428 OPHTHALMOLOGY 



a narrow specialism, prevents the exaggerater from becoming an 

 extremist, and forbids the extremist from becoming a hobby-rider. 

 In obedience to it, the specialist must always be on the sharp look- 

 out for all the lines of cause and effect which may subtly run back 

 and forth, either way, between the diseases of his chosen field of 

 study and that of all the other specialists. We are, in truth, all of 

 us specialists nowadays, the general physician fully as much so as 

 any other. While knowing profoundly one specialty, as willy-nilly 

 we now must do, it is our common duty to maintain a keen out- 

 look over the work of others and preserve a large sanity of mind, 

 and a genuine sympathy of feeling with our colaborers in all other 

 fields. The direction to speakers at this meeting is to choose out 

 and emphasize the relations running between their specialties and 

 those of others, between one science and the other sciences. We 

 are to bind into unity, or preferably discover the number and 

 nature of the existing bonds which make the organism one, and its 

 parts interdependent, and which resolve all organisms into a uni- 

 verse. 



The relations which exist between refraction anomalies and 

 general medicine are almost solely of one kind, those, namely, 

 in which the ocular condition is causal. There are very few bodily 

 conditions or diseases that influence the ametropia. 1 Large changes 

 in general body weight, I have demonstrated, do so, a decided 

 increase of fat tending to lessen the anteroposterior diameter of 

 the globes; an extensive decrease of fat, conversely, lengthening 

 the eyeballs. I have also noticed that after a severe illness refrac- 

 tion changes will probably be found. Other illustrations may be 

 omitted. 



The eye and ear have extremely few, if any independencies, and 

 they are relatively unimportant. And yet an expert might write 

 an interesting monograph on the subject. One would say that the 

 dentist and oculist had little in common, and yet I have had more 

 than one patient who had violent toothache in sound teeth when- 

 ever he read or wrote five minutes. 



The specialist in diseases of the upper air-passages must never 

 forget the oculist. It is a significant fact that eye-strain patients 

 locate their headache directly in or behind the frontal sinuses. We 

 list them as frontal, but understand thereby that the forehead is 

 the location of the pain. For many years I had noticed that there 

 was a suspicious relation between eye-strain and frontal-sinus dis- 

 ease, and in several patients I had definitely traced it. Dr. Phillips 

 of Buffalo has made a close study of ten such cases in which the 



1 Although one well-known neurologist and one orthopedist have said that the 

 eye-strain is a result of the systemic disease rather than the reverse, an amusing 

 betrayal of a lack of knowledge of what ametropia is ! 



