Chapter 6

In infancy, when the child is developing, the one great avenue to the unfolding, or more properly speaking, the development, of the intellect is through the eye. The eye at this period holds in abeyance all the other senses. The child, when insensible to touch, taste, smell or hearing, will become aroused to action by a bright light or bright colors, or the movement of any illuminated object, proving to all that light is essential to the development of the first and most important sense. Again, the infant of but six days of age will recognize a candle flame, while its second sense and second in importance to its development--hearing--will not be recognized for _six_ weeks to two months. Taste, touch and smell follow in regular sequence. Inasmuch as light makes thus early an impression on the delicate organ of vision, how necessary it behooves us to guard the infant from too bright lights or too much exposure in our bright climate. Mothers--not only the young mother with her first child, but also those who have had several children--are too apt to try to quiet a restless child by placing it near a bright flame; much evil to the future use of those eyes is the outgrowth of such a pernicious habit. Light throws into action certain cells of that wonderful structure of the eye, the retina, and an over stimulus perverts the action of those cells. The result is that by this over-stimulation the seeds of future trouble are sown. Let the adult gaze upon the arc of an electric light or into the sun, and for many moments, nay hours, that individual has dancing before his vision scintillations and phosphenes. His direct vision becomes blurred, and as in the case of a certain individual I have in mind, there may be a permanent loss of sight. Parents should take the first precaution in the child's life, and not expose it to a light too bright or glaring. When in the open air let the child's eyes be protected from the direct rays of the sun. While it is impossible to give all children the advantage of green fields and outdoor ramblings, yet nature never intended that civilization should debar the innocent child from such surroundings.

An anecdote is related of a French ophthalmic surgeon, that a distinguished patient applied to him for relief from a visual defect; the surgeon advised him to go into the country and look out upon the green fields. The green color with its soothing effect soon brought about a restoration of vision. What I wish to illustrate by this anecdote is that children should be allowed the green fields as their best friend in early life. It tones up the system and rests the eye. After outdoor exercise and plenty of it, we should turn our attention to the home surroundings of our little ones. The overheated rooms of the average American home I am sure have more to do with the growing tendency of weak eyes than we feel like admitting. Look at these frail hot-house plants, and can any one believe that such bodies nourished in almost pestilential atmosphere can nourish such delicate organs of vision, and keep them ready for the enormous amount of work each little eye performs daily? The brain developing so rapidly wills with an increasing rapidity the eye to do increasing duties; note the result--a tendency to impoverished circulation first, and the eye with its power to give the brain a new picture in an infinitesimal short space of time means lightning-like circulation--the eye must give way by its own exhaustion.

Civilization is the progenitor of many eye diseases.

After a boy has grown to that age when it becomes necessary for him to begin the education prescribed by the wise men, obstacles are placed in his way to aid again in causing deterioration of vision. It is not so much the overcrowded condition of our school rooms as the enormous amount of work that causes deterioration of sight. Our children begin their school life at a time when they are too young. A child at six years of age who is forced to study all day or even a part of a day will not run the same race that one will who commences his studies at ten--all things being equal. The law prescribes that so much time must be devoted to study, so many forms must be passed, so many books must be read, so many pages of composition written--all probably in badly lighted rooms, or by artificial light. Note the effect. First, possibly, distant vision gives way; the teacher, sympathizing with the overburdened child, tries to make the burden lighter by changing his position in the room or placing him under the cross light from a window; as the evil progresses, the child is taken to an ophthalmic surgeon, and the inevitable result, glasses, rightly called "crutches for the eyes," are given. What would be thought of a cause which would weaken the legs of that boy so that he would have to use crutches to carry him through life? If civilization be responsible for an evil, let our efforts be put forth in finding a remedy for that evil.

A discussion, in a recent number of the _British Medical Journal_,[2] on "The Claims and Limitations of Physical Education in Schools," has many valuable hints which should be followed by educators in this country. Dr. Carter, in the leading paper on this subject, makes the pregnant remark: "If the hope is entertained of building up a science of education, the medical profession must combine with the profession of teaching, in order to direct investigation and to collect material essential to generalization. Without such co-operation educational workers must continue to flounder in the morasses of empiricism, and be content to purchase relative safety at the cost of slow progress, or no progress at all." In other words, an advisory medical board should coexist with our board of public education, to try to hold in check or prevent a further "cruelty in trying to be kind." Private institutions of education recognize the importance of physical training and development, and in such institutions the deterioration of vision is in proportion less than in institutions where physical training is not considered. In one school of over 200 middle class girls, Dr. Carter found that, during a period of six years, no fewer than ten per cent. of the total number of girls admitted during that time have been compelled to take one or more terms' leave of absence, and of the present number twenty-eight per cent. have medical certificates exempting them from gymnastic exercise and 10.25 per cent. of the total present number wear eye glasses of some kind or other. From my own experience the same number of students in our schools would show about the same percentage of visual defects. These questions are of such growing importance that not only instructors, but the medical fraternity, should not rest until these evils are eradicated.

[Footnote 2: Nov. 1, 1890.]

Dr. J.W. Ballantyne, of Edinburgh, in a lecture[3] on diseases of infancy and childhood, says: "The education of the young people of a nation is to that nation a subject of vital importance." The same writer quotes the startling statement made by Prof. Pfluger, that of 45,000 children examined in Germany more than one-half were suffering from defective eyesight, while in some schools the proportion of the short sighted was seventy or eighty per cent., and, crowning all, was the Heidelberg Gymnasium, with 100 per cent. These figures, the result of a careful examination, are simply startling, and almost make one feel that it were better to return to the old Greek method of teaching by word of mouth.

[Footnote 3: _Lancet_. Nov. 1, 1890.]

Prof. Pfluger attributes this large amount of bad sight to insufficient lighting of school rooms, badly printed books, etc. One must agree with a certain writer, who says: "Schools are absolute manufactories of the short sighted, a variety of the human race which has been created within historic time, and which has enormously increased in number during the present century." Granting that many predisposing causes of defective vision cannot be eliminated from the rules laid down by our city fathers in acquiring an education, it would be well if the architects of school buildings would bear in mind that light when admitted into class rooms should not fall directly into the faces of children, but desks should be so arranged that the light must be sufficiently strong and fall upon the desk from the left hand side. My attention has repeatedly been called to the cross lights in a school room. The light falling directly into the eyes contracts the pupil which is already contracted by the action of the muscle of accommodation in its effort to give a clearer picture to the brain. This has a tendency to elongate the eyeball, and as a permanent result we have near sightedness. Where the eyeball has an unnatural shortness this same action manifests itself by headaches, chorea, nausea, dyspepsia, and ultimately a prematurely breaking down of health. The first symptom of failing sight is a hyper-secretion of tears, burning of the eyelids, loss of eyelashes, and congestion either of the eyelids or the eyeball proper.

The natural condition of aboriginal man is far sighted. His wild life, his nomadic nature, his seeking for game, his watching for enemies, his abstention from continued near work, have given him this protection. Humboldt speaks of the wonderful distant vision of the South American Indians; another traveler in Russia of the power of vision one of his guides possessed, who could see the rings of Saturn. My recent examinations among Indian children of both sexes also confirm this. While the comparison is not quite admissible, yet the recent investigations carried on by Lang and Barrett, who examined the eyes of certain mammalia, found that the larger number were hypermetropic or far sighted. With all the difficulties which naturally surround such an examination they found that in fifty-two eyes of rabbits, thirty-six were hypermetropic and astigmatic, eight were hypermetropic only, five were myopic and astigmatic, and others presented mixed astigmatism. In the eyes of the guinea pig about the same proportion of hypermetropia existed. The eyes of five rats examined gave the following result: Some were far sighted, others were hypermetropic and astigmatic, one was slightly myopic and one had mixed astigmatism. Of six cows, five were hypermetropic and astigmatic and one was slightly myopic.

Six horses were also examined, of which one had normal sight, three were hypermetropic and astigmatic, and two had a slight degree of astigmatism. They also examined other animals, and the same proportion of hypermetropia existed. These gentlemen found that as an optical instrument the eye of the horse, cow, cat and rabbit is superior to that of the rat, mouse and guinea pig.

I have for the last five years devoted considerable attention to the vision of the Indian children who are pupils at two institutions in this city. I have at various times made careful records of each individual pupil and have from time to time compared them. Up to the present there is a growing tendency toward myopia or short sightedness, i.e., more pupils from year to year require near sighted glasses. The natural condition of their eyes is far sighted and the demands upon them are producing many nervous or reflex symptoms, pain over the frontal region and headaches. A good illustration of the latter trouble is showing itself in a young Indian boy, who is at present undergoing an examination of his vision as a probable cause for his headaches. This boy is studying music; one year ago he practiced two hours daily on the piano and studied from three to five hours besides. This year his work has been increased; he is now troubled with severe headaches, and after continued near work for some time letters become blurred and run together. This boy is far sighted and astigmatic; glasses will correct his defect, and it will be interesting to note whether his eyes will eventually grow into near sighted ones. I have several cases where the defective vision has been due entirely to other causes, such as inflammation of the cornea, weakening this part of the eye, and the effect in trying to see producing an elongation of the anterior portion of the eyeball, and this in turn producing myopia. The eye of the Indian does not differ materially from that of any deeply pigmented race. The eyeball is smaller than in the Caucasian, but when we examine the interior we find the same distribution of the blood vessels and same shape of the optic nerves. The pigment deposit in the choroid is excessive and gives, as a background to the retina, a beautiful silvery sheen when examined with the ophthalmoscope. One thing which I noticed particularly was the absence of this excessive deposit of pigment and absence of this watered silk appearance in the half breeds, they taking after the white race.

Many of the intraocular diseases common among the white children were also absent, especially those diseases which are the result of near work.

It is a well known fact among breeders of animals that where animals are too highly or finely bred, the eye is the organ first to show a retrogression from the normal. In an examination by myself some years ago among deaf mutes, I found the offspring of consanguineous marriages much affected, and while not only were many afflicted with inflammatory conditions of the choroid and retina, their average vision was much below the normal.

My quoting Messrs. Lang and Barrett's figures was to bring more prominently to the notice of my hearers the fact that the eyes of primitive man resembled the eyes of the lower mammalia and that the natural eye as an organ of vision was hypermetropic, or far sighted, and that civilization was the cause of the myopic or near sighted eye. Nature always compensates in some way. I grant that the present demands of civilization could not be filled by the far sighted eye, but the evil which is the outgrowth of present demands does not stop when we have reached the normal eye, but the cause once excited, the coats of this eye continue to give way, and myopia or a near sighted condition is the result.

Among three hundred Indians examined, I found when I got to the Creeks, a tribe which has been semi-civilized for many years, myopia to be the prevailing visual defect.

Without going into statistics, I am convinced from my experience that the State must look into this subject and give our public school system of education more attention, or we, as a people, will be known as a "spectacled race."

Myopia or short-sightedness among the Germans is growing at a tremendous rate. While I do not believe that the German children perform more work than our own children, there is one cause for this defect which has never been touched upon by writers, and that is the shape of the head. The broad, flat face, or German type, as I would call it, has not the deep orbit of the more narrow, sharp-featured face of the American type. The eye of the German standing out more prominently, and, in consequence, less protected, is thereby more prone to grow into a near-sighted eye. One of the significant results of hard study was recently brought to my notice by looking over the statistics on the schools of Munich in 1889. In those schools 2,327 children suffered from defective sight, 996 boys and 1,331 girls.

Of 1,000 boys in the first or elementary class, 36 are short-sighted; in the second, 49; in the third, 70; in the fourth, 94; in the fifth, 108; in the sixth, 104; and in the last and seventh, 108. The number of short-sighted boys, therefore, from the first class to the seventh increases about three-fold. In the case of girls, the increase is from 37 to 119.

These statistics in themselves show us the effects of overwork, incessant reading or study by defective gas or lamp light, or from an over-stimulating light, as the arc light, late hours, dissipation, and frequent rubbing of the eye, also fatigue, sudden changes from darkness to light, and, what is probably worse than all, reading on railway trains. The constant oscillations of the car cause an over-activity of the muscle of accommodation, which soon becomes exhausted; the brain willing the eye to give it a clear photograph continues to force the ciliary muscle, which muscle governs the accommodation, in renewed activity, and the result may easily be foretold.

The fond parents finding that the vitiated air of the city is making their once rosy-cheeked children turn pale, seek a remedy in the fresh air of the country. The children find their way to city schools; this necessitates traveling so many miles a day in railway cars. The children take this opportunity of preparing their studies while _en route_ to the city, and here is where they get their first eye-strain. Children have the example set them by their parents or business men, who read the daily papers on the trains. Children are great imitators, and when their attention is called to the evil, quote their parents' example, and they follow it. No wonder each generation is growing more effeminate.

The light in sick rooms should never fall directly on the eyes, nor should the rooms be either too dark or too light.

The Esquimaux and Indians long ago noted the fact that sunlight reflected from freshly fallen snow would soon cause blindness.

The natives of northern Africa blacken themselves around the eyes to prevent ophthalmia from the glare of the hot sand. In Fiji the natives, when they go fishing, blacken their faces. My friend. Dr. Bartelott, presented me with a pair of eye protectors, which he brought from Alaska. The natives use them to protect themselves from snow blindness. These snow spectacles, or snow eyes, as they are called, are usually made out of pine wood, which is washed upon their shores, drift wood from southern climes.

The posterior surface is deeply excavated, to prevent its obstructing the free motion of the eye lids; on each side a notch is cut at the lower margin to allow a free passage for the tears. The upper margin of the front surface is more prominent than the under, to act as a shade to the eyes. The inner surface is blackened to absorb the excessive light. The openings are horizontal slits. The eyes are thus protected from the dazzling effect of the light.

My friend, Dr. Grady, of Omaha, communicated to me a history of three hunters who almost lost their eyesight by too long exposure to the bright rays of the sun falling on snow.

The abuse of tobacco leads to impairment of vision in the growing youth. Cigarette smoking is an evil. I am inclined to believe that the poison inhaled arrests the growth of boys; surely it prevents a mental development, and, when carried to excess, affects vision more by lessening the power of nerve conduction than acting directly on the eye.

It is not the one cigarette which the boy smokes that does the harm, but it is the one, two, or three packages smoked daily. This excessive smoking thoroughly perverts all the functions which should be at their best to aid this growing youth. First we have failing digestion, restless nights, suspension of growth, lack of mental development, the loss of nerve tone, loss of the power of accommodation in vision, failing sight, headaches, enfeeblement of the heart. Let a man who is a habitual smoker of cigars attempt to smoke even one package of cigarettes and he will complain of nausea, dry throat, and loss of appetite. If a strong man is so much affected by this poison, how much less can a boy resist the inroads of such poisons? In Germany the law forbids the sale of cigarettes to growing boys. New York State has a similar law, and why should our own or any other State be behind in passing prohibitory laws against this evil?--and this is a growing evil.

I have never seen a case of tobacco amblyopia in boyhood, but such a condition is not infrequent in adults. In boys the action of nicotine acts especially upon the heart, the impulse is rendered weaker and intermittent, and many young boys lay the seeds of organic disease which sooner or later culminates fatally. Boys should be prohibited from smoking, first by their parents, second by law, but not such laws whose enforcement is a failure, third by placing a heavy fine upon dealers who sell to minors. The pernicious evil of intoxication is no less an evil upon the nervous system of a youth than is the habit of cigarette smoking, but, fortunately, this habit is less common. Having traced from aboriginal man to the present civilized individual the cause of his myopia, what must we do to prevent a further deterioration of vision? Unfortunately, the physician of our country is not, as I am told, like the Japanese physician. Our medical men are called to attend people who are ill and to try to get them well--the Japanese physician is paid only to keep his patients in health.

The first effort parents should make is to see that their children have plenty of outdoor exercise. Good, warm clothing in winter, and light texture cloth in summer. A great difference of opinion exists as to the age at which a child should begin its studies. I feel sure that the boy who commences his studies at ten will far outrun the one who commences study at six. Every child should commence his lessons in the best kindergarten, the nursery. Let object lessons be his primer--let him be taught by word of mouth--then, when his brain is what it should be for a boy of ten, his eyes will be the better able to bear the fatigue of the burdens which will be forced upon him. Listen to what Milton has left on record as a warning to those young boys or girls who insist upon reading or studying at night with bad illumination.

"My father destined me, from a child, for the pursuits of polite learning, which I prosecuted with such eagerness that, after I was twelve years old, I rarely retired to bed, from my lucubrations, till midnight. This was the first thing which proved pernicious to my eyes, to the natural weakness of which were added frequent headaches."

Milton went blind when comparatively a young man, and it was always to him a great grief. Galileo, the great astronomer, also went blind by overwork. It was written of him, "The noblest eye which ever nature made is darkened--an eye so privileged, and gifted with such rare powers, that it may truly be said to have seen more than the eyes of all that are gone, and to have opened the eyes of all that are to come."

When the defect of far sightedness or near sightedness exists, we have but one recourse--_spectacles_.

Some time ago I published, in the _Medical and Surgical Reporter_ an article on the history of spectacles. The widespread interest which this paper created has stimulated me to continue the research, and since this article appeared I have been able to gather other additional historical data to what has been described as an invention for "poor old men when their sight grows weak."

The late Wendell Phillips, in his lecture on the "Lost Arts," speaks of the ancients having magnifying glasses. "Cicero said that he had seen the entire _Iliad_, which is a poem as large as the New Testament, written on a skin so that it could be rolled up in the compass of a nut shell;" it would have been impossible either to have written this, or to have read it, without the aid of a magnifying glass.