extraction of the lens in its capsule with Macnamara's scoop. This is very carefully passed behind the equator of the lens and slid downwards along the posterior capsule, until its free margin embraces the lower circumference of the equator of the lens. The lens is now drawn upwards, the handle of the scoop being at the same time somewhat depressed towards the edge of the orbit, thus pressing the lens slightly against the
gently
cornea and preventing its slipping out of the cavity of the scoop. My operation is in fact Pagenstecher's, with Yon Graefe's linear incision. As stated, my section is in purely corneal tissue. I think there is less danger of
escape of vitreous by this mode than in making the incision sclero-corneal. I have also found that it is well not to make the incision too steep, and I follow Von Graefe in
turning the edge of the knife somewhat obliquely upwards and forwards just when completing the incision ; the wound gapes less than in a steep inand there is less dan?er of escape of vitreous. It is also well not to introduce the scoop unless the len3 has been dislocated and is presenting at the incision ; sometimes it unfortunately happens that cortical matter or the capsule remains behind after extraction of the
cision,
nucleus of the lens.
Cautious efforts
everything before closing ought to be desisted from if
to remove
efforts
to be made the eye ; but all loss of vitreous
ought
occurs. *
1.?Mukkoo ; jet. 35 ; male ; Ahir ; of Pertabgurh ; beggar ; mixed cataract perfect in left, imperfect in right eye ; said to be of 5 months' duration ; linear extraction performed on right eye 2nd August 1878; cured. The
patient counted fingers on the third day, he sufferciliary neuralgia, which required for cure hypodermic injection of ? grain doses of morphia ; atropine instilled into the eye. (gr. iv to ?i) ; belladonna ointment, slight antiphlogistic remedies and iodide of potassium. 2.?Lukhy ; set. 48 ; male; Pasee ; of Pertabgurh ; cultivator ; hard cataract in right eye, left eye good ; 6 years' duration ; linear extraction performed on right eye 6th August 1878 ; cured. No complication. He had good sight on the fifth day. 3.?Madi; set. 60 ; male; Ahir ; of Sultanpur; cultivator ; hard cataract in right eye, left eye good ; 5 months' duration ; linear extraction performed on right eye 8th ed from
A RECORD OF OPHTHALMIC PRACTICE IN OUDH. By G. D.
Civil
MacReddie, M. D., Surgeon, Gondah.
for publication the following list of with reference to the cataract operato remark I cases, beg tions that I perform Von Graefe's modified linear extraction. I make the upward linear incision with a very narrow-bladed knife in purely corneal tissue. In
submitting
Next, I make an iridectomy by drawing out the iris with forceps and excising it quite close to its ciliary insertion by three or four successive snips with the The third stage of the operation consists curved scissors in
making gentle
pressure with the curette on the lower ; by this manoeuvre the lower portion
part of the cornea
of the lens is pressed downwards and the summit of the lens is tilted forwards and often presents at the incision. The last and most difficult part of the operation is the
; cured. escape of vitreous occurred ; capsule separated from nucleus and was removed with forceps ; patient made a good recovery : early return of vision. 4.?Golloo ; set. 40 ; male ; Mali; of Pertabgurh ; years' duration ; gardener ; mixed cataract both eyes ;
August 1878
Slight
liuear extraction 1878 ; cured.
performed
on
right
eye 8th August
escape of vitreous; lens removed with some to its having at first slipped away from the scoop. He did very well; early return of vision. 5.?Mussummat Sudhia ; tefc. 60 ; female ; Chamarin ; of Pertabgurh ; no occupation ; hard cataract both e}res ; duration ; linear extraction performed on left 2
Slight
difficulty, owing
years'
eye 10th August 1878 ; unsuccessful.
THE INDIAN MEDICAL GAZETTE.
4) This
complicated with pterygium in both pterygia were removed?completely partially from right eye, owing to the
was
case
eyes. from left and strong adhesions the growth had contracted with the cornea. On the 10th the left eye was operated on for cataOn completion of the corneal incision and iridecract.
from the anterior chamber?some escape of vitreous took place ; the humour was abnormally fluid ; it was presumed that the lens had sunk into the vitreous ; no inflammatory symptoms developed, but vision did
disappeared
subsequent
progress of the
case
years'
eye
on
August 1878 Both eyes
is
left
August 1878
cornea.
a liberal diet arrested further effusion in the On the 21st September effusion took place in the right cornea; the same treatment as that detailed above was adopted. But, though the extension of opacities in the
examining with the oblique illumination, the patient stated that he could see the light of the candle used.
arrested, the latter did not regain transparency, and both eye-balls began to atrophy. The patient's health was bad ; he suffered from intermittent fever and dysentery. The painful lesson taught me by this case is not to operate on both eyes at the same time, but always to await recovery in one eye before operating on cornea was
Linear extraction was performed; some cortical matter remained in the anterior chamber, this took several weeks to be absorbed ; sight did not return by the last reports made to me by the Assistant Surgeon of the Pertabgurh Dispensary. Deep-seated disease in existence
prior to the operation, and discoverable only by thalmoscope, is the sole reason to explain the
the
the other.
oph-
cause
13.?Mussummat Sobhanee ; fet. 60 ; female ; Mussul; of Gonda ; no occupation ; hard cataract in right eye, left eye good ; 4 months' duration ; linear extrac-
of
manee
failure. 7.?Musst. Mithnia ; set. 50 ; female ; Mussulmanee ; of
tion
Sultanpur ; no occupation ; hard cataract right eye, left eye good; one year's duration; linear extraction performed on right eye 10th August 1878 ; cured. No iridectomy was performed on the 10th. On the 15th as the iris appeared dull, iritis was feared ; iridectomy was consequently performed ; an iridectomy knife was used ;
a
opened
No
daily used ; Extr. belladonna was applied over the eye-brow ; effusion of blood in anterior chamber, however, took several weeks before it. was absorbed ; it was not till about the end of September was
that she regained vision. 8.?Ramdeen ; jet. 60 ; male ; Ivoormi; of Pertabgurh ; ; hard cataract in both eyes ; 1? year's duration ; linear extraction performed on both eyes on 14th August 1878 ; cured. No complications ; both eyes were
occupation labourer
operated
on
at the same time.
9.?Mussummat Sookhia ; set. 40; female ; Kunjar ; of ; vegetable seller ; hard cataract in right eye 1 year, left eye 3 years' duration ; linear extraction performed on left eye on 15th August 1878 ; cured. No ; vision
fifth day. 10.?Mussummat Edia ; tet. 38 ; female ; Mussulmanee ; of Pertabgurh ; no occupation ; hard cataract in right eye,left eye good; 5 years'duration ; linear extraction performed on right eye on 17th August 1878 ; cured. No complication ; vision good on third day. 11.?Ramoo ; ast. 45 ; male ; Bhogawa ; of
occupation
good
on
; cortical or soft cataract
eye
on
25th
vision
on
third
right
August 1878 ;
complication ; good
day.
cured. Examination of eyes by oblique illumination previous to operation showed cataracts of milky white opacity ; homogeneous, without solid nuclei ; on the inner side of the anterior capsules there were several brilliant opaque white dots. 21th August?The left eye was operated on : on attempting removal of the complete cataract with the scoop rupture of the capsule occurred ; the contents came ous
away leaving the capsule behind ; as a little vitreno attempt was made to bring away the cap-
escaped,
sule.
On the 4th
September,
or
9th
day
after
operation,
examination of the eye showed that the capsule lay in the axis of vision ; patient had perception of light, but could not count fingers. She was put under chloroform and an incision with a broad needle made in the outer an
Pertabgurh
complication
on
14.?Mussummat Wazeerun ; set. 35 ; female ; Mussalmanee ; of Gonda ; no occupation ; fluid cataract in both eyes from early life ; linear incision performed on left eye on 27th August 1878 ; right eye on 4th September ;
small tract of the former corneal wound was a piece of iris removed; no complication
atropine
performed
cured.
and
occurred ;
no
use
lants with
In
to be pure senile cataract.
repeated paracentesis with Bowman's stopof atropine and belladonna, counter-irritaadministration of ammonia, quinine and stimu-
the
tions, the
; unsuccessful.
presumed
at the same time on the 24th
cornea:
needle,
case was
operated on
Inflammatory symptoms?kerato-iritis?set
on
6.?Buktawar ; set. 60 ; male ; of Pertabgurh ; cultivator ; hard cataract in left eye, right eye lost ; one year's duration ; linear extraction performed on left eye 9 th This
; unsuccessful.
were
in 26th. On the 27th chemosis was observed in both eyes with a broad line of opacity on the upper portion of the
August.
not known.
'
; 12
12.?Bhola Singh ; set. 50 ; male ; Kutri ; of Gonda ; cultivator ; hard cataract in both eyes ; 4 months' duration ; linear extraction performed on both eyes on 24th
tomy, and before any pressure had been made to tilt the lens upwards with the curette, it was found that it had
The
1879.
duration ; linear extraction performed on 18th August 1878 ; cured. No complication occurred, but some cortical matter remained behind?this took some weeks to be absorbed ; patient regained good vision.
good right
On the 8th the
not return.
[January 1,
Pertabgurh
right
;
eye, left eye
side of the
cornea
; a hook was then introduced and an
the capsule,?this failed, but it and removed from the axis of vision. 4
gently
cornea and preventing its slipping out of the cavity of the scoop. My operation is in fact Pagenstecher's, with Yon Graefe's linear incision. As stated, my section is in purely corneal tissue. I think there is less danger of
escape of vitreous by this mode than in making the incision sclero-corneal. I have also found that it is well not to make the incision too steep, and I follow Von Graefe in
turning the edge of the knife somewhat obliquely upwards and forwards just when completing the incision ; the wound gapes less than in a steep inand there is less dan?er of escape of vitreous. It is also well not to introduce the scoop unless the len3 has been dislocated and is presenting at the incision ; sometimes it unfortunately happens that cortical matter or the capsule remains behind after extraction of the
cision,
nucleus of the lens.
Cautious efforts
everything before closing ought to be desisted from if
to remove
efforts
to be made the eye ; but all loss of vitreous
ought
occurs. *
1.?Mukkoo ; jet. 35 ; male ; Ahir ; of Pertabgurh ; beggar ; mixed cataract perfect in left, imperfect in right eye ; said to be of 5 months' duration ; linear extraction performed on right eye 2nd August 1878; cured. The
patient counted fingers on the third day, he sufferciliary neuralgia, which required for cure hypodermic injection of ? grain doses of morphia ; atropine instilled into the eye. (gr. iv to ?i) ; belladonna ointment, slight antiphlogistic remedies and iodide of potassium. 2.?Lukhy ; set. 48 ; male; Pasee ; of Pertabgurh ; cultivator ; hard cataract in right eye, left eye good ; 6 years' duration ; linear extraction performed on right eye 6th August 1878 ; cured. No complication. He had good sight on the fifth day. 3.?Madi; set. 60 ; male; Ahir ; of Sultanpur; cultivator ; hard cataract in right eye, left eye good ; 5 months' duration ; linear extraction performed on right eye 8th ed from
A RECORD OF OPHTHALMIC PRACTICE IN OUDH. By G. D.
Civil
MacReddie, M. D., Surgeon, Gondah.
for publication the following list of with reference to the cataract operato remark I cases, beg tions that I perform Von Graefe's modified linear extraction. I make the upward linear incision with a very narrow-bladed knife in purely corneal tissue. In
submitting
Next, I make an iridectomy by drawing out the iris with forceps and excising it quite close to its ciliary insertion by three or four successive snips with the The third stage of the operation consists curved scissors in
making gentle
pressure with the curette on the lower ; by this manoeuvre the lower portion
part of the cornea
of the lens is pressed downwards and the summit of the lens is tilted forwards and often presents at the incision. The last and most difficult part of the operation is the
; cured. escape of vitreous occurred ; capsule separated from nucleus and was removed with forceps ; patient made a good recovery : early return of vision. 4.?Golloo ; set. 40 ; male ; Mali; of Pertabgurh ; years' duration ; gardener ; mixed cataract both eyes ;
August 1878
Slight
liuear extraction 1878 ; cured.
performed
on
right
eye 8th August
escape of vitreous; lens removed with some to its having at first slipped away from the scoop. He did very well; early return of vision. 5.?Mussummat Sudhia ; tefc. 60 ; female ; Chamarin ; of Pertabgurh ; no occupation ; hard cataract both e}res ; duration ; linear extraction performed on left 2
Slight
difficulty, owing
years'
eye 10th August 1878 ; unsuccessful.
THE INDIAN MEDICAL GAZETTE.
4) This
complicated with pterygium in both pterygia were removed?completely partially from right eye, owing to the
was
case
eyes. from left and strong adhesions the growth had contracted with the cornea. On the 10th the left eye was operated on for cataOn completion of the corneal incision and iridecract.
from the anterior chamber?some escape of vitreous took place ; the humour was abnormally fluid ; it was presumed that the lens had sunk into the vitreous ; no inflammatory symptoms developed, but vision did
disappeared
subsequent
progress of the
case
years'
eye
on
August 1878 Both eyes
is
left
August 1878
cornea.
a liberal diet arrested further effusion in the On the 21st September effusion took place in the right cornea; the same treatment as that detailed above was adopted. But, though the extension of opacities in the
examining with the oblique illumination, the patient stated that he could see the light of the candle used.
arrested, the latter did not regain transparency, and both eye-balls began to atrophy. The patient's health was bad ; he suffered from intermittent fever and dysentery. The painful lesson taught me by this case is not to operate on both eyes at the same time, but always to await recovery in one eye before operating on cornea was
Linear extraction was performed; some cortical matter remained in the anterior chamber, this took several weeks to be absorbed ; sight did not return by the last reports made to me by the Assistant Surgeon of the Pertabgurh Dispensary. Deep-seated disease in existence
prior to the operation, and discoverable only by thalmoscope, is the sole reason to explain the
the
the other.
oph-
cause
13.?Mussummat Sobhanee ; fet. 60 ; female ; Mussul; of Gonda ; no occupation ; hard cataract in right eye, left eye good ; 4 months' duration ; linear extrac-
of
manee
failure. 7.?Musst. Mithnia ; set. 50 ; female ; Mussulmanee ; of
tion
Sultanpur ; no occupation ; hard cataract right eye, left eye good; one year's duration; linear extraction performed on right eye 10th August 1878 ; cured. No iridectomy was performed on the 10th. On the 15th as the iris appeared dull, iritis was feared ; iridectomy was consequently performed ; an iridectomy knife was used ;
a
opened
No
daily used ; Extr. belladonna was applied over the eye-brow ; effusion of blood in anterior chamber, however, took several weeks before it. was absorbed ; it was not till about the end of September was
that she regained vision. 8.?Ramdeen ; jet. 60 ; male ; Ivoormi; of Pertabgurh ; ; hard cataract in both eyes ; 1? year's duration ; linear extraction performed on both eyes on 14th August 1878 ; cured. No complications ; both eyes were
occupation labourer
operated
on
at the same time.
9.?Mussummat Sookhia ; set. 40; female ; Kunjar ; of ; vegetable seller ; hard cataract in right eye 1 year, left eye 3 years' duration ; linear extraction performed on left eye on 15th August 1878 ; cured. No ; vision
fifth day. 10.?Mussummat Edia ; tet. 38 ; female ; Mussulmanee ; of Pertabgurh ; no occupation ; hard cataract in right eye,left eye good; 5 years'duration ; linear extraction performed on right eye on 17th August 1878 ; cured. No complication ; vision good on third day. 11.?Ramoo ; ast. 45 ; male ; Bhogawa ; of
occupation
good
on
; cortical or soft cataract
eye
on
25th
vision
on
third
right
August 1878 ;
complication ; good
day.
cured. Examination of eyes by oblique illumination previous to operation showed cataracts of milky white opacity ; homogeneous, without solid nuclei ; on the inner side of the anterior capsules there were several brilliant opaque white dots. 21th August?The left eye was operated on : on attempting removal of the complete cataract with the scoop rupture of the capsule occurred ; the contents came ous
away leaving the capsule behind ; as a little vitreno attempt was made to bring away the cap-
escaped,
sule.
On the 4th
September,
or
9th
day
after
operation,
examination of the eye showed that the capsule lay in the axis of vision ; patient had perception of light, but could not count fingers. She was put under chloroform and an incision with a broad needle made in the outer an
Pertabgurh
complication
on
14.?Mussummat Wazeerun ; set. 35 ; female ; Mussalmanee ; of Gonda ; no occupation ; fluid cataract in both eyes from early life ; linear incision performed on left eye on 27th August 1878 ; right eye on 4th September ;
small tract of the former corneal wound was a piece of iris removed; no complication
atropine
performed
cured.
and
occurred ;
no
use
lants with
In
to be pure senile cataract.
repeated paracentesis with Bowman's stopof atropine and belladonna, counter-irritaadministration of ammonia, quinine and stimu-
the
tions, the
; unsuccessful.
presumed
at the same time on the 24th
cornea:
needle,
case was
operated on
Inflammatory symptoms?kerato-iritis?set
on
6.?Buktawar ; set. 60 ; male ; of Pertabgurh ; cultivator ; hard cataract in left eye, right eye lost ; one year's duration ; linear extraction performed on left eye 9 th This
; unsuccessful.
were
in 26th. On the 27th chemosis was observed in both eyes with a broad line of opacity on the upper portion of the
August.
not known.
'
; 12
12.?Bhola Singh ; set. 50 ; male ; Kutri ; of Gonda ; cultivator ; hard cataract in both eyes ; 4 months' duration ; linear extraction performed on both eyes on 24th
tomy, and before any pressure had been made to tilt the lens upwards with the curette, it was found that it had
The
1879.
duration ; linear extraction performed on 18th August 1878 ; cured. No complication occurred, but some cortical matter remained behind?this took some weeks to be absorbed ; patient regained good vision.
good right
On the 8th the
not return.
[January 1,
Pertabgurh
right
;
eye, left eye
side of the
cornea
; a hook was then introduced and an
the capsule,?this failed, but it and removed from the axis of vision. 4
