Rhases likewise makes mention of the lachrymal duct. He recommends us very particularly to make incisions down to the bone, to perforate it, or to apply the actual cautery to it. He makes mention also of escharotic applications containing arsenic, quicklime, and vitriol. He relates a case of apostema lachrymale in which he effected a cure by the ligature and friction. (Contin. ii, 2.)
The practice of perforating the bone as recommended by Albucasis, was approved of by Pott, and the use of the cautery for this purpose is also supported by the high authority of Scarpa. M. A. Severinus, Hildanus, and Garengoit, were likewise advocates for the actual cautery. Fabricius seems to have understood the disease very well, and treated it in the way recommended by the ancients. (Œuv. Chirurg. ii, 21.)
Guy of Cauliac, Theodoricus, and Lanfrancus describe and appear to have performed the ancient operations for the cure of fistula lachrymalis.
SECT. XXIII.—ON IMPERFORATE MEATUS AUDITORIUS.
This affection is sometimes congenital, being occasioned by a membrane which blocks up the entrance into the ear; and it is sometimes superficial and sometimes deep-seated. And it is formed in after life by a preceding ulceration in the meatus; for a growth of fungous flesh taking place blocks up the passage. If, therefore, the membrane which obstructs the opening be deep-seated, the attempt at cure is hazardous; and yet we may try with some slender instrument to divide it, but if it is superficial we divide it with a sharp knife, and if necessary cut it out. If there be a fleshy excrescence it may be dissected out with the scalpel used for the operation in pterygium, or that used for polypus; then making a twisted tent of the size of the meatus from a linen rag, we soak it in water, and sprinkling it with levigated chalcitis, or some such powder, we introduce it into the meatus to prevent the flesh from growing again. Should inflammation come on we must soon take it out. If there be a discharge of blood from the meatus we may soak a sponge in cold water, and apply it along with other appropriate remedies.
Commentary. Celsus describes this case with his usual terseness: “Solet tamen evenire vel a primo natali die protinus, vel postea factâ exulceratione, deinde per cicatricem aure repletâ ut foramen in eo nullum sit, ideoque audiendi sensu careat.” He directs us to make an examination with a sound (specillum) in order to ascertain whether the membrane be superficial or deep-seated, and in the latter case recommends us not to interfere with it, but in the former, directs us to make an opening by means of caustics, burning iron, or scalpel. (vii, 8.)
Albucasis describes the nature of the case and the operation in nearly the same terms as Celsus and our author. If the obstruction is occasioned by a superficial membrane he directs us to perforate it with a slender instrument. If a fleshy excrescence obstruct the passage he approves of seizing it with a hook, and dissecting it out. If the obstruction be more deeply seated he directs the membrane to be opened by means of a heated iron, taking care not to hurt the nerves. It is to be kept open with a tent. (Chirurg. ii, 7.)
Avicenna mostly borrows his account of the case from Paulus. When the obstruction is occasioned by a fleshy excrescence he directs it to be burnt down with arsenic or some other escharotic. He also approves of perforating the membrane. (iii, 4, 1, 17.)
The account given by Haly Abbas accords very well with our author’s. (Pract. ix, 30.)
Fabricius ab Aquapendente describes correctly the treatment recommended by the ancients. He admits that he had never attempted to perforate the membrane when deep-seated. (Œuv. Chirurg. ii, 41.)