368 
DEPARTMENT OF SURGERY. 
tions ; anything that will improve the condition of the patient 
may be administered. The local treatment is cleanliness and 
the application of mild antiseptics and germicides ; for this pur¬ 
pose boric acid may be used. If bichlorid of mercury is used 
the solution should be weak (i.15000). Formalin has also been 
recommended in the strength of 1.3000. The eye should be 
bathed three or four times a day with either of the above men¬ 
tioned solutions for at least ten or fifteen minutes each time. 
When the acute inflammation subsides the granulations may be 
touched slightly with the mitigated stick of nitrate of silver 
every two or three days. In ocular complication it may be 
necessary to use mydriatics. When the condition of the palpe¬ 
bral conjunctiva improves the corneal complications will disap¬ 
pear. 
Surgical Treatment .—The surgical treatment for trachoma 
may consist of grattage, expression or curetting. Each of 
these procedures have their indication ; grattage and expression 
should be used when a large area of the conjunctiva is involved, 
but when the granulations are localized, they can easily be re¬ 
moved with a curette. 
Fig. 54. Fig. 55. 
TRACHOMA. CICATRIZATION OF TRACHOMA 
WITH PANNUS. 
Grattage .—The instruments needed for the operation upon 
trachoma are : roller or trachoma forceps (Fig 56); a large and 
small pair of artery forceps; a tri-bladed-scarifier ; pair of scis¬ 
sors ; probe; spatula ; nail-brush ; sponges and dressings. Grat¬ 
tage is an operation recommended by French surgeons, and is 
