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THE PRESERVATION OF EYES IN WICKERSHEIMER'S
By E. GRUENING, M.D.,
A few months ago the Prussian Government made public a formula for the preparation of a fluid called Wickersheimer's. The fluid is said to preserve animal and vegetable specimens wonderfully, and prevent any alteration in their form and elasticity. The formula, as published in the Berliner Klinische Wochenschrift, is as follows: To 3000 parts of boiling water put 100 parts of alum, 25 parts of common salt, 12 parts of salt petre, 60 parts of potash (kali carbonum), 10 parts of arsenious acid; cool and filter, and add to ten parts of the solution four parts of glycerine and one part of methylic alcohol. In the Centralblatt für die Medizinischen Wissenschaften, Jan’y (No. II.), 1880, Dr. Broesicke states that the formula published by the Prussian Government contains two errors which should be corrected. Broesicke obtained a different formula from Mr. Wickersheimer. The discrepancies in the two formulæ are the following: the Government formula prescribes 10 parts of arsenious acid and 1 part of methylic alcohol; and Broesicke's 20 parts of arsenious acid and 4 parts of methylic alcohol. I had the fluid put up according to either of these prescriptions. Mr. Fingerhot, the druggist, at the corner of 59th Street and 3d Avenue, New York, made the fluid in accordance with the Government prescription; and Mr. Bilbeck, the druggist of the German Dispensary, prepared it according to Broesicke's formula. The first of these fluids is slightly opalescent and perfectly clear. The first preserves the transparency of the refractive media of the eye, while the second does not. The eye which I place before you bas been three weeks in Wickersheimer's fluid. prepared according to the Gov. ernment formula. It is an eye with glioma of the retina. The
cornea is clear, the anterior chamber of normal depth; the iris blue in color, the lens transparent; and even to-day, in this eye that has lain in a preservative fluid three months, the diagnosis of glioma of the retina could be made.
Eyes placed in the fluid prepared by Mr. Broesicke's formula are not preserved so perfectly. The lens becomes opaque in a few hours; the cornea and iris after a few days, or even in the course of the week, are as opaque as a cornea preserved in absolute alcohol.
THREE CASES OF TUMOR OF THE LACHRYMAL
By H. KNAPP, M.D.,
Owing to an acute laryngitis, Mr. President and Gentlemen, which makes it almost impossible for me to speak, I can give only an abridged history of the cases, and make some short remarks in explanation of the microscopic specimens I shall place
CASE I. Myxo-Adenoma of the Lachrymal Gland.-Mr. C. G., æt. 31, noticed ptosis eighteen months before he presented himself to me.
No pain. Eyeball gradually pushed downward. On March 12, 1880, I found : Ptosis; eyeball pushed down and forward, moved upward only to horizon. An uneven, immovable, moderately consistent tumor occupied the upper outer corner of the orbit, projecting beyond the superciliary arch. S 265 Retinal veins dilated, retinal tissue on and around disk slightly hazy (ædematous).
I removed the tumor March 13, 1880, in the presence of Drs. Aguew, Webster, and the medical staff of the New York Ophthalmic and Aural Institute. A curved incision was made along the upper and outer orbital margins; the tumor was exposed, detached with scissors and scalpel from its surroundings, and easily removed in toto, and in its capsule. The eye receded. The whole wound was closed with sutures, and healed without pain, swelling, or discharge, in five days. The patient, living at some distance, went home ten days after the operation perfectly cured. Mobility of lids and globe, as well as the position of the latter, norinal.
Under the microscopes you will find sections of the tumor exhibiting the structure of adenoma in the most beautiful and typical form. In some places there is myxomatous tissue. The specimen, therefore, should be ternied myco-adenoma.
CASE II. Father B., æt. 32. Exophthalmus five years ago. Lachrymal tumor removed three years ago by Henry W. Wil. Jiams, of Boston, and described in the Boston Med. and Surg. Journ. as epithelioma of the lachrymal gland. Two months later the eye protruded again, and was, at the time I saw be patient, considerably pushed forward, down and inward. A modular tumor, of fleshy consistence, occupied the whole upperouter half of the orbit. The lid was swollen, pushed forward by the tumor, and could not be raised. The eye did not more up and outward. Sight was good. Retinal venous hyperæmia, and some ædema.
The removal of the tumor, which I did Nov. 28, 1879, was tedious and laborious. The growth extended along the entire upper and outer walls of the orbit, being in firm connection with the periosteum. Its front part projected as large lobular masses into and beyond the orbital cavity; the posterior part, however, crept, as flat swellings, along the bony walls, and had to be removed with gouges and scissors. The removal was very thorough, and a considerable part of the bony wall of the orbit was denuded. The optic nerve was not cut, as it could be felt with the finger, but all the tissue on its outer side was removed. The wound was united by sutures, except on the outer-lower side, where a drainage-tube was inserted. When the operation was completed, the upper lid was inert, the eyeball moved only inward, the pupil was medium-sized, and absolutely immovable, the eye blind, the retinal arteries very thin, the veins gorged with dark blood, tapering at their exit from the disk. Evidently the retinal artery, with many other orbital vessels, had been cut.
The healing was unexpectedly smooth. Only a few drops of serous liquid -no pus-oozed from the drainage-tube. Four days after the operation, the tube was left off; four days later the wound was completely closed, per primam.
The examination of the fundus oculi showed a milky retina, with a cherry-red macula lutea, retinal veins numerous, dark, engorged, and tapering at the disk; arteries very small. In the course of several weeks, the retinal tissue became transparent again, and the retinal vessels, both veins and arteries, shrunk much beyond their natural calibre. The upper lid remained immovable, the eye blind. Patient was kept under observation for about a month, and several months later, when last heard from, there was no indication of a relapse.
The specimen shows, under the microscope, a large accumula. tion of epithelial cells, some connective tissue cords; but in some places plain alenoma structure. The growth, therefore, may be styled adenoma carcinomatosum.
Case III. A woman of 26 years was operated on by me, in 1865, at Heidelberg. A large tumor, starting from the region of the lachrymal gland, had filled the whole orbit, protruding beyond the palpebral fissure, and carrying the shrunken eyeball before it. It had a fleshy consistence, with soft parts. I removed it entire, emptying the whole orbit. The specimenwhich I preserve and have examined again-shows hypertro. phied lobules of gland, cysts, areolar cancer, and myxoma structure. No doubt it is also an adenoma, but from its further development should be styled a myco-adenoma carcinomatosum.