Local changes in the choroidal veins predispose to post-operate heinorrhage -within the eye. Bloom (Graef's Ar chives, July 19, '9S).
If no pain be complained of, the dress ings should be allowed to remain for twenty-four hours, at the end of which time they should be removed, the eye inspected, and the conjunctival cul-de sae gently flushed with a solution of boric acid. If all has gone well it will be found that the anterior chamber has re established itself and that the eye is quiet. If there be any injection, if the pupil is small, or if any sign of inflam matory reaction be present, a drop or two of sulphate of atropine or, better, hydrochlorate of scopolamine should be instilled. At the end of forty-eight hours' time the dressing over the sound eye may be removed, but that on the operated eye, which can be made lighter, should be allowed to remain for another day, when plain smok-ed glasses or, if unobtainable, a suitable shade can be worn.
To prevent tendency to prolapse of the iris and to favor smooth healing of the corneal incision, it is essential that the patient should rest absolutely quiet in bed for the first forty-eight hours. If he be old and feeble, more latitude can be given to his movements, which must be accomplished by the aid of careful attendants. At the end of the second day, a bed-rest may be em ployed, and on the third day, if the healing has been uncomplicated (which under the circumstances will be so almost without exception), the patient inay be allowed to sit up. For the first twenty four to forty-eight hours the diet, which is to be regularly given, should be liquid and semisolid. On the third day the bowels can be opened by a gentle laxa tive. After this, liberal nourishment may be ordered.
Although reclination of the lens in the very aged at one time was largely employed, and is still to some extent, personal observations at Hirschberg's clinic has shown that extraction is, after all, the most feasible procedure, even very late in life. The author's observa tions embrace 1645 cases of nuclear cataract, among which there were 36 patients over SO years of age. Only in
2 cases were the results not entirely satisfactory. Advanced age does not, therefore, offer an unfavorable progno sis for cataract extraction. In very restless patients general amesthesia may be employed. Delirium will occasionally occur, but the most serious complica tions are those related to the heart, lungs, and bladder. In one case heart disease gave rise to pulmonary cedema, which, however, was controlled by mor phine. Mendel (Berliner klin. Woch., _Aug. 12, 1901).
The operation which has just been de scribed is what is known as simple ex traction, or extraction without iridec tomy and is the one that is ordinarily in use to-day and should be the one chosen in all suitable cases in which there are no contra-indications.
Results obtained in series of 465 eases of extraction: 75.2 per cent. were suc cessful, 9.4 per cent. were partially suc cessful, 7 per cent. were failures, and the results of 7.9 per cent. were not recorded. Nineteen cases in which the patients were SO or more years of age showed entire success in all but 2 instances, and in 1 of these the success was partial, while in the other, which was a failure, the fellow-eye was lost through sympa thetic inflammation. Higgens (Lancet, Aug. 11, '94). • One hundred consecutive extractions; extraction without iridectomy preferred; Icnapp's method of making the cap sulotomy followed. Discission resorted to in SS per cent. of private cases and GO per cent. of hospital cases, the operation being performed about three weeks after extraction. No cause to regret the ex traction of an immature cataract. Weeks (N. Y. Med. Jour., Aug. 3, '95).
Study and comparison of 1032. cases of combined extractions and 1123 cases of simple extractions: Conclusion that the simple method extraction is far superior to all others in the very great majority of cases, and that, while it is a somewhat more difficult operation than the com bined method, any experienced surgeon will find the results proportionately greater. Ring (Med. Rec., Feb. 23, '95).