A RECORD OF OPHTHALMIC

GURKWAL, By Assistant-Surgeon

PRACTICE IN

N. W. P.

Mohendra Nath Ohdedab,

Srinagar. In October 1879, soon after taking my diploma in the Lahore Medical College, I was placed in charge of the Srinagar Hospital. The prospect of surgical practice was not a very bright one for the following reasons 1. The people of this district are particularly apathetic, and Srinagar being situated in a low valley, people of higher ranges prefer suffering in their homes to coming to this hot place, especially during the hot months?from April to

September._^n^^r

-jj0Sp;tal had a bad reputation at that time A rumour was current all over the district that in this hospital oil was extracted from human fat, that this was an infallible remedy for wounds, and that this oil was extracted for dressing the wounds of the soldiers then en^ved in the Russo-Turkish war. People?both the ignorant and they who ought to have known better?so thoroughly believed in this?rumour that the villagers not only ceased to come to the hospital, but gave up coming to the town even to buy their necessaries. 3 The Rev. P. Y. Wilson, M. D., on his being appointed Superintendent of the Hospitals (Sadar and Branches) in this district, began to perform major surgical operations in the Branch Dispensaries. This was calculated to reduce the at number of surgical cases Srinagar, since the majority of the cases of Vesical Calculus (lithotomy was the chief operation which swelled the number of surgical operations in this hospital) came from up-country, especially from the patties around Okliimuth and Branch Dispensaries. Such being the case, I was puzzled how I could attract surgical cases, so as to make up the number of major operations, at the end of the year, at least equal to the average number of former years. On enquiry I found out that the operation for cataract was never performed in this hospital since its establishment about 35 years ago, and that cases of cataract and internal piles were very common in this district. Here was an opportunity for not only affording substantial benefit to the people, but for raising the institution under my charge to its proper standard of usefulness. I was a tyro, nervous, just fresh from college, and had an unsteady hand ; but I made a mental note that, come what might, I would make an effort to introduce cataract operations in this hospital. The result of my cases, in 1880, was a very discouraging one; but remembering that a great ophthalmic surgeon once " said that every surgeon must first a hatful of eyes spoil before he can become proficient; I took heart and persevered. From a perusal of these notes I of my profesthose hope sional brethren who are beginners like myself, and who have not yet tried the operation for cataract, will take courage and try to relieve their fellow creatures of a curable disease. .

Karupriag

158

THE'INDIAN MEDICAL GAZETTE.

: I am very thankful to Native Doctor Gouri Dutt Naithani for his efforts in securing cataract cases, and it was mainly through his influence that cases Nos. 12, 14 and 26 (high caste Hindu females) came to the hospital. The cases of senile cataract were all operated on by LawSon's method. The dressing was of the ordinary kind?a piece of muslin with cotton pad over it, secured by a bandage. The eyes were looked into, for the first time, on the 4th day of operation. Chloroform was used in every case. 1. Panna, ast. GO ; female ; Hindu ; resident of Srinagar ; prostitute ; hard cataiact in both eyes ; 5 years' duration ; right eye operated on 23rd Nov. 1879 ; cured ; very fair vision on 4th day 2. Maoju, ast. 56 ; male ; Dhunar ("other caste") ; of Srinagar ; fisherman ; hard cataract in both eyes ; 3 years' duration ; .right eye operated on 17th Deer. 1879 ; cured ; gained good sight and is now working as a day-labourer. 3. Birkhi, set. 60 ; female ; Hindu ; of Kothar; no occupation ; hard cataract in both eyes ; 3 years' duration ; right eye operated on 1st March 1880 ; escape of vitreous; unsuccessful; eye sloughed. 4. Amartgiri, set. 62 ; female ; Hindu ; of Sirkote ; no occupation ; hard cataract in both eyes ; right eye operated on 3rd March 1880; escape of vitreous ; sloughed ; unsuc-

cessful. 5. Parmodi, prostitute ; hard

aat. 50; female ; Hindu; of Srinagar ; cataract in both eyes?fully developed in the left; left eye operated on 6th December 1880; in the endeavors to coax the lens out, it became depressed and could not be extracted ; had no scoop to use ; vitreous escaped and thought it best not to disturb the eye any more ; the wound healed ; was long under treatment for iritis ; no sympathetic irritation in the other eye; left hospital when free from all pain ; unsuccessful. 6 Daokhi, set. 55 ; female ; Hindu ; of Jakher ; no occupation ; hard cataract in both eyes ; 3 years' duration ; right eye operated on 29th December 1880 ; upper part of cornea became slightly hazy, but subsequently cleared; cured ; gained good sight, and is now doing all household work. 7. Maina, set. 53 ; female ; Hindu ; of Jakher ; no occupation ; hard cataract in right eye ; operated on 30th December 1880 ; unsuccessful; intraocular hsemorrhage and opacity of cornea. 8. Matalian, jEt. 44 ; male ; Hindu ; of Belkandi ; cultivator ; " mixed cataract" in both eyes ; 4 years' duration ; right eye operated on 14th Feb. 1881 ; prolapse of iris and iritis ; unsuccessful. 9. Gopal Dass, set. 70 ; male ; Hindu; of Maithana (Nandpriag); no occupation ; hard cataract in both eyes ; 2 years' duration; right eye operated on 15th Feb. 1881 ; cured ; gained good sight; was long under treatment for prolapse of iris. 10. Sibbu, set. 54 ; male ; Hindu ; of Pabon ; beggar ; hard cataract in both eyes ; 7 years' duration ; right eye operated on 22nd March 1881 ; cured ; gained good sight. 11. Chaita, set. 60; female; Dom (''other caste"); of Sapla ; no occupation ; hard cataract in right eye ; 2 years' ?duration ; operated on 24th March 1881 ; cured ; gained good

sight. 12. Gouri Dutt's mother, set. 60; female ; Hindu ; of Dang ; no occupation ; hard cataract in both eyes ; anterior synechia in right eye ; cataract of 4 years' duration ; left eye operated on 2nd April 1881 ; eured ; gained good sight; with a pair of cataract glasses can do needlework. 13. Chaita, set. 26 ; female ; Hindu ; of Srinagar ; beggar ;

leucoma of both cornea; cornea of left eye clear on the outer side ; has only perception of light with this eye ; performed iridectomy, for artificial pupil, on 3rd April 1881 ; absconded. 14. Dabki, set. 45 ; female ; Hindu ; of Bughani ; no occupation ; hard cataract in both eyes ; 3 years' duration ; right eye operated on 16th April 18S1 ; slight prolapse of iris which was treated by compress ; cured ; gained good sight. 15. Jalpu, set. 49 ; male ; Hindu ; of Chondia ; cultivator ; complete staphyloma of cornea in the right eye ; constant ; the eye lost for pain in the head, especially in the right half all visual purposes ; eye-ball excised on 3rd November 1881 ;

cured.

16. Karim Bux, set. 60 ; male ; Mahomedan ; of Srinagar; 2 years' duration ; shop-keeper ; hard cataract in right eye ; right eye operated on 5th December 1881 ; cured; gained good sight. 17. Maoju, set. 58 ; male : Dhunar (" other caste") ; of

?

\

[June 1,

1882.

Srinagar, day labourer; hard cataract in left eye; 5 years' duration; right eye was operated in Dec. 1879 (patient No. 2); left eye operated on 19th December 1881 ; on completing the iridectomy the lens spontaneously escaped with its capsule cured ; gained good sight. 18. Dil Jan, set. 55 ; female ; Mahomedan ; of Pouri no ; occupation ; hard cataract in right eye ; 6 years' duration;' left eye was operated on some time ago by a jerrah ; right eye operated on 19th December 1881; some cortical matter was left in the anterior chamber, but did not cause any harm eurcd; with a pair of cataract glasses she is now able to do ?

?

every kind of work. 19. Bag Singh, set. 31 ; male; Hindu ; of Dumaila ; cultivator; soft cataract in both eyes; 6 years' duration; the centi*e of the right lens appeared more dense and made me think that there wa3 a hard nucleus; on 20th December 1881 linear incision and iridectomy were made and the lens matter (principally soft) gradually removed by gentle pressure on the cornea, directed from below upwards ; some soft matter was left, but subsequently became absorbed ; cured ; gained good sight; was long under treatment for conjunctivitis. This case should have been treated by Gibson's

operation?" Linear extraction."

20. Bala Dutt, set. 65 ; male ; Hindu ; of Dang ; retired Sadar amin (moonsiff) of Gurhwal ; hard cataract in both eyes; 8 years' duration ; right eye operated on 13th January 1882 ; a blood clot in the anterior chamber became absorbed; cured ; gained good sight ; with a pair of cataract glasses is now able to read and write. 21. Deba, jet. 33 ; male ; Hindu; of Jakher ; cultivator ; hard cataract in right eye ; 2 years' duration ; operated on 13th January 1882 ; lost some vitreous ; cured ; gained good sight; complication?corneal fistula, which closed by pressure.

Ram, set. 40 (?) ; male ; Hindu ; of Serain ; court hard cataract in right eye ; 2 years' duration ; 14th January 1882 ; lost much vitreous ; cured. 23. Bag Singh, set. 31 ; male ; Hindu ; of Dumaila ; cultivator ; soft cataract in left eye ; 6 years' duration ; right eye was operated in December 1881. On 7th February 1882, the pupil being fully dilated by atropine, the first stage of " linear extraction" was performed ; the soft lenticuar needle matter was thoroughly comminuted by a needle; the patient was kept in a dark room and atropine lotion (gr. 3?oz. 1) dropped into the eye twice a day ; on the 6th day?12th February 1882?the 2nd stage of the operation was performed ; a linear opening was made by passing a broad needle obliquely inwards through the lamellae of the cornea and a curette introduced ; very little soft matter escaped ; the rest was of dense consistency and could not be made to flow out along the groove of the curette ; the opening was enlarged and iridectomy performed ; pressure from outside, failing to coax out the over the cornea, lenticular matter, the curette had to be repeatedly introduced ; vitreous escaped in large quantity and the eye had to be closed ; acute suppurative inflammation set in, and as this produced sympathetic irritation in the other eye, of cataract was excised result the eye-ball ; operation un22.

Kali

chupprasi ; operated on

(ophthalmitis)

24. Mangsiru, set. 58 ; male ; Hindu ; of Mandoli; cultivator ; hard cataract in both eyes ; 3 years' duration; right cured ; gained "some eye operated on 10th Februry 1882 ; amount of sight." Complications iritis, conjunctivitis, watery eye (Epiphora) and partial ptosis. 25. Lachmi, set. 60 ; female ; Hindu ; of Srinagar ; no occupation ; hard cataract in both eyes ; 1'- years' duration ; right eye operated on 2oth February 1882 ; cured : gained

good sight.

26. Gunga, set. 55 ; female ; Hindu of Uni ; no occupation ; hard cataract in both eyes ; 4 years' duration ; right eye operated on 28th February 1882 ; cured ; gained good sight. 27. Kumma, sat. 55 ; female Hindu ; of Yeri ; no occupation ; hard cataract in both eyes ; 4 years' duration ; right eye operated on 28th February 1882 ; corneitis and iritis ; unsuccessful ; only perception of light. 28. Mahtabo, set. 60 ; female ; Hindu ; of Srinagar ; no occupation ; hard cataract in left eye ; 2 years' duration ; operated on 8th March 1882 ; some lenticular matter and the to extract them, opaque capsule remained behind ; on trying a good deal of vitreous escaped and the eye had to be closed ;

unsuccessful. epiphora,

Complications?obstinate conjunctivitis

and

A Record of Ophthalmic Practice in Gurhwal, N. W. P.

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