Stories from the Clinic 3. Retinitis Pigmentosa By Emily C. Lierman I am not a physician, and I know very little about the disease of the eyes known as retinitis pigmentosa except how to relieve it. I have been told that in this condition spots of black pigment are deposited in the retina, that parts of the retina are destroyed, and that the nerve of sight is diseased. Eye books which describe the disease say that it usually begins in childhood, and progresses very slowly until it ends in complete blindness. The field of vision is contracted, and, because they cannot see objects on either side of them, patients frequently stumble against such objects. In most cases the vision is much worse at night than in the daytime. The books say further that no treatment is known which helps these cases. Nevertheless Dr. Bates reported, in the New York Medical Journal of February 3, 1917, a case of retinitis pigmentosa which had been materially benefited by treatment through relaxation, and by the use of the same methods, I have been able to greatly improve the sight in several cases of the same kind. My first case of retinitis pigmentosa was Pauline, a little girl of twelve who came to the clinic in October, 1917. At five feet from the card she could read only the seventy line, and her eyes vibrated continually from side to side, a condition known as nystagmus. She was very shy and extremely nervous, and appealed to me pathetically for glasses so that she could see the blackboard, and the teacher would not think her stupid and make fun of her. I have noticed that eye patients often suffer from extreme nervousness; but this poor child had the worst case of nervse I ever saw, and the slightest agitation made her sight worse. If, in asking her to read a line on the test card, I raised my voice and spoke a little peremptorily, her face would flush, and she would say, "I cannot see anything now." But just as soon as I lowered my voice and took pains to speak gently, her sight cleared up. I began her treatment by telling her to cover her eyes with the palms of her hands and remember the letters she had seen on the card. This improved her sight so much that before she left she was able to see all the fifty line at five feet, and—what thrilled me most of all—the dreadful movement of her eyes had stopped. She came quite steadily to the clinic, and every time she came I was able to improve her sight, so that at last she became able to read the writing on the blackboard at school. Then I did not see her again for six months. When she came back she told me that she had been working in a laundry during the summer because she hated school. She had also been ill during the summer, and her mother had taken her to a hospital for treatment. While she was there an eye specialist looked at her eyes, and this made her so nervous that they had started to vibrate from side to side. He said to her: "You ought to have your eyes treated; they are very bad." "I am having them treated at the Harlem Hospital Clinic," she answered. "I know how to stop that vibration." Then she palmed for a while, and when she uncovered and opened her eyes the doctor looked at them again. "Why they seem all right now," he said. "You had better go to that doctor until you are cured. He can do more for you than I can." I was very much pleased to find that in spite of having stayed away so long, she had not forgotten what I had told her, and was able to stop her nystagmus. I tested her sight, and found that it was no worse than when I had last seen her. In fact, in some ways, it was better. She was not so nervous, and she said that her family and friends noticed that her eyes looked better. She herself was now very enthusiastic and anxious to have me help her. I told her to palm as usual, and left her to treat other patients. Five minutes later she read the thirty line at thirteen feet. I now told her to look first to the right of the card and then to the left, and to note that it appeared to move in a direction opposite to the movement of her eyes; then to close her eyes and remember this movement. She did this, and when she opened her eyes she read two letters on the twenty line. At a later visit she read the whole of the twenty line at thirteen feet. The last patient I treated for this dreadful disease was an old man of seventy. He came to the clinic on January 14, 1920, and when I first saw him was standing with many others, waiting patiently for Dr. Bates to speak to him. Our work has to be done very rapidly, because of the very short time we have to treat so many patients, and I very seldom have time to observe individuals as I would like to do. But because of his unusual appearance, I at once singled out this dear old man from the crowd. Most men of his age who come to our clinic are unkempt, dirty and ragged—pitiable objects generally. But this man was well groomed. His clothes, though worn and old, were well brushed; his shoes were polished, his collar clean, his tie neatly adjusted. He had a great abundance of snow-white hair, neatly parted and brushed, and his skin was like a baby's, "pink and white." Dr. Bates asked me to treat him with the usual remark, "See what you can do for this man," and I placed him four feet from the card, asking him to read what he could. "I'm afraid I can't see so well, ma'am," he said; "my eyes bother me a great deal." "I'm going to show you how to rest your eyes so that they won't bother you," I answered. The best he could do at this distance was to read the fifty line. I told him to palm, and in less than five minutes he saw a number of letters on the forty line. The next time he came I put him nine feet from the card, and at this distance he read all the letters on the thirty line. He was so happy and excited over this that I became excited too. I forgot that I had other patients waiting for me and encouraged him to talk, a thing which I am seldom able to do with the patients. I was glad afterward that I did so, for he had a wonderful story to tell. "Do you know, ma'am," he said, "for two nights I palmed and rested my eyes for a long time before I went to bed—and what do you think?—I slept all the night through without waking up once. Now I think that's great, ma'am, because for years I have had insomnia. I would sleep only a little while; then I would get up and smoke my pipe to pass the time." At a later visit I put him twelve feet from the card, and at this distance also he was able to read the thirty line. When I told him what he had done he was again greatly pleased and excited. "You know I'm so much better," he said, "that I didn't even notice that I was further away than usual. Thank you, ma'am. God bless you, ma'am." During the practice, when he failed to see a letter I was pointing to, I said: "Close your eyes and tell me the color of your grandchild's eyes." "Blue, ma'am." he said. "Keep your eyes covered, keep remembering the color of baby's eyes." He did this, and after a few minutes his sight cleared up and he saw the letter. After we had finished the practice I again encouraged him to talk, and he told me more about his insomnia. "Do you know, ma'am," he said, "after I had had two night's sleep without waking up I didn't dare tell any of my family about it, for fear that it wouldn't last and I would only disappoint them. So I waited. Now, do you know, ma'am, it is just two weeks that I have slept the night through without waking up once, and so I told my wife about it. She is so happy, ma'am, I just can't tell you, for it has been many years since I was able to do that." I wish I could have a picture of his face when he is telling of the improvement in his eyesight and general health. It would be a picture of love, kindness and gratitude. Recently he looked up into my face and said: "I am seeing you better now, ma'am. You look younger." In two months his vision improved from 10/200 to 10/30. As he made but eight visits in this time, I feel that this record is remarkable. I also feel that the statements in the books about the impossibility of doing anything for patients with retinitis pigmentosa are in need of modification. ____ Better Eyesight A monthly magazine devoted to the prevention and cure of imperfect sight without glasses Copyright, 1920, by the Central Fixation Publishing Company Editor—W. H. Bates, M.D. Publisher—Central Fixation Publishing Co. .00 per year, 20 cents per copy 39-45 East 42nd Street, New York, N. Y. Vol. II - April, 1920 - No. 4 ____
