REPORT

ON THE

TREATMENT BEST ADAPTED TO EACH

VARIETY OF CATARACT.

WITH DRAWINGS ILLUSTRATING A CASE.

BY

MARK STEPHENSON, M. D.,

SURGEON TO THE NEW YORK OPHTHALMIC HOSPITAL.

REPORT ON THE TREATMENT BEST ADAPTED TO

EACH VARIETY OF CATARACT.

WITH DRAWINGS ILLUSTRATING A CASE.

HAVING accepted the appointment to write an essay on the subject of cataract, I enter upon the assigned duty with hesitancy, believing that there are in this distinguished and learned body those who are more competent for the task than myself.

In looking over the Transactions of the American Medical Association, I have been not a little surprised that so interesting and momentous a subject should not ere this have engaged the attention of the Association.

The human eye is not only the most perfect and delicate piece of mechanism in the human frame, but it is also the most perfect of optical instruments.

When its refracting media, the crystalline lens or its capsule, lose their transparency, the rays of light are intercepted in their course to the retina, producing that condition in the eye termed "cataract."

The treatment of cataract must vary, depending upon its variety, consistency, the age and constitution of the patient, the natural development, or physical construction of the eye and its appendages.

What is applicable to lenticular, would not be proper in capsular; and the treatment required for a hard cataract would be improper in a soft, or fluid cataract-the method must be suited to the case, and not the case to the method.

It is conceded by the best ophthalmic surgeons wherever the science of medicine has made much proficiency, that medical treatment, in genuine cataract, is unavailing.

Here it is, that operative surgery justly assumes the rank and position of a science.

Various operations have been devised, from time to time, in different ages of the world; but they all may be summed up under the heads of division, displacement, and extraction, modified in each case, according to circumstances.

No man, who makes any pretensions to ophthalmic surgery, would adopt either one of these methods to the entire exclusion of the others. Each method has its advantages and disadvantages.

Thus, division, while it is the safest operation, is on the other hand the most tedious in effecting a cure; then, again, displacement, although an easy operation, is not usually the most satisfactory in its results-while extraction, the quickest in accomplishing the object designed, is the most difficult in its performance.

The selection of the method best adapted to each case constitutes, in the majority of instances, the secret of success, and will call into requisition much skill and maturity of judgment.

Preparatory Treatment.-Before attempting an operation for cataract, the judicious surgeon will not only revolve and settle definitely in his mind the method best adapted to the variety, or consistency of the "cataract"-looking carefully at it in all its bearings, but he will also examine minutely the constitution of his patient, ascertaining, above all things, whether there be any gastric, hepatic, nephritic or cutaneous derangements; the appearance of the various excretions, the tongue-state of the pulse, the process of assimilation and nutrition. If the tongue be clean, and the patient otherwise free from disease, there will be little danger of inflammation, and still less of destructive inflammation following an operation.

But if the tongue be white, or coated with thick yellow adhesive mucus, ophthalmitis, followed by disorganization of the deeper seated tissues of the eye, may be the sequel to an operation, where there exists so deranged a condition of the system. In regard to the whiteness of the tongue, Dr. Walton, surgeon to the Central London Ophthalmic Hospital, observes: "In the old, this organ is not so ready an index of the state of health as in early years; attention, therefore, should be paid to the urine, the deposition of uric acid, or the urate of ammonia, being a sure indication of dyspepsia, or excess of nitrogenized food, or of fever, and that of phosphate of lime, or the triple phosphate, of the opposite status of prostration and nervous depression."

These are conditions of the system of momentous importance, for it must be admitted that the previous and after-treatment are of

equal importance to the proper performance of the operation itself; the latter may be performed dexterously and gracefully, yet if the former be omitted, it will be of no avail.

Should the surgeon be incapable or disqualified to detect and treat successfully incipient inflammation in any of the deeper seated tissues of the eye, lymph may be deposited upon the serous membrane covering the retina, occlusion of the pupil, and synechia, or nebulous opacity of the cornea, may supervene before the surgeon is aware of what has occurred. The importance of having medical and surgical knowledge united in the same individual who attempts. to practise surgery is fully illustrated in the preparatory and after treatment connected with operations for cataract.

It does not necessarily follow that a patient must go through a regular course of depletion, because he is about to submit to an operation. In many instances little or no change is required from the ordinary course of life, save a little abstemiousness and composure of body and mind for a few days; but, where functional derangements are found to exist, they must be corrected by such. measures as the case may indicate.

Instead of a depletory course, it may often become necessary to give the patient vegetable tonics, with an alkali or chalybeates, and in some instances even stimulants, in connection with a generous diet, after an operation, especially if the subject of it has been accustomed to free living. Dr. Jacobs, of Dublin, makes the following truly practical remarks on this subject: "In preparing a patient for operation, I do not act upon the belief that empty bowels are essential to health, or what are called feces should not be found in the intestinal canal; on the contrary, I proceed on a conviction totally different. If a patient be in good health, notwithstanding an habitual retention of the contents of the bowels beyond the prescribed periods, I do not wish to risk an interruption of health by disturbing the natural functions of the stomach and bowels, and I therefore refrain from giving physic. "But if the patient be not in good health, I of course endeavor to bring him into that condition by every means in my power, and resolutely resist every attempt to induce me to operate until I have accomplished that object."

"It is usual," says the same author, "in preparing for this and other operations, to make great alterations in diet, substituting liquid for solid and vegetable for animal aliments. "This, how