percent of perfect and six (6) of partial results, with only three (3) percent of absolute failures. The separate statistics of the hospital cases would show, of course, results proportionally worse than the general average.

Dr. WILLIAMS' first public mention of his employment of a suture in the corneal flap after extraction, is contained in a prize essay, published two years ago (Recent Advances in Ophthalmic Science, Boston, 1866). It is more fully described, with 25 reported cases, in the Ophthalmic Hospital Reports for September, 1867, from which we make the following extract:

Remarks on the Use of a Suture to Close the Corneal Wound after Removal of Cataract by Flap-Extraction. By HENRY W. WILLIAMS, M.D., of Boston, U. S.

[Ophthalmic Hospital Reports, Vol. vi., Part 1, London, Sept. 1867.] The abstract given below of 25 operations comprises all the cases treated according to this method in the City Hospital during the year 1866, and includes only those thus publicly treated; though I may, perhaps, be permitted to say that the results of cases in private practice, some of which have been watched with interest by distinguished confrères, have been even more gratifying (especially as regards shortening of the critical period after the operation, than those obtained at the hospital, and in no instance, of nearly a hundred in which the suture has been employed, have I seen any harm result from it use.

The novelty of the proposed method, and the evident advantages to be hoped for, provided the fact of toleration of a suture in the cornea be once established, may perhaps excuse the publication of some details of these cases, rather than a mere general statement of their results.

The advantages claimed for this plan are briefly these: The lips of the corneal incision (and as it seems to me, the same would be at least equally true where the incision is carried beyond the limits of the cornea) being maintained in contact, unite with more certainty by primary adhesion, and ulceration of their edges is less likely to occur

This early cohesion of the wound greatly lessens the chance of prolapsus iridis - the danger most to be dreaded in flap-extraction.

The prompt re-establishment of the anterior chamber renders it possible to make use of atropia, without fear of inducing hernia of the iris, and, by so doing, to avoid irritation from fragments of cortical substance or of capsule which may remain in the field of the pupil or the posterior chamber, thus diminishing the risk of irido-choroiditis.

The necessity for mutilation of the iris, or the repeated introduction of instruments for the removal of the lens is avoided, and flap-extraction is rendered safer than some recently proposed methods, whether they are combined or not with iridectomy.

The surgeon may, if he wishes to do so, make daily examinations of the condition of the eye, with little fear of disturbing the healing process in

the wound; he may instil solutions of atropia to keep up dilatation of the pupil; and, in case of the appearance of symptoms of internal inflammation, he may at once counteract them by suitable remedies.

The globe being sooner restored to nearly its normal condition, the patient may be less restricted to his bed after the first 24 hours, and may be allowed considerable liberty of movement at an early period.

My mode of inserting the suture is as follows: After extraction of the lens, the centre of the corneal flap is held by a delicate pair of iridectomy forceps, while a fine needle, one-fourth of an inch long, having a flat cutting point, and carrying a single strand only of the finest glover's silk, is passed through it, as near as possible to the edge. The opposite edge of the wound is then seized in the same manner, and the needle passed through at a point corresponding with the insertion of the suture in the flap. Of course, so minute a needle can not be held with the fingers, but must be passed by the aid of a needle-holder of some kind. I have used a short but strong pair of forceps, the blades of which are roughened at their extremities. The suture is then carefully tied, and, where the silk has been waxed, a common double knot has been found sufficient, without a resort to a "surgeon's knot," so called.

The presence of the knot, although so exceedingly minute, sometimes causes slight conjunctival irritation; but far less than might have been expected, and not enough to compromise in any respect the results of the operation. Yet, after its purpose has been served, I think it best carefully to remove it, say at the end of a week or ten days after the operation. This may be readily enough done with tractable patients; but in nervous subjects it may now and then be necessary to administer ether to induce unconsciousness, before attempting it, or to leave the suture, where it gives rise to almost no annoyance, to fall of itself. In more than one instance I have seen it remain in situ seven weeks without inconvenience. In all but four of the cases the extraction was done by the upper section; more recently, however, finding it easier both to insert and to remove the suture where the lower section has been made, this has been preferred.

The following general facts, applying to all the operations, are here stated, to avoid unnecessary repetition.

Complete anesthesia has been induced by inhalation of sulphuric ether; or, in a few cases, of ether reinforced with a little chloroform. This has long been my practice in operating by extraction; and, so far from observing any of the accidents which have been regarded as likely to occur during or subsequent to the anæsthesia, it has appeared to me that loss of vitreous has been less frequent where etherization has rendered the eye entirely passive, than during operations done while the patients retained consciousness, but could not control the spasmodic action of the recti muscles upon the globe. This opinion as to the advantages of anæsthesia is quite independent of my estimate of its value in facilitating the introduction of the suture, which could scarcely be safely accomplished without its aid, but was formed and acted on long before I conceived the idea of thus holding the edges of the wound in close contact.

The dressings applied have been small compresses laid upon each eye, upon which have been placed graduated pledgets of soft lint, and these have been covered by a strip of linen or calico sufficiently long to cover the forehead and temples; the whole retained in place, without much compression, by two turns of a flannel roller.

A full anodyne has been given at bedtime, after the operation, whenever the patient seemed unlikely to sleep quietly without it, even when no pain was complained of.

In most of the cases I have made a daily examination of the general condition of the eye, and have daily introduced a drop or two of the solution of sulphate of atropia, two grains to the ounce. Perhaps, where the patient makes no complaint, inspection of the eye might with advantage be delayed till the second day. The dressings have been continued for several days, and have been applied to both eyes, whether one or both had been subjected to operation.

Out of the total number of twenty-five (25) cases reported by Dr. WILLIAMS, which embrace all the cases publicly treated by him in hospital during the year 1866, there was but one (1) total failure, and one (1) partial result; the latter being, however, a case of closure of the pupil, remediable probably by an iridectomy. In the other cases the results were entirely satisfactory. Especially noteworthy is the fact that, in a total number of nearly a hundred cases in which the suture had been employed, in no instance had any harm resulted from its use.

In conclusion, we venture to express the opinion that the result of a careful study of recent statistics of cataract operations is, on the whole, favorable to the old and classical "flap extraction." And while we recognize in the new methods a most valuable addition to our resources in certain exceptional cases, and especially in dealing with large numbers of patients in public hospitals, we look upon the flap method, with its large corneal incision and unmutilated pupil, as pre-eminently the operation to be chosen in cases for which it is suited. Especially is this true of flap extraction as improved by Dr. WILLIAMS, in which the risks of the operation are greatly diminished without the sacrifice of any of its peculiar advantages.

J. G.

Meteorology at St. Louis.

METEOROLOGY OF JANUARY AND FEBRUARY, 1868.
By GEORGE ENGELMANN, M.D., St. Louis.

The weather of the two past months was distinguished by unusual steadiness and dryness, and thus the condition of the five or six preceding months continued to prevail, into which only December had made a break. We rarely have as pleasant and steady winter weather with so many fair days and so few changes as we enjoyed in the past two months. After a few warm days in the beginning of January, winter set in on the 6th with a heavy rain, followed by a northwest storm; in a few days the river was full of heavy floating ice, and in the last week of the month became bridged over near the city, and continued so until the 16th of February, nearly three weeks, after warmer weather had already set in on the 12th of that month. From the 12th to the 26th the weather was mild and springlike, and in the last few days of February again raw and chilly. The quantity of rain was unusually small, especially in February, and the

(184)

atmospheric humidity correspondingly low, and evaporation high; the barometrical pressure was very high, and the temperature, especially in January, much lower than the average.

COMPARATIVE METEOROLOGY OF THE PAST WINTERS AT ST. LOUIS.

The winter was principally characterized by the peculiar meteorological condition of the last two months as a dry, serene, and steady one, so that the disagreeable weather of December was soon forgotten. But not so its deleterious effects on the public health: the changeable, wet, gloomy, and rather warm weather, and the low barometrical pressure of December, together with the malarious influences prevailing in the fall, and still exerting their deleterious influences far into the winter months had their usual effect, and fevers of low and often of a typhoid character, complicated with affections of the abdominal organs or of the brain, and more frequently of the organs of the chest, were quite prevalent and not rarely fatal, so that the mortality in January was even greater than in December; since then, it has steadily decreased, and we have every reason to expect a healthy spring season, though the malarious influences, mentioned above, will undoubtedly begin to exhibit their effects again for a few weeks, as soon as the first hot weather sets in in April.