811 puration of the flap, tendency to prolapse of the iris, and the great loss of vitreous which sometimes occurs. These points of late years have been dwelt upon with such vehemence and weight in most works on ophthalmic surgery as virtually to put a veto upon the operation which I think it scarcely deserves. Out of close upon one hundred flap extractions, I have never seen a case of suppuration of the cornea, and I feel confident that this condition is no fault of the operation, but of the

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... ividual upon whom the operation is performed, and shows a debilitated state of the system which can easily be remedied by a few weeks or months of fresh air and good feeding, together with attention to other hygienic rules. It is the fashion now, and has been for many years, for all classes to resort to London for the performance of cataract extraction, and I believe firmly that in this circumstance alone we may find the cause of suppuration of the flap which occurs so frequently after this operation in metropolitan practice. Few persons bear changes of climate and external conditions so badly as aged persons, and what chance they may gain by increased skill in going to London they lose by being drawn from the quiet and repose of their own homes. In the days when it was thought a peculiarly dangerous thing to touch or wound the iris, and when this structure, like the peritoneum, was invested with a mysterious dread, prolapse of the iris in flap extraction was supposed to be -fraught with great danger. In the present day this accident is deemed of far less consequence, for we know that the prolapsed part may be excised without danger or detriment to the result of the operation; and I think this should always be done, without any attempt being made to reduce the protrusion. Prolapse occurring after the operation I have 1:'arely met with, and in every case could attribute it to some ,careless act on the part of the patient or attendants. Escape of vitreous is a thing which, I am happy to say, has rarely happened to me, and certainly it is not more frequent in the flap than in any other method of cataract -extraction. When a very fluid state of vitreous exists, some of it will almost invariably escape, whatever the mode of -operation adopted. In flap extraction no doubt more will -escape than in those forms of operation where the flap is small; but then, within certain limits, I think the escape of vitreous bears no relation to the results of the case, and I have frequently seen large escapes attended with little lowering of the visual power. Whilst I am quite ready to believe that the various forms of linear extraction may be attended with better results than flap extraction in the debilitated and fragile constitutions met with in our London hospitals, I feel quite convinced that the latter operation is the best adapted for our well-fed, healthy agricultural and mining population. Nor with such a simple and beautiful, I might almost say natural, operation to resort to, can I fully comprehend how persons can adopt conscientiously such a complicated and, to my mind, indefensible operation as Mr. Taylor's last, and which seems to me a veritable ophthalmic tour deforce. Two knives are required to make the corneal section. The iris is incised at its periphery, and the lens is extruded through the artificial opening in it. Every step is performed with difficulty and attended with danger, and when the operation is completed a double pupil ds left. Nor are the arguments Mr. Taylor uses in favour of the operation strictly logical. We are told that the peripheral section of the iris avoids its being bruised and stretched. As though any rational being could believe that seizing the iris with a forceps, which must necessarily crush its delicate structure, puncturing it, and subsequently completing its section with a pair of scissors, can be attended with less danger than the slight stretching of the naturally extensile and readily dilating pupil. If such a person does exist, we may soon expect to hear it seriously proposed that all women in future should be delivered by abdominal section, to avoid stretching the os uteri and vaginal walls. No doubt this latter operation would frequently be attended with success in young and healthy women, and if anyone were to commence to put it in practice he would soon obtain a few successful cases to bear testimony to its being a very great improvement on the old method of delivery. Having in my last paper made a few general remarks 'upon the plan of treatment I generally adopt, I will say a few words upon the cases in the table. There are in all twenty cases, fifteen of senile and five of traumatic cataract. The former are all the cases of senile cataract I have operated upon during the current year. The latter are selected from a large number, and are added to illustrate the beneficial results of the suction operation when the lens capsule has been ruptured by a blow upon the eye without any external wound. In all these five cases this accident happened, and, curiously enough, three of the cases were under my care at the same time. The senile cataracts were all successful, with one exception, and this exception illustrated well what I said at the commencement of my paper concerning persons coming from a distance. This patient was a highly nervous and excitable person. The operation was most successfully completed, but nevertheless, owing, as she said, to not being in her own bed and from the noises of the town, she could obtain no sleep; opiates did not relieve her. On the third day suppurative iritis set in, and the eye was eventually completely lost. In two cases prolapse of iris occurred during the operation, and the portions were removed. In one of these, after the iridectomy was performed, some vitreous escaped, and the lens in its capsule sunk out of sight. I succeeded, by means of Taylor's loop, in extracting it without difficulty or danger, and the patient made a good recovery. Newcastle-on-Tyne.