NOTES 
ON 
E LECTRO - S U RG E R Y 
WITH 
CASES AND OPERATIONS. 
EDWARD A. MURPHY, M.D 
OF NEW ORLEANS, LA. 
CHICAGO; 
Reprint from the Medical Investigator for January, 
18 74. Surgical Notes.— We desire to call the especial attention of our readers to 
the article on another page under the modest title of “ Surgical Notes,” They 
merit a most careful perusal, and if this is an earnest of what we may expect 
from this scientific author, we most heartily welcome Dr. E. A. Murphy, of New 
Orleans, to the surgical ranks. Our friend, Dr. W. H. Holcombe, thus speaks ot 
him: “ I inclose you some most interesting “ Surgical Notes,” by my talented 
and esteemed friend, Dr. Edward A. Murphy, of this city, who is destined, with 
proper encouragement, to be the Helmuth, Franklin or Beebe of the South. 
* * * * Our great need here has been for years a Homoeopathic surgeon. 
I think we have found one who will do us credit. He has been practicing 
almost exclusively among the old Creole population, and his worth has but 
recently been made apparent to the American element, He is also a most excel- 
lent Homoeopathic physician.”— Editorial, p. 68. Electro-Surgery, 
WITH CASTS AND OPERATIONS. 
Mr. Editor : I have taken the liberty to offer a few surgi- 
cal notes, extracted from my diary. I shall merely report the 
cases, without going into any unnecessary details, further than a 
statement of facts. Should you consider these articles worthy of 
your valuable journal, I shall be happy; as, through your columns, 
I may be able to impress upon the minds of the surgeons of our 
school the necessity of the study of galvanism. 
Already has the Homoeopathic surgeon shown to our opposers 
the advantage of our treatment in assisting the curative powers of 
nature, thereby lessening the dangers of the knife. With om Acon- 
ite, Arnica, Calendula, etc., conservative surgery has had a better 
opportunity of developing its benefits ; and now, to those advan- 
tages, may I not claim to have been the first in the South to intro- 
duce another benefactor galvanism. 
GALVANIC SURGERY. 
Mr. Gazzam, of Mobile, aged 75, had been submitted several 
times and by the best surgeons among them the late Dr. J. C. 
Nott —to the operations for hydrogele, but invariably the tumor 
returned. My talented friend and colleague, Dr. Wm. Murrill, of 
Mobile, advised Mr. G. to give me a trial, which he did, and the 
result was a complete cure, without pain, without losing a drop of 
blood, and without emptying the contents of the cyst. In twenty 
minutes he was cured. 
Although I do not intend to write an essay on electro-surgery, 
yet 1 shall call the attention of the profession to a few important 4 
points on this new adjutor. In former years it was well known 
that electricity gave two currents, but their effects were unknown, 
consequently they were indiscriminately employed and, as a conse- 
quence, the results were not encouraging. Study has thrown light 
enough on the subject to show the different electro-chemical de- 
composition which takes place at the poles; decomposition giving 
different products, which difference depends on the- substances 
upon which they act. The negative current dilates and decom- 
poses, while the positive contracts, irritates and inflames. The 
negative never causes inflammation ; the positive, as a general 
thing, does. The different actions of the two poles are to be borne 
in mind. Quantity and intensity are also to be well understood. 
In a thunderstorm there is great intensity and very little quantity; 
while the electricity from a battery has a great deal of quantity 
and very little intensity. Beard and Rockwell, two of our best 
authors on this subject, give the following example: “ A gallon of 
water heated to xoo° has a greater quantity of heat than a pint 
heated to 500° ; but the heat of the latter is much more intense.” 
If we use too much of one or the other, we do not decompose, we 
cauterize; if too little, we cause a momentary irritation, which 
offers no favorable result. Therefore, before resorting to this 
agent, I should advise a thorough knowledge of electricity. Many 
have failed to obtain even an encouragement from electricity,— 
but was it not due to a want of study ; to ignorance as to the dif- 
ferent actions of the two poles and to the difference between 
quantity and intensity ? 
The hydroqele of Mr. G. was of many years’ standing, and was 
on the right side. It contained fully half a gallon of liquid; its 
size, as may be judged, was enormous. I plunged into the tumor 
three gold needles, of about three inches in length and as large as 
a hair pin. They were then connected with the negative pole and 
the current was closed by placing the positive electrode upon the 
thigh. No pain, at first, was felt, but soon it became unbearable, 
for I had given the full power of 32 cells of a zinc and carbon bat- 
tery, thinking that the voluminous size of the tumor would require 
it; but I soon discovered my error I was cauterizing instead of 
decomposing. I then reduced to 20 cells, and immediately the 
scrotum began to move with a vermicular movement, and soon 
after a swelling appeared, as if a few ants had paid it a visit. This 
was caused by the escape of hydrogen through the tissues. A clear 5 
and distinct hissing was heard, so much so that one would have 
thought that a frying-pan was near by at work. The needles came 
easily out, showing that the tissues surrounding them had been 
decomposed and dilated. 
In this case, the tumor did not offer that doughy consistency 
which it generally does. I could not feel the coagulum which 
extreme polarization generally produces. The resorption, never- 
theless, was rapid. The only after treatment required was a sus- 
pensory bandage. 
Reader, think of the suffering of humanity when submitted to 
injections of port wine, iodine, and to the insertion of the 
seton ! Compare it to a galvanic cure! Just imagine, that in 
twenty minutes, watch in hand, and while conversing agreeably 
with your patient, that he leaves your office cured, having expe- 
rienced no pain, not even the loss of a drop of blood. lam proud 
to say that lam the first in the South who introduced this blessing 
to suffering humanity. 
Mr. 8., aged 24, has been suffering for years with stricture 
had been submitted to the old treatment, dilatation by Holts’ 
dilator, etc. After a protracted treatment, which caused a great 
deal of pain and loss of time, the operation of urethrotomy was 
whispered. Hearing of my galvanic cures (I am not a specialist) 
he called upon me. 
STRICTURE OF THE URETHRA. CURED BY GALVANISM. 
I passed up the urethra an insulated bougie, i. e., a bougie sur- 
rounded, with the exception of the tip end, by gum elastic. This 
protects the healthy portion while the current acts upon the 
stricture. The bougie was connected with the negative, and the 
positive applied to the thigh.— Remember the negative dilates.— 
He felt no pain, and in three or four minutes this stricture was 
non est. The small particles of hydrogen which were liberated 
by the decomposition, penetrated the minutest parts of the tissues, 
and thereby separated their fibres. No pain was felt. I used 
twelve cells. It is in those cases where it is absolutely necessary 
to fully comprehend the action of electricity, for if we were to 
use the wrong pole we would irritate and contract instead of dil- 
ating and decomposing; if we used intensity or too much quantity 
we would injure our parent by cauterizing. 6 
VARICOSE VEINS. GALVANIC CURE. 
Baumgarten and Wertheimer advised the use of the positive 
pole to obtain a rapid coagulation of the blood, while the more 
recent investigations of Althaus are opposed to it. A case having 
offered itself, I made the following experiment; A steel gilded 
needle was plunged into one portion of the vein, and another 
needle was introduced into another varix. The leg was bandaged 
to prevent further supply of blood, and one needle was connected 
with the negative, the other with the positive current. In a few 
minutes the portion acted upon by the positive pole was a resistant 
cord, while the negative portion was soft, and after the withdrawal 
of the needle there was oozing of serum. The blood was decom- 
posed, but no coagulum. The case was not seen after this. Stein- 
lin says that if a platina needle is used coagulation is slow ; if it 
has an iron point it is more rapid, and it is still more so if a zinc 
needle is used. This is due to the influence of the metal, as some 
favor more than others, the decomposition of acids, the pre- 
cipitation of albumen, etc., when certain salts are separated from 
the serum of the blood, by the electric current, the albumen and 
fibrin are no more held in solution, hence the immediate coagula- 
tion. 
REFLEX PARALYSIS. 
In adopting the name of reflex paralysis, I am aware of the 
injustice that I am doing to morbid anatomy while I am giving 
importance to a symptom, a prominent one it is true. Idoso to 
be better understood. A lady, aged 40, mother of three children, 
had a miscarriage, from which she bled profusely, so much so, that 
her life was despaired of. She became so feeble that she was una- 
ble to raise her head from the pillow. Her physician had the 
boldness and courage to bleed her to arrest the flow. After a few 
days she felt a pricking sensation in the lower limbs, and could 
not retain faeces. She complained of not urinating. It was said 
that she had not passed her urine for forty-eight hours(?) (un- 
doubtedly the urine was dribbling out with the flow). To arrest 
this flow Ergot was administered, and that freely; other drugs 
were given, but what they were I do not know. 
When I saw the lady she could not walk alone. A stick or 7 
pieces of furniture were required to prevent her from falling. Her 
legs were atrophied ; her sight was failing her (this was due to the 
action of the sympathetic); bowels very irregular, and every now 
and then there was a dribbling of urine. She could not walk in 
the dark, and she noticed that if she closed her eyes while stand- 
ing, although supported by a piece of furniture, she would waver 
and had to open them or fall. 
The question arises : What was the disease ? lam told that 
it was called myelitis by one physician. This gentleman, certainly, 
was laboring under a great mistake. We have three organic affec- 
tions of the cord : Myelitis which is an inflammation of the 
cord; spinal meningitis this is an inflammation of the mem- 
branes of the cord ; the third is, congestion either of the vessels 
of the cord or its membranes. Which of those three had Ito 
deal with ? Evidently none of them. 
To prove that I am correct, by giving the differences of the 
three diseases would occupy too much time and space, therefore 
I shall simply say that the case was one of “ Anaemia of the 
cord,” causing reflex paralysis. Putting aside my Homoeopathic 
ideas, let me view the treatment to which the case was submitted. 
In the first place, to arrest haemorrhage by blood-letting is entirely 
made away with, and no physician of standing will hesitate to 
condemn such a nonsensical method. 
The administration of Ergot showed that the M.D. did really 
believe that he was dealing with a case of myelitis, for it is a rem- 
edy very much used in inflammatory affections of the cord, and 
I must say with very encouraging results. But how could any 
thoughtful man, pretending to be a physician, think of conges- 
tion when the poor patient was nearly bloodless. Unfortunately, 
too numerous are the practitioners who look upon every case of 
paralysis as being the result of an organic affection of the cord. 
It is the same thing as those who are always ready to pronounce a 
case “ apoplexy,” let it be cerebral haemorrhage, or cerebral 
embolism, or cerebral thrombosis. In those cases apoplexy is a 
very prominent symptom, but this does not justify us in adhering 
to past ideas, such as existed before morbid anatomy was under- 
stood as fully as it is now a days. 
In the case of this lady Ergot was not indicated, as there was 
no need to lessen the amount of blood, neither was there any irri- 
tability to be diminished. On the contrary, a desired increase of 8 
blood and excitability were the two great desiderata. How irre- 
parable damage was not done is incomprehensible. 
We are more or less subject to errors, especially in diagnosis. 
As yet the mind of man is too limited to encompass and fully 
comprehend the organization of the human frame, but when the 
life of a fellow being is at stake, we should be certain that we are 
not adding injury to the disease. Why did the gentleman not 
make use of a simple means of diagnosis ?—a hypodermic injec- 
tion of Strychnia. This would have settled the question. This 
case does not belong to surgery, and, therefore, is not under the 
proper heading, but I thought that I would be allowed to trans- 
gress, while I was on the subject of electricity, as the lady was 
submitted by me to the beneficial influence of this agent. 
As a matter of experiment I applied the Faradaic current to the 
lower limbs, and found that it required a powerful current to affect 
them. As a rule, the action of the currents on the muscles is a 
sure aid to diagnosis. When the diseased muscles respond to Far- 
adaization, you may be certain of success, but there are cases, and 
they are numerous, where this current remains powerless; it is 
then we have to call upon the more powerful galvanic current be- 
fore we can get the Faradaic to act, and seldom later than sixty or 
sixty-five days after the action of this last named will be required 
to complete the cure. Many a practitioner has failed to derive 
any benefit from electricity by neglecting this difference. When 
the Faradaic current does not cause even a very feeble contraction 
it is perfectly useless to lose time by insisting on its application ; 
the galvanic must now be brought into action to start a cure ; the 
Faradaic treatment begins where the galvanic stops. 
The disease being located in the spine, it would have been folly 
to have resorted to local application as a means of cure, conse- 
quently general galvanization of the spine and sympathetic was 
first resorted to, and the patient kept, for a few days, under the 
influence of China. 
The cord needing irritation, its circulation increased and its 
nutrition cared for, I administered, daily, a hypodermic injection 
of the one-sixtieth of a grain of Strychnia. Under this treatment, 
assisted by a generous diet, my patient improved with wonderful 
rapidity. One month after the first application of the galvanism, 
I resorted to the Faradaic current, and two months afterwards 
I left the case cured. 9 
FIBROUS TUMOR. 
Mrs. Emilie Laurent, aged 21, married,'no children; had a 
small tumor over the angle of the shoulder. It was of the size of 
a hen’s egg, when a doctor was called in. lodine was injected into 
the tumor, after which it grew with wonderful rapidity. Finally, 
it grew to be as large as the head of a foetus. Her physician in- 
sisted that it could not be removed without exposing the articula- 
tion, thereby endangering the limb and life itself. I was called 
in, and advised extraction, which was agreed to. She was brought 
under the influence of chloroform, and an elliptic incision was 
made. Upon carefully dissecting away the piece of skin, the del- 
toid muscle came into view ; it was parted by carefully separating 
the fibres, when the whole tumour was removed. There was con- 
siderable bleeding, as the tumor was fed by numerous small arteries. 
Torsion was resorted to. A very curious freak of nature was this 
tumor. It was, in shape and appearance, a perfect penis with its 
testicles, having the raphge, etc., and a line of demarcation for the 
glans. The wound healed nicely, and on the third day the patient 
was attending to her household duties, with her arm in a sling. 
LEAD PARALYSIS. 
Mr. H., aged 37 years, married; a painter by occupation; habits 
good. Has suffered from several attacks of colic ; vomiting was a 
frequent thing with him ; very costive; urine scanty; both wrists 
offered the characteristic dropping. The right side was more 
affected than the left; he was losing control over his lower extre- 
mities ; the gums of the lower and upper jaws have the usual blue 
line. This dropping of the wrists, especially the right, was, and 
is yet, by some considered as being the result of the constant con- 
tact with the paint, and that other cases of poisoning, i. e., those 
not occurring among painters, have not the wrists affected. This 
is a grave error. In the first place, if the immediate contact of 
the lead with the hands was the cause, would it not be more 
reasonable to find the flexor muscles paralyzed, rather than the 
extensors? The flexors do the most work. But we invariably 
find the extensors victims. This single fact, according to my 
judgment, is enough to settle the question. Cases of lead paral- 
ysis, whether caused or not by certain washes, hair restorers, drinking water containing lead, etc., all have their extensors paral- 
yzed, and the right hand is the most affected. All have those 
characteristic symptoms, besides others which belong to the indi- 
viduality of the patient. 
In regard to the treatment, I do not think it boldness to say 
that it is impossible to complete a cure without the aid of elec- 
tricity. 
First of all. How can you prognosticate a case unless you 
obtain an idea of the muscular contractability ? Even with the 
Faradaic current as an aid you cannot, in advanced cases, form a 
diagnosis. You may say: the only trouble is the lead which is 
in the system ; remove this and nothing more will be required. 
You may make use of Strychnia, you may eliminate the lead from 
the system by the lodide of Potassium, which will combine with the 
lead, to form a soluble salt, leaving the kidneys to carry it off. 
You may soothe his intestinal spasm, etc., by our heroic Homoe- 
opathic remedies, yet the muscles will not come under control of 
the will, unless you call to your assistance electricity. 
This patient was ordered the following; 
Kali Hydriodatum 3 iii. 
A table-spoonful every four hours; the doses to be decreased in 
proportion as the blue lines disappear from the margin of the 
gums. 
Aq : Pi si : % vj. 
Having no dynamometer I could not test the muscular power 
of the hands. 
In this case the Faradaic current had no effect. The irrita- 
bility of the extensors was so nearly destroyed that the primary 
current from a 32 cell battery acted but feebly. Nevertheless 
this was enough to satisfy me that success would be obtained. 
Under this simple treatment, in six weeks, my patient was dis- 
charged. I must confess that 1 did not anticipate so speedy a 
cure. 
DISLOCATION OF THE MAXILLARY. 
At midnight, while all the world was asleep, and Nature herself 
appeared to be slumbering, I was roused, and called from the sweet 
arms of Morpheus, by the ringing of the door bell. It was an old 
colored woman, who “waked up with a pain in her ears.” Find- 
ing it impossible to close her mouth, she called upon one of my 11 
neighbors, an M.D., who tried to reduce the dislocation, but suc- 
ceeded only in mutilating her mouth by rough and ill-directed 
manipulations. Her gums and the angles of the mouth were 
bruised and torn. I found it a difficult task to reduce this dislo- 
cation. The poor woman’s mouth and face were so horribly 
bruised that I could not touch her without causing severe pain. 
I reduced it by using, on the dislocated side only, the thumb as a 
fulcrum and the chin as a lever. I shall not detail the indications 
to be fulfilled; they are too simple and well known; but I call 
particular attention to the diagnosis of these cases. Had my 
neighbor examined the case carefully, he would not have thought 
of using a thumb on each side. The usual four-tailed bandage 
was applied. 
LIGATION OF THE EXTERNAL ILIAC RECOVERY. 
The abdominal aorta bifurcates at the fourth lumbar vertebra, 
and gives off the two primitive iliacs that run downwards and out- 
wards ; then again they bifurcate into the external and internal 
iliacs ; between the two, but in close connection with external 
iliac, is the external iliac vein, while to the inside of the internal 
iliac artery is the vein of the same name. The external iliacs ex- 
tend from the upper margin of the sacro-iliac symphysis to seven 
millim., to the lower half of Poupart’s ligament, whence they take 
the name of femoral. The external iliac courses along the inner 
margin of the psoas muscle, having only the iliac fascia to separate 
them. Although Morton says that the artery is covered by the 
peritoneum, yet a careful dissection will show that a loose cellular 
tissue, which may be considered as a sheath to the artery, is be- 
tween it and the peritoneum. Without going into further anato- 
mical description, I will describe the operation. A negro boy, 
aged 16, had a tumor immediately under Poupart’s ligament, 
which proved to be an aneurism. Origin unknown. Some phy- 
sician had painted this swelling with iodine, and wanted to open 
the He maintained that the beating was due to the 
impulses which it received from the femoral artery, over which it 
was situated. The case came under my care, and the following 
operation was performed. He was placed under the influence of 
chloroform by placing an opened handkerchief over the mouth 
and nose, and allowing the chloroform to fall drop by drop from a 12 
pipette. I find this the most prudent manner of administering the 
anaesthetic, for equal parts of air and chloroform are inhaled. In 
fact, the patients themselves appreciate the difference, and they 
get as quickly under the influence. 
An incision was made just above and parallel to Poupart’s liga- 
ment, extending from the external abdominal ring to about three 
inches upwards, making a semilunar wound with the convexity 
downwards. The cellular tissue, the oblique and transverse 
muscles, were divided, when the fascia transversalis came to view. 
This fascia is a fibrous membrane, sub-peritoneal aponeurosis. In 
some places it is indistinct, and the thickened portion which is 
between the peritoneum and the transversalis takes the name of 
fascia transversalis. The cutting of this requires care, not to in- 
jure the peritoneum. This fascia was carefully taken up with 
forceps, and a small opening was made, then a grooved probe was 
introduced and the fascia opened the whole extent of the wound. 
The peritoneum was then carefully pushed aside, and “ lesparties 
soils jacentes ” were separated with the fingers, when the artery pre- 
sented itself. With one of Cooper’s needles a ligature was passed 
from inside under the artery and the vessel ligated. I was on one 
occasion present when a French surgeon performed this operation, 
and in passing the ligature he passed it from outside inwards. 
This is wrong, for in doing so he took up the vein. There have 
been instances where the intestines were wounded by this improper 
introduction of the needle. Always carry the needle from inside 
outwards. The wound was closed with twisted sutures, and Aeon- 
itum and Arnica were given internally. The latter was applied 
locally. 
After a few moments the temperature of the limb began to fall, 
when warm bran was applied ; this application was kept up during 
the whole day. He was fed on a good nourishing diet, and stimu- 
lants were strictly forbidden. In all abdominal wounds, the probe, 
stimulants and narcotics are to be “ done away with,” while in 
other wounds they are of importance. The wound healed nicely 
and the recovery was prompt. 
STRABISMUS. 
The operation for strabismus was at a time in great disrepute. 
This was due to the numberless failures of the old operation, when 13 
the conjuctiva and subconjunctival tissues were widely incised. 
No care was given to the capsule of tenon, which was freely 
lacerated, and the “ climax was capped” by cutting the muscle, 
which would retract to its separate attachments and the portion 
belonging to the globe would serve as a prop and prevent the 
globe from occupying its relative position in its orbit. Fre- 
quently to cure a converging squint a diverging one was produced. 
As a general thing, I prefer Von Graefe’s subconjunctival oper- 
ation, to which I submitted the following lady: * 
Mrs. C., aged 49, Myopic had a cataract “left eye,” also a 
double converging strabismus. 
Before operating for cataract, I performed strabotomy. When 
under the influence of chloroform the lids were kept apart by the 
spring speculum with a finely-pointed forceps. I seized a small 
fold of the conjunctiva close to the edge of the cornea, just above 
the insertion of the internal rectus, and with a blunt - pointed 
scissors, bent on its flat, I snipped the uplifted fold. Then a care- 
ful burrowing beneath the subconjunctival and in a backward 
direction. The squint-hook was then introduced, with its point 
in an opposite direction from the tendon. The rounded part of 
the hook was then pressed upon the globe, and a sweep, in the 
direction of the tendon, was made, passing the hook below the 
tendon, when the hook was drawn up pulling the tendon to the 
opening made in the conjunctiva. In this movement care should 
be taken to press downwards, otherwise the point of the hook may 
separate the fibres of the tendon, causing a re-introduction of the 
hook and useless manipulations. The tendon was then snipped 
with the scissors as near its insertion as possible. The hook was 
again introduced to find any fan-like expansion that might be 
there, for if a single fibre is left uncut the result of the operation 
maybe compromised. The other eye was operated on in the same 
way. In this division of the tendon it is necessary to divide it 
close to its insertion, otherwise it may retract within its sheath, 
which would prevent it from adhering to the sclerotis. I take 
this opportunity to call the attention of young surgeons to the 
imperative necessity of a thorough knowledge of the anatomy of 
the eye and its appendages, also a complete understanding of the 
actions of the muscles, before undertaking an operation, which, in 
itself, is not very difficult, yet this operation, when requisite, in 
other cases besides squint when diplopia exists for instance 14 
requires the greatest exactitude. Neither do I approve the band- 
age and confinement in a dark room. As a general rule, I send, if 
a school-boy, to school. I advise my patients to go to their usual 
occupation. Among twenty-two cases operated during one month, 
seventeen were sent from the operating-table to the school-room. 
Von Graefe’s modified linear extraction. In the operation for 
cataract, four things are to be taken into consideration, if we wish 
to have an idea of what the result will be. 
CATARACT CURE. 
The action of atropia; perception of light; the field of vision ; 
the size of the cornea. It is useless to go into any further details 
on these four conditions, as every oculist is familiar with them. 
Five periods are necessary in the operation for cataract: In- 
cision ; iridectomy; laceration of the capsule; removal of the 
lens ; and bandaging. 
The patient (the strabic case) having taken chloroform, the lids 
were separated by the spring speculum, then, with Graefe’s knife, 
its edge turned upwards, I entered the corneo-scleral upper portion 
of the cornea, one-third of a line from its edge. The knife entered 
at the point a, A©B and taking a downward direction to c until it 
could be seen in the anterior chamber, when the handle was de- 
pressed and the knifepoint took a horizontal position to make a conn - 
ter puncture at b. The edge of the knife was now turned towards 
the cornea, and pushed as far as the blade would allow, and by a 
careful drawing back of the knife the section was finished, giving 
a conjunctival flap, which was thrown back upon the cornea. The 
iris hook was introduced and a portion of the iris drawn out and 
snipped. The size of the iridectomy must vary according to the 
size of the hardened lens. Scientifically, this may be of great 
value, but practically of very little importance, except in exception- 
able cases ; for, as a general rule, the upper lid hangs so as to 
cover the upper third of the cornea. Of course, if the patient is 
possessor of a cornea unprotected by the lids, then we must make 
as small an iridectomy as possible, for besides the unsightliness 
there would be a diminished acuity of vision produced by the 
glare, which would cause irregular refraction. It is preferable to 
make a large section, as no bad result can come from it, while a 
too small opening will certainly compromise the operation. Always remove the iris very close to its insertion, otherwise the portion 
left may remain between the sections of the wound, and prevent 
or retard re-union. 
The cystitome was next introduced and the capsule lacerated. 
As I am not writing to give practical points, but simply to report 
cases, I shall not describe the modus operandi of the laceration of 
the capsule, although I consider it one of the most important mo- 
ments of the operation. 
By a gentle pressive movement of the spoon on the lower portion 
of the cornea the cataract was removed. The wound was care- 
fully closed and the conjunctival flap was made to resume its place 
and the eye closed. Then a small piece of linen was dipped into 
cold water and placed over the lids, and over this lint was put to 
fill up the cavity, so that the bandage would press evenly upon 
the eye when the flannel bandage was applied. Recovery was 
prompt. 
New Orleans, 
194 Canal Street. 
PRINTED AT THE LAKESIDE PRESS, CLARK AND ADAMS STS., CHICAGO.