Dr David Little Operating

Transcription

1 Dr David Little Operating A picture of Victorian Surgery Nicholas Jones Manchester Royal Eye Hospital

2 Dr David Little Born January 1840 at Corrie Stand Farm, Nr Lockerbie One of 11 children 1856 Edinburgh University 1859 MD Apprenticeships: Sowerby Bridge Stourbridge Durham 1863 MEH House Surgeon 1867 MREH Honorary Surgeon

3 Dr David Little 1880 President, MMS 1901 President, OSUK 1902 Died, pernicious anaemia 1902 MREH children s ward named after him 1903 Portrait by George Harcourt presented to MREH 1996 Preadmission clinic named after him

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7 Photograph by Mr JD Amenaber, Medical student MREH 1893

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10 Dr Robert Edie died by his own hand MREH April 1894

11 Nurse Lizzie Isherwood dismissed from MREH April 1894

12 Cataract surgery development: Couching

13 Cataract surgery development: Daviel 1752

14 Cataract surgery development von Graefe 1864 von Graefe A. The Operation for Cataract by Modified Linear Extraction (1864)

15 Victorian cataract surgery: the preparation The patient undergoes no special preparation; the operation is performed on a table in good daylight. A 4 per cent solution of cocaine in boracic acid is dropped three or four times in the upper part of the cornea. Before the introduction of cocaine into practice, it was quite the exception for me to give chloroform or ether. The conjunctival sac and external parts of the eyelids are well washed with corrosive sublimate solution 1 in 5,000. Little D. Address to the BMA Section of Ophthalmology 1889

16 Victorian cataract surgery: the apprehension I was summoned with others to the operating room. Just before my turn came, the nurse injected some liquid into my eye only one was to be operated on whispering at the same time words of good cheer. A minute or two afterwards I was lying on a high couch facing what appeared to be the strong sunlight. The physician placed cocaine in the eye to deaden the pain and then asked me to remain as quiet as possible. He put a little apparatus over the eye to keep it steady A cataract patient Manchester City News 1891

17 Victorian cataract surgery: the section ab interno or ab externo Factors to consider: Speed, iridectomy?, ambidexterity, instrument reliability

18 Victorian cataract surgery: the section With a second pair of forceps I fix the eye at the horizontal meridian inwards, so as to ensure perfect steadiness and the making of a perfectly even incision. With a Graefe s knife the incision is made throughout its whole extent in the apparent corneo-scleral junction, and the iris extracted close to the periphery. If the incision is made too corneal in any part of the section, the iris probably cannot be excised close enough to the periphery, and adhesions or dragging may result. If the iris after excision does not retract well within the anterior chamber from the corners of the wound, I do not hesitate to excise more (Little)

19 Victorian cataract surgery: the extraction The capsule is ruptured from below upwards with a Graefe s bent cystitome, and the lens expelled with a rubber spoon in the usual way. As soon as the nucleus has escaped the speculum is removed, and the pupil is cleared of cortex by pressure within the fingers over the eyelids only. I never introduce an instrument to remove cortex (Little) He put a little apparatus over the eye to keep it steady, and in a few seconds I distinctly saw him take a black sixpence gradually from my eye. I could see the light enter as the black disappeared. Remember, my other eye was perfectly useless for purpose of sight, so that I must have seen the operation with the eye operated on. The pain was rather severe, as I suppose the lens behind must have been cut away by a special and very sharp instrument. The sensation of something tearing away at the eye was not agreeable, and although the operation did not last more than a minute in all, I felt I could not have stood it much longer (Patient)

20 Victorian cataract surgery: closing up The wound is well-cleared of cortex and blood-clots by a piece of cotton-wool soaked in sublimate. The dressings consist, first, of a piece of lint soaked in corrosive, then a thin layer of dry cotton-wool and a single strip of plaster from cheek to forehead. The other eye is covered with a round piece of muslin, and both supported by a double flannel bandage. The patient is kept in bed for two days, and the dressing left undisturbed for three or four, unless unfavourable symptoms appear (Little) The next minute the nurse had the eyes bandaged, and grasping my arms firmly, she led me to my room, giving me strict instructions to hold my head steady. At the door another patient, who could partially see, took me in charge, and I went to bed, where I remained two days (Patient)

21 Victorian cataract surgery: the recovery When my cataract had been removed, severe inflammation set in, and shooting pains through the head followed. I awoke in the morning to see constellations and lightnings innumerable though my eyes were closely bandaged. For the careful attention I received at that troublesome time I will always be grateful. It was just the same in the night. Nurses and doctors appeared to be wandering about at all hours. Soon a day came when the physician said I could go home. After a month s absence I returned to the Hospital a short time since for an order on Messrs Armstrong, and now I can read the newspaper, after an interval of several years (Patient)

22 Victorian cataract surgery: the results About the beginning of 1887 I began to carry out antiseptic treatment systematically in every case of extraction, and from that period I have performed 133 cases There has been no case of suppuration of the cornea, and no absolute loss of the eye from any cause The employment of antiseptics has at least largely diminished the risks to suppuration (Little) However: cataract surgery results MREH 1913: 306 cataract operations 41 did not see 6/60 or better 13 blinded by complications 4 endophthalmitis (1.3%)

23 Sir William Richmond : a commission from Mrs Little

24 Harold Speed Society artist

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26 1919 David Little s widow commissions painting from Harold Speed and donates to City of Manchester

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