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versally left to do its work unaided and uncared for, until often serious and irreparable damage has been done and the innocent victims of our ignorance and neglect are deprived from the full realization of God's greatest gift, that of sight. It is not the vision alone that pays the penalty of this criminal neglect, but a long train of physical wrecks brought about through reflex action from eye-strain. It is not our purpose at this time to go into the details as to how or what general conditions may result from defective eyes, but merely to sound a warning as to the danger from neglect of the eyes in early life. To continue the comparison with the teeth we can get very acceptable false teeth, when lost from neglect, but artificial eyes have not proven of much practical service.
There is great need of popular education as to the importance of such examinations of the eyes. Parents who follow out the greatest precautions for the welfare of their children in other respects, are unmindful in this, through lack of knowledge of its importance.
Examination of the Eyes Upon Entrance of School.-Every school should possess a series of test letters and each scholar at the commencement of each term should have the eyes examined by the teacher. This examination is so simple that any teacher can be instructed in a few moments, so that they can determine if any defect exists. All that is essential is a set of Snellen's test-types placed in a good light, the smallest letters should then be read with each eye separately at twenty feet. The child should then be examined with the astigmatic card at the same distance, and the lines running in all directions should appear with each eye alone equally clear and distinct. Then a small card clearly printed in 43 point (diamond) type should be read by the child while the teacher measures with a rule the nearest point at which it can be clearly read. This distance should correspond with the normal near-point for an emmetropic eye, which should be recorded on the back of the card for the different ages from six to twenty years. If these tests show no defects, the child may then be admitted to the schools, but on the contrary if a defect be found in any of the tests, particularly the first, the parents of tlie child should be at once informed of the existing defect of vision and the consequent need of professional advice. Further than this, during the school year, if the child complains frequently of headaches while studying, or seems to be getting nervous, anæmic, etc., the teacher's duty is to again suggest to the parents the wisdom of seeking a physician's advice.
The examination as suggested would at once detect imperfect vision, from any cause; if due to refractive errors it could then be corrected, if to intra-ocular disease treatment might save the sight which otherwise might possibly be lost.
In all cases of children with inflamed eyes, they should be required to present a physician's certificate of the non-infectious nature of the disease, before being permitted to enter the schools. Our orphan asylums, public homes and institutions of all kinds require a physician's certificate before admitting children with any redness or inflammation of the eyes. Should we be any less strict before permitting these children to associate with the healthy ones in our schools? Let us
now consider the faulty conditions of school life which bear more or less directly on the eye as well as the general health of the child. The curriculum of study in the majority of public schools is a hard and fast one, which all students are expected to follow.
We believe a more elastic curriculum should be adopted, whereby children with defective eyes, or a more or less feeble health, shall only be required to take as many and such studies as they may master in safety. Such a modified course while it would lengthen the student life by one or more years would do much toward preserving the eyes and general health.
A decided reform should also be made in the system of requiring study at home. The average school session of five or six hours a day should be sufficient to prepare for college by the time they are sixteen or eighteen without requiring nearly as many additional hours of study at home which rob the students of the recreation and sleep they should have. The work at home is usually accomplished when the body is tired, and the brain sluggish, generally by artificial light (which is too often an improper one) and frequently with a faulty position of the body. We believe that with a proper regulation of recitation and study during school hours alone, the brain made more active by sufficient recreation, exercise and sleep outside will accomplish far more than by the present system.
and type used in school books have in recent years been vastly improved, yet there is room for still further improvement. In selecting books for children the types should always be large, bold and clear. Cohn and Webber claim that type at least one and a half millimetres in height (equal to long primer) is the smallest that should be used in school books, and the distance between the lines, or leading as it is called, should be two and a half millimetres. The paper should be a dull finish, instead of the highly
glazed finish of many books, and of a dead white or a cream color. In many of the books used by children the print is too small and of a poor impression which is very injurious to the eyes. This perhaps applies more particularly to the interesting books and periodicals prepared for the young, and especially to newspapers. The character and the amount of reading is too often not properly regulated at home. The reading of sensational papers and novels at hours when the child should be asleep is a habit too freely indulged at the expense of both mental and physical development.
There should also be frequent breaks in the application of the eyes at close work. This frequent interval of rest for both the brain and the eyes can easily be secured in the school-room by a change from the books to the blackboard, to oral instruction, lectures, etc. The school session should be broken by short recesses in the open air, gymnastic exercises, etc.
The system of examinations usually followed in schools we believe can be modified with benefit to the eyes and health of the pupil. The present method of frequent set examinations for promotions results in an unusual amount of study, or cramming, for a given time previous to the examination. This additional amount of study is always secured, at the expense of the eyes and health, by taking the time from the already too limited hours given up to recreation and rest. All educators recognize that "cramming" is not the best method of learning, and yet the prevalent system of examinations leads to this. We would suggest that a better method should be devised to determine the true standing of the pupil, or by allowing the standing and fitness for promotion to rest upon the marks for daily recitations, and the teacher's estimate of the pupil.
The Construction of School Buildings. A consideration of the eyes and health of our school-children must necessarily involve the location of the building, as to surroundings, light, etc., and the school furniture. The location in cities should avoid narrow streets and high surrounding buildings which interfere both with light and air; and away from noises, exhalations, smoke and dust of factories, stables, markets, etc. Play-grounds in the open air, either in ample grounds or on the roof of the building should be provided for intermission of the sessions. The building should be so constructed as to avoid dampness and should furnish ample ventilation without draughts. In the country, especially, care should be taken that the location be well drained, and away from malarial and other injurious environments.
Sufficient light is of the utmost importance and should be first considered in the architectural plan of all school houses. The quantity of light Cohn says cannot be too much, while Javal says that every portion of the room should be so flooded with light that the darkest place will have sufficient illumination on a dark day. To secure this Javal says that the distance of surrounding structures should be twice their height. The necessity of sufficient light is shown by an attempt to read in the twilight or in a dimly lighted room. A test as to the amount of light required, is the ability of a normal eye to read diamond type readily at twelve inches. According to Risley the window surface should never fall below one square foot of glass for every five square feet of floor space and that this should be exceeded in many localities, on the north side of the building, and on the ground floors. The quantity of light is of course modified by the color of the walls in the school-rooms. The light shades of yellow, green, blue or grey should be used in the coloring of the walls, and also of the furniture and wood-work. The loss of light caused by large surfaces of blackboards can be saved by roller shades, of the same color as the walls, to be lowered when not in
Next in importance to the quantity of light in the school-rooms is its direction. The ideal light of the school-room is that from the left side, or the left and rear, of the pupils. Lighting of the room from two opposite sides should be avoided if possible, yet when necessary to secure the requisite amount of light, that from the right side should be high up in the room. In this way we secure a diffused light in the room from the illumination of the ceiling and avoid the objectionable cross-lights. This arrangement at the same time affords means of ventilation.
School Furniture. In the most excellent and thorough article upon school hygiene by Dr. S. D. Risley ("System of Diseases of the Eye,” Worris and Oliver, Vol. II., 1897) to which we are greatly indebted in the preparation of this paper, much space has been devoted to the consideration of the school furniture. While the faulty construction of the school desk and seat is a very important factor, according to orthopædic surgeons, in the causation of spinal curvature, it has been, and undoubtedly still is, a no small factor in the increasing myopia of school life. Vast improvements have been made in the average school-rooms of to-day in this respect, still a visit to almost any school will show more or less of the pupils in an improper position. The great danger to the eyes lies in
the pupil bending over his desk and thus bringing the eyes too close to the work. This abnormal nearpoint adds greatly to the strain upon the accommodation and convergence, and at the same time causes an increased congestion of the coats of the eye, all of which serve to increase the tendency to near-sightedness. The proper arrangement of the seat and desk is such that the child will find it easier to sit upright at his work than in any other position he can assume. The direction and measurements for securing such a position by means of a correct seat and desk are fully given in many articles upon this subject.
The blackboard forms an important adjunct to school life and its more general and extended use should be encouraged. The strain upon the eyes is much less when looking at a relatively distant object like the blackboard than it is at the near-point, as in reading and writing Hence instruction by board exercises is much less fatiguing than work done with the pencil or pen. The surface of the board should be kept black and clear by frequent washing, and the crayons used should be either white or yellow. Wall maps and charts are also useful for the same reason as the blackboard, in that they permit of instruction at a greater distance. The character of the type, paper, etc., in school-books has already been referred to.
In all children who have already developed near-sight, to avoid the increasing tendency to draw the work nearer and nearer to the eyes, some of the many forms of head rest, which hold the head erect and at the proper distance from the work, should be used.
In considering the subject of hygiene of the eyes we have dwelt at length upon the care of the eyes in children because it is at this time of life that the greatest danger to vision exists. Furthermore when proper care has been given to the eyes in early life we enter adult life with better eyes and a better understanding of their requirements. In all classes, men, women and children, there is an inherent prejudice to the use of glasses, but to those suffering from refractive errors the use of the correct glass is one of the greatest boons to humanity. We acknowledge that the prevalent error of all oculists is the too early and frequent prescribing of glasses. In many instances the use of glasses can be avoided by the correction of some deficiency in the balance of the extrinsic muscles of the eyes which may be the cause of the asthenopic or reflex symptoms. In all cases of decided refractive errors, however, the use of correcting lenses is a necessity. When glasses are required they should be given proper