The ægilops is an apostematous swelling between the great canthus and the nose; and it is an affection difficult to cure, owing to the thinness of the bodies, and the fear of injuring the eye by sympathy. If, therefore, the abscess burst at the surface, we remove the whole protruberance as far as the bone; and if the fistulous sore incline towards the cheek, we must lay it all open, and if the bone be sound, we must scrape it; but if diseased, we must burn it with cauteries, applying to the eye a sponge soaked in cold water. Some, after the excision of the flesh, use a perforator, and make a passage for the fluid or matter to the nose; but we are contented with burning alone, using the cauteries for ægilops, and burning down until a lamina of bone drop off; and after the burning we have recourse to lentils and honey, or to the application consisting of pomegranate-rind with honey, and other such desiccative remedies. If the ægilops incline to the canthus, and do not tend at all towards the surface, then, with a lancet for the operation on ptrygium, or one for bleeding, we may dissect out the body between the canthus as far as the abscess, and remove the deep-seated flesh, and have recourse to moderately desiccative applications. Glass reduced to a fine powder is wonderfully desiccative, and aloes with manna, in like manner. The rest of the treatment of fistula lachrymalis we have delivered in the [Third Book].
Commentary. Celsus remarks that the ægilops is sometimes of a carcinomatous nature, in which case he recommends us not to interfere with it. He refers here, no doubt, to lupus, which is of not uncommon occurrence near the inner angle of the eye. In recent cases which are not of this kind, he directs us to proceed in the following manner: the whole cavity of the abscess, as in fistulæ, is to be laid open down to the bone, which is to be burned with a red-hot iron, more especially if the bone be carious. Others, he says, instead of the cautery, use caustics, such as atramentum sutorium, chalcitis, or verdigris; but these things, he adds, are more slow in their operation, and less effectual. (vii, 7.)
When the bone is diseased the celebrated Archigenes recommends it to be pierced with a slender perforator, or a hole is to be burnt in it with a red-hot iron. He mentions that others burned it by means of a funnel and melted lead. (Apud Galen. sec. loc. v; and Rhases Contin. ii, 4.)
Aëtius gives a full and lengthy account of ægilops. He recommends us to attempt the cure first with medicines (see Book Third); and if these do not succeed, he directs us to open the abscess freely, and apply to the fungous flesh medicines possessed of strong stypticity, such as powdered glass, stone alum, and the like. A pledget of lint is to be placed over the medicines. When this method of practice does not succeed, he recommends burning, and for this purpose directs us to make a triangular incision in the flesh, and then to touch the bone with a heated iron, so as to produce exfoliation. Alum with turpentine is then to be applied to the bottom of the sore. (vii, 77.)
When the disease does not yield to medicines, Albucasis directs us to open the abscess freely, so as to make an outlet for the matter, and expose the bone. If it is found to be diseased, he recommends us to scrape it with an iron instrument, and then to apply styptic and desiccative medicines to it. When this treatment does not succeed, he directs us to perforate the bone with a triangular instrument of iron. When air issues from the nose by the opening we know, he says, that the operation is completed.
For the cure of ægilops, Mesue recommends the removal of all the diseased flesh by means of strong caustics, such as arsenic, sal ammoniac, chalcitis, alum, &c. When the bone is carious, he directs us to scrape off the carious part. Some, he adds, perforate the bone; but the operation had not succeeded well in his hands. He makes mention of the cautery in the same terms as the others. (De Ægr. Oculi, 12.)
Jesu Hali approves decidedly of perforating the bone with a specillum, or any suitable instrument. He also speaks favorably of the actual cautery. (De Oculis, ii, 32.)
Haly Abbas directs us to lay open the swelling, and apply the cautery. We have mentioned in another place that he was acquainted with the lachrymal duct. (Pract. ix, 29, and ix, 72.)
It will be unnecessary to give a particular account of the treatment recommended by Avicenna, as it does not differ from that of Albucasis. According to circumstances he approves of perforating the bone, and of applying the actual cautery to it. He also speaks of introducing a thread into the lachrymal passages and of using injections. (iii, 3, 2, 14.)
Avenzoar recommends compression and injections, but does not describe the operation. He speaks of the matter passing into the nose, from which it may be inferred that he also was acquainted with the lachrymal duct. (i, 8, 10.)