156
OPPENHEIMER: The Blind of New York City.
THE BLIND OF NEW YORK CITY. By IHENRY S. OPPENHEIMER, M.D.
The city of New York makes an annual appropriation from its excise fund to be divided among such of the blind adtult poor of the city as try to maintain themselves without b'ecoming inmates of public institutions. The conditions upon which an applicant becomes entitled to participate in the benefits of this fund are: That he, or she, shall be of age, shall have lived in the city for at least two years, shall be poor enough to be considered in need of it, and shall be blind. The definition of blindness is not the scientific one,-" Incurable, total loss of sight," but rather the popular one: The loss of vision to so serious a degree as to prevent earning a livelihood at any vocation requiring eyesight. Visual di'sturbances which may be remedied by operation, such as cataract, for instance, are included in this definition of blindness. The medical examiner is simply required to certify that the applicant is unable to make his living by sight, or to refuse to sign this application. It is only of recent years that it has been found advisable, for various reasons, to employ an oculist in this capacity. Formerly any legally registered physician could sign the certificates of applicants. In consequence many abuses had crept in, of which it is not my purpose to speak here. The number of applicants which passed my examinations (as the official examiner for the city) successfully, are, so far, 572. They are of I5 different nationalities, and present many points which I thought might be of interest to this Society. There were 304 males and 268 females. The explanation of this difference I will endeavor to point out later on. It should be observed that the material I have thus brought together is made up of the poorest of the poor, the poor blind. The vast mass of it is made up of ignorant people of the lower, or lowest classes. Only rarely I found one who, through
OPPENHEIMER: The Blind of New York City.
1,57
blindness, had been brought down to this level from a higher plane of education and refinement. Their statements, as a rule, were unreliable, when they thought it to their interest to vary from the truth. Therefore, so far as this was possible, I relied upon objective signs in diagnosis, when these contradicted statements as to etiology, etc. NATIVITY.
Of all these applicants there were born in Ireland, New York, Germany, United States (outside of New York), England, Russia, Italy, Austro-Hungary, France, Scotland, Canada,. Denmark, Norway,
Switzerland, West Indies, Egypt, Natives of Unit ed States, Foreign-born,
.
.
213
.
189
.
72
37 25
8 6 5 5 5 2
I
I Total, 572 . 226=39.58 per cent. 346 -=60.42 per cent.
Of Foreigners 29 persons were blind when they arrived here. One of these was one year old on arrival. Twelve were between I0 and 20. "6 " Six 20 " 30. " Six " 30 " 40. " " Four 6o years of age, 40
at the time of their landing here. It is -worthy of remark that 5' lost their eyesight, according to their own statement, within the first five years after arriving here. This would show that of the 346 blind of foreign birth, 8.40 per cent. arrived here blind, and that 14.78 per cent. of their number have grown blind within the five years follow-
ing their arrival.
158
OPPENHEIMER: The Blinid of New York City.
The difficulty of arriving at the exact truth of these statements is apparent. Of this number of 5', it is most probable that quite a proportion should belong to the former of 29, and thus swell the number of blind arrivals on our shores. The lesson this should teach to the guardians of our ports is of great importance, and, in view of these startling figures, I venture to suggest to this Society to consider the advisability of recommending the systematic examination of the eyes of all immigrants who land at our ports with the intention of settling here. As to the causes of blindness, I have adopted the classification of Magnus and Roth, and put them under four heads, namely:
Congenital Blindness, Blindness due to idiopathic diseases of the eye, Traumatic Blindness, and Blindness dute to general diseases. Of Congenital blindness I have found 22 cases: Retinitis pigmentosa, Atrophy of the optic nerve, . . Buphthalmos, . Congenital cataract, . svphilis,
. . . . .
. . . .
I
2 cases, both in males. 5 " 4 males, I female. I " 8 " 5 " 3 " 6 " 4 " 2 "
. . . . .
Of the eight cases of cong-enital cataract, seven had been operated for the removal of the lenses. In three of these the operation was successful, so far as the removal of the lens and the kindly healing of the eye were concerned; but the six eyes showed each an atrophic nerve. In the other four operated cases, the nerves could not be seen on account of occluded pupils. But there was no light perception. From IDIOPATHIC DISEASES OF THE EY'FS, I have found of Males. Atrophy of both optic nerves, . 66 ' "49 one SC . Blennorrhea neonatorum, " virulenta, both eyes, is one eye, "9 . gonorrhoica,
. . . . . ,
. . . .
. . *
Females. Total. i6
26
I7
J8
47 2 -
40 4 S
35 87 6
TO
I
I
OPPENHEIMER: The Blind of New York City. Cataract, senile, both eyes, "1 "t one eye, D)islocated lens, Dalrymple's disease, Detached retina, Embolism, central artery, Choroiditis and Iritis, Iritis, Keratitis (3 double, 2 single), Glaucoma (eyes not operated), i (eyes operated), Myopia, Retinitis, Retinitis pigmeintosa, Trachoma,
*
Males.
Females.
25
i8
4
3
I -
* *
-
'59 Total.
43 7 I
I
6
1
5
I
-
.
13
7
20
.
4
5
2
3
9 5
14
24
38
1
23
24
5
-
5
I
I
2
*I
7 6
23
17
I
8
The atro.phy of the optic nerves, in the 26 cases put down as idiopathic, were those in which neither history nor careful examination could elicit any other cause or disease uporn which it t might depend. It will be noticed that I6 of the patients were male and only IO female. There were 35 cases of biennorrhea neonatorum, of which the history was usually uinmistakable. Blennorrhea viirutlenta, as I call it, was the cause of blindness in both eyes in 87 patients, and in onze eye each in six more. Whether many of these cases were specifically gonorrhoeal or not, coulcl not be told, either by the history or examination, and I have no means of knowing the number; but I do not doubt that quite a proportion were specific. Gonorrhioea, as a cause, was admitted by five men and by no women. When we add these three forms of blennorrhoea, as casual factors of blindness, we have I30 cases of communicable, and therefore pre ventable, disease. This gives us nearly 23 per cent. of the whole number, without adding Trachomra, of which there were and six men. Such a showing as this ought to spur us on to aid the laudable efforts made by several of our public-spirited members, to check this great evil. In this list are 43 persons with cataracts in both eyes, and seven with cataract in one eye, who refuse to have an operation performed. 23 cases, 17 women
i6o
OPPENHEIMER: The Blind of New York City.
It is a startling assertion to make that there are 50 persons, about equally divided between the sexes, who will not grasp at any remedy offered to be released from blindness; but it is a solemn fact. The advanced age of the patients, the absence of any positive promise of success, and the loss of this stipend from the city, combined, determine them to bear the ills they have. I may add also that the notion is very prevalent amongst the ignorant poor, that the hospitals are simply traps to catch operating material for the surgeons, and that the latter are wholly reckless as to the results of operations. It is worthy of note that amongst the six patients with detached retinae, there was only one woman; while, on the other hand, the five people blinded by myopic choroiditis and atrophy were all women. Of the clhoroiditis with iritis (21 cases), two-thirds were in women. Glaucoma was the cause of blindness in 62 eyes. Twentyfour of these eyes had had one or more operations performed upon them, while 38 eyes had not been operated upon at all. Of the 24 operated eyes, 23 belonged to men, and only one to a woman. Of the 38 unoperated eyes, there were 24 belonging to men and 14 to women. Combined, they furnish a percentage of glaucomatous eyes in women, 24, or I9 per cent. " - " "men, 75, or 8i per cent. or, in round numbers, about three times as many men as women. Retinitis pigmentosa furnished eight victims, one woman and seven men. In none of them was there any history of consanguinity of parents. Three of them were congenital. The other five grew blind at the ages of I9, 29, 33, 33, and 52 respectively. In one case there were distinct signs of congenital syphilis. This patient became blind at i9. There was no trace of syphilis to be found in the other seven cases, and no history of it. Blindness from Injurizics. In this table I have included eyes lost after cataract operations and sympathetic ophthalmia. I have left out losses from operations for Glauicoma, for obvious reasons.
OPPENHEIMER: The Blind of New York City.
I6I
There were lost from Burns, 14 eyes, i vitriol, i creosote, I lightning stroke, 3 lime. In each of these accidents both eyes were destroyed. All victims were men.
Cataract operations, Dislocated lens, . . Explosions (blasts, etc.), . . Foreign 'bodies, Injuries (to eyes direct), . Injuries (to head), . Jequirity, . . Poison Ivy, . . . Sunstroke, Sympathetic Ophthalmia,
. .
. . . .
.
. . . . . .
. . .
. . . . . . . . .
. . . . . . . .
Men.
Women.
24 2 46 7 44 i6 2 2 2 27
41
65
-
2 50 7 62 22 2 2 2 46
4 -
i8 6 -
I9
Total.
In those blinded by burns, sunstroke, jequirity, and poison ivy, both eyes were destroyed in each case. It will have been noticed that in this table most of the victims were men. Leaving out the cataract operations and the cases of sympathetic ophthalmia, we have a percentage of males to females of 78.48 per cent. to 21.52 per cent. If we include the two classes just mentioned and compare them with the total blindness, we have 20 per cent. of all eyes lost destroyed by injuries. Of these 20 per cent., the men furnish I2.50 per cent., the women 7.50 per cent. Sympathetic ophthalmia destroyed 46 eyes; or, to give what is the practical effect, it caused the permanent blindness of 46 people. We know that, as a rule, the eye which causes the sympathetic inflammation in its fellow is blind before it. I am cognizant of several exceptions to this rule, but they are extremely rare, I believe. The count, therefore, charging 8.05 per cent. of the 572 blind noticed in this paper, to sympathetic ophthalmia as the determining cause, must stand as a fair one. If we consider the number of eyes lost alone, the percentage would, of course, be only half that, or 4 per cent. In explanation of this astonishing record of ignorance and negligence, I would like to say that New York city is, in a very large measure, a place of last resort for people who are suffering from blindness, and whose homes are away from the city. In the hope of cure they come from all parts of this continent. Very often they are obliged to make a supreme effort OPH.-I I
OPPENHEIMER: The Blind of New York City.
I62
to raise money enough to bring them to the city, and they trust to luck and their hoped-for eyesight to return them to their homes. As an instance, I remember several miners from the Lake Superior copper mines, whose eyes had suffered in an explosion, and whose expenses to the city, which they reached penniless, had been made up by subscription among their comrades. These men were in my charge at the New York Eye Infirmary. Their eyes were hopelessly destroyed before they came East, and two of them are, to my certain knowledge, amongst these cases. I have no doubt that many cases come to the city under similar circumstances, optically and financially, and remain there, stranded and blind. The dense ignorance of the great majority of these patients, and their inherent distrust of the surgeon who proposes to remove an eye which, at the time, may be no longer painful or troublesome to them, is another prolific source of recruits to the list of victims to sympathetic ophthalmia. SYMPATHETIC OPHTHALMIA
Followed the fellow eye in Cases.
Keratitis (with perforating ulcer) in . . . Explosion, . . Shot (penetrating), . . Foreign bodies (in globe), . Operation (dislocated lens), . Blennorrhoea (with perforation),
. . . . .
. . . . . .
Aged.
I8 24 and 45
.
2 I
I2
. . .
3
6
41, S8, 65 23 from I to 47
31
3 to 63
I/I, I/IO, 1/19, 1/26, 1/29, I/47
Injury,
.
.
.
.
.
.
Two of these injuries were said to have been perforations of the globe by pins. All the others were either lacerated, incised, or stab wounds of the globe, excepting two, which are said to have been contusions by the fist. There may have been, in these two, ruptures of the globe in the posterior segment, but this was impossible to determine. Of these 46 patients, Six were blind in the first decade of life, " " " second " Six " " " " third " Five " " " " fourth " Four " " " " fifth " One " " " " sixth " Five " " " seventh" " Four "
OPPENHEIMER: The Blind of New York City.
I63
One old woman of 63 had the first injury with a pin. If we consider that children are more exposed to accidents than adults, and if we further bear in mind that children are less intelligent and less likely to complain of a slight annoyance in the eye, which may be in the first stage of sympathetic inflammation, also that they are much less apt to realize the necessity for mentioning it, nor the danger arising from the neglect to do so, we must conclude that the very slight preponderance of numbers of eyes lost in the first two decades of life, as given here, cannot be considered evidence that children are more liable to sympathetic inflammation than adults. Blindness from General Diseases Was ascribed to Diphtheria, Erysipelas, Interrupted menses, Malaria, Measles, Meningitis (cerebral), " (cerebro-spinal), Pertussis,
Female.
I
-
2
2
4 I
10
I I 9
15
II
2
I
I I
I
-
-
*
Pneumonia, Pregnancy, Rheumatism, Scarlatina, Sclerosis (multiple), Syphilis, Tobacco poisoning, Tabes, Typhoid, Typhus, Tumor of brain, Variola,
Male.
5
7 -
9
I
I
*
5
4
.
I
-
I
4
-
4
3 3
I
2
*
3
-
I
-
I
*
7
8
I5
* *
'9 26 3
2
'I
*
I
2 I I 2 12 2
-
*
Total.
It will be noticed that the sexes are represented about equally in all these diseases, excepting in Typhus 3, Tabes 4, and multiple Sclerosis 2, in which the patients are all males, and in Meningitis, in which males predominate, I7 to I2. Tobacco amblyopia has no female victims here. In atrophy of the optic nerves the cases in male subjects are almost triple those in females.
OPPENHEIMER: The Blind of New York City.
I64
I have made up a table of these cases, with their causes, as near as I could arrive at them. The histories very often were as unreliable as they were meagre, and it was very necessary to sift and make use of such as seemed probable. Above all, I preferred to decide by objective signs, where these could be obtained. In spite of all precautions, however, I feel that, where I have had to use the statements of the applicants as a basis, these statistics are not as reliable as I should desire them to be. There is no doubt in my mind that syphilis and gonorrhoea, for instance, should play a much greater rdle as causes here than appears. But, without objective signs or history to point them out, I could do nothing to prove it.
Causes of Atrophy of thle O)ptic Nerves In IOI patients, 72 males and 29 females. Meningitis (cerebral and spinal),
26
*Genuine atrophy,
24
Injuries (to head), Congenital, Scarlatina, Syphilis (acquired), . Typhus,.
13
Tabes, Syphilis (congenital), Sclerosis (multiple), Rheumatism, Erysipelas,
4
Measles,
I
7 4 4
3 2 2 2 I
Myopia and choroiditis, Pertussis, Sun and fire (in a cook), Sunstroke, Tobacco poisoning, Tumor of brain, Variola,.
I I I
I *I I
In conclusion, I should like to say that I made an attempt to arrive at the differenc4e between the longevity of the blind and those who can see. Of the 57=2 persons considered here, there were between * So
called in absence of any other apparent
cause.
GRUENING: Treatment of Divergent Strabismus. the ages of 20 and 30 is
It
"
" 30
40 "15 C
I65
94
40-- 97
50-100 " 60 " 70
102
I6o I05 41 " 70 " 8o 8o " 90 30 abovego- 3-572
I compared this with the table of the Institute of Actuaries
(H. M.), 1869, which was accessible to me. It involved a series of long and tedious calculations, which I will spare you the details of, and which showed a tremendous advantage in favor of the H. M. (healthy male), who can see and afford to insure. This is so easily understood as hardly to need comment. The blind, in spite of the fact that many of them reach an advanced age, are, with the exception of those blind from injuries and blennorrhoea, never thoroughly healthy subjects.
ON THE OPERATIVE TREATMENT OF DIVERGENT STRABISMUS. BY EMIL GRUENING, M.D., NEW YORK.
Absolute divergent strabismus is so often associated with high degrees of myopia, with anisometropia, or with monolateral amblyopia that these conditions are regarded as causative in the development of the muscular anomaly in question. Not infrequently, however, this very form *of squint is observed in persons whose two eyes are emmetropic and equal in vision. In divergent strabismus the range of motility is normal; both in the squinting eye and its fellow the inner edge of the cornea touches the caruncle upon extreme adduction, and the outer edge of the cornea the outer canthus upon extreme abduction. The power of accommodative convergence is lost. In some cases the degree of divergence changes with the position of the object, the deviation being more pronounced in distant than in
OPPENHEIMER: The Blind of New York City.
THE BLIND OF NEW YORK CITY. By IHENRY S. OPPENHEIMER, M.D.
The city of New York makes an annual appropriation from its excise fund to be divided among such of the blind adtult poor of the city as try to maintain themselves without b'ecoming inmates of public institutions. The conditions upon which an applicant becomes entitled to participate in the benefits of this fund are: That he, or she, shall be of age, shall have lived in the city for at least two years, shall be poor enough to be considered in need of it, and shall be blind. The definition of blindness is not the scientific one,-" Incurable, total loss of sight," but rather the popular one: The loss of vision to so serious a degree as to prevent earning a livelihood at any vocation requiring eyesight. Visual di'sturbances which may be remedied by operation, such as cataract, for instance, are included in this definition of blindness. The medical examiner is simply required to certify that the applicant is unable to make his living by sight, or to refuse to sign this application. It is only of recent years that it has been found advisable, for various reasons, to employ an oculist in this capacity. Formerly any legally registered physician could sign the certificates of applicants. In consequence many abuses had crept in, of which it is not my purpose to speak here. The number of applicants which passed my examinations (as the official examiner for the city) successfully, are, so far, 572. They are of I5 different nationalities, and present many points which I thought might be of interest to this Society. There were 304 males and 268 females. The explanation of this difference I will endeavor to point out later on. It should be observed that the material I have thus brought together is made up of the poorest of the poor, the poor blind. The vast mass of it is made up of ignorant people of the lower, or lowest classes. Only rarely I found one who, through
OPPENHEIMER: The Blind of New York City.
1,57
blindness, had been brought down to this level from a higher plane of education and refinement. Their statements, as a rule, were unreliable, when they thought it to their interest to vary from the truth. Therefore, so far as this was possible, I relied upon objective signs in diagnosis, when these contradicted statements as to etiology, etc. NATIVITY.
Of all these applicants there were born in Ireland, New York, Germany, United States (outside of New York), England, Russia, Italy, Austro-Hungary, France, Scotland, Canada,. Denmark, Norway,
Switzerland, West Indies, Egypt, Natives of Unit ed States, Foreign-born,
.
.
213
.
189
.
72
37 25
8 6 5 5 5 2
I
I Total, 572 . 226=39.58 per cent. 346 -=60.42 per cent.
Of Foreigners 29 persons were blind when they arrived here. One of these was one year old on arrival. Twelve were between I0 and 20. "6 " Six 20 " 30. " Six " 30 " 40. " " Four 6o years of age, 40
at the time of their landing here. It is -worthy of remark that 5' lost their eyesight, according to their own statement, within the first five years after arriving here. This would show that of the 346 blind of foreign birth, 8.40 per cent. arrived here blind, and that 14.78 per cent. of their number have grown blind within the five years follow-
ing their arrival.
158
OPPENHEIMER: The Blinid of New York City.
The difficulty of arriving at the exact truth of these statements is apparent. Of this number of 5', it is most probable that quite a proportion should belong to the former of 29, and thus swell the number of blind arrivals on our shores. The lesson this should teach to the guardians of our ports is of great importance, and, in view of these startling figures, I venture to suggest to this Society to consider the advisability of recommending the systematic examination of the eyes of all immigrants who land at our ports with the intention of settling here. As to the causes of blindness, I have adopted the classification of Magnus and Roth, and put them under four heads, namely:
Congenital Blindness, Blindness due to idiopathic diseases of the eye, Traumatic Blindness, and Blindness dute to general diseases. Of Congenital blindness I have found 22 cases: Retinitis pigmentosa, Atrophy of the optic nerve, . . Buphthalmos, . Congenital cataract, . svphilis,
. . . . .
. . . .
I
2 cases, both in males. 5 " 4 males, I female. I " 8 " 5 " 3 " 6 " 4 " 2 "
. . . . .
Of the eight cases of cong-enital cataract, seven had been operated for the removal of the lenses. In three of these the operation was successful, so far as the removal of the lens and the kindly healing of the eye were concerned; but the six eyes showed each an atrophic nerve. In the other four operated cases, the nerves could not be seen on account of occluded pupils. But there was no light perception. From IDIOPATHIC DISEASES OF THE EY'FS, I have found of Males. Atrophy of both optic nerves, . 66 ' "49 one SC . Blennorrhea neonatorum, " virulenta, both eyes, is one eye, "9 . gonorrhoica,
. . . . . ,
. . . .
. . *
Females. Total. i6
26
I7
J8
47 2 -
40 4 S
35 87 6
TO
I
I
OPPENHEIMER: The Blind of New York City. Cataract, senile, both eyes, "1 "t one eye, D)islocated lens, Dalrymple's disease, Detached retina, Embolism, central artery, Choroiditis and Iritis, Iritis, Keratitis (3 double, 2 single), Glaucoma (eyes not operated), i (eyes operated), Myopia, Retinitis, Retinitis pigmeintosa, Trachoma,
*
Males.
Females.
25
i8
4
3
I -
* *
-
'59 Total.
43 7 I
I
6
1
5
I
-
.
13
7
20
.
4
5
2
3
9 5
14
24
38
1
23
24
5
-
5
I
I
2
*I
7 6
23
17
I
8
The atro.phy of the optic nerves, in the 26 cases put down as idiopathic, were those in which neither history nor careful examination could elicit any other cause or disease uporn which it t might depend. It will be noticed that I6 of the patients were male and only IO female. There were 35 cases of biennorrhea neonatorum, of which the history was usually uinmistakable. Blennorrhea viirutlenta, as I call it, was the cause of blindness in both eyes in 87 patients, and in onze eye each in six more. Whether many of these cases were specifically gonorrhoeal or not, coulcl not be told, either by the history or examination, and I have no means of knowing the number; but I do not doubt that quite a proportion were specific. Gonorrhioea, as a cause, was admitted by five men and by no women. When we add these three forms of blennorrhoea, as casual factors of blindness, we have I30 cases of communicable, and therefore pre ventable, disease. This gives us nearly 23 per cent. of the whole number, without adding Trachomra, of which there were and six men. Such a showing as this ought to spur us on to aid the laudable efforts made by several of our public-spirited members, to check this great evil. In this list are 43 persons with cataracts in both eyes, and seven with cataract in one eye, who refuse to have an operation performed. 23 cases, 17 women
i6o
OPPENHEIMER: The Blind of New York City.
It is a startling assertion to make that there are 50 persons, about equally divided between the sexes, who will not grasp at any remedy offered to be released from blindness; but it is a solemn fact. The advanced age of the patients, the absence of any positive promise of success, and the loss of this stipend from the city, combined, determine them to bear the ills they have. I may add also that the notion is very prevalent amongst the ignorant poor, that the hospitals are simply traps to catch operating material for the surgeons, and that the latter are wholly reckless as to the results of operations. It is worthy of note that amongst the six patients with detached retinae, there was only one woman; while, on the other hand, the five people blinded by myopic choroiditis and atrophy were all women. Of the clhoroiditis with iritis (21 cases), two-thirds were in women. Glaucoma was the cause of blindness in 62 eyes. Twentyfour of these eyes had had one or more operations performed upon them, while 38 eyes had not been operated upon at all. Of the 24 operated eyes, 23 belonged to men, and only one to a woman. Of the 38 unoperated eyes, there were 24 belonging to men and 14 to women. Combined, they furnish a percentage of glaucomatous eyes in women, 24, or I9 per cent. " - " "men, 75, or 8i per cent. or, in round numbers, about three times as many men as women. Retinitis pigmentosa furnished eight victims, one woman and seven men. In none of them was there any history of consanguinity of parents. Three of them were congenital. The other five grew blind at the ages of I9, 29, 33, 33, and 52 respectively. In one case there were distinct signs of congenital syphilis. This patient became blind at i9. There was no trace of syphilis to be found in the other seven cases, and no history of it. Blindness from Injurizics. In this table I have included eyes lost after cataract operations and sympathetic ophthalmia. I have left out losses from operations for Glauicoma, for obvious reasons.
OPPENHEIMER: The Blind of New York City.
I6I
There were lost from Burns, 14 eyes, i vitriol, i creosote, I lightning stroke, 3 lime. In each of these accidents both eyes were destroyed. All victims were men.
Cataract operations, Dislocated lens, . . Explosions (blasts, etc.), . . Foreign 'bodies, Injuries (to eyes direct), . Injuries (to head), . Jequirity, . . Poison Ivy, . . . Sunstroke, Sympathetic Ophthalmia,
. .
. . . .
.
. . . . . .
. . .
. . . . . . . . .
. . . . . . . .
Men.
Women.
24 2 46 7 44 i6 2 2 2 27
41
65
-
2 50 7 62 22 2 2 2 46
4 -
i8 6 -
I9
Total.
In those blinded by burns, sunstroke, jequirity, and poison ivy, both eyes were destroyed in each case. It will have been noticed that in this table most of the victims were men. Leaving out the cataract operations and the cases of sympathetic ophthalmia, we have a percentage of males to females of 78.48 per cent. to 21.52 per cent. If we include the two classes just mentioned and compare them with the total blindness, we have 20 per cent. of all eyes lost destroyed by injuries. Of these 20 per cent., the men furnish I2.50 per cent., the women 7.50 per cent. Sympathetic ophthalmia destroyed 46 eyes; or, to give what is the practical effect, it caused the permanent blindness of 46 people. We know that, as a rule, the eye which causes the sympathetic inflammation in its fellow is blind before it. I am cognizant of several exceptions to this rule, but they are extremely rare, I believe. The count, therefore, charging 8.05 per cent. of the 572 blind noticed in this paper, to sympathetic ophthalmia as the determining cause, must stand as a fair one. If we consider the number of eyes lost alone, the percentage would, of course, be only half that, or 4 per cent. In explanation of this astonishing record of ignorance and negligence, I would like to say that New York city is, in a very large measure, a place of last resort for people who are suffering from blindness, and whose homes are away from the city. In the hope of cure they come from all parts of this continent. Very often they are obliged to make a supreme effort OPH.-I I
OPPENHEIMER: The Blind of New York City.
I62
to raise money enough to bring them to the city, and they trust to luck and their hoped-for eyesight to return them to their homes. As an instance, I remember several miners from the Lake Superior copper mines, whose eyes had suffered in an explosion, and whose expenses to the city, which they reached penniless, had been made up by subscription among their comrades. These men were in my charge at the New York Eye Infirmary. Their eyes were hopelessly destroyed before they came East, and two of them are, to my certain knowledge, amongst these cases. I have no doubt that many cases come to the city under similar circumstances, optically and financially, and remain there, stranded and blind. The dense ignorance of the great majority of these patients, and their inherent distrust of the surgeon who proposes to remove an eye which, at the time, may be no longer painful or troublesome to them, is another prolific source of recruits to the list of victims to sympathetic ophthalmia. SYMPATHETIC OPHTHALMIA
Followed the fellow eye in Cases.
Keratitis (with perforating ulcer) in . . . Explosion, . . Shot (penetrating), . . Foreign bodies (in globe), . Operation (dislocated lens), . Blennorrhoea (with perforation),
. . . . .
. . . . . .
Aged.
I8 24 and 45
.
2 I
I2
. . .
3
6
41, S8, 65 23 from I to 47
31
3 to 63
I/I, I/IO, 1/19, 1/26, 1/29, I/47
Injury,
.
.
.
.
.
.
Two of these injuries were said to have been perforations of the globe by pins. All the others were either lacerated, incised, or stab wounds of the globe, excepting two, which are said to have been contusions by the fist. There may have been, in these two, ruptures of the globe in the posterior segment, but this was impossible to determine. Of these 46 patients, Six were blind in the first decade of life, " " " second " Six " " " " third " Five " " " " fourth " Four " " " " fifth " One " " " " sixth " Five " " " seventh" " Four "
OPPENHEIMER: The Blind of New York City.
I63
One old woman of 63 had the first injury with a pin. If we consider that children are more exposed to accidents than adults, and if we further bear in mind that children are less intelligent and less likely to complain of a slight annoyance in the eye, which may be in the first stage of sympathetic inflammation, also that they are much less apt to realize the necessity for mentioning it, nor the danger arising from the neglect to do so, we must conclude that the very slight preponderance of numbers of eyes lost in the first two decades of life, as given here, cannot be considered evidence that children are more liable to sympathetic inflammation than adults. Blindness from General Diseases Was ascribed to Diphtheria, Erysipelas, Interrupted menses, Malaria, Measles, Meningitis (cerebral), " (cerebro-spinal), Pertussis,
Female.
I
-
2
2
4 I
10
I I 9
15
II
2
I
I I
I
-
-
*
Pneumonia, Pregnancy, Rheumatism, Scarlatina, Sclerosis (multiple), Syphilis, Tobacco poisoning, Tabes, Typhoid, Typhus, Tumor of brain, Variola,
Male.
5
7 -
9
I
I
*
5
4
.
I
-
I
4
-
4
3 3
I
2
*
3
-
I
-
I
*
7
8
I5
* *
'9 26 3
2
'I
*
I
2 I I 2 12 2
-
*
Total.
It will be noticed that the sexes are represented about equally in all these diseases, excepting in Typhus 3, Tabes 4, and multiple Sclerosis 2, in which the patients are all males, and in Meningitis, in which males predominate, I7 to I2. Tobacco amblyopia has no female victims here. In atrophy of the optic nerves the cases in male subjects are almost triple those in females.
OPPENHEIMER: The Blind of New York City.
I64
I have made up a table of these cases, with their causes, as near as I could arrive at them. The histories very often were as unreliable as they were meagre, and it was very necessary to sift and make use of such as seemed probable. Above all, I preferred to decide by objective signs, where these could be obtained. In spite of all precautions, however, I feel that, where I have had to use the statements of the applicants as a basis, these statistics are not as reliable as I should desire them to be. There is no doubt in my mind that syphilis and gonorrhoea, for instance, should play a much greater rdle as causes here than appears. But, without objective signs or history to point them out, I could do nothing to prove it.
Causes of Atrophy of thle O)ptic Nerves In IOI patients, 72 males and 29 females. Meningitis (cerebral and spinal),
26
*Genuine atrophy,
24
Injuries (to head), Congenital, Scarlatina, Syphilis (acquired), . Typhus,.
13
Tabes, Syphilis (congenital), Sclerosis (multiple), Rheumatism, Erysipelas,
4
Measles,
I
7 4 4
3 2 2 2 I
Myopia and choroiditis, Pertussis, Sun and fire (in a cook), Sunstroke, Tobacco poisoning, Tumor of brain, Variola,.
I I I
I *I I
In conclusion, I should like to say that I made an attempt to arrive at the differenc4e between the longevity of the blind and those who can see. Of the 57=2 persons considered here, there were between * So
called in absence of any other apparent
cause.
GRUENING: Treatment of Divergent Strabismus. the ages of 20 and 30 is
It
"
" 30
40 "15 C
I65
94
40-- 97
50-100 " 60 " 70
102
I6o I05 41 " 70 " 8o 8o " 90 30 abovego- 3-572
I compared this with the table of the Institute of Actuaries
(H. M.), 1869, which was accessible to me. It involved a series of long and tedious calculations, which I will spare you the details of, and which showed a tremendous advantage in favor of the H. M. (healthy male), who can see and afford to insure. This is so easily understood as hardly to need comment. The blind, in spite of the fact that many of them reach an advanced age, are, with the exception of those blind from injuries and blennorrhoea, never thoroughly healthy subjects.
ON THE OPERATIVE TREATMENT OF DIVERGENT STRABISMUS. BY EMIL GRUENING, M.D., NEW YORK.
Absolute divergent strabismus is so often associated with high degrees of myopia, with anisometropia, or with monolateral amblyopia that these conditions are regarded as causative in the development of the muscular anomaly in question. Not infrequently, however, this very form *of squint is observed in persons whose two eyes are emmetropic and equal in vision. In divergent strabismus the range of motility is normal; both in the squinting eye and its fellow the inner edge of the cornea touches the caruncle upon extreme adduction, and the outer edge of the cornea the outer canthus upon extreme abduction. The power of accommodative convergence is lost. In some cases the degree of divergence changes with the position of the object, the deviation being more pronounced in distant than in
