April 29, 1904.] 



SCIENCE. 



695 



' change of climate,' ' change of scene,' etc. 

 Most of them tormented themselves all their 

 lives in dieting, and two gave much of their 

 life to the hydropathic delusion.* In every 

 case the one fact stands out clearly, and it 

 could be verified by any number of quotations, 

 that their miseries were consequent directly 

 and quickly upon use of their eyes in writing 

 or reading, and yet not one of them, while 

 repeatedly chronicling the fact with his own 

 pen, ever caught a hint of the causal nexus." 

 Pully to appreciate the force of the evidence 

 one must read the facts that Dr. Gould has 

 patiently gathered not only from the narratives 

 of biographers and relatives, but also from the 

 letters and notes of the sufferers themselves. 

 In Chapter I. of Volume II., wliich reproduces 

 a paper upon ' Eye-strain and the Literary 

 Life,' read before the Canadian Medical Asso- 

 ciation, the author summarizes and keenly 

 analyzes the symptoms of these fourteen elect 

 men and women. He points out the folly of 

 attributing reflex symptoms to disease of the 

 organ in which the distress happens to be 

 manifested, thus treating the same person at 

 different times for "' brain-fag,' for ' dyspepsia,' 

 for ' neurasthenia,' or perhaps attributing the 

 condition to ' pure eussedness.' He shows 

 how, especially in the case of Nietzsche, a 

 sensitive organism may be irritated almost to 

 the point of madness by the continual torture 

 following the attempt to use the eyes for work 

 to which they are not adapted. The pity of it 

 is that with suitable glasses — mark the word 

 suitable — all this suffering might have been 

 averted. Dr. Gould further shows that the 

 chief and most poignant symptoms from 

 which the subjects of his clinics suffered 

 can, in at least ten of the cases, be re- 

 duced essentially to the symptom-complex 

 now termed ' hemicrania ' or ' migraine ' — in 

 ordinary language, ' sick headache.' Hence 

 the frequent recurrence of gastric distress, 

 distaste for food, nausea, vomiting, pain in 

 the head — ^hence the frequent erroneous ac- 

 cusation of stomach, brain, nerves, liver — 

 hence the frequent invocation of that indefinite 

 scape-goat, ' biliousness.' 



* Which is something far different from scien- 

 tific hydrotlierapy. — S. S. C. 



The dependence of migraine upon eye-strain 

 as an exciting cause in a large number, per- 

 haps the largest nvunber of cases can no longer 

 be denied by the most doubting Thomas. The 

 writer of this review jplaced himself upon 

 record to that effect so long ago as 1892. It 

 is true, however, and here we probably differ 

 from Dr. Gould, that in order for the eye- 

 strain reflex to take the form of this particular 

 paroxysmal neurosis the individual must pre- 

 sent that special type of organization in which 

 the inhibition or, to use a broader term, the 

 taxis, of the vaso-motor mechanism is deficient 

 — a defect* usually inherited but sometimes 

 acquired by unwise living or in sequel to some 

 pathologic accident. Otherwise the persist- 

 ently recurring disorder would be much more 

 common than it is among those whose eyes 

 present the very comxnon faults of astigma- 

 tism and hyperopia, as likewise among myopes 

 having high degrees of ametropia. Also, in 

 individuals presenting vasomotor ataxia, other 

 exciting causes, likewise, may provoke the at- 

 tack of migraine, as of asthma, of hayfever, or 

 of some other nerve-storm. Be this as it 

 may, the relief of eye-strain, by guarding the 

 powder from at least one of the sparks that 

 threaten, prevents that particular explosion. 



Dr. Gould's great merit lies not so much in 

 his individual theory of the causation of mi- 

 graine as in his directing strongly the atten- 

 tion of the medical profession and, it is to be 

 hoped, of workers in literature and science 

 who are not physicians, to the necessity for 

 eyes and the relief of eye-strain by suitable 

 glasses, with recorrection from time to time, 

 as the refraction alters and the reflex disturb- 

 ances recur; the other, and in some respects 

 greater, being the importance of gathering all 

 facts concerning the ill health of any indi- 

 vidual into a comprehensive whole, rather than 

 to consider detached fragments as things 

 utterly apart. As the writer has elsewhere 

 expressed the same thought, ' the spokes are 



* From the physical standpoint a defect; but in 

 my observation so frequently associated with 

 marked artistic and intellectual ability, that I am 

 not sure that in moderate degree it is less than an 

 advantage to a writer, actor or public speaker. 

 S. S. C. 



