Clinical lecture on cataract / by A. v. Gräfe.

  • Albrecht von Graefe
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lecture on cataract / by A. v. Gräfe. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    operator is as important as liis hand. Even if patients do not behave as we would wish, we should avoid any violent or threatening language; with few exceptions, it only lowers the patient’s courage, and renders him quite incapable of self- control. A jocose remark often acts as an efficient remedy, by distracting the patient’s attention from the importance of the moment to him. It is a recognized rule, not to keep a patient waiting long before the operation; but after having once determined on an operation, to perform it as soon as possible. Somewhat unfavourable weather or light is of less moment, than mental dejection of the patient. Should atropine be applied before the operation? Surgeons, more especially in England, have objected to this practice. The iris has been said to become thickened in consequence of the dilatation, and thus more exposed to injury from the cataract-knife. It has further been stated that the object of the atropine is illusory; for, as soon as the aqueous escapes, the pupil contracts. Finally, it has been feared that, by the concentric retraction of the iris, the vitreous partially loses its support, and is thus more prone to escape. None of these objections appear to me to be valid. If the iris really does increase in thickness as the pupil dilates, it is of not the slightest consequence; for if the internal circumference of the incision in an ordinary extraction is examined, it will be found to coincide with the edge of the pupil, or, at any rate, to but slightly exceed it in diameter. If, therefore, the pupil is sufficiently dilated, the edge of the iris lies beyond the line of the internal incision, or encroaches on it only by a very narrow ring of iris. This cannot possibly be so thick as to come into contact with the point of the knife, which is either close against the inner surface of the cornea or has for the second time nearly reached it. That the pupil contracts again as soon as the aqueous has escaped, is true; but the contraction is less than if atropine had not been used. In- dependent of this, however, the question is not so much that of overcoming spasmodic contraction of the pupil — that was formerly so extravagantly dreaded, as offering an impediment to the safe exit of the lens, as it is of making the section more easily. The latter, however, takes place during
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