HE importance of sight in modern education cannot be overestimated. Its value does not depend entirely upon the original or first-hand knowledge which this sense gives

us.

Perhaps its chief claim for pre-eminence among the senses comes from the fact that it is able to supplement the work of every other sense. Sight thus intensifies and reinforces the weaker impressions of hearing, of touch, and even of smell and taste.

This is seen to good advantage in the greater ease with which we hear a speaker when we watch the movements of his lips and his gestures. It also thus accounts for the aid to hearing which an opera glass furnishes the distant spectator at the play. Not a little of the success of some second-rate musicians has been due to the eyes of their hearers. The sight of food which we are about to eat adds to the intensity of the sensations both of taste and smell. A poorer article well prepared and nicely served produces as good results as a better article served in a slovenly manner. Touch is becoming so dependent upon sight that we never seem to be satisfied until this latter sense

has verified and supplemented the meagre data given by contact.

Still more striking, perhaps, is that class of cases in which sight originates the sensations appropriate to the other senses. Thus, it often suggests sensations of taste, smell, and touch. This is especially tue of paintings represent ing fruit, flowers, melons, and, in case of touch,

the architectural adornments of walls and ceilings in shaded relief.

These are the naturally acquired functions of the eye, and it is probable that even the lower races of man have developed the same general powers. It is, indeed, largely owing to this vicarious function of the eye that the child's conception of objects in its environment and of its environment as a whole is attained so early and so completely. For this purpose it is necessary that many impressions should be in the mind at the same time, in order that a perfect fusion of the elements of the conception may result. Now, it is clear that hearing cannot furnish many elements at one moment, nor can any of the other senses cover much space in short time. The eye, however, may receive its own proper sensations, and by suggestion may bring to the mind many sensations belonging to other senses. All of these elements, presented simultaneously, may then be fused into one conception of the present surroundings. Thus far all is natural and belongs to savage and philosopher alike. Effect of civilization.

The conditions of civilization have laid heavier and heavier burdens upon sight, until the performance of its duties without injury to its organ has become impossible. We have not been able to develop modifications in the old organ rapidly enough to supply the demand for the new functions; hence, we must accept

the inevitable result of our modern needs. We cannot lose the opportunity for education, even at considerable risk to eyesight. In this strug gle many must lose efficiency in sight, and some will lose sight entirely. Until we develop a new eye, better adapted to close work, the victims of the age of poring must be regularly counted off.

This does not mean, however, that nothing can be done to diminish the number of the victims or the severity of the injury. This is precisely the problem which we have before us. The evil is inherent in the rapid change of use to which our eyes have been subjected during the past few generations. We may not be able to eradicate it entirely, but a recognition of its existence will lead to a better understanding of its nature, and, perhaps, to considerable alleviation of its harmful effects. Few defects of sight belong to primitive man, or to the more civilized man who has received no education in school or in handiwork. And especially is this true of the most serious and most common de. fect of the eyes-near-sightedness.

Myopia, or near sight.

No phase of school hygiene has received more attention from this generation than the progressive near-sightedness ascribed to school life. If the facts have sometimes been exag gerated, they are, nevertheless, startling enough to call for the most earnest efforts on the part of teachers and students to understand them, and to mitigate the evil effects with as little loss to the child as is possible.

We shall not attempt to discuss the questions of structural or physiological factors which now divide the learned doctors. There is probably much truth in all views. We know that a tendency to near sight may be inherited, that it is more common among some peoples than among other peoples, and that it tends to become worse during the growing period of our lives. Whether it is due to the form of the orbit or to muscle strain in convergence and in accommodation, or to these together with other factors, need not now detain us. The great indirect cause is the necessity for fine discrimination in vision at short distance. This is the requirement of modern life, and we have been overtaxing our eyes to meet it. Unfortunately, we must continue to overtax our eyes. The demands of trade, of business, of science, of nearly every industry, are for finer and more exact work with the eyes. Our education is based on

symbols which appeal exclusively to the eyes. Pecuniary causes have increased the harmful. ness of these symbols. We must find substi tutes for much of this near eye work in the early school years. We must render the symbols less harmful, even at the expense of the purse, and we must place the child in more favorable situations in regard to light and distance.

The unstrained eyes look at distant objects without convergence. The strain in accommodation and in convergence for objects as near as, say twenty feet, is not great enough to receive notice. The direction of attention to nearer objects, especially if they be considerable in size, is harmful to the growing child only when the strain is continuous for long times. But the prolonged and uninterrupted strain of young eyes directed to small letters, at a short distance, even with the variation of arithmetic, language, geography, and reading, is most dangerous, and must be lessened in every possible manner.

Larger and blacker letters are already ap pearing in books for the lower grades. Less attention is given to fine work in the kindergarten. More emphasis is laid upon the training of hearing and touch, and especially upon the control of the muscles in drawing, building, and making. The relief thus afforded to the eyes in the first years of school life is inestimable. We must favor the eyes of growing children still more. In the higher grades the problem is not less serious. The substitutes avoid all risk, but we should endeavor to reduce for eye work are fewer. We cannot hope to

the evils to a minimum. Dangerous school influences.

The danger is not a new one, nor is it of recent discovery. But never before has it appealed with such force to the unprofessional world. The eyes of more than 100,000 children have been carefully examined during the past few years, and the results are public property. There is a fixed conviction that the increase in near-sightedness during school life is due to the conditions of school life. After allowing for the influence of all other factors, there is undoubtedly much to be charged against this account of school education.

The lack of agreement among investigators in regard to the percentage of near-sightedness in the various grades should not be considered strange; because it is known that physical type

has much to do with this defect. E. Pflueger, for example, found that, generally speaking, nearsighted people have a greater distance between the pupils of the eyes than the average person. Stilling claims that the form of the bony orbit determines the frequency of near sight. In a low orbit the action of the larger muscles tends to crowd the eye-ball forward, thus elongating the antero-posterior axis, which is the condition of near sight. The disturbance of the circulation in the eye-ball by the strains of convergence and accommodation reacts harmfully both on the sight and on the development of the eye as an optical instrument.

It is found that boys are twice as likely as girls to be short-sighted, and that age tends to change the natural far sight of very young eyes through a normal condition to the common abnormal one of chronic near-sightedness. According to this view, the school is responsible only for the degree of the evil, and not for its existence. Stilling believes that near sight is caused not by the unfavorable conditions of school work, but by the school work itself. The effort to attend closely to things at a short distance while the eyes and body are growing leads necessarily to an undue lengthening of the antero-posterior axis of the eye-ball, and hence to near-sightedness.

There is doubtless much truth in this view, but it is also a fact that unfavorable conditions greatly aggravate the evil. Our problem is not the total eradication of near sight, but the restriction of it to a minimum. Near work with the eyes is a necessity of modern education. as a preparation for every-day life. The eyes must be brought to do this work with least injury. Throughout school life the eyes must be guarded. In the earlier years there is imperative need for every precaution, and for daily and hourly observance of the laws which experience has already taught us.

Principal causes.

The chief causes of defective vision with which the school may be justly charged are as follows:

1. Prolonged exertion in looking at near ob jects.

2. Insufficient light.

3. Poorly printed books.

4. In needle work, too fine stitches are often required (a type of several injurious requirements).

5. Poor general health (partly due to the school, and seldom considered by the teacher in her relations to the pupil). Hypermetropia or far sight.

Other defects of sight are less common than the one we have just considered. Far sight is the opposite condition of the eye to that of near sight. In the latter the antero-posterior diameter of the eye is too great, and in the former it is too small. Far sight seldom or never increases during school life, but on the contrary, it tends to become less marked. It is usually inherited, and, except in rare cases, is scarcely noticeable in distant vision. But when the child attempts to use his eyes at short distance the muscles of accommodation are strained, and even then the image is more or less blurred. The ability of the child to see at the usual distance removes suspicion from the abnormal condition of the eyes.

All near work with the eyes is at the "cost of excessive effort, and generally for a limited time." Hence the far-sighted child is apt to be judged harshly by parents and teachers, who seldom understand how quickly he be comes tired and incapable of correcting the structural defect. Strong efforts to improve the blurred vision sometimes result in over straining the muscles of convergence, thus lead ing to cross-eyes. In the early years of childhood far sight is not often recognized, because the power of accommodation is so great that fairly distinct vision is generally possible. It thus often seems to increase with age, while the real change is in the loss of the power of accommodation which age always brings.

It is generally known that near sight and far sight are best corrected by the use of glasses. Whenever any considerable degree of either defect is noticeable an oculist or physician should be consulted. Teachers should ac custom themselves to recognize the abnormal eye, and should not be backward about calling attention of parents to peculiarities that may be due to such defects.

It is sometimes difficult for the uninitiated to distinguish between near sight and far sight in a child, as in the latter case there is often a tendency to hold the book too near the eyes in order to obtain the advantage of the larger image on the retina.

Strabismus or cross-eyes or squint.

Some attention should be paid to this subject in connection with far sight, as it is often

caused by neglect of far-sighted eyes, just as divergent squint results from near sight. The teacher can do little for children so afflicted except to urge the parents to consult an oculist. In mild cases proper glasses to correct the errors of refraction may often relieve the tendency to abnormal convergence until it is entirely outgrown. In more severe cases operation on the muscles (tendons) of convergence should be had before the child has become too

confirmed in its misfortune. Except in extreme cases, operation should not be resorted to before the age of six to ten years, in order that

other means of correction may be thoroughly tried. Any child who keeps his eyelids half closed, or who turns his head aside when closely examining small objects should have his eyes carefully studied by parent and teacher, until it is clear that no defect exists. Children of school age are not likely to outgrow these defects without aid from glasses or direction from friends.

Imperfect co-ordination.

It is known to all parents and students of children that co-ordination of the two eyes is established slowly in the first year of life. Many children often look cross-eyed in their second and third years, and if they are of a nervous nature this habit of crossing the eyes under excitement clings to them much later. We are reminded, therefore, that whenever any trouble of this kind arises in a child we should look after its general health most assiduously. We should also diminish the amount of trying eye work, even if the child fails to receive its promotion card at the end of the term. Such a child needs the physician skilled in nervous troubles far more than it needs the oculist.

Astigmatism.

The chief cause of astigmatism is irregular curvature of the cornea. Its principal effect is blurred vision. Children often outgrow these milder irregularities, but the more pronounced cases should be provided with glasses very early. If both eyes are considerably astigmatic the defect is noticed early in life, but it often happens that only one eye is seriously afflicted. This makes discovery difficult, and often children finish their school life without knowing that they are practically blind in one eye. The increased strain on the good eye is sometimes more than it can bear without harm to the general health. Headaches and nervous

ness are results of many eye defects, but uncompensated astigmatism doubtless leads the list of causes. The indistinctness of vision attendant on astigmatism makes much of the school work very unsatisfactory to pupils and cannot help but lead to inaccurate results, superficial training, and discouragement. The retina.

Other defects of sight belong to imperfect transparency of the media, to the retina, and to the brain. The first can be helped only by the improvement of the general health. Defects of the retina are often the direct results

of congested and diseased blood vessels. Here again the general health should receive first attention, and the eyes should be relieved as much as possible. It sometimes happens that parts of the retina lose their power of excitation. We then have more than one blind spot. If this condition extend over considerable area the eye gradually loses its power to see. If such conditions are caused by brain defects, vision is generally lost in one-half of both retinas. The division line is vertical and the defect may involve similar or opposite sides of the two retinas. Color blindness.

As is well known, the central portion of the retina serves us best for all visual uses. With

practice we may direct our attention to objects far out of our line of vision. Normally, however, we turn the central portion of the retina towards the point to be closely observed. It is found that even in the normal eye only this central portion is able to see all colors, that a zone lying just outside of this part is able to see yellow and blue, but not red or green, and that the outermost zone of the retina is entirely color blind. This means that it is possible to see objects with the outer part of the retina, although their colors cannot be recognized. In many eyes the middle zone, which enables us to distinguish yellow and blue, but not red or green, extends over the entire central part of the retina. In a few eyes the outer zone extends over all the retina. This latter is total color blindness, and the former case is color blindness as we all have seen it.

In perhaps half the cases of apparent color blindness the teacher and parent may do much towards removing this defect by furnishing frequent systematic practice with colors, not merely with the deep, bright colors, but also

Besides the above mentioned more or less permanent or progressive defects, there are numerous inflammations and affections of the parts of the eyes which may be directly relieved by the family physician. There are also other eye troubles, which accompany or follow certain diseases. Sore eyelids are very common in young children, especially those of the poorer classes. Inflammation of the edges of the lids is often caused by eye strain due to far sight or astigmatism. It also very commonly follows certain diseases, as measles. Even more common are the various inflammations of the conjunctiva. This sensitive membrane is easily affected by colds, catarrh, bruises, winds, and by specific diseases. Ex cept in the latter case, inflammations of lids, conjunctiva, and cornea may receive great relief from some simple eye wash, as a weak solution of boracic acid applied several times each day (ten grains to one ounce of water).

The cornea most frequently suffers from mechanical injury by some solid particle flying

against it and often lodging in its substance or between it and the conjunctiva. Affections of the outer coat of the eye-ball are comparatively rare. Inflammation of the iris often accompanies diseases of other parts of the eye, and frequently follows an attack of influenza. The most common disturbance of the lens is cataract, or opacity. This is usually of slow growth, though it sometimes comes on very rapidly, especially after severe injury to the eye, or as an accompaniment of certain diseases of other organs. Other diseases and defects of the eye are found in the retina, the optic nerve, derangement of the tear ducts or glands, and in the humors of the globe.

Teachers and parents should understand the unitary nature of the entire body. The sympathy between organs which are usually supposed to have no connection with each other seems miraculous to the layman. In most cases the relation is directly through diseased blood from the organ so affected to the eye or its part. In some cases it results from contamination by means of a specific germ, through the promiscuous use of towels or by personal contact. The extreme delicacy of most of the optical structures renders the eye especially sensitive to slight disorders in the blood, and hence the eye often assists in the diagnosis of kidney disease. This close rela tionship between different organs of the body necessitates the most careful attention to the general health of children. During any acute derangement of the eye rest is absolutely essential.