Case of a Lady Born Blind, Who Received Sight at an Advanced Age by the Formation of an Artificial Pupil

XXXI. Case of a lady born blind, who received sight at an advanced age by the formation of an artificial pupil. By James Wardrop, Esq. F. R. S. Edin. Surgeon Extraordinary to the King, &c. Communicated by the President. Read June 15, 1826. As imperfections in the original structure of our organs of sense, which are remediable by art, are extremely rare, and as cases of successful operations on these organs essentially contribute to illustrate their functions, as well as to throw light on the operations and development of the human mind, the following instance of vision being imparted to a lady born blind, by an operation at an advanced period of life, will, it is hoped, not be considered unworthy of being submitted to the consideration of the Royal Society. The case, besides establishing the curious physiological fact, that the nerve of the eye can remain fit to receive the impressions of external objects, though totally excluded for a long series of years from the performance of that function, claims a much higher interest in a philosophical point of view; some of the facts here detailed confirming in a remarkable manner what Berkeley had predicated of "a man born blind being made to see," in the 79th Section of his "New Theory of Vision," published in the year 1709. He says, "a man born blind being made to see, would, at the first opening of his eyes, make very different judgements of the magnitude of objects intromitted by them from what others do. He would not consider the ideas of sight with reference to, or as having any connection with the idea of touch.” It may also be observed, that in the present case the blindness was more complete, and the period at which vision was acquired was much later in life, than in any instance which has hitherto been recorded. The lady, whose case forms the subject of this paper, was observed, during the first months of her infancy, to have something peculiar in the appearance of her eyes, and an unusual groping manner, which made her parents suspect that she had defective vision. When about six months old, she was placed under the care of a Parisian oculist, who performed an operation on both her eyes, with a view to afford her sight. The operation on the right eye was, however, followed by violent inflammation, and a collapse of the eye-ball, thus causing a complete destruction of the organ of vision. The operation on the left eye, though equally unsuccessful in attaining its object, was not followed by any alteration in the form or size of the globe. From the account stated by her friends, it was impossible to form any correct notion of the state of her eyes previous to the operations which were performed. It seems, however, extremely probable that the blindness, which was attempted to be remedied, had been produced by congenital cataracts, and that these operations had for their object the removal of the opaque lenses. From the above early period she had continued totally blind, being able merely to distinguish a very light from a very dark room, but without having the power to perceive even the situation of the window through which the light entered; though in sunshine or in bright moonlight, she knew the direction from whence the light emanated. With regard therefore to the degree of sight, this lady was more completely blind than the boy in the celebrated case related by Mr. Cheselden, in the 35th volume of the Transactions of the Royal Society; for in that instance the boy knew black, white, and scarlet apart from one another; and when in a good light he had that degree of sight, which generally continues in an eye affected with cataract; whereas in this lady, the pupil being completely shut up, no light could reach the retina, except such rays as could pass through the substance of the iris. When she was placed under my care she had reached her 46th year. The right eye-ball was collapsed, but the left retained its natural globular form. The cornea of this eye was transparent, except at one point near its circumference, where there was a linear opacity, which had probably been the cicatrix of the wound made during the operation in her infancy. The anterior chamber of the eye was of its natural capacity, but I could not distinguish any vestige of a pupil, some streaks of yellow lymph being deposited in an irregular manner over the central part of the iris. There was every reason to believe that the retina was sound; for though she could not perceive objects, nor had any notion of colours, yet the circumstance already mentioned of her being able to distinguish between a very light and a very dark chamber, and between a gloomy day and sunshine, rendered it probable that the nerve was in a sound and natural state. Under this impression, I thought that the restoration of her sight by making an artificial pupil was practicable, and certainly well worthy of a trial. Accordingly, on the 26th of January, I introduced a very small needle through the cornea, passing it also through the centre of the iris; but I could not destroy any of the adhesions which had shut up the pupillary opening. After this operation she said she could distinguish more light, but she could perceive neither forms nor colours. The result of this first attempt justified the favourable views entertained of the state of the retina, and Mr. Lawrence, who at this time was consulted, coincided with me in this opinion. On the 8th of February, a second operation was performed, which consisted in passing a sharp edged needle through the sclerotica, bringing its point through the iris into the anterior chamber, repassing it into the posterior chamber at a small distance, and then dividing the portion of iris thus included between the two perforations of the needle. Only a very slight inflammation followed,—the light became offensive to her,—she complained of its brightness, and was frequently observed trying to see her hands; but it was evident her vision was very imperfect; for although there was an incision made in the iris, some opaque matter lay behind this opening, which must have greatly obstructed the entrance of light. On the 17th of February, a third operation was performed, which consisted in still further enlarging the opening in the iris, and in removing the opaque matter, by a needle introduced through the sclerotica. This was followed by a very slight degree of redness. The operation being performed at my house, she returned home in a carriage, with her eye covered only with a loose piece of silk, and the first thing she noticed was a hackney coach passing, when she exclaimed, "What is that large thing that has passed by us?" In the course of the evening she requested her brother to show her his watch, concerning which she expressed much curiosity, and she looked at it a considerable time, holding it close to her eye. She was asked what she saw, and she said there was a dark and a bright side; she pointed to the hour of 12, and smiled. Her brother asked her if she saw anything more? she replied, "Yes," and pointed to the hour of 6, and to the hands of the watch. She then looked at the chain and seals, and observed that one of the seals was bright, which was the case, being a solid piece of rock crystal. The following day I asked her to look again at the watch, which she refused to do, saying, that the light was offensive to her eye, and that she felt very stupid; meaning that she was much confused by the visible world thus for the first time opened to her. On the third day she observed the doors on the opposite side of the street, and asked if they were red, but they were in fact of an oak colour. In the evening she looked at her brother's face, and said that she saw his nose; he asked her to touch it, which she did; he then slipped a handkerchief over his face, and asked her to look again, when she playfully pulled it off, and asked, "What is that?" On the sixth day, she told us that she saw better than she had done on any preceding day; "but I cannot tell what I do see; I am quite stupid." She seemed indeed bewildered from not being able to combine the knowledge acquired by the senses of touch and sight, and felt disappointed in not having the power of distinguishing at once by her eye, objects which she could so readily distinguish from one another by feeling them. On the seventh day she took notice of the mistress of the house in which she lodged, and observed that she was tall. She asked what the colour of her gown was? to which she was answered, that it was blue: "so is that thing on your head," she then observed; which was the case: "and your handkerchief, that is a different colour;" which was also correct. She added, "I see you pretty well, I think." The teacups and saucers underwent an examination: "what are they like?" her brother asked her. "I don't know," she replied; "they look very queer to me; but I can tell what they are in a minute when I touch them." She distinguished an orange on the chimney-piece, but could form no notion of what it was till she touched it. She seemed now to have become more cheerful, and entertained greater expectation of comfort from her admission into the visible world; and she was very sanguine that she would find her newly acquired faculty of more use to her when she returned home, where every thing was familiar to her. On the eighth day, she asked her brother, when at dinner, "what he was helping himself to?" and when she was told it was a glass of port wine, she replied, "port wine is dark, and looks to me very ugly." She observed, when candles were brought into the room, her brother's face in the mirror, as well as that of a lady who was present; she also walked, for the first time without assistance, from her chair to a sopha which was on the opposite side of the room, and back again to the chair. When at tea, she took notice of the tray, observed the shining of the japan work, and asked "what the colour was round the edge?" she was told that it was yellow; upon which she remarked, "I will know that again." On the ninth day she came down stairs to breakfast in great spirits; she said to her brother, "I see you very well to-day;" and came up to him, and shook hands. She also observed a ticket on a window of a house on the opposite side of the street ("a lodging to let"); and her brother, to convince himself of her seeing it, took her to the window three several times, and to his surprise and gratification, she pointed it out to him distinctly on each trial. She spent a great part of the eleventh day looking out of the window, and spoke very little. On the twelfth day she was advised to walk out, which recommendation pleased her much. Mr.—— called on her, and she told him she felt quite happy. Her brother walked out with her as her guide, and took her twice round the piazzas of Covent-garden. She appeared much surprised, but apparently delighted; the clear blue sky first attracted her notice, and she said, "it is the prettiest thing I have ever seen yet, and equally pretty every time I turn round and look at it." She distinguished the street from the foot pavement distinctly, and stepped from one to the other like a person accustomed to the use of her eyes. Her great curiosity, and the manner in which she stared at the variety of objects, and pointed to them, exciting the observation of many bystanders, her brother soon conducted her home, much against her will. On the thirteenth day nothing particular took place till tea-time, when she observed that there was a different tea-tray, and that it was not a pretty one, but had a dark border; which was a correct description. Her brother asked her to look in the mirror, and tell him if she saw his face in it? to which she answered, evidently disconcerted, "I see my own; let me go away." She drove in a carriage, on the fourteenth day, four miles on the Wandsworth road; admired most the sky and the fields, noticed the trees, and likewise the river Thames as she crossed Vauxhall bridge. At this time it was bright sunshine, and she said something dazzled her when she looked on the water. On the fifteenth day, being Sunday, she walked to a chapel at some distance, and now evidently saw more distinctly, but appeared more confused than when her sight was less perfect. The people passing on the pavement startled her; and once when a gentleman was going past her, who had a white waistcoat and a blue coat with yellow buttons, which the sunshine brought full in her view, she started so as to draw her brother, who was walking with her, off the pavement. She distinguished the clergyman moving his hands in the pulpit, and observed that he held something in them; this was a white handkerchief. She went in a coach, on the sixteenth day, to pay a visit in a distant part of the town, and appeared much entertained with the bustle in the streets. On asking her how she saw on that day? she answered, "I see a great deal, if I could only tell what I do see; but surely I am very stupid." Nothing particular took place on the seventeenth day; and when her brother asked her how she was? she replied, "I am well, and see better; but don't tease me with too many questions, till I have learned a little better how to make use of my eye. All that I can say is, that I am sure, from what I do see, a great change has taken place; but I cannot describe what I feel." Eighteen days after the last operation had been performed, I attempted to ascertain by a few experiments her precise notions of the colour, size, forms, position, motions and distances of external objects. As she could only see with one eye, nothing could be ascertained respecting the question of double vision. She evidently saw the difference of colours; that is, she received and was sensible of different impressions from different colours. When pieces of paper one and a half inch square, differently coloured, were presented to her, she not only distinguished them at once from one another, but gave a decided preference to some colours, liking yellow most, and then pale pink. It may be here mentioned, that when desirous of examining an object, she had considerable difficulty in directing her eye to it, and finding out its position, moving her hand as well as her eye in various directions, as a person when blind-folded, or in the dark, gropes with his hands for what he wishes to touch. She also distinguished a large from a small object, when they were both held up before her for comparison. She said she saw different forms in various objects which were shown to her. On asking what she meant by different forms, such as long, round and square, and desiring her to draw with her finger these forms on her other hand, and then presenting to her eye the respective forms, she pointed to them exactly: she not only distinguished small from large objects, but knew what was meant by above and below; to prove which, a figure drawn with ink was placed before her eye, having one end broad, and the other narrow, and she saw the positions as they really were, and not inverted. She could also perceive motions; for when a glass of water was placed on the table before her, on approaching her hand near it, it was moved quickly to a greater distance, upon which she immediately said, "You move it; you take it away." She seemed to have the greatest difficulty in finding out the distance of any object; for when an object was held close to her eye, she would search for it by stretching her hand far beyond its position, while on other occasions she groped close to her own face, for a thing far removed from her. She learned with facility the names of the different colours, and two days after the coloured papers had been shown to her, on coming into a room the colour of which was crimson, she observed that it was red. She also observed some pictures hanging on the red wall of the room in which she was sitting, distinguishing several small figures in them, but not knowing what they represented, and admiring the gilt frames. On the same day, she walked round the pond in the centre of St. James's square, and was pleased with the glistening of the sun's rays on the water, as well as with the blue sky and green shrubs, the colours of which she named correctly. It may be here observed, that she had yet acquired by the use of her sight but very little knowledge of any forms, and was unable to apply the information gained by this new sense, and to compare it with what she had been accustomed to acquire by her sense of touch. When, therefore, the experiment was made of giving her a silver pencil case and a large key to examine with her hands; she discriminated and knew each distinctly; but when they were placed on the table, side by side, though she distinguished each with her eye, yet she could not tell which was the pencil case and which was the key. Nothing farther occurred in the history of this lady's case worthy of notice till the twenty-fifth day after the operation. On that day she drove in a carriage for an hour in the Regent's Park, and on her way there seemed more amused than usual, and asked more questions about the objects surrounding her, such as "What is that?" it is a soldier, she was answered; "and that, see! see!" these were candles of various colours at a tallow chandler's window. "Who is that, that has passed us just now?" it was a person on horseback: "but what is that on the pavement, red?" it was some ladies who wore red shawls. On going into the Park, she was asked what she saw particularly, or if she could guess what any of the objects were. "Oh yes," she replied, "there is the sky, that is the grass; yonder is water, and two white things;" which were two swans. On coming home along Piccadilly, the jewellers' shops seemed to surprise her much, and her expressions made those around her laugh heartily. From this period till the time of her leaving London on the 31st of March, being forty-two days after the operation, she continued almost daily to gain more information of the visible world, but she had yet much to learn. She had acquired a pretty accurate notion of colours and their different shades and names; and when she came to pay me a farewell visit, she then wore a gown, the first of her own choice, with the light purple colour of which she seemed highly gratified, as well as with her cap, which was ornamented with red ribbons. She had not yet acquired any thing like an accurate knowledge of distance or of forms, and up to this period she continued to be very much confused with every object at which she looked. Neither was she yet able, without considerable difficulty and numerous fruitless trials, to direct her eye to an object; so that when she attempted to look at any thing, she turned her head in various directions, until her eye caught the object of which it was in search. She still entertained however the same hope which she expressed soon after the operation, that when she got home her knowledge of external things would be more accurate and intelligible, and that when she came to look at those objects which had been so long familiar to her touch, the confusion which the multiplicity of external objects now caused, would in a great measure subside. May, 1826.