BY A MEMBER OF THE OPHTHALMOLOGICAL SOCIETY.
Among the grandest of our charitable institutions may be counted those for the care and instruction of the blind. Their utility and the benefit they confer are beyond question, and they are in the highest degree deserving of moral and material support. It is fortunate that human sympathy is seldom slow in extending itself to those, be they young or old, who have lost the priceless boon of vision and who dwell in ‘eternal night.’ Whilst this is the case, however, and it is a matter for thankfulness, it is well to remember that ours is peculiarly an age when prevention is held to be better than cure, and when considered in connection with cases that admit of ‘no cure,’ the wisdom of pursuing a course of ‘prevention’ is only too evident.
It is well known that a large number of the inmates of our blind institutions have been rendered fit objects for admission by preventable causes. The purpose the writer has now before him is the consideration of a class of such preventable cases, but which also embraces the largest proportion. It is peculiarly a subject on which the public need information, and by the acquirement and diffusion of which knowledge, it will be within their power to do an amount of good, and which will tend in some degree to lessen the number blinded in the manner to be now described.
The class of cases to which reference is made are those of young babies, to whom, in consequence of a serious inflammation occurring within a few days after birth, the light of the world may be taken away from them, almost, indeed, before their eyes have opened to it. The disease is principally, but by no means exclusively found among the poorer people; and as it is among them that ignorance mostly prevails, the direst results are most frequently witnessed. The affection—setting-in a few days after birth—is characterised by a discharge of matter from the eyes, and attended with redness and swelling, generally, of the eyelids. Whilst on the one hand it must be strongly urged that such a condition is a serious one, on the other it must be equally recognised that if treated sufficiently early it is amenable to remedies. No mother of a babe should, on noticing the appearances indicated, delay sending for or taking her child to a medical man. The grossest ignorance, however, prevails among mothers and those surrounding them, as to the gravity of this affection, at the time and after the births of their children. The writer in his medical practice experiences few circumstances more sad, and calculated to harrow one’s feelings more keenly, than for a baby to be brought for the first medical treatment when the disease has already wrought such havoc as to render a cure an improbability, and too often an impossibility. Such instances are of frequent occurrence in hospital practice. Dr Emrys-Jones some time ago collected statistics as to the condition of the eyes when brought for treatment at the Manchester Royal Eye Hospital; and he found six and a quarter per cent. of the eyes were hopelessly lost, in some cases both eyes, in others one only. There is, moreover, an amazing degree of careless indifference displayed, and when a case in a wretched condition is seen by a medical man for the first time at the end of one, two, or three weeks after the onset of the affection, to the question, ‘What have you been doing all this time for the baby’s eyes?’ will come the reply: ‘Why, nothing, sir;’ as if a special virtue lay in a negative answer.
The importance of preventing blindness being caused by this disease will be evident, when it is asserted that a third or more of all cases in the blind schools of England have been occasioned by it. Nor, indeed, does this in any manner show its entire effects; for those who have only lost one eye through it, would, of course, be omitted from calculation, as well as those whose vision had been affected in a less degree. On the continent, the proportion would appear to be equally large. In Germany, Reinhard, from investigations at twenty-two German blind asylums, found six hundred and fifty-eight blind from this disease among a total of twenty-one hundred and sixty-five, or thirty and a half per cent. Observations among our own institutions would appear to represent as large or a larger percentage of cases. The writer has kept a record of children admitted into a teaching institution with which he is connected, and the number in his notebook is sixty-two. Of this number he excludes seven, as either not having been examined by him, or the cause of blindness not verified; but of the remaining fifty-five, in no fewer than twenty-one is this affection distinctly traceable as the cause of blindness. This gives a percentage of about thirty-nine. No words, it would appear, can be necessary to add to the telling effect of such figures.
It must be recollected, moreover, that the blind are not only shut off from the pleasures of this world, but their unhappy lot too frequently renders them a necessary burden on their more fortunate sight-possessing fellows. It is desirable that a knowledge of the dreadful results following a neglect of this disease should be impressed upon the community. The results mentioned comparatively seldom occur among the well-to-do, for the reason that the doctor is in immediate attendance, and under skilful treatment the affection is cured; but, however, by extending information on this subject, it will, it is hoped, reach the less fortunately situated. A comprehensive plan for attaining such an object was introduced to the notice of the Ophthalmological Society of the United Kingdom, by Dr David M‘Keown of Manchester. He proposed to utilise the poor-law and birth registration organisations. Such a plan would enable every mother of new-born infants to have read to her, and to be put in possession of, or of whoever may be in attendance, a card specifying the characters and dangers of the disease; and again, as the birth of every child has to be registered within a certain number of days, another opportunity would be afforded for giving a card with the desired information. The card, it was proposed, should run in this way: ‘Instructions regarding new-born infants.—If the child’s eyelids become red and swollen, or begin to run matter within a few days after birth, it is to be taken without a day’s delay to a doctor. The disease is very dangerous; and if not at once treated, may destroy the sight of both eyes.’
The Society, on the Report of its Committee on this subject, adopted, with slight modifications, the series of resolutions suggested by Dr M‘Keown. The first resolution of the Society, and which chiefly concerns us here, was as follows: ‘That the purulent ophthalmia of new-born infants being the cause of a vast amount of blindness, mainly because of the ignorance of the public regarding its dangerous character, and the consequent neglect to apply for timely medical aid, it is desirable to instruct those in charge of new-born children by a card’ (as previously mentioned). This is to be distributed, the resolution adds, by the poor-law and birth registration organisations of the United Kingdom; and details the methods to be adopted for carrying the plan into operation. In a subsequent resolution, the aid of the medical press is solicited, and the attention of the various institutions which train or employ midwives is drawn to this very important subject.
These resolutions, as it has been said, were adopted by the Ophthalmological Society; and they were desired to be communicated to the Presidents of the Local Government Board, and of similar bodies in Scotland and Ireland. A deputation also was appointed to wait upon the Presidents of these bodies, if necessary, to urge the desirability of the plan sketched out being put into practice; and among other members of this deputation were Sir William Bowman, and the President (Mr Jonathan Hutchinson) of the Society.
It is very much to be hoped that the action of such an influential Society will have a good effect. It clearly puts the gravity of the case before the public; and any individual who can in any way spread the knowledge contained in the foregoing Report will be engaged in a really good cause.
For some time, the Society for the Prevention of Blindness has issued and circulated a leaflet entitled, ‘Advice to Mothers who do not wish their Children to be Blind.’ It contains sound directions as to the nature of the disease, its recognition, and hints as to what should be done whilst the doctor is being fetched, which should, however, be by no means delayed. Any one interested in the welfare of the blind, and wishing for further information as to the objects of the Society, should communicate with Dr Roth, Secretary, 48 Wimpole Street, London, W.