SQUINTING.

134 drawn far into the inner angle of the eyelids so as to produce considerable disfigurement. The operation was performed in the following Posterior curvature, with disease manner :-The head of the child was held Incurvation of spine ............ against the chest of one assistant, while In the treatment of distortion of the spine, another with two hooka kept the eyelids our author trusts chiefly to position, and the widely apart. The operator then passed a In anterior third hook, which he gave to a third assistexercise of certain muscles. incurvation the recumbent position is advi- ant to hold, through the cunjunctiva, and to some in the subjacent cellular tissue sable, though not absolutely necessary ; in at the depth internal canthus. He next fixed a fine lateral incurvation the recumbent posture is double hook in the sclerotica at the innep of essential importance. The second indi- angle, and, taking it in his left hand, drew cation is fulfilled by compelling the muscles the eye outwards. Then cutting into the to exert themselves with energy to restore conjunctiva close to the ball, where it is continued from it to the internal canthus, the spine to its natural situation. and penet. ating more deeply by separating " One of the methods (says Mr. Ward) the cellular tissue by the side of the sclero. that I employ for this purpose, and the tica, he divided the internal rectus muscle tail of which will place the subject in the close to its insertion with a fine pair of clearest point of view, is the following :- scissors. The eye was immediately drawn A weight appended to a cord is passed over outwards by the external rectus, as if it had a pulley, and the other extremity, having a received an electric shock; and in another became straight, so that there was strap attached to it, is fastened round the patient’s head ; the pelvis being fixed, the no difference perceptible between its direcpatient is directed to raise the weight by tion and that of the other eye. The haemorrhage during the operation drawing the head and trunk backwards, and to repeat this effort until fatigue is produced. I, was but slight, though sufficient to impede The frequency of repetition of this exercise it. The after-treatment consisted of cold of the muscles, and the weight of the body lotions; no inflammation ensued, and withia to be raised, must, of course, depend on the eight days the cure was completed. patient’s strength. After each effort it is CASE 2. Carl Gerhard, aged 10, affected advisable to take rest, by laying down on a with squint since his fourth year. His couch orsofa, in order that the muscles may not parents, wishing him to become a printer, be placed on the stretch, and thus prevented were anxious to have this defect removed, from recovering themselves. This mode of as it interfered with composing. The right exercising the muscles is equally applicable eye was so completely drawn into the innerto the anterior curvature of the spine, when angle, that, on a first view, the point of not connected with caries, as to that which junction of the iris and sclerotica formed the takes place laterally." centre of the anterior surface of the eyeball. Mr. Ward rejects altogether the use of By an effort the eye could be drawn from mechanical contrivances. We would refer the canthus and placed straight, but could’ our readers to the work itself for Mr. Ward’s not be turned at all outwards. The operation was performed as in the last case, the notions respecting deformities of the chest, conjunctiva being cut through, and the contractions of the limbs, paralysis, and sclerotica laid bare to the extent of four chorea, for we do not find that we possess lines, in order to bring the muscle into view, courage enough to continue an analysis of which was cut with a curved scissors as The squint was gone; the eyeball, a work which is so totally barren in a scien- before. when at rest, stood nearly straight, or rather tific point of view. a little turned outwards ; and could be turned more readily by the patient’s efforts in this direction than inwards. All the other SQUINTING. movements of the eye were free. The Cure of Congenital Squinting by Divisioyd of bleeding was here much less than in the the Internal Straight Muscle of the Eye. former case, and caused no interruption. The sudden turning of the eyeball outwards, By Professor DIEFFENBACH, of Berlin. observed in the first case, did not take place IN a late number of THE LANCET we an- here. nounced that Professor Dieffenbach had The boy felt quite well on the following He could separate the eyelids without to strabismus the day. successfully applied operation of the division of muscles. The difficulty. The conjunctiva in the inner of the eye was red. The eye was following cases illustrate the efficacy of this angle straight, only turned a little more nearly simple and most successful operation :outwards than the other. In eight days the CASE 1.—The subject of this operation was cure was complete, and the eye quite a child seven years old, whose eye was straight.

Posterior

curvature, without dis-

ease ........................

11 34 3

de-

instant

135 CASE 3.-Albert Victor, as;ed 15, affected with strabismus of the left eye since his earliest infancy. The eyeball was turned deeply into the inner angle; by an effort of the will it could be turned straight ; but, on this effort being relaxed, it instantly returned to the former position. The operation was performed precisely in the same manner, it being only here specified that the external incision in the conjunctiva was semilunar, and that the muscle was cut by introducing the pointed blade of the scissors beneath it. As soon as the hook that held the eye was removed, the ball turned at first outwards, but in a moment returned to the straight position. The edges of the wound did not gape, so that the external incision was barely perceptible. The eye was covered with a cold poultice, and the patient subjected to the antiphlogistic regimen, )n eight days the cure was complete, and the

knife I easily divided the conjunctiva from below upwards, about three lines distant from the cornea, and thus exposed the sclerotic coat. The edges of the incision almost immediately became swollen, from the effusion of hlood and tears into the connecting reticular tissue, forming a partial chernosis. Very slight haemorrhage took place from the vessels of the conjunctiva, which was checked by the application of cold water. Upon the eye being again exposed,

divided theincision

was readily recognised, and,introducing a small blunt probe between its edges, I separated the reticular tissue, connecting the inner portion of the conjunctiva

sufficient enable reach insertion the inner rectus ; I then inprobe, directing from troduced inbelow upwardshad little difliculty tendon of the muscle

to

extent to

a

the

a

of bent

me

to

and

it in

serting it between the as it approached its insertion, and the sclesquint entirely gone.-liledicinisclae Zeilung; rotic coat. Thus, having the muscle on the and Brit. and FO1’. Medical Revietv, April, probe at my command, I allowed the eye to rest for a moment or two, and then, carefully 1840. and gently drawing the tendon towards the The following cases prove that British iuciston of the conjunctiva, I divided it with surgeons have already applied this beautiful a pair of common scissors, and withdrew and simple operation to the cure of stra- the Drobe. The eye soon resumed its normal position, bismus :and the axes of both harmoniously correDirisinn of the Internal Rectus Muscle for sponded. On the diB ision of the muscle the Strabismus- By P. BENNETT LUCAS, Esq. eye was not forcibly drawn outwards, it grareturned to its pince. The lids were dnally The bold and interesting application to the muscles of the human eye, by frofeasor now allowed to remain closed ; a layer of in cold water, was placed over Dreffenbach, of the division of tendons for lint, dipped the them, powder was given, and following the cure of deformities, and the success child soon after fell asleep :which attended the operations performed by this eminent surgeon, induced me to repeat Colo- 2 grs.; their on the first occasions which presented James’s powder, 3 grs. themselves to me. 12. Both eyes are perfectly straight, and CASE t.-Mary Anne Daly, aged 6, was follow each other’s movements with reguborn with her eyes perfectly straight. After larity. The child’s bowels have been moved

the

the measles she suffered much from repfated attacks of strumous ophthalmia, on being cured of which it was found that her right eye was permanently turned deeply into the inner canthus, with also a slight decree of obliquity upwards. The strabismus has ex isted for three years. When the unaffected eye is closed the turned-in one endeavours to right itself, and the child, by an effort, can erect it as far as the centre of the orhital axis, but it speedily returns to its abnornal condition. ’rhe chrlrl is powerfully strong, of very fuit habit, and of a strumous diathesis. April 1t, 1840. In the presence, and with the kmd assistance of Mr. Fuzmaurice, Mr. Wardrop, jon., and Mr. Alexander, I pro. ceeded to perform the operation for the division of the interna) rectus muscle, in the follow ing manner. The Child was received in the lap of one assistant, and her head al1owf’d to rest on his right arm and che!-t, ivy which it was partsrally s-etirefi. Theeyetids Were kept apart by Mr. Fitzmaurice, and the struggles were prevented as much as possible. With a forceps and an artificial pupil

three times, and in all respects she is free from fever and excitement.

I have performed this operation in two other cases, without any material deviation.. One in a child, five years old, was equally In the other, that of an old successful. woman of sixty, it was unattended with henefit to the strabismus, which was of

fifty

years’ standing. particulars of these

seven

The

cases,

together

observation on the anatomy and physiology of the muscles of the human eye, I shall lay before the readers of THE LANCET in due course. It was at the saggestion of my friend, Dr. Hingeston, who assisted me in the operation upon the elderly patient, that I substituted the bent probe for the hooks, as recommended b) Dieffenbach.

with

some

London, April S,

1840.