Chronic suppurative dacryocystitis and its radical treatment : read before the British Medical Association, Toronto, Canada, Thursday, August 23rd, 1906 / by Fred T. Tooke.

  • Tooke, Fred T.
Date:
1906
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Credit: Chronic suppurative dacryocystitis and its radical treatment : read before the British Medical Association, Toronto, Canada, Thursday, August 23rd, 1906 / by Fred T. Tooke. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    of the lid should support the view that the prevention of bacterial growth in the conjunctiva must not be accounted for solely by the flow of tears, but,in a large measure by the free action of the lids, a circulation which is not impeded, and a secretion of conjunctival mucus which, when once collected can readily be distributed or expelled. In support of this assertion I may quote a case of keratitis neuro-paraly tica, complicating a cerebellar neoplasm, which recently came under my care. An eye which, beyond a swelling of the optic disc, had always been normal, de- veloped a paralysis of both lids a few days before death. The palpebral conjunctiva became very red, and a con- siderable quantity of mucus was collected in the lower cul-de-sac. I made bacteriological examinations of the secretion, which was found to contain enormous quantities of the Staphylococcus albus. To enforce my argument that when the lids are covered or rendered immobile the number of bacteria are in- creased, I have made the following experiment, which I hope to be able to tabulate more extensively later. I have taken cultures on Petri dishes from the conjunctivae of eyes suffering from some mild inflammatory disturbance. After bandaging the eyes tightly for two or three days and taking a second series of cultures, a decided increase in the number of the colonies of the micro-organism first observed is noticed. If a condition of this nature is produced in the eye by a simple bandage, a prevention of drainage in the lachry- mal channels, particularly at the nasal duct where stric- tures most commonly occur, can readily be seen to produce similar, if not more emphatic results. A more fertile field for the production and cultivation of bacteria than a stagnant lachrymal sac is difficult to find. Bacteria thus fostered readily find their way back to the conjunc- tival surface, producing severe forms of conjunctivitis and lamentable results in the cornea, after some insignificant superficial abrasion. Etiology. After a routine bacteriological e^feiination of all the patients which have come under my notice suffering from dacryocystitis I am able to concur with Ricchi2 that the micro-organism by far the most frequently found in diseased sacs is the Staphylococcus pyogenes albus: other forms found are the Staphylococcus pyogenes aureus and citreus and streptococci. Saprophytes have been found, as the Bacillus subtilis, radicosus, ramosus, luteus, Jluorescens putidus, and saccharomyces, while one case of Actinomyces albus has been reported. The diplobacillus of Morax- Axenfeld has been found in the sac as well as that micro- organism, the most dreaded by ophthalmic surgeons in cases of recent corneal abrasions, the pneumococcus. Conditions of stricture occurring as they do, as a rule, at the nasal duct, have been shown to be due in the vast majority of cases, not to a hypertrophy of the mucous membrane of the sac, but rather to an engorged condition of the subperiosteal veins, directly beneath the duct, pro-