Morning journal and courier., 1888-09-20
NO. 224

nerve behind the eye for tbe relief of pres
sure within the cavity of the skull. The
brain is invested by firm membranes. which
secrete certain amount of Auid, and are
continued down to the eye in the form of
sheath which surrounds the optic nerve; and
whenever the pressure within the cavity of
the skull is increased, as by the growth of q
brain tumor, or even by excess of secretion
from the membranes themselves, a supers-
bundance of fluid is apt to finds it's 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. 1t not infrequently happens that the
pressure within the brain cavity may be in
creased by temporary or durable causes,
which nevertheless continue in action sufi-
ciently long 10 produce permanent blindness,
even although the patient may in other re-
spests 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 grsvitation, and to relieve the brain
as well as the eye. DR.. de Wecker made two
endsavors to accomplish this object; but he
tried to feel his way to the optic nerve with
out the aid of sight, and to incise the sheath
by means of an instrument carrying q con-
sealed knife capable of being projected by
means Of spring. The risks of failure,
and still more the risks of indicting irrepar-
able injury upon the nerve, were such that
he only attempted his operation in two we'll
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 case in which the di-
minution of pressure within the optic nerve
sheath was manifestly desirable; and he de-
sheath could be exposed to view, and the OBJ
iect attained with certainty under the gui-
dance of sight at every step of the process.
He read before the Medical society of Lon
don last year an account of the first case in
which he operated, which was successful;
and he read an account of three more cases
at Glasgow, in one of which the result was
negative as far as sight was concerned; while
in the other two the patients were not only
quickly restored to useful vision-in one in
stance from complete, in the other from
nearly complete, blindness-but were at the
same time relieved or cured of other symp-
toms, such as heaache and sickness arising
from direct pressure on the brain. In his
paper at Glasgow, Mr.. Carter claimed for the
new operation that it could be performed
with certainty and without risk either to life
or to any important structure, and that it af-
forded q reasonable prospect of the preserva-
ton of sight in many forms of disease in
which it is now habitually or frequently lost.
AS in the case of every new operation, time
and further experience of its effects are re-
quired in order to determine the precise linn
it's of its usefulness In the discussion which
followed the paper Mr.. Bickerton, of Liver
pool, said that, in consequence of reading
the account of Mr. Carter's first case, he had
himself performed the operation in two in
stances; in one of which temporary restora-
ton of eight was followed by relapse, while
in the second the ultimabe issue was favora-
BILE.