Abscess of the orbit as the result of suppurating ethmoiditis : operation and radical cure / G. E. Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1897]
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Licence: Public Domain Mark

Credit: Abscess of the orbit as the result of suppurating ethmoiditis : operation and radical cure / G. E. Schweinitz. 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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    [Reprinted from the Medical and Surgical Reporter, November 20,1897.] ABSCESS OF THE OEBIT AS THE RESULT OF SUPPURATING ETHMOIDITIS: OPERATION AND RADICAL CURE.* G. E. de SCHWEINJTZ,t A.M., M.D., Philadelphia. In cases of purulent disease oi' the ethmoid sinuses the natural escape for the pus is into the nasal cavity, where it can be seen beneath the middle turbinat- ed body, or between thie structure and the septum; but according to Bosworth,1 this is by no means its invariable course, as is shown by the large number of cases in which the pus escapes through the os planum into the orbital cavity, giv- ing rise to exophthalmos and orbital dis- ease. The following case is a good ex- ample of abscess of the orbit connected with suppurating ethmoiditis, and illus- trates certain important and interesting points in regard to the operative technic: D. S. W., a grocer, aged 67, born in New Jersey, married, consulted me March 25, 1896, in the hope of obtaining relief from disease of the left orbit. History.—In his early life the patient- had been perfectly healthy. About his twenty-first year he was attacked in rapid succession with measles and scarlet fever. As the result of these diseases rhinitis de- veloped, which terminated in the chronic atrophic variety of this affection. He also had inflammation of the middle ear and perforation of the left drum-head. At the age of 65 the patient had a sun- stroke and afterwards much violent head- ache: in deed, prior to his sunstroke he suffered from brow-ague which was attrib- uted to malaria. For two years before he reported for treatment, and markedly during the preceding year, the headache was located chiefly over the left brow, and was often associated with a swelling at the inner angle of the orbit. For twelve months this swelling had been persistent, * Read before the Philadelphia Countv Medical Society, Novomber 10, 1897. t Professor of Ophthalmology in the Jefferson Medical Col- lege; Professor of Diseases of the Eve in the Philadelphia Polyclinic, etc. 1 Diseases of the Nose and Throat. New York: William Wood A; Co., 1896, p. 264. and for three months there had been marked diplopia. The patient's hahite had always been good. There was no his- tory of venereal disease. His wife and children are healthy. Examination.—The patient is a me- dium-sized man, with ruddy countenance, the flush on his face being particularly marked during the periods of severe head- ache. Physical examination failed to re- veal the presence of any disease, save that situated in the orbit and in the rhino- pharynx. Eyes.—B. E. practically normal, with the exception of a small pterygium at the inner side. The refraction was a moder- ate compound hypermetropic astigma- tism. L. E. The eye was displaced downward, the center of the cornea, being 8 mm. below the level of the center of the cor- nea of the opposite side, while the face of the cornea was tipped slightly upwards and backwards. There was no direct for- ward protrusion of the bulbus. Upward movement of the eye was abolished; the other movements were preserved. There was ptosis from edema of the upper lid, which was most marked upon the inner side. An elastic swelling was situated at the upper and inner portion of the orbit, and pressure elicited marked tenderness, especially in the region of the supraorbit- al notch. The ophthalmoscope revealed an oval optic disc, slightly grayish in color, and normal retinal vessels. There were no ex- travasations in the fundus. Y. with -f- 1.50 D. = The field of vision for form and for red was normal. There was vertical diplopia in all portions of the field of fixation. ■ • Rhino-pharynx and Adjacent Sinuses. —Examination by Dr. Walter J. Free- man: There was atrophy of the turbin- als, which was more advanced on the left side. The fossae were lined with thick,