_Of Squinting._
Though this is a subject which well deserves our particular attention, yet having spoken of such a variety of subjects in the preceding part of this lecture, I have not time for many observations on this. I shall just mention the princ.i.p.al opinions, concerning the cause of this deformity, and point out that which seems to me most probable. This subject is certainly very worthy the attention of the physician, as it is a case concerning which he may often be consulted, and which it may be sometimes in his power to cure.
A person is said to squint, when the axes of both his eyes are not directed to the same object.
This defect consists in the wrong direction of one of the eyes only.
I have never met with an instance in which both eyes had a wrong direction, neither have I seen one accurately described by any author.
The generality of writers on this subject have supposed this defect to proceed from a disease of, or want of proper correspondence in, the muscles of the eyes, which not acting in proper concert with one another, as in persons free from this blemish, are not able to point both eyes to the same object. But this, I think, is very seldom the cause, for when the other eye is shut, the distorted eye can be moved by the action of its muscles, in all possible directions, as freely as that of any other person, which shows that it is not owing to a defect in the muscles, neither is it owing to a want of correspondence in the muscles of both eyes; for when both eyes are open, and the undistorted eye is moved in any direction whatever, the other always accompanies it, and is turned the same way at the same instant of time.
I shall next take notice of the hypothesis of M. de la Hire, who supposes, that in the generality of mankind, that part of the retina which is seated in and about the axis of the eye, is of a more delicate sense and perception than what the rest of the coat is endowed with; and therefore we direct both axes to the same object, chiefly in order to receive the picture on that part of the retina which can best perceive it; but in persons who squint, he conceives the most sensible part of the retina of one eye, not to be placed in the axis, but at some distance from it: and that, therefore, this more sensible part of the retina is turned towards the object, to which the other eye is directed, and thus causes squinting. This ingenious hypothesis has been followed by Dr. Boerhaave, and many other eminent physicians. If it be true, then if the sound eye be shut, and the distorted eye alone be used to look at an object, it must still be as much distorted as before, for the same reason: but the contrary is true in fact; for if you desire such a person to close his other eye and look at you with that which is usually distorted, he will immediately turn the axis of it directly towards you. If you bid him open the undistorted eye, and look at you with both eyes, you will find the axis of this last pointed at you and the other turned away, and drawn close to the nose, or perhaps to the upper eye lid. From these facts, and some others mentioned by Dr.
Jurin, I think we may conclude that this defect is seldom, if ever, occasioned by such a preternatural make of the eye, as M. de la Hire supposed.
From the most accurate observations it will appear, that by far the most common cause of squinting, is a defect in the distorted eye. Dr.
Reid examined above twenty people that squinted, and found in all of them a defect in the sight of one eye; M. Buffon likewise, from a great number of observations, has found that the true and original cause of this blemish, is an inequality in the goodness, or in the limits of distinct vision, in the two eyes. Dr. Porterfield says this is generally the case with people who squint; and I have found it so in all that I have had an opportunity of examining.
With regard to the nature of this defect, the distorted eye is sometimes more convex, and sometimes more flat, than the sound one; sometimes it does not depend upon the convexity, but upon a weakness, or some other affection, of the retina, of the nature of which we are ignorant.
It will be easy to conceive how this inequality of goodness in the two eyes, when in a certain degree, must necessarily occasion squinting, and that this blemish is not a bad habit, but a necessary one, which the person is obliged to learn, in order to see with advantage. When the eyes are equally good, an object will appear more distinct and clear when viewed with both eyes than with only one; but the difference is very little. The ingenious Dr. Jurin, who has made some beautiful experiments to ascertain this point, has shown, that when the eyes are equal in goodness, we see more distinctly with both than with one, by about one thirteenth part only. But M. Buffon has found that when the eyes are unequal, the case will be quite different. A small degree of inequality will make the object, when seen with the better eye alone, appear equally bright or clear, as when seen with both eyes; a little greater inequality will make the object appear less distinct when seen with both eyes, than when it is seen with the stronger eye alone; and a still greater inequality will render the object, when seen with both eyes, so confused, that in order to see it distinctly, one will be obliged to turn aside the weak eye, and put it into a situation where it cannot disturb the sight of the other. The truth of this may be easily proved by experiment. Let a person take a convex lens, and hold it about half an inch before one of his eyes; he will, by these means, render them very unequal. and if he attempt to read with both eyes, he will perceive a confusion in the letters, caused by this inequality; which confusion will disappear as soon as he shuts the eye which is covered with the lens, and looks only with the other.
Squinting is a necessary consequence of this inequality in the goodness of the two eyes; for a person whose eyes are to a certain degree unequal, finds that, when he looks at an object, he sees it very indistinctly; every conformation, or change of direction of his eyes which lessens the evil, will be agreeable; and he will acquire a habit of turning his eye towards the nose, not for the sake of seeing better with it, but in order to avoid, as much as possible, seeing at all with the distorted eye; for which purpose it will be drawn either under the upper eye lid, so that the pupil may be entirely or partially covered; or directly towards the nose, in which case the image of the object will fall at a distance from the axis of the eye: and it is a fact well known to philosophers, that we never naturally attend to an image which is at a distance from the axis; so that in this situation it will give little disturbance to the sight of the other.
It is easy to show that a squinting person very seldom, if ever, sees an object with the distorted eye. Indeed in above forty cases that I have examined, I found that when I placed an opaque body between the undistorted eye and the object, it immediately disappeared, nor were they able to see it at all, till they directed the axis of the distorted eye to the object. I find the same observation made by Dr.
Reid and M. Buffon.
M. Buffon takes notice of a fact which I have often observed; viz.
that many persons have their eyes very unequal without squinting.
When the difference is very considerable, the weak eye does not turn aside, because it can see almost nothing, and therefore cannot disturb the vision of the good eye. Also, when the inequality is but small, the weak eye will not turn aside, as it affords very little disturbance to the sight of the other: when the inequality consists in the difference of convexity, or difference of the limits of distinct vision, having the limits of distinct vision in each eye given, it may be calculated with some degree of accuracy what degree of inequality is necessary to produce squinting. It seems then that there are certain limits with regard to the inequality of the eyes, necessary to produce this deformity; and that if the inequality be either greater or less than these limits, the person will not squint.
Having now endeavoured to show what is the most common cause of squinting, I shall briefly attempt to point out those cases in which we may expect to effect a cure, and afterwards give a very short account of the most likely methods of doing it.
We cannot have great hopes of success, when there is a very great defect in the distorted eye. When the eyes are of different convexities, there is no other way of removing the deformity, than by bringing them to an equality by means of gla.s.ses, and then the person would only look straight when he used spectacles. When this defect is owing to a weakness in the distorted eye, it may sometimes be cured: M. Buffon observes that a weak eye acquires strength by exercise, and that many persons, whose squinting he had thought to be incurable, on account of the inequality of their eyes, having covered their good eye for a few minutes only, and consequently being obliged to exercise their bad one for that short time, were themselves surprised at the strength it had acquired, and on measuring their view afterwards, he found it to be more extended, and judged the squinting to be curable. In order therefore to judge with any certainty of the possibility of a cure, it ought always to be tried whether the distorted eye will grow better by exercise; if it does not, we can have little hopes of success; but when the eyes do not differ much in goodness, and it is found that the distorted eye acquires strength by exercise, a cure may then be attempted: and the best way of doing it, (according to M. Buffon) is to cover the good eye for some time, for, in this condition, the distorted eye will be obliged to act, and turn itself towards objects, which by degrees will become natural to it.
When the eyes are nearly brought to an equality by exercise, but cannot both be directed to the same point, Dr. Jurin"s method may be practised, which is as follows.
If the person is of such an age, as to be capable of observing directions, place him directly before you, and let him close the undistorted eye, and look at you with the other; when you find the axis of this fixed directly upon you, bid him endeavour to keep it in that situation, and open the other eye; you will now see the distorted eye turn away from you towards his nose, and the axis of the other will be pointed towards you, but with patience and repeated trials he will, by degrees, be able to keep the distorted eye fixed upon you, at least for some time after the other is opened, and when you have brought him to keep the axis of both eyes fixed upon you, as you stand directly before him, it will be time to change his posture, and set him, first a little to one side of you, and then to the other, and so practise the same thing. And when, in all these situations, he can perfectly and readily turn the axes of both eyes towards you, the cure is effected. An adult person may practice all this before a mirror, without a director, though not so easily as with one: but the older he is, the more patience will be necessary.
With regard to the success of this method, M. Buffon says, that having communicated his scheme to several persons, and, among others, to M. Bernard de Jussieu, he had the satisfaction to find his opinion confirmed by an experiment of that gentleman, which is related by Mr.
Allen, in his Synopsis Universae Medicinae. Dr. Jurin tells us that he had attempted a cure in this manner with flattering hopes of success, but was interrupted by the young gentleman"s falling ill of the small pox, of which he died. Dr. Reid likewise tried it with success on three young gentlemen, and had brought them to look straight when they were upon their guard. Upon the whole this seems by much the most rational method of attempting to cure the deformity.
The only remaining morbid affections of the eye which I shall take notice of in this lecture, are two, which produce the indistinct vision of an object, by directly opposite means. The first is caused by the cornea, and crystalline, or either of them, being too convex, or the distance between the retina and crystalline being too great.
It is evident, that from any of these causes, or all combined, the distinct picture of an object, at an ordinary distance, will fall before the retina, and therefore the picture on the retina itself must be confused, which will render the vision confused and indistinct; whence, in order to see things distinctly, people whose eyes are so formed are obliged to bring the object very near their eyes; by which means the rays fall upon the eye in a more diverging state, so that a distinct picture will be formed on the retina, by which the object will be distinctly seen: from the circ.u.mstance of such persons being obliged to hold objects near their eyes, in order to see them distinctly, they are called short sighted.
If a short sighted person look at an object through a small hole made in a card, he will be able to see even remote objects, with tolerable distinctness, for this lessens the circles of dissipation on the retina, and thus lessens the confusion in the picture. For the same purpose, we commonly observe short sighted people, when they wish to see distant objects more distinctly, almost shut their eye lids: and it is from this, says Dr. Porterfield, that short sighted persons were anciently called myopes.
The sight of myopes is remedied by a concave lens of proper concavity, which, by increasing the divergency of the rays, causes them to be united into a focus on the retina: and they do not require different gla.s.ses for different distances, for, if they have a lens which will make them see distinctly at the distance most commonly used by other persons, for example, at the distance at which persons whose eyes are good generally read, they will, by the help of the same gla.s.s, be able to see distinctly at all the distances at which good sighted people can see distinctly: for the cause of shortsightedness, is not a want of power to vary the conformation of the eye, but is owing to the whole quant.i.ty of refraction being too great for the distance of the retina from the cornea.
The other defect to be mentioned, is of an opposite nature, and persons labouring under it are called long sighted, or presbytae: it is caused by the cornea and crystalline, or either of them, being too flat in proportion to the distance between the crystalline and retina: whence it follows, that the rays which come from an object at an ordinary distance, will not be sufficiently refracted, and, consequently, will not meet at the retina, but beyond it, which will render the picture on the retina confused, and vision indistinct.
Whence, in order to read, such persons are obliged to remove the book to a great distance, which lessens the divergency of the rays falling on the eye, and makes them converge to a focus sooner, so as to paint a distinct image on the retina.
The presbytical eye is remedied by a convex lens of proper convexity, which makes the rays converge to a focus sooner, and thus causes distinct vision: the sight of such persons is even more benefited by a convex lens, than that of myopes by a concave one; for a convex lens not only makes the picture of the object on the retina distinct, but also more bright, by causing a greater quant.i.ty of light to enter the pupil; while a concave one, at the same time that it renders vision distinct, diminishes the quant.i.ty of light.
Long sighted persons commonly become more so as they advance in years, owing to a waste of the humours of the eye; and even many people whose sight was very good in their youth, cannot see without spectacles when they grow old. The same waste in the humours of the eye, is the reason why shortsighted persons commonly become less so as they advance in years; so that many who were shortsighted in their youth, come to see very distinctly when they grow old. Dr. Smith seems to doubt this, and thinks that it is rather a hypothesis than a matter of fact. I have however myself seen several instances in confirmation of it; and it is very natural to suppose, that since short and long sight depend upon directly opposite causes, and since the latter is increased by age, the former must be diminished by it.
LECTURE IX.
THE LAWS OF ANIMAL LIFE.
In the preceding lectures I have taken a view, first of the general structure and functions of the living body, and next of the different organs called senses, by means of which we become acquainted with external objects. I shall next endeavor to show that, through the medium of these different senses, external objects affect us in a still different manner, and by their different action, keep us alive: for the human body is not an automaton; its life, and its different actions, depend continually on impressions made upon it by external objects. When the action of these ceases, either from their being withdrawn, or from the organization necessary to perceive them, being deranged or injured, the body becomes a piece of dead matter; becomes obedient to the common laws of chemical attraction, and is decomposed into its pristine elements, which, uniting with caloric, form gases; which gases, being carried about in the atmosphere, or dissolved in water, are absorbed by plants, and contribute to their nourishment.
These are devoured by animals, which in their turn die, and are decompounded; thus, in the living world, as well as in the inanimate, every thing is subject to change, and to be renewed perpetually.
"Look nature through, "tis revolution all, All change, no death; day follows night; and night, The dying day; stars rise, and set, and rise; Earth takes th" example; see the summer gay, With her green chaplet, and ambrosial flowers, Droops into pallid autumn; winter gray, Horrid with frost, and turbulent with storm, Blows autumn and his golden fruits away, Then melts into the spring; soft spring with breath Favonian, from warm chambers of the south Recals the first. All to reflourish, fades; As in a wheel, all sinks to reascend."
The subject on which we are entering is of the utmost importance; for, by pointing out the manner in which life is supported and modified by the action of external powers, it discovers to us the true and only means of promoting health and longevity; for the action of these powers is generally within our own direction; and if the action of heat, food, air, and exercise, were properly regulated, we should have little to fear from the attacks of diseases.
When we examine the human body, the most curious and unaccountable circ.u.mstance that we observe, is its life, or its power of motion, sensation, and thought: for though the structure of the different parts which we have examined must excite our admiration and wonder, each part being admirably fitted for the performance of its different functions, yet without the breath of life, all these beautiful contrivances would have been useless. We have seen that the structure of the eye indicates in its contriver, the most consummate skill in optics; and of the ear the most perfect knowledge of sounds; yet if sensibility had not being given to the nerves which administer to these organs, the pulses of the air might have been communicated to the fluid in the labyrinth, and the rays of light might have formed images in the retina, without our being, in the smallest degree, conscious of their existence.
Though our efforts to discover the nature of life have hitherto been, and perhaps always will be, unsuccessful, yet we can, by a careful induction, or observation of facts, discover the laws by which it is governed, with respect to the action of external objects. This is what I shall now attempt to do.
The first observation which strikes us, is that of the very different effects that are produced when inanimate bodies act on each other, and when they exert their action on living matter.
When dead matter acts upon dead or inanimate matter, the only effects we perceive are mechanical, or chemical; that is, either motion, or the decomposition and new combination of their parts. If one ball strikes another, it communicates to it a certain quant.i.ty of motion, this is called mechanical action; and if a quant.i.ty of salt, or sugar, be put into water, the particles of salt, or sugar, will separate from each other, and join themselves to the particles of the water; these substances in these instances are said to act chemically on each other, and in all cases whatever, in which inanimate or dead bodies act on each other, the effects produced are motion, or chemical attraction; for though there may appear to be other species of action which sometimes take place, such as electric and magnetic attraction and repulsion, yet these are usually referred to the head of mechanical action or attraction.
But when dead matter acts upon those bodies we call living, the effects produced are much different. There are many animals which pa.s.s the winter in a torpid state which has all the appearance of death; and they would continue in that state, if deprived of the influence of heat; now heat if applied to dead matter, will only produce motion, or chemical combination: in fluids it produces motions by occasioning a change in their specific gravity; and we know that it is one of the most powerful agents in chemical combination and decomposition; but these are the only effects it produces when it acts upon dead matter. But let us examine its effects when applied to living organized bodies. Bring a snake or other torpid animal into a moderately warm room, and observe what will be the consequence. After a short time the animal begins to move, to open its eyes and mouth; and when it has been subject to the action of heat for a longer time, it crawls about in search of food, and performs all the functions of life.
Here then, dead matter, when applied to the living body, produces the living functions, sense and motion: for if the heat had not been applied, the animal would have continued senseless, and apparently lifeless.
In more perfect animals, the effects produced by the action of dead matter upon them, are more numerous, and are different in different living systems; but are in general the following; sense and motion in almost all animals, and in many the power of thinking, and other affections of the mind.
The powers, or dead matters, which by their action produce these functions, are chiefly heat, food, and air. The proof that these powers do produce the living functions is in my opinion very satisfactory, for when their action is suspended, the living functions cease. If we take away, for instance, heat, air, and food, from animals, they soon become dead matter. This is as strong a proof that these matters are the cause of the functions, as that heat is the cause of the expansion of bodies, when we find that by withdrawing it the expansion ceases. Indeed it is not necessary that an animal should be deprived of all these powers to put a stop to the living functions; if any one of them is taken away, the body sooner or later becomes dead matter: it is found by experience, that if a man is deprived of air, he dies in about three or four minutes; for instance, if he is immersed under water: if he is deprived of heat, or in other words is exposed to a very severe degree of cold, he likewise soon dies; or if he is deprived of food, his death is equally certain, though more slow; it is sufficiently evident then that the living functions are owing to the action of these external powers upon the body.
What I have here said is not confined to animals, but the living functions of vegetables are likewise caused by the action of dead matter upon them. The powers, which by their actions produce the living functions of vegetables, are princ.i.p.ally heat, moisture, light, and air.
From what has been said, it clearly follows, that living bodies must have some property different from dead matter, which renders them capable of being acted on by these external powers, so as to produce the living functions; for if they had not, it is evident that the only effects which these powers could produce, would be mechanical, or chemical.
Though we know not exactly in what this property consists, or in what manner it is acted on, yet we see that when bodies are possessed of it, they become capable of being acted on by external powers, so as to produce the living functions.
We may call this property, with Haller, irritability, or, with Brown, excitability; or we may use vital principle, or any other term, could we find one more appropriate. I shall use the term excitability, as perhaps the least liable to exception, and in using this term, it is necessary to mention that I mean only to express a fact, without the smallest intention of pointing out the nature of that property which distinguishes living from dead matter; and in this we have the ill.u.s.trious example of Newton, who called that property which causes bodies in certain situations to approach each other, gravitation, without in the least hinting at its nature. Yet though he knew not what gravitation was, he investigated the laws by which bodies were acted on by it, and thus solved a number of phenomena which were before inexplicable: in the same manner, though we are ignorant of the nature of excitability, or of the property which distinguishes living from dead matter, we can investigate the laws by which dead matter acts upon living bodies through this medium. We know not what magnetic attraction is, yet we can investigate its laws: the same may be observed with respect to electricity. If ever we should obtain a knowledge of the nature of this property, it would make no alteration in the laws which we had before discovered.
Before we proceed to the investigation of the laws by which the living principle or excitability is acted on, it will be first necessary to define some terms, which I shall have occasion to use, to avoid circ.u.mlocution: and here it may not be improper to observe, that most of our errors in reasoning have arisen from want of strict attention to this circ.u.mstance, the accurate definition of those terms which we use in our reasoning. We may use what terms we please, provided we accurately define them, and adhere strictly to the definition. On this depends the excellence and certainty of the mathematical sciences. The terms are few, and accurately defined; and in their different chains of reasoning mathematicians adhere with the most scrupulous strictness to the original definition of the terms.
If the same method were made use of in reasoning on other subjects, they would approach to the mathematics in simplicity and in truth, and the science of medicine in particular would be stripped of the heaps of learned rubbish which now enc.u.mber it, and would appear in true and native simplicity. Such is the method I propose to follow: I am certain of the rect.i.tude of the plan; of the success of the reasoning it does not become me to judge.
When the excitability is in such a state as to be very susceptible of the action of external powers, I shall call it abundant or acc.u.mulated; but when it is found in a state not very capable of receiving their action, I say it is deficient or exhausted. Let no one however suppose that by these terms I mean to hint in the least at the nature of the excitability. I do not mean by them that it is really at one time increased in quant.i.ty or magnitude, and at another time diminished: its abstract nature is by no means attempted to be investigated. These or similar terms the poverty or imperfection of language obliges us to use. We know nothing of the nature of the excitability or vital principle, and by the terms here used I mean only to say, that the excitability is sometimes easily acted on by the external powers, and then I call it abundant or acc.u.mulated; at other times the living body is with more difficulty excited, and then I say the vital principle or excitability, whatever it may be, is deficient or exhausted.
On examination we shall find the laws by which external powers act on living bodies to be the following.
First, when the powerful action of the exciting powers ceases for some time, the excitability acc.u.mulates, or becomes more capable of receiving their action, and is more powerfully affected by them.