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if possible, of actual blindness in the event of the eye becoming diseased. This
latter consideration naturally overlaps with that of treatment. The various factors
are considered in the above-mentioned order.
Congenital defects.—Such conditions as imperfect eyes, congenital cataracts,
dislocation of the lens, absence of the iris (the coloured part of the eye) or albinism
are responsible for much visual defect and have been noted in some 20-30 per cent.
of the children who have attended schools for the blind in different parts of the
country. In some cases the defects tend to recur in families. No preventive
measures for these conditions are known. At the most it can only be urged that in
the case of familial defects the marriage of those affected should be discouraged.
In a eugenic campaign, which is the only method at present available, education
plays the main part. There is, however, little evidence that such conditions occur
with greater frequency in any particular class of the community.
Inflammatory conditions of the surface of the eye. The chief causes of this are—
Ophthalmia neonatorum; purulent conjunctivitis of later years; phlyctenular
(spring) keratitis; chronic inflammation of the eyelids and conjunctivas; trachoma.
Ophthalmia neonatorum is probably the most serious of all the causes of blindness
and is due to infection of the eyes by venereal discharges either at the course of birth
or very shortly afterwards. The complete prevention of ophthalmia neonatorum
would involve the prevention of gonorrhoea in the mother. Here education plays
a part by encouraging higher standards. More directly, however, it may lead to the
attendance of the mother at the ante-natal clinics of hospitals or welfare centres.
In this event the existence of the condition would be ascertained in time to permit
of such treatment, either at the ante-natal centre itself or at a clinic for venereal
disease or by other means, as would greatly minimise the risks to the infant. The
value of the ante-natal and welfare centres is impressed upon all students in the
health courses in the Council's evening schools.
Apart from this increased ante-natal care special care is taken to secure that all
midwives appreciate the value of immediate attention to the eyes of new born
infants and take all necessary measures recommended for this purpose. In this
connection it may be noted that the Council has for many years arranged "refresher"
classes at regular intervals for the further instruction of midwives in all districts of
London.
Ophthalmia neonatorum was made notifiable throughout England and Wales
in 1914. Under the general order then made the disease was defined as "a purulent
discharge from the eyes of an infant commencing within 21 days from the date of its
birth." The order laid upon every certified midwife, who had reasonable cause to
suspect that any child she was called upon to visit in her practice might be suffering
from this condition, the duty of notifying the same to the medical officer of health
of the local sanitary authority (in London, the borough council), unless the case had
already been notified by a medical practitioner. Under the rules of the Central
Midwives Board every midwife who attends an infant with any inflammation or
discharge from the eyes, however slight, is required to obtain medical aid and to
report to the local supervising authority (in London, the County Council) that she
has so done. Owing to the duty of notification to the local sanitary authority
being placed on two parties and the possibility of oversight resulting from either
party thinking the other had carried out the duty, the Ministry of Health have under
consideration a modification which would relieve the midwife from the obligation
to notify under the regulations. That duty would then rest solely on the medical
practitioner called in.
The arrangements made by the Council, as the supervising authority, provide
that on the receipt of a notice from a midwife that an infant has inflammation or
discharge from its eyes, however slight, the home is visited by an assistant medical
officer who assures herself that the child is under adequate medical care, and