Mm»1 ';'r1v,'!1'^; ,< ' v\,\ >*■ v\\;V SURGEON GENERAL'S OFFICE 9 LIBRARY. S Section, 1 1 /t^- man's suction The point of a Bowman s (Fig. syringe. 30), or a Teale's, syringe, is now 46 CRYSTALLINE LENS AND CAPSULE. passed through the corneal and capsular openings into the lens, and gentle suction employed which will cause the lens sub- stance to be withdrawn. Extraction of Cataract.— Another method of removing a soft cataract is that known as the simple linear extraction. The instruments required are the fixation forceps (Fig. g), a small keratome (Fig. 13), a cys- totome and a curette (Fig. 31). The eye being held with the fixation forceps at a point dia- metrically opposite to the pro- posed point of entrance of the keratome, the latter is passed into E ^jp the anterior chamber at right angles to the cornea on the tem- poral side at a point correspond- ing to the apparent edge of the fully dilated pupil. The point of the keratome is thrust into the lens so as to open the capsule freely, and u be CRYSTALLINE LENS AND CAPSULE. 47 in withdrawing the instrument the pos- terior lip of the wound is depressed while slight counter-pressure is made upon the opposite side with the fixation forceps, thus forcing the soft lens matter out. Instead of opening the lens capsule with the point of the keratome, it may be done with the cystotome. In this case the posterior lip of the wound should be de- pressed with the curette or a small spat- ula, while counter-pressure causes the evacuation of the lens substance. Some operators also make a practice of perform- ing a small iridectomy after making the corneal section. If it is the intention of the operator to pursue the latter course the section should be made just within the clear margin of the cornea. OPERATIONS FOR HARD CATARACT. In operating for hard cataract the prin- cipal steps are the making of a corneal section at, or in the neighborhood of, the corneo-scleral margin ; in some cases, the 48 CRYSTALLINE LENS AND CAPSULE. removal of a piece of the iris; the open- ing of the lens capsule and the deliver- ance of the lens through the pathway made by these various openings. The principal difference between the operations now employed is the manner of making the corneal incision and whether or not iridectomy is employed. Varieties of Section.—So many varie- ties of section have been suggested by different surgeons since the operation for the extraction of cataract began to be per- formed that there remains scarcely any portion of the cornea that has not, at some time or other, been the site of a pro- posed section. (a) Peripheral Linear Section.—The section made by von Graefe, and from which so many of the others have been modified, consisted of entering the knife at a point \\ millimetres behind the apparent corneo-scleral junction in the upper and outer part of the eye and about 2 millimetres below a tangent to the up- CRYSTALLINE LENS AND CAPSULE. 49 permost part of the cornea. The knife was then thrust downward and inward, parallel to the plane of the iris, until it reached the pupillary margin, when by lowering the handle the point was made to counter-puncture the sclera at a point opposite, and corresponding to, the point of entrance. The edge of the knife then being turned slightly forward, with a few sawing movements, the section was com- pleted in the corneo-scleral margin. As soon as the sclera was completely cut through, and before the conjunctiva was divided, the edge of the knife was turned forward even more to avoid making a large conjunctival flap (Fig. 32). Fig. 32. Peripheral linear section. (b) Section in Combined Extraction. {Three millimetre flap).—In making the section known as the three millimetre flap, the point of the knife is entered 50 CRYSTALLINE LENS AND CAPSULE. exactly at the apparent corneo-scleral junction on the temporal side of the cor- nea, at a point three millimetres below a tangent to the uppermost portion of the cornea, passed directly across the anterior chamber, and a counter-puncture made diametrically opposite the point of en- trance. With a to and fro movement of the knife upward, keeping exactly in the same plane as the puncture and counter- puncture, the cornea is separated from the sclera exactly at the junction of the two. This section will give a very small con- junctival flap. Should a larger one be desired it can be made by tilting the edge of the knife slightly backward just before the conjunctiva is cut. The section just described is employed in extraction with iridectomy, or what is known as the combined method. (c) Section in Simple Extraction. (Up- per half of cornea).—This is the section usually employed in performing the ex- traction of cataract by the simple method, CRYSTALLINE LENS AND CAPSULE. 51 or the method without iridectomy. The point of entrance into, and exit from, the anterior chamber is made just within the clear margin of the cornea, and the sec- tion includes about the upper or lower half of the circumference of the cornea, de- pending on the size of the lens and cornea, (in this country usually the former), the knife being kept in the same plane while the section is being made. By some sur- geons the section is made with a Beer's knife (Fig. 33), or a modification, but the majority use the knife of von Graefe. Fig. 33. Beer's knife. For Practicing the Different Sec- tions an eye may be held in the hand by means of a towel or napkin, as shown in (Fig. 34), the latter being wrapt around it in such a way as not to interfere with the knife. It is well to practice puncture and counter-puncture of the eye, and mak- 52 CRYSTALLINE LENS AND CAPSULE. ing the different sections by holding some eyes in this manner before attempting the operations for extraction of cataract; for CRYSTALLINE LENS AND CAPSULE. 53 in this way the student can become ac- quainted with the appearance of the point of the knife when covered by aqueous humor, so that the counter-puncture can be made in the proper place and the sec- tion completed in the proper plane. Methods of Opening the Capsule. —As to the manner in which the lens cap- sule should be opened there is some dif- ference of opinion. Some surgeons em- ploy for the purpose a cystotome (Fig. 31), which is in reality a small triangular- shaped knife, while others use a capsule forceps devised especially for the purpose. If the cystotome be used one of the openings illustrated in Fig. 35 should be 1 2 3 Fig. 35. Methods of Opening Capsule. made; or, if the operator prefers, the ex- treme peripheral openingas recommended 54 CRYSTALLINE LENS AND CAPSULE. C by Doctor Knapp may be made with a cystotome devised by the author of the method (Fig. 36). If the capsule forceps be em- ployed they are made to seize as much of the capsule as possible, which is then drawn out and ex- cised with the scissors. In either method, injury to the iris must be studiously avoided as well as the accidental dislocation of the lens. Extraction without Capsul- otomy.—Some surgeons instead of opening the capsule before the delivery of the lens, by a special instrument, deliver the lens and capsule together without opening the latter. By this method there is always great danger of serious / loss of vitreous. Position of the Mask.—The mask should be so placed as to resemble the position of a patient lying in bed, or in an CRYSTALLINE LENS AND CAPSULE. 55 operating chair. For this purpose it should be perfectly flat during some oper- ations and inclined at an angle during others. It is best to practice the opera- tions at the different angles of inclination of the mask so as to become accustomed to the varying positions. Position of the Operator.—If the operator be ambidextrous he may stand behind, or on either side of the mask as he chooses. If he is not ambidextrous, however, and employs his right hand to use the cutting instruments, he will stand behind the mask to operate on the right eye and on the left side of it to operate on the left eye. It is best to practice with each hand so as to become ambidextrous. Method of Operating.—The follow- ing description of the combined extraction, or the extraction with iridectomy, applies to the method known as de Wecker's three millimetre flap extraction. The instruments required are fixation forceps (Fig. 9), a Graefe cataract knife 56 CRYSTALLINE LENS AND CAPSULE. (Fig. 15), iris forceps (Fig. 22), iris scissors (Fig. 21), a cystotome and curette (Fig. 31,) and a spatula (Fig. 14). In addiiton, it is well to have a wire loop (Fig. 37) and a capsule forceps (Fig. 38). Fig. 38. Capsule forceps. The operation is divided into five stages consisting of the following procedures. First, making the corneal section; sec- ond, the iridectomy; third, the capsulo- tomy; fourth, the delivery of the lens; fifth, the toilet of the wound. The Corneal Section.—With the fixa- tion forceps in one hand, the eye is seized below the cornea and rotated downward while in the other is lightly held the cata- ract knife at some distance from the blade so that the full length of the latter can be employed. The point of the knife is now entered on the outer side of the eye, ex- CRYSTALLINE LENS AND CAPSULE. 57 Fig. 22. Iris forceps. Instruments Required in Extraction of Cataract. 4 58 CRYSTALLINE LENS AND CAPSULE. actly at the apparent corneo-scleral junc- tion, and at a point 3 millimetres below a tangent to the uppermost portion of the cornea. The knife may be entered per- pendicular to the cornea, or it may be entered in the direction of the counter- Fig. 39. Cataract knife making section. puncture, in the latter case care being taken to avoid passing it between the cor- neal layers. After the point has entered the anterior chamber it is thrust carefully across and brought out at a point diamet- CRYSTALLINE LENS AND CAPSULE. 59 rically opposite the point of entrance. The blade is pushed forward as far as the heel, or until the point almost touches the nose, when by a few to and fro sweeps, making the edge cut in both directions, and keeping in the same plane, parallel to the iris, in which the knife is entered, the upper portion of the cornea and sclera are divided exactly at their junction Fig. 39. If the section be made as above there will result a small conjunctival flap. Should it be desired to make a larger one, or to avoid the conjunctiva altogether, the edge of the knife is turned slightly back- ward, or forward, as soon as the cornea and sclera have been divided, and before the conjunctiva is cut. The Iridectomy.—The fixation forceps are now handed to an assistant who rotates1 the eye downward, when the iris 1 Frequently in animals' eyes it is impossible to rotate the eye downward without dragging it out of the mask, especially after the aqueous humor has escaped. In these cases the forceps will hold one of the small teeth that keeps the eye in position. Then, of course, when the holder is rotated the eye is rotated also. 60 CRYSTALLINE LENS AND CAPSULE. forceps, held in one hand, the blades closed, are passed into the anterior cham- ber as far as the pupillary margin. The blades are then opened and the handle dipped slightly downward and forward, thus throwing the tip of the forceps into the iris tissue, when the blades are again closed and the seized iris withdrawn. A pair of scissors in the disengaged hand are held in readiness, the blades open, and as soon as the iris is withdrawn from the anterior chamber it is excised with one or two snips (See Fig. 25). The coloboma thus formed should be small and narrow, although in von Graefe's original opera- tion the amount of iris excised corre- sponded to the length of the wound. A small coloboma, however, is sufficient for all purposes for which the iridectomy is performed, and presents a much better appearance from an aesthetic standpoint. In addition, there is less dazzling than would occur from a large coloboma, as a smaller quantity of light enters the eye. CRYSTALLINE LENS AND CAPSULE. 61 Capsulotomy.—The assistant1 is now relieved of the forceps which are again held by the operator, who, at the same time, passes a cystotome into the anterior chamber, held flatwise in such a manner as not to injure the iris or cornea. The instrument is carried as far as the lower margin of the pupil when it is turned with Fig. 40. Cystotome opening the capsule. the cutting point towards the capsule (Fig*. 40). A transverse opening is now 1 It is not necessary to have an assistant in operating on animals' eyes, though it resembles more closely the actual work on the human eye. 62 CRYSTALLINE LENS AND CAPSULE. made in the capsule by giving to the in- strument a lateral movement, and then by drawing the instrument upward a perpen- dicular opening is made at right angles to, and beginning at the middle of, the trans- verse cut, and terminating in the upper periphery of the capsule. This is the opening shown in (No. I, Fig. 35), though any of the others may be made according to the preference of the operator. The cystotome is then turned flatwise again and carefully withdrawn. Delivery of the Lens.—In this stage the operator may, or may not, continue to hold the eye with the forceps, as he pleases. The cornea should be made moist by dropping on it a little water, after which pressure is made on the lower margin by means of the convex surface of the curette, which follows the lens upwards as it is being expelled (Fig. 41). The curette should pass entirely across the cornea lying above its primary posi- tion, and the pressure at first should be CRYSTALLINE LENS AND CAPSULE. 63 downward towards the interior of the eye, so as to tilt the upper edge of the lens for- Fig. 41. Delivery of the lens. ward, and then downwards and upwards, following the lens. The curette must not be removed from the eye until the whole depth of the cornea has been passed over, as this procedure will oftentimes bring out some of the cortical matter which has broken off from the lens in its passage. Judgment must be exercised in regard to the amount of pressure to be made as 64 CRYSTALLINE LENS AND CAPSULE. there is always some danger of a prolapse of the vitreous, it being understood that as soon as the equator of the lens has passed the lips of the wound, the pressure is to be somewhat diminished. Toilet of the Wound.—Any remaining cortical matter, or pieces of capsule, are now cleared from the anterior chamber or from between the lips of the wound, by gently stroking the cornea with the back of the curette, or by passing the spatula along the corneal section. If the pillars of the coloboma have prolapsed, or seem to have a tendency to prolapse, they are replaced in their proper positions by means of the spatula. Should it be desired to practice irriga- tion of the anterior chamber, it may be done by using a small pipette, or a special syringe made for the purpose. It should be remembered that" in passing the liquid from the syringe into the anterior cham- ber, the direction of the flow should be over the wound from within outward, CRYSTALLINE LENS AND CAPSULE. 65 and not the reverse, lest portions of the blood and cortex be driven inward." (Knapp, from de Schweinitz's "Diseases of the Eye"). Accidents Occurring during Ex- traction of Cataract.—There are sev- eral accidents that may occur during the performance of this operation, the chief of which are the following: (i). The knife may be entered with its cutting edge in the wrong direction. If this has occurred the knife should be with- drawn, and if the aqueous humor escapes, as it most likely will do, a fresh eye must be substituted. (2). The point of counter-puncture may not be diametrically opposite the point of puncture. It may be also either too far in front of, or too far behind, the corneo- scleral junction. If the operator can see that the point of the knife is not in the proper position to make the counter-punc- ture, and it has not already been started through the corneo-scleral tissue, it should 66 CRYSTALLINE LENS AND CAPSULE. be slightly withdrawn and entered at the proper place. If the counter-puncture has been made before the error be discovered, the section should be completed as if it had not occurred. It is to be remembered that the conditions under which the knife is passed across the anterior chamber are somewhat deceptive, as the blade of the knife is under water, and it is only prac- tice that will enable the student to make the counter-puncture at the proper point. (3). The iris sometimes falls in front of the knife before the corneal section is completed, and indeed it is an exceedingly difficult thing to avoid in animals' eyes. The shape of the eye is partially the cause of this accident, while another factor is that the eye is screwed too tightly in the holder, thus making a shallow anterior chamber. In withdrawing the knife after the counter-puncture has been made, Noyes recommends to let the heel cut the temporal side of the wound as a maneu- ver to prevent the accident. Should it CRYSTALLINE LENS AND CAPSULE. 67 occur, however, the section must be com- pleted as if nothing had happened. (4). The wound may be too small for the lens to pass through—a very unfortu- nate accident, and if it occurs the wound must be enlarged with a pair of blunt- pointed scissors. In making a section of the cornea it is to be remembered that the inside opening is much smaller than the outside opening and that the size of the lens to be passed through it must be given due consideration. Thus a very large, or a very -small lens, might cause some slight deviation from the size of the sec- tions described. (5). The laceration of the capsule may not have been sufficiently extensive to permit the escape of the lens, so that when pressure is made on the lower part of the cornea it fails to present. In this case the cystotome is re-introduced and the open- ing enlarged. (6). The lens may become dislocated. If the dislocation is only partial, the cor- 68 CRYSTALLINE LENS AND CAPSULE. nea may be moistened and gently stroked with the spatula, when the lens will most likely fall into place and can be delivered in the usual manner. If the dislocation is complete and into the vitreous, the lens should be removed by means of the wire loop which is gently placed behind it, and as soon as the lens falls into the concavity of the loop it is lifted out. (7). The vitreous sometimes escapes before, and sometimes after, the expulsion of the lens. If the accident occurs before the expulsion of the lens it is weir to prac- tice the delivery as quickly as possible with the wire loop. If it occurs after the delivery of the lens, the prolapse should be excised and the lips of the wound gently cleared. All pressure must be avoided in either case. Extraction without Iridectomy. Simple Extraction.—This operation dif- fers from the combined method in the size and position of the corneal section and in omitting the iridectomy. Inasmuch as CRYSTALLINE LENS AND CAPSULE. 69 no iridectomy is performed, the opening in the cornea must necessarily be larger to allow the escape of the lens. The sec- tion instead of being made exactly at the apparent corneo-scleral junction is usually made slightly within the clear margin of the cornea, and (in human eyes) includes about half of the periphery. In the pigs' eyes, however, on account of the shape of the cornea, the puncture and counter- puncture should be made about 4 milli- metres below a tangent to the uppermost part, which makes a section sufficiently large for the delivery of the lens. Omit- ting the iridectomy, the subsequent pro- cedures are the same as described in the combined method. Should the iris pro- lapse, an attempt is made to replace it with the spatula, and should it continue to recur, and the prolapse be a large one, the prolapsed portion must be excised, thus converting, practically, the simple into the combined method. Operations for Secondary, or After Cataract.—The various operations per- 70 CRYSTALLINE LENS AND CAPSULE. formed for the relief of secondary, or after cataract, depend principally upon the character of the membrane forming the cataract. If it is a thin, web-like mem- brane, it may be divided with a Bowman's stop needle (Fig. 42), or with a knife nee- dle introduced in the manner described in Fig. 42. Bowman's stop needle. the operation of discission of cataract (page 43). If the capsule is thick and tough, it is better to employ two needles in order to prevent dragging upon the ciliary bodies (See Fig. 2g). Should the secondary cat- aract consist of thickened capsule, with an attached portion of the iris drawn upward, as a result of previous inflammation which followed the operation of extraction, the pupil being occluded to a greater or lesser extent, the better plan is to perform an iridotomy (See page 36). CHAPTER V. OPERATIONS UPON THE SCLERA. Anterior Sclerotomy.—The opera- tion of anterior sclerotomy is performed by some surgeons in certain cases of glau- coma, mostly of the chronic type, or in those cases in which an iridectomy had previously been performed, in spite of which an increase of the intra-ocular ten- sion had returned. A Graefe cataract knife (Fig. 15) and a pair of fixation forceps are required. The eye-ball being fixed, the point of the knife is passed into the anterior chamber at a point 3 millimetres below a tangent to the uppermost part of the cornea and 1 milli- metre behind the apparent corneo-scleral junction, then across the anterior cham- ber and the counter-puncture made at a 72 OPERATIONS UPON THE SCLERA. point diametrically opposite. An upward cutting movement of the knife, as in the section for the extraction of cataract is now made, but instead of completing the section and making a corneal flap a bridge of tissue, about 3 millimetres broad at the uppermost part of the cornea, is left un- divided (Fig. 43). The knife is now tilted Fig. 43. Anterior sclerotomy. slightly forward causing the lips of the wound to gape somewhat, allowing the aqueous humor to escape, if it has not OPERATIONS UPON THE SCLERA. 73 already done so, and then slowly and cau- tiously withdrawn. The bridge of tissue is left to guard against prolapse of the iris, but if this accident should occur, as it does sometimes, the iris must be re- placed into the anterior chamber by means of a small spatula (Fig. 14). Should this not prove effectual the prolapsed por- tion must be cut off with scissors, thus converting the sclerotomy into an iridec- tomy. Posterior Sclerotomy.—In cases of detached retina, or in cases of glaucoma, where for any reason the anterior cham- ber has become obliterated so that it is impossible to perform an iridectomy or an anterior sclerotomy, the operation of posterior sclerotomy is sometimes of use. The same instruments are employed as in anterior sclerotomy and the knife is passed through the posterior scleral tissue with its edge toward the cornea, as this is the direction of most of the scleral fibres. For a detached retina a puncture would 5 74 OPERATIONS UPON THE SCLERA. be made through the eye-ball over the detached portion and the knife turned through a quadrant of a circle to allow the subretinal fluid to escape. As soon as the latter takes place the knife is with- drawn. In glaucoma the point of selec- tion is usually about midway between the superior and external recti muscles, 7 or 8 millimetres from the corneal margin, and the incision has to be somewhat longer than in the preceding as the vit- reous is of greater consistency than the subretinal fluid. Practically the same operation is performed in some cases of extraction of a foreign body from the interior of the eye. CHAPTER VI. OPERATIONS UPON THE MUSCLES. In practicing the various operations upon the muscles of the eye, the mask must be discarded and some kind of ani- mal's head employed, in which the eyes are in their natural position. For this purpose may be used rabbits or dogs, they first being killed with chloroform. The muscles of the rabbit's eyes, however, are so much smaller than those of the human eye, and dogs are, as a rule, so difficult to obtain, that we most frequently resort to the use of the pigs' head. In preparing this the butcher must be careful not to allow it to remain in hot water too long preparatory to removing the bristles, or the cornea will not only become opaque but the bulbs shrunken, so that it will be 76 OPERATIONS UPON THE MUSCLES. useless for the purpose. Some haziness of the cornea cannot be prevented, if the bristles are to be removed, but this will not matter in practicing the following operations. The head to be employed should be from a young pig preferably, from four to eight weeks old. Complete Tenotomy.—There are several methods of performing this oper- ation, the two principal ones being the Open Method of von Graefe and the Sub- conjunctival Method of Critchett. Open Method. Method of von Graefe. —The instruments necessary are a lid speculum (Fig. 44), conjunctival forceps (Fig. 45), (ordinary fixation forceps may be used), a pair of blunt scissors (Fig. 46) and a strabismus hook (Fig. 47). The lids being separated by means of the speculum, the conjunctiva is seized immediately over the insertion of the muscle to be cut and incised by one or two snips of the scissors. Next, the capsule of Tenon is opened in the same manner. OPERATIONS UPON THE MUSCLES. Fig. 44. Lid speculum. Fig. 45. Conjunctival forceps. Fig. 46. Tenotomy scissors. Fig. 47. Strabismus hook. Instruments Required in Tenotomy of an Ocular Muscle. 78 OPERATIONS UPON THE MUSCLES. The eye-ball still being firmly held by the forceps in one hand the strabismus hook is now taken in the other and passed into* the opening just made. The direction at first is downward, for a short distance, when by rotating the hook, and keeping it in contact with the sclera, it is brought ■ behind the muscle which is then drawn forward (Fig. 48). The conjunctival for- ceps are now laid aside, and the hook Fig. 48. Tenotomy of an ocular muscle. being held in one hand and the scissors in the other the muscle is severed from its attachment by several snips of the latter. Care should be exercised to get all the fibers OPERATIONS UPON THE MUSCLES. 79 of the muscle on the hook if possible, be- fore cutting; but to make sure that every fiber is severed, the hook should be re- entered, and, keeping in contact with the sclera, brought forward to the attachment of the conjunctiva above and below the opening. Should any fibers be found, no matter how small, they should be divided. According to some authorities the con- junctival wound is now closed with a few vertically inserted sutures; according to others it is never closed except in those cases in which too great an effect has been obtained and it is desired to lessen it. The more conjunctiva included in the suture the more the effect of the operation will be diminished. Sub-conjunctival Method. Method of Critchett.—The same instruments that are used in the open method are also required in this method. In performing the oper- ation the conjunctiva and capsule of Tenon are seized over the insertion of the muscle and with one or two snips of the 80 OPERATIONS UPON THE MUSCLES. scissors a very small opening is made. A strabismus hook is now entered, as in the previous operation, and passed beneath the tendon. The closed scissors are now passed through the small conjunctival opening, opened and one blade carried beneath, the other above the tendon, when, keeping close to the sclera, the muscle is divided at its insertion. Arlfs Method.—^ modification pro- posed by Arlt, consists in seizing the ten- don with the conjunctival forceps as soon as the opening in the conjunctiva and Tenon's capsule has been made in the manner described in the open method, and dividing it at once with the scissors, a strabismus hook not being used. Partial Tenotomy.—In some condi- tions, such as insufficiencies of the ocular muscles, so free a dissection of the tendon from its insertion is not required. It is then that partial, or graduated tenotomies are performed. The instruments required are those employed in the previous oper OPERATIONS UPON THE MUSCLES. 81 ations for tenotomy except that the scis- sors have smaller blades and are more pointed (Fig. 49). The method of proced- ure is as follows: Fig. 49. Stevens' tenotomy scissors. A small opening is made in the conjunc- tiva and capsule of Tenon over the centre of the insertion of the muscle which is then seized with the small forceps a short distance back of its insertion. With the small pointed scissors an opening is now made in the centre of the tendinous at- tachment of the muscle to the sclera. This opening is then enlarged, by cutting towards either side, until the desired amount of the tendon has been divided. Complications.—Several complica- tions may arise in the performance of a tenotomy on one of the ocular muscles of 82 OPERATIONS UPON THE MUSCLES. the human eye, but in practicing the oper- ation on the pig's eyes those most liable to occur are the following. (a). Failure to open Tenons capsule. —Upon attempting to introduce the stra- bismus hook behind the eye in order to draw forward the tendon of the muscle, it may be found impossible to do so because the capsule of Tenon has not been opened. In such a case the hook is temporarily laid aside while the opening is being made, after which it can be re-introduced and the operation completed. (b). Perforation of the sclera.—This com- plication is exceedingly rare, but as it has happened to some very good operators it should be guarded against. Advancement of the Ocular Mus- cles.—There are many methods of per- forming advancement of the ocular mus- cles, but it is not within the scope of this work to describe all of them. The follow- ing is one that usually proves entirely satisfactory. OPERATIONS UPON THE MUSCLES. 83 The instruments required are the same as those used in the operation of tenotomy and, in addition, some curved needles, silk and a needle holder (Fig. 50). The conjunctiva and Tenon's capsule are divided immediately over the insertion of the muscle, the opening being as long as the tendon is wide. That portion of the conjunctiva lying between the opening thus made and the cornea is dissected up with the scissors. A strabismus hook is now intro- duced beneath the tendon, care being exercised that all of the fibers are included, and brought forward to its insertion. A curved Needle needle, armed with a silk suture, holder" .is now introduced from the up- per margin and passed through the middle of the tendon and tied, the needle and thread being left in position (Fig. 51). A similar suture is passed behind the ten- 84 OPERATIONS UPON THE MUSCLES. don from the lower margin and tied. The tendon is now divided with the scissors at Fig. 51. Advancement of an ocular muscle. (Modified from Swanzy). its insertion. The sutures are then passed in the direction of the muscle through the episcleral and conjunctival tissue at the margin of the cornea and tied, each with its own end. By drawing the sutures more or less tightly a large or small effect is obtained. A conjunctival suture is now introduced as the last step in the opera- tion. OPERATIONS UPON THE MUSCLES, 85 In a method proposed by Schweigger a portion of the muscle is resected before the advancement is made. Shortening an Ocular Muscle.— This is an operation devised by Dr. Sav- age, of Nashville, Tenn., to take the place of advancements, and consists essentially of taking a loop in a muscle thus reducing its length. If much effect is required it is preceded by a tenotomy of the opposing muscle just as in advancement. The operation is best described in Dr. Savage's own words : " The first step of the operation consists of a vertical conjunctival incision one- eighth of inch behind the insertion of the tendon and a little longer than the muscle is wide. From the lower extremity of this cut a horizontal conjunctional incis- ion is made one-fourth of an inch long, near to, and parallel with, the lower bor- ber of the muscle. The triangular flap of conjunctiva is now dissected up, and is held out of the way by an assistant. The 86 OPERATIONS UPON THE MUSCLES. second step of the operation consists in making a puncture through the capsule at the lower border of the tendon and and passing a strabismus hook beneath it and then making a slight puncture of the capsule at upper border for the exit of the point of the hook. Everything is now ready for the last operative proced- ure, the taking of the stitch for shortening the muscle. A thread is armed with two needles slightly curved. One needle is passed through the muscle from its outer surface and is brought out beneath the lower border of the muscle; the other is passed in the same way, but it is brought out beneath the upper border of the mus- cle. The capsule is included in this stitch. The amount of tissue thus included in the loop need not be more than one-fourth the width of the muscle; and the distance of this loop behind the insertion of the ten- don must depend on the amount of short- ening desired. The muscle is held away from the globe by fixation forceps while OPERATIONS UPON THE MUSCLES. 87 the needles are being passed as above in- dicated. The operator now taking the hook into his own hand draws it slightly back, and at the same time gently lifts the tendon from the globe. He now takes needle No. i and pierces the tendon from the ocular side, at its point of insertion and between the centre and its lower bor- der, bringing it out through the conjunc- tiva over the insertion, then removes the needle. In a similar way needle No. 2 is passed through the tendon between its centre and upper border and is brought out through the conjunctiva over the in- sertion. This needle is then removed. The two ends of the one thread need not be more than one-eighth of an inch apart as they emerge from the tendon. On tying the knot in the usual way, that part of the muscle at the loop is brought in contact with the tendon at its insertion and is there confined by completing the knot. The triangular flap of conjunctiva is now allowed :o fall and cover in the exposed muscle, including its ' tuck."1 88 OPERATIONS UPON THE MUSCLES. Enucleation of the Eye-ball.-There are two methods in general use for the performance of this opera- tion, viz., Bonnet's Method and the Vienna Method. Bonnet"s Method.—The instruments required are a pair of small blunt scissors (Fig. 46), a pair of larger and stronger scissors for divis- ion of the optic nerve (Fig. 52), fixation forceps (Fig. 9), a strabismus hook (Fig. 47), and a speculum (Fig. 44)- The eye being held with the fixation forceps, the conjunctiva and capsule of Tenon are divided from the attachment around the cor- Enucleation scis- nea and freely dissected sors- backward. Each muscle is then in turn picked up with the stra- bismus hook and divided at its insertion, OPERATIONS UPON THE MUSCLES. SO with the exception of the internal rectus, which is divided somewhat back of its in- sertion, leaving a stump that can be used for rotating the eye-ball. Seizing this stump with the fixation forceps and rota- Fig. 53. Enucleation of an eye-ball. (Modified from Meyer). ting the eye outward as far as possible, the large scissors, closed, are passed back- ward behind the eye-ball from the nasal side, and as soon as the optic nerve is reached they are opened and passed one 6 90 OPERATIONS UPON THE MUSCLES. blade below, and the other above, when the nerve is divided close to the eye-ball, or deep in the orbit as may be required (Fig. 53). The globe of the eye is now dis- located forward between the lids and any remaining attachments divided. The Vienna Method.—The only instru- ments required in this method are a strong pair of scissors and the fixation forceps. The tendon of the internal rectus muscle is seized with the conjunctiva and capsule and held during the entire operation. With the strong scissors it is divided back of the forceps. Then the scissors are passed around the entire eye-ball, one blade beneath the conjunctiva and mus- cles, the other on the outside, when by numerous cuts the muscles and conjunc- tiva are separated from the globe at the same time. The latter now being rotated outward the optic nerve is divided as in the preceding operation. Accidents.—The only accident that is liable to occur is perforation of the sclera, OPERATIONS UPON THE MUSCLES. 91 and this may, and should be, avoided by using only blunt scissors. Evisceration.—Two methods of evi- sceration are employed at the present time, viz., the one suggested by Graefe, the other suggested by Mr. Mules. Graefe s Method.—The instruments em- ployed are a Graefe cataract knife (Fig. 15), fixation forceps (Fig. g), a pair of curved scissors (Fig. 46), a scoop (Fig. 54), a speculum (Fig. 44), needles, needle Fig. 54. Evisceration scoop. holder (Fig. 50) and silk. The Graefe cata- ract knife is entered at the corneo-scleral junction,passed directly across the anterior chamber, the counter-puncture being op- posite the point of entrance, and a flap made separating the upper half of the cor- nea from the sclera. The remaining half of the cornea is then detached with scis- sors. With the scoop the contents of 92 OPERATIONS UPON THE MUSCLES. the globe are then thoroughly evacuated, care being exercised to remove every por- tion of the choroid and ciliary bodies. The sclera and conjunctiva are then sutured. Mules Operation—-To provide a stump for an artificial eye even better than the one obtained from the preceding opera- tion, the following measures have been devised. The conjunctiva is first detached from the corneal margin with a pair of curved scissors. The cornea is then re- moved and the contents of the globe evacuated, precisely as in the preceding operation. By making a snip with the scissors above and below, the opening in the globe is enlarged vertically. One of Mr. Mules' glass globes (Fig. 55) are now introduced by means of an instrument devised for the purpose (Fig. 56), and the sclera sutured from side to side. The Fig. 55. Mules' vitreous spheres. 999999999999� OPERATIONS UPON THE MUSCLES, 93 overlying conjunctiva is then sutured from above downward, at right angles to the line of scleral sutures. fer n 11...........■F Fig. 56. Artificial vitreous introducer. Resection of the Optic Nerve.—An opening is made in the conjunctiva slightly back of that portion lying over the insertion of internal rectus muscle. The conjunctiva is then dissected well backward and the muscle exposed as com- pletely as possible. Sutures are now passed through the muscle back of the tendon in order to secure it and the mus- cle is then divided about 5 or 6 millime- tres from its tendinous insertion. With a retractor the tissues are now pulled aside, and a hook is passed beneath the optic nerve which is drawn forward and divided as far back as possible with the strong curved scissors. A piece of the nerve is next excised from the globe of the eye 94 OPERATIONS UPON THE MUSCLES. when the muscle is re-attached by means of the sutures, and the conjunctival open- ing is closed. Exenteration of the Orbit.—The first step is to divide the external commis- sure to a point corresponding to the tem- poral margin of the orbit. The tissues are then dissected from the lids as far as the orbital margin, when both the perio- steum and tissues are together dissected backward to the optic foramen. This be- ing the only point of attachment left they are divided and any remaining shreds re- moved, the bone being completely de- nuded. INDEX. ABSORPTION of the lens.43 Accidents during ex- traction .....................65 Advancement of the ocular muscles........................82 After cataract,operationsfor,69 Alcohol lamp.....................20 Ambidextrous...................55 Animal..............................10 Anterior chamber 19, 24, 25, 61 Anterior chamber, irrigation of................................64 Anterior chamber, paracen- tesis of......................21, 25 Anterior sclerotomy.......71, 72 Application of cautery to cor- nea, instruments required. 19 Aqueous humor............23, 33 Artificial pupil...................36 Artificial vitreous introduce^ Assistant......................59, 61 BEER'S KNIFE..............51 Blood.........................65 Bowman's stop needle........70 Bowman's suction syringe...45 Bridge...............................72 Bristles.. ..........................76 Broad peripheral iridectomy. 30 Butcher.............................75 CAPSULE FORCEPS-54, 56 Capsule, methods o f opening....................53 Capsule of Tenon...............77 Capsule of the lens, opera- tions upon......................42 Capsule, laceration of.........67 Capsulotomy.....................60 Cataract, dicission of...........43 Cataract, extraction of........46 Cataract, hard, operations for..............................47 Cataracts, immature...........42 Cataracts, ripening imma- ture, Bettman's method....42 Cataracts, ripening imma- ture, Forster's method......42 Cataract, simple linear ex- traction of.......................46 Cataract, soft, methods of operating upon...............43 Cataract, suction operation.45 Cataractous lens.................29 Cautery, actual ....... .........19 Cautery, application of........19 Cautery, galvanic...............19 Cautery-probe....................20 Chloroform.......................75 Ciliary bodies.....................70 Clip, eye...........................12 Coloboma..........................60 Coloboma, method of mak- ing large in iridectomy...35 Coloboma, method of. mak- ing small in iridectomy...35 Coloboma, pillars of..... 35, 64 Coloboma, position of.........28 Coloboma, size of..............27 Combined extraction, meth- od of operating in...........55 Complete tenotomy............75 Complications in muscle op- erations..........................81 Conjunctiva......................16 Conjunctival flap......49, 50, 58 Cornea.....................10, 25, 26 Cornea, epithelium of....19, 20 Cornea, infection of............19 Cornea, operations upon......18 Cornea, sloughing ulcer of..24 96 INDEX. Cornea, tattooing the..........25 Cornea, tattooing, instru- ments required in............25 Cornea, ulcer of........20, 22, 24 Corneal section in combined extraction.......................56 Corneal section iniridectomy32 Corneal section, position of ..30 Cortical matter..............63, 64 Cosmetic...........................25 Counter-puncture...............58 Crystalline lens..................19 Crystalline lens, operations upon..............................42 Curette..............................62 Cystotome.........................61 Cystotome and curette.........46 Cystotome opening the cap- sule................................61 DAZZLING.....................60 Delivery of the lens. 62, 63 Detached retina..................73 Details, attention to............16 Dicission needle.................43 Dicission of cataract......43, 70 Dislocation of the lens...54, 67 Dissolution of the lens.........43 Dogs.................................75 ENUCLEATION of an eye- ball............................88 Enucleation of an eye-ball, Bonnet's method..............88 Enucleation of an eye-ball, Vienna method...............90 Episcleral tissue................84 Equator of the lens............64 Evisceration of an eye-ball.. 91 Evisceration scoop.............91 Excission of iris.................33 Exenteration of the orbit. ...94 External commissure..........94 Extraction of cataract.........46 Extraction of cataract, sim- ple linear........................46 Extraction without capsulo- tomy..............................54 Extraction without iridec- tomy..............................68 Eye, adjustment of in mask. 15 Eye, bullock's................9, 10 Eye, human......................17 Eye, pig's......................... 9 Eye, shape of.....................66 Eye, sheep's...................... 9 Eye speculum...................77 Eye-ball, enucleation of......88 Eye-ball, evisceration of......91 Eyes, choice of.................. 9 Eyes, preservation of..........10 CACE, HUMAN...............12 * Face, phantom............15 Forceps, fixation 17,18, 21, 24, 26 Forceps, iris.......................25 Forceps, iris, position of in iridectomy......................34 Foreign body, removal of... 18 Formaldehyde......... ........12 GLAUCOMA.............22, 71 Graefe knife.........29, 30 OYPOPYON...................24 IMMATURE CATARACTS A 42 Immature cataracts, ripen- ing of.............................42 Inflammation.....................70 Ink, India.........................26 Instruments required 18, 21, 24, 3°. 3i Instruments required in combined extraction........55 Instruments required in iri- do-dialysis.....................40 Instruments required in ten- otomy............................76 INDEX. 97 Instruments required for iri- dectomy................... 30, 31 Instruments required for par- acentesis of anterior cham- ber.................................21 Instruments required for re- moval of a foreign body from cornea....................18 Instruments required for Saemisch's section...........23 Instruments required for tat- tooing the cornea............25 Instruments required for the application of cautery to cornea...........................19 Insufficiencies of the ocular muscles..........................80 Intra-ocular tension............27 Intra-ocular tension, iridec- tomy tor.........................28 Iridavulsion.......................40 Iridectomy..................27, 59 Iridectomy, broad peripheral 27, 3<> Iridectomy, corneal section in...................................32 Iridectomy for optical pur- poses..............................28 Iridectomy for relief of intra ocular tension.................28 Iridectomy, method of per- forming..........................32 Iridectomy, narrow........... 30 Iridectomy, position of kera- tome in..........................33 Iridectomy preceding cata- ract extraction................28 Iridectomy, stages of..........32 Iridectomy, small...............28 Iridectomy, varieties of......27 Irido-dialysis ...................39 Irido-dialysis, instruments required in.....................4° Iridotomy.....................36> 7° Iridotomy, external............38 Iridotomy, internal.............37 Iridotomy, loss of vitreous in..................................38 Iridotomy, object of............36 Iris, excission of.................33 Iris forceps, position of in iridectomy.....................34 Iris, foreign bodies in.........27 Iris, operations upon...........27 Iris, prolapse of............23, 39 Iris scissors, position of in iridectomy......................34 Iritis, recurrent..................27 Irrigation of anterior cham- ber.................................64 JUDGMENT.....................63 KERATOME... 19, 21, 29, 30 Knife.......................16 Knife, Graefe cataract.........24 Knife needle....................43 T ACERATION of the cap- *-' sule............................67 Lance needle.....................43 Lens, absorption of............43 Lens, cataractous...............29 Lens, delivery of...........62, 63 Lens, dislocation of...43, 54, 67 Lens, equator of.................64 Lens, massage of................42 Leucoma...........................25 Light.................................60 Loss of vitreous..................54 Loss of vitreous in iridotomy 38 Lymph channels................41 MARGIN of the pupil......61 Mask................9, 12, 29 Mask, home-made..............13 Mask, position of...............54 Mask, Vienna.....................12 Massage of the lens............42 Membrane.........................70 Method of operating in iri- dectomy.........................32 98 INDEX. Method of operating in com- bined extraction..............55 Methods of opening the cap- sule................................53 Methods of operating upon soft cataract...................43 Mules' operation................92 Mules' vitreous spheres......92 Muscl e..............................16 Muscles, advancement of.....82 Muscles, insufficiencies of ..80 Muscles, operations upon....75 Muscles, shortening of........85 NARROW iridectomy......30 Needle discission........43 Needle holder ...................83 Needle, paracentesis............21 Needle for tattooing............25 Nose ..............................12 OPERATING CHAIR......55 Operations for after- cataract....................69 Operations for hard cataract 47 Operations for secondary cat- ract...............................69 Operations upon the cornea 18 Operations upon the crystal- line lens.........................42 Operations upon the iris.....27 Operations upon the lens capsule...........................42 Operations upon the mus- cles................................75 Operations upon the sclera 7i Operator, position of......29, 55 Optic foramen....................94 Optic nerve, resection of.....93 Optical purposes, iridectomy for.................................28 Optical purposes, operations for.................................29 Orbit.................................12 Orbit, exenteration of.........94 PARACENTESIS of ante- rior chamber, instru- ments required in........21 Partial tenotomy................80 Paste................................26 Patient, human.................13 Peripheral linear section.....48 Pigments...........................26 Pig's head.........................75 Pillars of coloboma........35, 64 Position of coloboma...........28 Posi ion of corneal section... 30 Position of iris forceps in iri- dectomy.........................34 Position of iris scissors in iridectomy......................34 Position of keratome in iri- dectomy.........................33 Position of the mask..........54 Position of the operator-29, 55 Posterior sclerotomy..........73 Practicing sections, method of.................................51 Preliminary iridectomy......28 Pressure............................68 Probe ..............................25 Prolapse of iris..................39 Prolapse of iris in simple ex- traction .........................69 Prolapse of vitreous.......64, 68 Pupil..........................25, 26 Pupil, artificial..................36 Pupil, restoration of............29 Pupillary margin................60 Pus...................................25 RABBITS.............•..........75 Resection of optic nerve 93 Ripening immature cata- racts.............................42 Ripening immature cata- racts, Bettman's method...42 Ripening immature cata- racts, Forster's method....42 Retina, detached................73 INDEX. CAEMISCH'S SECTION O 23 Saemisch's section, instru- ments required in............23 Scissors.............................60 Scissors, iris, position of in iridectomy......................34 Sclera, operations upon.......71 Sclerotomy, anterior......71, 72 Sclerotomy, posterior....... 73 Secondary cataract, opera- tions for........................69 Section in combined extract- ion.................................49 Section in simple extraction 5° Section of the cornea in com- bined extraction..............56 Section, peripheral linear...48 Section, position of corneal 30 Section, Saemisch's, instru- ments required in............23 Section, varieties of ...........48 Section, method of practic- ing ■•••............................51 Shape of the eye................66 Shortening an ocular mus- cle................................85 Simple extraction ............ 68 Simple extraction, prolapse of iris in ........................69 Simple extraction, section in.50 Simple linear extraction of cataract..........................46 Spatula.............................23 Spud.................................18 Strabismus hook................77 Stages of iridectomy..........32 Staphalomata.....................27 Student.............................66 Suction operation of cataract 45 Subretinal fluid...-...............73 Synechiae.........................29 Syringe, Bowman's suction 45 Syringe, Teale's suction......45 "TANGENT.................58, 69 1 Tattooing cornea, in- struments required in...25 Teale's suction syringe.......45 Temple.............................12 Tenon's capsule.................77 Tenotomy, Arlt's method....80 Tenotomy, Critchett's meth- od..................................79 Tenotomy, complete............76 Tenotomy, von Graefe's method.........................76 Tenotomy, partial .............80 Tension, intra-ocular 22, 23, 27 Three millimetre flap .......49 Toilet of the wound.......35, 64 U NIVERSAL HANDLE 20 VARIETIES of section.....48 " Vision, improvement of 27 Vitreous, loss of.................54 Vitreous, prolapse of......64, 68 WATER...................62, 66 Wire loop............... 57 Wound.............................25 Wound, toilet of, .............64 Wound, toilet of in iridec- tomy..............................35 A Manual of Ophthalmic Operation? ag practiced on Animal?' Eijeg, Being a Hand-Book for Students and Practitioners Be- ginning the Study of Operative Ophthalmology, By Clarence A. Veasey, A. M., M. D., Adjunct Professor of Diseases of the Eye, Philadelphia Polyclinic ; Chief Clinical Assistant to the Ophthalmological Department of Jefferson Medical College Hospital; Consult- ing Ophthalmologist, Philadelphia Lying in Charity, etc. Including 56 Illustrations, many of them entirely new and prepared especially for this work. The object of this work has been to present to the student and practitioner entering the field of operative ophthalmology a reliable guide to the various operations that can be practiced on animals' eyes, to enable him to possess a greater experience and a larger amount of confidence in himself when attempting operative work on the human eye. The various operations are taken up and the methods and techni- que of performing them fully described and illustrated, so that one may become thoroughly familiar with any operative procedure, practic- ing it as many times as he chooses. So far as can be ascertained this is the first time this matter has appeared in book form. Heretofore, the only way in which the informa- tion contained therein could be obtained was through personal instruc- tion or through some operative course in a public institution. This little work is intended not only to assist those who are able to avail themselves of such courses of instruction, but also those who are less fortunate in being remote from the medical centers where such courses can be obtained. PRICE, S/.OO. PUBLICATIONS OF THE EDWARDS & DOCKER CO., HORACE BINDER, Manager, 518-520 Minor St., Philadelphia, U. S. A. and Practical Application TO THE lts Study of Refraction. BY EDWARD JACKSON, A. M., M. D., Professor of Diseases of the Eye in the Philadelphia Polyclinic; Surgeon to Wills' Eye Hospital, Etc., Etc. Price S/.OO, Cloth. PRESS OPINIONS. " This little book gives a very complete and serviceable presentation of the theory of the shadow-test and its practical applications. To many it will seem too diffuse ; but, in reality, it contains but little superfluous matter, at least for those who have but an imperfect previous knowledge of this useful method of examination."—Archives of Ophthalmology. "An excellent expose of the underlying optical principles, and the practical application of skiascopy. Written by a gentleman who has devoted especial time and study to this subject, and has been one of its foremost advocates. This book must be very welcome to every student of ophthalmology."—American yournal of Ophthalmology. "Altogether, this little book of 109 pages, is one so full of practical information that it should be studied by every one who is not a thorough master of the subject treated."—Ophthalmic Record. "Considering the wide practical value of the shadow-test, it seems strange that this book, or something of the kind, has not been published before."—Annals of Ophthalmology and Otology. "Bears the stamp of personal experience and original observation, and cannot be too highly recommended to every oculist and physician desirous of becoming thoroughly familiar with the theory and practice of skiascopic examination."—yournal of the American Med. Asso. " All ophthalmologists will welcome Dr. Jackson's little manual. It is an authoritative and excellent exposition of the subject with which it deals."—Medical News. " The work as a whole is very creditable ; and the practitioner who takes the trouble to master its contents will know all that can be said of this very excellent, speedy and satisfactory mode of determining the nature and degree of both common and uncommon errors of refraction." — The Lancet. qkiasco modern medicine and Homoeopathy, By JOHN B. ROBERTS, A. M., M. D.f Ex-President of the Philadelphia County Medical Society and the Medical Society of the State of Pennsylvania. An exposition of the points of similarity and differences between homoeo- pathy and the science of medicine at the end of the nineteenth century. ■ 6 mo.; Cloth, 75 Cents. "Those who wish to become acquainted with the tenets of the homoeopathic sect, in their relations with modern medicine, will do well to procure this little work—which, while giving the points in which ' homoeopathy' still adheres to the teachings of modern medicine, sets forth clearly and without abuse the fallacies and distorted views held by some of the sectarians under consideration "—yournal of the American Medical A. soc. "The papers are conservative and dignified in the highest degree, and nobody who reads them can doubt how firm the writer is in his con- victions and how uncompromising in his ' regularity,' and yet the breadth and liberality of all he says are in most admirable contrast with the conduct of those who have not yet learned that the best way to put out a fire is not necessarily to blow at it."—New York Medical yourual. THE Functional Examination of the Eye. By J. Herbert Claiborne, Jr., M. D., Adjunct Professor of Ophthalmology in the N. Y. Polyclinic; Instructor in Ophthalmology College of Physicians and Surgeons, N. Y.; Assistant Surgeon to the New Amsterdam Eye and Ear Hospital ; Author of "Theory and Practice of Ophthalmoscope." 100 Pages with 21 Illustrations; $1.00, Cloth. This book consists of a number of lectures delivered at the N. Y. Polyclinic during the last eight years, and more particularly of a number of lectures or lessons in a practical course delivered to the graduating classes of the College of Physicians and Surgeons, N. Y. " This book is the result of the author's experience for a number of years as a teacher. It recognizes, consequently, the difficulties which beginners often feel in approaching the subject, and is calculated to be a good guide. The style is plain and somewhat colloquial, not without intention. The author deals with an important subject, and he has well performed his task."—The Medical Bulletin, Philadelphia. " Contains the facts necessary for the examination of the eye as per- taining to refraction expressed in a simple, clear and attractive manner— a fit companion for the author's previous work on the ophthalmoscope. The type and binding are also excellent.— The Canadian Medical Review. $4.00 per Year. $4.60 per Year (Foreign). 35 cts. per Copy. Trie incricu Naturalist A Monthly Journal Devoted to the Natural Sciences in their Widest Sense. Managing Editors: Prof. E. D. Cope, Philadelphia. Prof. J. S. Kingsley, Tufts College, College Hill, Mass. Associate Editors: Dr. C. O. Whitman, Chicago. Prof. C. M. Weed, Durham, N. H. Dr. C. E. Bessey, Lincoln, Neb. Prof. W. S. Bayley, Waterville, Me. Prof. E. A. Andrews, Baltimore. Prof. H. C. Warren, Princeton, N. J. Prof. A. C. Gill, Ithaca, N. Y. Erwin F. Smith, Washington, D. C. H. C. Mercer, Philadelphia. Contains, in addition to Original Articles and Reviews and Book Notices, General Notes on the following subjects: Mineralogy and Crystallography, Petrography, Geology and Paleontology, Botany, Vegetable Physiology, Zoology, Entomology, Embryology, Microscopy, Psychology and Anthropology.