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National Society for Prevention of Blindness
164
EDITORIALS
honor of the earlier observer designated the condition as Staphyloma verum Scarpae. Limits of space prevent a more ex tensive outline of the work of this great surgeon but it was a work so funda mentally sound and scientific as to make a firm and sure basis for the fu ture up-building of the science and art of ophthalmology. Park Lewis.
NATIONAL SOCIETY FOR PREVENTION OF BLINDNESS In the very interesting Seventh An nual Report of the Giza Memorial Oph thalmic Hospital, reviewed in this is sue, one of the most striking statements is that in the towns of Egypt one hun dred percent of the native children have acquired trachoma by the time they are one year old. Appalling beyond descrip tion ! Knowing the practically inevi table course of this scourge one can readily agree with the director of the Hospital, Rowland P. Wilson, that the hope for the eyes of these people lies in prevention. In wealthier countries, prevention of eye diseases does not have the impor tance that it does in Egypt but in oph thalmology, as in all medicine, preven tion will assume an increasingly promi nent part in the future. Many states have passed compensa tion laws to aid, among others, the ocu larly injured and have authorized pen sions for the blind. Soon after the pas sage of these laws the state executives began to realize the tremendous cost of the care of these people and the vast economic waste entailed. Industry has long realized this and has been trying for years to protect its workers. More recently tax payers have begun to count the cost and-have become inter ested in cutting down this expense. The answer is obviously, prevention. Fortunately some nineteen years ago there came into being through contri butions from the Russell Sage Founda tion and the Rockefeller Foundation, the National Committee for the Pre vention of Blindness, later called the National Society for the Prevention of
Blindness. To this national body it has been possible for ophthalmologists, state committees, social agencies, local societies for the blind and all interested parties to turn for aid and advice. The Society has in its program pre venting of infantile blindness, care of the eyes of preschool children, preven tion of accidents to the eyes in child hood, conserving the sight of school children, conserving the sight of the worker, publishing and distributing material, research and demonstration projects. In each of these fields it has been very active and much has been accomplished. The Society has been fortunate in having an unusually able Board which is closely in touch with the prevention work in each state and is constantly being of service. One of the recent interesting projects has been the training of social workers for ophthalmological purposes. Selected indi viduals have been placed for instruc tion in universities which have active social service and ophthalmological de partments. After finishing their train ing these students have been located in hospitals and clinics that need such workers. The Society's quarterly, the "Sight-Saving Review" and "SightSaving Class Exchange" for teachers and supervisors of sight-saving classes are well prepared and instructive jour nals. Work on prophylaxis of ophthal mia neonatorum has been active for a long time. Encouragement of sight-sav ing classes, and statistical enumeration of them has been a part of its task. The Society is constantly looking forward, being ever willing to enter new fields of usefulness. Under consid eration now is the advisability of giving instruction to workers to aid in the orthoptic clinics. The Society is en deavoring to discover if this is a suit able undertaking for it. The answer will depend on the reaction of the ophthal mologists of the country to the ques tionnaire sent out by the Society but the suggestion is cited as an example of the willingness to go forward. The National Society is to be con gratulated on what it has already ac complished and encouraged to go on with the good work. Whoever is inter-
EDITORIALS ested in work in ophthalmic preven tion or needs help in such matters, would do very well indeed to consult with this organization. Lawrence T. Post. IMPROVED FORM OF SLITLAMP MICROSCOPE The popularity and general employ ment of any piece of medical apparatus depend upon several factors: first, knowledge of its existence; second, un derstanding of its purposes and advan tages; third, the facility with which it can be used from day to day by the av erage worker; and, lastly, its cost. There are today few ophthalmolo gists who do not know of the existence of the slitlamp microscope, but many who have a limited understanding of its purposes and advantages. The cost of the more elaborate slitlamp micro scopes to which the name is properly restricted leaves much to be desired. But many perhaps have also avoided the apparatus because it appeared to be complicated and unwieldy. The mechanical objections to the slit lamp apparatus most widely used are clearly enumerated by Comberg (Klinische Monatsblatter fur Augenheilkunde, 1933, volume 91, page 577), di rector of the University Eye Clinic at Rostock, Germany. Especially incon venient is the need for detailed read justment of the light source in going from one eye to the other, with the in cidental swinging of the long bar of the slitlamp carrier across the body of the examiner. The second difficulty consists in the necessity for repeated and separate ad justment of the microscope and the slitlamp for the purpose of studying dif ferent parts of the eye, a necessity which employs both hands of the ex aminer. Changes in intensity of illumi nation and in width of the slit call for disturbing changes in the position of the examiner and in the direction of his gaze, and are usually complicated by disturbance in adjustment of the image of the slit. In the radically modified form of the
165
slitlamp microscope devised by Com berg,* these inconveniences have been avoided and other material improve ments have been introduced. The origi nal model of this apparatus has been in use by Comberg for over three years, and was briefly demonstrated at the In ternational Congress in Madrid. Both the microscope and the lamp revolve upon the post which supports the patient's chin and forehead. The whole apparatus becomes very much more compact. The troublesome long arm carrying the slitlamp in the old ap paratus is replaced by a very short arm, the beam of light being at first directed vertically and then turned horizontally by means of a prism. While the slitlamp image is being ad justed in relation to the patient's eye, the microscope is swung to one side. Once the patient's head is set at the proper height, either eye is brought into the necessary relationship with the microscope and lamp by means of a screw which displaces the head an inch or so to one side or the other. This, in combination with the up and down ac tion of the head rest, and with a much longer image of the luminous slit (eight millimeters) enables the observer to vary the position of the "object" (the patient's eye) almost as conveniently as one varies the position of the object beneath an ordinary microscope. Some of the arrangements included in this new apparatus are so obviously superior to those of the old slitlamp mi croscope that one wonders why they were not long ago incorporated in this increasingly important weapon of ophthalmologic diagnosis. But it is com mon experience that new devices ap pear simple and obvious when once the brain of the inventor has given birth to them. It is to be hoped that some day the manufacturer will see his way to produce an apparatus at much less than the present cost. In so doing it is not at all unlikely that he would actu ally increase his own profits by a great addition to the number of buyers.
W. H. Crisp. * In collaboration with the firm of Carl Zeiss.
EDITORIALS
honor of the earlier observer designated the condition as Staphyloma verum Scarpae. Limits of space prevent a more ex tensive outline of the work of this great surgeon but it was a work so funda mentally sound and scientific as to make a firm and sure basis for the fu ture up-building of the science and art of ophthalmology. Park Lewis.
NATIONAL SOCIETY FOR PREVENTION OF BLINDNESS In the very interesting Seventh An nual Report of the Giza Memorial Oph thalmic Hospital, reviewed in this is sue, one of the most striking statements is that in the towns of Egypt one hun dred percent of the native children have acquired trachoma by the time they are one year old. Appalling beyond descrip tion ! Knowing the practically inevi table course of this scourge one can readily agree with the director of the Hospital, Rowland P. Wilson, that the hope for the eyes of these people lies in prevention. In wealthier countries, prevention of eye diseases does not have the impor tance that it does in Egypt but in oph thalmology, as in all medicine, preven tion will assume an increasingly promi nent part in the future. Many states have passed compensa tion laws to aid, among others, the ocu larly injured and have authorized pen sions for the blind. Soon after the pas sage of these laws the state executives began to realize the tremendous cost of the care of these people and the vast economic waste entailed. Industry has long realized this and has been trying for years to protect its workers. More recently tax payers have begun to count the cost and-have become inter ested in cutting down this expense. The answer is obviously, prevention. Fortunately some nineteen years ago there came into being through contri butions from the Russell Sage Founda tion and the Rockefeller Foundation, the National Committee for the Pre vention of Blindness, later called the National Society for the Prevention of
Blindness. To this national body it has been possible for ophthalmologists, state committees, social agencies, local societies for the blind and all interested parties to turn for aid and advice. The Society has in its program pre venting of infantile blindness, care of the eyes of preschool children, preven tion of accidents to the eyes in child hood, conserving the sight of school children, conserving the sight of the worker, publishing and distributing material, research and demonstration projects. In each of these fields it has been very active and much has been accomplished. The Society has been fortunate in having an unusually able Board which is closely in touch with the prevention work in each state and is constantly being of service. One of the recent interesting projects has been the training of social workers for ophthalmological purposes. Selected indi viduals have been placed for instruc tion in universities which have active social service and ophthalmological de partments. After finishing their train ing these students have been located in hospitals and clinics that need such workers. The Society's quarterly, the "Sight-Saving Review" and "SightSaving Class Exchange" for teachers and supervisors of sight-saving classes are well prepared and instructive jour nals. Work on prophylaxis of ophthal mia neonatorum has been active for a long time. Encouragement of sight-sav ing classes, and statistical enumeration of them has been a part of its task. The Society is constantly looking forward, being ever willing to enter new fields of usefulness. Under consid eration now is the advisability of giving instruction to workers to aid in the orthoptic clinics. The Society is en deavoring to discover if this is a suit able undertaking for it. The answer will depend on the reaction of the ophthal mologists of the country to the ques tionnaire sent out by the Society but the suggestion is cited as an example of the willingness to go forward. The National Society is to be con gratulated on what it has already ac complished and encouraged to go on with the good work. Whoever is inter-
EDITORIALS ested in work in ophthalmic preven tion or needs help in such matters, would do very well indeed to consult with this organization. Lawrence T. Post. IMPROVED FORM OF SLITLAMP MICROSCOPE The popularity and general employ ment of any piece of medical apparatus depend upon several factors: first, knowledge of its existence; second, un derstanding of its purposes and advan tages; third, the facility with which it can be used from day to day by the av erage worker; and, lastly, its cost. There are today few ophthalmolo gists who do not know of the existence of the slitlamp microscope, but many who have a limited understanding of its purposes and advantages. The cost of the more elaborate slitlamp micro scopes to which the name is properly restricted leaves much to be desired. But many perhaps have also avoided the apparatus because it appeared to be complicated and unwieldy. The mechanical objections to the slit lamp apparatus most widely used are clearly enumerated by Comberg (Klinische Monatsblatter fur Augenheilkunde, 1933, volume 91, page 577), di rector of the University Eye Clinic at Rostock, Germany. Especially incon venient is the need for detailed read justment of the light source in going from one eye to the other, with the in cidental swinging of the long bar of the slitlamp carrier across the body of the examiner. The second difficulty consists in the necessity for repeated and separate ad justment of the microscope and the slitlamp for the purpose of studying dif ferent parts of the eye, a necessity which employs both hands of the ex aminer. Changes in intensity of illumi nation and in width of the slit call for disturbing changes in the position of the examiner and in the direction of his gaze, and are usually complicated by disturbance in adjustment of the image of the slit. In the radically modified form of the
165
slitlamp microscope devised by Com berg,* these inconveniences have been avoided and other material improve ments have been introduced. The origi nal model of this apparatus has been in use by Comberg for over three years, and was briefly demonstrated at the In ternational Congress in Madrid. Both the microscope and the lamp revolve upon the post which supports the patient's chin and forehead. The whole apparatus becomes very much more compact. The troublesome long arm carrying the slitlamp in the old ap paratus is replaced by a very short arm, the beam of light being at first directed vertically and then turned horizontally by means of a prism. While the slitlamp image is being ad justed in relation to the patient's eye, the microscope is swung to one side. Once the patient's head is set at the proper height, either eye is brought into the necessary relationship with the microscope and lamp by means of a screw which displaces the head an inch or so to one side or the other. This, in combination with the up and down ac tion of the head rest, and with a much longer image of the luminous slit (eight millimeters) enables the observer to vary the position of the "object" (the patient's eye) almost as conveniently as one varies the position of the object beneath an ordinary microscope. Some of the arrangements included in this new apparatus are so obviously superior to those of the old slitlamp mi croscope that one wonders why they were not long ago incorporated in this increasingly important weapon of ophthalmologic diagnosis. But it is com mon experience that new devices ap pear simple and obvious when once the brain of the inventor has given birth to them. It is to be hoped that some day the manufacturer will see his way to produce an apparatus at much less than the present cost. In so doing it is not at all unlikely that he would actu ally increase his own profits by a great addition to the number of buyers.
W. H. Crisp. * In collaboration with the firm of Carl Zeiss.