Volume 5

A system of surgery : theoretical and practical / in treatises by various authors ; edited by T. Holmes.

Date:
1870-1871
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery : theoretical and practical / in treatises by various authors ; edited by T. Holmes. Source: Wellcome Collection.

    1116/1184 (page 1086)
    the blades of -which being separable from eacli other, can be fixed into any accessible parts of the tuniour, and connected by means of the screw at any part corresponding to the notches shown in the figure—securing a grasp of a tumour of almost any form, the consistence of which is sufficient to afford a hold to the hooks. Fig. 4(54: .shows an apparatus for fixing a .speculum in the lower wall of the vagina, and thus dispensing with the services of an assistant, or sparing his labour in a protracted operation, as for vesicovaginal fistula. Tiie speculum is fi.xed at any angle which may be found convenient into an upright stem, to which is attached, at a proper height, regulated by a screw, a frame which is padded with a napkin and adapted Ao the sacrum. The instru- ment, having been properly adju.sted, will keep its own position. JSye {iiKfriuiiciiffi.—These may be classed under two heads : 1st, instruments employed in diagnosis ; 2nd, operative instruments. Under the first head must be mentioned that most essential instrument, the ophthalmoscope. Though very many forms of this instrument arc employed by surgeons, two or three only need bi; noticed here. For all ordinary pui-poses, the ophthalmoscopes of Lii.'breich, Coccius, and Zehender are recommended. They are very portable, of small cost, and of simple construction, and are, further, of easy application. With any one of these the eye may be effectively explored; but the two first named are more suitable for the indirect mode of examination, and the latter for the direct. The large iixed instrument of Liebreich (Fig. -Ki-j) is Avell adapted for class purposes, or for taking drawings. Small ophthalmoscopes that may be carried in the waistcoat-pocket are very convenient, and likely to be at hand when required. At the writer's suggestion, the mirror has been mounted as an ordinarj' pocket lens, and occupies less .space than a watch (Fig. 4(i(J); and, being made of glass, it is less likely to become tarnished than metallic specula. The binocular ophthalmoscopes of Giraud-Teulon and Laurence atlbrd beautiful views of the interior of the eye ; and as the observer is enabled to use both his eyes at once, he sees with less liglit, and can minutely scrutinise the details of the stereoscopic image without sense of I'atigue, and can judge more accurately of relief and depth than when using only one eye. For side-illumination of eyeball, two onlinary lenses, of about two-inches focus, are required. A good oil- or gas-lamp is also essential. For the subjective examination of the eye, the surgeon should have two sets of spherical lenses, of foci varying from two inches to 80 inches; one set being convex, the other concave. A series of cylindrical lenses is also required for the investigation of astigmatism ; and also a stenopeic apparatus. For examining cases of paralysis of the muscles of the eye, a series of prisms should be provided. Then, as test-objects for ascertaining the acuteness of vision, and for future comparison, the scale of type invented by Snellen is an invaluable aid. It has been recently adopted by the Government as a standard. The instruments required for the ordinary operations performed on the eye at the present date consist of the usual cataract-knife, or that of Beer modified by Sichel, &c. ; the sharp hook for lacerating the lens-capsule ; DavieFs spoon ; a bistoury for enlarging sections of cornea, or scissors; Jiiger's cornea-knives, straight and bent; iris-forceps and Tyrrell's blunt hook; curved iris-scissors, Schuift'.s spoons or Critchett's extractor, Liier's forceps and scissors, forceps for fixing the eye, strabismus scissors and hook, cilia-forceps, needle-holder, suture-needles, entropium-forceps, spring-wire speculum for holding the eyelids, set of probes for lachrymal canals and nasal duct, director for opening the punctum, cautery-needle, broad cutting-needles, and two of Dalrymple's needles. The needles may be very conveniently fixed in two handles and slide as in a pencil-case. Tyrrell's iris-hook should be made of silver or platinum, so that it may be bent as required. Many other instruments adapted to special purposes are used by ophthalmic surgeons, which, though not absolutely indispensable, yet are of so frequent application that they deserve to be noticed in this enumeration of eye-instru- uieuts.