Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson.

  • Robertson, J. Argyll.
Date:
1844
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Licence: Public Domain Mark

Credit: Excision of the eyeball in cases of melanosis, medullary carcinoma, and carcinoma : with remarks / by J. Argyll Robertson. 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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    I have never met with this form of disease either in my own practice or in that of others. Indeed, I am disposed to think that the ordinary form of scirrhus is seen only in the lachrymal gland, cellular tissue, conjunctiva, and integuments of the eyelids. That the sclerotic not only does not give origin to scirrhus, but is remarkable for rcsistmg cancerous infiltration from neighbomnng parts, as is shown in cases in which carcinoma exists on each side of that membrane, it remaining untouched We even find the sclerotic divided into two lamiucO by carcino- matous matter, these laminje remaining unaffected by the disease. When the carcinomatous deposit occurs in the interior of the eyeball, it is invariably of a soft medullary consistence. Ahhougli in _ most _ instances of carcinoma there exists a constitutional disposition to the affection, yet there can be as little doubt that in many cases the disease is entirely local in its origin, and that the general system only subsequently becomes contaminated if it be allowed to proceed. This more particularly holds good in regard to the skin. Hence the numerous _ cases_ of perfect cure effected in carcinoma of the hp, when excision is had recourse to in an early stage. I beheve that the operations for the cure of cancer oi' the eyehds would be equally successful with those performed on the hp, were they resorted to sufficiently early, and less care taken to save the surrounding parts to avoid the subsequent disfiguration. Much difficulty, however, is necessarily experienced in gaining the consent of the patient to a comparatively formidable operation for the cure of an apparently trivial disease. The probability of success in operating will be greatest where no firm connexion has been formed between the diseased parts and the subjacent bone, where the constitution of the patient is otherwise good, and where the operator uses his knife with sufiicient freedom. Again, where there is a strong constitutional disposition to the disease, often indicated by the appearance of the patient, when the disease commences without the apphca- tion of any external cause, and where the surrounding tissues are adherent to the diseased part, the chances of success will necessarily be much lessened. Scirrhus, in so far as I have had an opportunity of witnessmg the disease, most frequently commences in the lower eyehd, at its margin, and generally near the external cauthus. Why the lower eyelid and lower hp are more subject to scirrhus than the upper eyelid and upper lip, seeing they are so similar in struc- ture and function, it is impossible for us in the present state of our knowledge to determine. Scirrhus commonly first shows itself on the eyelid in the form of an indurated warty-looking excrescence, at other times in the form of a hard indurated swelhng, of small size, usually of a dusky reddish brown hue, and resting on a broad firm basis;