Miss M. E., a German, aged forty-three, was sent to me on June 14, 1899.
For two years sight had been failing, until at this time vision was as
follows: R. E. = 0; L. E = light perception. Tension was + 3. Both optic
nerves showed marked cupping of the disk; the vessels were pushed to the
nasal side. She stated that she had never had pain in the eyes, and had
not consulted an ophthalmic surgeon.
I advised her to submit to an excision of the left superior cervical
ganglion; she consented, and on June 15 the operation was performed by
myself, assisted by Dr. E. C. Renaud, at St. Joseph’s Sanatorium, in the
presence of Drs. J. C. Murphy, A. R. Kieffer, and S. A. Grantham. The
operation was difficult, owing to the abnormal position of the vagus
nerve. This was outside of and external to the carotid sheath, and was
much smaller than normal; it was not larger in diameter than the head of
a pin. It was identified by irritating it and watching the effect on the
heart. The superior cervical ganglion was removed and one-half inch of
the trunk of the sympathetic below. Shortly after the operation there
were lachrymation, ocular congestion, and contraction of the pupil on
the corresponding side. On the second day she counted fingers at 2½, and
on the third at 3½ feet. Slight ptosis was present.
She left the hospital on the eighth day. At this time she counted
fingers at four feet. There was only slight, if any, reduction of
tension during the eight days she was in the hospital. In counting
fingers she saw with the nasal side of the retina—temporal field. I did
not see her again until June 30, and she was then counting fingers at
five feet. Tension on that day was normal. She had light perception in
the right eye.
On July 16 I excised the right superior cervical ganglion without
difficulty, and on July 7 she counted fingers at seven feet with the
left eye, and could see the hand at four inches with the right. I
examined her on July 20, when vision remained the same, the tension of
the right eye was + 1, and of the left + 2. She was well pleased to have
the small amount of vision she possessed.