London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1908

[Report of the Medical Officer of Health for London County Council]

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28
NEEDLEWORK.
It is possible to get most beautiful specimens of patching done by children as young as five years
of age, but it is not wise. The immature eye of a young child is quite capable of working efficiently
in accommodating itself to vision for all objects over a foot distant, but the rate of increase of accommodative
effort increases out of all proportion as objects are brought nearer to the eye. The child generally
sacrifices clear vision to a bigger image not so clear, and tends to work on fine objects at 4 to 6
inches distance. The ultimate results to vision in many cases are serious and the nervous strain great.
The nerve groupings which are concerned with finger work are so immature that children in
the infant department, at six or seven years of age, can only use the muscles concerned clumsily, and
with immense strain to themselves and more remotely to the teachers also. Knowing the physiological
importance of these facts, the following articles were inserted in the London County Council School
Management Code, 1904 :—
110d. ii. It is exceedingly important that the children should be prevented, as far as is possible, from
acquiring the bad habit of working with a short distance from eye to work. In no case should any child be permitted
to occupy itself with work nearer to the eye than a foot distance.
iii. In infants' departments, in girls' when sewing, in boys' writing or doing fine drawing or painting, children
often bring their eyes down closely to their work, enduring cramped chests, round backs, and much eye strain.
During such work teachers should pay espccial attention to prevent these habits, and endeavour to secure observance
of a proper working distance.
147. v. Teachers of girls and infants' departments are instructed to study the eyesight of children when
doing needlework, by seeing that they have sufficient light, and by strictly adhering to the Government Regulations.
In 1905 it was reported by the Council's officers that this article (i.e., 110(d) of the Code) was
practically ignored in nearly all our schools.
Dr. Louisa W oodcock has therefore investigated sewing as actually taught in thirteen schools,
including some with a considerable alien population, and has endeavoured to discover the relations
of such needlework to visual defect and nerve strain. Sewing was abolished in infants' schools in
1905 for all children below standard I., that is below the age of six, but is still taught between six and
seven. Especial attention has, therefore, been paid to these children. The method of investigation
was first simply to note children at work, without in any way criticising, and later to endeavour to
find out the kind of work aimed at, and the reason for it. In 100 children, standards I. to IV. and
aged from 6 to 10, doing either sewing or knitting, 84 per cent, held their work at from 4 to 6 inches
distance or nearer, and the 16 per cent, who had a better working distance were mostly knitting.
Knitting, with one exception, was held further off than sewing; the exception was a girl of seven wearing
glasses, who from habit held her knitting 3 inches away, although she could work equally well at a
greater distance. No child worked at the distance of 12 inches recommended in the Code. The
children seemed to find it less effort to hold the work near. No instructions as to eye distance are
usually given by the teachers, although some trouble is taken about this matter in regard to reading.
The rule is for sewing to be held very closely, knitting nearly double the distance, whilst reading is
done at three or four times the distance of sewing ; and often when the reading is held nearer it is found
that it can be done equally well further off. For instance a girl in standard III. whose sewing was
held 2½ to 3 inches off and who had already had a red warning card in regard to defective vision, read
her book at 6 to 7 inches, but when asked to hold it at 13 inches read equally well. The evidences
of strain which Miss Woodcock noted as commonest are :—
(i.) A bad position of the body, the work usually being pressed closely to the chest to
obtain a point d'appui, entailing a stooping posture, and rounded and high shoulders. Sometimes
this point is attained by fixing some other part of the body, by fixing the head, or by
resting the elbows on the desk, or pressing the knees up against desk edge, and so on.
(ii.) Squinting, which shows itself where the child keeps up its accommodation and the
convergence overacts. It is temporary but means eye strain which may be a preliminary to
changes ending in myopia.
(iii.) Corrugated forehead, overaction of the frontal muscles forming horizontal creases,
knitting of the eyebrows.
(iv.) Twisting of the body and neck, the head being held sideways from incoordinate
action of muscles of the two sides.
(v.) Grimacing. The mouth often open, due to muscular relaxation and "habit spasm"
of the face. There is also muscular spasm due to over action in the efforts to control the
finger movements. It is only when these actions are excessive and long continued that they
can be classed as indicating injurious strain.
On all points there are abundant instances of the effects of the work, but single typical cases
will be quoted as illustrative of the effects noted.
In a standard I. class of 28 in a girls' school, ages 6 and 7, the children were hemming with a
needle No. 7 about 10 stitches to the inch in a poorly-lighted room. A few minutes after beginning
work 10 were squinting, especially when threading the needle, 11 were knitting the eyebrows, 2 standing
up to sew ; and 6 stopped working. Halfway through the hour only 4 children did not present
nervous effects, and at the end of the hour only 1.
In standard II. of the same school, average age about 8, half the class knitting, and the other
half (20) sewing, of whom 16 were working in a bad position and 9 squinting.
In the higher standards the girls tend naturally to hold their work at a reasonable distance,
perhaps a third of the number working quite satisfactorily. It is in standards I. and II. that nervous
overstrain and awkward postures are so apparent, and from the length of these children's arms, 10