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From the outset Dr. Nash gave me a free hand (within the above mentioned limits) to
do what I thought necessary and I wish to acknowledge with gratitude the encouragement he
has always given me.
Five points appear to me to be necessary in any scheme for the care of vision in school
children, and it is on these lines that the work has been built up.
1. Detection of visual errors.
2. Treatment.
3. Periodic re-examination of those for whom spectacles are prescribed.
4. Co-operation of parents.
5. A flat rate charge for spectacles, and definite charges for repairs.
Points 1, 2 and 3 are obvious, and form part of all "care of vision" schemes, but success
is determined by the thoroughness of their application.
Point 4 should be an integral part of any scheme, but is often neglected, and 5 admits
of some difference of opinion, though in this Borough we are convinced of the superiority of
the flat rate of charges as against charges varying with the type of lenses ordered.
I. Detection of Visual Errors.
Routine Medical Inspection of children in the schools is the chief means of discovering
children with defects of vision, although a number of cases are found at the School Medical
Clinics to which they are referred by Head Teachers, Nurses or Attendance Officers.
Elementary School Children have three routine medical inspections during their school
life, viz.:—
As Entrants,
At the age of 8,
At the age of 12.
In 1923 it was the custom in this area, as in many parts of the country, to omit the vision
testing at the Entrants' Examination on the grounds that a child of five could not read. I was
impressed by the possibility of a defect of vision being overlooked for the first three school years,
or even longer if the second inspection is missed, and, with Dr. Nash's permission, in 1924 I
instituted routine vision testing at the Entrants' Examination, and this has been continued ever
since, thus ensuring that information regarding a child's vision is obtained at the earliest moment
after entering school.
The importance of this was emphasized by the Board of Education Committee of Enquiry
into Problems connected with Defective Vision in School Children, who, reporting in 1931 stated
in their General Conclusions "that children should be brought earlier under the test than is done
at present, when only children who have attained the age of eight are tested as a routine measure."
In this Borough we anticipated this conclusion by seven years, and are convinced of its utility
and practicability.
Testing the vision of children of five presents no real difficulty—it only requires patience.
Many children already know their letters when first seen—actually most of them do not pronounce
the letters as such, but make the appropriate sounds which is how they are taught the alphabet
in the Infant class. These, however, are quite simple to follow.
It is much easier, but not imperative, to have someone to point to the letters, as a young
child finds it difficult to keep its place when reading. In most Infant Schools the Head Teacher
will do this, and she is a great help, as her presence tends to allay any nervousness on the part
of the children. Most children, however, respond very well. Young children are usually pleased
to show what they can do.
The actual testing is done by the Nurse who accompanies the Medical Officer, and for the
Infants we always use Dr. Nash's modification of the Snellen test type consisting of the five
vowels in "lower case" type, which are the letters and type that the Entrant is most familiar
with—whereas other cards are printed in capitals.
Any children who cannot read, or whose testing is doubtful, are referred to the subsequent
Re-inspection. In three or four months' time most of them can be tested. An exceptional case
which still does not know the letters is referred to the Routine Medical Inspection next year—
so that at the worst, a child's vision is tested at six years of age.
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