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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    cumstance that his partner, Mr. Ware, subsequently proposed and advised another mode of proceeding. Velpeau says, that it is often necessary to withdraw the canula in conse- quence of its rising under the integuments ; that M. Darcet relates twenty- seven cases, in which its extraction had been required; that it sometimes sinks into the nasal fossa, and hence the operation fails. M. Delpech had seen a case, in which it had gone through the roof of the mouth. {Nouveaux Elemens de Medecine Operatoire, vol. i., p. 647.) Professor Jaeger, of Vienna, informed me that an instance of the latter kind had come under his own observation. Beer recommends the employment of catgut to enlarge the constricted duct. The sac must be opened, and the obstruction of the duct removed in the manner already described. A piece of catgut *'&• 137- [fig. 137] is then to be introduced into the sac, and passed through the duct into the nose, when it will either present itself at the nostril, so that it may be drawn out with forceps, or it must be forced out by the patient blowing his nose. The ex- tremity of the catgut, thus brought out at the anterior aperture of the nostril, is to be fixed by sticking plaster in a convenient position near the ala nasi; and the rest of the string may be fastened in a coil to a cap, or may be fixed on the brow by a turn or two of a narrow roller. Every day a fresh portion of the catgut is drawn down through the duct, and that which had been there the previous day is cut off, the extremity being fast- ened as before. After thus consuming a piece of catgut of the ordinary length and size of the fiddle-string E, Beer commences with a similar length of the string A, and then with the string D. When this has been passed through, he considers the cure completed, and allows the open- ing into the sac to heal.* The method, proposed by Laforest,! of examining the nasal duct, and removing obstructions in it by means of instruments introduced at the infe- rior orifice, which seems hardly to have been employed, except by the inventor, has again been brought into notice by Mons. Gensoul, of Lyons, whose mode of proceeding is thus mentioned in the Dictionnaire de Mede- cine et de Chirurgie pratiques.% M. Gensoul employs the escharotic method in most cases of fistula lachrymalis, making his applications by the inferior orifice of the nasal canal. He filled that canal, in the dead body, with fusible metal, which, being removed when cold, by breaking away the bone, afforded a model for probes, capable, as he says, of entering and passing the canal with the greatest facility. When the application of caustic is required, the instrument is formed into a porte-caustique analogous to that employed by Decamp in strictures of the urethra. The probe is bent, nearly at a right angle, about nine or ten lines from its extremity; near this curve there is a slight lateral inflexion, the direction of which must be opposite for the two nostrils; it corresponds to the projection of the nasal process of the superior maxillary bone. M. Gensoul represents that his probe passes into the lachrymal sac as easily as a catheter into the bladder. The mode of proceeding, which I consider the most eligible, as com- bining the advantages of efficiency, simplicity, and complete safety, is that * Lehre, vol. ii., in the chapter on the hernia sacci lachrymalis, and hydrops sacci lachrymalis, p. 151—183. | Nouvelle Methode de traiter les Maladies du Sac Lachrymal; Mem. de l'Acad. de Chirurgie, torn. ii.. p. 175. The instruments are represented in plate xiii. 4 Tom. viii., p. 210.
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