These few preliminary remarks are apropos to what is to follow in the subject which I have selected as the topic for discussion this evening.
Vision is the most useful of all the senses. It is the one gift which we should cherish and guard the most. And at no time in one's life is it more precious than in infancy and youth.
In infancy, when the child is developing, the one great avenue to the unfolding, or more properly speaking, the development, of the intellect is through the eye. The eye at this period holds in abeyance all the other senses. The child, when insensible to touch, taste, smell or hearing, will become aroused to action by a bright light or bright colors, or the movement of any illuminated object, proving to all that light is essential to the development of the first and most important sense. Again, the infant of but six days of age will recognize a candle flame, while its second sense and second in importance to its development—hearing—will not be recognized for six weeks to two months. Taste, touch and smell follow in regular sequence. Inasmuch as light makes thus early an impression on the delicate organ of vision, how necessary it behooves us to guard the infant from too bright lights or too much exposure in our bright climate. Mothers—not only the young mother with her first child, but also those who have had several children—are too apt to try to quiet a restless child by placing it near a bright flame; much evil to the future use of those eyes is the outgrowth of such a pernicious habit. Light throws into action certain cells of that wonderful structure of the eye, the retina, and an over stimulus perverts the action of those cells. The result is that by this over-stimulation the seeds of future trouble are sown. Let the adult gaze upon the arc of an electric light or into the sun, and for many moments, nay hours, that individual has dancing before his vision scintillations and phosphenes. His direct vision becomes blurred, and as in the case of a certain individual I have in mind, there may be a permanent loss of sight. Parents should take the first precaution in the child's life, and not expose it to a light too bright or glaring. When in the open air let the child's eyes be protected from the direct rays of the sun. While it is impossible to give all children the advantage of green fields and outdoor ramblings, yet nature never intended that civilization should debar the innocent child from such surroundings.
An anecdote is related of a French ophthalmic surgeon, that a distinguished patient applied to him for relief from a visual defect; the surgeon advised him to go into the country and look out upon the green fields. The green color with its soothing effect soon brought about a restoration of vision. What I wish to illustrate by this anecdote is that children should be allowed the green fields as their best friend in early life. It tones up the system and rests the eye. After outdoor exercise and plenty of it, we should turn our attention to the home surroundings of our little ones. The overheated rooms of the average American home I am sure have more to do with the growing tendency of weak eyes than we feel like admitting. Look at these frail hot-house plants, and can any one believe that such bodies nourished in almost pestilential atmosphere can nourish such delicate organs of vision, and keep them ready for the enormous amount of work each little eye performs daily? The brain developing so rapidly wills with an increasing rapidity the eye to do increasing duties; note the result—a tendency to impoverished circulation first, and the eye with its power to give the brain a new picture in an infinitesimal short space of time means lightning-like circulation—the eye must give way by its own exhaustion.
Civilization is the progenitor of many eye diseases.
After a boy has grown to that age when it becomes necessary for him to begin the education prescribed by the wise men, obstacles are placed in his way to aid again in causing deterioration of vision. It is not so much the overcrowded condition of our school rooms as the enormous amount of work that causes deterioration of sight. Our children begin their school life at a time when they are too young. A child at six years of age who is forced to study all day or even a part of a day will not run the same race that one will who commences his studies at ten—all things being equal. The law prescribes that so much time must be devoted to study, so many forms must be passed, so many books must be read, so many pages of composition written—all probably in badly lighted rooms, or by artificial light. Note the effect. First, possibly, distant vision gives way; the teacher, sympathizing with the overburdened child, tries to make the burden lighter by changing his position in the room or placing him under the cross light from a window; as the evil progresses, the child is taken to an ophthalmic surgeon, and the inevitable result, glasses, rightly called "crutches for the eyes," are given. What would be thought of a cause which would weaken the legs of that boy so that he would have to use crutches to carry him through life? If civilization be responsible for an evil, let our efforts be put forth in finding a remedy for that evil.
A discussion, in a recent number of the British Medical Journal,[2] on "The Claims and Limitations of Physical Education in Schools," has many valuable hints which should be followed by educators in this country. Dr. Carter, in the leading paper on this subject, makes the pregnant remark: "If the hope is entertained of building up a science of education, the medical profession must combine with the profession of teaching, in order to direct investigation and to collect material essential to generalization. Without such co-operation educational workers must continue to flounder in the morasses of empiricism, and be content to purchase relative safety at the cost of slow progress, or no progress at all." In other words, an advisory medical board should coexist with our board of public education, to try to hold in check or prevent a further "cruelty in trying to be kind." Private institutions of education recognize the importance of physical training and development, and in such institutions the deterioration of vision is in proportion less than in institutions where physical training is not considered. In one school of over 200 middle class girls, Dr. Carter found that, during a period of six years, no fewer than ten per cent. of the total number of girls admitted during that time have been compelled to take one or more terms' leave of absence, and of the present number twenty-eight per cent. have medical certificates exempting them from gymnastic exercise and 10.25 per cent. of the total present number wear eye glasses of some kind or other. From my own experience the same number of students in our schools would show about the same percentage of visual defects. These questions are of such growing importance that not only instructors, but the medical fraternity, should not rest until these evils are eradicated.
Dr. J.W. Ballantyne, of Edinburgh, in a lecture[3] on diseases of infancy and childhood, says: "The education of the young people of a nation is to that nation a subject of vital importance." The same writer quotes the startling statement made by Prof. Pfluger, that of 45,000 children examined in Germany more than one-half were suffering from defective eyesight, while in some schools the proportion of the short sighted was seventy or eighty per cent., and, crowning all, was the Heidelberg Gymnasium, with 100 per cent. These figures, the result of a careful examination, are simply startling, and almost make one feel that it were better to return to the old Greek method of teaching by word of mouth.
Prof. Pfluger attributes this large amount of bad sight to insufficient lighting of school rooms, badly printed books, etc. One must agree with a certain writer, who says: "Schools are absolute manufactories of the short sighted, a variety of the human race which has been created within historic time, and which has enormously increased in number during the present century." Granting that many predisposing causes of defective vision cannot be eliminated from the rules laid down by our city fathers in acquiring an education, it would be well if the architects of school buildings would bear in mind that light when admitted into class rooms should not fall directly into the faces of children, but desks should be so arranged that the light must be sufficiently strong and fall upon the desk from the left hand side. My attention has repeatedly been called to the cross lights in a school room. The light falling directly into the eyes contracts the pupil which is already contracted by the action of the muscle of accommodation in its effort to give a clearer picture to the brain. This has a tendency to elongate the eyeball, and as a permanent result we have near sightedness. Where the eyeball has an unnatural shortness this same action manifests itself by headaches, chorea, nausea, dyspepsia, and ultimately a prematurely breaking down of health. The first symptom of failing sight is a hyper-secretion of tears, burning of the eyelids, loss of eyelashes, and congestion either of the eyelids or the eyeball proper.
The natural condition of aboriginal man is far sighted. His wild life, his nomadic nature, his seeking for game, his watching for enemies, his abstention from continued near work, have given him this protection. Humboldt speaks of the wonderful distant vision of the South American Indians; another traveler in Russia of the power of vision one of his guides possessed, who could see the rings of Saturn. My recent examinations among Indian children of both sexes also confirm this. While the comparison is not quite admissible, yet the recent investigations carried on by Lang and Barrett, who examined the eyes of certain mammalia, found that the larger number were hypermetropic or far sighted. With all the difficulties which naturally surround such an examination they found that in fifty-two eyes of rabbits, thirty-six were hypermetropic and astigmatic, eight were hypermetropic only, five were myopic and astigmatic, and others presented mixed astigmatism. In the eyes of the guinea pig about the same proportion of hypermetropia existed. The eyes of five rats examined gave the following result: Some were far sighted, others were hypermetropic and astigmatic, one was slightly myopic and one had mixed astigmatism. Of six cows, five were hypermetropic and astigmatic and one was slightly myopic.