CHAPTER XXIX
STRABISMUS
SQUINT, which technically is called strabismus, is an abnormal condition in which one eye deviates, or both eyes deviate, instead of pointing directly toward an object being looked at. The customary observation of such conditions is so casual that very few have any knowledge of the different forms in which squint is recorded. The abnormal deviation may be toward the nose, or outward, up or down, or in some oblique direction. When both eyes squint, they may assume similar abnormal directions, or may deviate in directions that are dissimilar. In some cases both eyes may look straight at the same object when both are uncovered, but when covered, either eye may deviate in any direction. That specific type of abnormal action is spoken of as insufficiency.
Deviations may be constant, always present; or intermittent, not always present. They may be continuous—when the degree of deviation is the same during distant and near vision; or they may he periodic—when the degree is greater for near objects than for distant ones, or the reverse. They may be concomitant—when the amount of deviation is constant; or non-comitant when the degree changes, as the eyes move in different directions. These different conditions are often mixed, and the various combinations have specific names. Deviations always confined to one eye, when eyes are open, are known as monocular (one eye), right or left; and are called alternating, if sometimes one eye deviates, when both eyes are open, and sometimes the other eye deviates. There are other details described, some of diem very intricate. There may be good vision in both eyes, but the refraction may be unequal. This inequality of vision may vary, one eye or the other having the better vision, and that variation may be irregular. When only one eye deviates, it may have very little vision.
The reasons given in the text books for the development of squint involve so much intricate description and explanation that they would have no place in a book like this, which makes no pretense of being a text book. The predominating fundamental cause is an inherited predisposition. Inequalities in the two eyes, involving their refracting powers, and excesses or deficiencies in functioning, are discussed at great length. The poorer sight of one eye, because of some of these abnormal factors, is sometimes an apparent causative influence. It is explained that through different kinds and degrees of faltering co-ordination, there is a lack of development in the fusion-faculty. The fusion-faculty is a function of the mind. It acts, so it is explained, by means of a cerebral nerve center, called the fusion center, the site of which is undetermined. When both eyes are normal, and both look, there is solid or stereoscopic vision. That faculty of the mind fuses the two retinal images, so that an object appears single and clear. When a clear single image is not seen, different abnormal reactions are produced. These reactions have different effects on the mechanism of vision as a whole, and specifically on the variable conduct of the eyeball.
In standard text books some of these abnormal functions are attributed to hysteria, traumatic neuroses, neurasthenia, anaemia, and debilitated conditions however caused; and it is stated that they occur even in those who are apparently healthy. It is common knowledge that the beginning of a squint is often noted following some sickness, generally in childhood. It may follow a mental shock. A girl of seven was thrown down by a big dog, and the result was an instantaneous squint involving both eyes. The text books state that certain causative factors are not located in the muscles that move and may hold the eyes in abnormal positions. The books point out that until very late in the development of most cases of squint, the rotations of the eyes are normal, indicating that the power of the muscles is neither impaired nor excessive. The books conclude therefore, that the changes which take place are doubtless central. due to excessive stimulation of the center for one movement producing inhibitions for the center of the opposing movement, and vice versa. It is only late in the course of the condition, so it is explained, that there is developed an hypertrophy, or contracture, of one muscle, and atrophy or stretching of its opponents. The effects of such unequal developments are the causes assigned for the various abnormal positions found in cases of squint. We are told that a moderate proportion of cases of squint do, however, develop from a true muscular defect. Sometimes abnormal conditions of the tissues of the eye interfere with the fusion-faculty, and a complicated mechanism forces the affected eye to conduct itself in an abnormal manner. The accumulation of findings which have been recorded with infinite care has not yet enabled the text books to offer any specific course of treatment that is aimed at the admitted fundamental central cause of the disorder.
We are told that the many abnormal functions, on the part of the different factors involved, are only secondary conditions. In the ultimate analysis, the books explain, the primary fault is in the conduct of the central control. That central control is responsible for the various and complicated interlocking abnormal stimulations and inhibitions. The earlier practice of cutting the muscles attached to the outside of the eyeball proved so unsatisfactory that it is not being offered as the remedy to be used at first. It is stated specifically that whether an operative procedure does, or does not, make the eyeball stop pointing in the wrong direction, the operation has no curative effect on the sight of that eye. Often any correction secured in the position of the eyeball is lost, sooner or later, or it is replaced by some other abnormal position. The hope for the relief of this specific disorder in the mechanism of vision is based primarily and principally upon whatever correction may be secured by treatment with artificial lenses. It is stated that when there is an "out-growing" of the squint, the defective vision of the formerly squinting eye remains, and real vision, with normal co-operation by that eye, is rarely restored. That word rarely, in the standard text book, is a pregnant word. It is not explained. Why not try to account for those admittedly rare cases? Some of the grandest discoveries in the field of medicine have been made, and relief from epidemics has been secured, on phenomena less obvious and more obscure.
Thus far, I have described briefly, the explanations one finds in a standard text book regarding the many different forms of squint, and the theories which are offered to account for the abnormal conduct of the different factors involved. I will now present the conception of Dr. Bates which recognizes that the fault in the mechanism of vision originates in the center in the brain, and endeavors to correct that fault by influencing the conduct of that center. Since it is established that some eyes afflicted with squint, as reported in the text books, not only become straight, but recover normal vision, there is, then, a way to actually cure them. That way is the way by which they cure themselves. The laws of that way are not known. But the symptoms are quite evident, and the causes are indicated in what is known of the mechanism. The established facts would seem to point out the line of endeavor. It is that line of endeavor which is the foundation of the successful methods of Dr. Bates.
Suppose we consider some plain facts by recalling for examination some examples of what occurs. For instance, that girl of seven years, who was knocked down by a big dog. In that moment, both of her eyes became crossed—she had a typical case of strabismus. This was not the result of a continued straining at nearby, or at far-off objects (which is given as the commonest cause of strabismus). It was an instantaneous result caused by an extreme mental shock.
A case of my own illustrates a different aspect of the subject. A boy of six who was bright and reliable mentally, had a peculiar, alert, tense, mental attitude. Both of his eyes were constantly crossed, pointing inward. The degree of squint varied, and any excitement would so stimulate the convergent obliquities of the two eyes, that they would jerk around without any order. I have frequently stopped that turmoil of his eyeballs in a moment by distracting his mind from some disturbing thought, and interesting it in some pleasant idea. Several times I had only to say quietly, with a friendly smile: "Put on the brakes little man, your front wheels are shimmying." By different practices of the Bates method his eyes gradually became straight. The vision of both of his eyes also is normal. If it is objected that the practices used did not influence the cure of the condition, there are two answers. First: an unsupported contradiction like that is not a scientific statement. Second: if he is one of those cases which secure a spontaneous correction of the squint and also recover good normal vision, what explanation is offered by the objector for the recovery to normal, or rather, why is some explanation not sought?
A young woman of twenty-two came with the following record. Her left eye had been crossed from earliest child hood. At twelve years of age the left eye became straight, and the squint was transferred to the right eye. She had worn glasses for ten years. During two hours of treatment in my office the squint in the right eye disappeared entirely. She discarded her glasses at once. It is two years now since that treatment. Her eyes have remained straight, and she has good normal vision. That record is correct to date. The patient is employed as an accountant with a well known San Francisco firm.
Her brother had a right eye crossed for a lifetime, and it is so crossed now. There are three other cases of squint in near relatives, so an obviously hereditary tendency is a factor in this case. Her cure was a plain illustration of an autosuggestion. She was convinced and confident, and ready for action before she came to me, through the reports she heard from an intimate friend, and her own mind cured her.
An illustration of the opposite influence of mind was a case of mine in which a girl of ten had first one eye crossed before the age of two, and the transfer of the squint to the other eye during the next year, while wearing spectacles under the direction of an eye specialist. The years of treatment, and the attitude of her parents, constrained by fears of arousing an inferiority complex in the child's mind, had gradually developed an antagonistic feeling toward any further effort, and she was not in the least degree responsive. Any effort she made was either under protest, or without any confident and interested attention, and the part of her mind which could have cured the condition never entered into the endeavor. There was no success, and the undertaking was discontinued.
A similar case was a boy of ten, stupid and cantankerous, and blocked by a natural mental inertia. A considerable improvement was secured in his near-sighted and astigmatic vision. But he would relapse, and lose entirely some of the lines on the Snellen Card, which he had seen clearly a few days before. In response to enthusiastic encouragement in practice, he would show a deliberate indifference, or even resentment. He demonstrated, unconsciously, by his own personal feeling, the antagonistic part that the mind can play in a correction of the abnormal function.
A girl of eight, whose father and mother each had a squint in one eye, had an inward squint in her left eye since earliest childhood. They were patients of mine before I knew of the method of Dr. Bates. The girl's mother brought her to my office to see if any improvement could be accomplished in the position of her eye. The crossed eye could see as well as the normal eye when the normal eye was closed. After interesting the child in general conversation so that she was amused, and had no thought of her eye, I suggested a new game. She was to keep her eyes closed until I asked her to open them, and expect to see things I would tell her were in front of her. At first I suggested some grotesque objects, for instance, a tame hear on roller skates, a very red dog with a very black tail, and a chair that had a kettle of boiling water on it, with red steam corning out of the spout. We had some good laughs, and I kept warning her that if she opened her eyes, the game would be off. Soon I asked her to draw a line in front of her face, about six inches long, from left to right. When we had succeeded in that, I called for a line starting at the right end of the horizontal line and slanting downward toward the left, so that when it was finished it would be directly under the left end of the horizontal line. It did not take long to teach her to draw the two lines in the air promptly when asked. Then she was encouraged to tell us what the two lines made her think of. When she was asked to make believe that she was in school, she instantly replied that it was a seven. After some persistent assertions that if she would keep looking she would see something to the left of where she had drawn the seven, there finally came a joyful exclamation that she saw a six. By the same method, and making her point to the seven, and point to the six, and then point to the right of the seven, she was encouraged until she exclaimed triumphantly that she saw an eight. I kept reminding her that she must not open her eyes.
Leaving the figures, I told her there was something black in front of her eyes. She insisted there was not. But suddenly she said: "Yes, there it is—it is my dog." When I asked for something red, it was harder, but I promised her a twenty-five cent piece if she saw something red, and finally she replied gladly that it was there. This time it was a camp fire, and her dog was there, and some people. Her mother sat facing her, and I warned the girl I would ask her to, open her eyes in a moment, and directed her to look first at her mothers face. When she opened her eyes, the crossed eye was perfectly straight. Her mother looked at the straightened eye for almost a minute and the eye remained straight, in the laughing face of the child. But then the mother faltered, and looked at me with a smothered exclamation. Instantly the eye popped back to its old abnormal position.
There have been some skeptical comments on the possibility of the child actually seeing the figures, and the dog and the fire. Those critics have not realized that all sight is some thing which happens in the brain. They have not realized either, the flashing of fresh young minds, which are not yet hardened into the automatic habits of later life. They have not tried to imagine the mind of a young girl telling her doll about the new baby, and carrying on a conversation which shows that her mind distinguishes between the live baby, and the make-believe doll, but still, somehow, makes the doll a thing which understands and responds, and makes of herself a little mother. That is why a wise man once said that a little child can teach us, if we try to read what is in the picture. The parents of that child had their last quarrel soon after that first lesson, and separated, and the mother took the girl away from Berkeley. I have told this story because it illustrates how the visual center controls the squint in an eye. The boy I reported, who still lives here, showed in a graphic way what an added mental tension can do to an eye that is squinting. This girl demonstrated how a condition of mental relaxation can relax the tension and correct the abnormal position of the eye.
Few have not experienced the rigid tension in the body muscles caused by some shock or some fear, and the soft relaxation which followed when the cause disappeared. Why refuse to admit that the eye muscles can likewise be stiffened by a mental tension, and likewise be relaxed when the mental tension is relieved—especially when there is abundant proof that it is frequently happening? Such a shock caused a psychic blindness in my own eyes, two hours after I felt myself drowning. It was an hour before my sight was clear again. But that fearful shock left such a tension in my visual center that for thirty-seven years one pair of glasses after another did not restore my sight so that I could do my work without the lenses: I have had better vision without them now for ten years—even after the prolonged subjection to an artificial control—because my mind learned the cause and the cure for the condition. In the text books the same disorder in the mechanism of vision is assigned for astigmatism as that assigned for strabismus.
Many can produce a strabismus in one eye, or both eyes, at will. I saw a man make his eyes roll in unison like a moving figure eight; and he could hold them wherever he wished. A famous German movie star, in Hollywood, acted realistic parts in some very tragic scenes. Several times in the performance, at a very tense moment, his eyes showed an extreme strabismus which disappeared instantly when he had finished that specific portrayal. Such well-established facts are the warrant for a technique in the Bates method that is to be used in the treatment of strabismus. In some cases, when a patient demonstrates that it is possible to make the eyes squint more, or squint differently, the realization is forced on the conscious mind that the abnormal condition is not unchangeable, and is even within the control of the mind. When such a new state of mind is secured, a fine beginning is already established. The new mental attitude not only develops a new hope, but soon finds new experiences with the eye through the co-operation of the visual center in the brain. Dr. Bates reported one case of a woman brought to him by an ophthalmologist, because her squint was so complicated that the other specialist was puzzled concerning treatment. She was taught to change the degree of the squinting eyes, and with that beginning the fault was soon corrected.
In the text book it is explained that all the different forms of strabismus are caused by some specific strain or strains, and that the strains all originate in the control center in the brain. This explanation warrants a claim that relaxation—which is a release from abnormal tension—removes the cause of the disorder in the function. If the squint is caused by poor vision in one or both eyes—which poor vision itself is caused by some abnormal tension—relaxation improves the poor vision, and the squint is relieved.
Another technique requires the patient to learn how to see two lights when looking at one. This is not hard to learn. It is sufficient to stare hard with the eyes, while looking at the light, and imagine there are two lights. It is easier to accomplish this when the light is a candle, as the flickering flame facilitates the illusion. If the sight of one eye is better, it will help if a blue glass is placed before it, so as to interfere with the vision of that eye. When such an illusion has been produced, the eyes should be gradually relaxed in the manner directed before, by alternate palming or swinging, and the mind will have been instructed by a helpful new experience. A variation of this technique is to imagine the two lights when the eyes are closed. This requires a closer attention, but is a proof, when accomplished, that the visual center is giving more co-operation.
With quite young children a most effective method is to swing them around so their whole body leaves the floor, holding them by the arms, and having them look into the face of the adult swinging them. The exhilaration produced has a most relaxing effect. Another excellent practice with children is to use a number of small objects of different colors and sizes. They can be taught the names of the objects, and the names of the colors, as they see them nearby. The objects should then be gradually removed farther from their eyes, as they are able still to see them clearly. If care for all the details is observed, and a daily practice is continued, the mind will he interested, the vision improved, and the squint gradually corrected.
These specific suggestions are illustrations of practices especially adapted to the treatment of squint. Each case, naturally, has to be studied individually, and the practices selected which seem to suit the specific condition present, and the individual mind and temperament. In the several chapters devoted to detailed descriptions of techniques, there will be found practices suitable for every type of strabismus.
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