Chapter 6
As I said in my last lecture, the government has a well-defined plan for the re-education of its blinded soldiers. But suppose this plan is carried out, and the men are returned to their home cities, qualified to pursue a certain line of work, only to find that the public does not share the government's confidence, is unwilling to give them an opportunity to prove their ability? The public will cheerfully pay taxes to care for these men in idleness and seclusion, thus diverting to the rear of life's battle line these heroes who have given the most precious of all their physical possessions in their country's cause. The soldier killed on the field of battle pays the supreme sacrifice all in a moment, but the sacrifice of the blinded soldier is lifelong. Are we going to find employment for these returned heroes, or are we going to add yet another burden to their already heavy load? Are we going to add the burden of dependence to the burden of darkness? If we want these men to know that we appreciate the service they have rendered to their country, let us provide occupations for them, and in order to do this let us begin by employing the civilian blind, the blind right here in our midst. Let us study the problem with an open mind, freed from the old prejudice and unbelief; let us turn the light on ourselves, and see that it is we who sit in darkness. Let us ask the blind leaders of the blind what work can be done without eyesight, and let us be guided by their judgment, their experience. And, as a bit of Red Cross service, let us employ the blind; let us create a demand for their labor; let us ask for work made by the blind, and tell our friends to ask for it; let us buy our newspapers from the men on the streets, and let us give our magazine subscriptions to blind men who have subscription agencies; let us patronize blind lawyers, osteopaths, salesmen, piano tuners and musicians. Let us find other and broader avenues of usefulness for these our civil blind heroes, who went into the dark with no blare of trumpets, no applause from cheering multitudes, and who wear no badge of honor on their breasts. Let us do this, so that when the blinded soldiers return, we may welcome them with the glad tidings that we have work waiting for them, that we know they can do it, because blind men and women here have blazed the trail, and have, by their splendid courage and boundless enthusiasm, succeeded in changing the attitude of the public, and removing the last lingering vestige of doubt as to the ability of the blind to become self-supporting, self-respecting citizens. In this campaign of enlightenment, this bit of Red Cross service for the blinded soldiers and the blind adults of our civil communities, every one of you can help, and I feel sure it will be unnecessary for me to ask a pledge of co-operation from any one who has heard me speak this afternoon. The State Library is heartily with me in every phase of this campaign, and, with its co-operation and encouragement, I go fearlessly forward, overcoming obstacles, uprooting prejudices, laboring with heart and mind and voice in the service of the blind and in the hope of bringing about a clearer understanding of their needs in the minds of the public.
And now, in conclusion, let me tell you my dream for the future of the blind, a dream which, please God, will one day come true. I dream of seeing blind men occupying chairs in our colleges and universities, blind heart and lung specialists, anatomists and osteopaths, lawyers and lecturers. In my dream, I see blind salesmen, telegraphers, musicians, piano tuners and electricians, and other men making brooms, brushes, mattresses and furniture now so often made by prison labor. And in my dream, I see blind women teachers, stenographers, dictaphone and switchboard operators; and other women knitting, crocheting, sewing, cooking, weaving rugs and making baskets, and doing the work side by side with their more fortunate sisters, and doing it as well, and often better. Then and only then will the greatest sting be removed from blindness; then and only then will the blind beggar depart from our public thoroughfares, and when all these things come to pass, my dream for my people will be realized. Aren't you going to help to make my dream "come true"?
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."
[Footnote 2: Reprinted from News Notes of California Libraries, vol. 14, no. 1, Jan. 1919.]
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.
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.