WITH THE COMPLIMENTS OF THE AUTHOR. 
15 Chestnut Street, Boston, Mass. 
REPORTS OF SIXTEEN CASES OF CATARACT 
OPERATIONS. 
B. JOY JEFFRIES, M. D., 
OF BOSTON, 
Ophthalmic Surgeon to the Massachusetts Eye and Ear Infirmary, the Carney Hospital, 
and the New England Hospital for Women and Children. 
[Reprinted from The Boston Medical and Surgical Journal, Not. 4, 1875.] REPORTS OF SIXTEEN CASES OF CATARACT OPERATIONS.1 
BT B. JOT JEFFEIES, M. D., OF BOSTON, 
Ophthalmic Surgeon to the Massachusetts Eye and Ear Infirmary, the Carney Hospital, and 
the New England Hospital for Women and Children. 
Last season I published in the Journal 2 the records of one hundred 
and five cases of cataract operations, in seventy-one of which I used 
Graefe’s operation for other than congenital, soft, or traumatic cataracts. 
To these I have now to add the records of sixteen more cases, being 
those which 1 have done since last season. The resulting vision in all 
comes within the range of success, and they therefore bring up the 
percentage. The relations of the family physician, the ophthalmic 
operator, and the surroundings of the cataract patient, I discussed in my 
previous article, and will say nothing further here on these topics. 
The success I have met with I must attribute to the employment of 
Graefe’s method of operating, from which I have varied only as the 
individual case required. Whilst in some or many of these eighty- 
seven cases I could have used the old flap operation with equal success, 
on the other hand, Graefe’s operation alone was in place in all. I have 
not yet seen reason to depart from it, as I believe it gives me the largest 
number of successful operations. I was taught the old flap operation in 
Europe. Graefe’s method came into use after my return, and I adopted 
it as soon as I became convinced of its superiority from its adaptability 
to all cases of cataract extraction. 
In looking over my cases I can realize how valuable this method is, 
for I recognize many in which I should hardly have dared attempt any 
other. I have not thought it good ophthalmic surgery to try to prove 
by practice or precept in what way other than Graefe’s modified linear 
extraction a cataract could be removed, but rather by the steady use of 
it, as most in place in all cases, to give my patients the best chance so 
far as the operation was concerned. That cataracts can be removed, 
and successfully, by various cuts through the cornea, I know and admit, 
but to me Graefe’s operation still seems the safest and, as time shows, 
the most useful. 
1 Head before the Suffolk District Medical Society. 
2 Boston Medical and Surgical Journal, October 1, 1874. 4 
Reports of Sixteen Cases of Cataract Operations. 
My friend Mr. Carter, in his recent work, has expressed these rela- 
tions so practically and clearly that I can best serve my own purpose 
by quoting them at some length here. After explaining how Graefe 
was Jed to his operation and discussing the subsequent introduction of 
various forms of spoons, he says, “From this time onwards the history 
of cataract extraction bears a great surgical analogy to the history of ovari- 
otomy ; for just as one by one the causes of death have been eliminated 
from the latter operation by careful study and successive setting aside of 
the conditions which tended to the production of a fatal result, so in like 
manner the causes of failure have been eliminated from the former. Von 
Graefe then strove to combine an incision so small that it should produce 
little risk of corneal slouching with one so made and so situated that it 
o o 
should permit the exit of the lens without injurious pressure. The result 
was that method of ‘ modified linear-extraction ’ which was the last of his 
great contributions to the art he loved so well. But in order that 
Graefe’s incision should avoid the cornea, and should at the same time 
preserve the direction of a plane passing from the margin of the cornea 
through the centre of the eyeball, it became necessary that its extrem- 
ities should lie very near to the ciliary region ; and hence arose the 
danger already mentioned of inflicting an injury liable to be followed by 
cyclitis and irido-choroiditis in the eye which was operated upon, and by 
sympathetic ophthalmia in its fellow. In order to avoid these risks, 
many operators prefer a somewhat more extended incision in an anterior 
plane, not, as in the old method, in a plane parallel to the iris, but in 
one which, although inclined with reference to the iris, would not pass 
through the centre of the globe. In this preference I myself concur, 
and perhaps the best rules for making such an incision are those which 
have been laid down by M. de Wecker. Ido not think, however, that 
an experienced operator will allow himself to be very closely bound by 
any rules of procedure, but he will vary every operation a little, in ac- 
cordance with the size and prominence of the eye, the position of the 
cornea, and the estimated size of the hard nucleus of the lens.” 
As to various innovations proposed by one or another, Mr. Carter is 
quite outspoken, and with what he says I must agree. “ During the 
period,” he remarks, “ when real and important changes were being 
effected in the methods by which cataracts were removed, the surgeons 
engaged in the work had many followers who made changes which for 
the most part were only apparent. It is hardly possible for two pairs 
of human hands, especially if endowed with different degrees of skill, 
to execute all the steps of a complicated operation precisely in the same 
way ; and so it came about that each of several operators found it more 
convenient to himself, more suited to the requirements of his own eyes 
and fingers, to deviate in some minute point of detail from the practice 
of somebody else, of whom, nevertheless, he was in the main an imi- Reports of Sixteen Cases of Cataract Operations. 
5 
tator. Of such changes there were none really worthy of record, or 
which possessed more than a fleeting or personal interest. They mostly 
suggested themselves as natural correctives to some kind of manual 
c? 0 
incapacity, and will suggest themselves again, as it were instinctively, 
to those who share the defects of dexterity in which they had their 
origin.” 
As to the various transverse corneal incisions for cataract-extractions, 
I am agreeably surprised to find Mr. Carter so entirely agreeing with 
my own views and experiences. He says, “ Transverse corneal incis- 
ions stand self-condemned on a priori grounds. They have the single 
recommendation that it is very easy to make them, and they might 
perhaps be attempted with advantage by a benevolent traveler who 
was sojourning among a savage tribe, or by an ophthalmic surgeon 
upon whom the infirmities of age were creeping, or by one who was 
prevented by the natural quality of ambi-sinistrousness from employing 
better methods with ordinary prospects of success. Even in such cases 
Lord Melbourne’s pithy inquiry, ‘Couldn’t you have let it alone?’ 
would be likely to suggest itself to'reasonable men. As a matter of 
first principles, an incision through the front of the cornea must in a 
large proportion of cases be followed by adhesion of the iris to some 
the cicatrix ; and adhesion of the iris, even if vision is for a time 
restored, entails a perpetual liability to the occurrence of destructive 
morbid changes. Moreover, again in a large proportion of cases, such 
an incision must' be followed by alteration of curvature during the 
healing process, that is to say, by such a distortion of the cornea as to 
interfere seriously with vision. We see this every now and then in 
clean corneal wounds made accidentally by broken glass or by some 
sharp instrument, and in which the lens has escaped injury. It was 
seen still more frequently a few years ago, when flap-extraction was 
commonly performed, in the cases in which that operation had been 
badly done. On all the above grounds I have abstained from seeking 
any personal experience of transverse corneal sections, feeling that they 
cannot be said to fall within the boundaries of legitimate surgical ex- 
periment.” 
As will be seen by the following table, the ages of these sixteen pa- 
tients varied from forty-two to eighty-three. That my material was 
not favorable is shown by six, or more than one third, being recorded as 
not in good health at the time of operating. In one case the cataract 
was due to injury, in two there was old choroidal trouble, in four the 
cataract was old or “ overripe.” Hence the average of resulting vision 
is not large, but thanks, I think, to Graefe’s method, there was a success- 
ful result in all. Ether was given in all cases, and I cannot say I have 
ever seen cause to withhold it, or evil consequences from its use. Reports of Sixteen Cases of Cataract Operations. 
No. 
Age. 
Sex. 
General 
Health. 
Quality and 
Duration of 
Cataract. 
Functional 
Examination. 
Method of Operating ; Incidents ; Anesthesia, in all cases bv Ether ; Remarks ; 
After-Treatment. 
Duration 
of 
Treatment. 
Resulting Vision 
AND 
Date op Record. 
1 
83 
M. 
Good. 
Hard, more 
than ripe. 
0. S. 
All normal. 
Graefe upwards. Very large lens. Patient had done so well with previous operation on 
the other eye that after the wound healed in 48 hours he took off the bandage and got up 
and went about, opening inner angle of wound in which tag of iris is. This has given no 
trouble one year later. 
18 days. 
1 year. 
V. =15-100. 
Sn. 5J. 
2 
71 
F. 
Fair. 
Senile. 
0. S. 
Good. 
Graefe up. Normal. Patient very restless, and bandages kept on with difficulty. 
21 days. 
1 year. 
V. = Sn. 31. 
V. = 20-70. 
8 
57 
M. 
Feeble. 
Senile. 
0. S. 
Normal. 
Graefe up. Vitreous fluid, and flowed at completion of cut. Lens sank and removed with 
spoon. Did well till 9th day, when patient had an attack of neuralgia and conjunctivitis 
from being sent into a cold ward by mistake. The case, however, did well, and vision im- 
proving when discharged. 
37 days. 
37 days. 
V. =20-50. 
Sn. 6J. 
4 
48 
M. 
Good. 
Senile. 
0. S. 
Good. 
Graefe up. Quite normal, considering the posterior synechia. 
16 days. 
16 days. 
V.= 20-100. 
Sn. 1J. 
5 
58 
F. 
Feeble. 
Senile. 
0. D. 
Very convex 
cornea, and 
spots on it from 
ulceration. 
Graefe up. Normal, except the thin and very prominent cornea fell in quite flaccid, which 
did not prevent healing normally. 
21 days. 
21 days. 
V. =20-100. 
Sn. 3. 
6 
48 
M. 
Good. 
Senile. 
0. D. of No. 4. 
Good. 
Graefe up. Normal, except much cortical left, as patient was irritable under ether. 
17 days. 
17 days. 
y.=20-100. 
Sn. 2J. 
7 
42 
F. 
Good. 
Traumatic. 
6 months. 
0. S. 
Good. 
Graefe up. Normal. 
11 days. 
11 days, 
y.rr 20-70. 
Sn. 4J. 
8 
73 
M. 
Good. 
Senile. Hard. 
Overripe. 
10 years. 
0. S. 
Good. 
Graefe up. Normal, except considerable blood, and a large but flat lens emerged through 
a wound made large on purpose. Patient did very well till 12th day, when inflammation 
came on and some small pieces of cortical proliferated. Patient had senile delirium. Pulled 
off bandages constantly, and found on floor pulling off clothes. The mass in anterior cham- 
ber became absorbed under atropine, leeches, etc. In 4 months most of pupil cleared. The 
case did well beyond expectation. 
25 days. 
4 months. 
V. = 8-60. 
J. 12. 
REPORTS OF SIXTEEN CASES OF OPERATION FOR CATARACT. Reports of Sixteen Cases of Cataract Operations. 
7 
9 
70 
M. 
Good. 
Senile. Hard. 
Overripe. 
0. S. 
Good. 
Qraefe up. 
Large amount of cortical, showing lens was liquefying. 
14 days. 
14 days, 
y. =15-30. 
10 
66 
M. 
Good. 
Senile. 
Hard. 
O. D. 
Good. 
Graefe up. 
Normal. Either minute tag of iris or pigment in inner angle of the wound. 
14 days. 
37 days. 
V. =20-50. 
Sn. 1J. 
11 
65 
M. 
Good. 
Senile. 
O. S. 
Good. 
Graefe up. 
bandage. 
Normal. Considerable soft cortical. Patient constantly interfered with 
21 days. 
21 days. 
V. = 20-70. 
gn. 2. 
12 
64 
F. 
Fair. 
Senile. 
Overripe. 
0. S. 
Good. 
Graefe up. 
Eye very deep set. A hard, smooth lens escaped, quite clear of cortical. 
> 
IT days. 
25 days. 
V. =20-70. 
Sn. 3J. 
13 
45 
to 
50 
F. 
Fair, 
From old 
irido-cho- 
roiditis. 
Good. 
Graefe up. Upon pressure a large, pretty firm mass escaped through the cut, with a cup 
shaped depression on its anterior surface. On pressure again another mass came, the size of 
a nucleus, but of no firmer consistency than the former. Resulting vision is no better on 
account of former choroiditis. 
16 days. 
30 days. 
Y. = 20-200. 
14 
65 
F. 
Good. 
Senile. 
0. D. 
Good. 
Graefe up. 
Normal. 
14 days. 
14 days. 
V. = 20-70. 
Sn. 1J. 
15 
66 
F. 
Fair. 
4years. From 
old choroidal 
trouble. 
Good. 
Graefe up. 
suspension. 
Against orders patient had eaten; he vomited during ether, requiring its 
Operation rendered difficult. Long-continued ciliary redness. 
44 days. 
46 days. 
V. = 8-40. 
Jager, 8. 
16 
60 
M. 
Good. 
Senile. 
2J years, 
Good. 
Graefe up. 
Normal. Twice, without apparent cause, a little blood in anterior chamber. 
21 days. 
21 days. 
V. = 20-80. 
J.5.