78 



LACRYMAL ORGANS. 



into which the fingers could be sunk, and the 

 posterior articular surface of the patella could 

 be felt and the condyles of the femur also could 

 be recognised through the skin. The liga- 

 rnentum patella? seemed to be of its natural 

 length. The patient, when standing on the 

 sound limb, could easily flex the affected one, 

 but could not elevate it nor advance it in the 

 least. When supported under each arm and 

 desired to throw his weight on the injured limb, 

 it instantly gave way under him, becoming 

 suddenly flexed ; and if the man were not sup- 

 ported, he would instantly fall forwards. It 

 is now five months since he met with the acci- 

 dent, and being unable to earn his living he is 

 obliged to seek a shelter in the poor-house. 

 The upper edge of the patella can now be 

 plainly felt, and the muscular fibres normally 

 attached to this margin are separated from it 

 fully one inch, this interval being increased in 

 flexion. The surface of the trochlea and the 

 condyles of the femur can be plainly felt. The 

 man is obliged to use crutches in moving about. 

 The result has been unfavourable, but it is to 

 be recollected that the man was of a weak and 

 debilitated frame and neglected to seek assis- 

 tance for many days. A dignitary of the esta- 

 blished church in this country, aged 70 years, 

 who had met with this accident, was more for- 

 tunate ; he was under the care of Mr. Wilmot, 

 Professor of Surgery at the College of Surgeons, 

 who informs me that his recovery from this 

 accident took about a year, but that he 

 could walk without lameness, and that the 

 recovery was perfect. 



The tendon or ligament which connects the 

 lower extremity or front of the patella to the 

 tibia is sometimes broken transversely. This 

 rupture sometimes takes place across the fibres 

 of the ligament, and sometimes one or other of 

 the extremities of the tendon is detached from 

 the bone to which it is naturally connected. 

 This rupture usually takes place in a fall upon 

 the knee, the leg being at the time carried sud- 

 denly in the greatest possible degree of flexion 

 while the patella is drawn upwards by the con- 

 traction of the extensor muscles. We recog- 

 nize this rupture by the following signs : the 

 patient cannot raise himself from the ground ; 

 the-ieg has a singular tendency to flex itself, 

 and cannot voluntarily be extended. If we 

 examine the knee immediately after the acci- 

 dent and before any swelling has supervened, 

 we observe that the patella is elevated, that its 

 lowest point is now directed forwards, that a 

 great degree of lateral movement can be com- 

 municated to it, and that its ligament is preter- 

 naturally relaxed. We observe underneath 

 the skin at the place of the rupture a depres- 

 sion or considerable vacuum. If we push the 

 finger from below upwards underneath the 

 apex of the patella, we can elevate this bone so 

 as to distinguish by the touch the eminence 

 which separates the two articular surfaces of 

 the tibia from each other. Such signs leave no 

 doubt of the rupture of the ligament of the 

 patella ; but as this rupture takes place as a 

 consequence of a fall upon the knee, and as 

 this part is more or less contused, there fol- 



lows sometimes so considerable a swelling that 

 it is impossible to recognize the rupture. It is 

 not until after the disappearance of the swelling 

 that we can often assure ourselves of the true 

 nature of the accident, Under careful manage- 

 ment complete recovery takes place. 



(Robert Adams.) 



LACRYMAL ORGANS, or lacrymal pas- 

 sages, organa lacrymalia s. via lacrymales; 

 Fr. Les organes lacrymaux ouvoics lacrymales; 

 Ital. Gliorgani spettanti alle lagrime ; Germ. 

 Die Thr'dnenorgane. 



Under this head it is proposed to describe 

 not only the lacrymal organs properly so called, 

 but also the eyelids and conjunctiva. This 

 article therefore comprehends all the accessory 

 or protecting parts of the eye (tutamina oculi of 

 Haller) exceptthe orbit and muscles of the eye- 

 ball, for which see the articles FACE and ORBIT. 

 Those parts of the orbit directly connected with 

 the lacrymal organs are however noticed here. 



I. The eyelids. Palpebra:.* Fr. Les pau- 

 pieres; Ital. Le palpebre ; Germ. Die Augen- 

 lieder. 



The eyeball is invested in front by a mucous 

 membrane called conjunctiva. Towards the 

 margin of the orbit, this membrane leaves the 

 eyeball and forms together with the skin, with 

 which it is continuous, two horizontal folds, 

 an upper and a lower, intended occasionally to 

 cover and so to protect the delicate and trans- 

 parent front of the eyeball. The folds thus 

 formed by the application against each other 

 of a layer of mucous membrane and a layer of 

 skin are eyelids. 



Such is the simplest idea of eyelids, and such 

 are they found in the salamander and axolotl 

 among reptiles, and so far as in certain in- 

 stances they exist among fishes; such even 

 is their state in man and the higher animals at 

 the commencement of development. But, as 

 in the perfect condition of the organ of vision, 

 it is essential that the eyelids should admit of 

 being readily drawn over the front of the eye- 

 ball, and as readily retracted in order again to 

 permit the access of light, so something more 

 than a mere tegumentary fold was required to 

 constitute a perfect eyelid. There was, in fact, 

 required something to impart firmness, espe- 

 cially to the margins of the folds, a structure 

 which, whilst it served as an advantageous 

 point on which the muscles necessary for the 

 movements of the eyelids might exert their 

 action, should cause no undue pressure on the 

 eyeball, but rather give it an equable support 

 and shield it from that irregular compression 

 which might otherwise have been produced. 

 All these desiderata we find supplied by a thin 

 nbro-cartilaginous lamina, called tarsul carti- 

 lage, contained in either eyelid, within the fold 

 formed by the skin and conjunctiva. 



The tarsal cartilages do not occupy the whole 

 of the folds, but only a part at their free mar- 

 gins. Between the upper edge of the carti- 



* Palpebrae, a palpitando, quod palpitarc et 

 tremere videantur, propter citissimum et frequen- 

 tissimum motum. 



