MR. BRUDENELL CARTER ON SHORT-SIGHT.
MR. BRUDENELL CARTER, in his recent book on "Eye- sight,"* puts forward some opinions on short-sight and weak sight which are worth record, and which, if not new to oculists, will, we believe, be new to many of our readers. No idea about eyesight is so universal, or causes so much incon- venience, as the one about the danger of taxing it by fine work, by strain, as it is called, and close attention to very small objects. Most men, and almost all women, even in the educated classes, think that much reading or writing " tries " the eyes, and that "fine work," particularly fine needlework, is apt to induce, if not total blindness, at least some direct and painful affection of the eye. in thousands of households children are cautioned not to read so much or work so much, lest they should injure their eyes, and women constantly shrink from paying employments from the same latent or expressed fear. Mr. Trudenell Carter evidently does not believe this terror well founded. He doubts whether eyes in their normal condition, or raised to their-normal condi- tion by proper spectacles, are injured by exercising sight at all. The muscles which control the eye certainly are not, and there is no proof that any other part of the apparatus is. On the contrary, the class which of all others in the kingdom most strains its eyes is singularly and exceptionally free from eye- disease. Mr. Carter says :—" Remarkable evidence of the harm- lessness of continuous working by the aid of a single convex glass is furnished by watchmakers, among whom such work is an unavoidable condition of their calling, and who appear to me to enjoy an enviable immunity from eye-diseases. It is exceed- ingly uncommon to see a working watchmaker among the pati- ents of the ophthalmic department of a hospital ; and I enter- tain little doubt that the habitual exercise of the eye upon fine work tends to the development and to the preservation of its powers." Grant, what is very probable, that the watch- makers are picked men, with exceptionally good eyes, and still their exemption from suffering under such a strain serves to show that fine work, work requiring painful attention of the eye, does the organ no harm, while it also shows that an eye-glass does the eye which is less frequently used no per- ceptible injury. It is supposed popularly to decrease the sight in the other eye, but experience lends no support to that notion. The reason of the watchmaker's exemption clearly is that he takes care always to work in a good light, carefully arranged and moderated, so as neither to tire the eye nor to leave it in- sufficiently supplied. Long hours of -work by artificial light of course tire the sight, and long hours in badly-ventilated rooms may seriously increase a predisposition to weakness of the eyes ; but the evil is not in the exercise of the faculty, but in its exercise under unhealthy conditions. One great cause of the prejudice is the evil produced by stooping the head, as in writing for long periods at a flat table, which, in people with a tendency to short-sight, surcharges the veins of the eye with blood ; and another is the remarkable habit of people with that tendency, of contenting themselves with insufficient light. They can read, for reasons carefully explained by Mr. Carter, by fire- light and in twilight and with insufficient candles, and con- sequently they do it, and then lay the blame on the reading, or on the small print, or on the white paper, all of which are innocent. They are suffering either from the effect of strained visual attention in bad light, or from the effect of overwork on the brain, and not from using their eyes. We believe this opinion of Mr. Carter's will give comfort to thousands, and can offer at least one illustration of its exact truth. The writer has worn spectacles for thirty-three years, and during that time has probably not passed twenty days without reading or writing for at least eight hours. He uses strong glasses, and takes no precaution whatever, except to * Eyesight: Good and Bad. A Treatise on the Exercise and Preservation of Vision. By Robert Brudenell Carter, F.R.O.S. London : Macmillan and Co. 1880.
avoid work, even for a few minutes, in insufficient light or in a room too hot for his eyes ; and his sight, after that long period, is exactly as good as it was before, with the exception that, as years advance, exceptionally fine print becomes a little tiresome. He would dislike to pore for an hour over Mr. Bel- lows's French Dictionary, though he can read it in all its types. The whiteness of the paper is not painful, nor are the letters indistinct. It is the health, not the eyesight, which parents with studious children should protect, though they should be most merciless in insisting on a sufficiency of light, and light which actually reaches the object of attention. You may sit in a room full of light, but have all the while only twilight, or even a deep shadow, falling upon the work in hand. Light, full light, but light without glare, is the grand preservative of the eyes.
The next preservative, Mr. Carter says, is the habitual use of proper spectacles. The curious notion, once, we believe, general in all classes, and still almost universal among the poor, that glasses wear out the eyes, is, he believes, a mere delusion. They preserve the eyes. Bad glasses or unsuitable glasses, of course, produce great fatigue of the eyes, though that fatigue is not so injurious as is supposed ; but glasses of themselves, even when a little too "strong," do no permanent harm whatever. "A popular, but entirely unfounded, prejudice, which exists amongst the public with regard to the hurtful effects of wear- ing convex glasses which are too strong, appears to be trace- able to an error founded upon a curious coincidence. There is a disease of the eye termed glaucoma, which formerly ended in complete and irremediable blindness, but which, for twenty years past, has been cured by operation, when recognised suf- ficiently early. One of the first or even of the premonitory symptoms of glaucoma is a rapid failure of the accommodation, and hence a frequent demand for stronger and stronger glasses. At a time when this disease was very imperfectly understood, opticians saw many examples of people who came to them for stronger glasses every two or three months, who were helped by them for a time, but who soon became totally blind; and it was not unnatural for them to associate the blindness with the use of the strong glasses." Good pebble spectacles, carefully suited to the sight, may be worn perpetually, as if they were part of the anatomy of the body, and will produce no ill-effects upon the sight of any sort. They rather strengthen it, by the immense relief they afford to the six muscles which regulate the eye, and which in short-sighted people and people with old sight are apt, without spectacles, gradually to get strained, in the effort to enable the owner to see. It is, of course, important to obtain the right glasses, so important that it would pay even poor men to find a guinea for a compe- tent oculist once or twice in the course of a lifetime, merely to obtain an order for the spectacles exactly suited to their sight; but once obtained, the glasses may be worn for ever, and indeed are most beneficial when permanently worn. They should, as it were, grow to be part of the face. Mr. Carter, how- ever, pushes his theory rather far, when he applies it so strongly to children as he seems to us inclined to do. He is evidently of opinion that children with " myopic " or short-sighted eyes cannot wear spectacles too soon, not only because the glasses arrest the development of the malformation—for it is a malformation, an elongation of the eye-ball—but because they lose such an enormous amount of instruction through the eye, and grow up, as it were, comparatively inexperienced. "A distinguished man of science, who is myopic in a high degree, and who did not receive glasses until he was nineteen or twenty years old, has often told me how much he had to do in order to place himself upon the same level, with regard to experience of quite common things, with many of his normal-sighted contemporaries ; and it will be manifest on reflection that the matters which are lost by the short-sighted, as by the partially deaf, make up a very large
proportion of the pleasures of existence I once pre- scribed glasses to correct the myopia of a lady who had for many years been engaged in teaching, and who had never previously viorn them. Her first exclamation of pleasurable surprise, as she put on her spectacles and looked around her, was a curious commentary on the state in which her life had until then been passed. She said, ' Why ! I shall be able to see the faces of the children ! ' " All that is very true, and spectacles in child- hood might benefit the eyes—and we suppose do, for we begin to see them worn by children with ever-increasing frequency— but Mr. Carter's opinion is that of a man who, as he mentions, has very good sight himself, and never wore spectacles of any sort. Spectacles, he may depend on it, if healthy for children's eyes, are unhealthy for the rest of their bodies. They diminish the desire for activity too much. A squirrel in spectacles would never get a dinner. A child cannot jump easily in spectacles, and if he wears them restrains himself too much ; while he acquires rapidly that sense of possible danger to the eyes from a fracture of the glass, which no one who wears spectacles is ever quite without, which in fact becomes an instinct, like the winking of the eye-lid. A blow from a ball, or a stick, or a hand, which would hardly injure the face of an ordinary child, may mean for one who is wearing spectacles death by torture. There is an instinctive sense of that in most spectacle-wearers, which diminishes unconsciously their activity, and which would be most injurious to children, who ought to be always in motion, without thought of possible con- sequences. Of course, in serious cases the danger of sedateness must be risked ; but in ordinary cases we suspect it is better to leave things alone, and to take to spectacles only when child- hood is fairly past.
As we are writing upon spectacles, we may be permitted to ask a question. Would it be wholly beneath the dignity of some great oculist to give a, thorough study to the ques- tion of the mechanism of spectacle-frames P It is very far from perfect now. The bridge is a great deal too liable to get bent, producing the most distressing confusion, one eye seeing through the centre of the glass, and one not ; there can be no sound reason for rims of any sort, and they are a positive interruption to sight; and the whole plan of making the arms is barbarous. The frames should not be made in hundreds, but to fit each face, and the sides constructed in some way which will make them far less mobile. At present they will not stick on well without double arms, they require adjust- ment every few minutes, and their joints are perpetually get- ting loose. Spectacles without rims, with some better contriv- ance for the bridge, and so closely fitted as to require infrequent adjustment, would, we are convinced, prove a fortune to the inventor, and carry the name of the lucky oculist far and wide.
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