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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    tion is over in two or three seconds; the bistoury withdrawn, and the style safely lodged in the canal. The opening into the lachrymal sac, the division of the obstruction, and the passage of the style are all effected by one movement of the knife. Dr. Lubbock has found it advantageous to use a pin long enough to rest upon the floor of the nostril, for in this manner we prevent the head of the style from sinking within the lachrymal sac, which, whatever be the shape of the head, whether flat like a nail, or globular, is always sooner or later followed by increased inflammation and suppuration. The length of the pins which Dr. Lubbock employs varies from I5 to If inch; and in cases where the sac has become much distended by matter, and the surrounding parts have been much thickened by the effusion of lymph, he has in the first instance used them as long as two inches, or 2} inches. The length of the duct varies in the same manner as the length of the face, which, when measured from the top of the nose to the upper incisores, is very different in different persons, and even in the same person. As the swelling subsides, a small piece will require to be cut off from the end of the style. But Dr. L. always pre- fers having it rather too long than too short, until the swelling and inflam- mation have completely subsided, when it may be made to rest accurately on the fistulous orifice. As to the propriety of altogether omitting, after a time, the use of the style, Dr. L. thinks that it is best to discontinue its use gradually; as by taking out the style one hour on the first day, two hours on the second day, and so on.] If there should be fistula of the lachrymal sac, some modification of the proceeding may be necessary, such as a previous slitting of the fistulous track; or this may be done at the same time with the opening of the sac. Complicated contrivances for compressing the enlarged lachrymal sac, and thus reducing it to its proper dimensions, are described and delineated in surgical works; I must doubt whether they have been employed, as they seem ill calculated to answer the intended purpose. Of one thing I am certain; that the annoyance of wearing such machinery would be greater than the inconveniences incidental to the complaint. The various proposals for conveying setons into the nasal duct from the nose, and for attacking the constricted portion with escharotics or the actual cautery, are either obsolete or inappropriate, and therefore do not require detailed consideration. When inflammation of the sac occurs repeatedly, and the nasal duct is obliterated, so that the foregoing methods are inapplicable, it has been re- commended to expose the cavity completely, and to destroy the mucous membrane by the actual cautery, by pure pot-ash, or some other escharotic. Another method, suggested under similar circumstances, is that of perfo- rating the os unguis, so as to make a direct opening into the nostril. I have seen no cases requiring such proceedings. Obstruction of the duct may arise from syphilitic disease of the nose; from caries or exostosis of the surrounding bone; from morbid growths of various kinds, originating in the nose or antrum. Suppuration and ulcera- tion of the sac, with fistulous openings, may ensue in such cases, which admit of palliative relief only. Fistula lachrymalis has been kept up by the presence of a calculous con- cretion, and has healed on its removal. (Graefe und Walt Iter's Journal, vol. x., p. 597.) I have not seen such formations in the lachrymal pas- sages.
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