The development of cataract may be retarded by careful and repeated cor rection of any existing anomaly of re fraction and by constant care of the patient's general health.
OPER_kTIONS.—There are two opera tive methods of treating cataract: one by absorption and the other by extrac tion. The first is applicable to soft cat aracts only, and is consequently limited to those found in young subjects. It has for its object the bringing of the aque ous humor into contact with the lens fibres by means of an artificial opening made in the anterior capsule of the lens. This is accomplished by entering a needle, especially prepared for the pur pose, through the lower and outer or upper and inner quadrant of the cornea. and incising those portions of the ante rior capsule of the lens which are situ ated opposite the pupillary area.
The pupil should have been primarily dilated as much as possible with some efficient mydriatic. Care should always be taken, particularly in very young sub jects, that the capsular incisions are not made too extensively and that they do not penetrate too deeply into the lens structure, in order that the lens-mass may not be disturbed too greatly.
General aniustbesia is not necessary. The instillation of a few drops of a 2 per-cent. solution of hydroehlorate of cocaine is sufficient to render the opera tion painless. The patient should be placed in a recumbent position and the eyelids should be separated either by a speculum or by an elevator and the fin gers of an assistant. After the proced ure a few drops of sulphate of atropine should be instilled into the conjunctival cul-de-sac and ice-compresses applied until the eye becomes free from any sig,ns of operative irritation.
If no complications arise and there be sufficient reason, the operation can be repeated as soon as the absorption of the loosened cataractous masses seem to have been sufficiently accomplished and the mass itself has become stationary. The incisions in the second and any subse quent operations may be made more freely, as the danger of swelling of the lens-fibres is lessened, this being due to the diminished volume of the lens-ma terial. In uncomplicated cases the ab sorption of the eataractous masses is generally accomplished in eight or ten week's time.
it is concluded that: 1. Certain len ticular opacities, most often situated in the naso-inferior quadrant of the lens, occasionally are practically stationary and may be designated "non-progress ive." They do not handicap the patient's ocular abilities, and may with plopriety be separated from the class to which the name incipient cataract is ordinarily given. 2. Certain lenticular opacities undoubtedly depend on what may be designated "disturbances of the choroid," as apart from active and actual choral ditis; and their progress is sometimes apparently checked by measures—optical, local, and general medicinal—which re store the choroid coat to normality.
Such measures do not, however, remove from the lens the opacities which have already formed when the patient comes under treatment. 3. Certain lenticular opacities which appear in association with diabetes mellitus, nephritis, lith mmia, and arteriosclerosis, particularly the last two diseases, are sometimes ap parently retarded, like those in No. 2, by measures which are suited to the pa• ticnt's general condition in connection with local and optical therapeutics, but these measures never dissipate the lens lesions already present. 4. The extrac tion of unripe cataracts is preferable to any of the ordinary operations for ripen ing cataract. 5. Tbere is no evidence that electricity has the slightest influ ence in checking the rate of progress of incipient cataracts, or in dissipating the opacities which have formed. G. There is very insufficient evidence, if any, that massage of the eyeball favorably modi fies the rate of development of cataract. 7. There are no "specific remedies" for the treatment of cataract, and there is no reliable evidence that drugs exist which cause the absorption of partially or fully formed cataracts. S. All lenticu lar opacities, unless the "non-progressive" group, should indicate a thorough in vestigation of the patient from the gen eral as well as the ocular stand-point, and the employment of remedies accord ing to the findings. G. B. de Schweinitz (,Tour. Amer. Med. Assoc., Dec. S, 1900).