Volume 3

The American encyclopedia and dictionary of ophthalmology / edited by Casey A. Wood, assisted by a large staff of collaborators.

Date:
1913-1921
Catalogue details

Licence: In copyright

Credit: The American encyclopedia and dictionary of ophthalmology / edited by Casey A. Wood, assisted by a large staff of collaborators. Source: Wellcome Collection.

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    operate on cases exhibiting extreme anemia, menstruation, albuminu- ria Avith anemia and general edema, or recent syphilis. Apart, how- ever, from such serious considerations as these, the removal of the cataractous lens is not prohiliited if, by means of hygienic and other theraiDcutic aids, the surgeon brings his patient into as satisfactory a state of health as the systemic conditions permit. Shall we operate at a. hospital or in a private house? The surgeon will often be obliged to discuss this question. When he has access to a well-equipped hospital, public or private, he should insist upon the operation taking place there, meantime pointing out to the patient and friends that a serious operation of the projected kind should be done under the most favoi’able surroundings, and that an operation even in the best regulated house adds considerably to the post-opera- tive dangers. As is well known, the environment of the patient in the average hospital conduces to the success of a cataract extraction in a much larger measure than when done even in the homes of the well-to-do. Should the surgeon decide to do the operation in a private dwelling the preparation of the operating room should approach as nearly as possible the aseptic conditions and surgical conveniences of the regular operating room. Cataract extraction in the hed the patient is to occupy. There is much to be said in favor of this procedure. Undoubtedly, lifting a blind (and often heavy) patient from the operating table to the litter, stretcher or chair—however gently done—the subsequent journey to the room or ward and the process of settling him in bed are fraught with risks and dangers that he escapes when the eye is operated in the place and posture he is to maintain during the following twenty-four hours. Every surgeon of experience will recall instances where the apprehensive patient (with bandaged eyes) has tightly “squeezed” his lids in an attempt to save himself from a dreaded fall off the table or ambulance or from the arms of those who were lifting him off or onto it. Moreover, the ambulance wagon, in transit from the operating room to the patient’s bed, often strikes against a door-jamb or an article of furniture, stai'tling the patient and inducing involun- tary orbicular contractions that may be just enough to prevent per- fect coaptation of the incisional margins, determine an iridic hernia or force some intraocular debris between the lips of the corneal wound. The objection raised to operating in bed is the difficulty of insur- ing aseptic surroundings, the need of converting the ward or room into an operating theatre, the necessity for special (headless) beds, and the inconvenience thereby created. Wliile every operator will