SCHOOL HYGIENE -BY — Charles J. Lundy, A, M., M. D., PROFESSOR OF DISEASES OF THE EYE, EAR AND THROAT MICHIGAN COLLEGE OF MEDICINE, DETROIT. Read Before American Health Association. 1883. DETROIT: r^HA"?. M. Rousseau, Pkinter, 50 LAK^ED St. West. BCHOOL HYGIENE — BY — Charles J, Lundy, A, M., M. D., PROFESSOR OF DISEASES OF THE EYE, EAR AND THROAT IN THE MICHIGAN COLLEGE OF MEDICINE, DETROIT. i^o„.:wf.v..a.vb"ii Read Before American Health Association, 1883. \> 3^ 0« COPYRIGHTED 10 SCHOOL HYGIENE. Mr. President, Ladies and Gentlemen: — In a short paper on school hygiene it would not be appropriate to discuss the system of educa- tion pursued in our public schools ; and I trust that my remarks will in no way be construed as a criticism of that system. It may be ne- cessary, however, to point out some of the ill effects incident to the pursuit of studies under that system. To do this, and to suggest remedies for these ill effects, in so far as I am able, will be the object of this paper. I believe it will be admitted by a majority of careful observers that the course of study pursued in most public schools, and also in many acadamies and seminaries, embraces too many subjects. This neces- sitates too many hours of study and recitation at school, and also re- quires the pupil to spend much time in study at home. For the ave- rage pupil, the hours required for preparation and recitation are en- tirely too long. Eight, ten, and in some cases even twelve hours per day are devoted to study and recitation. For example: Miss L., who is now under my care for an affection of the eye^ recites six times a day, and each recitation occupies forty-five minutes. She is expected to study, and does study, five hours at home every day, in addition to which she studies music. She is a bright, intelligent young girl, and learns easily, but she complains that her work is too hard. Need I add that she is nervous ? No, it is not necessary, for it would be remarkable if she were not. Some time since the ques- tion of overwork in the schools was discussed in New York, and dur- ing that discussion some startling facts were brought to light. It was shown that many pupils in the higher grades and in the grammar schools spent from ten to thirteen hours per day in study and reci- tation. This was the case even in the ordinary every day work of the school, but at certain periods matters were much worse. In most, if not in all, schools and academies there is pursued at times a system of study commonly known as the cramming system. During certain portions of each month, or each quarter, or each semester, as the case * A paper read before the American Public Health Association, November, 1883. may be, the pupils are urged, if not actually forced, to make extensive reviews of subjects hurriedly gone over and imperfectly learned some weeks or months before. This cramming process is occasionally kept up for several weeks at a time, to the end that the pupils may pass well in their examinations. There is excited a sharp rivalry among the pupils, and this rivalry is often unwisely encouraged by the teachers, for the teacher is anxious to show the school superintendent or the school board how rapidly pupils advance under his or her care. This is a pernicious practice, and cannot be too strongly condemned. It subjects the pupil to unnatural mental strain, and the result is what might be expected. Why do so many pupils drop out of the classes and leave school at the end of one, two or three months after tne be- ginning of the school year ? It was shown in the New York schools that the average attendance was less than fifty per cent, of the num- ber of pupils enrolled. It was estimated that three-fourths of the ab- senteeism was due to sickness. Of course much of that sickness was, in a measure, unavoidable, or at least was not due to school work. But that much of this sickness and absenteeism were due to cramming and overwork there can be no reasonable doubt. The experience of every physician will bear testimony to the correctness of this statement. Indeed, the timely interference of the physician in advising weak, delicate pupils to leave school often averts the impending danger of prostration from overwork. Need I say that nervous excitability, with ultimate prostration, headache, impaired digestion, lack of proper physical development and myopia are among the many bad results of exciting competition and the long hours of study, especially when much of the pupil's time is spent in badly lighted and badly ventilated school rooms. The importance of thorough ventilation of schools cannot be over- estimated. With a large number of pupils in a single room, the at- mosphere soon becomes contaminated by exhalations from lungs and skin. In many schools the lack of proper ventilation is painfully manifest, especially in winter months, I venture the assertion, and without fear of successful refutation, that not one in three of all the school buildings in this great State of Michigan is properly lighted and properly ventilated. This, too, in a State that is a most liberal patron of education — a State noted among all States as having a su- perior educational system. And what is true of Michigan schools is true of the schools in other States. It seems a little surprising that with our health boards in almost every town that such a condition is permitted to exist. Were the masses of the people sufficiently educated to appreciate the import- ance of good ventilation in the school-room, they would not tolerate some things which now exist. I venture to assert that the next gene- ration will not submit to the things which we now tolerate in this regard. Just where to place the blame for the defects in ventilation of schools I am not prepargd to state. I thnik, however, that it would be advisable to substitute for the law making attendance at school obligatory, one which would compel members of school boards and the architects who plan our school buildings to pass creditable exami- nations in sanitary science. To compensate for the lack of proper ventilation teachers some- times resort to opening the windows of the school-room to admit fresh air. It will at once be seen that this remedy is as bad as the de- fect it is intended to correct. A draft of cold air is allowed to blow directly upon the pupils who sit in close proximity to the window, the body is suddenly chilled, and a cold is the result. When the body is at rest the surface is easily chilled, and under such circumstances the pupil catches cold (in the ordinary acceptance of the term) from com- paratively slight causes. Repetitions of these colds lead to chronic catarrhal affections of the nose, throat and ears. In this connection I may say that in many cases the temperature of the room becomes too high, owing to imperfect ventilation. In the majority of school- rooms the temperature ranges from 70 to 76 "^ , or even 78 ° , whereas it should not be more than 68 or 7o '^ . In Europe a temperature for school-rooms of 68 ° is thought quite high, and a much lower tem- perature usually prevails. The warm atmosphere is injurious and un healthful, and relaxes and debilitates the system. When pupils leave a warm, dry atmosphere with pores open and system relaxed and go directly out into the damp, frosty air of a mid-winter day, they are very liable to suffer in consequence. This it may be impossible to entirely avoid, but if the temperature of a room is 68 or 70 ° and the atmosphere is pure the system is not so likely to be relaxed as it would be by an impure atmosphere of 76 or 78 ° , and every careful observer knows that when the system is relaxed is a time of great dan- ger from sudden exposure to a cold atmosphere. Seats and Desks. — The construction and arrangement of seats and desks are worthy at least a passing notice. Although the American ' 6 schools are generally provided with better seats and desks than are the schools of most European countries, yet there is room for improve- ment even here. If seats and desks are faulty^in their construction, or if they are not properly suited to the size of the pupil, they tend to produce deformity. It is not necessary to discuss here the subject of deformities in gen- eral, or the ease with which deformity may be produced in the young and growing child. The facts are that a vast majority of deformities occur during the school age. Eulenburg, the noted orthopaedic sur- geon, states that 90 per cent, of all cases of spinal curvature not due to special disease occur during school life. In Switzerland, according to Liebrich, 20 per cent, of all schoolboys and 40 per cent, of all schoolgirls have one shoulder higher than the other. Dr. D. H. Agnew, the well known Philadelphia author and sur-- geon, gives as the principal causes of spinal curvature, " unequal exer- cise of muscular power on both sides of the spine " and "occupations." The same author further states : " I am disposed to think \\i?A partial or unequal use of the musailar system is most commonly concerned in developing lateral curvature of the spine." It is not necessary to discuss here, even did time and space permit, how faulty and unnatural positionsof the body may give rise to deformity, 01 the modus operandi by which the deformity is produced. Although it is very probable that a comparatively small number of deformities occur in this country as a result of badly ccnstructed and badly arranged seats and desks, yet we cannot afford to disregard this matter. Unless we would have our children less beautiful in form and figure than Nature intended them to be, we should not allow them to spend several hours day after day, year in and year out, in seats and before desks not pjoperly adapted to them. Different pupils of the same age will attain different degrees of advancement, and the higher the grade the larger the seat and the higher the desk. Then again, pupils of the same grade will differ greatly as to height of body and length of limb. Thus it will be seen that the proper seating of the pupils in the school-room is no easy matter. The seat should be so constructed as to support nearly the whole length of the thigh, as well as the pelvis. The seat should be of such a height as to permit the sole of the shoe to rest comfortably upon the floor. I have observed many instances in which the feet hung suspended between the seat and the floor because the seat was too high. Every seat should have a back, either straight or but slightly curved, and sufficiently high to support the lower half of the spinal column. This latter will help to prevent undue strain upon those muscles whose function it is to keep the trunk erect, and at the same time it will not interfere with the respiratory function. The proper adaptation of desks is even a more difficult matter than the arrangement of seats. If the desk is too high the pupil is obliged to elevate the shoulders unnaturally in order to rest the elbow and forearm upon the desk. Such positions are apt to produce the de- formity found among 40 per cent, of the girls in the schools of Switz;erland. In other words, it is apt to make one shoulder higher than the other. If the desk is too low the pupil will lean over it or upon it. This stooping position is a bad one on several accounts. It makes the pupil round shouldered, prevents the proper expansion of the chest in respiration, retards the flow of blood from the head, face and eyes, and favors the development of myopia. Liebrich says the desk should be high enough to enable the pupil to rest the forearm and elbow thereon without displacing the shoulder. He also advo- cates having the edge of the desk in a line perpendicular to the front of the seat. This general plan will be found to work quite well ; and it insures a correct position for the body, and one in which there will be no unnatural elevation of the shoulders, and no necessity for bend- ing the head over the desk. For various reasons the top of the desk should have a slight incline or slope, instead of being flat. Everyone may observe how quickly the eyes tire in looking for any considerable time at objects placed much above a line horizontal to the eye. One may also observe that the eyes tire quite easily in looking at an object if it be placed too far below the horizontal. As we walk in the street our gaze naturally strikes the walk twenty or thirty feet m front of us. This is accounted for by the fact that the ocular muscles easily adjust normal eyes for binocular single vision at this point. Without taking time to explain the action of these ocular muscles, I will briefly say that, within cer- tain limits, both eyes can be directed more easily to an object below the horizontal line than to an object above it. If, however, the object is too far below the horizontal line it strains the eye to look at it for any length of time. If a book be placed upon a flat surface either the head must be bent unnaturally forward to see distinctly or the eyes must be turned too far downward to be used with comfort. Besides, 8 letters which can be seen distinctly at a long distance when the book rests at an angle of forty or forty-five degrees, cannot be seen at all at such distance where the book rests upon a flat surface. Of this fact any one may be convinced by making the experiment. This will in great part be accounted for by the fact that the letters are " foreshort- ened," and that their retinal images are smaller than they naturally should be. On account of mechanical considerations the angle of 40 or 45 ° will be found too great when the desk is used for writing, and one of 20 ^ will answer better. Therefore, every school desk should be pro- vided with an adjustable top so that it may be used either for reading or writing with comfort and convenience. Light. — Light in the public schools has received considerable at- tention within the past few years, and deservedly so, for it is an im- portant subject. Light may be deficient in quantity, poor in quality, or it may come from the wrong direction. That such defects in the lighting of our schools do actually exist may be demonstrated by examination in al- most any part of the country. That a few — very few, indeed — of the more recently erected school buildings are well lighted is a fact, but unfortunately the well lighted buildings do not exceed one in five of the whole number. When light is deficient the retinal images are not clearly and well defined. The pupil tries to obviate the difficulties in two ways. First, he increases the amount of light reflected from the book to the eye by bringing the book closer. It is not necessary here to speak of the well known law that the reflection of light is in in- verse ratio to the square of the distance of the object. Second, he tries to increase the size of the retinal images of the letters by bring- ing the book nearer than twelve inches. The nearer the object the more divergent will be the rays of light reflected from it to the eye. The more divergent the rays of light the greater will be the eff'ort re- quired to focus them upon the retina, and the greater will be the strain upon the internal recti and upon the ciliary muscle. But the pupil further adds to the danger by stooping over and bringing the eye nearer the book, instead of maintaining the erect position and bringing the book towards the eye. The result of this stooping, un- natural position is, congestion of the head, face and eyes by interfer- ence with the return of blood from these parts. The strain upon the eyes causes them to grow weary and ache if the work is continued. 9 Indeed, we see many cases of inflammation of the eyes, and also of congestion of the optic nerve and retina, from this cause. Were this the appropriate place many examples could be cited. We also see many cases of headache and great nervous disturbance due to an unnatural strain upon the eyes, the prime cause of which was bad and insufficient light. But, while we see numerous examples of pain and discomfort of the eyes, and even of inflammation of the eyes, due to badly lighted school and living rooms, yet these are only the lesser evils. There is another affection much more important than these, in the production of which bad light, together with long hours of study, plays an important role. That affection is myopia, and to that I shall now call your attention, for in point of import- ance it is second to no subject connected with school hygiene. Myopia, or near sight, indicates that condition of refraction in which parallel rays of light are not fotused upon the retina but in front of it when the eye is at rest. This is due to an elongated condition of the eyeball, and such eyes do not see distant objects distinctly, the far point being within finite distance. The oculist regards such an eye as being something more than near sighted, for he knows that more than four-fifths of the myopic eyes are diseased. With myopia he associates certain conditions upon which it depends. With myopia he also associates certain anatomical and pathological changes which have taken place within the eye. He is aware of the fact that progress in these pathological changes means an increase of the myopia. He is also aware that the disease may reach a dangerous degree, and that, in some instances, there occurs total loss of sight. Finally, he is aware of the fact that this disease can, in a great measure, be prevented, but that it cannot be cured. The causes of myopia are both predisposing and exciting. It is a well known fact that children frequently inherit certain pecularities of shape, form and feature. I have observed certain pecularities of shape in \he eyeball in three consecutive generations, and in all three gen- erations these peculiarties led to the development of squint. Although children do inherit a predisposition to myopia, yet few, if any, children are near sighted at birth. In Germany there are more myopic people than in any other country, and the children born of German parents in this country show a greater predisposition to myopia than do the children of American and Irish parents. The pro- portion of myopic pupils found by Drs. Loring and Derby in the New 10 York schools was, among German pupils 24 per cent.; among Irish pupils 14 per cent., and among American. pupils 19 per cent. Chief among the exciting causes of myopia are close application to study in early youth while the tissues are lax and infirm ; long hours of study without proper periods of rest, and poor light, both in quan- tity and quality. Other causes are congestion of head, face and eyes, caused by the stooping position, or by tight clothing, or by cold feet; badly printed books, and books in which the print is too small; badly ventilated school and living rooms; debilitating influences of whatever nature, and lack of proper physical exercise in the open air. Very nq,turally the same causes will operate more seriously under certain circumstances tl^n under others. The causes, which would produce very bad results among children residing in large cities, would not be likely to produce such serious results among children in small villages and country places. Indeed I think many of the city schools are superior in their appointments to the schools of small towns and country districts, and yet the proportion of near sighted pupils is always greater in the city than in the country. This has been shown in regard to German pupils, and undoubtedly similar condi- tions exist in this country. Let us briefly examine the arguments bearing upon the develop- ment of myopia in the schools, and the influence of modern school life upon this disease. Some statistics upon this point may serve our purpose. These statistics have been prepared by able investigators both in this country and in Europe, and the results of the investi- gations show a remarkable similarity. Dr. Cohn, of Breslau, Germany, found only 1.4 per cent, of myopic pupils in the village schools, while among pupils of the same age in the city schools the per cent, of myopia was seven times as high. The per cent, of myopia increased year by year, until in the thir- teenth and fourteenth years of school life almost two-thirds pt the pupils were myopic. Dr. Conrad, of Koenigsburg, found that myopia increased from less than one-half of i per cent, at 7 years — the first school year — to more than 62 per cent, in the highest classes. Dr. Erisman, of St. Petersburg, found myopia to increase from 13 per cent, in the preparatory class to 41 per cent, in the fifth class. Pfluger found in the schools of Lucerne a condition almost identi- cal with that at Koenigsburg. 11 In thf gymnasia at Vienna, Reuss found almost 60 per cent, ot myopic students in the higher classes. Had not many students been compelled to discontinue their studies on account of the condition of their eyes, the per cent, of myopic students in the highest classes of the gymnasia would undoubtedly have been larger. By these and other observers in Europe tens of thousands ot pupils have been examined, and the results have been practically the same. In this country a large number of observations have also been made* and the results go to show a similar condition here. While the in- crease of myopia from year to year has not been so marked as in Ger- man schools, yet it is sufficiently great to arrest our attention. These observations show a steady increase in the number of myopic pupils through the primary and grammar schools, and through high school and college. In the public schools of New York Drs. Loring and Derby found that 3^ per cent, of the youngest pupils were myopic, while among the oldest pupils — those of 20 to 21 years — the per cent, of myopes had reached 26.78. Examinations made in the New York College, under the di- rection of Dr. C. R. Agnew, showed that 53 per cent, of the junior students were myopic. Investigations made elsewhere, for example, by Prout and Mathewson, of Brooklyn; by Ayers and Williams, of Cincinnati; by Risley, of Philadelphia; by myself in this city, and by others at various other points, show similar results. If the proportion of myopic pupils is a little greater at one point than at another, the difference is only trifling. It has been further shown that myopia was most prevalent in pupils who spent the greatest number of hours in study. Erisman furnishes the following statistics : Of 4,358 pupils examined by him, all studied two hours out of school; some studied four hours, some studied six hours, and some studied more than six hours out of School. Of those who studied only two hours out of school, 1 7 per cent, were myopic; of those who studied four hours, 29 per cent., and of those who studied six hours and over, more than 40 per cent, were myopic. Admitting that myopia is produced by attendance at school and by the conditions which such attendance imposes, is there anything to show that myopia does not prevail among children who are not sub- subject to the conditions imposed by modern school life ? There is. Dr. Macnamara, formerly professor in the Calcutta Medical College, states that myopia is almost unknown among the lower classes of 12 India. He informs us that in his examinations of the Abori^es ot Bengal he failed to find a single case of myopia. The same author states that " whole races in India appear to be actual strangers to the disease." Among the colored race in this country myopia is as yet quite rare. In England, where myopia is not nearly so prevalent as it is in Germany, the disease is found mainly among the better educated classes. How, then, do long hours of study, poor light, bad ventilation and other influences bring about the elongation of the eyeball, upon which myopia depends ? This is a pertinent question, and one I shall now attempt to answer. It is a well established fact that vigor- ous use of any part of the human economy causes an increased flow of blood to that part. To this general rule the eye forms no excep- tion. During close application to study the eyes receive a greater supply of blood than when the eye is at rest. If the application is long continued, and without proper periods of rest, the fluid contents of the eye become slightly increased, the coats of the eye become somewhat congested, and a slight increase in the tension of the eye- ball is apt to occur. Now, it is not difficult to see that repeated, though slight, increase of tension may lead to stretching of the coats of the eyeball. Repeated distension of the stomach, as we often see in the case of gonmandizers, leads to stretching of its walls and increase in its size. This is also true of other organs similarly formed. But there are other factors at work in the production of myopia. The muscles which turn the eyes in various directions and especially the musclds which converge the visual axes, exert consider- able pressure upon the eye-ball from without. To this may also be added pressure from contraction of the ciliary muscle in efforts of accommodation. Now, as you will observe upon the model which I here show you, the recti muscles are attached in front of the equator of the eye, and the ciliary muscle is also near the front of the ball. When these muscles contract upon the eye-ball, it would be natural to suppose the globe would yield, if at all, at the point of least resis- tance. This is precisely what occurs. The tunics of the eye do yield at the point of least resistance, and we find in myopic eyes, especially when the myopia is of a high degree, a bulging of the eye backward at its posterior pole. This is shown in the dia- gram. But why do myopia and elongation of the eyeball occur so 13 rarely among aduhs, many of whom use their eyes for near work for ten or even twelve hours a day ? We have seen that nine out of ten of the bodily deformities occur in early life, when the tissues are lax and infirm, and when shape and form yield readily to bad influences. So it is with myopia ; it occurs usually when the tissues have not yet hardened sufficiently to resist the evil influences of which I have spoken. Physical Culture. — While it is not my intention to devote any considerable space to the subject of physical culture among school children, yet a few words upon so important a matter would not be out of place in this connection. Dr. Brayton Ball says that "health may be described as that condition in which the various functional activities of the body are carried on with their normal energy and in a harmonious manner. For maintenance of such condition of the vital powers, a certain amount of physical exercise is indispensable, since the functions of respiration and of the circulation of the blood, which largely control the assimilative and dissassimilative processes of the body, are direct- ly and powerfully influenced by the activity or inactivity of the mus- cular system. " Any one who will carefully observe the physical appearances of our school children will be convinced that the " functional activities" of their bodies are neither carried on with harmony nor with energy. The listless air, the languid gait, the cold feet and hands and the lack of muscular development, especially among girls, at once indicate the lack of physical training. One very frequent result of this lack of physical strength is asthenopia or weakness of tho eye muscles. This condition is notoriously frequent among young people attending school and college^ Nearly one-half the patients who come to con- sult me regarding this affection are school children, and of these two- thirds are girls. If I ask one of these young girls how long she can walk without becoming fatigued the reply is, 20 or 30 or 40 minutes, as the case may be. Now, such pupils are expected to spend fi^om six to ten hours in study and recitation, but half or three-quarters of an hour's physical exercise completely exhausts them. Instead of being exhausted by such trifling physical exertion, pupils should be able to perform light physical labor for as many hours as they usually spend in study. If we desire to hav^ and to preserve the highest type of manhood and of womanhood in this country, we must cultivate ou 14 children physically as well as mentally. In the current number of Harper's Magazine there is an article entitled, "Our Children's Bodies," which I most heartily endorse. I would commend every one to read it carefully. Especially would I recommend it to those engaged in the noble occupation of teaching. Every one knows how a little " outing," as it is often called, or a few weeks spent in hunting, fishing or other out-door occupation helps to recuperate the exhausted energies of the over-taxed business or professional man or the accountant. Examples of this are so numer- ous that it seems idle to speak of it. Yet, we seldom think that physical exercise is necessary for our children who spend so many hours a day engaged in mental labor, at least, we provide no means for their taking this exercise in a proper manner. If it is necessary for the adult to take physical exercise in order that the vital functions may be well performed, how much greater the necessity for such exer- cise in the growing child. If we wish our children to attain the highest type of development, we must see to it that the physical is not entirely neglected for the sake of the purely mental culture. A child whose mental cultivation has been made at the expense of health and physical strength is like a house built upon a quicksand. I have al- ready expressed these sentiments so often that they may seem stale ; but a good maxim, '^ Let the physical keep pace with the mental training," will bear repetition. How shall we provide for the physical cultivation of our school children ! This is a question which will force itself upon the attention of our educators at no distant day. If I were to suggest a plan by which we could attain this object, it would be about as follows : In every city let the school board appoint a teacher of physical culture. Let him be a man of sound mental training, not merely a man who has a large biceps or an expansive chest. Let him be thoroughly posted in the anatomy and physiology of the human body. Let him understand thoroughly the effect of physical training, and the advantages to be derived from such training when properly carried out. But, above all, let him be a man who thoroughly understands the dapger of improper use of the muscles and of severe muscular strain, for hundreds are injured permanently by indiscretion in this regard. In a word, let him be a man who will teach the use ot the muscles, not the abuse of them. We do not wish our children to become gymnasts nor acrobats, wc simply wish to develop them physically as well as mentally, for by a harmonious blending of the mental and the physical we will obtain the highest 16 type of manhood and of womanhood. Now, if a teacher of physical culture were to be employed as are teachers of penmanship, music and drawing, he could accomplish wonders. Under his general direction the several teachers could carry out the details of a general plan of physical training. A certain period of time each day, or better, a shorter space of time twice a day might be devoted to physical training. This time could be very advantageously taken from the hours of recitation and one study could be discontinued. This plan would not entail any additional duty on the already over- worked teachers. What the nature of the physical exercise or drill should be, it is not necessary to intimate here beyond that it should be light and simple, and such as would bring into play all the muscles of the body. Although I fear my paper's length has already outrun your patience, yet I would beg your indulgence while I suggest a few reme- dies for the defects to which your attention has been called. In regard to overwork in the schools, I would suggest a reduction in the number of studies, some of which might well be dispensed with. Of some of the subjects taught, only the merest smattering is retained, and it were better to have fewer subjects and have those thoroughly under- stood. By discontinuing one subject, the forty miuutes required for the recitation could be devoted to out -door exercise or to physical culture, which would be a great relief to the already over-taxed ner- vous system. The reduction in the number of studies would also re- lieve the necessity for so much study at home. By thus lessening the mental labor, and by cultivating a taste for physical exercise, it would soon be an easy task to cultivate muscle as well as brain. If we desire to have pure air in the school -room we must supply the means for removal of the foul air, as well as for the ingress of fresh air. Most authorities place the amount of fresh air required to keep the atmosphere of the school-room at a healthy standard at 2,000 to 2,500 cubic feet^per hour for each pupil. This air should be warmed before distribution to the different parts of the room. To remove a like quantity of foul air would require a ventilating capacity much greater than I have anywhere observed. To correct the existing de- fects, I would suggest the procuring of facitities for heating and dis- tributing a much larger quantitiy of fresh air than is now admitted, and the introduction of well-heated ventilating flues where none now exist, and also an increase in the size or number of such flues in the rooms already partially supplied in this respect. 16 If we wish to avoid the ill effects of poor light, which ive found was an important factor in producing myopia, we should see to it that our schools are better lighted. Light should not come from the back, for a shadow will be cast upon the book or paper by the pupil's head and body. Light should not come from the front, for it irritates the eyes. In nearly all school? black-boards are placed between windows, thiit, compelling pupils to face the light for a portion of the time. In very wide rooms it is impossible to light all parts of the room properly if the windows are on one side. Light should be abundant; it should be distributed to all parts of the room, and it should come from a proper direction. The proportion of window space should equal 30 to 50 per cent, of the floor space. In many schools the window space does not ex- ceed 5 per cent, of the floor surface. Sunlight should not be allowed to fall directly on the paper, for it will irritate the eye. The school-room should be oblong, and not wider than a space equal to twice the height of the window. Such a room can be pro- perly lighted from one side, which should be the left. For wider rooms the windows must be placed on both sides. In conclusion, let me suggest the following rules, observance of which will materially help to remedy existing defects : 1. Avoid the cramming process in education, and the nervous ex- citement due to the spirit of rivalry. 2. Reduce the number of subjects in the curriculum, and shorten the periods of study. 3. Ventilate the school -rooms in accordance with the most ap- proved methods, 4. Regulate the temperature of the school-room — an atmosphere which is too warm debilitates the system. 5. Provide properly constructed and arranged seats and desks. 6. Instruct pupils to sit erect, and to hold the book or paper at least 12 inches from the eye. 7. Provide highly myopic pupils with proper spectacles, which will enable them to read at the natural distance of 1 2 inches. 8. Furnish pupils with well printed books. 9. Furn'sh abundance of light, without producing glare. Let it come from the left side if the room is narrow, from both sides if the room is wide. 10. Provide for the physical education of school children, and teach them the importance of of out-door exercise. hLS.^,)(.„.9'' congress lliillililfl 020 975 928 7 ss^V ill I