LachyrmalisXIII. A new method of treating the Fistula

Mr. William Blizard, F.A.S.

1780, 239-245, published 1 January701780 Phil. Trans. R. Soc. Lond. 

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XIII. A new Method of treating the Fiftula Lachrymalis.1 By Mr* William Blizard, , F. A. S. ; -I nicated by Mr* Jofeph Warner, , F. F. £.

Read Feb. 24, 1780,,

BrN every period of the difeafe, t e r m e d , P- there is underftood to exift a degree of obftru&ion in the nafal duft ; fo that more or lefs of the tears-, mixed p ith the oily fecretion of the febaceous glands of the eye-lids, and mucus of the internal furface of the lachry­mal fac, being prevented from palling into the nofe, are 'expelled through the lachry rpal punfta upon the furface mi the eye, and down the cheek.

Writers on furgery divide this difeafe into feveral ftages; the firft and moft Ample being that of obftruc- tion, with little or no inflammation; and fo on, accord­ing to the degree or effeft of inflammation, to the laft ftage, a floughy, ulcerated condition of the lac and its

|integuments, with, now and then, a caries of the bony sparts,

Though

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24.0 Mr. blizard’s new Method of

Though the difeafe.be frequently the effed of a § in the habit, yet furgeons find, that fometimes the caufe j# is very Ample, and eafily to be conceived from the ana- I ' logy of parts. ' . ■

The membranous portions of the nafal dud and la-chrvmalfac are a continuation of the pituitous membrane | jtof the nofe. This membrane is exceedingly valcular, i ■ -fecretes a large quantity of mucus upon its internal fur- <1 face, and is endued with a great degree of fenfibility.

Experience ihews the great defluxions that are often­times made upon the pituitous membrane; the increafed fecretion of mucus that happens upon the application of various ftimulants; and the firm confidence it! often acquires from ftagnation, abforption, and evapora-i tion of its thinner parts: moreover, that the membrane itfelf frequently becomes inflamed and thickened.

The dud and fac may be afleded through ob-ftruded perfpiration, See.; and thickened from the

,,

turgid ftate of their veflels: the fecretion of mucus may alfo be confiderably augmented. From the thickened ftate of the membrane of the dud, the fluids in the fad pafs with difficulty: by' retention, warmth, and abforp~< tion, they are rendered vifeid; and the difficulty, that* at firft arofe from the thickened ftate of the membrane,!

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treating the Fiftula Lachrymalis. 241 now arifes from another caufe, namely, the infpiffated

Iftate of the fluids,Thefe are, probably, the moft Ample caufes of obftruc-

ition in the nafal dud; but, from whatever caufe the ob- gftrudion had its origin, in its early ftate, when unattended jwith a morbid change of the contiguous parts, it is con- [iidered as the flrft and moft Ample ftage' of th machrymalis. It is in this ftage that the means of obviating ■the neceflitv of a trdublefome and uncertain operation Jftiould be employed, with any rational expectation of I fuccefs.I The principal of thefe means are :

tlCompreflion; declared by experienced practitioners ito be injudicious. fw 2. The pafling an inftrument into the noftril, and upmIthe dud; an operation very painful to the patient, andExceedingly troublefome to the operator.

3. The introducing a probe through one of the punda ■ * . finto the dud, after M. anel’s manner; by experience

proved to be inadequate to the deflgm \ 4. The impelling a fluid, by a fyringe, through one

’i f the punda, as direded by M. anel; allowed by judi­cious and experienced furgeons to be fometimes ufeful.■ On refleding upon the laft method, I was induced to think, that if a fluid, of a great degree of fpecific «VoL. LXX, I i gravity^

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gravity, as quickfilver, could be palled through one 1 of the punda,fo as to fill the fac and dud, and prefs u p o a | theobftruded part,it might be reafonablyexpeded to re-1 move the obltrudion in the Jirft and Ample ftage of th e ! difeafe ; at leaft, to have a much better chance of pro-4 ducing this effed than a watery fluid, urged throughl the pundum in an unfavourable diredion : befides, i t | would be no bar to the ufe of proper general means. 1 >

Flattered with the leeming reafonablenefs of the fug- k geftion, and convinced of the fafety of the experiment, ̂Irefolved on making a trial the firft opportunity; which foon occurred to me. \ ,

Mr. m-— B'—, a fadler, in Mark-Lane,had been trou-lj

2A2 Mr. blizard’s new

bled with a flux of tears and mucus down the cheek from the punda of the right eye-lids, about feven months.I There was a degree of fwelling or diftenfion of the lac, attended with pain* Upon preffing the fac, much ropy fluid, of a whitifli colour, was forced through the punda. The discharge \yaa always in greateft abundance in the evening; at which time he had adimnefs of fight] in that ey e.

The ufual means had been employed, without fuccefsj by his lurgeoo, who approved of the luggefted experi-j ment, and the patient agreed to have it tried.

Melfi Nairne and blunt provided an inftrument for the purpofe. It conlifts of a fine fteel pipe, a little curved,

4 cemented

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treating the Fiftula Lachrymalis. 243 ^cemented in a glafs tube about fix inches long. At the I top of the tube is a wooden funnel; and at the bottom 1 of this is a valve, which may be elevated by a filken firing I that is conveyed through a hole in the brim of the fun- jnel, and hangs down by the fide of the tube^.I The fteel pipe was paffed into the inferior pun&um, I without pain or difficulty. The quickfilver was then I poured into the funnel, and let down the tube by pulling

the firing of the valve. When the quickfilver regurgi­tated out by the fuperior punftum, the inftrument was

\ withdrawn. The quickfilver lay in thefac and dutt, 1 without exciting pain, about thirty hours, when it palled* I into the nofe, and the patient caught fome of it in his I hand.

I thought it belt at this time not to comprefs the fac; apprehending it would difcharge the quickfilver through the purnfta, and fo fruftrate the intention.

Oh the third day the operation Was repeated ; when, on I gently compreffing the fac, fome of the quickfilver paired 1 into the nofe, and with it a piece of congealed whitilh Imucus. A fmall quantity of the quickfilver, upon ■making the preffure, returned through the pun£ta.

I (a) I have defcribed the inftrument as it was ufed; but I have fince thought, ■that it would not-only be more fimple but do as well without a valvular appara­t u s , the quickiilver being poured in by an affiftant. (See the figure).

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At the third and fourth times of repeating the opera- • tion, without any compreffion, at intervals of a few j days, the quickfilver pafled readily into the nofe. I

I once introduced the point of a fteel pipe, ufed for in - | jeding the lymphatic veflels. It is cemented to a tube o fl glafs eighteen inches long. This pipe is not fo fine a s i that of the other inftrument, yet it was conveyed into* the pun&um without difficulty, and with little or no I pain. To gain a greater degree of momentum I raifed, the column of quickfilver to about twelve inches, when, it flowed into the nofe with a confiderable degree of ve­locity.

From the time that the quickfilver pafled into the nofe, lefs fluid trickled down the cheek than before. After the fecond or third operation, the fwelling or de­tention of the fac intirely fubfided. The patient at this time has no difcharge of mucus, and a tear but very fel- dom: the parts have a perfectly healthy appearance.

To afcertain the effe&s of medicines in difeafes of the I conftitution, many experiments, under various circum-J ftances, are neceflary;.butin matters determinable by a | mechanical operation, the effeft, as far as our fenfes can! direct us, is in general very plain and explicable.

f' " iB s ■ mIn the cafe related this is clear, namely, that previoufly |

to the inje&ing of quickfilver, the tears, febaceous mat- hter, 1

a44 Mr. blizard’s new Method of

I

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Philo's.Tram, /5/,Zxr.Tab.F7.p M l

a,. The Steel Pipe

\The Crhfs Me

c. The Funnel

I 1

B A S M .5 C ,

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treating the Fiftula Lachrymalis. 245 ter, and mucus, did not pafs through the nafal dud, or, but in a very fmall proportion to the quantity fecreted; that at the firft experiment, quickfilver did not pafs j but that quickfilver, tears, &c., have fince readily paffed.: I cannot, however, flatter myfelf that this method will

avail, except in the firft or Ample ftage of the diforder; but many cafes have a favourable ftate for the trial in (heir early period, and that opportunity may be feized with a probability of fuccefs.

The operation is fimple, eafily executed, produdive of but little pain, and attended with no kind of danger.

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