430 OPHTHALMOLOGY 



and in thousands of patients the spinal disease is unsuspected 

 by child, parent, and doctor. Within a few months I have discovered 

 thirty or forty cases of tilted heads, most of which caused or might 

 cause secondary or compensatory scoliosis, and all due to an axis of 

 astigmatism (about 15 unsymmetric, and to one side of 90 or 180, 

 in the dominant, that is the dextral eye in the dextromanual) 

 which compelled an habitual lateral inclination of the head in order 

 to see plainly. And the compensatory curvature of the spine in- 

 duces a score of other systemic diseases. We formerly allowed our 

 patients to tilt the head while making the refraction tests, and 

 so missed locating the astigmatic axis correctly. 1 By keeping the 

 head vertical during the testing we now apply glasses that keep it 

 straight afterwards, and when the spinal curve is still functional 

 we likewise straighten it by glasses alone. 



No podiatrist henceforth may forget the eyes in all of his patients 

 over eighteen months old. The chances are high that, without other 

 definite and easily ascertained cause exists, eye-strain is the source 

 of mischief in the child which suffers from night-terrors, breakfast 

 anorexia, tics, chorea, nervousness, disorders of digestion and nu- 

 trition, irritability, headache, etc. I have instantly cured nocturnal 

 enuresis in such children by spectacles alone. Alert-minded peda- 

 gogists are fast becoming aware of the tremendous role of eye-strain 

 in the health and success of their pupils. As every year of school- 

 life passes, the proportion of diseased pupils increases, until in the 

 upper grades it may rise to 60, and even 80, per cent; it is 40 per 

 cent, on the average, in Columbus, Ohio. And the diseases are 

 precisely those which every capable oculist knows are often due 

 to eye-strain. The rule is so certain that discerning teachers know 

 that those pupils who are one, two, or three years behind their 

 classes, have severe eye-strain, and without further inquiry they 

 are sent to the oculist. There is hardly a page of that magnificent 

 book on Adolescence by Dr. G. Stanley Hall, that does not need 

 rewriting with this new knowledge unfortunately and strangely 

 ignored in the mind of the writer. Its splendid power and truth- 

 fulness could have been doubled had its gifted author looked into 

 the vast existing literature, written by capable and scientific minds, 

 confirmatory of the role of eye-strain in school-life. 



In neurology there is almost no limit to what the refractionist 

 may justly claim. And posterity will allow it, although the neuro- 

 logist of to-day may often be unconscious and contemptuous of 

 the truth. Neurasthenia and hysteria he claims as his exclusive 

 possession. Private sanitariums or rest-cure establishments may 



1 An excellent rule of ophthalmic office-practice is that when we fail to cure 

 eye-strain results by our glasses, it is perhaps because we have allowed the head- 

 tilters to hold their heads as they pleased during the tests. 



