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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    what vaguely, recommends the extrac- tion of the lens when rendered opaque by accidental violence, without being dis- placed. But I do not know that this advice is intended to apply to young children, as the only examples brought forward, in proof of the utility of the practice suggested, ave, the cases of a country gentleman and a mechanic. I apprehend, however, it is not intended to apply to very young children, inas- much as the only operation proposed is that of extraction, an operation, which, although I will not go so far as to assert it is not possible to perform on a child two or three years old, yet I may safely affirm it is so difficult of performance, (the iris being convex, the leus soft, the eye, as it will be under the circum- stances in question, inflamed, the patient very young,&c.) in a manner which may justify the expectation of a successful result—successful as regards the appear- ance of the eye, and the restoration of the first, the consistence of the crystalli oe is soft; in the second, it is hard and concrete, like a stone; in the third, it is partly soft and partly petrified. When it is soft, the aqueous humour which lies behind this body thrusts it forwards and fixes it in the pupil; but, when this body is hard, it passes at once through the hole of the pupil, upon the least effort made in bending the head. (p. 262) Whatever passes during the operation <of couching), through the hole of the pupil, if it be of sufficient solidity, the point of the needle must be pushed through the hole of the pupil, without touching the iris; then pierce the body of the cataract wilh the point of youf needle, and place it where it is usuallv placed (that is, ir the vitreous humour), p. 271. The reader of these extracts will not fail to remark that St. Yves understood the nature of dislocation of the lens into the anterior chamber; was aware of the in- convenience its presence occasioned; and prac- tised and advised its extraction, with a view of relieving them. He was also aware that, when the lens was somewhat soft, it would occasionally press against the iris, (he calls this passing into— and who can say this is incorrect — not through the pupil) and that the extraction of this soft lens was necessary not only to restore vision but also to relieve pain and inflammation. Mr. Gibson of MiinChester, has received much credit for sug- gesting the removal of soft cataract, by making a small incision of the cornea ; and the justly ce- lebrated Dupuytren has been infinitely lauded for recommending the Introduction of a needle through the sclerotica into the anterior chamber, with a view of depressing the crystalline when dislocated into the anterior chamber ; but I much question if any impartial reader can give either of them much credit for pure originality, as far as those questions are concerned, after having pe- rused the work of St. Yves. The subject of dis- location of the lens is somewhat fully discussed by Dr. Warren, of Boston, and its treatment illus- trated by the recital of cases ; and I am rather as- tonished his remarks have been so little referred to. [They were re-published in the Medii aland Physical Journal, vol. xxxvl. p. 386.] He advises the early extraction of the lens when displaced, even although it may not have passed into the an- terior chamber, but makes no reference to the disease when occurring 111 infants and children. vision—as to be almost impossible. Per- haps, however, the question is set at rest by Mr. Hunt, who, in the course of an interesting communication, On extrac- tion of the lens, in some injuries of the eye, (which appears to be a further development of the views of liis able and experienced colleague, Mr. Barton,) makes the following statement: Be- fore concluding, it may, perhaps, be advisable to mention some restrictions which may be necessary in the employ- ment of the proposed method: as cir- cumstances may occasionally occur which would render the operation inap- plicable, attention must be given to the age of the individual; for if the patient be so young as to render the fixing of the eye, without the aid of a speculum, impossible, or of such an advanced age as would contra-indicate the perform- ance of any operation, extraction of the lens would, in both instances, he im- proper. And as a farther objection to the operation at an early age, it must be considered that absorption of an injured lens, like most other reparative pro- cesses, proceeds more rapidly, and with much greater certainty, in children than in adults. (North of England Medical and Surgical Journal, p. 495. London, 1831.) The latter part of this statement is perfectly true, but the question is, can we, by omitting an operation, certainly prevent the formation of the capsular disease, which is admitted,on all hands, to be so difficult of management? If this cannot be done, then, I apprehend, an operation is far more needful in early life than at any other period of existence : and that a suitable and effi- cient operation can be performed, and ought to be performed with but little delay, it is the object of my present communication to prove. I now proceed to explain the opera- tive proceedings it is the main object of this communication to recommend; and it will be understood they are adapted to those cases of traumatic, or other forms of cataract, occurring in infants or young persons. For, if traumatic cataract, not attended with displacement of the lens, occur after the latter age, the necessity for an operation is much less than at an earlier period, chiefly because the lens is less prone to become absorbed, and the capsule to undergo those changes which so generally occur in younger subjects. And here I beg to state that, on one or two important