A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones.

Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones. 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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    as lunar caustic, either solid or in solution. Its effect is to kill that part of the bone which is in a state of caries ; and to promote the separation of what is already dead. Plvery second or third day, a strong solution of this substance may be injected along the fistula, taking precautions against the solution being allowed to touch the eye; or the caustic pencil may be conveyed into contact with the bone, and kept there for a minute or two. There is reason to believe that sometimes diseased portions of bone are absorbed by the granulations with which they are in contact, so that the part heals up without any discharge of bone; but in general, no cure takes place unless bone comes away. The coming away of the bone is not always evident. It sometimes separates in minute scales, sticking to the dossil of lint, or washed out by the injection; while in other cases, a considerable portion is thrown off at once, is felt with the probe to be loose, and is to be extracted with the forceps. There is no stated time for the necessary exfoliation in such cases. It may take place in a month ; or many months may elapse before the diseased bone comes entirely away. As soon as we judge it probable that the whole diseased part has been removed, we lay aside the dossil of lint, and allow the opening to close. I do not imagine that in cases of caries or necrosis of the bones of the orbit, there ever is any considerable formation of new bone. All that nature effects in such cases, is, I believe, a healing up of the diseased part, without any attempt to restore what has been removed by ulcerative absorption, or by exfoliation. Fortunate indeed must the case be regarded, when the former process ceases, or the latter is completed, so that the diseased bone may heal, and the external wound be allowed to close, and this without any con- siderable deformity. The eversion of the eyelid, the impossibility of covering the eye, and the deformity caused by the retraction of the external aperture of the fistula, are events very annoying under any circumstances. Suppose the patient to be a young lady, naturally anxious about her appearance, I need scarcely say how meritorious the surgeon will be in her judgment and that of her ^ friends, if the case is brought to a speedy and favourable termination, j especially if they have ever witnessed the deformity and the destruc- i tion of the eye which may have been the result in less fortunate ] cases of the same disease. _ 1 It may sometimes happen that we are deceived in regard to the j state of the bone. The fistula may even close, and yet the bone ' continue diseased. Granulations may fill up the sinus, without its bottom being sound. Perhaps some trifling exfoliation has taken place, without the whole diseased piece ot bone having come away ; and the surgeon, misled by appearances, and thinking that all is right, does his best to close up the sinus. Nothing, however, is gained, if the bone is still left in a state of disease. On the contrary, we are only obliged to go over again the same process of dilatation, and to wait for renewed exfoliation. The exfoliation and healing up of diseased bone is throughout an