THE NEW OPHTHALMOLOGY 437 



But as optics grow into physiology, and physiology into pathology, 

 so must our pathology merge into biology. How is eye-strain related 

 to the evolution process of living things? The test of the validity 



Biographic Clinics, but with this difference : In his cases the dominant etiological 

 factor was discovered before irreparable damage had been done, and relief fol- 

 io w-ed the timely prescription of appropriate glasses ; in the lives which you have 

 discussed, relief came only in advanced age, when accommodation ceases from 

 troubling. 



To me the central and very significant fact is that the protracted sufferings, 

 always alleviated by rest from eye-work and always recurring with the resumption 

 of studious pursuits, as portrayed in the several biographies from which you have 

 culled, are such as ophthalmic practitioners recognize as dependent, in many 

 persons, on common ocular defects, and as preventable or curable by properly 

 directed optical treatment. 



It cannot be too strongly impressed on all intelligent persons, whether physi- 

 cians or w r orkers in other fields, that the demands made upon the eyes in modern 

 life are much greater than the visual apparatus, when of only average structural 

 perfection, can meet effectively and safely. The lesson which I have learned from 

 forty years of continuous study of the anomalies of accommodation and refrac- 

 tion is precisely in the line of your teaching, namely, that no degree of anisome- 

 tropia or of astigmatism can be regarded as too small to demand accurate correc- 

 tion in persons compelled to use the eyes continuously, or in patients suffering 

 either from so-called asthenopic symptoms, or from headache or other reflex 

 disorders induced or aggravated by eye-work. Neither can I accord any measure 

 of assent to the notion that a short term of attendance at a postgraduate school, 

 or any period of apprenticeship in selling eye-glasses and spectacles, can qualify 

 an uneducated or, at best, a crudely educated man to do work which often taxes 

 my own powers to the utmost, and in which I find that the continued cooperation 

 of the patient, by returning promptly for further advice when anything goes 

 wrong, and by permitting the necessary periodical revision of his optical correction, 

 is indispensable. 



It is surely not an extravagant contention that eyes which do not perform their 

 function perfectly in all respects and under all conditions, or whose use is attended 

 or followed either by local disturbances or by headache, nausea, insomnia, or other 

 reflex manifestations, ought, without exception, to be promptly and critically 

 examined. That such examination will very often bring to light a previously 

 unrecognized ocular defect, and so point the way to urgently needed relief through 

 wearing properly chosen and properly adjusted spectacles, needs only to be stated 

 to command assent. The knowledge that relief from headache may come through 

 wearing glasses is becoming more and more widely diffused; but comparatively 

 few physicians have learned as yet to recognize the protean forms which reflex 

 disorders of ocular origin may take on, or to estimate at its true value the service 

 which a wise and conscientious ophthalmic specialist may be able to render. 



The investigation and treatment of functional disorders dependent on struc- 

 tural imperfections of the visual organs call for the exercise of the minutest care, 

 and often of almost infinite tact and patience. That these essential qualifications 

 are sometimes conspicuously lacking in men eminent for their achievements along 

 other lines is also true. Careless or perfunctory refractive work by an ophthalmic 

 specialist will yield no better results than similarly defective work done by per- 

 sons of inferior scientific attainments and of vastly less reputation. The intelli- 

 gent and painstaking pioneer work of Ezra Dyer; the invention and employment 

 of new aids to diagnosis by William Thomson; the frank recognition and just 

 appreciation by S. Weir Mitchell of the far-reaching benefits rendered in his 

 reported cases, by William Thomson, William F. Norris, and George C. Harlan; 

 and lastly, the continued devotion to the cultivation of accurate methods by a 

 long line of careful investigators down to the present day, make up a sum of 

 achievement by Philadelphia men which may be regarded as more than sufficient 

 to justify the recognition of a distinctive Philadelphia School. 



The personal sufferings of Ambroise Pare" and of Percivall Pott were the means 

 of enriching surgical literature by two illuminating chapters on compound frac- 

 ture. Your early experience of the torments and disabilities incident to a too 

 long delayed diagnosis and correction of a complicated ametropia gives you, also, 

 the right to speak forcibly and with authority. 



Were not the Hebrew prophets decried, in their day, as enthusiasts? 



JOHN GREEN. 



