Five Lectures on Blindness

by Kate M. Foley

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.