There are many cases of complete or partial blindness which might have
been prevented, and a knowledge of the best methods of prevention and
cure should be spread as widely as possible. Magnus, Bremer, Steffen and
Rossler are of opinion that 40% of the cases of blindness might have
been prevented. Hayes gives 33.35% as positively avoidable, 38.75%
possibly avoidable, and 46.27% as a conservative estimate. Cohn regards
blindness as certainly preventable in 33%, as probably preventable in
43%, and as quite unpreventable in only 24%. If we take the lowest of
these figures, and assume that 400 out of every 1000 blind persons might
have been saved from such a calamity, we realize the importance of
preventative measures. For the physiology and pathology of the eye
generally, see VISION and EYE.
Ophthalmia.
The great majority of these cases are due to infantile purulent
ophthalmia. This arises from inoculation of the eyes with hurtful
material at time of birth. If the contagious discharges are allowed to
remain, violent inflammation is set up which usually ends in the loss of
sight. It depends on the presence of a microbe, and the effective
application of a weak solution of nitrate of silver is curative, if made
in a proper manner at an early period of the case. In Germany, midwives
are expressly prohibited by law from treating any affection of the eyes
or eyelids of infants, however slight. On the appearance of the first
symptoms, they are required to represent to the parents, or others in
charge, that medical assistance is urgently needed, or, if necessary,
they are themselves to report to the local authorities and the district
doctor. Neglect of these regulations entails liability to punishment.
Eleven of the United States of America have enacted laws requiring that,
if one or both eyes of an infant should become inflamed, swollen or
reddened at any time within two weeks of its birth, it shall be the duty
of the midwife or nurse having charge of such infant to report in
writing within six hours, to the health officer or some legally
qualified physician, the fact that such inflammation, swelling or
redness exists. The penalty for failure to comply is fine or
imprisonment.
The following weighty words, from a paper prepared by Dr Park Lewis, of
Buffalo, N.Y., for the American Medical Association, show that laws are
not sufficient to prevent evil, unless supported by strong public
sentiment:--
"When an enlightened, civilized and progressive nation quietly and
passively, year after year, permits a multitude of its people
unnecessarily to become blind, and more especially when one-quarter
of these are infants, the reason for such a startling condition of
affairs demands explanation. That such is the fact, practically all
reliable ophthalmologists agree.
"From a summary of carefully tabulated statistics it has been
demonstrated that at least four-tenths of all existing blindness might
have been avoided had proper preventative or curative measures been
employed, while one-quarter of this, or one-tenth of the whole, is due
to _ophthalmia neonatorum_, an infectious, preventable and almost
absolutely curable disease. Perhaps this statement will take on a new
meaning when it is added that there are in the state of New York alone
more than 6000, and in the United States more than 50,000 blind
people; of these 600 in the one state, and 5000 in the country, would
have been saved from lives of darkness and unhappiness, in having lost
all the joys that come through sight, and of more or less complete
dependence--for no individual can be as self-sufficient without as
with eyes--if a simple, safe and easily applied precautionary measure
had been taken at the right time and in the right way to prevent this
affliction. The following three vital facts are not questioned, but
are universally accepted by those qualified to know:--
"1. The ophthalmia of infancy is an infectious germ disease.
"2. By the instillation of a silver salt in the eyes of a new-born
infant the disease is prevented from developing in all but an
exceedingly small number of the cases in which it would otherwise have
appeared.
"3. In practically all those few exceptional cases the disease is
absolutely curable, if like treatment is employed at a sufficiently
early period.
"Since these facts are no longer subjects of discussion, but are
universally accepted by all educated medical men, the natural inquiry
follows: Why, as a common-sense proposition, are not these simple,
harmless, preventive measures invariably employed, and why, in
consequence of this neglect, does a nation sit quietly and
indifferently by, making no attempt to prevent this enormous and
needless waste of human eyes?
"The reasons are three-fold, and lie--first, with the medical
profession; second, with the lay public; third, with the state.
"For the education of its blind children annually New York alone pays
_per capita_ at least $350, and a yearly gross sum amounting to much
more than $100,000. If, as sometimes happens, the blind citizen is a
dependent throughout a long life, the cost of maintenance is not less
than $10,000, and the mere cost in money will be multiplied many times
in that a productive factor, by reason of blindness, has been removed
from the community.
"If, therefore, as an economic proposition, it were realized how
vitally it concerns the state that not one child shall needlessly
become blind, thereby increasing the public financial burden, there is
no doubt that early and effective measures would be instituted to
protect the state from this unnecessary and extravagant expenditure of
public funds.
"Eleven states have passed legislative enactments requiring that the
midwife shall report each case to the proper health authority, and
affixing a penalty for the failure to do so. As has been intimated,
however, it is not by any means always under the ministration of
midwives that these cases occur, and, like all laws behind which is
not a strong and well-informed public sentiment, this law is rarely
enforced. A more effective method must be devised. Every physician
having to do with the parturient woman, every obstetrician, every
midwife, must be frequently and constantly advised of the dangers and
possibilities of this disease, the necessity of prevention, and the
value of early and correct treatment. They must then have placed in
their hands, ready for instant use, a safe and efficient preparation,
issued by the health authorities as a guarantee as to its quality and
efficiency.
"An important step was taken in this direction when a resolution was
passed by the House of Delegates at the annual meeting of the New York
State Medical Society, requesting the various health officers of the
state to include _ophthalmia neonatorum_ among contagious diseases
which must be reported to the local boards of health.
"The second essential, in order that the cause of infantile ophthalmia
be abolished, is that a solution of the necessary silver salt be
prepared under the authority of somebody capable of inspiring
universal confidence, and that it be distributed by the health
department of every state gratuitously to every obstetrician,
physician or midwife qualified to care for the parturient woman. The
nature of the solution, together with the character of the descriptive
card which should accompany it, should be determined by a committee,
chosen by the president of the American Medical Association, which
should have among its members at least one representative
ophthalmologist, one obstetrician and one sanitarian. The conclusions
of this committee should be reported back to the House of Delegates,
so that the preparation and its text should carry with it, on the
great authority of this association, the assurance that the solution
is entirely safe and necessary, and that its use should invariably be
part of the toilet of every new-born child. The solution, probably
silver nitrate, could be put up either by the state itself or by some
trustworthy pharmacist, at an insignificant cost; its purity and
sterility should be vouched for by the board of health of the state.
It should be enclosed in specially prepared receptacles, each
containing a special quantity, and so arranged that it may be used
drop by drop. These, properly enclosed, accompanied by a brief lucid
explanation of the danger of the disease, the necessity of this
germicide, the method of its employment, and the right subsequent care
of the eyes, should be sent to the obstetrician on the receipt of each
birth certificate.
"I have said that responsibility for the indifference that is annually
resulting in such frightful disaster lies primarily with the state,
the public and the medical profession.
"The state is already aroused to the necessity of taking effective
measures to wipe out this controllable plague. Bills have been
introduced in the legislature of Massachusetts and of New York,
providing for the appointment of commissions for the blind, one of
whose duties will be to study the causes of unnecessary blindness and
to suggest preventative measures."
Trachoma.
One of the most common diseases of the eye is trachoma, often called
"granular lids," because the inner surface of the lid seems to be
covered with little granulations. The disease sometimes lasts for years
without causing blindness, though it gives rise to great irritation. It
is generally attended by a discharge, which is highly contagious,
producing the same disease if it gets into other eyes. Want of
cleanliness is one of the most important factors in the propagation of
trachoma, hence its great prevalence in Oriental countries. Trachoma is
very prevalent in Egypt, where those suffering from total or partial
blindness are said to amount to 10% of the population. During Napoleon's
Egyptian campaign, nearly every soldier, out of an army of 32,000 men,
was affected. During the following twenty years the disease spread
through almost all European armies. In the Belgian army, there was one
trachomatous soldier out of every five, and up to 1834 no less than 4000
soldiers had lost both eyes and 10,000 one eye. It is a disease which is
very common in workhouse schools, orphan asylums and similar
establishments. Unlike ophthalmia of new-born children, it is difficult
to cure, and a total separation of the diseased from the healthy
children should be effected.
Sympathetic inflammation.
About one-half of those who are blinded by injuries lose the second eye
by sympathetic ophthalmia. It is a constant source of danger to those
who retain an eye blinded by injury. Blindness from this cause can be
prevented by the removal of the injured eye, but unfortunately the
proposal often meets with opposition from the patient.
Glaucoma.
Glaucoma is a disease which almost invariably leads to total blindness;
but in most cases it can be arrested by a simple operation if the case
is seen sufficiently early.
Short-sight.
Myopia, or "short-sight," makes itself apparent in children between the
ages of seven and nine. Neglect of a year or two may do serious
mischief. Short-sight, when not inherited, is produced by looking
intently and continuously at near objects. Children should be encouraged
to describe objects at a distance, with which they are unacquainted, and
parents should choose out-door occupations and amusements for children
who show a tendency to shortsightedness.
A report was issued in 1906, by the school board of Glasgow, as to an
investigation by Dr H. Wright Thomas, ophthalmic surgeon, regarding the
eyesight of school children, which includes the following passage. Dr
Wright Thomas states that the teachers tested the visual acuteness of
52,493 children, and found 18,565, or 35%, to be below what is regarded
as the normal standard. He examined the 18,565 defectives by
retinoscopy, and found that 11,209, or 21% of the whole, had ocular
defects. The proportion of these cases was highest in the poor and
closely-built districts and in old schools, and was lowest in the
better-class schools and those near the outskirts of the city. Defective
vision, apart from ocular defect, seems to be due partly to want of
training of the eyes for distant objects and partly to exhaustion of the
eyes, which is easily induced when work is carried on in bad light, or
the nutrition of the children is defective from bad feeding and
unhealthy surroundings. Regarding training of the eyes for distant
objects, much might be done in the infant department by the total
abolition of sewing, which is definitely hurtful to such young eyes, and
the substitution of competitive games involving the recognition of
small objects at a distance of 20 ft. or more. An annual testing by the
teachers, followed by medical inspection of the children found
defective, would soon cause all existing defects to be corrected, and
would lead to the detection of those which develop during school life.