4l6 PHILOSOPHICAL TRANSACTIONS. [anNO 1753. 



Of all the 19, there was not one that escaped an inflammation; whereas, after 

 couching, there are great numbers who have neither inflammation nor pain. 

 But it was to be remarked, that notwithstanding the violent inflammation, which 

 sometimes ensued after the incision of the cornea, even to an enlargement of the 

 eyelids, and vesication of the tunica conjunctiva, the patient complained rather 

 of a tenderness of the eye, on touching it, than of pain ; being generally exempt 

 from those dreadful dartings m the head, which for the most part accompany an 

 inflammation after couching. And he believed he might assert, that none suf- 

 fered very much in that particular, except ae ; who was extremely bad, and lost 

 the eye on that side where the pain was. 



It could not, he presumed, be difficult to conceive how these inflammations 

 should excite such difi'erent symptoms, on reflecting, that in the incision of the 

 cornea, the cornea only suffers ; and in couching, the conjunctiva, the sclero- 

 tica, the choroides, and the tunica retina, are punctured; most of which organs 

 are either tendinous or nervous ; and every surgeon knows the painfulness and 

 obstinacy of inflammations, when they follow upon wounds and punctures of 

 tendinous or nervous parts. He had not mentioned, in this comparison, the 

 violence done to the vitreous humour; because he believed it did not occasion 

 the subsequent pain; and because it seemed to be often as much or more injured 

 in the new operation, without inconvenience. 



It had not occurred in any of these cases, that the inflammation had been so 

 slight, as to disappear entirely in a fortnight, or 3 weeks ; most of them re- 

 quiring 6 weeks, and some longer, for the total removal of them. The first 10 

 days, or more, the light was generally very offensive ; and he had observed, in 

 3 or 4 instances, that on forcibly opening the eyelids during that time, the 

 patient was only sensible of a glare of light, though the eye then appeareri clear, 

 and he afterwards recovered his sight. Which he mentioned to obviate the me- 

 lancholy prognostic one would be disposed to make on a first examination. How- 

 , ever, this was not to be understood as a constant fact ; some patients distinguish- 

 ing objects immediately from the time of the operation. 



It sometimes happens, after this operation, that the pupil loses its circular 

 figure ; which he imagines is owing to the great tenderness of the iris, which, on 

 the least violence, is subject to be ruptured ; and he supposes in this operation, 

 a slight pressure from the back or the flat of the blade may have produced the 

 accident in the instances alluded to. Possibly the sudden dilatation of the pupil, 

 from the rapid passage of the cataract through it, may sometimes occasion it ; 

 but the following history would induce one rather to ascribe it to the cause which 

 he first mentioned. 



Before he had thought of the knife for opening the cornea, he used the scis- 

 sars, as Mons. Daviel directs ; and in a certain patient, after he had made the 



