Five Lectures on Blindness Part 3

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 pa.s.sing 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 pa.s.sage 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 hards.h.i.+ps 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 kerat.i.tis, 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.

Interst.i.tial kerat.i.tis, 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 nouris.h.i.+ng food to counteract its pernicious effects. The victim of interst.i.tial kerat.i.tis is never strong, and, although a blood test may show a negative condition, any serious illness may cause the const.i.tutional 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 gla.s.ses 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 cla.s.ses for blind children in the public schools. In most of the cities having such cla.s.ses (Chicago and Los Angeles excepted), sight saving cla.s.ses, as they are called, are maintained. In these conservation cla.s.ses, 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 cla.s.ses 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 cla.s.ses 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 cla.s.ses, 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 cla.s.ses, and many of them give their time and money to the service of these handicapped children, establis.h.i.+ng clinics for their care and treatment. In Los Angeles the Parent-Teacher a.s.sociation has a wonderful clinic, and Dr Ross A. Harris and his a.s.sistants 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 gla.s.ses, and attend conservation cla.s.ses are promptly sent to the oculist, and a.s.signed 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 gla.s.ses 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 accomplis.h.i.+ng 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 G.o.d 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 ill.u.s.trated 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 cla.s.ses in Boston took her children to a museum, where they spent a morning studying statuary. The next day, wis.h.i.+ng 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 cla.s.ses, cla.s.ses 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 G.o.d's first gift to the world.

Before discussing the prevention of blindness in adults, I wish to say a few words concerning the att.i.tude 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 fort.i.tude. 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 cla.s.sed 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 gla.s.ses, they go into a ten-and-fifteen-cent store, try on a lot of cheap gla.s.ses, and purchase the ones that magnify the best, and feel most comfortable on the nose.

The cheap varieties of gla.s.ses 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 a.s.sociations 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 s.h.i.+pbuilding 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 s.h.i.+elds 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 gla.s.s goggles, but you can't see through gla.s.s eyes."

Many trades and occupations have their well-recognized types of injury.

In the bottling works eyes are frequently lost through the impact of popping corks. The bursting of unprotected water gauges caused many cases of blindness yearly among engineers and machinists. In the grinding trades eyes are frequently lost by bits of flying emery becoming imbedded in the eyeball, and the Industrial Accident Commission recommends iron or gla.s.s guards for emery wheels. In factories, quarries and mines more serious damage is done by larger bits of metal or stone.

Sometimes harm is done in an attempt to remove the foreign body from the eye, as the hands of the one performing this service may not be clean, or the instrument used may be the corner of a soiled handkerchief, a toothpick or match, or even, as sometimes happens, the tongue. More eyes are injured from infection than from the presence of foreign bodies, which, if properly and carefully removed, might result only in temporary inconvenience and the loss of a few days work. Workmen should not trust to the shop or factory doctor, but should go to the company doctor at once. Immediate and competent care should be secured without delay, and this will save eyes, and also save employers and insurance companies a great deal of money.

Lime-burn, solder-burn, and all the so-called dusty trades produce chronic inflammation of the eyes, which often results in total blindness. The National Council of Safety enumerates fifty-five industrial poisons, thirty-six of which affect the eyes. Absorption of drugs often causes blindness--tobacco, wood alcohol, lead, used in so many industries; bisulphide of carbon, used in making rubber; nitro-benzol, used in the manufacture of explosives, and some of the anilin dyes. Hoods and exhausts should be used to prevent the escape of dangerous fumes, vapors and gases. For men exposed to great heat, antisweat pencils have been manufactured, and when these are rubbed over the goggles, the gla.s.s will remain clear of steam for hours. Special eye coverings are designed for men working over acids, or in sand blasting.

One of our pupils, a man past fifty, who had worked in a creamery for over twenty years, and who usually wore goggles when making tests with sulphuric acid, neglected to take the precautionary measure one morning, and some of the acid splashed up into his eyes. He is totally blind, and must begin life all over again. There have been so many cases of blindness as a result of dynamite explosions occurring in quarries and mines, that laws have been enacted for the protection of workmen. When a blast has been fired, and it is not certain that all the charges have exploded, no person is permitted to enter the place until forty-five minutes after the explosion. My records prove the great need for this precautionary measure, and I only wish it had been enforced years ago, before so many men in the prime of life had been deprived of eyesight, and of earning capacity as well.

Improper lighting and ventilating in factories, shops and stores, and work requiring excessive eyestrain, contributes to a long list of disabilities often resulting in total blindness. The pa.s.sage, by our last Legislature, of the Common Towel Bill, prohibiting the use of roller towels anywhere in the state, has removed one of the most flagrant causes of infection, and one to which very little attention was paid by factory workers generally. I know one young man and two young women whose total blindness is the result of infection from the use of a roller towel.

I trust all these facts and figures may not prove wearisome, for it is necessary to know them if you are to realize the extent of the work being done here and elsewhere to prevent blindness and conserve vision.

I have not mentioned all the activities of the State Industrial Accident Commission, or the National Council of Safety, but a visit to the Safety Museum, 525 Market street, San Francisco, or to the Union League Building, Los Angeles, will enlighten you further as to the progress of the Safety First movement, and convince you of the wisdom and humanity of it. Let us adopt prevention and conservation as household words; let us do our share in spreading the gospel, and soon we shall have fewer blind babies, fewer children sitting on the side lines, and fewer men and women deprived of eyesight at the floodtide of life. This is another of my dreams, and this one is already coming true. "Let there be light!"

was the first recorded utterance of the Most High G.o.d. "Let there be light!" has been the watchword on the lips of human progress during all the centuries that have gone, and they must be the battle-cry of Progress during all the centuries that are to come. I am sure we shall all be glad to do our share to preserve this light for our own and future generations.