Eye Diseases

EYE DISEASES. Prevalence of eye diseases. Eye diseases were extremely widespread among the population of Russia even before the World War. According to literature data, in 1910 there were 300,000 blind people in the country, with the causes of blindness being trachoma in 21.4%, glaucoma in 19.2%, corneal diseases in 13.5%, smallpox in 12.1%, blennorrhea of newborns in 4.9%, optic nerve atrophy in 4.8%, central nervous system diseases in 3.9%, vascular tunic diseases in 3.9%, syphilis in 3.7%, eye injuries in 3.7%, and congenital blindness in 1.8%. The Imperialist and Civil wars contributed to an increase in eye diseases: the war caused mass traumatism, including of the eyes; displacement contributed to the spread of contagious diseases (trachoma, syphilis, gonococcal infection). Typhus, especially relapsing fever, as well as smallpox epidemics that broke out in places, resulted in a previously unseen number of eye complications. The spread of eye diseases was also facilitated by the mass consumption of denatured alcohol, varnish, wood alcohol, and moonshine during the years of alcohol prohibition. The diversity of the population composition of the USSR, the mass of nationalities differing significantly from one another in the degree of economic and cultural development, the nature of daily life and labor, find their reflection in the degree of prevalence of eye diseases, in their nature and severity. Table 2 shows the percentage ratios of individual ASSRs—539.4, in the Mari Autonomous Region—560.5, in the Oirat Autonomous Region—257.9, in the Yakut ASSR—227.5, in the Khakass District—276.5, etc. (predominantly among national minorities). Occupational diseases, as well as domestic and industrial eye trauma, also attract attention (see Occupational diseases). Examples can be seen in some figures on eye trauma in various places (Auerbach): in the Uzbek and Turkmen SSRs, eye injuries account for 1.3–1.8% of all blindness; in the Omsk eye clinic, eye injuries account for 1.01% of all eye diseases, in the eye hospital in Kharkov—2%, in the eye clinic in Kiev—0.3%, in the Perm clinic—3.1%, in the Ivanovo-Voznesensk hospital—3.5%, in the Sverdlovsk hospital—4.3%, in the eye clinic of the 2nd Moscow State University—5.1%, in the Tula eye hospital—7.6%, in the Helmholtz eye hospital in Moscow—8.9%, in the Grozny polyclinic—9.5%, on the transport system of the USSR—9.8%, in the Krasnodar eye clinic—10–12%, in the Stalingrad hospital—16.3%, in the eye hospital in Baku—23.5%. Information recently received from many places in the Union speaks of the growth, along with the development of industry, of industrial traumatism in general and of the eyes in particular, and also indicates a significant number of eye injuries associated with the daily life of the population in agricultural regions (Central Black Earth Region, Kuban District). Control of eye diseases. In 1913, the whole of Russia had about 2,500 eye hospital beds and up to 300 eye doctors. Work was conducted almost exclusively in treatment. From 1918, with the foundation of the People's Commissariats of Health (first of the RSFSR, and then of the other SSRs), with the gradual implementation of the basic principles of Soviet medicine, the fight against eye diseases and blindness also began to develop. Trachoma is so highly developed in the USSR that in some places in the Union the entire plan for combating eye diseases has to be built with regard to it. A more energetic fight against trachoma began first in those cities where, in connection with the influx of refugee children, a large number of trachomatous patients were discovered in children's homes. Examinations of children's towns and homes were carried out and measures were taken for their best possible organization, for the isolation and treatment of trachomatous patients, sanitary-educational work was started, etc. Following this, the work began to cover schoolchildren and pre-conscripts, and in places their families. The People's Commissariats of Health and Education issued regulations on trachomatous children's homes, on the fight against trachoma in schools and among pre-conscripts; eye detachments began to be organized and sent to the most remote areas affected by eye diseases (trachoma). These detachments, in accordance with the regulations issued on them in 1925, carry out survey work, detecting foci of trachoma through universal eye examinations of the population, then therapeutic and sanitary-educational work, and where possible also train local workers to fight trachoma, contributing to the organization of permanent eye care. In individual places, e.g., in the Tatar Autonomous Soviet Socialist Republic, interdepartmental commissions have been organized with the participation of representatives of various organizations, which carry out a number of measures to combat trachoma, paying considerable attention to survey and dispensary work. A further shift in the organization of the fight against trachoma was outlined in connection with the resolution of the 12th All-Russian Congress of Soviets (on the report of the People's Commissariat of Health), which recognized trachoma as a public disaster and emphasized the need for decisive measures for its eradication. As a natural consequence of this, in 1927 the decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR on measures to combat trachoma appeared, followed by a corresponding circular from the People's Commissariat of Health and the People's Commissariat of Education, proposing a number of preventive measures and partly the methodology of work. In connection with the decree of the Central Executive Committee, a number of local orders were issued: for example, the Central Executive Committee of the Chuvash ASSR, one of the areas most affected by trachoma in the USSR, issued a decree on measures to combat trachoma in its republic, developing the decree of the Central Executive Committee in relation to local conditions, and organized a society to combat trachoma with branches in districts. General instructions on the organization of eye care, its standards, work methods, and the need to bring it closer to the population in the form of not only curative but also preventive work are outlined in a special instruction of the People's Commissariat of Health of the RSFSR in 1926. Attention was drawn to the study of trachoma (Trachoma Institute in Kazan since 1922), the training of eye doctors at institutes for the advanced training of doctors and at large eye hospitals (three-year internship, one-year special fellowship). Recently, there has been an intensification and growth of the medical and sanitary network, and consequently the care of eye patients; rural doctors are increasingly supplementing their knowledge in the field of practical ophthalmology. In some places (Vyatka Governorate), special trachoma stations are organized with a small radius of activity (1–3 versts) in settlements heavily affected by trachoma and far from paramedic and medical stations; survey and sanitary-educational work is conducted here, and drug treatment of trachomatous patients is permitted by persons with secondary medical education, prepared and supervised by periodically visiting district doctors, with the participation of district and regional sanitary doctors. The decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR on measures to combat trachoma grants health authorities the right of compulsory treatment under certain conditions for certain groups of the population. The significant prevalence of blennorrhea of newborns to date is explained by the frequently occurring gonorrhea among women, poorly developed hospital maternity care, the conduct of the majority of births in unsanitary home conditions, especially in villages, and the weak application of the Credé method as a consequence. The growth of maternity care and the work of consultations for pregnant women contribute to the fight against blennorrhea of newborns. The People's Commissariat of Health has issued a special decree prescribing mandatory use of the aforementioned method by medical personnel in all obstetrical care. - As for tuberculous (scrofulous) eye diseases, measures to improve the living and working conditions of the population, as well as the work of the tuberculosis organization, which is increasingly covering the population with its dispensary work, should contribute to their reduction. - A widely launched fight against syphilis should lead to a decrease in the incidence of this disease among the population, and consequently of the corresponding eye diseases. - Relapsing fever has declined sharply, as a result of which eye diseases on its basis are now very rare. - Smallpox still gives outbreaks in places (Votyak Region, Ural Region, Tatar Republic, some places in Siberia, etc.), but the total number of cases has decreased significantly. This cannot yet be said of acute childhood infections, which until recently have given many complications on the part of the eyes, often with a persistent decrease in vision. - The number of eye diseases caused by poisoning with denatured alcohol has decreased. - The fight against occupational diseases and industrial eye trauma is carried out by studying their causes and improving the working and living conditions of workers and peasants. In addition to republics (in 1928), beds and doctors are distributed as follows...

Eye Diseases

Doctors

The development of specialized eye care has been observed in recent years throughout the Union. Table 3 shows its growth in the RSFSR from 1913 to 1927 (the network for 1913 is taken within the territory of the RSFSR). (See Table 3.) In addition, work is being carried out along the lines of selecting workers suitable in terms of health, development, and training for a given production, improving the sanitary and hygienic condition of workspaces (ventilation, lighting, heating, etc.), using protective devices on machines and lathes, wearing corrective and protective glasses, complying with labor protection requirements, and eliminating the causes of premature fatigue among workers. The extent and pace of development of the network of medical institutions and the approximation of eye care to the population are not identical everywhere. In the RSFSR, for example, they are most significant in national republics and regions, less so in industrial regions, and weak in the Central Black Earth Region and in provinces with mixed populations (see Table 4). In the further construction and expansion of the medical and sanitary network, the organization of the fight against eye diseases must constitute one of the primary tasks. (See Table 4.) All measures for the prevention of eye diseases and the fight against them are carried out both by special medical institutions with ophthalmologists and, especially in rural areas, by the entire network of medical and prophylactic institutions. The observed growth and strengthening of the latter also contribute to the improvement and accessibility of eye care for the population. Across individual union republics...

A. Savvaitov. Eye detachments, sent for a period of 2 to 4 months, having the character of temporary medical stations with an outpatient clinic and beds exclusively for eye patients, predominantly surgical ones, arose on the initiative of Prof. L. G. Bellyarminov, with whose close participation a project for organizing eye detachments to combat the spread of blindness among the population was developed and approved in 1893. For the first experiment, seven mobile eye detachments were sent out in 1893. Their work convinced the Trusteeship for the Blind, which took upon itself the entire management of this matter, that the population of areas remote from the center had a great need for ophthalmological assistance; that existing ophthalmological assistance in the provinces was extremely insignificant; and that the adoption of measures to prevent blindness was necessary and urgent. Since experience showed that the detachments were practically quite suitable and achieved their purpose, the Trusteeship dispatched already 21 detachments to the most diverse areas of Russia in the following year. Subsequently, the number of detachments began to gradually increase and reached its maximum (38 eye detachments) in 1900. Then this number decreased and fluctuated between 30 and 32 (with the exception of 1904-05, when it dropped to 17-19). From the available reports of the Trusteeship for the Blind, it is evident that over a 20-year period, 535 detachments were dispatched, working in the most diverse areas of European Russia, Siberia, and the Caucasus for 1,033 months, consequently about 2 months each detachment. Over the same period, 1,008,564 initial patients were received, averaging 1,885 per detachment. Of course, this figure fluctuated significantly depending on the duration of the detachment's work, population density, and the prevalence of trachoma among it. The surgical activity of the eye detachments was expressed in the performance of 177,384 major and 142,316 minor operations and surgical aids. Working in the direction of treatment and prevention of blindness, the eye detachments did not miss another of their purposes: the training of personnel for further permanent work on site. Each head of an eye detachment strove to prepare local doctors on site for further practical activity, train secondary and junior personnel in the care of eye patients, and familiarize them with the prophylaxis and hygiene of eye diseases. The majority of local doctors and secondary personnel, seeing the benefit brought by the mobile eye detachment, took an interest in its work, took an active part in it, and the doctors, under the guidance of the heads, performed almost all eye operations. The training of local doctors conducted by the detachment under the conditions of their normal activity gave doctors more than they could have received upon being attached to clinics and hospitals in major centers, where this work is carried out under different conditions unusual for them and in a completely different setting than in the countryside. The organization and dispatch of mobile detachments were usually carried out as follows: a state or public institution or a private individual applied to the Trusteeship with a request to send a mobile eye detachment to a certain locality for a known period and undertook at the same time to provide the detachment with premises for an outpatient clinic, medicines, hospital furnishings for stationary patients, and secondary and junior medical personnel. The Trusteeship, for its part, undertook the payment of salary to the head and his assistant, paid for their travel there and back, and supplied the detachment with instruments, special equipment, a set of glasses, and a small sum of money for unforeseen expenses. At the agreed time, the detachment departed to the place of work, where it usually found everything already prepared for its activity. From 1915, the dispatch of detachments ceased due to the lack of doctors and local funds, since all the attention of the state and public organizations was directed to the fronts. Then the Civil War began, which was also unfavorable to the cause. Only in 1923, on the initiative of the People's Commissariat of Health, was one mobile eye detachment sent as an experiment, and in 1924, in view of the successful outcome of the experiment, already 9 detachments. Subsequently, the number of eye detachments began to increase and soon exceeded their pre-war number. The People's Commissariat of Health of the RSFSR, the Russian Society of the Red Cross, and the People's Commissariats of Health of individual republics took part in the equipping and dispatch of mobile eye detachments. Funds for the detachments were allocated partly by the People's Commissariat of Health of the RSFSR and partly from local budgets. In 1924/25, 30 detachments were dispatched (15 by the People's Commissariat of Health, 4 by the Red Cross, 3 by the Children's Commission of the All-Russian Central Executive Committee, and 8 detachments on local funds). In 1925/26, 44 detachments (15 by the People's Commissariat of Health, 6 by the Red Cross, and 23 on the local budget). In 1926/27, 73 detachments (18 by the People's Commissariat of Health, 8 by the Red Cross, and 47 on the local budget). Detachments are now sent mainly to areas predominantly affected by trachoma or to those in which eye care is particularly unsatisfactory (e.g., in the mountains of the Caucasus). An especially large number of detachments was dispatched to autonomous republics and regions with a significant spread of trachoma and a significant population of national minorities. In the activity of the detachment now, in accordance with the general preventive direction of Soviet medicine, the widest place is assigned to sanitary and educational work. Both detachment heads and their assistants are charged with the duty of holding conversations with the population of the localities visited by the detachments as often as possible about eye diseases, prevention measures and causes of their occurrence, and the like, and this will undoubtedly lead in the future both to the reduction of eye diseases, mainly contagious ones (trachoma, blennorrhea), and to the reduction of blindness. The activity of mobile eye detachments is thus not only medical and preventive, but also agitational. They interest medical, administrative, and public circles, point out to them the unsatisfactory state of eye care in certain regions, and simultaneously prompt them to take certain measures to eliminate these shortcomings. Thanks to the activity of mobile eye detachments, a whole cadre of ophthalmologists is formed, perfecting their special education in such a detachment, so that a locality once visited by a detachment can no longer be considered completely devoid of eye care, since many local doctors who previously avoided practicing this specialty now receive and operate on eye patients on a par with others. All detachments of the People's Commissariat of Health and its local bodies act in accordance with the regulations and instructions on mobile eye detachments (Bulletin of the People's Commissariat of Health, 1925, no. 16, circular 161). The main emphasis in the work of eye detachments is currently placed on survey work—schools, pre-conscripts, Komsomol, individual villages, even entire volosts. Identified foci of trachoma attract the attention of the population, public health authorities, and the rural medical district itself, which in the end has to conduct work to combat eye morbidity in rural areas. The results of the survey work affect the increase in the influx of patients into the outpatient clinic and hospital of the detachment, which, treating and operating on patients, accustoms the population to medical care, demonstrating in practice the possibility of being cured of many diseases that the population previously considered incurable, and the possibility in many cases of preventing blindness. Of great importance, along with survey and treatment work, is the sanitary and educational work carried out by eye detachments—conversations, lectures, reports with demonstrations, distribution of popular literature—which familiarizes the population with the essence of eye diseases (especially social and domestic ones), the degree of their spread in a given locality, the damage caused by them, speaks about the possibilities and methods of combating them, opens the eyes of the population to all this, and draws it into the cause of its own healthcare. And the population itself begins to achieve and often achieves the organization of permanent eye care for itself, exerting certain pressure on public health authorities and helping them in this itself. Eye detachments have, especially on the outskirts of the USSR, also the significance of a political factor. A mass of protocol resolutions, addresses, letters, and appeals from district executive committees, rayon executive committees, volost executive committees, village soviets, etc., regarding the work of eye detachments speaks of the role of the Soviet power, which shows exceptional attention to the health of precisely the backward nationalities of the USSR, and also notes the ideological, 'not for fear, but for conscience,' selfless work of Soviet doctors and all medical personnel.