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under treatment, and except in the case of some of the children in residential schools it has not
been done.
Glasses.—Although there should be no deviation from a proper scientific examination of the
eye, yet in the application of the results to practical life certain considerations are of great weight
in the case of elementary school children.
For young children, where the elasticity of the lens is unimpaired and accommodative power
great, single spheres will generally improve vision and relieve strain so much that nothing more is
wanted; the correction of a diopter of astigmatism in children under 10 is scarcely ever called
for, and, except in neurotic children who happen to be astigmatic, ocular headaches are practically
unknown at these ages.
A considerable number of children who suffer from corneal and conjunctival troubles of a
chronic nature are seen on account of defective vision being given as their reason for nonattendance
at school, and in very many of these cases there is a long history of attendance at eye
hospitals, and co-existing conditions of the nasopharynx (adenoids), and often actual rhinitis,
associated with the conjunctival conditions, which have existed untreated. In such cases treatment
directed to the eyes gives no permanent benefit till relief to the nasal and pharyngeal conditions is
obtained. Possibly more damage is done to vision by phlyctenulae depending on general conditions
than from any other cause common in school children.
Apart from hospitals, there is a want of provision for the treatment of defective vision. The
field has been much exploited by quacks, "qualified opticians," and others, but the need of a means
of obtaining such help at a lower fee than the ophthalmic surgeon's two guineas is shown by the
fact that of the class from which candidates are drawn for employment, under the Council
(Teachers, Clerks, &c.), who were referred back for defective visual acuity, 80 per cent. went to
hospitals for advice.
Since January, 1904, the Oculists have reported on many general school matters.
They have repeatedly called attention to the prevalence of near eye-working distance in school.
This is the worst of school habits, and lies at the base of educational hygiene; it will be referred to
in considering school work.
It is commonly supposed that almost every child with defective visual acuity requires glasses,
but there could be no greater mistake ; some can get no improvement from glasses, some will do
better without glasses, a very small number are found with defective visual acuity and no refractive
error, and in the course of one or two years ultimately attain normal vision. Viewed from a wide
public health point of view, it ought not to be necessary for a considerable percentage of children
to wear glasses. The rational treatment of most of these children should rather be an educational
modification which avoids the necessity of glasses. There is a considerable number of children
with permanently damaged or diseased conditions who are not blind, and not ever likely to benefit
by the training as given at blind schools, who yet may be actually harmed by the ordinary school
education. Children with diminished visual acuity—seen in cases with considerable corneal
opacities, with chronically recurring phlyctenulae, with interstitial keratitis, old choroiditis, high
myopia, congenital cataract, congenital absence of iris, some albinos, children with nystagmus.
This group is probably as large a group in totality as that of the blind, and, from the results to be
obtained, much more worth educating. Some are in blind sohools, some in ordinary schools,
and others sometimes away for weeks or months under medical certificates; sometimes a short time
in school. Special school classes, with modified tasks, are required for these children. The literary
element being as far as possible eliminated from their work, and special attention given to fit them
for tasks in which vision is not chiefly involved, but yet of subsidiary use.
In 1902 a special inquiry was made as to the vision of children in the Infants' schools. 2,782
infants were carefully tested, every precaution possible being taken to get only the visual acuity.
With the smaller letters it was found that the children would not make the effort to recognise them,
although they knew them perfectly. Sweets were used as an inducement, and the letter E given to
hold in their hands pointing it the same way as the test letter shown, up, down, or reversed. The
child has apparently a great difficulty in making the effort to recognise varied letters, unless, as it
were, a certain intensity is attained, by stimulation of a considerable retinal area. Using all the