the relation of dyspepsia to eye-strain

2
672 THE RELATION OF DYSPEPSIA TO EYE-STRAIN. A solicitor who is struck off the rolls by the High Court at the instance of the Incorporated Law Society, or who even fails to pay for his annual certificate, or a barrister who is disbarred is thereby precluded from practising. A medical man who is struck off the Register can still practise. His only disabilities are that he is unable to sign a death cer- tificate, to sue for fees, and to hold certain public appoint- ments. In order that the General Medical Council should have more power it is necessary that the law as to unqualified practice should be amended. Unqualified practice should either be made illegal or, if that be considered imprac- ticable, a licence should be made obligatory and such licence should be made to cost a very large sum. It need not be any guarantee of knowledge or skill any more than a licence to sell beer or tobacco is any guarantee of the purity of the goods sold. But if such licence were made to cost, say, £500 per annum the being struck off the Medical Register would be a punishment in reality instead of being, as at present in the case of the gross offender, little more than nominal. The Relation of Dyspepsia to Eye-strain. J FEW terms are more familiar to the ear of the physician than that of "biliousness." " By the laity it is held to constitute an altogether satisfactory explanation of a multitude of symptoms which, whilst collectively they pro- duce much discomfort, are so inconstant in their seat and manifestation as to prevent their rising to the dignity of a definite disease. Has a man some swimming in his head on rising he is bilious " ; does he suffer from flatulence, nausea and want of appetite, from low spirits, and from inability to read without headache, he is " ° bilious. He proceeds to dose himself with salts and feeds himself on articles of diet which the advertisements assure him will promptly remove every ill. At length, failing to obtain relief by these means, he betakes himself to some prudent and experienced practitioner who, casting about for the hidden cause of his patient’s troubles, minutely inquires into his habits of life, his diet, the state of his alimentary canal, his allowance of tobacco and of alcohol, and the time he can devote to exercise. Sometimes the answers to all these questions are atisfactory, while sometimes modifications can be suggested and some degree of improvement generally follows ; if not, then mental worry or, it may be, uterine trouble is diagnosed and rest, change of air and scene, or a system of topical treatment is advised and adopted. Then again a partial or complete restoration to health is effected and the ordinary avocation is resumed. But the cure is soon found to have been, like the former, only temporary. The dyspeptic symptoms and the disposition to look at the dark rather than at the bright side of things in general recur and with all this there are headache and incapacity to work or even to try to work. After a time the victim becomes inured to his troubles, ceases to apply remedies, finds out what is best for him, and rests satisfied that his disease is alike inscrutable and incurable. Such is the life-history of many distinguished literary and scientific men. In a highly suggestive volume that has just been published Dr. GEORGE GOULD of Philadelphia has selected as examples five well-known men-DE QUINCEY, CARLYLE, DARWIN, HUXLEY, and BROWNING-all of whom, whilst daily performing a prodigious amount of work, were constantly complaining of dyspepsia, inability to read or to work, and headache. He endeavours to show that in all these cases the primary defect, the starting-point of the whole train of symptoms, has hitherto been strangely over- looked and is to be really found in some error of refraction in the eyes-such, for example, as hypermetropic or mixed astigmatism or some defect in the innervation of the extrinsic muscles of the globes. With this clue every- thing, he maintains, becomes clear and the symptoms range themselves with those that are very familiar to the ophthalmic surgeon. They are persistent because the cause is persistent. They disappear or are greatly relieved when work is given up and long walks or rides are taken in the open country and in the gloaming for the eyes are then no longer strained ; they are increased on the resumption of literary or scientific work, for the efforts to obviate the defects are recommenced ; the head- ache, anorexia, and depression of spirits are all reflex phenomena well known in ophthalmic practice. Lastly, they entirely disappear when the error of refraction is duly corrected by appropriate glasses. The conditions required for the recognition of a vera causa are fulfilled--præsens morbum ficcit, sublata tollit. It may, indeed, be said that the view here advanced proceeds naturally from the ophthalmic specialist and we are irresistibly reminded of the shoemaker who declared to the citizens of the beleaguered city that there was nothing like leather ; but Dr. GOULD is an accomplished physician and supports his opinion with so much ingenuity that our first disposition to smile gives place to the feeling that there is much to be said in its favour. It is to be remembered that the healthy eye can bear an enormous amount of work without harm either to its own structure and functions or to those of the body at large ; it is only the ill-formed astigmatic or otherwise defective eyes which are compulsorily brought into play that are instrumental in inducing the long chain of symptoms that constitute the troublesome and obscure affections dyspepsia and hypo- chondria. Our knowledge of the etiology of these conditions has been masked by the circumstance that the efforts of the patients to use their eyes are not made apparent by any marked symptoms of inflammation in these organs them- selves, but are apt to excite a train of neuroses which have hitherto distracted the attention of physicians from the eyes and concentrated it upon the stomach, brain, or other organ to the distress of the patient and the opprobrium of medicine. Dr GOULD sometimes takes for granted what a Scotch jury would return as "Not proven." " But it is clear that in every case in which the various symptoms commonly included under the terms chronic dyspepsia and " bilious- ness " are present and prove resistant to ordinary treatment it would be well to obtain the advice and opinion of an 1 Biographic Clinics: The Origin of the Ul-health of De Quincey, Carlyle, Darwin, Huxley, and Browning. By George M. Gould, M.D. London : Rebman, 1903.

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Page 1: The Relation of Dyspepsia to Eye-strain

672 THE RELATION OF DYSPEPSIA TO EYE-STRAIN.

A solicitor who is struck off the rolls by the High Court

at the instance of the Incorporated Law Society, or who evenfails to pay for his annual certificate, or a barrister who is

disbarred is thereby precluded from practising. A medical

man who is struck off the Register can still practise. His

only disabilities are that he is unable to sign a death cer-tificate, to sue for fees, and to hold certain public appoint-ments.

In order that the General Medical Council should have

more power it is necessary that the law as to unqualifiedpractice should be amended. Unqualified practice shouldeither be made illegal or, if that be considered imprac-ticable, a licence should be made obligatory and such

licence should be made to cost a very large sum. It need

not be any guarantee of knowledge or skill any more thana licence to sell beer or tobacco is any guarantee of the

purity of the goods sold. But if such licence were made to

cost, say, £500 per annum the being struck off the Medical

Register would be a punishment in reality instead of being,as at present in the case of the gross offender, little morethan nominal.

The Relation of Dyspepsia to

Eye-strain.J -

FEW terms are more familiar to the ear of the physicianthan that of "biliousness." " By the laity it is held to

constitute an altogether satisfactory explanation of a

multitude of symptoms which, whilst collectively they pro-duce much discomfort, are so inconstant in their seat and

manifestation as to prevent their rising to the dignity of adefinite disease. Has a man some swimming in his head on

rising he is bilious " ; does he suffer from flatulence, nauseaand want of appetite, from low spirits, and from inability toread without headache, he is " ° bilious. He proceeds to dosehimself with salts and feeds himself on articles of diet which

the advertisements assure him will promptly remove every ill.At length, failing to obtain relief by these means, he betakeshimself to some prudent and experienced practitioner who,casting about for the hidden cause of his patient’stroubles, minutely inquires into his habits of life, his

diet, the state of his alimentary canal, his allowance of

tobacco and of alcohol, and the time he can devote to

exercise. Sometimes the answers to all these questions are

atisfactory, while sometimes modifications can be suggestedand some degree of improvement generally follows ; if

not, then mental worry or, it may be, uterine trouble

is diagnosed and rest, change of air and scene, or a

system of topical treatment is advised and adopted. Then

again a partial or complete restoration to health is effected

and the ordinary avocation is resumed. But the cure is

soon found to have been, like the former, only temporary.The dyspeptic symptoms and the disposition to look at thedark rather than at the bright side of things in generalrecur and with all this there are headache and incapacityto work or even to try to work. After a time the victim

becomes inured to his troubles, ceases to apply remedies,finds out what is best for him, and rests satisfied that hisdisease is alike inscrutable and incurable.

Such is the life-history of many distinguished literaryand scientific men. In a highly suggestive volume thathas just been published Dr. GEORGE GOULD of Philadelphiahas selected as examples five well-known men-DE QUINCEY,CARLYLE, DARWIN, HUXLEY, and BROWNING-all of whom,whilst daily performing a prodigious amount of work, were

constantly complaining of dyspepsia, inability to read or towork, and headache. He endeavours to show that in all

these cases the primary defect, the starting-point of the

whole train of symptoms, has hitherto been strangely over-looked and is to be really found in some error of refractionin the eyes-such, for example, as hypermetropic or mixedastigmatism or some defect in the innervation of the

extrinsic muscles of the globes. With this clue every-

thing, he maintains, becomes clear and the symptomsrange themselves with those that are very familiar to

the ophthalmic surgeon. They are persistent becausethe cause is persistent. They disappear or are greatlyrelieved when work is given up and long walks or rides

are taken in the open country and in the gloamingfor the eyes are then no longer strained ; they are increasedon the resumption of literary or scientific work, for the

efforts to obviate the defects are recommenced ; the head-

ache, anorexia, and depression of spirits are all reflex

phenomena well known in ophthalmic practice. Lastly,they entirely disappear when the error of refraction is dulycorrected by appropriate glasses. The conditions requiredfor the recognition of a vera causa are fulfilled--præsensmorbum ficcit, sublata tollit.

It may, indeed, be said that the view here advanced

proceeds naturally from the ophthalmic specialist and weare irresistibly reminded of the shoemaker who declared tothe citizens of the beleaguered city that there was nothinglike leather ; but Dr. GOULD is an accomplished physicianand supports his opinion with so much ingenuity that ourfirst disposition to smile gives place to the feeling that thereis much to be said in its favour. It is to be remembered

that the healthy eye can bear an enormous amount

of work without harm either to its own structure and

functions or to those of the body at large ; it is onlythe ill-formed astigmatic or otherwise defective eyes whichare compulsorily brought into play that are instrumental

in inducing the long chain of symptoms that constitute

the troublesome and obscure affections dyspepsia and hypo-chondria. Our knowledge of the etiology of these conditionshas been masked by the circumstance that the efforts of

the patients to use their eyes are not made apparent by anymarked symptoms of inflammation in these organs them-

selves, but are apt to excite a train of neuroses which havehitherto distracted the attention of physicians from the eyesand concentrated it upon the stomach, brain, or other organto the distress of the patient and the opprobrium of

medicine. Dr GOULD sometimes takes for granted what aScotch jury would return as "Not proven." " But it is clear

that in every case in which the various symptoms commonlyincluded under the terms chronic dyspepsia and " bilious-

ness " are present and prove resistant to ordinary treatmentit would be well to obtain the advice and opinion of an

1 Biographic Clinics: The Origin of the Ul-health of De Quincey,Carlyle, Darwin, Huxley, and Browning. By George M. Gould, M.D.London : Rebman, 1903.

Page 2: The Relation of Dyspepsia to Eye-strain

673"RUN DOWN."-REGULATIONS IN REGARD TO CREMATION.

ophthalmic surgeon, for this can certainly do no harm and

may quickly abolish the trouble and restore the patient tohealth.

" Run Down."THE claims of medicine to be ranked as one of the exact

sciences meet no more formidable reproach than the unde-niable one that certain ill-defined terms are used by some orall of its followers to cloak a multitude of vague disorders.

The most familiar perhaps of these is the universal "rheu-matism," a term which even in these enlightened days is

commonly employed to designate a number of disorders the

pathology of which, if still to a large extent unknown, is,at any rate, almost certainly of very diverse kinds. Our

ideas of rheumatic fever appear certainly, thanks to recent

bacteriological researches, to have gained a foundation ofexact knowledge, but he would be a rash physician whoventured to define the limits or the pathological essentialityof muscular rheumatism or of rheumatoid arthritis. We

shall be told, no doubt, and confidently told, that the

latter is, of course, a microbic affection. When we ask

for even a vestige of actual proof it will not be so easyto satisfy our demands.

Among the many conditions, the circumstances of whichare so familiar and the actual nature of which is so obscure.there is none perhaps more commonly met with than thatwhich is known as the state of being "run down." The

expression is a good one to describe a certain physical andmental state in our present ignorance of its pathogenesis.To say that a man is "run down" conveys quite plainlyto our minds that there is a general depression in the

vitality of the organism, a depression that is widespread,embracing the purely physical as well as the intellectual

functions, while at the same time the term gives no hintwhatever as to the anatomical site or the pathological natureof the underlying cause. This negative nature of the namefor a condition with which we are all only too familiar is Iunfortunately completely justified by an entire absence of

exact pathological knowledge with reference to the con-

dition itself. Certain experiments and observations upon

fatigue in school-children may bear definitely upon the pointin question. Except these we can recall no positive know-

ledge bearing upon the state which we may suppose to bepresent in a person who is, as we say, "run down.

" We

cannot get much nearer to a definition of this condition

than to describe it in wide terms as one of fatigue.We possess certainly a fair sum of chemico-physiologicalknowledge relating to fatigue so far as muscle tissue

is concerned. As regards the fatigue of mental func-

tions and of digestive, secretory, and absorptive functionswe still know remarkably little. This little we would

probably express by saying that in the condition to

which we are alluding there is a general depression of

innervation, that the higher centres of the brain are

depressed, and that there is a lowered condition also of

all the organic functions resulting in an incomplete per-formance of digestion and assimilation, consequently in

impoverished nutrition and also in impoverished power ofmuscular action. The resulting impoverished blood reacts

upon the nervous system which is imperfectly fed and

thus a vicious circle is completed.

In the production of this condition, as it is most commonlyseen, monotony of action-whether physical or mental-

seems to play a very important part. The typical case of aman who is ’’ run down " is that of the business man who,with the regularity of a timepiece, goes from his breakfasttable to his office chair, from his office chair to the luncheon-

room, from luncheon to the office chair, and from the

office home again in the evening. This process repeated dayafter day, accompanied by an occasional attack of dyspepsiaor of insomnia, or of extra business worry, tends to depresseven an ordinarily healthy constitution. On the nervous

or delicate the condition of being " run down" is frequentlyimposed before the machine-like existence has been manyyears, or even many months, in play. Man is not meant for

monotony. A constant recurrence of the same activities,the same thoughts and the same associations appearsto produce a dead level of mere weariness, even thoughthe daily round is of itself made up of varying details.

Thus, in the instance we have taken it might be thoughtthat in the short railway journey, in the meeting of dailycompanions, and in the little interval at luncheon enoughvariety would be imposed upon the city man’s existence

to save him from monotony. But the variety is itself

monotonous. He cannot vary his railway journey, he can-

not vary his daily meetings, or even, in many cases, his

place of luncheon, and so the daily round becomes weari-some, and the excursions for luncheon become as tryingas the monotony of a sandwich in the office.

We have glanced at the pathology of the state of the

man who is " run down " and we have briefly alluded toone potent factor in the production of this condition. We

may therefore in a few words suggest a remedy. The

nature of this will be obvious from what has just been said.The first step towards saving us from getting run down willbe taken if we can save ourselves from monotony. At will a

man cannot change his main daily occupation. As a business

man, he must attend to his office work; as a professionalman, he must execute the daily duties of his calling ; and formost men the greater part of every 24 hours is thus absorbed.Even then, however, there are little intervals and there are

gaps before and after the actual working hours. It is

here that a variety of pursuits should save the mind

from the dulling effects of monotony. The brain should

be trained, so to speak, to switch itself off directly the

opportunity occurs and instead of continuing to wearyitself with the contemplation of business or professionalcomplexities should revel as soon as active work is stoppedin other intellectual fields. The pleasures and distractionsof the society of one’s fellow-creatures, to some tempera-ments the most complete of all alleviations of worry, are

not always at hand. But a hobby may be constantlyaccessible and it behoves all men who find themselves

"run down " to make an attempt towards the enjoyment ofsome intellectual activity different from that constantlydemanded by their daily occupation.

Regulations in regard to Cremation.

I LEGISLATIVE sanction has recently been accorded to

cremation as a means of disposing of human remains in this1 Cremation Act, 1902 (2 Ed. VII., c. 8), Sec. 7.