Observations on the disease lethargus : with cases and pathology / by Robert Clarke.

  • Clarke, Robert.
Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the disease lethargus : with cases and pathology / by Robert Clarke. Source: Wellcome Collection.

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    976 MR. DUFF1N ON THE NEW OPERATION FOR THE tnlfy in convolutions; general injection of the arachnoid, which was red and thicker than natural. Both cortical and concre- tious substances very red. To choroid plexus of left side there was a small hard tumor attached, of an oval shape and of a dark ash colour. Several eccliymotiespots on lateral parts of middle lobes. On the Internal and external sides of olfactory groove of left hemisphere there was consi¬ derable ramollissemcnt. Vessels ramifying on circumvolutions of cerebellum engorged. Spinal cord much congested; investing membrane of a rose colour. Thorax •• Lungs were of a light rose colour, and congested every where with dark blood. Heart filled with very dark coloured blood. Abdomen: Omentum loaded with fat; minute injec. tfon of peritoneum ; liver much gorged; gall bladder filled with very dark tarry-like bile; intestines filled with matter of a very dark green colour, being mixed at lower portion with hardened scybalm; several lumbrici were also found among their con¬ tents. At upper third of jejunum there wns an ccchymotic spot about the size of a half-crown piece; kidneys much loaded with fat, the cortical substance being en¬ gorged. Autopsia of a boy of the Bucongn tribe, net. 16, who died 14 days after admission to hospital, but whose case I did not note down. Head: Calvarium being removed, a great quantity of very dark coloured blood es¬ caped. The dura mater was infiltrated with some fluid, which ablution failed to remove ; glandular pacchioni enlarged ; effusion of lymph over arachnoid mcm- hrane. On slicing the brain streaks of blood were observable; the ventricles were filled with bloody serum; choroid plexuses were turgid, small vesicles appearing on their structure. Over the corpora striata blood-vessels ramified in arborescent form : the circle of Willis was well marked, from the great turgidity of vessels; a netting of blood-vessels stretched over the pons va- rolii; the cerebellum and its coverings were equally congested. Thorax: On open¬ ing the thorax both lungs were found en¬ gorged ; considerable adhesions to pleura costalis; pericardium collapsed; the heart was enlarged, its walls being thickened. On making a section through right ventri¬ cle, fibrinous clots three inches and a half in length were discovered, of very dark co¬ loured blood; coagula filled the auricles. Abdomen: On opening the abdomen, the liver was found enlarged and of a purple tint, some parts of its structure being infil¬ trated with bile. The gall bladder was distended with bite of a tar-like consistence and colour. Thcomcntum was contracted and thickened, tinged of a ycllowjhuc ; the stomach contained a glairy fluid, the mu¬ cus being dotted over with grumous coa- guln ; tho duodenum was also much stud, ded, intestines being removed from bodr, wnshed, and slit open were found filled with lumbrici and hardened scybalm; spleen softened; kidneys were normal; bladder thickened, and distended with urine. In the case of a boy, net. 14, of Akoo tribe, who was admitted to hospital on 2d September, 180!), and who had been ill for six weeks prior to admission, dis¬ section revealed sanguineous infiltra¬ tion of cerebral substance, thickening of dura mater, and several spots of a black colour scattered over its slniclurc. Along; the course of longitudinal sinus it was marked of a brownish blue colour. Lungs were found with tubercles in first stage ; hypertrophy of walls of heart. Several lumbrici were found in the in- testinal canal, at its upper portion. Dr. Copland, in Part IL, section 25, page 345, of his valuable Dictionary,, observes that in the dark races of man, worms, especially lumbrici, in the intes¬ tinal canal, are frequently connected with the origin of many maladies of remote but related organs; affections of the stomach, diarrhoea, colicky' pains, &c. &c. very often arising from this cause. Those parasites, it will be no¬ ticed, were found in great numbers to be present, both during,and after life in those cases. In conclusion, I hope it will be con¬ ceded, that if the practice pursued in those cases proved unsuccessful, that circumstance may with propriety he accounted for from the advanced stage to which the disease had arrived prior to admission, or to its being subjected to medical treatment. ■ In Mary Coker’s case the right lung weighed 14£ oz.; left lung, 5 oz. In the ease here alluded to the weight of brain was 3 lb. avoirdupois ; liver, 2J lb. ; spleen, 9 oz. AN INQUIRY INTO SOME OF TIIE CONSE¬ QUENCES AND CAUSES OF FAILURE OF THE NEW OPERATION FOR THE CURE OF STRABISMUS OR SQUINT1NO. By E. W. Duffin, Esq. Surgeon. [JPur the Ieondofi Medical Gazette.] [Continued from pngc M3.] Much diversity -of opinion certainly prevails in regard to the functions of the oblique muscles of the eye; but if CURE OF STRABISMUS OR SQUINTING. 977 we dissect them with very great care to their insertions, we must admit, what¬ ever else we may call in question, that the direction of their fibres, as well as their ultimate attachments, warrant the conclusion that the function of the supe¬ rior oblique is to roll the eve inwards and downwards, and that that of the inferior is to rotate the organ in tho opposite direction. When both muscles contract at the same lime, the effect will he to bring the eye forwards, and render it a little more prominent; thence pro¬ ceeds one of the common results—in¬ creased fulness of the eye, when the adductor is divided. But in what manner the superior oblique can assist in rotating the globe upwards and inwards, as Sir Charles Bell, Dr. Franz, and others have imagined, I am at a loss to comprehend. Were it indubitable that Dr. F. divided the tendon of the superior oblique in his operation, the result he relates would, of course, be conclusive that this muscle does by some means nr other contribute to the performance of the movement in question, The following case, an exceedingly instructive one, affords ground for be¬ lieving that the only muscles requisite to enable the.eye ball to move diago¬ nally upwards and jusvards, i. e., towards the nasal process of the frontal bone, arc the superior rictus and the adductor; al¬ though it is possible that the superior oblique, by rolling the globe downwards and inwards, may contribute slightly, in some individuals, in causing the pupil to approximate the inner canlhus, but certainly not in directing it upwards. A man presented himself for operation who squinted in a most remarkable de¬ gree with the right eye, in the manner we have been discussing, viz., upwards and inwards ; so much so, indeed, that, Ai lien the eye was at rest, fully a fourth part of the cornea was concealed from view. The gentlemen who examined this case previous to operation, viz., Dr. J. C. Williams, Mr. J. N. Thompson, of Nottingham, and Messrs. Smith and Walker, surgeons in the immediate neighbourhood of that town, were all convinced that either the superior or in¬ ferior oblique muscle was implicated in producing the deformity. From what I had experienced in similar cases, I was of opinion that the position of the eye proceeded from the conjoint operation of the superior rectus and adductor only, GG8.—xxvi. the former pulling the globe upwards, whilst it was unnaturally tethered or hound down by the latter. On dividing the tendon of the adductor, and com¬ pletely liberating the eye from all con¬ finement on its inner aspect, it imme¬ diately darted directly upwards, so that one-third of the cornea was concealed under the superior palpcbra, and the pupil was restored to the natural central ’line, hut, of course, much above its proper situation. In this position the eye remained fixed, unless the patient made an unusual effort to look down¬ wards, which he could never so effec¬ tually accomplish as to make the axis of the two eyes correspond, and obviate double vision. On the third day after the first operation 1 divided the tendon of the superior rectus by cutting down upon it anterior to where that of tho superior oblique passes under it. This I did in the manner that I usually per¬ form the operation on the adductor, by inserting a flat blunt hook underneath, and then snipping it across with a pair of scissors. The pupil immediately afterwards descended to its proper posi¬ tion in the centre of the orbit, vision became single, and the case went on satisfactorily in cvevy respect afterwards. I have met with numerous other in¬ stances of precisely the same description, as regards the direction of the pupil upwards and inwards, but never in any other case found it necessary to divide any thing but the tendon of the adduc¬ tor, and to liberate the eye from such abnormal connections as I have de¬ scribed, that tended to confine its inner aspect. When in the course of an ope¬ ration, after cutting across the band of tendinous fibres by which the adductor muscle is inserted, the eye lias been turned upwards and inwards, or in the contrary direction downwards, and towards the nasal cantluis, l have always found some adventitious adhesion to he the sole cause of the movement, the contraction of the superior or inferior rectus not exceeding that which was natural to them, but productive of an irregular effect because exerted on a tethered globe. We have stated that one of the imme¬ diate effects of tho operation is a f rilling projection of the eyeball ; the extent, however, to which this occurs is very variable, and depends, I conceive, much upon the manner in which the division of the tendon has been accomplished. 3 P