370 
DEPARTMENT OF SURGERY. 
Fig. 56. 
A. Noyes’ trachoma forceps. 
B. Knapp’s roller forcecs. 
roller or trachoma-forceps is used in the following manner : one 
blade of the forceps is pushed as far back as the fornix, and the 
other blade is placed on the ciliary border of the eyelid ; then, 
by a milking process the morbid material in the folds or granu¬ 
lations is squeezed out thoroughly ; this application of the for¬ 
ceps is continued until the entire surface involved has been sub¬ 
jected to this squeezing process. The granulations on the bor¬ 
der of the lid are expressed by placing one blade upon the cutan¬ 
eous surface of the lid. After the expression is completed, the 
entire surface thoroughly washed with warm water or mild an¬ 
tiseptic solution, and cold compress applied as recommended 
after grattage of the surface. The sequelae and after-care are the 
same as those already mentioned in the preceding operation. In 
such instances absolute rest is necessary and such patients should 
be kept in a quiet stall free from flies, (1) because they (flies) 
deprive the patient of its rest, and (2) they may spread infection 
{Rev, XXV , No. 4, p. 268, u Dissemination of Infectious Dis¬ 
eases by Insects ,” C, F. Dawson , M.D ., D.V.S.) 
Curetting .—If the trachomatous growths are confined to 
groups aud involve only a small part of the conjunctival surface, 
they can be removed with a curette. The eyelid is inverted in 
the same manner as for other operations upon the conjunctiva, 
and the granulations curetted with a small curette. The after- 
treatment is the same as that following grattage and expression. 
SURGICAL ITEMS. 
House-to-house Operating means house-to-house isolation 
and for this the room-to-room risks of infection in the hospital 
are lessened to a minimum degree. Surgical cleanliness is sur¬ 
gical godliness, and every time we forget this we add to our 
