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
Straub[2] has described some experiments which he made on animals,
in the course of which he injected pathogenic organisms either into
the vitreous or into the ciliary body. The result varied according
to the part infected, and the poisoned area attracted leucocytes by
chemotaxis to itself. Particular interest attaches to the following
of his findings: (1) The optic nerve head was swollen and filled up
with leucocytes; (2) there was evidence “that the lymph current of the
vitreous goes by the optic nerve, and that chemotaxic substances are
brought by this current from the granuloma (the artificial infection)
to the nerve”; (3) the leucocytes found in the vitreous showed the way
from the granuloma to the cup of the optic nerve--they were seated on
thin membranes, and most of them were heaped together in small dots;
(4) aggregations were found on the walls of the cavities of the eye
(on the cornea, on the retina, on the lens capsule, etc.), attracted
there, in Straub’s opinion, by a chemotaxic action.
[2] “The Pathology of Dust-like Bodies in the Vitreous,” etc., Trans.
of the O.S. of the U.K., 1912, xxxii. 60.
In the experiments above considered, which were very limited in number,
an effort was made to localise the infection to one or other part
of the eye, and to work with a virus (tubercle bacilli) which was
comparatively constant in its toxicity.
What Straub did with a few eyes has been done in the series now
before us, by the Indian coucher, in fifty-four. The interest of the
experiments is heightened by the fact that, whereas in the Dutch
experiments the toxicity of the virus was kept as constant as possible,
in the Indian ones it varied from that of organisms which took many
years to destroy the sight to that of one which at once produced a
fulminating panophthalmitis. One point more: The Indian operator made
no effort to confine his procedure (and with that procedure went
infection) to any one structure; sometimes he attacked the lens from
in front, and in doing so he often primarily injured the iris, but may
have spared the vitreous chamber; sometimes he entered through the
ciliary body or through the choroid, opening up the hyaloid cavity
in doing so. His want of skill and the slenderness of his anatomical
knowledge made him catholic in the damage he inflicted, but running
through his work is the trail of septic infection of the eyeball by
penetrating wounds. The result is that he has provided us with a large
material of extraordinary interest in the study of the problem which
Straub started on.
_The Filmy Masses in the Vitreous Chamber._--As has already been
stated, the contents of the vitreous chamber in these specimens vary
from thin gauzy films, which can only be detected by careful search, up
to thick masses which strike the eye as soon as the specimen is looked
at.
Public-domain text, read in full here on John Shaqi.
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