Page:EB1911 - Volume 04.djvu/73

 The following table gives the number of blind persons as reported in the census of each country. Unless otherwise stated, it refers to the statistics of 1900.

There are many cases of complete or partial blindness which might have been prevented, and a knowledge of the best methods of prevention and cure should be spread as widely as possible. Magnus, Bremer, Steffen and Rössler are of opinion that 40% of the cases of blindness might have been prevented. Hayes gives 33.35% as positively avoidable, 38.75% possibly avoidable, and 46.27% as a conservative estimate. Cohn regards blindness as certainly preventable in 33%, as probably preventable in 43%, and as quite unpreventable in only 24%. If we take the lowest of these figures, and assume that 400 out of every 1000 blind persons might have been saved from such a calamity, we realize the importance of preventative measures. For the physiology and pathology of the eye generally, see and.

The great majority of these cases are due to infantile purulent ophthalmia. This arises from inoculation of the eyes with hurtful material at time of birth. If the contagious discharges are allowed to remain, violent inflammation is set up which usually ends in the loss of sight. It depends on the presence of a microbe, and the effective application of a weak solution of nitrate of silver is curative, if made in a proper manner at an early period of the case. In Germany, midwives are expressly prohibited by law from treating any affection of the eyes or eyelids of infants, however slight. On the appearance of the first symptoms, they are required to represent to the parents, or others in charge, that medical assistance is urgently needed, or, if necessary, they are themselves to report to the local authorities and the district doctor. Neglect of these regulations entails liability to punishment. Eleven of the United States of America have enacted laws requiring that, if one or both eyes of an infant should become inflamed, swollen or reddened at any time within two weeks of its birth, it shall be the duty of the midwife or nurse having charge of such infant to report in writing within six hours, to the health officer or some legally qualified physician, the fact that such inflammation, swelling or redness exists. The penalty for failure to comply is fine or imprisonment.

The following weighty words, from a paper prepared by Dr Park Lewis, of Buffalo, N.Y., for the American Medical Association, show that laws are not sufficient to prevent evil, unless supported by strong public sentiment:—

“When an enlightened, civilized and progressive nation quietly and passively, year after year, permits a multitude of its people unnecessarily to become blind, and more especially when one-quarter of these are infants, the reason for such a startling condition of affairs demands explanation. That such is the fact, practically all reliable ophthalmologists agree.

“From a summary of carefully tabulated statistics it has been demonstrated that at least four-tenths of all existing blindness might have been avoided had proper preventative or curative measures been employed, while one-quarter of this, or one-tenth of the whole, is due to ophthalmia neonatorum, an infectious, preventable and almost absolutely curable disease. Perhaps this statement will take on a new meaning when it is added that there are in the state of New York alone more than 6000, and in the United States more than 50,000 blind people; of these 600 in the one state, and 5000 in the country, would have been saved from lives of darkness and unhappiness, in having lost all the joys that come through sight, and of more or less complete dependence—for no individual can be as self-sufficient without as with eyes—if a simple, safe and easily applied precautionary measure had been taken at the right time and in the right way to prevent this affliction. The following three vital facts are not questioned, but are universally accepted by those qualified to know:—

“1. The ophthalmia of infancy is an infectious germ disease.

“2. By the instillation of a silver salt in the eyes of a new-born infant the disease is prevented from developing in all but an exceedingly small number of the cases in which it would otherwise have appeared.

“3. In practically all those few exceptional cases the disease is absolutely curable, if like treatment is employed at a sufficiently early period.

“Since these facts are no longer subjects of discussion, but are universally accepted by all educated medical men, the natural inquiry follows: Why, as a common-sense proposition, are not these simple, harmless, preventive measures invariably employed, and why, in consequence of this neglect, does a nation sit quietly and indifferently by, making no attempt to prevent this enormous and needless waste of human eyes ?

“The reasons are three-fold, and lie—first, with the medical profession; second, with the lay public; third, with the state.

“For the education of its blind children annually New York alone pays per capita at least $350, and a yearly gross sum amounting to much more than $100,000. If, as sometimes happens, the blind citizen is a dependent throughout a long life, the cost of maintenance is not less than $10,000, and the mere cost in money will be multiplied many times in that a productive factor, by reason of blindness, has been removed from the community.

“If, therefore, as an economic proposition, it were realized how vitally it concerns the state that not one child shall needlessly become blind, thereby increasing the public financial burden, there is no doubt that early and effective measures would be instituted to protect the state from this unnecessary and extravagant expenditure of public funds.

“Eleven states have passed legislative enactments requiring that the midwife shall report each case to the proper health authority, and affixing a penalty for the failure to do so. As has been intimated, however, it is not by any means always under the ministration of midwives that these cases occur, and, like all laws behind which is not a strong and well-informed public sentiment, this law is rarely enforced. A more effective method must be devised. Every physician having to do with the parturient woman, every obstetrician, every midwife, must be frequently and constantly advised of the dangers and possibilities of this disease, the necessity of prevention, and the value of early and correct treatment. They must then have placed in their hands, ready for instant use, a safe and efficient preparation, issued by the health authorities as a guarantee as to its quality and efficiency.

“An important step was taken in this direction - when a resolution was passed by the House of Delegates at the annual meeting of the New York State Medical Society, requesting the various health officers of the state to include ophthalmia neonatorum among contagious diseases which must be reported to the local boards of health.

“The second essential, in order that the cause of infantile ophthalmia be abolished, is that a solution of the necessary silver salt be prepared under the authority of somebody capable of inspiring universal confidence, and that it be distributed by the health department of every state gratuitously to every obstetrician, physician or midwife qualified to care for the parturient woman. The nature of the solution, together with the character of the descriptive card which should accompany it, should be determined by a committee, chosen by the president of the American Medical Association, which should have among its members at least one representative ophthalmologist, one obstetrician and one sanitarian. The conclusions of this committee should be reported back to the House of Delegates, so that the preparation and its text should carry with it, on the great authority of this association, the assurance that the solution is entirely safe and necessary, and that its use should invariably be part of the toilet of every new-born child. The solution, probably silver nitrate, could be put up either by the state itself or by some trustworthy pharmacist, at an insignificant cost; its purity and sterility should be vouched for by the board of health of the state. It should be enclosed in specially prepared receptacles,