THE HYGIENE OF VISION F. PARK LEWIS, M.D., CHAIRMAN OF COMMITTEE ON CONSERVATION BUFFALO, N.Y. In order that my meaning may be clear, I will premise this paper with a statement of the propositions which it is especially desired to emphasize: 1) That the nation's most valuable asset is its children. All other forms of wealth are of secondary importance, because later it will be thru their efforts that all progress -material, intellectual, and moral-shall become possible. 2) That except for their minds and morals-and both depend in a larger degree than we realize upon their sight-their eyes constitute their most valuable possession. 3) That the present methods of book-study, especially in the large proportion of cases in which uncorrected organic defects are present, not only affect the eyes them- v selves but retard the normal development of the brain, prolonging thereby unnecessarily the period of tutelage and lessening life's later opportunities. 4) That there should be less close work for the eyes in book-study, note-taking, etc., and more care of the eyes in providing conditions under which they may be used with the least possible effort. 5) This can be secured only by the organized and concerted efforts of great bodies, like those representing the teachers, the doctors, the architects, the illuminating engineers, and, more especially, the parents of the children themselves. Words sometimes take on new meanings by reason of new conditions with which they are associated. As conditions change, the old words which we must employ to describe the new methods express an additional or a modified thought as a new interpretation comes from new procedures. Our supreme court has just been obliged to recognize this fact in its most recent decision; the interpretation of exactly the same words made by an act of Congress twenty-one years ago is today widely different from that which its framer designed. Not that the words have changed, but new combinations, new adjustments, new relationships have given them a new significance. The same process which has been going on in the business world in an analogous way affected all of life's relationships. By reason of the new thought illuminating one old word, business combinations have been reconstructed and railroad managements reorganized. There is no institution so venerable, there is no profession so firmly grounded, that it has not been stirred to its foundations by this word. Industries that were supposed to have been conducted under most approved methods were found, when studied in the new light thrown on them, to have been directed with prodigal indifference to the least expenditure compatible with the largest possible returns. That word is "Efficiency." In medicine it is compelling the substitution of exact knowledge for speculation. It insists that in the most important profession of all, because it is the one upon which all others are based, that of teaching, the standard of proficiency shall not be determined by the facts acquired but by the growing ability on the part of the student to meet the demands that shall be made upon him; in his increased mental alertness, in his greater powers of concentration, of logical reasoning, of straight thinking, of his physical development, and of the added keenness of all of his senses. If in the acquisition of certain of these factors he is losing in others, then the method must be restudied and the unworkable factor eliminated. Measured by the standard of efficiency, the problem of education is almost exactly analogous to that with which our great business interests are confronted. The children constitute a vast asset. They are the equivalent of a certain amount of actual wealth, from which we have a right to expect the largest possible returns. They constitute the machine by which the world's work is to be done, and if the methods which we employ prove destructive to the machine which we are endeavoring to construct, there must be something fundamentally wrong with the methods. We thereby violate one of the first principles of efficiency long since enunciated, "that no great thing is ever accomplished by great effort." When a great thing is done it is done easily. When the wheels begin to grind, it not only means that the machine is being destroyed but that power is being lost and progress is being impeded. When, therefore, we find that in the process of educating the child his nerves give way, his eyes are used with difficulty, or his sight becomes impaired, it is in itself evidence that there is internal friction and that the highest intellectual results are not being conserved. The excessive use of books and of note-taking, which by reason of the added visual effort required for near work is the chief cause of eye-strain and of the structural changes in the eyeball, is at the same time an obstacle to direct and logical thinking. The printed word is but a symbol of the thing or action which it represents, and it must be interpreted in terms of sense images. The groups of letters constituting the word in and of themselves are meaningless until they are so interpreted. So definitely are the seeing of the word and its interpretation dual processes that when a break occurs in the line of transmission in the brain connecting these two centers their sense of relationship is lost and the printed page carries no meaning to the otherwise intelligent brain. The action which the word or group of words represents is immediately understood. This condition is called "aphasia," or word-blindness. Its importance in pedagogy seems to have been overlooked. It means, if it means anything, that two efforts are required to convey an idea from the printed page when but one would have been sufficient had the act itself been portrayed rather than the symbols used to represent the act. The human mind is incapable of performing two functions at the same time. While the attention is given to the written or printed word it is diverted from the thought which it is intended to convey. Hence every hour of book-study means twice the time and twice the effort that would have been needed had direct methods been employed. Apply this to the whole long, costly period of tutelage and we can realize how school life might be shortened and eyes and nerves might be saved by teaching the thing sought for itself without the intervention of the impeding symbols. A student grew most expert in taking the lectures as given by his professor at college, but with added facility of transmission was proportionately lessened retention. The mental damage was incalculable. He was making a sieve of his brain, and the hour that he might have spent in mental athletics, in grasping the thought and in following the argument which was addressed to his intelligence thru his ears, was lost, and another hour was laboriously occupied late in the night in straining his eyes, in developing myopia, mental as well as physical, in interpreting, thru visual images, ideas that should have been made clear thru his auditory impressions. It is the act of thinking that is the essential thing. We do not see with our eyes nor do we hear with our ears except as the brain understandingly recognizes the impressions made upon it. We use our eyes so constantly that we fail to hear much that should impress us. When immersed in thought or when deeply interested in a book or a newspaper we often fail to hear our names when called. It is not that the ears are out of function, but the mind is not alert and the message is not conveyed to the receptive center. A condition quite analogous occurs when we see without intelligently noting what passes before our eyes. The habit of doing anything that should require thought without thinking of it is always mentally demoralizing. The penalty sometimes exacted of requiring children to write the same word a large number of times when it has been misspelled, or as a punishment for a misdemeanor, is pernicious, not only in giving added work to the eyes, but psychologically it is deplorable in permitting the mind to act automatically. Professor Münsterberg recently asked the members of his class in psychology to watch every movement which he was going to make. As he drew geometrical figures in the air with one hand, he took his watch from his pocket with the other, glancing at it meanwhile; but so fixed was the attention of the boys on the unusual motions that the common, habitual, automatic one passed quite unobserved. "Eyes have we, but we see not." Brain-building comes from thinking, and printed books are only the guideposts, not the steps, from point to point. Lewis Carll was born blind. He worked his way thru college by the aid of his brains, and subsequently gained a life professorship in Columbia University by the unprecedented, the phenomenal, tour de force of an original work on Differential Calculus. Mr. Carll, tho able, is not an astoundingly brilliant man. He visualized his impressions and he followed each process in this intricate mathematical labyrinth thru the chambers of his brain. He mentally saw the picture of each problem at pleasure. This is what every noted chess-player does, especially those who play many games at once. Just as the pictures received in the brain may be held to be recalled at will, so they may be received with the rapidity of photography. Catharine Aiken, a very brilliant teacher, had some years ago a school in New England. She taught her girls what is called "glance work" and which is now in some form employed in many schools. Several disassociated letters or figures were placed upon the blackboard and the pupils were allowed to look at them for three seconds, when the board was turned and the girls reproduced what they had seen. The next day these symbols were increased in number or in complexity, and each day following they were added to, until finally a line of twenty letters, complicated by various distinguishing signs, was reproduced after a brief glance at them: X I PCB X 2 0 9 D M 4 R Q 8 LOPTES An equally complicated and rapid grasp of visible symbols occurs when any good pianist reads, as she must, the coming phrase, in both clefs, with its modulations, its incidentals, its pedal markings, and perhaps the voice part, if she sings and all during the brief time in which the previous phrase is being given. All of this is simply to urge that our present laborious method of using printed books to the extent that we do might be simplified, might be replaced by brain-training, giving us thereby a larger intellectual output at a lower cost of effort and without destroying the machine in the process. That these ideas are neither fanciful nor chimerical is instanced in the fact that many of our best teachers and wisest thinkers have applied them practically with such effect that otherwise normal boys and girls are looked upon as prodigies. In doing this we avoid internal resistence and we prevent structural damage as a consequence. Just as the Tungsten filament lasts longer and gives far more light than the carbon because it allows the passage of the current without resistance, so the more easily an idea can be transmitted to the brain the less injury to the paths of transmission. In our present methods the energy that should be directly used in thought is used in an effort to see, and as a consequence the eyes suffer. So recently as at the International Congress at Paris, 1910, the late Professor Dufour, than whom there was no more careful observer, corroborated the rules laid down by Cohn more than twenty years ago, viz.; I. In all schools the number of short-sighted pupils increases from class to class. 2. The average degree of short-sightedness increases from class to class. 3. The number of short-sighted pupils increases with the increase of school demands. Does it not seem imperative that such a destructive method, at least when the danger is imminent, should be replaced by one in which the same results mentally can be more quickly secured without injuring valuable eyes? If we may not change the methods under which our children are taught, may we not at least secure for them hygienic conditions under which their studies may be prosecuted? As the result of a questionnaire sent generally thruout the country inquiring as to the care of the children's eyes and the hygiene of the schoolroom, certain conclusions of great value were elicited. It was shown that there were no accepted standards governing the construction of school buildings, no general regulations as to the length of time which the adolescent eye should devote to close work, no consensus of opinion as to the tint, surface, or quality of paper to be employed. As a supplemental report, I would like to submit the conclusions reached by the Committee on the Standardization of Schoolbooks of the American School Hygiene Association at a meeting held in New York, of which William H. Burnham, Ph.D., was chairman, as the report on this subject of this committeeDr. Burnham, professor of psychology of Clark University, being also a member of the committee of this Association. Many causes that are instrumental in producing defective sight are now known to be largely controllable. In order that thought may be fixed upon this subject and the public enlightened as to the necessity of wider knowledge concerning the care of the eyes, it is proposed that a certain day be chosen in the fall of 1912 as a Conservation of Vision Day, when the care of the eyes will form the subject for consideration in the schools and public assemblies thruout the United States. This has already been taken under advisement by the Council on Education of the American Medical Association, and they will be prepared to confer with a like committee which is to be appointed by this Association on matters concerning the public health. The children will be invited to consider the conditions under which eyework is carried on in their own schools and in their homes. Addresses will be given by sanitarians, teachers, illuminating engineers, and others. The local lighting conditions of public buildings will be studied. The American Association on Conservation of Vision, which has received the moral and financial support of the Russell Sage Foundation, will act as a clearing-house, and the executive secretary, whose office is in the United Charities Building, 105 East 22d Street, New York City, will aid in the formulation of plans in sending suggestive and helpful literature in development of this method of educating the public on this important subject -the right care of the eyes and the hygiene of vision. SCHOOL ACTIVITIES IN RELATION TO CHILDREN'S EYES J. A. SHAWAN, SUPERINTENDENT OF SCHOOLS, COLUMBUS, OHIO In these days of educational progress when school conditions are being so thoroly studied and work is planned according to the ability and adaptation of the individual child, it is but natural that the question of sense limitations, especially that of vision, should be taken into account in matters of school activities. The study of the causes of retardation which is now in progress has already shown that a larger percentage of pupils are handi |