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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    wounds must, in general, be similar to those described in the fol- lowing case by Wepfer, in which it is surprising that death did not ensue more speedily. Still more remarkable are those instances, in which gunshot wounds, traversing the orbit and the brain, have been followed by recovery. Case 46.— A huntsman, says Wepfer,'^ holding the upper end of his gun with his hand, accidently touched the trigger with his foot. 'I'lie piece went off, and two halls entering by the right side of the lower jaw, traversed the left orbit, and made their exit through the left parietal hone, near the lanibdoid suture. The left eye was driven from its orbit. The patient’s mind seemed entire, and he moved all his limbs, till the close of the 4th day. At that time he began to sing; but an hour or two before death, his spcecn became indistinct, although he still testified by nods that he understood what was saiil to him. He began to toss about his arms, as if in jiain ; short fits of a convulsive kind came on ; he raved during the night; and died on the 3th day. During life, a copious ichorous discharge took jdacc from the aperture in the jaw. t)n dissection, the course of the balls through the brain was traced from the parietal bone to the back of the orbit, and was observed to be filled with the same sort of ichor as had flowed from the jaw during life. The following interesting case of recovery from a gunshot wound traversing the orbit and the cranium, in several respects resembles Mr Cagua’s case of fractured orbit, referred to at page 4 :— Case 47.—A lad of 17 years of ago, was wounded by a muskct-ball, which, passing from below upwards, penetrated through the upjier li|), the right nostril, and the roof of the orbit into the cranium, whence it escaped at the upper part of the frontal bone near to the sagittal suture, where it made a large wound of the integuments, with loss of substance. Such a degree of swelling came on as made the head frightful. An incision was made over the wounded jiart of the orbit, whence, at the first dressing, there came out a portion of both substances of the brain, in bulk about the size of a small hen’s-egg. The eye was exceedingly swoln, especially the upper eyelid, into which an incision was made, to give issue to the blood which was sujiposed to be there extravasated ; but, instead of blood, there came out a splinter of bone and a portion of both substances of the brain, nearly equal to a third of the portion which had formerly come away. The wounds were dressed lightly, and the patient was repeatedly bled. Some small portion of brain was agaia discharged. On the 4th day, the brain appeared to be in a state of suppuration; and pn the .5th, the discharge became very considerable. From the time that he had been bled, the patient continued pretty well till the 11th day. Next day he was more feeble. On the Iflth day, the matter from the brain which had been discharged both from the wound above and from that below, was in part retained, and the jiatient fell into a state of drowsiness and general dejiression. M. Bagieu, who treated the case, having anew' examined the wounds with minute attention, removed a large piece of loose bone from the ujiper part of the skull. The jiatient did not appear to be relieved by this, but became worse till the 15th day, when every one exjiceted him to die. M. Bagieu remarked, that, on jiressing the skin where he had removed the piece of bone, pus oozed out, w hich made him suspect that there was an accumulation of matter at that ]dace. Led by'this idea, he removed the skin and some portions of dura mater, so as freely to re-establish the discharge. The pulse rose, the ]iatient was next day able to speak, and afterwards thesujipuration slowly subsided. About the 10th day, the fleshy parts began to granulate, and the wound on the upjier jiart of the headwia soon covered over. It was otherwise with that of the eyelid, where supervened a considerable fungus, occasioned by the sjdintcrs separating from the neighhour- ing bone. In spite of cutting and burning this fungus, it was found necessary to wait patiently tilt all these siilinters had come away ; after w hich the excrescence was easily destroyed, the wound closed, and the patient reciivercd completely. The following sut eessfiil case is related by Professor Ansiaux :