SURGERY. 
made of various shapes ; those of Mr. Hey 
and Scarpa are the best. 
Extraction is performed by cutting the 
lower haif of the corriea, near its junction 
with the sclerotica, with a slender knife car- 
ried across the eye by one motion of the 
hand. A scratch is then made in the crys- 
talline capsule, through which the cataract 
escapes. The dexterity required in per- 
forming extraction, and particularly in mak- 
ing the cut througli the cornea, is only to 
be acquired by long practice; and tlris ope- 
ration has consequently become confined 
almost entirely to the oculists. 
Much has been written on the respective 
advantages of the two operations ; the me- 
rit of ease of performance, simplicity, and 
mildness in the subsequent symptoms, be- 
longs to couching ; also that of the power of 
repeating the operation. Extraction is more 
difficult, attended with greater injury to 
the eye, and consequently greater inflam- 
;mation, but it removes the cause entirely. 
After both operations light must be care- 
fully excluded, and every precaution taken 
against inflammation. The use of convex 
glasses is required as an assistance to the 
sight, rendered necessary by the loss of the 
lens. 
The capsule of the lens sometimes be- 
comes opaque after the operation, and thus 
a secondary membranous cataract is form- 
ed, requiring the operation. 
DISEASES OF THE MOUTH. 
Ranula is an indolent tumour, formed un- 
der the tongue, consisting of a membran- 
ous cyst, containing a fluid generally like 
white of egg, and occasioning no inconveni- 
ence until its bulk becomes troublesome. 
If punctured, it will collect again. Cut 
away that surface of the bag, which projects, 
and rub the remainder with lunar caustic. 
Tumours under the tongue may be entirely 
removed ; and calcareous concretions in the 
ducts must also be cut out. 
Shortness of the frcnum of the tongue^ 
causing a preternatural confinement of the 
organ, may be remedied by dividing it to 
the requisite extent with blunt scissars. 
Ulcers of the tongue may arise from the 
rugged edge of a tooth, which should be 
made smooth; from the use of mercury, 
when pushed to salivation ; from disorders 
of the prim® vi®, foul state of the stomach, 
&c. in which case emetics, and afterwards 
alterative medicines, are required. They 
may, lastly, be of a cancerous nature, com- 
mejiciiig in a small scirrhous tumour, or an 
induration of the substance of tlie tongU^,’ 
and accompanied with hard irregular edges,; 
and fold discharge. This cancerous state 
of the organ will end inevitably in a misera- 
ble death, unless an operation for the remo- 
val of the disease be performed. This may 
be accomplished by the bistoury, or by a 
double ligature passed through the sub- 
stance of the organ, and tied so as to include 
the disease. If the glands under the jaw 
have been affected, it is too late to operate. 
The tonsils, when inflamed, sometimes 
swell so as, to impede deglutition and respi- 
ration, particularly when abscesses form in 
the neighbourhood. They may be scarified 
freely by the pliaryngotomus (which is a 
lancet contained in a sheath) ; and the same 
instrument may be employed in opening 
collections of matter. An indolent enlarge- 
ment of the tonsil may be remedied by cut- 
ting away the projecting portions by means 
of a hook and bistoury ; or by means of li- 
gature. 
The elongated uvula requires astringent 
gargles, or the removal of its extremity by 
scissars constructed for the purpose. 
AFFECTIONS OF THE NECK. 
The w'ounds of this part, inflicted in at- 
tempts at suicide, often require the surgeon’s 
assistance. After stopping any bleeding ves- 
sels, let the wound be approximated by bring- 
ing the head forwards on the neck, and retain- 
ing it in that position. Sutures, placed in the 
trachea, cause great and very detrimental 
irritation : yet if the tube be cut complete- 
ly through, and position alone will not bring 
the ends together, a hitiu'e should be placed, 
so as not to affect the lining of tlie tube. If 
tlie ffisophagus be wounded, a hollow bougie 
should be introduced through the nose, for 
the purpose of conveying nourishment into 
the stomach ; and tliis may even be neces- 
sary when the trachea alone is injured. In- 
flammation may require bleeding, and the 
antiphlogistic plan. If there be cough, al- 
mond emulsion, with opium, will afford ser- 
vice. Foreign bodies, lodging in the oeso- 
phagus, may be either thrust down into the 
stomach, or drawn upwards through the 
mouth. The former plan may be pursued 
with those which can produce no harm 
when in the alimentary canal; the latter 
with such as might prove hurtful from their 
hardness, indissolubility, pointed angular 
shape, &c. Indeed bodies of the latter de- 
scription, if very low down, must still be 
pushed on into the stomach; as they hardly 
admit of extraction. When tlie substance 
