resect the joint after the periosteum has been removed; and in every case the operation will be a failure. No man can remove the periosteum so well and so effectually as inflammation does; consequently, in diseases of the bones we must have patience. Wait until the periosteum separates from the bone, then the diseased bone can be removed. A new bone may then be formed by the periosteum. A bone covered by the periosteum should not be removed; and when resections have been performed in such cases, they have proved to be failures. Should an articulation be diseased without the bone being implicated, then open the joint, remove the articulating surfaces, but do not disturb the periosteum of a healthy bone, and never resect anything except the articulating surface.

Cataract depends upon the loss of transparency of the crystalline body or its capsule, and may be divided into lenticular, capsular, capsulo-lenticular and spurious. The crystalline lens possesses, in its normal state, the highest degree of transparency and absence of color. It is far more complex in its structure than at first sight would appear; and its anatomical relations, both in a surgical and physiological sense, demand attentive consideration on the part of those who wish to acquire accuracy of diagnosis and dexterity in operation.

It is well known that the lens and its capsule (in the adult) is a non-vascular structure, no trace of blood-vessels having been demonstrated in the healthy adult lens or its membranous investment.. Hence, as it is undeniably a living structure, it can only derive its nutrition from contiguous parts, and is therefore affected directly or indirectly by congestions or inflammations of the choroid, ciliary body, iris and retina. As a non-vascular body, it is necessarily of low vitality, and, consequently, liable to derangement from constitutional diseases affecting the circulation.

The frequency of cataract in old persons is probably due to this cause. Cataract not infrequently occurs in persons shortly

past the middle period in life, especially in females and those of inactive habits, as one of the results of venous congestion; but it also presents itself at all periods of life, for children are born with it; we meet with it in youth, early adult life, but

ever increasingly as age advances.

As perfect transparency is the normal state of the lens, so any approach to opacity is a deviation from that condition, which is a disease, and may be a loss

No. 1.-Lenticular Cataract, with Soft Circumference. of due nutrition of this complex mechanism.

I state fearlessly, that whenever opacity has fully occurred in the lens, as shall be unequivocally determined, though it may be slow in progress, or even arrested for a time, it will never recover its former pellucid state. No medical treatment, no improvement of the general health, will restore the lens to its original transparency. It is necessary to state this firmly, because patients. have been again and again deluded by glowing announcements of the cure of cataract without operation. Innumerable specifics have been put before the public, holding out the inducement that cures could readily be effected, and after the patient had squandered his time and money, he would awake to the fact that he had been imposed upon by some heartless charlaThe time thus consumed robs the patient not infrequently of the chances of success by operation, when they have become blind by the further progress of the disease.

tan.

It cannot be denied that when cataract has undeniably and fully formed, the only means of cure is an operation. Those instances in which relief has been given for a time have been, for the most part, benefited by one or other of our means of dilating the pupil, while some have been, from the first, simple opacities of the cornea that occasionally, in ignorance, and often by design, have been denominated cases of more or less developed cata

ract.

However certain it may be that opacity of the crystalline lens is a defect of its healthy and normal nutri

tion, it is by no means easy

to say what are the causes of this disease in all cases. One point, however, is clear, viz., that if a healthy lens be accidentally wounded, or if its capsule only have been opened by the puncture of a sharp instrument, it speedily becomes opaque, and constitutes what is then denominated traumatic cataract. If, however, the wound in the capsule is slight, and it heal

again quickly, the opacity may not extend beyond an opaque spot in the site of the wound. A sudden blow or concussion will sometimes give rise to the formation of cataract, without rupture of the capsule of the lens, and it is then probable that the nutrition is interrupted by some displacement of the natural relations of the capwith the canal of Petit. It

sule with the vitreous body, or sometimes happens that the lens, with its capsule entire, is dislocated into the anterior chamber, and may there remain for some time in a transparent state, but unless it is extracted,

I have seen an

it will, sooner or later, become opaque. instance where a dislocated lens and capsule floated about in the anterior chamber for a number of years, the patient refusing to have it extracted, on account of fear of the operation. Such an accident is liable at any time to set up inflammation of the iris and ciliary body, and thus endanger

the uninjured eye, by press

ure upon the iris, exciting irido choroiditis,descemetitis, aquo-capsulitis and iridocyclitis. Extraction of the lens, in all such cases, is advisable in the outset, as nothing can be gained by letting it alone, and much trouble may be averted where prompt action is practiced. The normal transparency of

the lens, therefore, appears to depend upon its capsule, and its nutrition is by endosmosis; but it is essential, also, that the vascular structures of its immediate neighborhood should duly perform their office. We see in cases of long-continued acute or chronic inflamma

tion of the choroid, iris and ciliary body, the nutrition of the lens interrupted, and finally becomes opaque. Glaucomatous cataract is evidence of this process, as also, those cataracts that follow chronic congestion of the cho

roid and iris. In common iritis, if effusions of lymph have been poured out, rendering the anterior capsule of the lens opaque, we not infrequently find, in addition to the closed pupil and capsular opacity, that the lens at length loses its transparency, and spurious or inflammatory cataract. is the

result. Thus, in whatever way the healthy state of the neighboring capillary vessels become altered, the process by which the lens is kept in its proper transparent condition is often interrupted, and cataract supervenes.

I am of opinion that in all conditions where cataract forms, there is more or less inflammatory action, although it may be of such a low degree that the patient will not realize it. Yet, if we carefully examine the vascular system of the eye, we shall always, while the cataract is progressing, find more or less congestion. In those cases of congenital opacity of the lens, or its capsule, not infrequently met with, in which partial vision exists for a considerable length of time, or during a lifetime, there appears to

No. 8.-Cataract, with adhesions of the Iris to the Cap

sule of Lens. The above cut represents quite extensive

adhesion of the Iris to Capsule of Lens, showing that

at some time in progress of the disease considerable inflammation existed.

be an arrest of development at a period, varying in different cases, anterior to the birth of the child; for, if we see the patient for the first time, in youth or early manhood, we find on dilating the pupil that the lens is not more than two-thirds its natural bulk; that, in fact, a clear ring of black may be seen between

the pupillary margin of the iris and the circumference of the opaque lens. Tolerable vision is restored by this means, and continues as long as the atropia exerts its usual power.