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Surgeon to the Western Ophthalmic Hospital.

THE loss of sight in one eye, though not an incomparably lesser calamity than complete blindness, is still a serious handicap in life, as is recognized by the substantial compensation awarded in cases of accident involving this disability. Few people are aware of the fact that a very large number of our population are at the present time suffering from loss of sight in one eye, due not to accident but to squint dating from infancy, and left either untreated till too late or insufficiently treated. The fact that the number of adults with a pronounced squint that one ordinarily meets is not very great, whereas the proportion of children with an obvious squint is far greater, leads to the mistaken idea that the effects of squint are confined, as a rule, to childhood, and that in the majority of cases the child is in time "cured" or "grows out of it" without any special treatment being necessary. So far as appearance goes this idea is to a great extent justified. There is a natural tendency in most cases of divergent squint for the angle to become less pronounced as the child grows older, even without any treatment. What generally happens is that the child is brought to the hospital some years after the squint has first developed, and the prescription of suitable glasses very often in time entirely corrects the faulty appearance, or in cases when this is impossible the same result may be attained by operation. This is all very well and the mother may be very pleased, but what is not realized is that a very large proportion of these squinting eyes have already become partially blind, in some cases so blind as to be practically useless, whereas, if only a certain amount of care had been exercised soon after the squint first became evident, this would not have been the case.

The faculty of vision-i.e., the interpretation by the brain cells of the images from the external world that are formed upon the retinais one of the many difficult lessons which is gradually learnt by the infant. At first he learns to interpret the image on each retina separately without combining them. The faculty of complete or binocular vision-i.e., the combination by the brain cells of the two slightly different retinal images which are formed of any object

towards which the two eyes are directed-is a more difficult lesson which is only learnt later. In some cases this faculty is only acquired with difficulty or imperfectly, and in some it may never be acquired at all, owing to an inherited or congenital peculiarity. Now the possession of binocular vision is Nature's great safeguard against squint. Those who do not possess it may still never squint, but they are in great danger of doing so at the time of life when the nervous mechanism by which the movements of the two eyes are co-ordinated, though developed, is not sufficiently stable to withstand a strain such as may happen to any child through some infantile illness (measles or whooping-cough, as a rule) or through a fright. When one inquires from the mother of a squinting child at what age the squint was first noticed, one is occasionally told that it began soon after birth, but far more often the answer will be between the third and the sixth year. Now the importance of this matter consists in this: the younger the child at the time when the squint starts, the more disastrous is the effect on vision in any untreated case. The essentials of treatment are three first, to force the squinting eye into use by blocking up the good eye; second, to make it easier for the squinting eye to see by means of an appropriate spectacle glass; and third, to educate the faculty of binocular vision by means of special appliances. In cases where early and efficient treatment is obtained the child does not forget how to see with the squinting eye. If, on the other hand, the squint is neglected, the eye which is never directed towards the object which the child is looking at with his good eye becomes more or less permanently blind. When a squint which is constant in one eye, and dates from early childhood, has lasted for a certain time, the sight of the squinting eye can seldom be materially improved by treatment, no matter whether it continues to squint or not.

Those who desire fuller information on this subject should consult Worth's book on "Squint." He there publishes tables of cases in which he could be reasonably certain as to the time of onset of the squint, and in which his directions were followed to his satisfaction. The little patients who were brought to him when the squint had only lasted during one-eighth of their life numbered 193. In the case of the great majority (165) of these the vision was subsequently found to be normal. In the case of 188 children who were brought to him when the squint had lasted more than one-eighth, but less than onehalf of their life, the results of treatment were not so good, but still

146 Squint, its Causes, Pathology and Treatment," by Claud Worth. Published by Bale, Sons and Danielsson, Ltd. Fourth edition. 260 pp. ; illustrated. 6s. net.

fair. Only 73, or less than half, retained normal vision, the majority retaining varying degrees of useful vision. In seven cases the eyes were practically blind. Unfortunately, the majority of Worth's patients and this is the experience of every ophthalmic surgeon attached to a hospital--were not brought to him until they had squinted during more than half their life. These cases numbered 604, and in them the improvement of vision effected by treatment was only very slight. In only fourteen of these cases was normal vision retained. In 191 the eye was hopelessly blind, and in 179 nearly blind. These tables also bring out the fact that the younger the child is at the time of onset of squint, the more essential is it for treatment to be prompt. Of 370 children with a squinting eye blind or nearly blind (less than), 334, or nine out of every ten, began to squint before the age of 3, whereas of the eyes which retained better vision less than half began to squint before that age.

I have said enough to show how important it is that the children in nursery schools should have efficient ophthalmic supervision. It is, indeed, the mothers who need educating in this matter, and whatever arrangements are made for providing treatment for the children, the education of the mothers should not be left out of account. Two plans are possible. Either the entire treatment of these cases could be entrusted to the school doctor, who in this case would be required to possess the requisite special ophthalmic training, or else the treatment could be laid down, as is now done in the case of older children, by the doctor attending the school clinic or the hospital, in which case the duty of the school doctor would be merely to see that the prescribed treatment was being efficiently carried out. In either case the school doctor would be required to keep himself or herself in touch with both the teachers and the mothers of the affected children.

If in this paper I have confined myself to the one subject of squint, it is not because that is the only infantile disease of the eyes which requires attention, but because the number of children now affected by it who are left without adequate treatment until too late is so very large in comparison with the rest.

Inflammatory conditions and cases of defective vision in both eyes, whether from infantile cataract, congenital defect, a high degree of astigmatism or infantile myopia, all occur, and all need proper attention, but they are not so likely to be overlooked until too late, under present conditions, as are the cases of squint.

36, Weymouth Street,



Under this heading are gathered thoughts from literature, both ancient and modern, which seek to provide information likely to be of assistance to students of child life and practical workers for child welfare. It is hoped that our readers will co-operate in making this section both suggestive and serviceable.


The system of eurhythmics introduced and developed by M. Jaques Dalcroze, of Geneva, has justly found much favour in this country. Realizing the educational advantages of scientifically ordered and effectively conducted eurhythmics we have repeatedly brought this subject before our readers. The newly formed Dalcroze Society of Great Britain and Ireland, the Hon. Secretary of which is Mrs. M. L. Eckhard, Broome House, Didsbury, Manchester, is now undertaking the exposition of eurhythmics and is publishing a series of "Eurhythmics Papers." These are issued by the Liverpool Booksellers Co., Ltd., 70, Lord Street, Liverpool. No. 2 of the series consists of an interesting address by Professor J. J. Findlay, M.A., of the Department of Education in the Victoria University of Manchester. Professor Findlay concisely defines eurhythmics as "the use of the body as a musical instrument." He lucidly explains the educational advantages of M. Dalcroze's work. The following quotation will doubtless direct many to the study of the whole article, which will well repay thoughtful study: "Eurhythmics, we say, is the use of the body as a musical instrument; all your other instruments, piano, flute and the rest, touch solely my ear and my voice; but music belongs to the whole of me, every muscle and nerve, from the crown of the head to the soles of the feet are concerned in the physical response to fine music; if you or I are not thus moved, then it is because with advancing years our powers of response have become atrophied by disuse if all we can do with music is to hear it, then it has lost half its meaning to us. Watch your children when music really lays hold of them; there is vibration and attention in every sense and every limb. Dalcroze, then, has invented a technique by which the human body can take its place, side by side with violin and piano, as a master


The achievement of this task, the elaboration of this newly discovered instrument, adapted to modern music, has not been a trivial affair; and to learn eurhythmics, although most delightful to the student, is not the affair of an

an idle moment, to be picked up like a new fashion in dancing. Naturally, since Dalcroze began to be well-known, plenty of cheap imitators have offered to produce the same æsthetic result on easier terms, and those who prefer a tin whistle to the flute of Orpheus may be left to enjoy their own taste. There are

many wise parents who have misgivings about any pursuit which appears to make much of the human body, whether it be a case of dancing or of gymnastics. We know that the old warfare which our Puritan forefathers waged, opposing 'the flesh to the 'spirit,' is a real warfare, a conflict which every generation must renew the scene of battle changes, but the battle itself is perpetual. What is this body, this physical tenement in which we dwell? Can we ignore its claims and centre our attention on what we call the higher, the spiritual life? or can we discover modes by which, as Browning said, flesh helps soul'? Surely the reconcilement can only be affected by recognizing that the body is designed to be the servant, the organ, the instrument of mind in every department of our life. The child to begin with is the subject of gross and animal pleasures; in educating him we cannot bid him despise pleasure, but we teach him to use both body and mind so that he can enjoy more exalted pleasure. The Puritan was wrong not in his ethics, but in his psychology and St. Paul who described the body as the temple of the Holy Ghost' was nearer to the truth. The present position of what is called physical training in our schools is the result of similar confusions of thought. You should not, while in good health, fix your attention to any great extent on physical processes. It is unwholesome to

think too much about food or drink; and it is equally unwholesome to spend much attention on muscle and limbs. Hence if your immediate aim is to maintain health and vigour, you will achieve this best if you aim at something else at the same time. Nature always tries to kill two birds with one stone' if she can! Hence the benefit of formal systems of gymnastics, such as those we owe to Ling or Sandow or Muller, are only sought by people who live cramped lives in cities,


need extra attention to physical strength when serving as soldiers or sailors. At any rate as regards the period of life when eurhythmics can most easily be learnt, I would request our teachers of Swedish gymnastics to yield the ground. This period lies between the years 6, 7 and 9, 10; when the child is ready also to learn to read music and to sing music. Let him at the same time learn to embody' music, and thus unite in one subject of the curriculum all that is needed at this period both for physical training, voice and ear training, musical notation, and the delight of song. Until such a universal reform in the curriculum of young children is achieved every boy and girl who pays special attention to music, whether in singing or in playing an instrument, should also be permitted to gain the unique experience in rhythm and musical expression afforded by eurhythmics. Even if only a short course is followed the effects on musical taste and appreciation are so marked as to warrant the highest claims which Dalcroze and his pupils put forward. The fine arts can never remain stationary; they respond at each age to the new views of life which a new generation experiences; we welcome Dalcroze not merely or chiefly because we enjoy the exhibition of graceful movement, but because he has found the key to a new apprehension of life, both of the physical life and of that more subtle and mysterious realm which we call the emotional life. If to us of an older generation the door to this temple has been closed, let us not bar the entrance to our children."

THE SOLACE OF SONG. Music is not only a luxury, a recreation, an adornment, but an energizing force to safeguard, direct, control and stimulate the governing forces of life.

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We as a people have been too neglectful to cultivate a love for our national songs. But in days of sorrow and suffering wisdom is born. Amidst the horrors of war we are learning something of the solace of song. The November issue of the School Music Review, a monthly journal devoted to the interests of music in schools, and published by Messrs. Novello and Co., Ltd., 160, Wardour Street, W.1 (price 1d. each number), there appears a suggestive article on Music in Schools in Time of Air Raids,” by G. G. Lewis. We commend this helpful article to the notice of all teachers, and particularly to those in London and other districts liable to raids. The following quotation indicates the practical character of this communication: “Our air raid rules gathered the children in classrooms away from windows towards the Central Hall. Four far-off classes were to leave their rooms and spread round the hall. All the books needed by the pianist were to be kept in one place, and brought out by a monitor specially detailed for the service. And then one day the warning came just as the children were assembling for school, and we had the opportunity of testing our plans under the actual tension of expected trouble. Children were soon in their proper places-some left home after the signal, as they preferred to come to school to sing it through. Teachers stood at the door of their classroom where they could see the conductor, and one or two of the best violins stood behind the pianoforte to give a hand. The head conducted from the floor of the hall, and walked round from class to class occasionally. We started with Begone, dull care,' and went on with other national songs, imperfectly known, for we judged that if trouble was coming it would be later, and we reserved our best-known songs to drown gun-fire. The children joined in well, the only visible sign of excitement being the way in which they tried to shout the loud parts. The head hinted that this showed lack of control, and that boys doing it were really nervous. It had an immediate effect in the desired direction. . . . At the end of three-quarters of an hour the welcome All clear' filtered through. Then we all trooped out into the hall, and this time we certainly sang a hymn, O God our

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