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nerves as well as the large number of gish to stimuli. Near work is perassociation fibres which are stimulated formed in deficient light, the shoulders during ocular activity gives us a ration may be stooped, and there may be a al basis for tracing certain of the gen- lateral movement of the head during eral subjective symptoms.

close work. It is not necessary to go into detail In Astigmatism there are but few concerning the less frequent and ob- reliable objective signs. There somescure symptoms of beginning eye times is seen frowning, head turned strain and we shall only consider those to one side, narrowed palpebral fissure which are practically always observed. in myopic astigmatism and widened

In hyperopia, or far sight: the symp- fissure in hyperopic astigmatism. None toms are many and various but fore- of these are dependable but since astigmost is headache or “brow ache:” it is matic errors are observed as complicausually frontal, frontotemporal, or may tions the diagnosis can safely be left extend to the occipital region or all to such methods as retinoscopy. over the head. If headache be due to Heterophoric asthenopia, the eye the eyes diagnosis is simple owing to strain arising from faulty muscle balthe fact that it arises during periods ance, is occasionally seen alone but of ocular activity and diminishes or more often in combination with some disappears during ocular rest. So- form of ametropia and constitutes a called "sick headache" is most fre- comparatively large percentage of paquently of ocular origin. Inflammation tients. Reflex neuroses are very freof the lid margins, styes, cysts of the quent accompaniments of muscular imMeibomian glands, and conjunctival ir- balance.

balance. Vertigo, migraine, mental ritations are very frequently present. confusion and consequent depressed An abnormal desire to sleep after close mental activity, and various gastric application is good evidence. Print disturbances are often the symptoms blurs and becomes dimmed after short presented by patients who are not even periods of activity or the lines of aware of any ocular disorder. Conprinted matter "run together." The tinued over a period of time these neueye in hyperopia is small, with short in- roses affect the general system and this terpupillary distance. A convergent reduction in general physical tone in squint in children usually indicates hy- turn augments the condition of eye peropia. Distant vision is good but for strain. Thus a vicious circle is estabclose work there occurs a narrowing of lished which, if not properly diagnosed the palpebral fissure and the act of and treated, means great physical sufreading is accomplished very slowly. fering and actual pathologic changes in There is an inability for long continued the structures of the eye. The migraine reading or close work, a necessity for found in these cases has been described greater illumination and a marked va- as “an explosive paroxysmal psychoneriation in the distance at which the urosis, comparable to an epileptic seizwork is held from the eyes.

ure in that the manifestations are senIn Myopia or near sight, there is not sory rather than motor.” Its usual site as a rule severe or annoying headache. is occipital, nuchal, and cervical and in An inability to see distant objects some cases extending even to the dorclearly is the primary and often the sal areas. "Church" and "Opera" only symptom complained of by the headaches, car sickness, confusion and patient. The eyeball is usually promi- nausea from observing rapidly moving nent, there is a long interpupillary dis- objects and the more recent “Moving tance, and a divergent squint usually Picture” headache are all most freindicates Myopia. The two cardinal quently dependent upon ocular irregupoints are the poor distant vision and larities. the good near vision. The pupils are It is not necessary to consider the sometimes dilated and the irides slug- other forms of asthenopia in this article for they are usually, if not always as- sistency with white flakes, slight musociated with one or more of the forms cuos and rerely greenish streaks. Exdescribed, presenting merged symptom amination shows no blood nor pus. groupings and can be diagnosticated Urinates every 2 Oto 40 minutes and only by the special methods employed perspires freely and constantly. Vomby the trained ophthalmologists. its only rarely but cries very much

The experience of any ophthalmolo- and sleeps poorly. gist will warrant the statement that On inquiry as to the feeding, the there are a great many cases of eye mother said that "several physicians strain treated symptomatically, unre- had tried everything” and that for the cognized by the physician, and allowed last two weeks it had been getting as to go uncorrected until such changes follows: Cream, 71/2 oz., milk, 11 oz., have occurred as render the ocular milk sugar, 2 oz., lime water, 2 oz., structures irretreivably damaged. And water, 191/2 oz. This is a total of 40 there are some physicians who do not oz. in 24 hours, besides a small drink realize the importance and scope of a of water “between meals.” The meals thorough examination and consider were 5 oz. of the above formula every their obligation to the patient dis- two hours. Thus, the infant received charged when they send him to the about 50 oz. of fluids in the 24 hours. optician for an "Eyes Tested Free" Examination revealed a thin, pale infiasco.

fant without signs of rachitis and with It has truthfully been said that the a soft abdomen, normal temperature. greatest judgment and the utmost skill The integument was somewhat loose, are necessary in the prescribing of easily lifted into folds and very moist. lenses for any pair of eyes. So much is Diagnosis.-Overfeeding with conto be taken into consideration, and such sequent indigestion and inanition. slight modifications are so productive

Upon calculating the caloric worth of such harmful results that a medical of the 24 hours' food it was found to education and a thorough training in be about 750 Ca.-enough for an infant this special form of work are obliga- weighing 17 pounds--in other words tory.

about twice the amount necessary to The sooner we come to a full realiza

support the case before us. tion of the serious secondary disorders

Treatment--Give no water between and the very harmful functional dis

meals. Feed milk, whole and pasteurarrangements that may arise from the

ized 16 oz., barley water, 16 oz., milk eyes in a state of strain, just so soon

sugar, 1/2 oz. Allow 5 oz. every three will we see a decrease in the distress

hours and increase the milk proportion ing neuroses and in the harmful and unwarranted therapy now so frequent- servation.

very gradually under physician's obly. 217 Newton Claypool Building.

This prescription was based upon

the calorimetric principle in infant A CASE OF INANITION FROM OVER

feeding (see article by writer in InFEEDING.

diana Medical Journal, 1907), and upon

the evident fact of overwork of the BY DR. G. B. JACKSON, OF INDIANAPOLIS. urinary, circulatory, respiratory and

digestive systems by the too great August 1, 1908. Baby Il.

quantity of Auid ingestion. The writer Female; age four months; weight 834 always uses simple milk dilutions pounds; weighed 71/2 pounds at birth ;

when borne well by the infant. fed artificially; never gained very well, Results: August 3d. Bowel moved. lately losing weight. Bowels always Results: August 3d. Bowels moved loose and move six to ten times a day four times in last 24 hours and less with great volume of semi solid con- volume. There is less urination and sweating and the child is more restiul. whose unclouded vision sees things August 14th. Bowels moving twice; just as they are, including the right one-half as many micturitions as for- and wrong of almost any and every merly. Weight 934 pounds and the question may, allowing himself to be child has a much more contented gen- dominated by love, ambition, avarice eral appearance.

or some other passion, with open eyes This case tells its own story. It was choose a low course. Per contra, he selected from my records because its whose intellect, which may be acute history spoke so emphatically and typ- though narrom, fails to grasp the true ically upon one of the points of great- relation of things, may, subduing all est danger in artificial feeding, i. e., passion and apparent self-interest, act overfeeding

nobly, even if, with a mind more log340 Newton Claypool Building. ical than clear, false premises lead to

false conclusions. History affords exMEDICAL ETHICS.*

amples of either extreme, as well as a

few of that harmonious balance of inaBY FREDERICK C. SILATTUCK, M. D.

tellect and character, which, in General Jackson Professor of Clinical Medicine Washington, has so impressed the in Harvard Medical School, world, and as long as man works upBoston.

ward must remain a living force.

Standards of ethical conduct-that

is, conduct which not only tends to The subject of my remarks this evening is not of my choice. It was as

the development of individual characsigned me by the higher powers for

ter but also to that of the well-being reasons I do not presume fully to un

of the race—have undergone considerderstand. I cannot believe that you

able evolution, the most potent single

influence which has been brought to are peculiarly in need of instruction medical ethics, and I know that I am

bear upon them being Christianity. not specially qualified to give it; but

“An eye for an eye and a tooth for a having from my youth been brought

tooth" of the Judiac, is supplanted by up in habits of obedience I cannot

the offering of the other cheek to the break away from early and long train

smiter, of the Christian dispensation. ing, and-you must take the conse

Taking the world as a whole, even to

day, external standards vary enormquences. Of several definitions of ethics in

ously with the degree and kind of civ

ilization-and its lack-with the relithe Century Dictionary, I have selected the following as perhaps best meet

gion and organization of society, the ing our requirements of the evening physical peculiarities of a country, the as I conceive them. "Ethics is the

density of population, means of com

munication and doctrine of man's duty in respect of

thousand other himself and of the rights of others."

things. With us a state of relative Ethics thus formulates right conduct fixity has been reached. and o aids us to see the light; but we The more complex society becomes, must constantly strive to be led by it. the closer knit by applied science, the Intellect and character are very dif- more organization gains on individual ferent qualities, too rarely. coexistent

action, the more numerous are the rein their higher degrees in the same strictions which must be placed on the person. One or the other may be high- individual for the benefit of society as ly developed, or less or more atrophied,

a whole. That which may be perfectly congenitally, from disuse, or both. He right and proper for the savage, or

even for the civilized man in the *An address to the students of Western Reserve University

Medical College and the Academy of Medicine of Cleve. wilderness, may be highly reprehensiland, April 25, 1908. From The Cleveland Medical Journal, August, 1908.

ble under other conditions.

a

9

cases

We are all agreed that as men we observation and experiment, the care should so live as to cultivate our in- of the soul and of the body cannot retellects, to enlighten our consciences, main in the same hands. to strengthen and elevate our charac

The most ancient statement on medters, and, in as far as in us lies, to ical ethics of which I can get clear promote the well-being of mankind.

trace is the Hippocratic Oath, of about This is practical ethics. What, then, 460 B. C. This oath was taken on enis medical ethics? Has an adjective tering studies and runs as follows: “I any place in ethics? If so, why? Can

swear by Apollo, the physician, by not all practical ethics be summed up Aesculapius, by Hygeia, Panacea, and in the Golden Rule? Yes and no. It

all the gods and goddesses, that accan be so summed up, but rules based

cording to my ability and judgment I on analysis are useful as short-cuts, will keep this oath and stipulation, to promoting the rapidity of decision as reckon him who teaches me this art to right conduct in concrete

equally dear to me as my parents, to which may seem, or really be, com

share my substance with him and replex. Every calling involves some pe- lieve his necessities if required, to look culiarities of relation to other persons, upon his offspring on the same footing which adds to or modifies the restric

as my own person, and to teach them tions imposed by general ethics. The

this art if they shall wish to learn it peculiarly intimate relations, especial- without fee or stipulation, and that by ly with female patients, involved in the

precept, lecture and every other mode practice of medicine necessitate a very of instruction I will impart a knewlstrict standard, lapses from which are edge of this art to my own sons, to less pardonable to the doctor than to those of my teachers and to disciples nien of any other calling save the bound by a stipulation and oath, acpriesthood. This has been recognized cording to the law of medicine, but to from very early times as we shall see no others. I will offer that system of later.

regimen, which, according to my abilThe French law, it would seem very

ity and judgment, I consider for the properlypronounces void a legacy benefit of my patients, and abstain from a patient devised during the ill- from whatever is deleterious and misness to the physician in charge of him chievious. I will give no deadly mediduring the

same. Neither in this cine to anyone if asked, nor suggest country, England or Germany is there any such counsel, and in like manner any such legal provision, and it seems I will not give a woman a pessary to to me to speak well for the integrity produce an abortion. With purity and of our profession that physicians with with holiness I will pass my life and us are so seldom legatees of their pa- practise my art.

I will not cut pertients.

sons laboring under the stone, but will History tells us that everywhere in

leave this to be done by men who are early times the priest and the physi- practitioners of this work. Into whatcian were one, and SO it is today ever houses I enter, I will go into them among many primitive peoples.

In

for the benefit of the sick, and will the absence of knowledge superstition

abstain from every voluntary act of rules, and as long as illness is regarded mischief and corruption, and further,

from the seduction of females and as a demoniac possession the priest is naturally the medicine man and lays

males, of freemen and slaves. Whatdown the rules for his conduct. When

ever in connection with my professionthe mind gets to the point of coldly al practice, or not in connection with collecting and collating facts and of it, I see or hear, I will not divulge, as recognizing that they are the masters, reckoning that all such things should not the servants, in all matters open to be kept secret. Ilhile I continue to

"'*

it were,

a

keep this oath inviolate, may it be

“He should have all his senses perfect.

“He should be disposed for solitude. granted to me to enjoy life and the

“He should be free from haughtiness. practice of my art, respected by all “He should be of a thoughtful disposition. men at all times; but should I trespass "He should be free from those faults which and violate this oath, may the reverse

go by the name of Vyasana.” be my lot.”

Then follow elaborate ceremonies Charaka, dating probably, as I am

which are gone through with, so interinformed by Professor Lanman, from

esting and curious that I wish we had about 100 A. D., deals at some length

time for them in full. And finally, the with medical ethics and the mutual re

perceptor formulates, as

code, the acceptance of which is a prelations of pupil and teacher. It is too long to give in full, but I permit my

requisite of pupilage.

“If thou desirest to achieve success of self to make some extracts, calling

areatment, earn wealth, acquire celebrity. your attention to the fact that this an

and win Heaven thereafter, thou shouldst, cient Indian oath was administered to reverencing kine and Brahmanas above all, the pupil about to enter on the study always seek, whether standing or sitting, the

good of all living creatures. of medicine, not at the end of his pupil

Thou shouldst. with thy whole heart, age. We note the stress which is laid

strive to bring about the cure of those that on the physical perfection of the can

are ill. didate, and remember that such, in a Even for the sake of thy life thou shouldst

not drain those that are ill of their sublimited way, is a pre-requisite to ad

stance. mission to the Romish priesthood.

Thou shouldst not, even in imagination, After setting forth what constitutes a know another man's wife. good treatise to select for minute Thou shouldst not, similarly, appropriate study a list of the qualifications de

other people's possessions.

Thou shouldst not keep any connection sirable in the preceptor, the pupil de- with publicans, or sinful men, or with those sirous of courting him should attend that are abettors of sinful behavior. on him with heedfulness like one re

Thou shouldst speak words that are soft, vering one's sacrificial fire, or one's

unstained by impurity (obscenity), fraught

with righteousness, incapable of giving pain deity, or one's king, or one's father, or

to others, worthy of praise, truthful, benefione's patron.” A very proper attitude cial and properly weighed or measured. of pupil to teacher, not always ob

Thou shouldst always conduct thyself takserved at the present day.

ing note of place and time.

While entering the family dwelling-house Next come the qualities of the pupil: of the patient, thouldst do it with notice to

the inmates “He should be of a mild disposition.

and with their permission.

Thou shouldst (at such times) be accompa“He should be noble by nature. “He should not be mean in acts.

nied by some male member of the family.

Thou shouldst cover thy person properly. "His eyes, mouth and nasal line should

Thou shouldst (while entering) keep thy be straight.

face downwards. With thy wits about thee, “His tongue should be thin, red and unslimy.

thou shouldst, with understanding and mind

properly fixed, observe all thoings. Duly “His teeth and lips should have no deform

conducting thyself in this way thou shouldst ity.

enter (the dwelling-house of the patient.) “He should not have a nasal voice.

Having entered, thou shouldst not devote “He should be possessed of intelligence. “He should bef ree from pride.

thy words, mind, understanding, and the "He should be endued with a large under

senses to anything else than what is calcustanding.

*Certain habits and acts go by the name "Hhe should have power of judgment and of "Vyasana.” They arfe hunting, gambling memory.

with dice, sleep during day time, speaking “He should have a liberal mind,

ill of others, infatuation for women, exces. "He should belong to a family the mem- sive addiction to singing, dancing and instrubers of which have studied the medical mental music, purposeless sauntering, and scriptures or followed medicine as a profes- others of a similar nature. The HinduScripsion.

tures abound with exhortations to avoid “He should have a devotion for truth. them. In the case, of a Brahmacharin (pu

"He should not be defective in respect of pil living in the house of his preceptor), any limb.

their avoidance is doubly incumbent.-T.

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