Chapter III: Part 3

Those who remain for a certain length of time, not too long, however, in the condensed atmosphere, exhibit a most striking exacerbation of mental and physical vigor. They go up and down ladders, lift heavy weights, are more or less exhilarated, and, in short, behave as though under the influence of a stimulant.

Hardly had I observed these things, which are perfectly well known to those who have been able to familiarize themselves with the ordinary effects of compressed air as used in caissons and submarine works of various kinds, when my attention became attracted by what at first appeared to be a phenomenon of trivial importance. In a word, I observed that some of the men exposed to the effects of the compressed air were more exhilarated by it than others. Upon superficial reflection one might have supposed that this discrepancy in physiological effect was to be accounted for merely on the basis of constitutional idiosyncrasy; maturer thought, however, convinced me that the exaggerated effects of the condensed air were both too numerous and too constant to be amenable to such an explanation. This led me to study the habits of the men; and thus it was that I arrived at a discovery of real practical value to neurotherapy. To be brief, I found that a certain percentage of the men, before entering the compressed air employed in the construction of the Hudson River tunnel, were in the habit of drinking a quantity of alcohol, usually in the form of whisky. So long as these men remained outside the tunnel, where the atmospheric conditions were normal, they were not visibly affected by their potations. When, however, they entered the compressed air of the tunnel, but a short time elapsed before they became exhilarated to an inordinate degree, acting, as one of the foremen graphically expressed it, "as though they owned the town."

On the other hand, when the customary draught of alcohol was withheld from them, these same men were no more, if as much, exhilarated on entering the compressed air as were their fellows.

The effects of alcohol, then, are enhanced by exposing the subject to the influence of an atmosphere condensed to a considerable degree beyond that of the normal atmosphere.

Acting on the hint derived from this discovery, I proceeded to administer absinthe, ether, the wine of coca, vermouth, champagne, and other stimulants, before exposing the subject to the influence of the condensed atmosphere, and invariably observed analogous effects, i.e., palpable augmentation of the physiological effects of the remedy.

Upon what principle does this augmentation of physiological effect depend? how is it to be accounted for?

In my opinion, the answer to this question may be given as follows: In the first place, we know that the primary effect of the compressed air upon the organism must be to force the blood from the surface of the body toward the interior, and especially into the cerebro-spinal canal. Or, to express it more succinctly, the blood will be forced in the direction of the least resistance, that is, into the soft organs inclosed by bony walls, which latter completely shut out the element of counter-pressure. Now, when the blood stream is freighted with a soluble chemical of some sort--let us say, for the present, with alcohol--this medicated blood will exert its greatest chemical effect where the tension--the pressure--is greatest, that is, in the cerebro-spinal canal. The reason for this is found in the fact that endosmosis is most pronounced where the blood pressure is greatest. This explanation of why the effects of alcohol are enhanced by exposing the individual who has taken it to the effects of a condensed atmosphere will, I believe, appeal to the physiological conceptions of most medical men. It was the above course of reasoning which, at this stage of the argument, led me to the idea that, just as the effects of stimulating substances are enhanced by exposing the subject to the influence of compressed air, so, inversely, sedatives and analgesics, when brought in solution into the blood stream, either hypodermically or by the stomach, might be greatly enhanced in effect by causing the subject to remain, while under their influence, in a condensed atmosphere.

When I came to investigate the validity of these predictions, as I did shortly after the introduction of antipyrin, phenacetin, and the other members of the same group of compounds, I found my predictions verified, and, indeed, exceeded. To summarize the whole matter, I ascertained that not only could therapeutic effects be obtained from much smaller doses by exposing the subject to the influence of a condensed atmosphere, but, what was of equal interest, I found that the analgesic influence of the remedies was much more permanent, was prolonged, in short, by this mode of administration. When we consider how great must be the nutritive changes in the nervous system, and especially in the cerebro-spinal axis, consequent upon increasing the blood pressure in this way, I hardly think that these things should be matters of astonishment.

CONCERNING THE PRACTICAL APPLICATION OF THE FOREGOING FACTS.--Truths like the foregoing possess, however, much more than a theoretical interest, and we should be greatly lacking in perspicuity did we not seek to derive from them something further than a foundation for mere speculation. Indeed, the whole tenor of these facts is opposed to such a course, for, view them as we may, the thought inevitably arises that here are things which contain the germ of some practical acquisition. This, at least, is the impression which they engendered in my own mind--an impression which, being unable to rid myself of, I have allowed to fructify. Nor has regret followed this tenacity of purpose, since, by the _combination_ of the three principles previously enunciated, I have been able to devise a procedure which, in my hands, has yielded flattering results in the treatment of a wide range of nervous affections, and notably so in melancholia, chorea, insomnia, neurasthenia, and painful conditions of various kinds.

RECAPITULATION OF ARGUMENT.--The method in question consists, then, in the combination of the three facts already elucidated. To recapitulate, they are:

1. That the effects of remedies upon the cerebro-spinal axis may be enhanced by the sequestration of the blood contained in one or more extremities, previous to the administration of the medicament. This is only another way of saying that the quantity of a remedy required to produce a given physiological effect may be reduced by any expedient which suspends, or sequestrates, the blood in one or more extremities. As has been previously said, however, care should be exercised to avoid dangerous exsanguination of the trunk, and consequently of the respiratory and cardiac centers contained in the medulla. This may be done by compressing the central portion of both artery and vein; but I shall presently indicate a better way of accomplishing the same thing.

2. The duration of the effect of a remedy upon the cerebro-spinal axis is in the inverse ratio of its volatility. For this reason the anaesthetic effects of ether disappear shortly after removal of the inhaler, whereas solutions of antipyrin, phenacetin, morphine, and other salts possessing an affinity for nervous tissue exert much more permanent effects upon the cerebro-spinal system.

It is evident, therefore, that the administration of remedies designed to exert an influence upon the central nervous system in the form of gases must be far inferior to the exhibition of potent solutions hypodermically or by the mouth.

3. The pharmaco-dynamic potency of stimulants, sedatives, analgesics, and probably of all remedies possessing a chemical affinity for nervous matter, is enhanced by exhibiting them (the remedies) in solution, or at least in _soluble form while the subject remains in a condensed atmosphere_.

And, as a corollary to this, it may be stated that this increase--this enhancement of therapeutic effect--is, within physiological limits, in the ratio of the atmospheric condensation. By physiological limits we mean simply that there is a degree of atmospheric condensation beyond which we cannot go without jeopardizing the well-being of the subject.

(_To be continued_.)

* * * * *

EYESIGHT: ITS CARE DURING INFANCY AND YOUTH.[1]

[Footnote 1: A lecture delivered before the Franklin Institute, December 5, 1890.--_From the Journal of the Institute_.]

By L. WEBSTER FOX, M.D.

Medical science, as taught in our medical colleges to-day, has two objects in view: (1) the prevention of disease; (2) the amelioration of disease and its cure. Some of our advanced thinkers are suggesting a new mode of practice, that is the prevention of disease by proper hygienic measures. Chairs are being established and professors appointed to deliver lectures on hygiene. Of what value is the application of therapeutics if the human economy is so lowered in its vital forces that dissolution is inevitable? Is it not better to prevent disease than to try the cure after it has become established, or has honeycombed the constitution?

These few preliminary remarks are _apropos_ to what is to follow in the subject which I have selected as the topic for discussion this evening.

Vision is the most useful of all the senses. It is the one gift which we should cherish and guard the most. And at no time in one's life is it more precious than in infancy and youth.

In infancy, when the child is developing, the one great avenue to the unfolding, or more properly speaking, the development, of the intellect is through the eye. The eye at this period holds in abeyance all the other senses. The child, when insensible to touch, taste, smell or hearing, will become aroused to action by a bright light or bright colors, or the movement of any illuminated object, proving to all that light is essential to the development of the first and most important sense. Again, the infant of but six days of age will recognize a candle flame, while its second sense and second in importance to its development--hearing--will not be recognized for _six_ weeks to two months. Taste, touch and smell follow in regular sequence. Inasmuch as light makes thus early an impression on the delicate organ of vision, how necessary it behooves us to guard the infant from too bright lights or too much exposure in our bright climate. Mothers--not only the young mother with her first child, but also those who have had several children--are too apt to try to quiet a restless child by placing it near a bright flame; much evil to the future use of those eyes is the outgrowth of such a pernicious habit. Light throws into action certain cells of that wonderful structure of the eye, the retina, and an over stimulus perverts the action of those cells. The result is that by this over-stimulation the seeds of future trouble are sown. Let the adult gaze upon the arc of an electric light or into the sun, and for many moments, nay hours, that individual has dancing before his vision scintillations and phosphenes. His direct vision becomes blurred, and as in the case of a certain individual I have in mind, there may be a permanent loss of sight. Parents should take the first precaution in the child's life, and not expose it to a light too bright or glaring. When in the open air let the child's eyes be protected from the direct rays of the sun. While it is impossible to give all children the advantage of green fields and outdoor ramblings, yet nature never intended that civilization should debar the innocent child from such surroundings.

An anecdote is related of a French ophthalmic surgeon, that a distinguished patient applied to him for relief from a visual defect; the surgeon advised him to go into the country and look out upon the green fields. The green color with its soothing effect soon brought about a restoration of vision. What I wish to illustrate by this anecdote is that children should be allowed the green fields as their best friend in early life. It tones up the system and rests the eye. After outdoor exercise and plenty of it, we should turn our attention to the home surroundings of our little ones. The overheated rooms of the average American home I am sure have more to do with the growing tendency of weak eyes than we feel like admitting. Look at these frail hot-house plants, and can any one believe that such bodies nourished in almost pestilential atmosphere can nourish such delicate organs of vision, and keep them ready for the enormous amount of work each little eye performs daily? The brain developing so rapidly wills with an increasing rapidity the eye to do increasing duties; note the result--a tendency to impoverished circulation first, and the eye with its power to give the brain a new picture in an infinitesimal short space of time means lightning-like circulation--the eye must give way by its own exhaustion.

Civilization is the progenitor of many eye diseases.

After a boy has grown to that age when it becomes necessary for him to begin the education prescribed by the wise men, obstacles are placed in his way to aid again in causing deterioration of vision. It is not so much the overcrowded condition of our school rooms as the enormous amount of work that causes deterioration of sight. Our children begin their school life at a time when they are too young. A child at six years of age who is forced to study all day or even a part of a day will not run the same race that one will who commences his studies at ten--all things being equal. The law prescribes that so much time must be devoted to study, so many forms must be passed, so many books must be read, so many pages of composition written--all probably in badly lighted rooms, or by artificial light. Note the effect. First, possibly, distant vision gives way; the teacher, sympathizing with the overburdened child, tries to make the burden lighter by changing his position in the room or placing him under the cross light from a window; as the evil progresses, the child is taken to an ophthalmic surgeon, and the inevitable result, glasses, rightly called "crutches for the eyes," are given. What would be thought of a cause which would weaken the legs of that boy so that he would have to use crutches to carry him through life? If civilization be responsible for an evil, let our efforts be put forth in finding a remedy for that evil.

A discussion, in a recent number of the _British Medical Journal_,[2] on "The Claims and Limitations of Physical Education in Schools," has many valuable hints which should be followed by educators in this country. Dr. Carter, in the leading paper on this subject, makes the pregnant remark: "If the hope is entertained of building up a science of education, the medical profession must combine with the profession of teaching, in order to direct investigation and to collect material essential to generalization. Without such co-operation educational workers must continue to flounder in the morasses of empiricism, and be content to purchase relative safety at the cost of slow progress, or no progress at all." In other words, an advisory medical board should coexist with our board of public education, to try to hold in check or prevent a further "cruelty in trying to be kind." Private institutions of education recognize the importance of physical training and development, and in such institutions the deterioration of vision is in proportion less than in institutions where physical training is not considered. In one school of over 200 middle class girls, Dr. Carter found that, during a period of six years, no fewer than ten per cent. of the total number of girls admitted during that time have been compelled to take one or more terms' leave of absence, and of the present number twenty-eight per cent. have medical certificates exempting them from gymnastic exercise and 10.25 per cent. of the total present number wear eye glasses of some kind or other. From my own experience the same number of students in our schools would show about the same percentage of visual defects. These questions are of such growing importance that not only instructors, but the medical fraternity, should not rest until these evils are eradicated.

[Footnote 2: Nov. 1, 1890.]

Dr. J.W. Ballantyne, of Edinburgh, in a lecture[3] on diseases of infancy and childhood, says: "The education of the young people of a nation is to that nation a subject of vital importance." The same writer quotes the startling statement made by Prof. Pfluger, that of 45,000 children examined in Germany more than one-half were suffering from defective eyesight, while in some schools the proportion of the short sighted was seventy or eighty per cent., and, crowning all, was the Heidelberg Gymnasium, with 100 per cent. These figures, the result of a careful examination, are simply startling, and almost make one feel that it were better to return to the old Greek method of teaching by word of mouth.

[Footnote 3: _Lancet_. Nov. 1, 1890.]

Prof. Pfluger attributes this large amount of bad sight to insufficient lighting of school rooms, badly printed books, etc. One must agree with a certain writer, who says: "Schools are absolute manufactories of the short sighted, a variety of the human race which has been created within historic time, and which has enormously increased in number during the present century." Granting that many predisposing causes of defective vision cannot be eliminated from the rules laid down by our city fathers in acquiring an education, it would be well if the architects of school buildings would bear in mind that light when admitted into class rooms should not fall directly into the faces of children, but desks should be so arranged that the light must be sufficiently strong and fall upon the desk from the left hand side. My attention has repeatedly been called to the cross lights in a school room. The light falling directly into the eyes contracts the pupil which is already contracted by the action of the muscle of accommodation in its effort to give a clearer picture to the brain. This has a tendency to elongate the eyeball, and as a permanent result we have near sightedness. Where the eyeball has an unnatural shortness this same action manifests itself by headaches, chorea, nausea, dyspepsia, and ultimately a prematurely breaking down of health. The first symptom of failing sight is a hyper-secretion of tears, burning of the eyelids, loss of eyelashes, and congestion either of the eyelids or the eyeball proper.

The natural condition of aboriginal man is far sighted. His wild life, his nomadic nature, his seeking for game, his watching for enemies, his abstention from continued near work, have given him this protection. Humboldt speaks of the wonderful distant vision of the South American Indians; another traveler in Russia of the power of vision one of his guides possessed, who could see the rings of Saturn. My recent examinations among Indian children of both sexes also confirm this. While the comparison is not quite admissible, yet the recent investigations carried on by Lang and Barrett, who examined the eyes of certain mammalia, found that the larger number were hypermetropic or far sighted. With all the difficulties which naturally surround such an examination they found that in fifty-two eyes of rabbits, thirty-six were hypermetropic and astigmatic, eight were hypermetropic only, five were myopic and astigmatic, and others presented mixed astigmatism. In the eyes of the guinea pig about the same proportion of hypermetropia existed. The eyes of five rats examined gave the following result: Some were far sighted, others were hypermetropic and astigmatic, one was slightly myopic and one had mixed astigmatism. Of six cows, five were hypermetropic and astigmatic and one was slightly myopic.

Six horses were also examined, of which one had normal sight, three were hypermetropic and astigmatic, and two had a slight degree of astigmatism. They also examined other animals, and the same proportion of hypermetropia existed. These gentlemen found that as an optical instrument the eye of the horse, cow, cat and rabbit is superior to that of the rat, mouse and guinea pig.

I have for the last five years devoted considerable attention to the vision of the Indian children who are pupils at two institutions in this city. I have at various times made careful records of each individual pupil and have from time to time compared them. Up to the present there is a growing tendency toward myopia or short sightedness, i.e., more pupils from year to year require near sighted glasses. The natural condition of their eyes is far sighted and the demands upon them are producing many nervous or reflex symptoms, pain over the frontal region and headaches. A good illustration of the latter trouble is showing itself in a young Indian boy, who is at present undergoing an examination of his vision as a probable cause for his headaches. This boy is studying music; one year ago he practiced two hours daily on the piano and studied from three to five hours besides. This year his work has been increased; he is now troubled with severe headaches, and after continued near work for some time letters become blurred and run together. This boy is far sighted and astigmatic; glasses will correct his defect, and it will be interesting to note whether his eyes will eventually grow into near sighted ones. I have several cases where the defective vision has been due entirely to other causes, such as inflammation of the cornea, weakening this part of the eye, and the effect in trying to see producing an elongation of the anterior portion of the eyeball, and this in turn producing myopia. The eye of the Indian does not differ materially from that of any deeply pigmented race. The eyeball is smaller than in the Caucasian, but when we examine the interior we find the same distribution of the blood vessels and same shape of the optic nerves. The pigment deposit in the choroid is excessive and gives, as a background to the retina, a beautiful silvery sheen when examined with the ophthalmoscope. One thing which I noticed particularly was the absence of this excessive deposit of pigment and absence of this watered silk appearance in the half breeds, they taking after the white race.

Many of the intraocular diseases common among the white children were also absent, especially those diseases which are the result of near work.

It is a well known fact among breeders of animals that where animals are too highly or finely bred, the eye is the organ first to show a retrogression from the normal. In an examination by myself some years ago among deaf mutes, I found the offspring of consanguineous marriages much affected, and while not only were many afflicted with inflammatory conditions of the choroid and retina, their average vision was much below the normal.

My quoting Messrs. Lang and Barrett's figures was to bring more prominently to the notice of my hearers the fact that the eyes of primitive man resembled the eyes of the lower mammalia and that the natural eye as an organ of vision was hypermetropic, or far sighted, and that civilization was the cause of the myopic or near sighted eye. Nature always compensates in some way. I grant that the present demands of civilization could not be filled by the far sighted eye, but the evil which is the outgrowth of present demands does not stop when we have reached the normal eye, but the cause once excited, the coats of this eye continue to give way, and myopia or a near sighted condition is the result.

Among three hundred Indians examined, I found when I got to the Creeks, a tribe which has been semi-civilized for many years, myopia to be the prevailing visual defect.

Without going into statistics, I am convinced from my experience that the State must look into this subject and give our public school system of education more attention, or we, as a people, will be known as a "spectacled race."

Myopia or short-sightedness among the Germans is growing at a tremendous rate. While I do not believe that the German children perform more work than our own children, there is one cause for this defect which has never been touched upon by writers, and that is the shape of the head. The broad, flat face, or German type, as I would call it, has not the deep orbit of the more narrow, sharp-featured face of the American type. The eye of the German standing out more prominently, and, in consequence, less protected, is thereby more prone to grow into a near-sighted eye. One of the significant results of hard study was recently brought to my notice by looking over the statistics on the schools of Munich in 1889. In those schools 2,327 children suffered from defective sight, 996 boys and 1,331 girls.

Of 1,000 boys in the first or elementary class, 36 are short-sighted; in the second, 49; in the third, 70; in the fourth, 94; in the fifth, 108; in the sixth, 104; and in the last and seventh, 108. The number of short-sighted boys, therefore, from the first class to the seventh increases about three-fold. In the case of girls, the increase is from 37 to 119.

These statistics in themselves show us the effects of overwork, incessant reading or study by defective gas or lamp light, or from an over-stimulating light, as the arc light, late hours, dissipation, and frequent rubbing of the eye, also fatigue, sudden changes from darkness to light, and, what is probably worse than all, reading on railway trains. The constant oscillations of the car cause an over-activity of the muscle of accommodation, which soon becomes exhausted; the brain willing the eye to give it a clear photograph continues to force the ciliary muscle, which muscle governs the accommodation, in renewed activity, and the result may easily be foretold.

The fond parents finding that the vitiated air of the city is making their once rosy-cheeked children turn pale, seek a remedy in the fresh air of the country. The children find their way to city schools; this necessitates traveling so many miles a day in railway cars. The children take this opportunity of preparing their studies while _en route_ to the city, and here is where they get their first eye-strain. Children have the example set them by their parents or business men, who read the daily papers on the trains. Children are great imitators, and when their attention is called to the evil, quote their parents' example, and they follow it. No wonder each generation is growing more effeminate.

The light in sick rooms should never fall directly on the eyes, nor should the rooms be either too dark or too light.

The Esquimaux and Indians long ago noted the fact that sunlight reflected from freshly fallen snow would soon cause blindness.

The natives of northern Africa blacken themselves around the eyes to prevent ophthalmia from the glare of the hot sand. In Fiji the natives, when they go fishing, blacken their faces. My friend. Dr. Bartelott, presented me with a pair of eye protectors, which he brought from Alaska. The natives use them to protect themselves from snow blindness. These snow spectacles, or snow eyes, as they are called, are usually made out of pine wood, which is washed upon their shores, drift wood from southern climes.

The posterior surface is deeply excavated, to prevent its obstructing the free motion of the eye lids; on each side a notch is cut at the lower margin to allow a free passage for the tears. The upper margin of the front surface is more prominent than the under, to act as a shade to the eyes. The inner surface is blackened to absorb the excessive light. The openings are horizontal slits. The eyes are thus protected from the dazzling effect of the light.

My friend, Dr. Grady, of Omaha, communicated to me a history of three hunters who almost lost their eyesight by too long exposure to the bright rays of the sun falling on snow.

The abuse of tobacco leads to impairment of vision in the growing youth. Cigarette smoking is an evil. I am inclined to believe that the poison inhaled arrests the growth of boys; surely it prevents a mental development, and, when carried to excess, affects vision more by lessening the power of nerve conduction than acting directly on the eye.

It is not the one cigarette which the boy smokes that does the harm, but it is the one, two, or three packages smoked daily. This excessive smoking thoroughly perverts all the functions which should be at their best to aid this growing youth. First we have failing digestion, restless nights, suspension of growth, lack of mental development, the loss of nerve tone, loss of the power of accommodation in vision, failing sight, headaches, enfeeblement of the heart. Let a man who is a habitual smoker of cigars attempt to smoke even one package of cigarettes and he will complain of nausea, dry throat, and loss of appetite. If a strong man is so much affected by this poison, how much less can a boy resist the inroads of such poisons? In Germany the law forbids the sale of cigarettes to growing boys. New York State has a similar law, and why should our own or any other State be behind in passing prohibitory laws against this evil?--and this is a growing evil.

I have never seen a case of tobacco amblyopia in boyhood, but such a condition is not infrequent in adults. In boys the action of nicotine acts especially upon the heart, the impulse is rendered weaker and intermittent, and many young boys lay the seeds of organic disease which sooner or later culminates fatally. Boys should be prohibited from smoking, first by their parents, second by law, but not such laws whose enforcement is a failure, third by placing a heavy fine upon dealers who sell to minors. The pernicious evil of intoxication is no less an evil upon the nervous system of a youth than is the habit of cigarette smoking, but, fortunately, this habit is less common. Having traced from aboriginal man to the present civilized individual the cause of his myopia, what must we do to prevent a further deterioration of vision? Unfortunately, the physician of our country is not, as I am told, like the Japanese physician. Our medical men are called to attend people who are ill and to try to get them well--the Japanese physician is paid only to keep his patients in health.

The first effort parents should make is to see that their children have plenty of outdoor exercise. Good, warm clothing in winter, and light texture cloth in summer. A great difference of opinion exists as to the age at which a child should begin its studies. I feel sure that the boy who commences his studies at ten will far outrun the one who commences study at six. Every child should commence his lessons in the best kindergarten, the nursery. Let object lessons be his primer--let him be taught by word of mouth--then, when his brain is what it should be for a boy of ten, his eyes will be the better able to bear the fatigue of the burdens which will be forced upon him. Listen to what Milton has left on record as a warning to those young boys or girls who insist upon reading or studying at night with bad illumination.

"My father destined me, from a child, for the pursuits of polite learning, which I prosecuted with such eagerness that, after I was twelve years old, I rarely retired to bed, from my lucubrations, till midnight. This was the first thing which proved pernicious to my eyes, to the natural weakness of which were added frequent headaches."

Milton went blind when comparatively a young man, and it was always to him a great grief. Galileo, the great astronomer, also went blind by overwork. It was written of him, "The noblest eye which ever nature made is darkened--an eye so privileged, and gifted with such rare powers, that it may truly be said to have seen more than the eyes of all that are gone, and to have opened the eyes of all that are to come."

When the defect of far sightedness or near sightedness exists, we have but one recourse--_spectacles_.

Some time ago I published, in the _Medical and Surgical Reporter_ an article on the history of spectacles. The widespread interest which this paper created has stimulated me to continue the research, and since this article appeared I have been able to gather other additional historical data to what has been described as an invention for "poor old men when their sight grows weak."

The late Wendell Phillips, in his lecture on the "Lost Arts," speaks of the ancients having magnifying glasses. "Cicero said that he had seen the entire _Iliad_, which is a poem as large as the New Testament, written on a skin so that it could be rolled up in the compass of a nut shell;" it would have been impossible either to have written this, or to have read it, without the aid of a magnifying glass.

In Parma, a ring 2,000 years old is shown which once belonged to Michael Angelo. On the stone are engraved the figures of seven women. You must have the aid of a glass in order to distinguish the forms at all. Another _intaglio_ is spoken of--the figure is that of the god Hercules; by the aid of glasses, you can distinguish the interlacing muscles and count every separate hair on the eyebrows. Mr. Phillips again speaks of a stone 20 inches long and 10 wide containing a whole treatise on mathematics, which would be perfectly illegible without glasses. Now, our author says, if we are unable to read and see these minute details without glasses, you may suppose the men who did the engraving had pretty strong spectacles.

"The Emperor Nero, who was short sighted, occupied the imperial box at the Coliseum, and, to look down into the arena, a space covering six acres, the area of the Coliseum, was obliged, as Pliny says, to look through a ring with a gem in it--no doubt a concave glass--to see more clearly the sword play of the gladiators. Again, we read of Mauritius, who stood on the promontory of his island and could sweep over the sea with an optical instrument to watch the ships of the enemy. This tells us that the telescope is not a modern invention."

Lord Kingsborough, speaking of the ancient Mexicans, says: "They were acquainted with many scientific instruments of strange invention, whether the telescope may not have been of the number is uncertain, but the thirteenth plate of _Dupaix's Monuments_, part second, which represents a man holding something of a similar nature to his eye, affords reason to suppose that they knew how to improve the powers of vision.

Our first positive knowledge of spectacles is gathered from the writings of Roger Bacon, who died in 1292.[3] Bacon says: "This instrument (a plano-convex glass or large segment of a sphere) is useful to old men and to those who have weak eyes, for they may see the smallest letters sufficiently magnified."

[Footnote 3: _Med. and Surg. Reporter_.]

Alexander de Spina, who died in 1313, had a pair of spectacles made for himself by an optician who had the secret of their invention. De Spina was so much pleased with them that he made the invention public.

Monsieur Spoon fixes the date of the invention between 1280 and 1311. In a manuscript written in 1299 by Pissazzo, the author says: "I find myself so pressed by age that I can neither read nor write without those glasses they call spectacles, lately invented, to the great advantage of poor old men when their sight grows weak." Friar Jordan, who died in Pisa in 1311, says in one of his sermons, which was published in 1305, that "it is not twenty years since the art of making spectacles was found out, and is indeed one of the best and most necessary inventions in the world." In the fourteenth century spectacles were not uncommon and Italy excelled in their manufacture. From Italy the art was carried into Holland, then to Nuremberg, Germany. In a church in Florence is a fresco representing St. Jerome (1480). Among the several things represented is an inkhorn, pair of scissors, etc. We also find a pair of spectacles, or _pince-nez_--the glasses are large and round and framed in bone.

It was not until 1575 that Maurolicus, of Messina, pointed out the cause of near sightedness and far sightedness and explained how concave glasses corrected the former and convex glasses the latter defect.

In the wake of advanced, education stalks the spectacle age. Any one watching a passing crowd cannot fail but note the great number of people wearing spectacles. Unfortunately it is not limited to adults, but our youths of both sexes go to make up this army of ametropes.

At what age should children first wear glasses? This is a much debatable question. Where there is simply a defect of vision I should never prescribe a pair of glasses for a child under ten years of age. A child under this age runs many risks of injury to the eyeball by accident to the glasses, and to cut the eye with glass is a very serious affair. Rather let a child go without study, or even with impaired vision, than run the risk of a permanent loss of sight.

Another source of evil I must call your attention to, and that is the indiscriminate use of glasses given by itinerant venders of spectacles who claim a thorough knowledge of the eye, who make examination free, but charge double price for glasses.

Persons, before submitting themselves into the hands of opticians, should know that they are not suffering from any incipient disease of their eyes. I do not, for a moment, claim that a practical optician cannot give you a pair of glasses which will make you see--he does nothing more than hand you a number of pairs of glasses and you select the one pair which you think answers the purpose. How can anyone but a medical man know that the impairment of vision does not arise from diminished sensibility of the retina? If so, the glasses just purchased, which may be comfortable for a time, may cause an irreparable loss of vision. Every ophthalmic surgeon will tell you that he has had a number of such cases. Do not be misguided by purchasing cheap spectacles. Glasses advertised as having "remarkable qualities" are always to be passed by. They have "remarkable qualities;" they always leave the person wearing them worse at the end of a few months. Whenever an eye finds relief in a shaded or colored glass, something is going wrong with the interior of that eye. Seek advice, but do not trust the eyes of yourself, much less those of your children, in the hands of the opticians who advertise their examinations free.

Such individuals should be brought before a tribunal and the matter sifted as to whether the sense of sight is less to be taken care of than if that same patient were ill with pneumonia and a druggist were to prescribe remedies which might or might not aid this patient. If one man must comply with the law, why should not the other? Our medical colleges are lengthening the course of studies; the advances in the various departments of science demand this. It is by the aid of the ophthalmoscope that many obscure diseases are diagnosed, and while it is impossible for every young man who obtains a diploma to become thoroughly proficient in the use of this instrument, yet the eye shows to him many conditions which guide him to the road of successful treatment. Think of a case of optic neuritis--inflammation of the optic nerve--going to an optician and fitting one set of glasses after another until the patient suddenly discovers that blindness is inevitable. Many individuals, and very intelligent ones at that, think that so long as a glass makes them see, that is all they need. When we know that scarcely two eyes are alike, we can at once feel that it is very important that each eye should be properly adjusted for a glass; by this we are sure of having comfort in reading and preserving vision.

There is a very important defect in vision which should be detected as early in life as possible, and that is color blindness. The boy who is a color blind will always remain a color blind, and as forty in every 1,000 of the male sex are color blind, it is essential that they know their defect, and train their course accordingly. It would be to the advantage of all boys to undergo such an examination once in their school life; a color blind would be useless where the selection of color entered into his life work. If a boy had a talent for drawing or engraving, and were color blind, he would make a success of his life, whereas if he would attempt to mix paints of different colors he would be a failure.

I shall not dwell upon the scientific part of color blindness, nor discuss either the Young-Helmholtz or the Hering theories of color defect, but shall deal with its practical use in everyday life.

Until the year 1853, very little was known about color blindness, and much less written about it.

Dr. George Wilson, in 1853, wrote several articles, which were published in the _Edinburgh Monthly Journal of Medical Science._ These articles created such an interest in the scientific world that Dr. Wilson brought out a book, entitled "Researches on Color Blindness," two years later. So thoroughly did Dr. Wilson sift this subject that no writer up to the present day has added anything practical to what was then known.

Dr. Wilson writes in his preface: "The most practical relation of color blindness is that which it has to railway and ship signals." He further states: "The professions for which color blindness most seriously disqualifies are those of the sailor and railway servant, who have daily to peril human life and property on the indication which a colored flag or a lamp seems to give."

Dr. Bickerton, in an article on this same subject, speaking of the careless way in which lights were used on ships at sea, says: "Until the year 1852, there were no definite rules regarding the carrying of lights at night by vessels at sea.... At this time the subject of color blindness had not awakened the attention of practical observers, and had the fact been known that between three and four per cent. of the whole male population are color blind, some other mode might have been devised to indicate the positions of vessels at night than by showing red and green lights."

If it is so very important to have sailors with good color perception, where, at least, four men are on the lookout, how much more important is it to have our engine drivers with perfect color perception, where one man alone watches the signal of safety or danger.

The growth of our railway system is constantly increasing. We have to-day probably 150,000 men employed in this service. The boys attending public schools to-day in a few years will have to fill the ranks of these men. How important for these boys to know that they have not this defect. If the forty boys in every 1,000 are found, what is to be done with them? The engraver, the wood cut engraver, the etcher, all wish apprentices. I am also informed that these occupations pay well. It requires talent to fill them, and here is an opening for the color blind. Hear what a color blind writes:[4] "I beg to offer some particulars of my own case, trusting it may be of use to you. I am an engraver, and strange as it may appear, my defective vision is, to a certain extent, a useful and valuable quality. Thus, an engraver has two negative colors to deal with, i.e., white and black. Now, when I look at a picture, I see it only in white and black, or light and shade, and any want of harmony in the coloring of a picture is immediately made manifest by a corresponding discord in the arrangement of its light and shade or, as artists term it, the _effect_. I find at times many of my brother engravers in doubt how to translate certain colors of pictures which to me are matters of decided certainty and ease. Thus, to me it is valuable." Having already spoken about the importance of having all boys undergo an examination for color blindness once in their school lives, we have two very good reasons for making this suggestion.

[Footnote 4: Wilson, p. 27.]

First, prevent a boy following a trade or occupation where he is incapacitated, and, secondly, let him be trained for a certain trade or occupation when the defect exists. The savage races possess the perception of color to a greater degree than do civilized races. I have just concluded an examination of 250 Indian children; 100 were boys. Had I selected 100 white boys from various parts of the United States I would have found at least five color blinds; among the Indian boys I did not find a single one. Some years ago I examined 250 Indian boys and found two color blind, a very low percentage when compared with the whites. Among the Indian girls I did not find any. When we know that only two females in every 1,000 among whites are color blind, it is not surprising that I did not find any examples among the Indian girls.

The usual tests for color blindness are the matching of wools; the common error the color blind falls into is matching a bright scarlet with a green. On one occasion, a color blind gentleman found fault with his wife for wearing, as he thought, a bright scarlet dress, when in point of fact she was wearing a bright green. Another color blind who was very fond of drawing, once painted a red tree in a landscape without being aware that he had done so.

Among the whites it affects all classes. It is found as relatively common among the intelligent as the illiterate, and unfortunately, up to the present, we have not discovered any remedy for this defect.

Without quoting many instances where a color blind man was responsible for accidents at sea, I must quote a case where an officer on the watch issued an order to "port" his vessel, which, if his order had been carried out, would have caused a collision, and a probable serious loss of life.

The letter was written by Capt. Coburn, and is to be found in the _Mercantile Marine Reporter_, vol. xiv.

"The steamer Neera was on a voyage from Liverpool to Alexandria. One night, shortly after passing Gibraltar, at about 10.30 p.m., I went on the bridge, which was then in charge of the third officer, a man of about forty-five years of age, and who up to that time I had supposed to be a trustworthy officer, and competent in every way. I walked up and down the bridge until about 11 p.m., when the third officer and I almost simultaneously saw a light at about two points on the starboard bow. I at once saw it was a green light, and knew that no action was called for. To my surprise, the third officer called out to the man at the wheel, 'port,' which he was about to do, when I countermanded the order, and told him to steady his helm, which he did, and we passed the other steamer safely about half a mile apart. I at once asked the third officer why he had ported his helm to a green light on the starboard bow, but he insisted it was a red light which he had first seen. I tried him repeatedly after this, and although he sometimes gave a correct description of the color of the light, he was as often incorrect, and it was evidently all guesswork. On my return, I applied to have him removed from the ship, as he was, in my opinion, quite unfit to have charge of the deck at night, and this application was granted. After this occurrence I always, when taking a strange officer to sea, remained on the bridge with him at night until I had tested his ability to distinguish colors. I cannot imagine anything more dangerous or more likely to lead to fatal accidents than a color blind man on a steamer's bridge."

A similar experience is thus related by Capt. Heasley, of Liverpool: "After passing through the Straits of Gibraltar, the second officer, who had charge of the deck, gave the order to 'port,' much to my astonishment, for the lights to be seen about a point on the starboard bow were a masthead and green light, but he maintained that it was a masthead and red, and not until both ships were nearly abreast would he acknowledge his mistake. I may add that during the rest of the voyage I never saw him making the same mistake. As a practical seaman I consider a great many accidents at sea arise from color blindness."

Dr. Farquharson has brought this subject before the House of Commons in England and measures are being taken which will insure to the traveling public immunity from accidents at sea. I need not mention that the majority of railways of our country have a system of examinations which prevents a color blind entering their service.

Dr. Wilson makes the suggestion that he noticed a singular expression in the eyes of certain of the color blind difficult to describe. "In some it amounted to a startled expression, as if they were alarmed; in others, to an eager, aimless glance, as if seeking to perceive something but unable to find it; and in certain others to an almost vacant stare, as if their eyes were fixed upon objects beyond the limit of vision. The expression referred to, which is not at all times equally pronounced, never altogether leaves the eyes which it seems to characterize."

Dr. B. Joy Jeffries, of Boston, has recently written an article on this same topic, but unfortunately I have not his pamphlet at hand to quote his views on this subject.

In this lecture I have shown that the normal eye is far sighted. The mammalia have this kind of an eye; the Indian the same. The white man is fast becoming near sighted. The civilized Indian is also showing the effects of continuous near work; and now the question arises. What are we to do to prevent further deterioration of vision? The fault lies at our own doors. Let us try to correct these now existing evils, so that future generations will, instead of censuring us, thank us for our wisdom.

To aid in a feeble way for the protection of posterity I have formulated ten rules on the preservation of vision:

(1) Do not allow light to fall upon the face of a sleeping infant.

(2) Do not allow babies to gaze at a bright light.

(3) Do not send children to school before the age of ten.

(4) Do not allow children to keep their eyes too long on a near object, at any one time.

(5) Do not allow them to study much by artificial light.

(6) Do not allow them to use books with small type.

(7) Do not allow them to read in a railway carriage.

(8) Do not allow boys to smoke tobacco, especially cigarettes.

(9) Do not necessarily ascribe headaches to indigestion. The eyes may be the exciting cause.

(10) Do not allow the itinerant spectacle vender to prescribe glasses.

* * * * *

THE WATER MOLECULE.[1]

[Footnote 1: Translated from the _Pharmaceutische Centralhalle_, by A.G. Vogeler.--_Western Druggist_.]

By A. GANSWINDT.

"Water consists of one atom of oxygen and two atoms of hydrogen." This proposition will not be disputed in the least by the author; still, it may be profitable to indulge in a few stereo-chemic speculations as to the nature of the water molecule and to draw the inevitable conclusions.