and asked in vain, but which we have been permitted to answer in part at any rate, and to answer in hope. "If you walk through a forest at certain seasons, you will see what is called a blaze of white paint upon certain élite of the trees marked out by the forester as ripe for the axe. Such a blaze, if the shadowy world could reveal its futurities, would be seen everywhere distributing its secret badges of cognizance amongst our youthful men and women. Of those that, in the expression of Pericles, constitute the vernal section of our population, what a multitudinous crowd would be seen to wear upon their foreheads the same sad ghastly blaze, or some equivalent symbol of dedication to an early grave. How appaling in its amount in this annual slaughter among those that should by birthright be specially the children of hope, and levied impartially from every rank of society! Is the income-tax or the poor-rate, faithful as each is to its regulating time-tables, paid by any class with as much punctuality as this premature florilegium, this gathering and rendering up of blighted blossoms by all classes? Then comes the startling question that pierces the breaking hearts of so many thousand afflicted relatives: 'Is there no remedy? Is there no palliation of the evil?' It is one of the greatest triumphs of scientific medicine to be able to reply, Yes, the evil may be palliated and is rapidly being lessened, and for many at least, a remedy has been found."

GOITRE IN A NEW-BORN CHILD.

By W. T. BURNS, B.A., M.B., Toronto.

The day after its birth, the child, a female, became very cyanosed, the breathing being extremely labored. This lasted for several minutes, when, gradually, the breathing became more easy and the child regained the normal color. It was at this time that I noticed the enlargement on the neck which I took to be a goitre. It was very pronounced, the tumor showing on both sides and in front of the trachea.

These attacks of dyspnoea and cyanosis occured frequently for the next few days. On the sixth day, the child was free from them and I noticed a distinct diminution of the size of the tumor. On the ninth day, the child died.

The autopsy showed a greatly enlarged thyroid gland of a consistency which was nearly fibrous. On each lobe were several cysts full of a clear fluid; and, on the left one, the remains of a large cyst which had reptured. The rupture of this cyst was probably the cause of the decrease in size of the tumor, remarked on the sixth day.

The gland was placed high up, being near the hyoid bone, and was closely adherent to the trachea.

EYE-STRAIN FROM THE PHYSICIANS' POINT OF VIEW.*

By G. H. BURNHAM, M.D., C.M.

Professor of Ophthalmology, University of Toronto.

'HE first question naturally asked is, what is eye-strain?

ΤΗ Eye-strain is a condition of the eye owing to its faulty shape which

causes it to make more than the natural or physiological efforts to focus any object, that is, to get a clear view of an object. This peculiarity of shape is not visible to an observer; though, perhaps, there are certain peculiar appearances, which may arouse the suspicion of an expert.

This condition may be present and give rise to no symptoms of eyestrain whatsoever. That is, a condition of irregularity of shape and focusing power may exist and still the person be quite free from any symptoms. This is quite often the case. When this state is accidentally found out, it is my usual rule to let the eyes alone, that is, not to give glasses. However, with this latitude, always explain to the person its presence, and the fact that if a certain train of symptoms arise this condition is probably the

cause.

Eye-strain does give rise to so many nerve storms that to any member of the profession, save the expert, it savors of exaggeration. We oculists deny this, and assert, on the contrary, that we ourselves are often astonished at the unexpected benefit which arises from the relief of eyestrain. Many examples can be given of the wonderful healing power of the correction of eye-strain.

It is, of course, now allowed by the profession that a prolific cause of headache is eye-strain. This fact, however, had to be again and again insisted upon and demonstrated before the general profession would even entertain it.

Nervous diseases, before eye-strain was regarded as of any importance, were diagnosed and prognosed in very many cases as being associated with marked structural changes. No one was so certain that these conclusions were correct as the pathologist. I wish to say that the dogmatism of the pathologist, as to what conditions of the nervous system, evidenced by symptoms during life, could be cured or remedied or was beyond aid, was based upon his interpretation of tissue changes, as seen after death, and has been responsible for many a gloomy prognosis which should not have been given.

as

As a student, I worked under Dr. Hughlings Jackson, a clinical observer who, in acuteness and accuracy of observation, was unrivalled. Then we, I well remember, looked upon many phases of abnormal states of the nervous system as due to structural changes, incurable, or almost so, which we now know were only due to the teasing of the nerve centres

Bead at the Toronto Medical Society, 16th February, 1905.

by improper activities of other organs. No organ has been so prolific a cause as the eye.

There is a type of nervous depression which consists of a general weakness of the nervous system, only temporarily lessened by internal remedies, which is due to eye-strain. In this type the patients disclaimed any such connection, for as they say, which is true, I see well with the eyes, have no headaches, have no complaint of any kind to make of the I simply complain of a general weariness and languor. This is a type in which eye-strain is a marked factor, though it is so insidious as often to escape notice.

eyes.

In these cases, eye-strain is rot always the cause or even sometimes one of them; but a careful examination can always demonstrate whether it be or not.

That certain varieties of cpiiepsy have been stopped and pe. n'anently so by correcting the eye-strain, is new an acknowledged fact.

The range of this class of cases is limited and is not as far reaching as some have thought. Disorders of the stomach and bowels, as inability properly to digest food, severe attacks of pain in the stomach, vomiting associated or unassociated with headaches, are also its offspring. Several years ago I had a business transaction with a man who was so peculiarly irritable that I was on the point of speaking to him about his want of ordinary decent manners. However, I did not; for, on observing this man he seemed to me to have a very irritable nervous system. He was apparently a thoroughly healthy man. Three years later this same man saw me professionally. He said I have been suffering for years from indigestion, pain in my stomach, vomiting, headaches and am now so bad that something must be done. I have come to consult you as an oculist. Physicians have not been able to help me. I come of my own accord and not at their suggestion, for they have never mentioned such a thing. Even now I do not think it is my eyes, as my sight is so good. He said often the attacks were so severe that he had to remain at home one or two days each week. I tested his sight and found an error of refraction with weak ocular muscles. I gave him glasses and then proper exercises for the eyes, with the result that he has now been quite free from any such attacks for nine months.

A man several years ago consulted me, suffering so acutely from pain in his left eye and side of head that hypodermic injections of morphine had to be given. The right eye, he said, had been about blind for years, and that previous to this his right eye and side of head had ached as the left was now doing. Consequently he was very anxious. I found the right eye with a normal fundus. With proper glasses the vision was normal. The left eye with proper glasses gave normal vision. With the constant

wearing of the proper glasses for distance and reading all symptoms went away, and he is well up to this day.

The eyes with normal vision, or even that in excess of normal, may and, as a rule, do suffer the most from eye-strain. The reason is that these eyes can, by exertion, focus so as to see clearly and, consequently, they always make this exertion. However, from these eyes very severe and, even the most severe, nerve storms may arise; for this continued abnormal exertion so irritates the nervous centres that they cannot finally bear the strain.

In these cases, it is especially difficult to give glasses accurately, as there are such irritation of the retina and weakness and spasm of the eye muscles. I mean that it is quite easy to give the eyes good vision with glasses; but it is very difficult to get the eyes to take the proper glasses.

The so-called opticians have sprung into existence purely as the result of commercial greed and, as a class, are doing much harm.

The maker and seller of spectacles inaugurated the following scheme to line their pockets. This will exemplify one of the evils of allowing the commercial world to exploit medicine in order to get the public's money. The formation of the so-called schools in which men could be trained to give glasses was begun. The course was of two to three weeks duration. At the end, a diploma was given saying, the one herein mentioned is in every way capable to give glasses for every variety of eye-strain. The poor owner of the certificate, or dupe, I should like to call him, believed it, I suppose.

Then the companies sold to each graduate, or optician, or doctor of refraction, a set of trial lenses and a quantity of spectacles and, moreover, arranged to fill any orders for glasses that were sent in. In this way came the profit, and a big one it has turned out to be. At first, in fact, it is still the same, there came from every corner of the country bakers, shoemakers, grocers, druggists, jewellers, etc., to take this highly advertised and money making course. They returned home, hung up their diplomas, and went to work. Thus do these people, ignorant of any knowledge of the eye, in three weeks audaciously claim to have learned to be able to practise properly one of the most difficult branches of ophthalmology.

They do not hesitate to prescribe glasses for every eye no matter how poor the vision or how little improvement they may be able to make.

Of course, any form of disease of the eye may be present and of that they are unaware, and give no thought to unless it be glaring. Some of these so-called opticians are too ignorant to be able to guage their own ignorance and, hence, go on. Others again are heedless and deal out glasses with about as much care as sugar or tea. Others again are out and out fakirs.

I now do accuse the general profession of being culpably ignorant and thoughtless in this grave matter. They constantly send their patients, suffering from the effects of eye-strain to one of these so-called opticians. Some of them do more. They send them to fakirs, and aye, even worse, do employ full-fledged fakirs to attend to these patients, at their patient's houses, or in their own hospitals. This support the opticians fully publish and through it they are able to still any question of the public. This support they again use as a lever to exalt their own importance and standing. One of the offices of the general physician is to tell his clients when it is necessary for them to consult a specialist.

The practice of this duty does not loosen their hold on their clients; it strengthens it. The right minded specialist gladly commends them for it. How much more pleasant it is to say, your physician did quite right to send you to me, than to have the patient say, when the whole case is brought out so that he himself can see, why did not my physician suggest this to me, or why did not my physician send me to an oculist? When physicians thus patronize irregulars how can they rightly demur to druggists prescribing for the ills of people? For these irregulars, as opticians undoubtedly are, though some will honestly deny it, merely dabble with the eye, treating it as if it were a piece of machinery and not liable to all kinds of serious affections to which often the eye, viewed externally, gives no, or very slight, clue.

Oculists, when a case is brought to them, suffering from eye-strain and when it is proved that marked errors of refraction are present, test with great care. The more the oculists know or have had to do with these cases, the greater is the care they take. If the glasses do not give relief, they do not say the symptoms are not due to the eyes, as I have given glasses more than once. On the contrary, so difficult to manage are eyes so affected that we again test and work for some still hidden error. For an eye, racked by long overstrain, will not at first give up its secrets. After the rest from the glasses which have been properly given, a quieting of the eye is brought about and then we can get further into its peculiarities.

We test with all the means at our command, for we realize that the missing of some hidden error may mean unrelieved misery. One curse and a rapidly expanding one is the efforts of men to prostitute, to commercial gain, the discoveries made in medicine. It is a biting comment on our boasted care for the individual that we allow patent medicines to be so shamelessly brought to the notice of the public. So little cares the State that it does not even inquire into their ingredients. Under the guise of patent medicines, a great quantity of vile spirits are sold.

Our duty being to prevent the continuation of everything prejudicial to health, as well as to cure disease, must always make us a foe to all