It is more usual, however, to find congenital cataract more dense than those cases of arrested development, and the capsule usually participates in the opacity. Shortly after birth, the mother, finding the child not taking the usual notice of objects, or of bright lights, or perhaps observing a pecular rolling or oscillating movement of the eyes, detects a white spot where the black pupil ought to exist. The surgeon subsequently confirms her fears by announcing that the child has been born blind with congenital cataract. If steps be not taken to remove this defect early in life by operation, changes go on that ultimately produce considerable embarrassment in the future treatment. The lens not only does not increase with the rest of the organ, as it unquestionably would were its nutrition or vitality not arrested, but it wastes; the lenticular mass of the cataract becomes absorbed gradually; the anterior and posterior surfaces of the capsule become approximated, and, if the operation be delayed until the twelfth or fourteenth year, it is not unusual to find little more than a tough, unyielding and opaque membrane inclosing some few opaque debris of the former lens.

When the operation has been delayed only for a few years, we observe that the globes have acquired a peculiar involuntary motion; in fact, they are never at rest, but an oscillatory or rolling movement is perpetually going on, giving a distressing appearance to the eyes, and, in some degree, interfering with good vision after the removal of the cataract. If the sight be restored early, this habit disappears, but if it be postponed until after the eighth or tenth year, the stability of the eyes is seldom entirely regained.

This oscillation of the eye-ball is not confined entirely to cases of congenital cataract, for we occasionally observe it in children whose sight is otherwise good, and in whom no defect of lens ever existed. The patient himself is generally unconscious of the motion, and instances occur in which the sight is apparently good. In true soft cataract we generally find the lens of a milky-white color, with just sufficient translucency to indicate by a more opaque white color that the center, or nucleus of the lens, is denser than the periphery.

When the pupil is well dilated with atropia, the margin of the lens is of a more bluish-white color, showing its greater degree of thinness; the opacity may therefore be said to increase from the circumference of the lens to its center, both because of its greater density and because of the increased thickness between its two poles.

It sometimes happens that the lens becomes more bulky than natural, and appears to press against the posterior surface of the iris, causing it to protrude into the anterior chamber. In this case the lens is unusually soft, and requires more than usual care in operation, lest by opening the capsule too freely the body of the lens becomes displaced, or makes, by its swelling, injurious pressure upon the iris.

Fluid cataract is met with at all ages, but is a somewhat rare species.

In July, 1875, I operated on Cora B. Cook, of Magnolia, Wis., for fluid cataract, by division of the capsule; the fluid, which was of a milky-white color, commingling with the aqueous, and in a very few moments becoming almost as transparent as the aqueous itself. This child could, before the operation, barely see to go about, but now, with the aid of glasses, reads ordinary print. In the above case, if the retina had been perfect, the result would have been still better

Fluid cataract is seldom extracted, and when it is may be accompanied by an evacuation of the vitreous humor, yet no inflammation may succeed the operation, and excellent vision result. I think from my own experience that fluid cataract is dependent upon more extensive disease of the humors than in other and more common cases of opaque lenses.

Traumatic cataract is always of a soft character.

Wounds

of the capsule by thorns, or punctures by needles, awls, or in any other way, even when little or no general disturbance is set up, almost invariably lead to more or less opacity of the crystalline lens.

If the wound that produces cataract does not suffice to produce absorption of the lens, it should be treated as soft cataract in general, by a division of the anterior capsule and breaking up of the cataractuous mass. This should be done

without much delay, as it frequently happens that the iris becomes adherent to the capsule of the lens, rendering the operation more difficult of execution.

The most common form of cataract met with by the surgeon is that denominated hard cataract, a condition in which the lens assumes a tint varying from an amber-yellow to a brownishyellow, and, in some instances, to a dark sepia, or even mahogany-brown; indeed, more rarely still, it becomes so dark as to be very difficult to detect it at all, without the use of oblique illumination, or the ophthalmoscope.

In persons about fifty years of age, the cataract is compounded of a hard or yellow nucleus, and softer periphery, in which case the surface appears of a semi-transparent gray color, showing the deeper-seated and deeper-colored nucleus through the various parts of the lameller structure.

Hard cataract is of slower growth than the other varieties, and is sometimes two or even three years before coming to maturity, or, in other words, before opacity is complete. The opacity may and generally does begin in the center of the lens, or simultaneously in the nucleus and periphery; and hence, in order to clearly diagnose it in its earlier stages, the pupil should be widely dilated, that we may fully explore its whole surface before an opinion is given.

Since the discovery of the opthalmoscope, we are no longer in the dark in regard to the diagnosis of intra-ocular diseases, but can now state with certainty the nature of the case, and the probable chances of a case.

In conclusion of this article, I will briefly give the mode of operation for extraction of the lens, which, though difficult of execution, and attended by many dangers, yet the success of which far exceeds any other operation that has yet been devised. It is not surprising that the chances of a successful operation for cataract should diminish with advancing years. The older the patient, the more the function of his eye must fall short of the power to resist operation, the less speedy and complete is the recovery, and the more unfavorable are the results. In all cases where a low form of inflammation exists in the ciliary body, with congestion of the

ciliary vessels, the operation should be postponed until the inflammatory action could be entirely reduced, as the dangers. in operating at such a time are far greater.

The knife which I use in the operation is one inch and one-eighth on its cutting-blade, and tapers to a very fine point; the width of the blade at its widest point being one-eighth of an inch.

LOCALITY OF THE SECTION.

The section should be made in the cornea, the knife entering on a parallel line with the upper third of the pupil, and passing out at the opposite side; then, with a gentle sawing motion, the blade should be carried upward until within one line of the periphery of the cornea, when it should be turned upon its back, so that the upper portion of the section will be linear, instead of semi-lunar. It will sometimes happen that the section will be either too large or too small, and of these two errors the latter is infinitely the worse. The danger of too small a section is fracture of the lens, and dislocation into the vitreous, bruising the iris and cornea in an attempt to ́enlarge it, thus setting up an inflammation that may result in the loss of the organ.

DIVISION OF THE CAPSULE.

The second step in the operation is the division of the capsule of the lens. I know of no operator except myself that divides the capsule of the lens in the second step, and for so doing I will give the following reasons:

1. The danger of a rupture of the hyalid membrane is not so great, as the iris is a guide to the cystotome.

2. The anterior chamber is free from blood (which is not always the case where the iridectomy is made first.)

3. We have a perfectly transparent field to work in, which is of the greatest importance to the operator.

It is well known by all ophthalmic surgeons that hemorrhage frequently follows iridectomy, thus filling the anterior chamber with blood, and totally obscuring the field of operation. This either arrests the operation, or greatly endangers the eye by its further continuation. If the upper portion of

the iris be bruised by the cystotome, it will do no harm, as that section of the iris is removed by the iridectomy.

THE IRIDECTOMY.

But little need be said of the third step, or iridectomy. If the iris has not already prolapsed through the wound, we may pass a curved iris-forceps into the anterior chamber, and carefully draw it out and cut out a large section, care being taken that the iris be not incarcerated in the corners of the wound. It is of the greatest importance that the iris-scissors are sharp, as iritis is liable to follow bruising that tissue.

EXTRACTION OF THE LENS.

The conjunctiva should be seized just below the cornea; and while the posterior flap of incision is depressed with the cataractspoon, a gentle pressure inward and upward with the forceps will cause the lens to present itself at the opening, and by a careful manipulation with the spoon the lens, with its cortical substance, will pass through the opening.

If the iris is incarcerated at the corners of the incision, we may now carefully push it back into the anterior chamber, and the operation is finished. I usually put on a wet compress, and keep the patient quiet from four to seven days.

[XXXVI.]

TREATMENT OF SPERMATORRHEA.

BY E. F. RUSH, M. D.

The very first and most important thing to do is to impress the patient with a belief in your power to effect a cure of his disease if he will but follow directions. Obtain his confidence and allay his fears and anxieties. Patients of this class always have two "stock" questions which they will propound at the earliest opportunity, viz.: "Do you think you can cure me?" and "How long will it take?" Answer the first promptly and decidedly in the affirmative, and, in answer to the second, give him to understand that, to accomplish a permanent cure, he must go through a regular course of treatment, which will vary in length in different cases, but assure bim that you will cure him as quickly as is consistent with safety and