N>:U Wl^ "#Afl: ^UIl ^V)l NVWV^" -' ^\\\E-UN!VER% & A\tf-UN!VER//, v^lOS ANGELA LIBRAR' LIBRARY^ \\\E UNIVERS/A BULLETIN AMERICAN ASSOCIATION /O7* t/JO CONSERVATION o/VlSION DOUGLAS C. McMURTRIE, General Editor. Conserving Vision Compiled by Douglas C. McMurtrie. Edited by [ G. E. de Schweinitz, M.D., F. Park Lewis, M.D., Louis Bell, Ph.D., and E. Leavenworth Elliott. AMERICAN ASSOCIATION ;/// CONSERVATION o/*VisiON 25 WEST 3QI STREET . NEW YORK CITV Douglas C. McMurtrie New York City Copyright. 1911. by the American Association for the Conservation of Vision wu) Conserving Vision The eye is one of the most useful and indispensable organs of the body. Through the function of vision practically all knowledge is acquired and by aid of the eye almost all work and activity is directed. Yet the eye has been the victim of serious abuse and neglect, and the mistreatment is reflected in present conditions, which are little realized and have been given but slight attention. In the United States there are estimated to be 100,000 persons totally or practically blind. And most of this blindness is preventable. But there is another situation of far more gravity. At least half of the educated class in the United States are afflicted with serious defects of vision. The truth of this statement is easily seen by thinking of the number of people who are absolutely dependent upon spectacles or eyeglasses. Even with these artificial aids there are thousands of people who are chronic victims of eye-strain. In addition to the physical discomfort such people suffer, the loss in efficiency is tremendous. They are only able to use their eyes for part of the day and they are absolutely prevented from doing any con- tinuous work. In addition it is a w r ell known fact that eye trouble is the cause of many other physical ills. Many chronic maladies, such as headache, indigestion and nervousness, are direct resultants of eye-strain. The economic loss engendered by eye-strain is thus seen to be of vast importance. In the present age, with the great increase of printed matter and the consequent increase in close eye-work, the importance to the people of good eyes, capable of doing efficient work, is tremen- dously enhanced. But instead of being a people with good eyesight, the contrary is conspicuously the case. The situation is one which has received almost no attention at all, yet eye-strain and defective vision can 4 Bulletin of the American Association also be practically entirely prevented. The conspicu- ous reason for the present conditions is the practically universal ignorance regarding the eyes, their care, and the way in which they should be used. Perhaps because eye-strain and defective vision do not have fatal results is the reason the importance of the situation has not been brought to us before with more emphasis. With the realization of present conditions, how- ever, there is presented a hopeful aspect in the fact that a very large proportion of eyesight defects and losses can be prevented. And this is essentially fundamental work. While it is desirable and necessary to care for present cases of lost and impaired vision, real progress will be made only by preventive work by shutting up the sources whence the trouble has come. So, while rem- edying poor eyesight to the best of our ability, the most permanent results will be attained by saving the eyesight we have from further harm. The conservation of vision is of vast importance in every respect. From the standpoint of economics, soci- ology and personal happiness, good eyesight is essential. It will, therefore, be thoroughly worth while to consider the agencies detrimental to the eyes together with the respective preventive measures best calculated to coun- teract or avoid them. At the present time most people are using their eyes under the worst possible conditions rather than under the best. This situation could easily be reversed were people given any instruction in the care of their vision. How, then, are the eyes injured and what are the best methods of care? Detriments to Eyesight. Loss or impairment of vision results from strain due to overwork, from using the eyes in ways calculated to strain them, or under improper conditions of illumina- for the Conservation of Vision tion, from uncorrected defects in the physiological structure of the eye, from accidents to the eye, and from eye diseases. Overwork of the Eyes. Most people very often overwork their eyes. They work continuously on fine matter, when their eyes are in no condition to perform their duty, especially in cases where eyesight is already defective; such a policy is suicidal. The length of application should be regulated to the strength of the eyesight and the eyes should be rested occasionally, either by closing them for a few minutes or by looking at some distant object. Children are especially liable to overwork of the eyes, and the schools are persistent offenders in this re- gard. The muscular weakness of children is so apparent that ample allowance is made in the tasks the muscles of the body are assigned to perform ; but that the eyes are equally incapable of performing the work which would be expected of a mature person is far too frequently disregarded. The fact that a child's vision is appar- ently even more distinct than that of an older person is due to the flexibility of the lens of an immature eye, and only adds to the popular misconception. That the vision of children is more easily fatigued to the point of injury by continuous application to near objects, there is not the slightest doubt. Conditions which Strain the Eyes. It would seem that matter expressly intended for interpretation through the eye should be prepared with some regard for the welfare of that organ. This ap- pears, however, to be seldom the case. Printed mat- ter, which is the most frequent object of eye-work, is a persistent offender against vision. Whereas the type should be large, the margins ample, the spacing clear, and the paper of a dull finish so as not to reflect the light, the direct contrary is often the case. Books and 6 Bulletin of the American Association magazines are far too frequently printed on shiny paper and the newspapers offend not only in the size of their type, but also in the clarity of their impression. As type figures so largely in the work of the eye, its character is of great importance. In general it may be said that it should be of generous size, plain in style, and free from "hair-lines" and fancy addenda. All work with the eyes should be done, so far as possible, with the matter more nearly perpendicular to the line of vision. That is, school desks and other read- ing supports should be tilted at an angle of about thirty degrees. It is hardly necessary to point out that this fact has been almost universally disregarded in the schools, where the great majority of close study is done. As the eye is part of, and dependent upon, the physiological structure, it is important that general con- ditions be as hygienic as possible. Reading in moving trains or other conveyances is injurious because the relative positions of the eye and the matter being read are constantly shifting. for the Conservation of Vision Illumination One of the most prevalent sources of injury to the eye is improper illumination. The prevalence of bad illumination is as general as defective eyesight, and both are well-nigh universal. Furthermore, the effects of eye-strain caused by bad illumination may produce defects in vision, besides aggravating those already existing. To have the eyes properly tested and fitted with glasses involves more or less expense, and hence affords some excuse for the neglect of this prolific cause of bodily ills and discomfort ; but this does not hold in the case of bad illumination, for good illumination costs no more, and in the majority of cases considerably less. The use of bad illumination can therefore be charged to nothing but want of knowledge of the subject. But for such ignorance there are some extenuating circum- stances. The subject is one which has only recently been given careful scientific attention, and the knowl- edge of what is good and bad illumination, and of how to obtain that which is good, has been by no means gen- erally disseminated. The subject, however, is neither difficult nor complicated, and the observance of a few plain rules will obviate at least the more serious faults. Daylight Illumination. Daylight has always been accepted as the standard of perfect illumination, and this is true for all general purposes, although there are some exceptional cases in which artificial light is superior. Direct sunlight should never be used for any kind of close eye-work, and win- dows which receive direct sunlight should be equipped with light buff or green Holland shades. 8 Bulletin of the American Association Ceilings should be kept white, and side walls either white, light buff or light olive green, according to condi- tions, if efficient artificial lighting is desired. Dark tints greatly increase the amount of light required for adequate illumination. White should be used where the supply of daylight is limited, as in the case of many factories and workshops, especially in the larger cities; light buff or cream color is preferable where there is an abundance of north light and a considerable amount of blank wall; while green or deep buff is preferable for rooms with large window space receiving direct sunlight. The daylight illumination of rooms having win- dows only on one side or end can be greatly improved by the use of prismatic glass in the upper half of the window. By this means it is possible to illuminate a room having a length at least twice its width, with win- dows at one end only, with practical uniformity. Flat skylights are to be avoided as they give the same effect as working under the open sky. The most satisfactory of all methods of daylight illumination is the so-called "saw-tooth construction" ; but this of course is only available in one-story structures. The eyes should never be obliged to face a window having the open sky in view unless window shades are provided to cut down the light if it becomes too strong. This pre- caution should be observed in the placing of machinery and benches in factories. Artificial Illumination. The first thing is to discharge the mind of all pre- conceived notions as to this or that light being "hard on the eyes." All light sources in common use are capa- ble of giving an illumination that is perfectly agreeable to the eyes; it is the way in which the lights are used that makes them hard on the vision. Thus, with the proper equipment it would be impossible to tell whether for the Conservation of Vision a room were lighted with oil lamps, gas or electricity. Many people still use oil lamps with the idea that their light is easier on the eyes, the notion still being common that electric light is hard on the eyes. The light of kerosene lamps is easy on the eyes because such lamps are always placed on tables, and nearly always covered with shades which completely hide the flame; and even if the flame is seen, it is so much less bright than the electric light that it is comparatively harmless. But use an electric lamp in the same way that an oil lamp is used, that is, supply it with the proper shade to protect the eyes and diffuse the light, and the illumination pro- duced is not only just as easy on the eyes, but cannot be distinguished from that of an oil lamp. The same conditions apply to gas. Thus, the gen- eral notion in regard to gas is taken from the old-fash- ioned flame jet, which flickers and blows and gives a wavering, unsatisfactory illumination. The modern mantle burner, however, when fitted with the proper shade, gives an illumination which is absolutely steady and of a quality which cannot be distinguished from the best electric or oil light. If gas is used for illumination the flame burner should be entirely discarded except in the few places where a light is seldom required. Good mantle burners consume but half the gas of an ordinary jet and give from four to six times the amount of light. The mantle burner, however, is entirely too brilliant to be used without a shade or diffusing globe. The test for the proper equipment of either a gas or electric lamp is to look at it from every position in which you would be likely to sit or stand, and see if any part of the mantle or filament is in sight ; if so, it should be covered in some way. Globes and Shades, The various devices for use in connection with lamps may be roughly divided into globes and shades. 10 Bulletin of the American Association The former include those which the light passes through, and the latter, those which are intended to reflect the light. The purpose of globes is to diffuse and soften the light, and thus prevent glare. A globe should entirely hide the luminous surface and should show no brilliant spots of light. Those made of some form of white glass most completely diffuse the light and are, there- fore, most agreeable to the eyes. Globes of a light yel- low or green tint still further soften the light. Shades of translucent material are generally prefer- able, those of white porcelain coated with translucent green being very satisfactory, as are also those of heavy white glass. Prismatic glass shades should either be of the satin-finished type or should be covered on the out- side with thin silk. When an open shade is used with an electric lamp the lower portion of the bulb should be frosted, and when used with a mantle burner an eye-cup, or "bobesche," should be used. Bare gas or electric lamps should never be tolerated. Lighting Fixtures. Wall brackets are generally a poor method of lighting a room; they produce cross lights, and shine more or less directly into the eyes. They are admissi- ble for general illumination in rooms where no reading or close eye-work is to be done, provided they are well shaded or screened. A single bracket can be made to give an excellent reading light by using a good reflec- tor, and sitting with the back to the light. A single tungsten lamp or mantle burner will thus give a light for several people. The central chandelier is often no more satisfactory than brackets. It is very common to find such chande- liers supplied with gas jets in the form of Imitation can- dles, the flame consequently having no globe or shade, and electric lamps in a vertical position, sometimes with for the Conservation of Vision 11 no shade at all, and frequently with some fancy shade or globe which shows bright spots of light and cuts off the rays underneath where one would naturally sit to read or work. In other cases the electric lamps are turned out at an angle and fitted with open globes which expose the bare filament of the lamp. In any of these cases the resulting illumination is exceedingly hard on the eyes. .Diffusing globes or shades entirely concealing the filament should always be used for chandeliers. Where the ceiling is white, as is now generally the case, an exceedingly restful effect can be obtained by indirect lighting. This is accomplished by using an opaque reflector which will throw the light on the ceil- ing, from which it is diffused throughout the room. This can be very easily accomplished on chandeliers in which the electric lamps are in an upright position by simply using such reflectors in the space of the ordinary globes. Small mantle gas burners which take the same size shade-holder as an electric lamp can be obtained, and by using these in the place of the ordinary gas jet the same method can be carried out with gas. Fix- tures especially designed for indirect lighting can be had in many beautiful patterns. The fixture known as the "dome," when properly used, gives an excellent light for reading or for the dining room. The height of the fixture and position of the lamp should be such that the light source cannot be seen. Electric lamps should be frosted to prevent streaks of light, unless enclosed in thoroughly diffusing shades. If gas is used a single inverted mantle burner thoroughly screened is advisable. Light Sources. Within the past few years a new type of electric lamp having a metal filament has come into use. These lamps are more economical than the old types, giving 12 Bulletin of the American Association two or three times the amount of light for the same amount of electric current. They are also far more bril- liant, and consequently even greater care should be taken in diffusing their light. The latest form of mantle gas burner is known as the "inverted," since the mantle is suspended below the flame. Such lamps are the most economical of all in the use of gas, and require the least frequent renewing of the mantles. The light is very brilliant, however, and should always be covered with a good diffusing globe. General Directions. In reading or writing the light should never come from squarely in front, since this will produce a shine on the surface of the paper which not only irritates the eyes but blurs the vision. This is one of the worst faults in desk lighting. A desk lamp should never be placed in the middle of the desk, but well over to the left side, or the right side for left-handed people. In reading always sit with the back towards the light or table. Writing or reading with the book on the table necessitates bending forward the head and chest, which seriously interferes with the proper action of the lungs and heart, which in the case of children may result in permanent deformity. It is a common mistake to suppose that the brighter the light the better it is for fine eye-work. The amount, or intensity, of illumination must be varied according to the color of the objects seen. For reading or w r riting on white paper, or sewing on white goods, a compara- tively small amount of light is required, and too much light may produce a dazzling effect upon the surface. If, on the other hand, work is done on dark material, such as sewing on dark-colored cloth, from three to five times as much light may be required. Bare light sources in the line of vision are abso- for the Conservation of Vision 13 lutely bad and to be avoided, whether in the home, school, public hall, factory or office. They dazzle the eyes, produce eye-strain and prevent clear vision, and are therefore both harmful and uneconomical. Mirrors and polished surfaces should be avoided absolutely in nurseries and rooms in which children or others habitually use their eyes for close work, such as writing, reading or sewing, unless the light sources are well screened from them. Light reflected from a pol- ished table is even more annoying than the direct light, since it comes from the direction in which the eye is unaccustomed to bright lights. The familiar snow- blindness is an exaggerated case of this effect. Lamps of any kind should not be too near the eyes, since all light sources give off a considerable quantity of heat which is very irritating. Anyone who has looked at a fire in a grate will understand the discom- fort to the eyes from radiated heat. Industrial Lighting. The use of bad lighting for industrial purposes is an outrage on those who work under it, and the cause of serious losses to the manufacturer by reducing the quality and quantity of work which the operative turns out. The cost of good artificial light, even if used dur- ing the entire working hours, will not represent more than half of one per cent, of the workmen's wages. The question of cost of the light is wholly inconsiderable as compared with the efficiency of the workmen. This especially applies to offices and industries employing female labor, for the double reason that such labor commonly requires much careful vision, and the female constitution is most susceptible to nervous strains of any kind. Great improvements in the production and use of artificial light have been made within the past ten years, and it is now a proven fact that by the selection of the 14 Bulletin of the American Association proper light sources and accessories, and their correct placing with reference to those using the light, it is pos- sible to produce conditions of illumination which will enable the eyes to be used with the same degree of effi- ciency and comfort as by natural light. Where illumination is to be furnished to a consid- erable number of people, as in schools, offices, factories, public halls, etc., the services of a competent illuminat- ing engineer should be secured. The directions given for the lighting of the home can generally be carried out by the householder, and if assistance is desired the local lighting companies can now be depended upon to give safe and sound advice. for the Conservation of Vision 15 Structural Defects of the Eye The structure of an eye, from the optical stand- point, may be conveniently compared to a camera, in which the diaphragm corresponds in the eye to the pupil in the middle of the iris, the photographic lens to the crystalline lens, the dark chamber of the camera to the interior chamber of the eye, and the sensitive plate of the photographic apparatus to the sheet of nervous tissue in the eye called the retina, on which the rays of light fall in order that the images of external objects may be perceived. Any luminous point diffuses light in all directions in straight lines. These lines are called the rays of light. Rays which come from an infinite dis- tance are parallel, but as there is very little difference to the eyes between rays coming from twenty feet and those coming from infinity, this distance of twenty feet (or six meters) may be regarded for practical purposes as infinity. Rays which come from any point nearer than this distance are divergent. The formation of images of external objects on the sheet of nervous tissue which is called the retina, or, in other words, the function of seeing correctly, depends upon what is called the refracting apparatus of the eye, which consists of a series of lenses, the most important one of which is known as the crystalline lens, and which corresponds to the photographic lens in the camera. Now the rays of light which have been described must have a certain character in order to be brought to a focus on the retina of the eye, which corresponds to the sensitive plate of the camera. If the eye is of exactly the proper length it is, without any exertion, adapted to receive parallel rays. Such an eye is a normal eye, tech- nically known as an emmetropic eye. If the eye is too long, that is, longer than the normal eye, it is adapted only to receive divergent rays, or such rays as come from 16 Bulletin of the American Association objects nearer than infinity, as it has been before de- scribed. Such an eye is a near-sighted or a short-sighted eye, technically known as a myopic eye. If the eye is too short, that is, shorter than the normal eye, it is adapted only to receive convergent rays, or such rays as have been passed through a convex lens or come from a concave mirror, because in nature there are no con- vergent rays, but only divergent and parallel rays. Such an eye is a far-sighted or over-sighted eye, tech- nically known as a hyperopic eye. Naturally this relation of the rays of light to the eye must be constantly changing in accordance with the position of the object looked at, that is to say, whether the object is far from or near to the eyes. Therefore the focus of the eye must constantly be altered to meet these conditions. With a camera, to which the eye has been compared, this is readily accomplished by altering its length, but this cannot be done with an eye because the eyeball is inextensible. Therefore this can only be brought about in an eye either by changing the adjust- ment of its lenses, that is, by increasing their power, or by placing in front of the eye lenses of different values. This adjustment of the eyes for the purpose of seeing objects at different distances is accomplished by the con- traction of a small muscle in the eye which increases the power of the crystalline lens of the eye, and the power which is thus exercised is called the power of accommo- dation. These explanations are made in order that the reader may understand what is meant by eye-strain, or those difficulties which occur when the structure of the eye is not normal, that is to say, when it is either far- sighted or near-sighted. If the normal eye wishes to see objects at a distance, it can do so without effort because it is adapted to receive parallel rays, which, as has been explained, are those rays which proceed from distant objects, and only when objects are held close to for the Conservation of Vision 17 the eye as, for example, print the muscle which has been described exercises its contracting power in order to increase the value of the crystalline lens. On the other hand, if an eye is far-sighted, it could not see ob- jects at any distance distinctly because it is adapted to receive only convergent rays, and such rays do not exist in nature, the rays coming from distant points being parallel and those from near points divergent. Therefore this muscle must be in a constant state of tension in order to give the rays the necessary converg- ence, so that images shall be correctly focussed upon the back of the ej^e on the sheet of nervous tissue w r hich has been compared to the sensitive plate of the camera. This constant tension produces many of the symp- toms of eye-strain. The most important of these are headache, which may occur in any portion of the head, pain in and around the eyes, congestions and irritations of the eyes, and a host of nervous symptoms which at one time were not at all understood, that is to say, their cause was not known; for example, vertigo, sleepless- ness, twitchings so severe that they may be comparable to convulsive seizures, night terrors, dyspepsia, often called nervous dyspepsia, melancholia, hysteria, neuras- thenia, and many other similar phenomena. These phe- nomena may be so aggravated that if the eye-strain is not stopped by the adjustment of suitable glasses the health of the patient breaks down, and his capacity for work is not only very often limited but sometimes entirely checked. If, on the other hand, the eye is near-sighted, that is longer than the normal eye, it cannot see distant objects with any distinctness, but only such objects as are near enough to furnish the rays which are suffi- ciently divergent to focus the image of the object prop- erly on the back of the eye. Therefore these patients are constantly straining to see things which are far away, and often the strain is very severe, as they are much in 18 Bulletin of the American Association the condition of one who tries to see the details of a blurred photograph, or one which has been improperly focussed. But more important than either far-sightedness or near-sightedness is the presence of what is known as astigmatism. In the presence of astigmatism, which depends upon the fact that the clear membrane in front of the eye, called the cornea, has a greater refracting power, for example, in the vertical meridian than it has in the horizontal, so that the eye can never focus accu- rately a point of light, but can only see a point drawn out as a circle, an oval or a line, the effort of sight, or eye-strain, is enormously increased. What astigmatism means can best be understood, perhaps, by remembering that the w r ord is derived from two Greek words which mean practically the inability to see a point of light as a point of light. Under these circumstances the effort either of the near-sighted or of the far-sighted eye (because astigmatism may occur either in near-sighted or in far-sighted eyes) is greatly increased and the images it receives are always blurred and distorted. That is the reason why, when astig- matic eyes look at a series of parallel lines, some of the lines are seen clear and black, while others are blurred and fuzzy, and such eyes readily mistake letters which are similar to one another, s's and v's, m's and w's, t's and y's, etc., and because of these things there is an ever increasing effort and constant elaboration of eye-strain in its most pronounced form. The influence of astig- matism, if uncorrected or inaccurately treated, pro- duces the worst type of eye-strain and the symptoms which have been described as characteristic of it in the most violent degree. It would take many pages to describe the evils which uncorrected astigmatism has produced. Now all of these conditions, far-sightedness, near- sightedness and astigmatism, can be perfectly relieved for the Conservation of Vision 19 by suitably adjusted glasses. The difficulty is that because the eyes themselves look normal, and often because there is no pain in the eyes, the symptoms are not believed to be the result of eye-strain and treatment is not properly directed. Therefore it is absolutely necessary for the health of children that before they go to school their eyes should be carefully examined by a competent physician to find whether or not they are in a normal, or practically normal, condition, and if the far-sightedness is greater than the eye can bear, and if there is any astigmatism, these errors of focus should be corrected so that the child may begin the studies of early life without these handicaps. More than this, inasmuch as near-sightedness develops because of many conditions which are undetected in early life, amongst the most important of which are errors of focus, the early investigation of eyes will prevent in many cases the development of near-sightedness and prevent the serious consequences to which reference has been made, and which in general terms are known as the results of eye-strain. Fortunately in properly conducted schools at the present time these examinations are made at suit- able intervals, but it should be the object of every one who is interested in education and in the bringing up of children to make it a point that no child is allowed to begin his school career until a satisfactory examination of the eyes has been made. There is no excuse that the expense of treatment may act as a deterrent to such examinations, because if children are poor all such measurements and investigations can always be made in hospitals and dispensaries where competent physi- cians are at work and where the treatment is free. Therefore the poor are in no sense excluded from the benefits of such examination. 20 Bulletin of the American Association Accidents Impaired vision and blindness itself are only too frequently the results of accidents. Many of these acci- dents are due, on the one hand, to carelessness on the part of workmen, and, on the other, to indifference in the erection or use of suitable safety devices. Eyes are constantly exposed to danger in many occupations and industries. Among them may be men- tioned grinding, stone-trimming, sand-blasting, turn- ing metal at a speed sufficient to cause flying chips, working with a cold chisel, forging, and rolling steel. Again, there are occasional risks to the eyes in other occupations, a notable instance of which is the danger of bursting to which the glass water gauges on boilers are always subject. The safeguards are comparatively simple. The best type of emery wheels now have guards to protect the eyes of the workman from the flying particles and blowers to draw in the dust and discharge it elsewhere. Some lathes have glass or wire-netting screens to guard the eyes of the operator from flying turnings. In cases where there is danger of sharp particles rebounding and reaching the eye, canvas screens are arranged, so that the fragments striking them either stick in the texture or fall dead. In forging special forms of goggles may be provided, and in some of the steel rolling mills the platforms on which the operators of the rolls are sta- tioned are guarded by a sheet of plate glass, thus effect- ually protecting the eyes of the workers from injury. A safe device which has found very general accept- ance is a series of rods down the sides of the water gauge tubes on boilers. In the event of the tube bursting these rods prevent the glass from flying in all directions. Farmers working in the fields are often injured by being struck in the eyes with a beard of wheat. for the Conservation of Vision 21 Such a seemingly trifling injury may be the cause of a serious ulcer of the cornea which will destroy the eye, and should such an accident occur, the workman should at once stop his labor and no time should be lost in placing the eye under proper treatment. Bits of mortar, lime, and particles of molten lead produce most serious injuries of the eye. If lime or mortar is the offending substance the eye should imme- diately be flushed with a stream of cold water and all foreign particles removed. As quickly as possible the patient should seek competent medical advice and receive treatment. Very disastrous are the conse- quences of the bursting of the receptacles containing ammonia, so much used at present in refrigerating plants, and every precaution should be taken by work- men and by employers to guard against the dangers of ammonia burns under these circumstances. Every one is familiar with the protruding hatpin which on more than one occasion has been responsible for the loss of an eye. Public sentiment has been some- what aroused and some legislation has been enacted; but it is high time that this silly freak of fashion should be abolished. Fourth of July celebrated in the conventional manner has been a persistent menace to eyesight, and every year many eyes are destroyed by the senseless and reckless discharge of fireworks and firecrackers. The recent movement for a "safe and sane Fourth" is one which all who believe in conserving vision will heartily endorse. The commonest accident to the eye, however, is what is known as "getting something in the eye." The "something" may be a grain of dust, a cinder, a piece of ash, a bit of iron or steel, etc. If the foreign body gets beneath the upper lid, the eye, exposed to a good light, should be examined in the following manner: Ask the patient to look down, then take hold of the 22 Bulletin of the American Association eyelashes with the thumb and forefinger of the left hand, pull the eyelid downward and slightly away from the eyeball, and evert it by placing midway between the eyelashes and eyebrow the tip of the thumb of the right hand and gently making the same movement which would be required to turn back the edge of a cuff or sleeve. During all these maneuvers the patient must steadily look downward. If the particle rests on the under surface of the lid, it can now be seen and can be removed with the corner of a clean handkerchief, or better, with a fragment of pure cotton twisted on the end of a matchstick. The handkerchief should not be twisted to a point with soiled fingers, and should never be moistened with the tongue. If the body is not found on the under surface of the upper lid, it should be searched for beneath the lower lid and removed in the same way. If the body is imbedded in the cornea, it is usually necessary to have skilled advice, and the body is removed after the eye has been made insensitive with cocain. In many workshops and on trains the laborers and trainmen have a habit of removing these bodies with toothpicks which have been moistened with saliva. This is a most pernicious practice, as the saliva often contains an active germ, which if inoculated into the eye produces a violent ulceration. Many eyes have been lost in this manner. A filthy practice among ignorant persons is to attempt to remove the body with the tip of the tongue, often followed by disastrous consequences. A silly performance is to introduce beneath the eyelids a so- called "eye-stone" or a flaxseed, in the belief that it will remove the foreign substance. Eyes inflamed as the consequence of injury or disease are often treated with applications of tea-leaves, poultices, scraped pota- toes, and the like. Such meddlesome domestic medica- tion has in many instances been followed by serious results. for the Conservation of Vision 23 Contagion may be carried into the eye by the for- eign body, and after its removal the eye should be pro- tected and frequently irrigated with a saturated solu- tion of boric acid. Ordinary "black eye" is caused by the rupture of bloodvessels. Home treatment in simple cases con- sists of cold applications for one hour and then hot applications until the congestion about the eye is ab- sorbed. In any cases where the results seem at all serious a physician should be called in. Bulletin of the American Association Diseases of the Eye The eyelids are lined and the eyeball is covered with a membrane which is called conjunctiva. This is a mucous membrane similar to the membrane, for example, which lines the mouth. It is very readilj" infected by various poisons, notably those which are produced by bacteria. Under these circumstances vio- lent inflammation arises, which is called conjunctivitis. There are many varieties, but the most important are: Gonorrkoeal Ophthalmia. This is a most violent form of inflammation which occurs if the virus of gonor- rhoea is transferred to the eye, either because the person himself is affected with this disease and some of the matter gets into the eyes, or very frequently because the eyes have been touched with something that has been contaminated with the gonorrhoeal poison, the sufferer himself being innocent of the disease. This happens, for example, when soiled linen is used; if the face, for instance, has been wiped with a towel in the toilet room of a railway station, this towel having pre- viously been used by somebody who was thus affected. Unless the disease is very promptly treated it rapidly destroys the sight, producing great ulcers of the eye which perforate its coats and speedily produce blind- ness. The greatest care, therefore, should be exercised by those who travel and who are obliged to use the public toilet rooms, bath rooms, wash stands, etc., and such towels should never be used in drying the face, or used in any way so that they may come in contact with the eyes, for fear that some uncleanly and affected per- son has contaminated them. Ophthalmia Neonatorum. This is a disease, often called "babies' sore eyes," which usually appears about the third day after birth, and in its worst varieties it is caused by the same virus which originates gonorrhoeal for the Conservation of Vision 25 ophthalmia, because during the birth of the child the eyes come in contact with infecting secretions. This disease is the cause of much blindness, and at the pres- ent time there are probably more than 10,000 children in the United States that have lost their sight through its results. Moreover, it is pathetic to remember that most, if not all, of these children's eyes could have been saved had the proper remedies been used when the children were born, because it has been known for many years that what is called Crede's method is an almost sure safeguard, even though the child should be born of a mother who is afflicted with this disease. It should be a punishable offense for any one in attendance on a woman in labor who fails promptly to report the appear- ance of any purulent material in the eye of a baby soon after its birth, because if the disease is promptly treated by those who are familiar with the proper remedies the eyes can be saved; and more than this, it should be required of those who are in attendance on labor cases where it has been impossible to determine before the birth of the child whether the mother is free from infec- tion or not, that the remedy to which reference has been made should be used. This remedy consists in a 1 per cent, solution of nitrate of silver, one drop of which is put into each eye as soon as the baby is born, the eyes afterwards being covered with cold compresses to subdue the slight irritation which the remedy causes. Of course it is not necessary to use this prophylactic in the better class of practice, where the physician can make himself sure of conditions before the birth of the child, but it should always be used where such assurance cannot be obtained, or where it is known that the mother is infected. Trachoma. This disease is often called granular lids, and is an affection of very ancient origin. It is endemic in certain regions of the world, for example, in Egypt, and is one of the greatest menaces with which 26 Bulletin of the American Association the immigration officers have to contend, as the poor immigrants, especially from certain regions, for exam- ple, Italy, Eastern Prussia, Russia, etc., are often, owing to lack of proper inspection at the various points of exit, affected with this disease. Under its influence granulations grow in the eyelids and, by rubbing over the front of the eyeball, produce ulcers which are likely to mar the sight and sometimes destroy it. In certain regions of our own country it is also an endemic disease, and one case introduced into a region where the laws of hygiene are not properly carried out and where poor people are huddled together in small rooms, tenement houses, etc., may cause a widespread infection through- out the inmates of such region or of such houses. For- tunately the rules of inspection of immigrants are strict, but even so, a certain number of patients with trachoma get into our country, and, moreover, mild types of the affection, which may at any time take on a severe char- acter, are unfortunately present among the school chil- dren of some of our large cities. Wherever many chil- dren, or, for that matter, grown-up people, are gath- ered together under the conditions w r hich have been described, a frequent inspection of the eyelids is there- fore necessary, and the detection of any one affected with this disease should be followed by his immediate isolation in order that the spread of the disease may be checked. Phlyctenular Keratitis. This is a disease of the eye, known by the name just recorded, which attacks children usually in the poorer walks of life who are of a strumous habit. Now we know that this really means that they have a form of tuberculosis, and it is probable that this disease should be regarded as one of the mani- festations of the so-called tubercular diathesis. When it occurs little blister-like bodies form on the lining of the eyeball and on the clear membrane in front of the eyeball, which is known as the cornea, and these break for the Conservation of Vision 27 down and create ulcers, in their turn followed by scars which materially affect the vision. Careful treatment, not only of the eyes themselves, but of the constitution, in order to neutralize the effect of constitutional causes of this disease, are followed by the happiest results, but it is very important that the mothers of children should realize how serious the later effects of this disease are, and that these children should promptly receive compe- tent examination and treatment. Acute Conjunctivitis. There are a great many varieties of inflammation of the conjunctiva caused by bacteria which are not so seriously poisonous as those which bring into existence gonorrhoeal ophthalmia and ophthalmia neonatorum. One of the most notable of these affections is the one commonly known as "pink eye," which is prevalent especially in the spring months. It is exceedingly contagious and w T ill sometimes attack many children in a school, or many adults who are living in the environments of the affection. While it is not apt to produce blindness and can readily be cured by mild measures, neglected, it often leaves the eye weak- ened and irritable and subject to other inflammatory states owing to the congestion of the membrane which remains after the severity of the disease has subsided. Cataract. Cataract is a term which means that the crystalline lens of the eye becomes opaque. Some- times children are born with cataract; sometimes from various causes young persons acquire cataract; but the commonest form is the cataract of old persons, and therefore called senile cataract, and which comes about as part of the degenerative changes which take place in many tissues of the body as age advances. It is certain that the best hygiene of the eye that is to say, taking care that the eyes are always used with suitable light and not subjected to prolonged strain, and that if their focus is imperfect it be corrected with glasses pre- vents the development of cataract, although if patients 28 Bulletin of the American Association live long enough some form of cataract is apt to appear. If the cataract becomes complete, that is to say, gets ripe, it can readily be removed by an operation, which is in the largest number of instances successful. Fool- ish advertisements often appear with the statement that there are certain remedies, absorbing remedies, which can cure cataract. This is not true. Proper treatment of the eyes and of the patient doubtless may render the development of cataract less rapid, but when a cataract is formed, and when it is fully formed, there is only one way to relieve the patient and that is by operation. Some occupations render patients liable to cataract, for example, glass-blowers and those who live and work in very heated rooms, for example, puddlers, and therefore great care should be exercised by these workers to protect the eyes as much as possible from the blinding glare of the light under which they must labor. Glaucoma. There is a very serious disease of the eyes which is called glaucoma, and which comes about because what is known as the eye tension becomes in- creased. Exactly why this occurs is not fully under- stood, although the treatment of the disease, when it occurs, especially in the so-called acute varieties of it, is quite successful. These acute varieties are associ- ated with great pain and redness of the eye, which becomes very hard, and blindness speedily ensues unless the eye is promptly treated. It is uncommon in young persons, but elderly persons who have any violent pain in and around the eye, especially if it is associated with loss of vision, should speedily seek relief and not allow precious time to be wasted with the thought that they are suffering with a neuralgia of the eye which will pass away. There are also some chronic varieties of the disease in which there is little or no pain, but a slow loss of vision owing to a gradual degeneration of the optic nerve, and very often patients believe, because for the Conservation of Vision 29 they are old and their vision is failing, that they are probably getting cataract and that they must wait until it gets ripe before anything can be done. This is the greatest folly. Any person past middle life who has any feeling that his sight is failing should always go at once and have it investigated. It may be due to some simple trouble, error of focus or the like, which is readily relieved, but it may also be due to the beginning of this disease, and it is only when one sees the disease in its earlier stages that the proper remedies, either medical or surgical, can be applied to check its progress. A very curious symptom of this disease, which sometimes is manifested for long periods of time, is the appearance of colored rings around lights; for example, if the eye looks at an electric light, it seems to be surrounded with a sort of rainbow. If any one ever has a symptom like this, not a minute's delay should occur until he goes to a competent physician for investigation. 30 Bulletin of the American Association The Conservation of Vision To promote all the methods by which eyesight may be protected and conserved there has been formed the American Association for the Conservation of Vision. Its object directly appeals to every individual, for no one is exempt from impairment of sight by accident, disease, or by the improper use of the eyes. In order to accomplish its purpose most effectively the work of the Association has been divided into six different departments as follows: Department of Diseases and Defects of the Eye; Educational Department (hygiene of the eyes in schools) ; Industrial Department (hygiene of the eyes in fac- tories, stores and offices) ; Department of Statistics and Information; Department of Legislation; Department of Publicity. Each of these departments is conducted by a Direc- tor, with a staff of five or more associates, and such special committees as may be found useful, the work of all departments being coordinated by the general super- vision of the Board of Managers and the constant assist- ance of the General Secretary. The activities of the Association will be directed : First : to collecting and coordinating existing infor- mation on the various matters pertaining to the con- servation of vision. Second: to a careful and impartial investigation of matters upon which present knowledge is either incom- plete or inconclusive. Third: to standardizing methods and practices as fast as definite knowledge can be obtained. Fourth : to carrying on a general campaign of edu- cation in regard to the proper care and use of the eyes. for the Conservation of Vision 31 Fifth: to securing legislation tending to prevent wilful or ignorant practices which result in injury to or destruction of vision. To insure an impartial review of conditions and sound conclusions from existing knowledge of the vari- ous subjects, and unbiased investigations, the personnel of the Departments and Committees of the Association will be confined rigidly to the profession and to laymen who have no commercial interests, directly or indirectly, in the objects of the Association. Every necessary pre- caution will be taken to obtain the most accurate and authoritative scientific facts. The work of educating the public will be done through the frequent issuance of bulletins on special subjects, by lectures, by exhibitions, by cooperation with other scientific and humanitarian organizations, and publicly through the newspaper and periodical press. The American Association for the Conservation of Vision is the outgrowth of a movement having its origin in a desire to prevent blindness from infectious disease, and which gradually developed and extended its pur- pose until it included the prevention of all causes of impaired vision. The following organizations and committees were identified with this initial movement and will be actively affiliated with this Association in its work : Committee on Prevention of Blindness of the Russell Sage Foun- dation; Committee on Prevention of Blindness of the New York Association for the Blind; Maryland Society for the Prevention of Blindness; Ohio State Commis- sion for the Blind; Massachusetts Commission for the Blind; Kentucky Society for the Prevention of Blind- ness ; Arkansas Association for the Prevention of Blind- ness ; Missouri Association for the Prevention of Blind- ness; California Association for the Prevention of Blindness; Committee on Prevention of Blindness of the American Medical Association ; Committee on Con- 32 Bulletin of the American Association servation of Vision of the National Educational Asso- ciation; Illuminating Engineering Society; and Com- mittee for the Blind of the Council of Jewish Women. Membership in the Association is open to all who are interested in any way in any of its objects. Mem- bers are sought rather as a channel through which to promote the objects of the Association than as a source of contributions, financial or otherwise. The member- ship fee is $1.00 a year. The constitution provides that all those who apply for membership during the first year and pay an initia- tion fee of $5.00 shall be enrolled as charter members. It is believed that the objects of the Association are such that many will wish to contribute this small addi- tional amount to its foundation. The annual dues for charter members will be the same as those of the regu- lar members, namely, $1.00 a year. Both classes of members will receive the general bulletins of the Association. The ultimate value of the work of the Association will depend primarily upon the funds available for its use. Those desiring to further the work for scientific or humanitarian reasons are invited to make further contributions. If desired, such contributions may be made for specific purposes. There is pressing need of immediate work by all departments of the Association. Will you further this work by becoming a member and thus lending your support? THE AMERICAN ASSOCIATION FOR THE CONSERVATION OF VISION 25 West 39th Street, New York City. for the Conservation of Vision 33 OFFICERS: President, DR. F. PAKK LEWIS, Buffalo; Vice-President, E. LEAYEN WORTH ELLIOTT,, New York ; Secretary, IDA B. HILTZ, New York; Treasurer, SAMUEL ELY ELIOT, New York. BOARD OF MANAGERS: E. LEA VEX WORTH ELLIOTT, New York, Editor of The Illuminating Engineer. T. COMMERFORD MARTIN, New York, Secretary National Electric Light Association; Formerly editor of The Electrical World. JAMES P. MUXROE, Boston, Mass., President of the Massachusetts Commission for the Blind; Chairman of "Boston 1915." H. FiTz-JoHX PORTER, New York, Efficiency Engineer. F. S. TOMLIN, New York, Secretary of the Federated Committees on Workmen's Compensation of the New York Labor Unions. J. A. SHAWAX, Columbus, Ohio, Superintendent of Schools; member of the Council of the National Educational Association. EDWARD M. VAX CLEVE, Columbus, Ohio, President of the Ohio Commission for the Blind; Superintendent Ohio State School for the Blind. M. C. WHITTAKER, New York, Professor of Industrial Chemistry, Columbia Univer- sity. DR. HIRAM WOODS, Baltimore, Md., Vice-President Maryland Society for the Prevention of Blindness. UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. APR 2 S 1959 APR22RECP AY27J9g8 961 63 WW JUN 3 1964 JUN2 ram NHV5 1965. MAY 1 8 REC' D MAY 1 8 RHTD Form L9-25m-9,'55(B4283s4)444 Orl