SECT. XIV.—ON HYDATIDS.
The hydatid is a fatty substance, naturally lodged under the skin of the eyelid, which, in some persons, more especially in children of a more humid temperament, increases until it become the cause of disagreeable symptoms by encumbering the eye, and thereby occasioning defluxions. The eyelids, therefore, under the brows appear watery and cannot be raised in a becoming manner; and if, when we press upon them with our fingers, we separate the fingers, the intermediate space swells up. They are most troubled with defluxions about day-break, and cannot look direct against the rays of the sun, but shed tears and are subject to continued ophthalmies. Wherefore, having placed the patient in a proper position, we compress the eyelid with the index and middle fingers a little separated from one another, so as to form a collection of the watery contents between the fingers, and direct the assistant, who stands behind and holds the head, to stretch the eyelid moderately at the middle of the brow; then taking a lancet used for bleeding, we make a transverse incision through the middle, not longer than that made in venesection, and of such a depth as to divide the skin or even to touch the hydatid itself; but this is to be done with due circumspection. For many plunging the instrument too deep, have either divided the cornea or wounded some muscle of the eyelid. If the hydatid immediately appear, we draw it out, or if not, we again make a slight incision. When it comes in sight we seize on it by the fingers, with a soft cloth, and moving it hither and thither and round about, we draw it out. After the removal of it we soak a double compress in oxycrate, and bind it on the part. Some apply levigated salts, upon the knob of a specillum, to the incision, in order that if any part of the hydatid remain it may be dissolved. After the removal, should there be no inflammation, we accomplish the cure with collyria in the form of liniments, or with lycium, horned poppy, or saffron. But when there is inflammation we treat it with suitable cataplasms and the other remedies.
Commentary. Celsus describes them by the name of vesicæ pingues gravesque. It is clear that they are different from the tumours to which modern surgeons apply the name. They appear to have been encysted tumours, or perhaps enlargements of the sebaceous glands. Celsus directs us to apply pressure with two fingers, and the skin being stretched to make a transverse incision, taking care not to wound the bladder or cyst. The tumour is then to be seized with the fingers and pulled out. He remarks that when the cyst is opened, and its contents evacuated, it renders the operation more difficult. When such a thing happens he recommends us to encourage suppuration.
To this class of tumours we may perhaps refer the white rough bodies resembling chalk-stones, on the inner surface of the eyelid, which are described by Aëtius. He directs us to evert the eyelid, and, making an incision along the vertex of the tumour, to scoop it out with an earpick, and apply burnt copper, finely triturated, to the part. When extracted outwardly he recommends a dressing with tetrapharmacum. (vii, 82.)
See Albucasis (Chirurg. ii, 10); Avicenna (iii, 3, 3, 18); and Haly Abbas (Pract. ix, 21.) They evidently copy from our author. Rhases professes to borrow his description of the operation from Antyllus and Paulus. (Cont. ii, 3, 2.)
Fabricius ab Aquapendente, describes under the name of hydatid, two kinds of encysted tumours, the contents of the one being of a thick and heavy nature, and the other, an atheroma. He approves of the ancient modes of operating. (O. L. ii, 9.) Heister incorrectly calls them vesiculæ aquâ plenæ. (Ch. ii, 2, 9.) Tumours similar to those which we have here treated of are described by Scarpa, in the third chapter of his work on the Eye, and every practical surgeon must be familiar with them.