Under this heading we shall endeavor to gather together a few very essential and practical points, some of which, while they may be elsewhere considered, are of sufficient importance to merit repetition. Many cases of blindness have undoubtedly resulted from the neglect of simple everyday precautions, which are supposed to be generally understood, by the laity as well as the medical profession, that we are unable to find any author who has devoted the slightest space to the subject.
The care of the eye commences at birth, and in order to secure its highest usefulness must be continued throughout the whole life. The eyes of the new-born babe should be at once carefully cleansed with warm water or a saturated solution of boracic acid. In all cases of gonorrhoeal or leucorrhoeal discharge in the mother the method recommended by Crede should always be employed. This consists of the instillation between the eyelids of the child immediately after birth of a 2 Percen solution, gr. x. ad 3j., of nitrate of silver. This method is practiced by many of the best obstetricians in all cases, and since its general adoption the percentage of cases of blindness from ophthalmia neonatorum has been wonderfully reduced. In former years the percentage of blindness from this disease alone formed, in different countries, from 20 to 79 per cent. of all the cases of blindness.
The examination of the eyes of the babe from day to day should be a part of the physician’s routine duty for at least one or two weeks, so that the onset of any trouble may be at once met by active treatment. The eyes of young infants should be protected from all glaring lights, and especially the direct rays of the sun, both indoors and out.
The babe should never have its attention attracted by objects held close to the eyes, for repeated convergence at close objects may predispose or even produce strabismus. This observation holds good as the child grows older, for in addition, from poring over story and picture books, when too fine or held too close to the eyes, myopia threatens. The fine worsted and bead work used in some of the kindergarten teachings is for this reason objectionable. Give the growing child plenty of out-door amusements, where the eyes may have a long range during the developing period of life, and we shall see fewer little ones wearing glasses for myopia and astigmatism.
School Hygiene.-We believe that one of the most important fields for the exhibition of the to-day knowledge and interest in hygiene is presented in our educational institutions. When we consider the total number of hours passed in the class rooms during the child’s school and college life, the additional hours required for study and preparation outside of the school-room by the present day system of forcing the child too rapidly and all children alike, to keep up with their classes, then when we compare these hours with the time left for recreation, exercise and sleep, and recall that these years are the years of physiological growth, is it any wonder that we find so many commencing their active life as physical wrecks? It is, therefore, plainly a duty we owe to posterity to consider carefully the hygienic environments of our children as well as their mental and moral training. The school life of the growing child should be so regulated as to secure the best mental advancement and at the same time the best physical development. Every observing physician has seen many children who commenced school life in apparently good health soon complaining of headaches, nervousness, loss of appetite and other symptoms indicative of impaired general vigor.
It is however, not our function to consider the subject of school hygiene in its relation to the general health, but simply as its bearing upon the eyes of our children.
In the early part of the present century we find attention first called to the relations existing between the myopic eye and the demands of civilized life. Within a comparatively few years more complete and systematic examinations of the eyes of school children have been made, so that to-day we have as a basis for our statistics the examinations of the eyes of over two hundred thousand pupils of all grades. An analysis of these examinations show that in the primary schools nearly all the children enter with normal eyes. In the higher grades 25 per cent. have become myopic, while in university life the percentage of myopia has increased to from 60 to 70 per cent., which shows that the number of near-sighted pupils increase from the lowest to the highest schools and that the increase is in direct proportion to the length of time devoted to the strain of school life.
In the face of these facts, it seems the imperative duty of the hour to carefully investigate the cause of this deterioration in the eyes of our children during school life. The evident relationship of this increasing near-sightedness with school work seems to indicate some fault in our educational methods. Owing to the fact that myopia is often hereditary, it is impossible to wholly eradicate the condition for generations to come. We believe, however, that acquired myopia can be prevented, or very greatly decreased, by careful and frequent examinations of the eyes, together with thorough hygienic preventive methods, during the years of physical growth and mental training of the child.
First, as to the importance of frequent examinations of the eye of children. Statistics prove that a very large proportion of the eyes of young children are hypermetropic. So great is this preponderance that many authorities claim the normal eye to be a hypermetropic one. Careful observations have shown that in almost every instance the change from far to near-sight is through the turnstile of astigmatism. That this change does take place has been proven by the progressive increase in the percentage of myopia during school life. By repeated examinations, from year to year, the first change can be detected and suitable treatment taken to check its progress. We believe that the eyes of every child should be carefully examined at the commencement of school life, and that the examination be repeated every year at least until the time of full development of both body and mind. The care of the teeth commences even earlier than this and is continued through the whole life. We have become educated to the importance and necessity of sending our children to the dentist every six months or year for examination, whether disease is suspected or not. The far more precious and delicate organ, the eye, on the contrary, is almost universally left to do its work unaided and uncared for, until often serious and irreparable damage has been done and the innocent victims of our ignorance and neglect are deprived of the full realization of God’s greatest gift, that of sight. It is not the vision alone that pays the penalty of this criminal neglect, but a long train of physical wrecks brought about through reflex action from eye- strain.
It is not our purpose at this time to go into the details as to how or what general conditions may result from defective eyes, but merely to sound a warning as to the danger from neglect of the eyes in early life. To continue the comparison with the teeth, we can get very acceptable false teeth, when lost from neglect, but artificial eyes have not proven of much practical service.
There is great need of popular education as to the importance of such examinations of the eyes. Parents who follow out the greatest precautions for the welfare of their children in other respects are unmindful in this, through lack of knowledge of its importance.
Examination of the Eyes Upon Entrance of School.-Every school should possess a series of test letters, and each scholar at the commencement of each term should have the eyes examined by the teacher. This examination is so simple that any teacher can be instructed in a few moments so that they can determine if any defect exists. All that is essential is a set of Snellen’s test-types placed in a good light; the smallest letters should then be read with each alone equally clear and distinct. Then a small card clearly printed in 4 1/2 point (diamond) type should be read by e child, while the teacher measures with a rule the nearest point at which it can be clearly read. This distance should correspond with the normal near-point of an emmetropic eye, which should be recorded on the back of the card for the different ages from six to twenty years. If these tests show no defect the child may then be admitted to the school, but, on the contrary, if a defect be found in any of the tests, particularly the first, the parents of the child should be at once informed of the existing defect of vision and the consequent need of professional advice. Further than this, during the school year, if the child complains frequently of headaches while studying, or seems to be getting nervous, anaemic, etc., the teacher’s duty is to again suggest to the parents the wisdom of seeking a physician’s advice.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.