Stories From the Clinic
by Emily C. Lierman. Истории из клиники.
SQUINT OR CROSS EYES
SQUINT - Case No. 1
A LITTLE mulatto boy, aged four years, was the most unruly youngster who ever came for treatment. While testing his sight with the test card, I had a most trying time. When he tried to look straight ahead, his right eye turned in so far that one could hardly see the iris. His young grandmother, who came with him, expressed deep sympathy for me and assured me that I would have a hard time trying to manage him or to help him. I asked him his name several times before he answered:
"I ain't got no name."
Later he said it was Francisco, Frisco for short. Frisky would have suited him much better. I could see that he was straining and was extremely nervous. I decided to be very patient with him, but for some time the only answers I could get from him were: "I don't wanna" and "I won't."
All sorts of apologies came from his grandmother, but I assured her that I was not discouraged with him. I made up my mind to help the little chap, and in some way relieve him of that awful tension and nervous strain, which I felt was the cause of all his devilishness. Finally I said to him:
"If I had a bad eye and a good eye, I would not make my good eye do all the work. I would make the bad eye work hard so that I could see better."
This interested the child, and he asked: "Have I got a bad eye?"
"Yes," I said, "and the reason it is bad is because it is lazy, and you won't let it be good. All you can say when I try to tell you how to make it behave is, 'I don't wanna.' Nice boys with good eyes don't say that." Thereupon he shouted in a loud voice which startled the rest of the patients: "Make my bad eye do some work; I want good eyes like you have."
I immediately showed him a test card called pot hooks. Little folks at the age of two or older like this card because all they have to do is to point a finger up or down, left or right, whichever way the K may be pointing. When they cannot see the way the E is arranged, then we have them cover their eyes just as grown-ups do, to obtain relaxation; only we pretend to play hide and seek. As I held the card two feet away I covered his left eye with the palm of my hand, and asked him to show me how the E's were pointing. At that distance he was able to see the 100 line letters. He could see straight ahead with the right eye only just long enough to see those letters; then his eye turned in again.
At first I could not induce him to palm, so I told him to close his eyes as though he were sleeping. He was very obedient about doing this, and his grandmother stood by in astonishment while his eyes were closed. I praised him for closing and resting them, and I said if he would do this many, many times every day, his right eye would become straight like the left and would not be bad any more. Then t told him to cover his left eye with his hand and look at the card, which I had fastened on the wall five feet away. This amused him, and he acted as though he were in for a good time. I told him to look at the 200 tine letter, and then quickly close his eyes; then to look at the 100 line letters and close his eyes quickly again. In this way, Frisco did not have a chance to strain, because his eyes were not open long enough at any one time to stare. He was able to see these letters as well at five feet as he did at two, and this encouraged me. When he opened his eyes a third time he showed me with his hand how the next line of letter E's pointed.
He attended regularly three days a week for a few months, and was always very obedient. Each time he came he was able to keep his eye straight, not only while practicing with the card, but also while talking to me. His sight improved at each visit. His grandmother purchased a Snellen Test Card and assisted with the treatment faithfully at home. Six months later he was able to read the ten line letters at ten feet away with each eye, and had learned to read the alphabet and first grade words.
I did not hear from Frisco for a year or so, when one day he and his grandmother surprised me. Dr. Bates and I had just arrived and found a large group of patients waiting. From among this group I saw a pretty mulatto woman, stretching her head above the rest, smiling at me. Her eyes were dancing and she seemed eager to talk to me. Standing beside her was a little chap. I did not recognize my little Frisco of a year ago,—he looked so different. His large beautiful eyes, now perfectly straight, gazed into mine, and he smiled as he noticed that I had finally remembered who he was.
His grandmother then said: "I have come especially to thank you for what you have done for our boy. When we first came to see you, no one in the world wanted him but me. He was so disobedient to his mother and so cruel to his baby sister He would hurt and destroy everything he touched, and my daughter and I feared that he would grow up a criminal. Since his eye became straight he is a quiet, lovable boy and he is now living at home with his mother and father."
Then I greeted Frisco and he made a gentle little bow to me saying that it was a pleasure to see me again. I thought that was a fine little speech, as he was only five years old. Grandma said I had transformed him, but I assured her that it was her love and her untiring efforts to help in the cure of his eyes that had made the great change in him. Frisco's last words to me were; "I love baby sister now. I don't pinch her any more. I just kiss her."
SQUINT - Case No. 2
Doris and Arthur were cousins. Both had convergent squint. The only difference between them was that Doris's right eye turned in, while Arthur's trouble was with the left eye.
Doris was four years old when she was brought to us. At the age of two it was noticed that her right eye turned in. Although glasses were immediately obtained for her, they did not correct her squint. When I first saw her, the vision of the squinting eye was 10/40, while that of the other eye was 10/20. Later, the sight of each eye became 12/10.
Doris did not know the alphabet; so in treating her I had to use a card covered with the letter E arranged in different ways, and she was able to tell me in which direction they were pointing, left, right, up or down. I found it rather hard at first to get her to palm for any length of time. One day the mother told me of a dear baby brother at home, and I told Doris to think of her brother when she closed and covered her eyes. She very willingly did this and kept perfectly still. When she thought it time to open her eyes, usually after a minute or so, she called out questioningly, "open them?" If I answered, "No," she would keep them closed until I said, "Ready." During the first few treatments the right eye would not keep straight for more than half a minute, but later it stayed straight all the time, while she read the chart down to the ten line. In the beginning after a treatment it turned in again, but not so badly as before, and if she was reminded to make it look straight she could do so very readily.
The child's mother was a great help in the treatment, both at home and at the clinic. She derived much good from the treatment herself. She was a most unselfish parent, absolutely devoted to her children; but this devotion caused her to get excited and nervous, so that when she arrived at the clinic her eyes were staring almost out of her head. She soon became able to relax and the condition of her eyes improved.
Arthur's left eye turned in. His vision for the test card was right 10/20, left 10/50. His age was twelve years. His mother wanted me to know that he was a very bright boy, obedient and lovable. When he looked at the chart it was sad to see the left eye turn in until the iris was almost hidden. Arthur was quite different in many ways from any child I had ever treated for squint. All the rest showed signs of nervousness or were cross and dissatisfied. But not so with Arthur. He always did as I told him and his lovable face always wore a smile. He made rapid progress and his mother, who came with him, was very happy over the good results obtained in a very short while. At his first visit, after reading a line of letters on the chart, he was told to remember the last letter while he closed and covered his eyes. When he looked at the card again he was able to read another line. His vision became normal, 10/10, in just six weeks' time and his left eye no longer turned in. His mother told me that he got on much better at school than he did formerly. He did his exercises daily because he was eager to get well.
At Christmas time unusual gratitude was shown by the mothers to both the Doctor and me, because their children had obtained normal vision.
SQUINT - Case No. 3
Another patient had been wearing glasses for twelve years for the correction of squint, but was not benefited. When she began wearing them her mother tried to console her by saying that perhaps in another year the squint would be cured; but instead it only got worse. Her playmates made unkind remarks about it, and when she found her sight was getting worse for reading she became utterly discouraged.
I tested her sight, and she read 15/40 with her left, or better eye. When I asked her to read the card with her squinting eye she turned her head half way round to the left in trying to see. The vision of her right eye was 15/70. She was told to palm, and her mother was astonished when in a few minutes she opened her eyes, and, with her head perfectly straight, read 15/40 with her right eye without R mistake. When palming is done right it improves squint very quickly. Two days later, she read 15/15 with each eye separately, and her right eye was perfectly straight. She had followed my instructions to palm at least six times a day for as long a period as was comfortable for her. Three days later she came to the clinic smiling and expressed her gratitude for what had been done for her.
"I can read a book for hours at a time," she said, "without headaches or discomfort. I visited another clinic where I had received treatment and asked the doctor who had treated me to let me show him what I could do. I showed him how I could palm, and then I read the test card for him with each eye separately. The doctor said it was remarkable, because he had told me that I could never again get along without glasses and to be sure to have them changed every year or so."
After six months her vision was still normal.
SQUINT - Case No. 4
Cross eyes are indeed an affliction. This was plainly shown by the look of disgust which appeared on the face of the young colored mother who brought her nine year old boy to me for treatment. He had the most wistful expression. He kept looking up into his mother's face and his actions were that of a deaf and dumb person. When he looked at his mother with his right eye, the left eye turned out. When he looked at her with his left eye, the right eye turned out. He had alternate divergent squint. My heart went out to James, as his mother related to me the fact that her other three children had normal sight, while James looked so repulsive with his crooked eyes. A chill went through me when I heard her say, "I wish he had never been born." Then with more disgust in the sound of her voice she said, "I can't help it, but I hate him." Can anyone imagine a mother disliking her own child so much? All because his eyes were crooked. Complaints came to her from the school he attended. His teacher declared that he was stupid.
All this time the little fellow looked up at his mother apparently without moving an eyelid. Her question was, "What can be done with him or for him? Can you give him glasses or operate to cure his eyes?" I told her that glasses would never cure his squint, and neither would an operation. I asked her to watch carefully, and see what James was about to do for me.
First, I held him very close to me and patted his woolly head. He pressed a little closer. He liked the beginning of his treatment. I told him to say the alphabet for me, but he could not remember all the letters. He stood ten feet from the test card. I asked him to read, starting with the largest letter at the top. He read a few letters correctly, but I soon found out that he did not know many letters. His mother remarked: "The teacher in school thought his mind was affected because of his eyes, and that there was little hope of curing him." I had my doubts about the teacher saying such a thing, but I did not say so to the mother. What a pity it was to have the dear little fellow hear all this,—he looked so worried and restless. Perhaps he wanted to run away somewhere because his eyes caused others so much trouble.
I taught him to palm, telling him to remember a small Bible-class pin I was wearing on my dress. In a few minutes I tested his sight with the E card, which is used in cases where children do not know their letters. At ten feet he saw the fifty line. Again I told him to palm, and asked his mother not to speak to him while he was resting his eyes. In the meantime I attended to other patients. After a few moments I glanced at him and saw two big tears rolling down each cheek. He was weeping silently. His mother was just about ready to find fault with him, but I intervened and led her gently out of the room to a bench outside the door. I whispered to James that I loved him a whole lot, and if he would learn to read his letters at home and could read half of the test card correctly the next time he came, I would give him a nickel. I saw him smile, and when I was able to treat him again, I found that his sight had improved to the forty line of the E card. I have been wondering ever since, whether it was the mental picture of the Bible-class pin on my dress which he was asked to remember, or the clear vision he had of that nickel I had promised him, that improved his sight for the forty line of letters.
Two days later James appeared again with his mother, and both were smiling. He could hardly wait to tell me that he knew his letters perfectly. His big brother had taught him at home, and he hoped I would be as pleased as his teacher was, when he read all his letters on the blackboard for her that day.
It was amusing to see James looking toward my purse which was hanging on the wall in the clinic room. I produced a strange test card which he had not seen. When he began to read the card I placed him fifteen feet away, which was five feet further than the first day. He was so excited that his squint became worse and he could not read. Dr. Bates saw this, and said that his trouble was mostly nervousness. I told James to palm again, and reminded him of the letter E with its straight line at the top and to the left, with an opening to the right. Then he became able to see the letters after a few moments' rest. I called Dr. Bates' attention to the sudden improvement in his eyes as he read one line after another, until he reached the thirty line, when suddenly his eyes turned out again, but after he had rested his eyes they became straight. I gave him the promised nickel that day, and made him very happy.
After he had been coming to the clinic for a month, James was able to keep his eyes straight most of the time. The attitude of his mother toward him was decidedly better and she promised to help him with the treatment of his eyes at home.
SQUINT - Case No. 5
As I entered the clinic one afternoon I saw two mothers standing side by side, each holding a little boy by the hand. The children were both about the same age, five years, and both were cross-eyed; but there the resemblance ceased. One seemed happy and contented, and it was quite evident that he was much loved and well-cared for. Both mother and child were clean and neat, and often the boy would look at the mother for a smile, which was always there. The other boy was plainly unhappy and neglected. I could read the mind of the mother, who was anything but clean, as she stood there grasping his hand a little too tightly. Even without her frequent whispered threats of dire things to happen if the child did not keep still, I should have known that she considered him a nuisance, and not a precious possession as the other boy plainly was in the eyes of his mother.
I was at a loss to know which child to treat first, but decided upon Nathan, the clean one, and tried to keep the other interested while he waited. Nathan had beautiful black curls, and would have been pretty but for the convergent squint of his right eye, which gave him a peculiar appearance. His vision was very poor. With both eyes together he could read at ten feet the fifty line of the test card, and with the squinting eye he read the seventy line. I showed him how to palm, and while he was doing so I had time to talk to his mother. She said that his right eye had turned in since he was two years old and that all the doctors to whom she had taken him had prescribed glasses. These, however, had not helped him. I asked Nathan to read the card again, and was delighted to find that the vision of the bad eye had become equal to that of the good one, namely 10/50. I had difficulty in keeping his head straight while I was testing him, for like most children with cross eyes he tried to improve his sight by looking at the object of vision from all sorts of angles. After he had palmed for a sufficient length of time, however, he became able to correct this habit. The extraordinary sympathy which existed between mother and child became more apparent during the treatment, for no matter what I said or did the child would not smile until the mother smiled.
Nathan came to the clinic very regularly for a year, and for the first six months he always wore a black patch over his left, or better eye. Atropine was also put in this eye to prevent its use in case the patch was not worn constantly. Nathan did not like the patch, and his mother had to promise all sorts of things to keep it on. After it was removed the atropine was continued. Dr.' Bates had told me what to expect when the patch was removed, and so I was not shocked to see the good eye turn in. I knew the condition would be temporary, and that in time both eyes would be straight. Treatment was continued for six months, and then the boy became able to read 15/10 with both eyes, and always with both eyes straight.
The other little boy, to whom we must now return, was called George, and his condition was worse than that of Nathan, for both his eyes seemed crossed. At ten feet he read the fifty line, but complained that he saw double. I showed him how to palm, and while he was doing so his mother told me how very bad he was, adding that I must spank him if he did not mind me.
"I think he gets enough of that already," I said, but I was careful to say it with a smile, fearing that she might lose her temper and say more than I would like.
George had been palming five minutes, when I asked him to uncover his eyes and look at the card. He was much surprised to find that he could read the forty line without seeing the letters double. I asked his mother to be a little patient with him and help him at home, and I gave her a test card for him to practice with.
"Madam," she replied, "I am the mother of six, and I haven't time to fuss with him."
"No wonder the kiddie is cross-eyed," I thought, and seeing I could get no help in that quarter, I appealed to George.
It was near Christmas time and when I revealed to him the possibility of a Christmas present if he came to the clinic regularly, and did what I told him, he became interested. I did not know how much could be done for his eyes in the eight weeks that remained before the holidays, but I felt sure that with his co-operation we could at least make a good start. This he gave me in full measure. Never did I have a more enthusiastic patient. He attended the clinic regularly three days a week, and often when I came late I would find him waiting with other boys for me on the hospital steps.
After he had been practicing faithfully for two weeks, palming six times a day, and perhaps more, according to his own report he was able to keep his eyes straight while he read all of the test card at ten feet. When he had done this I asked him to spell a word with four letters, and instantly his eyes turned. I had him palm again, and then I asked him to count up to twenty. His eyes remained straight, because he could do this without strain.
Two days before Christmas, George was at the clinic bright and early, and with him had come three of his brothers to get their share also, "if there were any presents left," as George explained. Fortunately a little fairy had prepared me for such an emergency, and I had gifts for everyone. That day George was able to keep his eyes straight both before and after treatment, and to read 10/10 with each eye separately.
The third case of squint was little Ruth, aged three. Dr. Bates suggested to her mother, who was nearsighted, that she should have her own eyes cured, because her condition had a bad effect on the child. She consented, and soon obtained normal vision. Ruth was so tiny that I had to put her on a table to treat her. As she could not, of course, read the letters on the test card, I held before her a card covered with E's of various sizes turned in different directions. Her mother was quite positive that she couldn't understand what I wanted her to do, but Ruth, as often happens in such cases, had more intelligence than her mother gave her credit for.
I asked the child to tell me whether a certain E pointed upward, or to the right or left, by merely indicating the direction with her finger, and it did not take an instant for her to show her mother how bright she was, I showed her how to palm, and in a little while she indicated correctly the direction of the letters on several lines. When the letters grew indistinct, as I moved the card further away, she became excited and wanted to cry, and her left eye turned in markedly. She palmed again and while she was doing so, I asked her all about her dolly, whether her eyes were blue, or some other color, and what kind of clothes she wore. When she removed her hands from her eyes, both were straight.
Her mother was instructed to practice with Ruth many times a day at short intervals, so that she would not tire of it. Each time I tested her sight her eyes remained straight. I was much interested to learn from her mother that if Ruth's daddy raised his voice in the slightest degree when he spoke to her, her eyes were sure to turn in. This merely confirmed my own experience that it is necessary to treat children who have defects of vision with the utmost gentleness if one wants to cure them. Ruth came to us for about nine months altogether and when I last saw her, both eyes were straight.