The passing of probes into the duct from its lower aperture is useful
in removing trifling obstructions caused by concretion of deteriorated
mucus, or slight thickening of the lining membrane, and in chronic
dilatation of the sac with probable contraction of the duct. But, at
the same time, it is an operation requiring much dexterity, and which
ought not to be attempted till after much practice on the dead body.
The first introduction of the instrument is always the most difficult,
from obstruction by a valvular projection of the membrane at the lower
orifice, the use of which in the healthy state of the parts must be
apparent. Destruction of it renders after-introduction of instruments
much more easy.
But the preferable practice is making an opening into the sac, and
then introducing instruments from the upper orifice of the duct; more
especially in cases where the swelling and pain are considerable.
The instruments employed for dilatation of the passage are tubes and
styles. The tubes are made either of silver or gold, of equal calibre
throughout, and of the same length as the passage. For some time
after their introduction they cause much irritation; this gradually
diminishes, and the wound heals over them. But, according to my
experience, the effects are not satisfactory. The irritation which
they at first occasion generally subsides, but abscess again occurs,
with much swelling, and it becomes necessary to remove the foreign
body. Again, the tube sometimes becomes obstructed by thickening and
concretion of the discharge, and then, when it is necessary to remove
it, the process is found to be by no means an easy one; a free incision
is required; a screw must be fastened into the tube, or, when that
cannot be accomplished, the foreign body must be laid firmly hold of
with strong forceps; altogether the extraction is very painful, and
often extremely tedious. In short, the practice of introducing tubes
does not appear to be founded on sound surgical principles.
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