Is Cataract Couching Ever Justifiable?

reproduce my paper criticised therein which appeared in the Ophthalmic Review, Vol. XXII, April, 1903. In the Ophthalmoscope for December 1904, in a brief notice of Major Smith's paper I came across the following paragraph, but though objecting to its inferences I decided to take 110 notice of it. "Smith is, therefore, of opinion (despite the views recently expressed by Power, Maynard and others) that lens couching at the present time is not an operation that should be practised outside the ranks of charlatans." As you reproduce the paper at his request, however, I think the two papers should receive equal publication in India and be judged side by side, more especially as Major Smith's paper might lead anyone who had not read the article on which it is apparently based to believe that I advocate couching in preference to extraction. A reference to my paper will show this inference to be quite incorrect. In my contribution there were recorded the after-residts of 63 operations for depression of the lens by 'suteyas.' Finding that 46 per cent, of these non-selected cases retained good vision after an interval of nearly five years I agreed with Mr. Henry Power in his conclusion that under certain circumstances " it would be at least allowable if not advisable to revert to the ancient method of ' depression ' for the restoration of light in cases of cataract." What those circumstances were I did not repeat in the paper as they had already appeared in the Ophthalmic. Review, but they are now reproduced as Ma jor Smith would seem not to have known them and they are necessary to the understanding of the position. (I may add that I do not agree with all of them as justifying couching.) Such a qualified statement as the above can hardly be called ' advocacy ' of the operation. Like Mr. Henry Power, Professor Albertotti and others I regard it as justifiable under certain conditions. The fact that numerous eyes, many of them unsuited to the method, are ruined from sepsis and other causes at the hands of itinerant quacks does not affect this conclusion. I am, Sir, &c.,