Many modern series showing the results of the treatment of retinal detachment report high success rates (Custodis, I965; Davis, I965; Jesberg, I965; Hagler, I965; Schepens, i965; Kreiger, Hodgkinson, Frederick, and Smith, 1971). The object of this report is to focus attention on anatomical failure in retinal detachment surgery in an attempt to highlight the important preoperative, operative, and postoperative factors that can contribute to failure, and as a result ofthese findings to suggest means by which the incidence of failure may be reduced.In this series failure has been defined as either incomplete flattening of the retina after surgery, or re-detachment within a period of 6 months. Material and methodsIn this series only cases which have been treated exclusively by the unit have been included. This is because it was sometimes difficult to be sure of the factors responsible for failure in cases that had been operated upon elsewhere as it was not possible in such cases to observe either the preoperative state or the operation itself. Those which received prophylaxis only have not been included.There were 452 cases treated by the Unit between I967 and I972. The minimum follow-up period was 6 months. Cases were operated upon by either a Resident or a post-graduate Surgeon.Although there was sometimes divergence of views amongst us about the surgical treatment of some cases, in general the techniques employed were similar. Thus, for local procedures, episcleral silastic sponge implants buckled over full-thickness sclera were used, and for encirclement procedures, episcleral silicone rubber bands. In all cases cryotherapy was employed.The data on the failed cases in this study were compared to those obtained from a study of 0OO randomly selected successful cases ranging over the same period of time. ResultsOf the 452 cases, I I4 (25 per cent.) needed further surgery after the first operation. It was possible to re-attach 6I of these (a further 13 per cent.), but 53 cases (12 per cent.) were complete failures. Thus the overall success rate in this series was 88 per cent. (Table I). Of the I I4 cases, five were successfully re-attached after the first operation but re-detached within 6 months. PREOPERATIVE FACTORSThe factors that were found to be of particular significance (P < o .os) are set out in Table II. The term "uncertain holes" refers to cases in which it was not possible to be sure of the exact location of some or all of the retinal holes. The depth of subretinal fluid was roughly estimated by clinical examination as the depth of the subretinal fluid beneath the

No abstract

No abstract

No abstract

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. This content downloaded from 129.96.252.188 on Fri, 08 Jan 2016 08:42:52 UTC All use subject to JSTOR Terms and Conditions This content downloaded from 129.96.252.188 on Fri, 08 Jan 2016 08:42:52 UTC All use subject to JSTOR Terms and ConditionsMother-fright to Father-rigid. 31sole primary cause of the movement, unless we take for granted that the immigrants never reckoned descent otherwise than through males, an assumption which cannot be proved. As far, therefore, as our present purpose is concerned, external impulse of this kind may be set aside. It may have effected the change in particular instances, but it does not effect a solution of the general question.The second cause advanced (a change of circumstances within the tribe compelling new arrangements) can be shown to have been active and effectual, but the question still remains, " What disturbing element was it that arose within the tribe, upsetting the old regulations, and how did it aiise ? "The process under which the changae of circumstances was effected may be classed under two heads-(1) orderly movements, (2) disorderly movements. By orderly movements is meant a gradual and peaceful change, resulting from the rise and growth of new ideas accepted by the whole comimunity. By disorderly movement is meant a rebellion against law (i.e., custom) successfully establishing itself and working out its own results: or the enforced segregation of a part of the tribe, resulting in circumstances under which the old regulations can no longer be obeyed.The workilng of what we have called orderly movements is plainly seen among agricultural tribes. As long as a tribe of savages continues to be mere hunters and nomadic within certain boundaries which limit the tribal territory, uterine succession works smoothly enough. The entire domiain is a hunting-ground common to the tribe, and there is nothing to call for its parcelling out among the tribal subdivisions into which it has broken up by force of its own expansion. It is not asserted that no such tribes reckon descent through mnales. On the contrary, not a few within our knowledge have this line of descent. Our contention is, that if a savage tribe have uterine succession the ancient rule is not likely to be disturbed bv disputes among the tribal divisions as to land inheritance. Say, for instance, that a tribe of hunting savages is divided into two exogamous intermarryiiig classes called respectively A and B. The members of A and of B are distributed over the whole tribal territory, and collectively form the tribe. It is manifest that with exogamous marriage and uterine descent the children of A fathers are B, and the children of B fathers are A. Consequenitly, where any form of a...