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long reaches of fields and forests, hills, valleys and landscapes, by which their eyes are cultivated to see plainly at long- as well as short-range. This was well illustrated in the shooting tournaments of the American with the Irish and English teams. The foreigners barely held their own at short-range, while the Americans were superior at long range; which was. attributable to the different conditions in the education of the
9th. Ill-constructed covering for the head. The good, oldfashioned sun-bonnets, which the girls wore at home and to and from school when you and I were boys, were undoubtedly a great protection by warding the the blinding rays of the sun, but this nondescript article of female apparel called "a hat," is of but little use in protecting the eyes or any other part. The parasol must be brought into requisition to do what the sun-bonnet did much better.
These, from the nature of the case, cannot be curative, so far as eyes already injured are concerned, but rather prophylactic, to these pupils who are to follow in the educational road, and may be highly noted as follows:
Make the school-age or the age of admission greater, say ten years, unless it be for kindergartens.
Abolish black-boards and substitute white or some shade of blue or green which will be more agreeable and less fatiguing to the eye and make use of colored crayons.
3d. Abolish slates and substitute white paper.
4th. Tone down profuse or direct light by muslin shades of light color.
5th. Substitute text-books with larger print.
6th. Permit the pupils to rest the eyes by "looking off of the book" occasionally, while your diligent pupil, intent upon his studies, scarcely lifts his eyes from the book. Your dolt who is "everlastingly gawking around," although he may not make as much intellectual progress, comes out of his schoolgoing days with his eyes and other faculties uninjured, ready
to grapple and wrestle with the world at sight, whilst the other fellow must see it through glass.
7th. Shorten the school-term to three months; make the hours of study less, especially for children under ten; continue the old-fashioned forenoon and afternoon recesses.
8th. Limit the number of simultaneous studies so that the pupil shall not be required to study at night when he ought to be asleep.
9th. Let the children play often, or change the programme so as to give variety and rest to the eyes. The Jesuits have a rule which requires every one to change his employment as often as each two hours.
10th. Instruct teachers how to take care of the pupil's
11th. Teach directors and architects how to build and furnish school-buildings with reference to preserving not only the eyes but every faculty and function.
Two of my daughters who graduated in our high school are afflicted with myopia, which I attribute to two causes: intense study and too much light reflected from the blackboard in room No. II, which is the worst one in the building. I would rather to-day that they had stopped in the common branches and thereby retained the proper use of their I eyes. hope this matter will be properly investigated, so that causes of diseases of the eyes, incident to acquiring an education, may receive due consideration.
By WILLIAM BAIRD, M. D., Barnesville, Kansas.
It has been asserted by several authors that purulent conjunctivitis is rarely found in this country. I, however, come across it frequently in my field of practice, especially among those who are poor or filthy, and irregular in their habits, or live in low, unhealthy districts. It usually begins with a general aching of the joints and bones; with bowels constipated;
tongue coated; a bad, disagreeable taste in the mouth; appetite poor; irregular, chilly sensations followed by flashes of heat; headaches; the eyes itch and burn and feel as though there were particles of dirt or sand in them. This itching and burning is accompanied with a thin, watery, acrid discharge from the eyes, which in a day or two becomes thick and purulent or muco-purulent. The conjunctiva of the lids is generally considerably swollen and reddened, which sometimes quickly involves the ocular conjunctiva, and there is a free effusion into the areolar tissue. In severe or neglected cases vision may be permanently impaired by opacity of the cornea, or by a trachomatous condition of the lids. In some severe cases the cornea becomes thin and softened, and bursts, thereby allowing the escape of the aqueous humor, which is followed in a short time by the crystalline lens and a considerable portion of the vitreous humor. This disease is both contagious and infectious. Some are so susceptible that they will take it by being in the presence of those who have the disorder; but it is usually conveyed by using the same handkerchief or towel that has been used by those affected; and when it gets into a family all the members will have the disease unless great care is taken to prevent it.
The treatment of this disease should be both local and constitutional. We might succeed in curing some very mild cases with local treatment alone, but in all probability they would do well if not treated at all. Constitutional treatment alone will not cure. It is highly necessary that the practitioner should see that the patient is kept clean by frequent baths; that his clothing is changed as often as every other day; and that he is supplied with clean handkerchiefs, towels, etc., several times daily. When there is reason to believe that there are morbid accumulations in the stomach and bowels, they should be removed by giving an emetic or cathartic, or by both if indicated. Arterial excitement should be controlled by the special sedatives; generally gelsemium should be associated or alternated with the ones used. Periodical fever
should be arrested by giving full doses of quinia. If the patient is very restless and cannot be quieted with the Gelsemium, chloral hydrate may be given; or, if the bowels are open, an opiate may be used for the purpose of procuring rest. Locally the following should be used:
R. Zinci Sulp. grs. ii. to x.
M. S. Drop two to five drops into the eyes four or five times daily.
The above prescription in any hands accomplishes all that can be reasonably expected, and for some years I have used no other.
PURULENT OPHTHALMIA IN INFANTS.
By R. A. REID, M. D., Boston.
Grave as is the purulent form of ophthalmia, as seen in adult life, it is equally grave and much more common in infancy. In this, as in the purulent affection of adults, the whole importance of the case depends upon the degree to which the cornea is involved, and the attention, when an infant is first examined, should be chiefly fixed upon the transparency or opacity of that structure, rather than on the inflammatory evidences that exist, such as redness, swelling and purulent discharge. Some regard this as an affection purely catarrhal in character, while others of equal authority hold it as due to actual contact with the leucorrhoeal discharge of the mother during parturition; still others tracing it in every case, as they contend to irritating substances, applied soon after birth, such as soap, during the washing process by an inexperienced or careless nurse.
From the variety of symptoms seen, it seems, to say the least, highly probable that all cases are not due to the same cause; and that while many of the milder ones are the result of exposure to draughts of cold air, and abrupt changes of temperature, or irritating substances, the more severe cases in
which rapidly-destructive ulceration, or sloughing, of the cornea dooms the unfortunate child to life-long blindness, are due to actual contact with the gonorrhoeal or leucorrhoeal discharge.
Since the accuracy of the diagnosis, and also of the prognosis, depends altogether on the integrity of the cornea, no pains should be spared to ascertain the exact condition. It is always difficult, however, to obtain a satisfactory view of the cornea of a child suffering with either this or other variety of corneal disease. Light causes so much pain that the little sufferer makes every effort to exclude it by keeping the eyelids firmly pressed together and resisting all attempts to separate them, thrusting his face into the pillow or against the dress of the attendant. To attempt to coax or parley with such a patient is but to waste time, and the surgeon must therefore have recourse to other means. He should sit with a towel spread over his knees, the attendant sitting just in front, securing the child's hands, and lowering him backward till his head is received between the surgeon's knees where it can be firmly held. No little tact is required to expose the cornea thoroughly without everting the lids, but that tact can be acquired by a little practice. The extreme end of the first finger with a small piece of rag twisted over it to prevent slipping, should be laid upon the middle of the upper tarsus at the very edge-between the roots of the lashes and the globe; and the lid, without any dragging of the skin, should be pushed in a direction which in the erect posture of the body would be up and back. Almost the entire cornea will thus be brought into view, but if the finger drags the skin of the lid, the tarsal cartilage becomes instantly tilted over; and the conjunctiva, bulging forward, effectually hides the eyeball. It is never necessary to interfere with the lower lid, for the cornea is always rolled upward under cover of the upper. A small wire speculum, if at hand, will readily accomplish the same purpose. Having exposed the cornea, the creamy matter that oozes out as the lids are drawn apart should be gently removed with a moistened rag or some cotton batting. The conjunctiva will be found red and swollen whatever the con