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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    1 such cases, what is the result of these proceedings ? The wound of the cap- sule heals very readily, if no portion of the lens be interposed between Us edges, and there is scarcely any vestige of the puncture; but if any portion of the lens protrude through the opening, it is gradually absorbed, and there remains an opacity of the capsule of a greater or less extent. The capsule being not at all, or only very slightly, opaque, pro- ceeds to the absorption of the lens, which it generally accomplishes ; it then becomes opaque ; its two layers meet, or they become united, and constitute a thick, tough, opaque texture, which is, in fact, worse than the original disease. Sometimes, when the posterior operation of solution has been performed, the injury to the capsule may have been more extensive than I have now stated, but still not sufficiently great to permit the discharge of the whole of its con- tents, nor to destroy its opacity until it has completely absorbed the lens, when, having become, as it oftentimes will do, inflamed, it generally secretes a lymphatic matter, by means of which the capsules, the iris, and an intervening mass of lymph, are united, and remain as a future obstacle to vision. Hence, then, arises the necessity—and the fact cannot be too frequently presented to the notice of junior practitioners—of making a free laceration, and extensive comminution of the anterior hemisphere of the capsule,ata>-sfo/Jer«*io»t,namely, to prevent the occurrence of that form of disease in which the two layers of the capsule meet or become united, form adhesions to the iris, and constitute an obstacle to vision which nothing short of extraction can entirely remove. The importance of preventing the se- condary disease, by a due attention to the treatment necessary for the perfect cure of the primary affection, is mani- festly very great; and, on this account, I hope to be excused for referring to the subject in a manner which to some may hear the appearance of needless repe- tition. If, however, the disease take place in theeyeofa young person, from injury— for example, a slight wound of the cornea and capsule—what are the mea- sures best adapted to secure to the patient the best chance of the restoration of sight? If the injury be unattended with dis- placement of the lens, or any materia] wound of the cornea, or any severe in- flammatory symptoms, the plan of treat- ment I am about to propose, and which has not been previously stated by any author with whose labours I am ac- quainted, appears to possess many ad- vantages. On referring to the ophthalmic articles in the Surgical Dictionary of Samuel Cooper,* and the Treatise of W. Lawrence,t —works which are charac- terized by fulness of detail, accuracy of statement, and extent of research—I find the treatment of such injuries is repre- sented to consist in the employment of purgatives, the application of leeches, blisters, &c.; no mention being made of an early operation with a view of pre- venting the formation of tough capsular cataract. The only allusion to the sub- ject I can find is in a communication by Mr. Barton,.j in which, sanctioning the recommendation and practice of St. Yves,§ Warren.11 Beer,1J and others, he advises the early extraction of the lens, in cases where it has been accidentally displaced ;** and likewise, though some- * A Dictionary of Practical Surgery, p. 1038, London, 1838. t A Treatise on the Diseases of the Eye, p. 143, London, 1833. ± London Medical Gazettr, vol. v., p. /»4. § A Treatise on the Diseases of the Eyes, trans- lated from the French, by J. Stockton, M.D. London, 1744. 0 New England Journal. f Lehre von den Augenkrankheiten, b. 2, Wein, 1813—1817. ** The following quotation, from the ingenious Treatise of St. Yves, may not be uninteresting :— When the eye receives a violent stroke, the crystalline is loosed immediately, and, in two or three days, it becomes opaque, so that the patients can onlvperceive thelight (p. 228). After having stated that the lens, when so displaced, may have two situations, which he describes, he proceeds as follows :— The third place is when the cata- ract passes altogether into the anterior chamber, and is placed between the cornea transparent and the iris ; from whence it must be taken out in the manner that shall be described in the sequel of this Treatise (p. 229). The manner con- sists in making a section of the cornea, intro- ducing a scoop, and canting the lens through the opening. The author's words are: U hen you design to perform this operation, to draw out the crystalline which bas passed in the foregoing manner (that is, into the anterior chamber), the, patient must be seated in a chair, with his eye fronting the light; open both his eye-lts with, ymir thumb and fore-finger, then, with a sharp- edged lancet, divide the cornea transparent a.little below the middle of the pupil. You must con^ tlnue your incision transversely, from one sine oq the cornea to the other, In such a manner that you, do not leave unsevered, on each side, above hair a line's breadth of the cornea transparent. 1 nem introduce a fine small scoop through the orifice, convey it behind the crystalline, and. with it, riraw out that humour, through the Incision made IB the cornea. (P. i.62.) I shall still further ex tend this foot note, for the purpose of introducing th* following curious quotations :- Three sorts ofi cataracts pass through the hole of the pupil. ■