June
SUTHERLAND: OPERATING FOR CATARACT.
1898.]
203
we shall probably find a little discharge, caked about the palpebral fissure. This is removed by By Surgn.-Capt. W. D. Sutherland, i.m.s., dropping warm boiled water over the upper Save/or, Central Provinces. eyelid just above the fissure, the head being I have never been able to understand why turned to the side operated on. Then swabs of absorbent wool dipped in the should form such a sacred part of boiled water are lightly passed over the fissure. the technique of cataract extraction. Obviously when we so interfere with the Each swab being thrown away after having continuity of the fibres of the iris, we cannot touched the lids. A drop of atropia solution is instilled, and the hope to attain to success in giving back sight to our boric acid and absorbent wool dressing applied patient. " A key-hole pupil may be good enough" as before. tor the The last two patients whom I operated on cultivator, who is content if he can see 'iien as trees a be but if (four our eyes) had perfect union, without any walking; patient clerk, surely we should be able to promise him an inflammation on the third day in a temperature of 95??106? in the shade, and this I claim to be eye more useful and more aesthetic. as he allowed that a central what is good as one can reasonably expect. Of course pupil is in these cases, and as I have found they had central pupils. wanted^ that this is Much has been said of the advantages of a easily enough obtained, I think it woi tli while to describe the process. conjunctival flap. I cannot sa}7 that I think this -Elist, we must secure an aseptic wound. is Ia sine qua 11011. Ihe more have tried Graefe's incision, and have modithe means used to obtain this, simple the more certain are to be carried out in fied it to secure a conjunctival flap, and m}r they India as elsewhere. results were certainly nut as good as I could Second, we must keep our wound aseptic, have wished. and this is not Since I gave up iridectomy as a routine part quite so easy in India, as it would be at home. The following method I of the operation, I have not had more disasters lave found gives results quite as good as those than I had before, and I feel sure that my obtained by any other that I have tried,?and patients' eyes are really more useful to them. it once or twice I would note by the way that the cocaine practised, it will be found to have the merit of solution which I use is prepared in a boiled simplicity. 1- The face is thoroughly washed with bottle?with very hot indeed almost boiling, boiled water?and is always prepared fresh at turpentine and soap and water. 2. the time of operation. is into the solution instilled eye. Atropia It is an advantage, if one can manage it, to 3. When the pupil is dilated, the e}'e is instil sol. zinci sulph. gr. ij?Ji for a couple of cocainised. 4. The conjunctival sac is thoroughly irridays before operating, where secretion is plentigated with boiled water to which a little boric ful. Unfortunately few of my cases care to solution has been added. undergo any preliminary treatment. As a matter of routine they have a grain of 5. All instruments having been boiled, the corneal incision is made after Teale's method. calomel every night for three nights, and milk 6. The capsule is lacerated, and the lens ex- and rice for the first two days; but I do not think that diet is a very important matter, if pressed by gentle pressure. Ihe anterior chamber is one's wound is aseptic. with irrigated oiled water and boric solution if any cortical masses or fragments of capsule appear to require this proceeding. 8. The edges of the wound are gently adapted to each other. 9. A drop or two of eserine solution is instilled. 10. The patient is ordered " to go to sleep," which prevents him his eyebrows pricking up and too his firmly
OPERATING FOR CATARACT.
iridectomy
.
closing
~,'le eyelids
eyelids.
dusted with boric acid. absorbent cotton-wool is laid lightly on le eye and fixed with a piece of stout cloth smeared wit], emr,lastn,m resin?. ?5oth eyes are padded, and the plaster is applied from temple to temple. The eye is dressed daily thus : first, the plaster is carefully removed irom the temple of the side operated on, then t le absoibent wool is gently removed. On it '
1
are
SUTHERLAND: OPERATING FOR CATARACT.
1898.]
203
we shall probably find a little discharge, caked about the palpebral fissure. This is removed by By Surgn.-Capt. W. D. Sutherland, i.m.s., dropping warm boiled water over the upper Save/or, Central Provinces. eyelid just above the fissure, the head being I have never been able to understand why turned to the side operated on. Then swabs of absorbent wool dipped in the should form such a sacred part of boiled water are lightly passed over the fissure. the technique of cataract extraction. Obviously when we so interfere with the Each swab being thrown away after having continuity of the fibres of the iris, we cannot touched the lids. A drop of atropia solution is instilled, and the hope to attain to success in giving back sight to our boric acid and absorbent wool dressing applied patient. " A key-hole pupil may be good enough" as before. tor the The last two patients whom I operated on cultivator, who is content if he can see 'iien as trees a be but if (four our eyes) had perfect union, without any walking; patient clerk, surely we should be able to promise him an inflammation on the third day in a temperature of 95??106? in the shade, and this I claim to be eye more useful and more aesthetic. as he allowed that a central what is good as one can reasonably expect. Of course pupil is in these cases, and as I have found they had central pupils. wanted^ that this is Much has been said of the advantages of a easily enough obtained, I think it woi tli while to describe the process. conjunctival flap. I cannot sa}7 that I think this -Elist, we must secure an aseptic wound. is Ia sine qua 11011. Ihe more have tried Graefe's incision, and have modithe means used to obtain this, simple the more certain are to be carried out in fied it to secure a conjunctival flap, and m}r they India as elsewhere. results were certainly nut as good as I could Second, we must keep our wound aseptic, have wished. and this is not Since I gave up iridectomy as a routine part quite so easy in India, as it would be at home. The following method I of the operation, I have not had more disasters lave found gives results quite as good as those than I had before, and I feel sure that my obtained by any other that I have tried,?and patients' eyes are really more useful to them. it once or twice I would note by the way that the cocaine practised, it will be found to have the merit of solution which I use is prepared in a boiled simplicity. 1- The face is thoroughly washed with bottle?with very hot indeed almost boiling, boiled water?and is always prepared fresh at turpentine and soap and water. 2. the time of operation. is into the solution instilled eye. Atropia It is an advantage, if one can manage it, to 3. When the pupil is dilated, the e}'e is instil sol. zinci sulph. gr. ij?Ji for a couple of cocainised. 4. The conjunctival sac is thoroughly irridays before operating, where secretion is plentigated with boiled water to which a little boric ful. Unfortunately few of my cases care to solution has been added. undergo any preliminary treatment. As a matter of routine they have a grain of 5. All instruments having been boiled, the corneal incision is made after Teale's method. calomel every night for three nights, and milk 6. The capsule is lacerated, and the lens ex- and rice for the first two days; but I do not think that diet is a very important matter, if pressed by gentle pressure. Ihe anterior chamber is one's wound is aseptic. with irrigated oiled water and boric solution if any cortical masses or fragments of capsule appear to require this proceeding. 8. The edges of the wound are gently adapted to each other. 9. A drop or two of eserine solution is instilled. 10. The patient is ordered " to go to sleep," which prevents him his eyebrows pricking up and too his firmly
OPERATING FOR CATARACT.
iridectomy
.
closing
~,'le eyelids
eyelids.
dusted with boric acid. absorbent cotton-wool is laid lightly on le eye and fixed with a piece of stout cloth smeared wit], emr,lastn,m resin?. ?5oth eyes are padded, and the plaster is applied from temple to temple. The eye is dressed daily thus : first, the plaster is carefully removed irom the temple of the side operated on, then t le absoibent wool is gently removed. On it '
1
are
