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205
Report of the County Medical Officer—Education.
centages. Whichever way the figures be exhibited there is evidence of a distinct increase in the incidence
of myopia with each year of age. This result agrees almost exactly with that obtained in 1908, and
with observations published by other observers both at home and abroad. In conjunction with this
higher incidence of myopia in the elder children the greater incidence both of myopia and all forms of
errors of refraction amongst the elder girls should be considered.
Boys. Girls
Cases. Cases.
All errors 644 766
Myopia 230 252
Ophthalmic surgeons are not in complete agreement regarding the primary cause or causes of
myopia, but there can be no doubt that these constantly recurring figures showing many cases of
defective vision associated often with comparatively small errors of refraction amongst the girls, and of
the increased incidence of myopia in the elder children, do point to some correlation between the visual
defect and the work done; they suggest that the failure in the nutrition and stability of the eye is connected
with undue stress or unnatural conditions.
Incidence of
serious cases
of error of
refraction.
An error ol refraction 01 5 dioptres or upwards, whatever the nature 01 that error, is beyond all
question a distinct handicap. With such a degree of error it is common to find that vision cannot be
brought up to the normal standard even with the most accurately arranged correcting glasses. The
disability is more pronounced when the error is partly or wholly astigmatism. The next table shows the
number and character of these cases. They form 16.2 per cent, of the whole number of refraction
cases, actually 231 cases, in 1,420.
Error of 5 dioptres and over. Boys. Girls. Totals.
Hypermetropia 35 33 68
Do. with astigmatism 37 44 91
Mixed astigmatism 1 1 2
Myopia 8 7 15
Do. with astigmatism 17 37 54
Odd eyes — 1 1
Totals 108 123 231
The total number of eye cases throughout London referred for treatment by the Council from
January, 1910, to December, 1912, was 41,946. The number seen at the Belgrave hospital centre was
1,907, or 4.5 per cent. of the total. As an interesting comparison the total figures have been dealt
with in the same manner as the Belgrave figures. In this way it is possible to form some idea of the
number of special difficulty children who will have to be dealt with in the schools, and who will probably
require some form of modified educational curriculum such as that contained in any general scheme for
dealing with children suffering from myopia of more than ordinary degree.
Estimate of
total number
of myopes.
Total cases 41,946
Deduct unfinished cases not included in analysis 10 per cent 4,194'6
Deduct ineffective cases 3 per cent l,132-5
37,751.4
Diseases of the superficies of the eyes 19.17 per cent. 7,019
Cases of defective vision from errors of refraction 29,599
Special difficulty children with errors over 5D = 16.2 per cent. 4,795
Of these those with hypermetropia, or hypermetropic astigmatism could
in most cases be dealt with in the elementary schools with "easy
treatment as regards eye work," the balance are myopes requiring
special educational treatment to the number of 1,509
Add proportion of children with damaged eyes from ulcers, etc., in
existing myope classes = 30 per cent., say 500
Number of children requiring the education of a myope class on a three
years' basis 2,000
The demonstration in Germany of a considerable percentage of low-grade short-sightedness among
the population proportionate to the amount of education which they had received, made nearly half
a century ago, was the beginning of the modern movement of school hygiene.
Siies of type
sehool books,
etc.
The researches of Cohn, of his pupils Ensmann in Russia (as regards print), and Schubert in
Bavaria (as regards script), and also of Javal in France, have given the data for fixing the requirements
of sizes of print necessary for ocular hygiene. In 1908 the Russian Education Department issued
complete regulations requiring for elementary schools a minimum height of small letters of 1 75mm.,