FIGURE.
ENCE ON SIGHT AND
th
TWO LECTURES.
BY
R. LIEBREICH,
consulTING OPHTHALMIG SURGEON TO ST. THOMAS's HOSPITAL.
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LONDON
J. & A. CHURCHILL, NEW BURLINGTON STREET.
1878.






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PR E FA C E.
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IT is now six years since I delivered the first of these two
lectures. The interest which the London School Board took
in the matter, and the large scale on which that body carried
out in practice the principles which I had laid down, were
an encouragement to me to give further attention to the sub-
ject, and also to devote such time as I could spare from my
professional duties to the study of the influence which posture
has on the figure, and particularly on the spine. In fact there
is more connection than might at first sight be supposed be-
tween certain anomalies of the eye and those slight curvatures
of the spine which are only too often artificially produced
during schooltime; there is for instance action and reaction
between weakness of the spine and certain defects in vision, it
being a fact that short-sightedness increases curvature of the
spine, and that this latter tends to produce or to increase short-
sightedness; and, above all, bad posture is a cause common to
these two very different diseases. I therefore had no hesita-
tion, when a second edition of my lecture on ‘School-life in its
Influence on Sight’ became necessary, to let it appear together
with a lecture delivered only a short time ago, and to give
them the common title, ‘School-life in its Influence on Sight
and Figure,’ hoping thus to call the attention of parents,
teachers, and medical men, to whose care children are entrusted,
to both these subjects.
16, ALBERMARLE STREET, July, 1878.
1.
SCHOOL LIFE IN ITS INFLUENCE ON SIGHT.
A LECTURE DELIVERED BEFORE THE COLLEGE OF PRECEPTORS AT THE
House of THE SOCIETY OF ARTS, JULY 13, 1872.
CoNSIDERING the great care which, in English schools, is
bestowed upon the physical well-being and development of the
children, I have been surprised to find almost everywhere
arrangements more or less injurious to the Organ of Sight. I
am inclined to believe that this arises from the masters,
architects, and others concerned in schoºl arrangements, not
being sufficiently acquainted with the first principles laid down
for the preservation of sight. It seems to me as if the question,
what those principles are, had never yet been asked.
Therefore I think it is very opportune to lay a thorough
consideration of this subject before the College of Preceptors.
I shall not have to speak of the different diseases of the eye to
which childhood is subject, and which therefore often appear
during the school-life of a child; but only of those changes in
the functions of the visual organ, which are immediately de-
veloped under the influence of school-life. These are three in
number,
1. Decrease of the range of vision.
2. Decrease of the acuteness of vision.
3. Decrease of the endurance of vision.
1. Decrease of the range—Short-sightedness (Myopia)—is that
condition of the eye in which rays of light from an infinite
distance, i.e. parallel rays, are united in front of the retina in
consequence of an extension of the axis of the eye. The rays
( 6 )
must be made more divergent with the aid of a concave glass,
in order to see distinctly.
Short-sightedness is developed almost exclusively during
school-life; rarely afterwards, and very rarely before that time.
Is this coincidence of time accidental?—i.e. does the short-
sightedness arise at the period about which children go to
school? or has school-life caused the short-sightedness? Sta-
tistical inquiries prove the latter to be the case, and have
shown, at the same time, that the percentage of short-sighted
children is greater in schools where unfavourable optical con-
ditions prevail.
It is true that short-sightedness is often hereditary, but this
must not be thought to mean that the children of short-sighted
parents are born short-sighted. - They have only the predis-
position to become so, and this predisposition is developed
during school-life, more or less, according to certain external
conditions; and the more so, of course, under conditions which
tend to produce short-sightedness even in children who have
no hereditary predisposition.
If the predisposition is thus hereditary, and new cases are
continually added, we can easily understand that short-sighted-
ness in general must be continually on the increase. This,
with regard to civilized countries, is an established fact ; and
if you flatter yourselves that there are fewer short-sighted
people here than in any other country, you must not therefore
think that England is an exception with regard to the relative
increase of myopia.
But is myopia in itself actually a defective condition of the
eye 2 The notion that short-sighted eyes are the most durable
is one commonly received, but this unfortunately is no proof
of its truth. It is merely founded upon the fact that short-
sighted eyes can see near objects distinctly without the aid of
glasses, at an age when normal eyes require the assistance of
convex lenses.
This advantage, when the short-sightedness is very slight,
( 7 )
may be considered to counterbalance the inconvenience of con-
cave glasses being always necessary in order to see distant
objects clearly; but in a higher degree of myopia the advantage
is entirely outweighed by more serious considerations. The
far-sightedness that appears about the age of forty-five, and
steadily increases with years, is a purely physiological condition
of the healthy normal eye. It has no other disadvantage than
that of rendering convex glasses necessary for reading. It is
only in cases where a prejudice against spectacles, or a certain
vanity and reluctance to appear old, deprive the eye of its
natural assistance, that it is accompanied by fatigue and weak-
ness of sight. A high degree of short-sightedness, on the con-
trary, is a pathological condition, caused by anatomical changes
in the membranes of the eye, which involve a greater tendency
to serious complication than the normal eye.
Short-sightedness has an injurious influence on the general
health by inducing a habit of stooping. Its increase from a
national point of view is to be considered a serious evil. In
former times, when literary education was confined to a small
number, this question was of little or no importance; but now,
especially when England is about to extend the benefits of
school education to a far greater number of her citizens, the
Question how to prevent short-sightedness deserves serious con-
sideration.
2. The decrease of acuteness of vision—Amblyopia. In gene-
ral, this serious condition is the result of positive diseases of
the eye, which may exceptionally be induced at school, but
which are of too individual a character to be considered here.
Amblyopia of one eye only is, however, often produced by
unsuitable arrangements for work, which disturb the common
action of the two eyes, and weaken the eye which is excluded
from use.
3. Decrease of endurance—Asthenopia. This very frequent
affection, which has destroyed many a career, prevented the
development of many a fine intellect, and deprived many of
( 8 ) ~
the fruit of their laborious exertions and persevering industry,
arises principally from two causes. The first is a congenital
condition, called hyper-metropia, which can be corrected by
convex glasses, and which cannot therefore be laid at the door
of school-life. The second is a disturbance in the harmonious
action of the muscles of the eye—a defect which is difficult
to cure, and which is generally caused by unsuitable arrange-
ments for work, in a manner which I shall presently explain.
Do not be afraid that I am about to enter on a scientific
explanation of the various causes of these disturbances of the
organ of sight. For the three anomalies I have mentioned all
arise from the same circumstances—viz, insufficient or ill-
arranged light, or from a wrong position during work.
Insufficient or ill-arranged light obliges us to lessen the
distance between the eye and the book while reading or
writing. We must do the same if the desks or seats are not
in the right position, or of the right shape and size.
When the eye looks at a very near object, the accommodating
apparatus and the muscles which turn the eye, so that the axes
converge towards the same object, are brought into a con-
dition of greater tension, and this is to be considered as the
principal cause of short-sightedness and its increase.
If the muscles of the eye are not strong enough to resist
such tension for any length of time, one of the eyes is left to
itself; and whilst one eye is being directed on the object, the
other deviates outwardly, receives false images, and its vision
becomes indistinct—amblyopic. Or perhaps the muscles resist
these difficulties for a time, become weary, and thus is pro-
duced the dimunition of endurance.
How can these evils be prevented P
The light must be sufficiently strong, and fall on the table
from the left-hand side, and, as far as possible, from above.
The children ought to sit straight, and not have the book nearer
to the eye than ten inches at the least. Besides this the book
ought to be raised 20° for writing, and about 40° for reading.
( 9 )
t
Are these rules attended to in English schools? I have, in
order to find an answer to this question, visited a great many
Schools, and made inquiries about others. Having done so, I
must state as my opinion—which, after having entered more
into detail, I think will be yours also—that hardly in any
School in England are these things attended to, at least not in
anything approaching a perfect manner.
The proper light is most easily obtained if the class-room is
of an oblong shape; the windows being in one of the long
sides, and the tables arranged parallel to the short walls, so
that the light falls from the left side. The desk of the master
ought to be placed near the short wall towards which the
scholars look.
This simple arrangement is at the same time the most
practical, and has been received in every country as a matter
of course. I was therefore much astonished to find this
arrangement in England only exceptionally, sometimes in one
class-room of a large school, and sometimes in the single class-
room of a small school. On such occasions, the master generally
excused himself by saying that I should find his arrangements
rather old-fashioned, and expressed a wish to alter them. I
had therefore to examine, 1st, if the English arrangements
were better or worse than those adopted by the rest of the
world; and, 2ndly, what might be the motives for this exception
from the rule. I tried to find the principle or system which
regulated the arrangements, but soon found that none existed,
and that the lighting of the rooms depended entirely upon
accidental circumstances. Sometimes the windows were in the
short sides of the room, sometimes in the long; sometimes in
one, sometimes in two or more sides, adjacent or opposite.
Further, the arrangement of the desks was also accidental, and
differed in every class-room in all possible ways.
From my conversations with the masters, I clearly perceived
that in these arrangements, other considerations, to which I
shall refer, had been attended to, while the matter of light
( 10 )
had been entirely overlooked. Those schools only which are
under the superintendence of the Committee of Council on
Education are exceptions to this rule. The Education Depart-
ment, in its rules to be observed in planning and fitting-up
schools, has made regulations for the lighting of class-rooms,
and has chosen, of all the different kinds, the very worst.
No. 15 of the rules is as follows:—“The windows should be
so placed that a full light should fall upon the faces both of
the teachers and of the children.” Light coming from the
right hand is not so good as that from the left, because the
shadow of the hand falls upon that part of the paper at which
we are looking. Light from behind is still worse, because the
head and upper part of the body throw a shadow on the book;
but the light that comes from the front and falls on the face, is
by far the worst of all. In the first place, it does not attain
the object desired; and next, it is most hurtful to the eye.
The object is to make the fully illuminated faces more visible
to the master; but the children, instinctively desirous of avoid-
ing the unpleasantness of the full glare, assume all sorts of
positions which turn their faces from the master. In reading,
they turn the head round the vertical axis, generally towards
the right, in order to let the light fall on the book, which, when
held straight before them, is completely in shadow; while in
writing, or in reading (the book being on the table), they bend
their heads as low as possible, in order to shade their eyes by
the projection of the forehead. In this way the faces are
much less visible to the master than if they were held upright
and illuminated from the left side; and if, according to the
regulations of the Committee of Council, the light also falls full
upon the face of the master, he will be entirely prevented from
seeing them.
This method of lighting the room is very injurious to the
eye, because, firstly, the retina becomes fatigued by the full
glare upon it, and the diffused light renders the comparatively
dark images of the printing and writing more difficult to be
( 11 )
perceived. Secondly, the position assumed by the children, in
order to avoid the disturbing influence of the light, places the
axis of the eye in a very unfavourable direction, which, as I
have already mentioned, and shall explain more fully by-and-
by, induces short-sightedness, differences in the sight of the two
eyes, and certain weaknesses of the muscles of the eye.
The motives for this diversity in the lighting of rooms cannot
easily be given, as they are different in almost every school. I
will, however, mention a few of the more prevalent.
Some of the principal schools are in buildings, two, three,
and even four hundred years old. Here the windows are not
in the most desirable positions; comparatively speaking, how-
ever, the lighting in the large class-rooms is very good. They
have high Gothic windows, and the light falls through them
more directly from above. The more directly the light falls
from above, the less is felt any fault with regard to the side
from which it comes. In small old buildings, the lighting is
frequently very bad. This would have been of little consequence
where the old building serves merely as a nucleus for new ones,
were it not that the unfortunate idea of building the new part
in the old style has deprived the children of the favourable
opportunity of obtaining several well-lighted rooms, in addition
to a small number of badly-lighted ones.
If we have to condemn this sacrifice of a most important
object to architectural taste, what shall we say when one of
the first architects in England builds, at an enormous cost, a
perfectly new, large, splendid school on an extensive piece of
ground, open on all sides, and who lights every class-room from
three sides at once, by low broad windows; thus rendering it
impossible to place the desks in any suitable position ? Are
trustees and architects aware of their responsibility, when they
build a school without consulting the masters, and only for out-
ward show? Or have they no misgivings of the evil consequences
resulting from such unpractical arrangements in a school?
In the schools of the middle classes I have generally found
:
tº
*
:
( 12 )
better arrangements with regard to light, especially where
limited means did not allow the architect to ornament the
house in the Tudor style, in which the upper part of the window
i.e. the most important, is useless, but obliged him to build in
a simpler manner. Buildings with rectilineal and rectangular
ground plan, with high, rectangular modern windows, do not
, produce such a pretty effect in the landscape, and do not
proclaim the genius of the architect to the superficial beholder;
but this seems to me of small consequence in the case of
institutions of such practical importance as our schools.
In the schools for the poor, where the light depends essentially . a
upon the situation and means of the school, and where the
first is often unfavourable and the latter limited, no one can
be blamed for the lighting, which is generally insufficient
rather than ill-arranged.
With regard to the various positions of the desks and seats,
it is difficult to give any account of the reasons for them, as in
most cases they appear to be the result of mere accident. Some-
times unimportant circumstances, such as the position of the 9.
door or fireplace, or the best place for the black-board, &c.,
have decided the matter. More frequently it has depended on
the desire to have the faces of the children in full light.
Against this I have already declared myself, in speaking of
the Government regulations. Most frequently, however, the
wish to place the children as near as possible to the master,
has regulated the arrangement, and has led to placing the
seats in a horse-shoe form. This seems to be the favourite
arrangement of all, and I am convinced that the large majority
of my hearers are in its favour. I am therefore very sorry
that, from my point of view, I must declare positively against
it. In the first place, only one-third of the children can have
a proper light; next, as is the case with the front light, it
defeats its own object. The children in this position are not,
as much as they might be, under the eye of the master. If he
turns to the right end of the horse-shoe, his back is turned to
( 13 )
the left, and his eyes would require the mobility of the cha-
meleon's to survey all the children. at the same time. The
arrangement of seats adopted in other countries, makes it easy
to see the whole class at a glance, and without turning the
head. The principal objection raised against this arrangement
is that it is difficult to see several rows placed one behind the
other; but this is easily overcome. The benches need only be
raised one above the other; or, what is still simpler and more
desirable, the master's place might be sufficiently raised. If
you will only make a practical trial, and not form an à priori
conclusion to the contrary, you will soon be convinced of the
correctness of what I say. Other objections, as, for example,
the difficulty of changing places, are also easily overcome. I
believe that you would then all return to that simple arrange-
ment which alone affords a suitable light. In most class-rooms
it would be easy to make the necessary alterations, nor would
this arrangement prevent the head-master from surveying the
different classes (separated by curtains) if he is in the right
position.
The lighting of the rooms in the evening ought to be as
similar as possible to that by day. It is difficult to arrange gas-
light well, but easy to arrange it better than has been done
in most schools. Almost everywhere I have found naked gas-
jets, which give an unsteady, bad light. Glass cylinders would
make the flame whiter and steadier. Reflectors would improve
it still more. They might in most cases be made to perform
at the same time the office of ventilators, carry off the bad
products of gas-burning, and improve the general ventilation of
the room.
Ground-glass globes ought not to be used: they are useful for
the ordinary lighting up of a room, as they diffuse the light
more equally throughout all parts; but, for that very reason,
they give an indistinct light for work, and, if they are opposite
the eye, are dazzling and injurious. This property of diffusing
light renders ground glass useful for lighting up the darker
( 14 )
parts of a room by daylight also, where there is no direct light
from the window; but care must be taken that it be only used
for skylights or the upper parts of windows. If lower, it is
hurtful, and positively injurious if opposite to the eye. It
ought therefore never to be used for the lower parts of windows
to prevent looking out. In such cases it would be preferable to
cover the lower part of the window altogether, as the light
which comes through is of little importance. In some schools
I have observed windows of ribbed glass, used on account of its
strength, so that balls from the playground may not break them
so easily. Instead of this, wire netting ought to be used, as the
optical effect of this glass, in that position, is decidedly hurtful.
In drawing classes, the employment of such glass is sometimes
very useful, if the light comes, as it ought in such cases, from
the higher part of the room. If the glass should reach lower,
it would, by diffusing light, destroy the distinctness of shadow
on the plaster casts. I may here observe that the arrangement
of seats in these ought not to be the same as in ordinary class-
rooms. Generally a diagonal arrangement is preferable; or, if
the room is long and very narrow, and the pupils only draw
from copies, and the light comes from the top, it will be best
to turn the back to the light.
If you have thus placed the seats in the right position, and
taken care to have a suitable light, there will be no optical
reason for the children assuming an injurious posture, and we
have then to inquire into the mechanical causes for such a
posture, viz. the form of the desks and seats.
The injurious effects which the crooked and stooping position
of children in schools has upon their health, in particular on
the lungs, abdominal viscera, figure, and sight, have lately
excited much attention among physicians, and produced the
works of Barnard, Schreber, Gast, Passavant, Guillaume,
Coindet, Fahrner, Cohn, Heinemann, and many others. I re-
commend to your perusal especially the excellent work of the
Swiss physician, Fahrner, entitled ‘The Child and the Desk.’
( 15 )
These various investigations have led to an almost unanimous
opinion as to the causes of the unhealthy posture assumed by
the children; while, as to the means to be adopted for obviating
these evils, there is now also an equal consensus of opinion.
Formerly it was supposed that a bad posture arose partly from
the inattention of the master, partly from the negligence of the
children; but now it has been clearly proved that, from ana-
tomical and physiological reasons, it is impossible that children
should preserve a good posture with unsuitable seats and desks.
The faults of the furniture commonly used have been carefully
analyzed, and the following have been found to be the most
important:—
1. Want of, or unsuitable, backs.
2. Too great a distance between the seat and the desk.
3. Disproportion, generally too great a difference, between
the height of the seat and that of the desk.
4. Wrong form and slope of the desk.
If the back is wanting or unsuitable, the strength of the
muscles which keep the spine straight is not sufficient to main-
tain it long in an upright position; the body stoops, and the
lower part of the spine becomes bent forward, presses on the
viscera and lungs, and prevents the free action of these organs.
If the child has to read a book placed on a table at too great a
distance, it sits on the edge of the seat, a very unhealthy and
fatiguing position. It rests the body on the two arms, and if
the difference between the desk and seat is too great, the chest
is supported by the projecting shoulders, instead of the shoulders
resting on the thorax. Soon this position becomes too fatiguing;
the head, bent forward, becomes too heavy, and must be sup-
ported by one or both hands at the temples, or by the chin
resting on both arms. Thus every possible modification of the
two positions immortalized by Raphael in the two angels at
the feet of the Sixtine Madonna, is adopted by the children;
but while the angels look into the far ether, our children stare
into a book, which, in one of these positions, is only two or
( , 16 )
three inches from the eye; and, in the other, sideways from the
head, and therefore at an unequal distance from the two eyes.
It is still worse when writing; with desks and seats of the
ordinary form, only one arm rests on the table, it is generally
the right arm, the left hangs so that the elbow approaches the
left knee, and only the tips of the fingers hold the book on the
table. The edge of the book is no longer parallel with the rim
of the table, but slanting, or even perpendicular to it. If one
observes the position which the upper part of the body assumes,
we find that the lumbar vertebrae are bent forward, those of the
chest towards the left, and those of the neck forward with an
inclination to the right; at the same time, the lower part of
the shoulder-blade stands too far off from the ribs, and is
elevated too much towards the right, and the shoulder-joint is
raised and pushed forward. To be in such a position for several
hours of the day, at a time when the youthful body is rapidly
developing, must naturally produce permanently bad effects.
Statistics prove this to be the case. In Switzerland, for instance,
20 per cent. of all school boys, and 40 per cent. of girls, have
one shoulder higher than the other. The well-known orthopaedic
surgeon, Eulenburg, also states that 90 per cent. of curvatures
of the spine, which do not arise from a special disease, are de-
veloped during school-life. These statements have particularly
struck me, as coniciding exactly with the period of the develop-
ment of short-sightedness, and I have paid the more attention
to this relation between spinal curvature and short-sightedness,
as they seem to form a circulus vitiosus, in so far as short-
sightedness produces curvature, and curvature favours short-
sightedness; while evidently the same bad arrangements are
at the foundation of both these anomalies.
How can these great evils be removed?—First of all, the
benches must have backs, and these must not be high, and not
slanting backwards, as I found them in some schools. These
only favour a negligent reclining posture, the body slides for-
ward, and the position becomes unsuitable for reading, and im-
( 17 )
possible for writing. The back ought to be straight, and consist
of a piece of wood only 3 inches broad. If this is fixed at the
proper height, viz. close above the hips, it supports the loins
sufficiently to make it easy and comfortable for even the most
delicate children to sit perfectly upright. The seat ought to
be broad enough to support almost the whole length of the
thigh, and the height of the seat such as to allow the sole of
the foot in its natural position to rest on a foot-board. The
edge of the desk must be perpendicularly above that of the
seat, and just high enough to allow the elbow to rest on it,
without displacing the shoulder. I think that all who have
carefully considered this question will be, on the main points,
of nearly the same opinion. I must add another condition,
which is of special importance for the eye, viz. that the desks
should have an inclination, for reading, of about 40°, for
writing 20°. The need of this arises from a physiological law,
which is not so generally known as most of the other laws re-
lating to the eye. It has, therefore, not even been considered
by physicians, who have made the improvement of School
arrangements their special study. Mr. Heinemann, who has
addressed you on the subject of school seats, has deduced the
necessity of having table-tops with a slope of 1:3, from the
foreshortening of letters lying on a flat table, which diminishes
the image of the letters on the retina, and thus causes a greater
exertion of the eye. This, however, is of small importance, and
need hardly be considered; the true reason for the necessity of
an inclined desk is as follows:—
The eyes are moved in different directions by six muscles.
The muscles of both eyes can only be brought into contem-
poraneous action in a certain way. Thus we can only move
both eyes at the same time up or down, or bring them together
from parallelism to convergence, and vice versá, not, however,
from parallelism to divergence. Of the possible combinations
of the muscles, some can be brought into action for a length of
time, others only for a few seconds. Thus we can only with
C
( 18 )
\ \
an effort look at a near object, if it is higher than the eye.
On the contrary, we can look with ease at an object equally
distant if it is below the eye. If we want to see distinctly
with both eyes, not a point, but a line or a plane, a particular
turning of both retinae is required for each position of the
object. Only when this turning can be produced by a com-
bination of muscles which can be effected with ease and for
some length of time, can we look at the object long without
fatigue. Therefore you must not think that the natural position
of the book while reading depends upon chance. It is a physio-
logical necessity; if we strive against it, the eye becomes
fatigued, and if the effort is repeated regularly and for a long
time, a derangement of the harmonious action of the muscles of
the eye is the consequence.
This is the reason why it is so fatiguing to look at the pictures
of a gallery, hung high on a vertical wall, while we could see
without fatigue the same number of pictures placed before us
one after the other upon easels. For the same reason it is so
hurtful to read while lying down, and, as we have often occa-
sion to observe, it produces great weakness of sight (asthen-
opia) in those who are forced to lie down much. Therefore
it is necessary, if we want to look long at any plane surface,
as for instance a book, to place it so that for the central posi-
tion the axis of vision is set at an angle of about 45° down-
wards, and we ought therefore to give the book an inclination
which will place it nearly perpendicular to our axis of vision,
viz. at an angle of about 45° with the horizon. For Writing,
the same inclination of the book would be advantageous, but
mechanical reasons prevent this, and we must be content with
an angle of about 20°.
In order to answer both requirements, I have had a desk
made, which, by a very simple contrivance, gives the desired
position either for writing or reading. There is, as in Heine-
mann's model, a flap which moves up and down. By the
shape which I have given to this flap, and some small details
( 19 )
in the construction, I have succeeded in giving, without me-
chanical, inconvenience, the inclination of 20° for writing,
and 40° for reading. For writing, the distance between desk
and seat is zero, for reading it is 5 inches, which has no
disadvantage, and enables the children to change their places
more easily. # *
If I were to confine myself to the proposal of such a desk, I
should be deceived in the hope of seeing it introduced into
English schools. The great difficulty of giving children of dif-
ferent sizes suitable school furniture would in this way not be
diminished. Shall I then recommend to you the American
system, where every child has its own seat and desk measured 2
or the Swiss system, where seven or more different sizes of seats
and desks are made, to suit the different classes P I would no
more do so than prescribe to one of my patients a medicine I
knew beforehand he would not take. I should prefer a less
efficacious treatment if it were more likely to be followed. I
have therefore endeavoured to find a method by which the
English school furniture may be greatly improved, without
coming too violently into collision with other arrangements and
the method of teaching in use here, and which will yet satisfy
the demands of hygiene as much as possible.
I shall consequently make the following propositions:—
1. One and the same size and model of desk should be used
for children and grown-up persons of both sexes.
2. The adaptation to the height of each child should be
effected by varying the height of the seat and the foot-board.
3. The edge of the table is always to be perpendicular to
that of the seat.
4. No seat is to be without a back, and the top of this is
always to be one inch lower than the edge of the table for boys,
and one inch higher than the edge of the table for girls.
5. In all classes where the boys change places, the height of
the seat is to be regulated in proportion to the average height
of the pupils.
C 2
( 20 )
6. In all girls' schools, in all those boys' schools where the
children do not change places, in boarding schools, and in
private schoolrooms, the seat of each child should be accurately
regulated in proportion to its height. * * -
Figs. 1, 2, and 3 show sections of school furniture made
according to my calculations of the average sizes of children of
three different classes. The relative height of the desk, the
seat, and the foot-board are, in No. 3, adapted to the average
al
É
A- **.S.
proportions of children of seven, eight, and nine years; in No. 2
to children of ten, eleven, and twelve years; in No. 1 to the
average proportion of children of thirteen, fourteen, and fifteen
years. t ſ
These are the proportions which the London School Board
accepted in adopting the principles laid down in my lecture.




( 21 )
FIG. 2.
FIG. 3.


( * ,
The flap b has three different purposes:— -
1.—To bring the edge of the desk near enough to the
children, to enable them to use the back-board when
writing. * *
2—To transform (by turning up) the inclination proper
for writing into the inclination proper for reading.
3.—To allow the children to stand up in their places, and
also to pass in and out easily.
The London School Board desks are double desks, with one
flap for two children. I should have preferred to give a separate
flap to each child, and, if necessary, to make up for the greater
expense by using one desk for four children; if the back-rail is
intercepted in the middle each child may get out of his place
without disturbing his neighbours. wº -
FIG. 4.
º
A ſº
§
Fig. 4 shows a desk and a chair which I have designed for
Schools in which each child is allowed to have his own desk and
seat, and for private schools.

( 23 )
The desk is the same for boys and girls of different sizes.
The proportions of children, or grown-up persons, are adapted
to the desk by the use of chairs of different heights and by the
shifting of the foot-board f . The shape of the back of the
chairs is different for the two sexes; the projecting part of it
fits into the hollow of the lower part of the spine. The chair
must be placed so near the desk that the flap, when turned
down, touches the child while it is sitting upright. In order to
regulate the height of the chair, it is sufficient to put a rule on
the top of the desk, so as to continue its sloping outline towards
the elbow of the child. The elbow of the arm which rests on
the desk should fall just into the continuation of that sloping
outline. If it is higher or lower, a lower or higher chair has to
be chosen.
II.
SCHOOL LIFE IN ITS INFLUENCE ON FIGURE, AND
* ESPECIALLY ON THE SPINE,
A. LECTURE DELIVERED BEFORE THE SOCIETY FOR THE DEVELOPMENT
oF THE SCIENCE OF EDUCATION, JUNE 5, 1878.
SEVERAL Members of this Society were present at a Lecture
which I delivered six years ago before the College of Preceptors,
at the house of the Society of Arts.
The subject of that Lecture was: School Life in its influence
on Sight. I laid down in it the rules for lighting school-
rooms, and for the position and form of the benches and desks.
The influence, which the following of these rules exercises on
the sight, formed the principal subject of it; I only incidentally
mentioned the influence of posture upon the spine. It is to this
latter point, which I have been closely investigating during the
last six years, that I should like to draw your attention this
evening. I hope to make you share my conviction that the
frequency of the so-called scoliosis, or lateral curvature of the
spine, has its principal origin in the position in which the
children sit during their school-time, especially while writing.
Few of you may have realized the frequency of this curvature,
and yet most of you have daily opportunity of observing it.
The number of boys with lateral curvature is very consider-
able, but far smaller than that of girls; for among those of the
higher classes, more than half will be found to have at least a
slight curvature. I shall afterwards enter more minutely into
the reasons of this fact; but first allow me to draw your atten-
tion to the alterations which are visible in the figure of those
children whose spine has undergone the before-mentioned
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( 26 ) {
deviation from the normal state. The drawing which I place
before you gives the view of the back, and, so far as outlines and
shāde can do, shows, first, that the right shoulder projects more,
and is lower than, the left one. Secondly, that the ribs below
the shoulder-blades also project more on the right side than
on the left. Thirdly, that the lateral outline, which runs
from the armpit to the legs, is on the left side almost straight,
whilst on the right side it shows above the hip a strong bend.
Fourthly, that the right hip stands higher than the left, and
that the whole pelvis has an oblique position. What the draw-
ing does not show distinctly, but what can be easily made
evident in every case of this kind, is a twisting of the spinal
column round a vertical axis. By this twisting, the upper half
of the body is so altered in its relative position to the lower half,
that it seems as if the thorax had been turned from the left to
the right, and the pelvis from the right towards the left. Seen
from the front, this is made evident by the chest appearing
fuller on the left side and flattened on the right, whilst the hip
projects on the right side, and appears higher. The lateral
deviation is scarcely to be noticed, first, because it is really not
so very great, and moreover its appearance is partly hidden by
the twisting.
Scoliosis may originate in different affections of the bones, as
well as in pleurisy, in paralysis, in rheumatism affecting single
groups of muscles, in irregular shape of the pelvis, in the
shortening of one leg, and in many other diseases. Of such
cases we have not to speak at all, but only of those slight forms
of deviation of the spine which are so very frequent, and occur
in quite healthy children. They deserve your earnest attention
the more as they are alterations of the normal body which are
exclusively produced by unfavourable conditions of School life.
This has been denied by several authors; and anatomical con-
ditions, congenital disposition, habits of the children, the
prevalent use of the right arm, &c., have been alleged as the
true reasons. Against this it has been stated that the develop-
( 27 )
ment of scoliosis has been statistically proved to be simulta-
neous with the school-time of children; that this disease does
not affect children who are not put to school; and that the simi-
larity of the deformity and of the appearance which a normal
body assumes during the usual writing position, is most striking.
To these arguments I have to add another one, which, as
far as I am aware, has not been mentioned by any author; and
this argument seems to me a very forcible one. I constantly
observe that the different methods of writing, and different
postures assumed for that purpose, produce anatomical modi-
fications in the shape of the curvature, which are in every case
characteristic of those postures. Let us consider three different
postures.
First: the left elbow rests on the table; the weight of the
head and upper part of the body is supported by the left
shoulder-joint and by the ribs of the left side, which lean
against the table; the right forearm rests only lightly on the
table, and the right elbow is placed near the right ribs. This
posture is almost exclusively adhered to in English girls' schools.
The lateral curvature of the spine produced by it differs from
the description given in German orthopaedic handbooks, by
the right shoulder, though more projecting, being lower, and
not, as generally described, higher than the left; and, more-
over, by the lumbar, that is the lower curve, being much
greater than the upper, the dorsal curve; and by the twisting
round the axis being the prevalent alteration.
Second posture.-The right elbow rests on the table. The
left one hangs down, the left hand rests on the edge of the table,
and on the copy-book. The weight of the head and upper part
of the body is supported by the right shoulder-joint and the
ribs of the right side, and slightly by the left hand. This
posture we find in many German girls' schools, but very excep-
tionally in England. The curvature produced by it corresponds
better to the description given in surgical papers. It shows
the right shoulder higher and only slightly more projecting
( 28 )
than the left. The lumbar curve is not so strong, and the
dorsal curve stronger than in the form of curvature produced
by the first posture. The twisting also is not quite so strong.
Third posture—Both elbows rest on the table. The weight
of the head, which is strongly bent forward, is equally supported
by both shoulder-joints, and the chest-bone leans against the
edge of the table. This is the favourite posture in English
boys' schools, chiefly in those of the higher classes. It seldom
produces scoliosis, and if so, only the slighter forms; but it
produces very frequently another slight deformity, which may
be described as an augmentation of the natural bends of the
spine. In these cases, both shoulder-bones stand higher, and
their lower angles stand off from the ribs. The shoulder-
joints are pushed forwards. This is the deformity most
frequent in boys. By this I don't mean to say that the
universally stated difference in the frequency of scoliosis for
both sexes depends upon this difference in the posture. It
is, on the contrary, perfectly clear that everywhere scoliosis
is more frequent amongst girls than boys, even where
the boys sit exactly in the same position as the girls. This
depends upon the bones, ligaments, and muscles being stronger
in boys; further, upon the fact that the growth of the boys is
extended over a longer period, and that therefore mechanical
influences do not produce so much effect upon them as upon
girls, their growth being completed in so much shorter a period;
and lastly, upon the antidote against the writing position which
boys possess in their games and bodily exercise, and in their
facility of indulging in all sorts of postures of which girls are
naturally deprived.
What now, anatomically considered, is the process by which
this affection is developed 2 Are the muscles first affected, or
the ligaments, or the bones?.
On this question there has been considerable discussion,
chiefly between those who base their views on the purely
physical ideas of gravitation, pressure, traction, and so forth;
( 29 )
and those, on the other hand, who lay great stress upon the
physiological action of nerves and muscles. It would lead me
too far to enter into this discussion, and I must therefore limit
myself to the description of my own views in the matter.
The ligaments, Ibelieve, in the beginning undergo a stretching
in a mere mechanical way. The ligaments which connect the
processes of the vertebrae are elongated on the convex side of
the curve. The very strong and elastic ligaments connecting
the two large surfaces of every two vertebrae are at the same
time drawn sideways by the twisting of the spine, and unequally
pressed upon, in consequence of the weight coming in an
oblique direction. They become, therefore, gradually thinner
towards that edge to which the vertebrae incline during the
writing posture.
Soon the bones, and especially the vertebrae of the lumbar
region, begin to yield to the traction produced by the twisting
of the spine, and the oblique pressure of the weight caused by
the curve. It is a well-known fact that even the strongest
bones of the human body are influenced in their shape by a
continuous, though slight, traction or pressure. Nevertheless,
it appeared strange that the vertebræ, which are fit to support
the weight of the body for the greater part of the day when in
the normal position, should be altered in shape by being several
hours in a certain abnormal position. I have therefore made
anatomical researches to explain this fact, and I shall show you
preparations which demonstrate the results of my researches.
The vertebrae have to offer a large surface, they have to
carry a great weight, and at the same time they must not be
heavy. They are, therefore, essentially formed by a spongy
substance of bone, the tissue of which appears by , nerficial
examination to be quite irregular. I have, howev$., by means
of fine cuts, made systematically in different directions, been
able to prove that the elements of the bones are arranged in an
absolutely regular, though very complicated, manner. So you
will see, in the horizontal sections, which are made through the
so
vertebræ at the height of the insertion of the processes, bundles
of lines forming regular curves, which cross the corresponding
ones coming from the other side. In the horizontal sections, -
which are near to the upper or lower surface, the principal
lines form regular concentric circles running parallel to the
outline. More important for the subject of our lecture is what
you see in the vertical section. Here you find, first of all, that
the network formed by the elements of the bones is finer on
the top and the bottom of the section, and much wider in the
e 2.
ºf - * , v i ſº -
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- ... " * * *
w = 7 sº sº
ºs-ºº-º-º: "P -
middle part. A still more important difference between these
parts of the vertical section is, that in the top and bottom
part you recognize some strong horizontal lines, and that, on
the contrary, in the middle part the elements form very strong
vertical lines, connected with each other by very fine lateral
branches. This middle part is the one in which the modifica-
tions in the form of the vertebrae originate.
The elements of this part are strong enough to carry a
weight which falls upon them in a strictly perpendicular direc-
tion, and, as long as they are in their normal position; but as
soon as, by 3 shifting of the superior and inferior surface of the
vertebrae, these elements are brought ever so little out of their
vertical direction, even a vertical pressure, and still more so
a lateral one, will make them break down. You will easily
understand this, if you think of those iron beams by which, in

( 31 )
modern buildings, the square wooden beams are now frequently
replaced. These beams answer the purpose only as long as
their largest diameter is vertical, and as they are loaded from
above. In any other position they would break down.
The diminution of height produced by the breaking of the
elements of the middle region is, it is true, very small in a
single vertebra; it is, however, quite sufficient to produce a
considerable curvature and twisting of the spinal column, if it
affects a series of the vertebrae, as it acts together with the
similar changes in the thickness of the intervertebral ligaments.
I have not yet mentioned the muscles. They act, however,
a considerable part in lateral curvature of the spine. Still,
I don’t believe that unequal action of the muscles of the two
sides forms the starting-point. On the contrary, I am convinced
that the difference in the muscles is only the consequence of
lateral curvature, as the weakness in the muscles of the more
convex side of the spinal column is produced by stretching and
prolonged extension.
This only concerns those deep-lying layers of muscles which
are next to the vertebral column, and not those superficial ones
which are accessible to ordinary observation. Only too frequently
I find that teachers and parents who consult me about this
affection in children are convinced that the stronger develop-
ment in the muscles of the right side has produced the projecting
of the right shoulder, whilst it is so very easy to convince oneself
that the shoulder blade adheres as closely to the ribs on one
side as on the other, and that the projecting of the shoulder is
caused by the twisting of the spinal column towards the right,
and through the projecting of the ribs of the right side, which
is dependent on that twisting. It is very important to get rid
of such mistakes, because they lead to positively pernicious
measures, which are carried out with the more energy the more
parents are impressed by the external symptoms—namely, the
projection of the shoulder and the hip; and the less they give
attention to the real disease in their children, the curvature of
( 32 ) .
the spine. Such false views of the matter can alone explain
the success of a very fashionable stay-maker, who, to the great
satisfaction of the mothers, apparently diminishes the projection
of the shoulder. She systematically produces in the course of a
few years a deformity of the whole thorax, which she, artificially,
adds to the scoliosis while pretending to cure it. I have had
the opportunity of minutely examining a large number of her
victims, and I shall describe to you the process, partly in order
*.

( 33 )
\
to caution you against it and partly to show you to what extent
it is possible artificially to produce modifications in the bones of
girls not yet fully grown.
Madam , by means of straps, draws the shoulders back-
wards, and so near together that they touch one another, and
by that cover the part of the spine lying between them (Fig. 7).
Then with gradually increasing force, and by means of stays
which are exceedingly strong and stiffin front, she presses the ribs
so tightly together that they are flattened at the side, whilst the
hindermost ends of the ribs become more convex and are pressed
so much backwards, that the spinal column sinks as it were
into a recess, and thus advances towards the chest-bone. In the
ordinary dress the waist appears very small and cylindrical, the
lower ribs flattened, the higher ribs with the chest-bone more
convex in front, while the whole back appears flat like a board,
and the shoulders angular and high. The mother, who has not
taste enough to see that this artificial doll’s figure is by no
means beautiful, and who does not know that the child had and
still has a lateral curvature, and that this deformity is only
partly hidden by the addition of another deformity, is quite
satisfied. It is only in evening dress that she discovers the
disfigurement of the shoulders, the deep fold formed by their
displacement, and the very ugly modifications in the appear-
ance of the neck. -
School hygiene, however, has not to deal with any surgical
treatment, whether right or wrong, but with the precautions to
be taken to prevent school life from having an obnoxious
influence upon the health of the children. The precautions
necessary to prevent spinal affections I feel entitled to recom-
mend to your careful consideration the more strongly, as they
are identical with those I had to ask for in the interests of the
preservation of the sight of the children. A back rest is neces-
sary to avoid short-sightedness, and good light is necessary to
avoid curvature of the spine. For preservation of sight, as well
as of a normal figure, the possibility of remaining in a normal
D
( 34 )
posture during school-time, and especially when writing, is an
absolute necessity. But what, now, is the normal posture?
The upper part of the body is to be kept straight, the
vertebral column neither twisted to the right nor to the left;
the shoulder-blades both of the same height, are, together with
the upper arm, freely suspended on the ribs, and in no way
supporting the body; both elbows on a level with each other,
and almost perpendicular under the shoulder-joint, without any
support; only the hands and part of the forearm resting on the
table; the weight of the head freely balanced on the vertebral
column, and not on any account bent forward, but only turned
so much round its horizontal axis, that the face is inclined suffi-
ciently to prevent the angle at which the eye is fixed on the
book from being too pointed.
As to the form to be given to school furniture, in order to
enable the children to assume the desirable posture, I must
refer to my former lecture on “School Life, and its Influence
on Sight.” I shall, however, show you some models of benches,
desks, and seats (Figs. 1, 2, 3, and 4), and at the same time
draw your attention to the inclined chair I designed for re-
placing the so-called inclined board used chiefly in young ladies'
schools, and this by a great mistake. The aim of the method
of lying down on an inclined board or on the floor is to rest
the back, when tired, in a position where the weight would
be taken from the vertebrae, and where those parts of the body
which had momentarily lost their symmetry, would be gradu-
ally forced back into a symmetrical position. That, instead
of attaining this end, the method has rather a contrary result,
and is, moreover, generally disliked by the children, is explained
by the following reason:
The vertebral column, in its normal shape, has certain
regular curvatures, both in the sitting and in the lying down
posture. If we lie with our back on any flat surface, our body
touches it with only a comparatively small portion of its outline.
This small portion, therefore, has to bear a disproportionately
( 35' )
great weight, and suffers inconvenience accordingly, while the
non-supported parts of the vertebral column are forced out of
their normal curvature by the weight of the parts of the body
resting on them.
This is at once fatiguing and hurtful. And yet even those
who themselves have suffered from this procedure, are still
found to cling to it.
In analyzing this question I have come to the following
result: if a hard surface is to give the back rest, without
making it suffer, it must have certain curvatures so adapted to
the normal shape of the body, that this latter is supported
everywhere, and its weight equally distributed.
These curvatures I have carefully studied, and following
their outlines, I have designed a couch adapted to the inclina-
FIG. 8.
tion of the body at an angle of 45°. For girls who have any
predisposition to lateral curvature of the spine, it will be found
useful to let them do every work that will admit of it, while
reclining on such a couch at an angle of 45°.
I should specially recommend to let them rest on it from

( 36 )
time to time during the day for ten minutes or more, in order
to relieve the fatigue of the upright position. For very delicate
children, and for grown-up persons with weak spine, I have
Fig. 9.
designed pillows which support the body in the same way as
the inclined chair, but are softer, and admit of a change in the
degree of inclination.
LONDON : PRINTED BY WILLIAM CLOWES AND SONS, STAMFORD STREET AND CHARING CROSS.





ATLAS OF OPHTHALMOSCOPY: (*
Representing The Nowai and Pathological Conditions of The Funbus \
OCULI, As SEEN witH THE OPHTHALMoscoPE. , \
*
\
- º Composed of Twelve Chromolithographic Plates, containing Fifty-nine Figures -
- - drawn from nature, and accompanied by an explanatory text.
London: J. & A. CHURCHILL, New Bunington Stºrer, 1870.
ON A NEW NETHOD OF EXTRACTION OF CAIARACT.
J. E. ADLARD, BARTHolourw Close. 1872.
London: J. E. ADLARD. 1873.
LoNDON : SMITH, ELDER, AND CO. 1874.
NEw ophth ALMIC INSTRUMENTS.
J. E. ADLARD, BARTHolomew Close.
* - TURNER AND MULREADY
"ON THE EFFECT OF GERTAIN FAULTS OF VISION ON PAINTING
WITH （FCIAL REFERENCE TO THEIR WORKS."
"ON THE REAL AND IDEAL IN PORTRAITURE.”
"THE DETERIORATION of oil PAINTINGs.
THREE LECTURES DELIVERED AT THE Royal, INSTITUTION.