A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
_Operation._--Evert the lid, incise the conjunctiva freely over the
tumour, insert the blunt end of a probe and roughly stir up the contents
of the cyst, thus evacuating it. If the tumour is large and of old
standing it may be requisite to cut out an elliptical or circular
portion of its conjunctival wall. The probe may require to be reapplied
once or twice at intervals of two or three days, and in certain rare
cases it may be necessary as a last resource freely to cauterise the
inside of the cyst with the solid nitrate of silver.
In _no_ case is it ever necessary to excise the tumour from the outside
of the eyelid; when this has been done in error there frequently remains
an awkward and unsightly scar.
2. _Fibrous cysts_, frequently congenital, are met with in one
situation, just over the external angular process of the frontal bone.
These are larger in size than the preceding, ranging from the size of a
barley pickle to that of an almond. Their treatment is excision by a
prolonged and careful dissection from the periosteum, to which they
almost invariably are adherent.
OPERATIONS ON THE LACHRYMAL ORGANS.--In a system of ophthalmic surgery,
various operative procedures might be detailed under this head,
authorised and sanctioned by old custom. Excision of a diseased
lachrymal gland, and removal of stones in the gland or ducts, need no
special directions for their performance, and the operation immediately
to be described, under the head of Mr. Bowman's operation, is applicable
in almost every one of the diseased conditions of the lachrymal canal,
sac, and nasal duct, to the exclusion of all the older methods.
_Mr. Bowman's Operation._--In cases of obstruction of the punctum,
canaliculus, and nasal duct, resulting in watery eye, accumulation of
mucus in the canal, and dryness of the nose, great difficulty used to be
experienced in the treatment. To pass a probe along the punctum was
extremely difficult, in fact, possible only with a very small one, while
the common operation of opening the dilated sac, through the skin, and
then passing probes through this artificial opening, was found quite
useless from the rapid closure of the wound, unless the treatment was
followed up by the insertion and retention of a style in the nasal
duct. This was painful, unsightly, often unsuccessful; and even in some
cases dangerous, from the amount of irritation, suppuration, and even
caries of the nasal bones which is set up.
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