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
1. There is no essential difference between the cases in which there
is a definite cone of filmy or infiltrated membrane reaching from the
optic nerve head to the ciliary body, and those in which deposits of
a similar nature are found confined to the anterior portion of the
vitreous chamber. The grounds for this statement are as follows: (_a_)
An examination of the more complete specimens of conical exudate shows
that the membrane becomes very slender as the nerve head is approached,
and it is obvious that very little violence would be required to break
this delicate thread across, and so to allow the whole membrane to
be gathered up by its own elasticity towards its large and strong
anterior attachments. (_b_) There is strong evidence in a number of the
specimens of this series to show that the contraction of the shrinking
inflammatory material within the globes takes place with such force as
might easily suffice to break across the slender nerve attachment of
some of these cones. (_c_) It is obvious that in not a few cases the
tapering apex of a conical exudate is likely to be cut across during
section of the globe, or broken across during subsequent manipulations.
(_d_) Specimens in which the exudates presented a definite conical
shape, when they were first cut in India, have arrived in this country
transformed during the voyage into the similitude of those in which
the exudate is loosely gathered into the fore part of the vitreous
chamber; the apex of the cone had been broken off at the nerve head,
and the exudate had moved forward by virtue of its own elasticity
toward the anterior attachments of the mass. Taking all these
points into consideration, we may conclude that in all the eyeballs
which present the appearance of shrunken vitreous the structure was
originally conical in form, and that departures from that shape are
merely artefacts. Stress is laid on this point, because in a number of
the globes the appearances present suggest that the exudate is poured
out from the ciliary body, and is confined to the neighbourhood of that
structure. We believe such an interpretation to be quite erroneous, and
to be founded on the observation of artefacts.
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