The practical details of cataract extraction / by H. Herbert.

  • Herbert, H.
Date:
1903
Catalogue details

Licence: In copyright

Credit: The practical details of cataract extraction / by H. Herbert. Source: Wellcome Collection.

    45/142 (page 29)
    protection against really powerful contraction of the orbicularis. The eyelids beyond the tarsi can still be pressed upon the globe. In a few very nervous patients the speculum must be replaced by Desmarres’ lid-retractor after the corneal section has been made. To minimize the tendency to spasm of the orbicularis during the operation, the fellow eye should always be kept open, even if blind from cataract. A few excitable patients, who at the start show a tendency to forcibly shut their eyes, are made to keep their mouths opened also. The connection here may seem strained, but giving them something to think of in this way undoubtedly appears to help them to keep quiet. The patient must not be allowed to answer by word of mouth to orders given, otherwise he is apt to substitute this to some degree for perfect compliance with the directions given. It is well that the orders should be delivered as much as possible by the chief assistant, who stands in the position towards which the eyes have to be turned. Nervous patients, especially those blind in both eyes, feel a natural inclination to look towards the person who issues the commands. Frightened people sometimes behave better during the actual operation if the preliminary lid-manipulations have been done a trifle roughly ; the comparative quiet and gentleness are then by contrast reassuring. The lid-manipulations are of use also as a test of the patient’s self-control, often warning the surgeon of the need of special care and watchfulness. If the hospital arrangements are such that patients waiting for operation are close at hand, within (sight and) hearing, it is most important to begin with the more docile and intelligent ones of the batch, and to keep the less reliable ones to the last. The quiet behaviour of the earlier patients has a most calming influence on the remainder ; on the other hand, trouble with a stupid person at the start may alarm the whole batch. One would expect, in operating on the second e}^ of a patient a fortnight or so after the first, to meet with quieter and more reasonable behaviour, but I have generally found the patient rather more nervous and excitable. At one time in our work chloral and bromide were administered to nervous patients beforehand. It might still, perhaps, be of use in exceptional cases, in addition to the training of the patients, which has now replaced it.