Lectures on the operations of surgery : and on diseases and accidents requiring operations . and the coverings may have so farcontracted, but still the fluids from the eye and sac are dischargedupon the cheek, you must endeavour to restore the nasal duct. Forthis purpose an incision must be made into the sac. It is of no useto attempt passing a probe through the fistulous opening. Youmust introduce a narrow bistoury through the sac down into theduct, and lodge it fairly in the bony canal, or you may employ asort of sharp-pointed grooved director, which has been recom- Fig. 43. Fig. 44. mended
Lectures on the operations of surgery : and on diseases and accidents requiring operations . and the coverings may have so farcontracted, but still the fluids from the eye and sac are dischargedupon the cheek, you must endeavour to restore the nasal duct. Forthis purpose an incision must be made into the sac. It is of no useto attempt passing a probe through the fistulous opening. Youmust introduce a narrow bistoury through the sac down into theduct, and lodge it fairly in the bony canal, or you may employ asort of sharp-pointed grooved director, which has been recom- Fig. 43. Fig. 44. mended by Dr. Lubbock, of Norwich, a very old pupil and house-surgeon of mine, who, though he is adoctor of medicine, still practises thehigher branches of the profession.—You are told that it is necessary to feelfor the tendon of the orbicularis palpe-brarum, but when there has been in-flammation present, and this alwaysprecedes the formation of matter andfistula, you can feel nothing of thekind,—you must trust to your eyesand to your anatomical the direction of the canal. AFFECTIONS OF THE EYE. 123 you put your knife behind the margin of the bone, behind the nasalprocess of the superior maxilla, push it down at once, and lodgeit fairly in the canal. In that way you are in a position to makethe passages pervious. If you follow the knife with a probe, with-drawing the knife whilst you introduce the blunt instrument, youcome at once into the nose, and there will possibly be some slightflow of blood from the nostril. If, after a few days, you close the nos-tril and make the patient expire forcibly, the blood and matter willbe thrown up into the corner of the eye, and then you are sure thatyou have properly effected your object. You must remember thatthe bony parietes of the nasal duct are, in some respects, very intentional perforation of them was contemplated, proposed,and even practised by our forefathers. When any difficulty arosein getting the natural
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