Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson.

  • Robertson, J. Argyll.
Date:
1844
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Credit: Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    protrusions, and the growth of tlie tumour is owing to the vessels of the surrounding textures continuing their abnormal secretion. In carcinoma, on the contrary, the skin becomes affected witli mahgnant ulceration, and fungous protrusions take place, accom- panied by fetid discharge, hemorrhage, and sloughing. Although melanotic deposits are often met with, in the same man- ner as tubercles, distributed in various organs in thesameindividual, I am not aAvare of any instance of the disease being propagated to the neighbouring glands by absorption, as we see in carcinoma. In the six cases operated upon, incisions were made into the tumours some time prior to operation, and serous fluid tinged with the black deposit escaped. There was no bleeding, and no subsequent fungous protrusion such as occur in carcinoma. Further, melanosis, in as far as 1 have had an opportunity of learning, occurs only beyond the middle period of life. Finally, the result of excision of the eyeball in cases of melan- osis and medullary carcinoma, proves the dissimilarity of the two diseases. In all the cases in wliicli the melanotic deposit was within the eyeball, so as to render its entire removal certain, a cure was effected; whereas in only one case of medullary carcinoma did success follow the operation. In unsuccessful cases of medullary carcinoma, large fungous growths, accompanied by severe pain, frequent bleedings, and profuse fetid discharge, followed ; whereas in the case of melanosis, in which the suc- cess of the operation was doubtful, there was no protrusion, n& hemorrhage, and the only local symptom which indicated that the disease might not have been eradicated, was a constant pain in the back part of the orbit, and a sanious discharge. From the hollow condition of the orbit, and contracted state of the eyelids, the surface of the cavity could not be well examined. The patient died from an apoplectic seizure eleven months after the operation. No post mortem examination took place. I*]ven in this case it is doubtful whether the disease remained in the orbit after the operation. It was more hkely to do so in this instance than in the others, as the melanotic matter was not limited to the interior of the eyeball, but occupied nearly the whole orbit, and consequently its entire-excision could not with certainty be determined. Symptoms of Melanosis.—This disease may commence either within the eyeball or in the orbit exterior to that organ. In neither case are marks of inflammation necessarily present. When it takes its origin within the sclerotic, vision is impaired and ultimately lost. In the early stages I am not aware of any means of diagnosis between this affection and amaurosis. The pupil in both is dilated, and presents the same liorny, black colour ; and the iris remains stationary under every change of hj^ht. But as tlie melanotic deposit hicreases in quantity, the ins and lens arc pushed forwards towards the cornea, so as to diminish or altogether to obliterate the anterior chamber. At this