HANSELL: Tumor of the Iris.
393
and kidney diseases were reported as secondary to myxcedema. No doubt that the thyroid extract, when employed judiciously, relieves the distressing mental and physical symptoms of this disease, so that the afflicted patients take renewed interest in life; but, as the thyroid gland is atrophied, the treatment must be kept up indefinitely.
DISCUSSION. DR. 0. F. WADSWORTH of Boston, Mass.- As the author has referred to me, I will say that I have seen more than a dozen cases of myxcedema, but only in the one which I reported has there been any special eye lesion. With regard to that case, I may say that some years after it was reported, a gentleman writing on acromegaly referred to it as probably a case of that disease. I looked up the history of the case again, and think the writer may have been right, although several physicians who saw the case had no doubt it was one of myxcedema; but at the time I saw the case acromegaly had hardly been described. It is possible that in that case it was not myxcedema but acromegaly that caused the optic atrophy.
TWO CASES OF TUMQR OF THE IRIS. BY HOWARD F. HANSELL, M.D., PHILADELPHIA.
CASE I. - Cyst.' Referred to me by Dr. George Hartmann of Port Kennedy, Pa. J. W., aged 20, while harvesting, was struck forcibly in the eye with a cornstalk. The cornea was perforated, the anterior chamber emptied, the capsule torn, and probably the lens inj ured. I saw the patient a few days after the accident. The cornea showed an irregular cicatrix near the center, the iris was attached in several places to the capsule, the lens was opaque, striae running backward from the point of densest adhesion, and there was moderate ciliary injection. In six months the eye was free from injection, the synechie persistent, and the
394
31ANSELL: Tumor of the Iris.
lens was entirely opaque. Extraction of the traumatic cataract was advised and refused. Two years later W. returned on account of the development, six months earlier, of a growth in the anterior chamber. The tumor was the size of a large pea, round, perfectly white and glistening, resembling very closely a large pearl, and attached to the iris at the lower outer quadrant - the section that had been injured. Its antero-posterior diameter was longer than the depth of the anterior chamber, so that the opaque and partly absorbed lens was dislocated backward. The growth of the tumor had been slow and nearly painless, but, on account of its unsightly appearance, the patient desired to have it removed. The cut was made in the corneo-scleral border opposite the tumor. Upon the escape of the aqueous, and in consequence of the withdrawal of the support of the cornea and the pressure from behind, the tumor rotated obliquely into the pupil, forcing the lens still farther backward. A Levis wire loop was, after one or two attempts, successfully forced over and behind the tumor. It was then drawn out without difficulty, and the iris, including its attachment, cut off. The wound healed without interruption. One month later the lens and portion of the capsule were extracted, resulting in restoration of moderate acuity of vision. The cyst contained a yellow glutinous substance; after removal, the cyst wall ruptured and the contents, in part, discharged. This rare variety of iris tumor has been designated by Fuchs as " Pearencyst." Its anterior wall consists of single fibres of iris tissue and the inner surface is lined with epithelium from which the contents are derived. He supposes the epithelium to be conveyed into the anterior chamber at the time the perforating wound is made. Others, (De Wecker, Arlt,) think the cysts arise from traumatic subdivision of the posterior chamber, and Eversbusch from separation -of the anterior lamella of the ligamentum pectinatum. CASE II.- Fibroma. J. W. Ellis, male, aged 17, sent to me by Dr. K. C. McWilliams. He had had no ocular trouble until June, I 894, when, while in bathing, he had smarting in the left eye followed by violent inflammation, for which he received proper
FRYER: Trauma of Orbit.
395
treatment. At that time a small growth was noticed on the iris. Dr. McWilliams saw the case in December, six months after the commencement of the symptoms. There was a deposit in the anterior chamber, a few posterior synechia, and a small oval, non-vascular, brownish, pigmented tumor growing from the anterior surface of the iris. This was afterward removed by me by iridectomy. Vision 20/70 before and after operation. Three weeks later he received a blow on the eye which opened the wound through which the tumor had been removed and filled the anterior chamber with blood. The wound healed, but vision never cleared up on account of membranous network of inflammatory material which had formed as a result of traumatic iritis in both the did and new pupil. The tumor was given to my friend, Dr. Loeb, of the Philadelphia Polyclinic, for microscopical examination. He reports: "The small growth submitted to us for examination proved to be a fibroma in active state of inflammation. The elementary structures of said growth are of non-malignant type, which excludes the probability of its being of the sarcomatous or carcinomatous nature. Bacteria have not been found, nor has it been of a tuberculous origin, for no tubercles could be discavered in staining."
REPORT OF A CASE OF TRAUMA OF LEFT ORBIT, IN WHICH EXOPHTHALMOS AND PROBABLY ANEURISM OF INTERNAL CAROTID ARTERY IN THE CAVERNOUS SINUS RESULTED: RECOVERY FROM THE ANEURISMAL SYMPTOMS WITHOUT OPERATIVE INTERFERENCE. By DR. B. E. FRYER, OF KANSAS CITY, MO.
On September [8, t893, I was asked by Dr. J. M. Singleton of Kansas, City to see with him J. B., 8 years of age, who had, two hours previously, received a severe and peculiar injury in the left orbit. The boy, who- was healthy and of perfectly healthy parents, on going out in a terrible storm, had tried to
393
and kidney diseases were reported as secondary to myxcedema. No doubt that the thyroid extract, when employed judiciously, relieves the distressing mental and physical symptoms of this disease, so that the afflicted patients take renewed interest in life; but, as the thyroid gland is atrophied, the treatment must be kept up indefinitely.
DISCUSSION. DR. 0. F. WADSWORTH of Boston, Mass.- As the author has referred to me, I will say that I have seen more than a dozen cases of myxcedema, but only in the one which I reported has there been any special eye lesion. With regard to that case, I may say that some years after it was reported, a gentleman writing on acromegaly referred to it as probably a case of that disease. I looked up the history of the case again, and think the writer may have been right, although several physicians who saw the case had no doubt it was one of myxcedema; but at the time I saw the case acromegaly had hardly been described. It is possible that in that case it was not myxcedema but acromegaly that caused the optic atrophy.
TWO CASES OF TUMQR OF THE IRIS. BY HOWARD F. HANSELL, M.D., PHILADELPHIA.
CASE I. - Cyst.' Referred to me by Dr. George Hartmann of Port Kennedy, Pa. J. W., aged 20, while harvesting, was struck forcibly in the eye with a cornstalk. The cornea was perforated, the anterior chamber emptied, the capsule torn, and probably the lens inj ured. I saw the patient a few days after the accident. The cornea showed an irregular cicatrix near the center, the iris was attached in several places to the capsule, the lens was opaque, striae running backward from the point of densest adhesion, and there was moderate ciliary injection. In six months the eye was free from injection, the synechie persistent, and the
394
31ANSELL: Tumor of the Iris.
lens was entirely opaque. Extraction of the traumatic cataract was advised and refused. Two years later W. returned on account of the development, six months earlier, of a growth in the anterior chamber. The tumor was the size of a large pea, round, perfectly white and glistening, resembling very closely a large pearl, and attached to the iris at the lower outer quadrant - the section that had been injured. Its antero-posterior diameter was longer than the depth of the anterior chamber, so that the opaque and partly absorbed lens was dislocated backward. The growth of the tumor had been slow and nearly painless, but, on account of its unsightly appearance, the patient desired to have it removed. The cut was made in the corneo-scleral border opposite the tumor. Upon the escape of the aqueous, and in consequence of the withdrawal of the support of the cornea and the pressure from behind, the tumor rotated obliquely into the pupil, forcing the lens still farther backward. A Levis wire loop was, after one or two attempts, successfully forced over and behind the tumor. It was then drawn out without difficulty, and the iris, including its attachment, cut off. The wound healed without interruption. One month later the lens and portion of the capsule were extracted, resulting in restoration of moderate acuity of vision. The cyst contained a yellow glutinous substance; after removal, the cyst wall ruptured and the contents, in part, discharged. This rare variety of iris tumor has been designated by Fuchs as " Pearencyst." Its anterior wall consists of single fibres of iris tissue and the inner surface is lined with epithelium from which the contents are derived. He supposes the epithelium to be conveyed into the anterior chamber at the time the perforating wound is made. Others, (De Wecker, Arlt,) think the cysts arise from traumatic subdivision of the posterior chamber, and Eversbusch from separation -of the anterior lamella of the ligamentum pectinatum. CASE II.- Fibroma. J. W. Ellis, male, aged 17, sent to me by Dr. K. C. McWilliams. He had had no ocular trouble until June, I 894, when, while in bathing, he had smarting in the left eye followed by violent inflammation, for which he received proper
FRYER: Trauma of Orbit.
395
treatment. At that time a small growth was noticed on the iris. Dr. McWilliams saw the case in December, six months after the commencement of the symptoms. There was a deposit in the anterior chamber, a few posterior synechia, and a small oval, non-vascular, brownish, pigmented tumor growing from the anterior surface of the iris. This was afterward removed by me by iridectomy. Vision 20/70 before and after operation. Three weeks later he received a blow on the eye which opened the wound through which the tumor had been removed and filled the anterior chamber with blood. The wound healed, but vision never cleared up on account of membranous network of inflammatory material which had formed as a result of traumatic iritis in both the did and new pupil. The tumor was given to my friend, Dr. Loeb, of the Philadelphia Polyclinic, for microscopical examination. He reports: "The small growth submitted to us for examination proved to be a fibroma in active state of inflammation. The elementary structures of said growth are of non-malignant type, which excludes the probability of its being of the sarcomatous or carcinomatous nature. Bacteria have not been found, nor has it been of a tuberculous origin, for no tubercles could be discavered in staining."
REPORT OF A CASE OF TRAUMA OF LEFT ORBIT, IN WHICH EXOPHTHALMOS AND PROBABLY ANEURISM OF INTERNAL CAROTID ARTERY IN THE CAVERNOUS SINUS RESULTED: RECOVERY FROM THE ANEURISMAL SYMPTOMS WITHOUT OPERATIVE INTERFERENCE. By DR. B. E. FRYER, OF KANSAS CITY, MO.
On September [8, t893, I was asked by Dr. J. M. Singleton of Kansas, City to see with him J. B., 8 years of age, who had, two hours previously, received a severe and peculiar injury in the left orbit. The boy, who- was healthy and of perfectly healthy parents, on going out in a terrible storm, had tried to
