Some practical aspects of conjunctival bacteriology / by Freeland Fergus.

  • Fergus, A. Freeland (Andrew Freeland), 1858-1932.
Date:
[1905]
Catalogue details

Licence: In copyright

Credit: Some practical aspects of conjunctival bacteriology / by Freeland Fergus. 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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    formed with the greatest skill and dexterity by several sur- geons gave unsatisfactory results. Many of them were fol- lowed by irido-cyclitis, and not a few by acute suppuration. Unquestionably the introduction of so-called antiseptic treat- ment eliminated a great number of these, but still left many disappointing cases. Patients after operation continued to have acute catarrhal conditions, sometimes severe iritis, and some- times even suppuration. Nothing can be more distressing to a surgeon who has used every care than to find a case oper- ated on with proper precautions going wrong. I have no doubt whatever that disaster can often be prevented by a thorough bacteriological investigation before attempting to operate, yet, odd to say, so far as I have perused the ordinary text- books, there is not one of them which mentions anything of the kind. We are given abundance of directions as to how to prepare patients, what sort of diet they are to have, what medicine is to be given them the night before. Full and explicit directions are sometimes given, even as to the special form of knife to be used, as if that in the hands of a good operator were a matter of much importance; and yet none of the textbooks with which I am acquainted advise the operator to look carefully before he leaps, and to make bacteriological investigations before operating on any eye. I therefore think that this practice, the adoption of which I urged many years ago, has not yet found favour. It may be stated as a general rule that no operation should be performed until such investigations have been made by a reliable observer. The only exception to this rule which I remember at present Is in cases of glaucoma. Many of these cases do not admit of the possibility of delay and the risk of an infection must be run. Let me illustrate my meaning by a few concrete examples, and, in the first place, let me take some cases in which bacterio- logical investigation showed the presence of streptococcus. In my own experience I have known this parasite to cause the loss of three eyes after cataract extractions. About the year 1896, a patient was sent to me from the South of Ayrshire. One eye had already undergone the operation of cataract ex- traction, but the result had been an intense suppuration with the destruction of the eyeball. She was sent to me to see if I would undertake the other eye. The first step was to have the conjunctival fluid from both eyes examined, and at once there came a report that the fluid on each side contained streptococcus. That was to my mind an ample and full ex- Pjanation of this melancholy occurrence. With a good deal of difficulty the streptococcus was got rid of in the remain- ing eye, which was then operated upon, and good vision obtained. The second case of failure due to streptococcus was in my own clinic. I had a suspicion in this case that the lachrymal sac and the conjunctiva were not altogether healthy. When ine patient was admitted to the ward there was a certain amount of discharge. She was kept for a considerable time fmfl ^ believed in those days to be suitable treatment, ww^ house-surgeon informed me that the eyelids were per- extra^ofpr%???'f* discharge, and the lens was then ?n tinf ' V, ^as a severe suppuration, and discharge streptococci were found, ban Wn a ^^s^J^l^ich I wish to mention in this connexion fitp A a ^-^^ ^7 .l'*® recently, and is very instruc- tive. A senile cataract m the right eye was extracted toy a