Tuberculosis of the choroid : perforation of the sclera ; extension posteriorly with involvement of the optic nerve ; histological and bacteriological examination of the specimen / by G. E. de Schweinitz and E. A. Shumway.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: Tuberculosis of the choroid : perforation of the sclera ; extension posteriorly with involvement of the optic nerve ; histological and bacteriological examination of the specimen / by G. E. de Schweinitz and E. A. Shumway. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    8/10 (page 6)
    0 case recorded by Maufredi and Cofler, the patient was 43 years old, and in one described by Posey before the American Ophthal- mological Society, in July, 1904, the man was 49 years old. Ac- cording to Zur Nedden, the age of patients suffering from tubercu- lar tumors of the choroid has varied between and 62 years, although the age of childhood has furnished by far the greatest percentage. Between the ages of 6 and 20 years, however, the probabilities will be in favor of tuberculo^sis, as it is too late for glioma and too early for sarcoma. 2. The evolution of tuberculosis is generally more rapid than that of a tumor, and an ectasia of the sclera follows soon after the appearance of glaucomatous symptoms. Scleral perforation has been noted in from three weeks to four months in many cases, although the process is sometimes slower, and very exceptionally in adults the duration may be several years. Zur Nedden also con- siders the early involvement of the sclera with perforation a sign of first diagnostic importance. 3. The appearance of iritis is also a probable symptom of value, and the earlier it is found the greater is the likelihood of uveal tuberculosis, even if the iris does not show typical tubercular nodulqs. In the case of intraocular tumor, the inflammatory symp- toms do not appear usually until a much later period. 4. Choroidal tuberculosis is very rarely primary, and other signs of tuberculosis will be found in the general system. Hence inquiry into the state of health of the individual, and his family history, together with very careful examination of the other organs of the body, are very important. 5. The test with tuberculin may be of value, although Dupuy- Dutemps does not place any great reliance upon it. 6. Finally, the inoculation into a rabbit's eye of the aqueous humor obtained from the patient by corneal puncture, although often negative in its results, especially in the early stages of intrar ocular tuberculosis, should not be omitted, as a positive result would make the diagnosis certain. The case we have described fulfils in all important respects the requirements of diagnosis of tuberculosis of the choroid, and is chiefly interesting in the elaboration of tlic process, its exten- sion posteriorly with involvement of the optic nerve, the early per-