On the treatment of certain injuries of the eye, occurring in infants and young persons / by Richard Middlemore.

  • Middlemore, Richard, 1804-1891.
Date:
[1840?]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of certain injuries of the eye, occurring in infants and young persons / by Richard Middlemore. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    I purpose, iu my present communi- cation, to place bejore the readers of the Medical Gazette the result of my experience in the treatment of cataract occurring- in early life, whether conge- nital, the Tesult of local injury, or taking place from any circumstance not dis- tinctly ascertained. If ordinary congenital cataract be allowed to continue until the subject of this defect has arrived at or towards adult age, certain important changes take place; for instance, the lens is absorbed, the anterior and posterior hemispheres of the capsule become thick and opaque, and either fall into appo- sition, or become united by an organized medium. Concussion of the eye or head, wound of the lens and its capsule, and a variety ofother accidents, may occasion cataract, and, if such an event take place in early life from any of these circumstances, and no attempt be made to relieve it, thick, tough, capsular cataract is likely to remain, and is especially prone to contract adhesions to the iris, and to diminish the pupillary aperture. It will be perceived from this state- nent, that if, in early life, the lens and ts capsule become opaque from any :ause, and no prompt surgical efforts »e employed to procure the disappear- nce of the opaque matter, a secondary, nd far more troublesome, and less □anageable form of disease will almost crtainly occur. Hence, it may be laid own as a rule of practice, admitting of carcely any exception, that operative roceedings should be employed soon fter the distinct establishment of the ataractous malady, whenever it occurs i early life. I say in early life, be- ause, when the same malady occurs t an after peiiod, the same reasons for mioving it by operation do not exist, 'or instance—I, if, then (at a late period ni!e),tliediseasccontinue for very many ears, il is not by any means so liable » be converted into a more unmanage- ble description of malady, so that a ime of choice is, as it were, allowed us; II this account it would be manifestly proper to select, for the purpose of brforminj* an operation, the period of • flammation, just when the eye is very unfavourably situated for such a pro- ceeding ; 2, the eye is perfectly de- veloped, and its growth cannot, there- fore, be arrested, as it mav be if an operation be too long delayed, as in the case of congenital cataract ; 3, the sensibility of the retina has been perfect, and has been exercised, so that atony of that important part is not likely to take place from the oftentimes temporary, and always partial, discontinuance of its natural stimulus*, as occurs in the instance of cataract (traumatic or other- wise), affecting only one eye, in elderly persons; 4, the question of personal appearance is comparatively of little im- portance, &c. Cataract occurring in young persons is now generally treated by the anterior or posterior operation of solution. In performing either of these operations, we are very properly directed to destroy the anterior capsule to an extent at least equal to the size of the natural pupil ; but I am convinced this important di- rection is by no means sufficiently attended to. In the operation of kera- tonyxis, owing to the difficulty of moving the needle about in a texture like that of the cornea, without causing the es- cape of the aqueous humour, the capsule is sometimes merely divided; a portion of the cataract escapes into the cham- bers of the eye, and perhaps a small quantity of the soft flocculent lens is interposed between the lips of the in- cision in the capsule. So, also, in the posterior operation of solution, the needle, having passed through the lens towards its margin, is, indeed, pushed through the anterior capsule, if that membrane be healthy, but, if unusually thick nnd tough, it may be raised upon and pushed before its point; but in de- pressing its point, with a view of lacerating the capsule, it will, very often I fear, pass nearly through the same aperture at which it entered, into the substance of the lens, where it may be moved about with much apparent, but little really useful, effect. Now, in • Die render will be bo good as to bear In mind thut 1 am noi professing to dlscusB nt all lndetnil tin; proprletyof operating for cataract, when es IBIIng only in one eye, in persons at an advanced period of life.