A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
_c._ These two flaps are united over the vertical meridian of the cornea
by sutures, three generally being sufficient. This entirely hides the
cornea for a time, but eventually shrivels and contracts, and the
remnants are to be cut off with scissors three weeks after the
operation.
PUNCTURE OF THE CORNEA.--_Paracentesis of the Anterior
Chamber._--_Tapping of the Aqueous Humour._--This very simple operation
is in many cases extremely useful. In cases of corneal ulcer, the result
either of injury or disease, where there is much pain in the bone, and
evidence of tension of the globe, it gives great relief, and when
repeated at short intervals greatly hastens a cure. Sperino of Turin
recommends its frequent use in cases of chronic glaucoma.
_Operation._--The surgeon stands behind the patient, who is seated; the
lids being fixed, the upper by the surgeon's left hand, and the lower by
an assistant, the cornea is punctured a little in front of the sclerotic
margin, either with a broad needle, or, what is as good, a well-worn
Beer's knife. Care must be taken on entering the knife, on the one hand,
not to wound the iris, which is sometimes arched forwards in the cases
of commencing glaucoma, and, on the other, fairly to enter the anterior
chamber, not merely split up the layers of the cornea. On withdrawing
the cataract knife, the aqueous humour gets out by its side, aided by a
slight turn of the knife, sometimes with great force, and in much larger
quantity than usual. If the operation has been done by a needle, a blunt
probe requires to be introduced on the removal of the needle. Once
punctured, the remarkable fact is that the same wound suffices for many
succeeding tappings, which are effected by pressing the probe into the
wound day after day, sometimes several times a day, with great relief
to the symptoms. If the probe is to be used for succeeding evacuations,
the operator must be careful to remember the exact spot at which the
needle or knife was entered. To facilitate remembering it, it is best,
when nothing prevents it, to operate always in the same spot. Sperino
chooses the horizontal meridian of the cornea at the temporal side, at
the junction of the cornea and sclerotic.
CATARACT OPERATIONS.--Here we cannot enter into any discussion of the
pathology of cataract and the varieties of it. Enough for our purpose to
know that the lens is in some cases hard, in others soft, and that thus
in the latter it may be removed piecemeal, and by a small incision,
while in the former, removal must be almost entire, and by a larger
opening.
In cataract, the lens, which should be transparent, has become opaque,
and the object of treatment is to get it out of the line of sight, to
prevent it from obstructing, now that it can no longer assist sight.
The operations used for this end may be classed under three heads:--
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