Oedema during Macrocytic Anaemia
Authors: E. G. Holmes
Journal: BMJ (1945)

beginning of the last century.The control of blindness in India is thus largely a problem of the control of infectious disease.That this is not purely an issue of pathology and pharmacology is obvious enough from the history of public health in Western Europe, and is grimly emphasized by the fact that keratomalacia -a nutritional deficiency disturbance-is ranked as first among the causes of blindness in children.The problem of blindness in India is not one of the elimination of a particular infectious dis- ease such as trachoma or the acute ophthalmias.It has to be conceived in terms of standards of living, education, facilities for treatment, and adequate and well-trained ophthalmic personnel.None the less there is much that can be done immediately both outside and as part of the long-term plans-how much, can be seen more clearly from a consideration of the position in Egypt and Palestine.-Herethe social problems are not dis- similar in their broad aspects from those seen in India, but unlike in India two clearly defined infectious diseases are the main causes of blindness-the acute purulent ophthalmias and trachoma.Purulent ophthalmia, the more significant cause, is now easily treated by the sulphonamides and by penicillin.An immediate and striking reduction of blindness in Egypt, Palestine (and, indeed, throughout the whole of the Near and Middle East), and perhaps India, could be brought about by the organization of relatively simple treatment stations and possibly mobile units, with adequate supplies of the new chemo- therapeutic and antibiotic agents.Trachoma, too, could be considerably reduced by such stations, for the beneficial effect of sulphonamide therapy in trachoma is no longer open to doubt; moreover, there are indications that penicillin may also be highly effective.The creation of such treatment stations will in any case have to be undertaken in any long-term pro- gramme, but a sense of urgency has now been supplied by the availability of the new therapeutic agents, for each day that such treatment is not available to the millions of Africa and Asia adds many blind to the roll of the avoidably blinded.Summary 1.The number of blind in the British Isles is not less than 90,0Oand is likely to exceed 100,000.In the white population of the Dominions it is between 40,000 and 50,000.In the native population of the British possessions in Africa, Asia, and Indonesia it is con- siderably more' than 10 millions.2. There has been a marked decline in the incidence of blindness in childhood in England and Wales during the past 21 years, but there is no evidence that there has been any substantial decrease in the older age groups.Before long the decline in the incidence of blindness in childhood witl come to an end, as already about 65% of all blindness in children is due to congenital and genetic infections not readily amenable to treatment.With the rapid elimination of blindness due to infectious disease, intensive research in the problems of genetic disease, maternally transmitted infections, cataract, glaucoma, and the pathology of senescence, has become an im- mediate task if the incidence of blindness in England and Wales is to be reduced.