Education and Health of the Partially Seeing Child 9780231881364

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EDUCATION and HEALTH of the PARTIALLY SEEING CHILD

M O D E R N , W E L L - E Q U I P P E D CLASS FOR P A R T I A L L Y SEEING P U P I L S

Fluorescent illumination for general lighting; incandescent inserts for chalkboard lighting.

EDUCATION and HEALTH of the PARTIALLY SEEING CHILD « K *

By Winifred Hathaway

REVISED

EDITION

Published, for the N A T I O N A L S O C I E T Y FOR T H E P R E V E N T I O N OF BLINDNESS, INC. By C O L U M B I A

UNIVERSITY

New York:

1947

PRESS

Copyright COLUMBIA

1943,

UNIVERSITY First Revised

Edition Edition

1947 PRESS,

NEW

YORK

1943 1947

PUBLISHED IN GREAT BRITAIN AND INDIA BY GEOFFREY CUMBERLEGE, OXFORD UNIVERSITY PRESS LONDON AND BOMBAY MANUFACTURED IN THE UNITED STATES OF AMERICA

ACKNOWLEDGMENTS THE MATERIAL presented in this publication, intended for the use of administrators, supervisors, teachers, nurses, social workers, and others concerned with the welfare of children, has been gathered from many sources. T h e author acknowledges with appreciation the assistance of those who have most generously supplied data: Matie M. Carter, former supervisor, Physically Handicapped Children's Bureau, State Education Department, Albany, New York; Marcella S. Cohen, supervisor, Prevention of Blindness Department, Pennsylvania Association for the Blind, Pittsburgh, Pennsylvania; W . G. Darley, Lamp Department, Nela Park Engineering Department, General Electric Company, Cleveland, Ohio; Audrey M. Hayden, executive secretary, T h e Illinois Society for the Prevention of Bindness, Chicago, Illinois; Estella V. Lawes, supervisor, Braille and sight-saving classes, Cincinnati and Southern Ohio, Cincinnati, Ohio; Loetta L. Lovejoy, teacher of sight-saving class, Martins Ferry, Ohio; Hazel C. Mclntire, director, Division of Special Education, State Department of Education, Columbus, Ohio; Olive S. Peck, supervisor, Braille and sight-saving classes, Cleveland, Ohio. T h e author expresses appreciation to members of the staff of the National Society for the Prevention of Blindness, who gave most valuable assistance in the preparation of the sections of the book particularly related to their special fields: Elizabeth G. Gardiner, formerly medical social worker for the Society; C. Edith Kerby, associate in program planning and research; Eleanor W . Mumford, associate for nursing activities; and to Isobel Janowich, editor, National Society for the Prevention of Blindness, and Ida M. Lynn, assistant editor, Columbia University Press, for their painstaking editing of the manuscript. T h e author is grateful to the busy people who made time to read portions of the text and to offer helpful suggestions. WINIFRED

New York City

HATHAWAY

CONTENTS Part One: H I S T O R I C A L L

BACKGROUND

H I S T O R Y of the E D U C A T I O N of P A R T I A L L Y SEEING CHILDREN Introduction; Function of Special Education for the Partially Seeing; Historical Background; Great Britain; T h e European Continent; T h e United States of America; Nomenclature.

Part Two: A D M I N I S T R A T I V E RESPONSIBILITIES II.

C L A S S I F I C A T I O N of the P A R T I A L L Y SEEING

13

Defining the Partially Seeing; Placement; Procedures for Partially Seeing Pupils; Transportation. III.

M E T H O D of F I N D I N G P A R T I A L L Y SEEING CHILDREN

20

Screening Process (Illinois, New York, Ohio, Other communities). IV.

ADMINISTRATIVE PROGRAM PLANNING

26

Number of Pupils in Classes for Partially Seeing; Elementary School; Junior High School; Senior High School; Vocational Opportunities. V.

PROBLEMS in ADMINISTRATIVE PROGRAM P L A N N I N G for SMALL C O M M U N I T I E S and R U R A L AREAS

31

A Consolidated School; T h e Demonstration School of a Teachers College; A Special Class in the Nearest City; Class for Children with Different Types of Handicap; Special Educational Facilities for Partially Seeing Children in Their Home Rural Schools; Consideration of Minority Groups. VI.

S C H O O L H E A L T H SERVICES for V I S U A L L Y HANDICAPPED C H I L D R E N General Health Services; Mental Health of the Partially Seeing Child; Records; Glasses.

37

viii VII.

CONTENTS S E L E C T I O N and P R E P A R A T I O N of the T E A C H E R of the P A R T I A L L Y S E E I N G

51

Personal Qualifications; Fundamental Preparation and Experience; Special Preparation (Elementary courses, advanced courses). VIII.

S U P E R V I S I O N of P A R T I A L L Y SEEING PUPILS

58

Ophthalmological Supervision; Educational Supervision; Duties of Special Supervisor; T h e Visiting Teacher. IX.

METHODS

of

CONDUCTING

and

FINANCING

CLASSES for the P A R T I A L L Y SEEING

65

Co-operative Program; Cost of Educating the Partially Seeing (Salary of teacher, Cost of lighting and decorating, Cost of equipment); Financing the Education of the Partially Seeing. X.

P R E P A R I N G the S C H O O L for the P A R T I A L L Y SEEING CHILD

75

Selection of a Building; Selection of a Classroom; Illumination and Decoration (Measurement of light, Natural illumination, Placement of windows, Window shades, Artificial illumination, Selection of luminous bowl, Number of luminaires, Fluorescent lighting, Maintenance); Decoration of Rooms (Influence of color). XI.

E Q U I P M E N T of C L A S S R O O M S

86

Physical Equipment (Closets, Chalkboards, Seats and desks, Tables and chairs. Equipment for hot lunches); Educational Media and Equipment (Typewriters, Typewriter tables, chairs, and copystand, Books, Maps, globes and charts, Paper, Pencils, Chalk, Pens and ink, Material for motivated handwork, Other equipment).

Part Three: E D U C A T I O N A L RESPONSIBILITIES XII.

T E A C H I N G P A R T I A L L Y SEEING C H I L D R E N

95

Curriculum; Sharing Responsibilities; Program Planning; Policies Regarding Interrelationship of Teachers. XIII.

T h e T E A C H I N G of T O O L S U B J E C T S

103

Reading: Reading difficulties; Selection of Reading Material: Typography and paper, Shortage of large-type material; Writing: Manuscript writing, Chalkboard writing; Typewriting; Arithmetic; Motivated Art and Handwork. XIV.

T h e USE of M E C H A N I C A L DEVICES in T E A C H I N G Typewriters; Recording Machines; Talking Books; Radios.

123

CONTENTS XV.

ix

CHILD GUIDANCE for PARTIALLY SEEING PUPILS 128 Role of the Teacher; Prevocational Training as Guidance; Vocational Guidance.

Part Four: C O M M U N I T Y SERVICE XVI.

SOCIAL

RESPONSIBILITIES

COMMUNITY SOCIAL SERVICE and CIVIC ORGANIZATIONS 137 Community Social Service (Group services, Case work, Medical social work, Voluntary agencies); Civic Organizations; Community Responsibilities of the Special Teacher of Partially Seeing Children.

XVII.

The ROAD AHEAD

144

APPENDIXES 1.

W H A T the TEACHER SHOULD KNOW about the EYE and EYE HYGIENE 151

2. VISION TESTING, a SCREENING PROCESS

175

3.

OUTLINE for CHECKING LIGHTING FACILITIES and EQUIPMENT for EYE WORK in the CLASSROOM 183

4.

EQUIPMENT for PARTIALLY SEEING PUPILS

188

5.

VOCABULARY of TERMS RELATING to the EYE

193

BIBLIOGRAPHY

203

INDEX

2OQ

ILLUSTRATIONS PLATES Modern, Well-Equipped Class for Partially Seeing Pupils

Frontispiece

Courtesy Poughkeepsie, N.Y., Public Schools.

Early Myope School in England

6

The First Class in the United States Established Especially for Partially Seeing Pupils, Boston, Mass., 1913

6

Courtesy Birmingham, England, School System.

Courtesy School Committee of the City o£ Boston, Mass.

Early Class for Partially Seeing Pupils in New Bedford, Mass.

7

Courtesy New Bedford, Mass., Public Schools.

Early Class for Partially Seeing Pupils in Ohio

7

Courtesy Ashtabula, Ohio, Public Schools.

Well-Conducted Elementary Class for Partially Seeing Pupils

26

Courtesy Detroit, Mich., Public Schools.

Group of Partially Seeing High School Pupils

27

Courtesy Detroit, Mich., Public Schools.

Class for Partially Seeing Chinese Children

34

Courtesy San Francisco, Cal., Public Schools.

Class for Partially Seeing Negro Children

34

Courtesy Louisville, Ky., Public Schools.

A Well-Prepared and Understanding Teacher Holds the Key to Success

56

Courtesy Detroit, Mich., Public Schools.

Resourcefulness and Participation—Willing Hands Make Light Work Courtesy Akron, Ohio, Public Schools and Akron Beacon

Example of Excellent Co-operation Courtesy Detroit, Mich., Public Schools.

57

Journal.

65

xii

ILLUSTRATIONS

Well-Lighted Class for the Partially Seeing Indirect System of Lighting Using Luminous Bowls

76

Courtesy Akron, Ohio, Public Schools and Akron Beacon Journal.

Grade Classroom Equipped with Fluorescent Lighting

80

Courtesy General Electric Co., Nela Park, Cleveland, Ohio.

Classroom Equipped with Fluorescent Lighting for Partially Seeing Pupils

81

Courtesy Mt. Vernon, 111., Public Schools.

Desk Adjusted to Best Position for Hyperopic Child

88

Adjustable Movable Seat and Desk

88

Progressive Table No. 128, with Reading T o p Especially Suited for Use of High School Pupils

88

Courtesy American Seating Co., Grand Rapids, Mich.

Desk with Adjustable Reading Rack

88

Courtesy American Seating Co., Grand Rapids, Mich.

Materials for Partially Seeing Pupils Compared with Those for the Normally Seeing

88

Courtesy National Society for the Prevention of Blindness, Inc., New York, N.Y.

Geography Lessons Have a N e w Meaning W h e n Maps Are Large Enough to Be Easily Read

89

Courtesy Nathaniel Hawthorne School, Oak Park, 111., and The Illinois Society for the Prevention of Blindness, Chicago, 111.

Creative Activities Are of Special Interest to Partially Seeing Pupils 116 Courtesy Nathaniel Hawthorne School, Oak Park, 111., and T h e Illinois Society for the Prevention of Blindness, Chicago, 111.

Illustrations by the Pupils for the Stories T h e y Have Read

117

Courtesy Nathaniel Hawthorne School, Oak Park, 111., and T h e Illinois Society for the Prevention of Blindness, Chicago, 111.

A Partially Seeing Child Learning to Use the Typewriter

124

Courtesy Nathaniel Hawthorne School, Oak Park, 111., and T h e Illinois Society for the Prevention of Blindness, Chicago, 111.

Interest (a Magic Word in Education) Manifested in the Story the Talking Book Tells 124 Courtesy Nathaniel Hawthorne School, Oak Park, 111., and T h e Illinois Society for the Prevention of Blindness, Chicago, III.

ILLUSTRATIONS

x i i i

Learning to Use the Dictaphone Courtesy Akron, Ohio, Public Schools and Akron Beacon

125 Journal.

Learning by Hearing

125

Courtesy Akron, Ohio, Public Schools and Akron Beacon

Journal.

A Series of Pictures Illustrating Vision Testing Techniques

176

Courtesy National Society for the Prevention o£ Blindness, Inc., New York, N.Y.

FIGURES 1.

Loss of Light from Maintenance Neglect

82

Courtesy Westinghouse Electric and Manufacturing Company, Bloomfield, N.J.

2.

External Muscles of the Eye

154

3.

Horizontal Section of Left Eye

156

4.

Rays of Light Passing through Prism and Deflected toward the Base 158

5.

Convex Lens: (a) bases of prism at center; (b) curved sides; (c) parallel rays of light becoming convergent 158

6.

Concave Lens: (a) apexes of prisms toward center; (b) curved sides; (c) parallel rays of light becoming divergent 159

7.

Convex Lens: (a) parallel rays of light brought to a focus; (b) effect of increasing curvature of lens 160

8.

Concave Lens: (a) parallel rays of light becoming divergent; (b) effect of increasing curvature of lens 160

9.

Window Cards Showing Position of Opening: (a) on 2030 Foot Lines of Snellen Test Chart; (b) on 40-50 Foot Lines of Snellen Test Chart; (c) on 70-100 Foot Lines of Snellen Test Chart 181

TABLES I.

Legal Provisions for Establishing and Financing Classes for the Partially Seeing in the United States

70

Summary of Legal Provisions Given in Table I

73

III.

Reflection Factors of Paints

85

IV.

Size of Type for Books

II.

V.

112

Percentage of Visual Efficiency Retained, Based on Snellen's Notation 179

Part One:

H I S T O R I C A L BACKGROUND

Illiteracy, the product of educational neglect, must be stopped at its source and that can be done only by giving educational opportunity to the children—all the children of all the people of America. ELBERT D. THOMAS

Chapter One: H I S T O R Y of the E D U C A T I O N of

P A R T I A L L Y SEEING C H I L D R E N

I

the State is charged with the responsibility of providing educational opportunities for all children capable of receiving instruction. For such an undertaking there can be no universally accepted program even for so-called "normal" children. When marked mental or physical deviations exist, the problem becomes even more complex and possible solutions become more difficult. Even when solutions are found, they must be considered tentative. Progress can be made only in proportion to the ability and the willingness of a democracy to adapt itself to changing modern conditions. Partially seeing children form one of the groups which show marked deviations from an accepted norm. Because of their visual limitations, they cannot take advantage of many of the educational opportunities which are provided for normally seeing children, and they are equally unable to profit from those suited to the needs of the blind. In some measure the problem has been solved by the establishment of 620 special classes in 35 states, the Territory of Hawaii, and the District of Columbia, representing 221 cities and counties. In addition, some assistance is given to a comparatively small number of children in rural areas. T h e nine thousand children thus provided for, however, form a small proportion of the group; more than fifty thousand of them are struggling along as best they can in regular grades or in institutions or are without any educational advantages because of difficulties with regard to placement. T h e reasons are not hard to find. Although a democracy stands for educational opportunities for all, when funds for educational purposes are limited, the majority—in this case those having normal vision—are given first consideration. A more pertinent reason, N A DEMOCRACY

4

HISTORICAL

BACKGROUND

however, is that approximately 70 percent of children and young adults of school age in the United States live in towns or rural areas too small to warrant the establishment of classes for special groups. FUNCTION

OF SPECIAL EDUCATION FOR THE

PARTIALLY

SEEING

Special facilities are provided for partially seeing children in order that they may take advantage of the opportunities a school system has to offer. T h e aim, as in all educational procedure, is to enable them to develop to the full their innate abilities. Special classes for the partially seeing in school systems have come to perform a secondary function: they serve as a demonstration of opportunities that should be available to all children, by stressing observance of the rules of general health; provision of good lighting; correctly printed textbooks; adjustable seats; desks that can be tilted at an angle in order to encourage good posture for ease and comfort of seeing; periods of rest for the eyes following study requiring close use of the eyes; emphasis on oral learning rather than on too much close eye work; and in some instances the use of mechanical devices to lessen the eye load. T h e purpose of this book is to indicate the principles underlying educational procedures and health services for all partially seeing children and to present ways and means by which educational opportunities suited to their needs may be provided for such pupils in cities, towns, villages, and isolated rural areas. HISTORICAL

BACKGROUND

In the United States some form of educational opportunity has been available for children with normal sight ever since the days of colonial settlement. Special residential schools for blind pupils have been in operation considerably more than one hundred years, but until very recently no provision was made for partially seeing children who were unable to take advantage of the educational opportunities offered to the other groups. GREAT BRITAIN

In initiating a school medical program, James Kerr, M.D., D.P.H., the first medical director of the old-time London School

HISTORICAL

BACKGROUND

5

Board (later the London County Council), called on a number o£ young clinical assistants at Moorfields and other London hospitals to help him make an investigation of the vision of school children in that city. Among those selected was N. Bishop Harman, M.D., later a noted ophthalmic surgeon. Dr. Kerr's instructions were very definite. Go to your schools. Examine the children's eyes for surface diseases. Test for visual acuity. Record your findings so that they may be made use of in a general record of the state of the eyes of children, and if your experience suggests some allied investigation, go ahead with that inquiry and count the doing of it a part of your service. In 1902 Mr. Harman 1 was placed in charge of the ophthalmological service of the London schools for the blind. As a result of examining the eyes of the children in these institutions he found that many of the pupils were not blind, but had been placed in these schools because of high myopia. 2 Dr. Kerr requested that a report of the findings be presented to the Second International Congress of School Hygiene, held in London in 1907. In his report Mr. Harman stated that since these children were not blind they should not be in an institution for the blind, but, rather, should be given special educational facilities adapted to their needs. Miss Nettie Adler, chairman of the section at which this report was given, was a member of the educational committee of the London County Council. So great was the interest aroused by the report, that she presented to that body a project formulated by Dr. Kerr and Mr. Harman for the education of these high myopes. T h e members approved the plan; Dr. Kerr lost no time in putting it into action. He entrusted Mr. Harman with carrying out the experiment and gave characteristic directions. " T h e r e is a small vacant school in the playground of a large elementary school. You may have this and two women teachers. T r y out your suggestions there. Get the idea going." T h e school proved to be a little onestory building at Camberwell in South London, and here, in 1908, was established the first class, or school, in the world devoted specifically to the education of partially seeing children. There was some question about what to name the school. T h e 1 In Great Britain the term "doctor" is not generally used by ophthalmologists. i Definition of terms will be found in the Glossary.

6

HISTORICAL

BACKGROUND

law gave the London County Council authority to establish schools for "the blind or partially blind." In order to get the necessary grants, the newly established school had to come under this division, but in order to distinguish it from the institutions for the blind, Mr. Harman selected the name "myope school." One of the main reasons for removing these children from the school for the blind was that it seemed undesirable for seeing pupils, even though suffering from serious eye difficulties, to be segregated from their companions with normal vision. In the large elementary school to which Dr. Kerr had referred, much oral work was being carried on, and arrangements were made for the children in the myope school to participate in that part of the program with the children having normal vision. Oral methods of instruction were also used in the myope school itself. T o emphasize this, a legend was placed over the doorway: "Reading and writing shall not enter here." Much handwork requiring no close use of the eyes was undertaken. THE

EUROPEAN

CONTINENT

T h e need for providing special educational facilities for partially seeing children had long been recognized on the European continent. In 1911 a class for them was established in the public school system of Strasbourg. A t an ophthalmological congress held in that city December 7, 1913, Dr. Edmond Redslob, a noted ophthalmologist who was especially interested in the welfare of the partially seeing, presented a paper 8 in which he stated that he wished to acquaint his fellow ophthalmologists with a "new social institution, a public school class for children with defective sight." T h e personnel of the Strasbourg class differed considerably from that of the London myope school. In addition to high myopes, children were admitted who had eye difficulties such as corneal scars, cataracts, dislocated lenses, congenital aniridia, nystagmus, and congenital amblyopia. Dr. Redslob stated that if such educational facilities were to be effective they must be established, as in the case of the Strasbourg class, on a strong footing and they must be a recognized part of » Edmond Redslob, "Schools for Children with Defective Eyesight," Strassburger medizinischen Zeitung, X I (1914), 5-9.

EARLY

MYOPE

SCHOOL

IN

TYPE

ENGLAND OF

SHOWING

TABLE

DESK

Material being prepared by pupils with rubber-stamp letters.

THE

FIRST

CLASS

IN

THE

UNITED

STATES

ESTABLISHED

PECIALLY FOR PARTIALLY SEEING PUPILS, BOSTON, MASS.,

ES1913

AN

EARLY

CLASS

FOR

PARTIALLY

BEDFORD,

SEEING

PUPILS

IN

NEW

MASS.

Portable building; attention to nutrition; little waitresses serving hot chocolate.

EARLY

CLASS

FOR P A R T I A L L Y

SEEING

PUPILS

IN

OHIO

W h e n incandescent lamps totaling 500 watts were installed, the electrician warned that pupils would be blind within a few years from so much light.

HISTORICAL

BACKGROUND

7

the public school system, the community being responsible for their administration and the running expenses; that if these classes were to be successful, only children of normal mentality should be admitted, special arrangements being made elsewhere for children with the double handicap of defective vision and subnormal mentality. As in the case of the London myope school, the Strasbourg class emphasized oral recitation and handwork, depending as much as possible on the senses of hearing and of touch to lessen the eye load. It is interesting to note that in both these classes ophthalmologists took the lead, not only in determining what children were eligible, but also in recommending educational procedures. T h u s was initiated a movement that was to grow and—after many changes—develop into the present-day opportunities for the education of partially seeing children throughout the world. International conditions make it impossible to obtain any accurate information regarding the current status of this educational development in many foreign countries. Reports indicate that schools or classes have been established in Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechoslovakia, Denmark, England, France, Germany, Holland, Hungary, Japan, Russia, Scotland, South Africa, and Switzerland. THE UNITED STATES OF

AMERICA

In 1909 Edward E. Allen attended a conference in London and learned of the newly established school for myopes. Throughout his long experience as teacher and later as director of a school for the blind he had constantly been faced with the necessity of solving problems arising from the presence of partially seeing children in these institutions; however, there seemed to be no other place for them. T h e problems were both educational and psychological. T h e educational media provided for blind pupils were quite unsuited to the needs of the partially seeing. From the psychological standpoint Dr. Allen found many difficulties. Children with some sight were likely to develop a superior attitude which was almost certain to be deflated when they attempted to take their places in their community. Partially seeing children were irked by regulations that had to be made in these schools for the protection of

8

HISTORICAL

BACKGROUND

blind pupils, and in consequence many of them left school before they had received anything like an adequate education. Such young people found it very difficult to get and to keep jobs because of the double handicap of defective vision and educational limitations. T h e tendency to use the partially seeing as guides and helpers for the blind often meant added strain on their eyes. Dr. Allen realized that the principles underlying the educational procedures in the school for myopes in Great Britain gave a clue to a solution of these problems. He felt, however, that opportunities similar to those afforded myopes in London should be extended to meet the needs of children having any serious eye difficulties that interfere with educational progress (as was later demonstrated in Strasbourg). He recognized the fact that many changes and adaptations of the British program would be necessary, and he gave consideration to these adjustments in presenting a plan to educators and physicians in America. T h e assimilation of a new idea is usually a slow process, and this one proved no exception. Finally, through the co-operative effort of a number of interested individuals and organizations, on April 3, 1913, the School Committee of Boston, Massachusetts, opened the first class for partially seeing children in America in the Thornton Street School, Dillaway District, Roxbury. Finding the children, persuading parents to allow them to attend the class, preparing in advance material for which there was little precedent, and finally settling the group in a small, unused school building assigned for this purpose were heroic undertakings. They called for someone with a pioneer spirit, an almost unlimited capacity for work, infinite patience, and a determination to make the undertaking a success. Helen L. Smith possessed these qualifications and, in addition, a deep love and understanding of children. She was therefore able to lay a foundation on which others could build. Since there were no other classes in the little school, these children, unlike those in the London class, were segregated from their companions for all school work. In Superintendent Dyer's annual report of the Boston public schools for 1 9 1 3 4 he commended the class and stated: * Boston, Mass., Superintendent of Schools, Report, 1913, p. 54.

HISTORICAL

BACKGROUND

9

The progress made by the children to whom school meant almost nothing has been remarkable, showing that the effort is well worthwhile if the children can be reached. H e expressed the hope that it would prove the forerunner of a number of classes throughout the city, providing for all children in the public schools whose deficiency in vision makes it essential for them to have special, individual attention. Such classes, however, should not be established unless, at the same time, there are provided ophthalmologists to make periodical expert examinations of the children's eyes, in order that the kind of training may be so adapted to the individual child as to improve, rather than to injure, the fraction of vision which he may possess. Educators in other parts of the United States had been experiencing similar difficulties and were seeking solutions for the problems of educating partially seeing children. Early in the century classes for blind children had been established in the public school systems of several cities, notably Cleveland, Chicago, Milwaukee, and N e w York. A co-operative plan had been formulated by which these children would do work requiring special teaching and equipment in their special classroom but would participate with the normally seeing pupils in oral work and other activities. Some administrators, in attempting to solve the problem of educating the partially seeing, placed a few of them in these classes for the blind. A t first, the only material available was that provided for blind children, but gradually innovations were made, such as the use of large writing on chalkboards. In 1 9 1 3 Dr. Robert Irwin, who was in charge of these special classes for blind children in Cleveland, requested that the two groups be separated and that material suited to the needs of the partially seeing be supplied for them. In September of that year this plan was carried out, and thus was established, in the Waverley School, in Cleveland, the second class specifically for the education of the partially seeing in the United States. Dr. Irwin initiated for this group the same co-operative system, according to which the members of the class carried on as many activities as possible with the normally seeing pupils, that he had demonstrated as feasible for blind children.

10

HISTORICAL

BACKGROUND

Thus were set up two methods of conducting these classes—one a system of segregation, and the other a system of co-ordination or cooperation. When other states and cities made provision for partially seeing pupils, some followed the Boston method, and others that initiated in Cleveland. NOMENCLATURE

The first class, or school, in Great Britain was known as the "myope school"; but since children with various eye difficulties were accepted in the Boston class, it was at first called "the defective eyesight class." Prior to this time President Theodore Roosevelt had been stressing the conservation of natural resources, and the term "conservation" had come into common use. Hence the classes later became known officially in Boston as "classes for conservation of eyesight" and in Cleveland as "conservation of vision classes." When classes were opened in New York City, they were called "sight conservation classes," a name which New York continues to use, whereas in other parts of the country the term has been shortened to "sight-saving classes." There has long existed a controversy concerning all these appellations. It is contended that "sight-saving" is a misnomer, for many of the children having static low vision are placed in these classes because media suited to their needs make educational procedures possible for them, not because such placement is expected to save their sight or because blindness is feared. Those objecting to the term "conservation" argue that the other senses are not conserved, and why should sight be the exception? This indicates rather inexact thinking, since conservation does not mean lack of use, but rather correct use, and correct use of the eyes is one of the principles upon which this program is based. Moreover, hearing and sight are often conserved through medical and surgical treatment. The only name that seems acceptable to the great majority is "classes for the education of the partially seeing." It is a long and somewhat cumbersome title, but it does express the meaning and does not readily lend itself to misinterpretation.

Part Two: ADMINISTRATIVE RESPONSIBILITIES

Chapter Two: C L A S S I F I C A T I O N of the P A R T I A L L Y SEEING

I

administrative procedures for the welfare of all the pupils are of prime importance. Such procedures are determined by state and local departments of education. T h e first administrative responsibility in any plan for the education of partially seeing children is to ascertain what children belong in this classification; the second, to find such children; the third, to devise means by which educational opportunities suited to their needs may be made available. N EDUCATIONAL SYSTEMS,

DEFINING T H E P A R T I A L L Y

SEEING

No definition of a "partially seeing child" is universally applicable. T h e term is variously interpreted in different communities. Many people have a mistaken idea that only children with refractive errors, such as myopia, hyperopia, and astigmatism need special educational facilities. Children with eye difficulties caused by diseases of the ocular system or diseases of the body that affect the eyes are often even more in need of special medical and educational attention, and if children suffering from strabismus are not given the proper care, they may lose the sight of the affected eye. In general, the following groups should be considered possible candidates for special education: (i) children having a visual acuity between 20/70 and 20/200 in the better eye after all medical and optical help has been provided; (2) children with serious, progressive eye difficulties; (3) children suffering from diseases of the eye or diseases of the body that seriously affect vision. More attention than ever before is being given to the effect of eye difficulties on educational processes and to the psychological reactions to physical disabilities; hence it is well to consider children who may need special educational facilities as a temporary

14

CLASSIFICATION

measure because of: (a) operations on the eyes (especially enucleation) resulting in the need for readaptation in the use of the eyes or of psychological adjustment; (b) crossed eyes or other muscle anomalies which necessitate re-education of the deviating eye, especially when untoward psychological reactions are manifested; (c) possible effects on the eyes of diseases such as measles. Special care is needed for such children until they are able to resume the full work of their regular school grade. PLACEMENT

So many factors are involved in determining whether children shall be placed in regular or in special classes that it is evident each child must be given consideration according to his needs. Decisions regarding placement should be made by the ophthalmologist in co-operation with the psychologist and the authorities who are responsible for providing educational opportunities. It must be remembered, however, that just as educators often have little knowledge of medicine, ophthalmologists, in turn, may be unacquainted with educational procedures. All too often ophthalmologists recommend that a partially seeing child be kept out of school, either because they do not know of any suitable educational provisions in the community or because they do not fully recognize the significance of such provisions. The co-operation of the psychologist is important, since these special classes are intended to provide educational opportunities for partially seeing children with normal mentality. Determining the placement of a child with high myopia is difficult because of the great diversity of opinion regarding its cause. Some ophthalmologists believe that myopia is due to a hereditary tendency to abnormal growth of the eyeball and that the use of the eye has no effect on its growth. They feel that there is no reason why even highly myopic children should not use their eyes to the fullest extent in regular school work. Others think that the intensive use of the eye causes the eyeball to increase in depth and recommend the avoidance of all close eye work. Some look upon myopia as merely a refractive error, whereas others believe that it is due to a systemic difficulty and, therefore, possibly amenable to

CLASSIFICATION

15

treatment. Many believe that the age of the child should be considered a determining factor; that if a young child has even a low degree of myopia at an age when he should normally be hyperopic, the condition is much more serious than if he had the same, or even a greater, amount at the age of sixteen or seventeen. Some ophthalmologists feel that until a great deal more is known about causes and effects of myopia it is advisable to place the child with a fairly high degree for his age in a class for the partially seeing. Here he may be given careful guidance in eye use by a specially prepared teacher, who can help him and encourage outdoor play and exercise by arranging games and other activities in which he can readily participate. Decisions regarding the placement of cross-eyed children are likewise difficult, especially when occlusion (covering the good eye) may cause untoward psychological reactions. Some ophthalmologists feel that if the child can be encouraged by a skillful, specially prepared teacher to use the eye he has been suppressing, this may help greatly to save the sight of that eye. Others feel it is unwise to place a cross-eyed child in a group of the partially seeing, even temporarily, because the printed material used by them is in large type; such ophthalmologists wish the cross-eyed child to use small type so that the affected eye will have to make an effort to see it. T h e educator is confused by this multiplicity of opinions. It would seem, therefore, that his best procedure is to abide by the recommendations of the ophthalmologist in charge, provided the latter is familiar with the educational facilities available. T h e administrator is likewise faced with the necessity of placing partially seeing children who have other serious handicaps—a problem that is particularly troublesome when these are both physical and mental. If there are enough children in the community having the same types of handicap, such as subnormal mentality and serious eye difficulties, a special class may be established for them, in charge of a teacher who understands the significance of both handicaps and is prepared to give the necessary help. Several cities have worked out their problems in this manner. If there are not enough such children to warrant the establishment of a special class for them, their placement should be determined by their

16

CLASSIFICATION

major difficulty—in such cases the mental handicap. They should be placed in a class for the mentally subnormal and there be given as much eye help as possible. PROCEDURES FOR PARTIALLY SEEING PUPILS

Even after partially seeing pupils have been located and facilities for their education made available, the carrying out of procedures for placement is not always as simple as it seems. It has been emphasized that such facilities are for the partially seeing children of normal mentality. If no mental tests have been given, the educational authorities must arrange for the best type of test that circumstances permit. If it is doubtful whether a child is actually mentally subnormal or is merely retarded because of an eye condition which has interfered with his progress, he should be given the benefit of the doubt and be placed in a class for the partially seeing, where he may have the opportunity of proving himself mentally capable of carrying on the program. In some instances the functions of the special classes are either not understood or not appreciated, and a few administrators have a mistaken idea that because the number of pupils in a special class is small compared with the number in regular grades, a child who for any reason appears to be a misfit may be placed therein. Often a very slight eye difficulty is made the excuse, although occasionally even this is not considered necessary. Incredible as it may seem, in some instances not only are children with subnormal mentality placed in these classes but also normally seeing pupils who present disciplinary problems that upset the procedure of regular grades; even a child with a brain tumor and one with epilepsy have been so assigned. It must be evident that in such cases the teacher can give little time or attention to the children for whom the class has been established. Moreover, unsuitable placements have very serious effects on partially seeing children and on their parents. They also influence the attitude of both teachers and children in the rest of the school toward the special group. A teacher who maneuvers to have a child with whose behavior problems she is unable to cope placed in a class for the partially seeing, as a means of escaping from her

CLASSIFICATION

17

responsibility, is naturally averse to any co-operative plan of work according to which he may be returned to her class for oral work or other activities. Only a thorough appreciation of the principles upon which such a class is founded and knowledge concerning which children legitimately belong in the group can make the undertaking successful. It is very important in placing partially seeing children to obtain the consent of the parents or guardians. In order that they may understand and appreciate the opportunity that is being offered the partially seeing child, they are often invited to the school for initial conferences. In some cases a home visit is preferable; this is usually made by a visiting teacher or a nurse. In small communities and in rural areas the child's teacher may make the visit.1 It is necessary for the visitor to have in advance definite information regarding the child's eye condition and his school progress. It is desirable to have some knowledge of the home situation—the social and economic status of the family and, if possible, the educational background. Such knowledge will greatly aid in determining the kind of approach to be made. The importance of such interviews in gaining the co-operation of the parents can hardly be overestimated; the initial approach usually influences results. Since the child under consideration has an eye difficulty serious enough to warrant the provision of special educational facilities for him, the parents are usually aware that the difficulty exists, although they may not have appreciated its seriousness. The visitor may therefore use this fact as a basis of approach and may place emphasis on the advantages of special arrangements for the child's education—the small number of pupils in the group, equipment suited to his needs, individual assistance from a teacher who understands the problems that arise from eye difficulties and is able to give the child help in solving them. If the parents can be brought to see that their child is in no way being discriminated against, but rather is being offered a most desirable opportunity, they are much more likely to show a favorable reaction which, in turn, influences the pupil's attitude. In places in which special classes have been established, parents 1 See chapter School Health Services, p. 37.

18

CLASSIFICATION

may be invited to visit them in order to see the equipment and understand how the program is carried out. They may note the attitude of the children toward one another and toward the teacher and see for themselves how children in the special class mingle with those in the regular grades. They may be encouraged to talk with the parents of children in the group who are making good and are happy in their surroundings. When it has been decided that a partially seeing child is to be placed in a special class, arrangements must be made by the educational authorities for his transfer. If the class is not in the school he has been attending and is not near his home, arrangements must be made for his transportation. In small communities and rural areas the placement of a partially seeing child is more difficult, but the underlying principles are the same for urban and for rural children. TRANSPORTATION

Transporting children to special classes has always presented one of the problems most difficult of solution in connection with this special type of education. Efforts are made to place classes in centrally located schools, accessible by bus or car, but even in such instances transfer from one car or bus line to another is often necessary, and parents hesitate to consent to such arrangements, especially for young children. When satisfactory plans can be made for the use of public transportation and carried out successfully, it is the best solution. It helps make the pupils independent and is the least expensive method of transporting them. When it is necessary for young children to travel a long distance to reach the school, the most successful plan is to have one of the parents or an older brother or sister accompany them. The department of education should pay the carfare of the child, and, when necessary, that of the accompanying person. If there is no one in the family to whom this duty can be entrusted, an older boy or girl living in the vicinity may act as guide; Girl or Boy Scouts, and responsible volunteers make good guides. Sometimes the department of education may pay a small sum for guidance in addition to the carfare. In some places school busses similar to those in use for crippled

CLASSIFICATION

19

children are provided; in others, busses are shared by both groups; in still others, arrangements are made for the use of taxis, paid for by the department of education or, in a few cases, civic organizations. T h e greatest care must always be exercised in the selection of drivers, and every precaution must be taken to prevent accidents. Recently, companies providing busses or taxis have been required to carry insurance.

Chapter Three: M E T H O D of F I N D I N G P A R T I A L L Y SEEING CHILDREN

S

o

IMPORTANT is the use of the eyes in educational procedures that everyone interested in the welfare of children is vitally concerned to discover all those with sufficient deviation from the normal to affect their health, education, or social relationships. Statistics regarding the number of such deviates differ so widely, because of the use of various tests and methods of conducting them, that it is impossible to indicate the percentage with any degree of accuracy. Fortunately the percentage of children with eye difficulties so serious that they require special educational facilities is small. W h e n only those in groups 1-3 mentioned above (p. 13) are considered, the most conservative estimate is one child in a thousand of the school population. In educational systems with long experience in this work, the ratio has been found to be more nearly one to five hundred. If groups a, b, and c mentioned on p. 14 are included, the ratio would naturally be considerably higher. Taking these figures into consideration, a superintendent of schools can judge the number of children in the system requiring special educational facilities. SCREENING

PROCESS

T h e most efficient evaluation of the physical and mental status of children naturally results from thorough medical and psychological examinations. If periodic medical examinations, including thorough eye examinations, are made in preschool years, developments can be noted and signs of deviation from the normal detected early enough so that many of them can be remedied before the child enters school, thus making it possible for him to use to the best advantage the opportunities offered. Even if difficulties cannot

L O C A T I N G the P A R T I A L L Y S E E I N G C H I L D

21

be overcome, a knowledge of their existence may facilitate proper placement and be of much assistance to teachers in determining desirable methods of approach—educational, psychological, social, emotional, and vocational. Although a medical check-up is mandatory for school children in twenty-one states and must be given annually in twelve, it is possible only in rare instances to provide thorough medical examinations and seldom, indeed, are ophthalmological examinations included. In some school systems adequate preliminary tests are given and arrangements are made for all who appear to need this service to have a medical examination. In such cases the school nurse or any other public health nurse who gives services to children of school age should have no difficulty in identifying from the records children in need of special educational facilities. In most communities there is no such adequate service; therefore it has been found necessary to devise procedures by which it will be possible, without a highly specialized staff, to give preliminary screening tests and to find ways of obtaining examinations when the need is indicated. It is obvious that no single test will meet all situations. Determination of what shall constitute adequate tests must be made by the authorities in each community responsible for such decisions. If only one test can be given, it is generally conceded that the Snellen test for visual acuity is the most desirable, supplemented by observations of the reaction of the children and of evident ocular symptoms. T h e value of this test is commensurate with the accuracy with which it is given. 1 Tests may be given by school physicians, nurses, or teachers, or by technically trained personnel. There are advantages in having the preliminary screening done by the classroom teacher. Her daily contact with the children gives her many opportunities to observe their reactions to various types of eye work. She can compare these reactions with those observed by her when the screening tests are given. A teacher can usually plan to give such tests at the most advantageous time. So important has this aspect of the subject been considered that i "Vision Testing—a Screening Process," is presented in the Appendix.

22

LOCATING

the P A R T I A L L Y

SEEING

CHILD

in Massachusetts tests have been carefully developed; special preparation is given to teachers and others who will conduct them. 2 By no means all the children whose tests indicate a possible deviation from the normal are candidates for special classes for the partially seeing. Compensating lenses or medical or surgical treatment will make it possible for the great majority of those who need such help to carry on their work in regular grades. In rural areas arrangements for finding visually handicapped children and for their medical examination are often exceedingly difficult, but they are seldom impossible if all resources are used. A few states, notably Illinois, New York, and Ohio, have initiated special programs for rural as well as urban areas. ILLINOIS

For many years the Illinois Society for the Prevention of Blindness has been the leader not only in discovering children with eye difficulties in the state but also in helping make possible special educational opportunities for those with serious eye troubles. As a means of finding such children, the Illinois Society, in cooperation with the State Department of Public Instruction, initiated and carried out a project for vision testing. Qualified workers were selected and were given special preparation for this service. Thereafter they gave visual acuity tests to hundreds of thousands of children throughout the state. In line with its usual custom, at the request of many communities the Illinois Society co-operated with local boards of health, boards of education, medical societies, clinics, and private ophthalmologists in providing medical examinations for all children indicated by these tests to be in need of them, if parents or guardians were unable to take the responsibility. W h e n as a result of such examinations children needing special educational facilities were identified, the society consulted with state, city, and county superintendents and supervisors and rendered every possible assistance in meeting their needs. 2 Massachusetts, Dept. of Public Health, Field Service in Child Growth and Development, Division of Child Hygiene, Instructions for the Massachusetts Vision Test. Boston, Mass., 1941.

LOCATING

the P A R T I A L L Y

SEEING CHILD

23

NEW YORK

In New York State the Medical Inspection Bureau of the State Department of Education has set up a standard for health work which requires a report by each school nurse of any defects found; the report must state whether medical attention has been given. This bureau refers to the Physically Handicapped Children's Bureau all those who need special educational advantages. T h e Prevention of Blindness Service, Commission for the Blind, New York State Department of Social Welfare, through its case-work program, likewise refers to the Physically Handicapped Children's Bureau children of school age who should receive special attention. Parents, teachers, social workers, private physicians, and clinics may also refer children. Records of children who have eye difficulties are reviewed by the special state supervisor of the visually handicapped. She confers with the educational authorities of the districts in which the children live and makes whatever arrangements seem most advantageous. These may include medical or surgical care, hospitalization, placement in classes for the partially seeing, home teaching, transportation, scholarships, tuition, or maintenance. W h e n recommendations are approved by the court of the district under the Children's Court Act, a charge is made upon the county or subdivision; or the court may adjudge that the person or persons charged with the liability under the laws to support these children shall pay a part or all of such expenses. OHIO

In Ohio the Prevention of Blindness Department of the Ohio Commission for the Blind, working in co-operation with the State Department of Special Education, is responsible for holding diagnostic eye clinics. T h e clinics are preceded by demonstrations of vision testing for teachers in the districts in which the clinics are to be held; general instructions concerning procedures are given the teachers by the commission nurses. T h e teachers of each school in the district to be served by the clinic are expected to have completed the eye tests within thirty days following the vision testing demonstration. Reports of these tests are forwarded to the nurse

24

L O C A T I N G the P A R T I A L L Y S E E I N G

CHILD

serving each school. A commission nurse inspects the records with her and indicates which children should be examined at the diagnostic clinics. Clinics are usually all-day affairs, and arrangements must be made in advance for ophthalmological and nursing service, location of the clinic, transportation of parents and children, and other necessary details. Women's clubs and other local organizations usually volunteer their services for any assistance feasible. If arrangements can be made to have a psychologist in attendance at the clinics, children who prove on examination to be candidates for special education can be given a mental test at this time, thus obviating the necessity of making special arrangements later. If the clinic is not too crowded, it offers an opportunity for the parents to discuss with the examining physician the difficulties found and the procedures necessary for the best interests of the child. Children examined at the diagnostic clinic are referred by the commission nurses to the proper school or health authority for the care specified by the examining oculist. If the parents are able to pay for the necessary medical or other ocular attention, it is expected that they will accept this responsibility; if they cannot do so, official or voluntary agencies, state or local, may make the required provision. After refraction, medical care, or surgical treatment have been given, it is the duty of the medical officer of the commission to refer to the State Department of Special Education any children who because of eye conditions need special educational facilities; it is the responsibility of the department to make the best possible provision for them. OTHER COMMUNITIES

In many states activities are carried on by a number of organizations which are directly or indirectly concerned with the health of children's eyes. Welfare organizations, especially those serving small communities and rural districts, include in their case-work programs the finding of partially seeing children. Under that part of the Social Security Act which authorizes grants to the states for crippled children's services administered through the Children's Bureau, official organizations in some states are charged with

LOCATING

the P A R T I A L L Y

SEEING CHILD

25

the responsibility of making arrangements for operations for cataract, strabismus, and ptosis. It is also their function to report to the educational authorities the names of children in need of special educational facilities. Where there is no organized program providing for medical examination of the eyes, it is sometimes possible, with the co-operation of county medical societies or local health and welfare agencies, to make arrangements for such examinations for indigent children as a follow-up to vision testing. A more difficult part of the program, especially in rural areas, is to provide for the necessary correction of defects or treatment of eye diseases and diseases of the body that affect the eyes, especially when parents are unable to take the responsibility. Sometimes treatment or glasses may be obtained and paid for by co-operating welfare agencies. But even in such cases, if it is at all possible the parents should pay on the installment plan. Among agencies which frequently participate in such programs in large and in small communities are the Lions Clubs, other service clubs, the Junior Red Cross, local tuberculosis and health associations, parent-teacher associations. In rural areas T h e Grange, the American Legion, the Legion Auxiliary, and other local groups may be of assistance.

Chapter Four: A D M I N I S T R A T I V E

PROGRAM

PLANNING

T

o DISCOVER the children who are unable because of eye conditions to take advantage of the educational opportunities offered for the normally seeing is of the utmost importance. But little is accomplished by the discovery unless definite steps are taken to make available to them not only resources for treatment or for optical aids, when these are necessary, but also educational facilities suited to their requirements. Ways have been suggested by which medical attention and optical aids may be secured. The most satisfactory method of solving the educational problem is to establish special classes for partially seeing children in public school and private school systems in communities which are large enough to warrant this procedure. For partially seeing children in small communities and rural areas educational opportunities must be provided according to the facilities available. States best equipped to establish special classes are those having an appropriation for this purpose—a state department of special education with adequate administrative and supervisory personnel and a school population large enough to warrant the establishment of classes in many well-distributed centers. A lack of these advantages should not, however, discourage any community or, indeed, any rural area from providing for its partially seeing pupils such special educational facilities as may be possible. NUMBER

OF PUPILS IN CLASSES FOR PARTIALLY SEEING

It is evident from the comparatively small number of partially seeing pupils needing special educational advantages (one in five hundred of the school population) that even in large cities the establishment of special classes in every school or even in each school

WELL-CONDUCTED ELEMENTARY

CLASS FOR P A R T I A L L Y SEEING

PUPILS

Note teacher working with one pupil, other pupils working independently; program on chalkboard at right; position of seats for pupils and teacher.

G R O U P OF P A R T I A L L Y SEEING HIGH SCHOOL

PUPILS

Note teacher dictating lesson for typing; three pupils at back of room listening to Talking Book; regular grade pupil in center reading material to partially seeing pupil.

ADMINISTRATIVE

PROGRAM

PLANNING

27

district is not warranted. Hence, the group in any class may represent several grades. In a large city school system based on the 6-3-3 P^ an ( s * x years elementary, three years junior high school, and three years senior high school) the ideal set-up provides a class for three grades each (first, second, and third grades; fourth, fifth, and sixth grades; seventh, eighth, and ninth grades; and tenth, eleventh, and twelfth grades). In systems following the 8-4 plan (eight years elementary and four years high school), each class can probably best include four grades (first, second, third, and fourth grades; fifth, sixth, seventh, and eighth grades; ninth, tenth, eleventh, and twelfth grades). Because it is necessary for each class to serve children representing more than one grade and—of even greater importance—because of the difference in their eye difficulties, the teacher must give individual instruction, and she is able, consequently, to care for only a limited number of pupils. A group of sixteen is considered a good number if they do not represent too many grades. In classes in which there are only three grades, a somewhat greater number may be accommodated; but it is unwise to overload any one school with such a large number of partially seeing pupils that there is not room in regular grade classrooms for them to participate in as many activities as possible with the normally seeing pupils. ELEMENTARY

SCHOOL

A consistent program provides for the education of partially seeing pupils on all school levels. Experience indicates that it is best to establish the first class for partially seeing children on the elementary school level. T h e philosophy underlying this decision is that the earlier these children are given special educational advantages, the greater is the hope of success. In communities in which the school population is too small to warrant the establishment of more than one class, it is sometimes considered advisable, if all partially seeing children cannot be accommodated, to give the advantages of the special class to children above the second grade. Children of the first and second grades do much less close work with their eyes than those in upper grades; a great deal of material

28

ADMINISTRATIVE PROGRAM

PLANNING

in large, clear type is available for young children—preprimers, primers, first- and second-grade books and charts. Another point that may have to be considered is the fact that nearly all pupils attending the class have to travel considerable distances to reach the school. Parents of young children often object to a long journey involving an earlier start than would otherwise be necessary and a later arrival at home. Such journeys may present serious transportation problems. In determining, therefore, which children shall be accommodated, it is necessary to decide what is best for the general welfare of each child and to balance the program accordingly. It should always be borne in mind, however, that it is desirable to establish good habits of using the eyes as early as possible; that when learning to read partially seeing children should have the benefit of a teacher who, realizing the difficulties that may arise from poor eye conditions, is able to adapt the best methods to their needs and so prevent the necessity for later remedial work. JUNIOR HIGH SCHOOL

Some educators think that if partially seeing pupils are taught in the elementary school to understand the principles of eye hygiene and general health they should be able to assume responsibility for correct eye use when they enter junior high school. Even after the best preparation and a well-rounded program of health education children of junior high school age are not sufficiently versed in all that pertains to the complicated process of seeing to have this responsibility thrust upon them. For pupils of junior high school age it has proved most desirable to establish in junior high schools classes based on the general principles underlying those on the elementary level. In such classes the pupils are encouraged to assume increasing responsibility for using their eyes correctly. SENIOR HIGH SCHOOL

Many cities make no special provision for partially seeing pupils on the senior high school level. It is indeed a shortsighted policy to provide educational facilities for elementary and junior high school pupils and then to turn them adrift to work out their salvation as best they may. Although they are better fitted to assume responsibil-

ADMINISTRATIVE PROGRAM PLANNING

29

ities than are the younger pupils, they are faced with two difficulties: (1) the very great increase in eye use for close work, if they are to meet the requirements of the senior high school curriculum, and (2) the lack of educational media suited to their needs and of other assistance provided for them in elementary and junior high school (unless special arrangements are made for them). Because of these obstacles to success, many partially seeing pupils of good mentality fail in high school work. For high school students each community works out a plan best suited to its needs and facilities. In some places special classes are established in one or more high schools, according to the number of pupils to be considered. T h e work is directed by a teacher who holds a high school license and is prepared to conduct this type of class. Regarding the program to be undertaken and the best arrangements for carrying out its provisions she consults with the pupils, the high school advisers, and the teachers of regular grades whose classes the partially seeing pupils will attend. She explains to the teachers the problems that may arise because of the eye conditions of the pupils and makes every effort to gain their cooperation. She arranges for necessary equipment and educational media and selects voluntary or paid readers. She gives any necessary assistance to the pupils in preparing their assignments, but encourages them to work as independently as possible. She is careful to see that pupils keep up to standard so that they may participate with their normally seeing companions and may be adequately prepared if they decide to undertake college work. In order that these pupils may wisely select occupations, in cooperation with the vocational counselor she discusses with them their desires, their abilities to carry them out from physical, mental, and social standpoints, and the possibilities for preparation and placement. She consults vocational guidance departments and rehabilitation bureaus in case further training must be provided. In other communities a teacher having the qualifications already mentioned is appointed to supervise the work of partially seeing pupils in two or more high schools. She carries out in each as much of the above-mentioned program as time will permit. In small communities the general high school adviser makes as satisfactory arrangements for partially seeing pupils as possible. In

3o

ADMINISTRATIVE PROGRAM

PLANNING

some states and cities which have departments o£ special education a visiting teacher is charged with making the arrangements. The first-mentioned plan is the most desirable. The second is less efficient, because of the limited time the teaching adviser may be able to give to each school. The third is the least desirable, because it includes no provision for a teacher who is familiar with the problem. It has, however, one advantage; it can be put into operation immediately, in part at least, by securing the co-operation of some competent adviser functioning in the high school attended by partially seeing pupils. This adviser must, of course, be given considerable information concerning the eye difficulties of these pupils, their effect on the learning process, and the possible psychological reactions that may result. She must be willing to take the responsibility for all necessary adjustments. Whatever plan is followed, volunteer readers should be selected from fellow students, upper-grade students who have some time to give, Girl or Boy Scouts, or other well-prepared persons. Special care must be taken in selecting readers; whenever possible, reading tests should be given before a decision is made. Poor readers tend to confuse rather than to help partially seeing pupils. In all these plans arrangements should be made for reproducing in large type needed material not otherwise available. For this work volunteers who are good typists are sometimes available. Sometimes students may be assigned from commercial departments and credit given them for work done for this purpose. VOCATIONAL OPPORTUNITIES

Plans for partially seeing pupils in vocational high schools should be included in all school programs. Careful consideration must be given to the types of vocation which it is advisable for the pupils to undertake, based on a knowledge of the individual's actual eye difficulty, his general health, his mental ability, his desires, and his aptitudes. Emphasis should be placed on the capabilities of each pupil, and his limitations should be considered only in so far as they may interfere with the successful carrying out of a desired program or with his physical well-being.

Chapter Five: P R O B L E M S in A D M I N I S T R A T I V E P R O G R A M P L A N N I N G for S M A L L C O M M U N I T I E S and R U R A L A R E A S

I

N

A FEW

STATES

special arrangements have been made for the

education of partially seeing children in small communities and occasionally even in isolated rural areas. Educational authorities are keenly aware that these children should be provided for. In all recent legislative provision for the education of physically handicapped children the necessity for giving opportunities to rural children is stressed. There are several ways in which they may be provided: (i) establishment of a special class for the partially seeing in a consolidated school; (2) establishment of a special class in the demonstration school of a teachers college; (3) placement of partially seeing children in a special class in the nearest city; organization of a class to serve children with different types of handicap; (5) arrangement for special educational facilities for partially seeing children in their own rural schools. A CONSOLIDATED SCHOOL

One of the trends in modern educational procedures is toward reducing the number of small rural schools, especially one-room schools, by building consolidated schools at selected centers, to which children in the surrounding districts are transported. T h e advantages are many. T h e children have the benefit of a modern, well-lighted, well-equipped building; the system of grading in vogue in city schools is followed; a teacher is appointed for each grade whenever possible. If a class for partially seeing children is established in such a school, its members share these opportunities. T h e grades to which pupils in the group belong exist in the school; hence, a co-operative setup can be established and carried out. No special problems of transportation arise, since all children

32

P R O G R A M S for R U R A L

COMMUNITIES

attending the school, except those living in the immediate vicinity, must be provided with transportation facilities. A class for the partially seeing in a consolidated school may serve a county or any part of it determined upon by the state department of education in co-operation with the several communities and the rural areas to be included in the arrangement. THE DEMONSTRATION SCHOOL OF A TEACHERS COLLEGE

Classes for the partially seeing may be established in the demonstration schools of state teachers colleges; such classes not only provide the necessary educational facilities for partially seeing children but also give those preparing to teach an opportunity to become directly acquainted with the organization, administration, and conduct of such classes. In addition, they may provide, under the direction of teachers adequately prepared to conduct them, opportunities for internships in practice teaching for those interested in undertaking this work. Partially seeing children in these classes participate in the normal activities of the school which do not require close use of their eyes. A SPECIAL CLASS IN THE NEAREST CITY

Placing the partially seeing child in a special class in the nearest city having the necessary advantages offers an excellent solution. T h e child has the benefit of an established class conducted by wellprepared teaching personnel and equipped with the necessary educational media. If the partially seeing pupil does not live at too great a distance to be traveled daily, the situation parallels that in which communities having no high school make arrangements (including the payment of tuition) to transport pupils to near-by communities having such facilities to offer. If the distance is too great for daily travel, the child may live in a selected boarding home for the school days of the week and return to his own home for week ends. Such an arrangement, however, is often complicated by the difficulty of finding desirable boarding homes and the necessity of getting the co-operation of a number of agencies and individuals. In order to protect both the children and the foster parents in any home selected, many states have found it necessary to make

P R O G R A M S for R U R A L

COMMUNITIES

33

definite regulations regarding the placement of children and the supervision of all approved homes. In Ohio, where there is a state subsidy for the education of the partially seeing, approval of the State Board of Education, through its Department of Special Education, is necessary for all applications for assignments to special classes, for the payment of board, transportation, and tuition. Arrangements for placement in a boarding home are made with the approval of the state supervisor of boarding homes in co-operation with local placement social agencies. Certification is required by the Ohio Code for all homes in which a child unrelated to the family is boarded. Child-placement agencies make arrangements for partially seeing children only in these certified homes. For the intelligent selection of a suitable foster home the personnel of the placement agency must have understanding and appreciation of the child's background, his physical and mental conditions, and his personality. CLASS FOR CHILDREN WITH DIFFERENT TYPES OF HANDICAP

In a small community there may be enough children with different types of physical disability to warrant the establishment of a special class. It is, however, most undesirable to group together those requiring different educational procedures. In the early history of special schools in America many educators felt that if blind and deaf children could be cared for in one institution, the blind could be ears for the deaf, and the deaf, eyes for the blind. T h e fallacy of this proposition soon became evident, and in practically all schools so established it has been found necessary to separate the two groups. From this experience it will be readily seen that it is inadvisable to place in one class children with types of handicap requiring different procedures. T h e most successful scheme of this kind has been to combine partially seeing children with the orthopedically handicapped. In neither of these groups are special methods of teaching necessary. Since, in many cases, the orthopedically handicapped will need to have exceptionally good eyesight in order to earn a living, to compensate for the orthopedic handicap, the care of the eyes and the good lighting conditions provided for the partially seeing will be of benefit to both groups. If possible the teacher selected for this class should have had prepara-

34

P R O G R A M S for R U R A L

COMMUNITIES

tion along both lines. W h e n such classes are established, the number in each group is comparatively small (otherwise separate classes should be established); the teacher is therefore able to give a very great deal of individual attention. Since deaf children and partially seeing pupils require very different educational procedures, there is little, if indeed any, hope of success in grouping them together. Since classes for the partially seeing were originally established because it was felt that such children could not profit by the educational facilities provided for blind children, the same objections to combining these two groups into one class are valid. One of the requirements of a child who is to be placed in a class for the partially seeing is normal mentality. It is therefore evident that to combine in one class the mentally subnormal and the partially seeing would violate the principles upon which the education of partially seeing children is founded. SPECIAL EDUCATIONAL FACILITIES FOR PARTIALLY SEEING CHILDREN IN THEIR HOME RURAL SCHOOLS

If none of these suggestions can be carried out, much can still be done for the education of partially seeing children in their local rural schools. Books in a type suited to their needs are often distributed through the traveling department of state libraries. Such books, selected according to the grade and age of the child concerned, are loaned for the term; at the end of that time they are returned to headquarters and a set for the next term is supplied. However, there exists a mistaken idea that the loan of these books is all that is necessary. It is not the possession of the books that is important, but rather the correct use of the eyes and of all educational media. Teachers in rural areas are not equipped to undertake the education of partially seeing pupils. It is, however, well worth while to work out a plan for their education, provided a state supervisor of special education who is thoroughly familiar with this work can give the rural teacher the help that will enable her to understand and appreciate the problems and to find solutions for them. In order that she may do this, it will not be sufficient for her to know what educational media are necessary and how to use them correctly. T h e supervisor must help her under-

C L A S S FOR P A R T I A L L Y SEEING N E G R O

CHILDREN

P R O G R A M S for R U R A L

COMMUNITIES

35

stand the implications of the eye difficulties from which each child is suffering; what precautions are necessary in using the eyes; in what types of activity each child may engage; why good seating and lighting are essential; how to make the best use of the resources at hand, if the most desirable cannot be obtained. If a plan can be carried through efficiently, it will prove of benefit not only to the partially seeing children for whom it is primarily intended but also to the rest of the group, since it will demonstrate the desirability of caring for the eyes of all children. If the services of state supervisors are not available, the county or regional supervisor of elementary education of the district in which the school is located should be encouraged to prepare adequately for this undertaking. Supervisors (state, city, or county), have usually attained their position because they have been aware that education is a continuing process and have kept abreast of the times by taking advantage of courses in supervision and in special subjects. T h e y may well take a course for the preparation of teachers for the partially seeing one summer and later a course for teaching children with another type of handicap. Such efforts pay full dividends to children who receive the benefit and to their teachers, as well as to the supervisors, who are thus raising their own standards and increasing their own efficiency. CONSIDERATION OF MINORITY

GROUPS

One of the most important themes emphasized by the White House Conference on Children in a Democracy is provision for the welfare of minority groups. Among the several types named as coming under this category are negro children. In states making no distinction between the educational procedures for white and for negro pupils, partially seeing children of both groups have been afforded equal opportunity. In states having separate schools, the partially seeing negro child has received little attention. It is probable that when funds for educational purposes are very limited, those in the majority—in this case, white children—are given first consideration. T h e District of Columbia, Kentucky, Maryland, and Missouri have led the way in offering educational advantages for this minority group by establishing special classes for them. Florida, North

36

P R O G R A M S for R U R A L

COMMUNITIES

Carolina, and Virginia have recently followed their example, and other states are planning to join their ranks. In some states laws for the education of partially seeing children include provision for those in rural as well as in urban communities; such laws are applicable to minority groups.

Chapter Six: S C H O O L H E A L T H S E R V I C E S for VISUALLY HANDICAPPED

CHILDREN

T

a mistaken idea that when children are placed in classes for the partially seeing they are no longer the concern of the school health service. Nothing could be further from the truth; the health of all school children is a responsibility which every member of the school staff shares with the children, their parents, and the community. This requires the finest kind of co-operation if a co-ordinated effort is to be made possible. HERE IS SOMETIMES

GENERAL H E A L T H

SERVICES

In its broadest sense the term "school health service" embraces the health work of all the members of the school staff. But for the purpose of this discussion the term is applied to the medical and nursing personnel serving the school system. T h e administrative organization of this service varies greatly. T h e department of education may employ a medical and a nursing staff to give full- or parttime service in the school system. T h e service may be supplied by the department of health or by a private agency. In large cities the medical staff often includes specialists, and the conduct of special clinics such as eye clinics may be one of the functions of such a medical staff. In small communities and in rural areas there may or may not be provisions for medical service in the schools. However, many schools having no physician do provide a nursing service, either by employing nurses or through some co-operative arrangement with other health agencies. It is obvious that every teacher should be familiar with whatever medical and nursing services are available in her school system and should take advantage of any assistance and guidance such services can give. If she is planning educational adjustment for a handi-

38

SCHOOL

HEALTH

SERVICES

capped child, she is in special need of such help and guidance. Frequently eye difficulties are caused by some form of malnutrition or by diseases for which treatment is essential. Furthermore, the visually handicapped may have emotional reactions which, in turn, may affect the general health. T h e classroom teacher shares with the school health staff the responsibility for discovering handicaps. T h e teacher's daily observations are important, especially with regard to serious eye troubles; she should refer to the health service any child whom she suspects of having visual difficulty. It is usually the responsibility of the health service to refer to the parents any question concerning the need for medical attention and to assist them in making arrangements for further examination. If they have a family physician, they are urged to consult him. If they cannot afford a private physician, the school health service should assist the family to make the best use of community resources to secure the necessary attention. After the child has been examined the health service should obtain from the examiner a report of his findings and recommendations. Such a report is essential to make possible an intelligent adjustment for the child. It should be in writing and should constitute part of the child's permanent record. 1 Its contents should always be accessible to the child's teacher and to the staff of the school health service. Its terminology should be familiar, both to the teacher and to the school health staff. In case it is not, a member of the school health staff should seek further information from the examiner and, with his permission, interpret the meaning to teacher and parents. T h e confidential nature of all medical reports must be recognized and safeguarded by all concerned. T h e written report alone is often not sufficient. A personal conference between the members of the staff of the school health service and the examiner is frequently necessary in order to discuss the findings and recommendations. T h i s affords the school an excellent opportunity to acquaint the examiner with its facilities and program for adjustment of children with visual handicaps. It is, therefore, of the utmost importance that the staff members of the i See section Records, p. 47.

SCHOOL

HEALTH

SERVICES

39

school health service making such contacts be thoroughly familiar with their school program and able to interpret it concisely to eye specialists in the community. When the first class for partially seeing children is established in a community, the special teacher and the nurse may find it advantageous to join in making contacts with ophthalmologists. This will permit a dual interpretation. T h e teacher will undoubtedly stress the educational advantages of such classes, and the nurse will emphasize the health aspects. A similar procedure might well be used subsequently in calling on physicians newly established in the community. Interpreting to the parents the necessary adjustments is another responsibility which the special teacher shares with the members of the staff of the health service. T h e nurse usually makes the first contact by calling at the child's home, or the parents may be invited to the school for a conference with the school physician, the nurse, and the teacher. A visit by the parents to the class should be planned so that they may see the adjustments which are made there. T h e child may accompany his parents on this visit in order that he, too, may be introduced to the advantages to be gained. It must be borne in mind that adjustment to a physical handicap may be a long, slow process. Parents cannot be expected to gain in a single conference or class visit comprehension of all the factors involved. T h e y should be encouraged to have frequent conferences with the teacher and with the school health staff. Home visits by both nurse and teacher are helpful. T h e y may occasionally go together, having planned the conference, but more often each person will go alone. T h e nurse's visits can often be made during the school day, when the child will be absent from home. If both parents are working, special arrangements will have to be made. T h i s type of teamwork requires the closest co-operation. T h e family must not be confused by different opinions. Rather than rigidly limit the field which each will discuss, it is better to develop a policy according to which the nurse defers to the teacher in matters of education and the teacher defers to the nurse in matters of health. This long-term follow-up should be marked by a continuous effort to sustain and build up the child's general health

40

SCHOOL

HEALTH

SERVICES

by correcting physical defects, establishing good habits of health, and adjusting health problems in the environment. Eye difficulties often result from systemic diseases, hence it cannot be too emphatically stated that attention to the general health of the child is essential. Simultaneously, follow-up of the eye condition should be continued in an effort to maintain the sight at its maximum or to retard the progress of the defect or disease. T h e major responsibility for this aspect of follow-up lies with the health service, which must interpret to the family and to the teaching staff the recommendations of the doctor and explain why it is important to carry them out promptly and exactly. Through contacts with community resources the health service also assists the family in making necessary arrangements and in interpreting the eye and health problems to co-operating agencies. T h e teacher contributes to this phase of follow-up by showing to parents and child her interest in the progress of the child's health program and by encouraging them to carry it through faithfully and intelligently. She also contributes by keeping the health personnel informed of the child's progress, of his reaction to treatment, and of any new developments that might influence the health program. T h e right of the family to make its own health and social plans should be recognized. Those who give assistance should do so in the role of family adviser, showing those responsible how to plan wisely and encouraging them to carry through the plans with such modifications as changing conditions may indicate. T h e y should never try to impose their opinions and plans on the family, even if they feel that the members are not choosing wisely. T h e y should seek to provide them with the necessary information on which to base decisions, and then they should respect the family's desires and lend their assistance in whatever plan the family decides to adopt. Only when such decisions definitely jeopardize either the child's life or his future welfare or the health and welfare of others has a public agency the right to interfere. 2 T h e teacher must recognize the sight-conservation aspects of the 2 National Organization for Public Health Nursing, Manual of Public Nursing, 3d ed.. New York, Macmillan, 1939, pp. 91-104.

Health

SCHOOL HEALTH SERVICES

41

health program and stand ready to modify her own program with relation to the child's health needs, subordinating, if necessary, education to health. If there is a conflict between the child's need for rest and the amount of school work he can do, the teacher should realize that rest is the more important of the two and that her pupil's educational load should be lightened so that he will not feel a sense of pressure or defeat. Frequent conferences are necessary between the teacher and the staff of the school health service. The alert teacher will be aware of the status of the child's emotional adjustment, his and his family's attitude toward his defective sight, and his ability to mingle with other children in work and play. She will observe variations in his health condition, and by means of her contact with the child in school and at home she will have an intimate knowledge of him which can be of value to the health staff. An exchange of information makes for co-ordinated effort. The special-class teacher should have greater appreciation of these aspects of the child's life than can be expected of the regular classroom teacher. Hence, when a visually handicapped child is receiving his instruction in a regular grade instead of in a class for the partially seeing, the school health staff should be prepared to assume the additional responsibility of helping the classroom teacher understand the health, emotional, and social problems attendant upon poor sight, in general, and any of the problems related to the child's specific type of eye condition. Health teaching is also a shared function. In its broadest sense, it embraces the entire school health program. T h e most fruitful teaching is that resulting in desirable attitudes and practices. Of what avail is it to tell a child to read in a good light and to instruct him concerning what constitutes a good light if no opportunity is given him to use this information? Indeed, formal health instruction is far less productive than the child's daily experiences. T h e child who learns in school to adjust shades, to move his desk to a desirable position to get the best possible light on his work, and to raise the desk top to the most favorable angle is developing habits and attitudes which are likely to carry over into his home life and his life after his school years. If this teaching is extended to the parents in the personal conferences between them and the school health staff and the teacher, and if practical suggestions are made

42

SCHOOL

HEALTH

SERVICES

regarding home adjustments, the child will be aided in applying his learning in his home life. On an administrative level the health service has much to contribute in planning programs and curricula. Policies and standards for eligibility and admission to classes for the partially seeing should represent the joint thinking of the ophthalmologist, the school administrative staff, the guidance department, the division of special education, the educational staff, and the health service. Often members of the health staff are the first to recognize the need for special educational programs and facilities for children with limited sight, and they perform a real service by bringing such needs to the attention of the proper educational authorities. It is quite evident that no teacher, either in a class for the partially seeing or in a regular classroom, should attempt to assume the full responsibility for the health of the children under her care. There is a tendency to believe that special-class teachers should relieve the health service of some responsibilities, because teachers of the partially seeing have a fairly small pupil load, whereas the pupil load of the health service is almost always high. This is not sound thinking. These pupils have greater health problems than the average child, and such an approach is likely to result in overemphasis of the eye problem and underemphasis, or even neglect, of related health problems. Administratively, it should be recognized that the education of these children is costly and that the community cannot afford to neglect any aspect of their school health program. MENTAL

HEALTH OF THE PARTIALLY SEEING

CHILD

There is a growing realization that emotional, mental, and physical health are inseparable and should be so considered in any health program. No educational opportunity for handicapped children can be expected to meet their needs unless the health program includes all these important aspects. Such children have characteristics common to all groups, but their emotional and mental health may be seriously affected by their own reactions to their handicap and by the reactions of those who come in contact with them. Even a minor handicap, such as the loss of a finger or part of a finger, may cause emotional and mental repercussions. T h e individual sustaining the loss may be able to adjust himself to the extent of making

SCHOOL

HEALTH

SERVICES

43

his other fingers do the work, but every time he meets a stranger he may be more or less conscious of the fact that his loss is a cause of speculation. H o w was the finger lost? H o w did the owner readjust himself to his loss? Might the loss have been prevented? A n d a dozen other questions. T h e child with a handicap is often fearful of the reaction of others to his defect. As he grows older there arises the question of the possibility of prevention. W h o was at fault? If the difficulty might have been prevented, bitterness toward those responsible may develop—a bitterness that cannot help but impede social adjustment. Among preventable handicaps are eye difficulties resulting from preventable diseases—because of lack of adequate attention. A cross-eyed child who realizes that his eye might have been straightened and its sight preserved by proper treatment, may resent the negligence or ignorance that prevented this. T h e attitude of society toward his handicap may also have an effect on his emotional and mental health. If the parents feel themselves responsible for the difficulty, they may be overprotective in an effort to make up for their neglect. On the other hand, parents may develop an aversion to a child whose handicap is a constant reminder of their own mistakes or negligence. Even in cases in which the parents realize that they are not in any way responsible for the handicap, they may hinder the child's development by doing everything for him instead of encouraging him and providing him with opportunities to become independent. T h e y may discuss his difficulties with others, in his presence, and thus develop in him a feeling of selfpity, or of egotism because of the attention given him, or of dislike for them and withdrawal within himself. Economic conditions may affect the situation. T h e family may feel that a handicapped child is an extra burden placed upon them and their limited resources, or they may resent any curtailment of their social activities because of the necessary care that may have to be given to a handicapped child. Brothers and sisters will in general follow the example of the parents, except when the latter are overprotective and expect the same attention for the handicapped child from the rest of the family. Such reactions may extend to his playmates, who may be afraid to include him in games because of the possibility of injuring him, because he cannot compete and may

44

SCHOOL

HEALTH

SERVICES

interfere with the game, or because he has been so spoiled by the family attitude that he always demands preferential treatment. For the development and carrying out of a sound health program, emotional, physical, and mental, there must be a clear understanding of the influences affecting the child from within and from without. Naturally the chief responsibility lies with the parents, but it is often difficult for them to view the picture objectively. T h e teacher of a partially seeing child who is alive to this need has to take the child as she finds him, for he has been influenced long before she comes into contact with him. She may have to cope with inhibitions and repressions that have resulted from failures caused by lack of normal vision or successes bought too dearly by great expenditures of effort without the proper educational media and other opportunities. She must therefore deal with results, but in order to do this efficiently she must unearth causes and, if possible, eliminate them. For this she may need the co-operation of parents, the school nurse or other public health nurse, other school personnel, welfare workers, and medical social workers. But most important of all, she needs the co-operation of the child himself. A t times she must meet a child's resistance to entering a class for the partially seeing—usually an antagonism reflected from parental attitudes. As soon as the child becomes somewhat accustomed to his new surroundings, his tenseness is often relieved by the discovery that he actually can see the material provided for him; that he has a movable seat and desk which may be placed in any position that increases his ease and comfort in seeing; that light is adapted to his use; that there are no long periods of exhausting close eye work; that soon he may try his skill on a typewriter; and that the individual help he missed so sorely when in a large group is accorded him. If he has built up a defense mechanism based on the excuse that he cannot accomplish a desired aim because he cannot see well enough, the thoroughly prepared teacher of the partially seeing will help him by proving to him that the materials provided invalidate such an excuse. She will, furthermore, make possible for him situations in which he can succeed, but she will be careful to see that such situations lead to more advanced ones which will be a challenge to his desire for success.

SCHOOL

HEALTH

SERVICES

45

T h e observant teacher of the partially seeing will soon recognize the aptitudes, abilities, and limitations of the children in her group. For the myope she will encourage contacts with other pupils, so that he may develop interests in persons and things that may previously have been shut out of his limited visual world. She will make every effort to broaden his social experiences so that he will not become self-centered. Realizing that the hyperope sees things at a distance better than those near at hand, the teacher will take care to provide such interesting pictures, books, and other materials that in his desire to become acquainted with them he will make some real effort to concentrate. A t first she will wisely encourage only very short periods of attention; later she will increase the time gradually. T h e need for these procedures on the part of the teacher explains why it is necessary for her to understand the eye difficulties of her pupils and to appreciate the attitudes they may manifest in consequence. But all these efforts to meet the personal difficulties of the child accomplish only a small part of their purpose without as great an effort to overcome environmental obstacles. Reciprocal relations between the home and the school are often keynotes in solving problems. Visits of the teachers to the home to establish friendly relations and visits of the parents to the school for the same reason will materially help clear away misunderstandings. During visits the wise teacher will emphasize the child's assets; she will suggest ways and means by which the co-operation of everyone interested in his welfare will assist him to overcome difficulties. If the economic conditions of the family are such as to undermine the child's physical or emotional health or if his eyes are not being given proper care, the co-operation of the school health service will prove invaluable in making adjustments, since the nurse in such a service is familiar with the home and with the community resources. If the child is attending a clinic where there is a medical social worker, the latter can help greatly by explaining existing conditions to the parents and by stressing how necessary it is to follow the physician's directions for treatment and to continue his visits. It is important to take into consideration the personality of the child in relation to his handicap. One child may use it as an asset to

46

SCHOOL H E A L T H

SERVICES

gain desired ends; another may go down to defeat because of it. Two children who were unfortunate enough to lose an eye typify these extremes. Each was carefully fitted with a well-matched artificial eye. Joe strutted with pride at this accomplishment. In his school much attention had been given to nutrition, and excellent lunches were provided at the low cost of five cents (free for those who could not pay). Usually the hungry children trooped in eagerly at lunchtime, but one day the tables were set, and the food was ready—yet no one appeared. The teachers noted a commotion in the schoolyard and saw the children forming a long line. They followed this to a shed a short distance away and discovered Joe demonstrating the insertion and removal of the artificial eye at five cents per person. So fine had been his powers of salesmanship that not only were the children with the requisite five cents actually foregoing their much desired food in order to witness this miracle, but children without the necessary admission fee for Joe's performance were likewise standing in line in the hope that they might somehow gain an entrance. Joe's teacher would have no difficulty in guiding him to select a vocation; his financial acumen and his ability for salesmanship indicated the lines along which his future lies. Perhaps her more difficult responsibility is to guide him to become an asset to society in the work for which he is evidently fitted, rather than a highpressure salesman, taking unfair advantage of others. John's artificial eye gave him no such satisfaction. He was so fearful that people would notice it that he walked with his head down, avoiding others as much as possible; he took no part in games with the other children. The family did not help him meet his difficulties; in fact, they did not give him the attention necessary to keep the socket in good condition, and John soon became so repulsive to those about him that they did everything possible to avoid him. John's teacher had a difficult task. Since there was no school nurse to give aid, she applied to the Visiting Nurse Association for help. A nurse went to the home and showed the mother how to care for the socket in order to prevent irritation and possible infection. She used this opportunity wisely, co-operating with the family and John's teacher in devising ways to help him overcome his real handi-

SCHOOL H E A L T H SERVICES

47

cap—his emotional reaction to the physical. Gradually, because of the co-operation of those interested in the boy, he was able to take his place with the children in his group and to make educational as well as social progress. RECORDS

Carefully prepared, concise, and up-to-date records are essential to the success of any undertaking with partially seeing pupils. Unless the teacher is familiar with the condition of the eyes and the general health of each pupil, his mental ability, his personality and aptitudes, and the influences affecting his well-being, she cannot hope to prepare and conduct a well-rounded program suited to his needs. Although general health records and eye records belong in the office of the school health service, they should be made available to the teacher. She must often consult such records in arranging programs. It is therefore advisable for her to have her own copy in a special folder for each child, together with all other records of a helpful nature. Since medical records are confidential, care must be taken to see that they are safeguarded. T h e best arrangement is to have a locked filing cabinet in the classroom; one with a single compartment is usually large enough. Each child's folder should contain the following: a copy of his general health records; his eye record; results of the mental and psychological tests which are given in that particular school system; records of home visits; school progress; personality traits and vocational trends. These records are of value not only to the child's teacher of the moment, but also to the teacher to whose class he may be transferred after being graduated from a lower to an upper school, after moving to another locality, or after being returned to a regular grade because of improved eye condition. All records should be sufficiently full and clear to give the necessary information. Standards and forms vary in different localities; a uniformity of eye records would be of great assistance, especially when the family moves from one city or state to another. In the sample records that follow, efforts have been made to produce a form as simple and clear as is compatible with securing the necessary information,

48

SCHOOL HEALTH

SERVICES

Form i, 3 "Physician's Report of Eye Examination," is a record form to be sent to the private physician or clinic to be filled at the time of each examination. Before sending the form to the physician it is suggested that the top three lines be completed by the school personnel, thus furnishing the physician with the information available with regard to the child's name, address, age, grade, and so forth, as well as indicating the reason for referral. The two bottom lines should also be completed by the school, for the physician may consider it wise to mail his report rather than entrust it to the family for transmission. A statement showing the state or local basis for eligibility to classes for the partially seeing and to Braille classes should be furnished to the physician with this form, or it may be printed on the back of the form. Information from the physician's form should be transferred promptly to Form 2, and Form 1 should then be filed as a permanent record. Form 2,3 "School's Cumulative Report of Eye Examinations and Recommendations," is arranged as a cumulative record of six examinations. Additional forms will be necessary for a complete eye record of the child during his school life. These forms should constitute a part of the child's school health record and should be filed with the other health records. In systems having special classes for the partially seeing, the teacher will need a copy of this form, which should be kept up to date. In schools without such classes, the school nurse should summarize from the record such information as will assist the classroom teacher in making necessary educational adjustments and in co-operating in the follow-up program. A cumulative record is necessary so that by comparing results of examinations the health service, the teacher, and the ophthalmologist may know whether the eye condition is improving, is static, or is growing worse. Only on such information can health and educational programs be based. Records of personality traits, trends, and reactions should be constructive. Occasionally a child is passed from one teacher to another with a record that is likely to be prejudicial. T h e records s Samples of the record forms may be obtained from the National Society for the Prevention of Blindness, 1790 Broadway, New Vork 19, N,Y,

FORM 1 P H Y S I C I A N ' S

-

R E P O R T

^

Narae of pupil

_

0 F

_ Address

E Y E

Date of birth

_

School Ffeascn for referral

E X A M I N A T I O N

Day

Sex

, History of eye condition, date of onset» eye conditions in others in family, etc. Right _

^

—

Left

—

Both

—

,

Visual acuity with present glasses

« ...

recommended

—

—

—

^

—

—

Prescription for glasses

—

—

—

—

.

—

^

—

RECOMMENDATIONS Re&ilar

Ifestrictlons:

Close eye work*

Use of glasses:

None

j

n j

•

,

Sight-saving

Close work only

^

• •

—

—

_

Braille

[

|

•

j

j

Physical activity Cens tant ly

Other examinations needed (specify). Rirther treatment needed

(specify)

Symptoms to watch for — Other recommendations

Date for next eye examination • ( I f sight-saving placement is recommended i t is assumed that restrictions on close eye work are based on the use of visual materials planned for sltfit-savlng class pupils - e.g. large, clear type.)

Si feature of examiner Date of examination Title

To be formrded by examiner to:

N a * of school system

_

. —

Class placement:

— - ••

• _

—

— _ _ _ _ _ _ _ .

Etiology

_

Left

—

^

Other ocular defect or disease

_

—

Right TVpe of refractive error

Prognosis

Year

Grade

Visual acuity without glasses

Visual acuity with ^

Mcnth

SCHOOL

HEALTH

SERVICES

49

may stress the child's desirable qualities and suggest lines along which he will need special assistance. GLASSES

It is not the responsibility of the school nurse, other public health nurse, or the teacher to furnish glasses. If parents can afford to buy them, they should be expected to do so. If, however, they cannot pay for them, the nurse or teacher may recommend organizations that will give assistance. If the family is on relief, the matter may be referred to the agency already in touch with the situation. It is advisable, whenever possible, to have the parents pay some part of the cost; such a procedure fosters in them a much better attitude toward their responsibilities and usually results in better care of the glasses. In cities there are usually numerous welfare and civic organizations that may be in a position to provide glasses. In one large city the Junior Red Cross supplies them for all indigent children in classes for the partially seeing. In other cities the Lions Clubs meet this need. In rural communities requests may be made to the county welfare association, T h e Grange, and to church groups. For children of soldiers, help may usually be obtained from the Legion or its Auxiliary. When glasses have been fitted, it becomes the responsibility of the nurse and the teacher to encourage the child to wear them according to the directions of the ophthalmologist. A child's reaction to glasses depends upon many factors—the type of eye condition for which they are prescribed; whether or not the frames fit well and look well; the clearness of the lenses; and the attitude of the child, his parents, his playmates, and his classmates toward the wearing of glasses. T h e type of eye defect is the most important factor. Glasses open such a new world of interest to the nearsighted child that usually no encouragement to wear them is necessary. T h e child who has been operated upon for cataract is dependent upon his glasses for clear vision and would not willingly be without them. On the other hand, the farsighted child needs much encouragement. Since he sees things at a distance much better than those at close range, he naturally prefers the activities that do not call for close eye use.

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SCHOOL HEALTH

SERVICES

He is, therefore, often impatient and unappreciative of any device that may help him to do the thing he is not interested in undertaking. The appearance and proper fitting of frames are also important. Poor frames are not an economy, and they may prove a source of trouble. They bend easily, throwing the lenses out of focus, which may add to the eye difficulty rather than compensate for it. Often poor frames fail to hold the lenses in place, and consequently they are easily broken. If frames are bent, every effort should be made to have them straightened. If a special, readily recognizable type of frame is the only kind used for all glasses provided for indigent children, it is often very difficult to get them to wear their glasses, because other children soon learn to identify the frames. Obviously, unless lenses are kept clean and free from scratches, desired results cannot be expected. Teaching the care of glasses is the responsibility of both the nurse and the teacher. When not in use, glasses should be placed carefully in their case. If put down for a moment, they should be placed on the frame side to prevent the scratching of lenses. They should be washed frequently and dried with a soft, clean cloth. Teaching the care of glasses is one approach to developing a desirable attitude toward wearing them. An activity program concerned with the history and making of glasses would add greatly to the interest of the group and to the willingness of the children to wear them. A health educator on the school staff can be of inestimable value in co-ordinating health programs and suggesting methods for making them practical and effective.

Chapter Seven: S E L E C T I O N and P R E P A R A T I O N of the T E A C H E R of the P A R T I A L L Y S E E I N G

F

ROM THE foregoing chapters it must readily be seen that the superintendent of schools—city or county—who has decided to establish a class for the partially seeing must realize that, although the co-operation of all concerned with the welfare of these children is essential, a teacher well qualified to undertake the major responsibility holds the key and is vital to the success of the undertaking. T h e most satisfactory way to secure a teacher is to select the most promising candidate from the school system and to arrange for her special preparation. This plan has many advantages. T h e superintendent has, or can obtain, information regarding the qualifications of the teachers in the system and can judge which of them are desirable candidates for such undertaking. These teachers are familiar with the community and its schools; hence they would not have to make as many adjustments as would be necessary for a newcomer. T h e y have already established co-operative relationships with other teachers in the system. If, however, the superintendent, or in large cities one of his associates, is to make a wise selection, he must have an appreciation of the qualifications necessary for success. A good recipe states: Take one teacher with excellent fundamental preparation, add at least three years of successful experience in teaching regular grades, a large amount of common sense, infinite tact and patience, a sane attitude toward handicapped children, a willingness to work hard, an open mind toward new ideas, and a co-operative spirit; season with the spice of humor and enrich the recipe with special preparation for teaching partially seeing children. PERSONAL

QUALIFICATIONS

In his classic, The Ideal Teacher/ George Herbert Palmer states: i George Herbert Palmer, The Ideal Teacher, New York, Houghton Mifflin, 1910,

The T E A C H E R 53 The touch of the teacher, like that of no other person, is formative. . . . Such weighty work is ill adapted for amateurs. . . . When, however, it is entered as a profession, as a serious and difficult fine art, there are few employments more satisfying. What are the qualifications for the profession? Palmer believes that in reality there is no human excellence which is not useful for teachers, but that there are four fundamentals without which no one can hope to be successful in the art of teaching: "an aptitude for vicariousness; an already accumulated wealth; an ability to invigorate life through knowledge; a readiness to be forgotten." Possessing these four qualifications, would-be teachers may build according to the pattern for which other qualifications fit them. Although these fundamentals apply to all teachers, nowhere are they more necessary than for teachers of partially seeing pupils, first, because an understanding of their difficulties is essential if educational procedures are to be successfully carried out, second, because these teachers often have children in their classes for several years, hence greatly influence their development. An aptitude for "vicariousness," or empathy, makes it possible for the teacher possessing it to put herself, to some extent at least, in the position of her pupils, to understand which difficulties arise directly from eye conditions and which are indirect results. T h e necessity for understanding possible maladjustment in the handicapped has sometimes led to a misconception with regard to the selection of teachers. Some educators, believing in the adage "like to like," have felt that only teachers with difficulties approximating those of their pupils can understand the reactions arising from them. Hence the blind must teach the blind; the deaf, the deaf; and the partially seeing, those who are suffering from serious eye difficulties. This theory has only to be carried to a logical absurdity to prove the fallacy—the appointment of mentally subnormal persons to teach mentally subnormal children. So far as partially seeing children are concerned, the appointment of a person with a serious eye difficulty may defeat the very purpose for which the class is established. In order to prevent too much close eye work by the pupils, the teacher must use her own eyes in preparing quantities of material. When mechanical devices such as the Dictaphone and the Talking Book are not available, she

The T E A C H E R

53

must read aloud for her pupils the assignments not printed in large type. She must make maps when they are required and must always be on the alert concerning the correct use of vision by her pupils. In some cases in which because of this mistaken idea partially seeing persons have been appointed as teachers of children with serious eye difficulties, those with photophobia have been known to keep the shades drawn down so that the children were obliged to work under very low illumination. In other cases teachers with serious eye difficulties could not see how children were holding their material or note the mistakes made. In some cases added strain on the eyes of the teacher has had very serious visual and emotional results. Unfortunately this old idea persists in some places; even in the present era it is not a rare occurrence for the director of an institution for the preparation of teachers to suggest to a partially seeing student that he or she take the special courses necessary to become a teacher of a class for partially seeing children. Usually directors of these courses refuse admission to such students, knowing the disappointments they will suffer when the time comes for them to seek appointment. A teacher with the aptitude for vicariousness can apply her knowledge of eye conditions to her pupils and can understand their eye difficulties without having actually experienced them or suffered because of them. The second fundamental, "already accumulated wealth," refers to wealth of experience, learning and storing up not only factual material but also what Palmer calls "special knowledge, trained insight, professional skill, sound, practical judgment." Perhaps most of all the teacher of the partially seeing will need to accumulate a wealth of resourcefulness. But all such experiences are useless in teaching unless the person possessing them has the power to invigorate life through education, to inspire the pupils. This fundamental is of special interest to the teacher of the partially seeing, who must cope not only with the discouragements that at times beset even normally seeing children, but with those that almost inevitably come at one time or another as a result of the handicap. In such instances her wealth of accumulated resources should be such as to enable her to inspire her pupils to make the efforts necessary to reach their goal.

54

The

T E A C H E R

T h e f o u r t h f u n d a m e n t a l for success, "a willingness to b e forgotten," is perhaps especially applicable to the teacher of the partially seeing. C h i l d r e n entering these classes are o f t e n discouraged b y their failure in other grades. W h e n they have educational media suited to their needs and i n d i v i d u a l teaching, the hope of success is rekindled; and in their eagerness for achievement, they are likely, unless great care is taken to prevent it, to d e p e n d u p o n the teacher instead of m a k i n g every effort to find o u t w h a t they themselves can accomplish w h e n given the o p p o r t u n i t y . T h e teacher of a partially seeing g r o u p may have the same children under her care for several years, possibly through the elementary school, and even through the seventh and eighth grades, I n a co-operative system the pupils have the benefit of contact w i t h other teachers in the regular grades they attend for oral work and other activities; b u t each child may come to look u p o n his home-room teacher as the one w h o is chiefly responsible n o t only for his education b u t also for the ordering of his school life. She has a difficult row to hoe. She must keep the confidence of her pupils in her ability to understand and to guide, b u t she must likewise " b e w i l l i n g to b e forgotten," to step aside w h e n ever it is for the best interests of her pupils and to let them go forw a r d as i n d e p e n d e n t l y as possible. She must h e l p them through her o w n thinking, b u t must teach them to think for themselves. B y her resourcefulness she must find ways and means to help them discover and develop their o w n resources. FUNDAMENTAL

PREPARATION AND EXPERIENCE

Each state determines w h a t f u n d a m e n t a l preparation is necessary for certification to teach w i t h i n its borders. I n general, before a teacher can b e appointed she must b e able to present credentials showing that she has met n o t only the educational b u t also the health requirements of the state in which she wishes to teach. Before a teacher undertakes work in a special field it is desirable that, in addition to her f u n d a m e n t a l preparation, she shall have three years of experience in teaching regular grade children.

A

c o u n t y superintendent w h o plans to establish a class in a consolidated school w o u l d do well to select for special preparation a successful rural school teacher with the necessary qualifications. H e r experience in teaching several grades w o u l d be of great value.

The

TEACHER

55

SPECIAL PREPARATION

Very few states (and these only in recent years) have made regulations regarding the requirements that must be met by a teacher in order to obtain a certificate or license to teach partially seeing children. T h e chief reason for this is that, as in any new undertaking, even though plans are carefully formulated in advance, it is necessary to follow the trial and error method until definite procedures can be determined. For several years after the establishment of the first classes for partially seeing pupils in the United States each teacher, having no precedent to follow, developed her own program and techniques as best she could. ELEMENTARY COURSES

In 1920, realizing the waste of time and energy involved in such a procedure, a group of people and organizations interested in the education of the partially seeing conferred to find ways and means of making the results of the experiences of teachers of the pioneer classes available to others. T h e first course for the preparation of teachers of partially seeing children was offered at Teachers College, Columbia University, in 1921. It was attended by a group of teachers engaged in the work and some new recruits. A beginning was thus made, but because of lack of facilities Teachers College did not again offer a course until 1929. In the meantime, at the request of an interested group, George Peabody College for Teachers, Nashville, Tennessee, offered experimental courses; here again facilities proved inadequate, and the courses were withdrawn. T h e first summer session course providing adequate facilities was given in 1924 at the University of Cincinnati, Cincinnati, Ohio. This included provision for educational and medical lectures, observation and some participation in a well-equipped and wellconducted demonstration class and in eye clinics. It also included arrangements for individual conferences and for participation in campus activities, an essential feature in having the course recognized as a part of the regular college program. Although there have been many developments in such courses since that time, the plan initiated at the University of Cincinnati set the pattern which other colleges and universities have followed. Because the number of partially seeing children is small in pro-

5

6

The T E A C H E R

portion to the school population, there is not a demand for a large number of teachers for these groups. It is thought inadvisable, therefore, to offer special courses in many colleges and universities. In order to save teachers and supervisors who desire to prepare themselves for this work unnecessary expenditure of time, energy, and money for travel, efforts have been made to establish courses in different parts of the United States. In addition to the colleges and universities mentioned, the following institutions have given courses: the University of Texas, Austin; Tulane University, New Orleans, Louisiana; University of Southern California, Los Angeles; University of California, Los Angeles; University of Chicago, Chicago, Illinois; Wayne University, Detroit, Michigan; Michigan State Normal College, Ypsilanti, Michigan; State Teachers College, Buffalo, New York; State Normal School, Oswego, New York; Fordham University, New York, New York; Western Reserve University, Cleveland, Ohio; University of Oregon, Portland; State Teachers College, Milwaukee, Wisconsin; University of Washington, Seattle; New York University, New York, New York; University of Hawaii, Honolulu. The courses are intensive, and students are expected to devote their entire time to them when they are given during summer sessions. In a few instances they are available during the regular college year. All elementary courses follow the same general program, including thirty hours of lectures and discussion on the organization and administration of classes for the partially seeing, physical surroundings, and equipment; thirty hours of lectures and discussions on the ways and means of conducting classes in elementary, junior high schools, and senior high schools, educational media and their use, and vocational guidance; thirty hours of observation and participation in a well-conducted demonstration class; thirty hours of medical lectures on the anatomy, physiology, and hygiene of the eye, principles of refraction, refractive errors, and the study of common eye diseases, together with observation of cases demonstrated in clinics; individual conferences. ADVANCED COURSES

At the request of teachers and supervisors with experience in this work, advanced courses were initiated. These have been given at:

A

WELL-PREPARED

AND THE

UNDERSTANDING KEY

TO

TEACHER

HOLDS

SUCCESS

Note pupils variously engaged; left-handed pupil near window is seated so that light comes over her right shoulder.

RESOURCEFULNESS

AND

PARTICIPATION

Willing hands make light work; moving a desk to a more desirable position.

The T E A C H E R

57

the University of Chicago; Western Reserve University, Cleveland, Ohio; Wayne University, Detroit, Michigan; State Teachers College, Buffalo, New York; Teachers College, Columbia University, New York, New York; University of Minnesota, Minneapolis, Minnesota. Advanced courses are in the nature of workshops, combining lectures in advanced eye work and a consideration of new techniques in educational procedures with making and working out programs and plans by individuals and by groups; discussion of problems; exhibits of new material; demonstration of the use of mechanical devices. Each participant works individually or with others in a group on some phase of special interest. As a result of these undertakings students have prepared material for a number of bulletins that have been made available to all teachers and supervisors of classes for the partially seeing and to school superintendents, principals, and others interested in this work. States formulating requirements for the certification of teachers of classes for the partially seeing usually base these on the program included in these courses, adding whatever seems advisable to the educational authorities in any particular state in order to obtain the best results. Helen L. Smith, 2 from her own experience in establishing the first class for the partially seeing in America, wrote: "Let these teachers, one and all, be thankful that there is some sort of blazed trail ready for them to follow, that they are not quite so dependent upon their own resources as were those who made the start." 2 Helen L . Smith, "Pioneer Work in Sight Saving," The Sight-Saving Class Exchange, June, 1938, No. 65, pp. 2 - 1 4 . Reprinted as Publication No. 265 of National Society for the Prevention of Blindness, New York.

Chapter Eight: S U P E R V I S I O N of P A R T I A L L Y

SEEING PUPILS

S

of partially seeing pupils includes the oversight of all that concerns their welfare—the general medical and educational supervision provided for all children and, in addition, special ophthalmological and educational supervision, according to their needs. UPERVISION

OPHTHALMOLOGICAL

SUPERVISION

As has been indicated, matters relating to the health of school children are the concern of the school health service, and naturally general ophthalmological supervision is included. It is, however, necessary to emphasize the special ophthalmological supervision and care that must be accorded partially seeing pupils. Such care and supervision should be maintained throughout the school life of the partially seeing and should be continued for those who enter colleges as well as for those who enter industry. If throughout their school life they can be imbued with the necessity for periodic ophthalmological examinations, many of them will continue to follow the proper routine. If in high school and college they gain some understanding and appreciation of the latest scientific medical advances, they may be encouraged to keep abreast of them thereafter. Ophthalmological care may be given by private or school oculists or through clinical service, but ophthalmological supervision means much more than examination or treatment of the eyes or the prescription of glasses for refractive errors. If educational authorities are to be able to adapt their procedures to the eye condition of each pupil, the school health service and the special teacher must be supplied with as full medical and ophthalmological records as possible. 1 i See section Records, p. 47.

SUPERVISION

59

In one school system an ophthalmologist devotes half his time to the care and supervision o£ children in classes for the partially seeing. In this city there are approximately 278 partially seeing pupils in elementary, junior high, and senior high school classes. He makes careful periodic examinations of each of these for whom ophthalmological care is not otherwise provided, and gives ocular supervision in the classroom. During his visits he confers with the teacher about the eye conditions of her pupils, noting improvement, static conditions, and conditions that have grown worse. For pupils showing improvement he may recommend return to a regular grade; for those whose conditions have grown worse he may suggest changes in eye use. O n such visits the ophthalmologist notes the physical condition of the classroom and its effect on the children. If the eye condition is caused by systemic disease, he is interested to know the regularity with which treatments are carried out. Since he has been a member of the school staff for a long time, he knows every partially seeing pupil in the elementary, junior high, and senior high schools and is personally concerned with the welfare of each. This, to be sure, is an ideal situation—one that few cities can attain. But even in rural areas where ophthalmological service is seldom obtainable, the children can sometimes be taken to the nearest place where it is available or attend an ambulatory clinic. Every effort should be made to supervise all partially seeing children so that they will receive the necessary periodic examination, treatment, and change of lenses when the eye conditions show need for them. As in all other health matters, the co-operation of the school health service is essential. EDUCATIONAL SUPERVISION

T h e responsibility for educational direction and supervision is divided between state and local authorities, especially in states having a subsidy for special classes. T h e director of the department of special education of the state board of education assumes the responsibility for the development ot special education throughout the state and for the allocation of state funds to local communities. In some states adequately prepared personnel are appointed to undertake the supervision of various types of special education.

6o

SUPERVISION

Thus there may be a supervisor for the mentally handicapped and one for the physically handicapped. In a few instances there are supervisors for each type of the physically handicapped—the orthopedically crippled, the deaf, the hard-of-hearing, the blind, and the partially seeing. Such supervisors usually give service throughout the state except in cities where there are enough classes to require the services of a special, local supervisor. For example, in New York State the personnel of the Bureau of Physically Handicapped Children of the State Department of Education supervise all classes except those in New York City, for which special supervisory provisions are made. Ohio has a state director of special education for the physically handicapped; Cleveland and Cincinnati have special supervisors for partially seeing children; the supervisor of Cincinnati supervises also the classes for the partially seeing in the southern part of the state. A special supervisor is appointed for the classes in the northern part of the state, exclusive of Cleveland. In Michigan there is a state supervisor of special education who supervises all special classes throughout the state. Detroit has, in addition to his services, a special supervisor of Braille classes and classes for the partially seeing; in Grand Rapids and Jackson the services of supervisors of all special education are available. Illinois has a state supervisor of classes for the partially seeing and local supervisors in the large cities. California has a state supervisor of special education, a special supervisor in San Francisco, and a special supervisor of Braille classes and classes for the partially seeing in Los Angeles. In Pennsylvania the law provides for a special supervisor in the Department of Public Instruction and for supervisors in a few cities, such as Philadelphia and Harrisburg. Pennsylvania also makes provision by law for exceptional children in rural communities, by the appointment of supervisors who work with children referred by administrators and teachers, as well as with regional groups that meet for the discussion of common problems and the development of an in-service program. These examples are indicative of various supervisory methods. In general it may be said that where there is a state department of special education, state supervisory powers are vested in it and the

SUPERVISION

61

responsibility rests with one supervisor for all types of special education, or with one supervisor for the mentally subnormal and one for the physically handicapped. In states in which there is no department of special education, state supervisors of elementary education and of secondary education must assume this general responsibility, but should have the help of supervisors of counties, townships, or other state divisions. All supervisors, whether state or local, recognize the authority of the administrative personnel—in the state, the commissioner of education; in cities, the city superintendent; in counties, the county superintendent; in districts or parishes, the superintendent in charge. Supervisors also recognize that the principal of a school is its direct administrative head, and consult with him on matters pertaining to the administration of special classes within his school. DUTIES OF SPECIAL SUPERVISOR

Naturally there is a distinct advantage in having for any group supervisors specially prepared to understand the needs of that group and to develop plans to meet these needs. Therefore, whenever a supervisor, state or local, can be appointed for partially seeing children, it is possible to service rural as well as urban areas. The duties of such supervisors are manifold; they keep continually in touch with sources for finding children in need of special educational advantages because of eye difficulties; in co-operation with administrative officers they establish new classes when necessary; they help select and equip classrooms; they assist teachers of these children in solving administrative, educational, ocular, and social problems and in making the many adjustments necessary to insure the best results. Since recent legislation for the handicapped stresses opportunities for such children in rural communities, the responsibilities of the supervisors have ever-widening implications, not the least among them to acquaint superintendents, principals, teachers, nurses, parents, parent-teacher associations, civic groups, and other community groups with the importance of caring for the eyes of all children. Supervision is even more essential for groups of partially seeing children than for the normally seeing. In small communities or

62

SUPERVISION

rural areas teachers have little or no opportunity o£ talking over their problems with others doing the same type of work; moreover, they can seldom attend conferences, and it is difficult for them to keep in touch with developments involving advanced methods and new materials. A special supervisor is able to bring to them the results of conferences and, having a number of classes to supervise, is able to make suggestions to teachers in the more isolated communities based on procedures found successful in city classes. Often the rural teacher has suggestions that are equally valuable to urban communities. Her resources are usually limited; she must find ways to make the most of what she has and must often improvise equipment. Her suggestions, therefore, are sometimes very practical, and a special supervisor may be the means of making them available to other teachers. As in all the other supervisory work, evaluation of teaching should be along constructive lines. Naturally, the first consideration must be given to the children for whom the class is established. If the teacher is unfitted for the task, it becomes the duty of the supervisor to recommend replacement. But if by helping the incumbent it is possible to adjust the difficulties, the supervisor is the one who should make this help available. The personality of the supervisor should be such that teachers may feel free to discuss their work with her and know that an understanding consideration will be given to all difficulties that may have arisen and that, if possible, ways of meeting them will be suggested. It is obvious that supervisors of the partially seeing must have as thorough a knowledge of eye conditions and of conditions affecting the eyes as is necessary for the best interests of those vitally concerned. They must depend, however, on the medical profession for diagnosis, treatment, prognosis, and recommendations. Hence their fundamental preparation and experience should be educational rather than medical. THE VISITING TEACHER

When the number of classes for the partially seeing in any community is large enough to warrant their appointment, it is desirable to have visiting teachers assigned to this work. As the name im-

SUPERVISION

63

plies, a visiting teacher acts in a dual capacity; in the first place she visits homes, schools, hospitals, clinics, and (if legal complications arise) courthouses; in the second, she interprets for the partially seeing child and his parents the reason for these special classes and the necessity for certain procedures. In order to render efficiently the former service, she must have fundamental preparation in social service. T o be able to interpret correctly the reasons for special educational facilities, she must have fundamental preparation for teaching and a very thorough understanding of the principles upon which this type of special education is founded, as well as an appreciation of the problems that may result from the eye difficulty. As a visitor she must possess a personality that will make her welcome in the child's home and the ability to give such helpful suggestions that the family will have confidence in her judgment. She must learn the needs of the family and must be sufficiently familiar with community resources—medical, economic, and social —to recommend the necessary contacts for meeting these needs. T h e visiting teacher works in co-operation with the school health service and with the teacher of the special class. In some cases the visiting teacher carries a much more extensive program. She may be the liaison person between elementary classes for the partially seeing and the high schools. In such instances she arranges for placement of pupils in high school in accordance with decisions made by the supervisor of the department of special education, in conference with elementary school and high-school principals, the special teacher, the child and his family, and the ophthalmologist. In communities in which there is no special visiting teacher, the visiting teacher of the general school system may fulfill as many of these duties as her time will permit. In these cases it is, of course, necessary for her to have sufficient understanding of the needs of the visually handicapped child to enable her to render efficient service. In order to assume these responsibilities such staff members often take advantage of the special courses offered in colleges and universities for the preparation of teachers and supervisors of partially seeing children. In small communities and in rural areas the

64

SUPERVISION

teacher of the partially seeing group must assume as much o£ the load as she is able to carry, in co-operation with the county elementary school supervisor, the county nurse, and the personnel of any welfare agency that is available.

EXAMPLE

OF E X C E L L E N T

CO-OPERATION

Partially seeing pupils taking notes on typewriter; regular grade pupils using notebooks. T o avoid confusion, notes are not taken while teacher is speaking; result—concentration on the part of all.

Chapter Nine: M E T H O D S of C O N D U C T I N G and F I N A N C I N G C L A S S E S for the P A R T I A L L Y SEEING

M

ETHODS by which classes for the partially seeing are to be conducted must be determined by the administrative authorities. Wherever possible such methods should be in accordance with modern educational procedures, avoiding segregation. Although educators, physicians, psychologists, and others concerned with human welfare recognize that situations exist in which the best interests of the individual and of those with whom he comes in contact make segregation necessary, modern educational procedures are based upon the proposition that school situations should approximate as nearly as possible those in society at large. Unnecessary segregation of any group defeats this purpose. CO-OPERATIVE PROGRAM

It is difficult to define the exact meaning of "exceptional child." Every child differs from every other—mentally, physically, and socially. Even in identical twins parents and others in frequent contact with them usually learn to recognize individual differences that distinguish one twin from the other. T h e partially seeing child may be considered exceptional because in one respect he differs more radically from his companions than they differ from one another. Like them, he faces problems that are common to all children; but, unlike them, he must in addition meet problems arising from his visual disability. In many instances he cannot use the educational equipment provided for those who see better than he does. Other children have different types of problems. Many have more marked reading difficulties than their companions. Educational authorities take cognizance of their need for special help and provide it in the way best suited to that need. A room may be equipped

66

C O N D U C T I N G and F I N A N C I N G

CLASSES

with educational material and mechanical devices to aid poor readers. During reading periods, or at other prearranged times, they may go to this room and be given the necessary help by a teacher prepared to understand their difficulties and to assist them to overcome these by whatever method is advisable. In the same way, educational authorities recognize that partially seeing pupils have difficulty in using the educational material provided for those with normal vision; hence a room is equipped with material they can use, and necessary help is given by a teacher prepared to understand the problems that arise from their visual handicap and able to assist in solving them. Just as the poor readers participate in the activities of their companions, so partially seeing pupils should join in all regular grade undertakings not requiring close use of the eyes—oral work, rote singing, assembly periods, story telling, dramatization, gymnasium work (if recommended), clubs, cooking classes, shop work—the extent of participation being determined by the eye condition. This method of conducting classes for partially seeing children is known as the co-operative, or co-ordinated, plan. In a few instances partially seeing children are completely segregated and do all their work in the special classroom. Occasionally this is a matter of expediency. T h e number of partially seeing children in a community may make the establishment of a class necessary, but there may be no room available in a school'building in which the class should be placed. If these children are in the elementary grades, the only room available may be in a junior high school or even in a senior high school. In such instances, unless there is an elementary school in fairly close proximity a co-ordinated program would be impractical. However, with the erection of new school buildings the difficulty of finding suitable rooms may be overcome. There are many drawbacks in the segregation plan: the partially seeing child is deprived of the stimulus of working with other children of his own age and ability; he loses not only educational but social contacts. T h e children of the regular grade may look upon those in a segregated class as essentially different from themselves and possibly as inferior. Segregation tends to make the partially seeing child feel that his limitations rather than his possibilities

CONDUCTING

and F I N A N C I N G

CLASSES

67

are stressed. Since the class includes pupils from several grades, a partially seeing child may have but one teacher throughout his elementary-school life. No matter how good a teacher she is, it is probable that she cannot teach all subjects equally well. A child needs the experiences that come from different points of view. If there is no contact with regular grades, the teacher may lose the attitudes of regular grade teaching and may come to look upon her pupils as a special group removed from the rest of the school. In this case the children are likely to become very dependent upon her, and thus another problem may be added to the problems they must face. O n the other hand, the pendulum sometimes swings too far in the opposite direction. Partially seeing children are in some cases expected to participate in regular grade activities that require close use of the eyes, and the value of the special class is thus lost. A l l sides of the question must be given careful consideration if the child is to obtain the greatest possible benefit from the educational opportunities offered. In spite of possible difficulties in finding rooms for classes for the partially seeing, 95 percent of all classes for the partially seeing in the United States are conducted on the co-operative plan. COST OF EDUCATING T H E

PARTIALLY

SEEING

In computing the cost of establishing and maintaining classes for the partially seeing the following factors must be taken into account: (1) salary of teacher; (2) buildings in which classes are to be established; (3) number of children to be accommodated and number of grades represented; and (4) transportation. SALARY OF TEACHER

Salaries differ so widely, not only from state to state but in communities within the state, that definite local data are necessary before any computation can be made. In some states an additional amount is paid to the teacher of a special class because of the extra preparation needed for this work. This varies from $100 to $250 a year. However, in one large city this prerogative is not allowed if the regular increase in salary equals or exceeds it. In another large city salaries of special-class teachers are based on junior-high-school

68

C O N D U C T I N G and F I N A N C I N G CLASSES

schedules, even though the teachers may be in charge of elementaryschool groups. COST OF LIGHTING AND DECORATING

If a class for the partially seeing is placed in a new school building, in all probability the color and finish of walls, ceilings, and woodwork will be found to meet modern standard requirements. If the class is in an old building which has not been recently redecorated, it will be necessary to paint walls and ceilings and refinish woodwork and chalkboards. The cost of this service will depend largely on labor rates in the community. However, this expense should not be charged against the account of classes for the partially seeing, because it is a service that should be provided for all children. In a new building, illumination—natural and artificial—will probably meet standard requirements; but since a greater amount of illumination is recommended for the partially seeing, provision of extra wattage may be necessary in artificial illumination. Here, again, cost of electric current differs in various communities. In old buildings the expense may be greater if it is necessary to change the wiring because of the increased wattage. In new buildings the control of natural lighting has doubtless been cared for by the placement of standard shades; in old buildings new shades may have to be purchased for the special classroom. COST OF EQUIPMENT

Without having a fairly accurate estimate of the number of pupils to be accommodated and the grades they represent, it is practically impossible to make calculations regarding costs. Books in large type for partially seeing pupils are one of the chief items of expense. Naturally, books for the more advanced pupils cost much more than those for lower-grade children; also, many books and charts used by children of regular first and second grades are printed in type sufficiently large for the partially seeing and are very much less expensive than specially prepared texts. Oral work is emphasized more in the lower grades than in the upper grades; hence fewer books are necessary in the former. Seats and desks are likewise items of considerable expense, and the prices are subject to change. Desks for upper-grade pupils cost considerably more than those for little children. Upper-grade

CONDUCTING

and F I N A N C I N G

CLASSES

69

pupils need more maps, globes, and materials in current use, such as pencils, pens, and paper, than do those in the younger group. T h e younger children need more material for motivated handwork and creative activities than older pupils who can take advantage of workshops, cooking classes, clubs, and similar opportunities. Uppergrade pupils need several typewriters for the group if they are to prepare their assignments with a minimum of eye use. It is desirable for them to have the use of a Dictaphone or Ediphone, and readers to read aloud material not available in large type. In some cities readers are paid for this service. In addition means and costs of transportation must be considered in relation to the location of the class and community resources. Careful consideration of all the varying factors will reveal that no estimate even approximating accuracy can be made without definite data regarding the points raised. T o assist those responsible for the establishment of classes, a list of equipment and materials that have been found satisfactory in classes for the partially seeing is to be found in the Appendix. T h e best plan is to obtain the necessary data, and to ascertain current prices for equipment and material needed for the group according to the number of pupils and grades represented, and to get estimates for decoration and illumination of classrooms when changes are necessary. However, in computing costs it is well to remember that, with the exception of the salary of the teacher and the costs of material currently used, the initial expense will consist of outlay for equipment that will not need replacement for several years. FINANCING

THE

EDUCATION

OF THE

PARTIALLY

SEEING

Thirty-five states in the Union, the District of Columbia, and the Territory of Hawaii have established classes for the education of partially seeing children. In thirty-three states, the District of Columbia, and Hawaii, the establishment of these classes is authorized by law if a sufficient number of children can be found in any community to warrant the establishment of a special class for them. T h e minimum number usually specified is ten, although in some instances—especially when the law applies to both blind and partially seeing—the minimum is five. In twenty-six of these states, the

7o

C O N D U C T I N G and F I N A N C I N G

CLASSES

District of Columbia, and Hawaii some financial provision is made to meet the expense. Methods used for reimbursement to local communities are in accordance with state laws. Appropriations may be made as follows: a per capita amount; a sum appropriated by the legislature annually or biennially and apportioned by the state director of special education; payment in whole or in part of the salary of the special teacher; part of the salary of the special teacher plus a sum for equipment; an equalization plan in which the same amount is appropriated for ten children in a special class as for twenty-seven in a regular grade. Table I shows the provisions made in the various states; Table II gives a summary of these provisions. TABLE

I

LEGAL PROVISIONS F O R ESTABLISHING AND FINANCING CLASSES F O R T H E P A R T I A L L Y SEEING IN T H E

UNITED

STATES

(As of January, 1947)

STATE

Alabama Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky

TYPE OF LEGISLATION NUMBER OF Without Granting AMOUNT OF ALLOTMENT " CLASSES Financial Financial Aid Aid O

0 0 32

1» 6

0

%# #

,

it

X

..

4 0 99 3' 1

X

...

••• •.•

One-half excess up to $100 per child

...

• * •

X

See notes c and d

X X

Special annual appropriation by Congressc See note d

X

...

X X

Excess up to $ 3 0 0 per child Three-fourths of excess

,,

87

it

X

,«

5 5

##

...

...

• . .

C O N D U C T I N G and F I N A N C I N G CLASSES TABLE

NUMBER OF STATE

CLASSES

I

71

(continued)

T Y P E OF LEGISLATION „,.,. , „ Granting AMOUNT OF ALLOTMENT ® Financial Financial Aid Aid

Louisiana Maine

7 1f

X X

Maryland

7

X

Massachusetts

37

X

Michigan Minnesota

56 30

X X

Mississippi Missouri

o 8

X

Montana Nebraska Nevada New Hampshire New Jersey

1 0 o

X. X

1 17

X X

See note d, below One-half of excess plus $500 on teacher's salary

New Mexico 1 New York 144 North Carolina 3

X X

Equalization 1 $25 a month subsidy for teacher's salary

North Dakota Ohio

1 ' 74

X

o 8

X X

24

X

Excess up to $300 per child Excess up to $100 per child Excess cost up to one and one-half times cost of regular class 25% of minimum salary of teachers in first class district; 30% in 2d, 3d, and 4th class districts

Oklahoma Oregon Pennsylvania

Not specified" Excess up to $200 (or $350 if child boarded away from home) $2,000 per class of ten or more h $500 per year plus $250 for initial equipment per class Excess up to $200 per child $300 per child plus general grant for schools 0 $750 per teacher, provided it does not exceed twothirds of salary ••• See note d, below

7 2

CONDUCTING

and F I N A N C I N G

TABLE

I

CLASSES

(continued)

T Y P E OF LEGISLATION NUMBER OF STATE

CLASSES

Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington

10 8

West Virginia Wisconsin Wyoming

0 9 0

2' 1 0

Without Financial Aid

Granting Financial Aid

AMOUNT OF ALLOTMENT

0

... X

,, X X X

6

2> 1

,.

0 X

• • .

...

• • •

Excess up to $200 per child See note d, below

...

X

Five times amount per normal child, or about 65-70 cents per diem per child 0

X

Excess over $70 to $250

X

o In some states the total received by local schools is below the amount stated, either because actual costs are lower or because annual appropriations are insufficient. 6 Colorado has legislation on a matching basis in anticipation of Federal aid; failing this, the law remains inoperative. «Mandatory legislation only for geographic areas within the state that can be served by such special facilities. & Financial aid is implied in statement that State Board of Education must provide and maintain, but amount or method is not specified. e T h e r e is no law, but Congress appropriates varying amounts from year to year. /Classes have been established under general educational authorizations, without specific legislation on sight-saving classes. 0 Law gives authority to aid in support of classes out of any available funds at the disposal of the State Board of Education. » A n n u a l appropriations have never been made, in spite of law; classes are financed locally. * Formula (i): appropriation for io partially-seeing children equals amount for 27 in regular grade; formula (2): $100 per elementary or $130 per secondary pupil, plus $800 per class of 10 or more (pro-rated at $80 per pupil, if less than 10 in class). 1 $300 is allowed for a nine-month school year; for a longer year, proportionate amounts are granted; current appropriation limits grant to $200 per child.

In some states, although the law provides that children in rural areas who need the advantages of special education shall receive them, there is no appropriation to make this possible. It is evidently taken for granted in these instances that eventually the Congress of the United States will enact legislation by which the Federal Government will assist the states in providing funds for this purpose.

CONDUCTING

and F I N A N C I N G TABLE

SUMMARY

OF

LEGAL

CLASSES

73

II

PROVISIONS

GIVEN

IN

TABLE

I

(As of J a n u a r y , 1947) NUMBER OF STATES

PERCENTAGE OF

TYPE OF

(INCLUDING DIST.

n u m b e r

LEGISLATION

OF COLUMBIA

JVumier

o f

CLASSES ^fTotal

AND HAWAII)

Legislation granting financial aid Legislation without financial aid No legislation Total

TOTAL U.S. SCHOOL ENROLLMENT AFFECTED

28«

585

94-3

73-6

56 17«

24 11 620 d

3-9 1.8 100.0

7-5 18.9 100.0

5°

o Includes f o u r states in w h i c h n o special classes f o r the partially seeing have been established. i> Includes o n e state in w h i c h no special class f o r the partially seeing has b e e n established. " I n six of these states special classes for the p a r t i a l l y seeing h a v e been established. ¿ L o c a t e d in 221 cities a n d counties i n 35 states, the T e r r i t o r y of H a w a i i , and the District of C o l u m b i a .

Several states make some provision for special educational material and for supervision of handicapped children for whom no special classes are available. But in some of these states provisions are not put into effect for the partially seeing. Moreover, not infrequently, even when the legislature has appropriated money for the education of exceptional children, state funds have not been sufficient to meet the amounts stipulated, and the local communities that established such classes under the law have been obliged to bear the expense in full or in part. A t one time it was the custom for anyone interested in a special group of the handicapped to seek special state or Federal legislation and appropriations for that group. Often this proved detrimental to other handicapped groups. Recently states have made appropriations for all these groups or have divided them into two general classes—the physically handicapped and the mentally handicapped. Provisions in the Social Security Act, carried out under the aus-

74

C O N D U C T I N G and F I N A N C I N G

CLASSES

pices of the Children's Bureau, are differently interpreted in various states. In accepting the Act, each state may, within limits, make its own interpretation of the term "crippled." In some states the Act refers only to orthopedic cripples; in others, it has been interpreted to include children crippled by congenital cataract, strabismus (crossed eyes), and ptosis. Operations and hospital care for those having such conditions are provided under the Act. In some states "needed appliances" are included; this is interpreted to mean braces and other mechanical helps for orthopedic cripples and glasses for children who have been operated upon for cataract. Although civic groups and other organizations are most generous in supplying classroom equipment which the state cannot provide, the responsibility for the education of these children rests with state and local educational authorities.

Chapter Ten: P R E P A R I N G the S C H O O L for the P A R T I A L L Y SEEING CHILD

W

HEN the preliminary steps have been taken—that is, the discovery of the partially seeing pupils and the selection and preparation of a special teacher to undertake their education—arrangements must be made for housing the group. SELECTION OF A

BUILDING

T h e first essential requirement with regard to the selection of a building is that it shall accommodate pupils on the same grade levels —elementary, junior high, and senior high school—that are represented in the special class. A class for the partially seeing may serve a wide area; it is therefore desirable to establish it in a centrally located building. Transportation facilities are important factors in making the selection. A n up-to-date building will make possible desirable surroundings and better opportunities than are found in the majority of old buildings. Modern school buildings usually provide good lighting and facilities for shopwork, cooking classes, physical education, and cafeteria service. Since the success of a class for the partially seeing depends greatly on personnel, the class should be placed in a school having a cooperative principal and teachers who are willing to make an effort to understand the problems arising from visual difficulties and to share the responsibility for solving them. SELECTION OF A CLASSROOM

Although a room for these special classes usually houses a comparatively small number of children, it should be as large as an ordinary classroom—approximately 30 feet long by 20 feet wide, and 12 feet high. It is necessary for the pupils to move around a

76

PREPARING

the

SCHOOL

great deal in order to be able to see to the best advantage; the material used in these classes is on a larger scale than that provided for regular grades and therefore requires more space. Experience indicates that ground-floor rooms are usually undesirable; rooms having the same exposure are lighter on upper floors than on lower floors. Ground-floor rooms may be subject to glare from snow or sand on the playground and are often noisy. Partially seeing pupils must rely more on their sense of hearing than do normally seeing children; hence a very noisy classroom is a detriment. T h e choice of floor will depend somewhat on the grades represented in the special class, and the location of such grades in the rest of the school. ILLUMINATION

1

AND

DECORATION

Illumination is one of the most important factors in the complicated process of seeing. Without light even the best of eyes cannot see. For efficiency, ease, and comfort of seeing, correct illumination is essential, and should be provided in all school buildings. A l l too often emphasis is put entirely on the amount of illumination; but quality is of equal, if not of greater, importance. Illumination, natural and artificial, must meet requirements regarding the amount of light and its diffusion, distribution, direction, and control. If illumination meets these requirements, it will be free from glare, which may be defined as any quality of illumination that causes such discomfort as to interfere with the ease of or the actual process of seeing. T h e decision regarding the amount of illumination desirable is, to some extent at least, an individual matter. In general it may be stated that there should be enough light for the individual to be able to perform with ease and comfort the particular eye task that is to be undertaken. It is evident that the eye condition and the type of task are contributing factors in making decisions. MEASUREMENT OF LIGHT

T o avoid confusion arising from the use of different units of i For full information consult American Standard Practice of School Lighting, (ASA, A23-1947). Prepared under the joint sponsorship of Illuminating Engineering Society and T h e American Institute of Architects, rev. 1947, Illuminating Engineering Society, 51 Madison Avenue, New York 10, N.Y.

A

WELL-LIGHTED

CLASS

FOR T H E

PARTIALLY

SEEING

Indirect system with luminous bowls controlled by photoelectric cells.

PREPARING

the S C H O O L

77

measurement by various peoples (yard in one country and meter in another), efforts were made to find a universally known source on which to base the unit of measurement of quantity of illumination. Since practically all peoples are familiar with the candle, this was selected. Naturally a standard candle had to be made the basis. Quantity of illumination on any given surface is measured in terms of foot-candles, one foot-candle being the amount of light received from a standard candle on a surface one foot from the light source in any direction. Precision instruments are used for making accurate measurements of illumination. Small portable instruments called light meters are available for general use. T h e y are not as scientifically accurate as are the precision instruments, but are valuable in determining the approximate amount of illumination on any given surface. W h e n recommendations regarding the quantity of illumination were first made, the suggested minimums were exceedingly low. As more information regarding the process of seeing became available and the results of research showed what a large amount of bodily energy is used by the individual in an effort to see under inadequate illumination, much more attention began to be paid to comfort and ease in seeing. Although no definite amount of illumination can be decided for individuals, a level of 30 footcandles is being recommended for ordinary school work, with increased amounts for tasks requiring intensive eye use. In order to compensate as much as possible for eye difficulties, higher levels of illumination are usually necessary for the partially seeing than for the normally seeing. A level of 50 foot-candles is therefore being recommended. T h e type of illumination used and its adequate control determine the direction, diffusion, and distribution of light and the avoidance of glare. NATURAL ILLUMINATION

Decisions regarding the orientation of classrooms for the partially seeing are based on the same principles that are used in the selection of all classrooms. Because of wide differences in climatic conditions it is impossible to lay down definite rules that will prove. satisfactory in all parts of the country. It is evident that classrooms should be so oriented as to give a maximum of light and a minimum

78

PREPARING

the

SCHOOL

of glare. Seasonal and diurnal changes, as well as meteorological conditions, such as cloudiness, fog, and incidence of rainfall or snow, must be taken into account. In some areas northern exposures are preferred because they make possible a comfortable, u n i f o r m light. However, rooms facing north are sometimes exceedingly cheerless. In tropical or subtropical areas southern exposures are often selected because prevailing breezes come from the south, a factor to be given careful consideration in ventilation; b u t south light is sometimes so difficult to control that the advantages of this exposure may be overbalanced by the disadvantages. Experience seems to indicate that east or west exposures prove satisfactory in many locations. Few school buildings are oriented exactly north, south, east, and west. Rooms facing northeast or northwest are often desirable, since they give the benefit of sunlight during some part of the day and the added advantage of a fairly u n i f o r m north light. In locations in which frequent, violent windstorms come from the northwest or northeast other exposures may be preferable. PLACEMENT OF WINDOWS

C a r e f u l consideration is b e i n g given to the advantages and disadvantages of unilateral lighting of classrooms. T h i s system of installation provides desirable natural light for pupils near the windows. However, the amount of illumination decreases rapidly as the distance from the windows increases; hence many pupils receive little benefit. Efforts are being made to improve these conditions by (a) special attention to room decoration and effective control of the light entering the windows; (b) bilateral lighting through the placement of windows on adjacent walls at the left and behind the pupils, or, where the type of b u i l d i n g permits, windows on opposite sides of the room. W h a t e v e r system is decided upon, windows on back and inner walls should be so installed as to obviate shadows or cross lights. Precautions must be taken to prevent direct sunlight from entering the room at undesirable angles. T h e m i n i m u m glass area recommended for classrooms housing partially seeing pupils is 20 percent of the floor area. T h e most desirable light comes from the top of the window, especially for

PREPARING

the S C H O O L

79

pupils seated on the side of the room farthest from the windows; hence glass area should reach as near to the ceiling as possible. N o room should be wider than twice the height of the glass area from the floor. There will be less shadow from casements if narrow bastions are used. Windows should be placed at least as near the rear of the room as the last row of seats. WINDOW SHADES

Natural illumination must be well controlled if glare is to be prevented. Satisfactory results may be obtained by the placement of two light buff or light gray translucent shades at each window. It has been found that these are effective in diffusing direct sunlight and in preventing glare. Shades in soft finish will not crack and are easily cleaned. T h e rollers of these shades are placed at or near the center of the window, one directly below the other, and the space between them is covered by a V-shaped bar. Shades should be wide enough to prevent any light from the sides. T o accomplish this it is usually necessary, unless the windows are deeply recessed, to fasten the rollers on the bastions. T h e plan of placing the roller of the upper shade below the roller of the lower shade is impractical. It necessitates fastening one roller considerably further out than the other in order that the shades may be operated. This causes the shades to be pulled away from the window, thus allowing streaks of light at the sides. In tropical latitudes and in places where there is likely to be glare reflected from snow or sand on a playground, it has been found expedient to place a shade with the roller at the bottom of the window so that light may be controlled at eye level. It must be remembered that no matter how carefully shades are selected and installed, attention must be given to their adjustment. ARTIFICIAL ILLUMINATION

Artificial illumination is necessary for all school buildings. T h e selection of the type of equipment depends upon many factors. In some instances, as in workshops, direct illumination, even with tungsten filament lamps is satisfactory, provided it is so controlled that the light does not shine into the eyes of the pupils. When fluorescent lamps are preferred, direct illumination may prove satis-

8o

P R E P A R I N G the S C H O O L

factory for workshops or classrooms, if the units are well shielded, are of low brightness, and the number of foot-candles is sufficiently high to reduce the effect of annoying reflections on desks, chalkboards, and educational material. In any event, before installing any system of illumination in school buildings it is advisable to consult an illuminating engineer in order that the type be selected that will best meet the needs. In classrooms for partially seeing children indirect illumination has been proved to give desirable results. For this the light is directed toward the ceiling from which it is reflected throughout the room. This result may be obtained by a "luminaire," or lighting fixture having an opaque bowl or a slightly luminous bowl. Experience seems to indicate that the latter is preferred for two reasons: there is less contrast between the bowl and the white ceiling and light-color walls; psychologically, people usually think they are getting more light when a luminous bowl is used. SELECTION OF LUMINOUS BOWL

There are certain essentials to be considered in the selection of a luminous bowl. The color of the light will be affected by any tinting of the bowl. The nearer white the artificial illumination is, the better it will blend with natural daylight. The lower the brightness of the bowl, the less will be the possibility of glare. The bowl must be large enough for the lamp that is to be used and must be so hung that there is no light source visible over the top. Possibly because of the demand for highly polished luminaires, manufacturers often supply units that are a constant source of glare, with resulting irritation. Not only the bowl but all other parts of the luminaire should be in dull finish, and the bowl should be free from any ornamentation around the top that is likely to be a source of reflected glare. NUMBER OF LUMINAIRES

The number of luminaires for any classroom is determined by the proportions of the room. In a classroom of normal size six to eight indirect luminaires may be installed in two rows lengthwise and operated by separate switches, since artificial illumination is needed on the side of the room farthest from the windows much more often than on the window side. For good distribution luminaires must be

A GRADE

CLASSROOM

EQUIPPED

FLUORESCENT

WITH

A

LIGHTING

Glare is reduced to a minimum.

SYSTEM

OF

CLASSROOM

EQUIPPED WITH FLUORESCENT P A R T I A L L Y SEEING P U P I L S

LIGHTING

FOR

P R E P A R I N G the S C H O O L

8l

hung at correct distances apart—to be determined by the ceiling height and the number of luminaires used. The size of lamp is determined by the number of luminaires and the illumination required on horizontal and vertical working planes. Unless classrooms are used at night, there is some natural illumination on the side nearest the windows. Lower wattage lamps are often placed in luminaires of this row. FLUORESCENT LIGHTING

Recent developments in artificial illumination indicate that fluorescent illumination will be the lighting of the future. Careful consideration should be given to all aspects of this new development, especially to the possibility of installing the system in new school buildings. Many experiments are being conducted to determine the best types of installation to meet different needs and to prevent glare. The stroboscopic effect, or flicker, noticeable in early installations, is now being overcome by the use of lamps so placed that when the wave of light is at lowest ebb in one lamp or tube, it will be highest in the adjacent lamp. Although fluorescent lamps give a much higher percentage of illumination than filament lamps of equal wattage, the installation of such a system of illumination in school buildings may not under present conditions be an economy measure. The cost of installation and of lamps is greater than in a system using filament or incandescent lamps, and to obtain equal quality more illumination is necessary. There are, however, advantages in the use of the fluorescent system, especially in tropical areas, for higher illumination may be obtained without as much heat as is produced by the filament or incandescent lamp. Chalkboard illumination is sometimes necessary, not only to give sufficient light on the writing surface but also to overcome glare. Lighting units may be inserted flush with the ceiling. In the majority of cases eyes adapt to gradual changes in illumination, and often teachers and pupils are not conscious that the light has fallen below the desired level until they experience fatigue or strain. In order to prevent this from happening illumination in many classrooms is controlled by a photoelectric cell. In such cases artificial light is turned on automatically whenever foot-candles fall below an indicated level.

82

PREPARING

the

SCHOOL

MAINTENANCE

Maintenance is of the utmost importance in all lighting; proper attention at regular intervals is essential if desired results are to be obtained from both natural and artificial illumination. Accumulation of dust on windows, transoms, skylights, walls, ceilings, and luminaires cuts down the levels of illumination. Deterioration of lamps is a factor in reducing artificial illumination. Lamps, both fluorescent and filament, blacken with use. T h e

FIGURE I LOSS OF LIGHT FROM M A I N T E N A N C E

NEGLECT

process is fairly uniform and is therefore not noticeable unless an old lamp is compared with a new one. Hence, tests of all lamps should be made at fairly frequent intervals, and lamps should be replaced whenever the tests indicate need for replacement. T h e illumination from fluorescent lamps decreases rapidly during the first hundred hours of operation; the loss may amount to as much as ten percent. Long before the end of the rated period, approximately 2,500 hours for fluorescent lamps and 750 hours for filament lamps, the output may have decreased so much that it is uneconomic to wait to replace lamps until they are burned out (Fig. 1).

PREPARING DECORATION

the

SCHOOL

83

OF ROOMS

T h e color and finish of walls, ceilings, woodwork and floors greatly affect illumination. Light colors have a higher reflectance value than darker tones. A dull finish or surface minimizes the possibility of glare. It is surprising to note how rapidly the values decrease with apparently only slight change in color. For instance, while some whites reflect as high as 90 percent, the highest reflection factor of ivory is around 77 percent and of ivory tan, 54 percent. T h e only safe way to be sure that classroom reflection factors are what they should be is to specify not only the color but the reflection factor of the paint or stain to be used. T a b l e III indicates the wide range of reflection factors. T h e choice of wall color is influenced by many factors—the orientation of the room, the purpose for which the room is to be used, and the system of artificial illumination. In rooms having a northern exposure, a light warm buff or cream may give desirable results. T h e general trend, however, especially in rooms in which fluorescent illumination is used, is toward light gray-greens, gray-blues, or other pastel colors. If the room is to be occupied by young children, a light peach may prove very desirable. In rooms having a northern exposure, a slight touch of rose may be added to the buff. Whatever color is selected, it should have a reflection value of from 50 to 60 percent. Woodwork may be of a light, natural color or stained to harmonize with wall coloring. White or oyster white ceilings are essential if an indirect or semi-indirect system of illumination is installed. It is sometimes advisable to have the color of the ceiling extend onto the upper walls for two feet or more, especially in case luminous bowls are used for artificial illumination, since this lessens the contrast between the bowl and the wall coloring. T h e exact amount of space so treated would depend upon the distance of the bowl from the ceiling. If reflection values are to be maintained, it is evident that all surfaces must be kept clean. A type of paint or stain may be used that can be easily washed, otherwise repainting must be done whenever walls and ceilings become soiled. Floors as well as seats, desks, and tables, should be in light color not only for the purpose of giving good reflection values, but also,

84

PREPARING

the

SCHOOL

in the case of desks and tables, for preventing too great a contrast between woodwork and the paper of books and writing and drawing materials. Naturally, all must be in dull finish to prevent glare. INFLUENCE OF COLOR

2

T h e influence of color has long been recognized, and much study has been devoted to determine the colors that in a given situation will produce the most desirable results from the standpoints of eye health and efficiency, educational and industrial procedures, and emotional and psychological reactions. Many officials responsible for making decisions regarding the decoration of school buildings are taking advantage of the experiences of industrial concerns that have increased production by using colors that tend to lessen eye and bodily fatigue, prevent accidents, and promote harmonious relationships. Studies made to determine the most desirable results have taken into consideration three aspects, or dimensions, of color—hue, indicated by the common name "color"; value, the lightness or darkness of any color; chroma, the strength or weakness of the color under consideration. In making a selection of colors for decoration of school buildings, although hue and chroma must be taken into account, value is the most important component of color to be considered, since all places in the school in which close eye work is to be performed should meet the requirements necessary for eye health and efficiency. So far as the decoration of classrooms intended for the use of partially seeing children is concerned, the criteria for determining the choice for regular grade classrooms are applicable, but in the selection of colors for maps, posters, and illustrations, hue and chroma must be given careful attention. For these, strong colors are necessary because many partially seeing children cannot distinguish differences in certain pastel hues. Thus, if in a map of the United States one state is colored a pastel pink and a contiguous state, a pastel lavendar, a partially seeing child will, in all probability, be unable to recognize boundary lines. Similar difficulties may be 2 For full information consult Munsell Book of Color, Standard edition, Munsell Color Company, Inc., 10 E. Franklin Street, Baltimore, Maryland.

P R E P A R I N G the S C H O O L

85

experienced with illustrations in pastel colors, with the result that the partially seeing may not be able to interpret their meaning correctly. TABLE REFLECTION

APPROXIMATE COLOR

White Ivory Light gray Gray Cream Buff Tan Brown Dark red Pink Dark pink Yellow Light green Green Light blue Blue Orchid

III

FACTORS

OF

PAINTS

PERCENTAGE OF REFLECTION IN DAYLIGHT 80-90

74-77 45-60

43 51-70

51-54 25-54 11 7 38-70

23 69

51-65 37-47 45-63 n 62

Chapter Eleven: E Q U I P M E N T of

CLASSROOMS

A

of the equipment in classrooms used by the partially seeing is of great importance, and care should be taken to select suitable closets, chalkboards, correct seats, desks, tables, and chairs. CONSIDERATION

PHYSICAL

EQUIPMENT

CLOSETS

Built-in closets, large enough to hold the extra-size material used in these classes, have proved practical. Closets that jut out into the room often prove hazardous for children who see none too well. Glass doors are a source of glare; if used at all, they should be covered on the outside with an opaque material. CHALKBOARDS

It is evident from the discussion of reflectance values that lightcolored chalkboards are preferable to dark ones. Glass and composition boards in a light gray-green are proving satisfactory not only because they reflect more light, but because they offer a good contrast for white chalk, thus adding to eye comfort and to speed and efficiency of seeing. Care must be taken in the selection of composition boards to see that no abrasives have been used in their manufacture that will cause glare. SEATS AND DESKS

In the great majority of classrooms, old-time seats and desks, fastened to the floor in a fixed position, are giving way to modern, movable classroom furniture. T h e position of the child when seated at a desk affects his whole being. Incorrect positions, such as bending over a flat desk, may result in round shoulders and narrow chests and may reduce the

E Q U I P M E N T of C L A S S R O O M S

87

amount of light on the desk. An uncomfortable position causes restlessness and inattention and thus interferes with school progress. In selecting seats and desks, therefore, certain underlying principles in structure should be considered in order to obtain desirable results. T h e seat should be adjustable; it should fit the child so that he may sit comfortably with both feet on the floor. A seat that is too high often obliges the child to try to obtain his balance by touching his toes to the floor, a position which, according to orthopedists, is likely later to cause serious foot trouble. A seat that is too deep from front to back causes pressure on the nerves under the knees. In an effort to relieve the resulting irritation and strain, the child sits forward on the edge of the seat and thus loses his body balance. For young children a depth of thirteen inches is usually comfortable; for older pupils a depth of from thirteen to sixteen inches. Naturally, the variations in size of children of approximately the same age is always taken into account. An open space at the back of the seat should provide ample room for the thighs. A back rest in good position for the individual provides adequate support. Desks should be adjustable with regard to height, angle, and position. Desk tops should be so constructed that they may be raised to any desired angle from the horizontal to the vertical plane in order that books and other materials may be correctly placed so that the child may sit in a comfortable position when viewing them. It should be possible to adjust desk tops horizontally in order that the distance of the material from the eyes may be adapted to individual needs. They should be equipped with adjustable rods in order that books and papers may be held in place on a slanting surface. Large clips (1 % inches) will be found helpful for this purpose. Adjustments in the height of chair and desk should be made as often as the physical growth and development of the child make a change necessary. All too often, regardless of the child's possible discomfort, adjustments are made, if at all, only at the beginning of a term. Pupils should be encouraged to turn their seats and desks at an angle of approximately 30 degrees from the windows in order to prevent glare from the skyline and to insure good illumination on the work. Desks and tables should be so arranged that no child

88

E Q U I P M E N T of C L A S S R O O M S

faces the light or sits in his own shadow. Care should be taken that furniture for the use of left-handed children is so placed that the light will fall over their right shoulder. Special attention must be given to the seating arrangements of albinos and other children with marked photophobia in order to insure eye comfort. The teacher's desk may be placed either in front, near the side wall or at the back of the room. A teacher seldom sits at her desk long at a time, yet all too often it occupies the best-lighted section of the room, in front nearest the windows. If the teacher gives any instruction from a desk in this position, the children must face the light in order to look toward her. TABLES AND CHAIRS

Two fairly large tables are usually required for handwork. If the children in the group vary considerably in age it will be advisable to have one table of kindergarten height for the young children and one of standard height for the older group. Chairs should follow the principles suggested for seats. If work to be done at the tables does not require close use of the eyes, the tables may be placed at the back of the room. Desks, seats, tables, and chairs should be of a fairly light neutral color, in dull finish. A sand table is very desirable for project work. If it is painted a sea-blue-green, geographical divisions such as islands, peninsulas, gulfs, bays, and rivers may be graphically shown. Single easels for brushwork are a desirable part of the classroom equipment. They should be so situated in relation to windows as to provide the best illumination on the work. In a school in which there is no workshop, a work table and tools are very desirable. E Q U I P M E N T FOR H O T LUNCHES

All children should have hot lunches. This is especially important for partially seeing children, for whom good nutrition is essential. In a building having no cafeteria or other luncheon service it is necessary to provide simple equipment for the preparation of food. EDUCATIONAL MEDIA AND EQUIPMENT

Educational media include typewriters, typewriter chairs, tables, and copystands; books, maps, globes, and charts; paper; pencils;

DESK

ADJUSTED

TO

B E S T POSITION FOR A PEROPIC

THE HY-

CHILD

ADJUSTABLE MOVA B L E S E A T AND D E S K E X C E L L E N T FOR A L L CHILDREN

PROGRESSIVE T A B L E I 2 8 , WITH READING T O P PECIALLY

SUITED

H I G H SCHOOL

DESK ABLE

WITH

ADJUST-

READING

RACK

ESFOR

PUPILS

H e a v t j

l

O r d i o a f u

W a d

iulutin

e

a

d

p e n

typ.writins

«mi™,

'ham* long-* length of dothralbt foe learning to tie the taM ends of the rope should b ttat the end» will not ft»; Terms Used In 1. The standing rope is die loot 2. The end (or part) Id is end, which by woven with the standing part or the end of another rope formi the hitch or knot. 3. The bight is formed b y bending the rope, keeping the aides parallel. 4. The loop it made by crossing the •ides of the bight (B>. For example, the square knot consists of two bights; the sheet bend, of a Mghf and 3 loop; the clove hitch, "I two loop«,

•hoe-strlngs and ctoflie»square knot is used more commonly than any other, for it does not slip and stays until untied If the KfW» are of equal thickness. The

Bowline

A botvUtw is w e d chiefly lor hoist®g and lowering; it may be used for a Miter or with the sheet liend in making • guard-line o r fence. It is a knot . 51

MATERIALS FOR PARTIALLY SEEING PUPILS C O M P A R E D WITH T H O S E FOR THE N O R M A L L Y SEEING

GEOGRAPHY ARE

LESSONS LARGE

HAVE

A

ENOUGH

NEW TO

BE

MEANING EASILY

WHEN READ

MAPS

EQUIPMENT

of C L A S S R O O M S

89

chalk; pens and ink; materials for motivated handwork; and other equipment. TYPEWRITERS

In every classroom for the partially seeing there should be at least one typewriter equipped with type of a size especially suited to the use of pupils whose vision is impaired. Since typewriting is such an essential part of the curriculum of these pupils, there should preferably be two or more such typewriters. TYPEWRITER TABLES, CHAIRS, COPYSTAND

Typewriter tables and chairs are necessary items of the equipment. Although little copying is desirable for these children, a stand permitting correct placement of material should be available for any occasion for which it is required. BOOKS

Books printed in the size and kind of type best suited to the use of partially seeing pupils are essential. T h e y should meet accepted specifications regarding spacing, contrast, size and kind of type, illustrations, and paper. MAPS, GLOBES, AND CHARTS

Many teachers of classes for the partially seeing, realizing how difficult it is for these children to distinguish details, prefer to make their own maps in heavy outlines in clay, plasticine, or other material. There are, however, excellent wall maps designed especially for the use of the partially seeing. A supply of these is very helpful in supplementing or in preparing assignments in geography and history taught in the regular grades. For young children the reading, phonetic, and arithmetic charts supplied for regular primary grades are as a rule sufficiently clear for use in the special classroom. PAPER

Slightly rough, unglazed, cream manila 9 x 1 2 paper has been found practicable. Unlined paper is recommended in modern education. In Kerr's opinion "lines mean fine adjustment of the eyes at every stroke that touches the line." 1 If ruled paper is preferred, 1 James Kerr, School Ltd., 1925, p. 104.

Vision and the Myopic

Scholar, London, Allen & Unwin,

go

EQUIPMENT

of

CLASSROOMS

green lines have usually been found more satisfactory than black. Lines, if used, should be from about % inch to 1 inch apart and not darker than is necessary to serve as a guide; for beginners in writing it is sometimes helpful to have lines indicating the height of "lower case" (small) letters. PENCILS

Pencils with fairly soft, thick, heavy lead, making a broad, clear line, are best adapted for the use of partially seeing pupils. Children are anxious to have material as nearly as possible like that used by their companions; pencils with heavy lead but no larger in circumference than the ordinary pencil will encourage partially seeing children to use them. CHALK

Large-size, comparatively soft chalk, approximately 1 inch in diameter makes a broad, heavy, even line. Similar chalk V2 inch in diameter may be preferred. T h e chalk generally used in schools breaks easily; in order to avoid this, little pressure is exerted, and the resulting lines on the chalkboards are usually too faint and thin to be visible to most of the pupils. T h e color of chalk will depend on the type of chalkboard used. For slate, gray-green, or gray-blue boards, white chalk is desirable. Recent researches indicate that this is preferable to yellow, since it offers greater contrast and leaves the boards much easier to clean. Leading chalk manufacturers now guarantee that no lead is used in coloring chalk. T o prevent the scattering of chalk dust throughout the room, children should be taught to clean boards correctly; the eraser should be placed as nearly as possible at the top of the board and drawn downward, carrying the chalk dust into the special tray at the bottom of the board. Aerated rubber erasers are recommended. PENS AND INK

Since much of the work of the partially seeing is done on the typewriter, there is less need for the use of pen and ink in these classes than in the regular grades. Pens making a broad, heavy line are desirable. India ink is preferable to the usual school ink. T h e two may be mixed if they do not neutralize each other. India ink

E Q U I P M E N T of C L A S S R O O M S

91

in black, white, and colors is useful in outlining maps and illustrations. MATERIAL FOR MOTIVATED HANDWORK

Handwork that can be correlated with the regular work of the class and can be carried on without the close use of the eyes is desirable for partially seeing pupils. Clay, plasticine, materials for a sand table, finger painting, and other forms of handwork should be provided. Such work is of great value in creative undertakings; it serves as a needed change from work requiring close use of the eyes, and stimulates interesting home occupations. OTHER EQUIPMENT

These classes frequently have the benefit of lessons in music appreciation and of radio programs. If such opportunities are not available, a victrola or some similar mechanical device is desirable. The Talking Book will prove to be very beneficial, especially for junior high school and senior high school sight-saving classes. A Dictaphone or Ediphone, if provided for these groups, would save much eye use and the time of pupils and teachers.

Part Three: EDUCATIONAL

RESPONSIBILITIES

Chapter Twelve: T E A C H I N G P A R T I A L L Y SEEING C H I L D R E N

W

for partially seeing children was established in the United States, there was little precedent on which to base procedures. Ophthalmologists and educators responsible for the British classes, concerned as they were with the education of highly myopic children, arranged their educational programs according to the needs of this particular group. Children with other types of visual difficulties were included in the American classes; hence different procedures became necessary. At first teachers were so fearful that they might increase eye difficulties that they were prone to emphasize the limitations imposed by eye conditions, and efforts were made to work out special methods of teaching. Such ideas prevailed for several years, although some teachers soon learned that the real need was special educational media rather than special methods of teaching. When the potentialities of partially seeing children began to be stressed more than their limitations, educational procedures for normally seeing pupils were found to be applicable to this group, provided suitable educational media were made available and sufficient attention was given to the care of the eyes. Like teachers of the normally seeing, special teachers began to realize that they were teaching children and that subjects of the curriculum were the tools with which teachers and children must work to build an education. As was done for the normally seeing, all the abilities of partially seeing pupils began to be taken into consideration in determining the best use of subjects and the most approved methods of acquainting children with their educational tools. For the special methods at first employed in this work, the most approved ways of presenting the subjects were therefore substituted. Some adjustments were necessary, as they are for all HEN THE FIRST CLASS

96

TEACHING

the P A R T I A L L Y

SEEING

children. Since eye defects limit the length of time for close eye work, periods of reading, writing, and arithmetic were curtailed and programs were arranged to include as much oral work as possible. CURRICULUM

Placing partially seeing children in a special class so far as close eye work is concerned does not relieve teachers in regular grades from all responsibility for the education of these children. T h e first step in a co-operative program is to decide upon the curriculum to be followed by partially seeing pupils. Since they are mentally normal, there is every reason why they should follow the curriculum planned for the other children in the school. T h i s is made possible by the fact that in the special class they are provided with educational media suited to their needs and have the services of a specially prepared teacher and often individual instruction. For such subjects as sewing and detailed drawing substitutions may readily be made of other creative activities: modeling in clay or plasticine; freehand painting on a large scale or even large freehand drawing; the painting of murals. If partially seeing children do not follow the curriculum of the school, they will be unable to participate advantageously with their normally seeing companions in regular grade subjects. T h e eye conditions of some of these children improve so that special educational opportunities are no longer necessary; they may then return to regular grades. If they have not followed the school curriculum, they are at a great disadvantage. Many partially seeing pupils desire to enter college; if they have not followed the high school curriculum, they find themselves unprepared in certain required courses. SHARING

RESPONSIBILITIES

T h e second step is to decide which subjects shall be taught in the special class and which in the regular grade. T h a t there may be no misunderstanding, it is necessary to prepare a class program showing where every member of the group is expected to be at each period of the day and the subject for each period. There should be a separate program for each child, so that he may know where he is to be and for what subject he is to prepare, in order that he

TEACHING

the P A R T I A L L Y

SEEING

97

may assume the responsibility of carrying out his particular program. Naturally, allowance must always be made for flexibility in the program. Except in cases in which departmental work would interfere, the carrying over of a lesson into the following period may be advantageous; sometimes stopping abruptly at the end of a period results in much wasted effort and makes it necessary to repeat explanations at the beginning of another period. According to the principles underlying the work for the partially seeing, subjects requiring close use of the eyes are to be taught in the special class; the special teacher in an elementary school will have the responsibility of teaching reading, writing, arithmetic, and spelling. Because in all probability there will be no typewriters in the regular grade, she will add typewriting to her list of subjects. She will also be responsible for determining what hand or art work may be undertaken by her pupils, according to recommendations regarding the use of the eyes made by the ophthalmologist. If for lessons assigned by the regular grade teacher educational material is not available in suitable type, it will be the duty of the special teacher to see that it is made available by the administrative department or to prepare the material herself or see that it is prepared by someone assigned to this work. T h e regular grade teacher will be responsible for teaching subjects not requiring close use of the eyes; for making assignments; for keeping partially seeing children up to the standard that is maintained by others in the class; for rating tests, even if these are put into large type by the special teacher and given in the special room. Duplication of teaching is to be avoided. If a partially seeing pupil does not understand an explanation given in the regular grade, he has the privilege accorded to all members of the group of asking for further elucidation. When in a geography or history lesson maps are used, he should be supplied with his own map in large size or should be given the opportunity of going as close as necessary to the globe or wall or chalkboard map, provided this is not too detailed for him to see. If during the course of oral lessons it is necessary to refer to books in small type, the wise teacher will have a member of the class read that section aloud so that the partially seeing child may have the benefit of the reference; or she may

g8

TEACHING

the P A R T I A L L Y

SEEING

read the passage herself, thus having the group concentrate by means of the sense of hearing. If teaching is duplicated, the partially seeing child, realizing that the special teacher will repeat the lesson, will be likely to give scant attention in the regular grade and may become a very troublesome member of the group. If the special teacher repeats lessons taught in the regular grades, she is making the partially seeing pupil dependent upon her and is curtailing the time that should be devoted to the actual teaching of subjects requiring close eye use. In such cases she may develop into a coach or an assistant rather than a true teacher, who constantly strives to add to the child's experiences in order that he may better develop his abilities. PROGRAM

PLANNING

When a decision has been made regarding all these responsibilities, the preparation of group and individual programs must be considered; the resourceful teacher will draw upon experiences common to all children in the group. School children, no matter how young, are familiar with traffic signals; to them green signifies go, and red, stop. In making the program, all periods that are to be spent in the special room may therefore be marked in red; the others, in green. Differentiation may also be made in the red group to signify the time when the pupil is to work by himself (silent reading; preparation of lessons; handwork) and the period in which actual teaching is to be done by the special teacher. T h e program for the group and the one for the individual should be prepared in large, easy-to-see letters and figures; the group program should be placed in such a position in the room—probably near the door—that teacher and children may be able to tell at a glance just where a pupil is expected to be at a particular period and what he is doing. Because programs must be flexible, it is well to prepare them in such a manner that changes may readily be made. For the group program a long sheet of heavy paper may be folded crosswise so as to make as many pockets as there are periods in the day. It should be wide enough to include space for each grade and be stitched lengthwise into as many divisions as there are grades represented in the group. T h e time each period begins should be clearly marked

TEACHING

the P A R T I A L L Y

SEEING

99

at the left of the sheet, and the grades represented should be marked at the top. A sheet for each day of the week may be fastened to a piece of cardboard wide enough to accommodate the full week's program, or a separate sheet may be arranged for each day. T h e former plan may not seem as convenient as presenting the program for each day separately, but the children will need to know what subjects they are to prepare for the following day. Pieces of cardboard or heavy paper may be cut to fit into the slots or pockets, and on each of these may be written in clear lettering the name of the activity that is to be undertaken at a particular period, the place being indicated by the color of the lettering. Some pupils and teachers prefer to have red or green cardboard lettered in heavy black ink. The cardboard pieces should be so cut that they will fit easily into the slots or pockets, which should be deep enough so that the pieces will not become displaced or lost. Junior high school and, especially, senior high school programs are usually more complicated than those for elementary grades; yet they are often easier to arrange, since departmental work is scheduled for definite periods of time. Tagboard may be equipped with small hooks on which red and green price tags may be hung; changes in programs can be easily made. T h e next step for the special teacher is to check the program in order to see that: (1) periods of close eye work are not scheduled so that one immediately follows another; (2) every pupil is allowed his full share of the teacher's time and attention; (3) time is provided for all necessary subjects; and (4) the teacher is not scheduled to teach more than one group or individual during a period. Periods of rest for the eyes do not indicate that the child is idle at these times; he may be doing modeling, preparing his part in a sandtable project, listening to music, or participating in arithmetic or other subject games. When the curriculum has been decided upon and the programs prepared, teachers still share responsibilities. It is essential that the special teacher arrange for the children in her group to enter the regular grade classroom on time, otherwise they may miss the beginning of the lesson and interrupt the work of the teacher and the children in the regular grade. The grade teacher is responsible for making assignments; the special teacher, for the preparation of the

ioo

TEACHING

the P A R T I A L L Y

SEEING

lessons assigned. Both teachers must co-operate in working out a plan by which the special teacher is informed about the assignment. If the grade teacher writes out the assignment for her own reference, she may make a carbon copy for the special teacher. It is the responsibility of the regular grade teacher to notify the special teacher of any change in program which definitely affects the work of both groups. POLICIES REGARDING INTERRELATIONSHIP

OF

TEACHERS

When difficulties occur, they usually arise from lack of understanding of this sharing of responsibilities. In one city in which it was feared that the welfare of the children was being jeopardized by such misunderstandings, the superintendent of schools, the principal, the teachers of the regular grade school in which the class for the partially seeing was located, the special teacher, and the school nurse held conferences to discuss ways and means of clarifying the situation. T h e suggestions made at these conferences were tried for a semester; at the end of this time a statement of policies was compiled based on the experiences. 1 This statement is based on the premise that regular grade teachers will familiarize themselves with the principles underlying the education of the partially seeing in order that they may discharge their obligation to these children. 1. The principal is the administrative head of all classes in the school, hence problems relating to the organization and administration of classes for the partially seeing should be referred to him. 2. Experience indicates that segregating a partially seeing child tends to emphasize his difficulties by depriving him of contact with normally seeing children of his own mental age and ability. For this reason the special class is conducted on the co-operative plan, i.e., the handicapped pupils carry on all work requiring close use of the eyes (work involving reading and writing) in the special classroom, and all other activities (discussion, singing, dramatization, listening, manipulation of materials) with normally seeing pupils in the regular grade classroom. Children learn a great deal from one another. Participation in the group activities of a normal class is a very valuable part of any child's education. 3. T o obtain best results, there must be as close co-ordination as V

1 This statement is an abstract of an article by Ben A. Sylla, "Sight-Saving, a Cooperative Movement," presented at the Round Table of the Illinois Society for the Prevention of Blindness, Nov. 25, 1940.

T E A C H I N G the P A R T I A L L Y SEEING

101

possible between the class for the partially seeing and the regular grades. This arrangement requires the most careful attention to program making on the part of both the special teacher and the regular grade teacher in order to avoid duplication and confusion. 4. T h e special teacher and the regular grade teacher share the responsibility of educating partially seeing children. Each must work closely with the other in order to understand the problems and to cooperate in solving them. Through this co-operation the teacher of the special class is better able to keep her pupils up to standard, and the teacher of the regular grade not only realizes the difficulties under which partially seeing children work, but learns preventive methods which may be applied to normally seeing children. 5. Minimum standards of achievement for partially seeing pupils, so far as possible, should be the same as those of the regular grade for the following reasons: a. Partially seeing pupils possess normal mentality, albeit they sometimes appear subnormal because of their handicapped vision. b. It is possible that some of them may be assigned to the regular classroom when the visual defects are remedied or outgrown. c. Some of them may wish to attend high school. 6. T h e co-operative plan makes possible the maintenance of minimum standards, given wholehearted, sympathetic, and intelligent cooperation on the part of the regular teachers and the special teacher. 7. In general, therefore, a pupil in the class for the partially seeing will: a. Do all his reading in the special room. b. Do most of his writing on paper in the special room, except that he may write on the blackboard in the regular room. c. Receive such special individual instruction as he requires in the special room. d. Receive his assignments from the regular teacher. e. Listen to and participate in oral presentations and discussions in the regular classroom. /. Participate in group activities in the regular classroom when reading and writing on his part are not involved. Special programs, play, and socializing activities especially serve to give the handicapped child what he most seriously needs. g. Report to the regular grade room promptly on schedule and in a quiet and orderly manner so as to disturb the regular pupils as little as possible. h. Assume full responsibility for himself. He must not be indulged on account of his visual deficiency. 8. T h e regular grade teacher's attitude toward the handicapped child should be one not of mere tolerance but rather of keen interest in guiding his educational and social development. It is her privilege

102

TEACHING

the P A R T I A L L Y

SEEING

and obligation to make him feel that, though handicapped in vision, he is not inferior to normal children. She is in a position to do much to help him build up confidence in himself. T o that end she will wish to: a. Explain to the regular grade children the purpose of this class or invite the special teacher to explain to them. It may be advisable to have the normally seeing children visit the classroom to see the books, the equipment, the special furniture, and the special lighting facilities. b. Strive to develop among the regular grade children a wholesome attitude toward the handicapped child. T h e regular grade children should be encouraged to take an interest in his welfare. c. Encourage the handicapped child to participate in all group activities with the normal children in the classroom and at play. d. Insist that the handicapped child grow in responsibility for himself. e. Appreciate the fact that the teacher of the special class carries an extremely heavy load, despite the small number of children in the class, in that: (1) She has one or more pupils in almost every grade from first to eighth. (2) Every pupil requires much individual attention. (3) She has to keep in close touch with the daily program of all grades represented in her group. (4) She is obliged to copy on the typewriter much textual and exercise material which is not available in type large enough for the handicapped children. (5) She supervises the children during the lunch hour. (6) She is obliged to keep detailed records on each child. (7) She is obliged to keep in close touch with each child's home. /. Understand that a child whose vision is impaired would be a serious problem in a regular classroom if the facilities of a special class were not available to him.

Chapter Thirteen: T H E T E A C H I N G of T O O L SUBJECTS

R

writing, and arithmetic are tool subjects, forming the foundation upon which modern education is built. Because they all require close use of the eyes, they are taught in the special class for the partially seeing. EADING,

READING

Children learn to read in order that they may read to learn. For the great majority reading means much more than this; it is the key that opens the door not only to a wealth of information but to a magic place of pleasure. Unfortunately the eye difficulties of partially seeing children restrict their reading chiefly to the gaining of information. Because of such limitations it becomes the responsibility of their teacher to be sure that the most worthwhile material is made available and that the actual reading done by them is supplemented by a wealth of material in other forms. This is important so that the child not only may be able to get the full value of what he himself reads but also may have access to the world of pleasure enjoyed by his normally seeing companions. If the children are early taught to use the sense of hearing for lessening eye work, they will find by means of modern discoveries and inventions, such as radio, phonograph, and Talking Book, much that they might otherwise miss. In order that the partially seeing child may get the most out of what he reads, instruction in reading is one of the chief concerns of the special teacher. In common with all teachers, she recognizes two very definite duties: (1) providing the best possible instruction for beginners in reading, and (2) providing adequate remedial measures for those who for one reason or another are such poor readers that educational progress is retarded.

104

TOOL

SUBJECTS

READING DIFFICULTIES

Because reading requires close use of the eyes, and since partially seeing children have serious eye troubles, the natural impulse is to attribute any reading difficulties they may develop to the eye conditions. But experts such as Dr. Thomas H. Eames 1 sound a very important word of warning: The part played by physical handicaps has been recognized, but no single factor . . . is the primary cause of difficulties in learning to read. Every case of reading difficulty has a multiple cause, with factors involving instruction, motivations, emotion, temperament, mental maturity, physical fitness for reception of the material presented, possession of basic skills sufficient to constitute reading readiness, and a good many other components. T h e task, therefore, of all who are teaching beginners to read is to find the causes of any difficulties that occur, to eliminate these causes if it is possible to do so, and then to adapt the most approved methods to the needs of the individual. Because of the great amount of energy and time that pupils and teachers must put into remedial reading, emphasis is being laid increasingly on preventive measures. Many informal tests have been developed that can be given in kindergartens, some even in nursery schools, in order that possible difficulties may be foreseen and perhaps avoided. Stanger and Donohue 2 have presented a number of such tests; to perform them incorrectly may indicate the possibility of later regressions and reversals in reading. Being cognizant of such possibilities before instruction in reading is begun, the teacher will use methods that should help in preventing them. Good instruction in beginning reading will obviate the possibility of such help becoming a crutch on which the children may learn to depend. Teachers of partially seeing pupils, because of their familiarity with eye conditions, are able to foresee possible difficulties that may arise from them. T h e y know that the sins of the myopic child are likely to be of commission rather than omission—too avid a desire to read to the 1 Thomas H. Eames, " T h e Reading Problem," The Columbia Optometrist, X V I (No. 62, May, 1942), 2-3. 2 Margaret A . Stanger and Ellen K. Donohue, Prediction and Prevention of Reading Difficulties, New York, Oxford University Press, 1937.

TOOL SUBJECTS

105

exclusion of other activities. The teacher's responsibility to these children includes careful adaptation of methods of teaching; attention to good eye focus and emphasis on oral work; insurance of correct position; wise choice of material; encouraging the children to join in suitable games and other activities. The high hyperope, on the other hand, will require infinite patience; he will tire quickly when using his eyes at close range. Methods must be used that call for short periods of concentration, and material must be provided in a type that can be read at a distance greater than normal. Having the child tell a story portrayed by large, clear illustrations without much detail will help develop vocabulary and interest. Because of possible blurring of objects, the astigmatic child will probably find it difficult to differentiate between letters that look somewhat alike: m and n, and o and c may present no distinctive characteristics to him; and b and d, and q and g may prove obstacles to success. The low vision child will probably have difficulty in perceiving the content of material, because he may be able to see only part of a word or letter or part of a picture and therefore may be deprived of the significance of the whole. The child with nystagmus may become a reading failure because an eye tremor causes him to lose his place, and regressions are almost sure to follow unless care is taken to prevent them. Children with crossed eyes or other muscle difficulty may display any one of a number of reactions, according to the muscles affected. But in addition to all these aspects that the teacher of the partially seeing must consider, there are innumerable others; some of them may result indirectly from eye difficulties, but many are caused by entirely different factors. The greatest help in solving the problems of the beginning reader is an understanding of the individual and the use of methods best fitted to his need. A teacher of partially seeing children is somewhat forearmed by having the benefit of a diagnosis of the eye conditions of the children under her care and of recommendations made by the examining ophthalmologist regarding the use of the eyes. She may also be among the fortunate who are notified of the results of mental tests. Otherwise she must learn from the child and from the influences of his environment before she can hope to teach him. As a guide to

i o6

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teachers in seeking the causes of reading difficulties, Gates 8 suggests consideration of the following handicaps: low intelligence; constitutional and educational immaturity; special mental defects; physical deficiencies; bodily injuries or defects; defects of sensory apparatus; hand, eye, and brain dominance; temperament and personality peculiarities; unfortunate management; misleading motivation and lack of motivation; inadequate guidance and teaching. Teachers occasionally come in contact with children who are reading failures because of word blindness. This difficulty is due, not to a defect in eye structure, but to some type of blocking in the brain which results in inability to interpret written or printed material, although the subject is familiar with the spoken words. If the cause of the blocking is a lesion which has seriously damaged or completely destroyed the brain cells which are necessary for these functions, it is generally conceded that nothing can be done. If, however, such destruction has not occurred, results can be accomplished, in proportion to the extent of the difficulty, through remedial reading techniques. The condition is comparable to word deafness, a condition in which the child has normal hearing, but no power to interpret the sounds heard. It is analogous to hearing people speak an unfamiliar foreign language; the sounds are distinctly heard, but they have no meaning. In cases of incomplete word blindness or deafness each word must be learned as in studying a foreign language, and a connection must be made between the spoken word and its printed symbol. It is a slow process, requiring patience and perseverance on the part of both pupil and teacher. Mirror reading and mirror writing are also encountered in rare instances. These are manifested by holding material upside down. As in word blindness, the difficulty is due, not to eye structure, but to the brain's failure to function. Just as in a photographic negative the object is upside down and must be developed for correct position, so under normal conditions the image of an object is upside down on the retina (the photographic part of the eye) and s Arthur I. Gates, "The Teaching of Reading; a Second Report," in National Society for the Study of Education, Thirty-sixth Yearbook, Part I, Bloomington, 111., Public School Publishing Co., 1937.

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must be developed by the brain into its correct position. W h e n this function of the brain is lacking, there is no known remedy. If, however, it is present, but is being interfered with, it is usually possible to discover the cause of interference and to eliminate it. In such cases, through the use of approved remedial reading techniques, the difficulty can be overcome; but this, too, is a long and painstaking process. SELECTION

OF READING

MATERIAL

When the teacher has decided upon the course she is to pursue, selection of material is the next step. For beginning readers there is no lack of material. Many of the charts and books prepared for regular grade children can be used to advantage for the partially seeing. Preprimers and primers with excellent print and illustrations abound; the teacher has but to select those suited to the needs of the individual. Many may be obtained at such small cost that the budget will permit a sufficient variety to hold the child's interest and to develop his vocabulary and experience. However, many children enter a class for the partially seeing after they have completed the third or fourth grade, and they may need remedial reading measures. In such cases the teacher may have great difficulty in finding enough interesting material printed in a suitable size and kind of type. Except in cases in which remedial reading is necessary, special reading lessons are not given after the foundation has been laid; but material in a type suited to their eye conditions is more necessary than ever to enable pupils to prepare assignments. Administrators of departments of special education, as well as teachers of the partially seeing, must find ways and means of making it available. Originally the plan for the British classes did not include reading or writing, but it was soon found that since the ages of the children varied it was impossible to keep all of them interested in oral work and other planned activities not requiring close use of the eyes. Reading from material printed in very large letters on wall and seat chalkboards was gradually introduced, together with the use of charts on which material in equally large letters was printed with a set of rubber stamps. T h e early American classes followed this

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example in making charts, and for some time a set of rubber-stamp letters was considered a necessary part of the equipment and much laborious printing was done. It was a beginning, but it had several disadvantages: it was time-consuming; often the inking was uneven and the printing was therefore difficult to read; only a very small amount of subject matter could be included on one sheet of paper; the letters had to be so large that even a very short story thus printed required many sheets. A book composed of these charts was heavy, bulky, and difficult to keep in good condition. TYPOGRAPHY AND PAPER

In Cleveland the idea was conceived of putting material into the form of a book printed in large type. Robert B. Irwin, then supervisor of the special classes, was interested in developing this idea, and he put a very great deal of time, thought, skill, and effort into working it out. A small committee was formed to give consideration to the various aspects of the problem. T h e first step was to decide the size and kind of type that should be used. T h e two-inch letters used on the paper charts were, naturally, too large for book form. Moreover, the material on charts and chalkboards was intended to be read at a distance; books must be read at fairly close range. In attempting to determine the best size of type, members of the committee found it necessary to acquaint themselves with the measurements of type and with the scale—72 points to the inch. As a result of much study of the subject it was finally decided to print some preliminary books in 36 point type. Selection of a type face (style of type) was even more difficult. Certain requirements, however, were obvious: the type must be clear and simple and must have no serifs at all or inconspicuous ones. A careful review of many type faces resulted in the selection of Caslon Boldface. T h e next point to be considered was the paper on which these books should be printed. As a result of considerable research and experimentation, it was decided to use a light buff or cream color paper in dull finish, since this gives a good contrast with black ink and prevents reflected glare. T h e question of texts for the experiment was next in order. T h e

SAMPLES OF CASLON BOLDFACE T Y P E 8 Point Type Few parents realize that during the progress of these diseases the eyes of the patient may develop serious ulcers or other dangerous conditions, which, unless skilfully treated, may leave a white film over the "sight" of the eye 10 Point Type

Few parents realize that during the progress of these diseases the eyes of the patient may develop serious ulcers or other dangerous conditions, which, unless skilfully treated. 12 Point Type

Few parents realize that during the progress of these diseases the eyes of the patient may develop serious ulcers or other dangerous conditions, which, unless 14 Point Type

Few parents realize that during the progress of these diseases the eyes of the patient 18 Point Type

Few parents realize that during the progress of these diseases the 24 Point Type

Few parents realize that during the progress of these 30 Point Type

Few parents realize that during the prog36 Point Type

Few parents realize that during

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Aldine and Elson readers were being widely used at that time, and it was decided to print some of these in the selected type. T h e books were hailed with delight by children and teachers. However, although quite as much could be put on a page of these books as on the large sheets of paper formerly used, the lines were comparatively short and the printing was so heavy that only one side of the paper could be used. This, together with the fact that all the type had to be set by hand, made the books very expensive. Later, Dr. Irwin, in co-operation with the committee, decided to try out a smaller type and a 24 point Caslon bold was selected, inked so that both sides of the paper could be used. By this time classes had been established in several cities. A number of samples were printed in both sizes of type and distributed to the supervisors of these classes for testing purposes. T h e results indicated that 24 point type seemed desirable, and books were therefore printed in type of that size. When typewriting became a definite part of the school curriculum for partially seeing children, the only typewriters available in large type were bulletin machines having capital letters. T h e question of manufacturing typewriters in upper case (capital) and lower case (small letters) in a 24 point type was discussed with the leading typewriter companies. They were all interested and willing to experiment; the verdict was that such a typewriter could not be manufactured with a single keyboard. Machines with two keyboards would be very difficult for children to manipulate; even if some of the older pupils could learn to do so, they would then be unable to use any other typewriter. A compromise was reached by which typewriters in 18 point upper case and lower case letters were manufactured. Many partially seeing children discovered that so far as content was concerned material in 18 point type was more easily mastered than that in 24 point type, because more could be included in the eye span and in one line on a page. A few books in this size type were printed as an experiment. A recent cursory survey based on the experience of teachers and pupils indicates that 24 point type is preferred for elementary partially seeing children, and 18 point for junior and senior high school pupils. Research is being conducted not only to determine

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the most desirable type size and type face but also to discover the best mechanical methods of magnifying the printed page. Recent researches 4 regarding the best working conditions for the eyes indicate that black on white is desirable; 6 that if there is any tinting in the paper it should not be at the blue-green end of the spectrum. Since a very light cream loses little in contrast and in some instances appears, perhaps psychologically, to aid the ease and comfort of seeing, it was decided to continue to use light buff or cream paper. Realizing that it is necessary to take into consideration the relation of the growth of children's eyes to educational material, the British Association for Advancement of Science made a study of textbooks and published a report on the influence of schoolbooks upon eyesight. In this report the specifications in Table V (see p. 112) were set up (for convenience in interpretation, millimeters have been translated into corresponding type sizes and into inches). From this table it will be seen that the British report recommended 24 to 30 point type for children under seven years of age and 18 point type for those from seven to eight. This led to the preparation of preprimers, primers, and first-grade material in 24 point type. T h e report likewise recommended that books for normally seeing children eight to nine years of age be printed in 14 point type and that the size of type should gradually be decreased; for children twelve years of age or more a 10 point type was advised. Hence the only demand for schoolbooks in the 18 to 24 point type for children above the third grade is for the partially seeing. This is such a small group that publishers feel that the demand is insufficient to warrant printing textbooks for upper-grade pupils in larger type. The problem is further complicated by the wide variety of texts used in different communities. However, one company is now publishing a much-needed dictionary in large type, and other companies are considering making available some texts found to be in fairly general demand. 4 C. E. Ferree and G. Rand, Optimum Working Conditions for the Eye, New York, National Society for the Prevention of Blindness, Publication No. 322; reprinted from the Sight-Saving Review, X (No. 1, March, 1940), 3-12. s Matthew Luckiesh and Frank K. Moss, Visibility and Readability of Print on White and Tinted Papers, New York, National Society for the Prevention of Blindness, Publication No. 271; reprinted from the Sight-Saving Review, VIII (No. 2, June, J938). 123-134-

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•s K O

T O O L SUBJECTS SHORTAGE OF LARGE-TYPE MATERIAL

Supervisors and teachers have made great efforts to overcome this shortage of material in large type. When W.P.A. workers were available, their services were greatly in demand, particularly in cities having a number of classes for the partially seeing. Thus, Minneapolis had assigned to its department of special education a number of W.P.A. workers, including artists, typists, and bookbinders. Any teacher of partially seeing pupils in that city desiring to have material reproduced for current use could send a request to the supervisor. If in the latter's opinion it seemed advisable to reproduce this material in large type, she made the necessary arrangements with the publisher and gave the material to one of the W.P.A. workers assigned because of administrative ability to supervise such an undertaking; the latter arranged for its preparation. If illustrations or diagrams were included, one of the artists drew them in a size commensurate with the large type. A typist prepared a stencil of the material on a large-type machine. Enough copies were run off on an excellent duplicating machine to meet the immediate needs and for possible future use. If the material was desired in book form, the sheets were then sent to the W.P.A. bookbinder. In this way a very large selection of material was made available for partially seeing children in all grades in that city. Detroit followed the same plan, except that all the pages were prepared on the typewriter, no copies being made. This was a much more expensive method, but it gave excellent results. Other cities have solved their problems differently; some, by obtaining the co-operation of the commercial departments of the school, others, by having typists assigned by the department of education. In practically all junior high school and senior high school classes for the partially seeing, pupils with normal eyesight are selected to read assignments aloud. In this way they accomplish their own work and at the same time make possible the fulfillment of the assignment by the partially seeing. It is always necessary to have the consent of the publishers when planning to reproduce copyrighted material. In general, publishers are generously co-operative in giving such permission when there is mutual understanding and a willingness on both sides to agree

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to certain limitations in distribution. In some instances, when contracts are made for the purchase of textbooks or other school books for regular grade children, a clause is inserted granting permission for reproduction in whole or in part under prescribed conditions. In some instances the Talking Book is made available, and all pupils, both partially seeing and normally seeing, can benefit by resting their eyes for a period and concentrating on the use of the sense of hearing rather than the sense of sight. WRITING

Writing is one of the chief media of expression. Although it is desirable for the partially seeing, especially those on the junior high school and senior high school level, to use the typewriter in preference to the pen for most purposes, it is just as essential for them as for the normally seeing to learn the graphic art of handwriting. When entering school the child is confronted with such a multiplicity of new and strange concepts that he is likely to be bewildered. He is doubtless familiar with pictures, but the symbols that tell their story, whether in printed or in written form, are usually meaningless to him. Step by step he must find his way out of the maze, and the teacher must be the modern Ariadne who furnishes him with the thread of guidance and initiates him into its use. T h e partially seeing child may have, in addition to this confusion arising from the unknown and the unfamiliar, a type of eye difficulty that even distorts pictures and interferes with the sending of clear images to the brain for interpretation. Fortunately American children are better off than those of many other nationalities. Formerly, German children were expected to familiarize themselves with eight alphabets. Chinese and Japanese children must still learn to distinguish a vast number of characters. T h e alphabet the American child must conquer consists of fewer characters, but still they are sufficiently complicated to lead to confusion. MANUSCRIPT WRITING

In order to prevent difficulties arising from various concepts, the beginner's alphabet should be reduced to the simplest form pos-

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sible. Manuscript writing serves to fulfill requirements. It is nearest in form to printing, thus lessening the number of concepts, and because of its legibility it is an asset in conveying thoughts. K e r r 6 makes this emphatic statement: The only handwriting which should be used or taught in sight-saving classes is the print or manuscript writing of single letters in their elemental forms. So far as eyes are concerned, the work is nearly halved, and it is eye work that slows the writing. There is, therefore, everything to gain educationally from this script-writing, which abolishes the useless and time-consuming loops and turns . . . Manuscript writing is the revival of an old art preceding printing; in fact early type faces were copied from the manuscript letters. Manuscript writing met with such success in the British schools that in 1921, Marjorie Wise, 7 specialist in the teaching of manuscript writing in her own country, introduced it at the request of Teachers College, Columbia University, to teachers and children in the Horace Mann school. A number of schools throughout the United States followed this example. Three chief objections were raised regarding this type of writing: it might prove slower than the cursive form; it might be difficult to change to cursive writing; the writing would not be sufficiently characteristic to prevent forgery. Experience soon discounted the first two objections. So far as the third is concerned, it is argued that individual characteristics in writing do not usually develop much before the teen age, when most children who have been using manuscript writing change easily to the cursive form of handwriting. Young children would not be likely to sign important documents. It would seem advisable for partially seeing children to use manuscript writing at least in this learning period because of the simplicity of the letters, their resemblance to print letters, and their legibility. CHALKBOARD WRITING

Chalkboard writing is desirable for the beginner. Children, particularly if they are myopic, are likely to write very small, « James Kerr, School Vision and the Myopic Scholar, London, Allen and Unwin, Ltd., 1925, 159 pp. 7 Marjorie Wise, On the Technique of Manuscript Writing, New York, Scribner's, 1924, 53 pp.

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cramped letters. Chalkboard writing helps overcome this by making possible the use of the large arm muscles. Spacing between letters, words, and lines is just as important as the formation of the letters. Large, soft chalk assists children and teachers to make broad, heavy, even lines for letters, which are much more easily seen than the faint outlines so often produced with hard, small chalk. When children enter the class for the partially seeing after their writing habits have been formed, unless their writing is poor it is usually the better part of wisdom not to make unnecessary changes. They will not find it difficult to read the manuscript writing used on the chalkboard or in preparing material assigned to them. In many instances they will voluntarily make use of it because they find it easier to read. Since writing requires close use of the eyes and concentrated attention, periods of study should be short. If lessons are well prepared and conducted, there should be no need of special, formal writing lessons beyond the second grade; thereafter all written material should constitute practice for legibility. TYPEWRITING

The typewriter is such an important tool for avoiding close use of the eyes that probably in time opportunities for learning to use it will be made available for the children in all schools as it is at present in many progressive private and public schools. Unfortunately, in many classes for the partially seeing this important subject is given so little attention that it fails of its purpose. Naturally, the touch system should be taught; accuracy rather than speed should be the initial aim. Just as maturation for reading readiness is essential for the best results in beginning reading, so typing readiness should be a deciding factor in determining when the teaching of typewriting should begin. In order to prepare her pupils for typewriting, the wise teacher of partially seeing children will give them finger exercises and will encourage them to use their fingers as well as their palms for clay modeling, modeling in plasticine, or other material, so that they may the sooner be ready to learn to use this tool that will be of inestimable value to them. In general, children of the fourth grade are not only able but also avid to try their skill in typewriting. It depends

CREATIVE

ACTIVITIES

OF S P E C I A L I N T E R E S T SEEING P U P I L S

TO

PARTIALLY

I L L U S T R A T I O N S BY T H E P U P I L S F O R T H E S T O R I E S T H E Y READ

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largely upon the teacher whether their enthusiasm is sustained. In initiating this work, short, well-supervised periods are essential for obtaining desirable results. Instituting good habits of position, touch, rhythm, and accuracy in the beginning will save much time and energy later. Although mastery of the keyboard is essential, children readily tire of typing consonants; if a vowel is introduced as early in the procedure as is feasible, the joy the child experiences in being able to type words will give zest and meaning to the undertaking. If typing is well taught and thoroughly learned, when a partially seeing child is graduated from the elementary school he should be able to prepare his written material directly on the typewriter, especially if he has been encouraged to do original work, as soon as he has mastered the use of the keyboard. Some partially seeing pupils enter junior high school or senior high school unable to use this tool, either because they have not attended a special class in the elementary school or because they did not have the benefit of fundamental work in learning to type. If a Dictaphone is available, they may, with help from the teacher and with perseverance, make up for this lack. The Dictaphone Corporation has prepared a series of lessons in typewriting to be used with this machine. When the pupil has learned to use the records and to follow the directions given in each lesson, he can make steady progress and should soon be able to use the typewriter in preparing his work. Teachers of partially seeing pupils in the school system of Detroit found that most of the manuals on typewriting were too advanced for elementary school children. They tried out various methods of teaching and arrangements of material and then prepared their own manual.8 ARITHMETIC

Knowledge of the fundamentals of arithmetic is necessary for everyday life. Methods of teaching this subject to the partially seeing do not differ from those employed for the normally seeing; the most up-to-date approved procedures apply to all. The changes that have taken place in the teaching of this subject are beneficial to all 8 Detroit, Board of Education, Sight-Saving Study in Typewriting, 1939.

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groups, but especially helpful to the partially seeing. Modern educators realize that an understanding of the principles underlying arithmetical processes is the real goal for which to strive; hence children are taught so that they may have a practical knowledge of the importance of arithmetic in daily living. They are no longer made to labor during long periods over a discouraging array of figures. In the great majority of schools formal arithmetic is no longer taught in the first grade. Yet if guided in the first grade by an alert, resourceful, and well-prepared teacher, children entering the second grade may be better equipped to use elementary arithmetical processes than those who have been taught according to old-time, formal methods, for they have gained their knowledge through everyday experiences. How quickly they learn to distinguish the greater from the lesser through the simple process of throwing a beanbag into certain holes of a gameboard! Soon they want to keep score, and thus they realize the need of some method of written expression to represent figures. If not too difficult to accomplish, they may keep score mentally and thus lay an excellent foundation for later work. Even a first-grader soon learns the worth of various coins from buying at the school cafeteria. T h e principles of such methods of learning may be carried into higher grades, with emphasis on mental arithmetic. T h e special teacher of the partially seeing, in particular, will make use of every possible means of fulfilling the requirements of the curriculum with a minimum use of the eyes. If reading is keeping pace, problems written in large type on the chalkboard or on sheets of paper may be solved with little eye use; in case a mechanical recording device is available, even less eye use is necessary. Drill is as essential for these children as for others; indeed more so, because the limited use of the eyes curtails much repetition of processes. T h e skilled teacher will find ways of accomplishing this drill without putting too much strain on the eyes. The familiar pedagogic principle that one should lead from the known to the unknown finds practical application in methods which deal with concrete problems drawn from the experiences of everyday living. Storekeeping exemplifies an excellent drill in the four arithmetical fundamentals: addition, subtraction, multiplication, and division.

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It also provides much needed practical drill in weights and measures. Knowledge of the United States money system is found to be necessary in computing costs, overhead expenses, sale prices, and profit or loss, and all of these, in turn, lay the foundation for more advanced undertakings and broader experiences. Cooking classes are most helpful in illuminating the dark world of fractions in which so many children lose their way because abstract problems have no meaning for them. Shopwork that is suitable for the partially seeing may likewise provide opportunities for putting into practice rules of measurement and design and may demonstrate in a practical way the necessity for accuracy. Numerous games offer exhilarating opportunities for interesting drill in arithmetic. No alert teacher needs to be reminded that on the shelves of any good educational library will be found books suggesting innumerable games and other devices, many of which may be used as a means of converting a dry lesson in arithmetic into a joyous experience that serves not only as a means to an end but also as a foundation on which to build new achievements. MOTIVATED ART AND HANDWORK

What art or handwork should be or may be undertaken in a class by partially seeing children is a pertinent question. This should be determined according to the recommendations made by the ophthalmologist regarding eye use. There are many reasons why partially seeing children should have the benefit of work of this nature. In common with all children, they yearn for creative activities. Encouraged by success, they desire new experiences. If such work is appropriate for their abilities, they can carry on similar undertakings at home, substituting them for close eye work, which they may often be tempted to do, particularly when their brothers and sisters are reading or doing other work requiring close use of the eyes. Because of their eye difficulties, it is well to train the hand so as to lessen the eye load. Handwork or art is very useful for eye-rest periods. In determining what art and handwork shall be undertaken by partially seeing pupils, there are definite questions that must be satisfactorily answered: (1) Is the undertaking merely old-fashioned "busy work," or does it serve a real purpose? (2) Are the results

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commensurate with the effort required? (3) What is its experience value for the child? (4) Has it some relation to the rest of his school program? (5) Shall it be undertaken in the special classroom or in the regular grade classroom? When the education of partially seeing children began to receive some consideration, there was very little appreciation of the difference between blind children and partially seeing children; hence many activities desirable for blind children were accepted as equally desirable for the partially seeing. Little thought was given to the fact that although certain tasks might be accomplished by both groups, their performance might cause too great a strain on the eyes of the partially seeing. Thus, in raffia work, the blind child soon learns to depend wholly upon his sense of touch for threading his needle and for finding the exact place into which it must fit. T h e partially seeing child, because his chief avenue of educational approach is his sight, will use his eyes. The close eye work necessary for the accomplishment of the task is likely to cause such strain that much nervous energy is unnecessarily expended for a task of so little value that it is out of all proportion to the effort. Weaving rugs and other fabrics is usually a source of great satisfaction to the blind child, but to a child with astigmatism it may prove little short of torture. During the initial period in the development of special education for the partially seeing a supervisor unprepared for this work and with little understanding of the problem was heard to say that she always judged the efficiency of a class by the number of baskets the children made. Evidently if the display shelves were crowded with baskets, the class was a success. Gradually, as a better understanding of the difference between the groups developed, advances were made along this line as well as in other educational procedures. It was realized, for instance, that although the making of raffia baskets might cause too great a strain, reed basket-making in moderation might be an excellent undertaking, since (1) it helps strengthen the fingers and therefore is a good preparation for typing; (2) it gives the children a feeling of satisfaction to create a definitely useful and often very artistic product; (3) it proves a desirable occupation for the home; and (4) it develops a sense of form, color, and harmony and can be readily related to other sub-

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jects in the curriculum, such as the growing of cane, a study of countries or the people having basket-making as one of their occupations. Soon the making of Mexican and Indian baskets began to take on a new meaning. But no longer is the success of a class measured by the number of baskets on the shelf. Resourceful teachers began to realize that the help of the art supervisor was available to them as well as to regular grade teachers. A co-operative program developed in which the special teacher acquainted the supervisor with the limitations imposed by the eye conditions of the pupil, and the art supervisor contributed the benefit of her wide knowledge and experience. T h e next step was to decide what part of the work should be undertaken in the regular grade and what should be carried on in the special classroom. The verdict in general was: (1) that whenever work in the regular grades proved suitable for the partially seeing, they should have the benefit of participating in it with the normally seeing pupils (taking into consideration not only the eye condition and the type of work but also the physical surroundings of the regular grade classroom, particularly lighting conditions under which the work must be done); and (2) that some art or handwork should be made available in special classes in order to provide periods of eye rest. Such work might take the form of a sand-table project heipful in the study of geography, history, or social science; making seasonable murals; knitting for the Red Cross with large bone needles. In present-day classrooms for the partially seeing it is quite usual to see well-thought-out and equally well-executed murals prepared as seasonal activities or as illustrations for current lessons. They may be undertaken in the special classroom as supplementary to work done in the regular grade, either as a means of resting the eyes by changing their focus or because the illustrations made in the regular grade are on too small a scale to be used by the partially seeing. But every supervisor of classes for the partially seeing continued to meet the question: "What can I do for art or handwork for these pupils?" An intensive study of the problem was therefore undertaken by teachers participating in an advanced course for the teaching of the partially seeing. Their findings were presented

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in two publications, 9 which were made available to all teachers of these classes. So helpful did they prove that soon not only teachers of other types of special classes but also teachers of regular grades were using them. However, no resourceful teacher will consider these presentations as final solutions of her problem; she will use them as suggestions, but will always adapt the undertaking to the role the art or handwork is expected to play in the school program. Cognizant of constant change, she will keep abreast of the times and open new avenues of interest to her pupils. For example, finger painting is a very recent development, but used with discrimination it can be made an excellent medium for creative activities; the resourceful teacher will have the children make the paints so that they may have an understanding of the whole process. 8 Io Starr, Work Units for Sight-Saving Classes, New York, National Society for the Prevention of Blindness, Publication No. 311; reprinted from the Sight-Saving Class Exchange, No. 70 (Nov., 1939), pp. 20-40. Sarah Latimer Phelps, Motivated Handwork and Activity Units in Sight-Saving Classes, New York, National Society for the Prevention of Blindness, Publication No. 312; reprinted from the Sight-Saving Class Exchange, No. 70 (Nov., 1939), pp. 41-53.

Chapter Fourteen: T H E U S E of M E C H A N I C A L

D E V I C E S in T E A C H I N G is sometimes called the mechanical because of the many inventions that make possible the substitution of mechanical devices for personal labor or service. Such inventions often lessen to a remarkable degree manual labor in agriculture, factory work, and countless other occupations. Some, such as the adding machine, lessen mental labor and, equally important, the fatigue caused by the close use of the eyes in writing and in adding figures. Still others aid the medical profession to make delicate and intricate examinations not formerly possible. Some devices are of assistance in substituting the use of one sense for another. Present-day educational procedures demand so much close eye use that even pupils with normal sight are often overtaxed to meet the requirements. Just as the farmer, factory worker, and physician have learned through actual experience the value of mechanical aids, so in time educational authorities will realize the desirability of making available to all pupils those that are of practical use in the educational program. Such results are often brought about through procedures demonstrated in special classes. If partially seeing children are to keep abreast of their normally seeing companions, they need every mechanical aid that can be provided in order that they may obtain the desired information with as little close eye use as possible. Chief among these mechanical helps are the typewriter, recording machines such as the Dictaphone and Ediphone, the Talking Book, and the radio. HE TWENTIETH CENTURY

TYPEWRITERS

The typewriter is the mechanical device in most common use. Practically every class for the partially seeing is equipped with at least one machine in large type. When the touch system is cor-

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DEVICES

rectly taught and correctly learned, this machine is most helpful in reducing the amount of close eye use. The use of the typewriter for this purpose is fully described in Chapter Thirteen. RECORDING

MACHINES

Comparatively few classes have the benefit of a Dictaphone or Ediphone. Where they have been made available they have proved their value beyond doubt, not only in reducing the amount of close eye use but in saving the time and the energy of pupils and teachers. A teacher may in five minutes make a record that would require half an hour or longer to write. Lessons, not only in English, history, and geography, but also problems in arithmetic, algebra, geometry, and lessons in foreign languages may thus be brought to the pupils. The teacher may dictate when the pupils for whom the material is being prepared are participating in activities in regular grades. Each record is carefully marked and placed in a cabinet especially planned for this purpose. When pupils are ready to prepare a lesson, they select the record and place it on the machine; some machines are equipped with earphones so that four pupils may listen to the record at the same time. The pupils study the assignment and write whatever is indicated directly on the typewriter, thus accomplishing the work without any close eye use, except the reading of the typed material. The record may be stopped at any point on signal and may be repeated when desired. Pupils who are absent at the time the assignment is made may use the record at another time. TALKING

BOOKS

The Talking Book 1 is likewise of great assistance to the partially seeing. When Edison produced his experimental wax cylinder in a New Jersey laboratory, he laid the foundation for the Talking Book which today makes it possible for the blind and the partially seeing to "read with their ears." The Talking Book, developed by the American Foundation for the Blind, consists of a series of disks on which are recorded current books, plays, and articles, as i Complete information regarding the Talking Book may be obtained irom the American Foundation for the Blind, 15 West 16th St., New York, N.Y.

A

PARTIALLY

SEEING

CHILD

LEARNING

TO

USE

THE

TYPE-

WRITER

I N T E R E S T (A M A G I C W O R D IN E D U C A T I O N ) M A N I F E S T E D IN STORY THE T A L K I N G BOOK

TELLS

THE

L E A R N I N G TO U S E THE

DICTAPHONE

LEARNING

BY

HEAR-

ING

Dictaphone records and typewriter ready for use.

MECHANICAL

DEVICES

125

well as the classics. These disks are used on a special Talking Book machine, with or without radio attachment. Much of the best literature is thus made available for individuals or for groups who because of eye difficulties cannot make use of ordinary print. T h e recording is done by experts whose well-modulated voices and fine diction are excellent examples for the pupils to follow. RADIOS

T h e fourth mechanical device of great value to the partially seeing is the radio. This wonderful invention has opened to all peoples throughout the world information and entertainment through the medium of the sense of hearing. T h e great majority of homes in America and many other countries are equipped with radios; hence there is little, if any, difficulty in getting partially seeing children to substitute listening to the radio for much close eye work. There is great need, however, for stressing discrimination in the choice of programs and for making listening an art rather than merely a pastime. T o the partially seeing child radio is a gift beyond evaluation. One of its chief assets is that at small cost it may be brought into the school and form a delightful, as well as an instructional, part of the school program. T h e contribution that Walter Damrosch has made to the children of the United States and neighboring countries in music has only to be mentioned to indicate what may be accomplished along other lines if the aim of the Damrosch concerts is followed out—to present good programs in such a way as to cultivate a desire for them through understanding and enjoyment. By no means have all the so-called "educational" programs presented over the radio met with success. Many of them have been misnamed; some have been too didactic to appeal to children; and others have been lacking in interest, perhaps because they have been prepared from the standpoint of the writer rather than that of the listener. A n experiment carried out successfully in Cleveland, Ohio, 2 opens the door for similar undertakings in many school systems. 2 Olive S. Peck, The Radio and the Talking Book in Sight-Saving Classes, New York, National Society for the Prevention of Blindness, Publication No. gog; reprinted from the Sight-Saving Class Exchange, No. 70 (Nov., 1939), pp. 6-14.

MECHANICAL

DEVICES

Even in remote one-room rural schools a radio is often a possibility. Where there is no electricity, a portable radio operated by a battery may bring desirable messages to thousands o£ children. In Cleveland, as early as 1925, music appreciation lessons were broadcast. In 1929 arithmetic lessons were arranged to present the local course of study. These attempts were so successful that efforts were made to include other subjects. In 1938 a grant from the General Education Board of the Rockefeller Foundation enabled the Cleveland Board of Education to establish the Cleveland School Radio Station W B O E , the first of its kind in the United States. T h e radio studios are in the school administration building. In each school a room is selected for the installation of a radio set, and arrangements are made for the showing of slides to illustrate lessons given over the radio. A syllabus on each subject to be covered in the radio lessons during the semester is prepared in advance and sent to each teacher of that subject, in order that any necessary preparatory work may be done in advance of the radio lesson. Material may have to be prepared for experiments or exhibits of various kinds procured for demonstration. If the lesson is to be illustrated with slides, they are made available to the school. T h e special school station operates from 8:30 A.M. to 4:30 P.M. Programs are so arranged that every child in a particular grade throughout the city will be listening to a special lesson at the same time. Fourth-grade children may all be listening to a lesson in spelling given over the radio at 9:30; during the following period all fifth-grade children may be having a lesson in geography or history. High school pupils are not forgotten, and even parents come in for their share of time and attention, especially for help with preschool children. T h e lessons are prepared and given by experts—experts from many points of view: subject matter; adaptation of material to the particular group; and radio presentation. T h e final program is a composite of the efforts of the many concerned. T h e lessons are carefully prepared and rehearsed. T h e y are first tried out in a limited number of schools. Children and teachers in these schools send comments to headquarters, and any desirable changes are made before the program is radioed through the regular channels. T i m e is allowed for pauses during which children may ask

MECHANICAL DEVICES

127

their classroom teacher questions concerning anything not understood. Directions are given over the radio, and the children react to these as they would to instruction given by their own teacher. If the talk is illustrated by slides, the children manage this part of the program; the slides are arranged in sequence and are placed in the slide machine according to the instruction given by radio. These radio programs are advantageous for all children in the school system, who thus have a period of eye rest during which they learn to concentrate through the sense of hearing. They also accomplish something less tangible, but of equal, if not greater, importance; they bring together through a common interest the partially seeing and the normally seeing, not as separate groups, but as a little company of good listeners, all anxious to hear whatever is transmitted to them over the air through the miracle of the radio. When a school budget does not permit investment in mechanical aids, civic organizations are often willing to assist in obtaining them if the educational authorities so desire.

Chapter Fifteen: C H I L D G U I D A N C E for

P A R T I A L L Y SEEING PUPILS

I

N EVERY large school system there is a department of child guidance upon which teachers of partially seeing pupils may call for service. In many junior high schools and senior high schools there are guidance and vocational counselors, whose responsibilities include service to all pupils in the school. Such responsibilities are, however, shared. T h e teacher of the partially seeing has much information regarding the personality, the possibilities, and the limitations of her pupils that will be most helpful to the expert. T h e expert, in turn, has much to offer that will be of assistance to the teacher in carrying out her program. ROLE OF THE TEACHER

W h e n child-guidance services are not available, the teacher of the partially seeing must integrate into her already full program as much service as she is capable of rendering. In a larger sense her program must, of necessity, be one of guidance. She may not be able to make nice distinctions with regard to various types of guidance, as the experts can, but she realizes that it is her function to guide the children along all lines that will be for their greatest development. T o her, all types of guidance are fused; they blend into one pattern—the life pattern of the child. In order to guide him, she must know what he is, what he does, and how he does it. She must have an appreciation of his present tendencies and their probable influence upon his future. Aptitude tests are of great value, but they are usually given in high school and long before then the teacher must have some way of knowing in what direction her pupil's aptitudes point. She may not have expert knowledge concerning intelligence or personality quotients, but experience soon teaches her how to recognize trends.

CHILD GUIDANCE

129

Happy, indeed, is the teacher of the partially seeing who finds in her group a child with a definite inclination and the ability tp follow it. Her joy in this discovery may be tempered by the knowledge that his eye difficulty may hinder the attainment of his desires; to the resourceful teacher this will prove but an added impetus for finding ways by which the special aptitude may be used to the child's greatest advantage. But few and far between are those who show a definite trend. How, then, is the teacher to build a guidance program that will be flexible enough to be applicable to various conditions and personalities? In this modern age of progressive school systems and of activity programs and even in systems following the more formal procedures in education, daily work and play provide the observant teacher with opportunities for discovering at least two rather definite trends: one points in an academic direction; and the other, toward motor achievement. T h e one does not necessarily preclude the other. T h e motor-minded child may have just as great mental ability as his academically minded companions; but his special aptitude may be in using his brain to direct his hands, while the academically minded child may prefer to devote his time and energy wholly to intellectual pursuits. T h e goal in guidance should be the development of a wellrounded personality capable of undertaking a well-rounded program. By careful observation the teacher may find definite clues for procedure in laying foundations. Individual aptitudes will often be revealed in group activities. Even choosing the part of an activity each desires to undertake may prove enlightening. T h e manner in which this choice is carried to a conclusion may help to indicate desirable traits to be encouraged or undesirable ones to be avoided. PREVOCATIONAL TRAINING AS GUIDANCE

Elementary school experiences deal chiefly with personality and educational guidance. By the time the partially seeing child enters junior high school he is more concerned with future undertakings and is perhaps showing somewhat more definite trends in certain directions. Some junior high schools are meeting this increased interest by providing short prevocational courses for the purpose of acquainting pupils with possible vocations to follow and of ori-

130

CHILD

GUIDANCE

enting them by providing an opportunity of trying different lines of interest. In this connection representatives of various occupations usually give very informal talks in which they discuss points of special interest—the demand for workers in particular occupations, the income, the possibility of advancement. When these preliminary courses are finished, the teacher in charge of them, the special teacher, and the vocational counselor meet with the pupil and his parents; together they discuss his preferences and his ability—mental, physical, and social—to carry them out. If he is academically inclined and shows evidences of being able successfully to undertake academic high school work, arrangements are made for him to attend an academic high school in which, if he is a partially seeing pupil, he will be given the necessary assistance for carrying out that part of the program requiring close eye use. If he prefers direct vocational preparation, the ophthalmologist must pass upon the type of work the pupil wishes to undertake, and the counselor or the special teacher must follow through very carefully to see that he is given the opportunity for training. Rehabilitation departments are also sources of guidance for selecting occupations and arranging for special preparation and suitable placement. Here, again, a co-operative effort is necessary in making decisions, in which the child, his parents, his teacher, the vocational counselor, and the rehabilitation officer participate. In a small number of high schools which partially seeing pupils attend, an excellent plan of co-operation is being carried out. It is based on the principles underlying the program at Antioch and some other colleges, in which students, having gone through the preliminaries of deciding upon a vocation for which they think they are fitted, confer with their advisers. If there are evidences that the student is likely to succeed and if it is possible to place him as an intern or apprentice in the desired position, he spends a certain number of weeks at work and a commensurate number in school or college. He thus learns at first-hand what the undertaking entails and is in a position to judge for himself whether he has selected wisely. He also learns to know what subjects he must emphasize in his work in order to become most efficient. Where such a plan is in operation for partially seeing pupils in high schools, such a division

CHILD

GUIDANCE

131

of time is rarely made; usually the pupils spend certain hours each day at school and certain others on the job, but the principles on which these experiments are based are the same in both instances. VOCATIONAL

GUIDANCE

Every vocational counselor, every teacher of the partially seeing, and every rehabilitation and employment agency would welcome a list of occupations that the pupils may safely undertake. But there is no highroad to the solution of the problem. It must always be borne in mind that there is just as much variation—mental, physical, and social—in a group of the partially seeing as is to be found in any other group. T h e personality plus of a partially seeing pupil may make him an expert salesman despite serious eye difficulty. Not only does a myope have an even chance of competing favorably with his normally seeing companions in academic work, he may even surpass them. His very inability to engage in activities requiring good visual acuity for distance may have led to his acquiring the power of concentration necessary for success in scholarship. T h e Vocational Division of the United States Office of Education has issued publications dealing in a most careful and detailed manner with a vast number of occupations. These may be used as a basis for considering possible vocations for the partially seeing. Certain points must, however, always be kept in mind: in a constantly changing world occupations do n o t remain static; inventions and discoveries open up new possibilities. It is well, therefore, that the child guidance, educational and vocational advice, and vocational preparation be of such a nature that the pupil may have the adaptability necessary to meet changing conditions and that if possible the foundation laid shall be such that he will not be limited to one specialized course of action. T h e teacher of a partially seeing pupil demonstrated this most acceptably. W h e n her pupil entered junior high school he was a shy, retiring boy, mixing little with his companions and showing no special ability in any direction. His intelligence rating was 98; his personality appeared to be negative. His dynamic and thoroughly interested teacher, however, was not discouraged by his listless attitude. Experience had taught her that there is usually a touchstone and that if it can be found an unexpected spark may be

132

CHILD

GUIDANCE

struck. She took some time to gain the boy's confidence, and at last she discovered that he was possessed by one real desire—to enter the ministry. The long preparation for such an undertaking was somewhat appalling, particularly since it was complicated by a none-too-high mental ability, very low vision, and a personality apparently lacking in energy and appeal. T h e teacher gave careful consideration to the whole matter and discussed it with him and his family. He was the only child of parents in very moderate circumstances; both parents worked in unskilled jobs. Their desire for him to enter a religious order was so great that the teacher had to assure herself that the boy's desire was real, not a reflection of theirs. She consulted the ophthalmologist. T h e prognosis was uncertain; the eye condition might possibly grow worse. She next consulted the personnel of the school for religious preparation. They felt that anyone having such an ardent desire should be given every assistance, but questioned the boy's ability to undertake the intensive work necessary. She tried to interest him in other activities, but there was no response. She felt, therefore, that she must assume the responsibility of so guiding him that if he failed to reach his goal he would have the foundation for something as nearly akin as possible. First she interested him in typewriting as a medium of expression to reduce eyestrain; next, in the Dictaphone, for preparation work. His English and spelling were very poor and had to be given special attention, for he would need to be able to use good English in order to prepare sermons. Of literature, he knew practically nothing; its cultural influence would be of great benefit to him. A Talking Book made this possible. A minister must understand his fellow men; he must gain their confidence in order to help them in their difficulties and guide them in their responsibilities. Where better could this boy begin than in his own group? Gradually, through the teacher's help and example, he learned the meaning of service. His companions, who had been indifferent to him, came to look upon him as a personality and often turned to him for assistance. By the time he finished junior high school, he would never have been recognized as the shy, awkward, rather helpless lad who had entered the class.

CHILD GUIDANCE

133

Realizing the effort the boy had made to enable him to undertake his chosen work, the ophthalmologist gave consent for him to attempt training, and the school for religious preparation accepted him. Even if he is unable to carry through, he is equipped for other activities. His English and speech have improved beyond recognition; he can write an excellent book report and an acceptable composition; his knowledge and appreciation of literature have widened and deepened, and he is imbued with the spirit of service. Thus has the guidance program so carefully worked out by his teacher succeeded in opening for him the way to prepare for his chosen vocation, or, failing this, to undertake other useful service.

Part Four:

COMMUNITY SOCIAL SERVICE RESPONSIBILITIES

Chapter Sixteen: C O M M U N I T Y

S E R V I C E and C I V I C

SOCIAL

ORGANIZATIONS

T

who recognizes the need to obtain social service for any of her pupils may well be puzzled by the heterogeneous collection of societies and departments ordinarily referred to as "social agencies." Services of great variety are available to the teacher who knows how to find them and to make use of them. There is, however, a wide variation in official and voluntary social agencies in different communities regarding policies, functions, procedures, and personnel. T h e teacher's best procedure would be to check with whatever school health service exists before taking steps on her own responsibility. T h e nurse in this service is usually familiar with community resources and can aid her in making an appropriate selection. Indeed, the nurse may already have referred the child about whom the teacher is concerned, or another member of his family, to a social agency, and any duplication of effort may prove confusing to the child and to his family. This suggested procedure, however, does not free the teacher from the obligation of knowing as fully as possible the resources of the community in which she lives and works. HE TEACHER

COMMUNITY

SOCIAL

SERVICE

In general, social agencies may be classified under two headings —official and voluntary. In the past few years there has been a rather definite shift of some of the responsibilities for social and health service from the voluntary organizations to official public welfare units, necessitating considerable change in the programs of both groups. Each group, however, makes every effort to avoid duplication, by complementing the work of the other.

138

SOCIAL

SERVICE

GROUP SERVICES

Social services may be considered under two main headings— group services and case work. A teacher who is trying to develop outside interests for a child with high myopia who wants to read constantly may find it advisable to use group services: first, those of the school such as clubs and special excursions; second, social services rendered through settlement house clubs, Boy or Girl Scouts, summer camps. CASE WORK

Case work falls into several subdivisions; perhaps those who can render the greatest service to the partially seeing are: (1) child and family case workers in both official and voluntary agencies; (2) medical social workers in hospitals and in community services. Social workers in the first group may contribute concrete services regarding the health of the child and the family's physical necessities of life—shoes, clothing, adequate food and shelter, adjustments within the family, selection of foster homes, and the supervision of children placed in them. These services are especially helpful for partially seeing children in rural communities, for whom attendance in special classes in cities can be arranged when suitable foster homes can be found for them. T h e majority of child and family case workers, however, have little knowledge of eye difficulties, and it sometimes becomes the responsibility of a supervisor or teacher to acquaint them with the facts and to stress the importance of taking them into consideration in making any plans for the welfare of partially seeing children. MEDICAL SOCIAL WORK

Medical social workers are less numerous and less widely distributed than general social workers. T h e y are usually found in university medical school hospitals and outpatient departments, also in large municipal and state hospitals. Medical social workers are sometimes found on the staffs of organizations having public medical care programs, such as the Crippled Children's Services or prevention of blindness programs. Of the medical social workers within institutions, those most helpful for the partially seeing are the relatively small number assigned to the eye department for full

SOCIAL

SERVICE

139

or part time. A close working relationship between the health service of the school, the supervisor or the teacher of these children, and the worker of the eye service should develop from mutual exchange of information and thinking regarding the child and the problems growing out of his difficulty. One of the primary responsibilities of such workers is to understand the point of view of the child and his family toward any medical treatment or surgical plan and the adjustment required. Another responsibility is to stimulate interest in obtaining community resources to meet the child's needs in cases in which educational facilities do not exist for partially seeing pupils. In this type of activity the observant teacher in a regular classroom and the worker in the eye service may well collaborate. When there is no medical social worker for eye service, help may often be obtained from workers on other services, especially the department of pediatrics. These workers may not have first-hand information regarding eye conditions of the child for whom help is sought, but they may obtain this from the ophthalmologist. T h e y are, however, familiar with general health problems and can be genuinely helpful because of their knowledge of the attitudes, behaviors and reactions of children. Medical social workers on other services encounter a sufficient number of eye cases to sustain their interest in all eye difficulties. H o w often the nurse or the teacher will have an opportunity to obtain help from medical social workers in state- or county-wide programs for crippled children, maternal and child health, or specialized eye care will vary according to the legal provisions and the administrative organization in the state in which she is working. In many states the age of the child may determine the source and the amount of funds available for medical or surgical care, hospitalization and transportation. In other states the eye condition may be the determining factor. T h e definition of a "crippled" child varies. In some states a child needing operation for congenital cataract, strabismus, or ptosis, is considered a "crippled" child according to the law, and is, therefore, eligible for any necessary service. W h e n there is only one medical social worker to serve an extended territory, such as a state, a group of counties, or even one

SOCIAL

SERVICE

large county, only consultation service may be possible. But this worker is usually able to direct the teacher to sources of local help. VOLUNTARY AGENCIES

In a few states and cities there are voluntary societies staffed by executives with social service training. In such places profitable teamwork may develop between the organization, the supervisors, and the school nurses or teachers. Such interrelationships have usually been built up in cities, but in the small number having state services a great deal of assistance has been given in stimulating cooperative relationships and community interest in providing educational opportunities for the partially seeing. CIVIC

ORGANIZATIONS

It must always be borne in mind that the education of partially seeing pupils in public school systems is the responsibility of educational departments—state and local. Many programs that might have proved valuable to the partially seeing have been wrecked because of unwise procedures on the part of enthusiastic but uninformed groups or individuals. The approach to this subject should be made to the state or local superintendent of schools or to the state director of the department of special education. T h e approach may be made by the parents of the partially seeing child, the school principal, the supervisor, the teacher, the nurse, the social worker, or any civic group. The superintendent is thus acquainted at first hand with the situation and is sufficiently familiar with the educational resources to view the matter from all sides. Having statistics regarding the school population available and knowing the proportion of partially seeing to the general school population, the superintendent of a school system is able to judge whether or not there are enough partially seeing children in the community to justify the establishment of a class for them. If there is any doubt in his mind, he may request school principals, nurses, teachers, and others to report the names of children who may be candidates, in order to verify his estimate. If there are no state funds available to meet the expenses of a special class, he will have to consider local financial resources. If crowded conditions exist in school buildings, he will have to take

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141

into account the possible places in which a class could be held. He will, in all probability, have the matter placed on the agenda of the board meeting and have an open discussion of the question. In small communities or rural areas the county or other state division superintendent of schools will have to consider what facilities can be made available. Civic organizations can be of the greatest possible value in supplementing the efforts of the educational authorities. Practically all civic organizations include in their programs some form of special service to their communities. It may be necessary for them to acquaint the community with the need for educational facilities for partially seeing pupils in order to arouse public opinion. Civic organizations may assist in providing equipment and supplies or transportation for pupils in case there are no school funds available. T h e Lions Clubs—international, national, and local—have taken as their social obligation to the community the interests of the blind and the partially seeing, although a number of other clubs give, directly or indirectly, similar service. In many instances Lions Clubs have provided scholarships for the preparation of teachers for this special work. T h e y have backed legislation for state appropriations for the education of the handicapped. They have provided glasses for hundreds of thousands of children and have paid, when necessary, for operations and for medical and hospital care. In fact, they have co-operated in every way with departments of education in providing opportunities for partially seeing pupils and are vitally interested in their welfare. COMMUNITY RESPONSIBILITIES

OF THE

PARTIALLY SEEING

SPECIAL TEACHER

OF

CHILDREN

T h e aim of every good teacher is, naturally, to assist each child coming under her guidance to make the most of his abilities. This accomplishment is evidence of a job well done. But no teacher who is in contact each day with children having serious eye difficulties would be worthy of her calling if she stopped at this point. Important as remedial work is, the goal is prevention. Through contact with parents, parent-teacher associations, women's clubs, Lions Clubs, and other civic organizations, the teacher has an unusual opportunity for educating the public to understand

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SOCIAL SERVICE

preventive measures and to co-operate in putting them into effect. However, in order to be able to instruct others, the teacher must keep informed of advances—medical, educational, and social— that affect human welfare. Realizing the necessity of having children enter school as well equipped as possible to take advantage of opportunities offered, the teacher will stress the need for thorough, periodic medical examinations of preschool children. T h e importance of prevention may have been brought home to the teacher by the fact that some children in her group have scars on their eyes caused by fireworks, guns, or hazardous toys. She will therefore want to know whether the state in which she is teaching is among those that control the sale of fireworks. Perhaps some of these scars may be the result of infection of the eyes at birth. What are the state laws or the regulations of the State Board of Health regarding the use of a prophylactic in the eyes of the newborn, and how are they enforced? Some children may be in the group because of the effects of syphilis upon their eyes before they were born. T h e teacher should know whether the state requires premarital examinations, and the examination and treatment when necessary of expectant mothers. If she is in a section of the country in which trachoma is prevalent, she will want to be familiar with the state regulations for reporting cases and will be interested to learn how the discovery of sulfa drugs is helping to eradicate this dread disease. T h e well-informed teacher of the partially seeing will know whether her state requires the routine examination of children in order to discover defects and the reporting of those found; whether authorization is given for the establishment of special classes for the handicapped, permissive or mandatory; and whether the state has an appropriation for the latter purpose. She will inquire into the question of provisions made for education of the handicapped outside the district of residence; arrangements provided for special educational material and supervision for handicapped children in areas in which no class is available; and provisions made for the training and rehabilitation of the handicapped. She will strive to keep abreast of scientific advances in medicine, surgery, and appliances, with the hope that some of them might be helpful to the children in her group—possibly a new cornea for

SOCIAL

SERVICE

143

one that has been recently scarred through accident or some other cause; an operation for a junior high school girl whose personality is being warped by the fact that her eyes are crossed; an operation for cataract that may change a little blind child into a seeing individual; a pair of contact lenses for a child with a conical cornea. It is not within her province to diagnose or to treat, but she needs to know much about eye health and efficiency, and she should be familiar with community resources in order that she may share her knowledge with those in her community who need her help.

Chapter Seventeen: The R O A D AHEAD of partially seeing pupils of school age will not decrease appreciably in the near future. A l t h o u g h the longdistance view gives a m u c h brighter prospect, the task that lies directly ahead is to provide educational and health services for the 50,000 partially seeing children in the United States w h o are now without them. If such services are to be made available, many more special classes will have to be established in cities and in consolidated and demonstration schools. Of equal, if not greater, importance, adequate service must be provided for such children living in small communities and in rural areas for w h o m special classes cannot be made available. In order to fulfill such obligations, several courses of action are necessary: 1. A n u m b e r of teachers who have had successful experience with normally seeing children should prepare themselves to conduct the new classes that need to be established. HE NUMBER

For such preparation intensive courses are given during the summer sessions of colleges and universities; for those who can devote full time, a few colleges and universities offer courses throughout the school year. 2. Prospective teachers should be adequately prepared in teachertraining institutions to understand the problems of partially seeing pupils and to help solve them. T h e preparation of prospective teachers is a somewhat more complicated process, requiring the introduction of special courses into the curriculum and opportunities for observation and practice teaching of the partially seeing in demonstration schools. In the curriculum of all normal schools, colleges, and universities for the preparation of teachers, courses should be included that will give the prospective teacher an appreciation of the importance of eye health and efficiency, not only in modern education, but in the social and economic life of the community. Courses should include an understanding of the anatomy, physiology, and hygiene of the eye, refraction and

The R O A D

AHEAD

145

refractive errors; the effect of deviations from the normal on educational processes and on personality; techniques of correct vision testing; responsibility of the teacher for observing the reaction of children to work requiring close use of their eyes. Other courses should deal much more specifically than any course at present given in many of these colleges with the lighting and ventilating systems of school buildings, their physical equipment and educational media. Such courses should not only emphasize correct lighting and seating conditions, selection of chalkboards, format of books and duplicated material but also should offer students an opportunity to see these principles carried out in the college and in its demonstration school. In order that prospective teachers may have actual experience in observing the best provisions for the education of partially seeing pupils, and for practice teaching of such groups under expert supervision colleges should establish classes for the partially seeing in their demonstration schools. Such experience would make it possible for the teachers to care later for partially seeing pupils individually or in groups. A course in social economics should include a study of community resources for medical, social, and educational services for partially seeing children and their families. 3. Teachers in service should be given the necessary instruction and assistance to enable them to care for partially seeing children in their groups for whom special classes cannot be made available. Teachers in service may prepare themselves for teaching partially seeing children by taking advantage of the various intensive courses offered for the preparation of teachers for this particular work or of general courses dealing with the education of the physically handicapped, provided these give sufficient attention to the needs of the partially seeing child. In cases in which it is not possible for the in-service teacher to take advantage of such opportunities, state supervisors of special education may give them the necessary help, or the responsibility for such instruction and assistance may rest with supervisors of elementary and high school education. 4. Supervisors of elementary and high school education should prepare themselves to give the necessary instruction and assistance to teachers in service. Because some states are without departments of special education and others do not have sufficient personnel in these departments to give the necessary assistance to in-service teachers, supervisors of elementary and

146

The R O A D

AHEAD

high school education should prepare themselves for this work by taking advantage of courses which will give them the necessary foundation. 5. School nurses and other public health nurses should be given adequate instruction, either in their preparatory work or in graduate courses, to enable them to understand the principles of eye health and efficiency and to qualify them to meet the health problems of partially seeing pupils. Nurses in preparation for school health service or other public health service should be given the advantage of courses similar to those suggested for teachers, with emphasis on the medical and social aspects. Those in service should keep informed about advances in medicine and surgery and of opportunities for social welfare. 6. M a n y more hospitals should place on their staffs medical social eye workers. Medical social eye workers are proving of such worth in the few hospitals in which they have demonstrated the necessity for this type of service, that a much larger number of hospitals should include such workers on their staffs in order that the medical care provided may have the best results through the co-operation of the patients and their families. 7. Social workers in welfare and other agencies should have such a thorough understanding of eye conditions that they will be able to render adequate service to partially seeing pupils and to their families. Social workers in welfare organizations often have little understanding of eye diseases or of the effects on the eyes of diseases of the body, malnutrition, insanitary living conditions, and emotional upsets. Some schools of social work have recognized the need for more adequate preparation along these lines. Schools that have not yet included it in their curriculum should do so. 8. If adequate provisions are to be made for pupils in rural communities, state libraries should include in their traveling libraries textbooks and other books suitable for the use of partially seeing pupils. Programs should be instituted in such libraries by which books necessary for a term's work could be supplied in suitable type for all partially seeing children in rural areas within the state; these books should be returned to the library at the end of the term, and books for the new term should then be supplied.

The R O A D

AHEAD

147

g. If partially seeing pupils graduating from elementary and Junior high schools are not to be deprived of the help necessary for them to undertake high school work, much more adequate provision must be made for them in high schools throughout the United States. This may be accomplished by establishing special classes for partially seeing pupils in high schools, under the direction of qualified teachers; by appointing a qualified teacher to arrange for and supervise the work of partially seeing pupils in a number of high schools; by supplying advisory assistance and readers for partially seeing pupils in high schools for whom more adequate assistance cannot be arranged. If all of this seems too ideal, it is well to look to the more distant future which promises a far more encouraging picture. T h e epigrammatic nature of Winston Churchill's statement that the way to solve the problem of unemployment is to have no unemployment is equally applicable to the problems of the education and health of partially seeing pupils. Much has already been done and more is now being undertaken that will eventually bring about a marked reduction in the number of partially seeing. One of the first steps in overcoming any difficulty is to find its cause. Research has accomplished much in determining the causes of blindness and defective vision; advances in medicine and surgery are making possible the elimination of many of these causes. Smallpox, diphtheria, and other diseases once responsible for many eye difficulties are under control. Ophthalmia neonatorum (babies' sore eyes), until recently one of the chief causes of blindness in children, is now so preventable that communities are ashamed to list cases that occur within their jurisdiction. Operations for cataract, the chief cause of blindness in children now in schools for the blind, are restoring vision to many. Detachment of the retina, considered only a few years ago as inevitably leading to blindness, now responds, in many cases, to skilled surgery, provided the ophthalmologist is given the opportunity to operate soon enough. Examination, and treatment where necessary, of expectant mothers are preventing eye diseases that result from the transmission of syphilis from the mother to the unborn child. In some cases skilled surgeons are able to substitute a clear cornea for one that is scarred, thus making it possible for light to enter the eye. The use

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of sulfa derivatives is rapidly decreasing the scourge of trachoma. Glaucoma, one of the chief causes of blindness and impaired vision in middle and later life, can be controlled in the great majority of cases if adequate medical or surgical care is given in time. Children need no longer look at life through crossed eyes, provided the attention necessary to straighten them is given early enough to prevent the loss of vision in the affected eye. Optical aids are constantly being improved. The road ahead promises to lead to other discoveries for the benefit of humanity. The fact that better illumination in factories is helping prevent accidents, is speeding up production, lessening wastage of material, and reducing loss of time caused by fatigue, will undoubtedly have an influence on home, school, and office lighting. The school of the future will be so constructed and equipped that it will have a maximum of well-controlled natural illumination and a system of artificial illumination best suited to the eyes of children and to the work they are expected to do. Classes will be smaller, so that individual as well as group instruction will be possible. Teachers and nurses will be prepared to give the necessary educational and health services. Educational equipment and material will be suited to the needs of the child for whom it is intended. Textbooks will be better printed, and the use of mechanical devices will decrease the amount of close eye work now required in the great majority of schools. If the advances of the future will so greatly lessen the number of partially seeing pupils, present preparation of prospective teachers, nurses, supervisors, and social workers may seem a waste of time and energy. But Utopia cannot be reached at a bound. Unfortunately, just as there are still isolated cases of smallpox, diphtheria, and other dread diseases, so there will be, scattered throughout the United States, a small number of partially seeing children who will need the assistance of those who understand their difficulties and are equipped to help in solving their problems. But of infinitely greater importance is the fact that knowledge and preparation will enable those interested in the welfare of humanity to make positive health the goal of the future. No time and energy spent in acquiring a knowledge of eye health and efficiency that will bring this goal nearer can be wasted.

APPENDIXES

Appendix

One: W H A T the T E A C H E R S H O U L D

KNOW about the EYE and EYE H Y G I E N E of the individual with the world about him is possible only through his senses. Of these, sight is by far the most important, since it is through this avenue of approach that the greatest number of impressions reach the brain. Seeing is an extremely complicated process involving the coordination of many factors, which have their origin in two sources: (i) those within the individual—the eyes through which to see and the brain to interpret messages sent to i t from the outside world through the eyes and (2) those in his environment—the light by which to see and the object to be seen. Objects can be seen only when they reflect light. In the sweep of a searchlight over wide areas of the sky an airplane suddenly appears. T h e drone of its engine may have been heard for some time, but it became visible to the individual looking skyward only when it reflected the rays of the searchlight. It would, however, have remained invisible to the individual had not certain processes known as refraction taken place within his eyes. T h e rays of light reflected by the airplane were refracted, or bent by the refracting media of the eye through which they passed. T h e rays of light were thus brought to such a focus that the image of the airplane was reflected on the retina—the receiving station of the eye corresponding to the film or plate used in a camera. T h e optic nerve carried this reflected image to the seeing portion of the brain. As in the case of a photographic negative, it was upside down. By some as yet unknown process the brain inverted the image to a right-side-up position and so interpreted the impressions received that the airplane became visible. Although time is a factor in seeing, these various actions took place in such rapid succession that the individual was unconscious of the many involuntary processes contributing to the phenomenon. ONTACT

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If for any reason the eyes had been unable to transmit the rays of light reflected from the airplane, the individual would have been unable to see it. If the eyes had been able to function in part so that some impression of the airplane, however faulty or indistinct, was able to reach the brain for interpretation, the individual would have been able to get some visual concept of the plane. Conversely, if there had been no light, the airplane would have remained invisible, however competent the eyes and the brain may have been. If, as in the case of a partially seeing individual, the eyes are not able to function fully, improved illumination and simplification of the visual tasks must be considered. If, on the other hand, the eyes are able to function fully, but the light is inadequate to meet the visual needs, either the eyes must work harder or the task be made easier. If for any reason the occipital lobes, or the seeing portion of the brain, cannot receive, interpret, or send messages, there can be no vision. From this brief analysis it will be seen that everyone concerned with the welfare of the child should have a practical knowledge of the eyes, the effect of light upon them, and the task they must perform. Practical knowledge of the eyes should include a general understanding at least of anatomy, physiology, and hygiene—anatomy, the structure; physiology, the functioning of the structure; hygiene, such adequate attention to eye growth and to the laws of eye health and efficiency that the structure will be able to function most successfully. In addition, a knowledge of refractive errors and common eye diseases is essential if the teacher, the nurse, and the social worker are to co-operate for the physical, emotional, social, and educational welfare of the child. Practical knowledge of light should include principles of correct illumination and the principles of refraction. Practical knowledge concerning various tasks the eyes are called upon to perform should include an appreciation of their relationship to the efficiency or inefficiency of the eyes. The general principles of illumination and those governing eye tasks have been presented. This section is therefore concerned with the anatomy, physiology, and hygiene of the eye, the general principles of refraction, and consideration of refractive errors and of common eye diseases.

T h e E Y E and E Y E EYE

HEALTH AND

HYGIENE

153

EFFICIENCY

It should be recognized at the outset that the term "eye health" is not necessarily synonymous with "eye efficiency." A healthy eye may be color blind; hence not able to distinguish colors; an eye that is efficient so far as central visual acuity (the power to see objects directly in front of it) is concerned, may be so affected by disease that there is no side or peripheral vision. GROSS A N A T O M Y A N D

PHYSIOLOGY

THE EYEBALL AND ITS PLACEMENT

T h e human eye is an outgrowth of the brain. T h e adult eyeball is about one inch in diameter and is spherical in shape. It is placed in the eye socket, or orbit, and is held in place by six muscles known as the extrinsic, or external, muscles, which enable it to move in many directions. These muscles are attached to the orbit and to the eyeball. T h e y must work in perfect co-ordination, not only with one another but also with the muscles in the other eye, in order to get the best results (Fig. 2). PROTECTIVE DEVICES

T h e eyeball is protected by the walls or bony structure of the orbit and by layers of fat that act very much like the shock absorbers in an automobile. Through these layers of fat run blood vessels, nerves, and muscles. T h e orbit is somewhat the shape of a cone with the apex toward the back through an opening of which the optic nerve passes to the ocular lobes, or seeing portion, of the brain. T h e eyeball is further protected by the eyelids, eyelashes, and eyebrows. T h e eyelids have two sets of muscles: (1) circular muscles by which the lids may be closed and (2) the levator muscle by which, as the name implies, the upper lid may be raised. T h e eyelids are well supplied with nerves by which their action is controlled. T h e lids close automatically when any foreign body approaches them, and thus they serve to protect the eyeball from possible injury. In this they are aided by the eyelashes which tend to interlace when the lids are closed, thus preventing the entrance of dust or other irritating substances. A delicate mucous membrane called the conjunctiva lines the lids and covers the front portion of the eyeball. Secretions make

P u l l e y of Superior Oblique

Eyeball

L e v a t o r of Upper Eyelid (Course indicated by d o t t e d l i n e s )

Nasal Bone

ic N e r v e

External

Inferior Inferior

Rectus

Rectus

Oblique

L e v a t o r of

I n f e r i o r O b l i q u e to B o n e FIGURE 2 EXTERNAL

MUSCLES OF THE

EYE

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155

it possible for the lids to move smoothly over the eyeball without irritation or discomfort. Glands in the eyelid secrete an oily substance which, with the tears, lubricates the eye. T h e eyebrows prevent perspiration and particles of dust from entering the eyes from above. T h e y also help soften any blow directed toward the eye. In this they are aided by that part of the bony structure of the orbit which is above the eyeball. In the orbit, on its temporal side, between the walls and the layers of fat, is a gland which secretes tears. T h i s is known as the lacrimal gland. T h e tears pass over the eyeball toward the nose, are excreted through a very small opening at the inner corner of the eye called the "punctum" into the lacrimal sac, from which they pass into the adjoining nasal duct. T h e chief functions of the tears are to keep the eyeball moist and to act as a mild antiseptic. T h e eyeball is composed of three coats or tunics: (1) sclerotic, or outer, coat; (2) choroidal, or middle, coat; and (3) retinal, or inner, coat (Fig. 3). 1. T h e sclerotic coat is composed of the sclera, identified as the white of the eye, and the cornea, identified as the transparent portion in front of the eye through which light is transmitted. T h e sclera, tough, opaque, and inelastic, protects the eyeball and helps maintain its shape. T h e cornea serves as a protection and as a refracting medium, bending the rays of light entering the eye so that they may be brought to a focus. 2. T h e choroidal coat provides nourishment for the eye. It is composed of the choroid, the ciliary body, and the iris, complicated organisms known collectively as the uvea or uveal tract. T h e choroid is the part directly beneath the sclera. Pigment on its interior surface gives it a brown color. It is well-supplied with blood vessels, through which nourishment is received. Attached to the choroid is the ciliary body, composed of the ciliary muscle and the ciliary processes. T h e chief function of the ciliary muscle is to control the curvature of the crystalline lens of the eye, making possible accommodation—the ability of the eye to focus the rays of light reflected from objects at varying distances. As the name implies, the ciliary is a circular muscle. T h e ciliary processes secrete a watery fluid called the aqueous. T h e y are also replete with blood vessels. T h e iris, or rainbow of the eye, is the circular colored portion of

Sclera Choroid Retina

Aqueous Chamber

Macula

Ciliary

Optic Nerve

FIGURE

3

HORIZONTAL SECTION ( L E F T EYE)

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157

this coat situated directly back of the cornea. It is perforated in the center by an opening known as the pupil. Its chief functions are to regulate the amount of light entering the eye and to cut off the marginal rays which would interfere with the sharpness of the image on the retina. T h e iris has two muscles: (1) a circular muscle that contracts under high illumination and thus decreases the size of the pupil and (2) a radial muscle that expands the iris under low illumination and thus increases the size of the pupil. Just back of the iris is suspended the crystalline lens, a transparent, biconvex body. It is one of the refracting media of the eye for focusing rays of light reflected from any object within the range of vision. In order to perform this function it must change its convexity according to the distance of the object from the eye. T h i s is known as accommodation. 1 3. T h e retinal, or innermost and best protected, coat of the eye is composed of the retina and the optic nerve. In reality the retina is an extension of the optic nerve which spreads out in a thin membrane under the choroid. T h e retina is identified as the receiving station of the eye. It is composed of many layers, all working in coordination. Its most sensitive area is known as the "macula," situated slightly toward the temporal side of the optic nerve. In the center of the macula is the fovea, the portion of the retina used for discriminating exact details of form. T h e optic nerve is a composite body actually made up of a very large number of nerves. Starting with the nerve ends of the retina, the fibers converge toward a place at the back of the eye known as the "optic disk"; they extend through the opening in the orbit to the brain. T h e chief function of the optic nerve is to transmit to the brain messages received by the retina. T h e front part of the interior of the eyeball is filled with a watery nutrient fluid known as "the aqueous," which is secreted by the ciliary processes. Under normal conditions it circulates between the lens and the iris and between the iris and the cornea and is excreted through a small circular canal called, from the name of its discoverer, the canal of Schlemm. T h e back part of the interior of the eye is filled with a jelly-like, transparent substance known as "the vitreous," which assists in keeping the eyeball in shape and in 1 See section "Refraction," p. 158.

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T h e E Y E and E Y E

HYGIENE

maintaining a normal balance of pressure within the eyeball. Both aqueous and vitreous have some refractive power. PRINCIPLES OF REFRACTION

There are certain principles of refraction which, if borne in mind, aid in understanding how the eye functions to bring rays of light reflected from an object to a focus. W h e n rays of light pass through a glass prism, they are always deflected or bent toward the base (Fig. 4). A convex lens is in reality made up of two prisms with

RAYS

OF

LIGHT PASSING THROUGH

PRISM

AND

DEFLECTED

TOWARD THE BASE

a common base at the center (Fig. 5a), the sides being curved (Fig. 5 b). Parallel rays of light passing through such a lens will be deflected or bent toward the bases of the prisms (Fig. 5c) and will thus

00 I

a

FIGURE 5 CONVEX LENS (a) Bases of prism at center; (b) Curved sides; (c) Parallel rays of light becoming convergent.

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become convergent, making it possible for them to meet, or be brought to a focus. Conversely, a concave lens is made up of two prisms with their apexes toward the center (Fig. 6a) their sides being likewise curved

c FIGURE 6 CONCAVE

LENS

(a) Apexes of prisms toward center; (b) Curved sides; (c) Parallel rays of light becoming divergent.

(Fig. 66). Parallel rays of light passing through such a lens will follow the principle of being deflected toward the bases and therefore will become divergent (Fig. 6c). In order to make them converge they will have to pass through a convex medium. Naturally, rays of light passing through the exact center of either convex or concave lenses will not change their direction. It is evident that the greater the curvature of the lens, the more the rays of light will be bent or deflected. Since the eyeball is spherical in shape, the chief refractive media through which rays of light pass, the cornea and the lens, are convex, and in the normal eye rays of light are brought to such a focus by these refracting media that the image of the object from which they are reflected falls directly on the retina. When an object within the range of vision is twenty feet or more distant from the eye, the rays of light reflected from it are parallel; hence the lens in the normal eye does not have to change its curvature. The ciliary muscle, which controls its curvature is therefore at rest.

i 6o

T h e E Y E and E Y E

HYGIENE

When, however, an object is close to the eyes, rays of light reflected from it are no longer parallel but divergent. T h e chief refractive media of the eye, being convex, change their direction to convergent rays, but unless the curvature of some of the refracting media is increased, the image of the object will not be reflected on the retina.

«

b FIGURE CONVEX

7 LENS

(a) Parallel rays of light brought to a focus; (6) Effect of increasing curvature of lens.

T h e lens is the only refracting medium within the eye that can change its curvature. When it is increased by the action of the ciliary muscle the rays of light are bent sufficiently so they are brought to such a focus that the image of the object is reflected on the retina. T h e power of the lens to accommodate its curvature according to the distance of the object from the eye is called "accommodation."

FIGURE 8 CONCAVE

LENS

(a) Parallel rays of light becoming divergent; (b) Effect of increasing curvature of lens.

"Emmetropia" is a word derived from em (in), metron (measure), and opia (eye). A n emmetropic eye is one in which the size, shape, and refracting media are such that, with accommodation relaxed, the image of an object twenty feet or more from the eye is focused directly on the retina.

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161

T h e significance of the word "ametropia" lies in the prefix a, meaning "away from." An ametropic eye is therefore one that has a refractive error because it deviates in some particular "away from" emmetropia. Ametropic eyes are of three general types: hyperopic; myopic; and astigmatic. Ametropic eyes can usually be given compensation for their errors of refraction by the placement of lenses or glasses in front of the eyes. T h e strength of such lenses depends upon the amount of deviation from the normal. T h e unit of measurement of refraction is called a diopter, meaning "to see through." Refracting media in the eye and artificial lenses must, therefore, be transparent; and the latter must be of a correct number of diopters to compensate for the difficulties for which they are prescribed. T h e hyperopic eye is too short from front to back; it is often spoken of as being "farsighted," because it sees objects better at a distance than at hand. It does not, however, see even distant objects as clearly as does the normal eye. Rays of light become parallel when they are reflected from a distance of twenty feet or more from the individual. Normal eyes do not have to accommodate in order to see distant objects and are, therefore, at rest. The hyperopic eye, however, experiences no such rest period, since its ciliary muscle is constantly working to try to increase the curvature of the lens sufficiently to give a correct focus, and considerable strain or fatigue may result. In cases of marked hyperopia and in those of less degree in which there are symptoms of strain, compensation for the difficulty is made possible by placing in front of the eye a lens similar in shape to that in the eye, thus helping the crystalline lens to overcome the difficulty. Such a convex lens is called a plus lens because it adds to the efficiency of the crystalline lens of the eye in bringing the rays of light to a focus, so that the image of the object will be reflected on the retina of the foreshortened eye. T h e myopic eye, on the other hand, is usually too long from front to back; hence the rays of light focus in front of the retina. In order to obtain a focus farther back, where the retina of a nearsighted eye is, it is necessary to place in front of the eye a lens differing in shape from the crystalline lens, namely, a concave lens, which will diverge rays of light. When the divergent rays pass through the

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The E Y E and E Y E

HYGIENE

convex refracting media of the eyes they are brought to a focus farther back than would be possible without the extra lens. This type of lens is called a minus lens, because in contrast to a convex lens it decreases the refracting power of the lens of the eye. Astigmatism is an error of refraction resulting from a deviation from the normal in the curvature of the cornea or of the crystalline lens. One of the two main meridians at right angles to each other is usually affected, but the error may occur in any meridian; hence a type of lens must be used that will correct only the affected meridian. A spherical lens cannot be used, because it corrects all meridians. A cylindrical lens, therefore, must be selected, since it corrects in one direction only. When a cylindrical lens is prescribed, the meridian affected must be designated and the lens must be placed in the frame at exactly the position indicated. Differences in temperature may cause a frame to expand; hence a round lens may become slightly turned in the frame, in which position it not only fails to correct the error but places a correction on a normal meridian, thus causing two deviations. T o avoid this difficulty, elongated lenses are now used rather than round ones. Simple astigmatism is always hyperopic or myopic, but astigmatism may be associated with refractive errors of the whole eyeball which may be either of the same type as the astigmatism, or an opposite type. If of the same type, it is a compound hyperopic or myopic astigmatism; if of the opposite type, it is a mixed astigmatism. Occasionally the cornea, instead of being a segment of a sphere, is cone shaped. It is then known as a conical cornea, or keratoconus, which neither spherical nor cylindrical lenses will correct. A contact lens is therefore sometimes recommended. As its name suggests, it fits directly on the eyeball. It is held in place through suction by means of a fluid resembling as nearly as possible the tears. A contact lens actually forms a false spherical cornea, through which rays of light are normally refracted. The liquid lies between the false and the true cornea, thus keeping the latter moist. Occasionally contact lenses are prescribed in other types of refractive errors, such as very high progressive myopia. Another very important deviation from the normal is imbalance of the extrinsic or external muscles, the six muscles holding each

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eyeball in place. A deviation which is not apparent, but latent, is called a "phoria"; a marked deviation is called a "tropia" and manifests itself in some form of strabismus, or crossed eyes. In both phorias and tropias the type of deviation depends upon the muscles affected. T h e most common form of tropia is an internal strabismus, or squint, in which the deviating eye turns toward the nose. In an external strabismus, or squint, the deviating eye turns away from the nose. In less common forms the deviating eye turns upward or downward. Sometimes the eyes turn inward (toward the nose) alternately—a condition known as alternating strabismus. When an individual with normal eyes looks directly at an object, rays of light are focused to bring the image simultaneously on the fovea of each eye. T h e optic nerve carries these impressions to the brain, which under normal conditions has the power to fuse them into one image; hence there is no confusion, and the individual sees one distinct picture. In strabismus the unaffected eye may be looking straight ahead, but the eye that is turned inward or outward or upward or downward will be looking in another direction; hence, a different image falls on the fovea of each eye. T h e result is that such confused impressions reach the brain that it cannot fuse them into one picture. Double vision, or diplopia, may result, which is so distressing to the individual that he often gradually suppresses the image in the crossed eye; in time such an eye may cease to function. T h e end result is known as "amblyopia ex anopsia," signifying a dimming of vision from nonuse. Occasionally such a deviating eye may be reeducated by special exercises, known as orthoptics, given by an eye specialist or by a trained technician under his direction. These exercises are intended to make the eye straight, just as orthopedic exercises are for the purpose of making limbs straight. In both conditions, however, prevention of the difficulty, if possible, is infinitely to be preferred. GROWTH AND DEVELOPMENT OF THE

EYE

In order to understand the implications of deviations from the normal, everyone interested in the welfare of the child needs an appreciation of the growth and development of the eye. This

164

The E Y E

and E Y E

HYGIENE

knowledge gives a basis for understanding and interpreting the child's reaction to visual effort. T h e teacher must have such knowledge to enable her to adapt educational processes intelligently. A t birth, eyes, like other parts of the body are not fully developed. T h e eyeball is short from front to back. In keeping with the rest of the body, the eye grows until it reaches adult proportions, approximately an inch in diameter. T h e rate of growth differs with the individual, some eyes attaining adult proportions much earlier than others. As has been stated, an eye that is too short from front to back is a hyperopic or farsighted eye. T h i s condition is normal in young children and unless there is some other eye defect such as muscle imbalance, glasses are not prescribed, because, as is the case with other parts of the body, the eye depends upon exercise for growth and development. Since the hyperopic eye sees things at a distance much better than those nearby, great care must be taken in the selection of playthings for young children. Small objects or pictures may have to be brought so close to the eyes that considerable strain or fatigue will result, due to the excessive action the ciliary muscle is called upon to make. When children enter school, they are still hyperopic; hence these principles should be taken into account in the selection of all educational material. Indeed, consideration should be given to this subject even in high school; statistics show that the chief deviation from the normal in the eyes of high school pupils is hyperopia. In some cases the eyes of an individual do not stop growing when adult proportions have been reached. T h e eyeball becomes too long from front to back—the condition known as "myopia." Occasionally this may be found in a very young child. In myopia the visual range is limited, and the myopic child usually prefers to hold objects close to his eyes. His writing is likely to be small and cramped. For myopia even the young child is given compensating glasses to increase his range of vision, and objects and materials should be of a size to enable his eyes, when corrected, to see them at the normal range. In the very young child the two eyes do not work together any more than do the two hands or the two feet. By the end of the

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first year, however, visual co-ordination should be fairly well established. T h e processes continue to develop until the child is approximately seven or eight years of age. If at the end of the first eighteen months the two eyes do not focus together, immediate attention should be given. In many cases in which there is a strain on the deviating eye because of an error of refraction, correction may so relieve the strain that the deviating eye will have an opportunity to straighten. In some cases an operation may be necessary. T h e important point to be noted, however, is that the earlier proper attention is given, the greater is the hope of correction. Not only is a "crossed" eye likely to become a useless eye, as has been explained, but also it is so disfiguring that it may affect the emotional and social life of the child as well as his educational processes.

STRUCTURAL ANOMALIES

OF

THE

EYE

2

Structural anomalies or abnormal conditions may occur in prenatal or postnatal development of the eye. Some of these affect the eyeball as a whole, and others affect certain parts of the eye structure. A few of these are briefly discussed. Congenital and hereditary deficiency of pigment is known as "albinism." Cases of all grades of albinism occur. It is sometimes difficult, in fair races, to differentiate between extreme blondness and albinism. T h e incidence of albinism is estimated as one person in 10,000. When it is complete, there is no pigment in hair, skin, or eyes; when incomplete, the hair, eyes, or the skin may be affected. It is more common in dark than in fair races, being found even in the negro. In albinism the eye has a pinkish appearance, because the lack of pigment allows the light to pass through the iris and sclera so readily that the reflected light coming from the pupil gives a reddish glow from the choroidal blood. High errors of refraction, especially myopia and astigmatism'and also a condition known as "nystagmus," a constant movement of the eyeball due to a cong e n i a l l y defective macula, are often found in albinos. T h e vision 2 Sir W. Stewart Duke-Elder, Text-Book of Ophthalmology, Vol. II, St. Louis, Mosby, 1938, Section X, chap, xxx, "Congenital and Developmental Anomalies."

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of albinos is often extremely defective and is usually accompanied by intense photophobia. Aniridia is a rare condition in which the iris is extremely rudimentary. The apparent complete absence of iris is due to the fact that the rudimentary part is hidden. In very marked cases of microphthalmus (abnormally small eyeball) the iris is sometimes completely absent, if the entire anterior portion of the eye has failed to develop. Anophthalmus is a condition in which the eyeball fails to develop; it is exceedingly rare. Usually in such cases a small, solid, rudimentary mass is all that exists. Aphakia is characterized by the absence of a lens. The term "aphakic" is usually applied to an eye from which the lens has been removed by operation. Congenital aphakia is exceedingly rare. If an eye has suffered such prenatal interference in development that aphakia has resulted, it will show other abnormalities—usually an extreme degree of microphthalmus. Coloboma is a type of congenital anomaly in which a portion of a structure of the eye is lacking. A coloboma of one structure, such as the choroid or the retina, may be limited to the particular structure or may involve associated structures. An artificial coloboma is created by an optical iridectomy, performed to make a new pupil, or by an operation in which part of the iris is removed, usually preliminary to an operation for cataract. Macrophthalmus (buphthalmos, hydrophthalmos, megalophthalmos) indicating an abnormally large eyeball usually results from infantile glaucoma. This is caused by an interference with the filtration of fluid from the eye, due to a congenital defect. Usually both eyes are affected. The prognosis is unfavorable, although in some few cases an operation is helpful. In microphthalmus an eyeball is congenitally abnormally small in all its meridians. COMMON EYE DISEASES

T o one unfamiliar with medical terms, those relating to the eye appear exceedingly difficult. A few suggestions may be of help. The suffix itis always indicates an inflammation. The part that is so affected is indicated by the root of the word. Thus, tonsilitis means

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167

an inflammation of the tonsils; appendicitis, an inflammation of the appendix. A n inflammation may affect parts of the eyeball or its appendages. Iritis would, naturally, indicate inflammation of the iris; cyclitis, inflammation of the ciliary. In some instances the inflammation may affect contiguous parts. T h u s such a condition starting in the choroid may extend to the ciliary muscles and processes and to the iris making up the uveal tract; it would then be called "uveitis." When inflammation affects the entire eyeball, it is known as "panophthalmitis." Any part of the eye may become diseased, the disease having its origin in the eye or in some other part of the body. Injuries to the eye may result in blindness, in seriously impaired vision, or in the loss of the eyeball. Scars resulting from disease or from injury may so affect the transparency of the cornea that light cannot be transmitted. T h e contents of the lens of the eye may become opaque, thus preventing rays of light from passing through it. Any part of the eye, such as the optic nerve, may atrophy and thus be unable to function. As a result of a fall, a blow, or from some other cause, part of the retina may become detached from the feeding coat, the choroid, and be unable to receive impressions from the outside world. Diseases of the body and even an emotional upset may affect the eyes. Before the discovery of vaccine to prevent smallpox, that disease was one of the chief causes of blindness and impaired vision. Venereal diseases have taken a heavy toll of eyes. Diabetes is sometimes a contributing factor in eye difficulties. Lack of certain vitamins may have disastrous effects. It cannot be reiterated too often that it is not the function of the nurse, the social worker, or the teacher to diagnose, but it is their responsibility to recognize untoward symptoms as early as possible in order that adequate attention may be obtained. COMMON AFFECTIONS

OF THE

EYELIDS

One of the most common diseases of the eyelid is the hordeolum, or sty. This may occur at any age, but is most common in children and young adults. T h e direct cause is an infection of the root of the eyelashes. Very often one sty follows another for a considerable period, because the infection travels from one eyelash to the next.

T h e EYE and EYE

HYGIENE

No teacher or nurse who has suffered from a sty or has seen a child so afflicted needs to be told that this eye difficulty is painful and depressing. A child who develops sties over a long period of time is a sick child, and efforts must be made to find the underlying cause which makes it impossible for him to resist infection. T h e cause may be a run-down condition of the body, anemia, malnutrition, too little sleep, or an uncorrected error of refraction. A child with sties often needs careful medical attention. Home visits of nurse and teacher assist greatly in discovering underlying causes. Blepharitis is an inflammation of the margin of the lids. It is usually accompanied by the formation of white scales or crusts around the eyelashes. If the difficulty becomes chronic, there is often permanent loss of the eyelashes and reddening and thickening of the lids, giving a very unsightly appearance, which may cause an unfavorable psychological reaction. T h e underlying causes of blepharitis are much the same as of sties; in both there is usually soreness, itching, tearing, photophobia (extreme sensitiveness to light), and fatigue of eyes and body. Occasionally an oil gland, usually in the upper lid, becomes stopped up and a small lump called a "chalazion" forms. It is in reality an enlargement of the gland. It is not serious unless it becomes chronically inflamed or unless it presses upon the eyeball. An operation is usually performed under a local anesthetic to remove the obstruction. Ptosis is the drooping of the upper lid due to deficient development or paralysis of the levator muscle. It usually affects both eyes, and when pronounced it interferes with vision by covering the pupil; it may be congenital or acquired. Occasionally a patient with ptosis may be helped by a mechanical device for holding up the lids, but in the majority of cases an operation is usually necessary. Conjunctivitis is an inflammation of the membrane lining the eyelids. It is caused by an infection. There are many types of conjunctivitis; one is commonly known as "pink eye," because of the inflammation of that part of the conjunctiva which covers the eyeball. Pink eye is exceedingly communicable, and children showing symptoms of any such difficulty should be excluded from school and be given adequate medical care. Poor hygienic surroundings, anemia, or errors of refraction are some underlying causes.

T h e E Y E and E Y E H Y G I E N E

169

W h e n the infecting germ is the gonococcus, the streptococcus, or one of a number of other harmful organisms, the condition is exceedingly serious. Before Credi's discovery of nitrate of silver as a prophylactic in the eyes of the newborn, this purulent conjunctivitis was one of the most common causes of blindness. Prevention is the keynote, but should the disease develop, immediate attention is essential if the sight is to be saved. Trachoma, which is a disease of the cornea as well as the conjunctiva, is discussed below under the topic "Affections of the Cornea." DISEASES OF THE LACRIMAL

APPARATUS

Occasionally the lacrimal gland secretes an oversupply of tears, or the duct excreting tears into the nose becomes stopped up and epiphora, or watery eye, results. Tears flow over the face and cause much irritation. Inflammation of the lacrimal gland itself is rare, but unfortunately inflammation of the lacrimal sac into which tears flow is not uncommon. It is called by a long name, dacryocystitis, meaning a cyst or growth in the lacrimal sac. T h e condition is often very painful. Treatment usually consists of probing through the sac, removal of the cyst, or removal of the sac. DISEASES OF THE

ORBIT

Among the many difficulties that may affect the orbit, the most common trouble is sinusitis, an inflammation of the sinuses. When the inflammation occurs in the frontal sinuses just above the eyes, it usually causes severe headaches, dizziness, and ocular complications. AFFECTIONS OF THE

CORNEA

T h e Greek word for cornea, kera, is often used to describe difficulties that affect the transparent portion of the front of the eye. Thus, "keratoconus," described under "Refraction," page 162, is a cone-shaped cornea, causing a complicated astigmatism difficult to correct. Various forms of keratitis may affect the outside layers of the cornea and cause affections. One form of keratitis is called "phlyctenular keratitis." T h i s

170

The E Y E and E Y E

HYGIENE

usually occurs in young children. Little phlyctenules—small, red projections—often form ulcers that may appear on either the conjunctiva or the cornea. Phlyctenular keratitis is usually accompanied by lacrimation and marked photophobia. A child with phlyctenular keratitis wants to remain in the dark and will often bury his face in a pillow. The disease usually occurs in debilitated children and in those who suffer from poor nutrition, caused by either poor food or improper diet. Insanitary living conditions may be a contributing factor. A child with phlyctenular keratitis is usually a sick child requiring rest and treatment in accordance with the underlying cause. Many physicians believe it to be a tubercular condition and recommend the same treatment that is given in other forms of this disease. If the middle layer of the cornea (called the "substantia propria") is affected, interstitial keratitis results. It is an eye condition that may cause blindness unless adequate care is given in time. This disease, found chiefly in children and young adults, is usually caused by the transmission of syphilis from the mother to the unborn child. Often there is no sign of this infection until between the fifth year and the fifteenth year, the very time of a child's school life when he needs the best sight possible for laying an educational foundation. If the disease is in a communicable stage, the afflicted child should not be permitted to attend school. If on discovery of the difficulty, treatment for syphilis is given and carried out faithfully, and if the eyes have not been too seriously affected, the condition may clear up. Even in quiescent forms an inflammation may flare up at almost any time, so social workers, nurses, and teachers should be on the lookout for this possibility. There are three preventive measures for syphilitic interstitial keratitis: premarital examinations; examination of the prospective mother and her treatment, if found necessary, at least five months before the child is born; thorough medical examination of all infants in order that the presence of any infection may be detected early enough to prevent its ravages. Trachoma is an infectious disease of the eyes, the cause of which is believed to be a filterable virus. It affects the conjunctiva and the cornea and in acute cases, other parts of the eye.

T h e E Y E and E Y E H Y G I E N E

171

It is sometimes known as granular conjunctivitis, because of the hard granules that form on the conjunctiva. Disastrous complications result, which in many cases are responsible for partial or total blindness. Trachoma was at one time prevalent in many parts of the United States, especially on some of the Indian reservations and in regions of Arkansas, Illinois, Indiana, Kentucky, Missouri, Oklahoma, Tennessee, Virginia, and West Virginia. In fact in Missouri it was at one time the chief cause of blindness among those receiving pensions for the blind. Until very recently the treatment was exceedingly painful. It has been found, however, that especially in the early stages certain forms of the sulfa drugs are efficacious, and there seems to be considerable hope of finally eradicating the disease. DISEASE OF THE SCLERA

As the name implies, scleritis is an inflammation of the tough, protective coat of the eye. If it is confined to the outer layer of this coat, it is called "episcleritis." T h i s form is usually much less serious than an inflammation extending to the deeper parts. In the latter case the disease often affects the subadjacent and contiguous parts. DISEASES OF THE

CHOROID

T h e choroid, the iris, and the ciliary bodies are all subject to inflammation, singly or together. A l l such difficulties are serious, because this is the feeding coat of the eye upon which the rest of the eye depends for nourishment. Iritis may be caused by syphilis, gonorrhea, or a local infection. It may be rheumatic, diabetic, tubercular, traumatic, or sympathetic. Sympathetic iritis is usually due to an inflammation of the uveal tract in one eye resulting from a similar inflammation in the other. T h e iris appears swollen and dull; its color changes, becoming a green hue in gray or blue eyes and muddy in appearance in darker eyes. One of the chief possible difficulties in iritis is the formation of adhesions between the iris and the cornea and the iris and the lens, thus interfering with both the circular and radial muscles and making it difficult, if not impossible, for the iris to per-

172

The EYE and EYE H Y G I E N E

form its function of regulating the amount of light passing through the pupil. It is a very painful disease, accompanied by photophobia, profuse tearing, and interference with vision. Here, again, the elimination of the cause is important. Rest for the eye is not only desirable but essential. Cyclitis is likewise a very serious eye inflammation, having the same causative factors as iritis and definitely interfering with the seeing process. The treatment, as in iritis, depends upon the underlying cause. DISEASES OF THE LENS

The chief difficulty to which the lens is subject is cataract, an opacity of its contents or its capsule. Although there are many forms of cataract, the most common is the senile type, appearing frequently in persons more than fifty years old. The lens becomes hard and opaque and no longer responds to the action of the ciliary muscle. Both eyes are usually affected, one, however, before the other. Although some physicians believe that nutrition is a factor, the generally accepted treatment is removal of the lens by operation, after which an artificial lens is placed in front of the eye to act as a refracting medium in its place. Congenital cataract, although far less common than the senile type, is found in almost every group of partially seeing children and is one of the causes of blindness among children. Congenital cataract is caused by the failure of the contents of the lens to become clarified in prenatal stages. The condition is sometimes hereditary, and it is not uncommon to find a number of children from one family group in a school for the blind because of this difficulty. The treatment for congenital cataract differs radically from that used in the senile type. In the former the contents of the lens is not hard and opaque as in the latter, but usually soft and cloudy. This type requires an operation called needling, by which openings are made through the lens capsule. The lens swells and protrudes through this opening, parts falling into the interior chamber of the eye where they are absorbed by the aqueous. Usually several needlings are necessary. Often the results are so good that with compensating glasses cataractous children are able to carry on their

The EYE and EYE H Y G I E N E

173

work in regular grades. In other cases the lens material is only partly clarified and vision is definitely affected. In a class for the partially seeing there will occasionally be found a child with a subluxated lens, the center of which is below the pupil of the iris, causing a definite interference with the refraction of light rays. DISEASES OF THE RETINA

The retina, perhaps because of its delicate structure, is subject to many affections. Among these are defects of the macula, inflammation, circulatory disturbances, degeneration, and detachment. Inflammation of the retina is rarely limited to its area but is commonly associated with diseases of the choroid and of the optic nerve. The retina, like other parts of the eye, may be affected by diseases of other parts of the body—syphilis, arteriosclerosis, nephritis, diabetes. One of the difficulties with which those concerned with the welfare of partially seeing pupils should be conversant is retinal detachment. This sometimes occurs in cases in which both high myopia and pathological conditions of the eye exist. Because of elongation of the eyes from front to back the retina may become thinned or the vitreous material may shrink and thus pull the retina away from its attachment to the choroid. Any very sudden action, like diving, may cause the thinned retina to tear. Sometimes a blow or a fall will cause detachment. Until very recently a detached retina meant blindness, but surgical techniques have been developed by which, if the necessary attention is given as soon as possible after detachment occurs, the retina may in some cases be reattached, and part of the vision may be saved. Any sudden decrease in vision always indicates the need for immediate examination of the eyes. DISEASES OF THE OPTIC NERVE

The affections of the optic nerve are likewise numerous: hyperemia, or congestion of the optic disk; choked disk; inflammation; tumors; atrophy; and injuries. A common cause of some of these eye affections is syphilis. Less frequent causes are encephalitis, meningitis, focal infections, and poisoning—especially lead poisoning. Treatment depends upon the cause,

i74

T h e EYE and EYE

HYGIENE

AFFECTIONS OF THE AQUEOUS OR VITREOUS

T h e fluids that are found within the eye are not immune from affections. Any difficulty with the circulation of the aqueous vitally affects the pressure within the eyes and is often responsible for one of the most serious of eye diseases, glaucoma. If for any reason the canal of Schlemm is unable to excrete the aqueous that has been secreted by the ciliary and circulated throughout the front part of the interior of the eyeball, the pressure within the eye becomes abnormal; the eyeball hardens, and blindness often results, if treatment is not instituted early. Usually an operation is necessary to relieve such pressure. Glaucoma is a most insidious eye difficulty. In acute cases there is some pain; but in chronic cases there is no pain to indicate the need for help, and the side or peripheral vision which is first affected diminishes so gradually that the patient is not aware that his sight is going until it is too late. Although there are cases of congenital glaucoma, they are comparatively rare; the disease usually occurs in middle age and later life, and the only way to be sure that it does not exist is for the individual to have periodic medical examinations including eye examinations. Affections of the vitreous are usually due to complications in adjacent parts; the jelly-like substance may change its consistency and become fluid. There may be opacities in the vitreous, some of which may interfere with vision; foreign bodies may penetrate into this interior of the eye. Primary inflammation does not occur in this area, because it is devoid of blood vessels. Occasionally, because of an accident, the vitreous is lost and the eyeball collapses.

Appendix Two: VISION TESTING, a SCREENING PROCESS are given for the purpose of screening out those who appear to need ophthalmological attention. In some communities the school physician does the testing; in others, the school or other public health nurse; in still others, the teacher. T o meet varying needs it has been found necessary to devise procedures by which it will be possible, without a highly specialized staff, to have tests given. It is evident that these procedures must be adapted to the understanding of those to be tested, to the ability of the tester, and often to the physical facilities available. If the school physician is designated, he may include tests to evaluate the following aspects of visual functioning: (1) central visual acuity—the ability to distinguish form; (2) visual fields— the ability to discern objects not in the direct line of vision; (3) simultaneous single binocular vision—the ability of the two eyes to work together to obtain a single image which has depth. This procedure includes tests for muscle balance, stereposis (depth perception), and fusion (the blending into one visual concept of the images seen by both eyes), and (4) color vision (chiefly the ability to distinguish red, yellow, and green). If the school nurse is designated to give tests, she may include any or all the above, provided she has had adequate preparation for giving them. If the teacher is designated, with few exceptions she is expected to give only visual acuity tests. ISION TESTS

SUPERVISION

OF

TESTING

Regardless of the person chosen to do the actual testing, the screening program is primarily the responsibility of the school health service. Delegation to a teacher or to any other worker does not relieve the health service of the responsibility for insuring correct techniques and for guiding and supervising the program.

176

VISION

TESTING

Preparation for giving tests should include: (1) a working knowledge of the general structure and function of the eyes; (2) the ability to recognize obvious symptoms of eye difficulties; (3) an understanding of the general principles underlying the test; (4) an appreciation of the psychological factors involved; and (5) the importance of and the reasons for following standard techniques. Demonstrations and practice testing, as well as discussions of the significance of the findings, should be an essential part of the preparation. Desirable as such preparation and supervision are, there are situations in which no such help is available and the teacher must rely on her own initiative for getting the necessary information. In all cases, however, there are certain principles that must be adhered to if any test is to be worth the giving. TEST FOR VISUAL ACUITY

T h e test for central visual acuity is conceded to be the most important single test of visual ability; the test used for this purpose is called the Snellen test and requires a chart with test objects, symbols, letters, or numbers of graded sizes, drawn to a definite scale. Such a chart is called a Snellen chart. For giving central visual acuity tests, the following suggestions are made: 1. T h e test chart must be drawn to correct scale and properly printed. Since it is difficult for the teacher to evaluate charts, it is best to obtain them from a reliable source. T h e chart must be clean so that it will afford maximum contrast between the test objects (symbols, letters, or numbers) and the background. 2. T h e chart must be properly placed in accordance with background, lighting, and desired height. 3. T h e child must be at a correct distance from the chart. 4. T h e child's reactions during the test must be observed and compared with his general classroom behavior. 5. T h e results of the test should be understood not for the purpose of diagnosis (which is not the function of the nurse or the teacher), but in order to know whether further action is necessary. TYPE OF CHART

T h e Snellen test chart, either a Symbol E or Lines of Letters, is

MEASURING

THE

AMOUNT CHART

OF

WITH

ILLUMINATION LIGHT

METER

ON

THE

TEST

M E A S U R I N G THE T W E N T Y - F O O T

D I S T A N C E F R O M THE

CHART

CORRECT

METHOD

THE

NOT

WELCH

EYE

ALLYN

OF

BEING

TEST

COVERING TESTED

CHART

ILLU-

MINATOR

Designed according to specifications of the Advisory Committee of Ophthalmologists of the American Student Health Association and the National Society for the Prevention of Blindness, Inc.

COVER

AND W I N D O W

C A R D S IN

USE

Child indicates the direction in which the prongs of the symbol point.

VISION T E S T I N G

177

recommended. For general screening purposes the Symbol E chart has several advantages: (1) it makes use of a single test object; (2) it cannot be easily memorized; (3) it can be used with young children; (4) it focuses attention, because the child does not need to distinguish one letter from another or to name what he sees; and (5) it makes it possible for the individual merely to indicate with hand or arm the direction in which the prongs of the E point. Older children usually prefer to state the direction—up, down, right, left. T o avoid mistakes that sometimes arise from confusion between the right and the left hand, it is suggested that an object be selected on each side of the chart and that the direction be indicated by naming the object. LIGHTING AND PLACEMENT

Accurate testing requires that a diffused light shall be evenly distributed over the chart, which shall be so placed that no glare or distracting objects or other sources of light are within the child's vision, and that the room illumination shall be at least one-fifth of the amount of the light on the chart. T h e unit of measurement of illumination is a foot-candle, the amount of light produced by one standard candle on the surface one foot from the light source. For convenience in measuring illumination, small portable light meters are available. In many school systems these are considered as much a part of the school equipment as the classroom thermometer. Since increased illumination compensates for some eye difficulties, thus preventing their detection, the light on the chart should be approximately 10 foot-candles—a variation from 8 to 12 being allowable. If there is no instrument available for measuring the illumination, the teacher must do the best she can and must make every effort, in successive tests, to reproduce like conditions so that results of the tests may be comparable. DISTANCE OF CHILD FROM CHART

A distance of twenty feet has been selected as the most desirable, since normal eyes are practically at rest when viewing objects at this distance. Accurate measurement of distance is essential; a yardstick or long tape measure should be used.

178

VISION

TESTING

SYMPTOMS OF VISION DIFFICULTIES

General or local symptoms may be the most important way of discovering eye difficulties. N o t all the symptoms can be observed during the periods of testing, but many can be seen in daily contacts with the child. Throughout the test it is important to watch for evidences of strain, such as thrusting head forward; tilting head; watering eyes; frowning or scowling; puckering the face; closing one eye, when both eyes are being tested together; excessive blinking. T h e following symptoms, noted during daily contacts with a group of children, may be indications of eye difficulties: Behavior Walks with extreme caution, looking closely or feeling with the foot for a step up or a step down or for small obstructions; trips or stumbles frequently. Holds reading material or other types of fine visual work close to eyes or at a greater distance from the eyes than is normal. Attempts to brush away blur; rubs eyes frequently; frowns; distorts face when using eyes for either distant work or close work. Shuts or covers one eye; tilts head to one side or thrusts it forward. Fails to see distant objects readily visible to others. Is unduly sensitive to light. Is unable to distinguish colors. Is unable to estimate accurately locations of objects, hence frequently runs into them or fails to place object properly. Fails to see objects not directly within the line of vision, which are clearly visible to the average person, while the eyes are fixed looking straight ahead. Appearance of eyes Red-rimmed, crusted, or swollen eyelids. Frequent sties. Watery or red. Crossed or not functioning together. Discharge of pus.1 Bloodshot. 1 T h e presence of any of the symptoms so marked indicates the need of immediate ophthalmological care.

Complaints due to use of eyes Dizziness. Headache. Nausea. Pain in the eyes.2 Blurring of letters or objects. Double vision. Burning or itching lids. RECORDING T o s i m p l i f y the recording of eye tests, the results are usually written as t h o u g h they were fractions, the n u m b e r a b o v e the line always indicating the child's distance f r o m the chart, and the n u m ber b e l o w the line s i g n i f y i n g the line on the chart that the child is able to read at that distance. T h u s , a record of 20/30 indicates that the c h i l d was twenty feet f r o m the chart and at that distance was able to read the line that the n o r m a l eye can see at thirty feet away. I t is rather u n f o r t u n a t e that this f o r m of recording was selected, since m a n y think of the results as actual fractions and attempt to reduce t h e m to the percentages such fractions w o u l d indicate. I t is n o t u n c o m m o n to hear a teacher state that a child w i t h a record of 20/40 has " o n l y 50 percent vision," whereas, in reality, he has a visual efficiency of 83.6 percent, as shown i n T a b l e V I of e q u i v a l e n t percentages mathematically w o r k e d o u t for the A m e r i c a n M e d i c a l Association: TABLE

V

PERCENTAGE OF VISUAL EFFICIENCY RETAINED, BASED ON SNELLEN'S NOTATION DISTANCE 20/20 20/30 20/40 20/50 20/70 20/100 20/200 2 Ibid.

PERCENTAGE OF VISUAL EFFICIENCY 100.0 91-5 83.6 76.5 64.0 48.9 20.0

i 8o

VISION

TESTING

In rural areas it is often difficult for teachers to get the necessary preparation for making visual acuity tests, but all can follow the principles indicated. Even if no test chart is available, by careful observation of the reactions of the children, especially in situations requiring close use of the eyes, teachers should be able to discover at least marked deviations from the normal. FREQUENCY OF SCREENING

In order to detect difficulties as early as possible, it is desirable that, beginning with children of three years of age, tests should be given annually. METHODS OF GIVING TESTS

T o obtain desired results it is essential that a child shall understand what he is expected to do. It is usually necessary to teach young children the procedure before giving the test. Apparently the simplest method of teaching children to participate in the test is to use a card bearing a large Symbol E, like that on the 200-foot line of the chart. This card is turned in various positions so that the prongs of the E point upward, downward, to the right, and to the left; the child is told to point with hand or arm in the direction indicated by the letter. One child may be taught or a group of children. When this procedure is followed, even a three-year-old will soon be able to take the test. Comfort and ease are assets in obtaining results. For the many children who prefer to sit, a chair should be placed in such a position that the child will be twenty feet from the chart, with the twenty-foot line on a level with his eyes. In order to hold the attention, especially of young children, it is desirable to cover all but the one letter or symbol indicated. DIRECTIONS FOR MAKING AND USING COVER CARDS

Select dull-finish white for use in daylight illumination; soft light gray for artificial illumination. A set consists of five cards to show a single letter or symbol at a time. Cover Cards.—There should be cover cards of solid cardboard, one measuring 9 in. x 11 % in. and the other, 9 in. x in. These two cards are used to cover sections of chart not in use. T h e first is to be clipped to the chart so as to cover the upper half, while the second

VISION

TESTING

can be fastened so as to cover the section below the twenty-foot line. If necessary to use upper half of chart (for individuals who cannot read 20/50), the first card can be slipped down to cover the lower half. Window cards.—Three "window" cards are needed, 9 in. x 11 y2 in. (1) with hole so cut that a circle 1% in. in diameter will be not more than 3% in. from center of hole to bottom of card (fig. a);

O

O

0

a

FIGURE WINDOW

c

b CARDS

SHOWING

9 POSITION

OF

OPENING

(«) On 20-30 foot lines of Snellen Test Chart; (&) on 40-50 foot lines of Snellen Test Chart; (c) on 70-100 foot lines of Snellen Test Chart.

this card is so placed that only one letter of the twenty-foot or the thirty-foot line of the chart will be visible; (2) with hole so cut that a circle 2 in. in diameter will be in center of card (fig. b); this card is so placed that only one letter on the forty-foot or the fifty-foot line of the chart will be visible; (3) with hole so cut that a circle 3 in. in diameter will be in center of card (fig. c); this card is used as above for the seventy-foot or the one hundred-foot line. PROCEDURE

Each child should be supplied with a card 3 in. x 5 in. or with a piece of paper folded to these measurements to hold in front of the eye not being tested. This eye should be completely covered, but the card must be held so that there is no pressure on the eyeball and the vision of the other eye is not obstructed. It is necessary for someone to hold the card in place for young children; older pupils can make their own adjustment. T h e right eye is generally tested first; then the left eye; then both eyes together. Unless an eye difficulty is suspected, it is desirable to cover the upper part of the chart and begin with the 50-foot line,

VISION

TESTING

in order not to tire the child by having him indicate the direction of more symbols than necessary. If he cannot see this line, the larger symbols may be exposed. If he cannot distinguish the symbol or letters on the 200-foot line, he may be allowed to move nearer to the chart. His record will then read 15/200 or 10/200, signifying that he stood at a distance of 15 or 10 feet from the chart. If a child is wearing glasses, it is advisable to test first with them and then without them. If this order is reversed, he may be discouraged by not being able to see the symbols or letters. For older pupils or adults the first test is usually made without the glasses and then with the glasses. T h e teacher should make no comment regarding failure to read a line, because of the possibility of discouraging the child. If one symbol or letter on a line cannot be distinguished, the record may read 20/30-1; if more symbols are missed, the last line correctly read is recorded. EVALUATING RESULTS OF VISION

TESTING

A l l findings should be correlated. A record of visual acuity, plus observation of behavior during test, plus eye conditions noted in inspection, plus behavior observed in classroom should disclose any children in need of medical examination. Refer for further examination: (a) all children who consistently present any of the symptoms of visual disturbance, regardless of visual acuity (particularly pertinent to the discovery of children whose farsightedness is a handicap and those who have astigmatism); (b) older children who have a visual acuity of 20/30 or less, with or without symptoms; (c) younger children who, upon rechecking, consistently present a visual acuity of 20/30, with or without symptoms. Correlate findings on eye health with those on general health. General systemic diseases and focal infections have a close relationship to eye health.

Appendix Three: O U T L I N E for CHECKING LIGHTING FACILITIES and E Q U I P M E N T for EYE WORK in the CLASSROOM GLASS AREA AMOUNT

Sixteen to eighteen percent of floor area for classrooms in general; twenty percent for classrooms for the partially seeing. LOCATION

Unilateral placement, left of the pupils. Bilateral placement of windows in adjacent walls, with those at back at a sufficient distance from the floor to prevent shadows on desks, or windows on opposite sides, with those at the right of the pupils placed near the ceiling. Top of glass as near to ceiling as window frame will permit. Minimum distance from floor to top of glass equal to y2 width of room. Rear end of glass as near rear wall as practicable. Mullions and piers between windows to be narrow to prevent casting of shadows. SHADES TYPE

Neutral light color. Sufficient density so that surface brightness will not cause glare when sun shines on shade. (No greater density, as this will absorb too much light.) Unfilled, durable material that will not crack. Two shades mounted on separate rollers. SIZE AND LOCATION

Both rollers placed near center of window, one operating upward and the other downward, or one roller at the middle and one at the bottom, both operating upward.

A CHECKING PROGRAM T o prevent streaks of light between shades, rollers should be mounted with metal bar between, and the roller of the shade pulling up should not be placed under the other. T o prevent streaks of light at the sides, shades should be ample in width. LUMINA1RES TYPE

Indirect units, which direct 90 percent to xoo percent of the light toward the ceiling, or Semi-indirect units, which direct 60 percent to 90 percent of the light toward the ceiling and the rest downward. Fluorescent units, covered to prevent glare and so installed as to prevent flicker. GLOBES

Where diffusing glass globes are visible, as in semi-indirect units, globes to be of sufficient density to conceal completely the lamp within. Maximum surface brightness of 2% foot-candles per square inch of surface which can be seen at any angle from which luminaire can be viewed in actual service. LOCATION

Placement, size and shape selected to secure required quantity and quality of light and prevent marked variations in light and shadow on ceiling or workplaces. Luminaires placed well above normal line of vision. Luminaires placed only against light background. OPERATION

Control apparatus so arranged that illumination can be equalized by turning on lights on inner side of room separately.

QUANTITY

OF

ILLUMINATION

MINIMUM

30 foot-candles on all desks, tables, chalkboards and other workplaces in regular classrooms. Increased illumination on the work in rooms where fine detail work is to be done. 50 foot-candles on desks and chalkboards in sight-saving classrooms.

A CHECKING PROGRAM

185

SOURCES

Daylight from windows, if and when possible. Supplemented by artificial light, especially for inner side of room, when and as needed. EQUALIZATION

Adjustment of levels of illumination to avoid wide variations in different parts of room by means of window shades or artificial illumination. DECORATIONS, FURNITURE,

EQUIPMENT

REFLECTION VALUE

Ceilings of high reflection factor (85 percent or higher), preferably white. Upper walls of reflection factor between 50 percent and 60 percent obtained by use of light colors. Desk or table tops in light tan, gray or neutral shade. No large dark-surfaced wall areas, chalkboards, etc. (Dark chalkboards can be covered with light panels or shades when not in use.) Minimum reflection factor of surroundings to be at least one-tenth as bright as on work. SURFACE FINISH

Only dull matte finish on ceilings, walls, woodwork, chalkboards, desks, etc. (No glass-covered, enamelled or polished surfaces.) Only unglazed paper in books, charts, maps, etc. LOCATION

Arrangement of workplaces to insure good light, or use of movable equipment. UTILIZATION

OF

FACILITIES

DAYLIGHT

T o insure maximum light on innerside of room, shades drawn over upper portion of glass area only when necessary for diffusing direct sunlight. (Exception, when darkened room is required for special purposes, such as motion pictures.) Shades drawn over lower portion of glass area only when necessary to diffuse direct sunlight, to reduce glare from sky or adjacent buildings or to equalize light in various parts of room.

i 86

A CHECKING

PROGRAM

Shades not to be drawn to improve eye comfort of individual pupil or teacher. (The desired effect can usually be attained by changing the position of the person who is uncomfortable without sacrificing light needed by other members of the group.) Amount of daylight in various positions and under varying conditions checked with a light meter, so teacher will know what adjustments are necessary to insure requirements. Desks to be turned slightly (approximately 30 degrees) away from window to bring light from behind left shoulder and avoid glare from window. Daylight unobstructed by curtains, plants, or other decorations. No seating arrangement requiring that pupils face window or work in own shadow (e.g. at tables or in facing toward teacher). Workplaces selected to make best use of available light. ARTIFICIAL LIGHT

Used whenever necessary to increase light in any part of room falling below minimum requirements. Adjusted as often as necessary because of variation in amount of daylight available due to seasonal, weather, or hourly changes. MAINTENANCE

Selection of facilities and equipment that can be readily cleaned, particularly luminaires. Regular cleaning of luminaires sufficient to prevent reduction in quantity of illumination. Regular cleaning of windows and cleaning or repainting of reflecting surfaces sufficient to maintain illumination at standard. Regular inspection of lighting facilities, including testing of levels of illumination with light meter and replacement of lamps, sufficient to maintain illumination at standard. Cleaning and replacement of deteriorated chalkboards, books, illustrative material, etc., to insure legibility. ARRANGEMENTS AND ADJUSTMENTS

Adjust seat and desk to pupil to insure comfortable upright posture. Raise top of desk or use easel to make best use of light and maintain good posture for close eye work. Utilize best-lighted places in room for most exacting eye work, and for children with eye difficulties.

A CHECKING

PROGRAM

187

Special arrangements for left-handed pupils, so that light will fall over right shoulder. Material on chalkboard and elsewhere large, clear and placed in line of vision. Plan daily program to avoid difficult or prolonged eye work, such as having two subjects requiring close work follow each other.

Appendix Four: E Q U I P M E N T for P A R T I A L L Y SEEING PUPILS

E

and material included in the following list have proved satisfactory for the use of partially seeing pupils. Names and addresses of manufacturers and supply houses are given for the convenience of order departments, not for the purpose of advertising the products of any commercial concerns. In all probability equally satisfactory material may be obtained from other sources. QUIPMENT

ART

EASELS

Hill Mathias Easel (single type); Milton Bradley Co., 200 Fifth Ave., New York, N.Y. Local dealers. BOOKS BOOKS IN

1 8 OR 2 4 POINT

TYPE1

Books for Children with Seriously Defective Vision, compiled by Bureau of Physically Handicapped Children and the School Library Supervisors of the New York State Education Department and a subcommittee of the School Libraries Committee of the New York Library Association, 1939; T h e University of the State of New York Press, Albany, N.Y. Clear Type Series (price list), August 1, 1946; Clear Type Publishing Committee, Pomp ton Lakes, N.J. Lorraine Galisdorfer, Reading Guide for Boys and Girls with Partial Vision, Chas. A. Lindbergh School, Kenmore 17, N.Y. John C. Winston Co., 1010 Arch Street, Philadelphia 7, Pa. Elementary readers, etc. Stanwix House, 336 4th Ave., Pittsburgh 22, Pa. Large-type editions of Winston Dictionary for Schools, Stanford Achievement Test, elementary readers, etc. NOTE

Garnette Watters and S. A. Courtis, Picture Dictionary for Children, 1939; New York, Grosset and Dunlap, has been used with good results by younger partially seeing children. 1 T h e John C. Winston Company and Stanwix House plan to make available other text, supplementary, and measurement materials in large type.

EQUIPMENT

189

TYPEWRITING MANUAL

Detroit. Board of Education. Sight-Saving Study in Typewriting, 1939. Department of Statistics and Publications, Board of Education, 1354 Broadway, Detroit, Mich. CHALK AND CRAYON

Alpha (% in. diameter) white; Weber-Costello Co., Chicago Heights, 111. Freart (i in. diameter) white; American Crayon Co., Sandusky, Ohio. Perma-dull Crayons; Binney & Smith Co., 41 East 42d St., New York 17, N.Y. Poster chalk (all colors); local dealers. CHALKBOARD ERASERS

Airfoam; Jefferson Sales Co., Kingsport, Tenn. Hygieia Cleaner; American Crayon Co., Sandusky, Ohio. Neverip Felt; Beckley-Cardy Co., 1633 Indiana Avenue, Chicago 16, 111. DESKS, s e e SEATS AND DESKS DUPLICATING

MACHINES

A. B. Dick Mimeograph; A. B. Dick Co., Chicago, 111. The New Multigraph Duplicator; Multigraph Division, Addressograph-Multigraph Corp., 329 Fifth Ave., New York 16, N.Y. GLOBES, s e e MAPS AND GLOBES INK

American India ink (black, white, and colors); local dealers. LIGHT METERS (SMALL,

PORTABLE)

Junior Foot-Candle Meter No. 703, type 6 (for fluorescent and incandescent illumination) No. 703, type 3 (incandescent illumination only); Weston Electrical Instrument Corp., Newark, N.J. Light meter; General Electric Co., Nela Park, Cleveland, Ohio. LUMIN AIRES

Data from leading manufacturers of equipment for fluorescent and incandescent luminaires. MAPS AND GLOBES

2

Graphic-Project Globe for sight-saving classes; A. J. Nystrom & Co., 3333 Elston Ave., Chicago, 111. 2

Teachers find it satisfactory to make many of their own maps.

EQUIPMENT Wall and seat maps: George F. Cram Co., Indianapolis, Ind.; Denoyer-Geppert Co., 5235 Ravenswood Ave., Chicago, 111.; Dobson, Evans Co., Columbus, Ohio; A. J. Nystrom & Co., Chicago, 111.; R a n d McNally & Co., 536 S. Clark St., Chicago, 111.; Universal Map Co., 22 Park Place, New York, N.Y. MATERIALS FOR CREATIVE HANDWORK

Clay, plasticine, etc.; local dealers. MECHANICAL DEVICES

Sound Scriber, Sound Scriber Corp., 146 Munson Street, New Haven, Conn. Dictaphones and Ediphones; local dealers. Talking Book; American Foundation for the Blind, Inc., 15 West 16th St., New York 11, N. Y. PAINTS

Artista Powder Paints (all colors, Tempera Poster Colors; Binney & York 7, N.Y. Liquid tempera colors; American Ready-to-use paints or powders in Shaw Finger-Paint (in sets, cans, East 42d St., New York 7, N.Y.

in one-pint packages) and Artista Smith Co., 41 East 42d St., New Crayon Co., Sandusky, Ohio. dull finish; local dealers. or jars); Binney 8c Smith Co., 41

PAINT BRUSHES

Large wash paint brushes; Milton Bradley Co., 200 Fifth Ave., New York 10, N.Y., and local dealers. PAPER

Sight Conservation Paper, No. 56; J. L. Hammett Co., 380 Jelliff Ave., Newark 8, N.J. Sight-Saving Paper (lined, if desired); T h e Diem & Wing Paper Co., Gilbert Ave. Viaduct, Cincinnati 2, Ohio. Typewriting paper, typewriting copy paper, and carbon paper; local dealers. Unprinted newspaper, tonal, and construction paper; local dealers. PENCILS

Extra Black, No. 6120; J. S. Staedtler, Inc., 55 Worth St., New York 13, N.Y. Dixon Shadow, No. 305; Joseph Dixon Crucible Co., Jersey City, N.J.

EQUIPMENT Eagle Auditor, No. 286, Eagle Veri Black, No. 315, and Mikado, No. 5174; Eagle Pencil Co., 703 East 13th St., New York 9, N.Y. Weatherproof Faber, No. 6639, Faber Editor Verisoft, No. 1; Eberhard Faber Pencil Co., 37 Greenpoint Ave., Brooklyn 22, N.Y. Zabco Primary Mechanical Pencil (with sight-saving leads); ZanerBloser Co., Columbus 8, Ohio. PENS

Esterbrook Drawing and Lettering Pen, No. 1; Esterbrook Steel Pen Manufacturing Co., 277 Broadway, New York 7, N.Y. Speedball pen, 4-B; local dealers. SEATS AND DESKS

American Seating Co., 9th St., and Broadway, Grand Rapids 2, Mich. TYPEWRITERS AND COPY HOLDERS

Remington No. 17, with Bulletin Type No. 48. Remington Portable No. 5, with type No. 105 (cuts stencils). Remington Portable No. 5, with Bulletin Type No. 48 (does not cut stencils). L. C. Smith, with Bulletin Caslon type, upper and lower case, No. 27. L. C. Smith, Sight Ease Type No. 47 (cuts stencils). Underwood, Bulletin Type, Pitch No. 6, upper and lower case for sight-saving classes. TYPEWRITER CHAIRS

Local dealers. TYPEWRITING MANUAL, see u n d e r BOOKS TYPEWRITER RIBBONS

Extra-heavy, black; local dealers. TYPEWRITER TABLES

E. A. W. Rowles Co., 2345-51 S. La Salle St., Chicago, 111., and local dealers. WINDOW SHADES

Buff or gray translucent shades—two for each window: BeckleyCardy Company, 1632 Indiana Avenue, Chicago 16, 111.; Forse Manufacturing Co., Anderson, Ind.; Luther O. Draper Shade Co., Spiceland, Ind.; Maxwell's Shade Service Bureau, Chicago, 111.

192

EQUIPMENT EXHIBITS

National, state, and local exhibits offer to supervisors and teachers of the partially seeing opportunities for getting acquainted with new equipment and educational media. When desirable material cannot be obtained, either because it is not available or from lack of funds, resourceful teachers are often able to plan substitutions—such as having the children make their own reading racks, paint discarded globes, and arrange planks on a firm foundation to serve as shelves.

Appendix Five: V O C A B U L A R Y of T E R M S R E L A T I N G to the E Y E the increase of the refractive power of the crystalline lens for vision at various distances. ALBINISM, a congenital and hereditary deficiency of pigment; usually associated with lowered visual acuity, nystagmus, and photophobia and often accompanied by refractive errors. AMBLYOPIA, dimness of vision without any apparent disease of the eye. AMBLYOPIA EX ANOPSIA, dimness of vision due to disuse of the eye. AMETROPIA, refractive defect which prevents the eye in a state of rest from focusing the image of distant objects upon the retina; includes hyperopia, myopia, and astigmatism. ANIRIDIA, congenital absence of the iris. ANOPHTHALMIA, absence of a true eyeball. ANTERIOR CHAMBER, space in the anterior portion of the eye, bounded in front by the cornea and behind by the iris; filled with aqueous. APHAKIA, absence of the lens of the eye. AQUEOUS, clear, watery fluid which fills the anterior and posterior chambers within the front part of the eye. ASTHENOPIA, eyestrain caused by fatigue of the internal or external muscles. ASTIGMATISM, refractive error which prevents the light rays from coming to a single focus, because of different degrees of refraction in the various meridians of the eye. ACCOMMODATION,

the ability to use the two eyes simultaneously to focus on the same object and to fuse the two images into a single image which gives a correct interpretation of its solidity and its position in space. BLEPHARITIS, inflammation of the margin of the eyelids. BLEPHAROSPASM, spasm of the orbicular muscle of the eyelids. BULBAR CONJUNCTIVA, the part of the conjunctiva covering the anterior surface of the eyeball. BUPHTHALMUS, large eyeball (infantile glaucoma).

BINOCULAR VISION,

c, cc

with correction, i.e., wearing lenses prescribed. the angle at either end of the slit between the eyelids, specified as outer, or temporal, and inner, or nasal. (CUM CORRECTION),

CANTHUS,

194

GLOSSARY

opacity of the lens, or its capsule, or both. faculty of the eye to perceive the shape or form of objects in the direct line of vision. CHALAZION, inflammatory enlargement of a meibomian gland in the eyelid. CHOROID, the vascular, intermediate coat which furnishes nourishment to the other parts of the eyeball. CHOROIDITIS, inflammation of the choroid. CILIA, eyelashes. CILIARY BODY, portion of the vascular coat between the iris and the choroid. It consists of ciliary processes and the ciliary muscles. COLOBOMA, congenital cleft due to the failure of the eye to complete growth in the part affected. COLOR BLINDNESS, diminished ability to perceive differences in color. CONES, together with rods, are receptors for the optic nerve; they are the light-perceiving layer of the retina. Cones concentrated at the macula are concerned with sharp vision and perception of shape. CONJUNCTIVA, mucous membrane which lines the eyelids and covers the front part of the eyeball. CONCAVE LENS, lens having the power to diverge rays of light; also known as diverging, reducing, negative, myopic, or minus lens, denoted by the sign - . CONTACT LENS, lens so constructed that it fits directly on the eyeball. Used chiefly in connection with a cone-shaped cornea and high myopia. CONVEX LENS, lens having power to converge rays of light and to bring them to a focus; also known as converging, magnifying, hyperopic, or plus lens, denoted by sign + . C R Y S T A L L I N E LENS, a transparent, colorless body suspended in the anterior portion of the eyeball between the aqueous and the vitreous chambers, the function of which is to bring the rays of light to a focus. CYLINDRICAL LENS, a segment of a cylinder, the refractive power of which varies in different meridians; used in the correction of astigmatism. Cylinders are convex or concave. CONJUNCTIVITIS, inflammation of the conjunctiva. CONVERGENCE, the ability to direct the visual lines of the two eyes to a near point. CORNEA, clear, transparent (watch crystal) portion of the external coat of eyeball forming front of aqueous chamber. CYCLITIS, inflammation of the ciliary body. CYCLOPLEGIC, a drug which temporarily paralyzes accommodation and dilates the pupil.

CATARACT,

C E N T R A L VISUAL A C U I T Y ,

DACRYOCYSTITIS,

inflammation of lacrimal sac. the power of the eye to adjust itself to a dim light.

DARK ADAPTATION,

GLOSSARY

195

the ability to perceive the solidity of objects and their position in space. DESCEMET'S MEMBRANE, a thin membrane between the substantia propria and the endothelial layer of the cornea. DIOPTER, unit of measurement of strength or refractive power of lenses. DUCTION, a stem word used with a prefix to describe the turning or rotation of the eyeball (abduction, adduction).

DEPTH PERCEPTION,

a condition in which there is an eversion (turning inside out) of the eyelids. EMMETROPIA, condition of normal refraction of the eye. The images of distant objects are focused exactly upon the retina when the eye is in a state of rest. ENTROPION, a condition in which there is an inversion (turning inward) of the eyelid. ENUCLEATION, complete surgical removal of the eyeball. ESOPHORIA, a tendency of the eye to turn inward. ESOTROPIA, a manifest turning inward of the eye (convergent strabismus or crossed eyes.) EXOPHORIA, a tendency of the eye to turn outward. EXOPHTHALMUS, abnormal protrusion of the eyeball. EXOTROPIA, abnormal turning outward from the nose of one or both eyes (divergent strabismus). EXTRINSIC MUSCLES, external muscles of the eye which move the eyeball. Each eye has has four recti and two oblique muscles. EYE DOMINANCE, tendency of one eye to assume the major function of seeing, being assisted by the less dominant eye.

ECTROPION,

FIELD OF VISION,

gaze.

the entire area which can be seen without shifting the

point to which rays are converged after passing through a lens; focal distance is the distance rays travel after refraction before focus is reached. FORNIX, a loose fold connecting palpebral and bulbar conjunctiva. FOVEA, depression or pit in the retina at the posterior part of the eye (temporal of the optic disk), the most sensitive part of the retina. FUNDUS, the posterior part of the eye within its coats. FUSION, the co-ordination by the brain into one image of the separate images formed on the retinas of the two eyes.

FOCUS,

increased intraocular tension of the eye; "hardening of the eyeball." GLIOMA, malignant tumor of the retina.

GLAUCOMA,

HEMIANOPSIA,

blindness of one-half the field of vision of one or both eyes. a constant tendency of the eyes to deviate from the nor-

HETEROPHORIA,

GLOSSARY

ig6

mal axis counterbalanced by simultaneous fixation forced by muscular effort (prompted by the desire for single binocular vision). Deviation is not usually apparent, hence is said to be "latent." HETEROTROPIA (strabismus, squint), a manifest deviation of the axis of the eyes, making single binocular vision impossible; fixation is maintained with either eye, but not simultaneously with both. HOLMGREN WOOL TEST, a test for color blindness based on the ability to match correctly wool samples from a set especially dyed in various shades and colors. HORDEOLUM (STY), acute inflammation of a sebaceous gland in the margin of the eyelid, due to infection and usually resulting in the formation of pus. HYPEROPIA (farsightedness), a refractive error in which, because the eyeball is short or the refractive power of the lens weak, the point of focus for rays of light from distant objects (parallel light rays) is behind the retina; thus, accommodation to increase the refractive power of the lens is necessary for distant as well as near vision. HYPERPHORIA, a tendency of one eye to deviate upward. HYPERTROPIA, elevation of one of the visual axes. usually congestion of ciliary or conjunctival vessels. affection of the middle layer of the cornea (substantia propria), disease found chiefly in children and young adults; usually caused by transmission of syphilis from mother to unborn child. IRIDOCYCLITIS, inflammation of the iris and ciliary body. IRIS, colored, circular membrane, suspended behind the cornea and immediately in front of the lens, which regulates the amount of light entering the eye by changing the size of the pupil. IRITIS, inflammation of the iris; the condition is marked by pain, congestion in the ciliary region, photophobia, contraction of pupil, discoloration of iris and is caused by injury, syphilis, rheumatism, gonorrhea, tuberculosis, etc. ISHIHARA COLOR PLATES, a test for color blindness; based on the ability to trace patterns in a series of multicolored charts.

INJECTION,

INTERSTITIAL KERATITIS,

a test for near vision; lines of reading matter printed in a series of various sizes of type.

JAEGER TEST,

inflammation of the cornea; frequently classified as to type of inflammation and layers of cornea affected as "interstitial" keratitis or "phlyctenular" keratitis. KERATOCONUS, cone-shaped deformity of the cornea.

KERATITIS,

LACRIMAL GLAND,

of the orbit.

a gland which secretes tears; it lies in the outer angle

GLOSSARY

197

the dilated upper end of the lacrimal duct. production of a slightly alkaline liquid known as "tears." LAGOPHTHALMUS, a condition in which the lids cannot be completely closed. LENS, a refractive medium having one or both surfaces curved. LIGHT ADAPTATION, the power of the eye to adjust itself to variations in the amount of light. LIGHT PERCEPTION (L.P.), ability to distinguish light from dark. LIMBUS, boundary between cornea and sclera. LACRIMAL SAC, LACRIMATION,

abnormally large eyeball, resulting chiefly from infantile glaucoma. MACULA (YELLOW SPOT), the small area of the retina which surrounds the fovea; with the fovea, it is the area of distinct vision. MEGALOPHTHALMOS, abnormally large eyeball, resulting usually from infantile glaucoma. MICROPHTHALMIA, eyeball congenitally abnormally small in all its meridians. MIOTIC, an agent that causes the pupil to contract. MYDRIATIC, a drug that dilates the pupil. MYOPIA (nearsightedness), a refractive error in which, because the eyeball is too long, the point of focus for rays of light from distant objects (parallel light rays) is in front of the retina; thus, to obtain distinct vision, the object must be brought nearer to take advantage of divergent light rays (those from objects less than twenty feet away). MACROPHTHALMUS,

the nearest point at which the eye can perceive an object distinctly. It varies according to the power of accommodation. NEAR POINT OF CONVERGENCE, the nearest single point at which the two eyes can direct their visual lines, normally about three inches from the eyes. NEAR VISION, ability to perceive objects clearly at normal reading distance (usually considered to be approximately fourteen inches from the eyes). NIGHT BLINDNESS, a condition in which the sight is good by day, but deficient at night and in any faint light. NYSTAGMUS, an involuntary, rapid movement of the eyeball; it may be lateral, vertical, rotary, or mixed. NEAR POINT OF ACCOMMODATION,

or OPHTHALMOLOGIST, terms used interchangeably; a physician who is a specialist in the diseases and defects of the eye. OCULUS DEXTER fo.D.), right eye. OCULUS SINISTER (o.s.), left eye. OCULUS UTERQUE (O.U), both eyes.

OCULIST

198

GLOSSARY

inflammation of the eye or of the conjunctiva. an acute, purulent conjunctivitis in the newborn; for control purposes, it is sometimes legally defined as "an inflamed or discharging eye in a newborn baby under two weeks."

OPHTHALMIA, OPHTHALMIA

NEONATORUM,

OPHTHALMOLOGIST, see

OCULIST.

an instrument having a perforated mirror; used in examining the interior of the eye. OPTIC ATROPHY, atrophy of the optic nerve. OPTIC CHIASM, the crossing of the fibers of the optic nerves on the ventral surface of the brain. OPTIC DISK, head of the optic nerve. OPTICIAN, one who makes or deals in eyeglasses and (or) other optical instruments. He fills prescriptions for glasses. OPTIC NERVE, second cranial nerve; the special nerve of the sense of sight. OPTIC NEURITIS, inflammation of the optic nerve. OPTOMETRIST, one skilled in the measurement of the refraction of the eye for prescription of glasses. ORTHOPTIC TRAINING, series of scientifically planned exercises for developing or restoring the normal teamwork of the eyes. OPHTHALMOSCOPE,

pertaining to the eyelid. invasion of the cornea by infiltration of lymph and formation of new blood vessels. PERIMETER, an instrument for measuring the field of vision. PERIPHERAL VISION, ability to perceive presence, motion, or color of objects outside of the direct line of vision. PHLYCTENULAR KERATITIS, a variety of keratitis characterized by the formation of postules or papules on the cornea; usually occurs in young children and may be caused by poor nutrition; many physicians believe it to be a tubercular condition. PHORIA, a root word denoting a latent deviation in which the eyes have a constant tendency to deviate from the normal axis; used with a prefix to indicate the direction of such deviation (hyperophoria, esophoria, exophoria). PHOTOPHOBIA, abnormal sensitivity to light. POSTERIOR CHAMBER, space between the posterior surface of the iris and the anterior surface of the lens; filled with aqueous. PRESBYOPIA, loss of accommodation due to advanced age. PROSTHESIS, the replacement of a human eye by an artificial one. PTERYGIUM, a fold of mucous membrane consisting of subepithelial growth of vascular connective tissue of the conjuntiva which may extend into the cornea; it occurs most frequently on the nasal side. PTOSIS, a paralytic drooping of the eyelid.

PALPEBRAL, PANNUS,

GLOSSARY

199

(1) deviation in the course of rays of light in passing from one transparent medium into another of different density; (2) determination of refractive errors of the eye and their correction by glasses. REFRACTIVE ERROR, a defect in the eye that prevents light rays from being brought to a single focus exactly on the retina. REFRACTIVE MEDIA, the media of the eye having refractive power; include cornea, aqueous, lens, and vitreous. RETINA, innermost coat and perceptive structure of the eye formed by the expansion of the optic nerve. RETINITIS, inflammation of the retina; it is marked by impairment of sight, perversion of vision, edema and exudation into the retina, and occasionally by hemorrhages into the retina. RETINOSCOPE, an instrument for determining the refractive state of the eye by observing the movements of lights and shadows across the pupil by the light thrown onto the retina from a moving mirror. RODS, together with cones, are receptors for the optic nerve; the lightperceiving layer of the retina, concerned with seeing light and motion.

REFRACTION,

sc, s (SINE CORRECTION), without correction; that is, not wearing glasses. membrane which, with the cornea, forms the external, protective coat of the eye. SCLERITIS, inflammation of the sclera. SCOTOMA, a blind or partially blind area in the visual field. SLIT L A M P , provides a narrow beam of light like a searchlight; often used with a corneal microscope for examination of cornea. SNELLEN CHART, a chart for testing central visual acuity, in which the letters or symbols are drawn to the Snellen scale of measurements, in such a way that the uppermost letter is designed to be read by the normal eye at 200 feet; rows of letters follow which should be read at 100, 70, 50, 40, 30, 20, 15, and 10 feet, respectively. SPHERICAL LENS, segment of sphere refracting rays of light equally in all meridians. STRABISMUS, squint; failure of the two eyes to direct their gaze at the same object because of muscle imbalance. SCLERA,

STY, see

HORDEOLUM.

inflammation of one eye due to an infection in the other eye (usually traumatic iridocyclitis from a perforating injury). SYNECHIA, adhesion; usually iris to cornea or lens.

SYMPATHETIC OPHTHALMIA,

the framework of connective tissue which gives shape to the eyelid. TELESCOPIC GLASSES, spectacles founded on the principles of a telescope; TARSUS,

GLOSSARY

2 OO

occasionally prescribed for improving very poor vision which cannot be helped by ordinary glasses. TENSION, INTRAOCULAR, the pressure or tension of the contents of the eyeball. TONOMETER, an instrument for measuring tension. TRACHOMA, a chronic form of infectious conjunctivitis, which may also seriously affect other parts of the eye. TROPIA, a root word denoting a manifest deviation from normal of the axis of the eyes (strabismus) used with a prefix to denote the type of strabismus (heterotopia, esotropia, exotropia). TUNNEL VISION, contraction of the visual field to such an extent that only central visual acuity remains, thus giving the affected individual the impression of looking through a tunnel. entire vascular coat of the eyeball, consisting of iris, ciliary body, and choroid. UVEITIS, inflammation of the vascular coat of the eye. UVEA,

VISION,

the art or faculty of seeing; sight.

VISUAL ACUITY, see

CENTRAL VISUAL ACUITY.

the pigment of the outer segment of the visual rods. VITREOUS, transparent, colorless mass of soft, gelatinous material filling the eyeball behind the lens. VISUAL PURPLE,

YELLOW SPOT, SEE MACULA.

VOCABULARY OF GENERAL TERMS

unit of measurement of electric current (from A. M. Ampere, French electrician).

AMPERE,

book in 18 or 24 point type of clear, simple design without many serifs, produced especially for the education of partially seeing pupils; see also POINT, CLOSE WORK, work such as reading, sewing, drawing, normally done at a short distance from the eyes and hence requiring an effort of accommodation. COEFFICIENT OF UTILIZATION, the proportion of light that reaches the plane of work from any light source; it depends upon the type of diffusing and reflecting equipment, the color and maintenance of walls and ceilings, and the proportions of the room. CLEAR-TYPE BOOK (LARGE-TYPE BOOK),

the scattering of light rays by a reflecting surface or by transmission through a translucent material. DIRECT ILLUMINATION, type of artificial illumination in which the major portion of the light falls directly on the surface to be illuminated. DIFFUSION (OF LIGHT),

glass tube filled with mercury vapor; the inside is coated with a powder which fluoresces.

FLUORESCENT BULB,

GLOSSARY

SOI

illumination produced by Mazda F (fluorescent) lamps, popularly known as bulbs or tubes. FOOT-CANDLE, amount of light falling on a surface one foot from a standard candle; used as a unit of measurement of quantity of light. FUSE, plug or bar of soft metal that melts or fuses when too great strength of current causes too much heat for safety. FLUORESCENT LIGHTING,

a quality of light which causes discomfort; it may result from a direct light source within the field of vision or from a reflection from a light source. GLASS AREA, the total area of the window panes of a given room; a measurement used particularly in relation to floor area.

GLARE,

a glass bulb in which a filament (usually tungsten) is heated to whiteness and maintained at a high temperature by an electric current. There are two types of incandescent lamps: in one the filament is operated in a vacuum; in the other the bulb is gas-filled. Lamps of the first type are under 50 watts and are known as Mazda B lamps to distinguish them from the Mazda C or gas-filled lamp. INDIRECT ILLUMINATION, a type of illumination in which 90 percent or more of the light is directed toward the ceiling for diffused reflection over the room area. INCANDESCENT L A M P ,

a generic term applied to any artificial light source and its operating mechanism.

LAMP,

LARGE-TYPE BOOK, SEE CLEAR-TYPE BOOK.

a specially formed piece of hard glass, having one or both of its surfaces ground and polished to a spherical or parabolic shape. "Lens" also applies to crystalline lens, one of the chief refracting media of the eye. LEVEL OF ILLUMINATION, amount of light on a given surface, usually measured in foot-candles. LIGHT, form of energy which by action of organs of vision produces sight. LIGHT CONTROL, AUTOMATIC, control of illumination by a photoelectric cell which switches the artificial lights on or off to maintain the desired level of lighting. LENS,

LIGHT METER, see

PHOTOMETER,

small (not capital) letters. LUMEN, a unit of measurement of the light output of a light source. Modern lamps are rated in lumens. LUMINAIRE, lighting fixture or complete unit including lamp, shade, and other accessories. LOWER CASE,

a name applied to an incandescent or a fluorescent lamp (from Mazda, the goddess of light).

MAZDA LAMP,

NATURAL LIGHTING,

lighting by daylight, as opposed to artificial lighting.

GLOSSARY

202

the light given off by a lighting unit of any kind after the losses due to reflection and transmission are deducted.

OUTPUT,

a device for measuring the amount of illumination. POINT, the unit of measurement of the size of type (72 points to the inch). 18 point type: font in which capital letters are approximately y 4 in. and small letters in proportion. 24 point type: font in which capital letters are approximately % in. and small letters in proportion. point type: font in which capital letters are approximately % i n and small letters in proportion. PRIMARY COLORS, red, green and blue; if mixed in correct proportion, they will give white light. PRISM, a wedge-shape piece of glass which possesses the property of refracting or bending rays of light toward its base. PHOTOMETER (LIGHT METER),

factor expressing the relationship between the amount of light reflected and that absorbed by a given surface; used especially to express the reflection value of colors and shades of paints. REFLECTION FACTOR, the percentage of light reflected by an object. REFLECTOR, any object which turns back rays of light. Reflectors are used to redirect light rays. REFRACTOR, a device, usually of glass, designed to control the direction of emergent rays of light.

REFLECTION COEFFICIENT,

a rare metal that has the property of changing its electric characteristics when light strikes it. Practical use of selenium is made in the photoelectric cell; one of its functions is to keep illumination at or above a selected level. SEMI-INDIRECT ILLUMINATION, a type of illumination in which between 60 percent and 90 percent of the light is reflected toward the ceiling. SELENIUM,

a phonograph record made from a text read aloud; it can be played to a class or an individual and is usually for entertainment or instruction of blind or partially seeing persons.

TALKING BOOK,

UPPER CASE,

capital letters.

unit of measurement of electromotive force (from Alessandro Volta, Italian physicist).

VOLT,

unit of measurement of electric lamps (from James Watt, Scottish engineer and inventor). Electric lamps are marked in watts but rated in lumens. WORKING PLANE, plane, such as a desk top, a chalkboard, an easel, etc., at which work requiring eye use is done. WATT,

BIBLIOGRAPHY

BIBLIOGRAPHY In a constantly changing world, those interested in h u m a n welfare have need of two types of materials: (1) basic information and (2) information regarding new discoveries, inventions, and techniques. Instead, therefore, of a general bibliography, a few references to basic texts and periodicals and sources for obtaining information and printed matter are listed.

BASIC

TEXTS

Fox, Sidney A. Your Eyes. New York, Knopf, 1944. 191 pp. Good, Carter V., Ed. Dictionary of Education. New York and London, McGraw-Hill, 1945. 495 pp. Illuminating Engineering Society (51 Madison Avenue, New York 10, New York). Lighting Handbook. New York, T h e Society, 1947. Illuminating Engineering Society (51 Madison Avenue, New York 10, New York) and T h e American Institute of Architects. American Standard Practice of School Lighting. New York, T h e Society, 1947. ASA, A23. Kimber, Diana C., Carolyn E. Gray, and Caroline E. Stackpole. Textbook of Anatomy and Physiology, n t h ed. New York, Macmillan, 1942. 640 pp. Luckiesh, Matthew, and Frank K. Moss. Reading as a Visual Task. New York, Van Nostrand, 1942. 428 pp. May, Charles H., Manual of the Diseases of the Eye; 18th ed., revised by Charles A. Perera. Baltimore, William Wood, 1943. 520 pp. National Education Association of the United States (1201 Sixteenth Street, Northwest, Washington 6, D.C.), Joint Committee on Health Problems in Education. Health Education; a Guide for Teachers in Elementary and Secondary Schools and Institutions for Teacher Education. 2d ed. Washington, D.C., T h e Association, 1941. 368 pp. Teaching about Light and Sight; a Handbook for Classroom Teachers in Elementary and Secondary Schools. Washington, D.C., T h e Association, 1946. Prepared by the Research Division. 79 pp. National Education Association of the United States and the American Association of School Administrators, Educational Policies Commission (1201 Sixteenth Street, Northwest, Washington 6, D.C.). Education for A l l American Youth, Washington, D.C., T h e Association, 1944. 421 pp.

2O6

BIBLIOGRAPHY

National Society for the Prevention of Blindness, Inc. (1790 Broadway, New York 19, N.Y.). Eye Health; a Teaching Handbook for Nurses. New York, T h e Society, 1947. 108 pp. Publication 447. Paterson, Donald G. and Miles A. Tinker. How to Make Type Readable. New York, Harper, 1940. 209 pp. Stanger, Margaret A., and Ellen K. Donohue. Prediction and Prevention of Reading Difficulties. New York, Oxford University Press, 1937. 191 pp. United States. Office of Education and Other Publications Relating to Education. Price List 31. 35th ed., February, 1946. Washington, D.C., Gov't. Printing Office, 1946. White House Conference on Child Health and Protection. Section I, Medical Service, Committee A. Growth and Development of the Child; Part II: Anatomy and Physiology. New York and London, Century, 1933. 629 pp. White House Conference on Child Health and Protection. Section III, Education and Training, Committee F, Special Classes. Special Education: T h e Handicapped and the Gifted. New York and London, Century, 1931. 604 pp. PERIODICALS

American Journal of Nursing. American Nurses' Association and the National League of Nursing Education (1790 Broadway, New York 19, N.Y.). Published monthly. American Journal of Ophthalmology. Ophthalmic Publishing Co. (837 Carew Tower, Cincinnati 2, Ohio). Published monthly. American Journal of Public Health. American Public Health Association (1790 Broadway, New York 19, N.Y.). Published monthly. Better Light Better Sight News. National Better Light Better Sight Bureau (420 Lexington Avenue, New York 17, N.Y.). Nine issues published annually. Elementary School Journal. University of Chicago Press (5750 Ellis Ave., Chicago 37, 111.). Published monthly from September to June. Eye, Ear, Nose and T h r o a t Monthly. Professional Press, Inc. (5 N. Wabash Ave., Chicago 2, 111.). Published monthly. Hygeia. American Medical Association. (535 N. Dearborn Street, Chicago 10, 111.). Published monthly. Illuminating Engineering. Illuminating Engineering Society (51 Madison Avenue, New York 10, N.Y.). Published monthly except August and October. Journal of Exceptional Children. International Council for Exceptional Children (Saranac, Mich.). Published eight times a year, October to May inclusive. Journal of Health and Physical Education. American Association for

BIBLIOGRAPHY

207

Health, Physical Education and Recreation (1201 Sixteenth Street, Northwest, Washington 6, D.C.). Published monthly from September to June (10 issues). Journal of Pediatrics. C. V. Mosby Co. (3207 Washington Blvd., St. Louis 3, Missouri). Published monthly. Journal of Rehabilitation. National Rehabilitation Association, Inc. (11x4 56th St., Des Moines 11, Iowa). Published bi-monthly. Journal of School Health. American School Health Association (3335 Main Street, Buffalo 14, N.Y.). Published monthly except July and August. Journal of the American Medical Association. American Medical Association, 535 N. Dearborn St., Chicago 10, 111.). Published weekly. Journal of the National Education Association. National Education Association of the United States (1201 Sixteenth Street, Northwest, Washington 6, D.C.). Published monthly except June, July, and August. Magazine of Light. Lamp Department of the General Electric Company (Nela Park, Cleveland 12, Ohio). Published irregularly. National Parent-Teacher. National Parent-Teacher, Inc. (600 South Michigan Blvd., Chicago 5, 111.). Published monthly, September through June. Optical Journal and Review of Optometry. Chilton Co., Inc. (Chestnut and 56th St., Philadelphia 39, Pa.). Published semi-monthly. Public Health Nursing. National Organization for Public Health Nursing (1790 Broadway, New York 19, N.Y.). Published monthly. School Life. United States Office of Education (Federal Security Agency, Washington 25, D.C.). Published monthly, except August and September. Sight-Saving Review. National Society for the Prevention of Blindness, Inc. (1790 Broadway, New York 19, N.Y.). Published quarterly. State and local journals of education and state and local journals of health. SOURCES OF INFORMATION, BULLETINS, POSTERS, AND OTHER MATERIALS OF INTEREST

American Medical Association, 535 N. Dearborn St., Chicago 10, 111., and state and county medical societies. General Electric Co., Nela Park, Cleveland 12, Ohio. National Education Association of the United States, 1201 Sixteenth Street, Northwest, Washington 6, D.C. National Health Council, 1790 Broadway, New York 19, N.Y. National Society for Crippled Children and Adults, Inc., 11 South La Salle Street, Chicago 3, 111. National Society for the Prevention of Blindness Inc., 1790 Broadway, New York 19, N.Y.

2o8

BIBLIOGRAPHY

Science Service, 1719 N Street, N.W., Washington 6, D.C. S.C.A. Bulletin of Services, 1947 ed., lists material and services supplied by science clubs of America, United States Government, and commercial, industrial, educational, and philanthropic organizations. United States Department of Agriculture, Fourteenth Street and Independence Avenue, S.W., Washington 4, D.C., for information on nutrition. United States Department of Labor, Children's Bureau, Fourteenth Street and Constitution Avenue, N.W., Washington, D.C., for information on handicapped children. United States Office of Education, Federal Security Agency, Temporary Building M, Twenty-sixth Street and Constitution Avenue, N.W., Washington 7, D.C., for material on education and guidance. United States Office on Vocational Rehabilitation, Federal Security Agency, Rochambeau Building, 815 Connecticut Ave., N.W., Washington 6, D.C., for material on vocational education and rehabilitation. United States Public Health Service, Federal Security Agency, Washington 25, D.C. Westinghouse Electric and Manufacturing Co., Lamp Division, Bloomfield, N.J. Information regarding lighting, maps, posters and other helpful material on many subjects may be obtained from the headquarters or the local offices of many other commercial companies; also from state and local departments of education and state and local departments of health.

INDEX Accommodation, 157, 160 Adler, Nettie, 5 Administrative program planning, 26-30; see Program planning Administrative responsibilities, 13-91 Albinism, 165 Aldine and Elson readers, 110 Allen, Edward E., 7 f. Amblyopia ex anopsia, 163 American Foundation for the Blind, Inc., 124 American Medical Association, 179 American Recommended Practice of School Lighting, 76« Ametropic eye, 161 Anatomy and physiology of eye, 153-58 Aniridia, 166 Anophthalmus, 166 Aphakia, 166 Aqueous, the, 157, 174 Arithmetic, 117 f., 126; drill, 119 Art and handwork, 7, 119-22; published studies on, 122; equipment for, 91, 188, 190, 191 Astigmatism, 105, 120, 162, 165 Babies, lack of visual co-ordination, 164; prophylactic in eyes, 169 Babies' sore eyes, 147 Basket-making, 121 Behavior, observation of, during vision tests, 178, 182 Bibliography, 205-8 Blepharitis, 168 Blind, the: schools for, 4, 5; classes in public schools, 9; reasons for separating the partially seeing from, 6 , 7 ; in schools with the deaf, 33, 34; handwork for, not suited to the partially seeing, 120 Blindness, research for determining cause, 147; diseases responsible for, 169, 171, 172, 173, 174 Blindness, word, 106 Boarding homes in cities, 32 Books, for home rural schools, 34; a chief

item of expense, 68; should meet accepted specifications, 89; Clear T y p e books, 188; T a l k i n g Book, 91, 114, 124 f., 190; typography and paper, 108, 112, 188; influence upon eyesight, i n ; overcoming shortage of large-type material, 113 f.; provision for rural communities, 146; sources of supply, 188 Boston, first class in America, 8, 10 Brain, difficulties due to defects in, 106; seeing portion, 151, 152; eye an outgrowth of, 153 British Association for Advancement of Science, 111 Brushes, paint, 191 Building and classroom, selection and preparation of, 75-85; costs, 68; illumination, 76-82; decoration: color, 83-85, 185; reflection factors, 83 f., 185; equipment, physical, 86-88, 188-92; education media, 88-91, 188-92 (see Equipment); outline for checking lighting facilities and equipment for eye work in, 183-87 California, 60 Canal of Schlemm, 157, 174 Candle, unit of light measurement, 77, 177 Carfares, 18 Case work services, 138 Caslon type, 108, 109, 110 Cataract, 147, 172« Chairs and Tables, 88, 89, 192 Chalk and crayon, 90, 189 Chalkboards, 86; erasers, 90, 189 Chalkboard writing, 115 f. Character development, 101; emotional and mental health, 42 ff. Charts, 89 Charts, Snellen, for visual acuity, 176 ff.; see entries under Testing, vision Child guidance, 29, 128-33; vocational guidance, 30,131-33; role of the teacher, 128; goal, 129; prevocational training as, 129-31

2 1 O

INDEX

Children's Bureau, 24, 74 Choroidal coat of eye, 155, 171 Churchill, Winston, 147 Ciliary body, 155, 159, 171 Cincinnati, University of, 55 City, classes in nearest: placement of rural children in, 32 f. Civic organizations, value in supplementing efforts of educational authorities, 127, 140 f.; see also Social service "Classes for the education of the partially seeing," term, 10 Classification of the partially seeing, defining candidates for special education, 13; placement in regular or special classes, 14-16; procedures for placement, 16-18; transportation, 18 f.( 28 Classroom, see Building and classroom Cleveland, Waverley School, 9, 10; special supervisor, 60; study and selection of typography and paper for books, 1081 1 ; radio educational program and Station WBOE, 125-27 Clips, 87 Closets, 86 Colleges offering special courses, 55 f., 57 Coloboma, 166 Colors, affecting the lighting, 80; in decoration of classrooms, 83 f.; reflection factors, 83 f., 185; of paper and other education media, 90; of paper for books, 108, 1 1 1 ; cover cards for test charts, 180 Columbia University, Teachers College, 55- 1 '5 Community aids, see Civic organizations; Social service organizations; Volunteer services Community responsibilities of teacher, 141-43 Concave lens, »159, 160, 161 "Congenital and Developmental Anomalies" (Stewart), 1650 Conjunctivitis, 168 f., 171 Conservation, use of term, 10 Consolidated school, 31 Contact lens, 162 Convex lens, 158, 160, 161 Co-operative plan of conducting classes, 6, 9, 10, 65-67, 101 f. Cornea, 155, 159, 162; substitution of, 147; affections of, 169-71 Cover cards, test-chart, 180 Creative activities, 119-22; see Art and Handwork

Credé's discovery, 169 Crippled, interpretation of term, 74, 139 Crossed eyes, 148, 163, 165; placement of children with, 15; reading difficulties, 105 Crystalline lens, 157, 15g, 160 Curriculum, 96 Cyclitis, 172 Cylindrical lens, 162 Dacryocystitis, 169 Damrosch, Walter, 125 Deaf and blind in same school, 33, 34 Deafness, word, 106 Decoration of classrooms, 83 f.; cost, 68; reflection factors, 83, 185 Defining the partially seeing, 13 f. Demonstration schools of teachers colleges, 32, 145 Desks and seats, expense, 68; importance, 86; types: structure, 87; placement in light, 87; color, 185; firms supplying, !9i Detroit, 60, 1 1 3 , 1 1 7 Dictaphones, 91, 1 1 7 , 124, igo Diopter, 161 Diplopia, 163 Diseases of eyes, see Eyes and eye hygiene Donohue, Ellen K., Stanger, M. A., and, 104 Double vision, 163 Duke-Elder, 165« Duplicating machines, 189 Dyer, Superintendent, 8; quoted, 9 Eames, Thomas H., quoted, 104 Easels, 88, 188 Economic conditions in family, 43, 45 Ediphones, 91, 124, 190 Edison, Thomas A., 124 Education, Office of, 131 Educational departments, responsibility rests with: approach should always be made through, 140 Education of partially seeing children, history, 3-10; number of special classes, 3, 70 ff.; why so few, 3; function, 4; earliest classes established, 5, 6, 8; in Europe, 6; other countries, 7; the United States, 7-10; co-operative plan, 6, 9, 10, 65-67, 101 f.; segregation plan, 8, 10, 66, 100; appellations for the schools, or special classes, 10; groups considered candidates for, 13 f.; placement of candidates, 14-18; classes for

INDEX children w i t h different types of handicap, 15, 33; transportation to classes, 18 f.; n u m b e r of children requiring, 20, 144; establishment of special classes the most satisfactory method f o u n d , 26; n u m b e r and grades in classes, 26 f.; administrative program planning, 26-30; for small communities and rural areas, 31-36 (see entries under Program planning); classes in demonstration schools, 32; supervision and supervisors (q.v.), 34, 58-64; costs, 67-69; legal provisions for establishing and financing classes, 69-74; preparing the school, 75-91, 18392 (see entries under B u i l d i n g and classroom); the f u t u r e , and courses of action necessary to prepare for it, 14448; see also Teachers: T e a c h i n g Elementary school, program planning, 27; preparation of teachers for, 55 f. Emmetropic eye, 160 Emotional a n d mental health, 42-47 E p i p h o r a , 169 Episcleritis, 171 Equalization plan of finance, 70, 72 E q u i p m e n t of classrooms, 86-91, 18892; costs, 68; closets, chalkboards, 86; f u r n i t u r e , 86-88; e q u i p m e n t for hot lunches, 88; educational media and e q u i p m e n t , 88-91, 188 If.; names and addresses of manufacturers and supply houses, 188-91; see also L i g h t i n g Erasers, chalk, 90 E symbol chart, 176, 180 Europe, the Strasbourg class, 6 f. " E x c e p t i o n a l child," 65 Exercises, eye, 163 Eyeball, placement, 153; protective devices, 153-55; its three coats, 155-57 Eyebrows, 155 Eyelashes, 153, 167 Eyelids, 153, 168; affections of, 167 Eyes and eye hygiene, proper use of eyes, 28, 35; correlation between general a n d eye health, 40, 167, 182; follow-up of eye condition, 40; rest periods for eyes, 99; research for determining cause of eye troubles, 147; facts about, 151-74; w h a t practical knowledge of, should include, 152; eye health and efficiency, 153; gross anatomy and physiology, 153-58; principles of refraction, 158-63; g r o w t h and development of eye, 16365; of the very y o u n g child, 164; necessity for early attention, 165;

2 1 1

structural anomalies, 165 f.; common diseases, 166; results of injuries, 167; common affections of eyelids, 167-69; of cornea, 169-71; diseases of lachrymal apparatus: of orbit, 169; of sclera: of choroid, 171; of lens, 172; of retina; of optic nerve, 173; affections of the aqueous or vitreous, 174 Family, see Parents Farsighted, 161, 164 Ferree, C. E., and G . R a n d , 1 1 1 » Finances, 18, 23, 25; grants under Social Security Act, 24, 73; Ohio's subsidy for, and aid to, the partially seeing, 33; provision of glasses, 49; cost of educating the partially seeing, 67-69; salary of teacher, 67; cost of lighting, decorating, equipment, 68; legal provisions for establishing and financing classes, 69-74; equalization plan, 70, 72 Finding the children: screening process, 20-25, 1 75-82; see T e s t i n g , vision Fluorescent lighting, 79, 81 Foot-candle, unit of light measurement, 77. 177 Foster homes in cities, 32 Fundamentals for the art of teaching, 52-54 F u r n i t u r e for classroom, 86-88; Desks; Tables Gates, A r t h u r I., 106 General Education B o a r d of the Rockefeller Foundation, 126 George Peabody College for Teachers, 55 Glare, avoidance of, 76, 78, 79, 80, 83, 86 Glass area for classrooms, 78, 183 Glasses, financial provision for: child's use of, 49; frames: care of glasses, 50 Glaucoma, 148, 166, 174 Globes, 189 Glossary, terms relating to eye, 193-200; general terms, 200-202 Grades in special classes, 27 Granular conjunctivitis, 171 Great Britain, classes and methods, 4-6, 10, 107, 115 Guardians, co-operation of, 17; *ee Parents Guides for children, 18 Handicaps, different types: classes f o r children w i t h , 15, 33; effects of child's

INDEX

2 1S

reactions to, 42 ff.; helping child to overcome, 102 Handwork and art, 7 119-22; published studies on, 122; equipment for, 91, 188, 190, 191 Harman, N. Bishop, 5, 6 Health, general: correlation between eye health and, 40, 167, 182 Health service, school, 37-50; use of term: administrative organization, 37; general services by medical and nursing personnel, 37-42; examination and its follow-up, 38-41; interpreting the service, 38 f.; health teaching, 41; emotional and mental health, 42-47; records, 47 f.; glasses, 49 f.; courses of action needed to provide for future, 146, 147 f.; screening program, 175 ff.; see also under Medical, Nursing H i g h schools, program planning, 28-30; preparation of teachers for, 56; reading, 113; prevocational courses, 129; need of more adequate provision in, 147 Historical background, 3-10; see Education Horace Mann School, 115 Hordeolum, 167 Hyperopic eye, 105, 161, 164 Ideal Teacher,

The (Palmer), 51; excerpt,

5« Illinois, eye and medical examinations, 22; supervisor, 60 Illinois Society for Prevention of Blindness, 22, loon Illumination, see Lighting Imbalance of muscles, 162 Indirect illumination, 80 f. Individual instruction, why necessary, 27 Inflammation, indicated by suffix itis, 166; eye diseases, 167 ff. Ink, 90, 189 Interstitial keratitis, 170 Iris, 155, 166, 171 Iritis, 171 Irwin, Robert B., g, 108, 110 Junior high school, 28; see H i g h schools Junior R e d Cross, 49 Keratitis, 169 Kerr, James, 4-6,90; quoted, 115 Lacrimal apparatus, diseases, 169

Lacrimal gland, 155 Lens, crystalline, 157, 159, 160; convex, 158, 160, 161; concave, 159, 160, 161; cylindrical: contact, 162; absence of, 166; diseases of the, 172 Light, sight dependent upon reflection of, 151; principles of refraction, 151, 158-63 Lighting, cost, 68; importance, 76; measurement of light, 76, 177; avoidance of glare, 76, 78, 79, 80, 83, 86; natural illumination, 77-79; artificial, 79-82; fluorescent, 79, 81; indirect, 80 f.; automatic control, 81; maintenance, 82, 186; reflection value of colors, 83 f., 185; on vision-testing chart, 177; outline for checking lighting facilities and equipment, 183-87 Light meters, 77, 177, 189 Lions Clubs, aids for the blind and partially seeing, 4g, 141 London, myope school, 5 f., 10 London County Council, 5, 6 Low vision child, reading, 105 Luckiesh, Matthew, and F. K. Moss, lilt! Luminaires, 80 f., 184, 189 Lunches, hot: equipment for, 88 Macrophthalmus, 166 Manufacturers of equipment, names and addresses, 188-91 Manuscript writing, i i 4 f . Maps, globes, charts, 89, i8g f. Massachusetts, screening tests, 22 Measurement of light, 76, 177 Mechanical devices used in teaching, g i , 123-27, igo; see also under names, e.g., Dictaphones, Ediphones; T a l k i n g Book; Typewriters; etc. Medical examinations, in preschool years, 20; in schools, 21, 38 If. Medical Inspection Bureau . . . [N.Y.] State . . . , 23 Medical personnel of school, 37 Medical social work, 138-40, 146 Mental and emotional health, 42-47; reactions to handicaps, 42 ff., 102 Mentally subnormal, combination in one class, of the partially seeing and, 7, 15, 16, 34; placement, 15, 16; tests, 16 Mental status, evaluation of, 20 Mental tests, 16 Michigan, 60 Microphthalmus, 166

INDEX Minneapolis, 1 1 3 Minority groups, provision for, 35 Minus lens, 162 Mirror reading and writing, 106 Moss, Frank K... and Matthew Luckiesh, mn Motivated Handivork and Activity Units. . . . (Phelps), 12271 Murals, 121 Muscles, of eyelid, 153; of eye, 154, 155, 157, 168; imbalance, 162 Music appreciation, g i , 125, 126 Myope school, London, 5 f., 10 Myopes, in school for blind, 5; avid desire to read, 104 Myopia, 164, 165; difficulty of placing child with: uncertainty re cause, 14 Myopic eye, 161, 164 National Society for the prevention of Blindness, Inc., 4871 Negro children, provision for, 35 New York City, sight conservation classes, 10; supervision in, 60 New York State, reference and placement of the partially seeing, 23; supervision in, 60 Nitrate of silver, 169 Nomenclature, 10; names built of root word and itis, 166; vocabulary of terms, 193-202 Nursing service, 37; use of community resources, 137; nurse's preparation for the future, 146; responsibility to recognize symptoms, 167 N.Y.A., help from, 1 1 3 Nystagmus, 105, 165 Ohio, eye clinics, 23; treatment: followup, 24; subsidy for the partially seeing: placement in boarding homes, 33; supervision in, 60; see also Cleveland On the Technique of Manuscript Writing (Wise), 1 1 5 « Ophthalmia neonatorum, 147 Ophthalmologists, British, 5n; lead in establishing special schools, 7; decisions regarding placement, 14; eye examinations, 2 1 , 5 8 ; supervision and care by, 58 f., 17971 Optic nerve, 1 5 1 , 153, 157; diseases, 173 Optimum Working Conditions for the Eye (Ferree and Rand), 11 in Oral instruction, 6, 7 Orbit, diseases of, 169

Orthopedically handicapped, 33 Orthoptics, 163 Paints, reflection factors, 83 f. Paints, art: sources of supply, 190; brushes, 190 Palmer, George Herbert, 5 1 ; quoted, 52 Paper, 89, 108, 1 1 1 , 190 Parents, co-operation of, in placement, 17; with health service, 38, 39, 45; right to make own plans, 40; when cause of emotional upset, 43 Partially seeing children, number of, 20, 144; the road ahead, and courses of action necessary to prepare for it, 14448 Partially seeing teachers, 52 Partial sight, research for discovering cause, 147 Peck, Olive S., 12571 Pencils, 90, 191 Pennsylvania, supervision of special education, 60 Pens and ink, 90, 191 Phelps, Sarah Latimer, 122« Phlyctenular keratitis, 169 Photophobia, 166, 170, 172 Physically Handicapped Children, Bureau of. New York, 23, 60 "Physician's Report of Eye Examination," reproduction, 48 Physiology and anatomy of eye, 153-58 Pigment, deficiency of, 165 Pink eye, 168 "Pioneer Work in Sight Saving" (Smith), 57n Placement in classes, 14-16; procedures for, 16-18; effect of unsuitable placement, 16 Plus lens, 161 Posture, 87 Prediction and Prevention of Reading Difficulties (Stanger and Donohue), 104« Prevention, lack of, and its effects, 43 Prevention of Blindness Department . . . Ohio . . . , 23 Prevention of Blindness Service . . . N.Y. State . . . , 23 Prevocational training as guidance to vocations, 129 Principal, school, 61, 100 Program planning, co-operative plan of conducting classes, 6, 9, 10, 65-67, 101 f.; segregation plan, 8 , 1 0 , 66, 100; number

2 14

INDEX

and grades in classes, 26 f.; elementary school program, 27; junior high school, 28; senior, 28-30; vocations, go, 131; problems in, for small communities and rural areas, 31-36; consolidated school, 31; demonstration school of a teachers college, 32; special class in nearest city, 32 f.; class for children with different types of handicap, 33; facilities in home rural schools, 34; minority groups, 35; contribution of health service, 42; preparation of group and individual programs, g8-ioo Psychological reactions, 13 Psychologist, services, 14, 20, 24 Ptosis, 168 Radio and the Talking Book, The . . . (Peck), I2.p>n Radios, 125; Cleveland's educational program and radio station, 125-27 Raffia work, îao Rand, G., and C. E. Ferree, 11 in Readers, volunteer, 30 Reading, why one of teacher's chief concerns, 103; difficulties to be overcome, 104-7; mental and other handicaps, 106; selection of material for, 107; typography and paper, 108-12; largetype material, 113 f. "Reading Problem, T h e " (Eames), 104« Recording machines, 91, 117, 124,189,190 Records, filing and keeping of health and eye records, 47 f., 179; "Physician's Report of Eye Examination," reproduction, 48; "School's Cumulative Report of Eye Examinations and Recommendations," reproduction, 49 Redslob, Edmond, 6 f. Reflection value of colors, 83 f., 185 Refraction, principles of, 151, 158-63 Rehabilitation departments as sources of guidance, 130 Rest periods for eyes, 99 Retina, 147, 157, 173 Retinal coat of eye, 157 Rockefeller Foundation, 126 Rubber-stamp printing, 108 Rural areas and small communities, placement, 18; states with special programs, 22; welfare agencies, 25; problems in administrative program planning for, 31-36 (see Program planning); provision of glasses, 49; supervision in Pennsylvania, 60; supervision for, 60,

61; legal provision for, 61, 72; lack of appropriation, 72; social service aids, 138; provision of books, 146 Salary of teacher, 67 Schlemm, canal of, 157, 174 School health service, 37-50; see Health service "School's Cumulative Report of Eye Examinations and Recommendations," reproduction, 48 School Vision and the Myopic Scholar (Kerr) gon, 115« Sclera, 155, 171 Sclerotic coat of eye, 155 Scouts, 18 Screening process for visual acuity, 20-25, 175-82; see Testing, vision Script-writing, 115 Seats and desks, 68, 86-88, 185, 191; see Desks and seats Second International Congress of School Hygiene, 5 Segregation plan of conducting classes, 8, 10, 66, 100 Senior high schools, 28-30; see High schools Shades, window, 79, 183, 185 f., 192 Sight, a complicated process: origin in two sources, 151; see under Eyes Sight-Saving; a Cooperative Movement (Sylla), loon Sight-saving classes, term, 10 Sight-Saving Study in Typewriting (Detroit Board of Education), 117« Sinusitis, 169 Small communities, see under Rural areas Smith, Helen L „ "Pioneer Work in Sight Saving," 8, 57 Snellen test and chart, use in vision testing, 21, 176-82; see entries under Testing, vision Social Security Act, 24, 73 Social service organizations, finding the children, 24; other aids, 25, 127, 137-40; those frequently participating in programs, 25; provision of glasses, 49; official and voluntary agencies, 137, 140; group services: case work, 138; medical social work, 138-40, 146; responsibility to recognize symptoms, 167 Social Welfare, N. Y. State Department of, 23 Society for the Prevention of Blindness, Illinois, 82, loon; National, 48«, 183«

INDEX Sources, m a n u f a c t u r e r s a n d supply houses furnishing equipment, 188-91; bibliog r a p h i c a l m a t e r i a l , 206 f. S t a n g e r , M a r g a r e t A., a n d D o n o h u e , E . K . , 104 S t a r r , I o , 128n States, g r a n t s u n d e r Social Security A c t , 24, 7 3 ; e q u i p m e n t f o r e s t a b l i s h i n g spec i a l classes, 26; d i r e c t i o n a n d supervision o f special e d u c a t i o n , 59-63; legal provisions for e s t a b l i s h i n g a n d financi n g classes, 69-74 S t a t e supervisors o f special e d u c a t i o n , 34 f.; see Supervisors S t e w a r t , Sir W . , 1 6 5 « S t r a b i s m u s , 163; see Crossed eyes S t r a i n o n eyes, evidences o f , 178 S t r a s b o u r g , " S c h o o l s for C h i l d r e n w i t h D e f e c t i v e S i g h t " ( R e d s l o b ) , 6 f. Sty, 167 S u l f a , use o f , 148, 1 7 1 S u p e r i n t e n d e n t of schools, a u t h o r i t y a n d responsibilities, 140 f. Supervision o f p a r t i a l l y seeing p u p i l s , 34 f., 58-64; o p h t h a l m o l o g i c a l , 5 8 f.; e d u c a t i o n a l , 59-63; duties of special supervisor, 61 f.; visiting teacher, 62 f. Supervisors, of special e d u c a t i o n , 34 f., 60; of e l e m e n t a r y e d u c a t i o n , 3 5 ; for t h e p a r t i a l l y seeing, 60, 61 f.; k n o w l edge of eye c o n d i t i o n s necessary, 62 S u p p l y houses of e q u i p m e n t , n a m e s a n d addresses, 188-91 Sylla, B e n A., loon S y m p t o m s of vision difficulties, 1 7 8 f. Syphilis as cause of eye troubles, 147, 170, 171. >73 Systemic diseases as cause, 40, 182 T a b l e s a n d chairs, 88, 89, 191 T a l k i n g B o o k , 9 1 , 1 1 4 , 190; d e v e l o p m e n t a n d use, 124 f. T e a c h e r s , c o - o p e r a t i o n with p a r e n t s , 17, 39, 45; with h e a l t h staff, 38 ff.; selection and preparation of, 5 1 - 5 7 ; personal qualifications: the four fundamentals, 5 1 - 5 4 ; those h a n d i c a p p e d by eye troubles, 52; f u n d a m e n t a l p r e p a r a t i o n a n d e x p e r i e n c e , 54; special p r e p a r a t i o n , 5 5 5 7 ; for e l e m e n t a r y courses, 5 5 ; for advanced courses, 56; colleges a n d u n i versities giving t r a i n i n g for, 5 5 f., 5 7 ; t h e visiting t e a c h e r , 62 f.; salary, 67; responsibilities o f g r a d e a n d special

2 1 5

class teachers, 96-98; s t a t e m e n t of policies re t h e i r i n t e r r e l a t i o n s h i p , 100-102; role i n c h i l d g u i d a n c e , 128; c o m m u n i t y responsibilities, 1 4 1 - 4 3 ; p r e p a r a t i o n n e e d e d for t h e years a h e a d , 144 f.; responsibility to recognize symptoms, 167 T e a c h e r s College, C o l u m b i a University, 55- » 5 T e a c h e r s colleges, d e m o n s t r a t i o n schools, 32. 145 T e a c h i n g , earliest a t t e m p t s , 5 f., 6, 8, g, 95; e d u c a t i o n a l procedures f o u n d suita b l e , 95; c u r r i c u l u m , g6; s h a r e d responsibilities of g r a d e a n d special class teachers, 96-98, 100-102; d u p l i c a t i o n to b e avoided, 97; p r o g r a m p l a n n i n g , 98100; tool subjects, 103-22; r e a d i n g , 10314; difficulties e n c o u n t e r e d , 104-7; s e " lection of r e a d i n g m a t e r i a l , 1 0 7 - 1 4 ; w r i t i n g , 1 1 4 - 1 6 ; typewriting, 1 1 6 - 1 8 ; arithmetic, n 8 f . ; art and handwork, 1 1 9 - 2 2 ; use of m e c h a n i c a l devices, 1 2 3 27; see also E d u c a t i o n "Teaching of Reading, The" . . . (Gates), io6?i T e a r s , 1 5 5 , 169; profuse, 1 7 2 T e s t i n g , vision: a s c r e e n i n g process, 20-25, 175-82; Snellen test a n d c h a r t for visual acuity, 2 1 , 176-82; for discovery of readi n g difficulties, 104; aspects of visual f u n c t i o n i n g , 1 7 5 ; supervision, 1 7 5 ; l i g h t i n g , p l a c e m e n t a n d distance of c h a r t , 177; symptoms o f vision difficulties, 178 f.; r e c o r d i n g results, 179; f r e q u e n c y a n d m e t h o d s o f giving tests, 180; m a k i n g a n d u s i n g cover cards, 180 f.; p r o c e d u r e , 1 8 1 ; e v a l u a t i n g results, 182 T e s t s , m e n t a l , 16 Text-Book of Ophthalmology (DukeE l d e r ) 16571 T e x t b o o k s , see B o o k s T o o l subjects, t e a c h i n g o f , see T e a c h i n g T r a c h o m a , 148, 170 T r a i n i n g courses in colleges a n d u n i versities, 32, 5 5 f., 5 7 , 145 T r a n s p o r t a t i o n , 18 f., 28 T y p e size a n d face, 108-12 T y p e w r i t e r s a n d accessories, 89, 191 f.; type size a n d style, 1 1 0 Typewriting, n 6 f . , 123 T y p e w r i t i n g m a n u a l s , 1 1 7 , 189 T y p o g r a p h y a n d p a p e r , study o f : type f a c e a n d colors selected f o r books, 10812

INDEX United States, earliest classes established in, 7-10 Universities offering special courses, 55 f., 57 Uveal tract, 155, 171

Vicariousness, aptitude for, 52 Visibility and Readability of Print on White and Tinted Papers (Luckiesh and Moss), 11 in Visiting teacher, 62 f. Visual acuity, screening process, 20-25, 175-82; see Testing, vision Visual co-ordination, period of, 165 Vitreous, the, 157, 174 Vocabulary, of terms relating to the eye, 193-200; of general terms, 200-202 Vocational Division of the U.S. Office of Education, 131 Vocational guidance, 29, 30, 131-33 Volunteer services, 18, 30, 49, 141; need

of finding new sources, 114; see also Social service Watery eye, 169 Wattages, lamp, 80 Waverley School, 9; see also Cleveland Welfare organizations, see Social service White House Conference on Children in a Democracy, 35 Window cards, test-chart, 181 Windows, 78 Window shades, 79, 183, 185 f., 192 Wise, Marjorie, 115 W P A , services rendered by, 113 Word blindness and deafness, 106 Work and study, alternate: as prevocational guidance, 130 Work Units for Sight-Saving Classes (Starr), i2in Writing, mirror, 106 Writing, teaching of, 114; manuscript writing, 115; chalkboard writing, 115 f.