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On the day of writing this, a young girl was seen who, at the same place, had been prescribed
bifocals. The glasses were R and L upper distance —0.5D sph.—0.5 D.Cyl. and lower section for
near work—0.5 D.Cyl. They cost fifteen shillings and she cannot manage home work with them. A
pair of simple cylinders for constant wear would have been as efficacious, caused her less disturbance in
her work, and saved her parents at least ten shillings in cost.
More of such cases might be narrated to show that it is not on account of caretul work or well
thought-out prescriptions that patients' parents are so often asked to pay as much as fifteen shillings
for glasses which the child may break in a week whilst still unused to their care.
No hospital surgeon in London or elsewhere should habitually prescribe bifocal spectacles for
children. It is an absurdity showing a want of appreciation of the optical needs and physiological
powers of children, as well as some ignorance of human nature.
Accurate measurements of the refraction are a necessity, but approximate corrections are quite
sufficient for elementary school children, and rarely is it necessary to prescribe two pairs of spectacles
or their equivalent.
Even in hypermetropic astigmatism the young child should first be accustomed to distant glasses,
and then scarcely ever will it be necessary to have increased spheres added.
The class of child especially who attends hospital does not need fine corrections, and simple
spheres, or, less frequently, simple cylinders should do all that is wanted. Cases of squint, which is a very
serious visual defect, are of course excepted from this generalisation. For spherical glasses, tough
bridges are wanted to the frames, as otherwise the brittle frames are snapped in a week and all the
trouble has been expended in vain, as they are rarely replaced. On the other hand cylinders must
have strong and rigid frames.
One or two children can be found in almost any school whose vision can be improved perhaps
a couple of lines of the test type by a little manipulation of the frames to bring the axes of the hospital
spectacle eyes into the same line and restore the cylinders to their correct axial positions.
The Voluntary Association For Providing Spectacles.—Having regard to the
excessive cost of spectacles at hospital price, and to the fact that the law does not yet empower the
Council to provide glasses, the members of the Special Schools Sub-Committee decided to
form a voluntary association, of which Miss Susan Lawrence is secretary. It is called the
Association for Providing Spectacles for Children in the London Elementary Schools. Where,
from family reasons, any child with defective vision cannot obtain glasses, a prescription card of
this Association is given to the child by the head teacher. On attending hospital the child presents
the card to the prescribing surgeon, and if he is willing to help it to get glasses, he fills in the
card, which is then returned to the teacher, who sends it to the Chairman of Managers. The
Chairman communicates with the optician to the Association who, when sufficient children require
glasses, attends the school and fits the frames. The glasses are the property of the Association, and
are kept at school until paid for, unless the surgeon has ordered them for constant wear, when they
are given at once.
Most hospital surgeons are now aiding the work of this voluntary association. In some cases
when this help is refused, it means that the hospital work has been in vain, for the child cannot procure
the glasses, and may have to go to another hospital where it will be more charitably treated.
The spectacles provided by the Association cost, for ordinary spherical lenses, tenpence a pair
as against the hospital prices three or four times as great. For cylinders or their combinations there
is a correspondingly great reduction. These frames are good enough for the first pair for any child
wearing spheres, and where it is these or nothing will be of great service educationally to the children.
Elaborate frames and glasses of costly construction are almost wasted on such children; to insist on
their parents purchasing such, as a result of the hospital advice, is an injustice which to a great extent
mars the charity for which the hospital exists. The refraction work done, almost necessarily under
great difficulties and pressure in the ophthalmic out-patient rooms, has been frequently referred to by
the oculists. It is neither entirely satisfactory to the hospital authorities nor to the patients, and
would greatly relieve the charities if it could be elsewhere disposed of. For this reason it is mentioned
on page 44 as a reason why public provision is desirable for the determination of refraction in elementary
school children with visual errors and for its correction where necessary by providing spectacles of a
suitable kind and at a reasonable cost.
SPECIAL SCHOOLS.
Provision is made for special education of children unfitted for the elementary schools by reason
of special defects. This provision is under the Blind and Deaf Act of 1893, and the Defective and
Epileptic Act of 1899. Between 1 and 2 per cent, of children are included in this group. Some of
these children have been allowed to go on attending at non-provided schools till the extension of
medical inspection has caused many of them to be examined with a view to special education. A
formal examination is provided under the Act of 1899, and the parents or guardians, His Majesty's
Inspector of Schools, and the child's teacher should all be given the opportunity of attending. The
number of these examinations continually increases. During the past year 415 have been held, with
the following results :—