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.

    92/142 (page 70)
    rarely happens without some warning, in the form of prelimi- nary twitches of the lids and general uneasiness. The most easily expressed lenses are, in my experience, the Morgagnian ; the adaptable soft sac of fluid at times fills the wound as soon as pressure is applied to the globe, and the exact moment of rupture of suspensory ligament is often not evident. This easy gradual delivery of the lens is especially frequent after an attempt at puncture of the capsule with the cystotome; the pull on tough capsule may have partly torn the zonule below (see p. 39). It is surprising how often the lens can be thus expelled without being followed or accompanied by vitreous. Captain Henry Smith, I.M.S,, reports* a series of 1,651 of these extrac- tions at Jullundur in the Punjab, with only 8‘2 per cent, of vitreous escape. He and Lieutenant-Colonel Mulroney, of Amritsar, also in the Punjab, are the chief latter-day exponents of this operation.f Both of these surgeons get an enormous experience in cataract work. In their hands and in those of a few other Indian operators extraction in the capsule has not been restricted to over-ripe cataracts only, but has formed the routine procedure for ripe and even unripe cataracts. With the latter, however, a second serious complication is frequently encountered ; the capsule is liable to give way together with the zonule, with the result that cortex is left behind embedded in vitreous, and hence only imperfectly absorbed. That a surgeon should be able to obtain such results by this operation, as have been published by Smith, speaks volumes not only for the extraordinary dexterity of the operator, but ecpially so for the absolute confidence, self-control, and docility exhibited by the patients. For the average operator and for the ordinary patient this operation must always remain chiefly one of neces- sity, and not of choice ; and it will be combined with iridec- tomy, though this has been largely dispensed with in the Punjab. (When the iris is forced into the wound by the pressure of vitreous at the close of the operation. Smith evacuates some vitreous to allow of the reduction of the pro- lapse.) * Indian Medical Gazette, xxxvi. 220-225. f An operation usually associated with the name of Pagenstecher in Europe.