myopia to increase, but there would be no such tremendous increase were these children not obliged to go to school.

I lay particular stress on the increase of myopia, because that eye is so subject to disease. Other errors of refraction, like hyperopia and astigmatism, while conducive to disease, are more likely to give rise to earache and headache, etc. Not only are these children subject to intra-ocular disease, but they are frequently backward and stupid or irritable.

How can this increase be diminished? Well, the first means is school hygiene; good light, good print and paper, correct desks, and a correct position at the desk. And this was the first method by which they undertook to solve the problem. It was not very successful; there was no marked diminuition; still, it is of importance.

Correction of errors of refraction by the wearing of glasses will do far more to check the evil than all other means combined; proof of this may be obtained from numerous statistics. I do not wish to be understood as advocating the wearing of glasses by every school child who has an error of refraction, but I do wish to state that glasses are indicated if the error of refraction is causing troublesome symptoms or is likely to lead to disease.

When I first heard of this law, I was not very enthusiastically in favor of it. I recognized its desirability, but I did not think it was practical. But after looking up the subject I have changed my views.

The method of examination by school teachers as proposed by Dr. Alport of Chicago and embodied in this law will eliminate all except the milder cases, and it is so simple:

"Does the child habitually have inflamed eyes?

Is his vision less than normal?

Does he frequently have pain in eyes or head after studying?

Is he cross-eyed?"

And these four questions correctly answered are all there is to it. Certainly it is simple enough so that any school teacher who has intelligence suffcient to teach can carry it out.

In regard to the examination of school-children's ears, I do not consider that so important, for those troubles are not so insidious as a rule. The marked deafness and the earache attract attention and locate the trouble.

In closing I would like to join in thanking Dr. Gorham for his excellent paper and to congratulate the state of Vermont on having a Board of Health so alive and up to date.

Dr. Cramton, St. Johnsbury.

Gentlemen: It is obviously evident to you, and very evident to me that this subject has been thoroughly gone over by the excellent paper of Dr. Gorham, and the discussion of Dr. Twitchell.

All of you can easily recall that throughout Vermont and all the states, that the majority of the people have always thought the only people who

should wear glasses were those forty years of age or older; everyone younger than that was supposed to wear them for looks! But the fact that there are such a large number of children having defective vision has been more published and written about than formerly, and it has brought about a change, so much so that states are taking action upon it. As Dr. Twitchell says, I congratulate the state of Vermont upon formulating the law, and the health officers who had to do with the formulating.

You can get up all the cards and different means of conducting the proper tests, but, you must as individuals and as health officers bring about two things. You must bring about enthusiasm on the part of the parents and on the part of the teacher; you must interest both parent and teacher in the work. You must warn them; you must teach parents that above all things their child must have a sound body. It has been proven most conclusively that children who are badly nourished, who have bad hygienic surroundings, who do not have proper exercise, and as I said before, that they are badly nourished, are more prone to eye diseases,-because the body is in a weak condition. Malnutrition together with over-taxation of the eyes easily causes either one of the forms of defective vision, or some of the many pathological conditions of the eyes.

Therefore, you must warn the teacher that she should not give longer lessons than can be easily learned, if possible, in the school hours, and if possible with the minimum amount of artificial light for studying; for the reason that the best observations have proven that over-taxation of the eyes is the common cause of myopia. The school directors and the superintendent of schools should also be instructed in the buying of books having the proper type, causing the minimum amount of eye strain; that there should be proper ventilation in the schoolroom; the children should have proper posture at the desks, the desks placed in a proper position relative to the rays of light being shed upon the books. All these things will be conducive to very good results, if this law is enforced.

We want you to remember that the student of to-day is to be the teacher in September, and a year from next September perhaps another teacher will start in, and this work will all have to be gone through again and again. Doctors and health officers in charge will have to go over it every year, in order to properly enforce this law.

I look at the condition of deafness in children a little differently from Dr. Twitchell. I think it is just as essential for the children to have good hearing as good eyesight.

Now, gentlemen, I consider that it is most important that both teachers and parents, should have as complete an understanding as possible, relative to the cause of deafness in children, in order that they may be better equipped to prevent and advise proper treatment for its relief or care, therefore, I will briefly outline the pathological changes that take place in a large percentage of deaf children.

I can safely state that seventy-five per cent of the deafness in children is due, directly or indirectly, to adenoids. Adenoids are fibrous growth in

the post-nasal space. When present they cause partial or complete obstruction to nasal breathing. They interfere with the circulation of the blood to the brain; they cause marked catarrhal condition of the nose and throat, and last but not least in many instances they cause partial or complete obstruction of the orifices of the Eustachian tubes.

As a result of this obstruction to free nasal breathing we have a child that soon develops a severe type of naso-pharyngeal catarrh; he becomes a weak, sickly child. He is stupid in appearance and gradually becomes stupid in reality; as a result of the catarrhal condition and the obstruction in the Eustachian orifices a tubal catarrh develops also, the Eustachian tubes become partially or wholly obstructed; as a result the middle ear becomes a vacuum. Then there is suction, and the eardrum is retracted, the small bones of the ear displaced, inflammation and adhesions take place, resulting in permanepixation of the small bones of the ear and the eardrum in an abnormal position, and the result is deafness.

It is in this simple mechanical manner that seventy-five per cent of all the deafness in children is caused. Therefore you can all easily understand how important it is that these adenoids should be noted by the teacher and parent. For, unless the deafness is too far advanced and the little bones have become-firmly fixed, the eardrum can be replaced in normal position by inflation. The very simple operation of removal of the adenoid growths will remove the cause and these deaf children will marvelously recover. I certainly consider the subject of deafness in children, its cause and treatment just as important as that of defective vision; therefore, I again urge the health officers of Vermont to constantly warn the teachers to note carefully all mouth-breathing children, and when found, to advise their parents as to their proper treatment.

In conclusion: As I wished to present to you some real facts with reference to the real condition existing in our public schools to-day, I sent a letter to several school superintendents in different towns, requesting them to first send me the number of children in the different grades who wore glasses. Secondly, the number that apparently had defective vision, that did not wear glasses. As a result, I was able to collect statistics of 1,078 children from the first to the tenth grades. Out of these 1,078 there was reported a total of only 69 wearing glasses. The greater number being in the sixth grade; the majority being about twelve years of age. The number of children who did not wear glasses but who apparently had defective vision, was 74.

This shows better than anything, that there are many more school children in Vermont that have defective vision that has not been properly corrected than corrected. I found also, among the 1,078 reported, 45 as being apparently deaf.

Now, in conclusion, gentlemen, the state of Vermont has passed the law and it is for you, her health officers to create enthusiasm among the parents and teachers, in order that Vermont children will have proper care, nutrition, and hygienic surroundings at home. In the schoolroom the teacher

must regulate the work in such a manner that there need be no overtaxation of mental work.

It can only be by the hearty coöperation of both parents and teachers that the eyes and ears of Vermont school children can be properly cared for.

Dr. Clark of Castelton.

I would like to ask this question: I have noticed that in many of our public schools, in the work in arithmetic for the small children, in the second and third grades, are required to do that sitting in their seats, while the. teacher writes it on the board for them, they are compelled to copy on their papers and carry it home, or lose their work. I would like to ask whether that will have or does have a deleterious effect upon the eyesight of the children?

Answer by Dr. Caverly.

I will say in answer to Dr. Clark's question, if the pupil has perfect vision it would be no strain, but if he is farsighted, and certainly if he is nearsighted, it would be a strain looking across the room to the blackboard.

Question by Dr. Clark.

The point I had is whether this method, constantly repeated day after day, if it would do harm to the muscles of the children's eyes?

Answer by Dr. Caverly.

Not if a child has good eyes. It is possible that a defect in the muscles might be increased.

I simply wish to speak in regard to the cards to be used for this examination which have been furnished the schools, which I presume you have all seen, which is something like the one hanging up here on the board, giving seven lines of letters; also below it is full instruction to the teacher; and by looking this over carefully, you can find out how this examination should be conducted, and I think no one need have any trouble at arriving at a correct understanding in regard to sight and hearing of the pupils. The card of warning to be sent to the parents or guardians of the children, giving the name of the child with defective hearing or eyesight is also furnished. I can most heartily endorse what Dr. Twitchell has said in regard to refraction of the eyes and correcting these errors of eyesight; thus staying the progress of disease. I don't believe in placing lenses before young people's eyes unless it is necessary; pain and headache are undoubtedly due to error of refraction, and in this case the eyes should be corrected. If they do not have symptoms, I do not believe in correcting it.

I most heartily endorse what Dr. Cramton has said in regard to adenoid growth, and I don't know that there is anything we can do to relieve this condition of the tonsils and upper part of the throat. I think a large percentage of deafness is due to this same cause. By relieving it in the younger years, they can preserve good hearing.

Question.

Do you understand that the health officer has anything to do with conducting this examination of the eyes and ears?

Answer by Dr. Caverly.

According to law, the State Board of Health and the superintendent of education carry out and fulfill this law, and as officers under the State Board of Health, you are to see that the law is enforced.

Judge Fisher.

There are a great many teachers who are not competent to make this examination. It seems to me it will be a most excellent idea to have them instructed at the summer schools, that they may be able to carry out the tests at the beginning of the fall term.

Answer by Dr. Caverly.

They were last summer, and they will be this.

Question by S. W. Butterfield.

We are to understand that we are to have supervision of this law, and to see that it is enforced?

Answer by Dr. Caverly.

Yes.

TO THE SCHOOL TEACHERS OF VERMONT.

BY DR. CHARLES S. CAVERLY.

Section I. of Number 45 of the Acts of 1904 contains the following: "The superintendent, principal or teacher, in every school, during the month of September in each year, shall test the sight and hearing of all pupils under his charge and keep a record of such examination according to the instructions furnished; and shall notify in writing the parent or guardian of every pupil who shall be found to have any defect of vision or hearing, or disease of eyes or ears, with a brief statement of such defect or disease; and shall make written report of all such examinations to the superintendent of education as he may require."

This law is in harmony with a widespread movement in this country and is the result of knowledge gained from quite a large number of examinations of the eyes and ears of school children both here and abroad. It has been estimated by very well posted men that two thirds of the 15,000,000 children in the public schools of the United States have some defect of either eyes,

ears, noses or throats.