378 TRAINING THE SQUINTING EYE

doctors over such things as return to work com-bined with treatment, and consultation over

individual traits and circumstances that onlybecome manifest in the patient’s working environ-ment. Our columns in the past few years havecontained numerous contributions dealing withthese matters, and future developments were

considered at the recent congress of the RoyalSanitary Institute in Bournemouth, when a sectionof hygiene in industry collaborated with theIndustrial Welfare Society. At this congress Dr.T. E. A. STOWELL emphasised the foundationscommon to all medical services in industry; no

matter what the needs of a special concern mightbe there is an A.B.C. of industrial hygiene withoutwhich nothing can succeed. Dr. W. D. JENKINSoutlined the opportunities and duties that existfor employers to help and care for their olderworkmen. Important now this is a side that willgain in importance if the average age of the popula-tion continues to rise and the proportion of olderpeople to increase. Even after they have left

industry these older people can be useful citizensand it is a social duty to see that in their later

years their work does not unnecessarily impairtheir powers of happy and useful life. The dis-tribution of goods is undergoing rapid changes andnot the least of these is that more people are beingemployed in what may be called the ancillaryservices of production. Though not strictly indus.trial the work of the sales-shop and store is orga-nised on lines which call -for medical supervisiondifficult to apply except in large single establish-ments. Dr. M. L. DoBBiE-BATEMAN dealt withthe shop assistant and the meeting was notablefor the emphasis laid on the medical problems ofretail selling. Working with a large retail staff,albeit under the ideal condition of having themalmost under one roof, Dr. DOBBIE-BATEMAN hasutilised her opportunities to collect informationabout an occupation which in general is scatteredin small units but which nevertheless calls for asmuch medical attention as the ordinary run offactory work. Lord TRENT, who presided over

the section, was able to draw on his own admini-strative experience and stated frankly that the

picture of the life of a shop-assistant in big citiescan be an unpleasant one unless the employeris expertly advised and takes medical considera-tions into account in a fair and sympatheticmanner.

The boundaries of occupational medicine are

thus widening from mines and factories to officesand shops-from mere hazards to the deeper, moreintimate and individual psychological maladjust-ments of the worker. That this extension couldunder improper administration result in victimisa-tion is obvious, but the phase of suspicion is dyingdown as industrial medical officers continue to

prove that they are doctors to their patientsbefore they are servants to anyone, and they aregradually widening their own function to embracethose wider economic interests which are so potentin the making or breaking of the health of. indi-vidual workers. Lord TRENT showed a ’deep

understanding of this social aspect of medicinewhen he stated that " the removal of that per-petual fear of losing one’s job which besets workingpeople of all ages [is] the greatest human problemthat will have to be solved in the course of this

century." The acknowledgment that economicsand medicine are inextricably interwoven is atonce the justification for industrial medicine andits greatest urge to progressive and far-seeingdevelopment. The medical profession as a wholehas a deep concern in the trends of industrial andeconomic organisation because while a movement,such as for instance large-scale grouping, maybring forward new problems it also produces newopportunities ; and who will deny that in a complexworld centralisation is essential if we would remainsane and that through cooperative effort preventivemedicine is .made easier and treatment more com-prehensive and efficient ? Industrial medicine will

develop not with the object of increasing sectionalprofits but because an industrial state cannotafford to leave untilled a most fruitful and econo-mically efficient field of preventive and curative-medicine.

TRAINING THE SQUINTING EYETHE interest now taken in the treatment of

squint, whether with or without operation, shows,no signs of abating. Miss DoBSON’s most recentcontribution to the subject will be found of greatpractical use. She describes a device for the use-

of children whose concomitant squint has alreadybeen overcome, or nearly so, either by the wearingof glasses or by other methods, but in whom oneeye remains to a greater or less extent amblyopicfrom disuse. Suppression of the image in a

squinting eye is the great obstacle to successfulorthoptic treatment. Hitherto complete occlusionof the non-squinting eye has been the favouritemethod for developing vision in a squinting one,and in the case of young children with constantmonolateral squint it is often the only practicableone. The ideal method of occlusion, which admitsof some indirect vision on the temporal side of therfield but completely shuts off direct vision, wasset out in our columns (July 27th, p. 183) byMrs. THORNETT-JOHNSON, but she admits that forany child after the age of six with vision in the

squinting eye reduced to much below 6/60 it is avery trying and long treatment. For older child-ren, although it may be possible, unless the visionof the squinting eye has improved considerablybeyond 6/60 it must necessarily be a serious handicapto education. In Mrs. THORNETT-JOHNSON’S experi-ence the average time taken at a clinic to restorethe vision of a squinting eye seeing less than 6/6(}to normal has been 18 months, the shortest being6 months and the longest 3 years. Any methodof quickening the pace would be welcome.When the child is able to read, when the squintis only slight or occasional, and when the visionof the squinting eye is good enough, with refraction

1 The Amblyopia Reader : A System of Eye-sight Develop-ment. With foreword and notes by Margaret Dobson, M.D.London: Rembrandt Photogravure Ltd. Pp. 93. 15s.