Jesu Hali’s description of these operations is very circumstantial; he speaks of cutting out the piece of skin with a fine pair of scissors.
Rhases states that the cure of trichiasis may be effected by burning the roots of the hairs with a red-hot needle, or by making the excision of the superfluous skin of the eyelid. He also makes mention of the treatment by agglutinants. In his great work, the ‘Continens,’ he briefly notices the four operations described by Albucasis. He appears to have approved very much of the burning. He also describes the operation with the reeds or pieces of wood.
Avenzoar mentions four methods of curing inversion of the ciliary hairs. 1. By everting the upper eyelid and securing it with agglutinants until the roots of the hairs have been cauterised with a rod of gold. This method he does not approve of. 2. By extirpating the offending hairs and applying the blood of a bat to the places from which they were torn. 3. By making an excision of the superfluous skin of the eyelid, and afterwards applying sutures. He alludes, we suppose, to the operation of Aëtius. 4. By twisting the skin about small reeds or tubes, in the manner described by our author and Albucasis.
Haly Abbas accurately describes the four following operations: 1. By excision and the suture. He directs the under-incision not to be made deep. 2. By twisting the hairs into the fold of a silk thread and flattening it to the forehead. 3. By the actual cautery. 4. By the potential cautery.
We will give the description of the veterinary surgeon, Vegetius, in his own words: “Non longe a pilis ab interiori parte scalpello plagam dabis in cute palpebræ, post forficibus per longum ad mensuram oculi fasciolam præcides, et impositis fibulis consucs palpebram foris versus, ut oculus sine deformitate recipiat visum et gratiam naturalem.”
It is to be remarked that Albucasis, Jesu Hali, and Vegetius speak of cutting out the superfluous skin of the eyelid with a pair of scissors, as was done by Scarpa.
All the ancient operations for trichiasis are described by Guido de Cauliaco (vi, 2.) The mode of cure by twisting the skin about small reeds until the parts slough is still generally practised in China. The Chinese surgeons grasp the fold between two slips of bamboo, which being tightly fastened at their ends perform the office of a ligature.
SECT. IX.—ON BURNING OF THE EYELIDS BY MEDICINES.
The burning of the eyelids with caustic medicines was reprobated, in a word, by all the ancients, lest the acrimony of the application should prove injurious to the eyes; and because when the burning was carried to too great an extent the affection called lagophthalmos was produced, in which case the eyelids cannot be shut, and the vision is apt to be injured by everything that comes in the way. But since many who suffer from the irritation of the ciliary hairs are not able to endure even the name of the operation by suture, we are compelled from necessity, against our will, to have recourse to burning by medicine. The following is a composition of that kind: of quicklime, p. ij; of Gallic or common soap, p. ij; and some add of aphronitrum, p. iv. These things being pounded with strained ley, or soap ley, or some other ley, as that of figs or of oaks, and being mixed with the urine of a young man not come to maturity, we apply to the eyelid, upon the knob of a specillum, the part touched having the shape of a myrtle leaf; and we burn to the extent comprehended in the operation by suture. The skin being burnt at the first application, we remove so much of it with a sponge, and apply the medicine a second time, allowing it to remain until the part blacken; and if it does not blacken we apply it a third time. When the skin is blackened and the eschar also formed, we must clean away the medicine and have recourse to bathing and washing until the eschar drop off; after which it will be proper to complete the cure by means of pledgets of charpie and emollient collyria.
Commentary. None of the other authorities describe this method of cure so minutely as our author, except Haly Abbas, who evidently copies from him. (Pract. ix, 71.) Rhases and Albucasis, however, also mention the operation. They direct us to burn the part with a preparation of quicklime and soap, with the addition of some caustic lixivia, or leys. These ancient leys, or lixivian ashes, appear to have been preparations of potass more or less pure. We need scarcely remark that these applications must have resembled the caustic paste, now used for forming issues. The method of treatment here described is, in principle, much the same as that performed by Quadri with sulphuric acid. A caustic paste very similar to that now used is described by Guy of Caulico. (vii, 1.)