OPHTHALMIC SCIENCE IN ITS APPLICATION TO

SCHOOL HYGIENE.

C. S. RODMAN, M.D.,

WATERBURY.

The President of this Association has the sanction of custom in the selection of his annual address of a subject to which his thought has been recently directed, or in which he feels an especial interest. I ask your attention to no technical exposition of the errors of refraction; to no statistical computation, but to generally accepted results of research into defects of vision as developed by civilization. I desire to indicate certain reforms pertaining to school hygiene and to enlist your interest in their more rapid adoption.

In our Republic the training and education of the youth to whose control its affairs and resources are soon to be entrusted, is a recognized duty of the State. "In the intelligence of the many lies the good of all." Modern educational methods sometimes work injury to the physical stamina. There are evils for whose correction our united effort is required. With the bibliography of the subject we will not concern ourselves. The literature is abundant and accessible to those who will study it. Defects of vision interfere with the acquisition of the education which the State seeks to provide. Such defects increase in frequency and in gravity under our system of public school instruction. These are truisms which, however, we must be prepared to demonstrate, as also the remedies that our science offers. We have need of simple definition or homely illustration of the meaning of a few terms for which it is not easy to find terms in the vernacular.

The eye we describe as a sphere capable of visual impressions, as possessing the power of forming pictures of external objects upon its posterior lining membrane or retina. The emmetropic eye is one in which distant objects are so pictured distinctly and without exertion or adjustment. It is one in which light rays from a distance are focused as by a lens to a point, which point falls upon the retina.

The myopic eye is one by which distant objects cannot be clearly seen because the eyeball has become too long; light rays focus before reaching the retina, then disperse or diverge. Except in the wearing of concave glasses there is no remedy. While no more than four or five per cent. of the children entering primary schools are myopic, of those whose course is continued until a liberal and professional education is secured, the per cent. of myopes increases to twenty-five or even fifty in some European universities. Myopia is by no means an evolution or appropriate adaptation. There is often an early history of painful or difficult vision, of headache and fatigue. Examination reveals congestion of the tunics of the eye, hyperemia of the retina and spasm of the muscle of accommodation. Progressive myopia signifies in middle-life increased liability to disease of the choroid or vitreous, to detachment of the retina and to cataract. The hypermetropic eye is too short. the retina before coming to a focus. scious exercise of the muscle of increase the refraction of the eye, hypermetropia is not necessarily inconsistent with the exhibition of normal vision. The greater the degree of the error, and the greater the consequent effort required to compensate, the more probable it is that the use of the eye in study may induce asthenopia, strain or fatigue. When such symptoms arise, hypermetropia is to be corrected by convex glasses. Astigmatism is perhaps less easily

Light rays strike Because an unconaccommodation may

defined for the popular understanding. The eye may be likened to an egg instead of a sphere. The radii of curvature differ, and it is evident that if one radius is normal, or that of the emmetropic eye, that the radius which is at right angles to it is of too great or too little curvature. In at least one meridian the eye is myopic or hypermetropic. A lens which is oval in form, focuses light rays to a line, not a point. In the astigmatic eye, a clear image is not formed upon the retina, but to unite the different foci is the constant effort of the muscle of accommodation. For the resultant fatigue or asthenopia there is no remedy, consistent with the continued use of the eye, excepting in the wearing of appropriate cylindrical glasses.

It is needless to dwell upon the influence of defective eyes in preventing the acquisition of the education which it is the policy of the State to give, or to refer to the children who are assumed to be stupid or indolent, when the unsuspected fact may be that they do not see well or cannot employ their eyes without pain or fatigue. With the increase of visual defects during and in consequence of school life we are familiar. Examination of more than 200,000 scholars in this and other countries, substantiates the report made by Cohn nearly thirty years ago after examining some ten thousand schoolchildren in Breslau. Myopia occurs in five or ten per cent. in the primary schools, in ten to fifteen per cent. of the pupils in schools of higher grade, increasing to twenty-five per cent. in the graduates of our colleges.

It is therefore to the application of ophthalmic science in the hygiene of schools that your attention is invited. The importance of early recognition of ocular defects needs no further demonstration when we remember that there are no fewer than 15,000,000 pupils in our schools and colleges. No entrance examination can compare in value with that of the eyesight. Whether conducted by

a medical expert or by a duly-instructed teacher, such entrance examination is as essential as the testing of the color-perception of the employees of a railway. The architecture of school-houses is a science in itself in our rapidly growing towns and cities. Present and future requirements are to be considered. The disadvantage of selection from the designs of competing architects as in the case of a church or monument are obvious. For general plan of construction perhaps none better has been brought before us than that of Mr. Austin, architect of the Philadelphia Board of Education, fully described by Dr. Risley in Norris & Oliver's encyclopedic work now being published. The design involves a large central square, the sides of which are built upon as increased accommodations are required. The outer sides are used for school-rooms, the inner sides for corridors, offices, closets, etc. Light is to be admitted only from the left and rear, and window space is to be equal to at least twenty per cent. of the floor space. Distance of surrounding buildings should be twice their height, window space being proportionately increased when this require

ment cannot be met.

In New York City, where school-buildings are erected in compactly-built sections, a new system has been adopted, termed the capital letter H. Blank walls upon the party lines shut off disturbing sights and sounds of adjoining structures, as factories, stables, tenements, etc. Large open courts are in this way secured for both fronts of the building and every foot of land is utilized. Such a school house is now being built three hundred feet west of Amsterdam avenue, with the extremities of the H upon One Hundred and Eighth and One Hundred and Ninth streets.

School furniture almost forty years ago received the attention of Henry Barnard of our State, who first pointed out the faulty construction of seats and desks

in the school-rooms.

There is to-day general recognition

of the importance of a separate adjustment of both to the height of the pupil. Text-books are best submitted to an expert for opinion upon quality and tint of paper, for size and form of type, the spacing, leading, etc.

Far less work at the near point should be imposed upon younger children. Especially in the home is this apt to be performed under bad conditions of light and posture. Interdict works of fiction during the years of preparation for business and college. Encourage parental coöperation with the teacher's efforts, but let this be in review, not in preparation of a to-morrow's lesson. The continuity of work at the near point should be often broken and the school work interspersed with oral and blackboard exercises, with short recesses, marches, drills, gymnastics. Term examinations ruin countless eyes. Abolish them. Neither let class standing be based on the daily memorized lessons nor upon a semi-annual cramming. Let every recitation be chiefly a review. Base promotion upon the understanding of all previous instruction. Let the teacher's estimate of his pupil rest not on that which the latter has learned by rote good for this day only-but upon that which he has assimilated, made for all time a part of his mental self. Under such instruction and with such grading we shall oftener be able to select from the pupils the successful men of to-morrow.

Such criticism of public school methods, it may be said, is the verdict of a medical crank around whose hobby the world revolves. Appeal then to other motives. Pardon a moment's digression from our subject and digest the opinion of Wm. J. Shearer, Superintendent of Public Schools in Elizabeth, N. J. The promotion examination is a test of memory rather than power. It forces pupils to go over far more work than they can grasp or understand. It is, moreover, a great temptation to deceit. It puts a premium, not upon the work done