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grades are reached, while, at the same time, the frequency of hyperopia decreases in almost the same proportion.

Erisman, in 1871, examined 4,368 scholars in St. Petersburgh, with the following results:

Class

Myopia

Hyperopia

I 2 3 4 5 6 7 8 9 13.6 15.8 22.4 30.7 38.4 41.3 42.0 49.8 41.7 67.8 55.6 50.5 41.3 34.7 34.5 32.4 36.2 40.0 This increasing frequency of myopia and its deleterious influence upon the development and education of the child, has led to numerous investigations as to its causation. The conclusion is nearly unanimous that it depends much more on the demands made upon the eyes, by modern civilization and education, than to the influence of heredity, race or cranial formation.

At birth practically all eyes are hyperopic, and with age, progress towards emmetropia or the normal eye. The influences which prevent this beneficial change taking place, or delay its progress, are not entirely determined, though probably they are the same that produce the myopic increase.

The effect of education and intellectual advancement upon the eyes is most clearly shown by a comparison of the results of investigations made among the educated and the illiterate races. In Germany, probably the home of the most intellectual people of the world, as high as 50 per cent. of the students in the more advanced seats of learning were found to be myopic, to say nothing of hyperopia or astigmatism. In our country, in a number of cities, as high as 40 to 50 per cent. of the pupils are found to have ocular defects.

In Mexico, Ramas found, upon the examination of 2,000 school children, but 88 myopes, 60 hyperopes and 10 astigmatics. These defectives were all found among the mixed types, the pure Mexican being practically free from error.

Though hyperopia and astigmatism are not found as frequently as myopia, nor fraught with as much danger to the integrity of the eye, they are the cause of much suffering and are a great hindrance to the educational advancement of the child. Many a scholar's mental activity is greatly reduced by the suffering caused by these refractive errors. It is not an uncommon occurrence to transform the indolent, stupid, irri

table, fault-finding scholar (even the school "dunce") into a cheerful, industrious, bright, active pupil who readily takes his place at the head of his class, by the correction of his refractive error with properly adjusted glasses.

The deleterious influence of ocular defects upon the mental and moral developments of the scholar will be best shown by the report of a few cases taken from the examinations recently made.

Case I.-E. S., age sixteen. Complained of headache and pain in the eyes, especially after reading or doing any close work. She was nervous, restless, and somewhat irritable. It was found necessary to give up some of her studies, and finally all school work for two weeks at a time because of the intense headaches and distress. Vision was found to equal 6-60 in each eye. Retinoscopy proved the error to be myopic astigmatism, refraction, 1.00-.50; ax. 180 in each eye, the correction of which by spectacles has entirely relieved all discomfort, and enables the patient to pursue her school work without interruption.

Case II.-J. V., age twelve. Complains of headache, nausea and dizziness, especially when at school. During vacation time she is entirely free from these symptoms. Vision equals 6-9 in each eye. Retinoscopy proved error to be a hyperopic astigmatism of comparatively small degree, the correction being plus 25 Sph. plus .50 cyl. ax. 90 for both eyes; which gives vision of 6-6. This correction worn constantly relieves all distressing symptoms, and permits her to continue school work in comfort.

Case III.-C. L. H., age eight years. Complains of headache when at school; can not see work on blackboard; is inattentive and restless; makes little or no progress in school, and is considered very backward. Vision, R. E. 6-18; L. E. 6-12. Retinoscopy proved error to be a hyperopic astigmatism as follows: R. E. plus .75 sph. plus 2.75 cyl. ax. 105; L. E. plus .75 sph. plus 2.00 cyl. ax. 105; which gives him vision of 6-9. A decided improvement has occured since he has been wearing the glasses.

Case IV.-N. H., age about 10 years. General condition poor, suffering from adenoids and hypertrophied tonsils, which are responsible for a bad nasal cartarrh; considerable deafness and suppurative discharge from right ear. Vision, R. E. 2-40; L. E. 2-40 (there is not much more trouble that she could reasonably be expected to possess). Teacher reported that she was doing practically nothing in school. Since having the myopia corrected and the adenoids and tonsils re

moved, she has become a comparatively strong child, and is succeeding in school quite well.

At the same time this child was examined, another was seen who was in practically the same conditions. Her parents will do nothing for her, probably through ignorance, though they have been urged by the principal of the school to have her treated.

These cases are a fair sample of the many found in the examination of school children. They are not extremes in either direction, and should help to prove the necessity of some systematic work in this direction.

About 50 per cent. of all those examined were found to have adenoids or hypertrophied tonsils, usually both. The detrimental effect upon the ears and the mental and physical development, particular of adenoids, is often very pronounced. The symptoms produced by adenoids are mouth-breathing, a want of proper nasal tone to voice, catarrh and colds which are frequent and more liable to occur on slight exposure, facial expression dull and listless. The aural symptoms, while not constant, are sometimes the first to attract attention to the naso-pharynx; earache is of frequent occurrence and commonly followed by a discharge; deafness and a sense of fullness in the ears is often complained of.

The report of one or two cases will serve to show the harmful effects of these conditions.

Case I.-I. B. W., age ten. Constant sufferer from colds and catarrh; frequently confined to bed with sore throat; physical condition very poor; appetite capricious; mentally rather stupid and dull; nervous, restless, excitable and irritable; breathes through mouth, nasal respiration being practically impossible; snored so as to be heard all over the house; voice wanting in proper nasal tone. At school always behind. her class and below in her averages. The removal of the adenoid vegetations and the enlarged tonsils has changed the entire picture. She is strong and healthy-a good natured child -perfectly able to keep up with her classmates, and easily obtains marks above grade in all branches.

Case II.-C. M. Suffered from deafness, both ears, though no discharge; mouth breather; could not breathe through nose day or night; general health only fair; was not progressing as well as other children. A diagnosis in this case had been made of impacted wax as cause of deafness. Removal of the adenoid vegetations and hypertrophied tonsils has wrought a

complete change. The hearing is perfect and the child more active and attentive.

Deafness and aural diseases are so closely associated with adenoids, in children especially, that any involvement of the ear should at once excite suspicion as to condition of the tissues in the pharynx and naso-pharynx. The prevalent idea of the laity that an aural discharge is of little consequence and will recover if left to itself, should be corrected. Many can trace their deafness to this idea. Besides deafness the involvement of the mastoid, with its train of complications, is frequently one of the serious results of neglect to properly care for a suppurative otitis media, acute or chronic.

Good hearing is of equal importance with good vision in the acquirement of an education. The proportion of defective eyes and ears among our school children is quite large. The educational loss to these children is very great. Means, therefore, should be provided to prevent as far as possible this great loss. Action is necessary.

I wish to present for your consideration the following:

Whereas, The deleterious influence exerted by defects of the eyes, ears, noses and throats of school children upon the mental, moral and physical development is not fully appreciated by educators and the public at large, therefore

Be it Resolved, That it is the sense of the Washington State Medical Association that measures be taken by the State Board of Health, the State Board of Education, all school authorities and, if possible, legislation be secured, looking to the systematic examination of the eyes, ears, noses and throats of all school children, that diseased conditions may be found and corrected.

Similar resolutions have been adopted by the American Medical Association, by the Mississippi Valley Medical Association, the Missouri Medical Association, and also by the State Medical Associations of New York, Illinois, Michigan, Colorado, Ohio, South Dakota and others.

The adoption of this resolution will be of little value unless some means be provided for carrying out its suggestions.

FRACTURES IN THE NEW-BORN.

BY G. C. TRAWICK, M.D.,

OF NASHVILLE, TENN.

The statistics of some of the larger lying-in hospitals give a ratio of one fracture to each 250 deliveries. This is a frequency much greater than is ordinarily noted in private practice. It is very difficult to obtain any accurate statistics of this accident in private practice, on account of the failure of the attendant to report them, but the general practitioner will probably have one in about every 500 deliveries.

Fractures in the new-born occur in equal proportion to the number of operative deliveries. Almost invariably they are due to manual interference in delivery, under conditions that would sacrifice the life of the baby, and perhaps the life of the mother, without such interference. Fractures most frequently occur during breech extractions. Next in frequency come low forceps operations, plural births, podalic versions, high forceps, shoulder presentations, and embryotomy, in the order named. In any one of these complications, it may become necessary to fracture a bone of the fetus in order to save the baby. As the number of still-births decrease, there will probably be either an increased number of fetal fractures, or the number of induced labors.

There is no doubt, however, that a great many fractures result from the ignorance of the obstetrical operator; while he satisfies himself with the statement that it "could not be helped." The fractures most commonly resulting from ignorance are those of the humerus in breech extractions; fractures of the skull due to pressure through the abdominal wall in efforts to deliver an aftercoming head; and multiple fractures in cases where violent obstetrical procedures have been performed, when induction of labor or Cæsarean section should have been done.

Cases have been reported of spontaneous multiple fractures in the fetus. Cazeaux mentions a child born after a rapid and easy labor, during which no force was applied, which had forty-three fractures involving the cranium and other bones. Another case is reported in which, after a very short and easy labor, a baby was

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