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.

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    The loud intracranial bruit was arrested by pressure on the left common carotid artery. Four minutes was the longest time attempted successfully. Pressure on the right carotid made no difference. Ophthalmoscopic examination : “ In both fundi signs of optic neuritis. There is a blurred disc in the right fundus oculi, and in the left the margins are ill-defined, in portions not distinguished.” On March 0, I spoke of him to the Cambridge Medical Society as follows : “ Since the last note, a gradual improvement has taken place in all respects. The patient now presents his natural manners, and is perfectly sensible. His pupils are dilated and there is some ptosis, with signs of optic neuriiis and vision somewhat impaired. The bruit on ausculta- tion of the head is to be easily heard.” “ My explanation of this bruit was that, the base of the skull having been fractured in the region of the cavernous sinus, a communication had been made between the carotid artery and the venous channel. There are many such cases on record, and some have been cured by ligature of the carotid, an operation which I was much tempted to perform in this case, and it may yet be necessary. It does not appear that the boy is annoyed by the noise in his head, and he is doing so well in most respects that I do not consider myself justified in operating.” “ The chief reason for urging an operation now is found in the precarious state of the vision. It is contended that ligature gives a better chance for recovery from the optic neuritis, with restoration of vision.” “ Unfortunately the optic neuritis has happened, is improving, and cannot easily be shown to be due solely to the communica- tion which is supposed to exist between the internal carotid artery and cavernous sinus. The painful retraction of the head and other signs described were probably due to basic meningitis. On December 19, after he was shown to the Cambridge Medical Society, a violent attack of pain came on, which, though not serious as before, was accompanied by much more proptosis and oedema of the lids on the left side. His mental condition seemed also worse. The left common carotid artery nas accordingly tied on December 21. The effect was the immedi- ate cessation of the intracranial bruit, but alarming symptoms followed which threatened his life. During a month he was