Diseases of the lachrymal apparatus : a paper read before the Maine Medical Association, June 13, 1882 / by E. Eugene Holt.

  • Holt, E. E. (Erastus Eugene), 1849-1931.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the lachrymal apparatus : a paper read before the Maine Medical Association, June 13, 1882 / by E. Eugene Holt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    to the most important part of the subject, namely, the diagnosis and treatment. When a'case of epiphora presents itself for treat- ment, it is very important to ascertain the exact cause of it, that no unnecessary thing may be done ; for we believe that, in the treatment of the conditions which give rise to epiphora, as in the treatment of other diseases whose etiology is imperfectly under- stood, much is done that is unnecessary and even harmful. We should keep prominently before us the various causes of epiphora which have been enumerated under the ten heads. If it is due to granulations or foreign body on the lid or in the retro- tarsal fold, it will be unnecessary to direct special treatment to any other part. If it is due to displacement, obstructions or oblitera- tion of the puncta, stricture of or foreign body in the canaliculi, it will be unnecessary to direct special treatment beyond these parts. Again, if it is due to any constitutional diathesis or unhygienic condition, to catarrh of, polypus or foreign body in, the nasal cavity, or to any defect in the eye as an organ of vision, these causes should receive our first attention. Excluding all cases of epiphora due to these various extrinsic causes, there still exists a wide difference in the treatment of the most common conditions wrbich give rise to it, namely, inflammation of the sac, with more or less stricture in some part of the lachrymal passage. They differ so widely in their procedure that the one might be called the conservative and the other the radical method. In the conservative method, the case is not unfrequently treated by small probes and syringing, without having previously opened the canaliculus by the knife. Sometimes minor operations are substituted for that devised and first practiced by Mr. Bowman, of laying the canaliculus open. Small probes are invariably used, and by some (Donders, Landolt) no probes are employed when a liquid can be readily syringed into the nose. In the radical method, the first step is to slit up the canaliculus, then to pass as large a probe as possible without doing violence. (?) The nasal duct is further dilated and kept open by passing probes as large as can be introduced. All the cases of which the statistics have been given were treated upon the conservative plan, no probe larger than Bowman, No. 8, being used. As an illustration, I