Stephenson as "an inflammatory disease of the conjunctiva, usually
appearing within the first few days of life, due to the action of a
pus-producing germ introduced into the eyes of the infant at birth." Dr
Crede found that, by putting two drops of the solution into each of the
infant's eyes at birth, all danger of infection was averted. The
solution is harmless to healthy eyes, and, in ninety-nine cases out of a
hundred, destroys infecting germs when they are present. The cost of the
drops is nominal, about two cents per patient, and yet over ten thousand
persons in the United States, and as many more in other countries, have
been deprived of the most important of the special senses through the
ignorance and neglect of doctors and midwives, and the public at large,
as to the gravity of the disease, and the methods of prevention. It is
estimated that twenty babies in every one thousand have sore eyes, and
that from five to eight of these cases are serious, and capable of
causing blindness. Infant ophthalmia is found among all classes, but
more especially among the poor, who must so often depend upon the
services of a midwife or neighbor who, in most instances, does not know
the meaning of the word antiseptic. Consequently, it was found necessary
to make laws for the prevention of this disease. For various reasons, it
is difficult to pass a law making the use of a prophylaxis compulsory,
and in only a few states has this been done. But in more than thirty
states the immediate reporting of infants' sore eyes is compulsory, and
in thirteen states the prophylaxis is distributed free to doctors and
midwives.
In our own state, every precaution is taken to prevent infant
ophthalmia. Dr Edward F. Glaser, secretary of the State Board of Health,
has given this subject unlimited time and study, and, with the help of
the California State Library, California Society for the Prevention of
Blindness, and many social and civic organizations, has conducted a
continuous campaign, and has succeeded in passing a law which is both
simple and effective, and which has resulted in lowering the percentage
of infantile blindness, and in arousing the public to a sense of its
duty in this regard. Dr Glaser and the above-named organizations have
also rendered yeoman service in securing the passage of laws prohibiting
the use of a roller towel, and for the licensing and registering of
midwives.
In this state, the law for the prevention of infant ophthalmia provides
for the immediate reporting of every case of babies' sore eyes, and
failure to do so is considered a misdemeanor, and a third offense
results in the revocation of the license to practice medicine. In 1915,
the State Board of Health purchased 23,000 prophylactic outfits. These
are little wax ampules, containing just enough one per cent nitrate of
silver solution for the eyes of a child at birth. These ampules are
distributed free to physicians and midwives all over the state, and in
the past two years, more than 16,000 have been so distributed. In
California, the birth certificate asks these questions: "Was a
prophylactic for ophthalmia neonatorum used? If so, what?" The birth
certificate must be filed within five days. Few doctors have the
temerity to ignore these questions, or confess that they have used no
prophylactic, so the questions on the certificate insure the use of the
nitrate of silver solution in nine cases out of ten, though its use at
birth is not made compulsory. Dr Glaser reports that the birth
certificates in fourteen of the largest cities of the state, for the
year 1917, show that on eighty-seven per cent of the certificates filed,
the questions had been answered, and the prophylactic used. In Berkeley,
every one of the birth certificates filed in 1917 reported the use of a
prophylactic. The State Board of Health insists on the reporting of all
communicable diseases, and infant ophthalmia is considered one of these,
and in this connection, Dr Glaser says, "a case reported is a case
safeguarded, a physician aided, and a community protected." But it is
necessary to urge a ceaseless warfare against this most prolific cause
of infantile blindness, and social and civic organizations, churches,
schools, and all individuals who deplore needless suffering, are asked
to give the subject the widest publicity. Physicians are only now
beginning to realize that, in all phases of preventive medicine, their
strongest, most necessary, and, indeed, essential ally, is the public,
and the needed stimulus to a better medical performance is an
intelligent knowledge on the part of the people as to what should be
done.
It is a common belief that ophthalmia neonatorum is an indication that
one or both of the infant's parents have led unclean lives, and so,
until recently, it has been difficult to have all such cases reported.
While ophthalmia neonatorum _is_ often the result of the social evil,
the introduction of other pus-producing germs into the eyes at birth is
responsible for a large number of cases. So it should be remembered that
babies' sore eyes is not a disgrace (any baby may have the disease), but
blindness from babies' sore eyes _is_ a disgrace, for, in almost every
case, it can be prevented.
Dr Park Lewis says: "And when we think of the long life of darkness of
the blind, the limited possibilities of the child to be educated, the
narrow lines in which he may hope to be trained, the fields of
usefulness from which he will be cut off by his blindness, his
dependence on others for things he should otherwise do for himself, the
financial loss to the community for his maintenance when he might, under
happier conditions, not only have been self-supporting, but possibly
independent--the pity of it all comes with added emphasis. The
importance, then, increases of every intelligent human being knowing
that the most serious forms of birth infection of the eyes, in almost
every instance, should not have occurred." Dr Lewis continues, "The
majority of the blind are not wage earners, and are thus not only an
added expense, but an economic loss. The education of each blind child
costs the state yearly about three hundred and fifty dollars, while it
costs but thirty dollars to educate a seeing child for the same period.
Ophthalmia neonatorum is a crime, because of the suffering it brings to
helpless, innocent persons, and because it leads to a reduction in
economic efficiency, deprivation of many pleasures and privileges and,
very often, immeasurable misery, suffering and sorrow during a lifetime
in the dark."
Of the twenty children brought to me for inspection during the past
three years, fifteen were blind from infant ophthalmia, and, as I myself
am a victim of this same disease, I am leaving no stone unturned in my
efforts to save other children from hardships and limitations that are
wholly preventable, and I feel that I am peculiarly fitted to help in
this great work.
There are other common causes of blindness in children, one of which is
phlyetenular keratitis, usually the result of poor or improper feeding,
or lack of ventilation, and it often leaves the cornea badly scarred.
Tuberculosis of the eyes results in much the same condition, often
causing total blindness. Measles and scarlet fever cause blindness or
defective vision. Parents do not realize the gravity of these diseases,
and fail to cleanse the eyes frequently, or to keep the room properly
darkened. In some cities, during epidemics of these diseases, health
officers are requested to distribute circulars, calling attention to the
danger to the eyes, and giving instructions as to their care. In this
state, measles and scarlet fever are among the communicable diseases
which must be reported.
Trachoma, a virulent form of conjunctivitis, is a communicable eye
disease which must be carefully safeguarded. It flourishes in
unsanitary surroundings, camps, and homes where the family uses the
common wash basin and towel. There are not many cases in this state, but
even one is too many. We are profiting by the unhappy experience of
Kentucky and other Southern states, and are adopting drastic measures
for its prevention.
Interstitial keratitis, or inherited syphilis, is a common cause of
blindness in children, though, in many cases, the blindness is only
partial, and, if taken in time, the remaining eyesight may be saved.
This disease usually appears between the ages of four and twenty, often
following some childish malady, and it requires the greatest care and
most nourishing food to counteract its pernicious effects. The victim of
interstitial keratitis is never strong, and, although a blood test may
show a negative condition, any serious illness may cause the
constitutional trouble to reappear.
It is a common belief that children will outgrow cross-eyes. This is not
true, for the eye that turns either in or out, will, sooner or later,
become useless, simply from disuse. Such children should have attention
as early as possible, even in infancy, as properly fitted glasses will
usually restore such eyes to their normal condition.
Children are often needlessly blind as the result of an unwise and
harmful selection of toys, such as scissors, forks, toy pistols, air
rifles and bows and arrows. The observance of a sane Fourth of July has
lessened the number of accidents to the eyes of children.
I have thus far spoken of the prevention of blindness in children, and
now I wish to call your attention to what is being done for the
conservation of vision in childhood. In the lecture on the development
of the blind child, I mentioned special classes for blind children in
the public schools. In most of the cities having such classes (Chicago
and Los Angeles excepted), sight saving classes, as they are called, are
maintained. In these conservation classes, the children do not read with
their fingers, but books in heavy face, large type are provided. And for
these books we are indebted to Mr R. B. Irwin, the blind supervisor of
special classes in Cleveland. So here again we find a blind man planning
not only the advancement of blind children, but the conservation of
vision of partially-sighted children. In these classes desk blackboards
are provided, and a great deal of oral instruction is given, and the
amount of reading is limited. A great deal of handwork is required and
everything possible is done to save eyestrain. Much time and thought is
given to the proper lighting of schoolrooms, and to the color scheme of
the buildings. Light should not be judged by its brightness, but rather
by the way it helps us to see what we are looking at. Walls should have
light paper or tinting, as dark walls absorb light strongly, instead of
reflecting it. Reds, greens and browns reflect only ten to fifteen per
cent of the light which falls on them; while cream-color or light
yellowish tints reflect over one-half the light.
As a result of the ophthalmic work of the medical inspection departments
of many of our public schools throughout the country, much is being done
to help children who are partially blind, or suffering from some visual
defect which may lead to blindness if they continue in school under
ordinary conditions. Every large city should have one or more of these
conservation classes, and the demand for them will increase when the
public realizes their importance in saving the sight of school children.
Dr De Schuynitz, an eminent oculist of Philadelphia, in an address on
conservation of vision, asked these questions: "Shall children be
allowed to trifle with their most precious possession? Shall our homes
be permitted to disregard the rules of visual hygiene? Shall children,
and those children of the larger growth--men and women--remain on the
side lines because they can not see well enough to play the great game
of stirring life, with its joy of untrammeled effort? Shall they not
have a game which they _can_ play? Shall we of these better walks of
life pursue our way in smug contentment, and permit the preventable
causes of blindness to continue their black business, and ever add to
the roll of their victims?" The leading oculists of the country
recommend sight-saving classes, and many of them give their time and
money to the service of these handicapped children, establishing clinics
for their care and treatment. In Los Angeles the Parent-Teacher
Association has a wonderful clinic, and Dr Ross A. Harris and his
assistants have saved the eyes of hundreds of children who would
otherwise have become public charges. But here again it is necessary to
educate the public. An old schoolmaster, rich in the wisdom of ripe
experience, has said, "More children's eyes are injured in the home than
in the school," and his words receive daily verification. But in schools
where medical inspection is given, and where a visiting nurse is in
attendance, untold good is being accomplished, and children who should
wear glasses, and attend conservation classes are promptly sent to the
oculist, and assigned a place in school.
The commonest visual defects are, first, inflammation of the cornea, or
imperfections of the lens--the cornea is often so scarred as to make
vision imperfect; second, myopia, or progressive shortsightedness, a
condition in which the axis of the eye gradually grows longer. This
lengthening is accompanied by stretching of the eyeball, and such
children always run the risk of the inner and most important part of the
wall of the eye, the retina or nerve layer, being torn away, and
blindness resulting. When nearsightedness is discovered early, and
glasses are given that make distant vision normal, and all needless near
work forbidden, the myopia may be held in check, and any considerable
increase prevented. Teachers are usually the first to notice such
defects, but many parents do nothing when their attention is called to
the matter. But happily these conditions are improving, and the school
nurse and school clinic, and all the clinics maintained by public and
private charities, are accomplishing wonderful results. When preventive
medicine and preventive social service are joined in the effort to help
mankind, there must result a saving of our most precious physical
possession, and an addition to human joy. The National Committee for the
Prevention of Blindness and Conservation of Vision, with headquarters at
130 East Twenty-second street, New York City, carries on a ceaseless
campaign of enlightenment by means of pamphlets, lectures, charts,
lantern slides and posters, and the work of this society is directed by
Mr Edward M. Van Cleve, Superintendent of the School for the Blind in
New York City. The leading oculists of the United States are members of
the society. Charts and lantern slides are loaned to societies for the
prevention of blindness in the various states, and pamphlets on many
important topics are sold at a nominal cost. When addressing a large
gathering in New York, and urging the wisdom of publicity, Dr De
Schuynitz said: "We are here to help in the work of health education, of
eyesight protection; we are to call on society for aid in devising
measures, and for means to carry them out, in order that effective
results shall merge into perfect victory. We are here, too, I take it,
to cure those who are dull-sighted in this regard, so that, with vision
cleared, they shall join in the struggle for ocular conservation and
make it possible to give sweetness of disposition and ever-present
cheerfulness, not to the blind, the good God sees to that, but to those
who shall be saved from blindness."
In New York and Boston, the children are given instruction in hygiene,
taught to properly care for the nose, throat, eyes and teeth. These
lessons begin as early as the second grade, and are illustrated with
charts showing how perfect teeth and eyes should look. These lessons
include the harmful effect of enlarged tonsils and adenoids, and the
children are very anxious to be in as perfect condition as those shown
in the pictures. A teacher of one of these classes in Boston took her
children to a museum, where they spent a morning studying statuary. The
next day, wishing to see how they had been impressed by what they saw,
she asked, among other questions, "What do you remember about
Aphrodite?" One little boy held his hand up, saying, "She has adenoids."
"What makes you think so?" asked the teacher, wonderingly. "Why, she had
her mouth open all the time." The children learn just how far from the
eyes a book should be held, and often call attention to a companion
whose myopic condition makes it necessary to hold the book very close.
And so the outlook for the children is very promising. With conservation
of vision classes, classes in hygiene, with school nurses and clinics,
with medical inspection of schools, and with the public aroused as never
before to its responsibility towards its boys and girls, we should have
less need for oculists and schools for the blind, and fewer persons
should be obliged to go through life deprived of the light, which was
God's first gift to the world.
Before discussing the prevention of blindness in adults, I wish to say a
few words concerning the attitude of oculists toward patients suffering
from eye diseases which, in all probability, will result in loss of
vision. If, for some special reason, the oculist fears it would be
unwise to tell the patient that blindness is imminent, he should at
least urge him to conserve his remaining vision, and advise him to do as
many things as possible by touch, and warn him of the consequences of
eyestrain. But, whenever possible, it is kinder to prepare the patient
for oncoming blindness, so that he may shape his life accordingly, and
may be induced to learn to read raised type, and use a writing device,
before the light is entirely gone. Most of us exclaim over our trifling
hurts, the mosquito bites of life, but when the real trial comes, when
we know we must face a great crisis, we square our shoulders, take a
long breath, and meet the inevitable with courage and fortitude. I wish
the oculists could hear as I do the despairing cry of men and women who
were led, until the very last, to hope for a restoration of eyesight,
and then told that in their particular case, all usual remedies failed.
Dr Daval, an eminent French oculist, who lost his eyesight at sixty,
makes an eloquent plea to his colleagues to tell their patients the
truth, and, instead of treating them when they know that loss of
eyesight is inevitable, advise them to study methods used by the blind,
even though they may not need to use the knowledge for months or even
years.
There are a number of eye diseases that may be inherited, and those
having such diseases should be told that they will transmit them to
helpless, innocent children. The social evil is largely responsible for
the infections of which ophthalmia neonatorum is only one result, but
since this disease comes so often from a cause which is not generally
discussed, it is particularly hard to combat. Forty per cent of existing
blindness, and a vast amount of physical degeneracy, is the direct
result of venereal causes.
Certain forms of glaucoma may be inherited, and children whose parents
have had this disease should watch their own eyes very carefully, since,
if taken in time, the progress of this disease, in certain forms, may be
arrested. Persons who see rings around the lights should heed the danger
signal and see an oculist.
Retinitis may also be inherited. I have known of three generations
becoming blind from this cause.
Nearsightedness may also be inherited. I have known this condition of
the eye to be present in four successive generations, and in the last
generation, the young woman became totally blind from detached retina,
due to excessive eyestrain while in school. If you could see my records,
and count the number of cases where blindness is given as the result of
straining nearsighted eyes, you would realize with me that progressive
myopia should be classed as one of the preventable eye diseases, and a
vigorous campaign waged against the marriage of persons so affected.
Nearsighted people should be especially careful to avoid eyestrain, and
should not work by artificial light. Bookkeepers, hotel clerks, and
women who do fine sewing at night should be cautioned against such work,
if they are myopic.
Optic atrophy is an eye disease very baffling to oculists, sapping the
vision slowly but surely, as a rule, but occasionally destroying
eyesight in a very short time. Electricians and those working in
chemical laboratories are susceptible to optic atrophy.
A common cause of eyestrain is reading on street cars, or using the
last, lingering bit of daylight to finish a chapter or complete some
fine work. It is easier to turn on the light than to spend years in the
dark.
The eyes of many people are ruined because, instead of going to an
oculist to have their eyes properly fitted to glasses, they go into a
ten-and-fifteen-cent store, try on a lot of cheap glasses, and purchase
the ones that magnify the best, and feel most comfortable on the nose.
The cheap varieties of glasses are often made from bits discarded by
opticians, and never intended to be used again. People are not always
careful in selecting eye shades, and often use those made of very
inflammable materials, which frequently catch fire, and destroy the
eyesight.
I can not understand how people can trifle with the most precious of
their physical possessions, and yet my records teem with such instances,
and the victims realize when too late how criminally thoughtless and
careless they were. Some of our grown-up children need instructions as
to the use and abuse of their eyes. In Los Angeles, I addressed the
various Parent-Teacher Associations on these important subjects, and I
believe that the note of warning sounded by one who is herself a victim
of unnecessary blindness, went straight home to every heart.
The percentage of adult blindness is increasing at a very rapid rate,
owing to the numerous accidents in factories and workshops, accidents
that are, in many instances, preventable. Owners of factories, quarries,
mines and other industrial plants have become alive to the necessity of
safeguarding the eyes of their operatives, and much needed legislation
is being enacted in all parts of the country. The National Council of
Safety, an organization in existence but five years, has accomplished a
great deal and this council co-operates with State Industrial Accident
Commissions, and with civic and social organizations. The National
Council of Safety estimates that there is one worker killed every 15
minutes, day and night, in the United States, and one injured every 15
seconds, day and night. This gives 30,000 killed and 2,000,000 injured,
and of this number 200,000 are eye injuries. The National Committee for
the Prevention of Blindness estimates that there are 100,000 blind in
the United States, and half this number are needlessly so. Mr Will C.
French of the State Industrial Accident Commission estimates that we
have 1,000,000 employees in the state, and we have 300 industrial
injuries daily, including Sundays. We thus have approximately 100,000
industrial accidents each year in this state. Since 1914, there were
23,451 eye injuries, and of these 549 were permanent injuries, and 11
resulted in total blindness. The medical and compensation costs of these
eye injuries will be about $788,000. The 11 blind call for life
pensions. The State Library home teachers are teaching 7 out of the 11
cases, and the Industrial Accident Commission is very glad to co-operate
with us.
In California we have an average of 26 eye injuries each working day,
and this number is likely to increase, especially in the shipbuilding
industry, because of the chipping steel, use of emery wheels, and
machinery in the construction of vessels. The State Accident Commission
advocates goggles, one pair to each man. There are four kinds of goggles
used. Those for the protection against flying material, for protection
against intense heat and light, for protection against gases, fumes and
liquids, and dust goggles. Masks are urged for welders and babbiters,
and these masks are so strongly constructed that they not only fit the
eye, but have shields at the sides of each lens to prevent the flying
chips from entering the eyes from the sides. In most of the large plants
there are committees of safety composed of employees, and they do much
to reduce industrial accidents. Precautionary leaflets are circulated
among the workmen, and attractive posters, printed in all languages, are
used. Some of these are very effective. One shows a man saying
"good-bye" to his wife and five little ones, and underneath is written,
"How could they do without you?" One of the best known slogans, and one
carrying conviction, is "You can see through glass goggles, but you
can't see through glass eyes."