Finally, it must be remembered by teachers, employers, parents, and all eye users that eyes are constantly changing; that eyes may need glasses six months after they are examined and found sound; that glasses change or develop the eye, so that they may be unnecessary and harmful six months after they are prescribed, or the eye may require a stronger glass; that eyeglasses become bent and scratched, so that they worry and strain the eye; that a periodic examination is essential to the health of the eye.

In caring for the health of the eye, we should also remember that our eyes are our chief interpreters of the world that gives us problems, profits, and pleasures. Out of gratitude, if not out of enlightened self-interest, we owe our eyes protection, attention, and training, so that without straining we shall always be able to see truth and beauty.

CHAPTER VIII

EAR TROUBLE, MALNUTRITION, DEFORMITIES

The presence of adenoids is a frequent cause of both slight and aggravated deafness. Of 156 deaf mutes examined 59 per cent had adenoids, while only 6 per cent of the general run of the children in the neighborhood had this trouble. In mouth breathing, the current of air entering the mouth draws out some of the air from the Eustachian tube which ventilates the middle ear and unequalizes the atmospheric pressure on the eardrum, causing it to sink in and to blunt the hearing. An examination of the eardrums of school children in New York who are mouth breathers showed a high percentage of deafness, incipient or pronounced, accompanying adenoids. For example, of 9 mouth breathers selected from one class (average age 7-8 years), 6 were well-marked cases of deafness. Of 8 mouth breathers (average age 8-9 years), and of 5 mouth breathers (average age 5-6 years), all had noticeable defects of hearing. Many adults that suffer from deafness maintain that they never had any trouble in childhood. Yet the evidences of nose and throat trouble in childhood persist and disprove such statements. The foundations of deafness in later life are, in most instances, laid in childhood. Since the majority of cases of ear trouble occurring in school children accompany diseased conditions of the nose and throat, the proper care of nose and throat will, in large measure, balance the shortcomings of the aural examinations. Since the examination of the drum itself is not practicable, especial care should be given to the examination of the nose and throat.

The figures published by New York City's department of health show that of 274,641 children examined from March, 1905, to January, 1908, 3540, or 1.2 per cent, gave evidence of defective hearing. Ear specialists suggest that this small percentage results from employing the whisper test at twenty feet. The whisper test at sixty feet has been set by experts as a test of normal hearing. But preciseness with this test is well-nigh impossible when we consider that the acoustics, the quality of the examiner's voice, the weather, the vowel or consonant sounds, all are variable quantities. The watch test is frequently used, but since a young teacher in her enthusiasm used an alarm clock to make the test, specialists have decided that the volume of sound differs in watches to such a degree as to make the watch test unreliable. The examination of the eye has been reduced to mathematical precision, due altogether to the anatomy of that organ. As yet there is no instrument for the ear comparable to the ophthalmoscope. The acoumeter is largely used by aurists and can be obtained from the optician. This instrument has an advantage over the whisper or watch tests in that its tick is uniform.

Each ear should be tested separately. Let the child place his finger against the flap of one ear while the other is being tested. Then compare the farthest distance from the ear at which the tick can be heard with the normal, standard distance. During the test all sound should be eliminated as far as possible and the eyes should be closed. At a demonstration of ear testing at Teachers College, one student stated that she could not hear the tick of the watch at a distance greater than twenty inches. Then the tester walked noisily toward her, leaving the watch on the desk, five feet away from the patient. She heard it now. When the class burst out laughing she opened her eyes, and, seeing the watch so far away, exclaimed, "Why,

I thought I imagined it." Be careful in testing a child to distinguish between what he "thinks he imagines" and what he really hears. Because of the difficulties of this test a doubt should be sufficient to warn the teacher to send the child to be tested by an expert. Detection of slight deafness may lead to the discovery of serious defects of nose or throat. Inflammation from cold or catarrh may cause deafness, which if neglected may permanently injure the ear. Often deafness is due to an accumulation of wax. A running ear should receive immediate attention, as it is an indication of inflammation which may imperil the integrity of the eardrum, and, if neglected, may eat its way through the thin partition between the ear and the brain and cause death.

It should never be assumed that deafness is incurable. Stupidity, inattention, and slowness to grasp a situation accompany difficulty of hearing and should cause the teacher to examine the ears. No ear trouble is negligible. Children and parents should be taught that the normal ear is intended to hear for us, not to divert our attention to itself. When the ear aches or "runs" or rumbles there is something wrong, and it should be examined together with the throat and nose.

NERVOUSNESS

In New York City one child in ninety-one already examined has had the form of nervous disease known as St. Vitus's Dance, or chorea. So prone are we to overlook moderate evils and moderate needs that the child with aggravated St. Vitus's Dance is apt to be cured sooner than the child who is just "nervous." Teachers cannot know whether twitching eyes, emotional storms, constant motion of the fingers or feet are due to chorea, to malnutrition, to eye strain, or to habits acquired in babyhood or early childhood and continued for the advantage that

accrues when discipline impends. Many a child treasures as his chief asset in time of trouble the ability to lose his temper, to have a "fit," to exhibit nervousness that frightens parent, teacher, or playmate, incites their pity, and wards off punishment. The school examination will settle once for all whether the trouble can be cured. The family physician will explain what steps to take.

TESTS OF MALNUTRITION

We Americans were first interested in the physical examination of school children by exaggerated estimates of the number of children who are underfed. As fast as figures were obtained for eye defects, breathing defects,

bad teeth, some one was ready to declare that these were results of underfeeding. Hence the conclusion: give children at least one meal a day at school. Scientific men began to set us straight and to give undernourishment a technical meaning, -soft bones, flabby tissue, under size, anæmia. While too little food might cause this condition, it was also explained that too much food of the wrong sort, or even food of the right sort eaten irregularly or hurriedly or poisoned by bad teeth, might also cause undernourishment, including the extreme type known as malnutrition. In extreme instances the symptoms enable an observant teacher who has learned to distinguish between the pretty hair ribbon and clean collar and the sunken, pale, or hectic cheek and lusterless eyes to detect the cause. But as with eyes and nose, an unhealthy condition