View report page

34
from the honorary collector to whom he pays his contributions; and the Hospital
Savings Association, a subscriber to which is given, by the optician, a form which
has to be filled in by the group secretary and returned to the optician with the
balance of the money. The benefit in this case is half the cost of spectacles in
ordinary frames.
When parents are in receipt of out-relief glasses can be obtained through the
Public Assistance Committee.
The
treatment of
squint.
There are two special arrangements for the treatment of squint in the Council s
scheme.
At the Belgrave hospital for children an operation centre is maintained at which
operations for advancement of the external rectus muscle of the eye are performed in
cases of obstinate squint. At the Paddington school treatment centre a "squint
class "has been carried on for 16 years under the direction of Dr. Thornett. The
committee of the centre has forwarded the following report by Dr. Thornett
upon the work of this class:—
Work of
the squint
clinic.
The squint clinic began in 1915, when I was ophthalmic surgeon to the Children's hospital
in Harrow-road. It was held during the ordinary ophthalmic clinic, making this a very arduous
task, until the Council, in 1917, started the clinic of its own, enabling one to put all one's
energies into the special treatment required.
A squint of the kind treated in this clinic is produced when one eye only focuses on an
object, the other turning in towards the nose or out towards the ear, ignoring the object seen
by the focussing eye. The inturning squint is much the most common, and is usually accompanied
by loss of vision of the squinting eye from disuse. Sometimes the loss is not great, but
in the majority of cases vision is reduced to a degree which makes the eye useless for all practical
purposes if, at a later time, the sight of the good eye is injured or lost. Moreover, when the
eye turns in towards the nose, the patient is in the position of a man with only one eye, as he
is aware of nothing on that side of the body. This makes it dangerous for him to go into any
occupation where accidents are liable to happen.
A large number of the cases have a vision as low as 6/36 or 6/60, but some have even less
than this, central vision being entirely lost. It is hardly necessary to stress the tremendous
handicap it is to a young man with vision only in one eye. The army, navy, police, railways
and engineering machine shops are all closed to him. Factories where machinery is used are
dangerous for such a man, and driving a car or other speedy vehicle is dangerous both to himself
and others. Even if the sight of the squinting eye is good, the loss of the field of vision is just
as great if the squint is very pronounced.
The aim of the clinic is two-fold—firstly to restore the sight of the squinting eye, and secondly
to teach the squinting eye to co-operate with the good eye, and to focus on the same object
simultaneously, and thus to become straight.
The causes of squint are both predisposing and direct. Most animals have no binocular
vision, each eye taking care of the corresponding field of vision. Binocular vision in man is
therefore a recent acquisition, comparatively speaking, and is more liable to be deficient than
the older powers, and it is probable that the centre in the brain which controls the power of
binocular convergence is deficient in certain cases. This explains the occurrence of squint in
children, with little or no error of refraction, and the hereditary appearance of squint in families.
Another predisposing cause of squint is error of refraction. When the sight is deficient
owing to this cause, the child finds great difficulty in bringing both eyes to bear on the same
object, especially if the error is greater in one eye. Relief is experienced by turning the eye
with the greater error into the corner, and a habit of squint is quickly formed. In a small
number of cases where the squinting eye has not lost much vision, glasses alone have been found
to cure the squint.
As to direct causes, anything which upsets the equanimity and health of the child may
precipitate matters and cause a squint, such as fright, shock, pain, illness, strain as in coughing,
the strain of starting school-work.
It is a thing worthy of remark that nearly all the patients in the squint clinic are mouthbreathers.
This is not to imply that mouth-breathing directly produces squint, but the illhealth,
and especially the chronic catarrh which is so frequent an accompaniment of mouthbreathing,
is directly responsible for the precipitation of squint. I find that it is essential to
cure this bad habit in the treatment of squint, and that those who are recalcitrant are very
much more difficult to treat.
The error of refraction having been carefully corrected in the refraction clinic, the child is
transferred to the squint clinic for treatment to restore the sight of the squinting eye. Vision
with glasses is tested, and where the visual acuity of the squinting eye is found to be less than
that of the good one, a cover of paper is gummed over the glass of the straight eye, forcing the
squinting eye to work. The eye comes out of its corner, and, if the glasses are constantly worn,
and the good eye not used, a slow but sure improvement in sight is obtained. When the sight