Clinical notes on nerve disorders in surgical practice / by George Wherry.

  • Wherry, George, 1852-1928.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on nerve disorders in surgical practice / by George Wherry. 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.

    11/42
    On the 28th, improvement in disposition, less ptosis, both pupils dilated. This evening, after a cheerful and even playful day, he was suddenly seized with pain in neck and occiput, and stiff retraction of the neck with head thrown back; the boy, screaming in agony, gave much the appearance of tetanus. The alteration in expression of his face from the ptosis also suggested a tetanic spasm. No other muscles were contracted, and the resemblance to tetanus merely describes his aspect. The boy continued in pain all night, occasionally screaming; he was quiet only for about an hour. Next morning there was oedema of the lids and proptosis of the left eye, but no pulsation in eyeball or orbit. The retraction of the head and other signs as before. The occiput and posterior cervical region were acutely tender to the touch, and even the gentlest movement could not be endured. This attack seemed to be much relieved by an application of leeches to the temples, followed by quarter-grain doses of calomel every two hours. Gradual improvement took place in the urgent symptoms. The projection of the left eyeball and oedema of the lids, with filling of conjunctival vessels, was more decided on the evening of the 30th; but he was able to lie easily and keep his neck bent forward. He was much quieter, the bowels acted well; and a good deal of sleep was obtained. On the 31st improvement was maintained, quiet and sleepy, could be roused to intelligence. Still proptosis of left eyeball, double jDtosis, and dilatation of both pupils. He could count fingers easily with either eye. Six days later (November G) there was a general improve- ment, and even some in the eye and eyelid signs, until on November 16 a sudden attack of jDain in the orbital region and increased proptosis came on, the lad putting his hand to his eye and screaming at intervals. Chloroform was given and an incision was made through the upper lid into the orbit to relieve tension; an effusion of blood into the cellular tissue with very distinct jmlsation was then noted. Auscultation of the forehead discovered a loud bruit, continuous but with reinforcements during the pulse. Pulsa- tion could be felt only for about an hour and a half; the upper eyelid was swollen by ecchymosis. The patient was irritable all day, but there was no more severe pain.