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Show nxrrararroa or me are. EXTIRPATION OF THE EYE. tion, he introduces the blunt end of a probe, (of a size rather smaller than the common dressing probe), and pushes it on gently and steadily in the course of the natural duct. He overcomes the obstruction by force, and he passes the instru~ ment into the nose by the nasal duct'lt. The probe being withdrawn, a small silver style of nearly This prevents the lodgment of matter, and the formation of 7b - being covered with black wax, or a bit of court plaister stuck upon it, has every appearance of a common patch. This operation is ingenious, whilst its simplicity ensures success. It is not followed by the high inflammation and quantity of matter which will sometimes follow the use of the bougie, and does not therefore endanger the closing of the upper part of the sac or puncta, while from the begin abscesses. From what has been said, it will readily be understood that during the cure we must carefully attend to the state of the conjunctiva, and the general secretion of the eye. As we have already hinted, there was formerly a method practised, the object of which was to fill up the abscess with granulations, and entirely to obliterate the sac, treating the disease like a common abscess. This, on first thoughts, would appear to be a method of increasing the evil, but a great part of this complaint of fistula lachrymalis arises from the excited state of the laehrymal sac and ducts, which produces, by sympathy, an irritation of the eye and of the laehrymal gland. There may occur ulceration and much internal disease in the part, which may make us still prefer this method to the long continued use of the bougie or the introduction of a ning there is neither confinement nor unseemly dressing re- style. quired, 1"ew people, however, will submit to a palliative remedy, such as this operation is, when it is intended that the style shall remain in the nose, and if the operation be performed with the intention of removing the style, and closing the sac, I would recommend that it should be performed as first described, viz. by piercin" the 0s unguis, and then sub-v stituting the style for the bougie, with the expectation that the patient will submit longer to its use. By this means while the patient enjoys comfort during the cure, he has the better chance of its being perfect in the end. When we perform the operation by wearing the leaden wire and bougie, or perform it in Mr, VVare's method, we ‘must withdraw the bougie or style, and wash the passage by means of the small syringe; at first every day, afterwards only occasionally, as it may seem to be required. Where the ducts are merely obstructed, there is only an occasional flow of the tears over the check, when the eye is accidentally excited. The patient complains little of the the same size of the probe, and with a flat head, which is to prevent its sinking altogether into the nose, is now introduced, and the operation is finished. This little style, passed down into the nose, keeps the duct permeable, while its head rent will l l E . l; 1‘. It. . disease until the sac inflames; and I know there are cases of the common operation producing abscess, followed by total obstruction, without the patient having an idea of any failure in the operation he has suffered. Searpa has thought it necessary to recommend in a partiv cular manner, that the sac should be dressed with escharotics to the bottom. I have always seen that the presence of the bougie in the passage was sufficient to inflame and cause the due contraction of the sac. He has thought it necessary too to recommend the use of the actual cautery, to destroy the os unguis, when a new passage is to be formed; a thing which I think I can say with confidence, is never necessary, and must be kept altogether out of the enumeration of our resources. .1 * The full descent of the point of the probe into the note will sink the instrument fully an inch and a quarter, 1 r,m7v‘:§ dW1M‘*}.~9-¢ w-‘-;, .a __ - ‘Q‘ ' ._ tong-$.37: '5‘,-; "ac-mt","a" 1 y--: . : |