The Parents' Review

A Monthly Magazine of Home-Training and Culture

Care of Children's Senses

Abstract of a Lecture delivered at the Hampstead Branch of the Parents' National Educational Union.

[Professor Henry Macnaughton Jones, 1844-1918, was an Irish doctor from Cork who worked in London as an obstetrician. He founded the Cork Eye, Ear and Throat Hospital, later known as the Victoria Hospital. In 1866 he married Henrietta Gregg; they had three children. He also wrote poetry.]

I.

In dealing with the subject I have selected to lecture on, I shall not touch on strictly medical prerogatives. My object is rather to press home for your serious consideration some facts connected with the care and education of the organs of sense, especially those of sight, hearing, smell and touch. Thus I hope that by a more intelligent appreciation of the causes of certain affections of these organs, the preventive measures necessary for their integrity might be taken in time, and destructive lesions thus be anticipated and prevented. I cannot say the number of children in the United Kingdom, who annually either lose their sight or have it impaired for all practical purposes of life and occupation through neglect and ignorance. But I have had an extensive experience of nearly twenty years of my life in a large and populous district, in a popular ophthalmic hospital and clinique, and this experience enables me truthfully to say that the direct and indirect consequences of such ignorance and neglect of infants' and children's eyes are more widespread than you imagine, and the results are melancholy in the extreme. Not in comfortable homes with intelligent friends and well-taught nurses is this so likely to occur as in the houses where poverty and over-population crowd out that parental or other supervision and care, and where often that strongest of all instincts, maternal love itself, is blunted by misery and despair. Still, it is wonderful how very frequently in well-to-do houses things are "taken for granted" in the case of children; that ignorant idea that the child will "grow out" of this or that is relied on, a belief only too welcome if it saved trouble, time, and expense. Procrastination precedes apathy, and both lead up to a fatal indifference, lulling into false security those on whom the responsibility for the child's future happiness and utility in society is rightly cast. Thus follows partial or complete loss of sight or hearing, and often in the case of the ear, loss of life, no doubt unconsciously, yet none the less fatally, encouraged. Could I give you the results of my experience of the causes of deafness and serious brain mischief in children, out of many thousands of such cases that have passed under my personal observation, and the consequence of the gross ignorance and neglect which prevail in regard to this delicate sense organ alone, you would agree with me that I do not exaggerate.

All I can attempt to do in a short lecture such as the present is to run lightly over some of the most important matters that any one might comprehend, and which affect the care and health of the organs of sense. (Dr. Macnaughton Jones having briefly by the aid of models and lime-light diagrams given an explanation of the construction of the eys, passed in review over its commoner affections in infancy and childhood.)

The eye is one of the first organs in the body needing attention at birth. From various causes, it is prone to inflammatory affections. Such early morbid conditions are easily recognised by some glueing together of the eyelids, the presence of a purulent discharge, and swelling. It should be understood that any such symptoms call for immediate action on the part of friends or nurses. The first object in such cases is cleanliness. This may seem superfluous caution when the value and importance of antiseptic measures in the prevention and cure of disease is widely and thoroughly understood. In the instance of no organs is that knowledge of more vital importance than those of the eye and ear. Most of their common inflammatory discharges are traced to a microbal origin. And in those suppurative discharges occurring from the eyes of infants this is the case. Hence the infinitive nature of such discharges both from a diseased to a healthy fellow eye, and to another child's; hence the importance of immediately using some such simple antiseptic as boric acid in solution or any weak perchloride of mercury wash in combination with similar astringents. The eyes of infants require under such conditions very gentle handling, as often these discharges are associated with ulceration and loss of substance of the cornea, or rough pressure may burst the ulcer and cause loss of the humours of the eye. Under these circumstances, when dressing a baby's eyes the proper thing to do is to sit on a chair, swathe the child's body in a large towel, and giving it then in charge of some one seated on another chair opposite, place the infant's head between the knees on the lap and thus fix it steadily, leaving the hands free to attend the eyes, while the movements of the body are controlled by the assistant. The child cannot thus resist and hurt itself by struggling while any manipulation may be carried out gently and without risk. In this way drops may be placed in the eyes, or the inside of the eyelids be gently syringed out with a stream of water, or the eyes themselves be sponged. Sponges, by the way, are dangerous media. They often act as carriers of infection; they are most difficult to keep clean, even when the greatest care is taken. Absorbent wool pads wet with an antiseptic solution which can be burned [for disposal] when used is far better--so is gentle douching of the eyes with a stream of warm water from a syringe or syphon douche. Many children's affections of the eyelids are contagious, hence they spread rapidly through schools and public institutions. The use of towels shared by several children increases this risk--as that of brushes and combs do skin diseases of the head--as in ringworm. Isolation of the infected children for a time is the first essential step, and great care must be taken in preventing all contagious media coming in contact with healthy eyes. To no affection of the eyes do these remarks apply more aptly than to that known as "granular ophthalmia," [infection caused by Chlamydia trachomatis] which consists of a congested and changed state of the natural structures of the lining membrane of the eyelids--often present with other states of ill-health in children. It often goes on for some time without discovery, as these granulations are concealed under the upper eyelid, and hence are not recognised until a gritty sensation forces the child to complain, and a discharge is seen to glue the lids together in the mornings, or the eye becomes red and irritable. Such a condition requires active and careful looking to. It may be well to remind parents how necessary it is at times to protect an eye from the risk of contagion by its fellow. This is done with an antiseptic lotion, then drawing the eyelids tightly together with a few strips of isinglass [fish glue] plaster, placing over these a small piece of linen which is glued down to the skin by some flexible collodion, while over all is placed an even layer of cotton wool and a light eye-bandage.

Most shades are worn too close to the eye, heating it, and collecting moisture and discharge. A capital shade can be constructed out of a sheet of stiff and hard brown paper (in the manner shown), which will last a long time, protect both eyes, and is cool and light. Many affections of the eye in the young are of a constitutional character, some have an hereditary source, some are congenital (present at or immediately following birth). Parents often encourage such constitutional tendencies. Perhaps no organ of sense reflects more quickly the impress of that constitutional delicacy in blood or nerve than the eye. Children (are there such in these modern days?) are pampered and fed with all sorts of indigestible, blood heating, trashy foods, while depraved appetites for educated palates are considered and developed. Be it remembered that, the pasty looking and flabby child, with muscles in feel like a jelly-fish, is just the most prone to catarrhal troubles of eye, ear, and skin. Hence, often, these capricious young squallers come not with eye or ear troubles only, but with faces and bodies all broken out with eczematous eruptions, white tongues, and stomachs out of order. Some of these children inherit taints, strumous [goiter] or other, and the delicate organs of the eye, ear, or nose, are specially liable to exhibit the evidences of these transmitted influences during infancy or childhood. Parents conscious of any such personal and family delicacies should attend to the first warning of impending mischief in these organs. Various errors of refraction are frequently inherited. Short sight, or myopia, and the opposite condition, or the vision of advanced life, are the results frequently of an inherited shape of the eye globe in which its axis is either too long or the reverse. (Diagrammatically this was illustrated by the lime light.) These aberrations of refraction are also induced by injudicious use of the eye, through over-muscular strain of its fine muscular apparatus, and are aggravated by bad habits acquired during early life. Imprudent stooping over badly constructed desks, defective light in schoolrooms, allowing children to read by firelight and in bed might be mentioned as contributing to such results; the habit of holding a book or paper near to the eye in order to read it, the feeling of tire after and prolonged use of the eye, the child complaining of the letters becoming "misty," pain in the head after reading, or at the back of the eye, or across the brow, are indications that immediate attention should be paid to the eye, and glasses procured of a proper strength and kind. The selection of glasses in such young patients frequently demands considerable knowledge and skill, and it is not to be thought that glasses are to be "fitted on" like gloves--at so many sizes. Astigmatism, the inability of the eye to focus meridional rays on the retina, so that vertical or horizontal lines were indistinctly perceived, confusion of vision resulting, produces a variety of troubles, as constant headache, sometimes giddiness in walking, often sick headache, and possibly irritability of temper. How often is stupidity ascribed to a child when the real defect in intelligent appreciation of teaching is due to some optical want, or a deficiency in the acuteness of hearing. I have known a child's ears brutally boxed for an assumed stupidity, or as barbarously pulled, when the unfortunate victim of a teacher's ignorance had almost complete loss of hearing in one ear, and considerable deterioration in the other. Children are keen judges of the justice or injustice of punishment. Unjust punishment demoralises, vitiates, and harbours the spirit of insubordination and sullen resistance. The young thistle only "polishes its prickles anew," and burrows its sturdy roots "more strong and deep" when crushed by the "hobnailed boot" of ignorance, stupidity, and injustice. Slight forms of squint, at times due to irritations remote from the eyes, as worms in the intestinal tract, should be looked to early; they often attend on the errors of refraction alluded to. A surgeon should be consulted, as very often operation is avoided by suitable glasses and the use of prisms, both for distance and near work. Such deviation of the eyes may be detected by getting the child to stand opposite the parent, who makes him look at the raised forefinger and follow its movements laterally backwards and forwards, all the time watching carefully the symmetrical movements of the child's eyes. Want of symmetry of the two sides of the face should make parents suspicious of a symmetry in the eyes and astigmatism, and possibly of a different form of vision in the two eyes. The moral of all these facts is simply this: attend early to any defective vision, or slight tendency to squint; have the child's vision thoroughly tested, and see to the school habits, directing the teacher's attention to such instructions as the medical adviser gives.

A few hints may not be here amiss on the subject of injuries to the eye. Small foreign bodies are apt to enter and find their way under the lids, or become imbedded in the corners. In some cases the simple knack of drawing the upper eyelid well down over the lower lashes so that they may brush its under-surface is sufficient for the purpose of removal. By catching an eyelid firmly (not by the eyelashes) betwixt the finger and thumb it may be easily everted, when the concealed particle can be removed with the tip of a camel's-hair brush, or the edge of a handkerchief. All this simple manoeuvre requires is a little delicacy of touch and steadiness of hand. If a body is lodged in the cornea or clear structure of the eye it is best to take the child at once to a surgeon. Clumsy efforts to extract such bodies only lead to serious abrasions of the delicate corneal surface. Some sedative drops and the anointing of the inner surface of the eyelid with a little castor oil are most soothing to the eye after any particle is taken out.

Proofread by LNL, August, 2023