The Indian operation of couching for cataract - Robert Henry Elliot

A Comparison of the Corneal and Scleral Routes for Operation.—It has been already shown that the Indian operators of the present day vary in their technique, some attacking the lens from in front through the cornea, and others from behind through the sclera. It is interesting to note that there is a similar difference in practice amongst those of the modern surgeons who have adopted couching in special cases. There can, however, be no doubt that the weight of opinion among the old writers was all in favour of the posterior operation; and Mackenzie, whose practical experience was, we may hope, vastly greater than that of any modern surgeon, summed up the position in these words: “In this way (i.e., through the cornea) neither operation (depression or reclination) can be satisfactorily performed.” We may close this subject with another word of warning to any who are inclined to favour the couching of lenses in selected cases. From the time of Celsus onwards, surgeons who have had large experience in couching have warned their disciples that it is an operation much more easy to undertake than to carry to a successful technical issue, and have cautioned them against venturing on it until they have seen it performed many times at the hands of an expert. One cannot conclude better than by a quotation from the writings of Lieut.-Colonel Henry Smith, who has had very large opportunities of observing the results of cataract couching. He is known to be a very skilful operator, and one, therefore, who is little likely to exaggerate the difficulties of any ophthalmic procedure, yet he writes: “It is no easy matter to completely dislocate the lens, and, in my observation, the partial dislocation is more frequent than the complete in the hands of adepts of the art.”

The Dislocation of Morgagnian Cataracts.—A curious error is to be found pervading many of the early writings on couching—viz., that a Morgagnian cataract could not be couched in its capsule. Our hospital experience in India proved that this idea was erroneous, and the examination of our pathological specimens has shown the correctness of our clinical deductions. The Morgagnian lens may be dislocated forward into the anterior chamber, backward into the vitreous, and even through the coats of the retina, without rupture of its capsule. This is far from being a surprise to any surgeon who has operated on a number of these cases, for the Morgagnian capsule is usually very much tougher than that of any other form of cataract. It has already been mentioned that, if the capsule bursts, the nucleus may escape, and may then sometimes be found either floating freely in one of the chambers of the eye, or fixed in one position by inflammatory adhesions, or, still more rarely, passing from chamber to chamber at intervals. The writer has observed that in some cases the escape of Morgagnian fluid into an eye appears to cause great irritation. The same fact has been observed by some of the early writers on couching.

INDEX

alpha-table

[A]
Abu el Kasim, [2], [4]
Accidental injuries during couching, [46]
Advocacy (modified) of couching, [10], [11], [12]
Ægineta, Paulus, [3]
Age of patient, usual in couching, [27]
Albertotti, [10]
Alexandria, ophthalmic surgeons in, [1]
Anæsthesia during couching, [15], [21]
Anatomical examination of couched eyes, by Collins, [11];
by Hudson, [11];
by Kirkpatrick, [11];
by Parsons, [10]
Anterior chamber, [55]
albuminous exudates in, [56]
blood in, [56]
lens matter in, [56]
pus in, [56]
scantiness of contents, [55]
vitreous substance in, [56]
Anterior operation, [14]
Antiquity of couching, [1]
Antillus, [7]
Apology for the coucher, [23]
Avicenna, [2], [3], [4]
[B]
Bartisch, [5]
Basso, [11]
Bell, Benjamin, [7]
Benvenuto, [4]
Bland-Sutton, Sir John, [1]
Brisseau, Pierre, [7]
[C]
Capsulo-corneal synechia, [46]
Cataracts, entangled in vitreous exudate, [39], [81]
fixed in vitreous chamber, [40], [80]
floating freely in vitreous, [39]
matted in inflammatory tissue, [43]
peculiarities of, in India, [32]
Causes of failure after couching, [28]
Celsus, [1], [2], [3], [7], [90]
Charlatanism, [6], [7], [20]
Chemotaxis, [61], [63]
Choroid, [73]
changes in, due to hypotony, [73]
detachments of, [73]
Choroidal vessels unusually distinct, [74]
Collins, E. T., [11], [12], [73]
Comparison of depression and reclination, [88]
of pain after couching and after extraction, [86]
of scleral and corneal routes for operation, [89]
Condemnation of couching, [11], [22], [26], [77]
Copper probe, [16], [17], [51]
Cornea, fistula of, [46], [78]
scars in, [16], [46], [78]
Coucher, descriptive titles of, [19]
Coucher’s methods, [20], [33]
Cusson, [7]
Cyanopsia, [32]
[D]
Dark Ages, couching in, [6], [20]
Daviel’s extraction, [7]
Delayed iridocyclitis, [28]
Demonstration of couched cataract, method of, [79]
Depression of cataract, [8], [88]
Diagnosis of couching having been performed, [77]
Difficulties in deciding surgical questions in India, [84]
Difficulty of couching, [11], [90]
Dislocation of cataract, backward, [39]
behind retina, [45], [88]
between ciliary body and sclera, [88]
forward, [36], [87]
in front of anterior hyaloid membrane, [44]
partial, [81]
Drake-Brockman, E. F., [22]
Drake-Brockman, H. E., [9], [22]
[E]
Ekambaram, [10], [11], [16], [17], [24], [26], [49]
Extraction of cataract, [7]
Extraction of couched cataract, [61], [77], [82], [83], [84]
[F]
Fees of couchers, [22]
Fixation of lens, degree of, [82]
Fowl’s blood, use of, by couchers, [18], [20]
Fundus reflex absent, [81]
[G]
Galen, [3]
Glaucoma, [28], [29], [74]
after couching, [86]
causes of, after couching, [75], [76]
frequency of, after couching, [74], [75]
Government servants as couchers, [22]
[H]
Habits of couchers, [19]
Hæmorrhage after couching, [67]
Haly Abbas, [2]
Hay, William, [7]
Headquarters of couchers, [19]
Hindu couchers, [19]
Hirschberg, [9]
Histories of Indian patients, unreliable, [77], [82]
Hudson, A. C., [11]
Hyphæma, [56]
Hypopyon, [56]
Hypotony, effect of, on uveal tract, [73]
[I]
Imperfect dislocation of cataract, [28], [29]
Incision, variation of site of, in couching, [49]
Indian Medical Service Officers and couching, [9]
Instruments for couching, [4], [16], [20]
Invention of couching, first, [2]
Iridocyclitis, [25], [28]
Iris, atrophy of, [78]
flat plane of, in couched eye, [77]
scars in, [16], [78]
tremulous, [78]
Iris bombé, [55]
[J]
Jesu Haly, [2]
[K]
Kirkpatrick, H., [11], [61], [84]
Knife, guarded, [16]
[L]
Lens, calcification of, [55]
Listerism, influence of, on couching, [9]
[M]
Mackenzie, [7], [90]
Magic, element of, in couching, [24]
Mahomedan couchers, [19], [21]
Maynard, F. P., [11]
Membrane, dried pieces of, used by couchers, [20]
Metabolic changes in development of cataract, [33]
Miracles, early Christian, [18]
Mistakes in diagnosis, couchers’, [23], [29], [30]
Morgagnian cataracts, [27], [90]
[O]
Ophthalmoscopy of couched eyes, [31], [80]
Optic atrophy, [28], [29]
Optic neuritis, [30], [63]
[P]
Pain during couching, [15]
following couching, [85], [87]
causes of, [86]
Panophthalmitis, [25], [52], [82]
Parsons, J. H., [10]
Pathological material available, [35]
Philoxenes, [1]
Phthisis bulbi, [82]
Position of couched cataract, recognition of, [77], [79], [80], [82]
Posterior operation, [16]
Pott, Percival, [7]
Power, Henry, [10]
Punjabi couchers, [21]
Pupil, blackness of, in couched cataract, [77]
occlusion of, [81]
[Q]
Quartillera, [11]
[R]
Razes, [2]
Reascension of couched cataract, [89]
Reclination of cataract, [7], [8], [88]
Reluctance to remove couched lenses, [77]
Removal of couched lens, [61]
Results of couching, [25], [26], [27]
Retina, cysts of, [65], [70], [73]
dots on, [68]
dots on, frequency of, [68]
dots on, pathology of, [69]
Retinal changes ascribed to couching, [30]
Retinal detachment, [28], [29], [64]
causes of, [64], [65], [66]
due to operative traumatism, [68]
stick-like, [65]
Retinal pigment, changes found in, after cataract-extraction, [32]
Retinal pigment, changes in, found in couched eyes, [31], [32]
Retino-corneal synechia, [46]
[S]
Sandalwood paste, [17]
Scarpa, [7]
Scarpa’s needle, [8]
Sclera, scars of, [49], [78]
Scleral fistula, [50]
Smith, H., [11], [22], [26]
Social status of couchers, [22]
Sprengel, [1]
Statistics of couching, author’s, [11], [22], [25], [26]
Kirkpatrick’s, [11], [25]
Maynard’s, [10], [22]
Straub on experimental hyalitis, [61]
Subretinal exudate, [67]
Suction of cataract, [7]
Suppression of couching, [34]
Sympathetic ophthalmia, [29], [55]
[T]
Tabri, [2]
Technique of couching, Abu el Kasim, [4]
Avicenna, [4]
Bartisch, [5]
Benvenuto, [4]
Brisseau, [7]
Celsus, [2], [3]
Indian operators, [10], [14], [16], [25]
Mackenzie, [7]
Thorn used in couching, [14]
Tobit, recovery of sight of, [1]
Transillumination of couched eyes, [80]
[U]
Uveal coat, calcification of, [55]
Uveal tract, injuries of, [50]
Uveitis, plastic, [52]
Uveitis, proliferative, [55]
[V]
Visual results after couching, [27]
Visual results of couching and extraction compared, [28]
Visual tests employed by couchers, [16]
Vitreous body, infiltration of, [59]
Vitreous chamber, [56]
cone of exudate in, [30], [43]
cone of exudate in, altered artificially, [60]
cone of exudate definitely pathological, [60]
filmy exudate in, [62]
Vitreous exudate, fibrous organisation of, [59], [64]
Vitreous opacities, [28]
[W]
Ware, James, [7]
Willburg, [7]

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FOOTNOTES:

[1] The whole series of specimens has been presented to the Royal College of Surgeons of England. The present chapter forms a descriptive catalogue of the most instructive of them. The original Madras numbers within the bottles have been retained, and are here quoted for ready reference.

[2] “The Pathology of Dust-like Bodies in the Vitreous,” etc., Trans. of the O.S. of the U.K., 1912, xxxii. 60.