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of a triangle. The iris forceps were now introduced, the upper end of the iris flap grasped and drawn out and cut off close to its ciliary attachment. By this means a large opening was obtained. Some little vitreous was lost in one case only. Both healed well without much inflammatory action, with vision in one of in the other there was a piece of thickened capsule that closed the pupil except a small line along one side of the iris, through which the light passed, giving a vision of and reads Jäger 10 with +14.

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Secondary cataract formed in four cases, which were operated on with good success. Three were torn through by the, needle, and one being thick, was drawn out by a small hook through an incision in the cornea.

Severe intra-ocular hemorrhage took place in one case of a male aged 66. The operation was satisfactorily performed, without the least hemorrhage into the anterior chamber, and the eye carefully bandaged. During the night he felt something trickling down his face, but thought nothing of it until morning, when he called his son, Dr. C., from the next room to see what it was; and it was found to be blood that had been oozing out from the eye all night. The lint and bandage were saturated, and the pillow covered with it. The bandage was removed, cold cloths applied for a while, and then a firm compress bandage placed over the eye.

This eye naturally was lost.

Sloughing of the cornea took place once only.

Irido-choroiditis with phthisis bulbi occurred in one case.

Case No, 13 is classed with that of total loss because no determination of vision was obtained as the patient died of an acute abscess of the brain forty-eight hours after a secondary operation for the removal of a band of lymph across the pupil. The first operation had been made two months previously, when the lens in its capsule was removed, and healed well in fifteen days, but a thin band attached to the iris and stretching across the pupil prevented clear vision, although objects could be seen and fingers counted. The patient had not been very well for some days, complaining of pain at times in the head, but said nothing about it to me, and underwent the second operation. The band was drawn out by a hook through a small incision in the cornea. During the night the pain in the head became very severe, with great restlessness. Next morning no pain in the eye, but exquisite pain in the head, back, and spine. Delirium during the afternoon and night, and death the next morning. His wife reported that he had two or three attacks of pain and

trouble in his head during his life of almost like character, but not so severe, and always recovered completely. Post-mortem would not be allowed.

Astigmatism was found in fifty-eight cases after the operation, necessitating the use of cylindrical glasses, showing 43.124 per cent. of the cases suffering from this anomaly of refraction. The great majority came no doubt from the operation causing a change in the curvature of the cornea.

In the operations by von Graefe's method, the corneal incisions were all begun in the sclerotic, at the sclero-corneal junction, and the most of them brought out in the same with a large conjunctival flap, care being taken not to cut too deep back towards the ciliary attachment of the iris, while in others the incision was brought out in the cornea close to its edge. In my experience the incision brought out in the cornea did not heal so quickly, although equally as well as that with a conjunctival flap. The flap adhering so readily as it does appears to be of assistance in holding the edges of the sclerotic wound together.

In many of the cases the upper part of the anterior capsule after its rupture by the cystotome was removed by gently grasping it with the iris forceps and drawing it out before the extraction of the lens, as recommended by Knapp. This manoeuvre I have found of great advantage, as it removes the liability of having an opaque piece hanging down in the pupil, to which the iris may become adherent by inflammatory action, and necessitate a secondary operation for its removal, thereby putting the eye a second time in jeopardy.

In a few cases a peculiar striated appearance of the posterior capsule was observed after the lens was removed, and fearing secondary cataract, the iris forceps were gently introduced, the capsule grasped and torn aside. The vitreous naturally came forward, but the eye being closed and properly bandaged, none of moment was lost, and all healed well with perfect (to) acuity of vision.

Care was taken before closing the eye to gently work the edges of the incised iris from the corners of the sclerotic wound into the anterior chamber, so as not to be allowed to heal in the cicatrix, which is likely to cause iritis, or to draw the pupil too much upward.

In some cases where the pupil was drawn too much upward by the edges of the iris having healed in the sclero-corneal wound, I relieved it by simply cutting the iris loose from its attachments in the cicatrix, by making an incision in the cornea on the line of the former wound with a lance-shaped iridectomy knife, and introducing

the small iridotomy scissors, allowing one branch to pass under and the other over the iris and snipping it through as close to the cornea as possible.

Atropia being put in the eye before and after the operation caused the iris to dilate, and being free, resumed its normal position. I found this a much more satisfactory operation than iridectomy; there is less hemorrhage into the anterior chamber, and gives a better shaped pupil.

Of the three operations performed after the method of Liebreich, in two of them the incision across the cornea was made according to Critchett's modification, on the line of the upper border of the pupil, and one, as Liebreich recommends, on the lower. In the first one of the upper incision, iritis set in with the result of complete occlusion of the pupil; in the second, there was a very large prolapse of the iris in the inner corner of the wound (necessitating an after-operation), and a complete anterior synechia of the upper part of the iris along the whole incision. Vn. was, however, good.

The case of the incision along the lower border, as recommended by Liebreich, turned out much better, there being no attachments of the iris, and Vn. = 1.

This was really a dislocated lens, and the incision across the cornea in that position suited the best for its removal, so that this one cannot be properly called a Liebreich operation, although classed therewith.

The lack of successful results, as well as the trouble to be feared from adhesions of the iris in the corneal wound, impressed me unfavorably with the operation and discouraged me from making any according to that method since. I will not say, however, that I have discarded it entirely, for the results in the hands of other oculists have been so successful that I may be tempted to give it another trial.

ON DEAF-MUTISM AND THE METHOD OF EDUCATING THE DEAF AND DUMB.

BY LAURENCE TURNBULL, M.D.,

PHYSICIAN TO THE DEPARTMENT OF THE EYE AND EAR OF HOWARD HOSPITAL,
PHILADELPHIA.

ABSOLUTE deafness is far more of a hindrance in acquiring an education than blindness. The lot of the uneducated and ignorant deaf-mute is sad indeed; cut off from his fellow-men, with nothing but his animal passions and appetites, he is almost allied to the lower order of the brute creation. It is not to be wondered at, that during the early times, even among the so-called civilized and refined nations of Egypt, Greece, and in the great city of Rome, the condition of this class was truly deplorable. The old idea that speech was essential to reason, prevented attempts at their instruction, and they were not permitted to become members of any religious denomination. Even when they committed outrages against law and order, or after the commission of the crime of murder, they were not allowed to act as witnesses in their own defence.

As early as the fifteenth century, some faint effort was made to teach these unfortunates by a celebrated Benedictine monk,' who, it is stated, taught two deaf-mutes, sons of a Castilian nobleman, this, no doubt, at an immense cost of time and money. But it was to the sixteenth century that the great honor is due of being the year of jubilee to the deaf and dumb. And to the Abbé de L'Epée this great gift was given to teach deaf-mutes, by a symbolic language, so that they might know good from evil, and give to them aspirations after true knowledge, fitting them for a happy home here and a better world above. In this, the good abbé showed true Christian genius, devoting his whole life to giving and teaching

'Teaching articulation to deaf-mutes was first practised by Pedro Ponce de Leon, who died in 1584, and was first described by Juan Pabbo Bonet, in a dissertation published in 1620; then by John Wallis, in an appendix to his English Grammar, entitled "Tractatus Grammatico-physicus de Loquela ;" and shortly after by Joliana Conrad Amman, in his "Suidus Soqueus," Amsterdam, 1692, and "Dissertatis de Loquela," Amsterdam, 1700.

them a language so that they could communicate with each other and with those they loved.

Another devoted man, the Abbé Sicard, took up the clue already given, and adopted the sign language for their instruction, and enlarged and improved it, reducing it to a system. The lives of two such devoted Christian men aroused public attention to the wants of deaf-mutes, and slowly but surely vanquished the prejudices that had existed against them even amongst professing Chris

tians.

Gradually, schools were founded, and capable teachers spent their lives in instructing the deaf-mutes. Germany was not long after France in this philanthropic labor, for in 1760 Samuel Heinicke, a Saxon by birth, developed the " Artificial Method" now termed German, in contra-distinction to what was already known, to the honor of France, as the "French System," or finger alphabet and artificial signs and gestures. The principal aim of Heinicke was to cultivate whatever remained of speech by developing all its power, which exists in all (save a very few). The training of the eye to watch the motion of the lips requires the cultivation of all the powers of observation and imitation. In the early stage of this system artificial signs are absolutely necessary, but when these have been acquired they are to be merely used as a ladder to reach the higher region, where the finger alphabet and other artificial signs are excluded.

There ought to be a commissioner in every State to examine and classify the deaf and dumb, where all who are found to possess any degree of hearing or any remnant of speech (having lost hearing after learning to talk), or any who manifest a marked facility in vocal utterances, should be assigned to the articulating schools, while all others should be placed in the older establishments, where the language of signs is made the basis of instruction.

In a recent convention of Teachers of Visible Speech, to which the writer was invited, an interesting address was made by Mr. Wm. Martin Chamberlain, of Marblehead (a semi-mute), which shows the advantages of lip-reading and articulation. We can only give an abstract. He addressed the audience by word of mouth, and although his speech was somewhat defective, he was perfectly understood by all present. He stated that he lost his hearing entirely at five years of age, and would, as a natural sequence, have lost his speech also, had it not been his good fortune to have parents who appreciated its value, and used persistent efforts to have him make use of his vocal organs. He was educated at Hartford, where he entered as a pupil about the time when articulation was beginning to attract atten

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