Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney.
- Date:
- 1873
Licence: Public Domain Mark
Credit: Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![oblique position, that one end of the bandage should be placed close under the lobe of the ear, the other over the forehead and exactly over the boss of the parietal bone, and then the ends cross over the center of the optical region, and are brought forward and tied in front. We should here take care that the knot does not lie on the eye, and thus cause a very un- pleasant pressure. This bandage has an important therapeutic advantage if properly applied, in entirely preventing the opening and shutting of the lids. It allows, also, the free escape of a certain amount of secretion from the palpebral fissure. If both eyes are closed, and vision rendered impossible, the movements of the globe as well as the accommodation arc reduced to a minimum. This muscular rest is an advantage in the treatment of irritated parts, which cannot be too much esteemed. Besides, immobility of the parts is often imperatively required, when wTe wish for a proper apposition, and the speediest possible adhesion of the edges of wounds; as, for instance, after accidental or operative injuries to the eye and its surroundings. Plaster is never sufficient for this purpose. When it covers only a small portion of the closed lids, it does not prevent their movement, and if the surface of the lid, particularly the edges, are entirely covered with plaster, the exit of the redundant secretion into the conjunctival sac is retarded. This becomes a source of unpleasant irritation, amounting sometimes to unbearable pain. If the plaster is of a material which is irritating in its nature, erythema of the extremely delicate integument may occur, and lead to a great irritation of the conjunctiva and of the globe. Added to this, plaster presses very unequally, according to the degree of its tension. This un- pleasant peculiarity is especially true of the isinglass plaster,which shrinks soon after its ap- plication, and thus the edges are turned in some places directly upon the surface of the lid. Then, too, the adhesive material readily dissolves in the tears, diffuses itself, and, again becom- ing dry, completely closes a great part of the palpebral fissure. Whether it is possible to prevent the movements of the eyes by purely mechanical means may be fairly doubted. The nearly spherical form of the globe, and the position of its axis, do not allow us to suppose that all motion can be prevented, even by the most accurate application of large masses of padding, without inflicting a degree of pressure which could not be endured. Still some believe that they can accomplish this without excessive annoyance to the patient. For this purpose the use of a roller bandage about four feet long, with a knit middle portion and flannel ends, is recommended. This is first carried circularly around the forehead, then above the ear of the unaffected side, to the back of the head, under the other ear over the affected eye. If both eyes are to be closed, then two bandages should be used. In order to exert a still more power- ful pressure upon the well-padded orbital region, a so-called laced bandage is highly spoken of. This renders necessary a bandage ten feet long, of the kind just described, and requires three as- cending monocular turns, in the manner indicated in the use of the pressure bandage (Graefe). It will require further experience to decide whether such a severe pressure, as is necessary in the use of this bandage, furnishes real therapeutic advantages, and whether the result, which in individual cases may be thereby attained, balances the disadvantages, which in very many instances are absolutely intolerable. It seems as if the ordinary protective bandage, with a somewhat greater tension of tfie elastic part of it, were able to accomplish all that is to be generally expected from a pressure bandage, without excessive annoyance and without danger of unpleasant consequences. [It is more than probable that the true function of the bandage would be better expressed by using the name retentive bandage, thus indicating the most important agency which the dressing fulfills, namely, to keep,the eyelids closed, the air ex- cluded ; and, in the case of a wound of the front of the eyeball, to givea splint- like support.] 2. The effects of dust upon the conjunctiva and cornea.—Working with dusty substances, or frequenting dusty localities during the existence of conjunctival or corneal disease, should be strictly forbidden, since the mechanical contrivances used for excluding dust fail to accomplish that purpose. *](https://iiif.wellcomecollection.org/image/b21987634_0045.jp2/full/800%2C/0/default.jpg)
