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an analysis of them in April.” The correspondence came altogether too late, even if it were not too long, for publication; and we must be content with a brief reference to some of its salient features.

Dr. Baldwin, under date of March 2d, writes to Dr. Nott, urging his attendance at the approaching meeting of the Association, states that the great mass of southern physicians are in full sympathy with the Association, that the few who are dissatisfied ground their complaint upon the rejection of the Gardner resolutions in 1864; he then discusses these resolutions, as to the propriety of the action of the Association, &c., &c.; finally, promising a hospitable welcome to the delegates at New Orleans next May.

Dr. Nott replies briefly under date of March 9th, speaks of the

Iness of the profession to him in New York, refers briefly to the Gardner resolutions, &c., and concludes thus: “My many old friends must throw aside all minor considerations and come forward in sustaining your efforts to maintain the true honor of the south, the dignity of the profession and the cause of humanity."

The third letter is to Dr. Gaillard. If Dr G., who lost an arm in the war, if Dr. Nott, who lost his two sons thus, and Dr. Baldwin, whose only son likewise perished in the strife, are foremost in the cultivation of amity and cordial friendship, not even the smallest fragment of the southern profession ought to feel or act otherwise.

VACCINE AGENT OF WESTERN VIRGINIA.—Dr. J. C. Hupp was appointed State Vaccine Agent a few days since by Governor Stevenson. Dr. Hupp, we believe, has filled this position since the formation of the State, and has given universal satisfaction.

OUR FRIEND Dr. J. D. Jackson, of Kentucky, requests us to make the following announcement: All the railroads in Kentucky, the “Kentucky Central" excepted, have offered half-fare (full fare going, return free,) to delegates attending the “American Medical Association" at New Orleans, in May next. The "Louisville & Nashville & Memphis Railway," have very kindly effected an arrangement with the roads connecting with it south, by which through half-fare tickets to New Orleans can be obtained at Louisville.

NOTWITHSTANDING the addition of four pages to this number of the Journal, we still find ourselves compelled to defer several matters, bibliographic, items of news, editorial notices, et cet., until our next issue.

THE WESTERN JOURNAL OF MEDICINE,

(Formerly, “CINCINNATI JOURNAL OF MEDICINE.")

Thus it will be seen that if man has passions which impel him to the destruction of man, if be be the only animal who, despising his natural means of attack and defence, has devised new means of destruction, he is also the only animal who has the desire, or the power, to relieve the suferings of his fellow citizens, and in whom the co-existence of reason and benevolence attests a moral as well as an intellectual superiority.-GRAVES' CLINICAL MEDICINE.

Vol. IV.

INDIANAPOLIS, MAY, 1869.

No. V.

ACCOMMODATIVE ASTHENOPIA.

BY DR. J. G. ROGERS, MADISON, IND.

This annoying affection of the eyes, the source of so much physical and mental misery, remained a subject of pure speculation and empiricism, from the birthday of medical science almost to the present time. In the last decade, however, Donders and others, in their exhaustive researches in the physiology of the eye, have been led to a complete elucidation of the pathology of this hitherto mysterious malady, so that now it is so clear and exact that he that runs may read. As a consequence of this exact pathology, sadly too often lacking in many instances of diseases, the treatment and cure are now as fixed and certain as any thing relating to so complex a machine as the physical man can be.

Asthenopia is characterized by intermittent blurring of vision, tension around eyes and frontal region, various facial neuralgiæ, lachrymation, congestion of conjunctiva, slight intolerance of light, &c., all induced or aggravated by reading, sewing, or other close work. It is essentially an irritability of the ciliary apparatus of the eye. This irritability is due to excessive straining in the effort to accommodate the vision for near objects. This excess of effort may either be relative, as where, owing to debility, the muscle is not able to do a normal

amount of work in accommodating, or it may be necessitated by the condition of the hypermetropia, an abnormal proximity of retina and crystalline lens. This arrangement of the optical apparatus requires an abnormal intensity of action on the part of the cilliary muscle in all positive accommodation, such as is essential in viewing near objects. This strain can be borne without inconvenience, until the age of thirty or thirty-five years, if not excessive. Then, by the gradual failure of accommodative power, it will have increased to such an extent as to induce an irritability of the muscle itself, and if continued, finally, a train of reflex irritations referable to the various nerves of the head and face, and sometimes of the whole nervous system. Such cases are truly pitiable, for often the suffering has continued for years, in spite of all sorts of empirical efforts.

At a much earlier age, asthenopia will supervene, in hypermetropic eyes, if the strain is excessive and continued, as in all employments requiring close and fixed vision. These two varieties of accommodative asthenopia, that from hypermetropia, and that from debility, may coincide in the same cases, and generally do, as even when the congenital defect is very considerable, unless debility assists in the evil, the powers of the cilliary muscle will be able to overcome the deficiency without any unpleasant result, until age weakens them. Hence, asthenopia is oftenest found in constitutions broken down by uterine disease, spermatorrhea, indulgence in prostrating vices, &c. However, it is present sometimes in the most robust persons. In such cases, there is always marked hypermetropia.

The indications for treatment are to afford artificial accommodatire power, and remove nervous and muscular debility and their causes. As to the latter, the requisite therapeutics, all will know and need not to be particularized. The artificial assistanee to the accommodation is afforded by a convex lens. As before intimated, hypermetropia is due to an abnormal nearness of retina and crystalline lens. This makes requisite a relatively abnormal increase of convergent power on the part of the lens, in order to concentrate the rays emanating from any object on the retina. This increase of power may be obtained by interposing an artificial lens. Its strength should be proportionate to the natural deficiency. The degree of this deficiency may be determined by several methods. The simplest is that of comparing the nearest point of distinct vision in a given case, with the near point normal to that age. The working formula is as follows: Unity divided by normal near point, minus unity divided by given near point, equals the hyperme

tropia. The denominator of the last fraction indicates the focal length of a glass which will totally annul the hypermetropia. In practice, however, it is found to be better to use a glass of somewhat less power, as the habit of over-exertion is not to be suddenly laid aside without inconvenience. Eventually, the whole deficiency may be artificially supplied.

The following cases illustrate the foregoing: S. W—, aged ten years, strong and healthy, presented herself as suffering severely from neuralgia of the forehead. In answer to questions, complained of inability to read without inducing severe pain and tension in frontal region, watering of eyes, blurring of vision, headache, &c. On careful examination by the means before noted, also by ophthalmoscope and by test glasses at distance, I found a hypermetropia of one-thirtieth, that is, a deficiency of convergent power equivalent to the force of a thirty inch lens. The asthenopia had supervened, in the course of a winter's severe study at school, the patient being remarkably diligent for one of her age. It had been increasing for six months, and lately had entirely prevented her from reading. A forty-eight inch glass was applied; with it all the discomfort was gone at once, and she was able to read for half an hour or more with ease and distinctness. She was ordered to wear spectacles with the same power, until all trouble had disappeared. This she did for three weeks, during which time she experienced little or no suffering, being able, in the meantime, to continue her studies at school. They were then laid aside. Vacation, with its rest, completed the cure. A year later, the same causes induced the return of asthenopia, but a short term of assistance from the spectacles again afforded complete relief. Another year has since passed; no occasion for treatment has occurred, but the little patient cherishes her glasses, well knowing, from experience, what good friends they may be in time of need, although they have brought upon her the soubriquet of "little old woman," a title which the serio-comic appearance of a child of ten years with spectacles, would induce one naturally to apply.

In this case, asthenopia was induced by excessive straining of accommodation in a case of marked hypermetropia.

In the following, debility coöperated with the congenital deficiency, to induce the same condition, but in a hundred fold more painful degree, and much more obstinate:

Mrs. aged thirty years, when first seen, had suffered for two years from asthenopia to such an extent that the mere effort of fixing

vision for a moment induced severe frontal pains, toothache, lachrymation, palpitation of the heart, and an intolerably "nervous" condition of the whole system, even pains in the lower extremities. Coupled with this, was an inability to walk or make any marked exertion without the same exhibition of inability of the whole muscular and nervous system. The foundation of all this trouble was, chronic metritis with retroversion, which had existed for several years. On examining the eyes, I found a hypermetropia of one twenty-fourth. Number thirty glasses were ordered to be worn constantly.

The habit of over exertion on the part of the accommodative apparatus, was so fixed, however, that their assistance was not kindly accepted, and no change was experienced. Thereupon the ciliary muscle was paralyzed by instillations of atropia, and it was found necessary to continue this for five months before the habit was obviated. Then the glasses were comfortably borne, and began to fulfil the indication of doing part of the work of accommodation, which, in ordinary cases, they will do from the moment of applying them. From that time to the present, two years, the irritability of the eyes has gradually lessened, and now the patient can read for a short time quite comfortably. In the meantime, the glasses are constantly worn, though at times, they are laid aside without discomfort. Moreover, by rational application of every possible means, the general nervous irritability and its cause, the organic uterine lesions, have been slowly made to succumb, until now, although yet somewhat an invalid, the patient expresses herself as enjoying a comparative elysium, when she refers to the torments she once suffered.

In practice, cases of asthenopia present themselves, affording great variety of symptoms. Some are very readily relieved by simple means; others require great perseverance with every measure that can be brought to bear. The latter, are those in which general nervous debility is prominent. All of them should be objects of careful attention from the medical man, and it is to be hoped that the profession will improve its very generally insufficient knowledge upon this subject, for then relief will be accessible to thousands of sufferers who now bear their ills with hopeless fortitude.

For a full consideration of the subject, the interested reader is referred to Soelberg Wells' late work, or Donders on Refraction and Accommodation, this article being merely a hurried note written for the purpose of suggesting attention to an opprobrium medicorum which ought no longer to remain such.

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