A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 1).

  • Cooper, Samuel, 1780-1848.
Date:
1810
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Wenzel and his father used to env ploy, for this purpose, a flat needle, one line, that is, one twelfth part of an inch, in diameter, having its cutting extremity a little incurvated. This needle, which should be made of neal- ed gold, that its pliability may allow the operator to bend it in different di- rections, as occasion requires, is fixed in a handle, two inches and a half in length, and similar to that of the cor- nea knife. At the other extremity of the same handle a small curette, or scoop, is fixed, made also of nettled gold, which is of use to extract the ca- taract. When the crystalline, dislodged from its capsule, protrudes through the wound in the cornea, its removal from the eye may sometimes be assisted by the use of the above needle; and after- wards the opaque and glutinous mat- ter, remaining, must be removed by means of the curette. It is always advisable, after the ope- ration, gently to rub the anterior part of the cornea over the lids, either with the thumb or the curette. This pro- cess usually collects in the centre of the pupil some small fragments of opaque matter, which the crystalline leaves behind it, and which, if not ta- ken away with the curette, might give rise to a particular kind of secondary cataract. The curette is also of use for replacing the iris, a portion of which membrane occasionally comes through the incision in the cornea. ( Wenzel. J Sometimes the cataract is hindered from coming out, on gentle pressure feeing made, in consequence of adhe- sions. Wenzel recommends these to be broken by means of the golden nee- dle, introduced under the cornea, and applied in different directions, accord- ing as the case requires, and more especially round the circumference of the crystalline. Sometimes, when the capsule of the crystalline is destroyed, and the crys- talline itself is perfectly free, this hu- mour plunges to the inferior part of the vitreous humour, leaving only its upper edge visible through the pupil. The hyaloid membrane is also most commonly destroyed, and the vitreous humour in a state of fluidity. All pres- sure, therefore, on the eyeball, must be avoided, since this would produce a large evacuation of the vitreous hu- mour. The only method is to intro- duce through the pupil, a small sttel hook to take hold of the crybtRlhne, which, in this case, is often very small, and with this instrument tp extract it from the eye. ( Wenzel} When the capsule used to become opaque after tfic operation, so as to form, what is termed, the .secondary membranous cataract, Wenzel, after dividing the cornea, used to remove the opaque substance, by means of a small pair of forceps. After the operation, no fluid applica- tion, according to Wenzel, should be made to the eye. It should be simply covered with a dossil of lint; over which a dry compress should be appli- ed. The dressings should in general be removed every day. Mr. Ware, however, approves of flu- id applications. He has found, that a dossil of lint, steeped in plain water, or brandy and water, and covered with the spermaceti, or saturnine cerate, and removed once every day, is the most easy and convenient dressing, that can be applied after the operation. The cerate over the lint prevents the latter, when impregnated with the discharge, from becoming stiff, and irritating the lids, Mr. Ware thinks the mode of applying the compress and bandage over the eye, a circumstance of no small importance, because, if too loose, the dressings are very apt to slip oft, and, consequently, to press unequally and injuriously on the eye; and, if too tight, the undue pressure will excite pain and inflammation, and even force out some of the vitreous humour. Mr. Ware's compress is made of soft linen, folded, two or three times, wide enough to cover both eyes, and sufficiently long1 to extend from the upper part of the forehead to the lower part of the nose. This he pins at the top of the patient's nightcap; and its lower part, which is divided in the middle, to allow the nose to come through it, he lays loosely over the eyes. The bandage, also made of old linen, and as broad as six fingers, he carries round the head over the compress, and pins to the side of the nightcap moderately tight, A slip of linen is afterwards carried under the chin, and pinned, at each end to the side of the bandage, to prevent it from slipping upwards. (Ware.J The patient should lie continually on his back, after the operation, as this posture has a tendency to prevent the escape of the humours.