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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    ception of light and shade. The irritability of stomach was allayed by the appli. % cation of a blister, but the other symptoms became worse, and she left the hospital despairing of relief. Although different views were taken of the case by the surgeons of the Meath hospital, yet the general impression was that it was malignant. The extent and severity of the deep-seated pain of the head, giving rise to the suspicion of the brain being implicated, seem to have deterred the medical attendants from proposing excision of the eye, an operation to which the patient, from her suffering, would readily have consented. About a week after she had left the hospital, Mr H. on carefully examining the eye, pressed hard on the orbit, which gave so much pain, that the existence of periostitis instantly struck him. Further examination showed the whole upper and inner part of the orbit, as far as the swoln lid allowed him to ascertain, to be equally tender, leading to the conclusion that the disease extended still farther back. On the supposition of inflammation of the periosteum, and consequent effusion between it and the bone, the pain, swelling, and protrusion of the eye, seemed fully accounted for. The patient now, for the first time, confessed that she had been infected by her husband eight years previously, and had taken mer- cury, soon after which an eruption had showed itself, and subsequently sore throat. She appeared also to have had iritis, and, for the last four years, had been occa- sionally troubled with pains in the bones. The disease being understood, the treatment became obvious. She was put on calomel and opium, with decoction of sarsaparilla. Salivation took place, and by the end of 6 weeks, she had lost all pain, and had regained her health and spirits. The eye had nearly returned into its place in the orbit, the swelling had left the lids, and vision was sensibly improved. Nine months after the time she first consulted Mr H. there was no difference between the two eyes in a])pearance ; her sight was tolerably good, though still misty ; and she had experienced no return of pain. Mr H. conceives the inflammation, in this case, to have terminated, in an effu- sion of serous fluid, between the bone and periosteum, which effusion had finally become cartilaginous. Had the disease been a mere thickening of the periosteum, he thinks the protrusion of the ball would scarcely have been so great; had it been a bony swelling, though the pain might have been subdued, the bony mass would have remained, and kept up the exophthalmos, or would have yielded only to a protracted treatment; had it been a purulent deposition, the disease would have run a more rapid course, and the exhibition of mercury have probably proved ineffectual.* Case 59.—Mr Swentman is mentioned * as possessing a remarkable specimen of scirrhous periosteum. A woman, about 70 years of age, in the cancer ward of the Middlesex hospital, had carcinoma of the breast. About a month before she died, one eye was observed to protrude; and 3 days before her death, she suddenly became comatose. Upon examining the skull, it was found that the pericranium, orbital periosteum, and dura mater, on the affected side of the head, were tliick- ened and hard. The dura mater was, at one part, the third of an inch in thick- ness. The arachnoid adhered to it, and partook in the thickening. The bone was somewhat more vascular than usual, but not otherwise diseased. § 2. Hyperostosis. laflammation of a bone being arrested before the occurrence of ‘ disorganization or death of the part, the consequence is sometimes hyperostosis. It is this process which, in some cases, and these generally complicated with atrophy of the brain, slowly thickens the bones of the cranium, without perhaps exciting any suspicion of the existence of such a state, till epilepsy or mania, and ultimately death are produced. The bones of the orbit are liable to the same pro- cess; the cavity will thereby be intruded upon; its contents pressed together; and the eyeball pushed forward from its natural place, and at last destroyed. T-w'iiiMKiwmi n -- ’