Case Records of the Historical Grand Rounds:
Case 3: Georgiana Cavendish, Duchess of Devonshire

Georgiana Cavendish, 1757-1806

Today we will discuss a condition that received prominent mention in our anatomy lectures, despite there being almost no reported cases of it in over 50 years. Georgiana, Duchess of Devonshire became a commanding presence in the realm of politics, fashion, and high society at a time when women were seldom known to do so. At the age of 17 she married the most powerful Duke in England and immediately became a social celebrity. This was all up until the Duke grew tired of their marriage and took her best friend as his mistress, sending Georgiana into a downward spiral that included a string of scandalous affairs, crippling debts, and a whole host of other social embarrassments. This is all addressed quite decently in the movie The Duchess (2008).

These hardships were made worse by an eye problem that struck her at the age of 35. Georgiana often complained of migraine-like headaches and vague eye pain, but one night she went to bed with a headache that developed into excruciating right eye pain and swelling. She also complained of nausea, vomiting, and photosensitivity. Apparently her screams were so loud  her children had to be transferred to a different estate. Three or four days into the episode she lost the ability to move the right eye and was permanently confined to a dark room. It is unclear whether or not she had a fever though there were definite chills and diaphoresis, which worsened with the development of a corneal ulceration. The left eye was also mildly swollen. The most esteemed physicians of the day were called, including the "Senior Surgeon-Extraordinary to the King", who recommended attaching leeches to the eye and partial strangulation to flush the eye of excess blood. These efforts were not terribly successful. Her mother Lady Spencer described her appearance: (read carefully...)

"The inflammation has been so great that the eye, the eyelids and the adjacent parts were swelled to the size of your hand doubled, and projecting forward from the face. Every attempt was made to lower this inflammation so as to prevent any ulceration, but this has been in vain. A small ulcer has formed on top of the cornea and has burst, and as far as that reaches the injury is not to be recovered. If the inflammation should increase, the ulcer form again, and again burst, it would destroy the whole substance of the eye, which would then sink. The eyelids are still much swelled and scarred with the leeches, and the little opening between them is always filled with a thick white matter... The eye itself, to those who see it (for I cannot) is still more horrible."

Lady Spencer to Ms. Sarah Trimmer, August 4th, 1796

Over the course of several weeks the swelling and headaches subsided, but the Duchess could still only make out shapes with the affected eye and needed to be kept in a dark room for months. She became increasingly frail over the next few years and had recurrent bouts of fever and headache. Charles Darwin's grandfather, Erasmus Darwin, even tried treating her with electric shock therapy to help with her vision, unfortunately without much success. Some wrote that she managed to re-enter society with great courage and a new-found confidence, though she never fully regained her vision or former appearance. She died of complications from a liver abcess at the age of 48. 

So what pathological event do you think was the most likely cause of the Duchess's eye problem?

The Duchess famously used her allure for political gain, trading kisses for votes at election rallies

Answer: (highlight to see)
Cavernous sinus thrombosis (orbital cellulitis is a less likely cause of exophthalmos and chemosis)