An Account of a Remarkable Cure, Performed on the Eye of a Young Woman in Scotland, by Tho. Hope, M. D. Communicated from Dr. Mead

XIV. Abstract of a Letter from Mr. Wm. Arderon to Mr. Baker, F.R.S. of a Shuttle-Spire taken out of the Bladder of a Boy. Norwich, Oct. 12. 1744. Read Dec. 6. On the 16th of September last, Mr. John Harmer, a Surgeon in this City, cut one Peter Riggs, a Boy about seventeen Years of Age, for the Stone; at which time there was extracted from him (to the utmost Surprize of the Spectators) an iron Shuttle Spire, four Inches long. He had, it is said, some time before, a Stoppage of Urine; and, by endeavouring with this Piece of Wire to relieve himself, and thrusting it too far along the urinary Passage, he let it drop into the Bladder, where it occasioned the same Symptoms as a Stone would have done. He underwent the Operation with great Fortitude; and said nothing of this Accident until it was all over. He is now perfectly recovered. XV. An Account of a remarkable Cure, performed on the Eye of a young Woman in Scotland, by Tho. Hope, M.D. communicated from Dr. Mead. Read Dec. 13. Jane Willson, a Girl now eighteen Years of Age, about seven Years ago began to have her left Eye turned towards the Temple, occasioned by some Tumour betwixt the Globe and the Orbit. This Tumour, for some Years, did not not appear outwardly; but, increasing by degrees, at last a hard Swelling appeared externally, reaching from the great Angle almost to the little Angle under the lower Eyelid, and half an Inch down on the Cheek: It had forced the Globe of the Eye almost out of the Socket, so that the Pupil of that Eye was, by Measure, above three Quarters of an Inch further from the Nose, than the Pupil of the other Eye; and the Eye was more jetting out in proportion; so that it seem'd to be out upon the Temple, and quite immoveable; which, with the Tumour, made a frightful Sight. The Patient had frequent Pains in her Head; but what was most surprising, the Sight of that Eye was not lost, tho' a good deal impaired. I shew'd this Patient to Mr. Alexander Monro, Professor of Anatomy at Edinburgh, whose Abilities are universally known; who, after examining it very narrowly, gave it as his Opinion, that this Tumour had begun at the Bottom of the Orbit; and that the Extirpation would be exceedingly difficult; and, as it seemed to be an incysted Tumour, if any of that Cystis remain'd at the Roots, it would be apt to sprout up again: But, withal, concluded, that there was Room for a Trial; and it would be a Pity not to do something in order to save the Patient's Eye, and, probably, her Life, which would be in Danger, if the Tumour continued to increase. I likewise shewed her to several other eminent Gentlemen of the Faculty, who were all pretty much of the same Opinion. Notwithstanding of this, considering the great Risque that the Patient run, if something was not speedily speedily done, I resolved to undertake it; having had a Case of the like Nature, but in a lesser Degree, under my Care about twelve Years ago in London, the Extirpation of which I performed without any bad Consequence; and, upon consulting my old Master St. Yves his Book, I found almost a parallel Case to this Girl's, which, he says, he extirpated with Success; and, as he was an honest Man, I knew I could trust to him. On the 19th of June last, in Presence of Dr. Lowis, Dr. Dundass, Dr. Mac-Farlane, Dr. Young, Mr. Cunningham, Surgeon, I performed the Operation in the following Manner: I turned the Patient backwards on a Chair upon an Assistant's Lap, her Head supported by Pillows; then, keeping the Skin tense with my Fingers, I made an Incision about an Inch long with a small Razor, beginning at the greater Angle, and following the Direction of the Fibres of the orbicular Muscle towards the lesser Angle. I then passed a crooked Needle armed with Silk thro' the Middle of the Tumour as deep as I could go; and, raising the Tumour with the Silk, with a fine Bistoury I separated all the lateral Adhesions from round the Tumour; and, with the Point of my Scissors, I cut the deeper Adhesions, which I could not so well reach with the Bistoury, and brought away all that the Thread had hold of. This seemed to be a tough membranous Substance, independent of the real Tumour; for, after this was quite taken out, there appeared a regular Tumour, of a spherical Figure, smooth and even, about the Bigness of a small Pigeon's Egg: I passed the Needle thro' the Middle of it, as I had done before, and plunged a Lancet into it as deep as I could, in order to let out any fluid Matter that might be contained therein, but found nothing but a carious Substance; then, lifting up the Tumour by the Thread, I dissected it, with great Care and Caution, from the adjacent Parts, as far as I could; in doing this, I found several strong callous Attachments on the Side next to the Globe, which felt almost as hard as a Cartilage, and obliged me to change two or three Instruments. I then, with the Point of my Scissors, cut the inward Adhesions at the Roots, and brought the Tumour away intire: Upon putting in my Finger to the Bottom of the Orbit, I could feel several hard callous Substances stil remaining; and keeping my Finger upon them, I slid a crooked Needle armed with Silk round the Point of my Finger, with which I hooked those callous Roots; then, making an Assistant raise the Thread, and directing the Scissors upon the Point of my Finger, where I felt the said Roots, with two or three Snips I cut them quite away; so that I left the Bottom even, and intirely free, as far as I could judge. All this while I had no great Effusion from any Artery, but a good deal of black grumous Blood from the varicose Vessels, I dressed it up the first time with dry Lint, which I did not take off till the third Day; when I found a soft Swelling in the Eye-lids and Conjunctiva, with a slight Inflammation, and a Pain in the Forehead. I dressed the Wound with a soft Dossel dipt in common digestive and warm Brandy, and ordered an emollient Fomentation to be applied every two Hours: The Pain in the Forehead, and the Swelling continued for three or four Days, with- out any Appearance of Matter. I then touched the Bottom of the Wound with the lunar Caustic, and some Hours after, there followed a pretty large Discharge of blackish Blood, and immediately her Head was relieved, and the Swelling subsided: A bloody Sanguis continued to issue out the two following Days, for which I injected warm Water, with a little Brandy and Honey of Roses, after which it came to a pretty good Digestion: As some spongy soft Substances began to appear, I touched them with the lunar Caustic, and the Wound filled up apace. The Eye still continued immovable, the Musculi Abductores had been so long contracted, and the Abductores so overstretched and lengthen'd, that they had lost their Use; I could however observe, that, by pressing with my Hand upon the Globe of the Eye with a little Force, I could bring it a good deal more into the Socket, but, upon taking away my Hand, it would immediately return to its former Place. This made me think, that a constant and gradual Pressure, by some proper Bandage, might be of Service to force the Globe into its Place, and keep it there till the Muscles had recover'd their Tone: Accordingly, I got a steel Bandage, with a concave brass Plate corresponding to the Convexity of the Eye; which, by the means of a Screw, bore upon the Side of the Globe next the Tempie: I applied this Bandage, by first gently forcing the Globe more into its Place with my Hand; then, putting a thick soft Compress betwixt the Globe and the brass Plate, I screwed it down upon the Globe in such a manner, that it was impossible for it to start back again as it used to do, I left an Assistant with the Patient all Night; with Instructions, If the Bandage caused great Pain, to ease the Screw; Screw; and so, by gradually forcing it more and more, and keeping this Bandage constantly applied Day and Night, in about twenty Days the Eye was brought entirely into its Place, so as to remain there of itself, had all its regular Motions every Way, and the Patient saw with that Eye as well as with the other. This Patient, after the Cure, was shewn to the Physicians that had been present at the Operation, and to others the most eminent of the Faculty. In the Morning, when I used to take off the Bandage, I could observe that Side of the Globe which the Plate bore upon considerably flatten'd, and yet not attended with any Pain, or bad Consequence. In about a Month the Wound was quite healed up. A spongy Carnosity had grown all along the Inside of the lower Eyelid, which, being long over-stretched by the Tumour, was so relaxed, that, after the Operation, it turned inside-out, and occasioned that Disorder which is called Ectropion: The upper Eyelid having been very much extended for so many Years by the Globe, upon the Eye returning to its Place, was so relaxed, that its Cartilage, on the contrary, turned inwards; whereby the Cilia or Hairs upon its Borders rubb'd against the Globe of the Eye, and occasion'd the Disease commonly call'd Trichiasis. For the Cure of the Ectropion, I passed a crooked Needle thro' the Middle of the Carnosity, and raising it by the Thread, I cut it off with the Scissors; I afterwards touched the Inside of the Eye-lid with the lunar Caustic, in order to destroy what remained of the Carnosity; and, giving the Eschar Time to throw off, I repeated the same twice or thrice, by which the Cc Eyelid, in about a Fortnight, recovered its healthful and proper Situation. I did not think proper to torment the poor Patient with the Operation of the Trichiasis; which, tho' very easy to the Operator, is not so to the Patient; and I found, by the Application of proper Topicks, the Eyelid recovered Strength daily; and I judged by the Continuance of the same Method it would soon be well. It will not be easy to account how Sight should remain after the Optic Nerve was so stretched; which it must be in a very considerable manner in this Case; and how it came to contract or recover itself so soon, after being so great a while extended. It is true, that while the Optic Nerve was in its State of Extension, the Sight was impaired; but, after seven Years Extension, how it came to recover itself in a Month's time, without any Alteration in the Sight, but for the better, I leave to the Speculation of the Curious. It is likewise pretty extraordinary how the Muscles, after having been so many Years in Disuse, should recover their natural Action in so short a time. See Tab. II. Fig. 8. XV. An Explication of a Roman Inscription found not long since on a Stone at Silchester in Hampshire: By John Ward, Rhet. Prof. Gresh. and F. R. S. Read Dec. 13. 1744. The Draught, which accompanies this Paper, contains an exact Copy of a Roman Inscription, lately communicated to me by Dr. John Collet, Physician at Newbury. The Account, IMP·CAES·M·AVRELI·SEVERO·ANTONINI·PIO·FELICI·XXG·PARVUS·MAX·BRIT·MAX·GERM·MAX·PONTIFICI·MAX·TRIB·POTEST·XVIII·COS·III·PROCONS·PP·QVINTI·FIDA·VARDVUL·CRESCENTIA·NNANA·FECIT·SVB·LEG· IMP·CAES·M·AVRELIO SEVERO·ANTONINO PIO·FELICI·XXG·PARTHIC· MAX·BRIT·MAX·GERM· MAX·PONTIFICI·MAXIM· TRIB·POTEST·XVIII·IMP·II· COS·III·PROCONS·PP·COH·I· FIDA·ARDVL·CREO·XANO· NNANA·FECIT·SVB·CVRA·IO· LEG·XX·GR MARTI VICTORI VLIVS LI IVS TRIE V·S·L·M. DEO·HER SAEGON T·TAMMON SAE·TAMMON VITALIS HONOR