air, the patient not having so much as a rag to cover it. Fever and in- flammation of the brain might have been apprehended ; yet, by a couple of bleed- ' ings, and some other antiphlogistics, the man was completely cured in five wceks^ without exfoliation, or the smallest operation.38 The following case shows the propriety of attempting union by the first intention, even when part of the osseous parietes of the orbit is completely separated by an incised wound. Case 33 A young man received a wound with a cutting instrument, extend- ing obliquely from the upper part of the left temjioral fossa, across the root of the nose, to the rif^ht fossa caniua. This wound divided the skin, the temporal branches of the portio dura, the anterior auricular muscle, part ot the teinj)oral muscle, orbicularis j)alpebrarum, and corrugator sujicrcilii, the frontal branch of the oi)hthalmic nerve, and the superciliary artery. These parts hanging over on the cheek, formed a flap, in which were also present a portion of the orbitary arch of the frontal bone and its e.\ternal angular process, so that a portion of the cavity of the cranium was laid ojteii, as well as the cavity of the orbit, exposing to view