Five Lectures on Blindness

by Kate M. Foley

PREVENTION OF BLINDNESS AND CONSERVATION OF VISION IN ADULTS AND CHILDREN.[2]

Helen Keller, in writing on prevention of blindness, says: "Try to realize what blindness means to those whose joyous activity is stricken to inactivity. It is to live long, long days, and life is made up of days. It is to live immured, baffled, impotent, all God's world shut out. It is to sit helpless, defrauded, while your spirit strains and tugs at its fetters, and your shoulders ache with the burden they are denied—the rightful burden of labor."

When I was twelve years old, the well-known oculist, Dr Barkan of blessed memory, came to examine the eyes of all the children in the School for the Blind at Berkeley. I was the first to be examined, and I remember distinctly every word of the great doctor when, after looking at my eyes, he turned to the superintendent, and said sadly, "Needlessly blind! her eyesight could have been saved." These words made a profound impression upon my childish mind, and as I sat and listened, while child after child was examined, and heard again and again the same remark, "needlessly blind!" I resolved to know more about this eye disease with the very long name, ophthalmia neonatorum, to learn its cause, and see just how it might have been prevented. But we did not hear as much about prevention as we do now, and, although I did not forget the matter, it was many years before I had an opportunity to study it further. When I did, I found that at least one-fourth of the children in schools for the blind in this country were there, just because a simple precaution was not taken at the time of their birth.

Five years before I knew there was such a thing as unnecessary blindness (since I had been told I was blind as the result of a severe cold in the eyes), a Belgian doctor, Professor Crede, a famous obstetrician of Leipsic, appalled at the number of children who lost their eyesight within a few days after birth from a virulent eye infection, determined to try the effect of a simple prophylaxis, a two per cent solution of nitrate of silver, dropped in the eyes of every newborn child. The effect of the prophylaxis used in Dr Crede's clinic was marvelous, reducing the number of cases from ten per cent in 1880, to one-fourth of one per cent in 1886.

"Babies' sore eyes," or ophthalmia neonatorum, is defined by Dr Sydney 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.