YO DISEASES CLASS 1. 2. 2. 13. 



a grain of corrosive sublimate of mercury dissolved in brandy, or 

 taken in a pill, twice a day for six weeks. Couching by depres- 

 sion, or by extraction. The former of these operations is much to 

 be preferred to the latter, though the latter is at this time so 

 fashionable, that a surgeon is almost compelled to use it, lest he 

 should not be thought an expert operator. For depressing the 

 cataract is attended with no pain, no danger, no confinement, 

 and may be as readily repeated, if the crystalline should rise again 

 to the centre of the eye. The extraction of the cataract is at- 

 tended with considerable pain, with long confinement, generally 

 with fever, always with inflammation, and frequently with irre- 

 parable injury to the iris, and consequent danger to the whole 

 eye. Yet has this operation of extraction been trumpeted into 

 Universal fashion for no other reason but because it is difficult to 

 perform, and therefore keeps the business in the hands of a few 

 empirics, who receive larger rewards, regardless of the hazard, 

 which is encountered by the flattered patient. 



A friend of mine returned yesterday from London after an 

 absence of many weeks; he had a cataract in a proper state for 

 the operation, and in spite of my earnest exhortation to the con- 

 trary, was prevailed upon to have it extracted rather than depress- 

 ed. He was confined to his bed three weeks after the operation, 

 and is now returned with the iris adhering on one side so as to 

 make an oblong aperture; and which is nearly, if not totally, 

 without contraction, and thus greatly impedes the little vision 

 which he possesses. Whereas I saw some patients couched by 

 depression many years ago by a then celebrated empiric, Cheva- 

 lier Taylor, who were not confined above a day or two, that the 

 eye might gradually be accustomed to light, and who saw as 

 well as by extraction, perhaps better, without either pain, or 

 inflammation, or any hazard of losing the eye. 



As the inflammation of the iris is probably owing to forcing 

 the crystalline through the aperture of it in the operation of ex- 

 tracting it, could it not be done more safely by making the open- 

 ing behind the iris and ciliary process into the vitreous humour? 

 but the operation would still be more painful, more dangerous, 

 and not more useful than that by depressing it. 



If extraction of the crystalline be used, Dr. Reimarus of Ham- 

 burgh advises to drop into the eye previous to the operation, 

 some extract of belladonna dissolved in water, which he has found 

 to produce a temporary paralysis of the retina, and thence a 

 total inaction of the iris, so that it remains perfectly expanded, 

 and is thence less liable to be injured by the operation, and the 

 eye perhaps less liable to inflammation. Might not this be of 

 advantage in some ophthalmies? 



