lens near its under edge, as Dr. Taylor ad- 
vises, and then carried some way down into 
the vitreous humours, so as to clear the way 
for the lens. It is then to be drawn a little 
back, and carried to the upper part of the 
capsule ; when, bv pressing upon it, the lens, 
if solid, is to be pushed down by one, or it 
fluid, by several movements, to the bottom 
of the vitreous humour. It should then be 
pushed downwards and outwards, as Mr. Bell 
directs, so as to leave it in the. under and 
outer side of the eye ; where, in case it should 
rise, the passage of the light would be little 
obstructed. The needle is then to be with- 
drawn, the speculum removed, and the eye- 
lids closed ; and a compress soaked in a sa- 
turnine solution to be applied over them.” 
It is not advisable, in general, to remove the 
dressings till about eight 6r ten days after the 
operation. 
Operation of extracting the lens. “ The 
operator takes t-lie knife, (fig. 23.) and holds 
it in the same way as he does the needle 
for couching ; he then enters the point of it 
with the edge undermost into the cornea, 
about the distance of half a line from its 
connection with the sclerotic coat, and as high 
as the centre of the pupil ; he is then to pass 
it across the pupil to the inner angle in an 
horizontal direction, keeping the edge a little 
outwards, to prevent the iris from being cut ; 
the point is then to be pushed through op- 
posite to where it entered; the under half of 
the cornea is next to be cut, .and at the same 
distance from the sclerotic with the parts at 
which the point of the knife wen tin and came 
out from the eye. In cutting the under half 
of the cornea, 'the pressure, of the speculum 
upon the eye should be gradually lessened; 
for if the eye be too much compressed, the 
aqueous humour, with the cataract and 
part of the vitreous humour, are apt to be 
forced suddenly out immediately after the 
incision is made. The operator then takes a 
flat probe, and raises the flap made in the 
cornea, while he passes the same instrument, 
or another probe, (tig- 24.) rough at the ex- 
tremity, '"cautiously through the pupil, to 
scratch an opening in the capsule of the lens. 
This being done, the eye should be shaded 
till the lens be extracted - , or the eyelids are 
to be shut, to allow the’pupil to be dilated as 
much as possible; and while in this situation, 
if a gentle pressure be made upon the eye- 
ball, at either the upper or under edge of the 
orbit, the cataract will pass through the pupil 
more readily than it would do when the eye- 
lids are open. If the lens cannot be easily 
pushed through the opening of the cornea, 
no violent force should be used, for this 
would tend much to increase the inflamma- 
tion. The opening should be enlarged so as 
to allow the lens to pass out more freely. 
When the cataract does not come out entire, 
or when it is found to adhere to the conti- 
guous parts, the end of a small flat probe or 
a scoop, (fig. 25.) is to be introduced, to re- 
move any detached pieces or adhesions that 
may be present. The iris sometimes either 
projects too much into the anterior chamber, 
or is pushed out through the opening of the 
cornea. When this happens, it is to be re- 
turned to its natural situation by means of 
the probe already mentioned. * Sometimes 
the opacity is not in the body of the It ns, 
but entirely in the capsule which contains it. 
The extraction of the lens alone would here 
SURGERY. 
answer no useful purpose. Some practition- 
ers attempt to extract first the lens and then 
the capsule by forceps ; others the lens and 
capsule entire.” The after treatment is to 
be the same as in couching. 
A difference of sentiment prevails respect- 
ing the superior eligibility of the one or Ihe 
other of these operations. Among the sur- 
geons of London, the extraction is principally 
advised. 
Of fistula lachrymalis. 
An obstruction of the lachrymal sac or 
duct constitutes this disease ; it is divided 
into four stages; the first is constituted by a 
mere dilatation of the sac, and is character- 
ised bv a tumour between the inner corner of 
the eye and the nose, attended with a dis- 
charge of tears and mucus over the cheek, 
the integuments being entire, and as yet free 
from inflammation. In the second stage the 
Swelling is larger, the skin inflamed, and out 
of the puncta lachrymalia may be now press- 
ed a yellowish purulent fluid. The bursting 
of tlm skin forms the third stage of the dis- 
order ; in the fourth, the passage from the sac 
into the nose is obliterated, its inside being 
ulcerated or fungous, and the bones being 
carious ; it is only then to this last stage that 
the term fistula can with propriety be ap- 
plied. 
It has been attempted, by the introduction 
of a probe (fig. 27.) from one of the puncta 
lachrymalia into the nasal duct, to overcome 
the obstruction without wounding the integu- 
ments : the injection of astringent fluids has 
likewise been proposed by means of a sy- 
ringe, (fig. 2S.) the pipe of which is also to 
enter one of the puncta; but these opera- 
tions are scarcely practicable,* and all per- 
haps that, in the first period of the disorder, 
ought lo he attempted, is frequent pressure 
with the finger on the tumour ; when the 
disorder advances, and the tumour threatens 
to burst, an opening should be made into it 
with a small scalpel, beginning the incision 
a little above the line from the angle of the 
eye to the nose, and laying the sac fairly 
open ; the contents of the tumour are then to 
be pressed out; and by some surgeons we are 
directed to search for the nasal duct with a 
probe, and if it can be found, to introduce a 
piece oLeatgut) bougie, or l£ad, bending it 
downwards so as to preserve it in the passage 
til! the sides of the duct are healed. The 
wound is to be dressed w ith wax and oil, and 
the dressings retained by sticking plaster. 
When the passage of the duct is secured, the 
substance that had been introduced is to be 
withdrawn, and the wound healed. 
In the last, or properly fistulous, stage of the 
disorder, the attempts at cure are attempts 
to procure a new duct for the passage of the 
tears, the original one being obliterated. For 
this purpose the canula of the trocar (fig. 30.) 
is to be introduced to' the under and back 
part of the lachrymal sac, and retained 
while the stilette is to be passed into it in 
an oblique direction downwards and inwards, 
till it reach the nasal cavity ; the perforation 
of the bones will be perceived by the ope- 
ration; and the passing of the instrument into 
the nostrils, is usually followed immediately 
bv the passage of some bloody mucus out of 
the nose. When the instrument has thus 
penetrated the spongy bones, it is to be with- 
drawn from the canula, and a leaden probe or 
749 
piece of catgut introduced. The canula is 
now to be removed, one end of the probe is 
to remain in the new-formed duct, and the 
other bent so as to secure its ..retention, and 
hang over the edge of the wound, which is 
now to be covered with lint aiid adhesive 
plaster. The probe is to be removed almost 
daily until the new duct is completely cal- 
lous, when it is entirely to be removed, and 
the wound healed. 
In cases of much constitutional affection, 
where the disorder treated in the above man- 
ner is likely to recur, it has been proposed 
to introduce a canula of gold, silver, or lead, 
into the artificial opening, and to heal the 
skin over it. The instruments used for this 
purpose are represented in figs. 31, 32, 33. 
Of diseases of ihe teeth. 
The causes of tooth-ach are obscure. 
Caries of the teeth seems to be sometimes a 
constitutional, at others an entirely local dis- 
ease. For the preservation of the teeth, they • 
ought to be kept constantly brushed, with a 
brush simply, or with some powder that is 
not of an 3' id nature. For acids, although 
for a time they cleanse and whiten the teeth, 
eventually injure their texture: tiie aridity 
constitutes the objection to several of the 
commonly vended dentifrice powders. Tooth- 
ach when it proceeds from a disease of the 
tooth itself, only admits of temporary cure 
by the common applications of opium, cam- 
phor, and the warm essential oils. r lhe 
empirical remedies for diseased teeth are 
perhaps generally composed of some strong 
concentrated mineral acid, by which the ca- 
rious is for a time separated from the sound , 
portion of the tooth. 
Extraction of the teeth. Many are by far 
too liberal in disposing of their teeth : it the 
first fit of the tooth-ach be endured, the dis- 
order will frequently, for years, or for 
life, be suspended, and the tooth remain 
useful, which by a precipitate extraction 
would have been unnecessarily lost. In some 
again, there is a tendency, from the fear of 
the operation, to the other extreme. When 
a tooth is extensively carious, it ought by all 
means to be extracted, for the sake of pre- 
serving those that are contiguous ; and the 
momentary pain of extraction is trifling in 
comparison of the multiplied and protracted 
fits of toooth-ach. 
The instruments for extracting teeth ope- 
rate in a lateral direction : it is indifferent on 
which side they are forced out, whether out- 
wardly or inwardly, excepting in the in- 
stance of the dentes sapiential of the lower 
jaw, which ought invariably to be forced out- 
wards. Before the claw of the instrument is 
fixed on the tooth, the gum should be sepa- 
rated from it as deep down as possible ; t he 
fulcrum of the instrument is to be on the 
side opposite to that at which the tooth is to 
be extracted, and with a single turn, which 
should not be by jerk or violence, but made 
with a slow, regular movement, the tooth will 
come out of its socket. 
From very violent affections of the teeth, 
and from other causes of inflammation, the 
membrane of the antrum maxillare some- 
times inflames, and becomes t lie seat of ab- 
scess. The symptoms of this disease are, vio- 
lent pain in the cheek, and swelling extend- 
ing upwards towards the nose, tin* ears, and 
the eyes ; the swelling generally points in the 
