by William H. Bates, M. D. Д. БейтсReprinted from New York Medical Journal, October 12, 1918, pp. 639-641.
Improving the Sight of Soldiers and Sailors and Relieving Pain
A Suggestion to the Surgeon Generals of the Army and Navy.
By W. H. Bates, M. D.,
Up to 1908 the United States required normal vision in its army. In that year Bannister and Shaw made some experiments from which they concluded that a perfectly sharp image of the target was not necessary for good shooting and that, therefore, a visual acuity of. 20/40, or even 20/70, was sufficient for the soldier. This conclusion was not universally accepted; but normal vision had become so rare that it would, doubtless, have been useless to insist upon it. The visual standard for admission to the army was accordingly lowered to 20/40 for the better eye and 20/100 for the poorer eye and it was further provided that a recruit might be accepted when unable, with the better eye, to read all the letters on the 20/40 line, provided he could read some of the letters on the 20/30 line.
It is a matter of common knowledge that in the enrollment of the present army these very low standards have been liberally interpreted. It appeared; no doubt, to those in authority that there was nothing else to be done if an army was to be raised at all, for even under these standards 21.68 per cent. of all rejections—thirteen per cent. more than for any other single cause—were for eye defects. To keep the enlisted eye defectives supplied with glasses, an optical service has been organized both for the training camps and the men at the front, the overseas force consisting of a central optical shop with eight auxiliary units.
While the visual standards of the navy are higher than those of the army, they are still below normal, while, owing to the extreme rarity of good eyesight and the difficulty of securing the combination of physical and mental qualities required for successful flying, it is probable that the former high standards of the aviation service are not being very strictly enforced. The British air service is very lenient in the matter of visual tests, and it has been noted that (1) some of the most famous of the British fliers have had very poor eyesight. On the currently accepted theory that the only remedy for errors of refraction is the placing of correcting lenses before the affected eyes, this is truly an appalling state of affairs. No aid to vision, however carefully adjusted, can compensate for the loss of the natural powers of the eye. No optical service, however excellent, can insure that the lenses will not break, or become clouded, at the moment when they are most needed.
For thirty years I have been of the opinion that the usefulness of correcting lenses has been greatly overrated, and I have lately been able to present evidence (2) which seems to me to show conclusively that the defects for which they are worn are functional and curable. Since the beginning of the war I have had the privilege of making it possible for many young men to gain admission to the army, or to favorite branches of the service from which their eyesight had previously excluded them. I believe that these benefits need not be confined to the few, but that all soldiers and sailors may obtain normal vision without glasses, and I have supplied the Surgeon General of the Army with a plan whereby this end might be attained with far less time, trouble, and expense than will be necessitated by the optical service on which we are now depending. The same method could be used with equal success in the navy.
The plan is similar to the one used successfully for eight years in the public schools of Grand Forks, North Dakota, and for a shorter time in Rochester, New York, and other cities. A Snellen test card was hung in each classroom, and the children were directed to read it every day with both eyes, also with each eye separately—the other being covered with the palm of the hand in such a way as to avoid pressure on the eyeball. This required but half a minute a day, but many children, finding that it improved their sight, or relieved their discomfort, repeated the exercise at frequent intervals during the day and were encouraged to do so. As the card hung in the classroom all the time, the children memorized it. It became a familiar distant object, and they learned to look at it without the strain always caused by unfamiliar distant objects.
At the front, or on the parade grounds of the training camps, a Snellen test card might be impracticable, but there are other letters, or small objects, on the uniforms, on the guns, on the wagons, or elsewhere, which would serve the purpose equally well. An officer has buttons on his coat with letters on them. A noncommissioned officer has a belt with cartridges. The letters, the cartridges, or the spaces between the cartridges, could be used as points of fixation.
Letters, or objects, which require a vision of 20/20 should be selected by some one who has been taught what 20/20 means, and the men should be required to regard these letters, or objects, twice a day. After reading the letters they should be directed to cover their closed eyes with the palms of their hands to shut out all the light, and remember some color, preferably black, as well as they are able to see it, for half a minute. Then they should read the letters again and note any improvement in vision. The whole procedure will take not more than a minute. It should be made part of the regular drill, night and morning, and men with imperfect sight should be encouraged to repeat it as many times a day as convenient. They will need no urging; most of them are eager to adopt any means for improving their sight, as imperfect vision is a bar to advancement, and excludes them from the favorite branch of the service, namely, aviation.
In each regiment every ten men should be under the supervision of one man who has been trained in a manner to be described later. He should carry a pocket test card, consisting of a few of the smaller letters, and should test the vision of the men at the beginning of the training, and thereafter at intervals of three months, reporting the results to the medical officer in charge. Men wearing glasses should not be required to take part in the drill, but when they see the benefits of eye education they may wish to practise it. They should be permitted to do so, but should be required to discard their glasses, as the method will do them no good while these are worn.
The method will not only correct defects of vision that have become permanent, but will prevent those deviations from the normal to which every eye—no matter how good its sight may ordinarily be—is subject.
The normal eye is commonly supposed to have perfect sight all the time, but as I have pointed out in a previous article (3), this is very far from being the case. It is unusual to find persons who can maintain perfect sight continuously, even under the most favorable conditions, and under the stress and strain of army life it is not surprising that men should frequently become more or less blind. Loss of color perception is frequent among persons whose sight is ordinarily normal. Night blindness of various degrees is also common. Errors of refraction of all kinds may be produced in normal eyes by various kinds of mental and physical disturbances; many accidents in civil life and disasters in military operations are doubtless due to this unrecognized cause. Accidents to aviators, otherwise unaccountable, are easily explained when one understands how dependent the aviator is upon his eyesight and how easily perfect vision may be lost amid the unaccustomed surroundings, the dangers and hardships of the upper air. It was formerly supposed that aviators maintained their equilibrium in the air by aid of the internal ear; but it is now becoming evident from the testimony of aviators who have found themselves emerging from a fog with one wing dawn, or even with their machine turned completely upside down, that equilibrium is maintained almost entirely, if not altogether, by the sense of sight (4). If the aviator loses his sight, therefore, he is lost, and we have one of these "unaccountable" accidents that are so unhappily common in the air service.
The cause both of continuous and of temporarily imperfect sight is a strain or effort to see, and eye training is very successful at relieving and preventing this strain. All persons connected with the army and navy, therefore, should make a daily practice of reading small, familiar letters, or observing other small, familiar objects, at a distance of ten feet or more. In addition, aviators should have a few small letters or a single letter on their machines, at a distance of five, ten, or more feet from their eyes, and should read them frequently when flying. This will greatly lessen the danger of visual lapses, with their accompanying loss of equilibrium and judgment. Arrangements should be made for illuminating these letters for night flying or fogs.
Eye education is important, not only because it improves the sight, but because the control of the visual memory obtained by palming, or the practice of seeing black with the eyes closed and covered, is extraordinarily efficacious in relieving pain and fatigue and other physical discomforts.
Many years ago patients who had been cured of imperfect sight by treatment without glasses quite often told me that after their eyes were cured they were always relieved of pain, not only in the eyes and head, but in other parts of the body, even when the pain was apparently caused by some organic disease, or by an injury. The relief in many cases was so striking that I investigated some thousands of cases, and found it to be a fact that persons with perfect sight, or the memory of perfect sight, do not suffer pain in say part of the body, while pain can always be produced in any part of the body by a strain or effort to see.
Perfect sight does not necessarily mean the perfect visual perception of words, letters, or objects, of a more or less complicated form. The color alone is sufficient, and the color which it is easiest to see perfectly is black. But perfect sight is never continuous. Careful scientific tests have shown that persons whose sight is ordinarily perfect may lose it tenporarily for a few minutes, while most people lose it even more frequently. For practical purposes in relieving pain, therefore, the use of the memory is more satisfactory. With eyes closed and covered with the palm of the hands, shutting out all light, a person with good eyesight who has had a little training in the method is ordinarily able, in a few minutes, or less, to remember or see a perfect black. An untrained person may require the assistance of some one who understands the method. When the black is seen perfectly, a temporary, if not a permanent, relief from pain always follows. By this means surgical operations have been performed and teeth extracted painlessly. The feeling of heat, the feeling of cold, hunger, fatigue, and the symptoms of disease, such as fever, weakness, and shock, have also been relieved by it. If soldiers understood this, not only much suffering, but many deaths from pain, shock, hunger, thirst, or cold, might be prevented.
A soldier in a trench full of water, if he can remember black perfectly, will know the temperature of the water, but will not suffer from cold. He may succumb from weakness on the march, but will not feel fatigue. He may die of hemorrhage, but he will die painlessly. The method would also obviate the necessity for using morphine to relieve pain, and would thus prevent the soldier from becoming the victim of lifelong morphine habit.
The Germans use a bullet which breaks when it strikes the bone and causes intense pain; the men often die of this pain before help arrives. When they are rescued the surgeons at once give them morphine. A few hours later the injection is probably repeated. Then the drug is given less frequently, but in many cases it is not discontinued entirely while the man is in the hospital. A Red Cross surgeon, at a recent meeting of the New York County Medical Society, stated that he had been responsible for producing the morphine habit in 10,000 soldiers, and that every physician at the front had done the same. By such a simple method as palming all this might be prevented. If the black can be remembered perfectly with the eyes open, the same benefits will be obtained as by palming, and since there are times, as with soldiers on the march, when palming is feasible, all soldiers should be taught to remember black with their eyes open.
Why the memory of black should have the effect of relieving pain cannot be fully explained; but it is evident that the body must be less susceptible to disturbances of all kinds when the mind is under control, and only when the mind is under control can black be remembered perfectly. That pain can be produced in any part of the body by the action of the mind is not a new observation, and if the mind can produce pain, it is not surprising that it should also be able to relieve pain.
To provide a corps of instructors in eye education and palming, ten men—either officers, physicians, or privates—who have normal vision and do not wear glasses, should first be trained by an expert. Each one should then train ten other men, and each of the latter should train ten more. In this way an endless chain will be started which will soon provide competent instructors for every division in the army and every vessel in the navy. All nurses, all Red Cross or Y. M. C. A. workers, and all members of the Medical Corps should qualify as instructors, as they will have constant occasion to use the method for the relief of pain. If the method is to be a success it must be practiced by those in authority as well as by those in humbler positions. It is so simple that the rank and file cannot be expected to take it seriously unless they see that those of higher rank think well enough of it to use it themselves.
1. PARSONS: U.S. Naval Med. Bull., April, 1918. 2. BATES: New York Medical Journal, May 8, 1915 [link], and May 18, 1918 [link]. 3. IBID: September 8, 1917. 4. ANDERSON: Lancet, March 16, 1918, p. 398. HUCKS: Scientific American, October 6, 1917, p. 263.
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