The surgical treatment of trachoma : a paper read in the Section of Ophthalmology, at the Annual Meeting of the British Medical Association, at Nottingham, July, 1892 / by Sydney Stephenson.

  • Stephenson, Sydney, 1862-1923.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of trachoma : a paper read in the Section of Ophthalmology, at the Annual Meeting of the British Medical Association, at Nottingham, July, 1892 / by Sydney Stephenson. 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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    the follicies. He employed the thumb or forefinger in the upper lids, while he used a pair of modified iris forceps for the lower lids. Hqtz’s article at once raised “ expression ” to the position and dignity of a formal operation. Since the appearance of his paper many surgeons, especially in America, have worked on a similar principle, and a considerable amount of literature has been published on the subject. The exact method employed to express the follicles varies, as might be expected, in the practice of different surgeons. Thus, Karwetsky uses fingers and forceps, as recommended by Hotz. Noyes (who has abandoned all other operative measures in favour of expression) uses two pairs of forceps, the ends of which are placed at right angles to the blades and are grooved, rrince employs ring-forceps, the extremities of which are rounded so as to avoid laceration of the conjunctiva. Jaesche, (23) of Dorpat, uses Himly’s fenestrated for- ceps. H. Knapp, however, has introduced one of the most noteworthy improvements in the shape of a pair of roller-forceps, which he thus describes :— “ The instrument is made according to the principle of the mangle. The branches of ordinary rather strong forceps divide at their ends like a horse-shoe, the free space of which is closed by a creased steel cylinder which rolls on pivots in sockets. The ends of the forceps thus resemble a stirrup The rolling cy- linder (the foot-plate of the stirrup) is 20 to 25 mm. long and 1 to 1'5 mm. thick. It is made of steel, and can be taken apart to be cleaned.” In my own operations, I employ two kinds of for- ceps—1st, Ordinary stout dissecting forceps, and 2nd. stirrup forceps modified from Knapp’s pattern. Thus, the rollers in my instrument are 9 or 10 mm. in length, and their surfaces are free from creases. Again, ex- perience has convinced me that the comparatively small diameter (1 to 1'5 mm.) recommended by Knapp is insufficient to allow the rolling action of the instru- ment to come into play when dealing with swollen tissues. In my own instrument, therefore, the diameter of each cylinder is at least 3 mm.