Cases of syphilitic affection of the third nerve, producing mydriasis, with and without ptosis / by Victor de Méric.

  • Méric, Victor de, 1811-1876.
Date:
[1869]
Catalogue details

Licence: Public Domain Mark

Credit: Cases of syphilitic affection of the third nerve, producing mydriasis, with and without ptosis / by Victor de Méric. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    we find that the patients all recovered, if not a completely normal, at least a very good, use of the affected eye. Hence we may, in such cases, offer a rather favourable prognosis. The result was not so satis- factory in Case in; but, when we consider the amount of disease of bone with which the orbit became involved, it is surprising that the eye did not suffer more. In this same case, there was hardly any confusion of vision when both eyes were used—probably because the globe was quite fixed on the affected side. Nor could it be asserted that, in this case, the third nerve will not in time, in the absence of debilitating causes, recover a portion of its integrity. We all know that the motor oculi nerve may, in otherwise healthy individuals, have its functions disturbed by inflammation, the pressure of tumours, abscesses, or clots, or through the rheumatic diathesis. Such cases as have just been related prove that syphilis may act in the same manner. A certain amount of doubt might be thrown on the first case, for the evidence of a syphilitic taint is not very decisive. Still we may, without straining, admit the etiological explanation which I have offered, as the eruption was decidedly of a syphilitic nature. I do not mean to deny, however, that in this case, and even in other cases where the ex- istence of the syphilitic poison is evident, such causes as rheumatism or cold air may lie at the bottom of the mischief. It is, however, fair to conclude, from the facts mentioned in Cases II, III, iv, and v, that generalised syphilis was the cause of the phenomena about the motor oculi. In these four cases, there is no doubt concerning the syphilitic contamination of the organism; and the diagnosis may be legitimately settled in the manner I have done. Some cases of this kind have been put upon record; but it is worthy of remark that, as a general rule, they are rare. In a special public and private practice of twenty-three years, I have not been able to collect more than the five I have mentioned. I exclude the sixth, as there is no positive evidence of syphilis. I have, however, in my notes, one more case of the syphilitic kind; but I have not included it, because the mydriasis depended more on retinitis than on a bond fide affection of the third nerve. It will be noticed that, in Cases I and ill, there was no ptosis. In the first, in fact, it would seem that the mischief lay principally in the lenticular ganglion. I may here quote Mr. Wharton Jones’s own words. “ When dilatation of the pupil occurs, unaccompanied by ptosis and incapacity to turn the eye except outwards and a little downwards, it is owing to paralysis of that branch only of the nerve of the third pair which goes to the lenticular ganglion.” In this first case, there was simply mydriasis, and no affection whatever of any muscles which move the globe of the eye; so that we are inclined to suppose that the short ciliary nerves, arising from the fore part of the ganglion, were exclu- sively affected. It is not clear, in the third case, how the levator pal- pebras escaped paralysis, whilst all the other muscles supplied by the third pair had lost their contractility. From the facts elicited by the five cases which I have put upon record, we may infer that the third nerve may be affected as well in very slight as in aggravated cases of syphilis. The first and second cases were extremely mild, whilst the three others were very severe. The latter were in the bond fide tertiary stage; the former, in the se- condary period of the disease. I have already said that the prognosis is favourable, this opinion be- ing based on my cases, and on some others which have been published ; but it may also be asked on which therapeutic agent we should rely in the treatment. Now I must state that I have not, like some of my pro-