Clinical report [on cases in the Edinburgh Surgical Hospital] for the winter session 1834-35.

  • Syme, James, 1799-1870.
Date:
1835]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical report [on cases in the Edinburgh Surgical Hospital] for the winter session 1834-35. Source: Wellcome Collection.

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    off in flesh considerably. Her appetite was impaired, and her bowels were moved with difficulty. The first appearance of the disease had been remarked fifteen months before, when a small speck of variable colour appeared in the back part of the eye, without pain or defect of vision, from both of which symptoms she began to suffer in November last. As no doubt could be entertained that a medullary fungus existed in the eye, the case seemed equally desperate, whether allowed to proceed unchecked or subjected to operation—but as excision is still believed by many to afford a chance of escape, if executed early, before the disease shows itself externally, it was resolved to perform it. On the 10th, I divided the eye¬ lids at their outer commissure, to obtain sufficient room, then cut through the reflexion of the conjunctiva, and lastly, detached the eyeball by a knife guided on the finger.* It now appeared that the morbid growth had proceeded backwards from the sclerotic coat, surrounding the optic nerve, and pressing the eyeball forwards. Some of this soft pulpy substance was taken away, but as it seemed plainly impracticable to remove the whole of it, the attempt was not prolonged. Some pieces of lint introduced into the orbit sufficed to arrest the bleeding, and the child required very little treatment afterwards. Hardly any constitutional disturbance followed, and a remarkable improve¬ ment in the general health was soon perceived. Advantage was taken of this temporary improvement to send her home, where, as was to be expected, the disease, I am informed, has again appeared. In adding another instance of unsuccessful extirpation of the eye for medullary degeneration to the many which are already upon record, I cannot refrain from expressing my conviction that it would be better both for the interests of humanity and the credit of surgery if this operation were entirely abandoned. The melanotic disease of the eyeball has been repeatedly re¬ moved, if not with permanent success, at all events with relief of considerable duration ; but the true medullary affection, sufch as is so often met with at an early period of life, does not, I be¬ lieve, admit of any salutary interference. Cases like that which has just been related do not afford a sufficient argument against the operation, because the existing disease being in them not era- dicable, no evidence can be obtained from their result to show that excision may not prove effectual under more favourable circumstances. In the following case, the parts affected were in the most promising state that it is possible to find them. Ilobert Scott, aged 3 years, was admitted into Minto House on * From repeated trials, I am satisfied that the most convenient instrument for the purpose is a pair of probe-pointed scissors curved on the side.