Cases of syphilitic affection of the third nerve, producing mydriasis, with and without ptosis / by Victor de Méric.

  • Méric, Victor de, 1811-1876.
Date:
[1869]
Catalogue details

Licence: Public Domain Mark

Credit: Cases of syphilitic affection of the third nerve, producing mydriasis, with and without ptosis / by Victor de Méric. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    what enlarged; but they were always so, according to the patient s state- ment. The occipital glands were very distinct; and one gland, of the size of a pea, could be felt near the left elbow. The patient was ex- tremely careful of himself, scrupulously clean, and maintained that he had never perceived the slightest primary symptom about the parts of generation or elsewhere. He was ordered to take one grain of iodide of mercury every night, and to apply mercurial ointment to the hands. The treatment was carried out for three months, during which time the hands quite recovered ; but papules appeared on the hairy scalp, and the tonsils enlarged considerably. A few very slight relapses had to be combated for a few months afterwards ; but the patient soon recovered his usual health. In January 1869, seventeen months after he had first been attacked with syphilis, the patient came to complain about the sight of the left eye. I perceived some epiphora and a slight dilatation of the pupil. He stated that vision was perfect on the right side, but indistinct on the left. There was much confusion when both eyes were used, but no actual diplopia nor ptosis. A blister was applied behind the left ear, and spirit-lotion to the eyes. As the ptosis some days afterwards had increased, I judged, considering the history, that a course of mercury was advisable : this was at once begun, and the blister repeated. In a few days the ptosis was more decided, but the movements of the globe were free ; there was no strabismus. I now commenced the use of the Calabar bean disks ; and, with the kind assistance of Mr. Wordsworth, we ascertained the state of the deeper portions of the eye on February 3rd, about three weeks after the eye was first affected. The deep struc- tures of the eyes were quite sound ; there was no paralysis of the recti or oblique muscles. The levator palpebrse was feeble. There was confused vision for want of power of accommodation. The left eye could distinguish objects well through a perforation on a card. The use of the Calabar bean produced some myopia. A favourable pro- gnosis was given ; and it was decided to persevere in the use of the Calabar bean, increase the doses of the iodide of potassium, and keep open the blister; to try spectacles with ground glass on the affected side ; and eventually to use the electric current on the face and brow. This treatment, save the use of the spectacles, was regularly carried out, the patient introducing the disks himself with great ease, thereby obtaining a pupillary contraction which allowed him for several hours to attend to his mercantile books. I applied the current myself two and three times a week, with the simple rotatory machine, the patient holding one pole, and the operator touching various portions of the orbit with the other. No current was applied to the globe itself. As the improvement was very slow, and as the psoriasis palmaris re- appeared, I substituted iodide of mercury for the iodide of potassium. The effect was very satisfactory; the metal was well borne, and the ptosis became less and less marked. The disks were now intermitted ; and on the days when they were not used, the circular fibres of the iris were seen to regain some energy. The treatment was thus continued to the end of May, the electricity being applied by the patient himself; and, about five months after the first onset of the eye-affection, the two pupils were of the same size, or thereabouts, and they acted with equal energy. Still the patient, at that period, experienced some fatigue after reading for a couple of hours. All evident symptoms of syphilis had disappeared. Case hi. — Tertiary Syphilis: Necrosis of Bone in the Orbit: My- driasis: Immobility of the Eye-ball: no Ptosis.—This patient was a