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.

    7/30 (page 7)
    the 24th of May last. In the pupil of the left eye, seemingly at the back part of the ball, there was an irregular reddish-white ap¬ pearance. The eye itself was not otherwise altered, nor did the child show any other signs of disease or suffering. An altera¬ tion in the colour of the pupil had been first noticed about twelve months before, and had since then gradually become more distinct. The eye was extirpated, and found to contain a medullary tumour springing from the central part of the retina, and occupying about a third part of the cavity. The optic nerve was perhaps a little smaller than usual, but not otherwise altered. The child made a good recovery, but, before the end of many weeks, was perceived to have the vision of the remaining eye impaired. Soon afterwards a white speck was observed through the pupil, which slowly and gradually assumed the distinctive features of the me¬ dullary disease. A fungus also at length protruded from the left orbit, and by its pressure causing absorption of the bones, made a way for itself into the mouth. If it could be proved that excision had been successful in a single well authenticated case of medullary tumour of the eye, it would be wrong to refuse the chance of benefit from the ope¬ ration. But if the result of numerous trials, under every variety of circumstances, has been uniformly unfavourable, it must be cruel to repeat the painful experiment any longer. The only instance of alleged success met with in this country is that recorded by the late Mr Wishart..* The operation was performed on a boy nine years of age, four months after he had received a blow on the eye. “ The left eye was dull, and pre¬ sented a general turbid appearance ; the cornea was transparent, but numerous vessels passed into it over the sclerotica. The pupil was moderately dilated and fixed; its margin was slightly serrated. In the posterior chamber an opacity was observed resembling a yellow dusky membrane, lining the whole posterior part of the eyeball, and perceived more distinctly when the eye was viewed laterally.” Mr Lawrence has remarked in regard to this case, -j* that “ it is more analogous to those instances of brilliant deep-seated discoloration following serious accidents, than to the unequivocal examples of the medullary fungus.” The justice of this suspicion was forcibly impressed upon me by a case which I lately saw with Dr Combe of Leith. The patient was a little boy whose eye had been wounded some weeks previously by a pin-pointed arrow. The appearances pre¬ sented by it were precisely those described by Mr Wishart, but the brilliant yellow coating at the bottom of the ball, * Edin. Med. and Chirurg. Journal, 1823. *{* Treatise on Diseases of the Eye, p. 623.