1000000031

668

nlí'ke Y0llr

inci(i~'\n

q'Jitc

throuót

the membrane : 2nd

the

0l'cr:\tlon

fuc..:.:cos , lt will

upon

wounding

fly

open,

and

.aprear a JArge orífice, though nOI fa widc'-as il becomes af·

lcrwards .

,.'he place to

opened in the

irlr,

will be acc.ording to

¡he n:\turc of {h e-

rl¡Ce3fe:

[he membrane

¡tCelr

be ooly

;»Ifl.:étcd \Vi :h a... contrilélion, the middle

pan

¡t,

which

is lhe

natural G¡ucuion

of the

pupil, mull

be cut; bUI

there be

("aranét

lhe

¡nciGon

mufl be

nude

abo

or below

lhe canra(t, though

is more

eligible,

above.

'The contraéled

¡rú,

{ro,.., a

pantlytic

d¡(arder, is fa of·

t en complic.ued with an aífec1ion of the

Telino,

that

lhe

fuccefs is very

prec.uious

in this cafe. This opcration has

anf\Vered be(l in ,dheGoos of lhe eryfhlline humour, lhough

bUl very ' feldom el'en -<'here.

EXPLAKATlON of Fij!,

P late CLVIII.

The eouehing needle, lhe broad plrl

whieh to–

wards the point is

(Ion

on ene fide ;

bUl

on the other is a

liule caove" , to

give

fubllance

and llrength .

The handJe of

lhis

inClrumem is whitt .\vory. ¡nlaid with

fircak of bl.lCk in that part of

Iying

evcn with

che

coa–

vex furCace of (he bl..dc : T he mc'aning of which ¡s, that

holding lhe h.ndle Wilh lhe fire.k up\V.rds, we may be

guided to deprefs the membrane of a milky catarat'l: with the

Hat

(u rfdcc ,

tbough the (ubílance of the cataraet {wimming

in the eye ouCcures {he

otedle,

and preveots

beiog diretl–

<d in a proper pofilion

lhe 6gh l.

E, A /rulJlu1IJ ocufi.

which is made to opeo

or(hu~

::In iron buuon fliding :il;long a

n lt

in, {he

hanqle.

This in–

Orument is compoled of one piece of (lee), in fu ch a manner

(hat

would

opeo

its daClieity,

the two braoches

of,he h. ndle were nOl eonfined by lhe bulton. The e"e1e

of it (hould

eovc:rc:d \Vith velvel, to mlke it lie COrter

on the eye.lids.

T he knife for eUlling lhe

iriJ,

lhe

bl.de

of whieh

bas t\YO edces, reCembliog a lancet, which are more adun.

t ag:ous than one only, incuuiog the

corn:a

lor the exuac.

t ion of the catarall.

Ih~

FISTULA LA CHRYM ALIS.

T H

[ jijlula lachryrn!zfiJ

i. generaJly under(lood to be

fuch a dlforder

lhe canals leading from tbe eye lO the

noCe, as obtlrulls lhe: natural progrefs of lhe tears, ana make:s

them " iekle down lhe eheek : bUl lhis is onl, lhe fid! . qd

mildeU

It age of the difeafe.

the neXl, there is a mucus

refe:lIbl,ng man er, ; od afterwards maner itfeH diCcharged

with lhe ¡ears from lhe

punfla lachrvmalia,

and fom ettmc:s

f «lm

dO orifice broken througb the Ikin between lhe nofe

and .ngle of lhe eye, The Idn .nd wor(l degree of i, i.,

wht n dle

m~((er

of lhe

~bfcefs,

by its long conlÍnlJance,

J¡"

nOl only eorrod. d lhe oeighbouring fof, p.m, bUl airo

lIffd ted

lhe fu bj.eenl bone.

Ivlonfitur Anncll, a Freneh furgeoo. recommcnds in tbe

reeenl fillul.,

p.fs

a fm aJl probe ,hrough one of lhe

puna.1

l,chr) lIIt1lia

ioto the

fOCCtU

and nore. in order to

brelk the coneretionl whieh were fuppored

make the ob·

fi rt.:élio:l, and wilh a fmalJ pipe and fyringe to throw an

in~

j,!.étmn lhrough Ihe olha, io order to walh them away.

'rhe ma nner of operating in thofe cares whc rc pcrforation

is not rcqulled , is this :

S~lppofing

Ihe abfecfs nOl brokeo,

chufe a time whcn it is

mq(l

(urgid

Wilh

m3.lter; ilnd lO

'h,

enJ, you

Ola)'

fhu, lhe pllioo,'s

"Y~

lhe d.y bofore,

2nd I.y lillle fl ips of pl.iner upon one .nolher 3eror. lhe

lids, from about the

pur.fla lachrymalia

tO rhe interoaL

angle ; which comprdliog lheir ellómnds, and preventing lhe

flux of the maner ,hilo' way, wiJl heap it up in the bag, aod

indicate more certainly ,he pldee

be cut.

lhe abretfs

a~ready

open, thetOri6ce and probe will ¡nform you where

to enhrge: then pl3ci ng the paucnt in a (eal

eoovenient

herght for the man"gemtnt ot your hl Od; \Vith a fmall in·

cifion-knife dilate (rom lhe upper pan o, the bag, down to

the cdgt: of lhe orbít, withom

él.ny

regud tO the lelldon of

,he orl)lcularis murcIe, or fe;,¡r of woundlng the blood ·,ef–

(e/s; though if you {ee (he vdrtls, it is propt:r tO !hun them.

The h:ngth of this ¡nc¡fion, will be nt u four tenl bs of

;,lD

;nch.

has becn advifed, in opt:DiDg the bag, to lAlroduce

a fmall prohe through ooe

the

punfia

into

i15

c...vit)',

prevent woundiog the po(lerior pan of it But tbis excefs

of care may be more lrouble!ome than ureful ; fince,

large a vetrd, a "ery fm0411 (hare of deXl crity is fufficlent

avoid the mi lake.·

mak.ing (his meiGon, care muU be

hado nOI

cut

100

near the j o

0 102

of Ihe eyc.llds, becaufe

of tbe deformity of (he fucelt!d'og fear; though the blear

eye or uoeven, eontraéllon of ¡he Iktn

thd p...r , artcr the

('.perarioo. is genc:rally owing to Ihe ufe of the ca.utery. and

not to the wound of the tendon\of .he orbiculdris mufcle ;

for chis laH

necdr...rily from in "tu.u :on al ways cut

through, but without

él.ny

ineoolCoience, becaufc of tbe

fina

eieatrix afterw.ards [har úxes

Itrongly

Ihe bonc:..

When the bag is open,.

ís to be tilled with dry liDt,

whieh the next day may be removed, aoo exchaoged

lor

doffil dipt io a fofl digeUive medicine : l hi. mult be repeal–

ed every day once or t\Vice, ae ·ording tO the qUiIootity of

the difcharge ; now aod theo, when lhe matter is

001

goad,

ufing lhe preC¡plt,ne:. medicine, and from time tO time:. a

fponge. tent,

prevent the

100

fulilden reunion ot tbe

up"

per p'r! or lhe .bfeef.. When lbe difeh.rge begins to

Id!'en, it wiJl be proper tO pafs • fm. JI probe, • fm, 1J bou–

gi~1

or lil ver ",ir: , through Ihe nafoil duét ioto the DOre e–

very time

drc::fi, in order lO dilate it a liule, and make

way for the tears and matter

~hich

hy Iheir ¿rain will coo–

tinue

keep il open. This melhod mull be foJlowed lill

thedifcharge is nearly over(",'hich will be in a few we.-:ks;)

.od then dr<ffing fuperfiC!a Jly wi,h dry lin" or any drying

.pplie,"on, lhe wound wtll feldu...

f.il

of healing. A fter

Ihe cure. in order to prevef'lt a r: l..pfc::. it will be propcr,

for a few wec:ks, to wear the compreffing inflrumen[ repre·

fen,ed in"lhe eapperplate.

'Vhen Ihe bone is

b~ re,

and lhe

6~uld. requlTC~:s

perfora.

tion, lhe períoralor is not tO be carrlcd down ,be

dufluJ ad

na/unJ.

for fe-ar of boriug ioto the

jinuJ

maxillllriJ ;

but

more internally towards (he noCe, which

~vill

bleed fredy,

if properly woundcd

The wound .flcrw.r d, Ihould be

drccr~d

with ¡Joffils, in Ihe manner aboye

d~fcnbed,

and the

probe or filver wire be every d..

p~crc::d

íhrough Ibe

till{1ur

na/uIN '

le(l, afler lh" cure of the .brccfs, il fhould Uill

remain obUruéled ; and if, opon trial. l he dua fhould be ro

611ed I!p as oot to admit lhe wire, it \ViII be right tO

ke~p

open the perroration ioto lhe Ilofe with a fmdll teDt, uU

lhe direharge is almo!! quite eeafed.

E"PLANA 'rlON ofFig, 4 . Plate CLVIII.

~1,

rhe

cyc,

with lhe

Ikin.of

lhe cye.Jids denoded, in

order to (he.v the orhieul.tris

m~rcle:

the. whlle llreak run·

ing from lh: inner ansle of tbe eye loward lbe Dofe is lh.

a'Ddor.