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unexceptionable, if not the most perfect of our performances, in the department of operative surgery.
The following is a concise summary of the contents of this
and the preceding memoir. I. The various textures of cataract admit of distinction into capsular and lenticular, single or in combination. The lenticu. lar cataract is either fluid, flocculent, caseous, hard, or of mixed consistence.
II. To the two former and the soft of the caseous species, the operation of forming a central aperture in the capsule, for the solution of the lens in the aqueous humor, is well adapted: to the firm of the caseous species and the two latter it is inapplicable.
III. The introduction of the needle through the cornea is preferable to passing it through the sclerotic, in performing this operation; except when, in consequence of a previous operation, or from other cause, the capsule is opake, and the lens has undergone a partial absorption, and lies at a distance from the pupil.
IV. The operation of couching, which is, strictly speaking, applicable only to firm caseous and hard cataracts, is objectionable on account of the injury done to the organ,
admitted in the theory of the operation, and evidenced by a destructive inflammation, and an ultimately impaired state of the retina, by which it is frequently succeeded.
V. Where the space occupied by the aqueous humour is narrowed by the considerable convexity of the iris, the firm cataract may be dislodged from its capsule, placed in the anterior chamber by the needle, and safely extracted by a section of the cornea.
VI. The fluid, flocculent, soft caseous and unadhering capsular cataract, congenital or adult, may be safely and expeditiously extracted through a quarter section of the cornea, by freely opening the capsule with the point of the knife, and afterwards depressing the margin of the pupil with the back
of the scoop
VII. The extraction by a quarter section should never be
attempted but in cases where the consistence of the cataract is manifestly soft, as its success depends on the susceptibility of the cataract of a change of figure, or its ready escape piecemeal. It is better adapted to the opake capsule if unadhering, than the operation with the needle.
VIII. Where the capsule of the fluid, flocculent, and soft caseous cataract is transparent, the operation of extensively rending it and dissipating its contents with the needle passed through the cornea, is efficient, and leaves the pupil in the most perfect state.
IX. The mixed, firm caseous, and hard cataract require the section of the cornea in its semi-circumference, being unsusceptible of an alteration of figure.
X. The inflammation which follows the easy extraction of the cataract is never hazardous, very seldom severe. That which ensues after the difficult extraction, frustrates in a great degree, if not entirely, the object of the operation, though the cataract be completely removed.
XI. The cause of the difficulty is the insufficient aperture of the cornea; the consequence of it, the implication of the iris with the wound of the cornea, and the participation of the former in the inflammation of the latter: the consequent coadhesion of the two, and the partial or total obliteration of the anterior chamber, with diffused opacity, greater or less, of the cornea.
XII, The principle of the operation of extraction is unexceptionable: the section of the cornea should be every where about one line distant from the sclerotic; it should be crescentic, and should commence on a level with the superior border of the pupil. The aperture of the capsule should be large and central, by laceration, not by incision of that membrane.
I trust that the observations contained in this paper, may afford satisfactory evidence of the justness of the principle, which I have endeavoured to establish. I by no means assume, that my experience is sufficiently extensive, or my description and arrangement sufficiently accurate, to lead the surgeon up to a prompt and unfailing decision of the most appropriate operation in every case. The subject probably does not admit of being reduced to unerring rules.* I have, however, pointed out a path, which I believe may be pursued with advantage; and if these observations should induce attention to the subject, I entertain no doubt that the several textures of cataract will ere long be distinguished with accuracy, and that thus the discretion of the surgeon, becoming subservient to his art, will render it in the highest degree efficacious.
"Simple views, whether of health or disease, however ingenious, can seldom be just. They have their origin in the spirit of system, not in the careful study and faithful enumeration of the various and complicated circumstances, which concur in the production of all vital phenomena."Thomson's Lectures on Inflammation.
Observations on Pulmonary Consumption,
BY DR. SOUTHEY.
[From the London Monthly Magazine, for April, 1816.]
In our Bills of Mortality are registered only those births and burials which take place in London, and 12 miles around it; yet in this little spot of our island, in this fragment of our population, between 5 and 6000 persons annually die of consumption. Holycross, a little village in Shropshire, long held a population of only 1050. During the ten years between 1750 and 1760, forty-seven of its inhabitants died of consumption; but, from 1760 to 1770, there died of the same disease one hundred and one: in the former period it caused one-sixth, but in th one-third of the total mortality of the place. During seven years, between 1790 and 1796, six hundred and eighty three persons died of consumption at Bristol, and its relative mortality was as one to two; at Plymouth, during the seven years from 1799 to 1808, the relative fatality of consumption was as one to four.
When the kingdom is unusually healthy, there annually dies one out of every forty persons; if consumption does onefifth of the whole work of mortality, of every two hundred inhabitants one dies consumptive every year. The total population of these islands has been moderately calculated at 16,000,000; consumption, therefore, annually destroys 80,000; thus, every day that passes over us, thirteen persons die of this disease in the metropolis alone, and upwards of two hundred and forty in the whole kingdom.
But figures never affect the feelings; numerical calculations go on in an unsensitive part of the mind; we cannot reckon and imagine at the same time. To place in a striking point of view the amount of its ravages, an eloquent writer, Dr. SOUTHEY, directs his reader to “ascend one of the high hills Vol. IV.
that surround Bristol, to remark how closely the buildings are crowded together, for an extent of some miles; to descend from the eminence, and walk through its populous streets; to calculate the multitude that are met on the walk, and the still greater multitudes who are at the same time within the houses; and, when the imagination has thus grasped the idea of an immense assemblage of human beings, he is reminded, that a number equal to this assemblage perishes annually in our own island of this devouring malady."
What remedies have we for this disease? It has prevailed so long, and is occurring so perpetually, that the knowledge and the resources of the profession must have found their way to the public; and, we believe, they are pretty well aware, that, when consumption is fairly and fully established, there is no remedy od which we have the smallest reliance for efficacy, and that the greater number of medical practitioners aim at little more than alleviating the sufferings, and managing the minds of their patients; or, if they ever go further, and prescribe any of those remedies from which more sanguine spirits have promised a complete recovery, it is as a forlorn hope, and without the faintest expectation of success. In truth, there is at this time, throughout the profession, a hopeless indolence upon the subject. Physicians have no faith in their present remedies, and the subject is so unpromising, that they feel little inclination to search for new ones. This state of opinion must inevitably influence the conduct of the profession, and the patient, in return for his confidence and his fees, gets little more than prescriptions that have no power, and visits that carry no comfort.
The following statement of the varieties which occur in strumous phthisis, is well calculated to be highly interesting and useful to those practitioners who have had less extensive experience of the disease than Dr. Southey, or who are accustomed to regard it with a less scrutinizing eye.
u Sometimes the disease proceeds to its fatal termination without any pain in the chest, even upon the full inspiration. The difficulty of breathing also varies greatly; in some instances, the respiration becomes hurried and laborious, and all the auxiliary muscles are exerted early in the disease. In other