SELECTIONS FROM OPHTHALMIC PRACTICE IN" THE COWASJEE JEHANGHEER OPHTHALMIC HOSPITAL, BOMBAY.
By
Assistant
Surgeon
George
"Waters, Bombay Army.
During the month of November, as will be seen further on in this report, a large number of important operations were performed in this hospital, on the eye and its appendages: but in order to trespass as little as possible on the columns of the Gazette, we purpose merely relating a few which we have selected as interesting. Most of the cataract extractions were successful, whilst a very small percentage were failures. The unsuccessful results were, however, with one exception, each anticipated by Dr. Sylvester, who dreaded operative interference, and only complied reluctantly on being urgently pressed by each patient and friends to remove the cataractous lens, due explanation was given as to the probable result. We frequently learn more from unsuccessful than successful cases in ordinary practice, and the same holds good in ophthalmology; hence, we shall report each failure as it crops up in the returns, with as much minuteness as the successes. Cataract extraction was performed eleven times during the month of November; but as several of the patients operated on were in hospital on the 1st December, we will only mention those discharged prior to that date. Condition on admission:?n.
daily.
16th day.?Kedness almost gone: has an excellent pupil in the capsule ; vision good. Continue mist, guttse atropise. ungt. belladonnse co., compress and bandage. 18th day.?Atropine no longer necessary. Substitute guttse belladonnas. Continue mist, and ungt. 21st day.?The eye is now quite well, patient being able to read No. 4 Jaeger with 2| inch spectacles. Discharged. Cases like the last related may fairly be considered as likely to succeed well by operation, and, generally speaking, may be undertaken with sanguine hopes of restoring good vision. The patient B. II.'s case was complicated with alternating divergent squint which after removal of the cataract of one exas might have been eye, permanently affected the other, pected. This was an adaptation of nature in order that the function of the more perfect organ might always be available, whilst that of the other, by persistent contraction of the external rectus, was thrown into abeyance to avoid diplopia. 65. Condition on admission:?" Has Case III?P. F. , aged cataract in both eyes, that in the right eye being most advanced ; it is fully formed, and has an amber-colored nucleus, whilst more opaque radii mark the divisions of the lens. The pupil is active and dilated almost to the full by atropine. Cataract has been three years in forming during which period there was no pain, but occasional redness; has only very faint perception of light; tension is normal: the left eye has cataract in process of formation." The cataract of right eye was extracted by Yon Graefe's method, and was just about being completed when patient strained violently ; the immediate result of which was the escape of a large quantity of fluid vitreous. Patient was not under the influence of chloroform. 2nd day.?The lids are swollen, and there is pain of the globe accompanied by muco-purulent discharge. The wound is is filled with muddy aqueous, opaque, and the anterior chamber and the stroma of iris obscured by neoplastic effusion. Cover all Guttoe atropice, ext. belladonnse around the orbit. with a compress and bandage.
jjo
Chloral
Syrupi
hydrat
...
...
???
???
???
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Potassii iodidi Aquae menth. pip. One-third to be taken thrice ...
???
...
???
...
_
daily.
Je Liquor morph. hydrochloratis Aquse camphorse
...
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5j*
3'3Sg''s> xv.
siVS3
1Yl.
xl. o*33
To be taken at bed-time. 3rd day.?The globe is now suppurating. Apply a poultice. Continue mixture and draught at bed-time, if necessary, to pro-
sleep. being one fortnight in hospital, the patient was discharged. At first the globe became intensely swollen and painful, whilst the lids were very much thickened from inflammation, Then followed a profuse discharge of pus, the pain meanwhile becoming diminished. The suppuration gradually subsided under the use of soothing applications, and the eye finally colcure
After
163
but still presented an appearance like the stump left by Critchett's operation for staphyloma, upon which an artificial eye might be fitted. That this case would probably turn out a failure could not by any external evidence be anticipated when extraction was resolved on. Indeed, the result was quite exceptional, inasmuch as Dr. Sylvester observed nothing on first seeing the patient, or subsequently, to contraindicate removal of the cataractous lens, and in the other failures he invariably prognosticated an unfavorable termination. Some vitreous having escaped, could not we opine, have been the exciting cause of what followed, for we have more than once witnessed an equal, if not greater loss of that medium in less healthy-looking patients, without the occurrence of a single bad symptom; afterwards indeed it has appeared to us beneficial as leaving a clearer pupil,
lapsed,
(To
be
continued.)
By
Assistant
Surgeon
George
"Waters, Bombay Army.
During the month of November, as will be seen further on in this report, a large number of important operations were performed in this hospital, on the eye and its appendages: but in order to trespass as little as possible on the columns of the Gazette, we purpose merely relating a few which we have selected as interesting. Most of the cataract extractions were successful, whilst a very small percentage were failures. The unsuccessful results were, however, with one exception, each anticipated by Dr. Sylvester, who dreaded operative interference, and only complied reluctantly on being urgently pressed by each patient and friends to remove the cataractous lens, due explanation was given as to the probable result. We frequently learn more from unsuccessful than successful cases in ordinary practice, and the same holds good in ophthalmology; hence, we shall report each failure as it crops up in the returns, with as much minuteness as the successes. Cataract extraction was performed eleven times during the month of November; but as several of the patients operated on were in hospital on the 1st December, we will only mention those discharged prior to that date. Condition on admission:?n.
daily.
16th day.?Kedness almost gone: has an excellent pupil in the capsule ; vision good. Continue mist, guttse atropise. ungt. belladonnse co., compress and bandage. 18th day.?Atropine no longer necessary. Substitute guttse belladonnas. Continue mist, and ungt. 21st day.?The eye is now quite well, patient being able to read No. 4 Jaeger with 2| inch spectacles. Discharged. Cases like the last related may fairly be considered as likely to succeed well by operation, and, generally speaking, may be undertaken with sanguine hopes of restoring good vision. The patient B. II.'s case was complicated with alternating divergent squint which after removal of the cataract of one exas might have been eye, permanently affected the other, pected. This was an adaptation of nature in order that the function of the more perfect organ might always be available, whilst that of the other, by persistent contraction of the external rectus, was thrown into abeyance to avoid diplopia. 65. Condition on admission:?" Has Case III?P. F. , aged cataract in both eyes, that in the right eye being most advanced ; it is fully formed, and has an amber-colored nucleus, whilst more opaque radii mark the divisions of the lens. The pupil is active and dilated almost to the full by atropine. Cataract has been three years in forming during which period there was no pain, but occasional redness; has only very faint perception of light; tension is normal: the left eye has cataract in process of formation." The cataract of right eye was extracted by Yon Graefe's method, and was just about being completed when patient strained violently ; the immediate result of which was the escape of a large quantity of fluid vitreous. Patient was not under the influence of chloroform. 2nd day.?The lids are swollen, and there is pain of the globe accompanied by muco-purulent discharge. The wound is is filled with muddy aqueous, opaque, and the anterior chamber and the stroma of iris obscured by neoplastic effusion. Cover all Guttoe atropice, ext. belladonnse around the orbit. with a compress and bandage.
jjo
Chloral
Syrupi
hydrat
...
...
???
???
???
???
Potassii iodidi Aquae menth. pip. One-third to be taken thrice ...
???
...
???
...
_
daily.
Je Liquor morph. hydrochloratis Aquse camphorse
...
???
5j*
3'3Sg''s> xv.
siVS3
1Yl.
xl. o*33
To be taken at bed-time. 3rd day.?The globe is now suppurating. Apply a poultice. Continue mixture and draught at bed-time, if necessary, to pro-
sleep. being one fortnight in hospital, the patient was discharged. At first the globe became intensely swollen and painful, whilst the lids were very much thickened from inflammation, Then followed a profuse discharge of pus, the pain meanwhile becoming diminished. The suppuration gradually subsided under the use of soothing applications, and the eye finally colcure
After
163
but still presented an appearance like the stump left by Critchett's operation for staphyloma, upon which an artificial eye might be fitted. That this case would probably turn out a failure could not by any external evidence be anticipated when extraction was resolved on. Indeed, the result was quite exceptional, inasmuch as Dr. Sylvester observed nothing on first seeing the patient, or subsequently, to contraindicate removal of the cataractous lens, and in the other failures he invariably prognosticated an unfavorable termination. Some vitreous having escaped, could not we opine, have been the exciting cause of what followed, for we have more than once witnessed an equal, if not greater loss of that medium in less healthy-looking patients, without the occurrence of a single bad symptom; afterwards indeed it has appeared to us beneficial as leaving a clearer pupil,
lapsed,
(To
be
continued.)
