K59lhSi.. N.Y 
 
 1 
 
 OPTOMETRY LIBRARY 
 
THE EYES OF OUR CHILDREN 
 
METHUEN'S HEALTH SERIES 
 
 Edited by N. BiSHOP Harman, M.B,, F.R.C.S, 
 
 Fcap. Zvo, \s. net. 
 
 THROAT AND EAR TROUBLES 
 By MACLEOD Yearsley, F.R.C.S. 
 
 HEALTH FOR THE MIDDLE AGED 
 By Seymour Taylor, M.D. 
 
 THE CARE OF THE TEETH 
 
 By A. T. Pitts, M.R.C.S., L.D.S. 
 
 THE EYES OF OUR CHILDREN 
 
 By N. Bishop Harman, M.B., F.R.C.S. 
 
 THE CARE OF THE BODY 
 By Francis Cavanagh, M.D. 
 
 THE HEALTH OF THE SKIN 
 By George Fernet, M.D. 
 
 THE PREVENTION OF THE COMMON COLD 
 By Oliver K. Williamson, M.D. 
 
 HOW TO LIVE LONG 
 
 By J. Walter Carr, M.D. 
 
THE EYES OF 
 OUR CHILDREN 
 
 N. BISHOP HARMAN 
 
 M.A., M.B. CANTAB. 
 
 FELLOW OK THE ROYAL COLLEGE OF SURGEONS OF ENGLAND 
 
 WITH THIRTY-TWO DIAGRAMS 
 
 » . '« » o 
 
 METHUEN & CO. LTD. 
 
 36 ESSEX STREET W.C. 
 
 LONDON 
 
OP'^O^S 
 
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 First Published in igib 
 
PREFACE 
 
 THE sight of the eye is the most precious of our 
 senses ; through the eyes we learn most and 
 can teach most ; and through them we may suffer if 
 they be defective or ill-used. Sight has determined 
 the very form of man : the upstanding frame, the 
 free acting arms, ' his fair large front,' the diminished 
 snout and the developed chin are all features related 
 to sight. More striking still is the massive brain and 
 the cunning craftsmanship that are the fruits of 
 perfect two-eyed vision. The influence of sight is 
 no less strong in the individual. Blindness is a 
 calamity few can weigh ; and in their degree defects 
 of sight, whether by reason of disease or natural 
 imperfection, affect mind and habit. The short- 
 sighted boy becomes a round-shouldered smug, a 
 book-reading recluse, just because the pleasure of 
 games has gone with the power to see clearly and 
 smartly ; another boy has eyes that focus near 
 objects with difficulty, and that boy hates lessons, 
 and, not unwisely perhaps, plays truant at every 
 opportunity. The influence of sight on the whole 
 attitude of the child, both mental and physical, is 
 so great that no pains should be spared to secure 
 
 3G442,> 
 
VI THE EYES OF OUR CHILDREN 
 
 the eyes from injury and to remedy those defects that 
 may be inherent in their working. It is of interest 
 to note that the first step in school hygiene, and all 
 this has meant for the health and happiness of 
 youth, was made in relation to the eyes. 
 
 This Uttle book deals with the eyes of the child, 
 their common defects, and the best means of safe- 
 guarding their use at school and at home ; it will 
 be found to be free from hard words and technical 
 phrases, so that all who are interested in children 
 
 may read and understand. 
 
 N. B. H. 
 
 January 1916. 
 
CONTENTS 
 
 CHAPTER I 
 
 THE EYE OF A CHILD 
 
 The primitive eye, a black speck, a pinhole camera, 
 brain and skin meet — A baby's eye, no tears, 
 change of colour — Inflammation at birth — ' Soft as 
 young '......... 
 
 CHAPTER II 
 
 SORE EYES 
 
 ' Tender eyed,' blepharitis, the eyelids, natural oint- 
 ment, tears, 'weakness of eyes,' 'pink rims,' 
 crusts, ulcers, microbes, cleanliness, effects of bad 
 
 focus 
 
 CHAPTER III 
 
 PINK EYE 
 
 Blight,' the conjunctiva or lining of the eyelids, the 
 cornea, ' the apple of the eye,' invasions of microbes, 
 conjunctivitis, contagious eye affections, dirty towels, 
 school epidemics, direct conveyance not miasma, 
 *sand and grit in the eyes,' photophobia — Blistering 
 inflammation, constitutional — Purulent inflammation 
 and blindness, danger to newborn, prevention — 
 Trachoma, the Ghetto disease, alien immigration . 
 
viii THE EYES OF OUR CHILDREN 
 CHAPTER IV 
 
 EYE-STRAIN 
 
 PAGE 
 
 Worried looks, frowning, blinking, face twitchings, 
 rubbing eyes, ' poking,' books too close to the eyes, 
 headaches — The perfect eye —Eye work, focusing, 
 cinematograph — Defective eye, handicap — Over- 
 strain, fatigue, injury ...... 29 
 
 CHAPTER V 
 
 FLAT EYE : ASTIGMATISM 
 
 Common defects, ' hypermetropia,' double work, town 
 V. country, ' astigmatism ' or no focus, comic mirrors, 
 irritation and temperament, school work and medical 
 inspection — The Services, failure to pass the doctor 
 — Eyes the barometers of the body, effects of ill- 
 health, petting the convalescent — Smoking . , 38 
 
 CHAPTER VI 
 
 SHORT SIGHT 
 
 ' Men as trees walking ' — Myopia or screwing up the eyes, 
 short sight and ' strong' sight a popular error, short 
 sight a disease — School influence, stooping, effects of 
 astigmatism, hereditary short sight, spots in the eyes, 
 floating cobwebs, ' flies ' — Prevention, outdoor life, 
 a model scheme of education ..... 45 
 
 CHAPTER VII 
 
 SQUINT 
 
 Loss of two-eyed vision — The 'evil eye,' * cast,' 'boss- 
 ing,' the proverbial thief — Eyes and the man, de- 
 velopment, benefits of two-eyed vision, sense of 
 size, distance and position, a simile, squint and 
 blindness, 'growing out of squint,' treatment, 
 operation 57 
 
CONTENTS ix 
 
 CHAPTER VIII 
 
 SPECTACLES 
 
 PAGE 
 
 A choice of evils, glasses or pain, a stitch in time — 
 Caution, professing to ' test the eyes scientifically ' 
 — The use of belladonna, the fit of glasses, risks of 
 wearing glasses ....... 72 
 
 CHAPTER IX 
 
 LIGHTING 
 
 Light and sight, too much and too little light, position, 
 relative illumination, windows, blinds, skylights, 
 decorations — Artificial light, experiments, photo- 
 metry, school-room planning, effects of reflectors, 
 electric light 11 
 
 CHAPTER X 
 
 READING 
 
 A place for everything, dirt is matter in the wrong place, 
 no books for infants— School books, binding, paper, 
 size and setting of print, standard scale of British 
 Association, model types— Desks, reading, intervals 
 of rest 91 
 
 CHAPTER XI 
 
 WRITING 
 
 Writer and reader, styles of penmanship, origin of styles, 
 western, eastern, Chinese, effects of materials, up- 
 right hand, Italian hand, model style, teaching 
 wiiting ......... 97 
 
X THE EYES OF OUR CHILDREN 
 CHAPTER Xn 
 
 SEWING : HANDICRAFT : DRAWING 
 
 PAGE 
 
 No sewing for infants, close position, strain, habit-spasms, 
 rational materials, knitting, proper lighting, no 
 counting stitches, embroidery — Handicraft for boys, 
 natural positions and movement, carpentry, bent- 
 iron work, netting, etc. — Housewifery for girls — 
 Drawing, materials and models, no freehand copies, 
 squared paper ....... 102 
 
 CHAPTER Xni 
 
 CATARACT 
 
 Flaws in the focusing lens of the eye, how the lens 
 grows, flaws in growth, defects at birth, effects of 
 illness — Operation, time for operation . . . 108 
 
 CHAPTER XIV 
 
 WORD-BLINDNESS : COLOUR-BLINDNESS 
 
 Not due to eyes but mental defects, colour blind males, 
 inheritance through mothers, dangers at sea and on 
 railway — Word-blindness, grouping of letters to form 
 words, lack of mental association, memory centres, 
 bad spellers, caning and teaching . . . . 113 
 
 Index - . . . 117 
 
FIG. I.— SECTION OF AN EYE. 
 
 cornea *, i', conjunctiva ; 2, hard coat or sclera ; 3, blood coat or 
 choroid ; 4, iris ; 5, focusing muscle ; 6, lens ligament ; 
 7, lens; 8, optic nerve ; 9, front fringe of retina ; 9", crntral 
 spot of retina ; 10, jelly packing eye. 
 
THE EYES OF OUR CHILDREN 
 
 CHAPTER I 
 
 THE EYE OF A CHILD 
 
 THE simplest form of eye is a speck of pigment. 
 Such an * eye ' may be seen in the amoeba, 
 the lowest form of animal organism. 
 
 Pigment is the first necessity for the reception of 
 impressions of light. There are born on occasions 
 boys and girls, white children and even negroes, in 
 whom the body is devoid of pigment. These abnor- 
 mal children are called albinos ; their sight is bad, 
 some are blind. 
 
 FIG. 2. — EYE OF PEARLY 
 
 NAUTILUS. 
 h, hole ; c, cavity ; r, retina ; 
 
 FIG. 3. — EYE OF SCORPION. 
 
 hi, horny lens ; r, retina ; 
 
 «, nerve. 
 
 In other lowly creatures we find eyes that are more 
 complex. In the pearly nautilus there is a focusing 
 
2 THE EYES OF OUR CHILDREN 
 
 arrangement. There are little pits open to the 
 water ; each of these pits is screened by a circular 
 cover which narrows the mouth to a small hole. 
 This chamber is Hke the pinhole camera with which 
 many a boy has made sun pictures when no finer 
 apparatus was available. 
 
 In the scorpion there is a thick plate covering the 
 eye ; the plate is part of the shell of the body, but 
 it is transparent, hke the horn spectacles of our 
 forefathers. 
 
 FIGS. 4, 5, 6.— STAGES IN THE GROWTH OF AN EYE. 
 /, lens ; r, retina ; 3, brain ; c, cornea ; n, nerve. 
 
 From eyes of these simple characters to the 
 complex eye of a man is really a very short step. 
 There is only a gradual development of the primitive 
 essentials and the addition of accessories, and these 
 improvements can be witnessed in many fishes, 
 reptiles, and animals. 
 
 In the growth of each human embryo there is 
 first a cup on the surface of the growing skin, and 
 beneath that a cupped protrusion from the growing 
 brain. These two cups meet. The skin cells become 
 
THE EYE OF A CHILD 3 
 
 separated from the surface and embedded within 
 the head of the embryo, whilst the brain cup grows 
 round them. That is an eye in being; the surface 
 cells form the focusing lens, the cup from the brain 
 all the sensitive layers of the eye with the pigment 
 cells. The equipment of the eye grows from the 
 loose tissue between the skin and brain layers ; from 
 that loose stuff there consoHdates the stiff coat of 
 the eye, and the blood-vessel coat, whilst a remnant 
 makes the jelly that packs the cavity of the eye. 
 Muscles and nerves form within and without it ; and 
 at birth a human eye is found, albeit immature. 
 
 The last word is the keynote of this chapter. 
 The eye of a child is an immature eye. It is a 
 growing eye when the child begins to learn lessons. 
 And it must be treated with the care that immaturity 
 demands. We all recognize that the slender back 
 of a child is no fitting place on which to heap 
 burdens, that its arms are weak, and its hands incap- 
 able of grasping heavy weights ; but very few seem 
 to understand that the eyes of a child arc as under- 
 grown as are the other members of its body, and from 
 failure to recognize that fact much mischief is done. 
 
 The eye of the new-born babe is apparently com- 
 plete in all its parts, but it has precious little vision. 
 It may be weeks before the infant will notice the 
 stimulation of a light, much less recognize the most 
 famihar object of its existence. 
 
 We may watch the actual growth of the eye. The 
 
4 THE EYES OF OUR CHILDREN 
 
 slaty-blue iris of the new-born may be seen to clear 
 so as to display the underlying texture and give the 
 effect of a blue eye, or else we may see the gradual 
 appearance of pigment to the painting of the brown 
 eye. Even tears are absent when the child is born, 
 and it may take two or three weeks before this 
 comfortable secretion is estabhshed. The smalbiess 
 of the eyeball may be noted by any judge of size, 
 and if the observer will compare the appearance of 
 the front of the eye of an infant with the eye of a 
 full-grown child he cannot fail to notice in the infant 
 the shallowness of the space separating the clear 
 watchglass front of the eye and the coloured iris 
 beneath, a condition that is due to the smallness of 
 the globe and the lack of space to accommodate the 
 focusing lens within it. Even the pupil of the eye 
 will be seen to be different ; it will be found to be very 
 small, quite different to the full black pupil of the 
 grown child, and that small pupil is a protective 
 agency shielding the infant eye from an excessive 
 stimulation of Hght. 
 
 These observations of the growth of the eye in 
 babies are but the more striking features of a growth 
 that continues far into school Hfe, and the whole 
 of this development is dependent upon proper and 
 balanced stimulation. Contrariwise, a very short 
 disturbance of the normal stimulation of Hght will 
 arrest the growth of the infant eye ; and irregular 
 or too severe or prolonged stimulation to the eye 
 
THE EYE OF A CHILD 5 
 
 of the school-child will tend to the production or 
 accentuation of defects. An extreme case will best 
 show what is meant. 
 
 The disastrous effects of the purulent inflammation 
 of the eyes of the new-bom [ophthalmia neonatorum) 
 is explained in the chapter on ' pink eye.' In some 
 of these cases the front of the eye is irreparably 
 damaged, maybe the eye is lost. There are other 
 cases in which the disease has been stopped with 
 little apparent damage ; but in later years some of 
 these children will have eyes constantly on the move, 
 with a fine shake from side to side that never stops 
 except when the child is asleep. This shake is called 
 ' nystagmus/ and its presence means that the growth 
 of the eye was stopped during the time that the eyes 
 were inflamed. 
 
 Similarly, the improper exercise of the eyes in the 
 growing years of a child either by reason of bad or 
 excessive light, the use of improper materials, pro- 
 longed close work, or of any work at all during 
 conditions of poor health, will account for the onset 
 of eye-strain, squint, short sight, and even mental 
 fatigue of a serious order. 
 
 The one lesson that inust be learned by every one 
 who essays to be the teacher of the young child is 
 the immaturity of the eye. We may well apply the 
 words of Edward Young : — 
 
 ' Beautiful as sweet, 
 And young as beautiful, and soft as young.' 
 
CHAPTER II 
 
 SORE EYES 
 
 * ^yOW Leah was tender eyed.' Such is the 
 1 ^ rendering by Tudor translators of a passage 
 
 in the Pentateuch. It has the tone of apology. 
 Leah was a woman who suffered, and was remarked 
 among a race of bright-eyed people. 
 The condition of sore eyelids goes by the name of 
 
 * Blepharitis.' That word indicates an inflammation 
 of the structures of the margins of the lids. The 
 eyelids are folds of skin. The skin surface of the 
 lids is thin, soft, and supple ; it is very loosely 
 attached to its supporting tissue, so that when the 
 lid is moved or drawn up as in opening the eyes wide, 
 the skin is thrown into folds which fit beneath the 
 brow better than any patent blind within its frame. 
 On the surface next to the eyeball the hd is stiffened 
 with a thin plate of tough tissue, and lined with a 
 delicate slippery membrane that unites the lids to 
 the eyeball. This membrane is called the * con- 
 junctiva,' — that which joins. Between these two 
 surfaces, the dry outer surface and the moist inner 
 surface, is the true edge of the hd. These edges come 
 
SORE EYES 7 
 
 into contact with each other many hundred times 
 each day without — in healthy people — the least sign 
 of distress. This immunity is the result of the 
 arrangement of the grease glands set in the edge of 
 the lids. 
 
 There are no scattered sweat and grease glands 
 on the conjunctiva as there are on the ordinary skin. 
 They are not needed ; the conjunctiva is unctuous by 
 reason of its mucus. The sweat glands have been 
 collected together to form the tear glands, which are 
 tucked away into the corner of the eye-socket, 
 whence they issue their bland secretion to wash the 
 eye when occasion or sentiment should stimulate 
 them. The grease glands are now arranged in line, 
 like soldiers, with their mouths opening on to the 
 edge of the eyelids, where alone there is danger of 
 friction or soreness. 
 
 The secretion of these glands coats the margins 
 of the lids with a layer of smooth grease, so that 
 they do not come into contact directly with each 
 other. The grease is not sticky, so the lids open as 
 readily as they close. And lastly, and by no means 
 least, the grease coats the margins with a natural 
 water-proofing, so that, so long as the secretion is 
 healthy, the margins are not wetted by the tears. 
 When this secretion is defective in these qualities 
 there follow those symptoms and changes in the lids 
 that we know as blepharitis. 
 
 Blepharitis is one of the commonest of eye diseases 
 
8 THE EYES OF OUR CHILDREN 
 
 amongst children. One year I examined 22,000 
 school children in London elementary schools, and 
 found 351 cases of sore eyes ; of these 270, or nearly 
 two-thirds, were varieties of blepharitis. The disease 
 is much more common amongst children than adults, 
 amongst very young children than older children, and 
 amongst the dirty and ill-kept than amongst the 
 clean. 
 
 The onset of the disease may be sudden ; then it 
 is usually due to some fever, such as an attack of 
 measles. The fever causes some soreness of the 
 eyes, and this attack starts chronic sore eyelids 
 if the other conditions are favourable. But the 
 chronic form may start so quietly that no one 
 remarks it, and it is not until some damage is done 
 and the disease has got a secure hold on the lids, that 
 attention is called to it. In the earlier stage there 
 is only a little dry, white, bran-like material fixed 
 on to the lashes like papers on a file. After much 
 reading and particularly after doing fine sewing, the 
 edges of the hds will be found to be pink instead of 
 yellowish white, and the rate of bhnking will be 
 increased. Later the redness of the margins — the 
 * weakness of the eyes ' — is noticed all day long. 
 
 Crusts form and accumulate about the lashes and 
 provide excellent breeding-places for the abounding 
 microbes ; small ulcers form under the crusts, and 
 if we remove these we find raw, bleeding surfaces. 
 The disease spreads into the roots of the eyelashes 
 
SORE EYES 9 
 
 and kills them, so that they fall out and are not 
 replaced. There is set up a vicious circle ; the 
 blepharitis predisposes on even the sUghtest provoca- 
 tion to attacks of conjunctivitis and eczema of the 
 skin, and these in turn exaggerate the blepharitis. 
 Ultimately, in bad cases, both the eyelashes and the 
 grease glands may be totally destroyed, and the lids 
 left with an unsightly, red, tender-looking margin. 
 
 Three factors go to make up the habihty to the 
 disease : — 
 
 1. The subjects of the affection are most frequently 
 possessed of skin and hair which are thick and greasy, 
 and they are liable to ' blackheads,' acne, and 
 dandruff. There is then the susceptible soil. 
 
 2. The subjects of the affection will, when their 
 eyes are accurately examined, most commonly be 
 found to have an error of focus ; generally they are 
 astigmatic, so that close work irritates the eyes. 
 There is in this factor a preparation of the soil. 
 
 3. Lastly, there is the never-faihng presence, in 
 even the cleanest persons, of microbes about the 
 Hd margins. There "is then plenty of seed ready to 
 hand for sowing. 
 
 The relations between these three factors are very 
 definite. But the factor of greatest importance, 
 certainly in the chronic cases, and those cases that 
 occur in the children of the better classes where 
 cleanhness is all that could be desired, is the second 
 of the three — the preparation of the soil. The defect 
 
10 THE EYES OF OUR CHILDREN 
 
 of vision may be very slight, but when the child is 
 put to close and difficult work, especially when from 
 any condition of general ill-health there is an unusual 
 liabiHty to fatigue, then the ready tiring of the eyes 
 and the suffusion of tears cause repeated blinking, 
 so that the margins of the lids tap, tap, tap against 
 each other with far greater frequency than is normal. 
 The soil, naturally susceptible, is sHghtly irritated 
 by the mechanical stimulation, and prepared for 
 the reception of the seed. 
 
 To cure a disease dependent on three clearly 
 defined causes, all of which are well within our 
 control, should not be difficult, and it is not, provided 
 it be undertaken early. The plan of the cure may 
 be drawn up with delightful brevity and pre- 
 cision — clean the lids and remove the cause of the 
 irritation. 
 
 Every scrap of bran or crust must come off the 
 eyehds. Frequent bathing with an alkaline lotion — 
 simple bicarbonate of soda in water — will soften and 
 dissolve them. Then the application of a smooth, 
 mild, antiseptic ointment will keep the lids soft, and 
 reduce the habiUty to the collection of more cnists 
 and scabs. 
 
 These means will do much to reduce the unsightly 
 ravages made by the disease, but they will not touch 
 the thing which is at the root of it, and is the real 
 cause of the irritation. To get at this the vision of 
 the eyes must be examined by an expert in eye work, 
 
SORE EYES II 
 
 and any irregularity in the focus of the eye must be 
 corrected by the wearing of spectacles. 
 
 Spectacles are not things of beauty. But it is 
 a choice of evils — spectacles or worse. Certainly 
 spectacles are decorations compared with the raw, 
 red, lashless eyehds that are the end of chronic 
 blepharitis. 
 
CHAPTER III 
 
 PINK EYE 
 
 THE term was originally applied to inflammation 
 of the eyes in horses, but it has become attached 
 to similar conditions in human eyes, the more 
 particularly since outbreaks in certain schools 
 attracted the attention of Parliament. The term 
 merely intimates that the eyes are red, whereas we 
 all know that the healthy eye should show a clean 
 white surface. The common people use the term 
 ' blight.' Neither terms define any particular con- 
 dition ; they merely indicate that there is something 
 bad about the eyes. 
 
 . Pink eye or bhght is caused by many varieties 
 of noxious irritations. Some of these are the direct 
 outcome of the infection of the surface of the eye 
 with microbes, some are the outward and visible 
 sign of an inward and physical ill-condition. 
 
 There is a membrane lining the inner side of the 
 eyelids and covering the exposed part of the eyeball 
 called the conjunctiva. It bears the same relation 
 to the eyelids and the front of the eye as does the 
 silk hning of our clothes. It is much more delicate 
 
 12 
 
PINK EYE 13 
 
 than the structures it lines, and it dips down and 
 folds into all their crevices and crannies. 
 
 The membrane has two layers. There is an under- 
 lying fabric which is a tangle of fine fibres ; it holds 
 the blood vessels and nerves that nourish and 
 sensitize the membrane. There are also a very large 
 number of little clumps of cells ; these are the exact 
 equivalent of the tonsils of the throat, and they are 
 filters to catch noxious matter that falls on the 
 membrane. . The second layer of the membrane is 
 the surface layers of cells which give the conjunctiva 
 its particularly delicate polished appearance. These 
 cells are different to the cells that cover the general 
 body surface in one particular, for they are not dry 
 but moist ; each cell gradually prepares within itself 
 and becomes filled with a thin slippery substance 
 called mucus, and when the cell comes to maturity 
 it bursts and disgorges the mucus which, spreading 
 over the surface, keeps the whole moist and slippery 
 so that the movements of the eyes are faciHtated. 
 
 The conjunctiva is variously attached to the 
 structures that it lines. Above the upper lid it 
 forms a deep pouch so arranged that the movements 
 of the lid and of the eyeball upwards are not re- 
 stricted. This pouch is the place where foreign 
 bodies, dirt and pieces of grit, are very Hkely to get 
 lodged when they get into the eye. That part of 
 the membrane which covers the eyeball is attached 
 to the globe in the loosest manner possible ; this is 
 
14 THE EYES OF OUR CHILDREN 
 
 shown in any severe inflammation, for it readily 
 swells up into a balloon-like cushion and bulges 
 between the lids, forcing them apart. There is one 
 exception to this looseness of attachment in that 
 small part that covers over the very front of the eye, 
 the clear watchglass-like structure which goes by 
 the name of the * cornea.' On its surface the 
 cornea has several layers of delicate transparent 
 cells, and these are the cells of the conjunctiva which 
 are specially arranged to protect the cornea and 
 preserve its perfect transparency. Should these cells 
 get damaged there is a corresponding loss of clearness 
 of the cornea, and the sharpness of the sight is reduced, 
 either for the time during which the attack lasts, 
 or permanently if it be severe. 
 
 The conjunctiva is very sensitive. Most of all 
 that part of it which covers the very front of the 
 eye, the cornea, is exquisitely sensitive to the least 
 irritation. This delicacy has given occasion to the 
 well-known biblical simile, ' the apple of the eye.' 
 And the simile is a very true one, for on this delicate 
 sensibihty the very sight of the eye depends. In 
 some diseases the sensibility is lost because the 
 nerves are defective. Then there is nothing to warn 
 the eye when dirt settles on the cornea ; the membrane 
 ulcerates, until the whole sight may be destroyed. 
 The same may take place when children are uncon- 
 scious, in meningitis or brain fever, or in typhoid 
 fever ; then they he with their lids slightly parted, 
 
PINK EYE 15 
 
 the front of the eye becomes dried, and the cornea 
 may be destroyed if the eyes be not protected. 
 
 Inflammation of the conjunctiva is known by the 
 name ' conjunctivitis.' There are many varieties 
 of this disorder, and they differ according to the 
 cause of the inflammation. There is one that is a 
 very common habihty of children. It appears in 
 epidemics. When it gains entry into a household 
 or school it may spread throughout that family or 
 school. On occasions the disease has run through 
 a whole city. The inflammation is caused by a 
 particular microbe. It was first found out in Egypt, 
 and is called after its sponsors the Koch-Weeks 
 bacillus. It is one of the minutest microbes that 
 attacks the human body, and is very like that ba- 
 cillus which causes influenza. The two organisms 
 are alike in appearance under the microscope, the 
 way in which they grow in our incubators, and also 
 in the manner of their attack upon the body. Both 
 cause smart epidemics, both are very contagious, 
 and both leave weakness after an attack. 
 
 This organism is conveyed for the most part by 
 the hands, generally of the person who becomes 
 affected. That explains how much more frequently 
 dirty persons are attacked by contagious eye affections 
 than are clean persons, and also how much more 
 frequently children are attacked than either clean 
 or dirty adults. Next after the hands of the person 
 attacked the most common means of conveying 
 
t6 the eyes of our CHILDREN 
 
 contagion are towels and other toilet articles. 
 When an epidemic of this or any other eye disease 
 runs through a school there is always reason to 
 suspect the toilet arrangements. Every child should 
 have his or her own towel, sponge, hair-brushes, and 
 tooth-brushes. It goes without saying that this 
 should be so. But it takes a good deal of arrange- 
 ment to ensure the continuance of such regulations. 
 Not only must this care be carried out in the school 
 proper but it must be rigorously adhered to in the 
 sports pavilion, for there, as easily as anywhere 
 else, contagion may be conveyed by the common 
 use of towels. Not so long ago there was an epidemJc 
 of a common skin trouble, ' impetigo,' which went by 
 the school name of scrum pox. The epidemic was 
 due to the spread of a common pus-forming microbe, 
 a coccus, by the use of towels in common in the 
 sports paviHons of several schools ; the visiting 
 teams carried it from school to school until the 
 means of communication was cut by the insistence 
 on ordinary methods of cleanHness. Quite recently 
 I had to investigate the occurrence of an epidemic 
 of eye inflammation in a large day school run by a 
 rehgious organization. It was impossible to secure 
 individual towels, so the issue of towels was stopped 
 entirely. No child was to wash in the school ; if it 
 came dirty it was to go home to wash. The epidemic 
 was stopped promptly in aU except one class, that of 
 the senior girls ; there it continued despite all pre- 
 
PINK EYE 17 
 
 cautions. The flaw in the arrangements was an 
 enigma, until the teacher of that class was examined 
 as to what went on in the class. Then it was dis- 
 covered that the girls were working for a prize needle- 
 work competition, and to secure the cleanest work 
 she was in the habit of sending the girls to wash 
 before that work was done, and since all towels had 
 been withdrawn she had given them a piece of 
 ' clean ' linen to use. That piece of stuff went the 
 round of the class, so there was no wonder that the 
 epidemic was not stayed. 
 
 That disease is spread by the direct conveyance 
 of particles from person to person is a fact that has 
 been estabUshed in comparatively recent years. 
 Before the certainty of this means of communication 
 had been established it was held that miasma, vapours, 
 effluvia and the hke were responsible for the origin 
 and spread of disease. The distinction between 
 these two modes of communication is of chief im- 
 portance, especially so in regard to the responsibility 
 of those in authority for the outbreak and con- 
 tinuance of epidemics of eye disease. If some 
 subtle intangible miasma is the fons et origo malt, 
 then who is to blame for the trouble ? It is fate! But 
 if it be certain that this child had the disease and 
 passed it on to that child, and so on through the whole 
 school, then it is clear where the responsibility Hes. 
 
 Leaving the causes and means of communication 
 of epidemics of eye disease, we may consider the 
 
i8 THE EYES OF OUR CHILDREN 
 
 symptoms of common conjunctivitis. These vary 
 with the intensity of the attack, but whether the 
 attack be mild or severe certain signs can be recog- 
 nized. The one that most strikes the onlooker is 
 the altered colour of the eye, hence the term 
 * pink eye/ but it must be borne in mind that 
 this symptom is not characteristic of one form of 
 inflammation only; it is common to every form of 
 inflammation that affects the front of the eyeball. 
 Next there is always some swelling where there is 
 
 FIG. 7. — MATTER FROM EYE MAGNIFIED lOOO TIMES. 
 The rods are the microbes ; /, pus cell ; e, scale cell from conjunctiva. 
 
 inflammation, and the dehcate elastic conjunctiva 
 very easily becomes swollen ; the same symptom may 
 extend to the eyelids, so that in severe cases they also 
 are swollen and glassy-looking, for the natural folds 
 and creases of the lids are smoothed out. Next the 
 discharge calls for notice, and this is the specific 
 feature of a conjunctivitis. There is an extra flow 
 of tears, and these tears are flecked with little pieces 
 
PINK EYE 19 
 
 of thick whitish or yellowish material ; this is purulent 
 matter, or pus mixed with the mucus of the eye. 
 It tends to gather at the inner corners of the eyes, 
 and to clog the lashes, so that in the morning when 
 the patient awakes from sleep the eyelids may be 
 stuck together so tightly that the eyes cannot be 
 opened without first bathing them. It is this 
 discharge which carries the specific contagion of 
 the disease. If a film of the pus be made upon a 
 sHp of thin glass, stained in an appropriate fashion, 
 then examined under the high powers of the micro- 
 scope, mmierous short slender rods will be found. 
 To the presence of these on the surface of the con- 
 junctiva and deep down in the many folds of mem- 
 brane aU this irritation is due. The irritation is 
 so marked that many sufferers are convinced they 
 have ' got something into their eye,' and truly they 
 have, but not something of the nature they suspect. 
 The complaint of * sand and grit in the eyes ' is 
 due to the irritation of the endings of the nerves of 
 the conjunctiva ; these have been trained from the 
 beginning to report to the brain the presence of 
 specks in the eye. 
 
 Another symptom is intolerance of Hght, or ' photo- 
 phobia.' This is severe in proportion to the effect 
 the inflammation has on the cornea of the eye. 
 Hatred of light leads the sufferers to hide in the dark, 
 and it also leads kindly disposed persons to cover 
 the inflamed eyes with bandages, or even poultices, 
 
20 THE EYES OF OUR CHILDREN 
 
 But it is bad practice to bandage eyes when there 
 is discharge containing pus or thick matter. The 
 pus is kept within the eyehds, and the microbes 
 multiply, so that in the end the disease is made much 
 worse. Bandaging the eyes does for the microbe 
 the very thing that we do when we wish to grow it 
 in the laboratory incubators ; it keeps it warm and 
 snug, and as free from disturbance as may be. It 
 is far better, in the absence of expert advice, to wash 
 the child's eyes, and keep on washing them so as 
 to remove every trace of matter from the eyes, for 
 the repeated removal of the pus-laden tears will 
 so reduce the number of microbes that the conjunc- 
 tiva will be able to recover from the effects of the 
 invasion. When there is no doctor to direct treat- 
 ment it is a safe rule to wash well and often. If 
 Naaman the Syrian required to wash seven times in 
 Jordan to be rid of his skin disease, it is good to wash 
 the child's eyes seventy times seven to keep them 
 free from matter. There may or may not be any 
 drug or antiseptic in the water; unless a doctor 
 orders a lotion it is better to refrain from amateurish 
 experiments. 
 
 There is another form of eye inflammation, 
 particularly an affection of children, known as 
 phlyctenular conjunctivitis. The word phlycten 
 means a bUster or bleb. SmaU whitish spots or 
 blebs appear at the rim of the cornea, at the head 
 of a cluster of intensely inflamed vessels. Since 
 
PINK EYE 21 
 
 they appear at the very edge of the cornea, the 
 region of greatest sensibility of the eye, the pain 
 caused by the attacks is intense. The children keep 
 the eyes firmly closed, any attempt to look at them 
 causes cries of pain and resistance, and if the lids 
 are opened (as they must be to effect treatment) 
 hot tears will spurt from between them. These 
 cases demand urgent and careful attention, for if 
 they be neglected very grievous injury may be done 
 to the sight. The little elevations break down and 
 ulcerate, and the ulcers spread across the surface 
 of the naturally clear cornea, scarring it, so that the 
 sight is permanently injured. There is no disease 
 that is responsible for more damage to sight than is 
 this. 
 
 In a group of three hundred children whose vision 
 I had to examine on account of such serious defect 
 that they could not be educated at an ordinary school, 
 and yet who were not bad enough to require teaching 
 at the bHnd school, it was found that no less than 
 fifty were cases of this sort ; both eyes were seriously 
 damaged by the ' bhstering ' inflammation. 
 
 This disease differs in one respect from other forms 
 of pink eye, for the phlycten is not the direct produc- 
 tion of microbes. When the little bleb is examined 
 by microscopic methods in a fresh and undamaged 
 state we find that it is sterile, but when it has broken 
 down and ulcerated many organisms are found on 
 its surface. 
 
22 THE EYES OF OUR CHILDREN 
 
 If the records of a large number of children are 
 examined we can learn many things about the 
 disease. The cases are most frequent at the age of 
 five years. Among the sufferers from this disease 
 there is an unusual frequency of associated troubles, 
 such as enlarged tonsils, adenoids, sore noses, mouth 
 breathing, and decay of the teeth. Jewish children, 
 for the most part aliens, are very Httle liable to the 
 disease, though they are relatively more often 
 affected by microbic forms of pink eye and sore 
 eyelids than native children. The httle blebs 
 appear on that part of the cornea supplied by twigs 
 of the big nerve which suppHes the teeth. 
 
 Putting these facts together we get a connected 
 story. It appears most frequently at the age of 
 five years, just the time when the milk teeth are 
 decaying. If at this time the mouth be neglected 
 there is a swarming of microbes, so that there is 
 great liabihty to sore throat, sore nose, inflamed 
 glands, and the like. All these happenings are more 
 hkely to produce trouble in weakly children whose 
 resistance is feeble, than in robust, well-cared-for 
 children. In the weakly children the summation 
 of all these surface irritations sets up an irritable 
 state in the nerves, and there is an outbreak of these 
 little bhsters at the endings of those nerves most 
 nearly connected with the seat of the maximum 
 irritation in the teeth. 
 
 The disease is primarily one of bad general health. 
 
PINK EYE 23 
 
 The irritations of the teeth and mouth are like the 
 last straw that broke the camel's back. The ahen 
 Jewish children escape the disease because they are 
 among the best fed in the metropoHs, Their staple 
 food is richly impregnated with oil ; the children 
 are fat and round, and their resistance to the effects 
 of irritations of eyes, nose, and mouth is propor- 
 tionately good. 
 
 There is no disease that is more ameliorable by 
 treatment on right lines than is this. The first 
 thing is to improve the general health of the child. 
 Clean up the teeth, make the mouth healthy and 
 sweet. Remove excessive growths of tonsils and 
 adenoids. Feed the child with plenty of milk, 
 butter, and cod hver oil. Best of all, take it to a 
 warm, dry place where it can be in the open air all 
 day, and the disease will be stopped and the danger 
 of relapses removed. The treatment of the local 
 eye condition will need the care of an expert, but his 
 services will be unavaihng unless the state of the 
 general health be attended to at the same time. 
 
 Amongst the poor and ill-fed children who form 
 so large a proportion of the out-patients at our 
 metropolitan hospitals these cases have a high 
 incidence. Their attendance drags on for weeks 
 and months unless steps are taken to transfer them 
 to convalescent homes, when the cure is magical in 
 its swiftness. There is no greater testimony to the 
 value of convalescent homes, and of open-air schools. 
 
24 THE EYES OF OUR CHILDREN 
 
 than cases such as these. On the mere ground of 
 values the homes are justified, for the saving of a 
 pair of eyes may mean in later years the difference 
 between a life of happiness and a hfe of constant 
 worry ; between a future as an unemployable 
 ne'er-do-well and a good workman ; and between 
 one who is a source of wastage of the public wealth 
 and one who adds thereto. 
 
 There is a form of conjunctivitis which is marked 
 by intense inflammation and the pouring out from 
 the eyelids of thick yellow matter or pus. This 
 is called purulent conjunctivitis. It is most fre- 
 quently seen immediately after birth, and in this 
 connexion goes by the name of ' ophthalmia neona- 
 torum,' that is, the eye inflammation of the new 
 born. It is one of the most serious types of inflam- 
 mation known, and is responsible for more blindness 
 than any other single form of inflammation. Of 
 all the children in the blind schools of Europe and 
 America from one-fourth to one-third owe their 
 pitiable state to this one cause. 
 
 The disease affects rather less than one in every 
 hundred children born, and it destroys the eyes in 
 about one in every two thousand children born. 
 It is due to a microbe getting into the eyes of the 
 child during the process of birth, and the microbe 
 that produces this intense form of inflammation is 
 the cause of one form of venereal disease. 
 
 It must not be thought that every attack of red 
 
PINK EYE 25 
 
 or pink eye found in a new-born baby is due to this 
 disease. The stress that the head of the child 
 endures during birth is such that a httle redness 
 is by no means an infrequent sequel, and it may be 
 noted in the babies of the most cleanly and virtuous 
 parents. 
 
 But whatever the type of inflammation that may 
 appear after birth, whether it appear shght or severe, 
 it should be put under the care of an expert without 
 delay. The words of the warning issued by the 
 Ophthalmological Society of the United Kingdom 
 in 1884 cannot be bettered : * If the child's eyes 
 become red and swollen or begin to run with matter 
 within a few days after birth, it is to be taken without 
 a day's delay to a doctor. The disease is very 
 dangerous, and, if not treated at once, may destroy 
 the sight of both eyes.' 
 
 The disease has now been scheduled under the 
 Infectious Disease (Notification) Act, 1889, and the 
 occurrence of any case has to be notified to the local 
 medical oflicer of health, who has power to ensure 
 that efficient treatment is carried out. 
 
 The matter that escapes from the eyes of the 
 affected infants is highly contagious, and every 
 precaution must be taken to prevent other inmates 
 of the home being affected. Two bhnd children 
 who came under my care in a blind school had lost 
 their eyes by contamination with the discharges from 
 the eyes of a baby in their home. 
 
26 THE EYES OF OUR CHILDREN 
 
 In recent years there has been a distinct decline 
 in the incidence of ophthahnia neonatorum, owing 
 to the measures that are taken to prevent it. Since 
 this book may be read by those who spend some of 
 their time in health-visiting and the Hke, it may be 
 well to set out here the preventive measures against 
 the disease. They are well summed up in the words 
 of Gibson, a Manchester doctor, who wrote in 1807 
 thus : * (i) The leucorrhoea of the mother ought, if pos- 
 sible, to be cured during pregnancy. (2) When this 
 has not been done, the noxious secretion ought to be 
 removed from the vagina during deUvery. (3) The 
 infant's eyes ought, immediately after birth, to be 
 cleansed with a fluid which either removes the 
 noxious matter or is able to prevent its injurious 
 effects.' This was written before the microbic origin 
 of the disease was known, but it gives an admirable 
 summary of the measures necessary to stamp out 
 this cause of blindness. 
 
 An inflammation of equal severity, but due to 
 other microbes, may occur as a sequel to an attack 
 of some infantile fever, such as measles or scarlet 
 fever ; happily these cases are very rare. They 
 used not to be so in the days before smallpox had 
 been practically stamped out by vaccination. Before 
 this protection was known bhndness from smallpox 
 was comparatively common ; it is rare now, and the 
 few cases that have come under my care were in 
 un vaccinated children. 
 
PINK EYE 27 
 
 In the foregoing, conjunctivitis has been considered 
 as a smart or acute disorder. Some types are chronic 
 and last for years. These are bad types and respon- 
 sible for much damage to sight. The disease called 
 Trachoma is of this order. It is a severe chronic 
 inflammation which affects the inside of the eyelids, 
 making them very rough and coarse, hence the name 
 of the disease, which signifies a roughness. When 
 the Hds get into this state the irritation produced 
 on the tender front of the eyeball is severe, and the 
 reaction to that causes the cornea to become blood- 
 shot. If there is no proper treatment the front of 
 the eye may become dull and opaque, so that sight 
 is lost. Trachoma is exceedingly common in the 
 East : MacCallan, who has charge of the ophthalmic 
 hospitals in Egypt, reports that 51 per cent, of the 
 school children in that country are affected by it. 
 It is very common in Eastern Europe, especially in 
 those parts where there are densely crowded city 
 populations — e.g. in the Ghettos. We in England 
 are now comparatively free from the disease, thanks 
 to the special precautions adopted to check the 
 introduction and spread of contagious eye disease 
 amongst school children. It was at one time rife 
 in poor-law schools and asylums, but now there are 
 hospital-schools to which any child that shows signs 
 of inflamed eyes is drafted until it is cured. These 
 are measures that should be insisted upon in the 
 case of all schools, particularly those into which 
 
28 THE EYES OF OUR CHILDREN 
 
 poor or neglected children are taken, and also in 
 all homes or workshops for girls and young women. 
 The occurrence of trachoma in a charitable institu- 
 tion, or in the young people who have been residents 
 in such institutions, is the gravest reflection on the 
 hygienic arrangements in such places. Nowadays 
 most of the few cases of trachoma that are seen at 
 home hospitals can be traced to charitable schools, 
 residence abroad, or alien emigration. 
 
 Trachoma is one of the conditions which render a 
 would-be emigrant to the United States of America 
 inadmissible to that country. The eyes of every 
 emigrant are examined on arrival by experienced 
 doctors, and the slightest sign of the disease causes 
 their rejection. This is a fair indication of the 
 seriousness with which the disease is regarded in 
 the New World. The same care is not taken in 
 this country by our emigration authorities, for in 
 more than one instance I have known a whole 
 family of affected aliens to be admitted to live, work, 
 and even take domestic service amongst us. 
 
CHAPTER IV 
 
 EYE-STRAIN 
 
 THIS is a term that we hear much of in these 
 days. It means that the eyes are working with 
 some difficulty, so that strain or trouble is caused. 
 The strain may be felt by the owner of the eyes only, 
 but sometimes it is possible for others to see signs 
 of the irritation. The range of effects is very wide : 
 some are pecuHar to trouble with the eyes, others 
 are common to eye conditions and to other disorders 
 of the body. 
 
 One of the chief signs of eye-strain is to be seen 
 in the face of the child. A worried, strained ex- 
 pression, particularly when it is associated with a 
 perpetual frown, is very frequently due to difficulty 
 with the eyes. It is not natural for a child to frown ; 
 if it does there is good reason for finding out why 
 it does so. 
 
 BHnking in excess is a very common sign of diffi- 
 cult vision. Things do not appear quite clear, the 
 eyes tend to water too much, and so there is more 
 blinking than usual. This is the state of affairs 
 that may be the start of sore eyelids, so there is 
 
 29 
 
30 THE EYES OF OUR CHILDREN 
 
 good reason to investigate the eyes of children who 
 are liable to red and tired eyes especially after they 
 have been to the pantomime or picture-show. 
 
 From excessive bhnking some nervous children 
 pass on to twitchings of the face and brows. Not 
 every case of facial twitching is due to eye trouble, 
 but many are. If this be forgotten, we may waste 
 much time in trying to correct the habits by other 
 and futile means. 
 
 There is occasionally associated with the habits 
 of bhnking and twitching of the face the bad habit 
 of rubbing the eyes. This is done with marked 
 frequency when the child is tired, or after the eyes 
 have been used for reading and sewing lessons, 
 especially if these be done by artificial Hght. 
 
 Young children, especially when they are first 
 allowed to have picture and reading books, frequently 
 put their Httle faces very close to the thing that 
 they are looking at. This habit may or may not 
 indicate difficulty in seeing. Children hke to see 
 things big, and they get a big image of an object if 
 they get close up to it. This habit, which is a bad 
 one even for those eyes that are perfect in their 
 focus, must be checked, and if it be found to per- 
 sist it may be taken as an indication that the child 
 cannot see sufficiently clearly without looking closely 
 at the book. 
 
 The foregoing are some of the manifest signs of 
 difficulty. They arc the most important signs in 
 
EYE-STRAIN 31 
 
 dealing with very young children, for in the very 
 young the discovery of defects must be made by 
 the elders ; the little ones are not to be expected to 
 tell us what is the matter with them. 
 
 There is another class of symptoms referable to 
 difficulty with the eyes : aches and pains. We have 
 to depend on the sensations of the child for our 
 knowledge of them ; there may be no outward and 
 visible sign of the trouble to give the mother a hint 
 that the eyes are at fault. Constant headaches are 
 without doubt in a great many cases due to eye- 
 strain, but they may also be due to a variety of 
 causes — general ill-health, indigestion, constipation, 
 bad teeth, febrile conditions, and many other 
 disorders. Persistent headaches should always be 
 taken as a sign that the eyes are possibly at fault 
 and need attention. 
 
 The importance of attending to these defects at 
 an early stage cannot be overestimated. Many a 
 quick nervous child, of just that type that is full of 
 ideas and energy, is spoiled by the neglect of some 
 httle defect of this sort. Its natural quickness be- 
 comes a jumpiness ; it is no longer nervous in a 
 good sense, but in a weak, irritable sense; and 
 the energy wherewith it might have done much 
 is dissipated in antics, habit-spasms, and aches, 
 which only serve to aggravate the very conditions 
 that started them. All these forms of irritation are 
 of most importance in organisms that are dehcate 
 
32 THE EYES OF OUR CHILDREN 
 
 and finely balanced, for the more delicate the balance, 
 
 whether it be of flesh and blood or of steel and brass, 
 the more disturbing are the impressions of even 
 minor shocks. It is held by many, and on good 
 grounds, that these slight but continuous irritations 
 may be held accountable for serious disturbances 
 of mental balance in young children, particularly 
 where by reason of inheritance there is a predisposi- 
 tion to nervous affections. 
 
 Next we may inquire what sort of eyes are re- 
 sponsible for eye-strain. Eyes vary considerably. 
 There is no standard eye, only an average eye. A 
 few have perfect eyes, the many very fair eyes, and 
 some have poor or even bad eyes. 
 
 The perfect eye is the eye that can see objects in 
 the distance without need for adjustment or focus- 
 ing ; to it is given the elegant Greek name * emme- 
 tropic,' that is to say, it is a * well turned ' or well 
 shaped eye. The majority of eyes are just a little 
 short of the fuU and perfect focus or length. They 
 are just a little over-turned or flattened, but they 
 do their work with exemplary regularity, provided 
 always that the work is such as they can do. 
 
 That last phrase suggests a question. How does 
 the eye work ? The work of the eye is one of the 
 most complicated pieces of execution that has ever 
 been conceived. It would be quite impossible for 
 me here to suggest any true picture of the perfection 
 of the association of the eye and the impressions it 
 
EYE-STRAIN 33 
 
 receives with the perceiving and translating func- 
 tions of the brain, and with all those varied move- 
 ments, expressions, and actions that result from the 
 translation of sight into deed. But we can judge 
 of the effects of sensation and the stresses of muscles 
 within and without the eye. 
 
 Light enters the eye, the hght produces nervous 
 sensations, and the eyes get tired from the stimula- 
 tion ; even when they are perfect eyes they are 
 liable to fatigue. Again, the eyes are a very sensitive 
 part of the body, so that when the body is tired the 
 eyes are tired. In a very real sense the eyes are 
 the barometer of the body. When we are tired the 
 eyes are Hkely to feel yet more tired, or we find they 
 get more easily tired than we think they should. 
 
 The work of the eye is directly associated with 
 muscular effort. Inside the eye there is a most 
 dehcate muscular apparatus. It works all day long, 
 so long as we are awake and have the eyes open. 
 One group of these muscles is within the curtain of 
 the eye. In the middle of the curtain is a hole, 
 called the pupil. The curtain has within its sub- 
 stance two sets of muscles : one that encircles the 
 pupil, and has the work of closing or making small 
 the pupil so as to shut out excessive Hght ; and the 
 other that has the contrary work, that of puUing 
 open the curtain so that the pupil is large to let all 
 possible hght into the eye. This work is going on 
 all day long. If it were not for this wc should not 
 
34 THE EYES OF OUR CHILDREN 
 
 be able to see as we stepped from the dimly lighted 
 house into the sunlit street, or passed from the 
 sunshine into the darkness of a building. But with 
 this perfect regulating mechanism we can pass from 
 one to the other with very Httle sensation of diffi- 
 culty, except only when the contrasts are intense. 
 The fatigue that is felt when children are taken to 
 the cinematograph show is due to the sudden alterna- 
 tions of Hght and dark, the perpetual flicker of the 
 moving images, which throws much strain on the 
 mechanism of the eyes, both by stimulating sensation, 
 and by the amount of muscular effort demanded. 
 
 Another muscular apparatus has to do with the 
 focusing of the eye. When hght enters the eye 
 it is brought to a focus on the sensitive membrane 
 of the retina by means of a lens. That is an 
 arrangement we are famihar with in the photographic 
 camera. In using the camera, unless it be one of 
 the fixed-focus snapshot variety, we are accustomed 
 to adjust the focus for the picture, and we do that by 
 either lengthening the body of the camera or by shift- 
 ing the position of the lens. The arrangement in the 
 human eye is much neater and more delicate than 
 that ; it depends on the alteration of the curvature 
 and thickness of the lens. There is inside the e3^e a 
 ring of muscles ; these act upon a set of fibres that 
 sling the lens all round its edge and keep it taut, 
 very much in the same way that the ropes of a bell- 
 tent keep the canvas taut. When these muscles 
 
EYE-STRAIN 35 
 
 are brought into action the tension of the fibres or 
 hgaments attached to the lens is altered, and the 
 lens bulges by reason of its elasticity, so that it is 
 fatter and thicker. The altered shape makes it a 
 more powerful lens, for its focus is shorter. 
 
 Focusing is done every time the perfect eye looks 
 at any object that is nearer to it than six yards ; 
 beyond that distance the perfect eye can see things 
 clearly without focusing. The eye that is not 
 perfect has to do this work of adjustment of focusing 
 always, not only for near objects, but even for distant 
 objects. Such a state of affairs as this make a very 
 different basis of calculation of work done as between 
 the perfect eye and the defective eye. We can do 
 a great deal of work provided we get decent rests 
 between the several efforts. The heart of every 
 man beats regularly and without difficulty from 
 birth to death, for from forty to eighty years, sixty 
 or seventy times a minute, sleeping and waking, 
 just because it has a momentary rest between each 
 beat. Prevent that momentary rest and the work 
 of the heart will be deranged so seriously that there 
 will be a bad heart attack. It is the same with the 
 eye. The perfect eye can work at reading and other 
 close work for a long time, just because every time 
 it looks away from the work into the distance it is 
 at rest. But the defective eye has to do work at all 
 times both for distant and near objects. It is this 
 that accounts for fatigue and eye-strain in these 
 
36 THE EYES OF OUR CHILDREN 
 
 children when they are sent to school, and especially 
 when they are not very well, either because of some 
 feverish attack, or because they have been allowed 
 too much dissipation either in sweets or in entertain- 
 ments the day before. 
 
 There is one other form of muscular work that has 
 to be done for the eyes. The muscles that do this 
 part of the work are outside the eyeballs. They 
 are the muscles that turn the eyes this side or that, 
 up or down, and, hardest work of all, turn them both 
 inwards towards the middle line as when we desire 
 to look at something that is near to us. This last 
 piece of work is particularly fatiguing. Any one 
 can demonstrate the effort on his own person ; 
 the attempt to look at the end of one's nose will 
 surely cause a pain in the eyes, and that pain is 
 caused by excessive effort. That is one of the 
 reasons why it is essential that children should be 
 taught to sit well away from their work and books. 
 
 So far all these several actions have been spoken 
 of separately, as though they took place at different 
 times. That is not so. They are performed all 
 together, at one and the same moment ; and the 
 necessity for the perfect association of all these 
 efforts calls for the expenditure of further nervous 
 energy and therewith more possibihty of fatigue. 
 When that association is made difficult, from defects 
 in the focus of the eyes, then the fatigue is dispro- 
 portionately great and positive pain will be caused. 
 
EYE-STRAIN 37 
 
 There is one other way in which work is done in 
 the eye. Pigment is necessary to sight. When 
 light enters the eye the pigment or ' visual purple ' is 
 bleached ; it undergoes changes just as the chemicals 
 in the photographic plate. Continued exposure to 
 light exhausts the visual purple, but during sleep 
 the pigment is restored. This points to the necessity 
 for sleeping in the dark. The child's night nursery 
 should have bHnds that will make it sufficiently dark 
 in the early hours of the summer mornings. Louvre 
 shutters outside the windows will do this without 
 any interference with free ventilation. The old idea 
 that it was bad to sleep in the rays of the moon had 
 just this much basis of fact ; exhausted travellers 
 sleeping exposed to the rays of the moon had their 
 eye pigments stimulated and wasted even when 
 they were asleep, so the eyes were doubly exhausted 
 and the sight injured. 
 
CHAPTER V 
 
 FLAT EYE I ASTIGMATISM 
 
 F'ULLY eighty per cent, of the population have 
 eyes that show some deviation from the 
 normal. When the difference is small and there is 
 not much close work it may cause no trouble at all ; 
 indeed, some have even argued that a small degree 
 of flat eye is an advantage ! 
 
 The commonest of these deviations is that known 
 as hypermetropia. The eyeball has not grown to 
 
 FIG. 8. 
 //, flat eye ; IV, normal eye. 
 
 the full size, it is too flat. Such an eye as this cannot 
 see into the distance without the necessity for some 
 focusing of the lens of the eye ; and when it is 
 necessary to look at things close at hand there is 
 
 38 
 
FLAT EYE : ASTIGMATISM 39 
 
 double work to be done, for the ordinary near 
 adjustment must be made, and in addition just so 
 much extra adjustment as the eyes are flat. This 
 extra may be very httle, but it tells when added up 
 in terms of work through a whole day. Some eyes 
 are much flatter than others, then the defect is 
 serious ; there is the difficulty of focusing and the 
 difficulty of working the two eyes together, so that 
 squint may be caused. 
 
 If the children with the flat eyeballs were always 
 out in the fields, running and playing, they would 
 not experience these fatigue effects, except in the 
 few extreme cases. But when we put them to books 
 they are hable to suffer. For these children glasses 
 are needed. They may not be wanted to make them 
 see better, but they are needed to prevent the eyes 
 getting tired. Many only need the glasses for near 
 work ; they can do without them safely when they 
 are at play, or on holiday ; but if we wish to prevent 
 eye-strain, glasses they must have. 
 
 There is another cause of difficult vision. It 
 comes next in frequency to flat eye, and it not only 
 causes fatigue, but it also makes the vision poor or 
 even bad. This condition is called ' astigmatism.' 
 The word means ' that which has no point,' and it 
 indicates that there are eyes that have no focus — 
 that is, they are so shaped that it is impossible for 
 the eye to get a perfect focus under any circumstances. 
 This defect arises from an irregular curvature of 
 
40 THE EYES OF OUR CHILDREN 
 
 the front of the eye ; the clear cornea is not perfect 
 in its curves, so that it distorts the rays of hght that 
 
 FIG. 9. — ASTIGMATIC EFFECTS. 
 V is seen as W ; the crescent moon has manj' horns. 
 
 pass through it to enter the eye. When we were 
 children we have all been puzzled at the weird shapes 
 our faces and hands took when viewed in the mirror 
 of the sides of the silver teapot ; and maybe we have 
 seen some comic mirrors that reflected the face 
 * before and after dinner ' : these are all astigmatic 
 effects. 
 
 When there is astigmatism there is almost certain 
 to be eye-strain sooner or later. The time of the 
 trouble will depend on the nature and health of the 
 child, and on the character of the school-work it is 
 put to. If the health be poor, and if the school- 
 work be heavy, the complaint of trouble will be 
 made early. Similarly when the child is of a high- 
 strung, nervous temperament there will be early 
 complaint, and in these cases the effects of the strain 
 may appear altogether disproportionate to the degree 
 of the astigmatism. 
 
FLAT EYE : ASTIGMATISM 41 
 
 The reason for the trouble is as follows. When 
 there is a small degree of this sort of defect vision 
 may be good — that is, the child may be able to read 
 the standard distance sight-test quite well ; but the 
 very act of reading makes the child unconsciously 
 aware that the perception of the letters is not all 
 that it might be. This leads the focusing muscles 
 of the eye to try to get a better focus, and since this 
 cannot be obtained there is a continuance of unavailing 
 effort, and fatigue is induced by ordinary reading 
 much more easily than it should be. The same 
 happens when there is such a degree of astigmatism 
 as will cause the child to fail to read the last line or 
 two of the test ; then the trouble is Hkely to be 
 marked, and headaches, frowning, and the like 
 will be evident, even before the child is taught to 
 read. Curiously enough there is often no complaint 
 at all when the astigmatism is of high degree ; the 
 child does not see well, and the only abnormal thing 
 to be noticed about the child will be the habit of 
 holding things close to the eye ; it may escape all 
 headaches, its httle brow may never show a frown, 
 and it may never develop the bhnking habit or an 
 ugly twitch. This seems a puzzle at the first glance, 
 but the explanation is simple. When the degree 
 of astigmatism is high the eyes recognize, uncon- 
 sciously to the subject, that it is quite hopeless to 
 attempt to focus objects that are so distorted, so 
 that none of that futile work is attempted which 
 
42 THE EYES OF OUR CHILDREN 
 
 causes so much discomfort when the astigmatism is 
 of low degree. 
 
 The foregoing facts all point to one conclusion : 
 that the eyes of every child should be examined 
 before it is put to school-work. This has become the 
 regular practice of many of the more enhghtened 
 educational authorities of the world. It is being 
 adopted in many private and public schools ; and 
 there can be no doubt of the benefit that would 
 accrue from its universal adoption. Nothing is more 
 distressing than the experience of parents, teachers, 
 and child, when, as is by no means infrequent, a 
 smart, well-set-up youth, who has been carefully 
 prepared for some competitive examination — say, for 
 entry into the Navy — meets with his first failure at 
 the hands of the examining doctor : he is failed for 
 defective eyesight. If his eyes had been examined 
 earlier in his career the defect would have been 
 known, his school-work would have been altered 
 accordingly, and the disappointment of the rejection 
 avoided. It is even possible that the knowledge 
 of a small eye defect in the early years might have 
 prevented the increase of the defect, for the proverbial 
 stitch in time applies as much to the eyes as to one's 
 clothes. 
 
 The frequency of eye defect shows how important 
 is a routine examination of the eyes. In one good- 
 class school I examined the eyes of all the boys and 
 girls. 341 boys and 328 girls were examined. Of 
 
FLAT EYE : ASTIGMATISM 
 
 43 
 
 the girls 74 per cent, had good vision and 26 per 
 cent, failed ; of the boys 82 per cent, had good vision 
 and 18 per cent, failed. 
 
 In 1913 I examined the returns of the patients 
 at my children's hospital. 1670 children were seen 
 on account of bad eyes; 1348 had eyes with bad 
 focus so that they could not see properly. 
 
 The kinds of errors of focus found in the eyes of 
 these children were as follows : — 
 
 Defect. 
 
 Number. 
 
 Per cent. 
 
 Flat eye or hypermetropia, 
 Astigmatism of all sorts except 
 myopic, ..... 
 Myopia or short sight, 
 Myopia with astigmatism. 
 
 349 
 
 655 
 167 
 
 177 
 
 25-9 
 
 487 
 12-4 
 13-0 
 
 Ill-health has a marked effect upon the eyes. The 
 eyes are the barometers of the body. It is quite a 
 common thing for a mother to date the onset of a 
 squint in her child's eyes from an illness. It is not 
 the fever itself that causes the defect, but the poison 
 of the fever sets up a state which may be likened to 
 excessive exhaustion, arid the eyes fail under the 
 added stress. This points to the necessity for special 
 care in the use of the eyes during and after illness. 
 Generally it is just the other way about ; the sick 
 child has unlimited books given to it. Then when 
 the child is convalescent more and more books are 
 
44 THE EYES OF OUR CHILDREN 
 
 showered upon it by indulgent parents, and the 
 muscles of the eyes which are already suffering from 
 the effects of the poison are further strained by 
 the continuous reading. Not a few cases of short 
 sight date from the occurrence of an illness. Better 
 by far give the child a box of paints and let it draw, 
 or a box of plasticine and let it model, or if the little 
 patient be old enough give it wood and a penknife 
 and let it carve ; the risk of eye-strain with any of 
 these materials is far less than with books. 
 
 Smoking by boys has only to be mentioned to 
 receive the reprobation of all. There are definite 
 ill effects known to be due to the smoking of cheap 
 cigarettes. The attention of the child tends to 
 wander from the work in hand, there is a general 
 listlessness, the handwriting becomes unsteady, the 
 lines of the writing are crooked, and the words are 
 ill-formed and quavering in outHne hke the work 
 of an old man. Cessation of the bad habit and tonic 
 treatment brings a return of stability. 
 
CHAPTER VI 
 
 SHORT SIGHT 
 
 THE short-sighted child is able to see the finest 
 details of objects which are held close to its 
 eyes, but it cannot see the leaves on the trees, the 
 details of the landscape, the beauty of the work of 
 the pubHc buildings, or even the features of the face 
 of a friend. Everything beyond a certain distance 
 is in a fog or blur. Yet the child knows that there 
 are things to be seen, for by screwing up the eyes 
 details can be made out that are invisible when 
 the eyes are wide open. It is this habit of screwing 
 up the muscles of the eyelids that gives the name to 
 the condition. Proper short sight is known as 
 ' Myopia,* a term derived from a Greek word that 
 means ' to shut the eyes.' The eyelids are screwed up 
 to convert them into pinhole cameras like the eyes 
 of the pearly nautilus, mentioned in Chapter i. 
 
 There is a popular idea that short sight is strong 
 sight. It is the very reverse. The idea rests on 
 certain observations. Short-sighted people are 
 commonly able to read very fine print close to their 
 e3^cs ; also moderately short-sighted adults do not 
 
46 THE EYES OF OUR CHILDREN 
 
 have to take to reading-glasses at the age natural 
 to folk with healthy eyes. These two observations 
 are true in point of fact, but neither estabhsh the 
 strength of the sight ; they merely demonstrate the 
 shortness of the sight. 
 
 In short sight the shape of the eyeball is altered. 
 Instead of the globe of the eye being spherical, it 
 
 FIG. lO. 
 M, slretched myopic eye ; X, normal eye. 
 
 has become elongated, inclining to a sausage shape. 
 The elongation is not a natural condition Hke the 
 short or flattened eye. The flat eye is born, not 
 made. The elongation is the result of a gradual 
 yielding of the coats of the eyeball. This yielding 
 is the bad thing ; it indicates an inability to resist 
 the ordinary internal pressure of the eye, or the 
 ordinary strains exerted on the eye in the process 
 of vision. The yielding is a disease. The coats of 
 the eye that yield are in a state, of low-grade inflam- 
 mation, and being inflamed they are soft and yield 
 to strain exerted either from within or from without 
 the eye. It is no mere ' state,' it is a process, and 
 one that is changing in nearly every short-sighted 
 
SHORT SIGHT 47 
 
 eye during school years. Short sight is never, or 
 hardly ever, present at birth. It is rare at five years 
 of age. It usually begins during school Hfe, and 
 increases more or less from year to year during the 
 period of growth. It sometimes continues to increase 
 after growth is completed. 
 
 
 
 
 FIG. II. — BACK OF SHORT-SIGHTED EYE. 
 
 H, nerve ; a, artery ; v, vein ; C, crescent where the soft coats 
 of the eye have torn away from the nerve exposing the 
 white outside coat. 
 
 In the past few years much attention has been 
 given to the anatomical changes involved in near 
 work ; various theories have been formulated, and 
 some experimental work done in support of these. 
 Stress is laid on near work that involves the stooping 
 posture. One German ocuhst has gone so far as to 
 
48 THE EYES OF OUR CHILDREN 
 
 assert that the elongation of the eye is caused by 
 the drag of the optic nerve on the back of the eye- 
 ball, for in the stooping posture, he asserts, the eye 
 falls forward by virtue of its own weight. Personally 
 I do not credit the idea, but rather favour the theory 
 that it is largely the effect of the active constriction 
 of the eyeball by the muscles surrounding it, and 
 that come into play for the purpose of turning the 
 eyes inwards and downwards during near vision. 
 Be the actual process what it may, the effects of 
 near vision and the stooping posture are the factors 
 we must fix our minds on, particularly when we 
 have to consider the work that may be done by 
 myopic children. 
 
 The frequency with which myopia is met with 
 amongst children differs considerably in different 
 countries, and in different parts of the same country. 
 The first estimates of the incidence of the defect 
 were made by Cohn in Germany, and the report 
 which he gave was alarming. Amongst the children 
 attending the gymnasia or higher schools he found 
 the percentage exceedingly high, and increasing 
 from the lowest classes to the highest. The figures 
 varied from 15 '5 per cent, in the lowest class to 
 55 -8 per cent, in the highest. These figures were 
 serious, and called for a thorough overhauling of 
 the educational system under which it occurred. 
 That was the judgment of Germany, and in that 
 land no pains have been spared to improve school 
 
SHORT SIGHT 49 
 
 conditions, and so far as possible reduce the causes 
 of the short sight. 
 
 In this country the figures are much better. I 
 have pubhshed the returns of 2500 London school 
 children who had bad vision : 68 per cent, were 
 hypermetropic and 32 per cent, myopic. Roughly, 
 30 per cent, of the children who failed to pass the 
 standard vision-test failed because they were short- 
 sighted. These defective children represent about 
 10 per cent, of the school population, so that it 
 follows some 3 per cent, of the children are myopic. 
 
 But it must not be supposed that these myopes 
 were evenly distributed throughout the v/hole 2500 
 children examined, so many for each age group. 
 When the cases were plotted down according to the 
 ages of the children it was found that there were 
 very few short-sighted children in the younger years, 
 but a steady increase right through the school years 
 up to the leaving age. Here are the percentages :— 
 
 Age in years, .4567 8 9 10 11 12 13 14 
 Myopia percent., . o 2 8 12 20 24 33 40 49 52 65 per cent. 
 
 That return shows very well the character of the 
 myopia ; it comes on during school Hfe, and increases 
 in frequency and in degree with each year of school 
 age. 
 
 There are two sorts of myopia. There is, first, a 
 large group of cases of moderate myopia. These 
 may be called the school myopes. They are probably 
 the astigmatic children who, by reason of excessive 
 
50 THE EYES OF OUR CHILDREN 
 
 work, or work under bad conditions, have become 
 myopic. This class of case is a reflection on the 
 methods of education in vogue, and on the current 
 print of schoolbooks. 
 
 The other class is numerically small, but the 
 degree of myopia may be high. In this group are 
 most of the hereditary cases, children of myopic 
 families. These are tlie dangerous cases, for amongst 
 them we are hkely to find sooner or later some ten- 
 dency to compHcations which may endanger sight. 
 Opacities of the vitreous jeUy of the eye, miisccB 
 volitantes, or floating spots of irregular shape, are 
 very common occurrences. Small floaters may be 
 present in even low degrees of myopia and in quite 
 young children ; but spots so large that they may 
 be seen by the surgeon with the ophthalmoscope are 
 ominous. The stretched eyes are more delicate 
 than ordinary, so that relatively sHght injuries may 
 produce serious changes. The subjects of myopia 
 of any degree are more hable to eye-strain than 
 ordinary children ; so they often exhibit ' weak ' 
 eyes which are the outward signs of the eye-strain. 
 
 The part played by heredity in the production of 
 myopia may very well be considered here. There 
 is no one who is not thoroughly convinced of the 
 truth of the inheritance of family characters. Each 
 child of a family has been subject to scrutiny 
 on this score. If we recognize features, characters, 
 and tricks of mannerism that are pleasing, then we 
 
SHORT SIGHT 51 
 
 are quite sure that those characters came through 
 our side of the family tree ; if those same tricks or 
 features are not attractive, then no doubt they are 
 the result of a throw-back to a branch that we 
 remember most to forget ! As with general characters 
 so with particular characters ; and the eyes are no 
 exception to the rule. Indeed, the knowledge of the 
 hereditary characters of particular eye states is more 
 complete than for any other character of the body. 
 Workers on heredity have been able to follow out 
 eye peculiarities better than any other, for they do 
 not interfere with the possibility of continuance of 
 the family ; often they do not interfere with health, 
 and they are sufficiently marked to be remembered 
 by relatives even when the distant forbears have 
 departed. Congenital or birth cataract is a character 
 of this tj^pe, so is colour-bhndness, and there are 
 numerous pedigrees of these, and other defects, 
 running through many generations, which clearly 
 prove the inheritance of family characters in the eyes. 
 As regards myopia the case is not so simple. 
 There may be an inherited predisposition to the 
 stretching of the eyes. But if it be true, and of this 
 there is no manner of doubt, that defective school 
 conditions, or ill-health, may induce this same 
 stretching in the eye of the young child, then the 
 case is complicated. For all that, there can be no 
 doubt that myopia is very common in some families, 
 and comparatively rare or even unknown in others. 
 
52 THE EYES OF OUR CHILDREN 
 
 Recently I collected the case papers of 300 highly 
 myopic children for comparison, and of these 50 
 cases showed a definite family history of myopia — 
 that is, nearly 17 per cent. 
 
 Again, astigmatism is unduly common in myopes ; 
 it is responsible for eye-strain, and therefore may 
 be the start of myopia. In 300 highly myopic 
 children no less than 158, or 53 per cent., had marked 
 astigmatism, or nearly 10 per cent, more than the 
 average percentage in children with bad focus. 
 Astigmatism is due to the shape of the eye ; it is 
 hereditary, and in certain conditions may predispose 
 to short sight. 
 
 One other factor in the causation of myopia must 
 be considered. There is no doubt that health has 
 much influence on the state of the eyes. A robust 
 child, well fed, enjoying a maximum of outdoor 
 life, is less likely to get tired eyes and subsequent 
 stretching of the coats of the eyeball and myopia 
 than is a child that is cooped up indoors all day, 
 sitting over lessons, and never joining in vigorous 
 outdoor games. The figures given of the incidence 
 of myopia show that we in this country are less liable 
 to the condition than some continental nations. 
 Part of this difference may be due to the different 
 reading types : the gothic type of Germany is particu- 
 larly difficult to read, and certainly engenders eye- 
 strain in even normal eyes. But this is not the only 
 factor, for in countries where this type is not used 
 
SHORT SIGHT 53 
 
 there is also an excess of short sight. Opinion is 
 growing amongst ocuHsts in those countries that the 
 excess is in part due to the lack of vigorous outdoor 
 sports during school years, and efforts are being 
 made to stimulate the popularity of games such as 
 are played by all sections of our own community. 
 
 The education of short-sighted children presents 
 some difficulties. In London there have been 
 established special classes for the short-sighted 
 children of the elementary schools. These bid fair 
 to be a success ; already they are being copied ex- 
 tensively both at home and abroad. The principle 
 underlying the scheme of education adopted in these 
 classes is very simple ; it is a return to the primitive 
 methods such as must have existed amongst our 
 woad-tinted forbears, when the wise one of the 
 tribe taught the traditions of the fathers to the 
 children, initiated them in the secrets of their cun- 
 ning handiworks, and showed them how to make the 
 tribal marks upon the walls of their huts and caves. 
 There, in brief, is the scheme of the myope class : it 
 is essentially personal, and lacking in that modern 
 substitute for personal teaching, the book. 
 
 The scheme of work laid down for these classes 
 is as follows : — 
 
 (i) Oral teaching with the normal children for 
 such subjects as can be taught orally. 
 
 (2) Literary work, such as is necessary for the 
 knowledge of the ordinary means of comnmnication, 
 
54 THE EYES OF OUR CHILDREN 
 
 to be learned without the use of books, pens, or 
 paper, but by the use of blackboard and chalk, the 
 writing to be done free-arm fashion. 
 
 (3) A very full use of every sort of handicraft that 
 will develop attention, method, and skill, with the 
 minimum use of the eyes. 
 
 FIG. 12. — THE author's MYOPE DESK, IN USE 
 
 AS TARLK. 
 
 {Hammer and Co., Cliarins; Cross.) 
 
 These classes have now been working for some 
 seven years ; the eyes of the children admitted to 
 them have been the subject of regular periodic 
 examination, and it is found that their state is 
 benefited by the manner of work. The method is 
 attractive both to teachers and scholars, notwith- 
 
SHORT SIGHT 
 
 55 
 
 standing that the teachers must exert a degree of 
 alertness that is not the rule in ordinary teaching. 
 The teachers have to do real teaching. They can no 
 longer set a task from a book ; they have to give out 
 that which they know and which is part of themselves. 
 The children benefit proportionately, for there is a 
 
 FIG. 13.- 
 
 -TIIE author's myope DESK, 
 AS BLACKBOARD, 
 
 personal impression that can never be gained by 
 the use of a book, however excellent that may be. 
 
 The room in which this work is done must have 
 perfect natural light, and when that fails all black- 
 board or manual work should cease, and drill or 
 conversation be substituted. The numbers in a 
 class must be small ; twelve is the optimum number. 
 
56 THE EYES OF OUR CHILDREN 
 
 The hours should be short, and the periods of work 
 broken by frequent intervals. The teacher should 
 teach, then the children should write what they have 
 learned in large hand upon their own blackboards, 
 or print them with type on sheets of paper hung on 
 the walls. Drill, games, and dancing may be enjoyed 
 by most of these children, but there are some whose 
 eyes are so fragile that the greatest care must be 
 exercised, or the pleasure of some of these things 
 denied them. Manual work is dealt with in 
 Chapter xii. 
 
 The whole scheme of these classes is set out in a 
 paper that may be consulted by those interested. ^ 
 
 * Harman, 'The Education of High Myopes,' Proceedings Royal 
 Society of Medicine, 1913. Vol. vi., Ophthalmology, pp. 146-63. 
 
CHAPTER VII 
 
 SQUINT 
 
 SQUINT is the disorganization of the mechanism 
 which works the two eyes together; there is 
 with its onset a total loss of that most perfect and 
 valuable of all the functions of the human eyes — 
 binocular or stereoscopic vision. 
 
 The frequency with which squint appears amongst 
 children can be best judged by examining the figures 
 of my children's hospital. Of 1400 children examined 
 for bad focus no less than 199 had been brought on 
 account of squint ; all the younger children seen were 
 squinters. 
 
 Age . .4 
 
 5 
 
 6 
 
 7 
 
 8 
 
 9 
 
 Per cent, . j loo 
 
 100 
 
 63-2 
 
 32 
 
 7-6 
 
 177 
 
 5-5 5-2 
 
 7 "5 
 
 13 
 
 27 5"4 
 
 The great majority were of the fixed type with 
 one eye turned inwards: this is called convergent 
 squint ; when one eye turns out it is spoken of as 
 a divergent squint. 
 
 The ugliness of squint is patent to every one. It 
 is probable that the ' evil eye,' for which many hapless 
 old women were harried to their death on the sus- 
 
 67 
 
58 THE EYES OF OUR CHILDREN 
 
 picion of witchcraft in ' the good old days,' was no 
 more than a common squint, a ' cast ' in the eye, or 
 ' bossing,' as it is called in many parts of the country 
 to this day. And bossing has an evil significance ; 
 of persons it indicated a despicable and worthless 
 character, usually of decrepit age. ' I speak to you, 
 auld Bossis of perditioun,' Lyndsay, Works (ed. 1592). 
 Not only was squint thought to have evil significance, 
 and truly it caused the unfortunate subject thereof 
 many pains at the hands of others, but the defect 
 itself was considered to be the work of evil spirits. 
 In King Lear we find the following in the scene on the 
 heath at night : * This is the foul fiend Flibberti- 
 gibbet : he bec^^ns at curfew, and walks till the first 
 cock ; he gives the web and the pin, squints the eye, 
 and makes the hare-hp ; mildews the white wheat, 
 and hurts the poor creature of the earth.' 
 
 In nearer times than those in which Shakespeare 
 wrote, a squint has been the cause of slanderous 
 accusations against quite harmless individuals ; in 
 rural districts the squinter has been proverbially a 
 thief, somewhat after the kind of Taffy in the chil- 
 dren's rhyme. There is even something of this feehng 
 still existent to-day, and in more than one case a 
 man in business has desired to have the deformity of 
 squint corrected by operation, ' because he found that 
 people with whom he had dealings seemed to doubt 
 his probity when they noticed the squint ! ' 
 
 In its essence squint is a falling back into a lower 
 
SQUINT 59 
 
 state of organization, so far as the eyes are concerned. 
 Instead of the ' eyes right ' direct look of the man, 
 we get the irregular fixation of the eyes normal to 
 the lower animals. Monocular vision is the normal 
 condition of the lower vertebrates. Who has not 
 seen the movements of the eyes of a chameleon ? 
 One eye of the creature has been awake when the 
 other was lowered as if asleep, or one has looked 
 forwards whilst the other seemed to look backwards. 
 But that obvious absence of association of the two 
 eyes is no more remarkable than the regular lateral 
 position of the eyes in fishes. Their eyes can by no 
 means work together, for they are set on the opposite 
 sides of the head. When we examine the anatomy 
 of the nerves of the fish we find that there are two 
 distinct optic nerves that run quite independently 
 to the two sides of the brain, and there is no con- 
 nexion between them. It is quite otherwise with 
 the eye-nerves of man ; the two great eye-nerves meet 
 inside the skull, and join in such a fashion that half 
 the nerve of one eye unites with the corresponding 
 half of the nerve of the other eye ; so that the brain 
 receives the joint impression of the two images the 
 eyes have gained of the one object looked at. In the 
 fishes a complex arrangement would be no use ; their 
 eyes are more in the nature of alarums than organs 
 of perception, for they have other senses wherewith 
 to find their food and detect their foes. 
 
 The same holds good for the lower mammalia, e.g. 
 
6o THE EYES OF OUR CHILDREN 
 
 the rabbits. In these animals it is obvious that so 
 fine a faculty as binocular vision would be wasted, 
 for their visual perception is practically limited to 
 moving objects. At the least sign of movement in 
 the surrounding objects they are alert and run ; 
 whereas if a man will remain quite motionless the 
 rabbits will go on feeding all unconscious of his near 
 presence, provided the wind be in a favourable 
 direction. 
 
 There appears to be some attempt at two-eyed 
 vision in the higher hunting mammaha. The 
 domestic cat seems to have some such power, for it is 
 noticeable that the eyes work together in examining 
 near objects, and that a cat is able to ' handle ' an 
 object with great nicety, much more so than can 
 the dog. With this development of the eyes in the 
 hunting animals there is a large increase in the area 
 on the surface of the brain where is all the active 
 grey matter which belongs to the sense of sight. 
 This area is small in the hunted animals, but large 
 in the hunting animals. 
 
 In man the development is complete. The whole 
 of his face and the position of his body has been 
 remodelled to secure this great object. Man stands 
 erect to the view ; his face is flattened so that the 
 eyes may come well to the front, in which position 
 alone can they work together ; and the snout has 
 gone, and with it some of the keen sense of smell that 
 belongs to the lower animals. Man's eyes now work 
 
SQUINT 6i 
 
 on parallel axes, and they can be turned in towards 
 each other so as jointly to examine near objects. 
 
 FIG. 14.— NO squint: 'eves right.' 
 
 There is now constant association of the two eyes, 
 and tHis gives binocular vision, and with that the 
 ability to determine the size, the bulk, and the dis- 
 tance of any object. This judgment is effected by 
 
 FIG. 15.— squint: right eye turned in. 
 
 an unconscious, but trained, perception of the nerve 
 impulses required by the muscles of the eyeballs in 
 moving the eyes from one position to the other, as a 
 
 FIG. 16. — squint: right eye turned out. 
 
 man looks first at one and then at another object. 
 Binocular vision is something that the unfortunate 
 
62 THE EYES OF OUR CHILDREN 
 
 person who has not the faculty cannot understand ; 
 he therefore cannot be brought to reahze what is 
 missed. It is something Hke colour vision : to the 
 normal person red is a glorious colour, to the colour- 
 blind it is no more than drab, and no power can enable 
 such a person to understand the raptures of the 
 artistic over fine colour effects. So it is with tone- 
 deafness. 
 
 With the growth of this power of the eyes, there 
 has been a corresponding development of the brain 
 in the area where the visual centres are situated. 
 In man these occupy an enormous area as compared 
 with the hunted animals, and even when compared 
 with the areas of the hunting animals. Man is there- 
 fore easily first as the * mighty hunter before the 
 Lord.' If it were not for this great cerebral develop- 
 ment there never could have been that perfect 
 association of hand and eye that make the artificer, 
 the artist, and the musician. 
 
 The brain is the real factor in the production and 
 maintenance of binocular vision. It is the brain 
 that keeps the eye in control. This control goes by 
 the name of the ' fusion faculty ' ; the term indicates 
 the power of the brain to fuse into one satisfactory 
 picture the two divers images seen by the two eyes. 
 When we look out of the window the two eyes do 
 not see exactly the same view, for they are differently 
 related in point of space to each other. The right 
 eye is somewhat to the right, and therefore gets a 
 
SQUINT 63 
 
 wider view beyond the left-hand side of the window 
 frame; the left eye is situated rather to the left, 
 and gets a better view towards the right side. 
 The width between the two eyes is not great, 
 no more than four inches in the most widely set 
 eyes, but that little difference makes all the differ- 
 ence to the impression that is received by the eyes. 
 The two sHghtly diverse images are telegraphed up to 
 the brain by the nerve currents, the cells of the grey 
 matter of the brain fuse them together or overlap 
 the two impressions so that they become one, and the 
 sHght difference of the two impressions gives all that 
 feeling of solidity that we perceive in the view, 
 whether it be of trees, of statuary, or of persons. 
 
 Binocular vision is not present at birth. It 
 comes into play about the third or fourth week of 
 life ; but then it is weak and tottering, and just as 
 uncertain as a child beginning to walk. A very little 
 irritation, even a pin-prick, will cause the eyes to 
 squint. Pain, the convulsions of indigestion, the 
 irritation of worms, all will set up a squint of tem- 
 porary or permanent character. 
 
 The observation of the ease with which squint 
 may be induced is very old. Bacon writes : * Some 
 can squint when they will ; and children set upon a 
 table with a candle behind them, both eyes will move 
 outwards, to seek the light, and so induce squinting.* 
 A very similar warning is to be heard even nowadays 
 in many nurseries : the elder children are forbidden 
 
64 THE EYES OF OUR CHILDREN 
 
 to look at the baby from over the head of the cradle, 
 lest the baby in trying to see them should develop 
 a squint. There is an even more interesting obser- 
 vation in the famous Diary of Pepys. He writes : 
 ' At supper the three doctors of physic again in my 
 cabin, when I put Dr. Scarborough in mind of what 
 I heard him say : that children do, in every day's 
 experience, look several ways with both eyes, till 
 custom teaches them otherwise ; and that we do 
 now see but with one eye, our eyes looking in parallel 
 lines.' 
 
 Once binocular vision is established it is rarely 
 disturbed, but should the control of the brain be 
 weak, a very little irregularity of one or both eyes 
 will cause a squint to appear. 
 
 The state of the case may be illustrated by a simile. 
 The relation between the two eyes, the muscles of the 
 eyes, the nerves that stimulate the muscles, and the 
 brain that controls the nerves, is very Hke that 
 between the horses, the traces, the reins and the 
 driver of a four-in-hand. A good driver will master 
 a bad team. If the driver be bad, even though the 
 team be perfectly matched and the equipment all 
 that could be desired, the fool of a driver will surely 
 run the coach into the ditch at the first bad turn in 
 the road. So with the eyes. There may be an ill- 
 matched pair of eyes, the focus of one or both may 
 be bad, but if there be perfect brain control there will 
 be no squint, however adverse the conditions may be, 
 
SQUINT 65 
 
 but there will certainly be all the symptoms of eye- 
 strain. On the other hand, there may be a perfectly 
 matched pair of eyes, and with an equipment that is 
 perfect so far as can be determined, yet if there be an 
 imperfect brain control, then at the least difficulty 
 there will be * an overturning of the coach,' the eyes 
 will squint. If the baby be young, a prin-prick or 
 the worms will do it. When it is older a mild fever 
 will do it. When it goes to school the first turn 
 of close work will do it. Each of these things is 
 debited with the disaster, but really the fault was 
 with the brain. 
 
 This is an extreme case: there are some such, 
 but happily not many. For the most part squints 
 appear in those who have some defect in the focus of 
 the eyes ; there is some brain control, but it is not 
 so strong as to be able to keep the eyes together when 
 the circumstances are adverse also. When there is 
 the prin-prick, or the worms, or the fever, or the 
 lessons at school, then the added strain thrown on 
 the brain makes the work too much for it ; it ceases 
 to control the unequal eyes, so that one squints. 
 Squinters rarely or never complain of eye-strain 
 when the squint is estabhshed ; they have given up 
 the struggle. 
 
 It is obvious from the foregoing that it is very im- 
 portant to check the squint at its very onset. For 
 it means the cessation of a very important piece of 
 brain-work, one that has taken aeons of time to weld 
 
66 THE EYES OF OUR CHILDREN 
 
 into the brain fibre of man, and the loss of which 
 is something that cannot be measured in vulgar 
 fractions. 
 
 There is, however, another reason for deaHng with 
 a squint at the earUest possible date. And this is a 
 reason that is easier to understand than the fore- 
 going. When an eye is turned so that it continually 
 looks in a different direction to the other, the sight 
 of the turned or squinting eye is lost. The eye sees 
 nothing. That this should be so is an obvious 
 necessity. If it were otherwise the child would be for 
 ever seeing two objects, two steps, two doors, and 
 the confusion would be distressing and possibly en- 
 danger its life. With a child the connexions of the 
 nerves of sight are so lightly joined that the double 
 vision produced by squint may be lost in an hour 
 or so ; indeed, it is rare to hear of any record of such 
 a difficulty from the parents or nurses of these 
 children, except when the squint is of sudden onset, 
 as in the case of accidents, falls, and the hke. 
 
 If a squint be neglected the squinting eye may 
 become completely blind for all the finer purposes 
 of the eye. It will no longer be able to see letters 
 or recognize faces, it may even lose the power of turn- 
 ing so as to fix its axis on the spot that the owner 
 wishes to look at. Such a change as this in an eye 
 means the loss of the eye to all intents and purposes, 
 and it is a serious thing to begin fife with such a 
 handicap. It is a handicap that makes it impossible 
 
SQUINT 67 
 
 for the child in later years to enter most of the public 
 services. 
 
 When a squint is noticed the child should be taken 
 at once to a doctor who has skill in eye-work. His 
 first care will be to examine the focus of the eyes, for 
 if this be bad there must be difficulty in keeping them 
 under control. The correction of these difficulties 
 by the means of suitable glasses will in many cases 
 reheve the squint, and the eyes will come straight 
 again. Everything depends on getting the child early, 
 before the binocular faculty has withered from 
 disuse, and before the sight of the eye has been lost 
 by suppression. We are familiar with the effects of 
 disuse of the limbs after a long illness in bed, or we 
 have seen the pictures of the Indian fakir with an 
 arm shrivelled and powerless from years of disuse. 
 It is just the same with the squinting eye, even 
 though by the minutest examination we cannot 
 detect any visible sign of this withering. But if we 
 get the case early we can revive all the benumbed 
 and sleeping faculties, and get them back into full 
 work again. 
 
 If the squint has existed for some time the eye 
 doctor will try to wake up the sleepy, squinting eye, 
 by using a form of stereoscope ; by covering the good 
 eye for three or four weeks so as to make the other 
 do all the work ; or by putting some belladonna into 
 the good eye every day to prevent that eye seeing 
 near objects. All the methods depend for their 
 
68 THE EYES OF OUR CHILDREN 
 
 success on an early start ; if several years have passed 
 it may be impossible to reawaken the benumbed 
 sight of the eye. 
 
 Operation will cure squint. It is the only method 
 whereby we can get rid of the deformity when it has 
 persisted for several years. And it is the way to cure 
 squint when we find that we can both revive the sight 
 of the turned eye to a sufficient degree, and awaken 
 the dormant binocular brain centres : putting the 
 eyes straight by operation will allow the brain once 
 more to assume control, and binocular vision may be 
 restored. A fixed squint is like an obstacle to the 
 brain. We may correct the bad focus of the eyes 
 by glasses, awaken the sleepy eye and the binocular 
 brain centres, but yet fail to get rid of the squint. 
 The obstacle arises in this fashion. When there is a 
 marked squint the muscles of the eye are altered ; 
 some stretch, others shrink, and they get fixed in this 
 condition just Hke a crooked tree, then the brain 
 cannot regain control, and we can only get the eyes 
 to work together again by readjusting the tendons. 
 We shorten the stretched tendon and lengthen the 
 shnmken one. To-day these operations are among 
 the neatest and most perfect of surgical measures, 
 and as far removed as can be from the crude opera- 
 tions with which squint was first straightened. The 
 operation can be compared with the adjustment of a 
 bell-tent : when the pole is not set straight the whole 
 tent is lopsided, we therefore tighten one set of the 
 
SQUINT 6q 
 
 tent ropes and loosen another until the pole is 
 straight. The old-time practice of cutting the 
 shrunken tendon has been abandoned, for it slackened 
 the attachment of the eye, and involved the risk of 
 a squint in the other direction in later years. 
 
 There is a popular idea that children grow out of 
 squints. There is some truth in this idea. Many a 
 very young child has been seen to squint for a few 
 days when it is ill. Irritation may make it squint, 
 and when that irritation is withdrawn it wiU cease 
 to squint ; these are only temporary cases. Then 
 there are children who grow up with a squint, and 
 when they are well on through their teens, at the 
 time of puberty, the eyes of a few of them will get 
 straighter, or aknost straight, and the squint will 
 only be noticed when they are tired, and in the even- 
 ing. The temporary squint of the young child does 
 no harm. But it is a warning to the parents that it 
 probably has a weak brain control over the eye, so 
 they should be watchful to see that it is not over- 
 worked in its early years at school. The case of the 
 children who grow up with the squint is different. 
 Even though their eyes should come straight they 
 never lose the effects of the squint. They have 
 lost their precious faculty of binocular vision, and 
 the sight of the eye that was crossed is lost for all 
 practical purposes. 
 
 Squint is very frequently seen in families for 
 several generations. A weakness of brain control. 
 
70 THE EYES OF OUR CHILDREN 
 
 or a bad focus of the eyes may be inherited ; either 
 may precipitate squint when other circumstances are 
 favourable. The squint itself is not inherited, only 
 the conditions that favour its onset. It follows that 
 parents who know of the liabiUty to squint in one 
 or other side of their pedigree should exercise great 
 care when the children first go to school. There 
 should be no reading or writing when they are ill, and 
 no home lessons at any time. Further, it is well to 
 have their eyes examined early in case there should 
 be a bad focus to the eyes. 
 
 Occasional squint is a matter that must be referred 
 to. This is most frequently seen in girls. During 
 the day they look with both eyes straight forwards, 
 but when they are excited or tired, especially after 
 an evening party, or when they are not quite well, 
 one eye is seen to turn outwards. They are quite 
 unconscious of the turning, for the sight of the squint- 
 ing eye is suppressed, but when they are told of it 
 the eye is promptly brought back to its duties again. 
 This is due to weakness of the brain control. The 
 brain is able under most circumstances to keep the 
 eyes in order, but when there is excitement or fatigue 
 it gives up work for a moment and the eyes turn 
 out. We have all experienced something like this 
 when in a * brown study ' things seemed to double ; 
 that was because we were not paying attention, and 
 there was no definite object on which the brain could 
 balance the eyes. There is another condition that 
 
SQUINT 71 
 
 produces this occasional squint. In some children 
 the muscles of the eyes are not accurately balanced, 
 so that use of the eyes easily causes fatigue of the 
 controlling mechanism. It is hke driving a four-in- 
 hand with badly adjusted reins ; the driver soon gets 
 tired of the unequal strain. If then the control be 
 naturally a trifle below the standard, with the onset 
 of fatigue there will be temporary loss of control. 
 In any of these cases of temporary squint it is necessary 
 for the eyes to be examined by the doctor ; there may 
 be some error in the focus or some defect in the 
 balance of the muscles. The correction of either of 
 these will help the eyes and the controlling centres ; 
 also it is possible in some cases to institute a series 
 of exercises which will strengthen the control. 
 
CHAPTER VIII 
 
 SPECTACLES 
 
 SPECTACLES were once so rare as to be be- 
 queathed in last wills and testaments as heir- 
 looms. Now the use of glasses is so common as to 
 pass unremarked. 
 
 Glasses are indispensable for some children, but 
 even so they are a nuisance. No one can suggest 
 that they improve the looks of a child. Yet they 
 must be worn by some children lest a worse thing 
 befall them. It is a choice of evils, and when that 
 choice is between the wearing of a pair of spectacles 
 and the continuance of headaches, facial antics, or 
 any other of the host of fatigues and disabiHties, 
 there can be no question that it is better to have the 
 glasses than to have the pains. In many cases there 
 is the possibiHty that a pair of spectacles may be 
 like the proverbial * stitch in time,' and the timely 
 wearing of glasses may enable the child to do without 
 them at a later date, even perhaps for many years. 
 
 One caution must be given. There are many who 
 profess the necessary skill to * test the eyes scientifi- 
 cally.' We see these words, or others hke them, on 
 
SPECTACLES 73 
 
 many shop windows ; and those who so advertise 
 their capability are accustomed to add to their 
 names mysterious letters which represent the initial 
 letters of the trade societies to which they belong. 
 This is a free country. There is nothing to prevent 
 any one claiming any skill that he thinks he has. 
 The books we doctors write are open to any one to 
 read, and to understand if they will, and it may be 
 that som.c of those who hold out these advertise- 
 ments of skill have learned the lessons of these books 
 of ours so far as it is possible to learn by book and 
 not by hospital experience. But for those who have 
 the care of children and who value the eyes of their 
 charges, it will be wiser and safer to submit the eyes 
 of their children to the examination of an ophthalmic 
 surgeon whose training and experience will stand 
 them in good stead. It must ever be borne in mind 
 that the eyes are not mere optical instruments, but in 
 very truth members of the body, sharing in all the 
 difficulties and distresses of the body. It is by no 
 means infrequent that the eye surgeon sees first in 
 the eyes those signs of danger that are a warning to 
 the physician, and an indication for his treatment. 
 The knowledge of t&e eye cannot stand apart from 
 the knowledge of the body, and he who would be an 
 expert in the treatment of one member of the body 
 must first be a master of the art and craft of the 
 physician. 
 The work of the optician is of the utmost value. 
 
74 THE EYES OF OUR CHILDREN 
 
 We look to him to prepare the lenses and frames that 
 are necessary for the child ; he has the skill of grinding 
 the curvature of the glasses to the prescribed degree, 
 and the capability of making metals into convenient 
 and comfortable frames. But his work begins and 
 ends there. To expect him to ' test the eyes scien- 
 tifically ' would be hke expecting the oil and colour- 
 man to be an artist just because he has skill in 
 stretching canvases and mixing paints ; we know 
 he can prepare paints, he might by chance be an 
 artist of no mean skill, but we do not go to him for 
 academy pictures. 
 
 Lastly. It is very frequently necessary in examin- 
 ing young children to put drops or ointment into 
 the eyes so that a true judgment may be made of the 
 condition of the eyes. These preparations are derived 
 from the plant called belladonna atropina ; in the 
 hands of a doctor they are safe, harmless, and neces- 
 sary ; they should not, and indeed they are not, used 
 by any one but a doctor. The necessity for the use 
 of the drug is accounted for as follows : the focusing 
 muscles of a young child are very active, the focusing 
 lens is very elastic; between the two the range of 
 focusing power is very great. It is therefore not 
 possible in most cases to obtain a true judgment of 
 the focus of the eye unless this activity be temporarily 
 quieted by the use of a belladonna preparation. 
 When that is used the pupil of the eye dilates, and 
 the internal focusing muscle goes to sleep, then the 
 
SPECTACLES 75 
 
 true state of the vision can be determined. When 
 that has been done the belladonna is allowed to pass 
 off, or is driven out by the use of another extract. 
 When this procedure is not followed there is grave 
 danger in mistaking the focus of the child's eyes — 
 it may even be thought to be short-sighted when it 
 is not ; and if this be done glasses to correct short 
 sight may be ordered and the initial condition of eye- 
 strain aggravated, or the child may even be made 
 short-sighted by the wearing of the wrong sort of 
 glasses. 
 
 When glasses are worn the parent should be sure 
 that they are straight on the face, that the fit is such 
 
 FIG. 17. — THE AUTHOR S MODE OF FASTENING 
 GLASSES ON INFANTS. 
 
 that the Httle nose and ears are not cut by the frames, 
 and in many cases it is better to have a second 
 pair for use in case of damage to the first. 
 Occasionally spectacles have to be worn by very 
 
7^ THE EYES OF OUR CHILDREN 
 
 small children, or in case of squint even by infants, 
 then there may be some difficulty in fastening the 
 frames on comfortably and yet securely. The drawing 
 in Fig. 17 shows a very simple and satisfactory way of 
 securing the glasses, and one that will quite prevent 
 unpleasant pressure effects. 
 
 There is very little danger of injury to the face or 
 eye by the breaking of glasses. Accidents arising out 
 of their use are very rare ; and when the number of 
 glasses worn are considered, accidents are so rare 
 that one may say that the risk is altogether neghgible. 
 
CHAPTER IX 
 
 LIGHTING 
 
 THAT light is necessary to sight is a truism. But 
 to say that proper light is necessary to good 
 sight is to state a fact that is more honoured in the 
 breach than in the observance. To-day in our cities 
 there is more light than has ever been known since 
 the world began ; night is turned into day, and the 
 eyes suffer from over-stimulation. It is bad for the 
 elders, it is worse for the children. The production 
 of high-power lighting effects have added to the 
 apparent attraction of streets, halls, and shops, but 
 the manner in which these effects are obtained are in 
 many cases really damaging to the sight. 
 
 There are certain first principles in the matter of 
 lighting : (i) the source of the light must never be 
 directly in the line of sight ; (2) all lighting is relative. 
 
 The first of these principles seems almost self- 
 evident. Every one knows that to look at the sun 
 is dangerous. The sun is our chief source of hght, 
 and to get it directly into the line of sight is to risk 
 blindness, temporary or permanent. It is so with 
 
78 THE EYES OF OUR CHILDREN 
 
 every source of illumination. To look straight into 
 the light is to temporarily diminish the capacity of 
 the eye to see ; the eye is benumbed by the direct 
 briUiance of the illumination. 
 
 The second of these principles states that all 
 hghting is relative. There is no absolute standard 
 of illumination so far as the eye is concerned. If 
 we go into a cathedral that gives the impression of 
 fair general lighting on an ordinarily clear day, we 
 may see the walls and monuments. If we go into 
 that building again when the sun is streaming through 
 the clerestory windows, and stand in or near the 
 sunht space, we shall be quite unable to see the 
 walls or monuments, except in places where there 
 is sunshine, either direct or reflected. If we were 
 to measure the light on each of these two occasions 
 with a photometer we should find that the measure 
 of the light on the second occasion would be two or 
 three times stronger than on the first, but for all 
 that we could not see so well because the patches of 
 sunlight dazzled our eyes. Lighting is relative. 
 
 To learn those two lessons is to get at the secret of 
 good lighting. Make your lighting even, prevent 
 the exposure to the eye of any brilHant spots of 
 light, then sight will be comfortable, and fatigue will 
 be reduced to the minimum. 
 
 In these days we are sinners in this respect. When 
 the sources of artificial illumination were weak and 
 costly folk went to bed when it was dark, and their 
 
LIGHTING 79 
 
 eyes were well rested. When lights were feeble they 
 were careful to get the most out of the hght by the 
 use of good reflectors. With the new forms of 
 illumination, the electric arc, the metallic filament 
 glow lamp, and the high-pressure gas lamp, the source 
 of illumination is exceedingly small as compared with 
 the amount of light that is emitted therefrom. It is 
 this intensity of the light at the source that makes 
 the new lights painful to the eyes ; properly modified 
 by well-arranged shades they are safe, exposed and 
 unshaded they are dangerous in a manner that the 
 old flickering, low-intensity candle, oil, and gas jet 
 could never be. The tests of good lighting are 
 comfort, restfulness, and withal sufficiency for the 
 work or use of the place. 
 
 The environment of first importance in a school 
 is light. Buildings necessitate windows, and when 
 there are many rooms windows can only be fitted on 
 one side. A single source of illumination produces 
 shadows, therefore we must consider the source of 
 light from the position of the child. Light from 
 behind is absurd — the child sits in its own light. 
 Light from the front is bad — the child is dazzled by 
 the glare. Light from the right-hand side is poor — 
 shadows are cast by the writing hand. There remains 
 only the left-hand side, and light therefrom is at its 
 best. 
 
 The left-hand wall of the classroom should carry 
 one large window extending from four feet above the 
 
8o THE EYES OF OUR CHILDREN 
 
 floor to the clear level of the ceihng, and from the 
 hind wall forward for a full two-thirds of the wall. 
 Transoms and muUions should be as narrow and 
 shallow as possible, and blind boxes should be recessed 
 in the ceiling so that they do not encroach upon the 
 window area. Where obscured glass is required, 
 fluted glass should be used, and never ground glass, 
 for this latter reduces light considerably. Sun- 
 blinds for use in day-rooms in England should not be 
 coloured, but of cream holland. With such windows 
 in a fairly proportioned room, in a school built on a 
 suitable site, each desk will be well lighted, and the 
 blackboards and charts in the teacher's part of the 
 room will show up well. 
 
 The site of the school is important. If the school 
 building be in a crowded neighbourhood then the 
 school windows are likely to be overshadowed by 
 the near buildings. If this be so the best of windows 
 will be useless, for the clear light of the sky, 
 which should be visible from each desk in the room, 
 will be cut off by the buildings. A crowded region 
 is no place for a school. 
 
 Skylights give a fine light, but they are uncom- 
 fortable arrangements ; the room into which they are 
 fitted is always cheerless, and suggestive of the well 
 of an ancient prison into which the offender was 
 dropped. Again, they are cold in winter, hot in 
 summer, and dirty at all times. Such fitments are 
 good for certain types of workroom, such as art- 
 
LIGHTING 8i 
 
 rooms ; but for the partial living-room such as is the. 
 child's class-room they are bad. 
 
 Some authorities favour windows on two sides of 
 a room with the view of getting cross ventilation. 
 From the point of ventilation such an arrangement 
 is good, but from the view of the eyes it is bad ; the 
 eye is disturbed by the cross hghting, especially if 
 the level of the windows be nearly similar. 
 
 In America windows on all walls is advocated by 
 some, the idea being to imitate * natural open-air 
 conditions.' Such conditions cannot be imitated 
 in a room. A room is a box with holes in it, and by 
 no means can an enclosed space imitate the free 
 open air and hght of the earth. Neither is it desirable 
 that we should imitate the conditions of the open 
 sky for the workroom ; it is not pleasant to read out 
 of doors, the Hght is too strong in its reflection from 
 the white surface of the paper. 
 
 The decorations and furniture of a room have a 
 material effect on the hght. White reflects the most 
 light, but it is hard and uncomfortable to the eye 
 if unreUeved. The ceiling and a frieze of two feet 
 deep may be white. A pale grey or green tint 
 serves best for the walls ; it is restful to the eye and 
 permits of the largest amount of reflected hght that 
 is possible with any other than white walls. The 
 surface should be flatted, and on no account var- 
 nished, for that causes dazzling reflections. The 
 lower three feet of the wall should be painted a rather 
 
82 THE EYES OF OUR CHILDREN 
 
 darker colour. The desk furniture should not be too 
 dark : a light fumed oak is an excellent tint, and the 
 wood should be wax polished and not varnished. 
 
 Artificial Light. — So far as is possible close work 
 should be stopped when daylight fails. It is better 
 to prohibit it for children under eight years of 
 age. 
 
 The principles that underUe the planning of good 
 schemes of artificial illumination are simple. They 
 can be demonstrated by experiment : take an 
 ordinary wax candle, set it in a stand ; make an 
 opaque shade of some stiff paper white within, fix it 
 in a suitable frame so that it can be fixed around 
 the candle. 
 
 Take the hghted candle into a dark room, and try 
 to read some very fine print by the naked light ; it 
 will be difficult, for the light will be so close to the eyes 
 as to dazzle them. Now put the shade on so that the 
 naked light cannot be seen by the eyes, it will be 
 found quite easy to read the finest print and at a fair 
 distance ; in effect, the shading of the Hght has in- 
 creased its illumination manifold. That is the whole 
 art of illumination. These same effects can be 
 produced by lamp, gas, and electric light, and when 
 so produced none of these illuminants are injurious 
 to the eyes. Electric Hght has been debited with 
 unduly tiring the eyes, but these effects have arisen 
 out of the defective use of the light ; well used it is 
 better than any other light, for it is the only type 
 
LIGHTlNrx 
 
 83 
 
 of artificial light that does not flicker, and that does 
 not foul the air of the room. 
 
 Photometry, or measuring Light. — It is often 
 necessary to measure the light in terms that can be 
 recorded. We compare it with the hght of a stan- 
 dard candle — that is, a candle that bums so many 
 
 FIG. 18.— THE author's PHOTOMETER. 
 {Dav!(hon, Great Portland Street, London.) 
 
 grains of wax in an hour ; and the measure is the light 
 of one of these candles at the distance of one foot. For 
 convenience some simple piece of apparatus is needed. 
 Fig. 18 shows one devised by the author. Within 
 the box is the standard candle; it can be moved 
 to and fro, nearer or farther from the indicator plat- 
 form (F). The platform has a window in it screened 
 
84 THE EYES OF OUR CHILDREN 
 
 with waxed paper ; when the light within the box in 
 any position of the candle balances the light that 
 falls on the window from without, the window cannot 
 be seen, for both Hghts are of equal intensity. If the 
 candle is the stronger the window is bright, when the 
 outer hght is the stronger the window is dark. When 
 the point of equaHty is made out all that remains is 
 to read off the illumination in standard foot-candles on 
 the scale at the base of the box (C). Should we read 
 off five foot-candles, that means the hght of the room 
 at the particular spot examined is equal to the Hght 
 of five standard candles one foot away from the 
 point of examination. 
 
 There are other and rougher methods of estimating 
 the Hght. One that has been proposed by the school- 
 lighting committee of the Society of Illuminating 
 Engineers is the capabiHty of reading diamond type 
 (Fig. 19) at a distance of half a metre (20 inches). 
 
 This is Diamond Type. 
 
 FIG. 19. 
 
 If it can be done, the hght will pass ; if it cannot be 
 done, the light is bad. The test is rough, for much 
 depends upon the observer. 
 
 The standard of illumination fixed by that com- 
 mittee for artificial lighting of class-rooms was a mini- 
 mum requirement of two foot-candles ; for daylight 
 no absolute standard was fixed, for so much depends 
 
LIGHTING 
 
 85 
 
 upon the condition of the hght in all parts of the 
 room. From many experiments my judgment is 
 that no room that has in its darkest part Hght that 
 is less than nine foot-candles on an ordinarily clear 
 day is fit for class purposes. 
 
 How lighting can be varied by attention to details 
 can best be shown by photometric charts of class- 
 rooms, good and bad. 
 
 
 1 M 1 I 1 
 
 ^ 
 
 1 II 
 
 Ixf-x 
 
 1 
 
 
 1 — 1 
 
 
 1 
 
 X X 
 
 
 ^."'^ 
 
 ® .-v^ ! 
 
 FIG. 20.— BADLY PLANNED ROOM. 
 
 X, points of light ; 7", teacher. 
 
 Fig. 20 shows a class-room. The plan is bad. The 
 natural Hght is to the left of the children, but the 
 desks are separated from the window by a gangway, 
 so that the best region of illumination is unused ! 
 The artificial illumination is a typical gasfitter's plan. 
 Four points of Hght are set close together in the middle 
 of the room without any relation to the use of the 
 room. The effect can be seen in the photometric 
 charts of Figs. 21, 22, and 23. No. 21 is the lighting 
 
86 
 
 THE EYES OF OUR CHILDREN 
 
 as it was with naked fish-tail gas-bumers. The light 
 was everywhere insufficient, and, worse than that, it 
 was in a constant state of flicker. No. 22 shows the 
 
 
 
 .8 
 
 ^vot-candIe$ 
 
 1 
 
 
 1 
 
 0.4 
 
 1 
 
 
 0.4 
 1 
 
 
 0. 
 
 8 
 
 FIG. 21.— PHOTOMETRIC CHART. 
 NAKED GAS JETS. 
 
 illumination when Welsbach incandescent gas-burners 
 and the stock * Calypso ' type of shade were substi- 
 tuted : no more gas was consimied, but the light was 
 
 FIG. 22.— WELSBACH GAS, WITH 
 STOCK SHADE. 
 
 good for the centre of the room, although insufficient 
 for the sides. No. 23 shows the light when the best 
 form of reflector with sides set at an angle of 90° to 
 each other was used ; then the room was fairly well 
 lighted in all parts. 
 
LIGHTING 
 
 87 
 
 Fig. 24 shows a model class-room. The natural 
 illumination is all that could be desired ; there is also 
 a * squint ' to light the blackboard. The artificial 
 
 3co/-'Cana/«6 
 
 FIG. 23.— WELSBACH GAS, WITH 
 90° SHADE. 
 
 lighting begins also from the left-hand side, and is 
 arranged so as to give an even distribution over the 
 
 1 &LACKBOAR0 
 
 
 / 
 
 8^ 1 1 
 
 
 ^z][:n □d 1 
 
 
 l^e 1 11^ 
 
 53 1 i 
 
 
 □ 
 
 1 d 
 
 
 FIG. 24.— MODEL CLASS-ROOM FOR 40 CHILDREN. 
 
 T, teacher ; X, special lights ; A and B, positions 
 of two schemes of ighting. 
 
 whole room. There is a separate point of light for 
 the teacher's desk and for the blackboard, and both 
 
88 
 
 THE EYES OF OUR CHILDREN 
 
 are screened so that they do not shine in the eyes of 
 the children. Two sets of lamps are marked, A and 
 B ; A provides for extra illumination of rooms where 
 much close work has to be done. 
 
 The influence of shades and reflectors can be 
 judged by experiment. Fig. 25 shows the manner 
 of investigating the spread of the light along the 
 tops of the desks five feet below the light. With 
 
 FIG. 25.— METHOD OF EXAMINING SPREAD OF LIGHT. 
 
 the photometer the power of the hght was first 
 read off immediately under the hght, and then at 
 intervals along the desk tops from one to six yards 
 from the first spot. The first set of tests was made 
 with an ordinary Welsbach burner and incandescent 
 mantle, and the following results were obtained : 
 
 Shade. 
 
 Perpendicularly 
 5' below burner. 
 
 I yard. 
 
 2 yards. 
 
 3 yards. 
 
 4 yards. 
 
 None 
 
 'Reflex' globe 
 90° shade 
 
 O'l 
 08 
 2 '2 
 
 0-2 
 
 o'8 
 I '5 
 
 0'2 
 
 07 
 
 o-i 
 
 0'2 
 0-2 
 
 01 
 O'l 
 01 
 
LIGHTING 89 
 
 The increase in the desk illumination with the 
 90° shade is striking ; there was no appreciable loss 
 in the general room lightness, and the eyes were pro- 
 tected from the glare of the naked mantle. One 
 other advantage was noticed, and the figures show it 
 clearly : when there was no shade, or a stock pattern 
 shade, there was a black shadow immediately under 
 the light caused by the brass-work of the burner ; 
 
 FIG. 26.— A WELSBACH SHADE-GLOBE OF 
 SATISFACTORY PATTERN. 
 
 with the 90° shade there was no shadow at all. This 
 is a considerable point in gas-lighting, for the inverted 
 gas-burner should not be used in children's rooms, 
 since upside-down burning produces more unpleasant 
 fumes than erect burning. 
 
 Then the tests were made with electric Hghting 
 by the glow lamp, and the following results were 
 obtained, which show just the same improvement 
 by the use of an effective shade to reflect the light 
 
90 THE EYES OF OUR CHILDREN 
 
 downwards and protect the eyes from the glare of the 
 exposed lamp. 
 
 Shade. 
 
 Perpendicularly 
 4' below lamp. 
 
 I yard. 
 
 2 yards. 
 
 3 yards. 
 
 4 yards. 
 
 None 
 
 iio°, 3i"deep. 
 80°, 5" deep . 
 
 2 
 3 
 
 0-9 
 0-9 
 
 1 
 O'l O'l 
 
 05 1 03 
 
 1 
 0-5 0*2 
 
 O'l 
 O'l 
 01 
 
 There are other methods of using hght, known as 
 the indirect and the semi-indirect. By these methods 
 lamps are hung up within bowls, so arranged that the 
 light is thrown on to the white ceiUng, from whence 
 it is reflected in an even intensity over the whole 
 room. With the indirect the bowls are completely 
 opaque, no light strikes directly downwards. With 
 the semi-indirect the bowls are translucent, and allow 
 about thirty per cent, of the Hght to strike directly 
 downwards. These methods are deUghtful for rooms 
 where there has to be continuous movement, as in 
 play-rooms, or where large masses have to be shown, 
 as in museums. But they are expensive, for a great 
 deal of the hght is lost by absorption into the reflect- 
 ing surfaces. Of the two the semi-indirect is by far 
 the more comfortable to the eyes, and it gives better 
 illumination for a given expenditure. Of indirect 
 methods the cornice fashion of hghting is the most 
 pleasant. The light is placed two or three feet down 
 the wall within a deep cornice, from whence it is re- 
 flected by the walls and ceihng over the whole room. 
 
CHAPTER X 
 
 READING 
 
 HOWEVER excellent books may be in their 
 matter and in their print and paper, there is 
 a proper place for them, and away from that proper 
 place they are Hke dirt — matter in the wrong place. 
 They are out of place in the infants' departments. 
 There work should be modelled on the plan of the 
 primitive school, when books were too costly and 
 rare to be owned by any one of lesser years than the 
 teacher. For the infant, the sand-tray, the black- 
 board, and in their highest class only, the large paper 
 sheet, are all the equipment that is fitting for reading 
 and writing. The myope class is the ideal model 
 for an infants' school. 
 
 The first thing about a book that should engage 
 our attention is the binding. It must open flat, 
 otherwise the print will be unreadable ; many good 
 school-books are ruined by bad binding. The paper 
 of the book should be of a smooth, even texture, 
 neither glossy nor rough. If it be glossy then in 
 certain hghts there will be reflections from the pages, 
 and it will be quite impossible to see the print thereon 
 
 91 
 
92 
 
 THE EYES OF OUR CHILDREN 
 
 without fatiguing the eye. The paper must be of 
 just sufficient thickness to prevent the print of the 
 other side of the page showing through. The type 
 depends for its character upon many points : size, 
 boldness, face, the tags and finishes or ' serifs,' the 
 hair hues, and lastly, that most important matter, 
 the spacing of the words and the Unes. A good type 
 of print may be marred and rendered unpleasant to 
 the eye of the reader by a fault in any one of these 
 points. 
 
 In the report of the British Association there is a 
 typographical table showing the scale of print and 
 the relation of Hues and spacing for children of differ- 
 ent ages. It is reproduced here : 
 
 Standard Typographical Table 
 
 Age of 
 Reader. 
 
 Minimum 
 Height of 
 
 Face of 
 Short 
 
 Letters. 
 
 Minimum 
 Length of 
 Alphabet 
 of Small 
 Letters. 
 
 Minimum 
 Inter- 
 linear 
 Space. 
 
 Maximum 
 
 No. of 
 Lines per 
 Vertical 
 100 mm. 
 
 or 
 4 inches. 
 
 Maximum 
 
 Length or 
 
 Measure of 
 
 Line. 
 
 Under 7 yrs. 
 
 7 to 8 yrs. . 
 
 8 to 9 yrs. . 
 
 9 to 12 yrs. . 
 Over 12 yrs. 
 
 3 "5 mm. 
 
 2-5 mm. 
 
 20 mm. 
 
 I "8 mm. 
 
 1-58 mm. 
 or ^^jj inch 
 
 96 mm. 
 72 mm. 
 55 mm. 
 50 mm. 
 47 mm. 
 
 6 "5 mm. 
 40 mm. 
 29 mm. 
 2-4 mm. 
 2"2 mm. 
 
 1 
 
 10 ! 
 
 15 100 mm. 
 
 or 4 in. 
 20 93 mm. 
 
 orsfin. 
 22 93 mm. 
 
 or 3§ in. 
 
 24 93 mm. 
 
 1 or3§in. 
 
 Fig. 27 shows a ' typometer,' devised by the author, 
 to measure the type. It consists of a metal tube 
 
READING 93 
 
 containing a high-power lens ; at the bottom of the 
 tube is a millimetre scale ; when the instrument is 
 set on the print there is seen through the lens side by 
 side the magnified print and millimetre scale. 
 
 FIG. 27. — THE AUTHORS 
 ' TYPOMRTKR.' 
 
 The second column of figures seen in the table 
 indicates the breadth of the letters. This cannot be 
 given for the separate letters, as these vary. A fair 
 judgment can be obtained by measuring the length 
 of a word of thirteen letters and doubling that. 
 
 l/Vy I^V^ J. V^«.VI. Urj VxX.LlXVlX \^XX XX ^^xxx 
 
 FIG. 28. 
 
 Size in type does not mean height only. Tall 
 type gives a dazzling palisade effect, and it is less 
 legible than shorter and broader type. We read 
 along the tops of the letters and the chief points of 
 recognition are there (see Fig. 28). 
 
94 THE EYES OF OUR CHILDREN 
 
 Fig. 29 shows a model type ; it is bold and clear, 
 the letters form distinctive words, and the spacing is 
 
 This type may be used for 
 books to be read by children 
 from seven to eight years 
 old. Printed from Eighteen 
 Point Old Style Antique. 
 
 FIG. 29.— SPECIMEN NO. 4, BRITISH ASSOCIATION REPORT. 
 A MODEL TYPE. 
 
 perfect. The same type is shown without proper spac- 
 ing in Fig. 30, and it is ruined. It is false economy to 
 
 This type may be used for 
 books to be read by children 
 from seven to eight years 
 old. Printed from Eighteen 
 Point Old Style Antique. 
 
 FIG. 30.— GOOD TYPE SPOILED BY ABSENCE OF LEADING. 
 
 attempt to save space by cutting down the leading ; 
 legibility is destroyed and the book rendered worthless. 
 There are some books that ought never to be pub- 
 lished as a whole for school use. Shakespeare and 
 the Bible. Neither are whole books. And there is 
 no reason why the Bible should be issued to the 
 
READING 95 
 
 children in one volume of thin paper and poor print 
 that would be counted bad for a trade catalogue. 
 
 Recently I collected the used pages of some two 
 dozen school Bibles that had been withdrawn from 
 different schools as being too dirty for further service. 
 The used pages were so dirty that the print was in 
 many parts illegible. But the unused parts of the 
 books were as clean and untouched as the day they 
 came from the press. When all the used pages of 
 these Bibles were collated, it was evident that less 
 than one-fourth of the whole Bible was made use of 
 in these schools ! We want a school Bible of one- 
 fourth the present mass ; and this, produced in the 
 size of an ordinary school Bible, would allow of good 
 paper and good print, and the result would be worthy 
 of the greatness of the book and the use to which it 
 was to be put. If Cromwell in the days of the civil 
 war, when the Bible was the one and only book, 
 could make a ' Soldier's Bible,* there is no reason 
 why we cannot have a ' Children's Bible.' 
 
 Lastly, on the manner of the use of a book. It 
 should always be set up on a frame or reading-desk 
 at an angle of 60° with the horizontal ; it should be 
 on a relatively high level, with the bottom edge a very 
 little lower than the chin. It should never be held 
 any nearer to the eyes than twelve inches, and the 
 farther from the eyes it can be read the better. The 
 ideal reading position is that seen in any church. 
 There is the lectern with a large-print Bible set up at 
 
96 THE EYES OF OUR CHILDREN 
 
 a good angle and convenient to the eyes of the reader. 
 The standing position is excellent, for when the 
 limbs are tired of holding up the body it is full time 
 for the eyes to cease to read. Albeit there is one 
 point in which the church building is rarely conducive 
 to good vision : the Hghting, ' the dim rehgious light ' 
 is not to be copied in the nursery or the school. Such 
 counsels of perfection are scarcely possible in every- 
 day Hfe. But we may fairly insist on a good position 
 during reading, and totally inhibit the slovenly 
 crouch that children habitually fall into when ab- 
 sorbed in a story-book. One other practice should 
 be inculcated. Reading should cease for a few 
 minutes at frequent intervals ; the eye is rested, and 
 the momentary meditation will increase the value 
 of the reading. 
 
CHAPTER XI 
 
 WRITING 
 
 PENMANSHIP affects the sight of both writer 
 and reader. The writer is doubly affected; 
 the legibihty of the writing influences his eyes, but the 
 attitude assumed during writing has an even greater 
 effect upon his eyes. That the reader is tried both 
 in sight and in temper by bad writing is evident. 
 
 The style of handwriting is aifected more by 
 materials than by any other circumstance. Differ- 
 ences in material will explain the divergence in the 
 styles of writing of the world races. 
 
 The near Oriental script, e.g. Hebrew, is written 
 from right to left and in discontinuous letters. That 
 script had its origin in the delta of the Nile ; there the 
 most ready material was the reed, the prototype of 
 paper. With such material single-handed writing is 
 natural. The movement from right to left is deter- 
 mined by the balance of the muscles. The flexor 
 muscles that bend the fingers and arm are more 
 differentiated than the extensors that straighten them 
 and throw out the arm ; there are eighteen flexors 
 and only eleven extensors. Fine movements of the 
 
98 THE EYES OF OUR CHILDREN 
 
 hand are best controlled by the flexors, and by them 
 mark after mark can be most regularly placed from 
 right to left. We teach our children a single-handed 
 writing, and find they often begin to write from right 
 to left ; this perversity is a puzzle to the teacher, but 
 it is easier so to write. 
 
 Our western style arose on the rocky shores of the 
 northern side of the Mediterranean. Rock was the 
 material at hand. Our script was two-handed — the 
 left hand held the cutting tool, whilst the right de- 
 livered the blow. Sight compelled work from left 
 to right, for in that way only can the letter already 
 graven be kept in view. When the stone gave place 
 to wax and style there came single-handed writing, 
 and since the extensors are swift rather than delibe- 
 rate our originally discontinuous script has become 
 continuous and cursive. 
 
 The far-eastern Chinese vertical script is essen- 
 tially brush-work ; and, controlled by gravity, down 
 comes the aching arm ! 
 
 Our early penmanship had a bold, upright stroke, 
 the effect of parchment, coarse paper, and the quill ; 
 the delicate, sloping Italian hand is the outcome of 
 fine paper and the steel pen. The new materials led 
 the writing-master to emulate the florid work of the 
 engraver, forgetful that this work was designed to 
 render the subscription scarcely noticeable to the eye 
 lest it should compete for notice with the picture ! 
 
 The Italian hand was bad, not only because it was 
 
HANDWRITING 99 
 
 of poor legibility, but because the doing of it involved 
 cramped hands, twisted bodies, and eyes that were 
 set unequally before the work to be done ; all in- 
 duced a fatigue altogether disproportionate to the 
 nature of the task. 
 
 In recent years, thanks to the labours of Mr. George 
 Jackson, there has been a return to the upright style 
 of handwriting ; the change is in every way to ad- 
 
 FIG. 31.— ENGROSSING HAND. 
 
 vantage, the writing is easier to produce, and it is 
 easier to read. The only criticism that can be 
 advanced against the new style is that it is un- 
 commonly ugly. That is the effect of two conditions. 
 The schools that have adopted the upright style have 
 kept the old fine-pointed pen ; a good upright hand 
 can only be produced with a broad, smooth-pointed 
 pen. Again, the model on which the writing is 
 
100 THE EYES OF OUR CHILDREN 
 
 planned is none other than the Italian hand, and this 
 does not look well when it is straightened up. It 
 would be far better to adopt one of the fine old styles 
 such as the beautiful ' engrossing hand,' than which 
 nothing could be more pleasing to the eye or more 
 convenient to the hand. Another essential of a good 
 writing habit is the recognition that the ItaHan style 
 of holding the pen is quite wrong for an upright hand. 
 The child should be taught to hold the pen with the 
 holder pointing away from the body ; in this position 
 the flexors get the best control of the instrument and 
 the work is proportionately easy. There is no doubt 
 that the natural slope of the writing, from the writer's 
 point of view, is from left to right, just the reverse of 
 the Italian hand. This can be demonstrated by the 
 examination of any copy-book that contains the 
 initial efforts of the infant. The first pot-hooks will 
 be a fair imitation of the copy, the succeeding will 
 lean more and more to the left. On one occasion I 
 collected some infants who had never made any 
 attempt to write. Each was shown a large vertical 
 straight line, first on the sand-tray and then on paper. 
 By way of imitation they drew their chubby fingers 
 from the top left-hand corner of the tray towards the 
 bottom right-hand corner. It is worth remembering 
 these little natural difficulties lest we press our con- 
 ventions too rapidly upon them. 
 
 One thing is certain : all pens, copy-books, slates, 
 and pencils should be banished from the infants' 
 
HANDWRITING •' • ' " ' 'loi 
 
 school. The initial lessons in writing should be 
 made with the finger on the sand- tray. Slates should 
 never be used ; they are dirty, and marks thereon are 
 difficult to see. Succeeding the tray there should be 
 the blackboard and chalk. The board should be set 
 up at a slight angle from the vertical ; all work should 
 be done free-arm fashion and in large size. When 
 there is a desire for some permanent record sheets of 
 coarse paper should be clipped on the blackboards 
 and the work be done with crayons. It is time 
 enough for the infants to learn the use of pen and 
 pencil and paper when they have arrived at the age of 
 seven. Such a reasonable limitation as this would do 
 much to check the early onset of eye troubles. 
 
CHAPTER XII 
 
 SEWING : HANDICRAFT I DRAWING 
 
 NO child should make the acquaintance of the 
 ordinary sewing-needle before the age of seven 
 years, for its use is certain to be fraught with evil to 
 the eyes, and perhaps the general health, of the child. 
 
 The reason for this denunciation of needlework for 
 young children is to be found in this one fact : no child 
 can be persuaded to do what we know as sewing at 
 anything like a safe distance from the eyes. 
 
 Dr. Louisa Woodcock, in 1909, investigated the 
 habits of children in sewing. In one hundred children 
 in several classes, from six to ten years of age, 
 doing either sewing or knitting, 84 per cent, held 
 their work at from four to six inches distance from 
 the eyes, or even nearer, and the 16 per cent, 
 who had a better working distance were mostly 
 engaged in knitting. Not one child in the whole 
 hundred did her work at the distance of twelve inches 
 from the eye, which was the distance prescribed by 
 the rules of that school. 
 
 These observations are starthng ; they show the 
 difficulty of controUing the practice of fine work. 
 102 
 
SEWING: HANDICRAFT: DRAWING 103 
 
 In the fineness lies the whole difficulty. Work that 
 is fine demands the concentrated attention of the 
 child, and when that is engaged the child tends un- 
 consciously to get closer and yet closer to the work. 
 The reason for this is to be found in the fact that the 
 nearer we can get to an object the larger is the image 
 that our eyes get of it, and consequently the more 
 impressive is the effect upon the brain. 
 
 In these children the evidences of strain were 
 many : (i) There was a bad position of the body, 
 the work being pressed close to the chest to obtain 
 a point d'appui, entailing a stooping posture, and 
 rounded and high shoulders. (2) Squinting, set up 
 by the excessive convergence of the eyes. (3) Cor- 
 rugated forehead and knitting of the brows. (4) 
 Twisting of the body and neck, the head being held 
 sideways from unequal action of the muscles of the 
 two sides. (5) Grimacing, open mouth, and as- 
 sociated action of the muscles of the face with the 
 movements of the fingers. These are often merely 
 tricks of manner, but they are Hable to be the start 
 of ' habit spasms ' in nervous children. 
 
 Girls must learn needlework. And most boys 
 find it useful in after life to have some knowledge 
 of the handUng of a needle. Most of the bad effects 
 of the teaching of this necessary subject come about 
 by the endeavour to get something done. We should 
 be content rather to teach the methods with large- 
 scale materials, believing that with the knowledge of 
 
104 THE EYES OF OUR CHILDREN 
 
 the method there will come in later and more robust 
 years the capacity to make practical use of these 
 lessons. 
 
 Knitting is a less absorbing task, and the distance 
 at which the child will do it, even when not under the 
 eye of the teacher, is better and safer. 
 
 One word must be written on the materials to be 
 used for these early lessons. The wools had better 
 be of the duller colours, and not of briUiant reds 
 and yellows. Canvas should be of an unbleached tint, 
 and wools of the green and brown shades are the least 
 dazzling to the eye, and therefore the more restful. 
 
 In later years when children are allowed to practise 
 needlework, there are certain rules that must be 
 put into force. The work should never be done by 
 artificial light ; if the natural light fail then that 
 lesson should be postponed. The Ught of the window 
 must fall upon the left-hand side of the child and of 
 the work, so that the sewing hand does not over- 
 shadow the light. Let the periods of sewing be short 
 with intervals of other work in between, say half 
 an hour of stitching to be followed by five minutes' 
 interval of body movements. Never let a child 
 count stitches. And last, and by no means least, if 
 a child should be found to excel in the fine sewing, 
 insist upon her eyes being examined lest she be short- 
 sighted. There are not a few cases on record where 
 girls who have shown great skill in needlework and 
 embroidery have been exploited by ignorant teachers 
 
SEWING: HANDICRAFT: DRAWING 105 
 
 for the production of competition work, and even 
 embroidery for church purposes, to the grave injury 
 of their eyes. 
 
 Handicraft for boys has few dangers to the eye, 
 and many advantages over all forms of schoolwork. 
 First and foremost it is most natural work, for in 
 doing it the child is all motion. Arms, legs, body 
 and head are all agog, and the motion is all to the 
 good. Contrast the positions of the child in the 
 class-room and in the workshop. In the class there 
 is a teacher who is * an excellent disciplinarian,' and 
 the children are like Httle Buddhas, rigid in the 
 perfection of obedience. 
 
 A child with ordinarily healthy eyes may do any 
 handicraft. In the case of children with short- 
 sighted eyes we must ask. Can the child do the parti- 
 cular sort of work without undue or too prolonged 
 stooping? Judged by this test thero is a great 
 difference between carpentry and bent-iron work. 
 In carpentry the head is almost always bent down- 
 wards towards the bench ; it is quite useless to 
 attempt to raise the bench to a near level of the eyes 
 to prevent stooping, for then the muscles of the arms 
 and shoulders lose all power over the tools, and the 
 work is unduly fatiguing. Bent-iron work, on the 
 other hand, can be done standing or sitting ; the bench 
 may be at a comparatively high level, and, best of all, 
 the work is done for the most part with the eyes 
 looking straight forwards. 
 
io6 THE EYES OF OUR CHILDREN 
 
 For short-sighted children sewing should be pro- 
 hibited at any age. Knitting may be done if the 
 child shows aptitude, and can do it more or less 
 automatically. Small children may be taught paper- 
 folding, stick-laying, felt-weaving in colours, and 
 knitting. The older children and some juniors may 
 be taught map-modeUing and rough wood-work, 
 where measuring can be done with rulers marked 
 with quarter-inch marks. Advanced basket-work 
 may be taught, but not including raffia work, which 
 is too fine. Bent-iron work is particularly satis- 
 factory for the boys. Netting of hammocks, tennis- 
 nets, etc., may be done by boys and girls. For the 
 girls cookery, laundry, and simple housewifery may 
 be used as a substitute for the sewing lesson. 
 
 Drawing. — In the last ten to twenty years the 
 teaching of drawing has been so revolutionized that 
 there is httle room for criticism, but much for praise. 
 The manner of the training, the materials used, and 
 the type of model chosen are as far removed as can 
 be from the old-time teaching of ' freehand drawing,' 
 or rather the copying of stiff line copies. Recently 
 in watching the work of classes in several different 
 types of schools there was no fault to find with the 
 general style of work. In a few instances models 
 of too small size were set up for drawing. Also free- 
 hand drawing was being practised from a large-scale 
 copy hung up on the blackboard. The copies were 
 found to be unsatisfactory, in that they were printed 
 
SEWING: HANDICRAFT: DRAWING 107 
 
 in dark grey ink on tinted paper ; the contrast 
 was not sufficient to render them visible at a sufficient 
 distance. 
 
 A word of caution is needed on the use of ' squared 
 paper ' for use in mechanical drawing and perspective. 
 The rulings must of necessity be weak and pale in 
 tint, otherwise they overpower the subject of the 
 drawing; therefore such papers must only be used 
 by well-grown children, and only in rooms where 
 there is natural daylight of the most perfect type. 
 
CHAPTER XIII 
 
 CATARACT 
 
 CATARACT is the name given to opacity of the 
 lens of the eye. It means hterally a pouring 
 down. It got this appHcation before the facts of 
 cataract were known, and it merely meant that 
 something had gone over the sight. 
 
 To appreciate cataract the origin of the lens must 
 be understood. Reference should be made to 
 Chapter i. on the growth of the eye and to the pic- 
 tures of the early eye. The crystalline lens, the teeth, 
 the hair, the nails, and the numerous skin glands of 
 the body, although so different in their final forms, 
 have each a similar origin and mode of development. 
 They spring from the surface tissue that makes the 
 epidermis or scarf skin. They commence their 
 growth by pushing down as pits into the underlying 
 tissue that makes the general skeleton and muscu- 
 lature of the body. These pits become flask-shaped, 
 and from the cells at the bottom of them there grow 
 up these appendages of the skin — nails, the hair, 
 teeth, etc. In the case of the lens of the eye there is 
 no return outgrowth, for the connexion of the lens 
 
 108 
 
CATARACT 109 
 
 pit with its mother surface cells is cut off, so an island- 
 like sphere of cells is buried to continue an isolated 
 development. Within the limits of this sphere the 
 solid lens is produced. 
 
 The cells within the sphere elongate, become 
 fibrous, assume a clear, transparent character, and 
 spread over each other in neatly arranged layers. 
 The fibres are cemented together by a fine glue, and 
 the whole lens is enveloped by a clear elastic capsule. 
 
 Since the lens is made up of many fibres glued 
 together along their contour and also at the ends 
 where they meet in radiating lines, it follows that a 
 very little defect in this delicate joinery will result 
 in flaws of the lens. Indeed, no lens is absolutely 
 perfect. To the eye with the most perfect vision a 
 distant point of fight appears as a ' star,' that is, a 
 point of light with several rays ; these rays are the 
 dispersion of the fight along the flaws of the joints of 
 the ends of the lens fibres, and each ray coincides 
 with a line of joinery. When these fines are grossly 
 marked one form of cataract is present. 
 
 The outgrowth of the nails and the enclosed growth 
 of the lens are both specialized in that their sub- 
 stances become transparent. A very fittle injury 
 to the nail-bed, from accident or from disturbance of 
 growth by severe iUness, wiU produce flaws in the 
 nail which appear as white marks. So with the lens ; 
 serious disturbance of its nutrition will cause a whole 
 layer of fibres to be badly formed or shrink, and 
 
no THE EYES OF OUR CHILDREN 
 
 fluid is deposited in minute drops along their lines. 
 These defective layers of fibres are more or less 
 opaque, and form a cataract. 
 
 Cataract in children is frequently divided into two 
 classes according to the time at which the disturbance 
 of the lens is beHeved to have happened. One is called 
 
 * congenital ' cataract, because the child is born with 
 the cataract already in the eye. The other is called 
 
 * infantile ' cataract, because the cataract is formed 
 after the child is born. 
 
 Congenital cataract has many different forms. 
 Some are very curious ; they rival the eccentricities 
 of the Venetian fancy glass workers, but they cause 
 bad sight or even bhndness. Many are hereditary ; 
 their occurrence has been traced for generations in 
 many pedigrees. 
 
 Not all congenital cataracts are due to inheritance ; 
 many are due to pre-natal arrest of development. 
 For some reason the nourishment of the infant 
 developing within the mother is arrested, and the 
 delicate structure of the lens is affected. Other 
 congenital defects of the eyes and of other parts of 
 the body, such as hare-lip and cleft palate, are pro- 
 duced in the same way. Since the eye in its develop- 
 ment is so closely associated with the brain, a shock 
 of sufficient degree to disturb the lens may also dis- 
 turb the growth of the brain. Many children who 
 have congenital defects are not quite so smart as their 
 normal playmates. Further, the disturbance of the 
 
CATARACT iii 
 
 growth of the eyes is not confined to the lens ; it 
 affects the retina to some degree, so that even when 
 the surgeon has successfully operated on the eye 
 and removed the cataract the sight may not be so 
 keen as in ordinary children, nor so good as in 
 children operated on for infantile cataract. 
 
 Infantile cataract comes on after birth, and is the 
 result of some illness, such as fits, rickets, or digestive 
 
 FIG. 32. —CATARACT. 
 /, iris ; cut away at c to show edge of 
 lens, and //, ligament ; o, main opacity; 
 r, secondary opacity. 
 
 troubles. The cataract is not unhke the ' alley 
 marble ' beloved in boyhood days. It was a sphere 
 of glass, clear for the greater part, but within its core 
 was embedded a device of threads of coloured glass 
 arranged in spherical or spiral fashion. The cataract 
 is something hke that ; instead of a wholly clear, 
 transparent lens there is within it a layer of opaque 
 substance. 
 
 Cataracts of both orders are usuallv, but not in- 
 
112 THE EYES OF OUR CHILDREN 
 
 variably, found in both eyes. The opacity varies in 
 density and in size ; in some it obstructs vision 
 completely, in other cases fair vision may be obtained 
 either through the substance of the opacity when it 
 is thin, or around its edges when it is of small dia- 
 meter. When the opacity is so marked or large that 
 the child cannot see through it, then the cataract 
 should be removed. Operation is quite a safe pro- 
 cedure, and can be done in infants under a year old. 
 The earlier it is done the better, for there is so much 
 the better chance of the back of the eye, the retina, 
 getting the necessary stimulus to enable it to attain 
 a satisfactory growth. 
 
 The operation consists in removing the damaged 
 lens, so as to make once more a clear pupil and a free 
 path for the rays of Hght to the back of the eye. 
 When that is done the loss of the lens is made up by 
 the wearing of spectacles. 
 
CHAPTER XIV 
 
 WORD-BLINDNESS AND COLOUR-BLINDNESS 
 
 THESE two defects are of great interest, though 
 they are not very common. They are not 
 defects of the eyes at all, but are really mental 
 defects. But that does not mean to suggest that the 
 subjects of these peculiarities are ' mentally deficient ' ; 
 indeed, the reverse is often the more true. Certainly 
 this is so in the case of the subjects of colour-bHndness. 
 Some of the affected are brilHant members of society, 
 and the discoverer of the defect, Dalton, the great 
 scientist, was himself colour-bHnd. 
 
 Colour-bHndness occurs in about three to four per 
 cent, of males, and in a smaller number of females. 
 It is frequently hereditary, and the manner in which 
 it is handed down through generations is peculiar. 
 The males suffer from the defect, but the females 
 carry it on. A mother may have good colour vision, 
 but if she comes of an affected family her sons may 
 be colour-blind, but her daughters may not be ; yet 
 these girls may have the defect latent within their 
 germ plasm, and their sons may be colour-bHnd. 
 
 Colour-blindness is a defect in the registering 
 
114 THE EYES OF OUR CHILDREN 
 
 apparatus in the brain, and in some sort a reversion 
 to a primitive condition. It is incurable. Many 
 colour-blind persons are able by a carefully trained 
 judgment of light and shade to detect the differ- 
 ences between coloured objects and correctly name 
 those differences. But ask them the name of one 
 isolated colour, and their incapacity may be dis- 
 closed at once. It is of importance to recognize the 
 defect early and to turn the attention of the pupil 
 to work in which his lack will present no handicap 
 when the time for the labour of life comes. Such 
 children should early learn there is no work for 
 them at sea, or on the railway. 
 
 Word-blindness is a much more serious defect, for it 
 cuts off those marked by it from ready appreciation 
 of the ordinary means of communication by print. 
 They see correctly. Tested with figures or pictures 
 they may pass the standard. But the letters of the 
 alphabet when strung together to form words con- 
 vey no meaning to them. The defect is due to a 
 want of association of the brain centres. Reading 
 after the western method is a performance that re- 
 quires a high degree of cerebral association. The 
 eyes see first letters, then combinations of letters. 
 What the eyes see is translated into sensible ideas by 
 the correlation of the sight centres of the brain with 
 the educated memory centres. In the ordinary sub- 
 ject the association has become by training ahnost 
 automatic. 
 
WORD-BLINDNESS: COLOUR-BLINDNESS 115 
 
 The defect is usually mistaken at first to indicate 
 some visual incapacity, but the examination of the 
 eyes readily leads to their exoneration. It is note- 
 worthy that these same children may show consider- 
 able facility in reading figures, even money sums. In 
 this work the association is much less extended ; the 
 symbols are shorter for the idea that they are in- 
 tended to convey. This gives th^ clue to the best 
 mode of teaching these children. They must be 
 taught on the plan of the Chinese. The Chinese script 
 is a sign script, each word or idea has its own symbol ; 
 the idea is not conveyed by a string of letters in com- 
 bination, but by one particular sign. A certain 
 mark conveys to the taught child the idea of a house, 
 just as does a picture, or as the symbol 1 the idea of 
 unity or one. To teach these children reading we 
 must fall back on this plan. The word * cat ' must 
 be taken as a whole, not as c « t—cat, but the whole 
 thing is the sign for cat. The method is known as 
 the * look and say ' plan, and when carried out by a 
 teacher of intelHgence and with great patience, it is 
 possible to teach the child to read. In such cases it 
 is obvious that individual teaching is necessary to 
 secure any effective progress. 
 
 There are differences in the degree with which the 
 defect is found. Those which have it in small 
 degree are most likely to be overlooked, and such 
 children get into constant difficulties with teachers 
 who are not themselves quick enough to recognize 
 
Ii6 THE EYES OF OUR CHILDREN 
 
 that they have to do with something other than 
 stupidity. This defect when of small degree pro- 
 duces children who are bad readers or execrable 
 spellers. 
 
 Such a condition as this brings this httle book 
 very fittingly to a close. The time was when, accord- 
 ing to a crude but estabhshed usage, the mistakes of 
 the child were debited to an extra dose of original 
 sin which the rod of correction would drive far from 
 him. To-day we know that some of these defects are 
 indeed in their essence due to a dose of original defect, 
 but the child is not responsible, and punishment is no 
 fitting treatment. We now try to discover the circum- 
 stances of these defects ; and the more care we take 
 in these investigations the better our success in the 
 treatment of them. 
 
INDEX 
 
 Accommodation, 34. 
 
 Aching eyes, 31. 
 
 Adenoids, 22. 
 
 Albino, I. 
 
 Antics, 29. 
 
 ' Apple of the eye,' 14. 
 
 Astigmatism, 39, 52. 
 
 Bacilli, 18. 
 Bandages, 20. 
 Binocular vision, 59. 
 Blackboards, 87, loi. 
 Blepharitis, 6. 
 'Blight,' 12. 
 Blindness, 24, no. 
 
 colour, 51, 113. 
 
 moon, 37. 
 
 word. 114. 
 
 Blinking, 10, 29. 
 
 Blisters, 21. 
 
 Books, 43, 55, 91. 
 
 ' Bossing,' 58. 
 
 Brain growth, 60. 
 
 control, 62, 71, 114. 
 
 Candle-power, 83. 
 Cataract, 51, 108. 
 Ceilings, 81. 
 Cinematograph, 34. 
 Class-rooms, 79, 85. 
 Close work, 30, 65, 102. 
 Colour-blindness, 51, 113. 
 Congenital defects, no. 
 Conjunctiva, 6, 12. 
 Conjunctivitis, 15. 
 
 epidemic, 16. 
 
 phlyctenular, 20. 
 
 purulent, 24. 
 
 school. 15. 
 
 trachoma, 27. 
 
 Contagion, 15, 17. 
 Convalescent homes, 23. 
 Convalescents, 43. 
 Cornea, 14. 
 ulcers, 21. 
 
 Defective eyes, 35. 
 Desks, 53. 
 Dirt, 8, 13. 
 Drawing, io5. 
 
 Eczema, 9. 
 
 Egypt. 27. 
 
 Electric light, 79. 
 
 Emigration. 28. 
 
 Emmetropic, 32. 
 
 Errors of focus. 9, 35, 65, 71. 
 
 Eyelids, 6, 30, 45. 
 
 ' Evil eye,' 57, 
 
 Eyes — 
 
 Coats. 46. 
 
 Complex, I. 
 
 Defective, 35. 
 
 Development, i, 108. 
 
 Fiat, 38. 
 
 Muscles, 33. 
 
 Simple, I. 
 
 ' Sleepy," 65. 
 
 Sore, 6. 
 
 Stretched, 47. 
 
 Weak, 8. 
 
 Work, 32. 
 Eye-strain, 5. 29, 65, 71. 
 
 Fatigue, 10, 34. 
 
 Fever, 8, 14, 43, 65. 
 
 Fine print, 45. 
 
 Flat eye, 38. 
 
 Focus, error of, 9, 32, 64, 71. 
 
 Foot-candles, 83. 
 
 117 
 
ii8 THE EYES OF OUR CHILDREN 
 
 Frowning, 29. 
 Fusion, 62. 
 
 Gas light, 79. 
 Glands, 7. 
 Growth, 4. 
 
 Habit-spasms, 31. 
 Handicraft, 55, 105. 
 Hands, dirty, 15. 
 Handwriting, 97. 
 Headaches, 31, 41, 71. 
 Heredity, 50,69, no, 113. 
 Hours of school, 56. 
 Hypermetropia, 38. 
 
 Ill-health, 10, 22, 43, 51. 
 Illumination, 80. 
 Impetigo, 16. 
 Indirect light, 81, 90. 
 Iris, 4, 33. 
 
 Knitting, 102. 
 
 Lens, 34, 108. 
 
 Light, 4, 34, 77, 80. 
 Lotions, 10. 
 
 Manual work, 105. 
 Maternal inheritance, 113. 
 Measles, 8. 
 
 Mental defects, no, 113. 
 A4icrobes, 9, 18. 
 Modelling, 44. 
 Monocular vision, 59. 
 Moon-blindness, 37. 
 Muscles of eyes, 33, 68. 
 Myope class, 53. 
 Myopia, 43, 45. 
 
 Navy tests, 42. 
 Nautilus, I. 
 Nerves, 31. 
 
 Notification of disease, 25. 
 Nystagmus, 5. 
 
 Oil, 23. 
 Ointment, 10. 
 Open-air schools, 24. 
 Operation, cataract, 112. 
 
 squint, 68. 
 
 Ophthalmia neonatorum, 5. 
 Oral teaching, 55. 
 
 Pain, 18. 
 Painting, 44. 
 Paper, 91, 107. 
 Penmanship, 97. 
 Photophobia, 19, 
 Photometry, 83. 
 Picture-writing, 115. 
 Pigment, i, 4, 37. 
 Pink eye, 5, 13. 
 Posture, 96, 97, 103. 
 Print, 45, 92, 
 Prophylaxis, 26. 
 Pupil, 4. 
 
 Purulent conjunctivitis, 24. 
 Pus, 19. 
 
 Reading, 91. 
 
 glasses, 46. 
 
 Rest, 35, 96. 
 
 School conditions, 27, 51, 77. 
 
 Scorpion, i. 
 
 Serum pox, 16. 
 
 Sewing, 102. 
 
 Shades for Hghts, 82, 89. 
 
 Short sight, 45. 
 
 Signs, 115. 
 
 Skylights, 80, 
 
 Slates, 100. 
 
 Sleepy eye, 67. 
 
 Smallpox, 26. 
 
 Smoking, 44. 
 
 Sore eyes, 6. 
 
 Sore noses, 22, 
 
 Spectacles, 11, 72, 112. 
 
 Spelling, bad, 115. 
 
 Squint, 5, 57. 
 
 Stars, 109. 
 
 Stooping, evil of, 47, 96. 
 
 Stretched eye, 46. 
 
 Teaching, 55, 115. 
 Tears, 4, 7. 
 Teeth, 22. 
 Tonsils, 22. 
 Towels, 16. 
 Trachoma, 27. 
 Typography, 92. 
 
 Ulcers, 21. 
 
 Vaccination, 26. 
 
INDEX 
 
 riQ 
 
 Vision— 
 
 Beginnings of, 3. 
 Binocular, 59. 
 Distant, 45. 
 
 Walls, colouring. 
 
 Washing, 17, 20. 
 Weak eyes. 8. 
 Window-lighting, 80. 
 Word-blindness, 114. 
 Writing, 97. 
 
Printed by T. and A. Constable, Printers to His Majesty 
 at the Edinburgh University Press 
 
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