The Indian operation of couching for cataractElliot, Robert Henry
History
The Indian operation of couching for cataract
Elliot, Robert Henry
Cataract -- Surgery -- India; Ophthalmology -- India -- History
=The Anterior Operation.=--The patient and operator sit facing each
other in a good light; both squat on their hams in accordance with the
immemorial custom of the East (Fig. 8). The patient is frequently,
if not usually, told that no operation is to be performed, and that it
is merely a question of putting medicine into the eye. He is directed
to look downward, and the coucher raises the upper lid with one hand
whilst in the other he conceals either a needle or a sharp thorn. It
is said that the long needle-like thorn of the babul-tree is usually
selected for the purpose. Many of the patients have mentioned that
their heads were steadied by a friend from behind. In the majority of
cases, at least, it would appear that no form of local anæsthesia is
attempted. The operators appear to rely largely on manual dexterity,
and to aim at completing the procedure in a minimum of time. The
needle or thorn is thrust suddenly through the cornea, and on through
the pupil or iris, into or on to the periphery of the lens. The next
movement, which appears to follow the first so rapidly as practically
to melt into it, is that of depression or reclination. In this,
the spot where the cornea grasps the shaft of the needle serves as
a fulcrum. The operator raises his end of the instrument, and the
opposite one, which lies either on the surface of the lens or imbedded
in it, is consequently depressed, thus carrying the cataract with it
downwards, or downwards and backwards, and so clearing the pupil. In
the course of speaking to a very large number of patients thus operated
on, it has struck the writer as most remarkable that they made as
little complaint as they usually did of the pain inflicted on them
during the operation. They described the sensation of a sudden prick,
but it was obvious that they had no acute recollection of agonising
suffering. This point is emphasised by the fact that in nearly every
case the operator tested his patient’s vision immediately after the
operation by holding up fingers, coloured cloths, necklaces, or other
common objects, for triumphant identification. Very great stress is
laid on this part of the ritual, and the onlookers are not allowed to
lose sight of the wonderful results achieved by the operation. There
seems reason to believe that an effort is made to enter the point of
the instrument through the pupil, and to pass it between the iris
and the lens. This cannot fail to be a difficult thing to do, as is
evidenced by the frequency with which we were able to discover scars
in the iris, which had obviously resulted from tears at the time of
the operation. The point of perforation of the cornea could frequently
be discovered, especially if a loupe were used for the purpose. The
relative positions of the scars in the cornea and iris were frequently
of great value to us from the diagnostic point of view. The eye is
bandaged for at least twenty-four hours. By the end of that time the
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