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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    tice to perform it with facility is, so far as my experience has gone, most satisfactory in its result. No force must be used in introducing the instrument, the point of which having been carefully fixed in the lower opening of the duct, after being carried under the inferior turbin- ated bone, is to be gently pushed upwards into the sac through the stric- ture by depressing the handle of the probe or sound, keeping the convex part next to the handle upwards, then having established a free passage through one canal from below, 1 generally inject tepid waters from day to day, by means of a small catheter [similar in form to the sound] in- troduced in the same manner as the sound, and attached to an Anel's syringe. By following this plan, suppuration may sometimes be pre- vented, but at all events a fistulous opening in the face is prevented, if the disease is confined to the membrane, (although an abscess may have formed in the sac,) in consequence of the prevention of any accumulation there by frequent injections. {Lectures on the Diseases of the Eye, pp. 219, 220.) We have tried this method of treatment and have found it more un- pleasant to the patients than that advised by Mr. Travers, and not, so far as our experience has gone, more effectual or speedy in accomplishing a cure. Within a few years Dr. Paul Bernard has proposed a new method of curing lachrymal fistula? and chronic lachrymations, which consists in the ablation of the lachrymal gland, and he relates one case in which he resorted to it with success. The patient was a man 30 years of age, who had had lachrymation of the left eye for ten years, during which period he underwent various methods of treatment without receiving any relief. The eye was so constantly suffused with tears as to render vision with it indistinct. After trying various means without success, Dr. B. excised a portion of the lachrymal gland. This having afforded some relief, though it did not effect a cure, two months afterwards Dr. B. ex- tirpated the remainder of the gland. The result, he says, was perfectly satisfactory. Dr. B. says, that though every vestige of the left lachrymal gland was removed, the left eye was more moist than the right, and, what is still more extraordinary, that the left nostril, which had been dry for ten years, has become at times moist. It will require much stronger evidence of the advantages of this opera- tion, than has been adduced by Dr. B., to lead us to resort to so severe a procedure in preference to the already recognized means of treating lach- rymation, and which we have reason to regard as much more frequently successful than is represented by him. Congenital absence of the nasal duct.—M. Berard has recorded a case in which the nasal duct was congenitally absent, and in which he made an artificial one. The subject of this case, a man 21 years of age, was admitted into hospital Necker on account of a congenital fistula lachryma- lis. This fistula discharged a limpid transparent fluid, and caused con- tinual epiphora. On pressing on the angle of the eye in the morning, a muco-purulent liquid flowed from the fistulous orifice and from the puncta. The nostril of the same side was habitually dry; stimulating powders, such as snuff, becoming dry without exciting the secretion of the pituitary membrane. A stylet introduced into the fistulous orifice in the direction of the nasal duct would not pass, nor was it possible to penetrate its nasal orifice. No doubt could exist, therefore, of its congenital absence, and M. Berard made an artificial nasal duct by piercing the os unguis after the manner of Woolhodse. The inferior border of the internal portion of the tendon of the orbicu-
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