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Report of the County Medical Officer—Education.
111
In the four schools selected by Dr. Macdonald the vision of children from 4 to 7 years
of age was tested by means of a Cohn's "E" specially prepared for this enquiry. The usual method
of examination, in which the child holds his own card so that the limbs of the "E" point in the same
direction as those on the test card 6 metres distant, was very soon abandoned, as the response of the
younger children was naturally slow, owing to the complex mental processes involved. This was the
case even when the teachers gave the children a few lessons beforehand. A simpler method,
where the child shows by arm movements the direction required, was substituted except in one school,
in which the head teacher gave instruction concerning the "E" in the course of the educational regime.
The children, after drawing the "E," cut it out and pasted it on a piece of brown paper, and they
then, being thoroughly familiar with it, responded to the test with singular rapidity, treating it
throughout as part of a game.
During the examination the rapid onset of fatigue in young children was well observed. After
seeing one or two of the letters the child's attention wandered, and with the exception of the school
just mentioned, resort was necessary to a stimulus in the shape of a brightly coloured sweetmeat. It
was found also that if each letter was isolated from the others on the card the child responded much
more readily. Accordingly a square hole admitting only one E at a time was cut in a piece of thick
brown paper, which was held over the card and moved from one sized E to the next. By this means
of concentrating attention a child who at first found difficulty at 6/6 could be brought to see 6/6
The children were found to respond with much greater readiness during the morning than
during the afternoon session, when they were duller and more listless, and afternoon sessions for the
purposes of this investigation were as far as possible abandoned. The test was carried out in the
brightest daylight available as measured by the lumeter. The remarkable differences in daylight
illumination in various parts of the same school were in some cases rather startling. In one school the
room where the vision test was carried out was illuminated to the degree of 70 foot candles, whereas
the degree of illumination in the greater part of the hall was one foot candle power, and only in one
or two bright spots did it rise to three. The degree of daylight illumination should have been at
least 30 foot candles.
The accuracy of the examination vvas verified afterwards by subjecting those children whose
vision was found to be 6/12 or worse to a retinoscopic examination under a mydriatic. Five children did
not attend for this further examination for the reason that three had obtained spectacles and two had
left the district.
Ten children were found to have five or more dioptres of hypermetropia, one child aged 7
having seven dioptres in the vertical diameter and eleven dioptres in the horizontal. It is interesting
to note that the vision of this child was 6/6 ; she had a slight convergent squint. One child aged
5,6/12 was found suffering from high myopia, and was recommended for a myopia class. Squint was
present in two per cent, of the children examined.
The result of retinoscopic examination of 37 children with defective vision was as follows:—
Emmetropia, 1; hypermetropia, 13 ; hypermetropic astigmatism, 15 ; myopia, 0; myopic astigmatism,
4: mixed astigmatism, 3; irregular cornea (due to old corneal ulcers), one case.

Good 6/6 84%
Fair 6/6 and 6/12 11%
Bad 6/12 and less 3%
Amb =Amblyopic.
R.I.S.—Right internal strabismus.
L.I.S.=Left internal strabismus.