A treatise on the diseases of the eye / By W. Lawrence.

  • Sir William Lawrence, 1st Baronet
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By W. Lawrence. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    873/920 page 835
    to the transmission of the tears, and will soon close again. I therefore consider the employment of Anel's probes in this way more likely to do harm than good, lie himself acknowledges that the method is applicable to mild cases only. [Our experience with this method of treatment has led us to a very different conclusion as to its value. We are, indeed, persuaded that it is applicable to most cases of obstruction of the nasal duct, and that it is the safest, most rational, and least painful method of treatment. At the end of this section we shall expose our views more fully.J It has been proposed to fill the lachrymal sac with quicksilver, by means of a glass tube, with a steel stopcock, terminated by a steel tube sufficiently minute to enter the puncta and lachrymal canals.* It has been expected that the weight of the metal thus conveyed into the sac, would cause the obstruction to give way. As the cavity of the sac does not exceed the size of a garden-pea, the force thus applied would certainly cure no obstructions which would not have got well of themselves. A more considerable power, corresponding in degree to the height of the column, may be applied in the act of injecting the sac, if the escape of the mercury through the other punctual be prevented by compressing the corresponding canal. If the obstruction does not yield to this power, we cannot expect it to give way to the weight of the small globule contained in the sac. As the nasal duct, after having been cleared and enlarged, will contract again, it has been proposed, in order to prevent such relapse, and to maintain a permanent passage for the Fig- 134« Fig. 135. tears, to introduce, through an opening in the lachry- mal sac, a gold or silver tube, [figs. 134, 135,] and to leave it there. In length and size the tube must be accommodated to the nasal duct and the adjoining portion of the sac. Its upper end, which is a little expanded, rests in the lower portion of the lachrymal sac, while the lower extremity, terminating in an aper- ture cut obliquely, should clear the opening of the nasal duett In order to introduce it, the lachrymal sac must be laid open. The tendon of the orbicularis palpebrarum is the guide for this incision. The distended sac must be punctured below the tendon with a double edged pointed knife, the point of which is directed towards the cavity of the sac. If the mere puncture does not make a suffi- ciently ample opening, the knife may be carried downwards and outwards in a direction parallel to the edge of the orbit. The escape of mucus and tears shows that the sac has been opened. A silver probe is carried through the opening thus made in the sac, and into the nasal duct, not perpendicu- larly downwards, but a little backwards and inwards; the inclination back- * A New Method of Treating the Fistula Lachrymalis, by Mr. (afterwards Sir Wil- liam) Buzahd, in the Philosophical Transactions, vol. lxx. p. 239. | The employment of the tube, proposed in France by Pellier de Qcjengsy, in his Recueil de Memoires et d'Observations sur les Maladies de PCEil, Montpellier, 1783, was strongly recommended in this country by Mr. Wathf.x, in A new and easy Method of applying a Tube for the Cure of Fistula Lachrymalis. 4to. London, 1781 ; second edition, 8vo., 1792. In this work, the tubes and the other means connected with their employment, are minutely described and figured. [Fig. 135 represents Wathex's tube.] The same plan was followed exclusively by Barox Dcputtrf.x, whose method, with the forms and dimensions of the tube and subsidiary apparatus, are detailed in the two works already quoted, see note, p. 834. The instruments employed by Du- pcitren are delineated in Froriep's Chirurgische Kupfertafeln, No. xxx., pi. 147. [Fig. 134 represents Dcpcytuex's tube.]
    digitised image 1
    digitised image 2
    digitised image 3