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146
to the Metropolitan Asylums Board's institution fell from 47 per cent. to 17 per
cent. Since trachoma is usually introduced from abroad, the departmental
committee pointed out that the first line of defence is in the examination of aliens
at the ports, where there is, however, the difficulty of the absence of power to check
the landing of affected transmigrants.
Inflammations within the eye.—Of the causes of these conditions syphilis
undoubtedly takes the leading place. Estimates have been made by different
ophthalmic surgeons which show that it is responsible for some 30 per cent. of the
cases of blindness in children and for between 7 per cent. and 15 per cent. of the
cases of blindness in adults. The main line of attack is clearly that of the prevention
of veneral disease in general. Once the disease has been acquired prompt treatment
is the only preventive of the sequelæ. So far as children are concerned, it should
be remembered that the existence of the congenital disease is first rendered evident
by the occurrence of active manifestations when it is a matter of cure rather than of
prevention. The great aim is to secure ante-natal treatment. This could be
provided by close co-operation between the ante-natal centres and the V.D. clinics.
At this stage treatment is most effective and usually cures the mother and protects
the child.
The scheme of the Council for the treatment of venereal disease provides all that
is necessary, and the steady educational campaign which is being carried on
simultaneously should effect, in time, a steady improvement. One of the sources
of trouble, though a diminishing one, is the relinquishing of treatment by the
patients before they are discharged as cured and by their failure to return at intervals
for observation. So far as school children are concerned the scheme of medical
inspection and treatment affords the opportunity of treatment for all affected at
the V.D. clinics, etc., while once a child has been taken to a clinic the officers thereat
use every effort to secure the examination of the whole family.
Accidents.—The majority of these are of an industrial character, though London
is not an area in which such conditions bulk largely towards the quota of the blind.
The prevention of industrial blindness depends in the main upon the adoption of
suitable precautions in the factories, a matter which is in the hands of the factories
department of the Home Office.
Myopia.—This is a congenital condition which is responsible for much defective
vision. During early life the condition may increase in most individuals, but only
to a harmless extent. In a certain number, however, it may increase rapidly and
seriously. This increase is accompanied by a stretching of the coats of the eye
which proceeds unevenly, so that in time the inner coat, which is the actual seat of
the first of the processes which result in vision, may become detached with resulting
blindness. This condition is known as detachment of the retina. When the eye
is squeezed continuously, as it is in the convergence of the eye which accompanies
looking at any object which is held close to the eye, it tends to elongate, and if for
any reason the coats of the eye are soft this stretching may be extreme. The shortsighted
naturally tend to hold objects close to their eyes and so have to converge the
eyes to secure binocular vision. They thus increase the pressure and so tend to increase
the stretching. The coats of the eye yield more readily in certain persons in
early life so that at this time the risk of close work is greatest. Unfortunately the
closest work done by a child is in such occupation as reading, writing and sewing,
which form the largest part of the school curriculum. Hence the need for special
educational methods for those who suffer from marked and progressive short sight.
This has been fully recognised in London and the Council provides special sight
saving (myope) schools for the purpose. The arrangements for detecting such children
at medical inspections are elaborate and whenever a need for special care is evident,
the children are examined by the Council's ophthalmic consultant who decides whether
their transfer to the myope classes is needed. These arrangements have proved