Report of the fourth international ophthalmological congress, held in London, August, 1872 / published by a committee composed of G. Critchett [and others] ; the papers arranged, and the text and translations revised by Henry Power.

Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: Report of the fourth international ophthalmological congress, held in London, August, 1872 / published by a committee composed of G. Critchett [and others] ; the papers arranged, and the text and translations revised by Henry Power. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Some years’ practice in operating, and without the two instruments in question, leave me no room to doubt but that I shall never use them any more. I do not think, whatever they may be in the hands of other operators, that they can ever be for me better than the instrument which I always use instead of either of them. But if theoretically either or both of these instruments can be proved to be better for their pur- poses than my own knife, I will begin again to make practical use of it, or of them, and to try them once more. I have no peculiar instrument, and when I say “ my own knife,” I mean only such a knife as I gene- rally use. It must have just sufficient strength and stiffness not to be liable to bend ; it must have a sharp point to enter the cornea easily, and a single sharp cutting edge to incise it. I find all these combined in a knife that was generally used in the latter days of the old semicircular flap extractions—Sichel’s knife. This knife I therefore generally use when I have to open the anterior chamber. Indeed, I always use it unless I require only so small an opening as can be made by the direct puncture of a broad needle. If I have to make a larger opening, to make an incision in the cornea (however small a section may be required), I very much prefer Sichel’s knife (or any other having such qualifications), in any of the modern operations requiring a preliminary section of the cornea, to any of the instruments generally used for the purpose in these operations. Especially do I believe it to be very superior to the lance knife in iridectomies, or to the long narrow knife in extraction of cataract. In either of these operations, as I have said, I use Sichel’s knife. In extracting cataract, however, I never make a counter-punc- ture. The eye must be perfectly well fixed, and secured with speculum and forceps. The patient is inert by anaesthesia, I then enter the point of the knife at either extremity of the section I intend to make, at such inclination to the surface (/ mean more or less perpendicularly') as may seem desirable. In this way I can direct the knife to the centre, whether of the anterior chamber, of the pupil, or even of the eye itself, in any case. I pass it on into the anterior chamber more or less until the point is near the iris, and then it is turned outwards, away from the iris towards that part of the cornea I am about to cut through, and, holding the knife firmly, maintaining the same inclination, and pressing it onwards in the direction it is to take (with a slight sawing movement if necessary), it is advanced more and more, and very steadily, in the direction and to the limit I have assigned to it beforehand. I never allow the point, of the knife to transgress the pupil at any time or stage of the proceedings or under any circumstances, but keep it always in the circumference of the anterior chamber, always in view between the cornea and iris, and in front of the latter. The sweeping section need not be very quickly