Cases of extirpation of the lachrymal sac / by Freeland Fergus and A.L. M'Millan.
- Fergus, A. Freeland (Andrew Freeland), 1858-1932
- Date:
- [1907?]
Licence: In copyright
Credit: Cases of extirpation of the lachrymal sac / by Freeland Fergus and A.L. M'Millan. Source: Wellcome Collection.
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![diverticula in which micro-organisms might find a resting- place, setting up from time to time acute or subacute inflammation. Most of these cases were due to infection either from the streptococcus or pneumococcus; occasionally they were tubercular in origin. He believed that probing with thorough irrigation might sometimes procure recovery, and thought that in most cases this line of treatment should be given a trial. When the dacryo-cystitis, however, was recurrent, he thought that the sac should invariably be excised. If properly done, in most cases this effected a radical cure. In only one of his patients a small piece of the mem¬ brane had inadvertently been left in, and suppuration had recurred. Cases due to tubercular disease were apt to be disappoint¬ ing, for the involvement of the sac was only part of the mischief, and frequently the deeper structures were invaded by tubercle. In conclusion, he wished strongly to deprecate the old treatment by division of the canaliculus either by Weber’s or Stilling’s knife. There was no doubt a stricture at the end of the passage, right down at the junction of the sac with the duct. He could not conceive how it was possible to remedy this by the destruction of the punctum and canaliculus at the upper part of the passage. It seemed to him that any such procedure was as unjustifiable as it would be in stricture of another organ to divide it from the meatus externus right up to its membranous portion. When this operation was proposed to a patient, he was almost invariably asked whether it would not cause great and permanent lachrymation. Practically he had not found this to be the case. If it did occur, however, it would be perfectly simple to remove the lachrymal gland by the method of double eversion of the eyelid. [Dr. M'Millan.] Description of the operation.—The sac is well douched out beforehand, and at the time of operation an attempt is made to dilate the sac with pure glycerine. I chose glycerine as being of a thick consistency and little liable to injure the tissues should any escape from the sac. Having defined the internal palpebral ligament, an incision is made through the skin, beginning over the centre of the ligament and extending obliquely downwards and outwards for about three-quarters](https://iiif.wellcomecollection.org/image/b30611143_0002.jp2/full/800%2C/0/default.jpg)
