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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    ii large venereal node occupying the upper edge of the orbit. Exos- cosis is often combined with greatly thickened periosteum. ( A node is not unfrequently affected with secondary inflammation; I :t then becomes more swoln, and tender to the touch ; it coramuni- j 'cates a feeling of fluctuation, and a flow of matter is looked for on j ilividing it with the knife. Pus is sometimes discharged under such I'bircumstances, while in other cases a reddish serum only escapes rjy the incision. Periostosis of the orbit, except when syphilitic, and brought under jildie influence of mercury, is not likely to be either readily recognised jtor successfully treated. I Case 58.—Mary Falkner, aged 33, of a florid complexion, married, and who I; had Iiad three children, the first two alive and healthy, the last a miscarriage at i 7 months, applied to Mr Hamilton at the South Eastern Dispensary, Dublin, com- plaining of gi’cat pain in the left eye, and side of the head, with impaired Hsion. There was a considerable protrusion of the eye; the left eyelids, and especially the uj)per, was swoln and j)ufly, so as to fill up the usual depression beneath the eyebrow ; they were of a dull red colour, and streaked with veins. The eyeball , presented no marks of inflammation, only a few tortuous veins being seen at its 1 upper and inner part. The iris was of a greenish hue ; the pupil was natural in f size, but not in form, being transversely oval; while at its upper and back part, a 1 bright green spot, of irregular shape and metallic lustre, was very distinct. The j pain was most intense, and was referred to the eyeball, but darted also into the head, the whole left side of which was affected ; it was worse at night, and dc- ] prived the patient of sleep, and was aggravated by the least motion of the body • or eye, and by lying on the affected side. There was a distressing feeling of sand in the eye, probably produced by the friction of the tense eyelids over the pro- vtruded ball. Sight was much impaired, and on looking down objects were seen ' double. Muscffi volitantes were constantly before the eye. The patient complain- ed of giddiness. Pulse quick and full. Tongue furred. Tliree months before consulting Mr H. she had miscarried, and supposed she had got cold, as the eyes became painful, and the eyelids red and swoln. From that period, the pain gradually increased, and vision diminished. At first sight, Mr H. was inclined to regard the case as one of incipient fun- gus haematodes ; but the woman’s healthy appearance, and the circumstance of vision, though itnpaired, being still retained, led him to doubt the soundness of this opinion. He next suspected the presence of matter, or of some tumour in the orbit, but the most careful examination failed to detect either. As the symptoms were such as warranted the conclusion that some of the tissues of the eye were inflamed, he resolved to try antiphlogistic treatment. Leeches, cujiping, blisters, and active purgatives were resorted to, without the least benefit. Finding the symptoms daily becoming worse, Mr H. asked the ad- vice of another surgeon, who declined giving any decided opinion as to the nature of^ the disease, pronounced a most unfavourable prognosis, and recommended a trial of small doses of oxymuriate of mercury. As the stomach was now so irritable that this medicine could not be borne, it was given up; and after some little time, the patient was admitted into the Meath hospital. The prominence of the eye was now so much increased, that it had the appear- ^ice of being larger than the other, and the eyelids could not be completely closed. The protrusion was downwards and outwards. The pupil haHng been dilated by •belladonna, it did not return to its natural size, and appeared to be prevented from contracting, by the lens being pushed against it. It had still the same oval I form, and its lower edge was turned in. The metal-like spot now appeared much I more forward, and seemed to occupy the whole of the pupil, giving it a greenish t and rather opaque look, while a small brown waving line, like a blood-vessel, was V -seen crossing it. The patient had no relief from the jiain, night or day. Mitigat- 5 ed for a short time by leeching, it soon returned worse than ever. The stomach became so irritable, that nothing would stay on it. Vision was reduced to a per-