Licence: Public Domain Mark
Credit: Ophthalmic surgery / by J. F. Streatfield. Source: Wellcome Collection.
Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)
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![paratively few) cases of blindness in which we cannot see any morbid change— to nerve- or brain-diseases more or less affecting vision, and of which, even with the ophthalmoscope, we can find no evidence. But the ophthalmoscope has not added much to our powers of surgical treatment of eye-diseases. With its aid, detached retina has been evacuated and foreign bodies or cysticercus removed from the vitreous chamber. With it, also, we can often make a previous ex- amination to find if there be any deep-seated disease to mar the good result otherwise to be expected of operation. If we include in the term ophthalmo- scopic examination the lateral focal illumination of an eye by a convex lens and artificial light, our prognosis is of course by this often very much assisted in any proposed surgical interference, as it is in the diagnosis of many of the diseases, but only of those whose progress could be less perfectly seen and watched years ago, before the ophthalmoscope was invented and the lens used in this way,—the iritic, cataractous, and other cases of disease, not very deep- seated, above mentioned. This concentrated side light, or oblique illumination, has been used in some operations within the eye, such as those for the removal of foreign bodies in the iris or anterior chamber, at the time of the operation, as Avell as for the diagnosis and prognosis generally of these and other cases. Performance of Operations on the Eye.—Nothing by way of gaining experience in eye-operations is of much account, except actually operating on the patients themselves. Sliort of this, it is most valuable to watch carefully the operations of others. In eye-surgery, practising operations on the dead su])ject is of little or no good to the beginner. When, in general surgery, a limb is to be removed, it is amputated at a distance froin the seat of the disease; or, if an artery is to be tied, it is secured at a place remote from the aneurism, so that such operations may well be practised on the dead subject. But, in eye-surgery, we can never operate at a distance from the disease; either we are immediately concerned in the part that is diseased or we are close upon it, as in removing an opaque lens, or in performing iridectomy on an adherent iris. Squint operations (tenotomy), extirpation of the eyeball, tapping the cornea, slitting the canaliculus, and some of the first steps of the more important eye-operations, such as the making a section of the cornea, may be practised on the dead subject; but, as to all the rest, it is mere waste of time. Almost all operations on the eye are done with the patient lying on a hard couch, not quite so high as an ordinary surgical operating table, with a hard pillow to raise the head of the patient a little, and' comfortably. The foot of the couch is in a window, facing the north if possible, and giving a good light. The Surgeon stands behind the head of the patient, so as to use both hands conveniently, and to be out of the way of the light. A towel spread on the pillow is thrown from behind forwards over the patient's head, as far as his forehead, and this, at the temples, may be held, if neces- sary, on each side, by the hands of an assistant. In some cases the wrists of the Surgeon may be brought, on each side, up against the temples, to steady the patient^s head when he is passive under chloroform. In eye-surgery, the arms are seldom required to be moved whilst actually operating. In these minute operations often the fingers only, seldom more than the hands as well, are necessarily changed from their first position. Perhaps some pronation and supination of the fore-arms may be called for; but, the patient being under the influence of chloroform, his head even then may be steadied or rotated or moved from side to side, as may be best, by resting the wrists against the temples of the patient. Even the ordinary internal squint-operation may be done from behind the head of the patient; but, in this case, the Surgeon is in](https://iiif.wellcomecollection.org/image/b21636953_0007.jp2/full/800%2C/0/default.jpg)
