Page:The Indian Medical Gazette1904.pdf/120

Mar. 1904]

A CASE OF CONGENITAL DOUBLE ABLEPHARON.

93 crop of boils on the back and abdomen. During the next few days eight carbuncles appeared : there was a large one behind the left shoulder, and seven smaller ones were upon the buttocks and thighs. Thirst and frequency of micturi- tion continued. The reply given to repeated enquiries on this subject was that these symp- toms dated only from the commencement of the present illness.

The urine was now acid; of specific gravity 1022 ; free from albumen, and contained abun- dance of sugar: from six to seven pints were passed daily.

On July 25th, the patient declining general ansesthesia, free crucial incisions were made under eucaine in the large carbuncle on the back. There had been a slight evening rise of temperature for a few days previously: after the carbuncle was incised, the temperature re- mained normal, The slough came away satis- factorily from the large carbuncle: the smaller ones were injected with carbolic acid.

For the next week the patient progressed favourably ; his appetite improved, his temper- ature remained normal, and except slight insomnia, he had no complaints to make. The urine gradually decreased in quantity to about the normal amount.

On August 4th, it was noticed that the patient was a little drowsy : he became slightly delirious and very restless that night. On the foNowing day he showed signs of commencing coma: the breathing became laboured, and the pulse rapid. Transfusion of saline solution was proposed, and was, at first, agreed to by the relatives ; however, it was never carried out, as the patient was removed from my care and handed over to a hakim. I ascertained that he became more and more comatose, and died three days later.

This case seems to me to be of some interest on account of a possible connection between the hyperpyrexia and the diabetes. It may be that the diabetes was of longer standing, though both the patient himself and his friends were quite sure that the great thirst and polyuria had not existed prior to the hyperpyrexia.

In any case, the coincidence of hyperpyrexia, with possible cerebral damage, and a rapidly fatal attack of diabetes is suggestive.

It is much to be regretted that no post-mortem examination could be made.

A Hindoo male child, of. one year, was brought to the Prossonnath Rai Charitable Dispensary at Ramrore Boalia on July 24th. The skin from forehead to.cheek on both sides was continuous over the orbital cavities. There waa ‘no trace or :uggestion of a palpebral fissure on either side. The skin was smooth, neither lax nor very tense. The eyebrows were poorly deve- loped, and what existed of them was placed slightly below the upper orbital margin. The nasal bones were poorly developed even for an infant of twelve months, and the face presented an extraordinary mask-like appearance.

The globe of the right eye was more promi- nent than the left, and the skin and integument over it could be easily pinched into a fold, and seemed to be freely moveable. The skin and integument were somewhat less moveable over the globe on the left side, and to the lower and outer part there was a small finctuating swell- ing, which, on examination, was found to be quite local ; the fluid in it could not be displaced in the direction of the normally situated conjunctival sac.

The mother stated that the child could distin- guish between light and darkness, and I satisfied inyself that this was so, though I could not say whether perception of light existed on both sides. She also said that tears ran down the nose when the child cried. Iam inclined to doubt this statement, as far as a true lachrymal secretion is concerned,

The orbicularis muscle was evidently fairly developed on both sides. The child waa ad- mitted on July 27th, and on the following day I operated on the right side under chloro- form. A transverse incision slightly convex downwards was made across the orbital cavity, by pinching up a vertical fold and transfixing ié. The incision was then carried well in- to the inner and outer angles, and the loose areolar tissue, which was found connecting the cornea and integuments, was carefully dissected off the surface of the cornea. A very rudiment- ary trace of a conjunctival sac was found at the lower and outer part. By carrying on the dis- section all over the globe, and suturing the in- teguments to the margin of the skin incision an attempt at the formation of eyelids was made. The cornea presented an opaque ground- ginss appearance, its curvature was irregular and bulging. The normal pearly white appearance of the sclerotic was absent, it was bluish grey in colour, not unlike but still quite distinct from the cornea. No trace of the lachrymal apparatus was found. The results of the oper- ation were very disappointing. In spite of the free dissection, the eyelids, or rather the margins of the skin incision, would not touch or even approximate. The cornea ulcerated and eventually sloughed, and the wound con- tracted, leaving a granulating sore which had not quite healed when the mother took the child away. No operation was attempted on the left side. I have thought the case worthy of record on account of its extreme rarity. Jales in his work on the eye, the only book 1+have acoess _to-at the moment, speaks of complete) ankylo-