RADICAL NAIL PRICK OPERATION 461 



cumbent position under profound anaesthesia. Local anaes- 

 thesia is not sufficient, and the strictest asepsis must be 

 respected. 



The eye is held open with strong silk threads stitched 

 through the center of each eyelid. 



An incision, encircling the entire eye is made through 

 the conjunctiva, about one-half inch behind the ciliary margin, 

 excepting at the canthi, where it more nearly approaches 

 the border. After carrying the incision inward equally at 

 every part so that the knife passes easily into the sub-con- 

 junctival space, blunt dissection with the handle of the scalpel 

 or with the index finger is continued backward toward the 

 optic foramen until the globe hangs loosely in the orbit, at- 

 tached only by its constricted peduncle. A double-half hitch 

 of strong braided silk is now passed over the globe and fixed 

 upon the peduncle about one inch from the foramen, or less 

 if the disease extends beyond. It is drawn as tight as the 

 finger tips can draw it, and then secured against slipping by 

 adding a knot or two. The globe is then excised well in front 

 of the ligature, leaving a funnel-shaped stump to prevent slip- 

 ping. 



The cavity is irrigated moderately with mercuric chloride 

 solution, and then packed with antiseptic gauze, which is re- 

 tained by tying together the two sutures used to separate 

 the eyelids" during the dissection. 



In removing large growths which obstruct free admission 

 into the cavity, each canthus may be incised outwardly to 

 enlarge the orbital opening. 



AFTER-CARE. — The wound must at all hazards be pre- 

 vented from becoming infected, and the ligated stump from 

 putrefying, by painstaking irrigations of hydrogen peroxide 

 followed with liberal dustings of iodoform. 



Radical Nail Prick Operation. 



DEFINITION. — By "radical nail prick operation" is 

 meant the evacuation of purulent synovia from the navicular 

 sheath by removing a part of the plantar cushion and divid- 

 ing the plantar aponeurosis. 



INDICATIONS. — When a street nail pierces the side of 

 the frog at the level of the navicular bursa and then pene- 

 trates through the perforans tendon (plantar aponeurosis) 

 serious consequences usually ensue. The wound discharges 

 purulent synovia, the patient falls sick, and unable to support 

 Weight on the affected leg for weeks and sometimes months, 



