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.

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    wards being just such as the projection of the eyebrow would give to a probe passed into the nasal duct from above. We shall meet with resist- ance at the point of obstruction, and we must employ a gradually increased pressure to overcome it; the probe then goes on into the nose, from which, on using a handkerchief, a little blood escapes. If we cannot force the obstruction with the blunt end of the probe, we must have recourse to the sharp point. The resistance may be so great, as to render it advisable to desist, and repeat the attempt after an interval of two or three days. The tube is placed in the nasal duct by means of a steel stilet, [fig. 136,] bent ri?. 136. at a right angle, of which the portion beyond the bend corresponds to the cavity of the tube. The latter must be fairly lodged in the duct, with its upper or extended portion occupying the lower part of the sac. The skin heals over, the tube provides an artificial passage for the tears, and the immediate result of the operation appears very favorable. Unfortunately, the future history of these cases is not equally satisfactory. We could hardly expect, a priori, that a metallic tube would permanently answer the purpose of the natural duct. We find accordingly, that the artificial sub- stitute, after the lapse of some months, gets out of its place, rising too high, or sinking too low, or that it becomes obstructed. It causes inflammation in some instances, and in others, pain more or less severe, an intolerable aching in the corner of the eye and cheek, which cannot be remedied with- out removing the tube. I have seen all the inconveniences now enumerated resulting from this practice, and have found it necessary, on account of them, to remove tubes which had been introduced by others, a proceeding often attended with considerable pain. That the necessity for such removal is not a very rare occurrence, may be inferred from the circumstance of the Baron Dupuytren having devised an instrument expressly calculated for the extraction of the tubes.* In one case, after removing the tube, 1 found it filled with a slender production of the mucous membrane exactly like a mucous polypus, entering above, and extending nearly to the lower end of the tube. That the method, although strongly recommended by Mr. Wathen, was not permanently successful, may be inferred from the cir- * This instrument, which has received the name of tire-canule, is described and figured in Graefe und Walthiu's Journal, vol. viii., p. 153, tab. 1, fig. 12. The sur- geon, who contributes this account, says that he saw several canulsc extracted while he was in Paris; and that, in the case of a young girl, the tube had sunk so low that it could not be withdrawn from above, so that Dcputtrkx was obliged to extract it from the nose with forceps, which was only accomplished with considerable trouble.
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