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IV. Observations relative to the near and distant Sight of different
Persons. By James Ware, Esq. F. R. S.
Read November 19, 1812.
The fact that near sightedness most commonly commences at an early period of life, and distant sightedness generally at an advanced age, is universally admitted. Exceptions, however, to these rules so frequently occur, that I fatter myself a brief statement of some of the coincident circumstances, attendant on these different imperfections in vision, may not be found wholly undeserving the attention of the Royal Society. Near sightedness usually comes on between the ages of ten and eighteen. The discovery of it most commonly arises from accident; and, at first, the inconvenience it occasions little, that it is not improbable the imperfection would remain altogether unnoticed, if a comparison were not instituted with the sight of others, or if the experiment were not made of looking through a concave glass. Among persons in the inferior stations of society, means are rarely resorted to for correcting slight defects of this nature; and, indeed, I have reason to believe the imperfection in such people is not unfrequently overcome by the increased exertions that are made by the eye to distinguish distant objects. This, however, is not the case, in the present day, with persons in the higher ranks of life. When these discover that their discernment of distant objects is less quick or less correct than that of others,
though the difference may be very slight, influenced perhaps by fashion more than by necessity, they immediately have recourse to a concave glass; the natural consequence of which is, that their eyes in a short time become so fixed in the state requiring its assistance, that the recovery of distant vision is rendered afterwards extremely difficult, if not quite impossible. With regard to the proportion between the number of near sighted persons in the different ranks of society, I have taken pains to obtain satisfactory information, by making inquiry in those places where a large number in these several classes are associated together. I have inquired, for instance, of the surgeons of the three regiments of foot guards, which consist of nearly ten thousand men; and the result has been, that near sightedness, among the privates, is almost utterly unknown. Not half a dozen men have been discharged, nor half a dozen recruits rejected, on account of this imperfection, in the space of nearly twenty years: and yet many parts of a soldier's duty require him to have a tolerably correct view of distant objects; as of the movements of the fugleman in exercise, and of the bull's eye when shooting at the target; the want of which might furnish a plausible apology for a skulker to skreen himself from duty, or to get his discharge from the service. I pursued my inquiries at the military school at Chelsea, where there are thirteen hundred children, and found that the complaint of near sightedness had never been made among them until I mentioned it; and there were then only three who experienced the least inconvenience from it. After this, I inquired at several of the colleges in Oxford and Cambridge; and, though there is a great diversity in the number of students who make use of glasses in the various
colleges, they are used by a considerable proportion of the whole number in both Universities; and, in one college in Oxford, I have a list of the names of not less than thirty-two out of one hundred and twenty-seven, who wore either a hand glass or spectacles, between the years 1803 and 1807. It is not improbable, that some of these were induced to do it solely because the practice was fashionable; but, I believe, the number of such is inconsiderable, when compared with that of those whose. sight received some small assistance from them, though this assistance could have been dispensed with, without inconvenience, if the practice had not been introduced. The misfortune resulting from the use of concave glasses is this, that the near sightedness is not only fixed by it, but a habit of inquiry is induced with regard to the extreme perfection of vision; and, in consequence of this, frequent changes are made for glasses that are more and more concave, until at length the near sightedness becomes so considerable, as to be rendered seriously inconvenient and afflicting. It should be remembered, that, for common purposes, every near sighted eye can see with nearly equal accuracy through two glasses, one of which is one number deeper than the other; and though the sight be in a slight degree more assisted by the deepest of these than by the other, yet on its being first used, the deepest number always occasions an uneasy sensation, as if the eye was strained. If, therefore, the glass that is most concave be at first employed, the eye, in a little time, will be accommodated to it, and then a glass one number deeper may be used with similar advantage to the sight; and if the wish for enjoying the most perfect vision be indulged, this glass may soon be changed for one that is a number still deeper, and so MDCCCXIII.
in succession, until at length it will be difficult to obtain a glass sufficiently concave to afford the assistance that the eye requires.*
Although near sightedness is in general gradual in its progress, instances occasionally occur of its existence, in a considerable degree, even in children; in whom it is sometimes discovered almost as soon as they begin to take notice of the objects around them. This may be occasioned by some degree of opacity in the transparent parts of the eye; but such a cause of near sightedness is easily discovered by an examination, and is quite different from that state of the eye to which the term myopia, or near sightedness, is usually applied; by which is simply meant, too great a convexity either in the cornea or in the crystalline, in proportion to the distance of these parts from the retina. In such cases of extreme near sightedness in children, it is sometimes necessary to deviate from a rule, which in slighter cases I always follow, of discouraging the use of spectacles; since without their assistance, it would be impossible for them to prosecute their learning with ease or convenience.
Extreme near sightedness is sometimes occasioned by an evident change in the spherical figure of the cornea, and its assumption of a conical shape. This morbid state of the cornea is not only productive of near sightedness, but when the projection is considerable, vision is so much confused, that it affords little or no service, and cannot be amended by any glass. The cornea, in most of these cases, is preternaturally
* I have observed, that most of the near sighted persons, with whom I have had an opportunity of conversing, have had the right eye more near sighted than the left; and I think it not improbable, that this difference between the two eyes has been occasioned by the habit of using a single concave hand-glass; which, being most commonly applied to the right eye, contributes, agreeably to the remark abovementioned, to render this eye more near sighted than the other.
, thin, and not unfrequently it is accompanied with symptoms of general debility; under which last circumstance chalybeate medicines, and bracing applications to the eye, have been found to afford considerable benefit.
Near sightedness, to an alarming degree, has sometimes attacked young persons suddenly. A remarkable case of this kind came under my notice a few years ago in a young gentleman at Westminster school, who had been attended by Sir GEORGE Baker and Mr. SUTHERLAND, on account of a variety of anomalous nervous symptoms. These had wholly left him before I was consulted; and the consultation with me was solely for the purpose of determining whether he might be permitted to make use of concave glasses, and to return to the business of the school. The patient's health at that time not being perfectly restored, it was thought adviseable to send him for a few weeks into the country, and to postpone the use of glasses. This advice was followed; but in ten days the afflicted youth died suddenly. No anatomical examination of the head was permitted by the relatives. It seems, however, probable, that the near sightedness, as well as the previous indisposition, no less than the death of the patient, were occasioned by the pressure of a morbid substance of some kind or other on the source of the nerves in the brain.
Near sightedness is seldom alike in the two eyes, and a few cases have come under my observation, in which one eye of