EXAMINATION 
OF 
(| olorcd Jjetaal (| Itildrrn’s pO. 
JiY 
PETER A. CALLAN, M. D., 
Assistant Surgeon to the New York Eye and Ear Infirmary. 
NEW YORK: 
WOOD & REILLY, BOOK AND JOB PRINTERS, 
113 Nassau Street. 
1875- EXAMINATION 
OF 
pOLORED pCHOOL pHILDREN’S pYES. 
BY 
PETER A. CALLAN, M. D., 
Assistant Surgeon to the New York Eye and Ear Infirmary. 
Examinations of schools in Europe, in order to deter- 
mine the refraction of the scholars’ eyes, have of late years 
been of quite frequent occurrence. 
Jager was one of the first to make examinations, and the 
only one to determine the refraction in new-born children ; 
he was followed by Cohn, of Breslau, who tabulated 10,060 
school children. Erismann and Dobrowlsky of St. Peters- 
burg, Hofman of Wiesbaden, and many other European 
oculists, made examinations of schools and universities, and 
all found an increase of myopia in the higher classes of the 
lower schools, and in the higher classes and universities 
alarmingly high percentages of myopia. The increase of 
myopia could, in a great part, be shown to depend on badly 
lighted study-rooms, unsuitable seats and desks, too long 
continuous hours of study, and a confined range of vision. 
Jager s examination is quite interesting, inasmuch as all 
his calculations had to be made with the ophthalmoscope, no 
other means being possible under the circumstances, and as 
there are but few, if any, who excel him in the use of that 
instrument, his results must be regarded as accurate. He 
found 75 per cent, of myopia amongst the new-born children, 
ranging in degree from a A to a Only in a few cases was 
posterior staphyloma (conus) present. This very large per- 
centage of myopia is due to the great thickness of the in- 
fantile lens, and to the as yet imperfectly developed zonula 2 
zinnii, not being able to exert any influence on it. Colin 
tabulated 10,060 school children, 6,059 of whom lie examined 
personally. He examined the scholars with test-types at 4 
feet distance, and in this way most of the cases of myopia 
less than A escaped, and were reckoned to the emmetropes. 
The same author* in 1871 examined some 240 village school 
children, and found 88 per cent, apparently emmetropic. 
In each of the apparently emmetropic eyes he put s. atropia. 
When the accommodation was completely paralyzed, the 
emmetropes again examined, and as a result all the 
emmetropes became hypermetropes; the greatest number 
ranging in degree from a A to a A of hypermetropia. 
Erismannf found in his investigations as high as 42 per 
cent, of myopia in certain classes, and only 26 percent, in 
the whole school, while hypermetropia in the lower classes 
amounted to two thirds. Commenting on this large number 
of H. in the lower classes, he adds : “ Hypermetropia is the 
normal reflection of the healthy youthful Gye, and not that 
which we denominate emmetropia, still less myopia, as they 
are only the exception at that age The smaller por- 
tion remain hypermetropic, but the yrenter number become 
myopic, having passed through a transitory state, i. e., em- 
metropia; some remain, however, in this state through for- 
tunately favoring circumstances.” 
Donders’ views on this subject are decidedly in opposition 
to the above. His doctrine is, youth hypermetropia, ado- 
lesence emmetropia, old age hypermetropia acquisita. 
Donders, in his classical work,:}: remarks, under Chapter 
V.: 
“ The Emmetropic Eye.—Slight degrees of H. are in 
youth not even to be proved, much less to be reduced to 
their numerical value; indeed, whenever a deficiency of re- 
fractive power exists in the eye, when in a state of absolute 
rest, it is supplied by the accommodation. And even if the 
eye in paralysis of accommodation should be emmetropic, 
the tone of the accommodation alone affects a slight degree 
of myopia, consequently the actually emmetropic vision re- 
quires, in a certain sense, a minimum of II., and that mini- 
* V. Grsefe’s Archtv, vol. xvii , part 2, p. 315. 
t V. Grwfa’s Archiv, vol. xxii. part 1, p. 1. 
* Accommodation and Refraction, 174, German edition, 148 3 
mum is capable of no accurate taxation, because to the tone 
itself a certain latitude, perhaps from ib* to A, should be 
allowed. 
“In this sense, and it is practically the only correct one, 
the majority of eyes are undoubtedly emmetropic.” 
The selection of colored scholars was not made without 
good reasons. Heretofore nearly all the examinations have 
been made in Germany, and, needless to remark, on whites. 
It is to most familiar that there is a very large percentage 
of myopia amongst the students in the gymnasiums and 
universities of Germany; the percentage is much greater 
there than in the other countries of Europe. The Germans 
acquire myopia by their long years of study, having perhaps 
inherited a predisposition to it, or inherited it already de- 
veloped and increased in attaining their manhood. Our 
colored brethren as a rule never did enjoy a thorough system 
of education. The present generation in New York may be 
said to enjoy as thorough as the city affords; but their fore- 
fathers did not; neither have they been raised to such pur- 
suits as demand a very close application of the eye, viz., 
engraving, etc.; ccrter is paribus the negro’s eye should ap- 
proach nearest to a natural eye, L e. normal eye. The very 
best material for examinations of this kind could be ob- 
tained in the Southern States, where, until of late years, the 
negro was unjustly debarred from the luxury of spoiling 
his eyes, /. e. a modern education. 
The examination was begun last spring, and finished be- 
fore the summer vacation. In examining the scholars, Suel- 
len’s test types were also—“A” and “ E,” old and new se- 
ries-placed in the wall of the study room. The scholar to 
be examined was placed thirty feet distant from test types, 
and each eye alternately tested on card “A” for example, 
the result being noted; then convex and concave glasses 
were placed in turn before each eye, and pupil asked to read 
card “E.” This changing of the examined card was to pre- 
vent learning by heart, and consequent deception on the 
part of the scholars. Each pupil was likewise tested for 
color blindness. Cohn was very fortunate in being able to 
examine two hundred and forty scholars’ eyes under the in- 
fluence of s. atropine, an opportunity which does not present 4 
itself very often, and such a procedure was entirely out of 
the question in the present instance, particularly as the col- 
ored children feared from the first that their eyes were by a 
species of legerdemain to be taken out, and then and there 
replaced—a belief, by the way, which is not confined to col- 
ored children, but to very large children of the Caucasian 
race. Not being able to put s. atropke info the scholars’ 
eyes, we put it in our own, so as to thoroughly paralyze the 
action of the ciliary muscle, and kept our eyes in that con- 
dition during the ophthalmoscopic examination of the schol- 
ars’ eyes. Each scholar’s eyes were separately examined 
with the ophthalmoscope in the upright image, and the cor- 
recting glass used to view fundus distinctly gave the refrac- 
tive condition of the examined eyes. In this manner the 
examination was made with all due accuracy. Our eyes 
being under the free influence of s. atropke, we were not 
able to use our accommodation, and the glass used to see 
the fundus gave the desired refraction. 
In theory it is quite simple to estimate the refraction by 
means of the ophthalmoscope—the refraction of the exam- 
iner’s eyes being known, say emmetropic, and if he sees dis- 
tinctly the fundus of examined eye without accommodating 
or the aid of glasses, then is the refraction of examined eye 
likewise emmetropic; but if he does not accommodate, and 
can only see with minus or plus glasses as correction, ;lien 
there is myopia or hypermetropia, of a degree indicated by 
the glass, plus the distance of nodal points of both eyes in 
myopia, and less the distance in hypermetropia. When the 
examining surgeon is ametropic, then his refractive condi- 
tion must be taken into consideration. 
Apparently it involves a small amount of calculation in 
any given case, when the refraction is obtained, but a very 
important factor must not be lost sight of, viz : can the ex- 
aminer avoid accommodating, and rely on his correcting 
lenses in the ophthalmoscope in order to see the fundus of an 
examined eye distinctly? 
We all know how difficult it is, when examining in the di- 
rect or upright image, to avoid using our accommodations, 
and what a large amount of practice in the use of the oph- 
thalmoscope it demands, before we can say that our ciliary 5 
muscle is under our control; in order to avoid this difficulty, 
and place the results of an examination beyond dispute, s. 
atropise must be used either in the eyes to be examined, if 
possible, or in the examiner’s own eyes. 
Two public schools were examined; both together con- 
tained 457 scholars. The following is the result of the ex- 
amination; 431 emmetropic, 94 per cent,; 12 myopie, 2.6 
per cent.; 14 amblyopic, 3 percent. 
Public School No. 3 contained 293 scholars; 274 emme- 
tropes, 10 myopes, 9 amblyopes. 
Public School No. 4 contained 163 scholars: 157 emme- 
tropes, 2 myopes, 5 amblyopes. 
School No. 3 has a percentage of 3.4 per cent, myopes, 
while School No. 4 has only 1.2 per cent, myopes; the ex- 
planation is that School No. 3 has an excellent corps of 
teachers, and is really the colored high school, and, in con- 
sequence of its superior advantages, is frequented by schol- 
ars of well-to-do parents from all parts of the city proper? 
Manhattanville and Harlem. 
School No. 4 has only a local attendance. Had we ex- 
amined an equal number of white scholars, we are fully sat- 
isfied that our examination would show a much larger per- 
centage of myopia than that found amongst the colored 
scholars, viz., 2.6 per cent. 
Public School No. 3. Primary Department. 
Classes. 
Boys. 
Girls. 
Ages. 
Emmetropes. 
Myopes. 
Amblyopes. j 
1st and 2d Class 
19 
9-17 
18 
0 
i 
“ “ .. 
21 
19 
0 
2 
3d and 4th “ 
32 
7-15 
32 
0 
0 
36 
35 
0 
1 
5th and 6th “ 
27 
5 -12 
26 
0 
1 
36 
35 
0 
1 
Total 
171 
165 
0 
6 
Per cent 
96.5 
3.5 6 
Grammar Department. School No. 3. 
Claeses. 
Boys. 
Girls 
Ages. 
Emmetropes. 
Myopes. 
Amblyop's 
1st and 2d Class 
8 
12-19 
6 
2 
0 
“ “ 
it; 
44 
13 
2 
1 
,3d and 4th “ 
It 
10—17 
11 
3 
0 
“ “ .. 
19 
•• 
18 
1 
0 
|5th and tith “ 
13 
10-17 
13 
0 
1) 
“ “ 
14 
“ 
12 
2 
0 
7th and 8th “ . . 
24 
9-15 
24 
0 
0 
H it 
14 
12 
0 
2 
Total 
. .. 122 
109 
10 
3 
Per C' nt 
89 3 
8.2 
2.5 
In the above public school there were nine cases of am- 
blyopia, three of which depended on astigmatism, and for 
convenience, put under that head, as likewise one case of 
mixed refraction, the one eye being myopic, whilst the other 
was hypermetropic; the remaining live cases depended on 
macula cornea. 
Primary Department. Public School No. 4. 
Classes. 
Boys. 
Girls. 
Ages. 
Eminetropes. 
Myopes. 
Amblyopes. 
1st and 2d Class, 
20 
6-13 
2) 
0 
0 
24 
21 
0 
U 
Total, 
4 
4 
44 
Grammar Department. Public School No. 4. 
Classes. 
Boys. 
Girls. 
Ages. 
Emmetropes 
Myopes. 
Amblyopes. 
let and 2d Class, 
15 
12-19 
15 
0 
0 
“ “ 
26 
44 
23 
1 
2 
3d and 4th “ 
12 
11-18 
12 
0 
0 
H “ 
30 
“ 
29 
0 
1 
5th and 6th “ 
14 
11-17 
14 
0 
0 
23 
20 
1 
2 
Total, 
120 
113 
2 
5 
Per cent 
94.2 
1.6 
4.2 
In Public School No. 4 there were only live cases of am- 
blyopia, two of which depended on astigmatism ; the 
remaining three cases on macula cornea. 
The following tables show the number of scholars who 
were able to read the test types at the given distance with 7 
concave and convex glasses. In tlie majority of cases, in 
testing with convex glasses the scholars could not see well 
with them ; but making them close the eyes and remain so 
for a short period of time, then again trying they had a 
vision of §°. \ ery few of them but gave the preference to 
concave glasses, and in about 10 per cent, of the scholars 
they imagined that the concave glasses magnified the letters, 
the convex making them smaller. 
This preference of concave to convex glasses is easy to 
explain, inasmuch as it is quite easy for the youthful hyper- 
metropic eye to concentrate divergent rays upon the retina ; 
but for the same eye to avoid accomodating, which is neces- 
sary in order to see with the convex glasses, is at first diffi- 
cult and only to be obtained with a little practice. The 
tables for the convex glasses represent the number and de- 
gree of facultative hypermetropia in both schools. 
Facultative Hypermetropes. 
Boys 125. 
Girls 
164. 
Numbers of Convex Glasses. 
Age, 
72 
60 
48 
42 
36 30 
24 | 
72 I 60 
48 
42 
36 
30 
24 
6 
1 
1 
3 
1 
7 
1 
2 
2 
3 
8 
3 
2 
7 3 
1 
2 
11 
3 
1 
9 
4 
3 
2 1 
1 
6 
6 
5 
2 
10 
2 
6 
7 
3 2 
2 
5 
8 
2 
11 
2 
2 
5 4 
4 
5 
5 
3 
12 
1 
3 
4 
5 
3 4 
2 
9 
4 
5 
3 
13 
1 
2 
4 
2 2 
1 
1 
6 
6 
2 
14 
2 
2 
4 
2 
1 1 1 
5 
6 
5 
15 
1 
1 
5 
4 
1 
11 
4 
4 
5 
16 
1 
1 
1 
1 
1 
1 
1 
1 
2 
17 
1 
1 
1 
18 
1 
2 
2 
19 
1 ’ 
1 1 
Total 
4 
9 
31 
36 
28 17 
2 16 
40 
51 
42 
13 
Per cent. 
3.2 
7.2 
24.8 
28.8 
22.4 13.6 
i.2.: 9.i 
24.5 
31.1 
25.6 
7.9 
Only the scholars with an acuity of vision of *« were tested 
with convex and concave glasses, and higher degrees of 
concave than convex glasses were accepted, as can be seen 
by the following tables, in which we omit the details and 
give only the general results : 8 
Boys 181. 
Girls lb7. 
Numbers of Concave Cltssos. 
A^e. 
72 60 
48 
42 
88 
30 
24 20 
72 
60 
48 
42 
36 
30 
21 
20 
6 
1 
1 
1 
2 
1 
7 
1 
2 
2 
1 
2 
8 
3 
5 
4 
1 
2 
2 
8 
4 
2 
3 
9 
3 
3 
3 
1 
4 
9 
7 
1 
10 
4 
7 
4 
3 
3 
2 
3 
6 
2 
3 
1 
11 
2 
4 
4 
.*> 
2 
3 
4 
4 
5 
12 
1 
2 
6 
4 
3 
3 
1 
4 
5 
6 
4 
2 
18 
1 
1 
4 
4 
2 
1 2 
2 
2 
8 
3 
1 
1 
14 
1 
2 
1 
3 
2 
1 
1 
2 
4 
0 
4 
1 
15 
1 
2 
4 
4 
1 
1 
2 
3 
5 
2 
1 
1 
16 
1 
1 
1 
1 
2 
1 
1 
1 
17 
1 
1 
1 
18 
1 
1 
2 
1 
1 
1 
19 
1 
1 
Total 
0 J 4 
21 
37 
35 
15 
17 2 
2 
10 
20 
43 
48 
19 
15 
4 
Per cent. 
0 3 
16 
27.7 
27.4 
11.4 
12.9 1.6 
1.1 
5.9 
15.8 
25.7 
28.8 
11.5 
8.9 
2.3 
It will be seen from the following table of percentages 
that amongst boys 3 per cent, more in favor of the concave 
glasses were found, whilst there is only a difference amongst 
the girls of 0.4 percent, in favor of concave glasses. 
Scholars. 
• 
Convex Glasses. 
Per cent. 
Concave Glasses. 
Per cent. 
Boys 
191 
125 
65.4 
131 
6«.5 
Girls ,.. 
210 
164 
68.3 
165 
68.7 
Total 
431 
289 
67. 
296 
68.6 
Each scholar was tested with one eye, then with the other; 
the second column shows the number of scholars who saw 
IH with convex glasses, and the fourth the same with concave 
glasses. 
67 per cent, of the 461 examined presented facultative 
hypemetropia. Erismann found only 43 per cent., while 
Cohn found as high as 77 per cent, in their respective ex- 
aminations. 
The ophthalmoscopic examinations were made in the fore- 
noon, and extended over a period of live weeks, during 
which time both eyes of the examiner were under the influ- 
ence of a four grain solution of s. atropim applied three 
times daily, so that the accommodation was completely 
paralyzed. Forty-nine of the apparent emmetropes refused 
to have their eyes examined with the ophthalmoscope any 9 
further, in some few cases the mothers not wishing it; the 
great reason was fear on the part of the scholars, and as we 
had not time to try and persuade thsm, they were lost to 
the ophthalmoscopic examination. 
The following tables show the refraction of the scholars’ 
eyes as tested with the ophthalmoscope. First column, ages; 
second, emmetropia found; and the following, the different 
degrees of hypermetropia: 
Hypermetropia. 
Boys, 
188. 
Girls, 194. 
Hypermetropia. 
Em. 
1 
1 
36 
1 
3(F 
1 
1 
tV 
1 
T Z 
A 
tV 
1 
Em. 
1 
ISIS 
sV 
1 
3 TS 
1 
1 
T&JS 
1 
TT 
Ages. 
00 
5X 
1 00 
6 
1 
3 
2 
2 
1 
2 
i 
7 
1 
3 
2 
1 
2 
2 
2 
i 
8 
4 
4 
8 
i 
1 
3 
8 
3 
i 
2 
i 
9 
2 
3 
3 
2 
4 
1 
i 
1 
1 
1 
2 
7 
3 
1 
i 
10 
1 
2 
7 
4 
3 
1 
1 
i 
1 
1 
2 
6 
5 
5 
2 
1 
11 
1 
3 
■r> 
4 
3 
1 
1 
i 
6 
5 
2 
4 
2 
12 
4 
4 
6 
6 
1 
2 
1 
2 
1 
8 
5 
2 
1 
2 
13 
1 
3 
10 
2 
4 
i 
1 
3 
3 
7 
9 
4 
1 
14 
2 
7 
4 
2 
3 
1 
i 
3 
5 
5 
4 
2 
1 
15 
1 
1 
3 
3 
1 
2 
3 
4 
5 
4 
1 
1 
2 
16 
1 
1 
4 
2 
1 
1 
1 
2 
3 
£ 
1 
1 
1 
17 
2 
2 
2 
2 
1 
1 
18 
2 
1 l 
1 
2 
1 
19 
1 
1 
1 
Total. 
17 
25 
55 
40 
20 
9 
3 
9 
5 
4 
t 
19 
30 
62 
45 
16 
13 
9 
Per cent. 
9 
13.4 29.3 21.2 10.6 
4.8 
1.7 
4.8 
2.6 
2.1 
0.5 
9.8 15.5 
81.9 23.2 
8.2 
6.7 
4.7 
Percentages of Ophthalmoscopic 
Examinations. 
Em 
00 
l i l 
1 
8D 
1 1 
ST SO 
iV 
1 
TT 
1 
XT 
l 
13 
1 
5i/2 
Total. 
Boys 
... 188 
9.0 
13.4 29 3 21.2 
10.6 4.8 
1.7 
4.8 
2.6 
2.1 
0.5 
109 
Girls 
... 191 
9.8 
15.5 31.9 23.2 
8.2 6.7 
.4.7 
100 
Total 
... 382 
9.4 
14.4130.5 22.3 
1 
9.4 5.8 
1 
3.2 
2.4 
1.3 
1.0 
0.3 
100 
As is sliown by the above table of percentages of the 382 
apparent emmetropes, examined with the opthalmoscope, 
only 9.4 per cent, were found to be emmetropic, whilst 90.6 
per cent, were found to be hypermetropic. 
The following table comprises the myopes in both schools, 
male and female; two more females were myopic than males: 10 
Myopia. Males and Females. 
aV 
A 
IS 
A 
1 
A 
1 
1 
4 
8 
» 
10 
11 
12 
13 
14 
1 
1 
1 
i 
i 
15 
IK 
17 
1 
1 
i 
•• 
i 
1 
18 
1 
i 
Total 
1 
2 
2 
i 
l 
2 
1 
1 
The acuity of vision was tested in all cases, but we only 
make use of the 431 apparent emmetropes. 
We believe Snellen’s test-types to be the most reliable for 
distance. His xx can be read by young subjects very often 
at much greater distance, but taking it as a standard for av- 
erage vision it is quite good. Very often xx of A series is 
incorrectly given; for instance, U is rendered as V, Y taken 
for T, C and G mistaken for O, and there are but few who 
see the figure 2 distinctly. All these letters have been 
changed to series E, new edition. 
Acuity of Vision. 
20-24 
20 
25-29 
20 
30-34 
20 
35-39 
20 
40-44 
20 
45-49 
20 
60 
20 
Total. 
Boys 
126 
35 
22 
3 
8 
3 
191 
Girls 
189 
28 
18 
3 
1 
i 
240 
Total 
315 
63 
40 
6 
4 
i 
2 
431 
Per cent 
73 1 
14.7 
9.8 
1.4 
0.9 
0.2 
0.4 
100 
As can be seen by consulting the above table, 73 per cent, 
had a normal vision; not quite one per cent, had a vision of 
IS, whilst the highest found was a vision of or IS. Still 
greater degrees of acuity of vision have been found by other 
examiners, but then they can be regarded as curious cases, 
and not for a moment to be taken as a standard. 11 
Three cases classified under amblyopia as macula cornea 
presented a rather singular form of eye disease—hyper- 
trophy of the limbus. All around the cornna at limbus an 
elevated ring extended, keeping as it were the sclerotic and 
cornea in position. This ring was grayisli-white in color, 
devoid of vessels, 3 mm. in width, and £ mm. to mm. in 
height. In the sclerotic there were some fine vessels running 
toward the limbus, but they did not appear to penetrate 
into it. The cornea was quite hazy all around its circum- 
ference, and the haziness extended about 2 mm. toward its 
centre. (No color blindness found among the scholars.) 
During the examination of the scholars we fouiuj three 
cases of persistent hyaloid artery, two boys and a girl, and, 
singular enough, in the left eye of each. Considering the 
number of scholars in the two public schools examined, and 
the comparatively few cases on record of persistent hyaloid 
artery, the number is very large. Are we to expect to find 
more such cases in the colored race than in the white? The 
three cases will soon be published in full. Should our re- 
sults cause similar examinations of other colored schools, 
we would consider ourselves amply repaid for our time and 
trouble.