Introduction
In the forty-third part of the series of columns on the fascinating
history of Dacryology, I will discuss the anatomical research on
the lacrimal ducts and the dimensions of the nasal canal carried
out by the famous French ophthalmologist, physician, and sur
geon from Paris, Alexander Bourjot St-Hilaire (1801–1886).
Bourjot was a polymath, and his significant contributions to
science, besides medicine, include the field of Zoology and
Ornithology (the study of birds). Bourjot studied at the Hötel-
Dieu in Paris and the Ophthalmic schools of Naples and Florence.
He then became a prosector of the operative medicine courses of
Mr. Lisfranc and Mr Sanson in Paris. In 1831, he married
Stéphanie Geoffroy Saint-Hilaire and adopted the surname of
his in-laws, ‘St-Hilaire’. He joined the Hötel-Dieu in Paris and
was the head of the Ophthalmology clinics from 1833 to 1834.
Bourjot was also the Professor of Elementary Zoology at the Royal
College. The present work will dissect his treatise titled,
‘Considérations générales sur les voies lacrymales, recherches ana
tomiques sur les dimensions du canal nasal, et modifications
importantes à apporter au modèle de la canule à demeure, dite
de M. Dupuytren’ (General considerations regarding lacrimal
ducts. Anatomical research on the dimensions of the nasal canal
and important modifications to be made to the model of the
cannula as requested by M. Dupuytren) (Figure 1). The treatise
was published in 1835 and was an excerpt from the ‘Journal of
Medico-Surgical Know-how’, February 1835 issue. I have taken
the help of experts to get it authentically translated from French
into English (Tomedes Language and Technology Solutions,
Oregon, USA). I have been selective in highlighting only the
most significant aspects of several treatises that I will discuss in
this paper. I have also shortened some text when reproducing it
verbatim to remove redundant sentences and convey the point
more directly for better understanding.
TREATISE DISSECTION
The treatise is broadly divided into three parts: Anatomy and
Physiology, Therapy, and modifications to Dupuytren’s cannula.
Interestingly, this treatise was published in 1835, the year
Dupuytren passed away, and it was nice of Bourjot to acknowl
edge that, ‘This article was in print when the learned Professor,
cited here, suffered the common fate; no one does justice to his
immense talents more than we do. We were one of the first to kneel
respectfully on his grave, and we expressed our sincere admiration
for this great Master’.
1
Anatomy and Physiology
Bourjot begins by observing how extensive the human lacrimal
drainage system is compared to that of animals. While describ
ing the suction action to draw tears from the ocular surface
into the lacrimal sac, he notes the action of the Horner-
Duverney muscle and credits Duverney for its description.
Bourjot notes, ‘The suction for drawing tears from the sac of
the large angle of the eye is mainly by the action of a muscle that
we thought we had discovered in recent research, but the anato
mist Duverney had already published. This muscular apparatus
consists of long and rather pale fibers, which from the internal
edge of the orbit, at the junction of the internal third with the
middle two-thirds, are carried to the lacrimal sac, and distend
its fibrous wall with each contractions.’ Bourjot also described
the ‘Appariel myologique du lachrymal sac (myological appa
ratus of the lacrimal sac) and demonstrated the lacrimal pump
muscle.
1
He labelled it in the illustration as ‘Muscle dilatateur
du sac lachrymal ou muscle de Horner dejä connu par
Duverney’ (Lacrimal sac dilator muscle or Horner’s muscle,
already known by Duverney) (Figure 2).
1
These again reem
phasize that several researchers of Horner’s time did not
believe in his claim of having discovered the muscle.
2–4
Hence, I reiterate that to place the historical credits in their
right place, the muscle should be referred to as the ‘Horner-
Duverney muscle’, in line with the earlier proposal and histor
ical chronology.
2–7
Bourjot described the significance of the ‘valve at the lower
orifice of the nasal duct’ in 1835, five years before Hasner
graduated from medical school in 1840. He notes, ‘The tears
enter the lacrimal points when the membranous valve located at
the lower orifice of the nasal duct under the inferior turbinate
lowers and opens the passage, after rising with each inhalation.
This is a closing movement that prevents the inspired air from
entering the lacrimal ducts. Therefore, it is impossible to force
lotions or douches up the tear duct by inhaling from the nose.
This valve, which moves back and forth, has long been of great
importance in making the lacrimal ducts a true suction siphon.’
1
8,9
This reflects how well the anatomical and physiological aspects
of this valve were understood much before its description by
Hasner.
Therapy
Bourjot classified his treatments according to the natural his
tory and severity of lacrimal drainage disorders. However,
Bourjot’s medical treatments appear to be regressive when
compared to his peers. For example, during the first phase or
the acute phase of the disease, while he endorsed the antiphlo
gistic methods (similar to his peers), he also supported the
leech therapy. He notes, ‘It has been reported that certain cures
could have been realized by repeated application of one or two
leeches toward the large angle of the eye and inside the nasal ala.
Leeches act by producing a very useful form of bloodletting. This