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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    Case v. Tertiary Syphilis: Affection of the Third Nerve: Mvdri- cists: Ptosis.— In July 1865, I admitted into the Royal Free Hospital a man, aged about thirty, a native of France, whose whole body was covered with tertiary ulcers. The primary symptom had appeared full three years before, and the succession of manifestations had been of the ordinary land. As happens in the case of debilitated patients, there was here a lame suppurating bubo on the right side. This being freely laid open, and the numerous ulcers treated by red precipitate ointment, there was, in about six weeks, great improvement. The internal treatment consisted prin- cipally of iodide of potassium in large doses, and the liberal adminis- tration of tonics and stimulants. The patient was discharged after six weeks’ stay in the hospital, and called upon me about one month afterwards, complaining of pains in his head. lie also stated that he saw double ; and I perceived that the upper lid of the left eye had fallen. On examination, I found mydriasis of the same eye; but the globe moved pretty freely, and fol- lowed the fingers in various directions. The patient wished to return to Paris, where he probably underwent an appropriate treatment. When I saw him again, accidentally, some months afterwards, the ptosis had disappeared. Case vi. Affection of the Third Nerve: Mydriasis: Ptosis—This case refers to a lady, aged about forty, of a very nervous temperament, and is mentioned, not because a distinct syphilitic history could be made out, but on account of the rapid improvement obtained by the use of mercury. The patient requested my advice in July 1866. She had been mar- ried fifteen years, and had no family. Once famous in the artistic world, she still possessed attractive features, and had enjoyed good health, save the numerous discomforts connected with a highly sus- ceptible nervous system. After fits of vomiting for several days, the patient became somnolent and listless, speaking slowly and with some effort. Appropriate remedies did not improve her state; and, after about a month had elapsed, I found the left eyelid drooping, and the pupil dilated. On inquiry, the amblyopia described in the pre- ceding cases was complained of. I of course suspected some cerebral mischief, and ordered blistering on the nape of the neck, and rather large doses of iodide of potassium. The listlessness and somnolence diminished considerably; and, though anxious to know more of the history, I did not feel called upon to make very minute inquiries into the past. The eye moved freely in all directions, save upwards; the dilatation of the pupil was considerable, and not affected by a strong light. The deeper portions of the eye were not examined in this case. I now determined to bring the patient under the influence of mercury; and succeeded, by means of calomel (though not dropping the iodide of potassium, nor allowing the blisters to heal), to affect the gums to a rather high degree. From this moment the improvement began; and the joy of the patient on recovering power over the upper lid, the ugly effects of ptosis having been deeply deplored, was very great. The cir- cular fibres of the iris gradually recovered their tone, and the eye was quite restored six weeks after the calomel had been first administered. There is no evidence of the syphilitic nature of the affection of the third nerve in this case; and it is reported merely to prove the power of mercurial action. This action is frequently so maligned, that I am anxious not to lose an opportunity of giving it a good word. Remarks.—In reviewing the facts mentioned in the preceding cases,