Record and analysis with conclusions upon the examination of 1,041 school children attending the Bradford Eye and Ear Hospital, from April 1902 to November 1905
With -- regard to the Hypermetropíc eye
becoming Myopic, I fail to find sufficient
evidence as to whether the cause is due to the
strain pure and simple, or to a diseased
condition of the Choroid etc: Personally I
think it is due to a combination of both of
these conditions, although the: strain certainly
plays a very important part.In comparing the different groups it is a
noticeable fact that girls are greater sufferers
than boys, and I would emphasize the fact that
it is in children between the ages of 7 and 11
years that the strain upon the eyesight appears
to be the greatest.The absolute necessity for school children
having both eyes examined separately for visual
acuity upon admission to the school.I have tabulated a series of cases (see
appendix) showing that undoubtedly children may
have fairly good, or very good vision in one
eye, whilst the vision of the other eye is
moderate, or even bad.Several of these cases which have been
tabulated were not-sent-by the school authorities but, brought by the parent, these children
having passed the tests employed.It certainly appears to me to be a
distinct advantage for children to have the
combined use of.both eyes. If they are
allowed to go on using one eye only, the other
eye eventually becomes Amblyopic, thus they
are handicapped during their school life, and
also in after ' life.Spasm of Accommodation is a condition
which is frequently met with in our children,
and it is on this account that I strongly
condemn the practice which is very much in . vogue, of parents, and even school authorities
sending children to so -.called "Opticians ";
for it is impossible for anyone to fully
estimate the degree of error of refraction in
any child unless its "accommodation" is
properly paralysed; a fact which has been
well illustrated in numerous instances in my
paper.In many of the children who had
Homatropine dropped into their eyes, their
retinoscopy taken, yet obtained no improvement with glasses, I find that when Atropine
was given for a week, and retinoscopy again
taken, there was found to be a great
difference'between the first and second
examination, showing the fact that "Spasm of
" Accommodation" may lead one into error.Although the visual acuity may be bad in
some cases, upon examination by retinoscopy
the eye is proved to be Emmetropic.
Of the 110 cases of Spasm of Accommodation:
91 were Hypermetropes,
12 were Myopes,
3 were Mixed Astig:
1 was Hyper: c Myopia,
4 were Normal.
This shows, that the condition occurs most
frequently in Hypermetropes.From the complications which occurred in
the various groups I think we can safely
deduct that it is absolutely necessary to
have the eyes of every child examined as soon
as there is any inflammatory condition of the
mechanism of the eye; for although the defect
in refraction may not be the actual cause, yet,
it does aggravate the trouble, and if the
proper correcting glasses are given, this
prevents a recurrence.It is suggested that very many of these
complications are produced and aggravated by
the child rubbing its tired eye.Here again I consider we have a very
strong argument against unqualified men being,
partially trained as so- called "Opticians"
when they would be quite unable to diagnose
any of these diseased conditions.Children should not be admitted to any
school before the age of six, and even at
that age the work should be light.It. should be forcibly impressed upon
parents that schools are not nurseriesè
The early training of all children should be
in the hands of the mothers, and they alone
are responsible for the care and training of
their children.It would certainly be interesting to
compare the eyesight of children who have
attended school from the age-of three and
upwards with those who have not been sent to
school before the age of five or six years.I consider that a wise course has been
adopted by the authorities during the past.
twelve months in stopping the grant for
children under five years. of age.I am convinced that the authorities are
taking precautions in all directions save that
of compelling-parents to have the eyes of
their children properly examined by an
Ophthalmologist.What might be done with advantage would
be to point out to'the parents by a "printed
letter" the absolute necessity of their
children having the full and combined use of
both eyes, and the folly of not allowing them
to wear glasses simply for the sake of
appearance; and also to point out that from
the disuse of one eye, the child may eventually lose the sight of this eye, and thus be
considerably handicapped in his after life.I am fully aware of the fact that no action
could be taken if the parent refused to have
his child attended to, yet I feel certain
that if compulsory education is enforced,
then it is not sufficient for the authorities
to simply give one, two, or three notices,
and then take no further action, but they
must,in the interest of the child, and thus,
of the community, refuse to allow children t
take advantage of free education; for
undoubtedly drastic measures are necessary,
otherwise, through lack of thoughts or through
ignorance, our children may become useless
citizens.Another alternative is to provide a
properly trained Ophthalmologist and have
children attending all schools thoroughly
examined, ignoring- the'parent. Upon this
point I will make same observations later.Home lessons for children. under nine
or ten years old, should be strongly discouraged, and even at this age it should
depend upon the child's capabilities as to the
amount given.It should be impressed upon the parent
the importance of seeing that the child when
doing home lessons, should be in a properly
lighted room, and that the desk, form or chair,
and paper, be in proper relationship.Children who have defective eyesight
or are otherwise weakly, should have a
modified curriculum.There should be a period of rest between all lessons, also constant change
from reading or writing to black board, or
object lessons etc.Teachers should be instructed as to the
elementary facts of the relationship of school
work and strain to the eyesight. I find that
upon this point very many teachers are
extremely ignorant, and I would enforce a
special class of instruction upon this subject.That there is an advantage of having
the eyesight of school children properly
examined and their error of refraction corrected, I think no one will doubt, but I think
the following-tables. which give the visual
acuity of the right and left eye of 683 cases
upon their first "visit, and the visual acuity
of 407 of these cases upon their last visit
to the Hospital, will give an indication of
the advantages which are obtained by treatment
