Scientific American Supplement, No. 664, September 22,1888Various
History
Scientific American Supplement, No. 664, September 22,1888
Various
Science -- Periodicals
Among the matters of interest which were brought before the British
Medical Association, at the recent Glasgow meeting, was an account by
Mr. Brudenell Carter of a method which he had devised of opening the
sheath of the optic nerve behind the eye, for the relief of pressure
within this sheath and within the cavity of the skull. The brain is
invested by firm membranes, which secrete a certain amount of fluid
and are continued down to the eye in the form of a sheath which
surrounds the optic nerve; and, whenever the pressure within the
cavity of the skull is increased, as by the growth of a brain tumor,
or even by excess of secretion from the membranes themselves, a
superabundance of fluid is apt to find its way down the nerve sheath
to the level of the eye, to subject the optic nerve to injurious
pressure, and, in many cases, to destroy the sight. It not
infrequently happens that the pressure within the brain cavity may be
increased by temporary or curable causes, which, nevertheless,
continue in action sufficiently long to produce permanent blindness,
even although the patient may, in other respects, recover. In view of
these conditions it was suggested by Dr. De Wecker, of Paris, sixteen
or seventeen years ago, that it might be possible to open the optic
nerve sheath, and thus not only to relieve the nerve from pressure and
to preserve it from injury, but also, on account of the position of
the eye relatively to the brain cavity, to drain the latter by
gravitation, and to relieve the brain as well as the eye. Dr. De
Wecker made two endeavors to accomplish this object, but he tried to
feel his way to the optic nerve without the aid of sight, and to
incise the sheath by means of an instrument carrying a concealed
knife, capable of being projected by means of a spring. The risks of
failure, and, still more, the risks of inflicting irreparable injury
upon the nerve, were such that he only attempted his operation in two
well nigh hopeless cases, and only one attempt to follow his example
has been recorded. Mr. Carter's attention was called to the matter
last year by a case in which the diminution of pressure within the
optic nerve sheath was manifestly desirable; and he devised a method
of operating by which the sheath could be exposed to view, and the
object attained with certainty, under the guidance of sight at every
step of the process.
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