696 



SCIENCE. 



[N.S. Vol. XIX. No. 487. 



many, but the hub is one.' This method ap- 

 plies indirectly even to pathologic accidents 

 such as acute infections ; but its direct bearing 

 is of course upon what may be termed the 

 basic condition of health or disorder. 



Many ophthalmologists of high repute and 

 many internists (' general physicians ') of ex- 

 perience and authority concur in greater or 

 less extent with the views that Dr. Gould puts 

 forth, but others of equal standing, and among 

 them many reviewers in the medical press, 

 differ from him radically; and some have even 

 sought to cast ridicule upon ' Biographic 

 Clinics ' and their author because of what are 

 termed his ' extreme ' assertions. Doubtless 

 he is over-emphatic. He has an earnest and 

 virile style and evidently feels deeply upon 

 the subject he is treating. There can be no 

 mistaking his earnestness or his meaning and 

 there can be no doubt that he arraigns with 

 some bitterness, not his brother practitioners, 

 but the inertia or the blindness that has de- 

 layed their full acceptance of the great med- 

 ical truth to which he calls attention and to 

 the development of which Dyer, Weir Mitchell, 

 Thomson and Norris, of Philadelphia, Martin, 

 of Paris, and others, including Dr. Gould him- 

 self, have contributed importantly. 



Nobody likes to be scolded in public, and 

 Dr. Gould has not been wise in seeming to 

 scold. Grant this, however, and the truth still 

 remains true. Grant, moreover, that he is 

 extreme in the statement of the truth — let us 

 then forget the ' extremity ' of the statement 

 and remember the verity of the fact stated. 

 Unquestionably it is a truth of vast signifi- 

 cance. Unquestionably physicians have not 

 yet fully realized that significance. 



The great importance of the eyes in human 

 life and work, or the complexity of the work 

 demanded of the eyes by modern civilization, 

 need not be dilated upon. Our early ancestors 

 had greatest need of good distant vision, and 

 their range was bounded only by the sky and 

 by the horizon. We spend much of our time 

 within narrow walls and beneath low ceilings ; 

 walls too narrow, ceilings too low, even in 

 palaces. In addition, we read or write or sew 

 or paint or do surgical operations or decipher 

 cuneiform inscriptions or study palimpsests 



or set type or look through microscopes or 

 work at machines of various kinds, demanding 

 close sight and more or less constant accom- 

 modational effort. Pew are born nowadays 

 with natural optical apparatus perfectly adapt- 

 ed to the environment. Some are fortunate 

 enough not to undertake just exactly those 

 lines of endeavor that call for the greatest 

 use or most delicate adjustment of the ocular 

 mechanism. Moreover, in many cases a fair 

 approximation to good refraction answers; a 

 pair of glasses is obtained which more or less 

 imperfectly corrects the error, and all goes 

 well. There are many persons, however, in. 

 whom, whether from natural sensitiveness of 

 temperament, from the complexity, obscurity 

 or magnitude of the ocular defect, from the 

 excessive amount of eye-work done, or from 

 failure of general health rendering the whole 

 organism more sensitive to peripheral irrita- 

 tion, neglect of the eye or happy-go-lucky cor- 

 rection will not serve. Eye-strain ensues; 

 asthenopic reflexes of all kinds are set up and 

 these may be as varied in kind or grouping 

 as the number of organs in the body multi- 

 plied by the number of possible individual 

 peculiarities, and then as the number of pos- 

 sible permutations among the figures thus ob- 

 tained. 



' Eye-strain,' it is to be added, does not 

 mean exclusively, or even chiefly, strain of the 

 external muscles of the eye. Muscular de- 

 fects may or may not, as Dr. Gould contends, 

 be dependent in every instance upon refractive 

 error — that it is so in many instances must be 

 admitted. In any event accommodational 

 strain is the fact of greatest importance. 

 Moreover, Dr. Gould asserts that astigmatism, 

 is, of refractive errors, the one causing great- 

 est distress. This is borne out not only by 

 the personal experience of the writer as a 

 patient, but also by his observation as a physi- 

 cian and the reports of many oculists to whom 

 he has referred patients presenting reflex 

 symptoms. Nor can any, however small,, 

 amount of astigmatism safely be treated as 

 the old Prench doctor is said to have advised 

 his students to treat a cold in the head — ' with 

 contempt.' The smallest appreciable amount 

 needs correction. Astigmatism imperfectly 



